P2648Uncontrolled hypertension is common among patients with implanted pacemaker

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Sharma ◽  
M Tasgaonkar ◽  
A Abeyratne
Keyword(s):  
Public Health ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Significant Proportion ◽  
Public Health Problem ◽  
Therapeutic Strategies ◽  
One Year ◽  
Implanted Pacemaker ◽  
Time Point

Abstract Background Given the significance of hypertension (HTN) as a major risk factor for cardiovascular disease, stroke, HF, and mortality, uncontrolled HTN remains a large public health problem. Pacemaker patients are well trapped in the healthcare system, and hence are expected to have a lower rate of uncontrolled HTN than general HTN patient population. However, incidence of uncontrolled HTN in pacemaker patients is not well characterized. Purpose We sought to characterize the prevalence of uncontrolled HTN in pacemaker patients using real-world EHR data. Methods Patients who received an implanted pacemaker were identified from a large EHR de-identified database of a cohort of patients with or at risk of cardiovascular disease from 01/2007 to 03/2017. The data were queried to determine prevalence of uncontrolled HTN. Results From a total of 11,472,727 patients in the EHR dataset, a total of 140,701 (1.23%) had implanted pacemaker with implant date available. Of these 72,846 (51.8%) had systolic blood pressure (SBP) available within 60 days of device implant. Depending on SBP cut-off, the proportion of patients with uncontrolled HTN ranged from 32.9% (SBP>140 mmHg) to 11.5% (SBP>160 mmHg) at the time of implant. A subset (11,676, 16%) had SBP available at implant and one-year post-implant. At one year time point uncontrolled HTN in these patients ranged from 20.8% (SBP>140 mmHg) to 2.4% (SBP>160 mmHg) (Figure). Conclusion A significant proportion of pacemaker patients have uncontrolled HTN at the time of implant. While there is a decline in this proportion at one year, substantial proportion of pacemaker patients remain with uncontrolled HTN. In addition to better guideline directed medical therapy, there may be an opportunity for better monitoring and alternative therapeutic strategies in these patients. Acknowledgement/Funding Medtronic Inc.

scholarly journals ASSESSMENT OF ALCOHOL USE BY POPULATION AND RELATED PROBLEMS

2019 ◽  
Vol 4 (9-10) ◽  
pp. 93-99
Author(s):  
V. B. Zamkevich ◽  
M. D. Diachuk ◽  
T. S. Gruzieva
Keyword(s):  
Public Health ◽  
Information System ◽  
Risk Factor ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Fatal Outcome ◽  
Significant Proportion ◽  
Public Health Problem ◽  
Well Being ◽  
Negative Consequences

Introduction. The development of the public health system provides for the solution of the basic operational functions of public health, including surveillance and assessment of the state of health and well-being of the population, taking into account risks to public health.Given the importance of alcohol as a risk factor for the development of diseases, the study of its prevalence in the population, consumption patterns and health effects is an important public health problem. The aim of the study. To identify current trends in alcohol consumption and the associated risk factor for health damage in Ukraine and countries of the WHO European Region.Materials and methods. Bibliographic, medical, statistical and information-analytical methods were used in the study. The key  scientific base were the European Health for All Database, the Global Information System on Alcohol and Health (GISAH) and the European Information System on Alcohol and Health (EISAH). Results. Significant differences were found in the prevalence of alcohol consumption by population in different regions of the world per capita per year, up to 16 times, with the highest rates in the WHO ER. Ukraine is characterized by high levels of alcohol consumption (8.6 liters) and negative tendencies for their growth during 1991-2016 by 45.8%. At the same time, in Ukraine the consumption of strong alcoholic drinks predominates, while in the countries of the European Union - wine and beer. The increase in alcohol consumption in Ukraine and the prevalence of strong drinks in the structure of consumed products (51.5%) is an unfavorable prognostic indicator and requires the adoption of preventive measures. The negative consequences of alcohol consumption are the prevalence of alcohol dependence (2.2%), alcohol-related disorders (6%), a significant proportion of deaths (20.5%) due to this risk factor in the overall structure of all deaths, etc. Significant is the contribution of alcohol to the formation of indicators of road traffic injuries, including those with a fatal outcome, crime rates, etc. Conclusions. Surveillance of the prevalence of alcohol use, patterns of consumption and assessment of alcohol-related public health problems is an important basis for determining directions, justification and taking countermeasures.

B-Vitamins, Methylenetetrahydrofolate Reductase (MTHFR) and Hypertension

2011 ◽  
Vol 81 (4) ◽  
pp. 240-244 ◽  
Author(s):  
Mary Ward ◽  
Carol P Wilson ◽  
J J Strain ◽  
Geraldine Horigan ◽  
John M. Scott ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Low Dose ◽  
Methylenetetrahydrofolate Reductase ◽  
Genetic Determinant ◽  
Gene Encoding ◽  
Homocysteine Concentration ◽  
Homozygous Mutant ◽  
B Vitamin

Hypertension is a leading risk factor for cardiovascular disease (CVD) and stroke. A common polymorphism in the gene encoding the enzyme methylenetetrahydrofolate reductase (MTHFR), previously identified as the main genetic determinant of elevated homocysteine concentration and also recognized as a risk factor for CVD, appears to be independently associated with hypertension. The B-vitamin riboflavin is required as a cofactor by MTHFR and recent evidence suggests it may have a role in modulating blood pressure, specifically in those with the homozygous mutant MTHFR 677 TT genotype. If studies confirm that this genetic predisposition to hypertension is correctable by low-dose riboflavin, the findings could have important implications for the management of hypertension given that the frequency of this polymorphism ranges from 3 to 32 % worldwide.

scholarly journals The impact of obesity on cardiovascular disease risk factor

2018 ◽  
Vol 10 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Arun Kumar
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Sodium Intake ◽  
Action Plan ◽  
Saturated Fat ◽  
The World

Obesity has emerged as the most potential cardiovascular risk factor and has raised concern among public and their health related issues not only in developed but also in developing countries. The Worldwide obesity occurrence has almost has gone three times since 1975. Research suggests there are about 775 million obese people in the World including adult, children, and adolescents. Nearly 50% of the children who are obese and overweight in Asia in are below 5 years. There is a steep incline of childhood obesity when compared to 1971 which is not only in developed countries but also in developing countries. A considerable amount of weight gain occurs during the transition phase from adolescence to young adulthood. It is also suggested that those adultswho were obese in childhood also remained obese in their adulthood with a higher metabolic risk than those who became obese in their adulthood. In India, the urban Indian female in the age group of 30-45 years have emerged as an 〝at risk population” for cardiovascular diseases. To understand how obesity can influence cardiovascular function, it becomes immense important to understand the changes which can take place in adipose tissue due to obesity. There are two proposed concepts explaining the inflammatory status of macrophage. The predominant cause of insulin resistance is obesity. Epidemiological and research studies have indicated that the pathogenesis of obesity-related metabolic dysfunction involves the development of a systemic, low-grade inflammatory state. It is becoming clear that targeting the pro-inflammatory pathwaymay provide a novel therapeutic approach to prevent insulin resistance, particularly in obesity inducedinsulin resistance. Some cost effective interventions that are feasible by all and can be implemented even in low-resource settings includes - population-wide and individual, which are recommended to be used in combination to reduce the greatest cardiovascular disease burden. The sixth target in the Global NCD action plan is to reduce the prevalence of hypertension by 25%. Reducing the incidence of hypertension by implementing population-wide policies to educe behavioral risk factors. Reducing cigarette smoking, body weight, blood pressure, blood cholesterol, and blood glucose all have a beneficial impact on major biological cardiovascular risk factors. A variety of lifestyle modifications have been shown, in clinical trials, to lower bloodpressure, includes weight loss, physical activity, moderation of alcohol intake, increased fresh fruit and vegetables and reduced saturated fat in the diet, reduction of dietary sodium intake, andincreased potassium intake. Also, trials of reduction of saturated fat and its partial replacement by unsaturated fats have improved dyslipidaemia and lowered risk of cardiovascular events. This initiative driven by the Ministry of Health and Family Welfare, State Governments, Indian Council of Medical Research and the World Health Organization are remarkable. The Government of India has adopted a national action plan for the prevention and control of non-communicable diseases (NCDs) with specific targets to be achieved by 2025, including a 25% reduction inoverall mortality from cardiovascular diseases, a 25% relative reduction in the prevalence of raised blood pressure and a 30% reduction in salt/sodium intake. In a nutshell increased BMI values can predict the nature of obesity and its aftermaths in terms inflammation and other disease associated with obesity. It’s high time; we must realize it and keep an eye on health status in order to live long and healthy life.

Cardiovascular Prognosis in Drug-Resistant Hypertension Stratified by 24-Hour Ambulatory Blood Pressure: The JAMP Study

Hypertension ◽  
2021 ◽  
Author(s):  
Kazuomi Kario ◽  
Satoshi Hoshide ◽  
Keisuke Narita ◽  
Yukie Okawara ◽  
Hiroshi Kanegae ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Ambulatory Blood Pressure ◽  
Resistant Hypertension ◽  
Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Artery Disease

Resistant hypertension is an important cardiovascular risk factor. This analysis of the JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) data investigated the effects of uncontrolled resistant hypertension diagnosed using ambulatory blood pressure (BP) monitoring on the risk of heart failure (HF) and overall cardiovascular events. The JAMP study patients with hypertension and no HF history were included. They had true resistant hypertension (24-hour BP ≥130/80 mm Hg), pseudoresistant hypertension (24-hour BP <130/80 mm Hg), well-controlled nonresistant hypertension (24-hour BP <130/80 mm Hg), or uncontrolled nonresistant hypertension (24-hour BP ≥130/80 mm Hg). The primary end point was total cardiovascular events, including atherosclerotic cardiovascular disease (fatal/nonfatal stroke and fatal/nonfatal coronary artery disease), and HF. During 4.5±2.4 years of follow-up the overall incidence per 1000 person-years was 10.1 for total cardiovascular disease, 4.1 for stroke, 3.5 for coronary artery disease, and 2.6 for HF. The adjusted risk of total cardiovascular and HF events was significantly increased in patients with true resistant versus controlled nonresistant hypertension (hazard ratio, 1.66 [95% CI, 1.12–2.48]; P =0.012 and 2.24 [95% CI, 1.17–4.30]; P =0.015, respectively) and versus uncontrolled nonresistant hypertension (1.51 [1.03–2.20]; P =0.034 and 3.03 [1.58–5.83]; P <0.001, respectively). The findings were robust in a sensitivity analysis using a slightly different definition of resistant hypertension. True resistant hypertension diagnosed using ambulatory BP monitoring is a significant independent risk factor for cardiovascular disease events, especially for HF. This highlights the importance of diagnosing and effectively treating resistant hypertension. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000020377.

scholarly journals Sex Difference in Risk Factors, GRACE Scores, and Management among Post-Acute Coronary Syndrome Patients in Sri Lanka

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Priyadarshani Galappatthy ◽  
Vipula Bataduwaarachchi ◽  
Priyanga Ranasinghe ◽  
Gamini Galappatthy ◽  
Upul Senerath ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Sri Lanka ◽  
Disease Risk ◽  
Management Strategies ◽  
Significant Proportion ◽  
Coronary Syndrome ◽  
One Year ◽  
Grace Score

Objective. To assess sex-based differences in the prevalence of risk factor, their management, and differences in the prognosis among acute coronary syndrome (ACS) in Sri Lanka. Methods. Patients diagnosed with ACS were recruited from hospitals throughout the island. The Joint European Societies guidelines were used to assess recommended targets for coronary heart disease risk factors, and the GRACE score was used to assess the post-ACS prognosis. Age-adjusted regression was performed to calculate odds ratios for men versus women in risk factor control. Results. A total of 2116 patients, of whom 1242 (58.7%) were men, were included. Significant proportion of women were nonsmokers; OR = 0.11 (95% CI 0.09 to 0.13). The prevalence of hypertension (p<0.001), diabetes (p<0.001), and dyslipidemia (p=0.004) was higher in women. The LDL-C target was achieved in a significantly higher percentage of women (12.6%); OR = 0.33 (95% CI 0.10 to 1.05). When stratified by age, no significant differences were observed in achieving the risk factor targets or management strategies used except for fasting blood sugar (p<0.05) where more men achieved control target in both age categories. Majority of the ACS patients had either high or intermediate risk for one-year mortality as per the GRACE score. In-hospital and 1-year mean mortality risk was significantly higher among men of less than 65 years of age (p<0.05). Conclusions. Smoking is significantly lower among Sri Lankan women diagnosed with ACS. However, hypertension, diabetes, and dyslipidemia were more prevalent among them. There was no difference in primary and secondary preventive strategies and management in both sexes but could be further improved in both groups.

Identifying Properties for an Aortic Stent-Graft That Counteracts Hypertension

2018 ◽  
Author(s):  
Shannen B. Kizilski ◽  
Omid Amili ◽  
Filippo Coletti ◽  
Rumi Faizer ◽  
Victor H. Barocas
Keyword(s):  
United States ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Stent Graft ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
The United States ◽  
Aortic Stent Graft

In 2017, the American Heart Association reported that one third of deaths in the United States, and 31% of deaths worldwide, are attributed to cardiovascular disease (CVD) [1]. A risk factor pervasive across most types of CVD is chronic high blood pressure, or hypertension [2].

Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease

2017 ◽  
Vol 35 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Jianqi Wang ◽  
Xubo Shi ◽  
Changsheng Ma ◽  
Hua Zheng ◽  
Jie Xiao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Blood Pressure Variability ◽  
All Cause Mortality

scholarly journals Blood pressure as a risk factor for cardiovascular disease. The Framingham Study--30 years of follow-up.

Hypertension ◽  
1989 ◽  
Vol 13 (5_Suppl) ◽  
pp. I13-I13 ◽  
Author(s):  
J. Stokes ◽  
W. B. Kannel ◽  
P. A. Wolf ◽  
R. B. D'Agostino ◽  
L. A. Cupples
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Framingham Study

Role of endothelin in mediating postmenopausal hypertension in a rat model

2005 ◽  
Vol 288 (1) ◽  
pp. R229-R233 ◽  
Author(s):  
Licy L. Yanes ◽  
Damian G. Romero ◽  
Valeria E. Cucchiarelli ◽  
Lourdes A. Fortepiani ◽  
Celso E. Gomez-Sanchez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Spontaneously Hypertensive Rats ◽  
Renal Cortex ◽  
Hypertensive Rats ◽  
Spontaneously Hypertensive ◽  
Peptide Expression ◽  
Premenopausal Female

Cardiovascular disease is the leading cause of death in women after menopause. Hypertension, a major cardiovascular risk factor, becomes more prevalent after menopause. The mechanisms responsible for the increase in blood pressure (BP) in postmenopausal women are unknown. We have recently characterized the aged, postestrous-cycling (PMR) spontaneously hypertensive rats (SHR) as a model of postmenopausal hypertension. The purpose of the present study was to determine whether endothelin plays a role in the increased BP in PMR. Premenopausal female SHR, aged 4–5 mo (YF), and PMR, aged 16 mo, were studied. Expression of preproendothelin-1 mRNA was not different in either renal cortex or medulla between PMR and YF ( n = 7–8/group). In contrast, ET-1 peptide expression was significantly higher in renal cortex of PMR than in renal cortex of YF, but there was no difference in medullary ET-1. Expression of endothelin ETA receptor (ETAR) mRNA was lower in renal cortex and medulla of PMR than of YF. Additional groups of rats ( n = 6–7/group) were treated for 3 wk with the ETAR antagonist ABT-627 (5 mg·kg−1·day−1). BP was significantly higher in PMR than in YF. ETAR antagonist reduced BP in PMR by 20% to the level found in control YF. ETAR antagonist had no effect on BP in YF. These data support the hypothesis that the increase in BP in PMR is mediated in part by endothelin and the ETAR.

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