Effects of cardiac rehabilitation treatment modalities in Sub-Saharan Africa: A systematic review

Purpose Although Cardiac Rehabilitation (CR) implementation models recommend delivery of any CR treatment component, Sub-Saharan Africa (SSA) constitutes only 17% of globally available CR programs. The aims of this review were to assess the benefits of employing any CR treatment modality in SSA, and evaluate if this approach should be encouraged in this resource-constrained region.MethodologyRecords were identified electronically via CINAHL, MEDLINE, Cochrane library, African journal online, PubMed, Web of science and google scholar, and grey literature was hand-searched. Articles reporting effectiveness of any CR treatment modality were included if participants had any cardiovascular disease and if the study was conducted in SSA. Quality assessment for each enrolled study was done using Downs and Black (1998) checklist and data was extracted using a modified standard tool.ResultsSearches identified 1666 records, 24 full text articles were examined and 10 were included for the review; 60%, 30% and 10% of the enrolled studies were done in South Africa, Nigeria and Benin respectively. The studies implemented exercise, psychosocial and education treatment modalities of CR, and the approach of delivery was either comprehensive or modified. Comprehensive CR and delivery of combined aerobic and resistance exercises improved physical (13%, p=0.001), social (40%, p=0.001) and mental aspects of quality of life and reduced anxiety (-12%, p<0.05) and depression (-6%, p<0.001) respectively. Comprehensive CR and aerobic training both reduced systolic blood pressure (range of mean reduction [RMR] -6 to -14mmHg), diastolic blood pressure (RMR -4 to -6mmHg) and resting heart rate (RMR -7 to -17bpm). Overall, all types of exercises showed a 1-5ml.kg-1.min-1 increase in peak oxygen consumption.ConclusionThe findings support delivery of exercise treatment modality and comprehensive delivery of CR in SSA. However, efficacy of independent implementation of education and psychosocial therapeutic components of CR remains unclear; hence the need for further investigations

Optimal Blood Pressure Keeps Our Brains Younger

Background: Elevated blood pressure (BP) is a major health risk factor and the leading global cause of premature death. Hypertension is also a risk factor for cognitive decline and dementia. However, when elevated blood pressure starts impacting cerebral health is less clear. We addressed this gap by estimating how a validated measure of brain health relates to changes in BP over a period of 12 years.Methods: Middle-age (44–46 years at baseline, n = 335, 52% female) and older-age (60–64 years, n = 351, 46% female) cognitively intact individuals underwent up to four brain scans. Brain health was assessed using a machine learning approach to produce an estimate of “observed” age (BrainAGE), which can be contrasted with chronological age. Longitudinal associations between blood pressures and BrainAGE were assessed with linear mixed-effects models.Results: A progressive increase in BP was observed over the follow up (MAP = 0.8 mmHg/year, SD = 0.92; SBP = 1.41 mmHg/year, SD = 1.49; DBP = 0.61 mmHg/year, SD = 0.78). In fully adjusted models, every additional 10 mmHg increase in blood pressure (above 90 for mean, 114 for systolic, and 74 for diastolic blood pressure) was associated with a higher BrainAGE by 65.7 days for mean, and 51.1 days for systolic/diastolic blood pressure. These effects occurred across the blood pressure range and were not exclusively driven by hypertension.Conclusion: Increasing blood pressure is associated with poorer brain health. Compared to a person becoming hypertensive, somebody with an ideal BP is predicted to have a brain that appears more than 6 months younger at midlife.

Tracking blood pressure changes by means of non-invasive intermittent blood pressure measurements in clinical application

Considering accuracy/precision cut-offs of 5 ± 8 mmHg and cut-off values for inter-class correlation coefficients (ICC=0.37...1, from DIN EN ISO 81060-2), absolute and relative errors in time independent measurement of blood pressure changes with non-invasive intermittent devices (NiBP) are derived mathematically for mean arterial blood pressure range of 40-180 mmHg. As a clinically relevant value for change of arterial blood pressure 20% of the baseline blood pressure is considered. The mean ratio between the change of BP measured by the NiBP and measured by the invasive reference device (TE%) were proposed as quality measure for the evaluation of NiBP device tracking capability. The proposed measure TE%is theoretically independent of absolute accuracy but depends on precision and ICC of a device. NiBP devices show considerable maximum TE% of 41% in tracking mean blood pressure changes respectively. In 10% of the measurements in the low blood pressure range TE% exceeding 100%. The mean 50th/90th TE% percentile over the whole blood pressure range were 25/61%, respectively. Furthermore, TE% was relatively insensitive to assumed blood pressure range but sensitive to ICC. NiBP devices have high relative error in tracking blood pressure changes that make those devices not well-suited for tracking blood pressure changes. The proposed tracking error allows the definition of reasonable accuracy/precision requirements of NBP devices.

Evaluation of Present Status of Hypertension at Port City Chattogram, Bangladesh: A Survey Study

Hypertension is one of the most common Non-Communicable Diseases, which is increasing day by day, and its complications account for 9.4 million annual deaths worldwide. The rate of hypertension in Chattogram is relatively higher and majority are undiagnosed hypertension. This study was conducted to investigate the risk factors of hypertension on the population of Chattogram and to determine the complication of Hypertension. This survey study was carried out from June 2019 to December 2019. From the survey, it was found that about 49% of people have hypertension in age between 20-49, 43% people have in age between 50-79, about 12% people have in age above 80, and majority of population have hypertension in age between 20-49. Among them, about 46% of male are suffered fromhypertension whereasfemale are 57%. Hence, the risk of hypertension is higherin female rather than in male. About 50% of people have systolic blood pressure range above 130, 38% people have above 160, 10 people have above 180 & 6% people have above 100. About 44% of people have blood relative with hypertension, about 35% people do not have & about 24% people do not aware of the relative with hypertension. Among them about 21% people are given metformin for the treatment of diabetes mellitus in hypertension & about 10% people are given both metformin & glibenclamide. About 54% of people are given Enalapril, 33% people are given Amlodipine, 7% people are given both enalapril & Amlodipine and 5% people are given hydrochlorothiazide. Compliance with treatment was relatively high; however, accessessibilty of drugs was mainly from private pharmacies. Hypertension was significantly associated with increasing age, being male, unemployment and obesity.

Analysis of intraoperative modifiable factors to prevent acute kidney injury after elective noncardiac surgery: intraoperative hypotension and crystalloid administration related to acute kidney injury

Background The optimal intraoperative blood pressure range and crystalloid administration protocol for the prevention of acute kidney injury (AKI) after elective noncardiac surgery remain unknown. Methods This single-center retrospective cohort study included 6296 patients aged ≥ 50 years who had undergone elective noncardiac surgery under general anesthesia. We evaluated the relationship between duration of intraoperative hypotension and AKI. To assess whether the effects of crystalloid administration differed according to baseline estimated glomerular filtration rate (eGFR), we examined the interaction between intraoperative crystalloid administration and eGFR. We calculated univariable and multivariable adjusted odds ratios (ORs) and their 95% confidence intervals (95% CIs) for the prevalence of AKI. Results AKI occurred in 431 (6.8%) patients and was associated with intraoperative hypotension. Effects of intraoperative crystalloid administration differed significantly according to baseline eGFR. Increased risk of AKI was noted in patients with eGFR ≤45 ml min−1 1.73m−2 who were managed with restrictive or liberal crystalloid administration [OR 4.79 (95% CI 3.10 to 7.32) and 6.43 (95% CI 2.23 to 16.03), respectively] as opposed to those with eGFR >45 ml min−1 1.73m−2 who were managed with moderately restrictive crystalloid administration. Conclusions Our findings suggest that anesthesiologists should avoid intraoperative hypotension as well as either restrictive or liberal (as opposed to moderately restrictive) crystalloid administration in patients with decreased eGFR. Intraoperative blood pressure and crystalloid administration protocol are major modifiable factors that must be optimized to prevent postoperative AKI.

Office Blood Pressure Range and Cardiovascular Events in Patients With Hypertension: A Nationwide Cohort Study in South Korea

Background It is unclear what office blood pressure (BP) is the optimal treatment target range in patients with hypertension. Methods and Results Using the Korean National Health Insurance Service database, we extracted the data on 479 359 patients with hypertension with available BP measurements and no history of cardiovascular events from 2002 to 2011. The study end point was major cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, or stroke. This cohort study evaluated the association of BP levels (<120/<70, 120–129/70–79, 130–139/80–89, 140–149/90–99, and ≥150/≥100 mm Hg) with MACE. During a median follow‐up of 9 years, 55 401 MACE were documented in our cohort. The risk of MACE was the lowest (adjusted hazard ratio [HR], 0.79; 95% CI, 0.76–0.84) at BP level of <120/<70 mm Hg, and was the highest (HR, 1.32; 95% CI, 1.29–1.36) at ≥150/≥100 mm Hg in comparison with 130 to 139/80 to 89 mm Hg. These results were consistent in all age groups and both sexes. Among patients treated with antihypertensive medication (n=237 592, 49.5%), in comparison with a BP level of 130 to 139/80 to 89 mm Hg, the risk of MACE was significantly higher in patients with elevated BP (≥140/≥90 mm Hg), but not significantly lower in patients with BP of <130/<80 mm Hg. Low BP <120/70 mm Hg was associated with increased risk of all‐cause or cardiovascular death in all age groups. Conclusions BP level is significantly correlated with the risk of MACE in all Korean patients with hypertension. However, there were no additional benefits for MACE amongst those treated for hypertension with BP <120/70 mm Hg.