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1.
Clin Interv Aging ; 14: 1657-1662, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31571845

RESUMO

Purpose: Previous studies have identified that electrocardiographic pattern of left ventricular hypertrophy (ECG LVH) is associated with mortality, but studies of its correlation in the oldest-old hypertensive population is extremely limited. We investigated the correlation between ECG LVH and mortality in a hypertensive Chinese population aged 80 years and older. Patients and methods: In this study, we included 284 Chinese participants older than 80 years. All included participants with hypertension (sitting systolic blood pressure [BP] 160 to 200 mmHg; sitting diastolic BP <110 mmHg) were ascertained at the baseline. ECG LVH was defined as a Sokolow-Lyon voltage calculated as the amplitude of SV1+ (max RV5 or RV6) greater than 3.5 mV. We categorized participants into two groups by the status of baseline ECG LVH. We used Cox regression models to calculate hazard ratio (HRs) for mortality due to ECG LVH, including cardiovascular mortality and all-cause mortality. Results: In this study, with a 28-month median follow-up, a total of 35 (12.3%) patients died; 21 of those died due to cardiovascular causes. Compared with participants without ECG LVH, there was an increased risk of cardiovascular mortality in participants with ECG LVH (adjusted HR 4.25 [95% confidence interval [CI], 1.50-12.06]) but ECG LVH did not predict all-cause mortality (adjusted HR 2.31 [95% CI, 0.93-5.72]). Conclusion: Our study shows that ECG LVH predicts the risk of cardiovascular mortality in an oldest-old hypertensive Chinese population.


Assuntos
Hipertensão/mortalidade , Hipertrofia Ventricular Esquerda/mortalidade , Hipertrofia Ventricular Esquerda/fisiopatologia , Idoso de 80 Anos ou mais , Pressão Sanguínea , China/epidemiologia , Eletrocardiografia , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Modelos de Riscos Proporcionais
2.
Rev Med Suisse ; 15(662): 1629-1632, 2019 Sep 11.
Artigo em Francês | MEDLINE | ID: mdl-31508915

RESUMO

Arterial hypertension (HT) affects hundreds millions of people suffering from chronic kidney disease: it could be a cause or a consequence. HT can aggravate their prognosis and then lead to a very high cardiovascular morbidity and mortality. HT must be systematically screened and optimally taken care of. However, general practitioners actually lack unambiguous guidelines regarding patients with kidney diseases. This article underlines the necessity and modalities of a precise diagnosis, and aims to discuss the last studies supporting new and better therapeutic targets. The pathophysiological aspects of HT in chronic kidney diseases are also discussed.


Assuntos
Hipertensão/complicações , Hipertensão/terapia , Insuficiência Renal Crônica/complicações , Humanos , Hipertensão/mortalidade , Guias de Prática Clínica como Assunto , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Fatores de Risco
3.
J Stroke Cerebrovasc Dis ; 28(11): 104350, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31492627

RESUMO

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) accounts for 10%-15% of all strokes and has an estimated annual incidence of 5/100,000 in young adults. Limited data on prognosis after ICH in young adults are available. We aimed to identify prognostic predictors after ICH among adults aged 18-65 years. METHODS: We retrospectively selected all patients with ICH from a prospective single-center registry of adults with first stroke before 65 years between 1997 and 2002. We recorded in-hospital mortality as well as mortality and recurrent stroke after discharge until December 1, 2018. For in-hospital analysis, we compared patients that died in-hospital versus patients discharged alive. For long-term analysis, we compared patients that died in follow-up versus patients still alive. Independent prognostic predictors were identified using multivariate analyses. RESULTS: Among 161 patients included, 24 (14.9%) died in-hospital. Among in-hospital survivors, 5-year survival was 92.0%, 10-year survival 78.1%, and 15-year survival 62.0%. After median follow-up of 17 years, 47.4% of patients died, 18 patients had ischemic stroke, and 6 recurrent ICH. Regarding in-hospital prognosis, coma at admission (OR .02 [.00-.11]) was independent predictor for mortality whereas alcoholic habits (OR 12.32 [1.82-83.30]) was independent predictor for survival. An increasing age (OR 1.08 [1.03-1.12]), higher blood glucose levels (OR 1.01 [1.00-1.01]), and hypertension (OR 2.21 [1.22-4.00]) were independent predictors of long-term mortality after ICH. CONCLUSIONS: Alcoholic habits may influence in-hospital survival after ICH in young adults. Long-term mortality in young adults seems to be lower than in elderly and was predicted by higher blood glucose levels and hypertension.


Assuntos
Hemorragia Cerebral/mortalidade , Admissão do Paciente , Acidente Vascular Cerebral/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/mortalidade , Biomarcadores/sangue , Glicemia/metabolismo , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/terapia , Feminino , Mortalidade Hospitalar , Humanos , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Recidiva , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Adulto Jovem
4.
JAMA ; 322(5): 409-420, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31386134

RESUMO

Importance: Blood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes. Objective: To evaluate the association of BP indexes with death and a composite CV event. Design, Setting, and Participants: Longitudinal population-based cohort study of 11 135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016). Exposures: Blood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or the night; and the dipping ratio (nighttime divided by daytime readings). Main Outcomes and Measures: Multivariable-adjusted hazard ratios (HRs) expressed the risk of death or a CV event associated with BP increments of 20/10 mm Hg. Cardiovascular events included CV mortality combined with nonfatal coronary events, heart failure, and stroke. Improvement in model performance was assessed by the change in the area under the curve (AUC). Results: Among 11 135 participants (median age, 54.7 years, 49.3% women), 2836 participants died (18.5 per 1000 person-years) and 2049 (13.4 per 1000 person-years) experienced a CV event over a median of 13.8 years of follow-up. Both end points were significantly associated with all single systolic BP indexes (P < .001). For nighttime systolic BP level, the HR for total mortality was 1.23 (95% CI, 1.17-1.28) and for CV events, 1.36 (95% CI, 1.30-1.43). For the 24-hour systolic BP level, the HR for total mortality was 1.22 (95% CI, 1.16-1.28) and for CV events, 1.45 (95% CI, 1.37-1.54). With adjustment for any of the other systolic BP indexes, the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant (HRs ranging from 1.17 [95% CI, 1.10-1.25] to 1.87 [95% CI, 1.62-2.16]). Base models that included single systolic BP indexes yielded an AUC of 0.83 for mortality and 0.84 for the CV outcomes. Adding 24-hour or nighttime systolic BP to base models that included other BP indexes resulted in incremental improvements in the AUC of 0.0013 to 0.0027 for mortality and 0.0031 to 0.0075 for the composite CV outcome. Adding any systolic BP index to models already including nighttime or 24-hour systolic BP did not significantly improve model performance. These findings were consistent for diastolic BP. Conclusions and Relevance: In this population-based cohort study, higher 24-hour and nighttime blood pressure measurements were significantly associated with greater risks of death and a composite CV outcome, even after adjusting for other office-based or ambulatory blood pressure measurements. Thus, 24-hour and nighttime blood pressure may be considered optimal measurements for estimating CV risk, although statistically, model improvement compared with other blood pressure indexes was small.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/epidemiologia , Hipertensão/complicações , Adulto , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/etiologia , Ritmo Circadiano , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
6.
Biomed Res Int ; 2019: 5274097, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467896

RESUMO

Background: Few studies compared the effects of BP changes in short- and long-terms on all-cause mortality and CVD mortality. Methods: We performed a 12.5-year follow-up study to examine the association between short- (2008 to 2010) and long-term [baseline (2004-2006) to 2010] BP changes and the risk of mortality (2010 to 2017) in the Fuxin prospective cohort study. The Cox proportional hazards model was used for this study, and the average BP was stratified according to the Seven Joint National Committee (JNC7). Results: We identified 1496 (805 CVD deaths) and 2138 deaths (1222 CVD deaths) in short- and long-term study. Compared with BP maintainer, in short-term BP changes, for participants from normotension or prehypertension to hypertension, the hazards ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality were 1.948 (1.118-3.392) and 1.439 (1.218-1.700), respectively, while for participants from hypertension to prehypertension, the HRs (95% CIs) were 0.766 (0.638-0.899) for all-cause mortality and 0.729 (0.585-0.908) for CVD mortality, respectively. In long-term BP changes, for participants from normotension or prehypertension to hypertension, the HRs (95% CIs) of all-cause mortality were 1.738 (1.099-2.749) and 1.203 (1.023-1.414), and they were 2.351 (1.049-5.269) and 1.323 (1.047-1.672) for CVD mortality, respectively. In addition, the effects of short-term BP changes on all-cause and CVD mortality, measured as regression coefficients (ß), were significantly greater than those in long-term change (all P<0.05). Conclusions: Our study emphasizes that short-term changes in BP have a greater impact on all-cause and CVD mortality than long-term changes and assess the cut-off value of the changes in blood pressure elevation.


Assuntos
Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/mortalidade , Sistema Cardiovascular/fisiopatologia , Hipertensão/mortalidade , Idoso , Determinação da Pressão Arterial/métodos , Feminino , Seguimentos , Humanos , Hipertensão/fisiopatologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pré-Hipertensão/mortalidade , Pré-Hipertensão/fisiopatologia , Modelos de Riscos Proporcionais , Fatores de Risco
7.
Hypertension ; 74(4): 767-775, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31422693

RESUMO

Concerns exist regarding the potential increased cardiovascular risk from lowering diastolic blood pressure (DBP) in hypertensive patients. We analyzed 30-year follow-up data of 10 355 hypertensive patients attending the Glasgow Blood Pressure Clinic. The association between blood pressure during the first 5 years of treatment and cause-specific hospital admissions or mortality was analyzed using multivariable adjusted Cox proportional hazard models. The primary outcome was a composite of cardiovascular admissions and deaths. DBP showed a U-shaped association (nadir, 92 mm Hg) for the primary cardiovascular outcome hazard and a reverse J-shaped association with all-cause mortality (nadir, 86 mm Hg) and noncardiovascular mortality (nadir, 92 mm Hg). The hazard ratio for the primary cardiovascular outcome after adjustment for systolic blood pressure was 1.38 (95% CI, 1.18-1.62) for DBP <80 compared with DBP of 80 to 89.9 mm Hg (referrant), and the subdistribution hazard ratio after accounting for competing risk was 1.33 (1.17-1.51) compared with DBP ≥80 mm Hg. Cause-specific nonfatal outcome analyses showed a reverse J-shaped relationship for myocardial infarction, ischemic heart disease, and heart failure admissions but a U-shaped relationship for stroke admissions. Age-stratified analyses showed DBP had no independent effect on stroke admissions among the older patient subgroup (≥60 years of age), but the younger subgroup showed a clear U-shaped relationship. Intensive blood pressure reduction may lead to unintended consequences of higher healthcare utilization because of increased cardiovascular morbidity, and this merits future prospective studies. Low on-treatment DBP is associated with increased risk of noncardiovascular mortality, the reasons for which are unclear.


Assuntos
Pressão Sanguínea/fisiologia , Diástole/fisiologia , Hipertensão/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Fatores de Risco , Taxa de Sobrevida , Atenção Terciária à Saúde
8.
Cardiology ; 143(1): 22-31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31352455

RESUMO

BACKGROUND: Gender differences in outcome and its predictors in patients with acute coronary syndrome (ACS) continue to be debated. OBJECTIVES: To assess long-term mortality and explore its association with the baseline variables in women and men. METHODS: We followed 2,176 consecutive patients (665 women and 1,511 men) with ACS admitted to a single hospital and still alive after 30 days for a median of 16 years 8 months. RESULTS: At the end of the follow-up, 415 (62.4%) women and 849 (56.2%) men had died (unadjusted hazard ratio [HR] for women/men 1.18 (95% confidence interval [CI], 1.05-1.33, p =0.005). After adjustment for age, the HR was reversed to 0.88 (95% CI, 0.78-1.00, p =0.04). Additional adjustment for potential confounders yielded a HR of 0.86 (95% CI, 0.76-0.98, p = 0.02). Using multivariable Cox regression, previous heart failure, previous or new-onset atrial fibrillation, and psychotropic drugs at discharge were significantly associated with increased long-term mortality in men only. Known hypertension, elevated creatinine, and inhospital Killip class >1/cardiogenic shock were significantly associated with mortality only in women. For late mortality, hypertension and inhospital Killip class >1/cardiogenic shock interacted significantly with gender. CONCLUSION: For patients with ACS surviving the first 30 days, late mortality was lower in women than in men after adjusting for age. The effects of several baseline characteristics on late outcome differed between women and men. Gender-specific strategies for long-term follow-up of ACS patients should be considered.


Assuntos
Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/terapia , Idoso , Fibrilação Atrial/mortalidade , Creatinina/análise , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Revascularização Miocárdica , Inibidores da Agregação de Plaquetas/uso terapêutico , Psicotrópicos/uso terapêutico , Fatores Sexuais , Choque Cardiogênico/mortalidade , Suécia/epidemiologia
9.
Hypertension ; 74(3): 572-580, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31352828

RESUMO

To study the effect of formulas on the estimation of dietary sodium intake (sodium intake) and its association with mortality, we analyzed the TOHP (Trials of Hypertension Prevention) follow-up data. Sodium intake was assessed by measured 24-hour urinary sodium excretion and estimations from sodium concentration using the Kawasaki, Tanaka, and INTERSALT (International Cooperative Study on Salt, Other Factors, and Blood Pressure) formulas. We used both the average of 3 to 7 urinary measurements during the trial period and the first measurement at the beginning of each trial. Additionally, we kept sodium concentration constant to test whether the formulas were independently associated with mortality. We included 2974 individuals aged 30 to 54 years with prehypertension, not assigned to sodium intervention. During a median 24-year follow-up, 272 deaths occurred. The average measured sodium intake was 3766±1290 mg/d. All estimated values, including those with constant sodium concentration, were systematically biased with overestimation at lower levels and underestimation at higher levels. There was a significant linear association between the average measured sodium intake (ie, gold standard method) and mortality. This relationship was altered by using the estimated sodium intakes. There appeared to be a J- or U-shaped relationship for the average estimated sodium by all formulas. Despite variations in the sodium-mortality relationship among various formulas, a common pattern was that all estimated values including those with constant sodium appeared to be inversely related to mortality at lower levels of sodium intake. These results demonstrate that inaccurate estimates of sodium cannot be used in association studies, particularly as the formulas per se seem to be related to mortality independent of sodium.


Assuntos
Causas de Morte , Hipertensão/induzido quimicamente , Hipertensão/mortalidade , Cloreto de Sódio/urina , Sódio na Dieta/efeitos adversos , Adulto , Fatores Etários , Idoso , Determinação da Pressão Arterial/métodos , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Taiwan , Fatores de Tempo , Urinálise/métodos
10.
Hypertension ; 74(3): 660-668, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31352830

RESUMO

Increased short-term blood pressure (BP) variability is associated with adverse cardiovascular outcomes in patients with hypertension. The present study investigated the long-term prognostic significance of the short-term blood pressure variability in patients on hemodialysis. A total of 149 patients (53.0% male; mean age: 54.5±15.1 years) receiving regular hemodialysis for >6 months were enrolled. They completed a 44-hour (excluding the hemodialysis session) ambulatory BP monitoring and comprehensive hemodynamic assessments, including carotid-femoral pulse wave velocity and pressure waveform decomposition (forward and backward wave amplitude). Blood pressure variability parameters, including average real variability (ARV) of systolic BP, diastolic BP, and pulse pressure (ARVp) during daytime, nighttime, and overall 44 hours were calculated. During a median follow-up of 14 years, 78 deaths (52.4%) were confirmed. In multivariable Cox regression analysis, none of the ambulatory BP parameters were predictive of mortality. In contrast, nighttime ARVp was consistently and significantly associated with all-cause mortality in multivariable Cox models adjusting for age, sex, albumin, hemodialysis treatment adequacy, and 44-hour systolic BP (continuous variable analysis, per 1-SD, hazard ratio=1.348; 95% CI, 1.029-1.767; categorical variable analysis, ≥8.5 versus <8.5 mm Hg; hazard ratio=1.825; 95% CI, 1.074-3.103). Forward wave amplitude and 44-hour systolic BP were identified as the 2 most important determinants of nighttime ARVp. Addition of nighttime ARVp to the base model significantly improved prediction of all-cause mortality (Net reclassification improvement =0.198; P=0.0012). In hemodialysis patients, increased short-term nighttime pulse pressure variability but not ambulatory BP levels were significantly predictive of long-term all-cause mortality.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea , Causas de Morte , Ritmo Circadiano , Hipertensão/fisiopatologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/mortalidade , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Análise de Onda de Pulso , Diálise Renal/métodos , Diálise Renal/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Fatores de Tempo
11.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3 Supl): 314-319, jul.-set. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1023191

RESUMO

O procedimento da medida indireta da pressão arterial (PA) é usado na prevenção, diagnóstico e tratamento de pacientes com hipertensão arterial nas diversas fases de evolução da doença. Embora o procedimento seja considerado simples e de fácil execução, muitos profissionais realizam-no de forma inapropriada e sem o devido conhecimento científico, o que pode interferir na fidedignidade dos resultados obtidos. Objetivo: Identificar na literatura as falhas no cumprimento da técnica de medida indireta da PA realizada por profissionais de saúde. Método: Trata-se de uma revisão integrativa que analisou estudos publicados entre 2013 e 2017, nas bases de dados Cumulative Index to Nursing and Allied Health Literature, Base de Dados de Enfermagem, Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System, Literatura latino-americana e do Caribe em ciências da saúde, Índice Bibliográfico Espanhol em Ciências da Saúde e Biblioteca COCHRANE. Sete artigos compuseram a amostra do estudo, a qual foi analisada com relação à identificação do artigo, características metodológicas e avaliação do rigor metodológico. Resultados: Cinco estudos foram desenvolvidos no Brasil (71,5%), um no Egito (14,3%) e um nos Estados Unidos (14,3%). Os achados apontaram falhas relacionas à etapa do preparo do paciente, à etapa do procedimento e à etapa do registro da PA. Conclusão: Inúmeras falhas foram identificadas durante a realização do procedimento de medida indireta da PA, o que reforça a necessidade do desenvolvimento de estudos de intervenção que possam promover o conhecimento teórico-prático dos profissionais da saúde


The indirect blood pressure (BP) measurement procedure is used in the prevention, diagnosis and treatment of patients with arterial hypertension in the various phases of disease progression. Although the procedure is considered simple and easy to perform, many professionals perform it incorrectly and without adequate scientific knowledge, which may interfere with the reliability of the results obtained. Objective: To identify in the literature failures in compliance with the technique of indirect BP measurement performed by health professionals. Method: This is an integrated review that analyzed studies published between 2013 and 2017 in the Cumulative Index to Nursing and Allied Health Literature, the Brazilian Nursing Database (BDENF), the Scientific Electronic Library Online, the Medical Literature Analysis and Retrieval System, the Latin American and Caribbean Health Sciences Literature, the Spanish Bibliographical Health Sciences Index, and the COCHRANE Library databases. Seven articles made up the study sample, which was analyzed in terms of article identification, methodological characteristics and assessment of methodological rigor. Results: Five studies were developed in Brazil (71.5%), one in Egypt (14.3%) and one in the United States (14.3%). The findings pointed to failures related to the patient preparation stage, the procedure stage and the BP recording stage. Conclusion: Numerous failures were identified during the indirect BP measurement procedure, which reinforces the need to develop intervention studies that can promote the theoretical-practical knowledge of health professionals


Assuntos
Humanos , Masculino , Feminino , Determinação da Pressão Arterial , Pressão Arterial , Pressão Sanguínea , Artéria Braquial , Doenças Cardiovasculares , Pessoal de Saúde , Artéria Radial , Prática Clínica Baseada em Evidências/métodos , Hipertensão/mortalidade , Equipe de Enfermagem/métodos
12.
BMC Health Serv Res ; 19(1): 373, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196079

RESUMO

BACKGROUND: Hypertension remains one of the leading causes of death in Nigeria. Appropriate and cost-effective treatment of the disease is necessary to reduce mortality. This study evaluates (i) the prescription patterns and quality (ii) blood pressure control and (iii) cost of medication among patients with hypertension uncomplicated by co-morbid diseases or compelling indications. METHOD: Patients with uncomplicated hypertension attending three clinics in the University College Hospital, Ibadan in Nigeria were recruited into this study. Information on demographics, antihypertensive medication prescribed, blood pressure measurements, and cost of medications were collected for each patient. Antihypertensive medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) system. The frequency of usage of each drug class and their prescribed doses per patient/day were calculated and compared with the DDD to assess the quality of prescription. Cost of antihypertensive medication was calculated for each patient and reported as cost per patient/day and cost per patient/month. Effect of variables on BP control was ascertained. Statistical analyses were done using SPSS, chi-square and correlation test was used to test for associations. RESULT: A total number of 1050 hypertensive patients were included in this study. The mean age was 60 years, females made up 62% of the study population. A high level of polypharmacy (87%) and sub-optimal blood pressure control was observed. An increase in blood pressure was observed with increase in the number of medication prescribed (χ2 = 33.618, p < 0.001; r = .18, p < 0.001). The most prescribed antihypertensive medication either as a single therapy or a fixed-dose combination was diuretic. About 54% of the prescribed daily doses of antihypertensive medication exceeded the DDD. The total monthly expenditure on antihypertensive drugs was approximately N3.2 million ($15,300). CONCLUSION: Study findings show a high level of polypharmacy and non-generic prescribing. Increased prescribing of drugs that are cost-effective, as well as prescription of fixed dose combinations (FDCs), is recommended in hypertensive patients. This is necessary to control blood pressure while increasing treatment adherence.


Assuntos
Anti-Hipertensivos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Hipertensão/tratamento farmacológico , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/economia , Análise Custo-Benefício , Prescrições de Medicamentos/economia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/economia , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia
13.
BMC Public Health ; 19(1): 719, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182076

RESUMO

BACKGROUND: The incidence and associated risk factors for premature death were investigated in a population-based cohort study in Iran. METHODS: A total of 7245 participants (3216 men), aged 30-70 years, were included. We conducted Cox proportional hazards models to identify the risk factors for premature death. For each risk factor, hazard ratio (HR), 95% confidence intervals (95% CI) and population attributable fraction (PAF) were calculated. RESULTS: After a median follow-up of 13.8 years, 262 premature deaths (153 in men) occurred. Underlying causes of premature deaths were cardiovascular disease (CVD) (n = 126), cancer (n = 51), road injuries (n = 15), sepsis and pneumonia (n = 9) and miscellaneous reasons (n = 61). The age-standardized incident rate of premature death was 2.35 per 1000 person years based on WHO standard population. Hypertension [HR 1.40, 95% CI (1.07-1.83)], diabetes (2.53, 1.94-3.29) and current smoking (1.58, 1.16-2.17) were significant risk factors for premature mortality; corresponding PAFs were 12.3, 22.4 and 9.2%, respectively. Overweight (body mass index (BMI): 25-29.9 kg/m2) (0.65, 0.49-0.87) and obesity (BMI ≥30 kg/m2) (0.67, 0.48-0.94) were associated with decreased premature mortality. After replacing general adiposity with central adiposity, we found no significant risk for the latter (0.92, 0.71-1.18). Moreover, when we excluded current smokers, those with prevalent cancer/cardiovascular disease and those with survival of less than 3 years, the inverse association between overweight (0.59, 0.39-0.88) and obesity (0.67, 0.43-1.04), generally remained unchanged; although, diabetes still showed a significant risk (2.62, 1.84-3.72). CONCLUSIONS: Controlling three modifiable risk factors including diabetes, hypertension and smoking might potentially reduce mortality events by over 40%, and among these, prevention of diabetes should be prioritized to decrease burden of events. We didn't confirm a negative impact of overweight and obesity status on premature mortality events.


Assuntos
Mortalidade Prematura/tendências , Adulto , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/mortalidade , Causas de Morte , Estudos de Coortes , Diabetes Mellitus/mortalidade , Feminino , Humanos , Hipertensão/mortalidade , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Sobrepeso/mortalidade , Pneumonia/mortalidade , Modelos de Riscos Proporcionais , Fatores de Risco , Sepse/mortalidade , Fumar/mortalidade , Ferimentos e Lesões/mortalidade
14.
High Blood Press Cardiovasc Prev ; 26(3): 227-237, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31228169

RESUMO

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


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Fumar/epidemiologia , África do Norte/epidemiologia , Ásia/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Diabetes Mellitus/terapia , Estilo de Vida Saudável , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Hipertensão/terapia , Obesidade/diagnóstico , Obesidade/mortalidade , Obesidade/terapia , Prevalência , Serviços Preventivos de Saúde , Prognóstico , Fatores de Proteção , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Fumar/efeitos adversos , Fumar/mortalidade , Abandono do Hábito de Fumar
15.
PLoS One ; 14(5): e0216348, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31063480

RESUMO

BACKGROUND: Potato consumption has been hypothesized to be associated with higher risk of hypertension, diabetes, and colorectal cancer. OBJECTIVE: The aim of this study was to examine the association between potato consumption and the risk of overall and cause specific mortality in the large prospective National Institutes of Health-AARP (NIH-AARP) Study. DESIGN: The NIH-AARP study recruited 566,407 persons, aged 50-72 years in 1995-1996. We excluded subjects that reported a history of chronic disease at baseline. Potato consumption data from a validated food frequency questionnaire completed at baseline was used in Cox proportional hazard models to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for overall and cause specific mortality. Final models were adjusted for potential risk factors for mortality. RESULTS: Among 410,701 participants included in this analysis, 76,921 persons died during the 15.6 years of follow-up. Eating baked, boiled, or mashed potatoes, French fries or potato salad seven or more times per week was associated with higher risk of overall mortality, in models adjusted only for age and sex (HR C4 vs C1 = 1.17, 95%CI = 1.13, 1.21). These results were attenuated in fully adjusted models (HR C4 vs C1 = 1.02, 95%CI = 0.97, 1.06). Potato consumption was not associated with risk of mortality caused by cancer (HR C4 vs C1 = 1.04, 95%CI = 0.97, 1.11), heart disease (HR C4 vs C1 = 1.00, 95%CI = 0.93, 1.09), respiratory disease (HR C4 vs C1 = 1.16, 95%CI = 0.99, 1.37), or diabetes (HR C4 vs C1 = 0.91, 95%CI = 0.71, 1.19). We tested for an association with different preparation methods and found limited evidence for differences by preparation method. The only statistically significant association was that for French fry consumption with cancer-related mortality (HR C4 vs C1 = 1.27, 95%CI = 1.02, 1.59), a finding for which uncontrolled confounding could not be ruled out. CONCLUSION: We find little evidence that potato consumption is associated with all-cause or cause-specific mortality.


Assuntos
Neoplasias Colorretais , Diabetes Mellitus , Preferências Alimentares , Hipertensão , Solanum tuberosum , Inquéritos e Questionários , Idoso , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/mortalidade , Diabetes Mellitus/etiologia , Diabetes Mellitus/mortalidade , Feminino , Seguimentos , Humanos , Hipertensão/etiologia , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia
16.
Nat Commun ; 10(1): 2172, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092829

RESUMO

Inducing mitochondrial uncoupling (mUncoupling) is an attractive therapeutic strategy for treating metabolic diseases because it leads to calorie-wasting by reducing the efficiency of oxidative phosphorylation (OXPHOS) in mitochondria. Here we report a safe mUncoupler, OPC-163493, which has unique pharmacokinetic characteristics. OPC-163493 shows a good bioavailability upon oral administration and primarily distributed to specific organs: the liver and kidneys, avoiding systemic toxicities. It exhibits insulin-independent antidiabetic effects in multiple animal models of type I and type II diabetes and antisteatotic effects in fatty liver models. These beneficial effects can be explained by the improvement of glucose metabolism and enhancement of energy expenditure by OPC-163493 in the liver. Moreover, OPC-163493 treatment lowered blood pressure, extended survival, and improved renal function in the rat model of stroke/hypertension, possibly by enhancing NO bioavailability in blood vessels and reducing mitochondrial ROS production. OPC-163493 is a liver-localized/targeted mUncoupler that ameliorates various complications of diabetes.


Assuntos
Hipoglicemiantes/farmacologia , Fígado/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , Desacopladores/farmacologia , Administração Oral , Animais , Pressão Sanguínea/efeitos dos fármacos , Células CHO , Cricetulus , Diabetes Mellitus/sangue , Diabetes Mellitus/tratamento farmacológico , Modelos Animais de Doenças , Fígado Gorduroso/tratamento farmacológico , Fígado Gorduroso/etiologia , Fígado Gorduroso/patologia , Feminino , Células Hep G2 , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Hipertensão/mortalidade , Hipoglicemiantes/farmacocinética , Hipoglicemiantes/uso terapêutico , Rim/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Masculino , Camundongos , Mitocôndrias/metabolismo , Fosforilação Oxidativa/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Análise de Sobrevida , Desacopladores/farmacocinética , Desacopladores/uso terapêutico
17.
High Blood Press Cardiovasc Prev ; 26(3): 209-215, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30989620

RESUMO

INTRODUCTION: Automated office blood pressure (AOBP) has been recently shown to predict equally well to ambulatory blood pressure (ABP), conventional office blood pressure (OBP) and home blood pressure (HBP), cardiovascular (CV) events among hypertensives. AIM: To compare AOBP recording and ABP monitoring in order to evaluate morning blood pressure (BP) peak in predicting CV events and deaths in hypertensives. METHODS: We assessed 236 initially untreated hypertensives, examined between 2009 and 2013. The end points were CV and non-CV death and any CV event including myocardial infarction, evidence of coronary heart disease, heart failure hospitalization, severe arrhythmia, stroke, and symptomatic peripheral artery disease. We fitted proportional hazards models using the different modalities as predictors and evaluated their predictive performance using two metrics: the Akaike's Information Criterion, and Harrell's C-index. RESULTS: After a mean follow-up of 7 years, 23 subjects (39% women) had at least one CV event. In Cox regression models, systolic conventional OBP, AOBP and peak morning BP were predictive of CV events (p < 0.05). The Akaike Information Criterion showed smaller values for AOBP than peak morning BP, indicating a better performance in predicting CV events (227.2736 and 238.7413, respectively). The C-index was 0.6563 for systolic AOBP and 0.6243 for peak morning BP indicating a better predicting ability for AOBP. CONCLUSION: In initially untreated hypertensives, AOBP appears to be at least equally reliable to 24-h monitoring in the evaluation of morning BP peak in order to detect CV disease whereas the sleep-trough and preawakening morning BP surge did not indicate such an effect.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Doenças Cardiovasculares/etiologia , Ritmo Circadiano , Hipertensão/diagnóstico , Visita a Consultório Médico , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/mortalidade , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
18.
PLoS One ; 14(4): e0215593, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31009512

RESUMO

BACKGROUND: To investigate the associations of marital status with major clinical outcomes including type 2 diabetes (T2D), hypertension, cardiovascular disease (CVD) and all-cause mortality. METHODS: The study cohort (1999-2014) included 9,737 (45% male) Iranian adults with a mean age of 47.6 years. Marital status was defined as married versus never married, divorced and widowed. The relationship between marital status and the four above mentioned outcomes were investigated using Cox regression models adjusted for the main confounders, specific to each outcome. RESULTS: After more than 12 years of follow-up, 1,889 (883 men) individuals developed hypertension, 1,038 (468 men) T2D, 1015 (597 men) CVD and 668 (409 men) all-cause mortality. Compared with married, being never married in men was associated with higher risk of hypertension [hazard ratio (HR): 1.55; 95% confidence interval (CI), 1.11-2.16] and all-cause mortality (2.17; 0.95-5.00; p-value = 0.066) after adjusting for confounders. Among women, compared with married status, widowed status was associated with a lower risk of T2D (0.74; 0.56-0.97) in the confounders adjusted model. Moreover, never married women had a lower risk of hypertension (0.58; 0.37-0.90) compared to married ones in the age adjusted model, a finding that did not achieve significance, after further adjustment for confounders. CONCLUSION: We found that the relationship between marital status and health outcomes varied by gender. Being never married was an important risk factor for hypertension and tended to be a significant risk factor for mortality in men. However, among women, being widowed was associated with a lower risk of T2D.


Assuntos
Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Hipertensão/mortalidade , Estado Civil/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão/epidemiologia , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
19.
Rev Port Cardiol ; 38(3): 205-212, 2019 03.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31028004

RESUMO

INTRODUCTION AND OBJECTIVE: Socioeconomic factors may affect mortality due to cerebrovascular diseases (CBVDs), hypertensive diseases (HYPDs), and circulatory system diseases (CSDs). This study aimed to assess the association between the Human Development Index (HDI) and the extent of supplementary health coverage and mortality due to these diseases in the Brazilian Federative Units (FUs) between 2004 and 2013. METHODS: The Municipal HDI (MHDI) scores of each FU for 2000 and 2010 were retrieved from the Atlas Brasil website, and supplementary health coverage data for the period 2004-2013 were obtained from the national regulatory agency for private health insurance. Population and mortality data were obtained from the website of the Department of Information Technology of the Unified Health System (DATASUS). Mortality rates were weighted by ill-defined causes of death and standardized by age. RESULTS: The MHDI increased between 2000 and 2010 in all FUs, in half of which it was 0.7 or higher. Supplementary health coverage increased in the country during the study period and was inversely associated with mortality due to CSDs and CBVDs between 2004 and 2013. Mortality due to CBVDs and HYPD in 2013 showed an inverse linear association with the MHDI in 2000. CONCLUSION: Mortality due to CSDs, CBVDs, and HYPDs was influenced by socioeconomic factors. There was a significant inverse association between socioeconomic factors and mortality due to CSDs, CBVDs, and HYPDs. Plans to reduce mortality due to these diseases should include measures to foster economic development and reduce inequality.


Assuntos
Transtornos Cerebrovasculares/mortalidade , Hipertensão/mortalidade , Seguro Saúde/economia , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Causas de Morte/tendências , Transtornos Cerebrovasculares/economia , Feminino , Humanos , Hipertensão/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Taxa de Sobrevida/tendências
20.
BMC Med ; 17(1): 83, 2019 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023377

RESUMO

BACKGROUND: Resistant hypertension is independently associated with an increased risk of death in the general hypertensive population. We assessed whether resistant hypertension is an independent predictor of all-cause mortality in individuals with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study. METHODS: On 31 October 2015, vital status information was retrieved for 15,656 of the 15,773 participants enrolled in 2006-2008. Based on baseline blood pressure (BP) values and treatment, participants were categorized as normotensive, untreated hypertensive, controlled hypertensive (i.e., on-target with < 3 drugs), uncontrolled hypertensive (i.e., not on-target with 1-2 drugs), or resistant hypertensive (i.e., uncontrolled with > 3 drugs or controlled with > 4 drugs). Kaplan-Meier and Cox proportional hazards regression analyses were used to assess the association with all-cause mortality. RESULTS: Using the 130/80 mmHg targets for categorization, crude mortality rates and Kaplan-Meier estimates were highest among resistant hypertension participants, especially those with controlled resistant hypertension. As compared with resistant hypertension, risk for all-cause mortality was significantly lower for all the other groups, including individuals with controlled hypertension (hazard ratio 0.81 [95% confidence interval 0.74-0.89], P < 0.0001), but became progressively similar between resistant and controlled hypertension after adjustment for cardiovascular risk factors and complications/comorbidities. Also when compared with controlled resistant hypertension, mortality risk was significantly lower for all the other groups, including controlled hypertension, even after adjusting for cardiovascular risk factors (0.77 [0.63-0.95], P = 0.012), but not for complications/comorbidities (0.88 [0.72-1.08], P = 0.216). BP was well below target in the controlled hypertensive groups (resistant and non-resistant) and values < 120/70 mmHg were associated with an increased mortality risk. Results changed only partly when using the 140/90 mmHg targets for categorization. CONCLUSIONS: In the RIACE cohort, at variance with the general hypertensive population, resistant hypertension did not predict death beyond target organ damage. Our findings may be explained by the high mortality risk conferred by type 2 diabetes and the low BP values observed in controlled hypertensive patients, which may mask risk associated with resistant hypertension. Less stringent BP goals may be preferable in high-risk patients with type 2 diabetes. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00715481 , retrospectively registered 15 July, 2008.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Hipertensão/epidemiologia , Idoso , Estudos de Coortes , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Humanos , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos
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