Hypertension

2020 ◽  
pp. 268-283
Author(s):  
Laura A. Magee ◽  
Peter von Dadelszen
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Disease Risk ◽  
Gestational Hypertension ◽  
Target Organ Damage ◽  
Expectant Management ◽  
Developed Countries ◽  
Chronic Hypertension ◽  
Pregnancy Hypertension ◽  
Premature Cardiovascular Disease

Pregnancy hypertension is associated with an estimated annual toll of 46,000 maternal and 2 million fetal, neonatal, and infant deaths. Over 99% of these deaths occur in less developed countries. The most dangerous form of pregnancy hypertension is pre-eclampsia, which, by international consensus, is defined more broadly than solely by proteinuric gestational hypertension to include markers of systemic target organ damage. Severe pre-eclampsia is defined by adverse features that mandate delivery irrespective of gestational age. There are numerous risk factors for pre-eclampsia and low-dose aspirin and, in women with low intake, calcium replacement appear to reduce the risk of pre-eclampsia and its complications. Time-of-disease risk estimation for women and, to a lesser extent, their fetuses, is possible to guide personalized decision-making and counselling. Heavy proteinuria is not an indication for delivery. Severe pregnancy hypertension must be treated as a matter of urgency. For all women with pregnancy hypertension, blood pressure should be normalized. Magnesium sulphate is the treatment to prevent and treat the seizures of eclampsia. Beyond viability, expectant management of pregnancy hypertension should be offered until 36+6 weeks of pregnancy. Women with either pre-eclampsia or gestational hypertension at more than 37+0 weeks should be offered induction, while induction should be offered to women with chronic hypertension at 38–39 weeks. Blood pressure reaches its maximal postpartum levels on days 3–6 postpartum. All forms of pregnancy hypertension are risk factors for premature cardiovascular disease and mortality, especially if associated with either fetal growth restriction, preterm birth, and/or stillbirth.

scholarly journals Assessment of Risk Factors in Hypertensive Disorder During Pregnancy: Hospital Based (KAP) Knowledge, Attitude and Practice Survey. A Key for Preventive Approach

2018 ◽  
Vol 16 (2) ◽  
pp. 74-77
Author(s):  
Merina Shrestha
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Pregnant Women ◽  
Gestational Hypertension ◽  
Cross Sectional Study ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Cross Sectional ◽  
Knowledge And Attitude ◽  
Associated Risk Factors

Background: Hypertensive disorder (HDP) during pregnancy is a group of conditions featuring with high blood pressure that may lead to feto-maternal morbidity and mortality, particularly in developing countries. Aims and Objectives: To assess relationship between risk factor of hypertensive disorder during pregnancy, their self care knowledge and practice to prevent and control hypertension. Materials And Method: A cross-sectional study of 93 registered, pregnant women belonging to reproductive ageth group, after 20th  gestation age completed, who came for ANC checkup or admitted for hypertension management or prior to delivery in Nepalgunj medical college and teaching hospital under department of Obstetrics and Gynecology from 15th  June to 15th  December 2018. Blood pressure was measured for each women at booking or at subsequent visits. Urine test for protein albumin was performed if blood pressure was elevated. Data was entered and analysis was completed using SPSS package version 20. Results: The overall prevalence of hypertensive disorder during pregnancy was 2.85% among all deliveries. Pre-eclampsia accounted 36% of the cases followed by eclampsia 18%. Gestational hypertension was 21%, pregnancy induced hypertension was 20% and chronic hypertension was only 5% in study population. Conclusion: Knowledge and attitude regarding lack of exercise, low salt diet, obesity and lack of rest were poor contributory risk factors. It is recommended that all pregnant women must develop knowledge about associated risk factors and ensure the application of behavioral change practices to control and prevent hypertensive disorder during pregnancy.

Abstract P199: Higher Circulating Triglycerides are Independently Associated With Greater Short-term Blood Pressure Variability in Middle-aged/older Adults With Obesity

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Rachel E Luehrs ◽  
Graziela Z Kalil ◽  
Seth W Holwerda ◽  
Nealy A Wooldridge ◽  
Jess G Fiedorowicz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Plasma Lipids ◽  
Target Organ Damage ◽  
Density Lipoprotein ◽  
Multiple Linear Regression Model ◽  
Middle Aged ◽  
Short Term ◽  
Cvd Risk

Elevated short-term (24 hour) blood pressure variability (BPV) is associated with subclinical target organ damage and cardiovascular disease (CVD) among middle-aged/older (MA/O) adults with hypertension and obesity. Circulating total cholesterol (TC), low-density cholesterol (LDL-C) and triglycerides (TGs) increase with human obesity and are independent risk factors for CVD. In addition, BPV is increased in mouse models of hyperlipidemia and is normalized with statins. However, whether higher circulating lipoproteins independently contribute to greater short-term BPV among adults with obesity remains unclear. We hypothesized that higher LDL-C, TGs and lower high-density lipoprotein (HDL-C) would be associated with greater short-term BPV among individuals with obesity. Fasting plasma lipids and 24 hour ambulatory BP monitoring were assessed in fifty-six MA/O adults with obesity defined as body mass index (BMI) ≥ 30 kg/m 2 (56% F; age 54±7 yrs; BMI, 38.2±5.6 kg/m 2 ) and at least one other CVD risk factor. There was a significant relation between 24 hour systolic BPV and TC (r=0.30, P=0.03), TGs (r=0.34, P=0.01) and LDL-C (r=0.25, P=0.059), but not HDL-C (r=-0.07, P=0.61). Interestingly, these findings remained significant after adjusting for age, sex, BMI and 24 hour systolic BP (TC: r=0.34, P=0.01; TGs: r=0.39, P<0.01; LDL-C: r=0.31, P=0.03) but HDL-C remained non-significant (r=-0.16, P=0.27). In contrast, other cardiometabolic risk factors such as fasting glucose, insulin, c-reactive protein concentrations, carotid-femoral pulse wave velocity and HOMA-IR were not associated with 24 hour systolic BPV. In a multiple linear regression model that included age, sex, BMI, 24 hour systolic BP, TGs and LDL-C, only fasting TGs (β=0.02 ± 0.01, P=0.02) were a significant correlate of 24 hour systolic BPV (Model R 2 =0.24, P=0.03). Results were the same if TC was substituted for LDL-C in the model. In conclusion, higher plasma TC, LDL-C and TGs are associated with greater 24 hour BPV among MA/O adults with obesity with only TGs being independently associated with BPV. These data suggest that greater variability in BP among MA/O adults with obesity is mediated in part through circulating TGs suggesting that TGs may be a therapeutic target to modify short-term BPV.

scholarly journals A Community-based Lifestyle Education Program Addressing Non-communicable Diseases in Low-literacy Areas of the South Pacific: A Pilot Control Cohort Study

2020 ◽  
Vol 7 (3) ◽  
pp. 5-10
Author(s):  
Lillian Kent ◽  
Pia Reierson ◽  
Darren Morton ◽  
Kesa Vasutoga ◽  
Paul Rankin
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Disease ◽  
Group Process ◽  
Disease Risk ◽  
Density Lipoprotein ◽  
Control Group ◽  
Low Literacy ◽  
Intervention Village ◽  
Control Village

Lifestyle interventions can effectively reduce chronic disease risk factors. This study examined the effectiveness of an established lifestyle intervention contextualized for low-literacy communities in Fiji. Ninety-six adults from four villages, with waist circumference (WC) indicative of risk of chronic disease, were randomly selected to an intervention or control group. Process evaluation indicated one intervention and one control village fulfilled the study protocol. There were no differences between intervention and control for body mass index BMI (P = 0.696), WC (P = 0.662), total cholesterol (TC) (P = 0.386), and TC:high-density lipoprotein (HDL) ratio (P = 0.485). The intervention village achieved greater reductions than the control village at 30 and 90 days for systolic blood pressure (30 days: −11.1% vs. −2.5%, P = 0.006; 90 days: −14.5% vs. −6.7%, P = 0.019); pulse rate (30 days: −7.0% vs. −1.1%, P = 0.866; 90 days: −7.1% vs. 4.3%, P = 0.027), and HDL (30 days: −13.9% vs. 1.7%, P = 0.206; 90 days: −18.9% vs. 2.2%, P = 0.001); at 90 days only for diastolic blood pressure (−14.4% vs. −0.2%, P = 0.010); at 30 days only for low-density lipoprotein (−11.6% vs. 8.0%, P = 0.009); and fasting plasma glucose (−10.2% vs. 4.3%, P = 0.032). However, for triglycerides, the control achieved greater reductions than the intervention village at 30 days (35.4% vs. −12.3%, P = 0.008; marginal at 90 days 16.4% vs. −23.5%, P = 0.054). This study provides preliminary evidence of the feasibility and potential effectiveness of the intervention to lower several risk factors for chronic disease over 30 days in rural settings in Fiji and supports consideration of larger studies.

scholarly journals Wuqinxi Qigong as an Alternative Exercise for Improving Risk Factors Associated with Metabolic Syndrome: A Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 16 (8) ◽  
pp. 1396 ◽  
Author(s):  
Liye Zou ◽  
Yangjie Zhang ◽  
Jeffer Eidi Sasaki ◽  
Albert S. Yeung ◽  
Lin Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Randomized Controlled Trials ◽  
Disease Risk ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Controlled Trials ◽  
Positive Effects ◽  
Randomized Controlled

Background: The improvement of living standards has led to increases in the prevalence of hypokinetic diseases. In particular, multifactorial complex diseases, such as metabolic syndrome, are becoming more prevalent. Currently, developing effective methods to combat or prevent metabolic syndrome is of critical public health importance. Thus, we conducted a systematic review to evaluate the existing literature regarding the effects of Wuqinxi exercise on reducing risk factors related to metabolic syndrome. Methods: Both English- and Chinese-language databases were searched for randomized controlled trials investigating the effects of Wuqinxi on these outcomes. Meanwhile, we extracted usable data for computing pooled effect size estimates, along with the random-effects model. Results: The synthesized results showed positive effects of Wuqinxi exercise on systolic blood pressure (SBP, SMD = 0.62, 95% CI 0.38 to 0.85, p < 0.001, I2 = 24.06%), diastolic blood pressure (DBP, SMD = 0.62, 95% CI 0.22 to 1.00, p < 0.001, I2 = 61.28%), total plasma cholesterol (TC, SMD = 0.88, 95% CI 0.41 to 1.36, p < 0.001, I2 = 78.71%), triglyceride (TG, SMD = 0.87, 95% CI 0.49 to 1.24, p < 0.001, I2 = 67.22%), low-density lipoprotein cholesterol (LDL-C, SMD = 1.24, 95% CI 0.76 to 1.72, p < 0.001, I2 = 78.27%), and high-density lipoprotein cholesterol (HDL, SMD = 0.95, 95% CI 0.43 to 1.46, p < 0.001, I2 = 82.27%). In addition, regression results showed that longer-duration Wuqinxi intervention significantly improved DBP (β = 0.00016, Q = 5.72, df = 1, p = 0.02), TC (β = −0.00010, Q = 9.03, df = 1, p = 0.01), TG (β = 0.00012, Q = 6.23, df = 1, p = 0.01), and LDL (β = 0.00011, Q = 5.52, df = 1, p = 0.02). Conclusions: Wuqinxi may be an effective intervention to alleviate the cardiovascular disease risk factors of metabolic syndrome.

scholarly journals Associations of estimated Δ-5-desaturase and Δ-6-desaturase activities with stroke risk factors and risk of stroke: the Kuopio Ischaemic Heart Disease Risk Factor Study

2017 ◽  
Vol 117 (4) ◽  
pp. 582-590 ◽  
Author(s):  
Roya Daneshmand ◽  
Sudhir Kurl ◽  
Tomi-Pekka Tuomainen ◽  
Jyrki K. Virtanen
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Stroke Risk ◽  
Disease Risk ◽  
Serum Insulin ◽  
Disease Risk Factor ◽  
Stroke Risk Factors ◽  
Risk Factor Study ◽  
Factor Study ◽  
Heart Disease Risk

AbstractStroke is a leading cause of morbidity and mortality. The role of PUFA in reducing the risk of stroke is uncertain. The concentrations of PUFA in the human body are determined both by dietary intake and by activities of desaturase enzymes. Desaturase enzymes have been associated with chronic diseases, but little is known about their association with stroke risk. We investigated the associations of Δ-6-desaturase (D6D) and Δ-5-desaturase (D5D) activities with stroke risk factors and risk of stroke among 1842 men from the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42–60 years and free of CVD at baseline in 1984–1989. ANCOVA and Cox regression models were used for the analyses. Whole serum desaturase activities were estimated as product:precursor ratios – γ-linolenic acid:linoleic acid for D6D and arachidonic acid:dihomo-γ-linolenic acid for D5D. Higher D6D activity was associated with higher systolic and diastolic blood pressure, BMI, serum insulin and TAG concentrations and worse homoeostatic model assessment (HOMA) indices. In contrast, higher D5D activity was associated with lower systolic and diastolic blood pressure, BMI, serum insulin, LDL-cholesterol, TAG and C-reactive protein concentrations, higher HDL-cholesterol concentration, and better HOMA indices. During the mean follow-up of 21·2 years, 202 stroke cases occurred. Neither D6D activity (multivariable-adjusted extreme-quartile hazard ratios (HR) 1·18; 95 % CI 0·80, 1·74) nor D5D activity (HR 1·06; 95 % CI 0·70, 1·60) were associated with stroke risk. In conclusion, higher D5D activity was favourably associated and higher D6D activity unfavourably associated with several stroke risk factors, but not with the risk of incident stroke.

scholarly journals Association between birth weight and childhood cardiovascular disease risk factors in West Virginia

2019 ◽  
Vol 11 (1) ◽  
pp. 86-95
Author(s):  
Amna Umer ◽  
Candice Hamilton ◽  
Lesley Cottrell ◽  
Peter Giacobbi ◽  
Kim Innes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Birth Weight ◽  
West Virginia ◽  
Disease Risk ◽  
Density Lipoprotein ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Relationship

AbstractThe reported associations between birth weight and childhood cardiovascular disease (CVD) risk factors have been inconsistent. In this study, we investigated the relationship between birth weight and CVD risk factors at 11 years of age. This study used longitudinally linked data from three cross-sectional datasets (N = 22,136) in West Virginia; analysis was restricted to children born full-term (N = 19,583). The outcome variables included resting blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP)] and lipid profile [total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL, and triglycerides (TG)]. Multiple regression analyses were performed, adjusting for child’s body mass index (BMI), sociodemographics, and lifestyle characteristics. Unadjusted analyses showed a statistically significant association between birth weight and SBP, DBP, HDL, and TG. When adjusted for the child’s BMI, the association between birth weight and HDL [b = 0.14 (95% CI: 0.11, 0.18) mg/dl per 1000 g increase] and between birth weight and TG [b = –0.007 (–0.008, –0.005) mg/dl per 1000 g increase] remained statistically significant. In the fully adjusted model, low birth weight was associated with higher LDL, non-HDL, and TGs, and lower HDL levels. The child’s current BMI at 11 years of age partially (for HDL, non-HDL, and TG) and fully mediated (for SBP and DBP) the relationship between birth weight and select CVD risk factors. While effects were modest, these risk factors may persist and amplify with age, leading to potentially unfavorable consequences in later adulthood.

scholarly journals Comparative study of labetalol and nifedipine in management of non- severe preeclampsia and its fetomaternal outcome

2019 ◽  
Vol 8 (5) ◽  
pp. 2034
Author(s):  
Delphine T. Rose ◽  
Jeyarani P.
Keyword(s):  
Blood Pressure ◽  
Tamil Nadu ◽  
Neonatal Outcome ◽  
Developed Countries ◽  
Severe Preeclampsia ◽  
Chronic Hypertension ◽  
Maternal Deaths ◽  
Medical College ◽  
Hypertensive Disorders ◽  
Significant Difference

Background: In developed countries, 16 percent of maternal deaths were attributed to hypertensive disorders. Of hypertensive disorders, the preeclampsia syndrome, either alone or superimposed on chronic hypertension, is the most dangerous. The incidence of preeclampsia in nulliparous populations ranged from 3 to 10 percent.Methods: The present study was conducted at Government Raja Mirasudhar Hospital, Thanjavur Medical College, Thanjavur, Tamil Nadu, India from October 2017 to October 2018. The study consisted of 100 antenatal women with non-severe preeclampsia. The efficacy of labetalol verses nifedipine in its management was studied along with the fetomaternal outcome.Results: In this study, in the labetalol and in the nifedipine groups adequate control of blood pressure was achieved. However, labetalol was well tolerated by our women without much side effects.Conclusions: The present study indicates both labetalol and nifedipine are equally efficacious in the control of hypertension in non-severe preeclampsia. Pathology of the disease was not altered significantly in both the groups. There was no significant difference in the neonatal outcome between the two groups.

scholarly journals Weight Loss Efficacy of 4-Hour Versus 6-Hour Time Restricted Feeding in Adults with Obesity

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 584-584
Author(s):  
Sofia Cienfuegos ◽  
Kelsey Gabel ◽  
Faiza Kalam ◽  
Mark Ezpeleta ◽  
Vasiliki Pavlou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Disease ◽  
Insulin Resistance ◽  
Blood Pressure ◽  
Weight Loss ◽  
Body Weight ◽  
Fat Mass ◽  
Disease Risk ◽  
Metabolic Disease Risk ◽  
Ad Libitum

Abstract Objectives This study was undertaken to compare the effects of 4-h TRF to that of 6-h TRF on body weight, body composition, and metabolic disease risk factors in adults with obesity. We hypothesized that 4-h TRF would produce the greatest decreases in body weight, fat mass, blood pressure, and insulin resistance, compared to 6-h TRF. Methods Adults with obesity (n = 49) were randomized to 1 of 3 interventions for 8 weeks: 4-h TRF (ad libitum eating between 3:00 to 7:00 pm, water fasting between 7:00 to 3:00 pm); 6-h TRF (ad libitum eating between 1:00 to 7:00 pm, water fasting between 7:00 to 1:00 pm); or control (ad libitum food intake with no timing restrictions). Results Body weight decreased similarly in the 4-h TRF group (–3.3 ± 0.5%) and 6-h TRF group (–2.6 ± 0.5%) relative to controls over 8 weeks (P &lt; 0.001). Fat mass, blood pressure and insulin sensitivity also decreased in the 4-h TRF and 6-h TRF groups versus controls. LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, and HbA1c were not significantly different from controls after 8 weeks. Conclusions This is the first trial to examine the effects of 4-h vs. 6-h TRF on body weight and metabolic disease risk factors. We show here that 8 weeks of 4-h and 6-h TRF decreases body weight by ∼3–4% relative to controls. We also demonstrate that this fasting regimen produces significant reductions in blood pressure, fat mass, insulin and insulin resistance. These preliminary data offer promise for the use of 4-h and 6-h TRF as a weight loss techniques in adults with obesity, but larger, longer-term trials are needed to confirm these findings. Funding Sources Department of Kinesiology and Nutrition, University of Illinois Chicago

Racial Disparity in Postpartum Readmission due to Hypertension among Women with Pregnancy-Associated Hypertension

2020 ◽  
Author(s):  
Rebecca Chornock ◽  
Sara N. Iqbal ◽  
Tetsuya Kawakita
Keyword(s):  
Risk Factors ◽  
Black Women ◽  
Maternal Age ◽  
White Women ◽  
Task Force ◽  
Gestational Hypertension ◽  
Mode Of Delivery ◽  
Chronic Hypertension ◽  
Antihypertensive Medications ◽  
Initial Discharge

Abstract Objective Postpartum hypertension is a leading cause of readmission in the postpartum period. We aimed to examine the prevalence of racial/ethnic differences in postpartum readmission due to hypertension in women with antepartum pregnancy-associated hypertension. Study Design This was a multi-institutional retrospective cohort study of all women with antepartum pregnancy-associated hypertension diagnosed prior to initial discharge from January 2009 to December 2016. Antepartum pregnancy-associated hypertension, such as gestational hypertension, preeclampsia (with or without severe features), hemolysis, elevated liver enzyme, low platelet (HELLP) syndrome, and eclampsia was diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions. Women with chronic hypertension and superimposed preeclampsia were excluded. Our primary outcome was postpartum readmission defined as a readmission due to severe hypertension within 6 weeks of postpartum. Risk factors including maternal age, gestational age at admission, insurance, race/ethnicity (self-reported), type of antepartum pregnancy-associated hypertension, marital status, body mass index (kg/m2), diabetes (gestational or pregestational), use of antihypertensive medications, mode of delivery, and postpartum day 1 systolic blood pressure levels were examined. Multivariable logistic regression models were performed to calculate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs). Results Of 4,317 women with pregnancy-associated hypertension before initial discharge, 66 (1.5%) had postpartum readmission due to hypertension. Risk factors associated with postpartum readmission due to hypertension included older maternal age (aOR = 1.44; 95% CI: 1.20–1.73 for every 5 year increase) and non-Hispanic black race (aOR = 2.12; 95% CI: 1.16–3.87). Conclusion In women with pregnancy-associated hypertension before initial discharge, non-Hispanic black women were at increased odds of postpartum readmission due to hypertension compared with non-Hispanic white women.

Sign in / Sign up

Export Citation Format

Share Document