Masked uncontrolled hypertension: risk factors and ways of influence

2021 ◽  
Author(s):  
A. S. Shalimova ◽  
J. Wolf
Keyword(s):  
Risk Factors ◽  
Calcium Antagonist ◽  
Antihypertensive Therapy ◽  
Sleep Disturbances ◽  
Uncontrolled Hypertension ◽  
Initial Assessment ◽  
Hypertension Control ◽  
Elderly Age ◽  
Essential Point ◽  
Current Guidelines

According to the current Guidelines, the effectiveness of antihypertensive therapy is assessed mainly by achieving target levels of office blood pressure (BP). However, masked uncontrolled hypertension (MUCH) increases the risk of cardiovascular events, therefore deserves timely diagnosis and correction. Objective — to establish the prevalence and risk factors of MUCH and to clarify how the use of fixed combinations can affect the control of office and out‑of‑office BP. Materials and methods. We examined 70 patients with arterial hypertension (AH) of 1 — 2 degrees. The initial assessment of the effectiveness of antihypertensive therapy was carried out 3 months after its appointment. Of the 70 patients initially enrolled in the study, 63 were able to reach essential office BP reduction point (< 140/90 mm Hg, according to 2020 ISH Guidelines). Patients who reached essential point of office BP reduction were additionally provided 24 hour ambulatory BP monitoring (ABPM) to detect possible MUCH. Results. It was found that among 63 patients in whom AH was controlled according to office BP data, 37 patients (58.7 %) had insufficient hypertension control according to ABPM data (they had MUCH). An assessment of possible factors for the development of MUCH showed that elderly age occurred in 29 (78.4 %) patients with MUCH, male sex — in 22 (59.5 %) patients, smoking — in 26 (70.3 %) patients, stress — in 29 (78.4 %) patients, various sleep disorders — in 17 (45.9 %) patients, diabetes mellitus (DM) — in 21 (56.8 %) patients, obesity — in 25 (67.6 %) patients, insulin resistance (IR) — in 27 (73 %) patients, chronic kidney disease (CKD) — in 13 (35.1 %) patients. Analysis of patient therapy showed that out of 37 patients with MUCH, 7 patients received monotherapy, 9 patients received free dual combinations (ACE inhibitor/sartan + calcium antagonist/diuretic), and 21 patients received fixed dual combinations. In accordance with 2018 ESC/ESH Guidelines, antihypertensive therapy was strengthened for patients with MUCH: those patients who had previously received monotherapy or free combinations were transferred to double fixed combinations (ACE inhibitors/sartans + calcium antagonist/diuretic), in which both drugs acted for 24 hours, and those patients with MUCH who received double fixed combinations were transferred to triple fixed combinations. Evaluation of antihypertensive therapy after 3 months showed that of 37 patients with initially established MUCH, complete BP control was achieved in 32 (86.5 %) patients (in the remaining 5 patients, despite sufficient control of office BP, MUCH was maintained according to ABPM data). Conclusions. In inadequate control of out‑of‑office BP, various disturbances of the circadian rhythm (with a predominance of the non‑dipper rhythm) are more common than with complete BP control. MUCH is associated with such risk factors as elderly age, male gender, smoking, stress, sleep disturbances, DM, obesity, IR, and CKD. Strengthening antihypertensive therapy contributed to the achievement of both office and out‑of‑office BP in 86.5 % of patients with previously established MUCH.  

Abstract P131: RISK FACTORS AND WAYS OF INFLUENCING MASKED UNCONTROLLED HYPERTENSION

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Anna Shalimova
Keyword(s):  
Risk Factors ◽  
Circadian Rhythm ◽  
Antihypertensive Therapy ◽  
Sleep Disturbances ◽  
Male Gender ◽  
Uncontrolled Hypertension ◽  
Initial Assessment ◽  
Elderly Age ◽  
Male Sex ◽  
Circadian Rhythm Disorders

Purpose: to establish risk factors of masked uncontrolled hypertension (MUCH) and clarify how fixed combinations can affect blood pressure (BP) control. Methods: We examined 70 patients with hypertension. The initial assessment of the effectiveness of antihypertensive therapy was carried out 3 months after its appointment. Of the 70 patients, 63 were able to reach essential office BP reduction point (these patients were additionally scheduled for ABPM). Results: Among 63 patients in whom hypertension was controlled according to office BP data, 58.7% had insufficient BP control according to ABPM data. Among patients with insufficient control of out-of-office BP, there were significantly more patients with circadian rhythm disorders (p=0.000). An assessment of possible factors for the development of MUCH showed that elderly age occurred in 78.4%, male sex - in 59.5%, smoking - in 70.3%, stress - in 78.4%, various sleep disorders - in 45.9%, diabetes mellitus (DM) - in 56.8%, obesity - in 67.6%, insulin resistance (IR) - in 73%, chronic kidney disease (CKD) - in 35.1% patients with MUCH. Analysis of patient therapy showed that out of 37 patients with MUCH, 7 patients received monotherapy, 9 patients - free dual combinations, and 21 patients - fixed dual combinations. For patients with MUCH, antihypertensive therapy was strengthened: patients who had previously received monotherapy or free combinations were transferred to double fixed combinations (both drugs acted for 24 hours), and those patients who received double fixed combinations were transferred to triple fixed combinations. Evaluation of therapy after 3 months showed that of 37 patients with initially established MUCH, complete BP control was achieved in 86.5% (in the remaining 13.5%, despite sufficient office BP control, MUCH was maintained according to ABPM data). Conclusions: In inadequate control of out-of-office BP, disturbances of the circadian rhythm are more common than with complete BP control. MUCH is associated with such risk factors as elderly age, male gender, smoking, stress, sleep disturbances, DM, obesity, IR, and CKD. Strengthening antihypertensive therapy contributed to the achievement of both office and out-of-office BP in 86.5% of patients with previously established MUCH.

Arterial Hypertension and Multiple Myeloma: Physiopathology and Cardiovascular Risk and ‘Practical’ Indications in Patients Receiving Carfilzomib

2019 ◽  
Vol 15 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Alberto Milan ◽  
Giulia Bruno ◽  
Ilaria Maffei ◽  
Andrea Iannaccone ◽  
Agnese Ravera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
Proteasome Inhibitors ◽  
Good Control ◽  
Cardiovascular Complications ◽  
Uncontrolled Hypertension ◽  
Refractory Multiple Myeloma ◽  
Current Guidelines

The introduction of carfilzomib in the treatment of relapsing and refractory multiple myeloma has allowed a significant increase in survival. The most frequent adverse effect of Carfilzomib treatment is arterial hypertension, even though the exact physiopathological mechanism are still unclear. MM patients, on the other hand, often present significant cardiovascular risk factors and comorbidities. Uncontrolled hypertension is frequently the cause of cardiovascular complications. It has been estimated that up to 50% of subjects in the general population are unaware of their hypertensive condition and only half of those who are aware of this risk factor present good control of blood pressure. Although the management of arterial hypertension is clearly important in reducing the risk of cardiovascular events, and is well described by the current guidelines, no clear indications are provided on how to approach and treat specifically MM patients undergoing treatment with proteasome inhibitors. The aim of our work is to summarize a practical approach to the stratification of cardiovascular risk of hypertensive in patients who are candidates for or actively treated with carfilzomib for refractory multiple myeloma (MMR). MM patients eligible for carfilzomib treatment should preliminary undergo a careful cardiovascular risk stratification. Perspective studies will help to better identify the specific risk factors that should be considered and treated in these patients.

scholarly journals Disease activity index is associated with subclinical atherosclerosis in childhood-onset systemic lupus erythematosus

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Priscila B. S. Medeiros ◽  
Roberta G. Salomão ◽  
Sara R. Teixeira ◽  
Diane M. Rassi ◽  
Luciana Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Subclinical Atherosclerosis ◽  
Disease Activity Index ◽  
Uncontrolled Hypertension ◽  
Childhood Onset ◽  
Systemic Lupus

Abstract Background Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events. The present study determined the prevalence of subclinical atherosclerosis in childhood-onset SLE using the carotid intima-media thickness (CIMT) measurement and investigated associations between traditional and nontraditional risk factors for atherosclerosis, such as medications, SLE Disease Activity Index - SLEDAI-2 K and SLICC-ACR damage index and CIMT. Methods Cross-sectional prospective study between 2017 and 2018. CIMT was assessed by ultrasonography. Data were collected by chart review, nutritional evaluation and laboratory tests and analyzed by Fisher, Wilcoxon-Mann-Whitney tests, multiple linear and log binomial regression. Results Twenty-eight patients (mean age 13.9 years, SD 3) were enrolled. The prevalence of subclinical atherosclerosis was 32% (95% CI 14.8, 49.4). The mean CIMT was 0.43 ± 0.035 mm. The most common traditional risk factors observed were dyslipidemia (82.1%), uncontrolled hypertension (14.2%), obesity (14.3%), and poor diet (78.6%). Uncontrolled hypertension (p = 0.04), proteinuria (p = 0.02), estimated glomerular filtration rate < 75 ml /min/1.73 m2 (p = 0.02) and SLEDAI-2 K > 5 (P = 0.04) were associated with subclinical atherosclerosis. SLEDAI-2 K > 5 maintained association with CIMT after adjusting for control variables. Conclusion Subclinical atherosclerosis is frequently observed in cSLE, mainly in patients with moderate to severe disease activity.

scholarly journals Sleep quality and COVID-19 outcomes: the evidence-based lessons in the framework of predictive, preventive and personalised (3P) medicine

2021 ◽  
Author(s):  
Kneginja Richter ◽  
Stefanie Kellner ◽  
Thomas Hillemacher ◽  
Olga Golubnitschaja
Keyword(s):  
Risk Factors ◽  
Sleep Quality ◽  
Sleep Disturbances ◽  
Acute Infection ◽  
Evidence Based ◽  
Physical And Mental Health ◽  
Mild Disease ◽  
Depth Analysis ◽  
Medical Approach ◽  
Poor Outcomes

AbstractSleep quality and duration play a pivotal role in maintaining physical and mental health. In turn, sleep shortage, deprivation and disorders are per evidence the risk factors and facilitators of a broad spectrum of disorders, amongst others including depression, stroke, chronic inflammation, cancers, immune defence insufficiency and individual predisposition to infection diseases with poor outcomes, for example, related to the COVID-19 pandemic. Keeping in mind that COVID-19-related global infection distribution is neither the first nor the last pandemic severely affecting societies around the globe to the costs of human lives accompanied with enormous economic burden, lessons by predictive, preventive and personalised (3P) medical approach are essential to learn and to follow being better prepared to defend against global pandemics. To this end, under extreme conditions such as the current COVID-19 pandemic, the reciprocal interrelationship between the sleep quality and individual outcomes becomes evident, namely, at the levels of disease predisposition, severe versus mild disease progression, development of disease complications, poor outcomes and related mortality for both - population and healthcare givers. The latter is the prominent example clearly demonstrating the causality of severe outcomes, when the long-lasting work overload and shift work rhythm evidently lead to the sleep shortage and/or deprivation that in turn causes immune response insufficiency and strong predisposition to the acute infection with complications. This article highlights and provides an in-depth analysis of the concerted risk factors related to the sleep disturbances under the COVID-19 pandemic followed by the evidence-based recommendations in the framework of predictive, preventive and personalised medical approach.

Abstract P614: Effect Sizes of Vascular Risk Factors for Stroke Occurrence by Age Among West Africans

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mayowa Owolabi ◽  
FRED S SARFO ◽  
Onoja Akpa ◽  
Joshua Akinyemi ◽  
Albert Akpalu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Age ◽  
Meat Consumption ◽  
The Elderly ◽  
Vascular Risk Factors ◽  
Effect Sizes ◽  
Modifiable Risk Factors ◽  
Age Group ◽  
Vascular Risk ◽  
Elderly Age

Background: Age is a non-modifiable risk factor for stroke occurrence due its influence on vascular risk factor acquisition. In sub-Saharan Africa, the effect sizes of vascular risk factors for stroke occurrence by age is unknown. Objective: To quantify the magnitude and direction of the effect sizes of key modifiable risk factors of stroke according to three age groups: <50years(young), 50-65 years(middle age) and >65 years(elderly) in West Africa. Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular, lifestyle, stroke severity and outcomes were performed. We used conditional logistic regression to estimate adjusted odds ratios (aOR) of vascular risk factors of stroke. Results: Among 3,553 stroke cases, 813(22.9%) were young, 1441(40.6%) were middle-aged and 1299(36.6%) were elderly. Five modifiable risk factors were consistently associated with stroke occurrence regardless of age namely hypertension, dyslipidemia, diabetes mellitus, regular meat consumption and non-consumption of green vegetables. Among the 5 co-shared risk factors, the effect size, aOR(95%CI) of dyslipidemia, 4.13(2.64-6.46), was highest among the young age group, hypertension, 28.93(15.10-55.44) and non-consumption of vegetables 2.34(1.70-3.23) was highest among the middle-age group while diabetes, aOR of 3.50(2.48-4.95) and meat consumption, 2.40(1.76-3.26) were highest among the elderly age group. Additionally, among the young age group cigarette smoking and cardiac disease were associated with stroke. Furthermore, physical inactivity and salt intake were associated with stroke in the middle-age group while cardiac disease was associated with stroke in the elderly age group. Conclusions: Age has a profound influence on the profile, magnitude and direction of effect sizes of vascular risk factors for stroke occurrence among West Africans. Population-level prevention of stroke must target both co-shared dominant risk factors as well as factors that are unique to specific age bands in Africa.

scholarly journals Low Body Mass Index Can Identify Majority of Osteoporotic Inflammatory Bowel Disease Patients Missed by Current Guidelines

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ashish Atreja ◽  
Ashish Aggarwal ◽  
Angelo A. Licata ◽  
Bret A. Lashner
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
At Risk ◽  
Risk Factor ◽  
Risk Group ◽  
Low Bmi ◽  
Inflammatory Bowel ◽  
Provider Adherence ◽  
Not At Risk ◽  
Current Guidelines

Background. Patients with inflammatory bowel disease (IBD) are at high risk of developing osteoporosis. Our objective was to determine the usefulness of IBD guidelines in identifying patients at risk for developing osteoporosis.Methods. We utilized institutional repository to identify patients seen in IBD center and extracted data on demographics, disease history, conventional, and nonconventional risk factors for osteoporosis and Dual Energy X-ray Absorptiometry (DXA) findings.Results. 59% of patients (1004/1703) in our IBD cohort had at least one risk factor for osteoporosis screening. DXA was documented in 263 patients with indication of screening (provider adherence, 26.2%), and of these, 196 patients had DXA completed (“at-risk” group). Ninety-five patients not meeting guidelines-based risk factors also had DXA completed (“not at-risk” group). 139 (70.9%) patients in “at-risk” group had low BMD, while 51 (53.7%) of “not-at-risk” patients had low BMD. Majority of the patients with osteoporosis (83.3%) missed by the current guidelines had low BMI. Multivariate logistic regression analysis showed that low BMI was the strongest risk factor for osteoporosis (OR 3.07; 95% CI, 1.47–6.42;P=0.003).Conclusions. Provider adherence to current guidelines is suboptimal. Low BMI can identify majority of the patients with osteoporosis that are missed by current guidelines.

scholarly journals Longitudinal Course and Risk Factors for Fatigue in Adolescents: The Mediating Role of Sleep Disturbances

2013 ◽  
Vol 38 (10) ◽  
pp. 1070-1080 ◽  
Author(s):  
See Wan Tham ◽  
Amy Lewandowski Holley ◽  
Chuan Zhou ◽  
Gregory N. Clarke ◽  
Tonya M. Palermo
Keyword(s):  
Risk Factors ◽  
Sleep Disturbances ◽  
Longitudinal Course ◽  
Mediating Role

scholarly journals Sleep Disorders in Pregnancy

2021 ◽  
Author(s):  
Patrizia Moretti ◽  
Giulia Menculini ◽  
Lucia Gonfia
Keyword(s):  
Risk Factors ◽  
Circadian Rhythms ◽  
Pregnant Women ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Pharmacological Treatments ◽  
Mother And Child ◽  
Physiological Sleep ◽  
In Pregnancy

Sleep disturbances and changes in circadian rhythms are commonly observed in pregnant women. These disorders can result from anatomical, physiological, psychological, and hormonal alterations that can influence sleeping during this phase. Sleep disorders during pregnancy can be responsible for detrimental effects on both mother and foetus. In this chapter we will focus on the epidemiology of sleep disorders, physiological sleep mechanisms and their alterations during pregnancy, as well as on risk factors for sleep disorders in pregnancy. We will then focus of the most frequent sleep disorders during pregnancy, also considering eventual adverse implications for both mother and child, prognosis, and possible pharmacological and non-pharmacological treatments.

scholarly journals A study on prevalence of chronic kidney disease and its risk factors among adults in selected slums of Chennai

2019 ◽  
Vol 6 (2) ◽  
pp. 504
Author(s):  
K. Kokila ◽  
K. Chellavel Ganapathi
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cross Sectional Study ◽  
Uncontrolled Hypertension ◽  
Adult Males ◽  
Cross Sectional ◽  
Slum Population

Background: Chronic kidney disease (CKD) is a silent epidemic. The true prevalence of CKD with in a population are very difficult to estimate, since early to moderate CKD were usually asymptomatic. ESRD in the consequence of CKD is one of the most expensive diseases to treat.Only way is to prevent it and Hence this was conducted to estimate the prevalence of CKD and its associated risk factors among adults in selected slums of Chennai.Methods: This is a cross sectional study done from May 2013 to June 2014 in selected slums of Chennai. The study population includes adult males and females. Multi stage sampling method used. Sample size covered was 400. A semi structured questionnaire used as tool. Based on the serum creatinine eGFR calculated using modified MDRD study equation and CKD prevalence was identified. The data was entered in MS excel and analyzed using SPSS version 21.Results: Total of 400 participants involved. Females were predominant in the study. Among them, 67 (16.8%) were diagnosed as CKD patients and Stage 1, 4.0% had stage 2, 3.6% had stage 3, 1.3% had stage 4 and 0.5% had stage 5 at the time of diagnosis.Conclusions: This study revealed prevalence of CKD among slum population was 16.8%. This study showed that old age, uncontrolled hypertension, uneducated, Diabetes with poor control, overuse of analgesics, H/o smoking, obesity, alcoholism, passive smoking, family H/o CKD and proteinuria were significant risk factor for CKD among study subjects. Slum population with risk factors should be regularly screened for CKD.

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