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2.
High Blood Press Cardiovasc Prev ; 27(3): 239-249, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32266707

RESUMEN

INTRODUCTION: This study examined the prevalence of pre-hypertension (PHT) and hypertension (HT) in urban youth, and assessed the effects of sodium intake and obesity on blood pressure (BP) by ethnicity. METHODS: A convenience sample of 557 multiethnic youth, aged 11-23 years, was recruited from 12 schools and institutions in Edmonton, Alberta, Canada. Participants were divided by self-identified ethnicity into four groups (Indigenous, African and Middle Eastern (AME), Asian, and European). RESULTS: Between October 2013 and March 2014, one-on-one interviews were conducted to collect data on demographics, physical activity, diet, and Body Mass Index (BMI). BP was obtained at two different times during the interview and measured a third time in cases of high variability. The standard deviation scores (SDS) of systolic BP (SBP) and diastolic BP (DBP) were used to estimate associations with sodium intake (per 1000 mg/day). Overall, 18.2% and 5.4% of the participants had PHT and HT, respectively. Indigenous and AME participants showed the highest rates of PHT (23.1%). Indigenous and European participants showed higher rates of HT (8.3% and 5.3%, respectively) than other ethnic groups (AME = 4.4%, Asian = 3.9%). There was a positive association between 1000 mg/day increase in sodium intake and SDS of SBP by 0.041 (95% CI 0.007-0.083; p = 0.04) among pre-hypertensive participants. Over 85% of participants exceeded the recommended dietary sodium intake. Mean BMI and dietary sodium intake were higher among pre-hypertensive participants (4219 mg/day) than normotensive (3475 mg/day). CONCLUSIONS: The prevalence of HT varied by ethnicity. High dietary sodium intake was of concern. There is a need for culturally-tailored, population-based interventions to reduce sodium intake.


Asunto(s)
Presión Sanguínea , Hipertensión/etnología , Estilo de Vida/etnología , Prehipertensión/etnología , Sodio en la Dieta/efectos adversos , Salud Urbana/etnología , Adolescente , Grupo de Ascendencia Continental Africana , Factores de Edad , Alberta/epidemiología , Grupo de Ascendencia Continental Asiática , Niño , Estudios Transversales , Dieta Hiposódica/etnología , Grupo de Ascendencia Continental Europea , Ejercicio Físico , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Encuestas Epidemiológicas , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Hipertensión/prevención & control , Indios Norteamericanos , Masculino , Obesidad Pediátrica/diagnóstico , Obesidad Pediátrica/etnología , Prehipertensión/diagnóstico , Prehipertensión/fisiopatología , Prehipertensión/prevención & control , Prevalencia , Factores Raciales , Ingesta Diaria Recomendada , Medición de Riesgo , Factores de Riesgo , Conducta de Reducción del Riesgo , Adulto Joven
3.
Life Sci ; 251: 117625, 2020 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-32247003

RESUMEN

OBJECTIVE: The present study was designed to investigate whether the novel peptide cysteine-based peptide (Cys-peptide) had protective effects on preeclamptic animal and cell models. METHODS: We investigated effects of Cys-peptide on (1) preeclamptic symptoms (e.g. hypertension, proteinuria, fetal growth restriction (FGR)) in preeclampia-like rat models induced by lipopolysaccharides (LPS), (2) TNFα-induced cytotoxicity of human umbilical vascular endothelial cells (HUVECs) and HTR-8 cells (an immortalised human trophoblast cell line), (3) endothelial dysfunction and injured angiogenesis, (4) migration and invasion of trophoblast cells induced by TNFα. RESULTS: Cys-peptide ameliorated LPS-induced hypertension, proteinuria and FGR and other PE symptoms in preeclampia-like rat models. In addition, Cys-peptide attenuated TNFα-induced cytotoxicity by decreasing soluble fms-like tyrosine kinase-1 (sFlt-1), endothelin-1 (ET-1) and tissue plasminogen activator (tPA) mRNA expression in both cells. Furthermore, Cys-peptide restored endothelial dysfunction and rescued angiogenesis caused by TNFα in vitro. Importantly, Cys-peptide could reverse insufficient ability to invade and migrate of trophoblast cells. CONCLUSIONS: These results suggest Cys-peptide can play beneficial roles in preeclampsia-like rat and cell models. Therefore, we propose that Cys-peptide is probably a novel therapeutic candidate for PE.


Asunto(s)
Cisteína/química , Retardo del Crecimiento Fetal/prevención & control , Péptidos/administración & dosificación , Preeclampsia/prevención & control , Animales , Línea Celular , Movimiento Celular/efectos de los fármacos , Modelos Animales de Enfermedad , Femenino , Células Endoteliales de la Vena Umbilical Humana , Humanos , Hipertensión/prevención & control , Péptidos/química , Péptidos/farmacología , Preeclampsia/fisiopatología , Embarazo , Proteinuria/prevención & control , Ratas , Ratas Sprague-Dawley , Trofoblastos/metabolismo , Factor de Necrosis Tumoral alfa/administración & dosificación
4.
Hipertens. riesgo vasc ; 37(1): 4-10, ene.-mar. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-188667

RESUMEN

Objetivo: Describir los hallazgos de la implementación de la iniciativa Mayo Mes de la Medición 2017 aplicada a población colombiana adulta con el objetivo de crear conciencia sobre la importancia de la medición, conocimiento y control de la presión arterial. Materiales y métodos: Mayo Mes de la Medición es una encuesta transversal que sigue las directrices de la Sociedad Internacional de Hipertensión y la Liga Mundial de Hipertensión, que recoge información de factores de riesgo cardiovascular y mediciones de presión arterial. En Colombia su implementación fue liderada por la Fundación Oftalmológica de Santander (FOSCAL) y la Sociedad Latinoamericana de Hipertensión (LASH) con el apoyo de la Red Colombiana para la Prevención de las Enfermedades Cardiovasculares y Diabetes (RECARDI). Resultados: Se recolectaron datos en 11 departamentos de 21.797 personas, siendo el 58,7% mujeres, la edad promedio fue de 40,5±17,7 años. La prevalencia global de hipertensión arterial (HTA) fue del 20,8% (autorreporte de tratamiento antihipertensivo o toma de presión arterial sistólica [≥140mmHg]). El 46,5% del total de hipertensos tuvieron cifras de presión arterial sistólica que les clasifica como no controlados (presión arterial sistólica<140mmHg) y el 26,4% no conocían su condición de hipertensos, los cuales en el presente reporte son considerados como los casos nuevos de HTA. Conclusión: La prevalencia de presión arterial es alta en esta población adulta joven, en la cual el desconocimiento de la condición de HTA es también alta, y en aquellos que conocen su condición existe un porcentaje bajo de control de la HTA, resultados que demuestran la necesidad de implementar programas eficaces de detección de pacientes hipertensos y de establecer tratamientos estandarizados para mejorar el control de la HTA como una estrategia para la reducción de eventos cardiovasculares


Aim: To describe the findings of implementing May Measurement Month 2017 in the adult Colombian population to raise awareness of the importance of blood pressure measuring, monitoring, and awareness. Materials and methods: May Measurement Month is a cross-sectional survey that follows the directives of the International Society of Hypertension and the World Hypertension League, which gathers information on cardiovascular risk factors and blood pressure readings. Its implementation in Colombia was lead by the Santander Ophthalmological Foundation (FOSCAL) and the Latin American Society of Hypertension (LASH) with the support of the Colombian Network for the Prevention of Cardiovascular Diseases and Diabetes (RECARDI). Results: Data was collected from 11 departments on 21,797 people, 58.7% of whom were female, with an average age of 40.5±17.7 years. The overall prevalence of high blood pressure (HBP) was 20.8% (self-reported antihypertensive treatment or systolic blood pressure reading [systolic blood pressure≥140mmHg]). Of the total number of hypertensives, 46.5% had systolic blood pressure readings classified as uncontrolled (systolic blood pressure<140mmHg), and 26.4% were unaware that they were hypertensive who, in this report, we consider to be new cases of HBP. Conclusion: The prevalence of (elevated) blood pressure is high in this young adult population, whose lack of awareness of HBP is also high, and HBP in those aware of their condition is poorly controlled. These results highlight the need to implement effective detection programmes for hypertensive patients and to establish standardised treatments to improve HBP control as a strategy to reduce cardiovascular events


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud , Determinación de la Presión Sanguínea/métodos , Monitoreo Ambulatorio de la Presión Arterial/métodos , Presión Arterial , Enfermedades Cardiovasculares/prevención & control , Hipertensión/prevención & control , Colombia , Estudios Transversales , Encuestas y Cuestionarios , Sociedades Médicas/normas , Factores de Riesgo , Promoción de la Salud , Antropometría
5.
Rev Bras Epidemiol ; 23: e200006, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32130395

RESUMEN

INTRODUCTION: Systemic arterial hypertension (SAH) has a high prevalence in Brazil and impacts on the use of health services. OBJECTIVE: This study verified the influence of the Family Health Strategy (FHS) on the use of health services by adults ≥ 18 years old who reported SAH in the National Health Survey (Pesquisa Nacional de Saúde - PNS) 2013. METHODS: The Propensity Score (PS) method was used to correct the lack of homogeneity between the groups with SAH under exposed or not to the FHS. PS was estimated using binary logistic regression, which reflected the conditional probability of receiving the household register in the FHS according to socioeconomic, demographic and health covariates of adults and their families. After estimating the PS, the stratification was used to group hypertensive adults into five mutually exclusive strata (pairing them). Prevalence and confidence intervals at 95% were estimated of medical consultations and hospitalizations. The effects of the complex NHS sampling were incorporated into all phases of the analysis. RESULTS: It was verified that hypertensive adults enrolled in FHS had worse socioeconomic, health and health conditions, but similar prevalence of medical consultations and hospitalizations to adults without a FHS registry and with better living and health conditions. The FHS has attenuated individual and contextual inequalities that impact the health of Brazilians by favoring the use of health services. CONCLUSION: The FHS can favor the care and control of SAH in Brazil. Thus, it must receive investments that guarantee its effectiveness.


Asunto(s)
Salud de la Familia , Servicios de Salud/estadística & datos numéricos , Hipertensión/epidemiología , Hipertensión/prevención & control , Programas Nacionales de Salud/estadística & datos numéricos , Anciano , Brasil/epidemiología , Composición Familiar , Femenino , Encuestas de Atención de la Salud , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Factores Socioeconómicos
6.
Isr Med Assoc J ; 22(3): 137-141, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32147976

RESUMEN

BACKGROUND: Pregestational diabetes mellitus (PGDM) carries a significantly elevated risk of adverse maternal and fetal outcomes. There is evidence that certain interventions reduce the risk for adverse outcomes. Studies have shown that a multi-disciplinary approach improves pregnancy outcomes in women with PGDM. OBJECTIVES: To determine pregnancy outcomes in women with PGDM using a multi-disciplinary approach. METHODS: We retrospectively reviewed consecutive women with pregestational type 1 and type 2 diabetes who were monitored at a high-risk pregnancy clinic at the Sheba Medical Center. Clinical data were obtained from the medical records. All data related to maternal glucose control and insulin pump function were prospectively recorded on Medtronic CareLink® pro software (Medtronic MiniMed, Northridge, CA). RESULTS: This study comprised 121 neonates from 116 pregnancies of 94 women. In 83% of the pregnancies continuous glucose monitoring (CGM) sensors were applied during a part or all of the pregnancy. Pregnancy outcomes among women who were followed by a multi-disciplinary team before and during pregnancy, and during labor and puerperium resulted in better glucose control (hemoglobin A1c 6.4% vs. 7.8%), lower risk for pregnancy induced hypertension/preeclampsia (7.7% vs. 15.6%), lower birth weight (3212 g vs. 3684 g), and lower rate of large size for gestational age and macrosomia (23.1% vs. 54.2% and 3.3% vs. 28.4%, respectively), compared to data from European cohorts. CONCLUSIONS: The multi-disciplinary approach for treating women with PGDM practiced in the high-risk pregnancy clinic at the Sheba Medical Center resulted in lower rates of macrosomia, LGA, and pregnancy induced hypertension compared to rates reported in the literature.


Asunto(s)
Diabetes Mellitus/terapia , Complicaciones del Embarazo/terapia , Atención Prenatal/métodos , Adulto , Glucemia , Femenino , Macrosomía Fetal/prevención & control , Humanos , Hipertensión/prevención & control , Recién Nacido de Bajo Peso , Recién Nacido , Insulina/uso terapéutico , Israel , Preeclampsia/prevención & control , Embarazo , Estudios Prospectivos , Estudios Retrospectivos
7.
Sports Health ; 12(3): 256-262, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32181705

RESUMEN

CONTEXT: Cardiovascular diseases cause 17 million deaths annually worldwide, of which hypertension is responsible for 9.4 million and a 7% burden of disease. High blood pressure is responsible for 45% of deaths from heart disease and 51% of deaths from stroke. OBJECTIVE: The aim of this systematic review and meta-analysis was to quantify the effect of isometric resistance training on systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MAP, respectively) values in normotensive adult participants. DATA SOURCES: This study was registered with the PROSPERO database. Eligible studies were identified after performing a systematic search within the following databases: PubMed, Scielo, BioMed Central, Clinical Trials, EMBASE, Cochrane Central Register of Controlled Trials, and EBSCO. STUDY SELECTION: Randomized controlled trials that categorized participants as normotensive according to the guidelines of the American Heart Association and the American College of Cardiology were included. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: Data related to participant characteristics, exercise programs, level of evidence, risk of bias, Consensus on Exercise Reporting Template, and outcomes of interest were systematically reviewed independently by 2 authors. RESULTS: A total of 6 randomized controlled trials were included. The following reductions in blood pressure (compared with the control group) were generated by isometric resistance training: SBP (mean difference [MD], -2.83 mm Hg; 95% CI, -3.95 to -1.72; P < 0.00001), DBP (MD, -2.73; 95% CI, -4.23 to -1.24; P = 0.0003), and MAP (MD, -3.07; 95% CI, -5.24 to -0.90; P = 0.005). CONCLUSION: It appears that isometric resistance training reduces SBP, DBP, and MAP in normotensive young adults in a statistically significant and clinically relevant manner. This type of exercise could be considered effective in preventing arterial hypertension.


Asunto(s)
Presión Sanguínea/fisiología , Entrenamiento de Resistencia/métodos , Humanos , Hipertensión/prevención & control , Contracción Isométrica , Prevención Primaria
8.
BMC Health Serv Res ; 20(1): 67, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-32000777

RESUMEN

BACKGROUND: Globally, hypertension is a leading cause of cardiovascular disease and mortality, with the majority of deaths occurring in low- and middle-income countries. Because the burden of hypertension is increasing in low resource settings with restricted infrastructure, it is imperative that new models for hypertension care are realised. One such model is the Community-based Hypertension Improvement Project (ComHIP) which employs a community-based method of task-shifting for managing hypertension. This study is a qualitative analysis of the barriers and facilitators of the main components of ComHIP. METHODS: We purposively selected 55 informants for semi-structured interviews or focus group discussions, which were carried out bythree trained local researchers in Krobo, Twi or English. Informants included patients enrolled in ComHIP, health care providers and Licensed Chemical Sellers trained by ComHIP, and Ghana Health Service employees. Data were analysed using a multi-step thematic analysis. RESULTS: While results of the effectiveness of the intervention are pending, overall, patients and nurses reported positive experiences within ComHIP, and found that it helped enable them to manage their hypertension. Healthcare providers appreciated the additional training, but had some gaps in their knowledge. Ghana Health Service employees were cautiously optimistic about the programme, but expressed some worries about the sustainability of the programme. Many informants expressed concerns over the inability of community nurses and workers to dispense anti-hypertensives, due to legal restrictions. CONCLUSIONS: The WHO recommends task-sharing as a technique for managing chronic conditions such as hypertension in resource constrained settings. ComHIP presents an example of a task-sharing programme with a high level of acceptability to all participants. Going forward, we recommend greater levels of communication and dialogue to allow community-based health workers to be allowed to dispense anti-hypertensives.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Accesibilidad a los Servicios de Salud , Hipertensión/prevención & control , Femenino , Grupos Focales , Ghana , Humanos , Masculino , Investigación Cualitativa
9.
REME rev. min. enferm ; 24: e-1275, fev.2020.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1051265

RESUMEN

Objetivo: identificar os fatores de riscos modificáveis de pacientes com hipertensão arterial sistêmica e relacioná-los às características sociodemográficas e clínicas. Métodos: estudo transversal e correlacional realizado em pacientes com hipertensão arterial sistêmica. Os fatores de risco analisados foram obesidade, consumo excessivo de sal, sedentarismo, consumo de bebida alcoólica, tabagismo, estresse e apneia do sono. A obesidade foi analisada pelo índice de massa corporal e medida da circunferência abdominal, o consumo de sal e o sedentarismo pelo relato dos pacientes, as desordens relacionadas ao consumo de álcool pelo Alcohol Use Disorders Indentification Test, o tabagismo pelo relato dos pacientes e pelo Questionário de Fagerström, o estresse pela Escala de Estresse Percebido e a apneia do sono pelo Questionário de Berlim. As variáveis sociodemográficas e clínicas analisadas foram idade, sexo, raça, escolaridade, estado civil, renda familiar, moradia, número de filhos e de conviventes e ocupação profissional. Resultados: foram avaliados 106 pacientes; 85 eram obesos, 73 sedentários, 71 apresentavam alto risco para apneia obstrutiva do sono e 25 faziam uso de álcool. A média do escore de desordens devido ao álcool foi de 0,83+2,8 pontos, do consumo de sal foi de 3,95 gramas, do estresse foi de 14,2+7,6 pontos e da dependência de nicotina foi de 3,00+1,7 pontos. Obesidade, sedentarismo, uso de bebida alcoólica, consumo de sal e estresse relacionaram-se a algumas variáveis sociodemográficas. Conclusão: ações preventivas devem ser adotadas para que haja mudança no estilo de vida desses pacientes e, consequentemente, redução de complicações e de outras doenças cardiovasculares.(AU)


Objective: to identify the modifiable risk factors of patients with systemic arterial hypertension and to relate them to sociodemographic and clinical characteristics. Methods: cross-sectional and correlational study carried out in patients with systemic arterial hypertension. The risk factors analyzed were obesity, excessive salt consumption, physical inactivity, alcohol consumption, smoking, stress and sleep apnea. Obesity was analyzed by body mass index and measurement of waist circumference, salt consumption and physical inactivity by patients' reports, disorders related to alcohol consumption by the Alcohol Use Disorders Identification Test, smoking by patients' reports and Fagerström Questionnaire, stress by the Perceived Stress Scale and sleep apnea by the Berlin Questionnaire. The sociodemographic and clinical variables analyzed were age, sex, race, education, marital status, family income, housing, number of children and cohabitants and professional occupation. Results: 106 patients were evaluated; 85 were obese, 73 were sedentary, 71 were at high risk for obstructive sleep apnea and 25 were using alcohol. The average score of disorders due to alcohol was...(AU)


Objetivo: identificar los factores de riesgo modificables de pacientes con hipertensión arterial sistémica y relacionarlos con características sociodemográficas y clínicas. Métodos: estudio transversal y correlacional realizado en pacientes con hipertensión arterial sistémica. Los factores de riesgo analizados fueron obesidad, consumo excesivo de sal, inactividad física, consumo de alcohol, tabaquismo, estrés y apnea del sueño. La obesidad se analizó mediante el índice de masa corporal y la medición de la circunferencia de la cintura, el consumo de sal y la inactividad física según los informes de los pacientes, los trastornos relacionados con el consumo de alcohol mediante el test para la identificación de trastornos por uso de alcohol (AUDIT), el tabaquismo según los informes de los pacientes y el cuestionario de Fagerström, estrés por la escala de estrés percibido y apnea del sueño por el cuestionario de Berlín. Las variables sociodemográficas y clínicas analizadas fueron edad, sexo, raza, educación, estado civil, ingresos familiares, vivienda, número de hijos y convivientes y ocupación profesional. Resultados: se evaluaron 106 pacientes; 85 eran obesos, 73 eran sedentarios, 71 tenían un alto riesgo de apnea obstructiva del sueño y 25 usaban alcohol. El puntaje promedio de los trastornos debidos al alcohol fue de 0,83 + 2,8 puntos, el consumo de sal fue de 3,95 gramos, el estrés fue de 14,2 + 7, 6 puntos y la dependencia de la nicotina fue 3,00 + 1,7 puntos. La obesidad, la inactividad física, el uso de alcohol, el consumo de sal y el estrés se relacionaron con algunas variables sociodemográficas. Conclusión: deben tomarse medidas preventivas para cambiar el estilo de vida de estos pacientes y, en consecuencia, reducir las complicaciones y demás enfermedades cardiovasculares. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Factores de Riesgo , Enfermería Cardiovascular , Hipertensión , Hipertensión/prevención & control , Factores Socioeconómicos , Técnicas de Diagnóstico Cardiovascular
10.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(2): 155-159, 2020 Feb 06.
Artículo en Chino | MEDLINE | ID: mdl-32074702

RESUMEN

Objective: To evaluate the effectiveness of health belief model-based health education intervention in improving blood pressure control of patients with hypertension in community settings. Methods: From September 2016 to September 2017, 400 newly diagnosed patients with hypertension were recruited from 6 community healthcare centers with comparable population size and health services in the Shunyi District of Beijing. All community healthcare centers were randomly assigned to the intervention group (206 patients) and the control group (194 patients). Patients in the intervention group received 3 lectures (20-30 min for each) of health belief model-based health education. Patients in the control group received usual care. The basic characteristics, health beliefs, and health literacy were collected, and blood pressure was measured before and after the intervention, respectively. The difference-in-difference model was used to analyze the change of blood pressure and the influencing factors between two groups before and after the intervention. Results: A total of 134 patients in the intervention group and 129 patients in the control group completed the study. After adjusting for the age, gender, family income, medical insurance, chronic diseases and family history, the score of perceived barriers was increased by 1.65 (P=0.016), and perceived seriousness was decreased by 0.73 (P=0.018). The systolic blood pressure of patients was decreased by 7.37 mmHg (1 mmHg=0.133 kPa, P=0.001) and diastolic blood pressure was decreased by 4.07 mmHg (P=0.014), respectively. The ß (95%CI) values were -7.37 (-11.88,-2.86) and -4.07 (-7.30, -0.84). The perceived susceptibility and self-efficacy had a significant influence on the blood pressure of patients (P<0.05). Conclusion: Health belief model-based health education intervention could significantly improve the blood pressure control of patients with hypertension in the community settings.


Asunto(s)
Hipertensión/prevención & control , Educación del Paciente como Asunto/métodos , Beijing , Presión Sanguínea , Servicios de Salud Comunitaria , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Modelos Psicológicos , Evaluación de Programas y Proyectos de Salud
11.
Medicine (Baltimore) ; 99(6): e19047, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028419

RESUMEN

BACKGROUND: Although evidence from animal and observational studies has supported the beneficial effects of green tea intake for lowering blood pressure (BP), randomized placebo-controlled trials (RCTs) have yielded conflicting results. In this meta-analysis of RCTs, we aimed to assess the effects of green tea supplementation on measures of BP control. METHODS: The PubMed, Embase, and Cochrane Library databases were electronically searched from inception to August 2019 for all relevant studies. The results were pooled using the generic inverse-variance method with random-effects weighting and expressed as mean differences (MDs) with 95% confidence intervals (CIs). The quality of studies was assessed using the Jadad score. Publication bias was evaluated using funnel plots, Egger test, and Begg test. RESULTS: Twenty-four trials with 1697 subjects were included in the meta-analysis. The pooled results showed that green tea significantly lowered systolic BP (SBP; MD: -1.17 mm Hg; 95%CI: -2.18 to -0.16mm Hg; P = .02) and diastolic BP (DBP; MD: -1.24 mm Hg; 95%CI:-2.07 to -0.40mm Hg; P = .004). Significant heterogeneity was found for both SBP (I = 43%) and DBP (I = 57%). In addition, no evidence of significant publication bias was found from funnel plots or Egger test (P = .674 and P = .270 for SBP and DBP, respectively). CONCLUSION: Overall, green tea significantly reduced SBP and DBP over the duration of the short-term trials. Larger and longer-term trials are needed to further investigate the effects of green tea supplementation on BP control and clinical events.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , , Suplementos Dietéticos , Humanos , Hipertensión/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto
12.
BMC Health Serv Res ; 20(1): 65, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996195

RESUMEN

BACKGROUND: The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS: Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS: Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION: Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION: Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.


Asunto(s)
Actitud del Personal de Salud , Delegación Profesional , Hipertensión/prevención & control , Enfermeros de Salud Comunitaria/psicología , Adulto , Centros Comunitarios de Salud/organización & administración , Femenino , Grupos Focales , Ghana , Hospitales de Distrito/organización & administración , Humanos , Hipertensión/enfermería , Masculino , Enfermeros de Salud Comunitaria/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa
14.
PLoS One ; 15(1): e0227439, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31945075

RESUMEN

BACKGROUND: The global burden of hypertension, currently estimated at 1 billion, is a leading Non-Communicable Disease (NCD) in Sub Saharan Africa. In Tanzania, the reported prevalence of hypertension is 25%. Inherent limitations of the healthcare system to control hypertension include inadequate provider knowledge, system capacity, medication access, and patient awareness, all of which hinder effective screening and disease management. To assess the quality of hypertension screening and patient counseling, we conducted a study in an ambulatory setting in Tanzania. METHODS: Observations of patient screening were conducted on 69 adult patients during routine outpatient care and screening camps. In addition, 33 healthcare providers participated in a pre-post knowledge assessment after observing instructional training videos. RESULTS: Patient observations indicated that blood pressure (BP) measurement was explained to 65% of patients, and 77% of the measurements were made with mercury sphygmomanometers. For several aspects of BP measurement, nurses performed better than doctors: patient's arm supported on a flat surface (doctors, 58% vs nurses 67%, p<0.05), and patient's back was supported (doctors, 50% vs nurses 88%, p<0.01). Among those diagnosed with hypertension, 7% were prescribed medications, 14% were advised on reduced salt during cooking, 29% on reduced salt consumption, 21% on reduced consumption of sodium rich foods, 21% on reducing caloric intake, 21% on increasing physical activity, and 43% were informed about follow up appointments. Provider knowledge assessments showed critical gaps in consequences of hypertension, 1st line medicines, and awareness of guidelines at baseline. Following the instructional videos there were improvements in some aspects: diagnostic criteria for hypertension (pre 45% vs post 91%, p<0.001) and counseling for controlling hypertension (pre 30% vs post 58%, p<0.01). CONCLUSION: Enhancing knowledge and performance competencies of health providers at the primary care level is a critical prerequisite for effective hypertension management in low resource settings.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Hipertensión , Educación del Paciente como Asunto , Médicos/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Determinación de la Presión Sanguínea/métodos , Consejo , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/prevención & control , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Tanzanía , Adulto Joven
15.
Clin Exp Hypertens ; 42(2): 99-104, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30698033

RESUMEN

Objective:Environmental cold stress is an important factor that leads to hypertension. The role and the mechanisms of in-utero cold stress in hypertension in adult offspring remain unknown.Methods: The pregnant rats were housed in cold (4°C) rooms from 14 to 21 days of gestation for prenatal cold exposure. The blood pressure and vascular response offspring of control and cold exposure were measured. And the receptor expression, phosphorylation and internalization were checked by immunoblotting or immunoprecipitation.Results: In the present study, we report that prenatal cold stress elevated the blood pressure via decreasing D1 receptor-associated vasodilation, which is ascribed to decreased D1 receptor expression and function. Moreover, the artery G protein-coupled receptor kinase 4 (GRK4) expression has been found to be higher in the prenatal cold stress treated offspring than the controls, which could cause the increased phosphorylation and internalization of D1 receptor in mesenteric artery from prenatal cold stress treated offspring, and led to receptor desensitization and vascular dysfunction.Conclusion: The results illustrate a new paradigm for the developmental origins of hypertension and imply that GRK4 and dopamine D1 receptor may be crucial determinants for the maternal hypertension.


Asunto(s)
Respuesta al Choque por Frío/fisiología , Dopamina/fisiología , Hipertensión/prevención & control , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Animales , Presión Sanguínea/fisiología , Femenino , Quinasa 4 del Receptor Acoplado a Proteína-G/metabolismo , Hipertensión/fisiopatología , Arterias Mesentéricas/fisiología , Fosforilación/fisiología , Embarazo , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Ratas Sprague-Dawley , Receptores de Dopamina D1/metabolismo , Vasodilatación/fisiología
17.
Am J Physiol Heart Circ Physiol ; 318(1): H34-H48, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31675258

RESUMEN

Obstructive sleep apnea is characterized by interrupted breathing that leads to cardiovascular sequelae including chronic hypertension that can persist into the waking hours. Chronic intermittent hypoxia (CIH), which models the hypoxemia associated with sleep apnea, is sufficient to cause a sustained increase in blood pressure that involves the central nervous system. The median preoptic nucleus (MnPO) is an integrative forebrain region that contributes to blood pressure regulation and neurogenic hypertension. The MnPO projects to the paraventricular nucleus (PVN), a preautonomic region. We hypothesized that pathway-specific lesions of the projection from the MnPO to the PVN would attenuate the sustained component of chronic intermittent hypoxia-induced hypertension. Adult male Sprague-Dawley rats (250-300 g) were anesthetized with isoflurane and stereotaxically injected bilaterally in the PVN with a retrograde Cre-containing adeno-associated virus (AAV; AAV9.CMV.HI.eGFP-Cre.WPRE.SV40) and injected in the MnPO with caspase-3 (AAV5-flex-taCasp3-TEVp) or control virus (AAV5-hSyn-DIO-mCherry). Three weeks after the injections the rats were exposed to a 7-day intermittent hypoxia protocol. During chronic intermittent hypoxia, controls developed a diurnal hypertension that was blunted in rats with caspase lesions. Brain tissue processed for FosB immunohistochemistry showed decreased staining with caspase-induced lesions of MnPO and downstream autonomic-regulating nuclei. Chronic intermittent hypoxia significantly increased plasma levels of advanced oxidative protein products in controls, but this increase was blocked in caspase-lesioned rats. The results indicate that PVN-projecting MnPO neurons play a significant role in blood pressure regulation in the development of persistent chronic intermittent hypoxia hypertension.NEW & NOTEWORTHY Chronic intermittent hypoxia associated with obstructive sleep apnea increases oxidative stress and leads to chronic hypertension. Sustained hypertension may be mediated by angiotensin II-induced neural plasticity of excitatory median preoptic neurons in the forebrain that project to the paraventricular nucleus of the hypothalamus. Selective caspase lesions of these neurons interrupt the drive for sustained hypertension and cause a reduction in circulating oxidative protein products. This indicates that a functional connection between the forebrain and hypothalamus is necessary to drive diurnal hypertension associated with intermittent hypoxia. These results provide new information about central mechanisms that may contribute to neurogenic hypertension.


Asunto(s)
Apoptosis , Presión Arterial , Caspasa 3/metabolismo , Hipertensión/prevención & control , Hipoxia/complicaciones , Núcleo Hipotalámico Paraventricular/enzimología , Área Preóptica/enzimología , Animales , Caspasa 3/genética , Ritmo Circadiano , Modelos Animales de Enfermedad , Frecuencia Cardíaca , Hipertensión/enzimología , Hipertensión/patología , Hipertensión/fisiopatología , Hipoxia/enzimología , Hipoxia/patología , Hipoxia/fisiopatología , Masculino , Estrés Oxidativo , Núcleo Hipotalámico Paraventricular/patología , Núcleo Hipotalámico Paraventricular/fisiopatología , Área Preóptica/patología , Área Preóptica/fisiopatología , Proteínas Proto-Oncogénicas c-fos/metabolismo , Ratas Sprague-Dawley , Transducción de Señal
18.
Drugs Aging ; 37(1): 43-55, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31755069

RESUMEN

INTRODUCTION: Aspirin is widely used to prevent cardiovascular diseases (CVDs). However, the balance of its benefits and risks in the primary prevention of CVDs and cancer is unclear, especially in elderly Asians. The present study aimed to evaluate the efficacy of aspirin in the primary prevention of major adverse cardiac and cerebrovascular events (MACCE), bleeding risk, and cancer in elderly Koreans with cardiovascular (CV) risk factors. METHODS: This retrospective cohort study used data from the Korean National Health Insurance Service-Senior cohort database (2002-2015). Patients aged 60-90 years with hypertension, type 2 diabetes mellitus (T2DM), or dyslipidemia were identified. Aspirin users were compared with non-users using propensity score matching at a 1:3 ratio. The primary outcome was MACCE, a composite of CV mortality, myocardial infarction, and ischemic stroke. The secondary outcomes were the components of MACCE, all-cause mortality, angina pectoris, heart failure, the incidence and mortality of cancer, and the risks of hemorrhagic stroke and gastrointestinal bleeding. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a Cox proportional hazard model. RESULTS: A total of 3366 aspirin users and 10,089 non-users were finally included in the study. During a mean follow-up of 7.8 years, the incidence of MACCE was 15.2% in aspirin users and 22.4% in non-users. The risk of MACCE was significantly lower in aspirin users than in non-users (HR 0.76; 95% CI 0.69-0.85), and this risk was significantly reduced in patients using aspirin over 5 years (HR 0.52; 95% CI 0.46-0.60). Aspirin use was associated with a 21% reduction in the risk of primary cancer (HR 0.79; 95% CI 0.70-0.88) and cancer-related mortality (HR 0.72; 95% CI 0.61-0.84). No significant differences in bleeding risks were observed between the two groups. CONCLUSION: Aspirin reduced the risks of MACCE and cancer without increasing the bleeding risk in elderly Koreans with hypertension, T2DM, or dyslipidemia. Moreover, the benefits of the long-term use of aspirin in reducing the risks of MACCE were demonstrated. However, the decision of using aspirin for primary prevention must be carefully made on an individual basis, while estimating the benefit-risk balance of aspirin.


Asunto(s)
Aspirina/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Neoplasias/prevención & control , Prevención Primaria/métodos , Anciano , Anciano de 80 o más Años , Aspirina/efectos adversos , Estudios de Cohortes , Diabetes Mellitus Tipo 2/prevención & control , Dislipidemias/prevención & control , Femenino , Hemorragia/inducido químicamente , Humanos , Hipertensión/prevención & control , Incidencia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , República de Corea , Estudios Retrospectivos , Medición de Riesgo
19.
Am J Physiol Regul Integr Comp Physiol ; 318(2): R351-R359, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31746626

RESUMEN

Maternal high-fat diet (HFD) is associated with metabolic syndrome and cardiovascular diseases in adult offspring. Our previous study demonstrated that maternal HFD enhances pressor responses to ANG II or a proinflammatory cytokine (PIC), which is associated with increased expression of brain renin-angiotensin system (RAS) components and PICs in adult offspring. The present study further investigated whether inhibition of angiotensin-converting enzyme (ACE) or tumor necrosis factor-α (TNF-α) blocks sensitization of ANG II hypertension in offspring of HFD dams. All offspring were bred from dams with normal fat diet (NFD) or HFD starting two weeks before mating and maintained until weaning of the offspring. Then the weaned offspring were treated with an ACE inhibitor (captopril) or a TNF-α inhibitor (pentoxifylline) in the drinking water through the end of testing with a slow-pressor dose of ANG II. RT-PCR analyses of the lamina terminalis and paraventricular nucleus revealed upregulation of mRNA expression of several RAS components and PICs in male offspring of HFD dams when compared with age-matched offspring of NFD dams. The enhanced gene expression was attenuated by blockade of either RAS or PICs. Likewise, ANG II administration produced an augmented pressor response in offspring of HFD dams. This was abolished by either ACE or TNF-α inhibitor. Taken together, this study provides mechanistic evidence and a therapeutic strategy that systemic inhibition of the RAS and PICs can block maternal HFD-induced sensitization of ANG II hypertension, which is associated with attenuation of brain RAS and PIC expression in offspring.


Asunto(s)
Angiotensina II , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Antihipertensivos/farmacología , Presión Sanguínea/efectos de los fármacos , Captopril/farmacología , Dieta Alta en Grasa , Hipertensión/prevención & control , Pentoxifilina/farmacología , Efectos Tardíos de la Exposición Prenatal , Inhibidores del factor de Necrosis Tumorales/farmacología , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Encéfalo/efectos de los fármacos , Encéfalo/metabolismo , Encéfalo/fisiopatología , Modelos Animales de Enfermedad , Femenino , Hipertensión/inducido químicamente , Hipertensión/metabolismo , Hipertensión/fisiopatología , Masculino , Fenómenos Fisiologicos Nutricionales Maternos , Embarazo , Ratas Sprague-Dawley , Sistema Renina-Angiotensina/efectos de los fármacos
20.
Internist (Berl) ; 61(4): 340-348, 2020 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-31578597

RESUMEN

Chronic kidney disease (CKD) is associated with substantial cardiovascular morbidity and mortality. This is mediated by the high prevalence of traditional cardiovascular risk factors in patients with CKD such as arterial hypertension and diabetes mellitus, but also by the presence of CKD-specific so-called nontraditional cardiovascular risk factors such as vascular calcification, uremic toxins, uremic dyslipidemia as well as inflammation and oxidative stress. Therefore, the primary and secondary prevention of cardiovascular disease represents an integral part of nephrology. This entails optimal control of blood pressure and diabetes, therapy of the uremic dyslipidemia as well as lifestyle-modifying factors such as weight reduction and smoking cessation.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Dislipidemias/epidemiología , Insuficiencia Renal Crónica/complicaciones , Toxinas Biológicas/sangre , Uremia/complicaciones , Presión Sanguínea/fisiología , Calcio/metabolismo , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus/epidemiología , Dislipidemias/etiología , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Hipertensión/prevención & control , Inflamación/complicaciones , Estrés Oxidativo , Factores de Riesgo , Uremia/epidemiología , Uremia/metabolismo , Calcificación Vascular/complicaciones , Calcificación Vascular/epidemiología , Rigidez Vascular
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