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Epidemiology of Hypertension in Ethiopia: A Systematic Review. 埃塞俄比亚高血压流行病学:一项系统综述。
IF 2.2 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-10-15 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S276089
Nanati Legese, Yohannes Tadiwos

Background: Hypertension is one of the leading causes of disease in the world. This study is a systematic review paper, intended to provide compressive evidence on the prevalence, distribution, determinants, and burden of hypertension in Ethiopia.

Methods: A quantitative epidemiological literature review was conducted by searching different articles in different databases, including PubMed, Cochrane, and Google scholar. The search involved population-based, hospital-based, and institution-based studies on hypertension conducted in Ethiopia. All data were extracted independently by two reviewers using data collection formats. Finally, this review included 22 studies.

Results: Different studies reported varied prevalence of hypertension because of the differences in participant's mean ages, source population, and study settings. Population-based studies revealed the prevalence of hypertension to be 9.3-30.3%, institution-based studies revealed 7-37%, whereas hospital-based studies revealed 13.2-18.8%. In studies included in this review, about 37-78% of hypertensive patients were not aware of their blood pressure condition. There was a high prevalence of hypertension in urban residents, and different factors were associated with hypertension, including being overweight, family history of hypertension, age, sex, diabetes mellitus, alcohol intake, physical inactivity, and obesity.

Conclusion and recommendation: Hypertension was substantially prevalent in Ethiopia, which calls for the implementation of timely and appropriate strategies for the prevention and control of the disease.

背景:高血压是世界上最主要的疾病之一。本研究是一篇系统综述论文,旨在提供关于埃塞俄比亚高血压患病率、分布、决定因素和负担的有力证据。方法:通过检索PubMed、Cochrane、Google scholar等不同数据库的不同文章,进行定量流行病学文献综述。检索包括在埃塞俄比亚进行的基于人群、基于医院和基于机构的高血压研究。所有数据均由两位审稿人使用数据收集格式独立提取。最后,本综述纳入了22项研究。结果:由于参与者的平均年龄、源人群和研究环境的差异,不同的研究报告了不同的高血压患病率。基于人群的研究显示高血压患病率为9.3-30.3%,基于机构的研究显示为7-37%,而基于医院的研究显示为13.2-18.8%。在本综述纳入的研究中,约37-78%的高血压患者没有意识到自己的血压状况。城市居民高血压患病率较高,与高血压相关的因素有:超重、高血压家族史、年龄、性别、糖尿病、饮酒、缺乏运动、肥胖等。结论和建议:高血压在埃塞俄比亚相当普遍,因此需要及时实施适当的战略,预防和控制这一疾病。
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引用次数: 27
Aortic Stiffness and Diastolic Dysfunction in Sprague Dawley Rats Consuming Short-Term Fructose Plus High Salt Diet. 短期果糖加高盐饮食对大鼠主动脉僵硬和舒张功能障碍的影响。
IF 2.2 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-09-28 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S257205
Dragana Komnenov, Peter E Levanovich, Natalia Perecki, Charles S Chung, Noreen F Rossi

Introduction: High fructose and salt consumption continues to be prevalent in western society. Existing studies show that a rat model reflecting a diet of fructose and salt consumed by the upper 20th percentile of the human population results in salt-sensitive hypertension mitigated by treatment with an antioxidant. We hypothesized that dietary fructose, rather than glucose, combined with high salt leads to aortic stiffening and decreased renal artery compliance. We also expect that daily supplementation with the antioxidant, 4-hydroxy-2,2,6,6-tetramethylpiperidine-1-oxyl (+T; Tempol), will ameliorate the increase in mean arterial pressure (MAP) and vascular changes.

Methods: Male Sprague Dawley rats were studied with either 20% fructose or 20% glucose in the drinking water and normal salt (0.4%) or high salt (4%) in the chow resulting in four dietary groups: fructose normal Fru+NS or high salt (Fru+HS) or glucose with normal (Glu+NS) or high salt (Glu+HS). Tempol (+T) was added to the drinking water in half of the rats in each group for 3 weeks.

Results: MAP was significantly elevated and the glucose:insulin ratio was depressed in the Fru+HS. Both parameters were normalized in Fru+HS+T. Plasma renin activity (PRA) and kidney tissue angiotensin II (Ang II) were not suppressed in the high salt groups. Pulse wave velocity (PWV), radial ascending strain, and distensibility coefficient of the ascending aorta were significantly decreased in Fru+HS rats and improved in the Fru+HS+T rats. No differences occurred in left ventricular systolic function, but the ratio of early (E) to late (A) transmitral filling velocities was decreased and renal resistive index (RRI) was higher in Fru+HS rats; antioxidant treatment did not change these indices.

Discussion: Thus, short-term consumption of high fructose plus high salt diet by rats results in modest hypertension, insulin resistance, diminished aortic and renal artery compliance, and left ventricular diastolic dysfunction. Antioxidant treatment ameliorates the blood pressure, insulin resistance and aortic stiffness, but not renal artery stiffness and left ventricular diastolic dysfunction.

引言:高果糖和高盐的摄入在西方社会仍然很普遍。现有的研究表明,一个大鼠模型反映了20百分位以上的人群摄入果糖和盐的饮食导致盐敏感性高血压,用抗氧化剂治疗可以减轻这种高血压。我们假设饮食中的果糖,而不是葡萄糖,结合高盐导致主动脉硬化和肾动脉顺应性降低。我们还期望每天补充抗氧化剂,4-羟基-2,2,6,6-四甲基哌啶-1-氧(+T;Tempol),将改善平均动脉压(MAP)升高和血管变化。方法:雄性斯普拉格·道利大鼠分别在饮水中添加20%果糖或20%葡萄糖,并在饲料中添加正常盐(0.4%)或高盐(4%),将其分为四组:果糖正常Fru+NS或高盐(Fru+HS)或葡萄糖正常(Glu+NS)或高盐(Glu+HS)。每组半数大鼠在饮水中加入天宝(+T),连续3周。结果:Fru+HS组MAP明显升高,葡萄糖胰岛素比明显降低。两个参数均归一化为Fru+HS+T。高盐组血浆肾素活性(PRA)和肾组织血管紧张素II (Ang II)未受抑制。Fru+HS大鼠的脉波速度(PWV)、径向上升应变、升主动脉扩张系数显著降低,Fru+HS+T大鼠的升主动脉扩张系数显著提高。Fru+HS大鼠左室收缩功能无差异,但早期(E)与晚期(A)递质充盈速度之比降低,肾阻力指数(RRI)升高;抗氧化处理对上述指标无明显影响。讨论:因此,大鼠短期食用高果糖加高盐饮食会导致中度高血压、胰岛素抵抗、主动脉和肾动脉顺应性降低以及左室舒张功能障碍。抗氧化治疗可改善血压、胰岛素抵抗和主动脉僵硬,但不能改善肾动脉僵硬和左心室舒张功能障碍。
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引用次数: 6
Approaches to the Management of Hypertension in Resource-Limited Settings: Strategies to Overcome the Hypertension Crisis in the Post-COVID Era. 资源有限环境下高血压管理的途径:克服后covid时代高血压危机的策略
IF 2.2 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-09-28 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S261031
Jamario Skeete, Kenneth Connell, Pedro Ordunez, Donald J DiPette

The COVID-19 pandemic has changed most aspects of everyday life in both the non-medical and medical settings. In the medical world, the pandemic has altered how healthcare is delivered and has necessitated an aggressive and new coordinated public health approach to limit its spread and reduce its disease burden and socioeconomic impact. This pandemic has resulted in a staggering morbidity and mortality and massive economic and physical hardships. Meanwhile, non-communicable diseases such as hypertension, diabetes mellitus, and cardiovascular disease in general continue to cause significant disease burden globally in the background. Though presently receiving less attention in the public eye than the COVID-19 pandemic, the hypertension crisis cannot be separated from the minds of healthcare providers, policymakers and the general public, as it continues to wreak havoc, particularly in vulnerable populations in resource limited settings. On this background, many of the strategies being employed to combat the COVID-19 pandemic can be used to re-energize and galvanize the fight against hypertension and hopefully bring the public health crisis associated with uncontrolled hypertension to an end.

2019冠状病毒病大流行改变了非医疗和医疗环境中日常生活的大多数方面。在医学界,大流行改变了提供医疗保健的方式,需要采取积极和协调一致的新公共卫生办法,以限制其传播,减少疾病负担和社会经济影响。这一流行病造成了惊人的发病率和死亡率以及巨大的经济和物质困难。与此同时,高血压、糖尿病和一般心血管疾病等非传染性疾病继续在全球范围内造成重大疾病负担。尽管目前公众对高血压危机的关注程度不如COVID-19大流行,但高血压危机仍在医疗服务提供者、政策制定者和公众的脑海中挥之不去,因为它继续造成严重破坏,特别是在资源有限的环境中对弱势群体造成严重破坏。在此背景下,许多用于抗击COVID-19大流行的战略可用于重振和激励防治高血压的斗争,并有望结束与不受控制的高血压相关的公共卫生危机。
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引用次数: 15
Admission and Inpatient Mortality of Hypertension Complications in Addis Ababa. 亚的斯亚贝巴高血压并发症的入院和住院死亡率。
IF 2.2 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-09-16 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S268184
Abayneh Birlie Zeru, Mikyas Arega Muluneh

Background: The number of people with undiagnosed, untreated, and uncontrolled hypertension is higher in Ethiopia. This in turn increases the risk of developing complications and hospitalization. This study aimed to assess the prevalence of hypertension complication hospitalization among medical admissions and admission outcomes of hypertension complication patients in the medical ward of Saint Peter Specialized Hospital, Addis Ababa.

Methods: We used a hospital-based cross-sectional study. Data were collected by reviewing all medical ward admission logbook records from January 1st, 2018 to December 30th, 2019. An individual patient folder of 308 patients admitted due to hypertension complications was selected for further detailed investigation and then entered into Epi Data version 3.1 and exported to SPSS version 24 statistical software for analysis.

Results: Of the total 2728 medical admissions, 308 (11.3%) were patients with hypertension complications. Hypertension complications account for 308 (11.3%) of all medical admissions. Their mean age and length of hospital stay were 59.85 (± 16.36) years and 11.45 (± 11.48) days, respectively. Near to two-third of 196 (63.6%) of them were stroke patients followed by 76 (24.7%) heart disease. Fifty-two (16.9%) hypertension complication patients died at admission which accounts for 52 (14.6%) of all medical ward deaths. As age increases, the risk of death at admission increases by 6.5%. Similarly, the risk of death increased by three-fold for a month increase in the duration of anti-hypertensive drug discontinuation. Rural residents had a 3.5% lesser risk of death than urban patients.

Conclusion: Hypertension complications had a significant share of the medical ward mortality rate. Cerebrovascular and cardiovascular complications were common causes of hospitalization and inpatient death. Old age, urban residence, and prolonged duration of anti-hypertensive drug discontinuation increased the risk of death at admission.

背景:在埃塞俄比亚,未确诊、未治疗和未控制的高血压人数较高。这反过来又增加了发生并发症和住院的风险。本研究旨在评估亚的斯亚贝巴圣彼得专科医院内科病房高血压并发症住院的患病率和高血压并发症患者的入院结果。方法:我们采用以医院为基础的横断面研究。通过查阅2018年1月1日至2019年12月30日所有住院日志记录收集数据。选取308例因高血压合并症入院患者的个体患者文件夹进行进一步详细调查,输入Epi Data 3.1版,导出到SPSS 24版统计软件进行分析。结果:2728例住院患者中,合并高血压并发症308例(11.3%)。高血压并发症占所有住院病人的308例(11.3%)。患者平均年龄59.85(±16.36)岁,平均住院时间11.45(±11.48)天。196名患者中近三分之二(63.6%)是中风患者,其次是76名(24.7%)心脏病患者。入院时高血压并发症死亡52例(16.9%),占住院总死亡52例(14.6%)。随着年龄的增长,入院时的死亡风险增加6.5%。同样,停止服用降压药的时间每延长一个月,死亡风险增加三倍。农村居民的死亡风险比城市患者低3.5%。结论:高血压并发症在内科病房死亡率中占有重要的份额。脑血管和心血管并发症是住院和住院患者死亡的常见原因。老年、城市居住和抗高血压药物停药时间延长增加了入院时的死亡风险。
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引用次数: 10
Prevalence of Hypertensive Emergency and Associated Factors Among Hospitalized Patients with Hypertensive Crisis: A Retrospective Cross-Sectional Study. 住院高血压危象患者高血压急症患病率及相关因素:一项回顾性横断面研究
IF 2.2 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-08-18 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S265183
Desilu Mahari Desta, Dawit Zewdu Wondafrash, Afewerki Gebremeskel Tsadik, Gebremicheal Gebreslassie Kasahun, Segen Tassew, Teklu Gebrehiwot, Solomon Weldegebreal Asgedom

Background: Hypertensive emergency (HE) is an acute stage of uncontrolled blood pressure which poses a substantial cardiovascular morbidity and mortality in developing countries. In our setting, the prevalence of HE and the characteristics of patients with a hypertensive crisis are not certainly known yet.

Objective: The study assessed the prevalence of hypertensive emergency and associated factors among hospitalized patients with hypertensive crisis.

Methods: A retrospective cross-sectional study was conducted by reviewing records of patients having a diagnosis of hypertensive crisis with systolic/diastolic blood pressure raised to more than 180/120 mmHg admitted to Ayder Comprehensive Specialized Hospital (ACSH) from September 2018 to August 2019. Patients' medical records with complete information were enrolled consecutively. Socio-demographic, clinical characteristics, and other related variables were collected using a structured data collection tool from patient medical records. Data were entered and analyzed using SPSS version 20. Logistic regression was employed to determine factors associated with HE.

Results: A total of 141 patients' records with a diagnosis of a hypertensive crisis were enrolled in the study; the majority were females 77 (54.6%) and residing in the urban setting 104 (73.8%). The mean age of the participants was 58.8 years. HE was found in 42 (29.8%) of patients. Intravenous Hydralazine 39 (27.7%) and oral calcium channel blocker 102 (72.3%) were the prescribed drugs for acute blood pressure reduction in the emergency setting. Surprisingly, patients who had no history of hypertension (adjusted odds ratio (AOR)=2.469; 95% confidence interval (CI): 0.176‒0.933) and female sex (AOR=2.494; 95% CI: 1.111‒5.596) were found to be independently associated factors with HE.

Conclusion: The prevalence of HE was found to account a significant proportion of patients. Hence, hypertensive patients should be strictly managed accordingly, and promoting screening programs could reduce the risk of target organ damage.

背景:高血压急症(HE)是血压不受控制的急性阶段,在发展中国家造成大量心血管疾病发病率和死亡率。在我们的环境中,HE的患病率和高血压危象患者的特征尚不清楚。目的:了解高血压危象住院患者的高血压急症发生率及相关因素。方法:回顾性分析2018年9月至2019年8月在艾德尔综合专科医院(ACSH)住院的收缩压/舒张压升高至180/120 mmHg以上的高血压危重患者的记录,进行横断面研究。连续入组信息完整的患者病历。使用结构化数据收集工具从患者病历中收集社会人口统计学、临床特征和其他相关变量。数据输入和分析使用SPSS版本20。采用Logistic回归确定与HE相关的因素。结果:共有141例诊断为高血压危象的患者被纳入研究;以女性77例(54.6%)为主,居住在城市104例(73.8%)。参与者的平均年龄为58.8岁。42例(29.8%)患者发现HE。静脉滴注肼39(27.7%)和口服钙通道阻滞剂102(72.3%)是急诊急性降压的处方药物。令人惊讶的是,没有高血压史的患者(调整优势比(AOR)=2.469;95%置信区间(CI): 0.176-0.933)和女性(AOR=2.494;95% CI: 1.111-5.596)是HE的独立相关因素。结论:HE患病率占患者的显著比例。因此,高血压患者应严格管理,并推广筛查计划,以降低靶器官损害的风险。
{"title":"Prevalence of Hypertensive Emergency and Associated Factors Among Hospitalized Patients with Hypertensive Crisis: A Retrospective Cross-Sectional Study.","authors":"Desilu Mahari Desta,&nbsp;Dawit Zewdu Wondafrash,&nbsp;Afewerki Gebremeskel Tsadik,&nbsp;Gebremicheal Gebreslassie Kasahun,&nbsp;Segen Tassew,&nbsp;Teklu Gebrehiwot,&nbsp;Solomon Weldegebreal Asgedom","doi":"10.2147/IBPC.S265183","DOIUrl":"https://doi.org/10.2147/IBPC.S265183","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive emergency (HE) is an acute stage of uncontrolled blood pressure which poses a substantial cardiovascular morbidity and mortality in developing countries. In our setting, the prevalence of HE and the characteristics of patients with a hypertensive crisis are not certainly known yet.</p><p><strong>Objective: </strong>The study assessed the prevalence of hypertensive emergency and associated factors among hospitalized patients with hypertensive crisis.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted by reviewing records of patients having a diagnosis of hypertensive crisis with systolic/diastolic blood pressure raised to more than 180/120 mmHg admitted to Ayder Comprehensive Specialized Hospital (ACSH) from September 2018 to August 2019. Patients' medical records with complete information were enrolled consecutively. Socio-demographic, clinical characteristics, and other related variables were collected using a structured data collection tool from patient medical records. Data were entered and analyzed using SPSS version 20. Logistic regression was employed to determine factors associated with HE.</p><p><strong>Results: </strong>A total of 141 patients' records with a diagnosis of a hypertensive crisis were enrolled in the study; the majority were females 77 (54.6%) and residing in the urban setting 104 (73.8%). The mean age of the participants was 58.8 years. HE was found in 42 (29.8%) of patients. Intravenous Hydralazine 39 (27.7%) and oral calcium channel blocker 102 (72.3%) were the prescribed drugs for acute blood pressure reduction in the emergency setting. Surprisingly, patients who had no history of hypertension (adjusted odds ratio (AOR)=2.469; 95% confidence interval (CI): 0.176‒0.933) and female sex (AOR=2.494; 95% CI: 1.111‒5.596) were found to be independently associated factors with HE.</p><p><strong>Conclusion: </strong>The prevalence of HE was found to account a significant proportion of patients. Hence, hypertensive patients should be strictly managed accordingly, and promoting screening programs could reduce the risk of target organ damage.</p>","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":"13 ","pages":"95-102"},"PeriodicalIF":2.2,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/IBPC.S265183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38359643","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: 11
Resistant Hypertension: Where are We Now and Where Do We Go from Here? 抵抗性高血压:我们的现状与未来?
IF 1.5 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-08-05 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S223334
Mansur K Pathan, Debbie L Cohen

Resistant hypertension is an important subtype of hypertension that leads to an increased risk of cerebrovascular, cardiovascular, and kidney disease. The revised guidelines from the American College of Cardiology and American Heart Association now define resistant hypertension as blood pressure that remains above goal despite use of three maximally titrated anti-hypertensive medications including a diuretic or as a hypertensive patient who requires 4 or more agents for adequate BP control. These agents typically include a calcium-channel blocker, a renin-angiotensin system inhibitor, and a diuretic at maximal or maximally tolerated doses. As recognition of resistant hypertension increases, it is important to distinguish pseudo-resistant or apparent hypertension from true resistant hypertension. Etiologies of apparent resistant hypertension include measurement error and medication non-adherence. The prevalence of true resistant hypertension is likely much lower than reported in the literature when accounting for patients with apparent resistant hypertension. Evaluation of patients with true resistant hypertension includes screening for causes of secondary hypertension and interfering medications. Successful management of resistant hypertension includes lifestyle modification and optimization of medical therapy, often including the use of mineralocorticoid receptor antagonists. Looking ahead at developments in hypertension management, a slew of new device-based therapies are under active development. Of these, renal denervation is the closest to routine clinical application. Further study is needed before these devices can be recommended in the routine treatment of resistant hypertension.

抵抗性高血压是高血压的一个重要亚型,会导致脑血管、心血管和肾脏疾病的风险增加。美国心脏病学会和美国心脏协会修订后的指南现在将耐药性高血压定义为,尽管使用了包括利尿剂在内的三种最大剂量的抗高血压药物,血压仍高于目标值,或者高血压患者需要使用四种或更多药物才能充分控制血压。这些药物通常包括最大剂量或最大耐受剂量的钙通道阻滞剂、肾素-血管紧张素系统抑制剂和利尿剂。随着对抵抗性高血压认识的提高,必须将假性抵抗性高血压或表观高血压与真正的抵抗性高血压区分开来。表观抵抗性高血压的病因包括测量误差和不遵医嘱用药。如果将表面抵抗性高血压患者计算在内,真正抵抗性高血压的患病率可能比文献报道的要低得多。对真正的抵抗性高血压患者的评估包括筛查继发性高血压的病因和干扰药物。成功治疗抵抗性高血压的方法包括改变生活方式和优化药物治疗,通常包括使用矿物质皮质激素受体拮抗剂。展望高血压治疗的未来发展,一系列基于设备的新疗法正在积极开发中。其中,肾脏神经支配是最接近常规临床应用的疗法。在推荐将这些设备用于抵抗性高血压的常规治疗之前,还需要进一步的研究。
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引用次数: 0
Renal Artery Stenosis in the Patient with Hypertension: Prevalence, Impact and Management. 高血压患者肾动脉狭窄:患病率、影响和管理。
IF 2.2 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-06-02 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S248579
Rohini Manaktala, Jose D Tafur-Soto, Christopher J White

Atherosclerosis is the primary cause of renal artery stenosis. Atherosclerotic renal artery stenosis (ARAS) is associated with three clinical problems: renovascular hypertension, ischemic nephropathy and cardiac destabilization syndrome which pose huge healthcare implications. There is a significant rate of natural disease progression with worsening severity of renal artery stenosis when renal revascularization is not pursued in a timely manner. Selective sub-groups of individuals with ARAS have had good outcomes after percutaneous renal artery stenting (PTRAS). For example, individuals that underwent PTRAS and had improved renal function were reported to have a 45% survival advantage compared to those without improvement in their renal function. Advances in the imaging tools have allowed for better anatomic and physiologic measurements of ARAS. Measuring translesional hemodynamic gradients has allowed for accurate assessment of ARAS severity. Renal revascularization with PTRAS provides a survival advantage in individuals with significant hemodynamic renal artery stenosis lesions. It is important that we screen, diagnosis, intervene with invasive and medical treatments appropriately in these high-risk patients.

动脉粥样硬化是肾动脉狭窄的主要原因。动脉粥样硬化性肾动脉狭窄(ARAS)与肾血管性高血压、缺血性肾病和心脏不稳定综合征相关,具有重要的临床意义。如果不及时进行肾血运重建术,随着肾动脉狭窄严重程度的加重,疾病自然进展的几率很大。经皮肾动脉支架置入术(PTRAS)后,ARAS患者的选择性亚组有良好的预后。例如,据报道,与肾功能未改善的患者相比,接受PTRAS并改善肾功能的个体有45%的生存优势。成像工具的进步使得对ARAS进行更好的解剖和生理测量成为可能。测量横截面血流动力学梯度可以准确评估ARAS的严重程度。PTRAS肾血运重建术为肾动脉血流动力学狭窄患者提供了生存优势。对这些高危患者进行筛查、诊断、干预和适当的医学治疗是很重要的。
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引用次数: 13
Magnitude and Determinants of Uncontrolled Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Nekemte Referral Hospital, Western Ethiopia. 在埃塞俄比亚西部Nekemte转诊医院随访的成年高血压患者中血压失控的幅度和决定因素
IF 2.2 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-04-21 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S245068
Ginenus Fekadu, Abdi Adamu, Mohammed Gebre, Busha Gamachu, Firomsa Bekele, Muktar Abadiga, Getu Mosisa, Adugna Oluma

Background: Hypertension is the leading cause of morbidity and mortality among non-communicable diseases. The rate of blood pressure (BP) control among hypertensive patients is poor and the reasons for poor control of BP remain poorly understood globally. Therefore, this study aimed to assess the magnitude and determinants of uncontrolled blood pressure among adult hypertensive patients on follow-up at Nekemte referral hospital (NRH).

Methods: A hospital-based cross-sectional study was conducted from February to April 2018 at NRH. BP control status was determined by the average consecutive BP recordings across the 3 months. The data was entered and analyzed using SPSS version 20.0 and p-value <0.05 was considered statistically significant.

Results: Out of 297 study participants included, the majority were females, 181 (60.9%), and the mean age of the patients was 59.4 ±10.4 years. About half, 137 (46.12%), of the patients had at least one comorbidity and the most common class of anti-hypertensive medication was angiotensin-converting enzyme inhibitors (88.2%). The mean of systolic blood pressure was 132.41± 15.61mmHg, while the mean of diastolic blood pressure was 84.37± 9.32 mmHg. The proportion of participants with optimally controlled BP was 63.6% and 36% were adherent to their medications. Male sex (Adjusted Odd Ratio [AOR]: 1.89, 95% CI: 1.09-4.84), illiteracy (AOR= 1.56, 95% CI: 1.22-6.78), duration of hypertension diagnosis > 10 years (AOR= 2.01, 95% CI: 1.04-16.11), non-adherence (AOR= 3.14, 95% CI: 1.35-10.76) and lack of physical exercise (AOR= 2.8, 95% CI: 1.16-6.74) were positively associated with uncontrolled BP status. Whereas age older than 55 years (AOR= 0.38, 95% CI: 0.11-0.92) was negatively associated with uncontrolled BP.

Conclusion: BP control was relatively achieved in about two-third of pharmacologically treated patients. We recommend better health education and care of patients to improve the rate of BP control status.

背景:高血压是非传染性疾病中发病和死亡的主要原因。高血压患者的血压控制率较低,而血压控制不佳的原因在全球范围内仍然知之甚少。因此,本研究旨在评估Nekemte转诊医院(NRH)随访的成年高血压患者血压失控的程度和决定因素。方法:2018年2月至4月在NRH进行了一项以医院为基础的横断面研究。通过3个月的平均连续血压记录来确定血压控制状态。使用SPSS 20.0版本和p值对数据进行输入和分析。结果:在纳入的297名研究参与者中,大多数为女性,181名(60.9%),患者的平均年龄为59.4±10.4岁。约一半,137例(46.12%)患者至少有一种合并症,最常见的降压药物是血管紧张素转换酶抑制剂(88.2%)。收缩压平均值为132.41±15.61mmHg,舒张压平均值为84.37±9.32 mmHg。血压得到最佳控制的比例为63.6%,坚持服药的比例为36%。男性(调整后的奇比[AOR]: 1.89, 95% CI: 1.09-4.84)、文盲(AOR= 1.56, 95% CI: 1.22-6.78)、高血压诊断持续时间> 10年(AOR= 2.01, 95% CI: 1.04-16.11)、不坚持(AOR= 3.14, 95% CI: 1.35-10.76)和缺乏体育锻炼(AOR= 2.8, 95% CI: 1.16-6.74)与未控制的血压状态呈正相关。而年龄大于55岁(AOR= 0.38, 95% CI: 0.11-0.92)与未控制的BP呈负相关。结论:约三分之二的药物治疗患者血压控制相对较好。我们建议加强对患者的健康教育和护理,以提高血压控制率。
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引用次数: 8
Isolated Nocturnal Hypertension: What Do We Know and What Can We Do? 孤立性夜间高血压:我们知道什么,我们能做什么?
IF 2.2 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-04-21 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S223336
Marijana Tadic, Cesare Cuspidi, Guido Grassi, Giuseppe Mancia

Nocturnal hypertension has been recognized as a significant risk factor for cardio- and cerebrovascular diseases. Blood pressure (BP) monitoring significantly increased our awareness of nocturnal hypertension and studies revealed its influence on target organ damage. Nocturnal hypertension is associated with nonphysiological 24-h BP patterns, which consider inadequate drop or even increment of nighttime BP in comparison with daytime BP (nondipping and reverse dipping). Nevertheless, investigations showed that nocturnal hypertension was a predictor of adverse outcome independently of circadian BP pattern. There are still many uncertainties regarding diagnosis, mechanisms and treatment of nocturnal hypertension. There is a small difference between American and European guidelines in cutoff values defining nocturnal hypertension. Pathophysiology is also not clear because many conditions such as diabetes, metabolic syndrome, obesity, sleep apnea syndrome, and renal diseases are related to nocturnal hypertension and nonphysiological circadian BP pattern, but mechanisms of nocturnal hypertension still remain speculative. Therapeutic approach is another important issue and chronotherapy provided the best results so far. There are studies which showed that some groups of antihypertensive medications are more effective in regulation of nocturnal BP, but it seems that the timing of drug administration has a crucial role in the reduction of nighttime BP and conversion of circadian patterns from nonphysiologic to physiologic. Follow-up studies are necessary to define clinical benefits of nocturnal BP reduction and restoring unfavorable 24-h BP variations to physiological variant.

夜间高血压已被认为是心脑血管疾病的重要危险因素。血压监测显著提高了我们对夜间高血压的认识,研究揭示了它对靶器官损伤的影响。夜间高血压与非生理性的24小时血压模式有关,这种模式认为夜间血压与白天相比下降甚至增加不足(非下降和反向下降)。然而,调查显示夜间高血压是一个独立于昼夜血压模式的不良预后预测因子。关于夜间高血压的诊断、机制和治疗仍有许多不确定因素。在定义夜间高血压的临界值上,美国和欧洲的指南有细微差别。由于许多疾病如糖尿病、代谢综合征、肥胖、睡眠呼吸暂停综合征和肾脏疾病都与夜间高血压和非生理性昼夜血压模式有关,病理生理学也不清楚,但夜间高血压的机制仍然是推测性的。治疗方法是另一个重要的问题,时间疗法提供了迄今为止最好的结果。有研究表明,一些抗高血压药物组在调节夜间血压方面更有效,但似乎药物给药的时间在夜间血压的降低和昼夜节律模式从非生理性向生理性的转化中起着至关重要的作用。有必要进行随访研究,以确定夜间血压降低和将不利的24小时血压变化恢复为生理变化的临床益处。
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引用次数: 18
Comparison of Ambulatory Tonometric and Oscillometric Blood Pressure Monitoring in Hypertensive Patients. 高血压患者动态血压计与振荡血压监测的比较。
IF 2.2 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2020-03-30 eCollection Date: 2020-01-01 DOI: 10.2147/IBPC.S235228
Bodil Gade Hornstrup, Jeppe Bakkestrøm Rosenbæk, Jesper Nørgaard Bech

Aim: Correct measurement of blood pressure (BP) is important for optimal diagnosis and treatment of patients with hypertension. The aim of this study was to compare a wrist-worn device using tonometric measurements of BP to a conventional device using oscillometric measurements of 24 h BP, diagnosing of hypertension, and non-dipping.

Methods: One-hundred patients in the Renal Outpatient Clinic had 24 h ambulatory BP monitoring performed with a tonometric device, BPro, and an oscillometric device, A&D, simultaneously.

Results: Twenty-four-hour and daytime systolic BP was significantly lower using tonometric monitoring compared to oscillometric (7 and 6 mmHg, respectively, p< 0.001). In the population of patients diagnosed with hypertension, the tonometric device diagnosed 90% of patients with uncontrolled hypertension correctly (positive predictive value), whereas 49% of patients classified as normotensive were uncontrolled hypertensive (negative predictive value). The mean difference between relative nocturnal BP decrease between tonometric and oscillometric was 2±8% (p< 0.01), and 33% of patients classified as dippers were non-dippers (negative predictive value).

Conclusion: Using the BPro device for tonometric monitoring of BP and classification of hypertension and non-dipping in patients diagnosed with hypertension leads to misclassification of patients. Therefore, the BPro device is not suitable for clinical practice in hypertensive patients from a Renal Outpatient Clinic.

目的:正确测量血压对高血压患者的诊断和治疗具有重要意义。本研究的目的是比较一种腕戴式血压测量装置和一种常规装置,采用24小时血压的振荡测量、高血压诊断和非浸入。方法:100例肾科门诊患者同时使用血压计BPro和示波仪A&D进行24 h动态血压监测。结果:使用血压计监测24小时和白天收缩压明显低于振荡测量(分别为7和6 mmHg, p< 0.001)。在被诊断为高血压的患者人群中,血压计正确诊断出90%未控制的高血压患者(阳性预测值),而49%被归类为血压正常的患者为未控制的高血压(阴性预测值)。血压计与示波计夜间相对血压下降的平均差异为2±8% (p< 0.01), 33%的患者被归为倾斜者而非倾斜者(阴性预测值)。结论:在诊断为高血压的患者中,使用BPro血压计监测血压,并将其分为高血压和非高血压,会导致患者的误分。因此,BPro装置不适合用于肾门诊高血压患者的临床实践。
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引用次数: 6
期刊
Integrated Blood Pressure Control
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