Integrated Blood Pressure Control[JOURNAL]
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166 papers
Treatment Outcome and Associated Factors Among Patients Admitted with Hypertensive Crisis in Public Hospitals at Harar Town, Eastern Ethiopia: A Cross-Sectional Study.
Samuel N, Nigussie S, Jambo A … +7 more , Dechasa M, Demeke F, Godana A, Birhanu A, Gashaw T, Agegnehu Teshome A, Siraj A
Integr Blood Press Control · 2022 · PMID 36536824 · Full text
BACKGROUND: Hypertensive crisis is a significant global health issue that raises the costs to healthcare systems and requires specific attention to improve clinical outcome. There is scarce information on hypertensive cr...
BACKGROUND: Hypertensive crisis is a significant global health issue that raises the costs to healthcare systems and requires specific attention to improve clinical outcome. There is scarce information on hypertensive crisis cases treatment outcome in the study setting. OBJECTIVE: This study aimed to assess treatment outcome and associated factors among patients admitted with hypertensive crisis at Public Hospitals in Harar Town, Eastern Ethiopia. METHODS: A cross-sectional study was conducted among 369 hypertensive crisis patients who had been admitted to the emergency department of Hiwot Fana Comprehensive Specialized Hospital and Jugol General Hospital from May 1, 2017, to May 1, 2022. All hypertensive crisis patients who fulfilled the inclusion criteria were included. The data were extracted from medical records using a data abstraction format. The collected data were analyzed using Statistical Package for Social Sciences version 22. Binary logistics regression model using bivariate and multivariable analysis with 95% confidence intervals and -values were used to determine the association between variables. RESULTS: The medical records of 369 patients in total were reviewed. Of these, the medical records of 363 patients contained all the necessary information and were used in the study. More than half of the patients (238; 65.6%) were males. Among 363 patients admitted with hypertensive crisis, 98 (27.0%, 95% Confidence Interval (CI):22.5%-31.9%) of them had poor treatment outcome of hypertensive crisis. Being female (Adjusted Odds Ratio (AOR)=3.4; 95% CI=1.7-7.9), residing in rural areas (AOR=2.4; 95% CI=2.7-5.1), taking captopril during admission (AOR=5.6; 95% CI=2.4-7.9), taking antihypertensive treatment before admission (AOR=0.5; 95% CI=0.2-0.9), and being non compliant to treatment (AOR=2.7; 95% CI=1.4-3.5) had statistically significant associations with poor treatment outcome of hypertensive crisis compared to their counterparts. CONCLUSION: The magnitude of poor treatment outcome of hypertensive crisis was high. Sex, residence, non-compliance, and type of emergency drug administered during admission were substantially related with poor treatment outcome of hypertensive crisis. Health professionals should put great emphasis on emergency drugs administered during admission to achieve the desired outcome.
Medication Adherence and Blood Pressure Control Among Hypertensive Outpatients Attending a Tertiary Cardiovascular Hospital in Tanzania: A Cross-Sectional Study.
Pallangyo P, Komba M, Mkojera ZS … +12 more , Kisenge PR, Bhalia S, Mayala H, Kifai E, Richard MK, Khanbhai K, Wibonela S, Millinga J, Yeyeye R, Njau NF, Odemary TK, Janabi M
Integr Blood Press Control · 2022 · PMID 35991354 · Full text
BACKGROUND: Notwithstanding the availability of effective treatments, asymptomatic nature and the interminable treatment length, adherence to medication remains a substantial challenge among patients with hypertension. S...
BACKGROUND: Notwithstanding the availability of effective treatments, asymptomatic nature and the interminable treatment length, adherence to medication remains a substantial challenge among patients with hypertension. Suboptimal adherence to BP-lowering agents is a growing global concern that is associated with the substantial worsening of disease, increased service utilization and health-care cost escalation. This study aimed to explore medication adherence and its associated factors among hypertension outpatients attending a tertiary-level cardiovascular hospital in Tanzania. METHODS: The pill count adherence ratio (PCAR) was used to compute adherence rate. In descriptive analyses, adherence was dichotomized and consumption of less than 80% of the prescribed medications was used to denote poor adherence. Logistic regression analyses was used to determine factors associated with adherence. RESULTS: A total of 849 outpatients taking antihypertensive drugs for ≥1 month prior to recruitment were randomly enrolled in this study. The mean age was 59.9 years and about two-thirds were females. Overall, a total of 653 (76.9%) participants had good adherence and 367 (43.2%) had their blood pressure controlled. Multivariate logistic regression analysis showed; lack of a health insurance (OR 0.5, 95% CI 0.3-0.7, p<0.01), last BP measurement >1 week (OR 0.6, 95% CI 0.4-0.8, p<0.01), last clinic attendance >1 month (OR 0.4, 95% CI 0.3-0.6, p<0.001), frequent unavailability of drugs (OR 0.6, 95% CI 0.3-0.9, p = 0.03), running out of medication before the next appointment (OR 0.6, 95% CI 0.4-0.9, p = 0.01) and stopping medications when asymptomatic (OR 0.6, 95% CI 0.4-0.8, p<0.001) to be independent associated factors for poor adherence. CONCLUSION: A substantial proportion of hypertensive outpatients in this tertiary-level setting had good medication adherence. Nonetheless, observed suboptimal blood pressure control regardless of a fairly satisfactory adherence rate suggests that lifestyle modification plays a central role in hypertension management.
Low Subjective Cardiovascular Disease Risk Perceptions among Hypertensive Patients in Addis Ababa, Ethiopia.
Bekele DM, Goshu DY, Yalew AW … +2 more , Higgins MK, Gary RA
Integr Blood Press Control · 2022 · PMID 35959381 · Full text
BACKGROUND: Accurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcome...
BACKGROUND: Accurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients' risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS). METHODS: A cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants' risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level. RESULTS: Participants (n=377) had a mean age of 53.61 ± 12.80-years, range (18-82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43-18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36-14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants' CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation. CONCLUSION: Hypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients' CVD risk perception to reduce adverse CVD events.
Hypertension and Its Associated Factors Among Long-Distance Truck Drivers in Ethiopia.
Rike ME, Diress M, Dagnew B … +5 more , Getnet M, Hasano Kebalo A, Sinamaw D, Solomon D, Akalu Y
Integr Blood Press Control · 2022 · PMID 35761970 · Full text
INTRODUCTION: Hypertension is rising globally and is one of the leading causes of cardiovascular disease. It affects people of different groups; however, owing to a rise in a sedentary lifestyle it is more prevalent amon...
INTRODUCTION: Hypertension is rising globally and is one of the leading causes of cardiovascular disease. It affects people of different groups; however, owing to a rise in a sedentary lifestyle it is more prevalent among long-distance truck drivers. However, the prevalence of hypertension and its associated factors among truck drivers in Ethiopia is not known. Therefore, this study aimed to determine the prevalence of hypertension and its associated factors among long-distance truck drivers in Ethiopia. METHODS: A cross-sectional study was conducted among 415 long-distance truck drivers selected by systematic random sampling technique at Modjo dry port from May 15 to 30, 2021. The data were collected and entered into Epi-data 4.6 then it was exported to SPSS version 25 for analysis. Descriptive statistics, bivariable, and multivariable logistic regression analyses were executed. The odds ratio with a 95% confidence interval was computed. In the final model, a variable with a p ≤ 0.05 was declared as a predictor of hypertension. RESULTS: The prevalence of hypertension among long-distance truck drivers in Ethiopia was 34.7%. The odds of hypertension was higher among drivers who were ≥45 years old [Adjusted odds ratio (AOR) = 4.32; 95% Confidence interval (CI): 2.16, 8.62], obese [AOR= 5.12; 95% CI: 1.33, 19.8], alcohol drinkers [AOR=3.05; 95% CI: 1.27, 7.31], and cigarette smokers [AOR= 3.74; 95% CI: 1.64, 8.51]. Drivers who had regular physical exercise were less likely [AOR=0.33; 95% CI: 0.17, 0.63] to have hypertension than drivers with no physical activity. CONCLUSION: More than a third of the participants in Ethiopia had hypertension. Higher age, obesity, absence of rest between driving, short sleep duration, smoking, alcohol drinking, and physical inactivity were significantly associated with hypertension. Therefore, health education on lifestyle modifications, sleep habits, and the importance of rest breaks between driving should be considered to prevent hypertension and further complications.
The Association Between Habitual Sleep Duration and Blood Pressure Control in United States (US) Adults with Hypertension.
Ogugu EG, Catz SL, Bell JF … +3 more , Drake C, Bidwell JT, Gangwisch JE
Integr Blood Press Control · 2022 · PMID 35642173 · Full text
PURPOSE: This study examined the relationship between habitual sleep duration and blood pressure (BP) control in adults with hypertension. METHODS: This cross-sectional study used data of 5163 adults with hypertension ob...
PURPOSE: This study examined the relationship between habitual sleep duration and blood pressure (BP) control in adults with hypertension. METHODS: This cross-sectional study used data of 5163 adults with hypertension obtained from the 2015-2018 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression was used to analyze the association between habitual sleep duration and BP control. Habitual sleep duration was self-reported and defined as the amount of sleep usually obtained in a night or main sleep period during weekdays or workdays. It was categorized as <6, 6 - <7, 7-9, and >9 hours. BP control was defined as average systolic BP <130mmHg and diastolic BP <80mmHg. RESULTS: Results from the fully adjusted models show that among all adults with hypertension, habitual sleep duration of <6 hours night/main sleep period was associated with reduced odds of BP control (OR = 0.53, 95% CI: 0ss.37-0.76, = 0.001) when compared to 7-9 hours. In the subpopulation of adults who were on antihypertensive medication, those with a sleep duration of <6 hours had lower odds of BP control than those with a sleep duration of 7-9 hours (OR = 0.53, 95% CI: 0.36-0.77, = 0.002). No significant differences were noted in all adults with hypertension and in the subpopulation of those on antihypertensive medication in BP control between the reference sleep duration group (7-9 hours) and the 6 - <7 or >9 hours groups. There were no significant differences across age groups or gender in the relationship between habitual sleep duration and BP control. CONCLUSION: Sleep duration of <6 hours is associated with reduced odds of hypertension control. These significant findings indicate that interventions to support adequate habitual sleep duration may be a promising addition to the current hypertension management guidelines.
Serum Levels of NT-Pro BNP in Patients with Preeclampsia.
Nguyen TX, Nguyen VT, Nguyen-Phan HN … +1 more , Hoang BB
Integr Blood Press Control · 2022 · PMID 35418780 · Full text
OBJECTIVE: This study aims to determine the serum levels of NT-proBNP in women with preeclampsia with and without severe signs and to evaluate the cardiovascular risks in these two groups of participants. METHODS: A desc...
OBJECTIVE: This study aims to determine the serum levels of NT-proBNP in women with preeclampsia with and without severe signs and to evaluate the cardiovascular risks in these two groups of participants. METHODS: A descriptive cross-sectional study was conducted on 52 women with preeclampsia in the Department of Gynecology and Obstetrics - Hue Central Hospital, from August 2019 to September 2020. RESULTS: In preeclampsia women, the rate of hypertension in stage 3, stage 2, and stage 1 were 46.1%, 32.7%, and 21.2%, respectively. The average Sokolow-Lyon index in the preeclampsia group with and without severe signs was 22.25 ± 7.38mm, 20.16 ± 5.54mm, respectively. The average left ventricular mass index in the group of preeclampsia patients without and with severe signs was 92.27 ± 14.56g/m and 120.68 ± 16.47g/m, respectively. The average ejection fraction in the group of preeclampsia patients without severe signs and with severe signs was 65.11 ± 3.45%, 56.21 ± 7.12%, correspondingly. In contrast, the difference between the two groups was statistically significant with p < 0.05. The plasma NT-proBNP level in the preeclampsia group without severe signs was 349.12 ± 93.51pg/mL, whereas the concentration in the preeclampsia group with severe signs was 725.32 ± 290.46pg/mL (p < 0.05). CONCLUSION: The NT-proBNP level was statistically significantly increased in the patients with preeclampsia. Analyzing and comparing the figures and changes found in two groups of PE patients, with and without severe signs, we suggest that women diagnosed with PE with severe signs have a higher risk of developing cardiovascular problems forthwith and henceforth.
Pulmonary Hypertension in Pregnancy: Challenges and Solutions.
Afify H, Kong A, Bernal J … +1 more , Elgendy IY
Integr Blood Press Control · 2022 · PMID 35401013 · Full text
Pulmonary hypertension (PH) is a heterogeneous disease characterized by an elevated mean pulmonary artery pressure of 20 mm Hg or above. PH is a prevalent condition among women of reproductive age and is linked with poor...
Pulmonary hypertension (PH) is a heterogeneous disease characterized by an elevated mean pulmonary artery pressure of 20 mm Hg or above. PH is a prevalent condition among women of reproductive age and is linked with poor prognosis during pregnancy. Pregnancy is a stressful event and complicates the management and prognosis in patients with PH. In this review, we discuss the pathogenesis, clinical presentation as well as therapeutic options for PH during pregnancy. We also highlight knowledge gaps to guide future research.
Perioperative Hypertension Etiologies in Patients Undergoing Noncardiac Surgery in University Health Network Hospitals-Canada from 2015-2020.
Mohseni S, Behnam-Roudsari S, Tarbiat M … +3 more , Shaker P, Shivaie S, Shafiee MA
Integr Blood Press Control · 2022 · PMID 35340537 · Full text
INTRODUCTION: Perioperative hypertension, defined as increased blood pressure around the surgery, is a known risk factor for perioperative complications, including cardiovascular events. Identifying reasons associated wi...
INTRODUCTION: Perioperative hypertension, defined as increased blood pressure around the surgery, is a known risk factor for perioperative complications, including cardiovascular events. Identifying reasons associated with hypertension in each period is of great help in preventing and better managing perioperative hypertension. OBJECTIVE: The aim of the study was to explore common etiologies of hypertension during the perioperative period (pre, intra, and post-operation) in patients who underwent noncardiac surgeries in University Health Network (UHN) hospitals, Canada, from 2015 to 2020. PATIENTS AND METHODS: We retrospectively analyzed the medical records of 174 patients undergoing noncardiac surgeries who experienced perioperative hypertension. We assessed the prevalence of 10 reasons for perioperative hypertension as a whole and also each period separately according to the physicians' notes in patients' medical records. Two-way measurements ANOVA was used to determine the change of mean hypertension among patients for specific etiology. RESULTS: The common etiologies of perioperative hypertension were poorly controlled hypertension (21.8%), excessive fluid therapy (19.5%), excessive vasopressor (18.4%), and medication withdrawal (13.7%). Regarding each period separately, the most common reasons were poorly controlled hypertension for pre (42.9%) and intraoperative period (22.7%) and fluid overload for the postoperative period (20.1%). Poor control of hypertension showed both within-subject statistical significance for systolic and between-subject statistical significance for diastolic blood pressure. CONCLUSION: Poorly controlled hypertension is the most significant etiology of perioperative hypertension in patients undergoing noncardiac surgeries. Apart from poorly controlled hypertension, as a patient-related factor, iatrogenic factors such as excessive vasopressor therapy, aggressive fluid replacement and poor management of antihypertensive medications can also cause perioperative hypertension.
Effects of Single Pill Combinations Compared to Identical Multi Pill Therapy on Outcomes in Hypertension, Dyslipidemia and Secondary Cardiovascular Prevention: The START-Study.
Wilke T, Weisser B, Predel HG … +8 more , Schmieder R, Wassmann S, Gillessen A, Blettenberg J, Maywald U, Randerath O, Mueller S, Böhm M
Integr Blood Press Control · 2022 · PMID 35250308 · Full text
AIM: Current guidelines for the treatment of arterial hypertension (AH) or cardiovascular (CV) prevention recommend combination drug treatments with single pill combinations (SPC) to improve adherence to treatment. We ai...
AIM: Current guidelines for the treatment of arterial hypertension (AH) or cardiovascular (CV) prevention recommend combination drug treatments with single pill combinations (SPC) to improve adherence to treatment. We aimed to assess whether the SPC concept is clinically superior to multi pill combination (MPC) with identical drugs. METHODS AND RESULTS: In an explorative study, we analyzed anonymized claims data sets of patients treated with CV drugs for hypertension and/or CV disorders who were insured by the German AOK PLUS statutory health fund covering 01/07/2012-30/06/2018. Patients at age ≥18 years who received either a SPC or MPC with identical drugs were followed for up to one year. A one to one propensity score matching (PSM) was applied within patient groups who started identical drug combinations, and results were reported as incidence rate ratios (IRRs) as well as hazard ratios (HRs). After PSM, data from 59,336 patients were analyzed. In 30 out of 56 IRR analyses, superiority of SPC over MPC was shown. In 5 out of 7 comparisons, the HR for the composite outcome of all-cause death and all-cause hospitalizations was in favor of the SPC regimen (SPC versus MPC): valsartan/amlodipine: HR=0.87 (95% CI: 0.84-0.91, p ≤ 0.001); candesartan/amlodipine: 0.77 (95% CI: 0.65-0.90, p = 0.001); valsartan/amlodipine/hydrochlorothiazide: HR=0.68 (95% CI: 0.61-0.74, p ≤ 0.001); ramipril/amlodipine: HR=0.80 (95% CI: 0.77-0.83, p ≤ 0.001); acetylsalicylic acid (ASA)/atorvastatin/ramipril: HR=0.64 (95% CI: 0.47-0.88, p = 0.005). CONCLUSION: SPC regimens are associated with a lower incidence of CV events and lower all-cause mortality in clinical practice. SPC regimens should generally be preferred to improve patient's prognosis.
Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies.
Murphy L, Maloney K, Gore L … +1 more , Blanchette E
Integr Blood Press Control · 2022 · PMID 35082528 · Full text
Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children under the age of 18. While modern diagnostic technologies, risk-stratification, and therapy intensification have led to outstanding outco...
Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children under the age of 18. While modern diagnostic technologies, risk-stratification, and therapy intensification have led to outstanding outcomes for many children with ALL, the side effects and consequences of therapy are not to be underestimated. Hypertension is a well-known acute and chronic side effect of treatment for childhood ALL, although limited data are available regarding the prevalence of hypertension in children undergoing treatment for ALL. In this review of hypertension in pediatric ALL patients, we examine the existing data on incidence and prevalence during treatment and in pediatric ALL survivors. We describe independent risk factors for development of hypertension along with treatment-related causes. Long-term consequences and the risk to survivors of pediatric ALL are further defined. While many ALL patients require antihypertensive medications during some portion of their treatment, there are no clear guidelines on treating inpatient hypertension given challenges that exist in recognizing and managing hypertension in this setting and in this population. Here, we propose an algorithmic approach to diagnose and treat pediatric ALL patients with HTN, along with monitoring and continuation versus cessation of antihypertensive therapy as an outpatient.
The Diastolic Blood Pressure J-Curve in Hypertension Management: Links and Risk for Cardiovascular Disease.
Gaffney B, Jacobsen AP, Pallippattu AW … +2 more , Leahy N, McEvoy JW
Integr Blood Press Control · 2021 · PMID 34938115 · Full text
PURPOSE OF REVIEW: The treatment of hypertension has changed dramatically over the last century, with recent trials informing clinical guidelines that recommend aiming for lower blood pressure (BP) targets than ever befo...
PURPOSE OF REVIEW: The treatment of hypertension has changed dramatically over the last century, with recent trials informing clinical guidelines that recommend aiming for lower blood pressure (BP) targets than ever before. However, a "J"- or "U-shaped curve" in the association between diastolic BP and cardiovascular events has been observed in epidemiological studies, suggesting that both high diastolic BPs and diastolic BPs below a certain nadir are associated with higher risk of cardiovascular disease (CVD) events. Despite the potential for confounding and reverse causation, this association may caution against overly intensive BP lowering in some hypertensive adults who also have a low baseline diastolic BP. RECENT FINDINGS: Recent post-hoc analyses of the landmark Systolic Blood Pressure Intervention Trial (SPRINT) appear to contradict these J-curve concerns, finding that the benefit of more intensive BP treatment did not differ based on baseline blood pressure. Similarly, sensitivity analyses of The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) randomized controlled trial found that patients experienced similar benefits from an intensive BP goal, regardless of whether their diastolic BP was above or below 60 mm Hg. Finally, several Mendelian randomization analyses, which are less susceptible to confounding and reverse causation, demonstrated a clear linear relationship between diastolic BP and cardiovascular events. These studies indicate that a potential reduction in CVD risk is possible, irrespective of baseline diastolic BP values. SUMMARY: Sufficient recent evidence indicates that low diastolic BP is not causal of worse cardiovascular outcomes but rather represents confounding or reverse causation. Therefore, while low diastolic BP can be considered a marker of CVD risk, this risk is not expected to increase with further BP lowering when necessary to control concomitant elevations of systolic BP. Indeed, BP reduction in this setting appears beneficial.
A Qualitative Study on Barriers to Treatment and Control of Hypertension Among Patients at Dessie Referral Hospital, Northeast Ethiopia, Ethiopia: Healthcare Workers' Perspective.
Abaynew Y, Hussien M
Integr Blood Press Control · 2021 · PMID 34887681 · Full text
INTRODUCTION: Hypertension is the leading cause of morbidity and mortality and accounts for 13% of all deaths and 7% of the disease burden in the world. Although the importance of controlling hypertension has been recogn...
INTRODUCTION: Hypertension is the leading cause of morbidity and mortality and accounts for 13% of all deaths and 7% of the disease burden in the world. Although the importance of controlling hypertension has been recognized for many years, the majority of patients with hypertension remain uncontrolled. Studies indicate a very low adherence to lifestyle modifications among patients in the study area. Hypertensive patients face set of problems associated with adherence to antihypertensive drugs and healthy lifestyle modifications. OBJECTIVE: The objective of the study was to explore barriers to hypertension treatment and control from healthcare workers' perspective and experiences at Dessie Referral Hospital, Ethiopia. METHODS: Seven healthcare workers actively involved in managing hypertensive individuals at Dessie Referral Hospital were recruited for the study. Participants were purposively selected from outpatient, inpatient, and pharmacy departments. The required data were collected by the principal investigator on exit interviews. An interview guide was developed by reviewing previous literature. Interviews were semi-structured, 8-20 minutes in duration, and designed to elicit healthcare workers'experiences and perceptions and conducted until data saturation was reached. All interviews were recorded, transcribed verbatim, and thematically analyzed. Each theme was supported by using the participants' quotes. RESULTS: Three themes emerged. The major barriers impacted patients' medication adherence and healthy lifestyle modifications were common use of diets during social settings, low level of awareness, lack of resources, misconceptions about hypertension, use of traditional medicines, inadequate physical activities, and high cost of drugs. CONCLUSION: Patients' misconceptions about hypertension, common use of diets during festivals, and inadequate physical activities were factors associated with inadequate blood pressure control. Healthcare workers should better understand the problems that hypertensive patients' face, thus achieving better control.
Determinants of Preeclampsia Among Pregnant Women in Chiro Referral Hospital, Oromia Regional State, Ethiopia: Unmatched Case-Control Study.
Katore FH, Gurara AM, Beyen TK
Integr Blood Press Control · 2021 · PMID 34880674 · Full text
BACKGROUND: Preeclampsia causes striking maternal, fetal, and neonatal mortality and morbidity both in developed and developing countries. However, evidence of risk factors of preeclampsia is limited in the study area. O...
BACKGROUND: Preeclampsia causes striking maternal, fetal, and neonatal mortality and morbidity both in developed and developing countries. However, evidence of risk factors of preeclampsia is limited in the study area. OBJECTIVE: To identify determinants of preeclampsia among pregnant women attending antenatal care services in Ciro Referral Hospital, Ethiopia, 2020. METHODS: A facility-based unmatched case-control study was conducted from July 1 to July 30, 2020, in Chiro Referral Hospital on a sample size of 306 (ie, 76 cases and 230 controls; with a 1:3 ratio). Data were coded and entered into Epi Info version 7 and then exported to SPSS version 21 for analysis. The odds ratio was calculated with 95% confidence intervals to show the strength of association and -value<0.05 was used to declare statistical significance. RESULTS: A total of 302 (75 cases and 227 controls) pregnant mothers were interviewed with a response rate of 98.7%. Being in the age group ≥35 years (AOR=4.00; 95% CI=1.25-12.80), rural residence (AOR=3.30; 95% CI=1.50-7.26), having a family history of hypertension (AOR=3.25; 95% CI=1.36-7.73), and being primigravida (AOR=3.71; 95% CI=1.49-9.22) were identified as risk factors for preeclampsia. However, consuming fruits more than 2-4 times per a week in their diet (AOR=0.38; 95% CI=0.15-0.98) was a protective predictor of preeclampsia. CONCLUSION: Maternal age, residence, family history of hypertension, gravida, and frequency of fruit consumption were identified determinants of preeclampsia. Thus, healthcare providers should give emphasis for pregnant mothers in the older age category, primigravida, those who have a history of a family with hypertension, and those from a rural residence to diagnose the diseases as early as possible. Additionally, advising pregnant mothers attending antenatal care to consume fruits as early as possible in their daily diet reduces the risk of preeclampsia.
Which anthropometric and metabolic index is superior in hypertension prediction among overweight/obese adults?
Abolhasani M, Maghbouli N, Karbalai Saleh S … +5 more , Aghsaeifar Z, Sazgara F, Tahmasebi M, Ashraf H, Haidar Ali J
Integr Blood Press Control · 2021 · PMID 34795521 · Full text
BACKGROUND: Although the effectiveness of some combined anthropometric and metabolic scores were evaluated in hypertension prediction, none of them had addressed their accuracy in association with overweight/obese popula...
BACKGROUND: Although the effectiveness of some combined anthropometric and metabolic scores were evaluated in hypertension prediction, none of them had addressed their accuracy in association with overweight/obese populations. This study examined the accuracy of several anthropometric parameters in this regard and compared the novel indices to the ancient ones. METHODS: Through a cross-sectional study, 5115 patients have been evaluated at the weight loss clinic. Data on demographic information, anthropometric indices, and biochemical measurements were assembled into a checklist. Multivariable regression modeling and the area under the receiver-operating characteristic (ROC) were analyzed using SPSS version 20. To find new combined scores, SEM (structural equation modeling) analysis was also adopted. P-values < 0.05 were considered statistically significant. RESULTS: Considering ancient indices, WHtR (waist-to-height ratio) showed a sufficient area under the curve in predicting hypertension among both genders concomitant with WC (waist circumference) in men, and BRI (body roundness index) in women as highest AUC. The highest odds ratio (OR) for the presence of hypertension, based on the age-adjusted model, was BRI in females (OR, 3.335; 95% confidence interval [CI], 1.58-7.28) and WC in males (OR, 13.478; 95% CI: 1.99-45.02). The combined scores were not superior to the single ones. CONCLUSION: The most powerful association between hypertension and sufficient discrimination ability of normotensives from hypertensive patients was detected for BRI in women and WC among men. However, neither the BSI and BAI nor FMI and FFMI showed superiority to WC or WHtR in predicting the presence of hypertension.
Insights into the Mechanisms of Fetal Growth Restriction-Induced Programming of Hypertension.
Bhunu B, Riccio I, Intapad S
Integr Blood Press Control · 2021 · PMID 34675650 · Full text
In recent decades, both clinical and animal studies have shown that fetal growth restriction (FGR), caused by exposure to adverse uterine environments, is a risk factor for hypertension as well as for a variety of adult...
In recent decades, both clinical and animal studies have shown that fetal growth restriction (FGR), caused by exposure to adverse uterine environments, is a risk factor for hypertension as well as for a variety of adult diseases. This observation has shaped and informed the now widely accepted theory of developmental origins of health and disease (DOHaD). There is a plethora of evidence supporting the association of FGR with increased risk of adult hypertension; however, the underlying mechanisms responsible for this correlation remain unclear. This review aims to explain the current advances in the field of fetal programming of hypertension and a brief narration of the underlying mechanisms that may link FGR to increased risk of adult hypertension. We explain the theory of DOHaD and then provide evidence from both clinical and basic science research which support the theory of fetal programming of adult hypertension. In addition, we have explored the underlying mechanisms that may link FGR to an increased risk of adult hypertension. These mechanisms include epigenetic changes, metabolic disorders, vascular dysfunction, neurohormonal impairment, and alterations in renal physiology and function. We further describe sex differences seen in the developmental origins of hypertension and provide insights into the opportunities and challenges present in this field.
Orthostatic Hypotension in Male Hypertensive Patients: A Cross-Sectional Study at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.
Getu AA, Abuhay DA, Goshu BT
Integr Blood Press Control · 2021 · PMID 34675649 · Full text
BACKGROUND: Orthostatic hypotension (OH) is defined as a fall in systolic blood pressure (SBP) ≥20 mmHg or diastolic BP (DBP) ≥10 mmHg within 3 minutes of standing. OH incidence is increased with hypertension, and manage...
BACKGROUND: Orthostatic hypotension (OH) is defined as a fall in systolic blood pressure (SBP) ≥20 mmHg or diastolic BP (DBP) ≥10 mmHg within 3 minutes of standing. OH incidence is increased with hypertension, and management of these patients may pose challenges, as treatment of one can worsen the other. OBJECTIVE: This study aimed to determine the prevalence of OH and its associated factors among male hypertensive patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia. METHODS: A hospital-based cross-sectional design was employed. Seated BP was measured twice and the average of the two taken. After BP had been stabilized for 5 minutes, SBP within 3 minutes of standing was measured twice and the minimum of the two taken. A drop of ≥20 mmHg in SBP within 3 minutes of standing was taken as OH. All male hypertensive patients who were able to attain a standing position were included. Sociodemographic, anthropometric, and clinical status of the patients were taken using structured interviewer-administered questionnaires. Data were entered and analyzed using SPSS 21. Both bivariate and multivariate logistic regression analysis were done. P≤0.05 was considered statistically significant. RESULTS: The median age of study participants was 57 (25-96) years. The prevalence of OH was 17.6%. Uncontrolled hypertension (adjusted OR 2.08, 95% CI 1.125-3.872) and duration of hypertension ≥5 years (adjusted OR 2.04, 95% CI 1.069-3.895) were significantly associated with OH in hypertensive patients. CONCLUSION: The prevalence of OH among male hypertensive patients was high. Hypertensive patients whose BP was uncontrolled and having had hypertension ≥5 years were risk factors of OH.
Dietary and Behavioral Risk Factors of Ischemic Heart Disease Among Patients of Medical Outpatient Departments in Southern Ethiopia: Unmatched Case-Control Study.
Gebremedhin MH, Gebrekirstos LG
Integr Blood Press Control · 2021 · PMID 34588813 · Full text
BACKGROUND: Worldwide mortality due to cardiovascular disease is the dominant cause of death, and ischemic heart disease is the leading one. Though risk factors for Ischemic heart diseases are modifiable and preventable,...
BACKGROUND: Worldwide mortality due to cardiovascular disease is the dominant cause of death, and ischemic heart disease is the leading one. Though risk factors for Ischemic heart diseases are modifiable and preventable, it is not well investigated in the local context. Thus, this study aimed to assess the dietary and behavioral risk factors for ischemic heart disease among patients in medical outpatient departments in Southern, Ethiopia. METHODS: A facility-based unmatched case-control study was conducted from November 16 to March 20, 2020, among patients with ischemic heart disease and those patients who visited the three hospitals of the Wolaita Zone. A convenient sampling method was used and the data were entered using Epi data version 3.1 and exported to SPSS version 21 for analysis, a p-value <0.05, were considered statistically significant. RESULTS: A total of 557 study participants (140 cases and 417 controls) were included in a ratio of 1:3. The adjusted odds ratio for having no formal education (AOR = 3.18; 95% CI: 1.59, 6.34), previous history of hypertension (AOR= 2.84; 95% CI: 1.73, 4.66), physical inactivity (AOR= 2.23; 95% CI: 1.32, 3.76), inadequate intake of fruit and vegetable consumption (AOR= 2.43; 95% CI; 1.40, 4,22), palm oil use for food preparation (AOR= 2.12; 95% CI: 1.23, 3.63) and obesity (AOR= 5.68; 95% CI: 2.63, 12.23) increased the occurrence of the disease. CONCLUSION: Although ischemic heart disease is preventable, using relatively simple and inexpensive lifestyle changes, it is projected to cause preventable loss of life. So, expanding health education and healthy life styles including exercise is recommended.
Predictive Factors for Target Organ Injuries in Hypertensive Individuals.
Paz Landim M, Cosenso-Martin LN, Polegati Santos A … +5 more , Roma Uyemura JR, Barufi Fernandes L, da Silva Lopes V, Yugar-Toledo JC, Vilela-Martin JF
Integr Blood Press Control · 2021 · PMID 34429649 · Full text
BACKGROUND: The causal relationship between systemic arterial hypertension and target organ damage (TOD) is well known, as well as the association with cardiovascular risk factors (CV). Ambulatory blood pressure monitori...
BACKGROUND: The causal relationship between systemic arterial hypertension and target organ damage (TOD) is well known, as well as the association with cardiovascular risk factors (CV). Ambulatory blood pressure monitoring (ABPM) is important in monitoring hypertension and assessing the risk of TOD. OBJECTIVE: To evaluate the relationship between blood pressure (BP) and clinical and biochemical parameters in the development of TOD in hypertensive patients. METHODS: This was a retrospective cohort study with 162 hypertensive patients followed for an average period of 13 years. The TOD investigated were left ventricular hypertrophy (LVH), microalbuminuria, coronary artery disease (CAD) and stroke. Blood pressure was assessed by ABPM and LVH using echocardiogram and electrocardiogram, respectively. Biochemical-metabolic tests and 24-hour microalbuminuria were performed at baseline and follow-up. The P-value <0.05 was considered significant. RESULTS: The average age was 69±11.8 years, with a predominance of women (64.8%), white ethnicity (79.6%) and diabetics (78.4%). ABPM showed a significant reduction in BP values during follow-up, although without association with TOD (microalbuminuria, stroke, and CAD), except for LVH that showed a correlation with sleep BP ≥120/70 mmHg (P=0.044). The most frequent TODs were LVH (29.6%), microalbuminuria (26.5%), CAD (19.8%) and stroke (17.3%). In the follow-up, there was an association between LVH and diabetes; microalbuminuria was associated with diabetes and triglycerides; stroke was associated with HDL-cholesterol (HDL-c), microalbuminuria and carotid disease. CAD showed a relationship with age and HDL-c. CONCLUSION: Predictive factors for TOD are age, microalbuminuria, diabetes, HDL-c, triglycerides and carotid disease. Nocturnal BP is correlated with LVH. The absence of a relationship between ABPM and other TODs can be explained by the use of effective drugs, improvement of metabolic and blood pressure parameters.
Evaluation of Anthropometric Indices for Screening Hypertension Among Employees of Mizan Tepi University, Southwestern Ethiopia.
Dereje R, Hassen K, Gizaw G
Integr Blood Press Control · 2021 · PMID 34295187 · Full text
BACKGROUND: Globally, hypertension is becoming a serious problem affecting the health and wellbeing of the adult population. Anthropometric indices like body mass index (BMI), waist circumference (WC), and waist-to-hip r...
BACKGROUND: Globally, hypertension is becoming a serious problem affecting the health and wellbeing of the adult population. Anthropometric indices like body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) have long been utilized to screen hypertension; in contrast, other evidence indicates the superior utility of waist-to-height ratio (WHtR) to screen hypertension. There are inconclusive results from different studies done in different settings regarding the best screening index for hypertension. In addition, there is a paucity of information on the evaluation of anthropometric indices for screening hypertension in the study area. Therefore, this study evaluates the utility of anthropometric indices for screening hypertension among Mizan Tepi University employees, southwestern Ethiopia. METHODS: An institution-based cross-sectional study was conducted among Mizan Tepi University employees. A gender-based stratified simple random sampling technique was used to select 585 employees. Logistic regression analysis was conducted to assess the association between anthropometric indices and hypertension. Receiver operating characteristic curve (ROC) was employed to evaluate anthropometric indices for screening hypertension, and optimal cutoff points were also developed based on Youden index (sensitivity + specificity - 1) and presented with sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV). RESULTS: The overall prevalence of hypertension was 20.9%, which was 22.5% in males and 18.7% in females. Among males, WHtR, WHR, and BMI were significantly associated with hypertension, while, in females, only BMI was associated with hypertension. WHtR had a higher screening ability for hypertension followed by WC in both sexes. For males, the cutoff point for WHR, WC, BMI, and WHtR for screening hypertension was 0.897, 85.17cm, 24.6kg/m, and 0.51, respectively. In females, the cutoff point developed for screening hypertension for WHR, WC, BMI, and WHtR were 0.92, 85.67cm, 24.8kg/m, and 0.52, respectively. CONCLUSION: The waist-to-height ratio was found to be the best obesity index to screen hypertension than BMI, WC, and WHR. The finding supports the use of WHtR for screening hypertension in resource-limited settings.
Clinical and Angiographic Prophesy of Hemodynamic Status in Patients with Acute Anterior Wall ST-Segment-Elevation Myocardial Infarction and Totally Occluded Left Anterior Descending Artery.
Otaal PS, Shah A, Batta A … +2 more , Sood A, Pal A
Integr Blood Press Control · 2021 · PMID 34168494 · Full text
BACKGROUND: Left anterior descending artery (LAD) is the most common occluded vessel in a patient presenting with acute anterior wall ST-segment elevated myocardial infarction (STEMI). Acute occlusion of LAD usually resu...
BACKGROUND: Left anterior descending artery (LAD) is the most common occluded vessel in a patient presenting with acute anterior wall ST-segment elevated myocardial infarction (STEMI). Acute occlusion of LAD usually results in hemodynamic compromise. However, some patients maintain hemodynamic stability despite its proximal occlusion. As the factors associated with hemodynamic status in such patients are poorly understood, our study sought to determine the clinical and angiographic parameters associated with hemodynamic stability in these patients. METHODS: In this prospective observational study, 60 consecutive patients of acute anterior wall STEMI with completely occluded LAD on coronary angiography were included. Various clinical and angiographic parameters associated with hemodynamic status were evaluated. RESULTS: Of the 60 patients, 30 patients each were included in the hemodynamically stable (group I) and hemodynamically unstable group (group II). The mean age of the patients in group I and group II was 51.07±13.78 years and 55.47±11.69 years, respectively. The hemodynamically unstable group had a significantly higher number of patients with diabetes mellitus, elevated Troponin T level, and lower left ventricular ejection fraction as compared to the stable group (p<0.05). In contrast, 11 (36.7%) patients in the hemodynamically stable group had rich collaterals compared to 4 (13.3%) patients in the hemodynamically unstable group. The difference was statistically significant (p=0.037). CONCLUSION: The present study showed that the presence of diabetes, severe LV systolic dysfunction, elevated Troponin-T level, and poor collaterals were associated with hemodynamic instability, whereas the presence of better collaterals predicted hemodynamic stability in patients presenting with anterior wall STEMI and total LAD occlusion.
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