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1.
Front Endocrinol (Lausanne) ; 12: 652765, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33841339

RESUMEN

Previous studies link obesity and components of metabolic health, such as hypertension or inflammation, to increased hospitalizations and mortality of patients with COVID-19. Here, in two overlapping samples of over 1,000 individuals from the UK Biobank we investigate whether metabolic health as measured by waist circumference, dyslipidemia, hypertension, type 2 diabetes, and systemic inflammation is related to increased COVID-19 infection and mortality rate. Using logistic regression and controlling for confounding variables such as socioeconomic status, age, sex or ethnicity, we find that individuals with worse metabolic health (measured on average eleven years prior to 2020) have an increased risk for COVID-19-related death (adjusted odds ratio: 1.75). We also find that specific factors contributing to increased mortality are increased serum glucose levels, systolic blood pressure and waist circumference.


Asunto(s)
/complicaciones , Estado de Salud , Enfermedades Metabólicas/complicaciones , Enfermedades Metabólicas/mortalidad , Anciano , Anciano de 80 o más Años , Glucemia , Presión Sanguínea , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/mortalidad , Dislipidemias/complicaciones , Dislipidemias/mortalidad , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Reino Unido/epidemiología , Circunferencia de la Cintura
2.
Iran J Allergy Asthma Immunol ; 20(2): 140-146, 2021 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-33904672

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic in Iran is part of the worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The present study aimed to demonstrate the clinical characteristics of patients affected by COVID-19, in our tertiary teaching hospital. Medical records and compiled data of 668 patients with suspected COVID-19 were obtained retrospectively between January to April 2020. The present study outcomes included demographic features of infected patients, underlying diseases and conditions, the relationship between the results of reverse transcription-polymerase chain reaction (RT-PCR) or CT-scan with the manifestations of the disease, mortality rate, and age distribution of fatalities among men and women. The median age of hospitalized patients was 63 years old (from 18 to 94). The patients' chief complaints in the admission time were cough, dyspnea, fever, and gastrointestinal problems, respectively. Hospitalized patients' common comorbidities were hypertension (HTN), and cardiovascular disease (CVD) (24%), diabetes mellitus (DM) (21.5%), asthma, or chronic obstructive pulmonary disease (COPD) (6%), or other underlying diseases (15.5%). One-third of patients had no comorbidity according to the data of medical records. In hospitalized patients, 169 (84.5%) had positive RT-PCR, and 156 (78%) had positive chest CT findings. The mortality rate of males was higher than females (66.3% vs. 33.3%) and in patients with positive RT-PCR compared to patients with positive chest CT-scan findings. The majority of deaths had a history of DM or HTN/CVD in their medical records. The chief complaint of patients was cough. DM and HTN or CVD were the common underlying disease related to death in hospitalized cases. Besides, the hospitalization and mortality rate in males was higher than in females. About 87% of dead hospitalized cases had positive RT-PCR results, and this rate was 82% for chest CT results.


Asunto(s)
Asma , Diabetes Mellitus , Hipertensión , Pandemias , Enfermedad Pulmonar Obstructiva Crónica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Asma/mortalidad , Asma/patología , Asma/terapia , /patología , Comorbilidad , Diabetes Mellitus/mortalidad , Diabetes Mellitus/patología , Diabetes Mellitus/terapia , Femenino , Humanos , Hipertensión/mortalidad , Hipertensión/patología , Hipertensión/terapia , Irán/epidemiología , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/patología , Enfermedad Pulmonar Obstructiva Crónica/terapia
3.
J Stroke Cerebrovasc Dis ; 30(6): 105764, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33823461

RESUMEN

BACKGROUND: The Systolic Blood Pressure Intervention Trial (SPRINT) randomized patients to a goal systolic blood pressure (SBP) <120 mm Hg vs. <140 mm Hg. In a subset of participants, the SPRINT MIND ancillary study performed a baseline MRI and measured white matter hyperintensity volume (WMHv). In this secondary analysis, we evaluated the association between baseline WMHv and cardiovascular events during follow-up in the overall sample. METHODS: The primary outcome was the same as SPRINT, a composite of stroke, myocardial infarction, acute coronary syndrome, decompensated congestive heart failure, or cardiovascular death. We fit Cox models to the primary outcome and report adjusted hazard ratios (HR) for log-transformed WMHv and quartiles of WMHv. RESULTS: Among 717 participants, the median (IQR) baseline WMHv was 1.62 (0.66-3.98) mL. The primary outcome occurred in 51/719 (7.1%). The median WMHv was higher in patients with the primary outcome (3.40 mL versus 1.56 mL, p < 0.001). In adjusted models, WMHv as a log-transformed continuous variable was associated with the primary outcome (HR 1.44, 95% CI 1.15-1.80). The highest quartile of WMHv, compared to the lowest, was also independently associated with the primary outcome (HR 3.21, 95% CI 1.27-8.13). CONCLUSIONS: We found that the baseline volume of WMH was associated with future CVD risk in SPRINT MIND. Prospective clinical trials with larger sample sizes than the current study are needed to determine whether intensive BP lowering can reduce the high cardiovascular risk in patients with WMH.


Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Hipertensión/terapia , Leucoencefalopatías/diagnóstico por imagen , Imagen por Resonancia Magnética , Sustancia Blanca/diagnóstico por imagen , Anciano , Enfermedades Cardiovasculares/mortalidad , Bases de Datos Factuales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Incidencia , Leucoencefalopatías/mortalidad , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Factores de Tiempo
4.
Vopr Virusol ; 66(1): 40-46, 2021 03 07.
Artículo en Ruso | MEDLINE | ID: mdl-33683064

RESUMEN

INTRODUCTION: Analysis of the pathogenesis of coronavirus infection caused SARS-CoV-2 indicates a significant impact of hemorheological disorders on its course and outcomes. It is known that chronic cardiovascular diseases are associated with the risk of severe course and lethal outcomes both in COVID-19 and other infectious diseases. Therefore, in each case it is necessary to study the interaction and mutual influence of different components of the treatment program prescribed to such patients.The purpose of this work was to evaluate the effect of coagulation activity on the course of a novel coronavirus infection (COVID-19) and to justify the management of comorbid patients having been received novel oral anticoagulants (NOACs) in previously selected doses according to indications in concomitant somatic diseases. MATERIAL AND METHODS: Total 76 cases of confirmed coronavirus infection in patients who had been received initial therapy on an outpatient basis were analyzed. 26 patients who received NOACs (rivaroxaban, apixaban, dabigatran) made up the main group and 50 - the comparison (control) group in which patients had not been administered any drugs that affect blood clotting until the episode of COVID-19. All patients have been prescribed therapy following the Provisional guidelines «Prevention, diagnosis and treatment of coronavirus infection (COVID-19)¼ (https://static-0.minzdrav.gov.ru/system/attachments/attaches/). RESULTS AND DISCUSSION: The number of hospitalizations was significantly fewer in the group of patients who had been received NOACs (19 vs. 66% in the control group). No deaths or cases of severe respiratory and/or renal failure were observed in the main group, while adverse outcomes were noted in 14% of patients who had not been administered these drugs. CONCLUSION: Taking NOACs reduces the probability of severe course and adverse outcomes in the development of coronavirus infection caused by SARS-CoV-2, which indicates a significant contribution of coagulation mechanisms to the pathogenesis in COVID-19. There were no indications for drug replacement and correction of anticoagulant therapy regimens in patients who received adequate therapy with oral anticoagulants for treating a non-severe form of coronavirus infection in ambulatory patient settings.


Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Enfermedad Coronaria/tratamiento farmacológico , Coagulación Intravascular Diseminada/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Arteriosclerosis Intracraneal/tratamiento farmacológico , Acetilcisteína/uso terapéutico , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/mortalidad , Fibrilación Atrial/virología , Azitromicina/uso terapéutico , /patología , Estudios de Cohortes , Comorbilidad , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/virología , Dabigatrán/uso terapéutico , Coagulación Intravascular Diseminada/diagnóstico , Coagulación Intravascular Diseminada/mortalidad , Coagulación Intravascular Diseminada/virología , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Hipertensión/virología , Indoles/uso terapéutico , Interferón alfa-2/uso terapéutico , Arteriosclerosis Intracraneal/diagnóstico , Arteriosclerosis Intracraneal/mortalidad , Arteriosclerosis Intracraneal/virología , Masculino , Persona de Mediana Edad , Pirazoles/uso terapéutico , Piridonas/uso terapéutico , Rivaroxabán/uso terapéutico , /patogenicidad , Índice de Severidad de la Enfermedad , Análisis de Supervivencia
5.
Med Sci Monit ; 27: e928937, 2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33534782

RESUMEN

BACKGROUND Serum uric acid (UA) is involved in the development of hypertension. However, its impact on mortality in hypertension remains unclear. We aimed to assess the association of cardiovascular and all-cause mortality with UA in a hypertensive population. MATERIAL AND METHODS This study included 15 583 hypertensive patients from the NHANES study during 1999-2014. Weighted Cox regression analyses and cubic spline fitting were used to assess the relationship between UA and mortality risk. RESULTS Over a median follow-up of 7.4 years (116 351 person-years), a total of 3291 deaths occurred. Mortality was examined according to 5 predefined UA levels: £3.5, 3.5-5, 5-6, 6-7.5, and >7.5 mg/dL. In multivariable analysis with 5-6 mg/dL as a reference, the hazard ratios (95% confidence interval) of total mortality across the 5 groups were 1.40 (1.05-1.88), 1.08 (0.95-1.21), 1.00 (reference), 1.14 (1.02-1.29), and 1.74 (1.50-2.02), respectively. According to a restricted cubic spline, we noted a U-shaped relationship between UA and total mortality. The U-shaped relationship between UA and cardiovascular mortality remained in both females and males. The increased cardiovascular mortality in the lowest and highest UA groups was attributed to stroke and heart-specific mortality, respectively. However, serum UA was not significantly associated with cancer mortality. CONCLUSIONS Our findings showed a U-shaped relationship between serum UA levels and total and cardiovascular mortality in patients with hypertension. Furthermore, low UA was associated with stroke mortality, while higher UA was associated with heart-related mortality. Further research is needed to identify the potential mechanisms of UA in hypertension.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Hipertensión/mortalidad , Accidente Cerebrovascular/mortalidad , Ácido Úrico/análisis , Enfermedades Cardiovasculares/sangre , Sistema Cardiovascular , Causas de Muerte , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/sangre , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/complicaciones , Estados Unidos , Ácido Úrico/sangre
6.
Biomed Environ Sci ; 34(1): 1-8, 2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-33531102

RESUMEN

Objective: To investigate the association between blood pressure and all-cause mortality in Shanxi, China. Methods: The '2002 China Nutrition and Health Survey' baseline data in Shanxi province was used. A retrospective investigation was performed in 2015. The effects of SBP and DBP on the all-cause mortality were analyzed using the Cox regression model. The hazard ratio ( HR) and 95% confidence interval ( CI) were estimated by the sex and age groups. Results: The follow-up rate was 76.52% over 13 years, while the cumulative mortality rate for all participants was 917.12/100,000 person-years. The mortality rose with an increasing SBP ( χ 2 trend = 270.537, P < 0.001) or DBP level ( χ 2 trend = 57.240, P < 0.001). After adjustment for the confounding factors, a significant association between mortality and high SBP (≥ 160 mmHg) and high DBP (≥ 100 mmHg), with adjusted HR ranging from 1.405- to 2.179-fold for SBP and 1.550- to 2.854-fold for DBP, was noted. Significant HRs for most DBP subgroups were found in > 60-year-old participants. Males with DBP ≥ 100 mmHg had a significantly higher mortality, with an HR (95% CI) of 2.715 (1.377-5.351). Conclusion: Adults with SBP > 160 mmHg and DBP > 100 mmHg had a higher mortality risk. Sex and age difference was noted in both DBP and mortality risk.


Asunto(s)
Hipertensión/mortalidad , Mortalidad/tendencias , Adolescente , Adulto , Anciano , Presión Sanguínea , China , Estudios de Cohortes , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Adulto Joven
7.
Curr Probl Cardiol ; 46(5): 100819, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33631706

RESUMEN

OBJECTIVES AND METHODS: the current understanding of the interplay between cardiovascular (CV) risk and Covid-19 is grossly inadequate. CV risk-prediction models are used to identify and treat high risk populations and to communicate risk effectively. These tools are unexplored in Covid-19. The main objective is to evaluate the association between CV scoring systems and chest X ray (CXR) examination (in terms of severity of lung involvement) in 50 Italian Covid-19 patients. Results only the Framingham Risk Score (FRS) was applicable to all patients. The Atherosclerotic Cardiovascular Disease Score (ASCVD) was applicable to half. 62% of patients were classified as high risk according to FRS and 41% according to ASCVD. Patients who died had all a higher FRS compared to survivors. They were all hypertensive. FRS≥30 patients had a 9.7 higher probability of dying compared to patients with a lower FRS. We found a strong correlation between CXR severity and FRS and ASCVD (P < 0.001). High CV risk patients had consolidations more frequently. CXR severity was significantly associated with hypertension and diabetes. 71% of hypertensive patients' CXR and 88% of diabetic patients' CXR had consolidations. Patients with diabetes or hypertension had 8 times greater risk of having consolidations. CONCLUSIONS: High CV risk correlates with more severe CXR pattern and death. Diabetes and hypertension are associated with more severe CXR. FRS offers more predictive utility and fits best to our cohort. These findings may have implications for clinical practice and for the identification of high-risk groups to be targeted for the vaccine precedence.


Asunto(s)
/diagnóstico por imagen , Enfermedades Cardiovasculares/diagnóstico , Indicadores de Salud , Radiografía Torácica , Adulto , Anciano , /terapia , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/terapia , Comorbilidad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Italia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad
8.
Nutr Metab Cardiovasc Dis ; 31(3): 745-755, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-33549450

RESUMEN

AIMS: As reported, hypertension may play an important role in adverse outcomes of coronavirus disease-2019 (COVID-19), but it still had many confounding factors. The aim of this study was to explore whether hypertension is an independent risk factor for critical COVID-19 and mortality. DATA SYNTHESIS: The Medline, PubMed, Embase, and Web of Science databases were systematically searched until November 2020. Combined odds ratios (ORs) with their 95% confidence interval (CIs) were calculated by using random-effect models, and the effect of covariates was analyzed using the subgroup analysis and meta-regression analysis. A total of 24 observational studies with 99,918 COVID-19 patients were included in the meta-analysis. The proportions of hypertension in critical COVID-19 were 37% (95% CI: 0.27 -0.47) when compared with 18% (95% CI: 0.14 -0.23) of noncritical COVID-19 patients, in those who died were 46% (95%CI: 0.37 -0.55) when compared with 22% (95% CI: 0.16 -0.28) of survivors. Pooled results based on the adjusted OR showed that patients with hypertension had a 1.82-fold higher risk for critical COVID-19 (aOR: 1.82; 95% CI: 1.19 - 2.77; P = 0.005) and a 2.17-fold higher risk for COVID-19 mortality (aOR: 2.17; 95% CI: 1.67 - 2.82; P < 0.001). Subgroup analysis results showed that male patients had a higher risk of developing to the critical condition than female patients (OR: 3.04; 95%CI: 2.06 - 4.49; P < 0.001) and age >60 years was associated with a significantly increased risk of COVID-19 mortality (OR: 3.12; 95% CI: 1.93 - 5.05; P < 0.001). Meta-regression analysis results also showed that age (Coef. = 2.3×10-2, P = 0.048) had a significant influence on the association between hypertension and COVID-19 mortality. CONCLUSIONS: Evidence from this meta-analysis suggested that hypertension was independently associated with a significantly increased risk of critical COVID-19 and inhospital mortality of COVID-19.


Asunto(s)
/epidemiología , Hipertensión/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crítica , Femenino , Mortalidad Hospitalaria , Humanos , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad
9.
Arterioscler Thromb Vasc Biol ; 41(3): e175-e182, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33535790

RESUMEN

OBJECTIVE: Although statins are widely prescribed lipid-lowering drugs, there are concerns about the safety of their use in the context of coronavirus disease 2019 (COVID-19), since statins increase the expression of ACE2 (angiotensin-converting enzyme 2). This study aimed to disclose the association between statins and 60-day COVID-19 mortality. Approach and Results: All patients hospitalized with laboratory-confirmed COVID-19 were enrolled in this study from January 19 to April 16, 2020, in Korea. We evaluated the association between the use of statins and COVID-19-related mortality in the overall and the nested 1:2 propensity score-matched study. Furthermore, a comparison of the hazard ratio for death was performed between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia between January and June 2019 in Korea. The median age of the 10 448 COVID-19 patients was 45 years. Statins were prescribed in 533 (5.1%) patients. After adjusting for age, sex, and comorbidities, Cox regression showed a significant decrease in hazard ratio associated with the use of statins (hazard ratio, 0.637 [95% CI, 0.425-0.953]; P=0.0283). Moreover, on comparing the hazard ratio between COVID-19 patients and the retrospective cohort of hospitalized pneumonia patients, the use of statins showed similar benefits. CONCLUSIONS: The use of statins correlates significantly with lower mortality in patients with COVID-19, consistent with the findings in patients with pneumonia. Graphic Abstract: A graphic abstract is available for this article.


Asunto(s)
/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Pandemias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , /mortalidad , Niño , Preescolar , Estudios de Cohortes , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/mortalidad , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/mortalidad , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neumonía/tratamiento farmacológico , Neumonía/mortalidad , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , República de Corea/epidemiología , Estudios Retrospectivos , Adulto Joven
10.
Cochrane Database Syst Rev ; 2: CD008274, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-33555049

RESUMEN

BACKGROUND: All major guidelines for antihypertensive therapy recommend weight loss. Dietary interventions that aim to reduce body weight might therefore be a useful intervention to reduce blood pressure and adverse cardiovascular events associated with hypertension. OBJECTIVES: Primary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on all-cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non-serious adverse events). Secondary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on change from baseline in systolic blood pressure, change from baseline in diastolic blood pressure, and body weight reduction. SEARCH METHODS: For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to April 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 3), Ovid MEDLINE, Ovid Embase, and ClinicalTrials.gov. We also contacted authors of relevant papers about further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of at least 24 weeks' duration that compared weight-reducing dietary interventions to no dietary intervention in adults with primary hypertension. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risks of bias and extracted data. Where appropriate and in the absence of significant heterogeneity between studies (P > 0.1), we pooled studies using a fixed-effect meta-analysis. In case of moderate or larger heterogeneity as measured by Higgins I2, we used a random-effects model. MAIN RESULTS: This second review update did not reveal any new trials, so the number of included trials remains the same: eight RCTs involving a total of 2100 participants with high blood pressure and a mean age of 45 to 66 years. Mean treatment duration was 6 to 36 months. We judged the risks of bias as unclear or high for all but two trials. No study included mortality as a predefined outcome. One RCT evaluated the effects of dietary weight loss on a combined endpoint consisting of the necessity of reinstating antihypertensive therapy and severe cardiovascular complications. In this RCT, weight-reducing diet lowered the endpoint compared to no diet: hazard ratio 0.70 (95% confidence interval (CI) 0.57 to 0.87). None of the trials evaluated adverse events as designated in our protocol. The certainty of the evidence was low for a blood pressure reduction in participants assigned to weight-loss diets as compared to controls: systolic blood pressure: mean difference (MD) -4.5 mm Hg (95% CI -7.2 to -1.8 mm Hg) (3 studies, 731 participants), and diastolic blood pressure: MD -3.2 mm Hg (95% CI -4.8 to -1.5 mm Hg) (3 studies, 731 participants). We judged the certainty of the evidence to be high for weight reduction in dietary weight loss groups as compared to controls: MD -4.0 kg (95% CI -4.8 to -3.2) (5 trials, 880 participants). Two trials used withdrawal of antihypertensive medication as their primary outcome. Even though we did not consider this a relevant outcome for our review, the results of these RCTs strengthen the finding of a reduction of blood pressure by dietary weight-loss interventions. AUTHORS' CONCLUSIONS: In this second update, the conclusions remain unchanged, as we found no new trials. In people with primary hypertension, weight-loss diets reduced body weight and blood pressure, but the magnitude of the effects are uncertain due to the small number of participants and studies included in the analyses. Whether weight loss reduces mortality and morbidity is unknown. No useful information on adverse effects was reported in the relevant trials.


Asunto(s)
Dieta Reductora/efectos adversos , Hipertensión/dietoterapia , Anciano , Antihipertensivos/uso terapéutico , Sesgo , Presión Sanguínea , Enfermedades Cardiovasculares/prevención & control , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/mortalidad , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Pérdida de Peso
11.
Rev Mal Respir ; 38(3): 240-248, 2021 Mar.
Artículo en Francés | MEDLINE | ID: mdl-33589360

RESUMEN

INTRODUCTION: The development of acute respiratory distress syndrome indicates a serious form of COVID-19. Although there have been several studies on the prognostic factors of its severe form, no such study has been conducted in Burkina Faso. METHODS: This was a retrospective cohort study conducted from March 9 to June 9, 2020 in Ouagadougou, Burkina Faso which involved 456 patients with COVID-19. RESULTS: Nearly a quarter of the patients (23.2%) had presented with acute respiratory distress and 44.3% of them died. Being over 65 years old (HR: 2.7; 95% CI: 1.5-5.1) and having hypertension (HR: 1.9; 95% CI: 1-3.5) were independently associated with the risk of mortality. However, after adjustment, only age over 65 years (HR: 2.3; 95% CI: 1.2-4.3) was a risk factor for death. The survival rate for patients over 65 was 38.5% at 7 days and 30.3% at 15 days. CONCLUSIONS: Acute respiratory distress leading to death is mainly found in older people with COVID-19. Close monitoring of these high-risk patients may reduce the risk of death.


Asunto(s)
/complicaciones , /etiología , /mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Burkina Faso/epidemiología , /epidemiología , Niño , Preescolar , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Hipertensión/mortalidad , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mortalidad , Pronóstico , /epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven
12.
J Korean Med Sci ; 36(2): e15, 2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33429474

RESUMEN

BACKGROUND: Data regarding the association between preexisting cardiovascular risk factors (CVRFs) and cardiovascular diseases (CVDs) and the outcomes of patients requiring hospitalization for coronavirus disease 2019 (COVID-19) are limited. Therefore, the aim of this study was to investigate the impact of preexisting CVRFs or CVDs on the outcomes of patients with COVID-19 hospitalized in a Korean healthcare system. METHODS: Patients with COVID-19 admitted to 10 hospitals in Daegu Metropolitan City, Korea, were examined. All sequentially hospitalized patients between February 15, 2020, and April 24, 2020, were enrolled in this study. All patients were confirmed to have COVID-19 based on the positive results on the polymerase chain reaction testing of nasopharyngeal samples. Clinical outcomes during hospitalization, such as requiring intensive care and invasive mechanical ventilation (MV) and death, were evaluated. Moreover, data on baseline comorbidities such as a history of diabetes, hypertension, dyslipidemia, current smoking, heart failure, coronary artery disease, cerebrovascular accidents, and other chronic cardiac diseases were obtained. RESULTS: Of all the patients enrolled, 954 (42.0%) had preexisting CVRFs or CVDs. Among the CVRFs, the most common were hypertension (28.8%) and diabetes mellitus (17.0%). The prevalence rates of preexisting CVRFs or CVDs increased with age (P < 0.001). The number of patients requiring intensive care (P < 0.001) and invasive MV (P < 0.001) increased with age. The in-hospital death rate increased with age (P < 0.001). Patients requiring intensive care (5.3% vs. 1.6%; P < 0.001) and invasive MV (4.3% vs. 1.7%; P < 0.001) were significantly greater in patients with preexisting CVRFs or CVDs. In-hospital mortality (12.9% vs. 3.1%; P < 0.001) was significantly higher in patients with preexisting CVRFs or CVDs. Among the CVRFs, diabetes mellitus and hypertension were associated with increased requirement of intensive care and invasive MV and in-hospital death. Among the known CVDs, coronary artery disease and congestive heart failure were associated with invasive MV and in-hospital death. In multivariate analysis, preexisting CVRFs or CVDs (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.07-3.01; P = 0.027) were independent predictors of in-hospital death after adjusting for confounding variables. Among individual preexisting CVRF or CVD components, diabetes mellitus (OR, 2.43; 95% CI, 1.51-3.90; P < 0.001) and congestive heart failure (OR, 2.43; 95% CI, 1.06-5.87; P = 0.049) were independent predictors of in-hospital death. CONCLUSION: Based on the findings of this study, the patients with confirmed COVID-19 with preexisting CVRFs or CVDs had worse clinical outcomes. Caution is required in dealing with these patients at triage.


Asunto(s)
/complicaciones , Diabetes Mellitus/mortalidad , Hipertensión/mortalidad , Anciano , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/patología , Comorbilidad , Cuidados Críticos/estadística & datos numéricos , Diabetes Mellitus/patología , Femenino , Mortalidad Hospitalaria , Humanos , Hipertensión/patología , Masculino , Persona de Mediana Edad , Pronóstico , República de Corea
15.
High Blood Press Cardiovasc Prev ; 28(1): 5-11, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33471297

RESUMEN

The COVID-19 infection has rapidly spread around the world and a second wave is sweeping in many countries. Different clinical and epidemiological aspects characterize the disease and their understanding is necessary to better face the management of the pandemic in progress. The Italian society of arterial hypertension with the SARS-RAS study has contributed significantly to the knowledge of the interaction between inhibition of the renin-angiotensin system and COVID-19 infection. Furthermore, the study results help to understand some of the main aspects related to mortality and morbidity deriving from the infection through a multicentre analysis throughout the national territory.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Arterial/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Sistema Renina-Angiotensina/efectos de los fármacos , Antihipertensivos/efectos adversos , /mortalidad , Comorbilidad , Estudios Transversales , Fragilidad/mortalidad , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Hipertensión/fisiopatología , Italia/epidemiología , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Resultado del Tratamiento
16.
Cochrane Database Syst Rev ; 1: CD007654, 2021 01 17.
Artículo en Inglés | MEDLINE | ID: mdl-33454957

RESUMEN

BACKGROUND: This is the third update of this review, first published in July 2009. All major guidelines on treatment of hypertension recommend weight loss; anti-obesity drugs may be able to help in this respect. OBJECTIVES: Primary objectives: To assess the long-term effects of pharmacologically-induced reduction in body weight in adults with essential hypertension on all-cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non-serious adverse events).. Secondary objectives: To assess the long-term effects of pharmacologically-induced reduction in body weight in adults with essential hypertension on change from baseline in systolic and diastolic blood pressure, and on body weight reduction. SEARCH METHODS: For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. The searches had no language restrictions. We contacted authors of relevant papers about further published and unpublished work. SELECTION CRITERIA: Randomised controlled trials of at least 24 weeks' duration in adults with hypertension that compared approved long-term weight-loss medications to placebo.  DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risks of bias, and extracted data. Where appropriate and in the absence of significant heterogeneity between studies (P > 0.1), we pooled studies using a fixed-effect meta-analysis. When heterogeneity was present, we used the random-effects method and investigated the cause of the heterogeneity. MAIN RESULTS: This third update of the review added one new trial, investigating the combination of naltrexone/bupropion versus placebo. Two medications, which were included in the previous versions of this review (rimonabant and sibutramine) are no longer considered relevant for this update, since their marketing approval was withdrawn in 2010 and 2009, respectively. The number of included studies in this review update is therefore six (12,724 participants in total): four RCTs comparing orlistat to placebo, involving a total of 3132 participants with high blood pressure and a mean age of 46 to 55 years; one trial comparing phentermine/topiramate to placebo, involving 1305 participants with high blood pressure and a mean age of 53 years; and one trial comparing naltrexone/bupropion to placebo, involving 8283 participants with hypertension and a mean age of 62 years. We judged the risks of bias to be unclear for the trials investigating orlistat or naltrexone/bupropion. and low for the trial investigating phentermine/topiramate. Only the study of naltrexone/bupropion included cardiovascular mortality and morbidity as predefined outcomes. There were no differences in the rates of all-cause or cardiovascular mortality, major cardiovascular events, or serious adverse events between naltrexone/bupropion and placebo. The incidence of overall adverse events was significantly higher in participants treated with naltrexone/bupropion. For orlistat, the incidence of gastrointestinal side effects was consistently higher compared to placebo. The most frequent side effects with phentermine/topiramate were dry mouth and paraesthesia. After six to 12 months, orlistat reduced systolic blood pressure compared to placebo by mean difference (MD) -2.6 mm Hg (95% confidence interval (CI) -3.8 to -1.4 mm Hg; 4 trials, 2058 participants) and diastolic blood pressure by MD -2.0 mm Hg (95% CI -2.7 to -1.2 mm Hg; 4 trials, 2058 participants). After 13 months of follow-up, phentermine/topiramate decreased systolic blood pressure compared to placebo by -2.0 to -4.2 mm Hg (1 trial, 1030 participants) (depending on drug dosage), and diastolic blood pressure by -1.3 to -1.9 mm Hg (1 trial, 1030 participants) (depending on drug dosage). There was no difference in the change in systolic or diastolic blood pressure between naltrexone/bupropion and placebo (1 trial, 8283 participants). We identified no relevant studies investigating liraglutide or lorcaserin in people with hypertension. AUTHORS' CONCLUSIONS: In people with elevated blood pressure, orlistat, phentermine/topiramate and naltrexone/bupropion reduced body weight; the magnitude of the effect was greatest with phentermine/topiramate. In the same trials, orlistat and phentermine/topiramate, but not naltrexone/bupropion, reduced blood pressure. One RCT of naltrexone/bupropion versus placebo showed no differences in all-cause mortality or cardiovascular mortality or morbidity after two years. The European Medicines Agency refused marketing authorisation for phentermine/topiramate due to safety concerns, while for lorcaserin the application for European marketing authorisation was withdrawn due to a negative overall benefit/risk balance. In 2020 lorcaserin was also withdrawn from the US market. Two other medications (rimonabant and sibutramine) had already been withdrawn from the market in 2009 and 2010, respectively.


Asunto(s)
Fármacos Antiobesidad/efectos adversos , Depresores del Apetito/efectos adversos , Hipertensión/tratamiento farmacológico , Adulto , Fármacos Antiobesidad/uso terapéutico , Depresores del Apetito/uso terapéutico , Sesgo , Presión Sanguínea/efectos de los fármacos , Peso Corporal/efectos de los fármacos , Bupropión/efectos adversos , Bupropión/uso terapéutico , Dieta Reductora , Combinación de Medicamentos , Femenino , Fructosa/efectos adversos , Fructosa/análogos & derivados , Fructosa/uso terapéutico , Humanos , Hipertensión/mortalidad , Lactonas/efectos adversos , Lactonas/uso terapéutico , Masculino , Persona de Mediana Edad , Naltrexona/efectos adversos , Naltrexona/uso terapéutico , Orlistat/efectos adversos , Orlistat/uso terapéutico , Fentermina/efectos adversos , Fentermina/uso terapéutico , Piperidinas/efectos adversos , Piperidinas/uso terapéutico , Pirazoles/efectos adversos , Pirazoles/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Retirada de Medicamento por Seguridad , Tiempo , Topiramato/efectos adversos , Topiramato/uso terapéutico
17.
Epidemiol Infect ; 149: e14, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-33413720

RESUMEN

Pre-existing health conditions may exacerbate the severity of coronavirus disease 2019 (COVID-19). We aimed to estimate the case-fatality rate (CFR) and rate ratios (RR) for patients with hypertension (HBP) and diabetes mellitus (DM) in the New York state. We obtained the age-specific number of COVID-19 confirmed cases and deaths from public reports provided by the New York State Department of Health, and age-specific prevalence of HBP and DM from the Behavioral Risk Factor Surveillance System 2017. We calculated CFR and RR for COVID-19 patients with HBP and DM based on the reported number of deaths with the comorbidity divided by the expected number of COVID-19 cases with the comorbidity. We performed subgroup analysis by age and calculated the CFR and RR for ages of 18-44, 45-64 and 65+ years, respectively. We found that the older population had a higher CFR, but the elevated RRs associated with comorbidities are more pronounced among the younger population. Our findings suggest that besides the elderly, the young population with comorbidity should also be considered as a vulnerable group.


Asunto(s)
/mortalidad , Complicaciones de la Diabetes/mortalidad , Hipertensión/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Diabetes Mellitus/epidemiología , Humanos , Hipertensión/epidemiología , Hipertensión/mortalidad , Persona de Mediana Edad , Adulto Joven
18.
BMC Cardiovasc Disord ; 21(1): 23, 2021 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413093

RESUMEN

BACKGROUND: A high prevalence of cardiovascular risk factors including age, male sex, hypertension, diabetes, and tobacco use, has been reported in patients with Coronavirus disease 2019 (COVID-19) who experienced adverse outcome. The aim of this study was to investigate the relationship between cardiovascular risk factors and in-hospital mortality in patients with COVID-19. METHODS: MEDLINE, Cochrane, Web of Sciences, and SCOPUS were searched for retrospective or prospective observational studies reporting data on cardiovascular risk factors and in-hospital mortality in patients with COVID-19. Univariable and multivariable age-adjusted analyses were conducted to evaluate the association between cardiovascular risk factors and the occurrence of in-hospital death. RESULTS: The analysis included 45 studies enrolling 18,300 patients. The pooled estimate of in-hospital mortality was 12% (95% CI 9-15%). The univariable meta-regression analysis showed a significant association between age (coefficient: 1.06; 95% CI 1.04-1.09; p < 0.001), diabetes (coefficient: 1.04; 95% CI 1.02-1.07; p < 0.001) and hypertension (coefficient: 1.01; 95% CI 1.01-1.03; p = 0.013) with in-hospital death. Male sex and smoking did not significantly affect mortality. At multivariable age-adjusted meta-regression analysis, diabetes was significantly associated with in-hospital mortality (coefficient: 1.02; 95% CI 1.01-1.05; p = 0.043); conversely, hypertension was no longer significant after adjustment for age (coefficient: 1.00; 95% CI 0.99-1.01; p = 0.820). A significant association between age and in-hospital mortality was confirmed in all multivariable models. CONCLUSIONS: This meta-analysis suggests that older age and diabetes are associated with higher risk of in-hospital mortality in patients infected by SARS-CoV-2. Conversely, male sex, hypertension, and smoking did not independently correlate with fatal outcome.


Asunto(s)
/mortalidad , Enfermedades Cardiovasculares/mortalidad , Mortalidad Hospitalaria , Factores de Edad , Análisis de Varianza , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus/mortalidad , Femenino , Humanos , Hipertensión/mortalidad , Masculino , Estudios Observacionales como Asunto , Sesgo de Publicación , Análisis de Regresión , Factores de Riesgo , Factores Sexuales , Fumar/mortalidad
19.
Medicine (Baltimore) ; 100(2): e23975, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466138

RESUMEN

ABSTRACT: Our aim was to analyze characteristics of atrial fibrillation (AF) patients with chronic kidney disease (CKD) from the Croatian cohort of the ESH A Fib survey and to determine the association of estimated glomerular filtration rate (eGFR) with cardiovascular (CV) mortality after 24 months of follow-up.Consecutive sample of 301 patients with AF were enrolled in the period 2014 to 2018. Hypertension was defined as BP > 140/90 mm Hg and/or antihypertensive drugs treatment, CKD was defined as eGFR (CKD Epi) < 60 ml/min/1.73 m2 which was confirmed after 3 months.CKD was diagnosed in 45.2% of patients (13.3% in CKD stage > 3b). CKD patients were older than non-CKD and had significantly more frequent coronary heart disease, heart failure and valvular disease. CKD patients had significantly higher CHA2DS2-VASc score and more CKD than non-CKD patients had CHA2DS2-VASc > 2. Crude CV mortality rate per 1000 population at the end of the first year of the follow-up was significantly higher in CKD vs non-CKD group who had shorter mean survival time. CV mortality was independently associated with eGFR, male gender, CHA2DS2VASc and R2CHA2DS2VASc scores.Prevalence of CKD, particularly more advanced stages of CKD, is very high in patients with AF. Observed higher CV mortality and shorter mean survival time in CKD patients could be explained with higher CHA2DS2VASc score which is a consequence of clustering of all score components in CKD patients. However, eGFR was independently associated with CV mortality. In our cohort, R2CHA2DS2VASc score was not associated significantly more with CV mortality than CHA2DS2VASc score.


Asunto(s)
Fibrilación Atrial/epidemiología , Hipertensión/epidemiología , Insuficiencia Renal Crónica/epidemiología , Factores de Edad , Anciano , Fibrilación Atrial/mortalidad , Enfermedades Cardiovasculares/mortalidad , Comorbilidad , Croacia/epidemiología , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales
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