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1.
Compend Contin Educ Dent ; 41(9): 458-464; quiz 465, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33001656

RESUMO

More than 1 billion people worldwide have hypertension. Since the guidelines for classification and treatment of hypertension were updated in 2017 by American College of Cardiology/American Heart Association, it is now estimated that nearly half of the US adult population has hypertension. Hypertension may not show any sign or symptom apart from an elevated blood pressure reading until signs and symptoms of complications occur. Hence, dentists can play a unique role in identifying undiagnosed patients or those with uncontrolled blood pressure levels. This article is intended to provide dental clinicians essential information about hypertension and how the new guidelines affect the classification and treatment of the disease, and it discusses the management of patients with hypertension in the dental office.


Assuntos
Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/terapia , Adulto , Pressão Sanguínea , Humanos , Estados Unidos
2.
Hipertens. riesgo vasc ; 37(3): 108-114, jul.-sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193519

RESUMO

INTRODUCCIÓN Y OBJETIVOS: Las alteraciones del sistema nervioso autónomo fueron propuestas como precursoras en la génesis y perpetuación de la aterosclerosis hace ya mucho tiempo. Nuestro objetivo fue determinar si existe asociación entre la presencia de aterosclerosis carotídea y la función autonómica evaluada mediante la variabilidad de la frecuencia cardíaca. MÉTODOS: A través de un estudio prospectivo de casos y controles investigamos la variabilidad de la frecuencia cardíaca en 5 min y la presencia de aterosclerosis carotídea mediante ultrasonografía en 54 pacientes que dividimos en 2 grupos según la presencia (+) o ausencia (−) de placas ateroscleróticas en carótidas (ATE). Se analizó la variabilidad de frecuencia cardíaca en dominio de frecuencia en el espectro de alta frecuencia, baja frecuencia, cociente alta/baja frecuencia y potencia espectral total. RESULTADOS: Sobre una población de 54 individuos sin enfermedad cardiovascular establecida evaluados en forma consecutiva, se detectaron 26 individuos (48%) portadores de ATE+. Se observó una reducción en la variabilidad de la frecuencia cardíaca en el grupo ATE+ representada por el espectro de baja frecuencia (LF) (p < 0,0001). La actividad parasimpática específicamente representada por el componente espectral de alta frecuencia también resultó menor en el grupo ATE+en análisis univariado (p < 0,0001) al igual que la potencia espectral total (p < 0,0001), un índice de regulación autonómica integral. No se encontraron diferencias significativas cuando se analizó el balance autonómico de baja y alta frecuencia (LF/HF) (p = 0,1598). En un modelo de regresión logística solo la presión arterial sistólica y el poder espectral total resultaron predictores independientes de ATE+. CONCLUSIÓN: Verificamos una disminución en la variabilidad de la frecuencia cardíaca en sujetos con aterosclerosis carotídea, que se estableció tanto a través de sus componentes espectrales como de la potencia espectral total, no así a través de la valoración del balance autonómico. La potencia espectral total, en principio, sería un método correcto de evaluación autonómica en este grupo de pacientes


INTRODUCTION AND OBJECTIVES: Alterations of the sympathetic and parasympathetic nervous system have been proposed as precursors of the genesis and perpetuation of atherosclerosis for a long time. The objective of this study is to determine if there is an association between the presence of carotid atherosclerosis and the reduction in heart rate variability. METHODS: Using a prospective case-control design, the heart rate variability and the presence of carotid atherosclerosis was investigated in 54 patients, divided into 2 groups according to the presence or absence of carotid atherosclerosis. An analysis was made of the heart rate variability variables of the frequency (spectral) domain in high frequency band, low frequency band, parasympathetic autonomic balance, and the total spectral band. RESULTS: Of the 54 individuals evaluated without previous cardiovascular disease consecutively, 26 of them (48%) presented with subclinical carotid atherosclerosis (ATE+). A reduction in heart rate variability was observed in the ATE+group represented by the low frequency (LF) spectrum (P < .0001). The parasympathetic activity specifically represented in the high frequency (HF) band was also lower in the ATE+group in the univariate analysis (P < .0001), same as the total spectral power (P < .0001), an index of integral autonomic regulation. No significant differences were found in the LF/HF analysis (P = .1598). After analysing variables with significant differences in the univariate analysis with a logistic regression model, only systolic blood preassure and the total spectral power were shown to be independent predictors of ATE+. CONCLUSION: A reduction in heart rate variability was found in subjects with carotid atherosclerosis. Some spectral components of heart rate variability, like low frequency or total spectral power, were better predictors of carotid atherosclerosis than the parasympathetic autonomic balance. In this study it seems that total spectral power is an adequate measurement for analysing autonomic function


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Doenças do Sistema Nervoso Autônomo/diagnóstico , Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca , Aterosclerose/diagnóstico por imagem , Estudos de Viabilidade , Estudos Prospectivos , Modelos Logísticos , Pressão Sanguínea , Estudos de Casos e Controles , Antropometria , Hipolipemiantes/uso terapêutico , Índice de Massa Corporal , Hipertensão/terapia , Fatores de Risco
3.
Medicine (Baltimore) ; 99(33): e21451, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871992

RESUMO

BACKGROUND: Mental health is closely related to the occurrence of hypertension, particularly the prognosis of hypertension patients. The role of psychotherapy in the occurrence, development, prevention, and prognosis of hypertension, remains to be clarified. METHODS/DESIGN: We will conduct a prospective, double-blind, randomized, multiple-centers study. Eighty patients enrolled in this trial will be randomized at 1:1 ratio. The primary endpoint is will be the reduction of the patient psychological scale (PHQ-9) score. Secondary endpoints will be the drop in blood pressure, awareness of physical and mental health and self-efficacy scale. Measurements will be performed at baseline, 5-week (questionnaires only), 10-week (primary endpoint), using the Anxiety Screening Questionnaire (GAD-7) and Depression Scale (PHQ-9). Data analysis will be carried out using the SPSS v.25 software assuming a level of significance of 5%. Results will be analyzed using multilevel, regression analysis and hierarchical linear models. DISCUSSION: We hope to provide some insight in the understanding the underlying mechanism of the novel mindfulness in the management of hypertension related psychological stress/disturbance, and will enable us to develop novel approach to manage essential hypertension and its related psychological disorders. CLINICAL TRIAL REGISTRY:: http://www.chictr.org.cn (ChiCTR1900028258).


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Hipertensão/psicologia , Hipertensão/terapia , Psicoterapia/métodos , Método Duplo-Cego , Humanos , Prognóstico , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
BMC Public Health ; 20(1): 1364, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891134

RESUMO

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


Assuntos
Hipertensão/epidemiologia , Obesidade/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Comorbidade , Estudos Transversais , Assistência à Saúde , Feminino , Instalações de Saúde , Humanos , Hipertensão/etiologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Doenças não Transmissíveis/epidemiologia , Obesidade/etiologia , Obesidade/terapia , Prevalência , Fatores de Risco , Fatores Sexuais , Uso de Tabaco/efeitos adversos , Tuberculose/epidemiologia , Tuberculose Pulmonar/terapia
5.
Medicine (Baltimore) ; 99(38): e22230, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957364

RESUMO

BACKGROUND: Although the efficacy of antihypertensive drugs has been well established for primary hypertension, their effectiveness is always limited by side effects and poor compliance. Heat-sensitive moxibustion is an innovative acupoint stimulation therapy that is promising as a community health care intervention for hypertension. AIMS: This study aims to evaluate the pragmatic effectiveness and safety of heat-sensitive moxibustion self-administration by patients in the community with primary hypertension. METHODS: This study will adopt a multi-center, pragmatic, nonrandomized design. Six hundred patients with primary hypertension will be recruited from 4 communities. Each patient will choose to either receive heat-sensitive moxibustion self-administration + original antihypertensive drugs or maintain their original antihypertensive drugs without heat-sensitive moxibustion for 1 year. EXPECTED OUTCOMES: The primary outcome will be changes in systolic and diastolic blood pressures and the percentage changes in the doses of antihypertensive drugs. The secondary outcomes will be changes in quality of life assessed by a validated patient-reported outcome scale and the levels of fasting blood glucose, glycated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, urinary albumin, and serum creatinine. The proportion of patients with poor compliance with the heat-sensitive moxibustion regimen will also be evaluated as a secondary outcome. The safety of heat-sensitive moxibustion will be considered by analyzing the incidence of all and serious adverse events and their correlation with heat-sensitive moxibustion. DISCUSSION: The findings of this study will provide pragmatic evidence for heat-sensitive moxibustion self-administration in patients in the community with primary hypertension and may also establish an ethical basis for further randomized controlled trials. TRIAL REGISTRATION: The protocol of this trial was registered in ClinicalTrials.gov at May 11, 2020 (No. NCT04381520).


Assuntos
Temperatura Alta , Hipertensão/terapia , Moxibustão/métodos , Adolescente , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Hipertensão/urina , Adesão à Medicação , Pessoa de Meia-Idade , Moxibustão/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Autoadministração , Adulto Jovem
6.
BMC Public Health ; 20(1): 1227, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787809

RESUMO

BACKGROUND: Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore, identification of the factors related to patient adherence is warranted. In this study, we aimed to examine (i) the socio-demographic correlates of patient adherence to a set of self-management behaviors relevant to type 2 diabetes and hypertension, namely, medication therapy, diet therapy, exercise, tobacco and alcohol avoidance, stress reduction, and self-monitoring/self-care, and (ii) whether health attitudes and self-efficacy in performing self-management mediated the associations between socio-demographic characteristics and adherence. METHODS: We performed a secondary analysis of data collected in a randomized controlled trial. The sample comprised 148 patients with coexisting type 2 diabetes mellitus and hypertension. Data were collected by a questionnaire and analyzed using logistic regression. RESULTS: Female patients were found to be less likely to exercise regularly (odds ratio [OR] = 0.49, P = 0.03) and more likely to avoid tobacco and alcohol (OR = 9.87, P < 0.001) than male patients. Older patients were found to be more likely to adhere to diet therapy (OR = 2.21, P = 0.01) and self-monitoring/self-care (OR = 2.17, P = 0.02). Patients living with family or others (e.g., caregivers) were found to be more likely to exercise regularly (OR = 3.44, P = 0.02) and less likely to avoid tobacco and alcohol (OR = 0.10, P = 0.04) than those living alone. Patients with better perceived health status were found to be more likely to adhere to medication therapy (OR = 2.02, P = 0.03). Patients with longer diabetes duration (OR = 2.33, P = 0.01) were found to be more likely to adhere to self-monitoring/self-care. Self-efficacy was found to mediate the association between older age and better adherence to diet therapy, while no significant mediating effects were found for health attitudes. CONCLUSIONS: Adherence to self-management was found to be associated with socio-demographic characteristics (sex, age, living status, perceived health status, and diabetes duration). Self-efficacy was an important mediator in some of these associations, suggesting that patient adherence may be improved by increasing patients' self-management efficacy, such as by patient empowerment, collaborative care, or enhanced patient-physician interactions.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/terapia , Cooperação do Paciente/estatística & dados numéricos , Autogestão/psicologia , Idoso , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Autoeficácia , Fatores Socioeconômicos , Inquéritos e Questionários
7.
BMC Public Health ; 20(1): 1290, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847501

RESUMO

BACKGROUND: Self-care behaviors and positive changes in lifestyle are essential for successful hypertension control. We used a behavioral model based on the theory of planned behavior to assess which factors influence self-care behaviors for controlling hypertension. METHODS: In this cross-sectional study, five hundred patients with at leastaone-year history of diagnosed hypertension participated in this study. The data collection tool was designed based on the theory of planned behavior. Structural equation modeling was used to estimate the main parameters. RESULTS: For self-care behaviors, ninety-six (19.2%) and forty-five (9.1%) participants had good knowledge and acceptable behavior(≥8 out of 10 points). Having perceived behavioral control regarding quitting smoking and alcohol intake was associated with the patient's intention and behavior [b:1.283 ± .095 and b:1.59 ± .014 (p < .001)]. Having perceived behavioral control over the other self-care behaviors had a positive effect on the intention in female patients [b: .885 ± .442 (p = .045)]. Subjective norms had a positive effect on behavioral intention in younger patients [b:4.52 ± 2.24 (P = .04)]. CONCLUSIONS: Group-specific behavioral barriers are important when improving self-care behaviors in patients with hypertension. Perceived control over self-care behaviors is more important in vulnerable patients, such as the elderly and women.


Assuntos
Hipertensão/terapia , Teoria Psicológica , Autocuidado/psicologia , Idoso , Estudos Transversais , Feminino , Humanos , Intenção , Análise de Classes Latentes , Estilo de Vida , Masculino , Pessoa de Meia-Idade
9.
J Natl Black Nurses Assoc ; 31(1): 52-59, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32853497

RESUMO

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


Assuntos
Afro-Americanos , Hipertensão/etnologia , Hipertensão/terapia , Autogestão/métodos , Pesquisa Participativa Baseada na Comunidade , Disparidades nos Níveis de Saúde , Humanos , Projetos Piloto , Telemedicina
10.
Vasc Health Risk Manag ; 16: 299-305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764950

RESUMO

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


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Hipertensão/terapia , Adesão à Medicação , Modelos Teóricos , Comportamento de Redução do Risco , Adulto , Idoso , Anti-Hipertensivos/efeitos adversos , Estudos Transversais , Características Culturais , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Hipertensão/etnologia , Hipertensão/fisiopatologia , Hipertensão/psicologia , Irã (Geográfico)/epidemiologia , Masculino , Adesão à Medicação/etnologia , Pessoa de Meia-Idade , Resultado do Tratamento
11.
PLoS One ; 15(8): e0237083, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780769

RESUMO

INTRODUCTION: Adequate control of hypertension is a global challenge and is the key to reduce cardiovascular disease risk factors. This study evaluates management of hypertensive patients in primary care clinics in Malaysia. METHODS: A cross-sectional analysis of 13 784 medical records from 20 selected public primary care clinics in Malaysia was performed for patients aged ≥30 years old who were diagnosed with hypertension and had at least one visit between 1st November 2016 and 30th June 2019. Multivariable logistic regression adjusted for complex survey design was used to determine the association between process of care and blood pressure (BP) control among the hypertensive patients. RESULTS: Approximately 50% of hypertensive patients were obese, 38.4% of age ≥65 years old, 71.2% had at least one comorbidity and approximately one-third were on antihypertensive monotherapy. Approximately two-third of the hypertensive patients with diabetic proteinuria were prescribed with the appropriate choice of antihypertensive agents. Approximately half of the patients received at least 70% of the target indicated care and 42.8% had adequately controlled BP. After adjusting for covariates, patients who received counseling on exercise were positively associated with adequate BP control. Conversely, patients who were prescribed with two or more antihypertensive agents were negatively associated with good BP control. CONCLUSIONS: These findings indicated that BP control was suboptimal and deficient in the process of care with consequent gaps in guidelines and actual clinical practices. This warrants a re-evaluation of the current strategies and approaches to improve the quality of hypertension management and ultimately to improve outcome.


Assuntos
Hospitais Públicos/normas , Hipertensão/terapia , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Malásia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos
12.
Cardiovasc Ther ; 2020: 8157858, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32821284

RESUMO

Aim: The present study compared the acute effects of aerobic (AER), resistance (RES), and combined (COM) exercises on blood pressure (BP) levels in people with resistant hypertension (RH) and nonresistant hypertension (NON-RH). Methods: Twenty patients (10 RH and 10 NON-RH) were recruited and randomly performed three exercise sessions and a control session. Ambulatory BP was monitored over 24 hours after each experimental session. Results: Significant reductions on ambulatory BP were found in people with RH after AER, RES, and COM sessions. Notably, ambulatory BP was reduced during awake-time and night-time periods after COM. On the other hand, the effects of AER were more prominent during awake periods, while RES caused greater reductions during the night-time period. In NON-RH, only RES acutely reduced systolic BP, while diastolic BP was reduced after all exercise sessions. However, the longest postexercise ambulatory hypotension was observed after AER (~11 h) in comparison to RES (~8 h) and COM (~4 h) exercises. Conclusion: Findings of the present study indicate that AER, RES, and COM exercises elicit systolic and diastolic postexercise ambulatory hypotension in RH patients. Notably, longer hypotension periods were observed after COM exercise. In addition, NON-RH and RH people showed different changes on BP after exercise sessions, suggesting that postexercise hypotension is influenced by the pathophysiological bases of hypertension.


Assuntos
Pressão Sanguínea , Hipertensão/terapia , Treinamento de Resistência , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Brasil , Estudos Cross-Over , Resistência a Medicamentos , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
13.
Sports Health ; 12(5): 470-477, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776866

RESUMO

CONTEXT: High blood pressure is one of the leading preventable causes of cardiovascular death worldwide. In this regard, several studies have shown interest in the benefits of isometric exercise on blood pressure regulation. OBJECTIVE: To assess whether low-intensity isometric handgrip exercise (LI-IHE) is an effective strategy to lower blood pressure levels in prehypertensive and hypertensive patients. DATA SOURCE: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and registered with PROSPERO. Potentially eligible studies were identified after a systematic search conducted on 4 international databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), PEDro, and SPORTDiscus. STUDY SELECTION: We included randomized controlled trials that comprised patients who received LI-IHE. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Data related to patient characteristics, exercise programs, risk-of-bias assessment, and outcomes of interest were systematically reviewed independently by 2 authors. RESULTS: The following reductions (mean differences) were observed after LI-IHE: systolic blood pressure (SBP), (MD) = -5.43 mm Hg; (95% CI, -8.47 to -2.39; P = 0.0005); diastolic blood pressure (DBP), -2.41 mm Hg (95% CI, -4.33 to -0.48; P = 0.01); mean arterial pressure (MAP), -1.28 mm Hg (95% CI, -2.99 to 0.44; P = 0.14). CONCLUSION: LI-IHE seems to lower SBP, DBP, and MAP values in prehypertensive and hypertensive adults. It appears that LI-IHE reduces, in greater magnitude, blood pressure levels in hypertensive patients, specifically in patients aged <45 years, those who are overweight, and those on medications. Nevertheless, substantial heterogeneity in the main results and in the analyses by subgroups generated uncertainty about the real reduction magnitude that LI-IHE can produce on blood pressure.


Assuntos
Terapia por Exercício/métodos , Hipertensão/terapia , Pré-Hipertensão/terapia , Fatores Etários , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Exercício Físico/fisiologia , Força da Mão/fisiologia , Humanos , Hipertensão/tratamento farmacológico , Pré-Hipertensão/tratamento farmacológico
14.
BMC Public Health ; 20(1): 1185, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727423

RESUMO

BACKGROUND: Sierra Leone, a fragile country, is facing an increasingly significant burden of non-communicable diseases (NCDs). Facilitated by an international partnership, a project was developed to adapt and pilot desktop guidelines and other clinical support tools to strengthen primary care-based hypertension and diabetes diagnosis and management in Bombali district, Sierra Leone between 2018 and 2019. This study assesses the feasibility of the project through analysis of the processes of intervention adaptation and development, delivery of training and implementation of a care improvement package and preliminary outcomes of the intervention. METHODS: A mixed-method approach was used for the assessment, including 51 semi-structured interviews, review of routine treatment cards (retrieved for newly registered hypertensive and diabetic patients from June 2018 to March 2019 followed up for three months) and mentoring data, and observation of training. Thematic analysis was used for qualitative data and descriptive trend analysis and t-test was used for quantitative data, wherever appropriate. RESULTS: A Technical Working Group, established at district and national level, helped to adapt and develop the context-specific desktop guidelines for clinical management and lifestyle interventions and associated training curriculum and modules for community health officers (CHOs). Following a four-day training of CHOs, focusing on communication skills, diagnosis and management of hypertension and diabetes, and thanks to a CHO-based mentorship strategy, there was observed improvement of NCD knowledge and care processes regarding diagnosis, treatment, lifestyle education and follow up. The intervention significantly improved the average diastolic blood pressure of hypertensive patients (n = 50) three months into treatment (98 mmHg at baseline vs. 86 mmHg in Month 3, P = 0.001). However, health systems barriers typical of fragile settings, such as cost of transport and medication for patients and lack of supply of medications and treatment equipment in facilities, hindered the optimal delivery of care for hypertensive and diabetic patients. CONCLUSION: Our study suggests the potential feasibility of this approach to strengthening primary care delivery of NCDs in fragile contexts. However, the approach needs to be built into routine supervision and pre-service training to be sustained. Key barriers in the health system and at community level also need to be addressed.


Assuntos
Agentes Comunitários de Saúde/educação , Assistência à Saúde , Diabetes Mellitus/terapia , Hipertensão/terapia , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Pressão Sanguínea , Estudos de Viabilidade , Feminino , Humanos , Masculino , Assistência Médica , Mentores , Pessoa de Meia-Idade , Doenças não Transmissíveis/terapia , Serra Leoa
15.
Am J Med Sci ; 360(3): 229-235, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32653160

RESUMO

BACKGROUND: The outbreak of the coronavirus disease (COVID-19) has led to a major concern and caused a pandemic globally. The goal of this study was to clarify the clinical characteristics of recovery and death in patients with severe or critical COVID-19. MATERIALS AND METHODS: In this retrospective single-center study, clinical data were collected from 74 severe or critical COVID-19 patients in Wuhan Fourth Hospital between Jan. 25th and Feb. 26th, 2020. All patients were divided into a recovery group or a death group according to clinical outcomes, and the differences between the groups were compared. RESULTS: Of the 74 patients enrolled in the study, 48 (64.9%) were severe cases and 26 (35.1%) were critical cases. Sixty (81.1%) patients were recovered and 14 (18.9%) died. Compared with recovery patients, patients in the death group were older, and had higher incidences of hypertension, coronary disease and dyspnea at admission. Laboratory tests for lactate dehydrogenase, creatine kinase, myoglobin, brain natriuretic peptide and D-dimer indicated higher levels in the death group. The PaO2:FiO2 ratio and minimum SpO2 were lower in the death group, and a higher proportion of these patients received noninvasive mechanical ventilation, invasive mechanical ventilation and extracorporeal membrane oxygenation treatment. CONCLUSIONS: Elderly patients with comorbidities are at higher risk of severe COVID-19 or death. Patients with a low blood gas index and poor coagulation function at admission had a high mortality rate. For such patients, comprehensive treatment should be performed as soon as possible to improve the prognosis and reduce mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Estado Terminal/epidemiologia , Estado Terminal/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Infecções por Coronavirus/diagnóstico , Dispneia/diagnóstico , Dispneia/epidemiologia , Dispneia/terapia , Feminino , Hospitalização/tendências , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento
16.
PLoS One ; 15(7): e0236064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649727

RESUMO

BACKGROUND: The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old. DESIGN/SETTING: Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey. METHODS: GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries. RESULTS: Overall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used. CONCLUSION: Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.


Assuntos
Idoso Fragilizado , Clínicos Gerais/estatística & dados numéricos , Hipertensão/terapia , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Tomada de Decisão Clínica , Humanos , Hipertensão/fisiopatologia
17.
Lancet Diabetes Endocrinol ; 8(9): 782-792, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32687793

RESUMO

Since the initial COVID-19 outbreak in China, much attention has focused on people with diabetes because of poor prognosis in those with the infection. Initial reports were mainly on people with type 2 diabetes, although recent surveys have shown that individuals with type 1 diabetes are also at risk of severe COVID-19. The reason for worse prognosis in people with diabetes is likely to be multifactorial, thus reflecting the syndromic nature of diabetes. Age, sex, ethnicity, comorbidities such as hypertension and cardiovascular disease, obesity, and a pro-inflammatory and pro-coagulative state all probably contribute to the risk of worse outcomes. Glucose-lowering agents and anti-viral treatments can modulate the risk, but limitations to their use and potential interactions with COVID-19 treatments should be carefully assessed. Finally, severe acute respiratory syndrome coronavirus 2 infection itself might represent a worsening factor for people with diabetes, as it can precipitate acute metabolic complications through direct negative effects on ß-cell function. These effects on ß-cell function might also cause diabetic ketoacidosis in individuals with diabetes, hyperglycaemia at hospital admission in individuals with unknown history of diabetes, and potentially new-onset diabetes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/sangue , Diabetes Mellitus Tipo 2/sangue , Humanos , Hiperglicemia/sangue , Hiperglicemia/epidemiologia , Hiperglicemia/terapia , Hipertensão/sangue , Hipertensão/epidemiologia , Hipertensão/terapia , Obesidade/sangue , Obesidade/epidemiologia , Obesidade/terapia , Pandemias , Pneumonia Viral/sangue , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Hipertens. riesgo vasc ; 37(2): 78-81, abr.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-189195

RESUMO

La inercia terapéutica se define como la omisión de tomar una conducta terapéutica, tal como iniciar, adicionar un fármaco o incrementar su dosis durante el seguimiento del paciente, a pesar de tener indicación para ello. En hipertensión arterial, actualmente se considera que la inercia terapéutica es un notable impedimento para lograr un adecuado control y esto tiene implicaciones en el pronóstico de la enfermedad. La inercia terapéutica puede deberse a distintos factores que involucran al médico, al paciente y al sistema sanitario. Gran número de estudios han intentado encontrar determinantes que condicionen la presentación de inercia terapéutica en hipertensión arterial y explicar las causas por las que el profesional sanitario responsable del tratamiento no realiza las modificaciones terapéuticas adecuadas. Entre las múltiples causas que podrían motivar la aparición de inercia terapéutica por parte del médico, se describen la presencia de diversos sesgos cognitivos y afectivos que influyen en el razonamiento clínico y en la toma de decisiones durante la actividad asistencial en el consultorio. Identificar y reconocer estos sesgos cognitivos y afectivos podría ser importante para plantear estrategias educativas en los profesionales de la salud. Para esto se requiere un abordaje multidimensional, incluyendo otros conocimientos más allá de lo observado hasta ahora en relación con el déficit de información y actualización en la patología, abriendo el análisis a la consideración de otras causas. Evitar la inercia terapéutica debería considerarse una prioridad junto a otras importantes medidas, para lograr el control de la hipertensión arterial y minimizar sus consecuencias


Therapeutic inertia is defined as the failure to take therapeutic decisions, such as initiating, adding or increasing the dose of a drug during patient follow-up, despite there being an indication to do so. It is currently considered that therapeutic inertia is a considerable impediment to achieving adequate control of hypertension, and this has implications for the prognosis of the disease. Therapeutic inertia might be due to various factors involving physicians, patients and the health system. Many studies have attempted to find determinants for therapeutic inertia in hypertension and to explain the reasons why health professionals in charge of treatment are failing to make the appropriate modifications to therapy. The many reasons for therapeutic inertia on the part of physicians include the various cognitive and affective biases that influence clinical reasoning and decision-making during healthcare activity in doctors' surgeries. Identifying and recognising these cognitive and affective biases could be important for planning educational strategies for health professionals. This requires a multi-dimensional approach, including knowledge beyond that observed in terms of insufficient information and updating on the disease, and starting to analyse and consider other reasons. Preventing therapeutic inertia should be made a priority along with other important measures to control hypertension and minimise its consequences


Assuntos
Humanos , Hipertensão/terapia , Cooperação e Adesão ao Tratamento , Competência Clínica , Qualidade da Assistência à Saúde , Pressão Sanguínea/efeitos dos fármacos
20.
PLoS One ; 15(6): e0233785, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32521542

RESUMO

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


Assuntos
Hipertensão/terapia , Condicionamento Físico Animal/métodos , Animais , Barorreflexo , Pressão Sanguínea , Frutose/efeitos adversos , Frequência Cardíaca , Hipertensão/etiologia , Interleucina-10/metabolismo , Interleucina-6/metabolismo , Masculino , Miocárdio/metabolismo , NADPH Oxidases/metabolismo , Estresse Oxidativo , Ratos , Ratos Endogâmicos SHR , Fator de Necrose Tumoral alfa/metabolismo
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