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Patil SJ, Bhayani V, Yoshida Y, Bushweller L, Udoh EO, Todorov I, Saper R, Stange KC, Bolen S. Lay advisor interventions for hypertension outcomes: A Systematic Review, Meta-analysis and a RE-AIM evaluation. Front Med (Lausanne) 2024; 11:1305190. [PMID: 38831986 PMCID: PMC11144929 DOI: 10.3389/fmed.2024.1305190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Lay advisor interventions improve hypertension outcomes; however, the added benefits and relevant factors for their widespread implementation into health systems are unknown. We performed a systematic review to: (1) summarize the benefits of adding lay advisors to interventions on hypertension outcomes, and (2) summarize factors associated with successful implementation in health systems using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Methods We systematically searched several databases, including Ovid MEDLINE, CINAHL, PsycINFO from January 1981 to May 2023. All study designs of interventions delivered solely by lay advisors for adults with hypertension were eligible. If both arms received the lay advisor intervention, the study arm with lower intensity was assigned as the low-intensity intervention. Results We included 41 articles, of which 22 were RCTs, from 7,267 screened citations. Studies predominantly included socially disadvantaged populations. Meta-analysis (9 RCTs; n = 4,220) of eligible lay advisor interventions reporting outcomes showed improved systolic blood pressure (BP) [-3.72 mm Hg (CI -6.1 to -1.3; I2 88%)], and diastolic BP [-1.7 mm Hg (CI -1 to -0.9; I2 7%)] compared to control group. Pooled effect from six RCTs (n = 3,277) comparing high-intensity with low-intensity lay advisor interventions showed improved systolic BP of -3.6 mm Hg (CI -6.7 to -0.5; I2 82.7%) and improved diastolic BP of -2.1 mm Hg (CI -3.7 to -0.4; I2 70.9%) with high-intensity interventions. No significant difference in pooled odds of hypertension control was noted between lay advisor intervention and control groups, or between high-intensity and low-intensity intervention groups. Most studies used multicomponent interventions with no stepped care elements or reporting of efficacious components. Indicators of external validity (adoption, implementation, maintenance) were infrequently reported. Discussion Lay advisor interventions improve hypertension outcomes, with high intensity interventions having a greater impact. Further studies need to identify successful intervention and implementation factors of multicomponent interventions for stepped upscaling within healthcare system settings as well as factors used to help sustain interventions.
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Affiliation(s)
- Sonal J. Patil
- Center for Health Equity, Engagement, Education, and Research (CHEEER), Department of Family Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United States
| | - Vishwa Bhayani
- Department of Public Health, University of Missouri, Columbia, MO, United States
| | - Yilin Yoshida
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Leila Bushweller
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Eno-Obong Udoh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Irina Todorov
- Department of Wellness and Preventive Medicine, Primary Care Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Robert Saper
- Department of Wellness and Preventive Medicine, Primary Care Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kurt C. Stange
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Shari Bolen
- Department of Medicine, Center for Health Care Research and Policy, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United States
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Faraci FM, Scheer FA. Hypertension: Causes and Consequences of Circadian Rhythms in Blood Pressure. Circ Res 2024; 134:810-832. [PMID: 38484034 PMCID: PMC10947115 DOI: 10.1161/circresaha.124.323515] [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: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
Hypertension is extremely common, affecting approximately 1 in every 2 adults globally. Chronic hypertension is the leading modifiable risk factor for cardiovascular disease and premature mortality worldwide. Despite considerable efforts to define mechanisms that underlie hypertension, a potentially major component of the disease, the role of circadian biology has been relatively overlooked in both preclinical models and humans. Although the presence of daily and circadian patterns has been observed from the level of the genome to the whole organism, the functional and structural impact of biological rhythms, including mechanisms such as circadian misalignment, remains relatively poorly defined. Here, we review the impact of daily rhythms and circadian systems in regulating blood pressure and the onset, progression, and consequences of hypertension. There is an emphasis on the impact of circadian biology in relation to vascular disease and end-organ effects that, individually or in combination, contribute to complex phenotypes such as cognitive decline and the loss of cardiac and brain health. Despite effective treatment options for some individuals, control of blood pressure remains inadequate in a substantial portion of the hypertensive population. Greater insight into circadian biology may form a foundation for novel and more widely effective molecular therapies or interventions to help in the prevention, treatment, and management of hypertension and its related pathophysiology.
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Affiliation(s)
- Frank M. Faraci
- Department of Internal Medicine, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
- Department of Neuroscience and Pharmacology, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
| | - Frank A.J.L. Scheer
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, 02115
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, 02115
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Mahabaleshwarkar R, Bond A, Burns R, Taylor YJ, McWilliams A, Schooley J, Applegate WB, Little G. Prevalence and Correlates of Uncontrolled Hypertension, Persistently Uncontrolled Hypertension, and Hypertensive Crisis at a Healthcare System. Am J Hypertens 2023; 36:667-676. [PMID: 37639217 DOI: 10.1093/ajh/hpad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Uncontrolled hypertension significantly increases risk of cardiovascular disease and death. This study examined the prevalence of uncontrolled hypertension, persistently uncontrolled hypertension, and hypertensive crisis and factors associated with these outcomes in a real-world patient cohort. METHODS Electronic medical records from a large healthcare system in North Carolina were used to identify adults with uncontrolled hypertension (last ambulatory blood pressure [BP] measurement ≥140/90); persistently uncontrolled hypertension (≥2 ambulatory BP measurements with all readings ≥140/90); and hypertensive crisis (any BP reading ≥180/120) in 2019. Generalized linear mixed models tested the association between patient and provider characteristics and each outcome. RESULTS The study cohort included 213,836 patients (mean age 63.1 (±14.0) years, 55.5% female, 70.8% white). Of these, 29.7% and 13.1% had uncontrolled hypertension and hypertensive crisis, respectively. Among those experiencing hypertensive crisis, >50% did not have uncontrolled hypertension. Of the 171,061 patients with ≥2 BP measurements, 5.9% had persistently uncontrolled hypertension. The likelihood of uncontrolled hypertension, persistently uncontrolled hypertension, and hypertensive crisis was higher in patients with black race (vs. white), self-pay (vs. private), prior emergency room visit, and no attributed primary care provider. Readings taken in the evening (vs. morning) and at specialty (vs. primary care) practices were more likely to meet thresholds for uncontrolled hypertension and hypertensive crisis. CONCLUSIONS Hypertension control remains a significant challenge in healthcare. Health systems may benefit from segmenting their patient population based on factors such as race, prior healthcare use, and timing of BP measurement to prioritize outreach and intervention.
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Affiliation(s)
| | - Allan Bond
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - Ryan Burns
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - Yhenneko J Taylor
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - Andrew McWilliams
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - John Schooley
- Quality Management, Atrium Health, Charlotte, North Carolina, USA
| | - William B Applegate
- Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gary Little
- Medical Affairs, Atrium Health, Charlotte, North Carolina, USA
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Drugge ED, Farhan K, Zhao H, Abramov R, Graham LA, Stambler N, Hao S, Ferreri NR. Sex and race differences in urinary Tumor Necrosis Factor-α (TNF-α) levels: Secondary analysis of the DASH-sodium trial. J Hum Hypertens 2023; 37:701-708. [PMID: 36008598 DOI: 10.1038/s41371-022-00748-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/25/2022] [Accepted: 08/11/2022] [Indexed: 11/09/2022]
Abstract
Previous work in mouse models shows that urinary TNF-α levels become elevated when dietary salt (NaCl) intake increases. To examine if this relationship exists in humans, we conducted a secondary analysis of the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial to determine levels of urinary TNF-α in 367 subjects categorized by race, sex, and blood pressure. The DASH-Sodium trial is a multicenter feeding trial in which subjects were randomly assigned to either the DASH or control diet, and high, medium, and low sodium in random order. Multivariable linear regression was used to model baseline TNF-α and a mixed model was used to model TNF-α as a function of dietary intervention. At baseline, with all subjects on a "typical American diet", urinary TNF-α levels were lowest in Black, p = 0.002 and male subjects, p < 0.001. After randomization to either the DASH or control diet, with increasing levels of sodium, urinary TNF-α levels increased only in subjects on the control diet, p < 0.05. As in the baseline analysis, TNF-α levels were highest in White females, then White males, Black females and lowest in Black males. The results indicate that urinary TNF-α levels in DASH-Sodium subjects are regulated by NaCl intake, modulated by the DASH diet, and influenced by both race and sex. The inherent differences between subgroups support studies in mice showing that increases in renal TNF-α minimize the extent salt-dependent activation of NKCC2.
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Affiliation(s)
- Elizabeth D Drugge
- Departments of Pharmacology and Public Health, Epidemiology Division, New York Medical College, Valhalla, NY, 10595, USA
| | - Khalid Farhan
- Departments of Pharmacology and Public Health, Epidemiology Division, New York Medical College, Valhalla, NY, 10595, USA
| | - Hong Zhao
- Departments of Pharmacology and Public Health, Epidemiology Division, New York Medical College, Valhalla, NY, 10595, USA
| | - Rozalia Abramov
- Departments of Pharmacology and Public Health, Epidemiology Division, New York Medical College, Valhalla, NY, 10595, USA
| | - Lesley A Graham
- Departments of Pharmacology and Public Health, Epidemiology Division, New York Medical College, Valhalla, NY, 10595, USA
| | - Nancy Stambler
- Departments of Pharmacology and Public Health, Epidemiology Division, New York Medical College, Valhalla, NY, 10595, USA
| | - Shoujin Hao
- Departments of Pharmacology and Public Health, Epidemiology Division, New York Medical College, Valhalla, NY, 10595, USA
| | - Nicholas R Ferreri
- Departments of Pharmacology and Public Health, Epidemiology Division, New York Medical College, Valhalla, NY, 10595, USA.
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Inverse Salt Sensitivity of Blood Pressure Is Associated with an Increased Renin-Angiotensin System Activity. Biomedicines 2022; 10:biomedicines10112811. [PMID: 36359330 PMCID: PMC9687845 DOI: 10.3390/biomedicines10112811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
High and low sodium diets are associated with increased blood pressure and cardiovascular morbidity and mortality. The paradoxical response of elevated BP in low salt diets, aka inverse salt sensitivity (ISS), is an understudied vulnerable 11% of the adult population with yet undiscovered etiology. A linear relationship between the number of single nucleotide polymorphisms (SNPs) in the dopamine D2 receptor (DRD2, rs6276 and 6277), and the sodium myo-inositol cotransporter 2 (SLC5A11, rs11074656), as well as decreased expression of these two genes in urine-derived renal proximal tubule cells (uRPTCs) isolated from clinical study participants suggest involvement of these cells in ISS. Insight into this newly discovered paradoxical response to sodium is found by incubating cells in low sodium (LS) conditions that unveil cell physiologic differences that are then reversed by mir-485-5p miRNA blocker transfection and bypassing the genetic defect by DRD2 re-expression. The renin-angiotensin system (RAS) is an important counter-regulatory mechanism to prevent hyponatremia under LS conditions. Oversensitive RAS under LS conditions could partially explain the increased mortality in ISS. Angiotensin-II (AngII, 10 nmol/L) increased sodium transport in uRPTCs to a greater extent in individuals with ISS than SR. Downstream signaling of AngII is verified by identifying lowered expression of nuclear factor erythroid 2-related factor 2 (NRF2), CCCTC-binding factor (CTCF), and manganese-dependent mitochondrial superoxide dismutase (SOD2) only in ISS-derived uRPTCs and not SR-derived uRPTCs when incubated in LS conditions. We conclude that DRD2 and SLC5A11 variants in ISS may cause an increased low sodium sensitivity to AngII and renal sodium reabsorption which can contribute to inverse salt-sensitive hypertension.
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Grant MG, Pratt C, Wong RP, Addou E, Desvigne-Nickens P, Campo RA, Donze LF, Barnes VI, Schopfer DW, Jaquish CE, Fleg J, Galis ZS, Fenton K, Oh YS, Hong Y, Chen J, Wang W, Fine L, Goff DC. Implementing the National Heart, Lung, and Blood Institute's Strategic Vision in the Division of Cardiovascular Sciences-2022 Update. Circ Res 2022; 131:713-724. [PMID: 36173825 PMCID: PMC9757122 DOI: 10.1161/circresaha.122.321449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Spurred by the 2016 release of the National Heart, Lung, and Blood Institute's Strategic Vision, the Division of Cardiovascular Sciences developed its Strategic Vision Implementation Plan-a blueprint for reigniting the decline in cardiovascular disease (CVD) mortality rates, improving health equity, and accelerating translation of scientific discoveries into better cardiovascular health (CVH). The 6 scientific focus areas of the Strategic Vision Implementation Plan reflect the multifactorial nature of CVD and include (1) addressing social determinants of CVH and health inequities, (2) enhancing resilience, (3) promoting CVH and preventing CVD across the lifespan, (4) eliminating hypertension-related CVD, (5) reducing the burden of heart failure, and (6) preventing vascular dementia. This article presents an update of strategic vision implementation activities within Division of Cardiovascular Sciences. Overarching and cross-cutting themes include training the scientific workforce and engaging the extramural scientific community to stimulate transformative research in cardiovascular sciences. In partnership with other NIH Institutes, Federal agencies, industry, and the extramural research community, Division of Cardiovascular Sciences strategic vision implementation has stimulated development of numerous workshops and research funding opportunities. Strategic Vision Implementation Plan activities highlight innovative intervention modalities, interdisciplinary systems approaches to CVD reduction, a life course framework for CVH promotion and CVD prevention, and multi-pronged research strategies for combatting COVID-19. As new knowledge, technologies, and areas of scientific research emerge, Division of Cardiovascular Sciences will continue its thoughtful approach to strategic vision implementation, remaining poised to seize emerging opportunities and catalyze breakthroughs in cardiovascular sciences.
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Affiliation(s)
- Meagan G. Grant
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Renee P. Wong
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Ebyan Addou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Rebecca A. Campo
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Laurie Friedman Donze
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Vanessa I. Barnes
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - David W. Schopfer
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Cashell E. Jaquish
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Jerome Fleg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Zorina S. Galis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Kathleen Fenton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Young S. Oh
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Yuling Hong
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Jue Chen
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Wayne Wang
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - Lawrence Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
| | - David C. Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Bethesda, MD 20892
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Inverse Salt Sensitivity of Blood Pressure: Mechanisms and Potential Relevance for Prevention of Cardiovascular Disease. Curr Hypertens Rep 2022; 24:361-374. [PMID: 35708819 DOI: 10.1007/s11906-022-01201-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To review the etiology of inverse salt sensitivity of blood pressure (BP). RECENT FINDINGS Both high and low sodium (Na+) intake can be associated with increased BP and cardiovascular morbidity and mortality. However, little is known regarding the mechanisms involved in the increase in BP in response to low Na+ intake, a condition termed inverse salt sensitivity of BP, which affects approximately 15% of the adult population. The renal proximal tubule is important in regulating up to 70% of renal Na+ transport. The renin-angiotensin and renal dopaminergic systems play both synergistic and opposing roles in the regulation of Na+ transport in this nephron segment. Clinical studies have demonstrated that individuals express a "personal salt index" (PSI) that marks whether they are salt-resistant, salt-sensitive, or inverse salt-sensitive. Inverse salt sensitivity results in part from genetic polymorphisms in various Na+ regulatory genes leading to a decrease in natriuretic activity and an increase in renal tubular Na+ reabsorption leading to an increase in BP. This article reviews the potential mechanisms of a new pathophysiologic entity, inverse salt sensitivity of BP, which affects approximately 15% of the general adult population.
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Patil SJ, Golzy M, Johnson A, Wang Y, Parker JC, Saper RB, Haire-Joshu D, Mehr DR, Foraker RE, Kruse RL. Individual-Level and Neighborhood-Level Factors Associated with Longitudinal Changes in Cardiometabolic Measures in Participants of a Clinic-Based Care Coordination Program: A Secondary Data Analysis. J Clin Med 2022; 11:2897. [PMID: 35629024 PMCID: PMC9145991 DOI: 10.3390/jcm11102897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Identifying individual and neighborhood-level factors associated with worsening cardiometabolic risks despite clinic-based care coordination may help identify candidates for supplementary team-based care. Methods: Secondary data analysis of data from a two-year nurse-led care coordination program cohort of Medicare, Medicaid, dual-eligible adults, Leveraging Information Technology to Guide High Tech, High Touch Care (LIGHT2), from ten Midwestern primary care clinics in the U.S. Outcome Measures: Hemoglobin A1C, low-density-lipoprotein (LDL) cholesterol, and blood pressure. Multivariable generalized linear regression models assessed individual and neighborhood-level factors associated with changes in outcome measures from before to after completion of the LIGHT2 program. Results: 6378 participants had pre-and post-intervention levels reported for at least one outcome measure. In adjusted models, higher pre-intervention cardiometabolic measures were associated with worsening of all cardiometabolic measures. Women had worsening LDL-cholesterol compared with men. Women with pre-intervention HbA1c > 6.8% and systolic blood pressure > 131 mm of Hg had worse post-intervention HbA1c and systolic blood pressure compared with men. Adding individual’s neighborhood-level risks did not change effect sizes significantly. Conclusions: Increased cardiometabolic risks and gender were associated with worsening cardiometabolic outcomes. Understanding unresolved gender-specific needs and preferences of patients with increased cardiometabolic risks may aid in tailoring clinic-community-linked care planning.
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Affiliation(s)
- Sonal J Patil
- Department of Wellness and Preventive Medicine, Cleveland Clinic Community Care Institute, Cleveland, OH 44104, USA
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Mojgan Golzy
- Biostatistics and Research Design Unit, School of Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Angela Johnson
- Center for Applied Research and Engagement Systems (CARES), University of Missouri, Columbia, MO 65211, USA
| | - Yan Wang
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Jerry C Parker
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO 65211, USA
| | - Robert B Saper
- Department of Wellness and Preventive Medicine, Cleveland Clinic Community Care Institute, Cleveland, OH 44104, USA
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Randi E Foraker
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
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Cannone V, Burnett JC. Natriuretic Peptides and Blood Pressure Homeostasis: Implications for MANP, a Novel Guanylyl Cyclase a Receptor Activator for Hypertension. Front Physiol 2022; 12:815796. [PMID: 35222065 PMCID: PMC8878907 DOI: 10.3389/fphys.2021.815796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/24/2021] [Indexed: 12/11/2022] Open
Abstract
The heart serves as an endocrine organ producing the hormones atrial natriuretic peptide (ANP) and b-type natriuretic peptide (BNP) which via the guanylyl cyclase A (GC-A) receptor and the second messenger cGMP participate in blood pressure homeostasis under physiologic conditions. Genetic models of the ANP gene or the GCA receptor together with genomic medicine have solidified the concept that both cardiac hormones are fundamental for blood pressure homeostasis and when deficient or disrupted they may contribute to human hypertension. Advances in peptide engineering have led to novel peptide therapeutics including the ANP-analog MANP for human hypertension. Most importantly a first in human study of MANP in essential hypertension has demonstrated its unique properties of aldosterone suppression and blood pressure reduction. Physiology and pharmacology ultimately lead us to innovative peptide-based therapeutics to reduce the burden of cardiovascular disease.
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Affiliation(s)
- Valentina Cannone
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- *Correspondence: Valentina Cannone,
| | - John C. Burnett
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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Torres-Pinzon DL, Ralph DL, Veiras LC, McDonough AA. Sex-specific adaptations to high-salt diet preserve electrolyte homeostasis with distinct sodium transporter profiles. Am J Physiol Cell Physiol 2021; 321:C897-C909. [PMID: 34613843 PMCID: PMC8616593 DOI: 10.1152/ajpcell.00282.2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 02/04/2023]
Abstract
Kidneys continuously filter an enormous amount of sodium and adapt kidney Na+ reabsorption to match Na+ intake to maintain circulatory volume and electrolyte homeostasis. Males (M) respond to high-salt (HS) diet by translocating proximal tubule Na+/H+ exchanger isoform 3 (NHE3) to the base of the microvilli, reducing activated forms of the distal NaCl cotransporter (NCC) and epithelial Na+ channel (ENaC). Males (M) and females (F) on normal-salt (NS) diet present sex-specific profiles of "transporters" (cotransporters, channels, pumps, and claudins) along the nephron, e.g., F exhibit 40% lower NHE3 and 200% higher NCC abundance than M. We tested the hypothesis that adaptations to HS diet along the nephron will, likewise, exhibit sexual dimorphisms. C57BL/6J mice were fed for 15 days with 4% NaCl diet (HS) versus 0.26% NaCl diet (NS). On HS, M and F exhibited normal plasma [Na+] and [K+], similar urine volume, Na+, K+, and osmolal excretion rates normalized to body weight. In F, like M, HS lowered abundance of distal NCC, phosphorylated NCC, and cleaved (activated) forms of ENaC. The adaptations associated with achieving electrolyte homeostasis exhibit sex-dependent and independent mechanisms. Sex differences in baseline "transporters" abundance persist during HS diet, yet the fold changes during HS diet (normalized to NS) are similar along the distal nephron and collecting duct. Sex-dependent differences observed along the proximal tubule during HS show that female kidneys adapt differently from patterns reported in males, yet achieve and maintain fluid and electrolyte homeostasis.
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Affiliation(s)
- Diana L Torres-Pinzon
- Department of Physiology and Neuroscience, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Donna L Ralph
- Department of Physiology and Neuroscience, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Luciana C Veiras
- Department of Physiology and Neuroscience, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Alicia A McDonough
- Department of Physiology and Neuroscience, Keck School of Medicine of University of Southern California, Los Angeles, California
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11
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Chen HH, Wan SH, Iyer SR, Cannone V, Sangaralingham SJ, Nuetel J, Burnett JC. First-in-Human Study of MANP: A Novel ANP (Atrial Natriuretic Peptide) Analog in Human Hypertension. Hypertension 2021; 78:1859-1867. [PMID: 34657445 DOI: 10.1161/hypertensionaha.121.17159] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Horng H Chen
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester MN (H.H.C., S.R.I., J.S., J.C.B.)
| | - Siu-Hin Wan
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (S.-H.W.)
| | - Seethalakshmi R Iyer
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester MN (H.H.C., S.R.I., J.S., J.C.B.)
| | - Valentina Cannone
- Department of Internal Medicine, University of Parma, Parma, Italy (V.C.)
| | - S Jeson Sangaralingham
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester MN (H.H.C., S.R.I., J.S., J.C.B.)
| | | | - John C Burnett
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester MN (H.H.C., S.R.I., J.S., J.C.B.)
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12
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Abstract
Several important findings bearing on the prevention, detection, and management of hypertension have been reported since publication of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. This review summarizes and places in context the results of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics covered include blood pressure measurement, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and blood pressure threshold for drug therapy, lifestyle and pharmacological management, treatment target blood pressure goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches. Presenting new information in each of these areas has the potential to increase hypertension awareness, treatment, and control which remain essential for the prevention of cardiovascular disease and mortality in the future.
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Affiliation(s)
- Robert M Carey
- Department of Medicine, University of Virginia Health System, Charlottesville (R.M.C)
| | - Jackson T Wright
- Department of Medicine, Case-Western Reserve University School of Medicine, Cleveland, OH (J.T.W.)
| | - Sandra J Taler
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (S.J.T.)
| | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University, New Orleans, LA (P.K.W.)
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13
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Wild J, Wenzel P. Myeloid cells, tissue homeostasis, and anatomical barriers as innate immune effectors in arterial hypertension. J Mol Med (Berl) 2021; 99:315-326. [PMID: 33443617 PMCID: PMC7899956 DOI: 10.1007/s00109-020-02019-1] [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: 03/17/2020] [Accepted: 11/18/2020] [Indexed: 11/29/2022]
Abstract
Although essential hypertension affects a large proportion of the human population and is one of the key drivers of cardiovascular mortality worldwide, we still do not have a complete understanding of its pathophysiology. More than 50 years ago, the immune system has been identified as an important part of the pathogenesis of arterial hypertension. An exceeding variety of recent publications deals with the interplay between the numerous different components of the immune system and mechanisms of arterial hypertension and has substantially contributed to our understanding of the role of immunity and inflammation in the pathogenesis of the disease. In this review, we focus on myeloid cells and anatomical barriers as particular aspects of innate immunity in arterial hypertension. Since it represents a first line of defense protecting against pathogens and maintaining tissue homeostasis, innate immunity provides many mechanistic hinge points in the area of hypertension.
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Affiliation(s)
- Johannes Wild
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Center for Cardiology - Cardiology I and CTH Professorship "Vascular Inflammation", University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Berlin, Germany
| | - Philip Wenzel
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany. .,Center for Cardiology - Cardiology I and CTH Professorship "Vascular Inflammation", University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Berlin, Germany.
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14
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McDonough AA, Veiras LC, McFarlin BE, Ralph DL. Impact of casein- versus grain-based diets on rat renal sodium transporters' abundance and regulation. KIDNEY360 2021; 2:519-523. [PMID: 34095853 PMCID: PMC8174819 DOI: 10.34067/kid.0006702020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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15
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Watts SW, Alexander BT, Baylis C, Brown NJ, Cassis LA, Denton KM, Joe B, Lerman LO, Oparil S, Reckelhoff JF, Sandberg K, Touyz RM. Connecting Generations of Scientists in the Council on Hypertension Through Harriet Dustan. Hypertension 2021; 77:296-307. [PMID: 33390045 DOI: 10.1161/hypertensionaha.120.16623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephanie W Watts
- From the Department of Pharmacology and Toxicology, Michigan State University, East Lansing (S.W.W.)
| | | | - Chris Baylis
- Department of Physiology and Functional Genomics, University of Florida, Gainesville (C.B.)
| | - Nancy J Brown
- School of Medicine, Yale University, New Haven, CT (N.B.)
| | - Lisa A Cassis
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington (L.C.)
| | - Kate M Denton
- Cardiovascular Disease Program, Monash University, Melbourne, Australia (K.D.)
| | - Bina Joe
- Department of Physiology and Pharmacology, University of Toledo, OH (B.J.)
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.L.)
| | - Suzanne Oparil
- Division of Cardiovascular Disease, University of Alabama, Birmingham (S.O.)
| | - Jane F Reckelhoff
- Department of Cell and Molecular Biology (J.R.), University of Mississippi, Jackson
| | - Kathryn Sandberg
- Department of Medicine, Georgetown University, Washington, DC (K.S.)
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Science, University of Glasgow, Scotland (R.M.T.)
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16
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Carey RM. 2018 American Heart Association redefinition of resistant hypertension: Major adverse cardiovascular and renal events. J Clin Hypertens (Greenwich) 2020; 22:2103-2104. [PMID: 33058488 DOI: 10.1111/jch.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Robert M Carey
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
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17
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The Story of the Silent Killer : A History of Hypertension: Its Discovery, Diagnosis, Treatment, and Debates. Curr Hypertens Rep 2020; 22:72. [PMID: 32852612 DOI: 10.1007/s11906-020-01077-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hypertension is the leading risk factor for death and disability-adjusted life-years lost globally. Despite this tremendous impact on health, blood pressure measurement and treatment are relatively new to medical practice, with widespread measurement beginning just over 100 years ago. How, in such a short time, did blood pressure become such an integral measurement in medical practice that it is now considered one of the vital signs? Key revelations through Stephen Hales and his horse experiment, Riva-Rocci's modern blood pressure cuff, Korotkoff sounds, and President Roosevelt's death set the stage for discovery. Landmark trials such as the VA Cooperative studies of the 1960s through the recent Systolic Blood Pressure Intervention Trial and Prevention with Mediterranean Diet trials provide the foundation for modern clinical practice. An understanding of the history of hypertension can directly affect current clinical practice and offers unique insights into how the medical community has approached the management of one of the deadliest medical conditions in history.
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18
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Hu R, McDonough AA, Layton AT. Sex differences in solute transport along the nephrons: effects of Na + transport inhibition. Am J Physiol Renal Physiol 2020; 319:F487-F505. [PMID: 32744084 DOI: 10.1152/ajprenal.00240.2020] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Each day, ~1.7 kg of NaCl and 180 liters of water are reabsorbed by nephron segments in humans, with urinary excretion fine tuned to meet homeostatic requirements. These tasks are coordinated by a spectrum of renal Na+ transporters and channels. The goal of the present study was to investigate the extent to which inhibitors of transepithelial Na+ transport (TNa) along the nephron alter urinary solute excretion and how those effects may vary between male and female subjects. To accomplish that goal, we developed sex-specific multinephron models that represent detailed transcellular and paracellular transport processes along the nephrons of male and female rat kidneys. We simulated inhibition of Na+/H+ exchanger 3 (NHE3), bumetanide-sensitive Na+-K+-2Cl- cotransporter (NKCC2), Na+-Cl- cotransporter (NCC), and amiloride-sensitive epithelial Na+ channel (ENaC). NHE3 inhibition simulations predicted a substantially reduced proximal tubule TNa, and NKCC2 inhibition substantially reduced thick ascending limb TNa. Both gave rise to diuresis, natriuresis, and kaliuresis, with those effects stronger in female rats. While NCC inhibition was predicted to have only minor impact on renal TNa, it nonetheless had a notable effect of enhancing excretion of Na+, K+, and Cl-, particularly in female rats. Inhibition of ENaC was predicted to have opposite effects on the excretion of Na+ (increased) and K+ (decreased) and to have only a minor impact on whole kidney TNa. Unlike inhibition of other transporters, ENaC inhibition induced stronger natriuresis and diuresis in male rats than female rats. Overall, model predictions agreed well with measured changes in Na+ and K+ excretion in response to diuretics and Na+ transporter mutations.
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Affiliation(s)
- Rui Hu
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada
| | - Alicia A McDonough
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anita T Layton
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada.,Department of Biology, Cheriton School of Computer Science, and School of Pharmacology, University of Waterloo, Waterloo, Ontario, Canada
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