Trial of Exercise to Prevent HypeRtension in young Adults (TEPHRA) a randomized controlled trial: study protocol

Williamson, Wilby; Huckstep, O J; Frangou, Eleni; Mohamed, Afifah; Tan, Cheryl; Alsharqi, Maryam; Bertagnolli, Mariane; Lapidaire, Winok; Newton, Julia L.; Hanssen, Henner; McManus, Richard J; Dawes, Helen; Foster, Charlie; Lewandowski, Adam J.; Leeson, Paul

doi:10.1186/s12872-018-0944-8

Cited by 13 publications

(12 citation statements)

References 47 publications

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“…Anthropometry, Blood Samples, and Blood Pressure Measurements All participants fasted for a minimum of 6 hours before their study visit. As previously described, 7,10,11,13 trained clinical research investigators completed all height and weight measurements as well as blood sample collection. Participants were seated for 5 minutes before 3 resting brachial blood pressure readings (Dinamap V100; GE Healthcare) were taken on the left arm with a 1-minute interval in between.…”

Section: Study Visitmentioning

confidence: 99%

Association of Systolic Blood Pressure Elevation With Disproportionate Left Ventricular Remodeling in Very Preterm-Born Young Adults

et al. 2021

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IMPORTANCE Preterm-born individuals have higher blood pressure with an increased risk of hypertension by young adulthood, as well as potentially adverse cardiac remodeling even when normotensive. To what extent blood pressure elevation affects left ventricular (LV) structure and function in adults born preterm is currently unknown. OBJECTIVE To investigate whether changes observed in LV structure and function in preterm-born adults make them more susceptible to cardiac remodeling in association with blood pressure elevation. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional cohort study, conducted at the Oxford Cardiovascular Clinical Research Facility and Oxford Centre for Clinical Magnetic Resonance Research, included 468 adults aged 18 to 40 years. Of these, 200 were born preterm (<37 weeks' gestation) and 268 were born at term (Ն37 weeks' gestation). Cardiac magnetic resonance imaging was used to characterize LV structure and function, with clinical blood pressure readings measured to assess hypertension status. Demographic and anthropometric data, as well as birth history and family medical history information, were collected. Data were analyzed between January 2012 and February 2021. MAIN OUTCOMES AND MEASURESCardiac magnetic resonance measures of LV structure and function in response to systolic blood pressure elevation. RESULTSThe cohort was primarily White (>95%) with a balanced sex distribution (51.5% women and 48.5% men). Preterm-born adults with and without hypertension had higher LV mass index, reduced LV function, and smaller LV volumes compared with term-born individuals both with and without hypertension. In regression analyses of systolic blood pressure with LV mass index and LV mass to end-diastolic volume ratio, there was a leftward shift in the slopes in preterm-born compared with term-born adults. Compared with term-born adults, there was a 2.5-fold greater LV mass index per 1-mm Hg elevation in systolic blood pressure in very and extremely preterm-born adults (<32 weeks' gestation) (0.394 g/m 2 vs 0.157 g/m 2 per 1 mm Hg; P < .001) and a 1.6-fold greater LV mass index per 1-mm Hg elevation in systolic blood pressure in moderately preterm-born adults (32 to 36 weeks' gestation) (0.250 g/m 2 vs 0.157 g/m 2 per 1 mm Hg; P < .001). The LV mass to end-diastolic volume ratio per 1-mm Hg elevation in systolic blood pressure in the very and extremely preterm-born adults was 3.4-fold greater compared with those born moderately preterm (3.56 × 10 −3 vs 1.04 × 10 −3 g/mL per 1 mm Hg; P < .001) and 3.3-fold greater compared with those born at term (3.56 × 10 −3 vs 1.08 × 10 −3 g/mL per 1 mm Hg; P < .001).CONCLUSIONS AND RELEVANCE Preterm-born adults have a unique LV structure and function that worsens with systolic blood pressure elevation. Additional primary prevention strategies specifically targeting cardiovascular risk reduction in this population may be warranted.

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Section: Study Visitmentioning

confidence: 99%

Association of Systolic Blood Pressure Elevation With Disproportionate Left Ventricular Remodeling in Very Preterm-Born Young Adults

et al. 2021

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“…Given the known alterations in the renin-angiotensin system [56] and unique cardiac phenotype associated with preterm birth, it remains to be determined whether aerobic exercise training would have the same benefits in a population of preterm-born young adults and how this intervention might be used to reduce risk of hypertension and heart failure in these individuals. To explore this, the Trial of Exercise to Prevent HypeRtension in young Adults (TEPHRA) has been designed [57]. This randomized control trial aims to determine the effect of 16 weeks' guided aerobic exercise training on the cardiovascular system of n = 200 young adults between the ages of 18 and 35 years, including a subgroup of individuals born preterm.…”

Section: How Can We Intervene To Prevent Cardiovascular Risk?mentioning

confidence: 99%

Preterm Birth Is a Novel, Independent Risk Factor for Altered Cardiac Remodeling and Early Heart Failure: Is it Time for a New Cardiomyopathy?

Burchert

Lewandowski

2019

Curr Treat Options Cardio Med

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Purpose of review Around 10% of the global population is born preterm (G 37 weeks' gestation). Preterm birth is associated with an increased risk of cardiovascular events, with preterm-born individuals demonstrating a distinct cardiac phenotype. This review aims to summarize the main phenotypic features of the preterm heart and directions for future research to develop novel intervention strategies. Recent findings Being born between 28 and 31 weeks' gestation results in a 4-fold higher risk of heart failure in childhood and adolescence and 17-fold increased risk when born less than 28 weeks' gestation. In support of this being due to a reduction in myocardial functional reserve, preterm-born young adults have an impaired left ventricular cardiac systolic response to moderate and high intensity physiological stress, despite having a preserved resting left ventricular ejection fraction. Similar impairments under physiological stress were also recently reported regarding the right ventricle in young adults born preterm. Summary Preterm birth relates to a unique cardiac phenotype with an impaired response to stress conditions. These data, combined with the work in animal models, suggest that being born preterm may lead to a novel form of cardiomyopathy. Understanding the driving * The Author(s) 2019 mechanisms leading to this unique cardiac phenotype is important to reduce risk of future heart failure and cardiovascular events.

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“…Hypertensive patient's ongoing treatment, mode, pattern and timing of exercise can be personalized as compared to less efficient exercises to reduce the risk of CVD events [25]. To consider long-term changes in preventing hypertension related complications, lifestyle modification must be recommended particularly among young adults [26].…”

Section: Lifestyle Changesmentioning

confidence: 99%

The Role of Healthcare Personnel in Delivering Healthcare Interventions for High Blood Pressure: A Desk Review of Available Evidence

Khan¹

2021

AJBSR

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Objective: The objective of this study is to determine various healthcare personnel in delivering interventions as recommended by Disease Control Priorities (DCP3) strategies to manage and control high blood pressure among hypertensive patients. Methods:The guidance for conducting this desk review was adapted from a toolkit published by WHO and UNHCR (2012) and Save the Children. Secondary analysis was conducted of academically available and existing literature regarding hypertension management and control from 2015 to 2019 using PubMed and Google Scholar. Qualitative analysis of 526 articles was performed as per eligibility criteria and content of the desk review was prepared in accordance with the study objective by synthesizing available evidence.Results: Available evidence for blood pressure reduction interventions delivered by physicians, pharmacists, nurses and other health professionals were included. Five key components of DCP3 strategies were focused which comprised of interventions mainly for sodium intake (n=140), smoking cessation (n=160), physical activity, obesity and BMI (n=226). The findings elucidate that interventions for sodium intake by physicians are mostly studied worldwide for lowering blood pressure followed by smoking cessation and physical activity for hypertension. Less available data exists for nurses; however, pharmacists and CHWs are being mainly included for delivering supervised interventions and in task shifting roles. Conclusion:Control of blood pressure has been studied extensively within service delivery domain of DCP3 interventions. Although, most of the interventions have been physician led but for hypertension management, population-level interventions are needed for prevention of non-communicable diseases. Rural population must also be focused in implementing BP reduction strategies that are locally adapted. Whereas considering understaffed health system in LMICs, other healthcare professionals can be trained and supervised to implement awareness and behavioral interventions in communities.

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Trial of Exercise to Prevent HypeRtension in young Adults (TEPHRA) a randomized controlled trial: study protocol

Cited by 13 publications

References 47 publications

Association of Systolic Blood Pressure Elevation With Disproportionate Left Ventricular Remodeling in Very Preterm-Born Young Adults

Association of Systolic Blood Pressure Elevation With Disproportionate Left Ventricular Remodeling in Very Preterm-Born Young Adults

Preterm Birth Is a Novel, Independent Risk Factor for Altered Cardiac Remodeling and Early Heart Failure: Is it Time for a New Cardiomyopathy?

The Role of Healthcare Personnel in Delivering Healthcare Interventions for High Blood Pressure: A Desk Review of Available Evidence

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