Integrated Blood Pressure Control最新文献

Introduction: Hypertension is the leading cause of morbidity and mortality and accounts for 13% of all deaths and 7% of the disease burden in the world. Although the importance of controlling hypertension has been recognized for many years, the majority of patients with hypertension remain uncontrolled. Studies indicate a very low adherence to lifestyle modifications among patients in the study area. Hypertensive patients face set of problems associated with adherence to antihypertensive drugs and healthy lifestyle modifications.

Objective: The objective of the study was to explore barriers to hypertension treatment and control from healthcare workers' perspective and experiences at Dessie Referral Hospital, Ethiopia.

Methods: Seven healthcare workers actively involved in managing hypertensive individuals at Dessie Referral Hospital were recruited for the study. Participants were purposively selected from outpatient, inpatient, and pharmacy departments. The required data were collected by the principal investigator on exit interviews. An interview guide was developed by reviewing previous literature. Interviews were semi-structured, 8-20 minutes in duration, and designed to elicit healthcare workers'experiences and perceptions and conducted until data saturation was reached. All interviews were recorded, transcribed verbatim, and thematically analyzed. Each theme was supported by using the participants' quotes.

Results: Three themes emerged. The major barriers impacted patients' medication adherence and healthy lifestyle modifications were common use of diets during social settings, low level of awareness, lack of resources, misconceptions about hypertension, use of traditional medicines, inadequate physical activities, and high cost of drugs.

Conclusion: Patients' misconceptions about hypertension, common use of diets during festivals, and inadequate physical activities were factors associated with inadequate blood pressure control. Healthcare workers should better understand the problems that hypertensive patients' face, thus achieving better control.

Background: Preeclampsia causes striking maternal, fetal, and neonatal mortality and morbidity both in developed and developing countries. However, evidence of risk factors of preeclampsia is limited in the study area.

Objective: To identify determinants of preeclampsia among pregnant women attending antenatal care services in Ciro Referral Hospital, Ethiopia, 2020.

Methods: A facility-based unmatched case-control study was conducted from July 1 to July 30, 2020, in Chiro Referral Hospital on a sample size of 306 (ie, 76 cases and 230 controls; with a 1:3 ratio). Data were coded and entered into Epi Info version 7 and then exported to SPSS version 21 for analysis. The odds ratio was calculated with 95% confidence intervals to show the strength of association and p-value<0.05 was used to declare statistical significance.

Results: A total of 302 (75 cases and 227 controls) pregnant mothers were interviewed with a response rate of 98.7%. Being in the age group ≥35 years (AOR=4.00; 95% CI=1.25-12.80), rural residence (AOR=3.30; 95% CI=1.50-7.26), having a family history of hypertension (AOR=3.25; 95% CI=1.36-7.73), and being primigravida (AOR=3.71; 95% CI=1.49-9.22) were identified as risk factors for preeclampsia. However, consuming fruits more than 2-4 times per a week in their diet (AOR=0.38; 95% CI=0.15-0.98) was a protective predictor of preeclampsia.

Conclusion: Maternal age, residence, family history of hypertension, gravida, and frequency of fruit consumption were identified determinants of preeclampsia. Thus, healthcare providers should give emphasis for pregnant mothers in the older age category, primigravida, those who have a history of a family with hypertension, and those from a rural residence to diagnose the diseases as early as possible. Additionally, advising pregnant mothers attending antenatal care to consume fruits as early as possible in their daily diet reduces the risk of preeclampsia.

Background: Although the effectiveness of some combined anthropometric and metabolic scores were evaluated in hypertension prediction, none of them had addressed their accuracy in association with overweight/obese populations. This study examined the accuracy of several anthropometric parameters in this regard and compared the novel indices to the ancient ones.

Methods: Through a cross-sectional study, 5115 patients have been evaluated at the weight loss clinic. Data on demographic information, anthropometric indices, and biochemical measurements were assembled into a checklist. Multivariable regression modeling and the area under the receiver-operating characteristic (ROC) were analyzed using SPSS version 20. To find new combined scores, SEM (structural equation modeling) analysis was also adopted. P-values < 0.05 were considered statistically significant.

Results: Considering ancient indices, WHtR (waist-to-height ratio) showed a sufficient area under the curve in predicting hypertension among both genders concomitant with WC (waist circumference) in men, and BRI (body roundness index) in women as highest AUC. The highest odds ratio (OR) for the presence of hypertension, based on the age-adjusted model, was BRI in females (OR, 3.335; 95% confidence interval [CI], 1.58-7.28) and WC in males (OR, 13.478; 95% CI: 1.99-45.02). The combined scores were not superior to the single ones.

Conclusion: The most powerful association between hypertension and sufficient discrimination ability of normotensives from hypertensive patients was detected for BRI in women and WC among men. However, neither the BSI and BAI nor FMI and FFMI showed superiority to WC or WHtR in predicting the presence of hypertension.

In recent decades, both clinical and animal studies have shown that fetal growth restriction (FGR), caused by exposure to adverse uterine environments, is a risk factor for hypertension as well as for a variety of adult diseases. This observation has shaped and informed the now widely accepted theory of developmental origins of health and disease (DOHaD). There is a plethora of evidence supporting the association of FGR with increased risk of adult hypertension; however, the underlying mechanisms responsible for this correlation remain unclear. This review aims to explain the current advances in the field of fetal programming of hypertension and a brief narration of the underlying mechanisms that may link FGR to increased risk of adult hypertension. We explain the theory of DOHaD and then provide evidence from both clinical and basic science research which support the theory of fetal programming of adult hypertension. In addition, we have explored the underlying mechanisms that may link FGR to an increased risk of adult hypertension. These mechanisms include epigenetic changes, metabolic disorders, vascular dysfunction, neurohormonal impairment, and alterations in renal physiology and function. We further describe sex differences seen in the developmental origins of hypertension and provide insights into the opportunities and challenges present in this field.

Background: Orthostatic hypotension (OH) is defined as a fall in systolic blood pressure (SBP) ≥20 mmHg or diastolic BP (DBP) ≥10 mmHg within 3 minutes of standing. OH incidence is increased with hypertension, and management of these patients may pose challenges, as treatment of one can worsen the other.

Objective: This study aimed to determine the prevalence of OH and its associated factors among male hypertensive patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.

Methods: A hospital-based cross-sectional design was employed. Seated BP was measured twice and the average of the two taken. After BP had been stabilized for 5 minutes, SBP within 3 minutes of standing was measured twice and the minimum of the two taken. A drop of ≥20 mmHg in SBP within 3 minutes of standing was taken as OH. All male hypertensive patients who were able to attain a standing position were included. Sociodemographic, anthropometric, and clinical status of the patients were taken using structured interviewer-administered questionnaires. Data were entered and analyzed using SPSS 21. Both bivariate and multivariate logistic regression analysis were done. P≤0.05 was considered statistically significant.

Results: The median age of study participants was 57 (25-96) years. The prevalence of OH was 17.6%. Uncontrolled hypertension (adjusted OR 2.08, 95% CI 1.125-3.872) and duration of hypertension ≥5 years (adjusted OR 2.04, 95% CI 1.069-3.895) were significantly associated with OH in hypertensive patients.

Conclusion: The prevalence of OH among male hypertensive patients was high. Hypertensive patients whose BP was uncontrolled and having had hypertension ≥5 years were risk factors of OH.

Background: Worldwide mortality due to cardiovascular disease is the dominant cause of death, and ischemic heart disease is the leading one. Though risk factors for Ischemic heart diseases are modifiable and preventable, it is not well investigated in the local context. Thus, this study aimed to assess the dietary and behavioral risk factors for ischemic heart disease among patients in medical outpatient departments in Southern, Ethiopia.

Methods: A facility-based unmatched case-control study was conducted from November 16 to March 20, 2020, among patients with ischemic heart disease and those patients who visited the three hospitals of the Wolaita Zone. A convenient sampling method was used and the data were entered using Epi data version 3.1 and exported to SPSS version 21 for analysis, a p-value <0.05, were considered statistically significant.

Results: A total of 557 study participants (140 cases and 417 controls) were included in a ratio of 1:3. The adjusted odds ratio for having no formal education (AOR = 3.18; 95% CI: 1.59, 6.34), previous history of hypertension (AOR= 2.84; 95% CI: 1.73, 4.66), physical inactivity (AOR= 2.23; 95% CI: 1.32, 3.76), inadequate intake of fruit and vegetable consumption (AOR= 2.43; 95% CI; 1.40, 4,22), palm oil use for food preparation (AOR= 2.12; 95% CI: 1.23, 3.63) and obesity (AOR= 5.68; 95% CI: 2.63, 12.23) increased the occurrence of the disease.

Conclusion: Although ischemic heart disease is preventable, using relatively simple and inexpensive lifestyle changes, it is projected to cause preventable loss of life. So, expanding health education and healthy life styles including exercise is recommended.

Background: The causal relationship between systemic arterial hypertension and target organ damage (TOD) is well known, as well as the association with cardiovascular risk factors (CV). Ambulatory blood pressure monitoring (ABPM) is important in monitoring hypertension and assessing the risk of TOD.

Objective: To evaluate the relationship between blood pressure (BP) and clinical and biochemical parameters in the development of TOD in hypertensive patients.

Methods: This was a retrospective cohort study with 162 hypertensive patients followed for an average period of 13 years. The TOD investigated were left ventricular hypertrophy (LVH), microalbuminuria, coronary artery disease (CAD) and stroke. Blood pressure was assessed by ABPM and LVH using echocardiogram and electrocardiogram, respectively. Biochemical-metabolic tests and 24-hour microalbuminuria were performed at baseline and follow-up. The P-value <0.05 was considered significant.

Results: The average age was 69±11.8 years, with a predominance of women (64.8%), white ethnicity (79.6%) and diabetics (78.4%). ABPM showed a significant reduction in BP values during follow-up, although without association with TOD (microalbuminuria, stroke, and CAD), except for LVH that showed a correlation with sleep BP ≥120/70 mmHg (P=0.044). The most frequent TODs were LVH (29.6%), microalbuminuria (26.5%), CAD (19.8%) and stroke (17.3%). In the follow-up, there was an association between LVH and diabetes; microalbuminuria was associated with diabetes and triglycerides; stroke was associated with HDL-cholesterol (HDL-c), microalbuminuria and carotid disease. CAD showed a relationship with age and HDL-c.

Conclusion: Predictive factors for TOD are age, microalbuminuria, diabetes, HDL-c, triglycerides and carotid disease. Nocturnal BP is correlated with LVH. The absence of a relationship between ABPM and other TODs can be explained by the use of effective drugs, improvement of metabolic and blood pressure parameters.

Background: Globally, hypertension is becoming a serious problem affecting the health and wellbeing of the adult population. Anthropometric indices like body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) have long been utilized to screen hypertension; in contrast, other evidence indicates the superior utility of waist-to-height ratio (WHtR) to screen hypertension. There are inconclusive results from different studies done in different settings regarding the best screening index for hypertension. In addition, there is a paucity of information on the evaluation of anthropometric indices for screening hypertension in the study area. Therefore, this study evaluates the utility of anthropometric indices for screening hypertension among Mizan Tepi University employees, southwestern Ethiopia.

Methods: An institution-based cross-sectional study was conducted among Mizan Tepi University employees. A gender-based stratified simple random sampling technique was used to select 585 employees. Logistic regression analysis was conducted to assess the association between anthropometric indices and hypertension. Receiver operating characteristic curve (ROC) was employed to evaluate anthropometric indices for screening hypertension, and optimal cutoff points were also developed based on Youden index (sensitivity + specificity - 1) and presented with sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV).

Results: The overall prevalence of hypertension was 20.9%, which was 22.5% in males and 18.7% in females. Among males, WHtR, WHR, and BMI were significantly associated with hypertension, while, in females, only BMI was associated with hypertension. WHtR had a higher screening ability for hypertension followed by WC in both sexes. For males, the cutoff point for WHR, WC, BMI, and WHtR for screening hypertension was 0.897, 85.17cm, 24.6kg/m², and 0.51, respectively. In females, the cutoff point developed for screening hypertension for WHR, WC, BMI, and WHtR were 0.92, 85.67cm, 24.8kg/m², and 0.52, respectively.

Conclusion: The waist-to-height ratio was found to be the best obesity index to screen hypertension than BMI, WC, and WHR. The finding supports the use of WHtR for screening hypertension in resource-limited settings.

Background: Left anterior descending artery (LAD) is the most common occluded vessel in a patient presenting with acute anterior wall ST-segment elevated myocardial infarction (STEMI). Acute occlusion of LAD usually results in hemodynamic compromise. However, some patients maintain hemodynamic stability despite its proximal occlusion. As the factors associated with hemodynamic status in such patients are poorly understood, our study sought to determine the clinical and angiographic parameters associated with hemodynamic stability in these patients.

Methods: In this prospective observational study, 60 consecutive patients of acute anterior wall STEMI with completely occluded LAD on coronary angiography were included. Various clinical and angiographic parameters associated with hemodynamic status were evaluated.

Results: Of the 60 patients, 30 patients each were included in the hemodynamically stable (group I) and hemodynamically unstable group (group II). The mean age of the patients in group I and group II was 51.07±13.78 years and 55.47±11.69 years, respectively. The hemodynamically unstable group had a significantly higher number of patients with diabetes mellitus, elevated Troponin T level, and lower left ventricular ejection fraction as compared to the stable group (p<0.05). In contrast, 11 (36.7%) patients in the hemodynamically stable group had rich collaterals compared to 4 (13.3%) patients in the hemodynamically unstable group. The difference was statistically significant (p=0.037).

Conclusion: The present study showed that the presence of diabetes, severe LV systolic dysfunction, elevated Troponin-T level, and poor collaterals were associated with hemodynamic instability, whereas the presence of better collaterals predicted hemodynamic stability in patients presenting with anterior wall STEMI and total LAD occlusion.

[This corrects the article DOI: 10.2147/IBPC.S293251.].