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1.
Chin Med J (Engl) ; 129(24): 2907-2912, 2016 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-27958221

RESUMEN

BACKGROUND: Antihypertensive drugs have been linked to new-onset osteoporotic fracture (NOF), and different classes of antihypertensive drugs may alter the risk for the development of NOF; however, the classic effect of different antihypertensive drugs on the development of NOF in the elderly has not been well studied during long-term follow-up. METHODS: In this study, we investigated the association between different classic antihypertensives and the development of NOF in the elderly. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance in Central Taiwan, China including case patients with NOF aged 65-80 years from January 2002 to December 2012 and non-NOF controls. Prescriptions for antihypertensives before the index date were retrieved from a prescription database. We estimated the hazard ratios (HR s) of NOF associated with antihypertensive use. Non-NOF controls served as the reference group. RESULTS: A total of 128 patients with NOF were identified from among 1144 patients with hypertension during the study period. The risk of NOF after adjusting age, sex, comorbidities, and concurrent medications was higher among the users of angiotensin-converting enzyme (ACE) inhibitors (HR, 1.64; 95% confidence interval [CI], 1.01-2.66) than among nonusers. Patients who took calcium channel blockers (CCBs) (HR, 0.70; 95% CI, 0.49-0.99) were at a lower risk of developing NOF than nonusers. Loop diuretics, thiazide diuretics, angiotensin receptor blocker, beta-blocker, and alpha-blocker were not associated with the risk of NOF. CONCLUSIONS: Elderly with hypertension who take CCBs are at a lower risk of NOF and that the use of ACE inhibitors was associated with a significantly increased risk of developing NOF during the 11-year follow-up.


Asunto(s)
Antihipertensivos/efectos adversos , Fracturas Osteoporóticas/inducido químicamente , Anciano , Anciano de 80 o más Años , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Estudios de Cohortes , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Estudios Longitudinales , Masculino , Fracturas Osteoporóticas/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiología
2.
J Clin Lipidol ; 10(6): 1338-1343, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27919350

RESUMEN

BACKGROUND: Patients with severe familial hypercholesterolemia (FH) are often unrecognized despite typical presentation. The introduction of PCSK9 inhibitors opens new therapeutic options and emphasizes the need for identification of severe FH patients. OBJECTIVES: The objective was identification, characterization, and management of severe FH patients by screening of cardiac catheterization (CC) database. METHODS: Retrospective analysis of CC database from 2002 to mid-2015 was performed for low-density lipoprotein cholesterol (LDL-C) ≥130 mg/dL (n = 2383). Severe FH was diagnosed if any prior LDL-C was ≥280 mg/dL, excluding secondary causes. Peak/current LDL-C levels and lipid-lowering therapies were evaluated. Initial attempt was made to detect relatives with FH according to identifying data and age-dependent LDL-C cutoffs. RESULTS: Severe FH was identified in 54 of initial 2382 patients with CC LDL-C ≥130 mg/dL. Mean age at cardiovascular disease diagnosis was 45 years. Peak LDL-C was 280 to 464 mg/dL (median, 322). Coronary artery bypass graft surgery was performed in 26 patients (48%) and redo coronary artery bypass graft surgery in 5 patients (9%). Risk factors included obesity (33%), hypertension (59%), smoking (33%), and diabetes (24%). LDL-C reduction ≥50% of peak value was achieved in 56%, LDL-C <130 mg/dL in 32%, and LDL-C <100 mg/dL in 17% of patients. High-intensity statin plus ezetimibe was prescribed for 67%, high-intensity statin alone for 24%, and other lipid-lowering therapies for 9% of patients. Treatment intensity was directly associated with attainment of LDL-C goals. Matching probands' surnames and place of residency with district health maintenance organization database has identified 161 additional individuals with possible FH; 58% were not treated with lipid-lowering drugs. CONCLUSIONS: A simple algorithm for identification of patients with severe FH was implemented based on large catheterization and health maintenance organization databases and revealed patients with severe FH and coronary disease at a young age, with low attainment of cholesterol treatment goals. Screening existing cardiovascular databases of populations at risk will promote identification and management of severe FH patients and their affected family members.


Asunto(s)
Cateterismo Cardíaco , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Hiperlipoproteinemia Tipo II/complicaciones , Hiperlipoproteinemia Tipo II/patología , Adulto , Anciano , Anticolesterolemiantes/uso terapéutico , LDL-Colesterol/sangre , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Quimioterapia Combinada , Ezetimiba/uso terapéutico , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hiperlipoproteinemia Tipo II/tratamiento farmacológico , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad
3.
J Am Heart Assoc ; 5(12)2016 12 05.
Artículo en Inglés | MEDLINE | ID: mdl-27919932

RESUMEN

BACKGROUND: The incidence of hypertensive emergency in US emergency departments (ED) is not well established. METHODS AND RESULTS: This study is a descriptive epidemiological analysis of nationally representative ED visit-level data from the Nationwide Emergency Department Sample for 2006-2013. Nationwide Emergency Department Sample is a publicly available database maintained by the Healthcare Cost and Utilization Project. An ED visit was considered to be a hypertensive emergency if it met all the following criteria: diagnosis of acute hypertension, at least 1 diagnosis indicating acute target organ damage, and qualifying disposition (admission to the hospital, death, or transfer to another facility). The incidence of adult ED visits for acute hypertension increased monotonically in the period from 2006 through 2013, from 170 340 (1820 per million adult ED visits overall) to 496 894 (4610 per million). Hypertensive emergency was rare overall, accounting for 63 406 visits (677 per million adult ED visits overall) in 2006 to 176 769 visits (1670 per million) in 2013. Among adult ED visits that had any diagnosis of hypertension, hypertensive emergency accounted for 3309 per million in 2006 and 6178 per million in 2013. CONCLUSIONS: The estimated number of visits for hypertensive emergency and the rate per million adult ED visits has more than doubled from 2006 to 2013. However, hypertensive emergencies are rare overall, occurring in about 2 in 1000 adult ED visits overall, and 6 in 1000 adult ED visits carrying any diagnosis of hypertension in 2013. This figure is far lower than what has been sometimes cited in previous literature.


Asunto(s)
Urgencias Médicas/epidemiología , Hipertensión/epidemiología , Adolescente , Adulto , Anciano , Servicio de Urgencia en Hospital , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Transferencia de Pacientes/estadística & datos numéricos , Crecimiento Demográfico , Estados Unidos/epidemiología , Adulto Joven
4.
J Am Heart Assoc ; 5(11)2016 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-27930355

RESUMEN

BACKGROUND: People of South Asian (SAs) and African Caribbean (AC) origin have increased cardiovascular morbidity, but underlying mechanisms are poorly understood. Aging is the key predictor of deterioration in diastolic function, which can be assessed by echocardiography using E/e' ratio as a surrogate of left ventricular (LV) filling pressure. The study aimed to assess a possibility of premature cardiac aging in SA and AC subjects. METHODS AND RESULTS: We studied 4540 subjects: 2880 SA and 1660 AC subjects. All participants underwent detailed echocardiography, including LV ejection fraction, average septal-lateral E/e', and LV mass index (LVMI). When compared to ACs, SAs were younger, with lower mean LVMI, systolic blood pressure (BP), diastolic BP, and body mass index (BMI), as well as a lower prevalence of hypertension and smoking (P≤0.001 for all). In a multivariate linear regression model including age, sex, ethnicity, BP, heart rate, BMI, waist circumference, LVMI, history of smoking, hypertension, coronary artery disease, diabetes mellitus, medications, SA origin was independently associated with higher E/e' (regression coefficient±standard error, -0.66±0.10; P<0.001, adjusted R2 for the model 0.21; P<0.001). Furthermore, SAs had significantly accelerated age-dependent increase in E/e' compared to ACs. On multivariable Cox regression analysis without adjustment for E/e', SA ethnicity was independently predictive of mortality (P=0.04). After additional adjustment for E/e', the ethnicity lost its significance value, whereas E/e' was independently predictive of higher risk of death (P=0.008). CONCLUSIONS: Premature cardiac aging is evident in SAs and may contribute to high cardiovascular morbidity in this ethnic group, compared to ACs.


Asunto(s)
Envejecimiento Prematuro/etnología , Corazón/fisiopatología , Volumen Sistólico , Factores de Edad , Anciano , Envejecimiento Prematuro/diagnóstico por imagen , Envejecimiento Prematuro/fisiopatología , Asia , Bangladesh/etnología , Región del Caribe/etnología , Diástole , Ecocardiografía , Inglaterra , Femenino , Corazón/diagnóstico por imagen , Humanos , Hipertensión/epidemiología , India/etnología , Modelos Lineales , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Análisis Multivariante , Tamaño de los Órganos , Pakistán/etnología , Modelos de Riesgos Proporcionales , Factores de Riesgo , Fumar/epidemiología
5.
J Am Heart Assoc ; 5(11)2016 11 14.
Artículo en Inglés | MEDLINE | ID: mdl-27930356

RESUMEN

BACKGROUND: Insurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government-sponsored insurance had worse quality of care or in-hospital outcomes in acute ischemic stroke. METHODS AND RESULTS: Multivariable logistic regressions with generalized estimating equations stratified by age under or at least 65 years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in-hospital mortality and postdischarge destination. We included 589 320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guidelines-Stroke program between 2012 and 2015. Uninsured patients with hypertension, high cholesterol, or diabetes mellitus were less likely to be taking appropriate control medications prior to stroke, to use an ambulance to arrive to the ED, or to arrive early after symptom onset. Even after adjustment, the uninsured were more likely than the privately insured to die in the hospital (<65 years, OR 1.33 [95% CI 1.22-1.45]; ≥65 years OR 1.54 [95% CI 1.34-1.75]), and among survivors, were less likely to go to inpatient rehab (<65 OR 0.63 [95% CI 0.6-0.67]; ≥65 OR 0.56 [95% CI 0.5-0.63]). In contrast, patients with Medicare and Medicaid were more likely to be discharged to a Skilled Nursing Facility (<65 years OR 2.08 [CI 1.96-2.2]; OR 2.01 [95% CI 1.91-2.13]; ≥65 years OR 1.1 [95% CI 1.07-1.13]; OR 1.41 [95% CI 1.35-1.46]). CONCLUSIONS: Preventative care prior to ischemic stroke, time to presentation for acute treatment, access to rehabilitation, and in-hospital mortality differ by patient insurance status.


Asunto(s)
Isquemia Encefálica/rehabilitación , Cobertura del Seguro/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Rehabilitación de Accidente Cerebrovascular/estadística & datos numéricos , Anciano , Ambulancias/estadística & datos numéricos , Anticolesterolemiantes/uso terapéutico , Antihipertensivos/uso terapéutico , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/epidemiología , Femenino , Adhesión a Directriz , Mortalidad Hospitalaria , Humanos , Hipercolesterolemia/tratamiento farmacológico , Hipercolesterolemia/epidemiología , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipoglucemiantes/uso terapéutico , Seguro de Salud/estadística & datos numéricos , Modelos Logísticos , Masculino , Medicaid , Medicare , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Guías de Práctica Clínica como Asunto , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Accidente Cerebrovascular , Factores de Tiempo , Estados Unidos
6.
J Occup Environ Med ; 58(12): 1207-1211, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27930480

RESUMEN

OBJECTIVES: The aim of this study was to examine the effect of a worksite weight loss program hypertension. METHODS: Participants [N = 5998; body mass index (BMI) 34 ±â€Š7 m/kg, 33% hypertensive] participating in a 10-week weight loss program were examined for hypertension prevalence within categories of (1) weight gain, or loss (2) less than 3%, (3) 3% to 5%, (4) 5% to 10%, and (5) more than 10% using general linear models or Chi-square analyses. RESULTS: We observed a significant dose-response trend for the reduced prevalence of hypertension at follow-up (P-for-trend < 0.001). Baseline versus follow-up comparisons showed those gaining weight (28% vs 25%, adjres. = 2.5) or losing less than 3% (31% vs 25% adjres. = 2.9) were significantly more likely to present with hypertension at follow-up. Those losing 5% to 10% (33% vs 19%, adjres. = -3.2) or more than 10% (39% vs 17%, adjres. = -3.2) were significantly more likely to present without hypertension. CONCLUSION: Weight loss more than 5% significantly reduced workplace hypertension, while gaining weight increased its likelihood.


Asunto(s)
Hipertensión/terapia , Pérdida de Peso , Programas de Reducción de Peso , Lugar de Trabajo , Adulto , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad
7.
Medicine (Baltimore) ; 95(49): e5595, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27930582

RESUMEN

Cardiovascular disease, closely related to an early appearance of hypertension, is the most common mortality cause among autosomal dominant polycystic kidney disease patients (ADPKD). The development of hypertension is related to an increase in renal volume. Whether the increasing in the renal volume before the onset of hypertension leads to a major cardiovascular risk in ADPKD patients remains unknown.Observational and cross-sectional study of 62 normotensive ADPKD patients with normal renal function and a group of 28 healthy controls. Renal volume, blood pressure, and renal (urinary albumin excretion), blood vessels (carotid intima media thickness and carotid-femoral pulse wave velocity), and cardiac (left ventricular mass index and diastolic dysfunction parameters) asymptomatic organ damage were determined and were considered as continuous variables. Correlations between renal volume and the other parameters were studied in the ADPKD population, and results were compared with the control group. Blood pressure values and asymptomatic organ damage were used to assess the cardiovascular risk according to renal volume tertiles.Even though in the normotensive range, ADPKD patients show higher blood pressure and major asymptomatic organ damage than healthy controls. Asymptomatic organ damage is not only related to blood pressure level but also to renal volume. Multivariate regression analysis shows that microalbuminuria is only associated with height adjusted renal volume (htTKV). An htTKV above 480 mL/m represents a 10 times higher prevalence of microalbuminuria (4.8% vs 50%, P < 0.001). Normotensive ADPKD patients from the 2nd tertile renal volume group (htTKV > 336 mL/m) show higher urinary albumin excretion, but the 3rd tertile htTKV (htTKV > 469 mL/m) group shows the worst cardiovascular risk profile.Normotensive ADPKD patients show in the early stages of the disease with slight increase in renal volume, higher cardiovascular risk than healthy controls. An htTKV above 468 mL/m is associated with the greatest increase in cardiovascular risk of normotensive ADPKD patients with normal renal function. Early strategies to slow the progression of the cardiovascular risk of these patients might be beneficial in their long-term cardiovascular survival.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Hipertensión/etiología , Riñón/patología , Riñón Poliquístico Autosómico Dominante/complicaciones , Adulto , Factores de Edad , Análisis de Varianza , Presión Sanguínea/fisiología , Estudios Transversales , Progresión de la Enfermedad , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Tamaño de los Órganos , Riñón Poliquístico Autosómico Dominante/diagnóstico , Pronóstico , Curva ROC , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Estadísticas no Paramétricas
8.
Medicine (Baltimore) ; 95(49): e5613, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27930589

RESUMEN

The aim of this study was to evaluate the relationship between the hypertriglyceridemic waist (HTGW) phenotype and metabolic abnormalities in hypertensive adults.A cross-sectional study, with a sample of 5919 hypertensive adults (2892 men and 3027 women) aged 35 years or older, was recruited from rural areas of China. The participants underwent anthropometric measurements and laboratory examinations. The self-reported information was collected by trained personnel. The HTGW phenotype was defined as elevated triglycerides and elevated waist circumference. The logistic regression analysis was used to evaluate the associations of interest.Hypertensive adults with the HTGW phenotype had significantly higher prevalences of all cardiometabolic risk factors than those without the HTGW phenotype (P < 0.001). Compared with the normal waist normal triglyceride (NWNT) group, hypertensive adults with the HTGW phenotype had much higher possibilities to have all cardiometabolic risk factors, especially for 8.35 times more likely of having ≥3 cardiometabolic risk factors [95% confidence interval (95% CI) 5.92-11.79], 6.14 times more likely of having low HDL cholesterol (95% CI 4.98-7.58), 5.49 times more likely of having hyperuricemia (95% CI 4.40-6.86), and 4.32 times more likely of having 1 to 2 cardiometabolic risk factors (95% CI 3.68-5.07) (P < 0.001). Multivariate analysis indicated that the HTGW phenotype was positively associated with metabolic abnormalities (P < 0.05).This study concluded that the HTGW phenotype was positively associated with metabolic abnormalities in hypertensive adults. The HTGW phenotype showed to be an important tool for monitoring of hypertensive adults with metabolic abnormalities, which is low cost, simple, and useful in clinical practice, especially in primary health care in the rural area of China.


Asunto(s)
Hipertensión/epidemiología , Cintura Hipertrigliceridémica/epidemiología , Síndrome Metabólico/epidemiología , Adulto , Distribución por Edad , Anciano , Análisis de Varianza , China , Comorbilidad , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Cintura Hipertrigliceridémica/diagnóstico , Modelos Logísticos , Masculino , Síndrome Metabólico/diagnóstico , Persona de Mediana Edad , Selección de Paciente , Prevalencia , Medición de Riesgo , Población Rural , Índice de Severidad de la Enfermedad , Distribución por Sexo
9.
Pregnancy Hypertens ; 6(4): 288-290, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27939470

RESUMEN

OBJECTIVE: The American College of Obstetricians and Gynecologists (ACOG) recommends against the use of butorphanol in patients diagnosed with preeclampsia or chronic hypertension secondary to a theoretical concern that the drug will further elevate blood pressures. No past study has examined the drug's potential to elevate blood pressures in laboring patients. METHODS: In this retrospective cohort study all chronic hypertensive and preeclamptic patients who underwent an induction of labor and delivered a viable, singleton pregnancy between the dates of 1/1/2013 and 12/31/2014 at a single academic hospital were included. RESULTS: The use of butorphanol in chronically hypertensive patients during labor was not associated with the presence of severe range blood pressures during labor (OR=0.92 95% CI: (0.04-19.34) P=0.96). In preeclamptic patients there was similarly no change in the frequency of severe range blood pressures with the use of the drug (OR=0.59 95% CI: (0.19-1.83) P=0.36). CONCLUSION: In laboring patients with chronic hypertension or preeclampsia butorphanol is not associated with severe range blood pressures, and therefore it is a reasonable option for providing pain relief in these populations.


Asunto(s)
Analgésicos Opioides/farmacología , Presión Sanguínea/efectos de los fármacos , Butorfanol/farmacología , Hipertensión/fisiopatología , Preeclampsia/fisiopatología , Adulto , Analgésicos Opioides/uso terapéutico , Puntaje de Apgar , Butorfanol/uso terapéutico , Enfermedad Crónica , Femenino , Humanos , Cuidado Intensivo Neonatal , Trabajo de Parto Inducido , Trabajo de Parto/fisiología , Embarazo , Estudios Retrospectivos
10.
Pregnancy Hypertens ; 6(4): 291-294, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27939471

RESUMEN

OBJECTIVE: To assess maternal and fetal morbidity in women with mild to moderate chronic hypertension on antihypertensive drug therapy compared to cessation of therapy. METHODS: This was a prospective observational study included 222 women with mild to moderate chronic hypertension (systolic blood pressure of 140-159mmHg or diastolic blood pressure of 90-109mmHg) who were divided into two groups based on antihypertensive drug intake, treatment group (n=104) who received methyl dopa, and non-treatment group (n=118) who used only low dose aspirin. Patients were followed to assess maternal and fetal outcome. RESULTS: There were significant differences between the two groups regarding the development of severe hypertension (p<0.001), renal impairment (p<0.001), ECG changes (p<0.001), placental abruption (p<0.05), repeated hospital admissions (p<0.001), preterm delivery (p<0.05) and neonatal ICU admission (p<0.05) with higher occurrence in the non-treatment group. There were no significant differences between the two groups in terms of the development of preeclampsia, hepatic impairment, mode of delivery, venous thromboembolism, small for gestational age, intrauterine fetal demise or neonatal mortality (p>0.05). CONCLUSION: Maternal and fetal morbidity is increased following cessation of antihypertensive drug use in patients with mild to moderate chronic hypertension. Further larger studies are warranted to confirm or refute our findings.


Asunto(s)
Antihipertensivos/administración & dosificación , Hipertensión/tratamiento farmacológico , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Privación de Tratamiento , Desprendimiento Prematuro de la Placenta/epidemiología , Adulto , Presión Sanguínea , Enfermedad Crónica , Electrocardiografía , Femenino , Edad Gestacional , Humanos , Hipertensión/fisiopatología , Cuidado Intensivo Neonatal , Readmisión del Paciente , Embarazo , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Nacimiento Prematuro/epidemiología , Estudios Prospectivos , Insuficiencia Renal/epidemiología , Índice de Severidad de la Enfermedad
11.
BMJ Open ; 6(12): e012413, 2016 12 09.
Artículo en Inglés | MEDLINE | ID: mdl-27940627

RESUMEN

OBJECTIVES: The Italian project MATRICE aimed to assess how well cases of type 2 diabetes (T2DM), hypertension, ischaemic heart disease (IHD) and heart failure (HF) and their levels of severity can be automatically extracted from the Health Search/CSD Longitudinal Patient Database (HSD). From the medical records of the general practitioners (GP) who volunteered to participate, cases were extracted by algorithms based on diagnosis codes, keywords, drug prescriptions and results of diagnostic tests. A random sample of identified cases was validated by interviewing their GPs. SETTING: HSD is a database of primary care medical records. A panel of 12 GPs participated in this validation study. PARTICIPANTS: 300 patients were sampled for each disease, except for HF, where 243 patients were assessed. OUTCOME MEASURES: The positive predictive value (PPV) was assessed for the presence/absence of each condition against the GP's response to the questionnaire, and Cohen's κ was calculated for agreement on the severity level. RESULTS: The PPV was 100% (99% to 100%) for T2DM and hypertension, 98% (96% to 100%) for IHD and 55% (49% to 61%) for HF. Cohen's kappa for agreement on the severity level was 0.70 for T2DM and 0.69 for hypertension and IHD. CONCLUSIONS: This study shows that individuals with T2DM, hypertension or IHD can be validly identified in HSD by automated identification algorithms. Automatic queries for levels of severity of the same diseases compare well with the corresponding clinical definitions, but some misclassification occurs. For HF, further research is needed to refine the current algorithm.


Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Registros Electrónicos de Salud/normas , Insuficiencia Cardíaca/diagnóstico , Hipertensión/diagnóstico , Isquemia Miocárdica/diagnóstico , Algoritmos , Humanos , Italia , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad
12.
Physiol Rep ; 4(19)2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27940662

RESUMEN

We found variants from the Angiotensinogen-Converting Enzyme (ACE), Angiotensin Type 1 Receptor (AGTR1), Aldosterone Synthase (CYP11B2), and Adducin (ADD1) genes exhibited intensity-dependent associations with the ambulatory blood pressure (BP) response following acute exercise, or postexercise hypotension (PEH). In a validation cohort, we sequenced exons from these genes for their associations with PEH Obese (30.9 ± 3.6 kg m-2) adults (n = 23; 61% African Americans [AF], 39% Caucasian) 42.0 ± 9.8 years with hypertension (139.8 ± 10.4/84.6 ± 6.2 mmHg) completed three random experiments: bouts of vigorous and moderate intensity cycling and control. Subjects wore an ambulatory BP monitor for 19 h. We performed deep-targeted exon sequencing using the Illumina TruSeq Custom Amplicon kit. Variant genotypes were coded as number of minor alleles (#MA) and selected for further statistical analysis based upon Bonferonni or Benjamini-Yekutieli multiple testing corrected p-values under time adjusted linear models for 19 hourly BP measurements per subject. After vigorous intensity over 19 h among ACE, AGTR1, CYP11B2, and ADD1 variants passing multiple testing thresholds, as the #MA increased, systolic (SBP) and/or diastolic BP decreased 12 mmHg (P = 4.5E-05) to 30 mmHg (P = 6.4E-04) among AF only. In contrast, after moderate intensity over 19 h among ACE and CYP11B2 variants passing multiple testing thresholds, as the #MA increased, SBP increased 21 mmHg (P = 8.0E-04) to 22 mmHg (P = 8.2E-04) among AF only. In this replication study, ACE, AGTR1, CYP11B2, and ADD1 variants exhibited associations with PEH after vigorous, but not moderate intensity exercise among AF only. Renal variants should be explored further with a multi-level "omics" approach for associations with PEH among a large, ethnically diverse sample of adults with hypertension.


Asunto(s)
Tolerancia al Ejercicio/genética , Exones/genética , Riñón/metabolismo , Polimorfismo Genético/genética , Hipotensión Posejercicio/fisiopatología , Adulto , Afroamericanos , Presión Sanguínea/fisiología , Monitoreo Ambulatorio de la Presión Arterial/métodos , Proteínas de Unión a Calmodulina/metabolismo , Citocromo P-450 CYP11B2/metabolismo , Prueba de Esfuerzo/métodos , Tolerancia al Ejercicio/fisiología , Femenino , Humanos , Hipertensión/genética , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Hipotensión Posejercicio/metabolismo
13.
Pediatrics ; 138(6)2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27940711

RESUMEN

BACKGROUND AND OBJECTIVES: Pediatric hypertension predisposes children to adult hypertension and early markers of cardiovascular disease. No large-scale studies have examined diagnosis and initial medication management of pediatric hypertension and prehypertension. The objective of this study was to evaluate diagnosis and initial medication management of pediatric hypertension and prehypertension in primary care. METHODS: Retrospective cohort study aggregating electronic health record data on >1.2 million pediatric patients from 196 ambulatory clinics across 27 states. Demographic, diagnosis, blood pressure (BP), height, weight, and medication prescription data extracted. Main outcome measures include proportion of pediatric patients with ≥3 visits with abnormal BPs, documented hypertension and prehypertension diagnoses, and prescribed antihypertensive medications. Marginal standardization via logistic regression produced adjusted diagnosis rates. RESULTS: Three hundred ninety-eight thousand seventy-nine patients, ages 3 to 18, had ≥3 visits with BP measurements (48.9% girls, 58.6% <10 years old). Of these, 3.3% met criteria for hypertension and 10.1% for prehypertension. Among practices with ≥50 eligible patients, 2813 of 12 138 patients with hypertension (23.2%; 95% confidence interval, 18.2%-28.2%) and 3990 of 38 874 prehypertensive patients (10.2%; 95% confidence interval, 8.2%-12.2%) were diagnosed. Age, weight, height, sex, and number and magnitude of abnormal BPs were associated with diagnosis rates. Of 2813 diagnosed, persistently hypertensive patients, 158 (5.6%) were prescribed antihypertensive medication within 12 months of diagnosis (angiotensin-converting enzyme inhibitors/angiotensin receptive blockers [35%], diuretics [22%], calcium channel blockers [17%], and ß-blockers [10%]). CONCLUSIONS: Hypertension and prehypertension were infrequently diagnosed among pediatric patients. Guidelines for diagnosis and initial medication management of abnormal BP in pediatric patients are not routinely followed.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Prehipertensión/diagnóstico , Adolescente , Distribución por Edad , Atención Ambulatoria/métodos , Determinación de la Presión Sanguínea/métodos , Niño , Preescolar , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/epidemiología , Modelos Logísticos , Masculino , Prehipertensión/tratamiento farmacológico , Prehipertensión/epidemiología , Atención Primaria de Salud/métodos , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Resultado del Tratamiento , Estados Unidos , Adulto Joven
15.
J Am Heart Assoc ; 5(12)2016 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-27979807

RESUMEN

BACKGROUND: The clinical and epidemiological implications of using ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension have not been studied at a population level in sub-Saharan Africa. We examined the impact of ABPM use among Kenyan adults. METHODS AND RESULTS: We performed a nested case-control study of diagnostic accuracy. We selected an age-stratified random sample of 1248 adults from the list of residents of the Kilifi Health and Demographic Surveillance System in Kenya. All participants underwent a screening blood pressure (BP) measurement. All those with screening BP ≥140/90 mm Hg and a random subset of those with screening BP <140/90 mm Hg were invited to undergo ABPM. Based on the 2 tests, participants were categorized as sustained hypertensive, masked hypertensive, "white coat" hypertensive, or normotensive. Analyses were weighted by the probability of undergoing ABPM. Screening BP ≥140/90 mm Hg was present in 359 of 986 participants, translating to a crude population prevalence of 23.1% (95% CI 16.5-31.5%). Age standardized prevalence of screening BP ≥140/90 mm Hg was 26.5% (95% CI 19.3-35.6%). On ABPM, 186 of 415 participants were confirmed to be hypertensive, with crude prevalence of 15.6% (95% CI 9.4-23.1%) and age-standardized prevalence of 17.1% (95% CI 11.0-24.4%). Age-standardized prevalence of masked and white coat hypertension were 7.6% (95% CI 2.8-13.7%) and 3.8% (95% CI 1.7-6.1%), respectively. The sensitivity and specificity of screening BP measurements were 80% (95% CI 73-86%) and 84% (95% CI 79-88%), respectively. BP indices and validity measures showed strong age-related trends. CONCLUSIONS: Screening BP measurement significantly overestimated hypertension prevalence while failing to identify ≈50% of true hypertension diagnosed by ABPM. Our findings suggest significant clinical and epidemiological benefits of ABPM use for diagnosing hypertension in Kenyan adults.


Asunto(s)
Hipertensión/diagnóstico , Distribución por Edad , Monitoreo Ambulatorio de la Presión Arterial , Estudios de Casos y Controles , Diagnóstico Precoz , Femenino , Humanos , Hipertensión/epidemiología , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia
16.
Rev Assoc Med Bras (1992) ; 62(7): 647-651, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27925044

RESUMEN

Introduction:: In patients with essential thrombocythemia (ET), the vascular complications contribute to morbidity and mortality. To better predict the occurrence of thrombotic events, an International Prognostic Score for Thrombosis in Essential Thrombocythemia (IPSET-thrombosis) has recently been proposed. We present the application of this score and compare its results with the usual classification system. Method:: We retrospectively evaluated the characteristics and risk factors for thrombosis of 46 patients with a diagnosis of ET seen in the last 6 years at Faculdade de Medicina do ABC (FMABC). Results:: Thrombosis in the arterial territory was more prevalent than in venous sites. We observed that cardiovascular risk factors (hypertension, hypercholesterolemia, diabetes mellitus, and smoking) were also risk factors for thrombosis (p<0.001). Age over 60 years and presence of JAK2 V617F mutation were not associated with the occurrence of thrombotic events. No patient classified by IPSET-thrombosis as low risk had a thrombotic event. Furthermore, using the IPSET-thrombosis scale, we identified two patients who had thrombotic events during follow-up and were otherwise classified in the low-risk group of the traditional classification. Leukocytosis at diagnosis was significantly associated with arterial thrombosis (p=0.02), while splenomegaly was associated with venous thrombotic events (p=0.01). Conclusion:: Cardiovascular risk factors and leukocytosis were directly associated with arterial thrombosis. IPSET-thrombosis appears to be better than the traditional classification at identifying lower risk patients who do not need specific therapy.


Asunto(s)
Medición de Riesgo/métodos , Trombocitemia Esencial/complicaciones , Trombosis/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Complicaciones de la Diabetes , Femenino , Hospitales Públicos/estadística & datos numéricos , Humanos , Hipertensión/complicaciones , Janus Quinasa 2/genética , Masculino , Persona de Mediana Edad , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Factores de Riesgo , Fumar/efectos adversos , Trombosis/diagnóstico , Adulto Joven
17.
Rev Bras Enferm ; 69(6): 1067-1073, 2016.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-27925082

RESUMEN

Objective:: assess the influence of an intervention, comprised of counseling related to health and aerobic physical training for lowering pressure values, in anthropometric indicators and in the adjustment of biochemical parameters in individuals with hypertension. Method:: intervention study of the randomized clinical trial variety, with 42 individuals. The intervention-group followed the protocol of health counseling, nutrition and physical activity. Results:: two intervention groups were considered: intervention-group (a) and intervention-group (b). Intervention-group (a) showed significant decrease in measurements of systolic and diastolic arterial pressure, of high-density lipoprotein parameters, hip circumference values and waist-hip ratio. Intervention-group (b) presented significant decrease in systolic arterial pressure values. Conclusion:: it was found that the health intervention in conjunction with physical activities were effective in decreasing and/or controlling values for pressure, biochemical and anthropometric indicators.


Asunto(s)
Hipertensión/terapia , Grupo de Atención al Paciente , Adulto , Antropometría , Presión Sanguínea , Consejo , Ejercicio Físico , Femenino , Humanos , Hipertensión/enfermería , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Resultado del Tratamiento , Adulto Joven
18.
BMC Public Health ; 16(1): 1220, 2016 12 03.
Artículo en Inglés | MEDLINE | ID: mdl-27914466

RESUMEN

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in Mississippi. However, the prevalence of no known CVD risk factors among Mississippi adults and the change of prevalence in the past 9 years have not been described. We assess changes in prevalence of no known CVD risk factors during 2001 and 2009. METHODS: Prevalence of high blood pressure, high cholesterol, diabetes, physical inactivity, smoking, and obesity were investigated. Survey respondents who reported having none of these factors were defined as having no known CVD risk factors. Differences in prevalence and 95% confidence intervals were determined using t-test analysis. RESULTS: Overall, age-standardized prevalence of having no known CVD risk factors significantly decreased from 17.3% in 2001 to 14.5% in 2009 (p = 0.0091). The age-standardized prevalence of no known CVD risk factors were significantly lower in 2009 than in 2001 among blacks (8.9% vs. 13.2%, p = 0.008); males (13.5% vs. 17.9%, p = 0.0073); individuals with a college degree (25.2%, vs. 30.8%, p = 0.0483); and those with an annual household income of $20,000-$34,999 (11.6% vs. 16.9%, p = 0.0147); and $35,000-$49,999 (15.2% vs. 23.3%, p = 0.0135). CONCLUSION: The prevalence of no known CVD risk factors among Mississippi adults significantly decreased from 2001 to 2009 with observed differences by race, age group, sex, and annual household income.


Asunto(s)
Sistema de Vigilancia de Factor de Riesgo Conductual , Enfermedades Cardiovasculares/epidemiología , Vigilancia de la Población/métodos , Adulto , Diabetes Mellitus/epidemiología , Femenino , Estado de Salud , Humanos , Hipercolesterolemia/epidemiología , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Mississippi , Obesidad/epidemiología , Prevalencia , Factores de Riesgo , Fumar/epidemiología , Adulto Joven
19.
JACC Heart Fail ; 4(12): 911-919, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27908389

RESUMEN

OBJECTIVES: This study was designed to quantify the relationship between the absence of heart failure risk factors in middle age and incident heart failure, heart failure-free survival, and overall survival. BACKGROUND: Quantification of years lived free from heart failure in the context of risk factor burden in mid-life may improve risk communication and prevention efforts. METHODS: We conducted a pooled, individual-level analysis sampling from communities across the United States as part of 4 cohort studies: the Framingham Heart, Framingham Offspring, Chicago Heart Association Detection Project in Industry, and ARIC (Atherosclerosis Risk In Communities) studies. Participants with and without hypertension (blood pressure ≥140/90 mm Hg or treatment), obesity (body mass index ≥30 kg/m2), or diabetes (fasting glucose ≥126 mg/dl or treatment), and combinations of these factors, at index ages of 45 years and 55 years through 95 years. Competing risk-adjusted Cox models, a modified Kaplan-Meier estimator, and Irwin's restricted mean were used to estimate the association between the absence of risk factors at mid-life and incident heart failure, heart failure-free survival, and overall survival. RESULTS: For participants at age 45 years, over 516,537 person-years of follow-up, 1,677 incident heart failure events occurred. Men and women with no risk factors, compared to those with all 3, had 73% to 85% lower risks of incident heart failure. Men and women without hypertension, obesity, or diabetes at age 45 years lived on average 34.7 years and 38.0 years without incident heart failure, and they lived on average an additional 3 years to 15 years longer free of heart failure than those with 1, 2, or 3 risk factors. Similar trends were seen when stratified by race and at index age 55 years. CONCLUSIONS: Prevention of hypertension, obesity, and diabetes by ages 45 years and 55 years may substantially prolong heart failure-free survival, decrease heart failure-related morbidity, and reduce the public health impact of heart failure.


Asunto(s)
Diabetes Mellitus/epidemiología , Insuficiencia Cardíaca/epidemiología , Hipertensión/epidemiología , Mortalidad , Obesidad/epidemiología , Anciano , Anciano de 80 o más Años , Causas de Muerte , Diabetes Mellitus/prevención & control , Supervivencia sin Enfermedad , Femenino , Insuficiencia Cardíaca/prevención & control , Humanos , Hipertensión/prevención & control , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Obesidad/prevención & control , Prevención Primaria , Modelos de Riesgos Proporcionales , Factores de Riesgo , Tasa de Supervivencia , Estados Unidos/epidemiología
20.
JACC Heart Fail ; 4(12): 923-931, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27908391

RESUMEN

OBJECTIVES: This study evaluated the prevalence, profile, and prognosis of severe obesity in a large contemporary acute heart failure (AHF) population. BACKGROUND: Better prognosis has been reported for obese heart failure (HF) patients than nonobese HF patients, but in other cardiovascular populations, this effect has not been demonstrated for severely obese patients. METHODS: A cohort of 795 participants with body mass index (BMI) measured at time of admission and complete follow-up were identified from enrollment in 3 contemporary AHF trials (DOSE [Diuretic Strategies Optimization Evaluation], CARRESS-HF [Cardiorenal Rescue Study in Acute Decompensated Heart Failure], and ROSE [Renal Optimization Strategies Evaluation in Acute Heart Failure]). Patients were divided into 4 BMI categories according to standard World Health Organization criteria, as follows: normal weight: 18.5 to 25 kg/m2 [n = 128]; overweight: 25 to 29.9 kg/m2 [n = 209]; mild-to-moderate obese: 30 to 39.9 kg/m2 [n = 301]; and severely obese: ≥40 kg/m2 [n = 157]). The relationship between BMI and 60-day composite outcome (death, rehospitalization, or unscheduled provider visit) was investigated. RESULTS: Patients with severe obesity (19.7%) were younger, more often female, hypertensive, diabetic, and more likely to have higher blood pressures and left ventricular ejection fraction, and lower N-terminal pro-B-type natriuretic peptide and troponin I levels than other BMI category patients. Following admission for AHF, patients with normal weight showed the highest risk of 60-day composite outcome, followed by patients who were severely obese. Overweight and mild-moderately obese patients showed lowest risk. CONCLUSIONS: Nearly one-fifth of AHF patients enrolled in contemporary randomized clinical trials are severely obese. A U-shaped curve for short-term prognosis according to BMI is seen in AHF. These findings may help to better inform both HF clinical care and future clinical trial planning.


Asunto(s)
Insuficiencia Cardíaca/epidemiología , Obesidad Mórbida/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Diabetes Mellitus/epidemiología , Método Doble Ciego , Femenino , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Hospitalización , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Obesidad/epidemiología , Sobrepeso/epidemiología , Fragmentos de Péptidos/sangre , Prevalencia , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Distribución por Sexo , Volumen Sistólico , Troponina I/sangre , Estados Unidos/epidemiología
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