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1.
Trials ; 22(1): 438, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238363

RESUMO

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


Assuntos
Doenças Cardiovasculares , Hipertensão , Adulto , Idoso , Bangladesh , Pressão Sanguínea , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Estilo de Vida , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Medicine (Baltimore) ; 100(25): e26412, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160427

RESUMO

BACKGROUND: Hypertension is a kind of cardiovascular syndrome with the main clinical manifestation of continuous increase of systemic arterial blood pressure. Hypertension coexists with other cardiovascular risk factors and is an important risk factor for cardiovascular and cerebrovascular diseases. Acupuncture is an important part of Traditional Chinese Medicine intervention. The antihypertensive effect of acupuncture on hypertension is based on the neuroendocrine system, characterized by multichannel and multitarget. This study aims to provide latest and updated proof of systematic review to assess the effectiveness and safety of acupuncture for hypertension. METHODS: We will systematically search 9 databases from their inceptions to February 2021. Only randomized controlled trials of acupuncture combined with western medicine in the treatment of hypertension will meet the inclusion criteria. The main outcome measures we focus on include clinical efficacy, syndrome efficacy, Traditional Chinese Medicine syndrome score, diastolic and systolic blood pressure changes, blood pressure variability, heart rate variability, pulse rate variability, and adverse reactions. The research screening, data extraction, and risk of bias assessment will be employed by 2 reviewers independently, and disagreement will be decided by a third senior reviewer. The Revman 5.3 software will be used for meta-analysis. The confidence of proof will be rated adopting grading of recommendations assessment, development and evaluation tool and methodological quality of this research will be assessed using assessment of multiple systematic reviews-2 and risk of bias in systematic reviews. The publication quality will be evaluated by preferred reporting items for systematic reviews and meta-analyses (PRISMA). RESULTS: This systematic review (SR) will provide evidence-based medical evidence for hypertension therapy by acupuncture combined with western medicine and we will submit the findings of this SR for peer-review publication. CONCLUSIONS: This SR will provide latest and updated summary proof for assessing the effectiveness and safety of acupuncture for hypertension. REGISTRATION NUMBER: INPLASY 202150047.


Assuntos
Terapia por Acupuntura/métodos , Anti-Hipertensivos/administração & dosagem , Diuréticos/administração & dosagem , Medicina Baseada em Evidências/métodos , Hipertensão/tratamento farmacológico , Terapia por Acupuntura/efeitos adversos , Adulto , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Terapia Combinada/métodos , Diuréticos/efeitos adversos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Metanálise como Assunto , Sistemas Neurossecretores/efeitos dos fármacos , Sistemas Neurossecretores/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(25): e26452, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160441

RESUMO

BACKGROUND: Depending on the person, cervical spondylosis may have no clinical symptoms, but cervical spondylosis will definitely cause changes in people's blood pressure, which will further affect physical and mental health. OBJECTIVES: This study aims to explore the effect and safety of mind-body exercise intervention on the blood pressure in middle-aged and elderly patients with hypertension through meta-analysis. METHODS: This meta-analysis searched studies from 4 research databases: the China National Knowledge Infrastructure (from 1979), Web of Science (from 1950), PubMed (from 1965), and Cochrane (from 1991), Date of retrieval: January 22, 2021, Two authors will independently search literature records, scan titles, abstracts, and full texts, collect data, and assess materials for risk of bias. The data will be analyzed by Stata 14.0 software. RESULTS: The present study is a systematic review and meta-analysis program with no results. Data analysis will be completed after the program has been completed. DISCUSSION: This meta-analysis may provide clinical practice with more reliable evidence-based medical evidence that mind-body exercise can benefit the blood pressure of middle-aged and elderly hypertensive patients. INPLASY REGISTRATION NUMBER: INPLASY202130072.


Assuntos
Hipertensão/terapia , Terapias Mente-Corpo/métodos , Idoso , Determinação da Pressão Arterial , Humanos , Hipertensão/diagnóstico , Metanálise como Assunto , Pessoa de Meia-Idade , Terapias Mente-Corpo/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
4.
Vasc Health Risk Manag ; 17: 259-266, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34079273

RESUMO

Background: It is expected that around 50% of individuals with diabetes mellitus will develop hypertension in the course of medical follow-up. However, with strict medical follow-up and adherence to medical advice the incidence of hypertension can be highly reduced and the time to occurrence can be delayed. Therefore, this paper aimed to measure the time to development of hypertension and identify its predictors among a 10-year cohort of diabetic patients who have medical follow-up in health facilities of Gurage Zone. Methods: An institution-based retrospective cohort study was conducted in diabetic follow-up clinics of Gurage Zone by reviewing 540 consecutively selected records among the records enrolled from January 1, 2010 to December 31, 2019. The outcome variable was incidence rate and survival time to the occurrences of hypertension (a systolic blood pressure at or above 140 mmHg and/or a diastolic blood pressure at or above 90 mm Hg and known hypertensive cases taken from adults' age ≥18 years) among admitted diabetic patients (fasting blood sugar ≥126 mg/dL or random blood sugar ≥200 mg/dL). Data were collected using a standardized checklist by trained professionals by reviewing records of all clients ever enrolled. Data were cleaned and entered by Epi info version 7 and analyzed by STATA. A Cox-proportional hazard regression model was built to identify predictors of development of hypertension. Results: A total of 540 clients were followed for different periods with a median follow-up period of 2.3 years which gives 3,200 person-years of observation. Two hundred and seventy-six (51.1%) participants were males and the mean age of was 52.2 (+11.7) years. Three hundred (55.6%) participants were urban dwellers. The overall incidence density rate (IDR) of hypertension in the cohort was 48.6 cases per 1,000 persons-year. Older ages adjusted hazard ratio (AHR)=4.0 (95% CI=2.26-7.82), body mass index (BMI) >25 kg/m2 AHR=2.3 (95% CI=1.06-3.68), Type II diabetes mellitus (DM) AHR=2.0 (95% CI=1.16-3.04), presence of comorbidity AHR=2.9 (95% CI=1.74-4.58), and poor drug adherence AHR=2.5 (95% CI=1.45-4.65) predicted the development of hypertension. Conclusion: The risk of occurrences of hypertension among diabetic patients was high at the early periods and the risk was less at the late diabetic periods and the incidence density rate of hypertension among diabetic patients was high. In addition, age, BMI, type of DM, comorbidity, and drug adherence were independent predictors of occurrences of hypertension. Therefore, intervention to further reduce its occurrence has to focus on drug adherence and prevention of infection.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Comorbidade , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Etiópia/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Hipoglicemiantes/uso terapêutico , Incidência , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
5.
Vasc Health Risk Manag ; 17: 337-348, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34135591

RESUMO

ß-blockers are a heterogeneous class of drugs, with varying selectivity/specificity for ß1 vs ß2 receptors, intrinsic sympathomimetic activity (ISA), and vasodilatory properties (through ß2 stimulation, α receptor blockade or nitric oxide release). These drugs are indicated for the management of arterial hypertension, heart failure or ischemic heart disease (IHD; eg angina pectoris or prior myocardial infarction). Most of the benefit of ß-blockade in these conditions arises from blockade of the ß1 receptor, and, in practice, the addition of ISA appears to reduce the potential for improved clinical outcomes in people with heart failure or IHD. Aspects of the benefit/risk balance of ß-blockers remain controversial, and recent meta-analyses have shed new light on this issue. We have reviewed the current place of cardioselective ß-blockade in hypertension, IHD and heart failure, with special reference to the therapeutic profile of a highly selective ß1-adrenoceptor blocker, bisoprolol.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Hipertensão/tratamento farmacológico , Isquemia Miocárdica/tratamento farmacológico , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Antagonistas Adrenérgicos beta/efeitos adversos , Bisoprolol/uso terapêutico , Tomada de Decisão Clínica , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
6.
Methodist Debakey Cardiovasc J ; 17(1): 73-74, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104326

RESUMO

The column in this issue is supplied by Drs. Benjamin Lee, MD, and Usman Ansari, DO. Dr. Lee is an assistant professor of clinical medicine at the Houston Methodist Institute for Academic Medicine and Weill Cornell Medical College. After earning his medical degree at Harvard Medical School, Dr. Lee completed a residency in internal medicine and a nephrology fellowship at the University of California San Francisco (UCSF) while simultaneously obtaining a master of advanced study in clinical research from the UCSF departments of Epidemiology and Biostatistics. He maintains his clinical practice with the Houston Kidney Consultants. Dr. Ansari earned a Doctor of Osteopathy from Touro University College of Osteopathic Medicine in California and is completing his internal medicine residency at Houston Methodist.


Assuntos
Ablação por Cateter , Hipertensão/cirurgia , Rim/irrigação sanguínea , Rim/inervação , Artéria Renal/inervação , Simpatectomia , Sistema Nervoso Simpático/cirurgia , Pressão Sanguínea , Ablação por Cateter/efeitos adversos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Simpatectomia/efeitos adversos , Sistema Nervoso Simpático/fisiopatologia , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-34072304

RESUMO

Arterial hypertension (HT) is a chronic condition of elevated blood pressure (BP), which may cause increased incidence of cardiovascular disease, stroke, kidney failure and mortality. If the HT is diagnosed early, effective treatment can control the BP and avert adverse outcomes. Physiological signals like electrocardiography (ECG), photoplethysmography (PPG), heart rate variability (HRV), and ballistocardiography (BCG) can be used to monitor health status but are not directly correlated with BP measurements. The manual detection of HT using these physiological signals is time consuming and prone to human errors. Hence, many computer-aided diagnosis systems have been developed. This paper is a systematic review of studies conducted on the automated detection of HT using ECG, HRV, PPG and BCG signals. In this review, we have identified 23 studies out of 250 screened papers, which fulfilled our eligibility criteria. Details of the study methods, physiological signal studied, database used, various nonlinear techniques employed, feature extraction, and diagnostic performance parameters are discussed. The machine learning and deep learning based methods based on ECG and HRV signals have yielded the best performance and can be used for the development of computer-aided diagnosis of HT. This work provides insights that may be useful for the development of wearable for continuous cuffless remote monitoring of BP based on ECG and HRV signals.


Assuntos
Hipertensão , Fotopletismografia , Eletrocardiografia , Frequência Cardíaca , Humanos , Hipertensão/diagnóstico , Monitorização Fisiológica
8.
J Int Med Res ; 49(6): 3000605211016144, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34187215

RESUMO

OBJECTIVE: We assessed differences and correlations between 24-hour ambulatory blood pressure (ABP) and office blood pressure (OBP) monitoring. METHODS: We conducted an observational study among 85 untreated patients with essential hypertension and measured 24-hour ABP, OBP, target organ damage (TOD) markers, and metabolism indexes. Variance analysis and the Pearson method were used to compare differences and correlation between the two methods. The Spearman or Pearson method was applied to compare the correlation between TOD markers, blood pressure index, and metabolism index. Linear regression analysis was applied to estimate the quantitative relationship between the blood pressure index and TOD markers. RESULTS: There were significant differences in the mean and variance of systolic blood pressure (SBP) and diastolic blood pressure and a positive correlation between ABP and OBP. Correlations between the left ventricular mass index (LVMI) and average ambulatory SBP, daytime ambulatory SBP, nighttime ambulatory SBP, and fasting blood glucose were significant. Correlations between left intima-media thickness (IMT) and average ambulatory SBP, nighttime ambulatory SBP, right IMT, and nighttime ambulatory SBP were significant. In linear regression analysis of the LVMI (y) and ambulatory SBP (x), the equation was expressed as y = 0.637*x. CONCLUSION: Nighttime ambulatory SBP may be an optimal predictor of TOD.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Pressão Sanguínea , Determinação da Pressão Arterial , Espessura Intima-Media Carotídea , Humanos , Hipertensão/diagnóstico , Hipertrofia Ventricular Esquerda
9.
Korean J Intern Med ; 36(4): 888-897, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34092048

RESUMO

BACKGROUND/AIMS: To examine the prevalence and clinical characteristics of apparent treatment-resistant hypertension among ambulatory hypertensive patients. METHODS: We enrolled adult ambulatory hypertensive patients at 13 well-qualified general hospitals in Korea from January to June 2012. Apparent resistant hypertension was defined as an elevated blood pressure > 140/90 mmHg with the use of three antihypertensive agents, including diuretics, or ≥ 4 antihypertensives, regardless of the blood pressure. Controlled hypertension was defined as a blood pressure within the target using three antihypertensives, including diuretics. RESULTS: Among 16,915 hypertensive patients, 1,172 (6.9%) had controlled hypertension, and 1,514 (8.9%) had apparent treatment-resistant hypertension. Patients with apparent treatment-resistant hypertension had an earlier onset of hypertension (56.8 years vs. 58.8 years, p = 0.007) and higher body mass index (26.3 kg/m2 vs. 24.9 kg/m2, p < 0.001) than those with controlled hypertension. Drug compliance did not differ between groups. In the multivariable analysis, earlier onset of hypertension (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99; p < 0.001) and the presence of comorbidities (OR, 2.06; 95% CI, 1.27 to 3.35; p < 0.001), such as diabetes mellitus, ischemic heart disease, heart failure, and chronic kidney disease, were independent predictors. Among the patients with apparent treatment-resistant hypertension, only 5.2% were receiving ≥ 2 antihypertensives at maximally tolerated doses. CONCLUSION: Apparent treatment-resistant hypertension prevalence is 8.9% among ambulatory hypertensive patients in Korea. An earlier onset of hypertension and the presence of comorbidities are independent predictors. Optimization of medical treatment may reduce the rate of apparent treatment-resistant hypertension.


Assuntos
Hospitais Gerais , Hipertensão , Adulto , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Estudos Transversais , Resistência a Medicamentos , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Prevalência , República da Coreia/epidemiologia
10.
Clin Chim Acta ; 520: 147-153, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34116005

RESUMO

Renal function is associated with postoperative residual hypertension in aldosterone-producing adenoma(APA) patients. Cystatin C-based glomerular filtration rate (GFR) can more accurately estimate renal function than creatinine-based methods. However, which renal function estimation method can more accurately predict postoperative hypertension in APA patients is still unknown. We recruited 180 APA patients who underwent adrenalectomy. Preoperative creatinine and cystatin C-based GFRs were calculated. Residual hypertension was defined as persistent hypertension > 140/90 mmHg or requiring anti-hypertensive medications 1 year after surgery. Sixty-five(36.1%) of the 180 APA patients had residual hypertension. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis showed a combination of creatinine and cystatin method CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine-cystatin GFR was significantly associated with residual postoperative hypertension and had the largest area under the ROC curve, which was statistically larger than that of Cockcroft-Gault creatinine-based GFR. In both net reclassification index and integrated discrimination index models, CKD-EPI creatinine-cystatin GFR significantly improved the discriminatory power of CG-GFR. Among these renal function estimations used in the presented study, creatinine-cystatin combined GFR was a precise method to predict residual postoperative hypertension in APA patients received adrenalectomy. These finding may help identify those patients with higher risk of residual hypertension after operation.


Assuntos
Adenoma , Hipertensão , Insuficiência Renal Crônica , Adenoma/diagnóstico , Adenoma/cirurgia , Adrenalectomia , Aldosterona , Biomarcadores , Creatinina , Cistatina C , Taxa de Filtração Glomerular , Humanos , Hipertensão/diagnóstico
11.
Korean J Intern Med ; 36(4): 780-794, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34153181

RESUMO

Uncontrolled blood pressure (BP) in patients with chronic kidney disease (CKD) can lead to serious adverse outcomes. To prevent the occurrence of cardiovascular events (CVEs), and end-stage kidney disease, achieving an optimal BP level is important. Recently, there has been a paradigm shift in the management of BP largely as a result of the Systolic Blood Pressure Intervention Trial (SPRINT), which showed a reduction in CVEs by lowering systolic BP to 120 mmHg. A lower systolic blood pressure (SBP) target has been accepted by the Kidney Disease: Improving Global Outcomes (KDIGO) 2021 guidelines. However, whether intensive control of SBP targeting < 120 mmHg is also effective in patients with CKD is controversial. Notably, this lower target SBP is associated with a higher risk of adverse kidney outcomes. Unfortunately, there have been no randomized controlled trials on this issue involving only patients with CKD, particularly those with advanced CKD. In this review, we discuss the optimal control of BP in patients with CKD in terms of reduction in death and CVEs as well as attenuation of CKD progression based on the evidence-based literature.


Assuntos
Hipertensão , Hipotensão , Insuficiência Renal Crônica , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Rim , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico
12.
Vasc Health Risk Manag ; 17: 363-370, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34188478

RESUMO

Background: The leading preventable risk factor for premature death and disability worldwide is hypertension. Globally, 31.1% of adults (1.39 billion people) have hypertension and 9.4 million deaths are recorded annually, accounting for 13% of overall mortality. Objective: The objective of this study is to assess the prevalence of hypertension and associated factors among public servants in North Wollo Zone, Amhara Region, Ethiopia. Materials and Methods: An institutional-based cross-sectional study was conducted among 627 public servants. To classify candidate variables for multivariable logistic regression, a binary logistic regression model was applied. In order to analyze factors associated with hypertension among participants, all variables with a P-value<0.2 were entered into the multivariable logistic regression model. In order to determine statistical significance, a p value of less than 0.05 was taken. The assumptions of Chi square and multi-collinearity were verified. For model fitness, the Hosmer-Lemeshow goodness-of-fit was checked. Results: The total hypertension rate was 27.6% (95% CI: 24.1-31.3). The prevalence was higher in males 129 (32.5%) than in females 444 (19.1%). History of diabetes mellitus (AOR= 9.64, 95% CI: 3.20-29.30), age >35 years (AOR= 2.94, 95% CI: 1.91-4.51) and body mass index 25kg/m2 and above (AOR= 3.44, 95% CI: 2.21-5.34) have been found to be separately associated with hypertension. Conclusion and Recommendation: Among public servants in the study setting (study area), hypertension has become a major public health issue. Half of the newly reported cases is hypertensive. The conclusion of this study calls for a more holistic approach to hypertension in terms of hypertension prevention, screening, and proper management.


Assuntos
Hipertensão/epidemiologia , Setor Público , Adulto , Pressão Sanguínea , Comorbidade , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Estilo de Vida , Masculino , Saúde do Trabalhador , Prevalência , Medição de Risco , Fatores de Risco
13.
Sensors (Basel) ; 21(10)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34069396

RESUMO

The availability of simple, accurate, and affordable cuffless blood pressure (BP) devices has the potential to greatly increase the compliance with measurement recommendations and the utilization of BP measurements for BP telemonitoring. The aim of this study is to evaluate the correlation between findings from routine BP measurements using a conventional sphygmomanometer with the results from a portable ECG monitor combined with photoplethysmography (PPG) for pulse wave registration in patients with arterial hypertension. METHODS: The study included 500 patients aged 32-88 years (mean 64 ± 7.9 years). Mean values from three routine BP measurements by a sphygmomanometer with cuff were selected for comparison; within one minute after the last measurement, an electrocardiogram (ECG) was recorded for 3 min in the standard lead I using a smartphone-case based single-channel ECG monitor (CardioQVARK®-limited responsibility company "L-CARD", Moscow, Russia) simultaneously with a PPG pulse wave recording. Using a combination of the heart signal with the PPG, levels of systolic and diastolic BP were determined based on machine learning using a previously developed and validated algorithm and were compared with sphygmomanometer results. RESULTS: According to the Bland-Altman analysis, SD for systolic BP was 3.63, and bias was 0.32 for systolic BP. SD was 2.95 and bias was 0.61 for diastolic BP. The correlation between the results from the sphygmomanometer and the cuffless method was 0.89 (p = 0.001) for systolic and 0.87 (p = 0.002) for diastolic BP. CONCLUSION: Blood pressure measurements on a smartphone-case without a cuff are encouraging. However, further research is needed to improve the accuracy and reliability of clinical use in the majority of patients.


Assuntos
Hipertensão , Fotopletismografia , Pressão Sanguínea , Determinação da Pressão Arterial , Eletrocardiografia , Humanos , Hipertensão/diagnóstico , Análise de Onda de Pulso , Reprodutibilidade dos Testes , Smartphone
14.
JAMA ; 325(22): 2294-2306, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34100866

RESUMO

Importance: General health checks, also known as general medical examinations, periodic health evaluations, checkups, routine visits, or wellness visits, are commonly performed in adult primary care to identify and prevent disease. Although general health checks are often expected and advocated by patients, clinicians, insurers, and health systems, others question their value. Observations: Randomized trials and observational studies with control groups reported in prior systematic reviews and an updated literature review through March 2021 were included. Among 19 randomized trials (906 to 59 616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check, 7 evaluated annual health checks, 1 evaluated biannual checks, and 6 evaluated health checks delivered at other frequencies. Twelve of 13 observational studies (240 to 471 415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, in the South-East London Screening Study (n = 7229), adults aged 40 to 64 years who were invited to 2 health checks over 2 years, compared with adults not invited to screening, experienced no 8-year mortality benefit (6% vs 5%). General health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors, such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as quality of life and self-rated health. In the Danish Check-In Study (n = 1104), more patients randomized to receive to a single health check, compared with those randomized to receive usual care, received a new antidepressant prescription over 1 year (5% vs 2%; P = .007). In a propensity score-matched analysis (n = 8917), a higher percentage of patients who attended a Medicare Annual Wellness Visit, compared with those who did not, underwent colorectal cancer screening (69% vs 60%; P < .01). General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. In the OXCHECK trial (n = 4121), fewer patients randomized to receive annual health checks, compared with those not randomized to receive health checks, exercised less than once per month (68% vs 71%; difference, 3.3% [95% CI, 0.5%-6.1%]). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advance directives. Conclusions and Relevance: General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment, risk factor control, preventive service uptake, and improved patient-reported outcomes. Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection or inadequate access to primary care.


Assuntos
Exame Físico , Atenção Primária à Saúde , Prevenção Primária , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Doença Crônica , Neoplasias Colorretais/diagnóstico , Depressão/diagnóstico , Exercício Físico , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Observacionais como Assunto/estatística & dados numéricos , Exame Físico/efeitos adversos , Serviços Preventivos de Saúde/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
15.
Trials ; 22(1): 413, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167566

RESUMO

BACKGROUND: Self-management of hypertension is of great significance given its increasing incidence and its associated disabilities. In view of the increased use of mobile health in medicine, the present study evaluated the effect of a self-management application on patient adherence to hypertension treatment. METHODS: This clinical trial was performed on 120 hypertensive patients who were provided with a mobile intervention for 8 weeks and followed up until the 24th week. Data on the primary outcome (adherence to treatment) and secondary outcomes (adherence to the DASH diet, regular monitoring of blood pressure, and physical activity) were collected using a questionnaire and a mobile application, respectively. The inter-group change difference over time was analyzed using repeated measures ANOVA (general linear model). RESULTS: The treatment adherence score increased by an average of 5.9 (95% CI 5.0-6.7) in the intervention group compared to the control group. The scores of "adherence to the low-fat and low-salt diet plans" were 1.7 (95% CI 1.3-2.1) and 1.5 (95% CI 1.2-1.9), respectively. Moreover, moderate physical activity increased to 100.0 min (95% CI 61.7-138.3) per week in the intervention group. CONCLUSION: The treatment and control of blood pressure require a multifaceted approach given its complexity and multifactorial nature. Considering the widespread use of smartphones, mHealth interventions can be effective in self-management and better patient adherence to treatments. Our results showed that this application can be used as a successful tool for hypertension self-management in patients attending public hospitals in developing countries. TRIAL REGISTRATION: Iran Randomized Clinical Trial Center IRCT2015111712211N2 . Registered on 1 January 2016.


Assuntos
Hipertensão , Aplicativos Móveis , Autogestão , Pressão Sanguínea , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Irã (Geográfico) , Adesão à Medicação
16.
Curr Opin Cardiol ; 36(4): 429-435, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34059611

RESUMO

PURPOSE OF REVIEW: Hypertension is the foremost risk factor for cardiovascular disease (CVD) and death. This review highlights recent findings that apply to the prevention, detection, and management of high blood pressure (BP), in the context of the 2017 American College of Cardiology/American Heart Association BP guideline. RECENT FINDINGS: Several new findings on the association of BP measurement with CVD outcomes are now available. (1) Beginning with a systolic BP (SBP) as low as 90 mm Hg, coronary artery calcium deposition and the risk of incident atherosclerotic CVD (ASCVD) increased in stepwise fashion with increasing SBP levels within the normal range in adults at low risk for ASCVD. (2) Isolated diastolic hypertension was not associated with ASCVD, heart failure, or chronic kidney disease. (3) Nocturnal BP appeared to be better associated with CVD outcomes than office or daytime BP. (4) In a head-to-head comparison, home BP monitoring had higher reliability and predictive value than office or ambulatory BP to detect left ventricular hypertrophy, an intermediate form of hypertension-related target organ damage. In addition, new information indicates that autonomous aldosterone production is present in a substantially larger percentage of adults with hypertension than previously recognized. Finally, intensive BP lowering is associated with a significant reduction in the incidence of mild cognitive impairment, a precursor of dementia. SUMMARY: Ongoing research has made significant progress in the prevention, detection, and management of high BP, clarifying, amplifying, and/or supporting the 2017 ACC/AHA BP guideline recommendations.


Assuntos
Hipertensão , Adulto , American Heart Association , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Reprodutibilidade dos Testes , Estados Unidos
17.
Medicine (Baltimore) ; 100(23): e26266, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115020

RESUMO

ABSTRACT: Waon therapy (WT) has been used as a thermal therapy in chronic heart failure patients. However, its effect in patients with hypertension is unclear. This study aimed to reveal the hypotensive effect of WT in patients with hypertension. WT was performed on 31 patients with hypertension (63.9 ±â€Š11.9 years, male: 17) on standard hypertension treatment focusing on lifestyle modification and medication. Systolic and diastolic blood pressures were measured before and after WT using an upper arm automated sphygmomanometer. We investigated the effect of single and repeated (1 time/d, >5 times) WT sessions on blood pressure and further compared its effect between current smoking (n = 11, 55.4 ±â€Š6.4 years, 8.5 ±â€Š2.4 times) and non-smoking (n = 11, 66.9 ±â€Š8.5 years, 12.2 ±â€Š5.9 times) groups. A total of 370 sessions of WT were conducted. Systolic and diastolic blood pressures significantly decreased after a single WT session (systolic blood pressure: 118.5 ±â€Š10.1 to 115.1 ±â€Š9.0 mm Hg, P < .001; diastolic blood pressure: 70.5 ±â€Š6.4 to 65.9 ±â€Š5.3 mm Hg, P < .001). The blood pressure decrease following repeated WT was not significant when all participants were considered (systolic blood pressure: 122.3 ±â€Š15.2 to 116.9 ±â€Š19.6 mm Hg; diastolic blood pressure: 73.8 ±â€Š16.7 to 68.2 ±â€Š13.2 mm Hg); however, it was significant in the non-smoking group (systolic blood pressure: 124.2 ±â€Š11.3 to 108.8 ±â€Š13.4 mm Hg, P < .001; diastolic blood pressure: 73.6 ±â€Š4.9 to 62.1 ±â€Š7.6 mm Hg, P < .001). Repeated WT (at least 5 sessions) decreased blood pressure in patients with hypertension, especially in non-smokers. WT is a simple method to reduce blood pressure in non-smoking patients with hypertension.


Assuntos
Determinação da Pressão Arterial/métodos , Hipertensão , Hipertermia Induzida/métodos , Fumar , Pressão Sanguínea/fisiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/psicologia , Hipertensão/terapia , Japão , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , não Fumantes/estatística & dados numéricos , Fumar/efeitos adversos , Fumar/fisiopatologia , Resultado do Tratamento
18.
Angiol Sosud Khir ; 27(2): 32-40, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166342

RESUMO

The article is a review of contemporary randomized studies on radiofrequency denervation of renal arteries, followed by critical assessment of their advantages and disadvantages for possible optimization of endovascular treatment of resistant arterial hypertension.


Assuntos
Ablação por Cateter , Hipertensão , Anti-Hipertensivos , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Rim/cirurgia , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Simpatectomia , Resultado do Tratamento
19.
J Assoc Physicians India ; 69(5): 38-41, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34189885

RESUMO

Background: High blood pressure (BP) is the largest contributor to the global burden of disease and mortality. This Blood Pressure screening program was initiated in conjunction with the May Measurement Month to increase the awareness of the importance of BP and also designed to understand the problems of real time clinical situations. Methodology: This was a cross sectional, multicentric, non-interventional, observational and single visit study. The study was conducted in the Outpatient department of many clinics/ institutions. The convenience sampling technique was used to select the centers in this study and obtain the geographical distribution of India. Results: A total of 1,36,095 BP screening forms were considered for analysis. A total of 37,017 subjects (27.2%) had BP of >130/80 mm Hg. Among participants, 44.5% of men in age group of 51 ­ 60 years had high BP. 31.2 % of the women in the age group of 41-50 years had high BP. Among 37017 subjects, 14066 subjects (38%) were newly diagnosed subjects with hypertension. In the subset (N=22,951) of known cases of hypertension, Men were 14, 127 (Urban, N=7488 and Rural, N=6639) and 8824 were women (Urban, N=4588 and Rural, N=4236). The common comorbidities were dyslipidemia, cardiovascular disorders and diabetes. Conclusion: Despite the advances in hypertension management and emphasis on patient education, our study shows that hypertension continues to be a significant health burden. Improving patient compliance to lifestyle modifications, medication and regular follow-up clinic visits by imparting patient education and awareness can provide better results in Hypertension management.


Assuntos
Hipertensão , Adulto , Pressão Sanguínea , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , População Rural
20.
West Afr J Med ; 38(5): 434-438, 2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34051714

RESUMO

BACKGROUND AND OBJECTIVES: Non-communicable diseases have emerged as major public health concerns in developing nations, where communicable diseases used to be the major contributor to the public health burden. Diabetes and hypertension contribute significantly to this menace, and they are largely undiagnosed in the affected population. We determined the prevalence of previously diagnosed and undiagnosed hypertension and diabetes mellitus in adult Nigerians. METHODS: Participants who presented in response to advertisement for the study and gave informed consent were recruited using convenience sampling. Data was collected using a proforma to obtain salient medical and social history. Anthropometric and blood pressure measurements were done. Capillary blood was taken for initial glucose measurements. Oral glucose tolerance test (OGTT) was subsequently done in non-diabetics with elevated blood glucose to confirm the diagnosis of diabetes. RESULTS: One hundred and thirty-six participants with age range 24 - 90 years were recruited for the study. Participants were mainly females (61.8%). Prevalence of diabetes among study participants was 19.9% (previously diagnosed -16.9% vs undiagnosed - 3.0%) with higher occurrence among males. Hypertension was found in 50.7% of participants; 28.7% were on treatment for hypertension, while 22.0% were newly diagnosed. Diabetes was associated with older age and elevated systolic blood pressure while hypertension was associated with older age, obesity and elevated blood glucose. CONCLUSION: This study showed a high occurrence of diabetes and hypertension among adult Nigerians; hence efforts to address these should be intensified. Targeted screening of people at risk for non-communicable diseases is an added benefit.


Assuntos
Diabetes Mellitus , Hipertensão , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Teste de Tolerância a Glucose , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Obesidade , Adulto Jovem
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