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Lifestyle modifications to manage hypertension * † 

Lifestyle modifications to manage hypertension * † 

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The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this rep...

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Limited data are available about the incidence of hypertension over the 5-yr in non-hypertensive subjects. The study subjects were 1,806 subjects enrolled in a rural area of Daegu, Korea for a cohort study from August to November 2003. Of them, 1,287 (71.3%) individuals had another examination 5 yr later. To estimate the incidence of hypertension,...

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... In most cases, two treatment regimesare applied. The first involves the combination of an angiotensin-converting enzyme (ACE) inhibitor and a thiazide diuretic, recognized in Western practice [7,8]. The principal positive effect of this combination is obtained by reducing the synthesis of angiotensin 2. According to some studies, the maximum effect of this combination was observed in patients with a high activity of the renin-angiotensin-aldosterone system [9]. ...
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Objective: With the gradual aging of the world’s population, selecting an effective treatment regime for arterial hypertension (AH) becomes increasingly important. This article aims to analyze the pharmacokinetic and pharmacodynamic properties of parent enalapril and generic drugs in elderly patients suffering from AH. Materials and methods: The study is randomized, implying random distribution of patients into study groups. The study was conducted in 2018 among 200 patients diagnosed with AH. All elderly patients (mean age 77.5 ± 1.5 years) were divided into two equal groups. Group 1 was prescribed 10 mg of original enalapril orally, and Group 2 similarly took 10 mg of generic enalapril. The blood pressure of all patients was measured 1, 2, 4, 6, 8, and 11 hours after dosing and one day after treatment. Also, blood samples were taken after blood pressure measurements. Results and Discussion: After 1 hour, differences between Groups 1 and 2 (p ≤ 0.001) were found at the level of 29.84 ng/1 ml for the original drug and 19.01 ng/1 ml for the generic. Further, these values were 38.2 ng/1 ml vs. 28.7 ng/1 ml (p ≤ 0.001) after 2 hours, 36.6 ng/1 ml vs. 26.5 ng/1 ml (p ≤ 0.001) after 4 hours, and 9.2 ng/1 ml vs 5.1 ng/1 ml (p ≤ 0.001) after 24 hours, respectively. The maximum concentration-time curve values for both medications corresponded to the period of 2 hours after administration. Conclusion:Thus, generics are much less effective as an antihypotensive medication than the original enalapril. Keywords: Antihypotensive effect, enalapril original, generic drug, hypertension, senile age. (En prensa)
... Diabetes was defined as a FBG level ≥ 7.0 mmol/L, or current use of hypoglycemic medication, or self-reported physician-diagnosed diabetes [24]. Hypertension was defined as systolic BP (SBP)/diastolic BP (DBP) ≥ 140/90 mmHg, or use of antihypertensive medication, or selfreported physician-diagnosed hypertension [25]. ...
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Background Although obesity has been associated with risk of atrial fibrillation (AF), the associations of variability of obesity measures with AF risk are uncertain, and longitudinal studies among Chinese population are still lacking. We aimed to evaluate the impacts of obesity and variability of body mass index (BMI) and waist circumference (WC) on the risk of atrial fibrillation (AF) in a large Chinese cohort study. Methods A total of 44,135 participants of the Kailuan Study who were free of cancer and cardiovascular disease and underwent three consecutive surveys from 2006 to 2010 were followed for incident AF until 2020. Average BMI and WC over time and variability were calculated. Cox proportional hazards regression models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of obesity and variability in BMI and WC with AF risk. Results During a mean follow-up of 9.68 years, there were 410 cases of incident AF. In multivariable-adjusted models, compared with normal BMI/WC, individuals with general obesity and abdominal obesity had increased risk of AF, with corresponding HRs of 1.73 (95% CI: 1.31–2.30) and 1.38 (95% CI: 1.11–1.60), respectively. The short-term elevation in AF risk persisted for the obese even after adjustment for updated biologic intermediaries and weight. Variability in BMI and WC were not associated with the risk of AF. The restricted cubic spline models indicated significant linear relationships between levels of WC and BMI and risk of AF. Conclusions Elevated levels of BMI and WC were associated with an increased risk of AF, whereas variability in BMI and WC were not. Therefore, achieving optimal levels of BMI and WC could be valuable in AF prevention.
... A hypertensive crisis (HC) is one of the major acute complications of hypertension, resulting in an emergency admission to the hospital. It is estimated that 1 to 2% of hypertensive patients will develop a hypertensive crisis as a complication of untreated or poorly controlled hypertension [7]. Gender differences in the incidence and severity of hypertension are well established whereby males have a higher incidence of hypertension compared to females of the same age until the sixth decade of life [8,9]. ...
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Background. Several recent studies have shown di erences in the risk pro le and outcome of cardiovascular diseases between men and women, with a dearth of data from African populations. is study aimed to examine gender di erences in a group of patients from Cameroon hospitalized with a hypertensive crisis. Methods. We conducted a cross-sectional study from June 2018 until June 2019. e criteria to de ne a hypertensive crisis (HC) were systolic and/or diastolic blood pressure should be ≥180/110 mmHg. We compared the clinical presentation and outcome of males versus females. Results. Out of the 1536 patients admitted, 95 (6.2%) had an HC. ere were 49 (51.6%) men. ere was no signi cant age di erence between men and women (52.7 years vs. 49.3 years, p 0.28). Alcohol consumption (p < 0.0001), previous stroke (p 0.04), and smoking (p 0.03) were signi cantly higher in men compared to women. Men had a higher proportion of psychomotor agitation (p 0.05). ere was an equal proportion of men and women with hypertensive emergencies. Although acute left ventricular failure was most frequent in women (46.4% vs 42.9%), cerebral infarction (14.3% vs 17.9%), and acute coronary syndrome (0% vs 7.1%) were higher in men, the di erences were not statistically signi cant (all p > 0.05). Case fatality was also higher in men compared to women but the di erence was not statistically signi cant. Conclusions. Men admitted for an HC had a signi cantly higher cardiovascular risk burden and higher psychomotor agitation. However, there were no signi cant di erences in the types of hypertensive emergencies and outcomes between men and women.
... One of the conditions that can progress to hypertension and is associated with cardiovascular risk is prehypertension [3]. According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), this condition is defined as systolic blood pressure (SBP) of 120 to 139 mmHg and/or diastolic blood pressure (DBP) of 80 to 89 mmHg [4]. Following diagnosis, preventive measures such as a healthy diet, weight loss, lower sodium intake, lower alcohol consumption, and physical activity have shown to be effective in delaying and preventing the development of prehypertension [5]. ...
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Prehypertension is a clinical condition that increases the risk of hypertension and cardiovascular disease. In South American countries, prehypertension affects almost one-third of the population. The aim of the present study was to determine the association between prehypertension and the main cardiometabolic risk factors according to the US National Cholesterol Education Program Adult Treatment Panel III by sex in the Peruvian population. A total of 863 participants surveyed were included in the study. A total of 21.1% had prehypertension, 14.4% of whom were female, and 30.5% were male. Women belonging to the age group 50–59 years, having abdominal obesity and being a current smoker, were more likely to have prehypertension, while the likelihood of having prehypertension increased in men with abdominal obesity. Three out of 10 men and one out of 10 women in Peru have prehypertension. In women, being 50 to 59 years of age, having abdominal obesity, and being a current smoker, increased the probability of having prehypertension, whereas, in men, only abdominal obesity was found to be associated with prehypertension. Our findings will allow the development of prevention strategies focused on the appropriate diagnosis of prehypertension and cardiometabolic risk factors according to sex.
... There are variations between guidelines, and, whenever possible, researchers should include clinical parameters associated with hypertension, such as risk factors, target-organ damage, and imaging markers. HTN is traditionally defined as serial measurements of SBP greater than 140 mmHg or DBP equal to or greater than 90 mmHg [32]. However, studies demonstrate target-organ involvement with values above 115/75 mmHg, usually considered "low" [33]. ...
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Purpose of Review To provide an overview of the literature regarding the use of machine learning algorithms to predict hypertension. A systematic review was performed to select recent articles on the subject. Recent Findings The screening of the articles was conducted using a machine learning algorithm (ASReview). A total of 21 articles published between January 2018 and May 2021 were identified and compared according to variable selection, train-test split, data balancing, outcome definition, final algorithm, and performance metrics. Overall, the articles achieved an area under the ROC curve (AUROC) between 0.766 and 1.00. The algorithms most frequently identified as having the best performance were support vector machines (SVM), extreme gradient boosting (XGBoost), and random forest. Summary Machine learning algorithms are a promising tool to improve preventive clinical decisions and targeted public health policies for hypertension. However, technical factors such as outcome definition, availability of the final code, predictive performance, explainability, and data leakage need to be consistently and critically evaluated.
... The participant was seated in a chair and allowed to rest for 5 min before three measurements were performed at 3-min intervals. We used the average of the second and third measurements to determine the blood pressure of each participant [15]. ...
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Background Left ventricular diastolic dysfunction (LVDD) is a recognized complication of diabetes mellitus that precedes and is a risk factor for heart failure. We aimed to determine the prevalence of LVDD and its association with body mass index in ambulatory adults with diabetes mellitus in rural Uganda. Methods We conducted a cross-sectional study, over 5 months, to enroll 195 ambulatory Ugandan adults living with diabetes mellitus for at least five years at Mbarara Regional Referral Hospital. We collected demographic, and clinical data and measured body mass index (BMI). Echocardiography was performed to determine LVDD by assessing the mitral inflow ventricular filling velocities (E/A and E/è ratios), tricuspid regurgitant jet peak velocity, and left atrium maximum volume index. We used logistic regression to estimate the odds ratio for the association of LVDD with BMI and evaluated the variation of associations by age and hypertension status. Results Of the 195 participants, 141 (72.31%) were female, the mean age was 62 [standard deviation, 11.50] years, and the median duration of diabetes diagnosis was 10 [interquartile range, 7, 15] years. Eighty-six percent (n = 168) had LVDD with the majority (n = 127, 65.1%) of participants in the grade 1 category of LVDD. In the adjusted model, the odds of LVDD for each 1 kg/m² increase in BMI was 1.11 [95% confidence interval 1.00, 1.25, p = 0.04]. The adjusted odds of LVDD among individuals aged ≥ 50 years with BMI ≥ 25 kg/m² was 13.82 times the odds of LVDD in individuals aged < 50 years with BMI < 25 kg/m². Conclusion LVDD is prevalent and positively associated with BMI among ambulatory Ugandan adults living with diabetes mellitus for at least five years. The association was higher for older overweight/obese than younger individuals with normal weight. Future studies should focus on the effect of weight loss on LVDD as a possible target for the prevention of heart failure.
... [16] Systolic BP ≥140 mmHg, and/or diastolic BP ≥90 mmHg, or use of antihypertensive drug treatment defined hypertension. [17] Ten mL of peripheral venous blood was collected from each individual between 8 am and 10 am after overnight fast of 8 to 12 H. Two millilitres of the sample was put in an ethylenediaminetetraacetic acid bottle for haemoglobin estimation and the remaining 8 mL was placed in a plain tube for phosphate, calcium, albumin, creatinine and lipid estimation. ...
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INTRODUCTION Chronic kidney disease (CKD) is a major cause of cardiovascular (CV) morbidity and mortality worldwide which accounts for significant proportions of death in Nigeria and most parts of Africa. [1,2] Haemodialysis is indicated for the treatment of acute kidney injury, acute Background: Maintenance haemodialysis (MHD) is the major form of renal replacement therapy in Nigeria, and may have a significant impact on cardiovascular (CV) and metabolic burden in chronic kidney disease (CKD) patients. Methods: This is a prospective cohort study involving 40 CKD dialysis-naïve end-stage renal disease patients who were assessed at first contact before commencing dialysis and assessments repeated 3 months later while on MHD. Clinical, echocardiographic and biochemical indices were assessed on both occasions. We studied the impact of MHD on CV risk factors such as left ventricular hypertrophy, left ventricular ejection fraction (LVEF), high calcium-phosphate product, hypoalbuminaemia, anaemia and dyslipidaemia. Results: The mean serum calcium-phosphate product, plasma total cholesterol, triglycerides and low-density lipoprotein cholesterol were significantly higher at baseline than at three months; while the mean haemoglobin, serum albumin and plasma high-density lipoprotein were significantly lower at baseline than at 3 months (P < 0.01). There was a significant difference in echocardiographic indices at baseline and at 3 months in CKD patients on MHD. Left ventricular mass and left ventricular mass index were significantly higher at baseline than at 3 months (P < 0.01); while LVEF was significantly lower at baseline than at 3 months (P < 0.01). Conclusion: Our study showed statistically significant improvements in CV risk factors among CKD patients after 3 months on maintenance haemodialysis. Early and effective maintenance haemodialysis reduce CV risk factors in Nigerian CKD patients.
... 22 Hypertension was assessed 'based on measured blood pressure (BP) (mean of the last two of three readings) defined as systolic BP≥140 mm Hg and/or diastolic BP≥90 mm Hg or currently on antihypertensive medication'. 29 Heart disease or stroke was assessed with the question, 'Have you ever had a heart attack or chest pain from heart disease (angina) or a stroke (cerebrovascular accident or incident)? (Yes/No)'. ...
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Objective The study aimed to evaluate trends in the prevalence and correlates of sedentary behaviour (SB) in people aged 15–64 years from 2009 to 2019 in Mongolia. Design Repeat population-based cross-sectional study. Setting Nationally representative sample of persons living in the general community aged 15–64 years in Mongolia. Participants The sample included 17 780 people (15–64 years) who participated in Mongolia STEPS surveys 2009, 2013 or 2019. Primary and secondary outcome measures: self-reported SB, along with physical measurements, health status and health behaviour, and sociodemographic covariates. Multinomial logistic regression calculated OR with 95% CI for moderate and high SB, with low SB as reference category. Results Across study years, the proportion of low (<4 hours) SB was 62.3%, moderate (4–<8 hours) SB was 26.4% and high (≥8 hours) SB was 11.3%. Compared to the survey year 2009, in the survey years 2013 and 2019, high SB increased significantly, while moderate SB increased in the survey year 2013 but not in 2019. Urban residence was positively associated with moderate and high SB. Male sex and higher education were positively associated with moderate SB. Current tobacco use, current heavy alcohol use, and obesity class II were positively and high physical activity was negatively associated with moderate and/or high SB. Belonging to the Khalkha ethnic group and hypertension increased the odds of moderate or high SB in 2019 and 2013, respectively. Age, higher number of adults household members and inadequate fruit and vegetable intake were not associated with moderate or high SB. Conclusion More than 1 in 10 people aged 15 years and older engaged in high SB. Several sociodemographic and health variables associated with moderate and/or high SB were identified that can help guide public interventions.
... (2) In the case of alcohol consumption, the category is a present drinker or not; the number of drinks (cups or beers) and frequency is another registration. (46)(47)(48)(49)(50)(51)(52)(53)(54)(55), minor anxiety (36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and lowlevel anxiety (<35) (50,51). ...
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The fast, exponential increase of COVID-19 infections and their catastrophic effects on patients' health have required the development of tools that support health systems in the quick and efficient diagnosis and prognosis of this disease. In this context, the present study aims to identify the potential factors associated with COVID-19 infections, applying machine learning techniques, particularly random forest, chi-squared, xgboost, and rpart for feature selection; ROSE and SMOTE were used as resampling methods due to the existence of class imbalance. Similarly, machine and deep learning algorithms such as support vector machines, C4.5, random forest, rpart, and deep neural networks were explored during the train/test phase to select the best prediction model. The dataset used in this study contains clinical data, anthropometric measurements, and other health parameters related to smoking habits, alcohol consumption, quality of sleep, physical activity, and health status during confinement due to the pandemic associated with COVID-19. The results showed that the XGBoost model got the best features associated with COVID-19 infection, and random forest approximated the best predictive model with a balanced accuracy of 90.41% using SMOTE as a resampling technique. The model with the best performance provides a tool to help prevent contracting SARS-CoV-2 since the variables with the highest risk factor are detected, and some of them are, to a certain extent controllable.
... In contrast, drug and alcohol abuse can cause sleep-disordered breathing that will disappear if the individual abstained prior to a polysomnogram [7], potentially leading to misdiagnosis. This interdependence with substance abuse is especially concerning because OSA is a secondary cause of hypertension, with an attributed prevalence of up to 82% [8,9]. Despite the high prevalence of OSA and hypertension comorbidities, OSA remains largely underdiagnosed and undertreated [10][11][12][13]. ...
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Purpose Obstructive sleep apnea (OSA) is the most common pathologic sleep disorder with an estimated prevalence in the USA of up to 25% of adult males. With military aviation being heavily comprised of adult men, the impact of OSA on flying operations is concerning as OSA is disqualifying for all flying classes in the US Air Force. In order to minimize the impact of OSA on operations, early identification of at-risk patients is critical in disease management. Individuals could be identified for whom regular polysomnography testing may reveal OSA while mild or sub-clinical, at which point treatment may be initiated in order to promote continued medical qualification for duty and career retention. Methods We performed a keyword search of PubMed, EMBASE, and Google Scholar along with searches in the NHGRI/EBI GWAS Catalogue and the Atlas of GWAS Summary Statistics. We included primary research from candidate gene, GWAS, and meta-analyses. We also included other review articles in our search to confirm interpretations and implications of any genetic associations with OSA. Only studies related to OSA susceptibility or risk were included. Results We identified 134 publications reporting or reviewing genetic associations with OSA risk. These papers reported 301 variants, of which 195 were unique and 33 were replicated in at least two papers. With respect to the strength of association, 43 variants exhibited odds ratios greater than 2. Finally, there were 84 null results reported, 51 of which were in conflict with reported associations. Conclusion There is ample evidence in the literature to confirm that genetics provide an important contribution to OSA development. The high number of strongly associated variants suggests that a polygenic risk model could be created with high predictive value for prognostic screening.