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1.
J Assoc Physicians India ; 69(2): 35-39, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33527809

RESUMO

Background: Globally, women and men over the age of 25 years suffer from hypertension, the need for new treatment strategies to treat hypertension is due to the multi-faceted nature of the disease. Lack of optimal blood pressure control can lead to multiple complications. Therefore, this phase 3 study was conducted to assess the efficacy, safety and tolerability of potential product azilsartan hydrochloride for reduction in blood pressure in Indian patients with essential hypertension. Methods: This was a prospective, multicentre, randomized, comparative, parallel study of 303 participants over six weeks of treatment period with either azilsartan 40 mg or azilsartan 80 mg or telmisartan 40 mg in adult patients with essential hypertension. The primary endpoint was the change in mean trough sitting clinic systolic blood pressure (scSBP) from baseline to week 6. The secondary endpoints were the change in mean trough sitting clinic diastolic blood pressure (scDBP) from baseline and change in the 24-hour mean ambulatory systolic blood pressure (SBP)and diastolic blood pressure (DBP) from baseline. Results: The change in mean trough scSBP from baseline to week 6 was -27.2 ± 9.99, -28.2 ± 10.06 and -26.7 ± 9.72 (Per Patient (PP) Population) and -27.2 ± 9.93, -28.3 ± 10.01 and -26.7 ± 9.67 (Intent to Treat (ITT) Population) in the azilsartan 40mg, 80mg and telmisartan 40mg groups respectively. The lower limit of 95% CI of difference in change in mean systolic blood pressure was -2.35(Azilsartan 40mg) and 1.32 (Azilsartan 80mg) is less than the non-inferiority margin (i.e. 2.67). The change in mean trough scDBP from baseline to week 6 was -13.1 ± 8.46, -12.9 ± 7.20, and -13.0 ± 7.96 (PP) and -13.1 ± 8.42, -12.9 ± 7.16 and -13.0 ± 7.92 (ITT) in Azilsartna 40 mg, Azilsartan 80 mg and Telmisartan 40 mg respectively. The reduction in trough scDBP in Azilsartan 40 mg (p=0.9461: PP; p=0.9330: ITT) and Azilsartan 80 mg (p=0.9090: PP; p=0.9158: ITT) was not statistically significant compared to Telmisartan 40 mg. The difference in fall in the trough scSBP, scDBP and ambulatory SBP and DBP was similar between the groups from baseline to week 6 (P >0.05). Headache and dizziness were the most frequent treatmentrelated treatment-emergent adverse events. Conclusion: Azilsartan is an effective blood pressure lowering drug and well tolerated and was non- inferior to telmisartan in its safety and efficacy.


Assuntos
Benzimidazóis , Hipertensão Essencial , Hipertensão , Adulto , Anti-Hipertensivos/efeitos adversos , Benzimidazóis/efeitos adversos , Pressão Sanguínea , Método Duplo-Cego , Hipertensão Essencial/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Índia , Masculino , Oxidiazóis , Estudos Prospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(50): e22418, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327224

RESUMO

Hypertension (HT) has recently been defined as a systolic blood pressure (BP) of ≥130 mm Hg and/or a diastolic BP of ≥80 mm Hg. It is important to further understand the pathophysiology of essential HT as its proportion is larger among most of the diagnosed HT cases. The apelin and apelin receptor (APLNR) are known to play roles in regulating BP, but the putative associations of single nucleotide polymorphisms in the APLNR gene with the risk of development of essential HT have not yet been fully investigated. Herein, we conducted a meta-analysis to investigate the relationship between single nucleotide polymorphisms in the APLNR gene and the risk of essential HT.We conducted a search in the PubMed and Web of Science databases for eligible studies. The pooled odds ratios (ORs) with their 95% confidence intervals (CI) were calculated using random-effects models when heterogeneity was expected across the studies. Otherwise, fixed-effect models were used.Regarding the SNP rs7119375, 5 studies were analyzed, which included a total of 3567 essential HT patients and 3256 healthy controls. Four of the 5 studies were from China and 1 was from Mexico. The meta-analysis showed the existence of a significant association between the AA genotype of rs7119375 and the risk of developing essential HT in the Chinese population, as determined using additive and recessive models (OR, 2.11; 95% CI, 1.12-3.96; I = 86% for AA vs GG. OR, 1.53; 95% CI, 1.21-1.94; I = 28% for AA vs AG. OR, 1.88; 95% CI, 1.13-3.12; I = 79% for AA vs AG + GG).Our study showed, for the first time, the existence of an association between rs7119375 and the risk of development of essential HT in the Chinese population, although the sample size was small and there was considerable population heterogeneity. The apelin/APLNR system could be a novel therapeutic target for the treatment of essential HT, and more studies are warranted to further investigate the association.


Assuntos
Receptores de Apelina/genética , Hipertensão Essencial/genética , Polimorfismo de Nucleotídeo Único/genética , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China/epidemiologia , Hipertensão Essencial/diagnóstico , Hipertensão Essencial/fisiopatologia , Feminino , Genótipo , Humanos , Masculino , México/epidemiologia , Fatores de Risco
3.
Zhonghua Yi Xue Za Zhi ; 100(41): 3250-3254, 2020 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-33167113

RESUMO

Objective: To explore the cut-off point of aldosterone/direct renin ratio (ADRR) before drug washout in the screening for primary aldosteronism (PA) in the Chinese population and reduce the potential risk caused by drug washout during PA screening. Methods: Hospitalized hypertensive patients in the Hypertension Ward of Fuwai Hospital, Chinese Academy of Medical Sciences from January 2017 to October 2019 were enrolled. PA was diagnosed according to the criterion of 2016 American Guideline and 2016 Chinese Consensus for PA. The plasma aldosterone concentration (PAC), direct renin concentration (DRC) and ADRR before and after drug washout were measured. The receiver operating characteristic (ROC) curve of ADRR was drawn and the maximal Youden index was used to determine the best cut-off value. Results: A total of 542 hypertensive patients were included, with 467 patients diagnosed with essential hypertension (EHT) (297 males and 170 females), and 75 patients diagnosed with PA (51 males and 24 females). Patients with PA had higher PAC and ADRR before and after drug washout than those with EHT(150.0 (130.0, 210.0) vs 120.0 (80.0, 170.0) ng/L, 170.0 (120.0, 260.0) vs 130.0 (90.0, 180.0) ng/L; 28.9 (15.9, 63.5) vs 4.3 (1.9, 11.8) (ng/L) / (mU/L) , 55.6 (39.0, 109.0) vs 9.8 (4.5, 21.3) (ng/L) /(mU/L), all P<0.001). However, DRC of PA patients before and after washout were lower than those with EHT (4.0 (2.0, 10.0) vs 27.0 (10.0, 64.0) mU/L, 3.0 (2.0, 4.0) vs 12.2 (5.0, 27.0) mU/L, P<0.001). In EHT and PA groups, PAC and ADRR significantly increased (P=0.001, P<0.001) , but DRC significantly decreased after drug washout (all P<0.001) . The area under the ROC curve of ADRR before drug washout was 0.868 (95%CI 0.836-0.895) with the best cut-off value of 7.8 (ng/L) / (mU/L) for the screening of PA .The sensitivity and specificity was 94.7% and 66.8%, respectively, with the maximal Youden index of 0.615. Conclusion: ADRR before drug washout > 7.8 (ng/L) / (mU/L) can be used as an alternative cut-off point to screen PA when drug washout is not available.


Assuntos
Hiperaldosteronismo , Hipertensão , Aldosterona , Hipertensão Essencial , Feminino , Humanos , Hiperaldosteronismo/diagnóstico , Masculino , Renina
4.
Medicine (Baltimore) ; 99(46): e23164, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181690

RESUMO

BACKGROUND: Recently, many studies have been conducted to investigate the relationship between the A46G polymorphism in the ß2-adrenergic receptor (ADRB2) gene and essential hypertension risk in the Chinese population. However, the results of previous studies were conflicting. OBJECTIVES: The present study aimed to investigate the association between the ADRB2 A46G polymorphism and the risk of essential hypertension in the Chinese population. METHODS: We performed a systematic search of possible relevant studies on PubMed, Embase, Ovid, Web of Science, China National Knowledge Infrastructure, Wanfang, and China Biology Medicine disc databases up to January 3, 2020. Two authors independently extracted information from included articles and assessed the quality of each study by the use of the Newcastle-Ottawa Scale. According to the extent of interstudy heterogeneity, either a random-effect model or a fixed-effect model was used to calculate the combined odds ratio (OR) and 95% confidence interval (CI). RESULTS: Finally, 16 studies containing 3390 cases and 2528 controls were included in our meta-analysis. Significant associations were found between the ADRB2 A46G polymorphism and essential hypertension risk in the Chinese population under four genetic models: allele genetic model (OR: 1.14, 95% CI: 1.06-1.23, P = .001, Pheterogeneity = .09), homozygote genetic model (OR: 1.29, 95% CI: 1.11-1.51, P = .001, Pheterogeneity = .25), dominant genetic model (OR: 1.17, 95% CI: 1.05-1.32, P = .005, Pheterogeneity = .04), and recessive genetic model (OR: 1.21, 95% CI: 1.05-1.38, P = .007, Pheterogeneity = .72). CONCLUSION: The ADRB2 A46G polymorphism may increase the risk of essential hypertension in the Chinese population.


Assuntos
Hipertensão Essencial , Receptores Adrenérgicos beta 2/genética , Grupo com Ancestrais do Continente Asiático/genética , Hipertensão Essencial/etnologia , Hipertensão Essencial/genética , Predisposição Genética para Doença/etnologia , Humanos , Polimorfismo de Nucleotídeo Único
5.
Medicine (Baltimore) ; 99(40): e22399, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019414

RESUMO

BACKGROUND: Essential hypertension remains an enormous public health concern, imposing a major burden of morbidity and mortality worldwide. Relevant studies showed that acupuncture therapy might be effective in treating essential hypertension. However, there is no consistent conclusion so far. The aim of this study was to assess the efficacy and safety of acupuncture therapy for patients with essential hypertension. METHODS: We searched the PubMed, Embase, the Cochrane Library, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), and the Wan-fang databases from inception through November 29, 2019. Randomized controlled trials investigating acupuncture therapy for hypertension were included. We will use Endnote software X8 for studies selection, Review Manager software 5.3 for the data analysis. RESULTS: We will synthesize current studies to evaluate the safeties and effectiveness of acupuncture for essential hypertension. CONCLUSIONS: Our study will provide the evidence of acupuncture therapy for essential hypertension.


Assuntos
Terapia por Acupuntura/métodos , Hipertensão Essencial/terapia , Pontos de Acupuntura , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
6.
DNA Cell Biol ; 39(11): 2095-2101, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33016778

RESUMO

Angiotensin-converting enzyme 2 (ACE2) is known as the counter-regulator of the renin-angiotensin system, it cleaves angiotensin II to render Ag 1-7, a potent vasodilator with multiple roles in cardiovascular protection. A few studies have pinpointed ACE2 polymorphisms and their relationship with heart function and hypertension in a sex-dependent manner. These observations still lack replication mostly for admixed populations. This study aimed to report minor allele frequencies of four ACE2 intron variants, rs2285666, rs2048683, rs2106809, and rs4240157, derived from previous research using the GSA, v1.0, microarray in 1231 hypertensive and nonhypertensive patients. Logistic and multiple linear regression models were developed to identify potential associations with hypertension status and systolic and diastolic blood pressure (SBP and DBP). Allele frequency differences were identified for ACE2 rs2048683 and rs4240157 in populations with European ancestry and people of the Americas. Regression analyses identified a significant association of ACE2 rs2048683 and rs4240157 with SBP/DBP in males or females. Our observations confirm sex differences in ACE2 genetic associations with SBP and DBP and contribute to the collection of genetic variation in ACE2 for admixed populations.


Assuntos
Pressão Sanguínea/genética , Hipertensão Essencial/genética , Predisposição Genética para Doença , Peptidil Dipeptidase A/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/genética , Hipertensão Essencial/patologia , Feminino , Frequência do Gene , Estudos de Associação Genética , Genótipo , Humanos , Íntrons/genética , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Adulto Jovem
7.
High Blood Press Cardiovasc Prev ; 27(6): 515-526, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32964344

RESUMO

Epidemiological studies have documented a high incidence of diabetes in hypertensive patients.Insulin resistance is defined as a less than expected biologic response to a given concentration of the hormone and plays a pivotal role in the pathogenesis of diabetes. However, over the last decades, it became evident that insulin resistance is not merely a metabolic abnormality, but is a complex and multifaceted syndrome that can also affect blood pressure homeostasis. The dysregulation of neuro-humoral and neuro-immune systems is involved in the pathophysiology of both insulin resistance and hypertension. These mechanisms induce a chronic low grade of inflammation that interferes with insulin signalling transduction. Molecular abnormalities associated with insulin resistance include the defects of insulin receptor structure, number, binding affinity, and/or signalling capacity. For instance, hyperglycaemia impairs insulin signalling through the generation of reactive oxygen species, which abrogate insulin-induced tyrosine autophosphorylation of the insulin receptor. Additional mechanisms have been described as responsible for the inhibition of insulin signalling, including proteasome-mediated degradation of insulin receptor substrate 1/2, phosphatase-mediated dephosphorylation and kinase-mediated serine/threonine phosphorylation of both insulin receptor and insulin receptor substrates. Insulin resistance plays a key role also in the pathogenesis and progression of hypertension-induced target organ damage, like left ventricular hypertrophy, atherosclerosis and chronic kidney disease. Altogether these abnormalities significantly contribute to the increase the risk of developing type 2 diabetes.


Assuntos
Pressão Sanguínea , Diabetes Mellitus Tipo 2/fisiopatologia , Hipertensão Essencial/fisiopatologia , Resistência à Insulina , Animais , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão Essencial/sangue , Hipertensão Essencial/epidemiologia , Humanos , Incidência , Insulina/sangue , Prognóstico , Fatores de Risco , Transdução de Sinais
9.
Medicine (Baltimore) ; 99(32): e21465, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769878

RESUMO

BACKGROUND: Azilsartan medoxomil (AZL-M), an angiotensin II receptor blocker, has a well-characterized efficacy and safety profile in patients with hypertension. AZL-M is approved for use in over 40 countries globally; however, it is not yet approved in China. Therefore, a phase 3 registration study to assess the efficacy (antihypertensive effect), safety, and tolerability of AZL-M compared with valsartan in Chinese patients with essential hypertension was undertaken. METHODS: This multicenter, double-blind, randomized, 8-week phase 3 study compared AZL-M with valsartan in Chinese patients aged ≥18 years with essential hypertension. Endpoints included change from baseline to week 8 in trough sitting clinic systolic blood pressure (scSBP) and ambulatory blood pressure monitoring parameters. RESULTS: Overall, 612 patients (mean age, 57.1 years; 57.5% male) were randomized to AZL-M 80 mg (n = 209), AZL-M 40 mg (n = 199), or valsartan 160 mg (n = 204). Baseline mean scSBP was similar in all groups (157.9-158.5 mm Hg). The mean reduction in trough scSBP from baseline to week 8 was significantly greater with AZL-M 80 mg than with valsartan (-24.2 vs -20.6 mm Hg; P = .010), and noninferior with AZL-M 40 mg versus valsartan (-22.5 vs -20.6 mm Hg; P = .184). Mean reduction in 24-hour mean systolic blood pressure (n = 257) was significantly greater with both AZL-M 80 mg (-17.0 mm Hg; P < .001) and AZL-M 40 mg (-14.7 mm Hg; P = .014) than with valsartan (-9.4 mm Hg). Treatment-emergent adverse events had similar incidence (52.8%-56.5%) across the treatment groups and were generally mild or moderate. Dizziness was the most frequent treatment-related treatment-emergent adverse events (AZL-M 80 mg, 1.9%; AZL-M 40 mg, 1.5%; valsartan, 1.0%). The safety and tolerability of AZL-M were comparable with valsartan. CONCLUSIONS: AZL-M was noninferior to valsartan at the 40-mg dose and superior to valsartan at the 80-mg dose in reducing trough scSBP, and showed acceptable safety-consistent with the AZL-M safety profile in other populations-in Chinese adults with hypertension. TRIAL REGISTRATION NUMBER: NCT02480764.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Benzimidazóis/uso terapêutico , Hipertensão Essencial/tratamento farmacológico , Oxidiazóis/uso terapêutico , Valsartana/uso terapêutico , Idoso , China , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(32): e21577, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769904

RESUMO

OBJECTIVES: To analyze the influence of Baduanjin exercise on blood pressure in patients with essential hypertension. METHODS: Randomized controlled trials were identified in Chinese and English databases to study the impact of Baduanjin exercise on essential hypertension. Qualified trials were selected and methodologic quality was critically evaluated. Two reviewers selected studies independently of each other. RESULTS: Twelve trials were included. There was a significant difference between the Baduanjin exercise intervention and control groups with regard to the change in systolic blood pressure (SBP) [SMD = - 1.80, 95% CI (- 2.86, - 0.73), P = .0009] and diastolic blood pressure (DBP) [SMD = -0.22, 95% CI (-2.00, -0.57), P = .0004]. Taking into account the subgroup analyses, the combined results showed that Baduanjin plus Antihypertensive drugs significantly reduced both SBP and DBP over a period > 12 weeks in all studies. CONCLUSIONS: Compared with control interventions, Baduanjin exercise seems to be an effective physical exercise in treating essential hypertension. Different training durations can lead to different effects.


Assuntos
Hipertensão Essencial/terapia , Terapia por Exercício/normas , Exercício Físico/fisiologia , Terapia por Exercício/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
11.
Hypertension ; 76(3): 732-741, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32654555

RESUMO

Hypertension is one of the most common comorbidities in patients with coronavirus disease 2019 (COVID-19). This study aimed to clarify the impact of hypertension on COVID-19 and investigate whether the prior use of renin-angiotensin-aldosterone system (RAAS) inhibitors affects the prognosis of COVID-19. A total of 996 patients with COVID-19 were enrolled, including 282 patients with hypertension and 714 patients without hypertension. Propensity score-matched analysis (1:1 matching) was used to adjust the imbalanced baseline variables between the 2 groups. Patients with hypertension were further divided into the RAAS inhibitor group (n=41) and non-RAAS inhibitor group (n=241) according to their medication history. The results showed that COVID-19 patients with hypertension had more severe secondary infections, cardiac and renal dysfunction, and depletion of CD8+ cells on admission. Patients with hypertension were more likely to have comorbidities and complications and were more likely to be classified as critically ill than those without hypertension. Cox regression analysis revealed that hypertension (hazard ratio, 95% CI, unmatched cohort [1.80, 1.20-2.70]; matched cohort [2.24, 1.36-3.70]) was independently associated with all-cause mortality in patients with COVID-19. In addition, hypertensive patients with a history of RAAS inhibitor treatment had lower levels of C-reactive protein and higher levels of CD4+ cells. The mortality of patients in the RAAS inhibitor group (9.8% versus 26.1%) was significantly lower than that of patients in the non-RAAS inhibitor group. In conclusion, hypertension may be an independent risk factor for all-cause mortality in patients with COVID-19. Patients who previously used RAAS inhibitors may have a better prognosis.


Assuntos
Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Infecções por Coronavirus , Hipertensão Essencial , Pandemias , Pneumonia Viral , Antagonistas de Receptores de Angiotensina/administração & dosagem , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Betacoronavirus , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Hipertensão Essencial/diagnóstico , Hipertensão Essencial/tratamento farmacológico , Hipertensão Essencial/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Prognóstico , Sistema Renina-Angiotensina/efeitos dos fármacos , Estudos Retrospectivos , Medição de Risco
12.
Clin Exp Hypertens ; 42(8): 743-747, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32631160

RESUMO

AIMS: Circulating miR-29b and inflammatory process play a vital role in hypertension and hypertensive nephropathy. The aim of the present study was to investigate the association of circulating miR-29b and inflammatory markers with albuminuria and assess the predictive value of circulating miR-29b for albuminuria in essential hypertension. METHODS: This cross-sectional study was continuously enrolled 150 subjects and were divided into three groups based on random urinary albumin/creatinine ratio (UACR, mg/g), the patients with ACR<30 mg/g were classified as normal albuminuria, the values of 30< ACR<300 was defined as micro-albuminuria while the group with ACR over 300 mg/g are macro-albuminuria. Circulating miR-29b was assessed by quantitative real-time polymerase chain reaction (qRT-PCR). Multivariate logistic regression and area under the ROC curve (AUC) were used. RESULTS: We found miR-29b, C-reactive protein, and transforming growth factor-ß1 (TGF-ß1) in macro-albuminuria group were significantly higher than those in the micro-albuminuria and normal albuminuria group. The level of miR-29b was positively associated with TGF-ß1, C-reactive protein, and UACR, while negatively related to glomerular filtration rate. Circulating miR-29b was a significant independent determinant factor for albuminuria. CONCLUSION: Our results provided a clinical evidence of a positive association between circulating miR-29b, inflammatory markers, and UACR, and implied miR-29b was a significant independent determinant factor for albuminuria.


Assuntos
Albuminúria/complicações , Hipertensão Essencial/complicações , Inflamação/genética , MicroRNAs/genética , Idoso , Área Sob a Curva , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos Transversais , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Fator de Crescimento Transformador beta1/sangue
13.
Microvasc Res ; 131: 104036, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32603698

RESUMO

OBJECTIVE: The role of nailfold capillaroscopy (NC) in common non-rheumatic conditions has not been systematically reported. The aim of this review is to outline NC features observed in frequent non-rheumatic conditions, providing a practical tool to support rheumatologists for the interpretation of capillaroscopic abnormalities in patients with no established connective tissue disease (CTD). METHODS: We undertook a systematic search in PubMed and Web of Science databases. Studies reporting adults or children with common non-rheumatic diseases or conditions in which quantitative and/or qualitative assessment of morphological nailbed capillary findings was obtained, were included. The presence of a control group composed by subjects not affected by the studied condition and direct comparison of findings between groups were needed. RESULTS: We included 25 articles. Diabetes mellitus (11 studies), glaucoma (7 studies) and essential hypertension (3 studies) were the most represented diseases. Reduced capillary density, tortuosity, dilated capillaries, microhaemorrhages, ramified capillaries and avascular areas can be observed in diabetic patients. Association was reported between poor glycaemic control or longer duration of diabetes, or presence of microvascular complications as retinopathy and neuropathy, and more severe capillaroscopic abnormalities. Decreased capillary density, tortuosity, microhaemorrhages, dilated capillaries, avascular areas and ramifications might also be present in glaucoma, while in essential hypertension a reduced capillary density might be expected. CONCLUSION: Abnormal capillaroscopic findings are not uncommon even in individuals with no CTD. Therefore, presence of comorbidities known to potentially affect the microvascular array should always be investigated in patients undergoing NC and the interpretation of findings might be weighted accordingly.


Assuntos
Angiopatias Diabéticas/patologia , Hipertensão Essencial/patologia , Glaucoma/patologia , Angioscopia Microscópica , Microvasos/patologia , Doenças Reumáticas/patologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Valor Preditivo dos Testes
14.
J Assoc Physicians India ; 68(4): 17-20, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32610840

RESUMO

Background: Epicardial adipose tissue (EAT), a type of visceral adipose tissue, has been found to be a cardiometabolic risk factor contributing to cardiovascular disease. Albuminuria, a marker of endothelial dysfunction is also associated with an increased risk for cardiovascular disease. The aim of this study was to investigate the relationship of echocardiographic epicardial adipose tissue (EAT) thickness and albuminuria in hypertensive patients. Aims and Objectives: To compare EAT between essential hypertensive patients with normal UACR (<30) and albuminuria (UACR>30). Methods: 100 essential hypertensive patients were included into the study. Age, body mass index (BMI), blood pressure, hemoglobin, random blood sugar, creatinine, albumin was evaluated. Spot urine sample was collected for the assessment urine albumin creatinine ratio (UACR). Patients were divided into two groups according to UACR; Group A included UACR <30 mg/g; and Group B included UACR > 30mg/g. Thereafter, all subjects underwent transthoracic echocardiography to measure EAT thickness, left ventricular mass (LVM), left ventricular mass index (LVMI) and ejection fraction (EF). Main Outcomes and Measures: Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. The primary composite end-point was admission to an intensive care unit (ICU), the use of mechanical ventilation or death. Patients were categorized as severe pneumonia and non-severe pneumonia at time of admission and outcome data was compared. Results: The mean EAT was found to be significantly higher in patients with significant albumin excretion (UACR>30 mg/g) as compared to group A (6.65 ± 1.944 mm vs. 3.64 ± 1.13 mm, respectively, p<0.001). Upon correlation analysis, EAT was found to be positively correlated with age (r = 0.749, p < 0.001), serum creatinine (r = 0.244, p = 0.014), LVM (r = 0.691, p = 0.001) and LVMI (r = 0.677, p = 0.001) and negatively correlated with EF (r = -0.599, p = 0.001). Conclusions: Epicardial adipose tissue thickness can serve as a high-risk marker to stratify essential hypertensive patients.


Assuntos
Adiposidade , Albuminúria , Hipertensão , Pressão Sanguínea , Hipertensão Essencial , Humanos , Obesidade
15.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32669403

RESUMO

BACKGROUND AND OBJECTIVES: Long-term outcomes of urinary tract infection (UTI) in childhood are not well known. Pregnancy may reveal latent renal damage caused by a UTI because of stress on the kidneys. METHODS: Our cohort included adult women with an ultrasonography taken because of a childhood UTI in 1981-1991 (N = 1175). Nine women with a severe congenital kidney malformation or urinary tract obstruction were excluded. Altogether, 260 mothers with a childhood UTI and 500 population-based control mothers without a childhood UTI matched for age, and delivery dates were compared. Our primary end point was the proportion of women with essential or gestational hypertension, preeclampsia, proteinuria, or pyelonephritis during the first pregnancy. RESULTS: The pregnancy outcomes of the women with a UTI in childhood did not differ from those of the controls because 105 of 260 (40%) patients met the primary end point compared with 204 of 500 (41%) controls (relative risk [RR] 0.99; 95% confidence interval [CI] 0.82 to 1.2; P = .91). Similarly, there were no significant differences between the 2 groups in essential hypertension (RR 1.0; 95% CI 0.65 to 1.6; P = .92), gestational hypertension (RR 0.93; 95% CI 0.74 to 1.2; P = .54), preeclampsia (RR 1.5; 95% CI 0.91 to 2.5; P = .11), proteinuria (RR 1.2; 95% CI 0.81 to 1.8; P = .36) or pyelonephritis (2 controls and none of the patients; P = .55) during the first pregnancy. CONCLUSIONS: Childhood UTIs did not increase the risk of pregnancy-related complications in this controlled population-based study. Thus, UTIs in childhood without severe urinary tract abnormalities appear to have a minimal effect on kidney health in early adulthood.


Assuntos
Infecções Urinárias/epidemiologia , Adulto , Estudos de Casos e Controles , Criança , Estudos de Coortes , Hipertensão Essencial/epidemiologia , Feminino , Finlândia/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Proteinúria/epidemiologia , Pielonefrite/epidemiologia , Ultrassonografia , Sistema Urinário/diagnóstico por imagem , Adulto Jovem
16.
Medicine (Baltimore) ; 99(29): e21157, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702871

RESUMO

BACKGROUND: Essential hypertension is one of the risk factors of cardiovascular and cerebrovascular diseases, which can cause target organ damage such as heart, brain and kidney, and has extremely high disability rate and death rate. With the development of economy and society, the prevalence rate of hypertension in China has increased rapidly from 9.8% in the 1980s to over 30% in the 21st century. According to the data published in "China Cardiovascular Disease Report 2018," China currently has 245 million hypertension patients. Comprehensive prevention and treatment of hypertension has become one of the major public health problems in China. The clinical practice and theoretical innovation of traditional Chinese medicine in the prevention and treatment of hypertension have been carried out for decades. Relevant literature points out that Tianma Gouteng Decoction combined with Qiju Dihuang Pill has ideal effect in the treatment of primary hypertension. However, most of the literatures are small sample studies, with uneven quality and clinical evidence, and lack of evidence-based medical evidence for clinical efficacy. Therefore, this study makes further meta-analysis of Tianma Gouteng Decoction combined with Qiju Dihuang Pill in the treatment of primary hypertension, with a view to providing evidence-based medical evidence for the treatment of primary hypertension. METHODS: We will search 3 foreign electronic databases (Cochrane Library, Embase, PubMed) and 4 Chinese electronic databases (China National Knowledge Infrastructure, WangFang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database) to collect potential systematic reviews from their inceptions to February 2020. The language of publication is limited to Chinese or English. First, the quality of randomized controlled trials documents included in this study was evaluated by using the improved Jadad scoring scale. Then, the 2 researchers conducted the evaluation independently according to Cochrane bias risk tools. The evidence level of the results will be evaluated by using the recommended evaluation, development and evaluation grading of recommendations assessment, development, and evaluation method. Statistical analysis will be conducted using Revman 5.3. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSIONS: The conclusion of this study will provide evidence for the efficacy of Tianma Gouteng Decoction combined with Qiju Dihuang Pills in the treatment of primary hypertension due to the efficacy of western medicine alone in treating primary hypertension. REGISTRATION NUMBER PROSPERO: INPLASY202050088.


Assuntos
Protocolos Clínicos , Medicamentos de Ervas Chinesas/uso terapêutico , Hipertensão Essencial/tratamento farmacológico , Adulto , Medicamentos de Ervas Chinesas/administração & dosagem , Hipertensão Essencial/fisiopatologia , Humanos , Rim/efeitos dos fármacos , Rim/fisiopatologia , Medicina Tradicional Chinesa/métodos , Medicina Tradicional Chinesa/normas , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(23): e20552, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502021

RESUMO

BACKGROUND: To assess the association of the interaction between the rs9619311 and rs402007 polymorphisms and smoking with essential hypertension (EH) in a Chinese Han population. METHOD: Peripheral blood samples were extracted from 422 EH patients and 280 normotensive (NT) patients in a Chinese Han population. A whole blood genomic DNA extraction kit was used to extract genomic DNA from the blood samples. Polymerase chain reaction restriction fragment length polymorphism was used to detect the rs402007 polymorphism of a disintegrin and metalloproteinase with thrombospondin type motifs 1 gene and the rs9619311 polymorphism of the tissue inhibitor of metalloproteinase-3 gene. The distributions of the genotypes and alleles between the 2 study groups (EH and NT) were compared. The main risk factors for EH were determined by using logistic regression analysis. The effects of gene-gene and gene-smoking interactions on EH were analyzed using multifactor dimensional reduction. RESULTS: The frequencies of the rs402007 GC + CC genotype and the C allele were significantly different between the EH and NT groups (0.68 vs 0.57, χ = 8.99, P = .003, odds ratio [OR] = 1.19; 0.45 vs 0.32, χ = 22.16, P < .001, OR = 1.38). The frequencies of the rs9619311 TC + CC genotype and the C allele were also significantly different between the 2 groups (0.33 vs 0.25, χ = 4.51, P = .04, OR = 1.44; 0.18 vs 0.13, χ = 7.03, P = .01, OR = 1.50). Logistic regression analysis suggests that the rs402007 and rs9619311 polymorphisms are independent risk factors for EH (OR = 2.37, 1.86; P < .001, respectively). The multifactor dimensionality redundant analysis results showed that the interaction among rs402007, rs9619311, and smoking was statistically significant (P = .001). CONCLUSIONS: A disintegrin and metalloproteinase with thrombospondin type motifs 1 rs402007 and tissue inhibitor of metalloproteinase-3 rs9619311 polymorphisms are associated with EH in a Chinese Han population, and there was a positive interaction among rs402007, rs9619311, and smoking.


Assuntos
Proteína ADAMTS1/genética , Hipertensão Essencial/genética , Grupos Étnicos/genética , Predisposição Genética para Doença , Polimorfismo Genético , Fumar/epidemiologia , Inibidor Tecidual de Metaloproteinase-3/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China/epidemiologia , Hipertensão Essencial/epidemiologia , Feminino , Genótipo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase
18.
Zhongguo Zhen Jiu ; 40(6): 591-5, 2020 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-32538007

RESUMO

OBJECTIVE: To compare the infuences on circadian rhythm of blood pressure in the patients with non-dipper essential hypertension between the combined treatment of time acupuncture and western medication and the simple western medication. METHODS: A total of 70 patients with non-dipper essential hypertension were randomized into an acupuncture plus western medication group (35 cases, 2 cases dropped out) and a western medication group (35 cases). In the western medication group, levamlodipine maleate tablets were taken orally, 2.5 mg each time, once daily. In the acupuncture plus western medication group, on the base of the treatment as the western medication group, acupuncture was applied specially in the period of the day from 7:00 am to 9:00 am. The acupoints included Fengchi (GB 20), Zhongwan (CV 12), Tianshu (ST 25), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36), etc. Acupuncture was given once daily, 5 treatments a week. The duration of treatment in the two groups was 4 weeks. The clinic blood pressure before and after treatment, 24 h ambulatory blood pressure and the levels of serum melatonin (MT) and 5-serotonin (5-HT) were observed in the two groups. RESULTS: The total effective rate of anti-hypertension was 75.8% (25/33) in the acupuncture plus western medication group, better than 54.3% (19/35) in the western medication group (P<0.05). The 24 h average systolic blood pressure, the daytime average systolic blood pressure, the daytime average diastolic pressure, and the nighttime average systolic blood pressure were all reduced after treatment in the two groups (P<0.05). The reduction effect of the aforementioned 4 indexes in the acupuncture plus western medication group was much more obvious as compared with the western medication group (P<0.05). After treatment, the serum level of MT was increased and 5-HT decreased in the patients of two groups (P<0.05). The serum level of MT in the acupuncture plus western medication group was higher than that in the western medication group and the level of 5-HT was lower than the western medication group (P<0.05). CONCLUSION: Time acupuncture therapy in the period of the day from 7:00 am to 9:00 am, combined with western medication effectively reduce blood pressure and regulate the levels of serum MT and 5-HT so as to maintain the circadian rhythm of blood pressure in patients with non-dipper essential hypertension. The therapeutic effect of this combined treatment is superior to simple western medication.


Assuntos
Terapia por Acupuntura , Hipertensão Essencial/terapia , Periodicidade , Pontos de Acupuntura , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano , Humanos
19.
Rev. cuba. med ; 59(2): e1351, abr.-jun. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139047

RESUMO

Introducción: Las enfermedades cardiovasculares de mayor prevalencia y la hipertensión arterial tienen como sustento la aterosclerosis y la disfunción endotelial. La evaluación no invasiva de aterosclerosis subclínica constituye un complemento para la estratificación del riesgo cardiovascular en la evaluación del paciente hipertenso. Objetivo: Determinar la utilidad del diámetro basal de la arteria braquial en la evaluación del paciente con hipertensión arterial esencial. Método: Se realizó un estudio transversal analítico que incluyó 30 pacientes con hipertensión arterial esencial, a quienes se les realizó ultrasonografía para medir el diámetro basal de la arteria braquial, la vasorreactividad dependiente del endotelio y el grosor íntima media carotídeo, así como se precisó su riesgo cardiovascular, el tiempo de evolución y grado de la hipertensión arterial. Para determinar la asociación entre el diámetro arterial y el resto de las variables se utilizaron pruebas estadísticas como ANOVA de una vía y el coeficiente de correlación de Pearson. Resultados: La disfunción endotelial estuvo presente en 83,3 por ciento de los pacientes estudiados. Tanto el grosor del complejo íntima media carotídeo como la vasorreactividad dependiente del endotelio fueron adecuados marcadores de la enfermedad aterosclerótica. El diámetro basal de la arteria braquial tuvo una correlación inversa con la vasorreactividad dependiente del endotelio, y mostró valores medios esperados en relación a la presencia del tabaquismo, y con los peores grados de la enfermedad hipertensiva y el riesgo cardiovascular. Conclusiones: El diámetro basal de la arteria braquial no mostró la asociación esperada para la evaluación del paciente hipertenso esencial en la población estudiada(AU)


Introduction: The most prevalent cardiovascular diseases and high blood pressure are supported by atherosclerosis and endothelial dysfunction. The non-invasive assessment of subclinical atherosclerosis complements the cardiovascular risk stratification when evaluating hypertensive patients. Objective: To determine the value of the basal diameter of the brachial artery in assessing patients suffering from essential arterial hypertension. Method: An analytical cross-sectional study was carried out in 30 patients with essential arterial hypertension. They underwent ultrasonography to measure the basal diameter of the brachial artery, endothelium-dependent vasoreactivity and carotid mean intima thickness, as well as the cardiovascular risk, time of evolution and degree of arterial hypertension. Statistical tests such as one-way ANOVA and Pearson's correlation coefficient were used to determine the association between arterial diameter and the rest of the variables. Results: Endothelial dysfunction was present in 83.3% of the studied patients. Both the thickness of the carotid media intima complex and endothelium-dependent vasoreactivity were adequate markers for atherosclerotic disease. The basal diameter of the brachial artery had inverse correlation with endothelium-dependent vasoreactivity, and it showed expected mean values in relation to the presence of smoking, and with the worst degrees of hypertensive disease and cardiovascular risk. Conclusions: The basal diameter of the brachial artery did not show the expected association for the evaluation of essential hypertensive patients in the studied population(AU)


Assuntos
Humanos , Masculino , Feminino , Artéria Braquial/crescimento & desenvolvimento , Hipertensão Essencial/diagnóstico , Pacientes , Estudos Transversais
20.
Altern Ther Health Med ; 26(S2): 54-55, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32412919

RESUMO

By April 28th 2020, the global number of people that were viciously infected with the newfound novel corona virus (COVID-19) stood at a staggering 3 077 133 cases, as per the confirmed data released by the WHO. It has been reported that women from the Chinese Han population are associated with essential hypertension due to their relation with the 5 SNPs, namely, rs1514283, rs4646155, rs4646176, rs2285666, and rs879922, which belong to the ACE2 gene. The level of ACE2 activity was very low in normal healthy younger persons, and was reported to be increased in patients with cardiovascular diseases. Thus, there might be severe myocarditis, that may result in acute heart failure and cardiac complexities in the elderly subjects.


Assuntos
Fatores Etários , Infecções por Coronavirus/epidemiologia , Hipertensão Essencial/genética , Peptidil Dipeptidase A/genética , Pneumonia Viral/epidemiologia , Fatores Sexuais , Grupo com Ancestrais do Continente Asiático , Betacoronavirus , China , Feminino , Humanos , Masculino , Pandemias , Polimorfismo de Nucleotídeo Único , Fatores de Risco
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