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1.
Clin Exp Hypertens ; 38(8): 659-665, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27935319

RESUMEN

BACKGROUND: Aldosterone synthase (CYP11B2) is a key enzyme involved in the terminal steps of aldosterone biosynthesis. Genetic variability in CYP11B2 gene has been associated with heterogeneous aldosterone production, which can affect sodium homeostasis and thereby regulation of blood pressure. Hence, the present study was aimed to explore the single-locus variations, haplotype and epistasis patterns of CYP11B2 (C-344T, intron-2 gene conversion and Lys173Arg) gene polymorphisms, and the risk contributed by them to the development of essential hypertension (EHT). METHODS: A total of 279 hypertensive patients and 200 normotensive controls were enrolled in this study. C-344T and Lys173Arg polymorphisms of CYP11B2 gene were genotyped by PCR-RFLP method and intron-2 gene conversion (IC) polymorphism by allele-specific PCR analysis. RESULTS: Single-locus analysis revealed significant association of CYP11B2 C-344T and Lys173Arg polymorphisms with EHT (p < 0.05). Considering the sexes, Lys173 allele was found to be at risk for hypertension in males (OR 1.40; 95% CI = 1.01-1.96). Unphased haplotype analysis revealed H1 (T-Conv-Lys; p = 0.0017) to have significant risk for EHT, while haplotype H4 (T-Wt-Arg) had a significant protective effect. Multifactor dimensionality reduction (MDR) interaction analysis found the overall best model with C-344T and IC polymorphisms exhibiting strong synergistic effect. CONCLUSION: The present study revealed a strong synergistic effect of CYP11B2 C-344T and IC polymorphisms causing susceptibility to EHT and haplotype H1 (-344T-Conv-Lys173) as the risk-conferring factor for hypertension predisposition.


Asunto(s)
Aldosterona/sangre , Presión Sanguínea/fisiología , Citocromo P-450 CYP11B2/genética , ADN/genética , Predisposición Genética a la Enfermedad/genética , Hipertensión/genética , Polimorfismo Genético , Alelos , Citocromo P-450 CYP11B2/metabolismo , Hipertensión Esencial , Femenino , Genotipo , Haplotipos , Humanos , Hipertensión/epidemiología , Hipertensión/metabolismo , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Factores de Riesgo
3.
Am J Clin Nutr ; 104(6): 1703-1711, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27935524

RESUMEN

BACKGROUND: Renal transplant recipients (RTRs) have commonly been urged to limit their potassium intake during renal insufficiency and may adhere to this principle after transplantation. Importantly, in experimental animal models, low dietary potassium intake induces kidney injury through stimulation of ammoniagenesis. In humans, low potassium intake is an established risk factor for high blood pressure. OBJECTIVE: We hypothesized that low 24-h urinary potassium excretion [UKV; urinary potassium concentration × volume], the gold standard for assessment of dietary potassium intake, represents a risk factor for graft failure and mortality in RTRs. In secondary analyses, we aimed to investigate whether these associations could be explained by ammoniagenesis, plasma potassium, or blood pressure. DESIGN: In a prospective cohort of 705 RTRs, we assessed dietary potassium intake by a single 24-h UKV and food-frequency questionnaires. Cox regression analyses were used to investigate prospective associations with outcome. RESULTS: We included 705 stable RTRs (mean ± SD age: 53 ± 13 y; 57% men) at 5.4 y (IQR: 1.9-12.0 y) after transplantation and 253 kidney donors. Mean ± SD UKV was 73 ± 24 mmol/24 h in RTRs compared with 85 ± 25 mmol/24 h in kidney donors. During follow-up for 3.1 y (IQR: 2.7-3.9 y), 45 RTRs developed graft failure and 83 died. RTRs in the lowest sex-specific tertile of UKV (women, <55 mmol/24 h; men, <65 mmol/24 h) had an increased risk of graft failure (HR: 3.70; 95% CI: 1.64, 8.34) and risk of mortality (HR; 2.66; 95% CI: 1.53, 4.61), independent of potential confounders. In causal path analyses, 24-h urinary ammonia excretion, plasma potassium, and blood pressure did not affect these associations. CONCLUSIONS: Our results indicate that low UKV is associated with a higher risk of graft failure and mortality in RTRs. Specific attention for adequate potassium intake after transplantation seems warranted. This trial was registered at clinicaltrials.gov as NCT02811835.


Asunto(s)
Rechazo de Injerto/mortalidad , Trasplante de Riñón/mortalidad , Potasio en la Dieta/orina , Adulto , Anciano , Amoníaco/orina , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Hipertensión/sangre , Hipertensión/etiología , Riñón , Fallo Renal Crónico/cirugía , Masculino , Persona de Mediana Edad , Potasio en la Dieta/administración & dosificación , Potasio en la Dieta/efectos adversos , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios
4.
JNMA J Nepal Med Assoc ; 54(202): 85-87, 2016 Apr-Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27935930

RESUMEN

Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity.Here we present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden on set of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus (uncontrolled). He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis), acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and careful selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating condition.


Asunto(s)
Insuficiencia Renal Crónica/diagnóstico , Accidente Cerebrovascular/diagnóstico , Enfermedad Aguda , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Parálisis de Bell/diagnóstico , Isquemia Encefálica/diagnóstico , Deshidratación/complicaciones , Diabetes Mellitus/diagnóstico , Humanos , Hiperpotasemia/complicaciones , Hipertensión/diagnóstico , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/etiología
5.
PLoS One ; 11(12): e0162608, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27935938

RESUMEN

PURPOSE: In diabetes mellitus type 2, capillary rarefaction plays a pivotal role in the pathogenesis of end-organ damage. We investigated retinal capillary density in patients with early disease. METHODS: This cross-sectional study compares retinal capillary rarefaction determined by intercapillary distance (ICD) and capillary area (CapA), measured non-invasively and in vivo by scanning laser Doppler flowmetry, in 73 patients with type 2 diabetes, 55 healthy controls and 134 individuals with hypertension stage 1 or 2. RESULTS: In diabetic patients, ICD was greater (23.2±5.5 vs 20.2±4.2, p = 0.013) and CapA smaller (1592±595 vs 1821±652, p = 0.019) than in healthy controls after adjustment for differences in cardiovascular risk factors between the groups. Compared to hypertensive patients, diabetic individuals showed no difference in ICD (23.1±5.8, p = 0.781) and CapA (1556±649, p = 0.768). CONCLUSION: In the early stage of diabetes type 2, patients showed capillary rarefaction compared to healthy individuals.


Asunto(s)
Capilares/patología , Diabetes Mellitus Tipo 2/diagnóstico , Retina/patología , Vasos Retinianos/patología , Adulto , Anciano , Velocidad del Flujo Sanguíneo/fisiología , Estudios de Casos y Controles , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/patología , Método Doble Ciego , Diagnóstico Precoz , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Flujometría por Láser-Doppler , Microcirculación , Persona de Mediana Edad
6.
PLoS One ; 11(12): e0165625, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936096

RESUMEN

BACKGROUND: To assess factors associated with disability in a rural district of Bangladesh. METHODS: Using a population-based systematic sampling technique, data were collected from 3104 adults aged ≥ 30 years from the Banshgram union of Narail district. Data collected included an interviewer administered questionnaire to report physical disabilities including impairment that prevents engagement with paid work, visual, hearing, and mobility as well as mental disabilities. Socio-demographic and anthropometric factors including educational attainment and body mass index, as well as clinical factors such as blood pressure, and fasting blood glucose were also collected. Binary and multinomial logistic regression techniques were used to explore the association of various socio-demographic and clinical factors with disability. RESULTS: The mean (SD), minimum and maximum ages of the participants were 51 (12), 30 and 89 years. Of total participants, 65% were female. The prevalence of disability varied from 29.1% for visual impairment (highest) to 16.5% for hearing, 14.7% for movement difficulties and 1.6% (lowest) for any other disability that prevented engagement with paid work. Overall, the prevalence of a single disability was 28.6% and that of two or more disabilities was 14.7%. Older age, gender (female), lower socio-economic status (SES), and hypertension were associated with a higher prevalence of most of the disability components. The prevalence of hearing problems (24.5% vs. 13.3%, p<0.001) and movement difficulties (24.9% vs. 13.0%, p<0.001) was significantly higher among lower-income participants than their higher-income counterparts after controlling for age. Prevalence of visual impairment (54.6% vs. 9.2%, p<0.001), hearing (32.2% vs. 6.7%, p<0.001) and movement difficulties (29.2% vs. 5.5%, p<0.001) were significantly higher in people of aged 60 years or older than those aged 30-34 years. After multivariate adjustment, the prevalence of single disability (prevalence risk ratio [PRR] 1.25, 95% CI: 1.09-1.42, p<0.001), and multiple disabilities (PRR 1.41, 95% CI 1.14-1.73, p<0.001) was higher among females than males. The prevalence of single disability and multiple disabilities was respectively 21% (PRR 1.21, 95% CI: 1.02-1.42, p<0.001) and 88% (PRR 1.88, 95% CI: 1.38-2.54, p<0.001) higher among participants with low educational attainment (primary level or less) than those with at least a secondary level of education. CONCLUSIONS: In rural Bangladesh, the prevalence of disability is high. Public health programs should target those of low SES, older age, and female participants and aim to provide necessary supports in order to bridge disability-related inequities.


Asunto(s)
Ceguera/epidemiología , Sordera/epidemiología , Personas con Discapacidad/estadística & datos numéricos , Hipertensión/epidemiología , Discapacidad Intelectual/epidemiología , Trastornos del Movimiento/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Bangladesh/epidemiología , Ceguera/fisiopatología , Glucemia/metabolismo , Presión Sanguínea , Sordera/fisiopatología , Ayuno , Femenino , Encuestas Epidemiológicas , Humanos , Hipertensión/fisiopatología , Discapacidad Intelectual/fisiopatología , Masculino , Persona de Mediana Edad , Trastornos del Movimiento/fisiopatología , Prevalencia , Salud Rural/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Factores Socioeconómicos
7.
PLoS One ; 11(12): e0167831, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936147

RESUMEN

BACKGROUND: It is known that behavior in childhood is associated with certain physical and mental health problems in midlife. However, there is limited evidence on the role of childhood behavior problems in the development of hypertension in adulthood. The present study aimed to examine whether behavior problems in childhood influenced the risk of hypertension in midlife in the United Kingdom 1958 birth cohort. METHODS: The 1958 British birth cohort comprised 17,638 individuals born in the first week of March 1958 in the United Kingdom. Behavior problems were assessed at 7, 11, and 16 years of age by parents and teachers. At age 45, blood pressure was measured and hypertension was recorded if blood pressure was ≥140/90 mm Hg or if the participants were informed by their health professionals that they had high blood pressure. Behavioral information was reported according to the Rutter Children's Behaviour Questionnaire (RCBQ) and the Bristol Social Adjustment Guide (BSAG). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine behavior problems in childhood in relation to hypertension at 45 years of age according to logistic regression analysis, with adjustment for sex, social class in childhood and adulthood, childhood cognition, birth weight, gestational age at birth, body mass index (BMI), smoking, alcohol consumption, and physical activity. RESULTS: Behavior problems reported by parents at 7, 11, and 16 years were not associated with hypertension in midlife (OR, 0.93; 95% CI, 0.81, 1.07; OR, 0.95; 95% CI, 0.81, 1.11; OR, 0.98; 95% CI, 0.85, 1.12, respectively). Similarly, teacher-reported behavior problems at 7, 11, and 16 years were not associated with hypertension in midlife (OR, 0.92; 95% CI, 0.72, 1.18; OR, 0.92; 95% CI, 0.84, 1.02; OR, 1.03; 95% CI, 0.92, 1.15, respectively). Further separate analyses showed similar results for males and females. CONCLUSION: There is no association between behavior problems in childhood and hypertension in midlife.


Asunto(s)
Trastornos de la Conducta Infantil/complicaciones , Hipertensión/complicaciones , Adolescente , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad
8.
Clin Exp Hypertens ; 38(8): 691-695, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936332

RESUMEN

Hypertension is a major risk factor for cardiovascular diseases in China; hence, identifying good serum markers might provide cost benefits in terms of reducing morbidity rates. In this population-based case-control study, participants were recruited from five districts in Hunan province, and 416 cases were matched with an equal number of controls. Markers related to elevated blood pressure were assessed: Body Mass Index, total cholesterol, triglycerides, fasting blood glucose, and creatinine. Three potential serum markers homocysteine (HCY), C-reactive protein (CRP), and alanine aminotransferase (ALT) were dichotomized as normal or high level. Binary logistic regression was used to determine odds ratios (ORs) and 95% confidence intervals (CIs). The findings showed that ALT is a powerful serum marker for predicting high risk of high blood pressure with OR = 2.94, 95% CI (1.44-6.02), while there were no significant differences between cases and controls for HCY and CRP. Additionally, it seems likely that high concentrations of HCY conferred a protective effect against elevated blood pressure. When adjusted for sex, ORs for hypertensive females were nearly five times higher than for hypertensive males (OR = 4.34, 95% CI = 1.17-16.04). The study strongly supports findings showing ALT is a potential indicator for patients with hypertension.


Asunto(s)
Alanina Transaminasa/sangre , Presión Sanguínea/fisiología , Hipertensión/enzimología , Factores de Edad , Anciano , Biomarcadores/sangre , China/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Incidencia , Masculino , Oportunidad Relativa , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
9.
Clin Exp Hypertens ; 38(8): 673-679, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936339

RESUMEN

Current guidelines suggest the use of home blood pressure monitoring (HBPM) as a method complementary to ambulatory blood pressure monitoring (ABPM) for the identification of arterial hypertension. A cross-sectional study was conducted to evaluate the accuracy of a short HBPM schedule compared with ABPM, and to evaluate to what extent HBPM can replace ABPM. A total of 310 patients who performed ABPM in our hypertension clinic were enrolled between November 2011 and June 2015. They performed a 4-day HBPM schedule, with two readings in the morning and two readings at night. Results showed a moderate correlation between HBPM and ABPM (r = 0.59 for systolic blood pressure (SBP) and r = 0.72 for diastolic blood pressure (DBP)) and moderate diagnostic agreement (area under curve: 0.791 for SBP and 0.857 for DBP). No significant difference was found between first-day average and those of days 2-4. Diagnostic agreement between the two techniques was moderate, supporting the notion that HBPM cannot replace ABPM in the general population. However, we identified two HBPM thresholds, 123/75 and 144/87 mm Hg, through which subjects who may not require further ABPM can be identified.


Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial/métodos , Presión Sanguínea/fisiología , Hipertensión/fisiopatología , Pacientes Ambulatorios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
10.
Clin Exp Hypertens ; 38(8): 680-685, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936340

RESUMEN

BACKGROUND: Both oxidative stress and morning surge (MS) of blood pressure (BP) were found to be closely related with cardiovascular and cerebrovascular diseases. We investigated the association between MS of BP and oxidative stress in newly diagnosed hypertensive patients. METHODS: We prospectively included 237 newly diagnosed hypertensive patients in the present study (mean age: 51.6 ± 11.7 years). The patients were classified according to the extent of the sleep-through surge as follows: the top decile of sleep-through surge (>47.2 mmHg, n = 27; EMShigh group), versus all others (n = 210, EMSlow group). Total antioxidant capacity (TAC) and total oxidant status (TOS) levels were determined by using an automated measurement method. The oxidative stress index (OSI) was calculated as the ratio of TOS to TAC. Serum paraoxonase 1 (PON-1) activity was measured spectrophotometrically. RESULTS: Patients in EMShigh group were found to have higher hs-CRP, TOS, and OSI values and lower TAC and PON-1 values (p < 0.01, for all). MS of BP was associated with hs-CRP, PON-1, TOS, TAC, and OSI levels in bivariate analysis. Multivariate linear regression analysis showed that MS of BP was significantly associated with PON-1(ß = -0.206, p < 0.001), OSI (ß = 0.602, p < 0.001) and hs-CRP (ß = 0.210, p < 0.001). CONCLUSION: Present study shows that OSI is increased and antioxidant PON-1 activity is decreased in patients with enhanced MS of BP. There is a close association between high MS of BP and oxidative stress markers in newly diagnosed hypertensive patients.


Asunto(s)
Arildialquilfosfatasa/sangre , Presión Sanguínea/fisiología , Ritmo Circadiano/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Hipertensión/fisiopatología , Estrés Oxidativo , Biomarcadores/sangre , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertensión/diagnóstico , Hipertensión/enzimología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Función Ventricular Izquierda/fisiología
11.
Clin Exp Hypertens ; 38(8): 686-690, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936341

RESUMEN

BACKGROUND: It is well known that arterial stiffness is associated with hypertension. Recent studies have shown that adiponectin +276 G/T, ACE I/D, AGTR1 A1166C, and eNOS E298D polymorphisms are likely to be risk factors for arterial stiffness. In this study, we aimed to investigate possible associations between these single-nucleotide polymorphisms (SNPs) and essential hypertension in a Turkish population. METHODS: The study population consisted of 170 patients who were diagnosed with essential hypertension and 170 sex- and age-matched controls. Genotyping of adiponectin +276 G/T, ACE I/D, AGTR1 A1166C, and eNOS E298D SNPs were performed using real-time polymerase chain reaction and commercially produced kits. RESULTS: The percentage of the adiponectin +276 T allele carriers was significantly higher in the patients with hypertension (33%) than in the controls (25%, p < 0.011). Through multiple logistic regression analysis, the adiponectin +276 T allele carrier was found to be associated with an increased risk of hypertension (TT vs. GG and TG: odds ratio = 3.318, p = 0.014, 95% confidence interval: 1.269-8.678). The genotype distributions or allelic frequencies of ACE I/D, AGTR1 A1166C, and eNOS E298D SNPs did not significantly differ between the patients with hypertension and the controls. CONCLUSION: The present study demonstrated that the adiponectin +276 G/T SNP is likely to be a risk factor for essential hypertension in a Turkish population.


Asunto(s)
Adiponectina/genética , ADN/genética , Predisposición Genética a la Enfermedad , Hipertensión/genética , Polimorfismo de Nucleótido Simple , Adiponectina/metabolismo , Hipertensión Esencial , Femenino , Frecuencia de los Genes , Genotipo , Humanos , Hipertensión/epidemiología , Hipertensión/metabolismo , Incidencia , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Reacción en Cadena en Tiempo Real de la Polimerasa , Factores de Riesgo , Turquia/epidemiología
12.
Clin Exp Hypertens ; 38(8): 733-737, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936943

RESUMEN

We investigated the impact of sleep habits on blood pressure (BP) in cross-sectional analyses of 1533 participants aged ≥ 70 without cardiovascular disease or treatment for hypertension, diabetes mellitus, and dyslipidemia. We assessed sleep habits [time in bed (TIB), bed time, and taking sleeping pills], using the Pittsburgh Sleep Quality Index. For groups where TIB was >8 h and <6 h, systolic BP was significantly higher than the group where TIB ranged 6-8 h (134.2 ± 17.5, 134.8 ± 19.6 vs. 130.1 ± 17.7, p < 0.05, p < 0.001, respectively). Systolic BP was significantly higher in the group whose bed time was before 21:00 than that whose bed time was 21:00 or later (136.6 ± 18.6 vs. 132.0 ± 18.4, p < 0.01). Both systolic and diastolic BPs were lower in the group taking sleeping pills (133.2 ± 18.6 vs. 128.1 ± 17.3, p < 0.0001; 75.3 ± 11.5 vs. 73.3 ± 10.7, p < 0.05). Multiple regression analyses revealed that after adjusting for age, gender, body mass index, smoking, and alcohol intake, taking sleeping pills and short or long TIB were significantly associated with systolic BP, whereas bed time was not. These results suggested that inappropriate TIB and sleeping pills were associated with BP in elderly people.


Asunto(s)
Presión Sanguínea/fisiología , Hábitos , Sueño/fisiología , Anciano , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/fisiopatología , Masculino , Factores de Tiempo
13.
Clin Exp Hypertens ; 38(8): 738-743, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936941

RESUMEN

We compared the therapeutic effects of aliskiren (direct renin inhibitor (DRI) group) with angiotensin II (Ang II) type 1 receptor blockers (ARBs) (ARB group) on clinic blood pressure (BP) and ambulatory BP in 36 hypertensive chronic kidney disease (CKD) patients. The baseline clinic BP levels and the after-treatment/baseline (A/B) ratios of clinic BP levels, estimated after 24-week treatment period, were similar in DRI group (n = 18) and ARB group (n = 18). With respect to the effects on ambulatory BP, the A/B ratios of the daytime and nighttime systolic BP in DRI group were significantly higher than those in ARB group. The A/B ratio of ankle-brachial pressure index after the study was higher in the DRI group compared with the ARB group. The results of the present study suggest that DRI therapy is not superior to ARB therapy in lowering ambulatory BP in hypertensive CKD patients, in spite of comparable clinic BP-lowering effects.


Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea/efectos de los fármacos , Tasa de Filtración Glomerular/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Insuficiencia Renal Crónica/complicaciones , Renina/antagonistas & inhibidores , Adulto , Anciano , Antagonistas de Receptores de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Presión Sanguínea/fisiología , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/fisiopatología , Renina/sangre
14.
Clin Exp Hypertens ; 38(8): 710-714, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936947

RESUMEN

PURPOSE: This study aimed to compare blood pressure (BP) after isolated and combined sessions of aerobic and resistance exercises in hypertensive older women. Heart rate (HR) and heart rate variability (HRV) were included as additional variables. METHODS: Twenty-one older women (63±1.9 years; 69.9±2.7 kg; 158.8±2.1 cm) with controlled hypertension (resting BP = 132.2 ± 3.1/74.1 ± 4.0 mmHg) performed four random sessions on different days: 1) aerobic exercise (AE: treadmill walking/running; 40 min; 50-60% HRreserve); 2) resistance exercise (RE: 8 exercises; 3 sets; 15 reps; 40% 1RM)); 3) aerobic exercise followed by resistance exercise (A+R); 4); control (CON). BP, HR and HRV were measured at rest and during 180 min after the sessions. RESULTS: The AE and A+R sessions demonstrated significant decreases in SBP and DBP (30, 60, 120, and 180 min; P < 0.05) and increases in HR (30 and 60 min; P < 0.05) compared to the CON. The RE session demonstrated significant reductions compared to the CON only for DBP (120 and 180 min; P < 0.05). No significant differences were observed in HRV between resting and all sessions. CONCLUSION: All sessions that involved aerobic exercise (AE and A+R) caused postexercise hypotension in comparison to the CON, with no differences in HRV.


Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Presión Sanguínea/fisiología , Tolerancia al Ejercicio/fisiología , Frecuencia Cardíaca/fisiología , Hipertensión/fisiopatología , Entrenamiento de Resistencia/métodos , Determinación de la Presión Sanguínea , Prueba de Esfuerzo , Femenino , Humanos , Hipertensión/diagnóstico , Persona de Mediana Edad , Descanso/fisiología
15.
Clin Exp Hypertens ; 38(8): 721-724, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936949

RESUMEN

We tested the hypothesis that calcium channel blockers (CCBs: amlodipine group, n = 38)) are superior to angiotensin receptor blockers (ARBs: valsartan group, n = 38) against ambulatory blood pressure variability (BPV) in untreated Japanese hypertensive patients. Both drugs significantly reduced ambulatory systolic and diastolic BP values. With regard to BPV, standard deviation (SD) in SBP did not change with the administration of either drug, but the ARB significantly increased SD in awake DBP (12 ± 4-14 ± 4 mmHg). The ARB also significantly increased the coefficients of variation (CVs)in awake and 24-h SBP/DBP (all P < 0.05), but amlodipine did not change the CV. CCB significantly reduced the maximum values of awake SBP (193 ± 24-182 ± 27 mmHg, P = 0.02), sleep SBP (156 ± 18-139 ± 14 mmHg, P < 0 .001), and awake and sleep DBP (P < 0.01 in both cases), but the ARB did not change the maximum BP values. In conclusion, a once-daily morning dose of CCB amlodipine was more effective at controlling ambulatory BPV than ARB valsartan, especially in reducing maximum BP levels.


Asunto(s)
Amlodipino/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Valsartán/uso terapéutico , Adulto , Anciano , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Sístole , Resultado del Tratamiento
16.
Clin Exp Hypertens ; 38(8): 701-709, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936951

RESUMEN

This study aims to analyze continuity of care according to complications and examine the relationship between the continuity of care and health outcomes (hospitalization, emergency department visits, and complications) using data of new hypertensive patients from Korea's National Health Insurance Claims database. There were a total of 715,053 new hypertensive patients followed up for three years until 2011. Indices of continuity of care were Continuity of Care Index (COC), Modified, Modified Continuity Index (MMCI), and Most Frequent Provider Continuity (MFPC). The mean values of COC, MMCI, and MFPC were 0.79, 0.77, and 0.87, respectively, in new hypertensive patients with complications, and 0.80, 0.79, and 0.87, respectively, in those without complications. The factors affecting the continuity of care were sex, ambulatory care visits, number of providers, main medical institution, and Charlson's comorbidity score. Following analysis of the correlation between the treatment compliance and health outcomes, the low COC group had a higher association with hospitalization, the emergency department visit, and complications as compared with the high COC group. COC and medication adherence were associated with a reduction of hospitalization, emergency department visits, and complications. This indicates it would be mandatory to manage the patients' continuity of care.


Asunto(s)
Atención Ambulatoria/métodos , Continuidad de la Atención al Paciente , Hipertensión/terapia , Cooperación del Paciente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Hospitalización/tendencias , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Incidencia , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Tiempo , Adulto Joven
17.
Clin Exp Hypertens ; 38(8): 751-756, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936958

RESUMEN

BACKGROUND: Kidney resistive index (RI) correlates with tubulointerstitial changes and predicts renal prognosis. Most patients with chronic kidney diseases (CKDs) manifest high blood pressure and atherosclerotic cardiovascular diseases. In addition, various atherosclerotic indexes relate to variations in blood pressure. METHODS: Subjects were 70 CKD patients, who visited our office and agreed to measure home blood pressure and receive renal ultrasonography. Cross-sectional analyses were performed. RESULTS: Patient age was averaged 61 ± 15 (SD) y/o and 60% were male. Mean serum creatinine and proteinuria were 1.2 ± 0.5 mg/dl and 0.2 ± 0.5 g/gCr, respectively. Office blood pressure and kidney RI were 128 ± 17/75 ± 11 mmHg and 0.66 ± 0.08, respectively. Multivariate regression analysis revealed that age and office blood pressure independently correlated to kidney RI (p < 0.05 for each). Home blood pressure was averaged 122 ± 7/70 ± 6 mmHg. Both standard deviation and the maximal-minimal difference in home systolic blood pressure related to kidney RI (p < 0.05). CONCLUSIONS: The present results indicate that office blood pressure correlates to kidney RI, which predicts renal prognosis. In addition, our data implicate that kidney RI relates to variations in home systolic blood pressure, and suggest that kidney RI may be a good index for atherosclerosis in CKD patients.


Asunto(s)
Presión Sanguínea/fisiología , Hipertensión/fisiopatología , Riñón/diagnóstico por imagen , Insuficiencia Renal Crónica/complicaciones , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/etiología , Riñón/fisiopatología , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Pronóstico , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Ultrasonografía Doppler
18.
Clin Exp Hypertens ; 38(8): 696-700, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936961

RESUMEN

OBJECTIVE: The prognostic value of an exaggerated exercise systolic blood pressure response (EESBPR) remains controversial. This study was designed to assess whether an EESBPR is associated with the predictor of future blood pressure. METHODS: From an initial population of 1,534 male-subjects with normal BP or no medication who underwent ergometric exercise, 733 subjects (mean age: 41 years old) at baseline to follow-up BP after an average of 10 years were selected. A 12-min exercise tolerance test with three phases of estimated load from predictive maximum oxygen intake was performed at baseline, and exercise BP was measured. RESULTS: Exercise BP response was classified by three group: Low group (G) (exercise SBP < 180 mmHg), Middle G (exercise BP:180-199 mmHg), High G (exercise BP:200 mmHg ≦). BP after 10 years in Low G was 123 ± 12/79 ± 7 mmHg, in Middle G:127 ± 13/81 ± 8 mmHg, in High G :134 ± 15/84 ± 10 mmHg. Compared with in Low G, BP after 10 years in High G significantly increased (p < 0.05). Multiple regression analysis was carried out to clarify the relationship of exercise SBP at baseline to BP after 10 years. In multivariate-adjusted models, the relationship of SBP at follow-up was stronger to exercise SBP (ß = 0.271, P < 0.001) than to resting SBP (ß = 0.148, P < 0.001). Maximum oxygen intake (ß = -0.193, P = 0.003) and resting SBP correlated with SBP after 10 years. CONCLUSIONS: In middle-aged men, exercise SBP would be a stronger predictor of future SBP, DBP rather than BP at rest. In optimal of classification of BP (SBP < 120 mmHg), exercise BP response was clearly associated with BP after 10 years.


Asunto(s)
Presión Sanguínea/fisiología , Ejercicio/fisiología , Predicción , Hipertensión/fisiopatología , Vigilancia de la Población , Adulto , Determinación de la Presión Sanguínea , Prueba de Esfuerzo , Estudios de Seguimiento , Humanos , Hipertensión/epidemiología , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Descanso/fisiología
19.
Clin Exp Hypertens ; 38(8): 744-750, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27936999

RESUMEN

We examined the efficacy of single-pill irbesartan/amlodipine combination-based therapy for 12 weeks in 20 hypertensive chronic kidney disease (CKD) patients, by evaluating self-measured home blood pressure (BP) profile. The single-pill irbesartan/amlodipine combination-based therapy decreased clinic BP and home BP (morning, evening, and nighttime BPs), and improved within-visit clinic BP variability, day-by-day home BP variability (morning and evening), and nighttime home BP variability. Furthermore, the single-pill combination-based therapy reduced albuminuria and exerted improved parameters of vascular function. These results indicate that this single-pill combination-based therapy may exert beneficial effects on clinic and home BP profiles as well as on renal and vascular damages, in hypertension with CKD.


Asunto(s)
Amlodipino/administración & dosificación , Compuestos de Bifenilo/administración & dosificación , Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Insuficiencia Renal Crónica/complicaciones , Tetrazoles/administración & dosificación , Anciano , Bloqueadores del Receptor Tipo 1 de Angiotensina II/administración & dosificación , Presión Sanguínea/fisiología , Bloqueadores de los Canales de Calcio/administración & dosificación , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Irbesartán , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
20.
BMC Res Notes ; 9(1): 508, 2016 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-27938397

RESUMEN

BACKGROUND: Peripheral artery disease (PAD) is an important global health problem and contributes to notable proportion of morbidity and mortality. This particular manifestation of systemic atherosclerosis is largely under diagnosed and undertreated. For sustainable preventive strategies in a country, it is mandatory to identify country-specific risk factors. We intended to assess the risk factors of PAD among adults aged 40-74 years. METHODS: This case control study was conducted in 2012-2013 in Sri Lanka. Seventy-nine cases and 158 controls in the age group of 40-74 years were selected for the study in order to have case to control ratio 1:2. The criterion for selecting cases and control was based on Ankle brachial pressure index (ABPI). Cases were selected from those who had ABPI 0.85 or less (ABPI ≤0.85) in either lower limb. Controls were selected from those ABPI score between 1.18 and 1.28 in both lower limbs. Only newly identified individuals with PAD were selected as cases. Controls were selected from the same geographical location and within the 5 year age group as cases. RESULTS: The history of diabetes mellitus more than 10 years (OR 5.8, 95% CI 2.2-14.2), history of dyslipidemia for more than 10 years (OR 4.9, 95% CI 2.1-16.2), history of hypertension for more than 10 years (OR 3.8, 95% CI 1.8-12.7) and smoking (OR 2.9, 95% CI 1.2-6.9), elevated HsCRP (OR 3.7, 95% CI 1.2-12.0) and hyperhomocysteinemia (OR 3.0, 95% CI 1.1-8.1) were revealed as country specific significant risk factor of PAD. CONCLUSIONS: Diabetes mellitus, hypertension, dyslipidemia, smoking as well as elevated homocysteine and HsCRP found as risk factors of PAD. Longer the duration or higher level exposure to these risk factors has increased the risk of PAD. These findings emphasis the need for routine screening of PAD among patients with the identified risk factors.


Asunto(s)
Enfermedad Arterial Periférica/epidemiología , Adulto , Anciano , Índice Tobillo Braquial , Estudios de Casos y Controles , Estudios Transversales , Complicaciones de la Diabetes/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Modelos de Riesgos Proporcionales , Análisis de Regresión , Factores de Riesgo , Fumar/epidemiología , Sri Lanka , Encuestas y Cuestionarios
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