Journal of The American Society of Hypertension最新文献

This study was to investigate prevalence of depression among migrant hypertensive patients in primary care and to examine hypertensive patients' social capital and its relationship with the prevalence of depression. An on-site–based cross-sectional study was performed in Shenzhen, China. A total of 830 migrant hypertensive patients completed the survey by using systematic sampling design. A questionnaire including information of depressive symptoms and social capital was administered by face-to-face interview surveys. We found that the prevalence of depression was 11.0% among migrant hypertensive patients in primary care. Social ties (odds ratio = 1.197, 95% confidence interval: 1.034, 1.387) and trust (odds ratio = 2.061, 95% confidence interval: 1.342, 3.165) were statistically significant associated with the prevalence of depression. Our study shows that the prevalence of depression is high among migrant hypertensive patients in primary care. It also suggests an inverse association between social capital and depression among migrant hypertensive patients. Although causal pathways between social capital and depression cannot be established by the present study, it is plausible to design and implement social interventions to improve mental health of migrant hypertensive patients in primary care.

The objective of this study is to estimate the effect of aerobic training (AT) on metabolic syndrome (MetS) outcomes. The Medline, EMBASE, SPORTDiscus, The Cochrane Library, and PEDro databases were searched from inception to May 2017. Two independent reviewers selected the studies and assessed their quality and data. The pooled mean differences between intervention groups and the control group were calculated using a random-effect model. Only randomized controlled trials that compared the effect of AT on MetS with a control group were included. Seventeen published studies were included in the meta-analysis. Systolic and diastolic blood pressure were significantly reduced (−5.11 mmHg [95% confidence interval [CI] −7.36, −2.85] and −2.97 mmHg [−4.99, −0.94], respectively), following AT. There was also a significant reduction in waist circumference (−2.18 cm [95% CI −3.75, −0.62]) and a significant increase in high-density lipoprotein cholesterol (95% CI −3.15 mg/dL [−5.30, −1.01]). The pooled effect showed a reduction of −7.64 mg/dL [95% CI −17.65, 2.37] in triglycerides and −1.36 mg/dL [95% CI −4.11, 1.40] in fasting glucose. This systematic review and meta-analysis provides an overview of the evidence supporting AT as an effective approach to reduce blood pressure levels and waist circumference and increase high-density lipoprotein cholesterol levels. These changes may help to reduce the risk of stroke mortality and mortality from heart disease in people with MetS.

Individualized weighing of the risk benefit of anticoagulation is recommended in patients with atrial fibrillation (AF) who have low established risk scores or, conversely, are at increased risk for bleeding. Parameters of arterial stiffness and wave reflection could improve risk stratification, but their use has not been evaluated in arrhythmia. We measured carotid-femoral pulse wave velocity (PWV), central augmentation index (AI), and central pulse pressure (CPP) using the SphygmoCor system in 34 patients (53 to 85 years; 25 males) with AF before and after elective electrical cardioversion. Agreement was assessed using the intraclass correlation coefficient (ICC) and the coefficient of variation, completed with Bland–Altman plots. After cardioversion, mean arterial blood pressure (MAP) and heart rate (HR) decreased significantly by 8 mmHg and 18 bpm, respectively. PWV decreased from 11.8 m/s to 10.7 m/s, AI increased from 24% to 29%, and CPP rose from 38 mmHg to 43 mmHg. The decrease in PWV was related to the decrease in MAP (beta = 0.57; R² = 0.33; P < .001), whereas changes in AI and CPP were related to the decrease in HR (AI: beta = −0.59; R² = 0.35; P < .001, CPP: beta = −0.55; R² = 0.28; P = .001). After adjustment for changes in MAP and HR, reliability analysis showed an excellent agreement for PWV (ICC = 0.89; 95% confidence interval (CI): 0.79–0.95) but moderate agreement for AI (ICC = 0.59; 95% CI: 0.17–0.80). Excellent agreement was also found for CPP (ICC = 0.89; 95% CI: 0.72–0.95). Measurement of PWV and CPP is reliable in patients with AF, as they appear unaffected by the presence of arrhythmia.

Postmicturition syndrome refers to symptoms caused by overdistension of the bladder or micturition. Bladder paraganglioma is a rare neuroendocrine neoplasm, which arises from the chromaffin tissue of the sympathetic nervous system embedded in the muscle layer of the bladder wall. Clinical presentation of catecholamine-secreting paragangliomas may mimic that of hyperfunctioning adrenal pheochromocytoma. Typical symptoms such as sweating, palpitations, headache, nausea, hypertension, or flushing are due to catecholamine release and are related to micturition or bladder overdistension. We herein report the case of a 22-year-old woman admitted to the Emergency Department because of cranial trauma secondary to a car accident. She referred history of micturition-related headache, nausea, sweating, and increase in blood pressure since she was 13 years old. The neurological investigation was normal. No urogenital tract investigation was performed and, on admission, blood pressure was 190/125 mmHg. During hospitalization, abdominal ultrasonography, performed to rule out secondary hypertension, unexpectedly showed a large vascular soft tissue mass in the bladder wall, compatible with a paraganglioma. Twenty-four hours of urinalysis of catecholamines revealed high values of urine metanephrines. Abdominal magnetic resonance imaging and histopathological evaluation of the surgical specimen, following resection of the bladder lesion, confirmed the diagnosis. Our case underlines the importance not to underestimate symptoms compatible with postmicturition syndrome, especially in young patients, to make early diagnosis of bladder paraganglioma.

Estimating population attributable risks of potential modifiable risk factors for stroke and (or) myocardial infarction may be useful for planning cardiovascular disease (CVD) preventive strategies. A population of 17,292 adults aged 18 years and older from a cross-sectional survey was included in the study. The binary logistic regression was used to evaluate the association between risk factors with disease events, then population attributable fraction according to prevalence and odds ratios were calculated to identify and compare the effects at different subpopulations. We found that the main risk factor for CVD events was hypertension with about 50% of population attributable fraction; prehypertension (22.24%) only acts at rural older females; the efficiency of low- and moderate-level physical activities were higher in males (over 20%) than females (under 20%); ever smoked contributed to CVDs in rural older populations (males, 19.25%; females, 5.57%) and urban younger males (54.52%); while as for high body mass index, overweight (12.59%) only made contribution to rural males over 60 years. In conclusion, hypertension control in the whole population, physical activity increasing in males and older females, smoking prevention in rural elders and urban younger males, and slimming in rural elder males might be effective to reduce the burden of CVDs in Henan.

Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease but is often associated with other risks such as diabetes and hypertension and can be both a cause and an effect of cardiovascular disease. Although epidemiologic data of an independent association of reduced glomerular filtration rate with cardiovascular risk are strong, causative mechanisms are unclear.

Living kidney donors provide a useful model for assessing the “pure” effects of reduced kidney function on the cardiovascular system. After nephrectomy, the glomerular filtration rate ultimately falls by about one-third so many can be classified as having chronic kidney disease stages 2 or 3. This prompts concern based on the data showing an elevated cardiovascular risk with these stages of chronic kidney disease. However, initial data suggested no increase in adverse cardiovascular effects compared with control populations. Recent reports have shown a possible late increase in cardiovascular event rates and an early increase in left ventricular mass and markers of risk such as urate and albuminuria. The long-term significance of these small changes is unknown. More detailed and long-term research is needed to determine the natural history of these changes and their clinical significance.