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1.
JAMA ; 324(14): 1429-1438, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33048153

RESUMO

Importance: The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person's place of residence vs the characteristics of the people who live in different places remains unclear. Objective: To estimate the degree to which geographic differences in leading risk factors are associated with a person's place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. Design, Setting, and Participants: This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers' destination and origin zip codes and changes in individuals' likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. Exposures: The difference in the prevalence of uncontrolled chronic conditions between a person's origin zip code and destination zip code (excluding the individual mover's outcomes). Main Outcomes and Measures: Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. Results: The study population included 5 342 207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. Conclusions and Relevance: In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals' likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals' likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person's place of residence.


Assuntos
Transtorno Depressivo/epidemiologia , Diabetes Mellitus/epidemiologia , Migração Humana/estatística & dados numéricos , Hipertensão/epidemiologia , Obesidade/epidemiologia , Características de Residência/estatística & dados numéricos , Doença Crônica/epidemiologia , Doença Crônica/etnologia , Transtorno Depressivo/etnologia , Diabetes Mellitus/etnologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Geografia Médica , Migração Humana/tendências , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Incerteza , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos
2.
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
3.
J Natl Black Nurses Assoc ; 31(1): 46-51, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32853496

RESUMO

African-Americans are disproportionately affected by hypertension with lower rates of blood pressure control in comparison to the general population (Brennan et al., 2010). Low-sodium dietary intake is one of the most important lifestyle changes that can help control hypertension (Zhang et al., 2013). This qualitative study aimed to explore and describe the perceptions and experiences of low-sodium dietary practices among African-American women with hypertension. The study used a single-category focus group design. The findings suggest that African-American women are attempting to follow a low-sodium diet; however, they are influenced by personal and environmental factors and lack a clear understanding of what a low-sodium diet entails. Therefore, nurses must understand the factors that influence African-American women's ability to follow a low-sodium diet so that effective interventions can be implemented to improve adherence in this population.


Assuntos
Afro-Americanos/psicologia , Dieta Hipossódica/etnologia , Dieta Hipossódica/psicologia , Hipertensão/dietoterapia , Hipertensão/etnologia , Afro-Americanos/estatística & dados numéricos , Dieta Hipossódica/enfermagem , Feminino , Grupos Focais , Disparidades nos Níveis de Saúde , Humanos , Hipertensão/enfermagem , Pesquisa Qualitativa , Cooperação e Adesão ao Tratamento/etnologia
4.
J Natl Black Nurses Assoc ; 31(1): 52-59, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32853497

RESUMO

African-Americans with hypertension continue to demonstrate poor blood pressure (BP) control and have markedly lower rates of hypertension self-management compared to non-African-Americans. Innovative and practical solutions such as mHealth technology are promising and can be leveraged to promote self-management of hypertension. Substantial evidence has demonstrated the importance of community support in improving patients' management of chronic illnesses. Unfortunately, such programs do not offer technology-based interventions (TBI) as a delivery method. Thus, this paper describes the design and rationale of an ongoing pilot study that incorporates TBI using a community-based participatory approach.


Assuntos
Afro-Americanos , Hipertensão/etnologia , Hipertensão/terapia , Autogestão/métodos , Pesquisa Participativa Baseada na Comunidade , Disparidades nos Níveis de Saúde , Humanos , Projetos Piloto , Telemedicina
5.
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
6.
Vasc Health Risk Manag ; 16: 299-305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764950

RESUMO

Objective: The main aim of this study was to investigate predictive factors of adherence to the hypertension control therapeutic and lifestyle recommendations in a sample of Iranian patients based on the constructs of Pender's health promotion model. Patients and Methods: The cross-sectional study was performed on the 380 hypertensive patients who were referred to the health centers, the emergency and internal diseases departments of the Bagheralolom Hospital, and the cardiologists' offices in the city of Ahar, North West of Iran. Data were collected using a researcher designed questionnaire based on the Pender's health promotion model. The Pearson correlation test, multivariate linear regression, and independent t-test were used for data analysis. Results: Mean age of the recruited patients was 52.94 (SD=12.8). Perceived benefits, perceived barriers, situational influences, and interpersonal influences (adjusted R2= 0.525) explained 52.5% of the observed variation in adherence to hypertension control recommendations. Conclusion: Successful hypertension control in patients with chronic morbidity need to be based on sound data about major determinants of the relevant health/illness behaviors. The study findings revealed that the Pender's health promotion model could be applicable as a theoretical framework to identify major determinants of adherence to hypertension control recommendations. Future cross-cultural validation of the study findings in more representative and larger sample sizes could add to the legitimacy of the evidence surrounding self-care practices in hypertensive patients.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Hipertensão/terapia , Adesão à Medicação , Modelos Teóricos , Comportamento de Redução do Risco , Adulto , Idoso , Anti-Hipertensivos/efeitos adversos , Estudos Transversais , Características Culturais , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Hipertensão/etnologia , Hipertensão/fisiopatologia , Hipertensão/psicologia , Irã (Geográfico)/epidemiologia , Masculino , Adesão à Medicação/etnologia , Pessoa de Meia-Idade , Resultado do Tratamento
7.
J Stroke Cerebrovasc Dis ; 29(8): 104987, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689593

RESUMO

BACKGROUND AND PURPOSE: Recent studies show rising incidence of stroke in the young, for which risk factors are not well characterized. There is evidence of increased risk in certain racial and ethnic groups. We assessed racial differences in risk factors, stroke etiology, and outcomes among young stroke patients. METHODS: Using data from our inpatient registry for ischemic stroke, we reviewed patients aged 18-50 who were admitted 01/2013 to 04/2018. Race/ethnicity were characterized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HIS). For univariate comparisons Chi-square and Kruskal-Wallis tests were performed as appropriate. Multivariable logistic regression was used to assess impact of race on day seven modified Rankin score (mRS). RESULTS: Among 810 patients with race and outcome data who were admitted in the study period, median age was 43, 57.1% were male, and 36.5% NHW, 43.2% NHB, 20.2% HIS. History of hypertension (HTN), type II diabetes (DM II), smoking, heart failure (CHF), prior stroke, and end-stage renal disease varied significantly by race. Compared to NHW, NHB had higher odds of HTN (OR 2.28, 1.65-3.15), CHF (OR 2.17, 1.06-4.46), and DM II 1.92 (1.25-2.94) while HIS had higher odds of DM II (OR 2.52, 1.55-4.10) and lower odds of smoking (OR 0.56, 0.35-0.90). Arrival NIHSS was higher in NHB, but etiology and rates of tpA treatment and thrombectomy did not vary by race. Compared to NHW patients, NHB (OR 0.50 CI (0.31-0.78)) and HIS (OR 0.37 CI (0.21-0.67)) were less likely to have good functional outcome (mRS <2) at day 7 in adjusted analyses. CONCLUSIONS: In this study, there was a higher prevalence of several modifiable risk factors in NHB and HIS young stroke patients and early functional outcome was worse in these groups. Our study suggests a need for targeted prevention efforts for younger populations at highest risk for stroke.


Assuntos
Afro-Americanos , Isquemia Encefálica/etnologia , Grupo com Ancestrais do Continente Europeu , Disparidades nos Níveis de Saúde , Hispano-Americanos , Acidente Vascular Cerebral/etnologia , Adolescente , Adulto , Fatores Etários , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Bases de Dados Factuais , Diabetes Mellitus/etnologia , Avaliação da Deficiência , Feminino , Humanos , Hipertensão/etnologia , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores Raciais , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/etnologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Texas/epidemiologia , Fatores de Tempo , Adulto Jovem
8.
South Med J ; 113(6): 311-319, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483642

RESUMO

OBJECTIVES: Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18-39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored. METHODS: A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors. RESULTS: Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124). CONCLUSIONS: Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.


Assuntos
Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Doenças Vasculares Periféricas/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etnologia , Americanos Asiáticos/estatística & dados numéricos , Bases de Dados Factuais , Diabetes Mellitus/etnologia , Dislipidemias/etnologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização , Humanos , Hipertensão/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etnologia , Obesidade/etnologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Doenças Vasculares Periféricas/etnologia , Prevalência , Fatores de Risco , Fatores Sexuais , Fumar/etnologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etnologia , Estados Unidos/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etnologia , Adulto Jovem
9.
J Natl Med Assoc ; 112(3): 315-323, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563685

RESUMO

BACKGROUND: Cardiovascular disease related mortality is the leading cause of death in the United States, with hypertension being the most prevalent and potent risk factor. For decades hypertension has disproportionately affected African Americans, who also have a higher burden of associated comorbidities including diabetes and heart failure. METHODS: Current literature including guideline reports and newer studies on hypertension in African Americans in PubMed were reviewed. We also reviewed newer publications on the relationship between COVID-19 and cardiovascular disease. FINDINGS: While APOL1 has been theorized in the epidemiology of hypertension, the increased prevalence and associated risks are primarily due to environmental and lifestyle factors. These factors include poor diet, adverse lifestyle, and social determinants. Hypertension control can be achieved by lifestyle modifications such as low sodium diet, weight loss, and adequate physical activity. When lifestyle modifications alone do not adequately control hypertension, a common occurrence among African Americans who suffer with greater prevalence of resistant hypertension, pharmacological intervention is indicated. The efficacy of renal denervation, and the use of sodium-glucose cotransporter 2 and aminopeptidase A inhibitors, have been studied for treatment of resistant hypertension. Furthermore, the recent COVID-19 crisis has been particularly devastating among African Americans who demonstrate increased incidence and poorer health outcomes related to the disease. CONCLUSION: The disparities in outcomes, which are largely attributable to a greater prevalence of comorbidities such as hypertension and obesity, in addition to adverse environmental and socioeconomic factors, highlight the necessity of specialized clinical approaches and programs for African Americans to address longstanding barriers to equitable care.


Assuntos
Afro-Americanos/estatística & dados numéricos , Doenças Cardiovasculares/etnologia , Infecções por Coronavirus/etnologia , Disparidades em Assistência à Saúde/etnologia , Hipertensão/etnologia , Pneumonia Viral/etnologia , Populações Vulneráveis/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Hipertensão/diagnóstico , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Fatores Socioeconômicos , Análise de Sobrevida , Estados Unidos/epidemiologia
11.
N Z Med J ; 133(1514): 33-40, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32379737

RESUMO

BACKGROUND: Aortic dissection is a life-threatening condition frequently requiring emergency surgery. Key risk factors include hypertension and aortopathy syndromes; however, possible ethnic associations and differences in presentation and outcomes are less well established. We compared characteristics and outcomes of type A aortic dissection surgery by ethnicity. METHODS: Consecutive patients having type A aortic dissection surgery at Auckland City Hospital March 2003-March 2017 were divided into three ethnic groups: Maori, Pasifika and 'other', and analysed for characteristics, presentation and outcomes. RESULTS: Among 327 patients, 45 (14%) were Maori, 91 (28%) were Pasifika Islander and 191 (58%) were other ethnicities. Mean age was lowest for Maori 51+/-12 years, then Pasifika 56+/-12 and other ethnicities 63+/-13 (P<0.001). Maori and Pasifika ethnicities had higher body mass index, more hypertension, dyslipidaemia and smoking, but lower proportion presenting in critical pre-operative state. Operative mortality occurred in 5 (11%), 18 (20%) and 42 (22%) for Maori, Pasifika and other ethnicities (P=0.258). Pasifika had higher age-standardised operative mortality standardised mortality ratio 6.00, 95% confidence interval 3.67-9.30 than 'other' ethnicities, while Maori had higher age-standardised late mortality 5.71, 2.90-10.2 respectively, and the latter association persisted in multivariable analysis. Critical pre-operative state and malperfusion syndrome independently predicted operative mortality. CONCLUSION: Maori and Pasifika patients were younger and present less unwell with type A aortic dissection, but had higher prevalence of cardiovascular risk factors. They had higher age-standardised late and operative mortality respectively, suggesting that aggressive management and risk factor control are critical for these patients.


Assuntos
Aneurisma Dissecante/etnologia , Aneurisma Dissecante/cirurgia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/mortalidade , Adulto , Idoso , Índice de Massa Corporal , Dislipidemias/etnologia , Feminino , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Gravidade do Paciente , Fatores de Risco , Fumar/etnologia , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 29(7): 104754, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32370925

RESUMO

BACKGROUND AND AIM: It is unclear whether blood pressure (BP) is associated with cognition after stroke. We examined associations between systolic and diastolic BP (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP), and cognition, each measured 90 days after stroke. METHODS: Cross-sectional analysis of prospectively obtained data of 432 dementia-free subjects greater than or equal to 45 (median age, 66; 45% female) with stroke (92% ischemic; median NIH stroke score, 3 [IQR, 2-6]) from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project in 2011-2013. PRIMARY OUTCOME: Modified Mini-Mental Status Examination (3MSE; range, 0-100). SECONDARY OUTCOMES: Animal Fluency Test (AFT; range, 0-10) and Trail Making Tests A and B (number of correct items [range, 0-25]/completion time [Trails A: 0-180 seconds; Trails B: 0-300 second]). Linear or tobit regression adjusted associations for age, education, and race/ethnicity as well as variables significantly associated with BP and cognition. RESULTS: Higher SBP, lower DBP, higher PP, and lower MAP each were associated with worse cognitive performance for all 4 tests (all P < .001). After adjusting for patient factors, no BP measures were associated with any of the 4 tests (all P > .05). Lower cognitive performance was associated with older age, less education, Mexican American ethnicity, diabetes, higher stroke severity, more depressive symptoms, and lower BMI. Among survivors with hypertension, anti-hypertensive medication use 90 days after stroke was significantly associated with higher AFT scores (P = .02) but not other tests (P > .15). CONCLUSIONS: Stroke survivors' BP levels were not associated with cognitive performance at 90 days independent of sociodemographic and clinical factors.


Assuntos
Pressão Sanguínea , Transtornos Cognitivos/etnologia , Cognição , Hipertensão/etnologia , Acidente Vascular Cerebral/etnologia , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Cognição/efeitos dos fármacos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Estudos Transversais , Avaliação da Deficiência , Grupo com Ancestrais do Continente Europeu , Função Executiva , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Testes de Estado Mental e Demência , Americanos Mexicanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prognóstico , Fatores de Risco , Determinantes Sociais da Saúde/economia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Texas/epidemiologia , Fatores de Tempo
13.
Arch Cardiovasc Dis ; 113(6-7): 433-442, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32434710

RESUMO

BACKGROUND: Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. AIMS: To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. METHODS: We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. RESULTS: Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. CONCLUSIONS: High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Dieta Hipossódica , Hipertensão/terapia , Adesão à Medicação/etnologia , Comportamento de Redução do Risco , África ao Sul do Saara/epidemiologia , Grupo com Ancestrais do Continente Africano , Idoso , Estudos Transversais , Dieta Hipossódica/etnologia , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Hipertensão/diagnóstico , Hipertensão/etnologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
14.
Lancet ; 395(10234): 1444-1451, 2020 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-32234534

RESUMO

BACKGROUND: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. METHODS: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. FINDINGS: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0·999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was -3·9 mm Hg (Bayesian 95% credible interval -6·2 to -1·6) and for office systolic blood pressure the difference was -6·5 mm Hg (-9·6 to -3·5). No major device-related or procedural-related safety events occurred up to 3 months. INTERPRETATION: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. FUNDING: Medtronic.


Assuntos
Hipertensão/cirurgia , Rim/inervação , Rim/cirurgia , Adulto , Anti-Hipertensivos/normas , Austrália/epidemiologia , Áustria/epidemiologia , Teorema de Bayes , Pressão Sanguínea/fisiologia , Canadá/epidemiologia , Feminino , Alemanha/epidemiologia , Grécia/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/etnologia , Irlanda/epidemiologia , Japão/epidemiologia , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Placebos/efeitos adversos , Estudos Prospectivos , Simpatectomia/métodos , Resultado do Tratamento , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
15.
BMC Public Health ; 20(1): 566, 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345300

RESUMO

BACKGROUND: Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. METHODS: Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors. RESULTS: After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16-1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01-1.52 and PR 1.13 95% CI 1.03-1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03-1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46-0.84). CONCLUSIONS: Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.


Assuntos
Afeto , Afro-Americanos/psicologia , Doenças Cardiovasculares/psicologia , Adulto , Idoso , Ira , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Estudos Transversais , Depressão/complicações , Depressão/epidemiologia , Depressão/etnologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Diabetes Mellitus/psicologia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etnologia , Hipertensão/psicologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etnologia , Obesidade/psicologia , Distribuição de Poisson , Prevalência , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Classe Social , Estresse Psicológico/complicações , Estresse Psicológico/epidemiologia , Estresse Psicológico/etnologia
16.
High Blood Press Cardiovasc Prev ; 27(3): 239-249, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32266707

RESUMO

INTRODUCTION: This study examined the prevalence of pre-hypertension (PHT) and hypertension (HT) in urban youth, and assessed the effects of sodium intake and obesity on blood pressure (BP) by ethnicity. METHODS: A convenience sample of 557 multiethnic youth, aged 11-23 years, was recruited from 12 schools and institutions in Edmonton, Alberta, Canada. Participants were divided by self-identified ethnicity into four groups (Indigenous, African and Middle Eastern (AME), Asian, and European). RESULTS: Between October 2013 and March 2014, one-on-one interviews were conducted to collect data on demographics, physical activity, diet, and Body Mass Index (BMI). BP was obtained at two different times during the interview and measured a third time in cases of high variability. The standard deviation scores (SDS) of systolic BP (SBP) and diastolic BP (DBP) were used to estimate associations with sodium intake (per 1000 mg/day). Overall, 18.2% and 5.4% of the participants had PHT and HT, respectively. Indigenous and AME participants showed the highest rates of PHT (23.1%). Indigenous and European participants showed higher rates of HT (8.3% and 5.3%, respectively) than other ethnic groups (AME = 4.4%, Asian = 3.9%). There was a positive association between 1000 mg/day increase in sodium intake and SDS of SBP by 0.041 (95% CI 0.007-0.083; p = 0.04) among pre-hypertensive participants. Over 85% of participants exceeded the recommended dietary sodium intake. Mean BMI and dietary sodium intake were higher among pre-hypertensive participants (4219 mg/day) than normotensive (3475 mg/day). CONCLUSIONS: The prevalence of HT varied by ethnicity. High dietary sodium intake was of concern. There is a need for culturally-tailored, population-based interventions to reduce sodium intake.


Assuntos
Pressão Sanguínea , Hipertensão/etnologia , Estilo de Vida/etnologia , Pré-Hipertensão/etnologia , Sódio na Dieta/efeitos adversos , Saúde da População Urbana/etnologia , Adolescente , Grupo com Ancestrais do Continente Africano , Fatores Etários , Alberta/epidemiologia , Grupo com Ancestrais do Continente Asiático , Criança , Estudos Transversais , Dieta Hipossódica/etnologia , Grupo com Ancestrais do Continente Europeu , Exercício Físico , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Inquéritos Epidemiológicos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/prevenção & controle , Índios Norte-Americanos , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/etnologia , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/fisiopatologia , Pré-Hipertensão/prevenção & controle , Prevalência , Fatores Raciais , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Adulto Jovem
17.
Angiology ; 71(6): 520-535, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32180436

RESUMO

We evaluated the association between automatically measured carotid total plaque area (TPA) and the estimated glomerular filtration rate (eGFR), a biomarker of chronic kidney disease (CKD). Automated average carotid intima-media thickness (cIMTave) and TPA measurements in carotid ultrasound (CUS) were performed using AtheroEdge (AtheroPoint). Pearson correlation coefficient (CC) was then computed between the TPA and eGFR for (1) males versus females, (2) diabetic versus nondiabetic patients, and (3) between the left and right carotid artery. Overall, 339 South Asian Indian patients with either type 2 diabetes mellitus (T2DM) or CKD, or hypertension (stage 1 or stage 2) were retrospectively analyzed by acquiring cIMTave and TPA measurements of their left and right common carotid arteries (CCA; total CUS: 678, mean age: 54.2 ± 9.8 years; 75.2% males; 93.5% with T2DM). The CC between TPA and eGFR for different scenarios were (1) for males and females -0.25 (P < .001) and -0.35 (P < .001), respectively; (2) for T2DM and non-T2DM -0.26 (P < .001) and -0.49 (P = .02), respectively, and (3) for left and right CCA -0.25 (P < .001) and -0.23 (P < .001), respectively. Automated TPA is an equally reliable biomarker compared with cIMTave for patients with CKD (with or without T2DM) with subclinical atherosclerosis.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2 , Taxa de Filtração Glomerular , Rim/fisiopatologia , Placa Aterosclerótica , Insuficiência Renal Crônica/fisiopatologia , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Pressão Sanguínea , Doenças das Artérias Carótidas/etnologia , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Hipertensão/etnologia , Hipertensão/fisiopatologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etnologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
18.
BMC Med Genet ; 21(1): 44, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111194

RESUMO

BACKGROUND: Abnormal calcium homeostasis related to the development of hypertension. As the key regulator of intracellular calcium concentration, voltage-dependent calcium channels (VDCCs), the variations in these genes may have important effects on the development of hypertension. Here we evaluate VDCCs variability with respect to hypertension in the Dai ethnic group of China. METHODS: A total of 1034 samples from Dai individuals were collected, of which 495 were used as cases, and 539 were used as controls. Blood pressure was measured using a standard mercury measurement method, three times with a rest for 5 min, and the average was used for analyses. Seventeen single nucleotide polymorphisms (SNPs) in the four protein-coding genes (CACNA1A, CACNA1C, CACNA1S, CACNB2) of VDCCs were identified by multiplex PCR-SNP typing technique. Chi-square tests and regression models were used to analyse the associations of SNPs with hypertension. RESULTS: The results of chi-square tests showed that the allele frequencies of 5 SNPs were significantly different between the case and the control groups (P < 0.05), but the statistical significance was lost after Bonferroni's correction. However, after adjusting for BMI, age, sex and other factors by logistic regression analyses, the results showed that 5 SNPs consistent with chi-square tests (rs2365293, rs17539088, rs16917217, rs61839222 and rs10425859) were still statistically positive. CONCLUSIONS: This finding suggested that the significant association of these SNPs with hypertension may be noteworthy in future studies.


Assuntos
Grupo com Ancestrais do Continente Asiático , Canais de Cálcio/genética , Hipertensão/etnologia , Hipertensão/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Asiático/genética , Pressão Sanguínea/genética , Estudos de Casos e Controles , China/epidemiologia , Grupos Étnicos/genética , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Haplótipos , Humanos , Masculino , Pessoa de Meia-Idade
20.
Gac Med Mex ; 156(1): 17-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32026882

RESUMO

Introduction: In the United States, information on the Mexican-American population is available through the Health and Aging Brain among Latino Elders (HABLE) study; in Mexico, the results of the Mexican Health and Aging Study (MHAS) are available. Objective: To compare the prevalence of cardiovascular risk factors between men and women of the HABLE and MHAS studies. Method: The prevalence of hypertension, diabetes, hypercholesterolemia and abdominal obesity was transversely analyzed in 559 HABLE participants and compared with data from 13,663 MHAS participants. The comparison was made using Student's t-test and the chi-square test, according to the type of variable. Results: The analysis showed that the prevalence of hypertension (50 %, 95 % CI = 41.8-51.8), diabetes (35.5 %, 95 % CI = 27.6-43.8) and abdominal obesity (59.3 %, 95 % CI = 50.5-68.1) were significantly higher in HABLE males, whereas females had a higher prevalence of diabetes (36.8 %, 95 % CI = 32.2-41.5) and abdominal obesity (89.6 %, 95 % CI = 86.6-92.5). Hypercholesterolemia had a higher prevalence in MHAS females (53.3%, 95% CI = 50.3-56.2). Conclusion: The prevalence of cardiovascular risk factors was higher in Mexican American HABLE participants, than in Mexican MHAS participants.


Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Obesidade Abdominal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etnologia , Estudos Transversais , Diabetes Mellitus/etnologia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Hipercolesterolemia/etnologia , Hipertensão/etnologia , Estudos Longitudinais , Masculino , Americanos Mexicanos/estatística & dados numéricos , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Obesidade Abdominal/etnologia , Fatores de Risco , Distribuição por Sexo , Estados Unidos/epidemiologia
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