‘I believe high blood pressure can kill me:’ using the PEN-3 Cultural Model to understand patients’ perceptions of an intervention to control hypertension in Ghana

Objectives: Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients’ perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana.

Design: Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data.

Results: Emergent themes included patients’ perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes.

Conclusions: This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management.     

清肝解郁和健脾补肾法在治疗肝火上亢型慢性肾衰合并高血压中的应用

目的:观察清肝解郁和健脾补肾法治疗肝火上亢型慢性肾衰(CRF)合并高血压患者的临床效果。方法:选取2016年6月至2018年6月京东誉美医院收治的肝火上亢型CRF合并高血压患者90例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组45例。对照组给予口服硝苯地平控释片治疗,观察组在对照组治疗基础上给予清肝解郁、健脾补肾汤治疗,每4周为1个疗程,均治疗3个疗程。比较治疗前后中医症状评分、收缩压(SBP)、舒张压(DBP)变化;比较2组临床疗效;比较治疗前后肾功能指标:尿素氮(BUN)、血肌酐(Scr)、24 h尿蛋白定量(24 hPRO);统计治疗期间2组不良反应发生情况。结果:治疗前观察组与对照组中医症状评分、SBP、DBP、BUN、Scr、24 hPRO比较,差异均无统计学意义(P>0.05),治疗后2组患者中医症状评分、SBP、DBP、BUN、Scr、24 hPRO均显著降低(P<0.05),观察组均低于对照组,差异有统计学意义(P<0.05);2组临床疗效比较,差异有统计学意义(P<0.05),且观察组总有效率显著高于对照组,差异有统计学意义(P<0.05);观察组和对照组不良反应发生率分别为2.22%和6.67%,2组比较差异无统计学意义(P>0.05)。结论:清肝解郁、健脾补肾法辅助治疗肝火上亢型CRF合并高血压疗效确切,可较好控制血压,并且可显著改善肾功能,减少不良反应发生情况。     

Angiopathie amyloïde cérébrale ou atteinte des microvaisseaux cérébraux en rapport avec l’HTA : un challenge clinique

Cerebral amyloid angiopathy (CAA) is a entity characterized by degenerative Amyloïd deposits in the walls of the meningeal and cortical vessels. It is considered as the second cause of primitives cerebral hemorrhage in elderly. The differential diagnosis between AAC and hypertension-related cerebral small vessel diseases is difficult and represent a true challenge for the clinician. We report two cases of cerebral small vessel diseases revealed by malignant hypertension.     

ACE2 receptor polymorphism: Susceptibility to SARS-CoV-2, hypertension,multi-organ failure,and COVID-19 disease outcome

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged in Chinese people in December 2019 and has currently spread worldwide causing the COVID-19 pandemic with more than 150,000 deaths. In order for a SARS-CoV like virus circulating in wild life for a very long time to infect the index case-patient, a number of conditions must be met, foremost among which is the encounter with humans and the presence in homo sapiens of a cellular receptor allowing the virus to bind. Recently it was shown that the SARS-CoV-2 spike protein, binds to the human angiotensin I converting enzyme 2 (ACE2). This molecule is a peptidase expressed at the surface of lung epithelial cells and other tissues, that regulates the renin-angiotensin-aldosterone system. Humans are not equal with respect to the expression levels of the cellular ACE2. Moreover, ACE2 polymorphisms were recently described in human populations. Here we review the most recent evidence that ACE2 expression and/or polymorphism could influence both the susceptibility of people to SARS-CoV-2 infection and the outcome of the COVID-19 disease. Further exploration of the relationship between the virus, the peptidase function of ACE2 and the levels of angiotensin II in SARS-CoV-2 infected patients should help to better understand the pathophysiology of the disease and the multi-organ failures observed in severe COVID-19 cases, particularly heart failure.     

MicroARN: la biología molecular como herramienta de predicción en preeclampsia

Preeclampsia is a disease with a significant incidence worldwide that is directly associated with 15% of maternal deaths. This is usually characterized by the presence of hypertension and proteinuria, which manifests itself from the middle of pregnancy. MicroRNAs are single-stranded RNA molecules that act primarily by degrading transcribed messenger RNA or inhibiting microRNA translation. Placental microRNAs play a role in the growth and function of the placenta, their potential use as diagnostic biomarkers is considered feasible due to the ability to enter the maternal circulation and be detectable in maternal plasma.