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International Journal of Environmental... Aug 2021Hypertensive disorders in pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), characterize a major cause of maternal and prenatal morbidity... (Review)
Review
Hypertensive disorders in pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), characterize a major cause of maternal and prenatal morbidity and mortality. In this systematic review, we tested the hypothesis that occupational factors would impact the risk for HDP in pregnant workers. MEDLINE, Scopus, and Web of Knowledge databases were searched for studies published between database inception and 1 April 2021. All observational studies enrolling > 10 pregnant workers and published in English were included. Un-experimental, non-occupational human studies were excluded. Evidence was synthesized according to the risk for HDP development in employed women, eventually exposed to chemical, physical, biological and organizational risk factors. The evidence quality was assessed through the Newcastle-Ottawa scale. Out of 745 records identified, 27 were eligible. No definite conclusions could be extrapolated for the majority of the examined risk factors, while more homogenous data supported positive associations between job-strain and HDP risk. Limitations due to the lack of suitable characterizations of workplace exposure (i.e., doses, length, co-exposures) and possible interplay with personal issues should be deeply addressed. This may be helpful to better assess occupational risks for pregnant women and plan adequate measures of control to protect their health and that of their children.
Topics: Child; Female; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Pregnancy; Risk Factors; Workplace
PubMed: 34444025
DOI: 10.3390/ijerph18168277 -
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 -
Renal Failure Dec 2023Pre-emptive kidney transplantation (PEKT), i.e., transplantation performed before initiation of maintenance dialysis, is considered an ideal renal replacement therapy... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pre-emptive kidney transplantation (PEKT), i.e., transplantation performed before initiation of maintenance dialysis, is considered an ideal renal replacement therapy because there is no exposure to long-term dialysis therapy. Therefore, we summarized advantages/disadvantages of PEKT to assist in deciding whether kidney transplantation should be performed pre-emptively.
METHODS
This study was registered with PROSPERO, CRD42021269163. Observational studies comparing clinical outcomes between PEKT and non-PEKT were included; those involving only pediatric recipients or simultaneous multi-organ transplantations were excluded. The PubMed/MEDLINE, Cochrane Library, and Ichushi-Web databases were searched on 1 August 2021. Studies were pooled using the generic inverse-variance method with random effects model, and risk of bias was assessed using ROBINS-I.
RESULTS
Seventy-six studies were included in the systematic review (sample size, 23-121,853; enrollment year, 1968-2019). PEKT patients had lower all-cause mortality (adjusted HR: 0.78 [95% CI 0.66-0.92]), and lower death-censored graft failure (0.81 [0.67-0.98]). Unadjusted RRs for the following outcomes were comparable between the two patient groups: cardiovascular disease, 0.90 (0.58-1.40); biopsy-proven acute rejection, 0.75 (0.55-1.03); cytomegalovirus infection, 1.04 (0.85-1.29); and urinary tract infection, 0.89 (0.61-1.29). Mean differences in post-transplant QOL score were comparable in both groups. The certainty of evidence for mortality and graft failure was moderate and that for other outcomes was very low following the GRADE classification.
CONCLUSIONS
The present meta-analysis shows the potential benefits of PEKT, especially regarding patient and graft survival, and therefore PEKT is recommended for adults with end-stage kidney disease.
Topics: Humans; Adult; Child; Kidney Transplantation; Quality of Life; Kidney Failure, Chronic; Renal Dialysis; Cytomegalovirus Infections
PubMed: 36705051
DOI: 10.1080/0886022X.2023.2169618 -
Diagnostics (Basel, Switzerland) Mar 2023Early detection of pre-diabetes (pre-DM) can prevent DM and related complications. This review examined studies on non-laboratory-based pre-DM risk prediction tools to... (Review)
Review
Early detection of pre-diabetes (pre-DM) can prevent DM and related complications. This review examined studies on non-laboratory-based pre-DM risk prediction tools to identify important predictors and evaluate their performance. PubMed, Embase, MEDLINE, CINAHL were searched in February 2023. Studies that developed tools with: (1) pre-DM as a prediction outcome, (2) fasting/post-prandial blood glucose/HbA1c as outcome measures, and (3) non-laboratory predictors only were included. The studies' quality was assessed using the CASP Clinical Prediction Rule Checklist. Data on pre-DM definitions, predictors, validation methods, performances of the tools were extracted for narrative synthesis. A total of 6398 titles were identified and screened. Twenty-four studies were included with satisfactory quality. Eight studies (33.3%) developed pre-DM risk tools and sixteen studies (66.7%) focused on pre-DM and DM risks. Age, family history of DM, diagnosed hypertension and obesity measured by BMI and/or WC were the most common non-laboratory predictors. Existing tools showed satisfactory internal discrimination (AUROC: 0.68-0.82), sensitivity (0.60-0.89), and specificity (0.50-0.74). Only twelve studies (50.0%) had validated their tools externally, with a variance in the external discrimination (AUROC: 0.31-0.79) and sensitivity (0.31-0.92). Most non-laboratory-based risk tools for pre-DM detection showed satisfactory performance in their study populations. The generalisability of these tools was unclear since most lacked external validation.
PubMed: 37046512
DOI: 10.3390/diagnostics13071294 -
Frontiers in Physiology 2022Postexercise hypotension (PEH) is the immediate reduction in blood pressure (BP) of 5-8 mmHg that occurs after a single bout of aerobic exercise among adults with...
BACKGROUND
Postexercise hypotension (PEH) is the immediate reduction in blood pressure (BP) of 5-8 mmHg that occurs after a single bout of aerobic exercise among adults with hypertension. Across PEH studies, there are variations in the level of rigor of the study designs and methods that limit the conclusions that can be made about PEH.
OBJECTIVE
To develop and then apply a methodological study quality evaluation checklist to aerobic exercise PEH studies to provide methodological guidance.
METHODS
We developed a PEH checklist (PEH√list) based upon contemporary methodological study quality standards. The PEH√list contains 38 items divided into three categories: sample ( = 10 items), study ( = 23 items), and intervention characteristics ( = 5 items). We then systematically searched six databases to January 2019 to identify and then evaluate studies that: (1) enrolled adults ≥18 years with hypertension and without other chronic diseases or conditions; (2) included a bout of aerobic exercise and a non-exercise control session; and (3) were published in English.
RESULTS
Of 17,149 potential studies, 64 qualified. Participants ( = 1,489) were middle-aged (38.6 ± 15.6 year), overweight (26.1 ± 2.5 kg/m) mostly men (64.4%) with elevated BP (systolic BP 129.5 ± 15.2/diastolic BP 81.0 ± 10.1 mmHg). Overall, the qualifying studies satisfactorily reported 53.9 ± 13.3% (24.2-82.8%) of the relevant items on the PEH√list. Of note, only 20.3% of the studies disclosed BP was measured following professional guidelines, 18.8% reported BP was taken by the same assessor pre- and post-intervention, and 35.5% stated participants abstained from caffeine, alcohol, and physical activity prior to testing. Half (51.5%) indicated they statistically controlled for pre-exercise/baseline BP. Meanwhile, 100% of the studies reported the setting in which the BP measurements were taken, time from the end of the exercise to the start of the BP measurements, and if relevant, the length of the ambulatory BP monitoring period.
CONCLUSION
Overall, the PEH√list items were not well satisfied; especially items with potential confounding effects on PEH. We contend the PEH√list provides guidance to investigators on the important methodological study considerations in PEH aerobic exercise studies that should be attended to in the future.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/PROSPERO/], identifier [#CRD42020221996].
PubMed: 35360233
DOI: 10.3389/fphys.2022.851950 -
Journal of Endocrinological... Jun 2023To examine the association between isolated maternal hypothyroxinaemia (IMH) and adverse obstetric outcomes and offspring outcomes and also investigate the effects of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To examine the association between isolated maternal hypothyroxinaemia (IMH) and adverse obstetric outcomes and offspring outcomes and also investigate the effects of levothyroxine therapy on IMH for the above outcomes.
METHODS
We systematically searched PubMed, EMBASE, and Cochrane Library, and the reference lists of key reviews were hand searched on June 9, 2021. Two authors independently screened titles/abstracts. Full articles were further assessed if the information suggested that the study met the inclusion/exclusion criteria, and two researchers performed data extraction and risk-of-bias assessment using standardized tables. Summary relative risks or the mean difference between maternal effects and offspring outcomes were calculated by a random-effects model.
RESULTS
We identified 38 eligible articles (35 cohort studies and two randomized controlled trials [RCT]). Meta-analysis showed that maternal IMH was associated with increased gestational diabetes mellitus, preterm premature rupture of membranes, preterm birth, fetal distress, and macrosomia outcomes in IMH compared to euthyroid women, and the relative risks were 1.42 (1.03-1.96), 1.50 (1.05-2.14), 1.33 (1.15-1.55), 1.75 (1.16-2.65) and 1.62 (1.35-1.94), respectively. IMH was not associated with placenta previa, gestational hypertension, pre-eclampsia, intrauterine growth restriction, and offspring outcomes like birth weight, low birth weight infants, fetal macrosomia, neonatal intensive care, neonatal death, or fetal head circumference. In addition, we did not find an association between IMH and adverse offspring cognitive defects. Due to insufficient data for meta-analysis, it failed to pool the evidence of levothyroxine's therapeutic effect on IMH and their offspring.
CONCLUSIONS AND RELEVANCE
IMH in pregnancy may relate to a few maternal and offspring outcomes. Moreover, there is currently no sufficient evidence that levothyroxine treatment during pregnancy reduces adverse maternal outcomes and disability in offspring. Further investigation to explore the beneficial effects of levothyroxine therapy is warranted.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Thyroxine; Premature Birth; Diabetes, Gestational; Pre-Eclampsia; Birth Weight
PubMed: 36422828
DOI: 10.1007/s40618-022-01967-4 -
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 -
Reviews in Medical Virology May 2022This study aimed to systematically assess COVID-19 patient background characteristics and pre-existing comorbidities associated with hospitalisation status. The... (Meta-Analysis)
Meta-Analysis Review
This study aimed to systematically assess COVID-19 patient background characteristics and pre-existing comorbidities associated with hospitalisation status. The meta-analysis included cross-sectional, cohort, and case-series studies with information on hospitalisation versus outpatient status for COVID-19 patients, with background characteristics and pre-existing comorbidities. A total of 1,002,006 patients from 40 studies were identified. Significantly higher odds of hospitalisation were observed in Black individuals (OR = 1.33, 95% CI: 1.04-1.70), males (OR = 1.59, 95% CI: 1.43-1.76), and persons with current/past smoking (OR = 1.59, 95% CI: 1.34-1.88). Additionally, individuals with pre-existing comorbidities were more likely to be hospitalised [asthma (OR = 1.22, 95% CI: 1.02-1.45), COPD (OR = 3.68, 95% CI: 2.97-4.55), congestive heart failure (OR = 6.80, 95% CI: 4.97-9.31), coronary heart disease (OR = 4.40, 95% CI: 3.15-6.16), diabetes (OR = 3.90, 95% CI: 3.29-4.63), hypertension (OR = 3.89, 95% CI: 3.34-4.54), obesity (OR = 1.98, 95% CI: 1.59-2.46) and renal chronic disease (OR = 5.84, 95% CI: 4.51-7.56)]. High heterogeneity and low publication bias among all factors were found. Age was not included due to the large variability in the estimates reported. In this systematic review/meta-analysis for patients with COVID-19, Black patients, males, persons who smoke, and those with pre-existing comorbidities were more likely to be hospitalised than their counterparts. Findings provide evidence of populations with higher odds of hospitalisation for COVID-19.
Topics: COVID-19; Comorbidity; Cross-Sectional Studies; Humans; Hypertension; Male; Outpatients
PubMed: 34674338
DOI: 10.1002/rmv.2306 -
Journal of the American Heart... May 2021Background Maternal chronic hypertension is associated with adverse pregnancy outcomes. Previous studies examined the association between either chronic hypertension or... (Meta-Analysis)
Meta-Analysis
Background Maternal chronic hypertension is associated with adverse pregnancy outcomes. Previous studies examined the association between either chronic hypertension or antihypertensive treatment and adverse pregnancy outcomes. We aimed to synthesize the evidence on the effect of chronic hypertension/antihypertensive treatment on adverse pregnancy outcomes. Methods and Results Medline/PubMed, EMBASE, and Web of Science were searched; we included observational studies and assessed the effect of race/ethnicity, where possible, following a registered protocol (CRD42019120088). Random-effects meta-analyses were used. A total of 81 studies were identified on chronic hypertension, and a total of 16 studies were identified on antihypertensive treatment. Chronic hypertension was associated with higher odds of preeclampsia (adjusted odd ratio [aOR], 5.43; 95% CI, 3.85-7.65); cesarean section (aOR, 1.87; 95% CI, 1.6-2.16); maternal mortality (aOR, 4.80; 95% CI, 3.04-7.58); preterm birth (aOR, 2.23; 95% CI, 1.96-2.53); stillbirth (aOR, 2.32; 95% CI, 2.22-2.42); and small for gestational age (SGA) (aOR, 1.96; 95% CI, 1.6-2.40). Subgroup analyses indicated that maternal race/ethnicity does not influence the observed associations. Women with chronic hypertension on antihypertensive treatment (versus untreated) had higher odds of SGA (aOR, 1.86; 95% CI, 1.38-2.50). Conclusions Chronic hypertension is associated with adverse pregnancy outcomes, and these associations appear to be independent of maternal race/ethnicity. In women with chronic hypertension, those on treatment had a higher risk of SGA, although the number of studies was limited. This could result from a direct effect of the treatment or because severe hypertension during pregnancy is a risk factor for SGA and women with severe hypertension are more likely to be treated. The effect of antihypertensive treatment on SGA needs to be further tested with large randomized controlled trials.
Topics: Antihypertensive Agents; Female; Humans; Infant, Newborn; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Risk Factors
PubMed: 33870708
DOI: 10.1161/JAHA.120.018494