Female sexual dysfunction in essential hypertension: a common problem being uncovered

OBJECTIVES: Female sexual dysfunction (FSD) is increasingly attracting more scientific and public interest, and represents a poorly investigated issue in patients with essential hypertension. We evaluated the prevalence of sexual dysfunction in hypertensive women compared with normotensive women according to age, hypertension severity, hypertension duration, and antihypertensive treatment. METHODS: The study population consisted of consecutive, sexually active women attending an outpatient hypertension clinic. The Female Sexual Function Index (FSFI questionnaire) was used to evaluate FSD. Univariate and multivariate analyses were used to evaluate predictors of FSD. RESULTS: Four hundred and seventeen women were studied. From them, 216 women had arterial hypertension (136 treated, 80 untreated) and 201 were normotensive. Sexual dysfunction was found in 42.1% of hypertensive women compared with 19.4% of normotensive women (odds ratio, 3.2; 95% confidence interval, 1.9-4.7; P < 0.001). Systolic blood pressure levels were significantly related to FSFI score (r = -0.67, P < 0.001). Successful control of hypertension was related to lower prevalence of FSD. Increasing age (beta = -0.187, P = 0.001), increasing systolic blood pressure (beta = -0.687, P < 0.001), and beta-blocker administration (beta = -0.162, P = 0.001) were significant predictors of sexual dysfunction in this patient population. CONCLUSIONS: FSD is more prevalent in women with essential hypertension compared with women with normal blood pressure, and its prevalence declines with adequate blood pressure control. Adequate control of hypertension with medication not affecting sexual function can have a great impact on the quality of life of hypertensive patients. Physicians should recognize and properly manage FSD in hypertensive women.     

Sexual Dysfunction in Essential Hypertension: Myth or Reality?

Erectile dysfunction is currently considered a condition with high prevalence in the general population, exerting a major impact on patients' and their sexual partners' quality of life. Available data indicate that hypertension represents a risk factor for erectile dysfunction, which is more frequent in hypertensive compared with normotensive subjects. The pathophysiologic basis of erectile dysfunction in hypertension is under thorough investigation, and several mechanisms have been proposed. Erectile dysfunction has also been related to cardiovascular risk factors and might be used as a marker of cardiovascular disease in the future. Although male sexuality has been studied rather extensively, female sexual dysfunction in hypertension is underexplored. Recently published hypertension guidelines either ignore or superficially address sexual dysfunction, underlining the need for more attention and better education of health care professionals on this issue.     

Effects of transdermal scopolamine on pulmonary function, symptoms and bronchial hyperresponsiveness to methacholine

This study is a result of two consecutive double-blind, placebo-controlled, cross-over studies. In the first study, we evaluated therapeutic effects of a single transdermal scopolamine patch (Scopoderm® TTS, size 2.5 cm², Ciba Geigy) on forced expiratory volume in one second (FEV₁), reversibility, peak expiratory flow (PEF) and symptoms in ten patients with reversible airways disease (ΔFEV₁9% predicted). During the study, blood and urine samples were taken from the patients and analysed for scopolamine levels. The drug was adequately taken up from the patch into the systemic circulation. However, no significant clinical effects, nor correlations between the scopolamine levels and the outcome parameters were observed. Because of the possibility of sub-therapeutic doses in the first study, a second study with two transdermal scopolamine patches was performed in ten patients with bronchial hyperresponsiveness to methacholine. The blood and urine concentrations of free scopolamine were doubled compared to the first study. There were still no statistically significant effects on FEV₁, PEF, symptoms, and bronchial hyperresponsiveness, yet most of the patients now reported adverse side effects. We conclude that transdermal administration of scopolamine is not clinically useful in asthma and chronic obstructive pulmonary disease. Even application of two patches does not result in therapeutically effective levels at the muscarinic receptors in the lung, yet causes several side effects.     

Patients with autoimmune chronic inflammatory diseases present increased biomarkers of thromboinflammation and endothelial dysfunction in the absence of flares and cardiovascular comorbidities

Journal of Thrombosis and Thrombolysis - Cardiovascular risk is increased in patients with autoimmune rheumatic diseases. Endothelial, erythrocyte and platelet microvesicles (MVs) are elevated in...     

Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded

Background

D-dimer testing to rule out deep vein thrombosis is less useful in older patients because of a lower specificity. An age-adjusted D-dimer cut-off value increased the proportion of older patients (>50 years) in whom pulmonary embolism could be excluded. We retrospectively validated the efficacy of this cut-off combined with clinical probability for the exclusion of deep vein thrombosis.

Design and Methods

Five management study cohorts of 2818 consecutive outpatients with suspected deep vein thrombosis were used. Patients with non-high or unlikely probability of deep vein thrombosis were included in the analysis; four different D-dimer tests were used. The proportion of patients with a normal D-dimer test and the failure rates were calculated using the conventional (500 μg/L) and the age-adjusted D-dimer cut-off (patient''s age x 10 μg/L in patients >50 years).

Results

In 1672 patients with non-high probability, deep vein thrombosis could be excluded in 850 (51%) patients with the age-adjusted cut-off value versus 707 (42%) patients with the conventional cut-off value. The failure rates were 7 (0.8; 95% confidence interval 0.3-1.7%) for the age-adjusted cut-off value and 5 (0.7%, 0.2-1.6%) for the conventional cut-off value. The absolute increase in patients in whom deep vein thrombosis could be ruled out using the age-adjusted cut-off value was largest in patients >70 years: 19% among patients with non-high probability.

Conclusions

The age-adjusted cut-off of the D-dimer combined with clinical probability greatly increases the proportion of older patients in whom deep vein thrombosis can be safely excluded.Key words: deep vein thrombosis, D-dimer, diagnosis, hemostasis, pulmonary embolism, venous thromboembolism     

A fully traits-based approach to modeling global vegetation distribution

Dynamic Global Vegetation Models (DGVMs) are indispensable for our understanding of climate change impacts. The application of traits in DGVMs is increasingly refined. However, a comprehensive analysis of the direct impacts of trait variation on global vegetation distribution does not yet exist. Here, we present such analysis as proof of principle. We run regressions of trait observations for leaf mass per area, stem-specific density, and seed mass from a global database against multiple environmental drivers, making use of findings of global trait convergence. This analysis explained up to 52% of the global variation of traits. Global trait maps, generated by coupling the regression equations to gridded soil and climate maps, showed up to orders of magnitude variation in trait values. Subsequently, nine vegetation types were characterized by the trait combinations that they possess using Gaussian mixture density functions. The trait maps were input to these functions to determine global occurrence probabilities for each vegetation type. We prepared vegetation maps, assuming that the most probable (and thus, most suited) vegetation type at each location will be realized. This fully traits-based vegetation map predicted 42% of the observed vegetation distribution correctly. Our results indicate that a major proportion of the predictive ability of DGVMs with respect to vegetation distribution can be attained by three traits alone if traits like stem-specific density and seed mass are included. We envision that our traits-based approach, our observation-driven trait maps, and our vegetation maps may inspire a new generation of powerful traits-based DGVMs.To understand and predict the impacts of climate change on system Earth, it is essential to predict global vegetation distribution and its attributes. Vegetation determines the fluxes of energy, water, and CO₂ to and from terrestrial ecosystems. So-called Dynamic Global Vegetation Models (DGVMs) (reviewed in ref. 1) are indispensable tools to make predictions on such biosphere–climate interactions. Despite their importance, DGVMs are among the most uncertain components of earth system models when predicting climate change (2).DGVMs have been built around the concept of Plant Functional Types (PFTs) (3). Traditionally, various functional attributes (or traits) were assumed to be constant for a given PFT. This assumption has various drawbacks (reviewed in ref. 4). For instance, it implies assuming that trait values used to parameterize PFTs are valid under past environmental conditions and will be valid under future conditions. As such, this assumption neglects acclimation and adaptation (5), nonrandom species extinction (6), and major differences in dispersal rates among species and within PFTs (7). Moreover, this assumption strongly hampers quantifying feedback mechanisms between vegetation and its environment.For these reasons, the application of traits in DGVMs is increasingly refined. Trait responses to, for example, different soil fertility conditions are described as an emergent property in relation to nutrient feedbacks (8). Also, acclimation processes are increasingly included by replacing constant photosynthesis and respiration parameters by functions of temperature or CO₂ (9, 10), with profound impacts on predicted carbon fluxes (11). Within current DGVMs, traits are varied within a PFT (12), not allowing for assessing the direct impacts of traits relative to its indirect effects (for example, through productivity, biomass, or feedbacks changing environmental conditions). A comprehensive analysis of the direct impacts of trait variation as such (within and between PFTs) on global vegetation functioning and distribution does not yet exist. However, the paradigm shifts from species-centered approaches to traits-based approaches (13), the rapid increase in the compilation and application of traits-based analyses (14, 15), and the associated conceptual advances (e.g., in assembly theory) (16) allow for such analyses independent of a DGVM.Our aim was to describe global trait variation and evaluate whether trait variation alone already allows for predicting the global distribution of vegetation types, which is one of the principle aims of DGVMs. We first empirically describe global trait distribution and global trait maps—independent of vegetation type—as a function of multiple environmental drivers. Subsequently, in a posterior calculation, we predict the occurrence probability of vegetation types. This way, we derive a DGVM-independent trait-driven estimate of global vegetation distribution. We envision that our approach may inspire a new generation of powerful traits-based DGVMs applying (fully) traits-based concepts to predict carbon, water, and energy fluxes.