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1.
Glob Heart ; 16(1): 44, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34211830

RESUMO

During the COVI9-19 pandemic, Pakkred hospital in Thailand implemented innovative practices to ensure the continuation of essential medical services for non-communicable disease patients. These practices included decentralized care, telemedicine, home blood pressure monitoring, community delivery of medicines, and facility infrastructure changes. Despite the decrease in hospital visits by hypertension patients during the pandemic, our results suggest that this package of interventions may have contributed to sustained hypertension and diabetes control rates in Pakkred district.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/organização & administração , Diabetes Mellitus/terapia , Hipertensão/terapia , Monitorização Ambulatorial da Pressão Arterial/métodos , Agentes Comunitários de Saúde , Continuidade da Assistência ao Paciente , Instalações de Saúde , Ambiente de Instituições de Saúde , Acesso aos Serviços de Saúde , Humanos , Doenças não Transmissíveis/terapia , Inovação Organizacional , Equipamento de Proteção Individual , SARS-CoV-2 , Telemedicina/organização & administração , Tailândia , Ventilação
2.
PLoS One ; 16(7): e0254222, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34242327

RESUMO

Hypertension remains the leading cause of cardiovascular disease worldwide and disproportionately impacts patients living in low- and middle-income countries (LMICs). Telemedicine offers a potential solution for improving access to health care for vulnerable patients in LMICs. OBJECTIVES: The purpose of this scoping review was to summarize the evidence for telemedicine interventions for blood pressure management in LMICs and assess the relationships between the telemedicine intervention characteristics and clinical outcomes. DESIGN: Published studies were identified from the following databases (from their inception to May 2020): PubMed, Scopus, and Embase. Search terms related to "Low and Middle Income Countries," "Telemedicine," and "Hypertension" were used, and clinical outcomes were extracted from the screened articles. RESULTS: Our search resulted in 530 unique articles, and 14 studies were included in this review. Five studies assessed telemedicine interventions for patient-provider behavioral counseling, four assessed patient-provider medical management, and five assessed provider-provider consultation technologies. Out of fourteen individual studies, eleven demonstrated a significant improvement in systolic or diastolic blood pressure in the intervention group. Of the eight studies that reported difference-in-differences changes in systolic blood pressure, between-arm differences ranged from 13.2 mmHg to 0.4 mmHg. CONCLUSIONS: The majority of the studies in this review demonstrated a significant reduction in blood pressure with use of the telemedicine intervention, though the magnitude of benefit was not consistently large. Limitations of the studies included small sample sizes, short duration, and intervention heterogeneity. Current evidence suggests that telemedicine may provide a promising approach to increase access to care and improve outcomes for hypertension in LMICs, especially during events that limit access to in-person care, such as the COVID-19 pandemic. However, high-quality clinical trials of sufficient size and duration are needed to establish the impact and role of telemedicine in hypertension care. The protocol for this review was not registered.


Assuntos
COVID-19/epidemiologia , Países em Desenvolvimento , Hipertensão/terapia , Pandemias , SARS-CoV-2 , Telemedicina , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia
3.
Medicine (Baltimore) ; 100(25): e26452, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160441

RESUMO

BACKGROUND: Depending on the person, cervical spondylosis may have no clinical symptoms, but cervical spondylosis will definitely cause changes in people's blood pressure, which will further affect physical and mental health. OBJECTIVES: This study aims to explore the effect and safety of mind-body exercise intervention on the blood pressure in middle-aged and elderly patients with hypertension through meta-analysis. METHODS: This meta-analysis searched studies from 4 research databases: the China National Knowledge Infrastructure (from 1979), Web of Science (from 1950), PubMed (from 1965), and Cochrane (from 1991), Date of retrieval: January 22, 2021, Two authors will independently search literature records, scan titles, abstracts, and full texts, collect data, and assess materials for risk of bias. The data will be analyzed by Stata 14.0 software. RESULTS: The present study is a systematic review and meta-analysis program with no results. Data analysis will be completed after the program has been completed. DISCUSSION: This meta-analysis may provide clinical practice with more reliable evidence-based medical evidence that mind-body exercise can benefit the blood pressure of middle-aged and elderly hypertensive patients. INPLASY REGISTRATION NUMBER: INPLASY202130072.


Assuntos
Hipertensão/terapia , Terapias Mente-Corpo/métodos , Idoso , Determinação da Pressão Arterial , Humanos , Hipertensão/diagnóstico , Metanálise como Assunto , Pessoa de Meia-Idade , Terapias Mente-Corpo/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
4.
JMIR Mhealth Uhealth ; 9(6): e24116, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114961

RESUMO

BACKGROUND: Stroke is a common, harmful disease with high recurrence and mortality rates. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Telemedicine and mobile health (mHealth) interventions may have the potential to facilitate the control of blood pressure among stroke survivors, but their effect has not been established. OBJECTIVE: This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of telemedicine and mHealth interventions on the control of systolic blood pressure among stroke survivors. METHODS: The research literature published up to June 28, 2020, and consisting of RCTs related to telemedicine and mHealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane risk of bias tool (RoB 2.0) was used to evaluate the quality of the studies. The Cochran Q test and I2 statistic were used to assess heterogeneity. Data were meta-analyzed using a random-effects model. Mean difference (MD) with 95% CI and 95% prediction interval (PI) were calculated. RESULTS: In total, 9 RCTs with a total sample size of 1583 stroke survivors met the inclusion criteria. Compared with the usual care, telemedicine and mHealth had a significantly greater impact on the control of systolic blood pressure (MD -5.49; 95% CI -7.87 to -3.10; P<.001; 95% PI -10.46 to -0.51). A subgroup analysis showed that the intervention mode of telephone plus SMS text messaging (MD -9.09; 95% CI -12.71 to -5.46; P<.001) or only telephone (MD -4.34; 95% CI -6.55 to -2.13; P<.001; 95% PI -7.24 to -1.45) had a greater impact on the control of systolic blood pressure than usual care. Among the stroke survivors with an intervention interval ≤1 week (MD -6.51; 95% CI -9.36 to -3.66; P<.001; 95% PI -12.91 to -0.10) or a baseline systolic blood pressure ≥140 mm Hg (MD -6.15; 95% CI -9.44 to -2.86; P<.001; 95% PI -13.55 to 1.26), the control of systolic blood pressure using telemedicine and mHealth was better than that of usual care. CONCLUSIONS: In general, telemedicine and mHealth reduced the systolic blood pressure of stroke survivors by an average of 5.49 mm Hg compared with usual care. Telemedicine and mHealth are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke survivors, especially those with hypertensive stroke.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Telemedicina , Pressão Sanguínea , Humanos , Hipertensão/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/terapia
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(5): 517-522, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34112285

RESUMO

OBJECTIVE: To investigate the effect of fluid resuscitation and circulatory support, directed by different target mean arterial pressure (MAP), on abdominal blood flow, gastrointestinal function and inflammatory response in septic shock patients with hypertension. METHODS: A prospective randomized controlled study was conducted. Hypertensive patients with septic shock admitted to the department of intensive care unit (ICU) of Liuzhou People's Hospital from January 1, 2019 to May 31, 2020 were enrolled. Patients were randomly divided into the low MAP groups (low standard group, LS group) or high MAP group (high standard group, HS group). According to the Surviving Sepsis Campaign Guidelines in 2016 and the updated guideline in 2018, all patients were given treatment of primary disease, fluid resuscitation, supportive management. The target MAP was 65-70 mmHg (1 mmHg = 0.133 kPa) in LS group, and was 75-80 mmHg in HS group. Acute gastrointestinal function injury (AGI) classification was performed on the 1st, 3rd and 7th day. The mean flow rate (Vm) and resistance index (RI) of superior mesenteric artery were evaluated using ultrasound, and the gastrointestinal function was dynamically evaluated using the modified single section ultrasonic gastric antrum method. The gastric antrum movement index (MI) and gastric empaging time (GET) were recorded. The levels of inflammatory markers in serum were detected by enzyme linked immunosorbent assay (ELISA), such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT) and vascular endothelial growth factor (VEGF). The target MAP, the days of use of vasopressors and the amount of fluid resuscitation were recorded. RESULTS: A total of 208 hypertensive patients with septic shock were enrolled, including 109 in the LS group and 99 in the HS group. There were no significant differences in gender, age, acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score between the two groups when diagnosed. After treatment, there was no significant difference in AGI classification between the LS group and HS group on the 1st day. On the 3rd and 7th day, there were statistical differences between the two groups (3rd day: proportion of I, II, III, IV grades were 25.69%, 56.88%, 11.93%, 5.50% in LS group, 15.15%, 54.55%, 25.25%, 5.05% in HS group, respectively, χ2 = 7.900, P = 0.048; 7rd day: proportion of I, II, III, IV grades were 44.96%, 49.54%, 3.67%, 1.83% in LS group, 31.31%, 52.53%, 11.11%, 5.05% in HS group, respectively, χ2 = 8.178, P = 0.042). The Vm of superior mesenteric artery was higher and the RI was lower in the LS group than those in the HS group on day 1, 3 and 7 [Vm (cm/s): 21.72±3.02 vs. 19.50±2.83, 20.42±2.62 vs. 17.02±1.99, 26.52±2.70 vs. 22.47±4.03; RI: 0.86±0.05 vs. 0.92±0.04, 0.87±0.05 vs. 0.95±0.05, 0.81±0.03 vs. 0.85±0.03, all P < 0.01]. The MI was higher and the GET was shorter in the LS group than those in the HS group on day 3 and day 7 [MI: 3.00±0.33 vs. 2.60±0.29, 4.50±0.51 vs. 3.90±0.33; GET (minutes): 86.01±19.78 vs. 100.99±25.01, 71.00±16.37 vs. 84.98±20.18, all P < 0.01]. In addition, the levels of serum TNF-α, IL-6, PCT, VEGF were lower in the LS group than those in the HS group after 3 days of treatment [TNF-α (ng/L): 147.05±28.32 vs. 256.99±27.04, IL-6 (ng/L): 762.99±57.83 vs. 1 112.30±118.32, PCT (µg/L): 37.00±5.58 vs. 56.00±12.36, VEGF (ng/L): 123.00±19.78 vs. 167.01±21.55, all P < 0.05]. The target MAP was maintained at (68.02±4.71) mmHg in LS group, and (79.04±3.04) mmHg in HS group. The difference between the two groups was statistically significant (P < 0.01). Compared with the HS group, the days of using vasopressors was shorter in LS group (days: 3.50±1.27 vs. 4.55±1.47), and the amountof fluid was reduced significantly (mL: 1 602.29±275.49 vs. 2 000.30±272.59, both P < 0.01). CONCLUSIONS: Maintaining a low target mean arterial pressure (65-70 mmHg) in hypertensive patients with septic shock can improve blood supply of superior mesenteric artery, protect the gastrointestinal function, reduce the level of inflammatory factors, and diminish the duration of using vasopressors and the amount of fluid.


Assuntos
Hipertensão , Choque Séptico , Pressão Arterial , Humanos , Hipertensão/complicações , Hipertensão/terapia , Prognóstico , Estudos Prospectivos , Choque Séptico/complicações , Choque Séptico/terapia , Fator A de Crescimento do Endotélio Vascular
7.
BMC Public Health ; 21(1): 1114, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112122

RESUMO

BACKGROUND: Health-Related Quality of Life (HRQoL) of hypertensive patients is not only affected by the disease itself but also by some subjective factors. Low health literacy is prevalent among ethnic minorities. Considering the Kazakh-Chinese people have the highest prevalence of hypertension in Xinjiang, and the High Blood Pressure-Health Literacy (HBP-HL) has not been included in the study of HRQoL. The synergistic effects and the potential mechanism HBP-HL, self-management behavior, therapeutic adherence, self-efficacy, social support on HRQoL remain unclear. This study aimed to introduce the HBP-HL, and develop a structural equation model (SEM) to identify the factors influencing of the HRQoL among Kazakh hypertensive patients. METHODS: The data was obtained by questionnaire survey and physical examination in 2015. Patients with hypertension were recruited through random cluster sampling in Kazakh settlements in Xinjiang. Firstly, the blood pressure was measured. Then the one-for-one household interviews were conducted by Kazakh investigators. The questionnaires regarding HBP-HL, HRQoL, self-management behavior, therapeutic adherence, self-efficacy, and social support were used to collect data. Finally, SEM was constructed, and p ≤ 0.05 was taken as significant. RESULTS: The data was analysed by SPSS18.0 and AMOS18.0 software. 516 Kazakh hypertension patients were recruited, and 94.4% of them had a relatively low HBP-HL score. The mean standardized scores of HRQoL, self-management, therapeutic adherence were poor; they were 63.5, 66.2, and 64.4, respectively. But 96.1% and 98.3% of the participants had high levels of self-efficacy and social support. The SEM of the HRQoL had a good overall fit (χ2/df = 2.078, AGFI = 0.944, GFI = 0.968, CFI = 0.947, IFI = 0.949, RMSEA = 0.046). The model indicated that the HBP-HL has the highest correlation with HRQoL, following with self-management behavior, social support, and self-efficacy. CONCLUSIONS: Low HBP-HL is a major influenced factor of HRQoL among Kazakh hypertensive patients. Future programs should consider HBP-HL as the breakthrough point when designing targeting intervention strategies.


Assuntos
Letramento em Saúde , Hipertensão , Autogestão , China/epidemiologia , Estudos Transversais , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Qualidade de Vida , Autoeficácia , Apoio Social , Inquéritos e Questionários
8.
Medicine (Baltimore) ; 100(23): e26266, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115020

RESUMO

ABSTRACT: Waon therapy (WT) has been used as a thermal therapy in chronic heart failure patients. However, its effect in patients with hypertension is unclear. This study aimed to reveal the hypotensive effect of WT in patients with hypertension. WT was performed on 31 patients with hypertension (63.9 ±â€Š11.9 years, male: 17) on standard hypertension treatment focusing on lifestyle modification and medication. Systolic and diastolic blood pressures were measured before and after WT using an upper arm automated sphygmomanometer. We investigated the effect of single and repeated (1 time/d, >5 times) WT sessions on blood pressure and further compared its effect between current smoking (n = 11, 55.4 ±â€Š6.4 years, 8.5 ±â€Š2.4 times) and non-smoking (n = 11, 66.9 ±â€Š8.5 years, 12.2 ±â€Š5.9 times) groups. A total of 370 sessions of WT were conducted. Systolic and diastolic blood pressures significantly decreased after a single WT session (systolic blood pressure: 118.5 ±â€Š10.1 to 115.1 ±â€Š9.0 mm Hg, P < .001; diastolic blood pressure: 70.5 ±â€Š6.4 to 65.9 ±â€Š5.3 mm Hg, P < .001). The blood pressure decrease following repeated WT was not significant when all participants were considered (systolic blood pressure: 122.3 ±â€Š15.2 to 116.9 ±â€Š19.6 mm Hg; diastolic blood pressure: 73.8 ±â€Š16.7 to 68.2 ±â€Š13.2 mm Hg); however, it was significant in the non-smoking group (systolic blood pressure: 124.2 ±â€Š11.3 to 108.8 ±â€Š13.4 mm Hg, P < .001; diastolic blood pressure: 73.6 ±â€Š4.9 to 62.1 ±â€Š7.6 mm Hg, P < .001). Repeated WT (at least 5 sessions) decreased blood pressure in patients with hypertension, especially in non-smokers. WT is a simple method to reduce blood pressure in non-smoking patients with hypertension.


Assuntos
Determinação da Pressão Arterial/métodos , Hipertensão , Hipertermia Induzida/métodos , Fumar , Pressão Sanguínea/fisiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/psicologia , Hipertensão/terapia , Japão , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , não Fumantes/estatística & dados numéricos , Fumar/efeitos adversos , Fumar/fisiopatologia , Resultado do Tratamento
9.
Contemp Clin Trials ; 106: 106428, 2021 07.
Artigo em Inglês | MEDLINE | ID: covidwho-1220744

RESUMO

Sedentary behavior (SB) has recently been recognized as a strong risk factor for cardiovascular disease, with new guidelines encouraging adults to 'sit less, move more.' Yet, there are few randomized trials demonstrating that reducing SB improves cardiovascular health. The Effect of Reducing Sedentary Behavior on Blood Pressure (RESET BP) randomized clinical trial addresses this gap by testing the effect of a 3-month SB reduction intervention on resting systolic BP. Secondary outcomes include other BP measures, pulse wave velocity, plasma renin activity and aldosterone, and objectively-measured SB (via thigh-mounted activPAL) and physical activity (via waist-worn GT3X accelerometer). RESET BP has a targeted recruitment of 300 adults with desk jobs, along with elevated, non-medicated BP (systolic BP 120-159 mmHg or diastolic BP 80-99 mmHg) and physical inactivity (self-reported aerobic physical activity below recommended levels). The multi-component intervention promotes 2-4 fewer hours of SB per day by replacing sitting with standing and light-intensity movement breaks. Participants assigned to the intervention condition receive a sit-stand desk attachment, a wrist-worn activity prompter, behavioral counseling every two weeks (alternating in-person and phone), and twice-weekly automated text messages. Herein, we review the study rationale, describe and evaluate recruitment strategies based on enrollment to date, and detail the intervention and assessment protocols. We also document our mid-trial adaptations to participant recruitment, intervention deployment, and outcome assessments due to the intervening COVID-19 pandemic. Our research methods, experiences to date, and COVID-specific accommodations could inform other research studying BP and hypertension or targeting working populations, including those seeking remote methods.


Assuntos
Exercício Físico/fisiologia , Hipertensão/terapia , Comportamento Sedentário , Local de Trabalho , Acelerometria , Adulto , Idoso , Aldosterona/sangue , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , COVID-19/epidemiologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Renina/sangue , Projetos de Pesquisa , SARS-CoV-2 , Adulto Jovem
10.
J Am Heart Assoc ; 10(11): e020997, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1234323

RESUMO

The COVID-19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID-19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID-19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID-19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID-19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence-based pharmacotherapy are essential. There is a need to improve the implementation of community-based interventions and blood pressure self-monitoring, which can help build patient trust and increase healthcare engagement.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , COVID-19/epidemiologia , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/normas , Hipertensão , Racismo/prevenção & controle , Determinantes Sociais da Saúde/etnologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Disparidades nos Níveis de Saúde , Humanos , Hipertensão/etnologia , Hipertensão/terapia , Determinação de Necessidades de Cuidados de Saúde , SARS-CoV-2 , Fatores Socioeconômicos , Estados Unidos/epidemiologia
11.
Circ Cardiovasc Qual Outcomes ; 14(5): e007098, 2021 05.
Artigo em Inglês | MEDLINE | ID: covidwho-1232381

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted clinical care worldwide. Evidence of how this health crisis affected common conditions like blood pressure (BP) control is uncertain. METHODS: We used longitudinal BP data from an ongoing randomized clinical trial to examine variations in home BP monitored via a smartphone-based application (app) in a total of 7394 elderly patients with hypertension aged 60 to 80 years stratified by their location in Wuhan (n=283) compared with other provinces of China (n=7111). Change in morning systolic BP (SBP) was analyzed for 5 30-day phases during the pandemic, including preepidemic (October 21 to November 20, 2019), incubation (November 21 to December 20, 2019), developing (December 21, 2019 to January 20, 2020), outbreak (January 21 to February 20, 2020), and plateau (February 21 to March 21, 2020). RESULTS: Compared with non-Wuhan areas of China, average morning SBP (adjusted for age, sex, body mass index) in Wuhan patients was significantly higher during the epidemic growth phases, which returned to normal at the plateau. Between-group differences in ΔSBP were +2.5, +3.0, and +2.1 mm Hg at the incubation, developing, and outbreak phases of COVID-19 (P<0.001), respectively. Sensitivity analysis showed a similar trend in trajectory pattern of SBP in both the intensive and standard BP control groups of the trial. Patients in Wuhan also had an increased regimen change in antihypertensive drugs during the outbreak compared with non-Wuhan patients. Expectedly, Wuhan patients were more likely to check their BP via the app, while doctors were less likely to monitor the app for BP control during the pandemic. CONCLUSIONS: Our data demonstrate that the COVID-19 pandemic was associated with a short-term increase in morning SBP among elderly patients with hypertension in Wuhan but not other parts of China. Further study will be needed to understand if these findings extended to other parts of the world substantially affected by the virus. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03015311.


Assuntos
Determinação da Pressão Arterial , COVID-19/epidemiologia , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Smartphone , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , China , Feminino , Humanos , Hipertensão/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Autocuidado
12.
J Am Heart Assoc ; 10(11): e020997, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34006116

RESUMO

The COVID-19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID-19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID-19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID-19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID-19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence-based pharmacotherapy are essential. There is a need to improve the implementation of community-based interventions and blood pressure self-monitoring, which can help build patient trust and increase healthcare engagement.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , COVID-19/epidemiologia , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/normas , Hipertensão , Racismo/prevenção & controle , Determinantes Sociais da Saúde/etnologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Disparidades nos Níveis de Saúde , Humanos , Hipertensão/etnologia , Hipertensão/terapia , Determinação de Necessidades de Cuidados de Saúde , SARS-CoV-2 , Fatores Socioeconômicos , Estados Unidos/epidemiologia
13.
Heart Fail Clin ; 17(3): 337-343, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051966

RESUMO

The prevalence of heart failure with preserved ejection fraction (HFpEF) is increasing rapidly, and its prognosis is as poor as that of HF with reduced EF. Hypertension is an important risk factor involved in the pathophysiology of HFpEF. Although treatment of hypertension lowers the incidence of HF and is beneficial in patients with HFpEF, there is conflicting evidence on this topic. This article discusses the pathophysiological mechanisms linking hypertension with HFpEF and also the current evidence on the treatment of hypertension in patients with HFpEF.


Assuntos
Pressão Sanguínea/fisiologia , Gerenciamento Clínico , Insuficiência Cardíaca/fisiopatologia , Hipertensão/complicações , Volume Sistólico/fisiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/fisiopatologia , Hipertensão/terapia , Incidência , Prognóstico , Fatores de Risco
14.
Arq Bras Cardiol ; 116(5): 938-947, 2021 05.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34008818

RESUMO

BACKGROUND: Sustained high blood pressure can lead to vascular remodeling and endothelial cell injury, which may explain the endothelial dysfunction found in hypertensive individuals. Exercise training can improve vascular health in individuals with cardiovascular risk, but little is known about its effects in prehypertensive and hypertensive individuals. OBJECTIVE: To review the literature showing evidence of changes in endothelial function in response to different modalities of exercise training in prehypertensive and hypertensive individuals. METHODS: We conducted a systematic review of studies in the MEDLINE, Cochrane, LILACS, EMBASE, and SciELO databases following both the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the PICO framework (patient/population, intervention, comparison and outcomes). Randomized clinical trials (RCTs) published up to April 2019 were selected and assessed by four independent reviewers. The methodological quality was assessed using the PEDro (Physiotherapy Evidence Database) scale. RESULTS: Our search yielded 598 abstracts, and 10 studies were eligible for review. All of them had acceptable methodological quality by PEDro scale. Of the 10 studies, 7 involved aerobic training, 1 isometric resistance training, and 2 aerobic training and dynamic resistance training separately. Seven studies used flow-mediated dilation (FMD) to assess the vascular health, and three used plethysmography. Most training protocols involved hypertensive individuals and consisted of low and moderate-intensity exercise. CONCLUSION: Our systematic review showed that moderate continuous aerobic training is effective to improve vascular health in hypertensive individuals. In prehypertensive individuals, vigorous interval aerobic training seems to be an alternative to determine vascular health benefits. Resistance exercise training, either isometric or dynamic, can be used as a secondary alternative, but still requires further investigation.


Assuntos
Hipertensão , Treinamento de Força , Exercício Físico , Terapia por Exercício , Humanos , Hipertensão/terapia
16.
Circ Cardiovasc Qual Outcomes ; 14(5): e007098, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34003685

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted clinical care worldwide. Evidence of how this health crisis affected common conditions like blood pressure (BP) control is uncertain. METHODS: We used longitudinal BP data from an ongoing randomized clinical trial to examine variations in home BP monitored via a smartphone-based application (app) in a total of 7394 elderly patients with hypertension aged 60 to 80 years stratified by their location in Wuhan (n=283) compared with other provinces of China (n=7111). Change in morning systolic BP (SBP) was analyzed for 5 30-day phases during the pandemic, including preepidemic (October 21 to November 20, 2019), incubation (November 21 to December 20, 2019), developing (December 21, 2019 to January 20, 2020), outbreak (January 21 to February 20, 2020), and plateau (February 21 to March 21, 2020). RESULTS: Compared with non-Wuhan areas of China, average morning SBP (adjusted for age, sex, body mass index) in Wuhan patients was significantly higher during the epidemic growth phases, which returned to normal at the plateau. Between-group differences in ΔSBP were +2.5, +3.0, and +2.1 mm Hg at the incubation, developing, and outbreak phases of COVID-19 (P<0.001), respectively. Sensitivity analysis showed a similar trend in trajectory pattern of SBP in both the intensive and standard BP control groups of the trial. Patients in Wuhan also had an increased regimen change in antihypertensive drugs during the outbreak compared with non-Wuhan patients. Expectedly, Wuhan patients were more likely to check their BP via the app, while doctors were less likely to monitor the app for BP control during the pandemic. CONCLUSIONS: Our data demonstrate that the COVID-19 pandemic was associated with a short-term increase in morning SBP among elderly patients with hypertension in Wuhan but not other parts of China. Further study will be needed to understand if these findings extended to other parts of the world substantially affected by the virus. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03015311.


Assuntos
Determinação da Pressão Arterial , COVID-19/epidemiologia , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Smartphone , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , China , Feminino , Humanos , Hipertensão/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Autocuidado
17.
BMC Public Health ; 21(1): 903, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980187

RESUMO

BACKGROUND: Assessing inequities in health services utilization contributes to build effective strategies for health equity promotion. This study aimed to evaluate the socioeconomic inequalities and inequities in health services utilization among hypertensive patients and explore the changes between 2015 and 2019 in Pearl River Delta of China. METHODS: The cross-sectional surveys were conducted using the questionnaire. Eight hundred thirty and one thousand one hundred sixty-six hypertensive patients in 2015 and 2019 were interviewed, respectively. The concentration index (CI) and the horizontal inequity index (HI) were used to access the socioeconomic inequalities and horizontal inequities in outpatient and inpatient health services use. The contribution of influential factors to the overall inequalities was estimated via the concentration index decomposition. Oaxaca-type decomposition technique was utilized to measure the changes in socioeconomic inequalities between the observation periods. RESULTS: In 2015 and 2019, the CIs for outpatient and inpatient utilization decreased from 0.1498 to 0.1198, 0.1982 to 0.1648, respectively, and the HIs for outpatient and inpatient utilization decreased from 0.1478 to 0.1078, 0.1956 to 0.1390, respectively. Economic status contributed the maximum ratio of the socioeconomic inequalities in the use of outpatient service (81.05% in 2015, 112.89% in 2019) and inpatient service (82.46% in 2015, 114.68% in 2019) in these 2 years. Oaxaca decomposition revealed that educational level (78.30% in outpatient, 53.79% in inpatient) and time to the nearest health facilities (66.78% in outpatient, 31.06% in inpatient) made the main positive contributions to decline the inequalities. While the main factor pushing the equalities toward deterioration was economic status (- 46.11% in outpatient, -76.56% in inpatient). CONCLUSION: There were certain declines in the socioeconomic inequalities and inequities in health services utilization by hypertensive patients in Pearl River Delta of China over time. The widening economic gap was the largest contribution to the observed inequalities. Interventions to protect the vulnerable group deserve further concern from policy makers.


Assuntos
Utilização de Instalações e Serviços , Hipertensão , China/epidemiologia , Estudos Transversais , Disparidades em Assistência à Saúde , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Rios , Fatores Socioeconômicos
18.
Diabetes Res Clin Pract ; 176: 108861, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34022251

RESUMO

AIM: Type 2 diabetes (T2DM) and hypertension (HTN) are the main modifiable risk factors of chronic kidney disease (CKD), among the known traditional and non-traditional risk factors. METHODS: We determined the prevalence and care-cascade of these modifiable CKD-risk factors and their association with socioeconomic status in adjoining Lucknow and Puducherry cities of India. RESULTS: 439 participants reported no CKD were recruited. Serum analysis revealed an Estimated Glomerular Filtration Rate (eGFR) ≥ 90 ml/min/1.73 m2 in 60.36% of the population. Of them, 55.85% had HTN and/or T2DM as CKD-risk factors; however, less than half of this population was unaware of their CKD-risk status. Awareness and treatment were significantly higher in Puducherry and were associated with literacy, occupation, and residence place. Although the CKD-risk population was about two times higher in Puducherry than Lucknow, the populations with mild-low eGFR were comparable in the two regions. Moreover, in Lucknow, mild-low eGFR and low awareness were more prevalent among the younger participants (<30 years), relative to Puducherry. CONCLUSIONS: Despite a higher prevalence of CKD-risk factors in Puducherry, populations with mild-low eGFR were comparable to Lucknow. More heightened awareness and better care cascade for CKD-risk factors in Puducherry may prevent or delay eGFR reduction.


Assuntos
Procedimentos Clínicos/estatística & dados numéricos , Diabetes Mellitus Tipo 2/terapia , Hipertensão/terapia , Rim/fisiopatologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Atenção à Saúde/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/etiologia , Feminino , Geografia , Taxa de Filtração Glomerular , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Hipertensão/fisiopatologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Adulto Jovem
19.
Contemp Clin Trials ; 106: 106428, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33971295

RESUMO

Sedentary behavior (SB) has recently been recognized as a strong risk factor for cardiovascular disease, with new guidelines encouraging adults to 'sit less, move more.' Yet, there are few randomized trials demonstrating that reducing SB improves cardiovascular health. The Effect of Reducing Sedentary Behavior on Blood Pressure (RESET BP) randomized clinical trial addresses this gap by testing the effect of a 3-month SB reduction intervention on resting systolic BP. Secondary outcomes include other BP measures, pulse wave velocity, plasma renin activity and aldosterone, and objectively-measured SB (via thigh-mounted activPAL) and physical activity (via waist-worn GT3X accelerometer). RESET BP has a targeted recruitment of 300 adults with desk jobs, along with elevated, non-medicated BP (systolic BP 120-159 mmHg or diastolic BP 80-99 mmHg) and physical inactivity (self-reported aerobic physical activity below recommended levels). The multi-component intervention promotes 2-4 fewer hours of SB per day by replacing sitting with standing and light-intensity movement breaks. Participants assigned to the intervention condition receive a sit-stand desk attachment, a wrist-worn activity prompter, behavioral counseling every two weeks (alternating in-person and phone), and twice-weekly automated text messages. Herein, we review the study rationale, describe and evaluate recruitment strategies based on enrollment to date, and detail the intervention and assessment protocols. We also document our mid-trial adaptations to participant recruitment, intervention deployment, and outcome assessments due to the intervening COVID-19 pandemic. Our research methods, experiences to date, and COVID-specific accommodations could inform other research studying BP and hypertension or targeting working populations, including those seeking remote methods.


Assuntos
Exercício Físico/fisiologia , Hipertensão/terapia , Comportamento Sedentário , Local de Trabalho , Acelerometria , Adulto , Idoso , Aldosterona/sangue , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , COVID-19/epidemiologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Renina/sangue , Projetos de Pesquisa , SARS-CoV-2 , Adulto Jovem
20.
BMC Med Educ ; 21(1): 232, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888107

RESUMO

BACKGROUND: Psychiatry and Family Medicine residents frequently see patients with comorbid mental and physical disorders. Little is known about the difference in knowledge of Psychiatry residents and Family Medicine residents regarding management of common conditions they encounter. This study aimed to assess the knowledge of Psychiatry and Family Medicine residents regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia, as the findings could help to refine the training curriculum for residency training. METHODS: A cross-sectional survey design was used. Psychiatry and Family Medicine residents pursuing their residency in Singapore were recruited from November 2019 to June 2020. The survey questionnaire consisted of questions which assessed the knowledge regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia. Descriptive statistics were used to describe the demographic data; T-tests or Mann-Whitney U tests to compare the differences between groups; and multiple regression analyses to assess the factors associated with Psychiatry residents' knowledge of hypertension, diabetes mellitus, and dyslipidemia. RESULTS: Fifty-seven out of 70 (81.4%) Psychiatry residents and 58 out of 61 (95.1%) Family Medicine residents participated in the study. The majority of Psychiatry residents encountered patients with hypertension (93.0%), diabetes mellitus (87.7%) and dyslipidemia (91.2%) on a daily to weekly basis. Psychiatry residents had higher scores on questions about schizophrenia versus Family Medicine residents (mean 50.70 versus 43.28, p < 0.001). However, Psychiatry residents scored lower on questions about hypertension (mean 33.86 versus 40.98, p < 0.001), diabetes mellitus (mean 45.68 versus 49.79, p = 0.005) and dyslipidemia (mean 37.04 versus 44.31, p < 0.001). Receiving undergraduate medical education locally, compared to receiving it overseas, was associated with better knowledge of hypertension (beta = 0.515, p = 0.009) and dyslipidemia (beta = 0.559, p = 0.005); while younger age (26-30 versus > 35 and 31-35 versus > 35) was associated with better knowledge of hypertension (beta = 1.361, p = 0.002 and beta = 1.225, p = 0.003). A significant proportion of Psychiatry residents (61.4%) did not agree that the training provided to manage hypertension, diabetes mellitus, and dyslipidemia was adequate. Similarly, majority of Family Medicine residents (62.1%) did not agree that they had adequate training to manage schizophrenia. CONCLUSIONS: This study raises the awareness of Psychiatry residents' sense of discomfort in managing hypertension, diabetes mellitus, or dyslipidemia and conversely Family Medicine residents in management of schizophrenia, which can be further addressed during the training postings within the residency programs. Future studies are needed to look at local (such as training curriculum) and systemic factors (such as practice trends and culture) in order to better align residency selection criteria and training foci with real world practice factors over time.


Assuntos
Diabetes Mellitus , Dislipidemias , Hipertensão , Internato e Residência , Psiquiatria , Esquizofrenia , Estudos Transversais , Currículo , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Dislipidemias/epidemiologia , Dislipidemias/terapia , Medicina de Família e Comunidade/educação , Humanos , Hipertensão/terapia , Psiquiatria/educação , Esquizofrenia/terapia , Singapura
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