Clinical Audit on the Provision of Diabetes Care in the Primary Care Setting by United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

Read  full  paper  at:

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52841#.VKs2psnQrzE

ABSTRACT

<span “=””>OBJECTIVE: United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) <span “=””>provides primary health care services including care for diabetes and hypertension, with limited resources under difficult circumstances in Gaza, West Bank, Jordan, Lebanon and Syria. A total of 114,911 people with diabetes were registered with UNRWA health centres in 2011. The aim of this cross<span “=””>-<span “=””>sectional observational study was to assess the quality of diabetes care in the UNRWA primary health care centres. METHOD: The study population consisted of 1600 people with diabetes attending the 32 largest UNRWA health centres and treated there for at least one year. Between April and Sept<span “=””>.<span “=””> 2012 data from medical records, including results of clinical examinations and laboratory tests performed <span “=””>during the <span “=””>last <span “=””>one <span “=””>year, current management including self-care education and evidence of diabetes complications were collected and recorded in a previously validated data collection form (DCF). Patients were interviewed and clinically examined on the day of the audit and blood collected for HbA1c testing which was done at a central lab using High-performance liquid chromatography (HPLC) method (HLC®-723G8 Tosoh Corporation, Japan<span “=””>)<span “=””>. Data was transferred from paper records into a computer and analysed with Epi-info 2000. RESULTS: Type 1 diabetes was present in 4.3% and type 2<span “=””> <span “=””>diabetes in 95.7%. Co-morbid hypertension was present in 68.5%; 90.3% were either obese (64.0%) or overweight (26.3%). Clinical management of diabetes was largely in line with UNRWA’s technical instructions (TI) for diabetes. Records for 2 hour postprandial glucose (2<span “=””> <span “=””>h PPG), serum cholesterol, serum creatinine, and urine protein analysis were available in 94.7%, 96.4%, 91.4% and 87.5%, cases, respectively. Records of annual fundoscopic eye examination were available in 47.3% cases but foot examinations were less well documented. Most patients (95.6%) were on anti-diabetic drugs—68.2% oral anti diabetic drugs (OAD) only, 14.4% combination of OAD and insulin, and 12.9% insulin only. While 44.8% patients had 2 h PPG ≤ 180 mg/dl, only 28.2% had HbA1c ≤ 7%; 55.5% and 28.2% had BP ≤<span “=””> <span “=””>140/90 and ≤130/80 mm of Hg respectively. Serum cholesterol ≥<span “=””> <span “=””>200 mg/dl, serum creatinine ≥<span “=””> <span “=””>1.2 mg/dl and macro albuminuria were noted in 39.8%<span “=””>,<span “=””> 6.4% and 10.3% cases respectively. Peripheral neuropathy (52.6%), foot infections (17%), diabetic retinopathy (11%) and myocardial infarction (9.6%) were the most common long term complications. One or more episodes of hypoglycaemia were reported by 25% cases in total and in 48% of those using insulin. 17.7% and 22.6% cases received no or ≥4 self-care education sessions respectively. CONCLUSION: The study confirmed that UNRWA doctors and nurses follow TI for diabetes and hypertension fairly well. Financial constraints and the consequent effects on UNRWA TI and policies related to diabetes care were important constraints. Key challenges identified<span “=””> <span “=””>were<span “=””>:<span “=””> reliance on 2 h PPG to measure control; non-availability of routine HbA1c testing, self-monitoring of blood glucose (SMBG) and statins within the UNRWA system; and high levels of obesity in the community. Addressing these will further strengthen UNRWA health system’s efforts of providing services for diabetes and hypertension at the primary care level. Given that most developing countries either have no or only rudimentary services for diabetes and hypertension at the primary care level, UNRWA<span “=””>’<span “=””>s efforts can serve as an inspiration to others.

Cite this paper

Shahin, Y. , Kapur, A. , Khader, A. , Zeidan, W. , Harries, A. , Nerup, J. and Seita, A. (2015) Clinical Audit on the Provision of Diabetes Care in the Primary Care Setting by United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). Journal of Diabetes Mellitus, 5, 12-20. doi: 10.4236/jdm.2015.51002.

References

[1] United Nations Relief and Works Agency for Palestine Refugees in the Near East. UNRWA Health Department Annual Report 2012. Amman, Jordan: UNRWA, 2013.
[2] Husseini, A., Abu-Rmeileh, N.M., Mikki, N., Ramahi, T.M., Ghosh, H.A., Barghuthi, N., et al. (2009) Cardiovascular Diseases, Diabetes Mellitus, and Cancer in the Occupied Palestinian Territory. Lancet, 373, 1041-1049. http://dx.doi.org/10.1016/S0140-6736(09)60109-4
[3] Diabetes Atlas, International Diabetes Federation 2012. http://www.idf.org/diabetesatlas
[4] United Nations Relief and Works Agency Health Department. Technical Instructions and Management Protocols on Prevention and Control of Noncommunicable Diseases. Technical Instruction Series: HD/DC/01/1997. Revision No. 4. Amman, Jordan: UNRWA, 2009.
[5] Khader, A., Farajallah, L., Shahin, Y., Hababeh, M., Abu-Zayed, I., Kochi, A., et al. (2012) Cohort Monitoring of Persons with Diabetes Mellitus in a Primary Healthcare Clinic for Palestine Refugees in Jordan. Tropical Medicine International Health, 17, 1569-1576.
http://dx.doi.org/10.1111/j.1365-3156.2012.03097.x
[6] Khader, A., Farajallah, L., Shahin, Y., Hababeh, M., Abu-Zayed, I., Kochi, A., et al. (2012) Cohort Monitoring of Persons with Hypertension: An Illustrated Example from a Primary Healthcare Clinic for Palestine Refugees in Jordan. Tropical Medicine International Health, 17, 1163-1170.
http://dx.doi.org/10.1111/j.1365-3156.2012.03048.x
[7] Khader, A., Ballout, G., Shahin, Y., Hababeh, M., Farajallah, L., Zeidan, W., et al. (2013) Diabetes Mellitus and Treatment Outcomes in Palestine Refugees in UNRWA Primary Health Care Clinics in Jordan. Public Health Action, 3, 259-264. http://dx.doi.org/10.5588/pha.13.0083
[8] Khader, A., Ballout, G., Shahin, Y., Hababeh, M., Farajallah, L., Zeidan, W., et al. (2014) What Happens to Palestine Refugees with Diabetes Mellitus in a Primary Healthcare Centre in Jordan Who Fail to Attend a Quarterly Clinic Appointment? Tropical Medicine International Health, 19, 308-312.
http://dx.doi.org/10.1111/tmi.12256
[9] Jorgensen, L.N., Hajera, M., Pan, C.Y., Raheja, B.S., Sathe, S.A., Soweando, P., et al. (1999) DiabCare Asia Study. JAMA, 15, S40-41.
[10] Raheja, B.S., Kapur, A., Bhoraskar, A., Sathe, S.R., Jorgensen, L.N., Ram Moorthi, S., et al. (2001) Diabetes Care in India—Current Status. JAPI, 49, 717-722.
[11] Kapur, A., Shishoo, S., Ahuja, M.M.S., Sen, V. and Mankame, K. (1998) Diabetes Care in India: Physicians Perceptions, Attitudes and Practices. International Journal of Diabetes in Developing Countries, 18, 124-130.
[12] National Institute of Health and Clinical Excellence (2008) Audit Support—Type 2 Diabetes Clinical Criteria. NICE Clinical Guideline 66. http://www.ncbi.nlm.nih.gov/books/NBK11822/
[13] Shehab, A., Elnour, A. and Abdulle, A. (2012) A Clinical Audit on Diabetes Care in Patients with Type 2 Diabetes in Al-Ain, United Arab Emirates. The Open Cardiovascular Medicine Journal, 6, 126-132.
http://dx.doi.org/10.2174/1874192401206010126
[14] Govender, I., Ehrlich, R., Van Vuuren, U., De Vries, E., Namane, M., De Sa, A., et al. (2012) Clinical Audit of Diabetes Management Can Improve the Quality of Care in a Resource-Limited Primary Care Setting. International Journal for Quality in Health Care, 24, 612-618.
http://dx.doi.org/10.1093/intqhc/mzs063
[15] World Health Organization (2006) De?nition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia. Summary of Technical Report and Recommendations. WHO, Geneva.
[16] The United Nations Relief and Works Agency for Palestine Refugees in the Near East (2011) Annual Report Department of Health. http://www.unrwa.org/userfiles/file/publications/HealthReport2012.pdf
[17] Chuang, L.M., Tsai, S.T., Huang, B.Y. and Tai, T.Y. (2002) The Status of Diabetes Control in Asia—A Cross-Sectional Survey of 24 317 Patients with Diabetes Mellitus in 1998. Diabetic Medicine, 19, 978-985. http://dx.doi.org/10.1046/j.1464-5491.2002.00833.x
[18] Al-Hazzaa, H.M. (2012) Prevalence and Risk Factors Associated with Nutrition-Related Non-Communicable Diseases in the Eastern Mediterranean Region. International Journal of General Medicine, 5, 199-217.
[19] Mafauzy, M., Hussein, Z. and Chan, S.P. (2011) The Status of Diabetes Control in Malaysia: Results of DiabCare 2008. Medical Journal of Malaysia, 66, 175-181.
[20] Soewondo, P., Soegondo, S., Suastika, K., Pranoto, A., Soeatmadji, D.W. and Tjokroprawiro, A. (2010) The DiabCare Asia 2008 Study—Outcomes on Control and Complications of Type 2 Diabetic Patients in Indonesia. Medical Journal of Indonesia, 19, 235-244. http://dx.doi.org/10.13181/mji.v19i4.412
[21] Chinenye, S., Uloko, A.E., Ogbera, A.O., Ofoegbu, E.N., Fasanmade, O.A., Fasanmade, A.A. and Ogbu, O.O. (2012) Profile of Nigerians with Diabetes Mellitus—Diabcare Nigeria Study Group (2008): Results of a Multicenter Study. Indian Journal of Endocrinology and Metabolism, 16, 558-564.
http://dx.doi.org/10.4103/2230-8210.98011
[22] Sobngwie, E., Ndour-Mbayee, M., Boateng, K.F., Ramaiya, K.L., Njenga, E.W., Diop, S.N., Mbanya, J.C. and Ohwovoriole, A.E. (2012) Type 2 Diabetes Control and Complications in Specialised Diabetes Care Centres of Six Sub-Saharan African Countries: The Diabcare Africa Study. Diabetes Research and Clinical Practice, 95, 30-36. http://dx.doi.org/10.1016/j.diabres.2011.10.018
[23] Modern and Efficient UNRWA Health Services (2011) Family Health Team Approach.
http://www.unrwa.org/sites/default/files/Health%20Reform%20Strategy.pdf                        eww150105lx

Effect of Maternal Nutrition and Dietary Habits on Preeclampsia: A Case-Control Study

Read  full  paper  at:

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52741#.VKIJCcCAM4

ABSTRACT

Introduction: Preeclampsia is one of the most commonly encountered hypertensive disorders of pregnancy that accounts for 20% – 80% of maternal mortality in developing countries, including Ethiopia. For many years diet has been suggested to play a role in preeclampsia. However, the hypotheses have been diverse and often revealed inconsistent results across studies. Moreover, rarely were these hypotheses studied in Ethiopia. Therefore, this study aimed to explore whether the incidence of preeclampsia was related to nutrient or micronutrient deficiencies. Objectives: To describe the effect of nutrition and dietary habits on the incidence of preeclampsia. Methods: A facility based unmatched case-control study was conducted among 453 (151 cases and 302 controls) pregnant women attending antepartum or intrapartum care in public health facilities of Bahir Dar City Administration. Case-control incidence density sampling followed by interviewer administered face to face interview, measurement of mid-arm circumference (MUAC) and document review were conducted using a standardized and pretested questionnaire. Data entry and cleaning was done by Epi Info Version 3.5.3. The data were transported to SPSS Version 20 for analysis. Both bivariate and multivariate logistic regression analyses were applied. Backward stepwise unconditional logistic regression analysis was employed to determine the putative association of predictive variables with the outcome variable and to control for the effect of confounding variables. A P-value ≤ 0.05 was considered statistically significant at 95% confidence level throughout the study. Result: Those women having a MUAC value ≥ 25.6 cm were two times more likely than their counterparts to have preeclampsia (AOR = 2.49, 95% CI = 1.58, 3.94). Strikingly, higher odds of preeclampsia were found in women who reported to have taken coffee during pregnancy (AOR = 2.16, 95% CI = 1.32, 3.53). Similarly, those women who had anemia during the first trimester pregnancy were three times more likely than their counterparts to have incidence of preeclampsia (AOR = 2.80, 95% CI = 1.09, 7.21). The result in this study also revealed that taking fruit or vegetables during pregnancy was found to be protective of preeclampsia (AOR = 0.37, 95% CI = 0.19, 0.73, AOR = 0.45, 95% CI = 0.22, 0.91) respectively. In addition, folate intake during pregnancy has shown a significant independent effect on the prevention of preeclampsia in this study (AOR = 0.19, 95% CI = 0.10, 0.37). Conclusion and Recommendation: Vegetable and fruit consumption and folate intake during pregnancy are independent protective factors of preeclampsia. On the other hand, higher mid upper arm circumference, anemia and coffee intake during pregnancy are risk factors for the development of preeclampsia.

Cite this paper

Endeshaw, M. , Ambaw, F. , Aragaw, A. and Ayalew, A. (2014) Effect of Maternal Nutrition and Dietary Habits on Preeclampsia: A Case-Control Study. International Journal of Clinical Medicine, 5, 1405-1416. doi: 10.4236/ijcm.2014.521179.

References

[1] Siddik-Sayyid, S.M. (2011) Preclampsia, a New Perspective. MEJ Anaesthesia, 21.
[2] Rath, W. and Fischer, T. (2008) Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy. Deutsches Ärzteblatt International, 106, 733-738.
[3] National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy (2000) Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. American Journal of Obstetrics and Gynecology, 183, S1-S22. http://dx.doi.org/10.1067/mob.2000.107928
[4] Osungbade, K.O. and Ige, O.K. (2011) Public Health Perspectives of Preeclampsia in Developing Countries: Implication for Health System Strengthening. Journal of Pregnancy, 2011, Article ID: 481095.
http://dx.doi.org/10.1155/2011/481095
[5] Lill, T., Per, M., Rolv, S. and Camilla, S. (2008) Previous Abortions and Risk of Preeclampsia. International Journal of Epidemiology, 37, 1333-1340. http://dx.doi.org/10.1093/ije/dyn167
[6] Roberts, M.J. and Gammill, H.S. (2005) Preeclampsia: Recent Insights. American Heart Association, 46, 1243-1249.
[7] Duley, L. (2009) The Global Impact of Preeclampsia and Eclampsia. Seminars in Perinatology, 33, 130-137.
http://dx.doi.org/10.1053/j.semperi.2009.02.010
[8] WHO (2011) Recommendations for Prevention and Treatment of Preeclampsia and Eclampsia. Department of Maternal and Child Health.
[9] Ngoc, N.T.N., Merialdi, M., Abdel-Aleem, H., Carroli, G., Purwar, M., Zavaleta, N., et al. (2011) Causes of Stillbirths and Early Neonatal Deaths: Data from 7993 Pregnancies in Six Developing Countries. Bulletin of the World Health Organization, 84, 699-705. http://dx.doi.org/10.2471/BLT.05.027300
[10] Polyzos, N.P., Polyzos, I.P., Zavos, A., Valachis, A., Mauri, D., Papanikolaou, E.G., Tzioras, S., Weber, D. and Messinis, I.E. (2010) Obstetric Outcomes after Treatment of Periodontal Disease during Pregnancy: Systematic Review and Meta-Analysis. BMJ, 341, c7017. http://dx.doi.org/10.1136/bmj.c7017
[11] Edmonds, D.K. (2007) Dewhurst’s Textbook of Obstetrics & Gynaecology. Blackwell Publishing Asia Pty Ltd., Melbourne. http://dx.doi.org/10.1002/9780470753354
[12] Abdella, A. (2010) Maternal Mortality Trend in Ethiopia. Ethiopian Journal of Health Development, 24, 115-122.
[13] Owiredu, W., Ahenkorah, L., Turpin, C., Amidu, N. and Laing, E. (2012) Putative Risk Factors of Pregnancy-Induced Hypertension among Ghanaian Pregnant Women. Medical and Biomedical Sciences, 1, 62-76.
[14] Tebeu, P.M., Foumane, P., Mbu, R., Fosso, G., Biyaga, P.T. and Fomulu, J.N. (2011) Risk Factors for Hypertensive Disorders in Pregnancy: A Report from the Maroua Regional Hospital, Cameroon. Journal of Reproduction & Infertility, 12, 227-234.
[15] Cnossen, J.S., Leeflang, M.M., de Haan, E.E., Mol, B.W., van der Post, J.A., Khan, K.S. and Ter Riet, G. (2007) Accuracy of Body Mass Index in Predicting Pre-Eclampsia: Bivariate Meta-Analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 114, 1477-1485. http://dx.doi.org/10.1111/j.1471-0528.2007.01483.x
[16] Wolf, M., Shah, A., Jiminizekimble, R., Sauk, J., Ecker, J. and Thadnai, R. (2004) Differential Risk of Hypertensive Disorders of Pregnancy among Hispanic Women. Journal of the American Society of Nephrology, 15, 1330-1338.
http://dx.doi.org/10.1097/01.ASN.0000125615.35046.59
[17] Rasmussen, S. and Irgens, L.M. (2007) Pregnancy-Induced Hypertension in Women Who Were Born Small. Hypertension, 49, 806-812.
[18] Luo, B. and Ma, X. (2013) Risk Factors for Preeclampsia: A Case-Control Study. Hypertension in Pregnancy, 32, 432-438.
[19] Rosenberg, T.J., Garbers, S., Lipkind, H. and Chiasson, M.A. (2005) Maternal Obesity and Diabetes as Risk Factors for Adverse Pregnancy Outcomes: Differences among 4 Racial/Ethnic Groups. American Journal of Public Health, 95, 1545-1551.
[20] Xiong, X., Buekens, P., Fraser, W.D., Beck, J. and Offenbacher, S. (2006) Periodontal Disease and Adverse Pregnancy Outcomes: A Systematic Review. BJOG: An International Journal of Obstetrics & Gynaecology, 113, 135-143.
[21] Robillard, P.Y., Hulsey, T.C., Alexander, G.R., Keenan, A., de Caunes, F. and Papiernik, E. (1993) Paternity Patterns and Risk of Preeclampsia in the Last Pregnancy in Multiparae. Journal of Reproductive Immunology, 24, 1-12.
http://dx.doi.org/10.1016/0165-0378(93)90032-D
[22] Agrawal, S. and Walia, G.K. (2010) Prevalence and Risk Factors for Pre-Eclampsia in Indian Women: A National Cross Sectional Study. South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi.
[23] Sibai, B., Dekker, G. and Baumert, M. (2005) Pre-Eclampsia. The Lancet, 365, 785-799.
http://dx.doi.org/10.1016/S0140-6736(05)17987-2
[24] Qiu, C., Williams, M.A., Leisenring, W.M., Sorensen, T.K., Frederick, I.O., Dempsey, J.C. and Luthy, D.A. (2003) Family History of Hypertension and Type 2 Diabetes in Relation to Preeclampsia Risk. Hypertension, 41, 408-413.
[25] Brantsaeter, A.L., Haugen, M., Samuelsen, S.O., Torjusen, H., Trogstad, L., Alexander, J., et al. (2009) A Dietary Pattern Characterized by High Intake of Vegetables, Fruits, and Vegetable Oils Is Associated with Reduced Risk of Preeclampsia in Nulliparous Pregnant Norwegian Women. The Journal of Nutrition, 139, 1162-1168.
[26] Cynthia, V. and Max, W. (2001) Relationship of Twin Zygosity and Risk of Preeclampsia. American Journal of Obstetrics & Gynecology, 185, 819-821. http://dx.doi.org/10.1067/mob.2001.117352
[27] Torjusen, H., Lieblein, G., Næs, T., Haugen, M., Meltzer, H.M. and Brantsæter, A.L. (2012) Food Patterns and Dietary Quality Associated with Organic Food Consumption during Pregnancy; Data from a Large Cohort of Pregnant Women in Norway. BMC Public Health, 12, 612. http://dx.doi.org/10.1186/1471-2458-12-612
[28] Wen, S.W., Champagne, J., White, R.R., Coyle, D., Fraser, W., Smith, G., Fergusson, D. and Walker, M.C. (2013) Effect of Folic Acid Supplementation in Pregnancy on Preeclampsia: The Folic Acid Clinical Trial Study. Journal of Pregnancy, 2013, Article ID: 294312.
[29] Schoenaker, D.A., Soedamah-Muthu, S.S. and Mishra, G.D. (2014) The Association between Dietary Factors and Gestational Hypertension and Pre-Eclampsia: A Systematic Review and Meta-Analysis of Observational Studies. BMC Medicine, 12, 157. http://dx.doi.org/10.1186/s12916-014-0157-7
[30] Torjusen, H., Brantsæter, A.L., Haugen, M., Alexander, J., Bakketeig, L.S., Lieblein, G., et al. (2014) Reduced Risk of Pre-Eclampsia with Organic Vegetable Consumption: Results from the Prospective Norwegian Mother and Child Cohort Study. BMJ Open, 4, Article ID: e006143. http://dx.doi.org/10.1136/bmjopen-2014-006143
[31] den Heijer, M., Koster, T., Blom, H., Bos, G.M.J., Briët, E., Reitsma, P.H., et al. (1996) Hyperhomocysteinemia as a Risk Factor for Deep-Vein Thrombosis. England Journal of Medicine, 334, 759-762.
[32] Fanga, R., Dawsona, A., Lohsoonthorna, V. and Williamsa, M.A. (2009) Risk Factors of Early and Late Onset Preeclampsia among Thai Women. Asian Biomedicine, 3, 477-486.
[33] Meltzer, H.M., Brantsæter, A.L., Nilsen, R.M., Magnus, P., Alexander, J. and Haugen, M. (2011) Effect of Dietary Factors in Pregnancy on Risk of Pregnancy Complications: Results from the Norwegian Mother and Child Cohort Study. American Journal of Clinical Nutrition, 94, 1970S-1974S. http://dx.doi.org/10.3945/ajcn.110.001248
[34] den Heijer, M., Koster, T., Blom, H.J., Bos, G.M., Briet, E., Reitsma, P.H., Vandenbroucke, J.P. and Rosendaal, F.R.. (1996) Hyperhomocysteinemia as a Risk Factor for Deep-Vein Thrombosis. New England Journal of Medicine, 334, 759-762. http://dx.doi.org/10.1056/NEJM199603213341203
[35] Dodd, J.M., O’Brien, C. and Grivell, R.M. (2014) Preventing Pre-Eclampsia—Are Dietary Factors the Key? BMC Medicine, 12, 176. http://dx.doi.org/10.1186/s12916-014-0176-4
[36] Bakker, W.W., Donker, R.B., Timmer, A., van Pampus, M.G., van Son, W.J., Aarnoudse, J.G., et al. (2007) Plasma Hemopexin Activity in Pregnancy and Preeclampsia. Hypertension in Pregnancy, 26, 227-239.
http://dx.doi.org/10.1080/10641950701274896
[37] Yakub, M., Iqbal, M.P. and Iqbal, R. (2010) Dietary Patterns Are Associated with Hyperhomocysteinemia in an Urban Pakistani Population. The Journal of Nutrition, 140, 1261-1266. http://dx.doi.org/10.3945/jn.109.120477
[38] Haberg, S., London, S., Stigum, H., Nafstad, P. and Nystad, W. (2009) Folic Acid Supplements in Pregnancy and Early Childhood Respiratory Health. Archives of Disease in Childhood, 94, 180-184.
http://dx.doi.org/10.1136/adc.2008.142448
[39] Modder, J. and Fitzsimons, K. (2010) Management of Women with Obesity in Pregnancy. Centre for Maternal and Child Enquiries (CMACE) and the Royal College of Obstetricians and Gynaecologists (RCOG) Joint Guideline.
[40] Mahomed, K., Williams, M.A., Woelk, G.B., Jenkins-Woelk, L., Mudzamiri, S., Longstaff, L. and Sorensen, T.K. (1998) Risk Factors for Pre-Eclampsia among Zimbabwean Women: Maternal Arm Circumference and Other Anthropometric Measures of Obesity. Paediatric and Perinatal Epidemiology, 12, 253-262.
[41] Derbyshire, E. (2009) Can Anthropometric and Body Composition Measurements during Pregnancy Be Used to Predict Preeclampsia Risk? Current Women’s Health Reviews, 5, 225-229.
http://dx.doi.org/10.2174/157340409790069934
[42] Silva, D.A.S., Petroski, E.L. and Peres, M.A. (2012) Is High Body Fat Estimated by Body Mass Index and Waist Circumference a Predictor of Hypertension in Adults? A Population-Based Study. Nutrition Journal, 11, 112.
http://dx.doi.org/10.1186/1475-2891-11-112
[43] Ali, A.A., Rayis, D.A., Abdallah, T.M., Elbashir, M.I. and Adam, I. (2011) Severe Anaemia Is Associated with a Higher Risk for Preeclampsia and Poor Perinatal Outcomes in Kassala Hospital, Eastern Sudan. BMC Research Notes, 4, 311.
[44] Rohilla, M., Raveendran, A., Dhaliwal, L.K. and Chopra, S. (2010) Severe Anaemia in Pregnancy: A Tertiary Hospital Experience from Northern India. Journal of Obstetrics and Gynaecology, 30, 694-696.
http://dx.doi.org/10.3109/01443615.2010.509821
[45] Lee, A.I. and Okam, M.M. (2011) Anemia in Pregnancy. Hematology/Oncology Clinics of North America, 25, 241-259.
http://dx.doi.org/10.1016/j.hoc.2011.02.001
[46] Spaans, F., de Vos, P., Bakker, W.W., van Goor, H. and Faas, M.M. (2014) Danger Signals from ATP and Adenosine in Pregnancy and Preeclampsia. Hypertension, 63, 1154-1160.
[47] Sharbaf, F.R., Dehghanpour, P., Shariat, M. and Dalili, H. (2013) Caffeine Consumption and Incidence of Hypertension in Pregnancy. Journal of Family and Reproductive Health, 7, 3.
[48] Bakker, R., Steegers, E.A., Obradov, A., Raat, H., Hofman, A. and Jaddoe, V.W. (2010) Maternal Caffeine Intake from Coffee and Tea, Fetal Growth, and the Risks of Adverse Birth Outcomes: The Generation R Study. The American Journal of Clinical Nutrition, 91, 1691-1698. http://dx.doi.org/10.3945/ajcn.2009.28792
[49] Shamsi, U., Hatcher, J., Shamsi, A., Zuberi, N., Qadri, Z. and Saleem, S. (2010) A Multicenter Matched Case Control Study of Risk Factors for Preeclampsia in Healthy Women in Pakistan. BMC Women’s Health, 10, 14.
http://dx.doi.org/10.1186/1472-6874-10-14
[50] Zenebe, W., Hailemariam, S. and Mirkuzie, W. (2011) Hypertensive Disorders of Pregnancy in Jimma University Specialized Hospital. Ethiopian Journal of Health Sciences, 21, 147-154.
[51] Lardoeyt, R., Vargas, G., Lumpuy, J., García, R. and Torres, Y. (2013) Contribution of Genome-Environment Interaction to Pre-Eclampsia in a Havana Maternity Hospital. MEDICC Review, 15, 22-29.
[52] McCarthy, F., O´Keeffe, L. and Khashan, A. (2013) Association between Maternal Alcohol Consumption in Early Pregnancy and Pregnancy Outcomes. Obstetrics and Gynecology, 122, 830-837.
http://dx.doi.org/10.1097/AOG.0b013e3182a6b226                                                                eww141230lx

What Are the Determinants of Insulin Resistance (IR) and How Effective Is the Sub-Saharan Africa-Specific Threshold of Abdominal Obesity (AO-SSA) Identifying IR in Congolese Black Hypertensive Patients?

Read  full  paper  at:

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52289#.VI-PYMnQrzE

ABSTRACT

Background: Hypertensive patients with insulin resistance (IR) are at greater risk of cardiovascular disease and may represent a particular subset of hypertension (HTN) requiring special medical attention. Quantitative measurements of the IR are not suitable for routine clinical practice. Met-abolic syndrome (MetS) or simply abdominal obesity (AO) is surrogate of IR. The performance of the recently proposed Sub-Saharan Africa cut-off point of abdominal obesity for identifying IR in hypertensive patients has never been evaluated. Aims: The main objective was to compare the performance of the newly proposed Sub-Saharan Africa specific threshold of abdominal obesity (AO-SSA) to that of IDF (AO-IDF) in identifying IR in Congolese Black Hypertensive Patients. Methods: A cross-sectional study was conducted at the Heart of Africa Cardiovascular Center, Lomo Medical Clinic, Kinshasa Limete, DR Congo, between January 2007 and January 2010. Homeostatic model assessment (HOMA) index was calculated to determine IR. Multivariate logistic regression analysis was used to assess the independent determinants of IR. The intrinsic (sensitivity and specificity) and extrinsic (positive predictive value and negative predictive value) characteristics of the AO-SSA, AO-IDF, AO-ATP III, MetS-SSA, MetS-IDF, and MetS-ATP III were calculated. The kappa statistic was determined for agreement between the ATPIII, IDF and SSA defined AO and MetS with HOMA-IR. Results: Men represented the majority of the enrolled patients: 105 (64.4%) and the mean age of all participants were 57 ± 11 years. Insulin resistance was found in 79.1% of the study population with 88.7, 79.3, 84.6, 71.4, 75.5, 91.1, 60.3 and 44.8 respectively among patient with MetS-ATP, MetS-IDF, MetS-SSA, AO-ATP III, AO-IDF, AO-SSA, diabetics and non-obese non-diabetic hypertensive patients. In multivariate analysis, the risk of IR was associated independently and significantly (p < 0.05) with cigarette smoking, low-HDL-C, hyperuricemia, and diastolic HTN, as shown in the following equation: Y = ﹣1.404 + 1.054 Cigarette Smoking + 0.872 low HDL-C + 0.983 hyperuricemia + 0.852 diastolic hypertension. The AO-SSA, with 87.7% sensitivity and 67.6% specificity, was the only surrogate who showed an acceptable agreement with the HOMA-IR index. Abdominal obesity defined according to other thresholds and the metabolic syndrome whatever the used diagnostic criteria have a slight agreement with the HOMA-IR index. Conclusion: IR was found to be prevalent in our study population. Cigarette smoking, low-HDL-C, hyperuricemia, and isolated diastolic HTN magnify IR. The AO-SSA is an easy and cost efficient method to diagnose IR in Congolese Black Hypertensive Patients. Further study in wider group is indicated to validate our findings.

Cite this paper

Phanzu, B. , Longo-Mbenza, B. , Lasion’kin, J. , Pukuta, J. , Vita, E. and Kianu, N. (2014) What Are the Determinants of Insulin Resistance (IR) and How Effective Is the Sub-Saharan Africa-Specific Threshold of Abdominal Obesity (AO-SSA) Identifying IR in Congolese Black Hypertensive Patients?. World Journal of Cardiovascular Diseases, 4, 642-654. doi: 10.4236/wjcd.2014.413076.

References

[1] Giles, T.D. (2006) Assessment of Global Risk: A Foundation for a New, Better Definition of Hypertension. Journal of clinical Hypertension (Greenwich, Conn), 8, 5-14.
http://dx.doi.org/10.1111/j.1524-6175.2006.05835.x
[2] Kearney, P.M., Whelton, M., Reynolds, K., Muntner, P., Whelton, P.K. and He, J. (2005) Global Burden of Hypertension: Analysis of Worldwide Data. Lancet, 9455, 217-223.
http://dx.doi.org/10.1016/S0140-6736(05)17741-1
[3] Ezzati, M., Lopez, A.D., Rodgers, A., Vander Hoorn, S. and Murray, C.J. (2002) Selected Major Risk Factors and Global and Regional Burden of Disease. Lancet, 9343, 1347-1360.
http://dx.doi.org/10.1016/S0140-6736(02)11403-6
[4] Jeppesen, J., Hein, H.O., Suadicani, P. and Gyntelberg, F. (2001) Low Triglycerides-High High-Density Lipoprotein Cholesterol and Risk of Ischemic Heart Disease. Archives of Internalmedicine, 3, 361-366.
http://dx.doi.org/10.1001/archinte.161.3.361
[5] Mittal, B.V. and Singh, A.K. (2010) Hypertension in the Developing World: Challenges and Opportunities. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 3, 590-598.
[6] James, P.A., Oparil, S., Carter, B.L., Cushman, W.C., Dennison-Himmelfarb, C., Handler, J., Lackland, D.T., LeFevre, M.L., MacKenzie, T.D., Ogedegbe, O., et al. (2014) Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA: The Journal of the American Medical Association, 5, 507-520.
http://dx.doi.org/10.1001/jama.2013.284427
[7] Kengne, A.P., Awah, P.K., Fezeu, L. and Mbanya, J.C. (2007) The Burden of High Blood Pressure and Related Risk Factors in Urban Sub-Saharan Africa: Evidences from Douala in Cameroon. Africanhealth Sciences, 1, 38-44.
[8] Kadiri, S. (2005) Tackling Cardiovascular Disease in Africa. BMJ (Clinical Research ed), 7519, 711-712.
[9] Akinkugbe, O.O. (1990) Epidemiology of Cardiovascular Disease in Developing Countries. Journal of Hypertension Supplement: Official Journal of the International Society of Hypertension, 7, S233-S238.
[10] Lang, T. (1994) The Entity of Arterial Hypertension in Black Subjects. Presse Medicale, 36, 1642-1645.
[11] Saunders, E. (2004) Managing Hypertension in African-American Patients. Journal of Clinical Hypertension, 6, 19-25.
http://dx.doi.org/10.1111/j.1524-6175.2004.03564.x
[12] Fiscella, K. and Holt, K. (2008) Racial Disparity in Hypertension Control: Tallying the Death Toll. Annals of Family Medicine, 6, 497-502. http://dx.doi.org/10.1370/afm.873
[13] Perkovic, V., Huxley, R., Wu, Y., Prabhakaran, D. and MacMahon, S. (2007) The Burden of Blood Pressure-Related Disease: A Neglected Priority for Global Health. Hypertension, 50, 991-997.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.095497
[14] Longo-Mbenza, B., Ngoma, D.V., Nahimana, D., Mayuku, D.M., Fuele, S.M., Ekwanzala, F. and Beya, C. (2008) Screen Detection and the WHO Stepwise Approach to the Prevalence and Risk Factors of Arterial Hypertension in Kinshasa. European Journal of Cardiovascular Prevention and Rehabilitation: Official Journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, 15, 503-508.
http://dx.doi.org/10.1097/HJR.0b013e3282f21640
[15] Bayauli, P.M., M’Buyamba-Kayamba, J.R., Lemogoum, D., Thijs, L., Dramaix, M., Fagard, R., Staessen, J.A., Degaute, J.P., Ditu, M.S. and M’Buyamba-Kabangu, J.R. (2014) Cardiovascular Risk Factors among the Inhabitants of an Urban Congolese Community: Results of the VITARAA Study. IJC Metabolic & Endocrine, 4, 33-38.
http://dx.doi.org/10.1016/j.ijcme.2014.07.003
[16] Bayauli, M.P., M’Buyamba-Kayamba, J.R., Lemogoum, D., Fagard, R., Degaute, J.P., Ditu, M.S., Lepira, B.F. and M’Buyamba-Kabangu, J.R. (2014) Prehypertension, Hypertension and Associated Cardiovascular Risk Factors among Adult Congolese Urban Dwellers: Results of the Vitaraa Study. World Journal of Cardiovascular Diseases, 4, 390-398.
http://dx.doi.org/10.4236/wjcd.2014.48049
[17] Laakso, M. (1993) How Good a Marker Is Insulin Level for Insulin Resistance? American Journal of Epidemiology, 137, 959-965.
[18] Reaven, G.M. and Chen, Y.D. (1996) Insulin Resistance, Its Consequences, and Coronary Heart Disease. Must We Choose One Culprit? Circulation, 93, 1780-1783.
http://dx.doi.org/10.1161/01.CIR.93.10.1780
[19] Bergman, R.N. (2002) Pathogenesis and Prediction of Diabetes Mellitus: Lessons from Integrative Physiology. The Mount Sinai Journal of Medicine, 69, 280-290.
[20] Edelson, G.W. and Sowers, J.R. (1993) Insulin Resistance in Hypertension: A Focused Review. The American Journal of the Medical Sciences, 306, 345-347.
http://dx.doi.org/10.1097/00000441-199311000-00014
[21] Zavaroni, I., Mazza, S., Dall’Aglio, E., Gasparini, P., Passeri, M. and Reaven, G.M. (1992) Prevalence of Hyperinsulinaemia in Patients with High Blood Pressure. Journal of Internal Medicine, 231, 235-240.
http://dx.doi.org/10.1111/j.1365-2796.1992.tb00529.x
[22] Berglund, G. and Andersson, O. (1981) Body Composition, Metabolic and Hormonal Characteristics in Unselected Male Hypertensives. International Journal of Obesity, 5, 143-150.
[23] Ferrannini, E., Natali, A., Capaldo, B., Lehtovirta, M., Jacob, S. and Yki-Jarvinen, H. (1997) Insulin Resistance, Hyperinsulinemia, and Blood Pressure: Role of Age and Obesity. Hypertension, 30, 1144-1149.
http://dx.doi.org/10.1161/01.HYP.30.5.1144
[24] Zhou, M.S., Schulman, I.H. and Zeng, Q. (2012) Link between the Renin-Angiotensin System and Insulin Resistance: Implications for Cardiovascular Disease. Vascular Medicine, 17, 330-341.
http://dx.doi.org/10.1177/1358863X12450094
[25] Lakka, H.M., Laaksonen, D.E., Lakka, T.A., Niskanen, L.K., Kumpusalo, E., Tuomilehto, J. and Salonen, J.T. (2002) The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-Aged Men. JAMA: The Journal of the American Medical Association, 288, 2709-2716.
http://dx.doi.org/10.1001/jama.288.21.2709
[26] Isomaa, B., Almgren, P., Tuomi, T., Forsen, B., Lahti, K., Nissen, M., Taskinen, M.R. and Groop, L. (2001) Cardiovascular Morbidity and Mortality Associated with the Metabolic Syndrome. Diabetes Care, 24, 683-689.
http://dx.doi.org/10.2337/diacare.24.4.683
[27] McFarlane, S.I., Banerji, M. and Sowers, J.R. (2001) Insulin Resistance and Cardiovascular Disease. The Journal of Clinical Endocrinology and Metabolism, 2, 713-718.
[28] Pyorala, K., Savolainen, E., Lehtovirta, E., Punsar, S. and Siltanen, P. (1979) Glucose Tolerance and Coronary Heart Disease: Helsinki Policemen Study. Journal of Chronic Diseases, 32, 729-745.
http://dx.doi.org/10.1016/0021-9681(79)90052-3
[29] Ducimetiere, P., Eschwege, E., Papoz, L., Richard, J.L., Claude, J.R. and Rosselin, G. (1980) Relationship of Plasma Insulin Levels to the Incidence of Myocardial Infarction and Coronary Heart Disease Mortality in a Middle-Aged Population. Diabetologia, 19, 205-210.
http://dx.doi.org/10.1007/BF00275270
[30] Despres, J.P., Lamarche, B., Mauriege, P., Cantin, B., Dagenais, G.R., Moorjani, S. and Lupien, P.J. (1996) Hyperinsulinemia as an Independent Risk Factor for Ischemic Heart Disease. The New England Journal of Medicine, 334, 952-958.
http://dx.doi.org/10.1056/NEJM199604113341504
[31] Yip, J., Facchini, F.S. and Reaven, G.M. (1998) Resistance to Insulin-Mediated Glucose Disposal as a Predictor of Cardiovascular Disease. The Journal of Clinical Endocrinology and Metabolism, 83, 2773-2776.
http://dx.doi.org/10.1210/jcem.83.8.5005
[32] Zavaroni, I., Bonini, L., Gasparini, P., Barilli, A.L., Zuccarelli, A., Dall’Aglio, E., Delsignore, R. and Reaven, G.M. (1999) Hyperinsulinemia in a Normal Population as a Predictor of Non-Insulin-Dependent Diabetes Mellitus, Hypertension, and Coronary Heart Disease: The Barilla Factory Revisited. Metabolism: Clinical and Experimental, 48, 989-994.
http://dx.doi.org/10.1016/S0026-0495(99)90195-6
[33] Facchini, F.S., Hua, N., Abbasi, F. and Reaven, G.M. (2001) Insulin Resistance as a Predictor of Age-Related Diseases. The Journal of Clinical Endocrinology and Metabolism, 86, 3574-3578.
http://dx.doi.org/10.1210/jcem.86.8.7763
[34] Kraemer, F.B. and Ginsberg, H.N. (2014) Gerald M. Reaven, MD: Demonstration of the Central Role of Insulin Resistance in Type 2 Diabetes and Cardiovascular Disease. Diabetes Care, 37, 1178-1181.
http://dx.doi.org/10.2337/dc13-2668
[35] Sowers, J.R., Standley, P.R., Ram, J.L., Jacober, S., Simpson, L. and Rose, K. (1993) Hyperinsulinemia, Insulin Resistance, and Hyperglycemia: Contributing Factors in the Pathogenesis of Hypertension and Atherosclerosis. American Journal of Hypertension, 6, 260s-270s.
[36] Kidambi, S., Kotchen, J.M., Krishnaswami, S., Grim, C.E. and Kotchen, T.A. (2011) Cardiovascular Correlates of Insulin Resistance in Normotensive and Hypertensive African Americans. Metabolism: Clinical and Experimental, 60, 835-842.
http://dx.doi.org/10.1016/j.metabol.2010.07.036
[37] Reaven, G.M. (2003) Insulin Resistance/Compensatory Hyperinsulinemia, Essential Hypertension, and Cardiovascular Disease. The Journal of Clinical Endocrinology and Metabolism, 88, 2399-2403.
http://dx.doi.org/10.1210/jc.2003-030087
[38] Jeppesen, J., Hein, H.O., Suadicani, P. and Gyntelberg, F. (2000) High Triglycerides and Low HDL Cholesterol and Blood Pressure and Risk of Ischemic Heart Disease. Hypertension, 36, 226-232.
http://dx.doi.org/10.1161/01.HYP.36.2.226
[39] Abbasi, F., Feldman, D., Caulfield, M.P., Hantash, F.M. and Reaven, G.M. (2014) Relationship among 25-Hydroxyvitamin D Concentrations, Insulin Action, and Cardiovascular Disease Risk in Patients with Essential Hypertension. American Journal of Hypertension, 19, pii: hpu136.
[40] Bonora, E., Capaldo, B., Perin, P.C., Del Prato, S., De Mattia, G., Frittitta, L., Frontoni, S., Leonetti, F., Luzi, L., Marchesini, G., et al. (2008) Hyperinsulinemia and Insulin Resistance Are Independently Associated with Plasma Lipids, Uric Acid and Blood Pressure in Non-Diabetic Subjects. The GISIR Database. Nutrition, Metabolism, and Cardiovascular Diseases, 18, 624-631.
http://dx.doi.org/10.1016/j.numecd.2007.05.002
[41] Scheen, A.J., Paquot, N., Castillo, M.J. and Lefebvre, P.J. (1994) How to Measure Insulin Action in Vivo. Diabetes/ Metabolism Reviews, 10, 151-188.
http://dx.doi.org/10.1002/dmr.5610100206
[42] Singh, B. and Saxena, A. (2010) Surrogate Markers of Insulin Resistance: A Review. World Journal of Diabetes, 1, 36-47.
http://dx.doi.org/10.4239/wjd.v1.i2.36
[43] Hwu, C.M., Hsiao, C.F., Grove, J., Hung, Y.J., Chuang, L.M., Chen, Y.T., Curb, J.D., Chen, Y.D., Rodriguez, B. and Ho, L.T. (2007) Surrogate Estimates of Insulin Sensitivity in Subjects with Hypertension. Journal of Human Hypertension, 21, 246-252.
[44] Karter, A.J., Mayer-Davis, E.J., Selby, J.V., D’Agostino Jr., R.B., Haffner, S.M., Sholinsky, P., Bergman, R., Saad, M.F. and Hamman, R.F. (1996) Insulin Sensitivity and Abdominal Obesity in African-American, Hispanic, and Non-Hispanic White Men and Women. The Insulin Resistance and Atherosclerosis Study. Diabetes, 45, 1547-1555.
http://dx.doi.org/10.2337/diab.45.11.1547
[45] Grundy, S.M. (2006) Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worlds. Journal of the American College of Cardiology, 47, 1093-1100.
http://dx.doi.org/10.1016/j.jacc.2005.11.046
[46] Cheal, K.L., Abbasi, F., Lamendola, C., McLaughlin, T., Reaven, G.M. and Ford, E.S. (2004) Relationship to Insulin Resistance of the Adult Treatment Panel III Diagnostic Criteria for Identification of the Metabolic Syndrome. Diabetes, 53, 1195-1200.
http://dx.doi.org/10.2337/diabetes.53.5.1195
[47] Kasiam Lasi On’kin, J.B., Longo-Mbenza, B., Nge Okwe, A. and Kangola Kabangu, N. (2007) Survey of Abdominal Obesities in an Adult Urban Population of Kinshasa, Democratic Republic of Congo. Cardiovascular Journal of Africa, 18, 300-307.
[48] Alberti, K.G., Zimmet, P. and Shaw, J. (2005) The Metabolic Syndrome: A New Worldwide Definition. Lancet, 366, 1059-1062.
http://dx.doi.org/10.1016/S0140-6736(05)67402-8
[49] Delavari, A., Forouzanfar, M.H., Alikhani, S., Sharifian, A. and Kelishadi, R. (2009) First Nationwide Study of the Prevalence of the Metabolic Syndrome and Optimal Cutoff Points of Waist Circumference in the Middle East: The National Survey of Risk Factors for Noncommunicable Diseases of Iran. Diabetes Care, 32, 1092-1097.
http://dx.doi.org/10.2337/dc08-1800
[50] Mohsen Ibrahim, M., Elamragy, A.A., Girgis, H. and Nour, M.A. (2011) Cut off Values of Waist Circumference & Associated Cardiovascular Risk in Egyptians. BMC Cardiovascular Disorders, 11, 53-60.
http://dx.doi.org/10.1186/1471-2261-11-53
[51] Bener, A., Yousafzai, M.T., Darwish, S., Al-Hamaq, A.O., Nasralla, E.A. and Abdul-Ghani, M. (2013) Obesity Index that Better Predict Metabolic Syndrome: Body Mass Index, Waist Circumference, Waist Hip Ratio, or Waist Height Ratio. Journal of Obesity, 2013, Article ID: 269038.
http://dx.doi.org/10.1155/2013/269038
[52] Longo-Mbenza, B., Kasiam Lasi On’kin, J.B., Nge Okwe, A. and Kangola Kabangu, N. (2011) The Metabolic Syndrome in a Congolese Population and Its Implications for Metabolic Syndrome Definitions. Diabetes & Metabolic Syndrome, 5, 17-24.
http://dx.doi.org/10.1016/j.dsx.2010.05.009
[53] Ferdinand, K.C. (2010) Management of High Blood Pressure in African Americans and the 2010 ISHIB Consensus Statement: Meeting an Unmet Need. Journal of Clinical Hypertension, 12, 237-239.
http://dx.doi.org/10.1111/j.1751-7176.2010.00272.x
[54] Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Bohm, M., Christiaens, T., Cifkova, R., De Backer, G., Dominiczak, A., et al. (2013) 2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension. European Heart Journal, 34, 2159-2219.
http://dx.doi.org/10.1093/eurheartj/eht151
[55] Fagard, R.H. and Van den Enden, M. (2003) Treatment and Blood Pressure Control in Isolated Systolic Hypertension vs Diastolic Hypertension in Primary Care. Journal of Human Hypertension, 17, 681-687.
http://dx.doi.org/10.1038/sj.jhh.1001598
[56] Longo-Mbenza, B., Nkongo Mvindu, H., Kasiam On’kin, J.B., Bikuku, N., Kianu Phanzu, B., Nge Okwe, A. and Kabangu, N. (2011) The Deleterious Effects of Physical Inactivity on Elements of Insulin Resistance and Metabolic Syndrome in Central Africans at High Cardiovascular Risk. Diabetes & Metabolic Syndrome, 5, 1-6.
http://dx.doi.org/10.1016/j.dsx.2010.05.001
[57] Cockcroft, D.W. and Gault, M.H. (1976) Prediction of Creatinine Clearance from Serum Creatinine. Nephron, 16, 31-41.
http://dx.doi.org/10.1159/000180580
[58] Hogg, R.J., Furth, S., Lemley, K.V., Portman, R., Schwartz, G.J., Coresh, J., Balk, E., Lau, J., Levin, A., Kausz, A.T., et al. (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease in Children and Adolescents: Evaluation, Classification, and Stratification. Pediatrics, 111, 1416-1421.
http://dx.doi.org/10.1542/peds.111.6.1416
[59] Members of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2003) Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 25, S5-S20.
[60] Peretti-Watel, P., Constance, J., Seror, V. and Beck, F. (2009) Cigarettes and Social Differentiation in France: Is Tobacco Use Increasingly Concentrated among the Poor? Addiction, 104, 1718-1728.
http://dx.doi.org/10.1111/j.1360-0443.2009.02682.x
[61] Cleeman, J.I., et al. (2001) Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA: The Journal of the American Medical Association, 285, 2486-2497.
[62] Erdine, S., Ari, O., Zanchetti, A., Cifkova, R., Fagard, R., Kjeldsen, S., Mancia, G., Poulter, N., Rahn, K.H., Rodicio, J.L., et al. (2006) ESH-ESC Guidelines for the Management of Hypertension. Herz, 4, 331-338.
[63] Muniyappa, R., Lee, S., Chen, H. and Quon, M.J. (2008) Current Approaches for Assessing Insulin Sensitivity and Resistance in Vivo: Advantages, Limitations, and Appropriate Usage. American Journal of Physiology Endocrinology and Metabolism, 294, E15-E26.
[64] Ferrannini, E., Buzzigoli, G., Bonadonna, R., Giorico, M.A., Oleggini, M., Graziadei, L., Pedrinelli, R., Brandi, L. and Bevilacqua, S. (1987) Insulin Resistance in Essential Hypertension. The New England Journal of Medicine, 317, 350-357.
http://dx.doi.org/10.1056/NEJM198708063170605
[65] Williamson, D.F., Madans, J., Anda, R.F., Kleinman, J.C., Giovino, G.A. and Byers, T. (1991) Smoking Cessation and Severity of Weight Gain in a National Cohort. The New England Journal of Medicine, 324, 739-745.
http://dx.doi.org/10.1056/NEJM199103143241106
[66] Rashid, S., Watanabe, T., Sakaue, T. and Lewis, G.F. (2003) Mechanisms of HDL Lowering in Insulin Resistant, Hypertriglyceridemic States: The Combined Effect of HDL Triglyceride Enrichment and Elevated Hepatic Lipase Activity. Clinical Biochemistry, 36, 421-429.
http://dx.doi.org/10.1016/S0009-9120(03)00078-X
[67] Borggreve, S.E., De Vries, R. and Dullaart, R.P. (2003) Alterations in High-Density Lipoprotein Metabolism and Reverse Cholesterol Transport in Insulin Resistance and Type 2 Diabetes Mellitus: Role of Lipolytic Enzymes, Lecithin: Cholesterol Acyltransferase and Lipid Transfer Proteins. European Journal of Clinical Investigation, 33, 1051-1069.
http://dx.doi.org/10.1111/j.1365-2362.2003.01263.x
[68] Yoo, T.W., Sung, K.C., Shin, H.S., Kim, B.J., Kim, B.S., Kang, J.H., Lee, M.H., Park, J.R., Kim, H., Rhee, E.J., et al. (2005) Relationship between Serum Uric Acid Concentration and Insulin Resistance and Metabolic Syndrome. Circulation Journal: Official Journal of the Japanese Circulation Society, 69, 928-933.
http://dx.doi.org/10.1253/circj.69.928
[69] Wang, M., Zhao, D., Li, G.W., Wang, W., Liu, J., Liu, J., Liu, S., Qin, L.P. and Zhou, G.H. (2007) Correlation between Serum Uric Acid and Insulin Resistance. Zhonghua Yixue Zazhi, 46, 3260-3263.
[70] Salehidoost, R., Aminorroaya, A., Zare, M. and Amini, M. (2012) Is Uric Acid an Indicator of Metabolic Syndrome in the First-Degree Relatives of Patients with Type 2 Diabetes? Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 17, 1005-1010.
[71] Osgood, K., Krakoff, J. and Thearle, M. (2013) Serum Uric Acid Predicts Both Current and Future Components of the Metabolic Syndrome. Metabolic Syndrome and Related Disorders, 11, 157-162.
http://dx.doi.org/10.1089/met.2012.0151
[72] Lippi, G., Montagnana, M., Franchini, M., Favaloro, E.J. and Targher, G. (2008) The Paradoxical Relationship between Serum Uric Acid and Cardiovascular Disease. Clinica Chimica Acta, Clinica Chimica Acta, 392, 1-7.
http://dx.doi.org/10.1016/j.cca.2008.02.024
[73] Alderman, M. and Aiyer, K.J. (2004) Uric Acid: Role in Cardiovascular Disease and Effects of Losartan. Current Medical Research and Opinion, 20, 369-379.
http://dx.doi.org/10.1185/030079904125002982
[74] Soltani, Z., Rasheed, K., Kapusta, D.R. and Reisin, E. (2013) Potential Role of Uric Acid in Metabolic Syndrome, Hypertension, Kidney Injury, and Cardiovascular Diseases: Is It Time for Reappraisal? Current Hypertension Reports, 15, 175-181.
http://dx.doi.org/10.1007/s11906-013-0344-5                                                                           eww141216lx

Blunt Trauma to the Penis Post Penile Augmentation Surgery: Case Report

Read  full  paper  at:

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=51278#.VGFjcGfHRK0

ABSTRACT

Introduction: Blunt trauma to the penis is a rare but potentially serious injury that can occur by various mechanisms (e.g., kicks, accidents, sexual activity, and falls). The most common clinical presentation is sudden pain, swelling, and discoloration. Depending on the type and severity of injury, management can include conservative treatment or surgery, with the ultimate goal being the prevention of delayed complications. Case presentation: A 30-year-old male presented with penile pain, swelling, and redness as a result of blunt trauma to his penis 1 week after penile enhancement surgery using a subcutaneous soft silicone implant. Once the patient’s blood pressure was stabilized, surgical management consisted of exploration with evacuation of a large hematoma and removal of the subcutaneous penile implant to avoid further perioperative and postoperative bleeding. Discussion: Postoperative bleeding is a risk factor associated with almost all types of surgical procedures, and its prevention is best achieved by identification and elimination of potential causes pre- and postoperatively. Hypertension is another risk factor for excessive postsurgical bleeding, particularly bleeding associated with prosthetic implant surgeries, and should be considered for any potential surgical patient. Conclusion: With penile prosthesis and implant surgery, hypertension is an especially serious risk factor. Early surgical management is warranted in cases involving a major hematoma and swelling. Even cases with minimal bleeding should be evaluated in a timely manner, with surgical treatment indicated, rather than watchful waiting, to prevent further damage to the penis.

Cite this paper

J. Elist, J. , Shirvanian, V. , Hosseini, A. and Mirgoli, O. (2014) Blunt Trauma to the Penis Post Penile Augmentation Surgery: Case Report. Open Journal of Urology, 4, 132-136. doi: 10.4236/oju.2014.411023.

References

[1] Tonolini, M. (2013) Urgent-Setting Magnetic Resonance Imaging Allows Triage of Extensive Penoscrotal Hematoma Following Blunt Trauma. Journal of Emergencies, Trauma and Shock, 6, 304-306. http://dx.doi.org/10.4103/0974-2700.120390
[2] Varon, J. and Marik, P.E. (2008) Perioperative Hypertension Management. Journal of Vascular Health and Risk Management, 3, 615-627.
[3] Svenson, J.E. and Repplinger, M. (2008) Hypertension in the ED: Still an Unrecognized Problem. Congestive Heart Failure, 26, 913-917. http://dx.doi.org/10.1016/j.ajem.2007.11.024
[4] Nesbitt, S. and Victor, R.G. (2004) Pathogenesis of Hypertension in African Americans. Congestive Heart Failure, 10, 24-29. http://dx.doi.org/10.1111/j.1527-5299.2004.02021.x
[5] He, J. and Whelton, P.K. (1997) Epidemiology and Prevention of Hypertension. Medical Clinics of North America, 81, 1077-1097. http://dx.doi.org/10.1016/S0025-7125(05)70568-X
[6] Lehnert, B.E., Sadro, C., Monroe, E. and Moshiri, M. (2014) Lower Male Genitourinary Trauma: A Pictorial Review. Emergency Radiology, 21, 67-74. http://dx.doi.org/10.1007/s10140-013-1159-z
[7] Perovic, S.V., Djinovic, R.P., Bumbasirevic, M.Z., Santucci, R.A., Djordjevic, M.L. and Kourbatov, D. (2009) Severe Penile Injuries: A Problem of Severity and Reconstruction. BJU International, 104, 676-687. http://dx.doi.org/10.1111/j.1464-410X.2008.08343.x
[8] Hunter, S.R., Lishnak, T.S., Powers, A.M. and Lisle, D.K. (2013) Male Genital Trauma in sports. Clinics in Sports Medicine, 32, 247-254. http://dx.doi.org/10.1016/j.csm.2012.12.012
[9] Morey, A.F., Metro, M.J., Carney, K.J., Miller, K.S. and McAninch, J.W. (2004) Consensus on Genitourinary Trauma: External Genitalia. BJU International, 94, 507-515.
http://dx.doi.org/10.1111/j.1464-410X.2004.04993.x
[10] Weiser, T.G., Makary, M.A., Haynes, A.B., Dziekan, G., Berry, W.R. and Gawande, A.A. (2009) Safe Surgery Saves Lives Measurement and Study Groups. Standardized Metrics for Global Surgical Surveillance. The Lancet, 14, 1113- 1117. http://dx.doi.org/10.1016/S0140-6736(09)61161-2
[11] Albrecht, J.S., Gruber-Baldini, A.L., Hirshon, J.M., Brown, C.H., Goldberg, R., Rosenberg, J.H., Comer, A.C. and Furuno, J.P. (2014) Hospital Discharge Instructions: Comprehension and Compliance among Older Adults. Journal of General Internal Medicine, 29, 1491-1498.
http://dx.doi.org/10.1007/s11606-014-2956-0
[12] Kurkar, A., Elderwy, A.A. and Orabi, E. (2014) False Fracture of the Penis: Different Pathology But Similar Clinical Presentation and Management. Urology Annals, 6, 23-26.
http://dx.doi.org/10.4103/0974-7796.127015
[13] Nicolaisen, G.S., Melamud, A., Williams, R.D. and McAninch, J.W. (1983) Rupture of the Corpus Cavernosum: Surgical Management. Journal of Urology, 130, 917-919.
[14] Penson, D.F., Seftel, A.D., Krane, R.J., Frohrib, D. and Goldstein, I. (1992) The Hemodynamic Pathophysiology of Impotence Following Blunt Trauma to the Erect Penis. Journal of Urology, 148, 1171-1180.
[15] Morey, A.F., Rozanski, T.A. and Wein, A.J. (2007) Genital and Lower Urinary Tract Trauma. In: Wein, A.J., Kavoussi, L.R., Novick, A.C., Partin, A.W. and Peters, C.A., Eds., Campbell-Walsh Urology, 9th Edition, Chap 88, Saunders Elsevier, Philadelphia.
[16] Dagi, T.F. (2005) The Management of Postoperative Bleeding. Surgical Clinics of North America, 85, 1191-1213. http://dx.doi.org/10.1016/j.suc.2005.10.013
[17] Lip, G.Y. and Li-Saw-Hee, F.L. (1998) Does Hypertension Confer a Hypercoagulable State? Journal of Hypertension, 16, 913-916. http://dx.doi.org/10.1097/00004872-199816070-00003
[18] Richter, S. (2009) Avoiding Complications in Penile Prosthesis Surgery. International Society for Sexual Medicine Web Site.
http://www.issm.info/news/review-reports/avoiding-complications-in-penile-prosthesis-surgery/
[19] Jack, G.D., Garraway, I., Reznichek, R. and Rajfer, J. (2004) Current Treatment Options for Penile Fractures. Reviews in Urology, 6, 114-120.
[20] Dicks, B., Bastuba, M. and Goldstein, I. (2013) Penile Revascularization—Contemporary Update. Asian Journal of Andrology, 15, 5-9. http://dx.doi.org/10.1038/aja.2012.146                                                                                eww141111lx

Proteinuria in Hypertensive Nephropathy: A Review

Read  full  paper  at:

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=47231#.VFwq9GfHRK0

ABSTRACT

Hypertension defined as a systolic blood pressure of ≥140 and a diastolic blood pressure ≥90 is anextremely prevalent condition; and it is responsible for significant mortality and morbidity. NHANESdata from 2005-2006 found that nearly 30% of adult US population has HTN; and nearly 8% of the population has undiagnosed HTN. HBP mortality in 2008 was 61,005. Any mentioned mortality in 2008 was 347,689 (NHLBI tabulation of NCHS mortality data). More than 20% of patients with systemic hypertension have chronic renal insufficiency (NHANES). Hypertensive nephropathy is a leading cause of end-stage renal disease (ESRD) requiring dialysis or transplantation or leading to death. The incidence of hypertension is high but only a subset of hypertensive patients progress to frank renal failure. A subset of hypertensive patients develop proteinuria during the course of disease and manifest nephrotic syndrome. This syndrome includes marked proteinuria, edema, and low serum albumin. Neither the incidence nor the clinical significance of proteinuria in hypertension without diabetes is known. Progression to chronic renal failure in some patients is preceded by proteinuria as indicated on “dip-stick” analyses of random urine samples. It appears that proteinuria is likely to increase both prior to and during evident loss of glomerular filtration, but this clinical observation has never been formally confirmed. There is a need for large studies to answer these questions. We also need to focus on the roles that genetic and environmental factors play in development and progression of renal disease in the setting of hypertension and proteinuria.

Cite this paper

Sharma, R. , Kamalakar, S. , McCarthy, E. , Fields, T. , Gupta, K. , Barua, R. and Savin, V. (2014) Proteinuria in Hypertensive Nephropathy: A Review. Open Journal of Nephrology, 4, 92-99. doi: 10.4236/ojneph.2014.42013.

References

[1] Ostchega, Y., et al. (2008) Hypertension Awareness, Treatment, and Control–Continued Disparities in Adults: United States, 2005-2006. NCHS Data Brief, 3, 1-8.
[2] Centers for Disease Control and Prevention (2012) Vital Statistics Public Use Data Files―2008 Mortality Multiple Cause Files.
http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm-Mortality_
[3] Rutkowski, B., Tylicki, L. and Debska-Slizien, A. (2003) Pathogenetic and Epidemiological Aspects of Hypertensive Nephropathy. Polskie Archiwum Medycyn Wewnetrznej, 110, 1167-1171.
[4] US Renal Data System (2011) USRDS. Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National In-stitute of Diabetes and Digestive and Kidney Diseases, Bethesda.
[5] Udani, S., Lazich, I. and Bakris, G.L. (2011) Epidemiology of Hypertensive Kidney Disease. Natural Review of Nephrology, 7, 11-21.
http://dx.doi.org/10.1038/nrneph.2010.154
[6] Schmieder, R.E. (2010) End Organ Damage in Hypertension. Dtsch Arztebl International, 107, 866-873.
[7] Harvey, J.M., et al. (1992) Renal Biopsy Findings in Hypertensive Patients with Proteinuria. Lancet, 340, 1435-1436.
http://dx.doi.org/10.1016/0140-6736(92)92624-O
[8] D’Agati, V.D. and Mengel, M. (2013) The Rise of Renal Pathology in Nephrology: Structure Illuminates Function. American Journal of Kidney Disease, 61, 1016-1025.
http://dx.doi.org/10.1053/j.ajkd.2012.12.019
[9] Dasgupta, I., et al. (2007) “Benign” Hypertensive Nephrosclerosis. QJM, 100, 113-119.
http://dx.doi.org/10.1093/qjmed/hcl139
[10] Nonaka, K., et al. (2013) Clinical and Pathological Evaluation of Hypertensive Emergency-Related Nephropathy. Internal Medicine, 52, 45-53.
[11] Freedman, B.I., et al. (1994) Renal Biopsy Findings in Presumed Hypertensive Nephrosclerosis. American Journal of Nephrology, 14, 90-94.
http://dx.doi.org/10.1159/000168695
[12] Mujais, S.K., et al. (1985) Marked Proteinuria in Hypertensive Nephrosclerosis. American Journal of Nephrology, 5, 190-195.
http://dx.doi.org/10.1159/000166931
[13] Obialo, C.I., Hewan-Lowe, K. and Fulong, B. (2002) Nephrotic Proteinuria as a Result of Essential Hypertension. Kidney Blood Press Research, 25, 250-254.
http://dx.doi.org/10.1159/000066345
[14] Viazzi, F., Leoncini, G. and Pontremoli, R. (2013) Global Cardiovascular Risk Assessment in the Management of Primary Hypertension: The Role of the Kidney. International Journal of Hypertens, 2013, 542-646.
[15] Rahman, M., Douglas, J.G. and Wright Jr., J.T. (1997) Pathophysiology and Treatment Implications of Hypertension in the African-American Population. Endocrinology and Metabolism Clinics of North America, 26, 125-144.
http://dx.doi.org/10.1016/S0889-8529(05)70237-1
[16] Striker, G.E. (1992) Current KUH Notations. American Journal of Kidney Diseases, 20, 673.
http://dx.doi.org/10.1016/S0272-6386(12)70239-1
[17] Wright Jr., J.T., Bakris, G., Greene, T., Agodoa, L.Y., Appel, L.J., Charleston, J., et al. (2002) Effect of Blood Pressure Lowering and Antihypertensive Drug Class on Progression of Hypertensive Kidney Disease: Results from the AASK Trial. JAMA, 288, 2421-2431.
http://dx.doi.org/10.1001/jama.288.19.2421
[18] Appel, L.J., Wright Jr., J.T., Greene, T., Agodoa, L.Y., Astor, B.C., Bakris, G.L., et al. (2010) Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease. The New England Journal of Medicine, 363, 918-929.
http://dx.doi.org/10.1056/nejmoa0910975
[19] Kopp, J.B., Smith, M.W., Nelson, G.W., Johnson, R.C., Freedman, B.I., Bowden, D.W., et al. (2008) MYH9 Is a Major-Effect Risk Gene for Focal Segmental Glomerulosclerosis. Nature Genetics, 40, 1175-1184.
http://dx.doi.org/10.1038/ng.226
[20] Genovese, G., Friedman, D.J., Ross, M.D., Lecordier, L., Uzureau, P., Freedman, B.I., et al. (2010) Association of Trypanolytic ApoL1 Variants with Kidney Disease in African Americans. Science, 329, 841-845.
http://dx.doi.org/10.1126/science.1193032
[21] Cooke, J.N., Bostrom, M.A., Hicks, P.J., Ng, M.C., Hellwege, J.N., Comeau, M.E., et al. (2012) Polymorphisms in MYH9 Are Associated with Diabetic Nephropathy in European Americans. Nephrology Dialysis Transplantation, 27, 1505-1511.
http://dx.doi.org/10.1093/ndt/gfr522
[22] Lipkowitz, M.S., Freedman, B.I., Langefeld, C.D., Comeau, M.E., Bowden, D.W., Kao, W.H., et al. (2013) Apolipoprotein L1 Gene Variants Associate with Hypertension-Attributed Nephropathy and the Rate of Kidney Function Decline in African Americans. Kidney International, 83, 114-120.
http://dx.doi.org/10.1038/ki.2012.263
[23] Nguyen, K.D., Pihur, V., Ganesh, S.K., Rakha, A., Cooper, R.S., Hunt, S.C., et al. (2013) Effects of Rare and Common Blood Pressure Gene Variants on Essential Hypertension: Results from the Family Blood Pressure Program, CLUE, and Atherosclerosis Risk in Communities Studies. Circulation Research, 112, 318-326.
http://dx.doi.org/10.1161/CIRCRESAHA.112.276725
[24] Mao, S. and Huang, S. (2013) Lack of Association of Angiotensin II Type 1 Receptor A1166C Gene Polymorphism with the Risk of End-Stage Renal Disease. Renal Failure, 35, 1295-1301.
http://dx.doi.org/10.3109/0886022X.2013.820663
[25] Hallan, S.I., Coresh, J., Astor, B.C., Asberg, A., Powe, N.R., Romundstad, S., et al. (2006) International Comparison of the Relationship of Chronic Kidney Disease Prevalence and ESRD Risk. Journal of the American Society of Nephrology, 17, 2275-2284.
http://dx.doi.org/10.1681/ASN.2005121273
[26] Fields, L.E., Burt, V.L., Cutler, J.A., Hughes, J., Roccella, E.J. and Sorlie, P. (2004) The Burden of Adult Hypertension in the United States 1999 to 2000: A Rising Tide. Hypertension, 44, 398-404.
http://dx.doi.org/10.1161/01.HYP.0000142248.54761.56
[27] Rao, G.N., Corson, M.A. and Berk, B.C. (1991) Uric Acid Stimulates Vascular Smooth Muscle Cell Proliferation by Increasing Platelet-Derived Growth Factor A-Chain Expression. Journal of Biological Chemistry, 266, 8604-8608.
[28] Susic, D. and Frohlich, E.D. (2011) Hypertensive Cardiovascular and Renal Disease and Target Organ Damage: Lessons from Animal Models. CardioRenal Medicine, 1, 139-146.
http://dx.doi.org/10.1159/000329334
[29] Scialla, J.J., Appel, L.J., Astor, B.C., Miller 3rd, E.R., Beddhu, S., Woodward, M., et al. (2012) Net Endogenous Acid Production Is Associated with a Faster Decline in GFR in African Americans. Kidney Internatinal, 82, 106-112.
http://dx.doi.org/10.1038/ki.2012.82
[30] Luyckx, V.A., Bertram, J.F., Brenner, B.M., Fall, C., Hoy, W.E., Ozanne, S.E., et al. (2013) Effect of Fetal and Child Health on Kidney Development and Long-Term Risk of Hypertension and Kidney Disease. The Lancet, 382, 273-283.
http://dx.doi.org/10.1016/S0140-6736(13)60311-6
[31] Lüscher, T.F. and Barton, M. (2000) Endothelins and Endothelin Receptor Antagonists: Therapeutic Considerations for a Novel Class of Cardiovascular Drugs. Circulation, 102, 2434-2440.
http://dx.doi.org/10.1161/01.CIR.102.19.2434
[32] Brown, M.J., Coltart, J., Gunewardena, K., Ritter, J.M., Auton, T.R. and Glover, J.F. (2004) Randomized Double-Blind Placebo-Controlled Study of an Angi-otensin Immunotherapeutic Vaccine (PMD3117) in Hypertensive Subjects. Clinical Science (Lond), 107, 167-173.
http://dx.doi.org/10.1042/CS20030381
[33] Tissot, A.C., Maurer, P., Nussberger, J., Sabat, R., Pfister, T., Igna-tenko, S., et al. (2008) Effect of Immunisation against Angiotensin II with CYT006-AngQb on Ambulatory Blood Pressure: A Double-Blind, Randomised, Placebo-Controlled Phase IIa Study. The Lancet, 371, 821-827.
http://dx.doi.org/10.1016/S0140-6736(08)60381-5
[34] Navaneethan, S.D., Lohmeier, T.E. and Bisognano, J.D. (2009) Baroreflex Stimulation: A Novel Treatment Option for Resistant Hypertension. Journal of the American Society of Hypertension, 3, 69-74.
[35] Schlaich, M.P., Schmieder, R.E., Bakris, G., Blankestijn, P.J., Böhm, M., Campese, V.M., et al. (2013) International Expert Consensus Statement: Percutaneous Transluminal Renal Denervation for the Treatment of Resistant Hypertension. Journal of the American College of Cardiology, 62, 2031-2045.
http://dx.doi.org/10.1016/j.jacc.2013.08.1616
[36] Bhatt, D.L., Kandzari, D.E., O’Neill WW, D’Agostino, R., Flack, J.M., Katzen, B.T., et al. (2014) A Controlled Trial of Renal Denervation for Resistant Hypertension. The New England Journal of Medicine, 370, 1393-1401.
http://dx.doi.org/10.1056/NEJMoa1402670
[37] Hicks, L.S., Sequist, T.D., Ayanian, J.Z., Shaykevich, S., Fairchild, D.G., Orav, E.J., et al. (2008) Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial. Journal of General Internal Medicine, 23, 429-441.
http://dx.doi.org/10.1007/s11606-007-0403-1                                                                           eww141107lx

The Role of Premenstrual Syndrome in the Causation of Arterial Hypertension in Women

Read  full  paper  at:

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=50220#.VDINF1fHRK0

Author(s)

ABSTRACT

Introduction: Gender perspectives are gradually generating great interest in health matters. Hypertension is one illness where gender considerations are important. Advancements in knowledge of pathophysiology help in better understanding of diseases and improvements in treatment. Pre-menstrual syndrome has been reported to make hypertension less responsive to treatment. This work was therefore done to see if premenstrual syndrome contributed in some way to hypertension in women. Methodology: All female hypertensives consulting the author in a private specialized hypertension clinic were questioned using the University of Carlifornia at San Diego criteria with a view to determining if they suffered from pre-menstrual syndrome. The control status was also considered for each patient. Females who consulted over the same period and were not hypertensive served as controls. Result: Pre-menstrual syndrome was found to occur more in hypertensive women than normotensive controls; to a statistically significant extent (p < 0.05). Control tended to be poorer in hypertensives with pre-menstrual syndrome than those without. The difference however did not achieve statistical significance. Discussion: There is controversy surrounding the aetiology of pre-menstrual syndrome. However, each of the models albeit inconsistent is capable of initiating and sustaining hypertension. The result here shows that in women it is likely to be one of the many factors that could produce hypertension in those predisposed. Conclusion: Pre-menstrual syndrome should arouse suspicion of future hypertension, and should be sought in all female hypertensives. Its presence should evoke deliberate action to improve outcome or remove the need for pharmacotherapy, at least for some time.

Cite this paper

Okeahialam, B. (2014) The Role of Premenstrual Syndrome in the Causation of Arterial Hypertension in Women. Open Journal of Obstetrics and Gynecology, 4, 817-821. doi: 10.4236/ojog.2014.414113.

References

[1] Legato, M.J. (2003) Beyond Women’s Health: The New Discipline of Gender Specific Medicine. Medical Clinics of North America, 5, 917-937. http://dx.doi.org/10.1016/S0025-7125(03)00063-4
[2] Hanes, D.S., Weir, M.R. and Sowers, J.R. (1996) Gender Considerations in Hypertension Pathophysiology and Treatment. The American Journal of Medicine, 101, 10S-21S.
[3] Kaplan, N.M. (2004) What Can We Expect from New Guidelines? Medical Clinics of North America, 88, 141-148. http://dx.doi.org/10.1016/S0025-7125(03)00120-2
[4] Savoia, C. and Schiffrin, E.L. (2004) Significance of Recently Identified Peptides in Hypertension: Endothelin, Natriuretic Peptides, Adrenomedulin, Leptin. Medical Clinics of North America, 88, 39-62. http://dx.doi.org/10.1016/S0025-7125(03)00122-6
[5] Johnson, S.R. (1987) Pre-Menstrual Syndrome (Foreword). Clinical Obstetrics and Gynecology, 30, 365-366.
[6] Johnson, S.R. (1987) The Epidemiology and Social Impact of Pre-Menstrual Syndrome. Clinical Obstetrics and Gynecology, 30, 367-376.
[7] Okeahialam, B.N. (2004) Refractory Hypertension Controlled after Identifying and Addressing Pre-Menstrual Syndrome. Journal of the National Medical Association, 96, 1422-1423.
[8] Dickerson, R.M., Mazyck, P.J. and Hunter, M.H. (2003) Pre-Menstrual Syndrome. American Family Physician, 67, 1743-1752.
[9] Rasheed, P. and Al-Sowielem, L.S. (2003) Prevalence and Predictors of Pre-Menstrual Syndrome among College Aged Women in Saudi Arabia. Annals of Saudi Medicine, 23, 381-387.
[10] Daugherty, J.E. (1998) Treatment Strategies for Pre-Menstrual Syndrome. American Family Physician, 58, 183-192, 197-198.
[11] Steiner, M. and Born, L. (2000) Diagnosis and Treatment of Premenstrual Dysphoric Disorder. An Update. International Clinical Psychopharmacology, 15, S5-S17.
[12] Okeahialam, B.N., Obindo, J.T. and Ogbonna, C. (2008) Prevalence of Premenstrual Syndrome and Its Relationship with Blood Pressure in Young Adult Females. African Journal of Medicine Medical Sciences, 37, 361-367.
[13] Kaplan, N.M. (1994) Primary Hypertension. Pathogenesis. In: Kaplan, N.M., Ed., Clinical Hypertension, Wilkins and Wilkins, Baltimore/Philadelphia/Hongkong/London/Munich/Sydney/Tokyo, 47-108.
[14] Hallman, J. (1986) The Premenstrual Syndrome—An Equivalent of Depression? Acta Psychiatrica Scandinavica, 73, 403-411. http://dx.doi.org/10.1111/j.1600-0447.1986.tb02703.x
[15] Saeed, A.K. and Al-Dabbagh, T.Q. (2003) Type 2 Diabetes and Its Association with Hypertension and Depression in an Iraqi Population. Annals of Saudi Medicine, 23, 254-259.
[16] Carpenter, P.C. (1988) Diagnostic Evaluation of Cushings Syndrome. Endocrinology Metabolism Clinics of North America, 17, 445-472.
[17] Jonas, B.S., Fraubs, P. and Ingram, D.D. (1997) Are Symptoms of Anxiety and Depression Risk Factors for Hypertension? Longitudinal Evidence from the National Health and Nutritional Diseases/Epidemiological Follow-Up Study. Archives of Family Medicine, 6, 43-49.
http://dx.doi.org/10.1001/archfami.6.1.43
[18] Shechter, A. and Boivin, D.B. (2010) Sleep, Hormones, and Circadian Rhythms throughout the Menstrual Cycle in Healthy Women with Premenstrual Dysphoric Disorder. International Journal of Endocrinology, 2010, Article ID: 259345. http://dx.doi.org/10.1155/2010/259345
[19] Baker, F.C., Kahan, T.L., Trinder, J. and Colrain, I.M. (2007) Sleep Quality and the Sleep Electroencephalogram in Women with Severe Premenstrual Syndrome. Sleep, 30, 1283-1291.
[20] Meelo, P., Sgoifo, A. and Suchecki, D. (2008) Restricted and Disrupted Sleep: Effects on Autonomic Function, Neuroendocrine Stress Systems and Stress Responsivity. Sleep Medicine Reviews, 12, 197-210. http://dx.doi.org/10.1016/j.smrv.2007.07.007
[21] Stickler, R.C. (1987) Endocrine Hypothesis for the Etiology of Premenstrual Syndrome. Clinical Obstetrics & Gynecology, 30, 377-385. http://dx.doi.org/10.1097/00003081-198706000-00018
[22] Reid, R.L. (1988) Etiology: Medial Models. In: Keye Jr., W.R., Ed., The Pre-Menstrual Syndrome, WB Saunders Co., Philadelphia/Toronto/Montreal/Sydney/Tokyo, 75-77.
[23] Sharma, B.K., Sharma, N. and Jain, S. (1999) Hypertension and the Kidneys: Inter-Relationship and Therapeutic Approach. Journal of Indian Medical Association, 97, 91-105.
[24] Muntner, P., Shimbo, D., Tonelli, M., Reynolds, K., Arnett, D.K. and Oparil, S. (2011) The Relationship between Visit-to-Visit Variability in Systolic Blood Pressure and All-Cause Mortality in the General Population: Findings from NHANES III, 1988-1994. Hypertension, 57, 160-166.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.110.162255
[25] Stamatelopoulos, K.S., Georgiopoulos, G., Papaioannou, T., Lambrinoudaki, I., Kouzoupis, A., Vlachopoulos, C., et al. (2012) Can Premenstrual Syndrome Affect Arterial Stiffness or Blood Pressure? Atherosclerosis, 224, 170-176.
[26] Frohlich, E.D. (2004) Innovative Concepts of Hypertension to Understand and Manage the Disease (Preface). Medical Clinics of North America, 88, 13-21.
http://dx.doi.org/10.1016/S0025-7125(03)00143-3                                                                               eww141006lx

Aortic Stenosis and Stressed Heart Morphology

Read  full  paper  at:

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=49685#.VBeOqVd2W3M

Aortic Stenosis and Stressed Heart Morphology.

ABSTRACT

Myocardial geometric remodeling is a response to increased stress which includes increased afterload situations during clinical conditions. In this review, we have focused on early and late geometric features in aortic stenosis, importance of recognition of these findings and consequences due to progression of valve disease. We have also pointed out the similarities in early focal and global myocardial geometric remodeling in acute and chronic conditions as hypertension and acute stress cardiomypathy which are associated with myocardial functional and geometric response to acute or chronic stress exposure and relevant increased afterload. In aortic stenosis, target organ involvement in disease progression has been evaluated and discussed in the report. In addition to quantitative evaluation of valve disease, importance of myocardial involvement and global assessment of patients with aortic stenosis also have been mentioned in the report. Finally, we have discussed the importance of global myocardial geometric changes and timing for surgery before development of heart failure in this specific group of patients.

Cite this paper

Karatepe, C. and Yalçin, F. (2014) Aortic Stenosis and Stressed Heart Morphology. World Journal of Cardiovascular Surgery, 4, 151-157. doi: 10.4236/wjcs.2014.49022.
References

 

[1] Nkomo, V.T., Gardin, M., Skelton, T.N., Gottdiener, J.S., Scott, C.G. and Enriquez-Sarano, M. (2006) Burden of Valvular Heart Diseases: A Population-Based Study. Lancet, 368, 1005-1011.
http://dx.doi.org/10.1016/S0140-6736(06)69208-8
[2] Grossman, W., Jones, D. and McLaurin, L. (1975) Wall Stress and Patterns of Hypertrophy in the Human Left Ventricle. Journal of Clinical Investigation, 56, 56-64.
http://dx.doi.org/10.1172/JCI108079
[3] Saito, T., Muro, T., Takeda, H., et al. (2012) Prognostic Value of Aortic Valve Area Index in Asymptomatic Patients with Severe Aortic Stenosis. American Journal of Cardiology, 110, 93-97.
http://dx.doi.org/10.1016/j.amjcard.2012.02.056
[4] Dweck, M.R., Boon, N.A. and Newby, D.E. (2012) Calcific Aortic Stenosis: A Disease of the Valve and the Myocardium. Journal of the American College of Cardiology, 60, 1854-1863.
http://dx.doi.org/10.1016/j.jacc.2012.02.093
[5] Cioffi, G., Faggiano, P., Vizzardi, E., et al. (2011) Prognostic Effect of Inappropriately High Left Ventricular Mass in Asymptomatic Severe Aortic Stenosis. Heart, 97, 301-307.
http://dx.doi.org/10.1136/hrt.2010.192997
[6] Carabello, B.A. (1995) The Relationship of Left Ventricular Geometry and Hypertrophy to Left Ventricular Function in Valvular Heart Disease. The Journal of Heart Valve Disease, 4, S132-S138.
[7] Garcia, M.J., Thomas, J.D. and Klein, A.L. (1998) New Doppler Echocardiographic Applications for the Study of Diastolic Function. Journal of the American College of Cardiology, 32, 865-875.
http://dx.doi.org/10.1016/S0735-1097(98)00345-3
[8] Yalcin, F., Kaftan, A., Muderrisoglu, H., Korkmaz, M.E., Flachskampf, F., Garcia, M.J. and Thomas, J.D. (2002) Is Doppler Tissue Velocity during Early Left Ventricular Filling Preload Independent? Heart, 87, 336-339.
http://dx.doi.org/10.1136/heart.87.4.336
[9] Takeda, S., Rimington, H., Smeeton, N. and Chambers, J. (2001) Long Axis Excursion in Aortic Stenosis. Heart, 86, 52-56. http://dx.doi.org/10.1136/heart.86.1.52
[10] Levy, D., Garrison, R.J., Savage, D.D., Kannel, W.B. and Castelli, W.P. (1990) Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart Study. New England Journal of Medicine, 322, 1561-1566.
http://dx.doi.org/10.1056/NEJM199005313222203
[11] Iung, B., Baron, G., Butchart, E.G., Delahaye, F., Gohlke-Barwolf, C., Levang, O.W., Tornos, P., Vanoverschelde, J.L., Vermeer, F., Boersma, E., Ravaud, P. and Vahanian, A. (2003) A Prospective Survey of Patients with Valvular Heart Disease in Europe: The Euro Heart Survey on Valvular Heart Disease. European Heart Journal, 24, 1231-1243.
http://dx.doi.org/10.1016/S0195-668X(03)00201-X
[12] STS National Database (2000) STS U.S. Cardiac Surgery Database: 1997 Aortic Valve Replacement Patients: Preoperative Risk Variables. Society of Thoracic Surgeons, Chicago.
http:// http://www.ctsnet.org/doc/3031
[13] Bridgewater, B., Keogh, B., Kinsman, R. and Walton, P. (2008) The Society for Cardiothoracic Surgery in Great Britain & Ireland, 6th National Adult Cardiac Surgical Database Report. Demonstrating Quality, Dendrite Clinical Systems Ltd, Henley-on-Thames, UK.
[14] Kvidal, P., Bergstrom, R., Horte, L.G. and Stahle, E. (2000) Observed and Relative Survival after Aortic Valve Replacement. Journal of the American College of Cardiology, 35, 747-756.
http://dx.doi.org/10.1016/S0735-1097(99)00584-7
[15] Brown, M.L., Pellikka, P.A., Schaff, H.V., Scott, C.G., Mullany, C.J., Sundt, T.M., Dearani, J.A., Daly, R.C. and Orszulak, T.A. (2008) The Benefits of Early Valve Replacement in Asymptomatic Patients with Severe Stenosis. The Journal of Thoracic and Cardiovascular Surgery, 135, 308-315.
http://dx.doi.org/10.1016/j.jtcvs.2007.08.058
[16] Leon, M.B., Smith, C.R., Mack, M., Miller, D.C., Moses, J.W., Svensson, L.G., Tuzcu, E.M., Webb, J.G., Fontana, G.P., Makkar, R.R., Brown, D.L., Block, P.C., Guyton, R.A., Pichard, A.D., Bavaria, J.E., Herrmann, H.C., Douglas, P.S., Petersen, J.L., Akin, J.J., Anderson, W.N., Wang, D., Pocock, S. and Partner Trial Investigators (2010) Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. New England Journal of Medicine, 363, 1597-1607.
http://dx.doi.org/10.1056/NEJMoa1008232
[17] Gurvitch, R., Wood, D.A., Tay, E.L., Leipsic, J., Ye, J., Lichtenstein, S.V., Thompson, C.R., Carere, R.G., Wijesinghe, N., Nietlispach, F., Boone, R.H., Lauck, S., Cheung, A. and Webb, J.G. (2010) Transcatheter Aorticvalve Implantation: Durability of Clinical and Hemodynamic Outcomes beyond 3 Years in a Large Patient Cohort. Circulation, 122, 1319-1327.
http://dx.doi.org/10.1161/CIRCULATIONAHA.110.948877
[18] Kalavrouziotis, D., Li, D., Buth, K.J. and Légaré, J.F. (2009) The European System for Cardiac Operative Risk Evaluation (EuroSCORE) Is Not Appropriate for Withholding Surgery in High-Risk Patients with Aortic Stenosis: A Retrospective Cohort Study. Journal of Cardiothoracic Surgery, 4, 32.
http://dx.doi.org/10.1186/1749-8090-4-32
[19] Vinereanu, D., Florescu, N., Sculthorpe, N., Tweddel, A.C., Stephens, M.R. and Fraser, A.G. (2001) Differentiation between Pathologic and Physiologic Left Ventricular Hypertrophy by Tissue Doppler Assessment of Long-Axis Function in Patients with Hypertrophic Cardiomyopathy or Systemic Hypertension and in Athletes. American Journal of Cardiology, 88, 53-58.
http://dx.doi.org/10.1016/S0002-9149(01)01585-5
[20] Spirito, P., Bellone, P., Harris, K.M., Bernabo, P., Bruzzi, P. and Maron, B.J. (2000) Magnitude of Left Ventricular Hypertrophy and Risk of Sudden Death in Hypertrophic Cardiomyopathy. New England Journal of Medicine, 342, 1778-1785.
http://dx.doi.org/10.1056/NEJM200006153422403
[21] Schillaci, G., Verdecchia, P., Porcellati, C., Cuccurullo, O., Cosco, C. and Perticone, F. (2000) Continuous Relation between Left Ventricular Mass and Cardiovascular Risk in Essential Hypertension. Hypertension, 35, 580-586.
http://dx.doi.org/10.1161/01.HYP.35.2.580
[22] Yalcin, F., Shiota, T., Odabashian, J., Agler, D., Greenberg, N.L., Garcia, M.J., Lever, H.M. and Thomas, J.D. (2000) Comparison by Real-Time Three-Dimensional Echocardiography of Left Ventricular Geometry in Hypertrophic Cardiomyopathy versus Secondary Left Ventricular Hypertrophy. American Journal of Cardiology, 85, 1035-1038.
http://dx.doi.org/10.1016/S0002-9149(99)00929-7
[23] Yalcin, F., Muderrisoglu, H., Korkmaz, M.E., Ozin, B., Baltali, M. and Yigit, F. (2004) The Effect of Dobutamine Stress on Left Ventricular Outflow Tract Gradients in Hypertensive Patients with Basal Septal Hypertrophy. Angiology, 55, 295-301.
http://dx.doi.org/10.1177/000331970405500309
[24] Yalcin, F., Kucukler, N., Haq, N. and Abraham, T.P. (2011) Evaluation of Regional Myocardial Dynamics in Left Ventricular Hypertrophy Secondary to Essential Hypertension. Journal of the American College of Cardiology, 57, E2000.
http://dx.doi.org/10.1016/S0735-1097(11)62000-7
[25] Kucukler, N., Yalcin, F., Abraham, T.P. and Garcia, M.J. (2011) Stress Induced Hypertensive Response: Should It Be Evaluated More Carefully? Cardiovascular Ultrasound, 9, 22.
http://dx.doi.org/10.1186/1476-7120-9-22
[26] Yalcin, F., Yigit, F., Erol, T., Baltali, M., Korkmaz, M.E. and Müderrisoglu, H. (2006) Effect of Dobutamine Stress on Basal Septal Tissue Dynamics in Hypertensive Patients with Basal Septal Hypertrophy. Journal of Human Hypertension, 20, 628-630.
http://dx.doi.org/10.1038/sj.jhh.1002041
[27] Yalcin, F., Yalcin, H. and Abraham, T. (2010) Stress-Induced Regional Features of Left Ventricle Is Related to Pathogenesis of Clinical Conditions with both Acute and Chronic Stress. International Journal of Cardiology, 145, 367-368.
http://dx.doi.org/10.1016/j.ijcard.2010.02.041
[28] Sharkey, S.W., Lesser, J.R., Zenovich, A.G., Maron, M.S., Lindberg, J., Longe, T.F. and Maron, B.J. (2005) Acute and Reversible Cardiomyopathy Provoked by Stress in Women from the United States. Circulation, 111, 472-479.
http://dx.doi.org/10.1161/01.CIR.0000153801.51470.EB
[29] Yalcin, F. and Müderrisoglu, H. (2009) Tako-Tsubo Cardiomyopathy May Be Associated with Cardiac Geometric Features as Observed in Hypetensive Heart Disease. International Journal of Cardiology, 135, 251-252.
http://dx.doi.org/10.1016/j.ijcard.2008.03.018
[30] Holmgren, S., Abrahamsson, T. and Almgren, O. (1985) Adrenergic Innervation of Coronary Arteries and Ventricular Myocardium in the Pig: Fluorescence Microscopic Appearance in the Normal State and after Ischemia. Basic Research in Cardiology, 80, 18-26.
http://dx.doi.org/10.1007/BF01906740
[31] Kawano, H., Okada, R. and Yano, K. (2003) Histological Study on the Distribution of Autonomic Nerves in the Human Heart. Heart and Vessels, 18, 32-39.
http://dx.doi.org/10.1007/s003800300005
[32] Schlaich, M.P., Kaye, D.M., Lambert, E., Sommerville, M., Socratous, F. and Esler, M.D. (2003) Relation between Cardiac Sympathetic Activity and Hypertensive Left Ventricular Hypertrophy. Circulation, 108, 560-565.
http://dx.doi.org/10.1161/01.CIR.0000081775.72651.B6
[33] Yalcin, F., Shiota, M., Greenberg, N., Thomas, J.D. and Shiota, T. (2008) Real Time Three-Dimensional Echocardiography Evaluation of Mitral Annular Characteristics in Patients with Myocardial Hypertrophy. Echocardiography, 25, 424-428.
http://dx.doi.org/10.1111/j.1540-8175.2007.00603.x
[34] Núnez, J., Zamorano, J.L., Pérez De Isla, L., Palomegue, C., Almería, C., Rodrigo, J.L., Corteza, J., Banchs, J. and Macaya, C. (2004) Differences in Regional Systolic and Diastolic Function by Doppler Tissue Imaging in Patients with Hypertrophic Cardiomyopathy and Hypertrophy Caused by Hypertension. Journal of the American Society of Echocardiography, 17, 717-722.
http://dx.doi.org/10.1016/j.echo.2004.03.029
[35] Kato, T., Niizuma, S., Inuzuka, Y., Kawashima, T., Okuda, J., Tamaki, Y., et al. (2010) Analysis of Metabolic Remodeling in Compensated Left Ventricular Hypertrophy and Heart Failure. Circulation: Heart Failure, 3, 420-430.
http://dx.doi.org/10.1161/CIRCHEARTFAILURE.109.888479
[36] Vieira, M.L., Silva Filho, R.M., Brito Filho, F.S., Leal, S.B., Lira Filho, E.B., Fischer, C.H., de Souza, J.A. and Perin, M.A. (2003) Selective Contrast Echocardiography in Percutaneous Transluminal Septal Myocardial Ablation in an Elderly Patient with Left Ventricular Concentric Hypertrophy. Echocardiography, 20, 563-566.
http://dx.doi.org/10.1046/j.1540-8175.2003.03096.x
[37] Azzarelli, S., Galassi, A.R., Amico, F., Giacoppo, M., Argentino, V. and Fiscella, A. (2007) Intraventricular Obstruction in a Patient with Tako-Tsubo Cardiomyopathy. International Journal of Cardiology, 121, e22-e24.
http://dx.doi.org/10.1016/j.ijcard.2007.04.110
[38] Laskey, W.K. and Kussmaul, W.G. (2001) Subvalvular Gradients in Patients with Valvular Aortic Stenosis: Prevalence, Magnitude, and Physiological Importance. Circulation, 104, 1019-1022.
http://dx.doi.org/10.1161/hc3401.095041
[39] Dweck, M.R., Joshi, S., Murigu, T., Alpendurada, F., Jabbour, A., Melina, G., Banya, W., Gulati, A., Roussin, I., Raza, S., et al. (2011) Midwall Fibrosis Is an Independent Predictor of Mortality in Patients with Aortic Stenosis. Journal of the American College of Cardiology, 58, 1271-1279.
http://dx.doi.org/10.1016/j.jacc.2011.03.064
[40] Lund, O., Flo, C., Jensen, F.T., Emmertsen, K., Nielsen, T.T., Rasmussen, B.S., Hansen, O.K., Pilegaard, H.K. and Kristensen, L.H. (1997) Left Ventricular Systolic and Diastolic Function in Aortic Stenosis. Prognostic Value after Valve Replacement and Underlying Mechanisms. European Heart Journal, 18, 1977-1987.
http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a015209

LTEWW140916