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1
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Folyovich A, Mátis R, Biczó D, Pálosi M, Béres-Molnár AK, Al-Muhanna N, Jarecsny T, Dudás E, Jánoska D, Toldi G, Páldy A. High average daily temperature in summer and the incidence of thrombolytic treatment for acute ischemic stroke. L'ENCEPHALE 2024; 50:510-515. [PMID: 38040506 DOI: 10.1016/j.encep.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Meteorological factors can increase stroke risk; however, their impact is not precisely understood. Heat waves during summer increase total mortality. Therefore, we hypothesized that the average daily temperature in summer may correlate with the incidence of thrombolytic treatment for acute ischemic stroke in Budapest and Pest County, Hungary. METHODS We analyzed the relationship between the average daily temperature in summer months and the daily number of thrombolytic treatments (TT) performed with the indication of acute ischemic stroke between 1st June and 31st August each year from 2007 to 2016. The analysis was also performed after the omission of the data of the last day of the months due to possible psychosocial impact reported in our previous study. Spearman's correlation was used for statistical analysis. RESULTS No significant correlation was found between the average summer daily temperature and the number of TT in the entire sample of the 10-year period. When omitting the data of the last day of each month, positive correlations were suspected in 2014 (r=0.225, P=0.034) and 2015 (r=0.276, P=0.009). CONCLUSION Our findings did not confirm an association between the average daily temperature in summer and the daily number of TT throughout the examined 10-year period. However, importantly, in 2014 and 2015, the years with the highest average daily temperatures in this period, a positive correlation was found. The level of correlation is modest, indicating that risk factors, both meteorological and non-meteorological, other than the average temperature, play equally important roles in determining the incidence of thrombolytic treatment for acute ischemic stroke on the population level.
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Affiliation(s)
- András Folyovich
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Réka Mátis
- Faculty of Public Governance and International Studies, University of Public Service, Budapest, Hungary
| | | | - Mihály Pálosi
- National Institute of Health Insurance Fund Management, Budapest, Hungary
| | | | - Nadim Al-Muhanna
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Tamás Jarecsny
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Eszter Dudás
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Dorottya Jánoska
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Gergely Toldi
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Anna Páldy
- National Public Health Center, Budapest, Hungary
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2
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A Meteorological Paradox: Low Atmospheric Pressure-Associated Decrease in Blood Pressure Is Accompanied by More Cardiac and Cerebrovascular Complications: Five-Year Follow-up of Elderly Hypertensive Patients. ATMOSPHERE 2022. [DOI: 10.3390/atmos13020235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background: Variations in atmospheric pressure (AP) are known to affect blood pressure (BP). We assessed the effect of AP on BP, and the major fatal and nonfatal complications thereof (i.e., stroke, myocardial infarction, and pulmonary emboli). Methods: In this observational cohort study, 250 hypertensive patients (aged 65–92 years old) were followed for 3.5–5.4 years in a primary care clinic. Cox proportional hazard regression was performed to define the associations between AP, clinical, demographic and environmental factors, and major complications such as stroke, myocardial infarction, etc. Results: AP fluctuated between 1007 and 1024 millibars (MB). A total of 132 patients (53%) developed various complications, of which 13 (9.8%) were fatal. Among all fatalities, 93 of 119 nonfatal cases and 7 of 13 fatal cases occurred at AP < 1013 MB. A Cox regression analysis showed that low AP (AP < 1013 MB) had a higher hazard ratio (HR) on hypertension (HTN) complications among all demographic, clinical and environmental parameters. Conclusions: Most major complications were associated with very low APs. Low AP was the best predictive risk-factor for major complications of HTN.
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3
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Haghayegh S, Smolensky MH, Khoshnevis S, Hermida RC, Castriotta RJ, Diller KR. The Circadian Rhythm of Thermoregulation Modulates both the Sleep/Wake Cycle and 24 h Pattern of Arterial Blood Pressure. Compr Physiol 2021; 11:2645-2658. [PMID: 34636410 DOI: 10.1002/cphy.c210008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Borbély proposed an interacting two-component model of sleep regulation comprising a homeostatic Process S and a circadian Process C. The model has provided understanding of the association between core body temperature (CBT) as a key element of Process C that is deterministic of sleep onset and offset. However, it additionally provides a new perspective of the importance of the thermoregulatory mechanisms of Process C in modulating the circadian rhythm of arterial blood pressure (ABP). Herein, we examine the circadian physiology of thermoregulation, including at the end of the activity span the profound redistribution of cardiac output from the systemic circulation to the arteriovenous anastomoses of the glabrous skin that markedly enhances convective transfer of heat from the body to the environment to cause (i) decrease of the CBT as a pathway to sleep onset and (ii) attenuation of the asleep ABP mean and augmentation of the ABP decline (dipping) from the wake-time mean, in combination the strongest predictors of the risk for blood vessel and organ pathology and morbid and mortal cardiovascular disease events. We additionally review the means by which blood perfusion to the glabrous skin can be manipulated on demand by selective thermal stimulation, that is, mild warming, on the skin of the cervical spinal cord to intensify Process C as a way to facilitate sleep induction and promote healthy asleep ABP. © 2021 American Physiological Society. Compr Physiol 11:1-14, 2021.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biostatics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, Vigo, Spain
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
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4
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Jiang S, Warren JL, Scovronick N, Moss SE, Darrow LA, Strickland MJ, Newman AJ, Chen Y, Ebelt ST, Chang HH. Using logic regression to characterize extreme heat exposures and their health associations: a time-series study of emergency department visits in Atlanta. BMC Med Res Methodol 2021; 21:87. [PMID: 33902463 PMCID: PMC8077733 DOI: 10.1186/s12874-021-01278-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Short-term associations between extreme heat events and adverse health outcomes are well-established in epidemiologic studies. However, the use of different exposure definitions across studies has limited our understanding of extreme heat characteristics that are most important for specific health outcomes or subpopulations. Methods Logic regression is a statistical learning method for constructing decision trees based on Boolean combinations of binary predictors. We describe how logic regression can be utilized as a data-driven approach to identify extreme heat exposure definitions using health outcome data. We evaluated the performance of the proposed algorithm in a simulation study, as well as in a 20-year time-series analysis of extreme heat and emergency department visits for 12 outcomes in the Atlanta metropolitan area. Results For the Atlanta case study, our novel application of logic regression identified extreme heat exposure definitions that were associated with several heat-sensitive disease outcomes (e.g., fluid and electrolyte imbalance, renal diseases, ischemic stroke, and hypertension). Exposures were often characterized by extreme apparent minimum temperature or maximum temperature over multiple days. The simulation study also demonstrated that logic regression can successfully identify exposures of different lags and duration structures when statistical power is sufficient. Conclusion Logic regression is a useful tool for identifying important characteristics of extreme heat exposures for adverse health outcomes, which may help improve future heat warning systems and response plans. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01278-x.
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Affiliation(s)
- Shan Jiang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale University, New Haven, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Shannon E Moss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada Reno, Reno, USA
| | | | - Andrew J Newman
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Stefanie T Ebelt
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA.
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5
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Narang R, Saxena A, Desai A, Ramakrishnan S, Thangjam RS, Kulkarni S, Narvencar K, E Costa AKJ, Dias A, Sukharamwala R, Cleland J. Prevalence and determinants of hypertension in apparently healthy schoolchildren in India: A multi-center study. Eur J Prev Cardiol 2018; 25:1775-1784. [PMID: 30043628 DOI: 10.1177/2047487318790056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Hypertension in children is often under recognized, especially in developing countries. Data from rural areas of developing countries is particularly lacking. Objectives To study prevalence of hypertension and its determinants in apparently health school children from predominantly rural populations of India. Methods Apparently healthy schoolchildren ( n = 14,957) aged 5-15 years (mean (standard deviation) age 10.8 (2.8) years; 55.5% boys) at four predominantly rural sites in separate states of India were studied. Systolic and diastolic blood pressures were recorded by trained staff in addition to age, gender, height, weight, type of school and season. Waist circumference was also recorded in 12,068 children. Geographic location and type of school (government, government-aided or private) were used to determine socio-economic status. Results Systolic and/or diastolic hypertension was present in 3443 (23%) children. Systolic hypertension was present in 13.6%, diastolic hypertension in 15.3% and both in 5.9%. Isolated systolic hypertension was present in 7.7% while isolated diastolic hypertension was present in 9.4%. On univariate analysis, age, gender, geographical location, socio-economic status, season and anthropometric parameters (z-scores of height, weight and waist circumference, waist/height ratio and body mass index) were all significantly related to risk of hypertension ( p < 0.0001 for each). Similar association was observed with weight group (normal, overweight and obese). Multiple regression analysis showed lower age, female gender, richer socio-economic status, certain geographical locations, higher weight and larger waist circumference to be independently associated with a greater risk of hypertension. Conclusion There is a high prevalence of hypertension in apparently healthy schoolchildren even in predominantly rural areas of India. Screening and management programs targeted to high risk groups identified may prove cost-effective.
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Affiliation(s)
- Rajiv Narang
- 1 Department of Cardiology, All India Institute of Medical Sciences, India
| | - Anita Saxena
- 1 Department of Cardiology, All India Institute of Medical Sciences, India
| | - Ankush Desai
- 2 Department of Medicine and Department of Preventive & Social Medicine, Goa Medical College, Bambolim, Goa, India
| | | | - Rajendra S Thangjam
- 3 Department of Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | | | - Kedareshwar Narvencar
- 2 Department of Medicine and Department of Preventive & Social Medicine, Goa Medical College, Bambolim, Goa, India
| | - Ana K Jacques' E Costa
- 2 Department of Medicine and Department of Preventive & Social Medicine, Goa Medical College, Bambolim, Goa, India
| | - Amit Dias
- 2 Department of Medicine and Department of Preventive & Social Medicine, Goa Medical College, Bambolim, Goa, India
| | | | - John Cleland
- 5 Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, UK
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Amoah AO, Angell SY, Byrnes-Enoch H, Amirfar S, Maa P, Wang JJ. Bridging the gap between clinical practice and public health: Using EHR data to assess trends in the seasonality of blood-pressure control. Prev Med Rep 2017; 6:369-375. [PMID: 28593116 PMCID: PMC5443962 DOI: 10.1016/j.pmedr.2017.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 04/15/2017] [Accepted: 04/23/2017] [Indexed: 11/27/2022] Open
Abstract
Electronic health records (EHRs) provide timely access to millions of patient data records while limiting errors associated with manual data extraction. To demonstrate these advantages of EHRs to public health practice, we examine the ability of a EHR calculated blood-pressure (BP) measure to replicate seasonal variation as reported by prior studies that used manual data extraction. Our sample included 609 primary-care practices in New York City. BP control among hypertensives was defined as systolic blood pressure of 140 or less and diastolic blood pressure of 90 or less (BP < 140/90 mm Hg). An innovative query-distribution system was used to extract monthly BP control values from the EHRs of adult patients diagnosed with hypertension over a 25-month period. Generalized estimating equations were used to compare the association between seasonal temperature variations and BP control rates at the practice level, while adjusting for known demographic factors (age, gender), comorbid diseases (diabetes) associated with blood pressure, and months since EHR implementation. BP control rates increased gradually from the spring months to peak summer months before declining in the fall months. In addition to seasonal variation, the adjusted model showed that a 1% increase in patients with a diabetic comorbidity is associated with an increase of 3% (OR 1.03; CI 1.028–1.032) on the BP measure. Our findings identified cyclic trends in BP control and highlighted greater association with increased proportion of diabetic patients, therefore confirming the ability of the EHR as a tool for measuring population health outcomes.
We replicated seasonal fluctuations in BP control using aggregate EHR data on outpatients in NYC. BP was better controlled in the warmer months than in the colder months. A higher proportion of patients with diabetic comorbidity at a practice increases the seasonal fluctuations in BP control. We found no association between BP control and the proportion of females or elderly at the practice. Our findings using EHR data was similar to prior studies that relied on manual chart review.
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Affiliation(s)
- Aurora O Amoah
- Primary Care Information Project (PCIP) Division of Prevention and Primary Care New York City Department of Health and Mental Hygiene (NYCDOHMH), United States
| | - Sonia Y Angell
- Primary Care Information Project (PCIP) Division of Prevention and Primary Care New York City Department of Health and Mental Hygiene (NYCDOHMH), United States
| | - Hannah Byrnes-Enoch
- Primary Care Information Project (PCIP) Division of Prevention and Primary Care New York City Department of Health and Mental Hygiene (NYCDOHMH), United States
| | - Sam Amirfar
- Primary Care Information Project (PCIP) Division of Prevention and Primary Care New York City Department of Health and Mental Hygiene (NYCDOHMH), United States
| | - Phoenix Maa
- Primary Care Information Project (PCIP) Division of Prevention and Primary Care New York City Department of Health and Mental Hygiene (NYCDOHMH), United States
| | - Jason J Wang
- Primary Care Information Project (PCIP) Division of Prevention and Primary Care New York City Department of Health and Mental Hygiene (NYCDOHMH), United States
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7
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Folyovich A, Biczó D, Al-Muhanna N, Béres-Molnár AK, Fejős Á, Pintér Á, Bereczki D, Fischer A, Vadasdi K, Pintér F. Anomalous equivalent potential temperature: an atmospheric feature predicting days with higher risk for fatal outcome in acute ischemic stroke-a preliminary study. ENVIRONMENTAL MONITORING AND ASSESSMENT 2015; 187:547. [PMID: 26233665 DOI: 10.1007/s10661-015-4722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 07/01/2015] [Indexed: 06/04/2023]
Abstract
Acute stroke is a life-threatening condition. Fatal outcome is related to risk factors, some of these affected by climatic changes. Forecasting potentially harmful atmospheric processes may therefore be of practical importance in the acute care of stroke patients. We analyzed the history of all patients with acute ischemic stroke (N = 184) confirmed by neuroimaging including those who died (N = 35, 15 males) at our hospital department in the winter months of 2009. Patient data were anonymized, and the human meteorologists were only aware of patients' age, gender, and exact time of death. Of the meteorological parameters, equivalent potential temperature (EPT) has been chosen for analysis. EPT is generally used for forecasting thunderstorms, but in the case of synoptic scale airflow (10(6) m), it is suitable for characterizing the air mass inflowing from different regions. The behavior of measured EPT values was compared to the climatic (30 years) averages. We developed meteorological criteria for anomalous periods of EPT and tested if such periods are associated with higher rate of fatal outcome. The duration of anomalous and non-anomalous periods was nearly equal during the studied 3 months. Stroke onset distributed similarly between anomalous and non-anomalous days; however, of the 35 deaths, 27 occurred during anomalous periods: on average, 0.56 deaths occurred on anomalous days and 0.19 on non-anomalous days. Winter periods meeting the criteria of anomalous EPT may have a significant adverse human-meteorological impact on the outcome in acute ischemic stroke.
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Affiliation(s)
- András Folyovich
- Department of Neurology and Stroke Center, Szent János Hospital, Budapest, Hungary
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van den Hurk K, de Kort WLAM, Deinum J, Atsma F. Higher outdoor temperatures are progressively associated with lower blood pressure: a longitudinal study in 100,000 healthy individuals. ACTA ACUST UNITED AC 2015; 9:536-43. [PMID: 26089227 DOI: 10.1016/j.jash.2015.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/02/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
This study investigated the shape of associations between climate parameters (mean daily temperature and humidity) and systolic and diastolic blood pressure in a large longitudinal cohort of healthy individuals. The study population comprised 101,377 Dutch whole blood and plasma donors (50% men), who made 691,107 visits to the blood bank between 2007 and 2009. Climate parameters were acquired from the Royal Netherlands Meteorological Institute. Associations with blood pressure, measured prior to each blood donation, were studied using (piecewise) linear regression analyses within Generalized Estimating Equation models. On average, systolic blood pressure was 0.18 mm Hg, and diastolic blood pressure was 0.11 mm Hg lower per one degree Celsius higher mean daily temperature. Higher daily temperatures were associated with lower blood pressure, independent of humidity and potentially confounding factors. These associations were stronger at older age and higher temperatures. Seasonality should therefore be taken into account when monitoring blood pressure, particularly in older individuals.
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Affiliation(s)
- Katja van den Hurk
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands.
| | - Wim L A M de Kort
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands; Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Femke Atsma
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Abstract
This paper review seasonal patterns across twelve cardiovascular diseases: Deep venous thrombosis, pulmonary embolism, aortic dissection and rupture, stroke, intracerebral hemorrhage, hypertension, heart failure, angina pectoris, myocardial infarction, sudden cardiac death, venricular arrythmia and atrial fibrillation, and discuss a possible cause of the occurrence of these diseases. There is a clear seasonal trend of cardiovascular diseases, with the highest incidence occurring during the colder winter months, which have been described in many countries. This phenomenon likely contributes to the numbers of deaths occurring in winter. The implications of this finding are important for testing the relative importance of the proposed mechanisms. Understanding the influence of season and other factors is essential when seeking to implement effective public health measures.
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Affiliation(s)
- Auda Fares
- Department of Internal Medicine, Uinversity Hospital Bochum, Bedburg, Germany
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10
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Seasonal variation in blood pressure is modulated by gender and age but not by BMI in a large Taiwanese population, 1996-2006. ACTA ACUST UNITED AC 2013; 7:216-28. [PMID: 23490614 DOI: 10.1016/j.jash.2013.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 11/20/2022]
Abstract
Previous research has found that blood pressure tends to be higher in winter and lower in summer. The present study examined seasonal variation in blood pressure by gender, hypertension medication, age group, and body mass index using contemporary Taiwanese data. Over 400,000 health screening records collected biennially between 1996 and 2006 were used to calculate average monthly systolic (SBP) and diastolic blood pressure (DBP) measurements. Generalized estimating equations were used to estimate the difference between the highest and lowest mean monthly blood pressure measurements. Mean monthly blood pressure measurements were higher in winter than in summer for all age groups, regardless of medication for hypertension. The largest difference in mean monthly blood pressure between summer and winter months was 5.3 mm Hg (Standard error = 0.7) for SBP and 3.2 mm Hg (Standard error = 0.7) for DBP. These differences were more pronounced: in SBP than in DBP; in men than in women; and in older than in younger participants. Body mass index was not clearly associated with seasonal variation in blood pressure. Seasonal variation in blood pressure among contemporary Taiwanese populations is modest and may only approach clinical significance for the diagnosis and treatment of hypertension and the prevention of cardiovascular disease amongst older male individuals.
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Charach G, Shochat M, Argov O, Weintraub M, Charach L, Rabinovich A, Ayzenberg O, George J. Seasonal changes in blood pressure: Cardiac and cerebrovascular morbidity and mortality. World J Hypertens 2013; 3:1-8. [DOI: 10.5494/wjh.v3.i1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/10/2013] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
Cold is a seasonal and circadian risk factor for cardio- and cerebrovascular morbidity and mortality. Colder temperatures have been associated with higher blood pressure (BP), based on studies which show that BP levels measured during the summer months are generally lower than those measured during the winter months. Residents in geographic areas which have greater seasonal temperature differences show greater fluctuation in BP. Surprisingly, atmospheric pressure, rainfall, and humidity were not related to BP levels. The increased sympathetic nervous activity due to cold, as evidenced by elevated BP and by plasma and urinary catecholamines, has been proposed as being the underlying etiology. Patients with heart failure may experience, in cold conditions, endothelial dysfunction and produce fewer endogenous vasodilators (e.g., nitric oxide, prostaglandins) and more endogenous vasoconstrictors (e.g., endothelin), thus increasing afterload. Arterial stiffness is also related to seasonal BP changes. Increased BP, arterial stiffness and endothelial dysfunction could predispose to increased coronary and cerebrovascular events. Improved protection against lower temperatures or increased doses of existing medications or the addition of newer medications could lead to a reduction in increased cardiovascular mortality in winter. Here, we briefly review findings from existing literature and provide an update on seasonal long-term variation in BP along with the related complications.
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12
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Yackerson NS, Bromberg L, Adler B, Aizenberg A. Possible effects of changes in the meteorological state over semi-arid areas on the general well-being of weather-sensitive patients. Environ Health 2012; 11:26. [PMID: 22507174 PMCID: PMC3423070 DOI: 10.1186/1476-069x-11-26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 03/15/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND The influence of the changes in atmospheric states, typical for areas close to big deserts, on general well-being of hypertensive persons was analyzed. METHODS Under test was the group of 20 hypertensive weather-sensitive patients; their blood pressure, pulse rate and appearance of 4 symptoms of discomfort sensations: arthritic pain, unjustified anxiety, severe headache and inexplicable tiredness- were registered. Symptoms are classified in ICD-9 code (780-790) and scored on a 4-point scale. Results were defined as positive (no departure from the range of normal values) or problematic; the daily number of the latter results was collected under the name "pathological reactions" NPR if at least two of these 7 checked symptoms (of one patient) were outside the normal range. Comparison of the current weather conditions with their means, questioning of patients and repeated examinations are used to gain information. The data was analyzed employing the SAS statistical software. Pearson and Spearman correlations were used, applied on the best and worst days, when a minimum and a maximum of pathological changes NPR in the patients' well-being were observed. The statistical significance was p < 0.05 in all cases. RESULTS ~1500 medical observations and verbal statements were registered in the Primary Care Clinic (Be'er-Sheva, Israel) during 2001-2002. No meaning correlation was found between NPR and absolute values of temperature, humidity and atmospheric pressure. Variations in wind speed WS and direction were expressed in blood pressure changes and in exacerbation of discomfort of various degrees. Unfavorable conditions correspond to days with dominant desert air streams and to high WS, when NPR reaches 85.7%; during the days with prevalent sea breeze NPR was ≤22.9%. The role of wind direction in NPR occurrence is prevalent when WS > 4 m·s-1. The Spearman test gives higher correlation than Pearson test (ρ ~ 0.14, p < 0.03 against ρ ~ 0.1, p < 0.04). CONCLUSIONS NPR is more affected by the air streams than by absolute values of meteorological parameters. The method of this study might give to family doctors some additional tools to predict deterioration in general feelings of chronic patients and could be related to other health problems influenced by the meteorological environment.
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Affiliation(s)
- Naomy S Yackerson
- Department of Electrical and Computer Engineering, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Ljuba Bromberg
- Department of Mathematics, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Batiah Adler
- Department of Family Medicine, Clalit Health Services, Ben-Gurion University, Irus Hanegev Str 115, Be’er Sheva, 84851, Israel
| | - Alexander Aizenberg
- Department of Family Medicine, Clalit Health Services, Ben-Gurion University, Irus Hanegev Str 115, Be’er Sheva, 84851, Israel
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Abstract
The influence of temperature changes on risk factors like hypertension is often disregarded despite extensive literature on the phenomenon. Numerous surveys and studies have documented the correlation between temperature and blood pressure in various countries among adults, the elderly, and children. Twenty-four-hour blood pressure studies also generally show higher blood pressure in the winter. The suggested etiology is that cold increases sympathetic tone, evidenced by elevated blood pressure and plasma and urinary noradrenaline concentrations. The lower blood pressure in warm temperatures is attributed to cutaneous vasodilatation and loss of water and salt from sweating. Taking seasonal variations in blood pressure into account will increase the meaningful information collected in population surveys and mass screenings. It will also result in more personalized management of antihypertensive medications tailored to the individual.
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Mundal R, Kjeldsen SE, Sandvik L, Erikssen G, Thaulow E, Erikssen J. Seasonal covariation in physical fitness and blood pressure at rest and during exercise in healthy middle-aged men. Blood Press 1997; 6:269-73. [PMID: 9359996 DOI: 10.3109/08037059709062081] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
It has been suggested that seasonal changes in cardiovascular risk factors may explain simultaneous seasonal variations in cardiovascular diseases. Since systolic blood pressure (SBP) during an ergometer exercise test adds prognostic information beyond that of BP at rest we aimed to study whether SBP during exercise also demonstrates similar seasonal variation after adjustment for covariates. Blood pressures of 1574 apparently healthy men aged 40-59 years examined throughout two consecutive years showed a seasonal variation, with higher SBP during the period September-December compared with the rest of the year, 2.8 mmHg (p = 0.003) at rest and 4.2 mmHg (p < 0.001) during ergometer exercise at 600 kpm min-1. After adjustment for a parallel marked drop in physical fitness, these differences were no longer significant. Thus, the seasonal variation in SBP at rest and during exercise in apparently healthy middle-aged men may be explained by a parallel seasonal variation in physical fitness. A seasonal covariation in long-term cardiovascular mortality in the same study suggests that the parallel variation of independent risk factors is of clinical significance.
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Affiliation(s)
- R Mundal
- Department of Internal Medicine, Central Hospital of Akershus, Nordbyhagen, Norway
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15
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Jakovljević D, Salomaa V, Sivenius J, Tamminen M, Sarti C, Salmi K, Kaarsalo E, Narva V, Immonen-Räihä P, Torppa J, Tuomilehto J. Seasonal variation in the occurrence of stroke in a Finnish adult population. The FINMONICA Stroke Register. Finnish Monitoring Trends and Determinants in Cardiovascular Disease. Stroke 1996; 27:1774-9. [PMID: 8841328 DOI: 10.1161/01.str.27.10.1774] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Seasonal influence on the incidence of and mortality from cerebrovascular disease has been reported during the last three decades, but generally with some discrepancy in results, particularly regarding stroke subtypes. The aim of this study was to examine seasonal variation in the incidence, mortality, and case-fatality rate of stroke in data from the FINMONICA population-based stroke register. METHODS During 1982 to 1992, 15449 stroke events were registered in the monitored populations aged 25 to 99 years in three geographic areas of Finland: the provinces of Kuopio and North Karelia in eastern Finland and the Turku/Loimaa area in southwestern Finland. We analyzed the seasonal and monthly incidence, mortality, and case-fatality rate of stroke and subtypes of stroke by pooling the data for the three areas and stratifying by sex and age. RESULTS The rate of occurrence of ischemic stroke events was 12% (95% confidence interval [CI], 5% to 20%) greater in men and 11% (95% CI, 4% to 19%) greater in women in winter than in summer. For intracerebral hemorrhage, we observed a 28% (95% CI, 3% to 58%) greater rate of occurrence in men and a 33% (95% CI, 6% to 66%) greater rate of occurrence in women in winter than in summer. The occurrence of subarachnoid hemorrhage did not vary significantly by season. The greater incidence of ischemic strokes in winter was particularly prominent among men aged 25 to 64 years and less prominent in elderly men and in women. The 28-day case-fatality rate of ischemic stroke showed significant seasonal variation only in women (P = .001), with the lowest rate in summer. CONCLUSIONS There is a significantly greater incidence of ischemic strokes and intracerebral hemorrhages during winter in Finland. Further research that also takes meteorologic and sociodemographic factors into account is warranted, since it may help to determine new ways to prevent strokes.
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Affiliation(s)
- D Jakovljević
- Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
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16
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Kristal-Boneh E, Harari G, Green MS, Ribak J. Seasonal changes in ambulatory blood pressure in employees under different indoor temperatures. Occup Environ Med 1995; 52:715-21. [PMID: 8535490 PMCID: PMC1128351 DOI: 10.1136/oem.52.11.715] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The effect of indoor temperature control on summer and winter ambulatory blood pressure levels at work was studied. METHOD Ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) were monitored once in summer and once in winter in 101 healthy normotensive subjects aged 28-63 years, engaged in similar physical work, from two plants with and three without air conditioning. Subjects were interviewed about health related habits, and measurements of environmental and occupational conditions were obtained. RESULTS After controlling for possible confounders, mean SBP and DBP during work were significantly higher in winter than in summer (delta SBP = 3.4 mm Hg, P = 0.035; delta DBP = 3.3 mm Hg, P < 0.003). The seasonal change in SBP and DBP showed an independent association with the presence or absence of air conditioning of the industrial plants (SBP: beta = 0.194, P < 0.0001; DBP: beta = 0.054, P = 0.038). The percentage of subjects with increases of more than 10 mm Hg from summer to winter was higher in plants without than with air conditioning. CONCLUSIONS (1) In normotensive subjects ambulatory working BP varies by season, with higher values in winter. If validated for hypertensive subjects, it may be necessary to tailor drug treatment to these variations. (2) The findings make it clear that drawing valid conclusions from comparisons of BPs between groups requires controlling for several factors, particularly season of the year. (3) Climatic conditions in the industrial plant influence the magnitude of seasonal variations in BP. Work in plants without air conditioning places a considerable added load on the employee's cardiovascular system.
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Affiliation(s)
- E Kristal-Boneh
- Occupational Health and Rehabilitation Institute, Raanana, Israel
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17
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Chyatte D, Chen TL, Bronstein K, Brass LM. Seasonal fluctuation in the incidence of intracranial aneurysm rupture and its relationship to changing climatic conditions. J Neurosurg 1994; 81:525-30. [PMID: 7931585 DOI: 10.3171/jns.1994.81.4.0525] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Seasonal and climatic variations have been linked to the occurrence of some types of cerebrovascular disease; however, the conditions that lead to intracranial aneurysm rupture are not known. The purpose of the present study was to determine whether seasonal and climatic conditions are related to intracranial aneurysm rupture. Data provided by the Connecticut Health Information Management and Exchange were analyzed for all patients with a primary diagnosis of aneurysmal subarachnoid hemorrhage (SAH) for the fiscal years 1981, 1983, 1985, 1987, 1988, and 1989. Patient records were correlated with climatic conditions for the years 1981 to 1989 obtained from the National Climatic Data Center, National Oceanic and Atmospheric Administration, National Environmental Satellite Data, and Information Service. During the time periods studied, 1487 patients with a primary diagnosis of aneurysmal SAH were treated by reporting hospitals. Seasonal variation in the incidence of aneurysmal SAH and admission clustering were observed but differed significantly between men and women. Men showed a single large peak in late fall (Roger's r = 11.5, p < 0.005), whereas women had an annual peak occurring in late spring (Roger's r = 10.3, p < 0.01). Substantial climatic change occurred during the 72 hours prior to 10 of the 14 clusters of men who were admitted (p < 0.01, Yates' corrected chi-square 7.33, df = 1). In contrast, clusters of women admitted were not related to preceding climatic change (p > 0.25, Yates' corrected chi-square 0.06, df = 1). Hospital admissions for aneurysmal SAH display seasonal fluctuation, with women showing a different seasonal pattern from men. Changing climatic conditions precede aneurysm rupture in men but not in women, which suggests that weather is causally related to aneurysm rupture in men, and that factors that lead to aneurysm rupture in women may be different from those in men. These data do not explain why weather fronts or gradients are associated with aneurysm rupture in men.
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Affiliation(s)
- D Chyatte
- Department of Neurosurgery, Cleveland Clinic Foundation, Ohio
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