AIM:To describe the safety and efficacy of patterned laser trabeculoplasty(PLT)as an adjunctive treatment in primary open angle glaucoma(POAG)and ocular hypertension(OHT)after 18-month follow-up in Hispanic population...AIM:To describe the safety and efficacy of patterned laser trabeculoplasty(PLT)as an adjunctive treatment in primary open angle glaucoma(POAG)and ocular hypertension(OHT)after 18-month follow-up in Hispanic population.METHODS:A single-center,retrospective study was conducted.All patients with OHT or POAG undergoing PLT from June 2016 to August 2016 were included in the study.Investigated parameters were intraocular pressure(IOP),the number of IOP-lowering medications,best corrected visual acuity(BCVA),laser parameters and postoperative adverse events.Primary efficacy outcome measures were the proportion of eyes achieving an IOP reduction≥20%at 18 mo versus baseline medicated IOP or a reduction in the number of medications while maintaining IOP values.RESULTS:From 40 PLT-treated eyes(mean baseline IOP 20.3±1.7 mm Hg),24 patients were analyzed(age 63.4±7.3 y).The mean IOP reductions from baseline across visits(months 1,3,6,9,12,and 18)ranged from 14.1%to 20.8%.Success rate after 18-month follow-up was 61.7%with a mean IOP of 16±3.2 mm Hg(P<0.001).The number of glaucoma IOP-lowering medications per eye(preoperative 2.1±1.1 and postoperative 2.3±1.1,P=0.86)and the mean BCVA(preoperative 0.10±0.22 and postoperative 0.11±0.22 logMAR,P=0.42)remained stable.Adverse events comprised transitory IOP spikes in 4 eyes(10%)and peripheral anterior synechiae in 7 eyes(17.5%).CONCLUSION:Mid-term results of PLT show that this procedure may be an efficacious and safe technique to approach medically uncontrolled OHT or POAG patients.展开更多
This study investigated the association of hypertension with cognitive impairment and determined whether better adherence to plant-based diet(PBD)patterns may modify the association.We analyzed 4485 elderly individual...This study investigated the association of hypertension with cognitive impairment and determined whether better adherence to plant-based diet(PBD)patterns may modify the association.We analyzed 4485 elderly individuals with normal cognition at baseline from the Chinese Longitudinal Healthy Longevity Survey(2011−2018).Cognitive function was assessed by the Mini-mental State Examination(MMSE),and cognitive impairment was defined as an MMSE score below 18 points.Diet patterns were assessed using the overall plant-based diet index(PDI),healthful plant-based diet index(hPDI),and unhealthful plant-based diet index(uPDI)derived from a simplified food frequency questionnaire(FFQ).Blood pressure was measured through physical examination.Cox proportional hazard regression and restricted cubic spline were performed.Participants with hypertension had an increased risk of cognitive impairment compared with normal group.The associations between hypertension and cognitive impairment were more pronounced among participants with lower PDI than those with higher PDI,among participants with lower hPDI than those with higher hPDI,and among participants with higher uPDI than those with lower uPDI.A healthful PBD pattern may attenuate hypertension-induced cognitive impairment,while an unhealthful PBD pattern may exacerbate hypertensioninduced cognitive impairment in elderly.Adherence to healthful PBD pattern could be used to prevent or mitigate adverse neurological effects in the hypertensive population.展开更多
Introduction: Hypertension is a public health problem with a high prevalence in Nigeria. The cost of prescription medications is thought to be a barrier for many patients to access the healthcare they need. This study...Introduction: Hypertension is a public health problem with a high prevalence in Nigeria. The cost of prescription medications is thought to be a barrier for many patients to access the healthcare they need. This study was aimed at identifying associated co-morbid conditions, the prescribing patterns and cost of prescription for the treatment of hypertension in an outpatient clinic at Lagos University Teaching Hospital. Materials and Methods: A cross sectional study was carried out. A total of 147 prescriptions were obtained from the case notes of patients treated at the LUTH outpatient department between February 2012 and August 2012. For each prescription, the number of drugs, the class and combinations of antihypertensives were recorded. The monthly cost of a 30-day anti-hypertensive supply based on the recommended daily dose was calculated. Results: The mean age of the patients was 54(+/-14) years and of the 147 prescriptions, 77(52.4%) was for females and 70(47.6%) was for males. The mean systolic blood pressure was 141.6 mmHg (+/-20.5SD) and mean diastolic blood pressure was 86.5 mmHg (+/-13.3SD). Of the 147 prescriptions, 112(76.2%) were for patients with co-morbidities. The frequency of prescription of the various classes of anti hypertensives are;diuretics 117(79.6%), angiotensin receptor blockers 78(53.1%), angiotensin converting enzyme inhibitors 65(44.2%), calcium channel blockers 65 (44.2%) beta blockers 54(36.7%) and centrally acting agents 12(8.2%). Average cost per month was =N=6611.47 (US$44). There was a statistically significant association between co morbid conditions and high cost of prescriptions with 73.7% of those with diabetes and 63.2% of those with renal disease having cost of prescriptions within the high cost group (p < 0.05). Conclusion: The cost per month is high and it is recommended that hypertension should be addressed as part of an integrated care program. Ingenious ways of health care financing also have to be promoted.展开更多
BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship b...BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD.There remains variability in antihypertensive treatment practices.AIM To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients.METHODS The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002.All patients are followed up annually,and their medical records including the list of medications are updated until they reach study endpoints[starting on renal replacement therapy or reaching estimated glomerular filtration rate(eGFR)expressed as mL/min/1.73 m2≤10 mL/min/1.73 m2,or the last follow-up date,or data lock on December 31,2021,or death].Data on antihypertensive prescription practices in correspondence to baseline eGFR,urine albumin-creatinine ratio,primary CKD aetiology,and cardiovascular disease were evaluated.Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis.Kaplan-Meier analysis demonstrated differences in survival probabilities.RESULTS Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included.The median age was 65 years.A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages(53%of eGFR≤15 mL/min/1.73 m2 vs 26%of eGFR≥60 mL/min/1.73 m2,P<0.001).An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased(category A3:62%vs category A1:40%,P<0.001),with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers.The prescription of three or more antihypertensive agents was associated with all-cause mortality,independent of blood pressure control(hazard ratio:1.15;95%confidence interval:1.04-1.27,P=0.006).Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed(log-rank,P<0.001).CONCLUSION Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm.Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents.Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.展开更多
OBJECTIVE This study evaluated the interplay of blood pressure(BP)patterns during hospital admission for labour and delivery and the risk of postpartum readmission for hypertension.
Introduction:Inadequate blood pressure(BP)control is a significant challenge.Therapeutic decisions based on home blood pressure monitoring(HBPM)have been shown to lead to better blood pressure control compared to thos...Introduction:Inadequate blood pressure(BP)control is a significant challenge.Therapeutic decisions based on home blood pressure monitoring(HBPM)have been shown to lead to better blood pressure control compared to those based on office blood pressure(OBP)measurements alone.Objectives:To compare,over a five-year period,the annual BP control rates in hypertensive patients who were treated and monitored by the same cardiologists and who periodically used HBPM.Methodology:This was a multicenter study conducted with five cross-sectional analyses at annual intervals,with the first in 2019 and the last in 2023.OBP and HBPM measurements were performed according to current guidelines.Two cutoff points were considered for the analysis of BP control by OBP:<140/90 mmHg and<130/80 mmHg.For HBPM,the cutoff was<130/80 mmHg.Comparisons of quantitative variables between years were established using the t-test or chi-square test.A p-value<0.05 was considered significant.Results:A total of 8,890 individuals with a mean age of 63.3(±14.9)years were included,of whom 65.8%were women.A reduction in mean OBP values was observed between 2019-2020 and 2021-2022.There was also a reduction in the average number of antihypertensive medications used in 2020,with a mean of 1.99 medications taken that year.Compared to 2020,2022 showed an improvement in control rates for OBP<130/80 mmHg(31.5%vs.35.7%;p=0.008)and OBP<140/90 mmHg(58.7%vs.65.7%;p<0.001).Conclusion:Continuous monitoring by the same physician and the use of home measurement tools can lead to better BP control in hypertensive patients.展开更多
文摘AIM:To describe the safety and efficacy of patterned laser trabeculoplasty(PLT)as an adjunctive treatment in primary open angle glaucoma(POAG)and ocular hypertension(OHT)after 18-month follow-up in Hispanic population.METHODS:A single-center,retrospective study was conducted.All patients with OHT or POAG undergoing PLT from June 2016 to August 2016 were included in the study.Investigated parameters were intraocular pressure(IOP),the number of IOP-lowering medications,best corrected visual acuity(BCVA),laser parameters and postoperative adverse events.Primary efficacy outcome measures were the proportion of eyes achieving an IOP reduction≥20%at 18 mo versus baseline medicated IOP or a reduction in the number of medications while maintaining IOP values.RESULTS:From 40 PLT-treated eyes(mean baseline IOP 20.3±1.7 mm Hg),24 patients were analyzed(age 63.4±7.3 y).The mean IOP reductions from baseline across visits(months 1,3,6,9,12,and 18)ranged from 14.1%to 20.8%.Success rate after 18-month follow-up was 61.7%with a mean IOP of 16±3.2 mm Hg(P<0.001).The number of glaucoma IOP-lowering medications per eye(preoperative 2.1±1.1 and postoperative 2.3±1.1,P=0.86)and the mean BCVA(preoperative 0.10±0.22 and postoperative 0.11±0.22 logMAR,P=0.42)remained stable.Adverse events comprised transitory IOP spikes in 4 eyes(10%)and peripheral anterior synechiae in 7 eyes(17.5%).CONCLUSION:Mid-term results of PLT show that this procedure may be an efficacious and safe technique to approach medically uncontrolled OHT or POAG patients.
基金supported by the National Key R&D Program of China(2018YFC2000400)the National Natural Sciences Foundation of China(72061137004)+1 种基金the National Institute on Aging of National Institutes of Health(P01AG031719)Duke/DukeNUS(grant RECA(Pilot)/2019/0051 to Y.Z.).
文摘This study investigated the association of hypertension with cognitive impairment and determined whether better adherence to plant-based diet(PBD)patterns may modify the association.We analyzed 4485 elderly individuals with normal cognition at baseline from the Chinese Longitudinal Healthy Longevity Survey(2011−2018).Cognitive function was assessed by the Mini-mental State Examination(MMSE),and cognitive impairment was defined as an MMSE score below 18 points.Diet patterns were assessed using the overall plant-based diet index(PDI),healthful plant-based diet index(hPDI),and unhealthful plant-based diet index(uPDI)derived from a simplified food frequency questionnaire(FFQ).Blood pressure was measured through physical examination.Cox proportional hazard regression and restricted cubic spline were performed.Participants with hypertension had an increased risk of cognitive impairment compared with normal group.The associations between hypertension and cognitive impairment were more pronounced among participants with lower PDI than those with higher PDI,among participants with lower hPDI than those with higher hPDI,and among participants with higher uPDI than those with lower uPDI.A healthful PBD pattern may attenuate hypertension-induced cognitive impairment,while an unhealthful PBD pattern may exacerbate hypertensioninduced cognitive impairment in elderly.Adherence to healthful PBD pattern could be used to prevent or mitigate adverse neurological effects in the hypertensive population.
文摘Introduction: Hypertension is a public health problem with a high prevalence in Nigeria. The cost of prescription medications is thought to be a barrier for many patients to access the healthcare they need. This study was aimed at identifying associated co-morbid conditions, the prescribing patterns and cost of prescription for the treatment of hypertension in an outpatient clinic at Lagos University Teaching Hospital. Materials and Methods: A cross sectional study was carried out. A total of 147 prescriptions were obtained from the case notes of patients treated at the LUTH outpatient department between February 2012 and August 2012. For each prescription, the number of drugs, the class and combinations of antihypertensives were recorded. The monthly cost of a 30-day anti-hypertensive supply based on the recommended daily dose was calculated. Results: The mean age of the patients was 54(+/-14) years and of the 147 prescriptions, 77(52.4%) was for females and 70(47.6%) was for males. The mean systolic blood pressure was 141.6 mmHg (+/-20.5SD) and mean diastolic blood pressure was 86.5 mmHg (+/-13.3SD). Of the 147 prescriptions, 112(76.2%) were for patients with co-morbidities. The frequency of prescription of the various classes of anti hypertensives are;diuretics 117(79.6%), angiotensin receptor blockers 78(53.1%), angiotensin converting enzyme inhibitors 65(44.2%), calcium channel blockers 65 (44.2%) beta blockers 54(36.7%) and centrally acting agents 12(8.2%). Average cost per month was =N=6611.47 (US$44). There was a statistically significant association between co morbid conditions and high cost of prescriptions with 73.7% of those with diabetes and 63.2% of those with renal disease having cost of prescriptions within the high cost group (p < 0.05). Conclusion: The cost per month is high and it is recommended that hypertension should be addressed as part of an integrated care program. Ingenious ways of health care financing also have to be promoted.
基金the National Institute of Health Research Manchester Biomedical Research Centre for their funding support in the SKS(NIHR203308).
文摘BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD.There remains variability in antihypertensive treatment practices.AIM To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients.METHODS The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002.All patients are followed up annually,and their medical records including the list of medications are updated until they reach study endpoints[starting on renal replacement therapy or reaching estimated glomerular filtration rate(eGFR)expressed as mL/min/1.73 m2≤10 mL/min/1.73 m2,or the last follow-up date,or data lock on December 31,2021,or death].Data on antihypertensive prescription practices in correspondence to baseline eGFR,urine albumin-creatinine ratio,primary CKD aetiology,and cardiovascular disease were evaluated.Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis.Kaplan-Meier analysis demonstrated differences in survival probabilities.RESULTS Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included.The median age was 65 years.A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages(53%of eGFR≤15 mL/min/1.73 m2 vs 26%of eGFR≥60 mL/min/1.73 m2,P<0.001).An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased(category A3:62%vs category A1:40%,P<0.001),with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers.The prescription of three or more antihypertensive agents was associated with all-cause mortality,independent of blood pressure control(hazard ratio:1.15;95%confidence interval:1.04-1.27,P=0.006).Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed(log-rank,P<0.001).CONCLUSION Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm.Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents.Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.
文摘OBJECTIVE This study evaluated the interplay of blood pressure(BP)patterns during hospital admission for labour and delivery and the risk of postpartum readmission for hypertension.
文摘Introduction:Inadequate blood pressure(BP)control is a significant challenge.Therapeutic decisions based on home blood pressure monitoring(HBPM)have been shown to lead to better blood pressure control compared to those based on office blood pressure(OBP)measurements alone.Objectives:To compare,over a five-year period,the annual BP control rates in hypertensive patients who were treated and monitored by the same cardiologists and who periodically used HBPM.Methodology:This was a multicenter study conducted with five cross-sectional analyses at annual intervals,with the first in 2019 and the last in 2023.OBP and HBPM measurements were performed according to current guidelines.Two cutoff points were considered for the analysis of BP control by OBP:<140/90 mmHg and<130/80 mmHg.For HBPM,the cutoff was<130/80 mmHg.Comparisons of quantitative variables between years were established using the t-test or chi-square test.A p-value<0.05 was considered significant.Results:A total of 8,890 individuals with a mean age of 63.3(±14.9)years were included,of whom 65.8%were women.A reduction in mean OBP values was observed between 2019-2020 and 2021-2022.There was also a reduction in the average number of antihypertensive medications used in 2020,with a mean of 1.99 medications taken that year.Compared to 2020,2022 showed an improvement in control rates for OBP<130/80 mmHg(31.5%vs.35.7%;p=0.008)and OBP<140/90 mmHg(58.7%vs.65.7%;p<0.001).Conclusion:Continuous monitoring by the same physician and the use of home measurement tools can lead to better BP control in hypertensive patients.
