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Maternal hypertensive disorders in SLE pregnancy and future cardiovascular outcomes.

SLE 孕妇高血压疾病与未来心血管结局。

  • 影响因子:4.13
  • DOI:10.1002/acr.24160
  • 作者列表:"Simard JF","Rossides M","Arkema EV","Svenungsson E","Wikström AK","Mittleman MA","Salmon JE
  • 发表时间:2020-01-31
Abstract

BACKGROUND:Hypertensive disorders of pregnancy (HDP) increase cardiovascular disease (CVD) risk. Pregnancy morbidities, including preeclampsia, and CVD are common in systemic lupus erythematosus (SLE). Possible connections are important to explore. In a population-based cohort, we investigated whether HDP is associated with a higher risk of cardiovascular outcomes separately in SLE and non-SLE to examine the role of SLE. METHODS:We identified first singleton births in the Medical Birth Register (1987-2012) among mothers with SLE and a large general population comparison group. Discharge diagnoses for HDP, cardiovascular outcomes, and hypertension in the Patient Register were identified using ICD codes. We estimated adjusted hazard ratios and 95% confidence intervals (HR, 95% CI) of the association between HDP and outcomes, in separate models in women with and without SLE. We then evaluated additive and multiplicative effect modification using relative excess risk due to interaction and Cox models jointly accounting for SLE and HDP, respectively. Mediation analysis estimated the proportion of the association between SLE and outcome explained by HDP. RESULTS:HDP were more common in SLE pregnancies (20% vs 7%). In SLE, HDP were associated with a two-fold higher rate of cardiovascular outcomes and three-fold higher rate of incident hypertension. HDP mediated 20% of the latter association. In women without SLE, HDP was associated with higher hypertension incidence later in life. CONCLUSION:In women with and without SLE, HDP were associated with a three-fold higher rate of hypertension. In SLE, women with HDP developed cardiovascular outcomes twice as often as women without HDP.

摘要

背景: 妊娠期高血压疾病 (HDP) 增加心血管疾病 (CVD) 风险。妊娠发病率,包括先兆子痫和 CVD 在系统性红斑狼疮 (SLE) 中很常见。探索可能的联系很重要。在一个基于人群的队列中,我们研究了 HDP 是否与 SLE 和非 SLE 患者心血管结局的高风险分别相关,以检查 SLE 的作用。 方法: 我们在医学出生登记 (1987-2012) 中确定了 SLE 母亲和一个大的普通人群对照组的首次单胎出生。使用 ICD 代码确定患者登记中 HDP 、心血管结局和高血压的出院诊断。我们在单独的模型中估计了 HDP 与结局之间相关性的校正风险比和 95% 置信区间 (HR,95% CI),在伴和不伴 SLE 的女性中。然后,我们分别使用相互作用的相对超额风险和 Cox 模型联合考虑 SLE 和 HDP,评价了相加效应和乘法效应修饰。中介分析估计了 HDP 解释的 SLE 与结局之间关联的比例。 结果: HDP 在 SLE 妊娠中较常见 (20% vs 7%)。在 SLE 中,HDP 与心血管结局率高 2 倍,高血压发生率高 3 倍相关。HDP 介导了 20% 的后者关联。在无 SLE 的女性中,HDP 与以后生活中较高的高血压发病率相关。 结论: 在 SLE 患者和非 SLE 患者中,HDP 的高血压患病率是 SLE 患者的 3 倍。在 SLE 中,HDP 女性发生心血管结局的频率是无 HDP 女性的两倍。

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相关文献
影响因子:4.13
发表时间:2020-01-31
DOI:10.1002/acr.24160
作者列表:["Simard JF","Rossides M","Arkema EV","Svenungsson E","Wikström AK","Mittleman MA","Salmon JE"]

METHODS:BACKGROUND:Hypertensive disorders of pregnancy (HDP) increase cardiovascular disease (CVD) risk. Pregnancy morbidities, including preeclampsia, and CVD are common in systemic lupus erythematosus (SLE). Possible connections are important to explore. In a population-based cohort, we investigated whether HDP is associated with a higher risk of cardiovascular outcomes separately in SLE and non-SLE to examine the role of SLE. METHODS:We identified first singleton births in the Medical Birth Register (1987-2012) among mothers with SLE and a large general population comparison group. Discharge diagnoses for HDP, cardiovascular outcomes, and hypertension in the Patient Register were identified using ICD codes. We estimated adjusted hazard ratios and 95% confidence intervals (HR, 95% CI) of the association between HDP and outcomes, in separate models in women with and without SLE. We then evaluated additive and multiplicative effect modification using relative excess risk due to interaction and Cox models jointly accounting for SLE and HDP, respectively. Mediation analysis estimated the proportion of the association between SLE and outcome explained by HDP. RESULTS:HDP were more common in SLE pregnancies (20% vs 7%). In SLE, HDP were associated with a two-fold higher rate of cardiovascular outcomes and three-fold higher rate of incident hypertension. HDP mediated 20% of the latter association. In women without SLE, HDP was associated with higher hypertension incidence later in life. CONCLUSION:In women with and without SLE, HDP were associated with a three-fold higher rate of hypertension. In SLE, women with HDP developed cardiovascular outcomes twice as often as women without HDP.

翻译标题与摘要 下载文献
影响因子:2.49
发表时间:2020-01-29
DOI:10.1093/ajh/hpaa015
作者列表:["Zhang J","Gong WY","Liu M","Zhou W","Rao J","Li YQ","Wu JH","Luo D","Wang C","Peng H"]

METHODS:BACKGROUND:'Neuronal precursor cell expressed developmentally down-regulated 4-like' (NEDD4L) is considered a candidate gene for hypertension-both functionally and genetically-through the regulation of the ubiquitination of the epithelial sodium channel (ENaC). This study explores the relationship between genetic variation in NEDD4L and hypertension with chronic kidney disease (CKD) in the southeastern Han Chinese population. METHODS:We recruited 623 CKD patients and measured ambulatory blood pressure monitoring (ABPM), and the rs4149601 and rs2288774 polymorphisms in NEDD4L were genotyped using qPCR. RESULTS:For rs4149601, significant differences in genotype frequencies in an additive model (GG vs GA vs AA) were observed between normotensive patients and hypertensive patients when hypertension was classified into ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension (P = 0.038, 0.005 and 0.006, respectively). In a recessive model (GG+GA vs AA), the frequency of the AA genotype of rs4149601 in the hypertension groups were all higher than that in the normotensive groups. The genotype distribution of rs2288774 did not differ significantly between the normotensive and hypertensive patients. In both the full cohort and the propensity score matching (PSM) cohort, the AA genotype of rs4149601 (compared to the GG+GA genotype group) was independently correlated with ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension by multivariate logistic regression analysis. CONCLUSIONS:The present study indicates that the AA genotype of rs4149601 associates with hypertension in CKD. Consequently, the rs4149601 A allele might be a risk factor for hypertension with CKD.

翻译标题与摘要 下载文献
影响因子:2.26
发表时间:2020-01-29
DOI:10.1186/s12913-020-4912-5
作者列表:["Gyamfi J","Allegrante JP","Iwelunmor J","Williams O","Plange-Rhule J","Blackstone S","Ntim M","Apusiga K","Peprah E","Ogedegbe G"]

METHODS:BACKGROUND:The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS:Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS:Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION:Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION:Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.

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