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1.
Med Educ Online ; 26(1): 1841982, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33135567

RESUMEN

BACKGROUND: Simulation-Based Education (SBE) simulates specific physiological characteristics of a patient, allowing student practice in developing clinical skills and assessment of skill competency. Literature is limited regarding SBE's effectiveness in curriculum enrichment. This study investigated Blood Pressure (BP) measuring proficiency of second-year medical students with first-year SBE training and a second-year review, by comparing data from Simulation-Based assessments in 2017 and 2019. METHODS: Second-year medical students measured BP on three manikin arms, associated with distinct clinical contexts (healthy young male, young female experiencing hypotension, and older male suffering hypertension and diabetes). All manikins' BP settings were independent of clinical context. In January 2019, 108 second-year medical students who received traditional training, as well as SBE in 2017 and Simulation-Based practice in 2018, were divided into four groups (n = 32, 24, 24, and 28), with two groups each assessed on consecutive days. The proportions of correct BP values in each of three contexts were compared between experiments in 2017 and 2019. Additionally, systolic (SBP) and diastolic (DBP) blood pressure results were stratified into three groups: lower than setting value, correct, and higher than setting vgalue, with proportions for each group compared for the 2017 and 2019 studies using Fisher's Exact Tests. RESULTS: In Case Two and Three, the proportion of correct BP values significantly increased from 2017 (Case Two: 51%; Case Three: 55%) to 2019 (Case Two: 73%; Case Three: 75%). Additionally, proportions of students who reported lower SBP values than setting values were significantly decreased in Case One and Two, with five failing all contexts. CONCLUSIONS: Second-year student BP measurement skills were improved, not only due to repeated Simulation-Based practice but advancing basic science knowledge and mastery experience in ongoing curriculum. Simulation-Based assessment provided an effective tool for evaluating skill retention and proficiency in medical training.


Asunto(s)
Determinación de la Presión Sanguínea , Presión Sanguínea , Competencia Clínica , Estudiantes de Medicina , Determinación de la Presión Sanguínea/métodos , Curriculum , Educación Continua , Femenino , Humanos , Masculino , Maniquíes , Examen Físico , Entrenamiento Simulado
3.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(12): 1396-1401, 2020 Dec 06.
Artículo en Chino | MEDLINE | ID: mdl-33333657

RESUMEN

Objective: To analyze the association between elevated blood pressure (BP) and carotid intima-media thickness (cIMT) in children according to four BP references. Methods: Study population came from"Huantai Childhood Cardiovascular Health Cohort Study"in Huantai County, Zibo City, Shandong Province. A convenient cluster sampling method was used to conduct a cross-sectional survey on 1 515 children from November 2017 to January 2018 in a primary school. A total of 1 431 children aged 6-11 years old with complete data were included in this study. Data on demographic characteristics, BP and cIMT were collected through questionnaire survey, physical examination and ultrasound examination. High cIMT was defined as the level of cIMT ≥ age-and sex-specific 90th percentile of this study population. Based on the Chinese Guideline reference, the Health Industry reference, the International reference and the U.S. reference, all participants were divided into three subgroups: the normal BP, high normal BP and, elevated BP. The multivariate logistic regression models were used to examine the association between BP status and high cIMT in children. Results: The age of children was (8.9±1.5) years, and boys accounted for 53.4% (n=682). The multivariate logistic regression models showed that after adjusting for relevant confounding factors, the risk of high cIMT in elevated BP group was increased compared with the normal BP group according to the four references (all P values<0.05) Conclusion: Elevated BP according to the four BP references is associated with high cIMT in children.


Asunto(s)
Determinación de la Presión Sanguínea , Grosor Intima-Media Carotídeo , Presión Sanguínea , Niño , Estudios de Cohortes , Estudios Transversales , Humanos , Masculino , Factores de Riesgo
4.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(12): 1453-1456, 2020 Dec 06.
Artículo en Chino | MEDLINE | ID: mdl-33333666

RESUMEN

From November to December 2019, a cross-sectional study including 1 243 children aged 8~13 years was conducted in one primary school in Huantai County, and 1 238 children with complete data were finally included. A total of 1 238, 146, and 83 children were included in the first, second and third visit of the follow-up, respectively. With the follow-up visits increasing, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels of the 83 children who were followed up across all three different visits decreased significantly across three different visits (both Pfor trend<0.05). The prevalence of elevated blood pressure across the three visits was 11.8%, 6.8% and 4.0% (Pfor trend<0.001); the prevalence of elevated SBP was 11.4%, 6.5%, and 4.0% (Pfor trend<0.001); the prevalence of elevated DBP was 1.1%, 1.0%, and 0.4%, respectively (Pfor trend>0.05).


Asunto(s)
Hipertensión , Adolescente , Presión Sanguínea , Determinación de la Presión Sanguínea , Niño , Estudios Transversales , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Prevalencia
5.
Mayo Clin Proc ; 95(12): 2684-2696, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33168159

RESUMEN

OBJECTIVE: To evaluate the impact of insulin-like growth factor 1 receptor variant rs2016347 on the risk for breast and nonbreast cancers and cardiovascular disease in women with a history of hypertensive disorders of pregnancy (HDP). PATIENTS AND METHODS: This retrospective cohort study included all parous women in the UK Biobank with prior rs2016347 genotyping (N=204,155), with enrollment taking place from March 2006 to July 2010. History of HDP was self-reported, and outcomes included breast and all nonbreast cancers, hospital diagnoses of hypertension and cardiovascular disease, and direct blood pressure measurements. RESULTS: Women with previous HDP had a higher risk for future hypertension and cardiovascular diagnoses, increased blood pressures, and lower risk for breast cancer compared with women without HDP, consistent with prior studies. Hazard ratios for all nonbreast cancers were unchanged. However, when taking genotype into account, HDP-positive women carrying at least 1 thymine (T) allele of rs2016347 had a lower risk for nonbreast cancer (hazard ratio, 0.59; 95% CI, 0.37 to 0.92; P=.02) and lower systolic blood pressure (-2.08±0.98 mm Hg; P=.03) compared with women with the guanine/guanine (GG) genotype with positive evidence of interaction (HDP:T allele) for both outcomes; P=.04 and P=.03, respectively. CONCLUSION: Women who experience HDP and carry a T allele of rs2016347 have 41% lower risk for developing nonbreast cancer and a lower systolic blood pressure of 2.08 mm Hg when compared with those with the GG genotype, suggesting a possible role of the insulin-like growth factor 1 axis for both cardiovascular and cancer risk in women with HDP.


Asunto(s)
Hipertensión Inducida en el Embarazo , Neoplasias , Complicaciones Cardiovasculares del Embarazo , Receptor IGF Tipo 1/genética , Adulto , Determinación de la Presión Sanguínea/estadística & datos numéricos , Estudios de Cohortes , Femenino , Humanos , Hipertensión Inducida en el Embarazo/diagnóstico , Hipertensión Inducida en el Embarazo/epidemiología , Hipertensión Inducida en el Embarazo/genética , Neoplasias/diagnóstico , Neoplasias/epidemiología , Neoplasias/genética , Polimorfismo de Nucleótido Simple , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/genética , Estudios Retrospectivos , Medición de Riesgo/métodos , Reino Unido/epidemiología
6.
PLoS One ; 15(11): e0242450, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33201908

RESUMEN

BACKGROUND AND OBJECTIVE: Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) has emerged as a potential life-saving maneuver for the management of non-compressible torso hemorrhage in trauma patients. Complete REBOA (cREBOA) is inherently associated with the burden of ischemia reperfusion injury (IRI) and organ dysfunction. However, the distal organ inflammation and its association with organ injury have been little investigated. This study was conducted to assess these adverse effects of cREBOA following massive hemorrhage in swine. METHODS: Spontaneously breathing and consciously sedated Sinclair pigs were subjected to exponential hemorrhage of 65% total blood volume over 60 minutes. Animals were randomized into 3 groups (n = 7): (1) Positive control (PC) received immediate transfusion of shed blood after hemorrhage, (2) 30min-cREBOA (A30) received Zone 1 cREBOA for 30 minutes, and (3) 60min-cREBOA (A60) given Zone 1 cREBOA for 60 minutes. The A30 and A60 groups were followed by resuscitation with shed blood post-cREBOA and observed for 4h. Metabolic and hemodynamic effects, coagulation parameters, inflammatory and end organ consequences were monitored and assessed. RESULTS: Compared with 30min-cREBOA, 60min-cREBOA resulted in (1) increased IL-6, TNF-α, and IL-1ß in distal organs (kidney, jejunum, and liver) (p < 0.05) and decreased reduced glutathione in kidney and liver (p < 0.05), (2) leukopenia, neutropenia, and coagulopathy (p < 0.05), (3) blood pressure decline (p < 0.05), (4) metabolic acidosis and hyperkalemia (p < 0.05), and (5) histological injury of kidney and jejunum (p < 0.05) as well as higher levels of creatinine, AST, and ALT (p < 0.05). CONCLUSION: 30min-cREBOA seems to be a feasible and effective adjunct in supporting central perfusion during severe hemorrhage. However, prolonged cREBOA (60min) adverse effects such as distal organ inflammation and injury must be taken into serious consideration.


Asunto(s)
Oclusión con Balón/efectos adversos , Resucitación/métodos , Choque Hemorrágico/fisiopatología , Animales , Aorta/fisiopatología , Oclusión con Balón/métodos , Presión Sanguínea , Determinación de la Presión Sanguínea , Transfusión Sanguínea , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Hemodinámica , Hemorragia , Inflamación , Hígado/fisiopatología , Masculino , Modelos Animales , Daño por Reperfusión/fisiopatología , Choque Hemorrágico/metabolismo , Porcinos , Torso/fisiopatología
8.
JAMA Netw Open ; 3(11): e2024311, 2020 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-33206190

RESUMEN

Importance: Discrepancies in blood pressure (BP) estimates lead to incomparable BP assessment. Objective: To determine intraindividual discrepancies in BP estimates and classifications based on different BP estimation protocols. Design, Setting, and Participants: This cross-sectional study was a secondary analysis of data from the May Measurement Month Taiwan in 2017 and 2018, which were cross-sectional survey campaigns at pharmacies nationwide to raise awareness of high BP. Participants were volunteers aged 20 years or older. Analysis was conducted from February 2 to August 7, 2020. Exposure: Pharmacist-measured sitting BP using oscillometric sphygmomanometers. Main Outcomes and Measures: A total of 7 BP estimation protocols were assessed according to the latest American College of Cardiology (ACC), Chinese Hypertension League (CHL), European Society of Cardiology (ESC), International Society of Hypertension, Japanese Society of Hypertension, and National Institute of Health and Care Excellence (NICE) hypertension guidelines, and the proposed Averaging the Lowest Two systolic readings protocol. According to BP classification schemes of ESC and ACC guidelines, intraindividual discrepancies were identified if classification inconsistencies among 7 BP estimates were present. Results: Of 81 041 participants, 62 647 adults with 3 BP readings were included. The median (interquartile range) age was 59.0 (46.0-69.0) years, and 31 922 (51.5%) were women. The intraindividual maximum mean (SD) differences in systolic/diastolic BP estimates among the seven protocols were 4.8 (4.3)/3.3 (3.1) mm Hg. The highest prevalence of BP of 140/90 mm Hg or higher was by CHL (16 405 participants [26.2%]) and the lowest was by Averaging the Lowest Two (13 996 participants [22.3%]; P < .001); while the highest prevalence of 130/80 mm Hg or higher was by NICE (37 232 participants [59.4%]) and the lowest prevalence was by Averaging the Lowest Two (32 788 participants [52.4%]; P < .001). Compared with the other 6 estimates, Averaging the Lowest Two reclassified 7.3% to 15.8% of participants designated as 140/90 mm Hg or higher to less than 140/90 mm Hg, and 4.9% to 14.1% of those as 130/80 mm Hg or higher to less than 130/80 mm Hg. Intraindividual discrepancies in classifications occurred in 19 815 participants (31.6%) with the ESC classification and 16 401 participants (26.2%) with the ACC BP classification. Classification agreements were the lowest between NICE (κ coefficient, 0.667 [95% CI, 0.662-0.671]) and ESC protocols (κ coefficient, 0.705 [95% CI, 0.701-0.709]). Conclusions and Relevance: This cross-sectional study of adults in Taiwan found that different BP estimation protocols led to considerable intraindividual discrepancies in BP estimates and classifications. These findings suggest that the Averaging the Lowest Two protocol is less likely to overestimate BP and could serve as a prudent recommendation for BP estimation.


Asunto(s)
Determinación de la Presión Sanguínea/normas , Hipertensión/diagnóstico , Anciano , Determinación de la Presión Sanguínea/métodos , Estudios Transversales , Femenino , Promoción de la Salud/organización & administración , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Taiwán
9.
PLoS One ; 15(11): e0242666, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33227012

RESUMEN

INTRODUCTION: Cardiovascular disease (CVD) being the leading cause of the morbidity and mortality in Vietnam, the objective of this study was to estimate the total 10-year CVD risk among adults aged 40-69 years by utilizing World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in Central Vietnam. MATERIALS AND METHODS: In this cross-sectional study, multi-staged sampling was used to select 938 participants from a general population aged from 40 to 69. The CVD risk factors were then collected throughout the interviews with a standardized questionnaire, anthropometric measurements and a blood test. The cardiovascular risk was calculated using the WHO/ISH risk prediction charts. RESULTS: According to the WHO/ISH charts, the proportion of moderate risk (10-20%) and high risk (>20%) among the surveyed participants were equal (5.1%). When "blood pressure of more than 160/100 mmHg" was applied, the proportion of moderate risk reduced to 2.3% while the high risk increased markedly to 12.8%. Those proportions were higher in men than in women (at 18.3% and 8.5% respectively, p-value <0.001, among the high-risk group), increasing with age. Male gender, smoking, ethnic minorities, hypertension and diabetes were associated with increased CVD risk. CONCLUSIONS: There was a high burden of CVD risk in Central Vietnam as assessed with the WHO/ISH risk prediction charts, especially in men and among the ethnic minorities. The use of WHO/ISH charts provided a feasible and affordable screening tool in estimating the cardiovascular risk in primary care settings.


Asunto(s)
Hipertensión , Adulto , Anciano , Determinación de la Presión Sanguínea , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Medición de Riesgo , Vietnam/epidemiología , Organización Mundial de la Salud
10.
Niger J Clin Pract ; 23(11): 1542-1547, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33221779

RESUMEN

Background: The relationships among serum Apelin, Asymmetric- dimethylarginine (ADMA), N-terminal probrain natriureticpeptide (NT-proBNP) levels, and blood pressures in dialysis patients are not well known. Materials and Methods: Age and sex matched 30 hemodialysis (HD), 30 peritoneal dialysis (PD) patients, and 20 healthy controls were recruited. Serum apelin-36, ADMA, NT-proBNP levels, and blood pressures of both patients and healthy controls were measured and compared. Results: Serum ADMA and Apelin levels in HD patients were significantly higher than in PD patients. In multiple regression analyses the predictors of higher serum apelin levels were higher BMI, higher ADMA and lower systolic blood pressure. The predictors of serum ADMA levels were being on HD. The predictors of serum NT-proBNP levels were lower serum albumin and higher systolic blood pressure. Conclusion: Being on HD is a predictor of high ADMA levels. HD might be less effective on ADMA removal than PD. It seems that higher serum apelin levels related with lower sytolic blood pressure levels, whereas higher NT-proBNP levels related with higher sytolic blood pressure levels indicating potential roles as independent prognostic factors for systolic hypertension in dialysis patients.


Asunto(s)
Apelina/sangre , Arginina/análogos & derivados , Presión Sanguínea/fisiología , Fallo Renal Crónico/sangre , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Adulto , Anciano , Arginina/sangre , Biomarcadores/sangre , Determinación de la Presión Sanguínea , Femenino , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Peritoneal , Diálisis Renal
11.
JAMA ; 324(18): 1884-1895, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33170247

RESUMEN

Importance: Childhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks. Objective: To update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force. Data Sources: PubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020. Study Selection: Fair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions. Data Extraction and Synthesis: Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively. Main Outcomes and Measures: Sensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments. Results: Forty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were -4.38 mm Hg (95% CI, -7.27 to -2.16) for angiotensin-converting enzyme inhibitors and -3.07 mm Hg (95% CI, -4.99 to -1.44) for angiotensin receptor blockers. Candesartan reduced SBP by -6.56 mm Hg (P < .001; n = 240). ß-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (-4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (-2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (-7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure. Conclusions and Relevance: Observational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.


Asunto(s)
Hipertensión/diagnóstico , Tamizaje Masivo , Adolescente , Adulto , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , Determinación de la Presión Sanguínea/instrumentación , Enfermedades Cardiovasculares/prevención & control , Niño , Preescolar , Terapia Combinada , Dieta Saludable , Ejercicio Físico , Femenino , Humanos , Hipertensión/terapia , Masculino , Tamizaje Masivo/efectos adversos , Tamizaje Masivo/psicología , Estudios Observacionales como Asunto , Guías de Práctica Clínica como Asunto , Servicios Preventivos de Salud , Sensibilidad y Especificidad
12.
JAMA ; 324(18): 1878-1883, 2020 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-33170248

RESUMEN

Importance: Prevalence of hypertension (both primary and secondary) in children and adolescents in the US ranges from 3% to 4%. Primary hypertension in children and adolescents occurs primarily in children older than 13 years and has no known cause but is associated with several risk factors, including family history and higher body mass index. Secondary hypertension occurs primarily in younger children and is most commonly caused by genetic disorders, renal disease, endocrine disorders, or cardiovascular abnormalities. Objective: To update its 2013 recommendation, the USPSTF commissioned a review of the evidence on the benefits and harms of screening, test accuracy, the effectiveness and harms of treatment, and the association between hypertension and markers of cardiovascular disease in childhood and adulthood. Population: This recommendation statement applies to children and adolescents aged 3 to 18 years not known to have hypertension or who are asymptomatic. Evidence Assessment: The USPSTF concludes that the evidence to support screening for high blood pressure in children and adolescents is insufficient and that the balance of benefits and harms cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for high blood pressure in children and adolescents. (I statement).


Asunto(s)
Hipertensión/diagnóstico , Tamizaje Masivo , Adolescente , Determinación de la Presión Sanguínea/instrumentación , Enfermedades Cardiovasculares/prevención & control , Niño , Preescolar , Reacciones Falso Positivas , Femenino , Humanos , Hipertensión/terapia , Masculino , Tamizaje Masivo/efectos adversos , Servicios Preventivos de Salud , Valores de Referencia
13.
Zhonghua Yi Xue Za Zhi ; 100(41): 3246-3249, 2020 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-33167112

RESUMEN

Objective: To analyze the mechanism of invasive blood pressure change in radial artery caused by arm elevation by observing pressure, velocity and diameter of radial artery. Methods: Twenty-six hemodynamically stable hepatobiliary surgery patients admitted to the intensive care unit from June to December 2018 after general anesthesia in Tsinghua Changgung Hospital were selected. When the arm was raised, the invasive blood pressure was recorded, and the inner diameter and blood flow velocity of the radial artery were measured by Doppler ultrasound. The data following a normal distribution were compared with paired t test. Results: After arm elevation for 30 s, systolic blood pressure of radial artery decreased and diastolic blood pressure increased significantly((107±16) mmHg vs (120±17) mmHg, (75±6) mmHg vs (71±9) mmHg, t=25.0, -12.6, both P<0.05), but there was no significant difference in mean arterial pressure ((87±10) mmHg vs (87±11) mmHg, t=1.1, P>0.05). The peak velocity, end-diastolic velocity and resistance index of the radial artery increased significantly, and the transverse and longitudinal inner diameters of the radial artery decreased significantly after the arm was elevated for 30 s (t=-63.4, -14.6, -22.5, 31.4, 25.3, all P<0.01). Conclusions: Kinetic pressure compensation and vascular resistance compensation may be the main mechanism of radial artery pressure change when the arm is elevated. Arm elevation can be used as a vascular resistance response test clinically.


Asunto(s)
Presión Arterial , Hidrodinámica , Brazo , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Determinación de la Presión Sanguínea , Humanos , Arteria Radial
14.
Niger J Clin Pract ; 23(11): 1590-1597, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33221787

RESUMEN

Background: Hypertension is one of the commonest cause of chronic kidney disease (CKD) in Nigerians. We describe blood pressure (BP) control and kidney disease markers in patients with hypertension as part of measures to curb the burden of this chronic debilitating disease. Methods: Patients with hypertension in the main tertiary hospitals in three states in north central Nigeria were evaluated for indicators of CKD, including proteinuria and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Patients had their early morning first void urine tested for proteinuria using Combi-10 test strips. eGFR was estimated using the MDRD equation. Results: A total of 1063 subjects (63.1% females and 36.8% males) with a mean age of 55 ± 11 years were studied. Diabetes mellitus (DM) was present in 214 (20.6%) and 422 (39.7%) had optimal BP control. The median duration of hypertension was 6 years (range 1-44 years). Proteinuria occurred in 130 (12.2%), while 212 (19.9%) had reduced eGFR and 46 (4.3%) had proteinuria and reduced eGFR. The use of calcium channel blockers [adjusted odds ratio (AOR): 0.70, 95% Confidence Interval (CI) 0.50-0.99] and the use of more than two antihypertensive medications (AOR: 0.62, 95% CI 0.40-0.96) were associated with reduced odds of optimal BP control. Male sex (AOR: 1.75, 95% CI 1.14-2.70) and the use of renin-angiotensin-aldosterone system blocking medications (AOR: 2.07, 95% CI 1.18-3.64) were independently associated with proteinuria while DM (AOR: 1.69, 95% CI 1.06-2.55) and treatment with more than two medications (AOR: 1.86, 95% CI 1.09-3.17) were more likely to have reduced eGFR. Conclusion: A large proportion of hypertensive patients in north-central Nigeria have poorly controlled BP. Kidney damage is common among these patients.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Riñón/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Adulto , Anciano , Antihipertensivos/efectos adversos , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Proteinuria/epidemiología , Insuficiencia Renal Crónica/complicaciones , Factores de Riesgo
15.
J Clin Hypertens (Greenwich) ; 22(11): 1974-1983, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33006442

RESUMEN

Hypertension is proved to be associated with severity and mortality in coronavirus disease 2019 (COVID-19). However, little is known about the effects of pre-admission and/or in-hospital antihypertension treatments on clinical outcomes. Thus, this study aimed to investigate the association between in-hospital blood pressure (BP) control and COVID-19-related outcomes and to compare the effects of different antihypertension treatments. This study included 2864 COVID-19 patients and 1628 were hypertensive. Patients were grouped according to their BP during hospitalization and records of medication application. Patients with higher BP showed worse cardiac and renal functions and clinical outcomes. After adjustment, subjects with pre-admission usage of renin-angiotensin-aldosterone system (RAAS) inhibitors (HR = 0.35, 95%CI 0.14-0.86, P = .022) had a lower risk of adverse clinical outcomes, including death, acute respiratory distress syndrome, respiratory failure, septic shock, mechanical ventilation, and intensive care unit admission. Particularly, hypertension patients receiving RAAS inhibitor treatment either before (HR = 0.35, 95%CI 0.13-0.97, P = .043) or after (HR = 0.18, 95%CI 0.04-0.86, P = .031) admission showed a significantly lower risk of adverse clinical outcomes than those receiving application of other antihypertensive medicines. Furthermore, consecutive application of RAAS inhibitors in COVID-19 patients with hypertension showed better clinical outcomes (HR = 0.10, 95%CI 0.01-0.83, P = .033) than non-RAAS inhibitors users. We revealed that COVID-19 patients with poor BP control during hospitalization had worse clinical outcomes. Compared with other antihypertension medicines, RAAS inhibitors were beneficial for improving clinical outcomes in COVID-19 patients with hypertension. Our findings provide direct evidence to support the administration of RAAS inhibitors to COVID-19 patients with hypertension before and after admission.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Sistema Renina-Angiotensina/efectos de los fármacos , /efectos de los fármacos , Anciano , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Determinación de la Presión Sanguínea/métodos , Determinación de la Presión Sanguínea/estadística & datos numéricos , /epidemiología , Estudios de Casos y Controles , China/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/complicaciones , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , /genética
16.
Blood Press Monit ; 25(6): 359-367, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33074927

RESUMEN

OBJECTIVE: The objective of this study was to determine the accuracy of the auscultatory and oscillometric blood pressure (BP) measurement technologies of the Novacor Diasys 3 Plus (model number DIP-0001-00) BP monitor, intended for ambulatory BP measurement when used with the recommended Standard Plus (ACC-0210-00), Large Plus (ACC-0211-00) and Paediatric Plus (ACC-0212-00) cuffs. METHODS: The auscultatory measurement technology Novacor Diasys 3 Plus (model number DIP-0001-00) was evaluated according to the requirements of the AAMI/ANSI/ISO 81060-2:2013 standard, including an additional cardiac-stress study, a requirement for ambulatory BP measurement devices. It was also validated according to the requirements of the European Society of Hypertension International Protocol revision 2010. The oscillometric measurement technology was compared to that of the Novacor Diasys 3 (model number DIS-0001-00) according to the equivalence requirements of MEDDEV 2.7/1 rev 4. The protocol requirements for all three studies and the equivalence were followed precisely. RESULTS: The Novacor Diasys 3 Plus (model number DIP-0001-00) fulfilled all of the requirements for a pass in each of the three studies of the auscultatory measurement technology. In the primary AAMI/ANSI/ISO 81060-2:2013 study, the criterion 1 errors were + 3.6 ± 2.7 mmHg for SBP and + 3.0 ± 2.7 mmHg for DBP. It was also proven to be equivalent to the Novacor Diasys 3 (model number DIS-0001-00) with respect to the oscillometric measurement technology CONCLUSION: The Novacor Diasys 3 Plus (model number DIP-0001-00), when used with the recommended cuffs, can be recommended for ambulatory BP measurement in the adult population.


Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial , Monitores de Presión Sanguínea , Adulto , Presión Sanguínea , Determinación de la Presión Sanguínea , Niño , Humanos , Tecnología
17.
Blood Press Monit ; 25(6): 351-354, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33074930

RESUMEN

OBJECTIVE: Psoriasis is a chronic inflammatory disorder, which is associated with high risk of metabolic comorbidities. Hypertension (HTN) is among the most common and serious associations. In this study, we aimed to evaluate HTN in psoriatic patients through office and ambulatory blood pressure monitoring (ABPM). MATERIALS AND METHODS: Forty-nine patients with confirmed diagnosis of psoriasis were enrolled in the study. Office measurement of blood pressure was performed and then holter monitoring was used for 24-h ABPM. RESULTS: Thirty-six patients (73.4%) had HTN including 13 females (36.1%) and 23 males (63.9%) (P = 0.011). Twelve patients (33.3%) had masked HTN (six females and six males). Office, 24-h, morning, daytime, and nocturnal HTN were present in 49%, 40.8%, 34.7%, 36.7%, and 63.3% of our patients, respectively. The only factor significantly related to morning/daytime/24 h HTN was age, which hypertensive patients had higher age. About 22.4% of patients had metabolic syndrome, which was significantly associated with FBS, weight, waist circumference, and BMI. CONCLUSION: Psoriasis is associated with a high rate of HTN. Masked HTN constitutes nearly one-third of hypertensive patients. ABPM increases the accuracy of HTN detection in psoriatic patients.


Asunto(s)
Hipertensión , Psoriasis , Presión Sanguínea , Determinación de la Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertensión/epidemiología , Masculino , Psoriasis/complicaciones , Psoriasis/diagnóstico , Psoriasis/epidemiología
18.
Diabetes Res Clin Pract ; 170: 108515, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33096185

RESUMEN

AIMS: This study aimed to assess whether body mass index (BMI), fasting plasma glucose (FPG) levels, blood pressure (BP), and kidney function were associated with the risk of severe disease or death in patients with COVID-19. METHODS: Data on candidate risk factors were extracted from patients' last checkup records. Propensity score-matched cohorts were constructed, and logistic regression models were used to adjust for age, sex, and comorbidities. The primary outcome was death or severe COVID-19, defined as requiring supplementary oxygen or higher ventilatory support. RESULTS: Among 7,649 patients with confirmed COVID-19, 2,231 (29.2%) received checkups and severe COVID-19 occurred in 307 patients (13.8%). A BMI of 25.0-29.9 was associated with the outcome among women (aOR, 2.29; 95% CI, 1.41-3.73) and patients aged 50-69 years (aOR, 1.64; 95% CI, 1.06-2.54). An FPG ≥ 126 mg/dL was associated with poor outcomes in women (aOR, 2.06; 95% CI, 1.13-3.77) but not in men. Similarly, estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 was a risk factor in women (aOR, 3.46; 95% CI, 1.71-7.01) and patients aged < 70 years. CONCLUSIONS: The effects of BMI, FPG, and eGFR on outcomes associated with COVID-19 were prominent in women but not in men.


Asunto(s)
Glucemia/metabolismo , Determinación de la Presión Sanguínea/métodos , Pruebas de Función Renal/métodos , Obesidad/complicaciones , Caracteres Sexuales , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
19.
Sci Rep ; 10(1): 16116, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32999400

RESUMEN

Repeated blood pressure (BP) measurements allow better control of hypertension. Current measurements rely on cuff-based devices. The aim of the present study was to compare BP measurements using a novel cuff-less photoplethysmography-based device to a standard sphygmomanometer device. Males and females were recruited from within the general population who arrived at a public BP screening station. One to two measurements were taken from each using a sphygmomanometer-based and the photoplethysmography-based devices. Devices were considered equal if the mean difference between paired measurements was below 5 mmHg and the Standard Deviation (SD) was no greater than 8 mmHg. Agreement and reliability analyses were also performed. 1057 subjects were included in the study analysis. There were no adverse events during the study. The mean (± SD) difference between paired measurements for all subjects was -0.1 ± 3.6 mmHg for the systolic and 0.0 ± 3.5 mmHg for the diastolic readings. We found 96.31% agreement in identifying hypertension and an Interclass Correlation Coefficient of 0.99 and 0.97 for systolic and diastolic measurements, respectively. The photoplethysmography-based device was found similar to the gold-standard sphygmomanometer-based device with high agreement and reliability levels. The device might enable a reliable, more convenient method for repeated BP monitoring.


Asunto(s)
Determinación de la Presión Sanguínea/métodos , Presión Sanguínea/fisiología , Fotopletismografía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Monitores de Presión Sanguínea , Niño , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Manometría/métodos , Persona de Mediana Edad , Oscilometría/métodos , Estudios Prospectivos , Estándares de Referencia , Reproducibilidad de los Resultados , Esfigmomanometros , Adulto Joven
20.
Sci Rep ; 10(1): 16373, 2020 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33009445

RESUMEN

Pulse transit time (PTT) represents a potential approach for cuff-less blood pressure (BP) monitoring. Conventionally, PTT is determined by (1) measuring (a) ECG and ear, finger, or toe PPG waveforms or (b) two of these PPG waveforms and (2) detecting the time delay between the waveforms. The conventional PTTs (cPTTs) were compared in terms of correlation with BP in humans. Thirty-two volunteers [50% female; 52 (17) (mean (SD)) years; 25% hypertensive] were studied. The four waveforms and manual cuff BP were recorded before and after slow breathing, mental arithmetic, cold pressor, and sublingual nitroglycerin. Six cPTTs were detected as the time delays between the ECG R-wave and ear PPG foot, R-wave and finger PPG foot [finger pulse arrival time (PAT)], R-wave and toe PPG foot (toe PAT), ear and finger PPG feet, ear and toe PPG feet, and finger and toe PPG feet. These time delays were also detected via PPG peaks. The best correlation by a substantial extent was between toe PAT via the PPG foot and systolic BP [- 0.63 ± 0.05 (mean ± SE); p < 0.001 via one-way ANOVA]. Toe PAT is superior to other cPTTs including the popular finger PAT as a marker of changes in BP and systolic BP in particular.


Asunto(s)
Biomarcadores/metabolismo , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea/métodos , Electrocardiografía/métodos , Femenino , Dedos/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Fotopletismografía/métodos , Análisis de la Onda del Pulso/métodos , Frecuencia Respiratoria/fisiología
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