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High blood pressure [keywords]
- Pulse Pressure And Stroke Risk: Development And Validation Of A New Stroke Risk Model. [JOURNAL ARTICLE]
- Curr Med Res Opin 2014 Sep 29.:1-19.
Abstract Objective: This study aims to develop and validate a stroke risk model incorporating pulse pressure (PP) as a potential risk factor. Recent evidence suggests that PP, defined as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP), could be an incremental risk factor beyond SBP. Methods: Electronic health records (EHR) of hypertensive patients from a US integrated health delivery system were analyzed (01/2004-05/2012). Patients with ≥1 PP reading and ≥6 months of observation prior to the first diagnosis of hypertension were randomly split into development (two-thirds of sample) and validation (one-third of sample) datasets. Stroke events were identified using ICD-9-CM 433.xx-436.xx. Cox proportional hazards models assessed time-to-first-stroke-event within 3-years of first hypertension diagnosis based on baseline risk factors, including PP, age, gender, diabetes, and cardiac comorbidities. The optimal model was selected using the least absolute shrinkage and selection operator (LASSO); performance was evaluated by the c-statistic. Results: Among 34,797 patients selected (mean age 59.3 years, 48% male), 4,272 patients (12.3%) had a stroke. PP was higher among patients who developed stroke (mean [SD] PP, stroke: 62.0 [15.3] mmHg; non-stroke: 58.1 [14.0] mmHg, p<.001). The best performing risk model (c-statistic, development: 0.730; validation: 0.729) included PP (hazard ratio per mmHg increase: 1.0037, p<.001) as a significant risk factor. Limitations: This study was subject to limitations similar to other studies using EHR. Only patient encounters occurring within the single healthcare network were captured in the data source. Though the model was tested internally, external validation (using a separate data source) would help assess the model's generalizability and calibration. Conclusions: This stroke risk model shows that greater PP is a significant predictive factor for increased stroke risk, even in the presence of known risk factors. PP should be considered by practitioners along with established risk factors in stroke treatment strategies.
- Potential Limitations of E-mail and Text Messaging in Improving Adherence in Glaucoma and Ocular Hypertension. [JOURNAL ARTICLE]
- J Glaucoma 2014 Sep 26.
To determine how receptive patients are to the use of e-mail and text message reminders for appointments and medications.We conducted a consecutive cross-sectional survey of eligible patients with glaucoma or ocular hypertension at a private glaucoma subspecialty practice with 3 locations from February 2011 to January 2012. Main outcome measures were answers to survey questions regarding how receptive patients are to e-mail and text messaging reminders for appointments and medications.Of 989 patients, 404 (40.8%) patients reported that e-mail reminders would help remember appointments and 185 (18.7%) reported that they would help for medications. Among those with access to text messaging, 280 (68.9%) reported text messaging would help them remember appointments and 193 (47.5%) reported it would help with medications. Patients who reported e-mail would help them remember medications were more likely to live in an urban location [P=0.05, odds ratio (OR)=1.84], check the internet at least daily (P≤0.001, OR=1.04), check e-mail when not at home or the office (P=0.02, OR=1.62), and know how to open attachments (P=0.03, OR=1.87). Patients who reported that text messaging would help them remember their medications were more likely to be 40 or less (P≤0.001, OR=8.54) and African American (P<0.001, OR=2.59).E-mail and text messaging reminders currently may have a limited utility in improving adherence in the general glaucoma population but may be useful in younger patients with glaucoma.
- The Efficacy of a Latanoprost/Timolol Fixed Combination Versus Latanoprost and Timolol Gel-forming Solution Unfixed Combination on Daytime Intraocular Pressure. [JOURNAL ARTICLE]
- J Glaucoma 2014 Sep 26.
To evaluate the effect of a latanoprost/timolol fixed combination (LTFC) versus a latanoprost and timolol gel-forming solution unfixed combination (LTuFC) on daytime intraocular pressure (IOP) levels and fluctuations.This was an 8-week, randomized, parallel-group study. Ninety eyes of 90 patients diagnosed with primary open-angle glaucoma or ocular hypertension that were insufficiently controlled with latanoprost monotherapy were enrolled. Randomized patients received either a single evening dose of LTFC or unfixed combination of latanoprost administered once daily in the evening and timolol gel-forming solution administered once daily in the morning without a washout period. IOP measurements were taken at 8 AM, 11 AM, 2 PM, and 5 PM. The mean IOP, daytime IOP measurements, and fluctuation in IOP were assessed at weeks 4 and 8.The mean IOP reduction from baseline to each visit was significant in both groups (P<0.01). There was a significant difference in the mean IOP between groups at week 4 (P=0.0021). At week 8, the mean IOP reduction was 3.2±2.1 and 5.7±3.2 mm Hg in LTFC and LTuFC groups, respectively, and the difference was significant (P=0.001). A decrease in the daytime IOP fluctuation was observed in both groups over time, but the decrease in each group was not significant. At week 8, the mean IOP measurements at 8 AM, 11 AM, 2 PM, and 5 PM in LTuFC group were significantly lower than in the LTFC group (P=0.024, 0.0001, 0.0008, and 0.0011, respectively).The concomitant use of latanoprost and timolol gel-forming solution leads to a larger additional IOP reduction and lower daytime IOP levels as compared with the fixed combination.
- Attachment and the Metabolic Syndrome in Midlife: The Role of Interview-Based Discourse Patterns. [JOURNAL ARTICLE]
- Psychosom Med 2014 Sep 26.
Adult attachment discourse patterns and current family relationship quality were examined as correlates of health behaviors and number of metabolic syndrome (MetS) criteria met, and as mediators of the link between childhood adversity and these health outcomes.A sample of 215 white/European American and black/African American adults aged 35 to 55 years were examined using a cross-sectional study design. Discourse was assessed with the Adult Attachment Interview, using coherence (a marker of attachment security), unresolved trauma/loss (a marker of disorganized cognitions related to trauma or loss), and idealization (minimizing stressful experiences and their impact) scores. Relationship quality, adverse childhood experiences, and current depressive symptoms were assessed, as were health behaviors of diet, exercise, and smoking. MetS includes obesity, elevated blood pressure, elevated fasting glucose, high triglycerides, and low high-density lipoprotein cholesterol.Using path analysis and including childhood adversity severity and depressive symptoms in the model, both Adult Attachment Interview coherence and unresolved trauma/loss were directly linked to the number of MetS criteria (r = 0.186 and r = 0.170, respectively). Idealization was indirectly linked to MetS through poor diet (r = 0.183). The final model explained 21% of the variance in scores for the number of MetS criteria met.Insecure adult attachment is associated with increased risk of MetS.
- Organizational determinants of high-quality routine diabetes care. [JOURNAL ARTICLE]
- Scand J Prim Health Care 2014 Sep 29.:1-8.
Objective. Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care. Design. Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score. Setting. Primary care practices in the Netherlands. Subjects. 11,751 patients with diabetes in 354 practices. Main outcome measures. Patients' recorded glycated hemoglobin (HbA1c), systolic blood pressure, and serum cholesterol levels. Results. A higher score on the composite measure of organizational determinants was associated with better control of systolic blood pressure (p = 0.017). No effects on HbA1C or cholesterol levels were found. Exploration of specific organizational factors found significant impact of use of an electronic patient registry on HbA1c (OR = 1.80, 95% CI 1.12-2.88), availability of patient leaflets on systolic blood pressure control (OR = 2.59, 95% CI 1.06-6.35), and number of hours' nurse education on cholesterol control (OR = 2.51, 95% CI 1.02-6.15). Conclusion. In routine primary care, it was found that favorable healthcare organization was associated with a number of intermediate outcomes in diabetes care. This finding lends support to the findings of trials on organizational changes in diabetes care. Notably, the composite measure of organizational determinants had most impact.
- Let-7 miRNA profiles are associated with the reversal of left ventricular hypertrophy and hypertension in adult male offspring from mothers undernourished during pregnancy following pre-weaning growth hormone treatment. [JOURNAL ARTICLE]
- Endocrinology 2014 Sep 29.:en20141567.
Maternal undernutrition is known to cause cardiac hypertrophy, elevated blood pressure (BP) and endothelial dysfunction in adult offspring. Maternal undernutrition may also lead to disturbances in growth hormone (GH) regulation in offspring. As GH plays a key role in cardiac development, we utilised a model of maternal undernutrition to examine the effects of neonatal GH treatment on cardiac hypertrophy, cardiac miRNA profiles and associated gene regulation in adult offspring. Female Sprague-Dawley rats were fed either a standard control diet (CON) or 50 of CON intake throughout pregnancy (UN). From neonatal day 3 until weaning (day 21), CON and UN pups received either saline (CON-S, UN-S) or GH (2.5μ g/g/day) (CON-GH, UN-GH). Heart structure was determined by H&E staining and microRNA was isolated from cardiac tissue and miRNA expression analysed using Cardiovascular miRNA gene arrays (SABiosciences Ltd). Maternal undernutrition caused marked increases in cardiac hypertrophy and left ventricular cardiomyocyte area which were reversed by pre-weaning GH treatment. Systolic BP was increased in UN-S groups and normalised in UN-GH groups (CON-S 121±2mmHg, CON-GH 115±3, UN-S 146±3, UN-GH 127±2). GH treatment during early development facilitated a reversal of pathological changes in offspring hearts caused by undernutrition during pregnancy. Specific cardiac miRNA profiles were exhibited in response to maternal undernutrition, accompanied by up-regulation of the LET-7 miRNA family in GH treated offspring. miRNA target analysis revealed a number of genes associated with inflammation and cardiovascular development which may be involved in the altered cardiac function of these offspring. Up-regulation of the LET-7 family of miRNAs observed in GH groups may mediate the reversal of cardiac hypertrophy observed in adult offspring males of UN mothers.
- Clinicopathological Analysis of 155 Patients with Persistent Isolated Hematuria. [JOURNAL ARTICLE]
- Chin Med Sci J 2014 Sep 29; 29(3):148-155.
Objectives To reveal etiologies of persistent isolated hematuria (PIH) through ultrastructural pathological examination, to disclose clinicopathological correlation in cases with PIH, and to summarize appropriate management of patients with PIH. Methods we retrospectively studied 155 PIH patients receiving renal biopsy between January, 2003 and December, 2008 in Peking Union Medical College Hospital. All the clinical data and follow-up result were analyzed. Results All subjects included 38 children and 117 adults, with mean age of 11.38±3.25 years for children and 35.17±8.44 years for adults. Thin basement membrane nephropathy (TBMN) was the most common pathology (55.3% of children and 49.6% of adults), followed by IgA nephropathy (18.4% of children and 32.5% of adults, mainly grade 2-3) and mesangial proliferative glomerulonephritis (MsPGN) without IgA deposition (13.2% of children and 12.8% of adults). Besides, Alport syndrome (2.6% of children) and membrane nephropathy (2.6% of children and 0.9% of adults) were demonstrated as other causes of PIH. Elevated mean arteral pressure or protein excretion rate, as well as episodic macrohematuria, indicated higher risk for MsPGN rather than TBMN. On the other hand, severity of microhematuria was irrelevant to pathological types of PIH. Totally, 86 patients were followed up and 37 cases therein stayed on track for long term (mean duration 41.11?28.92 months, range 8-113 months). Most cases had benign clinical course except 3 cases with TBMN, 5 cases with IgA nephropathy, 1 case with MsPGN (without IgA deposition), and 1 case with Alport syndrome, who developed hypertension or proteinuria. All of them were administered timely intervention. Conclusions Close follow-up should be required as the primary management for PIH. Equally important is careful monitoring for early identification of undesirable predictors; while renal biopsy and other timely intervention are warranted if there is hypertension, significant proteinuria or renal impairment.
- Effect of home-based Kegel exercises on quality of life in women with stress and mixed urinary incontinence. [JOURNAL ARTICLE]
- J Obstet Gynaecol 2014 Sep 29.:1-4.
The aim of this study was to assess the effects of home-based Kegel exercises in women with stress and mixed urinary incontinence. A total of 90 women with urodynamically proven urinary stress (SUI) and mixed (MUI) incontinence awaiting anti-incontinence surgery were recruited in the urogynaecology clinic of Ankara Zekai Tahir Burak Women's Health Research and Education Hospital. Of these, 18 women were excluded due to low compliance and the remaining 72 were divided into two groups according to urodynamic diagnosis (SUI group, n = 38; MUI group, n = 34). Age, BMI, menopausal status and medical history of the women were recorded. The women took Kegel exercise, consisting of 10 sets of contractions/day; each set included 10 repetitions, for at least 8 weeks. To evaluate the pelvic floor muscle strength, the modified Oxford grading system was used before and after Kegel exercising. The Incontinence Impact Questionnaire (IIQ-7); Urogenital Distress Inventory (UDI-6) and the Patient Global Impression of Improvement (PGI-I) questions were compared before and after 8 weeks of Kegel exercising. The age, BMI, gravidity, menopausal status, macrosomic fetus history, hypertension and asthma were similar between the groups. There were statistically significant lower scores in both IIQ-7 and UDI-6 before and after Kegel exercises within each group (p < 0.001). The mean change of the IIQ-7 and UDI-6 score was statistically significantly higher in the SUI group than in the MUI group (p = 0.023 and p = 0.003, respectively). Results of the Oxford scale were also statistically significantly higher after Kegel exercises within each group (p = < 0.001). In total, 68.4% of the women in the SUI group and 41.2% of the women in the MUI group reported improvements which were statistically significant (p = 0.02). We conclude that home-based Kegel exercises, with no supervision, have been found effective in women with SUI and MUI. The improvement was more prominent in women with SUI.
- Hypoxic Vasospasm Mediated by cIMP : When Soluble Guanylyl Cyclase Turns Bad. [JOURNAL ARTICLE]
- J Cardiovasc Pharmacol 2014 Sep 26.
In a number of isolated blood vessel types hypoxia causes an acute contraction that is dependent on the presence of nitric oxide (NO) and activation of soluble guanylyl cyclase (sGC). It is more pronounced when the preparations are constricted and is therefore termed hypoxic augmentation of vasoconstriction. This hypoxic response is accompanied by increases in the intracellular level of inosine 5'-triphosphate (ITP) and in the synthesis of inosine 3',5'-cyclic monophosphate (cIMP) by sGC. The administration of exogenous cIMP or ITP causes augmented vasoconstriction to hypoxia. Furthermore, the vasoconstriction evoked by hypoxia and cIMP is associated with increased activity of Rho kinase (ROCK), indicating that cIMP may mediate the hypoxic effect by sensitizing the myofilaments to Ca via ROCK. Hypoxia is implicated in exaggerated vasoconstriction in the pathogenesis of coronary artery disease, myocardial infarction, hypertension and stroke. The newly found role of cIMP may help to identify unique therapeutic targets for certain cardiovascular disorders.
- Dysfunctional endothelial progenitor cells in cardiovascular diseases: role of NADPH oxidase. [JOURNAL ARTICLE]
- J Cardiovasc Pharmacol 2014 Sep 26.
Endothelial progenitor cells (EPCs) play a critical role in maintenance of the endothelial integrity and vascular homeostasis, as well as in neovascularization. Dysfunctional EPCs are believed to contribute to the endothelial dysfunction and are closely related to the development of various cardiovascular diseases, such as hypertension, hyperlipidemia and stroke. However, the underlying mechanisms of EPCs dysfunction are complicated and remain largely elusive. Recent studies have demonstrated that reactive oxygen species (ROS) are key factors that involve in modulation of stem and progenitor cell function under various physiologic and pathologic conditions. It has been shown that NADPH oxidase (NOX)-derived ROS are the major sources of ROS in cardiovascular system. Accumulating evidence suggest that NOX-mediated oxidative stress can modulate EPCs bioactivities, such as mobilization, migration and neovascularization, and that inhibition of NOX has been shown to improve EPCs functions. This review summarized recent progress in the studies on the correlation between NOX-mediated EPCs dysfunction and cardiovascular diseases.