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Archives of Gynecology and Obstetrics May 2024Preeclampsia is a major cause of health problems for both pregnant women and unborn babies worldwide. However, the underlying causes of preeclampsia are not fully... (Review)
Review
PURPOSE
Preeclampsia is a major cause of health problems for both pregnant women and unborn babies worldwide. However, the underlying causes of preeclampsia are not fully understood, leading to limited effective treatments. The goal of this study is to enhance our knowledge of its causes, devise prevention strategies, and develop treatments.
METHODS
We performed a systematic literature search. Six models regarding the pathogenesis of preeclampsia are discussed in this review.
RESULTS
This review focuses on the latest advancements in understanding preeclampsia's origins. Preeclampsia is a complex condition caused by various factors, processes, and pathways. Reduced blood flow and oxygen to the uterus and placenta, heightened inflammatory reactions, immune imbalances, altered genetic changes, imbalanced blood vessel growth factors, and disrupted gut bacteria may contribute to its development.
CONCLUSION
Preeclampsia is thought to result from the interplay of these factors.
Topics: Pregnancy; Female; Humans; Pre-Eclampsia; Placenta; Uterus
PubMed: 38421424
DOI: 10.1007/s00404-024-07393-6 -
Clinical Hypertension Sep 2023In patients with end-stage renal disease (ESRD) undergoing dialysis, hypertension is common but often inadequately controlled. The prevalence of hypertension varies... (Review)
Review
In patients with end-stage renal disease (ESRD) undergoing dialysis, hypertension is common but often inadequately controlled. The prevalence of hypertension varies widely among studies because of differences in the definition of hypertension and the methods of used to measure blood pressure (BP), i.e., peri-dialysis or ambulatory BP monitoring (ABPM). Recently, ABPM has become the gold standard for diagnosing hypertension in dialysis patients. Home BP monitoring can also be a good alternative to ABPM, emphasizing BP measurement outside the hemodialysis (HD) unit. One thing for sure is pre- and post-dialysis BP measurements should not be used alone to diagnose and manage hypertension in dialysis patients. The exact target of BP and the relationship between BP and all-cause mortality or cause-specific mortality are unclear in this population. Many observational studies with HD cohorts have almost universally reported a U-shaped or even an L-shaped association between BP and all-cause mortality, but most of these data are based on the BP measured in HD units. Some data with ABPM have shown a linear association between BP and mortality even in HD patients, similar to the general population. Supporting this, the results of meta-analysis have shown a clear benefit of BP reduction in HD patients. Therefore, further research is needed to determine the optimal target BP in the dialysis population, and for now, an individualized approach is appropriate, with particular emphasis on avoiding excessively low BP. Maintaining euvolemia is of paramount importance for BP control in dialysis patients. Patient heterogeneity and the lack of comparative evidence preclude the recommendation of one class of medication over another for all patients. Recently, however, β-blockers could be considered as a first-line therapy in dialysis patients, as they can reduce sympathetic overactivity and left ventricular hypertrophy, which contribute to the high incidence of arrhythmias and sudden cardiac death. Several studies with mineralocorticoid receptor antagonists have also reported promising results in reducing mortality in dialysis patients. However, safety issues such as hyperkalemia or hypotension should be further evaluated before their use.
PubMed: 37653470
DOI: 10.1186/s40885-023-00240-x -
International Journal of Gynaecology... Jul 2017Small observational studies have demonstrated that pre-eclampsia is associated with hypocalciuria. (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Small observational studies have demonstrated that pre-eclampsia is associated with hypocalciuria.
OBJECTIVES
To compare urinary calcium excretion in pre-eclampsia, gestational hypertension, and chronic hypertension with that in normotensive pregnancies.
SEARCH STRATEGY
Online databases were searched through February 2016 using medical subject headings "calcium homeostasis," "calcium excretion," "hypocalciuria," and "pre-eclampsia."
SELECTION CRITERIA
Observational studies were included that evaluated calcium excretion with 24-hour urine collection in patients with pre-eclampsia compared with normotensive pregnant women.
DATA COLLECTION AND ANALYSIS
Data were extracted from identified studies. The primary outcome was 24-hour urinary calcium excretion. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated.
MAIN RESULTS
Twenty-one studies were included. Urinary calcium excretion was lower among women with pre-eclampsia than among those with normotensive pregnancies (WMD -158.43, 95% CI -187.95 to -128.92) or chronic hypertension (WMD -92.92, 95% CI -100.55 to -85.29). Excretion was also reduced in severe versus mild pre-eclampsia (WMD -35.00, 95% CI -58.94 to -11.07) and gestational hypertension versus normotensive pregnancies (WMD -50.95, 95% CI -57.74 to -44.17). Calcium excretion was not significantly lower in chronic hypertension versus normotensive pregnancies (WMD -64.45, 95% CI -135.98 to 7.08).
CONCLUSIONS
Urinary calcium excretion decreases with increasing severity of pregnancy-induced hypertensive disorders, but this trend is not observed in chronic hypertension.
Topics: Calcium; Chronic Disease; Female; Humans; Hypertension; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Pregnancy
PubMed: 28369876
DOI: 10.1002/ijgo.12165 -
Journal of Human Hypertension Sep 2022Hypertension is a leading cause of mortality and morbidity globally. This study aimed to obtain an overall regional estimate of the prevalence of hypertension and... (Meta-Analysis)
Meta-Analysis Review
Hypertension is a leading cause of mortality and morbidity globally. This study aimed to obtain an overall regional estimate of the prevalence of hypertension and pre-hypertension and present the disease pattern based on the age and time in the Middle East region. We searched PubMed, Google Scholar, Medline for articles on the prevalence of hypertension, pre-hypertension among countries of the Middle East region from 1999 to 2019. STATA-14 was used to analyze the data. Data were pooled using a random-effects meta-analysis model, and heterogeneity between studies was assessed using I test and subgroup analysis. A total of eighty-three studies with 479816 participants met the criteria for inclusion in the meta-analysis process. The overall prevalence of hypertension and pre-hypertension in the Middle East region were 24.36% (95% CI: 19.06-31.14) and 28. 60% (95% CI: 24.19-33.80), respectively. An increasing trend in the prevalence of hypertension was observed with the increasing age. The prevalence of hypertension in the ≤ 49-year-old age group was 17.13% (95% CI: 13.79-21.27) and in people over 60 years was 61.24% (95% CI: 55.30-67.81) (P < 0.001). This pattern has been similar among both males and females. On the other hand, a decreasing trend in the prevalence of pre-hypertension was observed with the increasing age. The increasing trend in the prevalence of hypertension and decreasing trend in the prevalence of pre-hypertension with age are significant concerns in the Middle East region. Screening for the prevention and control of hypertension should prioritize public health programs.
Topics: Female; Humans; Hypertension; Male; Middle Aged; Middle East; Prehypertension; Prevalence
PubMed: 35031669
DOI: 10.1038/s41371-021-00647-9 -
Global Health Research and Policy 2019Studies regarding blood pressure of Nepal have demonstrated a contrasting prevalence. We aimed at providing a generalized estimate of the prevalence of hypertension and... (Review)
Review
BACKGROUND
Studies regarding blood pressure of Nepal have demonstrated a contrasting prevalence. We aimed at providing a generalized estimate of the prevalence of hypertension and prehypertension in urban, suburban, and rural areas of Nepal.
METHODS
This systematic review followed PRISMA guidelines. A thorough search of PubMed, EMBASE, and Web of Science was performed, and studies satisfying the eligibility criteria were reviewed. Pooled prevalence was calculated by random-effects model, and the sources of heterogeneity were explored with meta-regression and subgroup analysis.
RESULTS
Twenty-three studies with 99,792 subjects were identified, and the estimated rate of hypertension and prehypertension were found to be 27.3% (95% CI: 23.8-30.9) and 35.4% (30.3-40.8). The prevalence of hypertension was 28.4% (22.4-34.7), 25.5% (21.4-29.8), and 24.4% (17.9-31.6) among urban, suburban, and rural populations, respectively. Moreover, rates of hypertension were found to be substantially higher in male (31.6%, 27.3-36.1) compared to female (20.0%, 14.2-26.6), and significantly higher among the middle-aged (≥40 years; 36.8%, 29.4-44.5) than among younger adults (< 40 years; 13.2%, 9.2-17.7). Further, prehypertension prevalence was found to be highest in rural areas (40.4%, 25.4-56.4) followed by urban areas (29.3%, 20.8-38.5) and lowest in suburban areas (25.5%, 18.9-32.7).
CONCLUSIONS
Our study identified an alarming situation of hypertension among Nepalese males and middle-aged, and a situation of concern with prehypertension in rural areas affecting almost 40 % of the population.
PubMed: 31165100
DOI: 10.1186/s41256-019-0102-6 -
Environmental Research Aug 2023Hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), cause significant morbidity and mortality among pregnant women.... (Meta-Analysis)
Meta-Analysis
Hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), cause significant morbidity and mortality among pregnant women. Several environmental toxins, particularly those that affect the normal function of the placenta and the endothelium, are emerging as potential risk factors for HDP. Among them, per- and polyfluoroalkyl substances (PFAS), widely used in a variety of commercial products, have been related to a variety of adverse health effects including HDP. This study was conducted by searching three databases for observational studies reporting associations between PFAS and HDP, all of which were published before December 2022. We used random-effects meta-analysis to calculate pooled risk estimates, and assessing each combination of exposure and outcome for quality and level of evidence. In total, 15 studies were included in the systematic review and meta-analysis. The results from meta-analyses showed that risk of PE was increased with exposure to PFOA (perfluorooctanoic acid) (RR = 1.39, 95% CI = 1.05, 1.85; N = 6 studies; exposure = 1 ln-unit increment; low certainty), PFOS (perfluorooctane sulfonate) (RR = 1.51, 95% CI = 1.23, 1.86; N = 6 studies; exposure = 1 ln-unit increment; moderate certainty), and PFHxS (perfluorohexane sulfonate) (RR = 1.39, 95% CI = 1.10, 1.76; N = 6 studies; exposure = 1 ln-unit increment; low certainty). PFOS was also associated with an increased risk of HDP (RR = 1.39, 95% CI = 1.10, 1.76; exposure = 1 ln-unit increment; low certainty). Exposure to legacy PFAS (PFOA, PFOS, PFHxS) is associated with an increased risk of PE, and PFOS is further associated with HDP. In view of the limitations of meta-analysis and quality of evidence, these findings should be interpreted with caution. Further research is required that assesses exposure to multiple PFAS in diverse and well-powered cohorts.
Topics: Humans; Female; Pregnancy; Hypertension, Pregnancy-Induced; Environmental Pollutants; Pre-Eclampsia; Fluorocarbons; Alkanesulfonic Acids; Hazardous Substances; Observational Studies as Topic
PubMed: 37178750
DOI: 10.1016/j.envres.2023.116064 -
Pituitary Jun 2022To evaluate the association between acromegaly and pregnancy in terms of disease activity, maternal and fetal outcomes. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the association between acromegaly and pregnancy in terms of disease activity, maternal and fetal outcomes.
METHODS
This systematic review was conducted according to the Joanna Briggs Institute methodology for systematic reviews of etiology and risk. We focused on observational studies that included pregnant women with acromegaly. The outcomes were acromegaly activity, preterm birth, gestational diabetes, hypertension, eclampsia/preeclampsia, miscarriage, perinatal mortality, low birthweight, small for gestational age, and congenital malformations. Embase, Medline, LILACS, and CENTRAL were our source databases. To perform proportional meta-analyses, we used Stata Statistical Software 17.
RESULTS
Nineteen studies were included encompassing a total of 273 pregnancies in 211 women with acromegaly. The overall frequency of control of acromegaly during pregnancy was 62%, and of tumor growth was 9%. No fetal or maternal deaths were reported. The overall frequency of worsening of previous diabetes or development of gestational diabetes was 9%, and of previous hypertension or preeclampsia/eclampsia was 6%. The overall frequency of premature labor was 9% [from 17 studies of 263 pregnancies; 95% confidence interval (CI), 5-13%]; of spontaneous miscarriage was 4% (from 19 studies of 273 pregnancies; 95% CI, 2-11%); of small for gestational age was 5% (from 15 studies of 216 newborns; 95% CI, 3-9%); and of congenital malformations was 1% (from 18 studies of 240 newborns; 95% CI, 0-7%).
CONCLUSION
Pregnancy in women with acromegaly is frequently associated with disease control and is safe in relation to fetal and maternal outcomes, as in women without acromegaly.
Topics: Abortion, Spontaneous; Acromegaly; Diabetes, Gestational; Eclampsia; Female; Humans; Hypertension; Infant, Newborn; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth
PubMed: 35098440
DOI: 10.1007/s11102-022-01208-0 -
BJOG : An International Journal of... Nov 2022To examine the association between race and pre-eclampsia and gestational hypertension after adjustment for factors in maternal characteristics and medical history in a... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To examine the association between race and pre-eclampsia and gestational hypertension after adjustment for factors in maternal characteristics and medical history in a screening study from the Fetal Medicine Foundation (FMF) in England, and to perform a systematic review and meta-analysis of studies on pre-eclampsia.
DESIGN
Prospective observational study and systematic review with meta-analysis.
SETTING
Two UK maternity hospitals.
POPULATION
A total of 168 966 women with singleton pregnancies attending for routine ultrasound examination at 11-13 weeks of gestation without major abnormalities delivering at 24 weeks or more of gestation.
METHODS
Regression analysis examined the association between race and pre-eclampsia or gestational hypertension in the FMF data. Literature search to December 2021 was carried out to identify peer-reviewed publications on race and pre-eclampsia.
MAIN OUTCOME MEASURE
Relative risk of pre-eclampsia and gestational hypertension in women of black, South Asian and East Asian race by comparison to white women.
RESULTS
In black women, the respective risks of total-pre-eclampsia and preterm-pre-eclampsia were 2-fold and 2.5-fold higher, respectively, and risk of gestational hypertension was 25% higher; in South Asian women there was a 1.5-fold higher risk of preterm pre-eclampsia but not of total-pre-eclampsia and in East Asian women there was no statistically significant difference in risk of hypertensive disorders. The literature search identified 19 studies that provided data on several million pregnancies, but 17 were at moderate or high-risk of bias and only three provided risks adjusted for some maternal characteristics; consequently, these studies did not provide accurate contributions on different racial groups to the prediction of pre-eclampsia.
CONCLUSION
In women of black and South Asian origin the risk of pre-eclampsia, after adjustment for confounders, is higher than in white women.
Topics: Cohort Studies; England; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Observational Studies as Topic; Pre-Eclampsia; Pregnancy; Prospective Studies
PubMed: 35620879
DOI: 10.1111/1471-0528.17240 -
Interventions in hypertension: systematic review and meta-analysis of natural and quasi-experiments.Clinical Hypertension May 2022Hypertension is an urgent public health problem. Consistent summary from natural and quasi-experiments employed to evaluate interventions that aim at preventing or...
BACKGROUND
Hypertension is an urgent public health problem. Consistent summary from natural and quasi-experiments employed to evaluate interventions that aim at preventing or controlling hypertension is lacking in the current literature. This study aims to summarize the evidence from natural and quasi-experiments that evaluated interventions used to prevent or control hypertension.
METHODS
We searched PubMed, Embase and Web of Science for natural and quasi-experiments evaluating interventions used to prevent hypertension, improve blood pressure control or reduce blood pressure levels from January 2008 to November 2018. Descriptions of studies and interventions were systematically summarized, and a meta-analysis was conducted.
RESULTS
Thirty studies were identified, and all used quasi-experimental designs including a difference-in-difference, a pre-post with a control group or a propensity score matching design. Education and counseling on lifestyle modifications such as promoting physical activity (PA), promoting a healthy diet and smoking cessation consultations could help prevent hypertension in healthy people. The use of computerized clinical practice guidelines by general practitioners, education and management of hypertension, the screening for cardiovascular disease (CVD) goals and referral could help improve hypertension control in patients with hypertension. The educating and counseling on PA and diet, the monitoring of patients' metabolic factors and chronic diseases, the combination of education on lifestyles with management of hypertension, the screening for economic risk factors, medical needs, and CVD risk factors and referral all could help reduce blood pressure. In the meta-analysis, the largest reduction in blood pressure was seen for interventions which combined education, counseling and management strategies: weighted mean difference in systolic blood pressure was - 5.34 mmHg (95% confidence interval [CI], - 7.35 to - 3.33) and in diastolic blood pressure was - 3.23 mmHg (95% CI, - 5.51 to - 0.96).
CONCLUSIONS
Interventions that used education and counseling strategies; those that used management strategies; those that used combined education, counseling and management strategies and those that used screening and referral strategies were beneficial in preventing, controlling hypertension and reducing blood pressure levels. The combination of education, counseling and management strategies appeared to be the most beneficial intervention to reduce blood pressure levels.
PubMed: 35490246
DOI: 10.1186/s40885-022-00198-2 -
Frontiers in Public Health 2023We aimed to address which interventions best control blood pressure (BP) and delay disease progression in prehypertension and to give recommendations for the best option... (Meta-Analysis)
Meta-Analysis
BACKGROUND
We aimed to address which interventions best control blood pressure (BP) and delay disease progression in prehypertension and to give recommendations for the best option following a quality rating.
METHODS
A Bayesian network meta-analysis was used to assess the effect of the intervention on BP reduction, delaying hypertension progression and final outcome, with subgroup analyses for time and ethnicity. Recommendations for interventions were finally based on cumulative ranking probabilities and CINeMA.
RESULTS
From 22,559 relevant articles, 101 eligible randomized controlled trial articles (20,176 prehypertensive subjects) were included and 30 pharmacological and non-pharmacological interventions were evaluated. Moderate-quality evidence demonstrated that angiotensin II receptor blockers, aerobic exercise (AE), and dietary approaches to stop hypertension (DASH) lowered systolic blood pressure (SBP). For lowering diastolic blood pressure (DBP), AE combined with resistance exercise (RE) or AE alone provided high quality evidence, with calcium channel blockers, lifestyle modification (LSM) combined with drug providing moderate quality evidence. LSM produced the best BP lowering effect at 12 months and beyond of intervention. In Asians, TCD bubble was moderate quality evidence for lowering SBP and RE may have had a BP lowering effect in Caucasians. No recommendation can be given for delaying the progression of hypertension and reducing mortality outcomes because of low to very low quality of evidence.
CONCLUSION
AE combined RE are preferentially recommended for BP control in prehypertension, followed by DASH. Long-term BP control is preferred to LSM. Asians and Caucasians add TCD bubble and RE to this list as potentially effective interventions.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022356302, identifier: CRD42022356302.
Topics: Humans; Blood Pressure; Prehypertension; Bayes Theorem; Hypertension
PubMed: 37033077
DOI: 10.3389/fpubh.2023.1139617