| 1. |
- Błaszkowska, Magdalena, et al.
(författare)
-
Subclinical macroangiopathic target organ damage in type 1 diabetes mellitus patients
- 2020
-
Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 29:6, s. 344-356
-
Forskningsöversikt (refereegranskat)abstract
- Purpose: We have summarized key studies regarding the assessment of subclinical macroangiopathic target organ damage (TOD) in type 1 diabetes mellitus (T1DM). Results: Although chronic complications resulting from hyperglycemia, in particular macroangiopathies, are still the first cause of death in T1DM, there has been growing recognition of the role of hypoglycemia in cardiovascular morbidity and mortality. Subclinical TOD diagnosis ensures early implementation of the complex management aiming at either partial reversal of these complications or at least its downturn. To better identify patients with early TODs, several non-invasive diagnostic techniques are employed, including the ultrasonographic assessment of the intima-media thickness (IMT), computed tomography (CT) for coronary artery calcium (CAC) scores, and pulse wave velocity (PWV) measurement for arterial stiffness evaluation. Various studies reported that T1DM patients present an increased IMT. An increasing IMT fairly correlates with the cardiovascular (CV) events risk even after the adjustment to age, diabetes duration, quality of glucose control as well as the presence of hypertension, and chronic complications. Another, well established marker of the organ damage–CAC score is recommended by ACC/AHA guidelines to assess the overall CV risk in T1DM. Also, the arterial stiffness evaluation with PWV may further improve CV risk prediction, which has been reported in multiple studies including the Framingham Heart Study. Conclusions: There is shortage of data from prospective studies which could confirm the benefits of early treatment initiation based on the presence of the subclinical organ damage in T1DM. Most evidence comes from T2DM trials, where effective preventive measures were identified i.e.: smoking cessation, reasonable blood glucose control, efficacious hypertension treatment, and dyslipidemia management, as well as renoprotection. There is still a field for further research to see if routine assessment of asymptomatic vascular damage and early implementation of aggressive treatment would reduce mortality excess from CVD in T1DM.
|
|
| 2. |
- Brunström, Mattias, et al.
(författare)
-
Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease
- 2022
-
Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 31:1, s. 31-39
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. Materials and Methods Individuals >= 18 years with a blood pressure (BP) recording in Vasterbotten or Sodermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Vasterbotten County (intervention) compared with Sodermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. Results A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. Conclusions This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.
|
|
| 3. |
- Brunström, Mattias, et al.
(författare)
-
Effect of antihypertensive treatment in isolated systolic hypertension (ISH) : systematic review and meta-analysis of randomised controlled trials
- 2023
-
Ingår i: Blood Pressure. - : Taylor & Francis Group. - 0803-7051 .- 1651-1999. ; 32:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Isolated systolic hypertension (ISH) in middle-aged and elderly is associated with high cardiovascular risk, but no randomised controlled trial has assessed the effect of antihypertensive treatment in ISH using today's definition, i.e. systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) <90 mmHg.METHODS: A systematic review and meta-analysis of randomised controlled trials was performed. Studies with ≥1000 patient-years of follow-up, comparing more intensive versus less intensive BP targets, or active drug versus placebo, were included if the mean baseline SBP was ≥140 mmHg and the mean baseline DBP was <90 mmHg. The primary outcome was major adverse cardiovascular events (MACE). Relative risks from each trial were pooled in random-effects meta-analyses, stratified by baseline and attained SBP level.RESULTS: Twenty-four trials, including 113,105 participants (mean age 67 years; mean blood pressure 149/83 mmHg) were included in the analysis. Overall, treatment reduced the risk of MACE by 9% (relative risk 0.91, 95% confidence interval 0.88-0.93). Treatment was more effective if baseline SBP was ≥160 mmHg (RR 0.77, 95% CIs 0.70-0.86) compared to 140-159 mmHg (RR 0.92, 95% CIs 0.89-0.95; p = 0.002 for interaction), but provided equal additional benefit across all attained SBP levels (RR 0.80, 95% CIs 0.70-0.92 for <130 mmHg, RR 0.92, 95% CIs 0.89-0.96 for 130-139 mmHg, and RR 0.87, 95% CIs 0.82-0.93 for ≥140 mmHg; p = 0.070 for interaction).CONCLUSIONS: These findings support antihypertensive treatment of isolated systolic hypertension, regardless of baseline SBP, to target SBP <140 mmHg and even <130 mmHg if well tolerated.
|
|
| 4. |
- Hasan, M. J., et al.
(författare)
-
Health-care-seeking behaviour in patients with hypertension : experience from a dedicated hypertension centre in Bangladesh
- 2024
-
Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 33:1
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The study aimed to assess health-seeking behaviour (HSB) and associated factors among hypertensive patients in Bangladesh.Methods: This cross-sectional study was conducted in the Hypertension & Research Centre, Rangpur, Bangladesh, between January 2022 and June 2022. A total of 497 hypertensive adults were recruited consecutively. A pre-tested structured questionnaire was deployed by the research team for data collection. Multivariable logistic regression analysis was used to explore the predictors of HSB.Results: The mean age of the hypertensive patients was 52 ± 11 (SD) years. Most of them were aged between 51 and 60 years (33%), female (55%), came from rural areas (57%), and belonged to middle socioeconomic class (68%). One-fourth of the patients (27%) had chosen informal healthcare providers for their first consultation. Fear of stroke (244, 45%), headache (170, 36%), and neck pain (81, 17%) were the three most common compelling causes of their visit to the hypertension centre. Age (aOR 0.78, 95% CI 0.68 − 0.89), male sex (aOR: 1.79, 95% CI 1.05 − 3.10), living in semi-urban (aOR 4.68, 95% CI 1.45 − 15.10) and rural area (aOR 1.68, 95% CI 1.01 − 2.80), farmers as occupation (aOR: 3.24, 95%CI: 1.31 − 8.06) and belonging to lower social economic class (aOR 4.24, 95% CI 1.68 − 10.69) were predictors of visiting informal providers of hypertensive patient. One-fourth of the hypertensive patients received consultation from informal healthcare providers.Conclusions: Raising awareness among patients and proper referral to specialised hypertension centres could promulgate the patients towards appropriate behaviour.
|
|
| 5. |
- Imam, Hassan, et al.
(författare)
-
Evaluation of time delay between discovery of a high blood pressure in a health screening survey and hypertension diagnosis
- 2020
-
Ingår i: Blood Pressure. - : TAYLOR & FRANCIS LTD. - 0803-7051 .- 1651-1999. ; 29:6, s. 370-374
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose:Early treatment of hypertension is important to reduce adverse cardiovascular outcomes. The aim of this study was to investigate the time delay from detection of a high blood pressure in a health screening survey to hypertension diagnosis in primary care. Materials and methods:Seventy years old inhabitants in the Uppsala County were randomly invited to the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. We found 409 individuals without antihypertensive treatment with a blood pressure >140/90 mmHg, being the average of three recordings measured after 30 min rest in a supine position. These individuals were recommended to ask their primary care physician to further investigate this finding. Results:During 10 years of follow-up, 285 of them (70%) received a hypertension diagnosis. The mean time to diagnosis was 5 (SD 2) years. The chance of receiving a diagnosis of hypertension during the follow-up period in this group with elevated blood pressure at baseline was related to the systolic blood pressure (OR 1.04 per 1 mmHg, 95%CI 1.02-1.04), the BMI (OR 1.06 per 1 kg/m(2), 95%CI 1.01-1.12), and statin use (OR 3.76, 95%CI 1.35-10.3) at the health survey, but was not significantly related to sex, prevalence of diabetes, or use of salicylic acid. No significant interaction between sex and systolic blood pressure regarding hypertension diagnosis was observed. Conclusion:In conclusion, when an elevated blood pressure was discovered in elderly persons at a health screening, 70% of those received a hypertension diagnosis within 10 years, with a mean time to diagnosis of 5 years. Health care actions should be enforced to shorten this time lag both in terms of information to the individuals, as well as the handling of this patient group in primary care.
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
- Midlöv, Patrik, et al.
(författare)
-
PERson-centredness in hypertension management using information technology (PERHIT): a protocol for a randomised controlled trial in primary health care
- 2020
-
Ingår i: Blood Pressure. - : TAYLOR & FRANCIS LTD. - 0803-7051 .- 1651-1999. ; 29:3, s. 149-156
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: For primary health care (PHC), hypertension is the number one diagnosis for planned health care visits. The treatment of high blood pressure (BP) and its consequences constitutes a substantial economic burden. In spite of efficient antihypertensive medications, a low percentage of patients reach a well-controlled BP. The PERson-centredness in Hypertension management using Information Technology (PERHIT) Study is a multicentre randomised controlled trial. PERHIT is designed to evaluate the effect of supporting self-management on systolic blood pressure by the use of information technology in Swedish primary health care. Materials and Methods: After inclusion, 900 patients from 36 PHC centres are randomised to two groups. In the intervention group, patients are provided with a self-management support system including a home-BP monitor and further requested to perform self-reports and measure BP every evening for eight consecutive weeks. In the control group, patients receive treatment as usual. Results: The primary outcome will be the change in systolic blood pressure in patients with hypertension. In addition, person-centredness, daily life activities, awareness of risk and health care costs will also be evaluated. Conclusion: The results of this randomised controlled trial with assessment of blood pressure and same-day self-reports will provide patients a tool to understand the interplay between blood pressure and lifestyle applicable to primary health care. The self-management support system may be of importance for improved adherence to treatment and persistence to treatment recommendations.
|
|
| 9. |
|
|
| 10. |
|
|
