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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.
Khirurgiia (Mosk) ; (9): 38-42, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030000

RESUMO

OBJECTIVE: To report treatment outcomes in patients with congenital aortic arch disease. MATERIAL AND METHODS: There were 65 patients (45 boys and 20 girls) for the period from 2005 to 2019. Mean age of patients was 53±12 days (range 1-98), weight - 3,3±1,3 kg (range 2.2-4.6). All patients were divided into 2 groups depending on the method of surgical repair. The 1st group included 33 patients who underwent patch repair, the 2nd group (n=32) - anastomosis in end-to-side fashion. RESULTS: In group I, recurrent aortic arch coarctation was observed in 16.8% of cases, in group II - only in 4% of cases (p=0.02). Analysis of systolic pressure in both groups revealed that arterial hypertension was detected in 39% of cases in group I and only in 9,1% of cases in group II (p=0,0025). CONCLUSION: Surgical treatment of aortic arch disease using anastomosis in end-to-side fashion is associated with reduced risk of recurrent aortic arch coarctation and residual arterial hypertension in long-term postoperative period.


Assuntos
Aorta Torácica , Coartação Aórtica , Anastomose Cirúrgica , Pressão Sanguínea , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
6.
Vestn Oftalmol ; 136(5): 103-108, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33056970

RESUMO

Primary open-angle glaucoma is a major cause of irreversible blindness in all countries of the world. The pathogenesis of primary open-angle glaucoma has not been resolved. In addition to increased intraocular pressure, pathogenetic factors of this disease such as reduced systemic blood pressure, deterioration of ocular blood flow, as well as vascular dysregulation, reperfusion damage and oxidative stress of ocular tissues are now generally recognized. The role of α1-adrenoreceptors in regulation of, for example, ocular blood flow, blood flow in the retina, permeability of the vascular wall etc has already been described. PURPOSE: To identify the effects of different subtypes of α1-adrenoreceptors on the level of systemic blood pressure in laboratory mice. MATERIAL AND METHODS: Features of blood pressure of 36 laboratory mice older than 18 months having a genetic defect (lines ADRA-1A, ADRA-1D and ADRA-1D) of one of the subtypes of α1-adrenoreceptors (α1a, α1b, α1d) were studied. The control group included ten healthy laboratory mice of the same age. The blood pressure of mice was measured with modern high-precision and noninvasive method using the CodaTM Standard system (Kent Scientific Corporation, U.S.A.). RESULTS: The mice of the ADRA-1A line were revealed to have reduced systolic and diastolic blood pressure and maximum level of pulse pressure, as well as the greatest fluctuations of pulse pressure; for the ADRA-1B line - the highest levels of systolic and diastolic blood pressure; for the ADRA-1D line - the smallest systolic and diastolic blood pressure and the minimum values of pulse pressure. CONCLUSION: The obtained results show the specific contribution of α1a, α1b and α1d subtypes of the adrenoreceptors in the maintenance of normal hemodynamic of an organism, which should be considered when studying pathogenesis of primary open-angle glaucoma.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Animais , Pressão Sanguínea , Olho , Glaucoma de Ângulo Aberto/genética , Camundongos , Receptores Adrenérgicos alfa 1/genética
7.
Medicine (Baltimore) ; 99(40): e22432, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019423

RESUMO

Nesfatin-1 was identified as a satiety factor involved in the regulation of metabolism. Altered levels of circulating nesfatin-1 had been observed in a variety of diseases characterized by energy imbalance. However, there was no published data about nesfatin-1 levels in acromegaly.We evaluated serum nesfatin-1 levels in 13 patients with acromegaly at baseline and postoperatively, and in 21 age- and body mass index (BMI)-matched healthy subjects.Compared with the healthy subjects, patients with acromegaly had significantly increased levels of serum insulin, high-density lipoprotein cholesterol, triglyceride, and growth hormone (GH). Moreover, the acromegaly group had nesfatin-1 levels higher than controls (1.96 ±â€Š0.56 ng/mL vs 0.61 ±â€Š0.10 ng/mL, P = .004). There was a positive correlation of serum nesfatin-1 levels with diastolic blood pressure (r = 0.579, P = .038) and homeostasis model assessment of insulin resistance (HOMA-IR) (r = 0.598, P = .031) in patients with acromegaly. While a successful surgery decreased serum GH levels, the serum nesfatin-1 levels did not change in acromegaly (P = .965). At last, we compared serum GH/nesfatin-1 levels with predictive markers for aggressive behaviors in pituitary adenomas. There was no relationship between serum nesfatin-1 levels and tumor's size, Ki-67 index, mutant p53, or MGMT proteins. However, increased serum GH levels were positively correlated with tumors' size (P = .023) and mutant p53 proteins expression (P = .028).Circulating nesfatin-1 was increased in acromegaly, which was involved in metabolism regulation.


Assuntos
Acromegalia/sangue , Nucleobindinas/sangue , Adenoma/sangue , Adenoma/patologia , Adenoma/cirurgia , Adulto , Pressão Sanguínea , Estudos de Casos e Controles , Feminino , Hormônio do Crescimento Humano/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Curva ROC
8.
Medicine (Baltimore) ; 99(40): e22436, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019425

RESUMO

In addition to governing key functions in bone metabolism and the immune system, the RANK/RANKL/OPG system plays a role in the vascular system, particularly in vascular calcification and atherosclerosis.Given that these 2 phenotypes are considered a major cause of high blood pressure (BP), in this study we analyzed the association of SNPs in RANK and OPG genes with blood pressure. An observational study was conducted of 2 SNPs in the RANK gene (rs884205 and rs78326403) and 1 in the OPG gene (rs4876869) with systolic (SBP) and diastolic blood pressure (DBP) in a cohort of 695 women.Data analysis revealed a statistically significant association between the SNP rs884205 and BP pressure (SBP and DBP). Analyzing this relationship by the dominant inheritance model for this SNP (allele risk: A), women of the AA/AC genotype showed higher BP than women of the CC genotype, both for SBP (P = .001) and for DBP (P = .003), and these associations both surpassed the Bonferroni threshold for multiple comparisons. Multivariate regression analysis including known predictors of BP as independent variables was performed to evaluate the strength of this association, which in the case of the SNP rs884205 of the RANK gene remained statistically significant after adjustment for both SBP (P = .0006) and DBP (P = .005), demonstrating the key role of this SNP in BP.We report a robust association between the SNP rs884205 in RANK gene and BP in women, and this SNP is validated as a candidate in cardiovascular risk studies.


Assuntos
Pressão Sanguínea/genética , Receptor Ativador de Fator Nuclear kappa-B/sangue , Feminino , Estudo de Associação Genômica Ampla , Humanos , Pessoa de Meia-Idade , Osteoprotegerina/sangue , Polimorfismo de Nucleotídeo Único , Espanha
9.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(9): 721-727, 2020 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-32957753

RESUMO

Objective: To investigate the impact of history of hypertension and blood pressure levels on the thromboembolism risk in the setting of nonvalvular atrial fibrillation (NVAF). Methods: China Atrial Fibrillation Registry Study prospectively enrolled 25 512 atrial fibrillation (AF) patients between August 2011 and December 2018. After exclusion of patients with valvular AF, hypertrophic cardiomyopathy, receiving anticoagulation or ablation therapy at the enrollment, 7 757 patients were included in analysis. The primary endpoint was the time to the first occurrence of ischemic stroke or systemic embolism. Cox proportional hazards models were performed to evaluate whether a history of hypertension or blood pressure levels were independently associated with thromboembolism. Results: During a mean follow up of (35±25) months, 455 (5.9%)thromboembolic events occurred. The crude incidence rate of thromboembolism in patients with a history of hypertension was higher than that in patients without hypertension (2.38 vs. 1.35 per 100 patient-years, χ²=16.8,Log-rank P<0.001). Patients were further divided into 4 groups according to systolic blood pressure (SBP) levels at baseline, the crude incidence rate of thromboembolism significantly increased in proportion to the elevation of SBP levels (χ²=17.9,Log-rank P<0.001). However, there was no significant difference in thromboembolism risk among 4 groups stratified by diastolic blood pressure (DBP) levels (χ²=0.6,Log-rank P=0.907). Multivariable regression analysis showed that history of hypertension was independently associated with a 27% higher risk of thromboembolism (HR=1.27, 95%CI 1.01-1.61, P=0.045). Patients with SBP≥140 mmHg (1 mmHg=0.133 kPa) was associated with 36% higher risk of thromboembolism than patients with SBP<120 mmHg (HR=1.36, 95%CI 1.02-1.82, P=0.036). However, patients with SBP 120-129 mmHg or 130-139 mmHg were not at a higher risk of thromboembolism as compared to the patients with SBP<120 mmHg (SBP 120-129 mmHg: HR=1.23, 95%CI 0.90-1.67, P=0.193; SBP 130-139 mmHg: HR=1.30, 95%CI 0.95-1.77, P=0.098). In addition, DBP levels were not independently associated with the increased thromboembolism risk. Conclusion: A history of hypertension and SBP≥140 mmHg are independent predictors of thromboembolism risk in patients with NVAF. These results indicate that intensive efforts to lower SBP below 140 mmHg might be an important strategy to reduce the risk of stroke in patients with NVAF.


Assuntos
Fibrilação Atrial , Hipertensão , Acidente Vascular Cerebral , Tromboembolia , Pressão Sanguínea , China , Humanos , Fatores de Risco
10.
Ann Agric Environ Med ; 27(3): 384-387, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32955219

RESUMO

INTRODUCTION AND OBJECTIVE: Single ventricle anomaly is one of the complex congenital heart defects. A dependable non-invasive method of evaluation of Fontan circulation haemodynamics for early diagnosing unstable patients is hardly available in routine clinical practice. The aim of the study is non-invasive evaluation of the haemodynamic parameters in patients after Fontan operation. MATERIAL AND METHODS: The study involved 11 participants (age 24.4±4.3 years) with functionally univentricular hearts after Fontan operation. Evaluation of haemodynamic parameters was performed in supine and sitting positions using the impedance cardiography method. RESULTS: In comparative analysis, heart rate (70.1 vs.78.3 1/min; p=0.001), diastolic blood pressure (73.9 vs. 76.7 mm Hg; p=0.026), mean arterial blood pressure (84.5 vs. 88.0 mm Hg; p=0.013), systemic vascular resistance (1284.8 vs. 1334.9 dyn*s*cm-5; p=0.024), systemic vascular resistance index (2178.7 vs. 2272.8 dyn*s*cm-5*m2 ; p=0.018), pre-ejection period (124.2 vs. 136.2 ms; p=0.009), systolic time ratio (0.43 vs. 0.53; p=0.0001), and Zo (26.2 vs. 28.7 Ω; p<0.00001), were significantly higher in the sitting position. Stroke volume (75.4 vs. 68.5 ml; p=0.013), stroke index (42.7 vs. 39.0 ml*m-2; p=0.014), thoracic fluid content (38.5 vs. 35.4 1*kΩ-1; p=<0.00001), thoracic fluid content index (22.8 vs. 21.0 1*kΩ-1*m-2; p=<0.00001), and leftventricular ejection time 291.1 vs. 260.1 ms; p <0.00001, were significantly higher in the supine position. CONCLUSIONS: In patients after Fontan procedure, impedance cardiography can be a useful tool the assessment of shortterm haemodynamic changes provoked by postural changes. Its clinical value in patients with congenital heart defects should be further investigated.


Assuntos
Pressão Sanguínea , Técnica de Fontan/efeitos adversos , Frequência Cardíaca , Resistência Vascular , Adulto , Cardiografia de Impedância , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/cirurgia , Humanos , Polônia , Adulto Jovem
11.
Ecotoxicol Environ Saf ; 203: 111044, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32888613

RESUMO

BACKGROUND: Exposure to ambient fine particulate matter (PM2.5) is associated with various adverse health outcomes. Although several mechanisms have been proposed including oxidative stress and inflammatory responses, the exact mechanism is still unknown. Few studies have investigated the mechanism linking PM2.5 and blood pressure (BP). In this study, we measured urinary metabolites and BP -related renin-angiotensin-aldosterone system (RAAS) to investigate the associations between ambient PM2.5 exposure and BP in healthy C57BL/6 mice. METHODS: The C57BL/6 mice were exposed to ambient concentrated PM2.5 or filtered air (FA) for 16 weeks. Systolic BP and diastolic BP were measured by noninvasive BP system. The urine metabolites were quantified using the untargeted metabolomics approach. The expression of RAAS-related proteins angiotensin-converting enzyme (ACE)2, angiotensin (Ang) II, Ang (1-7) and aldosterone (ALD) were measured using Western blot and ELISA kits. RESULTS: The metabolomics analysis demonstrated that PM2.5 exposure induced significant changes of some metabolites in urine, including stress hormones, amino acids, fatty acids, and lipids. Furthermore, there was an elevation of BP, increase of serous Ang II and ALD, along with the decrease of ACE2 and Ang (1-7) in kidney in the PM2.5-exposed mice compared with FA-exposed mice. CONCLUSIONS: The results demonstrated that PM2.5 exposure-induced BP elevation might be associated with RAAS activation. Meanwhile, PM2.5 exposure-induced changes of stress hormone and lipid metabolism might mediate the activation of RAAS. The results suggested that the systemic stress hormone and lipid metabolism was associated with the development of hypertension.


Assuntos
Poluentes Atmosféricos/toxicidade , Angiotensina I/metabolismo , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/induzido quimicamente , Material Particulado/toxicidade , Fragmentos de Peptídeos/metabolismo , Peptidil Dipeptidase A/metabolismo , Acetilglucosaminidase/urina , Angiotensina I/sangue , Animais , Biomarcadores/sangue , Biomarcadores/urina , Hipertensão/urina , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , Metaboloma/efeitos dos fármacos , Metabolômica , Camundongos , Camundongos Endogâmicos C57BL , Fragmentos de Peptídeos/sangue , Peptidil Dipeptidase A/sangue , Sistema Renina-Angiotensina/efeitos dos fármacos , beta-Galactosidase/urina
12.
Emerg Med Clin North Am ; 38(4): 755-769, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981615

RESUMO

There are approximately 350,000 out-of-hospital cardiac arrests and 200,000 in-hospital cardiac arrests annually in the United States, with survival rates of approximately 5% to 10% and 24%, respectively. The critical factors that have an impact on cardiac arrest survival include prompt recognition and activation of prehospital care, early cardiopulmonary resuscitation, and rapid defibrillation. Advanced life support protocols are continually refined to optimize intracardiac arrest management and improve survival with favorable neurologic outcome. This article focuses on current treatment recommendations for adult nontraumatic cardiac arrest, with emphasis on the latest evidence and controversies regarding intracardiac arrest management.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Manuseio das Vias Aéreas , Antiarrítmicos/administração & dosagem , Pressão Sanguínea , Dióxido de Carbono/análise , Diástole , Ecocardiografia , Cardioversão Elétrica , Serviço Hospitalar de Emergência , Epinefrina/administração & dosagem , Humanos , Hipotermia Induzida , Infusões Intraósseas , Infusões Intravenosas , Monitorização Fisiológica , Sistemas Automatizados de Assistência Junto ao Leito , Guias de Prática Clínica como Assunto , Vasoconstritores/administração & dosagem
13.
Emerg Med Clin North Am ; 38(4): 807-818, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981619

RESUMO

Sepsis care has evolved significantly since the initial early goal-directed therapy (EGDT) trials. Early fluid resuscitation, source control, and antibiotic therapy remain cornerstones of care but overall understanding is more nuanced, particularly regarding fluid selection, vasopressors, and inotropic support. Timely nutrition therapy and ventilatory support tend to receive less attention but also are important. Recent research has explored immunomodulation, ß-blockade, and vitamin supplementation. A renewed emphasis on early, aggressive resuscitation reaffirms the importance of emergency medicine providers knowledgeable and skilled in sepsis management.


Assuntos
Ressuscitação/métodos , Sepse/terapia , Angiotensina II/uso terapêutico , Antibacterianos/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Glicemia/análise , Pressão Sanguínea , Cardiomiopatias/etiologia , Cardiomiopatias/terapia , Cardiotônicos/uso terapêutico , Estado Terminal , Serviço Hospitalar de Emergência , Nutrição Enteral , Hidratação , Glucocorticoides/uso terapêutico , Hemodinâmica , Humanos , Escores de Disfunção Orgânica , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Vasoconstritores/uso terapêutico
14.
Medicine (Baltimore) ; 99(35): e21955, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871944

RESUMO

BACKGROUND: Hypertension is a clinically common cardiovascular disease, resulting in many complications. Omega-3 might be beneficial in lowering blood pressure. This protocol will be performed to evaluate the effects of omega-3 on blood pressure in hypertensive patients. METHODS: We will search both the electronical databases and paper-published journals. Endnote software will be used to complete study screening and data extraction by 2 reviewers independently. Review Manager software will be used to synthesize the data. The primary outcomes are systolic blood pressure and diastolic blood pressure. Secondary outcome is the adverse effects. RESULTS: The results of this study will propose a trustworthy evidence to evaluate the effects of omega-3 on blood pressure of hypertensive patients. CONCLUSION: The conclusion of our systematic review will reply whether omega-3 is an effectual intervention to lower blood pressure of hypertensive patients. ETHICS: This review does not require ethical approval because all of the data analyzed in this review have been published. REGISTRATION NUMBER: INPLASY202070103 (DOI number: 10.37766/inplasy2020.7.0103).


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Ácidos Graxos Ômega-3/uso terapêutico , Hipertensão/prevenção & controle , Ácidos Graxos Ômega-3/farmacologia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
15.
Medicine (Baltimore) ; 99(33): e21566, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872008

RESUMO

Metabolic syndrome (MetS) refers to the pathological state of metabolic disorders in the body's proteins, fats, carbohydrates and other substances. MetS is a systemic metabolic disease. Periodontal disease is also a part of systemic inflammatory diseases. Among Chinese patients with middle-aged and elderly MetS, the periodontal morbidity is very high, which is due to the involvement of inflammatory mediators in the pathogenesis of MetS and periodontal disease. The latter may also be a risk factor for the former's morbidity and promotion of disease progression. At present, there are not many investigations and studies on periodontal examination data and periodontal disease prevalence of patients with MetS. Coal mine workers, especially coal mine underground workers, have different work natures and different working environments. See related report.We will collect the clinical diagnosis and treatment information of the enrolled patients. We will focus on checking the incidence of periodontal disease and recording. Establish a database, check every 10 medical records, and make corrections in time to ensure data accuracy. We will popularize oral hygiene knowledge for the included patients and guide them to brush their teeth correctly and how to use dental floss. We will perform periodontal examination on the patients' teeth by site and record the plaque index, gingival sulcus bleeding index, periodontal pocket exploration depth and other indicators. We will repeat the above inspection items and record in the second and fourth weeks of the experiment.This study will explore the correlation between periodontal disease and MetS of coal mine workers. We aim to clarify the role and mechanism of MetS in the occurrence and development of periodontal diseases, guide the prevention of periodontal diseases, and thus reduce the prevalence of periodontal diseases. TRIAL REGISTRATION:: ClinicalTrials.gov, ChiCTR2000034177, Registered on 27 June 2020.


Assuntos
Carvão Mineral , Síndrome Metabólica/epidemiologia , Mineradores/estatística & dados numéricos , Doenças Periodontais/epidemiologia , Adulto , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , China/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Índice Periodontal , Prevalência , Fatores de Risco , Fumar/epidemiologia , Adulto Jovem
16.
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
17.
Hipertens. riesgo vasc ; 37(3): 115-124, jul.-sept. 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-193520

RESUMO

INTRODUCCIÓN Y OBJETIVO: La obesidad y el síndrome metabólico (SM) continúan siendo un problema a nivel socioeconómico, causando elevada morbilidad y mortalidad en la población adulta, por lo que se debería realizar una prevención de factores de riesgo desde temprana edad. En la actualidad no existe un consenso del momento oportuno para iniciar la intervención y tratamiento con respecto al SM. El objetivo del estudio es describir el fenotipo para predecir diagnóstico temprano de SM en escolares. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo, transversal y analítico en escolares de seis a 15 años, aplicado en Guayaquil. Se realizó valoración antropométrica y encuesta escrita, tras firma del consentimiento informado. Se utilizó para los cálculos de asociación la plataforma de inteligencia artificial (IA) Watson de IBM y su software Modeler Flow. RESULTADOS: Se examinó una población de 1.025 estudiantes entre seis y 15 años (media de 12 años para varones y 13 años para mujeres), de los cuales 62,3% fueron hombres y 37,7% mujeres. El 23,9% de la población presentó sobrepeso y 14% obesidad. Se observó una mayor tendencia a la alteración del peso en varones que en mujeres (51,37% vs. 47,79%), y menor perímetro de cintura en varones (85 cm vs. 87 cm, respectivamente). Los varones tuvieron mayor nivel de presión arterial sistólica (PAS), encontrándose dentro del percentil 90 (PAS media de 123 mmHg) un 61,2%, en comparación con un 38,8% de las mujeres, con una p < 0,001. El sedentarismo es similar en ambos grupos, con una media de 4,79 horas frente a la pantalla y/o videojuegos. Se demostró correlación estadísticamente significativa entre la presión arterial y el índice cintura /talla (I c/t) en el percentil 90 y percentil 95 (X2 9,075, p < 0,028, y X2 23,54, p < 0,000, respectivamente), así como relación entre el P95 de la presión arterial y el sexo (X2 11,57, p < 0,001). El sistema Modeler Flow, nos demostró que, si se observa un I c/t > 0,46, peso > 56,1 kg, talla > 1,61 m, y sedentarismo puro mayor a tres horas de tiempo frente a la pantalla, hay una probabilidad de presentar SM de 82,4%. El modelado matemático del árbol de decisiones (basado en inteligencia artificial) tiene una precisión predictiva del 90% (desviación de error de 0,009). La importancia de los predictores de SM, van de un 97,57% a un 100%. CONCLUSIONES: Se observó en escolares de seis a 15 años, una prevalencia del 33,9% de SM, con puntos de corte patológicos de: I c/t ≥ 0,46, peso ≥ 56,1 kg, sedentarismo puro mayor a tres horas frente a la pantalla/videojuegos, y PAS dentro del P90 (> 123 mmHg). Con estos cuatro indicadores, podemos predecir una probabilidad de diagnóstico temprano de SM de 97% al 100%


INTRODUCTION AND OBJECTIVES: Obesity and metabolic syndrome (MS) continue to be a problem at a socioeconomic level, causing high morbidity and mortality in the adult population. Prevention of risk factors should be carried out from an early age. Currently, there is no consensus on the opportune moment to start an intervention or treatment, regarding metabolic syndrome. The objective of the study is to describe the phenotype to predict early diagnosis of metabolic syndrome in schoolchildren. MATERIAL AND METHODS: Observational, prospective, cross-sectional and analytical study in schoolchildren from 6 to 15 years old, conducted in Guayaquil. Anthropometric measurements and a survey were performed, obtaining signing informed consent. The IBM Watson artificial intelligence (AI) platform with its software Modeler Flow, were used for the analysis. RESULTS: A population of 1025 students between 6 and 15 years old (mean of 12 years for men and 13 years for women) was examined, of whom 62.3% were men and 37.7% women. 23.9% of the population was overweight and 14% obese. A greater tendency to weight alteration was observed in men than in women (51.37% vs 47.79%), and a lower waist circumference in men (85 cm vs 87 cm, respectively). Males had a higher level of systolic blood pressure (SBP), being within the 90th percentile (mean SBP of 123 mmHg) 61.2%, compared to 38.8% of women, with a p < 0.001. Sedentary lifestyle is similar in both groups, with an average of 4.79 hours in front of the screen and/or video games. A statistically significant correlation was demonstrated between SBP and the waist/height ratio (WHtR) in the 90th percentile and 95th percentile (X2 9.075, p < 0.028, and X2 23,54, p < 0,000 respectively), as well as a relationship between 95th percentile and sex (X2 11.57, p < 0.001). The Modeler Flow software showed us that if WHtR, > 0.46, weight > 56.1 kg and height > 1.61 m, the probability of presenting metabolic syndrome, was of 82.4%. The statistic of this study has a predictive accuracy of 90% (error deviation of 0.009). The importance in the predictors of metabolic syndrome, range from 97.57% to 100%. CONCLUSIONS: A prevalence of 33.9% of metabolic syndrome was observed in schoolchildren from 6 to 15 years old, with pathological cut-off points of: WHtR > 0.46, weight > 56.1 kg, pure sedentary lifestyle > 3 hours in front of the screen/playing video games, and SBP within the 90th percentile (> 123 mmHg). With these four indicators, we can predict a probability of early diagnosis of metabolic syndrome of 97% to 100%


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Diagnóstico Precoce , Síndrome Metabólica/diagnóstico , Fenótipo , Pressão Sanguínea , Estudos Prospectivos , Estudos Transversais , Antropometria , Inteligência Artificial , Estudantes/estatística & dados numéricos , Relação Cintura-Quadril
19.
Cochrane Database Syst Rev ; 9: CD008652, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32877573

RESUMO

BACKGROUND: This is the second update of this systematic review. High blood pressure represents a major public health problem. Worldwide, approximately one-fourth of the adult population has hypertension. Epidemiological and experimental studies suggest a link between hyperuricaemia and hypertension. Hyperuricaemia affects 25% to 40% of those with untreated hypertension; a much lower prevalence has been reported in those with normotension or in the general population. However, whether lowering serum uric acid (UA) might lower blood pressure (BP), is an unanswered question. OBJECTIVES: To determine whether UA-lowering agents reduce BP in people with primary hypertension or prehypertension, compared with placebo. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to May 2020: the Cochrane Hypertension Specialised Register, CENTRAL 2018, Issue 12, MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched LILACS (1982 to May 2020), and contacted authors of relevant papers regarding further published and unpublished work. The searches had no language or date restrictions. SELECTION CRITERIA: To be included in this updated review, the studies had to meet the following criteria: 1) randomised or quasi-randomised, with a group assigned to receive a UA-lowering agent and another group assigned to receive placebo; 2) double-blind, single-blind, or open-label; 3) parallel or cross-over trial design; 4) cross-over trials had to have a washout period of at least two weeks; 5) minimum treatment duration of four weeks; 6) participants had to have a diagnosis of essential hypertension or prehypertension plus hyperuricaemia (serum UA greater than 6 mg/dL in women, 7 mg/dL in men, and 5.5 mg/dL in children or adolescents); 7) outcome measures included change in 24-hour ambulatory systolic or diastolic BP, or both; or clinic-measured systolic or diastolic BP, or both. DATA COLLECTION AND ANALYSIS: The two review authors independently collected the data using a data extraction form, and resolved any disagreements via discussion. We assessed risk of bias using the Cochrane 'Risk of bias' tool. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: In this review update, we screened 722 records, selected 26 full-text reports for evaluation. We identified no ongoing studies and did not add any new studies. We included three randomised controlled trials (RCTs), enrolling 211 people with hypertension or prehypertension, plus hyperuricaemia. Low-certainty evidence from three RCTs found inconclusive results between those who received UA-lowering drugs and placebo, in 24-hour ambulatory systolic (MD -6.2 mmHg, 95% CI -12.8 to 0.5) or diastolic BP (-3.9 mmHg, 95% CI -9.2 to 1.4). Low-certainty evidence from two RCTs found that UA-lowering drugs reduced clinic-measured systolic BP (-8.43 mmHg, 95% CI -15.24 to -1.62) but results for clinic-measured diastolic BP were inconclusive (-6.45 mmHg, 95% CI -13.60 to 0.70). High-certainty evidence from three RCTs found that serum UA levels were reduced by 3.1 mg/dL (95% CI 2.4 to 3.8) in the participants that received UA-lowering drugs. Low-certainty evidence from three RCTs found inconclusive results regarding the occurrence of adverse events between those who received UA-lowering drugs and placebo (RR 1.86, 95% CI 0.43 to 8.10). AUTHORS' CONCLUSIONS: In this updated Cochrane Review, the current RCT data are insufficient to know whether UA-lowering therapy lowers BP. More studies are needed.


Assuntos
Alopurinol/uso terapêutico , Hipertensão/tratamento farmacológico , Hiperuricemia/tratamento farmacológico , Uricosúricos/uso terapêutico , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Criança , Humanos , Hipertensão/complicações , Hiperuricemia/complicações , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Placebos/uso terapêutico , Pré-Hipertensão/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Cochrane Database Syst Rev ; 9: CD010054, 2020 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-32888198

RESUMO

BACKGROUND: Beta-blockers are commonly used in the treatment of hypertension. We do not know whether the blood pressure (BP) lowering efficacy of beta-blockers varies across the day. This review focuses on the subclass of beta-blockers with partial agonist activity (BBPAA). OBJECTIVES: To assess the degree of variation in hourly BP lowering efficacy of BBPAA over a 24-hour period in adults with essential hypertension. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for relevant studies up to June 2020: the Cochrane Hypertension Specialised Register; CENTRAL; 2020, Issue 5; MEDLINE Ovid; Embase Ovid; the World Health Organization International Clinical Trials Registry Platform; and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA: We sought to include all randomised and non-randomised trials that assessed the hourly effect of BBPAA by ambulatory monitoring, with a minimum follow-up of three weeks. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the included trials and extracted the data. We assessed the certainty of the evidence using the GRADE approach. Outcomes included in the review were end-point hourly systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR), measured using a 24-hour ambulatory BP monitoring (ABPM) device. MAIN RESULTS: Fourteen non-randomised baseline controlled trials of BBPAA met our inclusion criteria, but only seven studies, involving 121 participants, reported hourly ambulatory BP data that could be included in the meta-analysis. Beta-blockers studied included acebutalol, pindolol and bopindolol. We judged most studies at high or unclear risk of bias for selection bias, attrition bias, and reporting bias. We judged the overall certainty of the evidence to be very low for all outcomes. We analysed and presented data by each hour post-dose. Very low-certainty evidence showed that hourly mean reduction in BP and HR visually showed an attenuation over time. Over the 24-hour period, the magnitude of SBP lowering at each hour ranged from -3.68 mmHg to -17.74 mmHg (7 studies, 121 participants), DBP lowering at each hour ranged from -2.27 mmHg to -9.34 mmHg (7 studies, 121 participants), and HR lowering at each hour ranged from -0.29 beats/min to -10.29 beats/min (4 studies, 71 participants). When comparing between three 8-hourly time intervals that correspond to day, evening, and night time hours, BBPAA was less effective at lowering BP and HR at night, than during the day and evening. However, because we judged that these outcomes were supported by very low-certainty evidence, further research is likely to have an important impact on the estimate of effect and may change the conclusion. AUTHORS' CONCLUSIONS: There is insufficient evidence to draw general conclusions about the degree of variation in hourly BP-lowering efficacy of BBPAA over a 24-hour period, in adults with essential hypertension. Very low-certainty evidence showed that BBPAA acebutalol, pindolol, and bopindolol lowered BP more during the day and evening than at night. However, the number of studies and participants included in this review was very small, further limiting the certainty of the evidence. We need further and larger trials, with accurate recording of time of drug intake, and with reporting of standard deviation of BP and HR at each hour.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Ritmo Circadiano/fisiologia , Hipertensão/tratamento farmacológico , Acebutolol/uso terapêutico , Agonistas Adrenérgicos beta/uso terapêutico , Adulto , Viés , Pressão Sanguínea/fisiologia , Ensaios Clínicos Controlados como Assunto , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pindolol/análogos & derivados , Pindolol/uso terapêutico , Fatores de Tempo
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