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1.
J Infect Chemother ; 27(1): 94-98, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32988730

RESUMEN

The effect of systemic corticosteroids on clinical outcomes in patients with coronavirus disease 2019 (COVID-19) remains controversial. While the use of corticosteroids raises concerns regarding delayed viral clearance, secondary infections, and long-term complications that can lead to increased mortality, corticosteroids have the potential to reduce mortality if used appropriately. Herein, we report good outcomes in two patients with COVID-19 who received systemic corticosteroids as adjunctive therapy. An 83-year-old man with hypertension and smoking history and a 62-year-old man with a drinking habit were transferred to our hospital with a diagnosis of COVID-19. The patients developed general malaise and loss of appetite with persistent high fever. Despite the prescription of antiviral drugs, their hypoxemia progressed rapidly. However, after the introduction of systemic corticosteroids, their symptoms improved as the fever decreased, and their hypoxemia gradually improved. These results suggest that some patients with COVID-19 may benefit from the appropriate use of systemic corticosteroids as adjunctive therapy.


Asunto(s)
Corticoesteroides/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Metilprednisolona/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/epidemiología , Antivirales/uso terapéutico , Betacoronavirus , Terapia Combinada , Infecciones por Coronavirus/epidemiología , Humanos , Hipertensión/epidemiología , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Fumar/epidemiología , Neoplasias Gástricas/epidemiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
2.
Texto & contexto enferm ; 29: e20180399, Jan.-Dec. 2020. tab, graf
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1101980

RESUMEN

ABSTRACT Objective: to evaluate the effectiveness of educational interventions in improving the quality of life of people with arterial hypertension. Method: an integrative literature review which included studies that conducted educational interventions aimed at the hypertensive public to improve quality of life. The search was performed in the following databases: MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO and CINAHL, without restriction of language, date and sample size. For this, the following descriptors were crossed: "hipertensão" (hypertension), "educação em saúde" (health education) and "qualidade de vida" (quality of life). 619 articles were retrieved and after the selection and analysis process, a total of 10 made up this review. Data extraction and analysis were performed with the help of validated instruments and the result summarized. Results: Most studies were developed on a quasi-experimental basis, using generic instruments to measure quality of life with significant improvement after educational interventions, with group technology being the most used educational strategy. Just one study used a specific instrument to evaluate hypertensive patients. Conclusion: these results may direct the interventions to be implemented by health professionals in managing arterial hypertension. Further investigations are needed to identify and verify the most effective interventions for hypertensive patients, considering heterogeneous profiles and aiming at improving quality of life.


RESUMO Objetivo: evaluar la eficacia de las intervenciones educativas en el mejoramiento de la calidad de vida de personas con hipertensión arterial. Método: revisión integradora de la literatura que incluyó estudios que han realizado intervenciones educativas direccionadas al público hipertenso con el objetivo de mejorar su calidad de vida. La búsqueda se realizó en las bases de datos MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO e CINAHL, sin restricción de idioma, fecha ni tamaño de muestra. A tal efecto, se utilizaron los descriptores "hipertensión", "educación en salud" y "calidad de vida". Se tomaron 619 artículos y luego de un proceso de selección y análisis esta revisión se compone de un total de 10. La extracción y el análisis de datos se realizaron con el auxilio de instrumentos validados e se procedió a la síntesis de los resultados. Resultados: la mayor parte de los estudios se desarrolló con carácter casi experimental mediante el uso instrumentos genéricos para medir la calidad de vida, con significativa mejoría después de realizadas las intervenciones educativas, siendo la tecnología grupal la estrategia educacional más utilizada. Apenas un estudio utilizó un instrumento específico para la evaluación de hipertensos. Conclusión: estos resultados pueden direccionar las intervenciones que deben llevarse a cabo por profesionales de la salud en el manejo de la presión arterial. Es necesario profundizar las investigaciones para identificar y verificar las intervenciones más eficientes en pacientes hipertensos, considerando perfiles heterogéneos a fin de mejorar su calidad de vida.


RESUMO Objetivo: avaliar a efetividade de intervenções educativas na melhora da qualidade de vida de pessoas com hipertensão arterial. Método: revisão integrativa da literatura que incluiu estudos que realizaram intervenções educacionais direcionadas ao público hipertenso com vistas à melhora da qualidade de vida. Busca realizada nas bases de dados: MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO e CINAHL, sem restrição de idioma, data e tamanho amostral. Para tal, cruzaram-se os descritores: "hipertensão", "educação em saúde" e "qualidade de vida". Foram resgatados 619 artigos e após o processo de seleção e análise, um total de 10 compuseram esta revisão. A extração e análise dos dados foram realizadas com auxílio de instrumentos validados e o resultado sumarizado. Resultados: a maioria dos estudos foi desenvolvida em caráter quase experimental, utilizando-se de instrumentos genéricos para mensuração da qualidade de vida com melhora significativa após a realização de intervenções educativas, sendo a tecnologia grupal a estratégia educacional mais utilizada. Apenas um estudo utilizou instrumento específico para avaliação em hipertensos. Conclusão: estes resultados podem direcionar as intervenções a serem implementadas por profissionais de saúde no manejo da hipertensão arterial. Futuras investigações são necessárias para identificar e verificar as intervenções mais eficazes aos pacientes hipertensos, considerando perfis heterogêneos e visando à melhora da qualidade de vida.


Asunto(s)
Calidad de Vida , Enfermedad Crónica , Hipertensión , Salud , Educación en Salud , Revisión , Presión Arterial , Análisis de Datos
3.
Rev. enferm. UERJ ; 28: e44773, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1119608

RESUMEN

Objetivo:descrever a frequência dos fatores de risco cardiovascular em idosos de uma comunidade quilombola. Método: estudo transversal desenvolvido com idosos quilombolas cadastrados na Estratégia Saúde da Família. A coleta foi realizada com uma amostra de 62 idosos, utilizando-se o teste do qui-quadrado para análise dos dados. Resultados: as frequências dos fatores de risco foram: 67,7% de hipertensão arterial, 54,8% de adiposidade abdominal, 22,6% de glicemia capilar elevada, 19,4% de excesso de peso, 3,2% de sedentarismo e 3,2% de tabagismo, com diferença estatística apenas para adiposidade abdominal em idosas de cor branca (p<0,05). Conclusão: o estudo identificou elevada frequência de fatores de risco cardiovasculares nos idosos quilombolas atendidos na atenção primária à saúde, com destaque para hipertensão arterial, adiposidade abdominal e glicemia capilar elevada. Os resultados apontam a necessidade de melhoria de acesso da comunidade quilombola aos serviços de saúde.


Objective: to describe the frequency of cardiovascular risk factors in the older adults of a quilombola community. Method: in this cross-sectional study of 62 older adults of a quilombo registered with Brazil's Family Health Strategy, the data collected were analyzed using the Chi-square test. Results: risk factor frequencies were: 67.7% for arterial hypertension; 54.8%, abdominal adiposity; 22.6%, high capillary blood glucose; 19.4%, overweight; 3.2%, sedentary lifestyle; and 3.2%, smoking. Statistical difference was observed only for abdominal adiposity in older, white women (p<0.05). Conclusion: this study identified a high frequency of cardiovascular risk factors in quilombola older adults treated in primary health care, particularly arterial hypertension, abdominal adiposity, and high capillary blood glucose. These results indicate the need to improve quilombola communities' access to health services.


Objetivo: describir la frecuencia de factores de riesgo cardiovascular en los adultos mayores de una comunidad quilombola. Método: en este estudio transversal de 62 adultos mayores de un quilombo inscrito en la Estrategia de Salud de la Familia de Brasil, los datos recolectados se analizaron mediante la prueba de Chi-cuadrado. Resultados: las frecuencias de los factores de riesgo fueron: 67,7% para la hipertensión arterial; 54,8%, adiposidad abdominal; 22,6%, glucemia capilar elevada; 19,4%, sobrepeso; 3,2%, sedentarismo; y 3,2%, tabaquismo. Se observó diferencia estadística solo para la adiposidad abdominal en mujeres blancas mayores (p<0,05). Conclusión: este estudio identificó una alta frecuencia de factores de riesgo cardiovascular en adultos mayores quilombolas tratados en atención primaria de salud, particularmente hipertensión arterial, adiposidad abdominal y glucemia capilar alta. Estos resultados indican la necesidad de mejorar el acceso de las comunidades quilombolas a los servicios de salud.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares , Grupos Étnicos , Factores de Riesgo , Accesibilidad a los Servicios de Salud , Tabaquismo , Glucemia , Brasil , Epidemiología Descriptiva , Estrategia de Salud Familiar , Circunferencia Abdominal , Conducta Sedentaria , Hipertensión , Obesidad
4.
Open Heart ; 7(2)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33154144

RESUMEN

OBJECTIVE: The association between the use of renin-angiotensin-aldosterone (RAAS) inhibitors and the risk of mortality from COVID-19 is unclear. We aimed to estimate the association of RAAS inhibitors, including ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality risk in patients with hypertension. METHODS: PubMed (MEDLINE) SCOPUS, OVID, Cochrane Library databases and medrxiv.org were searched from 1 January 2020 to 1 September 2020. Studies reporting the association of RAAS inhibitors (ACEi or ARBs) and mortality in patients with hypertension, hospitalised for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio (RR) estimates, and heterogeneity was quantified. RESULTS: Fourteen studies were included in the systematic review (n=73,073 patients with COVID-19; mean age 61 years; 53% male). Overall, the between-study heterogeneity was high (I2=80%, p<0.01). Patients with hypertension with prior use of RAAS inhibitors were 35% less likely to die from COVID-19 compared with patients with hypertension not taking RAAS inhibitors (pooled RR 0.65, 95% CI 0.45 to 0.94). The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations was graded as 'moderate' quality. CONCLUSIONS: In this meta-analysis, with prior use of RAAS inhibitors was associated with lower risk mortality from COVID-19 in patients with hypertension. Our findings suggest a potential protective effect of RAAS-inhibitors in COVID-19 patients with hypertension. PROSPERO REGISTRATION NUMBER: The present study has been registered with PROSPERO (registration ID: CRD 42020187963).


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Infecciones por Coronavirus/mortalidad , Hospitalización , Hipertensión/tratamiento farmacológico , Neumonía Viral/mortalidad , Sistema Renina-Angiotensina/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
5.
JAMA ; 324(18): 1855-1868, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33170239

RESUMEN

Importance: The benefits of vitamin D, omega-3 fatty acids, and exercise in disease prevention remain unclear. Objective: To test whether vitamin D, omega-3s, and a strength-training exercise program, alone or in combination, improved 6 health outcomes among older adults. Design, Setting, and Participants: Double-blind, placebo-controlled, 2 × 2 × 2 factorial randomized clinical trial among 2157 adults aged 70 years or older who had no major health events in the 5 years prior to enrollment and had sufficient mobility and good cognitive status. Patients were recruited between December 2012 and November 2014, and final follow-up was in November 2017. Interventions: Participants were randomized to 3 years of intervention in 1 of the following 8 groups: 2000 IU/d of vitamin D3, 1 g/d of omega-3s, and a strength-training exercise program (n = 264); vitamin D3 and omega-3s (n = 265); vitamin D3 and exercise (n = 275); vitamin D3 alone (n = 272); omega-3s and exercise (n = 275); omega-3s alone (n = 269); exercise alone (n = 267); or placebo (n = 270). Main Outcomes and Measures: The 6 primary outcomes were change in systolic and diastolic blood pressure (BP), Short Physical Performance Battery (SPPB), Montreal Cognitive Assessment (MoCA), and incidence rates (IRs) of nonvertebral fractures and infections over 3 years. Based on multiple comparisons of 6 primary end points, 99% confidence intervals are presented and P < .01 was required for statistical significance. Results: Among 2157 randomized participants (mean age, 74.9 years; 61.7% women), 1900 (88%) completed the study. Median follow-up was 2.99 years. Overall, there were no statistically significant benefits of any intervention individually or in combination for the 6 end points at 3 years. For instance, the differences in mean change in systolic BP with vitamin D vs no vitamin D and with omega-3s vs no omega-3s were both -0.8 (99% CI, -2.1 to 0.5) mm Hg, with P < .13 and P < .11, respectively; the difference in mean change in diastolic BP with omega-3s vs no omega-3s was -0.5 (99% CI, -1.2 to 0.2) mm Hg; P = .06); and the difference in mean change in IR of infections with omega-3s vs no omega-3s was -0.13 (99% CI, -0.23 to -0.03), with an IR ratio of 0.89 (99% CI, 0.78-1.01; P = .02). No effects were found on the outcomes of SPPB, MoCA, and incidence of nonvertebral fractures). A total of 25 deaths were reported, with similar numbers in all treatment groups. Conclusions and Relevance: Among adults without major comorbidities aged 70 years or older, treatment with vitamin D3, omega-3s, or a strength-training exercise program did not result in statistically significant differences in improvement in systolic or diastolic blood pressure, nonvertebral fractures, physical performance, infection rates, or cognitive function. These findings do not support the effectiveness of these 3 interventions for these clinical outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT01745263.


Asunto(s)
Colecalciferol/uso terapéutico , Suplementos Dietéticos , Ácidos Grasos Omega-3/uso terapéutico , Estado de Salud , Entrenamiento de Resistencia , Vitaminas/uso terapéutico , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/prevención & control , Método Doble Ciego , Femenino , Estudios de Seguimiento , Fracturas Óseas/prevención & control , Humanos , Hipertensión/terapia , Inmunidad , Masculino , Aptitud Física , Resultado del Tratamiento
7.
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
8.
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
9.
BMJ Open Respir Res ; 7(1)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33148777

RESUMEN

OBJECTIVE: To evaluate the role of continuous positive air pressure (CPAP) in the management of respiratory failure associated with COVID-19 infection. Early clinical management with limited use of CPAP (3% of patients) was compared with a later clinical management strategy which had a higher proportion of CPAP use (15%). DESIGN: Retrospective case-controlled service evaluation for a single UK National Health Service (NHS) Trust during March-June 2020 designed and conducted solely to estimate the effects of current care. SETTING: The acute inpatient unit in Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, a medium-sized English NHS Trust. PARTICIPANTS: 206 patients with antigen confirmed COVID-19 disease and severe acute respiratory syndrome admitted between 17 March 2020 and 3 April 2020 for the early group (controls), and between 10 April 2020 and 11 May 2020 for the late group (cases). Follow-up for all cases was until 11 June by which time all patients had a final outcome of death or discharge. Both groups were composed of 103 patients. Cases and controls were matched by age and sex. OUTCOME MEASURE: The outcome measure was the proportion of patients surviving at time t (time from the positive result of COVID-19 test to discharge/death date). The predictors were CPAP intervention, intubation, residence in care homes and comorbidities (renal, pulmonary, cardiac, hypertension and diabetes). A stratified Cox proportional hazard for clustered data (via generalised estimating equations) and model selection algorithms were employed to identify the effect of CPAP on patients' survival and the effect on gas exchange as measured by alveolar arterial (A-a) gradient and timing of CPAP treatment on CPAP patients' survival. RESULTS: CPAP was found to be significantly (HR 0.38, 95% CI 0.36 to 0.40) associated with lower risk of death in patients with hospital stay equal to, or below 7 days. However, for longer hospitalisation CPAP was found to be associated with increased risk of death (HR 1.72, 95% CI 1.40 to 2.12). When CPAP was initiated within 4 days of hospital admission, the survival probability was above 73% (95% CI 53% to 99%). In addition, lower A-a gradient was associated with lower risk of death in CPAP patients (HR 1.011, 95% CI 1.010 to 1.013). The selected model (best fit) was stratified by sex and clustered by case/control groups. The predictors were age, intubation, hypertension and the residency from care homes, which were found to be statistically significantly associated with patient's death/discharge. CONCLUSIONS: CPAP is a simple and cost-effective intervention. It has been established for care of other respiratory disorders but not for COVID-19 respiratory failure. This evaluation establishes that CPAP as a potentially viable treatment option for this group of patients during the first days of hospital admission. As yet there is limited availability of quantitative research on CPAP use for COVID-19. Whist this work is hampered by both the relatively small sample size and retrospective design (which reduced the ability to control potential confounders), it represents evidence of the significant benefit of early CPAP intervention. This evaluation should stimulate further research questions and larger study designs on the potential benefit of CPAP for COVID-19 infections. Globally, this potentially beneficial low cost and low intensity therapy could have added significance economically for healthcare provision in less developed countries.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Insuficiencia Respiratoria/terapia , Factores de Edad , Anciano , Betacoronavirus , Estudios de Casos y Controles , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Femenino , Humanos , Hipertensión/complicaciones , Pacientes Internos/estadística & datos numéricos , Intubación Intratraqueal , Tiempo de Internación , Masculino , Casas de Salud , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Modelos de Riesgos Proporcionales , Intercambio Gaseoso Pulmonar , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/virología , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo
10.
Artículo en Inglés | MEDLINE | ID: mdl-33166098

RESUMEN

Objective: To report the clinical characteristics and transmission rate of coronavirus disease 2019 (COVID-19) in a community inpatient long-term care psychiatric rehabilitation facility designed for persons with serious mental illness to provide insight into transmission and symptom patterns and emerging testing protocols, as well as medical complications and prognosis. Methods: This study examined a cohort of 54 residents of a long-term care psychiatric rehabilitation program from March to April 2020. Baseline demographics, clinical diagnoses, and vital signs were examined to look for statistical differences between positive versus negative severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) groups. During the early phase of the pandemic, the facility closely followed the local shelter-in-place order (starting March 19, 2020) and symptom-based testing. Results: Of the residents, the primary psychiatric diagnoses were schizoaffective disorder: 28 (51.9%), schizophrenia: 21 (38.9%), bipolar I disorder: 3 (5.5%), and unspecified psychotic disorder: 2 (3.7%). Forty (74%) of 54 residents tested positive for SARS-COV-2, with a doubling time of 3.9 days. There were no statistical differences between the positive SARS-COV-2 versus negative groups for age or race/ethnicity. Psychiatric and medical conditions were not significantly associated with contracting SARS-COV-2, with the exception of obesity (n = 17 [43%] positive vs n = 12 [86%] negative, P = .01). Medical monitoring of vital signs and symptoms did not lead to earlier detection. All of the residents completely recovered, with the last resident no longer showing any symptoms 24 days from the index case. Conclusion: Research is needed to determine optimal strategies for long-term care mental health settings that incorporate frequent testing and personal protective equipment use to prevent rapid transmission of SARS-COV-2.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Trastornos Psicóticos/rehabilitación , Centros de Rehabilitación , Esquizofrenia/rehabilitación , Adulto , Afroamericanos , Americanos Asiáticos , Betacoronavirus , Trastorno Bipolar/epidemiología , Trastorno Bipolar/rehabilitación , California/epidemiología , Técnicas de Laboratorio Clínico , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/transmisión , Diabetes Mellitus/epidemiología , Grupo de Ascendencia Continental Europea , Reflujo Gastroesofágico/epidemiología , Hispanoamericanos , Humanos , Hiperlipidemias/epidemiología , Hipertensión/epidemiología , Hipotiroidismo/epidemiología , Control de Infecciones , Cuidados a Largo Plazo , Tamizaje Masivo , Persona de Mediana Edad , Obesidad/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/transmisión , Rehabilitación Psiquiátrica , Psicoterapia de Grupo , Trastornos Psicóticos/epidemiología , Recreación , Rehabilitación Vocacional , Esquizofrenia/epidemiología , Fumar/epidemiología , Visitas a Pacientes
11.
PLoS One ; 15(11): e0242307, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33180862

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has quickly spread throughout the country and the world since first broke out in Wuhan, China. The outbreak that started from January 22, 2020, in Fujian Province has been controlled as the number of indigenous cases has not increased since March. We aimed to describe the clinical characteristics of patients with COVID-19 in Fujian Province, China. METHODS: In this retrospective, multicenter study, we collected and analyzed the epidemiological, clinical, and laboratory data of all cases confirmed by nucleic acid tests in five designated hospitals in Fujian Province between January 22 and February 27, 2020. All patients were followed up until discharge. COVID-19 severity was classified as mild, moderate, severe, or critical. RESULTS: Of 199 discharged patients with COVID-19, 105 patients were male, with a median age of 46.3 years, and 17 patients were severe, and 5 patients were critical on admission. Hypertension and diabetes were the most common comorbidities. The symptoms at illness onset were mainly fever (76.4%), cough (60.8%), and myalgia or fatigue (27.6%). A total of 96.5% of patients had abnormal imaging findings on chest computed tomography. Lymphopenia (37.2%) and hypoxemia (13.6%) were observed. Acute respiratory distress syndrome and respiratory failure occurred in 9 patients (4.5%) and 8 patients (4.0%) respectively. One patient died and the others were cured and discharged with the median hospital stay of 19 days. Old age was negatively correlated with lymphocyte count (r = - 0.296, p < 0.001) and oxygenation index (r = - 0.263, p = 0.001). Bivariate regression analysis revealed that old age (≥ 75 years), hypertension, diabetes, and lymphopenia were correlated with the severity of COVID-19. CONCLUSIONS: Patients in Fujian Province were mostly nonsevere cases with mild or moderate symptoms, and had a lower mortality than patients in Wuhan (4.3%-15%). Older age, hypertension, diabetes, and lymphopenia were risk factors for severity of COVID-19.


Asunto(s)
Infecciones por Coronavirus/patología , Alta del Paciente , Neumonía Viral/patología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Linfopenia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
12.
Zhongguo Zhong Yao Za Zhi ; 45(17): 4246-4253, 2020 Sep.
Artículo en Chino | MEDLINE | ID: mdl-33164410

RESUMEN

To explore the effect of Xiaoji Recipe on the stability of carotid artery vulnerable plaque in elderly patients with type 2 diabetes mellitus and type H hypertension(Qi-Yin deficiency with phlegm stagnation). From January 2017 to April 2019, in Endocrinology Department for Outpatients and Inpatients of the First Affiliated Hospital of Henan University of Chinese Medicine, 125 elderly patients with type 2 diabetes mellitus and type H hypertension with carotid artery vulnerable plaque(Qi-Yin deficiency with phlegm stagnation) were selected. According to the numerical table method, the patients were randomly divided into the control group(63 cases, including 56 cases completed) and Xiaoji group(62 cases, including 58 cases completed). Both groups were given control diet, hypoglycemic, hypotensive and symptomatic therapies. The control group was given Rosuvastatin Calcium Tablets 20 mg·d~(-1) before sleep. The Xiaojie group were given Ruisuvastatin Calcium Tablets 10 mg·d~(-1) before sleep, plus Xiaoji Recipe at the same time. Both groups were treated for 6 months. The number of vulnerable plaques, carotid intima-media thickness(IMT) and plaque thickness were detected by color Doppler ultrasound before and after treatment, in order to calculate IMT integral and improved Crouse integral. Meanwhile, lipid metabolism indexes, including total cholesterol(TC), triacylglycerol(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C) and lipoprotein a(LPa). And plaque stability indexes, including hypersensitive c-reactive protein(hs-CRP), matrix metalloproteinase-9(MMP-9), oxidized low-density lipoprotein(ox-LDL), Ⅰ type platelet depolymerization protein binding protein base sequence of metalloproteinases(ADAMTS-Ⅰ) and homocysteine(Hcy) were detected. To evaluate the 6-month curative effect on TCM syndrome, the patients were followed up for 6 months for adverse cardiovascular and cerebrovascular events and adverse drug reactions. After 6 months of treatment, the efficacy on Xiaoji group was better than that of the control group(Z=-2.600, P=0.009). The significant efficiency of the Xiaoji group was higher than that of the control group(χ~2=6.039, P=0.014). The total effective rate of the Xiaoji group was higher than that of the control group(χ~2=4.564, P=0.033). The number of vulnerable plaques form indexes(IMT, IMT integral, plaque thickness, improved Crouse integral), blood lipid metabolism indexes(TC, TG, LDL-C, HDL-C, LPa) and plaque stability indexes(hs-CRP, MMP-9, ox-LDL, ADAMTS-Ⅰ, Hcy) were significantly improved than before treatment in both groups of patients(P<0.01). Compared with the control group, the Xiaoji group showed more obvious improvement(P<0.01). The incidence of adverse cardiovascular and cerebrovascular events in the Xiaoji group was lower than that in the control group within 6 months after treatment(χ~2=4.566, P=0.033). The incidence of adverse drug reactions in the Xiaoji group was lower than that in the control group(χ~2=4.465, P=0.035). This indicated that Xiaoji Recipe combined with small-dose Rosuvastatin Calcium(10 mg·d~(-1)) was safe and effective in the treatment of elderly patients of type 2 diabetes mellitus with type H hypertension and vulnerable carotid artery plaque(Qi-Yin deficiency with phlegm stagnation), and superior to the single high-dose Risovastatin Calcium(20 mg·d~(-1)) regimen. It can reverse carotid plaque, and reduce the activity of vulnerable plaque and the incidence of adverse cardiovascular and cerebrovascular events and adverse drug reactions.


Asunto(s)
Estenosis Carotídea , Diabetes Mellitus Tipo 2 , Hipertensión , Anciano , Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Medicamentos Herbarios Chinos , Humanos , Hipertensión/tratamiento farmacológico
13.
Orv Hetil ; 161(45): 1908-1913, 2020 11 08.
Artículo en Húngaro | MEDLINE | ID: mdl-33161389

RESUMEN

Összefoglaló. Bevezetés: Az atorvasztatin (koleszterincsökkento), nifedipin (Ca2+-antagonista), kaptopril (angiotenzinkonvertáz-gátló) vegyületek a magas vérnyomás komplex kezelésének "alap"gyógyszerei. Mindhárom antioxidáns is. Célkituzés: A tanulmány célja annak megválaszolása volt, hogy e molekulák gátolhatják-e a vérsejtek fagocitamuködését. Betegek és módszer: Magas vérnyomásos betegek: 15 fo, 39-80 éves, no: 6, férfi: 9. Egészséges kontroll: 7 fo, 30-75 éves, no: 3, férfi: 4. A vizsgálat a téli hónapokban zajlott. A zimozán- (Saccharomyces cerevisiae) részecskék fagocitózisa során képzodo kemilumineszcencia mérése perifériás vérben a gyógyszerek jelenlétében történt luminométerrel. A gátlást a stimulációs index értékének csökkenésével jellemeztük. Eredmények: Mindhárom vegyület gátolta a kemilumineszcenciát (oxigénszabadgyök-képzést) a 65 év feletti, magas vérnyomásos betegek többségében: 11/13 fonél. Foleg magasabb életkorban és cukorbetegségben, de más társbetegségekben nott a gátlás. Következtetés: Az idos, magas vérnyomásos betegek fokozott orvosi figyelmet igényelnek a téli idoszakokban, mivel antioxidáns hatással is rendelkezo "alap"gyógyszereiknek, egyéntol függoen, lehetnek gátló hatásaik a fagociták mikrobaölo, oxigénszabadgyök-termelo képességére. Orv Hetil. 2020; 161(45): 1908-1913. INTRODUCTION: Atorvastatin (cholesterol synthesis blocker), nifedipine (Ca2+ antagonist), captopril (angiotensin-convertase inhibitor) are basic drugs in the therapy of hypertension. They are also antioxidants. OBJECTIVE: To investigate whether these molecules can inhibit the phagocytic activity of peripheral blood cells. PATIENTS AND METHOD: Hypertension group: 15 patients with ages between 39-80 years (6 women and 9 men). Healthy control group: 7 individuals with ages between 30-75 years (3 women and 4 men). The study was carried out in wintertime. The measurement of phagocytic activity was carried out by luminometry in peripheral blood samples. Chemiluminescence intensities were determined by the engulfment of zymosan (Saccharomyces cerevisiae) particles in the presence of drugs. The inhibitory effects were characterized by the decreased values of the stimulation index. RESULTS: All three substances decreased the chemiluminescence (reactive oxygen species production) in the majority of samples from hypertensive patients over 65 years: in 11 of 13 patients. Stronger inhibition was detected in older, diabetic patients with other co-morbidities, too. CONCLUSION: Older patients with hypertension require a special attention in wintertime. Antihypertensive drugs with antioxidant capabilities may have individually different inhibitory effects on the production of reactive oxygen species by phagocytes, which decreases their antimicrobial potency. Orv Hetil. 2020; 161(45): 1908-1913.


Asunto(s)
Antioxidantes , Hipertensión , Fagocitos , Adulto , Anciano , Anciano de 80 o más Años , Antihipertensivos/farmacología , Antioxidantes/farmacología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Luminiscencia , Masculino , Persona de Mediana Edad , Fagocitos/efectos de los fármacos
15.
Clin Sci (Lond) ; 134(21): 2791-2805, 2020 11 13.
Artículo en Inglés | MEDLINE | ID: mdl-33135725

RESUMEN

Angiotensin-converting enzyme II (ACE2) is a homologue of angiotensin-converting enzyme discovered in 2000. From the initial discovery, it was recognized that the kidneys were organs very rich on ACE2. Subsequent studies demonstrated the precise localization of ACE2 within the kidney and the importance of this enzyme in the metabolism of Angiotensin II and the formation of Angiotensin 1-7. With the recognition early in 2020 of ACE2 being the main receptor of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), the interest in this protein has dramatically increased. In this review, we will focus on kidney ACE2; its localization, its alterations in hypertension, diabetes, the effect of ACE inhibitors and angiotensin type 1 receptor blockers (ARBs) on ACE2 and the potential use of ACE2 recombinant proteins therapeutically for kidney disease. We also describe the emerging kidney manifestations of COVID-19, namely the frequent development of acute kidney injury. The possibility that binding of SARS-CoV-2 to kidney ACE2 plays a role in the kidney manifestations is also briefly discussed.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/enzimología , Enfermedades Renales/enzimología , Riñón/enzimología , Peptidil-Dipeptidasa A/metabolismo , Neumonía Viral/enzimología , Receptores Virales/metabolismo , Lesión Renal Aguda/enzimología , Lesión Renal Aguda/virología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Animales , Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/virología , Diabetes Mellitus/enzimología , Diabetes Mellitus/fisiopatología , Historia del Siglo XXI , Interacciones Huésped-Patógeno , Humanos , Hipertensión/enzimología , Hipertensión/fisiopatología , Riñón/fisiopatología , Enfermedades Renales/tratamiento farmacológico , Enfermedades Renales/fisiopatología , Pandemias , Peptidil-Dipeptidasa A/historia , Peptidil-Dipeptidasa A/uso terapéutico , Neumonía Viral/virología , Receptores Virales/historia
16.
JAMA ; 324(17): 1737-1746, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33141209

RESUMEN

Importance: Online programs may help with weight loss but have not been widely implemented in routine primary care. Objective: To compare the effectiveness of a combined intervention, including an online weight management program plus population health management, with the online program only and with usual care. Design, Setting, and Participants: Cluster randomized trial with enrollment from July 19, 2016, through August 10, 2017, at 15 primary care practices in the US. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes. Follow-up ended on May 8, 2019. Interventions: Participants in the usual care group (n = 326) were mailed general information about weight management. Participants in the online program only group (n = 216) and the combined intervention group (n = 298) were registered for the online program. The participants in the combined intervention group also received weight-related population health management, which included additional support from nonclinical staff who monitored their progress in the online program and conducted periodic outreach. Main Outcomes and Measures: The primary outcome was weight change at 12 months based on measured weights recorded in the electronic health record. Weight change at 18 months was a secondary outcome. Results: Among the 840 participants who enrolled (mean age, 59.3 years [SD, 8.6 years]; 60% female; 76.8% White), 732 (87.1%) had a recorded weight at 12 months and the missing weights for the remaining participants were imputed. There was a significant difference in weight change at 12 months by group with a mean weight change of -1.2 kg (95% CI, -2.1 to -0.3 kg) in the usual care group, -1.9 kg (95% CI, -2.6 to -1.1 kg) in the online program only group, and -3.1 kg (95% CI, -3.7 to -2.5 kg) in the combined intervention group (P < .001). The difference in weight change between the combined intervention group and the usual care group was -1.9 kg (97.5% CI, -2.9 to -0.9 kg; P < .001) and the difference between the combined intervention group and the online program only group was -1.2 kg (95% CI, -2.2 to -0.3 kg; P = .01). At 18 months, the mean weight change was -1.9 kg (95% CI, -2.8 to -1.0 kg) in the usual care group, -1.1 kg (95% CI, -2.0 to -0.3 kg) in the online program only group, and -2.8 kg (95% CI, -3.5 to -2.0 kg) in the combined intervention group (P < .001). Conclusions and Relevance: Among primary care patients with overweight or obesity and hypertension or type 2 diabetes, combining population health management with an online program resulted in a small but statistically significant greater weight loss at 12 months compared with usual care or the online program only. Further research is needed to understand the generalizability, scalability, and durability of these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02656693.


Asunto(s)
Intervención basada en la Internet , Obesidad/terapia , Pérdida de Peso , Programas de Reducción de Peso/métodos , Adulto , Anciano , Índice de Masa Corporal , Terapia Combinada/métodos , Diabetes Mellitus Tipo 2/terapia , Femenino , Humanos , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Sobrepeso/terapia , Satisfacción del Paciente , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , Adulto Joven
17.
Kardiologiia ; 60(8): 130-140, 2020 Sep 17.
Artículo en Ruso | MEDLINE | ID: mdl-33164724

RESUMEN

The article discusses results of secondary analysis of the data obtained in the SPRINT study and published in recent years. Unresolved issues in the tactics of managing patients with arterial hypertension are discussed. One of such issues is choosing an optimum level of blood pressure (BP) for a subgroup of patients with certain characteristics, including elderly and senile patients, patients with chronic kidney disease, and patients with arterial hypertension who continue smoking. The article discusses calculation of a threshold of risk for complications of cardiovascular diseases, at which a maximum advantage of intensified regimens of antihypertensive therapy could be achieved. In addition, the article addresses approaches to selection of antihypertensive drugs in the current conditions. The authors discussed the role of candesartan in the treatment of arterial hypertension, a sartan most studied in a broad range of patients. The issue of a rapid increase in BP without a damage to target organs is addressed; evidence for the role of captopril in such clinical situation is provided.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Anciano , Antihipertensivos/uso terapéutico , Presión Sanguínea , Captopril/farmacología , Enfermedades Cardiovasculares/tratamiento farmacológico , Humanos , Hipertensión/tratamiento farmacológico
18.
Zhonghua Yi Xue Za Zhi ; 100(41): 3230-3234, 2020 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-33167109

RESUMEN

Objective: To evaluate the effect on bleeding volume and postoperative recovery of regional cerebral oxygen saturation (rSO(2)) guides controlled hypotension in elderly patients with hypertension undergoing spinal surgery. Methods: One hundred and twenty elderly patients who underwent spinal surgery in the department of anesthesiology of Qingdao Municipal Hospital and the Affiliated Hospital of Qingdao University from January 2017 to December 2019 were selected and divided into 2 groups according to the random number table method (n=60): rSO(2) guides the controlled hypotension group (group A) and control group (group C). Both groups were performed with endotracheal intubation for general anesthesia, maintain anesthesia with sevoflurane and remifentanil, rSO(2) were monitored throughout the procedure. If necessary, sodium nitroprusside or esmolol were used to control blood pressure. In group A, the goal of controlled hypotension was that rSO(2) decreased ≤ 10% of the basic value or maintained at 64±3 and the moderate operative field bleeding. Group C underwent routine anesthesia management. Intraoperative blood loss and urine output, the incidence of hypothermia after operation, postoperative delirium, chills, nausea and vomiting, the PACU residence time, postoperative drainage volume, eating time, postoperative hospital stay were compared between the two groups. Results: Compared with group C, the blood loss [(589±157) vs (764±213) ml] and urine output [(778±121) vs (1 079±239) ml] of group A were decreased (t=-5.120, -8.712, all P<0.05). The rates of hypothermia after operation (26.7% vs 45.0%), postoperative delirium (18.3% vs 36.7%), chills (10.0% vs 25.0%), nausea and vomiting (21.7% vs 40.0%) of group A were decreased (χ(2)=4.385, 5.057, 4.675, 4.728, all P<0.05) . The PACU residence time [(56±9) vs (63±11) min], postoperative drainage volume [(217±66) vs (289±81) ml], eating time [(17.8±2.8) vs (22.3±4.1) h] and numbers of days in hospital [(7.2±2.7) vs (8.2±2.9) d] were decreased of group A (t=-3.399, -5.334, -7.000, -2.031, all P<0.05). Conclusion: The guidance of controlled hypotension with rSO(2) monitoring can reduce the blood loss and infusion volume during spinal surgery in elderly patients with hypertension, reduce postoperative related complications and enhance recovery after surgery.


Asunto(s)
Hipertensión , Hipotensión Controlada , Anciano , Humanos , Oxígeno , Periodo Posoperatorio , Sevoflurano
19.
Zhonghua Yi Xue Za Zhi ; 100(41): 3250-3254, 2020 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-33167113

RESUMEN

Objective: To explore the cut-off point of aldosterone/direct renin ratio (ADRR) before drug washout in the screening for primary aldosteronism (PA) in the Chinese population and reduce the potential risk caused by drug washout during PA screening. Methods: Hospitalized hypertensive patients in the Hypertension Ward of Fuwai Hospital, Chinese Academy of Medical Sciences from January 2017 to October 2019 were enrolled. PA was diagnosed according to the criterion of 2016 American Guideline and 2016 Chinese Consensus for PA. The plasma aldosterone concentration (PAC), direct renin concentration (DRC) and ADRR before and after drug washout were measured. The receiver operating characteristic (ROC) curve of ADRR was drawn and the maximal Youden index was used to determine the best cut-off value. Results: A total of 542 hypertensive patients were included, with 467 patients diagnosed with essential hypertension (EHT) (297 males and 170 females), and 75 patients diagnosed with PA (51 males and 24 females). Patients with PA had higher PAC and ADRR before and after drug washout than those with EHT(150.0 (130.0, 210.0) vs 120.0 (80.0, 170.0) ng/L, 170.0 (120.0, 260.0) vs 130.0 (90.0, 180.0) ng/L; 28.9 (15.9, 63.5) vs 4.3 (1.9, 11.8) (ng/L) / (mU/L) , 55.6 (39.0, 109.0) vs 9.8 (4.5, 21.3) (ng/L) /(mU/L), all P<0.001). However, DRC of PA patients before and after washout were lower than those with EHT (4.0 (2.0, 10.0) vs 27.0 (10.0, 64.0) mU/L, 3.0 (2.0, 4.0) vs 12.2 (5.0, 27.0) mU/L, P<0.001). In EHT and PA groups, PAC and ADRR significantly increased (P=0.001, P<0.001) , but DRC significantly decreased after drug washout (all P<0.001) . The area under the ROC curve of ADRR before drug washout was 0.868 (95%CI 0.836-0.895) with the best cut-off value of 7.8 (ng/L) / (mU/L) for the screening of PA .The sensitivity and specificity was 94.7% and 66.8%, respectively, with the maximal Youden index of 0.615. Conclusion: ADRR before drug washout > 7.8 (ng/L) / (mU/L) can be used as an alternative cut-off point to screen PA when drug washout is not available.


Asunto(s)
Hiperaldosteronismo , Hipertensión , Aldosterona , Hipertensión Esencial , Femenino , Humanos , Hiperaldosteronismo/diagnóstico , Masculino , Renina
20.
Kardiologiia ; 60(7): 36-43, 2020 Aug 11.
Artículo en Ruso | MEDLINE | ID: mdl-33155939

RESUMEN

Aim To evaluate changes in left ventricular (LV) systolic function by LV myocardial global longitudinal strain (GLS) and global strain rate (GSR) in patients with arterial hypertension (AH) and based on the effectiveness of blood pressure (BP) control in a Russian population sample of individuals older than 55 years.Materials and methods This cross-sectional study was a population-based cohort study (HAPIEE, Novosibirsk). LV myocardial GLS and GSR were studied by echocardiography in a random sample (n=1004, 55-84 years). Statistical analysis was performed with multivariate models of logistic regression.Results AH prevalence in the study sample was 78.4 %. Mean GLS was 19.1 % (SD, 4.07), which was less for men than for women (p=0.001). Mean GSR was 0.86 s-1 (SD, 0.19) and was not different between men and women. In individuals with AH, the GLS absolute value was lower than in normotensive people (18.8 %; SD, 4.04 vs. 20.2 %; SD, 4.03, p˂0.001); these differences remained irrespective of the age, gender, body weight index (BWI) (p=0.027), and LV mass index (p=0.05). When people with AH were divided into groups, the lowest GLS absolute values were observed among "ineffectively treated" or not receiving any therapy individuals (p<0.001 vs. normotensive group). AH 1.6 times increased the risk of LV GLS decrease. In individuals with AH, the GSR absolute value was lower than in normotensive people (- 0.85 s-1 (SD, 0.19) vs.- 0.92 s-1 (SD, 0.18), p<0.001); this difference remained in multivariate models. The lowest GSR absolute values were observed in the "ineffectively treated" group irrespective of the gender, age, and BWI (p=0.036 vs. normotensive group). AH doubled the risk of LV GSR decrease, which could be partially explained by the contribution of BWI and myocardial mass index.Conclusion In this population sample, LV GLS and GSR were independently associated with AH. The lowest GLS and GSR values were observed for ineffectively treated" individuals with AH, which may reflect an early decline of LV systolic function with inadequate control of AH.


Asunto(s)
Hipertensión , Disfunción Ventricular Izquierda , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Federación de Rusia/epidemiología , Volumen Sistólico , Función Ventricular Izquierda
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