Health seeking behaviour is important in older people with hypertension and overweight, in terms of managing health factors that are related to their health and illness. However, health seeking behaviour of Thai older people is not well documented. This qualitative study aimed to describe health seeking behaviour of overweight hypertensive older people. Seven older women and three men participated in this study through purposive sampling. Qualitative data were gathered via in-depth interviews and were analyzed using content analysis. The results of this study illustrated that older people started to seek health care after understanding the need to seek health care due to the severity of their symptoms. The older people began illness management by using their knowledge to take care of themselves. If management was ineffective, they would seek health care from professional health care providers and traditional healers. Additionally, family members play important roles in the health seeking behaviour of older people. In particular, Thai older people with hypertension and overweight demonstrate various health seeking behaviours that are useful to health care providers in providing appropriate care to these older people, aiming to promote better health of the older people.

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Insulin resistance plays an intricate role in the development of cardiovascular diseases, hypertension is associated with insulin-resistant states such as diabetes and obesity. However, the underlying mechanism to explain the associations between hypertension and insulin resistance is unknown. The insulin exerts various biological effects in different type of cells. Clinical studies have reported that insulin has been shown to stimulate the protein kinase Akt via activation of PI3K in endothelial cells. Furthermore, insulin stimulated production of nitric oxide (NO) is inhibited by wortmannin in human umbilical vein endothelial cells (HUVECs). We also reported previously that NO contributes to the regulation of blood pressure in central nervous system. The aim of this study was to elucidate the potential mechanisms linking hypertension with insulin resistance and whether insulin signaling may involved in cardiovascular regulation in rat NTS neurons, we investigated the cardiovascular effects of insulin in the nucleus tractus solitarii (NTS) of urethane-anesthetized male spontaneous hypertensive rat (SHR) and normotensive Wistar-kyoto rats (WKY). Unilateral microinjection of insulin (100 IU/ml) into the NTS produced prominent depressor and bradycardic effects in 8/16 week-old WKY. However, no significant cardiovascular effects were found in adult SHR (16 week-old) after insulin injection. Furthermore, young SHR (8 week-old) with normal blood pressure showed depressor and bradycardic effects after insulin injection. Pretreatment with PI3K inhibitor LY294002 and NO synthase inhibitor L-NAME into the NTS attenuated the cardiovascular response evoked by insulin in WKY and young SHR but not in adult SHR. Furthermore, insulin induced Akt phosphorylation in-situ in WKY and SHR rats. Thus, these results indicated that insulin-PI3K-Akt-NOS sensitive mechanisms were involved in WKY and young SHR (normotensive) but not in adult SHR (hypertensive). The results also suggested the possible defective insulin signaling may resulted in the development of hypertension in adult SHR.

Die Präeklampsie als schwangerschaftsspezifische Erkrankung zählt unverändert weltweit zu den Hauptursachen fetaler und maternaler Morbidität und Mortalität. Ungeachtet vieler Forschungsbestrebungen fehlt bisher vor allem eine effiziente Früherkennung sowie daraus ableitbare kausale Therapieoptionen. Obgleich Ätiologie und Pathogenese nach wie vor als ungeklärt gelten, existieren zunehmend überzeugende Hinweise, welche einer Dysbalance von angiogenen Faktoren, wie VEGF und PlGF, und antiangiogenen Faktoren, wie sFlt1 und sEng, eine zentrale Rolle in der Entstehung der Erkrankung zuschreiben. Mehrere Studiengruppen konnten in diesem Zusammenhang veränderte Plasmakonzentrationen antiangiogener Proteine noch vor der eigentlichen Manifestation der Erkrankung nachweisen. Ziel dieser Studie war es zu klären, ob eine pathologisch uterine Perfusion im 2. Trimenon mit erhöhten sFlt1-Werten assoziiert ist und in einem prospektiven Ansatz die prädiktive Wertigkeit der antiangiogenen Faktoren sFlt1 und sEng, in einem durch Dopplersonografie vorselektierten Risikokollektiv zu bestimmen. Dazu wurden im retrospektiven Teil von 39 und im prospektiven Teil von 77 Einlingsschwangerschaften im 2. Trimester in venös entnommenen Blutproben mit Hilfe des ELISA - Tests die maternalen sFlt1- und sEng- Konzentrationen gemessen. Es konnte gezeigt werden, dass in einem durch Dopplersonografie vorselektierten Patientenkollektiv die maternale sFlt1-Konzentration bei Patientinnen mit späteren Schwangerschaftskomplikationen signifikant erhöht ist. Zusätzlich konnte belegt werden, dass die sEng - Konzentration in einem dopplersonografisch vorselektierten Risikokollektiv ebenfalls als unabhängiger prädiktiver Marker zur Vorhersage einer späteren Präeklampsie genutzt werden kann. Vielmehr ist es sogar möglich, Hochrisikopatientinnen mit Manifestation der Erkrankung vor der 34. SSW durch ausgesprochen hohe Sensitivität und Spezifität zu identifizieren.

Orientador: José Carlos Peraçoli / Resumo: O conhecimento das condições do sistema cardiovascular materno, durante o trabalho de parto e no puerpério imediato, é importante para uma boa assistência a esses períodos, principalmente para as mulheres portadoras de cardiopatias e hipertensão arterial. Sujeitos e métodos: foram incluídas no estudo 60 parturientes, nas quais foi aplicada a monitorização ambulatorial da pressão arterial (MAPA) - modelo SpaceLabs 90207, durante o trabalho de parto e nas primeiras 12 horas após o parto. A pressão arterial e a freqüência cardíaca foram registradas a cada 15 minutos durante o trabalho de parto e na primeira hora após o parto e, a cada 30 minutos até a 12a. hora após o parto. Esses parâmetros foram avaliados em três momentos do trabalho de parto (com dilatação cervical até 7 cm, entre 8 cm e dilatação total e durante o período expulsivo) e em dois momentos do puerpério (na primeira e décima segunda hora). Primeiramente as parturientes foram avaliadas sem levar em consideração a realização de procedimento de analgesia/anestesia e depois dividindo-as em grupos conforme o tipo de procedimento realizado: anestesia local, analgesia/anestesia peridural lombar e anestesia subaracnóidea. Para comparação dentro de cada grupo foram realizados análise de variância (ANOVA) e teste t de Student pareado e, entre os grupos o teste t não-pareado. Foi considerado o limite de significância estatística de 5%. Resultados: quando as parturientes foram avaliadas sem levar em consideração o procedimento analgésico/anestésico, os valores da pressão... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The knowledge of maternal cardiovascular system conditions in labor and in early puerperium women is important to give good assistance to the women during these periods, mainly to the cardiac and hypertensive pregnant women. The aim of this study was to analyze the maternal blood pressure and heart beat variation during labor and early puerperium. Material and methods: a total of 60 primigravid women were included in the study, and submitted to automatic ambulatory blood pressure and heart beat monitor (SpaceLabs 90207) during the labor and the first 12 hours of puerperium. The register of blood pressure and heart beat was done every 15 minutes during the labor and every 30 minutes during the first 12 hours of puerperium. It was analyzed three times during labor (until cervix dilated 7 cm, cervix dilated between 8 cm and total dilatation, and delivery period) and two times during puerperium (first and twelfth hours). In the first moment the primigravid were analyzed without considering the submission to analgesia. In the second moment they were divided into three groups, according to the anesthetic techniques: local, lumbar extradural or subarachnoid. Results were analyzed by one-way analysis of variance (ANOVA) and paired Student's t test to blood pressure and heart beat in each group during labor and puerperium. To compare different groups, nonpaired Student's t test was used. A p value < 0.05 was regarded as statistically significant. Results: when the primigravid were analyzed without considering the... (Complete abstract, click electronic access below) / Doutor

Background: Hypertension is common, affecting over one billion people worldwide. Importantly, in Sub-Saharan Africa hypertensive disease not only affects the older population group, but is becoming increasingly prevalent in younger patients. In South Africa, over 30% of the adult population has hypertension, making it the single most common cardiovascular risk factor and the predominant contributor to cardiovascular disease and mortality. In non-cardiac surgical patients, elevated blood pressure is the most common perioperative comorbidity encountered with an overall prevalence of 20-25%, and it remains poorly controlled in low and middle-income countries. Furthermore, hypertension in the perioperative setting may adversely affect patient outcome. It thus not only flags possible perioperative challenges to anaesthesiologists, but also identifies patients at risk of long-term morbidity and mortality. Objectives: The primary objective of this study was to determine the prevalence and severity of hypertension in elective adult surgical patients in the Western Cape. Results: The study population included all non-cardiac, non-obstetric, elective surgical patients from seven hospitals in the Western Cape during a one-week period. Hypertension, defined as having had a previous diagnosis of hypertension or meeting the blood pressure criteria of more than 140/90 mmHg, was identified in 51.8% of patients during the preoperative assessment. Significantly, newly diagnosed hypertension was present in 9.6% of all patients presenting for elective surgery. Although 98.1% of the known hypertensive patients were on antihypertensive therapy, 36.9% were inadequately controlled. Numerous reasons exist for this but notably 32% of patients admitted to forgetting to take their medication, making patient factors the most common cause for treatment non-compliance. Conclusion: This study suggests that the perioperative period may be an important opportunity to identify undiagnosed hypertensive patient. The perioperative encounter may have a significant public health implication in facilitating appropriate referral and treatment of hypertension to decrease long-term cardiovascular complications in South Africa.

For more than half a century cardiovascular disease has been the leading cause of death in the United States.  Aging, hypertension, and obesity are major risk factors for cardiovascular disease and clearly associated with arterial stiffness.  Arterial stiffness generates higher afterloads and diminishes coronary perfusion thereby causing ventricular hypertrophy and ischemia.  Importantly, arterial stiffness is an independent predictor of cardiovascular disease risk and all-cause mortality.   Current strategies such as inhibition of angiotensin II or angiotensin converting enzyme, reduction of smooth muscle tone, blood volume, or inflammatory mediators, and improving glucose homeostasis are effective destiffening options.  Nebivolol, a third generation beta-blocker, has unique vasodilatory characteristics and may be particularly efficacious as a destiffening agent.  Only a few studies have addressed this issue while relying on indirect, blood pressure-dependent stiffness indices precluding clear understanding of study outcomes.  There remains a need to determine the potential utility of nebivolol therapy as an arterial destiffening strategy.   Thus, we hypothesized that the combination of nebivolol and lifestyle modification would reduce central arterial stiffness in middle-aged and older hypertensive adults more than either intervention alone.  To test this hypothesis, we randomized 45 hypertensive adults to receive lifestyle modification, nebivolol, or combination for 12 weeks.  β-stiffness index, pulse wave analysis, and arterial compliance were measured at baseline and following the intervention.  No baseline differences in variables of  interest were observed between groups.  In contrast to our hypothesis, lifestyle modification, nebivolol, and combination groups had similar (P>0.05) reductions in beta-stiffness index (-1.87±0.83; -2.03±0.60; and -2.51±0.90 U), respectively, while carotid-femoral pulse wave velocity declined only in the nebivolol and combination groups.   Our findings suggest combination of nebivolol and lifestyle modification reduces arterial stiffness to a similar degree as either intervention alone in middle-aged and older hypertensive adults.  Further studies are needed to determine if the changes in arterial stiffness continue to occur or remain clinically significant over longer durations. / Ph. D.

Präeklampsie ist weltweit eine der Hauptursachen perinataler Morbidität und Mortalität für Mutter und Kind. Es wird vermutet, dass unterschiedliche pathophysiologische Mechanismen je nach Zeitpunkt des Auftretens der Präeklampsie vorliegen. Eine Unterscheidung zwischen früher, mittlerer und später Präeklampsie scheint relevant für Screening, klinische Manifestation und Management der Erkrankung zu sein. Ziel dieser Studie ist es die drei Typen der Präeklampsie bezüglich Risikofaktoren, Entbindungsmodalität und maternaler und neonataler Morbiditäten und Mortalitäten zu charakterisieren und zusätzlich mit denen der Gestationshypertonie und chronischen Hypertonie zu vergleichen. In einem retrospektiven Studienaufbau wurden 1089 Einlingsschwangerschaften mit hypertensiver Schwangerschaftserkrankung, deren Entbindung in einem Zeitraum von 10 Jahren (2003-2012) erfolgte, analysiert. Die maternalen und neonatalen Charakteristika der verschiedenen Gruppen hypertensiver Schwangerschaftserkrankungen wurden miteinander verglichen. Es wurden deskriptive und analytische (Chi-quadrat-Test und U-Test) statistische Methoden verwendet. Es zeigten sich signifikant unterschiedliche maternale Komorbiditäten und Risikofaktoren in den untersuchten Gruppen hypertensiver Schwangerschaftserkrankungen. Für die Mehrzahl der untersuchten Parameter waren Fälle mit Präeklampsie häufiger durch Morbidität und Mortalität betroffen waren. Patientinnen mit früher Präeklampsie fielen durch einen signifikant höheren mittleren arteriellen Druck vor Entbindung, eine erhöhte Kaiserschnittrate, eine ausgeprägtere Proteinurie und eine häufigere Korrelation zu HELLP-Syndrom, Eklampsie und vorzeitige Plazentalösung auf. Die Häufigkeit pathologischer Doppleruntersuchungen in den Arteriae uterinae und der Arteria umbilicalis verhielt sich umgekehrt proportional zur Schwangerschaftswoche zum Zeitpunkt der Entbindung. Ein nachteiliges fetales Outcome bezogen auf die perinatale und neonatale Mortalität, Beatmung über einen längeren Zeitraum als 24 Stunden, RDS-Syndrom, fetale Wachstumsrestriktion und Verlegung auf eine neonatologische Intensivstation trat unter früher Präeklampsie häufiger als unter mittlerer und bei mittlerer häufiger als unter später Präeklampsie auf. Das neonatale Outcome von Feten unter der 33. SSW war nicht vom Ausmaß der mütterlichen hypertensiven Erkrankung abhängig. Die späte Präeklampsie viel durch günstigere Outcomes als die Gestationshypertonie und chronische Hypertonie auf. Die Ergebnisse der Studie unterstützen die These, dass unterschiedliche pathophysiologische Mechanismen Präeklampsie bedingen können und dass frühe, mittlere und späte Präeklampsie entweder verschiedene Erkrankungen sind, oder die Präeklampsie eine Erkrankung darstellt, die durch verschiedene Einflussfaktoren ein unterschiedlich starkes Ausmaß annimmt. Das Gestationsalter ist demnach das entscheidende Kriterium für die klinische Ausprägung. Die unterschiedlichen Risikoprofile der einzelnen Formen hypertensiver Schwangerschaftserkrankungen fordern ein angepasstes klinisches Management.

<p>Lack of knowledge about stroke in general and specific knowledge of the risk factors, signs, and symptoms of stroke results in the late presentation of patients at hospital. The aim of this study was to determine the knowledge of stroke among hypertensive patients in the Tanga region of Tanzania. To investigate this, a cross-sectional survey using a quantitative research design was used.</p>

Pre-hypertension (pre-HT) (Blood Pressure (BP) ≥120/80mmHg to ≤ 140/90mmHg) increases the risk of developing hypertension (HT). BP reductions following acute exercise are known as post exercise hypotension (PEH). BP and perhaps PEH shows a daily circadian rhythm. Purpose: To compare the magnitude of PEH after morning and evening aerobic exercise in adults with pre-HT. Hypothesis: The magnitude of PEH will be larger after evening versus morning exercise. Participants: Pre-HT men and women 50-65 years old. Study Design: Participants engaged in cycling exercise (60% VO2max) on two occasions: 1.5 and 11 hours following waking. Cardiovascular function was assessed for 30 minutes pre and one hour post exercise. Results: 1) Systolic PEH responses affected by TOD differed by gender. 2) Baseline Heart Rate Variability and its response to exercise differed gender but not TOD. The inconsistent significant gender and TOD differences of PEH and its mechanisms suggest that this group.