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Therapeutic Apheresis and Dialysis :... Oct 2016Hypertension is prevalent in 75-80% of hemodialysis patients and remains the most controversial prognostic marker in end stage kidney disease patients. In contrast to... (Review)
Review
Hypertension is prevalent in 75-80% of hemodialysis patients and remains the most controversial prognostic marker in end stage kidney disease patients. In contrast to the general population where systolic blood pressure of ≤120 mm Hg is considered normal, a debate remains regarding the ideal target blood pressure in hemodialysis patients. Using the PUBMED and EMBASE databases, the research studies that evaluated the relationship between blood pressure measurements and mortality in hemodialysis patients were searched. Thirteen studies were identified from different regions of the world. Five studies reported low predialysis systolic blood pressure as a prognostic marker of mortality. Other studies showed varying results and reported postdialysis systolic blood pressure as well as ambulatory blood pressure as better predictors of mortality and emphasized their optimized control. One study in this review concluded that there is no direct relationship between mortality and blood pressure if the patients are on anti-hypertensive medications. The observed all-cause mortality varied from 12% to 36%, whereas the cardiovascular mortality varied from 16% to 60%. On the basis of studies included in the current review, a low predialysis systolic blood pressure (<120 mm Hg) is shown to be a widely accepted prognostic marker of mortality while ambulatory blood pressure best predicts CV mortality. Therefore, we recommend that apart from routine BP (pre, post and intradialysis) monitoring in centers, assessment of ambulatory BP must be mandatory for all patients to reduce CV mortality in hemodialysis patients.
Topics: Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Diseases; Humans; Hypertension; Kidney Failure, Chronic; Prognosis; Renal Dialysis
PubMed: 27151394
DOI: 10.1111/1744-9987.12406 -
American Journal of Preventive Medicine Feb 2022Self-measured blood pressure monitoring with support is an evidence-based intervention that helps patients control their blood pressure. This systematic economic review... (Review)
Review
INTRODUCTION
Self-measured blood pressure monitoring with support is an evidence-based intervention that helps patients control their blood pressure. This systematic economic review describes how certain intervention aspects contribute to effectiveness, intervention cost, and intervention cost per unit of the effectiveness of self-measured blood pressure monitoring with support.
METHODS
Papers published between data inception and March 2021 were identified from a database search and manual searches. Papers were included if they focused on self-measured blood pressure monitoring with support and reported blood pressure change and intervention cost. Papers focused on preeclampsia, kidney disease, or drug efficacy were excluded. Quality of estimates was assessed for effectiveness, cost, and cost per unit of effectiveness. Patient characteristics and intervention features were analyzed in 2021 to determine how they impacted effectiveness, intervention cost, and intervention cost per unit of effectiveness.
RESULTS
A total of 22 studies were included in this review from papers identified in the search. Type of support was not associated with differences in cost and cost per unit of effectiveness. Lower cost and cost per unit of effectiveness were achieved with simple technologies such as interactive phone systems, smartphones, and websites and where providers interacted with patients only as needed.
DISCUSSION
Some of the included studies provided only limited information on key outcomes of interest to this review. However, the strength of this review is the systematic collection and synthesis of evidence that revealed the associations between the characteristics of implemented interventions and their patients and the interventions' effectiveness and cost, a useful contribution to the fields of both research and implementation.
Topics: Blood Pressure; Blood Pressure Determination; Cost-Benefit Analysis; Female; Humans; Pregnancy
PubMed: 34686388
DOI: 10.1016/j.amepre.2021.06.025 -
Journal of Sport and Health Science Sep 2024High blood pressure (BP) is a major contributor to mortality and cardiovascular diseases. Despite the known benefits of exercise for reducing BP, it is crucial to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
High blood pressure (BP) is a major contributor to mortality and cardiovascular diseases. Despite the known benefits of exercise for reducing BP, it is crucial to identify the most effective physical activity (PA) intervention. This systematic review and network meta-analysis (NMA) aimed to evaluate the available evidence on the effectiveness of various PA interventions for reducing BP and to determine their hierarchy based on their impact on BP.
METHODS
A search of PubMed, SPORTDiscus, PsycINFO, Web of Science, CINAHL, Cochrane, and Eric databases was conducted up to December 2022 for this systematic review and NMA. Randomized controlled trials and quasi-experimental studies targeting healthy children and adolescents aged 6-12 years old were included in this study. Only studies that compared controlled and intervention groups using PA or exercise as the major influence were included. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent investigators performed the literature screening, data extraction, and risk of bias assessment. We used Bayesian arm-based NMA to synthesize the data. The primary outcomes were systolic BP and diastolic BP. We calculated the mean differences (MDs) in systolic BP and diastolic BP before and after treatment. Mean treatment differences were estimated using NMA and random-effect models.
RESULTS
We synthesized 27 studies involving 15,220 children and adolescents. PA combined with nutrition and behavior change was the most effective intervention for reducing both systolic BP and diastolic BP (MD = -8.64, 95% credible interval (95%CI):-11.44 to -5.84; MD = -6.75, 95%CI: -10.44 to -3.11), followed by interventions with multiple components (MD = -1.39, 95%CI: -1.94 to -0.84; MD = -2.54, 95%CI: -4.89 to -0.29).
CONCLUSION
Our findings suggest that PA interventions incorporating nutrition and behavior change, followed by interventions with multiple components, are most effective for reducing both systolic BP and diastolic BP in children and adolescents.
Topics: Humans; Child; Blood Pressure; Exercise; Hypertension; Adolescent; Network Meta-Analysis
PubMed: 38244922
DOI: 10.1016/j.jshs.2024.01.004 -
Journal of Cardiothoracic and Vascular... Mar 2020To evaluate the association between preoperative pulse pressure (PP) and the incidences of renal, neurologic, cardiac, and mortality outcomes after surgery. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the association between preoperative pulse pressure (PP) and the incidences of renal, neurologic, cardiac, and mortality outcomes after surgery.
DESIGN
Systematic review and meta-analysis of cohort studies.
SETTING
Hospitals.
PARTICIPANTS
Patients who underwent cardiac or noncardiac surgeries.
INTERVENTION
The preoperative PP was measured.
MEASUREMENT AND MAIN RESULTS
Relevant cohort studies were obtained by systematic search of PubMed and Embase databases. A randomized effect model was used to pool the results. The multivariate adjusted risk ratio (RR) and its 95% confidence intervals (CI) were calculated to reflect the association between preoperative PP and adverse postoperative outcomes. Twelve cohort studies that included 40,143 patients who had undergone cardiac, vascular, or noncardiac surgery were included in the meta-analysis. The results showed that above a threshold of 40 mmHg, an increase in preoperative PP of 10 mmHg was independently associated with increased risk for renal events (adjusted RR: 1.13, 95% CI 1.08-1.19, p < 0.001; I = 0%), neurologic events (adjusted RR: 1.75, 95% CI 1.01-3.02, p = 0.04; I = 70%), cardiac events (adjusted RR: 1.19, 95% CI 1.03-1.37, p = 0.01; I = 0%), major cardiovascular adverse events (adjusted RR: 1.62, 95% CI 1.10-2.41, p = 0.02; I = 0%), and overall mortality (adjusted RR: 1.13, 95% CI 1.07-1.20, p < 0.001; I = 0%) after surgery.
CONCLUSIONS
Patients with higher-than-normal preoperative PP are at increased risk for adverse postoperative outcomes.
Topics: Blood Pressure; Cohort Studies; Humans; Kidney; Postoperative Period
PubMed: 31986286
DOI: 10.1053/j.jvca.2019.09.036 -
Critical Care (London, England) Nov 2023Pulse pressure and stroke volume variation (PPV and SVV) have been widely used in surgical patients as predictors of fluid challenge (FC) response. Several factors may... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pulse pressure and stroke volume variation (PPV and SVV) have been widely used in surgical patients as predictors of fluid challenge (FC) response. Several factors may affect the reliability of these indices in predicting fluid responsiveness, such as the position of the patient, the use of laparoscopy and the opening of the abdomen or the chest, combined FC characteristics, the tidal volume (Vt) and the type of anesthesia.
METHODS
Systematic review and metanalysis of PPV and SVV use in surgical adult patients. The QUADAS-2 scale was used to assess the risk of bias of included studies. We adopted a metanalysis pooling of aggregate data from 5 subgroups of studies with random effects models using the common-effect inverse variance model. The area under the curve (AUC) of pooled receiving operating characteristics (ROC) curves was reported. A metaregression was performed using FC type, volume, and rate as independent variables.
RESULTS
We selected 59 studies enrolling 2,947 patients, with a median of fluid responders of 55% (46-63). The pooled AUC for the PPV was 0.77 (0.73-0.80), with a mean threshold of 10.8 (10.6-11.0). The pooled AUC for the SVV was 0.76 (0.72-0.80), with a mean threshold of 12.1 (11.6-12.7); 19 studies (32.2%) reported the grey zone of PPV or SVV, with a median of 56% (40-62) and 57% (46-83) of patients included, respectively. In the different subgroups, the AUC and the best thresholds ranged from 0.69 and 0.81 and from 6.9 to 11.5% for the PPV, and from 0.73 to 0.79 and 9.9 to 10.8% for the SVV. A high Vt and the choice of colloids positively impacted on PPV performance, especially among patients with closed chest and abdomen, or in prone position.
CONCLUSION
The overall performance of PPV and SVV in operating room in predicting fluid responsiveness is moderate, ranging close to an AUC of 0.80 only some subgroups of surgical patients. The grey zone of these dynamic indices is wide and should be carefully considered during the assessment of fluid responsiveness. A high Vt and the choice of colloids for the FC are factors potentially influencing PPV reliability.
TRIAL REGISTRATION
PROSPERO (CRD42022379120), December 2022. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=379120.
Topics: Adult; Humans; Blood Pressure; Hemodynamics; Stroke Volume; Operating Rooms; Reproducibility of Results; Colloids; Fluid Therapy; ROC Curve
PubMed: 37940953
DOI: 10.1186/s13054-023-04706-0 -
Journal of Clinical Monitoring and... Aug 2017This systematic review aims to summarize the published data on the reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) to predict fluid... (Review)
Review
This systematic review aims to summarize the published data on the reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) to predict fluid responsiveness in an open-chest setting during cardio-thoracic surgery. The analysis included studies reporting receiver operating characteristics or correlation coefficients between PPV/SVV and change in any hemodynamic variables after a fluid challenge test in open-chest conditions. The literature search included seven studies. Increase in cardiac index and stroke volume index after a fluid challenge were the most adopted end-point variables. PPV and SVV showed similar area under the receiver operating characteristic curve values but high heterogeneity among studies. Cardiac and thoracic studies did not differ between PPV/SVV pooled area under the receiver operating characteristic curve. Studies exploring correlation between dynamic indices and end-point variable increase after fluid challenge showed conflicting results. The great heterogeneity between studies was due to small sample size and differences among protocol designs (different monitor devices, mechanical ventilation settings, fluid challenge methodologies, surgical incisions, and end-point variables). PPV and SVV seem to be inaccurate in predicting fluid responsiveness in an open-chest setting during cardio-thoracic surgery. Given the high heterogeneity of published data, more studies are needed to define the role of PPV/SVV in this context.
Topics: Anesthesia, General; Animals; Area Under Curve; Blood Pressure; Cardiac Surgical Procedures; Fluid Therapy; Heart Rate; Hemodynamics; Humans; Monitoring, Intraoperative; Pulse Wave Analysis; ROC Curve; Reproducibility of Results; Respiration, Artificial; Stroke Volume; Thoracic Surgical Procedures
PubMed: 27306799
DOI: 10.1007/s10877-016-9898-5 -
Critical Care (London, England) Feb 2023Pulse pressure variation (PPV) has been widely used in hemodynamic assessment. Nevertheless, PPV is limited in low tidal volume ventilation. We conducted this systematic... (Meta-Analysis)
Meta-Analysis
Does tidal volume challenge improve the feasibility of pulse pressure variation in patients mechanically ventilated at low tidal volumes? A systematic review and meta-analysis.
BACKGROUND
Pulse pressure variation (PPV) has been widely used in hemodynamic assessment. Nevertheless, PPV is limited in low tidal volume ventilation. We conducted this systematic review and meta-analysis to evaluate whether the tidal volume challenge (TVC) could improve the feasibility of PPV in patients ventilated at low tidal volumes.
METHODS
PubMed, Embase and Cochrane Library inception to October 2022 were screened for diagnostic researches relevant to the predictability of PPV change after TVC in low tidal volume ventilatory patients. Summary receiving operating characteristic curve (SROC), pooled sensitivity and specificity were calculated. Subgroup analyses were conducted for possible influential factors of TVC.
RESULTS
Ten studies with a total of 429 patients and 457 measurements were included for analysis. The predictive performance of PPV was significantly lower than PPV change after TVC in low tidal volume, with mean area under the receiving operating characteristic curve (AUROC) of 0.69 ± 0.13 versus 0.89 ± 0.10. The SROC of PPV change yielded an area under the curve of 0.96 (95% CI 0.94, 0.97), with overall pooled sensitivity and specificity of 0.92 (95% CI 0.83, 0.96) and 0.88 (95% CI 0.76, 0.94). Mean and median cutoff value of the absolute change of PPV (△PPV) were 2.4% and 2%, and that of the percentage change of PPV (△PPV%) were 25% and 22.5%. SROC of PPV change in ICU group, supine or semi-recumbent position group, lung compliance less than 30 cm HO group, moderate positive end-expiratory pressure (PEEP) group and measurements devices without transpulmonary thermodilution group yielded 0.95 (95%0.93, 0.97), 0.95 (95% CI 0.92, 0.96), 0.96 (95% CI 0.94, 0.97), 0.95 (95% CI 0.93, 0.97) and 0.94 (95% CI 0.92, 0.96) separately. The lowest AUROCs of PPV change were 0.59 (95% CI 0.31, 0.88) in prone position and 0.73 (95% CI 0.60, 0.84) in patients with spontaneous breathing activity.
CONCLUSIONS
TVC is capable to help PPV overcome limitations in low tidal volume ventilation, wherever in ICU or surgery. The accuracy of TVC is not influenced by reduced lung compliance, moderate PEEP and measurement tools, but TVC should be cautious applied in prone position and patients with spontaneous breathing activity. Trial registration PROSPERO (CRD42022368496). Registered on 30 October 2022.
Topics: Humans; Blood Pressure; Tidal Volume; Respiration, Artificial; Feasibility Studies; Positive-Pressure Respiration; Hemodynamics; Stroke Volume; Fluid Therapy
PubMed: 36732851
DOI: 10.1186/s13054-023-04336-6 -
Journal of Clinical Hypertension... Jul 2019The study aims to evaluate the effectiveness of different durations of aerobic exercise on hypertensive patients. Four electronic databases (PubMed, Embase, Cochrane... (Meta-Analysis)
Meta-Analysis
The study aims to evaluate the effectiveness of different durations of aerobic exercise on hypertensive patients. Four electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched from their inception until July 2018. English publications and randomized controlled trials involving aerobic exercise treatment for hypertensive population were included. Two reviewers independently extracted the data. The Cochrane's Risk of Bias tool was used to assess the quality of included studies. In this systematic review, a total of 14 articles were included, involving 860 participants. The quality of the included studies ranged from moderate to high. The results of the meta-analysis showed that compared with the control group, significant effects of aerobic exercise were observed on reducing systolic blood pressure (SBP) (mean difference [MD] = -12.26 mm Hg, 95% confidence interval [CI] = -15.17 to -9.34, P < 0.05), diastolic blood pressure (DBP; MD = -6.12 mm Hg, 95% CI = -7.76 to -4.48, P < 0.05), and heart rate (MD = -4.96 bpm, 95% CI = -6.46 to -3.43, P < 0.05). In addition, significant reductions were observed in ambulatory DBP (MD = -4.90 mm Hg, 95% CI = -8.55 to -1.25, P < 0.05) and ambulatory SBP (MD = -8.77mm Hg, 95% CI = -13.97 to -3.57, P < 0.05). Therefore, aerobic exercise might be an effective treatment for blood pressure improvement in hypertensive patients. However, the effectiveness between the duration of different treatment needs to be well-designed and rigorous studies will be required to verify the dataset.
Topics: Blood Pressure; Duration of Therapy; Exercise; Exercise Therapy; Humans; Hypertension; Randomized Controlled Trials as Topic
PubMed: 31169988
DOI: 10.1111/jch.13583 -
Arquivos Brasileiros de Cardiologia Mar 2023Central blood pressure (cBP) is considered an independent predictor of organ damage, cardiovascular events and all-cause mortality. Evidence has shown that high... (Meta-Analysis)
Meta-Analysis
Central blood pressure (cBP) is considered an independent predictor of organ damage, cardiovascular events and all-cause mortality. Evidence has shown that high intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness and vascular function. However, the effects of these aerobic training modalities on cBP have not yet been properly reviewed.This meta-analysis aims to investigate to effects of HIIT versus MICT on cBP.We conducted a meta-analysis of randomized controlled trials that compared HIIT versus MICT on cBP. Primary outcomes were measures of central systolic blood pressure (cSBP) and central diastolic blood pressure (cDBP). Peripheral systolic blood pressure (pSBP) and diastolic blood pressure (pDBP), pulse wave velocity (PWV) and maximal oxygen uptake (VO2max) were analyzed as second outcomes. Meta-analysis of mean differences (MD) was conducted using the random effects model.Our study included 163 patients enrolled in six trials. We found that HIIT was superior to MICT in reducing the cSBP (MD = -3.12 mmHg, 95% CI: -4.75 to -1.50, p = 0.0002) and SBP (MD = -2.67 mmHg, 95% CI: -5.18 to -0.16, p = 0.04), and increasing VO2max(MD = 2.49 mL/kg/min, 95% CI: 1.25 to 3.73, p = 0.001). However, no significant differences were reported for cDBP, DBP and PWV.HIIT was superior to MICT in reducing the cSBP, which suggests its potential role as a non-pharmacological therapy for high blood pressure.
Topics: Humans; Blood Pressure; High-Intensity Interval Training; Pulse Wave Analysis; Hypertension; Cardiorespiratory Fitness
PubMed: 37098987
DOI: 10.36660/abc.20220398 -
Hypertension (Dallas, Tex. : 1979) Aug 2021[Figure: see text]. (Meta-Analysis)
Meta-Analysis
[Figure: see text].
Topics: Adult; Aged; Blood Pressure; Blood Pressure Determination; Calibration; Female; Heart Rate; Humans; Male; Middle Aged; Pulse Wave Analysis
PubMed: 33934626
DOI: 10.1161/HYPERTENSIONAHA.120.16817