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1.
BMC Bioinformatics ; 21(Suppl 2): 92, 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32164533

RESUMO

BACKGROUND: Chronic diseases are becoming more widespread each year in developed countries, mainly due to increasing life expectancy. Among them, diabetes mellitus (DM) and essential hypertension (EH) are two of the most prevalent ones. Furthermore, they can be the onset of other chronic conditions such as kidney or obstructive pulmonary diseases. The need to comprehend the factors related to such complex diseases motivates the development of interpretative and visual analysis methods, such as classification trees, which not only provide predictive models for diagnosing patients, but can also help to discover new clinical insights. RESULTS: In this paper, we analyzed healthy and chronic (diabetic, hypertensive) patients associated with the University Hospital of Fuenlabrada in Spain. Each patient was classified into a single health status according to clinical risk groups (CRGs). The CRGs characterize a patient through features such as age, gender, diagnosis codes, and drug codes. Based on these features and the CRGs, we have designed classification trees to determine the most discriminative decision features among different health statuses. In particular, we propose to make use of statistical data visualizations to guide the selection of features in each node when constructing a tree. We created several classification trees to distinguish among patients with different health statuses. We analyzed their performance in terms of classification accuracy, and drew clinical conclusions regarding the decision features considered in each tree. As expected, healthy patients and patients with a single chronic condition were better classified than patients with comorbidities. The constructed classification trees also show that the use of antipsychotics and the diagnosis of chronic airway obstruction are relevant for classifying patients with more than one chronic condition, in conjunction with the usual DM and/or EH diagnoses. CONCLUSIONS: We propose a methodology for constructing classification trees in a visually guided manner. The approach allows clinicians to progressively select the decision features at each of the tree nodes. The process is guided by exploratory data analysis visualizations, which may provide new insights and unexpected clinical information.


Assuntos
Árvores de Decisões , Diabetes Mellitus/classificação , Hipertensão/classificação , Doença Crônica , Bases de Dados Factuais , Diabetes Mellitus/diagnóstico , Nível de Saúde , Humanos , Hipertensão/diagnóstico
2.
Ann Rheum Dis ; 79(5): 612-617, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32156706

RESUMO

BACKGROUND: The 2017 American College of Cardiology/American Heart Association guidelines defined hypertension at ≥130/80 mm Hg. Studies on patients with connective tissue diseases were not considered. Our aim was to assess the impact of this definition on atherosclerotic vascular events (AVEs) in systemic lupus erythematosus. PATIENTS METHODS: Individuals from the Toronto Lupus Clinic with at least 2 years of follow-up and no prior AVE were divided in three groups according to their mean blood pressure (BP) over that period (≥140/90 mm Hg, 130-139/80-89 mm Hg and <130/80 mm Hg). They were followed until the first occurrence of an AVE (fatal or non-fatal coronary artery disease, cerebrovascular event and peripheral vascular disease) or last visit. Groups were compared as per the baseline atherosclerotic risk factors. A multivariable time-dependent analysis was performed to adjust for the presence of other risk factors. RESULTS: Of 1532 patients satisfying the inclusion criteria, 155 (10.1%) had a BP ≥140/90 mm Hg, 316 (20.6%) 130-139/80-89 mm Hg and 1061 (69.3%) were normotensives. After a mean follow-up of 10.8 years, 124 AVEs were documented. The incidence rates were 18.9, 11.5 and 4.5 per 1000 patient-years for the three groups, respectively (p=0.0007 between the 130-139/80-89 mm Hg group and the normotensives). A mean BP of 130-139/80-89 mm Hg over the first 2 years was independently associated with the occurrence of AVEs (HR 1.73, 95% CI 1.13 to 2.65, p=0.011). CONCLUSION: Patients with lupus with a sustained mean BP of 130-139/80-89 mm Hg over 2 years had a significantly higher incidence of AVEs compared with normotensive individuals. This BP level should be the target for antihypertensive therapy to minimise their cardiovascular risk.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Hipertensão/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Infarto do Miocárdio/epidemiologia , American Heart Association , Análise de Variância , Anti-Hipertensivos/uso terapêutico , Cardiologia/normas , Estudos de Coortes , Doença da Artéria Coronariana/diagnóstico , Feminino , Hospitais Universitários , Humanos , Hipertensão/classificação , Hipertensão/tratamento farmacológico , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/diagnóstico , Ontário , Prevalência , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Sociedades Médicas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Análise de Sobrevida , Estados Unidos
5.
Dtsch Med Wochenschr ; 145(2): 79-86, 2020 01.
Artigo em Alemão | MEDLINE | ID: mdl-31958854

RESUMO

For decades, it was not clear how to deal with mild hypertension in patients, especially with low cardiovascular risk. In particular, the findings of the therapy studies, which have rarely examined the uncomplicated mild case of hypertension due to the low expected event rate, certainly suggest that therapy of mild hypertension in a period of 10 years has little effect on the patients. With a longer observation period and also through insights from register analyzes, especially with systematic follow-up, it becomes clear that it makes sense to treat a mild hypertension even at low cardiovascular risk. The Europeans definitely point out the right path in their guidelines. Here, the dilemma exists between the strict evidence base and the expert opinion with extrapolation of data. Patients well below the age of 65 years with mild hypertension and low overall cardiovascular risk should be offered the option to adjust blood pressure even with systolic targets below 130 mmHg. If the patient is older than 65, target blood pressure achievement should not be so ambitious anymore, but also dependent on the tolerance of the patient. Certainly, the practitioner must explain clearly to the younger patient that regular therapy will not necessarily bring him an advantage over the next 10 years, and that the effects may not really materialize until 20 years, and then reduce the risk of stroke or heart attack.


Assuntos
Hipertensão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão/classificação , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Risco , Adulto Jovem
6.
Medicina (Kaunas) ; 55(10)2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31635180

RESUMO

The American College of Cardiology/American Heart Association (ACC/AHA) updated its guideline redefining the classification of hypertension and the blood pressure cut-off in 2017. The current cut-offs for stage 1 hypertension of 130 mm Hg systolic blood pressure or 80 mm Hg diastolic blood pressure replace the previous cut-offs of 140 mm Hg systolic blood pressure or 90 mm Hg diastolic blood pressure which were based on the ACC/AHA guidelines from 1988. However, the blood pressure cut-off for the obstetric population still remains as 140/90 mm Hg despite the scarcity of evidence for it. Recent American College of Obstetricians and Gynecologists (ACOG) bulletins for pregnant women have not reflected the new ACC/AHA change of guideline. We reviewed a mounting body of evidence prompting the implementation of the new ACC/AHA guidelines for the obstetric population. These studies examined maternal and fetal outcomes applying the new ACC/AHA guidelines during antepartum or postpartum care.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/classificação , Pré-Eclâmpsia/classificação , Adulto , Prática Clínica Baseada em Evidências , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/fisiopatologia , Gravidez , Fatores de Risco
9.
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
10.
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
11.
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
12.
Am J Cardiol ; 124(3): 396-401, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31171318

RESUMO

American College of Cardiology/American Heart Association recently updated their guidelines for hypertension, and lowered the threshold of normal blood pressure (BP). However, the validity of the updated guidelines remains controversial. We investigated the relation between the revised BP classification and carotid intima-media thickness, using a community-based cohort. We examined 1,241 subjects who underwent health check-ups at our institute. They were divided into 3 groups based on their BP levels: normal blood pressure (sBP <130 mm Hg and dBP <80 mm Hg, n = 556); stage 1 hypertension (130 mm Hg ≤sBP <140 mm Hg or 80 mm Hg ≤ dBP <90 mm Hg, n = 236); and stage 2 hypertension (sBP ≥140 mm Hg or dBP ≥90 mm Hg, including subjects prescribed with antihypertensive medications, n = 449). With an increase in BP, increase in the mean age, proportion of males, and prevalence of CVD risk factors was seen. The prevalence of carotid plaque, defined as intima-media thickness ≥1.1 mm, also increased with increase in BP. After adjustment with covariates, higher BP was seen to be associated with carotid plaque presence. Atherosclerotic changes are present in stage 1 hypertension even in the healthy population, suggesting the importance of aggressive antihypertensive treatment based on the updated American College of Cardiology/American Heart Association guidelines.


Assuntos
Espessura Intima-Media Carotídea , Hipertensão/classificação , Hipertensão/diagnóstico , Guias de Prática Clínica como Assunto , Fatores Etários , American Heart Association , Estenose das Carótidas/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Estados Unidos
13.
Ann Glob Health ; 85(1)2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31148436

RESUMO

BACKGROUND: In 2017 the American Heart Association (AHA)/American College of Cardiology (ACC) changed the criteria to define hypertension (HTN). OBJECTIVE: To re-analyze Venezuelan data to update HTN prevalence rates and estimate the number of adults with uncontrolled blood pressure (BP) using AHA/ACC criteria. METHODS: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,420 adults from July 2014 to January 2017, with a response rate of 77.3%. The mean of two BP measurements was obtained using a standard oscillometric device protocol. HTN was defined using both 2017 AHA/ACC guideline (BP ≥ 130/80 mmHg) and JNC7 (BP ≥ 140/90 mmHg) criteria. FINDINGS: The crude prevalence of HTN using 2017 AHA/ACC guideline criteria was 60.4%, 13% higher than with the JNC7 criteria. The age-standardized prevalence was 55.4% in men and 49.0% in women (p < 0.001), 17.5% and 12.7% higher, respectively, compared with the JNC7 criteria. In subjects without self-reported HTN, the age-standardized prevalence of HTN was 43.4% in men and 32.3% in women, of whom, 22.9% and 19.2% were between 130-139/80-89 mmHg, respectively. In those with self-reported HTN, the prevalence of uncontrolled BP (≥130/80 mmHg) on antihypertensive medication was 66.8% in men and 65.8% in women. The total estimated number of subjects with HTN in Venezuela increased to 11 million, and only about 1.8 million are controlled. CONCLUSION: Using the new 2017 AHA/ACC guideline, the prevalence of HTN in Venezuela is approximately half of the adult population and associated with relatively poor BP control.


Assuntos
Hipertensão/classificação , Hipertensão/epidemiologia , Adulto , Idoso , American Heart Association , Determinação da Pressão Arterial/instrumentação , Análise por Conglomerados , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Estados Unidos , Venezuela/epidemiologia
14.
Mayo Clin Proc ; 94(5): 776-782, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31054605

RESUMO

OBJECTIVE: To evaluate the prevalence of apparent treatment-resistant hypertension (aTR-hypertension) in US adults with treated hypertension by using the nationally representative National Health and Nutrition Examination Survey (NHANES). PATIENTS AND METHODS: Nonpregnant US adults older than 20 years with a self-reported history of treated hypertension who had blood pressure measured in NHANES cycles 2007 to 2014 were included in this study. Study participants were stratified into 4 groups according to average blood pressure and antihypertensive medication use: well-controlled hypertension, undertreated hypertension, aTR-hypertension by the 2017 guideline, and aTR-hypertension by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guideline. National Health and Nutrition Examination Survey sample weights were used to estimate the national prevalence. RESULTS: From 2007 to 2014, 5512 participants with treated hypertension representing 46.7 million people nationally were included. Compared with JNC 7 guideline criteria, application of the 2017 high blood pressure guideline criteria increased the prevalence of aTR-hypertension in US adults with treated hypertension from 12.0% to 15.95%, identifying an additional 1.85 million individuals with aTR-hypertension nationally. Individuals newly reclassified as having aTR-hypertension were younger. However, the prevalence of thiazide diuretic use remained less than 70%, and that of mineralocorticoid antagonist use remained less than 10% regardless of the guideline definition. CONCLUSION: On the basis of the 2017 high blood pressure guideline, the prevalence of aTR-hypertension is 15.95% in US adults with treated hypertension. This represents an absolute increase of 4% (1.85 million additional individuals nationally) compared with the JNC 7 guideline definition, with a consistent increase across all subpopulations with treated hypertension.


Assuntos
Anti-Hipertensivos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/epidemiologia , Idoso , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Estudos Transversais , Feminino , Humanos , Hipertensão/classificação , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Guias de Prática Clínica como Assunto , Prevalência , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
15.
Technol Health Care ; 27(S1): 47-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31045526

RESUMO

BACKGROUND: In the classical process, it was proven that ABPM data were the most significant attributes both by physician and ranking algorithms for dipper/non-dipper pattern classification as mentioned in our previous papers. To explore if any algorithm exists that would let the physician skip this diagnosis step is the main motivation of the study. OBJECTIVE: The main goal of the study is to build up a classification model that could reach a high-performance metrics by excluding ABPM data in hypertensive and non-diabetic patients. METHODS: The data used in this research have been drawn from 29 hypertensive patients without diabetes in endocrinology clinic of Marmara University in 2011. Five of 29 patient data were later removed from the dataset because of null data. RESULTS: The findings showed that dipper/non-dipper pattern can be classified by artificial neural network algorithms, the highest achieved performance metrics are accuracy 87.5%, sensitivity 71%, and specificity 94%. CONCLUSIONS: This novel method uses just two attributes: Ewing-score and HRREP. It offers a fast and low-cost solution when compared with the current diagnosis procedure. This attribute reduction method could be beneficial for different diseases using a big dataset.


Assuntos
Determinação da Pressão Arterial , Diabetes Mellitus , Hipertensão/classificação , Hipertensão/fisiopatologia , Adulto , Idoso , Ritmo Circadiano , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sono
16.
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
17.
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
18.
Curr Cardiol Rep ; 21(5): 28, 2019 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-30880364

RESUMO

PURPOSE OF REVIEW: This review aims to summarize and discuss the relationship between outpatient clinic and ambulatory blood pressure (BP) measurements and cardiovascular morbidity and mortality. RECENT FINDINGS: Contemporary clinical practice guidelines worldwide recommend ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. Recent epidemiological studies and systematic reviews showed ABPM predicts cardiovascular events and mortality independent of clinic BP. Ambulatory BP appears to be prognostically superior to clinic BP. ABPM characterizes BP phenotypes that would not have otherwise identified with clinic BP measurement only. Identification of white coat hypertension, which carries a prognosis almost similar to normotension, and masked hypertension, which carries a prognosis almost similar to sustained hypertension, can be accomplished only by ABPM. Randomize controlled trials to assess the cardiovascular effects of hypertensive patients managed with ABPM vs. clinic BP measurement and cost-effective studies of ABPM are warranted.


Assuntos
Instituições de Assistência Ambulatorial , Monitorização Ambulatorial da Pressão Arterial , Hipertensão/diagnóstico , Hipertensão/mortalidade , Monitorização Ambulatorial da Pressão Arterial/mortalidade , Humanos , Hipertensão/classificação , Hipertensão/complicações
19.
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
20.
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 de Computação , Dinâmica não Linear , Sono/fisiologia , Máquina de Vetores de Suporte , Nervo Vago/fisiopatologia , Análise de Ondaletas
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