[Show abstract][Hide abstract] ABSTRACT: Immigrants are among the most vulnerable population groups in North America; they face multidimensional hurdles to obtain proper healthcare. Such barriers result in increased risk of developing acute and chronic conditions. Subsequently a great deal of burden is placed on the healthcare system. Community navigator programs are designed to provide culturally sensitive guidance to vulnerable populations in order to overcome barriers to accessing healthcare. Navigators are healthcare workers who support patients to obtain appropriate healthcare. This scoping review systematically searches and summarizes the literature on community navigators to help immigrant and ethnic minority groups in Canada and the United States overcome barriers to healthcare.
We systematically searched electronic databases for primary articles and grey literature. Study selection was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Articles were selected based on four criteria: (1) the study population was comprised of immigrants or ethnic minorities living in Canada or the United States ; (2) study outcomes were related to chronic disease management or primary care access; (3) the study reported effects of community navigator intervention; (4) the study was published in English. Relevant information from the articles was extracted and reported in the review.
Only one study was found in the literature that focused on navigators for immigrants in Canada. In contrast, 29 articles were found that reported navigator intervention programs for immigrant minorities in the United States. In these studies navigators trained and guided members of several ethnic communities for chronic disease prevention and management, to undertake cancer screening as well as accessing primary healthcare. The studies reported substantial improvement in the immigrant and ethnic minority health outcomes in the United States. The single Canadian study also reported positive outcome of navigators among immigrant women.
Navigator interventions have not been fully explored in Canada, where as, there have been many studies in the United States and these demonstrated significant improvements in immigrant health outcomes. With many immigrants arriving in Canada each year, community navigators may provide a solution to reduce the existing healthcare barriers and support better health outcomes for new comers.
Preview · Article · Dec 2016 · International Journal for Equity in Health
[Show abstract][Hide abstract] ABSTRACT: The growing burden of chronic kidney disease (CKD), with its associated morbidity and mortality, is recognized as a major public health problem globally and causing substantial load on health care systems. The current framework for the definition and staging of CKD, based on eGFR levels or presence of kidney damage, is useful for clinical classification of patients, but identifies a huge number of people as having CKD which is too many to target for intervention. The ability to identify a subset of patients, at high risk for adverse outcomes, would be useful to inform clinical management. The current staging system applies static definitions of kidney function that fail to capture the dynamic nature of the kidney disease over time. Now-a-days, it is possible to capture multiple measurements of different laboratory test results for an individual including eGFR values. A new possibility for identifying individuals at higher risk of adverse outcomes is being explored through assessment and consideration of the rate of change in kidney function over time, and this approach will be feasible in the current context of digitalization of health record keeping system. On the basis of the existing evidence, this paper summarizes important findings that support the concept of dynamic changes in kidney function over time, and discusses how the magnitude of these changes affect the future adverse outcomes of kidney disease, particularly the End Stage Renal Disease (ESRD), CVD and mortality.
No preview · Article · Jan 2016 · Clinical and Experimental Nephrology
[Show abstract][Hide abstract] ABSTRACT: As a result of an epidemiological transition from communicable to non-communicable diseases for last few decades, cardiovascular diseases (CVD) are being considered as an important cause of mortality and morbidity in many developing countries including Bangladesh. Performing an extensive literature search, we compiled, summarized, and categorized the existing information about CVD mortality and morbidity among different clusters of Bangladeshi population. The present review reports that the burden of CVD in terms of mortality and morbidity is on the rise in Bangladesh. Despite a few non-communicable disease prevention and control programs currently running in Bangladesh, there is an urgent need for well-coordinated national intervention strategies and public health actions to minimize the CVD burden in Bangladesh. As the main challenge for CVD control in a developing country is unavailability of adequate epidemiological data related to various CVD events, the present review attempted to accumulate such data in the current context of Bangladesh. This may be of interest to all stakeholder groups working for CVD prevention and control across the country and globe.
Full-text · Article · Dec 2015 · Journal of atherosclerosis and thrombosis
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Critical care transition programs have been widely implemented to improve the safety of patient discharge from ICU, but have undergone limited evaluation. We sought to evaluate implementation of a critical care transition program on patient readmission to ICU (72 h) and mortality (14 days).
Interrupted time series analysis of 32,234 consecutive adult patients discharged alive from medical-surgical ICUs in eight hospitals in two cities between January 1, 2002 and January 1, 2012. A multidisciplinary ICU provider team (physician, nurse, respiratory therapist) that serially evaluated each patient after ICU discharge was implemented in three hospitals in one city (study group), but not the five hospitals in the other city (control group). Temporal changes were examined using multivariable, segmented linear regression models.
After implementation of the program, there was an immediate non-significant decrease in the absolute proportion of patients readmitted to ICU in the study group (-0.4 %, 95 % CI -1.7 to +1.0 %) and a non-significant increase in the absolute proportion of patients readmitted to ICU in the control group (+1.0 %, 95 % CI -0.3 to +2.2 %). Subsequently, there were non-significant changes in the absolute proportion of patients readmitted to ICU in both the study (+0.1 % per quarter; 95 % CI, -0.1 to +0.2 %) and control (-0.1 per quarter; 95 % CI, -0.2 to +0.1 %) groups over time. No significant changes were observed in mortality. The results were stable across patient subgroups.
Implementation of a critical care transition program was not associated with patient readmission to ICU or mortality.
No preview · Article · Nov 2015 · Critical care medicine
[Show abstract][Hide abstract] ABSTRACT: Background:
The lifetime risk (LTR) articulates the probability of disease in the residual lifetime for an index age. These estimates can be useful for general audience-targeted knowledge translation activities against hypertension. There are only a few reports on lifetime of impact of hypertension on stroke events in Asians in whom stroke incidence is higher than Westerners.
The Suita Study, a cohort study of cardiovascular diseases in Japan, was established in 1989. We included all participants who were stroke free at baseline. Age (in years) was used as the time scale. Age-specific incidence rates were calculated with person-year method within 10-year bands. We estimated the sex and index-age specific LTR of first-ever stroke with taking the competing risk of death into account.
We followed 5783 men and women during 1989-2007 for 74 933 person-years. During the follow-up period, 276 (149 men and 127 women) participants had incident stroke. Of them, majority were cerebral infarction; 166 (102 men and 64 women). The LTR of stroke, accounted for competing risk of death, at 45 years of age for men without hypertension was 17.21% and it was 32.79% for hypertensive men. Among the hypertensive patients, participants with stage 2 or greater hypertension had higher LTR of stroke than the participants with stage 1 hypertension. This increased LTR of stroke for hypertensive patients were also observed among women and across all index ages for stroke.
In this urban community-based population, we observed that hypertension has significant effect on the residual LTR of stroke among both men and women of middle age, specifically for ischemic stroke.
No preview · Article · Nov 2015 · Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: Objectives:
To assess the effectiveness of interventions by laboratories to increase rational and reduce unnecessary family physician test-ordering.
Design and methods:
MEDLINE [1946-present], EMBASE [1980-present], EBM Reviews [1991-present](Cochrane Database of Systematic Reviews, ACP Journal Club, Database of Abstracts of Reviews of Effects, - Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment, NHS Economic Evaluation Database), PubMed [1966-present], PubMed Central [1900-present], Scopus [1960-present], Web of Science [1900-present] and CINAHL [1982-present] were searched with no language or publication limits. Non-randomised studies were assessed with the Ottawa-Newcastle scale.
The search identified 9282 titles and abstracts, 238 were read in full-text and 3 cohort and 7 before- and after-studies were included. Most focused on changing a few tests and evaluated the interventions over several months. Seven changed laboratory forms (the two largest involved 5.2 million and 3.2 million tests), one negotiated a test ordering protocol with family physicians, and two required laboratory approval. They achieved an average 35% reduction in the 19 targeted tests, with a wide range (0%-100% reduction).
Ten studies were identified which tested interventions by laboratories to reduce test ordering by family physicians, and achieved an average 35% reduction in the 19 targeted tests. The rationale for choosing specific tests for intervention was often not explained, most studies targeted a few tests for several months, the tests and test volumes differed widely across studies, no author improved the results of previous interventions or asked participants their opinions about the intervention or assessed factors impeding change.
No preview · Article · Oct 2015 · Clinical biochemistry
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Mitigation of unnecessary and redundant laboratory testing is an important quality assurance priority for laboratories and represents an opportunity for cost savings in the health care system. Family physicians represent the largest utilizers of laboratory testing by a large margin. Engagement of family physicians is therefore key to any laboratory utilization management initiatives. Despite this, family physicians have been largely excluded from the planning and implementation of such initiatives. Our purposes were to (1) assess the importance of lab management issues to family physicians, and (2) attempt to define the types of initiatives most acceptable to family physicians.
Design and methods:
We invited all Alberta family practice residents and practicing physicians to participate in a self-administered online electronic survey. Survey questions addressed the perceived importance of lab misutilization, prevalence of various types of misutilization, acceptability of specific approaches to quality control, and responsibility of various parties to address this issue.
Of 162 respondents, 95% family physicians considered lab misutilization to be either important or very important. Many physicians placed the responsibility for addressing lab misutilization issues on multiple parties, including patients, but most commonly the ordering physician (98%). Acceptability for common strategies for quality improvement in lab misutilization showed a wide range (35%-98%).
These responses could serve as a framework for laboratories to begin discussions on this important topic with primary care groups.
No preview · Article · Sep 2015 · Clinical biochemistry
[Show abstract][Hide abstract] ABSTRACT: To summarize information obtained from original research about barriers to access of primary healthcare by Canadian immigrants' and to identify research gaps. Electronic databases of primary research articles and grey literature were searched without restricting the time period. The preferred reporting items for systematic reviews and meta-analyses statement was followed for literature selection. Articles were selected based on three criteria: (a) the study population was Canadian legal immigrant(s), (b) the research was about the barriers to accessing primary healthcare in Canada, and (c) the article was written in English. Relevant information from the articles was extracted into tabular format and classified for thematic analysis. Identified barriers were grouped into five themes: cultural, communication, socio-economic status, healthcare system structure and immigrant knowledge. The barriers to accessing primary healthcare in each of these categories can provide insight and subsequent direction for changes needed to improve immigrant care and mitigate their deterioration in health status. The demographic and ethno-cultural distributions of the study populations across the provinces highlight the need to expand research to encompass more varied immigrant groups across more regions of Canada, including more research on male immigrants and immigrant seniors, and to increase research related to health care providers' perspectives on the barriers.
No preview · Article · Sep 2015 · Journal of Immigrant and Minority Health
[Show abstract][Hide abstract] ABSTRACT: To summarize information obtained from original research about barriers to access of primary
healthcare by Canadian immigrants’ and to identify research gaps. Electronic databases of primary research articles and grey literature were searched without restricting the time period. The preferred reporting items for systematic reviews and meta-analyses statement was followed for literature selection. Articles were selected based on three criteria: (a) the study population was Canadian legal immigrant(s), (b) the research was about the barriers to accessing primary healthcare in Canada, and (c) the article was written in English. Relevant information from the articles was extracted into tabular format and classified for thematic analysis. Identified barriers were grouped into five themes: cultural, communication, socio-economic status, healthcare system structure and immigrant knowledge. The barriers to accessing primary healthcare in each
of these categories can provide insight and subsequent direction for changes needed to improve immigrant care and mitigate their deterioration in health status. The demographic and ethno-cultural distributions of the study populations across the provinces highlight the need to expand research to encompass more varied immigrant groups across more regions of Canada, including more research on male immigrants and immigrant seniors, and to increase research related to health care providers’ perspectives on the barriers.
No preview · Article · Sep 2015 · Journal of Immigrant and Minority Health
[Show abstract][Hide abstract] ABSTRACT: Background:
Using a community-based cohort we sought to investigate the association between change in estimated glomerular filtration rate (eGFR) and risk of incident cardiovascular disease including congestive heart failure (CHF), acute myocardial infarction (AMI), and stroke.
We identified 479,126 adults without a history of cardiovascular disease who had at least 3 outpatient eGFR measurements over a 4year period in Alberta, Canada. Change in eGFR was estimated as the absolute annual rate of change (categorized as ≤-5, -4, -3, -2, -1, 0, 1, 2, 3, 4, and ≥5mL/min/1.73m(2)/year). In a sensitivity analysis we also estimated change as the annual percentage change (categorized as ≤-7, -6 to -5, -4 to -3, -2 to -1, 0, 1 to 2, 3 to 4, 5 to 6, and ≥7%/year). The adjusted risk of incident CHF, AMI, and stroke associated with each category of change in eGFR was estimated, using no change in eGFR as the reference, RESULTS: There were 2622 (0.6%) CHF, 3463 (0.7%) AMI, and 2768 (0.6%) stroke events over a median follow-up of 2.5years. Compared to participants with stable eGFR, those with the greatest decline (≤-5mL/min/1.73m(2)/year) had more than a two-fold increased risk of CHF (HR 2.57; 95% CI: 2.28 to 2.89). Risk for AMI and stroke was increased by 31% and 29%, respectively. After adjusting for the last eGFR at the end of the accrual period, the observed association remained significantly higher for CHF but diminished for AMI and stroke. A similar pattern was observed when change in eGFR was quantified as annual percentage change.
In this large community-based cohort, we observed that a declining eGFR was associated with an increased risk of CHF, AMI, and stroke. However, when the risk of CVD events was adjusted for the last eGFR measurement, decline in eGFR per se was no longer associated with increased risk of AMI or stroke, and the association with CHF remained significant but was attenuated. These results demonstrate the importance of monitoring change in eGFR over time to improve cardiovascular risk prognostication.
No preview · Article · Sep 2015 · International Journal of Cardiology
[Show abstract][Hide abstract] ABSTRACT: Obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with chronic kidney disease and up-regulation of the renin-angiotensin system (RAS), which is deleterious to renal function. The extent to which the magnitude of RAS activation is influenced by the severity of nocturnal hypoxemia and co-morbid obesity has not been determined.
To determine the association between the severity of nocturnal hypoxemia and RAS activity and whether this is independent of obesity in patients with OSA.
Effective renal plasma flow (ERPF) response to angiotensin II (AngII) challenge, a marker of renal RAS activity, was measured by para-aminohippurate clear-ance technique in 31 OSA subjects (respiratory disturbance index: 51±25hr-1), stratified accord-ing to nocturnal hypoxemia status (mean nocturnal oxyhemoglobin saturation (SaO2)≥90% (moderate hypoxemia) or <90% (severe hypoxemia)) and 12 obese control subjects.
Compared to controls, OSA subjects demonstrated decreased reno-vascular sen-sitivity (ERPF: -153±79 vs -283±31mL/min, p=0.004; filtration fraction 5.4±3.8 vs 7.1±2.6%, p=0.0025) in response to 60min of AngII challenge (mean±SD); all p-values OSA vs control). The fall in ERPF in response to AngII was less in patients with severe hypoxemia compared to those with moderate hypoxemia (p=0.001) and obese controls after 30min (p<0.001) and 60min (p<0.001) of AngII challenge, reflecting more augmented renal RAS activity. Severity of hypox-emia was not associated with the blood pressure or the systemic circulating RAS component re-sponse to AngII.
The severity of nocturnal hypoxemia influences the magnitude of renal, but not the systemic, RAS activation independently of obesity in patients with OSA.
No preview · Article · Jun 2015 · American Journal of Respiratory and Critical Care Medicine
[Show abstract][Hide abstract] ABSTRACT: We studied Facebook groups related to hypertension to characterize their objectives, subject matter, member sizes, geographical boundaries, level of activity, and user-generated content.
We performed a systematic search among open Facebook groups using the keywords "hypertension," "high blood pressure," "raised blood pressure," and "blood pressure." We extracted relevant data from each group's content and developed a coding and categorizing scheme for the whole data set. Stepwise logistic regression was used to explore factors independently associated with each group's level of activity.
We found 187 hypertension-related Facebook groups containing 8,966 members. The main objective of most (59.9%) Facebook groups was to create hypertension awareness, and 11.2% were created primarily to support patients and caregivers. Among the top-displayed, most recent posts (n = 164), 21.3% were focused on product or service promotion, whereas one-fifth of posts were related to hypertension-awareness information. Each Facebook group's level of activity was independently associated with group size (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 1.01-1.03), presence of "likes" on the most recent wall post (AOR, 3.55, 95% CI, 1.41-8.92), and presence of attached files on the group wall (AOR, 5.01, 95% CI, 1.25-20.1).
The primary objective of most of the hypertension-related Facebook groups observed in this study was awareness creation. Compared with the whole Facebook community, the total number of hypertension-related Facebook groups and their users was small and the groups were less active.
Preview · Article · Jan 2015 · Preventing chronic disease
[Show abstract][Hide abstract] ABSTRACT: Validation of current and promising surrogate outcomes for ESRD in randomized controlled trials (RCTs) has been limited. We conducted a systematic review and meta-analysis of RCTs to further inform the ability of surrogate outcomes for ESRD to predict the efficacy of various interventions on ESRD. MEDLINE, EMBASE, and CENTRAL (from inception through September 2013) were searched. All RCTs in adults with proteinuria, diabetes, or CKD stages 1–4 or renal transplant recipients reporting ≥10 ESRD events and a surrogate outcome (change in proteinuria or doubling of serum creatinine [DSCR]) for ESRD during a ≥1-year follow-up were included. Two reviewers abstracted trial characteristics and outcome data independently. To assess the correlation between the surrogate outcomes and ESRD, we determined the treatment effect ratio (TER), defined as the ratio of the treatment effects on ESRD and the effects on the change in surrogate outcomes. TERs close to 1 indicate greater agreement between ESRD and the surrogate, and these ratios were pooled across interventions. We identified 27 trials (97,458 participants; 4187 participants with ESRD). Seven trials reported the effects on change in proteinuria and showed consistent effects for proteinuria and ESRD (TER, 0.82; 95% confidence interval, 0.59 to 1.16), with minimal heterogeneity. Twenty trials reported on DSCR. Treatment effects on DSCR were consistent with the effects on ESRD (TER, 0.98; 95% confidence interval, 0.85 to 1.14), with moderate heterogeneity. In conclusion, DSCR is generally a good surrogate for ESRD, whereas data on proteinuria were limited. Further assessment of the surrogacy of proteinuria using prospective RCTs is warranted.
No preview · Article · Jan 2015 · Journal of the American Society of Nephrology
[Show abstract][Hide abstract] ABSTRACT: IntroductionTo derive literature-based summary estimates of readmission to ICU and hospital mortality for patients discharged alive from ICU.Methods
We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials from inception to March 2013, as well as reference lists of included studies. We selected cohort studies of ICU discharge prognostic factors that reported readmission to ICU or hospital mortality among patients discharged alive from ICU. Two reviewers independently abstracted the number of patients readmitted to ICU and hospital deaths among patients discharged alive from ICU. Fixed effect and random effects models were used to estimate the pooled cumulative incidence of ICU readmission and the pooled cumulative incidence of hospital mortality.ResultsThe analysis included 58 studies (n¿=¿2,075,610 patients). The majority of studies followed patients until hospital discharge (n¿=¿46) and reported readmission to ICU (n¿=¿44) or hospital mortality (n¿=¿45). The cumulative incidence of ICU readmission was 4.0 readmissions (95% confidence interval (CI), 4.0 to 4.1) per 100 patient discharges using fixed effect pooling and 6.3 readmissions (95% CI, 5.5 to 7.2) per 100 patient discharges using random effects pooling. The cumulative incidence of hospital mortality was 3.3 deaths (95% CI, 3.3 to 3.4) per 100 patient discharges using fixed effect pooling, and 7.4 deaths (95% CI, 6.6 to 8.2) per 100 patient discharges using random effects pooling. There was significant heterogeneity for the pooled estimates that was partially explained by patient, institution and study methodology characteristics.Conclusions
Using current literature estimates, for every 100 patients discharged alive from ICU, on average between 4 and 6 patients will be readmitted to ICU and between 3 and 7 patients will die prior to hospital discharge. These estimates can inform the selection of benchmarks for quality metrics of transitions of patient care between the ICU and hospital ward.
Full-text · Article · Dec 2014 · Critical care (London, England)
[Show abstract][Hide abstract] ABSTRACT: Lower estimated glomerular filtration rate is associated with reduced life expectancy. Whether this association is modified by the presence or absence of albuminuria, another cardinal finding of chronic kidney disease, is unknown.
Our objective was to estimate the life expectancy of middle-aged men and women with varying levels of eGFR and concomitant albuminuria.
A retrospective cohort study.
A large population-based cohort identified from the provincial laboratory registry in Alberta, Canada.
Adults aged ≥30 years who had outpatient measures of serum creatinine and albuminuria between May 1, 2002 and March 31, 2008.
Predictor: Baseline levels of kidney function identified from serum creatinine and albuminuria measurements. Outcomes: all cause mortality during the follow-up.
Patients were categorized based on their estimated glomerular filtration rate (eGFR) (≥60, 45–59, 30–44, and 15–29 mL/min/1 · 73 m2) as well as albuminuria (normal, mild, and heavy) measured by albumin-to-creatinine ratio or urine dipstick. The abridged life table method was applied to calculate the life expectancies of men and women from age 40 to 80 years across combined eGFR and albuminuria categories. We also categorized participants by severity of kidney disease (low risk, moderately increased risk, high risk, and very high risk) using the combination of eGFR and albuminuria levels.
Among men aged 50 years and with eGFR ≥60 mL/min/1.73 m2, estimated life expectancy was 24.8 (95% CI: 24.6-25.0), 17.5 (95% CI: 17.1-17.9), and 13.5 (95% CI: 12.6-14.3) years for participants with normal, mild and heavy albuminuria respectively. Life expectancy for men with mild and heavy albuminuria was 7.3 (95% CI: 6.9-7.8) and 11.3 (95% CI: 10.5-12.2) years shorter than men with normal proteinuria, respectively. A reduction in life expectancy was associated with an increasing severity of kidney disease; 24.8 years for low risk (95% CI: 24.6-25.0), 19.1 years for moderately increased risk (95% CI: 18.7-19.5), 14.2 years for high risk (95% CI: 13.5-15.0), and 9.6 years for very high risk (95% CI: 8.4-10.8). Among women of similar age and kidney function, estimated life expectancy was 28.9 (95% CI: 28.7-29.1), 19.8 (95% CI: 19.2-20.3), and 14.8 (95% CI: 13.5-16.0) years for participants with normal, mild and heavy albuminuria respectively. Life expectancy for women with mild and heavy albuminuria was 9.1 (95% CI: 8.5-9.7) and 14.2 (95% CI: 12.9-15.4) years shorter than the women with normal proteinuria, respectively. For women also a graded reduction in life expectancy was observed across the increasing severity of kidney disease; 28.9 years for low risk (95% CI: 28.7-29.1), 22.5 years for moderately increased risk (95% CI: 22.0-22.9), 16.5 years for high risk (95% CI: 15.4-17.5), and 9.2 years for very high risk (95% CI: 7.8-10.7).
Possible misclassification of long-term kidney function categories cannot be eliminated. Possibility of confounding due to concomitant comorbidities cannot be ruled out.
The presence and degree of albuminuria was associated with lower estimated life expectancy for both gender and was especially notable in those with eGFR ≥30 mL/min/1.73 m2. Life expectancy associated with a given level of eGFR differs substantially based on the presence and severity of albuminuria.
[Show abstract][Hide abstract] ABSTRACT: Uric acid is associated with hypertension and increased renin–angiotensin system activity, although this relationship diminishes after chronic exposure to high levels. Uric acid is more strongly associated with poor outcomes in women compared to men, although whether this is due to a sex-specific uric acid-mediated pathophysiology or reflects sex differences in baseline uric acid levels remains unknown. We examined the association between uric acid and vascular measures at baseline and in response to angiotensin-II challenge in young healthy humans. Fifty-two subjects (17 men, 35 premenopausal women) were studied in high-salt balance. Serum uric acid levels were significantly higher in men compared to women (328 ± 14 μmol/L vs. 248 ± 10 μmol/L, P < 0.001), although all values were within normal sex-specific range. Men demonstrated no association between uric acid and blood pressure, either at baseline or in response to angiotensin-II. In stark contrast, a significant association was observed between uric acid and blood pressure at baseline (systolic blood pressure, P = 0.005; diastolic blood pressure, P = 0.02) and in response to angiotensin-II (systolic blood pressure, P = 0.035; diastolic blood pressure, P = 0.056) in women. However, this sex difference lost significance after adjustment for baseline uric acid. When all subjects were stratified according to high (>300 μmol/L) or low (≤300 μmol/L) uric acid levels, only the low uric acid group showed a positive association between uric acid and measures of vascular tone at baseline and in response to angiotensin-II. Differences in uric acid-mediated outcomes between men and women likely reflect differences in exposure to increased uric acid levels, rather than a sex-specific uric acid-mediated pathophysiology.