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      Prevalence of Hypertension in Cardiovascular Disease in Iran: Systematic Review and Meta-Analysis

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          Abstract

          Background:

          Hypertension is a major cause of noncommunicable diseases such as cardiovascular disease. Therefore, this study aimed to estimate the prevalence of hypertension in cardiovascular patients in Iran by meta-analysis.

          Methods:

          The search was carried out using authentic Persian and English keywords in national and international databases including IranMedex, Scientific Information Database (SID), Magiran, IranDoc, Medlib, ScienceDirect, PubMed , Scopus, Cochrane, Embase, Web of Science, and Google Scholar search engine without any time limitation until 2017. Heterogeneity of studies was assessed using I2 statistic . Data were analyzed using STATA 11.1.

          Results:

          In 66 reviewed studies with a sample of 111,406 participants, the prevalence of hypertension was 44% in Iranian patients with cardiovascular disease 67%(95%CI: 38%–49%) in women and 42% in men. The prevalence of systolic hypertension in cardiac patients was 25%, diastolic 20%, diabetes 27%, and overexposure 43%. The prevalence of hypertension was 44% in patients with coronary artery disease, 50% in myocardial infarction, 33% in aortic aneurysm, and 44% in cardiac failure.

          Conclusions:

          Hypertension has a higher prevalence in women with cardiovascular disease than men, and it increases with age. Among patients with cardiovascular disease, myocardial infarction patients have the highest levels of hypertension. The prevalence of systolic hypertension in cardiac patients is higher than diastolic hypertension.

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          Most cited references89

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          Blood pressure variability and cardiovascular disease: systematic review and meta-analysis

          Objective To systematically review studies quantifying the associations of long term (clinic), mid-term (home), and short term (ambulatory) variability in blood pressure, independent of mean blood pressure, with cardiovascular disease events and mortality. Data sources Medline, Embase, Cinahl, and Web of Science, searched to 15 February 2016 for full text articles in English. Eligibility criteria for study selection Prospective cohort studies or clinical trials in adults, except those in patients receiving haemodialysis, where the condition may directly impact blood pressure variability. Standardised hazard ratios were extracted and, if there was little risk of confounding, combined using random effects meta-analysis in main analyses. Outcomes included all cause and cardiovascular disease mortality and cardiovascular disease events. Measures of variability included standard deviation, coefficient of variation, variation independent of mean, and average real variability, but not night dipping or day-night variation. Results 41 papers representing 19 observational cohort studies and 17 clinical trial cohorts, comprising 46 separate analyses were identified. Long term variability in blood pressure was studied in 24 papers, mid-term in four, and short-term in 15 (two studied both long term and short term variability). Results from 23 analyses were excluded from main analyses owing to high risks of confounding. Increased long term variability in systolic blood pressure was associated with risk of all cause mortality (hazard ratio 1.15, 95% confidence interval 1.09 to 1.22), cardiovascular disease mortality (1.18, 1.09 to 1.28), cardiovascular disease events (1.18, 1.07 to 1.30), coronary heart disease (1.10, 1.04 to 1.16), and stroke (1.15, 1.04 to 1.27). Increased mid-term and short term variability in daytime systolic blood pressure were also associated with all cause mortality (1.15, 1.06 to 1.26 and 1.10, 1.04 to 1.16, respectively). Conclusions Long term variability in blood pressure is associated with cardiovascular and mortality outcomes, over and above the effect of mean blood pressure. Associations are similar in magnitude to those of cholesterol measures with cardiovascular disease. Limited data for mid-term and short term variability showed similar associations. Future work should focus on the clinical implications of assessment of variability in blood pressure and avoid the common confounding pitfalls observed to date. Systematic review registration PROSPERO CRD42014015695.
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            Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study.

            Patients with optimum ( 140/90 mm Hg) over time. We aimed to establish the best frequency of BP screening by assessing the rates and determinants of progression to hypertension. We assessed repeated BP measurements in individuals without hypertension (BP<140/90 mm Hg) from the Framingham Study (4200 men, 5645 women; mean age 52 years) who attended clinic examinations during 1978-94. The incidence of hypertension (or use of antihypertensive treatment) and its determinants were studied. A stepwise increase in hypertension incidence occurred across the three non-hypertensive BP categories; 5.3% (95% CI 4.4-6.3%) of participants with optimum BP, 17.6% (15.2-20.3%) with normal, and 37.3% (33.3-41.5%) with high normal BP aged below age 65 years progressed to hypertension over 4 years. Corresponding 4-year rates of progression for patients 65 years and older were 16.0% (12.0-20.9), 25.5% (20.4-31.4), and 49.5% (42.6-56.4), respectively. Obesity and weight gain also contributed to progression; a 5% weight gain on follow-up was associated with 20-30% increased odds of hypertension. High normal BP and normal BP frequently progress to hypertension over a period of 4 years, especially in older adults. These findings support recommendations for monitoring individuals with high normal BP once a year, and monitoring those with normal BP every 2 years, and they emphasise the importance of weight control as a measure for primary prevention of hypertension.
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              Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables.

              To assess health related quality of life of patients with congestive heart failure; to compare their quality of life with the previously characterised general population and in those with other chronic diseases; and to correlate the different aspects of quality of life with relevant somatic variables. University hospital. A German version of the generic quality of life measure (SF-36) containing eight dimensions was administered to 205 patients with congestive heart failure and systolic dysfunction. Cardiopulmonary evaluation included assessment of New York Heart Association (NYHA) functional class, left ventricular ejection fraction, peak oxygen uptake, and the distance covered during a standardised six minute walk test. Quality of life significantly decreased with NYHA functional class (linear trend: p < 0.0001). In NYHA class III, the scores of five of the eight quality of life domains were reduced to around one third of those in the general population. The pattern of reduction was different in patients with chronic hepatitis C and major depression, and similar in patients on chronic haemodialysis. Multiple regression analysis showed that only the NYHA functional class was consistently and closely associated with all quality of life scales. The six minute walk test and peak oxygen uptake added to the explanation of the variance in only one of the eight quality of life domains (physical functioning). Left ventricular ejection fraction, duration of disease, and age showed no clear association with quality of life. In congestive heart failure, quality of life decreases as NYHA functional class worsens. Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown.
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                Author and article information

                Journal
                Int J Prev Med
                Int J Prev Med
                IJPVM
                International Journal of Preventive Medicine
                Wolters Kluwer - Medknow (India )
                2008-7802
                2008-8213
                2020
                30 April 2020
                : 11
                : 56
                Affiliations
                [1] Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
                [1 ] Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
                [2 ] Department of Nephrology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
                [3 ] Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord, Iran
                Author notes
                Address for correspondence: Dr: Bahareh Ghiasi, Department of Nephrology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran. E-mail: bahar55gh@ 123456yahoo.com
                Dr. Ali Hasanpour Dehkordi, Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord, Iran. E-mail: Alihassanpourdehkordi@ 123456gmail.com
                Article
                IJPVM-11-56
                10.4103/ijpvm.IJPVM_351_18
                7297428
                32577186
                22d7a4f6-bcf8-4fa4-864f-b15bc2651e2c
                Copyright: © 2020 International Journal of Preventive Medicine

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 01 August 2018
                : 12 February 2019
                Categories
                Review Article

                Health & Social care
                cardiovascular disease,hypertension,iran,meta-analysis
                Health & Social care
                cardiovascular disease, hypertension, iran, meta-analysis

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