Article

Prevalence, awareness, treatment and control of hypertension and salt intake in Portugal: changes over a decade. The PHYSA study

March 2014
Journal of Hypertension 32(6)

DOI:10.1097/HJH.0000000000000162

Source
PubMed

Authors:

Jorge Polonia

University of Porto

Luis Martins

Centro Hospitalar de Entre o Douro e Vouga

To determine prevalence, awareness, treatment and control of hypertension and the 24-h sodium excretion (24h-UNa) in the Portuguese adult population and to examine their changes from a similar study done in 2003. A population-based cross-sectional survey conducted in 2011-2012. A multistage-stratified (by age and sex) sampling method was used to select a representative sample of the 18-90-year-old population yielding 3720 participants (52.6% women, 97.1% Caucasians). Hypertension was defined as a SBP of at least 140 mmHg or DBP of at least 90 mmHg [average of 2-3 blood pressure (BP) measurements by trained observers with OMRON M6] or reported knowledge or treatment with antihypertensive drugs at the first visit (V1). A complete clinical information was obtained with a standard questionnaire. This procedure was repeated 10-15 days after visit 2 (V2) and 24-h urinary sample was collected for 24h-UNa, 24-h potassium excretion and creatinine excretion. The overall prevalence of hypertension at V1 was 42.2% (44.4% in men, 40.2% in women) (42.1% in 2003). The age-specific prevalence of hypertension was 6.8, 46.9 and 74.9% in people below 35 years, 35-64 years and above 64 years. Comorbidities were 2.2-6.3 times more common in hypertensive patients vs. normotensive individuals. Overall, among the hypertensive patients, 76.6% were aware of the hypertension condition, 74.9% were treated and 42.5% were controlled (BP <140/90 mmHg), that is, respectively, 1.7, 1.9 and 3.8 times higher vs. data in 2003, with lower values in men vs. women and younger vs. older people. Global mean BP was 127.4/74.6 ± 17.7/10.5 vs. 134.7/80.4 ± 21.2/14.1 mmHg in 2003. From V1 to V2, control of hypertension increased on average by 14.8%. Multivariate analysis showed that age and BMI were independently associated with prevalence of hypertension. 24h-UNa (84% valid urinary samples) was 182.5 ± 64.7 mmol/day (10.7 g salt/day) and 24-h potassium excretion 75.2 ± 26.1 mmol/day. 24h-UNa was higher in patients with hypertension than in normotensive individuals (185.4 ± 64.8 vs. 177.8 ± 64.5 mmol/day; P < 0.02) and correlated with SBP (r = 0.05), age (r = 0.08) and BMI (r = 0.10) (P < 0.01). Hypertension prevalence among Portuguese adults remained stable in the past decade, but proportions of awareness, treatment and control of hypertension improved significantly. Salt intake is still high being almost double the WHO recommendations.

Guidelines-based therapeutic strategies for controlling hypertension in non-controlled hypertensive patients followed by family physicians in primary health care in Portugal: the GPHT-PT study

Article

Full-text available

Apr 2024

Purpose In a prospective open study, with intervention, conducted in Primary Health Care Units by General Practitioners (GPs) in Portugal, the effectiveness of a single pill of candesartan/amlodipine (ARB/amlodipine), as the only anti-hypertension (anti-HTN) medication, in adult patients with uncontrolled HTN (BP > 140/or > 90 mm Hg), either previously being treated with anti-HTN monotherapies (Group I), or combinations with hydrochlorothiazide (HCTZ) (Group II), or not receiving medication at all (Group III), was evaluated across 12-weeks after implementation of the new therapeutic measure. Materials and methods A total of 118 GPs recruited patients with uncontrolled HTN who met inclusion/exclusion criteria. Participants were assigned, according to severity, one of 3 (morning) fixed combination candesartan/amlodipine dosage (8/5 or 16/5 or 16/10 mg/day) and longitudinally evaluated in 3 visits (v0, v6 and v12 weeks). Office blood pressure was measured in each visit, and control of HTN was defined per guidelines (BP< 140/90 mmHg). Results Of the 1234 patients approached, 752 (age 61 ± 10 years, 52% women) participated in the study and were assigned to groups according to previous treatment conditions. The 3 groups exhibited a statistically significant increased control of blood pressure after receiving the fixed combination candesartan/amlodipine dosage. The overall proportion of controlled HTN participants increased from 0,8% at v0 to 82% at v12. The mean arterial blood pressure values decreased from SBP= 159.0 (± 13.0) and DBP= 91.1 (± 9.6) at baseline to SBP= 132,1 (± 11.3) and DBP= 77,5 (± 8.8) at 12 weeks (p < 0.01). Results remained consistent when controlling for age and sex. Conclusion In patients with uncontrolled HTN, therapeutic measures in accordance with guidelines, with a fixed combination candesartan/amlodipine, allowed to overall achieve HTN control at 12 weeks in 82% of previously uncontrolled HTN patients, reinforcing the advantages of these strategies in primary clinical practice.

Association of Periodontitis with Ambulatory Blood Pressure, Salt Intake, and Neutrophil-Lymphocyte Ratio in High-Risk Hypertensive Patients

Article

Full-text available

Mar 2024

Objective : Periodontitis and cardiovascular disease are prevalent entities that often coexist, with a common pro-inflammatory pathway. The objective of this study was to evaluate the association between periodontitis and cardiovascular pro-inflammatory parameters rarely considered within risk factors. Methods : Forty-three participants aged between 38-82 years were examined. An association between mean probing depth (MPD), mean attachment loss (MAL), bleeding on probing (BOP), and periodontal inflamed surface area (PISA) was correlated with the following cardiovascular disease factors and inflammatory promoters: neutrophil-to-lymphocyte ratio (NLR), 24h ambulatory blood pressure, global cardiovascular risk, daily salt intake, night-time systolic blood pressure (nSBP), and pulse wave velocity (PWV). A two-way ANOVA and multiple comparison tests were performed using SPSS statistics software. Results : A highly significant correlation (p<0.05) was found between BOP, MPD, and MAL with high salt intake, global cardiovascular risk estimation, nSBP, and PISA. Also, significantly statistical correlation (p<0.05) was found between BOP, NLR, and PWV while PISA was only associated with NLR. Logistic regression analysis identified absolute values of nSBP, salt intake and NLR as possible independent contributors to the increase in the log odds of developing BOP. Conclusions : Several periodontal disease parameters are linked to cardiovascular risk factors such as hypertension, neutrophil-to-lymphocyte ratio, daily salt intake and night-time systolic blood pressure.

Influence of sociodemographic and family characteristics on adherence to treatment of hypertensive individuals in the community

Article

Full-text available

Dec 2021

Introdução: A hipertensão arterial apresenta uma elevada prevalência sendo considerada um problema de saúde pública. Um dos obstáculos do controlo da hipertensão é a não adesão ao tratamento. Objetivo: Identificar variáveis sociodemográficas e familiares que interferem na adesão ao tratamento de pessoas com hipertensão arterial em contexto comunitário. Métodos: Estudo transversal analítico. A amostra foi de 235 pessoas com hipertensão arterial e utilizadores da Unidade Móvel de Saúde de Castro Daire. Os dados foram recolhidos em 2015 através de um questionário composto por variáveis sociodemográficas, Escala de Apgar Familiar e Escala de Medida de Adesão aos Tratamentos (MAT). A análise dos dados efetuou-se no SPSS 23.0 com o recurso à estatística descritiva e inferencial. Resultados: A maioria da amostra era do sexo feminino (63,8%) com idade média 75±8,14 anos. Apenas 34,5% dos indivíduos hipertensos apresentavam tensão arterial controlada, sendo 28,2% homens e 38% mulheres. A MAT revelou uma média de 5,66±0,49 pontos e quase 45% da população não adere ao tratamento. Os participantes com maiores níveis de adesão ao tratamento eram do sexo masculino, com idades ≤ 64 anos, sem companheiro, viver sozinhos, sem habilitações literárias, reformados, com rendimentos inferiores, com apoio social, mas sem diferenças significativas. Conclusão: Mais de metade dos indivíduos não apresentava a pressão arterial controlada e quase metade da amostra não adere ao tratamento. Não encontrámos variáveis associadas com a adesão ao tratamento.

Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study

Article

Full-text available

Sep 2022

Background Excessive salt consumption—associated with a range of adverse health outcomes—is very high in Portugal, and bread is the second largest source. Current Portuguese legislation sets a maximum limit of 1.4 g salt per 100 g bread, but imported and traditional breads are exempted. In 2017 the Ministry of Health proposed reducing the salt threshold to 1.0/100 g by 2022, however the legislation was vetoed by the European Commission on free-trade grounds. Aims To estimate the health impact of subjecting imported and traditional breads to the current 1.4 g threshold, and to model the potential health impact of implementing the proposed 1.0 g threshold. Methods We gathered bread sales, salt consumption, and epidemiological data from robust publicly available data sources. We used the open source WHO PRIME modeling tool to estimate the number of salt-related deaths that would have been averted in 2016 (the latest year for which all data were available) from; (1) Extending the 1.4 g threshold to all types of bread, and (2) Applying the 1.0 g threshold to all bread sold in Portugal. We used Monte Carlo simulations to generate confidence intervals. Results Applying the current 1.4 g threshold to imported and traditional bread would have averted 107 deaths in 2016 (95% CI: 43–172). Lowering the current threshold from 1.4 to 1.0 g and applying it to all bread products would reduce daily salt consumption by 3.6 tons per day, saving an estimated 286 lives a year (95% CI: 123–454). Conclusions Salt is an important risk factor in Portugal and bread is a major source. Lowering maximum permissible levels and removing exemptions would save lives. The European Commission should revisit its decision on the basis of this new evidence.

Association of periodontitis with cerebral small vessel disease in hypertensive patients - A pilot study

Article

Full-text available

Mar 2024

Objectives: Cerebral small vessel disease is a chronic, progressive disorder of arterioles, capillaries, and small veins supplying the brain’s white matter and deep structures of gray matter. The latest evidence seems to suggest that chronic oral infections such as periodontitis contribute to cerebral small vessel disease progression. This study evaluated the relationship between periodontal disease and brain white matter hyperintensities. Methods: Forty-three hypertensive patients, aged between 38-82, without previous cardiovascular events, of which 42% were female and 50% diabetic, were evaluated. An association between mean probing depth, mean attachment level, bleeding on probing, total periodontal inflamed surface area, and white matter hyperintensities diagnosed by magnetic resonance was studied. A significance level (α) of 0.05 was considered, and Pearson’s chi-square and Mann-Whitney tests were applied. Results: Data analysis revealed an inverse correlation between mean probing depth, bleeding on probing, total periodontal inflamed surface area, and white matter hyperintensities. A positive correlation was found between mean attachment level and white matter hyperintensities. Conclusions: In our study and within our sample, lower values of mean probing depth, bleeding on probing, and total periodontal inflamed surface area were associated with more White matter hyperintensities. Contrarily, mean attachment level was positively associated with white matter hyperintensities.

Exploring Lifestyle Factors and Treatment Adherence among Older Adults with Hypertension Attending a Mobile Health Unit (MHU) in a Rural Area of Central Portugal

Article

Full-text available

Apr 2024

This cross-sectional and analytical study aimed to characterize a sample of hypertensive older adults attending a Mobile Health Unit (MHU) in a rural area of central Portugal according to their lifestyle and to analyze the impact of lifestyles on treatment adherence. The sample comprised 235 Portuguese hypertense patients, mainly females (63.8%) with a mean age of 75 years (±8.14 years) and low level of education. The data collection was carried out through a questionnaire consisting of sociodemographic questions, dietary variables, an Alcohol Dependence Questionnaire, an International Physical Activity Questionnaire (Short Version), a Nutrition Health Determination Questionnaire, a Self-Care with Hypertension Scale, and an Adherence to Treatments Measurement Scale. Only 34.5% of the hypertensive patients have controlled blood pressure values (28.2% men and 38% women). However, more than half (56.2%) of the hypertensive patients are classified as adherent to therapeutic measures. The hypertensive individuals, who present higher levels of adherence to the treatment, do not present alcohol dependence, are frequent consumers of aromatic herbs, sporadically consume salt, present good nutritional health, and practice moderate physical activity. The predictor variables for treatment adherence are the self-care dimensions general dietary (p = 0.001), specific dietary (p = 0.034), physical activity (p = 0.031), and antihypertensive medication intake (p < 0.001). Hypertensive patients with healthier lifestyles present better levels of treatment adherence. Therefore, promoting physical activity and healthy dietary practices is necessary to improve treatment adherence and increase antihypertensive treatment’s effectiveness.

Empowerment-based nutrition interventions on blood pressure: a randomized comparative effectiveness trial

Article

Full-text available

Nov 2023

Introduction Empowerment lifestyle programs are needed to reduce the risk of hypertension. Our study compared the effectiveness of two empowerment-based approaches toward blood pressure (BP) reduction: salt reduction-specific program vs. healthy lifestyle general program. Methods Three hundred and eleven adults (median age of 44 years, IQR 34–54 years) were randomly assigned to a salt reduction (n = 147) or a healthy lifestyle program (n = 164). The outcome measures were urinary sodium (Na⁺) and potassium (K⁺) excretion, systolic (SBP) and diastolic (DBP) blood pressure, weight, and waist circumference. Results There were no significant differences in primary and secondary outcomes between the two program groups. When comparing each program to baseline, the program focused on salt reduction was effective in lowering BP following a 12-week intervention with a mean change of −2.5 mm Hg in SBP (95% CI, −4.1 to −0.8) and − 2.7 mm Hg in DBP (95% CI, −3.8 to −1.5) in the intention-to-treat (ITT) analysis. In the complete-case (CC) analysis, the mean change was −2.1 mm Hg in SBP (95% CI, −3.7 to −0.5) and − 2.3 mm Hg in DBP (95% CI, −3.4 to −1.1). This effect increases in subjects with high-normal BP or hypertension [SBP − 7.9 mm Hg (95% CI, −12.5 to −3.3); DBP − 7.3 mm Hg (95% CI, −10.2 to −4.4)]. The healthy lifestyle group also exhibited BP improvements after 12 weeks; however, the changes were less pronounced compared to the salt reduction group and were observed only for DBP [mean change of −1.5 mm Hg (95% CI, −2.6 to −0.4) in ITT analysis and − 1.4 mm Hg (95% CI, −2.4 to −0.3) in CC analysis, relative to baseline]. Overall, improvements in Na⁺/K⁺ ratio, weight, and Mediterranean diet adherence resulted in clinically significant SBP decreases. Importantly, BP reduction is attributed to improved dietary quality, rather than being solely linked to changes in the Na⁺/K⁺ ratio. Conclusion Salt-focused programs are effective public health tools mainly in managing individuals at high risk of hypertension. Nevertheless, in general, empowerment-based approaches are important strategies for lowering BP, by promoting health literacy that culminates in adherence to the Mediterranean diet and weight reduction.

Vascular risk factors and carotid atheromatous disease in patients over 65 years of age

Article

Aug 2023

Introduction: Vascular risk factors are decisive in the evolution of atherosclerotic disease and the carotid and vertebral Doppler ultrasound allows monitoring its onset and progress. The measurement of arterial wall thickening allows the early diagnosis of the disease enhancing its treatment and control of vascular risk factors. Aim: Analysing the presence of atheromatous disease in individuals aged > 65 years and understanding its correlation with vascular risk factors. Materials and methods: This is a cross-sectional observational study, in individuals aged > 65 years and underwent carotid echoDoppler between January 1, 2012, and December 31, 2021. The intimal-media index was calculated, as was the presence of atheromatous plaques, their hemodynamic repercussion and vascular risk factors were recorded. Results: A sample of 5885 individuals was obtained with 41.8% female and 58.2% male. The mean age was 76.59 (± 6.69), with a range between 65 and 98 years. Arterial hypertension was the most prevalent 81.3%. There was a significant positive relationship between the intima-media index and age (p = 0.001). In the presence of plaques, male gender, arterial hypertension, diabetes, dyslipidemia, and smoking it presents a positive correlation. Conclusion: In this sample, non-modifiable vascular risk factors seem to be determinants in the presence of increased arterial wall thickness. In the presence of signs of a more advanced stage of atherosclerotic disease, modifiable vascular risk factors are decisive, corroborating the already-known importance of strict control over them for their treatment.

Environmental Taxation on the Agri-Food Sector and the Farm to Fork Strategy: The Portuguese Case

Article

Full-text available

Aug 2023

This research focuses on the environmental taxation applicable to the agri-food sector and aligns with the objectives of the Farm to Fork (F2F) Strategy of the European Green Deal context. Indeed, the methodology of the research develops a theoretical analysis through a literature review to assess environmental taxation and documental analysis of Portuguese tax codes. Furthermore, the Portuguese context of the empirical analysis assesses the contribution to the desired sustainability of the agri-food sector. The results show that the existing tax rules applicable to the agri-food sector are scant, with a few existing rules being misaligned with the objectives of the F2F strategy, because their potential impact on its objectives has been mostly negative or null. Most regulations predated the definition of the F2F strategy, seeking to respond to the need to minimise the price of basic food products, namely agri-food products, without considering concerns such as welfare and sustainability. It is worrisome, however, that a tax rule that does not conform to the F2F strategy has been approved after its definition, indicating that the Portuguese government does not envisage using taxation as an environmental tool in favour of the objectives outlined in the F2F strategy.

Vascular Risk Factors and Carotid Atheromatous Disease in Patients over 65 Years of Age

Preprint

Full-text available

May 2023

Introdução: Os fatores de risco vasculares são decisivos na evolução da doença aterosclerótica e a ecografia Doppler carotídea e vertebral permite acompanhar o seu aparecimento e evolução. A medida do espessamento da parede arterial permite o diagnóstico precoce da doença potencializando seu tratamento e controle dos fatores de risco vasculares. Objetivo: Analisar a presença de doença ateromatosa em indivíduos com idade > 65 anos e compreender sua transformação com fatores de risco vascular. Materiais e Métodos: Estudo observacional transversal, em indivíduos com idade > 65 anos manifestados ao ecoDoppler carotídeo entre 1º de janeiro de 2012 e 31 de dezembro de 2021. Foi calculado o índice médio-intimal, a presença de placas ateromatosas, sua repercussão hemodinâmica e fatores de risco vascular foram registrados. Resultados: Obteve-se uma amostra de 5885 indivíduos, sendo 41,8% do sexo feminino e 58,2% do sexo masculino. A média de idade foi de 76,59 anos, variando entre 65 e 98 anos (+6,69). A hipertensão arterial foi a mais prevalente 81,3%. Houve relação positiva significativa entre índice médio-intimal, idade e história pessoal de doenças cardiovasculares e cerebrovasculares (p=0,001). Na presença de placas, sexo masculino, hipertensão arterial, diabetes, dislipidemia, tabagismo e história pessoal de doenças cardiovasculares e cerebrovasculares apresentadas de forma positiva. Conclusões: Nesta amostra, fatores de risco vascular não modificáveis parecem ser determinantes na presença de aumento da espessura da parede arterial. Na presença de sinais de um estágio mais avançado da doença aterosclerótica, os fatores de risco vascular modificáveis são decisivos

Iodine Availability through Iodized Salt in Portugal: 2010–2021 Sales Evolution and Distribution

Article

Full-text available

Mar 2023

Salt iodization programs are considered the most cost-effective measures to ensure adequate iodine intake in iodine-deficient populations. Portuguese women of childbearing age and pregnant women were reported to be iodine-deficient, which led the health authorities, in 2013, to issue a recommendation for iodine supplementation during preconception, pregnancy and lactation. In the same year, iodized salt became mandatory in school canteens. Of note, no regulation or specific programs targeting the general population, or the impact of iodized salt availability in retailers, are known. The present study analyzed iodized salt supermarket sales from 2010 to 2021 from a major retailer, identifying the proportion of iodized salt in total salt sales and its distribution in mainland Portugal. Data on iodine content were collected through the nutritional label information. Of a total of 33 salt products identified, 3 were iodized (9%). From 2010 to 2021, the weighted sales of iodized salt presented a growing tendency, reaching the maximum of 10.9% of total sales (coarse plus fine salt) in 2021. Iodized salt reached a maximum of 11.6% of total coarse salt in 2021, a maximum of 2.4% of the total fine salt in 2018. The overall sales of iodized salt and their contribution to iodine intake are extremely low, prompting additional studies to understand the consumer’s choice and awareness of the benefits of iodized salt.

The prevalence of metabolic syndrome and its components in Bragança District, North-Eastern Portugal: A retrospective observational cross-sectional study

Article

Jun 2022

Introduction: Metabolic syndrome (MetS) is an independent determinant to increase the risk of metabolic and cardiovascular diseases. MetS prevalence in Portugal is high, however an update is needed since the latest Portuguese epidemiological report is from 2017. Thus, this study aims to examine MetS prevalence and its components in the adult and older Portuguese sub-population (Bragança District). Methods: A retrospective observational cross-sectional was conducted with a community sample collected from two Portuguese primary health care centres between January 2019 and December 2020. A total of 6570 individuals aged 18–102 years were included for analysis, among which 3865 women (57.37 ± 18.67 years) and 2705 men (59.97 ± 16.76 years). MetS was defined according to HARM2009 statement and binary logistic regression was performed to analyse the prevalence across sex and age. Results: MetS prevalence in Bragança District was 54.51%. MetS prevalence was higher in men (61.63%) than women (49.52%). Men are 1.53 (95% OR: 1.37–1.72, p < 0.001) times more likely of having MetS compared to women. MetS risk increases with age (OR: 2.68–42.57, p < 0.001) with a decline from the eighties onwards (OR: 27.84, 95% CI: 19.19–40.38, p < 0.001). Men presented higher prevalence of overweight (48.50%) and obesity (28.06%) and women have higher prevalence of abdominal obesity (62.07%). Conclusion: This study reported high prevalence of MetS in the Portuguese sub-population (Bragança District). A quasi-linear increase across age was verified in the MetS prevalence for both sexes with a decline from the eighties onwards.

Central obesity and radiographic severity are associated with symptomatic hand osteoarthritis: a population-based cross-sectional study

Article

Full-text available

May 2025
RHEUMATOL INT

To investigate the association between cardiometabolic factors, obesity, radiographic severity, and symptomatic hand osteoarthritis (HOA), as the role of these factors in HOA remains unclear. A cross-sectional analysis in the EPIPorto cohort included participants with HOA (≥ 1 joint with Kellgren-Lawrence (KL) grade ≥ 2 and/or American College of Rheumatology criteria). Cardiovascular risk factors, anthropometric measures, and radiographic severity (sum of KL hand score [0–128]) and number of affected joints [0–32]) were analysed. We tested the association between these factors and symptomatic HOA (≥ 1 joint with KL ≥ 2 and hand pain in the last month) by multivariable logistic regression. Of the 858 participants with HOA (61% women, mean age 59.6 years), 807 met radiographic criteria, and 160 presented symptomatic HOA. Among these, 77% were overweight or obese, 81% hypertensive, 95% had dyslipidaemia, and 20% were diabetic. Body mass index, waist circumference, and waist-to-height ratio, were associated with symptomatic HOA (OR 1.04, 95% CI 1.00; 1.09), (OR 1.02, 95% CI 1.00; 1.04), (OR 1.03, 95% CI 1.01; 1.06). Diabetes, hypertension, and dyslipidaemia showed no association. We observed an association between the KL score, the number of affected joints, and symptomatic HOA (OR 1.09, 95% CI 1.07; 1.12), (OR 1.09, 95% CI 1.06; 1.12). Increased central obesity and radiographic severity are associated with symptomatic HOA, highlighting the potential role of adiposity in HOA pain. These findings underscore the importance of weight management to improve pain outcomes in HOA. Furthermore, assessing radiographic changes may aid monitoring of disease symptoms. Further studies are needed to validate these associations and inform evidence-based clinical practice.

Adherence to pharmacological therapy for hypertension in Portugal: a health professionals focus groups study

Article

Full-text available

Feb 2025

Introduction The perspectives of local healthcare professionals for developing effective strategies to enhance medication adherence in arterial Hypertension as well as its barriers have not yet been explored through qualitative research in Portugal. Objectives This study aimed to assess the views of healthcare professionals including general practitioners/family physicians, nurses, and community pharmacists, from Portugal on effective strategies to improve medication adherence in Hypertension, and to identify factors hindering pharmacological adherence. Methods and analyses This was a qualitative study with synchronous online focus groups, in which, the participants were general practitioners/family physicians, family nurses, or community pharmacists in Portugal with experience managing patients with Hypertension. They were selected based on age, sex, and geographical region with the number of focus groups determined by theoretical saturation. Recruitment was facilitated through specific mailing lists. Purposive and snowball sampling techniques were employed. Focus group discussions were recorded and transcribed. Two researchers conducted content analyses via MAXQDA®2023, applying comparative analysis and reaching consensus. The results are described narratively. Results Three focus group discussions revealed a multifaceted approach to improving medication adherence for Hypertension. Key strategies to enhance coordination and communication among healthcare professionals, patients, and caregivers were identified. These included shared informatics software among healthcare professionals; using mobile applications and wearables; health literacy initiatives and patient empowerment; preprepared medication in pillboxes; involving family and the concept of a “family pharmacist”. Participants highlighted barriers to medication adherence such as the lack of communication with patients concerning issues like medication adherence. Conclusions This qualitative study outlines strategies to improve medication adherence among patients with Hypertension in Portugal. These involve improving healthcare coordination and communication, patient empowerment, and involving family and “family pharmacists” in supporting adherence. These strategies are based on the insights of healthcare professionals and could be implemented following robust intervention studies. Clinical trial number Not applicable.

Adherence to the Mediterranean Diet, Sodium and Potassium Intake in People at a High Risk of Dementia

Article

Full-text available

May 2024

Adequate sodium and potassium intake, along with adherence to the Mediterranean diet (MedDiet), are key factors for preventing hypertension and cerebrovascular diseases. However, data on the consumption of these nutrients within the MedDiet are scarce. This cross-sectional study aims to assess the association between MedDiet adherence and sodium/potassium intake in the MIND-Matosinhos randomized controlled trial, targeting Portuguese adults at a high risk of dementia. Good adherence to the MedDiet was defined using the Portuguese Mediterranean Diet Adherence Screener questionnaire (≥10 points), and both sodium/potassium intakes were estimated from 24-hour urine collections. The association between MedDiet adherence and these nutrients’ intake (dichotomized by the median) was quantified by calculating odds ratios (OR) and respective 95% confidence intervals (95% CI) using a logistic regression. A total of 169 individuals (60.9% female; median age: 70 years; range: 36–85 years) were included. Good adherence to the MedDiet was observed among 18.3% of the sample. After adjusting for sex, age, education and using antihypertensive drugs, good MedDiet adherence was associated with higher sodium (OR = 3.11; 95% CI: 1.27–7.65) and potassium intake (OR = 9.74; 95% CI: 3.14–30.26). Increased adherence to the MedDiet may contribute to a higher potassium intake but seems to have limited effects on the adequacy of sodium levels.

Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review

Article

Full-text available

Feb 2024

Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.

The Risk Factors of Hypertension and Their Predictive Power in Identifying Patients Using a Decision Tree

Article

Full-text available

Mar 2024

Hypertension (HTN) is the most important controllable risk factor for non-communicable diseases that can have various causes, which vary in different subgroups. This secondary analysis was conducted using the data obtained through the recruitment phase of Ravansar non-communicable cohort study (RaNCD). The multivariable logistic regression was used to determine the risk factors of HTN, and a decision tree with the CART algorithm was used to determine the predictive power of these variables. Of the 10,046 individuals aged 35 to 65 participating in RaNCD, 1579 (15.72%) of the participants had HTN. Aging and diabetes were the most important risk factors of HTN. The sensitivity and specificity of the decision tree for the training and testing models were very similar, such that the sensitivity of training was 69.0% and testing 68.0%, and their specificity was 73.0% and 71.0%, respectively. Overall, the accuracy rate of the training and testing models was 70% and 68%, respectively. The variable that best discriminated people with HTN from non-HTN was diabetes. In people with diabetes, the incidence of HTN was 5 years higher than those without diabetes. Since the predictive power and effect of the risk factors of HTN vary from one group to another, the decision tree can be of great help in identifying people with HTN due to the latent nature of the disease.

Sudden death in young South European population: a cross-sectional study of postmortem cases

Article

Full-text available

Dec 2023

To describe the annual incidence and the leading causes of sudden non-cardiac and cardiac death (SCD) in children and young adult Portuguese population. We retrospectively reviewed autopsy of sudden unexpected deaths reports from the Portuguese National Institute of Legal Medicine and Forensic Sciences’ database, between 2012 and 2016, for the central region of Portugal, Azores and Madeira (ages 1–40: 26% of the total population). During a 5-year period, 159 SD were identified, corresponding to an annual incidence of 2,4 (95%confidence interval, 1,5–3,6) per 100.000 people-years. Victims had a mean age of 32 ± 7 years-old, and 72,3% were male. There were 70,4% cardiac, 16,4% respiratory and 7,5% neurologic causes of SD. The most frequent cardiac anatomopathological diagnosis was atherosclerotic coronary artery disease (CAD) (33,0%). There were 15,2% victims with left ventricular hypertrophy, with a diagnosis of hypertrophic cardiomyopathy only possible in 2,7%. The prevalence of cardiac pathological findings of uncertain significance was 30,4%. In conclusion, the annual incidence of SD was low. Atherosclerotic CAD was diagnosed in 33,0% victims, suggesting the need to intensify primary prevention measures in the young. The high prevalence of pathological findings of uncertain significance emphasizes the importance of molecular autopsy and screening of first-degree relatives.

Hypertension and COVID-19: Relation with Complications, Comorbidities and Mortality

Article

Full-text available

Mar 2023

Introduction: SARS-CoV-2 infection is characterized by hyperproduction of pro-inflammatory cytokines that impact the cardiovascular system. In addition, several cardiovascular risk factors, like arterial hypertension, were identified as risk factors for greater disease severity and mortality in these patients. The objective of this study is to evaluate the prevalence of hypertension in patients with COVID-19 and its association with complications, comorbidities and mortality. Methods: Retrospective study of the patients with COVID-19 admitted to Internal Medicine ward between March 2020 and February 2021. Data was collected from the digital clinical file. Logistic regression was applied to clarify the effect of independent variables on mortality. Results: The sample included 1291 patients with COVID-19, a median age of 73 years (IQR: 22) and male gender predominance (n = 701, 54.3%). There were 65.5% (n = 845) of patients with hypertension, 54.9% (n = 709) dyslipidemia and about a third had diabetes mellitus and obesity (31 and 38%, respectively). Comparatively to the non-hypertensive patients, hypertensive group presented with higher prevalence of other cardiovascular risk factors (diabetes mellitus, obesity and dyslipidemia (p <0.001)) and lower functionality and more comorbidities (as calculated by AVDezIS and Charlson modified scores, p<0.001). There was also higher proportion of severe COVID-19 disease (p = 0.003), greater number of patients admitted to intensive care units (p <0.001) and higher in-hospital mortality (p <0.001). Hypertension was not a mortality predictive factor in these patients. Conclusion: In this study, patients with hypertension presented with higher severity of COVID-19 disease, higher pre-valence of other cardiovascular risk factors, complications during hospitalization and in-hospital mortality, however, its presence was not a mortality predictive factor.

Iodine intake assessment in the staff of a Porto region university (Portugal): the iMC Salt trial

Article

Full-text available

Apr 2023
EUR J NUTR

Purpose Iodine deficiency disorder (IDD) is an ongoing worldwide recognized problem with over two billion individuals having insufficient iodine intake. School-aged children and pregnant women are often target groups for epidemiological studies, but there is a lack of knowledge on the general adult population. The aim of this study was to assess the iodine status among a Portuguese public university staff as a proxy for the adult working population. Methods The population study covered 103 adults within the iMC Salt randomized clinical trial, aged 24–69 years. Urinary iodine concentration was measured spectrophotometrically using the Sandell–Kolthoff reaction. Iodine food intake was assessed using a 24-h dietary recall. The contribution of discretionary salt to the iodine daily intake was assessed through 24-h urinary sodium excretion (UIE) and potentiometric iodine determination of household salt. Results The mean urine volume in 24 h was 1.5 L. The median daily iodine intake estimated from 24-h UIE was 113 µg/day, being lower among women (p < 0.05). Only 22% of participants showed iodine intake above the WHO-recommended cutoff (150 µg/day). The median daily iodine intake estimated from the 24-h dietary recall was 58 µg/day (51 and 68 µg/day in women and men, respectively). Dairy, including yoghurt and milk products, were the primary dietary iodine source (55%). Iodine intake estimated from 24-h UIE and 24-h dietary recall was moderately correlated (Spearman rank correlation coefficient r = 0.34, p < 0.05). The average iodine concentration in household salt was 14 mg I/kg, with 45% of the samples below the minimum threshold preconized by WHO (15 mg I/kg). The contribution of discretionary salt to the daily iodine intake was around 38%. Conclusion This study contributes new knowledge about iodine status in Portuguese working adults. The results revealed moderate iodine deficiency, particularly in women. Public health strategies and monitoring programs are needed to ensure iodine adequacy in all population groups.

Intake of added sugar, fruits, vegetables, and legumes of Portuguese preschool children: Baseline data from SmartFeeding4Kids randomized controlled trial participants

Article

Full-text available

Mar 2023

Introduction The SmartFeeding4Kids (SF4K) program is an online self-guided intervention for parents with the propose of changing parental feeding practices and children’s dietary intake, focusing on the intake of added sugars, fruit, vegetables, and legumes. This paper aims to describe children’s dietary pattern at baseline through a 24-h food recall, the SmartKidsDiet24. Methods Overall, 89 participants recorded at least one meal of the 3-day food recall. Mean age was 36.22 ± 6.05 years and 53.09 ± 15.42 months old for parents and children, respectively. Of these, 22 participants were considered to have 2 days of near complete 24-h food recalls. Children’s dietary intake are reported for these 22 participants based on parents reports and, thus, represent estimations only, as it remains unknown whether children consumed other non-reported foods. Results Fruit was the group with the highest daily intake among children (mean 1.77 ± 1.10 portions/day), followed by added sugar foods (mean 1.48 ± 0.89 portions/day), vegetables [median 1.27 (1.64) portions/day] and legumes [median 0.12 (0.39) portions/day]. Fruit intake was positively correlated with vegetable intake (p = 0.008). Regarding Dietary Reference Values accomplishment, 13.6% of children exceeded the daily safe and adequate intake of sodium, 77.3% did not meet potassium and fiber recommendations, and 31.8% did not meet vitamin C recommendations. Discussion All children did not meet calcium, vitamin B12 and vitamin D intake recommendations. Our findings further justify the need for dietary interventions in this field, to improve young children’s diets. Clinical trial registration ClinicalTrials.gov, identifier NCT04591496.

Causes of sudden death in a young (<40 years-old) South European population: a postmortem study

Preprint

Full-text available

Jan 2023

Aims To describe the annual incidence and the leading causes of sudden non-cardiac and cardiac death (SCD) in children and young adult Portuguese population. Methods We retrospectively reviewed autopsy of sudden unexpected deaths reports from the Portuguese National Institute of Legal Medicine and Forensic Sciences’ database, between 2012 and 2016, for the central region of Portugal, Azores and Madeira (ages 1–40: 26% of the total population). Results During a 5-year period, 159 SD were identified, corresponding to an annual incidence of 2,4 (95%confidence interval, 1,5 − 3,6) per 100.000 people-years. Victims had a mean age of 32 ± 7 years-old, and 72,3% were male. There were 70,4% cardiac, 16,4% respiratory and 7,5% neurologic causes of SD. The most frequent cardiac histopathological diagnosis was atherosclerotic coronary artery disease (CAD) (33,0%). There were 15,2% victims with left ventricular hypertrophy, with a diagnosis of hypertrophic cardiomyopathy only possible in 2,7%. The prevalence of cardiac pathological findings of uncertain significance was 30,4%. Conclusions The annual incidence of SD was low. Atherosclerotic CAD was diagnosed in 33,0% victims, suggesting the need to intensify primary prevention measures in the young. The high prevalence of pathological findings of uncertain significance emphasizes the importance of molecular autopsy and screening of first-degree relatives.

Literacia em Saúde nos doentes Hipertensos e adultos sem Hipertensão Arterial

Article

Full-text available

Dec 2022

A literacia em saúde desempenha um papel fulcral na gestão da doença crónica e no acesso aos cuidados de saúde. O presente estudo teve como objetivo a avaliação e comparação dos níveis de literacia em saúde entre adultos com e sem Hipertensão Arterial. Foram utilizados um questionário sociodemográfico e o Inquérito em Literacia em Saúde em Portugal. Neste estudo transversal participaram 152 indivíduos, sendo 76 hipertensos e 76 indivíduos sem patologia crónica, com idades entre 35 e 65 anos. Os indivíduos sem doença crónica apresentaram níveis de literacia em saúde mais elevados nas dimensões de prevenção de doença e promoção da saúde e os participantes com hipertensão na dimensão de cuidados de saúde. Verificou-se que os indivíduos mais velhos e com menor escolaridade surgem como grupos vulneráveis com níveis problemáticos de literacia em saúde. Este estudo contribuiu para realçar a importância de uma adequada literacia em saúde para aumentar o conhecimento e compreensão sobre a doença e as suas complicações.

Conocimientos y prácticas relacionadas con el uso de la saluna investigación exploratoria de chefs iberos para promover universidades saludables

Article

Jul 2022

Fundamentos: Es importante comprometer a los chefs, actores principales en la producción de comidas, en estudios exploratorios de comportamientos para formular intervenciones efectivas para promover una alimentación saludable en las universidades. Por tanto, el objetivo de este estudio fue evaluar los conocimientos y prácticas de los cocineros asociados a la sal. Métodos: Se trata de un estudio transversal con manipuladores de alimentos de comedores de universidades públicas del norte de Portugal (PT) y España (SP) mediante cuestionario para evaluar los conocimientos y prácticas asociados al uso de sal. Resultados: Un total de 36 manipuladores de alimentos (12 de PT y 24 de SP) completaron la encuesta. Los manipuladores de alimentos SP eran significativamente más jóvenes (p = 0,034) y la mayoría de los sujetos eran mujeres. La mayoría reconoció el nivel recomendado de ingesta diaria de sal y conocía los impactos en la salud del consumo excesivo. El factor más importante que determinó la cantidad de sal agregada a las comidas fue el gusto del manipulador de alimentos y la mayoría estaba de acuerdo con la reducción de sal. La principal dificultad en la reducción de la sal fue la opinión del consumidor. La mayoría tenía interés en la inclusión de tecnología o nuevas herramientas para ayudar a la medición de la sal. El componente de la comida más adecuado para la reducción de sal fue la sopa (PT) y las ensaladas (SP) (p = 0,013). Conclusiones: Los resultados de este estudio proporcionan información valiosa sobre los muchos factores que influyen en el uso de la sal y las opiniones de los chefs con respecto a las posibilidades de reducción de la sal. Esta encuesta podría ser un primer paso en el desarrollo de estrategias para hacer que las comidas en los comedores universitarios sean más saludables.

Could salt intake directly affect the cerebral microvasculature in hypertension?

Article

Sep 2022
J Stroke Cerebrovasc Dis

Objectives Excess dietary salt and chronic kidney disease (CKD) are acknowledged stroke risk factors. The development of small vessel disease, similarly affecting the cerebral and renal microvasculatures, may be an important mechanistic link underlying this interaction. Therefore, we aimed to evaluate if the dietary salt intake and markers of CKD (estimated glomerular filtration rate, albuminuria) relate to transcranial Doppler (TCD) markers of cerebral small vessel disease (CSVD) in hypertensive patients. Materials and methods Fifty-six hypertensive patients (57% with diabetes) underwent TCD monitoring in the middle (MCA) and posterior (PCA) cerebral arteries for evaluating neurovascular coupling (NVC), dynamic cerebral autoregulation (dCA), and vasoreactivity to carbon dioxide (VRCO2). We investigated the relation between renal parameters and TCD studies using Pearson's correlation coefficient and linear regression analyses. Results There were no associations between dCA, VRCO2, NVC, and renal function tests. However, there was a negative association between the daily salt intake and the natural frequency during visual stimulation (r²=0.101, ß=-0.340, p=0.035), indicative of increased rigidity of the cerebral resistance vessels that react to cognitive activation. Conclusions In this cross-sectional study, we found an association between excess dietary salt consumption and CSVD in hypertensive patients. Future research is needed to evaluate whether the natural frequency could be an early, non-invasive, surrogate marker for microvascular dysfunction in hypertension.

The association between salt intake and blood pressure is mediated by body mass index but modified by hypertension: The ELSA-Brasil study

Article

Full-text available

Jun 2022

High salt intake has been linked to both obesity and high blood pressure (BP). Part of the variability of BP attributed to salt intake might be BMI-mediated. To investigate whether hypertension would be an effect modifier in the complex network including salt intake, obesity, and BP, we tested the hypothesis that salt intake has direct and BMI-mediated effects on systolic (SBP) and diastolic blood pressure (DBP). Data from 9,028 participants (aged 34–75 years, 53.6% women) were analyzed. A validated formula was used to estimate daily salt intake from the sodium excretion (12 h urine collection). A path model adjusted for covariates was designed in which salt intake has both a direct and a BMI-mediated effect on BP. In normotensives, standardized beta coefficients showed significant direct (Men: 0.058 and 0.052, Women: 0.072 and 0,061, P < 0.05) and BMI-mediated (Men: 0.040 and 0.065, Women: 0.038 and 0.067, P < 0.05) effect of salt intake on the SBP and DBP, respectively. However, in hypertensive individuals, neither the direct (Men: 0.006 and 0.056, Women: 0.048 and 0.017) nor the indirect effect (Men: −0.044 and 0.014, Women: 0.011 and 0.050) of salt intake on the SBP and DBP were significant. These data suggest that cardiovascular risk stratification should consider the complex interaction between salt intake and weight gain, and their effects on BP of normotensive and hypertensive individuals.

Evaluation of Cardiovascular Pharmacotherapy Guideline Adherence and Risk Factor Control in Portuguese Community Pharmacy Patients

Article

Full-text available

May 2022
Int J Environ Res Publ Health

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Assessing the patients' CVD risk, controlling the risk factors, and ensuring the guideline-adherent cardiovascular pharmacotherapy are crucial interventions to improve health outcomes. This study aimed to evaluate the potential of pharmacists to improve the adherence to pharmacotherapy guidelines and the achievement of risk factor goals among patients who attended a community pharmacy. Methods: We conducted a single-center cross-sectional study. We performed in-pharmacy point-of-care testing, blood pressure and anthropometric measurements, and reviewed patients' pharmacotherapy, based on European Society of Cardiology guidelines. Results: Of the 333 patients, 63.1% were in the high/very high risk category, 91.9% showed at least two modifiable risk factors, and in 61.9% of patients the cardiovascular pharmacotherapy was non-adherent to the current guidelines, failing to reach treatment goals. The lipid-lowering therapy was the least guideline adherent, with a suboptimal use of statins. However, we found no statistically significant difference between the guideline-adherent and the non-adherent group in terms of risk factor control. The pharmacist recommended 603 interventions to adhere to the guidelines. Conclusions: Community pharmacists are able to identify opportunities to optimize cardiovascular pharmacotherapy and support the patients to achieve cardiovascular risk factor goals, based on evidence-based guidelines, contributing to the improvement of CVD management.

Structural Equation Modelling for Predicting the Relative Contribution of Each Component in the Metabolic Syndrome Status Change

Article

Full-text available

Mar 2022
Int J Environ Res Publ Health

Understanding the factor weighting in the development of metabolic syndrome (MetS) may help to predict the progression for cardiovascular and metabolic diseases. Thus, the aim of this study was to develop a confirmatory model to describe and explain the direct and indirect effect of each component in MetS status change. A total of 3581 individuals diagnosed with MetS, aged 18–102 years, were selected between January 2019 and December 2020 from a community-representative sample of Portuguese adults in a north-eastern Portuguese region to test the model’s goodness of fit. A structural equation modelling (SEM) approach and a two-way ANOVA (age × body composition) were performed to compare the relative contribution of each MetS component using joint interim statement (JIS). Waist circumference (β = 0.189–0.373, p < 0.001), fasting glucose (β = 0.168–0.199, p < 0.001) and systolic blood pressure (β = 0.140–0.162, p < 0.001) had the highest direct effect on the change in MetS status in the overall population and concerning both sexes. Moreover, diastolic blood pressure (DBP), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-c) had a low or non-significant effect. Additionally, an indirect effect was reported for age and body composition involving the change in MetS status. The findings may suggest that other components with higher specificity and sensitivity should be considered to empirically validate the harmonised definition of MetS. Current research provides the first multivariate model for predicting the relative contribution of each component in the MetS status change, specifically in Portuguese adults.

Hypertension prevalence, awareness, treatment and control in 2019 in the adult population of Mayotte

Article

Full-text available

Feb 2022
EUR J PUBLIC HEALTH

Background: Mayotte is a French overseas territory with significant socio-economic and health challenges. This study updates the prevalence of hypertension in Mayotte to estimate the awareness, treatment and control of this disease and identify any associated factors. Methods: Data were taken from the cross-sectional Unono Wa Maore survey conducted in Mayotte in 2019. Analyses were based on the adult population aged 18-69 years who underwent a clinical examination with at least two blood pressure measurements (n = 2620). Results: In 2019, the prevalence of hypertension was estimated at 38.4% (36.1-40.7%) in the Mayotte population aged 18-69 years. The prevalence was similar in men (38.5%) and women (38.3%; P = 0.95). The prevalence of certain risk factors was high, with 75% of hypertensives being overweight or obese, 13% reporting diabetes and 69% being occupationally inactive. Among the hypertensives, 48% was aware of their diagnosis, with women more likely to be aware than men (P < 0.0001). Of those who were aware, 45% were treated pharmacologically and 49% reported engaging in physical activity to lower their blood pressure. The control rate was 30.2% among pharmacologically treated hypertensives. Overall, 80% of hypertensive patients had too high blood pressure during the survey's clinical examination. Conclusion: The prevalence of hypertension remains high in Mayotte, where certain risk factors like obesity are particularly common in the population. Awareness, treatment and control remain insufficient. Primary prevention measures, access to a healthy food, and screening and treatment of hypertension should be encouraged by targeting the most affected populations.

“Pela Saúde de Portugal “- data from a screening on blood pressure

Article

May 2025
Blood Pres

MISSÃO 70/26 -HIPERTENSOS CONTROLADOS APÓS UM ANO DE ATIVIDADE MISSION 70/26-CONTROLLED HYPERTENSIVE PATIENTS AFTER ONE YEAR OF ACTIVITY

Article

Full-text available

Apr 2024

Resumo A Hipertensão Arterial (HTA) é um fator risco major para morte e incapacidade muito prevalente e com um grau de controlo aquém do desejado. Neste contexto, a Sociedade Portuguesa de Hipertensão implementou a Missão 70/26, um programa estratégico multifacetado que tem como objetivo alcançar 70% de controlo nos hipertensos vigiados nos Cuidados de Saúde Primários até 2026. Após um ano do seu início, constatou-se um incremento mensal sustentado no controlo da HTA, verificando-se uma redução sazonal no mês de dezembro. Do ponto de vista geográfico, identificámos uma melhoria do controlo na metade Norte do território nacional e região Este do Algarve, com uma redução da assimetria previamente demonstrada entre as regiões litoral e interior centro. Abstract Hypertension (HTN) is a major risk factor for death and disability that is very prevalent and has a lower than desired degree of control. In this context, the Portuguese Hypertension Society implemented Mission 70/26, a multifaceted strategic program that aims to achieve 70% control in hypertensive patients monitored in Primary Health Care by 2026. One year after its start, there was a monthly increase in HTN control, with a seasonal reduction in December. From a geographical point of view, there was an improvement in the northern half of the country and eastern Algarve, with a reduction in the previously reported asymmetry between central coastal and inland regions.

Lifestyle and Brain Damage in Hypertension

Chapter

Jan 2024

Healthy lifestyle delays the onset of several cardiovascular risk factors such as hypertension, obesity, diabetes, and dyslipidaemia and reduces their progression to clinical cardiovascular disease such as stroke and cognitive decline. Healthy lifestyle habits may modify the activity and expression of several genes associated with this cardiovascular risk factors contributing to reduce cardiovascular morbidity and mortality. Healthy lifestyle includes a balanced diet with moderate salt intake, potassium supplementation, regular physical activity, reduction of alcohol consumption, weight control, and avoiding tobacco use. The adoption of healthy lifestyle together with pharmacological treatment is recommended by all guidelines for primary and secondary prevention of cardiovascular, cerebrovascular, and renal events and mortality. It is generally assumed that the adoption of some lifestyle changes such as losing weight, adherence to DASH diet, reduction of salt (sodium chloride) in the diet, augmentation of potassium intake, regular physical activity and structured exercise, moderation of alcohol consumption, and stopping tobacco use are able to reduce premature cardiovascular and cerebrovascular morbidity and mortality. This chapter shows and discusses the available evidence on the beneficial effects of healthy lifestyle in the prevention of brain damage including stroke and cognitive decline.

Hypertension Knowledge Test Published

Article

Full-text available

Jul 2024

ARTICLE INFO ABSTRACT Objective: The objective of the study was to develop and validate a multi-dimensional test for the measurement of hypertension-related knowledge among hypertensive patients. Methods: Using a two-stage sampling procedure, four villages were randomly selected from a total of 40 villages, and 224 hypertensive patients were randomly sampled from these villages in the Medchal district of Telangana in India. Results: Exploratory factor analysis using the principal components method, with varimax rotation revealed a five-factor solution viz. Hypertension-related Management and Control, General Knowledge, Lifestyle-related Knowledge, Health Complications, and Risk Factorswhich accounted for 75% of the total variance. The Hypertension Knowledge Test for Indian Hypertensive Patients (HKT-I) comprised of 31 items and the Cronbach's alpha reliability value of the test was found to be .97 for this sample. The criterion-related validity of the HKT-I was established as the HKT-I scores, were significantly positively correlated with the scores of the Hypertension Therapeutic Adherence Scale for Indian hypertensive patients (HTAS-I) (r = 0.81, p < 0.001), and the Health Beliefs Scale for Hypertensive Patients (HBSHP) (r = 0.84, p < 0.001) and significantly negatively correlated with the systolic (r =-0.44, p < 0.001)and diastolic (r =-0.56, p < 0.001) blood pressure (BP) measurements. Conclusion: The HKT-I was found to be a reliable and valid multi-dimensional instrument, for the measurement of hypertension-related knowledge, among Indian hypertensive patients. Hence the HKT-I can serve to quantify hypertension-related knowledge holistically, to identify and screen hypertensive patients with low levels of knowledge regarding their condition.

Cardiovascular risk assessment using SCORE2 in a population with hypertension – The reality at a primary health care unit

Article

Jul 2024

Assessment of Sodium Levels in Portuguese Supermarket Foods: A Global Benchmark Perspective

Article

May 2024
J FOOD COMPOS ANAL

Consumption of ultra-processed foods and relationship with sodium and potassium excretion: a cross-sectional study

Article

Full-text available

May 2024

Introduction: Higher consumption of ultra-processed foods (UPF) had been associated with higher risk of non-communicable diseases (NCD) and NCD-promoting nutrient profile such as high sodium content and low potassium content. The objective of the study was to evaluate the level of food processing according to the NOVA classification and its relationship with sodium and potassium intake estimated by 24-hour urinary excretion. Methods: This is a cross-sectional study. Data collection included 107 workers from a public university (51.4% female; mean age 47 years) participating in an iMC Salt clinical trial). A 24-hour urinary collection was used to estimate sodium and potassium intake, validated by the creatinine coefficient. The corresponding 24-hour dietary recall was used to assess food intake and foods were categorized using the NOVA classification according to the degree and purpose of processing, into four groups. Nutri-score was also used to categorize UPF and provide more information about the nutritional quality of products. Results: The largest energy contribution came from the group of unprocessed or minimally processed foods (51.6%), followed by UPF (24%), processed foods (21.8%) and processed culinary ingredients (2.6%). Individuals with the lowest caloric contribution of the consumption of UPF had higher average values of potassium (K) intake (1438 vs 1136 mg/1000kcal; p=0.007), as individuals with the highest weight contribution of the consumption of unprocessed or minimally processed foods (1434 vs 1109 mg/1000kcal; p=0.010). For sodium (Na) intake no significant results were found between individuals with the lowest and the highest consumption of each NOVA group. Conclusions: Higher consumption of fresh or minimally processed foods and lower UPF intake were associated with higher K intake values. On the other hand, higher UPF intake was not associated with higher Na intake values. Funding: This work was supported by Fundação para a Ciência e Tecnologia by Grant POCI-01-0145-FEDER-029269) and by the European Regional Development Fund (ERDF) through NORTE 2020 (Northern Regional Operational Program 2014/2020) - NORTE-01-0145-FEDER-072687.

Risk factors for uncontrolled blood pressure among individuals with hypertension on treatment: the CONSTANCES population-based study

Article

Feb 2024
INT J EPIDEMIOL

Background: We aimed to assess factors associated with uncontrolled blood pressure (BP) among individuals with hypertension on treatment, by sex. Methods: We conducted a nested cross-sectional analysis using data from the population-based cohort study CONSTANCES, designed as a randomly selected sample of French adults aged 18-69 years at study inception. We included 11 760 participants previously diagnosed with hypertension and taking antihypertensive medications. Uncontrolled BP was defined as mean systolic BP ≥140 mmHg and/or mean diastolic BP ≥90 mmHg. Sex-specific age-adjusted multivariable analyses were performed using logistic regression models stratified by stages of uncontrolled hypertension. Results: The mean age of participants was 59.4 years. The prevalence of uncontrolled BP was 51.4%, and it was higher in men than in women [adjusted odds ratio (aOR), 1.80; 95% CI, 1.67-1.94]. In both sexes, the lower the age, the lower the prevalence of uncontrolled hypertension. Low level of education and history of cardiovascular events had, respectively, higher and lower odds of uncontrolled BP. In men, additional risk factors included overweight and obesity (aOR, 1.15; 95% CI, 1.00-1.32; and aOR, 1.45; 95% CI, 1.23-1.70, respectively), lack of physical activity (aOR, 1.20; 95% CI, 1.04-1.40), low adherence to a Dietary Approach to Stop Hypertension diet (aOR, 1.21; 95% CI, 1.05-1.40) and heavy alcohol consumption (aOR, 1.33; 95% CI, 1.08-1.63), with the last two factors persisting across different stages of uncontrolled BP. Conclusions: From a population-based perspective, socio-economic and behavioural characteristics were risk factors for uncontrolled hypertension, but they differed by sex and by stage of uncontrolled hypertension. Modifiable risk factors, such as weight, diet, physical activity and alcohol consumption, have an important role in the control of hypertension.

Mission 70/26 Project: improving blood pressure control in Portugal.

Article

Full-text available

Dec 2023

Purpose As reported in most European countries, the percentage of treated hypertensive patients achieving a well-controlled blood pressure (e.g. < 140/90 mmHg) is insufficient. This represents a major health concern particularly in countries with a high prevalence of cardiovascular events such as stroke. Therefore, there is a need to develop national programs to increase not only the awareness regarding elevated blood pressure but also the percentage of treated patients achieving recommended blood pressure targets. The present paper describes the new initiative of the Portuguese Society of Hypertension (PSH) to achieveat least 70% of controlled hypertensive patients, followed in primary care, in 2026. Materials and Methods The strategies used to improve blood pressure control are aimed at healthcare professionals and general population and include governmental and organizational interventions. To be able to analyze the control rate of HTN patients, and using BI-CSP reports (the Primary Care health unit platform), every six months, we will be addressing the proportion of HTN patients (age: 18-65 years) with BP < 140/90 mmHg and the proportion of HTN patients with at least one blood pressure recorded in the last semester. Conclusion With Mission 70/26, the PHS aims to improve awareness among all health professionals and community alike about the problem of uncontrolled HTN and its role in the consequent disability and high mortality rate from cardiovascular causes.

Cardiovascular Risk Factors in Centenarians

Chapter

Sep 2023

Centenarians are a heterogeneous group of individuals for whom evidence-based clinical treatment guidelines may not apply. These oldest of adults are rarely included in clinical trials. This evidence gap leads to challenges for clinicians to know when to prescribe versus “deprescribe,” which dose to use, or even when an intervention will be effective or potentially harmful. What little is known about cardiovascular disease in centenarians is also at times contradictory. For example, while the prevalence of cardiovascular disease is low in this group, it remains the most common cause of mortality. In middle-aged adults, the control of blood pressure and hyperlipidemia is lifesaving. Among centenarians, higher blood pressures tended to correlate with higher scores on functional assessments. Similarly, in some centenarian cohorts, elevated lipids may play a protective role. This chapter will review the literature with respect to management of cardiovascular disease among centenarians.

19. Epidemiological aspects underlying the association between dietary salt intake and hypertension

Chapter

Sep 2017

Hypertension prevalence in Iran’s elderly according to new criteria: the Tehran Geriatric Eye Study

Article

Aug 2023

To determine the prevalence of hypertension in a population above 60 years of age and its relationship with demographic and anthropometric factors. A cross-sectional population-based study was conducted in 2019. Using a multistage random cluster sampling, 160 clusters were selected from 22 districts of Tehran. All participants were interviewed to collect demographic, anthropometric, and socioeconomic information. Then, systolic (SBP) and diastolic (DBP) blood pressures were measured under standard conditions twice, 10 min apart. A third measurement was performed if the two measurements showed a difference of ≥ 10 mmHg in SBP or ≥ 5 mmHg in DBP. Hypertension was defined as a SBP > 130 mmHg or a DBP > 80 mmHg (new criteria), being a known case of hypertension, or use of blood pressure lowering medications. Of 3791 invitees, 3310 participated in the study (87.3%). The mean age of the participants was 68.25 ± 6.54 years (60–97 years). The prevalence of hypertension was 81.08% (95% CI: 79.57–82.59) in the whole sample; 82.96% (95% CI: 81.02–84.91) in females, and 79.15% (95% CI: 76.6 -81.69) in males. The prevalence of hypertension ranged from 75.47% (95% CI: 72.65–78.29) in the age group 60–64 years to 88.40% (95% CI: 83.71–93.08) in the age group ≥ 80 years. The prevalence of hypertension unawareness was 32.84% (95% CI: 30.82–34.86). The highest and lowest prevalence of hypertension was seen in illiterate subjects (89.41%) and those with a university education (77.14%), respectively. According to the multiple logistic regression analysis, older age, lower education level, obesity and overweight, neck circumference, and diabetes were significantly associated with the prevalence of hypertension. A significant percentage of Iranian elderly have hypertension and one of every 3 affected individuals is unaware of their disease. Considering the population aging in Iran, urgent and special attention should be paid to the elderly population. Caring for the elderly, informing families, and using non-traditional screening methods are recommended by families at the first level and policymakers at the macro level.

Polypill use for the prevention of cardiovascular disease: A position paper

Article

May 2023

Cardiovascular (CV) guidelines stress the need for global intervention to manage risk factors and reduce the risk of major vascular events. Growing evidence supports the use of polypill as a strategy to prevent cerebral and cardiovascular disease, however it is still underused in clinical practice. This paper presents an expert consensus aimed to summarize the data regarding polypill use. The authors consider the benefits of polypill and the significant claims for clinical applicability. Potential advantages and disadvantages, data regarding several populations in primary and secondary prevention, and pharmacoeconomic data are also addressed.

As muitas faces da inflamação na arena cardiovascular: a importância da poluição do ar

Article

Jan 2023

Luís Bronze

Salicornia bigelovii, S. brachiata and S. herbacea: Their Nutritional Characteristics and an Evaluation of Their Potential as Salt Substitutes

Article

Full-text available

Oct 2022

Excessive sodium (salt) intake in our diet is a main contributor to hypertension and a major risk factor for cardiovascular illnesses. As a result, research has made great efforts to develop salt alternatives, and Salicornia spp. offers a very high potential in the food industry for its promising functional characteristics. This review focuses on the nutritional profile, health effects and commercial potential of three specific species of the Salicornia genus: S. bigelovii, S. brachiata and S. herbacea. It also addresses the methods that are used to produce them as salt substitutes. Owing to the antinutritional and anti-inflammatory effects of its bioactive compounds, Salicornia spp. can serve as an organic biological preservative in foods with better consumer appeal when compared with chemical preservatives that are common in the food industry. Overall, the commercial use of these underutilized species will help to improve food security.

Population level salt intake in the WHO European Region in 2022: a systematic review

Article

Full-text available

Oct 2022
PUBLIC HEALTH NUTR

Objective: The World Health Organization (WHO) recommends that adults consume less than 5 grams of salt per day to reduce the risk of cardiovascular disease. This study aims to examine the average population daily salt intake in the 53 Member States of the WHO European Region. Design: A systematic review was conducted to examine the most up-to-date salt intake data for adults published between 2000 and 2022. Data were obtained from peer-reviewed and grey literature, WHO surveys and studies, as well as from national and global experts. Setting: The 53 Member States of the WHO European Region. Participants: People aged 12 years or more. Results: We identified 50 studies published between 2010-2021. Most countries in the WHO European Region (n = 52, 98%) reported salt intake above WHO recommended maximum levels. In almost all countries (n = 52, 98%), men consume more salt than women, ranging between 5.39 – 18.51g for men and 4.27 – 16.14g for women. Generally, Western and Northern European countries have the lowest average salt intake, whilst Eastern European and Central Asian countries have the highest average. 42% of the fifty-three countries (n = 22) measured salt intake using 24h urinary collections, considered the gold standard method. Conclusions: This study found that salt intakes in the WHO European Region are significantly above WHO recommended levels. Most Member States of the Region have conducted some form of population salt intake. However, methodologies to estimate salt intake are highly disparate and underestimations are very likely.

Linkage between electronic prescribing data and pharmacy claims records to determine primary adherence: the case of antihypertensive therapy in the Lisbon and Tagus Valley Region, Portugal

Article

Sep 2022
FAM PRACT

André Coelho

Background: Hypertension (HT) is highly prevalent and a major risk factor for cardiovascular disease. Over 42% of Portuguese adults have HT. Even though the benefits of antihypertensive (AHT) drugs have been demonstrated, HT control remains inadequate. One major reason is that patients often fail to take their medications as prescribed. This paper aims to determine primary adherence to AHT therapy in newly diagnosed and treated hypertensive patients in Primary Health Care (PHC) units of Lisbon and Tagus Valley Health Region. Methods: This study reports data from a population-based, retrospective, cohort study from patients diagnosed with HT in PHC units of Lisbon and Tagus Valley Region from 1 January to 31 March 2011, with no prior use of AHT drugs. Primary adherence rate was expressed as number of claims records/total number of prescriptions records. Data were collected from SIARS for each patient during a 2-year period. Results: Overall primary adherence rate was 58.5%, increasing with age. Rates were higher for men, living in the Lisbon Metropolitan Area and diagnosed with uncomplicated HT. Drugs acting on the renin-angiotensin system had the highest rates, increasing for fixed-dose combinations and diminishing with the increase of cost for the patient. Conclusions: Overall, almost 1 out of 2 prescribed AHT drugs were not dispensed. Until this study, little was known in Portugal about primary adherence. Our findings imply that the potential benefits of AHT therapy cannot be fully realized in this population.

Multi-continent descriptive analytics of hypertension, obesity, and smoking

Conference Paper

Jul 2022

Noncompliance to iodine supplementation recommendation is a risk factor for iodine insufficiency in Portuguese pregnant women: results from the IoMum cohort

Article

May 2022
J ENDOCRINOL INVEST

Purpose: After a recommendation for iodine supplementation in pregnancy has been issued in 2013 in Portugal, there were no studies covering iodine status in pregnancy in the country. The aim of this study was to assess iodine status in pregnant women in Porto region and its association with iodine supplementation. Methods: A cross-sectional study was conducted at Centro Hospitalar Universitário São João, Porto, from April 2018 to April 2019. Pregnant women attending the 1st trimester ultrasound scan were invited to participate. Exclusion criteria were levothyroxine use, gestational age < 10 and ≥ 14 weeks, non-evolutive pregnancy at recruitment and non-signing of informed consent. Urinary iodine concentration (UIC) was measured in random spot urine by inductively coupled plasma-mass spectrometry. Results: Median UIC was 104 μg/L (IQR 62-189) in the overall population (n = 481) of which 19% had UIC < 50 µg/L. Forty three percent (n = 206) were not taking an iodine-containing supplement (ICS) and median UIC values were 146 µg/L (IQR 81-260) and 74 µg/L (IQR 42-113) in ICS users and non-users, respectively (p < 0.001). Not using an ICS was an independent risk factor for iodine insufficiency [adjusted OR (95% CI) = 6.00 (2.74, 13.16); p < 0.001]. Iodised salt use was associated with increased median iodine-to-creatinine ratio (p < 0.014). Conclusions: A low compliance to iodine supplementation recommendation in pregnancy accounted for a mild-to-moderately iodine deficiency. Our results evidence the need to support iodine supplementation among pregnant women in countries with low household coverage of iodised salt. Trial registration number NCT04010708, registered on the 8th July 2019.

The Effectivity of Flavonoid Content Which Contained in “Dark Chocolate” with Decreased Blood Pressure in Hypertension Without Complication Patients at Tresna Werdha Public Center in 2017

Article

Full-text available

May 2022

Christian Ronald Tanggo

As the times progressed, lifestyle and food pattern alterations have taken place in society these days. Such things cause the health issues, such as hypertension. Research recently declared “Dark Chocolate” could be one of the blood pressure-lowering food alternatives. This research aims to find out if “Dark Chocolate" could lower blood pressure in hypertension without complications in patients. The research method is a descriptive quantitative study, and the research has been done on 30 women 80-97 years old elderly at Tresna Werdha Public Center, Cibubur. The blood pressure was measured by calculating the systolic and diastolic blood pressure in mmHg before and after consuming “Dark Chocolate”. Data analysis was using the SPSS statistic test. The result of the research is that the blood pressure in 15 respondents who consumed “Dark Chocolate” began to decrease on the third day (p<0,05). Finally, it is concluded that "Dark Chocolate” could lower blood pressure. Keywords: “Dark Chocolate”, blood pressure

Reduced Levels of Circulating Endothelial Cells and Endothelial Progenitor Cells in Patients with Heart Failure with Reduced Ejection Fraction

Article

Feb 2022
ARCH MED RES

Background Endothelial dysfunction has been suggested as a potential mechanism contributing to the development and progression of heart failure (HF). Levels of circulating endothelial cells (CECs), endothelial progenitor cells (EPCs), and hematopoietic stem and progenitor cells (HSPCs) have been recognized as useful markers of vascular damage and endothelial repair in response to tissue injury. Aims To evaluate the circulating levels of EPCs, CECs, and HSPCs among patients with HF with reduced ejection fraction (HFrEF). Methods In 82 individuals (42 patients with HFrEF and 42 age-matched subjects without established cardiovascular disease), peripheral blood was drawn and levels of EPCs, CECs, and HSPCs were quantified by flow cytometry. Results Patients with HFrEF showed lower levels of circulating EPCs (5.28 × 10–3 ± 6.83 × 10–4% vs. 7.76 × 10–3 ± 4.91 × 10–4%, p ≤0.001) and CECs (5.11 × 10–3 ± 7.87 × 10–4% vs. 6.51 × 10–3 ± 5.21 × 10–4%, p = 0.005) when compared to the age-matched group. Circulating levels of HSPCs were not significantly different between groups (p = 0.590). Additionally, the number of EPCs and CECs was significantly higher in HFrEF patients with overweight/obesity (n = 24) compared to patients with normal weight (n = 17). Conclusion Circulating levels of EPCs and CECs were significantly decreased in patients with HFrEF in comparison to age-matched subjects without established cardiovascular disease, suggesting that the levels of CECs and EPCs may be potential biomarkers of the cellular response to vascular injury in patients with HFrEF.

Estimation of salt intake by urinary sodium excretion in a Portuguese adult population and its relationship to arterial stiffness [Determinação do consumo de sal numa amostra da população Portuguesa adulta pela excreção urinária de sódio. Sua relação com rigidez arterial]

Article

Full-text available

Sep 2006

Background: Portugal has one of the highest mortality rates from stroke, a high prevalence of hypertension and probably a high salt intake level. Aim: To evaluate Portuguese salt intake levels and their relationship to blood pressure and arterial stiffness in a sample of four different adult populations living in northern Portugal. Methods: A cross-sectional study evaluating 24-hour urinary excretion of sodium (24h UNa+), potassium and creatinine, blood pressure (BP), and pulse wave velocity (PWV) as an index of aortic stiffness in adult populations of sustained hypertensives (HT), relatives of patients with previous stroke (Fam), university students (US) and factory workers (FW), in the context of their usual dietary habits. Results: We evaluated a total of 426 subjects, mean age 50±22 years, 56% female, BMI 27.9±5.1, BP 159/92 mmHg, PWV 10.4±2.2 m/s, who showed mean 24h UNa+ of 202±64 mmol/d, corresponding to a daily salt intake of 12.3 g (ranging from 5.2 to 24.8). The four groups were: HT: n = 245, 49±18 years, 92% of those selected, 69% treated, BP 163/94 mmHg, PWV 11.9 m/s, 24h UNa+ 212 mmol/d, i.e. 12.4 g/d of salt); Fam: n = 38, 64±20 years, 57% of those selected, BP 144/88 mmHg, PWV 10.5 m/s, 24h UNa+ 194 mmol/d, i.e. 11.1 g/d of salt; US: n = 82, 22±3 years, 57% of those selected, BP 124/77 mmHg, PWV 8.7 m/s, 24h UNa+ 199 mmol/d, i.e. 11.3 g/d of salt; FW: n = 61, 39±9 years, 47% of those selected, BP 129/79 mmHg, PWV 9.5 m/s, 24h UNa+ 221 mmol/d, i.e. 12.9 g/d of salt. The ratio of urinary sodium/potassium excretion (1.9 (0.4) was significantly higher in HT than the other three groups. In the 426 subjects, 24h UNa+ correlated significantly (p < 0.01) with systolic BP (r = 0.209) and with PWV (r=0.256) after adjustment for age and BP. Multivariate analysis showed that BP, age and 24h UNa+ correlated independently with PWV taken as a dependent variable. Conclusions: Four different Portuguese populations showed similarly high mean daily salt intake levels, almost double those recommended by the WHO. Overall, high urinary sodium excretion correlated consistently with high BP levels and appeared to be an independent determining factor of arterial stiffness. These findings suggest that Portugal in general has a high salt intake diet, and urgent measures are required to restrict salt consumption in order to prevent and treat hypertensive disease and to reduce overall cardiovascular risk and events.

Clustering of Major Cardiovascular Risk Factors and the Association with Unhealthy Lifestyles in the Chinese Adult Population

Article

Full-text available

Jun 2013
PLOS ONE

Previous studies indicated that lifestyle-related cardiovascular risk factors tend to be clustered in certain individuals. However, population-based studies, especially from developing countries with substantial economic heterogeneity, are extremely limited. Our study provides updated data on the clustering of cardiovascular risk factors, as well as the impact of lifestyle on those factors in China. A representative sample of adult population in China was obtained using a multistage, stratified sampling method. We investigated the clustering of four cardiovascular disease (CVD) risk factors (defined as two or more of the following: hypertension, diabetes, dyslipidemia and overweight) and their association with unhealthy lifestyles (habitual drinking, physical inactivity, chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) and a low modified Dietary Approaches to Stop Hypertension (DASH) score). Among the 46,683 participants enrolled in this study, only 31.1% were free of any pre-defined CVD risk factor. A total of 20,292 subjects had clustering of CVD risk factors, and 83.5% of them were younger than 65 years old. The adjusted prevalence of CVD risk factor clustering was 36.2%, and the prevalence was higher among males than among females (37.9% vs. 34.5%). Habitual drinking, physical inactivity, and chronic use of NSAIDs were positively associated with the clustering of CVD risk factors, with ORs of 1.60 (95% confidence interval [CI] 1.40 to1.85), 1.20 (95%CI 1.11 to 1.30) and 2.17 (95%CI 1.84 to 2.55), respectively. The modified DASH score was inversely associated with the clustering of CVD risk factors, with an OR of 0.73 (95%CI 0.67 to 0.78) for those with modified DASH scores in the top tertile. The lifestyle risk factors were more prominent among participants with low socioeconomic status. Clustering of CVD risk factors was common in China. Lifestyle modification might be an effective strategy to control CVD risk factors.

Prevalence of Hypertension in China: A Cross-Sectional Study

Article

Full-text available

Jun 2013
PLOS ONE

The present study aimed to assess the prevalence of hypertension among Chinese adults. Data were obtained from sphygmomanometer measurements and a questionnaire administered to 46239 Chinese adults ≥20 years of age who participated in the 2007-2008 China National Diabetes and Metabolic Disorders Study. Hypertension was defined as blood pressure ≥140/90 mm Hg or use of antihypertensive medication. A total of 26.6% of Chinese adults had hypertension, and a significantly greater number of men were hypertensive than women (29.2% vs 24.1%, p<0.001). The age-specific prevalence of hypertension was 13.0%, 36.7%, and 56.5% among persons aged 20 to 44 years (young people), 45 to 64 years (middle-aged people), and ≥65 years (elderly people), respectively. In economically developed regions, the prevalence of hypertension was significantly higher among rural residents than among urban residents (31.3% vs 29.2%, p = 0.001). Among women or individuals who lived in the northern region, the disparity in the prevalence of hypertension between urban and rural areas disappeared (women: 24.0% vs. 24.0%, p = 0.942; northern region: 31.6% vs. 31.2%, p = 0.505). Among hypertensive patients, 45.0% were aware of their condition, 36.2% were treated, and 11.1% were adequately controlled. The prevalence of hypertension in China is increasing. The trend of an increase in prevalence is striking in young people and rural populations. Hypertension awareness, treatment, and control are poor. Public health efforts for further improving awareness and enhancing effective control are urgently needed in China, especially in emerging populations.

Normotension, Prehypertension, and Hypertension in Urban Middle-Class Subjects in India: Prevalence, Awareness, Treatment, and Control

Article

Full-text available

Feb 2013
Am J Hypertens

Objective: We conducted a multisite study to determine the prevalence and determinants of normotension, prehypertension, and hypertension, and awareness, treatment, and control of hypertension among urban middle-class subjects in India. Methods: We evaluated 6,106 middle-class urban subjects (men 3,371; women, 2,735; response rate, 62%) in 11 cities for sociodemographic and biological factors. The subjects were classified as having normotension (BP < 120/80), prehypertension (BP 120-139/80-89), and hypertension (documented or BP ≥ 140/90). The prevalence of other cardiovascular risk factors was determined and associations evaluated through logistic regression analysis. Results: The age-adjusted prevalences in men and women of normotension were 26.7% and 39.1%, of prehypertension 40.2% and 30.1%, and of hypertension 32.5% and 30.4%, respectively. The prevalence of normotension declined with age whereas that of hypertension increased (P-trend < 0.01). A significant association of normotension was found with younger age, low dietary fat intake, lower use of tobacco, and low obesity (P < 0.05). The prevalence of hypercholesterolemia, diabetes, and metabolic syndrome was higher in the groups with prehypertension and hypertension than in the group with normotension (age-adjusted odds ratios (ORs) 2.0-5.0, P < 0.001). The prevalences in men and women, respectively, of two or more risk factors were 11.1% and 6.4% in the group with normotension, 25.1% and 23.3% in the group with prehypertension, and 38.3% and 39.1% in the group with hypertension (P < 0.01). Awareness of hypertension in the study population was in 55.3%; 36.5% of the hypertensive group were receiving treatment for hypertension, and 28.2% of this group had a controlled BP (< 140/90 mm Hg). Conclusions: The study found a low prevalence of normotension and high prevalence of hypertension in middle-class urban Asian Indians. Significant associations of hypertension were found with age, dietary fat, consumption of fruits and vegetables, smoking, and obesity. Normotensive individuals had a lower prevalence of cardiometabolic risk factors than did members of the prehypertensive or hypertensive groups. Half of the hypertensive group were aware of having hypertension, a third were receiving treatment for it, and quarter had a controlled BP.

Prevalence of Overweight, Obesity, and Abdominal Obesity in a Representative Sample of Portuguese Adults

Article

Full-text available

Oct 2012
PLOS ONE

This study determined the prevalence of overweight, obesity, and abdominal obesity in the Portuguese adults and examined the relationship between above mentioned prevalences and educational level. Body mass, stature, and waist circumference were measured in a representative sample of the Portuguese population aged 18-103 years (n = 9,447; 18-64 years: n = 6,908; ≥65 years: n = 2,539). Overweight and obesity corresponded to a body mass index ranging between 25-29.9 kg/m(2) and ≥30 kg/m(2), respectively. Abdominal obesity was assessed as >102 cm for males and >88 cm for females. After adjusting for educational level, the combined prevalences of overweight and obesity were 66.6% in males and 57.9% in females (18-64 years). Respective values in older adults (≥65 years) were 70.4% for males and 74.7% for females. About 19.3% of adult males and 37.9% of adult females presented abdominal obesity. Correspondent values in older adults were 32.1%, for males, and 69.7%, for females. In adults, low educational level was related to an increased risk for overweight (OR = 2.54; 95% CI: 2.08-3.09), obesity (OR = 2.76; 95% CI: 2.20-3.45), and abdominal obesity (OR = 5.48; 95% CI: 4.60-6.52). This reinforces the importance of adjusting public health strategies for educational level.

Excess dietary sodium and inadequate potassium intake in Italy: Results of the MINISAL study

Article

Full-text available

Jul 2012

Objective: As excess sodium and inadequate potassium intake are causally related to hypertension and cardiovascular disease, the MINISAL-GIRCSI Program aimed to provide reliable estimates of dietary sodium and potassium intake in representative samples of the Italian population. Design and methods: Random samples of adult population were collected from 12 Italian regions, including 1168 men and 1112 women aged 35-79 yrs. Electrolyte intake was estimated from 24 hour urine collections and creatinine was measured to estimate the accuracy of the collection. Anthropometric indices were measured with standardised procedures. Results: The average sodium excretion was 189 mmol (or 10.9 g of salt/day) among men and 147 mmol (or 8.5 g) among women (range 27-472 and 36-471 mmol, respectively). Ninety-seven % of men and 87% of women had a consumption higher than the WHO recommended target of 5g/day. The 24 h average potassium excretion was 63 and 55 mmol, respectively (range 17-171 and 20-126 mmol), 96% of men and 99% of women having an intake lower than 100 mmol/day (European and American guideline recommendation). The mean sodium/potassium ratio was 3.1 and 2.8 respectively, i.e. over threefold greater than the desirable level of 0.85. The highest sodium intake was observed in Southern regions. Sodium and potassium excretion were both progressively higher the higher the BMI (p < 0.0001). Conclusions: These MINISAL preliminary results indicate that in all the Italian regions thus far surveyed dietary sodium intake was largely higher and potassium intake lower than the recommended intakes. They also highlight the critical association between overweight and excess salt intake.

Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades

Article

Full-text available

Jun 2011
CAN MED ASSOC J

Analyses of medication databases indicate marked increases in prescribing of antihypertensive drugs in Canada over the past decade. This study was done to examine the trends in the prevalence of hypertension and in control rates in Canada between 1992 and 2009. Three population-based surveys, the 1986-1992 Canadian Heart Health Surveys, the 2006 Ontario Survey on the Prevalence and Control of Hypertension and the 2007-2009 Canadian Health Measures Survey, collected self-reported health information from, and measured blood pressure among, community-dwelling adults. The population prevalence of hypertension was stable between 1992 and 2009 at 19.7%-21.6%. Hypertension control improved from 13.2% (95% confidence interval [CI] 10.7%-15.7%) in 1992 to 64.6% (95% CI 60.0%-69.2%) in 2009, reflecting improvements in awareness (from 56.9% [95% CI 53.1%-60.5%] in 1992 to 82.5% [95% CI 78.5%-86.0%] in 2009) and treatment (from 34.6% [95% CI 29.2%-40.0%] in 1992 to 79.0% [95% CI 71.3%-86.7%] in 2009) among people with hypertension. The size of improvements in awareness, treatment and control were similar among people who had or did not have cardiovascular comorbidities Although systolic blood pressures among patients with untreated hypertension were similar between 1992 and 2009 (ranging from 146 [95% CI 145-147] mm Hg to 148 [95% CI 144-151] mm Hg), people who did not have hypertension and patients with hypertension that was being treated showed substantially lower systolic pressures in 2009 than in 1992 (113 [95% CI 112-114] v. 117 [95% CI 117-117] mm Hg and 128 [95% CI 126-130] v. 145 [95% CI 143-147] mm Hg). The prevalence of hypertension has remained stable among community-dwelling adults in Canada over the past two decades, but the rates for treatment and control of hypertension have improved markedly during this time.

Prevalence, awareness, treatment, control, and risk factors associated with hypertension in urban adults from 33 communities of China: The CHPSNE study

Article

Full-text available

Jul 2011
J Hypertens

To assess the prevalence, awareness, treatment, and control of hypertension and their associated factors in an urban Chinese population. A cross-sectional study was conducted in three cities in northeast China from 2009 to 2010, using a multistage cluster sampling method to select a representative sample. A total of 25 196 adults, aged 18-74 years, were examined in 33 communities. Hypertension was defined as a mean SBP of at least 140 mmHg, DBP at least 90 mmHg, and/or use of antihypertensive medications. Overall, the prevalence of hypertension was 28.7% for urban residents, and 39.1% for middle-aged and elderly residents (aged ≥35 years). Among all the hypertensive patients examined in the study (n = 7237), 42.9% were aware of their condition, 28.2% were receiving treatment, and only 3.7% had their blood pressure adequately controlled. Female hypertensive patients had more effectively controlled blood pressure than their male counterparts. Among the study participants, 37.9% did not think that high blood pressure would endanger their lives. Among hypertensive patients aware of their conditions, the primary reason for not taking antihypertensive medication was a lack of money (34.8%). Age, sex, education, occupation, income, body mass, waist circumference, and family hypertension history significantly correlated with the prevalence of hypertension. Hypertension is highly prevalent in the urban population of China, and the effects of being overweight/obesity on hypertension were much larger than any other examined factors. The percentage of hypertensive patients aware of their condition, receiving proper treatment, and keeping their hypertension under control is unacceptably low.

Time trends in cardiovascular and all-cause mortality in the 'old' and 'new' European Union countries

Article

Full-text available

Feb 2011
EUR J CARDIOV PREV R

There are large differences in all-cause and cardiovascular disease (CVD) mortality between eastern and western countries in Europe. We reviewed the development of these mortality trends in countries of the European Union (EU) over the past 40 years and evaluated available data regarding possible determinants of these differences. We summarized all-cause mortality and specific cardiovascular mortality for two country groups - 10 countries that joined the European Union (EU) after 2004 (East), and 15 countries that joined before 2004 (West). Standardized mortality rates were retrieved from the World Health Organization "European Health for All" database for each country between 1970 and 2007. Currently (in the 2000s), mortality due to circulatory system disease, ischemic heart disease (IHD), cerebrovascular disease (CBVD), and all-causes in the 'new' EU countries (East) is approximately twice that in the 'old' EU countries (West). These differences were much smaller in the 1970s. The increasing gap in mortality between West and East is primarily the result of a continuous and rapid improvement in the West. Differences in lifestyle (i.e. diet, alcohol consumption, physical activity, and smoking) provide insufficient explanation for the observed mortality gap in these two groups of EU countries. Higher expenditures on health, better access to invasive and acute cardiac care, and better pharmacological control of hypertension and hypercholesterolemia in the West are well documented. Socioeconomic and psychosocial factors may also contribute to the changes in mortality trends.

Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease

Article

Full-text available

Feb 2010
NEW ENGL J MED

The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health. We used the Coronary Heart Disease (CHD) Policy Model to quantify the benefits of potentially achievable, population-wide reductions in dietary salt of up to 3 g per day (1200 mg of sodium per day). We estimated the rates and costs of cardiovascular disease in subgroups defined by age, sex, and race; compared the effects of salt reduction with those of other interventions intended to reduce the risk of cardiovascular disease; and determined the cost-effectiveness of salt reduction as compared with the treatment of hypertension with medications. Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit, with blacks benefiting proportionately more, women benefiting particularly from stroke reduction, older adults from reductions in CHD events, and younger adults from lower mortality rates. The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels. A regulatory intervention designed to achieve a reduction in salt intake of 3 g per day would save 194,000 to 392,000 quality-adjusted life-years and

10 billion to

24 billion in health care costs annually. Such an intervention would be cost-saving even if only a modest reduction of 1 g per day were achieved gradually between 2010 and 2019 and would be more cost-effective than using medications to lower blood pressure in all persons with hypertension. Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.

Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ 339, b4567

Article

Full-text available

Nov 2009
Br Med J

To assess the relation between the level of habitual salt intake and stroke or total cardiovascular disease outcome. Systematic review and meta-analysis of prospective studies published 1966-2008. Medline (1966-2008), Embase (from 1988), AMED (from 1985), CINAHL (from 1982), Psychinfo (from 1985), and the Cochrane Library. Review methods For each study, relative risks and 95% confidence intervals were extracted and pooled with a random effect model, weighting for the inverse of the variance. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed. Criteria for inclusion were prospective adult population study, assessment of salt intake as baseline exposure, assessment of either stroke or total cardiovascular disease as outcome, follow-up of at least three years, indication of number of participants exposed and number of events across different salt intake categories. There were 19 independent cohort samples from 13 studies, with 177 025 participants (follow-up 3.5-19 years) and over 11 000 vascular events. Higher salt intake was associated with greater risk of stroke (pooled relative risk 1.23, 95% confidence interval 1.06 to 1.43; P=0.007) and cardiovascular disease (1.14, 0.99 to 1.32; P=0.07), with no significant evidence of publication bias. For cardiovascular disease, sensitivity analysis showed that the exclusion of a single study led to a pooled estimate of 1.17 (1.02 to 1.34; P=0.02). The associations observed were greater the larger the difference in sodium intake and the longer the follow-up. High salt intake is associated with significantly increased risk of stroke and total cardiovascular disease. Because of imprecision in measurement of salt intake, these effect sizes are likely to be underestimated. These results support the role of a substantial population reduction in salt intake for the prevention of cardiovascular disease.

Prevalence, awareness and management of hypertension in a recently urbanised community, eastern Jordan

Article

Full-text available

Aug 2000
J Hum Hypertens

The objectives of this study were to: (1) estimate the magnitude of hypertension, and its levels of awareness and control of hypertension among a recently urbanised community of Jordanian aborigines; and (2) to compare the study findings with findings from other Jordanian communities. A sample was randomly selected from the roster of all inhabitants of the community aged 25 years or older. Data on 545 subjects included in the sample were collected during the months of January and February of 1995. A total of 89 (16.3%) subjects were suffering hypertension defined as systolic blood pressure > or =160 mm Hg and/or diastolic blood pressure > or =95 mm Hg or on antihypertensive medication. Prevalence rate of hypertension was comparable to that reported from other Jordanian communities who have experienced an urban lifestyle earlier than the reference community. Logistic regression analysis indicated that hypertension was positively associated with age, illiteracy, body mass index, family history of hypertension, and diabetes mellitus. No association was detected between hypertension and each of gender, smoking, and total serum cholesterol. This study showed that the vast majority of hypertensive patients (82.0%) were aware of their diagnosis. However, more than two-thirds (68.5%) of those aware of their diagnosis did not achieve control of their hypertension. In conclusion, hypertension is a common public health problem in this community and that the hypertension management programme is far below the optimal level.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report

Article

Full-text available

May 2003

"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.

Estimation of salt intake by urinary sodium excretion in a Portuguese adult population and its relationship to arterial stiffness

Article

Full-text available

Oct 2006

Portugal has one of the highest mortality rates from stroke, a high prevalence of hypertension and probably a high salt intake level. To evaluate Portuguese salt intake levels and their relationship to blood pressure and arterial stiffness in a sample of four different adult populations living in northern Portugal. A cross-sectional study evaluating 24-hour urinary excretion of sodium (24 h UNa+), potassium and creatinine, blood pressure (BP), and pulse wave velocity (PWV) as an index of aortic stiffness in adult populations of sustained hypertensives (HT), relatives of patients with previous stroke (Fam), university students (US) and factory workers (FW), in the context of their usual dietary habits. We evaluated a total of 426 subjects, mean age 50 +/- 22 years, 56% female, BMI 27.9+/-5.1, BP 159/92 mmHg, PWV 10.4+/-2.2 m/s, who showed mean 24h UNa+ of 202 +/- 64 mmol/d, corresponding to a daily salt intake of 12.3 g (ranging from 5.2 to 24.8). The four groups were: HT: n = 245, 49 +/- 18 years, 92% of those selected, 69% treated, BP 163/94 mmHg, PWV 11.9 m/s, 24 h UNa+ 212 mmol/d, i.e. 12.4 g/d of salt); Fam: n = 38, 64 +/- 20 years, 57 % of those selected, BP 144/88 mmHg, PWV 10.5 m/s, 24 h UNa+ 194 mmol/d, i.e. 11.1 g/d of salt; US: n = 82, 22 +/- 3 years, 57% of those selected, BP 124/77 mmHg, PWV 8.7 m/s, 24h UNa+ 199 mmol/d, i.e. 11.3 g/d of salt; FW: n = 61, 39 9 years, 47% of those selected, BP 129/79 mmHg, PWV 9.5 m/s, 24 h UNa+ 221 mmol/d, i.e. 12.9 g/d of salt. The ratio of urinary sodium/potassium excretion (1.9 (0.4) was significantly higher in HT than the other three groups. In the 426 subjects, 24h UNa+ correlated significantly (p < 0.01) with systolic BP (r = 0.209) and with PWV (r=0.256) after adjustment for age and BP. Multivariate analysis showed that BP, age and 24h UNa+ correlated independently with PWV taken as a dependent variable. Four different Portuguese populations showed similarly high mean daily salt intake levels, almost double those recommended by the WHO. Overall, high urinary sodium excretion correlated consistently with high BP levels and appeared to be an independent determining factor of arterial stiffness. These findings suggest that Portugal in general has a high salt intake diet, and urgent measures are required to restrict salt consumption in order to prevent and treat hypertensive disease and to reduce overall cardiovascular risk and events.

High salt intake predicts strokes and cardiovascular events: a meta-analysis of prospective studies

Article

Oct 2009
J Hum Hypertens

2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

Article

Jan 2013

2013 ESH/ESC Guidelines for the management of arterial hypertension

Article

Jul 2013

Jennifer Taylor

Assessing the prevalence of hypertension in populations

Article

Mar 2003

Background: Although it is well recognized that the diagnosis of hypertension should be based on blood pressure (BP) measurements taken on several occasions, notably to account for a transient elevation of BP on the first readings, the prevalence of hypertension in populations has often relied on measurements at a single visit. Objective: To identify an efficient strategy for assessing reliably the prevalence of hypertension in the population with regards to the number of BP readings required. Design: Population-based survey of BP and follow-up information. Setting and participants: All residents aged 25–64 years in an area of Dar es Salaam (Tanzania). Main outcome measures: Three BP readings at four successive visits in all participants with high BP (n = 653) and in 662 participants without high BP, measured with an automated BP device. Results: BP decreased substantially from the first to third readings at each of the four visits. BP decreased substantially between the first two visits but only a little between the next visits. Consequently, the prevalence of high BP based on the third reading – or the average of the second and third readings – at the second visit was not largely different compared to estimates based on readings at the fourth visit. BP decreased similarly when the first three visits were separated by 3-day or 14-day intervals. Conclusions: Taking triplicate readings on two visits, possibly separated by just a few days, could be a minimal strategy for assessing adequately the mean BP and the prevalence of hypertension at the population level. A sound strategy is important for assessing reliably the burden of hypertension in populations.

Recent Evidence on Drug Therapy of Mild to Moderate Hypertension and Decreased Risk of Coronary Heart Disease

Article

Mar 1993
ARCH INTERN MED

Patricia R. Hebert

MANY CLINICIANS consider a sufficiently high risk of stroke to be the clearest indication for pharmacological therapy of patients with mild to moderate hypertension. The rationale is derived from several recent overviews or meta-analyses of data from randomized trials. For stroke, there are clear reductions of about 40%, whereas for coronary heart disease (CHD), there are possible reductions of 9% to 14%.1-3 In those trials, the magnitude of the reduction in diastolic blood pressure (DBP) was 5 to 6 mm Hg, and the duration of treatment was about 3 to 5 years. In observational studies, such changes in DBP over longer periods are associated with about a 40% decrease in stroke but 20% to 25% reductions in risk of CHD.3,4 Several possible explanations have been offered for the smaller risk reductions in CHD observed in trials than predicted in observational studies. First, the beneficial effects on stroke may

2013 ESH/ESC Practice Guidelines for the Management of Arterial HypertensionESH-ESC The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

Article

Feb 2014

Effect of longer-term modest salt reduction on blood pressure (Review)

Article

Nov 2003

1 ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 PLAIN LANGUAGE SUMMARY,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 BACKGROUND,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW,. . . . . . . . . . . . . . . . . . 3 SEARCH METHODS FOR IDENTIFICATION OF STUDIES . . . . . . . . . . . . . . . . . . . 3 METHODS OF THE REVIEW,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 DESCRIPTION OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 METHODOLOGICAL QUALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 POTENTIAL CONFLICT OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ACKNOWLEDGEMENTS,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Characteristics of included studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Characteristics of excluded studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 01. Search strategy to identify randomised salt reduction trials . . . . . . . . . . . . . . . . . 32 ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Comparison 01. Mean Net Change in Blood Pressure with Salt Reduction (Fixed Effect Model) . . . . . . . . 32 INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 COVER SHEET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 GRAPHS AND OTHER TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Figure 01. Relationship between the net change in urinary sodium excretion and systolic blood pressure. The open circles

Evolución del control de la hipertensión arterial en Atención Primaria en España. Resultados del estudio Controlpres 2003

Article

Feb 2005

Antonio Coca

Introduction The aim of the Controlpres 2003 study was to estimate blood pressure control rates among hypertensive patients cared and treated by general practitioners in Spain. Material and methods This observational study was performed in a sample of 3,337 essential hypertensive patients (49,7% men, 50,3% women) with a mean age of 64±12 years (range 19 to 99 years), cared by 200 general practitioners. Results Among 3,264 (97,8% of all patients) hypertensive patients on pharmacological treatment 38,8 % achieved strict blood pressure control (BP < 140/90 mmHg). This rate increased to 58,6% when patients with BP < 140/90 mmHg were also considered controlled. The separate analysis of blood pressure control regarding the two BP components showed that only 43,1% of patients achieved strict systolic blood pressure control. Strict diastolic blood pressure control (< 90 mmHg) was achieved in 68,1 % of treated patients. Most un controlled patients were being treated with monotherapy strategies (58%) and only 42% were treated with combinations of two (32,7%) or more (9,3 %) antihypertensive drugs. In the great majority of uncontrolled patients (84,6%) no measures were taken to optimize pharmacological treatment. Discussion Blood pressure control rate among hypertensive patients treateb by Primary Care physicians has substantially improved during the past 9 years with a 25% increase from 1995.

Effect of longer-term modest salt reduction on blood pressure

Article

Apr 2013

Background: A reduction in salt intake lowers blood pressure (BP) and, thereby, reduces cardiovascular risk. A recent meta-analysis by Graudal implied that salt reduction had adverse effects on hormones and lipids which might mitigate any benefit that occurs with BP reduction. However, Graudal's meta-analysis included a large number of very short-term trials with a large change in salt intake, and such studies are irrelevant to the public health recommendations for a longer-term modest reduction in salt intake. We have updated our Cochrane meta-analysis. Objectives: To assess (1) the effect of a longer-term modest reduction in salt intake (i.e. of public health relevance) on BP and whether there was a dose-response relationship; (2) the effect on BP by sex and ethnic group; (3) the effect on plasma renin activity, aldosterone, noradrenaline, adrenaline, cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides. Search methods: We searched MEDLINE, EMBASE, Cochrane Hypertension Group Specialised Register, Cochrane Central Register of Controlled Trials, and reference list of relevant articles. Selection criteria: We included randomised trials with a modest reduction in salt intake and duration of at least 4 weeks. Data collection and analysis: Data were extracted independently by two reviewers. Random effects meta-analyses, subgroup analyses and meta-regression were performed. Main results: Thirty-four trials (3230 participants) were included. Meta-analysis showed that the mean change in urinary sodium (reduced salt vs usual salt) was -75 mmol/24-h (equivalent to a reduction of 4.4 g/d salt), the mean change in BP was -4.18 mmHg (95% CI: -5.18 to -3.18, I (2)=75%) for systolic and -2.06 mmHg (95% CI: -2.67 to -1.45, I (2)=68%) for diastolic BP. Meta-regression showed that age, ethnic group, BP status (hypertensive or normotensive) and the change in 24-h urinary sodium were all significantly associated with the fall in systolic BP, explaining 68% of the variance between studies. A 100 mmol reduction in 24 hour urinary sodium (6 g/day salt) was associated with a fall in systolic BP of 5.8 mmHg (95%CI: 2.5 to 9.2, P=0.001) after adjusting for age, ethnic group and BP status. For diastolic BP, age, ethnic group, BP status and the change in 24-h urinary sodium explained 41% of the variance between studies. Meta-analysis by subgroup showed that, in hypertensives, the mean effect was -5.39 mmHg (95% CI: -6.62 to -4.15, I (2)=61%) for systolic and -2.82 mmHg (95% CI: -3.54 to -2.11, I (2)=52%) for diastolic BP. In normotensives, the mean effect was -2.42 mmHg (95% CI: -3.56 to -1.29, I (2)=66%) for systolic and -1.00 mmHg (95% CI: -1.85 to -0.15, I (2)=66%) for diastolic BP. Further subgroup analysis showed that the decrease in systolic BP was significant in both whites and blacks, men and women. Meta-analysis of hormone and lipid data showed that the mean effect was 0.26 ng/ml/hr (95% CI: 0.17 to 0.36, I (2)=70%) for plasma renin activity, 73.20 pmol/l (95% CI: 44.92 to 101.48, I (2)=62%) for aldosterone, 31.67 pg/ml (95% CI: 6.57 to 56.77, I (2)=5%) for noradrenaline, 6.70 pg/ml (95% CI: -0.25 to 13.64, I (2)=12%) for adrenaline, 0.05 mmol/l (95% CI: -0.02 to 0.11, I (2)=0%) for cholesterol, 0.05 mmol/l (95% CI: -0.01 to 0.12, I (2)=0%) for LDL, -0.02 mmol/l (95% CI: -0.06 to 0.01, I (2)=16%) for HDL, and 0.04 mmol/l (95% CI: -0.02 to 0.09, I (2)=0%) for triglycerides. Authors' conclusions: A modest reduction in salt intake for 4 or more weeks causes significant and, from a population viewpoint, important falls in BP in both hypertensive and normotensive individuals, irrespective of sex and ethnic group. With salt reduction, there is a small physiological increase in plasma renin activity, aldosterone and noradrenaline. There is no significant change in lipid levels. These results provide further strong support for a reduction in population salt intake. This will likely lower population BP and, thereby, reduce cardiovascular disease. Additionally, our analysis demonstrates a significant association between the reduction in 24-h urinary sodium and the fall in systolic BP, indicating the greater the reduction in salt intake, the greater the fall in systolic BP. The current recommendations to reduce salt intake from 9-12 to 5-6 g/d will have a major effect on BP, but are not ideal. A further reduction to 3 g/d will have a greater effect and should become the long term target for population salt intake.

Blood Pressure as a Cardiovascular Risk Factor

Article

May 1996

William B. Kannel

Objective. —To examine the prevalence, incidence, predisposing factors for hypertension, its hazards as an ingredient of the cardiovascular risk profile, and the implications of this information for prevention and treatment.Methods. —Prospective longitudinal analysis of 36-year follow-up data from the Framingham Study of the relation of antecedent blood pressure to occurrence of subsequent cardiovascular morbidity and mortality depending on the metabolically linked burden of associated risk factors.Results. —Hypertension is one of the most prevalent and powerful contributors to cardiovascular diseases, the leading cause of death in the United States. There is, on average, a 20 mm Hg systolic and 10 mm Hg diastolic increment increase in blood pressure from age 30 to 65 years. Isolated systolic hypertension is the dominant variety. There is no evidence of a decline in the prevalence of hypertension over 4 decades despite improvements in its detection and treatment. Hypertension contributes to all of the major atherosclerotic cardiovascular disease outcomes increasing risk, on average, 2- to 3-fold. Coronary disease, the most lethal and common sequela, deserves highest priority. Hypertension clusters with dyslipidemia, insulin resistance, glucose intolerance, and obesity, occurring in isolation in less than 20%. The hazard depends on the number of these associated metabolically linked risk factors present. Coexistent overt cardiovascular disease also influences the hazard and choice of therapy.Conclusion. —The absence of a decline in the prevalence of hypertension indicates an urgent need for primary prevention by weight control, exercise, and reduced salt and alcohol intake. The urgency and choice of therapy of existing hypertension should be based on the multivariate cardiovascular risk profile that more appropriately targets hypertensive persons for treatment and prevention of cardiovascular sequelae.(JAMA. 1996;275:1571-1576)

Prevalence, awareness, treatment, control and risk factors of hypertension in Korea: The Ansan study

Article

Sep 2001

Objectives: To determine prevalence, awareness, treatment, and control of hypertension, and its risk factors in an urban Korean population. Design and setting: A cross-sectional survey in Ansan-city, Korea. Subjects and methods: Population-based samples of people aged 18-92 years in Ansan-city, Korea, were selected, yielding 2278 men and 1948 women, and their blood pressures were measured using a highly standardized protocol. Hypertension was defined as a systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or reported treatment with antihypertensive medications, and subclassified according to 1999 WHO-ISH guidelines. Isolated systolic hypertension (ISH) defined as a systolic BP ≥140 mmHg and diastolic BP < 90 mmHg was also examined. Data were stratified by age and sex. Results: The overall prevalence of hypertension in this study was 33.7%. Among these, 64.9% had Grade 1 hypertension, 22.5% Grade 2, and 12.5% Grade 3. Age-specific prevalence of hypertension increased progressively with age, from 14.19% in 18 to 24 year-olds to 71.39% in those 75 years or older. Hypertension prevalence was significantly higher in men (41.5%) than in women (24.5%) (P < 0.001). Isolated systolic hypertension had significantly lower prevalence (4.33%) within the population, although in the elderly aged 55 years or more it rose by 11.13%. Overall, 24.6% of hypertensive individuals were aware that they had high blood pressure, as much as 78.6% were being treated with antihypertensive medications, and 24.3% were under control. Hypertension awareness as well as treatment and control rates varied by sex, with women higher in all three rates. Multivariate analysis revealed that age, body mass index and abdomen circumference were significantly associated with prevalence of hypertension both in men and women. Conclusions: Hypertension is highly prevalent in Korea. Despite the high rate of treatment, the rates of awareness and control are relatively low, suggesting the nationwide demand for preventing and controlling high blood pressure in Korea in order to avert an epidemic of cardiovascular disease.

Achievement of Cardiometabolic Goals in Aware Hypertensive Patients in Spain A Nationwide Population-Based Study

Article

Sep 2012
Hypertension

Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008-2010 a total of 11 957 individuals representative of the Spanish population aged ≥18 years. Information on cardiometabolic characteristics was collected at the participants' homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index <25 kg/m(2), 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c <6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein <115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-developed, free-access healthcare system, achievement of many cardiometabolic goals among hypertensives is poor. Moreover, a serious deficiency in hypertension awareness and in the effectiveness of some lifestyle interventions among aware hypertensives is present. Greater effort is needed in the management of coexisting risk factors and on lifestyle medical advice to improve the cardiometabolic health of hypertensives.

Trends in Prevalence, Awareness, Management, and Control of Hypertension Among United States Adults, 1999 to 2010

Article

Jun 2012

The purpose of this study was to quantify the trends in blood pressure (BP), and the prevalence, awareness, management, and control of hypertension in U.S. adults (≥20 years of age) from 1999 to 2010, and to assess the efficacy of current clinical measures in diagnosing and adequately treating hypertensive patients. Hypertension is a major independent risk factor for cardiovascular disease and stroke. Recent data indicate a decreasing trend in hypertension prevalence, along with improvements in hypertension awareness, management, and control. The study used regression models to assess the trends in hypertension prevalence, awareness, management, and control from 1999 to 2010 among 28,995 male and female adults with BP measurements from a nationally representative sample of the noninstitutionalized U.S. population (National Health and Nutrition Examination Survey [NHANES] 1999 to 2010), with special attention given to 5,764 participants in NHANES 2009 to 2010. In 2009 to 2010, the prevalence of hypertension was 30.5% among men and 28.5% among women. The hypertension awareness rate was 69.7% (95% confidence interval [CI]: 62.0% to 77.4%) among men and 80.7% (95% CI: 74.5% to 86.8%) among women. The hypertension control rate was 40.3% (95% CI: 33.7% to 46.9%) for men and 56.3% (95% CI: 49.2% to 63.3%) for women. From 1999 to 2010, the prevalence of hypertension remained stable. Although hypertension awareness, management, and control improved, the overall rates remained poor (74.0% for awareness, 71.6% for management, 46.5% for control, and 64.4% for control in management); worse still, no improvement was shown from 2007 to 2010. From 1999 to 2010, prevalence of hypertension remained stable. Hypertension awareness, management, and control were improved, but remained poor; nevertheless, there has been no improvement since 2007.

Epidemiology of Resistant Hypertension

Article

Jul 2011
J Clin Hypertens

Pantelis Sarafidis

J Clin Hypertens (Greenwich). 2011;13:523–528. ©2011 Wiley Periodicals, Inc. Resistant hypertension is an entity that has gained a lot of attention in recent years. The prevalence and prognosis of resistant hypertension have not yet been examined by proper population studies, but data from several sources suggest that this entity is not uncommon and is associated with an elevated risk of hypertensive complications. Moreover, several factors and conditions that can interfere with blood pressure control such as excess sodium intake, obesity, diabetes, older age, kidney disease, and certain identifiable causes of hypertension were shown to be common among patients with resistance to antihypertensive treatment. Importantly, the prevalence of several of these conditions has been increasing continuously during the past years, suggesting a future increase in the frequency of resistant hypertension. This article will discuss current knowledge and associated future implications relevant to the epidemiology of resistant hypertension.

Potassium Intake, Stroke, and Cardiovascular Disease A Meta-Analysis of Prospective Studies

Article

Mar 2011

The objective of this study was to assess the relation between the level of habitual potassium intake and the incidence of cardiovascular disease (CVD). Prospective cohort studies have evaluated the relationship between habitual potassium intake and incidence of vascular disease, but their results have not been not entirely consistent. We performed a systematic search for prospective studies published, without language restrictions (1966 to December 2009). Criteria for inclusion were prospective adult population study, assessment of baseline potassium intake, assessment of vascular events as outcome, and follow-up of at least 4 years. For each study, relative risks (RRs) and 95% confidence intervals (CIs) were extracted and pooled using a random-effect model, weighted for the inverse of the variance. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed. Eleven studies were identified, providing 15 cohort samples that included 247,510 male and female participants (follow-up 5 to 19 years), 7,066 strokes, 3,058 coronary heart disease (CHD) events, and 2,497 total CVD events. Potassium intake was assessed by 24-h dietary recall (n = 2), food frequency questionnaire (n = 6), or 24-h urinary excretion (n = 3). In the pooled analysis, a 1.64-g (42 mmol) per day higher potassium intake was associated with a 21% lower risk of stroke (RR: 0.79; 95% CI: 0.68 to 0.90; p = 0.0007), with a trend toward lower risk of CHD and total CVD that attained statistical significance after the exclusion of a single cohort, based on sensitivity analysis (RR: 0.93; 95% CI: 0.87 to 0.99; p = 0.03 and RR: 0.74; 95% CI: 0.60 to 0.91; p = 0.0037). Higher dietary potassium intake is associated with lower rates of stroke and might also reduce the risk of CHD and total CVD. These results support recommendations for higher consumption of potassium-rich foods to prevent vascular diseases.

National, regional, and global trends in systolic blood pressure since 1980: Systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants

Article

Feb 2011
LANCET

Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP). We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5·4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative. In 2008, age-standardised mean SBP worldwide was 128·1 mm Hg (95% uncertainty interval 126·7-129·4) in men and 124·4 mm Hg (123·0-125·9) in women. Globally, between 1980 and 2008, SBP decreased by 0·8 mm Hg per decade (-0·4 to 2·2, posterior probability of being a true decline=0·90) in men and 1·0 mm Hg per decade (-0·3 to 2·3, posterior probability=0·93) in women. Female SBP decreased by 3·5 mm Hg or more per decade in western Europe and Australasia (posterior probabilities ≥0·999). Male SBP fell most in high-income North America, by 2·8 mm Hg per decade (1·3-4·5, posterior probability >0·999), followed by Australasia and western Europe where it decreased by more than 2·0 mm Hg per decade (posterior probabilities >0·98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0·8-1·6 mm Hg per decade in men (posterior probabilities 0·72-0·91) and 1·0-2·7 mm Hg per decade for women (posterior probabilities 0·75-0·98). Female SBP was highest in some east and west African countries, with means of 135 mm Hg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mm Hg or more. Men and women in western Europe had the highest SBP in high-income regions. On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries. Funding Bill & Melinda Gates Foundation and WHO.

Reappraisal of European guidelines on hypertension management: A European Society of Hypertension Task Force document

Article

Oct 2009
J Hypertens

Effect of Modest Salt Reduction on Blood Pressure, Urinary Albumin, and Pulse Wave Velocity in White, Black, and Asian Mild Hypertensives

Article

Aug 2009
Hypertension

A reduction in salt intake lowers blood pressure. However, most previous trials were in whites with few in blacks and Asians. Salt reduction may also reduce other cardiovascular risk factors (eg, urinary albumin excretion, arterial stiffness). However, few well-controlled trials have studied these effects. We carried out a randomized double-blind crossover trial of salt restriction with slow sodium or placebo, each for 6 weeks, in 71 whites, 69 blacks, and 29 Asians with untreated mildly raised blood pressure. From slow sodium to placebo, urinary sodium was reduced from 165+/-58 (+/-SD) to 110+/-49 mmol/24 hours (9.7 to 6.5 g/d salt). With this reduction in salt intake, there was a significant decrease in blood pressure from 146+/-13/91+/-8 to 141+/-12/88+/-9 mm Hg (P<0.001), urinary albumin from 10.2 (IQR: 6.8 to 18.9) to 9.1 (6.6 to 14.0) mg/24 hours (P<0.001), albumin/creatinine ratio from 0.81 (0.47 to 1.43) to 0.66 (0.44 to 1.22) mg/mmol (P<0.001), and carotid-femoral pulse wave velocity from 11.5+/-2.3 to 11.1+/-1.9 m/s (P<0.01). Subgroup analysis showed that the reductions in blood pressure and urinary albumin/creatinine ratio were significant in all groups, and the decrease in pulse wave velocity was significant in blacks only. These results demonstrate that a modest reduction in salt intake, approximately the amount of the current public health recommendations, causes significant falls in blood pressure in all 3 ethnic groups. Furthermore, it reduces urinary albumin and improves large artery compliance. Although both could be attributable to the falls in blood pressure, they may carry additional benefits on reducing cardiovascular disease above that obtained from the blood pressure falls alone.

Hypertension Prevalence, Awareness, Treatment, and Control in Mozambique Urban/Rural Gap During Epidemiological Transition

Article

Aug 2009
Hypertension

The prediction of cardiovascular risk profile trends in low-income countries and timely action to modulate their transitions are among the greatest global health challenges. In 2005 we evaluated a nationally representative sample of the Mozambican population (n=3323; 25 to 64 years old) following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Prevalence of hypertension (systolic blood pressure > or =140 mm Hg and/or diastolic blood pressure > or =90 mm Hg and/or antihypertensive drug therapy), awareness (having been informed of the hypertensive status by a health professional in the previous year), treatment among the aware (use of antihypertensive medication in the previous fortnight), and control among those treated (blood pressure <140/90 mm Hg) were 33.1% (women: 31.2%; men: 35.7%), 14.8% (women: 18.4%; men: 10.6%), 51.9% (women: 61.1%; men: 33.3%), and 39.9% (women: 42.9%; men: 28.7%), respectively. Urban/rural comparisons are presented as age- and education-adjusted odds ratios (ORs) and 95% CIs. Among women, hypertension (OR: 2.0; 95% CI: 1.2 to 3.0) and awareness (OR: 4.3; 95% CI: 1.9 to 9.5) were more frequent in urban areas. No urban/rural differences were observed in men (hypertension: OR: 1.3, 95% CI: 0.9 to 2.0; awareness: OR: 1.5, 95% CI: 0.5 to 4.7). Treatment prevalence was not significantly different across urban/rural settings (women: OR: 1.4, 95% CI: 0.5 to 4.4; men: OR: 0.3, 95% CI: 0.1 to 1.4). Control was less frequent in urban women (OR: 0.2; 95% CI: 0.0 to 1.0) and more frequent in urban men (OR: 78.1; 95% CI: 2.2 to 2716.6). Our results illustrate the changing paradigms of "diseases of affluence" and the dynamic character of epidemiological transition. The urban/rural differences across sexes support a trend toward smaller differences, emphasizing the need for strategies to improve prevention, correct diagnosis, and access to effective treatment.

Prevalence, awareness and treatment of hypertension in Finland during 1982-2007

Article

May 2009
J Hypertens

To assess the trends in prevalence and in control of hypertension in various parts of Finland during 1982-2007. Three independent cross-sectional population surveys were conducted in 1982, 2002 and 2007 with age-stratified samples of men and women aged 25-64 years from the national population register. The total number of participants with complete blood pressure (BP) measurements was 16 775. Overall, during 1982-2007, the prevalence of hypertension (systolic BP > or = 140 mmHg and/or diastolic BP > or = 90 mmHg and/or current use of antihypertensive drug treatment) fell significantly in both sexes. In men, it fell from 63.3 to 52.1%; in women, from 48.1 to 33.6% (P < 0.001 for both sexes). However, during the past 5-year period, a decline was observed only in women in south-western Finland (P = 0.003). Furthermore, previously observed significant increases in the proportions of treated and controlled hypertensive individuals did not continue among men during 2002-2007. Despite the evident progress in all aspects of hypertension care since 1982, still in 2007, only 68% of all hypertensive individuals were aware of their condition, 52% of those who were aware were treated with antihypertensive drugs and 37% of the drug-treated patients had normal BP. Steady progress has been made in the prevention and treatment of hypertension in Finland. However, further improvements are clearly needed.

Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries

Article

Jun 2009
J Hypertens

Objective To systematically review quantitative differences in the prevalence, awareness, treatment and control of hypertension between developed and developing countries over the past 6 years. Methods We searched Medline [prevalence AND awareness AND treatment AND control AND (hypertension OR high blood pressure)] for population-based surveys. Prevalence, awareness, treatment and control of hypertension were compared between men and women, and between developing and developed countries, adjusting for age. The proportions of awareness, treatment and control were defined relative to the total number of hypertensive patients. Results We identified 248 articles, of which 204 did not fulfill inclusion criteria. The remaining articles reported data from 35 countries. Among men, the mean prevalence, awareness, treatment and control of hypertension were 32.2, 40.6, 29.2 and 9.8%, respectively, in developing countries and 40.8, 49.2, 29.1 and 10.8%, respectively, in developed countries. Among women, the mean prevalence, awareness, treatment and control of hypertension were 30.5, 52.7, 40.5, and 16.2%, respectively, in developing countries and 33.0, 61.7, 40.6 and 17.3%, respectively, in developed countries. After adjusting for age, the prevalence of hypertension among men was lower in developing than in developed countries (difference, S6.5%; 95% confidence interval, S11.3 to S1.8%). Conclusion There were no significant differences in mean prevalence, awareness, treatment and control of hypertension between developed and developing countries, except for a higher prevalence among men in developed countries. The prevalence, awareness, treatment and control of hypertension in developing countries are coming closer to those in developed countries.

Increases in Antihypertensive Prescriptions and Reductions in Cardiovascular Events in Canada

Article

Feb 2009
Hypertension

The Canadian Hypertension Education Program, an extensive professional education program to improve the management of hypertension, was started in 1999. There were very large increases in diagnosis and treatment of hypertension in the first 4 years after initiation of the program. The purpose of this study was to examine the association between the changes in antihypertensive therapy with changes in hospitalization and death from major hypertension-related cardiovascular diseases in Canada between 1992 and 2003. Using various national databases, Canadian standardized yearly mortality and hospitalization rates per 1000 for stroke, heart failure, and acute myocardial infarction were calculated for individuals aged >or=20 years and regressed against antihypertensive prescription rates. Changes in rates were examined in a time series analysis. There were significant reductions (P<0.0001) in the rate of death from stroke, heart failure, and myocardial infarction starting in 1999. There was also a reduction in hospitalization rate from stroke (P<0.0001) and heart failure (P<0.0001) but not myocardial infarction in 1999. The changes in death (P<0.001 for all 3 diseases) and hospitalization (P<0.0001 for stroke and heart failure; P=0.018 for acute myocardial infarction) were associated with the increases in antihypertensive prescriptions. This study demonstrates that the reduction in cardiovascular death and hospitalization rates is associated with an increase in antihypertensive prescriptions and that it coincides with the introduction of the Canadian Hypertension Education Program. The Canadian Hypertension Education Program educational model for improving health care could be adopted by other countries with well-developed professional and scientific societies.

Community-based stroke prevention: A Portuguese challenge

Article

Feb 1994
Health Rep

Stroke is the leading cause of death in Portugal, accounting for about 20% of total mortality, despite a 25% decline in death rates from cerebrovascular diseases between 1980 and 1989. Epidemiological observations demonstrating that the high rates of cerebrovascular disease are accompanied by high levels of blood pressure have raised considerable interest concerning the primary prevention of hypertension. Excess salt consumption is considered to have an important role in the pathogenesis of hypertension. Since salt is widely consumed by the Portuguese population, priority has been given to salt reduction for the primary prevention of hypertension. Community-based programs have demonstrated that it is possible to improve lifestyles, for instance by reducing high salt intake. Integrated and multifactorial interventions have promoted health and better treatment of hypertension as well as better control of concomitant risk factors. As a consequence of the population aging, there is a high probability of an increase in stroke occurrence. The present and future number of stroke survivors, requiring both acute and long-term care, will increase the social and economic burden. It is important to raise the awareness of politicians and the public so that both the prevention and management of patients with stroke will be given high priority.

Recent evidence on drug therapy of mild to moderate hypertension and decreased risk of coronary heart disease

Article

Apr 1993
ARCH INTERN MED

Blood pressure as a cardiovascular risk factor: Prevention and treatment

Article

May 1996

William B. Kannel

- To examine the prevalence, incidence, predisposing factors for hypertension, its hazards as an ingredient of the cardiovascular risk profile, and the implications of this information for prevention and treatment. - Prospective longitudinal analysis of 36-year follow-up data from the Framingham Study of the relation of antecedent blood pressure to occurrence of subsequent cardiovascular morbidity and mortality depending on the metabolically linked burden of associated risk factors. - Hypertension is one of the most prevalent and powerful contributors to cardiovascular diseases, the leading cause of death in the United States. There is, on average, a 20 mm Hg systolic and 10 mm Hg diastolic increment increase in blood pressure from age 30 to 65 years. Isolated systolic hypertension is the dominant variety. There is no evidence of a decline in the prevalence of hypertension over 4 decades despite improvements in its detection and treatment. Hypertension contributes to all of the major atherosclerotic cardiovascular disease outcomes increasing risk, on average, 2- to 3-fold. Coronary disease, the most lethal and common sequela, deserves highest priority. Hypertension clusters with dyslipidemia, insulin resistance, glucose intolerance, and obesity, occurring in isolation in less than 20%. The hazard depends on the number of these associated metabolically linked risk factors present. Coexistent overt cardiovascular disease also influences the hazard and choice of therapy. - The absence of a decline in the prevalence of hypertension indicates an urgent need for primary prevention by weight control, exercise, and reduced salt and alcohol intake. The urgency and choice of therapy of existing hypertension should be based on the multivariate cardiovascular risk profile that more appropriately targets hypertensive persons for treatment and prevention of cardiovascular sequelae.

Long-Term Effects of Weight Loss and Dietary Sodium Reduction on Incidence of Hypertension

Article

Mar 2000
Hypertension

To examine the long-term effects of weight loss and dietary sodium reduction on the incidence of hypertension, we studied 181 men and women who participated in the Trials of Hypertension Prevention, phase 1, in Baltimore, Md. At baseline (1987 to 1988), subjects were 30 to 54 years old and had a diastolic blood pressure (BP) of 80 to 89 mm Hg and systolic BP <160 mm Hg. They were randomly assigned to one of two 18-month lifestyle modification interventions aimed at either weight loss or dietary sodium reduction or to a usual care control group. At the posttrial follow-up (1994 to 1995), BP was measured by blinded observers who used a random-zero sphygmomanometer. Incident hypertension was defined as systolic BP > or =160 mm Hg and/or diastolic BP > or =90 mm Hg and/or treatment with antihypertensive medication during follow-up. Body weight and urinary sodium were not significantly different among the groups at the posttrial follow-up. After 7 years of follow-up, the incidence of hypertension was 18.9% in the weight loss group and 40.5% in its control group and 22.4% in the sodium reduction group and 32.9% in its control group. In logistic regression analysis adjusted for baseline age, gender, race, physical activity, alcohol consumption, education, body weight, systolic BP, and urinary sodium excretion, the odds of hypertension was reduced by 77% (odds ratio 0.23; 95% confidence interval 0.07 to 0.76; P=0.02) in the weight loss group and by 35% (odds ratio 0.65; 95% confidence interval 0.25 to 1.69; P=0.37) in the sodium reduction group compared with their control groups. These results indicate that lifestyle modification such as weight loss may be effective in long-term primary prevention of hypertension.

Lewington S, Clarke R, Qizilbash N, Peto R, Collins R and Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet 2002; 360: 1903-1913

Article

Jan 2003

The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies. Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56000 vascular deaths (12000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade. Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative. Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.

Assessing the prevalence of hypertension in populations: Are we doing it right?

Article

Apr 2003

Although it is well recognized that the diagnosis of hypertension should be based on blood pressure (BP) measurements taken on several occasions, notably to account for a transient elevation of BP on the first readings, the prevalence of hypertension in populations has often relied on measurements at a single visit. To identify an efficient strategy for assessing reliably the prevalence of hypertension in the population with regards to the number of BP readings required. Population-based survey of BP and follow-up information. All residents aged 25-64 years in an area of Dar es Salaam (Tanzania). Three BP readings at four successive visits in all participants with high BP (n = 653) and in 662 participants without high BP, measured with an automated BP device.RESULTS BP decreased substantially from the first to third readings at each of the four visits. BP decreased substantially between the first two visits but only a little between the next visits. Consequently, the prevalence of high BP based on the third reading--or the average of the second and third readings--at the second visit was not largely different compared to estimates based on readings at the fourth visit. BP decreased similarly when the first three visits were separated by 3-day or 14-day intervals. Taking triplicate readings on two visits, possibly separated by just a few days, could be a minimal strategy for assessing adequately the mean BP and the prevalence of hypertension at the population level. A sound strategy is important for assessing reliably the burden of hypertension in populations.

Hypertension Treatment and Control in Five European Countries, Canada, and the United States

Article

Jan 2004
Hypertension

Levels of hypertension treatment and control have been noted to vary between Europe and North America, although direct comparisons with similar methods have not been undertaken. In this study, we sought to estimate the relative impact of hypertension treatment strategies in Germany, Sweden, England, Spain, Italy, Canada, and the United States by using sample surveys conducted in the 1990s. Hypertension was defined as a blood pressure of 160/95 mm Hg or 140/90 mm Hg, plus persons taking antihypertensive medication. "Controlled hypertension" was defined as a blood pressure less than threshold among persons taking antihypertensive medications. Among persons 35 to 64 years, 66% of hypertensives in the United States had their blood pressure controlled at 160/95 mm Hg, compared with 49% in Canada and 23% to 38% in Europe. Similar discrepancies were apparent at the 140/90 mm Hg threshold, at which 29% of hypertensives in the United States, 17% in Canada, and </=10% in European countries had their blood pressure controlled. At the 140/90 mm Hg cutpoint, two thirds to three quarters of the hypertensives in Canada and Europe were untreated compared with slightly less than half in the United States. Although guidelines vary among countries, resulting in different case definitions, this does not account entirely for the varying success of different national control efforts. Low treatment and control rates in Europe, combined with a higher prevalence of hypertension, could contribute to a higher burden of cardiovascular disease risk attributable to elevated blood pressure compared with that in North America.

Worldwide prevalence of hypertension: A systematic review

Article

Jan 2004

To examine the prevalence and the level of awareness, treatment and control of hypertension in different world regions. A literature search of the MEDLINE database, using the Medical Subject Headings prevalence, hypertension, blood pressure and cross-sectional studies, was conducted. Published studies, which reported the prevalence of hypertension and were conducted in representative population samples, were included in the review. The search was restricted to studies published from January 1980 through July 2003. All data were extracted independently by two investigators using a standardized protocol and data collection form. The reported prevalence of hypertension varied around the world, with the lowest prevalence in rural India (3.4% in men and 6.8% in women) and the highest prevalence in Poland (68.9% in men and 72.5% in women). Awareness of hypertension was reported for 46% of the studies and varied from 25.2% in Korea to 75% in Barbados; treatment varied from 10.7% in Mexico to 66% in Barbados and control (blood pressure < 140/90 mmHg while on antihypertensive medication) varied from 5.4% in Korea to 58% in Barbados. Hypertension is an important public health challenge in both economically developing and developed countries. Significant numbers of individuals with hypertension are unaware of their condition and, among those with diagnosed hypertension, treatment is frequently inadequate. Measures are required at a population level to prevent the development of hypertension and to improve awareness, treatment and control of hypertension in the community.

Prevalence, awareness, treatment, and control of hypertension in the Czech Republic. Results of two nationwide cross-sectional surveys in 1997/1998 and 2000/2001, Czech Post-MONICA Study

Article

Sep 2004
J Hum Hypertens

Hypertension is an easily diagnosed and eminently modifiable risk factor for the development of all clinical manifestations of atherosclerosis. Despite the availability of a simple, non-invasive, and rather accurate method of measuring blood pressure (BP), and overwhelming evidence that reducing BP effectively prevents cardiovascular events, hypertension at the population level is not managed optimally. In 1997/1998 and 2000/2001, two surveys for cardiovascular risk factors were conducted in nine districts of the Czech Republic, involving a 1% population random sample aged 25-64 years in each district. In concordance with the MONICA Project, the present study confirms a high prevalence of hypertension in the Czech population, detecting an increase in prevalence for the male population over a period of 3 years (males from 38.8 in 1997/1998 to 42.3 in 2000/2001; P<0.05). Within the same period, there is also a significant increase in the awareness of hypertension in males (from 57.3 in 1997/1998 to 60.0 in 2000/2001; P<0.05), and an increase in the number of male hypertensives being treated by antihypertensive drugs (from 30.9 to 44.3; P<0.05). Control of hypertension did not change in either sex, being still suboptimal (males 16.4%, females 25.4% in the last survey in 2000/2001).

Global Burden of Hypertension: Analysis of Worldwide Data

Article

Jan 2005
LANCET

Reliable information about the prevalence of hypertension in different world regions is essential to the development of national and international health policies for prevention and control of this condition. We aimed to pool data from different regions of the world to estimate the overall prevalence and absolute burden of hypertension in 2000, and to estimate the global burden in 2025. We searched the published literature from Jan 1, 1980, to Dec 31, 2002, using MEDLINE, supplemented by a manual search of bibliographies of retrieved articles. We included studies that reported sex-specific and age-specific prevalence of hypertension in representative population samples. All data were obtained independently by two investigators with a standardised protocol and data-collection form. Overall, 26.4% (95% CI 26.0-26.8%) of the adult population in 2000 had hypertension (26.6% of men [26.0-27.2%] and 26.1% of women [25.5-26.6%]), and 29.2% (28.8-29.7%) were projected to have this condition by 2025 (29.0% of men [28.6-29.4%] and 29.5% of women [29.1-29.9%]). The estimated total number of adults with hypertension in 2000 was 972 million (957-987 million); 333 million (329-336 million) in economically developed countries and 639 million (625-654 million) in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion). Hypertension is an important public-health challenge worldwide. Prevention, detection, treatment, and control of this condition should receive high priority.

Prevalence, awareness, treatment and control of hypertension in Portugal: The PAP study

Article

Sep 2005

The objective of this study was to estimate the prevalence and distribution of hypertension and to determine the status of hypertension awareness, treatment and control in the Portuguese adult population. This study was conducted in 2003, and a multistage cluster sampling method was used to select a national representative sample. A total of 5023 adults, age 18-90 years, were examined. Three blood pressure measurements were obtained by trained observers using an OMROM M4-I sphygmomanometer after a 5-min sitting rest. Information on the history of hypertension and the use of antihypertensive medications was obtained by use of a standard questionnaire. Hypertension was defined as a mean systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg, or the use of antihypertensive medications. Overall, 42.1% of the Portuguese adult population aged 18-90 years, representing 3 311 830 people, had hypertension. The age-specific prevalence of hypertension in the three age groups studied--younger than 35 years, 35-64 years old and older than 64 years--was 26.2, 54.7 and 79% in men and 12.4, 41.1 and 78.7% in women, respectively. Among hypertensive patients, only 46.1% were aware of their high blood pressure, 39.0% were taking antihypertensive medication and 11.2% achieved blood pressure control (< 140/90 mmHg). Our results indicate that hypertension is highly prevalent in Portugal. The percentages of those with hypertension that are aware, treated and controlled are unacceptably low. These results underscore the urgent need to develop national strategies to improve prevention, detection and treatment of hypertension in Portugal.

Blood pressure control among treated hypertensive patients by primary care in Spain. The 2003 Controlpres study.

Jan 2005
5

Coca

Worldwide prevalence of hypertension: a systematic review.

Jan 2004
11

Kearney

Prevalence, awareness, treatment and control of hypertension and salt intake in Portugal: changes over a decade. The PHYSA study

Abstract

No full-text available

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