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1.
Artigo em Inglês | MEDLINE | ID: mdl-34199019

RESUMO

Coronavirus disease 2019 (COVID-19) has put hypertensive patients in densely populated cities at increased risk. Nurse-coordinated home blood pressure telemonitoring (NC-HBPT) may help address this. We screened studies published in English on three databases, from their inception to 30 November 2020. The effects of NC-HBPT were compared with in-person treatment. Outcomes included changes in blood pressure (BP) following the intervention and rate of BP target achievements before and during COVID-19. Of the 1916 articles identified, 27 comparisons were included in this review. In the intervention group, reductions of 5.731 mmHg (95% confidence interval: 4.120-7.341; p < 0.001) in systolic blood pressure (SBP) and 2.342 mmHg (1.482-3.202; p < 0.001) in diastolic blood pressure (DBP) were identified. The rate of target BP achievement was significant in the intervention group (risk ratio, RR = 1.261, 1.154-1.378; p < 0.001). The effects of intervention over time showed an SBP reduction of 3.000 mmHg (-5.999-11.999) before 2000 and 8.755 mmHg (5.177-12.334) in 2020. DBP reduced by 2.000 mmHg (-2.724-6.724) before 2000 and by 3.529 mmHg (1.221-5.838) in 2020. Analysis of the target BP ratio before 2010 (RR = 1.101, 1.013-1.198) and in 2020 (RR = 1.906, 1.462-2.487) suggested improved BP control during the pandemic. NC-HBPT more significantly improves office blood pressure than UC among urban hypertensive patients.


Assuntos
COVID-19 , Hipertensão , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Humanos , Hipertensão/epidemiologia , SARS-CoV-2
2.
Nutrients ; 13(7)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34206633

RESUMO

In order to identify the status of salt-related knowledge and behavior of the residents who were active in WeChat software between 2019 and 2020, 10-day salt-related surveys were conducted in 2019 and 2020 based on the WeChat public platform of China Healthy Lifestyle for All Campaign. Distribution and scores of salt-related knowledge, salt reduction behavior and high-salt intake behavior between 2019 and 2020 were compared. Data of 2109 participants in 2019 and 12,732 participants in 2020 were left for analysis. Overall, 88.2% of participants in 2019 had a willingness to reduce the amount of cooking salt in their households, significantly lower than 90.2% in 2020 (p-value < 0.05). In 2019 and 2020, over 80% of the participants knew fine dried noodles contain salt, but less than 30% knew ice cream contains salt. Over 78% of participants chose 5 g or 6 g for the maximum daily salt intake of healthy adults, and about 98% of participants knew that excessive salt intake would increase the risk of hypertension in both years. The percentage of participants who used salt measuring spoons asked restaurants to use less salt, read the sodium content on the nutrition facts table, chose foods with low sodium content and regularly used low-sodium salt, were 36.1%, 45.0%, 44.1%, 40.3% and 35.8% in 2019, and the percentage increased significantly to 46.4%, 49.2%, 50.8%, 47.1% and 43.4% in 2020 (all p-value < 0.05). The percentage of people regularly eating pickled mustard tubers, salted vegetables and sauce foods or using high-salt condiments also increased from 2019 to 2020. The median of salt-related knowledge scores, salt reduction behavior scores and high-salt intake behavior scores were 11, 2, 5 points in 2019, and 10, 3, 5 points in 2020, respectively. Compared to 2019, the salt-related knowledge score was relatively lower, while the salt reduction behavior score and high-salt intake behavior score were relatively higher in 2020. Besides, the score of salt-related knowledge and behaviors differed in different gender, age and hypertension groups. The COVID-19 epidemic may have influenced the salt-related knowledge and behaviors status of WeChat users in China. Promotion and education of salt-related knowledge and online behavior intervention are still needed, particularly for male and hypertension patients in the future.


Assuntos
Comportamento Alimentar , Conhecimentos, Atitudes e Prática em Saúde , Aplicativos Móveis , Cloreto de Sódio na Dieta/administração & dosagem , Adulto , COVID-19/epidemiologia , China , Culinária , Dieta Hipossódica/métodos , Feminino , Promoção da Saúde/métodos , Estilo de Vida Saudável , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Cloreto de Sódio na Dieta/efeitos adversos , Inquéritos e Questionários
3.
Afr J Prim Health Care Fam Med ; 13(1): e1-e7, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212744

RESUMO

BACKGROUND: Hypertension is a public health threat of global concern with increasing prevalence in many countries, including Nigeria. AIM: The aim of the study was to determine the prevalence and determinants of hypertension in a rural agrarian community in Edo North, Nigeria. SETTING: The study was carried out in Ayua, a community in Edo North, southern Nigeria. METHODS: This cross-sectional descriptive study involved the use of a structured interviewer-administered questionnaire to obtain relevant data. Body mass index (BMI), blood pressure and glucose were recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0. RESULTS: Two hundred and nineteen participants aged 15 years completed the study with a mean age of 54.03 ± 16.61 years and females comprising 159 (72.6%) of the total. The prevalence of hypertension was 27.9% (in 61 participants). Twenty-one (9.8%) respondents gave a family history of hypertension. The mean BMI amongst respondents was 27.10 ± 6.61 kg/m2. Obesity and pre-obesity were found in 58 (26.5%) and 71(32.4%) respondents, respectively. The determinants of hypertension were age and BMI. Compared with those who were less than 40 years old, those aged 40-65 years and 65 years had 1.9 and 4.2 times increased odds of developing hypertension, respectively. Similarly, compared with the non-obese, obese participants had 2.3 times increased odd of having hypertension. CONCLUSION: Hypertension was highly prevalent in this rural community. Health sensitisation and intervention programmes are recommended in rural communities for early detection and management of hypertension, especially amongst older and obese adults.


Assuntos
Hipertensão/epidemiologia , Obesidade/epidemiologia , Determinantes Sociais da Saúde , Adulto , Idoso , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Hipertensão/etnologia , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Obesidade/complicações , Obesidade/etnologia , Obesidade/psicologia , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos
4.
BMC Health Serv Res ; 21(1): 647, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217285

RESUMO

BACKGROUND: PLWH are living longer as a result of advancement and adherence to antiretroviral therapy. As the life expectancy of PLWH increases, they are at increased risk of hypertension and diabetes. HIV chronic co-morbidities pose a serious public health concern as they are linked to increased use and need of health services, decreased overall quality of life and increased mortality. While research shows that integrated care approaches applied within primary care settings can significantly reduce hospital admissions and mortality levels among patients with comorbidities, the primary care system in South Africa continues to be challenged with issues about the delivery of quality care. METHODS: This study applied a phenomenological qualitative research design. IDIs were conducted with 24 HCPs and adults living with the comorbidity of HIV and either hypertension or diabetes across two provinces in South Africa. The objective of the research was to understand the challenges faced by HCPs and patients in health facilities where the ICDM model is implemented. The health facilities were purposively sampled. However, the HCPs were recruited through snowballing and the patients through reviewing the facilities' clinic records for participants who met the study criteria. All participants provided informed consent. The data was collected between March and May 2020. The findings were analysed inductively using thematic content analysis. RESULTS: The challenges experienced included lack of staff capacity, unclear guidelines on the delivery of integrated care for patients with HIV chronic comorbidities, pill burden, non-disclosure, financial burden, poor knowledge of treatments, relocation of patients and access to treatment. Lack of support and integrated chronic programmes including minimal information regarding the management of HIV chronic comorbidities were other concerns. CONCLUSION: The outcomes of the ICDM model need to be strengthened and scaled up to meet the unique health needs and challenges of people living with HIV and other chronic conditions. Strengthening these outcomes includes providing capacity building and training on the delivery of chronic care treatment under the ICDM model, assisted self-management to improve patient responsibility of chronic disease management and strengthening activities for comorbidity health promotion.


Assuntos
Diabetes Mellitus , Infecções por HIV , Hipertensão , Adulto , Instituições de Assistência Ambulatorial , Comorbidade , Infecções por HIV/epidemiologia , Pessoal de Saúde , Humanos , Pesquisa Qualitativa , Qualidade de Vida , África do Sul
5.
Medicina (Kaunas) ; 57(6)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34207161

RESUMO

BACKGROUND: The association of coronavirus disease 2019 (COVID-19) with hypertension has been one of the frequently discussed topics in current studies since hypertension was identified as a risk factor for coronavirus disease. However, no studies seem to be focused on the BP (blood pressure) in patients with hypertension after COVID-19. REPORT: This report presents the cases of five frail geriatric patients (avg. age 78.3 (±6.4) years) with sarcopenia and controlled hypertension (office BP < 140 mmHg) who were diagnosed with SARS-CoV-2. FINDINGS: Control ABPM performed after COVID-19 showed that these hypertensive patients were hypotensive and that the previously well-established therapy was suddenly too intensive for them. CONCLUSIONS: These findings suggest that BP control after COVID-19 is needed and that ABPM is, particularly in frail geriatric patients, by no means a luxury but a necessity.


Assuntos
COVID-19 , Hipertensão , Hipotensão , Idoso , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Idoso Fragilizado , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipotensão/complicações , SARS-CoV-2
6.
Nutrients ; 13(7)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: covidwho-1282545

RESUMO

In order to identify the status of salt-related knowledge and behavior of the residents who were active in WeChat software between 2019 and 2020, 10-day salt-related surveys were conducted in 2019 and 2020 based on the WeChat public platform of China Healthy Lifestyle for All Campaign. Distribution and scores of salt-related knowledge, salt reduction behavior and high-salt intake behavior between 2019 and 2020 were compared. Data of 2109 participants in 2019 and 12,732 participants in 2020 were left for analysis. Overall, 88.2% of participants in 2019 had a willingness to reduce the amount of cooking salt in their households, significantly lower than 90.2% in 2020 (p-value < 0.05). In 2019 and 2020, over 80% of the participants knew fine dried noodles contain salt, but less than 30% knew ice cream contains salt. Over 78% of participants chose 5 g or 6 g for the maximum daily salt intake of healthy adults, and about 98% of participants knew that excessive salt intake would increase the risk of hypertension in both years. The percentage of participants who used salt measuring spoons asked restaurants to use less salt, read the sodium content on the nutrition facts table, chose foods with low sodium content and regularly used low-sodium salt, were 36.1%, 45.0%, 44.1%, 40.3% and 35.8% in 2019, and the percentage increased significantly to 46.4%, 49.2%, 50.8%, 47.1% and 43.4% in 2020 (all p-value < 0.05). The percentage of people regularly eating pickled mustard tubers, salted vegetables and sauce foods or using high-salt condiments also increased from 2019 to 2020. The median of salt-related knowledge scores, salt reduction behavior scores and high-salt intake behavior scores were 11, 2, 5 points in 2019, and 10, 3, 5 points in 2020, respectively. Compared to 2019, the salt-related knowledge score was relatively lower, while the salt reduction behavior score and high-salt intake behavior score were relatively higher in 2020. Besides, the score of salt-related knowledge and behaviors differed in different gender, age and hypertension groups. The COVID-19 epidemic may have influenced the salt-related knowledge and behaviors status of WeChat users in China. Promotion and education of salt-related knowledge and online behavior intervention are still needed, particularly for male and hypertension patients in the future.


Assuntos
Comportamento Alimentar , Conhecimentos, Atitudes e Prática em Saúde , Aplicativos Móveis , Cloreto de Sódio na Dieta/administração & dosagem , Adulto , COVID-19/epidemiologia , China , Culinária , Dieta Hipossódica/métodos , Feminino , Promoção da Saúde/métodos , Estilo de Vida Saudável , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Cloreto de Sódio na Dieta/efeitos adversos , Inquéritos e Questionários
7.
Medicina (Kaunas) ; 57(6)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: covidwho-1273483

RESUMO

BACKGROUND: The association of coronavirus disease 2019 (COVID-19) with hypertension has been one of the frequently discussed topics in current studies since hypertension was identified as a risk factor for coronavirus disease. However, no studies seem to be focused on the BP (blood pressure) in patients with hypertension after COVID-19. REPORT: This report presents the cases of five frail geriatric patients (avg. age 78.3 (±6.4) years) with sarcopenia and controlled hypertension (office BP < 140 mmHg) who were diagnosed with SARS-CoV-2. FINDINGS: Control ABPM performed after COVID-19 showed that these hypertensive patients were hypotensive and that the previously well-established therapy was suddenly too intensive for them. CONCLUSIONS: These findings suggest that BP control after COVID-19 is needed and that ABPM is, particularly in frail geriatric patients, by no means a luxury but a necessity.


Assuntos
COVID-19 , Hipertensão , Hipotensão , Idoso , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Idoso Fragilizado , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipotensão/complicações , SARS-CoV-2
8.
Curr Cardiol Rep ; 23(8): 105, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196827

RESUMO

PURPOSE OF REVIEW: Primary aldosteronism (PA) is the most common cause of secondary hypertension. Emerging evidence suggests that PA is associated with cardiovascular, metabolic, and renal complications, that likely develop insidiously, due to prolonged inappropriate mineralocorticoid receptor activation. In this review, we discuss the expanding clinical and pathological spectrum of PA. RECENT FINDINGS: Clinical and molecular studies conducted over the recent years reveal that PA traverses a series of contiguous stages. Pre-clinical, but hormonally overt PA has been identified in patients with normal blood pressure, and such patients harbor an increased risk of developing hypertension. Similarly, genetic and histopathological advancements have exposed a spectrum of PA pathology that corresponds to a continuum that spans from pre-clinical stages to florid PA. PA evolves from pre-hypertensive stages to resistant hypertension, along with serious cardiovascular and renal consequences. Early recognition of PA and targeted therapy will be essential for cardiovascular morbidity and mortality prevention in a large number of patients.


Assuntos
Hiperaldosteronismo , Hipertensão , Aldosterona , Pressão Sanguínea , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/terapia , Hipertensão/etiologia , Rim , Renina
9.
Glob Heart ; 16(1): 44, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34211830

RESUMO

During the COVI9-19 pandemic, Pakkred hospital in Thailand implemented innovative practices to ensure the continuation of essential medical services for non-communicable disease patients. These practices included decentralized care, telemedicine, home blood pressure monitoring, community delivery of medicines, and facility infrastructure changes. Despite the decrease in hospital visits by hypertension patients during the pandemic, our results suggest that this package of interventions may have contributed to sustained hypertension and diabetes control rates in Pakkred district.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/organização & administração , Diabetes Mellitus/terapia , Hipertensão/terapia , Monitorização Ambulatorial da Pressão Arterial/métodos , Agentes Comunitários de Saúde , Continuidade da Assistência ao Paciente , Instalações de Saúde , Ambiente de Instituições de Saúde , Acesso aos Serviços de Saúde , Humanos , Doenças não Transmissíveis/terapia , Inovação Organizacional , Equipamento de Proteção Individual , SARS-CoV-2 , Telemedicina/organização & administração , Tailândia , Ventilação
10.
S Afr Fam Pract (2004) ; 63(1): e1-e5, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34212748

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a public health crisis that threatens the current health system. The sudden expansion in the need for inpatient and intensive care facilities raised concerns about optimal clinical management and resource allocation. Despite the pressing need for evidence to make context-specific decisions on COVID-19 management, evidence from South Africa remained limited. This study aimed to describe the clinical characteristics and outcomes of COVID-19 hospitalised patients. METHODS: A retrospective cross-sectional study design was used to evaluate the clinical outcomes of hospitalised adult patients (≥ 18 years old) with laboratory-confirmed COVID-19 illness at Mthatha Regional Hospital (MRH), Eastern Cape. RESULTS: Of the 1814 patients tested for COVID-19 between 20 March 2020 and 31 July 2020 at MRH, two-thirds (65.4%) were female. About two-thirds (242) of the 392 patients (21.6%) who tested positive for this disease were hospitalised and one-third (150) were quarantined at home. The mean age of the patients tested for COVID-19 was 42.6 years and there was no difference between males and females. The mean age of hospitalised patients was 55.5 years and the mean age of hospitalised patients who died (61.3 years) was much higher than recovered (49.5 years). Overall, 188 (77.6%) hospitalised patients had clinical comorbidity on admission. Diabetes (36.8%) and hypertension (33.1%) were the most common comorbidities amongst COVID-19 hospitalised patients. CONCLUSION: The majority of the patients who were hospitalised for COVID-19 were elderly and had high baseline comorbidities. Advance age and underlying comorbidities (diabetes, hypertension and HIV) were associated with high mortality in hospitalised COVID-19 patients.


Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Diabetes Mellitus/epidemiologia , Hospitalização/estatística & dados numéricos , Hipertensão/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Comorbidade , Estudos Transversais , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Administração dos Cuidados ao Paciente/métodos , SARS-CoV-2/isolamento & purificação , África do Sul/epidemiologia
11.
BMC Cardiovasc Disord ; 21(1): 327, 2021 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217220

RESUMO

BACKGROUND: The relative association between cardiovascular (CV) risk factors, such as diabetes and hypertension, established CV disease (CVD), and susceptibility to CV complications or mortality in COVID-19 remains unclear. METHODS: We conducted a cohort study of consecutive adults hospitalised for severe COVID-19 between 1st March and 30th June 2020. Pre-existing CVD, CV risk factors and associations with mortality and CV complications were ascertained. RESULTS: Among 1721 patients (median age 71 years, 57% male), 349 (20.3%) had pre-existing CVD (CVD), 888 (51.6%) had CV risk factors without CVD (RF-CVD), 484 (28.1%) had neither. Patients with CVD were older with a higher burden of non-CV comorbidities. During follow-up, 438 (25.5%) patients died: 37% with CVD, 25.7% with RF-CVD and 16.5% with neither. CVD was independently associated with in-hospital mortality among patients < 70 years of age (adjusted HR 2.43 [95% CI 1.16-5.07]), but not in those ≥ 70 years (aHR 1.14 [95% CI 0.77-1.69]). RF-CVD were not independently associated with mortality in either age group (< 70 y aHR 1.21 [95% CI 0.72-2.01], ≥ 70 y aHR 1.07 [95% CI 0.76-1.52]). Most CV complications occurred in patients with CVD (66%) versus RF-CVD (17%) or neither (11%; p < 0.001). 213 [12.4%] patients developed venous thromboembolism (VTE). CVD was not an independent predictor of VTE. CONCLUSIONS: In patients hospitalised with COVID-19, pre-existing established CVD appears to be a more important contributor to mortality than CV risk factors in the absence of CVD. CVD-related hazard may be mediated, in part, by new CV complications. Optimal care and vigilance for destabilised CVD are essential in this patient group. Trial registration n/a.


Assuntos
COVID-19 , Doenças Cardiovasculares , Diabetes Mellitus/epidemiologia , Mortalidade Hospitalar , Hipertensão/epidemiologia , Tromboembolia Venosa , Fatores Etários , Idoso , COVID-19/mortalidade , COVID-19/fisiopatologia , COVID-19/terapia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Reino Unido/epidemiologia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
12.
Ann Palliat Med ; 10(6): 6715-6725, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237974

RESUMO

BACKGROUND: A systematic evaluation of the therapeutic effects of calcium channel blockers (CCB) on stroke is carried out to provide clinical evidence for their application. METHODS: A search for randomized controlled trials (RCTs) of CCB in the treatment of stroke patients in the electronic databases of PubMed, Embase, Medline, Spring, and Ovid from their establishment to January 31, 2021 was performed, and the collected studies were then screened for the exclusion criteria. The Cochrane Handbook version 5.0.2 system evaluation writing manual was adopted to evaluate the risk of bias for the included literature, and a meta-analysis using Review Manager 5.3 software was applied. RESULTS: A total of 13 RCTs were included, comprising 1,067 subjects. The meta-analysis showed that the recurrence rate of stroke in patients from the observation group reduced sharply after CCB treatment [mean difference (MD) =0.41, 95% confidence interval (CI): 0.24-0.70, Z=3.31, P=0.0009], the Mini-Mental State Examination (MMSE) score improved markedly (MD =2.82, 95% CI: 1.69-3.95, Z=4.89, P<0.00001), and the Montreal Cognitive Assessment (MoCA) score was obviously increased (MD =6.07, 95% CI: 0.34-11.81, Z=2.08, P=0.04). Moreover, the diastolic blood pressure of the observation group decreased steeply after CCB treatment (MD =-1.11, 95% CI: -2.06-0.15, Z=2.27, and P=0.02). However, the effective rate of clinical treatment did not increase hugely (MD =1.70, 95% CI: 0.50-5.83, Z=0.85, P=0.40), and systolic blood pressure did not drop sharply (MD =-1.24, 95% CI: -2.85-0.37, Z=1.51, P=0.13). DISCUSSION: CCB treatment of stroke effectively prevented stroke recurrence, and showed faster recovery of cognitive function, and better lowering of blood pressure, all of which makes CCBs suitable for the treatment of stroke.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Pressão Sanguínea , Bloqueadores dos Canais de Cálcio/farmacologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Diagnóstico Precoce , Humanos , Hipertensão/tratamento farmacológico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico
13.
Ann Palliat Med ; 10(6): 6841-6849, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237981

RESUMO

BACKGROUND: The risk of cardiovascular and cerebrovascular events is the highest during the first several hours post-awakening in patients with hypertension. This is largely due to surges in morning blood pressure (BP). The current meta-analysis explored whether morning BP is affected by the timing of antihypertensive drug administration. METHODS: Four medical databases were searched for clinical trials that examined the relationship between the timing of antihypertensive drug administration and morning BP levels. This meta-analysis compared morning BP surges in patients administered medication at bedtime versus patients administered medication during the day. RESULTS: The random effects model demonstrated that bedtime administration of antihypertensive drugs reduced morning systolic blood pressure (SBP) by 1.17 mmHg [with 95% confidence interval (CI): -2.47 to 0.37; P=0.08), and reduced morning diastolic blood pressure (DBP) by 0.95 mmHg (95% CI: -2.03 to 0.13; P=0.08), compared with patients who were administered medication during the daytime hours. However, the results did not demonstrate statistical significance. There was strong heterogeneity in both morning SBP (I2 =77.9% >50%, and Q test >0.1) and morning DBP results (I2 =77.9% >50%, and Q test >0.1). The funnel plots showed no publication bias in this study. DISCUSSION: Studies have shown that a 1 mmHg change was sufficient to reduce the risk of cardiovascular-related deaths by 2.1%. Therefore, changing the time of taking antihypertensive medications may significantly reduce cardiovascular-associated mortality. There were certain limitations to this meta-analysis. First, the heterogeneity of the meta-analysis was strong, with undefined reasons. Second, the sample size was relatively small, and future studies involving larger cohorts are warranted to further assess the effects of bedtime antihypertensive medication on minimizing morning BP surges.


Assuntos
Anti-Hipertensivos , Hipertensão , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano , Humanos , Hipertensão/tratamento farmacológico
14.
J Med Case Rep ; 15(1): 352, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34238353

RESUMO

BACKGROUND: Paraganglioma is a very rare cause of pregnancy-induced hypertension. The objective of this case report is to present a case of paraganglioma presented during pregnancy and missed. Later, the diagnosis was made during the postpartum period because of persistence of hypertension. CASE PRESENTATION: Here, we describe the case of a patient with paraganglioma who initially presented with pregnancy-induced hypertension and gestational diabetes mellitus. She had persistence of hypertension and diabetes mellitus following delivery with proteinuria, thrombocytosis, and spells. Once her pelvic paraganglioma was removed, her blood pressure and blood sugar were normal without antihypertensives or hypoglycemic agents, respectively. Her proteinuria settled with near-normal platelet counts. CONCLUSION: Although neuroendocrine tumors are a rare cause of pregnancy-induced hypertension, it should be suspected in the appropriate clinical setting. Diabetes mellitus, proteinuria, and thrombocytosis can be a clinical feature in paraganglioma.


Assuntos
Diabetes Gestacional , Hipertensão , Paraganglioma , Trombocitose , Feminino , Humanos , Hipertensão/etiologia , Paraganglioma/complicações , Paraganglioma/diagnóstico , Paraganglioma/cirurgia , Gravidez , Proteinúria/etiologia
15.
Trials ; 22(1): 438, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238363

RESUMO

BACKGROUND: High blood pressure is an independent risk factor of cardiovascular disease (CVD) and is a major cause of disability and death. Managing a healthy lifestyle has been shown to reduce blood pressure and improve health outcomes. We aim to investigate the effectiveness of a lifestyle modification intervention program for lowering blood pressure in a rural area of Bangladesh. METHODS: A single-center cluster randomized controlled trial (RCT). The study will be conducted for 6 months, a total of 300 participants of age 30 to 75 years with 150 adults in each of the intervention and the control arms. The intervention arm will involve the delivery of a blended learning education program on lifestyle changes for the management of high blood pressure. The education program comprises evidence-based information with pictures, fact sheets, and published literature about the effects of high blood pressure on CVD development, increased physical activity, and the role of a healthy diet in blood pressure management. The control group involves providing information booklets and general advice at the baseline data collection point. The primary outcome will be the absolute difference in clinic SBP and DBP. Secondary outcomes include the difference in the percentage of people adopting regular exercise habits, cessation of smoking and reducing sodium chloride intake, health literacy of all participants, and the perceived barriers and enablers to adopt behavior changes by collecting qualitative data. Analyses will include analysis of covariance to report the mean difference in blood pressure between the control and the intervention group and the difference in change in blood pressure due to the intervention. DISCUSSION: The study will assess the effects of physical activity and lifestyle modification in controlling high blood pressure. This study will develop new evidence as to whether a simple lifestyle program implemented in a rural region of a low- and middle-income country will improve blood pressure parameters for people with different chronic diseases by engaging community people. TRIAL REGISTRATION: ClinicalTrials.gov NCT04505150 . Registered on 7 August 2020.


Assuntos
Doenças Cardiovasculares , Hipertensão , Adulto , Idoso , Bangladesh , Pressão Sanguínea , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Estilo de Vida , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
BMC Neurol ; 21(1): 268, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229606

RESUMO

BACKGROUND: Minimally invasive surgery has achieved good results in the treatment of cerebral haemorrhage.However, no large-scale clinical study has demonstrated that surgical treatment of cerebral haemorrhages less than 30 ml can improve the curative effect. Our study explored the efficacy and complication of stereotactic drainage based on the amount of cerebral hemorrhage (15-30 ml) in hypertensive basal ganglia. METHOD: Sixty patients with hypertensive basal ganglia haemorrhages were divided into a control group and an experimental group with 30 patients in each group. Patients in the control group were treated conservatively. In contrast, those in the experimental group received stereotactic drainage, and urokinase was injected into the haematoma cavity after the operation. The haematoma volume at admission and 1, 3, 7 and 30 days after treatment and National Institute of Health stroke scale(NIHSS) score data were recorded. Complications after treatment in the two groups of data were compared and analysed. RESULT: No significant differences in age, sex, time of treatment after onset, admission blood pressure, admission haematoma volume or admission NIHSS score were noted between these two groups (P > 0.05). After treatment, significant differences in haematoma volume were noted between the two groups on the 1st, 3rd, 7th and 30th days after treatment (P < 0.05). The amount of hematoma of patients in the experimental group was significantly reduced compared with that in the control group, and the NIHSS scores were significantly different on the 3rd, 7th and 30th days after treatment. The neurological deficit scores of patients in the experimental group were significantly reduced compared with those in the control group, and the incidence of pulmonary infection and venous thrombosis in the lower limbs of patients in the experimental group were significantly reduced (P < 0.05). ROC curve analysis showed that stereotactic drainage affected the early neurological function of patients with small and medium basal ganglia haemorrhages. CONCLUSION: For patients with small and medium basal ganglia haemorrhages, stereotactic drainage can be used due to the faster drainage speed of haematomas after operation, which is beneficial to the recovery of neurological function and reduce complications.


Assuntos
Hemorragia dos Gânglios da Base , Tratamento Conservador , Drenagem , Técnicas Estereotáxicas , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/terapia , Humanos , Hipertensão , Imageamento Tridimensional , Prognóstico , Curva ROC
18.
BMC Res Notes ; 14(1): 244, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193266

RESUMO

OBJECTIVE: Glutathione S-transferases have been associated with experimental resistance to some drugs. The present study investigated the factors associated with blood pressure control in patients with essential hypertension, especially the role of GSTT1 and GSTM1 genes polymorphisms. This cross-sectional study in Burkina Faso consisted of 200 patients with essential hypertension and under treatment. RESULTS: In the present study, 57.5% (115/200) of patients had their hypertension under control. No statistically significant difference was found between controlled and uncontrolled groups for anthropometric and biochemical parameters as well as for GSTT1 or GSTM1 gene polymorphisms (all p > 0.05). Current alcohol consumption (OR = 3.04; CI 1.88-6.13; p < 0.001), Physical inactivity (OR = 3.07; CI 1.71-5.49; p < 0.001), severe hypertension before any treatment (Grade III [OR = 3.79; CI 2.00-7.17; p < 0.001]) and heart damage (OR = 3, 14; CI 1.59-6.02; p < 0.001) were statistically more frequent in uncontrolled essential hypertensive patients than controlled hypertensive patients.


Assuntos
Predisposição Genética para Doença , Hipertensão , Pressão Sanguínea , Burkina Faso , Estudos de Casos e Controles , Estudos Transversais , Genótipo , Glutationa Transferase/genética , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/genética , Polimorfismo Genético
19.
Artigo em Inglês | MEDLINE | ID: covidwho-1288866

RESUMO

Coronavirus disease 2019 (COVID-19) has put hypertensive patients in densely populated cities at increased risk. Nurse-coordinated home blood pressure telemonitoring (NC-HBPT) may help address this. We screened studies published in English on three databases, from their inception to 30 November 2020. The effects of NC-HBPT were compared with in-person treatment. Outcomes included changes in blood pressure (BP) following the intervention and rate of BP target achievements before and during COVID-19. Of the 1916 articles identified, 27 comparisons were included in this review. In the intervention group, reductions of 5.731 mmHg (95% confidence interval: 4.120-7.341; p < 0.001) in systolic blood pressure (SBP) and 2.342 mmHg (1.482-3.202; p < 0.001) in diastolic blood pressure (DBP) were identified. The rate of target BP achievement was significant in the intervention group (risk ratio, RR = 1.261, 1.154-1.378; p < 0.001). The effects of intervention over time showed an SBP reduction of 3.000 mmHg (-5.999-11.999) before 2000 and 8.755 mmHg (5.177-12.334) in 2020. DBP reduced by 2.000 mmHg (-2.724-6.724) before 2000 and by 3.529 mmHg (1.221-5.838) in 2020. Analysis of the target BP ratio before 2010 (RR = 1.101, 1.013-1.198) and in 2020 (RR = 1.906, 1.462-2.487) suggested improved BP control during the pandemic. NC-HBPT more significantly improves office blood pressure than UC among urban hypertensive patients.


Assuntos
COVID-19 , Hipertensão , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Humanos , Hipertensão/epidemiologia , SARS-CoV-2
20.
Georgian Med News ; (314): 111-116, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34248038

RESUMO

The aim - to analyze the relationship between leptin levels and morphometric, anthropometric, biochemical parameters in patients with hypertension and obesity and in healthy individuals. The study included 64 patients with obesity and hypertension and 21 healthy individuals. The groups were comparable in age and gender. Leptin was determined by enzyme immunoassay method. Data are presented as mean values and the error of the mean (M±m). Differences were considered statistically significant at p<0,05. It was found out a strong positive correlation in the group with hypertension and obesity between plasma leptin levels and total cholesterol (r=0.40, p=0.00004), strong negative correlation between leptin and HDL (r=-0 , 43, p=0.0005), uric acid (r=0.32 p=0.00092) and ionized calcium levels (r=-0.35 p=0.00027). Leptin levels in the group of healthy individuals correlated with a waist circumference (r=0.78, p=0.005), BFM, BMI and age (r=0.92, r=0.94, r=0.81, p<0 , 05), uric acid levels (r=0.94) and ionized calcium (r=0.91) at p<0.05. The present study provides evidence that BFM, TG, HDL, VLDL, atherogenic index, ionized calcium levels and uric acid have a significant impact on serum leptin in patients with hypertension and obesity.


Assuntos
Hipertensão , Obesidade , Índice de Massa Corporal , Humanos , Leptina , Circunferência da Cintura
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