高血圧ジャーナル: オープンアクセス

Pregnancy-induced hypertension (PIH) development associates well with considerable abnormalities in the structure and function of vascular endothelium. Lowered number and weak function of circulating endothelial progenitor cells (EPCs) as a marker of worsening endothelial integrity were recognized a promising indicator of PIHrelated clinical outcomes. Although there are limiting data regarding predictive usefulness of serial EPC count measurement in pregnant women, it has been postulated that EPC dysfunction could be got better prognostication than other biomarkers including serum inflammatory cytokines, von Willebrand factor, E-selectin in prediction of some severe PIH-related states, i.e., fetoplacental insufficiency and premature parturitions. The sort communication is depicted the role of EPC dysfunction as a promising biomarkers in PIH.

Introduction: Hypertension is a prevalent and often asymptomatic chronic disease. Health related quality of life is emerging as an important outcome in hypertension. It can be adversely affected by hypertension itself and sideeffects of antihypertensive drugs. It is a multi-dimensional element of well-being affected by the physical, mental, emotional and social status of patients. The ability to identify indicators of poor health-related quality of life is crucial for both improving clinical care and determining targets of intervention for the prevention and treatment of disease.

Objective: The aim of this study was to assess health related quality of life and identify associated factors.

Methods: A cross sectional study was conducted to assess health related quality of life of hypertensive patient. A total of 243 hypertensive patients were included in the study. The study assessed the health related quality of life using a generic tool short form-36. Socio-demographic and clinical variables were used as explanatory variables. In the multivariate analysis the level of significance was set at p<0.05.

Result: The current study revealed that a very similar physical component (64.83) and mental component (64.88) summary mean score. This study has also shown that health related quality of life was significantly influenced by marital status, level of education of the study participants, duration of hypertension, blood pressure status and presence of health complaints.

Conclusion: Health related quality of life in hypertensive patients is still suboptimal. Because of the fact that, patient education and enhanced information can lead to better health related quality of life in hypertension patient, health care professionals should pay due emphasis in educating the patient about the importance of controlling their blood pressure.

Hypertensive heart disease presenting as left ventricular hypertrophy (LVH) is a common and potentially modifiable cardiovascular risk factor often overlooked in most sub-Saharan African countries including Ghana. This cardiac marker occurring in hypertension is very important because it affects the overall cardiovascular disease risk assessment and management. We sought to assess the prevalence and determinants of electrocardiographic left ventricular hypertrophy in patients with hypertension seen at the outpatient clinic of a Teaching Hospital in Ghana. A cross-sectional and prospective study was conducted on three hundred and fifty hypertensive patient at Komfo Anokye Teaching Hospital in Kumasi, Ghana. Following informed consent, a questionnaire was used to gather demographic, anthropometric and clinical details of patients. A standard resting 12-lead resting ECG was performed on all the study participants and Scott's criteria was used to determine LVH. Fischer's exact test for statistical significance at 95% confidence interval was used to evaluate associations between categorical variables. Various independent associations with LVH were also assessed using logistic regression analysis. P value of 0.05 was considered as statistically significant. The mean (± standard deviation) age of the patients was 59.65 ± 13.52 years. The mean systolic and diastolic blood pressures were 141.76 ± 20.26 mmHg, 84.28 ± 10.49 mmHg respectively; and the body mass index was 27.5 ± 6.09 kg/m2. The prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) among the hypertensive patients was 46.6%. When multiple logistic regression analysis was done, male gender (adjusted OR: 2.40, 95% CI 1.53-3.78, P=0.000), cigarette smoking (adjusted OR: 0.34, 95% CI 0.12-0.95, P=0.040) elevated SBP (adjusted OR: 1.79, 95% CI 1.09-2.93, P=0.200) and uncontrolled BP (adjusted OR: 1.86, 95% CI 1.15- 3.01, P=0.011) emerged as independent determinants of left ventricular hypertrophy. In conclusion, LVH is a common pre-clinical cardiac complication in Ghanaian individuals with hypertension. Male gender, cigarette smoking, elevated systolic blood pressure and uncontrolled BP appear to be the main determinants of this important pre-clinical cardiac damage.

Background: In settings where new drugs for pulmonary arterial hypertension (PAH) are not possible due to lack of availability and cost; PDE-5 inhibitors such as sildenafil is the drug of choice in the management of PAH. In this study we performed a meta-analysis to evaluate the effects of oral sildenafil in PAH, pointing on peak VO₂ improvement.

Methods: We retrieved randomized controlled trials (RCTs) of the effects of PDE-5 inhibitors, sildenafil in patients with PAH using PubMed, Medline, Embase, Cochrane Library, Google scholar and manual search from 2011 to 2016. Random controlled trials that compared oral sildenafil with placebo were selected. Data for populations, interventions, and outcomes were extracted independently by 2 investigators, and disagreements were resolved by consensus. Quality assessment was performed using the Cochrane risk-of-bias tool.

Results: Four randomized controlled clinical trials including a total of three hundred thirty six patients were identified in the primary analysis, with 51.5% patients in the PDE-5 inhibitors treatment group and 48.5% patients in the placebo group.

Two studies show reduction in statistical significance of mPAP (MD -4.15, 95% CI -17.28 to 8.98; P<0.00001) and PVR (MD -51.27, 95% CI -127.63 to 25.10; P<0.00001. Other three studies shown statistical significance in reduction of mPCWP (MD -2.70, 95% CI -7.14 to 1.75; P<0.0003). Other two studies which accessed the quality of life show no much differences among the two groups (MD 1.18, 95% CI -4.92 to 7.27; P<0.00001). However, all four trials, shown no statistical significant improvement in peak VO2, of patients allocated to PDE-5 inhibitors group, sildenafil compared to the placebo group with heterogeneity (MD 0.61, 95% CI -0.37 to 1.59, P=0.21, I2=34%).

Conclusion: The results of present review suggest that treatment with PDE-5 inhibitors; sildenafil reduced mPAP, PVR and mPCWP but could not significantly improve the peak VO₂.