Type 2 diabetes mellitus in adults: pathogenesis, prevention and therapy

Signal Transduction and Targeted Therapy, Journal Year: 2024, Volume and Issue: 9(1)

Published: Oct. 2, 2024

Language: Английский

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Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases

Hypertension, Journal Year: 2023, Volume and Issue: 81(3), P. 387 - 399

Published: Dec. 28, 2023

High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled cardiovascular disease (CVD) deaths. Despite improvements high-income countries, disparities persist, notably United States, where Black individuals face up to 4× higher CVD mortality than White individuals. Social determinants of health encompass complex, multidimensional factors linked an individual’s birthplace, upbringing, activities, residence, workplaces, socioeconomic environmental structures, significantly affect outcomes, including hypertension CVD. This review explored how social drive related morbidity from a socioecological life course perspective. We present evidence-based strategies, emphasizing interventions tailored specific community needs cross-sector collaboration address inequalities rooted factors, which are key elements toward achieving Nations’ Sustainable Development Goal 3.4 for reducing premature by 30% 2030.

Language: Английский

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Recommendations for the Use of Dietary Fiber to Improve Blood Pressure Control

Hypertension, Journal Year: 2024, Volume and Issue: 81(7), P. 1450 - 1459

Published: April 8, 2024

According to several international, regional, and national guidelines on hypertension, lifestyle interventions are the first-line treatment lower blood pressure (BP). Although diet is one of major modifications described in hypertension guidelines, dietary fiber not specified. Suboptimal intake foods high fiber, such as Westernized diets, a contributing factor mortality morbidity noncommunicable diseases due higher BP cardiovascular disease. In this review, we address deficiency by examining advocating for incorporation key modification manage elevated BP. We explain what is, review existing literature that supports its use prevent disease, describe mechanisms involved, propose evidence-based target levels intake, provide examples how patients can achieve recommended targets, discuss outstanding questions field. evidence reviewed here, minimum daily adults with should be >28 g/day women >38 men, each extra 5 estimated reduce systolic 2.8 mm Hg diastolic 2.1 Hg. This would support healthy gut microbiota production microbiota-derived metabolites called short-chain fatty acids Awareness about targets them will guide medical teams better educating empowering increase their and, result, disease risk.

Language: Английский

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The influence of different forms of apple products on all-cause mortality in patients with hypertension

Frontiers in Nutrition, Journal Year: 2025, Volume and Issue: 11

Published: Jan. 24, 2025

Objective Apple consumption has a positive effect on human health. Some studies have shown that an appropriate amount of apple intake can reduce the incidence hypertension. However, few investigated whether eating different forms apples same benefits as whole apples. This study is aimed to evaluate all-cause mortality in patients with Methods The included 2,368 All participants were followed up for at least 10 years. Cox regression model was constructed analyze correlation between apple, juice, and sauce Results 3–6 times/week associated 48% reduction risk hypertension (HR = 0.52, 95% CI: 0.37–0.72, p < 0.001). juice 1.02, 0.67–1.56, 0.930) 1.28, 0.59–2.74, 0.531) tended increase death hypertension, although this did not obtain statistically result. Conclusion Moderate reduced whereas may death.

Language: Английский

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Innovations in blood pressure measurement and reporting technology: International Society of Hypertension position paper endorsed by the World Hypertension League, European Society of Hypertension, Asian Pacific Society of Hypertension, and Latin American Society of Hypertension

Journal of Hypertension, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 9, 2024

Blood pressure (BP) is a key contributor to the lifetime risk of preclinical organ damage and cardiovascular disease. Traditional clinic-based BP readings are typically measured infrequently under standardized/resting conditions therefore do not capture values during normal everyday activity. Therefore, current hypertension guidelines emphasize importance incorporating out-of-office measurement into strategies for diagnosis management. However, conventional home ambulatory monitoring devices use upper-arm cuff oscillometric method only provide intermittent static or in limited number situations. New innovations include technologies estimation based on processing sensor signals supported by artificial intelligence tools, remote monitoring, reporting storage data, data interpretation patient interaction designed improve management (“digital therapeutics”). The volume relating new devices/technologies increasing rapidly will continue grow. This International Society Hypertension position paper describes devices/technologies, presents evidence techniques related indices, highlights standard validation discusses reliability utility novel devices, association these metrics with clinical outcomes, digital therapeutics. It also challenges gaps that need be overcome before can considered as user-friendly accurate source inform strategies.

Language: Английский

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Untapped potential of gut microbiome for hypertension management

Gut Microbes, Journal Year: 2024, Volume and Issue: 16(1)

Published: June 2, 2024

The gut microbiota has been shown to be associated with a range of illnesses and disorders, including hypertension, which is recognized as the primary factor contributing development serious cardiovascular diseases. In this review, we conducted comprehensive analysis progression research domain pertaining hypertension. Our emphasis was on interplay between blood pressure that are mediated by host microbiota-derived metabolites. Additionally, elaborate reciprocal communication antihypertensive drugs, its influence host. field computer science seen rapid progress great potential in application biomedical sciences, prompt an exploration use microbiome databases artificial intelligence realm high prediction prevention. We propose biomarkers context hypertension prevention therapy.

Language: Английский

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Prevalence of depression in hypertensive patients and its associated factors in India: A systematic review and meta-analysis

Hipertensión y Riesgo Vascular, Journal Year: 2024, Volume and Issue: 41(4), P. 217 - 225

Published: July 2, 2024

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National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030

The Medical Journal of Australia, Journal Year: 2024, Volume and Issue: unknown

Published: July 11, 2024

Raised blood pressure or hypertension is by far the leading risk factor for preventable deaths in Australia, contributing to over 25 000 annually (Supporting Information, figure 1 and 2),1-3 mainly due stroke, heart disease, kidney failure, atrial fibrillation dementia.3, 4 The reduction of less than 140/90 mmHg only achieved 32% people with control rates have stagnated a decade 3).5, 6 As our compare poorly other high income countries (eg, 68% Canada),5-7 we published call-to-action urgently bring about changes.5 In response call-to-action, National Hypertension Taskforce Australia (Taskforce) was formed, hosted Australian Cardiovascular Alliance Information), launched Minister Health Aged Care 2022.8, 9 partners are reflected authorship roadmap, listed Supporting 4. This article describes key actions be taken Taskforce, including roadmap help implement identified actions. methods identifying structure described 5 table 1. Background. cause death Australia. One three adults (6.8 million people) hypertension, defined as clinic office greater equal mmHg, based on randomised population data.10 Screening campaigns found that half these (3.4 million) not had their values detected unaware hypertension,11 hence receiving appropriate treatment. Of those who diagnosed treated general population, (2.2 effectively, is, reducing (Box 1).10, 11 Australians visit primary care centres somewhat different rates, where 55% patients effectively controlled.12 Goal. Increase current (< mmHg) from at least 70% 2030.5, 10 Targets strategies. 2024–2030 2) built pillars: (A) prevent; (B) detect; (C) treat raised pressure. An international modelling study recommended 80–80–80 targets, which translates 80% individuals being screened aware diagnosis; prescribed treatment; treatment having targets.13 However, because 20% remain unaware, untreated, achieving target, this model would achieve 51% control. To Taskforce's target 70%, 90–90–90 required approach 73% rate. prevention pressure-related disease will through system-based strategies promote levels 130/80 across nation. Setting recognises up morbidity occurs systolic 140 mmHg.14 Population-based shift whole distribution factors produce substantial reductions cardiovascular (CVD) burden,14 benefit children, older people, living rural remote areas, culturally linguistically diverse populations First Nations peoples, well accessing services. Such reduce all levels.15 support initiatives ensure full implementation Preventive Strategy 2021.16 For pressure, taskforce working group develop economic tools make healthy choices most affordable ones. We context-specific preventive greatest attributable development, such sodium increasing potassium intake using potassium-enriched salt substitutes), nutritious food supply, bodyweight, physical activity avoiding alcohol intake.17 Box 3 lists top ten priority areas action. list, Pillar A action Taskforce. has also targeting A, 2, 10. Developing up-to-date, simple management health providers Brief, user-friendly, easy access guidance relevant aspects adequate accurate measurement (in out-of-office pressure), simplified medication algorithm tools, preferred use single pill combination therapy, others reference existing HealthPathways feasible. Increasing patient activation engagement Key ensuring positive outcomes self-management information, engagement, empowerment, partnering ongoing support. Elements improving literacy, activities improve how already can "activated" own health, should addressed. Raising maintaining awareness importance general, its management, among community, providers, allied pharmacists, government any stakeholders. Establishing systems- data-based national surveillance system currently available infrastructure optimally data monitoring evaluation. Set processes integration standardised sector, electronic records, establish datasets rather individual points inform practice team-based care, facilitate identification patients. Detection (screening) elevated identify Systematic screening visiting practitioner clinics, care. Opportunistic community-based Stroke Foundation May Measure Month campaigns. analyses discussions federal state territory officials Detailed analysis estimate cost estimations cost-effectiveness implementing evidence-based approaches prevent, detect manage hypertension. structured pathways involve activities. Explore drive multidisciplinary Evaluate successes co-design local consumers accounting potential roles sharing tasks detection, long term patients, nurses, exercise physiologists, dieticians, physiotherapists professionals. Ensuring Implement automated settings. Ensure provision validated devices capable measurement. Deliver related educational programs. Develop toolkits home consumers. Educate expand 24-hour ambulatory diagnosis (Medicare Benefit Schedule item 11607) monitoring. Expand Medicare items measurements population-based Determine best contribute 2021, development Target lifestyle (increasing potassium) intake, supply body weight, increased alcohol. Regularly re-evaluate update via stakeholders, consolidate guide Keep track activities, adapt progress lessons learnt. several B 3), 2–8 When detected, it crucial made, effectively. With 37 practitioners Australia,20 common condition managed,21 optimised outcomes. controlled conservative mmHg.12 Government's 10-year reform plan strong focus consumer-centred care,22 MyMedicare 2023 step right direction incentivises continuity (beneficial targets).23 Current fee-for-service models (paying each time service delivered) work against lead financial drivers maintain number services professional. towards value-based delivering improves outcomes) optimal funding multiple better These notions were echoed 2022 Strengthening report.24 International guidelines recommend mmHg,25, 26 emphasising insufficient lower mmHg. account frequently associated poor control, fluctuations visit-to-visit fluctuations.27 Age driver risk.28 Effective thus essential. Two major trials (average age 6829 84 years30) demonstrated clear reduced mortality, safety.29, 30 Also, orthostatic hypotension deterrent more intensive lowering therapy — all-cause regardless hypotension.31 Education overcome perception adverse risks important reason low missing secondary aldosteronism).15 Specific recommendations causes integrated into routine clinical practice. optimise adopts World Organization successful32 HEARTS technical package care,33 tailored setting: Lifestyle modification first-line crosscutting benefits cancer diabetes. coaching modules delivered ideally made team, physiotherapists, community pharmacy. Messages reinforced an in-person follow-up, eHealth, mHealth telehealth. Most persist uncontrolled despite changes given while simultaneously making changes. Low (55%) care12 largely inertia hesitancy start intensify after readings. 1-page protocol regarded one successful components HEARTS,32 likely helps inertia.34 developed collaboration practitioners, professional colleges societies feasibility adoption. include plus linear, stepwise describing progressively until controlled. provide medicines doses,32 single-pill combinations (SPC) two drugs initial therapy. requires medications.26 SPCs cost-neutral result saving35 improved adherence;36 shorter period time,37 no increase side effects.37 lessen impact infrequent following prescribing. monotherapy, dose often follow-up visits.35, 38 It safer effective add another drug double dose,39 present, policy allow prescription subsidised Pharmaceutical Benefits Scheme treatment.35 C 3). Medicines. Treating $1.2 billion 2022, pharmacy-related, 29% practitioner-related, medicine costs.40 58% sources, 42% out-of-pocket payments, expenses highlight equity issue.40 About monotherapy regimens 57 (including strength variations) Australia35 supported Scheme. Although prescriptions require co-payment, set maximum $30 $7.30 concession card. dual triple included allowing dispensing 60 days. Longer durations access, adherence control.7 Availability generic (with ease Blood devices. Clinically upper-arm cuff-based used clinic, eliminate human error manual digit preference, hearing impairment) training.41 Lack validation underappreciated problem. Four out five sold online (www.amazon.com) validated, meaning they been properly tested accuracy.42 Approval Therapeutic Goods Administration, United States Food Drug Administration European Commission's equivalent CE Mark may reflect accuracy testing. Online resources, STRIDE BP (www.stridebp.org), adequately validated. By consensus standardized measurement,41 much likely. High quality measurement.38, 41 involves device records averages readings, without presence confirm diagnosis, recommended.25 gold standard method there now rebate 11607). monitoring, self/home recommended. More resources supporting doctors undertaking needed, Many cuffless wearable becoming widely available, but utility confirmed.43 address devices, 8 Pillars Targeting highest developing CVD proven strategy Higher conferred age, sex, smoking status, cholesterol, pre-existing diabetes chronic postcode. updated guidelines28 known aged 45–79 years (or 35–79 years, 30–79 years) calculator (www.cvdcheck.org.au/calculator). Once estimated intermediate 5–10%, 10% event within next consideration pharmacotherapy former combined statin latter, cholesterol level, unless contraindicated. professionals referred treatment.28 adults38 2016 update. recommends part supports recommendation initiate immediate 160/100 result. aligns statement "reducing reduces risk, wide range groups, irrespective baseline higher benefit".28 Thus, untreated 140–130 warranted. Team-based coordinates nurses others, laboratory data, medications.44 capacity allows support.44 Multidisciplinary teams linking pharmacists significantly formed cornerstone various settings Canada,44 signs nurse-coordinated Australia.45, 46 report24 states "struggling meet increasingly complex demand", encouraging government's intent strengthen outcome Scope Practice Review,47 potential.48 evaluation effectiveness particular 7 Person-centred Medicines Policy49 (2022) reiterates person-centred enhance consumer involvement, empowerment shared decision making. aims large-scale lived experience collaborate pillars prevention, detection 2 program patient, level.32 challenges level monitoring: (i) availability (similar what States) relies captured Bureau Statistics Surveys;8 (ii) systems capture designed systematic comparison between practices, networks. Complexities numerous software packages clinics Best Practice, Medical Director), audit CAT4, POLAR GP), informatic vendors networks (PEN CS, POLAR, Primary Sense). now, cannot Scheme, services, hospitalisation, time. Previously MedicineInsight provided transferred commission safety look forward again.12 Up-to-date selection essential, harmonised pathway. Pathways incentivise (%) improvement measure Incentives Program. There attempts harmonisation network Quality Improvement Program, New South Wales Lumos efforts streamlined, regularly updated. coordinated effort, involving leadership, Department platforms, Immunisation Register. Similar need pressure,2 Cancer Register includes single, digital platform, facilitating capture, participation screening.50 Other eHealth show promise evaluated implementation. 4, cognisant barriers provider level. aspect implementation, encourage research, liaise design feasible, acceptable, cost-effective, scalable setting. timely able rate 2030, thereby world. this, active stakeholders particularly government. propose refer established preventing gains possible Compared colonoscopy, mammography flu vaccinations, States51 indicates prevent 4). large numbers very (one adults), highly deaths.51 If prevalence 25% if everyone controlled, savings $91.6 gross domestic product (taking productivity losses sequalae lifetime).52 predicted prevented, every additional 14 prevented per year. Figure reproduced permission. paves way success. goal. drive, commitment collaboration, poised become global exemplar Aletta Schutte Research Council (NHMRC) investigator grant (APP2017504). Jun Yang NHMRC (APP1994576). Clara Chow (APP1195326). like thank members Advisory Panel (Sheldon Tobe, Norm Campbell, Mike Rakotz, Janet Wright, Paul Muntner, Andrew Moran Pedro Ordunez) helpful guidance. acknowledge input many volunteering join workshops meetings decisions. express sincere gratitude excellent continued strategic administrative Open publishing facilitated University Wales, Wiley - agreement Librarians. past president Society Hypertension, secretary Alliance, board member Garry Jennings chief medical advisor Heart Markus Schlaich chair treasurer League. Sharon James director Nurses Association. Nelson deputy-chair Committee, Foundation, co-chair Expert Committee Guidelines, Board Lisa Murphy executive officer Group Risk Guidelines. Sharman Taskeen Khan works Organization, views do represent organisation. Endocrine Aldosteronism Guideline Development Patient Engagement Committee. Breonny Robson manager, Clinical & Kidney Schutte, Schlaich, Sharman, Jennings, Nelson, Murphy, Goodman Steering received speaker fees Omron, Medtronic, Aktiia, Servier, Sanofi, Novartis advisory Skylabs Abbott. Medtronic. Stephen Nicholls research AstraZeneca, Amgen, Anthera, CSL Behring, Cerenis, Eli Lilly, Esperion, Resverlogix, Amsterdam Pharma, Novartis, InfraReDx Sanofi-Regeneron consultant Akcea, Boehringer Ingelheim, Kowa, Merck, Takeda, Pfizer, Sanofi-Regeneron, Vaxxinity, Sequiris Novo Nordisk. Geoffrey Cloud Astra Zeneca serves Board. ReCor (Otsuka), Boehringer-Ingelheim, Abbott, Idorsia, Janssen, scientific boards Zeneca. Not commissioned; externally peer reviewed. Supplementary figures tables Please note: publisher responsible content functionality information supplied authors. Any queries (other content) directed corresponding author article.

Language: Английский

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Feasibility of tongue image detection for coronary artery disease: based on deep learning

Frontiers in Cardiovascular Medicine, Journal Year: 2024, Volume and Issue: 11

Published: Aug. 23, 2024

Aim Clarify the potential diagnostic value of tongue images for coronary artery disease (CAD), develop a CAD model that enhances performance by incorporating image inputs, and provide more reliable evidence clinical diagnosis CAD, offering new biological characterization evidence. Methods We recruited 684 patients from four hospitals in China cross-sectional study, collecting their baseline information standardized to train validate our algorithm. used DeepLabV3 + segmentation body employed Resnet-18, pretrained on ImageNet, extract features images. applied DT (Decision Trees), RF (Random Forest), LR (Logistic Regression), SVM (Support Vector Machine), XGBoost models, developing models with inputs risk factors alone then additional inclusion features. compared different algorithms using accuracy, precision, recall, F1-score, AUPR, AUC. Results classified found this classification criterion was effective (ACC = 0.670, AUC 0.690, Recall 0.666). After comparing such as Decision Tree (DT), Random Forest (RF), Logistic Regression (LR), Support Machine (SVM), XGBoost, we ultimately chose The algorithm developed solely based ACC 0.730, Precision 0.811, 0.763. When were integrated, improved 0.760, 0.773, 0.786, 0.850, indicating an enhancement performance. Conclusion use is feasible, these can enhance existing algorithms. have customized novel algorithm, which offers advantages being noninvasive, simple, cost-effective. It suitable large-scale screening among hypertensive populations. Tongue may emerge biomarkers indicators CAD.

Language: Английский

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The relationship between frailty syndrome and quality of life in patients with hypertension: a multidimensional analysis

BMC Geriatrics, Journal Year: 2025, Volume and Issue: 25(1)

Published: Jan. 9, 2025

Hypertension is a common condition among the elderly and frequently accompanied by frailty syndrome (FS). The coexistence of hypertension FS poses significant challenges in patient management negatively impacts quality life (QoL). This study aimed to analyze relationship between QoL patients with suspected hypertension. A cross-sectional was conducted involving 201 aged 65 years or older, referred Clinic for diagnostic evaluation. Frailty assessed using Tilburg Indicator (TFI), evaluated World Health Organization Quality Life Instrument (WHOQOL-BREF). Sociodemographic clinical data were collected, statistical analyses performed identify correlations QoL. found that 79.60% identified as frail (TFI ≥ 5). significantly correlated all domains QoL, including physical health (r = -0.634, p < 0.001), psychological -0.675, social relationships -0.528, environmental factors -0.626, 0.001). Multivariate analysis revealed (β -0.091, 0.001) components -0.128, 0.016), well age -0.022, 0.004), predictors lower scores. Loneliness -0.235, 0.049) also predictor demonstrated strong association reduced hypertensive patients, emphasizing need comprehensive assessments personalized strategies. Routine evaluation implementation targeted interventions at improving physical, psychological, well-being could substantially enhance this vulnerable population. Not applicable.

Language: Английский

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