Objective:This study evaluated the optimal systolic blood pressure(SBP)target for older patients with hypertension.Method:A Bayesian network meta-analysis was conducted.The risk of bias of the included studies was ass...Objective:This study evaluated the optimal systolic blood pressure(SBP)target for older patients with hypertension.Method:A Bayesian network meta-analysis was conducted.The risk of bias of the included studies was assessed by using a modified version of the Cochrane risk of bias.The trial outcomes comprised the following clinical events:ma-jor adverse cardiovascular events(MACE),cardiovascular mortality,all-cause mortality,myocardial infarction,heart failure and stroke.Results:A total of six trials were included.We reclassified all treatment therapies into three conditions according to the final achieved SBP after intervention(<130 mmHg,130–139 mmHg and≥140 mmHg).Our results demon-strated that anti-hypertensive treatment with an SBP target<130 mmHg,compared with treatment with an SBP target≥140 mmHg,significantly decreased the incidence of MACE(OR 0.43,95%CI 0.19–0.76),but no statistical difference was found in other comparisons.Although the results showed a trend toward more intensive anti-hypertension therapy having better effects on preventing cardiovascular mortality,all-cause mortality,myocardial infarction,heart failure,and stroke,no significant differences were found among groups.Conclusions:Our meta-analysis suggested that SBP<130 mmHg might be the optimal BP control target for patients≥60 years of age;however,further evidence is required to support our findings.展开更多
Background: Sub-Saharan Africa has the highest prevalence of primary open-angle glaucoma (POAG), at 4.2%. The efficacy of medical treatment has been demonstrated and remains one of the treatments of choice for POAG. H...Background: Sub-Saharan Africa has the highest prevalence of primary open-angle glaucoma (POAG), at 4.2%. The efficacy of medical treatment has been demonstrated and remains one of the treatments of choice for POAG. However, in sub-Saharan Africa, its effectiveness has many challenges, due to multiple factors, including cost and access to care. Thus, the present study aimed to determine the epidemiological, clinical, therapeutic and evolutive profile of primary open-angle glaucoma patients. Methodology: A descriptive cross-sectional study was carried out in two hospitals in western Cameroon. Epidemiological, clinical, therapeutic, and evolutionary data on intraocular pressure at one year after medical treatment were analyzed. SPSS version 23 software was used for statistical analysis, with a significant p-value set at 5%. Results: A total of 201 patients with POAG were included in the study. The population comprised 100 men and 101 women, with a mean age of 54 ± 12 years. At diagnosis, the mean intraocular pressure was 23.9 ± 8.70 mmHg for the right eye and 25.5 ± 9.57 mmHg for the left eye. The mean cup/disc ratio was 0.64 ± 0.2 [0.2-1] and 0.67 ± 0.19 [02-1] in the right and left eyes, respectively. Monotherapy was the most prescribed treatment [59.2%]. After one year of treatment, intraocular pressure was reduced by 15.5% with beta-blockers, 23.66% with prostaglandins, 19.11% with carbonic anhydrase inhibitors, 35, 92% with beta-blockers and carbonic anhydrase inhibitors, 25.92% with beta-blockers and prostaglandins, 48.03% with carbonic anhydrase inhibitors and prostaglandin agonists, and 38.77% with triple therapy. Taking glaucoma severity into account, a significant reduction in intraocular pressure at one year was observed in all participants [p 0.05]. However, the target pressure was obtained in 47%, 20% and 14% of eyes suffering of mild, moderate, and severe grade of POAG respectively. Conclusion: In the present study, there was a significant reduction in intraocular pressure after one year of medical treatment. However, the reduction in intraocular pressure does not allow the target pressure to be reached in severe forms. Thus, alternatives to the medical treatment of POAG should be discussed early in the present context. .展开更多
基金This work was supported by grants from the National Natural Science Foundation of China(81770251)National Natural Science Foundation of China Youth Science Fund Project(81800254),Natural Science Foundation of Chongqing Science and Technology Commission(cstc2020jcyjmsxmX0210)Medical research projects of Chongqing Science and Technology Commission and Chongqing Health Committee(2021MSXM217,2020FYYX047).
文摘Objective:This study evaluated the optimal systolic blood pressure(SBP)target for older patients with hypertension.Method:A Bayesian network meta-analysis was conducted.The risk of bias of the included studies was assessed by using a modified version of the Cochrane risk of bias.The trial outcomes comprised the following clinical events:ma-jor adverse cardiovascular events(MACE),cardiovascular mortality,all-cause mortality,myocardial infarction,heart failure and stroke.Results:A total of six trials were included.We reclassified all treatment therapies into three conditions according to the final achieved SBP after intervention(<130 mmHg,130–139 mmHg and≥140 mmHg).Our results demon-strated that anti-hypertensive treatment with an SBP target<130 mmHg,compared with treatment with an SBP target≥140 mmHg,significantly decreased the incidence of MACE(OR 0.43,95%CI 0.19–0.76),but no statistical difference was found in other comparisons.Although the results showed a trend toward more intensive anti-hypertension therapy having better effects on preventing cardiovascular mortality,all-cause mortality,myocardial infarction,heart failure,and stroke,no significant differences were found among groups.Conclusions:Our meta-analysis suggested that SBP<130 mmHg might be the optimal BP control target for patients≥60 years of age;however,further evidence is required to support our findings.
文摘Background: Sub-Saharan Africa has the highest prevalence of primary open-angle glaucoma (POAG), at 4.2%. The efficacy of medical treatment has been demonstrated and remains one of the treatments of choice for POAG. However, in sub-Saharan Africa, its effectiveness has many challenges, due to multiple factors, including cost and access to care. Thus, the present study aimed to determine the epidemiological, clinical, therapeutic and evolutive profile of primary open-angle glaucoma patients. Methodology: A descriptive cross-sectional study was carried out in two hospitals in western Cameroon. Epidemiological, clinical, therapeutic, and evolutionary data on intraocular pressure at one year after medical treatment were analyzed. SPSS version 23 software was used for statistical analysis, with a significant p-value set at 5%. Results: A total of 201 patients with POAG were included in the study. The population comprised 100 men and 101 women, with a mean age of 54 ± 12 years. At diagnosis, the mean intraocular pressure was 23.9 ± 8.70 mmHg for the right eye and 25.5 ± 9.57 mmHg for the left eye. The mean cup/disc ratio was 0.64 ± 0.2 [0.2-1] and 0.67 ± 0.19 [02-1] in the right and left eyes, respectively. Monotherapy was the most prescribed treatment [59.2%]. After one year of treatment, intraocular pressure was reduced by 15.5% with beta-blockers, 23.66% with prostaglandins, 19.11% with carbonic anhydrase inhibitors, 35, 92% with beta-blockers and carbonic anhydrase inhibitors, 25.92% with beta-blockers and prostaglandins, 48.03% with carbonic anhydrase inhibitors and prostaglandin agonists, and 38.77% with triple therapy. Taking glaucoma severity into account, a significant reduction in intraocular pressure at one year was observed in all participants [p 0.05]. However, the target pressure was obtained in 47%, 20% and 14% of eyes suffering of mild, moderate, and severe grade of POAG respectively. Conclusion: In the present study, there was a significant reduction in intraocular pressure after one year of medical treatment. However, the reduction in intraocular pressure does not allow the target pressure to be reached in severe forms. Thus, alternatives to the medical treatment of POAG should be discussed early in the present context. .
