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1.
Rev Med Chil ; 147(4): 490-498, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344212

RESUMO

The renin-angiotensin-aldosterone system modulates volume, sodium and potassium homeostasis. In the setting of a high sodium diet, up to 30% of patients with hypertension have a low or suppressed renin and increased volume. This phenotype of low renin hypertension (LRH) is multifactorial and includes infrequent inherited genetic syndromes, milder phenotypes of classic diseases and environmental exposures. All these conditions have in common a higher cardiovascular risk mediated by the over activation of the mineralocorticoid receptor (MR), present not only in the kidney, but also in vasculature, myocardium and adipocytes. Consequently, the aim of LRH treatment goes beyond the control of blood pressure and requires antagonizing MR with specific pharmacologic agents, pursuing normalization of renin as a clinical objective. Due to the unusual evaluation of renin status by non-endocrinologists and lack of disease awareness, only a minority of hypertensive patients receive this pathophysiologically-driven treatment that should reduce cardiovascular outcomes.


Assuntos
Hipertensão/metabolismo , Hipertensão/terapia , Sistema Renina-Angiotensina/fisiologia , Aldosterona/metabolismo , Gerenciamento Clínico , Humanos , Hipertensão/fisiopatologia , Receptores de Mineralocorticoides/metabolismo , Renina/metabolismo
2.
Emerg Med Clin North Am ; 37(3): 365-379, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262409

RESUMO

Acute ischemic stroke (AIS) is a medical emergency that requires prompt recognition and streamlined work-up to ensure that time-dependent therapies are initiated to achieve the best outcomes. This article discusses frequently missed AIS in the emergency department, the role of various imagining modalities in the work-up of AIS, updates on the use of intravenous thrombolytics and endovascular therapy for AIS, pearls on supportive care management of AIS, and prehospital and hospital process improvements to shorten door-to-needle time.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Algoritmos , Glicemia/análise , Encéfalo/diagnóstico por imagem , Tomada de Decisão Clínica , Ensaios Clínicos como Assunto , Medicina de Emergência , Procedimentos Endovasculares , Febre/prevenção & controle , Fibrinolíticos/uso terapêutico , Humanos , Hipertensão/terapia , Oxigenoterapia , Transferência de Pacientes , Telemedicina , Tenecteplase/uso terapêutico , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico
3.
Medicine (Baltimore) ; 98(28): e16347, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305424

RESUMO

Blood pressure variability (BPV) is an independent cardiovascular risk factor in hypertensive patients. The best method for quantifying BPV is still an object of debate. The existence of different BPV patterns, particularly age and arterial stiffness related, is postulated. Our aims were:Cross-sectional study in 108 elderly hypertensive hospitalized patients. Each patient underwent blood pressure measurements with 5 different modalities: 24 hour BP and pulse wave velocity (PWV) monitoring (24hBPM), measurement by nurses or physicians, self-measurement and beat-to-beat monitoring. Differences between maximum and minimum values (ΔBP), averages of the absolute differences between consecutive values (ARV) and coefficients of variation (CV) were calculated.ΔBP showed the wider values' dispersion (Δ systolic blood pressure (SBP): 66.4 ±â€Š22.9 and Δ diastolic blood pressure [DBP]: 45.0 ±â€Š13.5 mmHg). ARV and CV were highest with nurses' measurements (SBP-ARV 9.2 ±â€Š6.2; DBP-ARV 6.9 ±â€Š5.2; SBP-CV 7.6 ±â€Š5.3; DBP-CV 9.6 ±â€Š5.5). The strongest correlation was found comparing physicians' SBP measurements and 24hBPM ARVs (R2 0.23, P <.05). 24hBPM ΔSBP in a multivariate analysis was significantly associated with age (ß -3.85, SE 0.83; P <.001) and PWV (ß 20.29, SE 3.70; P <.001). Calcium antagonists were associated with a lower ΔSBP (ß -14.6, SE 6.1, P <.05) while diuretics and alpha-blockers with a significant increase (ß 14.4 SE 5.4, P <.01; ß 26.9 SE 11.7, P <.05).Age, PWV, diuretics, alpha-blockers, but also measurements obtained by nurses, increase BP variability while calcium antagonists reduce it. BP profiles in elderly in-hospital patients potentially provide important information; they should, however, be interpreted cautiously.


Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea , Hipertensão/diagnóstico , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Estudos Transversais , Feminino , Hospitalização , Humanos , Hipertensão/fisiopatologia , Hipertensão/terapia , Masculino , Estudo de Prova de Conceito
4.
Medicine (Baltimore) ; 98(27): e16116, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277112

RESUMO

To assess the adherence level of antihypertensive treatment and identify any associated risk factors in a sample of hypertensive patients from China.A cross-sectional study involving 488 Chinese hypertensive patients was conducted in a tertiary hospital in Xi'an, China. Data were collected regarding socio-demographic factors and hypertension-related clinical characteristics. The adherence to treatment was assessed using the previously validated instrument: therapeutic adherence scale for hypertensive patients.A total of 27.46% of patients were compliant with their antihypertensive treatments. Three factors were identified to be independently associated with antihypertensive treatment adherence: gender (P = .034), residence (P = .029), duration of high blood pressure (P < .001). Gender, residence, occupation, and the duration of antihypertensive drugs treatment used were found to have significant effects on treatment adherence in certain categories.Treatment adherence among hypertensive patients in China was poor. More attention and effective strategies should be designed to address factors affecting treatment adherence. Education about hypertension knowledge should be strengthened for patients. Moreover, the importance of lifestyle modification during hypertension treatment is often neglected by patients, therefore, there is an urgent need to educate hypertensive patients about the adherence to lifestyle modifications.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/terapia , Adesão à Medicação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , China , Estudos Transversais , Feminino , Humanos , Hipertensão/classificação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
5.
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
6.
Medicine (Baltimore) ; 98(19): e15574, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083232

RESUMO

BACKGROUND: Hypertension and type 2 diabetes are chronic diseases, which generally require lifetime care. Meditation and yoga can be complementary to pharmacological therapies according to the scientific evidences so far. Brain education-based meditation (BEM) is a technique, which has been known to change brain structure, psychology, and physiology of healthy adult participants. This randomized, nonblinded pilot trial aimed to examine whether BEM affects the conditions of patients with hypertension and/or type 2 diabetes compared with health education classes. METHODS: We randomly allocated 48 patients with hypertension and/or type 2 diabetes to BEM (n = 24) or health education (n = 24) classes in the Ulsan Junggu Public Health Center in Korea, where the classes were run during the same period and explored the impact of 8-week practice on the serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, gamma glutamyl transpeptidase, creatinine, high-density lipoprotein cholesterol, and low-density lipoprotein (LDL) cholesterol. Total RNA was extracted to examine inflammatory gene expressions from the whole blood using PAXgene blood RNA System. In addition, self-reports on mental/physical health were evaluated. The Student's t test, chi-squared test, and analysis of covariance were used for statistical analysis. RESULTS: The number of people who participated until the completion of the study was 14 in the control and 21 in the BEM group. After 8 weeks, LDL cholesterol level was significantly decreased in the BEM group after the intervention (13.82 mg/dL reduction, P < .05), while it was not significantly altered in the control group. The expression of inflammatory genes was significantly reduced after 8 weeks of the BEM training (0.3-, 0.5-, and 0.2-fold change for NFKB2, RELA, and IL1B, respectively, all P < .05). In the item analysis of mental/physical health self-reports, a significant improvement was confirmed as follows: increases in focus, confidence, relaxation, and happiness; decreases in fatigue, anger, and loneliness (all P < .05). There were no important adverse events or side-effects by BEM intervention. CONCLUSION: Compared to health education, BEM helps lower LDL cholesterol level and the inflammatory gene expression in the patients with hypertension and/or type 2 diabetes. Moreover, BEM induces positive effects on the self-reported mental/physical states, warranting further study.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Hipertensão/terapia , Meditação , Educação de Pacientes como Assunto , Idoso , Biomarcadores/sangue , LDL-Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Feminino , Expressão Gênica , Humanos , Hipertensão/sangue , Hipertensão/complicações , Hipertensão/psicologia , Inflamação/sangue , Masculino , Projetos Piloto
7.
BMC Health Serv Res ; 19(1): 309, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088467

RESUMO

BACKGROUND: Clinical guidelines are systematically proven statements that help physicians to make healthcare decisions for specific medical conditions. Non-adherence to clinical guidelines is believed to contribute significantly to poor delivery of clinical care, and hence poor clinical outcomes. This study aimed at investigating adherence of doctors to hypertension clinical guidelines in Academy Charity Teaching Hospital, Khartoum, Sudan. METHODS: A cross-sectional hospital-based study was conducted during the period from January 2017 to October 2017 on a sample of 150 doctors. Adherence of doctors to hypertension guidelines was measured through the modified JNC7 adherence tool. Descriptive statistics was used to summarize the data (mean, standard deviation, median) and analyzed by frequency tables. Chi square test used to determine association among categorized variables. Logistic regression analysis was conducted to determine the relation between adherence to hypertension guidelines and the explanatory variables. All statistical tests were considered statistically significant when p value < 0.05. RESULTS: Of the 150 participants, 92% (138/150) were aware of the major hypertension treatment guidelines. 71% (98/138) reported the use of guidelines recommendations in their practice. Whereas 52% (78/150) were aware of local Sudanese guidelines. High adherence rate was highly statistically associated with job titles (p = 0.000), and also associated with age of the participants (p = 0.024) and duration of clinical experience (p = 0.012). However, the logistic regression analysis revealed despite all those variables were contributing to adherence to the treatment guidelines, only duration of clinical experience was statistically significant (p = 0.022). CONCLUSION: The overall adherence of doctors to hypertension treatment guidelines was very low. This study highlights how a gap in clinical governance contributes to low adherence to clinical guidelines. Establishing regular clinical audit, issuing regulations to enforce the use of updated guidelines, along with introducing training programs in hospitals and continuous assessment to the practicing doctors are suggested as crucial interventions. Considerable efforts to build clinical governance in Sudan are required.


Assuntos
Atitude do Pessoal de Saúde , Fidelidade a Diretrizes/estatística & dados numéricos , Hipertensão/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Academias e Institutos , Adulto , Instituições de Caridade , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais de Ensino , Humanos , Hipertensão/terapia , Masculino , Guias de Prática Clínica como Assunto , Sudão , Resultado do Tratamento
8.
Glob Health Action ; 12(1): 1610253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120345

RESUMO

Background: Health care in Vietnam is challenged by a high burden of hypertension (HTN). Since 2000, several interventions were implemented to manage HTN; it is not clear what is the status of patient access to HTN care. Objective: This article aims to perform a systematic narrative review of the available evidence on access to HTN care and services in primary health-care settings in Vietnam. Methods: Search engines were used to identify relevant records of scientific and grey literature. Data from selected articles were analysed using standardised spreadsheets and MaxQDA and following a framework synthesis methodology. Results: There has been increasing interest in research and policy concerning the burden of HTN in Vietnam, covering many aspects of access to treatment at the primary health-care level. Vietnam's National HTN Programme is managed as a vertical programme and its services integrated into the network of primary health-care facilities across the public sector in selected provinces. The Programme financed population-wide screening campaigns for the early detection of HTN among people above 40 years of age. There was no information on the acceptability of HTN health services, especially regarding the interaction between patients and health professionals. In general, articles reported good availability of medication, but problems in accessing them included: fragmentation and lack of consistency in prescribing medication between different levels and short timespans for dispensing medication at primary health-care facilities. There was limited information related to the cost and economic impact of HTN treatment. Treatment adherence among hypertensive patients based on four studies did not exceed 70%. Conclusions: Although the Vietnamese health-care system has taken steps to accommodate some of the needs of HTN patients, it is crucial to scale-up interventions that allow for regular, systematic, and integrated care, especially at the lowest levels of care.


Assuntos
Assistência à Saúde/organização & administração , Promoção da Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Hipertensão/terapia , Atenção Primária à Saúde/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vietnã
9.
Indian Pediatr ; 56(4): 317-321, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31064903

RESUMO

Childhood hypertension has become a significant health concern. There have been a slew of important new findings in this field over the last decade. This has led to an update by the American Academy of Pediatrics of the original recommendation of United States Fourth Working Group on blood pressure. We herein describe the important changes in the guideline, which include an updated normative data, change in blood pressure classification, strong endorsement of ambulatory blood pressure measurement and the reduction in the blood pressure target for both chronic kidney disease and non-chronic kidney disease hypertensive children.


Assuntos
Determinação da Pressão Arterial , Hipertensão , Adolescente , Criança , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Hipertensão/terapia , Pediatria/métodos , Pediatria/organização & administração , Guias de Prática Clínica como Assunto , Estados Unidos
10.
High Blood Press Cardiovasc Prev ; 26(3): 191-197, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31041682

RESUMO

The atherosclerotic alterations that are the basis of cardiovascular diseases can start already in childhood. For this reason the prevention of cardiovascular diseases should be undertaken very early both in the general population and, in a targeted manner, in subjects at cardiovascular risk. Preventive strategies should include measures to encourage physical activity and correct eating habits and to reduce exposure to pollutants. The main actors responsible for carrying out these preventive interventions are the local and national political authorities. Moreover, particular attention should be paid to the first thousand days of life starting from conception, to prevent unfavorable epigenetic modifications. In addition to initiatives aimed at the general population, interventions should be planned by the medical community to assess the individual risk profile. The current obesity epidemic has in fact made it relatively frequent even among children and adolescents to find some cardiovascular risk factors known in adults such as arterial hypertension, dyslipidemia, glucose metabolism disorders and increased of uric acid values. The purpose of this review is to indicate lines of intervention for cardiovascular prevention in children and adolescents.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Síndrome Metabólica/terapia , Serviços Preventivos de Saúde/métodos , Adolescente , Idade de Início , Pressão Arterial , Biomarcadores/sangue , Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Criança , Comorbidade , Dislipidemias/sangue , Dislipidemias/epidemiologia , Dislipidemias/terapia , Transtornos do Metabolismo de Glucose/sangue , Transtornos do Metabolismo de Glucose/epidemiologia , Transtornos do Metabolismo de Glucose/terapia , Nível de Saúde , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipertensão/terapia , Hiperuricemia/sangue , Hiperuricemia/epidemiologia , Hiperuricemia/terapia , Lipídeos/sangue , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/fisiopatologia , Obesidade Pediátrica/terapia , Fatores de Proteção , Fatores de Risco , Ácido Úrico/sangue , Ganho de Peso
11.
Rev Med Liege ; 74(S1): S109-S114, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31070325

RESUMO

Sympathetic hyperactivity is involved in the early stages of hypertension (HTN) and the mechanism persists during the course of HTN until organ damage and significant increase in cardiovascular risk. Radiofrequency renal denervation (RDN) using a percutaneous catheter inserted into the renal artery helps to destroy adventitial sympathetic nerve fibers, interrupting the connections between the renal sympathetic system and the central nervous system. After the first very encouraging clinical results in a small number of patients, the SIMPLICITY HTN-3 study halted the expansion of the technique because of negative results. From there, the technique has been redesigned conceptually as well as technically with the development of a new quadripolar spiral catheter. The first results of the SPYRAL program show this time a proven efficacy in hypertension and a larger study is underway. The results of this trial will help us to decide definitively on the future of this technique. Other pathologies such as heart failure, atrial fibrillation, obstructive sleep apnea and insulin resistance could also be improved by the RDN and studies to demonstrate this are ongoing.


Assuntos
Fibrilação Atrial , Denervação , Hipertensão , Rim , Pressão Sanguínea , Humanos , Hipertensão/terapia , Rim/irrigação sanguínea
13.
Cochrane Database Syst Rev ; 4: CD011337, 2019 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-31032884

RESUMO

BACKGROUND: Hypertension (high blood pressure) in pregnancy carries a high risk of maternal morbidity and mortality. Although antihypertensive drugs are commonly used, they have adverse effects on mothers and fetuses. Guided imagery is a non-pharmacological technique that has the potential to lower blood pressure among pregnant women with hypertension. Guided imagery is a mind-body therapy that involves the visualisation of various mental images to facilitate relaxation and reduction in blood pressure. OBJECTIVES: To determine the effect of guided imagery as a non-pharmacological treatment of hypertension in pregnancy and its influence on perinatal outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, and two trials registers (October 2018). We also searched relevant conference proceedings and journals, and scanned the reference lists of retrieved studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs). We would have included RCTs using a cluster-randomised design, but none were identified. We excluded quasi-RCTs and cross-over trials.We sought intervention studies of various guided imagery techniques performed during pregnancy in comparison with no intervention or other non-pharmacological treatments for hypertension (e.g. quiet rest, music therapy, aromatherapy, relaxation therapy, acupuncture, acupressure, massage, device-guided slow breathing, hypnosis, physical exercise, and yoga). DATA COLLECTION AND ANALYSIS: Three review authors independently assessed the trials for inclusion, extracted data, and assessed risk of bias for the included studies. We checked extracted data for accuracy, and resolved differences in assessments by discussion. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included two small trials (involving a total of 99 pregnant women) that compared guided imagery with quiet rest. The trials were conducted in Canada and the USA. We assessed both trials as at high risk of performance bias, and low risk of attrition bias; one trial was at low risk for selection, detection, and reporting bias, while the other was at unclear risk for the same domains.We could not perform a meta-analysis because the two included studies reported different outcomes, and the frequency of the intervention was slightly different between the two studies. One study performed guided imagery for 15 minutes at least twice daily for four weeks, or until the baby was born (whichever came first). In the other study, the intervention included guided imagery, self-monitoring of blood pressure, and thermal biofeedback-assisted relaxation training for four total hours; the participants were instructed to practice the procedures twice daily and complete at least three relief relaxation breaks each day. The control groups were similar - one was quiet rest, and the other was quiet rest as bed rest.None of our primary outcomes were reported in the included trials: severe hypertension (either systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher); severe pre-eclampsia, or perinatal death (stillbirths plus deaths in the first week of life). Only one of the secondary outcomes was measured.Low-certainty evidence from one trial (69 women) suggests that guided imagery may make little or no difference in the use of antihypertensive drugs (risk ratio 1.27, 95% confidence interval 0.72 to 2.22). AUTHORS' CONCLUSIONS: There is insufficient evidence to inform practice about the use of guided imagery for hypertension in pregnancy.The available evidence for this review topic is sparse, and the effect of guided imagery for treating hypertension during pregnancy (compared with quiet rest) remains unclear. There was low-certainty evidence that guided imagery made little or no difference to the use of antihypertensive drugs, downgraded because of imprecision.The two included trials did not report on any of the primary outcomes of this review. We did not identify any trials comparing guided imagery with no intervention, or with another non-pharmacological method for hypertension.Large and well-designed RCTs are needed to identify the effects of guided imagery on hypertension during pregnancy and on other relevant outcomes associated with short-term and long-term maternal and neonatal health. Trials could also consider utilisation and costs of health service.


Assuntos
Hipertensão/terapia , Imagens (Psicoterapia) , Feminino , Humanos , Gravidez , Resultado do Tratamento
14.
J Biol Regul Homeost Agents ; 33(2): 531-536, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30972997

RESUMO

The aim of this study was to evaluate the effects of rehabilitative aerobic exercise on blood pressure, serum inflammatory factors, endothelin and quality of life in patients with hypertension. Ninety patients with mild hypertension visiting West China Hospital of Sichuan University from June 2017 to December 2017 were enrolled and randomly divided into an experimental group and a control group. Patients in both groups were given a low-salt diet, and the experimental group was given an extra three-month treadmill training. Systolic blood pressure (SBP), diastolic blood pressure (DBP), serum tumor necrosis factor α (TNF-α), serum interleukin-6 and endothelin-1, body mass index (BMI), triglyceride (TG) and other indicators were examined in both groups before and after exercise, SF-36 scale was used to evaluate the quality of life. The results showed that after 3 months of exercise, SBP and DBP in the experimental group were significantly lower than those in the control group (P less than 0.05). Compared with the control group, the concentrations of TNF-α, interleukin-6 and endothelin-1 in the experimental group were significantly decreased (P less than 0.05). Correlation analysis showed that IL-6 was positively correlated with SBP (P less than 0.05), and TNF-α and ET-1 were positively correlated with diastolic blood pressure (P less than 0.05). The general health status, energy, mental health, social function, emotional function and health changes of the experimental group were significantly improved compared with before exercise (P less than 0.05). In conclusion, rehabilitative aerobic exercise can lower blood pressure and improve the overall quality of life in mild hypertension patients by inhibiting vascular inflammation and lowering plasma endothelin-1.


Assuntos
Pressão Sanguínea , Endotelina-1/sangue , Terapia por Exercício , Hipertensão/sangue , Hipertensão/terapia , Humanos , Interleucina-6/sangue , Qualidade de Vida , Triglicerídeos/sangue , Fator de Necrose Tumoral alfa/sangue
15.
Zhongguo Zhen Jiu ; 39(4): 349-54, 2019 Apr 12.
Artigo em Chinês | MEDLINE | ID: mdl-30957443

RESUMO

OBJECTIVE: To observe the effects of "Huoxue Sanfeng acupuncture" auxiliary therapy on neurological function, blood pressure load and morning blood pressure in elderly patients with stroke complicated with hypertension, on the basis of "Xingnao Kaiqiao acupuncture" combined with nifedipine. METHODS: Seventy patients with stroke complicated with hypertension were randomly divided into an observation group and a control group, 35 cases in each group. "Xingnao Kaiqiao acupuncture" and conventional nifedipine controlled release tablets were given in the control group. Regarding regaining consciousness with acupuncture, the main acupoint is Shuigou (GV 26), combined with Neiguan (PC 6) and Sanyinjiao (SP 6), retaining needle for 20 min, additionally, the quick needling technique was applied to Shangjiquan (Extra), Chize (LU 5) and Weizhong (BL 40) of the affected side, nifedipine controlled release tablets were orally administered 30 mg once a day for a total of 6 weeks. The "Huoxue Sanfeng acupuncture" was added on the basis treatment in the observation group, the acupuncture was applied at Renying (ST 9) as the main acupoint, combined with Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3). The strict manipulation quantitative acupuncture was used and the needle was retained for 20 min. Both acupuncture methods were performed once a day, 5 times a week, and continued treatment at intervals of 2 days, 10 times for one course, and a total of 3 courses were needed. The morning blood pressure and 24 h blood pressure load were measured before and after treatment. The National Institute of Health stroke scale (NIHSS) score and the Barthel index (BI) classification were observed before and after treatment. RESULTS: The systolic and diastolic blood pressures were significantly lower than those before treatment in the two groups (all P<0.01), and the systolic and diastolic blood pressures in the observation group were lower than those in the control group (both P<0.01). There was no significant difference between the difference of systolic blood pressure before and after treatment in the two groups (P>0.05), and the difference of the diastolic blood pressure before and after treatment in the observation group was higher than that in the control group (P<0.01). The systolic and diastolic pressures load in the two groups were lower than those before treatment (all P<0.01), and the systolic and diastolic pressures load in the observation group were lower than those in the control group (both P<0.05), the difference of systolic and diastolic pressure load before and after treatment in the observation group were higher than those in the control group (both P<0.05). After treatment, the NIHSS scores in the two groups were lower than those before treatment (both P<0.01). The NIHSS scores in the observation group were lower than those in the control group (P<0.05). The difference of NIHSS scores before and after treatment in the observation group was higher than that in the control group (P<0.01). After treatment, the BI grading was better than that before treatment in the two groups (both P<0.05), and the BI grading in the observation group was superior to that in the control group (P<0.05). CONCLUSION: On the basis of "Xingnao Kaiqiao acupuncture" combined with nifedipine controlled release tablets in the treatment of elderly patients with stroke complicated with hypertension, "Huoxue Sanfeng acupuncture" can further improve the function of nerve and limbs, effectively reduce the morning blood pressure level of elderly patients, especially diastolic blood pressure, and significantly improve systolic blood pressure and diastolic blood pressure load.


Assuntos
Terapia por Acupuntura , Hipertensão , Acidente Vascular Cerebral , Idoso , Pressão Sanguínea , Humanos , Hipertensão/terapia
16.
Artigo em Inglês | MEDLINE | ID: mdl-30959747

RESUMO

Aims: A community-based multi-component intervention (increasing awareness of the importance of physical activity in chronic illness management through reading comic books, training regarding warm-up stretching exercises, identifying facilitators and barriers to exercise through photosharing, supporting self-reflection and development of action plans) was developed to promote physical activity (PA) among patients with diabetes and hypertension. This study aimed to evaluate the efficacy of this intervention on health behaviour (walking) and health outcomes. Design: A non-randomized controlled trial with waitlisted control and pre- and post-measures. Setting: Community centres for the elderly. Participants: A total of 204 older adults with diabetes and/or hypertension were recruited. They were assigned to either the intervention group (IG) or waitlisted to the control group (CG). Intervention: Under the supervision of a nurse, six weekly group meetings were arranged in community centres for the elderly in which the participants freely exchanged their views regarding the barriers and facilitators of regular physical activity. Participants were encouraged to take photos in their neighbourhood or at home and brought these photos to share at the group meetings. The photos showed both the barriers and the facilitators to PA. In the last meeting, each participant worked out a plan to perform PA in the coming four weeks. Measures: PA referred to the number of steps taken per day and it was measured by a Garmin Accelerometer at baseline, Week 6 and Week 10. Other measures included the nine-item Self-Efficacy Scale for Exercise⁻Chinese version (SEE-C), and the 23-item Chinese Barriers to Exercise Scale and Senior Fitness Tests. Generalised estimating equations (GEE) models compared the outcomes over time between IG and CG. Results: A statistically significant difference in the changes in the average number of steps taken daily between the two groups at Week 10 (mean difference = 965.4; 95% confidence interval: 92.2, 1838.6, p = 0.030) was observed, although the difference at Week 6 was non-significant (mean difference = 777.6; 95% confidence interval: -35.3, 1590.5, p = 0.061). IG participants also showed significant improvements in lower body strength (mean difference = 0.967; 95% confidence interval: 0.029, 1.904, p = 0.043) and lower limb flexibility (mean difference = 2.068; 95% confidence interval: 0.404, 3.731, p = 0.015) at Week 10 compared to CG participants. Conclusion: This multi-component intervention improved the participants' physical activity level and physical fitness, particularly in lower limb flexibility and body strength.


Assuntos
Diabetes Mellitus/terapia , Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Promoção da Saúde/métodos , Hipertensão/terapia , Motivação , Fotografação , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Epidemiol Serv Saude ; 28(1): e2018110, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30970072

RESUMO

OBJECTIVE: to analyze trends of hospitalization for ambulatory care-sensitive cardiovascular conditions (ACSCC). METHODS: this was an ecological study of time series of rates of hospitalization for ACSCC in the municipality of Senador Canedo, GO, Brazil, 2001-2016; we used data from the Hospital Information System and population estimates provided by the Inter-Agency Health Information Network (RIPSA) and the Brazilian Institute of Geography and Statistics (IBGE); the Prais-Winsten method was used to analyze trends. RESULTS: we used data on 3,244 hospitalizations for ACSCC; there was decreasing trend in the rate of hospitalizations for ACSCC (annual increase rate [AIR] = -8.14 - 95%CI -11.78;-4.35) and in the heart failure rate (AIR = -12.07 - 95%CI -14.75;-9.30); hospitalization rate time trends for hypertension, angina and cerebrovascular diseases were stationary. CONCLUSION: rates of hospitalization for ACSCC and heart failure decreased, however rates for hypertension, angina and cerebrovascular diseases remained constant.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Doenças Cardiovasculares/terapia , Insuficiência Cardíaca/terapia , Hospitalização/estatística & dados numéricos , Adulto , Idoso , Angina Pectoris/epidemiologia , Angina Pectoris/terapia , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/terapia , Feminino , Insuficiência Cardíaca/epidemiologia , Sistemas de Informação Hospitalar/estatística & dados numéricos , Hospitalização/tendências , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Fatores de Tempo
18.
Emerg Med Clin North Am ; 37(2): 301-316, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940374

RESUMO

The 4 categories of hypertensive disorders of pregnancy are chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with superimposed preeclampsia. These disorders are among the leading causes of maternal and fetal morbidity and mortality. Proper diagnosis in the emergency department is crucial in order to initiate appropriate treatment to reduce the potential harm to the mother and the fetus. Prompt management should be undertaken when the blood pressure is greater than 160/110 mm Hg or there are other severe features such as acute kidney injury, elevated liver function tests, severe abdominal pain, pulmonary edema, and central nervous system disturbances.


Assuntos
Hipertensão/complicações , Complicações Cardiovasculares na Gravidez/diagnóstico , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/terapia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/terapia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Gravidez , Complicações Cardiovasculares na Gravidez/terapia
19.
Medicine (Baltimore) ; 98(14): e15111, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946378

RESUMO

BACKGROUND: High blood pressure (HBP) is a multifactorial clinical condition, with a high morbidity and mortality rate and low rates of control. Due to its high prevalence, it is necessary to search for methods which aim to improve the quality of life of hypertensive patients. Studies have shown that low level laser therapy (LLLT) is capable of inducing a photobiological response within the cells which modifies the micro and macrovascular response; this accompanies evidence showing the systemic effects of intravascular laser irradiation of blood (ILIB). In the hypothesis that the use of LLLT can influence blood pressure levels, and perhaps facilitate adherence to treatment, this study aims to present a clinical research protocol with the goal of determining the effect of photobiomodulation in relation to changes in the hemodynamic parameters of hypertensive and normotensive patients. METHOD: Forty-four participants, frequent attendees of an ambulatory university clinic, will be subdivided into 4 groups, and then submitted to protocol sessions of ILIB. The technique is noninvasive and consists of a laser which is attached to a bracelet which has been specifically developed for the light beam to be transcutaneously carried over the radial artery. Before the procedure, at the end of the photobiomodulation cycles, and 1 month after the end of therapy, blood samples will be collected for the evaluation of C-reactive protein, interleukin 6, and nitric oxide, to be analyzed by immunoturbidimetric, ELISA, and Griess reactions, respectively. ANALYSIS OF RESULTS: Results will be analyzed using descriptive and inferential statistics and will be compiled into tables and/or graphs, with the help of SPSS version 24.0 with the adopted significance level for all tests being α = 0.05. DISCUSSION: The treatment of HBP involves both pharmacological and nonpharmacological therapy. Animal studies with photobiomodulation have previously shown hypotensive effects. Gaps in the literature exist regarding the applicability of this nonpharmacological therapy in humans. This study aims to consider the possibility of offering nonpharmacological therapy to hypertensive patients with the goal of increasing adherence to the treatment as well as minimizing morbidity and mortality caused by hypertension.


Assuntos
Hipertensão/terapia , Terapia com Luz de Baixa Intensidade/métodos , Artéria Radial/efeitos da radiação , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Protocolos Clínicos , Feminino , Humanos , Masculino , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
20.
BMC Health Serv Res ; 19(1): 227, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987617

RESUMO

BACKGROUND: Globally, public housing is utilized to provide affordable housing for low-income households. Studies have shown an association between public housing and negative health outcomes. There is paucity of data pertaining to outpatient primary and tertiary healthcare resources utilization among public rental housing residents in Singapore. METHODS: A retrospective cohort study was performed, involving patients under the care of SingHealth Regional Health System (SHRS) in Year 2012. Healthcare utilization outcomes evaluated included number of outpatient primary and specialist care clinic visits, emergency department visits and hospitalization in Year 2011. Multivariate logistical analyses were used to examine the association between public rental housing and healthcare utilization. RESULTS: Of 147,105 patients, 10,400 (7.1%) patients stayed in public rental housing. There were more elderly (54.8 ± 18.0 vs 49.8 ± 17.1, p < 0.001) and male patients [5279 (50.8%) vs 56,892 (41.6%), p < 0.001] residing in public rental housing. Co-morbidities such as hypertension and hyperlipidemia were more prevalent among public rental housing patients. (p < 0.05). After adjustment for covariates, public rental housing was not associated with frequent outpatient primary care clinic or specialist outpatient clinic attendances (p > 0.05). However, it was associated with increased number of emergency department visits (OR: 2.41, 95% CI: 2.12-2.74) and frequent hospitalization (OR: 1.56, 95% CI: 1.33-1.83). CONCLUSION: Residing in public rental housing was not associated with increased utilization of outpatient healthcare resources despite patients' higher disease burden and frequency of emergency department visits and hospitalizations. Further research is required to elucidate their health seeking behaviours.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Comportamentos Relacionados com a Saúde , Recursos em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Hiperlipidemias/terapia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Habitação Popular/estatística & dados numéricos , Estudos Retrospectivos , Singapura , Atenção Terciária à Saúde/estatística & dados numéricos
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