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Global Disparities of Hypertension Prevalence and ControlClinical Perspective: A Systematic Analysis of Population-Based Studies From 90 Countries
Abstract
Background:
Hypertension is the leading preventable cause of premature death worldwide. We examined global disparities of hypertension prevalence, awareness, treatment, and control in 2010 and compared secular changes from 2000 to 2010.
Methods:
We searched MEDLINE from 1995 through 2014 and supplemented with manual searches of retrieved article references. We included 135 population-based studies of 968 419 adults from 90 countries. Sex- and age-specific hypertension prevalences from each country were applied to population data to calculate regional and global numbers of hypertensive adults. Proportions of awareness, treatment, and control from each country were applied to hypertensive populations to obtain regional and global estimates.
Results:
In 2010, 31.1% (95% confidence interval, 30.0%-32.2%) of the world's adults had hypertension; 28.5% (27.3%-29.7%) in high-income countries and 31.5% (30.2%-32.9%) in low- and middle-income countries. An estimated 1.39 (1.34-1.44) billion people had hypertension in 2010: 349 (337-361) million in high-income countries and 1.04 (0.99-1.09) billion in low- and middle-income countries. From 2000 to 2010, the age-standardized prevalence of hypertension decreased by 2.6% in high-income countries, but increased by 7.7% in low- and middle-income countries. During the same period, the proportions of awareness (58.2% versus 67.0%), treatment (44.5% versus 55.6%), and control (17.9% versus 28.4%) increased substantially in high-income countries, whereas awareness (32.3% versus 37.9%) and treatment (24.9% versus 29.0%) increased less, and control (8.4% versus 7.7%) even slightly decreased in low- and middle-income countries.
Conclusions:
Global hypertension disparities are large and increasing. Collaborative efforts are urgently needed to combat the emerging hypertension burden in low- and middle-income countries.
... Thus, one of the goals present in the United Nations Sustainable Development Goals to be achieved by 2030 concerns universal health coverage and access [7], such as the management of risk factors and Chronic Noncommunicable Diseases (NCDs), which has been used as an important performance measure for this achievement [8,9]. Of a total of 1.39 billion people with hypertension worldwide, 75% live in low-and middleincome countries and only one in three have their blood pressure treated with antihypertensives and one in seven have their pressure adequately controlled [10][11][12][13][14]. ...
... A systematic review of with data from low-and middle-income countries (regions East Asia and Pacific, Europe and Central Asia, Latin America and the Caribbean, Middle East and North Africa, South Asia, and sub-Saharan Africa) the rate of hypertension control was 30% [10], figures lower than those presented in this study. The prevalence of control in Brazil was similar to that estimated in high-income countries, higth 50.4% [10] and 39% [13]. ...
... A systematic review of with data from low-and middle-income countries (regions East Asia and Pacific, Europe and Central Asia, Latin America and the Caribbean, Middle East and North Africa, South Asia, and sub-Saharan Africa) the rate of hypertension control was 30% [10], figures lower than those presented in this study. The prevalence of control in Brazil was similar to that estimated in high-income countries, higth 50.4% [10] and 39% [13]. However, some of these a Canada, German and South Korea countries have already shown better hypertension control rates (70%) [13]. ...
Background
Hypertension is the main risk factor for cardiovascular diseases and more recent studies that estimated the prevalence of this condition considering aspects such as awareness of diagnosis, treatment, and control, revealing alarming results in the global scenario.
Objective
To estimate the prevalence and assess the factors associated with hypertension prevalence, awareness, treatment, and control.
Methods
This is a cross-sectional study based on data from the 2013 National Health Survey in Brazil. A total of 59,226 individuals of both sexes took part in this study. Exposure were defined based on blood pressure measurements, self-reported diagnosis of hypertension and use of antihypertensive medication. We estimated the prevalence of the dependent variables and the associations were subsequently tested by calculating prevalence ratios using Poisson regression.
Results
The study population was composed mostly of women (52.3%), aged 36 to 59 years (42.6%), of white race/color (47.5%), with low schooling between 0 and 8 years (49.1%), having a partner (55.7%), in the urban area of the country (86.2%), mainly in the Southeast region (43.9%) and without health insurance (69.7%). The prevalence of hypertension in the Brazilian population was 32.3%. 60.8% were aware of the diagnosis, 90.6% were taking medication treatment and, of these, 54.4% had controlled blood pressure. Female gender and older age were associated with greater awareness (PR 1,34; 95% CI 1,28 – 1,40 / PR 2,40; 95% CI 2,15 – 2,69; respectively), treatment (PR 1,10; 95% CI 1,07 – 1,12 / PR 1,25; 95% CI 1,17 – 1,35; respectively) and control (PR 1,10; 95% CI 1,02 – 1,17 / PR 0,83; 95% CI 0,73 – 0,96; respectively). Other factors such as having a partner, health insurance, living in the urban area, race/color and schooling were also associated with dependent variables.
Conclusion
This study reveals that although a high percentage of hypertensive patients are taking medication, there are still substantial gaps in awareness and control, particularly among certain sociodemographic groups. Men, those with less schooling, black and brown people, those living in rural areas and those without health insurance have lower levels of awareness and control of hypertension.
... Hypertension affects an estimated 1.4 billion people, most of whom reside in low-and middleincome countries (1). Hypertension treatment lowers the risk of cardiovascular disease and mortality by 20-40% (2). ...
... Hypertension treatment lowers the risk of cardiovascular disease and mortality by 20-40% (2). However, less than 10% of individuals treated for hypertension are under control in low-and middle-income countries, contributing to substantial morbidity and mortality (1). ...
Background: The World Health Organization recommends fixed-dose combination (FDC) pills for treating hypertension. Antihypertensive FDC pills often contain a renin-angiotensin inhibitor (RASI) or diuretic. Thus, screening and monitoring for dyskalemia (hypokalemia or hyperkalemia) before and after starting these classes of medications are recommended, a significant barrier for implementation in resource-limited settings. However, the need for blood tests may be overemphasized if the prevalence of dyskalemia in patients with hypertension is uncommon and the incidence of dyskalemia is rare after initiation of FDC. Methods: We conducted a community-based blood pressure (BP) screening program in Dhaka, Bangladesh, and determined the prevalence of dyskalemia, as defined by K < 3.0 or K > 5.5 mmol/L, in untreated adults with SBP ≥140 mmHg and/or DBP ≥90 mmHg. Among those with a baseline serum K of ≥3.0 or ≤5.0 mmol/L and creatinine clearance ≥30 ml/min, we determined the incidence of dyskalemia 2 months after initiation of a daily FDC of telmisartan 40 mg and amlodipine 5 mg. Secondary outcomes were BP change, medication adherence, and symptoms. Results: In 2022–2023, we recruited 1,073 adults with SBP ≥140 mmHg and/or DBP ≥90 mmHg. The mean age was 54 years, with 71% men and mean baseline BP 157/94 (SD 12/9.3) mmHg. The prevalence of hypokalemia and hyperkalemia was 1.6% and 0.2%, respectively. FDC was initiated in 1,017 eligible patients, and 864 completed the 2-month follow-up visit. Incident hypokalemia occurred in 1.5% of patients, but there was no case of incident hyperkalemia. The mean change in serum potassium after initiating FDC was –0.05 (0.53) mmol/L. At follow-up, 92% had BP <140/90 mmHg with a mean SBP change of –29.8 mmHg. 1% self-reported mild symptoms (e.g., leg swelling), and there was one death of undetermined cause. Conclusions: Given low prevalence and incidence of hyperkalemia and evident reduction in BP, our study suggests initiating FDC with telmisartan and amlodipine may be a practical and safe option for newly diagnosed hypertension, especially in resource-constrained settings where blood tests cannot be easily obtained.
... Interleukin 1β IL- 6 Interleukin 6 IL- 7 Interleukin 7 IR Insulin Resistance LDL Low-density lipoprotein (continued on next page) ...
... The high prevalence of hypertension in LMIC combined with a lack of awareness, poor control and ineffective treatment, makes it a major public health concern [6]. The global disparities in hypertension prevalence highlights significance gaps in awareness and medical illiteracy between LMIC and high-income countries [7]. Black African Americans are at a greater risk of developing hypertension due to genetic differences as well as socioeconomic factors [8]. ...
... Hypertension, a major risk factor of cardiovascular diseases, remains the leading cause of global mortality and a substantial contributor to disability-adjusted life-year (3). The prevalence of hypertension among adults was higher in low-and middle-income countries (LMICs) (31.5%, 1.04 billion people) than that in high-income countries (28.5%, 349 million people) (4). Moreover, the global prevalence of hypertension has been rising, especially in LMICs (5). ...
... The risk factors of hypertension included genetic factors, environmental influences, and lifestyles (4,5). An Australian longitudinal study demonstrated that individuals with more highrisk lifestyle factors had a higher likelihood of developing hypertension (8). ...
Objectives
Lifestyle may potentially influence blood pressure level, but the association of multiple healthy lifestyles with hypertension was limited, especially for rural population. The study aimed to explore the relationship of healthy lifestyles on hypertension, and then whether lifestyle change could influence hypertension in rural adults.
Methods
A total of 16,454 participants were enrolled from the Henan Rural Cohort study, in China. The healthy lifestyles score (HLS) was concluded by smoking status, alcohol consumption, physical activity, diet status and body mass index. Associations of HLS and lifestyle change with systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed by generalized linear models, and with hypertension were analyzed by logistic regression model and restricted cubic spline plots.
Results
The results from the generalized linear models showed SBP and DBP levels decreased with the HLS increasing (Ptrend < 0.01). Compared with participants with lower HLS (scored 0–2), the odds ratios (OR) and 95% confidence intervals (CIs) for hypertension in those with HLS = 3, 4, or 5 were 0.853 (0.737, 0.987), 0.881 (0.754, 1.029), and 0.658 (0.519, 0.834), respectively. And compared with participants with unhealthy lifestyle consistently, those changing lifestyle from unhealthy to healthy had lower levels of blood pressure [β (95% CI): SBP: −1.603 (−2.539, −0.668). DBP: −1.713 (−2.326, −1.100)] and hypertension risk [OR (95%CI): 0.744 (0.594, 0.931)]. Similar results could be found by the sensitivity analysis.
Conclusion
The findings showed that healthy lifestyles could reduce blood pressure and hypertension risk, and that implementing healthier lifestyle changes could be an effective strategy to prevent hypertension in rural area.
... It is the leading global cause of morbidity and mortality associated with cardiovascular diseases (CVD). The complexity of HTN lies not only in its widespread prevalence but also in its asymptomatic progression during early stages, often delaying timely diagnosis and treatment [2]. ...
Objective
To develop a machine learning (ML) model utilizing transfer learning (TL) techniques to predict hypertension in children and adolescents across South America.
Methods
Data from two cohorts (children and adolescents) in seven South American cities were analyzed. A TL strategy was implemented by transferring knowledge from a CatBoost model trained on the children’s sample and adapting it to the adolescent sample. Model performance was evaluated using standard metrics.
Results
Among children, the prevalence of normal blood pressure was 88.9% (301 participants), while 14.1% (50 participants) had elevated blood pressure (EBP). In the adolescent group, the prevalence of normal blood pressure was 92.5% (284 participants), with 7.5% (23 participants) presenting with EBP. Random Forest, XGBoost, and LightGBM achieved high accuracy (0.90) for children, with XGBoost and LightGBM demonstrating superior recall (0.50) and AUC-ROC (0.74). For adolescents, models without TL showed poor performance, with accuracy and recall values remaining low and AUC-ROC ranging from 0.46 to 0.56. After applying TL, model performance improved significantly, with CatBoost achieving an AUC-ROC of 0.82, accuracy of 1.0, and recall of 0.18.
Conclusion
Soft drinks, filled cookies, and chips were key dietary predictors of elevated blood pressure, with higher intake in adolescents. Machine learning with transfer learning effectively identified these risks, emphasizing the need for early dietary interventions to prevent hypertension and support cardiovascular health in pediatric populations.
... Research indicates that nearly 50% of patients discontinue antihypertensive medications within the first year, complicating global blood pressure management. Less than one-third of patients in high-income countries and only one-tenth in low-and middle-income nations achieve optimal blood pressure, contributing to rising cardiovascular diseases and mortality worldwide [4][5][6]. ...
Background
Hypertension (HTN) significantly contributes to cardiovascular disease (CVD) and mortality. This systematic review and meta-analysis specifically investigates how different levels of adherence to antihypertensive therapy (AHT) affect mortality rates in HTN patients. By synthesizing cohort studies, it aims to enhance understanding and inform clinical practices to improve outcomes in hypertensive populations.
Methods
Our meta-analysis employed a comprehensive search strategy using keywords related to hypertension, medical adherence, and mortality across PubMed, Scopus, and Web of Science, up to July 2024. The eligibility criteria focused on cohort studies linking AHT adherence to mortality. The Newcastle–Ottawa Scale (NOS) was used to assess the risk of bias (ROB). Quantitative analyses involved hazard ratios (HR) and confidence intervals (CI), with an 80% adherence threshold. Subgroup and meta-regression analyses were also conducted using STATA-17 to explore various outcome factors.
Results
From initial 1,999 studies 12 cohort studies included in our analysis. All included studies had low ROB score. A meta-analysis of 12 studies involving 2,198,311 patient with HTN revealed that poor adherence to treatment significantly increased all-cause mortality (HR: 1.32 [1.14, 1.51], p < 0.001) with high heterogeneity (I²: 98.73%). Additionally, an analysis of four studies with 1,695,872 patients indicated that low adherence was linked to elevated cardiovascular mortality (HR: 1.61 [1.43, 1.78], p < 0.001), showing moderate heterogeneity (I²: 49.51%).
Conclusions
The study found that poor adherence to AHT significantly increases overall and cardiovascular mortality risk, underscoring the need for improved compliance strategies. Limitations like inconsistent definitions, observational biases, and varying follow-up durations necessitate further research to validate these findings.
Clinical trial number
Not applicable.
... Therapies once considered experimental, such as autologous bone marrow stem cell transplantation and microRNA modulation for the de-repression of survival and pro-angiogenic genes, are also now reducing CIHD mortality [41,42]. Improvements in the management of other comorbidities, such as hyperlipidemia, hypertension, diabetes mellitus, and chronic kidney disease, have also led to improved mortality [43][44][45][46]. Smoking induces oxidative stress, vascular inflammation, platelet coagulation, vascular dysfunction, and impairs the serum lipid profile, which is linked to worsening mortality outcomes in chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, atherosclerosis, CIHD, and lung cancer [47][48][49]. ...
Introduction
Lung cancer remains the leading cause of cancer-related mortality in the United States and shares cardiovascular risk factors with chronic ischemic heart disease (CIHD). However, the cumulative mortality burden of these comorbid conditions is underexplored. This study aims to retrospectively assess mortality trends among American adults with concurrent lung cancer and CIHD.
Methods
We utilized death certificate data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, encompassing ICD-10 codes for individuals aged ≥45 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 population, annual percentage change (APC), and corresponding 95 % confidence intervals (CIs) were calculated. Data were further stratified by year, sex, race, and geographic region (state, rural-urban, and census regions).
Results
A total of 214,785 deaths were identified in adults aged ≥45 years with comorbid lung cancer and CIHD. The overall AAMR between 1999 and 2020 was 8.4 per 100,000 (95 % CI: 8.3 to 8.4). AAMRs remained relatively stable from 1999 to 2005 (APC: −0.84 %; 95 % CI: −1.91 to 1.54), followed by a significant decline from 2005 to 2010 (APC: −2.37 %; 95 % CI: −5.58 to −0.61) and from 2010 to 2017 (APC: −4.72 %; 95 % CI: −7.61 to −3.60). A subsequent period of stability was noted between 2017 and 2020 (APC: 0.86 %; 95 % CI: −2.17 to 5.22). In 1999, men had a threefold higher mortality rate compared to women (AAMR: 17.8 vs. 5.7), with a non-significant decline by 2020 (AAMR: 10 vs. 4). Stratification by race/ethnicity revealed that non-Hispanic (NH) Whites exhibited the highest AAMR at 9.3, followed by NH American Indian or Alaska Natives (7.3), NH Blacks (6.8), Hispanic/Latinos (3.3), and NH Asians or Pacific Islanders (3.2). Geographically, AAMRs were highest in the Midwest (9.6), followed by the Northeast (8.8), South (8.4), and West (6.8). Non-metropolitan regions exhibited higher AAMRs compared to metropolitan areas (10.3 vs. 8.0). States in the top 90th percentile, such as West Virginia, Kentucky, Vermont, Ohio, and Rhode Island, had nearly triple the AAMRs compared to states in the lower 10th percentile, including Utah, Nevada, Arizona, New Mexico, and Hawaii.
Conclusions
From 1999 to 2020, mortality rates for adults aged ≥45 years with concurrent lung cancer and CIHD declined. The highest AAMRs were observed among men, NH Whites, individuals residing in the Midwest, and non-metropolitan populations. This highlights the need for a more comprehensive and tailored approach to managing these patients moving forward.
... In small arteries, there are microvascular alterations that involve a decrease in the size of the inner opening and an increase in the ratio of the wall thickness to the inner opening size, resulting in elevated overall resistance in the periphery and blood pressure. In large arteries, stiffness of the arterial wall leads to a decreased ability to pump blood out of the left ventricle, resulting in increased SBP and pulse strength (Dąbrowska & Narkiewicz, 2023;Mills et al., 2016). ...
Nephrotic syndrome (NS) is the most frequently occurring kidney disease among children and increases the morbidity and mortality of cardiovascular disorders caused by hyperlipidemia, increased thrombogenesis, and endothelial dysfunction that occur in atherosclerosis. Carotid intima-media thickness (CIMT) is an accessible, noninvasive, and sensitive method for detecting subclinical atherosclerosis. This study aimed to determine the risk factors for CIMT in children with idiopathic nephrotic syndrome at RSUD dr. Zainoel Abidin Banda Aceh. This was an observational analytic study with a cross-sectional design, conducted from March 2024 until May 2024. This study included 35 patients with NS who were 2-18 years, receiving treatment for a minimum of 6 months, with a glomerular filtration rate exceeding 90 ml/minute/1,73 m2, and no recent acute infections in the past 3 months. Bivariate analysis was performed using the Pearson correlation test, and independent T tests and multivariate analyses were performed using multiple linear regressions. We found a statistically significant correlation between CIMT and total cholesterol (p=0,004, r=0,471), steroid-resistant nephrotic syndrome (p=0,001) and systolic blood pressure (p=0,011, r=0,427) with a mean CIMT of 1,5 ± 0,4 mm. In conclusion, the total cholesterol level, steroid-resistant nephrotic syndrome, and systolic blood pressure are risk factors for CIMT in children with NS.
... В группе с ЭКАГ преобладала доля женщин, что аналогично результатам исследования PURE, в котором женщины неизменно имели более высокие показатели контроля, чем мужчины [6], и данным ЭССЕ-РФ-2 [4]. Возможно, причины разнонаправленных гендерных зависимостей связаны с лучшей «заботой о здоровье» у женщин, чем у мужчин [12]. ...
Introduction. Arterial hypertension (HT) is the most common risk factor of cardiovascular diseases and leads to increased premature mortality. About half of HT patients do not reach the target values of blood pressure (BP).
Aim: To assess the frequency of failure to achieve the target BP level and to identify non-pharmacological factors associated with inefficient BP control in a clinical sample of patients with hypertension.
Material and Methods. A sequential clinical sample of patients ( n = 105, 19–84 years old) with an established diagnosis of HT receiving antihypertensive therapy (AHT), was examined. Clinical data were analyzed in groups with efficient (ECHT, n = 29) and inefficient control of hypertension (ICHT, n = 76) by the time of admission to the hospital.
Results. In the entire sample, the proportion of ICHT (72%) was higher compared to ECHT (28%). The groups did not differ in age, anthropometry, menopausal status in women, and duration of HT, but with an increase in the degree of hypertension, the proportion of patients with NCAH increased. There were more women in ECHT group, and there were equal proportions of men and women in ICHT group. In the ICHT group, we observed higher values of HDLC, more frequent chronic heart failure (CHF) and single atherosclerotic plaques (AP) of carotid and other peripheral arteries; in the ECHT group, the average levels of plasma glucose, glycated hemoglobin, the proportion of smokers were higher, and type 2 diabetes and multiple AP were more common. The AHT (doses, regimen, combinations) was more adequate in the ECHT group. About half of the patients received combination therapy.
Conclusion. In the clinical sample, one third of HT patients receiving AHT, had blood pressure controlled to target at hospital admission. Inefficient blood pressure control was associated with male gender, a higher level of HDLC, the high degree of HT, single AP and CHF. In the efficient control group, smoking, comorbidity with type 2 diabetes, multiple AP, higher glucose levels and HbA1c were more often noted.
... Essa tendência pode estar relacionada a fatores como diagnóstico tardio, baixa adesão ao tratamento medicamentoso, envelhecimento da população e a presença de múltiplas comorbidades. [33][34][35] Ademais, a maioria dos atendimentos por DM e HAS ocorreu em caráter de urgência (97,7% e 98,8%, respectivamente) e houve predominância de atendimentos no serviço público de saúde (65% para DM e 53% para HAS), sublinhando a necessidade de investimentos substanciais nesse setor. A alta demanda por atendimentos emergenciais sobrecarrega o serviço público, ressaltando a importância de reforçar a APS, a prevenção, o diagnóstico precoce e o controle adequado, levando à melhor gestão clínica das pessoas com essas DCNTs. ...
Introdução: Até o século passado, as principais causas de mortalidade no Brasil e no mundo eram as doenças infecciosas e a fome. No entanto, com as mudanças no perfil epidemiológico ao longo do século XXI, as doenças crônicas não transmissíveis, como Diabetes Mellitus (DM) e Hipertensão Arterial Sistêmica (HAS), passaram a predominar na morbimortalidade. Nesse sentido, Atenção Primária à Saúde (APS) desempenha um papel crucial na prevenção, detecção precoce, tratamento e acompanhamento dessas condições, ainda que muitos pacientes continuem a enfrentar complicações graves, como doenças cardiovasculares e renais. Objetivo: O objetivo deste estudo foi descrever a prevalência e o perfil epidemiológico de internações e óbitos por DM e HAS no estado da Bahia entre 2010 e 2022. Métodos: Foi realizado um estudo ecológico e descritivo com base nos dados dos Sistemas de Informação Hospitalar e de Mortalidade do DataSUS. A população-alvo incluiu residentes do estado da Bahia, com descrição de variáveis como internação e óbito de acordo com sexo, cor/raça, faixa etária, escolaridade, estado civil, caráter e regime de atendimento e local do óbito. Por se tratar de dados de domínio público, não foi necessária a aprovação do Comitê de Ética em Pesquisa. Resultados: No período, foram registradas 164.176 internações por DM, sendo a maioria de pacientes mulheres, com 60 anos ou mais e que se autodeclararam pardas. Em relação à HAS, ocorreram 127.080 internações, com o mesmo perfil de prevalência: pacientes do sexo feminino, com 60 anos ou mais e que se autodeclararam pardas. Foram registrados 67.385 óbitos atribuídos ao DM e 55.485 à HAS, com perfil de prevalência semelhante: pessoas do sexo feminino, maiores de 70 anos, pardas e com baixa escolaridade. O coeficiente de mortalidade para DM variou de 28,8 por 100.000 habitantes em 2010 para 46,5 em 2022, e o para HAS variou de 24,8 em 2010 para 43 em 2022. Ademais, 97,7% dos atendimentos relacionados ao DM e 98,8% à HAS ocorreram em situações de urgência. Conclusões: Esses achados evidenciam a necessidade de fortalecer a APS, com foco na prevenção, no diagnóstico precoce, no tratamento adequado e no controle do DM e da HAS para evitar complicações graves, hospitalizações e óbitos por essas causas. A implementação de programas de educação em saúde, visando à promoção de estilos de vida saudáveis, é crucial para reduzir a incidência dessas doenças. Além disso, é fundamental garantir condições de vida e trabalho que promovam escolhas saudáveis e o acesso equitativo aos serviços de saúde, especialmente para as populações mais vulneráveis, a fim de reduzir as desigualdades em saúde.
... It is also hard to ignore longstanding health inequity issues in hypertension. There is evidence linking high blood pressure and Social Determinants of Health (SDoH), including income measures [4][5][6][7]. Multiple studies have found that Black people have a higher incidence of hypertension than any other racial group in the U.S [8][9][10][11]. ...
Background
Hypertension control remains a critical problem and most of the existing literature views it from a clinical perspective, overlooking the role of sociodemographic factors. This study aims to identify patients with not well-controlled hypertension using readily available demographic and socioeconomic features and elucidate important predictive variables.
Methods
In this retrospective cohort study, records from 1/1/2012 to 1/1/2020 at the Boston Medical Center were used. Patients with either a hypertension diagnosis or related records (≥ 130 mmHg systolic or ≥ 90 mmHg diastolic, n = 164,041) were selected. Models were developed to predict which patients had uncontrolled hypertension defined as systolic blood pressure (SBP) records exceeding 160 mmHg.
Results
The predictive model of high SBP reached an Area Under the Receiver Operating Characteristic Curve of 74.49% ± 0.23%. Age, race, Social Determinants of Health (SDoH), mental health, and cigarette use were predictive of high SBP. Being Black or having critical social needs led to higher probability of uncontrolled SBP. To mitigate model bias and elucidate differences in predictive variables, two separate models were trained for Black and White patients. Black patients face a 4.7 higher False Positive Rate (FPR) and a 0.58 lower False Negative Rate (FNR) compared to White patients. Decision threshold differentiation was implemented to equalize FNR. Race-specific models revealed different sets of social variables predicting high SBP, with Black patients being affected by structural barriers (e.g., food and transportation) and White patients by personal and demographic factors (e.g., marital status).
Conclusions
Models using non-clinical factors can predict which patients exhibit poorly controlled hypertension. Racial and SDoH variables are significant predictors but lead to biased predictive models. Race-specific models are not sufficient to resolve such biases and require further decision threshold tuning. A host of structural socioeconomic factors are identified to be targeted to reduce disparities in hypertension control.
... Recent estimates suggest that over a quarter of the adult population in sub-Saharan Africa (SSA) is living with hypertension 1 and 4.5% with diabetes 2 . However, despite the increasing prevalence of these chronic conditions, only a small proportion of people with hypertension or diabetes are in regular care, and those who are tend to have suboptimal health outcomes [3][4][5] . In contrast, SSA has high coverage of antiretroviral therapy provision and HIV viral suppression 6 through health facilities as well as in community settings 7,8 . ...
Background The number of people living with multiple chronic conditions in sub-Saharan Africa is increasing, but health facilities are unable to meet demand. To improve health system capacity and access to care, community models of HIV care have been trialled in countries such as Tanzania and Uganda. However, no evidence exists to inform policymakers on the effectiveness and cost-effectiveness of integrated community-based models of care for HIV and chronic non-communicable conditions. This protocol outlines a within-trial economic evaluation to address this gap. Methods & analysis We will estimate the costs and cost-effectiveness of integrated community-based care for HIV, hypertension and diabetes compared with facility-based care within the INTE-COMM pragmatic cluster-randomised trial in Tanzania and Uganda. Analyses will adopt a 52-week time horizon, the duration of trial follow-up. The full enrolled trial sample will be analysed from a societal perspective, comprising provider and patient perspectives. Economic costs will be estimated, which includes valuing inputs such as donated goods or time foregone by participants because of receiving care. For provider costs, participant case report forms will inform resource use along with data from facilities and community sites. Resources will be valued using project accounts, facility spending, and locally available cost data. Patient costs will be estimated based on a care-seeking and cost questionnaire administered to participants. Estimated costs will be analysed with co-primary trial outcomes on plasma viral load suppression, glycaemia and blood pressure control to calculate incremental cost-effectiveness ratios (ICER). We will also calculate ICERs for secondary trial outcomes related to health-related quality of life and wellbeing. Cost drivers and outcomes will be varied within confidence bounds in a two-way sensitivity analysis. We will investigate equity impact by estimating the mean difference in outcomes between integrated community-based and facility-based care across household socio-economic quintiles and by measuring whether participants incurred catastrophic health expenditures. Trial registration number The ISRCTN Registry: ISRCTN15319595. Registered on 07 June 2022: https://doi.org/10.1186/ISRCTN15319595
... Hypertension affects approximately 31.1% of adults worldwide and is a leading cause of premature death globally (42). Hypertension increases the risk of ED, which may also serve as an early indicator of hypertension (43). ...
Background
Erectile dysfunction (ED) is a prevalent male sexual disorder, commonly associated with hypertension, though the underlying mechanisms remain poorly understood.
Objective
This study aims to explore the role of Fatty acid synthase (Fasn) in hypertension-induced ED and evaluate the therapeutic potential of the Fasn inhibitor C75.
Materials and methods
Erectile function was assessed by determining the intracavernous pressure/mean arterial pressure (ICP/MAP) ratio, followed by the collection of cavernous tissue for transcriptomic and non-targeted metabolomic analyses. In vitro, a concentration of 10⁻⁶ M angiotensin II (Ang II) was applied to rat aortic endothelial cells (RAOECs) to establish a model of hypertension. In vivo, spontaneously hypertensive rats (SHR) were randomly divided into two groups. The SHR+C75 group received intraperitoneal injections of C75 at a dose of 2 mg/kg once a week. After five weeks of treatment, the erectile function of the rats was assessed, and penile tissues were harvested for further analysis. Molecular and protein expression were assessed using Western blotting, qRT-PCR, immunofluorescence staining, and immunohistochemistry.
Results
The SHR exhibited ED, indicated by reduced maximum ICP/MAP ratios. Histologically, corpus cavernosum tissue of SHR showed elevated fibrosis and endothelial dysfunction. Additionally, increased expression of the NLRP3 inflammasome, Caspase-1, GSDMD, and the pro-inflammatory cytokines IL-1β and IL-18 was observed. Multi-omics analysis revealed significant enrichment in lipid metabolic pathways, with Fasn identified as a hub gene. In vitro, siFasn and C75 enhanced antioxidant markers Nrf2 and HO-1, reduced ROS accumulation, and suppressed NLRP3 and GSDMD levels. In vivo, C75 treatment restored endothelial function and reversed erectile dysfunction, accompanied by decreased oxidative stress and pyroptosis in the penile corpus cavernosum.
Conclusion
These findings suggest that Fasn inhibition may offer a promising therapeutic strategy for hypertension-induced ED by alleviating oxidative stress and suppressing NLRP3 inflammasome-dependent endothelial cell pyroptosis via activation of the Nrf2/HO-1 pathway.
... Despite hypertension being such a high prevalence condition, only 54% of affected adults are diagnosed, 42% receive treatment, and a mere 21% have their BP controlled. In addition, the report points out that approximately three-quarters of individuals with hypertension live in low-and middle-income countries, with the prevalence of this condition higher in such countries than in high-income ones [4]. ...
Systemic hypertension, a significant global health issue and a leading risk factor for cardiovascular mortality affects half of the adult population, with increasing prevalence notably in low- and middle-income countries. Despite advancements in diagnosis and treatment, only one in four individuals with hypertension achieve satisfactory control over their condition. Medication adherence, critical for effective hypertension management, is complex and multifaceted. Non-adherence, encompassing late or non-initiation, sub-optimal implementation, and early discontinuation of treatment, is prevalent worldwide, with reported rates of anti-hypertensive medication non-adherence ranging from 30% to 40%. Adherence is influenced by various factors including drug regimen complexity, patient education, and socioeconomic status. Poor adherence is linked to increased cardiovascular risks and is compounded by clinical inertia among physicians. Addressing barriers to adherence and implementing evidence-based interventions can significantly reduce the global burden of hypertension and its associated complications. This review highlighted the critical need for improved adherence strategies to enhance hypertension management. It focused on novel tools such as mobile health interventions and regimen-simplification through single-pill combinations, which can improve treatment persistence and blood pressure control.
... This makes classification of hypertension in pregnancy and the management of abnormal BP crucial to minimize adverse outcomes. In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) altered their definitions of abnormal BP outside of pregnancy, given the continuous relationship between elevated BP and cardiovascular disease, the prevalence of which continues to rise [6,7]. Hypertension was reclassified by the ACC/AHA as "Stage 1 hypertension" (BP 130 to 139/80 to 89 mmHg) and "Stage 2 hypertension" (BP �140/90 mmHg), with "Elevated" BP (sBP 120 to 129 mmHg and dBP <80 mmHg) as an additional category before BP was considered to be "Normal" (<120/80 mmHg) [8]. ...
Background
In 2017, the American College of Cardiology and American Heart Association (ACC/AHA) lowered blood pressure (BP) thresholds to define hypertension in adults outside pregnancy. If used in pregnancy, these lower thresholds may identify women at increased risk of adverse outcomes, which would be particularly useful to risk-stratify nulliparous women. In this secondary analysis of the SCOPE cohort, we asked whether, among standard-risk nulliparous women, the ACC/AHA BP categories could identify women at increased risk for adverse outcomes.
Methods and findings
Included were pregnancies in the international SCOPE cohort with birth at ≥20 weeks’ gestation, 2004 to 2008. Women were mostly of white ethnicity, in their 20s, and of normal-to-overweight body mass index (BMI). Excluded were pregnancies ending in fetal loss at <20 weeks’ gestation, and those terminated at any point in pregnancy. Women were categorized by highest BP during pregnancy, using ACC/AHA criteria: normal (BP <120/80 mmHg), “Elevated BP” (BP 120 to 129 mmHg/<80 mmHg), “Stage-1 hypertension” (systolic BP [sBP] 130 to 139 mmHg or diastolic BP [dBP] 80 to 89 mmHg), and “Stage-2 hypertension” that was non-severe (sBP 140 to 159 mmHg or dBP 90 to 109 mmHg) or severe (sBP ≥160 mmHg or dBP ≥110 mmHg). Primary outcomes were preterm birth (PTB), low birthweight, postpartum hemorrhage, and neonatal care admission. Adjusted relative risks (aRRs) and diagnostic test properties were calculated for each outcome, according to: each BP category (versus “normal”), and using the lower limit of each BP category as a cut-off. RRs were adjusted for maternal age, BMI, smoking, ethnicity, and alcohol use. Of 5,628 women in SCOPE, 5,597 were included in this analysis. When compared with normotension, severe “Stage 2 hypertension” was associated with PTB (24.0% versus 5.3%; aRR 4.88, 95% confidence interval, CI [3.46 to 6.88]), birthweight <10th centile (24.4% versus 8.8%; aRR 2.70 [2.00 to 3.65]), and neonatal unit admission (32.9% versus 8.9%; aRR 3.40 [2.59 to 4.46]). When compared with normotension, non-severe “Stage 2 hypertension” was associated with birthweight <10th centile (16.1% versus 8.8%; aRR 1.82 [1.45 to 2.29]) and neonatal unit admission (15.4% versus 8.9%; aRR 1.65 [1.31 to 2.07]), but no association with adverse outcomes was seen with BP categories below “Stage 2 hypertension.” When each BP category was assessed as a threshold for diagnosis of abnormal BP (compared with BP values below), only severe “Stage 2 hypertension” had a useful (good) likelihood ratio (LR) of 5.09 (95% CI [3.84 to 6.75]) for PTB. No BP threshold could rule-out adverse outcomes (i.e., had a negative LR <0.2). Limitations of our analysis include lack of ethnic diversity and use of values from clinical notes for BP within 2 weeks before birth. This study was limited by: its retrospective nature, not all women having BP recorded at all visits, and the lack of detail about some outcomes.
Conclusions
In this study, we observed that 2017 ACC/AHA BP categories demonstrated a similar pattern of association and diagnostic test properties in nulliparous women, as seen in the general obstetric population. BP thresholds below the currently used “Stage 2 hypertension” were not associated with PTB, low birthweight, postpartum hemorrhage, or neonatal unit admission. This study does not support implementation of lower BP values as abnormal in nulliparous pregnant women.
Effective therapy against Helicobacter pylori hinges on a timely and accurate diagnosis. The objective is to assess H. pylori infection in dyspeptic patients and compare various indicative tests. After approval, gastrointestinal biopsies and blood samples of 96 subjects exhibiting gastroduodenal symptoms were collected; both invasive and non‐invasive tests were employed to analyse the samples. Results revealed 40 cases (41.67%) positive for H. pylori via histopathology and rapid urease testing, while 46 subjects tested positive for IgA and IgG antibodies via ELISA. Eighteen biopsies showed positivity in the culture test, corroborated by endoscopic examination and biochemical assessments (urease, catalase and oxidase). The isolates showed various degrees of resistance to antibiotics, while polymyxin B showed the highest (100%) followed by amoxicillin (88.90%) and kanamycin (77.78%). Additionally, the CagA gene presence was detected in 18 individuals through molecular methods. Sensitivity and specificity percentages (%) varied among diagnostic methods: histopathology (95/77), rapid urease (100/83.5), gram staining (85.7/90), IgG serology (100/66.6), IgA serology (100/79.5), PCR (100/75), RUT and IgG serology combination (100/79.04), and RUT, Gram staining and IgG serology combination (100/92.4), respectively. PCR emerged as the most reliable test. In the current investigation, other tests also exhibited high sensitivity and specificity values. Thus, employing comparative detection methods rather than relying solely on one methodology is advisable for accurate detection.
Objective
Post-traumatic stress disorder (PTSD) and hypertension are highly prevalent among Veterans. Cognitive dispersion, indicating within-person variability across neuropsychological measures at one time point, is associated with increased risk of dementia. We examined interactive effects of PTSD symptom severity and hypertension on cognitive dispersion among older Veterans.
Methods
We included 128 Vietnam-era Veterans from the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI) with a history of PTSD. Regression models examined interactions between PTSD symptom severity and hypertension on cognitive dispersion (defined as the intraindividual standard deviation across eight cognitive measures) adjusting for demographics and comorbid vascular risk factors.
Results
There was an interaction between PTSD symptom severity and hypertension on cognitive dispersion ( p = .026) but not on mean cognitive performance ( p = .543). Greater PTSD symptom severity was associated with higher cognitive dispersion among those with hypertension ( p = .002), but not among those without hypertension ( p = .531). Results remained similar after adjusting for mean cognitive performance.
Conclusions
Findings suggest, among older Veterans with PTSD, those with both hypertension and more severe PTSD symptoms may be at greater risk for cognitive difficulties. Further, cognitive dispersion may be a useful marker of subtle cognitive difficulties. Future research should examine these associations longitudinally and in a diverse sample.
Objective
To determine the prevalence of fatty pancreas disease (FPD) diagnosed by transabdominal ultrasound in Chinese elderly aged 65 years and above to explore the correlation between triglyceride glucose index (TyG index) and FPD and its severity, and to evaluate the ability of TyG index to identify FPD and its severity.
Methods
The study population was derived from the Thyroid Diseases in Older Population: Screening, Surveillance, and Intervention (TOPS) study conducted in the iodine-adapted areas of Jiangsu Province from May to July 2021. A total of 567 participants aged 65 years and above in rural areas were included in the final analysis. TyG index was calculated by the established formula: Ln [TG (mg/dL) × FBG (mg/dL)/2]. FPD and the degree of intra-pancreatic fat deposition (IPFD) were diagnosed by abdominal ultrasound. The logistic regression model was performed to determine the correlation between clinical parameters, including TyG index, and FPD and its severity. The diagnostic power of TyG index was assessed by receiver operating characteristic curve (ROC).
Results
Overall, 72.66% (412/567) of subjects had FPD, of which over half had moderate to severe FPD. The proportions of overweight, obesity, NAFLD, and dyslipidemia were significantly higher in the moderate-to-severe FPD group than in the mild FPD group. Multivariate logistic regression showed that TyG index was independently associated with FPD in the elderly population, but was not significantly associated with the severity of IPFD. As the level of TyG index increased, the metabolic disorders in the population worsened and the prevalence of FPD increased significantly. TyG index had a good diagnostic performance for FPD. The combination of BMI or NAFLD and TyG index improved the diagnostic ability for FPD.
Conclusion
The prevalence of FPD diagnosed by abdominal ultrasound is high in the elderly aged 65 years and above in rural areas in China. TyG index has good identification of FPD but poor recognition of the severity of IPFD. TyG index, when combined with other clinical parameters, may have more diagnostic advantages.
Triglyceride glucose-body mass index (TyG-BMI), as a new surrogate index for evaluating insulin resistance (IR), has rarely been studied with the incidence rate of hypertension (HTN). This study aims to explore the correlation between TyG-BMI and HTN in American adults, to find a cost-effective and convenient marker to guide early prevention of HTN. We performed this cross-sectional study based on the NHANES database from 2017 to 2020. A multivariate logistic regression model was used to analyze the correlation between TyG-BMI and the prevalence of HTN. Additionally, stratified analysis was performed to test the robustness of the results. 3,069 eligible participants were included in our study (48.8% male, mean age 50.0 ± 17.2 years), and multivariate logistic regression analysis showed that TyG-BMI was maintained positively correlated with HTN after fully adjusting covariates. For every 10-unit increase in the TyG-BMI, the risk of HTN increases by 4.3% (95% CI: 1.007–1.08, P = 0.018). When TyG-BMI was represented as a Quartile, the relationship between TyG-BMI and increased risk of HTN remained significant, which were statistically significant for each model. Stratified analyses suggested that the correlation between TyG-BMI and HTN was more pronounced in those aged 60 years or older (P < 0.05). The correlation between TyG-BMI and HTN remained stable in all strata except the age subgroup (P > 0.05). TyG-BMI is significantly associated with HTN among American adults. Early monitoring of TyG-BMI may help to monitor early the risk of hypertension.
Objective
To systematically evaluate the effectiveness of mobile health (mHealth) interventions on self-management and blood pressure (BP) control in patients with hypertension and to provide recommendations for the clinic and future research.
Methods
Databases including Embase, Cochrane Library, CINAHL, CNKI, SinoMed, Wanfang, and Weipu were searched to collect systematic reviews (SRs) and meta-analyses on mHealth interventions for hypertension management. Two researchers independently screened the articles and extracted data, and the Assessment of Multiple Systematic Reviews (AMSTAR 2) was used to evaluate the methodological quality of the included reviews.
Results
A total of 11 SRs were included: 1 review was rated as high quality, 3 as low quality, and 7 as critically low quality. The mobile phone was the most common intervention type, followed by the internet. Seven reviews performed meta-analyses and showed that mHealth was associated with a significant reduction in systolic blood pressure (SBP), from 2.28 mmHg (95%CI –3.90 to –0.66; I ² = 40%) to 14.77 mmHg (95%CI 11.76–17.77; I ² = 89.7%), and diastolic blood pressure (DBP), from 1.50 mmHg (95%CI –2.20 to –0.08; I ² = 62%) to 8.17 mmHg (95%CI 5.67–10.67; I ² = 86%). Self-management behaviors included medication adherence (MA), diet, smoking, alcohol drinking, physical activity, and BP monitoring. There were inconsistent results on the effectiveness of mHealth interventions.
Conclusions
mHealth interventions can improve BP control, MA, diet, and smoking in patients with hypertension, but the evidence for the efficacy of mHealth on physical activity and alcohol drinking improvement is limited. The methodological quality of existing SRs on the management of BP in patients with hypertension was relatively low, and more well-designed SRs or meta-analyses were needed to provide more evidence. mHealth interventions are useful for improving BP control of patients with hypertension.
Background
The aim of the study was to evaluate the pharmacokinetic (PK) properties and safety profiles of test and reference amlodipine/benazepril capsules under both fasting and fed states, determine the bioequivalence between the two formulations, and provide sufficient evidence for new drug application.
Subjects and Methods
The bioequivalence study was conducted utilizing a randomized, open-label design, involving two formulations administered in a single-dose format. Healthy Chinese participants who met the eligibility criteria were administered a single dose of the test or reference amlodipine/benazepril capsule. Blood samples were taken serially for up to 168 hours post-administration during each period, and the plasma levels of amlodipine, benazepril, and benazeprilat were measured using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method. For bioequivalence evaluation, geometric mean ratios comparing the pharmacokinetic parameters of the test drug with those of the reference drug were calculated along with their corresponding 90% confidence intervals. Safety assessments were conducted throughout the duration of the study.
Results
The PK parameters of the test formulation were found to be comparable to those of the reference formulation under both fasting and fed conditions. The 90% confidence intervals (CIs) for the geometric mean ratios comparing the test and reference formulations for the peak concentration (Cmax), the area under the curve from time zero to the last measurable concentration (AUC0-t), and the area under the curve from time zero to observed infinity (AUC0-∞) of amlodipine, benazepril, and benazeprilat fell within the range of 80.00% to 125.00% in both groups. Both formulations were well tolerated by participants, with no serious adverse events reported throughout the trial.
Conclusion
The pharmacokinetic bioequivalence between the test and reference formulation in healthy individuals was confirmed under both fasting and fed states, meeting regulatory standards set for the study. Both drug formulations demonstrated safety and tolerability.
Hypertension is associated with vascular injury characterized by vascular dysfunction, remodeling, and stiffening, which contributes to end-organ damage leading to cardiovascular events and potentially death. Innate (macrophages and dendritic cells), innate-like (γδ T cells) and adaptive immune cells (T and B cells) play a role in hypertension and vascular injury. Perivascular adipose tissue that is the fourth layer of the blood vessel wall is an important homeostatic regulator of vascular tone. Increased infiltration of immune cells in perivascular adipose tissue in hypertension results in generation of oxidative stress and production of cytokines that may cause vascular injury. This review presents an overview of the role of the different immune cells that infiltrate the perivascular adipose tissue and are involved in the pathophysiology of hypertension.
Background
Hypertension is a chronic condition that represents a global burden across the world. The burden of hypertension is found to be particularly high in Middle Eastern countries such as Saudi Arabia. This study was undertaken to measure the prevalence of hypertension and its associated factors. An assessment of the impact of hypertension is required to alleviate/reduce the comorbidities and complications associated with hypertension in Saudi Arabia.
Materials and methods
A cross-sectional survey was conducted among 14,239 individuals in Saudi Arabia. A valid and reliable questionnaire was administered after randomly selecting study participants from 48 primary healthcare centers. Univariate analysis was performed to investigate the relationship between independent variables and hypertension. P-values less than 0.05 were considered significant. Multivariate logistic regression was used to establish the major associated factors of hypertension among Saudi citizens. A 95% confidence interval (CI) was presented for each of the adjusted odds ratios (AORs).
Results
It was found that 11.1% of research participants reported having hypertension. Compared to younger participants of < 50 years, those who are 50 to 75 years old are two times more likely to be hypertensive (AOR: 2.05; 95% CI: 1.68, 2.50). Compared to employed Saudi residents, unemployed residents were 1.43 times more likely to be hypertensive (AOR: 1.43; 95% CI: 1.25, 1.65). The odds of hypertension were higher by 1.73 times among obese than non-obese individuals (95% CI: 1.33, 2.25). Individuals with heart disease were 3.72 times more likely to suffer from hypertension than individuals without heart disease (95% CI: 2.84, 4.88). Similarly, those with high cholesterol levels were 8.37 times more likely to have hypertension than those with low cholesterol levels (95% CI: 6.94, 10.09). Diabetic individuals were 10.45 times more likely to develop hypertension than non-diabetic individuals (95% CI: 8,87, 12.30).
Conclusion
The prevalence of hypertension found in the current study was 11.1%. Older age, unemployment, insurance coverage, obesity, diabetes, heart disease, and high blood cholesterol were associated with high blood pressure in this study. The findings of this study suggest that researchers and policymakers should target modifiable risk factors to reduce the burden of hypertension among Saudi residents.
Purpose
To test the hypotheses that declining cognitive aging trajectories would increase mortality risk and that predictors of mortality would differ between trajectory groups.
Methods
This is a sub-study of the ZARADEMP project studying dementia and depression in older adults aged 55 years or more, conducted in Zaragoza, Spain, including 2403 cognitively healthy individuals who had completed at least three of the four waves in a 12-year follow-up. The three cognitive trajectories previously identified were based on the Mini-Mental State Examination (MMSE). Mortality information obtained from the city’s official population registry was registered up to 6 years after the end of the fourth wave of the study. Cox proportional hazard regression analyses for analyzing the risk of death were performed globally and for each cognitive trajectory.
Results
At follow-up, 42.4% of the participants had died. Individuals in class 2-moderate-stable and in class 3-low-and-declining had a 24% and 96%, respectively, higher risk of mortality than those in class 1-high-to-moderate. Those younger and women showed significant lower risks of death in all the classes. Being single, with diabetes, dependency in basic Activities of Daily Living, ex-drinkers, smokers, and ex-smokers increased the risk in class 2. Hypertension showed a higher risk of death in the high-to-moderate group. In the low-and-declining trajectory, anxiety nearly tripled the risk of death.
Conclusion
Trajectories with cognitive decline are associated with higher mortality, with the risk of death showing a gradient. Predictors of mortality differ by cognitive trajectory; the differences being observed even among the cognitively healthier groups.
Background
Hypertension, the first global modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality, is a consequential and remediable threat to the health of individuals and society. Therefore, we conducted this study to explore the role of calcium (Ca⁺⁺), magnesium (Mg⁺⁺), and vitamin D (Vit-D) supplementation as complementary therapies for hypertension, focusing on their effects on systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate.
Methods
This systematic review and meta-analysis examined relevant 6509 articles in PubMed, Scopus, Web of Science, and Cochrane CENTRAL up to October 2024. The primary outcome was the difference in blood pressure measurements (systolic and diastolic) and the pulse rate. The extracted data were analyzed using Open Meta Analyst software.
Results
This systematic review and meta-analysis included 40 studies; of them, 24 studies were analyzed. Ca⁺⁺ was associated with a significant drop in the DBP (MD: -2.04, 95% CI [-3.39, -0.69], P = 0.01), but not in the SBP (P = 0.34) or pulse rate (P = 0.84). Mg⁺⁺ significantly reduced DBP (MD: -1.64, 95% CI [-3.19, -0.09], P = 0.04), but had no significant effect on the SBP (P = 0.16) or pulse rate (P = 0.81). The estimated effect of Vit-D showed a significant reduction in SBP (MD: -2.83, 95% CI [-5.47, -0.199], P = 0.04) and DBP (MD: -1.64, 95% CI [-2.97, -0.3], P = 0.01).
Conclusion
Ca⁺⁺ and Mg⁺⁺ significantly reduced DBP but had no significant effect on SBP or the pulse rate. Whereas, vitamin D significantly reduced SBP and DBP.
Background
The association of genetic variants and environmental factors contribute to increased susceptibility to arterial hypertension (AH). Polymorphisms of the angiotensin-converting enzyme (ACE) gene have been identified as a genetic risk factor related to blood pressure (BP) levels and liver function, since they influence the renin-angiotensin-aldosterone system (RAAS).
Objective
To evaluate the influence of the rs4344 polymorphism of the ACE gene on AH and biochemical parameters of liver function (ALT, AST, GGT and ALP) in normotensive and hypertensive patients.
Method and results
The identification of the polymorphism was performed by qPCR, using the TaqMan® system, in 811 individuals (484 normotensive and 327 hypertensive) and biochemical dosages (AST, ALT, GGT and ALP) were performed by UV/Vis spectrophotometry. A univariate logistic regression model was used to identify factors associated with hypertension and Pearson’s chi-square test to assess allele frequency between groups. A multivariate logistic regression model was used to correct confounding factors and assess the association of the variant with hypertension. Data normality was assessed using the Shapiro-Wilk test. Continuous nonparametric variables were expressed as median and interquartile range and analyzed using the Mann-Whitney test and parametric data were expressed as mean and standard deviation and analyzed by unpaired Student’s t test. The rs4344 variant was not linked to hypertension in the individuals examined. However, concerning liver function marker enzymes, the G allele was associated with increased levels of GGT and ALT in hypertensive patients.
Conclusions
Our findings indicated that the rs4344 variant of the ACE gene is linked to impaired liver function in hypertensive individuals.
Objective
This study aimed to evaluate the psychometric properties of the Persian version of the TSQM-14 in patients with hypertension in Iran
Methods
This cross-sectional study was conducted among hypertensive patients referred to primary healthcare centers in Kerman City between January and February 2021. Cronbach's alpha and total-item correlation were used to evaluate internal consistency, while the Intraclass Correlation Coefficient (ICC) was employed to assess test-retest reliability. Construct validity was examined using structural equation modeling (SEM), known-groups validity, and convergent validity.
Results
A total of 319 participants took part in the study, with a mean age of 56.7 years (SD = 13.0), and 57.7% (n = 184) were female. The Cronbach's alpha and ICC values of the TSQM-14 for the composite scales were 0.83 and 0.91, respectively, indicating good reliability. The SEM indices for TSQM-14 demonstrated adequate model fit, with χ² = 118.9 (P ≤ 0.001), CFI = 0.96, RMSEA = 0.07, TLI = 0.95, and NFI = 0.91. The mean (standard deviation (SD)) scores of the composite scale for patients in the uncontrolled group (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) and the controlled group were 50.2 (SD = 6.6) and 47.6 (SD = 6.1), respectively (P = 0.021). Additionally, the Spearman correlation coefficient between the TSQM-14 scale and the MMAS-8 was 0.30 (P < 0.001), demonstrating a weak but significant correlation.
Conclusions
This study demonstrated that the Persian version of the TSQM-14 has acceptable reliability, as well as construct and convergent validity, for assessing treatment satisfaction among hypertensive patients.
Background
Hypertension presents as a modifiable risk factor for cardiovascular diseases, with approximately two-thirds of the global hypertensive population concentrated in low- and middle-income nations. Sarpagandha Mishran is an Ayurveda intervention utilized for the management of hypertension. The objective of the study is to assess the clinical efficacy and safety of Sarpgandha Mishran in the Management of Stage-I Hypertension.
Methods
This clinical trial employs a prospective design characterized by a double-dummy, double-blind, placebo-controlled methodology being conducted at Cardiology Outpatient Department of the AIIMS, New Delhi. A total of 150 participants (75 per group), diagnosed with Stage-I essential hypertension will be randomized and allocated in a 1:1 allocation ratio, to either Ayurveda group or Conventional Care group. Participants in Group I will receive Ayurvedic intervention, Sarpagandha Mishran 500 mg capsules orally twice daily, in addition to a matching placebo of Amlodipine 5 mg capsules orally once daily. Group II will receive a matching placebo of Sarpagandha Mishran 500 mg capsules along with Amlodipine 5 mg capsules orally once daily. All participants will also be administered Hydrochlorothiazide 12.5 mg tablets orally once daily for a duration of 12 weeks. The primary endpoint of this study involves evaluating changes in SBP and DBP from baseline to week 12. Secondary outcome includes assessing changes in IL-6, Serum Pro-BNP, oxidative stress markers, lipid profile, and the SF-36 Health Survey Score. Safety assessments will be done through recording of AE/ADR and assessments of liver function tests and renal function tests parameters.
Discussion
The present study is poised to furnish comprehensive insights into the clinical efficacy and safety profile of Sarpagandha Mishran in the management of Grade 1 hypertension. By adopting a rigorous scientific methodology, this investigation aims to contribute robust evidence that may significantly impact the formulation of future guidelines for integrative treatment protocols in hypertension management.
Trial Registration
The trial is prospectively registered with the Clinical Trial Registry of India [CTRI/2021/12/038589], dated 13.12.2021.
Background
High blood pressure, commonly referred to as hypertension, remains a prevalent global health concern characterized by elevated arterial pressure, posing significant risks such as cardiovascular diseases, stroke, and kidney diseases. Therefore, this study aimed to assess the burden and determinants of self-reported high blood pressure among women of reproductive age in Tanzania.
Methods
We utilized population-based cross-sectional data obtained from the Tanzania Demographic and Health Survey (TDHS) 2022. The analysis involved a weighted sample of 15,254 women aged 15–49 years. Multivariable logistic regression models were employed to examine the independent variables associated with self-reported high blood pressure, and the results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). The significance level was set at p < 0.05 for all analyses.
Results
Overall, the mean age of study participants was 29.3 ± 9.8 years, with a self-reported high blood pressure burden of 6.6% among women of reproductive age in Tanzania. Moreover, increased age correlated with higher odds of high blood pressure compared to women aged 15–19 years. Those with a secondary level of education exhibited a higher likelihood of high blood pressure in contrast to women with no education. Married and widowed individuals were more prone to high blood pressure than those who were never married. Additionally, women in higher wealth groups showed a significantly elevated risk of high blood pressure compared to those in the poorest wealth group. Conversely, self-reported poor health status and recent visits to health facilities were associated with significantly higher odds of high blood pressure.
Conclusion
This study highlights the burden of high blood pressure among reproductive-age women, urging heightened awareness and proactive screening measures. These findings prompt targeted interventions, emphasizing the need for collaborative efforts among stakeholders to effectively curb this health burden.
Background
previous studies have indicated that influenza vaccination may be associated with reduced risks of certain types of cancer. However, the protective effect of influenza vaccination against primary liver cancer in individuals with hypertension remains unclear.
Methods
In this cohort study, 37,022 patients over 55 years of age who received a diagnosis of hypertension at any time between January 1, 2001, and December 31, 2012, were enrolled from the National Health Insurance Research Database. The patients were divided into a vaccinated and an unvaccinated group. Categorical and continuous variables were analyzed using the chi-square test and t test, respectively, and the correlation between influenza vaccination and liver cancer in patients with hypertension was analyzed using time-varying COX model. Propensity score method was performed to reduce selection bias.
Results
Compared with the unvaccinated group, the vaccinated group had a significantly lower incidence of liver cancer (hazard ratio = 0.56, 95% confidence interval = 0.46–0.64; p < .001). In addition, a protective effect was observed regardless of sex, age, or comorbidities. Besides, the association was dose-dependent which could be noted when patients were stratified based on the total number of vaccinations. The adjusted HRs for patients receiving 1, 2 to 3, and ≥ 4 vaccinations during the follow-up period were 0.60 (0.51–0.78), 0.48 (0.38–0.65), and 0.39(0.30–0.51), respectively.
Conclusions
In summary, influenza vaccination is linked to a decreased risk of liver cancer in individuals with hypertension. However, unmeasurable confounders may have been present in the analysis.
This study investigated the association between fat-to-muscle ratio (FMR) and hypertension. A total of 1592 participants aged ≥ 40 years were included. Participants were divided into four groups by quartiles of FMR. Odds ratio (OR) and 95% confidence interval (CI) was calculated using logistic regression models. Restricted cubic spline was applied to examine the correlation of FMR and hypertension. Of 1592 participants, 943 (59.2%) participants had hypertension. Hypertension risk rose with FMR quartiles. Compared to FMR quartile 1, ORs were 1.496 (95% CI: 1.115–2.006), 2.445 (95% CI: 1.840–3.249), and 5.415 (95% CI: 3.993–7.344) for quartiles 2, 3, and 4, respectively (P for trend < 0.001). Adjusted OR in quartile 4 was 3.015 (95% CI: 2.083–4.365). Restricted cubic spline showed a linear relationship between FMR and hypertension. Adding FMR improved hypertension risk model performance (P = 0.006). Subgroup analysis revealed FMR interactions with sex (P = 0.010) and BMI (P < 0.016), with a higher hypertension risk in females and non-obese individuals. Additionally, versus FMR quartile 1, hypertensive individuals in quartiles 2 (OR: 1.370, 95% CI: 0.900–2.085), 3 (OR: 2.055, 95% CI: 1.374–3.073) and 4 (OR: 3.102, 95% CI: 2.055–4.682) exhibited a significantly elevated risk of atherosclerotic cardiovascular disease (ASCVD). In summary, Elevated FMR independently correlated with hypertension risk, especially in women, or even in non-obese individuals. FMR is a valuable tool for identifying populations with higher hypertension risk and assessing ASCVD risk in hypertensive individuals. Body composition warrants consideration in future hypertension risk studies.
Highlights
It is important to implement programs to improve prevention, awareness, and control of arterial hypertension. The levels of hypertension control vary depending on populations and time periods. This review presents an assessment of the variation in awareness, treatment, and control of hypertension in modern populations around the world.
Abstract
High blood pressure (BP) is a major risk factor in the development of premature death and disability throughout the world. We conducted an analytical review of the medical research publications for the period 2005–2023, which assessed the prevalence, awareness, treatment and control of hypertension (HT) in various populations in the contemporary period. For literature search we used electronic databases of Google Academy (https://scholar.google.ru/), PubMed (https://pubmed.ncbi.nlm.nih.gov), eLIBRARY.ru ( https://www.elibrary ), and the data from international and Russian journals dedicated to cardiology and internal medicine. The results of the analysis showed significant geographical variations in the HT prevalence (from < 20% to > 60%); predominantly high rates of HT awareness and treatment in developed countries (up to > 80%) with low relevant indicators in underdeveloped countries, for example, in Sub-Saharan African regions (below 15–20%). The level of hypertension control varies from < 10% to > 60%. The assessment of adherence to the guidelines for CVD prevention, is most consistently reported by the series of EUROASPIRE I–V, NHANES, NCD Risk factor Collaboration, ESSE-RF studies. Despite the availability of modern guidelines for the management of HT and existence of effective and safe antihypertensive drugs, the control of HT is very difficult. According to generalized data, about 50% of hypertensive patients do not achieve target BP levels. Recent trends demonstrate that a dual approach to reducing HT through primary prevention and improved treatment and control is achievable not only in high-income countries, but also in middle- and low-income settings. Accordingly, the implementation of coordinated programs to improve the prevention, detection, education, treatment and control of hypertension is warranted and important worldwide.
Background
Preventing cardiovascular disease (CVD) in adults with hypertension is essential, but it remains uncertain whether optimizing modifiable factors can eliminate the excess CVD risk associated with new-onset hypertension.
Methods
In this prospective cohort study, 29,597 adults with new-onset hypertension and no prior CVD (from 2006–2016 surveys) were each matched by age and sex to a normotensive control. Eight modifiable factors were assessed using the American Heart Association’s Life’s Essential 8 algorithm. We followed participants for incident CVD until December 2020, estimating 10-year and lifetime (age 25–95) CVD risks using the Fine-Gray competing risks model.
Results
Over a median follow-up of 9.81 years, adults with new-onset hypertension had higher 10-year (8.97% vs. 6.31%) and lifetime CVD risks (45.55% vs. 34.98%) compared to normotensive controls. After adjusting for age, sex, and other unmodifiable factors, each additional favorable factor was associated with a stepwise reduction in CVD risk (P-trend < 0.05). Hypertensive participants with four or more favorable factors had a 17% lower 10-year CVD risk (HR 0.83; 95% CI 0.72–0.97) and a similar lifetime CVD risk (HR 0.90; 95% CI 0.78–1.05) compared to normotensive controls. Notably, the protective effect was weaker among those with early-onset (before age 45) hypertension than those with later-onset (age ≥ 60) hypertension (P-interaction < 0.05).
Conclusions
In adults with new-onset hypertension, maintaining four or more modifiable factors at favorable levels was associated with a CVD risk comparable to that of normotensive individuals. However, young hypertensive adults may require more aggressive interventions to mitigate CVD risk.
Background
China is currently grappling with the escalating burden of hypertension and depression. This study aimed to assess the prevalence and number of hypertensive patients with depressive symptom, and to evaluate their risk of all-cause mortality.
Methods
Data from the China Health and Retirement Longitudinal Study (CHARLS) were utilized to estimate the prevalence of individuals with both hypertension and depressive symptom, the recommendation rate for antihypertensive medications, the blood pressure control rate, and the corresponding population size. The Cox proportional hazard model was employed to estimate the risk of all-cause mortality associated with hypertension combined with depressive symptom.
Results
Overall, 15.01% (95% CI: 13.80, 16.31) of adults, corresponding to 72.06 million (95% CI: 66.91, 77.23) individuals, were identified as having both hypertension and depressive symptom. Among these, 28.49 million (95% CI: 27.07, 29.92) were recommended to initiate blood pressure medications but did not comply. Furthermore, 19.53 million (95% CI: 18.01, 21.06) hypertensive patients with depressive symptom who were taking antihypertensive medications did not achieve their blood pressure control goals. Hypertension combined with depressive symptom was associated with an increased risk of all-cause mortality (hazard ratio = 2.21, 95% CI: 1.48, 3.31).
Conclusions
Our findings indicated a significant population of individuals with both hypertension and depressive symptom in China, with low treatment and control rates. The coexistence of hypertension and depression was linked to a heightened risk of all-cause mortality. Strategies for hypertension prevention and treatment should be integrated with considerations for depression.
Clinical trial number
Not applicable.
Background
Hypertensive heart disease (HHD) is a significant public health concern in China. We intend to provide an updated estimate of the burden of HHD in China between 1990 and 2030.
Methods
HHD prevalence, mortality, and disability-adjusted life years (DALYs) data were obtained from Global Burden of Disease (GBD) 2019 databases. Temporal trends of HHD from 1990 to 2019 were analyzed using Joinpoint regression models, and projections through 2030 were estimated by Bayesian age-period-cohort model.
Results
In 2020, an estimated 334,695 newly prevalent cases and 13,196 deaths due to HHD occurred in China. From 1990 to 2019, age-standardized rate of prevalence (ASPR), mortality (ASMR) and DALYs (ASDR) showed a decreasing trend. The behavior-related risk, diet risk and excessive BMI were the most common reasons of death in HHD. According to our prediction, ASMRs and ASDRs will continue to decrease from 2020 to 2030. However, ASPRs will have a moderate rise.
Conclusion
HHD continues to pose a significant threat to public health in China. To achieve the Healthy China 2030 objective, a tailored approach involving comprehensive strategies is essential. These strategies should include, but are not limited to, enhancing public awareness about hypertension through educational campaigns, improving access to healthcare services for early diagnosis and treatment, implementing policies to promote healthy lifestyles, such as regular physical activity and a balanced diet, and strengthening the surveillance and monitoring systems to track the prevalence and impact of HHD over time.
While gendered psycho-socio-cultural factors are recognized as major determinants of cardiovascular health, their contribution to our understanding of their effect on hypertension (HTN) in each country is poorly understood. Therefore, we investigated the role of these factors in HTN prevalence, focusing on sex- and gender-specific differences across countries. Data from the Canadian Community Health Survey (2015–2016, N = 109,659, women: 56.6%) and the European Health Interview Survey (2013–2015, N = 316,333, women: 51.3%) were analyzed. Primary endpoint was defined as HTN prevalence within 1-year. Relationship and interaction between sex, gender, and country with HTN prevalence were assessed using multivariate models. Federated analysis was conducted using DataShield. Prevalence of HTN was higher in Canada compared to Europe (30.1% vs 22.4%, P < .001). Amongst European countries, living in the Central-East region was associated with a greater risk of developing HTN. Women in the southern and central-east regions had higher prevalence of HTN. There was a significant interaction between socioeconomic status and sex in country-stratified analysis. This was more evident in central-east and southern countries compared to northern, western nations and Canada, where women with lower socioeconomic status, income, and education had a greater risk of developing HTN. Similar trends were observed regardless of country in women who were divorced or widowed. While immigrants were at higher risk of HTN, those in northern and southern Europe were at lower risk compared to central-east region. Sex- and gender-related factors and country should be considered in the prevention and control of HTN.
Background
Hypertension (HTN) is the leading modifiable risk factor for cardiovascular disease and all-cause mortality worldwide. The aim of this cross-sectional study is to determine the prevalence of HTN and its associated risk factors among the population of the Northern Region in Saudi Arabia.
Methods
This is a cross-sectional study and 631 participants were selected through multistage cluster sampling. A validated and structured questionnaire was used. The Chi-square test was used to determine the relationship between HTN and its risk factors. Data were analyzed using the Statistical Package for the Social Sciences version 26.
Results
A total of 101 (16%) study participants were diagnosed with HTN. Several common risk factors for HTN were identified. Specifically, 43.8% of those with HTN had diabetes, 37.6% had hypercholesterolemia, 60.9% were aged 50–59 years, 20.4% were obese, 12.5% were smokers, and 33.3% were divorced. All results were statistically significant ( P < 0.005).
Conclusion
The study found that 16% of the population was diagnosed with HTN. Common risk factors associated with HTN were diabetes, hypercholesterolemia, age between 50 and 59 years, obesity, and smoking.
Background
This study aimed to assess the association between obesity, sarcopenia, and sarcopenic obesity with hypertension and to explore the potential mediation of inflammation indicators and insulin resistance.
Methods
Data from the UK Biobank, a large-scale prospective cohort, were utilized. Obesity was defined using percentage of fat mass, while sarcopenia was defined as low muscle mass and low muscle strength. The primary outcome assessed was new-onset hypertension within a 5-year follow-up period. The association analysis was examined using a Cox regression model.
Results
A total of 183,091 participants were enrolled in this study. During 5 years of follow-up, 3812 (2.08%) developed hypertension. In the fully adjusted model, compared to men without these conditions, those with obesity, sarcopenia, and sarcopenic obesity had 2.32 times (95% CI, 2.12-2.55), 3.10 times (95% CI, 2.35-4.08), and 3.66 times (95% CI, 2.98-4.50) higher risks of developing hypertension, respectively. Women with obesity, sarcopenia, and sarcopenic obesity had 2.27 times (95% CI, 2.03-2.54), 2.93 times (95% CI, 1.95-4.39), and 4.04 times (95% CI, 3.32-4.91) higher risks of hypertension, respectively. Significant mediating effects of C-reactive protein, neutrophils, white blood cells, triglyceride-glucose index, and triglyceride to high-density lipoprotein cholesterol ratio were found, with mediations ranging from 6% to 13% for men and 2% to 21% for women in the association between sarcopenic obesity and hypertension.
Conclusions
Obesity, sarcopenia, and sarcopenic obesity significantly increased the risk of hypertension. Inflammation and insulin resistance appeared to mediate the association between sarcopenic obesity and hypertension.
Hypertension, a major global health issue and leading cause of death, is often under-assessed by traditional metrics like Body Mass Index which fail to capture comprehensive cardiovascular risks associated with obesity. The Cardiometabolic Index (CMI), which evaluates abdominal obesity and dyslipidemia, offers a more accurate assessment of visceral fat and metabolic dysfunction. In this study, we analyzed data from 45,250 participants from the National Health and Nutrition Examination Survey spanning 1999 to 2020. Using multivariable logistic regression, we explored the association between CMI and hypertension, employing Restricted Cubic Spline analysis to assess non-linear relationships and two-piecewise linear regression to identify threshold effects. Subgroup analyses confirmed the consistency of our findings across various demographic and clinical characteristics. Findings confirmed that hypertensive participants exhibited significantly higher CMI levels (median 0.46 vs. 0.73), with adjusted logistic regression showing a notable association between increased CMI and hypertension prevalence (OR 1.30, 95% CI 1.25–1.35, P < 0.01), characterized by a nonlinear L-shaped curve with a critical threshold identified at a CMI value of 1.37. Subgroup analysis revealed a more pronounced impact of CMI on hypertension in females. These results underscore CMI’s potential to enhance cardiovascular risk assessment across diverse U.S. populations.
Salt sensitivity of blood pressure (SSBP) is a complex physiological trait characterized by changes in blood pressure in response to dietary salt intake. Aging introduces an additional layer of complexity to the pathophysiology of SSBP, with mitochondrial dysfunction, epigenetic modifications, and alterations in gut microbiota emerging as critical factors. Despite advancements in understanding these mechanisms, the processes driving increased salt sensitivity with age and their differential impacts across sexes remain unclear. This review explores the current understanding of salt sensitivity, delving into its underlying mechanisms, the role of inflammation, and the influence of aging and sex differences on these processes. We also aim to provide insights into the multifaceted nature of salt sensitivity and its implications for personalized treatment strategies in hypertension management.
Introduction:
Primary hypertension (PH) affects over one billion individuals globally, yet less than 30% achieve controlled blood pressure (BP) with medication. Many patients require a combination of multiple medications to reach targets, but adverse effects and financial burdens undermine adherence. Additionally, prehypertension affects 25%-50% of adults, increasing the risk of cardiovascular complications. Early detection and management of prehypertension are crucial for delaying the need for pharmacological interventions. In recent years, clinical guidelines have increasingly emphasised non-pharmacological interventions for PH management. However, the diversity of non-pharmacological therapies and the inconsistencies in efficacy challenge clinical decision-making. This study aims to use network meta-analysis (NMA) to synthesise existing evidence on non-pharmacological interventions for PH, offering updated clinical insights and evidence-based support to optimise treatment strategies. It will also provide recommendations for integrating these interventions into community-based chronic disease management.
Methods and analysis:
To identify potentially relevant randomised controlled trials, a reverse search strategy will be employed to ascertain all non-pharmacological interventions for PH. A well-constructed search strategy will be applied across nine academic databases (Web of Science, Embase, PubMed, PsycINFO, CENTRAL, AMED, CNKI, WF and VIP database) and three clinical trial registries (WHO ICTRP, ClinicalTrials.gov and ChiCTR) for studies conducted between 1 January 2014 and 1 August 2024. Two investigators will independently extract information from eligible articles and document reasons for exclusions. The primary outcomes will encompass changes in systolic and diastolic BP. Pairwise and Bayesian NMA will be conducted using 'meta' and 'GeMTC' package (R 4.4.1). Risk of bias will be assessed using the Risk of Bias 2 tool, and the quality of evidence will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation approach.
Ethics and dissemination:
As this review involves secondary analysis of previously published data, ethical approval is not required. The results will be published in peer-reviewed journals.
Prospero registration number:
CRD42023451073.
Background:
The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain.
Methods:
We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.
Results:
At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group.
Conclusions:
Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01206062.).
Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.
Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.
Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.
Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.
Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.
The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int13,000 per QALY gained [95% uncertainty interval, Int18,000]). Of all one-way sensitivity analyses, assuming adherence to taking medications as low as 25%, high Shanghai drug costs, or low medication efficacy led to the most unfavorable results (treating all hypertension, about Int37,000, and Int$27,000 per QALY were gained, respectively). The strengths of this study were the use of a recent Chinese national health survey, vital statistics, health care costs, and cohort study outcomes data as model inputs and reliance on clinical-trial-based estimates of coronary heart disease and stroke risk reduction due to antihypertensive medication treatment. The limitations of the study were the use of several sources of data, limited clinical trial evidence for medication effectiveness and harms in the youngest and oldest age groups, lack of information about geographic and ethnic subgroups, lack of specific information about indirect costs borne by patients, and uncertainty about the future epidemiology of cardiovascular diseases in China.
Expanded hypertension treatment has the potential to prevent about 800,000 cardiovascular disease events annually and be borderline cost-effective in China, provided low-cost essential antihypertensive medicines programs can be implemented.
Background
The prevalence of diabetes is increasing worldwide, particularly in low and middle income countries, where treatment and control are often unavailable and inaccessible. Information on risk factors at local and regional levels is of utmost importance for tailored prevention programmes to curb the rise in diabetes.The current study was undertaken to investigate the prevalence of Impaired Fasting Glucose (IFG)/Type 2 Diabetes (T2D) and its risk factors in the adult population in Biyem-Assi-Yaoundé, Cameroon.Methods
Information on cardiovascular risk factors using the WHO STEPwise approach was obtained for 1623 men and women aged 25 years and older of the CAMBoD Project in Biyem-Assi, Yaoundé, Cameroon. T2D was defined as fasting capillary glucose (FCG)¿¿¿7.0 mmol/l and/or being on diabetes medication, IFG/T2D as FCG¿¿¿6.1 mmol/l and/or being on diabetes medication. Descriptive statistics and multivariate logistic regression analyses were used to describe prevalence of IFG/T2D, prevalence of risk factors for IFG/T2D and to investigate the association of risk factors with prevalence of IFG/T2D.ResultsPrevalence of T2D and of IFG/T2D was 3.3% and 5.7%. Prevalence of hypertension, obesity and abdominal obesity (elevated waist circumference) was 26.6%, 28.4% and 34.9%, respectively. Age and abdominal obesity were significantly associated with IFG/T2D in multivariate logistic regression.Conclusion
For successful primary prevention of T2D in the general population in Cameroon tailored efforts to address obesity, particularly abdominal obesity, and associated life-style factors are warranted.
On the basis of the 2014 guidelines for hypertension therapy in the United States, many eligible adults remain untreated. We projected the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines.
We used the Cardiovascular Disease Policy Model to simulate drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease, and quality-adjusted life-years (QALYs) gained by treating previously untreated adults between the ages of 35 and 74 years from 2014 through 2024. We assessed cost-effectiveness according to age, hypertension level, and the presence or absence of chronic kidney disease or diabetes.
The full implementation of the new hypertension guidelines would result in approximately 56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which would result in overall cost savings. The projections showed that the treatment of patients with existing cardiovascular disease or stage 2 hypertension would save lives and costs for men between the ages of 35 and 74 years and for women between the ages of 45 and 74 years. The treatment of men or women with existing cardiovascular disease or men with stage 2 hypertension but without cardiovascular disease would remain cost-saving even if strategies to increase medication adherence doubled treatment costs. The treatment of stage 1 hypertension was cost-effective (defined as <$50,000 per QALY) for all men and for women between the ages of 45 and 74 years, whereas treating women between the ages of 35 and 44 years with stage 1 hypertension but without cardiovascular disease had intermediate or low cost-effectiveness.
The implementation of the 2014 hypertension guidelines for U.S. adults between the ages of 35 and 74 years could potentially prevent about 56,000 cardiovascular events and 13,000 deaths annually, while saving costs. Controlling hypertension in all patients with cardiovascular disease or stage 2 hypertension could be effective and cost-saving. (Funded by the National Heart, Lung, and Blood Institute and others.).
Analyses of data from national surveys of the Japanese population have shown a clear decreasing tendency in mean systolic blood pressure (BP) level over the past 50 years in all age groups of men and women; however, mean diastolic BP level clearly did not decrease in men. Hypertension prevalence is high among older people and may increase in the future, especially in men aged years. The treatment and control rates of hypertension are not sufficiently high, although they have been continuously improving. Recent epidemiological studies also showed that the burden of cardiovascular diseases and total mortality because of the adverse BP level of the nation is still the highest among other preventable risk factors. To overcome this epidemic, the first priority should be primary prevention of a lifetime increase in BP through lifestyle improvement. Lowering the distribution of BP in the whole population and maintaining BP at optimal levels contributes to the achievement of this goal.
em>Background . Many studies throughout the world show that hypertension is not effectively treated and controlled, which continued to pose an important challenge in health systems in the world.
Design and methods . Population surveys were carried out in 2002 and 2012 in the Federation of Bosnia and Herzegovina (FBIH) on representative sample at the age of 25-64. The surveys used systematic stratified sample. Questionnaires and anthropometric measure protocols were adapted from internationally recommended surveys.
Results . In the past ten years there has been a slight increase in hypertension prevalence in researched population (41% vs . 42%). Percentage of hypertensive male and female respondents who are not aware of their hypertension actually dropped in the past decade from 54.3% to 51.4%. In 2002 total number of hypertensive respondents aware of their hypertension included 8.1% of male respondents and 10.3% female respondents whose condition was not treated and this rate effectively dropped during the 10-year period. Number of hypertensive, treated, and uncontrolled respondents dropped as reported in the 2012 survey; consequently percentage of hypertensive, treated, and controlled respondents in the 2012 survey increased, in particular in female population.
Conclusions . Investments in primary health care, improved availability, and improved quality of health care in the FBIH in the past 10 years can explain increased rate of hypertension detection and treatment; however, efforts should be continued to introduce hypertension screening programs and hypertension control programs.
Background: Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries.
Methods: We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions.
Findings: Global life expectancy for both sexes increased from 65·3 years (UI 65·0–65·6) in 1990, to 71·5 years (UI 71·0–71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8–48·2) to 54·9 million (UI 53·6–56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25–39 years and older than 75 years and for men aged 20–49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions.
Interpretation: For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.
The objective of this study is to estimate the prevalence, treatment, and control of high blood pressure, hypertension (HBP) in Panama and assess its associations with sociodemographic and biologic factors.
A cross-sectional, descriptive study was conducted in Panama by administering a survey on cardiovascular risk factors to 3590 adults and measuring their blood pressure 3 times. A single-stage, probabilistic, and randomized sampling strategy with a multivariate stratification was used. The average blood pressure, confidence intervals (CIs), odds ratio (OR), and a value of P ≤ 0.05 were used for the analysis.
The estimated prevalence of HBP was 29.6% (95% CI, 28.0–31.1); it was more prevalent in men than in women, OR = 1.37 (95% CI, 1.17–1.61); it increased with age and was more frequent among Afro-Panamanians (33.8%). HBP was associated with a family history of HBP with being physically inactive and a body mass index ≥25.0 kg/m2 or a waist circumference >90 cm in men and >88 cm in women (P < 0.001). Of those found to have HBP, 65.6% were aware of having HBP and taking medications, and of these, 47.2% had achieved control (<140/90 mm Hg).
HBP is the most common cardiovascular risk factor among Panamanians and consequently an important public health problem in Panama. The health care system needs to give a high priority to HBP prevention programs and integrated care programs aimed at treating HBP, taking into consideration the changes in behavior that have been brought about by alterations in nutrition and sedentary lifestyles.
Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods.
To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study.
A cross-sectional study of 153,996 adults (complete data for this analysis on 142,042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper-middle-income and low-middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC).
Hypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure-lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg.
Among the 142,042 participants, 57,840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26,877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23,510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure-lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries.
Among a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment.
Hypertension is the 3rd cause of death accounting for one in eight deaths worldwide. Hypertension was thought to be rare in Africa, but it is now recognized as one of the most important cerebrovascular diseases contributing to about 40% of these diseases in the continent.The aims of this study were to describe the pattern of blood pressure distribution among adults, and determine prevalence of prehypertension and hypertension among adults in Northern Ethiopia.
The study was done on a community-based sample of 1183 adults of 697 (58.8%) urban and 486 (41.1%) rural residents using statistical multistage sampling procedures. The study was based on the recent WHO and JNC-7 classification of blood pressure. Multi-item structured questionnaires were also developed to elicit additional information on the subjects.
The overall prevalence of hypertension and prehypertension in the study population was 18.1% and 37.2%, respectively. The prevalence of hypertension positively correlated with body mass index and age in both urban and rural residents (P = 0.001). Sex and age adjusted mean systolic blood pressure (SBP) was statistically higher in urban than in rural population (P = 0.001).
Hypertension was found to have high prevalence in the study region. However, people's awareness and control of hypertension was found to be very poor. Lack of a clear hypertension prevention guidelines and strategies nationwide can aggravate the impact of cardiovascular diseases.
Hypertension is a global public health challenge. National prevalence estimates can conceal important differences in prevalence in subnational areas. This paper aims to develop a consistent set of national and subnational estimates of the prevalence of hypertension in a country with limited data for subnational areas.
A nationally representative cross-sectional Survey of Lifestyle, Attitudes and Nutrition (SLAN) 2007 was used to identify risk factors and develop a national and a subnational model of the risk of self-reported, doctor-diagnosed hypertension among adults aged 18+ years in the Republic of Ireland. The subnational model's group-specific risk estimates were applied to group-specific population count estimates for subnational areas to estimate the number of adults with doctor-diagnosed hypertension in subnational areas in 2007. A sub-sample of older adults aged 45+ years who also had their blood pressure objectively measured using a sphygmomanometer was used to estimate the national prevalence of diagnosed and undiagnosed hypertension among adults aged 45+ years.
The prevalence of self-reported, doctor-diagnosed hypertension among adults aged 18+ years was 12.6% (95% CI = 11.7% - 13.4%). After adjustment for other explanatory variables the risk of self-reported, doctor-diagnosed hypertension was significantly related to age (p < 0.001), body mass index (p < 0.001), smoking (p = 0.001) and fruit and vegetable consumption (p = 0.003). Among adults aged 45+ years the prevalence of undiagnosed hypertension (38.7% (95% CI 34.6% - 42.8%)) was higher than self-reported, doctor-diagnosed hypertension (23.4% (95% CI = 22.0% - 24.7%)). Among adults aged 45+ years, the prevalence of undiagnosed hypertension was higher among men (46.8%, 95% CI 41.2% - 52.4%) than women (31.2%, 95% CI 25.7% - 36.6%). There was no significant variation in the prevalence of self-reported, doctor-diagnosed hypertension across subnational areas.
Services need to manage diagnosed hypertension cases and to detect and manage undiagnosed cases. Further population level improvements in lifestyle risk factors for hypertension are key in developing a more integrated approach to prevent cardiovascular disease. Better subnational data on hypertension outcomes and risk factors are needed to better describe the distribution of hypertension risk and hypertension prevalence in subnational areas.
Background: Recent scientific reports have shown that high blood pressure is a major public health problem in urban populations of sub-Saharan African countries. Yet, information on this morbidity in the rural areas is limited.
Objective: To estimate the prevalence of hypertension and to identify associated factors in rural and semi-urban populations in Burkina Faso.
Methods: This is a community-based cross-sectional study conducted between September and December 2012 among residents of Kaya Health and Demographic Surveillance System (HDSS). A stratified sample of 1481 residents, at least 18 years of age, was randomly selected and interviewed. Anthropometric measurements were carried out. Two blood pressure (BP) measurements were taken after sitting at rest for about 25 to 30 minutes. Hypertension was defined as mean systolic BP of at least 140 mmHg and/or diastolic BP of at least 90mmHg. Those taking hypertensive medication were also considered hypertensive. Logistic regression was carried out to identify factors independently associated with hypertension.
Results: The study sample comprised 726 rural residents and 755 semi-urban residents. The weighted overall prevalence of hypertension was 9.4% (95% CI: 7.3%-11.4%); 5.5% (95% CI: 3.8%-7.1%) in the rural areas; and 11.0% (95% CI: 8.8%-13.2%) in the semi-urban areas. In rural areas, older age and higher body mass index were associated with hypertension. In semi-urban areas, older age, not being married, familial history of hypertension, physical inactivity, psychological distress, presence of chronic conditions and poor self-assessment of health, were associated with hypertension.
Conclusion: Hypertension prevalence was higher in semi-urban than in rural areas of Kaya HDSS, but was overall relatively low. However, it may be possible to further reduce its prevalence and prevent increasing prevalence by acting on the identified risk factors. Encouragement to maintain low body weight through traditional diets and to increase physical activity could be beneficial.
Keywords :
Hypertension; Kaya; health and demographic surveillance system; urbanization.
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Objective
The Grenada Heart Project aims to study the clinical, biological, and psychosocial determinants of the cardiovascular health in Grenada in order to develop and implement a nationwide cardiovascular health promotion program.
Methods
We recruited 2,827 adults randomly selected from the national electronic voter list. The main outcome measures were self-reported cardiovascular disease and behavioral risk factors, anthropometric measures, blood pressure, point-of-care testing for glucose and lipids, and ankle-brachial index. Risk factors were also compared with the U.S. National Health and Nutritional Survey data.
Results
Prevalence of cardiovascular disease risk factors were: overweight and obesity—57.7% of the population, physical inactivity—23.4%, diabetes—13.3%, hypertension—29.7%, hypercholesterolemia—8.6%, and smoking—7%. Subjects who were physically active had a significantly lower 10-year Framingham risk score (p < 0.001). Compared with the U.S. National Health and Nutrition Survey data, Grenadian women had higher rates of adiposity, diabetes, hypertension, and elevated low-density lipoprotein cholesterol, whereas Grenadian men had a higher rate of diabetes, a similar rate of hypertension, and lower rates of the other risk factors. Prevalence of peripheral arterial disease was 7.6%; stroke and coronary heart disease were equally prevalent at ∼2%.
Conclusions
This randomly selected adult sample in Grenada reveals prevalence rates of obesity, hypertension, and diabetes significantly exceeding those seen in the United States. The contrasting, paradoxically low levels of prevalent cardiovascular disease support the concept that Grenada is experiencing an obesity-related “risk transition.” These data form the basis for the implementation of a pilot intervention program based on the Institute of Medicine recommendations and may serve as a model for other low- and middle-income countries.
Hypertension a major risk factor for cardiovascular disease and is the most widely recognized modifiable risk factor for this disease. There is little information on the prevalence and risk factors for hypertension in Zambia, and in particular in rural areas of the country. In order to contribute to the existing global literature on hypertension, particularly in rural Zambia, this study was conducted to determine the prevalence of hypertension and its correlates in two rural districts of Zambia, namely Kaoma and Kasama.
A cross-sectional study using a modified World Health Organization (WHO) global non communicable diseases (NCD) surveillance initiative NCD - STEPwise approach was used. Proportions were compared using the Yates' corrected χ2 test, and a result yielding a p -value of less than 5% was considered significant. Bivariate and multivariate logistic regression analyses were conducted. Factors that were significantly associated with the outcome in bivariate analyses were considered in a multivariate logistic regression analysis using a backward variable selection method. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were reported.
In total, 895 participants from Kaoma and 1198 participants from Kasama took part in the surveys. Overall, 25.8% participants (27.5% male, 24.6% female; p= 0.373) in Kaoma and 30.3% (31.3% male, 29.5% female; p= 0.531) in Kasama were hypertensive. In Kaoma, age and BMI were independently associated with hypertension. Compared with participants aged 45 years or older, participants aged 25-34 years were 60% (AOR=0.40, 95% CI [0.21, 0.56]) less likely to be hypertensive. Participants with BMI <18.5 and 18.5-24.9 were 54% (AOR=0.46, 95% CI [0.30, 0.69]) and 31% (AOR=0.69, 95% CI [0.49, 0.98]) less likely to be hypertensive compared with participants with BMI ≥30. In Kasama, age, smoking and heart rate were significantly associated with hypertension in multivariate analysis. Participants 25-34 years were 49% (AOR=0.51, 95% CI [0.41, 0.65]) less likely to be hypertensive compared with participants 45 years or older. Compared with participants who were non-smokers, smokers were 21% (AOR=1.21, 95% CI [1.02, 1.45]) more likely to be hypertensive. Participants who had heart rate >90 beats/min were 59% (AOR=1.59, 95% CI [1.17, 2.16]) more likely to be hypertensive compared with participants who had heart rate 60-90 beats/min.
The findings reveal that hypertension is prevalent among rural residents in Kaoma and Kasama, Zambia. The disease is highly associated with age, BMI, smoking and heart rate. Efficient preventive strategies are needed to halt the growing trend of non-communicable diseases through the control of risk factors highlighted in this study.
Black Caribbean women have a higher burden of cardiovascular disease (CVD) risk factors than their male counterparts. Whether this results in a difference in incident cardiovascular events is unknown. The aim of this study was to estimate the 10 year World Health Organization/International Society for Hypertension (WHO/ISH) CVD risk score for Jamaica and explore the effect of sex as well as obesity, physical activity and socioeconomic status on these estimates.
Data from 40-74 year old participants in the 2007/08 Jamaica Health and Lifestyle Survey were used. Trained interviewers administered questionnaires and measured anthropometrics, blood pressure, fasting glucose and cholesterol. Education and occupation were used to assess socioeconomic status. The Americas B tables were used to estimate the WHO/ISH 10 year CVD risk scores for the population. Weighted prevalence estimates were calculated. Data from 1,432 (450 men, 982 women) participants were analysed, after excluding those with self-reported heart attack and stroke. The women had a higher prevalence of diabetes (19%W;12%M), hypertension (49%W;47%M), hypercholesterolemia (25%W;11%M), obesity (46%W;15%M) and physical inactivity (59%W;29%M). More men smoked (6%W;31%M). There was good agreement between the 10-year cardiovascular risk estimates whether or not cholesterol measurements were utilized for calculation (kappa -0.61). While 90% had a 10 year WHO/ISH CVD risk of less than 10%, approximately 2% of the population or 14,000 persons had a 10 year WHO/ISH CVD risk of ≥30%. As expected CVD risk increased with age but there was no sex difference in CVD risk distribution despite women having a greater risk factor burden. Women with low socioeconomic status had the most adverse CVD risk profile.
Despite women having a higher prevalence of CVD risk factors there was no sex difference in 10-year WHO/ISH CVD risk in Jamaican adults.
High blood pressure is one of the most important risk factors for cardiovascular diseases and chronic kidney disease. It is a main determinant of morbidity and mortality in Germany. In the German Health Interview and Examination Survey for Adults (DEGS1) the blood pressure of 7,096 adults aged 18-79 years was measured in a standardised way using oscillometric blood pressure devices (Datascope Accutorr Plus). The average of the second and third measurements was used for analysis. The mean systolic blood pressure was 120.8 mmHg in women and 127.4 mmHg in men, while the mean diastolic blood pressure was 71.2 mmHg in women and 75.3 mmHg in men. Blood pressure values were hypertensive (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) in 12.7 % of women and in 18.1 % of men. Hypertension (defined as having hypertensive blood pressure or taking antihypertensive medication in known cases of hypertension) was present in 29.9 % of women and 33.3 % of men. Almost 75 % of the survey's highest age group, 70-79, had hypertension. DEGS1 demonstrates that high blood pressure remains a highly prevalent risk factor in the population at large. The methodology employed in measuring blood pressure has been improved as compared to that of the German National Health Interview and Examination Survey 1998 (GNHIES98) and it will be possible to draw comparisons soon, once a procedure for calibrating the 1998 data has been finalised. An English full-text version of this article is available at SpringerLink as supplemental.
The study attempted to identify the prevalence and distribution of risk factors of non-communicable diseases among urban and rural population in Gujarat, India. Using the WHO stepwise approach, a cross-sectional study was carried out among 1,805 urban and 1,684 rural people of 15-64 years age-group. Information on behavioural and physiological risk factors of non-communicable diseases was obtained through standardized protocol. High prevalence of smoking (22.8%) and the use of smokeless tobacco (43.4%) were observed among rural men compared to urban men (smoking-12.8% and smokeless tobacco consumption-23.1%). There was a significant difference in the average consumption of fruits and vegetables between urban (2.18 +/- 1.59 servings) and rural (1.78 +/- 1.48 servings) area. Prevalence of overweight and obesity was observed to be high among urban men and women in all age-groups compared to rural men and women. Prevalence of behavioural risk factors, overweight, and obesity increased with age in both the areas. Twenty-nine percent of the urban residents and 15.4% of the rural residents were found to have raised blood pressure, and the difference was found to be statistically significant (p < 0.01). For both men and women, the prevalence of overweight and obesity, hypertension, and lack of physical activities were significantly higher in the urban population while smoking, smokeless tobacco consumption, poor consumption of fruits and vegetables were more prevalent in the rural population. The results highlight the need for interventions and approaches for the prevention of risk factors of non-communicable diseases in rural and urban areas.
Hypertension represents a major cause of cardiovascular morbidity and mortality worldwide but its prevalence has been shown to vary in different countries. The reasons for such differences are still matter of debate, the relative contributions given by environmental and genetic factors being still poorly defined. We estimated the current prevalence, distribution and determinants of hypertension in isolated Sardinian populations and also investigated the environmental and genetic contribution to hypertension prevalence taking advantage of the characteristics of such populations.
An epidemiological survey with cross-sectional design was carried out measuring blood pressure in 9845 inhabitants of 10 villages of Ogliastra region between 2002 and 2008. Regression analysis for assessing blood pressure determinants and variance component models for estimating heritability were performed. Overall 38.8% of this population had hypertension, its prevalence varying significantly by age, sex and among villages taking into account age and sex structure of their population. About 50% of hypertensives had prior cardiovascular disease. High blood pressure was independently associated with age, obesity related factors, heart rate, total cholesterol, alcohol consumption, low education and smoking status, all these factors contributing more in women than in men. Heritability was 27% for diastolic and 36% for systolic blood pressure, its contribution being significantly higher in men (57%) than in women (46%). Finally, the genetic correlation between systolic and diastolic blood pressure was 0.74, indicating incomplete pleiotropy.
Genetic factors involved in the expression of blood pressure traits account for about 30% of the phenotypic variance, but seem to play a larger role in men; comorbidities and environmental factors remain of predominant importance, but seem to contribute much more in women.
Although globalization can contribute to increased blood pressure by spreading unhealthy behaviors, it also provides powerful means to tackle hypertension. The dissemination of information about and advice on cardiovascular prevention and facilitated contact with health services are valuable resources. To investigate the effects of urbanization, geographical area, and air temperature on hypertension burden and kidney damage, a survey was performed in 2008 with a door-to-door approach among urban and rural adult dwellers of three geographic areas (capital, inland, coast) of Yemen. Subjects (n=10 242) received two visits several days apart to confirm the diagnosis of hypertension. Proteinuria (dipstick test +1) was used as a marker of kidney damage. Prevalence rates were weighted to represent the Yemen population aged 15-69 years in 2008. Rates of hypertension and proteinuria progressively increased from the capital (6.4%; 95% confidence level (CI) 5.8-7.0 and 5.1%; 4.4-5.9, respectively), to inland areas (7.9%; 7.0-8.7 and 6.1%; 5.1-7.1), to the coastal area (10.1%; 8.9-11.4 and 8.9%; 7.3-10.4). When compared with urban dwellers, rural dwellers had similar hypertension prevalence (adjusted odds ratios (ORs) 1.03; 95% CI 0.91-1.17) but higher proteinuria rates (adjusted ORs 1.55; 1.31-1.85). Overall, home temperature was associated with a lower hypertension rate (adjusted OR 0.98; 0.96-0.99). This large population study reveals that the highest burden of hypertension and kidney damage is detectable in remote areas of the country.Hypertension Research advance online publication, 14 March 2013; doi:10.1038/hr.2013.14.
In the absence of evidence-based information, assessment of population awareness and management of diabetes, hypertension and dyslipidemia (treatable and preventable cardiovascular risk factors) are important to halt coronary and cerebrovascular diseases and to improve public health.
The analysis was based on a nationally representative sample of 1432 adult subjects, recruited for the ORISCAV-LUX survey (2007-2008). Descriptive and multivariable logistic regression analyses were performed. The 10-year Framingham risk score was calculated for each participant who classified at low, intermediate and high risk.
Among the diagnosed cases, 32%, 60%, and 85% were respectively unaware of their diabetes, hypertension and dyslipidemia. Increasing age and BMI were the strongest protective factors against unawareness of hypertension and dyslipidemia. Having a family history decreased the risk of unawareness of hypertension (OR = 0.57; 95% CI 0.36, 0.92; P = 0.021), whereas, not having a family doctor increased double-fold the odd of being unaware of hypertension (P = 0.048). Poor health perception reduced significantly the risk of unawareness of dyslipidemia (OR = 0.27; 95% CI 0.11, 0.68). Concerning the management, diabetes was markedly better treated than hypertension and dyslipidemia. Among diabetic subjects (constituting 4% of the population), 3% were treated vs. 1% not treated. In contrast, 22% of the hypertensive participants (35% of the population) were not treated vs. 13% treated. Concerning dyslipidemia, only 9% of those with lipid disorder (70% of the population) were under medication vs. 61% not treated. For the treated cases of these pathologies, almost only one-third was under control. Framingham risk of developing CHD within 10 years was moderate to high among 62%, 27%, and 17% of the unaware/untreated diabetic, hypertensive, and dyslipidemic participants, respectively.
The considerable lack of awareness and insufficient management underscore the urgent need for intensive efforts to reduce the gap in prevention strategies, and control of cases according to explicit clinical guidelines.
Background
The excess burden of hypertension among blacks has been a prominent feature of the heath disparities literature, and many scientists presume it to be a stable and inevitable phenomenon. The underlying causes of this disparity can only be disentangled in a setting in which the population does not experience racial stratification of socioeconomic opportunities. While such conditions of racial equality remain uncommon, they may be approximated in Cuba, a country with a persistent policy of social inclusion over the last 5 decades.
Methods
We report on a 2010–2011 stratified probability sample of those aged 15–74 years from the urban population of Cienfuegos in central Cuba. A total of 1496 adults (880 women and 616 men) were recruited and assessed for blood pressure and anthropometrics according to standardized protocols, as well as medication use, educational attainment and observed skin tone (dichotomized into “black” and “white”). Weighted tabular and regression analyses were conducted to estimate adjusted prevalences of hypertension (> 140/90 mmHg) and adjusted prevalence odds ratios for contrasts between the two skin color groups.
Results
Mean pressures were higher for men than for women, but overall did not differ importantly between racial groups. About half of all diagnosed hypertensive men were on medication, a proportion that did not vary by racial group. For women, however, adjusted prevalence was somewhat higher among blacks, and treatment and control rates were also somewhat advantaged for white women.
Conclusions
Overall, skin color was unrelated to mean blood pressure or hypertensive status in this population, although among women specifically some racial advantage appears evident in adjusted prevalence and control, and should be investigated further. The overall null result suggests that Cuba may exemplify the social conditions in which racial excess in hypertension, characteristic of much of the western world, is not a necessary reality.
Access to medicines and vaccines to prevent and treat non-communicable diseases (NCDs) is unacceptably low worldwide. In the 2011 UN political declaration on the prevention and control of NCDs, heads of government made several commitments related to access to essential medicines, technologies, and vaccines for such diseases. 30 years of experience with policies for essential medicines and 10 years of scaling up of HIV treatment have provided the knowledge needed to address barriers to long-term effective treatment and prevention of NCDs. More medicines can be acquired within existing budgets with efficient selection, procurement, and use of generic medicines. Furthermore, low-income and middle-income countries need to increase mobilisation of domestic resources to cater for the many patients with NCDs who do not have access to treatment. Existing initiatives for HIV treatment offer useful lessons that can enhance access to pharmaceutical management of NCDs and improve adherence to long-term treatment of chronic illness; policy makers should also address unacceptable inequities in access to controlled opioid analgesics. In addition to off-patent medicines, governments can promote access to new and future on-patent medicinal products through coherent and equitable health and trade policies, particularly those for intellectual property. Frequent conflicts of interest need to be identified and managed, and indicators and targets for access to NCD medicines should be used to monitor progress. Only with these approaches can a difference be made to the lives of hundreds of millions of current and future patients with NCDs.
Background
Seventy-five million people are estimated to be hypertensive in sub-Saharan Africa. This translates in high morbidity and mortality, as hypertension is now considered to be the number one single risk factor for death worldwide. Accurate data from countries lacking national disease surveillance is needed to guide future evidence-driven health policies. The authors aimed to estimate the prevalence, awareness, management and control of hypertension and associated factors in an adult population of Angola.
Methods
A community-based survey of 1,464 adults, following the World Health Organization's Stepwise Approach to Chronic Disease Risk Factor Surveillance, was conducted to estimate the prevalence of hypertension, awareness, treatment and control in Dande, Northern Angola. Using a demographic surveillance system database, a representative sample of subjects, stratified by sex and age (18–40 and 41–64 years old), was selected.
Results
Prevalence of hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or hypertensive therapy) was of 23% (95% CI: 21% to 25.2%). A follow-up consultation confirmed the hypertensive status in 82% of the subjects who had a second measurement on average 23 days after the first. Amongst hypertensive individuals, 21.6% (95% CI: 17.0% to 26.9%) were aware of their status. Only 13.9% (95% CI: 5.9% to 29.1%) of the subjects aware of their condition were under pharmacological treatment, of which approximately one-third were controlled. Older age, lower level of education, higher body mass index and abdominal obesity were found to be significantly (p<0.01) associated with hypertension.
Conclusions
Our survey is the first to provide insightful data on hypertension prevalence in Angola. There is an urgent need for strategies to improve prevention, diagnosis and access to adequate treatment in this country, where a massive economic growth and consequent potential impact on lifestyle risk factors could lead to an increase in the prevalence of hypertension and cardiovascular disease.
Population ageing is rapidly becoming a global issue and will have a major impact on health policies and programmes. The World Health Organization's Study on global AGEing and adult health (SAGE) aims to address the gap in reliable data and scientific knowledge on ageing and health in low- and middle-income countries. SAGE is a longitudinal study with nationally representative samples of persons aged 50+ years in China, Ghana, India, Mexico, Russia and South Africa, with a smaller sample of adults aged 18-49 years in each country for comparisons. Instruments are compatible with other large high-income country longitudinal ageing studies. Wave 1 was conducted during 2007-2010 and included a total of 34 124 respondents aged 50+ and 8340 aged 18-49. In four countries, a subsample consisting of 8160 respondents participated in Wave 1 and the 2002/04 World Health Survey (referred to as SAGE Wave 0). Wave 2 data collection will start in 2012/13, following up all Wave 1 respondents. Wave 3 is planned for 2014/15. SAGE is committed to the public release of study instruments, protocols and meta- and micro-data: access is provided upon completion of a Users Agreement available through WHO's SAGE website (www.who.int/healthinfo/systems/sage) and WHO's archive using the National Data Archive application (http://apps.who.int/healthinfo/systems/surveydata).
Indians have high rates of cardiovascular disease. Hypertension (HTN) is an important modifiable risk factor. There are no comprehensive reviews or a nationally representative study of the burden, treatments and outcomes of HTN in India. A systematic review was conducted to study the trends in prevalence, risk factors and awareness of HTN in India. We searched MEDLINE from January 1969 to July 2011 using prespecified medical subject heading (MeSH) terms. Of 3372 studies, 206 were included for data extraction and 174 were observational studies. Prevalence was reported in 48 studies with sample size varying from 206 to 167 331. A significant positive trend (P<0.0001) was observed over time in prevalence of HTN by region and gender. Awareness and control of HTN (11 studies) ranged from 20 to 54% and 7.5 to 25%, respectively. Increasing age, body mass index, smoking, diabetes and extra salt intake were common risk factors. In conclusion, from this systematic review, we record an increasing trend in prevalence of HTN in India by region and gender. The awareness of HTN in India is low with suboptimal control rates. There are few long-term studies to assess outcomes. Good quality long-term studies will help to understand HTN better and implement effective prevention and management programs.Journal of Human Hypertension advance online publication, 13 September 2012; doi:10.1038/jhh.2012.33.
To date, the epidemiological studies of noncommunicable diseases in Latvia were more episodic and covered only selected areas. The first national cross-sectional population-based survey of cardiovascular risk factors after regaining independence was carried out to provide reliable information on the cardiovascular risk factor profile in adults.
Computerized random sampling from the Registry of Latvian population was carried out. A total of 6000 enrolled subjects aged 25-74 years were divided into 10 age subgroups. The data of 3807 respondents (63.5% of all) were included into the final analysis.
The mean number of cardiovascular risk factors was 2.99±0.026 per subject: 3.45±0.043 and 2.72±0.030 for men and women, respectively. Of all the respondents, 75.2% had an increased total cholesterol level. Hypercholesterolemia was found in almost 56% of men and 41% of women in the age group of 25-34 years. Hyperglycemia was documented in 34.1% of the respondents (41.6% of men and 29.8% of women). More than two-thirds (67.8%) of the persons were overweight, while obesity was found in 25.6% of men and 32.6% of women. Arterial hypertension was identified in 44.8% of the respondents; its prevalence was higher in men than women (52.9% vs. 40.2%). There were more current smokers among men than women (30.5% vs. 11.4%).
The levels of cardiovascular risk factors in Latvia were found to be relatively high. The data can be utilized as baseline characteristics that can be compared down the road including the monitoring of health prevention activities.
The past 2 decades have seen a considerable global increase in cardiovascular disease, with hypertension remaining by far the most common. More than one-third of adults in Africa are hypertensive; as in the urban populations of most developing countries. Being a condition that occurs with relatively few symptoms, hypertension remains underdetected in many countries; especially in developing countries where routine screening at any point of health care is grossly underutilized. Because hypertension is directly related to cardiovascular disease, this has led to hypertension being the leading cause of adverse cardiovascular outcomes, as a result of patients living, often unknowingly, with uncontrolled hypertension for prolonged periods of time. In Africa, hypertension is the leading cause of heart failure; whereas at global levels, hypertension is responsible for more than half of deaths from stroke, just less than half of deaths from coronary artery disease, and for more than one-tenth of all global deaths. In this review, we discuss the escalating occurrence of hypertension in developing countries, before exploring the strengths and weaknesses of different measures to control hypertension, and the challenges of adopting these measures in developing countries. On a broad level, these include steps to curb the ripple effect of urbanization on the health and disease profile of developing societies, and suggestions to improve loopholes in various aspects of health care delivery that affect surveillance and management of hypertension. Furthermore, we consider how the industrial sectors' contributions toward the burden of hypertension can also be the source of the solution.
Major changes in the health profile of many developing countries are taking place. Life expectancy in these countries is increasing, and people are more exposed to diseases of old age like hypertension and cardiovascular diseases. Scientific research in the developing world -including this area - is lagging behind. However, high-quality research can still be carried out in spite of the limited resources. This paper identifies the different material and psychological barriers to scientific research. Epidemiological and clinical research represent high priorities in hypertension research in developing countries, and international cooperation is essential to improve the understanding of hypertension.
Background:
This programme of overviews of randomised trials was established to investigate the effects of angiotensin-converting-enzyme (ACE) inhibitors, calcium antagonists, and other blood-pressure-lowering drugs on mortality and major cardiovascular morbidity in several populations of patients. We did separate overviews of trials comparing active treatment regimens with placebo, trials comparing more intensive and less intensive blood-pressure-lowering strategies, and trials comparing treatment regimens based on different drug classes.
Methods:
The hypotheses to be investigated, the trials to be included, and the outcomes to be studied were all selected before the results of any participating trial were known. Individual participant data or group tabular data were provided by each trial and combined by standard statistical techniques.
Findings:
The overview of placebo-controlled trials of ACE inhibitors (four trials, 12,124 patients mostly with coronary heart disease) revealed reductions in stroke (30% [95% CI 15-43]), coronary heart disease (20% [11-28]), and major cardiovascular events (21% [14-27]). The overview of placebo-controlled trials of calcium antagonists (two trials, 5520 patients mostly with hypertension) showed reductions in stroke (39% [15-56]) and major cardiovascular events (28% [13-41]). In the overview of trials comparing blood-pressure-lowering strategies of different intensity (three trials, 20,408 patients with hypertension), there were reduced risks of stroke (20% [2-35]), coronary heart disease (19% [2-33]), and major cardiovascular events (15% [4-24]) with more intensive therapy. In the overviews comparing different antihypertensive regimens (eight trials, 37,872 patients with hypertension), several differences in cause-specific effects were seen between calcium-antagonist-based therapy and other regimens, but each was of borderline significance.
Interpretation:
Strong evidence of benefits of ACE inhibitors and calcium antagonists is provided by the overviews of placebo-controlled trials. There is weaker evidence of differences between treatment regimens of differing intensities and of differences between treatment regimens based on different drug classes. Data from continuing trials of blood-pressure-lowering drugs will substantially increase the evidence available about any real differences that might exist between regimens.
Our results show independent, strong, graded relationships between higher levels of current systolic blood pressure and urine protein excretion and the risk for kidney disease progression during antihypertensive therapy with or without ACE inhibitors in patients with nondiabetic kidney disease. After adjustment for systolic blood pressure, diastolic pressure was not a risk factor. The lowest risk for kidney disease progression seemed to be at levels of current systolic blood pressure of 110 to 129 mm Hg and urine protein excretion less than 2.0 g/d. However, the relationship of the level of current systolic blood pressure with the risk for kidney disease progression varied with the level of current urine protein excretion. At levels of current urine protein excretion greater than 1.0 g/d, the risk for kidney disease progression increased steeply at current systolic blood pressures greater than 120 to 130 mm Hg; however, at levels of current urine protein excretion less than 1.0 g/d, there was little relationship between risk for kidney disease progression and current systolic blood pressure from 110 to 159 mm Hg. At both levels of current urine protein excretion, a current systolic blood pressure less than 110 mm Hg was associated with a higher risk for kidney disease progression. The findings were similar in patients receiving antihypertensive regimens with or without ACE inhibitors.
Different age structures in two populations complicate any comparison of their levels of mortality. Many methods exist which provide death rates or mortality indices adjusted for age and other factors. Such summary measures inevitably lose information, but they are useful for the initial examination of large quantities of data and for the presentation of results. This paper reviews a number of techniques available for producing age-adjusted death rates or mortality indices, emphasizing their historical development. Formulae are given for their calculation. The appropriate context for using each method, and its associated disadvantages are described.
: Although the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials, this scientific knowledge has not been fully applied in the general population, especially in low-income communities. This article summarizes interventions to improve hypertension management and describes the rationale and study design for a cluster randomized trial testing whether a comprehensive intervention program within a national public primary care system will improve hypertension control among uninsured hypertensive men and women and their families. We will recruit 1,890 adults from 18 clinics within a public primary care network in Argentina. Clinic patients with uncontrolled hypertension, their spouses and hypertensive family members will be enrolled. The comprehensive intervention program targets the primary care system through health care provider education, a home-based intervention among patients and their families (home delivery of antihypertensive medication, self-monitoring of blood pressure [BP], health education for medication adherence and lifestyle modification) conducted by community health workers and a mobile health intervention. The primary outcome is net change in systolic BP from baseline to month 18 between intervention and control groups among hypertensive study participants. The secondary outcomes are net change in diastolic BP, BP control and cost-effectiveness of the intervention. This study will generate urgently needed data on effective, practical and sustainable intervention programs aimed at controlling hypertension and concomitant cardiovascular disease in underserved populations in low- and middle-income countries.
Hypertension is an important public health problem in India. To determine its prevalence, awareness, treatment and control among women, we performed a nationwide study. Population-based studies among women aged 35–70 years were performed in four urban and five rural locations. Stratified sampling was performed and we enrolled 4608 (rural 2604 and urban 2004) of the targeted 8000 (57%). Demographic details, medical history, diet, physical activity, anthropometry and blood pressure (BP) were recorded. Descriptive statistics are reported. Logistic regression was performed to determine the association of hypertension and its awareness, treatment and control with socioeconomic factors. Age-adjusted prevalence of hypertension (known or BP140/90 mm Hg) was observed in 1672 women (39.2%) (rural 746, 31.5%; urban 926, 48.2%). Significant determinants of hypertension were urban location, greater literacy, high dietary fat, low fibre intake, obesity and truncal obesity (P<0.01). Hypertension awareness was noted in 727 women (42.8%), more in urban (529, 56.8%) than in rural (198, 24.6%). Of these, 38.6% of the women were on treatment (urban 35.7, rural 46.5) and of those treated, controlled blood pressure (<140 and <90 mm Hg) was observed in 21.5% (urban 28.3 vs 10.2). Among hypertensive subjects, treatment was noted in 18.3% (rural 13.1, urban 22.5) and control in 3.9% (rural 1.3, urban 5.9). A significant determinant of low awareness, treatment and control was rural location (multivariate-adjusted P<0.05). There is a high prevalence of hypertension in middle-aged Asian Indian women. Very low awareness, treatment and control status are observed.
To report the blood pressure results from the 2008/09 New Zealand Adult Nutrition Survey (2008/09NZANS).
Blood pressure measurements were available for 4,407 adults who were part of a survey involving face-to-face interviews with 4,721 New Zealanders aged 15 years and over. Three measurements were taken one minute apart, and the mean of the second and third readings has been used for this analysis. Hypertension was defined as systolic blood pressure (SBP) greater than and equal to 140 mmHg or diastolic blood pressure (DBP) greater than and equal to 90 mmHg or self reported use of antihypertensive medications. Comparisons were made with previously published New Zealand population blood pressure estimates.
Mean SBP for the New Zealand adult population was 126 mmHg. The prevalence of hypertension was 31%, with 15% reporting taking antihypertensive medication. Mean SBP has increased since 2002/03 for New Zealand European and others (NZEO) aged 35-54 years and Maori aged 35-74 years, reversing a downward trend observed in NZEO between 1982 and 2002.
The increasing blood pressure levels are concerning. Given the importance of elevated blood pressure as a risk factor for cardiovascular disease, intensive screening, public health measures aimed at lowering population blood pressure, and further population monitoring are warranted.
Introduction:
El-Menia is an oasis located in the middle of Algerian Sahara. The drinking water in this oasis has low sodium content. The objectives of this study were to estimate the prevalence of hypertension, to describe the metabolic characteristics of population study and to assess the factors associated with blood pressure levels.
Methods:
A cross sectional study was conducted in 2010. Subjects (n=722) were selected from individuals aged 40 years or older by random cluster sampling. Blood pressure measurements, combined with a clinical questionnaire, and standard blood samples for the detection of dyslipidemia and diabetes mellitus, were collected.
Results:
Sixty-seven percent of subjects were females and 18% were black. The mean age was 58.5 ± 13.2 years. The prevalence of hypertension was 50.2%: 49.7% in females and 51.3% in males. The factors associated with presence of hypertension following a logistic multivariate regression were age, skin colour, waist circumference, and plasma glucose. The treatment and control of hypertension were 41% and 20% respectively.
Conclusions:
The prevalence oh hypertension was high in this oasis and the rate of treatment control was low. Our findings suggest that appropriate healthcare should be given to hypertensive subjects, including a better information on hypertension.
The post-2015 development agenda will build on the Millennium Development Goals (MDGs), in which health is a core component. This agenda will focus on human development, incorporate the components of the Millennium Declaration, and will be made sustainable by support from the social, economic, and environmental domains of activity, represented graphically as the strands of a triple helix. The approaches to prevention and control of non-communicable diseases (NCDs) have been elaborated in the political declaration of the UN high-level meeting on NCDs and governments have adopted a goal of 25% reduction in relative mortality from NCDs by 2025 (the 25 by 25 goal), but a strong movement is needed based on the evidence already available, enhanced by effective partnerships, and with political support to ensure that NCDs are embedded in the post-2015 human development agenda. NCDs should be embedded in the post-2015 development agenda, since they are leading causes of death and disability, have a negative effect on health, and, through their effect on the societal, economic, and the environmental domains, impair the sustainability of development. Some drivers of unsustainable development, such as the transport, food and agriculture, and energy sectors, also increase the risk of NCDs.
Background:
While socioeconomic gradients in cardiovascular disease have been well established in high-income countries, this relationship is not well understood in middle-income countries.
Methods:
Data from Demographic Health Surveys collected in Albania (2008-09), Armenia (2005), Azerbaijan (2006) and Ukraine (2007) were used to estimate age-adjusted differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), hypertension (HTN), elevated blood pressure, and optimal blood pressure across a standardized wealth index, level of educational attainment, and urban versus rural residence.
Results:
The wealthiest Albanian females had lower average SBP, DBP, PP (all p<0.01) and HTN status (odds ratio [OR]=0.3, CI: 0.2-0.5, p<0.001) compared to the poorest; similar education gradients were also found. Such disparities also existed for Albanian men. Among Armenian women, urban (OR=1.4, 1.1-1.8, p<0.01), more educated (OR=0.7, CI: 0.6-0.9, p<0.01), and wealthier (OR=1.8, 1.4-2.4, p<0.001) women were more likely to have optimal blood pressure. Urban Armenian men were also more likely to have optimal blood pressure (OR=1.8, 1.2-2.9, p<0.01). Wealthier and urban Azerbaijani had lower risk of elevated blood pressure and Azerbaijani women displayed strong wealth gradients with higher quintiles of wealth associated with lower continuous blood pressure measures. There were no socioeconomic gradients for Ukrainian males or females.
Conclusions:
There is compelling evidence that wealth and education gradients affect the probability of HTN for women in Albania, Armenia, and Azerbaijan, and for men in Albania.
Objectives: To assess longitudinal trends in cardiovascular mortality and population mean blood pressure, prevalence, awareness, treatment, and control of hypertension in a representative Czech population sample from 1985 to 2007/2008.
Methods: Source data on mortality rates were provided by the Czech Statistical Office and further processed by the Institute for Health Information and Statistics of the Czech Republic. Six independent cross-sectional population surveys were conducted in 1985, 1988, 1992, 1997/1998, 2000/2001, and 2007/2008 with randomly selected men and women aged 25–64 years and resident in six districts of the Czech Republic (Praha-východ, Benešov, Pardubice, Chrudim, Cheb, and Jindřichův Hradec). The total number of participants was 13 972.
Results: Since 1985, there has been a significant continuous, almost linear decline in standardized total, cardiovascular disease, ischemic heart disease, and stroke mortality (P < 0.001).
There was a significant downward trend in the population mean SBP (from 133.6 ± 20.2 to 129.5 ± 18.5 mmHg; P < 0.001) and DBP (from 84.1 ± 11.3 to 82.5 ± 10.0 mmHg; P < 0.001) from 1985 to 2007/2008. This was associated with a significant decrease in the prevalence of hypertension only in women (from 42.5 to 37.2%; P < 0.001). Awareness of hypertension increased in both sexes (men, from 41.4 to 68.4%; women, from 58.9 to 71.4%; both P < 0.001) as did the number of individuals on antihypertensive medication (men, from 21.1 to 58.2%, women: from 38.9 to 58.9%; both P < 0.001). Control of hypertension improved significantly (from 3.9 to 24.6%) over the same period.
Conclusion: The reduction in population blood pressure and improved hypertension control may have contributed substantially to the decrease in cardiovascular disease mortality in the Czech Republic.
Objective: To describe the prevalence, detection, treatment and control of hypertension in an urban and rural area of Tanzania.
Design: Two linked cross-sectional population-based surveys
Setting: A middle-income urban district of Dar es Salaam (Ilala) and a village in the relatively prosperous rural area of Kilimanjaro (Shari)
Participants: Seven hundred and seventy adults (> 15 years) in Ilala and 928 adults in Shari were studied
Results: Hypertension prevalence (blood pressure >140 and/or 90 mmHg, or known hypertensives receiving antihypertensive treatment) was 30% (95% confidence interval, 25.1-34.9%) in men and 28.6% (24.3-32.9%) in women in Ilala, and 32.2% (27.7-6.7%) in men and 31.5% (27.8-35.2%) in women in Shari. Age-standardized hypertension (to the New World Population) prevalence was 37.3% (32.2-42.5%) among men and 39.1% (34.2-44.0%) in women in Illala, and 26.3% (22.4-30.4%) in men and 27.4% (24.4-30.4%) in women in Shari. In both areas, just under 20% of hypertensive subjects were aware of their diagnosis, approximately 10% reported receiving treatment and less than 1% were controlled (blood pressure < 140/90 mmHg). Hypertensive subjects were older, had greater body mass indices and waist: hip ratios, and had more risk factors for hypertension and its complications (smoking, heavy alcohol consumption, physical inactivity, obesity and diabetes) than nonhypertensives.
Conclusions: There is a high prevalence of hypertension in rural and urban areas of Tanzania, with low levels of detection, treatment and control. This demonstrates the need for cost-effective strategies for primary prevention, detection and treatment of hypertension and the growing public health challenge of non-communicable diseases in Sub-Saharan Africa.
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.
To examine prevalence and distribution of blood pressure level among Chinese adults in 2010.
A total of 98 548 adults, which were sampled from 162 surveillance points, were enrolled in the blood pressure measurements in the 2010 China Chronic and non-communicable disease surveillance. Blood pressures were examined by electronic blood pressure monitor. After being weighted according to complex sampling scheme and post-stratification, the sample was used to estimate the prevalence of hypertension by age, gender, urban and rural areas, and geographic locations.
There were 37 461 respondents with hypertension in the sample which indicates an unweighted prevalence of hypertension was 38.0%. The average systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the sample were (132.7 ± 21.9) and (81.4 ± 11.9) mm Hg (1 mm Hg = 0.133 kPa), respectively, whereas the weighted average SBP and DBP were (130.8 ± 21.3) and (80.4 ± 11.7) mm Hg respectively. After being weighted, the weighted prevalence of hypertension in Chinese adults was 33.5% (95%CI: 31.6% - 35.4%). Hypertension prevalence increased with age, which was lowest among residents aged 18 - 24 years (9.7%, 95%CI: 8.5% - 10.9%) and highest among individuals aged 75 years and above (72.8%, 95%CI: 70.4% - 75.2%) (P < 0.05). The prevalence was statistically higher among males (35.1%, 95%CI: 33.1% - 37.1%) than females (31.8%, 95%CI: 29.8% - 33.9%) (P < 0.05). Residents living in urban area had a prevalence of hypertension (34.7%, 95%CI: 32.4% - 37.1%) similar to those in rural area (32.9%, 95%CI: 30.3% - 35.5%) (P > 0.05). Prevalence of hypertension in east, central, and west region of China were 36.2% (95%CI: 33.1% - 39.3%), 34.1% (95%CI: 30.7% - 37.5%), and 28.8% (95%CI: 25.1% - 32.6%) (P < 0.05), respectively.
The prevalence of hypertension was quite high among Chinese adults aged 18 years and over in 2010 with variations by gender, age and geographic regions.
Data from different national and regional surveys show that hypertension is common in developing countries, particularly in urban areas, and that rates of awareness, treatment, and control are low. Several hypertension risk factors seem to be more common in developing countries than in developed regions. Findings from serial surveys show an increasing prevalence of hypertension in developing countries, possibly caused by urbanisation, ageing of population, changes to dietary habits, and social stress. High illiteracy rates, poor access to health facilities, bad dietary habits, poverty, and high costs of drugs contribute to poor blood pressure control. The health system in many developing countries is inadequate because of low funds, poor infrastructure, and inexperience. Priority is given to acute disorders, child and maternal health care, and control of communicable diseases. Governments, together with medical societies and non-governmental organisations, should support and promote preventive programmes aiming to increase public awareness, educate physicians, and reduce salt intake. Regulations for the food industry and the production and availability of generic drugs should be reinforced.
Background:
In the Chronic REnal Disease in Turkey-CREDIT Study, a large populationbased study on 10,748 adults, the prevalence of chronic kidney disease (CKD) and relationship between CKD and other cardiovascular risk factors had been studied.
Methods:
This report presents the results of CREDIT study on the prevalence, awareness, treatment, and control of hypertension among CKD patients.
Results:
The prevalence and awareness of hypertension in CREDIT population was 32.7% and 48.6%, respectively. Of the patients with hypertension, 31.5% were under treatment, and 16.4% had hypertension under control. Prevalence of CKD was 25.3% in patients with hypertension. Among CKD patients (15.7% of the CREDIT study population), 56.3% had hypertension. The prevalence of hypertension was 34.8% at stage 1, 79.8% at stage 3, and 92.3% at stage 5 CKD. Only 13.4% of patients with CKD have optimal blood pressure. Among CKD patients, 61.9% were aware of hypertension, and 44.2% were under treatment. Overall control rate of hypertension in subjects with CKD was 16.3% with the lowest rate at stage 1 (12.3%) and highest rate at stage 4 (40%). The control rate increased to 28.8% for CKD patients under treatment for hypertension.
Conclusion:
As a conclusion, hypertension is highly prevalent in subjects with CKD in Turkey with suboptimal awareness, treatment, and control rates. Appropriate health strategies should be implicated to improve prevention, early diagnosis, and treatment of hypertension, which is one of the leading causes of CKD.