Factors associated with visit-to-visit variability of blood pressure in hypertensive patients at a Primary Health Care Service, Tabanan, Bali, Indonesia

Pertiwi, Gusti Ayu Riska; Aryawangsa, Anak Agung Ngurah; Prabawa, I Putu Yuda; Manuaba, Ida Bagus Putra; Bhargah, Agha; Ratni, Ni Wayan Sri; Budiana, I Putu Gede

doi:10.15212/fmch.2018.0124

Cited by 10 publications

(20 citation statements)

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“…The rise of aging population and the build-up of behavioral risk factors including unhealthy diet, physical inactivity, excess body weight, and noncardiovascular comorbidities all had inevitably contributed to atherosclerotic cardiovascular disease, including coronary artery disease and stroke. 1 Despite advancement of knowledge in risk factors and prevention through pharmacological intervention such as low density lipoprotein (LDL)-lowering therapy, there is still a challenge regarding the so called "residual risk". Genome wide association study revealed that the "residual risk" was associated with several biomarkers, one in particular involved in atherosclerotic disease was lipoprotein(a) (Lp(a)).…”

Section: Introductionmentioning

confidence: 99%

<p>High Lipoprotein(a) Levels as a Predictor of Major Adverse Cardiovascular Events in Hospitalized-Acute Myocardial Infarction Patients</p>

Sumarjaya¹,

Nadha²,

Lestari³

2020

VHRM

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Video abstractPoint your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:https://youtu.be/LUESRF3ZdccBackground: Risk stratification models with incorporation of biochemical markers have received attention recently. In acute myocardial infarction (AMI) one such marker is lipoprotein(a) (Lp(a)). Lp(a) has prothrombotic and proinflammatory properties. High levels of Lp(a) probably contribute to the additional adverse effects in AMI, as it enhances the damaging effect of acute thrombosis. This study aimed to evaluate serum Lp(a) as a predictor of major adverse cardiovascular events (MACE) in hospitalized-acute myocardial infarction patients. Methods: A prospective cohort study was conducted at Sanglah Hospital, Denpasar, during June-August 2018, among 66 people by consecutive sampling. Samples that met the inclusion and exclusion criteria were examined for serum Lp(a) at the time of admission and the occurrence of MACE during hospitalization was observed. Data regarding serum Lp(a), demography, smoking history, dyslipidemia, hypertension, diabetes mellitus, and MACE were collected. Log rank test and Cox proportional hazards regression were conducted with SPSS version 20 for Windows. Results: During observation, MACE occurred in 25 (38%) patients, including cardiogenic shock in 7 (10.6%) patients, heart failure in 20 (30.3%) patients, cardiovascular death in 5 (7, 6%) patients, malignant arrhythmias in 5 (7.6%) patients, and postinfarction angina in 5 (7.6%) patients. After the Log rank test, a significant difference in survival was observed (p = 0.001) between groups of high Lp(a) (survival rate of 60.6 hours; 95% CI 43.3-77.9) and low Lp(a) (average survival of 104.3 hours, 95% CI 91.4-117.2). The hazard ratio of high Lp(a) against MACE was 4.63 (p=0.002), and it increased to 4.69 in multivariate analysis with Cox proportional hazards regression test (p=0.003). Conclusion: The high level of Lp(a) in AMI patients was a risk factor for the occurrence of MACE during hospitalization. Patients with high Lp(a) also had worse survival compared to patients with low Lp(a).

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Section: Introductionmentioning

confidence: 99%

<p>High Lipoprotein(a) Levels as a Predictor of Major Adverse Cardiovascular Events in Hospitalized-Acute Myocardial Infarction Patients</p>

Sumarjaya¹,

Nadha²,

Lestari³

2020

VHRM

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“…No other sociodemographic variables showed significant variation. A previous study also found sodium intake was significantly higher in the high VVV group than in the low VVV group [16], but we have not assessed the sodium intake in our population, and it is a potential limitation of our study.…”

Section: Resultsmentioning

confidence: 89%

“…In this study, we used the standard deviation (SD) of BP of six visits as the main metric for VVV of SBP regardless of their being many other metrics available (coefficient of correlation, SD independent of the mean (SDIM)) as previous study found them to be equally significant. The SD of SBP was then classified into two groups by means of a cutoff point at median: values below the median were defined as low variability of SBP, and values equal to or greater than median are defined as high variability of SBP [16]. We also reported average real variability of SBP and diastolic blood pressure (DBP) which is calculated as the average of the absolute difference in blood pressure between visits [17].…”

Section: Methodsmentioning

confidence: 99%

Factors Associated with Visit-to-Visit Variability of Blood Pressure Measured as Part of Routine Clinical Care among Patients Attending Cardiology Outpatient Department of a Tertiary Care Centre in Northern Sri Lanka

Kumanan

Sujanitha

Guruparan

et al. 2019

International Journal of Hypertension

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Visit-to-visit variability (VVV) is a relatively new concept in the hypertensive arena. Data regarding VVV are lacking in our region, and factors associated with VVV are rarely examined in previous studies. This study was conducted among 406 patients attended to the cardiology outpatient department of Teaching Hospital, Jaffna, Sri Lanka, in 2018 to assess the long-term variability of blood pressure (BP) by reviewing last six consecutive BP readings from the records retrospectively. Data regarding sociodemographic variables and behavioural factors such as medication adherence, physical activity, smoking, alcohol consumption, and relevant comorbidities were taken through an interviewer-administered questionnaire. Data were analysed by using SPSS version 25 and VVV of systolic blood pressure (SBP) matrix expressed as mean of SD and association were examined with various factors and VVV of SBP. SBP showed high VVV among the participants as expressed by mean of SD which was 13.06 ± 5.64. When comparing mean SD among the categories of different variables, female sex (P=0.023) and comorbidities such as diabetes mellitus (DM) (P=0.013), chronic kidney disease (CKD) (P=0.007), and risk of developing obstructive sleep apnoea (OSA) (P=0.04) showed significant variation. Medication adherence to prescribed hypertensive medication was a major issue even though significant association was not found with high VVV (P=0.536). The SD of SBP was then classified into high and low VVV groups by means of a cutoff point at the 50th percentile. Bivariate analysis by using Chi-squared test revealed comorbidities such as DM, CKD, and physical activity (P=0.044) were significantly associated with high VVV. Further multivariate regression analysis revealed that comorbidities such as DM and CKD have 1.561 times and 5.999 times more risk to show high variability, respectively. In conclusion, we recommend simple practical measures to achieve sustainable BP control among hypertensive patients with DM and CKD to minimize the VVV and improve their cardiovascular outcome.

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“…[25][26][27] Penelitian lain menyebutkan bahwa cystatin C serum merupakan petanda awal kerusakan ginjal pada pasien DM. [27][28][29] Sebagai parameter kontrol glikemik, peningkatan HbA1c menggambarkan kondisi hiperglikemik kronik. Hubungan antara peningkatan HbA1c dengan kerusakan ginjal menandakan kondisi hiperglikemik yang terus berlangsung.…”

Section: Abstrakunclassified

Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien diabetes melitus tipe 2

Widyatmojo

Samsuria

Triwardhani³

2020

Intisari Sains Medis

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Background: Glycemic control in type 2 diabetes mellitus (DM) which can be assessed by examination of fasting blood sugar (FBG) and glycosylated hemoglobin (HbA1c) is thought to be associated with renal complications. Several markers can be used to assess the rate of damage to early kidney function, such as serum creatinine, urine creatinine albumin ratio (uACR), and serum cystatin C. The relationship of glycemic control with early kidney disorder markers in type 2 DM patients still shows controversial results.. The aim of the study to investigate the relationship between glycemic control (FBG and HbA1c) with early kidney disorder markers (serum creatinine, uACR, and cystatin C) in patients with type 2 diabetes mellitus.Methods: Analytic observational study with cross sectional approach conducted in April - June 2019 involved 34 type 2 DM patients in Karang Ayu Health Center who met the inclusion and exclusion criteria. Examination of GDP levels using the hexokinase method, HbA1c levels using the HPLC method, serum creatinine using the Jaffe method, uACR is calculated based on the ratio between urine albumin and creatinine, and cystatin C levels using the ELISA method. Statistical tests using Spearman's non-parametric correlation with p <0.05 were considered significant.Results: The mean Â± SD FBG and HbA1c levels were 130.41 Â± 39.37 mg/ \dL and 8.21 Â± 1.65%. Median (minimum-maximum) serum creatinine levels, uACR and serum cystatin C were 0.63 (0.35-2.79) mg/dL, 16.55 (4.1-29.8) mg/g and 0.72 (0.46 - 1.22) mg/L. The correlation of FBG levels with serum creatinine, uACR, and serum cystatin C were (r = 0.016; p = 0.927), (r = 0.293; p = 0.092), and (r = 0.334; p = 0.053). The relationship of HbA1c with serum creatinine, uACR, and cystatin C was (r = 0.120; p = 0.495), (r = 0.326; p = 0.059); and (r = 0.505; p = 0.002).Conclusions: There is no relationship between FBG with serum creatinine, uACR, and cystatin C. The HbA1c value is positively related to cystatin C but not related to serum creatinine and uACR in patients with type 2 diabetes mellitus.Â Latar belakang: Kontrol glikemik pada diabetes melitus tipe 2 (DM) yang dapat dinilai dengan pemeriksaan gula darah puasa (GDP) dan hemoglobin terglikosilasi (HbA1c) diduga berhubungan dengan komplikasi nefropati. Beberapa petanda dapat digunakan untuk menilai menilai kerusakan fungsi ginjal dini, misalnya kreatinin serum, rasio albumin kreatinin urin (uACR), dan cystatin C serum. Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien DM tipe 2 masih menunjukkan hasil yang kontroversial. Mengetahui hubungan antara kontrol glikemik (GDP dan HbA1c) dengan petanda gangguan ginjal dini (Kreatinin serum, uACR, dan cystatin C) pada pasien diabetes melitus tipe 2.Metode: Penelitian observasional analitik dengan pendekatan belah lintang dilakukan pada bulan April - Juni 2019 melibatkan 34 pasien DM tipe 2 di Puskesmas Karang Ayu yang memenuhi kriteria inklusi dan ekslusi. Pemeriksaan kadar GDP menggunakan metode heksokinase, kadar HbA1c menggunakan metode HPLC, kreatinin serum menggunakan metode Jaffe, uACR dihitung berdasarkan rasio antara albumin dan kreatinin urin, dan kadar Cystatin C menggunakan metode ELISA. Uji statistik menggunakan korelasi non parametrik Spearman dengan p < 0,05 dianggap signifikan.Â Hasil: RerataÂ±SD kadar GDP dan HbA1c adalah 130,41Â±39,37 mg/dL dan 8,21Â±1,65%. Median (minimum-maksimum) kadar kreatinin serum, uACR dan cystatin C serum berturut-turut adalah 0,63(0,35-2,79) mg/dL, 16,55(4,1-29,8) mg/g, dan 0,72(0,46 â€“ 1,22) mg/L. Korelasi kadar GDP dengan kreatinin serum, uACR, dan cystatin C serum adalah (r=0,016; p=0,927), (r=0,293; p=0,092), dan (r=0,334; p=0,053). Hubungan HbA1c dengan kreatinin serum, uACR, dan cystatin C adalah (r=0,120; p=0,495), (r=0,326; p= 0,059); dan (r = 0,505; p = 0,002).Simpulan: Tidak terdapat hubungan antara GDP dengan kreatinin serum, uACR, dan cystatin C. Nilai HbA1c berhubungan positif sedang dengan cystatin C namun tidak berhubungan dengan kreatinin serum dan uACR pada pasien diabetes melitus tipe 2.

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Factors associated with visit-to-visit variability of blood pressure in hypertensive patients at a Primary Health Care Service, Tabanan, Bali, Indonesia

Cited by 10 publications

References 0 publications

<p>High Lipoprotein(a) Levels as a Predictor of Major Adverse Cardiovascular Events in Hospitalized-Acute Myocardial Infarction Patients</p>

<p>High Lipoprotein(a) Levels as a Predictor of Major Adverse Cardiovascular Events in Hospitalized-Acute Myocardial Infarction Patients</p>

Factors Associated with Visit-to-Visit Variability of Blood Pressure Measured as Part of Routine Clinical Care among Patients Attending Cardiology Outpatient Department of a Tertiary Care Centre in Northern Sri Lanka

Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien diabetes melitus tipe 2

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