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The Journal of Cardiovascular Nursing Aug 2023Chronic sleep disturbance has been consistently associated with cardiovascular disease. We sought to determine whether behavioral interventions to improve sleep have...
BACKGROUND/OBJECTIVES
Chronic sleep disturbance has been consistently associated with cardiovascular disease. We sought to determine whether behavioral interventions to improve sleep have been associated with improvements in 4 common cardiovascular disease risk factors: hypertension, diabetes mellitus (DM), obesity, and smoking.
METHODS
Randomized controlled trials evaluating the prospective effect of behavioral sleep interventions on (a) blood pressure in participants with hypertension/prehypertension, (b) glycemic control in participants with DM/pre-DM, (c) anthropometrics in participants who were overweight/obese, and (d) smoking status in smokers were eligible. Where feasible, we undertook random-effects meta-analyses of standardized mean differences in cardiovascular disease risk factor change.
RESULTS
Overall, 3 trials met the inclusion criteria for blood pressure, 4 for glycemic control, 9 for overweight/obesity, and 2 for smoking. On meta-analysis, interventions with sleep as the sole behavioral target were associated with a significant reduction in hemoglobin A1c% (-0.84; 95% confidence interval [CI], -1.34 to -0.34), but not a significant reduction in systolic blood pressure (-0.18; 95% CI, -0.55 to 0.20) versus controls. In addition, any interventions with sleep as a behavioral target were associated with significant reductions in hemoglobin A1c% (-0.71; 95% CI, -1.01 to -0.42) and weight (-0.78; 95% CI, -1.11 to -0.45), but not systolic blood pressure (-0.72; 95% CI, -1.82 to 0.37). Trials evaluating smoking status were not amenable to meta-analysis.
CONCLUSION
Behavioral interventions to improve sleep were associated with improved glycemic control in patients with DM. It is also possible that these interventions improve weight in individuals who were overweight/obese. A low number of trials and small sample sizes indicate that further large, well-designed randomized controlled trials of interventions are warranted.
PubMed: 37556345
DOI: 10.1097/JCN.0000000000001018 -
Scandinavian Journal of Medicine &... Apr 2023To determine the impact of intermittent high-intensity exercise training ([IHIE], including high-intensity interval training [HIIT] and recreational team sports [RTS])... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the impact of intermittent high-intensity exercise training ([IHIE], including high-intensity interval training [HIIT] and recreational team sports [RTS]) on systolic (SBP) and diastolic blood pressure (DBP) in adults with pre- to established arterial hypertension.
DATA SOURCES
MEDLINE, Cochrane Library, Embase, and SPORTDiscus.
ELIGIBILITY CRITERIA
Randomized controlled trials (RCTs) comparing the impact of IHIE on BP versus a non-exercise control.
DATA COLLECTION AND ANALYSIS
Two authors independently conducted all procedures. Mean differences were calculated using random-effects model. The certainty of the evidence was assessed with GRADE.
RESULTS
Twenty-seven RCTs (18 HIIT and 9 RTS) were analyzed, with median duration of 12 weeks. Participants' (n = 946) median age was 46 years. Overall, IHIE decreased SBP (-3.29 mmHg; 95% CI: -5.19, -1.39) and DBP (-2.62 mmHg; 95% CI: -3.79, -1.44) compared to the control group. IHIE elicited higher decreases in office SBP and DBP of hypertensive subjects (SBP: -7.13 mmHg, [95% CI: -10.12, -4.15]; DBP: -5.81 mmHg, [95% CI: -7.94, -3.69]) than pre-hypertensive (SBP: -2.14 mmHg, [95% CI: -4.36, -0.08]; DBP: -1.83 mmHg, [95% CI: -2.99, -0.67]). No significant differences were found between HIIT (SBP: -2.12 mmHg, [95% CI: -4.78, -0.54]; DBP: -1.89 mmHg, [95% CI: -3.32, -0.48]) and RTS (SBP: -4.18 mmHg, [95% CI: -7.19, -2.43]; DBP: -4.04 mmHg, [95% CI: -6.00, -2.09]). These findings present low/very low certainty of evidence. No adverse cardiovascular events were reported.
CONCLUSIONS
IHIE appears to be safe and to promote substantial decreases in BP, particularly in patients with hypertension. However, the certainty of evidence was low/very low.
PROTOCOL
CRD42020163575.
Topics: Adult; Humans; Middle Aged; Hypertension; Blood Pressure; Exercise; Team Sports; High-Intensity Interval Training
PubMed: 36579740
DOI: 10.1111/sms.14299 -
Frontiers in Physiology 2023Non-pharmacological management of hypertension includes weight loss, alcohol and sodium restriction, regular exercise, and relaxation. In people with overweight...
Non-pharmacological management of hypertension includes weight loss, alcohol and sodium restriction, regular exercise, and relaxation. In people with overweight hypertension, systolic blood pressure (SBP) and diastolic blood pressure (DBP) can be decreased exercise and weight loss together. Breathing exercises are one method of relaxing. The aim of this scoping review is to map the information that is currently available about the advantages of breathing exercises in decreasing blood pressure in hypertension patients. This scoping review adheres to Arksey and O'Malley's framework, which entails identifying review questions, seeking pertinent evidence, choosing pertinent studies, mapping data, and discussing, concluding, and reporting the findings. The PRISMA flowchart is used to show how the evidence search process works. As a result, 339 articles in total were retrieved from the three databases. 20 papers total were included in this review after screening. In 14 of the 20 investigations, participants with stage 1 and stage 2 essential hypertension, two with pre-hypertension, and four with Isolated Systolic Hypertension (ISH) were studied. The respondents' ages ranged from 18 to 75. The systolic blood pressure declined by 4-54.22 mmHg, while the diastolic blood pressure dropped by 3-17 mmHg. Slow breathing can be used as an alternate, non-pharmacological therapy for hypertension individuals to reduce blood pressure. (https://osf.io/ta9u6/).
PubMed: 36760529
DOI: 10.3389/fphys.2023.1048338 -
Public Health in Practice (Oxford,... Nov 2021To analyse published literatures on prevalence, awareness, risk factors and control of hypertension in Nepal. (Review)
Review
OBJECTIVE
To analyse published literatures on prevalence, awareness, risk factors and control of hypertension in Nepal.
METHODS
We used electronic databases to search relevant articles from January 2000 till October 2020. All relevant data from selected studies were extracted into a standardized form designed in Excel. Statistical analysis was conducted using Comprehensive Meta-Analysis Software (CMA) version 3. Proportions or Odds Ratio (OR) was used to estimate the outcome with 95% confidence interval (CI). The I-squared (I) test was used for the assessment of heterogeneity.
RESULTS
We identified a total of 3726 studies after comprehensive database searching. We performed qualitative and quantitative analysis of 40 studies. Pooling data showed 28.52% of patients with hypertension (CI: 26.40-30.75); 45.28% (CI: 38.89-51.83) aware of their high blood pressure; 31.66% (CI: 23.18-41.56) under treatment; 44.4% (CI: 36.17-53.04) had their blood pressure under optimum range. 27.4% (CI: 21.57-34.11) had pre-hypertensive range elevated blood pressure. 25.99% (CI: 21.81-30.65) of females and 34.25% (CI: 30.49-38.21) of male were hypertensive (p = 0.007).The pooling of data showed smokers have 1.43 times (CI: 1.1429-1.7889); and alcohol users have 2.073 times (CI: 1.7154-2.5050) higher risk of having hypertension. Individuals with normal BMI have 53.15% (OR: 0.4685 CI: 0.3543-0.6195); with formal educated have 37.27% (OR: 0.6273, CI: 0.5485-0.7175); and with adequate exercise have 31.6% (OR: 0.6839, CI: 0.5203-0.8991) lower chance of having hypertension.
CONCLUSION
Our study shows the prevalence of hypertension in Nepal is high. However, awareness, treatment and subsequently control of high blood pressure are found to be alarmingly low. Hypertension was associated with male gender, smoking, alcohol use, high BMI, no education and inadequate exercise. It calls for more attention to address the burden of hypertension and associated risk factors in Nepal.
PubMed: 36101638
DOI: 10.1016/j.puhip.2021.100119 -
Frontiers in Nutrition 2022Findings of observational studies that evaluated the association of serum vitamin D status and high blood pressure were contradictory. This meta-analysis of...
BACKGROUND
Findings of observational studies that evaluated the association of serum vitamin D status and high blood pressure were contradictory. This meta-analysis of epidemiologic studies assessed the relation of serum vitamin D levels to hypertension (HTN) and pre-hypertension in adults.
METHODS
We conducted a systematic search of all published articles up to March 2021, in four electronic databases (MEDLINE (PubMed), Web of Science (ISI), Embase and Scopus), and Google scholar. Seventy epidemiologic studies (10 prospective cohort, one nested case-control, and 59 cross-sectional investigations) that reported relative risks (RRs), odds ratios (ORs), hazard ratios, or prevalence ratios with 95% CIs for HTN or pre-hypertension in relation to serum vitamin D concentrations in adults were included in the analysis.
RESULTS
In prospective studies, a 16% decrease in risk of hypertension was observed in participants with high levels of serum vitamin D compared to low levels (RR: 0.84; 95%CI: 0.73, 0.96; 12 effect sizes). Dose-response analysis in prospective studies revealed that each 25 nmol/L increase in serum vitamin D concentrations resulted in 5% reduced risk of HTN (RR: 0.95; 95% CI: 0.90, 1.00). Also, a significant nonlinear relationship between serum vitamin D levels and HTN was found (P < 0.001). In cross-sectional investigations, highest vs. lowest level of serum vitamin D was related to reduced odds of HTN (OR: 0.84; 95%CI: 0.79, 0.90; 66 effect sizes) and pre-hypertension (OR: 0.75; 0.95%CI: 0.68, 0.83; 9 effect sizes). Dose-response analysis in these studies showed that each 25 nmol/L increase in serum vitamin D levels was related to a significant 6% reduction in odds of hypertension in all populations (RR: 0.94; 95%CI: 0.90, 0.99) and 3% in studies with representative populations (RR: 0.97; 95%CI: 0.95, 0.99).
CONCLUSION
This meta-analysis of epidemiologic studies disclosed that serum vitamin D concentrations were inversely related to the risk of HTN in adults, in a dose-response manner in both prospective cohort and cross-sectional studies. http://www.crd.york.ac.uk/Prospero, identifier: CRD42021251513.
PubMed: 35360696
DOI: 10.3389/fnut.2022.829307 -
Complementary Therapies in Medicine Aug 2019Interest is increasing in nonpharmacological interventions to treat blood pressure in hypertensive and prehypertensive patients at low cardiac risk. This meta-analysis... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Interest is increasing in nonpharmacological interventions to treat blood pressure in hypertensive and prehypertensive patients at low cardiac risk. This meta-analysis of randomized controlled trials assesses the impact of device-guided and non-device-guided (pranayama) slow breathing on blood pressure reduction in these patient populations.
METHODS
We searched PubMed, EMBASE, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, BIOSIS (Biological Abstracts) Citation Index and Alt HealthWatch for studies meeting these inclusion criteria: randomized controlled trial or first phase of a randomized cross-over study; subjects with hypertension, prehypertension or on antihypertensive medication; intervention consisting of slow breathing at ≤10 breaths/minute for ≥5 min on ≥3 days/week; total intervention duration of ≥4 weeks; follow-up for ≥4 weeks; and a control group. Data were extracted by two authors independently, the Cochrane Risk of Bias Tool assessed bias risk, and data were pooled using the DerSimonian and Laird random effects model. Main outcomes included changes in systolic (SBP) and/or diastolic blood pressure (DBP), heart rate (HR), and/or decreased antihypertensive medication.
RESULTS
Of 103 citations eligible for full-text review, 17 studies were included in the meta-analysis. Overall, slow breathing decreased SBP by -5.62 mmHg [-7.86, -3.38] and DBP by -2.97 mmHg [-4.28, -1.66]. Heterogeneity was high for all analyses.
CONCLUSIONS
Slow breathing showed a modest reduction in blood pressure. It may be a reasonable first treatment for low-risk hypertensive and prehypertensive patients who are reluctant to start medication.
Topics: Blood Pressure; Cross-Over Studies; Heart Rate; Humans; Hypertension; Randomized Controlled Trials as Topic; Respiration
PubMed: 31331557
DOI: 10.1016/j.ctim.2019.03.005 -
Maturitas Jul 2021The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing... (Review)
Review
The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing hypertension. The aim of this systematic review was to synthesize the effect of exercise training on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in menopausal and postmenopausal women. This review was reported according to the PRISMA statement and registered in PROSPERO. The literature search was done in MEDLINE, Embase, Cochrane CENTRAL and ClinicalTrials. Randomized controlled trials involving menopausal and postmenopausal women undergoing exercise training were included. Two blinded reviewers assessed risk of bias in the included studies by using the Cochrane Risk of Bias tool. A random-effects model was used for all analyses. Significance was set at P < 0.05. Compared with the control group, exercise training resulted in clinically significant reductions on SBP (MD -3.43 mmHg; 95% CI, -5.16, -1.71; P < 0.0001), DBP (MD, -2.25 mmHg; 95% CI, -3.40, -1.11; P = 0.0001) and MAP (MD, -3.48 mmHg; 95% CI, -5.84, -1.11; P = 0.004). Aerobic training (AT) did not produce a significant reduction in SBP, DBP and MAP (P >0.05). Combined training (CT) generated larger reductions. Exercise training generated small but clinically relevant reductions in SBP, DBP and MAP in menopausal and postmenopausal women, younger or older than 65 years, with prehypertension or hypertension. AT did not lead to a clinically relevant improvement in blood pressure (BP) in this population. In addition, CT showed the largest reductions in SBP, DBP and MAP.
Topics: Blood Pressure; Exercise; Female; Humans; Hypertension; Menopause; Randomized Controlled Trials as Topic
PubMed: 34108092
DOI: 10.1016/j.maturitas.2021.05.005 -
International Journal of Cardiology.... Dec 2022Anthracyclines, a mainstay of cancer treatment, are associated with significant life-threatening cardiotoxicity. As cancer survivorship improves, there is a growing need...
AIMS
Anthracyclines, a mainstay of cancer treatment, are associated with significant life-threatening cardiotoxicity. As cancer survivorship improves, there is a growing need to identify patients most at risk and strategies to mitigate anthracycline-associated cardiotoxicity. Elevated baseline blood pressure (bBP) is a possible risk factor for cardiotoxicity. The aim of this systematic review was to summarise the literature and evaluate relationships between bBP and anthracycline-associated cardiotoxicity.
METHODS AND RESULTS
Systematic searches were conducted, limited to English language but without restrictions on study type or country of origin. All studies fulfilled the PRISMA statement and relevant studies reviewed and narratively synthesised. A total of 1330 papers were screened, with 12 included in the qualitative synthesis. Eight papers indicated elevated bBP was associated with significantly higher risk of developing cardiotoxicity. Four papers noted significant relationships between left ventricular ejection fraction (LVEF) decline and elevated bBP. Of the four papers that failed to show an association, one noted increased risk of developing chronic heart failure. A relationship between baseline diastolic and systolic BP and anthracycline-associated cardiotoxicity is also noted.
CONCLUSIONS
This study indicates adult patients with elevated bBP have increased vulnerability to anthracycline-associated cardiotoxicity, with those with pre-hypertension or raised systolic versus diastolic pressure potentially an overlooked population. Recommendations for inclusion of bBP, incorporating individual systolic versus diastolic pressures, in cardio-oncology risk prediction models to guide clinical decision-making are thus warranted.
PubMed: 36573186
DOI: 10.1016/j.ijcrp.2022.200153 -
Hormone and Metabolic Research =... Aug 2019Neck circumference (NC) has been suggested as a predictor for blood pressure disorders. Therefore, we sought to conduct a systematic review and meta-analysis regarding... (Meta-Analysis)
Meta-Analysis
Neck circumference (NC) has been suggested as a predictor for blood pressure disorders. Therefore, we sought to conduct a systematic review and meta-analysis regarding the association between NC and blood pressure in adults. Pertinent studies were identified by searching PubMed and Scopus databases, up to March 2018. Studies which reported the correlation coefficient between NC, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were selected. Also, studies reported the odds ratio (OR) of hypertension or pre-hypertension included adults older than 18 years old were selected. Results were pooled using a random-effects model. Of 29 studies included in meta-analysis, 26 studies reported only correlation coefficient, 3 studies reported only odds ratio and 2 studies reported both correlation coefficient and odds ratio. Overall, NC was significantly correlated with SBP [ES (z)=0.20; 95% CI=0.18, 0.23] and DBP [ES (z)=0.20; 95% CI=0.16, 0.24]. Type of correlation coefficient was the sources of observed heterogeneity. Also, NC was directly associated with the risk of hypertension (OR=1.29; 95% CI: 1.06-1.56), but not pre-hypertension (OR=1.18; 95% CI: 0.92, 1.52). Furthermore, subgroup analysis based on the region indicated that the studies conducted in Western regions reported higher risk of HTN in association with NC (OR=1.27; 95% CI: 1.23-1.32), but not among those conducted in the Eastern regions (OR=1.11; 95% CI: 0.96-1.28). NC seems to be a new anthropometric measurement, which is probably a good predictor of elevated blood pressure, especially in the Western population.
Topics: Blood Pressure; Humans; Hypertension; Neck; Observational Studies as Topic; Prognosis; Risk Assessment; Risk Factors
PubMed: 31408895
DOI: 10.1055/a-0957-3256 -
Current Problems in Cardiology Mar 2023High blood pressure (BP) is one of the main modifiable risk factors for cardiovascular disease (CVD) and preventing it greatly reduces the vascular consequences of aging... (Review)
Review
High blood pressure (BP) is one of the main modifiable risk factors for cardiovascular disease (CVD) and preventing it greatly reduces the vascular consequences of aging and, along with intensive treatment of hypertension, eliminates a large portion of the burden of CVD-related mortality. Many meta-analyses and studies proved that regular aerobic exercise (AE) reduces BP but most of these studies consider only hypertensive populations or only AE but not resistant exercise or their combination. In this review, we aimed to study the effect of different types of physical activity (PA)/AE on various populations including normotensive, prehypertensive, primary hypertensive, and resistant hypertensive with different comorbidities. We searched PubMed, Web of Science, and Google Scholar for English articles with keywords for physical activity, aerobic exercise, and blood pressure from January 2010 until September 2021. Finally, 24 studies were included. Results showed that chronic or acute AE (long-term or short-term), either alone or as combined with different sessions and programs can reduce systolic and diastolic BP in every group including normotensive, prehypertensive, primary hypertensive, resistant hypertensive individuals and diabetic patients and those with kidney problems but not in people with chronic heart failure. Isometric exercise training showed to be useful in reducing BP in all groups either as low intensity or as high intensity but the rate of reduction was different in terms of gender. AE showed to be effective in terms of BP reduction in a different age range. It can be seen that different types and duration of AE independent of the modality and programs and independent of the BP medical situation of individuals have been successful in terms of BP reduction. For those with chronic heart failure, more concern and help might be needed to decrease BP via exercise.
Topics: Humans; Hypertension; Exercise; Blood Pressure; Cardiovascular Diseases; Heart Failure
PubMed: 34718034
DOI: 10.1016/j.cpcardiol.2021.101034