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1.
Food Funct ; 12(9): 4072-4078, 2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-33977970

RESUMEN

The evidence for a linkage between dietary intake of choline and betaine, a choline metabolism product, and the risk of hypertension (HTN) is limited. The current population-based cohort study was designed to investigate the possible association between dietary intake of choline and betaine with the risk of HTN in adults. This cohort study was conducted on the participants of the Tehran Lipid and Glucose Study (TLGS). Dietary intake of choline and betaine was calculated using the United States Department of Agriculture (USDA) database. Hypertension was diagnosed as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or used drugs to treat hypotension. In this study, 2865 subjects participated and followed-up for a median of 7.4 years. During the follow-up period, 623 patients with hypertension (22.1%) were detected. Our results revealed per every 100 mg increased dietary intake of choline, the risk of developing HTN decreased by 16% (0.84; 95% CI: 0.74 to 0.96, P for trend = 0.009). No significant association was observed between habitual dietary intake of betaine and the risk of HTN (1.10; 95% CI: 0.88 to 1.38, P for trend = 0.21). After stratification based on age, sex, and BMI, each 100 mg per d increase in dietary choline decreased the risk of HTN occurrence in subjects younger than 55 years old by 17% (0.83; 95% CI: 0.71 to 0.96) and men by 21% (0.79; 95% CI: 0.66 to 0.95). The current study's findings provide further support to confirm the protective properties of choline and choline-rich foods against HTN.


Asunto(s)
Betaína , Colina/administración & dosificación , Dieta , Ingestión de Alimentos , Alimentos , Hipertensión/prevención & control , Adulto , Presión Sanguínea , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios
2.
BMC Health Serv Res ; 21(1): 472, 2021 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-34006266

RESUMEN

BACKGROUND: The aim of this study was to determine the feasibility of implementing and evaluating essential interventions for the management of hypertension and prevention of cardiovascular disease in primary healthcare in Tajikistan. METHODS: The study protocol was published a priori. A pragmatic, sequential, mixed methods explanatory design was piloted. The quantitative strand is reported here. All primary health care facilities that met inclusion criteria in Shahrinav district were included and computer randomized to either usual care or intervention. The intervention consisted of: adaptation of WHO PEN/HEARTS clinical algorithms for hypertension and diabetes, a two-day training of doctors and nurses, supportive supervision visits, clinical decision support tools, and quality improvement support. Data were collected from paper-based clinical records at baseline and 12 months follow-up. The primary outcome was blood pressure control among patients with hypertension, in addition to several secondary process indicators along the care pathway. Age and sex adjusted logistic regression models were used for intervention and control clinics to determine changes between baseline and follow-up and to assess interactions between allocation group and time. For continuous variables, multivariate linear regression models were used. RESULTS: 19 primary health care centres were included of which ten were randomized to intervention and nine to control. 120 clinicians received training. The records of all registered hypertensive patients were reviewed at baseline and follow-up for a total of 1,085 patient records. Blood pressure control significantly improved in the intervention clinics (OR 3.556, 95 % CI 2.219, 5.696) but not the control clinics (OR 0.644, 95 % CI 0.370, 1.121) (p < 0.001 for interaction). Smoking assessment, statin prescribing, triple therapy prescribing, and blood pressure measurement significantly improved in intervention clinics relative to control, whereas cholesterol and glucose testing, and aspirin prescribing did not. CONCLUSIONS: It is feasible to use routine, paper-based, clinical records to evaluate essential CVD interventions in primary health care in Tajikistan. Adapted WHO PEN/HEARTS guidelines in the context of a complex intervention significantly improved blood pressure control after 12 months.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Presión Sanguínea , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Humanos , Hipertensión/epidemiología , Hipertensión/prevención & control , Atención Primaria de Salud , Tayikistán/epidemiología
3.
BMJ Open ; 11(3): e043951, 2021 03 08.
Artículo en Inglés | MEDLINE | ID: mdl-34006029

RESUMEN

OBJECTIVES: This study was designed to assess levels of awareness, knowledge, attitude and practices relating to hypertension and diabetes among adults aged 35 years resident in selected communities in Imo and Kaduna states, Nigeria. DESIGN: A descriptive cross-sectional study. SETTING: Selected communities across 14 local government areas in Imo and Kaduna states were included. PARTICIPANTS: In total, 824 adults, aged 35 years or older and resident in selected communities where the Access-N project was being implemented in Imo and Kaduna states participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The study assessed the level of hypertension and diabetes knowledge among the participants. Regular blood pressure (BP) and glucose screening practices were also examined as outcome measures. RESULTS: The mean age of the respondents was 48.32 years. In total, 778 (94.4%) and 746 (90.5%) of the respondents were aware of hypertension and diabetes, respectively. The mean hypertension and diabetes knowledge scores (±SD) were 4.99 (±1.99) and 8.02 (±2.61), respectively. A total of 326 (41.9%) respondents aware of hypertension had a good knowledge of hypertension while 477 (63.9%) of those aware of diabetes had a good knowledge of diabetes. Levels of hypertension and diabetes knowledge were found to be associated with physical activity and the level of education of the respondents. About two-thirds (62.6%) and less than half (41.5%) of the respondents, respectively check their BP and blood glucose (BG) levels regularly (at least once yearly). Statistically significant associations were observed between age and regular BP and BG level checks. CONCLUSIONS: Despite the high awareness rate of hypertension and diabetes observed in this study and a relatively good knowledge about the two conditions, unhealthy lifestyle practices and non-regular routine screening abounds among the respondents. Thus, there is a need to improve access to quality information about hypertension and diabetes aimed at motivating adoption of healthy behaviours.


Asunto(s)
Diabetes Mellitus , Hipertensión , Adulto , Estudios Transversales , Diabetes Mellitus/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hipertensión/epidemiología , Hipertensión/prevención & control , Persona de Mediana Edad , Nigeria , Encuestas y Cuestionarios
4.
Medicine (Baltimore) ; 100(18): e25192, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-33950917

RESUMEN

BACKGROUND: Hypertension (HTN) has been considered as a health concern in developing countries. And Hui is a minority group with a large population in China. Its genetic background, inadequate access to health services, eating habits, religious belief, ethnic customs, and other factors differ from that of other ethnic groups, which may influence the prevalence of HTN. However, there is no current meta-analysis on the prevalence and risk factors of HTN among Hui population. Thus we conducted a systematic review aiming to estimate the pooled prevalence and risk factors of HTN among Hui population. METHODS: PubMed, The Cochrane library, Web of science, CINAHL Complete, Weipu Database (VIP), China Knowledge Resource Integrated Database (CNKI), Wanfang Database, and SinoMed were systematically searched from inception to February 28, 2020 with publication language restricted to English and Chinese. We included cross-sectional, case-control, or cohort studies that focused on prevalence and risk factors of HTN among Hui population. Two investigators independently assessed the risk of bias of the studies included in the review using tools developed by JBI. Meta-analysis was conducted using Stata 12.0 software package. RESULTS: Twenty-three studies were identified with a total of 30,565 study participants. The overall pooled prevalence of HTN was 28% (95% confidence interval [CI]: 24%-32%, I2 = 98.8%, P < .001). Stratified by gender, the pooled prevalence of HTN in Hui was 26% (95%CI: 20%-33%, I2 = 97.6%, P < .001) for males and 30% (95%CI: 23%-37%, I2 = 98.3%, P < .001) for females. Pooled prevalence of HTN in Hui was 2% (95%CI: 2%-6%, I2 = 70.6%, P = .065), 10% (95%CI: 3%-17%, I2 = 83.7%, P < .001), 22% (95%CI: 12%-32%, I2 = 87.9%, P < .001), 37% (95%CI: 20%-53%, I2 = 94.0%, P < .001), 39% (95%CI: 24%-54%, I2 = 97.7%, P < .001) and 42% (95%CI: 29%-56%, I2 = 95.6%, P < .001) for those aged 18 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70 years, respectively. Pooled prevalence of HTN in Hui was 22% (95%CI: 14%-29%, I2 = 97.9%, P < .001) in urban areas and 23% (95%CI: 16%-30%, I2 = 95.8%, P < .001) in rural areas. Daily salt intake (odd ratio [OR] = 3.94, 95%CI: 3.03-5.13, I2 = 90.2%, P < 001), family history (OR = 3.50, 95%CI: 2.60-4.71, I2 = 95.3%, P < .001), smoking (OR = 1.84, 95%CI: 1.61-2.09, I2 = 59.6%, P < .001), drinking (OR = 1.74, 95%CI: 1.26-2.39, I2 = 95.3%, P = .001), weekly meat intake (OR = 1.92, 95%CI: 1.04-3.54, I2 = 96.5%, P = .036), body mass index (OR = 2.20, 95%CI: 1.81-2.66, I2 = 91.3%, P < .001), and areas (OR = 1.29, 95%CI: 1.10-1.51, I2 = 81.5%, P = .001) were risk factors of HTN in Hui, while physical exercise (OR = 0.76, 95%CI: 0.66-0.88, I2 = 62.7%, P < .001) was protective factor. CONCLUSIONS: The pooled prevalence of HTN among Hui people was 28%, daily salt intake, family history, drinking, smoking, weekly meat intake, body mass index, areas, and physical exercise were all risk factors for HTN among Hui population. Early screening and treatment of HTN among Hui population should be given due attention.


Asunto(s)
Hipertensión/epidemiología , Grupos Minoritarios/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/epidemiología , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Índice de Masa Corporal , China/epidemiología , Conducta Alimentaria , Humanos , Hipertensión/prevención & control , Carne/efectos adversos , Anamnesis , Prevalencia , Factores de Riesgo , Fumar/epidemiología , Cloruro de Sodio Dietético/efectos adversos
5.
Lancet ; 397(10285): 1625-1636, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33933205

RESUMEN

BACKGROUND: The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure. METHODS: We did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. FINDINGS: Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/89 mm Hg in participants without previous cardiovascular disease (n=186 988). There was substantial spread in participants' blood pressure at baseline, with 31 239 (19·8%) of participants with previous cardiovascular disease and 14 928 (8·0%) of individuals without previous cardiovascular disease having a systolic blood pressure of less than 130 mm Hg. The relative effects of blood pressure-lowering treatment were proportional to the intensity of systolic blood pressure reduction. After a median 4·15 years' follow-up (Q1-Q3 2·97-4·96), 42 324 participants (12·3%) had at least one major cardiovascular event. In participants without previous cardiovascular disease at baseline, the incidence rate for developing a major cardiovascular event per 1000 person-years was 31·9 (95% CI 31·3-32·5) in the comparator group and 25·9 (25·4-26·4) in the intervention group. In participants with previous cardiovascular disease at baseline, the corresponding rates were 39·7 (95% CI 39·0-40·5) and 36·0 (95% CI 35·3-36·7), in the comparator and intervention groups, respectively. Hazard ratios (HR) associated with a reduction of systolic blood pressure by 5 mm Hg for a major cardiovascular event were 0·91, 95% CI 0·89-0·94 for partipants without previous cardiovascular disease and 0·89, 0·86-0·92, for those with previous cardiovascular disease. In stratified analyses, there was no reliable evidence of heterogeneity of treatment effects on major cardiovascular events by baseline cardiovascular disease status or systolic blood pressure categories. INTERPRETATION: In this large-scale analysis of randomised trials, a 5 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular events by about 10%, irrespective of previous diagnoses of cardiovascular disease, and even at normal or high-normal blood pressure values. These findings suggest that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment. Physicians communicating the indication for blood pressure lowering treatment to their patients should emphasise its importance on reducing cardiovascular risk rather than focusing on blood pressure reduction itself. FUNDING: British Heart Foundation, UK National Institute for Health Research, and Oxford Martin School.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea , Enfermedades Cardiovasculares/prevención & control , Hipertensión/prevención & control , Enfermedades Cardiovasculares/tratamiento farmacológico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/tratamiento farmacológico , Análisis de Intención de Tratar , Infarto del Miocardio/epidemiología , Infarto del Miocardio/mortalidad , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/mortalidad , Prevención Primaria , Modelos de Riesgos Proporcionales , Prevención Secundaria , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/mortalidad
6.
Artículo en Inglés | MEDLINE | ID: mdl-33920894

RESUMEN

Background: To overcome the problem of a high prevalence of undiscovered or untreated arterial hypertension in people of working age, the effects of behavioral change counseling in occupational health (OH) services should be investigated. The technique of motivational interviewing (MI) to support health-related lifestyle changes by physicians and/or occupational nurses ('health coach') has been shown to be successful in patients with chronic diseases. In 2010, we planned a randomized controlled trial (RCT) with employees who suffer from mild arterial hypertension. A preliminary feasibility study was performed in a large manufacturing company in Germany. Methods: All employees with elevated blood pressure measured by the OH-service were invited to undergo validation by 30 self-measurements. Persons with validated elevated values and without medical treatment received either usual hypertension counseling (control group, CG) or intensified MI-counseling (intervention group, IG) by the occupational health physician. Subsequently, the IG received MI-support from the 'health coach' in four telephone counseling sessions. Assessed feasibility factors included organizational processes, the acceptance of the validation procedure and the MI-counseling, and as primary outcome for an RCT the extent to which participants made health-related changes to their lifestyles. Results: Initially, 299 individuals were included in Study Part A (screening). At the end of Study Part B (intervention), out of 34 participants with validated and non-treated mild hypertension, only 7 (IG) and 6 (CG) participants completed the intervention including documentation. The high drop-out rate was due to the frequent lack of willingness to perform the 30 self-measurements at home with their own equipment. Acceptance was little higher when we changed the method to two repeated measurements in the OH service. MI-counseling, especially by the health coach, was evaluated positively. Conclusions: Despite the promising counseling approach, the feasibility study showed that an RCT with previous screening in the operational setting can only be implemented with high financial and personnel effort to reach an appropriate number of subjects. This substantial result could only be achieved through this comprehensive feasibility study, which investigated all aspects of the planned future RCT.


Asunto(s)
Hipertensión , Entrevista Motivacional , Presión Sanguínea , Consejo , Estudios de Factibilidad , Alemania , Humanos , Hipertensión/prevención & control , Lugar de Trabajo
7.
Arq Bras Cardiol ; 116(3): 516-658, 2021 03.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33909761
8.
Nutrients ; 13(3)2021 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-33806997

RESUMEN

Diet, physical activity, smoking and alcohol behaviour-change interventions delivered in pregnancy aim to prevent adverse pregnancy outcomes. This review reports a synthesis of evidence from meta-analyses on the effectiveness of interventions at reducing risk of adverse health outcomes. Sixty-five systematic reviews (63 diet and physical activity; 2 smoking) reporting 602 meta-analyses, published since 2011, were identified; no data were identified for alcohol interventions. A wide range of outcomes were reported, including gestational weight gain, hypertensive disorders, gestational diabetes (GDM) and fetal growth. There was consistent evidence from diet and physical activity interventions for a significantly reduced mean gestational weight gain (ranging from -0.21 kg (95% confidence interval -0.34, -0.08) to -5.77 kg (95% CI -9.34, -2.21). There was evidence from larger diet and physical activity meta-analyses for a significant reduction in postnatal weight retention, caesarean delivery, preeclampsia, hypertension, GDM and preterm delivery, and for smoking interventions to significantly increase birth weight. There was no statistically significant evidence of interventions having an effect on low or high birthweight, neonatal intensive care unit admission, Apgar score or mortality outcomes. Priority areas for future research to capitalise on pregnancy as an opportunity to improve the lifelong wellbeing of women and their children are highlighted.


Asunto(s)
Dieta , Ejercicio Físico , Salud del Lactante , Cese del Hábito de Fumar , Peso al Nacer , Diabetes Gestacional/prevención & control , Medicina Basada en la Evidencia , Femenino , Humanos , Hipertensión/prevención & control , Lactante , Fenómenos Fisiologicos Nutricionales Maternos , Preeclampsia/prevención & control , Embarazo , Complicaciones del Embarazo/prevención & control , Resultado del Embarazo , Aumento de Peso
9.
Artículo en Inglés | MEDLINE | ID: mdl-33803874

RESUMEN

Exercise has been recommended for blood pressure (BP) control, but not every individual can improve BP and reduce the risk of cardiovascular disease effectively by exercise. This study aimed to evaluate the BP response after 12-week exercise intervention and then identify the potential factors of responders on BP (R-BP) control. This was a retrospective cohort study from a project of Taipei City Government. Subjects completed the original program were included for further analysis. Sociodemographic factors, health-related behaviors, and cardiovascular risks were extracted as potential factors. The results were categorized into R-BP control, i.e., BP under optimal level (systolic BP (SBP) < 140 mmHg; and diastolic BP (DBP) < 90 mmHg) or a significant BP reduction (SBP ↓10 mmHg or DBP ↓5 mmHg) after intervention, or non-responder on BP control, i.e., subjects who failed to achieve the targets. There were 81.62% R-BP subjects. R-BP showed lower SBP and lower risk of hypertension at baseline. Active lifestyle could quadruple the number of R-BP. Higher educational level or more prescription medications were likely to be R-BP in subjects with diagnosed hypertension. Active lifestyle combined with exercise could benefit R-BP in the elderly population. Health-related factors also need to be considered for BP control.


Asunto(s)
Hipertensión , Anciano , Presión Sanguínea , Ejercicio Físico , Terapia por Ejercicio , Humanos , Hipertensión/epidemiología , Hipertensión/prevención & control , Estudios Retrospectivos
10.
Wiad Lek ; 74(3 cz 2): 652-657, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33843629

RESUMEN

OBJECTIVE: The aim: Is to scientifically substantiate the concept of personalized medicine in the prevention of arterial hypertension (AH) among the adult population at the regional level. PATIENTS AND METHODS: Materials and methods: The study, after obtaining informed consent, involved 2000 patients, residents of Zaporizhzhia Region, including 1000 patients (average age 59±0.5 years, the ratio of men to women 1:1.22 people) with and 1000 patients (average age of whom is 62±0.7 years, the ratio of men to women is 1:1.1) without AH. The data of the sociological survey were processed, the methods of mathematical modeling, statistical, system analysis were applied. Odds ratio (OR) is determined by generally accepted methods with the calculation of 95% of confidence interval (CI). RESULTS: Results: The application of the concept of personalized medicine in the prevention of AH among the adult population has been scientifically substantiated by studying the associations between medical and social risk factors and the development of AH and determining on their basis 3 modules - "risk behavior", "adverse health factors" and "social determinants of the development of AH", based on stepwise multiple logistic regression analysis. CONCLUSION: Conclusions: It has been proved that the use of the final prognostic model of the development of arterial hypertension with the inclusion of the most significant risk factorshas high operational characteristics: sensitivity - 78.6%, specificity - 96.6%, positive predicative value - 95.85%, negative predicative value - 81.86%, the area under the ROC curve is 0.9623. The application of the concept of personalized medicine in the prevention of this disease among the adult population was substantiated by studying the associations between medical and social risk factors and the development of arterial hypertension.


Asunto(s)
Hipertensión , Medicina de Precisión , Adulto , Femenino , Humanos , Hipertensión/prevención & control , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios
11.
Artículo en Inglés | MEDLINE | ID: mdl-33809392

RESUMEN

Regular exercise has been proven to prevent hypertension and to help in the management of hypertension. There is a lack of studies examining changes in these issues as a result of Taekwondo training intervention. The aim of the current trial is to identify the effects of a regular Taekwondo (TKD) training program on health-related physical fitness (HRPF), cardiovascular disease (CVD) risk factors, inflammatory factors, and epicardial adipose tissue (EAT) in elderly women with hypertension. To accomplish this, 20 participants, who were older women with hypertension, were divided into a TKD group (n = 10) and a control group (n = 10). The TKD program was conducted in program for 90 min, three times a week, for 12 weeks. Outcomes, including body composition, blood pressure (BP), HRPF, cardiovascular risk factor and EAT, were measured before and after the Taekwondo program. The 12-week TKD program improved body composition, BP, HRPF, CVD risk factor, and EAT in elderly women with hypertension relative to controls. Meanwhile, EAT and interukin-1ß (r = 0.530, p < 0.05), monocyte chemotactic protein-1 (r = 0.524, p < 0.05), triglyceride (r = 0.493, p < 0.05) and sedentary behavior (r = 0.459, p < 0.05) presented a positive correlation, while EAT and lean body mass (r = -0.453, p < 0.05) showed a negative correlation. The 12-week regular TKD training intervention was found to be effective in reducing the thickness of EAT measured by multi-detector computed tomography and can also enhance health-related physical fitness and risk factors of CVD in older individuals with hypertension.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Tejido Adiposo , Anciano , Enfermedades Cardiovasculares/prevención & control , Femenino , Humanos , Hipertensión/prevención & control , Aptitud Física , Factores de Riesgo
12.
Eur J Pharmacol ; 899: 173978, 2021 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-33691164

RESUMEN

Metabolic syndrome is linked to an increased risk of cardiovascular complications by a mechanism involving mainly decreased nitric oxide (NO) bioavailability and impaired NO-soluble guanylate cyclase (sGC)- cyclic guanosine monophosphate (cGMP) signalling (NO-sGC-cGMP). To further develop this scientific point, this study aimed to investigate the effects of long-term treatment with BAY 41-2272 (a sGC stimulator) on cardiovascular reactivity of spontaneously hypertensive rats (SHR) as a model of metabolic syndrome. SHR were randomly divided into 3 groups: control group, cafeteria diet (CD)-fed group and CD-fed group treated daily with BAY 41-2272 (5 mg/kg) by gastric gavage for 12 weeks. In vivo measurements of body weight, abdominal circumference, blood pressure and glucose tolerance test were performed. At the end of the feeding period, ex vivo cumulative concentration-response curves were performed on isolated perfused heart (isoproterenol (0.1 nM - 1 µM)) and thoracic aorta (phenylephrine (1 nM-10 µM), acetylcholine (1 nM-10 µM), and sodium nitroprusside (SNP) (0.1 nM-0.1 µM)). We showed that chronic CD feeding induced abdominal obesity, hypertriglyceridemia, glucose intolerance and exacerbated arterial hypertension in SHR. Compared to control group, CD-fed group showed a decrease in ß-adrenoceptor-induced cardiac inotropy, in coronary perfusion pressure and in aortic contraction to phenylephrine. While relaxing effects of acetylcholine and SNP were unchanged. BAY 41-2272 long-term treatment markedly prevented arterial hypertension development and glucose intolerance, enhanced the α1-adrenoceptor-induced vasoconstriction, and restored cardiac inotropy and coronary vasodilation. These findings suggest that BAY 41-2272 may be a potential novel drug for preventing metabolic and cardiovascular complications of metabolic syndrome.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Activadores de Enzimas/farmacología , Síndrome Metabólico/prevención & control , Pirazoles/farmacología , Piridinas/farmacología , Guanilil Ciclasa Soluble/metabolismo , Animales , Aorta Torácica/efectos de los fármacos , Aorta Torácica/enzimología , Aorta Torácica/fisiopatología , Enfermedades Cardiovasculares/enzimología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Circulación Coronaria/efectos de los fármacos , GMP Cíclico/metabolismo , Modelos Animales de Enfermedad , Activación Enzimática , Intolerancia a la Glucosa/enzimología , Intolerancia a la Glucosa/etiología , Intolerancia a la Glucosa/fisiopatología , Intolerancia a la Glucosa/prevención & control , Hipertensión/enzimología , Hipertensión/etiología , Hipertensión/fisiopatología , Hipertensión/prevención & control , Hipertrigliceridemia/enzimología , Hipertrigliceridemia/etiología , Hipertrigliceridemia/fisiopatología , Hipertrigliceridemia/prevención & control , Preparación de Corazón Aislado , Masculino , Síndrome Metabólico/enzimología , Síndrome Metabólico/etiología , Síndrome Metabólico/fisiopatología , Óxido Nítrico Sintasa de Tipo II/metabolismo , Obesidad Abdominal/enzimología , Obesidad Abdominal/etiología , Obesidad Abdominal/fisiopatología , Obesidad Abdominal/prevención & control , Ratas Endogámicas SHR , Vasoconstricción/efectos de los fármacos , Vasodilatación/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos , Presión Ventricular/efectos de los fármacos
13.
Eur J Pharmacol ; 899: 174010, 2021 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-33711309

RESUMEN

In the present study, the therapeutic effects of imperatorin on metabolic and vascular alterations and possible underlying mechanisms were investigated in high-fat/high-fructose diet (HFFD)-fed rats. Male Sprague-Dawley rats were fed a high-fat diet plus 15% fructose in drinking water for 16 weeks. HFFD-fed rats were treated with imperatorin (15 or 30 mg/kg/day) for the last 4 weeks. In HFFD-fed rats, imperatorin significantly reduced obesity, hypertension, dyslipidemia, and insulin resistance. Imperatorin markedly improved vascular endothelial function and alleviated changes in vascular morphology. Furthermore, imperatorin treatment significantly increased the plasma levels of the nitric oxide metabolite and adiponectin, and upregulated adiponectin receptor 1 and endothelial nitric oxide synthase (eNOS) protein expression in the thoracic aorta. Imperatorin treatment decreased vascular superoxide anion production and downregulated aortic NADPH oxidase subunit p47phox protein expression. These findings indicated that imperatorin alleviates HFFD-induced metabolic and vascular alterations in rats. The possible underlying mechanism may involve the restoration of adiponectin receptor 1 and eNOS expression and suppression of p47phox expression.


Asunto(s)
Aorta Torácica/efectos de los fármacos , Furocumarinas/farmacología , Hemodinámica/efectos de los fármacos , Hipertensión/prevención & control , Síndrome Metabólico/prevención & control , NADPH Oxidasas/metabolismo , Óxido Nítrico Sintasa de Tipo III/metabolismo , Receptores de Adiponectina/metabolismo , Animales , Aorta Torácica/metabolismo , Aorta Torácica/fisiopatología , Dieta Alta en Grasa , Azúcares de la Dieta , Modelos Animales de Enfermedad , Dislipidemias/enzimología , Dislipidemias/etiología , Dislipidemias/fisiopatología , Dislipidemias/prevención & control , Fructosa , Hipertensión/enzimología , Hipertensión/etiología , Hipertensión/fisiopatología , Resistencia a la Insulina , Masculino , Síndrome Metabólico/enzimología , Síndrome Metabólico/etiología , Síndrome Metabólico/fisiopatología , Óxido Nítrico/metabolismo , Obesidad/enzimología , Obesidad/etiología , Obesidad/fisiopatología , Obesidad/prevención & control , Estrés Oxidativo/efectos de los fármacos , Ratas Sprague-Dawley , Transducción de Señal
14.
Lancet Neurol ; 20(4): 265-274, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33647246

RESUMEN

BACKGROUND: High systolic blood pressure after successful endovascular therapy for acute ischaemic stroke is associated with increased risk of intraparenchymal haemorrhage. However, no randomised controlled trials are available to guide optimal management. We therefore aimed to assess whether an intensive systolic blood pressure target resulted in reduced rates of intraparenchymal haemorrhage compared with a standard systolic blood pressure target. METHODS: We did a multicentre, open-label, randomised controlled trial at four academic hospital centres in France. Eligible individuals were adults (aged ≥18 years) with an acute ischaemic stroke due to a large-vessel occlusion that was successfully treated with endovascular therapy. Patients were randomly assigned (1:1) to either an intensive systolic blood pressure target group (100-129 mm Hg) or a standard care systolic blood pressure target group (130-185 mm Hg), by means of a central web-based procedure, stratified by centre and intravenous thrombolysis use before endovascular therapy. In both groups, the target systolic blood pressure had to be achieved within 1 h after randomisation and maintained for 24 h with intravenous blood pressure lowering treatments. The primary outcome was the rate of radiographic intraparenchymal haemorrhage at 24-36 h and the primary safety outcome was the occurrence of hypotension. Analyses were done on an intention-to-treat basis. BP-TARGET is registered with ClinicalTrials.gov, number NCT03160677, and the trial is closed at all participating sites. FINDINGS: Between June 21, 2017, and Sept 27, 2019, 324 patients were enrolled in the four participating stroke centres: 162 patients were randomly assigned to the intensive target group and 162 to the standard target group. Four (2%) of 162 patients were excluded from the intensive target group and two (1%) of 162 from the standard target group for withdrawal of consent or legal reasons. The mean systolic blood pressure during the first 24 h after reperfusion was 128 mm Hg (SD 11) in the intensive target group and 138 mm Hg (17) in the standard target group. The primary outcome was observed in 65 (42%) of 154 patients in the intensive target group and 68 (43%) of 157 in the standard target group on brain CT within 24-36 h after reperfusion] (adjusted odds ratio 0·96, 95% CI 0·60-1·51; p=0·84). Hypotensive events were not significantly different between both groups and occurred in 12 (8%) of 158 patients in the intensive target and five (3%) of 160 in the standard target group. Mortality within the first week after randomisation occurred in 11 (7%) of 158 patients in the intensive target group and in seven (4%) of 160 in the standard target group. INTERPRETATION: An intensive systolic blood pressure target of 100-129 mm Hg after successful endovascular therapy did not reduce radiographic intraparenchymal haemorrhage rates at 24-36 h as compared with a standard care systolic blood pressure target of 130-185 mm Hg. Notably, these results are applicable to patients with successful reperfusion and systolic blood pressures of more than 130 mm Hg at the end of procedure. Further studies are needed to understand the association between blood pressure and outcomes after reperfusion. FUNDING: French Health Ministry.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hemorragia Cerebral/prevención & control , Procedimientos Endovasculares/métodos , /terapia , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/etiología , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/prevención & control , Masculino , Persona de Mediana Edad
16.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(3): 335-338, 2021 Mar 06.
Artículo en Chino | MEDLINE | ID: mdl-33730824

RESUMEN

Hypertension is a major problem of public health that endangers the health of the oldest old. However, the current guidelines for hypertension management do not uniformly diagnose hypertension among the oldest old, nor recommend a normal blood pressure range, which is not convictive enough to support the decision making to the prevention of blood pressure-related adverse events. This guideline gives guiding opinions on optimal blood pressure range for the Chinese oldest old, which applies to the staff of medical and health institutions at all levels nationwide to evaluate the blood pressure levels of the oldest old. It includes the sections of general principles, methods and standards of blood pressure evaluation, measurement conditions, specifications of blood pressure measurement, implementation approaches, etc. The guideline has important directive significance for improving the blood pressure management and decision-making level of the Chinese oldest old.


Asunto(s)
Hipertensión , Anciano de 80 o más Años , Grupo de Ascendencia Continental Asiática , Presión Sanguínea , Determinación de la Presión Sanguínea , China , Humanos , Hipertensión/diagnóstico , Hipertensión/prevención & control
17.
Lancet Child Adolesc Health ; 5(5): 357-366, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33711291

RESUMEN

Hypertension is a major modifiable cardiovascular disease risk factor and its presence in childhood is associated with the presence and burden of atherosclerosis. Moreover, hypertension tracks from childhood to adulthood and is associated with adverse cardiac changes and vascular damage that in turn are associated with premature cardiovascular disease in adulthood. Therefore, the early identification and effective treatment of hypertension in children and adolescents is key in the primordial and primary prevention of cardiovascular disease, particularly for at-risk individuals, such as those with obesity, diabetes, or chronic kidney disease, among others. Unfortunately, hypertension can be difficult to diagnose in children and adolescents and is as such frequently under-recognised. In this Review, we provide an overview of hypertension in adolescents, with a focus on its prevalence and diagnosis, the rationale for early identification and treatment, and current knowledge gaps.


Asunto(s)
Salud del Adolescente , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/prevención & control , Hipertensión/terapia , Adolescente , Enfermedades Cardiovasculares/prevención & control , Humanos , Prevalencia , Factores de Riesgo
18.
Am J Public Health ; 111(5): 890-895, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33734841

RESUMEN

Community-based risk factor modification is today an established approach to chronic disease control and public health practice. This article analyzes the shaping of the North Karelia Project (NKP), an early and influential formulation of the community approach that focused on coronary heart disease prevention in Finland. Instead of targeting only high-risk individuals, NKP aimed to change the culture of the local community. On the basis of archival material and interviews, I first trace the multiple origins of the notion of community in NKP, which combined "internal" factors (local risk factor distribution, the role given to the social environment in chronic disease prevention) and "external" influences (regional origin of the initiative, World Health Organization and national policy concepts of community control and primary health care). Second, I describe the shape of the community intervention in NKP. The project foregrounded social relationships as a way to educate the public and influence norms guiding individual behaviors while subordinating environmental changes of a more structural nature.


Asunto(s)
Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/prevención & control , Promoción de la Salud/organización & administración , Estilo de Vida , Enfermedades Cardiovasculares/prevención & control , Características Culturales , Finlandia/epidemiología , Conductas Relacionadas con la Salud , Humanos , Hipercolesterolemia/epidemiología , Hipercolesterolemia/prevención & control , Hipertensión/prevención & control , Factores de Riesgo , Fumar/epidemiología , Prevención del Hábito de Fumar , Factores Socioeconómicos
20.
Nutrients ; 13(2)2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33578935

RESUMEN

Hypertension (HT) is one of the pivotal risk factors for various detrimental diseases like cardiovascular diseases (CVDs), cerebrovascular disease, and renal dysfunction. Currently, many researchers are paying immense attention to various diet formula (dietary approach) with a special focus on micro and macronutrients along with modified lifestyle and standard anti-hypertensive drugs. Micronutrients (minerals/vitamins) play a central role in the regulation of blood pressure (BP) as they aid the function of macronutrients and also improve the anti-hypertensive functions of some anti-hypertensive agents. Even though several studies have demonstrated the beneficial effects of micronutrients on controlling BP, still some ambiguity exists among the nutritionists/doctors, which combination or individual mineral (dietary approach) contributes to better BP regulation. Therefore, this critical review article was attempted to delineate the underlying role of micronutrients (minerals and vitamins) for the management and prevention or delaying of HT and their related complications with strong affirmation from clinical trials as well as its mechanism of controlling BP. Moreover, the major source and recommended daily allowance (RDA) of various micronutrients are included in this review for guiding common readers (especially HT subjects) and dieticians to choose/recommend a better micronutrient and their combinations (other nutrients and standard anti-hypertensive drugs) for lowering the risk of HT and its related co-morbid conditions like CVDs.


Asunto(s)
Hipertensión/dietoterapia , Micronutrientes/uso terapéutico , Antihipertensivos/uso terapéutico , Presión Sanguínea , Enfermedades Cardiovasculares/epidemiología , Ensayos Clínicos como Asunto , Dieta , Suplementos Dietéticos , Humanos , Hipertensión/prevención & control , Metaanálisis como Asunto , Minerales/uso terapéutico , Ingesta Diaria Recomendada , Factores de Riesgo , Oligoelementos/uso terapéutico , Vitaminas/uso terapéutico
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