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Journal of Pediatric Nursing 2022Hypertension (HTN) is one of the non-communicable diseases which prevalence is rising in both developed and developing countries. There is a scarcity of data on the... (Meta-Analysis)
Meta-Analysis Review
PROBLEM
Hypertension (HTN) is one of the non-communicable diseases which prevalence is rising in both developed and developing countries. There is a scarcity of data on the prevalence of HTN in Arab countries. This review outlines what is currently known about prevalence and risk factors of HTN in adolescence in Arab world.
ELIGIBILITY CRITERIA
A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar databases from 2011 to 2021.
SAMPLE
Fourteen studies from 9 Arab countries met inclusion criteria. Studies included a total of 777 adolescents with HTN and 2147 adolescents with pre-HTN.
RESULTS
The overall prevalence of HTN among adolescents in the Arab World was estimated at 12.6% (95CI 0.083-0.176), while pre-HTN was 13.9% (95CI 0.084-0205). Overweight and obesity resemble the higher risk of developing hypertension. Family history, high consumption of salt, smoking and low physical activity also increase the risk of HTN. The development of adolescent HTN can be predicted through anthropometric measurements such as Body Mass Index (BMI), wrist circumferences, and high waist circumference.
CONCLUSION
The prevalence of HTN among adolescents in the Arab world was significant, ranging from 4 to 26%. The heterogeneity between studies was high.
IMPLICATION
Local governments and policymakers must consider strengthening regulations to address environmental risk factors and improve public awareness about risk factors to HTN. A combined use of nurse- and patient targeted educational interventions could also help in reducing the burden of HTN in this population.
Topics: Adolescent; Arabs; Body Mass Index; Humans; Hypertension; Prevalence; Risk Factors; Waist Circumference
PubMed: 35305878
DOI: 10.1016/j.pedn.2022.03.002 -
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 -
American Journal of Obstetrics and... Dec 2019An increasing number of original studies suggest that exposure to shift work and long working hours during pregnancy could be associated with the risk of adverse... (Meta-Analysis)
Meta-Analysis
BACKGROUD
An increasing number of original studies suggest that exposure to shift work and long working hours during pregnancy could be associated with the risk of adverse pregnancy outcomes, but the results remain conflicting and inconclusive.
OBJECTIVE
To examine the influences of shift work and longer working hours during pregnancy on maternal and fetal health outcomes.
DATA SOURCES
Five electronic databases and 3 gray literature sources were searched up to March 15, 2019.
METHODS OF STUDY SELECTION
Studies of all designs (except case studies and reviews) were included, which contained information on the relevant population (women who engaged in paid work during pregnancy); exposure (rotating shift work [shifts change according to a set schedule], fixed night shift [typical working period is between 11:00 pm and 11:00 am] or longer working hours [>40 hours per week]);comparator (fixed day shift [typical working period is between 8:00 am and 6:00 pm] or standard working hours [≤40 hours per week]); and outcomes (preterm delivery, low birthweight [birthweight <2500 g], small for gestational age, miscarriage, gestational hypertension, preeclampsia, intrauterine growth restriction, stillbirth, and gestational diabetes mellitus).
TABULATION, INTEGRATION, AND RESULTS
From 3305 unique citations, 62 observational studies (196,989 women) were included. "Low" to "very low" certainty evidence from these studies revealed that working rotating shifts was associated with an increased odds of preterm delivery (odds ratio, 1.13; 95% confidence interval, 1.00-1.28, I = 31%), an infant small for gestational age (odds ratio, 1.18, 95% confidence interval, 1.01-1.38, I = 0%), preeclampsia (odds ratio, 1.75, 95% confidence interval, 1.01-3.01, I = 75%), and gestational hypertension (odds ratio, 1.19, 95% confidence interval, 1.10-1.29, I = 0%), compared to those who worked a fixed day shift. Working fixed night shifts was associated with an increased odds of preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.03-1.42; I = 36%) and miscarriage (odds ratio, 1.23; 95% confidence interval, 1.03-1.47; I = 37%). Compared with standard hours, working longer hours was associated with an increased odds of miscarriage (odds ratio, 1.38; 95% confidence interval, 1.08-1.77; I = 73%), preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.11-1.33; I = 30%), an infant of low birthweight (odds ratio, 1.43; 95% confidence interval, 1.11-1.84; I = 0%), or an infant small for gestational age (odds ratio, 1.16, 95% confidence interval, 1.00-1.36, I = 57%). Dose-response analysis showed that women working more than 55.5 hours (vs 40 hours) per week had a 10% increase in the odds of having a preterm delivery.
CONCLUSION
Pregnant women who work rotating shifts, fixed night shifts, or longer hours have an increased risk of adverse pregnancy outcomes.
Topics: Abortion, Spontaneous; Diabetes, Gestational; Female; Fetal Growth Retardation; Humans; Hypertension, Pregnancy-Induced; Infant, Low Birth Weight; Infant, Newborn; Infant, Small for Gestational Age; Odds Ratio; Personnel Staffing and Scheduling; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Risk Factors; Shift Work Schedule; Stillbirth; Time Factors; Work Schedule Tolerance
PubMed: 31276631
DOI: 10.1016/j.ajog.2019.06.051 -
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 -
Current Hypertension Reports Dec 2013The quantitative associations between prehypertension or its separate blood pressure (BP) ranges and the risk of main cardiovascular diseases (CVDs) have not been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The quantitative associations between prehypertension or its separate blood pressure (BP) ranges and the risk of main cardiovascular diseases (CVDs) have not been reliably documented.
METHODS
We performed a comprehensive search of PubMed (1966 to June 2012) and the Cochrane Library (1988 to June 2012) without language restrictions. Prospective studies were included if they reported multivariate-adjusted risk ratios (RRs) and corresponding 95 % confidence intervals (CIs) of desirable outcomes, including fatal or non-fatal incident stroke, coronary heart disease, myocardial infarction (MI) or total CVD events, with respect to prehypertension or its separate BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline with normal BP (<120/80 mmHg) as reference. Pooled RRs were estimated using a random-effects model or a fixed-effects model.
RESULTS
Twenty-nine articles met our inclusion criteria, with 1,010,858 participants. Both low-range and high-range prehypertension were associated with a greater risk of developing or dying of total CVD (low-range: RR: 1.24; 95 % CI: 1.10 to 1.39; high range: RR: 1.56; 95 % CI: 1.36 to 1.78), stroke (low-range: RR: 1.35; 95 % CI: 1.10 to 1.66; high-range: RR: 1.95; 95 % CI: 1.69 to 2.24) and myocardial infarction (MI) (low range: RR: 1.43; 95 % CI: 1.10 to 1.86; high range: RR: 1.99; 95 % CI: 1.59 to 2.50). The whole range prehypertension had a 1.44-fold (95 % CI: 1.35 to 1.53), 1.73-fold (95 % CI: 1.61 to 1.85), and 1.79-fold (95 % CI: 1.45 to 2.22) risk of total CVD, stroke, and MI, respectively. There was no evidence of publication bias.
CONCLUSIONS
Prehypertensive patients have a greater risk of incident stroke, MI and total CVD events. The impact was markedly different between the low and high prehypertension ranges
Topics: Animals; Blood Pressure; Cardiovascular Diseases; Humans; Myocardial Infarction; Prehypertension; Prospective Studies; Risk Factors
PubMed: 24234576
DOI: 10.1007/s11906-013-0403-y -
Journal of the American College of... Oct 2013The goal of this study was to systematically review the peripartum cardiomyopathy (PPCM) literature and determine the prevalence of pre-eclampsia (PE) in women with... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The goal of this study was to systematically review the peripartum cardiomyopathy (PPCM) literature and determine the prevalence of pre-eclampsia (PE) in women with PPCM. Secondary analyses included evaluation of the prevalence of hypertensive disorders, multiple gestations, and multiparity.
BACKGROUND
PPCM is a significant cause of maternal and infant morbidity and mortality worldwide, yet its etiology remains unknown. PE is often cited as a risk factor for the development of PPCM and recent research suggests that PE and PPCM share mechanisms that contribute to their pathobiology. No comprehensive evaluation of the relationship between PE and PPCM exists.
METHODS
A systematic predetermined search strategy was performed in multiple databases to identify studies describing ≥3 women with PPCM. Prevalence rates of PE, hypertension, multiple gestations, and multiparity were pooled.
RESULTS
Data from 22 studies (n = 979) were included in this analysis. The pooled prevalence of 22% (95% confidence interval [CI]: 16% to 28%) was more than quadruple the 5% average worldwide background rate of PE in pregnancy (p < 0.001). There were no geographic or racial differences detected in the prevalence of PE in women with PPCM. The rates of hypertension during pregnancy (37% [95% CI: 29% to 45%]) and multiple gestations (9% [95% CI: 7% to 11%]) were also elevated.
CONCLUSIONS
The prevalence of PE, hypertensive disorders, and multiple gestations in women with PPCM is markedly higher than that in the general population. These findings support the concept of a shared pathogenesis between PE and PPCM and highlight the need for awareness of the overlap between these 2 diseases.
Topics: Cardiomyopathies; Female; Humans; Hypertension; Hypertension, Pregnancy-Induced; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy, Multiple; Prevalence; Racial Groups
PubMed: 24013055
DOI: 10.1016/j.jacc.2013.08.717 -
Frontiers in Nutrition 2021Calcium supplementation can prevent gestational hypertension and pre-eclampsia. However, besides the non-consensus of existing studies, there is a lack of evidence...
OBJECTIVE
Calcium supplementation can prevent gestational hypertension and pre-eclampsia. However, besides the non-consensus of existing studies, there is a lack of evidence regarding the optimal dosing of calcium.
METHOD
Eight electronic databases, namely, the Cochrane Library, PUBMED, Web of Science, EMBASE, WANGFANG, VIP, CBM, and CNKI, were searched. The studies were retrieved from inception to July 13, 2021. Two researchers independently screened the literature, extracted data, and evaluated the methodological quality based on the inclusion criteria. In particular, the calcium supplementation doses were divided into three groups, namely, the high-dose (≥1.5 g), medium-dose (1.0-1.49 g), and the low-dose group (<1.0 g). The participants were also divided into high-risk and low-risk groups, according to the risk of developing gestational hypertension and pre-eclampsia.
RESULTS AND DISCUSSION
A total of 48 studies were incorporated into the final analyses. All doses of calcium supplementation reduced the incidence of gestational hypertension in the low-risk population (low dose - three studies; medium dose- 11 studies; high dose- 28 studies), whereas the medium-dose (three studies) reduced the incidence of gestational hypertension in high-risk groups. Moreover, a medium dose of calcium supplementation had the maximum effect in reducing gestational hypertension in low-risk and high-risk populations. The medium (three studies) and high doses (13 studies) of calcium supplementation reduced the incidence of pre-eclampsia in the low-risk groups. However, a medium-dose calcium supplementation maximally prevented pre-eclampsia in the low-risk population. The authenticity and reliability of the results were reduced due to the limitations of contemporary studies in terms of experimental design, result measurement, statistics, and evidence quality. Therefore, high-quality studies with larger sample size are required to evaluate further the effect of calcium supplementation in preventing gestational hypertension and pre-eclampsia.
PubMed: 35111797
DOI: 10.3389/fnut.2021.795667 -
Journal of Research in Medical Sciences... 2023Researchers have shown that diet is associated with hypertensive disorders of pregnancy, and there are some reports of performed meta-analyses on observational studies.... (Review)
Review
BACKGROUND
Researchers have shown that diet is associated with hypertensive disorders of pregnancy, and there are some reports of performed meta-analyses on observational studies. However, very few randomized-controlled trials have systematically summarized. Thus, we reviewed and meta-analyzed the effects of nutritional interventions on risks of gestational hypertension (GH) or/and preeclampsia (PE).
MATERIALS AND METHODS
A systematic search was performed using Medline, Cochrane library, Google Scholar, ISI Web of Science, Scopus, and ProQuest to find randomized clinical trials assessing the effect of nutritional interventions on incidences of GH or/and PE compared to control or placebo interventions.
RESULTS
After considering duplicates, 1066 articles were screened from the database searches. Full-text articles were retrieved for 116 records, while 87 did not have the inclusion criteria and were later omitted. Twenty-nine studies were eligible, but 8 studies were not included in the meta-analysis due to insufficient data. Finally, seven studies were included in qualitative analysis. Furthermore, 7 studies (693 in intervention vs. 721 in control) were pooled for managed nutritional interventions, three (1255 vs. 1257) for a Mediterranean-style diet, and 4 (409 vs. 312) for sodium restricted. Our results revealed that managed nutritional programs were effective in reducing the incidence of GH (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.15, 0.92); = 66.9%; = 0.010), but not for PE (OR = 0.50; 95% CI = 0.23, 1.07); = 58.9%; = 0.032. The Mediterranean-style diets in three trials (1255 vs. 1257) did not reduce the risk of PE (OR = 1.10; 95% CI = 0.71, 1.70); = 2.3%; = 0.359). Likewise, sodium-restricted interventions in four trials (409 vs. 312) did not decrease total risk of GH (OR = 0.99; 95% CI = 0.68, 1.45); = 0%; = 0.520). Meta-regression did not indicate any significant association between maternal age, body mass index, gestational weight gain, and start time of all interventions with the incidence of GH or/and PE ( > 0.05).
CONCLUSION
The present meta-analysis showed that Mediterranean-style diets and sodium-restriction interventions did not decrease the incidence of GH or/and PE in healthy pregnancies; however, managed nutritional programs reduced the risk of GH, the total incidence of GH and PE, but not PE.
PubMed: 37213454
DOI: 10.4103/jrms.jrms_89_22 -
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 -
Pregnancy Hypertension Dec 2022Novel data support a possible correlation between preeclampsia and congenital dysfunction. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Novel data support a possible correlation between preeclampsia and congenital dysfunction.
STUDY DESIGN
A systematic review of the literature and a meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.
MAIN OUTCOME MEASURE
To investigate the association between the risk of future of dementia (vascular dementia, AD and dementia of any type) in women with a history of preeclampsia, based on current literature.
RESULTS
Overall, three studies and 2.309.946 women were included in the present meta-analysis. There was no statistically significant association between history of preeclampsia or pregnancy hypertension disease and any type of dementia (p = 0.14 and p = 0.29, respectively). In contrast, there was a statistically significant difference between history of preeclampsia and vascular dementia (HR: 2.60; 95 %CI: 2.03-3.33; p < 0.001). Furthermore, history of preeclampsia does not increase the risk for Alzheimer disease (Fixed Effects pooled-HR: 1.17; 95 %CI: 0.98-1.40; p = 0.08). Similarly, women with hypertensive disorder of pregnancy (HDP) had no statistically significant increased risk for later onset of any dementia (Fixed Effects pooled-HR: 1.08; 95 %CI: 0.93-1.25; p = 0.29).
CONCLUSIONS
History of preeclampsia increases the risk of vascular dementia. These patients are expected to benefit from screening for early symptoms of dementia, allowing early diagnosis and treatment. However, due to several limitations, further studies with large cohorts are required to elucidate the association between preeclampsia and dementia.
Topics: Pregnancy; Humans; Female; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Dementia, Vascular
PubMed: 36323061
DOI: 10.1016/j.preghy.2022.10.008