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BMC Cardiovascular Disorders Dec 2022Gender-based violence (GBV) is a significant global public health problem and the most prominent human rights violation severely impacting women's health and wellbeing....
BACKGROUND
Gender-based violence (GBV) is a significant global public health problem and the most prominent human rights violation severely impacting women's health and wellbeing. Therefore, the aim of this study is to evaluate the association between gender-based violence and hypertension in Kyrgyzstan Republic.
METHODS
This study was conducted using population-based data of women from the 2018 Kyrgyzstan Demographic and Health Survey. The odds ratio was calculated to measure the association between GBV and hypertension, and p-values < 0.005 was considered statistically significant.
RESULT
We included data of 4793 participants, and 621 (13%) of them had hypertension. Participants exposed to GBV were 24% more likely to have hypertension than unexposed participants (OR = 1.24, 95% CI: 1.03-1.48). Of all women with hypertension, 206 (33.0%) were exposed to GBV. Participants with secondary education or higher exposed to GBV were 24% more likely to be hypertensive than GBV unexposed women with the same education levels OR = 1.24, 95% CI: 1.04-1.49). Unemployed participants exposed to GBV were 45% more likely to develop hypertension than their unexposed counterparts (OR = 1.45, 95%CI: 1.15-1.81). Rural residents exposed to GBV were also 29% more likely to have hypertension than those unexposed to GBV (OR = 1.29, 95% CI: 1.04-1.59). The odds of hypertension among those exposed to GBV increase with age.
CONCLUSION
The study revealed that GBV is a significant factor of having hypertension among Kyrgyz women.
Topics: Female; Humans; Gender-Based Violence; Kyrgyzstan; Women's Health; Rural Population; Hypertension
PubMed: 36522737
DOI: 10.1186/s12872-022-02970-6 -
European Heart Journal Oct 2015Treatment-resistant hypertension (TRH) affects between 3 and 30% of hypertensive patients, and its presence is associated with increased cardiovascular morbidity and... (Review)
Review
Treatment-resistant hypertension (TRH) affects between 3 and 30% of hypertensive patients, and its presence is associated with increased cardiovascular morbidity and mortality. Until recently, the interest on these patients has been limited, because providing care for them is difficult and often frustrating. However, the arrival of new treatment options [i.e. catheter-based renal denervation (RDN) and baroreceptor stimulation] has revitalized the interest in this topic. The very promising results of the initial uncontrolled studies on the blood pressure (BP)-lowering effect of RDN in TRH seemed to suggest that this intervention might represent an easy solution for a complex problem. However, subsequently, data from controlled studies have tempered the enthusiasm of the medical community (and the industry). Conversely, these new studies emphasized some seminal aspects on this topic: (i) the key role of 24 h ambulatory BP and arterial stiffness measurement to identify 'true' resistant patients; (ii) the high prevalence of secondary hypertension among this population; and (iii) the difficulty to identify those patients who may profit from device-based interventions. Accordingly, for those patients with documented TRH, the guidelines suggest to refer them to a hypertension specialist/centre in order to perform adequate work-up and treatment strategies. The aim of this review is to provide guidance for the cardiologist on how to identify patients with TRH and elucidate the prevailing underlying pathophysiological mechanism(s), to define a strategy for the identification of patients with TRH who may benefit from device-based interventions and discuss results and limitations of these interventions, and finally to briefly summarize the different drug-based treatment strategies.
Topics: Antihypertensive Agents; Blood Pressure Monitoring, Ambulatory; Cardiology; Catheter Ablation; Chronic Disease; Drug Resistance; Echocardiography; Electric Stimulation Therapy; Humans; Hypertension; Kidney Function Tests; Prostheses and Implants; Sympathectomy; Treatment Failure; Vascular Remodeling; Vascular Stiffness
PubMed: 26261296
DOI: 10.1093/eurheartj/ehv392 -
Polish Archives of Internal Medicine Feb 2020In the industrialized world, hypertension affects approximately 30% of the general population. Hypertensive kidney disease is considered one of the consequences of... (Review)
Review
In the industrialized world, hypertension affects approximately 30% of the general population. Hypertensive kidney disease is considered one of the consequences of long-term and poorly controlled hypertension. According to renal databases, it is a leading cause of end‑stage renal failure, second only to diabetic kidney disease. We challenge this dogma by emphasizing lack of specificity of both clinical and morphological presentations of hypertension‑related kidney disease and very low prevalence of hypertensive kidney disease that is diagnosed based on kidney biopsy findings in registries. In most cases of concomitant hypertension and chronic kidney disease (CKD), the sequence of events (ie, which came first, CKD or hypertension) cannot be established. Arterial hypertension plays a role in the pathogenesis of chronic vascular disease and may occasionally lead to arterionephrosclerosis, but its general significance in the evolution of CKD and prevalence among CKD patients appear to be highly overestimated. Studies of the morphology of kidney biopsies have indicated that arterionephrosclerosis, classically considered a morphological equivalent of the clinical term "hypertensive kidney disease"(previously referred to as "hypertensive nephropathy"), most commonly superimposes upon variable chronic renal diseases, even in the absence of elevated blood pressure. To date, no prospective controlled clinical trials have been conducted in primary hypertension patients with renal events as primary endpoints. Data from available clinical trials with renal events that serve as secondary endpoints suggest that lowering blood pressure below current targets may provide additional cardiovascular benefits but may be harmful to the kidneys.
Topics: Humans; Hypertension; Kidney Failure, Chronic; Renal Insufficiency, Chronic
PubMed: 31964856
DOI: 10.20452/pamw.15150 -
Current Hypertension Reports Apr 2014Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently, and in some cases, if not recognized and treated promptly, it can lead to... (Review)
Review
Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently, and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age-specific etiologies of secondary HTN and provide more in-depth discussion on treatment targets, potential risks of acute HTN therapy, and available pediatric data on intravenous and oral antihypertensive agents, and it proposes treatment schema including unique therapy of specific secondary HTN scenarios.
Topics: Acute Disease; Adolescent; Age Factors; Antihypertensive Agents; Child; Child, Hospitalized; Essential Hypertension; Humans; Hypertension; Risk
PubMed: 24522943
DOI: 10.1007/s11906-014-0425-0 -
American Journal of Hypertension Jan 2015The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. (Observational Study)
Observational Study
BACKGROUND
The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic.
METHODS
We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review.
RESULTS
We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents") from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3-17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08-19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P < 0.0001), and lower prevalence of preterm birth (20% vs. 46%; P < 0.001). There was a bimodal distribution of age of diagnosis in those with secondary hypertension.
CONCLUSIONS
The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth.
Topics: Adolescent; Age Distribution; Age of Onset; Blood Pressure; Child; Child, Preschool; Female; Humans; Hypertension; Infant; Infant, Newborn; Male; Pedigree; Phenotype; Premature Birth; Prevalence; Retrospective Studies; Risk Factors; Tertiary Care Centers; Texas
PubMed: 24842390
DOI: 10.1093/ajh/hpu083 -
Indian Heart Journal 2022We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and...
OBJECTIVE
We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India.
METHODS
This cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression.
RESULTS
Totally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50-2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy.
CONCLUSIONS
In this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.
Topics: Antihypertensive Agents; Cross-Sectional Studies; Diabetes Mellitus; Humans; Hypertension; India; Prescriptions; Secondary Care
PubMed: 35644270
DOI: 10.1016/j.ihj.2022.05.005 -
BMJ Open Jun 2022Hypertension is a global healthcare burden that affects the structure and function of the macrocirculation and microcirculation and induces disease-specific end-organ...
INTRODUCTION
Hypertension is a global healthcare burden that affects the structure and function of the macrocirculation and microcirculation and induces disease-specific end-organ damage. Vascular biomarkers are essential to timely diagnose this end-organ damage to improve cardiovascular (CV) risk stratification and medical decision making. Exercise therapy is an effective means to improve vascular health and reduce overall CV risk. However, it is still not clear whether high-intensity interval training (HIIT) is recommendable for patients with hypertension to reduce blood pressure, increase cardiorespiratory fitness and ameliorate vascular health.
METHODS AND ANALYSIS
The 'Hypertension and retinal microvascular dysfunction' trial will investigate macrovascular and microvascular impairments in hypertensive patients compared with healthy controls to investigate hypertension-induced end-organ damage by using gold-standard methods as well as newly developed unique retinal microvascular biomarkers. In addition, this trial will investigate the reversibility of retinal end-organ damage by assessing the effects of an 8-week supervised and walking based HIIT on blood pressure, cardiorespiratory fitness as well as macrovascular and microvascular health, compared with a control group following standard physical activity recommendations. Primary outcome will be the arteriolar-to-venular diameter ratio. Secondary outcomes will be arteriolar and venular diameters as well as the flicker-light-induced dilation. Further outcomes will be other retinal microvascular biomarkers, flow-mediated dilation of the brachial artery as well as blood pressure, cardiorespiratory fitness, microalbuminuria, hypertensive retinopathy and classical CV risk markers. Analysis of variance and analysis of covariance will be used to investigate group differences between healthy controls and hypertensive patients and training effects in hypertensive patients, respectively.
ETHICS AND DISSEMINATION
The Ethics Committee of Northwestern and Central Switzerland approved this study (EKNZ-2021-00086). All participants will give informed consent.
TRIAL REGISTRATION NUMBER
NCT04763005.
Topics: Biomarkers; Cardiorespiratory Fitness; Exercise; High-Intensity Interval Training; Humans; Hypertension; Randomized Controlled Trials as Topic
PubMed: 35667713
DOI: 10.1136/bmjopen-2021-058997 -
Journal of Clinical Hypertension... Aug 2019Arterial hypertension is a well-established cardiovascular risk factor, and blood pressure (BP) control has largely improved the prognosis of hypertensive patients. A... (Review)
Review
Arterial hypertension is a well-established cardiovascular risk factor, and blood pressure (BP) control has largely improved the prognosis of hypertensive patients. A number of studies have assessed the role of BP levels in the prognosis of patients with acute coronary syndromes. Pathophysiologic links of hypertension to acute myocardial infarction (MI) include endothelial dysfunction, autonomic nervous system dysregulation, impaired vasoreactivity, and a genetic substrate. A history of hypertension is highly prevalent among patients presenting with MI, and some, but not all, studies have associated it with a worse prognosis. Some data support that low levels of admission and in-hospital BP may indicate an increased risk for subsequent events. Risk scores used in patients with MI have, therefore, included BP levels and a history of hypertension in their variables. Of note, good long-term BP control, ideally initiated prior to discharge, should be pursued in order to improve secondary prevention.
Topics: Acute Coronary Syndrome; Acute Disease; Blood Pressure; Blood Pressure Determination; Cardiovascular Diseases; Hospitalization; Humans; Hypertension; Myocardial Infarction; Prevalence; Prognosis; Risk Factors
PubMed: 31301119
DOI: 10.1111/jch.13622 -
PloS One 2022Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors....
BACKGROUND
Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors. This study examines the association between individual, neighborhood, and school-level influences during adolescence on young adult blood pressure.
METHODS
Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (1994-1995 aged 11-18 and 2007-2008 aged 24-32). We categorized hypertension as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Secondary outcomes included continuous systolic and diastolic blood pressure. We fit a series of cross-classified multilevel models to estimate the associations between young adulthood hypertension with individual-level, school-level, and neighborhood-level factors during adolescence (i.e., fixed effects) and variance attributable to each level (i.e., random effects). Models were fit using Bayesian estimation procedures. For linear models, intra-class correlations (ICC) are reported for random effects.
RESULTS
The final sample included 13,911 participants in 128 schools and 1,917 neighborhoods. Approximately 51% (7,111) young adults were hypertensive. Individual-level characteristics-particularly older ages, Non-Hispanic Black race, Asian race, male sex, BMI, and current smoking-were associated with increased hypertension. Non-Hispanic Black (OR = 1.21; 95% CI: 1.03-1.42) and Asian (OR = 1.28; 95% CI: 1.02-1.62) students had higher odds of hypertension compared to non-Hispanic White students. At the school level, hypertension was associated with the percentage of non-Hispanic White students (OR for 10% higher = 1.06; 95% CI: 1.01-1.09). Adjusting for individual, school, and neighborhood predictors attenuated the ICC for both the school (from 1.4 null to 0.9 fully-adjusted) and neighborhood (from 0.4 to 0.3).
CONCLUSION
We find that adolescents' schools and individual-level factors influence young adult hypertension, more than neighborhoods. Unequal conditions in school environments for adolescents may increase the risk of hypertension later in life. Our findings merit further research to better understand the mechanisms through which adolescents' school environments contribute to adult hypertension and disparities in hypertension outcomes later in life.
Topics: Adolescent; Adult; Bayes Theorem; Humans; Hypertension; Longitudinal Studies; Male; Residence Characteristics; Schools; Young Adult
PubMed: 35482649
DOI: 10.1371/journal.pone.0266729 -
Journal of the American Heart... Mar 2024This study aimed to investigate the causal relationships between branched-chain amino acids (BCAAs) and the risks of hypertension via meta-analysis and Mendelian... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study aimed to investigate the causal relationships between branched-chain amino acids (BCAAs) and the risks of hypertension via meta-analysis and Mendelian randomization analysis.
METHODS AND RESULTS
A meta-analysis of 32 845 subjects was conducted to evaluate the relationships between BCAAs and hypertension. In Mendelian randomization analysis, independent single-nucleotide polymorphisms associated with BCAAs at the genome-wide significance level were selected as the instrumental variables. Meanwhile, the summary-level data for essential hypertension and secondary hypertension end points were obtained from the FinnGen study. As suggested by the meta-analysis results, elevated BCAA levels were associated with a higher risk of hypertension (isoleucine: summary odds ratio, 1.26 [95% CI, 1.08-1.47]; leucine: summary odds ratio, 1.28 [95% CI, 1.07-1.52]; valine: summary odds ratio, 1.32 [95% CI, 1.12-1.57]). Moreover, the inverse variance-weighted method demonstrated that an elevated circulating isoleucine level might be the causal risk factor for essential hypertension but not secondary hypertension (essential hypertension: odds ratio, 1.22 [95% CI, 1.12-1.34]; secondary hypertension: odds ratio, 0.96 [95% CI, 0.54-1.68]).
CONCLUSIONS
The increased levels of 3 BCAAs positively correlated with an increased risk of hypertension. Particularly, elevated isoleucine level is a causal risk factor for essential hypertension. Increased levels of leucine and valine also tend to increase the risk of essential hypertension, but further verification is still warranted.
Topics: Humans; Amino Acids, Branched-Chain; Isoleucine; Leucine; Mendelian Randomization Analysis; Valine; Hypertension; Essential Hypertension; Genome-Wide Association Study
PubMed: 38420789
DOI: 10.1161/JAHA.123.032084