BackgroundA number of published literature has reported that, physiologically, heart rate variability (HRV) in patients with postural orthostatic tachycardia syndrome (POTS) to be greatly confounded by age, sex, race, physical fitness, and circadian rhythm. The purpose of this study was to compare between POTS patients versus healthy participants, in terms of heart rate (HR) and HRV after Head-Up tilt test (HUTT), by systematic review and meta-analysis of available published literature.MethodsMEDLINE (using PubMed interphase), EMBASE and SCOPUS were systematically searched for observational studies comparing POTS patients versus healthy patients, in terms of HR and HRV. HRV was grouped into Time and frequency domain outcome measurements. The time domain was measured as mean RR- interval and mean the square root of the mean of squares of successive R-R waves (rMSSD) in milliseconds. The frequency domain was measured as mean values of Low frequency power (LF), High frequency power (HF), LF/HF-ratio, LF-normalized units (LF(n.u)) and HF-normalized units (HF(n.u)). Demographic data, comorbidities, and mean values of HR, RR- interval, rMSSD, LF, HF, LF/HF-ratio, LF-(n.u) and H.F-n.u were extracted from each group and compared, by their mean differences as an overall outcome measure. Computer software, RevMan 5.3 was utilized, at a 95% significance level.ResultsTwenty (20) eligible studies were found to report 717 POTS and 641 healthy participants. POTS group had a higher mean HR (p < 0.05), lower mean RR-Interval (p < 0.05), lower rMSSD (p < 0.05) than healthy participants. Furthermore, POTS group had lower mean HF(p > 0.05), lower mean LF(p > 0.05), and lower mean HF(n.u) (p > 0.05), higher LF/HF-Ratio (p > 0.05) and higher LF(n.u) (p > 0.05) as compared to healthy participants.ConclusionPOTS patients have a higher HR than healthy patients after HUTT and lower HRV in terms of time domain measure but not in terms of frequency domain measure. HR and time domain analyses of HRV are more reliable than frequency domain analysis in differentiating POTS patients from the healthy participants. We call upon sensitivity and specificity studies.
BackgroundHypertension is the most important modifiable cardiovascular risk factor. Epidemiological studies have shown the benefits of lowering blood pressure (BP), but BP control is a major challenge. Furthermore, there are significant sex differences in antihypertensive drug use and BP control. This study examined sex differences in antihypertensive drug use and BP control, with the aim of reducing the complications of hypertension and improving quality of life.MethodsThe study was performed in our outpatient hypertension clinic, and included 1529 patients without secondary hypertension or comorbidities. The study, investigated BP control rates and patterns of antihypertensive drug use in male and female. All data were collected using structured questionnaires and patient measurements.ResultsThe study included 713 males and 816 females in this study. Fewer females had hypertension in the younger age group (16.2% vs 11.6%; p>0.05), but this difference disappeared in middle-aged (47.8% vs 49.9 %; p<0.05) and elderly age groups (36.0% vs 38.5%; p<0.05). BP control rates differed between males and females (35.6% in male, 31.9% in female, p<0.01). There was an overall difference in BP control rates between males and females (35.6% in males, 31.9% in females, p<0.01). In this aged 18–44 years, angiotensin converting enzyme inhibitors (ACEIs) showed the best control rate in males, while calcium channel blockers (CCBs) were least effective (61.5% with ACEIs, 28.6% with CCBs; p<0.05). In this aged 45–64 years, diuretics (DUs) showed the best control rate in females, while CCBs were least effective (47.5% with DUs, 28.3% with CCBs; p<0.05).ConclusionsSex plays an important role in BP control. In those aged 18–44 years, males using ACEIs showed best control rates. In those aged 45–64 years, females using DUs showed best control rates. Our study provides a basis with the selection of antihypertensive drugs according to sex and age.
Background: A number of published literature has reported that, physiologically, heart rate variability (HRV) in patients with postural orthostatic tachycardia syndrome (POTS) to be greatly confounded by age, sex, race, physical fitness, and circadian rhythm. The purpose of this study was to compare between POTS patients versus healthy participants, in terms of heart rate (HR) and HRV after Head-Up tilt test (HUTT), by systematic review and meta-analysis of available published literature. Methods: MEDLINE (using PubMed interphase), EMBASE and SCOPUS were systematically searched for observational studies comparing POTS patients versus healthy patients, in terms of HR and HRV. HRV was grouped into Time and frequency domain outcome measurements. The time domain was measured as mean RR- interval and mean the square root of the mean of squares of successive R-R waves (rMSSD) in milliseconds. The frequency domain was measured as mean values of Low frequency power (LF), High frequency power (HF), LF/HF-ratio, LF-normalized units (LF(n.u)) and HF-normalized units (HF(n.u)). Demographic data, comorbidities, and mean values of HR, RR- interval, rMSSD, LF, HF, LF/HF-ratio, LF-(n.u) and H.F-n.u were extracted from each group and compared, by their mean differences as an overall outcome measure. Computer software, RevMan 5.3 was utilized, at a 95% significance level. Results: Twenty (20) eligible studies were found to report 717 POTS and 641 healthy participants. POTS group had a higher mean HR (p<0.05), lower mean RR-Interval (p<0.05), lower rMSSD (p<0.05) than healthy participants. Furthermore, POTS group had lower mean HF(p>0.05), lower mean LF(p>0.05), and lower mean HF(n.u) (p>0.05), higher LF/HF-Ratio (p>0.05) and higher LF(n.u) (p>0.05) as compared to healthy participants. Conclusion: POTS patients have a higher HR than healthy patients after HUTT and lower HRV in terms of time domain measure but not in terms of frequency domain measure. HR and time domain analyses of HRV are more reliable than frequency domain analysis in differentiating POTS patients from the healthy participants. We call upon sensitivity and specificity studies.
Background: Regarding lupus disease activity, morbidity and survival, limited literature concluded conflicting results when comparing hemodialysis versus peritoneal dialysis as initial renal replacement therapies (RRT) prior to transplantation, in lupus nephritis end-stage renal disease (LN-ESRD) patients. This study was aimed to compare the risks of lupus flares, all-cause infections, all-cause cardiovascular events, and mortality, between hemodialysis versus peritoneal dialysis as initial RRT-modality before renal-transplant in LN-ESRD patients, by systematic review and meta-analysis. Methods: PubMed, EMBASE, and SCOPUS were searched for observational-studies comparing LN-ESRD-patients undergoing hemodialysis (Group1) versus peritoneal-dialysis (Group 2) prior to renal-transplantation, by their risks of lupus flare, all-cause infections, all-cause cardiovascular events, and mortality as outcome measures. Relative-Risks of outcomes between the groups measured overall effects at a 95% significance level. RevMan 5.3 computer software was used for analysis. Results: From search, 16 eligible studies reported 15,636 LN-ESRD-patients prior to renal transplantation with 4616 patients on hemodialysis, 2089 on peritoneal dialysis, 280 directly underwent kidney transplantation, 8319 were eliminated with reasons and 332 participants' details were not reported. Hemodialysis group had higher risk of allcause cardiovascular events, Relative-Risk = 1.44 (Confidence Interval:1.02, 2.04), p-Value< 0.05. With regards to risks for mortality, flare and all-cause infections, there were trends that were not statistically significant (p-Value> 0.05). Conclusion: Except for all-cause cardiovascular events in which peritoneal dialysis is superior to hemodialysis offering better outcomes, both treatment modalities offer more or less similar clinical outcomes as effective initial choices of RRT in LN-ESRD patients prior to renal transplant.
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