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1.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 48(3): 282-288, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31496160

RESUMO

OBJECTIVE: To determine the effect of trimetazidine on cardiac function and exercise tolerance in primary hypertension patients with type 2 diabetic. METHODS: In this randomized, double-blind, placebo-controlled prospective study, 60 primary hypertensive patients with diabetic were equally assigned into two groups, patients received trimetazidine (20 mg, 3 times a day) or placebo for 1 year. Echocardiography, cardiopulmonary exercise testing were performed; and the plasma N terminal pro B type natriuretic peptide (NT-ProBNP), hr-CRP, TNF-α, angiotensin Ⅱ and endothelin concentration were determined before and after treatment. RESULTS: In trimetazidine group, the left ventricular mass index, the mitral flow velocity E wave to A wave ratio (E/A), the peak early diastolic velocity (VE) to late diastolic velocity (VA) ratio (VE/VA) and the peak systolic velocity (Vs) were significantly improved, the plasma NT-ProBNP level was significantly decreased, and the exercise time, metabolic equivalent, maximal oxygen uptake and anaerobic threshold were significantly increased (all P<0.05); plasma concentration of hr-CRP, TNF-α, angiotensin Ⅱ and endothelin were significantly reduced after trimetazidine treatment, compared with baseline (all P<0.05) and with placebo (all P<0.05). There were no significant differences in any of above parameters after treatment in placebo group (all P>0.05). No severe adverse reaction was observed in both groups. CONCLUSIONS: For patients with both hypertension and diabetes, trimetazidine can improve cardiac function and increase exercise tolerance.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Tolerância ao Exercício , Coração , Hipertensão , Trimetazidina , Complicações do Diabetes/complicações , Diabetes Mellitus/tratamento farmacológico , Método Duplo-Cego , Tolerância ao Exercício/efeitos dos fármacos , Coração/efeitos dos fármacos , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Peptídeo Natriurético Encefálico/sangue , Estudos Prospectivos , Resultado do Tratamento , Trimetazidina/farmacologia , Trimetazidina/uso terapêutico , Vasodilatadores/farmacologia , Vasodilatadores/uso terapêutico
2.
Gan To Kagaku Ryoho ; 46(8): 1334-1336, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501383

RESUMO

Grade 2 or 3 proteinuria was observed in 54 patients out of 158 metastatic colorectal cancer patients receiving anti-VEGF therapy. Patients with diabetes and hypertension were risk for severe proteinuria. ARBs were more frequently used in patients with severe proteinuria. However, they could not reduce proteinuria. The examination of protein/creatinine ratio was useful for continuing anti-VEGF therapy.


Assuntos
Neoplasias Colorretais , Hipertensão , Bevacizumab , Neoplasias Colorretais/tratamento farmacológico , Humanos , Proteinúria , Fator A de Crescimento do Endotélio Vascular
3.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 355-361, July-Aug. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1012343

RESUMO

Depression and hypertension are highly prevalent among elderly people. Although the relationship between these conditions is well recognized, however, the factors that may influence such association are not clearly understood. Objective: To analyze the association between depression and hypertension in community-dwelling elders. Methods: Two-hundred and thirty-one community-dwelling elders provided information regarding the following variables: sex, age, ethnicity, smoking habit, physical activity level (PA), body mass index (BMI) and diabetes mellitus (DM). These variables can potentially influence depression and hypertension, as well as its relationship. Screening for depression was made using the Geriatric Depression Scale (GDS). The presence of hypertension was defined based on self-reported data and/or the use of antihypertensive drugs. The logistic regression technique was applied, using hypertension as the dependent variable and depressive state as a predictive variable. Logistic regression was applied with and without adjustment for the potential intervening variables. Results: The prevalence of depressive state and hypertension in the studied population was 14% and 59%, respectively. The association between depression and hypertension without adjustments was not significant (odds ratio [OR] = 2.28, 95% confidence interval [95%CI] = 0.98 - 5.32; p = 0.06). However, after adjusting for PA, BMI and DM, the strength of association between depression and hypertension significantly increased (OR = 3.08, 95%CI = 1.12 - 8.46; p = 0.03). Conclusion: The association between depression and hypertension in the elderly is directly influenced by PA, BMI and DM. This finding may guide strategies to increase the adherence to a healthier lifestyle


Assuntos
Humanos , Masculino , Feminino , Idoso , Composição Corporal , Depressão , Diabetes Mellitus , Vida Independente , Hipertensão , Atividade Motora , Idoso , Envelhecimento , Fumar , Índice de Massa Corporal , Prevalência , Análise Estatística , Obesidade
5.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 331-342, July-Aug. 2019. tab, graf, ilus
Artigo em Inglês | LILACS | ID: biblio-1012349

RESUMO

Cardiorespiratory (aerobic) fitness is strongly and directly related to major health outcomes, including all-cause mortality. Maximum oxygen uptake (VO2max), directly measured by maximal cardiopulmonary exercise test (CPET), represents the subject's aerobic fitness. However, as CPET is not always available, aerobic fitness estimation tools are necessary. Objectives: a) to propose the CLINIMEX Aerobic Fitness Questionnaire (C-AFQ); b) to validate C-AFQ against measured VO2max; and c) to analyze the influence of some potentially relevant variables on the error of estimate. Methods: We prospectively studied 1,000 healthy and unhealthy subjects (68.6% men) aged from 14 to 96 years that underwent a CPET. The two-step C-AFQ describes physical activities with corresponding values in metabolic equivalents (METs) - ranging from 0.9 to 21 METs. Results: Application of C-AFQ took less than two minutes. Linear regression analysis indicated a very strong association between estimated (C-AFQ) and measured (CPET) maximal METs - r2 = 0.83 (Sy.x = 1.63; p < .001) - with median difference of only 0.2 METs between both values and interquartile range (percentiles 25 and 75) of 2 METs. The difference between estimated and measured METs was not influenced by age, sex, body mass index, clinical condition, ß-blocker use or sitting-rising test scores. Conclusion: C-AFQ is a simple and valid tool for estimating aerobic fitness when CPET is unavailable and it is also useful in planning individual ramp protocols. However, individual error of estimate is quite high, so C-AFQ should not be considered a perfect substitute for CPET's measured VO2max


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Exercícios Respiratórios , Exercício , Estudos de Validação como Assunto , Aptidão Física , Análise Estatística , Estudos Prospectivos , Inquéritos e Questionários , Análise de Variância , Teste de Esforço/métodos , Terapia por Exercício , Hipertensão
6.
Braz Oral Res ; 33: e060, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365705

RESUMO

This study evaluated the effect of hypertension on tissue response and biomineralization capacity of white Mineral Trioxide Aggregate (MTA), High-plasticity MTA (MTA HP), and Biodentine® (BDT) in rats. Polyethylene tubes filled with MTA, MTA HP, BDT, and the control group (empty tubes) were placed into the dorsal subcutaneous tissue of 32 male rats (16 normotensive (NT) and 16 hypertensive rats - 8 per group). After 7 and 30 days, the polyethylene tubes surrounded by connective tissue were removed, fixed, and embedded in histological resin. The mean number of inflammatory cells was estimated in HE-stained sections, biomineralization was quantified as area (µm2) by Kossa (VK) staining, and examination by polarized light (LP) microscopy was performed. The differences amongst the groups were analyzed statistically by the Mann-Whitney or Student's t test, according to Shapiro-Wilk test of normality (p < 0.05). The inflammatory responses to all materials were greater in hypertensive rats than in NT rats (p < 0.05). Positive VK staining in MTA and BDT were more pronounced in NT rats at 7 and 30 days (p < 0.05). Birefringent structures in LP for MTA, MTA HP, and BDT were more pronounced in NT rats at 7 days (p<0.05). In rats, hypertension was able to increase inflammatory infiltrate and decrease biomineralization of the tested materials.


Assuntos
Compostos de Alumínio/farmacologia , Materiais Biocompatíveis/farmacologia , Biomineralização/fisiologia , Compostos de Cálcio/farmacologia , Hipertensão/fisiopatologia , Óxidos/farmacologia , Silicatos/farmacologia , Tela Subcutânea/efeitos dos fármacos , Tela Subcutânea/fisiopatologia , Animais , Combinação de Medicamentos , Hipertensão/complicações , Inflamação/patologia , Inflamação/fisiopatologia , Masculino , Teste de Materiais , Microscopia de Polarização , Ratos Wistar , Reprodutibilidade dos Testes , Tela Subcutânea/patologia , Fatores de Tempo
7.
J Biol Regul Homeost Agents ; 33(4): 1073-1084, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389227

RESUMO

This study used Sprague Dawley (SD) rats with stroke-prone renovascular hypertension (RHRSP) to establish an animal model of hypertensive white matter lesions (WML), so as to explore the brain functions and unusual ß-amyloid (Aß) accumulation in WML. Hypertensive WML and brain dysfunctions were evaluated by measuring the caudal arterial pressure of model rats, and by observing the histomorphological deformations o f the prefrontal lobe, temporal lobe, hippocampus and corpus callosum, as well as by counting of the number of neurons using Hematoxylin and Eosin (H and E) staining, and by evaluating the changes in rat brain functions, including memory and the ability of visual space learning, using the Morris Water Maze Test. In addition, the study discussed the correlation between Aß accumulation and hypertensive WML cognitive impairment by adopting an enzyme-linked immunosorbent assay (ELISA) to detect the level of Aß 1-42, and by detecting the expression of amyloid precursor protein (APP) and Beta-secretase 1 (BACE1) using Western blot. Results of the study showed that at 4 weeks, 8 weeks, 12 weeks and 16 weeks after operation, the blood pressure and brain Aß expression in the rats of the model group notably increased (P less than 0.01), along with deformed and degenerated brain tissues, confirming that the unusual Aß accumulation may participate in the occurrence and development of hypertensive WML as well as the induction of cerebral cognitive decreases.


Assuntos
Peptídeos beta-Amiloides/análise , Encéfalo/fisiopatologia , Hipertensão/patologia , Substância Branca/patologia , Secretases da Proteína Precursora do Amiloide/análise , Precursor de Proteína beta-Amiloide/análise , Animais , Ácido Aspártico Endopeptidases/análise , Ratos , Ratos Sprague-Dawley
8.
Anticancer Res ; 39(8): 4503-4509, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366552

RESUMO

BACKGROUND/AIM: Oral administration of Pantoea agglomerans-derived lipopolysaccharide (LPSp) has been reported to have a preventive effect against various lifestyle-related diseases. Therefore, we examined the preventive effect on high blood pressure, which is a kind of reserve arm for lifestyle-related diseases. MATERIALS AND METHODS: Spontaneous hypertensive rat (SHR) and WKY rat were bred from 6 to 16 weeks of age. SHR were orally administered 100 µg/kg LPSp and 0.1% NaCl, and blood pressure was measured at 6, 10, 13 and 16 weeks. Furthermore, at 16 weeks of age, blood biochemical markers were measured and microbial community composition was analyzed. RESULTS: SHRs developed hypertension with age, which was exacerbated by salt loading. Although there was almost no reduction in blood pressure in SHRs that received LPSp. It was suppressed at 13-16 weeks of age in those with salt loading. CONCLUSION: Oral administration of LPSp showed a preventive effect on salt-loaded hypertension.


Assuntos
Citocinas/genética , Hipertensão/tratamento farmacológico , Lipopolissacarídeos/administração & dosagem , Pantoea/química , Administração Oral , Animais , Pressão Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Humanos , Hipertensão/genética , Hipertensão/patologia , Lipopolissacarídeos/química , Masculino , Fagocitose/efeitos dos fármacos , Ratos , Ratos Endogâmicos SHR , Sais/toxicidade
9.
Pan Afr Med J ; 33: 27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384342

RESUMO

Introduction: In Nigeria, approximately 4.33 million adults suffer from hypertension and about a third of them do not adhere to prescribed medications. Depression has been reported to significantly predict poor medication adherence. The relationship between medication non-adherence and co-morbid depressive disorder in patients with hypertension has not been adequately explored in this environment. The study aimed to determine the prevalence of depression in patients with hypertension. The association between socio-demographic characteristics and presence of co-morbidity on medication adherence was also determined. Methods: A cross-sectional descriptive research design was adopted for the study. A socio-demographic questionnaire, the modified Morisky Medication Adherence Scale (MMAS), the Hamilton Rating Scale for Depression (HAM-D) and the Mini International Neuropsychiatric Interview (MINI), were administered to four hundred patients with hypertension attending medical out-patient clinic between August and September 2012. Results: About 43% (168) were aged 61 to 64 years the majority being females, with a female to male ratio of 1.63:1. The prevalence of comorbid depression was 22.8%, made up of mild (21.8%) and moderate (1.0%) depressive episodes only. Depression was commoner among females than males in a ratio of 3:1. A majority of the participants (96.8%) had high medication adherence; 2.8% and 0.4% had moderate and low adherence respectively. Depression was more among patients with good medication adherence. Conclusion: The occurrence of mild depressive disorder among hypertensives did not affect the level of medication adherence. Review of Antihypertensive drugs should also be done often to ensure patients are not likely to have depressive illness as a side effect of drugs used.


Assuntos
Anti-Hipertensivos/administração & dosagem , Depressão/epidemiologia , Hipertensão/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adulto , Anti-Hipertensivos/efeitos adversos , Estudos Transversais , Depressão/diagnóstico , Feminino , Humanos , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Nigéria , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e Questionários , Centros de Atenção Terciária , Adulto Jovem
10.
Adv Exp Med Biol ; 1121: 57-59, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31392652

RESUMO

Hypertension, obesity and metabolic syndromes are leading risk factors for the development of chronic kidney disease (CKD). Considering the high prevalence of hypertension and obesity in children and adolescents and it's risk of progression to cardiovascular disease, CKD should be considered a serious long-term health issue in children with metabolic syndrome. Prevention of CKD requires a professional teamwork consisting of primary care physicians, nephrologists, nutritionist, pharmacist, and social work to identify and manage children at risk of developing CKD in order to provide a highly valuable management strategies. This review focuses on the principles underlying the importance of a team approach for CKD prevention.


Assuntos
Falência Renal Crônica , Progressão da Doença , Humanos , Hipertensão , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/prevenção & controle , Obesidade Pediátrica , Prevalência , Insuficiência Renal Crônica , Fatores de Risco
11.
Wiad Lek ; 72(7): 1265-1268, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398153

RESUMO

OBJECTIVE: Introduction: Chronic obstructive pulmonary disease (COPD) with hypertension occupy a leading position in morbidity and mortality in the world. The question of studying a single pathological way of their development, the search for diagnostic markers and therapeutic targets in this comorbid pathology remains relevant. The aim of the study was to study cardiopulmonary parameters in patients with chronic obstructive pulmonary disease with concomitant hypertension, depending on the level of vasoactive intestinal peptide (VIP). PATIENTS AND METHODS: Materials and methods: 99 patients with COPD GOLD 2 were examined, 54 of whom had concomitant hypertension II stage, in which the dependence of lipid metabolism, spirometry and hemodynamic parameters, depending on the level of VIP in blood serum. RESULTS: Results and conclusions: It was established that the smallest values of VIP and the greatest changes in cardiopulmonary parameters, lipid metabolism were found in the cohort of persons with concomitant hypertension. There was a significant decrease in spirometry values and an increase in hemodynamic parameters, respectively, a decrease in VIP levels in patients with COPD in combination with hypertension, which may indicate its role in the formation of these pathologies due to a decrease in its protective function, both in relation to apoptosis of alveolar cells and in relation to progression atherosclerosis and high blood pressure. It was also noted that in patients with the lowest VIP serum levels, a more rapid formation of COPD was observed. The data obtained make it possible to consider VIP as a diagnostic marker and a potential therapeutic target for the comorbid pathology examined.


Assuntos
Hipertensão , Doença Pulmonar Obstrutiva Crônica , Progressão da Doença , Humanos , Peptídeo Intestinal Vasoativo
12.
Wiad Lek ; 72(7): 1295-1299, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398158

RESUMO

OBJECTIVE: Introduction: Multiple data available indicate high prevalence of comorbid abnormalities in gouty arthritis patients, namely, high incidence of arterial hypertension, coronary artery disease, stroke, atherosclerosis of carotid arteries, vascular dementia. For instance, hypertension is found in 36-41% gout patients, and combined with metabolic syndrome it may reach 80%. The aim: Studying features of clinical course, lipid profile and immune status in patients with combined hypertension and gout. PATIENTS AND METHODS: Materials and methods: The study involved examination of 137 male patients with stage II hypertension, average age 56.9±3.4. All patients underwent echocardiography with estimation of the left ventricular mass index to verify hypertension stage, blood chemistry test with estimation of uric acid level, as well as lipid profile and immune status. RESULTS: Results: We have found significant disorders in the lipid profile of blood serum in patients with combined hypertension and gout. Positively higher percentage of activated T-cells was found in patients with combined hypertension and gout, both with early (CD3+CD25+) and late (CD3+HLA-DR+) activation marker, as well as those expressing FAS receptor, and ready to enter into apoptosis. CONCLUSION: Conclusion: We have identified abnormalities in adhesion and cooperation of immune competent cells, resulting in more intense activation of the same, effector functions and migration to the area of inflammation in the vessel wall.


Assuntos
Artrite Gotosa , Gota , Hipertensão , Humanos , Sistema Imunitário , Masculino , Pessoa de Meia-Idade , Ácido Úrico
13.
West Afr J Med ; 36(2): 133-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385599

RESUMO

BACKGROUND: Anaemia is a common disorder occurring in about 33% of the global population. It is an important cardiovascular risk factor and a key indicator of some chronic complications of Diabetes Mellitus (DM). This study aimed to determine the burden of anaemia and its correlation with some clinical and biochemical parameters among patients with DM attending a tertiary health facility in Zaria, Northwestern Nigeria. SUBJECTS, MATERIALS AND METHODS: This was a case-control study in which 168 participants were enrolled (84 DM patients, 84 controls). It was conducted in the Endocrinology and Metabolic clinics of Ahmadu Bello University Teaching Hospital, Zaria. Consenting DM patients were enrolled consecutively and subsequently, sex- and age-matched with non-diabetic controls. Data on age, gender and Haemoglobin (Hb) concentrations were collated for all study participants. Additional data on type of DM, duration of DM once diagnosis, treatment, type of treatment, history of hypertension, chronic kidney disease, peripheral neuropathy, and Fasting Blood Sugar (FBS) were collated for all cases. Data were collated and analyzed using SPSS version 21. Level of significance was set at <0.05. Ethical approval for the study was obtained from the Institutional Health Research Ethics Committee and informed consent was obtained from the all the participants. RESULTS: Females constituted 39/84(46.4%) of each arm of the study. The mean ± SD of age for both cases and controls was 53.7 ± 8.9 years. The mean ± SD duration of DM, treatment for DM and FBS were 8.4 ± 5.7 years, 5.0 ± 3.6 years and 6.1 ± 2.5mmol/L respectively. Cases had significantly lower Hb concentration compared to controls (12.1±2.2g/dl vs. 13.1 ± 1.4g/dl, t= -3.446, p = 0.001). Overall prevalence of anaemia among cases and controls was 36/84(42.9%) vs. 26/84(31.0%) Z = 1.6, p = 0.110. Among cases, haemoglobin concentration had very weak, inverse and non-statistically significant relationships with age, duration of DM diagnosis, duration of therapy and FBS levels. There was a significant relationship between anaemia on one hand and type of DM and treatment on the other. The odds of DM patients with history of CKD or uncontrolled FBS having anaemia were OR= 0.600 (95% CI 0.196, 1.836) and OR=1.755 (95% CI 0.737, 4.181) respectively. CONCLUSION: The burden of anaemia amongst patients with DM is high in Zaria, Northwestern Nigeria, and it is associated with poor glycaemic control. Hence, the need to include haematological assessment as part of routine care of patients with DM.


Assuntos
Anemia/epidemiologia , Glicemia/análise , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobina A Glicada/análise , Adulto , Idoso , Estudos de Casos e Controles , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Prevalência , Insuficiência Renal Crônica/epidemiologia
14.
West Afr J Med ; 36(2): 183-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385606

RESUMO

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.


Assuntos
Disfunção Cognitiva/diagnóstico , Confusão/diagnóstico , Delírio/diagnóstico , Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Comorbidade , Confusão/psicologia , Delírio/epidemiologia , Delírio/psicologia , Demência/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Hipertensão/epidemiologia , Entrevista Psiquiátrica Padronizada/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Nigéria/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Centros de Atenção Terciária
15.
JAMA ; 322(5): 409-420, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31386134

RESUMO

Importance: Blood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes. Objective: To evaluate the association of BP indexes with death and a composite CV event. Design, Setting, and Participants: Longitudinal population-based cohort study of 11 135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016). Exposures: Blood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or the night; and the dipping ratio (nighttime divided by daytime readings). Main Outcomes and Measures: Multivariable-adjusted hazard ratios (HRs) expressed the risk of death or a CV event associated with BP increments of 20/10 mm Hg. Cardiovascular events included CV mortality combined with nonfatal coronary events, heart failure, and stroke. Improvement in model performance was assessed by the change in the area under the curve (AUC). Results: Among 11 135 participants (median age, 54.7 years, 49.3% women), 2836 participants died (18.5 per 1000 person-years) and 2049 (13.4 per 1000 person-years) experienced a CV event over a median of 13.8 years of follow-up. Both end points were significantly associated with all single systolic BP indexes (P < .001). For nighttime systolic BP level, the HR for total mortality was 1.23 (95% CI, 1.17-1.28) and for CV events, 1.36 (95% CI, 1.30-1.43). For the 24-hour systolic BP level, the HR for total mortality was 1.22 (95% CI, 1.16-1.28) and for CV events, 1.45 (95% CI, 1.37-1.54). With adjustment for any of the other systolic BP indexes, the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant (HRs ranging from 1.17 [95% CI, 1.10-1.25] to 1.87 [95% CI, 1.62-2.16]). Base models that included single systolic BP indexes yielded an AUC of 0.83 for mortality and 0.84 for the CV outcomes. Adding 24-hour or nighttime systolic BP to base models that included other BP indexes resulted in incremental improvements in the AUC of 0.0013 to 0.0027 for mortality and 0.0031 to 0.0075 for the composite CV outcome. Adding any systolic BP index to models already including nighttime or 24-hour systolic BP did not significantly improve model performance. These findings were consistent for diastolic BP. Conclusions and Relevance: In this population-based cohort study, higher 24-hour and nighttime blood pressure measurements were significantly associated with greater risks of death and a composite CV outcome, even after adjusting for other office-based or ambulatory blood pressure measurements. Thus, 24-hour and nighttime blood pressure may be considered optimal measurements for estimating CV risk, although statistically, model improvement compared with other blood pressure indexes was small.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/epidemiologia , Hipertensão/complicações , Adulto , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/etiologia , Ritmo Circadiano , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
16.
JAMA ; 322(6): 535-545, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31408138

RESUMO

Importance: The association between late-life blood pressure (BP) and cognition may depend on the presence and chronicity of past hypertension. Late-life declines in blood pressure following prolonged hypertension may be associated with poor cognitive outcomes. Objective: To examine the association of midlife to late-life BP patterns with subsequent dementia, mild cognitive impairment, and cognitive decline. Design, Setting, and Participants: The Atherosclerosis Risk in Communities prospective population-based cohort study enrolled 4761 participants during midlife (visit 1, 1987-1989) and followed-up over 6 visits through 2016-2017 (visit 6). BP was examined over 24 years at 5 in-person visits between visits 1 and 5 (2011-2013). During visits 5 and 6, participants underwent detailed neurocognitive evaluation. The setting was 4 US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and Minneapolis, Minnesota. Follow-up ended on December 31, 2017. Exposures: Five groups based on longitudinal patterns of normotension, hypertension (>140/90 mm Hg), and hypotension (<90/60 mm Hg) at visits 1 to 5. Main Outcomes and Measures: Primary outcome was dementia onset after visit 5, based on Ascertain Dementia-8 informant questionnaires, Six-Item Screener telephone assessments, hospital discharge and death certificate codes, and the visit 6 neurocognitive evaluation. Secondary outcome was mild cognitive impairment at visit 6, based on the neurocognitive evaluation. Results: Among 4761 participants (2821 [59%] women; 979 [21%] black race; visit 5 mean [SD] age, 75 [5] years; visit 1 mean age range, 44-66 years; visit 5 mean age range, 66-90 years), there were 516 (11%) incident dementia cases between visits 5 and 6. The dementia incidence rate for participants with normotension in midlife (n = 833) and late life was 1.31 (95% CI, 1.00-1.72 per 100 person-years); for midlife normotension and late-life hypertension (n = 1559), 1.99 (95% CI, 1.69-2.32 per 100 person-years); for midlife and late-life hypertension (n = 1030), 2.83 (95% CI, 2.40-3.35 per 100 person-years); for midlife normotension and late-life hypotension (n = 927), 2.07 (95% CI, 1.68-2.54 per 100 person-years); and for midlife hypertension and late-life hypotension (n = 389), 4.26 (95% CI, 3.40-5.32 per 100 person-years). Participants in the midlife and late-life hypertension group (hazard ratio [HR], 1.49 [95% CI, 1.06-2.08]) and in the midlife hypertension and late-life hypotension group (HR, 1.62 [95% CI, 1.11-2.37]) had significantly increased risk of subsequent dementia compared with those who remained normotensive. Irrespective of late-life BP, sustained hypertension in midlife was associated with dementia risk (HR, 1.41 [95% CI, 1.17-1.71]). Compared with those who were normotensive in midlife and late life, only participants with midlife hypertension and late-life hypotension had higher risk of mild cognitive impairment (37 affected individuals (odds ratio, 1.65 [95% CI, 1.01-2.69]). There was no significant association of BP patterns with late-life cognitive change. Conclusions and Relevance: In this community-based cohort with long-term follow-up, sustained hypertension in midlife to late life and a pattern of midlife hypertension and late-life hypotension, compared with midlife and late-life normal BP, were associated with increased risk for subsequent dementia.


Assuntos
Disfunção Cognitiva/complicações , Demência/etiologia , Hipertensão/complicações , Adulto , Idoso , Pressão Sanguínea , Determinação da Pressão Arterial , Disfunção Cognitiva/etiologia , Estudos de Coortes , Feminino , Humanos , Hipotensão/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
17.
Stud Health Technol Inform ; 264: 1982-1983, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438439

RESUMO

This study aims to investigate the use of theory in mobile health interventions for patient self-management of chronic conditions, with a focus on hypertension. We identified six theories in ten studies that were reviewed. These included Health Belief Model, Social Cognitive Theory, Self-Determination Theory, Theory of Planned Behavior, Transtheoretic Model, and Technology Acceptance Model. The findings are useful for further advancement of mobile health interventions to support chronic disease management.


Assuntos
Hipertensão , Autogestão , Telemedicina , Doença Crônica , Humanos
18.
Arch Endocrinol Metab ; 63(4): 411-416, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365629

RESUMO

OBJECTIVE: The prevalence of overweight and obesity is gradually increasing in both developed and developing countries. Obesity, for instance, can present multifactorial causes that interact with each other. Among the important factors, parental obesity plays a prominent role in the onset of obesity during childhood and teenage years through genetics and ambient aspects. This study aims to verify the possible existence of an association between overweight/obesity of schoolchildren and cardiovascular risk (CVR) factors for their parents. SUBJETCS AND METHODS: For this purpose, a cross-sectional study was conducted with a sample of 1,243 children and adolescents, aged between 7 and 17. Out of the total number of participants, 563 (45.3%) were boys who were selected across 19 schools in the urban and rural areas of Santa Cruz do Sul, Rio Grande do Sul (Brazil). The overweight/obesity status of the schoolchildren was evaluated through their body mass index (BMI). Additionally, a self-reference questionnaire was employed to measure their parents' CVR. RESULTS: The results of this study revealed that students with overweight/obesity have a higher probability of having a father with hypertension (OR = 1.49; p = 0.038) and obesity (OR = 2.36; p = 0.002) and a mother with obesity (OR = 1.72; p = 0.016). CONCLUSION: To conclude, this study confirms a relationship between overweight/obesity of schoolchildren with CVR for their parents.


Assuntos
Doenças Cardiovasculares/epidemiologia , Sobrepeso/epidemiologia , Pais , Obesidade Pediátrica/epidemiologia , Adolescente , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Humanos , Hipertensão , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários
19.
J Natl Black Nurses Assoc ; 30(1): 1-6, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31465678

RESUMO

African-American women have an increased risk of developing cardiovascular disease as a result of uncontrolled hypertension. Despite treatment guidelines that recommend lifestyle changes to manage hypertension, dietary lifestyle changes remain low. Lifestyle modification with the DASH (Dietary Approaches to Stop Hypertension) was integrated into the current treatment plan to reduce blood pressure to target (<120/80 mm Hg). The mean pre-Dash SBP (147.44 mm Hg)/(86.33 DBP) compared to mean post-Dash SBP (142.43 mm Hg)/(81.57 mmHg DBP) yielded a 5-mm Hg reduction in SBP and 4-mm Hg decrease in DBP. The Wilcoxon Signed Rank, a nonparametric test was used to determine statistical significance. A p value of <0.05 is considered statistically significant. As a result, the DASH Diet did not elicit a statistically significant change in BP (z = -1.355, p = 0.176). The DASH Diet lifestyle modification is an effective adjunct in the management of hypertension and must continue throughout all phases of treatment.


Assuntos
Afro-Americanos/psicologia , Abordagens Dietéticas para Conter a Hipertensão/etnologia , Hipertensão/dietoterapia , Hipertensão/etnologia , Afro-Americanos/estatística & dados numéricos , Feminino , Humanos , Resultado do Tratamento
20.
Zhonghua Yi Xue Za Zhi ; 99(30): 2367-2374, 2019 Aug 13.
Artigo em Chinês | MEDLINE | ID: mdl-31434418

RESUMO

Objective: To assess the effects of clinical medicine on salt sensitive hypertension. Methods: The PubMed, EMBASE, Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were searched to collect randomized controlled trials (RCTs) on clinical medicine in treating salt sensitive hypertension from inception to December 2018. Two reviewers independently screened the literature, extracted data, and another investigator assessed the risk of bias included in the study. Then meta-analysis was performed using RevMan 5.3 software. Results: A total of 16 RCTs studies involving 1 355 patients were included. Meta-analysis showed that angiotensin-converting enzyme inhibitors (ACEIs) combined with diuretics could effectively reduce 24 h systolic blood pressure variability [mean difference (MD)=4.45, 95%CI: 3.47-5.43, P<0.001] and 24 h diastolic blood pressure variability (MD=3.71, 95%CI:2.83-4.59, P<0.001) in salt-sensitive hypertension patients. Angiotensin Ⅱ receptor antagonists (ARBs) combined with diuretics had no antihypertensive effect on salt-sensitive hypertension patients. Indapamide alone can reduce systolic blood pressure (MD=-14.70, 95%CI:-18.57--10.83, P<0.001) and diastolic blood pressure (MD=-8.73, 95%CI:-11.57--5.89, P<0.001). The use of ACEIs alone in salt-sensitive hypertension patients can not reduce systolic pressure (MD=2.20, 95%CI:-1.48-5.88, P=0.240) and diastolic pressure (MD=2.95, 95%CI: 1.37~4.54, P<0.001). Amlodipine combined with metformin had therapeutic effect on salt-sensitive hypertension (RR=1.23, 95%CI: 1.14~1.33, P<0.001). Conclusions: ACEIs combined with diuretics can effectively reduce blood pressure variability in salt-sensitive hypertensive patients. The use of amlodipine in combination with metformin and indapamide alone have antihypertensive effect in salt-sensitive hypertensive patients.


Assuntos
Hipertensão , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Anti-Hipertensivos , Pressão Sanguínea , Humanos
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