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1.
J Assoc Physicians India ; 68(2): 47-50, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009363

RESUMEN

Objective: The present study intend to determine the association of anatomical site and clinical outcome in intracerebral hemorrhage patients with or without intraventricular extension. Methods: The present 1-year cross-sectional study included 56 patients presenting with spontaneous intracerebral hemorrhage with or without intraventricular extension. Relevant data were collected through a detailed interview with either the patient or the attender. Clinical examination was performed with the help of a predesigned and pretested proforma. Anatomical site of intracerebral hemorrhage and volume of ventricular bleed was estimated by computed tomography/magnetic resonance imagining scans. Clinical outcome was assessed based on modified Rankin scale score and Glasgow outcome scale. Mann-Whitney U test and chi-square test were employed in the analysis. Results: The most common clinical presentations were neuronal deficits, speech disorder, and cranial nerve dysfunction. Hypertension was the most important risk factor observed among the patients. Age, gender, habits, severity of hypertension, duration of hypertension, and site of bleed (P > 0.05) were not significantly associated with outcome. However, clinical features including neuronal deficits (P = 0.01), cranial nerve palsy (P = 0.0002), altered sensorium (P = 0.004), vomiting (P = 0.0006), volume or quantum of bleed (P < 0.04), and IVE of ICH (P = 0.026; significantly affected the outcome. Conclusion: The present study revealed that immediate outcome of patients with intracerebral hemorrhage associated with the clinical presentation of patients, quantum of bleed, and intraventricular extension of bleed.


Asunto(s)
Hemorragia Cerebral , Estudios Transversales , Humanos , Hipertensión , Pronóstico , Factores de Riesgo
2.
N Engl J Med ; 382(7): e11, 2020 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-32053315
3.
N Engl J Med ; 382(7): e11, 2020 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-32053316
4.
N Engl J Med ; 382(7): e11, 2020 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-32053317
5.
N Engl J Med ; 382(7): e11, 2020 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-32053318
6.
Vnitr Lek ; 65(12): 795-801, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32013523

RESUMEN

Beta-blockers have been ranked fourth in management recommendations for arterial hypertension in the management of arterial hypertension. This “retreat” is justified by the results of studies comparing different antihypertensive strategies that documented a lesser benefit of the beta-blockers tested compared to control therapies. Obviously, even within the beta-adrenergic receptor blocking group, there are important differences between agents. Properties such as selectivity to receptors and their subtypes, hydrophilicity and resp. lipophilicity, control of blood pressure, influence of intermediate metabolism or directly influence on vascular reactivity determine the resulting potential benefit associated with therapy. The results of clinical trials are also influenced by the test population and concomitant medications. There are a number of studies documenting the benefit of beta-blockers in patients with a history of atherothrombotic events or in the context of heart failure. In the context of the treatment of (yet) uncomplicated hypertension, we are interested not only in the main effects - lowering blood pressure, but also in other potentially effects significant for the resulting effect and influencing the prognosis (favorable or undesirable). In the case of beta-blockers, the effect on atherosclerosis development, lipidogram, vascular wall quality, anti-inflammatory effects, etc. In beta-blockers, several studies have suggested that their metabolic side-effect profile is so unfavorable that they need insulin resistance in patients with dyslipidemia, diabetes or obesity always avoid. This article returns to the question of the metabolic properties of beta-blockers and their possible direct antiatherogenic action and thus the site that this drug class should have in the field of cardiovascular prevention.


Asunto(s)
Antagonistas Adrenérgicos beta , Aterosclerosis , Hipertensión , Antagonistas Adrenérgicos beta/uso terapéutico , Antihipertensivos/uso terapéutico , Aterosclerosis/tratamiento farmacológico , Presión Sanguínea , Humanos , Hipertensión/tratamiento farmacológico
7.
Vnitr Lek ; 65(12): 809-814, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32013525

RESUMEN

In the care of a cardiovascular risk patient there is certainly a more frequent situation in which we try to influence several risk factors at the same time. Treatment of a single self-occurring risk factor is rather an exception. In most cases, we need to intervene with more risk factors, often involving combination therapy, which can achieve the desired goals more quickly and reliably. However, with the number of tablets taken by the patient, the patients willingness to take long-term and correct use decreases, which has a significant impact on the effectiveness of therapy and the development of individual cardiovascular risk. In an effort to control all risk factors for cardiovascular disease, there is a growing need to extend the availability of fixed drug formulations to suit the patients ease of use and suitably formulated with varying dose grades to meet the needs of our attending physicians. With regard to the fact that early intervention of risk factors brings greater benefits than deferred, we are looking for appropriate ways to manage it. The current intervention of arterial hypertension and dyslipidemia with safe and proven drugs seems to be one of the ways to further improve the results of the prevention of cardiovascular diseases. The new fixed combination of atorvastatin with perindopril, which is entering the Czech market right now, appears to be in many ways an ideal “tablet for cardiovascular prevention”.


Asunto(s)
Antihipertensivos , Enfermedades Cardiovasculares , Hipertensión , Amlodipino , Antihipertensivos/administración & dosificación , Atorvastatina/administración & dosificación , Presión Sanguínea , Enfermedades Cardiovasculares/prevención & control , Combinación de Medicamentos , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Perindopril/administración & dosificación
8.
Medicine (Baltimore) ; 99(7): e19200, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049858

RESUMEN

Elderly individuals with non-dipper hypertension are at high risk of cardiovascular disease because of increased stiffness of peripheral arteries. Since, vitamin D deficiency is prevalent in elderly Chinese. We examined whether reduced plasma levels of 25-hydroxyvitamin D [25(OH)D] may help promote this stiffness.Hypertensive patients at least 60 years old without history of peripheral arterial disease at our hospital were retrospectively divided into dipper and non-dipper groups according to the results of 24-hour ambulatory blood pressure monitoring. Plasma levels of 25(OH)D were measured by enzyme immunoassay. Peripheral arterial stiffness was measured based on the cardio-ankle vascular index (CAVI).Of the 155 patients enrolled, 95 (61.3%) were diagnosed with non-dipper hypertension and these patients had significantly lower plasma levels of 25(OH)D than the 60 patients with dipper hypertension (19.58 ±â€Š5.97 vs 24.36 ±â€Š6.95 nmol/L, P < .01) as well as significantly higher CAVI (8.46 ±â€Š1.65 vs 7.56 ±â€Š1.08 m/s, P < .01). Vitamin D deficiency was significantly more common among non-dipper patients (57.9% vs 31.7%, P < .01). Multivariate regression showed that age and 25(OH)D were independently related to CAVI, with each 1-ng/ml decrease in 25(OH)D associated with a CAVI increase of +0.04 m/s.Non-dipper hypertension is associated with vitamin D deficiency and reduced plasma levels of 25(OH)D. The latter may contribute to stiffening of peripheral arteries, increasing the risk of cardiovascular disease.


Asunto(s)
Hipertensión/sangre , Rigidez Vascular , Vitamina D/análogos & derivados , Anciano , Grupo de Ascendencia Continental Asiática , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Vitamina D/sangre
9.
Medicine (Baltimore) ; 99(6): e19047, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028419

RESUMEN

BACKGROUND: Although evidence from animal and observational studies has supported the beneficial effects of green tea intake for lowering blood pressure (BP), randomized placebo-controlled trials (RCTs) have yielded conflicting results. In this meta-analysis of RCTs, we aimed to assess the effects of green tea supplementation on measures of BP control. METHODS: The PubMed, Embase, and Cochrane Library databases were electronically searched from inception to August 2019 for all relevant studies. The results were pooled using the generic inverse-variance method with random-effects weighting and expressed as mean differences (MDs) with 95% confidence intervals (CIs). The quality of studies was assessed using the Jadad score. Publication bias was evaluated using funnel plots, Egger test, and Begg test. RESULTS: Twenty-four trials with 1697 subjects were included in the meta-analysis. The pooled results showed that green tea significantly lowered systolic BP (SBP; MD: -1.17 mm Hg; 95%CI: -2.18 to -0.16mm Hg; P = .02) and diastolic BP (DBP; MD: -1.24 mm Hg; 95%CI:-2.07 to -0.40mm Hg; P = .004). Significant heterogeneity was found for both SBP (I = 43%) and DBP (I = 57%). In addition, no evidence of significant publication bias was found from funnel plots or Egger test (P = .674 and P = .270 for SBP and DBP, respectively). CONCLUSION: Overall, green tea significantly reduced SBP and DBP over the duration of the short-term trials. Larger and longer-term trials are needed to further investigate the effects of green tea supplementation on BP control and clinical events.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , , Suplementos Dietéticos , Humanos , Hipertensión/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto
12.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(1): 47-53, 2020 Jan 24.
Artículo en Chino | MEDLINE | ID: mdl-32008295

RESUMEN

Objective: To identify the incidence of hypertension, overweight/obesity in middle-aged population in China, and explore their impact on cardiovascular events. Methods: From 2009 to 2010, 12 areas were sampled in China, and about 1 000 subjects aged 35 - 64 from each area were enrolled to collect the basic information, physical examination and blood tests were also performed. From 2016 to 2017, data from 8 835 subjects, who completed the 6 years follow-up, were analyzed.Blood pressure and body mass index(BMI) at both baseline and the follow-up, as well as incidence of hypertension, overweight and obesity, were calculated. Cox proportional hazard model was used to investigate the impacts of hypertension, overweight and obesity on cardiovascular events after adjusting confounders. Results: At the end of follow-up, both BMI and systolic and diastolic blood pressure increased significantly compared with the baseline levels (all P<0.001). The cumulative incidence of hypertension, overweight and obesity within 6 years was 39.3%(1 146/2 918), 11.5%(406/3 544) and 4.3%(302/7 025), respectively. Compared with subjects with both normal BMI and blood pressure, people with overweight, obesity, hypertension, overweight with hypertension, and obesity with hypertension faced significantly increased risk of cardiovascular disease (HRs (95%CIs) were 2.394(1.130-5.073), 3.341(1.454-7.674), 6.047(2.978-12.279), 5.808(2.924-11.539) and 8.716(4.391-17.302), respectively, all P<0.05), after adjusting for other confounders. Conclusions: The incidence of overweight, obesity, and hypertension is high in middle-aged people in China. Overweight, obesity and hypertension are associated with significantly increased risk of cardiovascular events during the 6 years follow up.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Adulto , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , China , Estudios de Seguimiento , Humanos , Hipertensión/complicaciones , Incidencia , Persona de Mediana Edad , Obesidad/complicaciones , Sobrepeso/complicaciones , Factores de Riesgo
13.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(1): 54-60, 2020 Jan 24.
Artículo en Chino | MEDLINE | ID: mdl-32008296

RESUMEN

Objective: To investigate the sex- and age-specific association between resting heart rate and hypertension in rural adult residents of Henan province. Methods: At baseline, a total of 20 194 participants were randomly selected from Xin'an County of Henan province between July 2007 and August 2008. After excluding participants with hypertension or without resting heart rate data at baseline, and participants died or without hypertension outcome or diagnosed as gestational hypertension during follow-up between July 2013 and October 2014, 10 212 participants were finally included in this study. Multiple linear regression model was used to examine the association between resting heart rate and change of blood pressure. Logistic regression model was used to estimate the association between resting heart rate and risk of hypertension. Results: There were 2 059 new hypertensive cases (839 male) during the 6 years follow-up. After controlling for potential confounders, per 5 beats/minutes increases in resting heart rate was associated with 0.18 mmHg (1 mmHg=0.133 kPa) (95%CI 0.01-0.36 mmHg, P=0.046) absolute increase in systolic blood pressure and 7% higher risk of developing hypertension in women (95%CI 1.03-1.11, P<0.05). Compared with resting heart rate<70 beats/minutes, the adjusted RRs for 76-82 and>82 beats/minutes groups were 1.39 (95%CI 1.18-1.63, P<0.05) and 1.22 (95%CI 1.02-1.45, P<0.05), respectively. For both age groups, increased resting heart rate was positively associated with risk of hypertension in women(RR=1.05(95% CI 1.01-1.10), P<0.05 (the women those <60 years); RR=1.14(95% CI 1.04-1.25), P<0.05 (the women those≥60 years). However, no significant association was found between resting heart rate and hypertension in male residents. Conclusions: Increased resting heart rate is associated with high risk of hypertension in women who live in rural area, especially in elder women of this cohort.


Asunto(s)
Hipertensión , Adulto , Presión Sanguínea , Estudios de Cohortes , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Factores de Riesgo , Población Rural
15.
Medicine (Baltimore) ; 99(5): e19006, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000442

RESUMEN

PURPOSE: The aim of this study was to systematically evaluate the efficacy and safety of nondrug therapies for hypertensive patients complicated with cervical spondylosis. METHODS: Randomized controlled trials (RCTs) concerned with nondrug therapies for hypertensive patients complicated with cervical spondylosis were identified by searching 5 English and Chinese databases. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 authors. RevMan 5.3 software was used for meta-analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). RESULTS: A total of 13 studies involving 929 patients were included. The majority of the included trials were assessed to be of high clinical heterogeneity and high risk of bias. The results of meta-analysis showed that there was a significant improvement in the effectiveness rate of cervical vertebra symptoms (RR = 1.67, 95% CI [1.33, 2.10], P < .0001), effectiveness rate of blood pressure lowering (RR = 1.35, 95% CI [1.06, 1.71], P = .02), systolic blood pressure reduction (MD = -11.05, 95% CI [-14.12, -7.98] mmHg, P < .0001), and diastolic blood pressure reduction (MD = -6.96, 95% CI [-8.89, -5.04] mmHg, P < .00001). Nondrug therapies had no significant difference compared with drugs in the effectiveness rate of overall improvement (RR = 1.3, 95% CI [0.93, 1.82], P = .12). There were no serious adverse effects related to nondrug therapies in the included trials. CONCLUSION: The results show sound advantages of nondrug therapies over conventional medicine or sham procedure in efficacy. However, the evidence remains weak because of the high clinical heterogeneity and high risk of the included trials. Therefore, further thorough investigation, large-scale, proper-designed, randomized trials of nondrug therapies for hypertension complicated with cervical spondylosis are warranted. PROSPERO REGISTRATION NUMBER: CRD2019123175.


Asunto(s)
Hipertensión/complicaciones , Hipertensión/terapia , Espondilosis/complicaciones , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
16.
Z Gastroenterol ; 58(1): 57-62, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31931541

RESUMEN

The rising prevalence of the metabolic syndrome has led to an increase of non-alcoholic fatty liver disease (NAFLD), and its progressive-inflammatory form called non-alcoholic steatohepatitis (NASH). In recent years, NAFLD and NASH have become major risk factors for developing liver cirrhosis and hepatocellular carcinoma (HCC). In this case, we report a 46-year-old patient with type 2 diabetes mellitus and metabolic comorbidities including obesity and arterial hypertension, who was referred because of rising liver enzymes. After clinical and diagnostic evaluation, the patient was diagnosed with NASH-associated liver cirrhosis, Child-Pugh stage B. A normal blood sugar level was difficult to achieve, and the patient presented with consistently elevated HbA1c-levels irresponsive to insulin therapy. Due to the underlying liver cirrhosis, the patient was enrolled in the HCC-surveillance program. Sonography during follow up showed a focal lesion. On magnetic resonance imaging (MRI), the diagnosis of HCC (BCLC stage A) was confirmed based on typical contrast enhancement and portal-venous wash-out. The patient was evaluated for liver transplantation with a labMELD of 17, and an intermittent therapy with TACE was initiated. Only 2 months after liver transplantation, the patient developed severe and lethal complications. Overall, this case highlights the different medical issues of patients with metabolic syndrome developing a chronic liver disease. In this patient, a rapid progression from NASH-associated liver cirrhosis to HCC was seen, and therefore highlights the importance of close surveillance to identify and treat potential risk factors early in the course of the disease.


Asunto(s)
Carcinoma Hepatocelular/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Neoplasias Hepáticas/complicaciones , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Comorbilidad , Resultado Fatal , Humanos , Hipertensión/complicaciones , Resistencia a la Insulina , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Imagen por Resonancia Magnética , Síndrome Metabólico/diagnóstico , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/terapia , Obesidad/complicaciones
18.
Adv Exp Med Biol ; 1216: 29-38, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894544

RESUMEN

This chapter focuses on the epidemiology of cardiovascular diseases in elderly adults who are 65 or older. Risk factors for morbidity and mortality, as well as variables associated with disability and physical and social functional decline in the elderly individuals are considered. Modifiable risk factors, such as life habits are differentiated from unmodifiable ones, such as age and sex. The chapter concentrates in particular on the impact of hypertension, dyslipidemia and diabetes on cardiovascular diseases and mortality, as well as the effect of cigarettes smoking, physical activity, obesity and isolation on cardiovascular diseases and quality of life. The results demonstrate that cardiovascular diseases are not necessarily a consequence of aging; instead, they are often linked to modifiable risk factors. We can conclude that specific, targeted prevention interventions should preferably be implemented when individuals are young, but they are also useful in the elderly not only to prolong life but also to improve their quality of life.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Diabetes Mellitus Tipo 2/epidemiología , Dislipidemias/epidemiología , Anciano Frágil , Humanos , Hipertensión/epidemiología , Calidad de Vida , Factores de Riesgo
19.
Adv Exp Med Biol ; 1216: 39-50, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894545

RESUMEN

Cardiovascular disease burden increases with the increasing age of populations. Also, with increasing longevity, some individuals are ageing along an unfavourable path developing frailty syndrome. Epidemiologic studies indicate that frailty is overrepresented among the persons with cardiovascular disease. On the other hand, frail subjects tend to be burdened with cardiovascular disease to a greater degree than their biologically better-off peers. Hypertension, diabetes, and obesity, especially abdominal, and at least some other risk factors appear to be shared between frailty and cardiovascular disease. The probable common underlying pathophysiologic feature is inflammation and associated phenomena, possibly having its root in the inflammageing. We discuss these issues based on the results of original studies, comprehensive literature reviews, and metaanalyses, by hundreds of dedicated researchers worldwide.


Asunto(s)
Enfermedades Cardiovasculares , Fragilidad , Anciano , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Anciano Frágil/estadística & datos numéricos , Fragilidad/complicaciones , Fragilidad/epidemiología , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Obesidad Abdominal/complicaciones , Obesidad Abdominal/epidemiología , Factores de Riesgo
20.
Clin Sci (Lond) ; 134(2): 289-302, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31961431

RESUMEN

Preeclampsia (PE) is regarded as a pregnancy-associated hypertension disorder that is related to excessive inflammatory responses. Although the gut microbiota (GM) and short-chain fatty acids (SCFAs) have been related to hypertension, their effects on PE remain unknown. We determined the GM abundance and faecal SCFA levels by 16S ribosomal RNA (rRNA) sequencing and gas chromatography, respectively, using faecal samples from 27 patients with severe PE and 36 healthy, pregnant control subjects. We found that patients with PE had significantly decreased GM diversity and altered GM abundance. At the phylum level, patients with PE exhibited decreased abundance of Firmicutes albeit increased abundance of Proteobacteria; at the genus level, patients with PE had lower abundance of Blautia, Eubacterium_rectale, Eubacterium_hallii, Streptococcus, Bifidobacterium, Collinsella, Alistipes, and Subdoligranulum, albeit higher abundance of Enterobacter and Escherichia_Shigella. The faecal levels of butyric and valeric acids were significantly decreased in patients with PE and significantly correlated with the above-mentioned differential GM abundance. We predicted significantly increased abundance of the lipopolysaccharide (LPS)-synthesis pathway and significantly decreased abundance of the G protein-coupled receptor (GPCR) pathway in patients with PE, based on phylogenetic reconstruction of unobserved states (PICRUSt). Finally, we evaluated the effects of oral butyrate on LPS-induced hypertension in pregnant rats. We found that butyrate significantly reduced the blood pressure (BP) in these rats. In summary, we provide the first evidence linking GM dysbiosis and reduced faecal SCFA to PE and demonstrate that butyrate can directly regulate BP in vivo, suggesting its potential as a therapeutic agent for PE.


Asunto(s)
Ácidos Grasos Volátiles/análisis , Microbioma Gastrointestinal/fisiología , Hipertensión/fisiopatología , Preeclampsia/fisiopatología , Adulto , Animales , Bacterias/clasificación , Bacterias/genética , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Butiratos/administración & dosificación , Butiratos/análisis , Butiratos/metabolismo , Ácidos Grasos Volátiles/metabolismo , Heces/química , Heces/microbiología , Femenino , Microbioma Gastrointestinal/efectos de los fármacos , Microbioma Gastrointestinal/genética , Humanos , Hipertensión/metabolismo , Hipertensión/microbiología , Ácidos Pentanoicos/análisis , Ácidos Pentanoicos/metabolismo , Dinámica Poblacional , Preeclampsia/metabolismo , Preeclampsia/microbiología , Embarazo , ARN Ribosómico 16S/genética , Ratas Sprague-Dawley
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