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1.
Arq. ciências saúde UNIPAR ; 27(2): 1027-1037, Maio-Ago. 2023.
Article in Portuguese | LILACS | ID: biblio-1425176

ABSTRACT

Objetivo: Descrever a importância do processo de educação em saúde reali- zado pelo enfermeiro aos pacientes hipertensos na atenção básica. Metodologia: Trata-se de uma revisão bibliográfica, onde foram utilizados artigos científicos identificados nas bases de dados: SciELO, LILACS e MEDLINE. Um total de 4.427 estudos foram encon- trados, após o refinamento oito foram selecionados para compor a amostra. Resultados: A estratégia educativa em saúde tem grande efetivação no tratamento da HAS, visto que o enfermeiro vai conhecer o paciente e direcioná-lo ao tratamento adequado, monitorando seu estado de saúde e evitando possíveis agravos. Contudo, o abandono do tratamento pelo cliente é uma das maiores dificuldades enfrentadas pelo o enfermeiro. Além disso, desafios no contexto do processo de trabalho em equipe e barreiras relacionadas à estru- tura física nas unidades de saúde. Considerações finais: O enfermeiro exerce um papel importante dentro do contexto da hipertensão arterial. Trazendo a prática baseada em evi- dências como abordagem, garantindo adesão ao tratamento e o controle dos níveis pres- sóricos da HAS.


Objective: To describe the importance of the health education process carried out by nurses with hypertensive patients in primary care. Methodology: This is a bibliographic review, where scientific articles identified in the databases: SciELO, LILACS and MEDLINE were used. A total of 4,427 studies were found, after refinement, eight were selected to compose the sample. Results: The health education strategy is highly effective in the treatment of SAH, as the nurse will get to know the patient and direct him to the appropriate treatment, monitoring his health status and avoiding possible injuries. However, abandonment of treatment by the client is one of the greatest difficulties faced by the nurse. In addition, challenges in the context of the teamwork process and barriers related to the physical structure in health units. Final considerations: Nurses play an important role within the context of arterial hypertension. Bringing evidence-based practice as an approach, ensuring adherence to treatment and control of blood pressure levels in SAH.


Objetivo: Describir la importancia del proceso de educación para la salud llevado a cabo por enfermeras con pacientes hipertensos en atención primaria. Metodología: Se trata de una revisión bibliográfica, donde los artículos científicos identificados en las bases de datos: SciELO, LILACS y MEDLINE. Fueron encontrados 4.427 estudios, después del refinamiento, ocho fueron seleccionados para componer la muestra. Resultados: La estrategia de educación sanitaria es altamente eficaz en el tratamiento de la HSA, ya que la enfermera conocerá al paciente y lo dirigirá al tratamiento adecuado, monitorizando su estado de salud y evitando posibles lesiones. Sin embargo, el abandono del tratamiento por parte del cliente es una de las mayores dificultades a las que se enfrenta la enfermera. Además, los desafíos en el contexto del proceso de trabajo en equipo y las barreras relacionadas con la estructura física en las unidades de salud. Consideraciones finales: Las enfermeras desempeñan un papel importante en el contexto de la hipertensión arterial. Traer la práctica basada en la evidencia como abordaje, garantizando la adherencia al tratamiento y el control de los niveles de presión arterial en la HTA.


Subject(s)
Patients , Health Education , Primary Care Nursing/instrumentation , Hypertension/nursing , Primary Health Care , Blood Pressure , Health Strategies , Treatment Adherence and Compliance/psychology , Nursing Care
2.
Rev. latinoam. enferm. (Online) ; 31: e3929, ene.-dic. 2023. tab, graf
Article in Spanish | LILACS, BDENF | ID: biblio-1441997

ABSTRACT

Objetivo: evaluar el efecto de la intervención educativa que realizan los enfermeros para controlar la presión arterial en personas con hipertensión arterial, en comparación con los cuidados habituales. Método: revisión sistemática con metaanálisis de ensayos clínicos aleatorizados realizada en seis bases de datos. Se incluyeron estudios en los cuales el enfermero llevó a cabo la intervención educativa en la persona con hipertensión arterial. El riesgo de sesgo se evaluó mediante la herramienta Risk of Bias Tool, el metaanálisis se hizo utilizando el software Review Manager y la certeza de la evidencia se calculó usando el sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: se encontraron 1692 estudios revisados por pares y se incluyeron ocho artículos en el metaanálisis. El metaanálisis se calculó para el resultado presión arterial sistólica y presión arterial diastólica, subagrupados por tiempo y tipo de implementación de la intervención. Para la intervención educativa presencial, realizada d forma individual combinada con actividad grupal, la estimativa del efecto fue -12,41 mmHg (Intervalo de Confianza 95%, -16,91 a -7,91, p<0,00001) para la presión sistólica y -5,40 mmHg (Intervalo 95% Confianza, -7,98 a -2,82, p<0,0001) para la presión diastólica, con certeza de evidencia alta. Conclusión: a intervención educativa realizada por el enfermero, de forma individual combinada con la actividad grupal, tiene efecto clínico y estadísticamente significativo. Registro PROSPERO: CRD42021282707.


Objetivo: to assess the effect of an educational intervention performed by nurses for blood pressure control in people with arterial hypertension, when compared to usual care. Método: a systematic review with meta-analysis of randomized clinical trials, conducted in six databases. The studies included were those in which an educational intervention was performed by nurses on people with arterial hypertension. The risk of bias was assessed by means of the Risk of Bias Tool, the meta-analysis was performed in the Review Manager software and certainty of the evidence was calculated in the Grading of Recommendations Assessment, Development and Evaluation system. Resultados: a total of 1,692 studies were found, which were peer-reviewed, including eight of them in the meta-analysis. The meta-analysis was calculated for the "systolic blood pressure" and diastolic blood pressure" outcomes, in subgroups by time and by intervention performance type. For the in-person educational intervention, performed individually combined with a group activity, the effect estimate was -12.41 mmHg (95% Confidence Interval: from -16.91 to -7.91, p<0,00001) for systolic pressure and -5.40 mmHg (95% Confidence Interval: from -7.98 to -2.82, p<0,00001) for diastolic pressure, with high certainty of evidence. Conclusión: the educational intervention performed by nurses, individually and combined with a group activity, presents a statistically significant clinical effect. PROSPERO registration No.: CRD42021282707.


Objetivo: avaliar o efeito da intervenção educativa realizada por enfermeiros para controle da pressão arterial em pessoas com hipertensão arterial, comparada com cuidado habitual. Método: revisão sistemática com metanálise de ensaios clínicos randomizados realizada em seis bases de dados. Foram incluídos estudos em que a intervenção educativa foi realizada pelo enfermeiro à pessoa com hipertensão arterial. O risco de viés foi avaliado pela Risk of Bias Tool, a metanálise no software Review Manager e a certeza da evidência no sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: foram encontrados 1692 estudos, revisados por pares, e oito artigos foram incluídos na metanálise. A metanálise foi calculada para o desfecho pressão arterial sistólica e pressão arterial diastólica, em subgrupo por tempo e por tipo de execução da intervenção. Para a intervenção educativa presencial, realizada de modo individual combinada com atividade de grupo, a estimativa de efeito foi de -12.41 mmHg (Intervalo de Confiança 95%, -16.91 a -7.91, p<0.00001) para pressão arterial sistólica e -5.40 mmHg (Intervalo de Confiança 95%, -7.98 a -2.82, p<0.0001) para pressão arterial diastólica, com certeza da evidência alta. Conclusão: a intervenção educativa realizada pelo enfermeiro, de modo individual combinada com atividade de grupo, apresenta efeito clínico e estatisticamente significativo. Registro PROSPERO: CRD42021282707.


Subject(s)
Blood Pressure/physiology , Health Education , Hypertension/diagnosis , Nurses
3.
Chinese Journal of Preventive Medicine ; (12): 614-625, 2023.
Article in Chinese | WPRIM | ID: wpr-985453

ABSTRACT

Objective: To investigate the distribution of blood pressure and analyze the associated factors of blood pressure of the elderly with type 2 diabetes in Jiangsu Province. Methods: The elderly over 60 years old participants with type 2 diabetes in the communities of Huai'an City and Changshu City, Jiangsu Province were selected in this study. They were divided into two groups: taking antihypertensive drugs and not taking antihypertensive drugs. The demographic characteristics, such as age and sex, and relevant factors were collected by questionnaire. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by physical examination. The percentile of SBP and DBP in each age group of men and women were described. The kernel density estimation curve was used to show the blood pressure distribution. The trend of blood pressure with age was fitted by locally weighted regression. The logistic regression model was used to analyze relevant factors of blood pressure. Results: A total of 12 949 participants were included in this study, including 7 775 patients in the antihypertensive drug group and 5 174 patients in the group without antihypertensive drugs. The SBP of participants was concentrated at 140-160 mmHg, and their DBP was concentrated at 75-85 mmHg. There were significant differences in the distribution of blood pressure among the subgroups of body mass index (BMI) and rural areas whether taking antihypertensive drugs and not. For participants aged under 80 years old, the SBP showed an increasing trend with age and the DBP showed a decreasing trend with age. Age, BMI ≥24 kg/m2, fasting blood glucose ≥7.0 mmol/L, living in rural areas and no smoking were influencing factors of the elevated SBP; BMI ≥24 kg/m2, male, living in rural areas, no smoking, drinking alcohol and not receiving drug hypoglycemic treatment were influencing factors of the elevated DBP. Conclusion: The SBP of older diabetic adults in Jiangsu Province is at a high level, and the distribution of blood pressure is significantly different between men and women in taking antihypertensive drugs group. The SBP presents a rising trend and the DBP is decreasing at the age of 60-80 years. The blood pressure level of this population are mainly affected by age, BMI, urban and rural areas, smoking.


Subject(s)
Adult , Aged , Humans , Male , Female , Middle Aged , Aged, 80 and over , Blood Pressure/physiology , Diabetes Mellitus, Type 2/epidemiology , Antihypertensive Agents/therapeutic use , Smoking , Body Mass Index , Hypertension/epidemiology
4.
Chinese Journal of Cardiology ; (12): 407-414, 2023.
Article in Chinese | WPRIM | ID: wpr-984667

ABSTRACT

Objective: To explore the percentage of in-use electronic sphygmomanometers independently validated clinically in China. Methods: We conducted a cross-sectional survey and Beijing, Shenzhen, Shijiazhuang, Datong, and Shihezi were selected according to the geographical location and economic level. In each site, one tertiary hospital, two community health centers, and 20 families with electronic sphygmomanometers in use were chosen. The information of electronic sphygmomanometers including brand, model, manufacturer and production date were obtained by the trained staff. Ten electronic sphygmomanometers from each hospital, five electronic sphygmomanometers from each community health center, and one electronic sphygmomanometer from each family were surveyed, and the user's subjective judgment results and judgment basis on the accuracy of the electronic sphygmomanometer measurement were collected. We searched six registration websites (Medaval, Stride BP, dabl Educational Trust, British and Irish Hypertension Society, American Medical Association and Hypertension Canada) and two research databases (PubMed and CNKI) for the clinical validation status of each electronic sphygmomanometer. Results: A total of 200 electronic sphygmomanometers were investigated in this study, of which only 29.0% (58/200) passed independent clinical validation. When stratified by users, the percentage of being clinical validated was 46.0% (23/50) for electronic sphygmomanometers in hospitals, 42.0% (21/50) for those in community health centers and 14.0% (14/100) for those in home use, respectively, and the proportions between the three groups were significantly difference (P<0.001). Doctors in tertiary hospitals and community health service centers judged the accuracy of electronic sphygmomanometers mainly on the basis of "regular correction" (41.0% (41/100)) and "comparison with other electronic sphygmomanometers" (20.0% (20/100)), while among home users, 41.0% (41/100) were not clear about the accuracy of electronic sphygmomanometers, and 40.0% (40/100) made the judgment by "comparison with the devices in hospitals". Conclusion: The clinical validation of in-use electronic sphygmomanometers in China is low. Most of users, including healthcare professionals, are not aware of clinical validation of electronic sphygmomanometers.


Subject(s)
Humans , Blood Pressure Determination , Cross-Sectional Studies , Sphygmomanometers , Hypertension/diagnosis , China , Electronics , Blood Pressure
5.
Chinese Journal of Cardiology ; (12): 377-383, 2023.
Article in Chinese | WPRIM | ID: wpr-984663

ABSTRACT

Objective: To investigate whether admission blood pressure (BP) variability during multiple hospitalizations is associated with all-cause mortality independent of baseline BP in acute decompensated heart failure (ADHF). Methods: Patients with ADHF admitted to the Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University from September 2013 to December 2017 were retrospectively enrolled. The risk of all-cause mortality associated with indices of BP variability, including mean admission BPs, standard deviation of BP and coefficient of variation of BP during multiple hospitalizations was assessed, using Cox regression model. Results: A total of 1 006 ADHF patients (mean aged (69.3±13.5) years; 411 (40.8%) female; 670 (66.6%) with preserved ejection fraction) were enrolled. During a median follow-up of 1.54 years, 47.0% of patients died. In all ADHF patients, after adjusting for confounding factors, for every 1-standard deviation (SD) increase in SD and coefficient of variation (CV) of systolic BP, the risk of all-cause mortality increased by 10% and 11%, respectively (SD: HR, 1.10, 95%CI, 1.01-1.21, P=0.029, CV: HR, 1.11, 95%CI, 1.02-1.21, P=0.017); for every 1-SD increase in the mean of diastolic BP, the risk of all cause mortality decreased by 25% (HR, 0.75; 95%CI, 0.65-0.87; P<0.001). In ADHF patients with preserved ejection fraction, after accounted for potential confounders, higher SD and CV of admitted systolic and diastolic BP were significantly associated with higher risk of all-cause mortality, regardless of whether confounding factors were adjusted (P≤0.049); After adjusting for confounding factors, the risk of all-cause mortality increased by 18% and 19% for every 1-SD increase in SD and CV of systolic BP, while the risk of all-cause mortality increased by 11% and 15% for every 1-SD increase in SD and CV of diastolic BP. In ADHF patients with reduced ejection fraction, after adjusting for confounding factors, the higher the mean admission systolic BP during multiple hospitalizations, the lower the risk of total mortality (HR, 0.68; 95%CI, 0.47-1.00; P=0.049). Conclusions: In patients with ADHF, independent of baseline BP, BP variability during multiple hospitalizations was strong predictor of all-cause mortality.


Subject(s)
Humans , Female , Middle Aged , Aged , Aged, 80 and over , Male , Blood Pressure , Retrospective Studies , Heart Failure , Hospitalization , Ventricular Dysfunction, Left , Risk Factors , Prognosis
6.
Philippine Journal of Internal Medicine ; : 29-35, 2023.
Article in English | WPRIM | ID: wpr-984321

ABSTRACT

Background@#Pheochromocytomas are rare catecholamine-secreting tumors that usually present with hypertension and palpitations. However, a subset of pheochromocytoma patients is asymptomatic, presenting as adrenal incidentaloma on imaging.@*Case@#We present a case of a 32-year-old normotensive female who presented with a right suprarenal mass on abdominal ultrasound. Diagnosis of pheochromocytoma was made after biochemical testing revealed elevated 24- hour urine metanephrine of 1.96 mg/24hrs (NV:0-1 mg/24hrs) and epinephrine of 129 mcg/24hrs (NV: 2-24 mcg/24hrs). In addition, plasma chromogranin A was elevated at 225.38 ng/ml (NV:<100 ng/ml). CT scan of the abdomen showed a 3.0 x 4.0 x 3.0 cm heterogeneous well-circumscribed right adrenal mass, with 87Hu on contrast, an absolute washout of 21%, and a relative washout of 13% on a delayed scan. After adequate preoperative medical therapy with an alpha-adrenergic blocker, a right laparoscopic adrenalectomy was done, with histopathologic confirmation of pheochromocytoma. Repeat 24-hour urine metanephrine measurements done on multiple follow-ups after surgery were normal.@*Conclusion@#Asymptomatic pheochromocytoma should be included in the differential diagnoses of adrenal incidentalomas. As in our case, patients with normotension and adrenal incidentalomas should still undergo biochemical workup to rule out the presence of pheochromocytoma. Long-term complications from chronic exposure to high catecholamine levels lead to significant adverse cardiovascular effects. Early detection, adequate perioperative preparation, and timely surgical intervention can prevent a potential catastrophe.


Subject(s)
Pheochromocytoma , Blood Pressure
7.
Chinese Journal of Epidemiology ; (12): 772-777, 2023.
Article in Chinese | WPRIM | ID: wpr-985560

ABSTRACT

Objective: To evaluate the effect of health management service on hypertension patients (HMSFHP) under the framework of the Basic Public Health Service Project by using regression discontinuity design. Methods: The participants were enrolled from an observational cohort survey in 2015 and followed up was conducted in 2019. The participants with SBP 130-150 mmHg and/or DBP 80-100 mmHg in the baseline survey of the cohort in 2015 were included in the present study. Additionally, we obtained the dates of participants receiving HMSFHP and their blood pressure data from follow-up records, physical examination records and telephone interview. The participants were divided into intervention group and control group based on the cutoff points, i.e. SBP ≥140 mmHg and/or DBP ≥90 mmHg. The local linear regression model were used to estimate the effect of HMSFHP on reducing blood pressure of the participants. Results: After adjusting for age, sex and time length of receiving HMSFHP, the results of the model including participants with 80-100 mmHg for DBP in 2015 indicated that, for the participants who received HMSFHP, the DBP decreased by 6.66 mmHg from 2015 to 2019. For the participants with SBP 130-150 mmHg in 2015, the reduction estimate of the model was -6.17 mmHg, the difference was not significant (P=0.178), suggesting that receiving HMSFHP did not cause change in SBP for the participants who received HMSFHP. Conclusion: Receiving HMSFHP had effect to reduce DBP, and HMSFHP had a positive effect on the control of blood pressure in patients with hypertension.


Subject(s)
Humans , Blood Pressure , Health Services , Hypertension , Linear Models , Physical Examination
8.
Chinese Journal of Cardiology ; (12): 303-309, 2023.
Article in Chinese | WPRIM | ID: wpr-969778

ABSTRACT

Objective: To investigate the influence of blood pressure control after discharge on prognosis of patients with acute aortic syndrome (AAS) complicated with hypertension who underwent thoracic endovascular aortic repair (TEVAR). Methods: This is a retrospective case analysis. Patients diagnosed with AAS complicated with hypertension and undergoing TEVAR in Northern Theater Command General Hospital from June 2002 to December 2021 were consecutively enrolled. Average systolic blood pressure (SBP) and the occurrence of endpoint events were recorded at one month, one year and every 2 years after TEVAR. According to the patients' average SBP, patients with average SBP<140 mmHg (1 mmHg=0.133 kPa) or<150 mmHg were divided into the target blood pressure achievement group, and the others were divided into target blood pressure non-achievement group. Endpoint events included all-cause death, aortic death, stroke, renal insufficiency, aortic related adverse events and a composite of these events (overall clinical adverse events), and re-accepting TEVAR. The incidence of endpoint events was compared between the two groups at each follow-up period. Results: A total of 987 patients were included, aged (55.7±11.7) years, including 779 male (78.9%). When the cutoff value was 140 mmHg, the rate of average target SBP achievement was 71.2% (703/987) at one month, 66.7% (618/927) during 1st to 12th month and 65.1% (542/832) from the first year to the third year after TEVAR. The proportion of patients taking≥2 antihypertensive agents was higher in the group of target blood pressure non-achievement group than the target blood pressure achievement group after TEVAR at 1 month (74.3% (211/284) vs.65.9% (463/703), P=0.010) and during 1st to 12th month (71.5% (221/309) vs. 63.6% (393/618), P=0.016). There were no statistical differences in the all-cause deaths, stroke, aortic related adverse events, and repeat TEVAR between the two groups (All P>0.05) during above follow-up periods. When the cutoff value was 150 mmHg, the rate of target SBP achievement was 89.3% (881/987) at one month, 85.2% (790/927) during 1st to 12th month and 85.6%(712/832) from the first year to the third year after TEVAR. The incidence of clinical total adverse events (8.8% (12/137) vs. 4.2% (33/790), P=0.021) and repeat TEVAR (4.4% (6/137) vs. 1.0% (8/790), P=0.003) in target blood pressure non-achievement group were significantly higher than the target blood pressure achievement group during 1st to 12th month after TEVAR. The incidence of all-cause deaths (5.8% (7/120) vs. 2.4% (17/712), P=0.037) in the target blood pressure non-achievement group was significantly higher than the target blood pressure achievement group from the first year to the third year follow-up period, but there were no statistical differences in the incidence of clinical total adverse events between the two group (P>0.05). Conclusion: Among TEVAR treated AAS patients complicated with hypertension, the average SBP more than 150 mmHg post discharge is associated with increased risk of adverse events. Ideal blood pressure control should be encouraged to improve the outcome of these patients.


Subject(s)
Humans , Male , Blood Pressure , Acute Aortic Syndrome , Retrospective Studies , Aftercare , Treatment Outcome , Blood Vessel Prosthesis Implantation/adverse effects , Aortic Dissection , Aortic Aneurysm, Thoracic/surgery , Endovascular Procedures/adverse effects , Patient Discharge , Hypertension , Prognosis , Stroke , Hospitals
9.
Chinese Journal of Cardiology ; (12): 296-302, 2023.
Article in Chinese | WPRIM | ID: wpr-969777

ABSTRACT

Objective: To evaluate the impact of individual and combined assessment of age- and sex-specific brachial-ankle pulse wave velocity (baPWV) and pulse pressure (PP) on all-cause mortality. Methods: This study is a prospective cohort study. Individuals participated in the Kailuan Study and completed baPWV measurements between 2010 and 2016 were included in this study. After stratifying by sex, 75th percentile baPWV and PP values for different age group were calculated at five years interval. BaPWV and PP values below the 75th percentile were defined as normal, and those above or equal to the 75th percentile were defined as increased. The participants were allocated to four groups according to their PP and baPWV status: normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group. The primary outcome was all-cause mortality during the follow-up period. Cox proportional hazards models were used to explore the impact of individual and combined assessment of baPWV and PP on all-cause mortality events. Results: A total of 39 339 participants were enrolled in this study, aged (49.3±12.8) years, of which 28 731 (73.03%) were males. There were 23 268, 6 025, 6 210 and 3 836 cases in the normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group, respectively. The average follow-up duration was (4.98±2.53) years. During the follow-up period, all-cause mortality occurred in 998 individuals. Multivariate Cox regression analysis showed increased risk of all-cause mortality in the high baPWV/normal PP group (HR=1.27, 95%CI 1.07-1.50), and in the high baPWV/PP group (HR=1.33, 95%CI 1.08-1.65) compared to the normal baPWV/PP group. Increased pulse pressure alone had no impcat on all-cause death (HR=1.06, 95%CI 0.87-1.29). Conclusions: The risk of all-cause mortality significantly increases with increased age-and sex-specific baPWV and PP values. BaPWV may be a better predictor of all-cause mortality than PP in this cohort.


Subject(s)
Male , Female , Humans , Blood Pressure , Ankle Brachial Index , Prospective Studies , Pulse Wave Analysis , Ankle , Vascular Stiffness , Risk Factors
10.
Chinese Journal of Cardiology ; (12): 164-171, 2023.
Article in Chinese | WPRIM | ID: wpr-969759

ABSTRACT

Objective: To explore the associations between blood pressure trajectories during pregnancy and risk of future pre-eclampsia in a large cohort enrolling pregnant women at gestational age of ~12 weeks from community hospitals in Tianjin. Latent class growth modeling (LCGM) was used to model the blood pressure trajectories. Methods: This was a large prospective cohort study. The study enrolled pregnant women of ~12 weeks of gestation in 19 community hospitals in Tianjin from November 1, 2016 to May 30, 2018. We obtained related information during 5 antepartum examinations before gestational week 28, i.e., week 12, week 16, week 20, week 24 and week 28. LCGM was used to model longitudinal systolic (SBP) and diastolic blood pressure (DBP) trajectories. For the association study, the predictors were set as SBP and DBP trajectory membership (built separately), the outcome was defined as the occurrence of preeclampsia after 28 weeks of gestation. Results: A total of 5 809 cases with known pregnant outcomes were documented. After excluding 249 cases per exclusion criteria, 5 560 cases with singleton pregnancy were included for final analysis. There were 128 cases preeclampsia and 106 cases gestational hypertension in this cohort. Univariate logistic regression and multivariate logistic regression showed the higher baseline SBP level and DBP level were related with increased risk of preeclampsia. Four distinctive SBP trajectories and DBP trajectories from 12 weeks to 28 weeks of gestation were identified by LCGM. After controlling for potential confounders (baseline BMI, being primipara or not, white blood cell counts, hemoglobin level, platelet counts and alanine aminotransferase level), the OR for SBP latent classification trajectory_ 4 was 4.023 (95%CI: 2.368 to 6.835, P<0.001), and the OR for SBP latent classification trajectory_3 was 1.854 (95%CI: 1.223 to 2.811, P=0.004). Logistic regression showed that: using the DBP latent classification trajectory_1 as the reference group, the OR for DBP latent classification trajectory_4 was 4.100 (95%CI: 2.571 to 6.538, P<0.001), and 2.632 (95%CI: 1.570 to 4.414, P<0.001) for DBP latent classification trajectory_2. After controlling for potential confounders (baseline BMI, being primipara or not, white blood cell counts, hemoglobin level, platelet counts and alanine aminotransferase level), the OR for DBP_traj_4 was 2.527 (95%CI: 1.534 to 4.162, P<0.001), and the OR for DBP_traj_3 was 1.297 (95%CI: 0.790 to 2.128, P=0.303), and 2.238 (95%CI: 1.328 to 3.772, P=0.002) for DBP_traj_2. Therefore, BP trajectories from 12 weeks to 28 weeks identified by LCGM served as novel risk factors that independently associated with the occurrence of preeclampsia. Receiver operating characteristic (ROC) curve analysis showed incremental diagnostic performance by combing baseline blood pressure levels with blood pressure trajectories. Conclusion: By applying LCGM, we for the first time identified distinctive BP trajectories from gestational week 12 to 28, which can independently predict the development of preeclampsia after 28 weeks of gestation.


Subject(s)
Female , Humans , Pregnancy , Infant , Blood Pressure , Pre-Eclampsia/diagnosis , Prospective Studies , Gestational Age , Alanine Transaminase , Hemoglobins
11.
Chinese Medical Sciences Journal ; (4): 1-10, 2023.
Article in English | WPRIM | ID: wpr-981596

ABSTRACT

Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia. Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.Methods PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched for randomized-controlled trials (RCTs) on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September, 2021. The standardized mean differences (SMD) with 95% confidence interval (CI) were employed to analyze the data. The random-effect model was used for the potential clinical inconsistency.Results A total of 12 RCTs with 833 elderly patients (dexmedetomidine group, 546 patients; control group, 287 patients) were included. There was no significant increase in perioperative heart rate (HR), mean arterial pressure (MAP), and diastolic blood pressure (DBP) in the dexmedetomidine group before and during the operation. In addition, the variations of hemodynamic indexes including HR, MAP, SBP (systolic blood pressure), and DBP were significantly lower in the dexmedetomidine group compared with the control group (HR: SMD = -0.87, 95% CI: -1.13 to -0.62; MAP: SMD = -1.12, 95% CI: -1.60 to -0.63; SBP: SMD = -1.27, 95% CI: -2.26 to -0.27; DBP: SMD = -0.96, 95% CI: -1.33 to -0.59). Subgroup analysis found that with the prolongation of 1.0 μg/kg dexmedetomidine infusion, the patient's heart rate declined in a time-dependent way.Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients. However, further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.


Subject(s)
Humans , Aged , Dexmedetomidine/adverse effects , Hemodynamics , Hypnotics and Sedatives/pharmacology , Blood Pressure , Heart Rate
12.
Journal of Biomedical Engineering ; (6): 249-256, 2023.
Article in Chinese | WPRIM | ID: wpr-981536

ABSTRACT

Hypertension is the primary disease that endangers human health. A convenient and accurate blood pressure measurement method can help to prevent the hypertension. This paper proposed a continuous blood pressure measurement method based on facial video signal. Firstly, color distortion filtering and independent component analysis were used to extract the video pulse wave of the region of interest in the facial video signal, and the multi-dimensional feature extraction of the pulse wave was preformed based on the time-frequency domain and physiological principles; Secondly, an integrated feature selection method was designed to extract the universal optimal feature subset; After that, we compared the single person blood pressure measurement models established by Elman neural network based on particle swarm optimization, support vector machine (SVM) and deep belief network; Finally, we used SVM algorithm to build a general blood pressure prediction model, which was compared and evaluated with the real blood pressure value. The experimental results showed that the blood pressure measurement results based on facial video were in good agreement with the standard blood pressure values. Comparing the estimated blood pressure from the video with standard blood pressure value, the mean absolute error (MAE) of systolic blood pressure was 4.9 mm Hg with a standard deviation (STD) of 5.9 mm Hg, and the MAE of diastolic blood pressure was 4.6 mm Hg with a STD of 5.0 mm Hg, which met the AAMI standards. The non-contact blood pressure measurement method based on video stream proposed in this paper can be used for blood pressure measurement.


Subject(s)
Humans , Blood Pressure/physiology , Blood Pressure Determination/methods , Algorithms , Hypertension/diagnosis , Sexually Transmitted Diseases
13.
China Journal of Chinese Materia Medica ; (24): 1982-1988, 2023.
Article in Chinese | WPRIM | ID: wpr-981418

ABSTRACT

Hypertension and its target organ damage have become a major public health problem. Sexual dysfunction is a new problem in the treatment of modern hypertension. Modern pathophysiological studies have shown that hypertension can lead to sexual dysfunction. In addition, three major hypotensive drugs represented by diuretics can also lead to sexual dysfunction. In traditional Chinese medicine(TCM), hypertension belongs to "vertigo" "headache" "head wind", etc. In the past, the understanding of the TCM pathogenesis of hypertension was mainly from the perspectives of "liver wind" and "Yang hyperactivity". However, based on the in-depth research on ancient and modern literature and medical records and many years of clinical practice, it has been identified that kidney deficiency was the key pathogenesis. Hypertension complicated with sexual dysfunction belongs to the category of kidney deficiency syndrome in TCM, especially the deficiency of kidney Yin. Previous studies by other research groups showed that Yin-enriching and kidney-tonifying method could effectively reduce blood pressure, improve sexual dysfunction, reverse risk factors, and protect target organs. This article systematically discussed the TCM understanding, modern pathophysiological mechanism, and the clinical treatment strategy of kidney-tonifying drugs(single drugs and compounds) in the treatment of hypertension complicated with sexual dysfunction in order to provide a scientific basis for kidney-tonifying method in the treatment of hypertension complicated with sexual dysfunction.


Subject(s)
Humans , Antihypertensive Agents/therapeutic use , Medicine, Chinese Traditional , Hypertension/drug therapy , Blood Pressure , Risk Factors , Drugs, Chinese Herbal/therapeutic use
14.
Chinese Journal of Biotechnology ; (12): 1644-1654, 2023.
Article in Chinese | WPRIM | ID: wpr-981160

ABSTRACT

To explore the effect of Mlk3 (mixed lineage kinase 3) deficiency on blood pressure, Mlk3 gene knockout (Mlk3KO) mice were generated. Activities of sgRNAs targeted Mlk3 gene were evaluated by T7 endonuclease I (T7E1) assay. CRISPR/Cas9 mRNA and sgRNA were obtained by in vitro transcription, microinjected into zygote, followed by transferring into a foster mother. Genotyping and DNA sequencing confirmed the deletion of Mlk3 gene. Real- time PCR (RT-PCR), Western blotting or immunofluorescence analysis showed that Mlk3KO mice had an undetectable expression of Mlk3 mRNA or Mlk3 protein. Mlk3KO mice exhibited an elevated systolic blood pressure compared with wild-type mice as measured by tail-cuff system. Immunohistochemistry and Western blotting analysis showed that the phosphorylation of MLC (myosin light chain) was significantly increased in aorta isolated from Mlk3KO mice. Together, Mlk3KO mice was successfully generated by CRISPR/Cas9 system. MLK3 functions in maintaining blood pressure homeostasis by regulating MLC phosphorylation. This study provides an animal model for exploring the mechanism by which Mlk3 protects against the development of hypertension and hypertensive cardiovascular remodeling.


Subject(s)
Animals , Mice , Mice, Knockout , CRISPR-Cas Systems , Blood Pressure , Gene Knockout Techniques , Zygote
15.
Biomedical and Environmental Sciences ; (12): 517-526, 2023.
Article in English | WPRIM | ID: wpr-981082

ABSTRACT

OBJECTIVE@#Current clinical evidence on the effects of home blood pressure telemonitoring (HBPT) on improving blood pressure control comes entirely from developed countries. Thus, we performed this randomized controlled trial to evaluate whether HBPT plus support (patient education and clinician remote hypertension management) improves blood pressure control more than usual care (UC) in the Chinese population.@*METHODS@#This single-center, randomized controlled study was conducted in Beijing, China. Patients aged 30-75 years were eligible for enrolment if they had blood pressure [systolic (SBP) ≥ 140 mmHg and/or diastolic (DBP) ≥ 90 mmHg; or SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg with diabetes]. We recruited 190 patients randomized to either the HBPT or the UC groups for 12 weeks. The primary endpoints were blood pressure reduction and the proportion of patients achieving the target blood pressure.@*RESULTS@#Totally, 172 patients completed the study, the HBPT plus support group ( n = 84), and the UC group ( n = 88). Patients in the plus support group showed a greater reduction in mean ambulatory blood pressure than those in the UC group. The plus support group had a significantly higher proportion of patients who achieved the target blood pressure and maintained a dipper blood pressure pattern at the 12th week of follow-up. Additionally, the patients in the plus support group showed lower blood pressure variability and higher drug adherence than those in the UC group.@*CONCLUSION@#HBPT plus additional support results in greater blood pressure reduction, better blood pressure control, a higher proportion of dipper blood pressure patterns, lower blood pressure variability, and higher drug adherence than UC. The development of telemedicine may be the cornerstone of hypertension management in primary care.


Subject(s)
Humans , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Hypertension/therapy , Telemedicine/methods , Hypotension
16.
Chinese Medical Journal ; (24): 941-950, 2023.
Article in English | WPRIM | ID: wpr-980944

ABSTRACT

BACKGROUND@#Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients.@*METHODS@#Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes.@*RESULTS@#Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality.@*CONCLUSION@#Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients.@*CLINICAL TRIAL REGISTRATION@#Chinese Clinical Trail Registry, No. ChiCTR2100044625.


Subject(s)
Humans , Blood Pressure , Pulmonary Disease, Chronic Obstructive/therapy , Cohort Studies , Respiration, Artificial , Inpatients , Hospital Mortality
17.
Chinese Medical Journal ; (24): 1015-1025, 2023.
Article in English | WPRIM | ID: wpr-980810

ABSTRACT

Wearable technology, which can continuously and remotely monitor physiological and behavioral parameters by incorporated into clothing or worn as an accessory, introduces a new era for ubiquitous health care. With big data technology, wearable data can be analyzed to help long-term cardiovascular care. This review summarizes the recent developments of wearable technology related to cardiovascular care, highlighting the most common wearable devices and their accuracy. We also examined the application of these devices in cardiovascular healthcare, such as the early detection of arrhythmias, measuring blood pressure, and detecting prevalent diabetes. We provide an overview of the challenges that hinder the widespread application of wearable devices, such as inadequate device accuracy, data redundancy, concerns associated with data security, and lack of meaningful criteria, and offer potential solutions. Finally, the future research direction for cardiovascular care using wearable devices is discussed.


Subject(s)
Big Data , Delivery of Health Care , Wearable Electronic Devices , Technology , Blood Pressure
18.
Journal of Southern Medical University ; (12): 308-316, 2023.
Article in Chinese | WPRIM | ID: wpr-971530

ABSTRACT

OBJECTIVE@#To investigate the correlation of inducible co-stimulatory molecules (ICOS) with mesenteric vascular endothelial- mesenchymal transition (EndMT) and sclerosis in spontaneously hypertensive rats (SHR).@*METHODS@#Twenty 4-week-old WKY rats and 20 SHRs of the same strain were both randomly divided into 4 groups for observation at 4, 6, 10 and 30 weeks of age. ICOS expression frequency in rat spleen CD4+T cells was analyzed using flow cytometry, and the expressions of ICOS, VE-cad, α-SMA and Col3 mRNA in rat mesentery were detected by RT-PCR. The distributions of ICOS, IL-17A and TGF-β in rat mesentery were detected by immunohistochemistry. The levels of IL-17A and TGF-β in rat plasma were measured using ELISA. The morphological changes of rat mesenteric vessels were observed with Masson staining. Spearman or Pearson correlation analyses were used to evaluate the correlation between ICOS expression and the expressions of the markers of vascular EndMT and sclerosis.@*RESULTS@#Compared with the control WKY rats, the SHRs began to show significantly increased systolic blood pressure and ICOS expression frequency on CD4+T cells at 6 weeks of age (P < 0.05). In the SHRs, the mRNA and protein expressions of ICOS, α-SMA, Col3, IL-17A and TGF-β in the mesentery were significantly higher than those in control group (P < 0.05), while the mRNA and protein expressions of VE-cad started to reduce significantly at 10 weeks of age (P < 0.05). The plasma levels of IL-17A and TGF-β were significantly increased in SHRs since 6 weeks of age (P < 0.05) with progressive worsening of mesenteric vascular sclerosis (P < 0.05). ICOS mRNA and protein expression levels in the mesenteric tissues of SHRs began to show positive correlations with α-SMA and Col3 expression levels and the severity of vascular sclerosis at 6 weeks of age (P < 0.05) and a negative correlation with VE-cad expression level at 10 weeks (P < 0.05).@*CONCLUSION@#ICOS play an important pathogenic role in EndMT and sclerosis of mesenteric vessels in essential hypertension by mediating related immune responses.


Subject(s)
Rats , Animals , Rats, Inbred SHR , Rats, Inbred WKY , Hypertension , Interleukin-17 , Sclerosis/pathology , Transforming Growth Factor beta , Mesentery/pathology , RNA, Messenger/metabolism , Blood Pressure
19.
Chinese Journal of Hepatology ; (12): 48-80, 2023.
Article in Chinese | WPRIM | ID: wpr-970945

ABSTRACT

The population of chronic kidney disease (CKD) with hypertension in China is characterized by complex etiology, high incidence rate, low awareness and control rate. How to diagnose and treat hypertension in CKD patients properly and improve their prognosis is particularly urgent. Several clinical guidelines or expert consensus on the diagnosis, treatment and management of hypertension have been issued. Some of them involve the diagnosis and treatment of hypertension in CKD patients, but they still can not meet the demand for diagnosis and treatment of hypertension in CKD patients. Based on the situation of hypertension in CKD patients in China, the Chinese Society of Nephrology organized an expert group to formulate this guideline. This guideline systematically introduces the diagnostic criteria, epidemiology, risk factors, poor prognosis of hypertension, the purpose, timing and control goals of antihypertensive therapy in CKD patients, as well as blood pressure control goals for special populations, non drug treatment and drug treatment of hypertension. This guideline aims to further strengthen the management of hypertension in CKD patients, standardize the diagnosis and treatment standards, formulate reasonable treatment plans, effectively control hypertension, reduce complications, so as to delay the progress of kidney diseases and improve the long-term prognosis of hypertension in Chinese CKD patients.


Subject(s)
Humans , Antihypertensive Agents/therapeutic use , Hypertension/therapy , Renal Insufficiency, Chronic/therapy , Blood Pressure , Risk Factors , China/epidemiology
20.
Chinese Journal of Industrial Hygiene and Occupational Diseases ; (12): 118-123, 2023.
Article in Chinese | WPRIM | ID: wpr-970722

ABSTRACT

Objective: To investigate the health status of workers exposed to occupational mercury, and to provide the theoretical basis for formulating reasonable health monitoring and targeted protection measures. Methods: In November 2021, 1353 mercury-exposed workers who underwent occupational health examination in a hospital in Xinjiang Uygur Autonomous Region from 2018 to 2021 were collected as research subjects. By analyzing their blood pressure, electrocardiogram, blood routine, liver function and urine β2-microglobulin and urinary mercury in different gender, age, length of service, industry and enterprise scale, and the health status. And the influencing factors of urinary mercury were evaluated. Results: Among 1353 workers exposed to mercury, there were 1002 males (74.1%), the average age was (37.2±9.8) years old, and the length of service was 3.1 (2.0, 8.0) years. The abnormal rates of physical examination, blood pressure, electrocardiogram, blood routine, liver function, urinary β2-microglobulin and urinary mercury were 73.9% (1000/1353), 12.3% (166/1353), 30.2% (408/1353), 59.9% (810/1353), 32.5% (440/1353), 15.2% (205/1353) and 2.2% (30/1353), respectively. The abnormal rates of blood pressure, blood routine, liver function, urinary β2-microglobulin and urinary mercury in male workers were higher than those in female workers (P<0.05). The abnormal rates of workers' blood pressure and physical examination results increased with the increase of age and length of service, while the abnormal rate of electrocardiogram results were opposite (P<0.05). There were statistically significant differences in the abnormal rates of blood pressure, blood routine, urinary β2-microglobulin and physical examination results among workers of different enterprises and different industries (P<0.05). Multivariate logistic regression analysis showed that the workers with age ≥30 years old, microminiature enterprises, abnormal physical examination results and urinary β2-microglobulin were the susceptible population with abnormal urinary mercury (P<0.05) . Conclusion: The occupational health status of mercury workers in Xinjiang Uygur Autonomous Region is not optimistic, and the health monitoring of microminiature enterprises and older workers should be improved to effectively protect the physical and mental health of workers.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Blood Pressure , Health Status , Mental Health , Mercury , Physical Examination , Occupational Exposure
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