International Journal of Cardiology: Hypertension最新文献_第6页

In-hospital morality associated with acute myocardial infarction was inversely related with the number of coronary risk factors in patients from a Japanese nation-wide real-world database 日本全国真实世界数据库显示，与急性心肌梗死相关的住院道德与患者冠状动脉危险因素的数量呈负相关

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100039

Hiroyoshi Mori , Hiroshi Suzuki , Kensaku Nishihira , Satoshi Honda , Sunao Kojima , Misa Takegami , Jun Takahashi , Tomonori Itoh , Tetsu Watanabe , Takashi Takenaka , Masaaki Ito , Morimasa Takayama , Kazuomi Kario , Tetsuya Sumiyoshi , Kazuo Kimura , Satoshi Yasuda , the JAMIR investigators

Background

Hypertension, diabetes, dyslipidemia and smoking are established coronary risk factors for coronary heart disease in the general population. However, in Japanese patients with acute myocardial infarction (AMI), the impact of the number of coronary risk factors on in-hospital morality remains unclear.

Methods

The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide real-world database. We examined the association between the number of coronary risk factors and in-hospital mortality.

Results

Data were obtained from total of 20462 AMI patients (mean age, 68.8 ± 13.3 years old; 15281 men, 5181 women). The prevalence of hypertension increased with advancing age, while the prevalence of smoking decreased with advancing age. The prevalence of diabetes and dyslipidemia were highest in middle age. A majority (76.9%) of the patients with AMI had at least 1 of these coronary risk factors. Overall, the number of coronary risk factor was relatively less in older subjects and women under 50 years old. Crude in-hospital mortality rates were 10.7%, 10.5%, 7.2%, 5.0% and 4.5% with 0, 1, 2, 3 and 4 risk factors, respectively. After adjusting for age and sex, there was an inverse association between the number of coronary risk factors and the in-hospital mortality (adjusted odds ratio [1.68; 95% confidence interval, 1.20–2.35] among individuals with 0 vs. 4 risk factors).

Conclusion

In the present study of Japanese patients with AMI, who received modern medical treatment, in-hospital mortality was inversely related to the number of coronary risk factors. To investigate the underlying reasons for these findings, further studies are needed.

背景高血压、糖尿病、血脂异常和吸烟是普通人群中冠心病的危险因素。然而，在日本急性心肌梗死(AMI)患者中，冠状动脉危险因素的数量对院内道德的影响尚不清楚。方法日本急性心肌梗死登记(JAMIR)是一个全国性的真实世界数据库。我们研究了冠状动脉危险因素数量与住院死亡率之间的关系。结果共纳入AMI患者20462例(平均年龄68.8±13.3岁;15281名男性，5181名女性)。高血压患病率随着年龄的增长而增加，而吸烟患病率随着年龄的增长而下降。糖尿病和血脂异常的患病率以中年人群最高。大多数AMI患者(76.9%)至少有1种以上冠状动脉危险因素。总体而言，老年受试者和50岁以下女性的冠状动脉危险因素数量相对较少。院内粗死亡率分别为10.7%、10.5%、7.2%、5.0%和4.5%，危险因素分别为0、1、2、3和4个。在调整年龄和性别后，冠状动脉危险因素数量与住院死亡率呈负相关(校正优势比[1.68;95%可信区间(1.20-2.35)，风险因素为0比4。结论在接受现代医学治疗的日本AMI患者中，住院死亡率与冠状动脉危险因素的数量呈负相关。为了调查这些发现的潜在原因，还需要进一步的研究。

{"title":"In-hospital morality associated with acute myocardial infarction was inversely related with the number of coronary risk factors in patients from a Japanese nation-wide real-world database","authors":"Hiroyoshi Mori , Hiroshi Suzuki , Kensaku Nishihira , Satoshi Honda , Sunao Kojima , Misa Takegami , Jun Takahashi , Tomonori Itoh , Tetsu Watanabe , Takashi Takenaka , Masaaki Ito , Morimasa Takayama , Kazuomi Kario , Tetsuya Sumiyoshi , Kazuo Kimura , Satoshi Yasuda , the JAMIR investigators","doi":"10.1016/j.ijchy.2020.100039","DOIUrl":"10.1016/j.ijchy.2020.100039","url":null,"abstract":"<div><h3>Background</h3><p>Hypertension, diabetes, dyslipidemia and smoking are established coronary risk factors for coronary heart disease in the general population. However, in Japanese patients with acute myocardial infarction (AMI), the impact of the number of coronary risk factors on in-hospital morality remains unclear.</p></div><div><h3>Methods</h3><p>The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide real-world database. We examined the association between the number of coronary risk factors and in-hospital mortality.</p></div><div><h3>Results</h3><p>Data were obtained from total of 20462 AMI patients (mean age, 68.8 ± 13.3 years old; 15281 men, 5181 women). The prevalence of hypertension increased with advancing age, while the prevalence of smoking decreased with advancing age. The prevalence of diabetes and dyslipidemia were highest in middle age. A majority (76.9%) of the patients with AMI had at least 1 of these coronary risk factors. Overall, the number of coronary risk factor was relatively less in older subjects and women under 50 years old. Crude in-hospital mortality rates were 10.7%, 10.5%, 7.2%, 5.0% and 4.5% with 0, 1, 2, 3 and 4 risk factors, respectively. After adjusting for age and sex, there was an inverse association between the number of coronary risk factors and the in-hospital mortality (adjusted odds ratio [1.68; 95% confidence interval, 1.20–2.35] among individuals with 0 vs. 4 risk factors).</p></div><div><h3>Conclusion</h3><p>In the present study of Japanese patients with AMI, who received modern medical treatment, in-hospital mortality was inversely related to the number of coronary risk factors. To investigate the underlying reasons for these findings, further studies are needed.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"6 ","pages":"Article 100039"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38821556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

Carotid intima-media thickness and metabolic syndrome in a rural population: Results from the Baependi Heart Study 农村人群的颈动脉内膜-中膜厚度和代谢综合征:来自Baependi心脏研究的结果

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100043

Glaucylara Reis Geovanini , Iguaracy Pinheiro de Sousa , Samantha Kuwada Teixeira , Miguel José Francisco Neto , Luz Marina Gómez Gómez , Guilherme Ciconelli Del Guerra , Alexandre Costa Pereira , Jose Eduardo Krieger

Background and aims

Carotid intima-media thickness (cIMT) is a strong predictor of cardiovascular events and associated with metabolic syndrome (MetS). MetS is a cluster of cardiovascular risk factors, but the association structure between specific factors and disease development is not well-established in rural populations. We described the association structure between MetS factors and cIMT in a sample from rural Brazil.

Methods

We studied 1937 participants from the Baependi Heart Study who underwent carotid ultrasound exam. We used ATP–III–2001 for MetS definition and linear mixed-effects models, adjusting by the family structure, to assess independent associations between the cardiovascular risk factors which define MetS and cIMT.

Results

The sample's mean age was 46 ± 16y, 61% female, 73% white, mean body-mass-index 26±5 kg/m², mean cIMT 0.53 ± 0.16 mm, with 35% of the sample classified with MetS. As expected, cIMT demonstrated a linear relationship with increasing age, and cIMT higher values were observed for MetS (0.58 ± 0.16 mm) compared to non-MetS (0.49 ± 0.14 mm). Considering models for cIMT with MetS and all of its factors, we found that blood pressure, glucose and obesity were independently associated with cIMT, but not HDL or triglycerides.

Conclusions

cIMT showed a linear relationship with increasing age. Blood pressure, obesity, and glucose were independently associated with cIMT, but not HDL-cholesterol or triglycerides. In a rural population, hypertension, diabetes and obesity play a more important role than lipids in determining cIMT interindividual variability.

背景和目的颈动脉内膜-中膜厚度(cIMT)是心血管事件的重要预测因子，与代谢综合征(MetS)相关。MetS是一组心血管危险因素，但在农村人群中，特定因素与疾病发展之间的关联结构尚未建立。我们在巴西农村的一个样本中描述了MetS因素和cIMT之间的关联结构。方法对1937例接受颈动脉超声检查的贝本地心脏研究参与者进行研究。我们使用ATP-III-2001定义MetS和线性混合效应模型，通过家庭结构调整，评估定义MetS和cIMT的心血管危险因素之间的独立关联。结果样本平均年龄46±16岁，女性61%，白人73%，平均体质指数26±5 kg/m2，平均cIMT 0.53±0.16 mm, 35%的样本归类为MetS。正如预期的那样，cIMT与年龄的增长呈线性关系，met组的cIMT值(0.58±0.16 mm)高于非MetS组(0.49±0.14 mm)。考虑到cIMT与met及其所有因素的模型，我们发现血压、血糖和肥胖与cIMT独立相关，但与HDL或甘油三酯无关。结论scimt与年龄增长呈线性关系。血压、肥胖和葡萄糖与cIMT独立相关，但与高密度脂蛋白胆固醇或甘油三酯无关。在农村人群中，高血压、糖尿病和肥胖在决定cIMT个体间变异性方面比血脂发挥更重要的作用。

{"title":"Carotid intima-media thickness and metabolic syndrome in a rural population: Results from the Baependi Heart Study","authors":"Glaucylara Reis Geovanini , Iguaracy Pinheiro de Sousa , Samantha Kuwada Teixeira , Miguel José Francisco Neto , Luz Marina Gómez Gómez , Guilherme Ciconelli Del Guerra , Alexandre Costa Pereira , Jose Eduardo Krieger","doi":"10.1016/j.ijchy.2020.100043","DOIUrl":"10.1016/j.ijchy.2020.100043","url":null,"abstract":"<div><h3>Background and aims</h3><p>Carotid intima-media thickness (cIMT) is a strong predictor of cardiovascular events and associated with metabolic syndrome (MetS). MetS is a cluster of cardiovascular risk factors, but the association structure between specific factors and disease development is not well-established in rural populations. We described the association structure between MetS factors and cIMT in a sample from rural Brazil.</p></div><div><h3>Methods</h3><p>We studied 1937 participants from the Baependi Heart Study who underwent carotid ultrasound exam. We used ATP–III–2001 for MetS definition and linear mixed-effects models, adjusting by the family structure, to assess independent associations between the cardiovascular risk factors which define MetS and cIMT.</p></div><div><h3>Results</h3><p>The sample's mean age was 46 ± 16y, 61% female, 73% white, mean body-mass-index 26±5 kg/m<sup>2</sup>, mean cIMT 0.53 ± 0.16 mm, with 35% of the sample classified with MetS. As expected, cIMT demonstrated a linear relationship with increasing age, and cIMT higher values were observed for MetS (0.58 ± 0.16 mm) compared to non-MetS (0.49 ± 0.14 mm). Considering models for cIMT with MetS and all of its factors, we found that blood pressure, glucose and obesity were independently associated with cIMT, but not HDL or triglycerides.</p></div><div><h3>Conclusions</h3><p>cIMT showed a linear relationship with increasing age. Blood pressure, obesity, and glucose were independently associated with cIMT, but not HDL-cholesterol or triglycerides. In a rural population, hypertension, diabetes and obesity play a more important role than lipids in determining cIMT interindividual variability.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"6 ","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38821490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Cardiovascular medications and regulation of COVID-19 receptors expression 心血管药物与COVID-19受体表达调控

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100034

Narjes Saheb Sharif-Askari , Fatemeh Saheb Sharif-Askari , Saba Al Heialy , Rifat Hamoudi , Tarek Kashour , Qutayba Hamid , Rabih Halwani

Introduction

Emerging epidemiological studies suggested that Renin–Angiotensin–Aldosterone system (RAAS) inhibitors may increase infectivity and severity of COVID-19 by modulating the expression of ACE2.

Methods

In silico analysis was conducted to compare the blood expression levels of SARS-CoV-2 entry genes between age and gender matched cohort of hypertensive patients versus control, and to determine the effect of common cardiovascular medications on the expression of COVID-19 receptors in vitro using primary human hepatocytes.

Results

The transcriptomic analysis revealed a significant increase of ACE2 and TMPRSS2 in the blood of patients with hypertension. Treatment of primary human hepatocytes with captopril, but not enalapril, significantly increased ACE2 expression. A similar pattern of ACE2 expression was found following the in vitro treatments of rat primary cells with captopril and enalapril. Telmisartan, a second class RAAS inhibitors, did not affect ACE2 levels. We have also tested other cardiovascular medications that may be used alone, or in combination with RAAS inhibitors. Some of these medications increased TMPRSS2, while others, like furosemide, significantly reduced COVID-19 receptors.

Conclusions

The increase in ACE2 expression levels could be due to chronic use of RAAS inhibitors or alternatively caused by other hypertension-related factors or presence of other comorbidities. Treatment of common co-morbidities often require chronic use of multiple medications, which may result in an additive increase in the expression of ACE2 and TMPRSS2. Our data suggest that more research is needed to determine the effect of different medications, as well as medication combinations, on COVID-19 receptors.

新出现的流行病学研究表明，肾素-血管紧张素-醛固酮系统(RAAS)抑制剂可能通过调节ACE2的表达来增加COVID-19的传染性和严重程度。方法采用硅片分析方法比较年龄和性别匹配的高血压患者与对照组血液中SARS-CoV-2进入基因的表达水平，并利用原代人肝细胞体外检测常用心血管药物对COVID-19受体表达的影响。结果转录组学分析显示高血压患者血液中ACE2和TMPRSS2显著升高。用卡托普利而不是依那普利治疗原代人肝细胞可显著增加ACE2的表达。在体外用卡托普利和依那普利处理大鼠原代细胞后，发现了类似的ACE2表达模式。替米沙坦，第二类RAAS抑制剂，不影响ACE2水平。我们还测试了其他可以单独使用或与RAAS抑制剂联合使用的心血管药物。其中一些药物增加了TMPRSS2，而其他药物，如速尿，显著降低了COVID-19受体。结论ACE2表达水平升高可能与长期使用RAAS抑制剂或其他高血压相关因素或存在其他合并症有关。常见合并症的治疗通常需要长期使用多种药物，这可能导致ACE2和TMPRSS2表达的增加。我们的数据表明，需要更多的研究来确定不同药物以及药物组合对COVID-19受体的影响。

{"title":"Cardiovascular medications and regulation of COVID-19 receptors expression","authors":"Narjes Saheb Sharif-Askari , Fatemeh Saheb Sharif-Askari , Saba Al Heialy , Rifat Hamoudi , Tarek Kashour , Qutayba Hamid , Rabih Halwani","doi":"10.1016/j.ijchy.2020.100034","DOIUrl":"10.1016/j.ijchy.2020.100034","url":null,"abstract":"<div><h3>Introduction</h3><p>Emerging epidemiological studies suggested that Renin–Angiotensin–Aldosterone system (RAAS) inhibitors may increase infectivity and severity of COVID-19 by modulating the expression of ACE2.</p></div><div><h3>Methods</h3><p>In silico analysis was conducted to compare the blood expression levels of SARS-CoV-2 entry genes between age and gender matched cohort of hypertensive patients versus control, and to determine the effect of common cardiovascular medications on the expression of COVID-19 receptors in vitro using primary human hepatocytes.</p></div><div><h3>Results</h3><p>The transcriptomic analysis revealed a significant increase of ACE2 and TMPRSS2 in the blood of patients with hypertension. Treatment of primary human hepatocytes with captopril, but not enalapril, significantly increased ACE2 expression. A similar pattern of ACE2 expression was found following the in vitro treatments of rat primary cells with captopril and enalapril. Telmisartan, a second class RAAS inhibitors, did not affect ACE2 levels. We have also tested other cardiovascular medications that may be used alone, or in combination with RAAS inhibitors. Some of these medications increased TMPRSS2, while others, like furosemide, significantly reduced COVID-19 receptors.</p></div><div><h3>Conclusions</h3><p>The increase in ACE2 expression levels could be due to chronic use of RAAS inhibitors or alternatively caused by other hypertension-related factors or presence of other comorbidities. Treatment of common co-morbidities often require chronic use of multiple medications, which may result in an additive increase in the expression of ACE2 and TMPRSS2. Our data suggest that more research is needed to determine the effect of different medications, as well as medication combinations, on COVID-19 receptors.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"6 ","pages":"Article 100034"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38821554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

Low serum vitamin C correlates with an increased risk of peripheral arterial disease in current smokers: Results from NHANES 2003–2004 低血清维生素C与当前吸烟者外周动脉疾病风险增加相关:NHANES 2003-2004的结果

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100037

Guangzhi Cong , Ru Yan , Ulka Sachdev

Background

Cigarette smoking is one of the most critical risk factors for peripheral arterial disease (PAD) and inversely correlated Vitamin C. Here we determine whether serum vitamin C correlates with the risk of PAD, especially among current smokers.

Methods

A cross-sectional analysis of 2383 individuals ≥40 y was performed from the U.S. National Health and Nutrition Examination Survey (NHANES 2003–2004), including measurement of ankle-brachial index (ABI), smoking status and serum vitamin C. We examined the interactions between plasma vitamin C and exposure to smoking on the risk of PAD.

Results

912 (38.2%) were current smokers while 207 participants were diagnosed with PAD based on ABI(ABI≤0.9). Current smokers in the lowest vitamin C quartile had the highest prevalence of PAD (14.1%) compared to other quartiles. However, this trend was not significant in nonsmokers. Current smokers in the lowest quartile had a 2.32-fold risk (95% CI, 1.03–5.32; P = 0.04) for PAD after weighted adjustment for potential confounders, including vitamin D and C-reactive protein. In contrast, non-smokers did not have a differing risk of PAD as a function of vitamin C (P for interaction = 0.019).

Conclusions

As an anti-oxidant and anti-inflammatory, low serum vitamin C appears to associates with the risk of PAD in smokers. A relationship between PAD and vitamin C in non-current smokers is not apparent. Modulating vitamin C in current smokers may help mitigate the risk of PAD and should be a target of mechanistic study.

吸烟是外周动脉疾病(PAD)最重要的危险因素之一，与维生素C呈负相关。在这里，我们确定血清维生素C是否与PAD的风险相关，特别是在当前吸烟者中。方法对来自美国国家健康与营养调查(NHANES 2003-2004)的2383名年龄≥40岁的个体进行横断面分析，包括测量踝-肱指数(ABI)、吸烟状况和血清维生素C，研究血浆维生素C与吸烟暴露对PAD风险的相互作用。结果912人(38.2%)为当前吸烟者，207人根据ABI(ABI≤0.9)诊断为PAD。与其他四分位数相比，维生素C含量最低的四分位数中当前吸烟者的PAD患病率最高(14.1%)。然而，这种趋势在不吸烟者中并不明显。最低四分位数中当前吸烟者的风险为2.32倍(95% CI, 1.03-5.32;P = 0.04)，对潜在混杂因素(包括维生素D和c反应蛋白)进行加权调整。相比之下，不吸烟者患PAD的风险与维生素C的作用没有差异(相互作用P = 0.019)。结论低血清维生素C具有抗氧化和抗炎作用，与吸烟者患PAD的风险有关。在非吸烟者中，PAD与维生素C之间的关系并不明显。在当前吸烟者中调节维生素C可能有助于降低PAD的风险，并应成为机制研究的目标。

{"title":"Low serum vitamin C correlates with an increased risk of peripheral arterial disease in current smokers: Results from NHANES 2003–2004","authors":"Guangzhi Cong , Ru Yan , Ulka Sachdev","doi":"10.1016/j.ijchy.2020.100037","DOIUrl":"10.1016/j.ijchy.2020.100037","url":null,"abstract":"<div><h3>Background</h3><p>Cigarette smoking is one of the most critical risk factors for peripheral arterial disease (PAD) and inversely correlated Vitamin C. Here we determine whether serum vitamin C correlates with the risk of PAD, especially among current smokers.</p></div><div><h3>Methods</h3><p>A cross-sectional analysis of 2383 individuals ≥40 y was performed from the U.S. National Health and Nutrition Examination Survey (NHANES 2003–2004), including measurement of ankle-brachial index (ABI), smoking status and serum vitamin C. We examined the interactions between plasma vitamin C and exposure to smoking on the risk of PAD.</p></div><div><h3>Results</h3><p>912 (38.2%) were current smokers while 207 participants were diagnosed with PAD based on ABI(ABI≤0.9). Current smokers in the lowest vitamin C quartile had the highest prevalence of PAD (14.1%) compared to other quartiles. However, this trend was not significant in nonsmokers. Current smokers in the lowest quartile had a 2.32-fold risk (95% CI, 1.03–5.32; P = 0.04) for PAD after weighted adjustment for potential confounders, including vitamin D and C-reactive protein. In contrast, non-smokers did not have a differing risk of PAD as a function of vitamin C (P for interaction = 0.019).</p></div><div><h3>Conclusions</h3><p>As an anti-oxidant and anti-inflammatory, low serum vitamin C appears to associates with the risk of PAD in smokers. A relationship between PAD and vitamin C in non-current smokers is not apparent. Modulating vitamin C in current smokers may help mitigate the risk of PAD and should be a target of mechanistic study.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"6 ","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38769849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Trends in ambulatory blood pressure monitoring use for confirmation or monitoring of hypertension and resistant hypertension among the commercially insured in the U.S., 2008–2017 2008-2017年美国商业参保人群中用于确认或监测高血压和顽固性高血压的动态血压监测趋势

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100033

Raj Desai , Haesuk Park , Eric A. Dietrich , Steven M. Smith

Background

Ambulatory blood pressure monitoring (ABPM) has been increasingly recommended for diagnosis confirmation and monitoring in patients with new-onset hypertension and apparent treatment-resistant hypertension (aTRH). We assessed insurance claims submitted for ABPM among a nationally representative sample of commercially insured U.S. patients.

Methods

We conducted a retrospective cross-sectional analysis using the IBM MarketScan® commercial claims database from January 2008–December 2017, including 2 populations: those with incident treated hypertension (ITH; first antihypertensive filled) or aTRH (first overlapping use of 4 antihypertensive agents). We identified ABPM claims filed within 6 months before to 6 months after the qualifying antihypertensive fill and determined prevalence of ABPM use overall and by year in each population.

Results

In total, 2,820,303 patients met ITH criteria and 298,049 met aTRH criteria. Of those with ITH, 7650 (2.7 per 1000 persons) had ≥1 ABPM claim submitted, and annual ABPM prevalence ranged from 2.0 to 3.7 per 1000 persons, increasing over time (P_trend<0.0001). Among those with aTRH, 630 (2.1 per 1000 persons) had ≥1 ABPM claim submitted, and annual ABPM prevalence ranged from 1.6 to 2.7 per 1000 persons, decreasing over time (P_trend = 0.054). Timing of ABPM claims suggested they were used primarily for diagnosis confirmation in ITH, and more evenly distributed between diagnosis confirmation and monitoring in aTRH.

Conclusions

Despite guideline recommendations for more widescale use, ABPM appears to be used rarely in the U.S., with fewer than 0.5% of commercially insured patients with newly treated hypertension or aTRH having ABPM claims submitted to their insurance.

背景:动态血压监测(ABPM)已越来越多地被推荐用于新发高血压和明显治疗难治性高血压(aTRH)患者的诊断确认和监测。我们评估了在美国商业保险患者的全国代表性样本中提交的ABPM保险索赔。方法采用2008年1月至2017年12月的IBM MarketScan®商业索赔数据库进行回顾性横断面分析，包括2个人群:突发治疗高血压患者(ITH;第一次降压药填充)或aTRH(第一次重叠使用4种降压药)。我们确定了在降压药合格前6个月至降压药合格后6个月内提交的ABPM申请，并确定了每个人群中ABPM使用的总体患病率和年患病率。结果共有2820303例患者符合ITH标准，298049例患者符合aTRH标准。在ITH患者中，7650人(每1000人中有2.7人)提交了≥1份ABPM索赔，ABPM的年患病率从每1000人中2.0到3.7不等，随着时间的推移而增加(Ptrend<0.0001)。在aTRH患者中，630人(每1000人中2.1人)有≥1次ABPM索赔，ABPM年患病率为1.6 - 2.7 / 1000人，随着时间的推移呈下降趋势(p趋势= 0.054)。ABPM声明的时间提示它们主要用于ITH的诊断确认，在aTRH的诊断确认和监测之间分布更均匀。结论:尽管指南建议更广泛地使用ABPM，但ABPM在美国似乎很少使用，只有不到0.5%的商业保险患者新治疗的高血压或aTRH向其保险提交了ABPM索赔。

{"title":"Trends in ambulatory blood pressure monitoring use for confirmation or monitoring of hypertension and resistant hypertension among the commercially insured in the U.S., 2008–2017","authors":"Raj Desai , Haesuk Park , Eric A. Dietrich , Steven M. Smith","doi":"10.1016/j.ijchy.2020.100033","DOIUrl":"10.1016/j.ijchy.2020.100033","url":null,"abstract":"<div><h3>Background</h3><p>Ambulatory blood pressure monitoring (ABPM) has been increasingly recommended for diagnosis confirmation and monitoring in patients with new-onset hypertension and apparent treatment-resistant hypertension (aTRH). We assessed insurance claims submitted for ABPM among a nationally representative sample of commercially insured U.S. patients.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cross-sectional analysis using the IBM MarketScan® commercial claims database from January 2008–December 2017, including 2 populations: those with incident treated hypertension (ITH; first antihypertensive filled) or aTRH (first overlapping use of 4 antihypertensive agents). We identified ABPM claims filed within 6 months before to 6 months after the qualifying antihypertensive fill and determined prevalence of ABPM use overall and by year in each population.</p></div><div><h3>Results</h3><p>In total, 2,820,303 patients met ITH criteria and 298,049 met aTRH criteria. Of those with ITH, 7650 (2.7 per 1000 persons) had ≥1 ABPM claim submitted, and annual ABPM prevalence ranged from 2.0 to 3.7 per 1000 persons, increasing over time (<em>P</em><sub>trend</sub><0.0001). Among those with aTRH, 630 (2.1 per 1000 persons) had ≥1 ABPM claim submitted, and annual ABPM prevalence ranged from 1.6 to 2.7 per 1000 persons, decreasing over time (<em>P</em><sub>trend</sub> = 0.054). Timing of ABPM claims suggested they were used primarily for diagnosis confirmation in ITH, and more evenly distributed between diagnosis confirmation and monitoring in aTRH.</p></div><div><h3>Conclusions</h3><p>Despite guideline recommendations for more widescale use, ABPM appears to be used rarely in the U.S., with fewer than 0.5% of commercially insured patients with newly treated hypertension or aTRH having ABPM claims submitted to their insurance.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"6 ","pages":"Article 100033"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38821552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 7

Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression 老年高血压患者的血压控制:荟萃分析和荟萃回归的系统综述

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100040

Biggie Baffour-Awuah , Gudrun Dieberg , Melissa J. Pearson , Neil A. Smart

Background

Managing blood pressure reduces CVD risk, but optimal treatment thresholds remain unclear as it is a balancing act to avoid hypotension-related adverse events.

Objectives

This systematic review, meta-analysis and meta-regression evaluated the benefits of intensive BP treatment in hypertensive older adults.

Methods

We systematically searched PubMed, MEDLINE, EMBASE, and the Cochrane Library of Controlled Trials until January 31, 2020. Studies comparing different BP treatments/targets and/or active BP against placebo treatment, with a minimum 12 months follow-up, were included. Risk ratios (RR) and 95% CIs were calculated using a random effects model. The primary outcome was RR of major cardiovascular events (MCEs); secondary outcomes included myocardial infarction (MI), stroke, heart failure (HF), cardiovascular (CV) mortality, and all-cause mortality.

Results

We included 16 studies totaling 65,890 hypertensive participants (average age 69.4 years) with a follow-up period from 1.8 to 4.9 years. Intensive BP treatment significantly reduced the relative risk of MCEs by 26% (RR:0.74, 95%CI 0.64–0.86, p = 0.000; I² = 79.71%). RR of MI significantly reduced by 13% (RR:0.87, 95%CI 0.76–1.00, p = 0.052; I² = 0.00%), stroke by 28% (RR:0.72, 95%CI 0.64–0.82, p = 0.000; I² = 32.45%), HF by 47% (RR:0.53, 95% CI 0.43–0.66, p = 0.000; I² = 1.23%), and CV mortality by 24% (RR:0.76, 95%CI 0.66–0.89, p = 0.000; I² = 39.74%). All-cause mortality reduced by 17% (RR:0.83, 95%CI 0.73–0.93, p = 0.001; I² = 53.09%). Of the participants - 61% reached BP targets and 5% withdrew; with 1 hypotension-related event per 780 people treated.

Conclusions

Lower BP treatment targets are optimal for CV protection, effective, well-tolerated and safe, and support the latest hypertension guidelines.

控制血压可降低心血管疾病风险，但最佳治疗阈值仍不清楚，因为它是避免低血压相关不良事件的平衡行为。目的:本系统综述、荟萃分析和荟萃回归评估强化血压治疗对老年人高血压的益处。方法系统检索PubMed、MEDLINE、EMBASE和Cochrane对照试验库，检索截止日期为2020年1月31日。比较不同的BP治疗/靶点和/或活性BP与安慰剂治疗的研究，至少随访12个月。采用随机效应模型计算风险比(RR)和95% ci。主要终点为主要心血管事件(MCEs)的RR;次要结局包括心肌梗死(MI)、中风、心力衰竭(HF)、心血管(CV)死亡率和全因死亡率。结果我们纳入了16项研究，共65,890名高血压患者(平均年龄69.4岁)，随访时间为1.8至4.9年。强化降压治疗可显著降低mce的相对风险26% (RR:0.74, 95%CI 0.64-0.86, p = 0.000;i2 = 79.71%)。MI的RR显著降低13% (RR:0.87, 95%CI 0.76-1.00, p = 0.052;I2 = 0.00%), 28%的中风(RR: 0.72, 95% ci 0.64 - -0.82, p = 0.000;I2 = 32.45%),高频47% (RR: 0.53, 95% CI 0.43 - -0.66, p = 0.000;I2 = 1.23%)， CV死亡率降低24% (RR:0.76, 95%CI 0.66-0.89, p = 0.000;i2 = 39.74%)。全因死亡率降低17% (RR:0.83, 95%CI 0.73-0.93, p = 0.001;i2 = 53.09%)。在参与者中，61%达到了BP目标，5%退出;每780名接受治疗的患者中有1例低血压相关事件。结论慢速降压治疗目标对心血管保护效果最佳，有效、耐受性好、安全，支持最新高血压指南。

{"title":"Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression","authors":"Biggie Baffour-Awuah , Gudrun Dieberg , Melissa J. Pearson , Neil A. Smart","doi":"10.1016/j.ijchy.2020.100040","DOIUrl":"10.1016/j.ijchy.2020.100040","url":null,"abstract":"<div><h3>Background</h3><p>Managing blood pressure reduces CVD risk, but optimal treatment thresholds remain unclear as it is a balancing act to avoid hypotension-related adverse events.</p></div><div><h3>Objectives</h3><p>This systematic review, meta-analysis and meta-regression evaluated the benefits of intensive BP treatment in hypertensive older adults.</p></div><div><h3>Methods</h3><p>We systematically searched PubMed, MEDLINE, EMBASE, and the Cochrane Library of Controlled Trials until January 31, 2020. Studies comparing different BP treatments/targets and/or active BP against placebo treatment, with a minimum 12 months follow-up, were included. Risk ratios (RR) and 95% CIs were calculated using a random effects model. The primary outcome was RR of major cardiovascular events (MCEs); secondary outcomes included myocardial infarction (MI), stroke, heart failure (HF), cardiovascular (CV) mortality, and all-cause mortality.</p></div><div><h3>Results</h3><p>We included 16 studies totaling 65,890 hypertensive participants (average age 69.4 years) with a follow-up period from 1.8 to 4.9 years. Intensive BP treatment significantly reduced the relative risk of MCEs by 26% (RR:0.74, 95%CI 0.64–0.86, <em>p</em> = 0.000; <em>I</em><sup>2</sup> = 79.71%). RR of MI significantly reduced by 13% (RR:0.87, 95%CI 0.76–1.00, <em>p</em> = 0.052; <em>I</em><sup>2</sup> = 0.00%), stroke by 28% (RR:0.72, 95%CI 0.64–0.82, <em>p</em> = 0.000; <em>I</em><sup><em>2</em></sup> = 32.45%), HF by 47% (RR:0.53, 95% CI 0.43–0.66, <em>p</em> = 0.000; <em>I</em><sup>2</sup> = 1.23%), and CV mortality by 24% (RR:0.76, 95%CI 0.66–0.89, <em>p</em> = 0.000; <em>I</em><sup>2</sup> = 39.74%). All-cause mortality reduced by 17% (RR:0.83, 95%CI 0.73–0.93, <em>p</em> = 0.001; <em>I</em><sup>2</sup> = 53.09%). Of the participants - 61% reached BP targets and 5% withdrew; with 1 hypotension-related event per 780 people treated.</p></div><div><h3>Conclusions</h3><p>Lower BP treatment targets are optimal for CV protection, effective, well-tolerated and safe, and support the latest hypertension guidelines.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"6 ","pages":"Article 100040"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38821557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

High milk consumption is associated with carotid atherosclerosis in middle and old-aged Chinese 中国中老年人群高牛奶摄入量与颈动脉粥样硬化相关

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-06-01 DOI: 10.1016/j.ijchy.2020.100031

Miao He , Zaogeng Guo , Zuxun Lu , Sheng Wei , Zhihong Wang

Background

Carotid atherosclerosis (CA) can reflect atherosclerotic status of systemic vessels, and is associated with ischemic stroke and cognitive impairment. Milk consumption is growing in China, and data are limited on the association between milk and CA risk.

Methods

Participants aged ≥40 years in China National Stroke Prevention Project were recruited for carotid ultrasound examination, and those with carotid endarterectomy, carotid stenting stroke or coronary heart disease were excluded. Participants were defined as having CA when intima–media thickness (IMT) ≥1 mm or plaques were detected by ultrasonography. For milk consumption, though contents were not analyzed, people were divided into high consumption (≥200 ml/day and ≥5 day/week) and low consumption (occasional or never) groups. Multivariate logistics regression analyses were done in both full and propensity score-matched population to identify the association between milk consumption and CA.

Results

84880 participants were included in the final analysis. After being adjusted by age, gender, living location, smoking habits, drinking habits, physical activity, obesity, hypertension, diabetes, and dyslipidemia, high milk consumption is associated with CA in both full population (odds ratio [OR] = 1.26, 95% confidence interval [CI] 1.19–1.33) and propensity score-matched population (OR = 1.25, 95%CI 1.17–1.34). High milk consumption is also a risk factor for IMT thickening (OR = 1.15, 95%CI 1.08–1.23), carotid plaque formation (OR = 1.17, 95%CI 1.09–1.25) and carotid stenosis over 50% (OR = 1.52, 95%CI 1.10–2.14) in the propensity score-matched population.

Conclusions

High milk consumption is related to CA in middle and old-aged Chinese population. More cautious advice on milk intake should be given in this population for prevention of atherosclerosis.

背景颈动脉粥样硬化(CA)可以反映全身血管的动脉粥样硬化状态，并与缺血性卒中和认知功能障碍有关。中国的牛奶消费量正在增长，牛奶与CA风险之间的关联数据有限。方法招募年龄≥40岁的中国卒中预防项目参与者进行颈动脉超声检查，排除颈动脉内膜切除术、颈动脉支架置入术卒中、冠心病患者。当内膜-中膜厚度(IMT)≥1mm或超声检测到斑块时，参与者被定义为CA。对于牛奶的摄入量，虽然没有分析含量，但人们被分为高摄入量(≥200毫升/天和≥5天/周)和低摄入量(偶尔或从不)组。对完全人群和倾向得分匹配人群进行多变量logistic回归分析，以确定牛奶消费与ca之间的关系。结果84880名参与者被纳入最终分析。在调整了年龄、性别、居住地点、吸烟习惯、饮酒习惯、体育活动、肥胖、高血压、糖尿病和血脂异常等因素后，高牛奶摄入量与CA相关，在整个人群(优势比[OR] = 1.26, 95%置信区间[CI] 1.19-1.33)和倾向评分匹配人群(OR = 1.25, 95%CI 1.17-1.34)中都是如此。在倾向评分匹配的人群中，高牛奶摄入量也是IMT增厚(OR = 1.15, 95%CI 1.08-1.23)、颈动脉斑块形成(OR = 1.17, 95%CI 1.09-1.25)和颈动脉狭窄超过50% (OR = 1.52, 95%CI 1.10-2.14)的危险因素。结论高牛奶摄入量与中国中老年人群CA发病有关。为了预防动脉粥样硬化，应该对这类人群的牛奶摄入量提出更谨慎的建议。

{"title":"High milk consumption is associated with carotid atherosclerosis in middle and old-aged Chinese","authors":"Miao He , Zaogeng Guo , Zuxun Lu , Sheng Wei , Zhihong Wang","doi":"10.1016/j.ijchy.2020.100031","DOIUrl":"10.1016/j.ijchy.2020.100031","url":null,"abstract":"<div><h3>Background</h3><p>Carotid atherosclerosis (CA) can reflect atherosclerotic status of systemic vessels, and is associated with ischemic stroke and cognitive impairment. Milk consumption is growing in China, and data are limited on the association between milk and CA risk.</p></div><div><h3>Methods</h3><p>Participants aged ≥40 years in China National Stroke Prevention Project were recruited for carotid ultrasound examination, and those with carotid endarterectomy, carotid stenting stroke or coronary heart disease were excluded. Participants were defined as having CA when intima–media thickness (IMT) ≥1 mm or plaques were detected by ultrasonography. For milk consumption, though contents were not analyzed, people were divided into high consumption (≥200 ml/day and ≥5 day/week) and low consumption (occasional or never) groups. Multivariate logistics regression analyses were done in both full and propensity score-matched population to identify the association between milk consumption and CA.</p></div><div><h3>Results</h3><p>84880 participants were included in the final analysis. After being adjusted by age, gender, living location, smoking habits, drinking habits, physical activity, obesity, hypertension, diabetes, and dyslipidemia, high milk consumption is associated with CA in both full population (odds ratio [OR] = 1.26, 95% confidence interval [CI] 1.19–1.33) and propensity score-matched population (OR = 1.25, 95%CI 1.17–1.34). High milk consumption is also a risk factor for IMT thickening (OR = 1.15, 95%CI 1.08–1.23), carotid plaque formation (OR = 1.17, 95%CI 1.09–1.25) and carotid stenosis over 50% (OR = 1.52, 95%CI 1.10–2.14) in the propensity score-matched population.</p></div><div><h3>Conclusions</h3><p>High milk consumption is related to CA in middle and old-aged Chinese population. More cautious advice on milk intake should be given in this population for prevention of atherosclerosis.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"5 ","pages":"Article 100031"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38821099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism 2020年意大利动脉高血压学会(SIIA)原发性醛固酮增多症管理实用指南

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-06-01 DOI: 10.1016/j.ijchy.2020.100029

Gian Paolo Rossi , Valeria Bisogni , Alessandra Violet Bacca , Anna Belfiore , Maurizio Cesari , Antonio Concistrè , Rita Del Pinto , Bruno Fabris , Francesco Fallo , Cristiano Fava , Claudio Ferri , Gilberta Giacchetti , Guido Grassi , Claudio Letizia , Mauro Maccario , Francesca Mallamaci , Giuseppe Maiolino , Dario Manfellotto , Pietro Minuz , Silvia Monticone , Teresa Maria Seccia

Background and aim

Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensionlogists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism.

Methods

To identify the most relevant studies, the authors utilized a systematic literature review in international databases by applying the PICO strategy, and then they were required to make use of only those meeting predefined quality criteria. For studies of diagnostic tests, only those that fulfilled the Standards for Reporting of Diagnostic Accuracy recommendations were considered.

Results

Each section was jointly prepared by at least two co-authors, who provided Class of Recommendation and Level of Evidence following the American Heart Association methodology. The guidelines were sponsored by the Italian Society of Arterial Hypertension and underwent two rounds of revision, eventually reexamined by an External Committee. They were presented and thoroughly discussed in two face-to-face meetings with all co-authors and then presented on occasion of the 36th Italian Society of Arterial Hypertension meeting in order to gather further feedbacks by all members. The text amended according to these feedbacks was subjected to a further peer review.

Conclusions

After this process, substantial updated information was generated, which could simplify the diagnosis of primary aldosteronism and assist practicing physicians in optimizing treatment and follow-up of patients with one of the most common curable causes of arterial hypertension.

背景和目的考虑到近五年来产生的新知识的数量，我们聚集了一组经验丰富的高血压学家，为原发性醛固酮增多症的管理提供最新的临床实践指南。方法为了确定最相关的研究，作者采用PICO策略在国际数据库中进行了系统的文献综述，然后他们被要求只使用那些符合预定义质量标准的研究。对于诊断测试的研究，只考虑那些符合诊断准确性报告标准建议的测试。结果每个章节由至少两位共同作者共同编写，他们按照美国心脏协会的方法提供推荐等级和证据水平。该指南由意大利动脉高血压协会发起，经过两轮修订，最终由外部委员会重新审查。在与所有共同作者的两次面对面会议中，他们被提出并进行了彻底的讨论，然后在第36届意大利动脉高血压学会会议上提出，以收集所有成员的进一步反馈。根据这些反馈修改的案文经过了进一步的同行审查。结论在此过程中，产生了大量更新的信息，可以简化原发性醛固酮增多症的诊断，并协助执业医生优化治疗和随访患者最常见的可治愈的原因之一的动脉高血压。

{"title":"The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism","authors":"Gian Paolo Rossi , Valeria Bisogni , Alessandra Violet Bacca , Anna Belfiore , Maurizio Cesari , Antonio Concistrè , Rita Del Pinto , Bruno Fabris , Francesco Fallo , Cristiano Fava , Claudio Ferri , Gilberta Giacchetti , Guido Grassi , Claudio Letizia , Mauro Maccario , Francesca Mallamaci , Giuseppe Maiolino , Dario Manfellotto , Pietro Minuz , Silvia Monticone , Teresa Maria Seccia","doi":"10.1016/j.ijchy.2020.100029","DOIUrl":"10.1016/j.ijchy.2020.100029","url":null,"abstract":"<div><h3>Background and aim</h3><p>Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensionlogists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism.</p></div><div><h3>Methods</h3><p>To identify the most relevant studies, the authors utilized a systematic literature review in international databases by applying the PICO strategy, and then they were required to make use of only those meeting predefined quality criteria. For studies of diagnostic tests, only those that fulfilled the Standards for Reporting of Diagnostic Accuracy recommendations were considered.</p></div><div><h3>Results</h3><p>Each section was jointly prepared by at least two co-authors, who provided Class of Recommendation and Level of Evidence following the American Heart Association methodology. The guidelines were sponsored by the Italian Society of Arterial Hypertension and underwent two rounds of revision, eventually reexamined by an External Committee. They were presented and thoroughly discussed in two face-to-face meetings with all co-authors and then presented on occasion of the 36th Italian Society of Arterial Hypertension meeting in order to gather further feedbacks by all members. The text amended according to these feedbacks was subjected to a further peer review.</p></div><div><h3>Conclusions</h3><p>After this process, substantial updated information was generated, which could simplify the diagnosis of primary aldosteronism and assist practicing physicians in optimizing treatment and follow-up of patients with one of the most common curable causes of arterial hypertension.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"5 ","pages":"Article 100029"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38821553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 60

Influence of height on blood pressure and hypertension among Bangladeshi adults 身高对孟加拉国成年人血压和高血压的影响

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-06-01 DOI: 10.1016/j.ijchy.2020.100028

Md. Tauhidul Islam , Md. Shahjahan Siraj , Md. Zakiul Hassan , Mohammad Nayem , Dipankar Chandra Nag , Md. Aminul Islam , Rafiqul Islam , Tapas Mazumder , Sohel Reza Choudhury , Ali Tanweer Siddiquee

Background

Recent studies have reported that height is inversely associated with blood pressure and hypertension. However, there is lack of comprehensive findings from Bangladesh in this regard.

Objective

The purpose of this study was to explore the association between height and blood pressure in a Bangladeshi population.

Setting

Rural and urban sites from seven divisions of Bangladesh.

Participants

Participants were 7932 males and females (aged ≥35 years) evaluated in the 2011 Bangladesh Demographic Health Survey. Participants (n = 7647) who had complete height, weight, systolic and diastolic blood pressure (SBP and DBP) measurements and non-missing medication history, were included in the analysis.

Methods

Hypertension was defined as an SBP over 140 mmHg or/and a DBP over 90 mmHg, or current use of antihypertensive medication. Difference between SBP and DBP was calculated to get pulse pressure (PP). Multivariate linear and logistic regression models were used.

Results

PP decreased linearly with increasing height among males (−0.11, P < 0.05) and females (−0.19, P < 0.05) after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. SBP decreased linearly with increasing height among only females (−0.14, P < 0.05), after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. No association was found between quartiles of height and prevalence of hypertension.

Conclusions

Height was found to be inversely associated with pulse pressure in both sexes. Studies with longitudinal design are needed to investigate the association between shortness with blood pressure and hypertension.

最近的研究表明，身高与血压和高血压呈负相关。然而，孟加拉国在这方面缺乏全面的调查结果。目的本研究的目的是探讨孟加拉国人群的身高和血压之间的关系。背景:孟加拉国七个省的农村和城市遗址。参与者为2011年孟加拉国人口健康调查评估的7932名男性和女性(年龄≥35岁)。参与者(n = 7647)具有完整的身高、体重、收缩压和舒张压(收缩压和舒张压)测量和无遗漏用药史，纳入分析。方法高血压定义为收缩压超过140 mmHg或/和舒张压超过90 mmHg，或目前使用抗高血压药物。计算收缩压与舒张压之差，得到脉压(PP)。采用多元线性和逻辑回归模型。结果男性spp随身高增加呈线性下降(- 0.11,P <0.05)和女性(- 0.19,P <0.05)，在调整了年龄、BMI、居住地区、职业类型、财富指数和最高教育程度后。仅女性的收缩压随身高的增加呈线性下降(- 0.14,P <0.05)，在调整了年龄、BMI、居住地区、职业类型、财富指数和最高教育程度后。身高四分位数与高血压患病率之间没有关联。结论在两性中，身高与脉压呈负相关。需要纵向设计的研究来调查矮个子与血压和高血压之间的关系。

{"title":"Influence of height on blood pressure and hypertension among Bangladeshi adults","authors":"Md. Tauhidul Islam , Md. Shahjahan Siraj , Md. Zakiul Hassan , Mohammad Nayem , Dipankar Chandra Nag , Md. Aminul Islam , Rafiqul Islam , Tapas Mazumder , Sohel Reza Choudhury , Ali Tanweer Siddiquee","doi":"10.1016/j.ijchy.2020.100028","DOIUrl":"10.1016/j.ijchy.2020.100028","url":null,"abstract":"<div><h3>Background</h3><p>Recent studies have reported that height is inversely associated with blood pressure and hypertension. However, there is lack of comprehensive findings from Bangladesh in this regard.</p></div><div><h3>Objective</h3><p>The purpose of this study was to explore the association between height and blood pressure in a Bangladeshi population.</p></div><div><h3>Setting</h3><p>Rural and urban sites from seven divisions of Bangladesh.</p></div><div><h3>Participants</h3><p>Participants were 7932 males and females (aged ≥35 years) evaluated in the 2011 Bangladesh Demographic Health Survey. Participants (n = 7647) who had complete height, weight, systolic and diastolic blood pressure (SBP and DBP) measurements and non-missing medication history, were included in the analysis.</p></div><div><h3>Methods</h3><p>Hypertension was defined as an SBP over 140 mmHg or/and a DBP over 90 mmHg, or current use of antihypertensive medication. Difference between SBP and DBP was calculated to get pulse pressure (PP). Multivariate linear and logistic regression models were used.</p></div><div><h3>Results</h3><p>PP decreased linearly with increasing height among males (−0.11, P < 0.05) and females (−0.19, P < 0.05) after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. SBP decreased linearly with increasing height among only females (−0.14, P < 0.05), after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. No association was found between quartiles of height and prevalence of hypertension.</p></div><div><h3>Conclusions</h3><p>Height was found to be inversely associated with pulse pressure in both sexes. Studies with longitudinal design are needed to investigate the association between shortness with blood pressure and hypertension.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"5 ","pages":"Article 100028"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38821097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Paradigm shift to disequilibrium in the genesis of orthostatic intolerance in patients with myalgic encephalomyelitis and chronic fatigue syndrome 在肌痛性脑脊髓炎和慢性疲劳综合征患者的直立不耐受的成因范式转移到不平衡

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-06-01 DOI: 10.1016/j.ijchy.2020.100032

Kunihisa Miwa , Yukichi Inoue

Background

Orthostatic intolerance (OI) markedly impairs activities of daily living in patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome. OI is surmised to be a cardiovascular symptom correlated with cerebral hypo-perfusion and exaggerated sympathetic activation. Postural instability or disequilibrium may be part of the etiology of OI.

Methods

The study comprised 72 patients with ME (18 men, 54 women; mean age, 37 ± 10 years) who underwent neurological examinations and the 10 min standing test. We quantified disequilibrium (instability upon standing with feet together and eyes shut), ability to complete the 10 min standing test, and postural orthostatic tachycardia (POT) during the test.

Results

Disequilibrium was detected in 23/72 (32%) patients and POT in 16 (22%). Nineteen (26%) patients failed to complete the 10 min standing test; disequilibrium was significantly more common in the 19- patient subgroup than in the 53-patient test-completing subgroup (89% vs. 11%, p < 0.01). However, the rate of POT was not different between the groups (21% vs. 23%, p = 1.00). Compared with the 49 (68%) patients without disequilibrium, the 23 (32%) patients with disequilibrium were significantly more likely to have failed to complete the test (74% vs. 4%, p < 0.01). The rate of POT was comparable between the groups (23% vs. 22%, p = 1.00). Among patients with disequilibrium who failed to complete the 10 min standing test and had a previous record, 6/8 had completed the test 6–24 months earlier when all six had reported no disequilibrium.

Conclusion

Disequilibrium should be recognized as an important cause of OI in patients with ME.

背景:静坐不耐受(OI)明显损害肌痛性脑脊髓炎(ME)或慢性疲劳综合征患者的日常生活活动。OI可能是一种与大脑低灌注和交感神经激活过度相关的心血管症状。体位不稳定或不平衡可能是成骨不全的部分病因。方法本研究纳入72例ME患者(男性18例，女性54例;平均年龄(37±10岁)，接受神经学检查和10分钟站立试验。我们量化了不平衡(两脚并拢、闭眼站立时的不稳定性)、完成10分钟站立测试的能力以及测试期间的体位性站立性心动过速(POT)。结果72例患者中有23例(32%)存在不平衡，16例(22%)存在POT。19例(26%)患者未能完成10分钟站立试验;不平衡在19例患者亚组中比在53例患者完成测试亚组中更为常见(89%对11%，p <0.01)。然而，两组间POT发生率无差异(21% vs. 23%， p = 1.00)。与没有失衡的49例(68%)患者相比，有失衡的23例(32%)患者更有可能无法完成测试(74% vs. 4%， p <0.01)。两组间POT发生率具有可比性(23% vs 22%， p = 1.00)。在未能完成10分钟站立测试且有先前记录的不平衡患者中，6/8在6-24个月前完成了测试，而所有6名患者均未报告不平衡。结论不平衡是ME患者成骨不全的重要原因。

{"title":"Paradigm shift to disequilibrium in the genesis of orthostatic intolerance in patients with myalgic encephalomyelitis and chronic fatigue syndrome","authors":"Kunihisa Miwa , Yukichi Inoue","doi":"10.1016/j.ijchy.2020.100032","DOIUrl":"10.1016/j.ijchy.2020.100032","url":null,"abstract":"<div><h3>Background</h3><p>Orthostatic intolerance (OI) markedly impairs activities of daily living in patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome. OI is surmised to be a cardiovascular symptom correlated with cerebral hypo-perfusion and exaggerated sympathetic activation. Postural instability or disequilibrium may be part of the etiology of OI.</p></div><div><h3>Methods</h3><p>The study comprised 72 patients with ME (18 men, 54 women; mean age, 37 ± 10 years) who underwent neurological examinations and the 10 min standing test. We quantified disequilibrium (instability upon standing with feet together and eyes shut), ability to complete the 10 min standing test, and postural orthostatic tachycardia (POT) during the test.</p></div><div><h3>Results</h3><p>Disequilibrium was detected in 23/72 (32%) patients and POT in 16 (22%). Nineteen (26%) patients failed to complete the 10 min standing test; disequilibrium was significantly more common in the 19- patient subgroup than in the 53-patient test-completing subgroup (89% vs. 11%, p < 0.01). However, the rate of POT was not different between the groups (21% vs. 23%, p = 1.00). Compared with the 49 (68%) patients without disequilibrium, the 23 (32%) patients with disequilibrium were significantly more likely to have failed to complete the test (74% vs. 4%, p < 0.01). The rate of POT was comparable between the groups (23% vs. 22%, p = 1.00). Among patients with disequilibrium who failed to complete the 10 min standing test and had a previous record, 6/8 had completed the test 6–24 months earlier when all six had reported no disequilibrium.</p></div><div><h3>Conclusion</h3><p>Disequilibrium should be recognized as an important cause of OI in patients with ME.</p></div>","PeriodicalId":36839,"journal":{"name":"International Journal of Cardiology: Hypertension","volume":"5 ","pages":"Article 100032"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchy.2020.100032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38821100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3