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Hypertension (Dallas, Tex. : 1979) Feb 2023Prior meta-analyses report a 2- to 4-fold increased risk of later cardiovascular disease among women with a history of hypertensive disorders of pregnancy (HDP). Given... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prior meta-analyses report a 2- to 4-fold increased risk of later cardiovascular disease among women with a history of hypertensive disorders of pregnancy (HDP). Given HDP's vascular underpinnings, it is hypothesized to also be a risk factor for later dementia. We aim to summarize the evidence for the impact of HDP on dementia and consider unique associations between HDP and dementia subtypes.
METHODS
Observational studies on the relationship between HDP and dementia were identified from online electronic databases to July 1, 2021 (PROSPERO identifier: CRD42020185630). We included observational studies published in English. Exposure among women was any HDP and HDP subtypes: gestational hypertension, preeclampsia/eclampsia, or other/unspecified HDP. Outcome was any dementia and dementia subtypes: Alzheimer's disease, vascular dementia, or other/unspecified dementias.
RESULTS
For our primary analyses, we included 5 cohort studies with a total of 183 874 women with and 2 309 705 women without HDP. Pooled analysis found a 38% higher risk of all-cause dementia among women with, versus without, any type of HDP (adjusted hazard ratio, 1.38 [95% CI, 1.18-1.61]; <0.01). When examining association by HDP and dementia subtypes, we found that women with, versus without, any type of HDP had over a 3-fold higher risk of vascular dementia (adjusted hazard ratio, 3.14 [95% CI, 2.32-4.24]; <0.01).
CONCLUSIONS
Our findings indicate that maternal history of HDP is an important risk factor for later development of vascular and all-cause dementia. Further research among more racially/ethnically diverse populations quantifying HDP's effect on all-cause dementia, and specifically vascular dementia, is warranted.
Topics: Pregnancy; Female; Humans; Hypertension, Pregnancy-Induced; Dementia, Vascular; Pre-Eclampsia; Risk Factors; Cohort Studies; Observational Studies as Topic
PubMed: 36345823
DOI: 10.1161/HYPERTENSIONAHA.122.19399 -
Annals of Global Health 2022Hypertension is one of the major factors for high mortality of adults in Africa. However, complications occur at lower values than those previously classified as... (Review)
Review
BACKGROUND
Hypertension is one of the major factors for high mortality of adults in Africa. However, complications occur at lower values than those previously classified as hypertension. Thus, prehypertension is considered as a new category of hypertension and a major risk factor for developing clinical hypertension relative to those with normotension, it has been linked with increased future risk of hypertension as well as cardiovascular diseases.
OBJECTIVES
The objective of this review was to determine prevalence of prehypertension and describe the associated factors of prehypertension in Africa during the past 10 years.
METHODS
We did a systematic review using the databases PubMed/Medline, and search engine google scholar. We selected sources of publications and conducted an analysis of articles. Keywords in English were: prehypertension, high normal blood pressure, high blood pressure, elevated blood pressure, Africa. Keywords in french were: préhypertension artérielle, préhypertension, pression artérielle normale haute, pression artérielle normale, Afrique.
MESH TERMS WERE
Prehypertension, Africa.
RESULTS
Twenty-seven articles were selected. Prevalence of prehypertension ranged from 2.5% to 34% in children and adolescents. In adults, prevalence varied from 32.9% to 56.8%. Several factors were associated with prehypertension in Africa. These factors included: age; sex; lifestyle such as smoking, alcohol consumption, low physical activity, overweight and obesity. There were also cardiometabolic factors and few others factors which were associated with prehypertension.
CONCLUSION
This review allowed us to observe that the prevalence of prehypertension was variable according to age of the population and prehypertension is associated with several factors.
Topics: Adolescent; Adult; Blood Pressure; Child; Humans; Hypertension; Prehypertension; Prevalence; Risk Factors
PubMed: 35340367
DOI: 10.5334/aogh.2769 -
Journal of Medical Internet Research Jul 2023With rising time constraints, health care professionals increasingly depend on technology to provide health advice and teach patients how to manage chronic disease. The... (Review)
Review
BACKGROUND
With rising time constraints, health care professionals increasingly depend on technology to provide health advice and teach patients how to manage chronic disease. The effectiveness of video-based tools in improving knowledge, health behaviors, disease severity, and health care use for patients with major chronic illnesses is not well understood.
OBJECTIVE
The aim of this study was to assess the current literature regarding the efficacy of video-based educational tools for patients in improving process and outcome measures across several chronic illnesses.
METHODS
A systematic review was conducted using CINAHL and PubMed with predefined search terms. The search included studies published through October 2021. The eligible studies were intervention studies of video-based self-management patient education for an adult patient population with the following chronic health conditions: asthma, chronic kidney disease, chronic obstructive pulmonary disease, chronic pain syndromes, diabetes, heart failure, HIV infection, hypertension, inflammatory bowel disease, and rheumatologic disorders. The eligible papers underwent full extraction of study characteristics, study design, sample demographics, and results. Bias was assessed with the Cochrane risk-of-bias tools. Summary statistics were synthesized in Stata SE (StataCorp LLC). Data reporting was conducted per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.
RESULTS
Of the 112 studies fully extracted, 59 (52.7%) were deemed eligible for inclusion in this review. The majority of the included papers were superiority randomized controlled trials (RCTs; 39/59, 66%), with fewer pre-post studies (13/59, 22%) and noninferiority RCTs (7/59, 12%). The most represented conditions of interest were obstructive lung disease (18/59, 31%), diabetes (11/59, 19%), and heart failure (9/59, 15%). The plurality (28/59, 47%) of video-based interventions only occurred once and occurred alongside adjunct interventions that included printed materials, in-person counseling, and interactive modules. The most frequently studied outcomes were disease severity, health behavior, and patient knowledge. Video-based tools were the most effective in improving patient knowledge (30/40, 75%). Approximately half reported health behavior (21/38, 56%) and patient self-efficacy (12/23, 52%) outcomes were improved by video-based tools, and a minority of health care use (11/28, 39%) and disease severity (23/69, 33%) outcomes were improved by video-based tools. In total, 48% (22/46) of the superiority and noninferiority RCTs and 54% (7/13) of the pre-post trials had moderate or high risk of bias.
CONCLUSIONS
There is robust evidence that video-based tools can improve patient knowledge across several chronic illnesses. These tools less consistently improve disease severity and health care use outcomes. Additional study is needed to identify features that maximize the efficacy of video-based interventions for patients across the spectrum of digital competencies to ensure optimized and equitable patient education and outcomes.
Topics: Adult; Humans; HIV Infections; Chronic Disease; Pulmonary Disease, Chronic Obstructive; Diabetes Mellitus; Heart Failure
PubMed: 37467015
DOI: 10.2196/41092 -
British Journal of Clinical Pharmacology Sep 2022Calcineurin inhibitors (CNIs) are often used for solid organ transplantation recipients or patients with immune-mediated diseases. This systematic review and... (Meta-Analysis)
Meta-Analysis Review
AIMS
Calcineurin inhibitors (CNIs) are often used for solid organ transplantation recipients or patients with immune-mediated diseases. This systematic review and meta-analysis aims to understand how CNIs affect pregnancy and neonatal outcomes.
METHODS
Electronic databases were searched for observational studies assessing pregnancy and neonatal outcomes in CNI-treated patients. The pooled rate of each outcome was determined. Metaregression was conducted to identify contributing factors to the outcomes.
RESULTS
We analysed 98 studies with a total of 5355 pregnancies in 4450 CNI-treated patients. The pooled rates of live birth and spontaneous abortion were 82.1% (95% confidence interval [CI] 76.7-86.4%) and 11.7% (95% CI 8.7-15.5%), respectively. The rates of preterm delivery (33.2%, 95% CI 29.2-37.5%), low birth weight (35.8%, 95% CI 27.7-44.8%) and preeclampsia (13.5%, 95% CI 9.4-19.2%) were 3-4 times higher than the rates of general population. Nearly half of the CNI-treated patients required caesarean delivery (43.5%, 95% CI 36.9-50.3%). The rates of stillbirth, neonatal and maternal death were 4.2% (95% CI 2.8-6.2%), 2.9% (95% CI 1.8-4.8%) and 2.3% (95% CI 1.3-4.1%), respectively. Metaregression showed that preeclampsia was significantly associated with the risks of preterm delivery and low birth weight. Older maternal age, prepregnancy hypertension and cyclosporine use increased the risk of preeclampsia.
CONCLUSION
Given the higher mortalities in CNI-treated patients and their children than the general averages, their pregnancy is considered high risk. The risks of preterm delivery and low birth weight were primarily attributed to preeclampsia. Since prepregnancy hypertension increased its risk, an appropriate preconception blood pressure management may improve their outcomes.
Topics: Calcineurin Inhibitors; Child; Female; Humans; Hypertension; Infant, Newborn; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth
PubMed: 35593302
DOI: 10.1111/bcp.15414 -
BMC Pregnancy and Childbirth Sep 2023There is a dearth of robust evidence regarding the correlation between psoriasis with maternal and neonatal outcomes, making it challenging to establish definitive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is a dearth of robust evidence regarding the correlation between psoriasis with maternal and neonatal outcomes, making it challenging to establish definitive recommendations for the management of these patients. This systematic review and meta-analysis aimed to review the evidence with regard to the impact of maternal psoriasis on maternal and neonatal outcomes.
METHODS
Following the PRISMA guideline, a systematic search of English articles using PubMed, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar, and the Cochrane Library was conducted. The search was performed from inception to 22 of May 2022.
RESULT
A significant association was observed between psoriasis and maternal outcomes, including cesarean delivery [OR = 1.25 (95% CI: 1.13-1.30, p-value = 0.001)], (pre)eclampsia [OR = 1.29 (95% CI: 1.15-1.44, p-value = 0.0001)], gestational diabetes [Odds Ratio (OR) = 1.23 (95% Confidence Intervals (CI): 1.15-1.30, p-value = 0.001)], gestational hypertension [OR = 1.31 (95% CI: 1.18-1.45, p-value = 0.001)] and preterm birth [OR = 1.22 (95% CI: 1.10-1.35, p-value = 0.001)]. Also, there was a significant association between psoriasis and neonatal outcomes, including small for gestational age [OR = 1.07 (95% CI: 1.02-1.11, p-value = 0.053)], low birth weight [OR = 1.19 (95% CI: 1.02-1.38, p-value = 0.001)] and stillbirth [OR = 1.27 (95% CI: 1.04-1.55, p-value = 0.023)].
CONCLUSION
Maternal psoriasis could negatively impact maternal and neonatal outcomes. Our results strengthen the importance of close monitoring of the mothers' psoriasis status before and during pregnancy.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy Outcome; Premature Birth; Stillbirth; Diabetes, Gestational; Pre-Eclampsia
PubMed: 37777747
DOI: 10.1186/s12884-023-06006-5 -
Frontiers in Cardiovascular Medicine 2021Sarcoidosis-associated pulmonary hypertension (SAPH) is associated with poor prognosis, conferring up to a 10-fold increase in mortality in patients with sarcoidosis,...
BACKGROUND
Sarcoidosis-associated pulmonary hypertension (SAPH) is associated with poor prognosis, conferring up to a 10-fold increase in mortality in patients with sarcoidosis, but the actual prevalence of SAPH is unknown.
METHODS
The PubMed, Embase, and Cochrane Library databases were systematically searched for epidemiological studies reporting the prevalence of SAPH up to July 2021. Two reviewers independently performed the study selection, data extraction, and quality assessment. Studies were pooled using random-effects meta-analysis.
RESULTS
This meta-analysis included 25 high-quality studies from 12 countries, with a pooled sample of 632,368 patients with sarcoidosis. The prevalence of SAPH by transthoracic echocardiography in Europe, the United States and Asia was 18.8% [95% confidence interval (CI): 11.1-26.5%], 13.9% (95% CI: 5.4-22.4%) and 16.2% (95% CI: 7.1-25.4%) separately, and the overall pooled prevalence was 16.4% (95%CI: 12.2-20.5%). By right heart catheterization (RHC), the pooled prevalence of SAPH was 6.4% (95% CI: 3.6-9.1%) in general sarcoidosis population, and subgroup analyses showed that the prevalence of SAPH was 6.7% (95% CI: 2.4-11.0%) in Europe and 8.6% (95% CI: -4.1 to 21.3%) in the United States. Further, the prevalence of pre-capillary PH was 6.5% (95% CI: 2.9-10.2%). For the population with advanced sarcoidosis, the pooled prevalence of SAPH and pre-capillary PH by RHC was as high as 62.3% (95% CI: 46.9-77.6%) and 55.9% (95% CI: 20.1-91.7%), respectively. Finally, the pooled prevalence of SAPH in large databases with documented diagnoses (6.1%, 95% CI: 2.6-9.5%) was similar to that of RHC. Substantial heterogeneity across studies was observed for all analyses ( > 80%, < 0.001).
CONCLUSIONS
The sarcoidosis population has a relatively low burden of PH, mainly pre-capillary PH. However, as the disease progresses to advanced sarcoidosis, the prevalence of SAPH increases significantly.
PubMed: 35111830
DOI: 10.3389/fcvm.2021.809594 -
BMC Pregnancy and Childbirth Jun 2021Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC).
METHODS
We identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups.
RESULTS
Eighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60-1.80; I = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20-1.50; I = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00-6.51; I = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58-1.92; I = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33-1.53; I = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively).
CONCLUSIONS
Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Hypertension, Pregnancy-Induced; Odds Ratio; Oocyte Donation; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic
PubMed: 34182957
DOI: 10.1186/s12884-021-03938-8 -
The Journal of Nutrition, Health & Aging 2023Frailty may increase the risk of adverse outcomes and the presence of comorbidities in hypertension. Understanding the prevalence of frailty in older adults with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Frailty may increase the risk of adverse outcomes and the presence of comorbidities in hypertension. Understanding the prevalence of frailty in older adults with hypertension is of great importance, whereas estimates of the prevalence of frailty in this population vary greatly.
OBJECTIVES
A systematic review and meta-analysis was conducted to estimate the pooled prevalence of frailty and prefrailty among community-dwelling older adults with hypertension, and to examine the risk factors associated with (pre)frailty in this population.
METHODS
PubMed, Web of Science, The Cochrane Library, EMBASE, and CINAHL were searched from the inception to May 10, 2023. Investigators assessed eligibility, extracted data, and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity. Sensitivity analysis was undertaken by the leave-one-out method and by removing studies with moderate/high risk of bias. The Mantel-Haenszel or inverse variance method was used to estimate risk factors of frailty.
RESULTS
A total of 14 studies met the inclusion criteria, involving 185,249 participants. The pooled prevalence in older adults with hypertension was 23% (95% CI 0.09-0.36) for frailty and 46% (95% CI 0.38-0.54) for prefrailty. The pooled prevalence of frailty was greater in studies with a higher proportion of females (24%, 95% CI 0.05-0.50), using multidimensional tools to define frailty (30%, 95% CI 0.10-0.51) and conducted in Western Pacific (27%, 95% CI 0.17-0.39). Age, female sex, depression, and previous hospitalizations were risk factors of frailty among older adults with hypertension.
CONCLUSION
Frailty and prefrailty are prevalent in community-dwelling older adults with hypertension, and limited risk factors are identified. This implicates the importance of frailty assessment integrated into the routine primary care for older adults with hypertension in community settings as well as the understanding of potential factors.
Topics: Humans; Female; Aged; Frailty; Independent Living; Frail Elderly; Prevalence; Hypertension
PubMed: 38151875
DOI: 10.1007/s12603-023-2035-5 -
Internal Medicine Journal Nov 2021The objective of the present study is to investigate the incidence, characteristics and outcomes of patients who were readmitted to hospital emergency departments or... (Meta-Analysis)
Meta-Analysis Review
The objective of the present study is to investigate the incidence, characteristics and outcomes of patients who were readmitted to hospital emergency departments or required re-hospitalisation following an index hospitalisation with a diagnosis of COVID-19. A systematic review of PubMed, EMBASE and pre-print websites was conducted between 1 January and 31 December 2020. Studies reporting on the incidence, characteristics and outcomes of patients with COVID-19 who represent or require hospital admission were included. Two authors independently performed study selection and data extraction. Study quality was assessed with the Newcastle-Ottawa Scale. Discrepancies were resolved by consensus or through an independent third reviewer. Data were synthesised according to the Preferred Reporting Items for Systematic Reviews guidelines. Six studies reporting on 547 readmitted patients were included. The overall incidence was 4.4%, most common in males (57.2%), and due to respiratory distress or prolonged COVID-19. Readmitted patients had a shorter initial hospital length of stay (LOS) compared with those with a single hospitalisation (8.1 ± 10.6 vs 13.9 ± 10.2 days). The mean time to readmission was 7.6 ± 6.0 days; the mean LOS on re-hospitalisation was 6.3 ± 5.6 days. Hypertension (odds ratio (OR) = 2.08; 95% confidence interval (CI) 1.69-2.55; P < 0.001; I = 0%), diabetes mellitus (OR = 1.77; 95% CI 1.38-2.27; P < 0.001; I = 0%) and chronic renal failure (OR = 2.37; 95% CI 1.09-5.14; P < 0.001; I = 0%) were more common in these patients. Intensive care admission rates were similar between the two groups; 12.8% (22/172) of readmitted patients died. In summary, readmitted patients following an index hospitalisation for COVID-19 were more commonly males with multiple comorbidities. Shorter initial hospital LOS and unresolved primary illness may have contributed to readmission.
Topics: COVID-19; Humans; Length of Stay; Male; Patient Readmission; Risk Factors; SARS-CoV-2; Survivors
PubMed: 34487424
DOI: 10.1111/imj.15350 -
The Lancet Regional Health. Southeast... Feb 2023Hypertension is a significant contributor to mortality in India. Achieving better hypertension control rate at the population level is critical in reducing...
BACKGROUND
Hypertension is a significant contributor to mortality in India. Achieving better hypertension control rate at the population level is critical in reducing cardiovascular morbidity and mortality.
METHODS
Hypertension control rate was defined as the proportion of patients with their blood pressure under control (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg). We conducted a systematic review and meta-analysis of community-based, non-interventional studies published after 2001 that reported hypertension control rates. We searched PubMed, Embase, and Web of Science databases, and grey literature, and extracted data using a common framework, and summarized the study characteristics. We conducted random-effects meta-analysis using untransformed hypertension control rates and reported the overall summary estimates and subgroup estimates of control rates as percentages and 95% confidence intervals. We also conducted mixed-effects meta-regression with sex, region, and study period as covariates. The risk of bias was assessed, and level of evidence was summarized using SIGN-50 methodology. The protocol was pre-registered with PROSPERO, CRD42021267973.
FINDINGS
The systematic review included 51 studies (n = 338,313 hypertensive patients). 21 studies (41%) reported poorer control rates among males than females, and six studies (12%) reported poorer control rates among rural patients. The pooled hypertension control rate in India during 2001-2020 was 17.5% (95% CI: 14.3%-20.6%)-with significant increase over the years, reaching 22.5% (CI: 16.9-28.0%) in 2016-2020. Sub-group analysis showed significantly better control rates in the South and West regions, and significantly poorer control rates among males. Very few studies reported data on social determinants or lifestyle risk factors.
INTERPRETATION
Less than one-fourth of hypertensive patients in India had their blood pressure under control during 2016-2020. Although the control rate has improved compared to previous years, substantial differences exist across regions. Very few studies have examined the lifestyle risk factors and social determinants relevant to hypertension control in India. The country needs to develop and evaluate sustainable, community-based strategies and programs to improve hypertension control rates.
FUNDING
Not applicable.
PubMed: 37383035
DOI: 10.1016/j.lansea.2022.100113