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1.
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
3.
Rev Med Suisse ; 16(706): 1676-1679, 2020 Sep 16.
Artigo em Francês | MEDLINE | ID: mdl-32936547

RESUMO

The kidneys play a central role in the regulation of blood pressure and are also one of the main culprits of arterial hypertension (HT). Renal ultrasound is a valuable diagnostic tool that can provide instant information at the bedside on possible underlying causes and consequences of HT. Its role in the screening for renal artery stenosis is well-known. However, renal ultrasound can also detect abnormalities in renal parenchyma, morphology, or the vascularization of the kidneys, and as such directly influence further diagnostic work-up and treatment. The significance of the renal resistive index and the place of renal ultrasound in the latest international guidelines on HT are reviewed in this article.


Assuntos
Pressão Sanguínea , Hipertensão/etiologia , Rim/diagnóstico por imagem , Obstrução da Artéria Renal/diagnóstico por imagem , Ultrassonografia , Humanos
4.
JAMA ; 324(9): 879-887, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32870301

RESUMO

Importance: Severe obesity and its related diseases, such as type 2 diabetes, hypertension, dyslipidemia, and sleep apnea, are very common in the United States, but currently very few patients with these conditions choose to undergo bariatric surgery. Summaries of the expanding evidence for both the benefits and risks of bariatric surgery are needed to better guide shared decision-making conversations. Observations: There are approximately 252 000 bariatric procedures (per 2018 numbers) performed each year in the US, of which an estimated 15% are revisions. The 1991 National Institutes of Health guidelines recommended consideration of bariatric surgery in patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 40 or higher or 35 or higher with serious obesity-related comorbidities. These guidelines are still widely used; however, there is increasing evidence that bariatric procedures should also be considered for patients with type 2 diabetes and a body mass index of 30 to 35 if hyperglycemia is inadequately controlled despite optimal medical treatment for type 2 diabetes. Substantial evidence indicates that surgery results in greater improvements in weight loss and type 2 diabetes outcomes, compared with nonsurgical interventions, regardless of the type of procedures used. The 2 most common procedures used currently, the sleeve gastrectomy and gastric bypass, have similar effects on weight loss and diabetes outcomes and similar safety through at least 5-year follow-up. However, emerging evidence suggests that the sleeve procedure is associated with fewer reoperations, and the bypass procedure may lead to more durable weight loss and glycemic control. Although safety is a concern, current data indicate that the perioperative mortality rates range from 0.03% to 0.2%, which has substantially improved since early 2000s. More long-term randomized studies are needed to assess the effect of bariatric procedures on cardiovascular disease, cancer, and other health outcomes and to evaluate emerging newer procedures. Conclusions and Relevance: Modern bariatric procedures have strong evidence of efficacy and safety. All patients with severe obesity-and especially those with type 2 diabetes-should be engaged in a shared decision-making conversation about the risks and benefits of surgery compared with continuing usual medical and lifestyle treatment, and the decision about surgery should be driven primarily by informed patient preferences.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias , Perda de Peso , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/etiologia , Feminino , Gastrectomia , Humanos , Hipertensão/etiologia , Masculino , Obesidade Mórbida/complicações , Síndromes da Apneia do Sono/etiologia
5.
Cochrane Database Syst Rev ; 9: CD010022, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32960976

RESUMO

BACKGROUND: High blood pressure constitutes one of the leading causes of mortality and morbidity all over the world. At the same time, heavy drinking increases the risk for developing cardiovascular diseases, including cardiomyopathy, hypertension, atrial arrhythmias, or stroke. Several studies have already assessed specifically the relationship between alcohol intake and hypertension. However, the potential effect on blood pressure of alcohol intake reduction interventions is largely unknown. OBJECTIVES: To assess the effect of any intervention to reduce alcohol intake in terms of blood pressure decrease in hypertensive people with alcohol consumption compared to a control intervention or no intervention at all. To determine additional effects related to mortality, major cardiovascular events, serious adverse events, or quality of life. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to June 2020: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2020), MEDLINE Ovid (from 1946), MEDLINE Ovid Epub Ahead of Print, and MEDLINE Ovid In-Process, Embase Ovid (from 1974), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. Trial authors were contacted when needed and no language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials with minimum 12 weeks duration and including 50 or more subjects per group with quantitative measurement of alcohol consumption and/or biological measurement of the outcomes of interest. Participants were adults (16 years of age or older) with systolic blood pressure (SBP) greater than 140 mmHg and diastolic blood pressure (DBP) greater than 90 mmHg, and SBP ≥ 130 or DBP ≥ 80 mmHg in participants with diabetes. We included any intervention implemented to reduce their alcohol intake. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed search results and extracted data using standard methodological procedures adopted by Cochrane. MAIN RESULTS: A total of 1210 studies were screened. We included one randomised controlled trial involving a total of 269 participants with a two-year follow-up. Individual patient data for all participants were provided and used in this review. No differences were found between the cognitive-behavioural intervention group and the control group for overall mortality (RR 0.72, 95% CI 0.16 to 3.17; low-certainty evidence), cardiovascular mortality (not estimable) and cardiovascular events (RR 0.80, 95% CI 0.36 to 1.79; very low-certainty evidence). There was no statistical difference in systolic blood pressure (SBP) reduction (Mean Difference (MD) -0.92 mmHg, 95% confidence interval (CI) -5.66 to 3.82 mmHg; very low-certainty evidence) or diastolic blood pressure (DBP) decrease (MD 0.98 mmHg, 95% CI -1.69 to 3.65 mmHg; low-certainty evidence) between the cognitive-behavioural intervention group and the control group. We also did not find any differences in the proportion of subjects with SBP < 140 mmHg and DBP < 90 mmHg (Risk Ratio (RR) 1.21, 95% CI 0.88 to 1.65; very low-certainty evidence). Concerning secondary outcomes, the alcohol intake was significantly reduced in the cognitive-behavioural intervention compared with the control group (MD 191.33 g, 95% CI 85.36 to 297.30 g). We found no differences between the active and control intervention in the proportion of subjects with lower-risk alcohol intake versus higher-risk and extreme drinkers at the end of the study (RR 1.04, 95% CI 0.68 to 1.60). There were no estimable results for the quality of life outcome. AUTHORS' CONCLUSIONS: An intervention for decreasing alcohol intake consumption did not result in differences in systolic and diastolic blood pressure when compared with a control intervention, although there was a reduction in alcohol intake favouring the active intervention. No differences were found either for overall mortality, cardiovascular mortality or cardiovascular events. No data on serious adverse events or quality of life were available to assess. Adequate randomised controlled trials are needed to provide additional evidence on this specific question.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Terapia Cognitivo-Comportamental , Hipertensão/prevenção & controle , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/mortalidade , Viés , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
BMC Public Health ; 20(1): 1364, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891134

RESUMO

BACKGROUND: The co-morbidity of cardiometabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardiometabolic risk factors among patients with Tuberculosis. METHODS: This was a cross-sectional study conducted among patients with tuberculosis in 12 tuberculosis treatment centers from eight districts of Nepal between May and July 2017. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on-site blood glucose tests. Data were analyzed using descriptive and inferential statistics. RESULTS: Among 221 study participants, 138 (62.4%) had new smear-positive pulmonary tuberculosis, 24 (10.9%) had new smear-negative pulmonary tuberculosis and 34 (15.4%) had new extra- pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardiometabolic risk factor. The prevalence of at least one cardiometabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR = 0.47; CI: 0.23-0.94), those from Gandaki Province (AOR = 0.32; CI: 0.13-0.79) and literate (AOR = 0.49; CI: 0.25-0.96) had reduced risk of cardiometabolic disease risk factors. CONCLUSIONS: This study highlights the role of gender and socio-demographic characteristics associated with the risk of cardiometabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.


Assuntos
Hipertensão/epidemiologia , Obesidade/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Comorbidade , Estudos Transversais , Assistência à Saúde , Feminino , Instalações de Saúde , Humanos , Hipertensão/etiologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Doenças não Transmissíveis/epidemiologia , Obesidade/etiologia , Obesidade/terapia , Prevalência , Fatores de Risco , Fatores Sexuais , Uso de Tabaco/efeitos adversos , Tuberculose/epidemiologia , Tuberculose Pulmonar/terapia
7.
J Pregnancy ; 2020: 7864816, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32802511

RESUMO

Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the most significant causes of maternal morbidity and mortality. Hypertensive disorders, specifically gestational hypertension, chronic hypertension, and preeclampsia, throughout pregnancy are contributors to the top causes of maternal mortality in the United States. Diagnosis of hypertensive disorders throughout pregnancy is challenging, with many disorders often remaining unrecognized or poorly managed during and after pregnancy. Moreover, the research has identified a strong link between the prevalence of maternal hypertensive disorders and racial and ethnic disparities. Factors that influence the prevalence of maternal hypertensive disorders among racially and ethnically diverse women include maternal age, level of education, United States-born status, nonmetropolitan residence, prepregnancy obesity, excess weight gain during pregnancy, and gestational diabetes. Examination of the factors that increase the risk for maternal hypertensive disorders along with the current interventions utilized to manage hypertensive disorders will assist in the identification of gaps in prevention and treatment strategies and implications for future practice. Specific focus will be placed on disparities among racially and ethnically diverse women that increase the risk for maternal hypertensive disorders. This review will serve to promote the development of interventions and strategies that better address and prevent hypertensive disorders throughout a pregnant woman's continuum of care.


Assuntos
Disparidades em Assistência à Saúde/tendências , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Fatores Etários , Grupos de Populações Continentais , Diabetes Gestacional , Escolaridade , Feminino , Humanos , Hipertensão/etnologia , Hipertensão/etiologia , Gravidez , Complicações na Gravidez/etnologia , Complicações na Gravidez/etiologia , Prevalência , Risco , Estados Unidos/epidemiologia , Ganho de Peso
8.
PLoS Med ; 17(7): e1003206, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32722673

RESUMO

BACKGROUND: Previous clinical trials and institutional studies have demonstrated that surgery for the treatment of obesity (termed bariatric or metabolic surgery) reduces all-cause mortality and the development of obesity-related diseases such as type 2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia. The current study analysed large-scale population studies to assess the association of bariatric surgery with long-term mortality and incidence of new-onset obesity-related disease at a national level. METHODS AND FINDINGS: A systematic literature search of Medline (via PubMed), Embase, and Web of Science was performed. Articles were included if they were national or regional administrative database cohort studies reporting comparative risk of long-term mortality or incident obesity-related diseases for patients who have undergone any form of bariatric surgery compared with an appropriate control group with a minimum follow-up period of 18 months. Meta-analysis of hazard ratios (HRs) was performed for mortality risk, and pooled odds ratios (PORs) were calculated for discrete variables relating to incident disease. Eighteen studies were identified as suitable for inclusion. There were 1,539,904 patients included in the analysis, with 269,818 receiving bariatric surgery and 1,270,086 control patients. Bariatric surgery was associated with a reduced rate of all-cause mortality (POR 0.62, 95% CI 0.55 to 0.69, p < 0.001) and cardiovascular mortality (POR 0.50, 95% CI 0.35 to 0.71, p < 0.001). Bariatric surgery was strongly associated with reduced incidence of T2DM (POR 0.39, 95% CI 0.18 to 0.83, p = 0.010), hypertension (POR 0.36, 95% CI 0.32 to 0.40, p < 0.001), dyslipidaemia (POR 0.33, 95% CI 0.14 to 0.80, p = 0.010), and ischemic heart disease (POR 0.46, 95% CI 0.29 to 0.73, p = 0.001). Limitations of the study include that it was not possible to account for unmeasured variables, which may not have been equally distributed between patient groups given the non-randomised design of the studies included. There was also heterogeneity between studies in the nature of the control group utilised, and potential adverse outcomes related to bariatric surgery were not specifically examined due to a lack of available data. CONCLUSIONS: This pooled analysis suggests that bariatric surgery is associated with reduced long-term all-cause mortality and incidence of obesity-related disease in patients with obesity for the whole operated population. The results suggest that broader access to bariatric surgery for people with obesity may reduce the long-term sequelae of this disease and provide population-level benefits.


Assuntos
Cirurgia Bariátrica , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Obesidade/cirurgia , Adulto , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Doenças Cardiovasculares/etiologia , Comorbidade , Diabetes Mellitus Tipo 2/etiologia , Dislipidemias/epidemiologia , Dislipidemias/etiologia , Humanos , Hipertensão/etiologia , Incidência , Pessoa de Meia-Idade , Mortalidade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/etiologia , Obesidade/complicações , Obesidade/mortalidade , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/etiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
9.
Kardiologiia ; 60(6): 880, 2020 Jul 07.
Artigo em Russo | MEDLINE | ID: mdl-32720616

RESUMO

Aim To evaluate incidence of arterial hypertension (AH) in the posttransplantation period and to identify risk factors for this complication.Materials and methods From January, 2010 through December, 2017, 96 heart transplantations (HT) (70 men and 26 women aged 46.5±13.9 years) were performed. During the first month following HT, 8 recipients died and were excluded from the analysis. The retrospective evaluation of results included 88 patients followed up for more than one year.Results For the entire post-HT period (maximum 92 months), AH was observed in 75 of 88 (85%) recipients. Post-HT AH was correlated with male gender (r=0.24; p=0.031), history of smoking before HT (r=0.45; p<0.001), history of ischemic heart disease (IHD) (r=0.28; p=0.01), older age (r=0.35; p=0.001), higher body weight index (r=0.37; p=0.0005), creatinine level (r=0.37; p=0.001), and low-density lipoprotein cholesterol level (r=0.27; p=0.04). Interrelations with other AH risk factors were not found. Most patients developed AH within the first two years after HT. During the first year, AH was diagnosed in 60% (53 of 88) of patients (relapse, 85% (n=29); newly diagnosed, 45% (n=24), p=0.0003). At two years, AH was detected in 79% (46 of 58) of patients (relapse, 53% (n=18); newly diagnosed, 53% (n=28), p=0.9). All recipients received an adequate antihypertensive therapy. 40-63% of patients required a single-drug therapy at different points of follow-up; from 29 to 45% of patients required a two-drug therapy, and 5-15% of patients required three or more drugs. During all 5 years of treatment, most patients used angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) (70-87%) and slow calcium channel blockers (SCCB) (48-53%). The presence of AH following HT was associated with development of all cardiovascular events (CVE; r=0.31; p=0.012) whereas persistent AH, which required a combination antihypertensive treatment, was associated with a high mortality (r=0.61; p=0.015).Conclusion AH is a frequent complication of HT (85%), which is newly diagnosed in most patients during the first two years. AH incidence was higher for male recipients with a history of IHD, hypertension, and smoking. Approximately half of patients required only a single-drug antihypertensive therapy. After HT, the most frequently prescribed drugs included ACE inhibitors or ARBs and SCCBs (70-87% and 48-53%, respectively, depending on the time elapsed after HT). Persistent AH requiring a treatment with two or more antihypertensive drugs was associated with development of all CVEs and a higher long-term mortality.


Assuntos
Transplante de Coração , Hipertensão , Adulto , Inibidores da Enzima Conversora de Angiotensina , Anti-Hipertensivos , Feminino , Transplante de Coração/efeitos adversos , Humanos , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 99(28): e20918, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664087

RESUMO

RATIONALE: Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare neuropathic syndrome with typical clinical and radiological features. There are large amounts of risk factors resulting in RPLS, those including hypertension, eclampsia, neoplasia treatment, renal failure, systemic infections, chemotherapy, and immunosuppressive therapy after organ transplantation. PATIENT CONCERNS: A 27-year-old male patient was admitted for a 2-week history of paroxysmal tic of limbs along with consciousness disorder. Blood pressure elevation was discovered for the first time on admission, and the highest record was 210/150 mmHg during hospitalization. Neurological examinations were positive among mental state, speech, reaction and pathological reflex. The computed tomography scan of the abdomen demonstrated a mass derived from right adrenal gland. The magnetic resonance imaging of the brain showed reversible lesions in the centrum ovale, paraventricular, area and corpus callosum. DIAGNOSES: After control of blood pressure and rationally preoperative preparation, the mass was radically resected and verified to be pheochromocytoma by postoperative pathologic findings. He was diagnosed as having RPLS due to adrenal pheochromocytoma. INTERVENTIONS: The right adrenal gland mass was completely removed after 2 weeks of α-blockers and ß-blockers to treat hypertension. OUTCOMES: One week after surgery, the cerebral lesions of RPLS gradually faded and the blood pressure was easy to control well. LESSONS: A few case reports of RPLS related to pheochromocytomas had been documented in the literature. Therefore, we believe that pheochromocytomas may be a potential risk factor of RPLS. If patients receive timely diagnosis and treatment, it can often lead to a favorable prognosis.


Assuntos
Encéfalo/diagnóstico por imagem , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Síndrome da Leucoencefalopatia Posterior/etiologia , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Assistência ao Convalescente , Encéfalo/patologia , Criança , Transtornos da Consciência/etiologia , Feminino , Hospitalização , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Exame Neurológico/métodos , Feocromocitoma/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Fatores de Risco , Transtornos de Tique/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
13.
PLoS One ; 15(6): e0234326, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516351

RESUMO

BACKGROUND: Studies in high-income countries have documented a consistent gradient between socio-economic status (SES) and high blood pressure (HBP), a key risk factor for cardiovascular disease (CVD). However, evidence from Latin American countries (LA) remains comparatively scarce and inconclusive. DATA: Data for 3,984 individuals came from a nationally representative survey of individuals aged 60 years or above in Colombia (Encuesta de Salud, Bienestar y Envejecimiento) (SABE) conducted in 2015. SES was measured by educational achievement and household assets. CVD risk factors included objectively measured HBP and body mass index (BMI), as well as behaviors (smoking, alcohol consumption, fruit and vegetables intake, and physical activity). METHODS: Bivariate methods and multivariate regression models were used to assess associations between SES with HBP as well as additional risk factors for CVD. RESULTS: Individuals with lower SES have significantly higher risk of suffering from HBP. Compared to those with no formal education, individuals with secondary or post-secondary education have a 37% lower risk of HBP (odds ratio [OR] = 0.63, P-value<0.001). Being in the highest asset quartile (most affluent) is associated with a 44% lower risk (OR = 56, P-value = 0.001) of HBP compared to those in the lowest asset quartile (most deprived). Individuals with lower SES are more likely to smoke, not engage in regular physical activity and not regularly consume fruits or vegetables. In contrast, individuals with higher SES are more likely to consume alcohol and, those with more assets, more likely to be obese. CONCLUSIONS: Among older Colombians there exists a marked SES gradient in HBP as well as several additional risk factors for CVD. The results highlight the importance of a public health approach towards HBP and additional CVD risk factors that takes into account the specific conditions of older individuals, especially among disadvantaged groups.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Hipertensão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Colômbia/epidemiologia , Estudos Transversais , Exercício Físico/fisiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/etiologia , Renda , Masculino , Pessoa de Meia-Idade , Obesidade/etiologia , Obesidade/metabolismo , Fatores de Risco , Fumar/efeitos adversos , Classe Social , Fatores Socioeconômicos
14.
PLoS One ; 15(6): e0234485, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525916

RESUMO

INTRODUCTION: Hypertension is the leading cause of death and disability in adult populations globally. Its prevalence is increasing rapidly in Ethiopia. Studies conducted to date address different population categories. However, there is lack of data on the prevalence and risk factors of hypertension among civil servants working in various sectors and levels. OBJECTIVE: To assess the prevalence and risk factors of hypertension among civil servants in Sidama Zone, south Ethiopia. METHODS AND MATERIALS: An institution-based cross-sectional study was conducted from March 1-30, 2019 on a sample of 546 civil servants selected randomly from different departments of Sidama Zone Administration. Data were collected using structured, face-to-face interviewer-administered questionnaire and standard physical measurements. The data were entered using Epi Data 3.1 and analyzed using SPSS version 20. Multivariable logistic regression analysis was used to identify factors associated with hypertension. Adjusted odds ratios (AORs) with 95% confidence interval (CI) were computed to assess the presence and strength of associations. RESULTS: A total of 546 civil servants responded resulting in a response rate of 94.9%. The prevalence of hypertension was 24.5% [95% CI: 23.3% - 25.6%]. The identified risk factors of hypertension were male sex (AOR 4.31[95% CI: 1.84-10.09]), moderate current alcohol consumption (AOR: 4.85; [95% CI: 1.73-13.61]), current khat chewing (AOR 2.97[95% CI: 1.38-6.40]), old age (AOR: 4.41[95% CI: 1.19-16.26]), being obese (AOR 5.94 [95% CI: 1.26-27.86]) and central obesity (AOR 3.57 [95% CI: 1.80-7.07]). CONCLUSIONS: One in four civil servants are hypertensive. Different demographic, behavioral and metabolic factors increase the odds of hypertension among civil servants. Prevention and control of hypertension shall involve promotion of healthy lifestyles such as weight management, regular physical activity and quitting or cutting down on harmful use of substances such as alcohol and khat.


Assuntos
Empregados do Governo/estatística & dados numéricos , Estilo de Vida Saudável , Hipertensão/epidemiologia , Comportamento Sedentário , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Promoção da Saúde , Humanos , Hipertensão/etiologia , Hipertensão/prevenção & controle , Governo Local , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
15.
Am Heart J ; 225: 78-87, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32474207

RESUMO

BACKGROUND: The severity of aortic coarctation (CoA) may be underestimated during cardiac catheterization. We aimed to investigate whether epinephrine stress testing improves clinical decision making and outcome in CoA. METHODS: We retrospectively evaluated CoA patients >50 kg with a peak systolic gradient (PSG) ≤20 mm Hg during cardiac catheterization who underwent epinephrine stress testing. Subsequent interventional management (stenting or balloon dilatation), complications, and medium-term clinical outcome were assessed. RESULTS: Fifty CoA patients underwent cardiac catheterization with epinephrine stress testing. Patients with a high epinephrine PSG (>20 mm Hg; n = 24) were younger and more likely to have a hypertensive response to exercise compared to patients with a low epinephrine PSG (≤20 mm Hg; n = 26). In total, 21 patients (88%) with a high epinephrine PSG underwent intervention, and 20 patients (77%) with a low epinephrine PSG were treated conservatively. After a mean follow-up of 25 ±â€¯18 months, there was a lower prevalence of hypertension in patients with a high epinephrine PSG who underwent intervention compared to patients with a low epinephrine PSG treated conservatively (19% vs. 76%; P = .001). In a multivariate model, intervention was independently associated with a 14.3-mm Hg reduction in systolic blood pressure (P = .001) and a decrease in the use of antihypertensive agents. CONCLUSIONS: In CoA patients with a low baseline PSG but high epinephrine PSG, percutaneous intervention is associated with a substantial reduction in systemic blood pressure and the use of antihypertensive medication. Accordingly, epinephrine stress testing may be a useful addition in the evaluation of CoA.


Assuntos
Agonistas Adrenérgicos beta/farmacologia , Coartação Aórtica/cirurgia , Pressão Sanguínea/efeitos dos fármacos , Cateterismo Cardíaco , Epinefrina/farmacologia , Adolescente , Adulto , Coartação Aórtica/diagnóstico , Coartação Aórtica/fisiopatologia , Tomada de Decisão Clínica , Teste de Esforço/métodos , Feminino , Humanos , Hipertensão/etiologia , Masculino , Estudos Retrospectivos , Sístole/fisiologia , Adulto Jovem
16.
PLoS One ; 15(6): e0233785, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32521542

RESUMO

This study evaluated the impact of combined exercise training on the development of cardiovascular and neuroimmune complications induced by fructose consumption (10% in the drinking water) in hypertensive rats (SHR). After weaning, SHR were divided into 3 groups: SHR (H), SHR+fructose (HF) and SHR+fructose+combined exercise training (treadmill+ladder, 40-60% of maximum capacity) (HFTC). Metabolic, hemodynamic, autonomic, inflammatory and oxidative stress parameters were evaluated in the subgroups (n = 6 group/time) at 7, 15, 30 and 60 days of protocol. Fructose consumption (H vs. HF groups) decreased spontaneous baroreflex sensitivity and total variance of pulse interval at day 7 (7 to 60); increased IL-6 and TNFα in the heart (at day 15, 30 and 60) and NADPH oxidase activity and cardiac lipoperoxidation (LPO) (day 60); increased white adipose tissue weight, reduced insulin sensitivity and increased triglycerides (day 60); induced an additional increase in mean arterial pressure (MAP) (days 30 and 60). Combined exercise training prevented such dysfunctions and sustained increased cardiac IL-10 (day 7) and glutathione redox balance (GSH/GSSG) for the entire protocol. In conclusion, combined exercise training performed simultaneously with exacerbated fructose consumption prevented early cardiovascular autonomic dysfunction, probably trigging positive changes in inflammation and oxidative stress, resulting in a better cardiometabolic profile in rats genetically predisposed to hypertension.


Assuntos
Hipertensão/terapia , Condicionamento Físico Animal/métodos , Animais , Barorreflexo , Pressão Sanguínea , Frutose/efeitos adversos , Frequência Cardíaca , Hipertensão/etiologia , Interleucina-10/metabolismo , Interleucina-6/metabolismo , Masculino , Miocárdio/metabolismo , NADPH Oxidases/metabolismo , Estresse Oxidativo , Ratos , Ratos Endogâmicos SHR , Fator de Necrose Tumoral alfa/metabolismo
17.
Angiol Sosud Khir ; 26(2): 10-16, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597880

RESUMO

Ageing is considered to be the major and non-modifiable risk factor for the development of hypertension and cardiovascular diseases. During ageing, the vascular system undergoes structural and functional alterations, including endothelial dysfunction, thickening of the vascular wall, reduced distensibility and increased arterial stiffness. Vascular rigidity results from fibrosis and remodelling of the extracellular matrix, processes that are associated with ageing and are amplified in hypertension. These events may be induced by vasoactive agents, such as angiotensin II, endothelin-1, and aldosterone, which are increased in the vasculature during aging and hypertension. Complex interaction between the process of ageing and prohypertensive factors results in accelerated vascular remodelling and fibrosis, as well as increased arterial stiffness. Hypertension accelerates and augments age-related vascular remodelling and dysfunction, and ageing may impact on the severity of vascular damage in hypertension, thus strongly suggesting close interactions between biological ageing and blood pressure elevation. Molecular and cellular mechanisms underlying vascular alterations in ageing and hypertension are common and include aberrant signal transduction, oxidative stress and activation of pro-inflammatory and pro-fibrotic transcription factors. Strategies to suppress age-associated vascular changes can ameliorate vascular damage associated with hypertension. This article looks into vascular alterations occurring during ageing and hypertension, focussing particularly on arterial stiffness and vascular remodelling, also emphasizing the importance of diagnostic methods.


Assuntos
Doenças Cardiovasculares , Hipertensão/etiologia , Rigidez Vascular , Envelhecimento , Endotelina-1 , Humanos
19.
Praxis (Bern 1994) ; 109(7): 513-516, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32456579

RESUMO

An Uncommon Cause of Arterial Hypertension Abstract. A 54-year-old patient was suffering from arterial hypertension, which was not treated sufficiently despite an antihypertensive therapy with three different types of drugs. In addition, the patient complained an increase in weight of ten kilos during the last year and a new onset of diabetes mellitus type 2. Investigations as to secondary forms of hypertension by MRI revealed an adrenal tumor with a diameter of approx. 6 cm suspect for an adrenal carcinoma. An ACTH-independent cushing syndrome was diagnosed by 24-hour urines collection, 1-mg dexamethasone supression test, and midnight-cortisol measurement. After a laparoscopic tumor excision, histopathological analyses confirmed an adrenal carcinoma.


Assuntos
Neoplasias das Glândulas Suprarrenais , Síndrome de Cushing , Hipertensão , Neoplasias das Glândulas Suprarrenais/complicações , Síndrome de Cushing/complicações , Humanos , Hidrocortisona , Hipertensão/etiologia , Pessoa de Meia-Idade
20.
Pediatr Blood Cancer ; 67(8): e28209, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32472983

RESUMO

BACKGROUND: Patients with high-risk neuroblastoma (HR NBL) treated with myeloablative regimens are reported to be at risk for cardiovascular morbidity, and this risk may be increased by impaired renal function. PROCEDURE: Long-term renal function was assessed in a national cohort of 18 (age 22.4 ± 4.9 years) HR NBL survivors by plasma creatinine (P-Cr), urea, and cystatin C (P-Cys C) concentrations, urine albumin/creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR). Ambulatory blood pressure was monitored, and common carotid intima-media thickness (CIMT) and left ventricular mass index (LVMI) were evaluated. RESULTS: No significant difference in P-Cr, P-Cys C, or eGFR was found between the NBL survivors and the age- and sex-matched 20 controls. P-Cys C-based eGFR (eGFRcysc) was significantly lower than the P-Cr-based eGFRcr (97 ± 17 mL/min/1.73 m2 vs 111 ± 19 mL/min/1.73 m2 , P < 0.001) among the NBL survivors. The eGFRcysc was below normal in 28%, and ACR was above normal in 22% of the NBL survivors. Abnormal blood pressure was found in 56% of the survivors, and an additional 17% were normotensive at daytime but had significant nocturnal hypertension. Both ACR and P-Cys C were associated with nighttime diastolic hypertension. CONCLUSIONS: Long-term survivors of childhood HR NBL showed signs of only mild renal dysfunction associated with diastolic hypertension. Elevated ACR and P-Cys C were the most sensitive indicators of glomerular renal dysfunction and hypertension in this patient cohort.


Assuntos
Sobreviventes de Câncer , Hipertensão , Testes de Função Renal , Neuroblastoma , Adolescente , Adulto , Creatinina/sangue , Cistatina C/sangue , Feminino , Seguimentos , Humanos , Hipertensão/sangue , Hipertensão/etiologia , Masculino , Neuroblastoma/sangue , Neuroblastoma/terapia , Ureia/sangue
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