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2.
BMC Anesthesiol ; 24(1): 221, 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38961365

RESUMO

BACKGROUND: This study aimed to evaluate the accuracy of ankle blood pressure measurements in relation to invasive blood pressure in the lateral position. METHODS: This prospective observational study included adult patients scheduled for elective non-cardiac surgery under general anesthesia in the lateral position. Paired radial artery invasive and ankle noninvasive blood pressure readings were recorded in the lateral position using GE Carescape B650 monitor. The primary outcome was the ability of ankle mean arterial pressure (MAP) to detect hypotension (MAP < 70 mmHg) using area under the receiver operating characteristic curve (AUC) analysis. The secondary outcomes were the ability of ankle systolic blood pressure (SBP) to detect hypertension (SBP > 140 mmHg) as well as bias (invasive measurement - noninvasive measurement), and agreement between the two methods using the Bland-Altman analysis. RESULTS: We analyzed 415 paired readings from 30 patients. The AUC (95% confidence interval [CI]) of ankle MAP for detecting hypotension was 0.88 (0.83-0.93). An ankle MAP of ≤ 86 mmHg had negative and positive predictive values (95% CI) of 99 (97-100)% and 21 (15-29)%, respectively, for detecting hypotension. The AUC (95% CI) of ankle SBP to detect hypertension was 0.83 (0.79-0.86) with negative and positive predictive values (95% CI) of 95 (92-97)% and 36 (26-46)%, respectively, at a cutoff value of > 144 mmHg. The mean bias between the two methods was - 12 ± 17, 3 ± 12, and - 1 ± 11 mmHg for the SBP, diastolic blood pressure, and MAP, respectively. CONCLUSION: In patients under general anesthesia in the lateral position, ankle blood pressure measurements are not interchangeable with the corresponding invasive measurements. However, an ankle MAP > 86 mmHg can exclude hypotension with 99% accuracy, and an ankle SBP < 144 mmHg can exclude hypertension with 95% accuracy.


Assuntos
Anestesia Geral , Tornozelo , Determinação da Pressão Arterial , Humanos , Feminino , Anestesia Geral/métodos , Masculino , Estudos Prospectivos , Pessoa de Meia-Idade , Determinação da Pressão Arterial/métodos , Tornozelo/irrigação sanguínea , Idoso , Oscilometria/métodos , Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Hipertensão/diagnóstico , Hipotensão/diagnóstico , Hipotensão/fisiopatologia , Adulto , Posicionamento do Paciente/métodos
3.
Sci Rep ; 14(1): 15410, 2024 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-38965318

RESUMO

High systolic blood pressure (BP) is the most important modifiable risk factor for cardiovascular disease. Managing systolic hypertension is especially difficult in underserved populations wherein access to cuff BP devices is limited. We showed that ubiquitous smartphones without force sensing can be converted into absolute pulse pressure (PP) monitors. The concept is for the user to perform guided thumb and hand maneuvers with the phone to induce cuff-like actuation and allow built-in sensors to make cuff-like measurements for computing PP. We developed an Android smartphone PP application. The 'app' could be learned by volunteers and yielded PP with total error < 8 mmHg against cuff PP (N = 24). We also analyzed a large population-level database comprising adults less than 65 years old to show that PP plus other basic information can detect systolic hypertension with ROC AUC of 0.9. The smartphone PP app could ultimately help reduce the burden of systolic hypertension in underserved populations and thus health disparities.


Assuntos
Hipertensão , Aplicativos Móveis , Smartphone , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Pressão Sanguínea , Adulto , Determinação da Pressão Arterial/métodos , Populações Vulneráveis , Idoso , Hipertensão Sistólica Isolada
4.
BMC Cardiovasc Disord ; 24(1): 338, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38965474

RESUMO

BACKGROUND: The relationship between obstructive sleep apnea (OSA) and the occurrence of arrhythmias and heart rate variability (HRV) in hypertensive patients is not elucidated. Our study investigates the association between OSA, arrhythmias, and HRV in hypertensive patients. METHODS: We conducted a cross-sectional analysis involving hypertensive patients divided based on their apnea-hypopnea index (AHI) into two groups: the AHI ≤ 15 and the AHI > 15. All participants underwent polysomnography (PSG), 24-hour dynamic electrocardiography (DCG), cardiac Doppler ultrasound, and other relevant evaluations. RESULTS: The AHI > 15 group showed a significantly higher prevalence of frequent atrial premature beats and atrial tachycardia (P = 0.030 and P = 0.035, respectively) than the AHI ≤ 15 group. Time-domain analysis indicated that the standard deviation of normal-to-normal R-R intervals (SDNN) and the standard deviation of every 5-minute normal-to-normal R-R intervals (SDANN) were significantly higher in the AHI > 15 group (P = 0.020 and P = 0.033, respectively). Frequency domain analysis revealed that the low-frequency (LF), high-frequency (HF) components, and the LF/HF ratio were also significantly elevated in the AHI > 15 group (P < 0.001, P = 0.031, and P = 0.028, respectively). Furthermore, left atrial diameter (LAD) was significantly larger in the AHI > 15 group (P < 0.001). Both univariate and multivariable linear regression analyses confirmed a significant association between PSG-derived independent variables and the dependent HRV parameters SDNN, LF, and LF/HF ratio (F = 8.929, P < 0.001; F = 14.832, P < 0.001; F = 5.917, P = 0.016, respectively). CONCLUSIONS: Hypertensive patients with AHI > 15 are at an increased risk for atrial arrhythmias and left atrial dilation, with HRV significantly correlating with OSA severity.


Assuntos
Arritmias Cardíacas , Frequência Cardíaca , Hipertensão , Polissonografia , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/complicações , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Hipertensão/fisiopatologia , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Idoso , Fatores de Risco , Prevalência , Eletrocardiografia Ambulatorial , Adulto , Fatores de Tempo , Ecocardiografia Doppler , Complexos Atriais Prematuros/fisiopatologia , Complexos Atriais Prematuros/diagnóstico , Complexos Atriais Prematuros/epidemiologia , Medição de Risco , Índice de Gravidade de Doença
5.
J Clin Hypertens (Greenwich) ; 26(7): 842-849, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38980252

RESUMO

Adequate management of nocturnal hypertension is crucial to reduce the risk of organ damage and cardiovascular events. The EARLY-NH study was a prospective, open-label, multicenter study conducted in Japanese patients with nocturnal hypertension who received esaxerenone treatment for 12 weeks. This post hoc analysis aimed to assess (1) the relationship between changes in morning home systolic blood pressure (SBP), bedtime home SBP, and nighttime home SBP based on changes in SBP and achievement rates of target SBP levels; and (2) the correlation between nighttime home SBP measurements using brachial and wrist home BP monitoring (HBPM) devices. This analysis evaluated 82 patients who completed the 12-week treatment period. Among those who achieved target morning home SBP (<135 mmHg) and target bedtime home SBP (<135 mmHg), the brachial HBPM device showed achievement rates of 63.6% and 56.4%, respectively, for target nighttime home SBP (<120 mmHg). The wrist device showed achievement rates of 66.7% and 63.4%, respectively, for the same targets. Significant correlations were observed between both devices for nighttime home SBP measurements at baseline (r = 0.790), Week 12 (r = 0.641), and change from baseline to Week 12 (r = 0.533) (all, p < .001). In this patient population, approximately 60% of individuals who reached target morning or bedtime home SBP levels <135 mmHg exhibited well-controlled nighttime home SBP. Although nighttime home SBP measurements obtained using both brachial and wrist HBPM devices displayed a significant correlation, the wrist device needs to be examined in more detail for clinical use.


Assuntos
Anti-Hipertensivos , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Ritmo Circadiano , Hipertensão , Punho , Humanos , Masculino , Feminino , Monitorização Ambulatorial da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Pessoa de Meia-Idade , Estudos Prospectivos , Hipertensão/tratamento farmacológico , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Idoso , Anti-Hipertensivos/uso terapêutico , Ritmo Circadiano/fisiologia , Pressão Sanguínea/fisiologia , Pressão Sanguínea/efeitos dos fármacos , Japão , Resultado do Tratamento
6.
Age Ageing ; 53(7)2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38970547

RESUMO

BACKGROUND: Based on observational studies and randomised controlled trials (RCTs), the benefit-harm balance of antihypertensive treatment in older adults with dementia is unclear. OBJECTIVE: To assess whether discontinuing antihypertensive treatment reduces neuropsychiatric symptoms (NPSs) and maintains quality of life (QoL) in nursing home residents with dementia. DESIGN: Open-label, blinded-outcome RCT. Randomisation 1:1, stratified by nursing home organisation and baseline NPS. Trial registration: NL7365. SUBJECTS: Dutch long-term care residents with moderate-to-severe dementia and systolic blood pressure (SBP) ≤160 mmHg during antihypertensive treatment. Exclusion criteria included heart failure NYHA-class-III/IV, recent cardiovascular events/procedures or life expectancy <4 months (planned sample size n = 492). MEASUREMENTS: Co-primary outcomes NPS (Neuropsychiatric Inventory-Nursing Home [NPI-NH]) and QoL (Qualidem) at 16 weeks. RESULTS: From 9 November 2018 to 4 May 2021, 205 participants (median age 85.8 [IQR 79.6-89.5] years; 79.5% female; median SBP 134 [IQR 123-146] mmHg) were randomised to either antihypertensive treatment discontinuation (n = 101) or usual care (n = 104). Safety concerns, combined with lacking benefits, prompted the data safety and monitoring board to advice a premature cessation of randomisation. At 16-week follow-up, no significant differences were found between groups for NPI-NH (adjusted mean difference 1.6 [95% CI -2.3 to 5.6]; P = 0.42) or Qualidem (adjusted mean difference - 2.5 [95% CI -6.0 to 1.0]; P = 0.15). Serious adverse events (SAEs) occurred in 36% (discontinuation) and 24% (usual care) of the participants (adjusted hazard ratio 1.65 [95% CI 0.98-2.79]). All 32-week outcomes favoured usual care. CONCLUSION: Halfway through this study, a non-significant increased SAE risk associated with discontinuing antihypertensive treatment was observed, and an associated interim analysis showed that significant worthwhile health gain for discontinuation of antihypertensive treatment was unlikely. This unbeneficial benefit-harm balance shows that discontinuation of antihypertensive treatment in this context does not appear to be either safe or beneficial enough to be recommended in older adults with dementia.


Assuntos
Anti-Hipertensivos , Demência , Instituição de Longa Permanência para Idosos , Casas de Saúde , Qualidade de Vida , Humanos , Feminino , Masculino , Demência/psicologia , Demência/tratamento farmacológico , Demência/diagnóstico , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Idoso , Países Baixos , Suspensão de Tratamento , Hipertensão/tratamento farmacológico , Hipertensão/psicologia , Resultado do Tratamento , Pressão Sanguínea/efeitos dos fármacos
7.
Exp Clin Transplant ; 22(5): 381-385, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38970281

RESUMO

OBJECTIVES: Lung transplant is the ultimate treatment of many end-stage lung diseases. Calcineurin inhibitors, crucial in immunosuppression for lung transplant recipients, are linked to secondary hypertension, necessitating antihypertensive treatment. In addition, lung transplant recipients frequently experience orthostatic hypotension, occasionally stemming from autonomic dysfunction, but also commonly attributed as a negative side effect of antihypertensive treatment. Our study aimed to evaluate the frequency of orthostatic blood pressure irregularities and investigate the involvement of antihypertensive treatment as a potential risk factor in the occurrence among lung transplant recipients. MATERIALS AND METHODS: Fifty-six consecutive lung transplant recipients, both inpatient and outpatient, at the University Hospital Zurich (Switzerland) were monitored from 1999 to 2013. Transplant recipients underwent a Schellong test (an active standing test). Our evaluation encompassed their initial traits, such as the existence of supine hypertension. We computed the odds ratio for the comparison of the likelihood of experiencing orthostatic hypotension while using a minimum of 1 type of antihypertensive medication versus absence of antihypertensive drugs. RESULTS: Of the lung transplant recipients, 25% showed a positive Schellong test. Within this group, 64% had supine hypertension, and 29% displayed symptoms of orthostatic hypotension. Among the patients, 71% were using at least 1 type of antihypertensive medication. The odds ratio for showing orthostatic hypotension while taking at least 1 type of antihypertensive drug versus the absence of antihypertensive medications was 1.64 (95% exact CI, 0.39-6.90) with P = .50. This finding remained consistent regardless of age, sex, inpatient or outpatient status, and the duration since transplant. CONCLUSIONS: Orthostatic blood pressure dysregulation is prevalent among lung transplant recipients, frequently without noticeable symptoms. In our cohort, the use of antihypertensive medications did not elevate the risk of orthostatic hypotension.


Assuntos
Anti-Hipertensivos , Pressão Sanguínea , Hipotensão Ortostática , Transplante de Pulmão , Humanos , Transplante de Pulmão/efeitos adversos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/fisiopatologia , Hipotensão Ortostática/epidemiologia , Feminino , Masculino , Estudos Transversais , Pessoa de Meia-Idade , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Fatores de Risco , Adulto , Resultado do Tratamento , Pressão Sanguínea/efeitos dos fármacos , Razão de Chances , Idoso , Hipertensão/tratamento farmacológico , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/epidemiologia , Hospitais Universitários , Estudos Retrospectivos
8.
BMC Cardiovasc Disord ; 24(1): 345, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38977943

RESUMO

BACKGROUND AND AIMS: H-type hypertension is essential hypertension combined with high homocysteine, and both synergistically increase the risk of cardiovascular and cerebrovascular events. The aim of this study was to investigate the risk factors of H-type hypertension in Tibetan plateau population and correlation with MTHFR C677T gene. METHODS AND RESULTS: A multi-stage cluster random sampling method was used to select the research subjects in Tibet Autonomous Region from June 2020 to November 2021. Among Tibetans, the incidence of H-type hypertension accounted for 84.31% of hypertensive patients. The logistic regression analysis demonstrated that age, uric acid (UA), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) were risk factors for the prevalence of H-type hypertension, the OR (95% CI) was 1.083(1.073-1.094), 1.002(1.001-1.004), 1.240(1.050-1.464) and 2.274(1.432-3.611), respectively. MTHFR C677T TT genotype patients with H-type hypertension OR (95% CI) was 1.629(1.004-2.643). Based on this, a nomogram model was established, and the reliability of the model was proved by area under ROC curve, Brier score and average absolute error. The model's results indicate that for every five years of age, the score increases by 6 points; for a 2mmol/L increase in TG, the score increases by 5.5 points; for a 1mmol/L increase in LDL-C, the score increases by 10 points; and individuals with the TT genotype receive 8 points. The higher the score, the greater the risk of disease. CONCLUSION: The MTHFR C677T TT genotype is a risk locus for Tibetan patients with H-type hypertension, with age, TG, and LDL-C were identified as risk factors for the disease.


Assuntos
Predisposição Genética para Doença , Metilenotetra-Hidrofolato Redutase (NADPH2) , Humanos , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Tibet/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Medição de Risco , Adulto , Prevalência , Fenótipo , Hipertensão Essencial/genética , Hipertensão Essencial/diagnóstico , Hipertensão Essencial/epidemiologia , Hipertensão Essencial/fisiopatologia , Pressão Sanguínea/genética , Idoso , Incidência , Polimorfismo de Nucleotídeo Único , Homocisteína/sangue , Hiper-Homocisteinemia/genética , Hiper-Homocisteinemia/diagnóstico , Hiper-Homocisteinemia/epidemiologia , Hiper-Homocisteinemia/sangue , Hipertensão/genética , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia
9.
BMC Public Health ; 24(1): 1868, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38997668

RESUMO

BACKGROUND: Bilateral blood pressure (BP) measurement is important in cardiovascular prevention for identifying systolic interarm BP difference (IAD) and hypertension. We investigated sex-stratified IAD prevalence and its associations and coexistence with screen-detected peripheral atherosclerosis and hypertension. Furthermore, we determined the proportion misclassified as non-hypertensive when using the lower versus the higher reading arm. METHODS: This sub-study formed part of the Viborg Screening Program (VISP), a cross-sectorial population-based cardiovascular screening programme targeting 67-year-old Danes. VISP includes screening for peripheral atherosclerosis (lower extremity arterial disease and carotid plaque), abdominal aortic aneurysm, hypertension, diabetes mellitus, and cardiac disease. Self-reported comorbidities, risk factors, and medication use were also collected. Among 4,602 attendees, 4,517 (82.1%) had eligible bilateral and repeated BP measurements. IAD was defined as a systolic BP difference ≥ 10 mmHg. IAD-associated factors (screening results and risk factors) were estimated by logistic regression; proportional coexistence was displayed by Venn diagrams (screening results). RESULTS: We included 2,220 women (49.2%) and 2,297 men (50.8%). IAD was more predominant in women (26.8%) than men (21.0%) (p < 0.001). This disparity persisted after adjustment [odds ratio (OR) 1.53; 95% confidence interval (CI) 1.32-1.77]. No other association was recorded with the conditions screened for, barring potential hypertension: BP 140-159/90-99 mmHg (OR 1.68, 95% CI 1.44-1.97) and BP ≥ 160/100 mmHg (OR 1.82, 95% CI 1.49-2.23). Overall, IAD and BP ≥ 160/100 mmHg coexistence was 4% in women and 5% in men; for BP ≥ 140/90 mmHg, 13% and 14%, respectively. Among those recording a mean BP ≥ 140/90 mmHg in the higher reading arm, 14.5% of women and 15.3% of men would be misclassified as non-hypertensive compared with the lowest reading arm. CONCLUSION: Female sex was an independent factor of IAD prevalence but not associated with other arterial lesions. Approximately 15% needed reclassification according to BP ≥ 140/90 mmHg when the lower rather than the higher reading arm was used; verifying bilateral BP measurements improved detection of potential hypertension. In future, the predictive value of sex-stratified IAD should be assessed for cardiovascular events and death to verify its potential as a screening tool in population-based cardiovascular screening. TRIAL REGISTRATION FOR VISP: NCT03395509:10/12/2018.


Assuntos
Determinação da Pressão Arterial , Hipertensão , Humanos , Feminino , Masculino , Idoso , Determinação da Pressão Arterial/métodos , Hipertensão/epidemiologia , Hipertensão/diagnóstico , Prevalência , Programas de Rastreamento/métodos , Braço , Fatores de Risco , Pressão Sanguínea/fisiologia , Fatores Sexuais , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/diagnóstico
10.
Vasc Health Risk Manag ; 20: 313-322, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39005236

RESUMO

Background: The coexistence of multiple standard modifiable risk factors (SMuRFs),classical and novel risk factors (RFs) for atherosclerotic cardiovascular disease (ASCVD) is common in the Middle East (ME). There is a paucity of data on the coexistence of these RFs in ME young women. Aim: Comparing the prevalence and the statistical patterns of the SMuRFs, classical and novel RFs in target population. Methods: In this case-control (1:2) study, consecutive young women aged 18-50 years were enrolled in 12 centers (July 2021 to October 2023). Prevalence and coexistence of 19 RFs were compared between cases with ASCVD and their controls. The RFs included SMuRFs (hypertension, type 2 diabetes, dyslipidemia, and cigarette smoking), other classical RF (obesity, family history of premature ASCVD, and physical inactivity), novel RFs and social determinants of health (health insurance, place of residence, depression, and level of education). Results: The study included 627 subjects; 209 had ASCVD (median age 46 years, IQR 49-42 years) and 418 controls (median age 45 years, IQR 48-41 years). The presence of 1-2 RFs; (ASCVD: 63.2%, Control: 54.1%, p=0.037) and 3-4 RFs; (ASCVD: 27.8%, Control: 3.3%, p < 0.001) SMuRFs was more prevalent in women with ASCVD. Similarly, the presence of 4-5 RFs; (ASCVD: 40.7%, Control: 14.6%, p<0.001), and 6-7 (ASCVD: 10.5%, Control: 1%, p < 0.001). The classical RF were also significantly common in these women. The distribution of multiple novel RF was not statistically significant across both groups. Finally, regarding the socioeconomic RFs in women with ASCVDs, the presence of 1-2 RFs (ASCVD: 59.8%, Control: 76.1%, p < 0.001) was significantly less common while the presence of 3-4 RFs (ASCVD: 39.2%, Control: 21.8%, p < 0.001) was vastly more common. Conclusion: An elevated rate of coexistence of classical RF in the case group, mainly socioeconomic and SMuRFs. By managing them primary and secondary ASCVDs prevention attained.


Assuntos
Aterosclerose , Fatores de Risco de Doenças Cardíacas , Determinantes Sociais da Saúde , Humanos , Feminino , Adulto , Prevalência , Adolescente , Adulto Jovem , Estudos de Casos e Controles , Pessoa de Meia-Idade , Medição de Risco , Aterosclerose/epidemiologia , Aterosclerose/diagnóstico , Fatores Etários , Oriente Médio/epidemiologia , Dislipidemias/epidemiologia , Dislipidemias/diagnóstico , Hipertensão/epidemiologia , Hipertensão/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Fumar Cigarros/epidemiologia , Fumar Cigarros/efeitos adversos , Obesidade/epidemiologia , Obesidade/diagnóstico , Comportamento Sedentário
11.
Glob Heart ; 19(1): 58, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39006864

RESUMO

Background: Hypertension is the leading cause of cardiovascular disease, whose death burden is dramatically increasing in sub-Saharan Africa. To curb its effects, early diagnosis and effective follow-up are essential. Therefore, this study aims to evaluate the impact of a hypertension screening corner on the hypertension care cascade at the primary healthcare level. Methods: A prospective cohort study was conducted between October 2022 and March 2023 in two PHCCs in Zambezia (Mozambique). The study involved a demographic and socioeconomic status (SES) questionnaire for those screened. Patients with blood pressure (BP) > 140/90 mmHg were given a follow-up questionnaire regarding the care cascade. The four cascade steps were: medical visit, diagnosis confirmation, follow-up visit, and recalling the follow-up appointment. The odds ratio (OR) of reaching each step of the cascade was assessed by binomial logistic regression. Results: Patients with BP > 140/90 mmHg were 454, and 370 (86.0%) completed both study phases. Individuals attending the medical visit were 225 (60.8%). Those with low SES had a higher probability of visit attendance than those with middle (OR = 0.46, 0.95CI[0.23-0.88] p = 0.020) and high (OR = 0.21 0.95CI[0.10-0.42], p < 0.001). Hypertension diagnosis was confirmed in 181 (80.4%), with higher probability in the low SES group compared to the middle (OR = 0.24 IC95[0.08-0.66], p = 0.007) and high (OR = 0.23, IC95[0.07-0.74], p = 0.016) groups. The OR to complete step 1 and step 2 were higher for older age groups. A follow-up appointment was received and recalled by 166 (91.7%) and 162 (97.6%) patients, respectively. Conclusions: The hypertension corner proved to be a useful tool for effective screening of hypertension with satisfactory retention in care, especially for people with lower socio-economic status.


Assuntos
Hipertensão , Programas de Rastreamento , Atenção Primária à Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Moçambique/epidemiologia , Programas de Rastreamento/métodos , Adulto , Pressão Sanguínea/fisiologia , Seguimentos , Idoso
12.
J Am Heart Assoc ; 13(14): e034915, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-38979821

RESUMO

BACKGROUND: The accurate selection of patients likely to respond to renal denervation (RDN) is crucial for optimizing treatment outcomes in patients with hypertension. This systematic review was designed to evaluate patient-specific factors predicting the RDN response. METHODS AND RESULTS: We focused on individuals with hypertension who underwent RDN. Patients were categorized based on their baseline characteristics. The primary outcome was blood pressure (BP) reduction after RDN. Both randomized controlled trials and nonrandomized studies were included. We assessed the risk of bias using corresponding tools and further employed the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the overall quality of evidence. A total of 50 studies were ultimately included in this systematic review, among which 17 studies were for meta-analysis. Higher baseline heart rate and lower pulse wave velocity were shown to be associated with significant antihypertensive efficacy of RDN on 24-hour systolic BP reduction (weighted mean difference, -4.05 [95% CI, -7.33 to -0.77]; weighted mean difference, -7.20 [95% CI, -9.79 to -4.62], respectively). In addition, based on qualitative analysis, higher baseline BP, orthostatic hypertension, impaired baroreflex sensitivity, and several biomarkers are also reported to be associated with significant BP reduction after RDN. CONCLUSIONS: In patients with hypertension treated with the RDN, higher heart rate, and lower pulse wave velocity were associated with significant BP reduction after RDN. Other factors, including higher baseline BP, hypertensive patients with orthostatic hypertension, BP variability, impaired cardiac baroreflex sensitivity, and some biomarkers are also reported to be associated with a better BP response to RDN.


Assuntos
Pressão Sanguínea , Hipertensão , Rim , Humanos , Hipertensão/fisiopatologia , Hipertensão/cirurgia , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Rim/inervação , Rim/fisiopatologia , Pressão Sanguínea/fisiologia , Resultado do Tratamento , Simpatectomia/métodos , Frequência Cardíaca/fisiologia , Análise de Onda de Pulso , Artéria Renal/inervação , Barorreflexo/fisiologia
13.
J Am Heart Assoc ; 13(14): e032568, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-38989822

RESUMO

BACKGROUND: Shared decision-making (SDM) has the potential to improve hypertension care quality and equity. However, research lacks diverse representation and evidence about how race and ethnicity affect SDM. Therefore, this study aims to explore SDM in the context of hypertension management. METHODS AND RESULTS: Explanatory sequential mixed-methods design was used. Quantitative data were sourced at baseline and 12-month follow up from RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) participants (n=1212) with hypertension. Qualitative data were collected from semistructured individual interviews, at 12-month follow-up, with participants (n=36) selected based on their SDM scores and blood pressure outcome. Patients were cross- categorized based on high or low SDM scores and systolic blood pressure reduction of ≥10 or <10 mm Hg. Multinomial logistic regression analysis showed that predictors of SDM scores and blood pressure outcome were race and ethnicity (relative risk ratio [RRR], 1.64; P=0.029), age (RRR, 1.03; P=0.002), educational level (RRR, 1.87; P=0.016), patient activation (RRR, 0.98; P<0.001; RRR, 0.99; P=0.039), and hypertension knowledge (RRR, 2.2; P<0.001; and RRR, 1.57; P=0.045). Qualitative and mixed-methods findings highlight that provider-patient communication and relationship influenced SDM, being emphasized both as facilitators and barriers. Other facilitators were patients' understanding of hypertension; clinicians' interest in the patient, and clinicians' personality and attitudes; and barriers included perceived lack of compassion, relationship hierarchy, and time constraints. CONCLUSIONS: Participants with different SDM scores and blood pressure outcomes varied in determinants of decision and descriptions of contextual factors influencing SDM. Results provide actionable information, are novel, and expand our understanding of factors influencing SDM in hypertension.


Assuntos
Tomada de Decisão Compartilhada , Hipertensão , Participação do Paciente , Humanos , Hipertensão/etnologia , Hipertensão/terapia , Hipertensão/psicologia , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Pressão Sanguínea/fisiologia , Pesquisa Qualitativa , Relações Médico-Paciente , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Etnicidade
14.
BMC Musculoskelet Disord ; 25(1): 536, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38997710

RESUMO

BACKGROUND: Hypertension is a common comorbidity of osteoarthritis (OA). Joint pain is the main clinical manifestation of OA. Knowledge about the relationship between hypertension and OA pain is limited. This study aimed to investigate whether blood pressure parameters are associated with knee pain severity in individuals with or at risks for OA. METHODS: Our sample consisted of 2598 subjects (60.7% female, aged 45-79 years) collected from the Osteoarthritis Initiative. Blood pressure parameters included blood pressure stage, systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP). Radiographic evaluation using Kellgren-Lawrence system and pain severity evaluation using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Numeric Rating Scale (NRS) were performed for right knee. Linear regression was used to examine the relationship between blood pressure parameters and knee pain severity. RESULTS: For the overall sample, blood pressure stage, SBP, and PP were positively correlated with WOMAC and NRS pain scores when adjusting for age, sex, and body mass index (BMI) (p ≤ 0.024) and were inversely correlated with KOOS score (p ≤ 0.004). After further adjusting for all covariates, PP remained a positive correlation with WOMAC score (p = 0.037) while other associations between blood pressure parameters and pain scores did not reach the statistical significance. In female, higher blood pressure stage, SBP, and PP were significantly associated with increased WOMAC and NRS scores and decreased KOOS score after adjustments of age and BMI (p ≤ 0.018). When adjusting for all covariates, the correlations of PP with WOMAC, KOOS and NRS scores remained significant (p = 0.008-0.049). In male sample, SBP was positively correlated with WOMAC score when adjusting for age and BMI (p = 0.050), but other associations between blood pressure parameters and pain scores were not statistically significant. No significant correlation was observed in male when further adjusting for other covariates. CONCLUSIONS: Increased PP is a risk factor for knee pain and mainly affects females, which suggested that controlling PP may be beneficial in preventing or reducing knee pain in females with or at risks for OA.


Assuntos
Artralgia , Pressão Sanguínea , Osteoartrite do Joelho , Medição da Dor , Índice de Gravidade de Doença , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/diagnóstico , Pressão Sanguínea/fisiologia , Artralgia/fisiopatologia , Artralgia/epidemiologia , Artralgia/diagnóstico , Artralgia/etiologia , Fatores de Risco , Articulação do Joelho/fisiopatologia , Articulação do Joelho/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipertensão/diagnóstico , Estudos Transversais
15.
Circulation ; 150(3): 230-242, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-39008556

RESUMO

BACKGROUND: Disparities in hypertension control are well documented but underaddressed. METHODS: RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) was a 2-arm, cluster randomized trial comparing the effect on blood pressure (BP) control (systolic BP ≤140 mm Hg, diastolic BP ≤90 mm Hg), patient activation, and disparities in BP control of 2 multilevel interventions, standard of care plus (SCP) and collaborative care/stepped care (CC/SC). SCP included BP measurement standardization, audit and feedback, and equity-leadership training. CC/SC added roles to address social or medical needs. Primary outcomes were BP control and patient activation at 12 months. Generalized estimating equations and mixed-effects regression models with fixed effects of time, intervention, and their interaction compared change in outcomes at 12 months from baseline. RESULTS: A total of 1820 adults with uncontrolled BP and ≥1 other risk factors enrolled in the study. Their mean age was 60.3 years, and baseline BP was 152.3/85.5 mm Hg; 59.4% were women; 57.4% were Black, 33.2% were White, and 9.4% were Hispanic; 74% had hyperlipidemia; and 45.1% had type 2 diabetes. CC/SC did not improve BP control rates more than SCP. Both groups achieved statistically and clinically significant BP control rates at 12 months (CC/SC: 57.3% [95% CI, 52.7%-62.0%]; SCP: 56.7% [95% CI, 51.9%-61.5%]). Pairwise comparisons between racial and ethnic groups showed overall no significant differences in BP control at 12 months. Patients with coronary heart disease showed greater achievement of BP control in CC/SC than in SCP (64.0% [95% CI, 54.1%-73.9%] versus 50.8% [95% CI, 42.6%-59.0%]; P=0.04), as did patients in rural areas (67.3% [95% CI, 49.8%-84.8%] versus 47.8% [95% CI, 32.4%-63.2%]; P=0.01). Individuals in both arms experienced statistically and clinically significant reductions in mean systolic BP (CC/SC: -13.8 mm Hg [95% CI, -15.2 to -12.5]; SCP: -14.6 mm Hg [95% CI, -15.9 to -13.2]) and diastolic BP (CC/SC: -6.9 mm Hg [95% CI, -7.8 to -6.1]; SCP: -5.5 mm Hg [95% CI, -6.4 to -4.6]) over time. The difference in diastolic BP reduction between CC/SC and SCP over time was statistically significant (-1.4 mm Hg [95% CI, -2.6 to -0.2). Patient activation did not differ between arms. CC/SC showed greater improvements in patient ratings of chronic illness care (Patient Assessment of Chronic Illness Care score) over 12 months (0.12 [95% CI, 0.02-0.22]). CONCLUSIONS: Adding a collaborative care team to enhanced standard of care did not improve BP control but did improve patient ratings of chronic illness care.


Assuntos
Pressão Sanguínea , Hipertensão , Medidas de Resultados Relatados pelo Paciente , Humanos , Hipertensão/terapia , Hipertensão/fisiopatologia , Hipertensão/diagnóstico , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Disparidades em Assistência à Saúde , Resultado do Tratamento , Anti-Hipertensivos/uso terapêutico
16.
Rev Bras Enferm ; 77Suppl 3(Suppl 3): e20230288, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-39016430

RESUMO

OBJECTIVES: to develop a Middle-Range Theory for the Risk for imbalanced blood pressure pattern among incarcerated women. METHODS: theoretical development study to obtain the theoretical-causal validity of the Nursing Diagnosis Risk for unstable blood pressure. The Middle-Range Theory was developed according to six stages: establishment of the approach to developing the theory; definition of the conceptual models to be later analyzed; definition of the main conceptions; a pictorial diagram; propositions; causal relationships and evidence for practice. RESULTS: two attributes and 20 antecedents related to imbalanced blood pressure were identified, a pictorial diagram was developed, and nine theoretical propositions were presented. CONCLUSIONS: the theory developed here favors the diagnostic reasoning of nurses and contributes to planning actions to promote the cardiovascular health of incarcerated women. A new proposition for the diagnosis of Risk for unstable blood pressure was also structured with a new title, definition, and etiological factors.


Assuntos
Prisioneiros , Humanos , Feminino , Prisioneiros/estatística & dados numéricos , Pressão Sanguínea/fisiologia , Adulto , Diagnóstico de Enfermagem/métodos , Fatores de Risco , Hipertensão/diagnóstico , Pessoa de Meia-Idade
17.
BMC Public Health ; 24(1): 1900, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-39014354

RESUMO

BACKGROUND: Non-communicable diseases (NCDs) are responsible for 51% of total mortality in South Africa, with a rising burden of hypertension (HTN) and diabetes mellitus (DM). Incorporating NCDs and COVID-19 screening into mass activities such as COVID-19 vaccination programs could offer significant long-term benefits for early detection interventions. However, there is limited knowledge of the associated costs and resources required. We evaluated the cost of integrating NCD screening and COVID-19 antigen rapid diagnostic testing (Ag-RDT) into a COVID-19 vaccination program. METHODS: We conducted a prospective cost analysis at three public sector primary healthcare clinics and one academic hospital in Johannesburg, South Africa, conducting vaccinations. Participants were assessed for eligibility and recruited during May-Dec 2022. Costs were estimated from the provider perspective using a bottom-up micro-costing approach and reported in 2022 USD. RESULTS: Of the 1,376 enrolled participants, 240 opted in to undergo a COVID-19 Ag-RDT, and none tested positive for COVID-19. 138 (10.1%) had elevated blood pressure, with 96 (70%) having no prior HTN diagnosis. 22 (1.6%) were screen-positive for DM, with 12 (55%) having no prior diagnosis. The median cost per person screened for NCDs was $1.70 (IQR: $1.38-$2.49), respectively. The average provider cost per person found to have elevated blood glucose levels and blood pressure was $157.99 and $25.19, respectively. Finding a potentially new case of DM and HTN was $289.65 and $36.21, respectively. For DM and DM + HTN screen-positive participants, diagnostic tests were the main cost driver, while staff costs were the main cost driver for DM- and HTN screen-negative and HTN screen-positive participants. The median cost per Ag-RDT was $5.95 (IQR: $5.55-$6.25), with costs driven mainly by test kit costs. CONCLUSIONS: We show the cost of finding potentially new cases of DM and HTN in a vaccine queue, which is an essential first step in understanding the feasibility and resource requirements for such initiatives. However, there is a need for comparative economic analyses that include linkage to care and retention data to fully understand this cost and determine whether opportunistic screening should be added to general mass health activities.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Diabetes Mellitus , Hipertensão , Programas de Rastreamento , Humanos , África do Sul/epidemiologia , Hipertensão/diagnóstico , COVID-19/prevenção & controle , COVID-19/diagnóstico , COVID-19/economia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/economia , Diabetes Mellitus/prevenção & controle , Vacinas contra COVID-19/economia , Vacinas contra COVID-19/administração & dosagem , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Masculino , Feminino , Estudos Prospectivos , Adulto , Pessoa de Meia-Idade
20.
Blood Press ; 33(1): 2350981, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38824645

RESUMO

OBJECTIVE: Few studies have evaluated the performance of non-drug-adjusted primary aldosteronism (PA) screening. Therefore, we aimed to examine the consistency between PA screening results with and without drug adjustment and to explore the effectiveness of screening without drug adjustment. METHODS: This prospective study included 650 consecutive patients with a high risk of incidence PA. Patients who initially screened positive underwent rescreening with drug adjustments and confirmatory tests. Regarding the remaining patients, one of every three consecutive patients underwent rescreening with drug adjustments and confirmatory tests. The changes in aldosterone and renin concentrations were compared between patients with essential hypertension (EH) and those with PA before and after drug adjustment. Sensitivity and specificity were used to assess the diagnostic performance of screening without drug adjustment, using the confirmatory test results as the reference. RESULTS: We screened 650 patients with hypertension for PA. Forty-nine patients were diagnosed with PA and 195 with EH. Regarding drugs, 519 patients were taking angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), or diuretics alone or in combination. Forty-one patients were taking beta-blockers. Ninety patients were taking beta-blockers in combination with other drugs. In patients treated with ACEIs, ARBs, CCBs, or diuretics alone, or in combination, or beta-blockers alone, PA positivity was determined using the criteria, aldosterone-to-renin ratio (ARR) >38 pg/mL/pg/mL and plasma aldosterone concentration (PAC) >100 pg/mL, and negativity, using the criteria, ARR <9 pg/mL/pg/mL; the sensitivity and specificity were 94.7% and 94.5%, respectively. After drug adjustment, the sensitivity and specificity of screening were 92.1% and 89%, respectively. CONCLUSIONS: In patients not treated with beta-blockers combined with others, when ARR >38 pg/mL/pg/mL and plasma aldosterone concentration (PAC) >100 pg/mL, or, ARR <9 pg/mL/pg/mL, non-drug-adjusted screening results were identical to with drug adjustment. Non-drug-adjusted screening could reduce the chance of medication adjustment, enable patients to continue their treatments and avoiding adverse effects, is of clinical importance.


Primary aldosteronism (PA) is the most common form of endocrine hypertension. The risk of stroke, myocardial infarction, heart failure, atrial fibrillation, and deterioration of kidney function is higher in PA than in essential hypertension (EH), even with the same blood pressure (BP) levels. However, many patients remain undiagnosed because most antihypertensive drugs substantially interfere with PA screening results, which makes drug adjustment necessary. This can be a time-consuming and unsafe process, requiring 4­6 weeks, and could lead to a hypertensive crisis and other complications. Some studies have suggested that certain antihypertensive drugs can be continued during PR screening. However, few studies have evaluated the performance of non-drug-adjusted PA screening. Therefore, in this prospective study, we aimed to compare patients with hypertension and a high risk of PA before and after drug adjustment and to use confirmatory test results as a reference to explore the diagnostic or exclusion effect. We found that non-drug-adjusted screening performs similarly to drug-adjusted screening in a particular group of patients. Our findings could aid in preventing unnecessary drug adjustment for PA screening, thereby reducing the risk in these patients.


Assuntos
Aldosterona , Hiperaldosteronismo , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/sangue , Hiperaldosteronismo/tratamento farmacológico , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Prospectivos , Aldosterona/sangue , Renina/sangue , Adulto , Bloqueadores dos Canais de Cálcio/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/sangue , Hipertensão/diagnóstico , Anti-Hipertensivos/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Programas de Rastreamento/métodos , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico
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