Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Pulse pressure, wide [keywords]
- Prevalence and correlates of chronic kidney disease among civil servants in Bayelsa state, Nigeria. [JOURNAL ARTICLE]
- Niger J Clin Pract 2014 September-October; 17(5):602-607.
Introduction: Chronic kidney disease (CKD) has become a public health problem with rising incidence and prevalence world-wide. Despite the fact that Sub-Saharan Africa, including Nigeria appears to be badly hit by this epidemic, there is a paucity of data on CKD prevalence in these regions and where data exists, they are mostly hospital-based. Objectives: The present study was carried out to determine the prevalence and correlates of CKD in an urban civil service population in Bayelsa State, Nigeria. Materials and Methods: A total of 179 civil servants in the Bayelsa State secretariat were screened for CKD during the World Kidney Day on March 2012. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m 2 body surface area and/or proteinuria. Socio-demographic data was obtained using interviewer-administered semi-structured questionnaire while anthropometric measurements were taken. Blood pressure (BP), urinalysis, serum urea and creatinine were also assessed. Results: The prevalence of CKD in the study was 7.8%. Age >50 years was associated with CKD in univariate analysis but none of age, gender, body mass index, BP or hyperglycemia independently predicted it. Conclusion: The prevalence of CKD among Nigerian civil servants was fairly high and was associated with advancing age. Routine screening for CKD in this population is recommended.
- Why Patients Know More About Cars than PAD. [JOURNAL ARTICLE]
- Circulation 2014 Sep 19.
Americans who are interested in purchasing a motor vehicle often investigate automobile manufacturers, car models, and even competitive pricing using the World Wide Web. When one uses an Internet search engine to investigate Toyota, the largest automobile manufacturer in the World, there are over 93,000,000 results. Virtually every possible question one would have about a Toyota vehicle is discoverable before ever visiting a local Toyota dealership. One would anticipate that physicians have a similar luxury. A patient presents with exertional discomfort in the calf that promptly resolves with rest. The patient struggles with her diet, is 30 pounds overweight, is on several medications for her high cholesterol and high blood pressure, and has been told that she has "pre-diabetes". With the continued comparisons between Toyota LEAN mechanics and healthcare, patients likely anticipate that a physician would enter this history in a search engine and uncover the diagnosis. In fact, it is anticipated that many healthcare systems will use this type of ediagnostic strategy for many disorders in the not too distant future.
- Effects of established blood pressure loci on blood pressure values and hypertension risk in an Algerian population sample. [JOURNAL ARTICLE]
- J Hum Hypertens 2014 Sep 18.
Genome-wide association studies and subsequent replication studies have pinpointed 29 genetic variants associated with blood pressure (BP). None of these studies included North African populations. We therefore looked at whether or not these genetic variants modulated BP and hypertension (HTN) risk in an Algerian population sample. Twenty-nine single-nucleotide polymorphisms (SNPs) were genotyped in a representative sample of 787 subjects from the InSulino-résistance à ORan (ISOR) study (378 men and 409 women aged between 30 and 64 years and recruited from within the city of Oran, Algeria). Genetic variants were considered both individually and when combined as genetic predisposition scores (GPSs) for systolic BP (SBP), diastolic BP (DBP) and HTN risk. The SNPs in CYP1A1-ULK3, HFE and SH2B3 were significantly associated with BP and/or HTN. The SBP-GPS, DBP-GPS and HTN-GPS were associated with higher levels of DBP (+0.24 mm Hg P=0.05, +0.23 mm Hg P=0.05 and +0.26 mm Hg P=0.03, respectively). Moreover, the three GPSs tended to be associated with a 6% higher risk of HTN. Our study is the first to show that some of the BP loci validated in subjects of European descent were associated (either individually or when combined as GPSs) with BP traits and/or the HTN risk in an Algerian population, but to a lesser extent than in European populations. Although larger studies and meta-analyses of North African populations are needed to confirm the present results, our data contribute to a better understanding of genetic susceptibility to HTN.Journal of Human Hypertension advance online publication, 18 September 2014; doi:10.1038/jhh.2014.81.
- A retrospective, cross-sectional study of real-world values of cardiovascular risk factors using a healthcare database in Japan. [JOURNAL ARTICLE]
- BMC Cardiovasc Disord 2014 Sep 17; 14(1):120.
Data collected by the Japanese Ministry of Health, Labour and Welfare (MHLW), namely data from the Specific Health Checkups and Specific Health Guidance (MHLW-SH) and the National Health and Nutrition Survey (MHLW-H&N) allow assessment of blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and hemoglobin A1c (HbA1c) in Japan. Recently, a large database of employment-based health insurance has been developed by MinaCare Co. Ltd.A retrospective, cross-sectional study using the Japanese healthcare checkup database developed by MinaCare Co. Ltd. was designed to investigate the distribution of real-world values of BP, LDL-C, and HbA1c in Japan. Data in the MinaCare database were also compared with those in the two national data sources to assess the extent to which the health status in Japan is reflected in each data source.Of the healthcare checkup results of 232515 subjects in the 2011 MinaCare database, 49.9% were male and 50.1% were female. The age of the subjects ranged from <20 to >70 years. The proportion of subjects with systolic BP (SBP) >=140 mmHg, LDL-C >=140 mg/dL, and HbA1c >=6.1% generally increased with increasing age. If one focused on the upper-end age group representing the majority of the MinaCare study population (i.e. age range, 55-59 years), the proportions of subjects with SBP >=140 mmHg, LDL-C >=140 mg/dL, and HbA1c >=6.1% were 19.0%/12.2% (males/females), 27.2%/42.7%, and 13.5%/5.4%, respectively. The MinaCare database was mostly comparable with the two national data sources; however, some notable differences in BP and lipid parameters were found between MHLW-H&N and the other two data sources.Analysis of the MinaCare database indicated that a substantial proportion of subjects did not achieve the target BP, LDL-C, and HbA1c levels to reduce the risk of future cardiovascular and cerebrovascular disease events. The results were generally consistent with those of the national data sources. Considering its characteristics of low selection bias, large sample size, wide age distribution, and high flexibility in analysis of subject-level data, the MinaCare database is highly valuable for studying the health status of the population covered by employment-based health insurance.
- Uromodulin: from monogenic to multifactorial diseases. [REVIEW]
- Nephrol Dial Transplant 2014 Sep 16.
Uromodulin, the major protein secreted in normal urine, is exclusively produced in the thick ascending limb (TAL) cells of the kidney. The exact role uromodulin (UMOD) plays in renal physiology remains enigmatic. UMOD has been linked to water/electrolyte balance and to kidney innate immunity and it is believed to protect against urinary tract infections and renal stones. A renewed interest in UMOD has been triggered by the identification of UMOD mutations as cause of hereditary dominant renal diseases, now referred to as uromodulin-associated kidney diseases (UAKDs), presenting with tubulointerstitial fibrosis, defective urinary concentration, hyperuricaemia and gout, and progressive renal failure. In UAKDs, the key primary pathogenetic event is a delayed intracellular trafficking of mutant UMOD, causing its intracellular accumulation. In the last decade, multiple genome-wide association studies have identified common variants in the UMOD gene, causing independent susceptibility to chronic kidney disease (CKD) and hypertension, two complex traits representing major global health problems. The biological mechanism underlying the association between UMOD risk variants and susceptibility to CKD and hypertension was not understood until last year, when the link between UMOD and hypertension was found to be caused by overactivation of the TAL sodium-potassium-chloride co-transporter NKCC2, pointing to UMOD as a therapeutic target for lowering blood pressure and preserving renal function.
- Two Further Blood Pressure Loci Identified in Ion Channel Genes with a Genecentric Approach. [JOURNAL ARTICLE]
- Circ Cardiovasc Genet 2014 Sep 10.
-Blood pressure (BP) is highly heritable, but our understanding of the genetic causes underlying variations in BP is incomplete. In this study we explored whether novel loci associated with BP could be identified using a genecentric approach in three community-based cohorts with accurate BP measurements.-Genotyping of 1,857 single nucleotide polymorphisms (SNPs) in 91 ion channel genes was performed in a discovery cohort (n=358). Thirty-four SNPs associated with BP traits (P ≤ 0.01) were followed up in an independent population (n=387), significant SNPs from this analysis were looked up in another independent population (n=1,010), and meta-analysed. Repeated clinic and ambulatory measurements were available for all but the discovery cohort (clinic only). Association analyses were performed, with systolic, diastolic and pulse pressures as quantitative traits, adjusting for age and sex. Quantile-quantile plots indicated that the genecentric approach resulted in an inflation of association signals. Of the 29 SNPs taken forward from the discovery cohort, two SNPs were associated with BP phenotypes with the same direction of effect, with experiment-wide significance, in follow-up cohort I. These were rs2228291, in the chloride channel gene CLCN2, and rs10513488, in the potassium channel gene KCNAB1. Both associations were subsequently replicated in follow-up cohort II.-Using a genecentric design and three well-phenotyped populations, this study identified two previously unreported, biologically plausible, genetic associations with BP. These results suggest that dense genotyping of genes, in pathways known to influence BP, could add to candidate-gene and GWA studies, in further explaining BP heritability.
- Emerging role of hydrogen sulfide in hypertension and related cardiovascular diseases. [JOURNAL ARTICLE]
- Br J Pharmacol 2014 Sep 10.
Hydrogen sulfide (H2 S) has traditionally been viewed as a highly toxic gas; however, recent studies have implicated H2 S as a third member of the gasotransmitter family, exhibiting properties similar to nitric oxide (NO) and carbon monoxide (CO). Accumulating evidence has suggested that H2 S influenced a wide range of physiological and pathological processes, among which blood vessel relaxation, cardioprotection and atherosclerosis have been particularly studied. In the cardiovascular system, H2 S production is predominantly catalyzed by cystathionine γ-lyase (CSE). Decreased endogenous H2 S levels have been found in hypertensive patients and animals, and CSE(-/-) mice develop hypertension with age, suggesting that deficiency of H2 S contributes importantly to blood pressure regulation. H2 S supplementation attenuates hypertension in different hypertensive animal models. The mechanism by which H2 S was originally proposed to attenuate hypertension was by virtue of its action on vascular tone, which may be related to effects on different ion channels. Both H2 S and NO cause vasodilation and there is cross talk between these two molecules to regulate blood pressure. Suppression of oxidative stress may also contribute to anti-hypertensive effects of H2 S. This review also summarizes the state of research on H2 S and hypertension in China. A better understanding of the role of H2 S in hypertension and related cardiovascular diseases will allow novel strategies to be devised for their treatment.
- Blood Pressure Differences Associated With Optimal Macronutrient Intake Trial for Heart Health (OMNIHEART)-Like Diet Compared With a Typical American Diet. [JOURNAL ARTICLE]
- Hypertension 2014 Sep 8.
The Dietary Approaches to Stop Hypertension-Sodium (DASH-Sodium) trial demonstrated beneficial effects on blood pressure (BP) of the DASH diet with lower sodium intake when compared with typical American diet. The subsequent Optimal Macronutrient Intake Trial for Heart Health (OMNIHEART) trial reported additional BP benefits from replacing carbohydrate in the DASH diet with either protein or monounsaturated fats. The primary aim of this study is to assess possible BP benefits of an OMNIHEART-like diet in free-living Americans using cross-sectional US population data of The International Study of Macronutrients, Micronutrients and Blood Pressure (INTERMAP) study. The INTERMAP data include four 24-hour dietary recalls, 2 timed 24-hour urine collections, 8 BP readings for 2195 individuals aged 40 to 59 years from 8 US INTERMAP population samples. Analyses are conducted using 2 approaches: (1) regression of BP on a linear OMNIHEART nutrient score calculated for each individual and (2) a Bayesian approach comparing estimated BP levels of an OMNIHEART-like nutrient profile with a typical American nutrient profile. After adjustment for potential confounders, an OMNIHEART score higher by 1 point was associated with systolic/diastolic BP differences of -1.0/-0.5 mm Hg (both P<0.001). Mean systolic/diastolic BPs were 111.3/68.4 and 115.2/70.6 mm Hg for Bayesian OMNIHEART and Control profiles, respectively, after controlling for possible confounders, with BP differences of -3.9/-2.2 mm Hg, P(difference ≤0)=0.98/0.96. Findings were comparable for men and women, for nonhypertensive participants, and with adjustment for antihypertensive treatment. Our findings from data on US population samples indicate broad generalizability of OMNIHEART results beyond the trial setting and support recommendations for an OMNIHEART-style diet for prevention/control of population-wide adverse BP levels.
- Risk Prediction in Patients With Heart Failure: A Systematic Review and Analysis. [JOURNAL ARTICLE]
- JACC Heart Fail 2014 Aug 27.
This study sought to review the literature for risk prediction models in patients with heart failure and to identify the most consistently reported independent predictors of risk across models.Risk assessment provides information about patient prognosis, guides decision making about the type and intensity of care, and enables better understanding of provider performance.MEDLINE and EMBASE were searched from January 1995 to March 2013, followed by hand searches of the retrieved reference lists. Studies were eligible if they reported at least 1 multivariable model for risk prediction of death, hospitalization, or both in patients with heart failure and reported model performance. We ranked reported individual risk predictors by their strength of association with the outcome and assessed the association of model performance with study characteristics.Sixty-four main models and 50 modifications from 48 studies met the inclusion criteria. Of the 64 main models, 43 models predicted death, 10 hospitalization, and 11 death or hospitalization. The discriminatory ability of the models for prediction of death appeared to be higher than that for prediction of death or hospitalization or prediction of hospitalization alone (p = 0.0003). A wide variation between studies in clinical settings, population characteristics, sample size, and variables used for model development was observed, but these features were not significantly associated with the discriminatory performance of the models. A few strong predictors emerged for prediction of death; the most consistently reported predictors were age, renal function, blood pressure, blood sodium level, left ventricular ejection fraction, sex, brain natriuretic peptide level, New York Heart Association functional class, diabetes, weight or body mass index, and exercise capacity.There are several clinically useful and well-validated death prediction models in patients with heart failure. Although the studies differed in many respects, the models largely included a few common markers of risk.
- Gene-Smoking Interactions Identify Several Novel Blood Pressure Loci in the Framingham Heart Study. [JOURNAL ARTICLE]
- Am J Hypertens 2014 Sep 3.
Cardiovascular diseases are among the most significant health problems in the United States. Blood pressure (BP) variability has a genetic component, and most of the genetic variance remains to be identified. One promising strategy for gene discovery is genome-wide analysis of interactions between single nucleotide polymorphisms (SNPs) and environmental factors related to cardiovascular diseases.We investigated SNP-smoking interaction effects on BP in genome-wide data in 6,889 participants from the Framingham Heart Study. We performed the standard 1 degree of freedom (df) test of the interaction effect and the joint 2 df test of main and interaction effects. Three smoking measures were used: cigarettes per day (CPD), pack years of smoking, and smoking status.We identified 7 significant and 21 suggestive BP loci. Identified through the joint 2 df test, significant SBP loci include: rs12149862 (P = 3.65×10(-9)) in CYB5B, rs2268365 (P = 4.85×10(-8)) in LRP2, rs133980 (P = 1.71×10(-8) with CPD and P = 1.07×10(-8) with pack-years) near MN1, and rs12634933 (P = 4.05×10(-8)) in MECOM. Through 1 df interaction analysis, 1 suggestive SBP locus at SNP rs8010717 near NRXN3 was identified using all 3 smoking measures (P = 3.27×10(-7) with CPD, P = 1.03×10(-7) with pack-years, and P = 1.19×10(-7) with smoking status).Several of these BP loci are biologically plausible, providing physiological connection to BP regulation. Our study demonstrates that SNP-smoking interactions can enhance gene discovery and provide insight into novel pathways and mechanisms regulating BP.