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1.
Medicine (Baltimore) ; 98(31): e16560, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374021

RESUMO

BACKGROUND: Patients with atrial fibrillation (AF) have a higher risk of fatal complications (e.g., stroke). This investigation was performed as an observational retrospective cohort study includes 137 patients (age 61 ±â€Š15; 34.3% women) with a primary diagnosis of AF (paroxysmal, persistent, and permanent). METHODS: We collected information about the drug therapy, comorbidities and survival of AF patients and determined their congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or TIA or thromboembolism, vascular disease, age, sex category (CHA2DS2-VASc) scores. Statistical analysis identified patients with high CHA2DS2-VASc scores and defined the predictive value of individual parameters, or their combination, with regards to the outcomes of stroke and mortality. RESULTS: CHA2DS2-VASc scores identified 43.8% of the patients as low to intermediate risk (score 0-1) and 56.2% of the patients as high risk (score ≥2). Increasing CHA2DS2-VASc scores were not only accompanied by an increase in the incidence of stroke (Ptrend < .001) but also by an increase in the 3 to 5 years mortality (P = .005). Comparison of anticoagulation and anti-aggregation treatment between the 3 groups of AF did not show any significant statistical difference. Highly significant predictors of death were the CHA2DS2-VASc score (OR 1.71, 95% CI 1.10-2.67, P < .017) as well as other risk factors not included in the CHA2DS2-VASc score such as valvular heart disease (OR 5.04, 95% CI 1.10-23.10, P = .037), hyperlipidemia (OR 4.82, 95% CI 1.03-22.63, P = .046) and chronic renal failure (OR 14.21, 95% CI 2.41-83.91, P = .003). The type of AF type did not affect survival (P = .158) nor the incidence of stroke (P = .466). Patients with paroxysmal AF were linked to significantly lower frequencies of ischemic heart disease (P < .0001), vascular disease (P = .002), diabetes mellitus (P = .047), valvular heart disease (P = .03) and heart failure/left ventricular dysfunction (P = .015). CONCLUSION: The CHA2DS2-VASc score correctly predicted the patients at high-risk for 3 to 5 years mortality and confirmed its significant predictive value in the patients with AF.


Assuntos
Fibrilação Atrial/complicações , Projetos de Pesquisa/normas , Medição de Risco/métodos , Acidente Vascular Cerebral/mortalidade , Fatores Etários , Idoso , Fibrilação Atrial/mortalidade , Estudos de Coortes , Diabetes Mellitus/classificação , Feminino , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/complicações , Humanos , Hipertensão/classificação , Hipertensão/complicações , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Tromboembolia/classificação , Tromboembolia/complicações
2.
Medicine (Baltimore) ; 98(27): e16116, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277112

RESUMO

To assess the adherence level of antihypertensive treatment and identify any associated risk factors in a sample of hypertensive patients from China.A cross-sectional study involving 488 Chinese hypertensive patients was conducted in a tertiary hospital in Xi'an, China. Data were collected regarding socio-demographic factors and hypertension-related clinical characteristics. The adherence to treatment was assessed using the previously validated instrument: therapeutic adherence scale for hypertensive patients.A total of 27.46% of patients were compliant with their antihypertensive treatments. Three factors were identified to be independently associated with antihypertensive treatment adherence: gender (P = .034), residence (P = .029), duration of high blood pressure (P < .001). Gender, residence, occupation, and the duration of antihypertensive drugs treatment used were found to have significant effects on treatment adherence in certain categories.Treatment adherence among hypertensive patients in China was poor. More attention and effective strategies should be designed to address factors affecting treatment adherence. Education about hypertension knowledge should be strengthened for patients. Moreover, the importance of lifestyle modification during hypertension treatment is often neglected by patients, therefore, there is an urgent need to educate hypertensive patients about the adherence to lifestyle modifications.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/terapia , Adesão à Medicação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , China , Estudos Transversais , Feminino , Humanos , Hipertensão/classificação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
3.
Medicine (Baltimore) ; 98(25): e16058, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232943

RESUMO

The study aimed to study the related factors of hypertension using multivariate logistic regression analysis and tabu search-based Bayesian Networks (BNs). A cluster random sampling method was adopted to obtain samples of the general population aged 15 years or above. Multivariate logistic regression analysis indicated that gender, age, cultural level, body mass index (BMI), central obesity, drinking, diabetes mellitus, Myocardial infarction, Coronary heart disease, Stroke are associated with hypertension. While BNs found connections between those related factors and hypertension were established by complex network structure, age, smoking, occupation, cultural level, BMI, central obesity, drinking, diabetes mellitus, myocardial infarction, coronary heart disease, nephropathy, stroke were direct connection with hypertension, gender was indirectly linked to hypertension through drinking. The results showed that BNs can not only find out the correlative factors of hypertension but also analyze how these factors affect hypertension and their interrelationships, which is consistent with practical theory better than logistic regression and has a better application prospects.


Assuntos
Hipertensão/classificação , Hipertensão/etiologia , Adolescente , Adulto , Idoso , Teorema de Bayes , Índice de Massa Corporal , China , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Hipertensão/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Razão de Chances , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
4.
Drugs Today (Barc) ; 55(4): 277-285, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31050695

RESUMO

Hypertension is a major risk factor for cardiovascular disease, heart failure, chronic kidney disease and stroke. Therefore, its early detection and treatment are very important according to blood pressure (BP) treatment guidelines issued by the various scientific societies. Over the years, BP treatment guidelines have changed from strict control of BP to more relaxed control, and lately to a strict BP control influenced by the results of the SPRINT trial. The recently published BP treatment guidelines by the American College of Cardiology/American Heart Association (ACC/AHA) recommend a systolic BP (SBP) and diastolic BP reduction to less than 130 mmHg and less than 80 mmHg, respectively, for all ages, and have also changed the classification of hypertension by changing the term "prehypertension" of the JNC 7 (7th Joint National Committee) guidelines to "stage 1 hypertension". These changes could have significant social and economic consequences for the patients. In order to get a better perspective of the current status of SBP control, we conducted a MEDLINE search of the English language literature from 2014 to 2018 in connection with recent (2014-2018) BP treatment guidelines, using the terms 'hypertension', 'blood pressure control', 'intensive blood pressure control', 'blood pressure treatment guidelines', and 'benefits and risks of intensive blood pressure control', and 26 pertinent papers were retrieved. These papers together with collateral literature, which goes beyond the year 2014, will be discussed in this review.


Assuntos
Pressão Sanguínea , Hipertensão/classificação , Guias de Prática Clínica como Assunto , American Heart Association , Doenças Cardiovasculares/complicações , Humanos , Insuficiência Renal Crônica/complicações , Acidente Vascular Cerebral/complicações , Estados Unidos
5.
Sensors (Basel) ; 19(7)2019 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-30934719

RESUMO

Hypertension is one of the most common cardiovascular diseases, which will cause severe complications if not treated in a timely way. Early and accurate identification of hypertension is essential to prevent the condition from deteriorating further. As a kind of complex physiological state, hypertension is hard to characterize accurately. However, most existing hypertension identification methods usually extract features only from limited aspects such as the time-frequency domain or non-linear domain. It is difficult for them to characterize hypertension patterns comprehensively, which results in limited identification performance. Furthermore, existing methods can only determine whether the subjects suffer from hypertension, but they cannot give additional useful information about the patients' condition. For example, their classification results cannot explain why the subjects are hypertensive, which is not conducive to further analyzing the patient's condition. To this end, this paper proposes a novel hypertension identification method by integrating classification and association rule mining. Its core idea is to exploit the association relationship among multi-dimension features to distinguish hypertensive patients from normotensive subjects. In particular, the proposed method can not only identify hypertension accurately, but also generate a set of class association rules (CARs). The CARs are proved to be able to reflect the subject's physiological status. Experimental results based on a real dataset indicate that the proposed method outperforms two state-of-the-art methods and three common classifiers, and achieves 84.4%, 82.5% and 85.3% in terms of accuracy, precision and recall, respectively.


Assuntos
Leitos , Mineração de Dados/métodos , Hipertensão/patologia , Adulto , Idoso , Algoritmos , Balistocardiografia/instrumentação , Balistocardiografia/métodos , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hipertensão/classificação , Masculino , Sistemas Microeletromecânicos , Pessoa de Meia-Idade , Análise de Ondaletas
6.
Hipertens. riesgo vasc ; 36(1): 44-52, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181584

RESUMO

Se estima que alrededor del 10 al 30% de los pacientes hipertensos pueden considerarse como resistentes al tratamiento (HR). Estos pacientes son definidos como aquellos no controlados con 3 fármacos, a las dosis máximas toleradas, incluyendo un diurético, como así también aquellos con una presión arterial controlada con 4 fármacos o más. Se utiliza este término con el fin de identificar a los pacientes que pueden beneficiarse de consideraciones diagnósticas y/o terapéuticas especiales. Recientemente, el término «hipertensión refractaria» se ha propuesto como un nuevo fenotipo de insuficiencia antihipertensiva. Estos pacientes son aquellos cuya presión arterial no puede controlarse con el tratamiento máximo. Los primeros estudios de este fenotipo indican que es poco común y afecta a menos del 5% de los pacientes con HR. La adhesión o cumplimiento del tratamiento médico es vital para asegurar la definición de hipertensión resistente. Desde la publicación de la primera declaración científica para el diagnóstico, evaluación y tratamiento de la HR de la American Heart Association en 2008, y en las guías europeas, se ha establecido una mayor atención en la investigación clínica y experimental. En esta revisión se expondrán los conceptos relacionados con prevalencia, pronóstico y cumplimiento abarcando las últimas novedades sobre el tema


An estimated 10% to 20% of hypertensive patients could be considered resistant to treatment (RH). These are patients who are not controlled using three drugs, at the maximum tolerated doses, including a diuretic, as well as those with high blood pressure controlled using four or more drugs. The term is used to identify patients that might benefit from special diagnostic and/or therapeutic consideration. The term 'refractory hypertension' has recently been proposed as a novel phenotype of antihypertensive failure. It refers to patients whose blood pressure cannot be controlled with maximum treatment. The first studies of this phenotype indicate that it is rare and affects less than 5% of patients with RH. Adherence to or compliance with medical treatment is key to defining resistant hypertension. Closer attention has been paid to clinical and experimental research since the first scientific statement for the diagnosis, assessment and treatment of RH from the American Heart Association, and in the European guidelines, was published in 2008. This review will set out the concepts relating to prevalence, prognosis and compliance and cover the latest developments on this subject


Assuntos
Humanos , Hipertensão/classificação , Hipertensão/epidemiologia , Adesão à Medicação , Prognóstico , Hipertensão/fisiopatologia , Anti-Hipertensivos/administração & dosagem , Estudos de Coortes , Fatores de Risco , Cooperação do Paciente
7.
Comput Math Methods Med ; 2019: 4936179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30805022

RESUMO

Hypertension is a common and chronic disease and causes severe damage to patients' health. Blood pressure of a human being is controlled by the autonomic nervous system. Heart rate variability (HRV) is an impact of the autonomic nervous system and an indicator of the balance of the cardiac sympathetic nerve and vagus nerve. HRV is a good method to recognize the severity of hypertension due to the specificity for prediction. In this paper, we proposed a novel fine-grained HRV analysis method to enhance the precision of recognition. In order to analyze the HRV of the patient, we segment the overnight electrocardiogram (ECG) into various scales. 18 HRV multidimensional features in the time, frequency, and nonlinear domain are extracted, and then the temporal pyramid pooling method is designed to reduce feature dimensions. Multifactor analysis of variance (MANOVA) is applied to filter the related features and establish the hypertension recognizing model with relevant features to efficiently recognize the patients' severity. In this paper, 139 hypertension patients' real clinical ECG data are applied, and the overall precision is 95.1%. The experimental results validate the effectiveness and reliability of the proposed recognition method in the work.


Assuntos
Eletrocardiografia/estatística & dados numéricos , Frequência Cardíaca/fisiologia , Hipertensão/classificação , Hipertensão/fisiopatologia , Algoritmos , Análise de Variância , Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea/fisiologia , Diagnóstico por Computador , Humanos , Hipertensão/diagnóstico , Bloqueio Interatrial , Modelos Cardiovasculares , Redes Neurais (Computação) , Dinâmica não Linear , Sono/fisiologia , Máquina de Vetores de Suporte , Nervo Vago/fisiopatologia , Análise de Ondaletas
8.
São Paulo; s.n; s.n; 2019. 190 p. tab, graf.
Tese em Português | LILACS | ID: biblio-997253

RESUMO

A hipertensão arterial sistêmica (HAS) é uma doença crônica altamente prevalente, que pode ser controlada com tratamento farmacológico. Para tal, recomenda-se aplicar as melhores evidências clínicas por meio da utilização de guias de prática clínica (GPC) de alta qualidade. No entanto, o processo de desenvolvimento de GPC requer recursos humanos e tempo, sendo a adaptação uma opção para reduzir a duplicação de esforços e adequar o GPC para uso local. O objetivo deste trabalho foi sintetizar as recomendações de GPC para o tratamento farmacológico da HAS. Aplicou-se o método de adaptação ADAPTE, realizando as duas primeiras fases: Configuração e Adaptação. Na fase de Configuração, o Grupo CHRONIDE realizou o planejamento e registrou a pesquisa no Próspero. Na fase de Adaptação, realizou-se uma revisão sistemática. Os critérios de eligibilidade foram: GPC que continham recomendações para o tratamento farmacológico da HAS em atenção primária, publicados em inglês, português ou espanhol, no período de 01/01/2011 a 31/12/2016. Em 31/11/2017 atualizou-se GPC incluídos. Para a determinação da qualidade destes GPC, três avaliadores, de forma independente, aplicaram o Appraisal of Guidelines for Research & Evaluation II (AGREE II). Dos 37 GPC avaliados, 6 foram considerados de alta qualidade (escore 60% ou mais no domínio Rigor de desenvolvimento do AGREE II). As recomendações destes foram extraídas e incluídas nas matrizes. Os GPC apresentaram divergências em suas recomendações. As divergências mais relevantes foram as recomendações mais rigorosas do GPC de 2017 da American College of Cardiology e American Heart Association (ACC/AHA), que trouxe metas terapêuticas e níveis pressóricos para indicação de farmacoterapia mais baixos que os demais. A maioria dos GPC recomendou o uso de diuréticos tiazídicos como farmacoterapia de primeira linha para tratamento da HAS e contraindicou o uso combinado de inibidores da enzima conversora de angiotensina e bloqueadores dos receptores de angiotensina II. Portanto, em uma discussão para adaptação local de recomendações, um dos pontos principais, além da questão do acesso aos medicamentos, seria adotar ou não os paramêtros mais rigorosos do GPC 2017 ACC/AHA


Arterial hypertension is a high prevalent chronic disease that can be controlled with pharmacologic treatment. For such, is recommended the use of the high clinical evidences presented in high quality clinical practice guidelines (CPG). However, the guideline development process requires time and capable human resources, which transform the adaptation to an option to reduce a duplication of efforts and to adapt the CPG to local use. The objective of this work was to synthesize the recommendations of CPG for the pharmacological treatment of arterial hypertension. The ADAPTE method was applied, using 2 steps: Configuration and Adaptation. In the Configuration step, the CHRONIDE group carried out the planning and the method was registered in Prospero. In the Adaptation step a systematic review was performed. The eligibility criteria were: CPG containing recommendations for the pharmacological treatment of arterial hypertension in primary care, published in English, Portuguese or Spanish, from 01/01/2011 to 12/31/2016. On 11/31/2017 it was updated the GPC included. To determine the CPG quality, 3 independent reviewers, assessed the CPG using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. Of the 37 evaluated CPG, 6 were considered to being as high quality (score 60% or higher in the domain " Rigour of Development "). The recommendations were extracted and included in the matrix of recommendations. The CPG has presentes differences in their recommendations. The most relevant divergences were the further rigorous recommendations described on CPG 2017 of the American College of Cardiology and American Heart Association (ACC/AHA), which brought therapeutic goals and blood pressure levels lower for pharmacotherapy than the others recommendations. The majority of CPG has recommended the use of thiazide diuretics as first-line pharmacotherapy for the treatment of arterial hypertension and has contraindicated the combined use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. Therefore, in a discussion for local adaptation of recommendations, one of the main points, apart from the issue of access to medicines, would be to adopt or would not be adopt the futher rigorous parameters of GPC 2017 ACC/AHA


Assuntos
Guias de Prática Clínica como Assunto/normas , Tratamento Farmacológico/normas , Hipertensão/classificação , Medicina Baseada em Evidências/legislação & jurisprudência , Prática Clínica Baseada em Evidências/normas
9.
JAMA ; 320(17): 1774-1782, 2018 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-30398601

RESUMO

Importance: Little is known regarding the association between level of blood pressure (BP) in young adulthood and cardiovascular disease (CVD) events by middle age. Objective: To assess whether young adults who developed hypertension, defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline, before age 40 years have higher risk for CVD events compared with those who maintained normal BP. Design, Setting, and Participants: Analyses were conducted in the prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) study, started in March 1985. CARDIA enrolled 5115 African American and white participants aged 18 to 30 years from 4 US field centers (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California). Outcomes were available through August 2015. Exposures: Using the highest BP measured from the first examination to the examination closest to, but not after, age 40 years, each participant was categorized as having normal BP (untreated systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg; n = 2574); elevated BP (untreated SBP 120-129 mm Hg and DBP <80 mm Hg; n = 445); stage 1 hypertension (untreated SBP 130-139 mm Hg or DBP 80-89 mm Hg; n = 1194); or stage 2 hypertension (SBP ≥140 mm Hg, DBP ≥90 mm Hg, or taking antihypertensive medication; n = 638). Main Outcomes and Measures: CVD events: fatal and nonfatal coronary heart disease (CHD), heart failure, stroke, transient ischemic attack, or intervention for peripheral artery disease (PAD). Results: The final cohort included 4851 adults (mean age when follow-up for outcomes began, 35.7 years [SD, 3.6]; 2657 women [55%]; 2441 African American [50%]; 206 taking antihypertensive medication [4%]). Over a median follow-up of 18.8 years, 228 incident CVD events occurred (CHD, 109; stroke, 63; heart failure, 48; PAD, 8). CVD incidence rates for normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were 1.37 (95% CI, 1.07-1.75), 2.74 (95% CI, 1.78-4.20), 3.15 (95% CI, 2.47-4.02), and 8.04 (95% CI, 6.45-10.03) per 1000 person-years, respectively. After multivariable adjustment, hazard ratios for CVD events for elevated BP, stage 1 hypertension, and stage 2 hypertension vs normal BP were 1.67 (95% CI, 1.01-2.77), 1.75 (95% CI, 1.22-2.53), and 3.49 (95% CI, 2.42-5.05), respectively. Conclusions and Relevance: Among young adults, those with elevated blood pressure, stage 1 hypertension, and stage 2 hypertension before age 40 years, as defined by the blood pressure classification in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, had significantly higher risk for subsequent cardiovascular disease events compared with those with normal blood pressure before age 40 years. The ACC/AHA blood pressure classification system may help identify young adults at higher risk for cardiovascular disease events.


Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Hipertensão/complicações , Adolescente , Adulto , American Heart Association , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Hipertensão/classificação , Incidência , Masculino , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
10.
JAMA ; 320(17): 1783-1792, 2018 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-30398603

RESUMO

Importance: Among young adults, the association of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) High Blood Pressure Clinical Practice Guidelines with risk of cardiovascular disease (CVD) later in life is uncertain. Objective: To determine the association of blood pressure categories before age 40 years with risk of CVD later in life. Design, Setting, and Participants: This population-based cohort study from the Korean National Health Insurance Service consisted of 2 488 101 adults aged 20 through 39 years with blood pressure measurements taken twice from 2002 through 2005. Starting from January 1, 2006, participants were followed up until the date of CVD diagnosis, death, or December 31, 2015. Exposures: Participants were categorized by blood pressure readings: normal (systolic, <120 mm Hg; diastolic, <80 mm Hg), elevated (sytolic, 120-129 mm Hg; diastolic, <80 mm Hg), stage 1 hypertension (systolic, 130-139 mm Hg; diastolic, 80-89 mm Hg), and stage 2 hypertension (systolic, ≥140 mm Hg; diastolic, ≥90 mm Hg). Main Outcomes and Measures: The primary outcome was CVD defined as 2 or more days of hospitalization due to CVD or death due to CVD. The secondary outcomes were coronary heart disease (CHD) and stroke. Results: The study population consisted of 2 488 101 participants (median age, 31 years [interquartile range, 27-36 years], 789 870 women [31.7%]). A total of 44 813 CVD events were observed during a median follow-up duration of 10 years. Men with baseline stage 1 hypertension compared with those with normal blood pressure had higher risk of CVD (incidence, 215 vs 164 per 100 000 person-years; difference, 51 per 100 000 person-years [95% CI, 48-55]; adjusted hazard ratio [HR], 1.25 [95% CI, 1.21-1.28]), CHD (incidence, 134 vs 103 per 100 000 person-years; difference, 31 per 100 000 person-years [95% CI, 28-33]; adjusted HR, 1.23 [95% CI, 1.19-1.27]), and stroke (incidence, 90 vs 67 per 100 000 person-years; difference, 23 per 100 000 person-years [95% CI, 21-26]; adjusted HR, 1.30 [95% CI, 1.25-1.36]). Women with baseline stage 1 hypertension compared with those with normal blood pressure had increased risk of CVD (incidence, 131 vs 91 per 100 000 person-years; difference, 40 per 100 000 person-years [95% CI, 35-45]; adjusted HR, 1.27 [95% CI, 1.21-1.34]), CHD (incidence, 56 vs 42 per 100 000 person-years; difference, 14 per 100 000 person-years [95% CI, 11-18]; adjusted HR, 1.16 [95% CI, 1.08-1.25]), and stroke (incidence, 79 vs 51 per 100 000 person-years; difference, 28 per 100 000 person-years [95% CI, 24-32]; adjusted HR [1.37, 95% CI, 1.29-1.46]). Results for state 2 hypertension were consistent. Conclusions and Relevance: Among Korean young adults, stage 1 and stage 2 hypertension, compared with normal blood pressure, were associated with increased risk of subsequent cardiovascular disease events. Young adults with hypertension, defined by the 2017 ACC/AHA criteria, may be at increased risk of cardiovascular disease.


Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Hipertensão/complicações , Adolescente , Adulto , American Heart Association , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hipertensão/classificação , Incidência , Masculino , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Estados Unidos , Adulto Jovem
11.
Presse Med ; 47(9): 811-816, 2018 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30293851

RESUMO

Hypertensive emergency. Stable incidence for several decades or even increasing (under diagnosed). Early and specific management improves prognosis. Absence of eye damage or lack of access to fundus should not delay or prevent the diagnosis. Multi Organ Damage Hypertension: new definition for an old entity: unusual, sudden and persistent blood pressure rise without threshold and ocular involvement or involvement of at least 3 target organs among brain, heart, kidney or endothelial disease.


Assuntos
Hipertensão/classificação , Hipertensão/complicações , Hipertensão/diagnóstico , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Encéfalo/patologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Diagnóstico Diferencial , Humanos , Rim/patologia , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/etiologia
12.
Hipertens. riesgo vasc ; 35(3): 119-129, jul.-sept. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180567

RESUMO

El American College of Cardiology (ACC) y la American Heart Association (AHA) han publicado recientemente la guía para la prevención, detección, evaluación y tratamiento de la hipertensión arterial (HTA) en adultos. El punto más controvertido es el umbral diagnóstico de 130/80mmHg, lo cual conlleva diagnosticar HTA en un gran número de personas previamente consideradas no hipertensas. La presión arterial (PA) se clasifica como normal (sistólica < 120 y diastólica 80mmHg), elevada (120-129 y <80mmHg), grado 1 (130-139 o 80-89mmHg) y grado 2 (≥140 o ≥90mmHg). Se recomienda la medida de PA fuera de la consulta para confirmar el diagnóstico de HTA o para aumentar el tratamiento. En la toma de decisiones sería determinante el riesgo cardiovascular (RCV), ya que precisarían tratamiento farmacológico personas con HTA grado 1 con riesgo a 10 años de enfermedad cardiovascular aterosclerótica ≥10% y aquellas con enfermedad cardiovascular establecida, enfermedad renal crónica y diabetes, siendo el resto susceptibles de medidas no farmacológicas hasta umbrales de 140/90mmHg. Dichas recomendaciones permitirían a los sujetos con HTA grado 1 y alto RCV beneficiarse de terapias farmacológicas y podrían mejorar las intervenciones no farmacológicas en todos los sujetos. Sin embargo, habría que ser cauteloso ya que sin poder garantizar una toma correcta de PA, ni el cálculo sistemático del RCV, la aplicación de dichos criterios podría sobrestimar el diagnóstico de HTA y suponer un sobretratamiento innecesario. Las guías son recomendaciones, no imposiciones, y el abordaje y manejo de la PA debe ser individualizado, basado en decisiones clínicas, preferencias de los pacientes y en un balance adecuado del beneficio y riesgo al establecer los diferentes objetivos de PA


The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently published their guidelines for the prevention, detection, evaluation, and management of hypertension in adults. The most controversial issue is the classification threshold at 130/80mmHg, which will allow a large number of patients to be diagnosed as hypertensive who were previously considered normotensive. Blood pressure (BP) is considered normal (<120mmHg systolic and <80mmHg diastolic), elevated (120-129 and <80mmHg), stage 1 (130-139 or 80-89mmHg), and stage 2 (≥140 or ≥90mmHg). Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication. In management, cardiovascular risk would be determinant since those with grade 1 hypertension and an estimated 10-year risk of atherosclerotic cardiovascular disease ≥10%, and those with cardiovascular disease, chronic kidney disease and/or diabetes will require pharmacological treatment, the rest being susceptible to non-pharmacological treatment up to the 140/90mmHg threshold. These recommendations would allow patients with level 1 hypertension and high atherosclerotic cardiovascular disease to benefit from pharmacological therapies and all patients could also benefit from improved non-pharmacological therapies. However, this approach should be cautious because inadequate BP measurement and/or lack of systematic atherosclerotic cardiovascular disease calculation could lead to overestimation in diagnosing hypertension and to overtreatment. Guidelines are recommendations, not impositions, and the management of hypertension should be individualized, based on clinical decisions, preferences of the patients, and an adequate balance between benefits and risks


Assuntos
Humanos , Hipertensão/epidemiologia , Sociedades Médicas/normas , Doenças Cardiovasculares/complicações , Fatores de Risco , Sociedades Médicas/organização & administração , Hipertensão/prevenção & controle , Hipertensão/classificação , Estilo de Vida , Fibrilação Atrial
13.
Rev Med Liege ; 73(5-6): 326-332, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29926574

RESUMO

Hypertensive crisis has fortunately become rarer due to a better diagnosis and management of arterial hypertension. However, its development needs urgent management with adapted therapy according to the severity of the blood pressure levels and the associated clinical signs. After confirmation of severe hypertension (blood pressure above or equal to 180/120 mmHg), target organ lesions have to be looked for and according to their pre-sence, an urgent hospitalization has to be immediately organized. Starting active drug therapy often occurs in intensive units with the intravenous route of administration.


Assuntos
Estado Terminal , Hipertensão , Estado Terminal/classificação , Estado Terminal/epidemiologia , Estado Terminal/terapia , Humanos , Hipertensão/classificação , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/terapia , Índice de Gravidade de Doença
14.
Kidney Blood Press Res ; 43(3): 690-700, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29763911

RESUMO

BACKGROUND/AIMS: Hypertension and its complications are major public health issues worldwide due to their association with high cardiovascular morbidity and mortality. Despite significant progress in health, the prevalence of hypertension is increasing. Ambulatory blood pressure monitoring (ABPM) is becoming increasingly important for the management of hypertension. In this study, we aimed to investigate the clinical and laboratory correlates of ambulatory blood pressure (ABP) phenotypes at a tertiary care hospital in Turkey. METHODS: The characteristics of 1053 patients were retrospectively obtained from the hospital database. Hypertension was defined as patients with office blood pressure (BP) ≥140/90 mmHg and/or previously diagnosed hypertension and/or the use of antihypertensive medication. According to the office BP and ABPM results patients were identified namely: (1) sustained normotensive (SNT) patients (both office BP and ABPM were normal), (2) sustained hypertensive (SHT) patients (both office BP and ABPM were high), (3) masked hypertensive (MHT) patients (office BP were normal, but ABPM were high), (4) white coat hypertensive (WCHT) patients (office BP were above limits, but ABPM were normal). RESULTS: A total of 1053 patients were included to the study (female/male: 608/445 and mean age 55 ± 15 years). The mean age of patients with hypertension was significantly higher than without hypertension (p< 0.0001). Hypertension was more frequent in females (p=0.009). The rates of history of diabetes mellitus (DM), hyperlipidemia (HL), and chronic kidney disease (CKD) were higher in patients with hypertension (p< 0.0001). Among patients with hypertension (n=853, 81%), ABPM results showed that 388 (45%) of patients had SHT, 92 (11%) had MHT, and 144 (17%) had WCHT, whereas 229 (27%) had SNT. Patients with MHT were significantly older than patients with SNT (p=0.025). The prevalence of SHT was higher in men than in women, whereas the prevalence of WCHT was higher in women than in men (p< 0.0001). There was no significant difference between 4 groups with regard to body mass index (p=0.142), a history of DM (p=0.189) and smoking status (self-reported) (p=0.306). Patients with SHT had the highest prevalence of history of hypertension, HL and CKD (p< 0.0001). Among patients without hypertension, 26 (13%) of patients had MHT and none of those patients was on antihypertensive treatment. CONCLUSION: Potential usages of ABPM in Turkey may include screening of high risk individuals who have traditional cardiovascular risk factors. It also provides clinicians valuable information on abnormal ABP phenotypes. Future studies are needed to clarify the risk factors of different ABP phenotypes and to evaluate the role of ABPM on detection and control of hypertension.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/complicações , Complicações do Diabetes , Feminino , Humanos , Hiperlipidemias/complicações , Hipertensão/classificação , Hipertensão/complicações , Masculino , Hipertensão Mascarada , Pessoa de Meia-Idade , Fenótipo , Prevalência , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Turquia , Hipertensão do Jaleco Branco
18.
Aging Clin Exp Res ; 30(5): 481-488, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28762210

RESUMO

BACKGROUND: The association between cumulative metabolic syndrome (MS) factors and knee osteoarthritis (KOA) has been highlighted over the past two decades. AIMS: To clarify the relationship between cumulative MS factors and symptomatic KOA. METHODS: A cross-sectional survey involving 119 women aged 45-88 years who were scheduled to undergo knee surgery was conducted. They were stratified into tertiles of symptoms as assessed by the Japanese Orthopedic Association score for KOA. Multinomial logistic regressions were performed using the severity of symptomatic KOA as the dependent variable and each MS factor or the cumulative MS factors as the independent variables. RESULTS: Logistic regression analyses were performed with the upper tertile of stratified symptoms of subjects used as the reference group. After adjustment for confounders, KOA patients who had two (p = 0.004) or three or more (p < 0.0001) MS factors were significantly more likely to have severe symptoms compared to those who had no MS factors. MS factors excluding obesity were similarly analyzed. Even after additional adjustment for body mass index (BMI), KOA patients who had two or more (p = 0.005) MS factors were significantly more likely to have severe symptoms. CONCLUSION: Among KOA female patients diagnosed using radiographic definition, the severity of symptomatic KOA was significantly associated with hypertension, dyslipidemia, and the number of MS factors after adjustment for age, BMI, strength of the knee extensor, and Kellgren-Lawrence grade. The severity of radiographic KOA was not associated with any MS factor or cumulative MS factors.


Assuntos
Síndrome Metabólica/etiologia , Osteoartrite do Joelho/complicações , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Índice de Massa Corporal , Estudos Transversais , Dislipidemias/classificação , Feminino , Humanos , Hipertensão/classificação , Hipertensão/etiologia , Articulação do Joelho/diagnóstico por imagem , Modelos Logísticos , Síndrome Metabólica/classificação , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Obesidade/classificação , Obesidade/epidemiologia , Osteoartrite do Joelho/classificação , Osteoartrite do Joelho/diagnóstico por imagem , Radiografia , Estudos Retrospectivos
19.
Hypertension ; 71(1): 103-109, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29133363

RESUMO

Preeclampsia is associated with increased cardiovascular and renal risk. The aim of this prospective cohort study was to characterize the early postpartum blood pressure (BP) profile after preeclampsia. We enrolled 115 women with preeclampsia and 41 women with a normal pregnancy in a prospective cohort study. At 6 to 12 week postpartum, we assessed the prevalence of different hypertensive phenotypes using 24-hour ambulatory BP monitoring (ABPM), as well as the risk of salt sensitivity and the variability of BP derived from ABPM parameters. Among patients with preeclampsia, 57.4% were still hypertensive at the office. Daytime ABP was significantly higher in the preeclampsia group (118.9±15.0/83.2±10.4 mm Hg) than in controls (104.8±7.9/71.6±5.3 mm Hg; P<0.01). Differences between groups were similar for nocturnal BP values. Fifty percent of preeclampsia women remained hypertensive on ABPM in the postpartum, of whom 24.3% were still under antihypertensive treatment; 17.9% displayed a white-coat hypertension and 11.6% had masked hypertension. In controls, 2.8% had white-coat hypertension; none had masked hypertension or needed hypertensive treatment. The prevalence of nondippers was similar 59.8% in the preeclampsia group versus 51.4% in controls. High-risk class of salt sensitivity of BP was increased in preeclampsia women (48.6%) compared with controls (17.1%); P<0.01. In conclusion, ABPM 6 to 12 weeks after delivery reveals a high rate of sustained ambulatory, nocturnal, and masked hypertension after preeclampsia. This finding may help identify women who should be included in a postpartum cardiovascular risk management program. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01095939.


Assuntos
Hipertensão , Pré-Eclâmpsia/epidemiologia , Adulto , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Estudos de Coortes , Feminino , Humanos , Hipertensão/classificação , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/genética , Fenótipo , Período Pós-Parto/fisiologia , Gravidez , Prevalência , Estudos Prospectivos , Fatores de Risco , Suíça/epidemiologia
20.
Ter Arkh ; 90(9): 4-7, 2018 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-30701728

RESUMO

Arterial hypertension (AH) refers to the most common cardiovascular diseases. The expert community regularly creates recommendations on the definition, diagnostics and treatment of hypertension. The most significant documents are recommendations American Medical Societies and the European Society for Hygiene in association with the European cardiological society. The latter document, as a rule, is fundamental for the creation of Russian recommendations on AH. Similarities are discussed in the article and differences in perceptions of the classification of hypertension, target levels of blood pressure, approaches to non-drug and drug therapy of the disease.


Assuntos
Anti-Hipertensivos/farmacologia , Hipertensão , Administração dos Cuidados ao Paciente , Determinação da Pressão Arterial/métodos , Humanos , Hipertensão/classificação , Hipertensão/diagnóstico , Hipertensão/terapia , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Guias de Prática Clínica como Assunto , Federação Russa , Sociedades Médicas
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