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1.
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
2.
Medicine (Baltimore) ; 98(26): e16053, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261512

RESUMO

The present study aimed to investigate the characteristics of the ambulatory central artery stiffness index (AcASI) and its related factors. The association between AcASI and the left ventricular mass index (LVMI), and other factors related to atherosclerosis were explored.Patients with primary hypertension were enrolled into this study. Ambulatory central artery blood pressure (CABP) and ambulatory brachial artery blood pressure (BABP) were assessed using a Mobil-O-Graph NG hemomanometer, whereas AcASI and the ambulatory arterial stiffness index (AASI) were determined. LVMI was assessed by echocardiography.A total of 136 patients with primary hypertension were enrolled from May 2011 to January 2013 in Beijing Hospital. AcASI was significantly associated with AASI (r = 0.879, P < .001). AcASI was significantly lower than AASI (0.422 ±â€Š0.302 vs 0.482 ±â€Š0.270; P < .001). AcASI increased with age, ambulatory brachial mean blood pressure (MBP), and fasting glucose. AcASI was significantly associated with office pulse pressure (PP), ambulatory brachial PP, ambulatory central PP, and pulse wave velocity (PWV). AcASI, but not AASI, was significantly associated with LVMI. Receiver operator characteristic analysis indicated that AcASI and AASI could may be a predictor of left ventricular hypertrophy (LVH). Multiple regression analysis indicated that AcASI, chronic kidney disease, and hypertension course were associated with LVMI, but AASI was not.AcASI, which is obtained from ambulatory CABP monitoring, could be a new marker for the evaluation of atherosclerosis. AcASI may be stronger associated with LVH than AASI.


Assuntos
Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Rigidez Vascular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Adulto Jovem
3.
BMJ ; 366: l4064, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296584

RESUMO

OBJECTIVE: To estimate the causal impact of community based blood pressure screening on subsequent blood pressure levels among older adults in China. DESIGN: Regression discontinuity analysis using data from a national cohort study. SETTING: 2011-12 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, a national cohort of older adults in China. PARTICIPANTS: 3899 older adults who had previously undiagnosed hypertension. INTERVENTION: Community based hypertension screening among older adults in 2011-12. MAIN OUTCOME MEASURE: Blood pressure two years after initial screening. RESULTS: The intervention reduced systolic blood pressure: -6.3 mm Hg in the model without covariates (95% confidence interval -11.2 to -1.3) and -8.3 mm Hg (-13.6 to -3.1) in the model that adjusts additionally for demographic, social, and behavioural covariates. The impact on diastolic blood pressure was smaller and non-significant in all models. The results were similar when alternative functional forms were used to estimate the impact and the bandwidths around the intervention threshold were changed. The results did not vary by demographic and social subgroups. CONCLUSIONS: Community based hypertension screening and encouraging people with raised blood pressure to seek care and adopt blood pressure lowering behaviour changes could have important long term impact on systolic blood pressure at the population level. This approach could address the high burden of cardiovascular diseases in China and other countries with large unmet need for hypertension diagnosis and care.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Determinação da Pressão Arterial , China , Diagnóstico Precoce , Feminino , Humanos , Estudos Longitudinais , Masculino , Programas de Rastreamento , Análise de Regressão , Resultado do Tratamento
4.
Pol Merkur Lekarski ; 46(276): 257-262, 2019 Jun 28.
Artigo em Polonês | MEDLINE | ID: mdl-31260435

RESUMO

Measurement of pulse wave velocity (PWV) is a simple and noninvasive way to assess stiffness of the arteries. PWV measurement can refer to both the aorta and peripheral arterial vessels. Currently, the most clinically significant is the measurement of PWV between the carotid artery and the femoral artery, which is defined as the speed of the aortic pulse wave. Numerous studies have demonstrated the significance of prognostic PWV aortic measurement as a recognized exponent of subclinical organ damage both among the general population as well as among patients with increased cardiovascular risk, examining patients in detail with hypertension, diabetes, chronic renal failure. The prognostic value of PWV aortic measurement was reflected in the guidelines of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). In clinical trials, the repeatability and reproducibility of PWV measurements were also evaluated, both parameters being considered satisfactory. The paper presents reports from studies on the significance of pulse wave velocity results in the prognosis assessment in different disease entities as well as in age groups.


Assuntos
Hipertensão , Análise de Onda de Pulso , Rigidez Vascular , Aorta , Artérias Carótidas , Humanos , Hipertensão/diagnóstico , Reprodutibilidade dos Testes
5.
Medicine (Baltimore) ; 98(28): e16347, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305424

RESUMO

Blood pressure variability (BPV) is an independent cardiovascular risk factor in hypertensive patients. The best method for quantifying BPV is still an object of debate. The existence of different BPV patterns, particularly age and arterial stiffness related, is postulated. Our aims were:Cross-sectional study in 108 elderly hypertensive hospitalized patients. Each patient underwent blood pressure measurements with 5 different modalities: 24 hour BP and pulse wave velocity (PWV) monitoring (24hBPM), measurement by nurses or physicians, self-measurement and beat-to-beat monitoring. Differences between maximum and minimum values (ΔBP), averages of the absolute differences between consecutive values (ARV) and coefficients of variation (CV) were calculated.ΔBP showed the wider values' dispersion (Δ systolic blood pressure (SBP): 66.4 ±â€Š22.9 and Δ diastolic blood pressure [DBP]: 45.0 ±â€Š13.5 mmHg). ARV and CV were highest with nurses' measurements (SBP-ARV 9.2 ±â€Š6.2; DBP-ARV 6.9 ±â€Š5.2; SBP-CV 7.6 ±â€Š5.3; DBP-CV 9.6 ±â€Š5.5). The strongest correlation was found comparing physicians' SBP measurements and 24hBPM ARVs (R2 0.23, P <.05). 24hBPM ΔSBP in a multivariate analysis was significantly associated with age (ß -3.85, SE 0.83; P <.001) and PWV (ß 20.29, SE 3.70; P <.001). Calcium antagonists were associated with a lower ΔSBP (ß -14.6, SE 6.1, P <.05) while diuretics and alpha-blockers with a significant increase (ß 14.4 SE 5.4, P <.01; ß 26.9 SE 11.7, P <.05).Age, PWV, diuretics, alpha-blockers, but also measurements obtained by nurses, increase BP variability while calcium antagonists reduce it. BP profiles in elderly in-hospital patients potentially provide important information; they should, however, be interpreted cautiously.


Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea , Hipertensão/diagnóstico , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Estudos Transversais , Feminino , Hospitalização , Humanos , Hipertensão/fisiopatologia , Hipertensão/terapia , Masculino , Estudo de Prova de Conceito
6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(7): 701-705, 2019 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-31288341

RESUMO

Objective: To develop and validate a simplified height-specific blood pressure cutoffs table for screening hypertension in Chinese children and adolescents. Methods: We developed a simplified height-specific blood pressure cut offs table according to Chinese Blood Pressure Reference for Children and Adolescents aged 7-18 years (WS/T 610-2018) (hereafter referred to as "complex definition"). Populations from Early Warning, Diagnosis and Treatment of Children Cardiovascular Disease Project ("Ji'nan sample") and Shandong Children Cardiovascular Cohort Study Project ("Zibo sample") were used as validation populations for evaluating the screening effect of the simplified table for elevated blood pressure and hypertension in children and adolescents. Results: We developed simplified height-specific blood pressure cutoffs table including 7 height groups and 28 cutoffs. Both Ji'nan and Zibo samples were selected by convenient sampling method, and the former included 7 233 participants aged 7 to 17 years, among whom 3 790 (52.4%) were boys. Latter population included 1 277 participants aged 7 to 11 years, among whom 681 (53.3%) were boys. The simplified table performed well for identifying elevated blood pressure in Ji'nan sample, with values of area under the receiver operating curve (AUC) (95%CI), sensitivity, specificity, and Kappa statistic as 0.96 (0.95-0.97), 93.0%, 98.5% and 0.91, respectively, which were similar with results in Zibo sample [the values were 0.92 (0.90-0.95), 87.0%, 98.0% and 0.85, respectively]. The simplified table also performed well for identifying hypertension in Ji'nan sample with values of AUC (95%CI), sensitivity, specificity, and Kappa statistic as 0.92 (0.91-0.94), 86.9%, 98.1% and 0.85, respectively, which were similar with results in Zibo sample [the values were 0.94 (0.91-0.96), 88.2%, 98.9% and 0.88, respectively]. Conclusion: Screening for elevated and high blood pressure based on simplified height-specific blood pressure cutoffs table is easy to use and it shows satisfying effect.


Assuntos
Pressão Sanguínea , Estatura , Hipertensão/diagnóstico , Programas de Rastreamento/métodos , Adolescente , Criança , China , Estudos de Coortes , Feminino , Humanos , Masculino , Valores de Referência , Reprodutibilidade dos Testes
7.
High Blood Press Cardiovasc Prev ; 26(4): 293-303, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31290085

RESUMO

INTRODUCTION: Automated office blood pressure (AOBP) has been proposed for blood pressure (BP) assessment in the office because it shows a strong association with the awake ambulatory BP. However, it remains unknown whether the presence or absence of an observer modulates AOBP readings. AIM: To determine the difference between unattended and attended AOBP measurements through systematic review and meta-analysis. METHODS: We searched the PubMed and the Cochrane Collaboration Library and we screened the references' list of relevant reports to identify potentially eligible articles. For included studies, quality was assessed by using the Quality Assessment for Diagnostic Accuracy Studies 2. The weighted pooled BP difference with 95% confidence interval (CI) between unattended and attended AOBP was estimated under the random effects model. RESULTS: Twelve studies (1762 subjects) were included. The systolic and diastolic BP difference between unattended and attended AOBP measurements was - 3.66 (- 6.58 to - 0.75) and - 1.67 (- 2.78 to - 0.55) mmHg, respectively. Heterogeneity across studies was high (I2 = 97,1% for systolic and I2 = 89% for diastolic BP, P < 0.001) and was partially determined by the sequence of performing unattended and attended BP measurements, the device used for AOBP, the geographic region in which studies were performed and the presence of a resting period before unattended AOBP. CONCLUSIONS: Due to the high heterogeneity, we cannot rely on the weighted pooled estimate. However, the available evidence suggests that attended AOBP yielded higher systolic and diastolic BP levels and it seems that the procedural methodology determines partially the statistical heterogeneity across studies.


Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea , Hipertensão/diagnóstico , Visita a Consultório Médico , Hipertensão do Jaleco Branco/prevenção & controle , Adolescente , Adulto , Idoso , Automação , Determinação da Pressão Arterial/efeitos adversos , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Risco , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/etiologia , Hipertensão do Jaleco Branco/fisiopatologia , Adulto Jovem
8.
High Blood Press Cardiovasc Prev ; 26(3): 247-257, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31201617

RESUMO

INTRODUCTION: Hypertension is a leading global risk factor for death and disability. Seeking new ways to prevent and treat hypertension is a priority for scientists and healthcare professionals worldwide. In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued a new hypertension guideline shifting the definition of hypertension from 140/90 mm Hg to 130/80 mm Hg for systolic/diastolic blood pressure. This new diagnostic threshold of hypertension has sparked a lively discussion worldwide over whether it should be applied in clinical settings to diagnose and treat hypertension. China, the world's most populous country, is facing a hypertension crisis. According to the 140/90 mm Hg guideline, China has an estimated 244.5 million population aged ≥ 18 years with hypertension, and another 435.3 million with pre-hypertension. If the new guideline is adopted, the prevalence of hypertension in China would double. This change would significantly impact patients, healthcare professionals, scientists, and policy makers in terms of the delivery of care and needed resources. AIM: This study aims to investigate whether Chinese physicians will use the 130/80 mm Hg threshold to diagnose hypertension in clinical practice. METHODS: In March 2018, we launched a mobile app-based survey to study 253 Chinese physicians' perspectives on the ACC/AHA Guideline. RESULTS: A total of 253 physicians from 21 Chinese provinces completed the survey. Nearly 80% of the participants had already noticed the ACC/AHA guideline change. The proportion of participants who said they would use the new threshold to diagnoses hypertension was 41%, while 59% said they would not use the new threshold. The primary reason for those who said "yes" was that they believed early diagnosis of hypertension can trigger early actions to prevent the increasing blood pressure. For those who said "no", they argued that their decision was based on the fact that the Chinese Hypertension Prevention Guideline had not yet changed the diagnostic threshold from 140/90 to 130/80 mm Hg. CONCLUSIONS: Different understanding of hypertension prevention and treatment exists among Chinese physicians. It is an emergent need to form an evidence-based authoritative answer to guide Chinese physicians' future clinical practice.


Assuntos
Anti-Hipertensivos/uso terapêutico , Atitude do Pessoal de Saúde , Pressão Sanguínea/efeitos dos fármacos , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/tratamento farmacológico , Médicos/psicologia , Guias de Prática Clínica como Assunto , Adulto , American Heart Association , China/epidemiologia , Assistência à Saúde , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Padrões de Prática Médica , Prevalência , Inquéritos e Questionários , Estados Unidos
9.
Rev Fac Cien Med Univ Nac Cordoba ; 76(2): 79-85, 2019 06 19.
Artigo em Espanhol | MEDLINE | ID: mdl-31216161

RESUMO

Background: High blood pressure is a category of blood pressure, poorly studied in young adults and is associated with other cardiovascular risk factors. Objective: To estimate the prevalence of high blood pressure and other cardiovascular risk factors in university students of the National University of Asunción-Paraguay. Methods: Cross-sectional study in first-year university students of careers related to health at the National University of Asunción. High blood pressure was considered at a systolic blood pressure of 120-129 mmHg and / or diastolic blood pressure of ?80 mmHg. The anthropometric, lipid and metabolic variables were measured and the smoking and alcohol habit were determined. Results: 284 university students were included in the analysis (mean age [± SD] 19.4 ± 2.1 years, 73.2% were women). The overall prevalence of high blood pressure was 25.5%; (95% CI: 20.5-30.5%) (Men 40%, Women 29%). High blood pressure was associated with increased abdominal circumference (OR: 1.031, 95% CI: 1.005-1.058, p = 0.024); low HDL-C (OR: 1.355, 95% CI 1.054-1.743, p = 0.018); obesity, OR: 2,124; 95% CI: 1.334-3.941; p = 0.007) and DM2 (OR: 4.431, 95% CI: 3,642-7,963, p = <0.001). The prevalence of other cardiovascular risk factors more frequent were alcohol consumption, overweight and obesity. More than 70% of college students have one or more cardiovascular risk factors. Conclusions: high prevalence of high blood pressure and is associated with other cardiovascular risk factors.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Hipertensão/diagnóstico , Obesidade/complicações , Fumar/efeitos adversos , Adolescente , Adulto , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Masculino , Paraguai/epidemiologia , Prevalência , Fatores de Risco , Estudantes de Ciências da Saúde/estatística & dados numéricos , Adulto Jovem
10.
Graefes Arch Clin Exp Ophthalmol ; 257(8): 1687-1698, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31147842

RESUMO

PURPOSE: Retinal and choroidal microvascular changes can be related to renal impairment in hypertension and chronic kidney disease (CKD). The study examines the association between retinochoroidal parameters and renal impairment in hypertensive, non-diabetic patients. METHODS: This is a cross-sectional study on Caucasian patients with systemic arterial hypertension with different levels of renal function. All subjects were studied by blood chemistry, urine examination, microalbuminuria and blood pressure. Complete eye examination was completed with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCTA) scans of macular region. Patients were divided in groups: LowGFR and HighGFR and CKD- and CKD+, according to the value of glomerular filtrate (GFR) and albuminuria. LowGFR and CKD+ groups included patients with clinical kidney impairment. RESULTS: One hundred and twenty eyes of 120 hypertensive patients were evaluated. The mean retinal thickness was thinner in CKD+ versus CKD- group (p < 0.009). LowGFR and CKD+ groups showed thinner choroidal values than HighGFR (p < 0.02) and CKD- (p < 0.001) groups. OCTA showed lower density in LowGFR than in HighGFR group (p < 0.001) and in CKD+ versus CKD- group (p < 0.001). Albuminuria was inversely related to choroidal and retinal thickness measures (p < 0.001) and to the indices of superficial parafoveal (p < 0.05) and foveal (p < 0.05) vascular densities. CONCLUSIONS: CKD is associated with retinal thinning, eGFR and decreasing renal function with progressive reduction of choroidal and retinal vascular density. SS-OCT and OCTA documented close association between CKD and reduction of both choroidal thickness and paracentral retinal vascular density in hypertensive patients.


Assuntos
Corioide/irrigação sanguínea , Angiofluoresceinografia/métodos , Insuficiência Renal Crônica/complicações , Doenças Retinianas/diagnóstico , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Adolescente , Adulto , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Fundo de Olho , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/diagnóstico , Doenças Retinianas/etiologia , Estudos Retrospectivos , Adulto Jovem
11.
Manchester; The National Institute for Health and Care Excellence (NICE); June 2019. 54 p.
Monografia em Inglês | BIGG | ID: biblio-1014955

RESUMO

This guideline covers diagnosing and managing hypertension (high blood pressure), including preeclampsia, during pregnancy, labour and birth. It also includes advice for women with hypertension who wish to conceive and women who have had a pregnancy complicated by hypertension. It aims to improve care during pregnancy, labour and birth for women and their babies.


Assuntos
Humanos , Gravidez , Pré-Eclâmpsia/prevenção & controle , Hipertensão/diagnóstico , Complicações do Trabalho de Parto/prevenção & controle , Saúde Materno-Infantil , Serviços de Saúde Materno-Infantil/organização & administração
12.
High Blood Press Cardiovasc Prev ; 26(3): 227-237, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31228169

RESUMO

INTRODUCTION: Contribution of risk factors for cardiovascular-related deaths in the Eastern Mediterranean Region Organization (EMRO) is not estimated quantitatively. AIM: To determine the avoidable burden of cardiovascular diseases (CVDs) due to hypertension, diabetes, smoking, overweight, and obesity in countries of EMRO of the WHO. METHODS: The comparative risk assessment methodology was used to calculate the potential impact fraction (PIF) and percentage of the avoidable burden of CVD-related death due to associated risk factors. Population exposure levels for CVDs and corresponding measures of association were extracted from published studies. The attributable burden was calculated by multiplying the Disability-Adjusted Life-Years (DALYs) for CVDs by the estimated impact fraction of risk factors. DALYs of the CVDs in all countries of the EMRO were extracted from the GBD official website in 2016. RESULTS: Following reduction of the current prevalence of smoking, obesity, hypertension, diabetes, and overweight to a feasible minimum risk exposure level in Lebanon, about 12.4%, 4.2%, 10.2%, 3.8%, and 5.7% of the burden of CVD-related mortality could be avoidable, respectively. The corresponding values of avoidable burden in selected EMRO countries were 5.1%, 3.5%, 9.4%, 5.9% and 5.3% in Iran and 9.5%, 4.1%, 11%, 8.2% and 5.4% in Egypt. CONCLUSIONS: Findings suggest that health policy makers of all EMRO countries should take into account the attributable burden of CVD-related mortality due to associated risk factors to effectively develop preventive interventions.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Fumar/epidemiologia , África do Norte/epidemiologia , Ásia/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Diabetes Mellitus/terapia , Estilo de Vida Saudável , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Hipertensão/terapia , Obesidade/diagnóstico , Obesidade/mortalidade , Obesidade/terapia , Prevalência , Serviços Preventivos de Saúde , Prognóstico , Fatores de Proteção , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Fumar/efeitos adversos , Fumar/mortalidade , Abandono do Hábito de Fumar
13.
High Blood Press Cardiovasc Prev ; 26(3): 217-225, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31236901

RESUMO

INTRODUCTION: A possible role of the oral microbiome, specifically oral nitrate reducing flora, in blood pressure (BP) homeostasis, if proven etiologic in nature, could lead to novel mechanism-based therapy to improve hypertension prevention and control. AIM: This cross-sectional study characterized and compared the oral microbiome between four study groups based on BP status among 446 postmenopausal women aged 53-82 years. METHODS: Three study groups were not taking hypertension medication and were separated based on BP, as follows: normal BP (systolic < 120 and diastolic < 80; N = 179), elevated BP/Stage I hypertension (systolic 120-139 or diastolic 80-90; N = 106), Stage II hypertension (systolic > 140 or diastolic > 90; N = 42). The forth group consisted of anyone taking hypertension medications, regardless of BP (N = 119). Subgingival microbiome composition was determined using 16S rRNA sequencing with the Illumina MiSeq platform. Kruskal-Wallis tests were used to compare species-level relative abundance of bacterial operational taxonomic units across the four groups. RESULTS: Sixty-five bacterial species demonstrated significant differences in relative abundance in women with elevated BP or using hypertension medication as compared to those with normal BP. After correction for multiple testing, two species, Prevotella oral (species 317) and Streptococcus oralis, remained significant and were lower in abundance among women taking antihypertension medications compared to those with normal BP (corrected P < 0.05). CONCLUSIONS: These data provide novel description of oral subgingival bacteria grouped according to BP status. Additional larger studies including functional analysis and prospective designs will help further assess the potential role of the oral microbiome in BP regulation and hypertension.


Assuntos
Bactérias/isolamento & purificação , Pressão Sanguínea , Hipertensão/microbiologia , Hipertensão/fisiopatologia , Microbiota , Boca/microbiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Bactérias/classificação , Bactérias/genética , Pressão Sanguínea/efeitos dos fármacos , Estudos Transversais , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Pessoa de Meia-Idade , Pós-Menopausa , Ribotipagem/métodos , Fatores de Risco , Fatores Sexuais
14.
Ideggyogy Sz ; 72(5-6): 195-197, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31241264

RESUMO

Background and purpose: Population-based screening is an option to identify persons at high risk for stroke. However it is associated with rather high expenses, necessitating the selection of effective methods that take local characteristics into account. The 12th district of Budapest has a long tradition of population-based screening for frequent and preventable diseases. The Szent János Hospital hosts an annual stroke screening day. In the present study, previously published data from the 2011 screening were compared with those obtained in 2016, looking for changes and tendencies throughout the examined period. Methods: The screening day was conducted in a generally similar way in 2011 and 2016. Similarly to the previous event, the program was organized on a Saturday, the call for the event was spread by the local newspaper. The crew composition was the same. As regards the components of the screening (currently including general history taking, risk status assessment, blood pressure measurement, BMI assessment, cholesterol and blood glucose tests, carotid duplex ultrasonography, and ophthalmological examination), the only difference was the absence of cardiologic examination (it was conducted on an independent day). The anonymous data sheet was the same. Results: The number of participants in the 2016 event was 33, to provide more comfortable conditions. The female predominance was slightly less pronounced but was still present in 2016 (60.6% vs. 72.9%). The mean age became substantially higher (71.2 y vs. 62.9 y). The ratios of participants with higher level of education (97% vs. 94%) and those who are married were still remarkable. The most frequent risk factors were the same; however the ratio of participants with hypertension, 'other heart disease', and diabetes increased, whereas that of with hyperlipidemia and obesity decreased. The incidence of atrial fibrillation was unaltered. None of the participants in 2016 admitted smoking (previously this ratio was 20.8%) or drinking heavily. The findings of the carotid ultrasonography revealed a more favorable vascular status. Ophthalmological assessments (predominantly hypertensive alterations on fundoscopy) revealed that the pathological vs. physiological ratio switched to 1:2 from 2:1. The final evaluation of the screening program likewise demonstrated an improved overall state of health of the population. Conclusion: We observed a more favorable stroke risk status of the population in 2016. Whether it is indeed a tendency unknown at present. The role of the local media in calling for screening is still decisive, and the cohesive power of the family is important.


Assuntos
Fibrilação Atrial/diagnóstico , Estenose das Carótidas/diagnóstico , Hipertensão/diagnóstico , Programas de Rastreamento/métodos , Acidente Vascular Cerebral/prevenção & controle , Fibrilação Atrial/epidemiologia , Pressão Sanguínea , Feminino , Humanos , Hungria/epidemiologia , Hipertensão/epidemiologia , Programas de Rastreamento/economia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
15.
Zhonghua Er Ke Za Zhi ; 57(6): 471-476, 2019 Jun 02.
Artigo em Chinês | MEDLINE | ID: mdl-31216806

RESUMO

Objective: To examine the plasma fibroblast growth factor-23 (FGF-23) concentration in children with primary hypertension and to investigate the association between plasma FGF-23 and subclinical cardiovascular damages,and to identify its predictive value for diagnosis. Methods: With prospective study,77 patients (61 males and 16 females) who were diagnosed as primary hypertension with the average age of (11.8±2.2) years were enrolled with informed consent in Children's Hospital,Capital Institute of Pediatrics from October 2016 to December 2017. Carotid wall intima-media thickness (cIMT) measured by Doppler ultrasound and left ventricular hypertrophy (LVH) identified by echocardiography were assessed as parameters of subclinical cardiovascular damages. Patients were divided into increased cIMT group (n=18) and normal cIMT group (n=46) (64 patients with complete data of cIMT). According to left ventricular geometry,patients were divided into LVH group (n=27) and normal geometry group (n=50). Concentration of plasma FGF-23 was detected in all children by enzyme linked immunosorbent assay test. Mann-Whitney U test was used to compare plasma levels of FGF-23 between groups. Kendall's tau-b correlation coefficient was used to analyze the correlation between plasma FGF-23 and cIMT/LVH. Receiver operating characteristic (ROC) curve was used to analyze the value of plasma FGF-23 in the prediction of subclinical cardiovascular damage. Results: The concentration of plasma FGF-23 in the increased cIMT group was higher than that in the normal cIMT group (55.6 (46.2,63.5) vs. 48.6 (39.4, 57.3) ×10(3) RU/L, Z=-2.143, P=0.032) . Also, plasma FGF-23 showed positive correlation with cIMT(r=0.222, P=0.032). According to ROC curve analysis,the cutoff value of plasma FGF-23 for prediction of increased cIMT was 53.9×10(3) RU/L (55.6% sensitivity and 71.7% specificity). The concentration of plasma FGF-23 in the LVH group was significantly higher than that in normal geometry group (55.0 (46.8, 65.7) vs. 48.2 (39.5, 56.0)×10(3) RU/L, Z=-2.375, P=0.018). And,plasma FGF-23 was correlated positively with LVH (r=0.224, P=0.018). The concentration of plasma FGF-23 in patients with concentric remodeling (n=10) was significantly higher than that of the normal geometry group (56.9 (49.6, 66.3) vs. 48.2 (39.5,56.0) ×10(3) RU/L, Z=-2.093, P=0.036). According to ROC curve analysis,the cutoff value of plasma FGF-23 for prediction of LVH was 49.1×10(3) RU/L (70.4% sensitivity and 60.0% specificity). Conclusion: The concentration of plasma FGF-23 in children with primary hypertension was correlated positively with LVH and cIMT and had certain predictive value of diagnosis for subclinical cardiovascular damages.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Fatores de Crescimento de Fibroblastos/sangue , Hipertensão/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Adolescente , Biomarcadores/sangue , Espessura Intima-Media Carotídea , Criança , Ecocardiografia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hipertensão/sangue , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Túnica Íntima/diagnóstico por imagem , Túnica Média/diagnóstico por imagem , Ultrassonografia Doppler
16.
BMC Public Health ; 19(1): 843, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253116

RESUMO

BACKGROUND: To determine the prevalence of hypertension and investigate sociodemographic correlates in an indigenous Kuna community living on the San Blas islands of Panama. METHODS: Data was collected from adults using a paper-based survey using a cross sectional study design. Blood pressure was measured, and hypertension defined at two cut-points: 130/80 mmHg and 140/90 mmHg. Individuals with undiagnosed hypertension had a blood pressure measurement that indicated hypertension, however, the individual had not been told by a doctor they had hypertension. Whereas individuals with diagnosed hypertension had been told by a healthcare provider that they had hypertension. Univariate tests compared diagnosed and undiagnosed hypertension by sociodemographic categories and logistic regression models tested individual correlates adjusting for all sociodemographic factors. RESULTS: Two hundred and eleven adult indigenous Kuna participated in the study. Overall prevalence of hypertension was 6.2% (95%CI:3.32-10.30) as defined by 140/90 mmHg, and 16.6% (95%CI:11.83-22.31) as defined by 130/80 mmHg. Hypertension was significantly higher in men (31.6, 95% CI:19.90-45.24, compared to 11.0, 95% CI:6.56-17.09). Individuals with low income were 3 times more likely to be hypertensive (OR = 3.13, 95% CI:1.02-9.60) and 3.5 times more likely to have undiagnosed hypertension (OR = 3.42, 95% CI:1.01-11.52); while those with moderate income were 6 times more likely to be hypertensive (OR = 7.37, 95% CI:1.76-30.90) compared to those who were poor. CONCLUSION: The prevalence of diagnosed and undiagnosed hypertension is higher in men and those with higher income. Investigating these factors remains vitally important in helping improve the health of the Kuna through targeted interventions to address chronic disease.


Assuntos
Hipertensão/etnologia , Índios Centro-Americanos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Panamá/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
17.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46541

RESUMO

Os idosos com mais de 65 anos são os mais afetados pela hipertensão. Ao todo, 60,9% dessa população que vive nas capitais brasileiras afirma ter o diagnóstico. Dados do SIM também mostram 388,7 mortes por dia em 2017


Assuntos
Hipertensão , Hipertensão/diagnóstico
18.
Ter Arkh ; 91(1): 8-16, 2019 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-31090364

RESUMO

AIM: The purpose of this study is to study the effect of sex on the features of therapy of arterial hypertension and the development of cardiovascular complications. MATERIALS AND METHODS: Data from the register of AH from outpatient hospital and cardiology departments of hospitals of 22 regions of the Russian Federation were analyzed. Data of medical documents of 33 564 patients with AH [(36.2%) men and 21 423 (63.8%) women] were entered into the on-line computer program and were analyzed using the statistical software package STATISTICA 10. RESULTS: Cardiovascular and cerebrovascular diseases are more often diagnosed in men: peripheral artery disease, coronary heart disease, acute coronary syndrome, congestive heart failure, ischemic stroke, dissecting aortic aneurysm. The beginning of development cardiovascular disease in men with elevated blood pressure is already observed at age of 25-44 years, which indicates the need for preventive measures already in adolescence and closer monitoring of treatment at a young age. CONCLUSION: The study confirmed the role of the male sex as a risk factor for the development of cardiovascular disease in hypertensive men and women with comparable figures of blood pressure in. Identified gender features must be considered when diagnosing patients with AH.


Assuntos
Hipertensão , Adulto , Pressão Sanguínea , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Sistema de Registros , Fatores de Risco , Federação Russa , Fatores Sexuais
19.
BMC Bioinformatics ; 20(Suppl 7): 193, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31074379

RESUMO

BACKGROUND: Haemorrhagic stroke accounts for approximately 31.52% of all stroke cases, and the most common origin is hypertension. However, little is known about the method to identify high-risk populations of hypertensive intracerebral haemorrhage. RESULTS: The results showed that the angle between the middle cerebral artery and the internal carotid artery (AMIC), the distance between the beginning of the median artery and superior trunk (DMS), and the density (CT value) of the lenticulostriate artery (CTL) were statistically significant enough to cause intracerebral haemorrhage. In addition, we chose these three potential features for the ensemble learning classification model. Our developed ensemble-learning method outperforms not only previous work but also three other classic classification methods based on accuracy measurements. CONCLUSIONS: The developed mathematical model in the present study is efficient in predicting the probability of intracerebral haemorrhage.


Assuntos
Hemorragia Cerebral/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Hipertensão/diagnóstico , Modelos Teóricos , Hemorragia Cerebral/diagnóstico por imagem , Humanos , Hipertensão/diagnóstico por imagem , Valor Preditivo dos Testes , Fatores de Risco
20.
BMC Health Serv Res ; 19(1): 309, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088467

RESUMO

BACKGROUND: Clinical guidelines are systematically proven statements that help physicians to make healthcare decisions for specific medical conditions. Non-adherence to clinical guidelines is believed to contribute significantly to poor delivery of clinical care, and hence poor clinical outcomes. This study aimed at investigating adherence of doctors to hypertension clinical guidelines in Academy Charity Teaching Hospital, Khartoum, Sudan. METHODS: A cross-sectional hospital-based study was conducted during the period from January 2017 to October 2017 on a sample of 150 doctors. Adherence of doctors to hypertension guidelines was measured through the modified JNC7 adherence tool. Descriptive statistics was used to summarize the data (mean, standard deviation, median) and analyzed by frequency tables. Chi square test used to determine association among categorized variables. Logistic regression analysis was conducted to determine the relation between adherence to hypertension guidelines and the explanatory variables. All statistical tests were considered statistically significant when p value < 0.05. RESULTS: Of the 150 participants, 92% (138/150) were aware of the major hypertension treatment guidelines. 71% (98/138) reported the use of guidelines recommendations in their practice. Whereas 52% (78/150) were aware of local Sudanese guidelines. High adherence rate was highly statistically associated with job titles (p = 0.000), and also associated with age of the participants (p = 0.024) and duration of clinical experience (p = 0.012). However, the logistic regression analysis revealed despite all those variables were contributing to adherence to the treatment guidelines, only duration of clinical experience was statistically significant (p = 0.022). CONCLUSION: The overall adherence of doctors to hypertension treatment guidelines was very low. This study highlights how a gap in clinical governance contributes to low adherence to clinical guidelines. Establishing regular clinical audit, issuing regulations to enforce the use of updated guidelines, along with introducing training programs in hospitals and continuous assessment to the practicing doctors are suggested as crucial interventions. Considerable efforts to build clinical governance in Sudan are required.


Assuntos
Atitude do Pessoal de Saúde , Fidelidade a Diretrizes/estatística & dados numéricos , Hipertensão/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Academias e Institutos , Adulto , Instituições de Caridade , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais de Ensino , Humanos , Hipertensão/terapia , Masculino , Guias de Prática Clínica como Assunto , Sudão , Resultado do Tratamento
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