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Pharmacological Research Apr 2021Quantitative comparison of the effects of intensive (IPT) or conventional (CPT) periodontal treatment on arterial blood pressure, endothelial function and... (Meta-Analysis)
Meta-Analysis
AIM
Quantitative comparison of the effects of intensive (IPT) or conventional (CPT) periodontal treatment on arterial blood pressure, endothelial function and inflammatory/metabolic biomarkers.
MATERIALS AND METHODS
A systematic search was conducted to identify randomized controlled trials (RCT) of IPT (supra and subgingival instrumentation). Eight RCTs were included in the meta-analysis. Difference in change of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after IPT or CPT were the primary outcomes. The secondary outcomes included: endothelial function and selected inflammatory/anti-inflammatory (CRP, IL-6, IL-10, IFN-γ) and metabolic biomarkers (HDL, LDL, TGs).
RESULTS
The overall effect estimates (pooled Weighted Mean Difference (WMD)) of the primary outcome for SBP and DBP was -4.3 mmHg [95%CI: -9.10-0.48], p = 0.08 and -3.16 mmHg [95%CI: -6.51-0.19], p = 0.06 respectively. These studies were characterized by high heterogeneity. Therefore, random effects model for meta-analysis was performed. Sub-group analyses confirmed statistically significant reduction in SBP [WMD = -11.41 mmHg (95%CI: -13.66, -9.15) P < 0.00001] and DBP [WMD = -8.43 mmHg (95%CI: -10.96,-5.91)P < 0.00001] after IPT vs CPT among prehypertensive/hypertensive patients, while this was not observed in normotensive individuals. The meta-analyses showed significant reductions in CRP and improvement of endothelial function following IPT at all analysed timepoints.
CONCLUSIONS
IPT leads to improvement of the cardiovascular health in hypertensive and prehypertensive individuals.
Topics: Antihypertensive Agents; Blood Pressure; Heart Disease Risk Factors; Humans; Hypertension; Periodontitis
PubMed: 33617973
DOI: 10.1016/j.phrs.2021.105511 -
Caspian Journal of Internal Medicine 2023Hypertension (HTN) is one of the primary risk factors for heart disease and stroke worldwide. The present meta-analysis was aimed to systematically review and... (Review)
Review
BACKGROUND
Hypertension (HTN) is one of the primary risk factors for heart disease and stroke worldwide. The present meta-analysis was aimed to systematically review and statistically estimate the prevalence rate of pre-hypertension (PHTN) and HTN in the Iranian child/adolescent and adult age groups.
METHODS
In this study, four International databases, including PubMed, Scopus, Web of Science, and Cochrane, as well as three Iranian databases, including SID, Magiran, and IranMedex, were separately investigated for articles published before January 2021. Also, we estimated the pooled effect size for the prevalence of PHTN and HTN in children/adolescent and adult age groups. Stata software (version 14.0) was used for all statistical analyses.
RESULTS
From a total of 1185 articles found in database searches, fifty-one were included in the meta-analysis. The prevalence of HTN in the Iranian adult population was 26.26% (25.11 % and 26.22 % for women and men, respectively). Meanwhile, the prevalence of PHTN and HTN in the child/adolescent age group was 8.97% (95% CI 7.33 - 10.61) and 8.98% (95% CI 7.59 - 10.36), respectively.
CONCLUSIONS
This study provides information which can be used for various purposes, including study designing. Further nationwide surveys should be carried out to obtain accurate information on the HTN prevalence rate, particularly based on the American College of Cardiology /American Heart Association guidelines in the Iranian population.
PubMed: 38024178
DOI: 10.22088/cjim.14.43.607 -
The Cochrane Database of Systematic... Sep 2020This is the second update of this systematic review. High blood pressure represents a major public health problem. Worldwide, approximately one-fourth of the adult... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This is the second update of this systematic review. High blood pressure represents a major public health problem. Worldwide, approximately one-fourth of the adult population has hypertension. Epidemiological and experimental studies suggest a link between hyperuricaemia and hypertension. Hyperuricaemia affects 25% to 40% of those with untreated hypertension; a much lower prevalence has been reported in those with normotension or in the general population. However, whether lowering serum uric acid (UA) might lower blood pressure (BP), is an unanswered question.
OBJECTIVES
To determine whether UA-lowering agents reduce BP in people with primary hypertension or prehypertension, compared with placebo.
SEARCH METHODS
The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to May 2020: the Cochrane Hypertension Specialised Register, CENTRAL 2018, Issue 12, MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched LILACS (1982 to May 2020), and contacted authors of relevant papers regarding further published and unpublished work. The searches had no language or date restrictions.
SELECTION CRITERIA
To be included in this updated review, the studies had to meet the following criteria: 1) randomised or quasi-randomised, with a group assigned to receive a UA-lowering agent and another group assigned to receive placebo; 2) double-blind, single-blind, or open-label; 3) parallel or cross-over trial design; 4) cross-over trials had to have a washout period of at least two weeks; 5) minimum treatment duration of four weeks; 6) participants had to have a diagnosis of essential hypertension or prehypertension plus hyperuricaemia (serum UA greater than 6 mg/dL in women, 7 mg/dL in men, and 5.5 mg/dL in children or adolescents); 7) outcome measures included change in 24-hour ambulatory systolic or diastolic BP, or both; or clinic-measured systolic or diastolic BP, or both.
DATA COLLECTION AND ANALYSIS
The two review authors independently collected the data using a data extraction form, and resolved any disagreements via discussion. We assessed risk of bias using the Cochrane 'Risk of bias' tool. We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
In this review update, we screened 722 records, selected 26 full-text reports for evaluation. We identified no ongoing studies and did not add any new studies. We included three randomised controlled trials (RCTs), enrolling 211 people with hypertension or prehypertension, plus hyperuricaemia. Low-certainty evidence from three RCTs found inconclusive results between those who received UA-lowering drugs and placebo, in 24-hour ambulatory systolic (MD -6.2 mmHg, 95% CI -12.8 to 0.5) or diastolic BP (-3.9 mmHg, 95% CI -9.2 to 1.4). Low-certainty evidence from two RCTs found that UA-lowering drugs reduced clinic-measured systolic BP (-8.43 mmHg, 95% CI -15.24 to -1.62) but results for clinic-measured diastolic BP were inconclusive (-6.45 mmHg, 95% CI -13.60 to 0.70). High-certainty evidence from three RCTs found that serum UA levels were reduced by 3.1 mg/dL (95% CI 2.4 to 3.8) in the participants that received UA-lowering drugs. Low-certainty evidence from three RCTs found inconclusive results regarding the occurrence of adverse events between those who received UA-lowering drugs and placebo (RR 1.86, 95% CI 0.43 to 8.10).
AUTHORS' CONCLUSIONS
In this updated Cochrane Review, the current RCT data are insufficient to know whether UA-lowering therapy lowers BP. More studies are needed.
Topics: Adolescent; Adult; Allopurinol; Blood Pressure; Child; Humans; Hypertension; Hyperuricemia; Patient Dropouts; Placebos; Prehypertension; Randomized Controlled Trials as Topic; Uricosuric Agents
PubMed: 32877573
DOI: 10.1002/14651858.CD008652.pub4 -
Current Problems in Cardiology Mar 2023Quality use of anti-hypertensive and cholesterol-lowering medications is crucial for successful cardiovascular disease management. This systematic review aimed to... (Review)
Review
Quality use of anti-hypertensive and cholesterol-lowering medications is crucial for successful cardiovascular disease management. This systematic review aimed to estimate levels of over and underuse of services for primary and secondary prevention of cardiovascular diseases from 2000 to 2020: overprescribing/underprescribing, overtesting/undertesting and overutilization/ underutilization of procedures compared to clinical practice guideline recommendations. Thirteen studies from USA, Europe, Asia and Australia were included. Wide practice variation was identified. Six studies reported overuse (eg, perioperative cardiac consultations, anti-hypertensive overprescribing for normotensive or pre-hypertensive people); and ten studies reported underuse (eg, under-prescribing of statins when indicated and under-screening for familial hypercholesterolemia). Lifestyle recommendations for cardiovascular disease prevention were largely underused. In summary, lack of adherence to published guidelines was prevalent over the past 2 decades for both primary and secondary prevention across settings. Further investigation of potentially justifiable deviations from guidelines are warranted to verify the estimates and identify points for intervention.
Topics: Humans; Cardiovascular Diseases; Antihypertensive Agents; Secondary Prevention; Hypertension; Hydroxymethylglutaryl-CoA Reductase Inhibitors
PubMed: 36493917
DOI: 10.1016/j.cpcardiol.2022.101529 -
Nitric Oxide : Biology and Chemistry Sep 2021Previous clinical studies have shown controversial results regarding the effect of inorganic nitrate supplementation on blood pressure (BP) in older individuals. We... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous clinical studies have shown controversial results regarding the effect of inorganic nitrate supplementation on blood pressure (BP) in older individuals. We performed this systematic review and meta-analysis to assess the effect of inorganic nitrate on BP in older adults.
METHODS
Eligible studies were searched in Cochrane Library, PubMed, Scopus, Web of Science, and Embase. Randomized controlled trials which evaluated the effect of inorganic nitrate consumption on BP in older adults were recruited. The random-effect model was used to calculate the pooled effect sizes.
RESULTS
22 studies were included in this meta-analysis. Overall, inorganic nitrate consumption significantly reduced systolic blood pressure (SBP) by -3.90 mmHg (95% confidence interval: -5.23 to -2.57; P < 0.001) and diastolic blood pressure (DBP) by -2.62 mmHg (95% confidence interval: -3.86 to -1.37; P < 0.005) comparing with the control group. Subgroup analysis showed that the BP was significantly reduced when participants' age≥65, BMI>30, or baseline BP in prehypertension stage. And both SBP and DBP decreased significantly after acute nitrate supplementation of a single dose (<1 day) or more than 1-week. However, participants with hypertension at baseline were not associated with significant changes in both SBP and DBP. Subgroup analysis of measurement methods showed that only the resting BP group showed a significant reduction in SBP and DBP, compared with the 24-h ambulatory BP monitoring (ABPM) group and daily home BP measurement group.
CONCLUSION
These results demonstrate that consuming inorganic nitrate can significantly reduce SBP and DBP in older adults, especially in whose age ≥ 65, BMI>30, or baseline BP in prehypertension stage.
Topics: Aged; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Dietary Supplements; Humans; Nitrates; Randomized Controlled Trials as Topic
PubMed: 33905826
DOI: 10.1016/j.niox.2021.04.006 -
JMIR Cardio Nov 2022Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approaches to Stop Hypertension (DASH) diet is one of the most... (Review)
Review
BACKGROUND
Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approaches to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile apps have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP.
OBJECTIVE
This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and consequently reduce BP. A secondary aim was to assess engagement, satisfaction, acceptance, and usability related to DASH mobile app use.
METHODS
The Embase (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The reference lists of the included articles were also checked. Studies were eligible if they (1) were randomized controlled trials (RCTs) or pre-post studies of app-based interventions for adults (aged 18 years or above) with prehypertension or hypertension, without consideration of gender or sociodemographic characteristics; (2) used mobile phone apps alone or combined with another component, such as communication with others; (3) used or did not use any comparator; and (4) had the primary outcome measures of BP level and adherence to the DASH diet. For eligible studies, data were extracted and outcomes were organized into logical categories, including clinical outcomes (eg, systolic BP, diastolic BP, and weight loss), DASH diet adherence, app usability and acceptability, and user engagement and satisfaction. The quality of the studies was evaluated using the Cochrane Collaboration's Risk of Bias tool for RCTs, and nonrandomized quantitative studies were evaluated using a tool provided by the US National Institutes of Health.
RESULTS
A total of 5 studies (3 RCTs and 2 pre-post studies) including 334 participants examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the 3 RCTs had a high risk of bias. One pre-post study had a high risk of bias, while the other had a low risk. As a consequence, no firm conclusions could be drawn regarding the effectiveness of DASH smartphone apps for increasing DASH diet adherence and lowering BP. All the apps appeared to be acceptable and easy to use.
CONCLUSIONS
There is weak emerging evidence of a positive effect of using DASH smartphone apps for supporting self-management to improve DASH diet adherence and consequently lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps.
PubMed: 36322108
DOI: 10.2196/35876 -
Diagnostics (Basel, Switzerland) Nov 2021Psychological stress is a well-established risk factor for cardiovascular disease (CVD). Heart rate variability (HRV)-biofeedback could significantly reduce stress... (Review)
Review
Psychological stress is a well-established risk factor for cardiovascular disease (CVD). Heart rate variability (HRV)-biofeedback could significantly reduce stress levels and improve autonomic nervous system function and cardiovascular endpoints. We aimed to systematically review the literature to investigate the impact of HRV modulation through HRV-biofeedback on clinical outcomes in patients with CVD. A literature search was performed in the following databases: MEDLINE (PubMed), Embase, and Cochrane from the inception until 1 October 2021. Patients in the HRV-biofeedback group had significantly lower rates of all-cause readmissions than patients who received psychological education (respectively, = 0.028 and = 0.001). Heart failure following HRV-biofeedback displayed an inverse association with stress and depression (respectively, = 0.022 and = 0.033). When stratified according to left ventricular ejection fraction (LVEF), patients with LVEF ≥ 31% showed improved values of the 6 min walk test after HRV-biofeedback interventions ( = 0.05). A reduction in systolic and diastolic blood pressure associated with HRV-biofeedback was observed ( < 0.01) in pre-hypertensive patients. HRV-biofeedback had beneficial effects on different cardiovascular diseases documented in clinical trials, such as arterial hypertension, heart failure, and coronary artery disease. A standard breathing protocol should be applied in future studies to obtain equivalent results and outcomes. However, data regarding mortality in patients with coronary artery disease are scarce and need further research.
PubMed: 34943435
DOI: 10.3390/diagnostics11122198 -
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 -
Indian Journal of Pediatrics Nov 2021To conduct a systematic review to provide pooled estimates of the prevalence of hypertension among children aged less than 18 y in India. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To conduct a systematic review to provide pooled estimates of the prevalence of hypertension among children aged less than 18 y in India.
METHODS
Three electronic databases (PubMed, EMBASE, and Web of Science) were searched from inception to August 2020 by using terms related to hypertension, children, prevalence, and India. Studies reporting the prevalence of hypertension, defined based on at least three measurements, were included. Two investigators independently performed the literature search, study selection, and data extraction for this review. Random effect meta-analysis was used to provide pooled estimates of hypertension.
RESULTS
A total of 64 studies were included in this systematic review. The pooled prevalence was 7% (95% CI: 6%-8%) for hypertension, 4% (95% CI: 3%-4.1%) for sustained hypertension and 10% (95% CI: 8%-13%) for prehypertension. While there was no significant difference in hypertension across five different regions of the country, an upward rising trend was observed after the year 2005. Urban children had a higher prevalence of hypertension as compared to their rural counterparts. Children with obesity had a significantly high prevalence of hypertension (29%) than normal-weight children (7%).
CONCLUSION
In this review, it was observed that considerable proportions (7%) of school going children are hypertensive in India. Prevalence was higher in urban and overweight children. This study highlights that hypertension is a public health problem in India; hence, there is a need to implement public health measures to prevent hypertension.
Topics: Adolescent; Child; Humans; Hypertension; India; Obesity; Prevalence; Rural Population
PubMed: 33796994
DOI: 10.1007/s12098-021-03686-9 -
Blood Pressure Monitoring Dec 2023Strict blood pressure control is essential to prevent cardiovascular disease and is associated with decreased mortality. However, in patients with end-stage renal... (Review)
Review
BACKGROUND
Strict blood pressure control is essential to prevent cardiovascular disease and is associated with decreased mortality. However, in patients with end-stage renal disease awaiting renal transplantation, the level of optimal blood pressure control is not yet defined.
METHODS
Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including 'end-stage renal disease', 'blood pressure', and 'pre-transplant' from their inception to 7 August 2022.
RESULTS
Seven observational studies, including one population-based study, were included in the review. Most studies investigated factors associated with post-transplant graft failure or mortality. There was considerable heterogeneity in defining optimal pre-transplant blood pressure measurement frequency among studies (average of three measurements vs. single measurement). One study suggested that low pre-transplant diastolic blood pressure (<50 mmHg) was associated with lower odds of delayed graft failure and mortality. Two studies noted that pre-transplant hypertension, or clinical criteria of hypertension that were present prior to transplant, was associated with post-transplant adverse outcomes. In contrast, one study noted that pre-transplant sustained hypotension with mean blood pressure <80 mmHg, was associated with a higher frequency of delayed graft failure.
CONCLUSION
This systematic review summarizes the current evidence regarding the relationship between pre-transplant blood pressure control and post-transplant outcomes in end-stage renal disease patients. While the results from the included studies are mixed, more stringent blood pressure control than currently practiced may be beneficial to decrease graft failure and mortality in this patient population.
Topics: Humans; Blood Pressure; Hypotension; Hypertension; Kidney Failure, Chronic; Prehypertension
PubMed: 37910025
DOI: 10.1097/MBP.0000000000000668