Factors Associated with Neonatal Arterial Hypertension: Case and Control Study

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Carolina Gutiérrez-Cortés

Carolina Gutiérrez-Cortés1, Catalina Lince-Rivera2, Adriana P. Bohórquez-Peñaranda3, Mariangel Castillo-Arteaga4, Ingrid Mayerly Gómez5, Juan Guillermo Cárdenas-Aguilera 6

1 Specialist in pediatric, Pontificia Universidad Javeriana, Bogotá, Colombia
2 Specialist in pediatric and neonatology, Pontificia Universidad Javeriana, Bogotá, Colombia
3 MSc Clinical Epidemiology, Pontificia Universidad Javeriana, Bogotá, Colombia
4 Specialist in pediatric nephrology, Hospital Universitario San Ignacio, Bogotá, Colombia
5 Specialist in pediatric and neonatology, Pontificia Universidad Javeriana, Bogotá, Colombia
6 Specialist in pediatric nephrology, Subred Integrada de Servicios de Salud Sur Occidente, Bogotá, Colombia

Corresponding author:
Juan Guillermo Cárdenas Aguilera
Pontificia Universidad Javeriana
Bogotá, Colombia
Tel (+57) 601 320 8320
Cra 7 No 40 - 62
Email: cardenasjg@javeriana.edu.co

 

Abstract

Background. Neonatal high blood pressure has been diagnosed more frequently in recent years, and its impact extends to adulthood. However, the knowledge gaps on associated factors, diagnosis, and treatment are challenging for medical personnel. The incidence of this condition varies depending on neonatal conditions. Patients in the Newborn Unit are at increased risk of developing high blood pressure. The persistence of this condition beyond the neonatal stage increases the risk of cardiovascular disease and chronic kidney disease in childhood and adulthood.
Methodology. A case-control study was carried out. It included hospitalized patients with neonatal hypertension as cases. Three controls were randomly selected for each case and matched by gestational age. The variables were analyzed based on their nature. Multivariate analysis was performed using a multivariate conditional regression model to identify variables associated with the outcome. Finally, the model was adjusted for possible confounders.
Results. 37 cases were obtained and matched with 111 controls. In the univariate analysis, heart disease (OR 2.86; 95% CI 1.22-6.71), kidney disease (OR 7.24; 95% CI 1.92-28.28), bronchopulmonary dysplasia (OR 6.62; 95% CI 1.42-50.82) and major surgical procedures (OR 3.71; 95% CI 1.64-8.39) had an association with neonatal arterial hypertension. Only the latter maintained this finding in the multivariate analysis (adjusted OR 2.88; 95% CI 1.14-7.30). A significant association of two or more comorbidities with neonatal arterial hypertension was also found (OR 3.81; 95% CI 1.53-9.49).
Conclusions. The study analyzed the factors related to high blood pressure in hospitalized neonates, finding relevant associations in the said population. The importance of meticulous neonatal care and monitoring of risk factors such as birth weight and major surgeries is highlighted.

Keywords: Hypertension, Prematurity, Bronchopulmonary Dysplasia, Epigenetics, Neonate, Prematurity, Kidney Disease, Blood Pressure

Introduction

With technological advances in neonatal care, Newborn Units (NU) have undergone significant changes, increasing survival in low-weight patients due to prematurity or intrauterine growth retardation. Low birth weight (LBW) is determined to correspond to weights less than 2500 grams (Table 1).

Birth Weight
Less than 2500 g Low birth weight
Less than 1500 g Very low birth weight
Less than 1000 g Extremely low birth weight
Table 1. Low birth weight classifications. Adapted and translated from Atehortua et al. [1].

 

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Clinical and social advantages of remote patient monitoring in home dialysis

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Massimo Morosetti

Massimo Morosetti1, Michelina Peccerillo1, Maria Iolanda Famà2

1 UOC di Nefrologia e Dialisi, Ospedale G.B. Grassi Roma, Italia
2 Vree Health Italia s.r.l., Roma, Italia

Corrispondenza a:
Prof. Massimo Morosetti
UOC di Nefrologia e Dialisi, Ospedale G.B. Grassi Roma, Italia
Tel. +39 0656482018
E-mail: massimo.morosetti@aslroma3.it

 

Abstract

Introduction. Home dialysis (both extracorporeal and peritoneal) can improve the management and the quality of life of patients with chronic disease. In this study we evaluated the possible clinical and social advantages derived from remote patient monitoring using the Doctor Plus® Nephro program, as opposed to the standard of care. Methods. We included in our analysis the patients participating in the remote monitoring program of the Nephrology Center of ASL 3 in Rome from July 2017 to April 2019. Each patient was observed from a minimum of 4 months to a maximum of 22 months. Systolic and diastolic pressure, heart rate, weight and oximetry were monitored. An SF-12 questionnaire was also administered to evaluate the level of satisfaction with the program Doctor Plus® Nephro. Results. 16 patients (56,3% males, mean age 62 years) were observed as part of the analysis. During the program there was a reduction of systolic pressure in 69% of the patients and of diastolic pressure in 62,5%. Mean heart rate decreased from 69,4 bpm to 68,8 bpm (p<0,0046). The answers to the SF-12 questionnaire showed that the perceived health status of all patients had improved. Due to the closer clinical monitoring, the number of patients accessing emergency services also decreased. Conclusion. Doctor Plus® Nephro could improve access to home treatment; the results of this study in fact show it to be a useful tool for Nephrological Centers to monitor patients undergoing home dialysis.

 Keywords: remote patient monitoring, dialysis, home dialysis, blood pressure, quality of life

Sorry, this entry is only available in Italian.

Introduzione

Puntare sulle cure domiciliari per migliorare la gestione e la qualità della vita del paziente cronico e della sua famiglia è l’indicazione contenuta nell’ultimo Piano Nazionale della Cronicità (PNC) approvato dal Ministero della Salute Italiano, che dedica una particolare attenzione alla malattia renale cronica e all’insufficienza renale. Nel capitolo del PNC dedicato alle malattie croniche e all’insufficienza renale uno degli obiettivi generali è favorire l’assistenza domiciliare del paziente; una delle linee di intervento proposte a supporto è sperimentare modelli di dialisi domiciliare (dialisi peritoneale e emodialisi domiciliare), utilizzando strumenti di tele-dialisi assistita [1].

La dialisi domiciliare offre numerosi vantaggi se comparata con la dialisi effettuata in ospedale. Gli studi dimostrano diversi benefici per i pazienti in dialisi domiciliare in termini di sopravvivenza, qualità di vita, costi di spostamento, autonomia e benefici clinici, quali aumento del controllo dei valori pressori e del fosforo [2–8]. Inoltre, nella maggior parte dei paesi, il costo della dialisi domiciliare è inferiore al costo della dialisi effettuata in ospedale [9–11].

 

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Between old and new targets: blood pressure control in hypertensive outpatients

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Antonio Del Giudice

Antonio Del Giudice1, Andrea Fontana2, Antonio Cicchella1, Claudio Carmine Guida1, Antonio Gesuete1, Rachele Grifa1, Antonio Mangiacotti1, Filomena Miscio1, Matteo Piemontese1, Michele Prencipe1, Michele Vergura1, Massimiliano Copetti2, Filippo Aucella1

1Dipartimento di Scienze Mediche, Struttura Complessa di Nefrologia e Dialisi e Centro per l’Ipertensione Arteriosa, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italia
2Unità di Biostatistica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italia

Autore corrispondente:
Antonio Del Giudice
S.C. di Nefrologia e Dialisi e Centro per l’Ipertensione Arteriosa
IRCCS Casa Sollievo della Sofferenza
Viale Cappuccini
71013 San Giovanni Rotondo, Italia
Tel. 0882410397 / Fax. 0882410944
E-mail: a.delgiudice@operapadrepio.it

 

Abstract

Objective. In developed countries, blood pressure (BP) control has increased over the past few decades and is now approaching 70% of patients. Herewith we report the results of a cross-sectional study carried out on hypertensive outpatients.

Design and methods. In a cohort of 1,412 consecutive hypertensive outpatients (790 females, 622 males; mean age: 60.3±12.2 years) evaluated from January 2015 to December 2016, the following parameters were assessed: age, gender, body mass index (BMI), waist circumference (WC), smoking habits, BP in the sitting position, estimated glomerular filtration rate (eGFR), serum glucose, lipid profile, antihypertensive drugs prescribed. In agreement with the European guidelines, hypertension was defined as sitting BP ≥140/90 mmHg or use of antihypertensive drugs. Patients whose BP was <140/90 mmHg were considered as having achieved BP control. Furthermore, in compliance with the redefinition of hypertension suggested by the American College of Cardiology/American Heart Association (ACC/AHA), a second level of BP control (BP <130/80 mmHg) was evaluated.

Results. Overall, 75.7% of hypertensive patients achieved BP levels <140/90 mmHg, while 50.5% achieved BP levels <130/80 mmHg. In both contexts, compared with patients whose BP was not controlled, those achieving the BP targets were mainly younger and females with a lower prevalence of obesity, diabetes and chronic kidney disease. Furthermore, they also had a lower WC and a higher eGFR.

Conclusions. Nearly 76% of patients achieved the BP target of <140/90 mmHg, a result which is higher than the 70% achieved in Europe, and 50.6% achieved that of <130/80 mmHg, a result which is slightly higher than the 47% recently reported in USA.

Keywords: Blood pressure, blood pressure control, hypertension.

Sorry, this entry is only available in Italian.

Introduzione

L’ipertensione arteriosa è uno dei maggiori fattori di rischio indipendenti e modificabili per cardiopatia ischemica, scompenso cardiaco, accidenti cerebrovascolari, insufficienza renale e mortalità cardiovascolare in tutti i gruppi di età (1).

 

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