scholarly journals The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018 (Preprint)

2019 ◽  
Author(s):  
Min Su ◽  
Victoria Haldane ◽  
Ross Upshur ◽  
Frank Sullivan ◽  
France Légaré ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Outcomes ◽  
Treatment Adherence ◽  
Retrospective Cohort ◽  
Regression Models ◽  
Hypertensive Patients ◽  
Primary Care Settings ◽  
Reference Number ◽  
The Impact

BACKGROUND Cardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence. OBJECTIVE This study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings. METHODS We will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization’s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level. RESULTS The project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019. CONCLUSIONS The findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/13571

scholarly journals Effects of Olive Oil on Blood Pressure: Epidemiological, Clinical, and Mechanistic Evidence

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1548 ◽  
Author(s):  
Marika Massaro ◽  
Egeria Scoditti ◽  
Maria Annunziata Carluccio ◽  
Nadia Calabriso ◽  
Giuseppe Santarpino ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Olive Oil ◽  
Mediterranean Diet ◽  
Lifestyle Changes ◽  
Antihypertensive Medications ◽  
Hypertensive Patients ◽  
High Oleic ◽  
The Mediterranean ◽  
The Impact

The increasing access to antihypertensive medications has improved longevity and quality of life in hypertensive patients. Nevertheless, hypertension still remains a major risk factor for stroke and myocardial infarction, suggesting the need to implement management of pre- and hypertensive patients. In addition to antihypertensive medications, lifestyle changes, including healthier dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, have been shown to favorably affect blood pressure and are now recommended as integrative tools in hypertension management. An analysis of the effects of nutritional components of the Mediterranean diet(s) on blood pressure has therefore become mandatory. After a literature review of the impact of Mediterranean diet(s) on cardiovascular risk factors, we here analyze the effects of olive oil and its major components on blood pressure in healthy and cardiovascular disease individuals and examine underlying mechanisms of action. Both experimental and human studies agree in showing anti-hypertensive effects of olive oil. We conclude that due to its high oleic acid and antioxidant polyphenol content, the consumption of olive oil may be advised as the optimal fat choice in the management protocols for hypertension in both healthy and cardiovascular disease patients.

scholarly journals Potential impact of a modest reduction in salt intake on blood pressure, cardiovascular disease burden and premature mortality: a modelling study

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000943 ◽  
Author(s):  
Leopold Ndemnge Aminde ◽  
Linda J Cobiac ◽  
J Lennert Veerman
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Disease ◽  
Salt Intake ◽  
Sodium Intake ◽  
Premature Mortality ◽  
Relative Reduction ◽  
Life Years ◽  
Potential Impact ◽  
The Impact

ObjectiveTo assess the potential impact of reduction in salt intake on the burden of cardiovascular disease (CVD) and premature mortality in Cameroon.MethodsUsing a multicohort proportional multistate life table model with Markov process, we modelled the impact of WHO’s recommended 30% relative reduction in population-wide sodium intake on the CVD burden for Cameroonian adults alive in 2016. Deterministic and probabilistic sensitivity analyses were conducted and used to quantify uncertainty.ResultsOver the lifetime, incidence is predicted to decrease by 5.2% (95% uncertainty interval (UI) 4.6 to 5.7) for ischaemic heart disease (IHD), 6.6% (95% UI 5.9 to 7.4) for haemorrhagic strokes, 4.8% (95% UI 4.2 to 5.4) for ischaemic strokes and 12.9% (95% UI 12.4 to 13.5) for hypertensive heart disease (HHD). Mortality over the lifetime is projected to reduce by 5.1% (95% UI 4.5 to 5.6) for IHD, by 6.9% (95% UI 6.1 to 7.7) for haemorrhagic stroke, by 4.5% (95% UI 4.0 to 5.1) for ischaemic stroke and by 13.3% (95% UI 12.9 to 13.7) for HHD. About 776 400 (95% UI 712 600 to 841 200) health-adjusted life years could be gained, and life expectancy might increase by 0.23 years and 0.20 years for men and women, respectively. A projected 16.8% change (reduction) between 2016 and 2030 in probability of premature mortality due to CVD would occur if population salt reduction recommended by WHO is attained.ConclusionAchieving the 30% reduction in sodium intake recommended by WHO could considerably decrease the burden of CVD. Targeting blood pressure via decreasing population salt intake could translate in significant reductions in premature CVD mortality in Cameroon by 2030.

scholarly journals Pengaruh Medication Therapy Management (MTM) terhadap Outcome Klinik dan Kualitas Hidup Pasien Hipertensi di Puskesmas Kota Yogyakarta

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Tiara Dewi Salindri Pratama ◽  
Nanang Munif Yasin ◽  
Susi Ari Kristina
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Clinical Outcomes ◽  
Medication Therapy Management ◽  
Wilcoxon Test ◽  
P Value ◽  
Hypertensive Patients ◽  
Therapy Management ◽  
Medication Therapy

Medication therapy management (MTM), is a service model aimed at helping general health problems by preventing morbidity and mortality. Hypertension is a non-communicable disease which is a serious health problem which requires long-term therapy.  This study aims to see the effect of MTM on clinical Outcomes and quality of life of patients in hypertensive patients. This type of research is a quasi experimental one group with a pretest-posttest design. Analysis using paired sample t-test and Wilcoxon test with a significance used P <0,05. Respondents were 70 people, 67,1% were women. The characteristics of the majority age are 55-64 years with a percentage of 51,4%, the majority of education level is high school with 42,8%, non-civil servant jobs with a percentage of 45,7%, the length of diagnosis is dominated by 1-10 years (77,1%) and comorbidities diabetes mellitus occurred the most (10,0%). The results showed that the quality of life increased from before getting MTM 54,4 ± 8,9 and after MTM intervention 60,4 ± 6,6 (P value <0,001). Clinical outcome from systolic 159,2 ± 8,9 mmHg and diastolic 103,8 ± 8,0 mmHg before MTM to 144,1 ± 14,4 mmHg for systolic and 89,7 ± 8,8 mmHg for diastolic with p value <0,001 (p <0,05) for systolic blood pressure and p value: 0,016 (p <0,05) after receiving MTM intervention. Medication Therapy Management (MTM) has a significant influence on improving the quality of life and clinical Outcomes of hypertensive patients. The higher the quality of life of patients, blood pressure becomes more controlled.

scholarly journals Do RATs save lives? A retrospective analysis of out-of-hospital cardiac arrest in an English Ambulance Service

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Richard Pilbery ◽  
M. Dawn Teare
Keyword(s):  
Retrospective Cohort ◽  
Regression Models ◽  
Spontaneous Circulation ◽  
Ambulance Service ◽  
Logistic Regression Models ◽  
Cad System ◽  
Routinely Collected Data ◽  
Collection Period ◽  
The Impact ◽  
Hospital Cardiac Arrest

<h3>Study aim</h3><p>This study aims to determine the impact of the red arrest teams (RATs) on survival to 30 days and return of spontaneous circulation (ROSC) at hospital.</p><h3>Methods</h3><p class="FirstParagraph">A retrospective cohort study analysing routinely collected data was undertaken. All adult (≥18 years) OHCAs entered onto the YAS computer aided dispatch (CAD) system between the 1st October, 2015 and 30th September, 2017 were included if the patient was resuscitated, and the cause of the arrest was considered to be medical in origin. Multivariable logistic regression models were created to enable adjustment for common predictors of survival and ROSC.</p><h3>Results</h3><p>During the 2-year data collection period, 15,151 cardiac arrests that were attended by Yorkshire Ambulance Service. After removing ineligible cases, 5,868 cardiac arrests remained. RATs attended 2,000/5,868 (34.1%) incidents, with each RAT attending a median of 13 cardiac arrests (IQR 7–23, minimum 1, maximum 78).</p><p class="FirstParagraph">The adjusted odds ratios suggest that a RAT on scene is associated with a slight increase in the odds of survival to 30 days (OR 1.01, 95%CI 0.74–1.38) and odds of ROSC on arrival at hospital (OR 1.13, 95%CI 0.99–1.29), compared to the odds of not having a RAT present, although neither results are statistically significant.</p><h3>Conclusion</h3><p class="FirstParagraph">The presence of a RAT paramedic was associated with a small increase in survival to 30 days and ROSC on arrival at hospital, although neither were statistically significant. Larger prospective studies are required to determine the effect of roles such as RAT on outcomes from OHCA</p>

scholarly journals Eligibility and subsequent burden of cardiovascular disease of four strategies for blood pressure-lowering treatment: a retrospective cohort study

The Lancet ◽  
2019 ◽  
Vol 394 (10199) ◽  
pp. 663-671 ◽  
Author(s):  
Emily Herrett ◽  
Sarah Gadd ◽  
Rod Jackson ◽  
Krishnan Bhaskaran ◽  
Elizabeth Williamson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Blood Pressure Lowering ◽  
Pressure Lowering

scholarly journals Association of Prior Atherosclerotic Cardiovascular Disease with Dementia After Stroke: A Retrospective Cohort Study

2020 ◽  
Vol 77 (3) ◽  
pp. 1157-1167
Author(s):  
Zhirong Yang ◽  
Duncan Edwards ◽  
Stephen Burgess ◽  
Carol Brayne ◽  
Jonathan Mant
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Practice Research Datalink ◽  
Atherosclerotic Cardiovascular Disease ◽  
Stroke Patients ◽  
Post Stroke ◽  
Increased Risk ◽  
The Impact

Background: Prior atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD) and peripheral artery disease (PAD), are common among patients with stroke, a known risk factor for dementia. However, whether these conditions further increase the risk of post-stroke dementia remains uncertain. Objective: To examine whether prior ASCVD is associated with increased risk of dementia among stroke patients. Methods: A retrospective cohort study was conducted using the Clinical Practice Research Datalink with linkage to hospital data. Patients with first-ever stroke between 2006 and 2017 were followed up to 10 years. We used multi-variable Cox regression models to examine the associations of prior ASCVD with dementia and the impact of prior ASCVD onset and duration. Results: Among 63,959 patients, 7,265 cases (11.4%) developed post-stroke dementia during a median of 3.6-year follow-up. The hazard ratio (HR) of dementia adjusted for demographics and lifestyle was 1.18 (95% CI: 1.12–1.25) for ASCVD, 1.16 (1.10–1.23) for CHD, and 1.25 (1.13–1.37) for PAD. The HRs additionally adjusted for multimorbidity and medications were 1.07 (1.00–1.13), 1.04 (0.98–1.11), and 1.11 (1.00–1.22), respectively. Based on the fully adjusted estimates, there was no linear relationship between the age of ASCVD onset and post-stroke dementia (all p-trend >0.05). The adjusted risk of dementia was not increased with the duration of pre-stroke ASCVD (all p-trend >0.05). Conclusion: Stroke patients with prior ASCVD are more likely to develop subsequent dementia. After full adjustment for confounding, however, the risk of post-stroke dementia is attenuated, with only a slight increase with prior ASCVD.

scholarly journals Clinical disparity of oxidative stress with blood pressure

2019 ◽  
pp. 3
Author(s):  
Elsa Mathew ◽  
J.K. Mukkadan
Keyword(s):  
Oxidative Stress ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Total Cholesterol ◽  
Diastolic Blood Pressure ◽  
Pearson Correlation ◽  
World Health ◽  
Oxidative Stress Marker ◽  
Major Public Health Problem ◽  
Hypertensive Patients

Background: Cardiovascular disease is one of the leading causes of mortality and morbidity in India and worldwide. Hypertension is a major public health problem because of its high frequency and concomitant risk of cardiovascular disease, kidney disease, and stroke. World Health Organization named it a Silent killer as hypertension is asymptomatic during its clinical course. Experimental evidence supports a role for oxidative stress in vascular injury and hypertension. This study was undertaken, to compare the serum levels of malondialdehyde (MDA) and super-oxide dismutase (SOD) among normotensive, prehypertensive and hypertensive subjects. Materials and methods: In this cross-sectional study, 34 normotensives, 44 prehypertensive and 45 hypertensive subjects were included. The participants were subjected to selection protocol consisting of physical examination and biochemical analysis. All subjects underwent blood pressure measurement, total cholesterol, and oxidative stress marker estimation, especially SOD and MDA. The comparison of parameters between the group was carried out using One Way ANOVA. The correlation between the parameter was analyzed by Karl Pearson Correlation Coefficient using SPSS 20.0. Result : The MDA (nmol/ml) in normotensive, prehypertensive and hypertensive patients was 2.55±0.072, 3.43±0.44 and 4.01±0.37 respectively. SOD (U/ml) level in normotensive, prehypertensive and hypertensive patients was 13.47±1.96, 11.57±0.81, and 8.52±1.78 respectively. Systolic and diastolic blood pressure had a negative correlation with SOD. MDA levels show a positive correlation with systolic blood pressure and diastolic blood pressure. Total cholesterol had no significant with SOD and MDA. Conclusion: The present study showed a strong association of oxidative stress with systolic and diastolic blood pressure.

scholarly journals Vitamin D Receptor Activation Mitigates the Impact of Uremia on Endothelial Function in the 5/6 Nephrectomized Rats

2010 ◽  
Vol 2010 ◽  
pp. 1-10 ◽  
Author(s):  
J. Ruth Wu-Wong ◽  
William Noonan ◽  
Masaki Nakane ◽  
Kristin A. Brooks ◽  
Jason A. Segreti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Heart Rate ◽  
Vitamin D ◽  
Endothelial Function ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Receptor Activation ◽  
The Impact

Endothelial dysfunction increases cardiovascular disease risk in chronic kidney disease (CKD). This study investigates whether VDR activation affects endothelial function in CKD. The 5/6 nephrectomized (NX) rats with experimental chronic renal insufficiency were treated with or without paricalcitol, a VDR activator. Thoracic aortic rings were precontracted with phenylephrine and then treated with acetylcholine or sodium nitroprusside. Uremia significantly affected aortic relaxation (% in NX rats versus % in SHAM at 30 M acetylcholine). The endothelial-dependent relaxation was improved to –%, –%, and –% in NX rats treated with paricalcitol at 0.021, 0.042, and 0.083 g/kg for two weeks, respectively, while paricalcitol at 0.042 g/kg did not affect blood pressure and heart rate. Parathyroid hormone (PTH) suppression alone did not improve endothelial function since cinacalcet suppressed PTH without affecting endothelial-dependent vasorelaxation. N-omega-nitro-L-arginine methyl ester completely abolished the effect of paricalcitol on improving endothelial function. These results demonstrate that VDR activation improves endothelial function in CKD.

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