Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36.669
Filtrar
1.
PLoS One ; 11(12): e0168504, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27992525

RESUMEN

BACKGROUND: The aging kidney manifests structural, functional as well as pharmacological changes, rendering elderly patients more susceptible to adverse environmental influences on their health, dehydration in particular. HYPOTHESIS: Higher temperature is associated with renal function impairment in patients 65 years and older who routinely take thiazide and/or ACE-inhibitors/ARBs. METHODS: We obtained health data of patients older than 65 who were admitted to a large tertiary center during the years 2006-2011, with a previous diagnosis of hypertension, and treated with thiazide, ACE-inhibitors/ARBs or both. We collected environmental data of daily temperature, available from collaborative public and governmental institutions. In order to estimate the effect of daily temperature on renal function we performed linear mixed models, separately for each treatment group and creatinine change during hospital admission. RESULTS: We identified 26,286 admissions for 14, 268 patients with a mean age of 75.6 (±6.9) years, of whom 53.6% were men. Increment in daily temperature on admission of 5°C had significant effect on creatinine increase in the no treatment (baseline creatinine adjusted 0.824 mg/dL, % change 1.212, % change 95% C.I 0.082-2.354) and dual treatment groups (baseline creatinine adjusted 1.032mg/dL, % change 3.440, % change 95% C.I 1.227-5.700). Sub-analysis stratified by advanced age, chronic kidney disease and primary diagnosis on hospital admission, revealed a significant association within patients admitted due to acute infection and treated with dual therapy. CONCLUSION: Whereas previous studies analyzed sporadic climate effects during heat waves and/or excluded older population taking anti-hypertensive medications, the present study is novel by showing a durable association of temperature and decreased renal function specifically in elderly patients taking anti-hypertensive medications.


Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Hospitalización , Calor , Hipertensión , Insuficiencia Renal Crónica , Inhibidores de los Simportadores del Cloruro de Sodio/administración & dosificación , Anciano , Anciano de 80 o más Años , Creatinina/sangre , Femenino , Humanos , Hipertensión/sangre , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Masculino , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/fisiopatología , Centros de Atención Terciaria
3.
Ann Intern Med ; 165(12): 889-890, 2016 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-27992903
4.
Biomedica ; 36(4): 509-518, 2016 Dec 01.
Artículo en Español | MEDLINE | ID: mdl-27992977

RESUMEN

INTRODUCTION: The fatty streaks in an arterial wall can appear from the third year of age, and they show an association with atherogenic risk factors such as hypertension and sodium in the diet. Given the difficulty of data gathering, few studies report the intake of sodium in the diet. OBJECTIVE: To determine average sodium intake in the diet of children between one and 18 months of age through a three-day dietary survey. MATERIALS AND METHODS: This was a cross-sectional study with 48 children without renal disease or diet restrictions seen in pediatric practice between January and June, 2011. It included a dietary survey for the parents, nutritional status classification by anthropometry, and blood pressure measurements. Sodium content and other nutrients in the diet program were analyzed with the International Food Consumption Program (CERES), anthropometry with the World Health Organization Anthro program, and Epi-info for socio-demographic characteristics. RESULTS: In total, 69% of children had high sodium consumption, 6.2% had high blood pressure, and 20.7% were overweight and obese. CONCLUSIONS: The prevalence of hypertension exceeds that reported for Colombia (1-3%). Two of the three children with high blood pressure had high sodium intake and they were overweight and obese, with values above those reported for Colombian children (16%). We suggest to measure blood pressure early, and to restrict salt and sugar in food for infants and children under two years of age. Also, larger studies should be conducted to collect population data on sodium intake and develop appropriate and timely intervention strategies to reduce risks in adulthood.


Asunto(s)
Hipertensión/epidemiología , Alimentos Infantiles , Sobrepeso/epidemiología , Sodio en la Dieta/efectos adversos , Edad de Inicio , Antropometría , Colombia , Estudios Transversales , Encuestas sobre Dietas , Femenino , Humanos , Hipertensión/etiología , Lactante , Masculino , Obesidad/epidemiología , Obesidad/etiología , Sobrepeso/etiología , Placa Aterosclerótica/etiología , Placa Aterosclerótica/prevención & control , Prevalencia , Factores Socioeconómicos , Población Urbana
5.
Clin Interv Aging ; 11: 1781-1790, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27994444

RESUMEN

BACKGROUND: Hypertension affects about 80% of people older than 80 years; however, diagnosis and treatment are difficult because about 55% of them do not adhere to treatment recommendations due to low socioeconomic status, comorbidities, age, physical limitations, and frailty syndrome. AIMS: The purposes of this study were to evaluate the influence of frailty on medication adherence among elderly hypertensive patients and to assess whether other factors influence adherence in this group of patients. METHODS AND RESULTS: The study included 296 patients (mean age 68.8±8.0) divided into frail (n=198) and non-frail (n=98) groups. The Polish versions of the Tilburg Frailty Indicator (TFI) for frailty assessment and 8-item Morisky Medication Adherence Scale for adherence assessment were used. The frail patients had lower medication adherence in comparison to the non-frail subjects (6.60±1.89 vs 7.11±1.42; P=0.028). Spearman's rank correlation coefficients showed that significant determinants with negative influence on the level of adherence were physical (rho =-0.117), psychological (rho =-0.183), and social domain (rho =-0.163) of TFI as well as the total score of the questionnaire (rho =-0.183). However, multiple regression analysis revealed that only knowledge about complications of untreated hypertension (ß=0.395) and satisfaction with the home environment (ß=0.897) were found to be independent stimulants of adherence level. CONCLUSION: Frailty is highly prevalent among elderly hypertensive patients. Higher level of frailty among elderly patients can be considered as a determinant of lower adherence. However, social support and knowledge about complications of untreated hypertension are the most important independent determinants of adherence to pharmacological treatment.


Asunto(s)
Antihipertensivos/administración & dosificación , Anciano Frágil/estadística & datos numéricos , Fragilidad/epidemiología , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Cumplimiento de la Medicación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Comorbilidad , Ambiente , Femenino , Evaluación Geriátrica , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Polonia , Prevalencia , Análisis de Regresión , Factores Socioeconómicos , Encuestas y Cuestionarios
6.
Sci Rep ; 6: 39469, 2016 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-27995995

RESUMEN

Hypertension is a major risk factor for cardiovascular and cerebrovascular disease. Prenatal exposure to lipopolysaccharide (LPS) leads to hypertension in a rat offspring. However, the mechanism is still unclear. This study unraveled epigenetic mechanism for this and explored the protective effects of ascorbic acid against hypertension on prenatal inflammation-induced offspring. Prenatal LPS exposure resulted in an increase of intrarenal oxidative stress and enhanced angiotensin-converting enzyme 1 (ACE1) gene expression at the mRNA and protein levels in 6- and 12-week-old offspring, correlating with the augmentation of histone H3 acetylation (H3AC) on the ACE1 promoter. However, the prenatal ascorbic acid treatment decreased the LPS-induced expression of ACE1, protected against intrarenal oxidative stress, and reversed the altered histone modification on the ACE1 promoter, showing the protective effect in offspring of prenatal LPS stimulation. Our study demonstrates that ascorbic acid is able to prevent hypertension in offspring from prenatal inflammation exposure. Thus, ascorbic acid can be a new approach towards the prevention of fetal programming hypertension.


Asunto(s)
Ácido Ascórbico/farmacología , Regulación del Desarrollo de la Expresión Génica , Histonas/metabolismo , Hipertensión/prevención & control , Peptidil-Dipeptidasa A/metabolismo , Acetilación , Animales , Antioxidantes/metabolismo , Presión Sanguínea , Peso Corporal , Islas de CpG , Epigénesis Genética , Femenino , Hipertensión/metabolismo , Inflamación/metabolismo , Riñón/patología , Lipopolisacáridos/metabolismo , Estrés Oxidativo , Peptidil-Dipeptidasa A/genética , Embarazo , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Regiones Promotoras Genéticas , ARN Mensajero/metabolismo , Ratas , Ratas Sprague-Dawley , Factores de Riesgo
7.
Sci Rep ; 6: 39361, 2016 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-27996026

RESUMEN

The overprovision and irrational use of antibiotics and injections are a major public health concern. Public reporting has been adopted as a strategy to encourage good prescribing practices. This study evaluated the effects of public reporting on antibiotic and injection prescriptions in urban and rural primary care settings in Hubei province, China. A randomized control trial was conducted, with 10 primary care institutions being subject to public reporting and another 10 serving as controls. Prescription indicators were publicly reported monthly over a one-year period. Prescriptions for bronchitis, gastritis and hypertension before and after the intervention were collected. Difference-in-difference tests were performed to estimate the effect size of the intervention on five prescription indicators: percentage of prescriptions containing antibiotics; percentage of prescriptions containing two or more antibiotics; percentage of prescriptions containing injections; percentage of prescriptions containing antibiotic injections; and average prescription cost. Public reporting had varied effects on prescriptions for different diagnoses. It reduced antibiotic prescribing for gastritis. Prescriptions containing injections, especially antibiotic injections, also declined, but only for gastritis. A reduction of prescription costs was noted for bronchitis and gastritis. Public reporting has the potential to encourage good prescribing practices. Its effects vary with different disease conditions.


Asunto(s)
Antibacterianos/uso terapéutico , Bronquitis/tratamiento farmacológico , Gastritis/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Prescripción Inadecuada/economía , Prescripción Inadecuada/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , China , Recolección de Datos , Humanos , Persona de Mediana Edad , Atención Primaria de Salud
8.
Int J Clin Pract ; 70(12): 1012-1018, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28032424

RESUMEN

AIMS: With self-reporting of erectile dysfunction (ED) in population-based surveys, men with ED may not represent men who are bothered sufficiently to seek an ED diagnosis and treatment. We used real-world observational data to assess: 1) the prevalence of ED diagnosis or treatment by age subgroups; and 2) the relationship of age with ED diagnosis or treatment after controlling for ED-related comorbidities in the USA. METHODS: This cross-sectional study used de-identified claims data (MarketScan® databases; primary analysis). Sensitivity analysis was conducted using electronic health records (Humedica® database). Inclusion criteria were men aged ≥18 years with a 360-day continuous enrollment before the index date. We assessed the prevalence of ED diagnosis or phosphodiesterase type 5 inhibitor (PDE5I) prescription by age and the risk for ED diagnosis or treatment by age after controlling for comorbidities (hypertension, other cardiovascular disease, diabetes mellitus, depression and benign prostatic hyperplasia). RESULTS: Of 19,833,939 men meeting inclusion criteria in the primary analysis, only 1 108 842 (5.6%) had an ED diagnosis or PDE5I prescription (mean [SD] age: 55.2 [11.2] years). Prevalence of ED diagnosis or treatment increased from age 18-29 years (0.4%) to 60-69 years (11.5%), then decreased in the seventh (11.0%), eighth (4.6%), and ninth (0.9%) decades. Men with ED diagnosis or treatment had a higher prevalence of any comorbidity (63.1% vs 29.3% for men without ED) and of each comorbid condition. In multivariate analyses, age was an independent risk factor for ED diagnosis or treatment. Sensitivity analysis provided consistent results. CONCLUSIONS: In a real-world setting in the USA, the prevalence of ED diagnosis or PDE5I treatment is generally low, increases with age, decreases in very old men, and is associated with increased prevalence of comorbidities. Age is an independent risk factor for ED diagnosis or treatment after controlling for comorbidities.


Asunto(s)
Depresión/epidemiología , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/tratamiento farmacológico , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Disfunción Eréctil/epidemiología , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/epidemiología , Factores de Riesgo , Adulto Joven
12.
Prev Chronic Dis ; 13: E179, 2016 12 29.
Artículo en Inglés | MEDLINE | ID: mdl-28033090

RESUMEN

INTRODUCTION: Rates of hypertension control remain low among underserved populations in the United States; moreover, disparities in hypertension-related cardiovascular disease death are increasing. Community health workers (CHWs) can address barriers to hypertension control among underrepresented and diverse populations. We identify unique roles CHWs play in hypertension self-management and medication adherence. METHODS: In 2014, we conducted a mixed methods study with an online survey of 265 CHWs and 23 telephone interviews. The survey and interview guide contained questions about CHWs' roles in hypertension self-management and hypertension medication adherence. We used descriptive statistics to analyze survey data and used inductive thematic analysis for the qualitative data. RESULTS: CHWs described working in partnership with patients and various health care providers to assist people in hypertension self-management. Roles were flexible and multifaceted but patient-driven. CHWs used various delivery methods to assist patients in overcoming barriers to medication adherence. CHWs interacted with patients primarily through individual clinical sessions or home visits. On average, they visit about 8 times per month, about 40 minutes per visit, over 7 months. CHWs often addressed barriers related to medicine-taking and refills and support patient-provider communications. CONCLUSION: Results from this study will help health care professionals, policy makers, and academics better understand the work of CHWs. CHWs are important provider allies for improving hypertension prevention and self-management, especially among underserved and diverse populations in the United States.


Asunto(s)
Actitud del Personal de Salud , Agentes Comunitarios de Salud , Hipertensión/terapia , Cumplimiento de la Medicación/estadística & datos numéricos , Autocuidado/métodos , Femenino , Humanos , Masculino , Investigación Cualitativa , Encuestas y Cuestionarios , Estados Unidos , Poblaciones Vulnerables
13.
Medicine (Baltimore) ; 95(52): e5791, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28033302

RESUMEN

INTRODUCTION: Hypertension is a major risk factor contributing to cardiovascular disease, which is the number one cause of deaths worldwide. Although antihypertensive medications are effective at controlling blood pressure, current first-line treatment for hypertension is nonpharmacological lifestyle modifications. Recent studies indicate that isometric resistance training (IRT) may also be effective for assisting with blood pressure management. The aim of this study was to determine the efficacy of IRT for blood pressure management and the suitability of a low-intensity working control group. METHODS: Forty hypertensive individuals, aged between 36 and 65 years, conducted IRT for 8 weeks. Participants were randomized into 2 groups, working at an intensity of either 5% or 30% of their maximum voluntary contraction. Participants performed 4 × 2 minute isometric handgrip exercises with their nondominant hand, each separated by a 3-minute rest period, 3 days a week. RESULTS: Blood pressure measurements were conducted at baseline and at the end of the protocol using a Finometer. Eight weeks of isometric resistance training resulted in a 7-mmHg reduction of resting systolic blood pressure (SBP) (136 ±â€Š12 to 129 ±â€Š15; P = 0.04) in the 30% group. Reductions of 4 mmHg were also seen in mean arterial pressure (MAP) (100 ±â€Š8 to 96 ±â€Š11; P = 0.04) in the 30% group. There were no statistically significant reductions in diastolic blood pressure for the 30% group, or any of the data for the 5% group. CONCLUSION: Isometric resistance training conducted using handgrip exercise at 30% of maximum voluntary contraction significantly reduced SBP and MAP. A lack of reduction in blood pressure in the 5% group indicates that a low-intensity group may be suitable as a working control for future studies.


Asunto(s)
Terapia por Ejercicio/métodos , Hipertensión/terapia , Contracción Isométrica , Entrenamiento de Resistencia/métodos , Adulto , Anciano , Presión Arterial , Femenino , Mano , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Esfuerzo Físico/fisiología , Sístole
14.
PLoS One ; 11(12): e0168312, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28033321

RESUMEN

INTRODUCTION: Coronary artery disease (CAD) and hypertension are the main reasons of ischemic heart diseases (IHDs). Cytokines as the small glycoproteins are the main arm of immune system and manipulate all of the cardiovascular diseases. The aim of the current study was to examine the effects of treatment of hypertension and CAD on serum levels of IL-6, IL-8, TGF-ß and TNF-α. MATERIAL AND METHODS: This interventional study was performed on the patients with hypertension without CAD (group 1), hypertension and CAD (group 2), CAD but not hypertension (group 3) and without hypertension and CAD as controls (group 4). The patients received routine treatment for hypertension and CAD. Serum levels of IL-6, IL-8, TGF-ß and TNF-α were analyzed in the groups treated with various drugs, using ELISA technique. RESULTS: With regard to the medications, Atorvastatin, Losartan and Captopril were administered more in patients (groups 1, 2 and 3) than the patients without hypertension and CAD. The results revealed that serum levels of TGF-ß and IL-6 were significantly increased and decreased, respectively, in the groups 1, 2 and 3 when compared to group 4. Serum levels of TGF-ß were also increased in females in comparison to males in the group 4. DISCUSSION: According to the results it seems that Atorvastatin, Losartan and Captopril have reduced inflammation in in vivo conditions via downregulation of IL-6 and upregulation of TGF-ß.


Asunto(s)
Antihipertensivos/uso terapéutico , Atorvastatina/uso terapéutico , Captopril/uso terapéutico , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipertensión/tratamiento farmacológico , Interleucina-6/biosíntesis , Losartán/uso terapéutico , Factor de Crecimiento Transformador beta/biosíntesis , Humanos , Inflamación/tratamiento farmacológico , Interleucina-6/sangre , Interleucina-8/sangre , Irán , Factor de Crecimiento Transformador beta/sangre , Factor de Necrosis Tumoral alfa/sangre , Regulación hacia Arriba/efectos de los fármacos
15.
PLoS One ; 11(12): e0164936, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28033332

RESUMEN

BACKGROUND: In patients with diabetes, albuminuria is a risk marker of end-stage renal disease and cardiovascular events. An increased renin-angiotensin system activity has been reported to play an important role in the pathological processes in these conditions. We compared the effect of aliskiren, a direct renin inhibitor (DRI), with that of angiotensin receptor blockers (ARBs) on albuminuria and urinary excretion of angiotensinogen, a marker of intrarenal renin-angiotensin system activity. METHODS: We randomly assigned 237 type 2 diabetic patients with high-normal albuminuria (10 to <30 mg/g of albumin-to-creatinine ratio) or microalbuminuria (30 to <300 mg/g) to the DRI group or ARB group (any ARB) with a target blood pressure of <130/80 mmHg. The primary endpoint was a reduction in albuminuria. RESULTS: Twelve patients dropped out during the observation period, and a total of 225 patients were analyzed. During the study period, the systolic and diastolic blood pressures were not different between the groups. The changes in the urinary albumin-to-creatinine ratio from baseline to the end of the treatment period in the DRI and ARB groups were similar (-5.5% and -6.7%, respectively). In contrast, a significant reduction in the urinary excretion of angiotensinogen was observed in the ARB group but not in the DRI group. In the subgroup analysis, a significant reduction in the albuminuria was observed in the ARB group but not in the DRI group among high-normal albuminuria patients. CONCLUSION: DRI and ARB reduced albuminuria in hypertensive patients with type 2 diabetes. In addition, ARB, but not DRI, reduced albuminuria even in patients with normal albuminuria. DRI is not superior to ARB in the reduction of urinary excretion of albumin and angiotensinogen.


Asunto(s)
Albuminuria/tratamiento farmacológico , Amidas/uso terapéutico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Fumaratos/uso terapéutico , Hipertensión/tratamiento farmacológico , Fallo Renal Crónico/prevención & control , Renina/antagonistas & inhibidores , Angiotensinógeno/orina , Presión Sanguínea/efectos de los fármacos , Creatinina/orina , Nefropatías Diabéticas/patología , Humanos , Hipertensión/fisiopatología , Fallo Renal Crónico/patología , Estudios Prospectivos , Sistema Renina-Angiotensina/efectos de los fármacos , Resultado del Tratamiento
16.
Curr Hypertens Rev ; 12(3): 215-221, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28034358

RESUMEN

BACKGROUND: High blood pressure (HBP) is a cardiovascular risk factor that can initiate in childhood and adolescence and may be associated with other risk factors such as sedentary lifestyles. Therefore, verifying if these associations occur from the earliest ages is of fundamental importance. OBJECTIVES: to report the prevalence of HBP combined with sedentary behavior through a systematic review. DESIGN AND METHODS: The research was performed based on studies published between 2010 and 2016 in Medline, Web of Science, Excerpta Medica (EMBASE), and Scielo, using terms related to: 'sedentary behavior' OR 'screen time' AND 'high blood pressure'. In the initial search, 821 studies were found and after exclusions twelve studies were included in the review. RESULTS: Twelve studies addressing the relationship between sedentary behavior and HBP were found. Eighty-three percent of the studies evaluated sedentary behavior using a questionnaire (n = 10). The majority of studies analyzed in the review were conducted in North America (41.6%). Only four studies presented the prevalence of HBP related to sedentary behavior (variation 1-22.9%). In seven studies a close relationship between sedentary behavior and HBP was observed. CONCLUSIONS: Although most studies observed a relationship between sedentary behavior and HBP, the results still need to be further explained. Based on the findings of this review, follow-up studies and objective measurements of time spent in sedentary behavior in young people could help to determine the cause-effect relationship between sedentary behavior and HBP in pediatric populations.


Asunto(s)
Hipertensión/epidemiología , Conducta Sedentaria , Adolescente , Niño , Humanos , Hipertensión/etiología , Prevalencia , Factores de Riesgo
17.
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
18.
Eur Rev Med Pharmacol Sci ; 20(23): 5017-5020, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27981528

RESUMEN

OBJECTIVE: We investigated the effects of oral administration of enteric coated aspirin (ASA) on blood pressure and blood pressure variability of hypertension patients before sleep. PATIENTS AND METHODS: We observed 150 hypertension cases, classified as Grade 1-2, from September 2006 to March 2008. They are divided into a control group with 30 cases, ASA I group with 60 cases and ASA II group with 60 cases randomly. Subjects in the control group had proper diets, were losing weight, exercising and maintaining a healthy mentality and were taking 30 mg Adalat orally once a day. Based on the treatment of control group, patients in ASA I group were administered 0.1 g Bayaspirin (produced by Bayer Company) at drought in the morning. Also, based on the treatment of control group, patients in ASA II group were administered 0.1 g Bayaspirin at draught before sleep. RESULTS: The course of treatment is 3 months and then after the treatment, decreasing blood pressure and blood pressure variability conditions in three groups will be compared. Through the comparison of ASA II group with the control group, they have differences in terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), decreasing range of blood pressure and blood pressure variability (p < 0.05). CONCLUSIONS: The oral administration of ASA before sleep has synergistic effects on decreasing blood pressure of hypertension patients and improving blood pressure variability.


Asunto(s)
Aspirina/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Administración Oral , Humanos , Sueño
19.
Eur Rev Med Pharmacol Sci ; 20(23): 5013-5016, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27981529

RESUMEN

OBJECTIVE: The aim of this study is to analyze the effect of 100 mg/d regular oral intake of aspirin during pregnancy on high-risk pregnancy-induced hypertension syndrome patients. PATIENTS AND METHODS: We consecutively selected 98 cases high-risk pregnancy-induced hypertension syndrome patients. After obtaining the informed consent of the patients, we randomly divided the patients into aspirin group (50 cases) and placebo group (48 cases). The oral intake of aspirin lasted from the final diagnosis of pregnancy to antepartum time, and was taken before sleep. The bleeding index was closely detected and we stop taking aspirin when necessary. RESULTS: The comparison of clinical outcome showed that the incidents of pregnancy-induced hypertension syndrome, pre-eclampsia and eclampsia of aspirin group were significantly lower than that of the placebo group (p<0.05). Comparing the complications of fetus perinatal period, the difference was not statistically significant (p>0.05). CONCLUSIONS: 100 mg/d regular oral intake of aspirin during pregnancy is safe, effective and worthy of generalization to high-risk pregnancy-induced hypertension syndrome patients.


Asunto(s)
Aspirina/uso terapéutico , Hipertensión Inducida en el Embarazo , Resultado del Embarazo , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Preeclampsia , Embarazo
20.
Arq Bras Cardiol ; 107(5): 437-445, 2016 Nov.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-27982269

RESUMEN

Background:: Lack of adherence to pharmacological treatment is one of the main causes of low control rates in hypertension. Objective:: To verify treatment adherence and associated factors, as well as blood pressure (BP) control in participants of the Resistant Hypertension Optimal Treatment (ReHOT) clinical trial. Method:: Cross-sectional study including all 109 patients who had completed the ReHOT for at least 6 months. We excluded those participants who failed to respond to the new recruitment after three phone contact attempts. We evaluated the BP control by ambulatory BP monitoring (ABPM; controlled levels: 24-hour systolic and diastolic BP < 130 x 80 mmHg) and analyzed the patients' treatment adherence using the Morisky Medication Adherence Scale (MMAS) questionnaire validated by Bloch, Melo, and Nogueira (2008). The statistical analysis was performed with the software IBM SPSS statistics 21.0. We tested the normality of the data distribution with kurtosis and skewness. The variables tested in the study are presented with descriptive statistics. Comparisons between treatment adherence and other variables were performed with Student's t test for independent variables and Pearson's chi-square or Fisher's exact test. To conduct analyses among patients considering adherence to treatment and BP control, we created four groups: G0, G1, G2, and G3. We considered a 5% significance level in all tests. Results:: During the ReHOT, 80% of the patients had good BP control and treatment adherence. Of 96 patients reevaluated in the present study, only 52.1% had controlled hypertension when assessed by ABPM, while 31.3% were considered adherent by the MMAS. Regarding other ABPM measures, we observed an absence of a nocturnal dip in 64.6% of the patients and a white-coat effect and false BP control in 23% and 12.5%, respectively. Patients' education level showed a trend towards being a determinant factor associated with lack of adherence (p = 0.05). Resistant hypertension and number of medications were significantly associated with BP control assessed by ABPM (p = 0.009 and p = 0.001, respectively). Resistant hypertension was also significantly associated with group G0 (patients with no control or adherence, p = 0.012). Conclusion:: There was a decrease in BP control and adherence measured by the MMAS after participation of at least 6 months in the ReHOT clinical trial. Fundamento:: A falta de adesão ao tratamento medicamentoso da hipertensão arterial sistêmica (HAS) é uma das principais causas das baixas taxas de controle da doença. Objetivo:: Verificar a adesão e fatores relacionados a ela, além do controle pressórico de pacientes que participaram do ensaio clínico Resistant Hypertension Optimal Treatment (ReHOT). Método:: Estudo transversal que incluiu todos os 109 pacientes que concluíram o ReHOT há pelo menos 6 meses. Foram excluídos aqueles que não responderam ao novo recrutamento após três tentativas de contato telefônico. Foi realizada avaliação do controle pressórico através de monitorização ambulatorial da pressão arterial (MAPA; PA controlada: pressão arterial [PA] sistólica e diastólica de 24 horas < 130 x 80 mmHg) e avaliação da adesão através de respostas ao questionário Morisky Medication Adherence Scale (MMAS) validado por Bloch, Melo e Nogueira (2008). A análise estatística foi realizada com o programa IBM SPSS statistics 21.0. Para verificar a normalidade da distribuição dos dados, utilizamos testes de curtose e assimetria. As variáveis relacionadas ao objeto de estudo são apresentadas por meio de estatística descritiva. Comparações entre a adesão ao tratamento e demais variáveis foi realizada com o teste t de Student para variáveis independentes e teste do qui-quadrado de Pearson ou exato de Fisher. Para a análise entre pacientes considerando a adesão ao tratamento e controle da PA, foram criados quatro grupos: G0, G1, G2 e G3. Em todos os testes estatísticos consideramos um nível de significância de 5%. Resultados:: Durante o ReHOT, 80% dos pacientes apresentaram controle pressórico e adesão ao tratamento. Do total de 96 pacientes reavaliados, apenas 52,1% foram identificados como tendo HAS controlada através da avaliação da MAPA e 31,3% apresentaram adesão pelo MMAS. Quando consideradas outras medidas da MAPA, verificou-se que 64,6% dos pacientes não apresentavam descenso noturno e 23% e 12,5% apresentavam efeito do avental branco e falso controle da PA, respectivamente. A escolaridade apresentou tendência a ser um fator determinante de falta de adesão (p = 0,05). O número de medicamentos e a HAS resistente (HAR) tiveram uma relação significativa com o controle da PA medida por MAPA (p = 0,009 e p = 0,001, respectivamente). A HAR teve relação significativa com o grupo G0 (sem controle e sem adesão, p = 0,012). Conclusão:: Houve redução do controle da PA e da adesão pelo MMAS após pelo menos 6 meses de participação no ensaio clínico ReHOT.


Asunto(s)
Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial/métodos , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Cumplimiento de la Medicación , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA