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Item The Association between Neighborhood Disorder and Hypertension Mediated through Stress(Office of the Vice Chancellor for Research, 2013-04-05) Henderson, Francis; Bell, Caryn; Duncan, Alexandra; Furr-Holden, DebraThis study seeks to understand the relationship between the physical and social neighborhood environment and self-reported hypertension status in order to improve the health of Baltimore City residents. However, the mechanism through which neighborhood disorder is associated with hypertension is unclear. Self-reported hypertension status and demographic information from 711 Baltimore City heads of households from the Windows to Health survey was combined with corresponding neighborhood block order/disorder ratings on the presence of violence, alcohol and other drugs using the Neighborhood Inventory for Environmental Typology (NIfTEy). Regression models were used to test the relationship between (1) neighborhood disorder and hypertension status, (2) neighborhood disorder and stress symptoms (tiredness, headache, and trouble concentrating), and (3) stress symptoms and hypertension status. Results showed a statistically significant association between neighborhood disorder (violence) and stress symptoms (tiredness) after adjusting for age, sex, race, employment status, and highest level of education completed (OR 1.35, CI 1.03-1.77). However, there was no association between neighborhood disorder and hypertension status or stress symptoms and hypertension status. It is possible stress symptoms could be related to other health outcomes. Given the shown relationship between neighborhood disorder and stress symptoms, public health practitioners should design and implement neighborhood level interventions in communities with high levels of disorder in order to improve the health and well-being of residents.Item Blood pressure in hemodialysis: targets?(Wolters Kluwer, 2017-11) Georgianos, Panagiotis I.; Agarwal, Rajiv; Medicine, School of MedicinePurpose of review In the absence of ‘hard’ clinical-trial evidence to define optimal blood pressure (BP) targets and validate different BP measurement techniques, management of hypertension in hemodialysis is based on expert opinions. In this review, we provide a comparative evaluation of out-of-dialysis BP monitoring versus dialysis-unit BP recordings in diagnosing hypertension, guiding its management and prognosticating mortality risk. Recent findings Owing to their high variability and poor reproducibility, predialysis and postdialysis BP recordings provide inaccurate reflection of the actual BP load outside of dialysis. Contrary to the reverse association of peridialytic BP with mortality, elevated home and ambulatory BP provides a direct mortality signal. Out-of-dialysis BP monitoring, even when done in the clinic, is a reliable approach to manage hypertension in the dialysis unit. Whenever none of these measures are available, median intradialytic SBP can provide a better estimate of interdialytic BP levels compared with peridialytic BP measurements. Summary Although out-of-dialysis BP monitoring have better diagnostic accuracy and prognostic validity, randomized trials are needed to ascertain BP targets for managing hypertension in hemodialysis patients.Item Cardiovascular Risk Factors as Differential Predictors of Incident Atypical and Typical Major Depressive Disorder in U.S. Adults(Wolters Kluwer, 2018-03) Patel, Jay S.; Bernston, Jessica; Polanka, Brittanny M.; Stewart, Jesse C.; Psychology, School of ScienceObjectives While the association between major depressive disorder (MDD) and future cardiovascular disease (CVD) is established, less is known about the relationship between CVD risk factors and future depression, and no studies have examined MDD subtypes. Our objective was to determine whether hypertension, tobacco use, and body mass index (BMI) differentially predict atypical and typical MDD in a national sample of U.S. adults. Methods We examined prospective data from 22,915 adults with no depressive disorder history at baseline who participated in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). CVD risk factors (Wave 1) and incident MDD subtypes (Wave 2) were determined by structured interviews. Results There were 252 atypical and 991 typical MDD cases. In fully-adjusted models, baseline hypertension (OR=0.58, 95% CI: 0.43-0.76), former tobacco use (OR=1.46, 95% CI: 1.20-1.78), and BMI (OR=1.32, 95% CI: 1.25-1.40; all p’s<0.001) predicted incident atypical MDD versus no MDD, whereas no CVD risk factor predicted incident typical MDD. Baseline hypertension (OR=0.52, 95% CI: 0.39-0.70), former tobacco use (OR=1.53, 95% CI: 1.22-1.93), and BMI (OR=1.26, 95% CI: 1.18-1.36; all p’s<0.001) also predicted incident atypical MDD versus typical MDD. Conclusions Our study is the first to report that CVD risk factors differentially predict MDD subtypes, with hypertension (protective factor), former tobacco use (risk factor), and BMI (risk factor) being stronger predictors of incident atypical versus typical MDD. Such evidence could provide insights into the etiologies of MDD subtypes and inform interventions tailored to MDD subtype.Item Clinical and Research Considerations for Patients with Hypertensive Acute Heart Failure(Elsevier, 2016-08) Collins, Sean P.; Levy, Phillip D.; Martindale, Jennifer L.; Dunlap, Mark E.; Storrow, Alan B.; Pang, Peter S.; Sawyer, Douglas B.; Fermann, Gregory J.; Lenihan, Daniel J.; Peacock, W. Frank; Albert, Nancy M.; Hollander, Judd E.; Lindenfeld, JoAnn M.; Teerlink, John R.; Felker, G. Michael; Fonarow, Gregg C.; Butler, Javed; Department of Emergency Medicine, IU School of MedicineManagement approaches for patients in the emergency department (ED) who present with acute heart failure (AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement underlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H-AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricular filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease based on these mechanisms. This consensus statement reviews the relevant pathophysiology, clinical characteristics, approach to therapy, and considerations for clinical trials in ED patients with H-AHF.Item Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction(American Heart Association, 2018-02) Bravata, Dawn M.; Daggy, Joanne; Brosch, Jared; Sico, Jason J.; Baye, Fitsum; Myers, Laura J.; Roumie, Christianne L.; Cheng, Eric; Coffing, Jessica; Arling, Greg; Medicine, School of MedicineBACKGROUND AND PURPOSE: The Veterans Health Administration has engaged in quality improvement to improve vascular risk factor control. We sought to examine blood pressure (<140/90 mm Hg), lipid (LDL [low-density lipoprotein] cholesterol <100 mg/dL), and glycemic control (hemoglobin A1c <9%), in the year post-hospitalization for acute ischemic stroke or acute myocardial infarction (AMI). METHODS: We identified patients who were hospitalized (fiscal year 2011) with ischemic stroke, AMI, congestive heart failure, transient ischemic attack, or pneumonia/chronic obstructive pulmonary disease. The primary analysis compared risk factor control after incident ischemic stroke versus AMI. Facilities were included if they cared for ≥25 ischemic stroke and ≥25 AMI patients. A generalized linear mixed model including patient- and facility-level covariates compared risk factor control across diagnoses. RESULTS: Forty thousand two hundred thirty patients were hospitalized (n=75 facilities): 2127 with incident ischemic stroke and 4169 with incident AMI. Fewer stroke patients achieved blood pressure control than AMI patients (64%; 95% confidence interval, 0.62-0.67 versus 77%; 95% confidence interval, 0.75-0.78; P<0.0001). After adjusting for patient and facility covariates, the odds of blood pressure control were still higher for AMI than ischemic stroke patients (odds ratio, 1.39; 95% confidence interval, 1.21-1.51). There were no statistical differences for AMI versus stroke patients in hyperlipidemia (P=0.534). Among patients with diabetes mellitus, the odds of glycemic control were lower for AMI than ischemic stroke patients (odds ratio, 0.72; 95% confidence interval, 0.54-0.96). CONCLUSIONS: Given that hypertension control is a cornerstone of stroke prevention, interventions to improve poststroke hypertension management are neededItem Diabetes or hypertension as risk indicators for missing teeth experience: An exploratory study in a sample of Mexican adults(Medknow Publications, 2017-01-01) Delgado-Pérez, V. J.; Rosa-Santillana, R. De La; Márquez-Corona, M. L.; Ávila-Burgos, L.; Islas-Granillo, H.; Minaya-Sánchez, M.; Medina-Solís, C. E.; Maupomé, G.; Periodontics and Allied Dental Programs, School of DentistryBackground: To determine an exploratory estimation of the strength of type 2 diabetes mellitus (T2DM) and hypertension diagnoses as risk indicators for missing teeth in a sample of Mexican adults.Materials and Methods: A comparative cross‑sectional study of sixty adult patients in a health center in Mexico included as dependent variable, the number of missing teeth (and having a functional dentition) and as independent variables, diagnoses for diabetes or hypertension, age, sex, maximum level of schooling, and tobacco use. Of the 60 participants, 20 were diagnosed with T2DM, 13 with hypertension, and 27 were otherwise diagnosed as healthy in their most recent medical checkup. A negative binomial regression (NBR) model was generated. Results: Mean age was 50.7 ± 16.2 and 50.0% were women. Mean number of missing teeth was 4.98 ± 4.17. In the multivariate NBR model, we observed that individuals with T2DM had higher risk of more missing teeth (incidence rate ratios [IRRs] = 3.13; 95% confidence interval [CI] = 2.09–4.69), followed by those with hypertension (IRRs = 2.63; 95% CI = 1.77–3.90). In addition, participants with current tobacco use were significantly more likely to have suffered tooth loss (P < 0.05) than those who were never smokers or former smokers, just like older participants (P < 0.05). Conclusions: T2DM and hypertension are independently associated with higher experience of missing teeth in an open adult population in Mexico. Future studies with a more sophisticated epidemiological design and encompassing a more detailed landscape of chronic diseases, type and length of use of long‑term medications, and patterns of dental care use are needed to better delineate these associations.Keywords: Adult, hypertension, Mexico, tooth loss, type 2 diabetesItem Effects of Magnesium Supplementation on Blood Pressure: A Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials(Elsevier, 2016-08) Zhang, Xi; Li, Yufeng; Del Gobbo, Liana C.; Rosanoff, Andrea; Wang, Jiawei; Zhang, Wen; Song, Yiqing; Department of Epidemiology, Richard M. Fairbanks School of Public HealthThe antihypertensive effect of magnesium (Mg) supplementation remains controversial. We aimed to quantify the effect of oral Mg supplementation on blood pressure (BP) by synthesizing available evidence from randomized, double-blind, placebo-controlled trials. We searched trials of Mg supplementation on normotensive and hypertensive adults published up to February 1, 2016 from MEDLINE and EMBASE databases; 34 trials involving 2028 participants were eligible for this meta-analysis. Weighted mean differences of changes in BP and serum Mg were calculated by random-effects meta-analysis. Mg supplementation at a median dose of 368 mg/d for a median duration of 3 months significantly reduced systolic BP by 2.00 mm Hg (95% confidence interval, 0.43–3.58) and diastolic BP by 1.78 mm Hg (95% confidence interval, 0.73–2.82); these reductions were accompanied by 0.05 mmol/L (95% confidence interval, 0.03, 0.07) elevation of serum Mg compared with placebo. Using a restricted cubic spline curve, we found that Mg supplementation with a dose of 300 mg/d or duration of 1 month is sufficient to elevate serum Mg and reduce BP; and serum Mg was negatively associated with diastolic BP but not systolic BP (all P<0.05). In the stratified analyses, a greater reduction in BP tended to be found in trials with high quality or low dropout rate (all P values for interaction <0.05). However, residual heterogeneity may still exist after considering these possible factors. Our findings indicate a causal effect of Mg supplementation on lowering BPs in adults. Further well-designed trials are warranted to validate the BP-lowering efficacy of optimal Mg treatment.Item Empowering Youth: Examining Health Literacy Gains in High School Students(2024-04-26) Grischke, Tyra; Tannir, Shadia; Bohn, Camden; Hoffman, Leslie A.Research Statement/ResearchQuestion This study assesses the health literacy of high school students’ before and after an educational presentation about hypertension, a health condition more prevalent in underserved communities. Background Low health literacy is associated with worse health outcomes, particularly within underserved communities. Improving health literacy among high school students can empower them to take action to improve health and well-being within their communities. Methods In spring 2023, medical students from IUSM visited four high schools to educate students on health literacy and hypertension. Participants completed a 15-item test prior to and immediately following the presentation. Demographic data (grade level, race, ethnicity, and gender) was collected. Data was collected anonymously, using assigned codes to match pre- and post-tests. Data was analyzed using paired samples t-tests and ANOVA. Results A total of 104 high school students completed pre- and post-tests. There was a significant improvement in quiz scores from pre- (7.95±1.74) to post-test (9.41±2.01; p<.001). One-way ANOVA found significant differences in pre- and post-test performance based on race, with Black students scoring lower than White students on both pre-test (7.28±1.28 vs. 8.31±1.70; p<.05) and post-test (8.55±2.21 vs. 9.85±1.76; p<.05). There was also a significant interaction between students’ gender and their pre- and post-test scores with female students showing greater improvements in test scores than male students. Limitations This study was conducted in a single school district in a small midwestern city and may not be generalizable to larger urban or rural populations. The presentation was given during a science class and may have been biased by students’ prior knowledge. Differences among presenters may also impact students’ comprehension. Conclusion High school students’ health literacy improved after an educational presentation on hypertension. This study revealed racial disparities in health literacy, highlighting the need for more health education in schools that have more students from underserved racial and ethnic groups.Item Evolving Concepts in Uromodulin Biology, Physiology, and Its Role in Disease: a Tale of Two Forms(American Heart Association, 2022-11) LaFavers, Kaice A.; Micanovic, Radmila; Sabo, Angela R.; Maghak, Lauren A.; El-Achkar, Tarek M.; Medicine, School of MedicineUromodulin (or Tamm-Horsfall protein) is a glycoprotein uniquely produced in the kidney by tubular cells of the thick ascending limb of the loop of Henle and early distal tubules. This protein exhibits bidirectional secretion in the urine and in the renal interstitium and circulation. The role of this protein in maintaining renal and systemic homeostasis is becoming increasingly appreciated. Furthermore, perturbations of its functions may play a role in various diseases affecting the kidney and distant organs. In this review, we will discuss important advances in understanding its biology, highlighting the recent discoveries of its secretion and differential precursor processing that generates two forms: a) a highly polymerizing form that is apically excreted in the urine and generates filaments, and b) a non-polymerizing form that retains a polymerization inhibitory pro-peptide and is released basolaterally in the kidney interstitium and circulation, but can also be found in the urine. We will also discuss factors regulating its production and release, taking into account its intricate physiology, and propose best practices to report its levels. We also discuss breaking advances in its role in hypertension, acute kidney injury and progression to chronic disease, immunomodulation and regulating renal and systemic oxidative stress. We anticipate that this work will be a great resource for researchers and clinicians. This review will highlight the importance of defining what regulates the two forms of uromodulin, so that modulation of uromodulin levels and function could become a novel tool in our therapeutic armamentarium against kidney disease.Item Factors Associated With Retinal Vessel Diameters in an Elderly Population: the Thessaloniki Eye Study(ARVO, 2019-05) Dervenis, Nikolaos; Coleman, Anne L.; Harris, Alon; Wilson, M. Roy; Yu, Fei; Anastasopoulos, Eleftherios; Founti, Panayiota; Pappas, Theofanis; Kilintzis, Vassilis; Topouzis, Fotis; Ophthalmology, School of MedicinePurpose: To identify the factors associated with retinal vessel diameters in the population of the Thessaloniki Eye Study. Methods: Cross-sectional population-based study (age ≥ 60 years). Subjects with glaucoma, late age-related macular degeneration, and diabetic retinopathy were excluded from the analyses. Retinal vessel diameters were measured using the IVAN software, and measurements were summarized to central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole to venule ratio (AVR). Results: The analysis included 1614 subjects. The hypertensive group showed lower values of CRAE (P = 0.033) and AVR (P = 0.0351) compared to the normal blood pressure (BP) group. On the contrary, the group having normal BP under antihypertensive treatment did not have different values compared to the normal BP group. Diastolic BP (per mm Hg) was negatively associated with CRAE (P < 0.0001) and AVR (P < 0.0001), while systolic BP (per mm Hg) was positively associated with CRAE (P = 0.001) and AVR (P = 0.0096). Other factors significantly associated included age, sex, alcohol, smoking, cardiovascular disease history, ophthalmic medication, weight, and IOP; differences were observed in a stratified analysis based on BP medication use. Conclusions: Our study confirms previous reports about the association of age and BP with vessel diameters. The negative correlation between BP and CRAE seems to be guided by the effect of diastolic BP as higher systolic BP is independently associated with higher values of CRAE. The association of BP status with retinal vessel diameters is determined by diastolic BP status in our population. Multiple other factors are also independently associated with retinal vessel diameters.
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