Background: The association between visit-to-visit systolic blood pressure variability (SBPV) and cardiovascular outcomes after being adjusted with mean systolic blood pressure (SBP) is questionable.Objective: To systematically review studies quantifying the associations of visit-to-visit SBPV adjusted to mean SBP with cardiovascular outcomes.Method: A systematic search in PubMed, Scopus, and Science Direct was conducted on 27 November 2022. We included studies evaluating the association of various SBPV parameters with cardiovascular outcomes. Only clinical trials and cohort studies were included. We included all patients with available data on visit-to-visit SBPV and cardiovascular outcomes. Hemodialysis patients were excluded due to inter-hemodialysis BPV. Different parameters of SBPV (standard deviation, coefficient of variation, variation in mean) were extracted and analyzed as standardized hazard ratios, a log-hazard ratio for each unit of SBPV divided by its standard deviation. Generic inverse variance using random effect meta-analysis was performed to estimate pooled standardized hazard ratio. The QUIPS tool for prognostic study was used for risk of bias assessment.Result: A total of 9,944,254 subjects from 43 studies (21 trials and 22 cohorts) were included in meta-analysis. Increased visit-to-visit SBPV was associated with a risk of all-cause mortality (HR 1.21, CI95%[1.16–1.25]), cardiovascular mortality (HR 1.1, CI95%[1.07–1.14]) cardiovascular events (HR 1.1, CI95%[1.07–1.13]), myocardial infarction (HR1.13, CI95%[1.07–1.19]) and stroke (HR 1.22, CI95%[1.16–1.29]). After sensitivity analysis for studies adjusted to mean SBP, SBPV is still significantly associated with all mentioned cardiovascular outcomes.Conclusion: Systolic blood pressure variability, independent of mean SBP, is associated with all-cause mortality, cardiovascular death, cardiovascular events, myocardial infarction, and stroke.PROSPERO registration number CRD42023389113
Background: The probability of in-hospital death was significantly higher in patients with hypertension, hence increasing the risk for severe clinical presentations of COVID-19.Objective: We aimed to determine whether cardiac examination is correlated with increasing mortality risk among hypertensive COVID-19.Methods: This retrospective cohort study included 406 patients with hypertension and confirmed COVID-19 in referral hospitals in East Java between March 2020 to April 2021. Clinical finding, electrocardiograph (ECG), laboratory and chest x-ray (CXR) findings are examined to predict mortality of the hypertensive COVID-19 patients.Results: The median patient age was 57 years with range 49–64 years old, predominantly men 58.4%. The final model associated with an increase of mortality in hypertensive COVID-19 patients include cardiomegaly (p = 0.036), sinus tachycardia (p = 0.001), ST-segment abnormalities (p = 0.036), right bundle branch block (p = 0.008), left bundle branch block (p = 0.046), left ventricle hypertrophy (p = 0,023)., which were found to be significant predictors of mortality in hypertensive COVID-19 patients after the multivariable regression analysis.Conclusion: We concluded that specific abnormal cardiac examination (cardiomegaly, tachycardia, ST Segment abnormalities, left ventricle hypertrophy, right and left bundle branch block) increase the mortality risk in hypertensive COVID-19 patients. Therefore, complete cardiac examination is important for hypertensive COVID-19 patients to determine prognosis.
Background: Resistant hypertension is a condition when blood pressure remains high despite the routine consumption of three antihypertensive agents, including diuretics. Due to the unwanted side effects of antihypertensive agents, non-pharmacology therapy such as renal denervation can be chosen as alternative management, even though this modality still remain controversial. This umbrella review appraises published meta-analyses of observational, controlled trial, and randomized controlled trial (RCT) for the efficacy of renal denervation in hypertension.Objective: The aim of this umbrella review is to provide an overview of the efficacy of controversial renal denervation as an alternative management in the case of resistant hypertension.Method: Eight databases were searched was the beginning of 2012 to the 15th of January 2023. Thirteen meta-analyses were included. Non-English languages, wrong study type, wrong population, and wrong study outcomes were excluded.Result: Eight of thirteen meta-analyses showed significant benefits of renal denervation in reducing blood pressure. Furthermore, one of which showed that the efficacy of renal denervation is better than pharmacological therapy in lowering the blood pressure in resistant hypertension. No significant benefit of renal denervation was found in any other meta-analyses, nonetheless, it was safe to use.Conclusion: Despite various results from multiple meta-analyses, this umbrella review reveals that renal denervation is beneficial in lowering the blood pressure in resistant hypertension. Further research using long-term follow-up and big-scale subjects is needed to confirm this result.
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