scholarly journals Impact of valve morphology, hypertension and age on aortic wall properties in patients with coarctation: a two-centre cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e034853
Author(s):  
Niky Ghorbani ◽  
Vivek Muthurangu ◽  
Abbas Khushnood ◽  
Leonid Goubergrits ◽  
Sarah Nordmeyer ◽  
...  

ObjectiveWe aimed to investigate the combined effects of arterial hypertension, bicuspid aortic valve disease (BAVD) and age on the distensibility of the ascending and descending aortas in patients with aortic coarctation.DesignCross-sectional study.SettingThe study was conducted at two university medical centres, located in Berlin and London.ParticipantsA total of 121 patients with aortic coarctation (ages 1–71 years) underwent cardiac MRI, echocardiography and blood pressure measurements.Outcome measuresCross-sectional diameters of the ascending and descending aortas were assessed to compute aortic area distensibility. Findings were compared with age-specific reference values. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology statement and reporting guidelines.ResultsImpaired distensibility (below fifth percentile) was seen in 37% of all patients with coarctation in the ascending aorta and in 43% in the descending aorta. BAVD (43%) and arterial hypertension (72%) were present across all ages. In patients >10 years distensibility impairment of the ascending aorta was predominantly associated with BAVD (OR 3.1, 95% CI 1.33 to 7.22, p=0.009). Distensibility impairment of the descending aorta was predominantly associated with arterial hypertension (OR 2.8, 95% CI 1.08 to 7.2, p=0.033) and was most pronounced in patients with uncontrolled hypertension despite antihypertensive treatment.ConclusionFrom early adolescence on, both arterial hypertension and BAVD have a major impact on aortic distensibility. Their specific effects differ in strength and localisation (descending vs ascending aorta). Moreover, adequate blood pressure control is associated with improved distensibility. These findings could contribute to the understanding of cardiovascular complications and the management of patients with aortic coarctation.

2021 ◽  
Author(s):  
MULUALEM ALEMAYEHU ◽  
Sintayehu Abebe ◽  
Dejuma Yadeta ◽  
Bekele Alemayehu

Abstract Background: Hypertension is the most common cardiovascular problem globally with a particularly increasing burden in developing countries like Ethiopia. Ambulatory blood pressure (ABPM) is superior to office blood pressure (OBP) measurement for diagnosing, prognosticating and following treatment efficacy for hypertension. There is no available data on ABPM control pattern in Ethiopians. This study will determine the ABPM control patterns in Ethiopian hypertensive patients on treatment. Material and Methods: This was a cross sectional study in hypertensive patients at Tikur Anbessa Specialized Hospitals outpatient departments carried out during January to May 2021. ABPM values of 244 consecutively sampled patients were analyzed. All patients had their BP monitored over 24 h with a Tonoport V (GE CS V6 71), and the data was interpreted using GE CardiosoftTM ABPM software in accordance with European Society of hypertension guidelines. Ethical clearance was given by Addis Ababa University Institutional Review Board and the study was conducted in compliance to standard ethical guidelines.Results: The study involved 244 adult hypertensive patients; mean age of the patients was 59.4years and, 54% were females. 58.6% of patients had controlled OBP, while only 45.1% had controlled ABPM. The mean OBP was 137 (19)/81 (10) mmHg and mean 24-hr ABP was 137 (16)/81 (10) mmHg; mean daytime BP was 136/79 ± 17/11 mmHg; mean night‑time BP, 138/84 ± 16/11 mmHg. Mean ABPM values were not significantly different between men and women. Comparison of ABPM values with OBP revealed high prevalence of the white coat effect (32%) and masked uncontrolled hypertension (46%). Presence of comorbidities particularly diabetes predicted poor ABPM control.Conclusion: More than half of patients had uncontrolled BP as per ABPM criteria and significant discrepancy exists between ABPM and OBP in assessing adequacy of BP control. Guiding management decisions using ABPM can improve BP control rates.


2020 ◽  
Author(s):  
Charity Masilela ◽  
Brendon Pierce ◽  
Oladele Vincent Adeniyi ◽  
Mongi Benjeddou

Abstract Background: Achieving the blood pressure treatment target in individuals with hypertension is a serious global health challenge. Furthermore, the actual burden of uncontrolled hypertension is poorly understood especially in the developing countries. Therefore, this study comprehensively examined the rate and factors associated with uncontrolled hypertension in individuals receiving care at the primary healthcare facilities in the rural areas of Mkhondo Municipality in the Mpumalanga Province, South Africa.Methods: In this cross-sectional study, individuals attending care for hypertension were recruited from January 2019 to June 2019 at three primary healthcare centres, namely, Piet Retief hospital, Mkhondo town clinic and Thandukukhanya community health centre. Uncontrolled hypertension was defined as systolic blood pressure ≥ 140mmHg and diastolic blood pressure ≥ 90mmHg in accordance with the South African Hypertension Society guideline (2014). Multivariate logistic regression (Forward LR method) analysis was used to identify the significant determinants of uncontrolled hypertension.Results: The majority of the participants were; 55 years old and above (69.0%), Zulus (81.2%), non-smokers (84.19%) and had been diagnosed with hypertension for more than a year prior to the study (72.64%). The overall prevalence of uncontrolled hypertension was 56.83% (n=187) with no significant difference between sexes, 57.38% males versus 56.88% females, respectively. In the multivariate logistic regression model analysis after adjusting for confounding variables, obesity (AOR=2.90; 95% CI 1.66-5.05), physical activity (AOR=4.79; 95% CI 2.15-10.65) and HDL-C (AOR=5.66; 95% CI 3.33-9.60) were the significant and independent determinants of uncontrolled hypertension in the cohort.ConclusionThe high rate of uncontrolled hypertension in the study setting, can be largely attributed to obesity, physical activity and dyslipidaemia. Treatment will require the collaborative efforts of individuals, clinicians and health authorities. All these determinants should be addressed decisively so as to achieve the treatment blood pressure targets in the study population.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Joyce Tik Sze Li ◽  
Amy Shuk Man Lam ◽  
Brian Tomlinson ◽  
Vivian Wing Yan Lee

Introduction. Hypertension is a modifiable risk factor for multiple cardiovascular diseases. Early identification and intervention of new cases are crucial to improve patients’ outcomes. May Measurement Month (MMM) is an annual global synchronised blood pressure (BP) screening campaign. Participants can have their BP measured at the screening sites. It may be a possible way to identify undiagnosed hypertensive patients in the population. Methods. It was a cross-sectional study of BP among Hong Kong adults. Multiple screening sites were set in local community pharmacies and on the campus of the Chinese University of Hong Kong. Participants were asked to fill in a questionnaire regarding their demographics, medical history, and social history. Then, they took at least one BP reading using an automated sphygmomanometer after sitting at for 5 minutes. Up to three BP readings were taken and recorded for each participant, with one-minute intervals between readings. Results. A total of 3224 adults participated in MMM between 2017 and 2019. The average BP among the 3224 participants was 139.8/75.5 mmHg. The prevalence of hypertension was 2282 (70.8%), of which 635 (27.8%) were undiagnosed before MMM. Among the 1647 participants previously diagnosed with hypertension, 1007 (61.1%) had uncontrolled hypertension. Conclusion. A high number of cases can be identified with untreated, or treated but uncontrolled, hypertension from MMM. Citizens should be encouraged to check BP regularly and take follow-up actions if hypertension is suspected.


Author(s):  
José João Mendes ◽  
João Viana ◽  
Filipe Cruz ◽  
Dinis Pereira ◽  
Sílvia Ferreira ◽  
...  

We aimed to investigate the association between blood pressure (BP) and tooth loss and the mediation effect of age. A cross-sectional study from a reference dental hospital was conducted from September 2017 to July 2020. Single measures of BP were taken via an automated sphygmomanometer device. Tooth loss was assessed through oral examination and confirmed radiographically. Severe tooth loss was defined as 10 or more teeth lost. Additional study covariates were collected via sociodemographic and medical questionnaires. A total of 10,576 patients were included. Hypertension was more prevalent in severe tooth loss patients than nonsevere tooth lost (56.1% vs. 39.3%, p < 0.001). The frequency of likely undiagnosed hypertension was 43.4%. The adjusted logistic model for sex, smoking habits and body mass index confirmed the association between continuous measures of high BP and continuous measures of tooth loss (odds ratio (OR) = 1.05, 95% CI: 1.03–1.06, p < 0.001). Age mediated 80.0% and 87.5% of the association between periodontitis with both systolic BP (p < 0.001) and diastolic BP (p < 0.001), respectively. Therefore, hypertension and tooth loss are associated, with a consistent mediation effect of age. Frequency of undiagnosed hypertension was elevated. Age, gender, active smoking, and BMI were independently associated with raised BP.


2014 ◽  
Vol 37 (8) ◽  
pp. 779-784 ◽  
Author(s):  
Hiromi Mori ◽  
Isao Saito ◽  
Eri Eguchi ◽  
Koutatsu Maruyama ◽  
Tadahiro Kato ◽  
...  

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