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The following is a brief statement of the 2003 European Society of Hypertension (ESH)-European Society of Cardiology (ESC) guidelines for the management of arterial hypertension. The continuous relationship between the level of blood pressure and cardiovascular risk makes the definition of hypertension arbitrary. Since risk factors cluster in hyper...
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The new international guidelines on hypertension management have been issued in the past few years. The AHA (2017) and ESH (2018) Guidelines are similar in many key aspects. However, they differ substantially in the area of blood pressure (BP) measurement methodology. In this article, we aim to explain the ESC Guidelines position, specifically the...
Citations
... As any degree of AKI is associated with increased risk-adjusted mortality, we decided to include all stages of AKI in this study rather than only choosing severe AKI (stages 2 and 3), as previously reported (2,7,8,18,19). Hypertension and diabetes mellitus were defined according to standard criteria (20,21). The definition of kidney diseases before surgery was kidney function damage or an estimated glomerular filtration rate (eGFR) < 60 ml/ min/1.73 ...
Acute kidney injury (AKI) after liver transplantation (LT) is a common complication, and its development is thought to be multifactorial. We aimed to investigate potential risk factors and build a model to identify high-risk patients. A total of 199 LT patients were enrolled and each patient data was collected from the electronic medical records. Our primary outcome was postoperative AKI as diagnosed and classified by the KDIGO criteria. A least absolute shrinkage and selection operating algorithm and multivariate logistic regression were utilized to select factors and construct the model. Discrimination and calibration were used to estimate the model performance. Decision curve analysis (DCA) was applied to assess the clinical application value. Five variables were identified as independent predictors for post-LT AKI, including whole blood serum lymphocyte count, RBC count, serum sodium, insulin dosage and anhepatic phase urine volume. The nomogram model showed excellent discrimination with an AUC of 0.817 (95% CI: 0.758–0.876) in the training set. The DCA showed that at a threshold probability between 1% and 70%, using this model clinically may add more benefit. In conclusion, we developed an easy-to-use tool to calculate the risk of post-LT AKI. This model may help clinicians identify high-risk patients.
... The study in animals showed a remarkable result as opposed to the difficulties in human applications, so there is hope for gene therapy [29]. Drug optimization along with lifestyle modifications is the way to go for now [30][31][32][33][34][35]. ...
Hypertension is a silent killer; however, the treatment of hypertension is simple, effective, readily available, and needs to be continued lifelong. It is a significant health problem that is included under the umbrella of non-communicable disease conditions and has a strong alliance with cardiovascular morbidity and mortality. The India Hypertension Control Initiative (IHCI) is an extensive program in India that involves the Indian Council of Medical Research, the Ministry of Health and Family Welfare (Government of India), the state governments of India, and World Health Organization Country Office for India (WHO-India). The IHCI is a multi-partner initiative carried forward systemically across various states. The states are categorized into Grade I and Grade II. There is the involvement of specialized teams of cardiovascular experts and health officials to insure precise execution and seamless healthcare service. The implementation of the free and easy-to-use mobile application and software, Simple (Resolve to Save Lives, New York City, United States), in the analysis and storage of data, is a novel step taken to insure safe record keeping and follow-ups. Emphasis is on the adoption of demography-specific interventional methods and drugs, and proper acquisition and storage of these drugs is the key step. Treatment modalities involve the adoption of medicines and lifestyle modifications as a combined recipe. Advancements have been made in the area of drug development like gene therapies but they seem to show low success rates at the given moment. Adoption of lifestyle modifications along with medications is the gold standard treatment option. This review article aims to shed light on the current status of IHCI, its milestones, and the future of the initiative in India.
... Due to the frequent coexistence of OSA and arterial hypertension, it is interesting to note that OSA per se does increase the risk of target organ damage (TOD) in the population of hypertensive OSA patients compared to hypertensive subjects without sleep-disorder breathing. Common, easily detected markers of early damage include left ventricular hypertrophy, as expressed by the left ventricular mass index (LVMI), intima-media thickness (IMT) of the common carotid artery, ankle-brachial index (ABI) or eGFR [5]. ...
... Left ventricular muscle mass was calculated using the formula proposed by the American Society of Echocardiography, modified by Devereaux [7]. The body surface area (BSA) was calculated from the Mosteller formula: BSA [m 2 ] = 0.01666667 × (height in cm) 0.5 × (body weight in kg) 0. 5 Based on the recommendations of the European Society of Cardiology, the European Society of Hypertension and the Polish Society of Hypertension, left ventricular hypertrophy was diagnosed when the LVMI value wa >115 g/m 2 BSA in men and >95 g/m 2 BSA in women [8]. ...
Introduction and objective:
Obstructive sleep apnea (OSA) is associated with cardiovascular risk and higher mortality. Assessment of subclinical organ lesions is significant for prevention of clinically manifested complications which might result in death. The aim of the study was to assess the prevalence of subclinical target organ damage in hypertensive patients with OSA, and to establish whether these lesions are dependent on the intensity of sleep-disordered breathing.
Material and methods:
The study covered 67 patients with OSA diagnosed on the basis of polygraphy. Depending on the apnea/hypopnea index (AHI), the patients were divided into two groups: G1 (n=32; AHI=5-30) and G2 (n=35; AHI>30). The control group C consisted of 31 hypertensive subjects with OSA risk estimated as low based on the Berlin Questionnaire (BQ). Each patient had the following parameters measured: intima-media thickness (IMT), ankle-brachial index (ABI), left ventricular mass index (LVMI), and estimated glomerular filtration rate (eGFR).
Results:
The patients with severe OSA had significantly higher LVMI compared to the control group (130.99±44.6 g/m2 versus 106.61±27.86 g/m2; p=0.0332). The G2 group had higher eGFR than C (104.7±17.96 ml/min/1.73m2, 88.85±17.68 ml/min/1.73m2; p=0.0058). Similar results of eGFR were observed between G1 and C (104.35±21.06 ml/min/1.73m2, 88.85±17.68 ml/min/1.73m2; p=0.0081). G1 and G2 did not differ significantly in terms of eGFR. The other measured parameters, such as IMT and ABI, did not differ significantly between OSA and controls.
Conclusions:
Patients with severe OSA demonstrate signs of left ventricular hypertrophy, while early atherosclerotic lesions (ABI and IMT) were not more intense than in the control group. High eGFR levels may indicate hyperfiltration, which does not correlate with OSA intensity level.
... Environmental determinants related to CVD include occupation related: chronic psychological stress due to activation of the hypothalamic-pituitary-adrenal axis (HPA axis) and sympathetic nervous system, which leads to increased blood pressure [20][21][22]. Acute stress may also trigger acute coronary syndromes in the group of chronic CAD [22] and consequently this stress then may impair rehabilitation and worsen the long-term prognosis [23]. Stress can also contribute to oxidative stress and induce inflammation in walls of blood vessels [24,25]. ...
... We also found an increasing trend in this combination among older adults. The JNC8 guideline and Korean Society of Hypertension recommend combination therapy of ARB or ACE inhibitor + CCB, ARB or ACE inhibitor + diuretics, and CCB + diuretics [1,21]. The Korean Society of Lipid and Atherosclerosis also recommended combination therapy of statin and other lipid-modifying agents in their guideline for the management of dyslipidemia. ...
Background
Fixed-dose combinations can simplify prescribing, and numerous combination products exist for hypertension and dyslipidemia in South Korea. This study’s aim was to compare trends in the consumption of single products versus fixed-dose combinations for hypertension and hyperlipidemia.
Methods and findings
We analyzed the Korean national health insurance claims database from January 2015 through December 2019. Consumption of medicines was calculated using the defined daily dose per 1,000 inhabitants per day (DIDs) and expenditures over time. During 2015–2019, the use of antihypertensive drugs increased with an annual growth rate (AGR) of 0.9% for single products and with an AGR of 35.6% for fixed-dose combinations. A notable increase was observed for antihyperlipidemic combination drugs with an AGR of 268.1% compared to single products with 35.7%. For older adults (65+ years), the consumption of drugs for hypertension and hyperlipidemia was 3–4.5 and about 3 times higher, respectively, than in adults aged 20–64 years, and a sharp increase was found in antihyperlipidemic fixed-dose combinations among older adults. A large increase was seen for C09 (agents acting on the renin-angiotensin system) with an AGR of 36.5%, especially C09DB (angiotensin II receptor blockers + calcium channel blockers) was widely used and steeply increased with 114.2%. For antihyperlipidemic drugs, C10AA (HMG CoA reductase inhibitors) accounted for a large share and sharply increased, with 52.1 DIDs in 2019 and with an AGR of 78.4%, whereas C10BA (combinations of various lipid modifying agents) increased 9.6 times from 2.9 DIDs (96 million USD) in 2015 to 27.7 DIDs (912 million USD) in 2019.
Conclusion
The findings of increased consumption and drug spending among older adults underscores the need for real-world evidence about health outcomes of fixed-dose combinations in this population.
... We have performed a prospective, controlled, randomized, comparative, unicentral clinical trial of patients with an essential AH of Grade II. The verification of AH diagnosis was made according to the ESH/ESC Guidelines for the management of arterial hypertension [17]. Among the exclusion criteria, there are: symptomatic AH, acute coronary or cerebrovascular pathology present at the moment of study, acute inflammatory diseases, chronic heart failure over II NYHA class, hemodynamically relevant cardiac rhythm disorder requiring the constant use of antiarrhythmic medication, glucocorticoid use, sarcoidosis, active pulmonary TB form, bronchial asthma, chronic obstructive lung disease, active inflammatory process of any localization, chronic kidney failure with creatinine clearance of 60 mL/min and below, liver function disorder, diabetes mellitus, oncological diseases, anemia and other concomitant diseases potentially affecting the studied parameters. ...
Background. The purpose of the study was to calculate the cost of lowering blood pressure (BP) in the complex antihypertensive therapy of arterial hypertension (AH) with and without Cholecalciferol. Materials and methods. 154 patients with grade II AH were divided into the AH(+)CH group receiving combined antihypertensive therapy plus Cholecalciferol in a dose of 2000 IU / day and into the comparison group —
AH(–)CH. Office BP and total Vitamin D levels were measured. The costs of medication were calculated. Results. During the follow-up examination, the blood level of Vtamin D increased; in the AH(+)CH group getting higher (p = 0.0000001) than in the AH(–)CH group. The per capita cost of medication in the AH(+)CH group was higher than in the AH(–)CH group ($ 106.8 and $91.5, respectively); however, the cost of SBP reduction by 1 mmHg in the AH(+)CH group was $ 3.9 lower than in the AH(–)CH group. The Cholecalciferol dose of 2000 IU/day for 3 months results in an optimum level of Vitamin D for 83 % cases, irrespective of antihypertensive therapy. The Cholecalciferol dose of 2000 IU/day from 6.5 to 12 months results in an optimum level of Vitamin D for 100 % cases. The greatest dynamics of increase in the level of 25(OH)D achieved in response to taking cholecalciferol occurs when its initial level is
... Laboratory parameters were obtained at the annual health check site during baseline. Hypertension was defined by a systolic/diastolic blood pressure ≥ 140/90 mmHg (Japanese Society of Hypertension) [29], and/or treatment with antihypertensive medications [30]. The presence of diabetes mellitus (DM) was defined as fasting plasma glucose level ≥ 126 mg/dL, hemoglobin A1c level ≥ 6.5% (Japanese Diabetes Society), or treatment with antidiabetic medications. ...
Background
Several studies have surveyed the relationship between the presence of ≥ 20 natural teeth and mortality. However, very few have evaluated this association over a long-term follow-up of more than ten years within a large population in Japan. This study aimed to prospectively confirm the associations between mortality and the presence of ≥ 20 natural teeth within a community-based population in Japan.
Methods
A prospective observational study including 2208 participants aged ≥ 40 years was conducted in Takahata Town, Japan, between May 2005 and December 2016. All participants answered a self-administered questionnaire to provide their background characteristics, including their number of teeth. The participants were classified into two categories based on their self-reported number of teeth (< 20 and ≥ 20 teeth). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional-hazards regression model to assess risk factors for all-cause, cancer-, and cardiovascular disease-related mortality.
Results
The total follow-up period was 131.4 ± 24.1 months (mean ± SD). After adjusting for covariates, the risk of all-cause mortality was significantly higher in the group with < 20 teeth than in those with ≥ 20 teeth (HR = 1.604, 95% CI 1.007–2.555, p = 0.047). However, the risk of cancer- and cardiovascular disease-related mortalities was not statistically significant between the two groups.
Conclusion
In this study, participants with < 20 teeth had a significantly higher risk of all-cause mortality, although the difference was borderline significant. These results emphasize the importance of having ≥ 20 natural teeth for a healthy life expectancy.
... 15,16 Definitions Hypertension was defined as a mean systolic blood pressure (SBP) ≥140 mmHg or a mean diastolic blood pressure (DBP) ≥90 mmHg and/or self-reported use of antihypertensive medication in the past 2 weeks according to the 2010 Chinese guidelines for the management of hypertension. 17 Stage 1 of hypertension was defined as SBP 140-159 mmHg and/or DBP 90-99 mmHg; stage 2 as 160-179 mmHg and/or 100-109 mmHg; and stage 3 as ≥180 mmHg and/or ≥110 mmHg. Prehypertension was defined as SBP ≥120 mmHg and <140 mmHg and/or DBP ≥80 mmHg and <90 mmHg and not being on antihypertensive medication. ...
Background:
To investigate the status of hypertension and related risk factor disparities between urban and rural areas of northeast China.
Methods:
A multi-stage, stratified, and cluster random sampling method was used to conduct the cross-sectional survey in Liaoning Province in 2017-2019. Finally, included 18,796 participants (28.9% urban, 71.1% rural) aged ≥40 years. The prevalence and control rate of hypertension were estimated based on Chinese hypertension guidelines and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines.
Results:
The mean age of the population was 60.4±9.9 years, and 61.0% were women. The overall prevalence of hypertension was 56.8%. Compared to urban areas, hypertension was more prevalent, but the awareness, treatment, and control rates were lower in rural areas (59.2 vs 50.2, 52.5% vs 47.0%, 46.9% vs 34.9%, and 11.4% vs 3.7%, P<0.001, respectively). Multivariate regression analysis identified that the lack of exercise (odds ratio (OR), 1.24; 95% confidence interval (CI), 1.10-1.38) in rural areas, whereas overweight/obesity (OR, 2.01; 95% CI, 1.79-2.27) and alcohol consumption (OR, 1.20; 95% CI, 1.01-1.41) in urban areas were specific risk factors for hypertension, besides common risk factors. Under the 2017 ACC/AHA guidelines, the prevalence of hypertension was 80.6% (urban 76.6%, rural 82.2%), increased 1.4-fold compared with the current Chinese guidelines, with increased rates of 27.9% in urban areas and 25.7% in rural areas.
Conclusion:
A highly diverse prevalence for hypertension was found between urban and rural areas in northeast China. Region-specific strategies targeting the prevention and management of hypertension should be highlighted.
... 1. Arterial hypertension stage I-III according to the recommendations of the European Associations of Hypertension and Cardiology (2013), or stage I according to the recommendations of the New York Association of Cardiology [14]. 2. Obesity: body mass index (BMI) 30-39 3. Dyslipidemia: total cholesterol >5 mmol/L, and/or LDL >3 mmol/L, triglycerides >1.7 mmol/L, and high-density lipoprotein (HDL)<1 mmol/L 4. Metabolic syndromewhen at least three of the following criteria were met: arterial hypertension >130/85 mm/Hg, fasting glucose >5.6 mmol/L, triglycerides >1.7 mmol/L, HDL levels <1.0 mmol/L, and waist circumference >94 cm [15]. 5. Compensated diabetes type II (glycosylated hemoglobin <7%). ...
In this cross-sectional study 1852 men aged 40–70 years attending primary health care were invited to fill out the aging male symptoms (AMS) scale. Out of these, 1222 men were found positive for the AMS and agreed to provide blood samples for the general blood test, lipid profile, glucose levels, and assessment of both total and free testosterone (T) levels. Men were screened for the following morbidities and syndromes: dyslipidemia, arterial hypertension, obesity, type II diabetes, metabolic syndrome, and chronic obstructive pulmonary disease (COPD). Testosterone deficiency was diagnosed if total T ≤ 3.46 ng/mL or free T ≤ 72 pg/mL. Among all 1222 men with positive AMS, decreased blood testosterone levels were detected in 669 men (55%). A total of 402 men were found healthy and 820 men were detected with different morbidities. Out of 669 men with testosterone deficiency, only 2.8% had no co-morbidities and 97.2% were men with co-morbidities. Testosterone levels were found significantly higher among healthy men (median 4.7 ng/mL) as compared to the men with morbidities (median 2.55 ng/mL, p<.001), adjusted for age. Testosterone deficiency was detected in significantly lower proportion of 402 men without co-morbidities as compared to the 820 men with co-morbidities: in 19 men (4.7) and in 650 men (79.3%, p<.05), respectively.
... Hypothetically, essential hypertension is thought to be multifactorial causes such as obesity, diabetes mellitus, aging, emotional stress, sedentary lifestyle also as well as described previously is low consumption of potassium [12]. Other risk factors that are thought to possibly cause hypertension are alcoholism, smoking cigarette, obstructive sleep apnea, dyslipidemia, high uric acid, race and last but not least is family history [13]. ...
