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1.
Cochrane Database Syst Rev ; 12: CD004022, 2020 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-33314019

RESUMEN

BACKGROUND: Recent cohort studies show that salt intake below 6 g is associated with increased mortality. These findings have not changed public recommendations to lower salt intake below 6 g, which are based on assumed blood pressure (BP) effects and no side-effects. OBJECTIVES: To assess the effects of sodium reduction on BP, and on potential side-effects (hormones and lipids) SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to April 2018 and a top-up search in March 2020: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. The top-up search articles are recorded under "awaiting assessment." SELECTION CRITERIA: Studies randomizing persons to low-sodium and high-sodium diets were included if they evaluated at least one of the outcome parameters (BP, renin, aldosterone, noradrenalin, adrenalin, cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride,. DATA COLLECTION AND ANALYSIS: Two review authors independently collected data, which were analysed with Review Manager 5.3. Certainty of evidence was assessed using GRADE. MAIN RESULTS: Since the first review in 2003 the number of included references has increased from 96 to 195 (174 were in white participants). As a previous study found different BP outcomes in black and white study populations, we stratified the BP outcomes by race. The effect of sodium reduction (from 203 to 65 mmol/day) on BP in white participants was as follows: Normal blood pressure: SBP: mean difference (MD) -1.14 mmHg (95% confidence interval (CI): -1.65 to -0.63), 5982 participants, 95 trials; DBP: MD + 0.01 mmHg (95% CI: -0.37 to 0.39), 6276 participants, 96 trials. Hypertension: SBP: MD -5.71 mmHg (95% CI: -6.67 to -4.74), 3998 participants,88 trials; DBP: MD -2.87 mmHg (95% CI: -3.41 to -2.32), 4032 participants, 89 trials (all high-quality evidence). The largest bias contrast across studies was recorded for the detection bias element. A comparison of detection bias low-risk studies versus high/unclear risk studies showed no differences. The effect of sodium reduction (from 195 to 66 mmol/day) on BP in black participants was as follows: Normal blood pressure: SBP: mean difference (MD) -4.02 mmHg (95% CI:-7.37 to -0.68); DBP: MD -2.01 mmHg (95% CI:-4.37, 0.35), 253 participants, 7 trials. Hypertension: SBP: MD -6.64 mmHg (95% CI:-9.00, -4.27); DBP: MD -2.91 mmHg (95% CI:-4.52, -1.30), 398 participants, 8 trials (low-quality evidence). The effect of sodium reduction (from 217 to 103 mmol/day) on BP in Asian participants was as follows: Normal blood pressure: SBP: mean difference (MD) -1.50 mmHg (95% CI: -3.09, 0.10); DBP: MD -1.06 mmHg (95% CI:-2.53 to 0.41), 950 participants, 5 trials. Hypertension: SBP: MD -7.75 mmHg (95% CI:-11.44, -4.07); DBP: MD -2.68 mmHg (95% CI: -4.21 to -1.15), 254 participants, 8 trials (moderate-low-quality evidence).   During sodium reduction renin increased 1.56 ng/mL/hour (95%CI:1.39, 1.73) in 2904 participants (82 trials); aldosterone increased 104 pg/mL (95%CI:88.4,119.7) in 2506 participants (66 trials); noradrenalin increased 62.3 pg/mL: (95%CI: 41.9, 82.8) in 878 participants (35 trials); adrenalin increased 7.55 pg/mL (95%CI: 0.85, 14.26) in 331 participants (15 trials); cholesterol increased 5.19 mg/dL (95%CI:2.1, 8.3) in 917 participants (27 trials); triglyceride increased 7.10 mg/dL (95%CI: 3.1,11.1) in 712 participants (20 trials); LDL tended to increase 2.46 mg/dl (95%CI: -1, 5.9) in 696 participants (18 trials); HDL was unchanged -0.3 mg/dl (95%CI: -1.66,1.05) in 738 participants (20 trials) (All high-quality evidence except the evidence for adrenalin). AUTHORS' CONCLUSIONS: In white participants, sodium reduction in accordance with the public recommendations resulted in mean arterial pressure (MAP) decrease of about 0.4 mmHg in participants with normal blood pressure and a MAP decrease of about 4 mmHg in participants with hypertension. Weak evidence indicated that these effects may be a little greater in black and Asian participants. The effects of sodium reduction on potential side effects (hormones and lipids) were more consistent than the effect on BP, especially in people with normal BP.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Dieta Hiposódica , Hipertensión/dietoterapia , Cloruro de Sodio Dietético/farmacología , Grupo de Ascendencia Continental Africana , Aldosterona/sangre , Grupo de Ascendencia Continental Asiática , Sesgo , Catecolaminas/sangre , Colesterol/sangre , Intervalos de Confianza , Epinefrina/sangre , Grupo de Ascendencia Continental Europea , Humanos , Hipertensión/etnología , Norepinefrina/sangre , Ensayos Clínicos Controlados Aleatorios como Asunto , Ingesta Diaria Recomendada , Renina/sangre , Triglicéridos/sangre
2.
N Z Med J ; 133(1527): 51-70, 2020 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-33332328

RESUMEN

AIM: To update data previously published on the health profile of the refugees resettling in New Zealand, and to draw attention to the change in health profile over time, with a decline of infectious disease/deficiencies, and a rise of non-communicable diseases, a worldwide phenomenon. METHOD: Comparative data was extracted from (1) written annual reports prepared by medical officers at the Mangere Refugee Resettlement Centre (1978-1991), (2) a Microsoft ACCESS patient management system between 1995 and 1999 and (3) a MEDTECH patient management system between 2010 and 2014. RESULTS: Over the period 1979-2014, the rate of infectious diseases has declined markedly in resettling refugees, and the rate of non-communicable diseases has increased. For example, the incidence of tuberculosis has decreased from 4% to 0.2%, gut parasites from more than 40% to, in some intakes, 15% and iron deficiency from 22% to 10%, while the diabetes rate has gone from 0.1% to 2.7%. CONCLUSION: While management of unfamiliar infectious diseases and deficiencies (especially vitamin D) still remains an important part of the management of refugee health, their management usually involves limited time and expense, and their burden is much less than before. However, refugees now resettling in New Zealand and the rest of the world often present with familiar non-communicable diseases that require long-term management.


Asunto(s)
Estado de Salud , Estilo de Vida/etnología , Atención Primaria de Salud/estadística & datos numéricos , Refugiados/estadística & datos numéricos , Adolescente , Adulto , África del Sur del Sahara/etnología , Anciano , Anciano de 80 o más Años , Asia Sudoriental/etnología , Bután/etnología , Índice de Masa Corporal , Niño , Preescolar , Colombia/etnología , Conducta Anticonceptiva/etnología , Conducta Anticonceptiva/tendencias , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/etnología , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Infecciones por VIH/etnología , Infecciones por Helicobacter/etnología , Helicobacter pylori , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etnología , Lactante , Recién Nacido , Parasitosis Intestinales/etnología , Irak/etnología , Masculino , Salud Mental/etnología , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Prevalencia , Enfermedades de Transmisión Sexual/etnología , Uso de Tabaco/etnología , Tuberculosis Pulmonar/etnología , Deficiencia de Vitamina D/etnología , Adulto Joven
3.
JAMA ; 324(14): 1429-1438, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-33048153

RESUMEN

Importance: The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person's place of residence vs the characteristics of the people who live in different places remains unclear. Objective: To estimate the degree to which geographic differences in leading risk factors are associated with a person's place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. Design, Setting, and Participants: This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers' destination and origin zip codes and changes in individuals' likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. Exposures: The difference in the prevalence of uncontrolled chronic conditions between a person's origin zip code and destination zip code (excluding the individual mover's outcomes). Main Outcomes and Measures: Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. Results: The study population included 5 342 207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. Conclusions and Relevance: In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals' likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals' likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person's place of residence.


Asunto(s)
Trastorno Depresivo/epidemiología , Diabetes Mellitus/epidemiología , Migración Humana/estadística & datos numéricos , Hipertensión/epidemiología , Obesidad/epidemiología , Características de la Residencia/estadística & datos numéricos , Enfermedad Crónica/epidemiología , Enfermedad Crónica/etnología , Trastorno Depresivo/etnología , Diabetes Mellitus/etnología , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Geografía Médica , Migración Humana/tendencias , Humanos , Hipertensión/etnología , Masculino , Persona de Mediana Edad , Obesidad/etnología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Incertidumbre , Estados Unidos/epidemiología , Estados Unidos/etnología , Servicios de Salud para Veteranos/estadística & datos numéricos
4.
JAMA ; 324(12): 1190-1200, 2020 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-32902588

RESUMEN

Importance: Controlling blood pressure (BP) reduces the risk for cardiovascular disease. Objective: To determine whether BP control among US adults with hypertension changed from 1999-2000 through 2017-2018. Design, Setting, and Participants: Serial cross-sectional analysis of National Health and Nutrition Examination Survey data, weighted to be representative of US adults, between 1999-2000 and 2017-2018 (10 cycles), including 18 262 US adults aged 18 years or older with hypertension defined as systolic BP level of 140 mm Hg or higher, diastolic BP level of 90 mm Hg or higher, or use of antihypertensive medication. The date of final data collection was 2018. Exposures: Calendar year. Main Outcomes and Measures: Mean BP was computed using 3 measurements. The primary outcome of BP control was defined as systolic BP level lower than 140 mm Hg and diastolic BP level lower than 90 mm Hg. Results: Among the 51 761 participants included in this analysis, the mean (SD) age was 48 (19) years and 25 939 (50.1%) were women; 43.2% were non-Hispanic White adults; 21.6%, non-Hispanic Black adults; 5.3%, non-Hispanic Asian adults; and 26.1%, Hispanic adults. Among the 18 262 adults with hypertension, the age-adjusted estimated proportion with controlled BP increased from 31.8% (95% CI, 26.9%-36.7%) in 1999-2000 to 48.5% (95% CI, 45.5%-51.5%) in 2007-2008 (P < .001 for trend), remained stable and was 53.8% (95% CI, 48.7%-59.0%) in 2013-2014 (P = .14 for trend), and then declined to 43.7% (95% CI, 40.2%-47.2%) in 2017-2018 (P = .003 for trend). Compared with adults who were aged 18 years to 44 years, it was estimated that controlled BP was more likely among those aged 45 years to 64 years (49.7% vs 36.7%; multivariable-adjusted prevalence ratio, 1.18 [95% CI, 1.02-1.37]) and less likely among those aged 75 years or older (37.3% vs 36.7%; multivariable-adjusted prevalence ratio, 0.81 [95% CI, 0.65-0.97]). It was estimated that controlled BP was less likely among non-Hispanic Black adults vs non-Hispanic White adults (41.5% vs 48.2%, respectively; multivariable-adjusted prevalence ratio, 0.88; 95% CI, 0.81-0.96). Controlled BP was more likely among those with private insurance (48.2%), Medicare (53.4%), or government health insurance other than Medicare or Medicaid (43.2%) vs among those without health insurance (24.2%) (multivariable-adjusted prevalence ratio, 1.40 [95% CI, 1.08-1.80], 1.47 [95% CI, 1.15-1.89], and 1.36 [95% CI, 1.04-1.76], respectively). Controlled BP was more likely among those with vs those without a usual health care facility (48.4% vs 26.5%, respectively; multivariable-adjusted prevalence ratio, 1.48 [95% CI, 1.13-1.94]) and among those who had vs those who had not had a health care visit in the past year (49.1% vs 8.0%; multivariable-adjusted prevalence ratio, 5.23 [95% CI, 2.88-9.49]). Conclusions and Relevance: In a series of cross-sectional surveys weighted to be representative of the adult US population, the prevalence of controlled BP increased between 1999-2000 and 2007-2008, did not significantly change from 2007-2008 through 2013-2014, and then decreased after 2013-2014.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/epidemiología , Adulto , Anciano , Presión Sanguínea , Estudios Transversales , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etnología , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Prevalencia , Estados Unidos/epidemiología
5.
Nat Commun ; 11(1): 3865, 2020 07 31.
Artículo en Inglés | MEDLINE | ID: mdl-32737319

RESUMEN

Polygenic scores (PGS) have been widely used to predict disease risk using variants identified from genome-wide association studies (GWAS). To date, most GWAS have been conducted in populations of European ancestry, which limits the use of GWAS-derived PGS in non-European ancestry populations. Here, we derive a theoretical model of the relative accuracy (RA) of PGS across ancestries. We show through extensive simulations that the RA of PGS based on genome-wide significant SNPs can be predicted accurately from modelling linkage disequilibrium (LD), minor allele frequencies (MAF), cross-population correlations of causal SNP effects and heritability. We find that LD and MAF differences between ancestries can explain between 70 and 80% of the loss of RA of European-based PGS in African ancestry for traits like body mass index and type 2 diabetes. Our results suggest that causal variants underlying common genetic variation identified in European ancestry GWAS are mostly shared across continents.


Asunto(s)
Asma/genética , Diabetes Mellitus Tipo 2/genética , Hipertensión/genética , Modelos Genéticos , Herencia Multifactorial , Polimorfismo de Nucleótido Simple , Adulto , África/epidemiología , Anciano , Alelos , Asia/epidemiología , Asma/diagnóstico , Asma/epidemiología , Asma/etnología , Índice de Masa Corporal , Colesterol/sangre , Simulación por Computador , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etnología , Europa (Continente)/epidemiología , Femenino , Frecuencia de los Genes , Estudio de Asociación del Genoma Completo , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/etnología , Desequilibrio de Ligamiento , Masculino , Persona de Mediana Edad , Pronóstico , Carácter Cuantitativo Heredable , Riesgo
6.
J Natl Black Nurses Assoc ; 31(1): 46-51, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32853496

RESUMEN

African-Americans are disproportionately affected by hypertension with lower rates of blood pressure control in comparison to the general population (Brennan et al., 2010). Low-sodium dietary intake is one of the most important lifestyle changes that can help control hypertension (Zhang et al., 2013). This qualitative study aimed to explore and describe the perceptions and experiences of low-sodium dietary practices among African-American women with hypertension. The study used a single-category focus group design. The findings suggest that African-American women are attempting to follow a low-sodium diet; however, they are influenced by personal and environmental factors and lack a clear understanding of what a low-sodium diet entails. Therefore, nurses must understand the factors that influence African-American women's ability to follow a low-sodium diet so that effective interventions can be implemented to improve adherence in this population.


Asunto(s)
Afroamericanos/psicología , Dieta Hiposódica/etnología , Dieta Hiposódica/psicología , Hipertensión/dietoterapia , Hipertensión/etnología , Afroamericanos/estadística & datos numéricos , Dieta Hiposódica/enfermería , Femenino , Grupos Focales , Disparidades en el Estado de Salud , Humanos , Hipertensión/enfermería , Investigación Cualitativa , Cumplimiento y Adherencia al Tratamiento/etnología
7.
J Natl Black Nurses Assoc ; 31(1): 52-59, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32853497

RESUMEN

African-Americans with hypertension continue to demonstrate poor blood pressure (BP) control and have markedly lower rates of hypertension self-management compared to non-African-Americans. Innovative and practical solutions such as mHealth technology are promising and can be leveraged to promote self-management of hypertension. Substantial evidence has demonstrated the importance of community support in improving patients' management of chronic illnesses. Unfortunately, such programs do not offer technology-based interventions (TBI) as a delivery method. Thus, this paper describes the design and rationale of an ongoing pilot study that incorporates TBI using a community-based participatory approach.


Asunto(s)
Afroamericanos , Hipertensión/etnología , Hipertensión/terapia , Automanejo/métodos , Investigación Participativa Basada en la Comunidad , Disparidades en el Estado de Salud , Humanos , Proyectos Piloto , Telemedicina
8.
Vasc Health Risk Manag ; 16: 299-305, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32764950

RESUMEN

Objective: The main aim of this study was to investigate predictive factors of adherence to the hypertension control therapeutic and lifestyle recommendations in a sample of Iranian patients based on the constructs of Pender's health promotion model. Patients and Methods: The cross-sectional study was performed on the 380 hypertensive patients who were referred to the health centers, the emergency and internal diseases departments of the Bagheralolom Hospital, and the cardiologists' offices in the city of Ahar, North West of Iran. Data were collected using a researcher designed questionnaire based on the Pender's health promotion model. The Pearson correlation test, multivariate linear regression, and independent t-test were used for data analysis. Results: Mean age of the recruited patients was 52.94 (SD=12.8). Perceived benefits, perceived barriers, situational influences, and interpersonal influences (adjusted R2= 0.525) explained 52.5% of the observed variation in adherence to hypertension control recommendations. Conclusion: Successful hypertension control in patients with chronic morbidity need to be based on sound data about major determinants of the relevant health/illness behaviors. The study findings revealed that the Pender's health promotion model could be applicable as a theoretical framework to identify major determinants of adherence to hypertension control recommendations. Future cross-cultural validation of the study findings in more representative and larger sample sizes could add to the legitimacy of the evidence surrounding self-care practices in hypertensive patients.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Hipertensión/terapia , Cumplimiento de la Medicación , Modelos Teóricos , Conducta de Reducción del Riesgo , Adulto , Anciano , Antihipertensivos/efectos adversos , Estudios Transversales , Características Culturales , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Hipertensión/etnología , Hipertensión/fisiopatología , Hipertensión/psicología , Irán/epidemiología , Masculino , Cumplimiento de la Medicación/etnología , Persona de Mediana Edad , Resultado del Tratamiento
9.
J Pregnancy ; 2020: 7864816, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32802511

RESUMEN

Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the most significant causes of maternal morbidity and mortality. Hypertensive disorders, specifically gestational hypertension, chronic hypertension, and preeclampsia, throughout pregnancy are contributors to the top causes of maternal mortality in the United States. Diagnosis of hypertensive disorders throughout pregnancy is challenging, with many disorders often remaining unrecognized or poorly managed during and after pregnancy. Moreover, the research has identified a strong link between the prevalence of maternal hypertensive disorders and racial and ethnic disparities. Factors that influence the prevalence of maternal hypertensive disorders among racially and ethnically diverse women include maternal age, level of education, United States-born status, nonmetropolitan residence, prepregnancy obesity, excess weight gain during pregnancy, and gestational diabetes. Examination of the factors that increase the risk for maternal hypertensive disorders along with the current interventions utilized to manage hypertensive disorders will assist in the identification of gaps in prevention and treatment strategies and implications for future practice. Specific focus will be placed on disparities among racially and ethnically diverse women that increase the risk for maternal hypertensive disorders. This review will serve to promote the development of interventions and strategies that better address and prevent hypertensive disorders throughout a pregnant woman's continuum of care.


Asunto(s)
Disparidades en Atención de Salud/tendencias , Hipertensión/epidemiología , Hipertensión/prevención & control , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/prevención & control , Factores de Edad , Grupos de Población Continentales , Diabetes Gestacional , Escolaridad , Femenino , Humanos , Hipertensión/etnología , Hipertensión/etiología , Embarazo , Complicaciones del Embarazo/etnología , Complicaciones del Embarazo/etiología , Prevalencia , Riesgo , Estados Unidos/epidemiología , Aumento de Peso
10.
BMC Public Health ; 20(1): 1068, 2020 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-32631296

RESUMEN

BACKGROUND: Cardiovascular disease (CVD) prevalence has increased continuously over the last 30 years in China. Dyslipidemia is an important modifiable risk factor in CVD. We aimed to collect current data on the prevalence of dyslipidemia in northern China and explore potential influencing factors. METHODS: In this cross-sectional study, we selected a representative sample of 65,128 participants aged ≥35 years in Inner Mongolia during 2015-2017. All participants completed a questionnaire and were examined for risk factors. Dyslipidemia was defined according to 2016 Chinese guidelines for adults. The associated factors for dyslipidemia were estimated by multivariate logistic regression analysis. RESULTS: The age-standardized prevalence of dyslipidemia was 31.2% overall, with 4.3, 2.4, 14.7, and 17.4% for high total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-C), respectively. The dyslipidemia prevalence was significantly higher in men than women (37.9% vs. 27.5%, P < 0.001), but postmenopausal women had a higher prevalence of dyslipidemia components (except low HDL-C). Compared with Han participants, Mongol participants had a lower prevalence of dyslipidemia (29.1% vs. 31.4%, P < 0.001). Male sex, living in urban areas, Han ethnicity, smoking, obesity, central obesity, hypertension, and diabetes were all positively correlated with dyslipidemia; alcohol consumption was linked to lower risk of dyslipidemia. CONCLUSIONS: Our study revealed that dyslipidemia is a health problem in northern China. Greater efforts to prevent and manage dyslipidemia, especially in men under age 55 years, postmenopausal women, and people with unhealthy lifestyles or chronic diseases.


Asunto(s)
Factores de Edad , Dislipidemias/epidemiología , Grupos Étnicos/estadística & datos numéricos , Factores Sexuales , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/etnología , China/epidemiología , Estudios Transversales , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etnología , Dislipidemias/etnología , Dislipidemias/etiología , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Hipertensión/etnología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/etnología , Prevalencia , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Fumar/etnología
11.
J Stroke Cerebrovasc Dis ; 29(8): 104987, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32689593

RESUMEN

BACKGROUND AND PURPOSE: Recent studies show rising incidence of stroke in the young, for which risk factors are not well characterized. There is evidence of increased risk in certain racial and ethnic groups. We assessed racial differences in risk factors, stroke etiology, and outcomes among young stroke patients. METHODS: Using data from our inpatient registry for ischemic stroke, we reviewed patients aged 18-50 who were admitted 01/2013 to 04/2018. Race/ethnicity were characterized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HIS). For univariate comparisons Chi-square and Kruskal-Wallis tests were performed as appropriate. Multivariable logistic regression was used to assess impact of race on day seven modified Rankin score (mRS). RESULTS: Among 810 patients with race and outcome data who were admitted in the study period, median age was 43, 57.1% were male, and 36.5% NHW, 43.2% NHB, 20.2% HIS. History of hypertension (HTN), type II diabetes (DM II), smoking, heart failure (CHF), prior stroke, and end-stage renal disease varied significantly by race. Compared to NHW, NHB had higher odds of HTN (OR 2.28, 1.65-3.15), CHF (OR 2.17, 1.06-4.46), and DM II 1.92 (1.25-2.94) while HIS had higher odds of DM II (OR 2.52, 1.55-4.10) and lower odds of smoking (OR 0.56, 0.35-0.90). Arrival NIHSS was higher in NHB, but etiology and rates of tpA treatment and thrombectomy did not vary by race. Compared to NHW patients, NHB (OR 0.50 CI (0.31-0.78)) and HIS (OR 0.37 CI (0.21-0.67)) were less likely to have good functional outcome (mRS <2) at day 7 in adjusted analyses. CONCLUSIONS: In this study, there was a higher prevalence of several modifiable risk factors in NHB and HIS young stroke patients and early functional outcome was worse in these groups. Our study suggests a need for targeted prevention efforts for younger populations at highest risk for stroke.


Asunto(s)
Afroamericanos , Isquemia Encefálica/etnología , Grupo de Ascendencia Continental Europea , Disparidades en el Estado de Salud , Hispanoamericanos , Accidente Cerebrovascular/etnología , Adolescente , Adulto , Factores de Edad , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatología , Bases de Datos Factuales , Diabetes Mellitus/etnología , Evaluación de la Discapacidad , Femenino , Humanos , Hipertensión/etnología , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Factores Raciales , Recuperación de la Función , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Fumar/efectos adversos , Fumar/etnología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Texas/epidemiología , Factores de Tiempo , Adulto Joven
12.
South Med J ; 113(6): 311-319, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32483642

RESUMEN

OBJECTIVES: Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18-39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored. METHODS: A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors. RESULTS: Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124). CONCLUSIONS: Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.


Asunto(s)
Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Hipertensión/epidemiología , Obesidad/epidemiología , Enfermedades Vasculares Periféricas/epidemiología , Fumar/epidemiología , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etnología , Americanos Asiáticos/estadística & datos numéricos , Bases de Datos Factuales , Diabetes Mellitus/etnología , Dislipidemias/etnología , Grupos Étnicos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización , Humanos , Hipertensión/etnología , Indios Norteamericanos/estadística & datos numéricos , Masculino , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etnología , Obesidad/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Enfermedades Vasculares Periféricas/etnología , Prevalencia , Factores de Riesgo , Factores Sexuales , Fumar/etnología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etnología , Estados Unidos/epidemiología , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etnología , Adulto Joven
13.
J Natl Med Assoc ; 112(3): 315-323, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32563685

RESUMEN

BACKGROUND: Cardiovascular disease related mortality is the leading cause of death in the United States, with hypertension being the most prevalent and potent risk factor. For decades hypertension has disproportionately affected African Americans, who also have a higher burden of associated comorbidities including diabetes and heart failure. METHODS: Current literature including guideline reports and newer studies on hypertension in African Americans in PubMed were reviewed. We also reviewed newer publications on the relationship between COVID-19 and cardiovascular disease. FINDINGS: While APOL1 has been theorized in the epidemiology of hypertension, the increased prevalence and associated risks are primarily due to environmental and lifestyle factors. These factors include poor diet, adverse lifestyle, and social determinants. Hypertension control can be achieved by lifestyle modifications such as low sodium diet, weight loss, and adequate physical activity. When lifestyle modifications alone do not adequately control hypertension, a common occurrence among African Americans who suffer with greater prevalence of resistant hypertension, pharmacological intervention is indicated. The efficacy of renal denervation, and the use of sodium-glucose cotransporter 2 and aminopeptidase A inhibitors, have been studied for treatment of resistant hypertension. Furthermore, the recent COVID-19 crisis has been particularly devastating among African Americans who demonstrate increased incidence and poorer health outcomes related to the disease. CONCLUSION: The disparities in outcomes, which are largely attributable to a greater prevalence of comorbidities such as hypertension and obesity, in addition to adverse environmental and socioeconomic factors, highlight the necessity of specialized clinical approaches and programs for African Americans to address longstanding barriers to equitable care.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Enfermedades Cardiovasculares/etnología , Infecciones por Coronavirus/etnología , Disparidades en Atención de Salud/etnología , Hipertensión/etnología , Neumonía Viral/etnología , Poblaciones Vulnerables/estadística & datos numéricos , Adulto , Anciano , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus/epidemiología , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Hipertensión/diagnóstico , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Pandemias , Neumonía Viral/epidemiología , Prevalencia , Factores Socioeconómicos , Análisis de Supervivencia , Estados Unidos/epidemiología
15.
J Stroke Cerebrovasc Dis ; 29(7): 104754, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32370925

RESUMEN

BACKGROUND AND AIM: It is unclear whether blood pressure (BP) is associated with cognition after stroke. We examined associations between systolic and diastolic BP (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP), and cognition, each measured 90 days after stroke. METHODS: Cross-sectional analysis of prospectively obtained data of 432 dementia-free subjects greater than or equal to 45 (median age, 66; 45% female) with stroke (92% ischemic; median NIH stroke score, 3 [IQR, 2-6]) from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project in 2011-2013. PRIMARY OUTCOME: Modified Mini-Mental Status Examination (3MSE; range, 0-100). SECONDARY OUTCOMES: Animal Fluency Test (AFT; range, 0-10) and Trail Making Tests A and B (number of correct items [range, 0-25]/completion time [Trails A: 0-180 seconds; Trails B: 0-300 second]). Linear or tobit regression adjusted associations for age, education, and race/ethnicity as well as variables significantly associated with BP and cognition. RESULTS: Higher SBP, lower DBP, higher PP, and lower MAP each were associated with worse cognitive performance for all 4 tests (all P < .001). After adjusting for patient factors, no BP measures were associated with any of the 4 tests (all P > .05). Lower cognitive performance was associated with older age, less education, Mexican American ethnicity, diabetes, higher stroke severity, more depressive symptoms, and lower BMI. Among survivors with hypertension, anti-hypertensive medication use 90 days after stroke was significantly associated with higher AFT scores (P = .02) but not other tests (P > .15). CONCLUSIONS: Stroke survivors' BP levels were not associated with cognitive performance at 90 days independent of sociodemographic and clinical factors.


Asunto(s)
Presión Sanguínea , Trastornos del Conocimiento/etnología , Cognición , Hipertensión/etnología , Accidente Cerebrovascular/etnología , Anciano , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Cognición/efectos de los fármacos , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/fisiopatología , Trastornos del Conocimiento/psicología , Estudios Transversales , Evaluación de la Discapacidad , Grupo de Ascendencia Continental Europea , Función Ejecutiva , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Masculino , Pruebas de Estado Mental y Demencia , Americanos Mexicanos , Persona de Mediana Edad , Pruebas Neuropsicológicas , Pronóstico , Factores de Riesgo , Determinantes Sociales de la Salud/economía , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Texas/epidemiología , Factores de Tiempo
16.
N Z Med J ; 133(1514): 33-40, 2020 05 08.
Artículo en Inglés | MEDLINE | ID: mdl-32379737

RESUMEN

BACKGROUND: Aortic dissection is a life-threatening condition frequently requiring emergency surgery. Key risk factors include hypertension and aortopathy syndromes; however, possible ethnic associations and differences in presentation and outcomes are less well established. We compared characteristics and outcomes of type A aortic dissection surgery by ethnicity. METHODS: Consecutive patients having type A aortic dissection surgery at Auckland City Hospital March 2003-March 2017 were divided into three ethnic groups: Maori, Pasifika and 'other', and analysed for characteristics, presentation and outcomes. RESULTS: Among 327 patients, 45 (14%) were Maori, 91 (28%) were Pasifika Islander and 191 (58%) were other ethnicities. Mean age was lowest for Maori 51+/-12 years, then Pasifika 56+/-12 and other ethnicities 63+/-13 (P<0.001). Maori and Pasifika ethnicities had higher body mass index, more hypertension, dyslipidaemia and smoking, but lower proportion presenting in critical pre-operative state. Operative mortality occurred in 5 (11%), 18 (20%) and 42 (22%) for Maori, Pasifika and other ethnicities (P=0.258). Pasifika had higher age-standardised operative mortality standardised mortality ratio 6.00, 95% confidence interval 3.67-9.30 than 'other' ethnicities, while Maori had higher age-standardised late mortality 5.71, 2.90-10.2 respectively, and the latter association persisted in multivariable analysis. Critical pre-operative state and malperfusion syndrome independently predicted operative mortality. CONCLUSION: Maori and Pasifika patients were younger and present less unwell with type A aortic dissection, but had higher prevalence of cardiovascular risk factors. They had higher age-standardised late and operative mortality respectively, suggesting that aggressive management and risk factor control are critical for these patients.


Asunto(s)
Aneurisma Disecante/etnología , Aneurisma Disecante/cirugía , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Procedimientos Quirúrgicos Vasculares/mortalidad , Adulto , Anciano , Índice de Masa Corporal , Dislipidemias/etnología , Femenino , Humanos , Hipertensión/etnología , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Gravedad del Paciente , Factores de Riesgo , Fumar/etnología , Resultado del Tratamiento
17.
Nutr Metab Cardiovasc Dis ; 30(8): 1249-1259, 2020 07 24.
Artículo en Inglés | MEDLINE | ID: mdl-32446870

RESUMEN

BACKGROUND AND AIMS: The alcohol-hypertension relation has been well documented, but whether women have protective effect or race and type of beverage consumed affect the association remain unclear. To quantify the relation between total or beverage-specific alcohol consumption and incident hypertension by considering the effect of sex and race. METHODS AND RESULTS: Articles were identified in PubMed and Embase databases with no restriction on publication date. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated by random effects models. Restricted cubic splines were used to model the dose-response association. This study involved 22 articles (31 studies) and included 414,477 participants. The hypertension risk was different among liquor, wine, and beer at 5.1-10 g/d of ethanol consumption (P-across subgroups = 0.002). The hypertension risk differed between men (RR: 1.14, 95% CI: 1.07, 1.20) and women (RR: 0.98, 95% CI: 0.89, 1.06) at 10 g/d (P-across subgroups = 0.005). We found a linear alcohol-hypertension association among white (P-linearity = 0.017), black people (P-linearity = 0.035), and Asians (P-linearity<0.001). With 10 g/d increment of consumption, the RRs for hypertension were 1.06 (95% CI: 1.04, 1.08), 1.14 (95% CI: 1.01, 1.28), and 1.06 (95% CI: 1.01, 1.10) for Asians, black, and white people, respectively. CONCLUSION: Sex modifies the alcohol-hypertension association at low level of alcohol consumption and we did not find evidence of a protective effect of alcohol consumption among women. Black people may have higher hypertension risk than Asians and white people at the same ethanol consumption.


Asunto(s)
Grupo de Ascendencia Continental Africana , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/etnología , Bebidas Alcohólicas/efectos adversos , Grupo de Ascendencia Continental Asiática , Presión Sanguínea , Grupo de Ascendencia Continental Europea , Hipertensión/etnología , Cerveza/efectos adversos , Relación Dosis-Respuesta a Droga , Etanol/efectos adversos , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Incidencia , Masculino , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Vino/efectos adversos
18.
Arch Cardiovasc Dis ; 113(6-7): 433-442, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32434710

RESUMEN

BACKGROUND: Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. AIMS: To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. METHODS: We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. RESULTS: Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. CONCLUSIONS: High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Dieta Hiposódica , Hipertensión/terapia , Cumplimiento de la Medicación/etnología , Conducta de Reducción del Riesgo , África del Sur del Sahara/epidemiología , Grupo de Ascendencia Continental Africana , Anciano , Estudios Transversales , Dieta Hiposódica/etnología , Femenino , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Hipertensión/diagnóstico , Hipertensión/etnología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento
19.
BMC Public Health ; 20(1): 566, 2020 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-32345300

RESUMEN

BACKGROUND: Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. METHODS: Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors. RESULTS: After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16-1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01-1.52 and PR 1.13 95% CI 1.03-1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03-1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46-0.84). CONCLUSIONS: Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.


Asunto(s)
Afecto , Afroamericanos/psicología , Enfermedades Cardiovasculares/psicología , Adulto , Anciano , Ira , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etnología , Estudios Transversales , Depresión/complicaciones , Depresión/epidemiología , Depresión/etnología , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etnología , Diabetes Mellitus/psicología , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/etnología , Hipertensión/psicología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/etnología , Obesidad/psicología , Distribución de Poisson , Prevalencia , Análisis de Regresión , Factores de Riesgo , Factores Sexuales , Clase Social , Estrés Psicológico/complicaciones , Estrés Psicológico/epidemiología , Estrés Psicológico/etnología
20.
Lancet ; 395(10234): 1444-1451, 2020 05 02.
Artículo en Inglés | MEDLINE | ID: mdl-32234534

RESUMEN

BACKGROUND: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. METHODS: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. FINDINGS: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0·999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was -3·9 mm Hg (Bayesian 95% credible interval -6·2 to -1·6) and for office systolic blood pressure the difference was -6·5 mm Hg (-9·6 to -3·5). No major device-related or procedural-related safety events occurred up to 3 months. INTERPRETATION: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. FUNDING: Medtronic.


Asunto(s)
Hipertensión/cirugía , Riñón/inervación , Riñón/cirugía , Adulto , Antihipertensivos/normas , Australia/epidemiología , Austria/epidemiología , Teorema de Bayes , Presión Sanguínea/fisiología , Canadá/epidemiología , Femenino , Alemania/epidemiología , Grecia/epidemiología , Humanos , Hipertensión/diagnóstico , Hipertensión/etnología , Irlanda/epidemiología , Japón/epidemiología , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Placebos/efectos adversos , Estudios Prospectivos , Simpatectomía/métodos , Resultado del Tratamiento , Reino Unido/epidemiología , Estados Unidos/epidemiología
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