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Cluster Randomized Trial for Hypertension Control: Effect on Lifestyles and Body Weight.
Poggio, R, Melendi, SE, Beratarrechea, A, Gibbons, L, Mills, KT, Chen, CS, Nejamis, A, Gulayin, P, Santero, M, Chen, J, et al
American journal of preventive medicine. 2019;(4):438-446
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INTRODUCTION Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families. STUDY DESIGN Cluster randomized trial conducted between June 2013 and October 2016. SETTING/PARTICIPANTS A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina. INTERVENTION Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months. MAIN OUTCOME MEASURES Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017. RESULTS Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000). CONCLUSIONS The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01834131.
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Association of obstructive sleep apnea plus hypertension and prevalent cardiovascular diseases: A cross-sectional study.
Wang, L, Cai, A, Zhang, J, Zhong, Q, Wang, R, Chen, J, Zhou, Y
Medicine. 2016;(39):e4691
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Current study sought to evaluate the associations of obstructive sleep apnea (OSA) plus hypertension (HTN) and prevalent cardiovascular diseases (CVD).This was a cross-sectional study and a total of 1889 subjects were enrolled. The apnea-hypopnea index (AHI) was measured by polysomnography and OSA degree was classified as mild (AHI 5-14.9) and moderate-severe (AHI ≥ 15), and AHI < 5 was considered no-OSA. Mean and lowest oxyhemoglobin saturation (SaO2) was detected by pulse oximetry. Between-group differences were assessed and logistic regression analysis was used to analyze the association of OSA plus HTN and prevalent CVD.Compared to normotensive subjects, hypertensive subjects were older and had higher body mass index (BMI), neck girth, waist-hip ratio, AHI, and low-density lipoprotein cholesterol (LDL-C) level. Conversely, mean and lowest SaO2 levels were significantly lower. Logistic regression analysis showed that in an unadjusted model, compared to subjects with no-OSA and no-HTN (reference group), the association of HTN plus moderate-severe-OSA and prevalent CVD was the most prominent (odds ratio [OR]: 2.638 and 95% confidence interval [CI]: 1.942-3.583). In normotensive subjects, after adjusted for potential covariates, the associations of OSA (regardless of severity) and prevalent CVD were attenuated to nonsignificant. In hypertensive subjects, however, the associations remained significant but were reduced. Further adjusted for mean and lowest SaO2, the associations remained significant in HTN plus no-OSA (OR: 1.808, 95% CI: 1.207-2.707), HTN plus mild-OSA (OR: 2.003, 95% CI: 1.346-2.980), and HTN plus moderate-severe OSA (OR: 1.834, 95% CI: 1.214-2.770) groups.OSA plus HTN is associated with prevalent CVD, and OSA may potentiate the adverse cardiovascular effects on hypertensives patients but not normotensives.
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Genome-wide association study in Chinese identifies novel loci for blood pressure and hypertension.
Lu, X, Wang, L, Lin, X, Huang, J, Charles Gu, C, He, M, Shen, H, He, J, Zhu, J, Li, H, et al
Human molecular genetics. 2015;(3):865-74
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Hypertension is a common disorder and the leading risk factor for cardiovascular disease and premature deaths worldwide. Genome-wide association studies (GWASs) in the European population have identified multiple chromosomal regions associated with blood pressure, and the identified loci altogether explain only a small fraction of the variance for blood pressure. The differences in environmental exposures and genetic background between Chinese and European populations might suggest potential different pathways of blood pressure regulation. To identify novel genetic variants affecting blood pressure variation, we conducted a meta-analysis of GWASs of blood pressure and hypertension in 11 816 subjects followed by replication studies including 69 146 additional individuals. We identified genome-wide significant (P < 5.0 × 10(-8)) associations with blood pressure, which included variants at three new loci (CACNA1D, CYP21A2, and MED13L) and a newly discovered variant near SLC4A7. We also replicated 14 previously reported loci, 8 (CASZ1, MOV10, FGF5, CYP17A1, SOX6, ATP2B1, ALDH2, and JAG1) at genome-wide significance, and 6 (FIGN, ULK4, GUCY1A3, HFE, TBX3-TBX5, and TBX3) at a suggestive level of P = 1.81 × 10(-3) to 5.16 × 10(-8). These findings provide new mechanistic insights into the regulation of blood pressure and potential targets for treatments.
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The multiple lifestyle modification for patients with prehypertension and hypertension patients: a systematic review protocol.
Li, J, Zheng, H, Du, HB, Tian, XP, Jiang, YJ, Zhang, SL, Kang, Y, Li, X, Chen, J, Lu, C, et al
BMJ open. 2014;(8):e004920
Abstract
INTRODUCTION The objective of this systematic review is to investigate the effectiveness, efficacy and safety of multiple concomitant lifestyle modification therapies for patients with hypertension or prehypertension. METHODS AND ANALYSIS Electronic searches will be performed in the Cochrane Library, OVID, EMBASE, etc, along with manual searches in the reference lists of relevant papers found during electronic search. We will identify eligible randomised controlled trials utilising multiple lifestyle modifications to lower blood pressure. The control could be drug therapy, single lifestyle change or no intervention. Changes in systolic blood pressure and diastolic blood pressure constitute primary end points, and secondary end points include the number of patients meeting the office target blood pressure, the number of patients reporting microvascular or macrovascular complications, etc. We will extract descriptive, methodological and efficacy data from identified randomised controlled trials (RCTs). We will calculate the relative risk for proportion of patients with a normal blood pressure in the experimental group. Dichotomous data will be analysed using risk difference and continuous data using weighted mean differences, both with 95% CI. We will use the χ(2) test and the I(2) statistic to assess heterogeneity. We will use the fixed effects model to compute the efficacy unless there is evidence of heterogeneity. If heterogeneity of effect size persists with respect to blood pressure change, further metaregression will be performed within groups. We will examine the potential for publication bias by using a funnel plot. DISSEMINATION We will synthesise results from RCTs which provide more precise and accurate information on the effect of multiple lifestyle changes on blood pressure. The results of this review will increase the understanding of multiple lifestyle modifications for patients with hypertension or prehypertension. TRAIL REGISTRATION NUMBER Our protocol is registered on PROSPERO (CRD42013006476), http://www.crd.your.ac.uk/PROSPERO.
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Effect of dietary protein supplementation on blood pressure: a randomized, controlled trial.
He, J, Wofford, MR, Reynolds, K, Chen, J, Chen, CS, Myers, L, Minor, DL, Elmer, PJ, Jones, DW, Whelton, PK
Circulation. 2011;(5):589-95
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BACKGROUND Observational studies have reported an inverse association between dietary protein intake and blood pressure (BP). We compared the effect of soy protein, milk protein, and carbohydrate supplementation on BP among healthy adults. METHODS AND RESULTS We conducted a randomized, double-blind crossover trial with 3 intervention phases among 352 adults with prehypertension or stage 1 hypertension in New Orleans, LA, and Jackson, MS, from September 2003 to April 2008. The trial participants were assigned to take 40 g/d soy protein, milk protein, or carbohydrate supplementation each for 8 weeks in a random order. A 3-week washout period was implemented between the interventions. Three BPs were measured at 2 baseline and 2 termination visits during each of 3 intervention phases with a random-zero sphygmomanometer. Compared with carbohydrate controls, soy protein and milk protein supplementations were significantly associated with -2.0 mm Hg (95% confidence interval -3.2 to -0.7 mm Hg, P=0.002) and -2.3 mm Hg (-3.7 to -1.0 mm Hg, P=0.0007) net changes in systolic BP, respectively. Diastolic BP was also reduced, but this change did not reach statistical significance. There was no significant difference in the BP reductions achieved between soy or milk protein supplementation. CONCLUSIONS The results from this randomized, controlled trial indicate that both soy and milk protein intake reduce systolic BP compared with a high-glycemic-index refined carbohydrate among patients with prehypertension and stage 1 hypertension. Furthermore, these findings suggest that partially replacing carbohydrate with soy or milk protein might be an important component of nutrition intervention strategies for the prevention and treatment of hypertension. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00107744.
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Epidemiology of hypertension and chronic kidney disease in China.
Chen, J
Current opinion in nephrology and hypertension. 2010;(3):278-82
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PURPOSE OF REVIEW Hypertension and chronic kidney disease have become major public health challenges in China. RECENT FINDINGS It is estimated that approximately 153 million Chinese adults had hypertension in 2002. It is also estimated that 2.33 million total cardiovascular deaths and 1.27 million premature cardiovascular deaths were attributable to increased blood pressure in 2005 in China. Approximately 39% of Chinese adult populations are highly sensitive to dietary sodium intake, a risk factor for hypertension and cardiovascular disease. The prevalence of chronic kidney disease varied greatly among studies due to differences in study populations and definitions of chronic kidney disease. A large prospective cohort study estimates that incidence and mortality of end-stage renal disease was 30.7 and 20.9 per 100,000 person-years among Chinese adults aged 40 years and older. Hypertension and the metabolic syndrome have been documented as risk factors for chronic kidney disease. In addition, a J-shaped association between body weight and incidence of end-stage renal disease and an inverse association between alcohol consumption and risk of end-stage renal disease were documented. SUMMARY These results underscore the urgent need to develop national strategies for the prevention, detection, and treatment of hypertension and chronic kidney disease.
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[Comparison of effect between multiplex and simplex nutritional intervention on hyperlipemia, hypertension or diabetes].
Zhai, C, Zhang, J, Zhai, Y, Chen, J, Zuo, H, Jiang, L
Wei sheng yan jiu = Journal of hygiene research. 2004;(6):719-21
Abstract
OBJECTIVE To explore the effect of simplex and multiplex nutritional intervention on hyperlipemia, hypertension or diabetes. METHODS 260 persons who have hyperlipemia were randomized to 3 groups: (1) "the multiplex nutritional intervention group", is given 100 g coarse food grain everyday and nutrition education, (2) "the simplex nutritional intervention group", is only given nutrition education, (3) "the control group". RESULTS After three months, the degressive value of blood pressure, blood sugar and blood lipid respectively in the multiplex nutritional intervention group were larger than in the simplex nutritional intervention. CONCLUSION There are better effect on hyperlipemia, hypertension and diabetes by nutrition education plus passive dietary intervention than by nutrition education.