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1.
Compend Contin Educ Dent ; 41(9): 458-464; quiz 465, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33001656

RESUMO

More than 1 billion people worldwide have hypertension. Since the guidelines for classification and treatment of hypertension were updated in 2017 by American College of Cardiology/American Heart Association, it is now estimated that nearly half of the US adult population has hypertension. Hypertension may not show any sign or symptom apart from an elevated blood pressure reading until signs and symptoms of complications occur. Hence, dentists can play a unique role in identifying undiagnosed patients or those with uncontrolled blood pressure levels. This article is intended to provide dental clinicians essential information about hypertension and how the new guidelines affect the classification and treatment of the disease, and it discusses the management of patients with hypertension in the dental office.


Assuntos
Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/terapia , Adulto , Pressão Sanguínea , Humanos , Estados Unidos
3.
Medicine (Baltimore) ; 99(40): e22536, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019461

RESUMO

RATIONALE: Paroxysmal autonomic instability with dystonia (PAID) is an underdiagnosed syndrome that describes a collection of symptoms following diverse cerebral insults, such as traumatic brain injury, hydrocephalus, hemorrhagic stroke, or brain anoxia. It is manifested by systemic high blood pressure, hyperthermia, tachycardia, tachypnea, diaphoresis, intermittent agitation, and certain forms of dystonia. PATIENT CONCERNS: A semi-comatose 46-year-old man was transferred from the regional rehabilitation hospital with various complaints involving fluctuating vital signs, including uncontrolled hyperthermia, hypertension, tachycardia, and tachypnea, and dystonia in all extremities. The patient underwent brain surgery for astrocytoma in 1996. The patient also had a history of first ischemic stroke on the basal ganglia in 2008 and a second one in the same area in 2017. DIAGNOSIS: The laboratory, electrocardiography, and radiologic findings were normal. Brain imaging indicated an old infarction on the basal ganglia with hydrocephalus. Tractography using diffusion tensor imaging showed discontinuity of multiple tracts, and electrophysiologic tests, such as evoked potentials, displayed an absent response. Based on the dysautonomic symptoms and brain evaluations, the physiatrist diagnosed the patient with PAID. INTERVENTIONS: Bromocriptine, propranolol, and clonazepam were administered sequentially, but autonomic instability persisted. Then, intravenous opioid was administered, and fluctuations in body temperature, heart rate, and respiratory rate, as well as decerebrate-type dystonia were improved. However, simultaneously, drug-induced severe hypotension developed (systolic blood pressure, 57 mm Hg). Subsequently, a transdermal opioid (fentanyl) patch for PAID was applied once every 3 days. OUTCOMES: Ultimately, all vital signs and dystonia were managed without further complications, and the patient was discharged. LESSONS: A patient diagnosed with PAID following multiple cerebral insults was observed, whose condition was controlled by application of opioid patch rather than by intravenous or oral routes. A transdermal opioid patch, such as fentanyl patch, can thus be effective in the treatment of patients with PAID following multiple cerebral insults.


Assuntos
Analgésicos Opioides/uso terapêutico , Doenças do Sistema Nervoso Autônomo/tratamento farmacológico , Distonia/diagnóstico , Fentanila/uso terapêutico , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Gânglios da Base/patologia , Isquemia Encefálica/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Distonia/etiologia , Febre/diagnóstico , Febre/etiologia , Humanos , Hidrocefalia/etiologia , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipotensão/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Síndrome , Taquicardia/diagnóstico , Taquicardia/etiologia , Taquipneia/diagnóstico , Taquipneia/etiologia , Adesivo Transdérmico/efeitos adversos , Resultado do Tratamento
5.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32948657

RESUMO

OBJECTIVES: To determine the natural history of pediatric hypertension. METHODS: We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared. RESULTS: Among 398 079 primary care pediatric patients ages 3 to 18, 89 347 had ≥3 blood pressure levels recorded during a 36-month period, and 43 825 children had ≥3 blood pressure levels for 2 consecutive 36-month periods. Among these 43 825 children, 4.3% (1881) met criteria for hypertension (3.5% [1515] stage 1, 0.8% [366] stage 2) and 4.9% (2144) met criteria for elevated blood pressure in the first 36 months. During the second 36 months, 50% (933) of hypertensive patients had no abnormal blood pressure levels, 22% (406) had elevated blood pressure levels or <3 hypertensive blood pressure levels, and 29% (542) had ≥3 hypertensive blood pressure levels. Of 2144 patients with elevated blood pressure in the first 36 months, 70% (1492) had no abnormal blood pressure levels, 18% (378) had persistent elevated blood pressure levels, and 13% (274) developed hypertension in the second 36-months. Among the 7775 patients with abnormal blood pressure levels in the first 36-months, only 52% (4025) had ≥3 blood pressure levels recorded during the second 36-months. CONCLUSIONS: In a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.


Assuntos
Determinação da Pressão Arterial/estatística & dados numéricos , Hipertensão/diagnóstico , Adolescente , Fatores Etários , Estatura , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Valores de Referência , Análise de Regressão , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo
6.
Vasc Health Risk Manag ; 16: 343-352, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32943869

RESUMO

Purpose: The impact of glycemic control on macrovascular complications and arterial stiffness in type II diabetes (T2D), as well as the extent of additive effect of hypertension, is unclear. The aims of this study were to investigate the impact of glycemic control on the cardio-ankle vascular index (CAVI), an indicator of arterial stiffness, and to determine the relative risk of concomitant diabetes and hypertension with arterial stiffness. Methods: One hundred and nine participants were enrolled and classified as non-diabetes (n= 37) and diabetes (n=72); the diabetic group was further identified as controllable and uncontrollable T2D depending on their hemoglobin A1c (HbA1c) levels. Univariate and multiple regression analyses were used to assess the association between CAVI and glycemic control status and hypertension. Relative risk analysis for abnormal CAVI with exposure to diabetes and hypertension was investigated. Results: In all participants, age, systolic blood pressure, body mass index, and fasting blood sugar were independent predictors of CAVI. In diabetic participants, glycemic control status or HbA1c levels did not significantly correlate with CAVI. Systolic blood pressure was an independent predictor for CAVI with ß = 0.26. In addition, the coexistence of diabetes together with hypertension was significantly associated with a 2.4-fold increase in the risk of abnormal CAVI (95% CI, 1.410-4.184; p <0.001). Conclusion: This study demonstrates that HbA1c as well as fasting blood sugar levels in diabetic participants do not correlate with arterial stiffness. Concomitant diabetes and hypertension significantly increase the risk of arterial stiffness.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Hemoglobina A Glicada/metabolismo , Hipertensão/fisiopatologia , Rigidez Vascular , Adulto , Idoso , Biomarcadores/sangue , Glicemia/efeitos dos fármacos , Índice Vascular Coração-Tornozelo , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco
7.
Cardiovasc Ther ; 2020: 4349612, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32983258

RESUMO

Background: Central aortic blood pressure (CABP) indices, central hemodynamics, and arterial stiffness are better predictors of cardiovascular events as compared with brachial cuff pressure measurements alone. The present study is aimed at assessing the effects of different antihypertensive drug combination regimens involving renin-angiotensin-aldosterone system (RAAS) inhibitors on CABP indices in Indian patients with hypertension. Methods: This was a cross-sectional, single-center study conducted in patients treated for hypertension for >6 weeks using different treatment regimens involving the combination of RAAS inhibitors with drugs from other classes. CABP indices, vascular age, arterial stiffness, and central hemodynamics were measured in patients using the noninvasive Agedio B900 device (IEM, Stolberg, Germany) and compared between different treatment regimens. Results: A total of 199 patients with a mean age of 54.22 ± 10.15 years were enrolled, where 68.8% had hypertension for over three years and 50.25% had their systolic blood pressure (SBP) < 140 mmHg. Combination treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was given to 77.9% and to 20.1% patients, respectively. The mean vascular age was higher than the actual age (58.13 ± 12.43 vs. 54.22 ± 10.15, p = 0.001). The SBP and diastolic blood pressure (DBP) levels in patients treated with ACEI-based combinations were lower than those in patients treated with ARB-based combinations (p < 0.05). The mean central pulse pressure amplification, augmentation pressure, and augmentation index were lower in patients treated with ACEI-based combinations than those treated with other treatments (p = 0.001). In a subgroup analysis, patients given perindopril and calcium channel blockers (CCBs) or diuretics had significantly lower CABP and pulse wave velocity than those given other treatments (p < 0.05). A total of 6.5% patients experienced any side effects. Conclusion: The majority of central hemodynamic parameters, including vascular age, were found to improve more effectively in patients treated with ACEIs than with ARBs. Our results indicate a gap between routine clinical practice and evidence-based guidelines in Indian settings and identify a need to reevaluate the current antihypertensive prescription strategy.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Adulto , Idoso , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Estudos Transversais , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Índia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Hypertension ; 76(5): 1368-1383, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32921195

RESUMO

Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients' access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Hipertensão/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/estatística & dados numéricos , Determinação da Pressão Arterial/métodos , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Medicina Baseada em Evidências , Feminino , Humanos , Hipertensão/diagnóstico , Itália , Masculino , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia , Índice de Gravidade de Doença
10.
BMC Cardiovasc Disord ; 20(1): 373, 2020 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-32799852

RESUMO

BACKGROUND: Hypertension is the most frequent co-morbidity in patients with covid-19 infection, and we might speculate that a specific blood group could play a key role in the clinical outcome of hypertensive patients with covid-19. METHODS: In this prospective study, we compared 0 vs. non-0 blood group in hypertensive patients with covid-19 infection. In these patients, we evaluated inflammatory and thrombotic status, cardiac injury, and death events. RESULTS: Patients in non-0 (n = 92) vs. 0 blood group (n = 72) had significantly different values of activated pro-thrombin time, D-dimer, and thrombotic indexes as Von Willebrand factor and Factor VIII (p < 0.05). Furthermore, patients in non-0 vs. 0 blood group had higher rate of cardiac injury (10 (13.9%) vs. 27 (29.3%)) and death, (6 (8.3%) vs. 18 (19.6%)), (p < 0.05). At the multivariate analysis, Interleukin-6 (1.118, CI 95% 1.067-1.171) and non-0 blood group (2.574, CI 95% 1.207-5.490) were independent predictors of cardiac injury in hypertensive patients with covid-19. D-dimer (1.082, CI 95% 1.027-1.140), Interleukin-6 (1.216, CI 95% 1.082-1.367) and non-0 blood group (3.706, CI 95% 1.223-11.235) were independent predictors of deaths events in hypertensive patients with covid-19. CONCLUSIONS: Taken together, our data indicate that non-0 covid-19 hypertensive patients have significantly higher values of pro-thrombotic indexes, as well as higher rate of cardiac injury and deaths compared to 0 patients. Moreover, AB0 blood type influences worse prognosis in hypertensive patients with covid-19 infection.


Assuntos
Sistema ABO de Grupos Sanguíneos , Betacoronavirus/patogenicidade , Pressão Sanguínea , Infecções por Coronavirus/sangue , Hipertensão/sangue , Pneumonia Viral/sangue , Adulto , Idoso , Biomarcadores/sangue , Coagulação Sanguínea , Fatores de Coagulação Sanguínea/análise , Estudos de Casos e Controles , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Interações Hospedeiro-Patógeno , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Mediadores da Inflamação/sangue , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , Fatores de Risco
11.
Medicine (Baltimore) ; 99(30): e21227, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791697

RESUMO

Variability of blood pressure (BP) is known as a prognostic value for the subsequent target organ damage in hypertensive patients. Arterial stiffness is a risk factor for cardiovascular morbidity and mortality. The relationship between the arterial stiffness and the BP variability has been controversial. The objective of the present study was to investigate the relationship between arterial stiffness and home BP variability in patients with high normal BP and new onset hypertension (HTN).Four hundred sixty three patients (252 males, 49 ±â€Š12 year-old) with high normal BP or HTN were enrolled. Using radial applanation tonometry, pulse wave analysis (PWA) was performed for evaluation of systemic arterial stiffness. All patients underwent both home BP monitoring (HBPM) and PWA. Home BP variability was calculated as the standard deviation (SD) of 7 measurements of HBPM. Multiple linear regression analysis was performed to estimate and test the independent effects of home BP variability on the arterial stiffness.Mutivariate analysis showed that both systolic and diastolic morning BP variabilities were correlated with arterial stiffness expressed as augmentation pressure (AP, ß-coefficient = 1.622, P = .01 and ß-coefficient = 1.07, P = .035). The SDs of systolic and diastolic BP of evening were also associated with AP (ß-coefficient = 1.843, P = .001 and ß-coefficient = 1.088, P = .036). The SDs of morning and evening systolic BP were associated with augmentation index (AI, ß-coefficient = 1.583, P = .02 and ß-coefficient = 1.792, P = .001) and heart rate (75 bpm) adjusted AI (ß-coefficient = 1.592, P = .001 and ß-coefficient = 1.792, P = .001).In present study, the variability of systolic BP was closely related with arterial stiffness. The home BP variability might be important indicator of arterial stiffness.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão/fisiopatologia , Rigidez Vascular/fisiologia , Adulto , Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Reprodutibilidade dos Testes , Fatores de Risco
12.
Nat Commun ; 11(1): 3865, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737319

RESUMO

Polygenic scores (PGS) have been widely used to predict disease risk using variants identified from genome-wide association studies (GWAS). To date, most GWAS have been conducted in populations of European ancestry, which limits the use of GWAS-derived PGS in non-European ancestry populations. Here, we derive a theoretical model of the relative accuracy (RA) of PGS across ancestries. We show through extensive simulations that the RA of PGS based on genome-wide significant SNPs can be predicted accurately from modelling linkage disequilibrium (LD), minor allele frequencies (MAF), cross-population correlations of causal SNP effects and heritability. We find that LD and MAF differences between ancestries can explain between 70 and 80% of the loss of RA of European-based PGS in African ancestry for traits like body mass index and type 2 diabetes. Our results suggest that causal variants underlying common genetic variation identified in European ancestry GWAS are mostly shared across continents.


Assuntos
Asma/genética , Diabetes Mellitus Tipo 2/genética , Hipertensão/genética , Modelos Genéticos , Herança Multifatorial , Polimorfismo de Nucleotídeo Único , Adulto , África/epidemiologia , Idoso , Alelos , Ásia/epidemiologia , Asma/diagnóstico , Asma/epidemiologia , Asma/etnologia , Índice de Massa Corporal , Colesterol/sangue , Simulação por Computador , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Europa (Continente)/epidemiologia , Feminino , Frequência do Gene , Estudo de Associação Genômica Ampla , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/etnologia , Desequilíbrio de Ligação , Masculino , Pessoa de Meia-Idade , Prognóstico , Característica Quantitativa Herdável , Risco
13.
Georgian Med News ; (303): 72-79, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32841185

RESUMO

Climate plays an essential role in the blood pressure (BP) regulation. BP seasonal fluctuations are often explained by meteorological factors, such as changes of outdoor temperature and etc. The 260 cases of BP monitoring of patients with uncomplicated hypertensive crisis were analyzed. We studied the daily fluctuations of climate data indicators reflected in 4-hour intervals. Data analysis was performed considering unmodifiable risk factors for hypertension: age and gender. In the young age group, the daily average SBP was 131, in the middle age group - 130.5, in the elderly group-136.3 mmHg., p=0.000. 4-hourly mean values of SBP were higher in the older group and their correlations with meteorological elements were more significant. A multi-dimensional regression model, which included temperature, atmospheric pressure, relative humidity and horizontal visibility had an r square of 25%. Comparison by gender showed that the daily average SBP was higher in women, but a statistically significant regression model couldn`t be obtained. The results showed the presence of greater sensitivity to climatic and meteorological fluctuations for individuals, aged ≥ 60.


Assuntos
Determinação da Pressão Arterial , Hipertensão/diagnóstico , Adulto , Idoso , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Temperatura
14.
Cardiovasc Ther ; 2020: 8157858, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32821284

RESUMO

Aim: The present study compared the acute effects of aerobic (AER), resistance (RES), and combined (COM) exercises on blood pressure (BP) levels in people with resistant hypertension (RH) and nonresistant hypertension (NON-RH). Methods: Twenty patients (10 RH and 10 NON-RH) were recruited and randomly performed three exercise sessions and a control session. Ambulatory BP was monitored over 24 hours after each experimental session. Results: Significant reductions on ambulatory BP were found in people with RH after AER, RES, and COM sessions. Notably, ambulatory BP was reduced during awake-time and night-time periods after COM. On the other hand, the effects of AER were more prominent during awake periods, while RES caused greater reductions during the night-time period. In NON-RH, only RES acutely reduced systolic BP, while diastolic BP was reduced after all exercise sessions. However, the longest postexercise ambulatory hypotension was observed after AER (~11 h) in comparison to RES (~8 h) and COM (~4 h) exercises. Conclusion: Findings of the present study indicate that AER, RES, and COM exercises elicit systolic and diastolic postexercise ambulatory hypotension in RH patients. Notably, longer hypotension periods were observed after COM exercise. In addition, NON-RH and RH people showed different changes on BP after exercise sessions, suggesting that postexercise hypotension is influenced by the pathophysiological bases of hypertension.


Assuntos
Pressão Sanguínea , Hipertensão/terapia , Treinamento de Resistência , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Brasil , Estudos Cross-Over , Resistência a Medicamentos , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
15.
Neurol Sci ; 41(10): 2675-2679, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32761396

RESUMO

Corona virus disease 2019 (COVID-19) pandemic has become a globally challenging issue after its emergence in December 2019 from Wuhan, China. Despite its common presentation as respiratory distress, patients with COVID-19 have also shown neurological manifestation especially stroke. Therefore, the authors sought to determine the etiology, underlying risk factors, and outcomes among patients with COVID-19 presenting with stroke. We conducted a systematic review of the electronic database (PubMed, Google Scholar, Scopus, Medline, EMBASE, and Cochrane library) using different MeSH terms from November 2019 to June 2020. A total of 39 patients with stroke from 6 studies were included. The mean age of our included patients was 61.4 ± 14.2 years. Majority of the patients (n = 36, 92.3%) with COVID-19 had ischemic stroke, 5.1% (n = 2) had hemorrhagic stroke, and 2.6% (n = 1) had cerebral venous thrombosis at the time of initial clinical presentation. Almost all of the patients presented had underlying risk factors predisposing to stroke which included diabetes mellitus, hyperlipidemia, hypertension, and previous history of cerebrovascular disease. 51.2% (n = 20) of the included patients infected with COVID-19 with stroke died, while remaining patients were either discharged home or transferred to a rehabilitation unit. Exploring the neurological manifestation in terms of stroke among patients with COVID-19 is a step towards better understanding of the virus, preventing further spread, and treating the patients affected by this pandemic.


Assuntos
Betacoronavirus , Isquemia Encefálica/diagnóstico , Infecções por Coronavirus/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Isquemia Encefálica/epidemiologia , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Pneumonia Viral/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
16.
Nat Commun ; 11(1): 4222, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32839436

RESUMO

Our understanding of Na+ homeostasis has recently been reshaped by the notion of skin as a depot for Na+ accumulation in multiple cardiovascular diseases and risk factors. The proposed water-independent nature of tissue Na+ could induce local pathogenic changes, but lacks firm demonstration. Here, we show that tissue Na+ excess upon high Na+ intake is a systemic, rather than skin-specific, phenomenon reflecting architectural changes, i.e. a shift in the extracellular-to-intracellular compartments, due to a reduction of the intracellular or accumulation of water-paralleled Na+ in the extracellular space. We also demonstrate that this accumulation is unlikely to justify the observed development of experimental hypertension if it were water-independent. Finally, we show that this isotonic skin Na+ excess, reflecting subclinical oedema, occurs in hypertensive patients and in association with aging. The implications of our findings, questioning previous assumptions but also reinforcing the importance of tissue Na+ excess, are both mechanistic and clinical.


Assuntos
Edema/metabolismo , Homeostase/fisiologia , Sódio/metabolismo , Equilíbrio Hidroeletrolítico/fisiologia , Envelhecimento/metabolismo , Animais , Edema/diagnóstico , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Fígado/metabolismo , Pulmão/metabolismo , Masculino , Miocárdio/metabolismo , Especificidade de Órgãos , Concentração Osmolar , Potássio/metabolismo , Ratos Endogâmicos WKY , Pele/metabolismo , Fatores de Transcrição/metabolismo
17.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(8): 884-887, 2020 Aug 06.
Artigo em Chinês | MEDLINE | ID: mdl-32842318

RESUMO

To explore the relationship between parental hypertension history and hypertension in children and adolescents based on the relevant data of 6 049 children and adolescents aged 6 to 17 years old in Jinan city from September 2012 to September 2014. The results showed that the history of hypertension in parents was positively correlated with systolic blood pressure in children and adolescents, with the value of coefficient ß (95%CI) about 0.91 (0.23-1.59). Compared with children and adolescents whose parents had no history of hypertension, those with history of hypertension in one parent and both parents were more likely to develop hypertension, with OR values (95%CI) about 1.28 (1.01-1.61) and 2.24 (1.09-4.61), respectively. Therefore, it is suggested that prevention and intervention measures should be taken as soon as possible for children and adolescents whose parents have a history of hypertension.


Assuntos
Hipertensão/diagnóstico , Adolescente , Pressão Sanguínea , Determinação da Pressão Arterial , Criança , Humanos , Pais
20.
Respir Res ; 21(1): 172, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631365

RESUMO

BACKGROUND: Previous studies have shown that Coronavirus Disease 2019 (COVID-19) patients with underlying comorbidities can have worse outcomes. However, the effect of hypertension on outcomes of COVID-19 patients remains unclear. RESEARCH QUESTION: The aim of this study was to explore the effect of hypertension on the outcomes of patients with COVID-19 by using propensity score-matching (PSM) analysis. STUDY DESIGN AND METHODS: Participants enrolled in this study were patients with COVID-19 who had been hospitalized at the Central Hospital of Wuhan, China. Chronic comorbidities and laboratory and radiological data were reviewed; patient outcomes and lengths of stay were obtained from discharge records. We used the Cox proportional-hazard model (CPHM) to analyze the effect of hypertension on these patients' outcomes and PSM analysis to further validate the abovementioned effect. RESULTS: A total of 226 patients with COVID-19 were enrolled in this study, of whom 176 survived and 50 died. The proportion of patients with hypertension among non-survivors was higher than that among survivors (26.70% vs. 74.00%; P < 0.001). Results obtained via CPHM showed that hypertension could increase risk of mortality in COVID-19 patients (hazard ratio 3.317; 95% CI [1.709-6.440]; P < 0.001). Increased D-dimer levels and higher ratio of neutrophils to lymphocytes (N/L) were also found to increase these patients' mortality risk. After matching on propensity score, we still came to similar conclusions. After we applied the same method in critically ill patients, we found that hypertension also increased risk of death in patients with severe COVID-19. CONCLUSION: Hypertension, increased D-dimer and the ratio of neutrophil to lymphocyte increased mortality in patients with COVID-19, with hypertension in particular.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Mortalidade Hospitalar , Hipertensão/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Idoso , China/epidemiologia , Técnicas de Laboratório Clínico/métodos , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/diagnóstico , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pandemias , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Sobreviventes , Centros de Atenção Terciária
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