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1.
Biochem Biophys Res Commun ; 480(4): 745-751, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27942049

RESUMEN

Kelch-like 3 (KLHL3) is a component of an E3 ubiquitin ligase complex that regulates blood pressure by targeting With-No-Lysine (WNK) kinases for degradation. Mutations in KLHL3 cause constitutively increased renal salt reabsorption and impaired K+ secretion, resulting in hypertension and hyperkalemia. Although clinical studies have shown that dietary K+ intake affects blood pressure, the mechanisms have been obscure. In this study, we demonstrate that the KLHL3 ubiquitin ligase complex is involved in the low-K+-mediated activation of Na-Cl cotransporter (NCC) in the kidney. In the distal convoluted tubules of mice eating a low-K+ diet, we found increased KLHL3 phosphorylation at S433 (KLHL3S433-P), a modification that impairs WNK binding, and also reduced total KLHL3 levels. These changes are accompanied by the accumulation of the target substrate WNK4, and activation of the downstream kinases SPAK (STE20/SPS1-related proline-alanine-rich protein kinase) and OSR1 (oxidative stress-responsive 1), resulting in NCC phosphorylation and its accumulation at the plasma membrane. Increased phosphorylation of S433 was explained by increased levels of active, phosphorylated protein kinase C (but not protein kinase A), which directly phosphorylates S433. Moreover, in HEK cells expressing KLHL3 and WNK4, we showed that the activation of protein kinase C by phorbol 12-myristate 13-acetate induces KLHL3S433-P and increases WNK4 levels by abrogating its ubiquitination. These data demonstrate the role of KLHL3 in low-K+-mediated induction of NCC; this physiologic adaptation reduces distal electrogenic Na+ reabsorption, preventing further renal K+ loss but promoting increased blood pressure.


Asunto(s)
Hipertensión/genética , Hipopotasemia/genética , Proteínas de Microfilamentos/genética , Deficiencia de Potasio/genética , Potasio en la Dieta/metabolismo , Proteínas Adaptadoras Transductoras de Señales , Animales , Dieta , Regulación de la Expresión Génica , Células HEK293 , Humanos , Hipertensión/metabolismo , Hipertensión/patología , Hipopotasemia/metabolismo , Hipopotasemia/patología , Riñón/metabolismo , Riñón/patología , Masculino , Ratones , Ratones Endogámicos C57BL , Proteínas de Microfilamentos/metabolismo , Antígenos de Histocompatibilidad Menor/genética , Antígenos de Histocompatibilidad Menor/metabolismo , Fosforilación , Deficiencia de Potasio/metabolismo , Deficiencia de Potasio/patología , Potasio en la Dieta/administración & dosificación , Proteína Quinasa C/genética , Proteína Quinasa C/metabolismo , Proteínas Serina-Treonina Quinasas/genética , Proteínas Serina-Treonina Quinasas/metabolismo , Transducción de Señal , Sodio/metabolismo , Miembro 3 de la Familia de Transportadores de Soluto 12/genética , Miembro 3 de la Familia de Transportadores de Soluto 12/metabolismo , Proteína Quinasa Deficiente en Lisina WNK 1
2.
JCI Insight ; 1(20): e89173, 2016 12 08.
Artículo en Inglés | MEDLINE | ID: mdl-27942587

RESUMEN

BACKGROUND. Chronic kidney disease (CKD) is strongly associated with cardiovascular disease and there is an established association between vasculopathy affecting the kidney and eye. Optical coherence tomography (OCT) is a novel, rapid method for high-definition imaging of the retina and choroid. Its use in patients at high cardiovascular disease risk remains unexplored. METHODS. We used the new SPECTRALIS OCT machine to examine retinal and retinal nerve fiber layer (RNFL) thickness, macular volume, and choroidal thickness in a prospective cross-sectional study in 150 subjects: 50 patients with hypertension (defined as a documented clinic BP greater than or equal to 140/90 mmHg (prior to starting any treatment) with no underlying cause identified); 50 with CKD (estimated glomerular filtration rate (eGFR) 8-125 ml/min/1.73 m2); and 50 matched healthy controls. We excluded those with diabetes. The same, masked ophthalmologist carried out each study. Plasma IL-6, TNF-α , asymmetric dimethylarginine (ADMA), and endothelin-1 (ET-1), as measures of inflammation and endothelial function, were also assessed. RESULTS. Retinal thickness, macular volume, and choroidal thickness were all reduced in CKD compared with hypertensive and healthy subjects (for retinal thickness and macular volume P < 0.0001 for CKD vs. healthy and for CKD vs. hypertensive subjects; for choroidal thickness P < 0.001 for CKD vs. healthy and for CKD vs. hypertensive subjects). RNFL thickness did not differ between groups. Interestingly, a thinner choroid was associated with a lower eGFR (r = 0.35, P <0.0001) and, in CKD, with proteinuria (r = -0.58, P < 0.001) as well as increased circulating C-reactive protein (r = -0.57, P = 0.0002), IL-6 (r = -0.40, P < 0.01), ADMA (r = -0.37, P = 0.02), and ET-1 (r = -0.44, P < 0.01). Finally, choroidal thinning was associated with renal histological inflammation and arterial stiffness. In a model of hypertension, choroidal thinning was seen only in the presence of renal injury. CONCLUSIONS. Chorioretinal thinning in CKD is associated with lower eGFR and greater proteinuria, but not BP. Larger studies, in more targeted groups of patients, are now needed to clarify whether these eye changes reflect the natural history of CKD. Similarly, the associations with arterial stiffness, inflammation, and endothelial dysfunction warrant further examination. TRIAL REGISTRATION. Registration number at www.clinicalTrials.gov: NCT02132741. SOURCE OF FUNDING. TR was supported by a bursary from the Erasmus Medical Centre, Rotterdam. JJMHvB was supported by a bursary from the Utrecht University. JRC is supported by a Rowling Scholarship. SB was supported by a Wellcome Trust funded clinical research fellowship from the Scottish Translational Medicine and Therapeutics Initiative, and by a Rowling Scholarship, at the time of this work. ND is supported by a British Heart Foundation Intermediate Clinical Research Fellowship (FS/13/30/29994).


Asunto(s)
Coroides/patología , Endotelio Vascular/fisiopatología , Inflamación/complicaciones , Insuficiencia Renal Crónica/complicaciones , Adulto , Anciano , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Hipertensión/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos
3.
BMC Musculoskelet Disord ; 17(1): 499, 2016 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-27955647

RESUMEN

BACKGROUND: Symptoms and prognosis of patients with rheumatoid arthritis (RA) have improved with more intensive therapy, including the biological disease-modifying anti-rheumatic drugs (bDMARDs). Real life data concerning how comorbidities are distributed among patients treated or not treated with bDMARDs are scarce. Our objective was to investigate differences in comorbidity and health care consumption in RA patients, with and without bDMARDs. METHODS: This cross-sectional study was performed in the Southwestern part of Sweden. Patients, aged ≥ 18 years and diagnosed with RA in secondary health care during 2009-2010, were identified in the regional health care database. Aggregated data of comorbidity and health care consumption were retrieved between 2006 and 2010. RA patients treated with bDMARDs on 31st December 2010 were identified in the Swedish Rheumatology Quality Register (SRQ), which includes the biologics register Anti-Rheumatic Therapy in Sweden (ARTIS). Descriptive, comparative, univariate and multiple logistic regression analyses were used to identify factors associated with bDMARDs. RESULTS: Seven thousand seven hundred and twelve (7712) RA patients were identified (age 64.8 ± 14.9 years, women 74.3%), of whom 1137 (14.7%) were treated with bDMARDs. Overall, the most common comorbidities were infections (69.2%), hypertension (41.1%), chronic respiratory disease (15.3%), ischemic heart disease (14.0%) and malignancy (13.7%). Patients without bDMARDs were older and had more comorbidity. In the multiple logistic regression analysis, older age, cerebrovascular and chronic respiratory disease, heart failure, depression and malignancy were all associated with no present bDMARDs. Infections were associated with bDMARDs. Patients treated with bDMARDs consumed more secondary outpatient care but less visits in primary health care compared to patients without bDMARDs. CONCLUSIONS: Patients treated with bDMARDs versus no bDMARDs were younger and had significantly lower period prevalence for most common comorbidities, with the exception of infections. Differences in comorbidities between RA patients with or without bDMARDs should be taken into consideration when evaluating effectiveness and safety of bDMARDs in ordinary care.


Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/epidemiología , Productos Biológicos/uso terapéutico , Aceptación de la Atención de Salud/estadística & datos numéricos , Anciano , Enfermedad Crónica/epidemiología , Enfermedades Transmisibles/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/epidemiología , Neoplasias/epidemiología , Prevalencia , Pronóstico , Enfermedades Respiratorias/epidemiología , Suecia/epidemiología
4.
BMC Public Health ; 16(1): 1243, 2016 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-27955664

RESUMEN

BACKGROUND: Hypertension and diabetes prevalence is high in Africans. Data from HIV infected populations are limited, especially from Malawi. Integrating care for chronic non-communicable co-morbidities in well-established HIV services may provide benefit for patients by preventing multiple hospital visits but will increase the burden of care for busy HIV clinics. METHODS: Cross-sectional study of adults (≥18 years) at an urban and a rural HIV clinic in Zomba district, Malawi, during 2014. Hypertension and diabetes were diagnosed according to stringent criteria. Proteinuria, non-fasting lipids and cardio/cerebro-vascular disease (CVD) risk scores (Framingham and World Health Organization/International Society for Hypertension) were determined. The association of patient characteristics with diagnoses of hypertension and diabetes was studied using multivariable analyses. We explored the additional burden of care for integrated drug treatment of hypertension and diabetes in HIV clinics. We defined that burden as patients with diabetes and/or stage II and III hypertension, but not with stage I hypertension unless they had proteinuria, previous stroke or high Framingham CVD risk. RESULTS: Nine hundred fifty-two patients were enrolled, 71.7% female, median age 43.0 years, 95.9% on antiretroviral therapy (ART), median duration 47.7 months. Rural and urban patients' characteristics differed substantially. Hypertension prevalence was 23.7% (95%-confidence interval 21.1-26.6; rural 21.0% vs. urban 26.5%; p = 0.047), of whom 59.9% had stage I (mild) hypertension. Diabetes prevalence was 4.1% (95%-confidence interval 3.0-5.6) without significant difference between rural and urban settings. Prevalence of proteinuria, elevated total/high-density lipoprotein-cholesterol ratio and high CVD risk score was low. Hypertension diagnosis was associated with increasing age, higher body mass index, presence of proteinuria, being on regimen zidovudine/lamivudine/nevirapine and inversely with World Health Organization clinical stage at ART initiation. Diabetes diagnosis was associated with higher age and being on non-standard first-line or second-line ART regimens. CONCLUSION: Among patients in HIV care 26.6% had hypertension and/or diabetes. Close to two-thirds of hypertension diagnoses was stage I and of those few had an indication for antihypertensive pharmacotherapy. According to our criteria, 13.0% of HIV patients in care required drug treatment for hypertension and/or diabetes.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Infecciones por VIH/complicaciones , Hipertensión/epidemiología , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Enfermedades Cardiovasculares/etiología , Comorbilidad , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Malaui/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Proteinuria/epidemiología , Factores de Riesgo , Población Rural , Población Urbana , Adulto Joven
6.
Neurology ; 87(24): 2533-2539, 2016 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-27956564

RESUMEN

OBJECTIVE: To study the association of N-terminal pro-brain natriuretic peptide (NT-proBNP) with several brain MRI markers of brain vascular disease in a sample of participants free of stroke and dementia. METHODS: NT-proBNP plasma level was determined by means of a sandwich immunoassay method in a cohort study comprising 278 hypertensive patients. The presence of silent brain infarcts, brain microbleeds, enlarged perivascular spaces, and white matter hyperintensity volumes was assessed by brain MRI. We performed univariate and multivariate analyses to determine whether NT-proBNP was independently associated with these imaging markers, individually or combined. RESULTS: Median age was 63 years, and 41.4% were women. NT-proBNP remained independently associated with silent brain infarcts (odds ratio [OR] per 1-SD increase in NT-proBNP 2.11, 95% confidence interval [CI] 1.44-3.10), brain microbleeds (OR 1.79, 95% CI 1.15-2.78), basal ganglia enlarged perivascular spaces (OR 1.55, 95% CI 1.12-2.15), and white matter hyperintensity volumes (ß 1.60, 95% CI 0.47-2.74), even after controlling for vascular risk factors, cardiovascular risk, atrial fibrillation, previous heart disease, duration of hypertension, and preventive treatments. A score combining several imaging markers was also related to NT-proBNP levels (common OR per 1-SD increase 1.74, 95% CI 1.21-2.50). CONCLUSIONS: NT-proBNP is independently associated with silent cerebrovascular lesions and could be a surrogate marker of vascular brain damage in hypertension.


Asunto(s)
Biomarcadores/sangre , Trastornos Cerebrovasculares/diagnóstico , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Anciano , Trastornos Cerebrovasculares/sangre , Estudios de Cohortes , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo
7.
Vasc Health Risk Manag ; 12: 435-442, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27956837

RESUMEN

BACKGROUND: A hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Mechanisms related to local ischemic damage, major vascular occlusion, and psychological stress due to acute illness have been proposed. We assessed the natural course of blood pressure (BP) within the first 24 h in groups of ischemic stroke patients with different characteristics. We hypothesized that a consistent BP reduction, regardless of stroke location, time window from debut to admission and presence of persistent vascular occlusion, would favor a stress-related mechanism as an important cause of the hypertensive response after ischemic stroke. METHODS: Ischemic stroke patients (n=1067) were prospectively registered, and BP was measured on admission and <3 h, 3-6 h, 6-12 h and 12-24 h after admission. Patients were categorized according to the location of diffusion-weighted imaging (DWI) lesions (cortical, large subcortical, mixed cortico-subcortical, lacunar, cerebellar, brain stem or multiple), time window (admitted within or after 6 h of symptom onset) and presence of persistent proximal middle cerebral artery (MCA) occlusion versus normal findings on magnetic resonance angiography (MRA) at 24 h. RESULTS: A reduction in systolic BP and diastolic BP from baseline to 12-24 h was found across all DWI locations except for diastolic BP in cerebellar (P=0.072) lesions. Apart from diastolic BP in patients with normal MRA findings at 24 h (P=0.060), a significant fall in systolic BP and diastolic BP at 12-24 h was registered, irrespective of whether patients were admitted within 6 h or after 6 h of stroke onset or had persistent MCA occlusion versus normal MRA findings. CONCLUSION: We found a relatively consistent decline in BP within 24 h after admission across different stroke locations in patients admitted within or after 6 h of stroke onset and in patients with persistent MCA occlusion. Our findings suggest that a systemic factor such as psychological stress may be an important contributor to the frequently elevated BP on admission in patients with ischemic stroke.


Asunto(s)
Presión Sanguínea , Isquemia Encefálica/complicaciones , Hipertensión/etiología , Estrés Psicológico/complicaciones , Accidente Cerebrovascular/complicaciones , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/fisiopatología , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Admisión del Paciente , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Estrés Psicológico/diagnóstico , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo
8.
Chin Med J (Engl) ; 129(24): 2907-2912, 2016 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-27958221

RESUMEN

BACKGROUND: Antihypertensive drugs have been linked to new-onset osteoporotic fracture (NOF), and different classes of antihypertensive drugs may alter the risk for the development of NOF; however, the classic effect of different antihypertensive drugs on the development of NOF in the elderly has not been well studied during long-term follow-up. METHODS: In this study, we investigated the association between different classic antihypertensives and the development of NOF in the elderly. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance in Central Taiwan, China including case patients with NOF aged 65-80 years from January 2002 to December 2012 and non-NOF controls. Prescriptions for antihypertensives before the index date were retrieved from a prescription database. We estimated the hazard ratios (HR s) of NOF associated with antihypertensive use. Non-NOF controls served as the reference group. RESULTS: A total of 128 patients with NOF were identified from among 1144 patients with hypertension during the study period. The risk of NOF after adjusting age, sex, comorbidities, and concurrent medications was higher among the users of angiotensin-converting enzyme (ACE) inhibitors (HR, 1.64; 95% confidence interval [CI], 1.01-2.66) than among nonusers. Patients who took calcium channel blockers (CCBs) (HR, 0.70; 95% CI, 0.49-0.99) were at a lower risk of developing NOF than nonusers. Loop diuretics, thiazide diuretics, angiotensin receptor blocker, beta-blocker, and alpha-blocker were not associated with the risk of NOF. CONCLUSIONS: Elderly with hypertension who take CCBs are at a lower risk of NOF and that the use of ACE inhibitors was associated with a significantly increased risk of developing NOF during the 11-year follow-up.


Asunto(s)
Antihipertensivos/efectos adversos , Fracturas Osteoporóticas/inducido químicamente , Anciano , Anciano de 80 o más Años , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Estudios de Cohortes , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Estudios Longitudinales , Masculino , Fracturas Osteoporóticas/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiología
9.
Int Marit Health ; 67(4): 196-204, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28009392

RESUMEN

BACKGROUND: Due to the high prevalence of arterial hypertension and its role in the development of atherosclerosis, myocardial infarction and stroke, hypertension is a major public health challenge worldwide. There is limited knowledge of the prevalence of hypertension among seafarers who, however, are known to have an excess morbidity and mortality from these disorders. This article addresses the prevalence of hypertension among Danish seafarers and discusses potential risk factors for hypertension in maritime settings. MATERIALS AND METHODS: A representative sample of 629 Danish seafarers who had statutory medical examinations was studied from the beginning of October 2011 to the end of June 2012. The medical examination included measurements of blood pressure. The prevalence of hypertension in the study population was stratified by age, work place on board, smoking status, alcohol intake, and body mass index. RESULTS: The overall prevalence of hypertension in the study population was 44.7% (95% CI 40.8-48.6). In a comparison sample of adult Danes, the crude rate of hypertension was 12.6%. In addition, 41.8% (95% CI 38.0-45.7) of seafarers were pre-hypertensive. Hypertension was particularly increased among younger seafarers. The proportion of seafarers in antihypertensive treatment was low, in particular among the young seafarers. CONCLUSIONS: Hypertension is a major health issue among Danish seafarers. In addition to ensuring antihypertensive treatment when needed, individual and collective prevention should address lifestyle issues as well as physical and psychosocial exposures at sea.


Asunto(s)
Hipertensión/epidemiología , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Índice de Masa Corporal , Dinamarca/epidemiología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Medicina Naval , Prevalencia , Factores de Riesgo , Fumar/epidemiología
10.
Nutrients ; 8(12)2016 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-28009811

RESUMEN

BACKGROUND AND AIM: The association of habitual intakes of dietary nitrate (NO3-) and nitrite (NO2-) with blood pressure and renal function is not clear. Here, we investigated a potential effect of dietary NO3- and NO2- on the occurrence of hypertension (HTN) and chronic kidney disease (CKD). METHODS: A total of 2799 Iranian adults aged ≥20 years, participating in the Tehran Lipid and Glucose Study (TLGS), were included and followed for a median of 5.8 years. Dietary intakes of NO3- and NO2- were estimated using a semi-quantitative food frequency questionnaire. Demographics, anthropometrics, blood pressure and biochemical variables were evaluated at baseline and during follow-up examinations. To identify the odds ratio (OR) and 95% confidence interval (CI) of HTN and CKD across tertile categories of residual energy-adjusted NO3- and NO2- intakes, multivariate logistic regression models were used. RESULTS: Dietary intake of NO3- had no significant association with the risk of HTN or CKD. Compared to the lowest tertile category (median intake < 6.04 mg/day), the highest intake (median intake ≥ 12.7 mg/day) of dietary NO2- was accompanied with a significant reduced risk of HTN, in the fully adjusted model (OR = 0.58, 95% CI = 0.33-0.98; p for trend = 0.054). The highest compared to the lowest tertile of dietary NO2- was also accompanied with a reduced risk of CKD (OR = 0.50, 95% CI = 0.24-0.89, p for trend = 0.07). CONCLUSION: Our findings indicated that higher intakes of NO2- might be an independent dietary protective factor against the development of HTN and CKD, which are major risk factors for adverse cardiovascular events.


Asunto(s)
Glucemia/análisis , Dieta , Hipertensión/prevención & control , Lípidos/sangre , Nitratos/administración & dosificación , Nitritos/administración & dosificación , Insuficiencia Renal Crónica/prevención & control , Adulto , Biomarcadores/sangre , Presión Sanguínea , Distribución de Chi-Cuadrado , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión/sangre , Hipertensión/epidemiología , Hipertensión/fisiopatología , Incidencia , Irán/epidemiología , Riñón/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Encuestas Nutricionales , Oportunidad Relativa , Estudios Prospectivos , Factores Protectores , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/fisiopatología , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Adulto Joven
11.
Artículo en Inglés | MEDLINE | ID: mdl-28009850

RESUMEN

Regular maintenance of non-communicable chronic diseases can constrain disease progression in diabetic and hypertensive patients. To identify the individual and social factors that are associated with positive health-seeking behaviors and regular maintenance of chronic diseases, we have conducted a follow up study in 2015 on diabetic and hypertensive patients in Hubei Province. We used binary logistic regression models to determine specific factors associated with diabetic and hypertensive patients that sought healthcare services for their conditions in accordance with current Chinese Centers for Disease Prevention and Control (CDC) guidelines. Our findings show that 42.16% of 510 people living with chronic conditions (PLCDs) sought health services in line with existing guidelines. Findings also show a higher probability (8.418 times) for PLCDs seeking healthcare services at higher-tiered hospitals (secondary and tertiary hospitals) than for PLCDs seeking care at primary hospitals (odds ratio (OR) = 8.418, 95% confidence interval (CI) = 4.82, 14.27, p < 0.001). These analyses underscore the importance of having patient advocates who can provide support, where necessary, and encourage positive health-seeking behavior. The study also shows a negative impact on regular maintenance for PLCDs in households with high financial constraints. In contrast, the study shows positive impacts for increased household income, age, and residency in rural locations. In sum, this study underscores the importance of primary hospitals as key points of care and critical players in care coordination for PLCDs. The study provides more evidence for Chinese policymakers seeking to contain costs and improve population health. The findings also underscore the need for community-based interventions, specifically interventions that link local primary hospitals, friends/family members, and PLCDs.


Asunto(s)
Diabetes Mellitus/terapia , Hipertensión/terapia , Aceptación de la Atención de Salud/psicología , Factores de Edad , Anciano , China/epidemiología , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Características de la Residencia , Población Rural , Factores Socioeconómicos
13.
BMJ Case Rep ; 20162016 Dec 23.
Artículo en Inglés | MEDLINE | ID: mdl-28011889

RESUMEN

Spontaneous rectus sheath haematomas and cough secondary to losartan are individually rare conditions. Abdominal wall haematomas present with abdominal pain and abdominal mass. Most patients are managed conservatively; Surgery or embolisation is indicated for shock, infection, rupture into the peritoneum or intractable pain. This is a man aged 65 years presented with dry cough and right-sided abdominal pain. He started losartan a few weeks prior to the onset of cough and had been on rivaroxaban for prior deep venous thrombosis. The right side of his abdomen was distended, bruised and tender. His haemoglobin dropped from 13.3to 9.5 g/dL. CT abdomen/pelvis showed a large 14.5×9.1×4.5 cm haematoma within the right lateral rectus muscle. His only risk factor for developing rectus sheath haematoma was cough in the setting of anticoagulation. Dry cough due to angiotensin receptor blockers is rare, but can have very serious consequences.


Asunto(s)
Antihipertensivos/efectos adversos , Tos/inducido químicamente , Inhibidores del Factor Xa/efectos adversos , Hematoma/inducido químicamente , Losartán/efectos adversos , Rivaroxabán/efectos adversos , Anciano , Diagnóstico Diferencial , Hematoma/diagnóstico por imagen , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Enfermedades Musculares/inducido químicamente , Enfermedades Musculares/diagnóstico por imagen , Recto del Abdomen/diagnóstico por imagen , Tomografía Computarizada por Rayos X
14.
Artículo en Inglés | MEDLINE | ID: mdl-28025517

RESUMEN

The purpose of this study was to assess the major risk factors for hypertension in oil workers, and investigate the effect of occupational stress on the incidence of hypertension after controlling for other risk factors. A prospective cohort approach was used following enrollment of 1354 oil workers. The occupational stress experienced by oil workers was higher than for the general population in China. By the end of the cohort study, 231 new cases of hypertension among the oil workers had been diagnosed. The cumulative incidence of hypertension was 17.06%. There were 44, 112, and 75 workers who developed hypertension in the low, intermediate, and high occupational stress groups, which represented a 12.0%, 15.6%, and 20.3% cumulative incidence, respectively (chi-square value = 9.812, p < 0.01). Multivariate Cox proportional hazard model analysis showed that type of work, cigarette smoking, excess body weight, and obesity were risk factors for hypertension (p < 0.05). After risk factors such as type of work, cigarette smoking, alcohol consumption, and body mass index (BMI) were controlled, the hypertension risk (hazard ratio, HR) in the high occupational stress group was 1.549 (1.072-2.236) compared to the low exposure group, and 2.337 (1.191-4.585) in female subjects. Our study indicated that an increase in occupational stress was associated with an increased risk of hypertension after other factors were adjusted.


Asunto(s)
Hipertensión/epidemiología , Industria del Petróleo y Gas , Estrés Psicológico/epidemiología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Peso Corporal , China/epidemiología , Ciudades/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Fumar/epidemiología
15.
JNMA J Nepal Med Assoc ; 55(204): 86-92, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28029674

RESUMEN

INTRODUCTION: Hypertension is growing among the population of Nepal. We aimed to determine the current knowledge, attitude and practice of hypertension among hypertensive patients taking antihypertensive medication in the community of Central Nepal. METHODS: A cross-sectional study was conducted among the hypertensive patients in Bharatpur, Chitwan, Nepal from July 2015 to September 2015 using clustered sampling technique. Suitably designed and validated questionnaire of knowledge, attitude and practice on hypertension consisting of 27 questions were used to determine the KAP scores. The difference in the median KAP scores between sex, level of education and duration of hypertension were assessed using Mann-Whitney U test. RESULTS: A total of 200 patients met the inclusion criteria and majority of them were male (60%), had received primary education (36%) and had hypertension for ≥5 years (46.5%). The blood pressure ranged from 100-180/60-110 mmHg. The median K, A and P scores were 8 (6), 5 (1) and 6 (3) respectively. K and A were statistically associated with sex both at p<0.001 and level of education (K at p<0.001 and A at p=0.016). CONCLUSIONS: The current knowledge, attitude and practice among hypertensive patients using antihypertensive medication can be improved.


Asunto(s)
Antihipertensivos/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Hipertensión/tratamiento farmacológico , Hipertensión/psicología , Estudios Transversales , Humanos , Masculino , Nepal
16.
Int J Clin Pract ; 70(12): 1012-1018, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28032424

RESUMEN

AIMS: With self-reporting of erectile dysfunction (ED) in population-based surveys, men with ED may not represent men who are bothered sufficiently to seek an ED diagnosis and treatment. We used real-world observational data to assess: 1) the prevalence of ED diagnosis or treatment by age subgroups; and 2) the relationship of age with ED diagnosis or treatment after controlling for ED-related comorbidities in the USA. METHODS: This cross-sectional study used de-identified claims data (MarketScan® databases; primary analysis). Sensitivity analysis was conducted using electronic health records (Humedica® database). Inclusion criteria were men aged ≥18 years with a 360-day continuous enrollment before the index date. We assessed the prevalence of ED diagnosis or phosphodiesterase type 5 inhibitor (PDE5I) prescription by age and the risk for ED diagnosis or treatment by age after controlling for comorbidities (hypertension, other cardiovascular disease, diabetes mellitus, depression and benign prostatic hyperplasia). RESULTS: Of 19,833,939 men meeting inclusion criteria in the primary analysis, only 1 108 842 (5.6%) had an ED diagnosis or PDE5I prescription (mean [SD] age: 55.2 [11.2] years). Prevalence of ED diagnosis or treatment increased from age 18-29 years (0.4%) to 60-69 years (11.5%), then decreased in the seventh (11.0%), eighth (4.6%), and ninth (0.9%) decades. Men with ED diagnosis or treatment had a higher prevalence of any comorbidity (63.1% vs 29.3% for men without ED) and of each comorbid condition. In multivariate analyses, age was an independent risk factor for ED diagnosis or treatment. Sensitivity analysis provided consistent results. CONCLUSIONS: In a real-world setting in the USA, the prevalence of ED diagnosis or PDE5I treatment is generally low, increases with age, decreases in very old men, and is associated with increased prevalence of comorbidities. Age is an independent risk factor for ED diagnosis or treatment after controlling for comorbidities.


Asunto(s)
Depresión/epidemiología , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/tratamiento farmacológico , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Disfunción Eréctil/epidemiología , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/epidemiología , Factores de Riesgo , Adulto Joven
20.
Prev Chronic Dis ; 13: E179, 2016 12 29.
Artículo en Inglés | MEDLINE | ID: mdl-28033090

RESUMEN

INTRODUCTION: Rates of hypertension control remain low among underserved populations in the United States; moreover, disparities in hypertension-related cardiovascular disease death are increasing. Community health workers (CHWs) can address barriers to hypertension control among underrepresented and diverse populations. We identify unique roles CHWs play in hypertension self-management and medication adherence. METHODS: In 2014, we conducted a mixed methods study with an online survey of 265 CHWs and 23 telephone interviews. The survey and interview guide contained questions about CHWs' roles in hypertension self-management and hypertension medication adherence. We used descriptive statistics to analyze survey data and used inductive thematic analysis for the qualitative data. RESULTS: CHWs described working in partnership with patients and various health care providers to assist people in hypertension self-management. Roles were flexible and multifaceted but patient-driven. CHWs used various delivery methods to assist patients in overcoming barriers to medication adherence. CHWs interacted with patients primarily through individual clinical sessions or home visits. On average, they visit about 8 times per month, about 40 minutes per visit, over 7 months. CHWs often addressed barriers related to medicine-taking and refills and support patient-provider communications. CONCLUSION: Results from this study will help health care professionals, policy makers, and academics better understand the work of CHWs. CHWs are important provider allies for improving hypertension prevention and self-management, especially among underserved and diverse populations in the United States.


Asunto(s)
Actitud del Personal de Salud , Agentes Comunitarios de Salud , Hipertensión/terapia , Cumplimiento de la Medicación/estadística & datos numéricos , Autocuidado/métodos , Femenino , Humanos , Masculino , Investigación Cualitativa , Encuestas y Cuestionarios , Estados Unidos , Poblaciones Vulnerables
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