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2019年 9月 期刊文獻精選

Prevention of hypertension in patients with prehypertension in the rural areas of China: a community-based quasi-experiment


Haijian Guo MPH, Xuanxuan Wang PhD, Jinshui Xu MPH, Tao Mao MPH 及 Jiaying Chen Prof
Lancet, The, 2018-10-01, 卷 392, 頁面 S82-S82, Copyright © 2018 Elsevier Ltd


Abstract

Background

People with prehypertension are highly likely to develop hypertension and other cardiovascular diseases. Lifestyle modifications may prevent hypertension in patients with prehypertension, but evidence remains scarce in developing countries. This study aimed to investigate whether a community-based intervention could prevent hypertension through lifestyle modifications in people with prehypertension in the rural areas of China.

Methods

A community-based quasi-experiment design was applied. Eighteen villages from six townships in Sheyang county, a rural area in eastern China, were randomly sampled. Of these local residents, patients with prehypertension—a systolic blood pressure (SBP) of 120–139 mm Hg or a diastolic blood pressure (DBP) of 80–89 mm Hg—and who were 30–60 years old were screened. Participants from three of the townships (n=206) were randomly assigned to the intervention group, and those from the other three townships (n=250) were assigned to the control group. At the outset, intervention group participants received individual consultations from a community health management team to assess their self-management ability, determine their lifestyle, set goals for a healthier lifestyle, and design individualised action plans. A guideline booklet was provided to intervention group participants, which contained detailed explanations of hypertension, prehypertension, healthy lifestyles and their impacts, and methods to lose weight, cease smoking, and deal with mental pressure. Intervention group participants also received quarterly follow-ups to assess the implementation of action plans, identify difficulties in changing unhealthy lifestyles, and find feasible solutions. In both intervention and control groups, usual care was provided to participants according to national guidelines, and the available resources were the same across the townships. Evaluations were conducted at baseline, and at the end of months 6, 12, 18, and 30. Between-group analyses were performed using repeated measures ANOVA. Written informed consent was obtained from the participants.

Findings

At 30 months, 18 participants in the intervention group (n=188) showed progression to hypertension, whereas 47 in the control group (n=234) developed hypertension. This difference between intervention and control groups was statistically significant (9.6 vs 20.1%, p=0.007). Significant changes in DBP (–2.7 vs 0.7 mmHg, p<0·0001), weight (–0.79 vs −0.66 kg, p=0.029), and daily walking steps (11 500 vs 8000 steps, p<0.0001) were observed between intervention and control groups. No differential effects were found for SBP, drinking, and smoking, with both groups showing substantial improvements.


Interpretation

This intervention could prevent hypertension among patients with prehypertension by improving health-related behaviours. This study might be one of the first community-based experiments implemented among people with prehypertension in the rural areas of China. Further investigations are required to assess the sustainability of this intervention.



Long-term mortality after blood pressure-lowering and lipid-lowering treatment in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study: 16-year follow-up results of a randomised factorial trial


Ajay Gupta MRCP, Judith Mackay MRCP, Andrew Whitehouse MBBS, Thomas Godec MSc, Tim Collier MSc, Stuart Pocock Prof, Neil Poulter Prof 及 Peter Sever Prof
Lancet, The, 2018-09-29, 卷 392, 期 10153, 頁面 1127-1137, Copyright © 2018 Elsevier Ltd


Abstract

Background

In patients with hypertension, the long-term cardiovascular and all-cause mortality effects of different blood pressure-lowering regimens and lipid-lowering treatment are not well documented, particularly in clinical trial settings. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy Study reports mortality outcomes after 16 years of follow-up of the UK participants in the original ASCOT trial.

Methods

ASCOT was a multicentre randomised trial with a 2 × 2 factorial design. UK-based patients with hypertension were followed up for all-cause and cardiovascular mortality for a median of 15.7 years (IQR 9.7–16.4 years). At baseline, all patients enrolled into the blood pressure-lowering arm (BPLA) of ASCOT were randomly assigned to receive either amlodipine-based or atenolol-based blood pressure-lowering treatment. Of these patients, those who had total cholesterol of 6.5 mmol/L or lower and no previous lipid-lowering treatment underwent further randomisation to receive either atorvastatin or placebo as part of the lipid-lowering arm (LLA) of ASCOT. The remaining patients formed the non-LLA group. A team of two physicians independently adjudicated all causes of death.

Findings

Of 8580 UK-based patients in ASCOT, 3282 (38.3%) died, including 1640 (38.4%) of 4275 assigned to atenolol-based treatment and 1642 (38.1%) of 4305 assigned to amlodipine-based treatment. 1768 of the 4605 patients in the LLA died, including 903 (39.5%) of 2288 assigned placebo and 865 (37.3%) of 2317 assigned atorvastatin. Of all deaths, 1210 (36.9%) were from cardiovascular-related causes. Among patients in the BPLA, there was no overall difference in cardiovascular mortality between treatments (adjusted hazard ratio [HR] 0.90, 95% CI 0.81–1.01, p=0.0776]), although significantly fewer deaths from stroke (adjusted HR 0.71, 0.53–0.97, p=0.0305) occurred in the amlodipine-based treatment group than in the atenolol-based treatment group. There was no interaction between treatment allocation in the BPLA and in the LLA. However, in the 3975 patients in the non-LLA group, there were fewer cardiovascular deaths (adjusted HR 0.79, 0.67–0.93, p=0.0046) among those assigned to amlodipine-based treatment compared with atenolol-based treatment (p=0.022 for the test for interaction between the two blood pressure treatments and allocation to LLA or not). In the LLA, significantly fewer cardiovascular deaths (HR 0.85, 0.72–0.99, p=0.0395) occurred among patients assigned to statin than among those assigned placebo.


Interpretation

Our findings show the long-term beneficial effects on mortality of antihypertensive treatment with a calcium channel blocker-based treatment regimen and lipid-lowering with a statin: patients on amlodipine-based treatment had fewer stroke deaths and patients on atorvastatin had fewer cardiovascular deaths more than 10 years after trial closure. Overall, the ASCOT Legacy study supports the notion that interventions for blood pressure and cholesterol are associated with long-term benefits on cardiovascular outcomes.




Angiotensin-Converting Enzyme Inhibitors vs. Angiotensin Receptor Blockers for the Treatment of Hypertension in Adults With Type 2 Diabetes: Why We Favour Angiotensin Receptor Blockers


Thomas A. Mavrakanas MD 及 Mark L. Lipman MD
Canadian Journal of Diabetes, 2018-04-01, 卷 42, 期 2, 頁面 118-123, Copyright © 2017 Diabetes Canada


Abstract

Interpretation

Cardiovascular disease is the principal cause of morbidity and mortality in patients with diabetes mellitus. The incidence or progression of kidney disease is also common in these patients. Several clinical trials have established the efficacy of angiotensin receptor blockers for the prevention of adverse cardiovascular and renal outcomes in this population and are summarized in this review article. Head-to-head comparison of angiotensin receptor blockers with angiotensin-converting enzyme inhibitors has shown similar cardioprotective and renoprotective properties of both medication classes. However, angiotensin receptor blockers have an improved safety profile with fewer episodes of cough and angioedema and may be the agent of choice in patients with diabetes and hypertension. Novel therapeutic strategies, such as those that include a mineralocorticoid receptor blocker or a selective sodium-glucose cotransporter type 2 inhibitor, may further protect patients with diabetes from cardiovascular and renal complications.




Prevention and Control of Hypertension


Robert M. Carey MD, Paul Muntner PhD, Hayden B. Bosworth PhD 及 Paul K. Whelton MB, MD, MSc
JACC (Journal of the American College of Cardiology), 2018-09-11, 卷 72, 期 11, 頁面 1278-1293, Copyright © 2018 American College of Cardiology Foundation


Abstract
Hypertension, the leading risk factor for cardiovascular disease, originates from combined genetic, environmental, and social determinants. Environmental factors include overweight/obesity, unhealthy diet, excessive dietary sodium, inadequate dietary potassium, insufficient physical activity, and consumption of alcohol. Prevention and control of hypertension can be achieved through targeted and/or population-based strategies. For control of hypertension, the targeted strategy involves interventions to increase awareness, treatment, and control in individuals. Corresponding population-based strategies involve interventions designed to achieve a small reduction in blood pressure (BP) in the entire population. Having a usual source of care, optimizing adherence, and minimizing therapeutic inertia are associated with higher rates of BP control. The Chronic Care Model, a collaborative partnership among the patient, provider, and health system, incorporates a multilevel approach for control of hypertension. Optimizing the prevention, recognition, and care of hypertension requires a paradigm shift to team-based care and the use of strategies known to control BP.



Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry)


Sreekanth Vemulapalli MD, Taku Inohara MD, Sunghee Kim PhD, Laine Thomas PhD, Jonathan P. Piccini MD, MHS, Manesh R. Patel MD, Paul Chang MD, Gregg C. Fonarow MD, Michael D. Ezekowitz MB, ChB, Elaine Hylek MD, Alan S. Go MD, Peter R. Kowey MD, Kenneth W. Mahaffey MD, Bernard J. Gersh MB, ChB, DPhil 及 Eric D. Peterson MD, MPH
American Journal of Cardiology, The, 2019-05-15, 卷 123, 期 10, 頁面 1628-1636, Copyright © 2019 Elsevier Inc.


Abstract
Systolic blood pressure (SBP) and its association with clinical outcomes in atrial fibrillation (AF) patients in community practice are poorly characterized. In patients with AF, we sought to (1) examine the prevalence of baseline uncontrolled hypertension and the overall change in SBP control, (2) identify predictors of uncontrolled SBP over 2 years of follow-up, and (3) determine the relation between SBP and clinical outcomes. We analyzed 10,132 patients with AF at 176 clinics in the ORBIT-AF registry between 2010 and 2014, classified as: (1) no history of hypertension; (2) controlled hypertension (baseline SBP <140 mm Hg); (3) and uncontrolled hypertension (baseline SBP >140 mm Hg). Predictors of SBP >140 mm Hg at baseline or in follow-up were identified with pooled logistic regression. Random effects Cox regression models were used to compare cardiovascular outcomes and major bleeding as a function of continuous, time-dependent SBP. Overall 8,383 (83%) of patients with AF had hypertension. Of these, 24.2% (n = 2032) had uncontrolled baseline SBP, with little change over 2 years. Predictors of elevated follow-up SBP included uncontrolled baseline SBP, females, previous percutaneous coronary intervention, and diabetes. For every 5 mm Hg increase in follow-up SBP, the adjusted risk of stroke or systemic embolism or transient ischemic attack (adjusted hazard ratio [aHR] 1.05, 95% confidence interval [CI] 1.01 to 1.08, p = 0.01), myocardial infarction (aHR 1.05, 95% CI 1.00 to 1.11, p = 0.04), and major bleeding (aHR 1.03, 95% CI 1.00 to 1.06, p = 0.04) increased modestly. In conclusion, in patients with AF, higher SBP was associated with increasing adverse events; therefore, more rigorous blood pressure control should be emphasized.



Arterial hypertension in cancer: The elephant in the room


Giacomo Tini, Matteo Sarocchi, Giuliano Tocci, Eleonora Arboscello, Giorgio Ghigliotti, Giuseppina Novo, Claudio Brunelli, Daniel Lenihan, Massimo Volpe 及 Paolo Spallarossa
International Journal of Cardiology, 2019-04-15, 卷 281, 頁面 133-139, Copyright © 2019 Elsevier B.V.


Abstract


The great therapeutical success achieved by oncology is counterbalanced by growing evidences of cardiovascular (CV) toxicity due to many antineoplastic treatments. Cardiac adverse events may cause premature discontinuation of effective oncologic treatments or occur as late events undermining the oncologic success. Arterial hypertension is both the most common comorbidity in cancer patients and a frequent adverse effect of anticancer therapies.

A pre-existing hypertension is known to increase the risk of other cardiac adverse events due to oncologic treatments, in particular heart failure. Moreover, as a strict association between cancer and CV diseases has emerged over the recent years, various analyses have shown a direct relationship between hypertension and cancer incidence and mortality. Finally, many antineoplastic treatments may cause a rise in blood pressure (BP) values, particularly the novel anti VEGF agents, this possibly compromising efficacy of chemotherapy.

Aim of this review is to revise the topic and the many aspects linking arterial hypertension and cancer, and to provide a comprehensive and practical guide of the current treatment approaches.



Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial


Michel Azizi Prof, Roland E Schmieder Prof, Felix Mahfoud Prof, Michael A Weber Prof, Joost Daemen MD, Justin Davies MBBS, Jan Basile MD, Ajay J Kirtane MD, Yale Wang MD, Melvin D Lobo PhD, Manish Saxena MBBS, Lida Feyz MD, Florian Rader MD, Philipp Lurz MD, Jeremy Sayer MD, Marc Sapoval Prof, Terry Levy MBChB, Kintur Sanghvi MD, Josephine Abraham MD, Andrew S P Sharp MD, Naomi D L Fisher MD, Michael J Bloch MD, Helen Reeve-Stoffer PhD, Leslie Coleman DVM, Christopher Mullin MS 及 Laura Mauri Prof
Lancet, The, 2018-06-09, 卷 391, 期 10137, 頁面 2335-2345, Copyright © 2018 Elsevier Ltd


Abstract

Background

Early studies suggest that radiofrequency-based renal denervation reduces blood pressure in patients with moderate hypertension. We investigated whether an alternative technology using endovascular ultrasound renal denervation reduces ambulatory blood pressure in patients with hypertension in the absence of antihypertensive medications.

Methods

RADIANCE-HTN SOLO was a multicentre, international, single-blind, randomised, sham-controlled trial done at 21 centres in the USA and 18 in Europe. Patients with combined systolic–diastolic hypertension aged 18–75 years were eligible if they had ambulatory blood pressure greater than or equal to 135/85 mm Hg and less than 170/105 mm Hg after a 4-week discontinuation of up to two antihypertensive medications and had suitable renal artery anatomy. Patients were randomised (1:1) to undergo renal denervation with the Paradise system (ReCor Medical, Palo Alto, CA, USA) or a sham procedure consisting of renal angiography only. The randomisation sequence was computer generated and stratified by centres with randomised blocks of four or six and permutation of treatments within each block. Patients and outcome assessors were blinded to randomisation. The primary effectiveness endpoint was the change in daytime ambulatory systolic blood pressure at 2 months in the intention-to-treat population. Patients were to remain off antihypertensive medications throughout the 2 months of follow-up unless specified blood pressure criteria were exceeded. Major adverse events included all-cause mortality, renal failure, an embolic event with end-organ damage, renal artery or other major vascular complications requiring intervention, or admission to hospital for hypertensive crisis within 30 days and new renal artery stenosis within 6 months. This study is registered with ClinicalTrials.gov , number NCT02649426 .

Findings

Between March 28, 2016, and Dec 28, 2017, 803 patients were screened for eligibility and 146 were randomised to undergo renal denervation (n=74) or a sham procedure (n=72). The reduction in daytime ambulatory systolic blood pressure was greater with renal denervation (−8.5 mm Hg, SD 9.3) than with the sham procedure (−2.2 mm Hg, SD 10.0; baseline-adjusted difference between groups: −6.3 mm Hg, 95% CI −9.4 to −3.1, p=0.0001). No major adverse events were reported in either group.

Interpretation

Compared with a sham procedure, endovascular ultrasound renal denervation reduced ambulatory blood pressure at 2 months in patients with combined systolic–diastolic hypertension in the absence of medications.



Impact of antihypertensive agents on arterial stiffness in hypertensive patients


Liwen Ye, Xixi Yang, Jie Hu, Qingwei Chen, Jian Wang 及 Xingsheng Li
International Journal of Cardiology, 2018-12-15, 卷 273, 頁面 207-212, Copyright © 2018


Abstract

Aims

The present network meta-analysis was performed to comprehensively compare the ability of different types of antihypertensive agents to ameliorate arterial stiffness in hypertensive patients.

Methods and results

To conduct this network meta-analysis , we searched PubMed, the Embase database, and the https://clinicaltrials.gov / website for all relevant articles concerning clinical trials on hypertension therapy. The last search date was 10 August 2017. As a result, 28 eligible articles were enrolled in our meta-analysis . According to the included studies, there was no significant difference in pulse wave velocity (PWV) between these treatments. The eight types of antihypertension agents outperformed placebo in controlling systolic blood pressure (SBP). Angiotensin-converting enzyme inhibitor (ACEI) outperformed angiotensin II receptor blocker (ARB) in SBP; and angiotensin receptor-neprilysin inhibitor (ARNI) outperformed diuretic (D) in SBP.

Conclusions

This study found that the eight antihypertensive agents show obvious effect on reducing SBP other than arterial stiffness.



Flavonoids in hypertension: a brief review of the underlying mechanisms


Dina Maaliki, Abdullah A Shaito, Gianfranco Pintus, Ahmed El-Yazbi 及 Ali H Eid
Current Opinion in Pharmacology, 2019-04-01, 卷 45, 頁面 57-65, Copyright © 2019 Elsevier Ltd


Abstract

Highlights

• Increased flavonoid consumption imparts antihypertensive benefits.
• Luteolin, Quercetin, Kaempferol, Epicatechin, and Daidzein increase eNOS activity.
• Many flavonoids reduce oxidative stress and improve endothelial function.
• Many flavonoids induce vasodilation by modulating K + and Ca 2+ ion channels.


Flavonoids are a diverse group of bioactive polyphenolic compounds abundant in dietary plants and herbs. Regular consumption of flavonoids exerts cardio-vasculoprotective effects and may reduce the onset or progression of many cardiovascular diseases, particularly hypertension. Observational studies suggest inverse associations among either of these three combinations: a) anthocyanin intake and risk of myocardial infarction (MI), b) flavanone intake and risk of ischemic stroke and c) flavonol intake and risk of type 2 diabetes mellitus. Human randomized controlled trials (RCTs) show that catechins and quercetin impart significant blood pressure lowering effects. Mechanistically, flavonoids mediate their antihypertensive effects through increasing nitric oxide (NO) bioavailability, reducing endothelial cell oxidative stress or modulating vascular ion channel activity. In this review, we focus on the six main subgroups of flavonoids, namely flavones, flavonols, flavanols, flavanones, anthocyanins, and isoflavones. We further discuss their antihypertensive effects, and their possible mechanisms of regulating blood pressure. We conclude by addressing the safety of these compounds as well as their potential use in hypertension management and treatment.



Effects of exercise training on endothelial function in individuals with hypertension: a systematic review with meta-analysis


Marinei L. Pedralli MSc, Bruna Eibel PhD, Gustavo Waclawovsky MSc, Maximiliano I. Schaun PhD, Walter Nisa-Castro-Neto PhD, Daniel Umpierre PhD, Linda S. Pescatello PhD, Hirofumi Tanaka PhD 及 Alexandre Machado Lehnen PhD
Journal of the American Society of Hypertension, 2018-12-01, 卷 12, 期 12, 頁面 e65-e75, Copyright © 2018 American Heart Association


Abstract

Interpretation

A slight increase (1%) in endothelial function is associated with reduction of cardiovascular risks by 13% in individuals with cardiovascular disease risk, including those with hypertension. Thus, we conducted a systematic review and meta-analysis to assess the efficacy of exercise training on endothelial function in individuals with hypertension.We included randomized clinical trials (RCTs) with adult participants diagnosed with hypertension undergoing exercise training (≥4 weeks), and the primary outcome was endothelial function, measured by flow-mediated dilatation (FMD). Five studies comprising a total of 362 participants (252 exercise and 110 controls; 59.3 years old, ranged from 52.0 to 67.2 years) were included in the meta-analysis. The pooled mean estimate indicated increased FMD after exercise training of 1.45 ( P = .001), and 95% confidence interval −0.11 to 3.00 compared with control comparators. The studies were characterized by significant heterogeneity (χ 2 = 23.34, P < .001, I 2 = 70%). The present results are consistent with the notion that aerobic exercise training elicits favorable adaptations in endothelial function in individuals with hypertension. However, more studies are needed to make more definitive conclusions.


 


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