scholarly journals Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 1-14
Author(s):  
Yuliang Zhao ◽  
Letian Yang ◽  
Shaobin Yu ◽  
Stephen Salerno ◽  
Yi Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Cardiovascular Mortality ◽  
Coefficient Of Variation ◽  
Blood Pressure Variability ◽  
Meta Analysis ◽  
Cochrane Library ◽  
All Cause Mortality ◽  
The Cochrane Library ◽  
Stratified Analysis

<b><i>Background:</i></b> The prognostic value of blood pressure variability (BPV) in patients receiving hemodialysis is inconclusive. In this study, we aimed to assess the association between BPV and clinical outcomes in the hemodialysis population. <b><i>Methods:</i></b> Pubmed/Medline, EMBASE, Ovid, the Cochrane Library, and the Web of Science databases were searched for relevant articles published until April 1, 2020. Studies on the association between BPV and prognosis in patients receiving hemodialysis were included. <b><i>Results:</i></b> A total of 14 studies (37,976 patients) were included in the analysis. In patients receiving hemodialysis, systolic BPV was associated with higher all-cause (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 1.07–1.19; <i>p</i> &#x3c; 0.001) and cardiovascular (HR: 1.16; 95% CI: 1.10–1.22; <i>p</i> &#x3c; 0.001) mortality. In the stratified analysis of systolic BPV, interdialytic systolic BPV, rather than 44-h ambulatory systolic BPV or intradialytic systolic BPV, was identified to be related to both all-cause (HR: 1.11; 95% CI: 1.05–1.17; <i>p</i> = 0.001) and cardiovascular (HR: 1.14; 95% CI: 1.06–1.22; <i>p</i> &#x3c; 0.001) mortality. Among the different BPV metrics, the coefficient of variation of systolic blood pressure was a predictor of both all-cause (<i>p</i> = 0.01) and cardiovascular (<i>p</i> = 0.002) mortality. Although diastolic BPV was associated with all-cause mortality (HR: 1.09; 95% CI: 1.01–1.17; <i>p</i> = 0.02) in patients receiving hemodialysis, it failed to predict cardiovascular mortality (HR: 0.86; 95% CI: 0.52–1.42; <i>p</i> = 0.56). <b><i>Conclusions:</i></b> This meta-analysis revealed that, in patients receiving hemodialysis, interdialytic systolic BPV was associated with both increased all-cause and cardiovascular mortality. Furthermore, the coefficient of variation of systolic blood pressure was identified as a potentially promising metric of BPV in predicting all-cause and cardiovascular mortality. The use of 44-h ambulatory systolic BPV, intradialytic systolic BPV, and metrics of diastolic BPV in the prognosis of the hemodialysis population require further investigation (PROSPERO registry number: CRD42019139215).

scholarly journals Do toe blood pressures predict healing after minor lower limb amputation in people with diabetes? A systematic review and meta-analysis

2020 ◽  
Vol 17 (3) ◽  
pp. 147916412092886
Author(s):  
Clare Linton ◽  
Angela Searle ◽  
Fiona Hawke ◽  
Peta Ellen Tehan ◽  
Mathew Sebastian ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Relative Risk ◽  
Systolic Blood Pressure ◽  
Meta Analysis ◽  
Limb Amputation ◽  
Cochrane Library ◽  
Amputation Level ◽  
Pressure Index ◽  
Blood Pressures ◽  
The Cochrane Library

Purpose of study: To investigate toe systolic blood pressure and/or toe-brachial pressure index in predicting healing post minor diabetic foot amputations. Key methods: A systematic search of EMBASE and PubMed (including Medline and The Cochrane Library) was conducted from database inception to 9 March 2020. Two authors independently reviewed and selected relevant studies. Quality was assessed with a modified Critical Appraisal Skill Programme checklist. Main results: Ten studies met the inclusion criteria. Nine studies investigating toe systolic blood pressure reported healing occurred at mean toe systolic blood pressure values ⩾30 mmHg, ranging between 30 and 83.6 mmHg. The meta-analysis (four studies) found toe systolic blood pressure <30 mmHg had 2.09 times the relative risk of non-healing post amputation, compared to toe systolic blood pressure ⩾30 mmHg (relative risk = 2.09, 95% confidence interval: 1.37–3.20, p = 0.001). Two studies investigating toe-brachial pressure index report successful healing where toe-brachial pressure index >0.2, with one study reporting a higher value of 0.8. Main conclusions: Successful post-amputation healing outcomes were reported at mean toe systolic blood pressure ⩾30 mmHg, and the results varied considerably between the studies. Further research should identify whether variables, including amputation level, method of wound closure and length of post-operative follow-up periods, affect the values of toe systolic blood pressure and toe-brachial pressure index observed in this review.

Serum Uric Acid and Mortality in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-9
Author(s):  
Jialing Zhang ◽  
Xiangxue Lu ◽  
Han Li ◽  
Shixiang Wang
Keyword(s):  
Uric Acid ◽  
Serum Uric Acid ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Hazard Ratios ◽  
Increased Risk ◽  
All Cause Mortality ◽  
The Cochrane Library

Background: Existing studies suggested conflicting relationships between serum uric acid (SUA) and mortality in CKD patients. The present meta-analysis aimed to determine whether SUA can be a predictor for mortality in CKD cohorts. Method: A systematical search was conducted on PubMed, EMBASE, and The Cochrane Library to identify studies reporting the relationship between SUA level and all-cause and cardiovascular mortality in CKD populations. In addition, random-effects models were adopted to calculate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Results: On the whole, 29 studies were involved. In the present meta-analysis, patients exhibiting the maximum SUA level showed an association with a significantly higher risk for all-cause mortality (HR, 1.30; 95% CI, 1.06–1.59) compared with patients exhibiting the minimum SUA level. As revealed from the meta-analysis of 8 studies, low level of SUA was another predictor for all-cause mortality in patients with CKD (HR, 1.36; 95% CI, 1.20–1.54). No significant relationship was identified between SUA and cardiovascular mortality. Conclusions: Higher and lower SUA levels are both associated with significantly increased risk of all-cause mortality in patients with CKD. A appreciate dose of treatment of lowering SUA agents should be confirmed.

scholarly journals Prognostic Value of Serum Magnesium in Mortality Risk among Patients on Hemodialysis: A Meta-Analysis of Observational Studies

2020 ◽  
pp. 1-10
Author(s):  
Hongwei Wu ◽  
Qiang Li ◽  
Lijing Fan ◽  
Dewang Zeng ◽  
Xianggeng Chi ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Cardiovascular Mortality ◽  
Observational Studies ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Serum Magnesium ◽  
Cochrane Library ◽  
Lower Serum ◽  
All Cause Mortality ◽  
End Stage

<b><i>Background:</i></b> Previous studies have reported that serum magnesium (Mg) deficiency is involved in the development of heart failure, particularly in patients with end-stage kidney disease. The association between serum Mg levels and mortality risk in patients receiving hemodialysis is controversial. We aimed to estimate the prognostic value of serum Mg concentration on all-cause mortality and cardiovascular mortality in patients receiving hemodialysis. <b><i>Methods:</i></b> We did a systematic literature search in PubMed, EMBASE, Cochrane Library, and Web of Science to identify eligible studies that reported the prognostic value of serum Mg levels in mortality risk among patients on hemodialysis. We performed a meta-analysis by pooling and analyzing hazard ratios (HRs) and 95% confidence intervals (CIs). <b><i>Results:</i></b> We identified 13 observational studies with an overall sample of 42,967 hemodialysis patients. Higher all-cause mortality (adjusted HR 1.58 [95% CI: 1.31–1.91]) and higher cardiovascular mortality (adjusted HR 3.08 [95% CI: 1.27–7.50]) were found in patients with lower serum Mg levels after multivariable adjustment. There was marked heterogeneity (<i>I</i><sup>2</sup> = 79.6%, <i>p</i> &#x3c; 0.001) that was partly explained by differences in age stratification and study area. In addition, subgroup analysis showed that a serum Mg concentration of ≤1.1 mmol/L might be the vigilant cutoff value. <b><i>Conclusion:</i></b> A lower serum Mg level was associated with higher all-cause mortality and cardiovascular mortality in patients receiving hemodialysis.

scholarly journals Influence of Mindfulness and Relaxation on Treatment of Essential Hypertension: Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Fushun Zhang ◽  
Yuanyuan Zhang ◽  
Nan Jiang ◽  
Qiao Zhai ◽  
Juanjuan Hu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Systolic Blood Pressure ◽  
Publication Bias ◽  
Effect Size ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Control Group ◽  
Effect Model

Background. Some studies published previously have shown a strong correlation between hypertension and psychological nature including impulsion emotion or mindfulness and relaxation temperament, among which mindfulness and relaxation temperament might have a benign influence on blood pressure, ameliorating the hypertension. However, the conclusion was not confirmed. Objective. The meta-analysis was performed to investigate the influence of mindfulness and relaxation on essential hypertension interventions and confirm the effects. Methods. Systematic searches were conducted in common English and Chinese electronic databases (i.e., PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, Cochrane Library, and Chinese Biomedical Literature Database) from 1980 to 2020. A meta-analysis including 5 studies was performed using Rev Man 5.4.1 software to estimate the influence of mindfulness and relaxation on blood pressure, ameliorating the hypertension. Publication bias and heterogeneity of samples were tested using a funnel plot. Studies were analyzed using either a random-effect model or a fixed-effect model. Results. All the 5 studies investigated the influence of mindfulness and relaxation on diastolic and systolic blood pressure, with total 205 participants in the control group and 204 in the intervention group. The random-effects model (REM) was used to calculate the pooled effect for mindfulness and relaxation on diastolic blood pressure (I2 = 0%, t2 = 0.000, P = 0.41 ). The random pooled effect size (MD) was 0.30 (95% CI = −0.81–1.42, P = 0.59 ). REM was used to calculate the pooled effect for mindfulness and relaxation on systolic blood pressure (I2 = 49%, t2 = 3.05, P = 0.10 ). The random pooled effect size (MD) was −1.05 (95% CI = −3.29–1.18, P = 0.36 ). The results of this meta-analysis were influenced by publication bias to some degree. Conclusion. All the results showed less influence of mindfulness and relaxation might act on diastolic or systolic blood pressure, when mindfulness and relaxation are used to intervene in treating CVD and hypertension.

scholarly journals Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality: a systematic review

2020 ◽  
Vol 49 (2) ◽  
pp. 184-192
Author(s):  
Toby O Smith ◽  
Julia Ann Sillito ◽  
Choon-Hian Goh ◽  
Abdel-Rahman Abdel-Fattah ◽  
Alice Einarsson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
Moderate Quality ◽  
Home Based ◽  
Potential Association ◽  
All Cause Mortality ◽  
Incident Cardiovascular Disease ◽  
Quality Evidence

Abstract Background Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality. Methods Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised. Results Sixty-one studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, “day-by-day” and “week-to-week” variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed). Conclusion An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes were not possible.

scholarly journals Association between Serum Vitamin C and the Blood Pressure: A Systematic Review and Meta-Analysis of Observational Studies

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Li Ran ◽  
Wenli Zhao ◽  
Xiaodong Tan ◽  
Hongwu Wang ◽  
Kaito Mizuno ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vitamin C ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Meta Analysis ◽  
Serum Vitamin ◽  
Inverse Correlation ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
English Articles

Background. Hypertension is regarded as a major and independent risk factor of cardiovascular diseases, and numerous studies observed an inverse correlation between vitamin C intake and blood pressure. Aim. Our aim is to investigate the relationship between serum vitamin C and blood pressure, including the concentration differences and the correlation strength. Method. Two independent researchers searched and screened articles from the National Library of Medicine, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP databases, and WANFANG databases. A total of 18 eligible studies were analyzed in the Reviewer Manager 5.3 software, including 14 English articles and 4 Chinese articles. Results. In the evaluation of serum vitamin C levels, the concentration in hypertensive subjects is 15.13 μmol/L lower than the normotensive ones (mean difference=−15.13, 95% CI [-24.19, -6.06], and P=0.001). Serum vitamin C has a significant inverse relation with both systolic blood pressure (Fisher’s Z=−0.17, 95% CI [-0.20, -0.15], P<0.00001) and diastolic blood pressure (Fisher’s Z=−0.15, 95% CI [-0.20, -0.10], P<0.00001). Conclusions. People with hypertension have a relatively low serum vitamin C, and vitamin C is inversely associated with both systolic blood pressure and diastolic blood pressure.

scholarly journals Influence ofDPYDGenetic Polymorphisms on 5-Fluorouracil Toxicities in Patients with Colorectal Cancer: A Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Qiang Li ◽  
Ying Liu ◽  
Hong-Mei Zhang ◽  
Yin-Peng Huang ◽  
Tian-Yi Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Genetic Polymorphisms ◽  
Web Of Science ◽  
Meta Analysis ◽  
Dihydropyrimidine Dehydrogenase ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Meta Analyses ◽  
The Cochrane Library ◽  
Stratified Analysis

Our meta-analysis aggregated existing results from relevant studies to comprehensively investigate the correlations between genetic polymorphisms in dihydropyrimidine dehydrogenase (DPYD) gene and 5-fluorouracil (5-FU) toxicities in patients with colorectal cancer (CRC). The MEDLINE (1966∼2013), the Cochrane Library Database (Issue 12, 2013), EMBASE (1980∼2013), CINAHL (1982∼2013), Web of Science (1945∼2013), and the Chinese Biomedical Database (CBM) (1982∼2013) were searched without language restrictions. Meta-analyses were conducted with the use of STATA software (Version 12.0, Stata Corporation, College Station, TX, USA). Seven clinical cohort studies with a total of 946 CRC patients met our inclusion criteria, and NOS scores of each of the included studies were ≥5. Our findings showed thatDPYDgenetic polymorphisms were significantly correlated with high incidences of 5-FU-related toxicity in CRC patients. SNP-stratified analysis indicated that there were remarkable connections of IVS14+1G>A, 464T>A, and 2194G>A polymorphisms with the incidence of marrow suppression in CRC patients receiving 5-FU chemotherapy. Furthermore, we found that IVS14+1G>A, 496A>G, and 2194G>A polymorphisms were correlated with the incidence of gastrointestinal reaction. Ethnicity-stratified analysis also revealed thatDPYDgenetic polymorphisms might contribute to the development of marrow suppression and gastrointestinal reaction among Asians, but not among Caucasians. The present meta-analysis suggests thatDPYDgenetic polymorphisms may be correlated with the incidence of 5-FU-related toxicity in CRC patients.

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