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Low Subjective Cardiovascular Disease Risk Perceptions among Hypertensive Patients in Addis Ababa, Ethiopia. 埃塞俄比亚亚的斯亚贝巴高血压患者主观心血管疾病风险认知较低
IF 2.2 Q2 Medicine Pub Date : 2022-08-05 eCollection Date: 2022-01-01 DOI: 10.2147/IBPC.S370838
Daniel Mengistu Bekele, Dejuma Yadeta Goshu, Alemayehu Worku Yalew, Melinda K Higgins, Rebecca A Gary

Background: Accurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients' risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS).

Methods: A cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants' risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level.

Results: Participants (n=377) had a mean age of 53.61 ± 12.80-years, range (18-82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43-18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36-14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants' CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation.

Conclusion: Hypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients' CVD risk perception to reduce adverse CVD events.

背景:准确的心血管疾病(CVD)风险评估对于高血压患者正确识别自身风险状态,及时采取有效的行为措施,避免重大不良后果的发生至关重要。然而,埃塞俄比亚高血压患者对心血管疾病事件的风险认知尚不清楚。因此,本研究旨在比较患者主观CVD风险感知水平与非实验室Framingham风险评分(nl-FRS)。方法:采用横断面设计。采用“心血管疾病风险态度与信念问卷”和“nl-FRS”比较主观与客观的心血管疾病风险指标。使用kappa统计检验了参与者的风险感知与nl-FRS之间的一致性。采用双变量卡方检验和多项逻辑回归分析来确定与风险感知相关的因素。p值< 0.05,差异有统计学意义。结果:参与者(n=377)平均年龄53.61±12.80岁,年龄范围18-82岁,男性占51.2%,42.7%为高中以下文化程度,45.1%达到目标血压控制,平均HTN持续时间为8.01±6.07年。大多数(58.62%)参与者对心血管疾病事件的主观风险感知较低(平均17.79,95% CI: 17.43-18.15)。大约四分之三(72.4%)的nl-FRS风险计算为中等(平均值13.84,95% CI: 13.36-14.33)。受试者感知风险与nl-FRS之间的一致性较差(kappa = 0.0002,标准误差= 0.023,p =0.99)。参与者的心血管疾病风险感知不准确性也很高(76%),主要是由于低估。高血压持续时间、就诊频率和糖尿病控制水平是CVD风险低估的重要预测因素。结论:与使用nl-FRS确定的中度客观风险相比,高血压患者对CVD事件的主观风险认知不准确且较低。有计划地教育患者HTN和CVD危险因素对于提高患者对CVD风险的认知以减少不良CVD事件至关重要。
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引用次数: 4
Hypertension and Its Associated Factors Among Long-Distance Truck Drivers in Ethiopia. 埃塞俄比亚长途卡车司机高血压及其相关因素
IF 2.2 Q2 Medicine Pub Date : 2022-06-21 eCollection Date: 2022-01-01 DOI: 10.2147/IBPC.S361789
Mohammed Ebrahim Rike, Mengistie Diress, Baye Dagnew, Mihret Getnet, Abbul Hasano Kebalo, Derese Sinamaw, Damtew Solomon, Yonas Akalu

Introduction: Hypertension is rising globally and is one of the leading causes of cardiovascular disease. It affects people of different groups; however, owing to a rise in a sedentary lifestyle it is more prevalent among long-distance truck drivers. However, the prevalence of hypertension and its associated factors among truck drivers in Ethiopia is not known. Therefore, this study aimed to determine the prevalence of hypertension and its associated factors among long-distance truck drivers in Ethiopia.

Methods: A cross-sectional study was conducted among 415 long-distance truck drivers selected by systematic random sampling technique at Modjo dry port from May 15 to 30, 2021. The data were collected and entered into Epi-data 4.6 then it was exported to SPSS version 25 for analysis. Descriptive statistics, bivariable, and multivariable logistic regression analyses were executed. The odds ratio with a 95% confidence interval was computed. In the final model, a variable with a p ≤ 0.05 was declared as a predictor of hypertension.

Results: The prevalence of hypertension among long-distance truck drivers in Ethiopia was 34.7%. The odds of hypertension was higher among drivers who were ≥45 years old [Adjusted odds ratio (AOR) = 4.32; 95% Confidence interval (CI): 2.16, 8.62], obese [AOR= 5.12; 95% CI: 1.33, 19.8], alcohol drinkers [AOR=3.05; 95% CI: 1.27, 7.31], and cigarette smokers [AOR= 3.74; 95% CI: 1.64, 8.51]. Drivers who had regular physical exercise were less likely [AOR=0.33; 95% CI: 0.17, 0.63] to have hypertension than drivers with no physical activity.

Conclusion: More than a third of the participants in Ethiopia had hypertension. Higher age, obesity, absence of rest between driving, short sleep duration, smoking, alcohol drinking, and physical inactivity were significantly associated with hypertension. Therefore, health education on lifestyle modifications, sleep habits, and the importance of rest breaks between driving should be considered to prevent hypertension and further complications.

导读:高血压在全球范围内呈上升趋势,是导致心血管疾病的主要原因之一。它影响不同群体的人;然而,由于久坐不动的生活方式的增加,它在长途卡车司机中更为普遍。然而,埃塞俄比亚卡车司机的高血压患病率及其相关因素尚不清楚。因此,本研究旨在确定埃塞俄比亚长途卡车司机的高血压患病率及其相关因素。方法:采用系统随机抽样方法,于2021年5月15日至30日在Modjo干港抽取415名长途货车司机进行横断面调查。收集数据并输入Epi-data 4.6,导出到SPSS 25版进行分析。进行描述性统计、双变量和多变量logistic回归分析。以95%置信区间计算比值比。在最后的模型中,一个p≤0.05的变量被宣布为高血压的预测因子。结果:埃塞俄比亚长途货车司机高血压患病率为34.7%。年龄≥45岁的司机患高血压的几率更高[校正优势比(AOR) = 4.32;95%可信区间(CI): 2.16, 8.62],肥胖[AOR= 5.12;95% CI: 1.33, 19.8],饮酒者[AOR=3.05;95% CI: 1.27, 7.31]和吸烟者[AOR= 3.74;95% ci: 1.64, 8.51]。经常进行体育锻炼的司机发生车祸的可能性较低[AOR=0.33;(95% CI: 0.17, 0.63)与没有体育锻炼的司机相比有高血压。结论:埃塞俄比亚超过三分之一的参与者患有高血压。年龄较大、肥胖、驾驶间隙缺乏休息、睡眠时间短、吸烟、饮酒和缺乏运动与高血压显著相关。因此,应考虑对生活方式的改变、睡眠习惯和驾驶间隙休息的重要性进行健康教育,以预防高血压和进一步的并发症。
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引用次数: 1
The Association Between Habitual Sleep Duration and Blood Pressure Control in United States (US) Adults with Hypertension 美国成年高血压患者习惯性睡眠时间与血压控制的关系
IF 2.2 Q2 Medicine Pub Date : 2022-05-25 DOI: 10.2147/IBPC.S359444
Everlyne G Ogugu, S. Catz, J. Bell, C. Drake, J. Bidwell, James E. Gangwisch
Purpose This study examined the relationship between habitual sleep duration and blood pressure (BP) control in adults with hypertension. Methods This cross-sectional study used data of 5163 adults with hypertension obtained from the 2015–2018 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression was used to analyze the association between habitual sleep duration and BP control. Habitual sleep duration was self-reported and defined as the amount of sleep usually obtained in a night or main sleep period during weekdays or workdays. It was categorized as <6, 6 - <7, 7–9, and >9 hours. BP control was defined as average systolic BP <130mmHg and diastolic BP <80mmHg. Results Results from the fully adjusted models show that among all adults with hypertension, habitual sleep duration of <6 hours night/main sleep period was associated with reduced odds of BP control (OR = 0.53, 95% CI: 0ss.37–0.76, P = 0.001) when compared to 7–9 hours. In the subpopulation of adults who were on antihypertensive medication, those with a sleep duration of <6 hours had lower odds of BP control than those with a sleep duration of 7–9 hours (OR = 0.53, 95% CI: 0.36–0.77, P = 0.002). No significant differences were noted in all adults with hypertension and in the subpopulation of those on antihypertensive medication in BP control between the reference sleep duration group (7–9 hours) and the 6 - <7 or >9 hours groups. There were no significant differences across age groups or gender in the relationship between habitual sleep duration and BP control. Conclusion Sleep duration of <6 hours is associated with reduced odds of hypertension control. These significant findings indicate that interventions to support adequate habitual sleep duration may be a promising addition to the current hypertension management guidelines.
目的探讨成人高血压患者习惯性睡眠时间与血压控制的关系。方法本横断面研究使用2015-2018年国家健康与营养调查(NHANES)中5163名高血压成年人的数据。采用多变量logistic回归分析习惯睡眠时间与血压控制的关系。习惯性睡眠时间是自我报告的,定义为通常在工作日或工作日晚上或主要睡眠时段获得的睡眠量。被划分为9个小时。血压控制定义为平均收缩压9小时组。习惯睡眠时间与血压控制之间的关系在年龄和性别上没有显著差异。结论睡眠时间<6小时与高血压控制几率降低有关。这些重大发现表明,支持充足习惯性睡眠时间的干预措施可能是当前高血压管理指南的一个有希望的补充。
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引用次数: 0
Pulmonary Hypertension in Pregnancy: Challenges and Solutions 妊娠期肺动脉高压:挑战和解决方案
IF 2.2 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.2147/IBPC.S242242
H. Afify, A. Kong, Jopher Bernal, I. Elgendy
Abstract Pulmonary hypertension (PH) is a heterogeneous disease characterized by an elevated mean pulmonary artery pressure of 20 mm Hg or above. PH is a prevalent condition among women of reproductive age and is linked with poor prognosis during pregnancy. Pregnancy is a stressful event and complicates the management and prognosis in patients with PH. In this review, we discuss the pathogenesis, clinical presentation as well as therapeutic options for PH during pregnancy. We also highlight knowledge gaps to guide future research.
摘要肺动脉高压(PH)是一种异质性疾病,其特征是平均肺动脉压升高20毫米汞柱或以上。PH是育龄妇女的常见疾病,与妊娠期预后不良有关。妊娠是一种压力事件,使PH患者的治疗和预后复杂化。在这篇综述中,我们讨论了妊娠期PH的发病机制、临床表现以及治疗选择。我们还强调了知识差距,以指导未来的研究。
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引用次数: 2
Serum Levels of NT-Pro BNP in Patients with Preeclampsia 子痫前期患者血清NT-Pro BNP水平的变化
IF 2.2 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.2147/IBPC.S360584
Thanh Xuan Nguyen, Van Tri Nguyen, Hong Ngoc Nguyen-Phan, Bui Bao Hoang
Objective This study aims to determine the serum levels of NT-proBNP in women with preeclampsia with and without severe signs and to evaluate the cardiovascular risks in these two groups of participants. Methods A descriptive cross-sectional study was conducted on 52 women with preeclampsia in the Department of Gynecology and Obstetrics – Hue Central Hospital, from August 2019 to September 2020. Results In preeclampsia women, the rate of hypertension in stage 3, stage 2, and stage 1 were 46.1%, 32.7%, and 21.2%, respectively. The average Sokolow-Lyon index in the preeclampsia group with and without severe signs was 22.25 ± 7.38mm, 20.16 ± 5.54mm, respectively. The average left ventricular mass index in the group of preeclampsia patients without and with severe signs was 92.27 ± 14.56g/m2 and 120.68 ± 16.47g/m2, respectively. The average ejection fraction in the group of preeclampsia patients without severe signs and with severe signs was 65.11 ± 3.45%, 56.21 ± 7.12%, correspondingly. In contrast, the difference between the two groups was statistically significant with p < 0.05. The plasma NT-proBNP level in the preeclampsia group without severe signs was 349.12 ± 93.51pg/mL, whereas the concentration in the preeclampsia group with severe signs was 725.32 ± 290.46pg/mL (p < 0.05). Conclusion The NT-proBNP level was statistically significantly increased in the patients with preeclampsia. Analyzing and comparing the figures and changes found in two groups of PE patients, with and without severe signs, we suggest that women diagnosed with PE with severe signs have a higher risk of developing cardiovascular problems forthwith and henceforth.
目的本研究旨在测定先兆子痫伴和不伴严重症状妇女的血清NT-proBNP水平,并评估这两组参与者的心血管风险。方法2019年8月至2020年9月,对顺化市中心医院妇产科52名先兆子痫妇女进行描述性横断面研究。结果子痫前期妇女3期、2期和1期的高血压发生率分别为46.1%、32.7%和21.2%。先兆子痫伴和不伴严重体征组的平均Sokolow-Lyon指数分别为22.25±7.38mm和20.16±5.54mm。先兆子痫无症状组和有严重症状组的平均左心室质量指数分别为92.27±14.56g/m2和120.68±16.47g/m2。先兆子痫无严重体征组和有严重体征组的平均射血分数分别为65.11±3.45%、56.21±7.12%。相反,两组之间的差异具有统计学意义,p<0.05。无先兆子痫组血浆NT-proBNP水平为349.12±93.51pg/mL,有先兆子痫组为725.32±290.46pg/mL(p<0.05)。通过分析和比较两组PE患者(有严重体征和无严重体征)的数据和变化,我们认为,被诊断为PE伴严重体征的女性立即和以后出现心血管问题的风险更高。
{"title":"Serum Levels of NT-Pro BNP in Patients with Preeclampsia","authors":"Thanh Xuan Nguyen, Van Tri Nguyen, Hong Ngoc Nguyen-Phan, Bui Bao Hoang","doi":"10.2147/IBPC.S360584","DOIUrl":"https://doi.org/10.2147/IBPC.S360584","url":null,"abstract":"Objective This study aims to determine the serum levels of NT-proBNP in women with preeclampsia with and without severe signs and to evaluate the cardiovascular risks in these two groups of participants. Methods A descriptive cross-sectional study was conducted on 52 women with preeclampsia in the Department of Gynecology and Obstetrics – Hue Central Hospital, from August 2019 to September 2020. Results In preeclampsia women, the rate of hypertension in stage 3, stage 2, and stage 1 were 46.1%, 32.7%, and 21.2%, respectively. The average Sokolow-Lyon index in the preeclampsia group with and without severe signs was 22.25 ± 7.38mm, 20.16 ± 5.54mm, respectively. The average left ventricular mass index in the group of preeclampsia patients without and with severe signs was 92.27 ± 14.56g/m2 and 120.68 ± 16.47g/m2, respectively. The average ejection fraction in the group of preeclampsia patients without severe signs and with severe signs was 65.11 ± 3.45%, 56.21 ± 7.12%, correspondingly. In contrast, the difference between the two groups was statistically significant with p < 0.05. The plasma NT-proBNP level in the preeclampsia group without severe signs was 349.12 ± 93.51pg/mL, whereas the concentration in the preeclampsia group with severe signs was 725.32 ± 290.46pg/mL (p < 0.05). Conclusion The NT-proBNP level was statistically significantly increased in the patients with preeclampsia. Analyzing and comparing the figures and changes found in two groups of PE patients, with and without severe signs, we suggest that women diagnosed with PE with severe signs have a higher risk of developing cardiovascular problems forthwith and henceforth.","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42859037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Perioperative Hypertension Etiologies in Patients Undergoing Noncardiac Surgery in University Health Network Hospitals–Canada from 2015–2020 2015-2020年加拿大大学健康网络医院接受非心脏手术患者围手术期高血压病因
IF 2.2 Q2 Medicine Pub Date : 2022-03-01 DOI: 10.2147/IBPC.S347395
S. Mohseni, Sahar Behnam-Roudsari, Mohammad Tarbiat, Pouyan Shaker, Seyedmohammadshahab Shivaie, Mohammad Ali Shafiee
Introduction Perioperative hypertension, defined as increased blood pressure around the surgery, is a known risk factor for perioperative complications, including cardiovascular events. Identifying reasons associated with hypertension in each period is of great help in preventing and better managing perioperative hypertension. Objective The aim of the study was to explore common etiologies of hypertension during the perioperative period (pre, intra, and post-operation) in patients who underwent noncardiac surgeries in University Health Network (UHN) hospitals, Canada, from 2015 to 2020. Patients and Methods We retrospectively analyzed the medical records of 174 patients undergoing noncardiac surgeries who experienced perioperative hypertension. We assessed the prevalence of 10 reasons for perioperative hypertension as a whole and also each period separately according to the physicians’ notes in patients’ medical records. Two-way measurements ANOVA was used to determine the change of mean hypertension among patients for specific etiology. Results The common etiologies of perioperative hypertension were poorly controlled hypertension (21.8%), excessive fluid therapy (19.5%), excessive vasopressor (18.4%), and medication withdrawal (13.7%). Regarding each period separately, the most common reasons were poorly controlled hypertension for pre (42.9%) and intraoperative period (22.7%) and fluid overload for the postoperative period (20.1%). Poor control of hypertension showed both within-subject statistical significance for systolic and between-subject statistical significance for diastolic blood pressure. Conclusion Poorly controlled hypertension is the most significant etiology of perioperative hypertension in patients undergoing noncardiac surgeries. Apart from poorly controlled hypertension, as a patient-related factor, iatrogenic factors such as excessive vasopressor therapy, aggressive fluid replacement and poor management of antihypertensive medications can also cause perioperative hypertension.
引言围手术期高血压,定义为手术前后血压升高,是围手术期并发症(包括心血管事件)的已知风险因素。识别每个时期与高血压相关的原因对预防和更好地管理围手术期高血压有很大帮助。目的探讨2015年至2020年在加拿大大学健康网络(UHN)医院接受非心脏手术的患者围手术期(术前、术中和术后)高血压的常见病因。患者和方法我们回顾性分析174例非心脏手术患者围手术期高血压的病历。根据医生在患者病历中的记录,我们评估了围手术期高血压的10个原因的患病率,并分别评估了每个时期的患病率。双向测量方差分析用于确定特定病因患者平均高血压的变化。结果围手术期高血压的常见病因为高血压控制不良(21.8%)、补液过量(19.5%)、血管升压药过量(18.4%)和停药(13.7%),最常见的原因是术前(42.9%)和术中(22.7%)高血压控制不佳,术后(20.1%)液体超负荷。高血压控制不佳表现出收缩压在受试者内的统计学意义和舒张压在受检者间的统计学意义。结论高血压控制不良是非心脏手术患者围手术期高血压最重要的病因。除了高血压控制不佳外,作为一种与患者相关的因素,医源性因素,如过度的血管升压药治疗、积极的补液和降压药物管理不善,也会导致围手术期高血压。
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引用次数: 3
Effects of Single Pill Combinations Compared to Identical Multi Pill Therapy on Outcomes in Hypertension, Dyslipidemia and Secondary Cardiovascular Prevention: The START-Study 与相同的多药治疗相比,单药联合治疗对高血压、血脂异常和心血管二级预防的影响:start研究
IF 2.2 Q2 Medicine Pub Date : 2022-02-01 DOI: 10.2147/IBPC.S336324
T. Wilke, B. Weisser, H. Predel, R. Schmieder, S. Wassmann, A. Gillessen, J. Blettenberg, U. Maywald, O. Randerath, S. Mueller, M. Böhm
Aim Current guidelines for the treatment of arterial hypertension (AH) or cardiovascular (CV) prevention recommend combination drug treatments with single pill combinations (SPC) to improve adherence to treatment. We aimed to assess whether the SPC concept is clinically superior to multi pill combination (MPC) with identical drugs. Methods and Results In an explorative study, we analyzed anonymized claims data sets of patients treated with CV drugs for hypertension and/or CV disorders who were insured by the German AOK PLUS statutory health fund covering 01/07/2012-30/06/2018. Patients at age ≥18 years who received either a SPC or MPC with identical drugs were followed for up to one year. A one to one propensity score matching (PSM) was applied within patient groups who started identical drug combinations, and results were reported as incidence rate ratios (IRRs) as well as hazard ratios (HRs). After PSM, data from 59,336 patients were analyzed. In 30 out of 56 IRR analyses, superiority of SPC over MPC was shown. In 5 out of 7 comparisons, the HR for the composite outcome of all-cause death and all-cause hospitalizations was in favor of the SPC regimen (SPC versus MPC): valsartan/amlodipine: HR=0.87 (95% CI: 0.84–0.91, p ≤ 0.001); candesartan/amlodipine: 0.77 (95% CI: 0.65–0.90, p = 0.001); valsartan/amlodipine/hydrochlorothiazide: HR=0.68 (95% CI: 0.61–0.74, p ≤ 0.001); ramipril/amlodipine: HR=0.80 (95% CI: 0.77–0.83, p ≤ 0.001); acetylsalicylic acid (ASA)/atorvastatin/ramipril: HR=0.64 (95% CI: 0.47–0.88, p = 0.005). Conclusion SPC regimens are associated with a lower incidence of CV events and lower all-cause mortality in clinical practice. SPC regimens should generally be preferred to improve patient’s prognosis.
目的目前的动脉高压(AH)或心血管(CV)预防治疗指南建议采用单药联合用药(SPC)来提高治疗依从性。我们旨在评估SPC概念在临床上是否优于具有相同药物的多药丸组合(MPC)。方法和结果在一项探索性研究中,我们分析了接受CV药物治疗的高血压和/或CV障碍患者的匿名索赔数据集,这些患者由德国AOK PLUS法定健康基金承保,涵盖2012年7月1日至2018年6月30日。年龄≥18岁的患者接受SPC或MPC治疗,并使用相同的药物,随访长达一年。在开始相同药物组合的患者组中应用一对一倾向评分匹配(PSM),结果报告为发病率比(IRRs)和危险比(HR)。PSM后,对59336名患者的数据进行了分析。在56次内部收益率分析中,有30次表明SPC优于MPC。在7项比较中的5项中,全因死亡和全因住院的复合结果的HR有利于SPC方案(SPC与MPC):缬沙坦/氨氯地平:HR=0.87(95%CI:0.84–0.91,p≤0.001);坎地沙坦/氨氯地平:0.77(95%CI:0.65-0.90,p=0.001);缬沙坦/氨氯地平/氢氯噻嗪:HR=0.68(95%CI:0.61-0.74,p≤0.001);雷米普利/氨氯地平:HR=0.80(95%CI:0.77–0.83,p≤0.001);乙酰水杨酸(ASA)/阿托伐他汀/雷米普利:HR=0.64(95%CI:0.47–0.88,p=0.005)。结论SPC方案在临床实践中可降低心血管事件的发生率和全因死亡率。SPC方案通常应优先用于改善患者的预后。
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引用次数: 9
Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies. 儿童急性淋巴细胞白血病患者的高血压:患病率、影响和管理策略。
IF 2.2 Q2 Medicine Pub Date : 2022-01-19 eCollection Date: 2022-01-01 DOI: 10.2147/IBPC.S242244
Lindsey Murphy, Kelly Maloney, Lia Gore, Eliza Blanchette

Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children under the age of 18. While modern diagnostic technologies, risk-stratification, and therapy intensification have led to outstanding outcomes for many children with ALL, the side effects and consequences of therapy are not to be underestimated. Hypertension is a well-known acute and chronic side effect of treatment for childhood ALL, although limited data are available regarding the prevalence of hypertension in children undergoing treatment for ALL. In this review of hypertension in pediatric ALL patients, we examine the existing data on incidence and prevalence during treatment and in pediatric ALL survivors. We describe independent risk factors for development of hypertension along with treatment-related causes. Long-term consequences and the risk to survivors of pediatric ALL are further defined. While many ALL patients require antihypertensive medications during some portion of their treatment, there are no clear guidelines on treating inpatient hypertension given challenges that exist in recognizing and managing hypertension in this setting and in this population. Here, we propose an algorithmic approach to diagnose and treat pediatric ALL patients with HTN, along with monitoring and continuation versus cessation of antihypertensive therapy as an outpatient.

急性淋巴细胞白血病(ALL)是18岁以下儿童最常见的癌症。虽然现代诊断技术、风险分层和强化治疗已经为许多急性淋巴细胞白血病儿童带来了显著的结果,但治疗的副作用和后果也不容低估。众所周知,高血压是儿童ALL治疗的急性和慢性副作用,尽管关于接受ALL治疗的儿童高血压患病率的数据有限。在这篇关于儿科ALL患者高血压的综述中,我们检查了治疗期间和儿科ALL幸存者的发病率和患病率的现有数据。我们描述了高血压发展的独立危险因素以及与治疗相关的原因。对儿童ALL幸存者的长期后果和风险进行了进一步界定。虽然许多ALL患者在治疗的某些阶段需要降压药物,但鉴于在这种环境和人群中存在的识别和管理高血压的挑战,目前尚无明确的住院高血压治疗指南。在这里,我们提出了一种算法方法来诊断和治疗患有HTN的儿科ALL患者,同时监测和继续与停止抗高血压治疗作为门诊。
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引用次数: 2
Treatment Outcome and Associated Factors Among Patients Admitted with Hypertensive Crisis in Public Hospitals at Harar Town, Eastern Ethiopia: A Cross-Sectional Study. 埃塞俄比亚东部哈拉尔镇公立医院收治的高血压危象患者的治疗结果及相关因素:一项横断面研究
IF 2.2 Q2 Medicine Pub Date : 2022-01-01 DOI: 10.2147/IBPC.S386461
Nahom Samuel, Shambel Nigussie, Abera Jambo, Mesay Dechasa, Fekade Demeke, Abduro Godana, Abdi Birhanu, Tigist Gashaw, Assefa Agegnehu Teshome, Amas Siraj

Background: Hypertensive crisis is a significant global health issue that raises the costs to healthcare systems and requires specific attention to improve clinical outcome. There is scarce information on hypertensive crisis cases treatment outcome in the study setting.

Objective: This study aimed to assess treatment outcome and associated factors among patients admitted with hypertensive crisis at Public Hospitals in Harar Town, Eastern Ethiopia.

Methods: A cross-sectional study was conducted among 369 hypertensive crisis patients who had been admitted to the emergency department of Hiwot Fana Comprehensive Specialized Hospital and Jugol General Hospital from May 1, 2017, to May 1, 2022. All hypertensive crisis patients who fulfilled the inclusion criteria were included. The data were extracted from medical records using a data abstraction format. The collected data were analyzed using Statistical Package for Social Sciences version 22. Binary logistics regression model using bivariate and multivariable analysis with 95% confidence intervals and P-values were used to determine the association between variables.

Results: The medical records of 369 patients in total were reviewed. Of these, the medical records of 363 patients contained all the necessary information and were used in the study. More than half of the patients (238; 65.6%) were males. Among 363 patients admitted with hypertensive crisis, 98 (27.0%, 95% Confidence Interval (CI):22.5%-31.9%) of them had poor treatment outcome of hypertensive crisis. Being female (Adjusted Odds Ratio (AOR)=3.4; 95% CI=1.7-7.9), residing in rural areas (AOR=2.4; 95% CI=2.7-5.1), taking captopril during admission (AOR=5.6; 95% CI=2.4-7.9), taking antihypertensive treatment before admission (AOR=0.5; 95% CI=0.2-0.9), and being non compliant to treatment (AOR=2.7; 95% CI=1.4-3.5) had statistically significant associations with poor treatment outcome of hypertensive crisis compared to their counterparts.

Conclusion: The magnitude of poor treatment outcome of hypertensive crisis was high. Sex, residence, non-compliance, and type of emergency drug administered during admission were substantially related with poor treatment outcome of hypertensive crisis. Health professionals should put great emphasis on emergency drugs administered during admission to achieve the desired outcome.

背景:高血压危像是一个重要的全球健康问题,它增加了医疗保健系统的成本,需要特别关注以改善临床结果。在研究背景下,关于高血压危象病例治疗结果的信息很少。目的:本研究旨在评估埃塞俄比亚东部哈拉尔镇公立医院收治的高血压危象患者的治疗结果和相关因素。方法:对2017年5月1日至2022年5月1日在希沃特法纳综合专科医院和居戈尔综合医院急诊科收治的369例高血压危重症患者进行横断面研究。所有符合纳入标准的高血压危重症患者均被纳入。使用数据抽象格式从医疗记录中提取数据。收集的数据使用Statistical Package for Social Sciences version 22进行分析。二元logistic回归模型采用双变量和多变量分析,95%置信区间和p值确定变量之间的相关性。结果:共查阅369例患者的病历。其中,363名患者的医疗记录包含了所有必要的信息,并被用于研究。超过一半的患者(238;65.6%)为男性。363例入院的高血压危象患者中,98例(27.0%,95%可信区间(CI):22.5% ~ 31.9%)高血压危象治疗效果较差。女性(调整优势比(AOR)=3.4;95% CI=1.7-7.9),居住在农村地区(AOR=2.4;95% CI=2.7-5.1),入院时服用卡托普利(AOR=5.6;95% CI=2.4-7.9),入院前已接受抗高血压治疗(AOR=0.5;95% CI=0.2-0.9),不适应治疗(AOR=2.7;95% CI=1.4-3.5)与高血压危象治疗结果差有统计学意义。结论:高血压危象治疗不良程度高。性别、居住地、不依从性和入院时使用的急诊药物类型与高血压危重症的不良治疗结果有实质性关系。卫生专业人员应高度重视在入院时使用的紧急药物,以达到预期的效果。
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引用次数: 2
The Diastolic Blood Pressure J-Curve in Hypertension Management: Links and Risk for Cardiovascular Disease. 高血压管理中的舒张压 J 曲线:心血管疾病的关联与风险。
IF 1.5 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2021-12-14 eCollection Date: 2021-01-01 DOI: 10.2147/IBPC.S286957
Brian Gaffney, Alan P Jacobsen, Abhishek W Pallippattu, Niall Leahy, John W McEvoy

Purpose of review: The treatment of hypertension has changed dramatically over the last century, with recent trials informing clinical guidelines that recommend aiming for lower blood pressure (BP) targets than ever before. However, a "J"- or "U-shaped curve" in the association between diastolic BP and cardiovascular events has been observed in epidemiological studies, suggesting that both high diastolic BPs and diastolic BPs below a certain nadir are associated with higher risk of cardiovascular disease (CVD) events. Despite the potential for confounding and reverse causation, this association may caution against overly intensive BP lowering in some hypertensive adults who also have a low baseline diastolic BP.

Recent findings: Recent post-hoc analyses of the landmark Systolic Blood Pressure Intervention Trial (SPRINT) appear to contradict these J-curve concerns, finding that the benefit of more intensive BP treatment did not differ based on baseline blood pressure. Similarly, sensitivity analyses of The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) randomized controlled trial found that patients experienced similar benefits from an intensive BP goal, regardless of whether their diastolic BP was above or below 60 mm Hg. Finally, several Mendelian randomization analyses, which are less susceptible to confounding and reverse causation, demonstrated a clear linear relationship between diastolic BP and cardiovascular events. These studies indicate that a potential reduction in CVD risk is possible, irrespective of baseline diastolic BP values.

Summary: Sufficient recent evidence indicates that low diastolic BP is not causal of worse cardiovascular outcomes but rather represents confounding or reverse causation. Therefore, while low diastolic BP can be considered a marker of CVD risk, this risk is not expected to increase with further BP lowering when necessary to control concomitant elevations of systolic BP. Indeed, BP reduction in this setting appears beneficial.

综述目的:高血压的治疗在上个世纪发生了巨大变化,最近的试验为临床指南提供了依据,指南建议将目标血压(BP)定得比以往任何时候都低。然而,在流行病学研究中观察到,舒张压与心血管事件之间的关系呈 "J "形或 "U "形曲线,表明舒张压过高和舒张压低于某一最低点都与心血管疾病(CVD)事件的风险较高有关。尽管存在混淆和反向因果关系的可能性,但这种关联可能提醒人们,对于一些舒张压基线也较低的高血压成人,不要过度强化降压治疗:最近对具有里程碑意义的收缩压干预试验(SPRINT)进行的事后分析似乎与这些 J 型曲线的担忧相矛盾,分析发现,根据基线血压的不同,强化降压治疗的益处也不尽相同。同样,"老年高血压患者血压干预策略"(STEP)随机对照试验的敏感性分析也发现,无论患者的舒张压是高于还是低于 60 毫米汞柱,都能从强化降压目标中获得类似的益处。最后,几项不易受混杂因素和反向因果关系影响的孟德尔随机分析表明,舒张压与心血管事件之间存在明显的线性关系。这些研究表明,无论舒张压基线值如何,都有可能降低心血管疾病风险。小结:最近有足够的证据表明,舒张压过低并不是心血管疾病恶化的因果关系,而是混杂或反向因果关系。因此,尽管舒张压过低可被视为心血管疾病风险的一个标志,但在必要时进一步降低血压以控制同时出现的收缩压升高,预计这种风险不会增加。事实上,在这种情况下降低血压似乎是有益的。
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引用次数: 0
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Integrated Blood Pressure Control
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