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Yang X, Mei Y, Li Y, Zhang X, Gui J, Wang Y, Chen W, Chen M, Liu C, Zhang L. Psychometric properties of the Chinese version of the Hypertension Belief Assessment Tool. BMC Geriatr 2024; 24:372. [PMID: 38664606 PMCID: PMC11046863 DOI: 10.1186/s12877-024-04853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 02/28/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Hypertension is prevalent in China. Hypertensive patients suffer from many health problems in life. Hypertension is a common chronic disease with long-term and lifelong characteristics. In the long run, the existence of chronic diseases will affect the patient's own health beliefs. However, people's health beliefs about Hypertension are not explicit. Therefore, it is vital to find a suitable instrument to comprehend and improve the health beliefs of hypertensive patients, thus, better control of blood pressure and improvement of patient's quality of life are now crucial issues. This study aimed to translate the Hypertension Belief Assessment Tool (HBAT) into Chinese and examine the psychometric properties of the Chinese version of the Hypertension Belief Assessment Tool in hypertensive patients. METHODS This is a cross-sectional study. We translated the HBAT into Chinese and tested the reliability and validity of the Chinese version among 325 hypertensive patients. RESULTS The Chinese version of the scale contains 21 items. The Exploratory Factor Analysis (EFA) revealed six factors and explained 77.898% of the total variation. A six-factor model eventually showed acceptable fit indices in the Confirmatory Factor Analysis (CFA). With modified Confirmatory Factor Analysis, the fit indices were Chi-square/Degree of Freedom (CMIN/DF) = 2.491, Comparative Fit Index (CFI) = 0.952, Incremental Fit Index (IFI) = 0.952, Root-mean-square Error of Approximation (RMSEA) = 0.068, Tucker Lewis Index (TLI) = 0.941. The HBAT exhibits high internal consistency reliability (0.803), and the scale has good discriminant validity. CONCLUSION The results suggest that the HBAT is a reliable and valid instrument for assessing the beliefs of Chinese hypertensive patients.
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Affiliation(s)
- Xue Yang
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, 241002, Wuhu City, An Hui Province, P.R. China
| | - Yujin Mei
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, 241002, Wuhu City, An Hui Province, P.R. China
| | - Yuqing Li
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, 241002, Wuhu City, An Hui Province, P.R. China
| | - Xiaoyun Zhang
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, 241002, Wuhu City, An Hui Province, P.R. China
| | - Jiaofeng Gui
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, 241002, Wuhu City, An Hui Province, P.R. China
| | - Ying Wang
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, 241002, Wuhu City, An Hui Province, P.R. China
| | - Wenyue Chen
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, 241002, Wuhu City, An Hui Province, P.R. China
| | - Mingjia Chen
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, 241002, Wuhu City, An Hui Province, P.R. China
| | - Changjun Liu
- School of Marxism, Jinzhou Medical University, No. 40, Section 3, Songpo Road, Linghe District, 121001, Jinzhou City, Liaoning Province, P.R. China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, 241002, Wuhu City, An Hui Province, P.R. China.
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Guimarães JMN, Jackson JW, Barber S, Griep RH, da Fonseca MDJM, Camelo LV, Barreto SM, Schmidt MI, Duncan BB, Cardoso LDO, Pereira AC, Chor D. Racial Inequities in the Control of Hypertension and the Explanatory Role of Residential Segregation: a Decomposition Analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Racial Ethn Health Disparities 2024; 11:1024-1032. [PMID: 37052798 DOI: 10.1007/s40615-023-01582-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/04/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
The mechanisms underlying racial inequities in uncontrolled hypertension have been limited to individual factors. We investigated racial inequities in uncontrolled hypertension and the explanatory role of economic segregation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All 3897 baseline participants with hypertension (2008-2010) were included. Uncontrolled hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg), self-reported race (White/Brown/Black people), and neighborhood economic segregation (low/medium/high) were analyzed cross-sectionally. We used decomposition analysis, which describes how much a disparity would change (disparity reduction; explained portion) and remain (disparity residual; unexplained portion) upon removing racial differences in economic segregation (i.e., if Black people had the distribution of segregation of White people, how much we would expect uncontrolled hypertension to decrease among Black people). Age- and gender-adjusted prevalence of uncontrolled hypertension (39.0%, 52.6%, and 54.2% for White, Brown, and Black participants, respectively) remained higher for Black and Brown vs White participants, regardless of economic segregation. Uncontrolled hypertension showed a dose-response pattern with increasing segregation levels for White but not for Black and Brown participants. After adjusting for age, gender, education, and study center, unexplained portion (disparity residual) of race on uncontrolled hypertension was 18.2% (95% CI 13.4%; 22.9%) for Black vs White participants and 12.6% (8.2%; 17.1%) for Brown vs White participants. However, explained portion (disparity reduction) through economic segregation was - 2.1% (- 5.1%; 1.3%) for Black vs White and 0.5% (- 1.7%; 2.8%) for Brown vs White participants. Although uncontrolled hypertension was greater for Black and Brown vs White people, racial inequities in uncontrolled hypertension were not explained by economic segregation.
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Affiliation(s)
- Joanna M N Guimarães
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil.
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Maria de J M da Fonseca
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
| | - Lidyane V Camelo
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sandhi M Barreto
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Leticia de O Cardoso
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Dora Chor
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
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Baklouti M, Mejdoub Y, Tombohindy MG, Ketata N, Jdidi J, Triki F, Yaich S, Abid L. Impact of Therapeutic Education on the Management of High Blood Pressure: A Quasi-experimental Survey From Southern Tunisia. Crit Pathw Cardiol 2024; 23:30-35. [PMID: 37831463 DOI: 10.1097/hpc.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The prevalence of arterial hypertension (HTA) was continuously increased with a low percentage of pressure control blood pressure among treated patients. Therapeutic education (TE) was one of the inventive methods in the management of high blood pressure (HBP) worldwide. The objective was to assess the impact of TE on the control and management of HBP. METHODS This was a quasi-experimental study consisting of an intervention, a pretest, and a post-test evaluation. This study was conducted in the external consultation service of cardiology CHU HEDI CHAKER of Sfax during over a period of 4 months (November 2021-March 2022). RESULTS In total, 35 of the patients (50%) were women with a sex ratio of 1. The mean age was 63.33 ± 8.91 years. We noted a statistically significant decrease on both systolic and diastolic blood pressure blood pressure values after TE among educated patients (135.3 ± 9.77 vs. 141.9 ± 10.9; P = 0.010) and (75 [70-80] vs. 80 [75-80]; P = 0.002), respectively. We found a significantly good knowledge about HBP definition (Odds ratio [OR] = 3.4; P = 0.022), HBP symptoms (OR = 9.1; P < 0.001), and HBP complications (OR = 12.3; P < 0.001) among educated patients. A significant association was noted between educated patients and low daily salt consumption after TE (OR = 2.7; P = 0.048). Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation Educated patients had significantly more adequate auto-control devise use (OR = 1.01; P = 0.028). Moreover, the respect of therapeutic compliance was statistically more important among educated patients (OR = 3.7; P = 0.028). CONCLUSIONS Our results showed that the TE training session is an operative intervention to improve HBP management. Thus, integrating TE therapy in daily care should be continuous and should be exhaustive to all cardiovascular and all chronic diseases.
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Affiliation(s)
- Mouna Baklouti
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Yosra Mejdoub
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | | | - Nouha Ketata
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Jihen Jdidi
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Faten Triki
- Cardiology Department Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Sourour Yaich
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Leila Abid
- Cardiology Department Hedi Chaker University Hospital, University of Sfax, Tunisia
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Néri A, Xavier R, Matos S, Almeida M, Ladeira R, Lopes A, Lino D, Lázaro A, Cairutas R, Silva J, Lima J, Chaves M, Silva R, Silva G. Factors associated with non-treatment of hypertension and gender differences at baseline in the ELSA-Brasil cohort. Braz J Med Biol Res 2024; 57:e12937. [PMID: 38359271 PMCID: PMC10868185 DOI: 10.1590/1414-431x2023e12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/26/2023] [Indexed: 02/17/2024] Open
Abstract
The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.
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Affiliation(s)
- A.K.M. Néri
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil
- Serviço de Cardiologia, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - R.M.F. Xavier
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - S.M.A. Matos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - M.C.C. Almeida
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brasil
| | - R.M. Ladeira
- Hospital João XXIII, Fundação Hospitalar do Estado de Minas Gerais, Secretaria Estadual de Saúde, Belo Horizonte, MG, Brasil
| | - A.A. Lopes
- Departamento de Medicina Interna/Nefrologia, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - D.O.C. Lino
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil
| | - A.P.P. Lázaro
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil
| | - R.V.B.M. Cairutas
- Serviço de Cardiologia, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - J.H. Silva
- Serviço de Cardiologia, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - J.M.O. Lima
- Serviço de Cardiologia, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - M.C. Chaves
- Serviço de Cardiologia, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - R.P. Silva
- Serviço de Cardiologia, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - G.B. Silva
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil
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Dutra RT, Bensenor IM, Goulart AC, Pereira AC, Lotufo PA, Santos IS. Carotid intima-media thickness and incident hypertension: the Brazilian Longitudinal Study of Adult Health. J Hypertens 2024; 42:129-135. [PMID: 37728130 DOI: 10.1097/hjh.0000000000003567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND High blood pressure (BP) increases carotid intima-media thickness (CIMT). On the other hand, it is not clear whether the vascular abnormalities reflected in high CIMT may predict incident hypertension. The present study aims to investigate the association between CIMT and incident hypertension after 4 years of follow-up in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multiethnic sample of middle-aged adults from six Brazilian cities. METHODS We analyzed data from 6682 ELSA-Brasil participants (aged 35-74) without hypertension and with complete CIMT data at baseline. After 4 years of follow-up, we describe hypertension incidence, stratifying the sample according to age, sex, and race-specific CIMT quartiles. We also built crude and adjusted Poisson regression models to analyze the association between mean and maximal CIMT values and incident hypertension. RESULTS We found incident hypertension in 987 (14.8%) participants. According to mean CIMT quartile groups, hypertension incidence varied from 10.2% (first quartile group) to 22.4% (fourth quartile group; P for trend <0.001). In fully adjusted models, 0.1 mm increments in mean CIMT values were associated with a 16% [relative risk (RR):1.16; 95% confidence interval (95% CI) 1.10-1.21; P < 0.001] higher risk of incident hypertension, respectively. Results were similar when maximal CIMT values were considered instead of mean CIMT values. CONCLUSION CIMT values at baseline strongly predicted incident hypertension after 4 years of follow-up in this large multiethnic cohort. This highlights the relationship between CIMT and BP and may provide important insights into the significance of this ultrasound measurement.
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Affiliation(s)
- Robertson T Dutra
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
| | - Isabela M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
- Departamento de Clínica Médica
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
| | - Alexandre C Pereira
- Laboratório de Genética e Cardiologia Molecular do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
- Departamento de Clínica Médica
| | - Itamar S Santos
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
- Departamento de Clínica Médica
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Zanuzzi MG, Garzon ME, Cornavaca MT, Bernabeu F, Albertini RA, Ellena G, Romero CA. Social determinants of blood pressure control in a middle-income country in Latin America. J Biosoc Sci 2024; 56:50-62. [PMID: 36794341 DOI: 10.1017/s0021932023000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Blood pressure (BP) control is a key intervention to decrease cardiovascular diseases (CVD), the main cause of death in low and middle-income countries (MIC). Scarce data on the determinants of BP control in Latin America are available. Our objective is to explore the role of gender, age, education, and income as social determinants of BP control in Argentina, a MIC with a universal health care system. We evaluated 1184 persons in two hospitals. Blood pressure was measured using automatic oscillometric devices. We selected those patients treated for hypertension. The average BP of less than 140/90 mmHg was considered a controlled BP. We found 638 hypertensive individuals, of whom 477 (75%) were receiving antihypertensive drugs, and of those, 248 (52%) had controlled BP. The prevalence of low education was more frequent in uncontrolled patients (25.3% vs. 16.1%; P < .01). We did not find association between household income, gender, and BP control. Older patients had less BP control (44% of those older than 75 years vs. 60.9% of those younger than 40; test for trend P < .05). Multivariate regression indicates low education (OR 1.71 95% CI [1.05, 2.79]; P = .03) and older age (OR 1.01; 95% IC [1.00, 1.03]) as independent predictors of the lack of BP control. We conclude that rates of BP control are low in Argentina. In a MIC with a universal health care system low education and old age but not household income are independent predictors of the lack of BP control.
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Affiliation(s)
- Matias G Zanuzzi
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Maria E Garzon
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Maria Teresita Cornavaca
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Francisco Bernabeu
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Ricardo A Albertini
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Gustavo Ellena
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Cesar A Romero
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Global Health Initiative, Henry Ford Hospital, Detroit, MI, USA
- Hypertension and Vascular Research Division, Internal Medicine Department, Henry Ford Hospital, Detroit, MI, USA
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Cesena FY, Generoso G, Santos IDS, Duncan BB, Ribeiro ALP, Brant LC, Mill JG, Pereira AC, Bittencourt MS, Santos RD, Lotufo PA, Benseñor IM. Percentiles of predicted 10-year cardiovascular disease risk by sex and age in Brazil and their association with estimated risk of long-term atherosclerotic events. Prev Med 2023; 177:107755. [PMID: 37931661 DOI: 10.1016/j.ypmed.2023.107755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/17/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Expressing the cardiovascular disease (CVD) risk in relation to peers may complement the estimation of absolute CVD risk. We aimed to determine 10-year CVD risk percentiles by sex and age in the Brazilian population and evaluate their association with estimated long-term atherosclerotic CVD (ASCVD) risk. METHODS A cross-sectional analysis of baseline data from the ELSA-Brasil study was conducted in individuals aged 40-74 years without prior ASCVD. Ten-year CVD risk and long-term ASCVD risk were estimated by the WHO risk score and the Multinational Cardiovascular Risk Consortium tool, respectively. Ten-year risk percentiles were determined by ranking the calculated risks within each sex and age group. RESULTS Ten-year CVD risk versus percentile plots were constructed for each sex and age group using data from 13,364 participants (55% females; median age, 52 [IQR, 46-59] years). Long-term ASCVD risk was calculated in 12,973 (97.1%) participants. Compared to individuals at the <25th risk percentile, those at the ≥75th percentile had a greater risk of being in the highest quartile of long-term risk (ORs [95% CIs] 6.57 [5.18-8.30] in females and 11.59 [8.42-15.96] in males) in regression models adjusted for age, race, education, and 10-year CVD risk. In both sexes, the association between risk percentile and long-term risk weakened after age 50. A tool for calculating 10-year CVD risk and the corresponding percentile is available at https://bit.ly/3CzPUi6. CONCLUSIONS We established percentiles of predicted 10-year CVD risk by sex and age in the Brazilian population, which independently reflect the estimated long-term ASCVD risk in younger individuals.
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Affiliation(s)
| | - Giuliano Generoso
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Itamar de S Santos
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Bruce B Duncan
- School of Medicine and Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luisa Caldeira Brant
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Jose Geraldo Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology (LIM13), University of São Paulo Medical School Hospital, São Paulo, SP, Brazil; Genetics Department, Harvard Medical School, Boston, MA, USA
| | | | - Raul D Santos
- Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, SP, Brazil
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Sun K, Chen XS, Muzhylko T, Andrade FCD. Doctors' recommendations and healthy lifestyle behaviors among individuals with hypertension in Brazil. Prev Med Rep 2023; 35:102315. [PMID: 37576845 PMCID: PMC10413139 DOI: 10.1016/j.pmedr.2023.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023] Open
Abstract
Little is known about whether doctors' recommendations encourage healthy behaviors among individuals with hypertension in Brazil. This study examined the biological, social, and health factors related to doctor's recommendations and the associations between doctor's recommendations and healthy behaviors. The sample consisted of individuals with hypertension (N = 18,260) from Brazil's 2019 National Health Survey. The outcomes examined included smoking, drinking, diet, salt intake, physical activity, and doctor visits. Study findings indicated that more than 80% of people with hypertension in Brazil received doctors' recommendations to adhere to medical care and engage in healthy behaviors. Those who received recommendations were more likely to practice healthy eating and exercise regularly but also to be obese/overweight, smoke, and drink excessively. Nonetheless, the findings concerning diet and exercise suggest the value of doctors' recommendations for individuals with hypertension in Brazil.
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Affiliation(s)
- Kang Sun
- University of Illinois at Urbana-Champaign, United States
| | | | - Tonya Muzhylko
- University of Illinois at Urbana-Champaign, United States
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Cesena FY, Kashiwagi NM, Minanni CA, Santos RD. Determining Percentiles of Atherosclerotic Cardiovascular Risk According to Sex and Age in a Healthy Brazilian Population. Arq Bras Cardiol 2023; 120:e20220552. [PMID: 37403871 PMCID: PMC10344368 DOI: 10.36660/abc.20220552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/28/2023] [Accepted: 04/05/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Expressing the risk of atherosclerotic cardiovascular disease (ASCVD) as percentiles of the distribution according to sex and age may provide a better perception of the risk. OBJECTIVES To determine percentiles of the 10-year ASCVD risk distribution according to sex and age in a sample of the Brazilian population; to characterize individuals at low 10-year risk but high risk percentile. METHODS We analyzed individuals aged 40 to 75 years who underwent routine health evaluations from 2010 to 2020. Persons with known clinical ASCVD, diabetes mellitus, chronic kidney disease, or LDL-cholesterol ≥ 190 mg/dL were excluded. The 10-year ASCVD risk was calculated by the ACC/AHA pooled cohort equations. Local polynomial regression was used to determine risk percentiles. Two-sided p-values < 0.050 were considered statistically significant. RESULTS Our sample comprised 54,145 visits (72% male, median age [interquartile range] 48 [43, 53] years). We constructed sex-specific graphs plotting age against ASCVD risk corresponding to the 10th, 25th, 50th, 75th, and 90th percentiles. Most males up to 47 years and females up to 59 years above the 75th percentile had a 10-year risk < 5%. Individuals at low 10-year risk and risk percentile ≥ 75th had a high prevalence of excess weight and median (interquartile range) LDL-cholesterol levels 136 (109, 158) mg/dL (males) and 126 (105, 147) mg/dL (females). CONCLUSIONS We established ASCVD risk percentiles according to sex and age in a large sample of the Brazilian population. This approach may increase risk awareness and help identify younger persons at low 10-year risk who may benefit from more aggressive risk factor control.
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Affiliation(s)
- Fernando Yue Cesena
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Nea Miwa Kashiwagi
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Carlos Andre Minanni
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Raul D. Santos
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
- InCorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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10
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da Silva EKP, Barreto SM, Brant LCC, Camelo LV, Araújo EMD, Griep RH, Fonseca MDJMD, Pereira ADC, Giatti L. Gender, race/skin colour and incidence of hypertension in ELSA-Brasil: an intersectional approach. ETHNICITY & HEALTH 2023; 28:469-487. [PMID: 35968763 DOI: 10.1080/13557858.2022.2108377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Race and gender inequities in the incidence of hypertension (HTN) are well documented; however, few empirical investigations looked into these associations, considering the synergies and heterogeneous experiences of intersectional gender and race/skin colour groups. This study investigated the association of intersectional identities defined by gender and race/skin colour with HTN incidence, and verified whether they are affected by educational level in adulthood. DESIGN We used the Longitudinal Study of Adult Health (ELSA-Brasil) data to estimate the incidence of HTN between visits 1 (2008-2010) and 2 (2012-2014), in 8528 participants without hypertension at visit 1. HTN was defined as systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or use of antihypertensive drugs. Generalized linear models with Poisson distribution and log link function were used to assess the associations. RESULTS The incidence of HTN was 43.4/1000 person-years, ranging from 30.5/1000 in White women to 59.4/1000 in Black men. After adjusting by age and family history of HTN, the incidence rate ratio (IRR) was higher in Black men (2.25; 95%CI: 1.65-3.08), Brown (Pardo) men (1.89; 95%CI: 1.59-2.25), Black women (1.85; 95%CI: 1.50-2.30), Brown (Parda) women (1.47; 95%CI: 1.31-1.67) and White men (1.76; 95%CI: 1.49-2.08), compared to White women. These associations were maintained even after considering socioeconomic, behavioural and health mediators in the model. No interaction was found between education level and intersectional identities in the IRRs observed. CONCLUSION By using an intersectional approach, we showed the complex relations between race/skin colour and gender inequities in the incidence of HTN, pointing not only that Black men have the highest risk of developing HTN, but also that the risk of HTN is greater in Black women than in White men, when compared to White women.
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Affiliation(s)
| | - Sandhi Maria Barreto
- Faculty of Medicine & Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Lidyane V Camelo
- Faculty of Medicine & Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Edna Maria de Araújo
- Department of Health, Universidade Estadual de Feira de Santana, Feira de Santana, Brazil
| | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Alexandre da Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Luana Giatti
- Faculty of Medicine & Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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11
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Wang L, Zhou H, Liu Y, Wang X, Yan W, Zhang J, Ren H. Factors influencing adherence to lifestyle prescriptions among patients with nonalcoholic fatty liver disease: A qualitative study using the health action process approach framework. Front Public Health 2023; 11:1131827. [PMID: 37006574 PMCID: PMC10065407 DOI: 10.3389/fpubh.2023.1131827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/17/2023] [Indexed: 03/19/2023] Open
Abstract
Background and objectiveLifestyle modifications aimed at weight loss have been introduced as a cornerstone of nonalcoholic fatty liver disease (NAFLD) management. However, very few patients follow the doctor's prescription to change their lifestyle to achieve weight loss in the real world. The purpose of this study was to use the Health Action Process Approach (HAPA) model to examine the factors that affect adherence to lifestyle prescriptions among patients with NAFLD.MethodsSemi-structured interviews were conducted with patients with NAFLD. Reflexive thematic analysis and framework analysis were used to determine naturally identified themes and allocate them to theoretically driven domains.ResultsThirty adult patients with NAFLD were interviewed, and the identified themes were mapped directly onto the constructs of the HAPA model. This study revealed that key barriers to adhering to lifestyle prescriptions are related to the coping strategy and outcome expectation constructs of the HAPA model. For physical activity, conditional limits, lack of time, symptoms such as fatigue and poor physical fitness, and fear of sports injury are the primary barriers. Barriers to diet are mainly diet environment, mental stress, and food cravings. Key facilitators for adherence to lifestyle prescriptions include developing simple and specific action plans, coping strategies to flexibly deal with obstacles and difficulties, receiving regular feedback from doctors to improve self-efficacy, and using regular tests and behavior recording to enhance action control.ConclusionsFuture lifestyle intervention programs should pay particular attention to the planning, self-efficacy, and action control-related constructors of the HAPA model to promote the adherence of patients with NAFLD to lifestyle prescriptions.
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Affiliation(s)
- Lina Wang
- Department of Physical Fitness and Health, School of Sport Science, Beijing Sport University, Beijing, China
| | - Huixuan Zhou
- Department of Physical Fitness and Health, School of Sport Science, Beijing Sport University, Beijing, China
| | - Yali Liu
- The Third Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Department of Nursing, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wenjing Yan
- Department of Physical Fitness and Health, School of Sport Science, Beijing Sport University, Beijing, China
- School of Physical Education, Shanxi Normal University, Taiyuan, China
| | - Jing Zhang
- The Third Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jing Zhang
| | - Hong Ren
- Department of Physical Fitness and Health, School of Sport Science, Beijing Sport University, Beijing, China
- Hong Ren
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12
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Rahut DB, Mishra R, Sonobe T, Timilsina RR. Prevalence of prehypertension and hypertension among the adults in South Asia: A multinomial logit model. Front Public Health 2023; 10:1006457. [PMID: 36777775 PMCID: PMC9911430 DOI: 10.3389/fpubh.2022.1006457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023] Open
Abstract
Hypertension has been the most common non-communicable disease in low and middle-income countries for the past two decades, increasing cardiovascular and renal disease risk. Urbanization, aging, dietary and lifestyle changes, high illiteracy rates, poor access to health facilities, poverty, high costs of drugs, and social stress have contributed to an increase in the prevalence of hypertension in developing countries. Nonetheless, little is known about the comprehensive risk factors associated with prehypertension and hypertension among economically active adult populations of South Asia, such as India, Nepal, and Bangladesh. This paper uses the Demographic and Health Survey data of 637,396 individuals from India (2019-21), 8,924 from Nepal (2016), and 8,613 from Bangladesh (2017-18) to examine the prevalence and driver of prehypertension and hypertension. We analyze the prevalence of prehypertension because it leads to hypertension and is directly related to cardiovascular disease, and many people live with it for prolonged periods without realizing it. The paper finds, among other things, that the prevalence of prehypertension and hypertension among adults (18-49 years) is 43.2 and 14.9% in India, 35.1% and 19.8% in Bangladesh, and 25.2% and 13.8% in Nepal, respectively. Better educated, wealthy individuals living in urban areas of developing economies in the South Asian region are more likely to have prehypertension and hypertension. The paper suggests the urgent need to launch preventive programs to reduce prehypertension before it develops to be hypertension as a precautionary measure. Thus, such measures shall help to prevent hypertension, thereby improving the overall wellbeing of individuals and families.
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Affiliation(s)
- Dil Bahadur Rahut
- Asian Development Bank Institute (ADBI), Tokyo, Japan,*Correspondence: Dil Bahadur Rahut ✉
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13
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Udosen B, Soremekun O, Kamiza A, Machipisa T, Cheickna C, Omotuyi O, Soliman M, Wélé M, Nashiru O, Chikowore T, Fatumo S. Meta-Analysis and Multivariate GWAS Analyses in 80,950 Individuals of African Ancestry Identify Novel Variants Associated with Blood Pressure Traits. Int J Mol Sci 2023; 24:2164. [PMID: 36768488 PMCID: PMC9916484 DOI: 10.3390/ijms24032164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023] Open
Abstract
High blood pressure (HBP) has been implicated as a major risk factor for cardiovascular diseases in several populations, including individuals of African ancestry. Despite the elevated burden of HBP-induced cardiovascular diseases in Africa and other populations of African descent, limited genetic studies have been carried out to explore the genetic mechanism driving this phenomenon. We performed genome-wide association univariate and multivariate analyses of both systolic (SBP) and diastolic blood pressure (DBP) traits in 80,950 individuals of African ancestry. We used summary statistics data from six independent cohorts, including the African Partnership for Chronic Disease Research (APCDR), the UK Biobank, and the Million Veteran Program (MVP). FUMA was used to annotate, prioritize, visualize, and interpret our findings to gain a better understanding of the molecular mechanism(s) underlying the genetics of BP traits. Finally, we undertook a Bayesian fine-mapping analysis to identify potential causal variants. Our meta-analysis identified 10 independent variants associated with SBP and 9 with DBP traits. Whilst our multivariate GWAS method identified 21 independent signals, 18 of these SNPs have been previously identified. SBP was linked to gene sets involved in biological processes such as synapse assembly and cell-cell adhesion via plasma membrane adhesion. Of the 19 independent SNPs identified in the BP meta-analysis, only 11 variants had posterior probability (PP) of > 50%, including one novel variant: rs562545 (MOBP, PP = 77%). To facilitate further research and fine-mapping of high-risk loci/variants in highly susceptible groups for cardiovascular disease and other related traits, large-scale genomic datasets are needed. Our findings highlight the importance of including ancestrally diverse populations in large GWASs and the need for diversity in genetic research.
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Affiliation(s)
- Brenda Udosen
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe 7545, Uganda; (B.U.); (O.S.); (A.K.)
- The African Center of Excellence in Bioinformatics of Bamako (ACE-B), University of Sciences, Techniques and Technologies of Bamako, Bamako 3206, Mali; (C.C.); (M.W.)
- H3Africa Bioinformatics Network (H3ABioNet) Node, Centre for Genomics Research and Innovation, NABDA/FMST, Abuja 901101, Nigeria;
| | - Opeyemi Soremekun
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe 7545, Uganda; (B.U.); (O.S.); (A.K.)
- Molecular Bio-Computation and Drug Design Laboratory, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, Durban 4001, South Africa;
| | - Abram Kamiza
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe 7545, Uganda; (B.U.); (O.S.); (A.K.)
- Malawi Epidemiology and Intervention Research Unit, Lilongwe P.O. Box 46, Malawi
| | - Tafadzwa Machipisa
- Hatter Institute for Cardiovascular Diseases Research in Africa (HICRA), Department of Medicine, University of Cape Town, Cape Town 7701, South Africa;
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Cisse Cheickna
- The African Center of Excellence in Bioinformatics of Bamako (ACE-B), University of Sciences, Techniques and Technologies of Bamako, Bamako 3206, Mali; (C.C.); (M.W.)
- Department of Biological Sciences, Faculty of Sciences and Techniques, University of Sciences, Techniques and Technologies of Bamako, Bamako 3206, Mali
| | - Olaposi Omotuyi
- Institute for Drug Research and Development, S.E. Bogoro Center, Afe Babalola University, Ado Ekiti 360101, Nigeria;
| | - Mahmoud Soliman
- Molecular Bio-Computation and Drug Design Laboratory, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, Durban 4001, South Africa;
| | - Mamadou Wélé
- The African Center of Excellence in Bioinformatics of Bamako (ACE-B), University of Sciences, Techniques and Technologies of Bamako, Bamako 3206, Mali; (C.C.); (M.W.)
- Department of Biological Sciences, Faculty of Sciences and Techniques, University of Sciences, Techniques and Technologies of Bamako, Bamako 3206, Mali
| | - Oyekanmi Nashiru
- H3Africa Bioinformatics Network (H3ABioNet) Node, Centre for Genomics Research and Innovation, NABDA/FMST, Abuja 901101, Nigeria;
| | - Tinashe Chikowore
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa;
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe 7545, Uganda; (B.U.); (O.S.); (A.K.)
- H3Africa Bioinformatics Network (H3ABioNet) Node, Centre for Genomics Research and Innovation, NABDA/FMST, Abuja 901101, Nigeria;
- Segun Fatumo, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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14
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Marques LP, de Aguiar OB, Paula DP, Oliveira FEG, Chor D, Benseñor I, Ribeiro AL, Brunoni AR, A C Machado L, da Fonseca MDJM, Griep RH. Multimorbidity prevalence and patterns at the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231173845. [PMID: 37223823 PMCID: PMC10201182 DOI: 10.1177/26335565231173845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/17/2023] [Indexed: 05/25/2023]
Abstract
Background To identify multimorbidity patterns, by sex, according to sociodemographic and lifestyle in ELSA-Brasil. Methods Cross-sectional study with 14,516 participants from ELSA-Brasil (2008-2010). Fuzzy c-means was used to identify multimorbidity patterns of 2+ chronic morbidities, where the consequent morbidity had to occur in at least 5% of all cases. Association rule (O/E≥1.5) was used to identify co-occurrence of morbidities, in each cluster, by sociodemographic and lifestyle factors. Results The prevalence of multimorbidity was higher in women (73.7%) compared to men (65.3%). Among women, cluster 1 was characterized by hypertension/diabetes (13.2%); cluster 2 had no overrepresented morbidity; and cluster 3 all participants had kidney disease. Among men, cluster 1 was characterized by cirrhosis/hepatitis/obesity; cluster 2, most combinations included kidney disease/migraine (6.6%); cluster 3, no pattern reached association ratio; cluster 4 predominated co-occurrence of hypertension/rheumatic fever, and hypertension/dyslipidemia; cluster 5 predominated diabetes and obesity, and combinations with hypertension (8.8%); and cluster 6 presented combinations of diabetes/hypertension/heart attack/angina/heart failure. Clusters were characterized by higher prevalence of adults, married and participants with university degrees. Conclusion Hypertension/diabetes/obesity were highly co-occurred, in both sexes. Yet, for men, morbidities like cirrhosis/hepatitis were commonly clustered with obesity and diabetes; and kidney disease was commonly clustered with migraine and common mental disorders. The study advances in understanding multimorbidity patterns, benefiting simultaneously or gradually prevention of diseases and multidisciplinary care responses.
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Affiliation(s)
- Larissa Pruner Marques
- Post-Graduate Program in
Epidemiology, Sergio Arouca National School of Public
Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Odaleia Barbosa de Aguiar
- Department of Applied Nutrition,
Institute of Nutrition, Rio de Janeiro State
University, Rio de Janeiro, Brazil
| | - Daniela Polessa Paula
- National School of Statistical
Sciences, Brazilian Institute of Geography and Statistics, Rio de
Janeiro, Brazil
| | | | - Dóra Chor
- Department of Epidemiology and
Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Isabela Benseñor
- Clinical and Epidemiologic Research
Center, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Antonio Luiz Ribeiro
- Department of Internal Medicine, Federal University of Minas
Gerais, Belo Horizonte, Brazil
| | - Andre R Brunoni
- Interdisciplinary Neuromodulation
Service, Psychiatry Institute, University of São Paulo School of
Medicine Hospital das Clínicas, HC-FMUSP, São Paulo, Brazil
| | - Luciana A C Machado
- Clinical Hospital/Ebserh, Universidade Federal de Minas
Gerais, HC-UFMG, Belo Horizonte, Brazil
| | - Maria de Jesus Mendes da Fonseca
- Department of Epidemiology and
Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rosane Härter Griep
- Laboratory of Health and
Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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15
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Miranda AM, Goulart AC, Generoso G, Bittencourt MS, Santos RD, Toth PP, Jones SR, Benseñor IM, Lotufo PA, Marchioni DM. Association between coffee consumption with serum lipid profile in ELSA-Brasil study: a metabolomic approach. Eur J Nutr 2022; 61:4205-4214. [PMID: 35895137 DOI: 10.1007/s00394-022-02946-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/17/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE This study evaluated the association between coffee consumption and serum lipid profile in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS This is a cross-sectional study on baseline data from participants of the cohort ELSA-Brasil. Only participants of São Paulo Research Center who underwent a nuclear magnetic resonance (NMR) spectroscopy examination of lipid profile were included (N = 4736). Coffee intake was categorized into four categories (cups/day, in reference cup size of 50 mL, which is the household measure adopted in Brazil): never/almost never, ≤ 1, 1-3, and > 3. Serum lipid profile [i.e., Total Cholesterol (TC), Total Triglycerides (TG), Very Low-Density Lipoprotein-cholesterol (VLDL-c), Low-Density Lipoprotein-cholesterol (LDL-c), High-Density Lipoprotein-cholesterol (HDL-c), Triglyceride-rich Lipoprotein Particles (TRLP) and subfractions particles] was analyzed. To estimate the effect of coffee consumption on serum lipid profile, multivariate Generalized Linear Models were performed. RESULTS Compared to participants who never or almost never drink coffee, individuals who consumed more than 3 cups/day showed an increase in concentrations of TC (β: 4.13; 95% CI 0.81, 7.45), TG (β: 9.53; 95% CI 1.65, 17.42), VLDL-c (β: 1.90; 95% CI 0.38, 3.42), TRLP (β: 8.42; 95% CI 1.24, 15.60), and Very Small-TRLP and Medium-TRLP subfractions (β: 7.36; 95% CI 0.21, 14.51; β: 2.53; 95% CI 0.89, 4.16, respectively), but not with HDL-c and LDL-c. Among individuals with low (≤ 1 cup/day) and moderate (1-3 cups/day) coffee consumption, no significant associations with lipids was observed. CONCLUSION High coffee consumption (more than 3 cups per day) was associated with an increase in serum lipids, namely TC, TG, VLDL-c, and TRL particles, highlighting the importance of a moderate consumption of this beverage.
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Affiliation(s)
- Andreia Machado Miranda
- Department of Nutrition, School of Public Health, University of São Paulo, Sao Paulo, SP, Brazil.
- Departamento de Nutrição, Faculdade de Saúde Pública, University of São Paulo, Av. Dr. Arnaldo, 715, Cerqueira César, São Paulo, SP, 01246-904, Brasil.
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Sao Paulo, SP, Brazil
| | - Giuliano Generoso
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Sao Paulo, SP, Brazil
| | - Márcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Sao Paulo, SP, Brazil
| | - Raul Dias Santos
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Sao Paulo, SP, Brazil
- Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Peter P Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, IL, USA
| | - Stevens R Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, IL, USA
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Sao Paulo, SP, Brazil
- School of Medicine, University of São Paulo, Sao Paulo, SP, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Sao Paulo, SP, Brazil
- School of Medicine, University of São Paulo, Sao Paulo, SP, Brazil
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, Sao Paulo, SP, Brazil
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16
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Santos IS, Lotufo PA, Goulart AC, Brant LCC, Pinto MM, Pereira AC, Barreto SM, Ribeiro ALP, Thomas GN, Lip GYH, Bensenor IM. Cardiovascular Health and Atrial Fibrillation or Flutter: A Cross-Sectional Study from ELSA-Brasil. Arq Bras Cardiol 2022; 119:S0066-782X2022005016205. [PMID: 36169453 PMCID: PMC9750207 DOI: 10.36660/abc.20210970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. OBJECTIVE To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05. RESULTS The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15-0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19-2.98; p=0.007) profiles were significantly associated with AFF diagnosis. CONCLUSIONS No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.
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Affiliation(s)
- Itamar S. Santos
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Paulo A. Lotufo
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Alessandra C. Goulart
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Luisa C. C. Brant
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Marcelo M Pinto
- Programa de Pós-Graduação em Infectologia e Medicina TropicalFaculdade de MedicinaUniversidade Federal de Minas Gerais,Belo HorizonteMGBrasil Programa de Pós-Graduação em Infectologia e Medicina Tropical da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte , MG – Brasil
| | - Alexandre C. Pereira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Laboratório de Genética e Cardiologia Molecular do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Sandhi M. Barreto
- Departamento de Medicina Preventiva e SocialFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Medicina Preventiva e Social da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Antonio L. P. Ribeiro
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - G Neil Thomas
- Institute of Applied Health ResearchCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamReino Unido Institute of Applied Health Research , College of Medical and Dental Sciences , University of Birmingham , Birmingham – Reino Unido
| | - Gregory Y. H. Lip
- Chest Hospital and Aalborg Thrombosis Research UnitDepartment of Clinical MedicineAalborg UniversityLiverpoolReino Unido Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital and Aalborg Thrombosis Research Unit , Department of Clinical Medicine , Aalborg University , Liverpool – Reino Unido
| | - Isabela M. Bensenor
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
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Holm AE, Gomes LC, Wegener A, Lima KO, Matos LO, Vieira IVM, Kaagaard MD, Pareek M, de Souza RM, Marinho CRF, Biering-Sørensen T, Silvestre OM, Brainin P. Is self-rated health associated with cardiovascular risk factors and disease in a low-income setting? A cross-sectional study from the Amazon Basin of Brazil. BMJ Open 2022; 12:e058277. [PMID: 36041756 PMCID: PMC9438027 DOI: 10.1136/bmjopen-2021-058277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Prior studies have suggested that self-rated health may be a useful indicator of cardiovascular disease. Consequently, we aimed to assess the relationship between self-rated health, cardiovascular risk factors and subclinical cardiac disease in the Amazon Basin. DESIGN Cross-sectional study. SETTING, PARTICIPANTS AND INTERVENTIONS In participants from the Amazon Basin of Brazil we obtained self-rated health according to a Visual Analogue Scale, ranging from 0 (poor) to 100 (excellent). We performed questionnaires, physical examination and echocardiography. Logistic and linear regression models were applied to assess self-rated health, cardiac risk factors and cardiac disease by echocardiography. Multivariable models were mutually adjusted for other cardiovascular risk factors, clinical and socioeconomic data, and known cardiac disease. OUTCOME MEASURES Cardiovascular risk factors and subclincial cardiac disease by echocardiography. RESULTS A total of 574 participants (mean age 41 years, 61% female) provided information on self-rated health (mean 75±21 (IQR 60-90) points). Self-rated health (per 10-point increase) was negatively associated with hypertension (OR 0.87 (95% CI 0.78 to 0.97), p=0.01), hypercholesterolaemia (OR 0.89 (95%CI 0.80 to 0.99), p=0.04) and positively with healthy diet (OR 1.13 (95%CI 1.04 to 1.24), p=0.004). Sex modified these associations (p-interaction <0.05) such that higher self-rated health was associated with healthy diet and physical activity in men, and lower odds of hypertension and hypercholesterolaemia in women. No relationship was found with left ventricular ejection fraction <45% (OR 0.97 (95% CI 0.77 to 1.23), p=0.8), left ventricular hypertrophy (OR 0.97 (95% CI 0.76 to 1.24), p=0.81) or diastolic dysfunction (OR 1.09 (95% CI 0.85 to 1.40), p=0.51). CONCLUSION Self-rated health was positively associated with health parameters in the Amazon Basin, but not with subclinical cardiac disease by echocardiography. Our findings are of hypothesis generating nature and future studies should aim to determine whether assessment of self-rated health may be useful for screening related to policy-making or lifestyle interventions. TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT04445103; Post-results.
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Affiliation(s)
- Anna Engell Holm
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Laura Cordeiro Gomes
- Department of Parasitology, University of São Paulo, Institute of Biomedical Sciences, São Paulo, Brazil
| | - Alma Wegener
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Karine O Lima
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Luan O Matos
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Isabelle V M Vieira
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Molly D Kaagaard
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Manan Pareek
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rodrigo Medeiros de Souza
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
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Zarife AS, Fraga-Maia H, Mill JG, Lotufo P, Griep RH, Fonseca MDJMD, Brito LL, Almeida MDC, Aras R, Matos SMA. Variabilidade da Pressão Arterial em Única Visita e Risco Cardiovascular em Participantes do ELSA-Brasil. Arq Bras Cardiol 2022; 119:505-511. [PMID: 36074482 PMCID: PMC9563895 DOI: 10.36660/abc.20210804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/06/2022] [Indexed: 11/18/2022] Open
Abstract
Fundamento A variabilidade da pressão arterial (VPA) tem valor prognóstico para desfechos cardiovasculares fatais e não fatais. Objetivos Este estudo teve como objetivo avaliar a associação entre a VPA em uma única visita e o risco cardiovascular em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos O presente estudo transversal foi conduzido com dados basais (2008-2010) de 14.357 participantes do ELSA-Brasil, sem história de doença cardiovascular. A VPA foi quantificada pelo coeficiente de variação de três medidas padronizadas da pressão arterial sistólica (PAS) realizadas com um oscilômetro. Medidas antropométricas e exames laboratoriais também foram realizados. O risco cardiovascular foi avaliado pelo estimador de risco de doença cardiovascular aterosclerótica (ASCVD), e se empregou a análise de regressão logística multivariada com nível de significância de 5%. Resultados Um risco cardiovascular significativamente maior foi determinado por uma VPA elevada para ambos os sexos. Uma prevalência significativamente maior de alto risco foi observada mais em homens que em mulheres em todos os quartis, com a maior diferença observada no quarto quartil de variabilidade (48,3% vs. 17,1%). Comparações entre quartis por sexo revelaram um risco significativamente mais alto para homens no terceiro (OR=1,20; IC95%: 1,02 - 1,40) e no quarto quartis OR=1,46; IC95%: 1,25 -1,71), e para mulheres no quarto quartil (OR=1,27; IC95%: 1,03 - 1,57). Conclusão Análises de dados basais de participantes do ELSA-Brasil revelaram que a variabilidade da pressão arterial se associou com risco cardiovascular aumentado, especialmente nos homens.
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Oliveira FEG, Griep RH, Chor D, Giatti L, Machado LAC, Barreto SM, da Costa Pereira A, Fonseca MDJMD, Bastos LS. Racial inequalities in multimorbidity: baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). BMC Public Health 2022; 22:1319. [PMID: 35810284 PMCID: PMC9270815 DOI: 10.1186/s12889-022-13715-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/29/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence of multimorbidity has come mainly from high-income regions, while disparities among racial groups have been less explored. This study examined racial differences in multimorbidity in the multiracial cohort of the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto), ELSA-Brasil. METHODS The study examined baseline (2008-2010) data for 14 099 ELSA-Brasil participants who self-reported being white, mixed-race, or black. A list of 16 morbidities was used to evaluate multimorbidity, operationalised by simple count into ≥ 2, ≥ 3, ≥ 4, ≥ 5 and ≥ 6 morbidities, in addition to evaluating the number of coexisting conditions. Prevalence ratios (PR) were estimated from logistic models and a quantile model was used to examine racial differences graphically in the distribution quantiles for the number of morbidities. RESULTS Overall prevalence of multimorbidity (≥ 2 morbidities) was 70% and, after controlling for age and sex, was greater among mixed-race and black participants - by 6% (PR: 1.06; 95% CI: 1.03-1.08) and 9% (PR: 1.09; 95% CI: 1.06-1.12), respectively - than among white participants. As the cutoff value for defining multimorbidity was raised, so the strength of the association increased, especially among blacks: if set at ≥ 6 morbidities, the prevalence was 27% greater for those of mixed-race (PR: 1.27; 95% CI: 1.07-1.50) and 47% greater for blacks (PR: 1.47; 95% CI: 1.22-1.76) than for whites. The disparities were smaller in the lower morbidity distribution quantiles and larger in the upper quantiles, indicating a heavier burden of disease, particularly on blacks. CONCLUSIONS Multimorbidity was common among adults and older adults in a Brazilian cohort, but important racial inequalities were found. Raising the cutoff point for defining multimorbidity revealed stronger associations between race/skin colour and multimorbidity, indicating a higher prevalence of multimorbidity among mixed-race and black individuals than among whites and that the former groups coexisted more often with more complex health situations (with more coexisting morbidities). Interventions to prevent and manage the condition of multimorbidity that consider the social determinants of health and historically discriminated populations in low- and middle-income regions are necessary.
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Affiliation(s)
| | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Dora Chor
- Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Luana Giatti
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luciana A. C. Machado
- Clinical Hospital/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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20
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Mendes PM, Nobre AA, Griep RH, Juvanhol LL, Barreto SM, Fonseca MJM, Chor D. Association between race/color and incidence of hypertension in the ELSA-Brasil population: investigating the mediation of racial discrimination and socioeconomic position. ETHNICITY & HEALTH 2022; 27:1047-1057. [PMID: 33356472 DOI: 10.1080/13557858.2020.1861586] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the mediation effect of socioeconomic position and racial discrimination in the association between race/color and incidence of hypertension in 4-years follow up. METHODS We included 8,370 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). A latent variable was constructed to represent socioeconomic position (SEP). The perception of discrimination was measured through an adaptation of the Lifetime Major Events Scale; and hypertension was defined using standard criteria. We investigated Body Mass Index (BMI) due to its role in proximal risk for hypertension. To investigate the mediating role of SEP and racial discrimination, we used structural equation modeling. RESULTS SEP had a direct and negative effect on HT incidence (HT incidence increased in worse SEP categories), while the effect of BMI on HT was direct and positive. We did not find significant direct effects of race/color and racial discrimination on HT. As for indirect effects, we observed associations between race/color and HT only through SEP mediation. CONCLUSION According to our results, race/color is indirectly related to HT incidence, mediated by SEP. Racial discrimination was not a mediator in the relationship between race/color and HT in the follow-up period.
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Affiliation(s)
- P M Mendes
- Faculdade de Nutrição, Universidade Federal do Pará, Belém, Brasil
| | - A A Nobre
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - R H Griep
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - L L Juvanhol
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, Brasil
| | - S M Barreto
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - M J M Fonseca
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - D Chor
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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21
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Mill JG. Differences among Angiotensin Receptor Blockers (BRA) in the Treatment of Arterial Hypertension. Arq Bras Cardiol 2022; 118:1083-1084. [PMID: 35703644 PMCID: PMC9345143 DOI: 10.36660/abc.20220281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- José Geraldo Mill
- Universidade Federal do Espírito SantoDepartamento de Ciências FisiológicasVitóriaESBrasilDepartamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, Vitória, ES – Brasil
- Hospital Universitário Cassiano Antônio MoraesVitóriaESBrasilHospital Universitário Cassiano Antônio Moraes, Vitória, ES – Brasil
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22
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Márquez DF, Garzón ME, Renna NF, Baroni M, Berger A, Caruso G, Ferretti V, Sabio R, König F, Marín M, Romero CA. [Argentine registry of office blood pressure monitoring. RAMPAC study]. HIPERTENSION Y RIESGO VASCULAR 2022; 39:62-68. [PMID: 35305932 DOI: 10.1016/j.hipert.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hypertension (HTN) is the leading cause of mortality and disability in the world. In Argentina, almost 44% of hypertensives do not know about their condition and this may be due to the low rate of blood pressure (BP) measurements during the office visit. Our hypothesis is that the measurement and electronic recording of BP (BPMR) is not a routine practice in Argentina. OBJECTIVE To describe the rate of office BP measurement in Argentina. METHODS This is a retrospective, multicentre, point prevalence study. We analysed all office visits on 9/19/2019 at 9 medical institutions in 6 provinces of Argentina. RESULTS Two thousand and eighty-two office visits were analysed. The patients' mean age was 52.1 years (18-103), 1790 (59.7%) were female, and 702 (36.1%) were hypertensives. BP was measured in 420 visits (14.1%; 95% CI 12.8-15.4). In a multivariate logistic regression model, history of HTN (OR 1.91, P<.001) and previous cardiovascular event (OR 1.76, P<.001) were associated with more odds of BPMR. The presence of cancer was associated with fewer odds of BPMR (OR .51, P<.01). Cardiology measured BP up to 49.5% (144/291 visits), followed by internal medicine 30% (152/507 visits). CONCLUSION BPMR during office visits is deficient in Argentina and represents a missed healthcare opportunity. Different strategies are needed to detect hypertensive patients and reduce cardiovascular events.
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Affiliation(s)
- D F Márquez
- Unidad de Hipertensión Arterial, Hospital San Bernardo, Salta, Argentina; Instituto de NefroUrología y Nutrición de Salta, Salta, Argentina
| | - M E Garzón
- Servicio de Clínica Médica, Hospital Ferreyra, Córdoba, Argentina; Servicio de Clínica Médica, Hospital Privado, Córdoba, Argentina
| | - N F Renna
- Departamento de Cardiología, Hospital Español, Mendoza, Argentina
| | - M Baroni
- Facultad de Ciencias Médicas, Universidad Nacional de Cuyo-Mendoza, Servicio de Cardiología, Instituto Modelo de Cardiología, Córdoba, Argentina
| | - A Berger
- Servicio de Clínica Médica, Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - G Caruso
- Servicio de Clínica Médica, Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - V Ferretti
- Servicio de Clínica Médica, Sanatorio Norte, Rosario, Argentina
| | - R Sabio
- Hospital de Alta Complejidad, SAMIC-El Calafate, Santa Cruz, Argentina
| | - F König
- Unidad de Hipertensión Arterial, Hospital San Bernardo, Salta, Argentina
| | - M Marín
- Unidad de Hipertensión Arterial, Hospital Italiano de San Justo, Buenos Aires, Argentina
| | - C A Romero
- Servicio de Clínica Médica, Hospital Privado, Córdoba, Argentina; Emory University School of Medicine, Renal Division, Atlanta, EE. UU..
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Sousa CT, Ribeiro A, Barreto SM, Giatti L, Brant L, Lotufo P, Chor D, Lopes AA, Mengue SS, Baldoni AO, Figueiredo RC. Racial Differences in Blood Pressure Control from Users of Antihypertensive Monotherapy: Results from the ELSA-Brasil Study. Arq Bras Cardiol 2022; 118:614-622. [PMID: 35319612 PMCID: PMC8959024 DOI: 10.36660/abc.20201180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/05/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It seems that the worst response to some classes of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, on the part of the Black population, would at least partially explain the worse control of hypertension among these individuals. However, most of the evidence comes from American studies. OBJECTIVES This study aims to investigate the association between self-reported race/skin color and BP control in participants of the Longitudinal Study of Adult Health (ELSA-Brasil), using different classes of antihypertensive drugs in monotherapy. METHODS The study involved a cross-sectional analysis, carried out with participants from the baseline of ELSA-Brasil. Blood pressure control was the response variable, participants with BP values ≥140/90 mmHg were considered out of control in relation to blood pressure levels. Race/skin color was self-reported (White, Brown, Black). All participants were asked about the continuous use of medication. Association between BP control and race/skin color was estimated through logistic regression. The level of significance adopted in this study was of 5%. RESULTS Of the total of 1,795 users of antihypertensive drugs in monotherapy at baseline, 55.5% declared themselves White, 27.9% Brown, and 16.7% Black. Even after adjusting for confounding variables, Blacks using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB), thiazide diuretics (thiazide DIU), and beta-blockers (BB) in monotherapy had worse blood pressure control compared to Whites. CONCLUSIONS Our results suggest that in this sample of Brazilian adults using antihypertensive drugs in monotherapy, the differences in blood pressure control between different racial groups are not explained by the possible lower effectiveness of ACEIs and ARBs in Black individuals.
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Affiliation(s)
- Camila Tavares Sousa
- Universidade Federal de São João Del-ReiDivinópolisMGBrasilUniversidade Federal de São João Del-Rei - Campus Centro-Oeste Dona Lindu, Divinópolis, MG – Brasil
| | - Antonio Ribeiro
- Universidade Federal de Minas GeraisFaculdade de MedicinaHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais - Faculdade de Medicina e Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Sandhi Maria Barreto
- Universidade Federal de Minas GeraisFaculdade de MedicinaHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais - Faculdade de Medicina e Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Luana Giatti
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais - Medicina Preventiva e Social, Belo Horizonte, MG – Brasil
| | - Luisa Brant
- Universidade Federal de Minas GeraisFaculdade de MedicinaHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais - Faculdade de Medicina e Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Paulo Lotufo
- Universidade de São PauloDepartamento de MedicinaSão PauloSPBrasilUniversidade de São Paulo - Departamento de Medicina, São Paulo, SP – Brasil
| | - Dora Chor
- Fundação Oswaldo CruzEscola de Saúde PúblicaRio de JaneiroRJBrasilFundação Oswaldo Cruz - Escola de Saúde Pública, Rio de Janeiro, RJ – Brasil
| | - Antônio Alberto Lopes
- Universidade Federal da BahiaFaculdade de MedicinaSalvadorBABrasilUniversidade Federal da Bahia - Faculdade de Medicina, Salvador, BA – Brasil
| | - Sotero Serrate Mengue
- Universidade Federal de Ciências da Saúde de Porto AlegrePrograma de Pós-Graduação em EpidemiologiaPorto AlegreRSBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre - Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS – Brasil
| | - André Oliveira Baldoni
- Universidade Federal de São João Del-ReiDivinópolisMGBrasilUniversidade Federal de São João Del-Rei - Campus Centro-Oeste Dona Lindu, Divinópolis, MG – Brasil
| | - Roberta Carvalho Figueiredo
- Universidade Federal de São João Del-ReiDivinópolisMGBrasilUniversidade Federal de São João Del-Rei - Campus Centro-Oeste Dona Lindu, Divinópolis, MG – Brasil
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Gomes IS, Rossi EM, Mendes SJ, Santos BRMD, Sabino W. Pharmaceutical Care in Primary Care: an Experience with Hypertensive Patients in the North of Brazil. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20200257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Guedes LFF, Felisbino-Mendes MS, Vegi ASF, Meireles AL, de Menezes MC, Malta DC, Machado ÍE. Health impacts caused by excessive sodium consumption in Brazil: results of the GBD 2019 study. Rev Soc Bras Med Trop 2022; 55:e0266. [PMID: 35107510 PMCID: PMC9022945 DOI: 10.1590/0037-8682-0266-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Excessive sodium consumption is associated with increased blood pressure, which is an important risk factor for non-communicable diseases (NCDs). This study therefore aimed to describe the burden of NCDs attributable to excessive sodium consumption among Brazilians. METHODS This observational study used mortality and Disability Adjusted Life Years (DALY) rates, and their respective uncertainty intervals (UI), from the Global Burden of Disease Study 2019 (GBD 2019). The burden was obtained by the population attributable fraction of each NCD, considering the minimum theoretical value of risk (intake of 0-3g of sodium/day); the excessive consumption proportion in the population, obtained through population inquiries; and the relative risks obtained through meta-analyses. RESULTS Excessive sodium consumption was the third highest dietary risk contributing to deaths (30,814; 95% UI = 2,034 - 84,130) and DALYs (699,119; 95% UI= 43,130 - 1,914,066) in 2019. States from the Northeast region had the highest age-standardized rates of deaths and DALYs, and the male population was more affected by NCDs caused by excessive sodium consumption. Cardiovascular diseases were the main contributing factors in the burden attributable to excessive sodium consumption. CONCLUSIONS Regardless of the progress in addressing NCDs related to this risk factor, the impact remains high, especially among men and in the Northeast region. More effective measures are needed to reduce sodium in industrialized products, such as health promotion actions to combat sodium consumption, in order to prevent and control NCDs in Brazil.
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Affiliation(s)
| | | | - Aline Siqueira Fogal Vegi
- Universidade Federal de Ouro Preto, Programa de Pós-Graduação em Saúde e Nutrição, Ouro Preto, MG, Brasil
| | - Adriana Lúcia Meireles
- Universidade Federal de Ouro Preto, Programa de Pós-Graduação em Saúde e Nutrição, Ouro Preto, MG, Brasil
- Universidade Federal de Ouro Preto, Departamento de Nutrição Clínica e Social, Ouro Preto, MG, Brasil
| | - Mariana Carvalho de Menezes
- Universidade Federal de Ouro Preto, Programa de Pós-Graduação em Saúde e Nutrição, Ouro Preto, MG, Brasil
- Universidade Federal de Ouro Preto, Departamento de Nutrição Clínica e Social, Ouro Preto, MG, Brasil
| | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Enfermagem, Belo Horizonte, MG, Brasil
| | - Ísis Eloah Machado
- Universidade Federal de Ouro Preto, Programa de Pós-Graduação em Saúde e Nutrição, Ouro Preto, MG, Brasil
- Universidade Federal de Ouro Preto, Departamento de Medicina de Família, Saúde Mental e Coletiva, Ouro Preto, MG, Brasil
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Oliveira GMMD, Brant LCC, Polanczyk CA, Malta DC, Biolo A, Nascimento BR, Souza MDFMD, Lorenzo ARD, Fagundes AADP, Schaan BD, Castilho FMD, Cesena FHY, Soares GP, Xavier GF, Barreto JAS, Passaglia LG, Pinto MM, Machline-Carrion MJ, Bittencourt MS, Pontes OM, Villela PB, Teixeira RA, Sampaio RO, Gaziano TA, Perel P, Roth GA, Ribeiro ALP. Estatística Cardiovascular – Brasil 2021. Arq Bras Cardiol 2022; 118:115-373. [PMID: 35195219 PMCID: PMC8959063 DOI: 10.36660/abc.20211012] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
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Graça Á, Oliveira DVD, Ribeiro AS, Lopes WA, Fiorillo RG, Fonseca HS, Mayhew JL, Nascimento MAD. Impact of resistance exercise order on postexercise hemodynamic measures in middle-aged and older women. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220020921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | - Higor Santos Fonseca
- Universidade Estadual de Maringá, Brazil; Universidade Estadual do Paraná, Brazil
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Camelo LV, Coelho CG, Chor D, Griep RH, Almeida MDCCD, Giatti L, Barreto SM. Racismo e iniquidade racial na autoavaliação de saúde ruim: o papel da mobilidade social intergeracional no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). CAD SAUDE PUBLICA 2022; 38:e00341920. [DOI: 10.1590/0102-311x000341920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
Resumo: Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.
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Rodrigues BLS, Silva RND, Arruda RGD, Silva PBC, Feitosa DKDS, Guarda FRBD. Impact of the Health Gym Program on mortality from Systemic Arterial Hypertension in Pernambuco state, Brazil. CIENCIA & SAUDE COLETIVA 2021; 26:6199-6210. [PMID: 34910010 DOI: 10.1590/1413-812320212612.32802020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022] Open
Abstract
The aim of this paper was to analyze the impact of the Health Gym Program (HGP) on the Systemic Arterial Hypertension mortality rate in Pernambuco state, Brazil. This public policy impact analysis used a quasi-experimental approach which consisted of the application of Propensity Score Matching in the years 2010 and 2017. Socioeconomic, demographic, and epidemiological data of 89 municipalities that implemented HGP (treated) and 54 that did not (controls) were collected from the Brazilian Health Data Department, Brazilian Institute of Geography and Statistics, and other databases. The impact of HGP on hypertension mortality rate was estimated through a logit model using the Kernel algorithm. Treated municipalities presented a decrease of 12.8% in global hypertension mortality rate, 12.5% in brown-skinned people and 13.1% in those over 80 years of age. The balancing test attests to the robustness of the estimated model to explain the impact of the program on mortality due to hypertension. The implementation of the program proved to be effective in decreasing the mortality rate in the treated municipalities, indicating that it seems to contribute to controlling the progress of chronic non-communicable diseases.
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Affiliation(s)
- Bárbara Letícia Silvestre Rodrigues
- Centro Acadêmico de Vitória, Universidade Federal de Pernambuco. R. Alto do Reservatório s/n, Alto José Leal. 55608-680 Vitória de Santo Antão PE
| | | | | | - Paloma Beatriz Costa Silva
- Centro Acadêmico de Vitória, Universidade Federal de Pernambuco. R. Alto do Reservatório s/n, Alto José Leal. 55608-680 Vitória de Santo Antão PE
| | - Daíze Kelly da Silva Feitosa
- Centro Acadêmico de Vitória, Universidade Federal de Pernambuco. R. Alto do Reservatório s/n, Alto José Leal. 55608-680 Vitória de Santo Antão PE
| | - Flávio Renato Barros da Guarda
- Centro Acadêmico de Vitória, Universidade Federal de Pernambuco. R. Alto do Reservatório s/n, Alto José Leal. 55608-680 Vitória de Santo Antão PE
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Guimarães MCDLP, Coelho JC, da Silva GV, Drager LF, Gengo e Silva Butcher RDC, Butcher HK, Pierin AMG. Blood Pressure Control and Adherence to Drug Treatment in Patients with Hypertension Treated at a Specialized Outpatient Clinic: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:2749-2761. [PMID: 34916785 PMCID: PMC8670885 DOI: 10.2147/ppa.s336524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate and identify variables associated with the control of hypertension and adherence to antihypertensive drug treatment in a group of patients with hypertension monitored in a specialized, highly complex outpatient service. METHODS A prospective, cross-sectional study was carried out in the hypertension unit of a tertiary teaching hospital. Patients diagnosed with hypertensive aged 18 years and over and accompanied for at least six months were included in the study. Patients with secondary hypertension and pregnant women were excluded. The sample consisted of 253 patients. Adherence/concordance to antihypertensive treatment was assessed using the Morisky Green Levine Scale. Blood pressure control was set for values less than 140/90 mmHg. Variables with p≤0.20 in univariate analysis were included in multiple logistic regression. The level of significance adopted was p ≤0.05. RESULTS Most of patients were white, married and women, with a mean age of 65 (13.3) years old, low income, and education levels. Blood pressure control and adherence were observed in 69.2% and 90.1% of the patients, respectively. Variables that were independently associated with blood pressure control were (OR, odds ratio; CI, 95% confidence interval): married marital status (OR 2.3; CI 1.34-4.28), use of calcium channel blockers (OR 0.4; CI 0.19-0.92) and number of prescribed antihypertensive drugs (OR 0.78; CI 0.66-0.92). Adherence was not associated with any of the variables studied. CONCLUSION There was a high frequency of patients with satisfactory adherence to antihypertensive drug treatment. Blood pressure control was less frequent and was associated with social and treatment-related factors.
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Affiliation(s)
| | - Juliana Chaves Coelho
- Graduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, Brazil
| | - Giovanio Vieira da Silva
- Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Luciano Ferreira Drager
- Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, SP, Brazil
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | | | - Howard K Butcher
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Angela Maria Geraldo Pierin
- Graduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, Brazil
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Benseñor IM, Junior FB, Janovsky CCPS, Marchioni D, de Fátima Haueisen Sander Diniz M, de Souza Santos I, de Almeida-Pititto B, Sgarbi JA, Del Carmen B Molina M, Mill JG, Lotufo PA. Urinary iodine and sodium concentration and thyroid status in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Trace Elem Med Biol 2021; 68:126805. [PMID: 34247033 DOI: 10.1016/j.jtemb.2021.126805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/14/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate urinary iodine concentration (UIC) in civil servants aged 35-74 years of the Brazilian Study of Adults Health (ELSA-Brasil) to analyze its relationship with sociodemographic, clinical risk factors, lifestyle, urinary Na and thyroid status. DESIGN Cross-sectional study in six Brazilian cities. METHODS This analysis included 792 participants with information about urinary iodine concentration (UIC). Thyroid status was defined by serum levels of TSH/FT4 and the current use of antithyroid drugs for treatment of overt hyperthyroidism or levothyroxine to treat overt hypothyroidism. The determination of UIC was carried out with an inductively coupled plasma mass spectrometer (ICP-MS) and was expressed as median with Interquartile Range (IQR). RESULTS In 792 participants, thereof 52% women, mean age was 51.9 (9.0) years. The median UIC was 219 (IQR, 166-291) for all persons studied, thereof 211 (IQR, 157-276) for women and 231 (IQR, 178-304) for men. According to the WHO classification, for all persons studied, 60% had more than adequate iodine-supply (UIC ≥200 μg/L), 37% were adequately supplied (UIC 100-199 μg/L) and <3% had a deficient iodine status (<100 μg/L). In the 35-44-year age strata, which includes women of childbearing age, 23.2% of women presented less than 150 μg/L of UIC. No differences in UIC were detected according to thyroid status. (P = 0.39) The correlation between Ur-Na and UIC showed a Spearman coefficient of 0.52 (P < 0.0001) and it was also found an association of Ur-Na with UIC: Beta of 1.76 (95% Confidence Interval (95% CI): 1.01 to 2.51. The urinary Na concentration showed a synergy with the UIC, that means medians of 57, 72, 107 and 141 mmol Na/L urine (P < 0.001) in the groups with the four UIC classes according to the WHO grading mentioned above. The very low Na content in the persons exhibiting <100 μg/L UIC seems to reflect also a higher urine volume due to the frequent use of diuretics. The strong relationship between the urinary Na concentration and the UIC points to a dependence of the UIC on the individual consumption of iodized salt, which should be more considered in future studies. The strong relationship between the urinary Na concentration and the UIC points to a dependence of the UIC on the individual consumption of iodized salt, which should be more considered in future studies. CONCLUSIONS Euthyroid persons were dominating by more than four fifths and no significant association was found between UIC and thyroid status. Although most of the persons studied present more than adequate iodine intake it was observed that nearly a quarter of women in childbearing age are iodine deficient.
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Affiliation(s)
- Isabela M Benseñor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
| | - Fernando Barbosa Junior
- Department of Clinical, Toxicological and Bromatological Analyzes. ASTox - Laboratory of Analytical and Systems Toxicology, Faculty of Pharmaceutical Sciences of Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Dirce Marchioni
- Department of Nutrition, School of Public Health, Faculdade de Saúde Pública, Universidade de São Paulo, Brazil.
| | | | - Itamar de Souza Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
| | | | - José Augusto Sgarbi
- Thyroid Unit, Division of Endocrinology and Metabolism, Department of Medicine, Faculdade de Medicina de Marília, São Paulo, Brazil.
| | | | | | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
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Donato TAA, Silva RMA, Andrade ACDS, Kochergin CN, Medeiros DSD, Soares DA, Louzado JA, Silva KO, Cortes ML, Mistro S, Amorim WWCC, Oliveira MGGD, Bezerra VM. [Periodic occupational examination: an opportunity for diagnosis and monitoring of chronic noncommunicable diseases in men]. CAD SAUDE PUBLICA 2021; 37:e00298320. [PMID: 34816961 DOI: 10.1590/0102-311x00298320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/15/2021] [Indexed: 11/22/2022] Open
Abstract
The study aimed to estimate the prevalence of arterial hypertension as the principal marker of chronic noncommunicable diseases (NCDs) and to identify associated modifiable factors in male workers. Baseline data were used from a longitudinal study with a sample of 1,024 male workers 18 years or older in a municipality in Northeast Brazil. The marker for NCDs was arterial hypertension, defined as systolic pressure ≥ 140mmHg and/or diastolic pressure ≥ 90mmHg and/or prior diagnosis of arterial hypertension and/or use of antihypertensive medication. Poisson regression with robust variance was used, adopting hierarchical entry of variables. Population attributable fractions (PAFs) were calculated for the lifestyle variables to measure the impact of modifiable factors on workers' health. Prevalence of hypertension was 28.6% (95%CI: 25.9-31.5). Distal factors associated with hypertension were age > 40 years, black skin color, and family income ≥ 3 times the monthly minimum wage. Intermediate factors were alcohol abuse, smoking, high self-rated salt intake, and physical inactivity. Proximal factors were overweight and obesity. Calculation of PAFs showed that a reduction or elimination of unhealthy lifestyle habits and behaviors in this population group would reduce the prevalence of the target NCD, hypertension, by 56.1%. The identification of modifiable factors and the ways they can negatively impact male workers' health allows planning interventions in the workplace itself to reach the largest number of individuals, aimed at reducing the harmful effects of NCDs.
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Affiliation(s)
| | | | | | | | | | - Daniela Arruda Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | - José Andrade Louzado
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | - Kelle Oliveira Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | - Matheus Lopes Cortes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | - Sóstenes Mistro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | | | | | - Vanessa Moraes Bezerra
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
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Bezerra TTD, Bezerra LS, Santos-Veloso MAO, Lordsleem ABDMDS, Lima SGD. Association between hyperuricemia and hypertension: a case-control study. ACTA ACUST UNITED AC 2021; 67:828-832. [PMID: 34709325 DOI: 10.1590/1806-9282.20210021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/21/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the association between hyperuricemia and systemic arterial hypertension. METHODS This was a case-control study where individuals aged >18 years were included, who were divided into hypertensive and non-hypertensive groups, excluding those with incomplete information in medical records or with the chronic kidney disease epidemiology collaboration <60 mL/min/1.73 m³. Systemic arterial hypertension was categorized as a dependent variable, while the independent variables were hyperuricemia (i.e., primary variable), sex, education, the practice of physical activity, alcoholism, smoking, diabetes mellitus, chronic kidney disease, a family history of systemic arterial hypertension, age, isolated hyperlipidemia, and mixed hyperlipidemia. Statistical analysis included the univariate and multivariate data analysis, performed by adjusting the logistic regression models using the software R (R Core Team [2018]). RESULTS Out of 103 patients evaluated, 75 patients were included in this study. In hypertensive patients, hyperuricemia was more frequent (p=0.029), being present in 18.9% individuals. In the univariate analysis, a statistically significant association was found between hyperuricemia and systemic arterial hypertension (OR 10.9; 95%CI 1.29-1420.0; p=0.023); however, in the multivariate analysis, when adjustment was made for age, the only control variable that persisted in the model, this association ceased to be significant (OR 8.5; 95%CI 0.87-1157.0; p=0.070). CONCLUSIONS There was no independent association between hyperuricemia and systemic arterial hypertension. The latter was associated with diabetes mellitus, chronic kidney disease, and age.
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Affiliation(s)
| | - Lucas Soares Bezerra
- Universidade Federal de Pernambuco, Programa de Pós-Graduação em Inovação Terapêutica - Recife (PB), Brazil
| | | | | | - Sandro Gonçalves de Lima
- Universidade Federal de Pernambuco, Hospital das Clínicas, Serviço de Cardiologia - Recife (PB), Brazil
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Lopes JAS, Giatti L, Griep RH, Lopes AADS, Matos SMA, Chor D, Fonseca MDJM, Barreto SM. Life Course Socioeconomic Position, Intergenerational Social Mobility, and Hypertension Incidence in ELSA-Brasil. Am J Hypertens 2021; 34:801-809. [PMID: 33544821 DOI: 10.1093/ajh/hpab029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Life course epidemiology is a powerful framework to unravel the role of socioeconomic position (SEP) disparities in hypertension (HTN). This study investigated whether life course SEP is associated with HTN incidence. Specifically, to test whether cumulative low SEP throughout life and unfavorable intergenerational social mobility increased HTN incidence. METHODS Longitudinal analysis of 8,754 ELSA-Brasil participants without HTN or cardiovascular in visit 1 (2008-2010). The response variable was the incidence of HTN between visits 1 and 2 (2012-2014). The explanatory variables were childhood, youth, and adulthood SEP, cumulative low SEP, and intergenerational social mobility. Associations were estimated by incidence rate ratios (IRRs) obtained by generalized linear models, with Poisson distribution and logarithmic link function, after adjustment for sociodemographic, behavioral, and health factors. RESULTS The incidence of HTN was 43.2/1,000 person-years, being higher in males, elderly (70-74 years), self-declared black, and low SEP individuals. After considering sociodemographic factors, low SEP in childhood, youth, and adulthood remained statistically associated with increased HTN incidence. Individuals in the third (IRR: 1.26; 95% confidence interval (CI): 1.11-1.44) and fourth top quartiles (IRR: 1.29; 95% CI: 1.11-1.49) of cumulative low SEP, vs. first, as well as those with low stable intergenerational trajectory (IRR: 1.29; 95% CI: 1.16-1.43), vs. high stable, also had increased HTN incidence rates. CONCLUSIONS Socioeconomic disparities at all phases of the life cycle appear to raise HTN incidence rates, being the individuals with greater accumulation of exposure to low SEP and with more unfavorable intergenerational mobility at greatest risk, even in a short follow-up time.
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Affiliation(s)
- José Aparecido Soares Lopes
- Department of Student and Community Affairs, Instituto Federal do Norte de Minas Gerais, Januária, Brazil
- Social and Preventive Department, Faculty of Medicine & Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luana Giatti
- Social and Preventive Department, Faculty of Medicine & Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Sheila Maria Alvim Matos
- Department of Collective Health, Institute of Collective Health, Universidade Federal da Bahia, Salvador, Brazil
| | - Dora Chor
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria de Jesus M Fonseca
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandhi Maria Barreto
- Social and Preventive Department, Faculty of Medicine & Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Barletta PH, Magalhães EFSD, Almeida VFD, Moreira JL, Silva MJD, Macedo C, Aras R. Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Moura AF, Moura-Neto JA, Rodrigues CIS, Miranda MO, Carvalho TC, Paschoalin Carvalho NP, Souza E, Moura-Jr JA, Cruz CMS. Resistant hypertension: Prevalence and profile of patients followed in a university ambulatory. SAGE Open Med 2021; 9:20503121211020892. [PMID: 34178337 PMCID: PMC8202308 DOI: 10.1177/20503121211020892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Hypertension affects about 36 million Brazilians. It is estimated that 10%-20% of these have resistant hypertension. These patients are at an increased risk of early target organ damage, as well as cardiovascular and renal events. OBJECTIVE To estimate the prevalence of resistant hypertension in a specialized outpatient clinic, to describe the sociodemographic and clinical characteristics of these patients, and to identify possible factors associated with resistant hypertension. METHODS Data collection from medical records of hypertensive patients treated using oral antihypertensive drugs in optimized doses at a specialized university clinic from March 2014 to December 2014, after ethical approval statement. All patients were using appropriate antihypertensive drugs in optimized doses and assisted at a teaching-assistance clinic of internal medicine of the Bahiana School of Medicine and Public Health in Brazil. RESULTS A total of 104 patients were enrolled and 31.7% (n = 33) had criteria for resistant hypertension. Of the total participants, 75.7% were female and 54.8% were black or brown. The average age was 61.7 years (SD ± 10.1). In the resistant hypertension group, 63.6% had diabetes, compared to 32.4% in the hypertension group. Among resistant hypertensive patients, 51.5% had dyslipidemia. Regarding drug treatment, 75.8% of the resistant hypertension group and 51.4% of the hypertension group used statins. Among patients with resistant hypertension, 90.9% used angiotensin II receptor blockers and 66.7%, dihydropyridine calcium channel blockers. In the resistant hypertension group, 75.8% used beta-blockers, against 25.4% in the hypertension group. CONCLUSION The prevalence of hypertension was higher than that described in the global literature, which may be associated with the high percentage of black and brown ("pardos") patients in the population studied, and also because the study was performed in a specialized outpatient clinic.
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Affiliation(s)
- Ana Flávia Moura
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - José A Moura-Neto
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Clínica de Nefrologia de Serrinha, Serrinha, Bahia, Brazil
- Clínica de Nefrologia de Juazeiro, Juazeiro, Bahia, Brazil
| | - Cibele Isaac Saad Rodrigues
- Faculdade de Ciências Médicas e da Saúde. Departamento de Clínica. Pontifícia Universidade Católica de São Paulo, São Paulo, Brazil
| | - Mariana O Miranda
- Hospital Universitário Professor Edgard Santos, UFBA, Salvador, Bahia, Brazil
| | | | - Nathalia Pereira Paschoalin Carvalho
- Clínica de Nefrologia de Serrinha, Serrinha, Bahia, Brazil
- Clínica de Nefrologia de Juazeiro, Juazeiro, Bahia, Brazil
- Clínica Senhor do Bonfim, Feira de Santana, Bahia, Brazil
| | - Edison Souza
- Hospital Universitário Pedro Ernesto, UERJ, Rio de Janeiro, Brazil, Brazil
| | - José A Moura-Jr
- Clínica de Nefrologia de Serrinha, Serrinha, Bahia, Brazil
- Clínica de Nefrologia de Juazeiro, Juazeiro, Bahia, Brazil
| | - Constança Margarida S Cruz
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil
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Coelho JS, Martinez OGE, Siqueira JH, Campos GC, Viana MC, Griep RH, Alvim RO, Mill JG, Molina MCB. Alcoholic beverage consumption, changes in blood pressure, and incidence of hypertension in the Longitudinal Adult Health Study (ELSA-Brasil). Nutrition 2021; 91-92:111387. [PMID: 34303960 DOI: 10.1016/j.nut.2021.111387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Alcohol consumption is generally associated with increased risk of hypertension. We aimed to investigate, prospectively, the effect of alcoholic-beverage consumption on blood pressure (BP) and incidence of hypertension, after a 4-y follow-up, in participants of the Longitudinal Adult Health Study (ELSA-Brasil). METHODS We analyzed information from 3,990 participants (ages 35-74 y), men and women, from educational and research institutions, at baseline (2008-2010) and follow-up (2012-2014). Socioeconomic, hemodynamic, anthropometric, and health data were collected. Hypertension was defined as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg and/or use of antihypertensive medication. Change in alcohol consumption (g/d) was estimated by subtracting total consumed at follow-up from total consumed at baseline, and was categorized in tertiles. RESULTS The consumption of alcoholic beverages was associated with changes in BP and hypertension only in men. Individuals who reduced total consumption of alcohol showed a smaller increase in systolic BP (1.1 versus 2.3 mm Hg; P = 0.03) and diastolic BP (1.3 versus 2.2 mm Hg; P = 0.008) compared to individuals who increased consumption. In addition, individuals in the highest tertiles of total consumption of alcohol (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.14-2.29) and consumption of beer (OR, 1.51; 95% CI, 1.07-12.13), wine (OR, 1.71; 95% CI, 1.01-2.86), and spirits (OR, 2.01; 95% CI, 1.21-3.32) showed higher odds ratios for hypertension compared to the lowest tertile. CONCLUSIONS Increased consumption of alcoholic beverages was positively associated with increased BP levels and higher chances of developing hypertension in men.
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Affiliation(s)
- Juliana S Coelho
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Oscar G E Martinez
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Jordana H Siqueira
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Gláucia C Campos
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Maria C Viana
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rafael O Alvim
- Department of Physiological Sciences, Federal University of Amazonas, Manaus, Brazil
| | - José G Mill
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Maria C B Molina
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil.
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Heidet M, Da Cunha T, Brami E, Mermet E, Dru M, Simonnard B, Lecarpentier E, Chollet-Xémard C, Bergeron C, Khalid M, Grunau B, Marty J, Audureau E. EMS Access Constraints And Response Time Delays For Deprived Critically Ill Patients Near Paris, France. Health Aff (Millwood) 2021; 39:1175-1184. [PMID: 32634362 DOI: 10.1377/hlthaff.2019.00842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Increased emergency medical services (EMS) response times and areas of low socioeconomic status are both associated with poorer outcomes for several time-sensitive medical conditions attended to by medical personnel before a patient is hospitalized. We evaluated the association between EMS response times, area deprivation level, and on-scene access constraints encountered by EMS in a large urban area in France. We conducted a multicenter prospective cohort study of EMS dispatches occurring in the forty-seven cities in a region southeast of Paris. We fit multilevel mixed-effects linear regression models for multivariate assessment of the predictors of EMS response times and then used multivariate logistic regression on outcomes among a subgroup of patients presenting with out-of-hospital cardiac arrest. We found evidence that access constraints were more frequently encountered by EMS in the most deprived areas compared to less deprived ones, and were associated with increased EMS response times until patient contact and with poorer outcomes from cardiac arrest. Strategies to anticipate and overcome access constraints should be implemented to improve outcomes for emergent conditions attended to by prehospital medical teams.
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Affiliation(s)
- Matthieu Heidet
- Matthieu Heidet is a physician with Service d'aide médicale urgente (SAMU) 94 and with Urgences at Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), in Créteil, France
| | - Thierry Da Cunha
- Thierry Da Cunha is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Elise Brami
- Elise Brami is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Eric Mermet
- Eric Mermet is a scientist at the Centre d'analyse et de mathématique sociales (CAMS), at the Centre national de la recherche scientifique (CNRS) and École des hautes études en sciences sociales (EHESS), in Paris, France
| | - Michel Dru
- Michel Dru is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Béatrice Simonnard
- Béatrice Simonnard is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Eric Lecarpentier
- Eric Lecarpentier is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | | | - Corinne Bergeron
- Corinne Bergeron is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Mohamed Khalid
- Mohamed Khalid is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Brian Grunau
- Brian Grunau is a physician in the Department of Emergency Medicine, University of British Columbia, in Vancouver, British Columbia, Canada
| | - Jean Marty
- Jean Marty is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP, and head of the research team Analysis of Risks in Complex Health Systems (ARCHeS), Université Paris-Est Créteil (UPEC), in Créteil, France
| | - Etienne Audureau
- Etienne Audureau is a public health physician and scientist with the research team Clinical Epidemiology and Ageing Unit (CEpiA), UPEC
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Teixeira MEF, Vitorino PVDO, Amodeo C, Martinez T, Brandão AA, Barbosa ECD, Feitosa ADM, Jardim PCBV, Souza ALL, Barroso WKS. Cardiovascular Risk Factors in Cardiology Specialists from the Brazilian Society of Cardiology. Arq Bras Cardiol 2021; 116:774-781. [PMID: 33886727 PMCID: PMC8121412 DOI: 10.36660/abc.20200125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/28/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A major cause of death worldwide, cardiovascular diseases and their prevalence in cardiologists are little known. OBJECTIVES To describe life habits and cardiovascular risk factors (CVRF) and to investigate the prevalence of diagnosis, awareness, and control of these CVRF among cardiologists members affiliated to and specialists from the Brazilian Society of Cardiology. METHODS National multicenter cross-sectional study to assess Brazilian cardiologists using a questionnaire on life habits, preexisting diseases, current medications, anthropometric measurements, blood pressure, and levels of glucose and lipids. RESULTS A total of 555 cardiologists were evaluated, of which 67.9% were male, with a mean age of 47.2±11.7 years. Most were non-smoker (88.7%) and physically active (77.1%), consumed alcohol (78.2%), had normal weight circumference (51.7%), and were overweight (56.1%). The prevalence of systemic arterial hypertension (SAH), diabetes mellitus (DM), and dyslipidemia (DLP) were 32.4%, 5.9%, and 49.7%, respectively, of which only 57.2%, 45.5%, and 49.6%, respectively, were aware of the diseases. CONCLUSIONS The Brazilian cardiologists participating in the study had a high prevalence of SAH, DM and DLP, but only a half of participants were aware of these conditions and, among these, the rates of controlled disease were low for SAH and DLP, although cardiologists are professionals with great knowledge about these CVRF. These findings represent a warning sign for the approach of CVRF in Brazilian cardiologists and encourage the conduction of future studies.
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Affiliation(s)
- Maria Emília Figueiredo Teixeira
- Universidade Federal de GoiásLiga de Hipertensão ArterialGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil.
- Universidade Federal de GoiásPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO - Brasil.
| | - Priscila Valverde de O. Vitorino
- Pontifícia Universidade Católica de GoiásEscola de Ciências Sociais e da SaúdeGoiâniaGoiásBrasilPontifícia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde, Goiânia, Goiás - Brasil.
| | - Celso Amodeo
- Universidade Federal de São PauloEscola paulista de MedicinaSão PauloSPBrasilEscola paulista de Medicina da Universidade Federal de São Paulo (Unifesp EPM), São Paulo, SP - Brasil.
| | - Tânia Martinez
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração (HCor) – Lipids, São Paulo, SP - Brasil.
| | - Andréa Araujo Brandão
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ) – Cardiologia, Rio de Janeiro, RJ - Brasil.
| | - Eduardo Costa Duarte Barbosa
- Instituto de CardiologiaLaboratório de Investigação ClínicaPorto AlegreRSBrasilInstituto de Cardiologia - Laboratório de Investigação Clínica (LIC), Porto Alegre, RS - Brasil.
| | - Audes Diógenes Magalhães Feitosa
- Universidade Federal de PernambucoLaboratório de Imunopatologia Keizo AsamiRecifePEBrasilLaboratório de Imunopatologia Keizo Asami - Universidade Federal de Pernambuco - Clínica Médica, Recife, PE - Brasil.
| | - Paulo Cesar B. Veiga Jardim
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Cardiologia, Goiânia, GO – Brasil.
| | - Ana Luiza Lima Souza
- Universidade Federal de GoiásLiga de Hipertensão ArterialGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil.
- Universidade Federal de GoiásPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO - Brasil.
| | - Weimar Kunz Sebba Barroso
- Universidade Federal de GoiásLiga de Hipertensão ArterialGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil.
- Universidade Federal de GoiásPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO - Brasil.
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40
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Camelo RM, Caram-Deelder C, Duarte BP, de Moura MCB, Costa NCDM, Costa IM, Roncal CGP, Vanderlei AM, Guimaraes TMR, Gouw S, Rezende SM, van der Bom J. Cardiovascular risk factors among adult patients with haemophilia. Int J Hematol 2021; 113:884-892. [PMID: 33677769 DOI: 10.1007/s12185-021-03104-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
Since the introduction of episodic and prophylactic treatments with safer factor concentrates, the life expectancy of people with haemophilia (PwH) has improved considerably. Ageing-related diseases such as cardiovascular disease (CVD) have also become more prevalent in PwH. This cross-sectional study aimed to evaluate CVD risk factors and estimate 10-year risk for CVD events among PwH. Male patients ≥ 30 years were interviewed and examined. Blood tests were performed at the local laboratory. Eighty-two patients were included, of whom 83% had haemophilia A and half had severe disease. Median age at study entry was 43.0 years (interquartile range [IQR], 36.0-51.3). Prevalence of obesity, systemic arterial hypertension (SAH) and diabetes mellitus were 16%, 60% and 16%, respectively. Hypertriglyceridaemia, hypercholesterolaemia and low HDL blood levels were present in 18%, 41% and 30% of patients, respectively. Metabolic syndrome was found in 37%. The Framingham Risk Score showed that 39% of PwH had a high risk of developing cardiovascular events in the following 10 years. We conclude that, in this cohort, PwH have a higher prevalence of SAH when compared with Brazilian men without haemophilia and about two-fifths have a high risk of developing a CVD event in the following 10 years.
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Affiliation(s)
- Ricardo Mesquita Camelo
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 2nd Floor, Room 255, Belo Horizonte, MG, 30130-100, Brazil. .,Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil. .,Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Camila Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Jon J Van Rood Centre for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
| | - Bruna Pontes Duarte
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | | | | | - Iris Maciel Costa
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | | | - Ana Maria Vanderlei
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | - Tania Maria Rocha Guimaraes
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil.,Faculdade de Enfermagem Nossa Senhora das Gracas, Universidade de Pernambuco, Recife, Brazil
| | - Samantha Gouw
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Paediatric Haematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Suely Meireles Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 2nd Floor, Room 255, Belo Horizonte, MG, 30130-100, Brazil
| | - Johanna van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Jon J Van Rood Centre for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
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41
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Campbell NR, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. [São Paulo call to action for the prevention and control of high blood pressure: 2020Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020]. Rev Panam Salud Publica 2021; 44:e27. [PMID: 33643393 PMCID: PMC7905737 DOI: 10.26633/rpsp.2021.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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Affiliation(s)
- Norm Rc Campbell
- Departamento de Medicina, Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde da Comunidade, Instituto O'Brien de Saúde Pública e Instituto Cardiovascular Libin de Alberta, Universidade de Calgary Alberta Canadá Departamento de Medicina, Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde da Comunidade, Instituto O'Brien de Saúde Pública e Instituto Cardiovascular Libin de Alberta, Universidade de Calgary, Calgary, Alberta, Canadá
| | - Aletta E Schutte
- Unidade de Hipertensão e Doença Cardiovascular, Equipe de Pesquisa de Hipertensão na África (HART, na sigla em inglês), Universidade Noroeste Potchefstroom África do Sul Unidade de Hipertensão e Doença Cardiovascular, Equipe de Pesquisa de Hipertensão na África (HART, na sigla em inglês), Universidade Noroeste, Potchefstroom, África do Sul
| | - Cherian V Varghese
- Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde Genebra Suíça Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde, Genebra, Suíça
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde Washington, D.C. Estados Unidos Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, D.C., Estados Unidos
| | - Xin-Hua Zhang
- Instituto Liga de Hipertensão de Pequim Pequim China Instituto Liga de Hipertensão de Pequim, Pequim, China
| | - Taskeen Khan
- Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde Genebra Suíça Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde, Genebra, Suíça
| | - James E Sharman
- Instituto Menzies para Pesquisa Médica, Universidade da Tasmânia, Hobart Tasmânia Austrália Instituto Menzies para Pesquisa Médica, Universidade da Tasmânia, Hobart, Tasmânia, Austrália
| | - Paul K Whelton
- Departamento de Epidemiologia e Medicina, Centro de Ciências da Saúde da Universidade de Tulane Nova Orleans Estados Unidos Departamento de Epidemiologia e Medicina, Centro de Ciências da Saúde da Universidade de Tulane, Nova Orleans, Estados Unidos
| | - Gianfranco Parati
- Departamento de Medicina e Cirurgia, Universidade de Milão-Bicocca e Departamento de Ciências Cardiovasculares, Neurais e Metabólicas, e Instituto Auxológico Italiano, IRCCS, Hospital San Luca Milão Itália Departamento de Medicina e Cirurgia, Universidade de Milão-Bicocca e Departamento de Ciências Cardiovasculares, Neurais e Metabólicas, e Instituto Auxológico Italiano, IRCCS, Hospital San Luca, Milão, Itália
| | - Michael A Weber
- Divisão de Medicina Cardiovascular, Universidade Estadual de Nova York, Centro Médico Downstate, Brooklyn Nova York Estados Unidos Divisão de Medicina Cardiovascular, Universidade Estadual de Nova York, Centro Médico Downstate, Brooklyn, Nova York, Estados Unidos
| | - Marcelo Orías
- Sanatorio Allende, y Universidade Nacional de Córdoba Córdoba Argentina Sanatorio Allende, y Universidade Nacional de Córdoba, Córdoba, Argentina
| | - Marc G Jaffe
- Resolve to Save Lives, Uma Iniciativa da Vital Strategies, Nova York, Estados Unidos e Kaiser Permanente do Norte da Califórnia, South San Francisco Califórnia Estados Unidos Resolve to Save Lives, Uma Iniciativa da Vital Strategies, Nova York, Estados Unidos e Kaiser Permanente do Norte da Califórnia, South San Francisco, Califórnia, Estados Unidos
| | - Andrew E Moran
- Controle Mundial de Hipertensão, Resolve to Save Lives, Uma iniciativa da Vital Strategies Nova York Estados Unidos Controle Mundial de Hipertensão, Resolve to Save Lives, Uma iniciativa da Vital Strategies, Nova York, Estados Unidos
| | - Frida Liane Plavnik
- Grupo de Hipertensão, Hospital Alemão Oswaldo Cruz; Instituto do Coração (InCor); Sociedade Brasileira de Hipertensão São Paulo Brasil Grupo de Hipertensão, Hospital Alemão Oswaldo Cruz; Instituto do Coração (InCor); Sociedade Brasileira de Hipertensão, São Paulo, Brasil
| | - Venkata S Ram
- Escola de Medicina Sudoeste da Universidade do Texas, Dallas, Estados Unidos; Faculdade de Medicina e Hospitais Apollo Hyderabad Índia Escola de Medicina Sudoeste da Universidade do Texas, Dallas, Estados Unidos; Faculdade de Medicina e Hospitais Apollo, Hyderabad, Índia; Universidade Macquarie, Faculdade de Medicina e Ciências da Saúde, Sydney, Austrália; Liga Mundial de Hipertensão, Escritório Regional do Sudeste Asiático, Hyderabad, Índia
| | - Michael Brainin
- Universidade do Danúbio Krems Áustria Universidade do Danúbio, Krems, Áustria
| | - Mayowa O Owolabi
- Centro de Excelência para Doenças Não Transmissíveis da Aliança de Universidades de Pesquisa Africana Universidade de Ibadan Nigéria Centro de Excelência para Doenças Não Transmissíveis da Aliança de Universidades de Pesquisa Africana, Universidade de Ibadan, Nigéria
| | - Agustin J Ramirez
- Unidade de Hipertensão Arterial e Doenças Metabólicas, Hospital Universitário, Fundação Favaloro Buenos Aires Argentina Unidade de Hipertensão Arterial e Doenças Metabólicas, Hospital Universitário, Fundação Favaloro, Buenos Aires, Argentina
| | - Eduardo Barbosa
- Sociedade Latino-americana de Hipertensão Porto Alegre Brasil Sociedade Latino-americana de Hipertensão, Porto Alegre, Brasil
| | - Luiz Aparecido Bortolotto
- Hospital das Clínicas da Universidade de São Paulo; Instituto do Coração (InCor); e Sociedade Brasileira de Hipertensão São Paulo Brasil Hospital das Clínicas da Universidade de São Paulo; Instituto do Coração (InCor); e Sociedade Brasileira de Hipertensão, São Paulo, Brasil
| | - Daniel T Lackland
- Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul Charleston Estados Unidos Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul, Charleston, Estados Unidos
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42
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Campbell NRC, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. [São Paulo call to action for the prevention and control of high blood pressure: 2020Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial: 2020]. Rev Panam Salud Publica 2021; 45:e26. [PMID: 33643404 PMCID: PMC7905751 DOI: 10.26633/rpsp.2021.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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Affiliation(s)
- Norm RC Campbell
- Departamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud de la Comunidad, Instituto O’Brien para Salud Pública e Instituto Cardiovascular Libin de Alberta, Universidad de CalgaryCalgary, AlbertaCanadáDepartamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud de la Comunidad, Instituto O’Brien para Salud Pública e Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Alberta, Canadá
| | - Aletta E Schutte
- Unidad para la Hipertensión y las Enfermedades Cardiovasculares, Equipo de Investigación de la Hipertensión en África (HART), Universidad NoroccidentalPotchefstroomSudáfricaUnidad para la Hipertensión y las Enfermedades Cardiovasculares, Equipo de Investigación de la Hipertensión en África (HART), Universidad Noroccidental, Potchefstroom, Sudáfrica
| | - Cherian V Varghese
- Departamento de Enfermedades no Transmisibles, Organización Mundial de la SaludGinebraSuizaDepartamento de Enfermedades no Transmisibles, Organización Mundial de la Salud, Ginebra, Suiza
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la SaludWashington, D.C.Estados UnidosDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos
| | - Xin-Hua Zhang
- Instituto de la Liga de Beijing contra la HipertensiónBeijingChinaInstituto de la Liga de Beijing contra la Hipertensión, Beijing, China
| | - Taskeen Khan
- Departamento de Enfermedades no Transmisibles, Organización Mundial de la SaludGinebraSuizaDepartamento de Enfermedades no Transmisibles, Organización Mundial de la Salud, Ginebra, Suiza
| | - James E Sharman
- Instituto Menzies de Investigación Médica, Universidad de TasmaniaHobartTasmaniaAustraliaInstituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Tasmania, Australia
| | - Paul K Whelton
- Departamentos de Epidemiología y Medicina, Centro de Ciencias Médicas de la Universidad de TulaneNueva OrleansEstados UnidosDepartamentos de Epidemiología y Medicina, Centro de Ciencias Médicas de la Universidad de Tulane, Nueva Orleans, Estados Unidos
| | - Gianfranco Parati
- Departamento de Medicina y Cirugía, Universidad de Milán-Bicocca, y Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Instituto Auxológico Italiano, IRCCS, Hospital San LucaMilánItaliaDepartamento de Medicina y Cirugía, Universidad de Milán-Bicocca, y Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Instituto Auxológico Italiano, IRCCS, Hospital San Luca, Milán, Italia
| | - Michael A Weber
- División de Medicina Cardiovascular, Universidad Estatal de Nueva York, Centro Médico DownstateBrooklynNueva YorkEstados UnidosDivisión de Medicina Cardiovascular, Universidad Estatal de Nueva York, Centro Médico Downstate, Brooklyn, Nueva York, Estados Unidos
| | - Marcelo Orías
- Sanatorio Allende, y Universidad Nacional de CórdobaCórdobaArgentinaSanatorio Allende, y Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marc G Jaffe
- Resolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos y Kaiser Permanente de California del Norte, San Francisco meridionalCaliforniaEstados UnidosResolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos y Kaiser Permanente de California del Norte, San Francisco meridional, California, Estados Unidos
| | - Andrew E Moran
- Control Mundial de la Hipertensión, Resolve to Save Lives, una iniciativa de Vital StrategiesNueva YorkEstados UnidosControl Mundial de la Hipertensión, Resolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos
| | - Frida Liane Plavnik
- Grupo de Hipertensión, Hospital Alemão Oswaldo Cruz; e Instituto del Corazón (InCor); y Sociedad Brasileña de HipertensiónSan PabloBrasilGrupo de Hipertensión, Hospital Alemão Oswaldo Cruz; e Instituto del Corazón (InCor); y Sociedad Brasileña de Hipertensión, San Pablo, Brasil)
| | - Venkata S Ram
- Escuela de Medicina Sudoeste de la Universidad de Texas, Estados Unidos; Colegio Médico y Hospital ApolloHyderabadIndiaFacultad de Medicina y Ciencias de la Salud de la Universidad de MacquarieSydneyAustraliaOficina Regional de Asia Meridional de la Liga Mundial de la HipertensiónHyderabadIndiaEscuela de Medicina Sudoeste de la Universidad de Texas, Estados Unidos; Colegio Médico y Hospital Apollo, Hyderabad, India; Facultad de Medicina y Ciencias de la Salud de la Universidad de Macquarie, Sydney, Australia; Oficina Regional de Asia Meridional de la Liga Mundial de la Hipertensión, Hyderabad, India
| | - Michael Brainin
- Universidad del DanubioKremsAustriaUniversidad del Danubio, Krems, Austria
| | - Mayowa O Owolabi
- Centro de Excelencia de las Universidades Africanas de Investigación sobre las Enfermedades no TransmisiblesUniversidad de IbadanNigeriaCentro de Excelencia de las Universidades Africanas de Investigación sobre las Enfermedades no Transmisibles, Universidad de Ibadan, Nigeria
| | - Agustin J Ramirez
- Unidad de Hipertensión Arterial y Enfermedades Metabólicas, Hospital Universitario, Fundación FavaloroBuenos AiresArgentinaUnidad de Hipertensión Arterial y Enfermedades Metabólicas, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Eduardo Barbosa
- Sociedad Latinoamericana de la Hipertensión, Artery LatamPorto AlegreBrasilSociedad Latinoamericana de la Hipertensión, Artery Latam, Porto Alegre, Brasil
| | - Luiz Aparecido Bortolotto
- Hospital de Clínicas, Universidad de San Pablo; Instituto del Corazón; y Sociedad Brasileña de HipertensiónSan PabloBrasilHospital de Clínicas, Universidad de San Pablo; Instituto del Corazón; y Sociedad Brasileña de Hipertensión, San Pablo, Brasil
| | - Daniel T Lackland
- División de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, CharlestonCarolina del SurEstados UnidosDivisión de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, Charleston, Carolina del Sur, Estados Unidos
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Hoshi RA, Santos IS, Dantas EM, Andreão RV, Mill JG, Lotufo PA, Bensenor I. Reduced heart-rate variability and increased risk of hypertension-a prospective study of the ELSA-Brasil. J Hum Hypertens 2021; 35:1088-1097. [PMID: 33462386 DOI: 10.1038/s41371-020-00460-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 01/14/2023]
Abstract
Although autonomic disturbances are known to precede hypertension onset, the risks underlying different ranges of blood pressure and impaired cardiac autonomic modulation are still unknown. This study aimed to identify the risk of hypertension incidence related to low heart-rate variability profile in normotensive blood pressure subcategories: normal (<120/80 mmHg) and prehypertension (120/80-139/89 mmHg) in a 4-year follow-up. 7665 participants free of hypertension at baseline were examined. They were allocated into one of two groups (<P25 and ≥P25) based on age-specific value distributions of heart-rate variability ranges presented in the literature. The relationship between heart-rate variability parameters (SDNN, RMSSD, VLF, LF, and HF) and hypertension incidence was analyzed using Poisson regression. The reference for the independent variable in these regressions was the dataset with all HRV values ≥P25. After full adjustments for age, sex, ethnicity, educational level, body mass index, smoking status, glucose, insulin, dyslipidemia, alcohol consumption, and physical activity, low values for all heart-rate variability indices were significantly associated with an increased relative risk of developing hypertension in the overall sample. Individuals with normal BP levels presented an increased risk for low SDNN, VLF, and LF values, whereas the risk in prehypertensive participants was only verified for low VLF. In conclusion, cardio autonomic disturbances precede the incidence of clinical hypertension and are potentially involved in its pathophysiological basis and progression. Even individuals with normal blood pressure may be at an increased risk for future hypertension in the presence of reduced cardio autonomic control.
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Affiliation(s)
- Rosangela A Hoshi
- Center for Clinical and Epidemiological Research of the University Hospital, University of Sao Paulo, São Paulo, São Paulo, Brazil.
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research of the University Hospital, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Eduardo M Dantas
- Department of Biological Sciences, Federal University of Vale do Sao Francisco, Petrolina, Pernambuco, Brazil
| | - Rodrigo V Andreão
- Department of Electrical Engineering, Federal Institute of Espirito Santo, Vitoria, Espírito Santo, Brazil
| | - José G Mill
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitoria, Espírito Santo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research of the University Hospital, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Isabela Bensenor
- Center for Clinical and Epidemiological Research of the University Hospital, University of Sao Paulo, São Paulo, São Paulo, Brazil
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Samelli AG, Santos IS, Padilha FYOMM, Gomes RF, Moreira RR, Rabelo CM, Matas CG, Bensenor IM, Lotufo PA. Hearing loss, tinnitus, and hypertension: analysis of the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Clinics (Sao Paulo) 2021; 76:e2370. [PMID: 33787654 PMCID: PMC7978663 DOI: 10.6061/clinics/2021/e2370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/03/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the association among hypertension, tinnitus, and sensorineural hearing loss and evaluate the influence of other covariates on this association. METHODS Baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were analyzed. Altogether, 900 participants were evaluated. The baseline assessment consisted of a 7-hour examination to obtain clinical and laboratory variables. Hearing was measured using pure-tone audiometry. RESULTS Overall, 33.3% of the participants had hypertension. Participants with hypertension were more likely to be older, male, and diabetic compared to those without hypertension. The prevalence of tinnitus was higher among hypertensive participants and the odds ratio for tinnitus was higher in participants with hypertension than in those without hypertension. However, the difference was not significant after adjusting for age. Audiometric results at 250-8,000 Hz were worse in participants with hypertension than in those without hypertension in the crude analysis; however, the differences were not significant after adjustment for age, sex, diagnosis of diabetes, and exposure to noise. No significant difference was observed in hearing thresholds among participants having hypertension for <6 years, those having hypertension for ≥6 years, and individuals without hypertension. CONCLUSION Hearing thresholds were worse in participants with hypertension. However, after adjusting for age, sex, diagnosis of diabetes, and exposure to noise, no significant differences were observed between participants with and without hypertension. A higher prevalence of tinnitus was observed in participants with hypertension compared to those without hypertension, but without significance after adjusting for age.
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Affiliation(s)
- Alessandra Giannella Samelli
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Itamar Souza Santos
- Centro de Pesquisa Clinica e Epidemiologica, Hospital Universitario, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Clinica Medica, Faculdade de Medicina (FMUSP) e Hospital Universitario, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Raquel Fornaziero Gomes
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Camila Maia Rabelo
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carla Gentile Matas
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Isabela M. Bensenor
- Centro de Pesquisa Clinica e Epidemiologica, Hospital Universitario, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Clinica Medica, Faculdade de Medicina (FMUSP) e Hospital Universitario, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo A. Lotufo
- Centro de Pesquisa Clinica e Epidemiologica, Hospital Universitario, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Clinica Medica, Faculdade de Medicina (FMUSP) e Hospital Universitario, Universidade de Sao Paulo, Sao Paulo, SP, BR
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45
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Paula DP, Lopes LJ, Mill JG, Fonseca MJM, Griep RH. Identifying patterns of diurnal blood pressure variation among ELSA-Brasil participants. J Clin Hypertens (Greenwich) 2020; 22:2315-2324. [PMID: 33017521 DOI: 10.1111/jch.14066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) is the gold standard method for the diagnosis of hypertension. ABPM provides a set of repeated measurements for blood pressure (BP), usually over 24 h. Traditional approaches characterize diurnal BP variation by single ABPM parameters such as average and standard deviation, regardless of the temporal nature of the data. In this way, information about the pattern of diurnal BP variation and relationship between parameters is lost. The objective of this study was to identify and characterize daily BP patterns considering the set of repeated measures from 24-h ABPM. A total of 859 adult participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) performed a 24-h ABPM record. Hypertension, sex, age, race/color, education, marital status, smoking, alcohol, physical activity, and BMI were the covariables analyzed. Techniques for longitudinal clustering, multinomial models, and models with mixed effects were used. Three daily BP patterns were identified. Daily BP patterns with high BP presented higher standard deviation and morning surge and lower nocturnal dipping. They showed greater systolic BP variability and faster rise than fall in diastolic BP during sleep. Hypertensive, "pardos," and men had greater odds to present these patterns. Daily BP patterns with high BP presented the worst profile concerning ABPM parameters associated with cardiovascular risk. The daily BP patterns identified contribute to the characterization of diurnal BP variation.
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Affiliation(s)
- Daniela P Paula
- National School of Statistical Sciences, Brazilian Institute of Geography and Statistics, Rio de Janeiro, Brazil
| | - Leidjaira J Lopes
- Department of Nutrition and Health, Federal University of Viçosa, Minas Gerais, Brazil
| | - José G Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Maria J M Fonseca
- Department of Epidemiology, National School of Public Health (ENSP/Fiocruz), Rio de Janeiro, Brazil
| | - Rosane H Griep
- Health and Environmental Education Laboratory, Oswaldo Cruz Institute (IOC/Fiocruz), Rio de Janeiro, Brazil
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Luz TCD, Cattafesta M, Petarli GB, Meneghetti JP, Zandonade E, Bezerra OMDPA, Salaroli LB. Cardiovascular risk factors in a Brazilian rural population. CIENCIA & SAUDE COLETIVA 2020; 25:3921-3932. [PMID: 32997024 DOI: 10.1590/1413-812320202510.36022018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/22/2019] [Indexed: 01/22/2023] Open
Abstract
Given the extensive costs due to cardiovascular diseases and the increased prevalence of these diseases in farmers, this study aims to estimate the prevalence of cardiovascular risk factors in this population and to evaluate their associated factors. A cross-sectional study was carried out involving 790 farmers from the municipality of Santa Maria de Jetibá-ES, Brazil. Six out of ten evaluated farmers had at least one cardiovascular risk factor (CRF). High blood pressure was the most prevalent risk factor in 35.8% (95%CI 32-39, n = 283) followed by dyslipidemia (34.4%, 95%CI 31-38, n = 272). Those aged more than 50 years were 5.6 times (95%CI 2.03-15.43) more likely to evidence two or more CRFs. High waist circumference or tricipital skinfold indicating overweight increased 2.35 times (95%CI 1.47-3.76) and 1.6 times (95%CI 1.05-2.44) this likelihood, respectively. These findings reveal the high prevalence of CRF in rural workers and the significant impact of age and the accumulation of body fat in the development of these factors, showing the need to intensify public health policies geared to this population.
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Affiliation(s)
- Tamires Conceição da Luz
- Universidade Federal do Espírito Santo. Av. Fernando Ferrari 514, Goiabeiras. 29075-910 Vitória ES Brasil.
| | - Monica Cattafesta
- Universidade Federal do Espírito Santo. Av. Fernando Ferrari 514, Goiabeiras. 29075-910 Vitória ES Brasil.
| | - Glenda Blaser Petarli
- Universidade Federal do Espírito Santo. Av. Fernando Ferrari 514, Goiabeiras. 29075-910 Vitória ES Brasil.
| | - João Paulo Meneghetti
- Universidade Federal do Espírito Santo. Av. Fernando Ferrari 514, Goiabeiras. 29075-910 Vitória ES Brasil.
| | - Eliana Zandonade
- Universidade Federal do Espírito Santo. Av. Fernando Ferrari 514, Goiabeiras. 29075-910 Vitória ES Brasil.
| | | | - Luciane Bresciani Salaroli
- Universidade Federal do Espírito Santo. Av. Fernando Ferrari 514, Goiabeiras. 29075-910 Vitória ES Brasil.
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Hasan MM, Tasnim F, Tariqujjaman M, Ahmed S, Cleary A, Mamun A. Examining the prevalence, correlates and inequalities of undiagnosed hypertension in Nepal: a population-based cross-sectional study. BMJ Open 2020; 10:e037592. [PMID: 33004393 PMCID: PMC7534699 DOI: 10.1136/bmjopen-2020-037592] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal. DESIGN This study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured. SETTING Nepal. PARTICIPANTS Adult patients with hypertension. RESULTS Among 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=-0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces. CONCLUSIONS Undiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden.
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Affiliation(s)
- Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, Queensland, Australia
| | - Fariha Tasnim
- Maternal and Child Health DIvision, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tariqujjaman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayem Ahmed
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Anne Cleary
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, Queensland, Australia
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Nascimento BR, Brant LCC, Yadgir S, Oliveira GMM, Roth G, Glenn SD, Mooney M, Naghavi M, Passos VMA, Duncan BB, Silva DAS, Malta DC, Ribeiro ALP. Trends in prevalence, mortality, and morbidity associated with high systolic blood pressure in Brazil from 1990 to 2017: estimates from the "Global Burden of Disease 2017" (GBD 2017) study. Popul Health Metr 2020; 18:17. [PMID: 32993676 PMCID: PMC7526365 DOI: 10.1186/s12963-020-00218-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension remains the leading risk factor for cardiovascular disease (CVD) worldwide, and its impact in Brazil should be assessed in order to better address the issue. We aimed to describe trends in prevalence and burden of disease attributable to high systolic blood pressure (HSBP) among Brazilians ≥ 25 years old according to sex and federal units (FU) using the Global Burden of Disease (GBD) 2017 estimates. Methods We used the comparative risk assessment developed for the GBD study to estimate trends in attributable deaths and disability-adjusted life-years (DALY), by sex, and FU for HSBP from 1990 to 2017. This study included 14 HSBP-outcome pairs. HSBP was defined as ≥ 140 mmHg for prevalence estimates, and a theoretical minimum risk exposure level (TMREL) of 110–115 mmHg was considered for disease burden. We estimated the portion of deaths and DALYs attributed to HSBP. We also explored the drivers of trends in HSBP burden, as well as the correlation between disease burden and sociodemographic development index (SDI). Results In Brazil, the prevalence of HSBP is 18.9% (95% uncertainty intervals [UI] 18.5–19.3%), with an annual 0.4% increase rate, while age-standardized death rates attributable to HSBP decreased from 189.2 (95%UI 168.5–209.2) deaths to 104.8 (95%UI 94.9–114.4) deaths per 100,000 from 1990 to 2017. In spite of that, the total number of deaths attributable to HSBP increased 53.4% and HSBP raised from 3rd to 1st position, as the leading risk factor for deaths during the period. Regarding total DALYs, HSBP raised from 4th in 1990 to 2nd cause in 2017. The main driver of change of HSBP burden is population aging. Across FUs, the reduction in the age-standardized death rates attributable to HSBP correlated with higher SDI. Conclusions While HSBP prevalence shows an increasing trend, age-standardized death and DALY rates are decreasing in Brazil, probably as results of successful public policies for CVD secondary prevention and control, but suboptimal control of its determinants. Reduction was more significant in FUs with higher SDI, suggesting that the effect of health policies was heterogeneous. Moreover, HSBP has become the main risk factor for death in Brazil, mainly due to population aging.
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Affiliation(s)
- Bruno Ramos Nascimento
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. .,Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Belo Horizonte, MG, Brazil.
| | - Luísa Campos Caldeira Brant
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Belo Horizonte, MG, Brazil
| | - Simon Yadgir
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Gregory Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Scott Devon Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Meghan Mooney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Bruce Bartholow Duncan
- Programa de Pós-graduação em Epidemiologia e Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Diego Augusto Santos Silva
- Federal University of Santa Catarina, Research Center in Kinanthropometry and Human Performance, Florianópolis, SC, Brazil
| | - Deborah Carvalho Malta
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Ministério da Saúde, Brasília, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Belo Horizonte, MG, Brazil
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Nishijima M, Sarti FM, Schor A. Results of primary health care intervention for prevention of hospitalizations and mortality due to hypertension in Brazil, 2000–2015. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01020-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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50
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Miranda AM, Goulart AC, Benseñor IM, Lotufo PA, Marchioni DM. Coffee consumption and risk of hypertension: A prospective analysis in the cohort study. Clin Nutr 2020; 40:542-549. [PMID: 32576389 DOI: 10.1016/j.clnu.2020.05.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Coffee is one of the most widely consumed beverages around the world. Dietary habits, specifically, coffee consumption has long been a suspected cause of hypertension. However, previous findings on coffee consumption and its association with the incidence of hypertension are not homogeneous and still inconsistent. PURPOSE To examine the association of habitual coffee consumption with the risk of developing hypertension in a middle-aged Brazilian cohort. METHODS Data were from the multicenter prospective cohort "Brazilian Longitudinal Study for Adult Health - ELSA-Brasil". The cohort comprises 15,105 civil servants, aged 35-74 years at baseline, who were sampled from universities located in six Brazilian cities. For the present study, we analyzed data from 8780 participants initially free of hypertension during a mean follow-up of 3.9 years. The consumption of coffee was obtained at baseline using a previously validated semi-quantitative food frequency questionnaire (FFQ). Subsequently coffee intake was categorized into four categories (cups/day): never/almost never, ≤1, 1-3, and >3. Hypertension status was defined as a systolic blood pressure ≥140 mmHg or a diastolic blood pressure ≥90 mmHg, use of antihypertensive drug treatment, or both. Poisson regression model with a robust variance was performed to estimate relative risk (RR) and confidence interval (95% CI) for hypertension according to baseline coffee consumption. The effect of interaction between coffee consumption and smoking status was assessed. RESULTS Most participants (90%) drank coffee, and the median total coffee intake was 150 mL/day. A total of 1285 participants developed hypertension. Compared to participants who never or almost never drink coffee, the risk of hypertension was lower for individuals consuming 1-3 cups/day (RR 0.82, 95% CI: 0.68-0.97) (P for interaction=0.018). After stratification by smoking status the analysis revealed a decreased risk of hypertension in never smokers drinking 1-3 cups of coffee per day (RR 0.79, 95% CI: 0.64-0.98), whereas the hypertension risk among former and current smokers was not associated with coffee consumption significantly. Moreover, upper category of coffee drinking (>3 cups/day) the association was not significant for risk of hypertension. CONCLUSION The association between coffee consumption and incidence of hypertension was related to smoking status. The beneficial effect of moderate coffee intake (1-3 cups/day) on risk of hypertension was observed only in never smokers.
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Affiliation(s)
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, SP, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, SP, Brazil; School of Medicine, University of São Paulo, SP, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, SP, Brazil; School of Medicine, University of São Paulo, SP, Brazil
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