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A Review on the Status of Hypertension in Six Southeast Asian Countries 东南亚6国高血压病现状综述
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/ins.johtn.0151
R. Oliva
Hypertension (HTN) is the most common chronic disease in both developed and developing countries and is a major public health concern affecting adults. It is the leading cause of mortality and disability-adjusted life year all over the world, causes more cardiovascular deaths than any other modifiable cardiovascular risk factors, and is the second only to smoking as a preventable cause of mortality.[1-2] In the United States, National Health and Nutrition Examination Survey of more than 23,000 subjects, more than 50% of deaths from chronic heart disease and stroke occurred among patients with elevated blood pressure (BP). Approximately 1 billion people were estimated to be hypertensive in 2000, and most of these identified to be hypertensive live in lower and middle-income countries.[3-4] There have been several measures done to control elevations in BP, and while in developed countries, the prevalence of HTN appears to be stabilizing, the rates in the Southeast Asian region continues to rise. Southeast Asia is a subregion in Asia consisting of Thailand, Malaysia, Indonesia, the Philippines, Singapore, Vietnam, Laos, Cambodia, Myanmar, and East Timor. About a third of adults in the region have HTN and nearly 1.5 million deaths are attributed to HTN annually.[5] It represents an important public health issue, as this is partly due in part to absent or poor disease management, with rates of uncontrolled HTN as high as 70%.[6] This paper looks at the different status of HTN prevalence, awareness, and control strategy available in six countries in SEA.
高血压(HTN)是发达国家和发展中国家最常见的慢性疾病,是影响成年人的主要公共卫生问题。它是全世界死亡和残疾调整生命年的主要原因,造成的心血管死亡人数超过任何其他可改变的心血管风险因素,并且是仅次于吸烟的第二大可预防的死亡原因。[1-2]美国国家健康与营养检查调查(National Health and Nutrition Examination Survey)对23000多名受试者进行了调查,发现50%以上的慢性心脏病和中风死亡发生在血压升高的患者中。据估计,2000年约有10亿人患有高血压,其中大多数被确定为高血压的人生活在低收入和中等收入国家。[3-4]已经采取了一些措施来控制血压升高,虽然在发达国家,HTN的患病率似乎趋于稳定,但东南亚地区的发病率继续上升。东南亚是亚洲的一个次区域,由泰国、马来西亚、印度尼西亚、菲律宾、新加坡、越南、老挝、柬埔寨、缅甸和东帝汶组成。该地区约有三分之一的成年人患有HTN,每年有近150万人死于HTN。[5]它代表了一个重要的公共卫生问题,因为这部分是由于缺乏或不良的疾病管理,不受控制的HTN率高达70%。[6]本文着眼于东南亚6个国家HTN流行、认识和控制策略的不同状况。
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引用次数: 5
Common but Underrated – Are we Neglecting these Hypertensive Subsets in India? 常见但被低估——我们是否忽视了印度的这些高血压亚群?
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/ins.johtn.0145
T. Nair
The detection, awareness, treatment, and control rates of hypertension are poor in Indian subcontinent; the huge 1.3 billion population posing a substantial challenge to health providers. The new data analysis in JAMA estimates that a systolic blood pressure (SBP) between 110 and 115 mmHg accounts for 212 million disability-adjusted life year worldwide; of which, 39 million (around 20%) are from India.[1] The scenario of hypertension detection management in India is challenging; as per the National Capital Region cross-sectional database, there is a progressive increase in prevalence – from 23% in urban areas and 11% rural areas in 1991–1994 period to 42.2% urban and 29.9% rural in 2012–2014. More concerning is the fact that these crosssectional data show that there has been no substantial change in terms of awareness, treatment, and control rates of hypertension in the tested population between the two time periods.[2] The data from Jaipur (Jaipur Heart watch), in contrast, show progressive rise in awareness (13–56%), treatment (95–36%), and control (2–21%) from 1991 to 1994 compared to 2012–2014 period, despite the point that the numbers fell short of the WHO global monitoring framework and UN sustainable development goal.[3]
印度次大陆高血压的发现、认识、治疗和控制率较差;庞大的13亿人口对卫生服务提供者构成了重大挑战。JAMA上的新数据分析估计,收缩压(SBP)在110至115 mmHg之间占全球2.12亿残疾调整生命年;其中3900万(约20%)来自印度。[1]印度的高血压检测管理情况具有挑战性;根据国家首都地区横断面数据库,患病率逐步上升,从1991-1994年期间城市地区的23%和农村地区的11%增加到2012-2014年期间城市42.2%和农村29.9%。更令人担忧的是,这些横断面数据显示,在这两个时间段内,受测人群对高血压的认识、治疗和控制率并没有实质性的变化。[2]相比之下,来自斋浦尔(斋浦尔心脏观察)的数据显示,与2012-2014年期间相比,从1991年到1994年,意识(13-56%)、治疗(95-36%)和控制(2-21%)逐步上升,尽管这些数字未达到世卫组织全球监测框架和联合国可持续发展目标。[3]
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引用次数: 0
Hypertension in Elderly – Pathogenesis and Treatment 老年高血压的发病机制与治疗
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/ins.johtn.0164
T. Padmanabhan, M. Azam
“Old age is like a plane flying through a storm. Once you’re aboard, there’s nothing you can do.” -Golda Meir Hypertension (HTN) is a leading risk factor in the aged for cardio/cerebrovascular events, the prevalence of which increases with age. Pathophysiologically, it differs from HTN of the young (altered structure and function of conduit arteries vis-a-vis resistance vessels of the young). Older hypertensives have altered or downregulated biological functions, have multiple comorbidities warranting polypharmacy with attendant drug interactions� Elevated blood pressure (BP) is the most common cause of mortality over the globe, being responsible for about 13% of all deaths every year, accounting for about 57 million disability-adjusted life years�[1] The prevalence of elevated BP worldwide in 2008 was about 40%, being highest in the WHO African region (46%) and lowest in the Americas (35% in both sexes). The prevalence of uncontrolled HTN has increased by approximately 600 million compared to that in 1980�[2] The burden of HTN is rising globally due to the growth of the obese and aged population and is projected to affect around 70% of the global population by 2025�[3] Abstract
“老年就像一架在暴风雨中飞行的飞机。一旦上了船,你就无能为力了。高血压(HTN)是老年人心/脑血管事件的主要危险因素,其患病率随着年龄的增长而增加。病理生理上,它不同于年轻人的HTN(导管动脉相对于年轻人的阻力血管的结构和功能改变)。老年高血压患者的生物功能改变或下调,有多种合共病,需要多种药物相互作用。血压升高(BP)是全球最常见的死亡原因,每年约占死亡总数的13%,约占5700万残疾调整生命年[1]。2008年,全球血压升高的患病率约为40%。在世卫组织非洲区域最高(46%),在美洲最低(男女均为35%)。与1980年相比,未控制的HTN患病率增加了约6亿人[2]。由于肥胖和老龄化人口的增长,HTN的负担在全球范围内不断上升,预计到2025年将影响全球约70%的人口[3]
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引用次数: 0
Echocardiography in Hypertension 高血压的超声心动图
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/INS.JOHTN.0142
P. Nair
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引用次数: 0
Select Considerations for Secondary Hypertension 选择继发性高血压的注意事项
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/ins.johtn.0148
G. Nair, J. Joseph
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引用次数: 0
White-coat Hypertension 穿白大衣高血压
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/INS.JOHTN.0143
Lexy Vijayan
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引用次数: 0
Clinical Presentation, Diagnosis, and Management of Primary Aldosteronism and Pheochromocytoma 原发性醛固酮增多症和嗜铬细胞瘤的临床表现、诊断和治疗
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/ins.johtn.0160
L. Mercado-Asis, R. Castillo
Primary hyperaldosteronism (PA) or Conn’s syndrome and pheochromocytoma (Pheo) are functioning tumors from the adrenal glands that can cause secondary hypertension.[1,2] Conn’s syndrome is the excess production of the hormone aldosterone from the zona glomerulosa of the adrenal glands. The prevalence of PA has been reported to range from 4.6 to 9.5% among hypertensive individuals.[3,4] The high circulating aldosterone results in hypokalemia which leads to weakness, tingling, muscle spasms, and periods of temporary paralysis.[4,5] Bilateral adrenal hyperplasia and aldosterone-producing adrenal tumor are the most common causes of PA.[6] Pheochromocytoma (Pheo) is a rare adrenomedullary tumor with an incidence of 0.1–0.6%.[1,7] About 0.05–0.1% of Pheo cases are undiagnosed in autopsy studies.[8] These tumors can synthesize, metabolize, store, and secrete catecholamines and their metabolites.[9] Pheos originate from adrenomedullary chromaffin cells that commonly produce epinephrine, norepinephrine, and dopamine. Chromaffin cells evolve into 80–85% Pheos and 15–20% are paragangliomas.[10] A high index of clinical suspicion remains the pivotal point to initiate biochemical studies, particularly in those patients with a certain pattern of spells, blood pressure elevation (paroxysmal or alternating with hypotension), drug-resistant hypertension, Abstract
原发性醛固酮增多症(PA)或康氏综合征和嗜铬细胞瘤(Pheo)是来自肾上腺的功能性肿瘤,可引起继发性高血压。[1,2]康氏综合征是肾上腺肾小球带醛固酮分泌过量。据报道,高血压患者的PA患病率为4.6 - 9.5%。[3,4]高循环醛固酮导致低钾血症,导致虚弱、刺痛、肌肉痉挛和暂时性瘫痪。[4,5]双侧肾上腺增生和醛固酮生成肾上腺肿瘤是PA最常见的病因嗜铬细胞瘤(Pheo)是一种罕见的肾上腺髓质肿瘤,发病率为0.1-0.6%。[1,7]尸检中约有0.05-0.1%的Pheo病例未被诊断这些肿瘤可以合成、代谢、储存和分泌儿茶酚胺及其代谢物Pheos起源于肾上腺髓染色质细胞,通常产生肾上腺素、去甲肾上腺素和多巴胺。染色质细胞进化为80-85%的pheo, 15-20%为副神经节瘤高的临床怀疑指数仍然是启动生化研究的关键点,特别是那些有一定模式的发作、血压升高(阵发性或交替性低血压)、耐药高血压的患者
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引用次数: 0
Statin Update: Intolerance, Benefit, and Beyond 他汀类药物更新:不耐受、益处及其他
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/INS.JOHTN.0141
Aaron Y. Kluger, K. Tecson, S. Sudhakaran, Jun Zhang, P. McCullough
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引用次数: 0
The Effectiveness of a Training Program for Advanced Practice Nurses in the Philippines on the Care of Patients with Primary Hypertension 菲律宾高级执业护士护理原发性高血压患者培训计划的有效性
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/ins.johtn.0156
Sarla F. Duller, Dan Louie Renz P. Tating, Lourdes Marie S. Tejero
Background: The same problems of access to health care due to inadequate and inequitable distribution of human resources for health continue to be present in countries worldwide, including the Philippines. However, these conditions have not stimulated the development of the role on advanced practice nursing (APN) in the country, despite hypertension (HTN) being a prevalent public health problem that can be addressed at the primary care level. Nurses, being the most numerous health professionals, can be trained to fulfill this deficiency. Objective: This study aimed to determine the validity and effectiveness of the investigatordesigned HTN training program for advanced practice nurses. Methods and Design: This was one group, pre-test-post-test design, involving nursing clinics for wellness in a government-subsidized university, located in Manila, the Philippines. Out of the 28 masters-prepared nurses who consented, 24 participants completed the training program and answered the post-training instruments; the majority were females, with a mean age of 32.42 years (standard deviations [SD] = 8.397) and mean the clinical experience of 5.84 years (SD = 3.503). A panel of six experts reviewed and validated the seven modules for the HTN training program. It consisted of lectures, demonstration sessions, small group discussions, oral examination, skill performance evaluation, and clinic visit with a demonstration, totaling 32 h of in-person training. Participants took the written examinations before and after the training program. Results: The expert panel determined that the module content covered the learning objectives adequately. After the training program, the total knowledge score of the participants increased from 33.00 points (SD = 5.25) to 43.08 points (SD = 43.08), which was statistically significant (t = −11.245, P < 0.001). Furthermore, self-efficacy scores increased significantly (t = −6.187, P < 0.001), from 8.08 points (SD = 1.16) to 9.06 (SD = 0.69). Conclusions: The validated HTN training program module effectively equipped the masters-prepared nurses with the required knowledge, skills, and attitudes in providing entry-level APN care for patients with primary HTN, addressing the competencies outlined by the National Organization of Nurse Practitioner Faculty in the United States. Since the positive outcomes on the nurse participants translated to the patient outcomes seen in the advanced practice nurse-led HTN Clinic done after this study, the competencies included in the training program modules should be integrated into the country’s master’s degree curriculum in Adult Health Nursing to provide adequate preparation for entry-level APN care.
背景:由于卫生人力资源分配不充分和不公平,在世界各国,包括菲律宾,仍然存在同样的获得保健的问题。然而,尽管高血压(HTN)是一个普遍存在的公共卫生问题,可以在初级保健层面解决,但这些情况并没有刺激该国高级实践护理(APN)角色的发展。护士是人数最多的卫生专业人员,可以通过培训来弥补这一不足。目的:探讨研究者设计的高级执业护士HTN培训方案的效度和有效性。方法和设计:这是一组,前-后-测试设计,涉及位于菲律宾马尼拉的一所政府资助大学的健康护理诊所。在28名同意参加硕士培训的护士中,有24名完成了培训计划并回答了培训后问卷;以女性居多,平均年龄32.42岁(标准差[SD] = 8.397),平均临床经验5.84岁(SD = 3.503)。一个由六名专家组成的小组审查并验证了HTN培训计划的七个模块。包括讲座、演示、小组讨论、口语考试、技能表现评估、门诊参观演示,共32小时的现场培训。学员在培训前后分别参加了笔试。结果:专家组确定模块内容充分覆盖了学习目标。培训结束后,参与者的总知识得分由33.00分(SD = 5.25)提高到43.08分(SD = 43.08),差异有统计学意义(t = - 11.245, P < 0.001)。自我效能评分由8.08分(SD = 1.16)提高至9.06分(SD = 0.69),显著提高(t = - 6.187, P < 0.001)。结论:经过验证的HTN培训项目模块有效地为准备硕士的护士提供了必要的知识、技能和态度,为原发性HTN患者提供入门级APN护理,解决了美国国家护士执业教师组织概述的能力问题。由于参与护士的积极结果转化为患者的结果,在这项研究后完成的高级实践护士领导的HTN诊所中看到,培训计划模块中包括的能力应纳入国家成人保健护理硕士学位课程,为入门级APN护理提供充分的准备。
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引用次数: 1
Angiotensin-converting Enzyme Inhibitor Radionuclide Renogram – A Non-invasive Tool to Suspect Renovascular Hypertension 血管紧张素转换酶抑制剂放射性核素肾图-一种怀疑肾血管性高血压的无创工具
Q4 Medicine Pub Date : 2019-01-01 DOI: 10.15713/INS.JOHTN.0144
S. Santhosh, Prabhu Ethiraj, J. Solomon, R. Rajasekar
A 42-year-old male who is a known smoker and alcoholic presented to the vascular surgery department with complaints of gripping pain in both lower limbs over the past 6 months. He is undergoing treatment for refractory hypertension (BP 200/130 mmHg) despite optimum medication comprising calcium channel blocker, beta-blocker, and diuretics over 6 years. His serum creatinine was 1.6 mg/dl while the blood sugar, electrolytes, cholesterol, and liver function tests were within normal limits. He is also being treated for chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] = 27 ml/min/1.73m2 at diagnosis) and possible bilateral renal artery stenosis (RAS) was considered. Contrast-enhanced computed tomography showed complete occlusion of the right renal artery with contracted right kidney and 70–80% occlusion at the origin of the left renal artery [Figure 1a and b]. Pan angiogram showed a significant peripheral vascular disease of both iliac arteries while the subclavian, carotid, and upper limb vessels were normal. He was treated for one episode of flash pulmonary edema 9 months ago. At that time, his echocardiography showed concentric LVH and global LVEF of 58%. There was no regional wall motion abnormality. ECG showed ST depression in II, III, and aVF, and therefore, he was started on statins also, along with aspirin. At the time of referral to our institution, his global LVEF was 43%. We received him in our department to study the functional significance of RAS with 99mTechnetium-DTPA renogram with angiotensin-converting enzyme inhibitors (ACEIs). The patient was prepared as per the Society of Nuclear Medicine and Molecular Imaging guidelines for baseline and ACEI renogram (2 days protocol).[1] He was allowed to continue his medication during the study period. On day 1, baseline renogram was performed by giving intravenous injection of 100 MBq of 99mTc-DTPA in 1.0 ml saline through an intravenous cannula. Sequential dynamic and periodic static images of the abdomen Abstract
一名42岁男性吸烟者和酗酒者因过去6个月双下肢夹持疼痛就诊血管外科。他正在接受顽固性高血压(血压200/130 mmHg)的治疗,尽管最佳药物包括钙通道阻滞剂、β受体阻滞剂和利尿剂超过6年。血清肌酐为1.6 mg/dl,血糖、电解质、胆固醇、肝功能检查均在正常范围内。他同时也在接受慢性肾脏疾病(CKD)的治疗(诊断时估计肾小球滤过率[eGFR] = 27 ml/min/1.73m2),并考虑可能的双侧肾动脉狭窄(RAS)。增强ct显示右肾动脉完全闭塞,右肾收缩,左肾动脉起源处70-80%闭塞[图1a和b]。泛血管造影显示双髂动脉明显外周血管病变,而锁骨下、颈动脉和上肢血管正常。9个月前,他曾因一次闪发性肺水肿接受治疗。当时超声心动图显示同心LVH和整体LVEF为58%。局部壁运动未见异常。心电图显示II期、III期和aVF期ST段抑郁,因此,他也开始服用他汀类药物和阿司匹林。在转介到我们机构时,他的全球LVEF为43%。我们在我科接收他,用99mtechneium - dtpa rengram联合血管紧张素转换酶抑制剂(angiotensin-converting enzyme inhibitors, ACEIs)研究RAS功能意义。患者按照核医学和分子成像学会基线指南和ACEI肾图(2天方案)进行准备。[1]在研究期间,他被允许继续服药。第1天,通过静脉插管在1.0 ml生理盐水中静脉注射100mbq 99mTc-DTPA,进行基线肾造影。连续动态和周期性静态腹部图像
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引用次数: 0
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Open Hypertension Journal
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