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Challenging the definition of hypertension in pregnancy: A retrospective cohort study.

挑战妊娠期高血压的定义: 一项回顾性队列研究。

  • 影响因子:4.22
  • DOI:10.1016/j.ajog.2019.12.272
  • 作者列表:"Reddy M","Lorber Rolnik D","Harris K","Li W","Willem Mol B","Silva Costa FD","Wallace EM","Palmer K
  • 发表时间:2020-01-16
Abstract

BACKGROUND:In routine antenatal care, blood pressure is used as a screening tool for preeclampsia and its associated adverse outcomes. As such women with a blood pressure greater than 140/90 mmHg undergo further investigation and closer follow up, whereas those with lower blood pressures receive no additional care. In the non-pregnant setting, the American College of Cardiology now endorses lower hypertensive thresholds and it remains unclear whether these lower thresholds should also be considered in pregnancy. OBJECTIVE:1) To examine the association between lower blood pressure thresholds (as per the American College of Cardiology guidelines) and pregnancy outcomes. 2) To determine if there is a continuous relationship between blood pressure and pregnancy outcomes and identify the point of a change at which blood pressure is associated with an increased risk of such outcomes. STUDY DESIGN:This was a retrospective study of singleton pregnancies at Monash Health, Australia. Data was obtained with regards to maternal characteristics and blood pressure measurements at varying gestational ages. Blood pressures were then categorized as 1) mean arterial pressure and 2) normal, elevated, stage one and stage two hypertension, as per the American College of Cardiology guidelines. Multivariable regression analysis was performed to identify associations between blood pressure categories and pregnancy outcomes. RESULTS:This study included 18,243 singleton pregnancies. We demonstrated a positive dose response relationship between mean arterial pressure and the development of preeclampsia in later pregnancy. Across all gestational ages, the risk of preeclampsia was higher in those with "elevated blood pressure" and "stage one hypertension" in comparison to the normotensive group (ARR 2.52, 95%CI 1.78, 3.55 and ARR 6.47, 95%CI 4.86, 8.61 respectively at 34-36 weeks' gestation). There was also an association between stage one hypertension, preterm birth, and adverse perinatal outcomes. CONCLUSION:This study demonstrated that preeclampsia and the associated adverse outcomes are not exclusive to those with blood pressures greater than 140/90 mmHg. As such, those with prehypertensive blood pressures may also benefit from closer monitoring. Further research is essential to determine whether lowering the blood pressure threshold in pregnancy would improve detection and outcomes.

摘要

背景: 在常规产前保健中,血压被用作先兆子痫及其相关不良结局的筛查工具。因此,血压大于 140/90 mmHg 的女性需要进一步调查和更密切的随访,而血压较低的女性则没有额外的护理。在非怀孕的情况下,美国心脏病学院现在支持较低的高血压阈值,目前还不清楚这些较低的阈值是否也应该在怀孕时考虑。 目的: 1) 检查较低的血压阈值 (根据美国心脏病学会指南) 与妊娠结局之间的关系。2) 确定血压和妊娠结局之间是否存在持续的关系,并确定血压变化与此类结局风险增加相关的点。 研究设计: 这是一项澳大利亚莫纳什健康中心单胎妊娠的回顾性研究。获得了关于不同胎龄的母体特征和血压测量值的数据。根据美国心脏病学会指南,血压分为 1) 平均动脉压和 2) 正常、升高、一期和二期高血压。进行多变量回归分析以确定血压类别与妊娠结局之间的相关性。 结果: 本研究包括 18,243 例单胎妊娠。我们证明了平均动脉压与妊娠后期先兆子痫发展之间的正剂量反应关系。在所有孕周,与血压正常组相比,“血压升高” 和 “一期高血压” 组的先兆子痫风险更高 (ARR 2.52,95% CI 1.78, 孕 34-36 周分别为 3.55 和 ARR 6.47,95% CI 4.86,8.61)。一期高血压、早产和不良围产结局之间也存在关联。 结论: 本研究表明,子痫前期及其相关的不良结局并不仅限于血压大于 140/90 mmHg 的患者。因此,那些有高血压前期血压的人也可能受益于更密切的监测。进一步的研究对于确定降低妊娠期血压阈值是否会改善检测和结局至关重要。

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影响因子:1.44
发表时间:2020-01-01
DOI:10.1080/10641963.2019.1601205
作者列表:["Meng L","Bai X","Zheng Y","Chen D","Zheng Y"]

METHODS::Aim: We explored the role of histone modification in the association of depression-hypertension by comparing norepinephrine transporter (NET) gene levels in different depression-hypertensive patients. Then, we analyzed the expression of NET correlation with inflammatory cytokines to provide a new direction for detecting the association mechanism between depression and hypertension.Methods: NE expression levels in serum of diverse groups were detected by enzyme-linked immunosorbent assay. Then histone acetyltransferase (HAT), histone deacetylase (HDAC), H3K27ac, NET, TNF-α, and interleukin-6 (IL-6) were detected by western blot in nine female subjects in different depression and hypertension groups, and Chromatin immunoprecipitation-polymerase chain reaction (Chip-PCR) were used to confirm the degree of acetylation affecting on the transcription level of NET gene. Meanwhile, correlation between NET with TNF/IL-6 was analyzed by SPSS19.0 software program. Finally, Quantitative real-time polymerase chain reaction (qPCR) and western blot were used to detect TNF-α and IL-6 expression levels after NET overexpression or interference treatment in human umbilical vein endothelial cells and Neuro-2a cells.Results: The expression of HAT and H3K27ac had lower levels in D-H and nonD-H group than nonD-nonH group. The results showed that higher acetylation could promote expression of NET genes. Meanwhile, the expression of NET had a significant negative correlation with IL-6 (R = -0.933, p < 0.01) and tumor necrosis factor (TNF) (R = -0.817, p < 0.01) in subjects. In addition, the results confirmed that TNF-α and IL-6 mRNA and protein partial expressions could be inhibited by NET in both HUVECs and Neuronal cells (p < 0.01).Conclusion: In conclusion, differential expression of NET gene might function as an important factor in interaction between depression and hypertension by partially targeting TNF-α and IL-6.

翻译标题与摘要 下载文献
影响因子:1.62
发表时间:2020-01-01
来源期刊:Angiology
DOI:10.1177/0003319719849737
作者列表:["Dugani SB","Murad W","Damilig K","Atos J","Mohamed E","Callachan E","Farukhi Z","Shaikh A","Elfatih A","Yusef S","Hydoub YM","Moorthy MV","Mora B","Alawadhi A","Issac R","Saleh A","Al-Mulla A","Mora S","Alsheikh-Ali AA"]

METHODS::The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.

影响因子:2.49
发表时间:2020-03-01
DOI:10.1136/archdischild-2019-317131
作者列表:["Göpel W","Müller M","Rabe H","Borgmann J","Rausch TK","Faust K","Kribs A","Dötsch J","Ellinghaus D","Härtel C","Roll C","Szabo M","Nürnberg P","Franke A","König IR","Turner MA","Herting E"]

METHODS:OBJECTIVE:The aim of our study was to determine if a genetic background of high blood pressure is a survival factor in preterm infants. DESIGN:Prospective cohort study. SETTING:Patients were enrolled in 53 neonatal intensive care units. PATIENTS:Preterm infants with a birth weight below 1500 g. EXPOSURES:Genetic score blood pressure estimates were calculated based on adult data. We compared infants with high genetic blood pressure estimates (>75th percentile of the genetic score) to infants with low genetic blood pressure estimates (<25th percentile of the genetic score). MAIN OUTCOME MEASURES:Lowest blood pressure on the first day of life and mortality. RESULTS:5580 preterm infants with a mean gestational age of 28.1±2.2 weeks and a mean birth weight of 1022±299 g were genotyped and analysed. Infants with low genetic blood pressure estimates had significantly lower blood pressure if compared with infants with high genetic blood pressure estimates (27.3±6.2vs 27.9±6.4, p=0.009, t-test). Other risk factors for low blood pressure included low gestational age (-1.26 mm Hg/week) and mechanical ventilation (-2.24 mm Hg, p<0.001 for both variables, linear regression analysis). Mortality was significantly reduced in infants with high genetic blood pressure estimates (28-day mortality: 21/1395, 1.5% vs 44/1395, 3.2%, p=0.005, Fisher's exact test). This survival advantage was independent of treatment with catecholamines. CONCLUSIONS:Our study provides first evidence that a genetic background of high blood pressure may be beneficial with regard to survival of preterm infants.

翻译标题与摘要 下载文献
高血压方向

高血压(hypertension)是指以体循环动脉血压(收缩压和/或舒张压)增高为主要特征(收缩压≥140毫米汞柱,舒张压≥90毫米汞柱),可伴有心、脑、肾等器官的功能或器质性损害的临床综合征。高血压是最常见的慢性病,也是心脑血管病最主要的危险因素。临床上高血压可分为两类:原发性高血压和继发性高血压。

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