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2.
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
4.
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
5.
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
6.
Cardiovasc Ther ; 2020: 8563135, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33123219

RESUMEN

Metabolic syndrome (MetS) is a combination of factors which, collectively, increase cardiovascular risk to a greater extent than each of them separately. Previous studies showed high cardiovascular risk to be associated with autonomic nervous system dysfunction. The purpose of this study was to assess the effects of antihypertensive treatment on heart rate variability (HRV) in patients with hypertension (HTN), depending on cooccurrence of MetS. 118 patients with uncontrolled HTN were enrolled to the study. HRV was compared among patients with and without MetS (MetS [+], n = 70) at baseline and following 12 months antihypertensive treatment. The HRV indices measured from RR intervals recorded form using 24-hour ambulatory electrocardiography. The measured HRV domains were the standard deviation of the average of NN intervals [SDNN], square root of the mean of the sum of the squares of differences between adjacent NN intervals [rMSSD], percentage of NN50 [pNN50], low frequency [LF], high frequency [HF], total power of variance of all NN intervals [TP], and LF/HF ratio. Baseline parameters: SDNN, rMSSD, pNN50, and HF were significantly lower in the MetS[+] compared to the MetS[-] subgroup (p < 0.05). After a 12-month antihypertensive treatment, MetS[+] patients achieved a significant improvement in parameters: SDNN, rMSSD, pNN50, and TP (p < 0.05), while the changes in HRV observed in the MetS[-] subgroup were not statistically significant. The cooccurrence of HTN and other components of MetS is associated with disturbances of the autonomic balance. HTN control has a beneficial effect on HRV, with the effect being more evident in patients with MetS.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Síndrome Metabólico/tratamiento farmacológico , Adulto , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Masculino , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento
7.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1440-1444, 2020 Sep 10.
Artículo en Chino | MEDLINE | ID: mdl-33076595

RESUMEN

Objective: To analyze the influence of different number of blood pressure measurement on the detection of elevated blood pressure in Tibetan adolescents and provide scientific reference for standardizing the number of blood pressure measurement and accurately diagnosing elevated blood pressure in adolescents. Methods: Data were from the project "survey of the risk factors for elevated blood pressure among Tibetan adolescents" conducted from August to September 2018 in Shigatse in Tibet. A total of 2 822 Tibetan adolescents aged 12-17 years, including 1 275 boys (45.2%), were recruited by a convenient, stratified cluster sampling method. Each participant underwent three consecutive blood pressure measurements. Elevated blood pressure was defined according to the Health Industry Criterion of China: WS/T 610-2018 "Reference of screening for elevated blood pressure among children and adolescents aged 7-18 years" . Analysis of variance and χ(2) test were used to analyze the effect of different blood pressure measurement on blood pressure levels and detection of elevated blood pressure, respectively. Results: SBP and DBP decreased substantially across three consecutive blood pressure measurements[SBP: (112.7±9.7), (110.7±9.7) and (110.2±9.5) mmHg (1 mmHg=0.133 kPa); DBP: (62.7±8.2), (61.1±8.5) and (60.6±8.5) mmHg; P value for trend<0.001]. The detection rates of elevated blood pressure based on three blood pressure measurements were 12.8%, 8.7% and 7.9%, respectively (P value for trend <0.001). Of note, the difference in the detection of elevated blood pressure based on the second blood pressure measurement or based on the average value of the second and third blood pressure measurements showed no significance (8.7% and 7.2%, P=0.039). Conclusions: Blood pressure levels and the detection of elevated blood pressure in adolescents decreased substantially across three consecutive blood pressure measurements. The second blood pressure measurement might be sufficient for screening elevated blood pressure in adolescents.


Asunto(s)
Determinación de la Presión Sanguínea , Hipertensión , Adolescente , Niño , Femenino , Humanos , Hipertensión/diagnóstico , Masculino , Tibet
8.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1445-1449, 2020 Sep 10.
Artículo en Chino | MEDLINE | ID: mdl-33076596

RESUMEN

Objective: To analyze the trends in blood pressure (BP) values and the elevated BP based on the measurements at three occasions in different days and its relationship with obesity in children and provide scientific evidence for the identification and prevention of hypertension in children. Methods: A public primary school in Huantai county of Zibo, Shandong province, was selected as the investigation field by using a convenient cluster sampling method. The baseline survey of "Children's Cardiovascular Health Cohort" was carried out from November 2017 to January 2018. All the students with willingness and informed consent in this school were included in the survey, and the valid sample size was 1 505 children (aged 6-11 years). Children with elevated BP at the measurement of the first occasion should had a second measurement 2 weeks later, and a third measurement was given 2 weeks later if BP was still high at the measurement of the second occasion. Hypertension was confirmed if elevated BP was detected in the measurements at all the three occasions in different days. Multivariate linear regression model was used to assess the trend in BP values in children in the measurements at three occasions in different days, Cochran-Armitage trend analysis was used to evaluate the trend of elevated BP, and logistic regression model was used to analyze the relationship of elevated BP with obesity at three occasions in different days. Results: In this study, with the increase of follow-up visits, the BP levels continued to rise (trend P<0.05). The elevated BP rates at three occasions were 15.5%, 4.0% and 1.9%, respectively, showing a significantly downward trend (trend P<0.05). Compared with both normal weight and normal waist circumference, the association between obesity types (general obesity only, abdominal obesity only, and mixed obesity) and elevated BP at three occasions increased (the first occasion: OR=3.62, 95%CI: 2.65-4.96; the second occasion: OR=9.50, 95%CI: 4.95-18.22; and the third occasion: OR=8.94, 95%CI: 3.48-22.96; all P<0.05). Stratified analysis by gender showed similar results. Conclusions: The elevated BP rates based on the measurements at three occasions in different days in children aged 6-11 years showed a significant decrease trend. The association between different types of obesity (especially mixed obesity) and elevated BP in children became stronger gradually with the progress of the follow up.


Asunto(s)
Hipertensión , Obesidad Pediátrica , Determinación de la Presión Sanguínea , Niño , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Masculino , Obesidad Pediátrica/epidemiología
9.
Compend Contin Educ Dent ; 41(9): 458-464; quiz 465, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33001656

RESUMEN

More than 1 billion people worldwide have hypertension. Since the guidelines for classification and treatment of hypertension were updated in 2017 by American College of Cardiology/American Heart Association, it is now estimated that nearly half of the US adult population has hypertension. Hypertension may not show any sign or symptom apart from an elevated blood pressure reading until signs and symptoms of complications occur. Hence, dentists can play a unique role in identifying undiagnosed patients or those with uncontrolled blood pressure levels. This article is intended to provide dental clinicians essential information about hypertension and how the new guidelines affect the classification and treatment of the disease, and it discusses the management of patients with hypertension in the dental office.


Asunto(s)
Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertensión/terapia , Adulto , Presión Sanguínea , Humanos , Estados Unidos
11.
Medicine (Baltimore) ; 99(40): e22536, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019461

RESUMEN

RATIONALE: Paroxysmal autonomic instability with dystonia (PAID) is an underdiagnosed syndrome that describes a collection of symptoms following diverse cerebral insults, such as traumatic brain injury, hydrocephalus, hemorrhagic stroke, or brain anoxia. It is manifested by systemic high blood pressure, hyperthermia, tachycardia, tachypnea, diaphoresis, intermittent agitation, and certain forms of dystonia. PATIENT CONCERNS: A semi-comatose 46-year-old man was transferred from the regional rehabilitation hospital with various complaints involving fluctuating vital signs, including uncontrolled hyperthermia, hypertension, tachycardia, and tachypnea, and dystonia in all extremities. The patient underwent brain surgery for astrocytoma in 1996. The patient also had a history of first ischemic stroke on the basal ganglia in 2008 and a second one in the same area in 2017. DIAGNOSIS: The laboratory, electrocardiography, and radiologic findings were normal. Brain imaging indicated an old infarction on the basal ganglia with hydrocephalus. Tractography using diffusion tensor imaging showed discontinuity of multiple tracts, and electrophysiologic tests, such as evoked potentials, displayed an absent response. Based on the dysautonomic symptoms and brain evaluations, the physiatrist diagnosed the patient with PAID. INTERVENTIONS: Bromocriptine, propranolol, and clonazepam were administered sequentially, but autonomic instability persisted. Then, intravenous opioid was administered, and fluctuations in body temperature, heart rate, and respiratory rate, as well as decerebrate-type dystonia were improved. However, simultaneously, drug-induced severe hypotension developed (systolic blood pressure, 57 mm Hg). Subsequently, a transdermal opioid (fentanyl) patch for PAID was applied once every 3 days. OUTCOMES: Ultimately, all vital signs and dystonia were managed without further complications, and the patient was discharged. LESSONS: A patient diagnosed with PAID following multiple cerebral insults was observed, whose condition was controlled by application of opioid patch rather than by intravenous or oral routes. A transdermal opioid patch, such as fentanyl patch, can thus be effective in the treatment of patients with PAID following multiple cerebral insults.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Enfermedades del Sistema Nervioso Autónomo/tratamiento farmacológico , Distonía/diagnóstico , Fentanilo/uso terapéutico , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Ganglios Basales/patología , Isquemia Encefálica/diagnóstico por imagen , Imagen de Difusión Tensora/métodos , Distonía/etiología , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Hidrocefalia/etiología , Hipertensión/diagnóstico , Hipertensión/etiología , Hipotensión/inducido químicamente , Masculino , Persona de Mediana Edad , Síndrome , Taquicardia/diagnóstico , Taquicardia/etiología , Taquipnea/diagnóstico , Taquipnea/etiología , Parche Transdérmico/efectos adversos , Resultado del Tratamiento
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2691-2694, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33018561

RESUMEN

The primary risk factor of hypertension, is the lack of awareness caused by the unavailability of ubiquitous blood pressure (BP) measurement. In this study, we have investigated the BP estimation using the photoplethysmogram (PPG) signal and a suitable subject-specific mathematical model. The linear transfer function (LTF) technique was used to identify the subject-specific model. Firstly, we tried to identify the model considering arterial blood pressure (ABP) as input and PPG as output, and we achieved an average estimation accuracy (normalized root mean square, NRMSE) of 84.4%. Next, we fitted an inverse model, where ABP is the output, and PPG is the input, and we achieved an average estimation accuracy (NRMSE) of 84.7%. Finallly, We verified that the two identified models mentioned above are inverse of each other. In this study, we have used ABP and PPG signals of 10 (male = 7, female = 3) subjets from the MIMIC II database. The results are quite promising for the use of the PPG in the detection and diagnosis of cardiovascular diseases.


Asunto(s)
Presión Arterial , Hipertensión , Determinación de la Presión Sanguínea , Humanos , Hipertensión/diagnóstico , Fotopletismografía , Factores de Riesgo
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2784-2787, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33018584

RESUMEN

We present an approach to quantifying nocturnal blood pressure (BP) variations that are elicited by sleep disordered breathing (SDB). A sample-by-sample aggregation of the dynamic BP variations during normal breathing and BP oscillations prompted by apnea episodes is performed. This approach facilitates visualization and analysis of BP oscillations. Preliminary results from analysis of a full night study of 7 SDB subjects (5 Male 2 Female, 52±5.6 yrs., Body Mass Index 36.4±7.4 kg/m2, Apnea-Hypopnea Index 69.1±26.8) are presented. Aggregate trajectory and quantitative values for changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) concomitant with obstructive apnea episodes are presented. The results show 19.4 mmHg (15.3%) surge in SBP and 9.4 mmHg (13.6%) surge in DBP compared to their respective values during normal breathing (p<0.05). Further, the peak of the surge in SBP and DBP occurred about 9s and 7s, respectively, post the end of apnea events. The return of SBP and DBP to baseline values displays a decaying oscillatory pattern.


Asunto(s)
Hipertensión , Síndromes de la Apnea del Sueño , Presión Sanguínea , Determinación de la Presión Sanguínea , Femenino , Humanos , Hipertensión/diagnóstico , Masculino , Polisomnografía , Síndromes de la Apnea del Sueño/diagnóstico
14.
Vasc Health Risk Manag ; 16: 389-401, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33061400

RESUMEN

Background: Globally, stroke appears as a major cause of preventable deaths and disabilities. In Ethiopia, the intra-hospital mortality of stroke is significant; however, epidemiologic data are scarce whether there is a difference in the overall survival time between hypertensive and non-hypertensive adult stroke patients admitted in specialized hospitals. This study was intended to determine the survival of stroke patients according to their hypertension status admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia from March 1, 2012, to February 28, 2019. Methods and Findings: A hospital-based retrospective cohort study was conducted among all cohorts of confirmed first-ever stroke patients admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Kaplan-Meier survival analysis was applied to estimate the survival probability of hypertensive and non-hypertensive first-ever stroke patients. Cox proportional hazards regression model was used to determine the adjusted hazard ratio of death for each main baseline predictor variable with 95% CI, and P-value <0.05 was used to declare statistical significance. The assumptions of the Cox proportional hazards regression model assessed by the global test, Schoenfeld residuals. There were 503 (323 were hypertensive, 180 Non-hypertensive) confirmed first, ever adult stroke patients, the overall median age of the patients was 65 years, IQR (53-75) years. Seventy-five (14.9%) of them were dead, with a median survival time of 48 days and 428 (85.1%) of them were censored. At any particular point in time, the hazard of death among hypertensive patients was two times higher than non-hypertensive patients, but this was not found to be a statistically significant (adjusted HR=2.13: 95% CI 0.66-6.81). Glasgow Coma Scale 3-8 at admission (adjusted HR=10.12; 95% CI 2.58-40.68), presence of stroke complications (adjusted HR=7.23; 95% CI 1.86-28.26) and borderline high total cholesterol level (adjusted HR=3.57; 95% CI 1.15-11.1) were the only independent predictors of intra-hospital patient mortality. Conclusion: The overall survival time difference between hypertensive and non-hypertensive first-ever adult stroke patients was not statistically significant. Early identification and treatment of stroke complications, co-morbidities along strict follow-up of comatose patients may improve the intra-hospital survival of stroke patients, and we also recommend community-based studies using a large sample size.


Asunto(s)
Hipertensión/epidemiología , Accidente Cerebrovascular/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Etiopía/epidemiología , Femenino , Hospitales de Enseñanza , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo
15.
Front Cell Infect Microbiol ; 10: 560899, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33117727

RESUMEN

Background: Coronavirus disease (COVID-19) is a current global public health emergency. However, current research on the blood test results of pregnant women with COVID-19 is insufficient. Methods: A case-control study was carried out based on clinical blood test results. Pregnant COVID-19 patients, pregnant COVID-19 patients with diabetes, and pregnant COVID-19 patients with hypertension, were assessed in this study. Also, 120 controls were matched by age, parity, fetus number, and presence of chronic disease. T-tests, Chi-square tests, Wilcoxon signed-rank tests, and Kruskal-Wallis tests were used to compare data from the blood tests and liver function indices among the selected groups. Results: Between January 24 and March 14, 2020, 60 pregnant COVID-19 patients delivered at the Maternal and Child Health Hospital of Hubei Province. The average maternal age of pregnant COVID-19 patients was 30.97 years and the mean gestational period was 37.87 weeks. 71.67% (43/60) of pregnant COVID-19 patients gave birth by cesarean delivery. In total, 21.67% (13/60) were diagnosed with diabetes and 18.33% (11/60) were diagnosed with hypertension during pregnancy. Compared to controls, pregnant COVID-19 patients showed significantly lower numbers of blood lymphocytes and higher numbers of neutrophils, as well as higher levels of C-reactive protein and total bilirubin. Among the three groups, pregnant COVID-19 patients with diabetes had significantly higher levels of neutrophils and lower levels of total protein. Aspartate transaminase levels were higher in pregnant COVID-19 patients with hypertension than in pregnant COVID-19 patients with no comorbidities and controls with hypertension. Interpretations: Blood and liver function indices indicate that chronic complications, including hypertension and diabetes, could increase the risk of inflammation and liver injury in pregnant COVID-19 patients.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Diabetes Mellitus/diagnóstico , Hipertensión/diagnóstico , Neumonía Viral/fisiopatología , Complicaciones Infecciosas del Embarazo/virología , Adulto , Aspartato Aminotransferasas/sangre , Betacoronavirus , Bilirrubina/sangre , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Cesárea/estadística & datos numéricos , Diabetes Mellitus/sangre , Femenino , Humanos , Hipertensión/sangre , Hígado/fisiología , Pruebas de Función Hepática , Recuento de Linfocitos , Linfocitos/citología , Neutrófilos/citología , Pandemias , Embarazo
16.
J Biol Regul Homeost Agents ; 34(4 Suppl. 2): 3-9, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33000593

RESUMEN

Hypertension is a growing health problem in children, and it is an important parameter of cardiovascular risk for adults. It is classified as primary (influenced by obesity, sedentary lifestyles and poor-quality food) or secondary to underlying causes. The AAP 2017 guidelines recommend measuring blood pressure every year from the age of three and in children under the age of three only if they have known risk factors. The measurement of infantile hypertension is relatively complicated and instable and, for this reason, ambulatory blood pressure monitoring (ABPM) and multiple office BP measurement (mOBPM), especially in infants who are not collaborating are indicated. High blood pressure may have an adverse effect on the heart, the vessels, the kidney, and the central nervous system so it is important recognize it and act promptly. Hypertension is initially treated with lifestyle changes such as weight loss, a healthy diet, and regular exercise, but, if non-pharmacological interventions have failed, a pharmacological treatment with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, thiazide diuretics and/or beta blocker may be indicated.


Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial , Hipertensión , Inhibidores de la Enzima Convertidora de Angiotensina , Antihipertensivos/uso terapéutico , Niño , Ejercicio Físico , Humanos , Hipertensión/diagnóstico , Hipertensión/etiología
18.
High Blood Press Cardiovasc Prev ; 27(6): 561-568, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32949380

RESUMEN

INTRODUCTION: Concerns have been raised about the possible harmfulness of angiotensin-converter enzyme inhibitors (ACEi) and aldosterone receptor blockers (ARB) in patients with COVID-19. However, few data from a European population have been published, especially from hypertensive patients. AIM: To study the association between ACEi or ARB treatments and major adverse outcomes during hospitalisation in COVID-19 patients. METHODS: We studied 545 consecutive hypertensive patients admitted to our institution due to COVID-19 with respiratory involvement. We analysed the incidence of combined event (death or mechanical ventilatory support) during hospitalisation, as well as the time to independent events. RESULTS: 188 (34.5%) patients presented the combined endpoint. 182 (33.4%) patients died, and 21 (3.9%) needed mechanical ventilatory support. Patients with previous treatment with ACEi or ARB presented similar incidence of the combined endpoint during hospitalisation (31.6% vs. 41.8%; p = 0.08), with a lower all-cause mortality rate (30.4% vs. 41.2%; p = 0.03) compared with those without prior treatment. Use of ACEi or ARB was not independently associated with lower incidence of the combined endpoint [Adjusted OR 0.675 (95% CI 0.298-1.528; p = 0.146)], but it was associated with lower mortality [Adjusted OR 0.550 (95% CI 0.304-0.930; p = 0.047)]. CONCLUSIONS: The use of ACEi or ARB was associated with less incidence of all-cause death during hospitalisation among hypertensive patients admitted with COVID-19 respiratory infection.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Infecciones por Coronavirus/terapia , Hipertensión/tratamiento farmacológico , Neumonía Viral/terapia , Respiración Artificial , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Factores de Riesgo , España , Resultado del Tratamiento
19.
J Stroke Cerebrovasc Dis ; 29(10): 105157, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32912502

RESUMEN

Cerebral arteriovenous malformations (AVMs) are generally attributed to congenital lesions that arise from aberrant vasculogenesis between the fourth and eighth weeks of embryonic life. However, this dogma has been challenged by several recent observations, one of which is de novo formation of AVMs. Forty cases of de novo AVMs were published between 2000 and 2019, all of which involved a history of intracranial insult, such as vascular abnormalities or nonvascular conditions, prior to AVM diagnosis. We hereby present two unique operative cases of ruptured de novo AVMs in older adult patients. Case 1 is novel in the sense that the patient did not experience any kind of environmental trigger ("second hit") such as a previous intracranial insult, while Case 2 serves as the second report of a de novo AVM patient with a medical history of Bell's palsy. Although the exact mechanisms of AVM formation remain to be elucidated, it is likely to be a multifactorial process related to environmental and hemodynamic factors.


Asunto(s)
Parálisis de Bell/complicaciones , Angiopatías Diabéticas/complicaciones , Hipertensión/complicaciones , Malformaciones Arteriovenosas Intracraneales/etiología , Anciano , Parálisis de Bell/diagnóstico , Circulación Cerebrovascular , Angiopatías Diabéticas/diagnóstico , Hemodinámica , Humanos , Hipertensión/diagnóstico , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/fisiopatología , Malformaciones Arteriovenosas Intracraneales/cirugía , Masculino , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Resultado del Tratamiento
20.
Cardiovasc Ther ; 2020: 4349612, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32983258

RESUMEN

Background: Central aortic blood pressure (CABP) indices, central hemodynamics, and arterial stiffness are better predictors of cardiovascular events as compared with brachial cuff pressure measurements alone. The present study is aimed at assessing the effects of different antihypertensive drug combination regimens involving renin-angiotensin-aldosterone system (RAAS) inhibitors on CABP indices in Indian patients with hypertension. Methods: This was a cross-sectional, single-center study conducted in patients treated for hypertension for >6 weeks using different treatment regimens involving the combination of RAAS inhibitors with drugs from other classes. CABP indices, vascular age, arterial stiffness, and central hemodynamics were measured in patients using the noninvasive Agedio B900 device (IEM, Stolberg, Germany) and compared between different treatment regimens. Results: A total of 199 patients with a mean age of 54.22 ± 10.15 years were enrolled, where 68.8% had hypertension for over three years and 50.25% had their systolic blood pressure (SBP) < 140 mmHg. Combination treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was given to 77.9% and to 20.1% patients, respectively. The mean vascular age was higher than the actual age (58.13 ± 12.43 vs. 54.22 ± 10.15, p = 0.001). The SBP and diastolic blood pressure (DBP) levels in patients treated with ACEI-based combinations were lower than those in patients treated with ARB-based combinations (p < 0.05). The mean central pulse pressure amplification, augmentation pressure, and augmentation index were lower in patients treated with ACEI-based combinations than those treated with other treatments (p = 0.001). In a subgroup analysis, patients given perindopril and calcium channel blockers (CCBs) or diuretics had significantly lower CABP and pulse wave velocity than those given other treatments (p < 0.05). A total of 6.5% patients experienced any side effects. Conclusion: The majority of central hemodynamic parameters, including vascular age, were found to improve more effectively in patients treated with ACEIs than with ARBs. Our results indicate a gap between routine clinical practice and evidence-based guidelines in Indian settings and identify a need to reevaluate the current antihypertensive prescription strategy.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Presión Arterial/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Sistema Renina-Angiotensina/efectos de los fármacos , Adulto , Anciano , Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Estudios Transversales , Quimioterapia Combinada , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , India , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
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