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1.
Nutrients ; 13(8)2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34444726

RESUMO

Several studies link cardiovascular diseases (CVD) with unhealthy lifestyles (unhealthy dietary habits, alcohol consumption, smoking, and low levels of physical activity). Therefore, the strong need for CVD prevention may be pursued through an improved control of CVD risk factors (impaired lipid and glycemic profiles, high blood pressure, and obesity), which is achievable through an overall intervention aimed to favor a healthy lifestyle. Focusing on diet, different recommendations emphasize the need to increase or avoid consumption of entire classes of food, with only partly known and only partly foreseeable consequences on the overall level of health. In recent years, the ketogenic diet (KD) has been proposed to be an effective lifestyle intervention for metabolic syndrome, and although the beneficial effects on weight loss and glucose metabolism seems to be well established, the effects of a prolonged KD on the ability to perform different types of exercise and the influence of KD on blood pressure (BP) levels, both in normotensives and in hypertensives, are not so well understood. The objective of this review is to analyze, on the basis of current evidence, the relationship between KD, regular physical activity, and BP.


Assuntos
Pressão Sanguínea , Dieta Cetogênica , Exercício Físico , Doenças Cardiovasculares/prevenção & controle , Estilo de Vida Saudável , Fatores de Risco de Doenças Cardíacas , Humanos , Hipertensão/fisiopatologia , Hipertensão/prevenção & controle
2.
Int J Mol Sci ; 22(15)2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34360574

RESUMO

Nitric oxide (NO), carbon monoxide (CO), and hydrogen sulfide (H2S), three major gasotransmitters, are involved in pleiotropic biofunctions. Research on their roles in hypertension and kidney disease has greatly expanded recently. The developing kidney can be programmed by various adverse in utero conditions by so-called renal programming, giving rise to hypertension and kidney disease in adulthood. Accordingly, early gasotransmitter-based interventions may have therapeutic potential to revoke programming processes, subsequently preventing hypertension and kidney disease of developmental origins. In this review, we describe the current knowledge of NO, CO, and H2S implicated in pregnancy, including in physiological and pathophysiological processes, highlighting their key roles in hypertension and kidney disease. We summarize current evidence of gasotransmitter-based interventions for prevention of hypertension and kidney disease in animal models. Continued study is required to assess the interplay among the gasotransmitters NO, CO, and H2S and renal programming, as well as a greater focus on further clinical translation.


Assuntos
Gasotransmissores/uso terapêutico , Hipertensão/prevenção & controle , Nefropatias/prevenção & controle , Animais , Humanos
3.
J Am Heart Assoc ; 10(15): e021154, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34320843

RESUMO

Background Considering the widespread risk of collider bias and confounding by indication in previous research, the associations between renin-angiotensin aldosterone system (RAAS) inhibitor use and COVID-19 remain unknown. Accordingly, this study tested the hypothesis that RAAS inhibitors influence the summation effect of COVID-19 and its progression to severe outcomes. Methods and Results This nationwide cohort study compared all residents of Sweden, without prior cardiovascular disease, in monotherapy (as of January 1, 2020) with a RAAS inhibitor to those using a calcium channel blocker or a thiazide diuretic. Comparative cohorts were balanced using machine-learning-derived propensity score methods. Of 165 355 people in the analysis (51% women), 367 were hospitalized or died with COVID-19 (246 using a RAAS inhibitor versus 121 using a calcium channel blocker or thiazide diuretic; Cox proportional hazard ratio [HR], 0.97; 95% CI, 0.74-1.27). When each outcome was assessed separately, 335 people were hospitalized with COVID-19 (HR, 0.92; 95% CI, 0.70-1.22), and 64 died with COVID-19 (HR, 1.22; 95% CI, 0.68-2.19). The severity of COVID-19 outcomes did not differ between those using a RAAS inhibitor and those using a calcium channel blocker or thiazide diuretic (ordered logistic regression odds ratio, 1.01; 95% CI, 0.89-1.14). Conclusions Despite potential limitations, this study is among the best available evidence that RAAS inhibitor use in primary prevention does not increase the risk of severe COVID-19 outcomes; presenting strong data from which scientists and policy makers alike can base, with greater confidence, their current position on the safety of using RAAS inhibitors during the COVID-19 pandemic.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , COVID-19 , Hipertensão/tratamento farmacológico , Medição de Risco , Idoso , Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Bloqueadores dos Canais de Cálcio/uso terapêutico , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Sistema Renina-Angiotensina/efeitos dos fármacos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Suécia/epidemiologia
4.
Soc Sci Med ; 283: 114194, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34274784

RESUMO

RATIONALE: Evidence on effectiveness of routine clinic-based cardiovascular disease (CVD) prevention in low- and middle-income countries is lacking. This study aimed to provide evidence on exposure to primary prevention of CVDs obtained through visits to public health clinics in the Philippines that are responsible for operating a widely-adopted CVD risk screening and management protocol. METHOD: In a 2018 cluster-randomized experiment in Nueva Ecija province, participants aged 40-70 with no history of CVD in randomly selected communities were offered a money-prize lottery ticket if they visited a public health clinic for a check-up. The induced variation in clinic visits was used to estimate effects of a check-up on exposure to CVD prevention indicators (measurement, diagnosis and medication of physiological CVD risk factors, and medical advice about behavioural risk factors), as well as on health behaviour and predicted 10-year CVD risk score. RESULTS: Going for a check-up at a public clinic raised a weighted average of effect sizes of the prevention indicators by 0.16 (95% CI 0.06 to 0.26, FWER-corrected p = 0.0218). Disaggregated analyses revealed positive effects on blood pressure measurement and receipt of medical advice, but no significant effect on diagnosis or medication of either hypertension or diabetes/dyslipidaemia. Despite high baseline prevalence of CVD risk factors and increased receipt of medical advice, there were no significant effects after six months on health behaviour, physiological risk factors or CVD risk score. CONCLUSION: Getting Filipinos to health clinics responsible for opportunistic CVD risk screening had a muted impact on exposure to CVD prevention and no significant impact on health behaviour and predicted CVD risk. Issuing well-founded protocols may be insufficient to ensure exposure to CVD prevention through routine clinic visits.


Assuntos
Doenças Cardiovasculares , Hipertensão , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Filipinas/epidemiologia , Prevenção Primária , Fatores de Risco
5.
Trials ; 22(1): 438, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238363

RESUMO

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


Assuntos
Doenças Cardiovasculares , Hipertensão , Adulto , Idoso , Bangladesh , Pressão Sanguínea , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Estilo de Vida , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Int J Mol Sci ; 22(13)2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34281264

RESUMO

Mibyou, or pre-symptomatic diseases, refers to state of health in which a disease is slowly developing within the body yet the symptoms are not apparent. Common examples of mibyou in modern medicine include inflammatory diseases that are caused by chronic inflammation. It is known that chronic inflammation is triggered by the uncontrolled release of proinflammatory cytokines by neutrophils and macrophages in the innate immune system. In a recent study, it was shown that molecular hydrogen (H2) has the ability to treat chronic inflammation by eliminating hydroxyl radicals (·OH), a mitochondrial reactive oxygen species (ROS). In doing so, H2 suppresses oxidative stress, which is implicated in several mechanisms at the root of chronic inflammation, including the activation of NLRP3 inflammasomes. This review explains these mechanisms by which H2 can suppress chronic inflammation and studies its applications as a protective agent against different inflammatory diseases in their pre-symptomatic state. While mibyou cannot be detected nor treated by modern medicine, H2 is able to suppress the pathogenesis of pre-symptomatic diseases, and thus exhibits prospects as a novel protective agent.


Assuntos
Doenças Assintomáticas , Hidrogênio/farmacologia , Substâncias Protetoras/farmacologia , Doença de Alzheimer/prevenção & controle , Animais , Doença Crônica , Diabetes Mellitus Tipo 2/prevenção & controle , Sequestradores de Radicais Livres/farmacologia , Hepatite/prevenção & controle , Humanos , Hipertensão/prevenção & controle , Inflamação/prevenção & controle , Modelos Biológicos , Neoplasias/prevenção & controle , Estresse Oxidativo , Doença de Parkinson/prevenção & controle , Insuficiência Renal Crônica/prevenção & controle
7.
Maturitas ; 149: 40-55, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34108092

RESUMO

The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing hypertension. The aim of this systematic review was to synthesize the effect of exercise training on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in menopausal and postmenopausal women. This review was reported according to the PRISMA statement and registered in PROSPERO. The literature search was done in MEDLINE, Embase, Cochrane CENTRAL and ClinicalTrials. Randomized controlled trials involving menopausal and postmenopausal women undergoing exercise training were included. Two blinded reviewers assessed risk of bias in the included studies by using the Cochrane Risk of Bias tool. A random-effects model was used for all analyses. Significance was set at P < 0.05. Compared with the control group, exercise training resulted in clinically significant reductions on SBP (MD -3.43 mmHg; 95% CI, -5.16, -1.71; P < 0.0001), DBP (MD, -2.25 mmHg; 95% CI, -3.40, -1.11; P = 0.0001) and MAP (MD, -3.48 mmHg; 95% CI, -5.84, -1.11; P = 0.004). Aerobic training (AT) did not produce a significant reduction in SBP, DBP and MAP (P >0.05). Combined training (CT) generated larger reductions. Exercise training generated small but clinically relevant reductions in SBP, DBP and MAP in menopausal and postmenopausal women, younger or older than 65 years, with prehypertension or hypertension. AT did not lead to a clinically relevant improvement in blood pressure (BP) in this population. In addition, CT showed the largest reductions in SBP, DBP and MAP.


Assuntos
Pressão Sanguínea , Exercício Físico , Hipertensão/prevenção & controle , Menopausa , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Feminino , Humanos
8.
Artigo em Inglês | MEDLINE | ID: mdl-34065454

RESUMO

In our randomized controlled trial, we investigated whether Wu-style Tai Chi (Tai Chi combined with Daoyin) as a potential exercise prescription is more effective than simplified Tai Chi in the prevention and treatment of hypertension and hyperlipidemia in the middle-aged and elderly. We randomly assigned 66 patients with hypertension and hyperlipidemia to one of the two groups: the Wu-style Tai Chi group or the simplified Tai Chi group; the simplified Tai Chi group only exercised simplified Tai Chi three times a week for 6 weeks. The Wu-style Tai Chi group participated in 60 min of Wu-style Tai Chi three times a week for 6 weeks. Serum biochemical tests were conducted at baseline and at the end of the study. Measurements of blood pressure were performed at the same time. Primary outcomes were compared within and between groups at baseline and at 6 weeks. The participants in the Wu-style Tai Chi group performed, at 6 weeks, significantly better than baseline on all of the primary outcomes (p value ≤ 0.05). The results also show significant difference within the simplified Tai Chi group from baseline to 6 weeks in TCHO (mmol/L), SBP (mmHg), and LDL-C (mmol/L) (p value < 0.05). From baseline to 6 weeks, the Wu-style Tai Chi group had significant differences at more test indexes in serum and blood pressure than the simplified Tai Chi group. At 6 weeks, the Wu-style Tai Chi group had a significantly greater mean improvement in the SBP (mmHg) than did the simplified Tai Chi group (mean between-group difference, -5.80 (mmHg) [95% CI, -14.01 to 2.41]; p = 0.007). The results showed that, compared with simplified Tai Chi, Wu-style Tai Chi had a better effect on hypertension in the middle-aged and elderly. At 6 weeks in LDL-C (mmol/L), the Wu-style Tai Chi group had significantly greater improvement between the two groups (means between-group difference, -0.45 (mmol/L) [95% CI, -0.89 to -0.17]; p = 0.03). The results showed that Wu-style Tai Chi protected the cardiovascular system of the middle-aged and elderly in improving LDL-C (mmol/L), and was more significant than simplified Tai Chi. After 6 weeks of exercise, Wu-style Tai Chi could effectively improve hyperlipidemia and hypertension. The total effective rate of cardiovascular disease was 90.00%. There was significant difference in the treatment effect of hypertension and hyperlipidemia between the two groups during 6 weeks (p = 0.039), showing that, in a small population of middle-aged and elderly subjects, Wu style Tai Chi could be useful in managing important CV risk factors, such as hypertension and hyperlipidemia.


Assuntos
Doenças Cardiovasculares , Hiperlipidemias , Hipertensão , Tai Ji , Idoso , Pressão Sanguínea , Humanos , Hiperlipidemias/prevenção & controle , Hipertensão/prevenção & controle , Pessoa de Meia-Idade
9.
Obes Rev ; 22(9): e13301, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34060197

RESUMO

In 2016, the South African government proposed a 20% sugar-sweetened beverage (SSB) tax. Protracted consultations with beverage manufacturers and the sugar industry followed. This resulted in a lower sugar-based beverage tax, the Health Promotion Levy (HPL), of approximately 10% coming into effect in April 2018. We provide a synthesis of findings until April 2021. Studies show that despite the lower rate, purchases of unhealthy SSBs and sugar intake consumption from SSBs fell. There were greater reductions in SSB purchases among both lower socioeconomic groups and in subpopulations with higher SSB consumption. These subpopulations bear larger burdens from obesity and related diseases, suggesting that this policy improves health equity. The current COVID-19 pandemic has impacted food and nutritional security. Increased pandemic mortality among people with obesity, diabetes, and hypertension highlight the importance of intersectoral public health disease-prevention policies like the HPL, which should be strengthened.


Assuntos
COVID-19/epidemiologia , Promoção da Saúde/métodos , SARS-CoV-2 , Bebidas Adoçadas com Açúcar/efeitos adversos , Bebidas Adoçadas com Açúcar/economia , Impostos , Comorbidade , Comportamento do Consumidor , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Obesidade/epidemiologia , Obesidade/prevenção & controle , Fatores Socioeconômicos , África do Sul/epidemiologia
10.
Eur Heart J ; 42(25): 2501-2505, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34117487

RESUMO

There is a causal relationship between dietary salt intake and blood pressure. A reduction in salt intake from the current world average of ∼10 g/day to the WHO recommended level of <5 g/day, lowers blood pressure and reduces the risk of cardiovascular disease and all-cause mortality. However, a few cohort studies have claimed that there is a J-shaped relationship between salt intake and cardiovascular risk, i.e. both high and low salt intakes are associated with an increased risk. These cohort studies have several methodological problems, including reverse causality, and inaccurate and biased estimation of salt intake, e.g. from a single spot urine sample with formulas. Recent studies have shown that the formulas used to estimate salt intake from spot urine cause a spurious J-curve. Research with inappropriate methodology should not be used to refute the robust evidence on the enormous benefits of population-wide reduction in salt intake. Several countries, e.g. Finland, the UK, have successfully reduced salt intake, which has resulted in falls in population blood pressure and deaths from stroke and ischaemic heart disease. Every country should develop and implement a coherent, workable strategy to reduce salt intake. Even a modest reduction in salt intake across the whole population will lead to a major improvement in public health, along with huge cost-savings to the healthcare service.


Assuntos
Doenças Cardiovasculares , Hipertensão , Pressão Sanguínea , Doenças Cardiovasculares/prevenção & controle , Humanos , Hipertensão/prevenção & controle , Cloreto de Sódio , Cloreto de Sódio na Dieta/efeitos adversos
11.
Nutrition ; 89: 111284, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34090213

RESUMO

OBJECTIVES: This study aimed to examine the secular trends of dietary food groups and diet quality among adults, overall and by sex, education, and employment status. METHODS: This study was conducted within the framework of the Tehran Lipid and Glucose Study. Demographic and anthropometric measurements were gathered using standard questionnaires. In terms of socioeconomic information, participants were divided into two groups according to their educational level and employment status. The regular dietary intakes of participants were gathered with a validated and reliable food frequency questionnaire over the previous year, and Dietary Approaches to Stop Hypertension scores were computed to evaluate diet quality. Generalized estimating equations were used to assess secular trends in food groups within the four phases. RESULTS: From 2006 to 2017, intake of whole grains, legumes, and nuts and seeds increased, and intake of refined grains, dairy products, and solid fats decreased significantly (P for trend < 0.001). Dietary fruit, vegetable, meat, and soft drink intake did not change significantly. According to socioeconomic groups, meat intake decreased significantly among men, uneducated, and unemployed participants, and fruit intake increased in both women and educated participants. Based on a 40-point scale, the Dietary Approaches to Stop Hypertension score increased from 18.1 ± 0.0 in phase1 to 22.7 ± 0.1 in phase 4 of the Tehran Lipid and Glucose Study (P for trend < 0.001). CONCLUSIONS: Over a decade, in addition to improvements in intake of a number of dietary food groups, the estimated overall diet quality of the study population showed a modest improvement. These findings may determine areas for more attention to improve the overall dietary intake of the population.


Assuntos
Glucose , Hipertensão , Adulto , Dieta , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Irã (Geográfico) , Lipídeos , Estudos Longitudinais , Masculino
12.
Vasc Health Risk Manag ; 17: 259-266, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34079273

RESUMO

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


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Comorbidade , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Etiópia/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Hipoglicemiantes/uso terapêutico , Incidência , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
13.
Ann Agric Environ Med ; 28(2): 319-325, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34184517

RESUMO

INTRODUCTION: Arterial blood pressure is one of the main vital signs reflecting body functions and, at the same time, the most important functional parameter of the cardiovascular system. High blood pressure is the major modifiable cardiovascular risk factor. OBJECTIVE: The aim of the study was assessment of the frequency of occurrence of cardiovascular risk factors, with particular consideration of arterial blood pressure. MATERIAL AND METHODS: The study was conducted among 509 volunteers from Lublin in eastern Poland who participated in the prophylactic programme entitled 'White Sunday'. Standard measurements of blood pressure were performed using a TM-Z dial pressure gauge. The level of arterial blood pressure and socio-demographic parameters were analyzed. RESULTS: Hypertension was more frequently observed in the group of males than females. The age group especially vulnerable to abnormal blood pressure values were those aged 51-60. Isolated hypertension significantly more often occurred in the group of respondents who mentioned hypertension in an interview, compared to those who reported its absence. Among 367 persons who, in preliminary interview, did not declare hypertension, 60 cases of isolated arterial hypertension were noted (16.3%). From among respondents who declared absence of hypertension in an interview, the largest age group diagnosed with isolated arterial hypertension were those aged 61-70 (17.9%). CONCLUSIONS: Arterial hypertension is a civilisation disease which may be effectively prevented, simultaneously reducing the risk of premature death due to cardiovascular events, as well as reducing social and economic costs. International health organizations recommend the implementation of social screening programmes in order to diagnose high blood pressure and the promotion of routine measurements of arterial blood pressure.


Assuntos
Hipertensão/economia , Hipertensão/prevenção & controle , Adulto , Distribuição por Idade , Idoso , Pressão Sanguínea , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Polônia
14.
FASEB J ; 35(7): e21678, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34133045

RESUMO

Hypertension is associated with excessive reactive oxygen species (ROS) production in vascular cells. Mitochondria undergo fusion and fission, a process playing a role in mitochondrial function. OPA1 is essential for mitochondrial fusion. Loss of OPA1 is associated with ROS production and cell dysfunction. We hypothesized that mitochondria fusion could reduce oxidative stress that defect in fusion would exacerbate hypertension. Using (a) Opa1 haploinsufficiency in isolated resistance arteries from Opa1+/- mice, (b) primary vascular cells from Opa1+/- mice, and (c) RNA interference experiments with siRNA against Opa1 in vascular cells, we investigated the role of mitochondria fusion in hypertension. In hypertension, Opa1 haploinsufficiency induced altered mitochondrial cristae structure both in vascular smooth muscle and endothelial cells but did not modify protein level of long and short forms of OPA1. In addition, we demonstrated an increase of mitochondrial ROS production, associated with a decrease of superoxide dismutase 1 protein expression. We also observed an increase of apoptosis in vascular cells and a decreased VSMCs proliferation. Blood pressure, vascular contractility, as well as endothelium-dependent and -independent relaxation were similar in Opa1+/- , WT, L-NAME-treated Opa1+/- and WT mice. Nevertheless, chronic NO-synthase inhibition with L-NAME induced a greater hypertension in Opa1+/- than in WT mice without compensatory arterial wall hypertrophy. This was associated with a stronger reduction in endothelium-dependent relaxation due to excessive ROS production. Our results highlight the protective role of mitochondria fusion in the vasculature during hypertension by limiting mitochondria ROS production.


Assuntos
GTP Fosfo-Hidrolases/fisiologia , Hipertensão/prevenção & controle , Dinâmica Mitocondrial , Substâncias Protetoras/administração & dosagem , Animais , Apoptose , Inibidores Enzimáticos/toxicidade , Hipertensão/induzido quimicamente , Hipertensão/metabolismo , Hipertensão/patologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , NG-Nitroarginina Metil Éster/toxicidade , Estresse Oxidativo , Espécies Reativas de Oxigênio/metabolismo
15.
Asia Pac J Public Health ; 33(5): 539-546, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34018402

RESUMO

Hypertension has become one of the most serious chronic diseases that threaten public health. Regulating self-management is considered a priority and in which physical activity plays a vital role. Based on the Fifth National Health Service Survey (NHSS, 2013), a total of 6079 patients with hypertension were investigated by stratified cluster random sampling. This study explored the relationships between blood pressure control and physical activity, and health-related quality of life (HRQoL). Tobit regression and generalized linear regression analysis were used to explore the relationships among participants' socioeconomic characteristics, health behaviors, and HRQoL. The results showed that 4712 respondents (77.51%) had no problems in any aspect, but the proportion of respondents with problems increased significantly with age (P for trend <.001). Blood pressure control was significantly correlated with the health utility value (P < .001). Patients who participated in physical activity and maintained normal daily blood pressure also showed higher health utility value. Physical activity was significantly related to blood pressure control and HRQoL. Therefore, regular physical activity is recommended for hypertensive residents to improve HRQoL.


Assuntos
Exercício Físico , Hipertensão , Qualidade de Vida , China/epidemiologia , Estudos Transversais , Exercício Físico/fisiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Medicina Estatal , Inquéritos e Questionários
16.
Lancet ; 397(10285): 1625-1636, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933205

RESUMO

BACKGROUND: The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure. METHODS: We did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. FINDINGS: Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/89 mm Hg in participants without previous cardiovascular disease (n=186 988). There was substantial spread in participants' blood pressure at baseline, with 31 239 (19·8%) of participants with previous cardiovascular disease and 14 928 (8·0%) of individuals without previous cardiovascular disease having a systolic blood pressure of less than 130 mm Hg. The relative effects of blood pressure-lowering treatment were proportional to the intensity of systolic blood pressure reduction. After a median 4·15 years' follow-up (Q1-Q3 2·97-4·96), 42 324 participants (12·3%) had at least one major cardiovascular event. In participants without previous cardiovascular disease at baseline, the incidence rate for developing a major cardiovascular event per 1000 person-years was 31·9 (95% CI 31·3-32·5) in the comparator group and 25·9 (25·4-26·4) in the intervention group. In participants with previous cardiovascular disease at baseline, the corresponding rates were 39·7 (95% CI 39·0-40·5) and 36·0 (95% CI 35·3-36·7), in the comparator and intervention groups, respectively. Hazard ratios (HR) associated with a reduction of systolic blood pressure by 5 mm Hg for a major cardiovascular event were 0·91, 95% CI 0·89-0·94 for partipants without previous cardiovascular disease and 0·89, 0·86-0·92, for those with previous cardiovascular disease. In stratified analyses, there was no reliable evidence of heterogeneity of treatment effects on major cardiovascular events by baseline cardiovascular disease status or systolic blood pressure categories. INTERPRETATION: In this large-scale analysis of randomised trials, a 5 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular events by about 10%, irrespective of previous diagnoses of cardiovascular disease, and even at normal or high-normal blood pressure values. These findings suggest that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment. Physicians communicating the indication for blood pressure lowering treatment to their patients should emphasise its importance on reducing cardiovascular risk rather than focusing on blood pressure reduction itself. FUNDING: British Heart Foundation, UK National Institute for Health Research, and Oxford Martin School.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Doenças Cardiovasculares/prevenção & controle , Hipertensão/prevenção & controle , Doenças Cardiovasculares/tratamento farmacológico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/tratamento farmacológico , Análise de Intenção de Tratamento , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/mortalidade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/mortalidade , Prevenção Primária , Modelos de Riscos Proporcionais , Prevenção Secundária , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade
17.
BMC Health Serv Res ; 21(1): 472, 2021 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-34006266

RESUMO

BACKGROUND: The aim of this study was to determine the feasibility of implementing and evaluating essential interventions for the management of hypertension and prevention of cardiovascular disease in primary healthcare in Tajikistan. METHODS: The study protocol was published a priori. A pragmatic, sequential, mixed methods explanatory design was piloted. The quantitative strand is reported here. All primary health care facilities that met inclusion criteria in Shahrinav district were included and computer randomized to either usual care or intervention. The intervention consisted of: adaptation of WHO PEN/HEARTS clinical algorithms for hypertension and diabetes, a two-day training of doctors and nurses, supportive supervision visits, clinical decision support tools, and quality improvement support. Data were collected from paper-based clinical records at baseline and 12 months follow-up. The primary outcome was blood pressure control among patients with hypertension, in addition to several secondary process indicators along the care pathway. Age and sex adjusted logistic regression models were used for intervention and control clinics to determine changes between baseline and follow-up and to assess interactions between allocation group and time. For continuous variables, multivariate linear regression models were used. RESULTS: 19 primary health care centres were included of which ten were randomized to intervention and nine to control. 120 clinicians received training. The records of all registered hypertensive patients were reviewed at baseline and follow-up for a total of 1,085 patient records. Blood pressure control significantly improved in the intervention clinics (OR 3.556, 95 % CI 2.219, 5.696) but not the control clinics (OR 0.644, 95 % CI 0.370, 1.121) (p < 0.001 for interaction). Smoking assessment, statin prescribing, triple therapy prescribing, and blood pressure measurement significantly improved in intervention clinics relative to control, whereas cholesterol and glucose testing, and aspirin prescribing did not. CONCLUSIONS: It is feasible to use routine, paper-based, clinical records to evaluate essential CVD interventions in primary health care in Tajikistan. Adapted WHO PEN/HEARTS guidelines in the context of a complex intervention significantly improved blood pressure control after 12 months.


Assuntos
Doenças Cardiovasculares , Hipertensão , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Atenção Primária à Saúde , Tadjiquistão/epidemiologia
18.
Trop Med Int Health ; 26(8): 895-907, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33938098

RESUMO

OBJECTIVES: To assess hypertension prevalence and the extent and associated factors of hypertension diagnosis, follow-up, treatment and control gaps in low-income urban Medellin, Colombia. METHODS: We randomly sampled 1873 adults aged 35 or older. Unaware hypertensive individuals were defined as those without previous diagnosis whose average blood pressure was equal to or above 140/90 mmHg. For aware hypertensive patients, control was delimited as average blood pressure below 140/90 if under 59 years old or diabetic, and as less than 150/90 otherwise. We used logistic regression to identify care gap-associated factors. RESULTS: Hypertension prevalence was 43.5% (95% CI 41.2-45.7). We found 28.2% aware and 15.3% unaware hypertensive individuals, which corresponds to a 35.1% (95% CI 31.9-38.5) underdiagnosis. This gap was determined by age, sex, education and lifestyle factors. 14.4% (95% CI 11.6-17.6) of aware hypertensive patients presented a follow-up gap, 93.4% (95% CI 90.9-95.2) were prescribed antihypertensive drugs, but 38.9% (95% CI 34.7-43.3) were not compliant. The latter was strongly associated with follow-up. The hypertension control gap in aware hypertensive patients, 39.0% (95% CI: 34.9-43.2), was associated with being older, having diabetes, weakly adhering to pharmacological treatment and receiving poor non-pharmacological advice. Overall, 60.4% (95% CI 57.0-63.8) of aware and unaware hypertensive participants had either diagnosed but uncontrolled or undiagnosed hypertension. CONCLUSIONS: We found high hypertension prevalence coupled with, from an international perspective, encouraging awareness and control figures. Still, there remains ample room for improvement. Our findings can assist in designing integrated primary healthcare measures that further strengthen equitable and effective access to hypertension care and control.


Assuntos
Disparidades em Assistência à Saúde , Hipertensão/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Colômbia/epidemiologia , Feminino , Humanos , Hipertensão/prevenção & controle , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana
19.
BMJ Open ; 11(3): e043951, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-34006029

RESUMO

OBJECTIVES: This study was designed to assess levels of awareness, knowledge, attitude and practices relating to hypertension and diabetes among adults aged 35 years resident in selected communities in Imo and Kaduna states, Nigeria. DESIGN: A descriptive cross-sectional study. SETTING: Selected communities across 14 local government areas in Imo and Kaduna states were included. PARTICIPANTS: In total, 824 adults, aged 35 years or older and resident in selected communities where the Access-N project was being implemented in Imo and Kaduna states participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The study assessed the level of hypertension and diabetes knowledge among the participants. Regular blood pressure (BP) and glucose screening practices were also examined as outcome measures. RESULTS: The mean age of the respondents was 48.32 years. In total, 778 (94.4%) and 746 (90.5%) of the respondents were aware of hypertension and diabetes, respectively. The mean hypertension and diabetes knowledge scores (±SD) were 4.99 (±1.99) and 8.02 (±2.61), respectively. A total of 326 (41.9%) respondents aware of hypertension had a good knowledge of hypertension while 477 (63.9%) of those aware of diabetes had a good knowledge of diabetes. Levels of hypertension and diabetes knowledge were found to be associated with physical activity and the level of education of the respondents. About two-thirds (62.6%) and less than half (41.5%) of the respondents, respectively check their BP and blood glucose (BG) levels regularly (at least once yearly). Statistically significant associations were observed between age and regular BP and BG level checks. CONCLUSIONS: Despite the high awareness rate of hypertension and diabetes observed in this study and a relatively good knowledge about the two conditions, unhealthy lifestyle practices and non-regular routine screening abounds among the respondents. Thus, there is a need to improve access to quality information about hypertension and diabetes aimed at motivating adoption of healthy behaviours.


Assuntos
Diabetes Mellitus , Hipertensão , Adulto , Estudos Transversais , Diabetes Mellitus/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Pessoa de Meia-Idade , Nigéria , Inquéritos e Questionários
20.
Food Funct ; 12(9): 4072-4078, 2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-33977970

RESUMO

The evidence for a linkage between dietary intake of choline and betaine, a choline metabolism product, and the risk of hypertension (HTN) is limited. The current population-based cohort study was designed to investigate the possible association between dietary intake of choline and betaine with the risk of HTN in adults. This cohort study was conducted on the participants of the Tehran Lipid and Glucose Study (TLGS). Dietary intake of choline and betaine was calculated using the United States Department of Agriculture (USDA) database. Hypertension was diagnosed as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or used drugs to treat hypotension. In this study, 2865 subjects participated and followed-up for a median of 7.4 years. During the follow-up period, 623 patients with hypertension (22.1%) were detected. Our results revealed per every 100 mg increased dietary intake of choline, the risk of developing HTN decreased by 16% (0.84; 95% CI: 0.74 to 0.96, P for trend = 0.009). No significant association was observed between habitual dietary intake of betaine and the risk of HTN (1.10; 95% CI: 0.88 to 1.38, P for trend = 0.21). After stratification based on age, sex, and BMI, each 100 mg per d increase in dietary choline decreased the risk of HTN occurrence in subjects younger than 55 years old by 17% (0.83; 95% CI: 0.71 to 0.96) and men by 21% (0.79; 95% CI: 0.66 to 0.95). The current study's findings provide further support to confirm the protective properties of choline and choline-rich foods against HTN.


Assuntos
Betaína , Colina/administração & dosagem , Dieta , Ingestão de Alimentos , Alimentos , Hipertensão/prevenção & controle , Adulto , Pressão Sanguínea , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários
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