Integrated Blood Pressure Control最新文献

Systemic sclerosis (SSc) is a rare and complex immune-mediated connective tissue disease characterized by multi-organ fibrosis and dysfunction. Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is a leading cause of death in this population. Pulmonary arterial hypertension (PAH) can coexist with other forms of pulmonary hypertension in SSc, including pulmonary hypertension related to left heart disease, interstitial lung disease, chronic thromboembolism and pulmonary venous occlusive disease, which further complicates diagnosis and management. Available pulmonary arterial hypertension therapies target the nitric oxide, endothelin and prostacyclin pathways. These therapies have been studied in SSc-PAH in addition to idiopathic PAH, often with different treatment responses. In this article, we discuss the management as well as the treatment options for patients with SSc-PAH.

Background: Hypertension and depression are among the most common public health issues affecting the population around the world. Like patients with other chronic medical conditions, hypertensive patients experience many intense emotions which increase their risk for the development of depression. Globally, depression is the leading cause of disability and 382 million people suffer worldwide.

Objective: The aim of this study was to assess the magnitude and factors associated with depression among hypertensive patients attending treatment follow up in the chronic OPD at Hawassa University Comprehensive Specialized Hospital (HUCSH) from March to May, 2019.

Methods: An institutional-based cross-sectional study was conducted with 310 hypertensive patients attending treatment follow up at the chronic Out-Patient Department of HUCSH at Hawassa from March to May, 2019. A validated patient health questionnaire (PHQ-9) was used to assess depression. The data were entered using EPI-data version 3.1 and analyzed in SPSS version 22. Binary logistic regression was used to determine the association of independent variables with dependent variables.

Results: The magnitude of depression among hypertension (HPN) patients was found to be 73 (24.7%). The independent predictors were sex 2.6 (1.16, 5.83), age 11.2 (2.98, 42), educational status, social support 2.55 (1.09, 5.94), family history of depression 7.12 (1.48, 34.26), hypertension 7.57 (2.67, 21.44), and medication adherence 11.6 (4.23, 31.78).

Conclusion: The magnitude of depression among HPN patients was high. So, continuous health information dissemination at a different level regarding factors affecting them should be given. Strengthening a referral linkage with a psychiatric unit for psycho-behavioral therapy will bring good clinical outcome. Besides, controlling hypertension was crucial to bring good clinical outcome.

Background: Self-monitoring of blood pressure (BP) among hypertensive patients is an important aspect of the management and prevention of complication related to hypertension. However, self-monitoring of BP among hypertensive patients on scheduled follow-up in hospitals in Ethiopia is unknown. The aim of the study was to assess knowledge and attitude of self-monitoring of BP among adult hypertensive patients.

Methods: A cross-sectional survey was conducted on 400 adult hypertensive patients attending follow-up clinics at four public hospitals of Arsi Zone, Oromia Regional State, Ethiopia. The data were collected from patients from March 10, 2019 to April 8, 2019 by face-to-face interview using a pretested questionnaire and augmented by a retrospective patients' medical records review. The data were analyzed using the SPSS version 21.0 software.

Results: A total of 400 patients were enrolled into the study with the response rate of 97.6%. The median age of the participants was 49 years (range 23-90 years). More than half (225 [56.3%]) were male. The majority (160 [40%]) were married and more than two-thirds (282 [70.5%]) were Oromo by ethnic background. About 206 (51.5%) had attended primary education. The proportion of patient's knowledge toward self-monitoring of BP and the practice of self-monitoring of BP among hypertensive patients was 31.5% (n=126 [95% CI; 26.5, 36.5]) and 7.75% (n=31 [95% CI; 5.3, 10.5]) respectively. The multivariable logistic regression analysis revealed; higher education (AOR=2.73, 95% CI [1.33, 13.88)], governmental employed (AOR=1.52, 95% CI [1.06, 6.48]), having an income of >3500 Ethiopian Birr (AOR=2.16, 95% CI [1.56, 7.39]), duration of hypertension >6 years (AOR=1.87, 95% CI [1.21, 6.37]), having health insurance (AOR=3.56, 95% CI [1.39, 10.53]), having co-morbidities (AOR=3.93, 95% CI [1.35, 10.32]), receiving a health professional recommendation toward self-monitoring of BP (AOR=6.08, 95% CI [2.45, 15.06]), and having an awareness of hypertension-related complication (AOR=3.94, 95% CI [1.34, 11.44]) were factors significantly associated with self-monitoring of BP.

Conclusion: In this study, the proportion of knowledge of self-monitoring of BP and the practice of self-monitoring of BP among hypertensive patients on follow-up were low. Educational programs on self-monitoring of BP including teaching through demonstration may be needed to be in place.

Hyperuricemia has long been recognized to be associated with increased cardiovascular risk, including risk of developing hypertension. Epidemiological findings suggest that the link with hypertension is stronger in children and adolescents. Uric acid acts as a strong antioxidant compound in the extracellular environment but has pro-inflammatory effects within the intracellular setting. A chronic phase of microvascular injury is known to occur after prolonged periods of hyperuricemia. This is proposed to contribute to afferent arteriolopathy and elevation of blood pressure that may become unresponsive to uric acid-lowering therapies over time. Studies have struggled to infer direct causality of hyperuricemia due to a vast number of confounders including body mass index. The aim of this review is to present the available data and highlight the need for large scale prospective randomized controlled trials in this area. At present, there is limited evidence to support a role for uric acid-lowering therapies in helping mitigate the risk of hypertension.

Purpose: The leaves of the Khat plant contain amphetamine-like compounds which are implicated in the development of hypertension. The increase in blood pressure coincides with the plasma cathinone level. Other factors associated with hypertension are being overweight, obesity, cigarette smoking, alcohol use, physical inactivity, unhealthy diet, and stress. Thus, this study assessed the association of chronic khat chewing with hypertension and other factors associated with hypertension.

Patients and methods: Acommunity based comparative cross-sectional study was undertaken from October 5, 2018 to February 15, 2019 in Gurage zone, southern Ethiopia. A total of 1200 adults (600 chewers and 600 non-chewers) aged 18 - 65 years were selected using a convenience sampling method. The data was collected by an interviewer-administered questionnaire plus physical measurements and were carried out at a fixed time of the day in the morning (7: 00 am-10:00 am). Linear regression and binary logistic regression analysis were performed to identify the determinant factors of blood pressure. The test of statistically significant association was declared by using 95% CI and p-value less than 0.05.

Results: A total of 1198 adults participated in the study giving a response rate of 99.8%. The mean age of Khat chewers were 34 (± 11.27) and non-chewers were 34.73 (± 11.48) years. The mean values of systolic blood pressure and diastolic blood pressure were higher in chewers than in non-chewers (p < 0.001). The prevalence of diastolic blood pressure > 80mmHg was significantly higher among Khat chewers than in non-chewers (17.4% versus 8.7%, p < 0.001). The duration of Khat chewing was significantly associated with systolic blood pressure (Beta coefficient = 0.83, p < 0.001) and diastolic blood pressure (Beta coefficient = 0.51, p < 0.001). The sex, age, BMI and alcohol were significantly associated with both systolic and diastolic blood pressure.

Conclusion: Chronic Khat chewing, male sex, BMI and alcohol were associated with increased systolic and diastolic blood pressure. To assess the cause and effect relationship between chronic Khat chewing and hypertension further studies with better defined cohorts and basic science studies need to be undertaken.

Background: Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Despite these facts, little information is available with regard to old age hypertension in Ethiopia. Thus, this study assessed old age hypertension and associated factors among older adults in rural Ethiopia.

Methods: A community-based cross-sectional study design was employed among 418 selected permanent residents of Chiro town aged 50 years and older using simple random sampling technique. Data were collected face to face using a structured questionnaire which is adapted from the WHO Stepwise approach to surveillance of non communicable disease instrument, and was used to collect data on risk factors. Physical measurements were taken as per WHO STEP guidelines. The data were entered into Epi Data version 3.1 and exported to SPSS Version 20 for analysis. Bivariate and multivariable logistic regression analysis were conducted and statistical significance was declared at a p-value ≤0.05.

Results: The overall prevalence of old age hypertension was 41.9% (95% CI: 37.2-46.6). Age ≥70 years (AOR: 1.91; 95% CI: 1.12-3.27), low intake of fruits (AOR: 2.45; 95% CI: 1.55-3.86), overweight/obese (AOR: 4.29; 95% CI: 2.48-7.42) and family history of hypertension (AOR: 2.95; 95% CI: 1.70-5.12) were significantly associated risk factors of hypertension.

Conclusion: The prevalence of hypertension among older adults was high. Older age ≥70 years, low intake of fruits, overweight/obese and having a family history of hypertension were significantly associated with hypertension. Consideration should be given for community-based screening of hypertension among older adults. In addition, fruit consumption habits and maintaining normal weight should be encouraged.

Liddle's syndrome is a genetic disorder characterized by hypertension with hypokalemic metabolic alkalosis, hyporeninemia and suppressed aldosterone secretion that often appears early in life. It results from inappropriately elevated sodium reabsorption in the distal nephron. Liddle's syndrome is caused by mutations to subunits of the Epithelial Sodium Channel (ENaC). Among other mechanisms, such mutations typically prevent ubiquitination of these subunits, slowing the rate at which they are internalized from the membrane, resulting in an elevation of channel activity. A minority of Liddle's syndrome mutations, though, result in a complementary effect that also elevates activity by increasing the probability that ENaC channels within the membrane are open. Potassium-sparing diuretics such as amiloride and triamterene reduce ENaC activity, and in combination with a reduced sodium diet can restore normotension and electrolyte imbalance in Liddle's syndrome patients and animal models. Liddle's syndrome can be diagnosed clinically by phenotype and confirmed through genetic testing. This review examines the clinical features of Liddle's syndrome, the differential diagnosis of Liddle's syndrome and differentiation from other genetic diseases with similar phenotype, and what is currently known about the population-level prevalence of Liddle's syndrome. This review gives special focus to the molecular mechanisms of Liddle's syndrome.

Background: Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Methods: Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. Results: We identified 10 RCTs involving 267 subjects (mean age range 51-71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (n=6) and moderate to high intensity (n=4) protocols, but the protocols varied considerably (duration: 1-12 weeks, frequency: 3-14 times/week, time: 10-30 mins). An overall increase of the MIP (cmH₂O) was observed (-27.57 95% CI -18.48, -37.45, I ²=64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (-0.72 95% CI-1.40, -0.05, I ²=50%). In a subgroup analysis, low- and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (-7.59 95% CI -13.96, -1.22 bpm, I ²=0%) and diastolic blood pressure (DBP) (-8.29 [-11.64, -4.94 mmHg], I ²=0%), respectively. Conclusion: IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.

Purpose: The aim of the study was to obtain feedback on the layout, content, and potential use of a blood pressure (BP) action sheet, a purpose-designed written resource for Indonesian patients with hypertension.

Methods: Telephone interviews were conducted with 13 health professionals, 12 community health workers, and 12 patients in rural Yogyakarta, Indonesia, to explore their impressions of the BP action sheet, how the sheet might affect management of hypertension, and suggestions for improvement.

Results: Participants felt that the sheet presented useful information about achieving the target BP and managing hypertension. The use of the sheet could be optimized by engaging community health workers to help explain the information and to provide assistance around the stated actions for hypertension management. A more attractive design and inclusion of more details were suggested. Both patients and health care workers expressed interest in using the sheet.

Conclusion: The BP action sheet has potential as a useful resource for patients with hypertension by providing information, recording target BP, and facilitating patient-centered communication. Use of the BP action sheet might provide an effective low-cost way for health professionals and community health workers to encourage patients to achieve their target BP.

Aortic stenosis (AS) is the most common valvular heart disease in the elderly and it causes significant morbidity and mortality. Hypertension is also highly prevalent in elderly patients with AS, and AS patients with hypertension have worse outcomes. Accurate assessment of AS severity and understanding its relationship with arterial compliance has become increasingly important as the options for valve management, particularly transcatheter interventions, have grown. The parameters used for quantifying stenosis severity have traditionally mainly focused on the valve itself. However, AS is now recognized as a systemic disease involving aging ventricles and stiff arteries rather than one limited solely to the valve. Over the last decade, valvuloarterial impedance, a measure of global ventricular load, has contributed to our understanding of the pathophysiology and course of AS in heterogeneous patients, even when segregated by symptoms and severity. This review summarizes our growing understanding of the interplay between ventricle, valve, and vessel, with a particular emphasis on downstream vascular changes after transcatheter aortic valve replacement and the role of valvuloarterial impedance in predicting left ventricular changes and prognosis in patients with various transvalvular flow patterns.