RESUMEN
The study examined the antihypertensive effect of peptides derived from pepsin-hydrolyzed corn gluten meal, namely KQLLGY and PPYPW, and their in silico gastrointestinal tract digested fragments, KQL and PPY, respectively. KQLLGY and PPYPW showed higher angiotensin I-converting enzyme (ACE)-inhibitory activity and lower ACE inhibition constant (Ki) values when compared to KQL and PPY. Only KQL showed a mild antihypertensive effect in spontaneously hypertensive rats with -7.83 and - 5.71 mmHg systolic and diastolic blood pressure values, respectively, after 8 h oral administration. During passage through Caco-2 cells, KQL was further degraded to QL, which had reduced ACE inhibitory activity. In addition, molecular dynamics revealed that the QL-ACE complex was less stable compared to the KQL-ACE. This study reveals that structural transformation during peptide permeation plays a vital role in attenuating antihypertensive effect of the ACE inhibitor peptide.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina , Antihipertensivos , Digestión , Glútenes , Péptidos , Peptidil-Dipeptidasa A , Ratas Endogámicas SHR , Zea mays , Inhibidores de la Enzima Convertidora de Angiotensina/química , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/metabolismo , Antihipertensivos/química , Antihipertensivos/farmacología , Animales , Glútenes/química , Glútenes/metabolismo , Humanos , Zea mays/química , Zea mays/metabolismo , Ratas , Células CACO-2 , Péptidos/química , Péptidos/farmacología , Masculino , Digestión/efectos de los fármacos , Peptidil-Dipeptidasa A/química , Peptidil-Dipeptidasa A/metabolismo , Presión Sanguínea/efectos de los fármacos , Hipertensión/metabolismo , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Tracto Gastrointestinal/metabolismo , Hidrolisados de Proteína/química , Hidrolisados de Proteína/farmacología , HidrólisisRESUMEN
This study gives an insight into certain systemic conditions and factors such as nutrition, age, hematological disorders, hypertension, smoking, obesity, and metabolic syndrome that have a notable effect on the periodontium. The review highlights the importance of taking these factors into consideration in periodontal therapy and their impact on the prognosis of periodontal therapies. The other systemic factors are discussed in detail elsewhere in the special issue.
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Hipertensión , Síndrome Metabólico , Obesidad , Enfermedades Periodontales , Humanos , Pronóstico , Enfermedades Periodontales/terapia , Obesidad/complicaciones , Fumar/efectos adversos , Factores de Edad , Factores de Riesgo , Estado NutricionalRESUMEN
BACKGROUND: Although intensive blood pressure (BP) control has not been shown to slow the progression of chronic kidney disease (CKD), intensive BP control has been shown to reduce the risk for adverse cardiovascular outcomes in the CKD population. The aim of this post-hoc study was to study the interplay between a self-monitoring BP system and glomerular function. METHODS: In all, 949 participants with hypertension underwent visits at baseline, after eight weeks and 12 months. Half of the participants received a BP monitor and installed a program on their mobile phone. During eight weeks, they measured daily and reported their BP values. RESULTS: Within the intervention group, BP and systolic BP (SBP) decreased from baseline to eight weeks and 12 months (p < .001). Pulse pressure (PP) and mean arterial blood pressure (MAP) decreased from baseline to eight weeks (p = .021 and p = .004) vs 12 months (p = .035 and p = .008). Within the control group, a decrease was observed from baseline to 12 months for SBP, diastolic BP (DBP) and PP (p = .025, p = .023 and p = .036). In the intervention group, we observed an association between a decrease in SBP, DBP, PP and MAP and a decrease in eGFR (estimated glomerular filtration rate), (p < .001, p < .001, p = .013 and p < .001). In the control group, similar results were observed for PP only (p = .027). Within the intervention group, eGFR decreased (p < .001) but within the control group, the decrease was non-significant (p = .051). CONCLUSION: We observed an association between a decrease in all BP components and eGFR decline within the normal range in the intervention group but not in the controls. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov [NCT03554382].
WHAT IS THE CONTEXTHypertension is a common risk factor and has been identified as the most important contributor to end stage renal disease (ESRD)At present, it is unclear if hypertension also plays a role in the gradual loss of kidney function that occurs with ageing in the general populationSome studies have found a link between baseline blood pressure and a decline in GFR (glomerular filtration rate), while others have shown no relationship or even higher GFRMost patients with hypertension attend primary care for diagnosis, treatment and follow-up. Home blood pressure monitoring in hypertension treatment is becoming increasingly commonThe PERson-centredness in Hypertension management using Information Technology (PERHIT) study was designed to evaluate the effect of supporting self-management on (home) blood pressure by the use of information technology and aimed to lower blood pressure in patients with hypertension in primary careThe aim of this sub-study was to evaluate whether a person-centred approach in the treatment of high blood pressure, according to PERHIT, will have an impact on kidney function in patients with hypertension.WHAT IS NEWBlood pressure reduction in the intervention group was associated with a greater fall of eGFR (estimated GFR)glomerular filtration rate), but within the normal range, present already after eight weeks.Our analyses showed significant interactions between improved treatment related to the blood pressure components and lowering of eGFR, suggesting that the association between blood pressure changes and eGFR reduction was most prominent in individuals undergoing more effective antihypertensive treatment.WHAT IS THE IMPACTOur study concerns a common patient group at primary healthcare centres. When blood pressure treatment is initiated, or when treatment is increased via the general practitioner, it is common practice to arrange for a follow-up check of kidney function estimates such as creatinine and eGFR. In many cases, unfortunately not in accordance with proven science and experience, hypertension medication might be discontinued, or the dose reduced due to a short-term deterioration of kidney function (eGFR) that often reverts to normal levels again. This is a development that must be observed and prevented.Our results show that intensified blood pressure control is associated with a reduction in glomerular function measured by eGFR, but within normal range.
Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea , Tasa de Filtración Glomerular , Hipertensión , Humanos , Masculino , Femenino , Persona de Mediana Edad , Hipertensión/fisiopatología , Anciano , Insuficiencia Renal Crónica/fisiopatologíaRESUMEN
The majority of Black women with hypertension in the United States have smartphones or tablets and use social media, and many use wearable activity trackers and health or wellness apps, digital tools that can be used to support lifestyle changes and medication adherence.
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Negro o Afroamericano , Hipertensión , Aplicaciones Móviles , Medios de Comunicación Sociales , Humanos , Femenino , Estados Unidos/epidemiología , Hipertensión/epidemiología , Persona de Mediana Edad , Adulto , Propiedad , Monitores de Ejercicio , Teléfono Inteligente , Dispositivos Electrónicos Vestibles , Encuestas y CuestionariosRESUMEN
The goal is to provide foundational data that could spearhead more extensive, prospective research into understanding the influences of micronutrient levels on the nocturnal patterns of hypertension, possibly aiding in identifying potential therapeutic strategies to reduce cardiovascular risk in this demographic. The research employed a retrospective design to analyze the micronutrient levels, including ferritin, folic acid, vitamin B12, and vitamin D, in a limited sample size from a single hospital. However, it is worth noting that the study did not scrutinize other potentially relevant micronutrients and biomarkers and lacked information on potential confounding factors such as lifestyle and dietary habits, physical activity levels, and specific details on antihypertensive medications used. The preliminary findings highlight a significant difference in ferritin levels between dipper and non-dipper groups, indicating a potential role in the development of non-dipper hypertension. Surprisingly, no notable difference was observed in vitamin D levels between the groups. The study underscores the increasing prevalence of hypertension and micronutrient deficiencies as age progresses. Despite its limitations, including limited sample size and potential influences from unaccounted variables, the study hints at a potential relationship between micronutrient levels and non-dipper hypertension. It emphasizes the necessity for larger scale, prospective research to delve deeper into the nature of this relationship, potentially fostering new therapeutic approaches in cardiovascular risk management within the elderly population.
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Hipertensión , Micronutrientes , Vitamina D , Humanos , Hipertensión/epidemiología , Estudios Retrospectivos , Anciano , Micronutrientes/sangre , Masculino , Femenino , Vitamina D/sangre , Ácido Fólico/sangre , Ferritinas/sangre , Vitamina B 12/sangre , Presión Sanguínea/fisiología , Anciano de 80 o más Años , Persona de Mediana Edad , Ritmo Circadiano/fisiologíaRESUMEN
In the present study, we investigated whether curcumin administration would interfere with the main renal features of l-NAME-induced hypertension model. For this purpose, we conducted both in vitro and in vivo experiments to evaluate renal indicators of inflammation, oxidative stress, and metalloproteinases (MMPs) expression/activity. Hypertension was induced by l-NAME (70 mg/kg/day), and Wistar rats from both control and hypertensive groups were treated with curcumin (50 or 100 mg/kg/day; gavage) or vehicle for 14 days. Blood and kidneys were collected to determine serum creatinine levels, histological alterations, oxidative stress, MMPs expression and activity, and ED1 expression. l-NAME increased blood pressure, but both doses of curcumin treatment reduced these values. l-NAME treatment increased creatinine levels, glomeruli area, Bowman's space, kidney MMP-2 activity, as well as MMP-9 and ED1 expression, and reduced the number of glomeruli. Curcumin treatment prevented the increase in creatinine levels, MMP-2 activity, and reduced MMP-2, MMP-9, ED1, and superoxide levels, as well as increased superoxide dismutase activity and partially prevented glomeruli alterations. Moreover, curcumin directly inhibited MMP-2 activity in vitro. Thus, our main findings demonstrate that curcumin reduced l-NAME-induced hypertension and renal glomerular alterations, inhibited MMP-2 and MMP-9 expression/activity, and reduced oxidative stress and inflammatory processes, which may indirectly impact hypertension-induced renal outcomes.
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Curcumina , Hipertensión , Metaloproteinasa 2 de la Matriz , Metaloproteinasa 9 de la Matriz , NG-Nitroarginina Metil Éster , Ratas Wistar , Animales , Curcumina/farmacología , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 9 de la Matriz/metabolismo , NG-Nitroarginina Metil Éster/farmacología , Hipertensión/inducido químicamente , Hipertensión/tratamiento farmacológico , Hipertensión/metabolismo , Ratas , Masculino , Riñón/efectos de los fármacos , Riñón/patología , Riñón/metabolismo , Estrés Oxidativo/efectos de los fármacos , Enfermedades Renales/inducido químicamente , Enfermedades Renales/prevención & control , Enfermedades Renales/patología , Enfermedades Renales/metabolismo , Enfermedades Renales/tratamiento farmacológicoRESUMEN
HLA donor specific antibodies (DSA) are implicated in antibody-mediated rejection (AMR), graft dysfunction and failure in kidney transplant (KT) recipients. Non-HLA antibodies including angiotensin II type 1 receptor (AT1R) may also play a role in AMR, impact graft function and survival. Data is limited in paediatric KT cohorts. We aimed to assess the prevalence and effect of pre-transplant AT1R antibodies on rejection, graft function and survival in paediatric KT recipients. This was a retrospective cohort study conducted across two paediatric centres including KT recipients with a pre-transplant AT1R antibody level. Outcomes included rejection, de novo DSA formation, graft function, failure, proteinuria and hypertension. Of 71 individuals, 72% recorded a positive pre-transplant AT1R Ab level (≥17 U/mL). Over a median follow-up of 4.7 years, AT1R Ab positivity demonstrated a trend towards increased risk of rejection however was not statistically significant (HR 3.45, 95% CI 0.97-12.35, p-value 0.06). Sensitivity analysis with AT1R Ab levels of ≥25 U/mL (HR 2.05 95% CI 0.78-5.39, p-value 0.14) and ≥40 U/mL (HR 1.32, CI 95% 0.55-3.17, p-value 0.53) validated this. De novo DSA formation occurred more frequently with AT1R Ab positivity (41% vs. 20%, p-value 0.9). AT1R Ab was not associated with hypertension, proteinuria, graft failure or dysfunction. In conclusion, this cohort study demonstrated a high prevalence of pre-transplant AT1R Ab positivity (72%). AT1R Ab positivity demonstrated a trend towards increased risk of rejection and de novo DSA formation however did not meet statistical significance. There was no association between AT1R Ab and hypertension, proteinuria, graft failure or dysfunction.
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Rechazo de Injerto , Supervivencia de Injerto , Trasplante de Riñón , Receptor de Angiotensina Tipo 1 , Humanos , Receptor de Angiotensina Tipo 1/inmunología , Rechazo de Injerto/inmunología , Masculino , Estudios Retrospectivos , Femenino , Niño , Adolescente , Isoanticuerpos/sangre , Isoanticuerpos/inmunología , Preescolar , Antígenos HLA/inmunología , Proteinuria/inmunología , Proteinuria/sangre , Hipertensión/inmunología , Hipertensión/fisiopatología , Hipertensión/sangreRESUMEN
Hypertension does not recognize obvious pathogenic causes in the majority of patients (essential hypertension). However, a secondary underlying cause of hypertension can be recognized in 5-10% of unselected hypertensive patients, and this prevalence may increase to more than 20% in patients with hypertension that is difficult to control or frankly resistant to treatment. In children, secondary hypertension is most often due to aortic coarctation, distal thoracic or abdominal aortic stenosis, or specific gene mutations. In adults or elderly individuals, secondary hypertension is most often due to atherosclerotic renal artery stenosis, primary hyperaldosteronism, and Cushing's disease or syndrome. Parenchymal nephropathy and hyperparathyroidism can cause hypertension at all ages, while pheochromocytoma and paraganglioma tend to occur more often in adolescents or young adults. In general, secondary hypertension should be suspected in subjects with: (a) onset of hypertension under 30 years of age especially if in the absence of hypertensive family history or other risk factors for hypertension; (b) treatment-resistant hypertension; c) severe hypertension (>180/110 mmHg), malignancy, or hypertensive emergencies; d) rapid rise in blood pressure values in previously well controlled patients. Any clinical signs suspicious or suggestive of hypertension from endocrine causes, a "reverse dipping" or "non-dipping'" profile at 24 h ambulatory blood pressure monitoring not justified by other factors, signs of obvious organ damage may be helpful clues for diagnosis. Finally, patients snoring or with clear sleep apnea should also be considered for possible secondary hypertension.
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Hipertensión , Humanos , Hipertensión/etiología , Hipertensión/diagnóstico , Adulto , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/complicaciones , Hiperaldosteronismo/terapia , Niño , Antihipertensivos/uso terapéutico , Coartación Aórtica/diagnóstico , Coartación Aórtica/complicaciones , Coartación Aórtica/terapiaRESUMEN
Although there is an association between income status and concentration of perfluoroalkyl and polyfluoroalkyl substance (PFAS), the association remains uncertain in patients with hypertension, hyperlipidemia, and comorbidities. Data from the 2013-2016 National Health and Nutrition Examination Survey were analyzed. A total of 2665 adults were included, and the data included participants' serum PFAS (perfluorooctanoic acid [PFOA], perfluorononaic acid, perfluorodecanoic acid, perfluoroundecanoic acid, perfluorohexane sulfonic acid, and perfluorooctane sulfonic acid) levels and selected covariates. Multivariate linear regression models were used to examine the association between the ratio of family income to poverty (PIR) and individual serum PFAS concentrations in the hypertensive and/or hyperlipidemia groups after adjusting for covariates. The potential effects of sex and age on the results were explored using stratified analysis. A mediating effect model was used to explore the mediating effects of body mass index (BMI) and waist circumference on the association results. After adjusting for potential confounders, for hyperlipidemia and comorbidities (hypertension and hyperlipidemia), serum levels of multiple common PFAS increased by 0.09% (95%Confidence interval [CI] 0.02-0.15%) to 0.13% (95%CI 0.08-0.19%) and 0.10% (95%CI 0.02-0.17%) to 0.12% (95%CI 0.06-0.18%), respectively, with each 1% increase in PIR. The covariate model and stratified analyses results suggested the potential effects of different covariates such as age and sex, leading to changes in the statistical significance of the association results. BMI significantly mediated the effect of PIR on PFOA in hyperlipidemia (13%, P < 0.001). Household income in adults with hyperlipidemia and comorbidities positively correlated with serum PFAS concentration in the United States. Obesity played an indispensable mediating role in the association between economic income and PFAS concentration.
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Fluorocarburos , Hiperlipidemias , Hipertensión , Humanos , Femenino , Masculino , Fluorocarburos/sangre , Hipertensión/sangre , Hipertensión/epidemiología , Persona de Mediana Edad , Adulto , Hiperlipidemias/sangre , Hiperlipidemias/epidemiología , Estados Unidos/epidemiología , Encuestas Nutricionales , Anciano , Ácidos Alcanesulfónicos/sangre , Índice de Masa Corporal , Caprilatos/sangreRESUMEN
The association between obstructive sleep apnea (OSA) and proteinuria is undetermined, with few studies on hypertension, a high-risk group for renal impairment. Therefore, we aimed to explore whether OSA is an independent risk factor for proteinuria in patients with hypertension. We investigated the cross-sectional association between OSA and proteinuria. Participants were divided into groups by apnea hypopnea index (AHI) category. Multivariable Logistic regression analysis was used to evaluate the association between OSA severity, objectively measured sleep dimensions, and proteinuria which is mainly defined by 24-h urine protein quantification > 300 mg/24 h. Sensitivity analyses were performed by excluding those with comorbidities (primary aldosteronism and homocysteine ≥ 15 µmol/L). Of the 2106 participants, the mean age was 47.57 ± 10.50 years, 67.2% were men, and 75.9% were OSA patients. In total participants, compared with those without OSA, patients with mild OSA, moderate OSA, and severe OSA showed 1.09 (95% CI 0.80-1.40), 1.24 (95% CI 0.89-1.74) and 1.47 (95% CI 1.04-2.08) fold risk for proteinuria with a trend test P trend < 0.05. Each 10-unit increase in the AHI, oxygen desaturation index (ODI), and time spent with oxygen saturation < 90% (T90) was found to be associated with 13%, 10%, and 2% higher likelihood of proteinuria in the crude model, significant in adjusted models. The more severe the OSA is, the higher the risk of proteinuria. AHI and T90 are independently associated with a higher risk of structural renal damage in the population with hypertension.
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Hipertensión , Proteinuria , Apnea Obstructiva del Sueño , Humanos , Apnea Obstructiva del Sueño/orina , Apnea Obstructiva del Sueño/complicaciones , Masculino , Persona de Mediana Edad , Femenino , Hipertensión/orina , Hipertensión/complicaciones , Proteinuria/orina , Adulto , Estudios Transversales , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Intracranial artery stenosis (ICAS) and cerebral small vessel disease (CSVD) are associated with a heavy socioeconomic burden; however, their longitudinal changes remain controversial. METHODS: We conducted a longitudinal analysis on 756 participants of Shunyi Cohort who underwent both baseline and follow-up brain magnetic resonance imaging (MRI) and MR angiography in order to investigate the risk factors for ICAS and CSVD progression in community population. Incident ICAS was defined as new stenosis occurring in at least one artery or increased severity of the original artery stenosis. CSVD markers included lacunes, cerebral microbleeds (CMB), and white matter hyperintensities (WMH). RESULTS: After 5.58 ± 0.49 years of follow-up, 8.5% of the 756 participants (53.7 ± 8.0 years old, 65.1% women) had incident ICAS. Body mass index (BMI) (OR = 1.09, 95% CI = 1.01-1.17, p = 0.035) and diabetes mellitus (OR = 2.67, 95% CI = 1.44-4.93, p = 0.002) were independent risk factors for incident ICAS. Hypertension was an independent risk factor for incident lacunes (OR = 2.12, 95% CI = 1.20-3.77, p = 0.010) and CMB (OR = 2.32, 95% CI = 1.22-4.41, p = 0.011), while WMH progression was primarily affected by BMI (ß = 0.108, SE = 0.006, p = 0.002). A higher LDL cholesterol level was found to independently protect against WMH progression (ß = -0.076, SE = 0.027, p = 0.019). CONCLUSIONS: Modifiable risk factor profiles exhibit different in patients with ICAS and CSVD progression. Controlling BMI and diabetes mellitus may help to prevent incident ICAS, and antihypertensive therapy may conduce to mitigate lacunes and CMB progression. LDL cholesterol may play an inverse role in large arteries and small vessels.
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Enfermedades de los Pequeños Vasos Cerebrales , Progresión de la Enfermedad , Humanos , Masculino , Enfermedades de los Pequeños Vasos Cerebrales/epidemiología , Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Femenino , Persona de Mediana Edad , Factores de Riesgo , Estudios Longitudinales , Imagen por Resonancia Magnética/métodos , Constricción Patológica/epidemiología , Adulto , Anciano , Hipertensión/epidemiología , Hipertensión/complicacionesRESUMEN
BACKGROUND: Healthcare workers (HCWs) including community health extension workers (CHEWs) in the Federal Capital Territory, Nigeria participated in a hypertension training series following the Extension for Community Healthcare Outcomes (ECHO) model which leverages technology and a practical peer-to-peer learning framework to virtually train healthcare practitioners. We sought to evaluate the patient-level effects of the hypertension ECHO series. METHODS: HCWs from 12 of 33 eligible primary healthcare centers (PHCs) in the Hypertension Treatment in Nigeria Program (NCT04158154) were selected to participate in a seven-part hypertension ECHO series from August 2022 to April 2023. Concurrent Hypertension Treatment in Nigeria Program patient data were used to evaluate changes in hypertension treatment and control rates, and adherence to Nigeria's hypertension treatment protocol. Outcomes were compared between the 12 PHCs in the ECHO program and the 21 which were not. RESULTS: Between July 2022 and June 2023, 16,691 PHC visits were documented among 4340 individuals (ECHO: n = 1428 [33%], non-ECHO: n = 2912 [67%]). Patients were on average (SD) 51.5 (12.0) years old, and one-third were male (n = 1372, 32%) with no differences between cohorts in either characteristic (p ≥ 0.05 for both). Blood pressures at enrollment were higher in the ECHO cohort compared to the non-ECHO cohort (systolic p < 0.0001 and diastolic p = 0.0001), and patients were less likely to be treated with multiple medications (p < 0.0001). Treatment rates were similar at baseline (ECHO: 94.0% and Non-ECHO: 94.7%) and increased at a higher rate (interaction p = 0.045) in the ECHO cohort over time. After adjustment for baseline and within site variation, the difference was attenuated (interaction p = 0.37). Over time, control rates increased and medication protocol adherence decreased, with no differences between cohorts. Staffing levels, adult patient visits, and rates of hypertension screening and empanelment were similar between ECHO and non-ECHO cohorts (p ≥ 0.05 for all). CONCLUSIONS: The ECHO series was associated with moderately increased hypertension treatment rates and did not adversely affect staffing or clinical capacity among PHCs in the Federal Capital Territory, Nigeria. These results may be used to inform strategies to support scaling hypertension education among frontline HCWs throughout Nigeria, and use of the ECHO model for CHEWs. TRIAL REGISTRATION: The Hypertension Treatment in Nigeria Program was prospectively registered on November 8, 2019 at www. CLINICALTRIALS: gov (NCT04158154; https://clinicaltrials.gov/ct2/show/NCT04158154 ).
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Agentes Comunitarios de Salud , Hipertensión , Atención Primaria de Salud , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/terapia , Nigeria/epidemiología , Masculino , Agentes Comunitarios de Salud/educación , Femenino , Persona de Mediana Edad , Adulto , Antihipertensivos/uso terapéuticoRESUMEN
BACKGROUND: Early neurological deterioration (END) occurs in many patients with acute ischemic stroke due to a variety of causes. Although pharmacologically induced hypertension (PIH) and anticoagulants have been investigated in several clinical trials for the treatment of END, the efficacy and safety of these treatments remain unclear. Here, we investigated whether PIH or anticoagulation is better as a rescue therapy for the progression of END in patients with lacunar stroke. METHODS: This study included patients with lacunar stroke who received rescue therapy with END within 3 days of symptom onset between April 2014 and August 2021. In the PIH group, phenylephrine was administered intravenously for 24 h and slowly tapered when symptoms improved or after 5 days of PIH. In the anticoagulation group, argatroban was administered continuously intravenously for 2 days and twice daily for next 5 days. We compared END recovery, defined as improvement in NIHSS from baseline, excellent outcomes (0 or 1 mRS at 3 months), and safety profile. RESULTS: Among the 4818 patients with the lacunar stroke, END occurred in 147 patients. Seventy-nine patients with END received PIH (46.9%) and 68 patients (46.3%) received anticoagulation therapy. There was no significant difference in age (P = 0.82) and sex (P = 0.87) between the two groups. Compared to the anticoagulation group, the PIH group had a higher incidence of END recovery (77.2% vs. 51.5%, P < 0.01) and excellent outcomes (34.2% vs. 16.2%, P = 0.04). PIH was associated with END (HR 2.49; 95% CI 1.06-5.81, P = 0.04). PIH remained associated with END recovery (adjusted HR 3.91; 95% CI 1.19-12.90, P = 0.02). Safety outcomes, like hemorrhagic conversion and mortality, were not significantly different between the two groups. CONCLUSIONS: As a rescue therapy for the progression of END in lacunar stroke patients, PIH with phenylephrine was more effective with similar safety compared to anticoagulation with argatroban.
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Anticoagulantes , Accidente Vascular Cerebral Lacunar , Humanos , Masculino , Femenino , Accidente Vascular Cerebral Lacunar/tratamiento farmacológico , Anciano , Persona de Mediana Edad , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Hipertensión/tratamiento farmacológico , Hipertensión/complicaciones , Anciano de 80 o más Años , Sulfonamidas/uso terapéutico , Sulfonamidas/administración & dosificación , Arginina/análogos & derivados , Arginina/uso terapéutico , Arginina/administración & dosificación , Resultado del Tratamiento , Antihipertensivos/uso terapéutico , Antihipertensivos/administración & dosificación , Estudios Retrospectivos , Progresión de la Enfermedad , Ácidos PipecólicosAsunto(s)
Angiotensinógeno , Hipertensión , ARN Interferente Pequeño , Animales , Humanos , Angiotensinógeno/genética , Angiotensinógeno/metabolismo , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/genética , Hipertensión/genética , Hipertensión/fisiopatología , Hipertensión/tratamiento farmacológico , Hipertensión/metabolismo , Interferencia de ARN , ARN Interferente Pequeño/uso terapéuticoAsunto(s)
Hipertensión , Refugiados , Humanos , Refugiados/estadística & datos numéricos , Siria , California , Irak , Hipertensión/epidemiología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cambio Climático , ClimaRESUMEN
Standardized blood pressure (BP) measurements for patients with chronic kidney disease (CKD) are paramount in the management of hypertension. Evidence shows nursing staff adherence to best practice guidelines for BP measurement are suboptimal. A pre-/posttest pilot study implementing a six-week hybrid educational intervention for nursing staff was conducted in an outpatient nephrology office. The Evidence-Based Practice (EBP) Beliefs Scale was administered to participants (n = 6) to assess individual beliefs about EBP and implementing EBP guidelines for BP measurement. One Likert-type question measured participant change in BP measurement. Improvement was noted in EBP beliefs and ability to implement EBP guidelines post-intervention. A favorable response was present for participant change in BP measurement per guidelines post-intervention. The intervention is a feasible method to improve staff adherence to EBP guidelines for BP measurement.
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Determinación de la Presión Sanguínea , Humanos , Proyectos Piloto , Determinación de la Presión Sanguínea/normas , Enfermería en Nefrología/normas , Insuficiencia Renal Crónica/enfermería , Femenino , Masculino , Hipertensión/enfermería , Persona de Mediana Edad , Fallo Renal Crónico/terapiaRESUMEN
This study investigated osteoporosis risk factors among older Asian men with type-2 diabetes mellitus, hypertension, or hyperlipidaemia in primary care. Advanced age, dementia, depression, and polypharmacy were associated with higher risks for osteoporosis. Screening strategies targeting these factors are crucial for improving bone health as part of comprehensive preventive care. PURPOSE: Asian patients with type-2 diabetes mellitus (T2DM), hypertension, or hyperlipidaemia (DHL) are predominantly managed in primary care. They are also at risk of osteoporosis, but men are often under-screened and under-treated for this preventable bone disorder. This study aimed to identify the clinical characteristics and risk factors of osteoporosis among older men with DHL in primary care for early intervention. METHODS: This retrospective study included men aged 65 years and older managed in public primary care clinics for their DHL between 1st July 2017 and 30th June 2018. Demographic, clinical, laboratory, and imaging data were extracted from their electronic medical records based on their International Classification of Diseases-10 (ICD-10) diagnosis codes. Descriptive statistical analyses, with statistical significance set at p < 0.05, were conducted, followed by generalized estimating equation (GEE) modelling. RESULTS: Medical records of 17,644 men (83.1% Chinese, 16.9% minority ethnic groups, median age 71 years) were analysed. 2.3% of them had diagnosis of osteoporosis, 0.15% had fragility fracture, and 26.0% of those diagnosed with osteoporosis were treated with bisphosphonates. Their mean HbA1c was 6.9%; mean systolic and diastolic blood pressure were 133 and 69 mmHg. The GEE model showed that age (OR = 1.07, 95%CI = 1.05-1.09, p < 0.001), dementia (OR = 2.24, 95%CI = 1.33-3.77, p = 0.002), depression (OR = 2.38, 95%CI = 1.03-5.50, p = 0.043), and polypharmacy (OR = 6.85, 95%CI = 3.07-15.26, p < 0.001) were significantly associated with higher risks for osteoporosis. CONCLUSION: Age, dementia, depression, and polypharmacy are associated with osteoporosis risks in men with DHL. Strategies to incorporate osteoporosis screening among older men with these risk factors are needed to improve their bone health.
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Diabetes Mellitus Tipo 2 , Hiperlipidemias , Hipertensión , Osteoporosis , Humanos , Masculino , Osteoporosis/epidemiología , Anciano , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Factores de Riesgo , Estudios Retrospectivos , Hiperlipidemias/epidemiología , Hiperlipidemias/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/complicaciones , Hipertensión/epidemiología , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Existing research indicates that the Mediterranean diet has a positive impact on preventing and treating hypertension. However, its specific effect on hypertension among elderly Chinese individuals is unclear. AIMS: The objective of this research was to explore the association between the Chinese version of the Mediterranean-DASH Intervention for Neurodegenerative Delay (cMIND) diet and hypertension among elderly Chinese individuals, aiming to offer novel strategies for alleviating the burden of hypertension in this demographic. METHODS: In this study, we used cross-sectional data published in 2018 by the China Longitudinal Health and Longevity Survey (CLHLS) to develop a binary logistic regression model to investigate the correlation between cMIND diet and hypertension in a Chinese elderly population. Restricted cubic spline was used to test for linear associations, and further subgroup analyses were performed to test for interactions. RESULTS: In total, 7,103 older adults were included in the study, with a prevalence of hypertension of 39.0%. When the cMIND diet score was used as a continuous variable, a significant protective effect against hypertension was present (OR = 0.955, 95% CI:0.923-0.988, p = 0.008); when used as a categorical variable, this protective effect was still present at higher levels (compared to lower levels) of the cMIND diet (OR = 0.869, 95% CI: 0.760-0.995, p = 0.042). DISCUSSION: Although the Mediterranean diet has great potential to reduce the chance of hypertension, it should also consider the effect on the Chinese population. The results of this study provide new ways to reduce the disease burden of hypertension in Chinese older adults and improve quality of life in later life. CONCLUSION: The cMIND diet can considerably reduce the risk of hypertension among older adults in China.
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Dieta Mediterránea , Hipertensión , Humanos , Hipertensión/epidemiología , Hipertensión/prevención & control , Anciano , Masculino , China/epidemiología , Femenino , Estudios Transversales , Enfoques Dietéticos para Detener la Hipertensión , Anciano de 80 o más Años , Persona de Mediana Edad , PrevalenciaRESUMEN
BACKGROUND: Higher cruciferous vegetable intake is associated with lower cardiovascular disease risk in observational studies. The pathways involved remain uncertain. We aimed to determine whether cruciferous vegetable intake (active) lowers 24-h brachial systolic blood pressure (SBP; primary outcome) compared to root and squash vegetables (control) in Australian adults with mildly elevated BP (SBP 120-160 mmHg inclusive). METHODS: In this randomized, controlled, crossover trial, participants completed two 2-week dietary interventions separated by a 2-week washout. Cruciferous vegetables were compared to root and squash vegetables (~ 300 g/day) consumed with lunch and dinner meals. Participants were blinded to which interventions were the active and control. Adherence was assessed using food diaries and biomarkers (S-methyl cysteine sulfoxide (SMCSO, active) and carotenoids (control)). Twenty-four-hour brachial ambulatory SBP and secondary outcomes were assessed pre- and post each intervention. Differences were tested using linear mixed effects regression. RESULTS: Eighteen participants were recruited (median (IQR) age: 68 (66-70); female: n = 16/18; mean ± SD clinic SBP: 135.9 ± 10.0 mmHg). For both interventions, 72% participants had 100% adherence (IQR: 96.4-100%). SMCSO and carotenoids were significantly different between interventions (mean difference active vs. control SMCSO: 22.93 mg/mL, 95%CI 15.62, 30.23, P < 0.0001; carotenoids: - 0.974 mg/mL, 95%CI - 1.525, - 0.423, P = 0.001). Twenty-four-hour brachial SBP was significantly reduced following the active vs. control (mean difference - 2.5 mmHg, 95%CI - 4.2, - 0.9, P = 0.002; active pre: 126.8 ± 12.6 mmHg, post: 124.4 ± 11.8 mmHg; control pre: 125.5 ± 12.1 mmHg, post: 124.8 ± 13.1 mmHg, n = 17), driven by daytime SBP (mean difference - 3.6 mmHg, 95%CI - 5.4, - 1.7, P < 0.001). Serum triglycerides were significantly lower following the active vs. control (mean difference - 0.2 mmol/L, 95%CI - 0.4, - 0.0, P = 0.047). CONCLUSIONS: Increased intake of cruciferous vegetables resulted in reduced SBP compared to root and squash vegetables. Future research is needed to determine whether targeted recommendations for increasing cruciferous vegetable intake benefits population health. TRIAL REGISTRATION: Clinical trial registry ACTRN12619001294145. https://www.anzctr.org.au.