1,721,226 research outputs found
Tight BP control reduced left ventricular hypertrophy in nondiabetic patients with hypertension
No full textHormonal regulation of human adipocytes at the cross-roads between obesity and hypertension
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Should high-normal blood pressure be treated?
No full textLetter about the importance of high-normal BP in determining cardiovascular risk
Blood pressure and hypertension in relation to lead exposure updated according to present-day blood lead levels
No full textLead is an environmental hazard that should be addressed worldwide. Over time, human exposure to lead in the Western world has fallen drastically to the levels comparable to those in humans living in the pre-industrial era, who were mainly exposed to natural sources of lead. To re-evaluate the health risks possibly associated with present-day lead exposure, a three-pronged approach was applied. First, we critically assessed the recently published population metrics describing the adverse health effects associated with lead exposure at the population level. Next, we summarized the key results of the Study for Promotion of Health in Recycling Lead (SPHERL; NCT02243904) and analyzed these results in the context of the published population metrics. Last but not least, we performed a brief literature review on the present-day lead exposure level in Poland. To our best knowledge, SPHERL is the first prospective study that accounted for interindividual variation in vulnerability to the toxic effects of lead exposure by assessing the participants' health status before and after occupational lead exposure, with blood pressure and hypertension as the primary outcomes. The overall conclusion of this comprehensive review on blood pressure and hypertension is that mainstream ideas about the public and occupational health risks related to lead exposure need to be urgently updated because a large part of the available literature has become obsolete given present-day exposure levels that sharply declined over the past 40 years.Funding:
The International Lead Association (www.ila-lead.org) provided an unrestricted grant to the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, partially supporting data collection and management and statistical analysis of the SPHERL project. The Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (URL, www.appremed.org) received a nonbinding grant from OMRON Healthcare Co Ltd, Kyoto, Japan. These funders played no role in the decision to submit this review article
Compared with whom? Addressing the prognostic value of ambulatory blood pressure categories
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Community based trial of home blood pressure monitoring with nurse-led telephone support in patients with stroke or transient ischaemic attack recently discharged from hospital.
No full textBACKGROUND: High blood pressure in patients with stroke increases the risk of recurrence but management in the community is often inadequate. Home blood pressure monitoring may increase patients' involvement in their care, increase compliance, and reduce the need for patients to attend their General Practitioner if blood pressure is adequately controlled. However the value of home monitoring to improve blood pressure control is unclear. In particular its use has not been evaluated in stroke patients in whom neurological and cognitive ability may present unique challenges.
DESIGN: Community based randomised trial with follow up after 12 months.
PARTICIPANTS: 360 patients admitted to three South London Stroke units with stroke or transient ischaemic attack within the past 9 months will be recruited from the wards or outpatients and randomly allocated into two groups. All patients will be visited by the specialist nurse at home at baseline when she will measure their blood pressure and administer a questionnaire. These procedures will be repeated at 12 months follow up by another researcher blind as to whether the patient is in intervention or control group.
INTERVENTION: INTERVENTION patients will be given a validated home blood pressure monitor and support from the specialist nurse. Control patients will continue with usual care (blood pressure monitoring by their practice). Main outcome measures in both groups after 12 months: 1. Change in systolic blood pressure.2.
Cost effectiveness: Incremental cost of the intervention to the National Health Service and incremental cost per quality adjusted life year gained
Environmental exposure to cadmium, forearm bone density, and risk of fractures: prospective population study
No full textBackground Chronic low-level exposure to cadmium may promote calcium loss via urinary excretion. We undertook a prospective population study to investigate whether environmental exposure to cadmium lowers bone density and increases risk of fractures. Methods We measured urinary cadmium excretion, a biomarker of lifetime exposure, in people from ten districts of Belgium, of which six districts bordered on three zinc smelters. We also measured cadmium in soil and in vegetables from the districts, and collected data on incidence of fractures and height loss. Bone density was measured at the forearm just above the wrist by single photon absorptiometry, and calculated as the mean of six proximal and four distal scans. Findings Mean cadmium excretion at baseline was 8.7 nmol dairy. Across the ten districts, mean cadmium concentration in soil ranged from 0.8 to 14.7 mg/kg, and from 0.1 to 4.0 mg/kg dry weight in vegetables. Median follow-up was 6.6 years. Mean forearm bane density in proximal and distal scans was 0.54 g/cm(2) and 0.43 g/cm(2) in men, and 0.44 g/cm(2) and 0.34 g/cm(2) in women, in postmenopausal women, a twofold increase in urinary cadmium correlated with 0.01 g/cm(2) decrease in bone density (p < 0.02). The relative risks associated with doubted urinary cadmium were 1.73 (95% CI 1.16-2.57; p = 0.007) for fractures in women and 1.60 (0.94-2.72, p = 0.08) for height toss in men. Cadmium excretion in districts near smelters was 22.8% higher (p = 0.001) than in other districts, with fracture rates of 16.0 end 10.3 cases per 1000 person-years, respectively, and a population-attributable risk of 35.0%. Interpretation Even at a low degree of environmental exposure, cadmium may promote skeletal demineralisation, which may lead to increased bone fragility and raised risk of fractures
LOW-DENSITY-LIPOPROTEINS-CHOLESTEROL MORTALITY IN THE ELDERLY
No full textOBJECTIVES:
To investigate the role of low-density lipoprotein cholesterol (LDL-C) as a predictor of mortality in elderly subjects.
DESIGN:
Population-based prospective cohort study.
SETTING:
Two communities in northern Italy.
PARTICIPANTS:
Three thousand one hundred twenty Caucasian subjects aged 65 and older recruited in for the Cardiovascular Study in the Elderly and followed up for 12 years.
MEASUREMENTS:
Anthropometric measures: fasting plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol, LDL-C, glucose, creatinine, and body mass index. Clinical measures: medical assessment, diabetes mellitus, hypertension, stroke, coronary disease, heart failure, and smoking and drinking habits. Vital status measures: death certificates from the Registry Office and causes of death according to the International Classification of Diseases. After plotting mortality rates using quartiles of LDL-C, relative hazard rates (RHRs) were calculated using multivariate Cox regression analyses. When the trend was nonlinear, the RHRs were further calculated for the 25th, 50th, and 75th percentiles of the distribution to confirm curvilinearity.
RESULTS:
The distribution of risk of total mortality in women and of fatal heart failure in all subjects was curvilinear (non J-shaped), decreasing nonlinearly with LDL-C. For total mortality in men and cardiovascular mortality in both sexes, the relationship with LDL-C was J-shaped. The risk of fatal myocardial infarction was J-shaped in men, whereas it increased linearly with higher LDL-C in women. In both sexes, the association between stroke mortality and LDL-C was not significant.
CONCLUSION:
This study adds to the uncertainty of the role of elevated levels of LDL-C as a risk factor for mortality in old people
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