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Jin M, Liu X, Liu X, Wu Y, Zhang Y, Zhang L, Li Z, Ye R, Li N. Association of pre-/early pregnancy high blood pressure and pregnancy outcomes: a systemic review and meta-analysis. J Matern Fetal Neonatal Med 2024; 37:2296366. [PMID: 38151254 DOI: 10.1080/14767058.2023.2296366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Maternal high blood pressure (BP) was associated with adverse pregnancy outcomes. This study aimed to synthesize evidence on the association between high BP prior to or in early pregnancy with maternal and fetal complications. METHODS We searched the cohort studies assessing the effect of high BP in the Medline, Embase, Web of Science and China National Knowledge Internet databases. A random-effects model was used to estimate the pooled odds ratios (ORs) with 95% confidence intervals (CIs). The protocol was registered in PROSPERRO (CRD 42023414945). RESULTS 23 eligible studies were identified. High BP prior to or in early pregnancy was associated with higher odds of hypertensive disorders of pregnancy (OR 2.90, 95% CI 1.91-3.89), gestational hypertension (2.56, 2.01-3.12), preeclampsia (3.20, 2.66-3.74), gestational diabetes mellitus (1.71, 1.36-2.06), preterm birth (1.66, 1.39-1.93), stillbirth (2.01, 1.45-2.58) and neonatal intensive care unit admission (1.22, 1.08-1.37). Subgroup analyses indicated that pre-hypertension could significantly increase the odds of these outcomes except for stillbirth, though the odds were lower than hypertension. CONCLUSIONS High BP prior to or in early pregnancy was associated with adverse pregnancy outcomes and this association increased with hypertension severity. The findings emphasized an urgent need for heightened surveillance for maternal BP, especially pre-hypertensive status.
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Affiliation(s)
- Ming Jin
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Xiaowen Liu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Xiaojing Liu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Yaxian Wu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Yali Zhang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Le Zhang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Zhiwen Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Rongwei Ye
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Nan Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
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Mei Y, Christensen GM, Li Z, Waller LA, Ebelt S, Marcus M, Lah JJ, Wingo AP, Wingo TS, Hüls A. Joint effects of air pollution and neighborhood socioeconomic status on cognitive decline - Mediation by depression, high cholesterol levels, and high blood pressure. Sci Total Environ 2024; 923:171535. [PMID: 38453069 DOI: 10.1016/j.scitotenv.2024.171535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
Air pollution and neighborhood socioeconomic status (N-SES) are associated with adverse cardiovascular health and neuropsychiatric functioning in older adults. This study examines the degree to which the joint effects of air pollution and N-SES on the cognitive decline are mediated by high cholesterol levels, high blood pressure (HBP), and depression. In the Emory Healthy Aging Study, 14,390 participants aged 50+ years from Metro Atlanta, GA, were assessed for subjective cognitive decline using the cognitive function instrument (CFI). Information on the prior diagnosis of high cholesterol, HBP, and depression was collected through the Health History Questionnaire. Participants' census tracts were assigned 3-year average concentrations of 12 air pollutants and 16 N-SES characteristics. We used the unsupervised clustering algorithm Self-Organizing Maps (SOM) to create 6 exposure clusters based on the joint distribution of air pollution and N-SES in each census tract. Linear regression analysis was used to estimate the effects of the SOM cluster indicator on CFI, adjusting for age, race/ethnicity, education, and neighborhood residential stability. The proportion of the association mediated by high cholesterol levels, HBP, and depression was calculated by comparing the total and direct effects of SOM clusters on CFI. Depression mediated up to 87 % of the association between SOM clusters and CFI. For example, participants living in the high N-SES and high air pollution cluster had CFI scores 0.05 (95 %-CI:0.01,0.09) points higher on average compared to those from the high N-SES and low air pollution cluster; after adjusting for depression, this association was attenuated to 0.01 (95 %-CI:-0.04,0.05). HBP mediated up to 8 % of the association between SOM clusters and CFI and high cholesterol up to 5 %. Air pollution and N-SES associated cognitive decline was partially mediated by depression. Only a small portion (<10 %) of the association was mediated by HBP and high cholesterol.
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Affiliation(s)
- Yiyang Mei
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Grace M Christensen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zhenjiang Li
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stefanie Ebelt
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - James J Lah
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Aliza P Wingo
- Division of Mental Health, Atlanta VA Medical Center, Decatur, GA, USA; Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas S Wingo
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA; Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Mat Nasir N, Md Isa Z, Ismail NH, Ismail R, Mohd Tamil A, Jaafar MH, Mohamed Yassin MS, Zainol Abidin N, Ab Razak NH, Zulkifli A, Yusof KH. A cross-sectional analysis of the PURE study on minerals intake among Malaysian adult population with hypertension. Sci Rep 2024; 14:8590. [PMID: 38615144 PMCID: PMC11016102 DOI: 10.1038/s41598-024-59206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
Hypertension (HPT) is the leading modifiable risk factor for cardiovascular diseases and premature death worldwide. Currently, attention is given to various dietary approaches with a special focus on the role of micronutrient intake in the regulation of blood pressure. This study aims to measure the dietary intake of selected minerals among Malaysian adults and its association with HPT. This cross-sectional study involved 10,031 participants from the Prospective Urban and Rural Epidemiological study conducted in Malaysia. Participants were grouped into HPT if they reported having been diagnosed with high blood pressure [average systolic blood pressure (SBP)/average diastolic blood pressure (DBP) ≥ 140/90 mm Hg]. A validated food frequency questionnaire (FFQ) was used to measure participants' habitual dietary intake. The dietary mineral intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc was measured. The chi-square test was used to assess differences in socio-demographic factors between HPT and non-HPT groups, while the Mann-Whitney U test was used to assess differences in dietary mineral intake between the groups. The participants' average dietary intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, sodium, and zinc was 591.0 mg/day, 3.8 mg/day, 27.1 mg/day, 32.4 mg/day, 0.4 mg/day, 1431.1 mg/day, 2.3 g/day, 27.1 µg/day, 4526.7 mg/day and 1.5 mg/day, respectively. The intake was significantly lower among those with HPT than those without HPT except for calcium and manganese. Continuous education and intervention should be focused on decreasing sodium intake and increasing potassium, magnesium, manganese, zinc, and calcium intake for the general Malaysian population, particularly for the HPT patients.
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Affiliation(s)
- Nafiza Mat Nasir
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor Branch, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Zaleha Md Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia.
| | - Noor Hassim Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia
| | - Rosnah Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia
| | - Azmi Mohd Tamil
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia
| | - Mohd Hasni Jaafar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia
| | - Mohamed Syarif Mohamed Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor Branch, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Najihah Zainol Abidin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia
- Department of Diagnostic and Allied Health Science, Faculty of Health and Life Sciences, Management and Science University, Shah Alam, Selangor, Malaysia
| | - Nurul Hafiza Ab Razak
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia
| | - Aziemah Zulkifli
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia
- Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Khairul Hazdi Yusof
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia
- Risk Management Unit, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Cheras, Malaysia
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Chen Y, Li Y, Liu M, Xu W, Tong S, Liu K. Association between systemic immunity-inflammation index and hypertension in US adults from NHANES 1999-2018. Sci Rep 2024; 14:5677. [PMID: 38454104 PMCID: PMC10920861 DOI: 10.1038/s41598-024-56387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/05/2024] [Indexed: 03/09/2024] Open
Abstract
Hypertension is a disease closely related to inflammation, and the systemic immunity-inflammation index (SII) is a new and easily detectable inflammatory marker. We aimed to investigate the association between SII and hypertension risk in a adult population in the US. We utilized data from the National Health and Nutrition Examination Survey spanning from 1999 to 2018, incorporating comprehensive information from adults reporting hypertension. This included details on blood pressure monitoring, complete blood cell counts, and standard biochemical results. The SII was computed as the platelet count multiplied by the neutrophil count divided by the lymphocyte count. We employed a weighted multivariate logistic regression model to examine the correlation between SII and hypertension. Subgroup analyses were conducted to explore potential influencing factors. Furthermore, smooth curve fitting and two-piecewise logistic regression analysis were employed to describe non-linear relationships and identify inflection points. This population-based study involved 44,070 adults aged 20-85 years. Following Ln-transformation of the SII, multivariable logistic regression revealed that, in a fully adjusted model, participants in the highest quartile of Ln(SII) had a 12% increased risk of hypertension compared to those in the lowest quartile, which was statistically significant (OR:1.12; 95% CI 1.01, 1.24; P < 0.001), with a P for trend = 0.019. Subgroup analysis indicated no significant interactions between Ln(SII) and specific subgroups except for the body mass index subgroup (all P for interaction > 0.05). Additionally, the association between Ln(SII) and hypertension displayed a U-shaped curve, with an inflection point at 5.89 (1000 cells/μl). Based on this research result, we found a U-shaped correlation between elevated SII levels and hypertension risk in American adults, with a inflection point of 5.89 (1000 cells)/μl). To validate these findings, larger scale prospective surveys are needed to support the results of this study and investigate potential mechanisms.
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Affiliation(s)
- Ying Chen
- Medical Laboratory Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Yanping Li
- Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Mengqiong Liu
- Medical Laboratory Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Wenxing Xu
- Geriatric Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Shan Tong
- Geriatric Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China.
| | - Kai Liu
- Geriatric Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China.
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Bludorn J, Railey K. Hypertension Guidelines and Interventions. Prim Care 2024; 51:41-52. [PMID: 38278572 DOI: 10.1016/j.pop.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Hypertension remains one of the most prevalent conditions encountered in the primary care setting and is a major contributor to cardiovascular disease in the United States. This reality underscores the importance for primary care clinicians to have an understanding of hypertension guidelines, interventions, and population-based considerations. This article provides a succinct overview of hypertension guidelines, reviews guideline-informed approaches to hypertension screening, diagnosis, and treatment, and concludes with a thoughtful discussion of population-based considerations.
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Affiliation(s)
- Janelle Bludorn
- Duke Physician Assistant Program, Department of Family Medicine and Community Health, Duke University School of Medicine, 800 South Duke Street, Durham, NC 27701, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914 Durham, NC 27710, USA.
| | - Kenyon Railey
- Duke Physician Assistant Program, Department of Family Medicine and Community Health, Duke University School of Medicine, 800 South Duke Street, Durham, NC 27701, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914 Durham, NC 27710, USA
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Krafcik BM, Stone DH, Cai M, Jarmel IA, Eid M, Goodney PP, Columbo JA, Mayo Smith MF. Changes in global mortality from aortic aneurysm. J Vasc Surg 2024:S0741-5214(24)00402-6. [PMID: 38408686 DOI: 10.1016/j.jvs.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Globally, there has been a marked increase in aortic aneurysm-related deaths between 1990 and 2019. We sought to understand the underlying etiologies for this mortality trend by examining secular changes in both demographics and the prevalence of risk factors, and how these changes may vary across sociodemographic index (SDI) regions. METHODS We queried the Global Burden of Disease Study (GBD) for aortic aneurysm deaths from 1990 to 2019 overall and by age group. We identified the percentage of aortic aneurysm deaths attributable to each risk factor identified by GBD modeling (smoking, hypertension, lead exposure, and high sodium diet) and their respective changes over time. We then analyzed aneurysm mortality by SDI region. RESULTS The number of aortic aneurysm-related deaths have increased from 94,968 in 1990 to 172,427 in 2019, signifying an 81.6% increase, which greatly exceeds the 18.2% increase in all-cause mortality observed over the same time interval. Examination of age-specific mortality demonstrated that the number of aortic aneurysm deaths markedly correlated with advancing age. However, when considering rate of death rather than mortality count, overall age-standardized death rates decreased 18% from 2.72 per 100,000 in 1990 to 2.21 per 100,000 in 2019. Analysis of the specific risk factors associated with aneurysm death revealed that the percentage of deaths attributable to smoking decreased from 45.6% in 1990 to 34.6% in 2019, and deaths attributable to hypertension decreased from 38.7% to 34.7%. Globally, hypertension surpassed smoking as the leading risk factor. The reported rate of death was consistently greater as SDI increased, and this effect was most pronounced among low-middle and middle SDI regions (173.2% and 170.4%, respectively). CONCLUSIONS Despite an overall increase in the number of aneurysm deaths, there was a decrease in the age-standardized death rate, demonstrating that the observed increased number of aortic aneurysm deaths between 1990 and 2019 was primarily driven by an overall increase in the age of the global population. Fortunately, it appears that the increase in overall aneurysm-related deaths has been modulated by improved risk factor modification, in particular smoking. Given the rise in aneurysm-related deaths, global expansion of vascular specialty capabilities is warranted and will serve to amplify improvements in population-based aneurysm health achieved with risk factor control.
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Affiliation(s)
- Brianna M Krafcik
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH; VA Outcomes Group, White River Junction VA Medical Center, White River Junction, VT.
| | - David H Stone
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH; Department of Vascular Surgery, White River Junction VA Medical Center, White River Junction, VT
| | - Ming Cai
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Isabel A Jarmel
- Geisel School of Medicine, Dartmouth University, Hanover, NH
| | - Mark Eid
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH; VA Outcomes Group, White River Junction VA Medical Center, White River Junction, VT; Department of Vascular Surgery, White River Junction VA Medical Center, White River Junction, VT
| | - Jesse A Columbo
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH; VA Outcomes Group, White River Junction VA Medical Center, White River Junction, VT; Department of Vascular Surgery, White River Junction VA Medical Center, White River Junction, VT
| | - Michael F Mayo Smith
- VA Outcomes Group, White River Junction VA Medical Center, White River Junction, VT; Department of Medicine, White River Junction VA Medical Center, White River Junction, VT
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Sekome K, Gómez-Olivé FX, Sherar LB, Esliger DW, Myezwa H. Feasibility and acceptability of a contextualized physical activity and diet intervention for the control of hypertension in adults from a rural subdistrict: a study protocol (HYPHEN). Pilot Feasibility Stud 2024; 10:22. [PMID: 38308346 PMCID: PMC10837970 DOI: 10.1186/s40814-024-01456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/22/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION In rural and remote South Africa, most strokes and ischaemic heart diseases are as a consequence of hypertension, which is a modifiable risk factor. The widely recommended therapeutic approaches to control hypertension are through physical activity and diet modifications. However, there is a lack of culturally sensitive community-based, lifestyle interventions to control hypertension among rural African adult populations. We designed an intervention which recommends adjusting daily routine physical activity and dietary behaviour of adults with hypertension. This study aims to evaluate the feasibility and acceptability of HYPHEN in a rural community setting. METHODS We aim to recruit 30 adult participants with a self-report hypertension diagnosis. A one-arm, prospective design will be used to assess the feasibility and acceptability of recruitment, uptake, engagement, and completion of the 10-week intervention. Recruitment rates will be assessed at week 0. Intervention uptake, engagement, and adherence to the intervention will be assessed weekly via telephone. Blood pressure, body mass index, waist-hip ratio, urinary sodium, accelerometer-measured physical activity, and 24-h diet recall will be assessed at baseline and at 10 weeks. Qualitative semi-structured interviews will be conducted at 10 weeks to explore feasibility and acceptability. DISCUSSION This study offers a person-centred, sociocultural approach to hypertension control through adaptations to physical activity and dietary intake. This study will determine whether HYPHEN is feasible and acceptable and will inform changes to the protocol/focus that could be tested in a full trial. TRIAL REGISTRATION NUMBER PACTR202306662753321.
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Affiliation(s)
- Kganetso Sekome
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa.
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Hellen Myezwa
- Faculty of Health Sciences, School of Therapeutic Science, University of the Witwatersrand, Johannesburg, South Africa
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Smires FB, Iloughmane Z, Elghazi M, Zerrik M, Echchachoui H, Chemsi M. High blood pressure and aeronautical fitness: experience at the aeromedical expertise center of Rabat. Pan Afr Med J 2024; 47:41. [PMID: 38371650 PMCID: PMC10870157 DOI: 10.11604/pamj.2024.47.41.42262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
High blood pressure is a major cardiovascular risk factor closely linked to serious cardiovascular events. A real public health problem affecting more than one in three adults. Aircrew does not escape this pathology, despite very strict medical selection and rigorous and regular medical monitoring by the aircrew doctor during revision visits. We conducted a retrospective study at the medical expertise center for aircrew in Rabat which made it possible to collect 34 hypertensive civilian aircrew for 10 years, from January 2012 to December 2022. The median age at the time of the study was 56.5. The aeronautical specialties practiced by our aircrew population were dominated by class 1. The prevalence of hypertension in Moroccan civilian aircrew: out of 2000 monitored annually at the Aeromedical Expertise Center for 10 years, 34 cases were collected, i.e.: 1.7%. The average age of discovery was 49 years and in 23 cases the diagnosis was established by systematic screening during periodic fitness visits. More than 24 aircrews had no family history of hypertension. On the therapeutic level, lifestyle and dietary measures were systematically prescribed in all our aircrew, 18 patients were put on monotherapy, 11 on dual therapy, and 2 on triple therapy. Compared to fitness decisions, they were variable according to the grade of hypertension, the control of complications, and the aeronautical function. The discovery of hypertension in aircrew can jeopardize aviation safety with the risk of subtle or sudden incapacity in flight through neurological or cardiovascular complications, which could impact the fitness decision. However, advances in medicine and the management of hypertension made in recent years have prompted the medical and aeronautical authorities to revise the standards of aptitude.
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Affiliation(s)
- Fahd Bennani Smires
- Aviation Medicine, Aeromedical Expertise Center of Rabat, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Zakaria Iloughmane
- Aviation Medicine, Aeromedical Expertise Center of Rabat, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Mouna Elghazi
- Aviation Medicine, Aeromedical Expertise Center of Rabat, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Meryem Zerrik
- Aviation Medicine, Aeromedical Expertise Center of Rabat, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Houda Echchachoui
- Aviation Medicine, Aeromedical Expertise Center of Rabat, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Mohamed Chemsi
- Aviation Medicine, Aeromedical Expertise Center of Rabat, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
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Benjamim CJR, da Silva LSL, Sousa YBA, Rodrigues GDS, Pontes YMDM, Rebelo MA, Gonçalves LDS, Tavares SS, Guimarães CS, da Silva Sobrinho AC, Tanus-Santos JE, Gualano B, Bueno Júnior CR. Acute and short-term beetroot juice nitrate-rich ingestion enhances cardiovascular responses following aerobic exercise in postmenopausal women with arterial hypertension: A triple-blinded randomized controlled trial. Free Radic Biol Med 2024; 211:12-23. [PMID: 38092272 DOI: 10.1016/j.freeradbiomed.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The increase in blood pressure (BP) levels in the postmenopausal period can be partly explained by the decrease in nitric oxide synthases (NOS). OBJECTIVE To investigate the acute and one-week effects of beetroot juice nitrate-rich (BRJ-NO3-rich) ingestion on cardiovascular and autonomic performance in response to submaximal aerobic exercise in postmenopausal women with systemic arterial hypertension (SAH) who are physically inactive. METHODS Fourteen postmenopausal women with SAH [mean (SD) age: 59(4) y; BMI (kg/m2): 29.2(3.1)] completed submaximal aerobic exercise bouts after an acute and a one-week intervention with BRJ in a placebo-controlled, randomized, triple-blind, crossover design. Participants ingested either BRJ (800 mg of NO3-) or placebo acutely and drank either BRJ (400 mg of NO3-) or placebo every day for the next six days. After two and ½ hours, they performed a session of aerobic submaximal aerobic exercise, and their systolic BP (SBP) and diastolic BP (DBP), flow-mediated dilation (FMD), heart rate (HR) recovery, and HR variability were measured. RESULTS In the post-exercise recovery period, SBP dropped significantly in the BRJ-NO3-rich group (-9.28 mmHg [95%CI: -1.68 to -16.88] ES: -0.65, p = 0.019) compared to placebo after acute ingestion. The FMD values increased after acute BRJ-NO3-rich on post-exercise (3.18 % [0.36 to 5.99] ES: 0.87, p = 0.031). After the one-week intervention, FMD values were higher in the BRJ-NO3-rich group before (4.5 % [1.62 to 7.37] ES: 1.21, p = 0.005) and post-exercise measurements (4.2 % [1.52 to 6.87] ES: 1.22, p = 0.004) vs. placebo. HRV indices with remarkable parasympathetic modulation to heart recovered faster on the BRJ-NO3-rich group than placebo group. No between-group differences were identified in values of HR post-exercise recovery in the 30s, 60s, 120s, 180s, and 300s. CONCLUSIONS Acute and short-term BRJ-NO3-rich ingestion may enhance cardiovascular and autonomic behavior in response to aerobic exercise in postmenopausal women diagnosed with SAH. CLINICAL TRIAL REGISTRY NUMBER https://clinicaltrials.gov/ct2/show/NCT05384340.
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Affiliation(s)
- Cicero Jonas R Benjamim
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP/USP), Ribeirão Preto, São Paulo, Brazil.
| | - Leonardo Santos L da Silva
- School of Physical Education of Ribeirão Preto, University of São Paulo (EEFERP/USP) Ribeirão Preto, Brazil
| | - Yaritza B Alves Sousa
- Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, USP, Ribeirao Preto, Sao Paulo, Brazil
| | - Guilherme da Silva Rodrigues
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP/USP), Ribeirão Preto, São Paulo, Brazil
| | | | - Macario Arosti Rebelo
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | | | - Simone Sakagute Tavares
- School of Physical Education of Ribeirão Preto, University of São Paulo (EEFERP/USP) Ribeirão Preto, Brazil
| | - Carolina S Guimarães
- Ribeirao Preto Nursing School, University of São Paulo (EERP/USP), Ribeirão Preto, SP, Brazil
| | - Andressa C da Silva Sobrinho
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP/USP), Ribeirão Preto, São Paulo, Brazil
| | - Jose E Tanus-Santos
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo (FMRP/USP), Ribeirão Preto, SP, Brazil
| | - Bruno Gualano
- Center of Lifestyle Medicine, Applied Physiology & Nutrition Research Group, University of São Paulo, Medical School (FMUSP), São Paulo, SP, Brazil
| | - Carlos R Bueno Júnior
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP/USP), Ribeirão Preto, São Paulo, Brazil; School of Physical Education of Ribeirão Preto, University of São Paulo (EEFERP/USP) Ribeirão Preto, Brazil; Ribeirao Preto Nursing School, University of São Paulo (EERP/USP), Ribeirão Preto, SP, Brazil
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Owolabi M, Taiwo O, Akinyemi J, Adebayo A, Popoola O, Akinyemi R, Akpa O, Olowoyo P, Okekunle A, Uvere E, Nwimo C, Ajala O, Adebajo O, Ayodele A, Ayodeji S, Arulogun O, Olaniyan O, Walker R, Jenkins C, Ovbiagele B. Geo-Demographic and Socioeconomic Determinants of Diagnosed Hypertension among Urban Dwellers in Ibadan, Nigeria: A Community-based Study. Res Sq 2023:rs.3.rs-3692586. [PMID: 38196605 PMCID: PMC10775392 DOI: 10.21203/rs.3.rs-3692586/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background The relationship between diagnosed high blood pressure (HBP) and proximity to health facilities and noise sources is poorly understood. We investigated the relationship between proximity to noise sources, sociodemographic and economic factors, and diagnosed HBP in Ibadan, Nigeria. Methods We investigated 13,531 adults from the African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study in Ibadan. Using a Geographic Information System (GIS), the locations of healthcare facilities, pharmaceutical shops, bus stops, churches, and mosques were buffered at 100m intervals, and coordinates of persons diagnosed with HBP were overlaid on the buffered features. The number of persons with diagnosed HBP living at every 100m interval was estimated. Gender, occupation, marital status, educational status, type of housing, age, and income were used as predictor variables. Analysis was conducted using Spearman rank correlation and binary logistic regression at p<0.05. Results There was a significant inverse relationship between the number of persons diagnosed with HBP and distance from pharmaceutical shops (r=-0.818), churches (r=-0.818), mosques (r=-0.893) and major roads (r=-0.667). The odds of diagnosed HBP were higher among the unemployed (AOR=1.58, 95% CI: 1.11-2.24), currently married (AOR=1.45, CI: 1.11-1.89), and previously married (1.75, CI: 1.29-2.38). The odds of diagnosed HBP increased with educational level and age group. Conclusion Proximity to noise sources, being unemployed and educational level were associated with diagnosed HBP. Reduction in noise generation, transmission, and exposure could reduce the burden of hypertension in urban settings.
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Affiliation(s)
- Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Nigeria
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Belna H, Fortrat JO, Augusto JF, Brilland B. Post-traumatic hypertension: when nerves break down. J Nephrol 2023; 36:2629-2632. [PMID: 37308776 DOI: 10.1007/s40620-023-01662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/28/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Hugo Belna
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, 4 rue Larrey, 49033, Angers CEDEX 09, France
| | - Jacques-Olivier Fortrat
- Service de Médecine Vasculaire, Mitovasc UMR INSERM 1083-CNRS 6015, CHU Angers, Angers, France
| | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, 4 rue Larrey, 49033, Angers CEDEX 09, France
- Université d'Angers Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, 4 rue Larrey, 49033, Angers CEDEX 09, France.
- Université d'Angers Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France.
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12
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You S, Gao JW, Zhang HF, Xiong ZC, Hao QY, Han JJ, Wang JF, Zhang SL, Liu PM. Predictors of long-term absence of coronary artery calcium in individuals with high blood pressure: results from the MESA study. Ann Med 2023; 55:2209334. [PMID: 37155413 PMCID: PMC10167869 DOI: 10.1080/07853890.2023.2209334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND & AIMS Individuals with high blood pressure (BP) have varying risks of cardiovascular events due to other coexisting factors. We aimed to identify the predictors of long-term absence of coronary artery calcium (CAC) in individuals with high BP, which is an indicator of healthy arterial aging and can guide preventive strategies. METHODS We analyzed data from participants with high BP (≥120/80 mm Hg) in the Multi-Ethnic Study of Atherosclerosis who had baseline CAC = 0 and underwent a second CAC scanning after 10 years. We used multivariable logistic regression to evaluate the association between various risk factors for atherosclerotic cardiovascular disease (ASCVD) and long-term CAC = 0. We also calculated the area under the receiver operating characteristic curve (AUC) to predict the phenotype of healthy arterial aging in this population. RESULTS We included 830 participants (37.6% male, mean ± SD age of 59.4 ± 8.7 years). During follow-up, 46.5% of participants (n = 386) had CAC = 0, and they were younger and had fewer metabolic syndrome components. Adding ASCVD risk factors to the demographic model (age, sex, and ethnicity) moderately increased the predictive value for long-term CAC = 0 (AUC: demographic model + ASCVD risk factors vs. demographic model alone, 0.653 vs. 0.597, p < .001; category net reclassification improvement = 0.104, p = .044; integrated discrimination improvement = 0.040, p < .001). CONCLUSION In individuals with high BP and initial CAC = 0, over 40% maintained CAC = 0 during a 10-year follow-up, which was associated with fewer ASCVD risk factors. These findings may have implications for preventive strategies in individuals with high BP.Clinical Trial registration number: The MESA was registered at clinical trials. gov as NCT00005487.KEY MESSAGESNearly half (46.5%) of individuals with high blood pressure (BP) maintained a long-term absence of coronary artery calcium (CAC) during a 10-year follow-up, and this was associated with a 66.6% lower risk of atherosclerotic cardiovascular disease (ASCVD) events compared to those who developed incident CAC.Individuals with high BP, who are usually assumed to have an increased risk of ASCVD, exhibit significant heterogeneity in their ASCVD risk; those who maintain CAC = 0 have a lower ASCVD risk.Adding overall ASCVD risk factors to demographic information resulted in a moderate improvement in predicting long-term CAC = 0.
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Affiliation(s)
- Si You
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Wei Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai-Feng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuo-Chao Xiong
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qing-Yun Hao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia-Jin Han
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Feng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shao-Ling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pin-Ming Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Clayton TL. Obesity and hypertension: Obesity medicine association (OMA) clinical practice statement (CPS) 2023. Obes Pillars 2023; 8:100083. [PMID: 38125655 PMCID: PMC10728712 DOI: 10.1016/j.obpill.2023.100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/06/2023] [Indexed: 12/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides an overview of the mechanisms and treatment of obesity and hypertension. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Mechanisms contributing to obesity-related hypertension include unhealthful nutrition, physical inactivity, insulin resistance, increased sympathetic nervous system activity, renal dysfunction, vascular dysfunction, heart dysfunction, increased pancreatic insulin secretion, sleep apnea, and psychosocial stress. Adiposopathic factors that may contribute to hypertension include increased release of free fatty acids, increased leptin, decreased adiponectin, increased renin-angiotensin-aldosterone system activation, increased 11 beta-hydroxysteroid dehydrogenase type 1, reduced nitric oxide activity, and increased inflammation. Conclusions Increase in body fat is the most common cause of hypertension. Among patients with obesity and hypertension, weight reduction via healthful nutrition, physical activity, behavior modification, bariatric surgery, and anti-obesity medications mostly decrease blood pressure, with the greatest degree of weight reduction generally correlated with the greatest degree of blood pressure reduction.
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Affiliation(s)
- Tiffany Lowe Clayton
- Diplomate of American Board of Obesity Medicine, WakeMed Bariatric Surgery and Medical Weight Loss USA
- Campbell University School of Osteopathic Medicine, Buies Creek, NC 27546, Levine Hall Room 170 USA
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Campbell E, Macey E, Shine C, Nafilyan V, Clark NC, Pawelek P, Ward I, Hughes A, Raleigh V, Banerjee A, Finning K. Sociodemographic and health-related differences in undiagnosed hypertension in the health survey for England 2015-2019: a cross-sectional cohort study. EClinicalMedicine 2023; 65:102275. [PMID: 38106553 PMCID: PMC10725049 DOI: 10.1016/j.eclinm.2023.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 12/19/2023] Open
Abstract
Background Hypertension is a leading cause of morbidity and mortality worldwide, yet a substantial proportion of cases are undiagnosed. Understanding the scale of undiagnosed hypertension and identifying groups most at risk is important to inform approaches to detection. Methods In this cross-sectional cohort study, we used data from the 2015 to 2019 Health Survey for England, an annual, cross-sectional, nationally representative survey. The survey follows a multi-stage stratified probability sampling design, involving a random sample of primary sampling units based on postcode sectors, followed by a random sample of postal addresses within these units. Within each selected household, all adults (aged ≥16 years) and up to four children, were eligible for participation. For the current study, individuals aged 16 years and over who were not pregnant and had valid blood pressure data were included in the analysis. The primary outcome was undiagnosed hypertension, defined by a measured blood pressure of 140/90 mmHg or above but no history of diagnosis. Age-adjusted prevalence of undiagnosed hypertension was estimated across sociodemographic and health-related characteristics, including ethnicity, region, rural-urban classification, relationship status, highest educational qualification, National Statistics Socio-Economic Classification (NS-SEC), Body Mass Index (BMI), self-reported general health, and smoking status. To assess the independent association between undiagnosed hypertension and each characteristic, we fitted a logistic regression model adjusted for sociodemographic factors. Findings The sample included 21,476 individuals, of whom 55.8% were female and 89.3% reported a White ethnic background. An estimated 30.7% (95% confidence interval 29.0-32.4) of men with hypertension and 27.6% (26.1-29.1) of women with hypertension were undiagnosed. Younger age, lower BMI, and better self-reported general health were associated with an increased likelihood of hypertension being undiagnosed for men and women. Living in rural areas and in regions outside of London and the East of England were also associated with an increased likelihood of hypertension being undiagnosed for men, as were being married or in a civil partnership and having higher educational qualifications for women. Interpretation Hypertension is commonly undiagnosed, and some of the groups that are at the lowest risk of hypertension are the most likely to be undiagnosed. Given the high lifetime risk of hypertension and its strong links with morbidity and mortality, our findings suggest a need for greater awareness of the potential for undiagnosed hypertension, including among those typically considered 'low risk'. Further research is needed to assess the impact of extending hypertension screening to lower-risk groups. Funding None.
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Affiliation(s)
- Emma Campbell
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Ellie Macey
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Chris Shine
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Vahé Nafilyan
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Nathan Cadogan Clark
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Piotr Pawelek
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Isobel Ward
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Andrew Hughes
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, SW1H 0EU, UK
| | - Veena Raleigh
- The King's Fund, 11–13 Cavendish Square, London, W1G 0AN, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Katie Finning
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
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Craig A, Breet Y, Gafane-Matemane LF, Norris SA, Kruger R. Detecting and Managing Childhood Onset Hypertension in Africa: A Call to Action. Curr Hypertens Rep 2023; 25:211-230. [PMID: 37318686 PMCID: PMC10491553 DOI: 10.1007/s11906-023-01247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE OF REVIEW To review recent evidence on childhood hypertension across Africa, identifying knowledge gaps, challenges and priorities, and highlight clinical perspectives in managing primary hypertension. RECENT FINDINGS Only 15 of the 54 African countries reported on absolute blood pressure (BP) measures, elevated BP, pre- and/or hypertension. The reported hypertension prevalence ranged between 0.0 and 38.9%, while elevated BP and/or pre-hypertnesion ranged from 2.7 to 50.5%. Childhood BP nomograms are lacking across Africa and the rates of hypertension were based on guidelines developed in countries with the lowest to no number of children from African ancestry. The recent studies across Africa also showed little to no detail when reporting BP specific methodology. No recent data informing the use or effectiveness of antihypertensive agents in children and adolesents are available. Childhood hypertension is on the rise, while data from Africa remains vastly under-represented. Collaborative research, resources, and policies need to be strengthened in addressing the growing public health concern of childhood onset hypertension on this continent.
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Affiliation(s)
- A Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Y Breet
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - L F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - S A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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Aouini H, Saadi A, Boussaffa H, Zaghbib S, Chakroun M, R BS. A juxtaglomerular cell tumor revealed by a hemorrhagic stroke. A case report. Urol Case Rep 2023; 50:102535. [PMID: 37621391 PMCID: PMC10445440 DOI: 10.1016/j.eucr.2023.102535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
With about 110 cases reported in literature, juxtaglomerular cell tumors are rare. We report a 25 years old patient who was admitted in neurology for a hemorrhagic stroke secondary to a cerebral aneurysm rupture due to high blood pressure. Etiological investigations showed a solid mass of the left kidney. A radical nephrectomy was realized and pathological examination and immunohistochemical profile concluded to juxtaglomerular cell tumor. The originality of this observation is based on the mode of presentation of a rare renal tumor by a malignant high blood pressure.
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Affiliation(s)
- H. Aouini
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - A. Saadi
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - H. Boussaffa
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - S. Zaghbib
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - M. Chakroun
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ben Slama R
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
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Vorwerg-Gall S, Stamm O, Haink M. Virtual reality exergame in older patients with hypertension: a preliminary study to determine load intensity and blood pressure. BMC Geriatr 2023; 23:527. [PMID: 37644380 PMCID: PMC10466734 DOI: 10.1186/s12877-023-04245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Lifestyle changes and physical activity can make an important contribution to reducing the risk factor for high blood pressure (BP). Whether virtual reality (VR) exergames are also appropriate and make a positive contribution to the reduction of BP has not yet been sufficiently investigated. Therefore, the aim of the study was to gain knowledge of the load intensities to be achieved during a VR exergame and to examine the short-term effects on BP. METHODS For the preliminary study, 22 participants with hypertension over the age of 65 years were analyzed. The study took place in a mobile laboratory truck. All participants visited on two occasions. During visit 1, VR strength endurance training (VR-SET) and during visit 2, VR endurance training (VR-ET) was performed. Each VR session lasted approximately 25 min and was of a moderate intensity. Heart rate (HR) was measured across the entire session, as well as BP before and after the VR exergame. The Rating of Perceived Exertion (RPE) and task load using NASA Task Load Index were determined after each VR session. Included in the statistical analysis were the Shapiro-Wilk test, the paired t-test, the Wilcoxon test and ANOVA for repeated measures. RESULTS During the "main part" (p < .001), at the "end" (p = .002) and for the "maximum HR" (p < .001), significant load differences between both VR sessions could be determined. In addition, significantly more participants in the VR-SET group achieved a moderate load intensity of at least 40% of heart rate reserve (p = .014). Regarding RPE, participants rated their subjectively perceived exertion significantly higher in the VR-SET than in the VR-ET (p = .028). Systolic BP decreased significantly in both VR sessions when compared before VR session and 5 min after VR session (p = .015; p = .003), as well as before VR session and 10 min after VR session (p = .018; p < .001). CONCLUSIONS An individual moderate load intensity of 40% can be reached during VR-SET. In addition, a positive short-term effect of the VR exergame on BP behavior (postexercise hypotension) was observed after both VR sessions. The preliminary results indicate that a VR exergaming could lead to blood pressure lowering effects for older people with hypertension. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00022881, 07/09/2020, https://drks.de/search/de/trial/DRKS00022881 ).
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Affiliation(s)
- Susan Vorwerg-Gall
- Department of Geriatrics and Medical Gerontology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Reinickendorfer Straße 61, 13347 Berlin, Germany
| | - Oskar Stamm
- Department of Geriatrics and Medical Gerontology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Reinickendorfer Straße 61, 13347 Berlin, Germany
| | - Michele Haink
- Department of Geriatrics and Medical Gerontology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Reinickendorfer Straße 61, 13347 Berlin, Germany
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Sakboonyarat B, Poovieng J, Sangkool T, Lertsakulbunlue S, Jongcherdchootrakul K, Srisawat P, Mungthin M, Rangsin R. Relationship between pulse pressure and body mass index in active-duty Royal Thai Army personnel in Thailand. BMC Cardiovasc Disord 2023; 23:361. [PMID: 37464282 DOI: 10.1186/s12872-023-03390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Elevated pulse pressure (PP) is a robust independent predictor of cardiovascular diseases. The relationship between PP and body mass index (BMI) was presented in a few studies. However, the findings were inconsistent. Therefore, the aim of the present study is to identify the association between elevated PP and BMI using a large sample of active-duty Royal Thai Army (RTA) personnel. METHODS A cross-sectional study was conducted through the use of the dataset obtained from the annual health examination database of RTA personnel in Thailand in 2022. BMI 25.0-29.9 kg/m2 was classified as obesity I, whereas BMI ≥ 30.0 kg/m2 was classified as obesity II. Elevated PP was defined as PP ≥ 50 mmHg. Multivariable linear regression and log-binomial regression models were utilized for determining the association between elevated PP and BMI. RESULTS A total of 62,113 active-duty RTA personnel were included in the study. The average BMI was 25.4 ± 3.8 kg/m2, while the average PP was 50.1 ± 11.2 mmHg. Compared to individuals with normal weight, the [Formula: see text] coefficients of PP and BMI were 1.38 (95% CI: 1.15-1.60) and 2.57 (95% CI: 2.25-2.88) in individuals with obesity I and obesity II, respectively. Effect modification by high blood pressure (BP) on the association between elevated PP and BMI was observed. Among participants with normal BP, in comparison with BMI of 18.5-22.9 kg/m2, the adjusted prevalence ratio (PR) for elevated PP was 1.23 (95% CI: 1.19-1.28) and 1.41 (95% CI: 1.35-1.48) in those with obesity I and obesity II, respectively. Meanwhile, among individuals with high BP, the adjusted PR for elevated PP was 1.05 (95% CI: 1.01-1.08) and 1.09 (95% CI: 1.06-1.13) in those with obesity I and obesity II, respectively. CONCLUSION PP was positively associated with BMI in active-duty RTA personnel. High BP was the modifier of the association between PP and BMI. A weaker association between elevated PP and BMI was observed among RTA personnel with high BP.
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Affiliation(s)
- Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Jaturon Poovieng
- Department of Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Tanatip Sangkool
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | | | - Kanlaya Jongcherdchootrakul
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Phutsapong Srisawat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Mathirut Mungthin
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.
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19
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Robbins MR, Strauch KA. Crown Preparation in a Patient with Hypertension and Type 2 Diabetes Mellitus. Dent Clin North Am 2023; 67:403-406. [PMID: 37244701 DOI: 10.1016/j.cden.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Management of the diabetic dental patient should focus on the delivery of comprehensive dental care with an emphasis on maintaining periodontal health. Gingivitis, periodontitis, and associated bone loss independent of plaque accumulation are associated with poorly controlled diabetes. Periodontal status should be monitored carefully in patients with diabetes and underlying disease managed aggressively. Likewise, the dental team plays an important role in the identification of hypertension and managing dental-related side effects of anti-hypertensives.
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Affiliation(s)
- Miriam R Robbins
- Department of Oral Health, Care Center for Persons with Disabilities, The University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Kimberly A Strauch
- Department of Oral Health, Care Center for Persons with Disabilities, The University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA; The University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104, USA
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20
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Atoh I, Ezeogu J, Okeke CV, Umeh SI, Ekure E, Omokhodion SI, Njokanma FO. High blood pressure pattern amongst adolescents in Lagos, South West Nigeria. Pan Afr Med J 2023; 44:206. [PMID: 37484578 PMCID: PMC10362662 DOI: 10.11604/pamj.2023.44.206.38670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/11/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction high blood pressure (HBP), once considered rare in adolescents is now a growing health problem. Usually asymptomatic in adolescents, if uncontrolled, can track into adulthood leading to various end-organ complications. In 2017, the American Academy of Pediatrics (AAP) published a new Clinical Practice Guideline (CPG) for screening and management of high blood pressure in children and adolescents to update the 2004 Fourth report. The objective of this study was to determine the prevalence of high blood pressure among adolescents in Mushin Local Government Area (LGA) using the 2017 AAP guidelines. Methods a descriptive cross-sectional study, conducted from August 2020 to December 2020. A two-stage sampling technique was used to select 1490 students aged 10 to 19 years, from 14 secondary schools. Socio-demographic information and relevant clinical data were obtained using a structured questionnaire. The anthropometry and blood pressure measurements were taken according to standard protocol (elevated blood pressure is systolic and/or diastolic blood pressure ≥ 90th percentile but ≤ 95th percentile for age, gender and height). Socio-demographic and anthropometric characteristics were described with descriptive statistics. Categorical variables were summarized using frequency and percentages, while numerical variables were summarized using mean and standard deviation. The predictors of hypertension were determined using logistic regression analysis. Results study participants were 1490, 49.9% (744) were male and 50.1% (746) females (male: female ratio was 1: 1). Subjects mean age was 14.39 ± 2.79 years. There were 8.9% overweight and 1.7% obese participants. Prevalence of high blood pressure, elevated blood pressure and hypertension were 26.7% (n = 398), 13.8% (n = 205), and 12.9% (n = 193). Middle and late adolescence, when compared to early adolescence, significantly predicted the likelihood of high blood pressure; aOR 1.78, 95%CI: 1.20 - 2.63, p=0.004 and 3.90 (2.69 - 5.67, p=0.001 respectively). Similarly, male sex had increased odds for raised blood pressure when compared to female sex aOR 1.49,95% CI: 1.1 - 2.0, p= 0.009. Conclusion the prevalence of high blood pressure, elevated blood pressure and hypertension amongst adolescents was high. Early detection and treatment will forestall development of complications.
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Affiliation(s)
- Ifeoma Atoh
- Department of Paediatrics, College of Medicine, University of Lagos, Nigeria
| | - Joseph Ezeogu
- Department of Paediatrics, Federal University Teaching Hospital Owerri, Imo, Nigeria
| | - Chinelo Vivian Okeke
- Department of Paediatrics, Federal University Teaching Hospital Owerri, Imo, Nigeria
| | - Stella Ijeoma Umeh
- Department of Paediatrics, Abia State University Teaching Hospital, Aba, Nigeria
| | - Ekanem Ekure
- Department of Paediatrics, College of Medicine, University of Lagos, Nigeria
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21
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Cui L, Li J, Lou X, Yang L, Chen T, Guo Y, Zhou H, Yang X, Li Z, Wang X. Associations between sleep characteristics and risk for high blood pressure among students aged 9-18: A cross-sectional study in China. Sleep Med 2023; 107:72-80. [PMID: 37121222 DOI: 10.1016/j.sleep.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE The aim was to investigate the association of multidimensional sleep indicators with high blood pressure (HBP) of Chinese students. METHODS Participants in this cross-sectional study included 11561 students aged 9-18. Sleep was characterized by sleep timing (e.g., bedtime), sleep duration and sleep consistency (e.g., bedtime/wake-up time deviations and social jet lag (SJL)). We used odds ratios (OR) and 95% confidence intervals (95% CI) to assess the relationship between sleep and HBP. RESULTS Primary school students who slept 8.00-9.00h had a lower risk of HBP compared with sleeping >10h (OR 0.370, 95%CI 0.208, 0.658), while junior middle school students reporting ≤8.00h on weekday night had a lower risk of HBP compared with sleeping >10h (OR 0.303, 95%CI 0.111, 0.829). Moreover, compared with deviations = 0h, the OR (95%CI) for wake-up time deviations <0h and bedtime deviations >0h in primary school students with HBP were 0.314 (0.125, 0.790) and 2.155 (1.205, 3.853). Furthermore, compared with SJL = 0h, senior high school students reporting SJL = 0.01-0.50h, SJL = 0.51-1.00h and SJL = 1.01-2.00h had greater risk of HBP (OR 1.566, 95%CI 1.039, 2.361; OR 1.760, 95%CI 1.177, 2.631; OR 1.660, 95%CI 1.124, 2.452, respectively). Bedtime at night was associated with HBP for three educational periods students, however, there was no significant association between mid-day nap and HBP. CONCLUSIONS Sleep timing, sleep duration and sleep consistency are associated with high blood pressure in children and adolescents.
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Affiliation(s)
- Lingling Cui
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Jiaxin Li
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Xiaomin Lou
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Liying Yang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Tingting Chen
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Yingying Guo
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Huijun Zhou
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Xiaoli Yang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Zhiqian Li
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Xian Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China.
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22
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Almenara CCP, de Oliveira TF, da Silva DCF, Krause M, Carneiro MTWD, Padilha AS. Cessation Restores Blood Pressure Levels and Endothelial Function Affected by Cadmium Exposure on Rats. Biol Trace Elem Res 2023; 201:1955-1964. [PMID: 35689757 DOI: 10.1007/s12011-022-03312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
Chronic cadmium exposure produces high blood pressure and endothelial damage; however, it is not known whether these effects could be reversed by interrupting the exposure to the metal. Therefore, we evaluate the systolic blood pressure (SBP) and vascular reactivity during and following chronic cadmium-exposure discontinuance. Rats received 100 mg.L-1 cadmium chloride (CdCl2) in the drinking water or tap water (Ct) for 30 days and/or tap water for 30 days more. The cadmium plasma content, blood pressure and vascular reactivity of isolated aorta were evaluated. Cadmium exposure increased cadmium plasma content, SBP and aorta contractile responses to phenylephrine, all reversed after suspending exposure. Endothelial removal and nitric oxide synthase (NOS) inhibition increased phenylephrine response both on control and Cd-discontinuation models. Cd-discontinuation group presented increased CAMKII and PKA protein expression, as peNOSSer1177. Superoxide dismutase (SOD) incubation reduced contractile response on control group, and catalase incubation enhanced the response to phenylephrine in this group. Meanwhile, both SOD2 and catalase protein expression were increased in Cd-cessation rats. Our findings provide evidence that increased SBP and endothelial dysfunction induced by Cd chronic exposure are reversed by suspending the metal exposure probably due to an improvement of antioxidant enzymes and eNOS function.
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Affiliation(s)
- Camila Cruz Pereira Almenara
- Centro de Ciências Biológicas e da Saúde, Universidade Federal Do Oeste da Bahia, Rua da Prainha, 1326, Morada Nobre, Barreiras, BA, 47810-047, Brazil.
| | | | | | - Maiara Krause
- Departamento de Química, Universidade Federal Do Espírito Santo, Vitoria, ES, Brazil
| | | | - Alessandra Simão Padilha
- Programa de Pós-Graduação Em Ciências Fisiológicas, Universidade Federal Do Espírito Santo, Vitoria, ES, Brazil
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23
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Lopez DL, Casillas OE, Jaramillo HJ, Romero-Garcia T, Vazquez-Jimenez JG. AT1 receptor downregulation: A mechanism for improving glucose homeostasis. World J Diabetes 2023; 14:170-178. [PMID: 37035227 PMCID: PMC10075037 DOI: 10.4239/wjd.v14.i3.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/13/2023] [Accepted: 02/23/2023] [Indexed: 03/15/2023] Open
Abstract
There is a pathophysiological correlation between arterial hypertension and diabetes mellitus, established since the pre-diabetic state in the entity known as insulin resistance. It is known that high concentrations of angiotensin-II enable chronic activation of the AT1 receptor, promoting sustained vasoconstriction and the consequent development of high blood pressure. Furthermore, the chronic activation of the AT1 receptor has been associated with the development of insulin resistance. From a molecular outlook, the AT1 receptor signaling pathway can activate the JNK kinase. Once activated, this kinase can block the insulin signaling pathway, favoring the resistance to this hormone. In accordance with the previously mentioned mechanisms, the negative regulation of the AT1 receptor could have beneficial effects in treating metabolic syndrome and type 2 diabetes mellitus. This review explains the clinical correlation of the metabolic response that diabetic patients present when receiving negatively regulatory drugs of the AT1 receptor.
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Affiliation(s)
- Diana L Lopez
- Department of Internal Medicine, General Hospital of Mexicali, Mexicali 21000, Baja California, Mexico
| | - Oscar E Casillas
- Faculty of Medicine, Autonomous University of Baja California, Mexicali 21000, Baja California, Mexico
| | - Hiram J Jaramillo
- Department of Internal Medicine, General Hospital of Mexicali, Mexicali 21000, Baja California, Mexico
| | - Tatiana Romero-Garcia
- Faculty of Sports, Autonomous University of Baja California, Mexicali 21289, Baja California, Mexico
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24
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Ortiz-Marrón H, Cabañas Pujadas G, Ortiz-Pinto MA, Martín García A, Matesanz Martínez C, Antonaya Martín MDC, Cortés Rico O, Galán I. Changes in general and abdominal obesity in children at 4, 6 and 9 years of age and their association with other cardiometabolic risk factors. Eur J Pediatr 2023; 182:1329-1340. [PMID: 36639534 PMCID: PMC10023764 DOI: 10.1007/s00431-022-04802-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023]
Abstract
Temporary changes in childhood obesity and their association with cardiometabolic risk factors have been receiving increased attention. The objective of this study was to evaluate changes in general (GO) and abdominal (AO) obesity in children from 4 to 9 years of age and their associations with cardiometabolic risk factors at 9 years of age. This study includes 1344 children from the Longitudinal Childhood Obesity Study (ELOIN). Physical examinations performed at 4, 6 and 9 years of age and a blood sample was only taken at 9 years of age. Changes in obesity from 4 to 9 years of age were estimated using Body Mass Index and waist circumference. Participants were classified into four groups according to GO and AO: (1) stable without obesity (no obesity at all three measurements); (2) remitting obesity at 9 years (obesity at 4 and/or 6 years but not at 9 years); (3) incident or recurrent obesity at 9 years (obesity only at 9 years, at 4 and 9 years or at 6 and 9 years); and (4) stable or persistent with obesity (obesity at 4, 6 and 9 years). Dyslipidemia and dysglycemia were defined by the presence of at least one altered parameter of the lipid or glycemic profile. Odds ratios (OR) were estimated using logistic regression. Compared with children without GO at all ages, those with persistent GO had an OR of 3.66 (95% CI: 2.06-6.51) for dyslipidemia, 10.61 (95% CI: 5.69-19.79) for dysglycemia and 8.35 (95% CI: 4.55-15.30) for high blood pressure. The associations were fairly similar in the case of AO, with ORs of 3.52 (95% CI: 1.96-6.34), 17.15 (95% CI: 9.09-32.34) and 8.22 (95% CI: 4.46-15.15), respectively, when comparing persistent versus stable without AO. Children with incident obesity at 9 years presented a moderate cardiometabolic risk that was nevertheless higher compared to those stable without obesity, whereas those with remitting obesity did not show any significant associations. CONCLUSION Incident, and especially, persistent obesity, is associated with an increased cardiometabolic risk. The very early prevention of obesity, with a focus on nutrition, physical activity and sedentary behaviour, as well as tracking growth from birth to age 5, should be a priority to prevent the burden of cardiometabolic disease with consequences for adulthood. WHAT IS KNOWN • General and abdominal obesity has been shown to be associated with other cardiometabolic risk factors such as dyslipidemia, insulin resistance and hypertension. • Temporary changes in obesity and their associations with cardiometabolic risk factors have not been sufficiently explored in childhood. WHAT IS NEW • Children with incident, and especially persistent, general and/or abdominal obesity, had an increased risk of dyslipidemia, dysglycemia and high blood pressure. •Remitting obesity was not associated with an increased cardiometabolic risk.
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Affiliation(s)
- Honorato Ortiz-Marrón
- Department of Epidemiology, General Directorate of Public Health, Ministry of Health, C/López de Hoyos, n° 35, 1st Floor, Community of Madrid, 28006, Madrid, Spain.
| | - Gloria Cabañas Pujadas
- Department of Epidemiology, General Directorate of Public Health, Ministry of Health, C/López de Hoyos, n° 35, 1st Floor, Community of Madrid, 28006, Madrid, Spain
| | | | - Aránzazu Martín García
- Clinical Analysis and Biochemistry Service, Puerta de Hierro University Hospital, Majadahonda, Community of Madrid, Spain
| | | | | | - Olga Cortés Rico
- Canillejas Health Center, Northern Area of Primary Care of Madrid, Community of Madrid, Madrid, Spain
| | - Iñaki Galán
- National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
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25
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Shibata S, Kobayashi K, Tanaka M, Asayama K, Yamamoto E, Nakagami H, Hoshide S, Kishi T, Matsumoto C, Mogi M, Morimoto S, Yamamoto K, Mukoyama M, Kario K, Node K, Rakugi H. COVID-19 pandemic and hypertension: an updated report from the Japanese Society of Hypertension project team on COVID-19. Hypertens Res 2023; 46:589-600. [PMID: 36550205 DOI: 10.1038/s41440-022-01134-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
The number of reported cases with coronavirus disease 2019 (COVID-19) has exceeded 620 million worldwide, still having a profound impact on people's health and daily lives since its occurrence and outbreak in December 2019. From the early phase of the COVID-19 pandemic, there has been a concern that the rapid spread of this communicable disease can negatively influence non-communicable diseases. Accumulating data indicate that the restriction on the access to medical care, psychological distress, and life-style changes triggered by the pandemic have indeed affected blood pressure control in hypertensive patients. Since our previous report in 2020 that summarized the findings of the literature related to COVID-19 and hypertension, there has been a considerable progress in our understanding of the association between these two disorders; nonetheless, there are remaining challenges and emerging questions in the field. In this article, we aim to summarize the latest information on the impact of the pandemic on blood pressure control, the use of the renin-angiotensin system inhibitors in patients with COVID-19, and the blood pressure changes as one of the possible post-acute sequelae of COVID-19 (also known as long COVID). We also summarize the evidence of telemedicine and COVID-19 vaccination in hypertensive subjects, based on data available as of June 2022.
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Paoin K, Pharino C, Phosri A, Ueda K, Seposo XT, Kelly M, Seubsman SA, Sleigh A. Association between greenness and cardiovascular risk factors: Results from a large cohort study in Thailand. Environ Res 2023; 220:115215. [PMID: 36610535 DOI: 10.1016/j.envres.2023.115215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The risk of cardiovascular diseases may be reduced by residing in green environments. However, there are relatively few longitudinal cohort studies, especially in Southeast Asia, that focused on the health benefits of long-term greenness exposure in young adults. The present study examined the association between long-term exposure to residential greenness and self-reported morbidities in participants of the Thai Cohort Study (TCS) in Thailand from 2005 to 2013. METHODS The self-reported outcomes, including high blood pressure, high blood cholesterol, and diabetes, were reported in 2005, 2009, and 2013, where the study participants provided the exact year of disease occurrence. Greenness was assessed by the satellite-based Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI), with a spatial resolution of 250 m. Long-term exposure to NDVI and EVI of each participant's sub-district was averaged over the period of person-time. We used Cox proportional hazards models to examine the association between greenness and health outcomes. Associations with self-reported morbidity were measured using hazard ratios (HRs) per interquartile range (IQR) increase in NDVI and EVI. RESULTS After adjusting for potential confounders, we observed that an IQR increase in NDVI was associated with lower incidence of high blood pressure (HR = 0.92, 95% CI: 0.89, 0.97) and high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.92), but not significantly associated with diabetes (HR = 0.93, 95%CI: 0.85, 1.01). EVI was also inversely associated with self-reported high blood pressure (HR = 0.92, 95%CI: 0.88, 0.96), high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.91), and diabetes (HR = 0.92, 95%CI: 0.85, 0.99). CONCLUSIONS Long-term exposure to residential greenness was inversely associated with self-reported high blood pressure, high blood cholesterol, and diabetes in participants of TCS. Our study provides evidence that greenness exposure may reduce cardiovascular disease risk factors in adult population.
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Affiliation(s)
- Kanawat Paoin
- Department of Environmental Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.
| | - Chanathip Pharino
- Department of Environmental Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.
| | - Arthit Phosri
- Department of Environmental Health Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan; Graduate School of Global Environmental Sciences, Kyoto University, Kyoto, Japan
| | - Xerxes Tesoro Seposo
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Sam-Ang Seubsman
- School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, Thailand
| | - Adrian Sleigh
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
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Shibata S, Hoshide S. Current situation of telemedicine research for cardiovascular risk in Japan. Hypertens Res 2023; 46:1171-1180. [PMID: 36849580 PMCID: PMC9969376 DOI: 10.1038/s41440-023-01224-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
Hypertension continues to be a principal risk factor for the occurrence of cardiovascular disorders, stroke, and kidney diseases. Although more than 40 million subjects suffer from hypertension in Japan, its optimal control is achieved only a subpopulation of patients, highlighting the need for novel approaches to manage this disorder. Toward the better control of blood pressure, the Japanese Society of Hypertension has developed the Future Plan, in which the application of the state-of-art information and communication technology, including web-based resources, artificial intelligence, and big data analysis, is considered as one of the promising solutions. In fact, the rapid advance of digital health technologies, as well as ongoing coronavirus disease 2019 pandemic, has triggered the structural changes in the healthcare system globally, increasing demand for the remote delivery of the medical services. Nonetheless, it is not entirely clear what evidence exists that support the widespread use of telemedicine in Japan. Here, we summarize the current status of telemedicine research, particularly in the field of hypertension and other cardiovascular risk factors. We note that there have been very few interventional studies in Japan that clearly showed the superiority or noninferiority of telemedicine over standard care, and that the methods of online consultation considerably varied among studies. Clearly, more evidence is necessary for wide implementation of telemedicine in hypertensive patients in Japan, and also those with other cardiovascular risk factors.
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Affiliation(s)
- Shigeru Shibata
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Satoshi Hoshide
- grid.410804.90000000123090000Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Mamman M, Gara PN, Adefemi SA, Imade OM. Anthropometric Indices for Predicting Hypertension among General Outpatient Clinic Attendees of Federal Medical Centre, Bida, Nigeria. West Afr J Med 2023; 40:5-10. [PMID: 36716163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND The literature is replete with overwhelming evidence that being obese is a predictor of hypertension risk. Obesity can be defined by anthropometric indices, such as Body Mass Index (BMI), Waist Circumference (WC), waist-hip ratio (WHR), and waistheight ratio (WHtR). Despite wide use of BMI as indicator of obesity, it does not reflect central fat distribution, whereas WC, WHR, and WHtR are used as surrogate markers for body fat centralization. A central distribution of body fat has been shown to be strongly associated with hypertension. Controversies, however, remain regarding the best predictor of hypertension risk. We determined the prevalence of hypertension and assess its association with the four obesity-related indices above. We evaluated which anthropometric measurement most closely relates to high blood pressure risk among adult patients 18 years and above in Bida. METHODS This is an analytical cross-sectional hospital-based study of 210 systematic randomly selected adults. Participants were administered a standardized questionnaire and had anthropometric measurements taken along with their blood pressure. RESULTS The percentage of people with high blood pressure was 38.6% (33.7% for males and 42.4% for females). WC (p-value <0.001), WHR (p-0.001), WHtR (p-value <0.001) and BMI (p-0.016) were all statistically significantly associated with hypertension. At the multivariate analysis level; waist circumference (OR= 3.635, p= 0.002, CI = 1.613-8.189) and waist-height ratio (OR= 7.183, p-value <0.001, CI = 2.661-19.389) remained strong predictors of hypertension risk. Analysis of the receiver operated characteristics curve showed that waist circumference (0.842) and waist-height ratio (0.838) were the best predictors of hypertension risk. CONCLUSION The central obesity indices WC, and WHtR were better than BMI for the prediction of hypertension in adults >18 years. Therefore, WHtR or WC is recommended as a screening tool for the prediction of hypertension in our clinics, as a means of prevention and early detection of hypertension to halt or slow down the rising burden of hypertension.
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Affiliation(s)
- M Mamman
- Department of Family Medicine, Federal Medical Centre, Bida, Niger State, Nigeria
| | - P N Gara
- Department of Family Medicine, Federal Medical Centre, Bida, Niger State, Nigeria
| | - S A Adefemi
- Department of Family Medicine, Federal Medical Centre, Bida, Niger State, Nigeria
| | - O M Imade
- Department of Family Medicine, Federal Medical Centre, Bida, Niger State, Nigeria
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Dormanesh B, Arasteh P, Daryanavard R, Mardani M, Ahmadi M, Nikoupour H. Epidemiology of obesity and high blood pressure among school-age children from military families: the largest report from our region. BMC Pediatr 2023; 23:37. [PMID: 36683049 PMCID: PMC9868491 DOI: 10.1186/s12887-023-03839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND For the first time, we aimed to determine the epidemiology and associated factors of obesity and hypertension among children of military families in our region. METHODS In this multi-centered study, children between the ages of 5 to 12 years old, entered the study. Data on baseline and clinical characteristics, history of disease and anthropometric measurements, were collected. RESULTS Among 504 children, 44.2% were males. Mean (SD) age of participants was 7.9 ± 1.9 years. Overall, 5% were obese and 9.9% were overweight. In total, 16.3% had elevated BP, 12.5% had stage one and 0.2% had stage two hypertension. Age (beta = 0.306, OR = 1.35, 95% CI:1.14-1.61), obesity/overweight (OR = 5.58, 95% CI:2.59-12.0), history of hypertension in mother (OR = 43.24, 95% CI:5.99-312.11), low birth weight (OR = 7.96, 95% CI:2.59-12.0), physical activity (OR = 0.27, 95% CI:0.10-0.72), and consumption of fast food more than once a week (OR = 3.36, 95% CI:1.82-6.19), were associated with risk of hypertension. Furthermore, age (beta = 0.346, OR = 1.41, 95% CI:1.21-1.64), history of childhood obesity in the father (OR = 3.78, 95% CI: 1.77-8.06) and mother (OR = 2.44, 95% CI:1.07-5.56), and physical activity (OR = 0.27, 95% CI:0.11-0.66), were associated with obesity. CONCLUSION Age, obesity/overweight, history of hypertension in the mother, birth weight, physical activity, and consumption of fast food, were associated with risk of hypertension. Moreover, age, history of childhood obesity in parents, and physical activity, were associated with obesity. Furthermore, we found that school-age children in military families have higher rates of hypertension and overweight compared to other reports from our region.
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Affiliation(s)
- Banafshe Dormanesh
- Department of Pediatric, AJA University of medical sciences, Tehran, Iran
| | - Peyman Arasteh
- AJA University of Medical Sciences, Tehran, Iran
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roya Daryanavard
- Department of Pediatric, AJA University of medical sciences, Tehran, Iran
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Garanet F, Samadoulougou S, Baguiya A, Bonnechère B, Millogo T, Degryse JM, Kirakoya-Samadoulougou F, Kouanda S. Low prevalence of high blood pressure in pregnant women in Burkina Faso: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:955. [PMID: 36544103 PMCID: PMC9773536 DOI: 10.1186/s12884-022-05242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND High blood pressure (HBP) during pregnancy causes maternal and fetal mortality. Studies regarding its prevalence and associated factors in frontline level health care settings are scarce. We thus aimed to evaluate the prevalence of HBP and its associated factors among pregnant women at the first level of the health care system in Burkina Faso. METHODS This cross-sectional study was conducted in six health facilities between December 2018 and March 2019. HBP was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Multivariable logistic regression analysis was performed to identify factors associated with HBP. RESULTS A total of 1027 pregnant women were included. The overall prevalence of HBP was 1.4% (14/1027; 95% confidence interval [CI] 0.7-2.3), with 1.6% (7/590; 95% CI 0.8-3.3) in rural and 1.2% (7/437; 95% CI 0.6- 2.5) in semi-urban areas. The prevalence was 0.7% (3/440; 95% CI 0.2-2.1) among women in the first, 1.5% (7/452; 95% CI 0.7-3.2) in the second and 3% (4/135; 95% CI 1.1-7.7) in the third trimester. In the multivariable analysis, pregnancy trimester, maternal age, household income, occupation, parity, and residential area were not associated with HBP during pregnancy. CONCLUSION The prevalence of HBP among pregnant women at the first level of health system care is significantly lower compared to prevalence's from hospital studies. Public health surveillance, primary prevention activities, early screening, and treatment of HDP should be reinforced in all health facilities to reduce the burden of adverse pregnancy outcomes in Burkina Faso.
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Affiliation(s)
- Franck Garanet
- grid.457337.10000 0004 0564 0509Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso ,grid.4989.c0000 0001 2348 0746Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Bruxelles, Belgique ,Université Ouaga1 Joseph Ki-Zerbo, Ecole Doctorale Science de la Santé (ED2S), Laboratoire de Santé Publique (LASAP), Ouagadougou, Burkina Faso
| | - Sekou Samadoulougou
- grid.23856.3a0000 0004 1936 8390Centre for Research on Planning and Development (CRAD), Laval University, Quebec, G1V 0A6 Canada ,grid.421142.00000 0000 8521 1798Evaluation Platform On Obesity Prevention, Quebec Heart and Lung Institute, Quebec, G1V 4G5 Canada
| | - Adama Baguiya
- grid.457337.10000 0004 0564 0509Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso ,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Bruno Bonnechère
- grid.12155.320000 0001 0604 5662REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tieba Millogo
- grid.457337.10000 0004 0564 0509Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso ,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Jean-Marie Degryse
- grid.7942.80000 0001 2294 713XInstitut de Recherche Sciences et Société (IRSS), Université Catholique de Louvain, Bruxelles, Belgique ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care - Katholieke Universiteit Leuven, Leuven, Belgique
| | - Fati Kirakoya-Samadoulougou
- grid.4989.c0000 0001 2348 0746Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Bruxelles, Belgique
| | - Seni Kouanda
- grid.457337.10000 0004 0564 0509Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso ,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
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Lemoine S, Courbebaisse M. Petits ARN interférents : applications potentielles pour les néphrologues Small interfering RNA: potential applications for nephrologists. Nephrol Ther 2022; 18:6S1-6S6. [PMID: 36585119 DOI: 10.1016/s1769-7255(22)00646-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Small interfering RNA (siRNAs) are double-stranded RNAs of around 20 base pairs in length that trigger RNAi machinery, which promotes degradation of a target mRNA avoiding protein translation. SiRNAs are liver-targeted, using tris N-acetylgalactosamine (GalNAc) as the targeting ligand. This discovery received the Nobel Prize for medicine and physiology in 2006 and lead to substantial therapeutic advances. Application field and development of these siRNA has been very fast. Indeed, patisiran has been released in 2018 for hereditary transthyretin amyloidosis. This first treatment showed the security and efficacy of such a product. Since, treatments have been developed for acute hepatic porphyria and primary hyperoxaluria. The current pipeline for new siRNA development is ambitious; clinical trial are ongoing in nephrology, as in the IgA nephropathy. Frequent diseases are also targeted such as hypertension or hypercholesterolemia. © 2022 Published by Elsevier Masson SAS on behalf of Société francophone de néphrologie, dialyse et transplantation.
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Affiliation(s)
- Sandrine Lemoine
- Service de néphrologie et d'exploration fonctionnelle rénale, centre de référence maladies rénales rares Néphrogones, Hospices civils de Lyon, université de Lyon, France.
| | - Marie Courbebaisse
- Service de physiologie, hôpital européen Georges-Pompidou, AP-HP, INSERM U1151, université de Paris, Paris, France
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Sengupta S, Collins T. Headache Disorders: Does Pain Affect Blood Pressure? Curr Pain Headache Rep 2022. [PMID: 36251159 DOI: 10.1007/s11916-022-01083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The perspective that pain corresponds to elevated blood pressure is overly simplistic. Our objective is to investigate and debunk misconceptions regarding the effect of pain on blood pressure. RECENT FINDINGS While pain can increase blood pressure in the acute setting, prolonged pain and migraine's effect on blood pressure varies and can result in lower-than-expected blood pressure. Therefore, attributing pain as a sole source of elevation of blood pressure may lead to delays in diagnosing hypertension. Based on limited studies available, comorbid pain and chronic hypertension have a higher concurrence than in the general population. We will review current literature to investigate the effect of pain on blood pressure and prevalence of hypertension in chronic pain sufferers. A better understanding of pain's effect on blood pressure will help practitioners appropriately diagnose and counsel patients without disproportionately attributing high blood pressure to pain.
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Dong Y, Chen L, Gao D, Li Y, Chen M, Ma T, Ma Y, Liu J, Zhang Y, Ma Q, Wang X, Song Y, Zou Z, Ma J. Endogenous sex hormones homeostasis disruption combined with exogenous phthalates exposure increase the risks of childhood high blood pressure: A cohort study in China. Environ Int 2022; 168:107462. [PMID: 35998410 DOI: 10.1016/j.envint.2022.107462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The structural similarity between sex hormones and exogenous phthalates (PAEs) enabled them as disrupters in regulating childhood blood pressure (BP). We aim to explore the association of sex hormones homeostasis and PAEs metabolites with childhood high BP (HBP). METHODS A cohort study was conducted with 1416 children aged 7-13 years at baseline and with 824, 819, and 801 children completing three waves' follow up. Serum testosterone (TT) and estradiol (E2) in children during three consecutive waves of surveys were measured by radioimmunoassay, and then TT/E2 ratio calculated as TT divided by E2 were used to represent sex hormones homeostasis. Seven urinary PAEs metabolites were measured in children of first wave. The BP Z-Scores and HBP across waves were obtained by sex, age, and height specific percentiles. Log-binomial regression models with adjusted risk ratios (aRR) after adjusting for confounders were utilized. RESULTS The prevalence of HBP at the baseline survey was 25.5%, and increased from 26.3% in the first wave of survey to 35.0% in the third wave of survey. PAEs were negatively correlated with E2, while positively correlated with TT and TT/E2 ratio. A positive association of the serum TT levels, TT/E2 ratio, and total PAEs was found with HBP prevalence (in wave 1, 2 and 3 with TT (aRR): 1.63, 1.37 and 1.45; with TT/E2: 1.63, 1.42 and 1.20; with PAEs: 1.40, 1.32 and 1.32), persistent HBP (with TT (aRR): 2.19; TT/E2: 2.16; PAEs: 2.57), occasional HBP (with TT (aRR): 1.94; TT/E2: 1.72; PAEs: 1.38), and new HBP incidence (with TT (aRR): 1.44; TT/E2: 1.57; PAEs: 1.67), but E2 had a negative association with HBP phenotypes (HBP prevalence in wave 1, 2 and 3 (aRR): 0.77, 0.93, and 1.10; persistent HBP: 0.47; occasional HBP: 0.96; new HBP incidence: 0.81). The E2 and PAEs had antagonistic effects on HBP risks in children, particularly in girls and those with high BMI group, but the TT levels, TT/E2 ratio and PAEs had synergistic effects on HBP risks in children, particularly in boys and those with high BMI group. CONCLUSION Exogenous PAEs exposure and endogenous sex hormones homeostasis disruption independently increase the risks of HBP. Moreover, the exogenous PAEs exposure could disrupt the endogenous sex hormones homeostasis in children, thereby combinedly increased risks of childhood HBP.
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Affiliation(s)
- Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Ying Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Qi Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Xinxin Wang
- School of Public Health and Management, Ningxia Medical University, Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, 750004, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China.
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China.
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
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de Simone G, Mancusi C, Hanssen H, Genovesi S, Lurbe E, Parati G, Sendzikaite S, Valerio G, Di Bonito P, Di Salvo G, Ferrini M, Leeson P, Moons P, Weismann CG, Williams B. Hypertension in children and adolescents. Eur Heart J 2022; 43:3290-3301. [PMID: 35896123 DOI: 10.1093/eurheartj/ehac328] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 12/12/2022] Open
Abstract
Definition and management of arterial hypertension in children and adolescents are uncertain, due to different positions of current guidelines. The European Society of Cardiology task-force, constituted by Associations and Councils with interest in arterial hypertension, has reviewed current literature and evidence, to produce a Consensus Document focused on aspects of hypertension in the age range of 6-16 years, including definition, methods of measurement of blood pressure, clinical evaluation, assessment of hypertension-mediated target organ damage, evaluation of possible vascular, renal and hormonal causes, assessment and management of concomitant risk factors with specific attention for obesity, and anti-hypertensive strategies, especially focused on life-style modifications. The Consensus Panel also suggests aspects that should be studied with high priority, including generation of multi-ethnic sex, age and height specific European normative tables, implementation of randomized clinical trials on different diagnostic and therapeutic aspects, and long-term cohort studies to link with adult cardiovascular risk. Finally, suggestions for the successful implementation of the contents of the present Consensus document are also given.
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Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center & Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center & Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Simonetta Genovesi
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital & School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Empar Lurbe
- Paediatric Department, Consorcio Hospital General, University of Valencia; CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital & School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Skaiste Sendzikaite
- Clinic of Paediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, 'S.Maria delle Grazie' Hospital, Pozzuoli, Italy
| | - Giovanni Di Salvo
- Paediatric Cardiology Unit, Department of Woman's and Child's Health, University-Hospital of Padova, University of Padua, Padua, Italy
| | - Marc Ferrini
- St Joseph and St Luc Hospital Department of Cardiology and Vascular Pathology, Lyon, France
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium & Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Constance G Weismann
- Paediatric Heart Center, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, and NIHR University College London Hospitals Biomedical Research Centre, London, UK
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Cichosz SL, Rasmussen NH, Vestergaard P, Hejlesen O. Is predicted body-composition and relative fat mass an alternative to body-mass index and waist circumference for disease risk estimation? Diabetes Metab Syndr 2022; 16:102590. [PMID: 35986982 DOI: 10.1016/j.dsx.2022.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS New methods to estimate body-composition have recently been proposed, but their relation to diseases, such as diabetes and coronary heart disease, needs further investigation. The purpose of this study was to investigate the association between proposed prediction of body-composition (PBC); Relative Fat Mass (RFM), Body Mass Index (BMI), Waist Circumference (WC) and disease. METHODS In a cross-sectional cohort (NHANES) the association between the four body measures and diabetes, high blood pressure, coronary heart disease, cancer, arthritis, and hospitalization were assessed. A total of 13,348 people was included in this study. Receiver operating characteristic (ROC), Area Under Curve (AUC) and statistical testing were used to evaluate the differences. RESULTS PBC/RFM had significant higher AUC than BMI or WC for diabetes, high blood pressure, hospitalization, and arthritis. PBC had a significant higher AUC than RFM, BMI, WC for Cancer and coronary heart disease. CONCLUSIONS RFM and PBC could be a better indicator to distinguish amongst people with a risk of diseases compared to traditional measures such as BMI and WC. However, future studies need to investigate the longitudinal association between RFM, PBC and the risk of disease development to assess if these measures are better suited for risk-stratification.
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Affiliation(s)
| | - Nicklas H Rasmussen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Denmark
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Lima Borges L, Rodrigues de Lima T, Augusto Santos Silva D. Accuracy of anthropometric indicators of obesity to identify high blood pressure in adolescents-systematic review. PeerJ 2022; 10:e13590. [PMID: 35966930 PMCID: PMC9373973 DOI: 10.7717/peerj.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/24/2022] [Indexed: 01/20/2023] Open
Abstract
Background Anthropometric indicators of obesity have been associated with blood pressure in adolescents. However, the accuracy of anthropometric indicators of obesity for screening for high blood pressure (HBP) in adolescents is not known. Thus, the aim of the present study was to summarize the set of evidence regarding the predictive ability of anthropometric indicators of obesity to identify HBP in adolescents. Methods Searches were performed in five databases: MEDLINE, Web of Knowledge, Scopus, Scientific Electronic online (SciELO) and SportDiscus. The inclusion criteria for studies were: adolescents aged 10-19 years or mean age included in this range, observational and intervention studies, studies that proposed cutoff points for anthropometric indicators of obesity, and studies in English, Portuguese and Spanish. The methodological quality of studies was assessed using the QUADAS-2 instrument. Results Ten studies met the inclusion criteria and had their information summarized. Based on the information described in these studies, the anthropometric indicators body mass index (BMI), waist circumference (WC), waist-to-height-ratio (WHtR), triceps skinfold thickness, body adiposity index, C index, body mass, waist-to-arm span ratio, arm fat area, average arm perimeter, fat percentage and arm span were likely to be used in high blood pressure (HBP) screening among adolescents. However, only one study showed acceptable values (moderate to high precision) in relation to the accuracy measurements of described cutoffs. Conclusion Caution is suggested in the use of anthropometric indicators of obesity for HBP screening in adolescents, in which a greater number of studies with accurate diagnostic tools are necessary.
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Affiliation(s)
- Leandro Lima Borges
- Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brasil
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Williamson W, Lewandowski AJ, Huckstep OJ, Lapidaire W, Ooms A, Tan C, Mohamed A, Alsharqi M, Bertagnolli M, Woodward W, Dockerill C, McCourt A, Kenworthy Y, Burchert H, Doherty A, Newton J, Hanssen H, Cruickshank JK, McManus R, Holmes J, Ji C, Love S, Frangou E, Everett C, Hillsdon M, Dawes H, Foster C, Leeson P. Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial. EClinicalMedicine 2022; 48:101445. [PMID: 35706495 PMCID: PMC9112102 DOI: 10.1016/j.eclinm.2022.101445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Exercise is advised for young adults with elevated blood pressure, but no trials have investigated efficacy at this age. We aimed to determine whether aerobic exercise, self-monitoring and motivational coaching lowers blood pressure in this group. METHODS The study was a single-centre, open, two-arm, parallel superiority randomized clinical trial with open community-based recruitment of physically-inactive 18-35 year old adults with awake 24 h blood pressure 115/75mmHg-159/99 mmHg and BMI<35 kg/m2. The study took place in the Cardiovascular Clinical Research Facility, John Radcliffe Hospital, Oxford, UK. Participants were randomized (1:1) with minimisation factors sex, age (<24, 24-29, 30-35 years) and gestational age at birth (<32, 32-37, >37 weeks) to the intervention group, who received 16-weeks aerobic exercise training (three aerobic training sessions per week of 60 min per session at 60-80% peak heart rate, physical activity self-monitoring with encouragement to do 10,000 steps per day and motivational coaching to maintain physical activity upon completion of the intervention. The control group were sign-posted to educational materials on hypertension and recommended lifestyle behaviours. Investigators performing statistical analyses were blinded to group allocation. The primary outcome was 24 h awake ambulatory blood pressure (systolic and diastolic) change from baseline to 16-weeks on an intention-to-treat basis. Clinicaltrials.gov registered on March 30, 2016 (NCT02723552). FINDINGS Enrolment occurred between 30/06/2016-26/10/2018. Amongst the 203 randomized young adults (n = 102 in the intervention group; n = 101 in the control group), 178 (88%; n = 76 intervention group, n = 84 control group) completed 16-week follow-up and 160 (79%; n = 68 intervention group, n = 69 control group) completed 52-weeks follow-up. There were no group differences in awake systolic (0·0 mmHg [95%CI, -2·9 to 2·8]; P = 0·98) or awake diastolic ambulatory blood pressure (0·6 mmHg [95%CI, -1·4. to 2·6]; P = 0·58). Aerobic training increased peak oxygen uptake (2·8 ml/kg/min [95%CI, 1·6 to 4·0]) and peak wattage (14·2watts [95%CI, 7·6 to 20·9]) at 16-weeks. There were no intervention effects at 52-weeks follow-up. INTEPRETATION These results do not support the exclusive use of moderate to high intensity aerobic exercise training for blood pressure control in young adults. FUNDING Wellcome Trust, British Heart Foundation, National Institute for Health Research, Oxford Biomedical Research Centre.
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Affiliation(s)
- Wilby Williamson
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Adam James Lewandowski
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Odaro John Huckstep
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Department of Biology, United States Air Force Academy, CO, USA
| | - Winok Lapidaire
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Alexander Ooms
- Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Cheryl Tan
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Afifah Mohamed
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Department of Diagnostic Imaging & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Maryam Alsharqi
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Mariane Bertagnolli
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Hôpital du Sacré-Cœur de Montréal Research Center (CIUSSS Nord-de-l’Île-de-Montréal), School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - William Woodward
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Cameron Dockerill
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Annabelle McCourt
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Yvonne Kenworthy
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Holger Burchert
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Aiden Doherty
- Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, UK
| | - Julia Newton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Switzerland
| | | | - Richard McManus
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Jane Holmes
- Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Sharon Love
- MRC Clinical Trials Unit, University College London, London, UK
| | - Elena Frangou
- MRC Clinical Trials Unit, University College London, London, UK
| | - Colin Everett
- Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK
| | | | - Helen Dawes
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Charlie Foster
- School of Policy Studies, University of Bristol, Bristol, UK
| | - Paul Leeson
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Corresponding author.
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Aramjoo H, Arab-Zozani M, Feyzi A, Naghizadeh A, Aschner M, Naimabadi A, Farkhondeh T, Samarghandian S. The association between environmental cadmium exposure, blood pressure, and hypertension: a systematic review and meta-analysis. Environ Sci Pollut Res Int 2022; 29:35682-35706. [PMID: 35257333 DOI: 10.1007/s11356-021-17777-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
We performed a systematic and meta-analysis study to find the association between cadmium (Cd) exposure and blood pressure (BP)/hypertension (HTN) in exposed general populations. We searched main databases for literature published between year 2000 and April 15, 2021. Quality assessment was performed with the Joanna Briggs Institute (JBI) critical appraisal tools. Heterogeneity between studies was determined by I-squared (I2) statistic. The random effects model was used to determine the association between blood and urine Cd levels with hypertension. The overall standard differences in mean for Cd level in hypertensive and control groups were 3.34, 1.79, and 8.09 based on samples from blood, urine, and hair, respectively. The overall standard differences in mean for Cd level in the low and high exposure groups were - 0.795 and - 1.036 based on blood and urinary samples, respectively. Our findings indicate a positive relationship between blood and hair Cd levels and hypertension. We also found that hair is the optimal biological sample to find the relationship between Cd exposure and hypertension for both genders. However, more studies are needed to confirm these findings.
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Affiliation(s)
- Hamed Aramjoo
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Feyzi
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Naghizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209 1300 Morris Park Avenue, Bronx, NY, USA
| | - Abolfazl Naimabadi
- Department of Environmental Health Engineering, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Tahereh Farkhondeh
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
- Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeed Samarghandian
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. 2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas. Lancet Reg Health Am 2022; 9:None. [PMID: 35711684 PMCID: PMC9107389 DOI: 10.1016/j.lana.2022.100219] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised blood pressure accounts for over 50% of CVD. In the Americas over a quarter of adult women and four in ten adult men have hypertension and the diagnosis, treatment and control are suboptimal. In 2021, the World Health Organization (WHO) released an updated guideline for the pharmacological treatment of hypertension in adults. This policy paper highlights the facilitating role of the WHO Global HEARTS initiative and the HEARTS in the Americas initiative to catalyze the implementation of this guideline, provides specific policy advice for implementation, and emphasizes that an overarching strategic approach for hypertension control is needed. The authors urge health advocates and policymakers to prioritize the prevention and control of hypertension to improve the health and wellbeing of their populations and to reduce CVD health disparities within and between populations of the Americas.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 1403 - 29th Street NW, Calgary, AB T2N 2T9, Canada.,Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Melanie Paccot Burnens
- Head of the Department of Non-Communicable Diseases, Ministry of Health in Chile, Santiago, Chile
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Sonia Y Angell
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Marc G Jaffe
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Jennifer Cohn
- Department of Internal Medicine, School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Alfredo Espinosa Brito
- Department of Internal Medicine, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Department of Research in Chronic Diseases, Center of Excellence for Cardiovascular Health, CESCAS, Institute for Clinical Effectiveness and Health Policy, IECS, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Department of Health Systems Science, Southern California Permanente Medical Group, Los Angeles, California, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Edward J Roccella
- United States National High Blood Pressure Education Program (Ret.) National Heart, Lung and Blood Institute National Institutes of Health Bethesda, MD, USA
| | | | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Mannemuddhu SS, Macumber I, Samuels JA, Flynn JT, South AM. When Hypertension Grows Up: Implications for Transitioning Care of Adolescents and Young Adults With Hypertension From Pediatric to Adult Health Care Providers. Adv Chronic Kidney Dis 2022; 29:263-274. [PMID: 36084973 DOI: 10.1053/j.ackd.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Abstract
Hypertension (HTN) is an important cause of morbidity and mortality in children as well as adults. HTN and related adverse cardiovascular health develop and progress on a continuum across an individual's life course. Pediatric HTN, or even isolated elevated blood pressure as a child, increases the risk of sustained HTN and cardiovascular disease in later adulthood. Transitioning the care of adolescents and young adults who have HTN is an important but unmet health care need that could potentially have a dramatic effect on mitigating the risk of cardiovascular disease in adulthood. However, very little has been published about the transition process in this population, and considerable gaps in the field remain. We discuss the epidemiology, etiology, and management approach in youth with HTN and how they differ from adults. We contextualize HTN and cardiovascular health on a continuum across the life course. We discuss key considerations for the transition process for adolescents and young adults with HTN including the major barriers that exist. Finally, we review key immediate health care needs that are particularly important around the time of the transfer of care.
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Affiliation(s)
- Sai Sudha Mannemuddhu
- East Tennessee Children's Hospital, Knoxville, TN; Department of Medicine, University of Tennessee Health Science Center-College of Medicine, Knoxville, TN
| | - Ian Macumber
- Department of Pediatrics, Keck School of Medicine, Division of Nephrology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Joshua A Samuels
- Department of Pediatrics, Pediatric Nephrology & Hypertension, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Division of Nephrology, Seattle Children's Hospital, Seattle, WA.
| | - Andrew M South
- Department of Pediatrics, Section of Nephrology, Wake Forest School of Medicine and Brenner Children's Hospital, Winston Salem, NC; Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC; Cardiovascular Sciences Center, Wake Forest School of Medicine, Winston Salem, NC
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41
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Ntaganda E, Mugeni R, Harerimana E, Ngoga G, Dusabeyezu S, Uwinkindi F, Utumatwishima JN, Mutimura E, Davila-Roman VG, Schechtman K, Nishimwe A, Twizeyimana L, Brown AL, Cade WT, Bushaku M, de Las Fuentes L, Reeds D, Twagirumukiza M. High rates of undiagnosed and uncontrolled hypertension upon a screening campaign in rural Rwanda: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:197. [PMID: 35473501 PMCID: PMC9044706 DOI: 10.1186/s12872-022-02606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hypertension remains the major risk factor for cardiovascular diseases (CVDs) worldwide with a prevalence and mortality in low- and middle-income countries (LMICs) among the highest. The early detection of hypertension risk factors is a crucial pillar for CVD prevention. Design and method This cross-sectional study included 4284 subjects, mean age 46 ± 16SD, 56.4% females and mean BMI 26.6 ± 3.7 SD. Data were collected through a screening campaign in rural area of Kirehe District, Eastern of Rwanda, with the objective to characterize and examine the prevalence of elevated blood pressure (BP) and other CVD risk factors. An adapted tool from the World Health Organization STEPwise Approach was used for data collection. Elevated BP was defined as ≥ 140/90 mm/Hg and elevated blood glucose as blood glucose ≥ 100 mg/dL after a 6-h fast. Results Of the sampled population, 21.2% (n = 910) had an elevated BP at screening; BP was elevated among individuals not previously known to have HTN in 18.7% (n = 752). Among individuals with a prior diagnosis of HTN, 62.2% (n = 158 of 254) BP was uncontrolled. Age, weight, smoking, alcohol history and waist circumference were associated with BP in both univariate analyses and multivariate analysis.
Conclusion High rates of elevated BP identified through a health screening campaign in this Rwandan district were surprising given the rural characteristics of the district and relatively low population age. These data highlight the need to implement an adequate strategy for the prevention, diagnosis, and control of HTN that includes rural areas of Rwanda as part of a multicomponent strategy for CVD prevention.
Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02606-9.
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Affiliation(s)
- Evariste Ntaganda
- Rwanda Biomedical Center (RBC), Rwanda Ministry of Health, Kigali, Rwanda
| | - Regine Mugeni
- Rwamagana Provincial Hospital, Rwamagana, Eastern Province, Rwanda.
| | | | - Gedeon Ngoga
- Partners in Health (PIH)/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | - Francois Uwinkindi
- Rwanda Biomedical Center (RBC), Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Eugene Mutimura
- National Council for Science and Technology (NCST), Kigali, Rwanda
| | - Victor G Davila-Roman
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kenneth Schechtman
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Aurore Nishimwe
- Regional Alliance for Sustainable Development (RASD Rwanda), Kigali, Rwanda.,School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Angela L Brown
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - W Todd Cade
- Duke University School of Medicine, Durham, NC, 27710, USA
| | - Marcus Bushaku
- Regional Alliance for Sustainable Development (RASD Rwanda), Kigali, Rwanda
| | - Lisa de Las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Dominic Reeds
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Marc Twagirumukiza
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Zhao Y, Bao WW, Yang BY, Liang JH, Gui ZH, Huang S, Chen YC, Dong GH, Chen YJ. Association between greenspace and blood pressure: A systematic review and meta-analysis. Sci Total Environ 2022; 817:152513. [PMID: 35016929 DOI: 10.1016/j.scitotenv.2021.152513] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Many studies have investigated the association between greenspaces and blood pressure (BP), but the results remain mixed. We conducted a systematic review and meta-analysis to comprehensively evaluate the evidence concerning greenspaces with BP levels and prevalent hypertension. Systematic literature searches were performed in Web of Science, PubMed, and Embase up to 25 April 2021. Combined effect estimates were calculated using random-effect models for each greenspace exposure assessment method that had been examined in ≥3 studies. Sensitivity analysis, subgroup analysis, and publication bias were also conducted. Of 38 articles (including 52 analyses, 5.2 million participants in total) examining the effects of normalized difference vegetation index (NDVI) (n = 23), proportion of greenspace (n = 11), distance to greenspace (n = 9), and others (n = 9) were identified. Most studies (65%) reported beneficial associations between greenspaces and BP levels/hypertension. Our results of meta-analyses showed that higher NDVI500m was significantly associated with lower levels of systolic blood pressure (SBP = -0.77 mmHg, 95%CI: -1.23 to -0.32) and diastolic blood pressure (DBP = -0.32 mmHg, 95%CI: -0.57 to -0.07). We also found that NDVI in different buffers and the proportion of greenspaces were significantly associated with lower odds (1-9%) of hypertension. However, no significant effect was found for distance to greenspaces. In summary, our results indicate the beneficial effects of greenspace exposure on BP and hypertension. However, future better-designed studies, preferably longitudinal, are needed to confirm and better quantify the observed benefits in BP and/or hypertension.
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Affiliation(s)
- Yu Zhao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wen-Wen Bao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jing-Hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhao-Huan Gui
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shan Huang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yi-Can Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ya-Jun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Ashworth DC, Bowen L, Maule SP, Seed PT, Green M, Bick D, Chappell LC. Postnatal health and care following hypertensive disorders in pregnancy: a prospective cohort study (BPiPP study). BMC Pregnancy Childbirth 2022; 22:286. [PMID: 35382795 PMCID: PMC8985263 DOI: 10.1186/s12884-022-04540-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction One in 10 women have hypertensive disorders in pregnancy (HDP) and are at risk of adverse short- and long-term health outcomes, yet there is limited information on their postnatal health and care needs. This study aimed to look at postnatal physical and psychological morbidity in women with HDP, compared to women without HDP, and the postnatal care received in both groups. Methods Within a prospective cohort study, women with and without HDP were identified and recruited on the postnatal ward of 17 maternity units across England and invited to complete a short baseline questionnaire. At 3 months postpartum, women were sent a follow-up questionnaire, with reminders. The principal outcomes were the mean score at 3 months for the Edinburgh Postnatal Depression Scale (EPDS) and the EuroQol Group 5-dimension (EQ-5D) scale. Results One thousand eight hundred twenty-nine women agreed to participate. Of these, 1757 (96%) completed the baseline questionnaire: 769 (44%) women had HDP and 988 (56%) women did not. Despite a difference in health-related quality of life and symptoms of depression at baseline between the two groups, at 3 months postnatal, within the 653 women who completed their follow-up questionnaire (37.2% of those who completed the baseline questionnaire) there were no significant differences between the groups (median EQ-5D VAS: 85 in women with HDP, 85 in women without HDP, p = 0.99 and mean EPDS score 5.5 in women with HDP, 5.0 in women without HDP, p = 0.80). Overall levels of physical postnatal morbidity were high, with 89% reporting one or more morbidities. Approximately 9% of women were re-admitted within 3 months after birth, higher in the HDP group (13.1%) higher compared to women without HDP (5.5%; RR 2.41; 95% CI 1.44–4.05). Conclusion Overall levels of physical and psychological morbidity were high in this postnatal population. Although there were increased needs of women with HDP in the immediate postnatal period (compared to other women), their health assessments were similar at 3 months. This study highlights the unmet needs of women in the postnatal period, in addition to a missed opportunity to influence future pregnancies and improve the longer-term health of women and their babies. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04540-2.
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Affiliation(s)
| | - Liza Bowen
- Department of Population Health Sciences, King's College London, London, UK
| | - Sophie P Maule
- Department of Women & Children's Health, King's College London, London, UK
| | - Paul T Seed
- Department of Women & Children's Health, King's College London, London, UK
| | - Marcus Green
- Action on Pre-eclampsia, Charity, Evesham, Worcestershire, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | | | - Lucy C Chappell
- Department of Women & Children's Health, King's College London, London, UK.
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Lebuso M, De Wet-Billings N. The prevalence and socio-demographic correlates of hypertension among women (15-49 years) in Lesotho: a descriptive analysis. BMC Public Health 2022; 22:562. [PMID: 35317759 PMCID: PMC8939203 DOI: 10.1186/s12889-022-12960-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background Hypertensive disorders are among the leading conditions for severe maternal morbidity across all regions and have a major impact on health care costs. This study aimed to identify the prevalence and its associated socio-demographic correlates of hypertension among women of the reproductive ages in Lesotho. Methods The study used the Lesotho Demographic and Health Survey (2014 LDHS) data set. A total of 3353 women of childbearing age (15–49 years) whose blood pressure was measured were used for analysis. The blood pressure readings were categorized according to the JNC7 cut-offs. The dependent variable of this study is hypertension. Both bivariate and binary logistic regressions were performed to determine socio-demographic correlates of hypertension. Results Results from this study revealed that one out of every five respondents of the study had hypertension compared to 23% who were in the prehypertension stage. The situation adds to the overall future risk of hypertension. About 30% percent who were at the hypertension stage were either living with a partner or widowed. The odds of being hypertensive were significantly 9.78 times higher among women aged 45–49 years [CI: 6.38–15.00]. Other factors associated with hypertension among women of the reproductive ages were “living with a partner” [OR 3.55:95% CI: 1.76–7.16], widowed [OR 2.61:95% CI: 1.89–3.60], and residing in the Maseru district [OR 2.12: 95% CI: 1.49–3.03]. Conclusion Chances of being diagnosed with high blood pressure increased with an increase with the age of the respondents. Age was found to be the most definite positive significant socio-demographic correlate of hypertension among women in Lesotho. To control hypertension, primary prevention strategies should target the identified high-risk -older age groups, the ever-married as well as prehypertensive women.
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Affiliation(s)
- Mapitso Lebuso
- Demography and Population Studies, School of Social Sciences, Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2000, South Africa.
| | - Nicole De Wet-Billings
- Demography and Population Studies, School of Social Sciences, Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2000, South Africa
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45
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Gallo G, Calvez V, Savoia C. Hypertension and COVID-19: Current Evidence and Perspectives. High Blood Press Cardiovasc Prev 2022; 29:115-123. [PMID: 35184271 PMCID: PMC8858218 DOI: 10.1007/s40292-022-00506-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) outbreak, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represents a real challenge for health-care systems worldwide. Male sex, older age and the coexistence of chronic comorbidities have been described as the most relevant conditions associated with a worse prognosis. Early reports suggested that hypertension might represent a risk factor for susceptibility to SARS-CoV-2 infection, a more severe course of COVID-19 and increased COVID-19-related deaths. Nevertheless, the independent role of hypertension remains under debate, since hypertension is often associated with the older age and other cardiovascular (CV) risk factors in the general population, which may also contribute to the SARS-Cov-2 infection and COVID-19. Moreover, the role of antihypertensive drugs, primarily angiotensin-converting inhibitors (ACEIs) and ARBs (angiotensin receptor blockers) in COVID-19 development and outcome appears controversial. Indeed, preclinical studies using these classes of drugs have suggested a potential upregulation of angiotensin-converting-enzyme 2 (ACE2) which is the key binding receptor promoting cell entry of SARS-CoV-2 in the organism. Renin–angiotensin system (RAS) blockers may potentially upregulate ACE2, hence, it has been initially hypothesized that these agents might contribute to a higher risk of SARS-CoV-2 infection and progressive course of COVID-19. However, several clinical reports do not support a detrimental role of RAS blockers in COVID-19, and an intense debate about the withdrawal or maintenance of chronic therapy with ACEi/ARB has been developed. In this review we will discuss the available evidence on the role of hypertension and antihypertensive drugs on SARS-CoV-2 infection and COVID-19 development.
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Affiliation(s)
- Giovanna Gallo
- Cardiology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Valentin Calvez
- Cardiology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Carmine Savoia
- Cardiology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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Striepe K, Schiffer M, Schmieder R. [Renal denervation : Really an alternative to reducing blood pressure?]. Internist (Berl) 2022; 63:330-340. [PMID: 35029703 DOI: 10.1007/s00108-021-01242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
Since the current guidelines were published in 2018, a total of 5 sham-controlled high-quality studies evaluating renal denervation have been conducted and the results were published. These five studies clearly confirmed the efficacy and safety of renal denervation, which correspond to the knowledge of the Clinical Consensus Conference. Thus, an update of the guidelines for the treatment of arterial hypertension regarding the clinical significance of renal denervation is urgently necessary. For this reason, the position paper of the working group of the European Society of Hypertension on the current state of renal denervation was reviewed. An approval of this procedure can soon be expected. In Germany there is a diagnosis-related group (DRG) for the reimbursement of renal denervation, which was suspended due to the erroneous Symplicity 3 study. This DRG should be revived in practice by a structured process of the implementation of renal denervation. It will then be a joint task of treating physicians and specialists in certified centers to identify eligible patients. In the future, antihypertensive treatment will consist of three pillars: lifestyle measures, pharmacotherapy and interventional treatment. These three treatment options should not be regarded as competitive (which is better) but alternative (patient preference) and additive (the aim is blood pressure control). It is the task of the treating physician to provide the patient with the ideal treatment concept. Clearly, renal denervation will not replace antihypertensive pharmacotherapy; however, it can lead to a reduction of the drug burden and increase of patient adherence to medication. It represents an option of modern antihypertensive treatment and will also become increasingly more important in special patient groups.
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Affiliation(s)
- Kristina Striepe
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - Mario Schiffer
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - Roland Schmieder
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland.
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Volpe M, Gallo G, Modena MG, Ferri C, Desideri G, Tocci G. Updated Recommendations on Cardiovascular Prevention in 2022: An Executive Document of the Italian Society of Cardiovascular Prevention. High Blood Press Cardiovasc Prev 2022; 29:91-102. [PMID: 35025091 PMCID: PMC8756172 DOI: 10.1007/s40292-021-00503-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/31/2021] [Indexed: 12/20/2022] Open
Abstract
This executive document reflects and updates the key points of a Consensus document on Cardiovascular (CV) Prevention realized through the contribution of a number of Italian Scientific Societies and coordinated by the Italian Society of Cardiovascular Prevention (SIPREC). The aim of this executive document is to analyze and discuss the new recommendations introduced by international guidelines for the management of major CV risk factors, such as hypertension, dyslipidemias and type 2 diabetes, consisting in the identification of lower therapeutic targets, in the promotion of combination fixed drug therapies and in the introduction in routine clinical practice of new effective pharmacological classes. Moreover, the document highlights the importance of effective CV prevention strategies during the the coronavirus disease 2019 (COVID-19) outbreak which has dramatically changed the priorities and the use of available resources by the national healthcare systems and have caused a reduction of programmed follow-up visits and procedures and even of hospital admissions for severe acute pathologies. In addition, the pandemic and the consequent lockdown measures imposed have caused a widespread diffusion of unhealthy behaviors with detrimental effects on the CV system. In such a context, reinforcement of CV prevention activities may play a key role in reducing the future impact of these deleterious conditions.
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Affiliation(s)
- Massimo Volpe
- Cardiology Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.
| | - Giovanna Gallo
- Cardiology Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Maria Grazia Modena
- Department of Cardiology, Università degli Studi di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Claudio Ferri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, S. Salvatore Hospital, L'Aquila, Italy
| | - Giovambattista Desideri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, S. Salvatore Hospital, L'Aquila, Italy
| | - Giuliano Tocci
- Cardiology Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
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Ponce de León-Ballesteros G, Sánchez-Aguilar HA, Mosti M, Herrera MF. Roux-en-Y Gastric Bypass in Patients with Super Obesity: Primary Response Criteria and Their Relationship with Comorbidities Remission. Obes Surg 2022. [PMID: 34988897 DOI: 10.1007/s11695-021-05862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The prevalence of super obesity has increased considerably in recent years, representing up to the 0.5% of the population. Even though bariatric surgery induces significant weight loss in these patients, it has been reported that up to 50% of the patients with super obesity will fail according to the current primary response criteria. OBJECTIVE To evaluate and compare different primary response criteria and their impact regarding comorbidities remission. PATIENTS AND METHODS A total of 104 patients with super obesity who underwent Roux-en-Y gastric bypass (RYGB) were identified in our institution from March 2004 to February 2019. An evaluation of the primary response at a 2-year follow-up was made using different criteria. A multivariate analysis was made to evaluate related variables to comorbidities remission. RESULTS Two years later, the rate of patients who achieved an EWL > 50%, %EWL > 70%, and BMI < 35 kg/m2 were 84.5%, 52.1%, and 62%, respectively. Regarding the comorbidities, 85%, 84.8%, and 81.1% of the patients improved or remitted T2D, HBP, and hyperlipidemia, respectively. An EWL > 50% 2 years later was related to complete remission of hyperlipidemia (p = 0.047), whereas weight regain above 10% is a risk factor for failure of complete remission of HBP in 3 years. CONCLUSIONS More than 75% of patients with super obesity yield an EWL > 50% 2 years later. In terms of hyperlipidemia, it is desirable to achieve an EWL of at least 50%. Whereas for T2D and HBP, a minimum of 25% TWL yields 72% and 60.5% of complete remission.
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49
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Barochiner J, Marín MJ, Janson JJ, Conti PR, Martínez R, Micali G, Conte IE, Plazzotta F. White Coat Uncontrolled Hypertension in Teleconsultation: A New and Frequent Entity. High Blood Press Cardiovasc Prev 2021; 29:155-161. [PMID: 34905157 PMCID: PMC8669402 DOI: 10.1007/s40292-021-00498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Cardiovascular risk seems not to be greater in patients with white coat uncontrolled hypertension (WUCH) than in patients with sustained blood pressure (BP) control. Therefore, its detection is important to avoid overtreatment. The COVID-19 pandemic determined a massive migration of hypertension consultations from the face-to-face modality to teleconsultations, and it is unknown whether WUCH exists in this context. Aim We aimed to evaluate the prevalence of WUCH through home BP monitoring (HBPM) in treated hypertensive patients evaluated by teleconsultation. Methods We included treated hypertensive patients that owned a digital BP monitor. During teleconsultation, patients were asked to perform two BP measurements and then a 7-day HBPM, using the same device. Patients were classified as having WUCH if BP was ≥ 140 and/or 90 mmHg in teleconsultation and < 135/85 mmHg on HBPM. The prevalence of WUCH and its 95% confidence interval were estimated. One-way ANOVA, the Chi-square test or Fisher’s exact test were used to compare the characteristics of these patients with the other groups. Results We included 341 patients (45.2% male, mean age 62.3 years). The prevalence of WUCH was 33.1% (95% CI 28.3–38.3%). Significant differences were found in terms of age, the number of antihypertensive drugs and the use of calcium channel blockers, all lower in the WUCH group as compared with the groups with elevated BP on HBPM. Conclusion WUCH exists in teleconsultation and is very frequent. It can be easily detected though HBPM, thus avoiding overmedication, and its potential impact on side-effects and health costs.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina. .,Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires, Argentina.
| | - Marcos J Marín
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Jorge J Janson
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Patricia R Conti
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina.,Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - Gabriel Micali
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Isabel E Conte
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Fernando Plazzotta
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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50
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Araujo-Castro M, Bengoa Rojano N, Fernández Argüeso M, Pascual-Corrales E, Jiménez Mendiguchía L, García Cano AM. [Cardiometabolic risk in patients with primary aldosteronism and autonomous cortisol secretion. Case-control study]. Med Clin (Barc) 2021; 157:473-479. [PMID: 33039136 DOI: 10.1016/j.medcli.2020.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To analyse the differences in the cardio-metabolic profile of patients with primary aldosteronism (PA) and autonomous cortisol secretion (ACS) matched by age and sex. METHODS Case-control study; cases of PA without associated ACS and as controls patients with ACS (dexamethasone suppression test ≥ 1.8 μg/dL in the absence of specific hypercortisolism clinical data), matched by age and sex. Comorbidities of hypertension, diabetes, obesity, dyslipidaemia, chronic kidney failure, and cardiovascular and cerebrovascular events were analysed, as well as their degree of control. RESULTS 57 patients with PA and 57 with ACS were included. On diagnosis, in addition to a higher prevalence of hypertension in the PA patients (100 vs. 52.7%, p < .0001) and higher systolic blood pressure levels (143.2 (2.5) vs. 135.3 (2.6) mmHg, p = .032) than in the ACS patients, no other differences were detected in the prevalence of other cardio-metabolic comorbidities. Nevertheless, the patients with ACS had higher HbA1c levels (p = .028) than the PA patients. After a median follow-up of 2.25 years, the patients with PA presented a greater deterioration in kidney function (Average decrease in glomerular filtration rate (MDRD-4) -17.4 (3.0) vs. -2.3 (4.4) mL/min/1.73 m2, p = .005) and lipid profile (Δtriglycerides of 34.5 (15.8) vs. -6.7 (11.3) mg/dL, p = .038) than the ACS patients. CONCLUSIONS Despite the higher prevalence of hypertension in the patients with PA than in the patients with ACS matched by age and sex, no differences were detected in the prevalence of other cardio-metabolic comorbidities. However, the PA patients showed a greater deterioration in kidney function and lipid profile throughout the follow-up than the ACS patients.
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Affiliation(s)
- Marta Araujo-Castro
- Servicio de Endocrinología y Nutrición. Hospital Universitario Ramón y Cajal, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España.
| | - Nuria Bengoa Rojano
- Servicio de Endocrinología y Nutrición. Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Fernández Argüeso
- Servicio de Endocrinología y Nutrición. Hospital Universitario Ramón y Cajal, Madrid, España
| | - Eider Pascual-Corrales
- Servicio de Endocrinología y Nutrición. Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Ana M García Cano
- Servicio de Bioquímica. Hospital Universitario Ramón y Cajal, Madrid, España
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