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Muhammed H, Misra DP, Jain N, Ganguly S, Pattanaik SS, Rai MK, Anuja AK, Mohindra N, Kumar S, Agarwal V. The comparison of cardiovascular disease risk prediction scores and evaluation of subclinical atherosclerosis in rheumatoid arthritis: a cross-sectional study. Clin Rheumatol 2022; 41:3675-3686. [PMID: 36006556 DOI: 10.1007/s10067-022-06349-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/28/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Primary objectives estimated prevalence of traditional cardiovascular disease (CVD) risk factors and compared different CVD risk prediction algorithms in an Indian rheumatoid arthritis (RA) population. Secondary objectives evaluated associations between carotid intima-media thickness (CIMT) and subclinical atherosclerosis (SCA) with CVD risk factors and CVD risk scores. METHODS The presence of CVD risk factors were recorded, and 10-year CVD risk was predicted using Framingham risk scoring (FRS) using lipids (FRS-Lipids), FRS using body mass index (FRS-BMI), QRISK-2, SCORE, and the algorithm recommended by ACC/AHA (ASCVD). CIMT was measured on the far-wall of the common carotid artery. Subclinical atherosclerosis was defined as CIMT > 0.9 mm or the presence of carotid plaque. RESULTS A total of 332 patents were enrolled, 12% had diabetes mellitus, 21.4% hypertension, and 6.9% were current/past smokers. Proportions of RA with predicted 10-year CVD risk > 10% varied from 16.2 to 41.9% between scores. Highest magnitude of risk was predicted by FRS-BMI. Agreement between scores in predicting risk was moderate in general. Mean CIMT was 0.70 ± 0.15 mm. Age, male sex, and extra-articular manifestations associated with greater CIMT. All risk scores except SCORE moderately correlated with CIMT. About one-seventh had SCA defined as CIMT > 0.9 mm or the presence of carotid plaques, associated with increasing age, male gender, or higher ratio of total cholesterol to high-density lipoprotein cholesterol. ASCVD and QRISK-2 scores had maximum area under curve for distinguishing SCA. CONCLUSION Individual CVD risk scores predict 10-year CVD risk differently in Indian patients with RA, and require validation for predicting hard end points (CVD events, mortality). Key Points • Diabetes mellitus and hypertension are the most prevalent cardiovascular disease risk factors in Indian patients with RA. • Individual cardiovascular risk prediction scores predict risk differently in Indian patients with RA, highest risk being predicted by the FRS-BMI. • Carotid intima-media thickness in RA associated with increasing age, male sex and extra-articular manifestations. • 14% RA had subclinical atherosclerosis, associated with increasing age, male sex, and higher total cholesterol to HDL-C ratio, best distinguished by ASCVD and QRISK-2 scores.
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Affiliation(s)
- Hafis Muhammed
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Neeraj Jain
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sujata Ganguly
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sarit Sekhar Pattanaik
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohit K Rai
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anamika Kumari Anuja
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Namita Mohindra
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Thakre S, Anjankar A, Singh A, Kumar T. National Hypertension Guidelines: A Review of the India Hypertension Control Initiative (IHCI) and Future Prospects. Cureus 2022; 14:e27997. [PMID: 36134089 PMCID: PMC9469808 DOI: 10.7759/cureus.27997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/14/2022] [Indexed: 11/05/2022] Open
Abstract
Hypertension is a silent killer; however, the treatment of hypertension is simple, effective, readily available, and needs to be continued lifelong. It is a significant health problem that is included under the umbrella of non-communicable disease conditions and has a strong alliance with cardiovascular morbidity and mortality. The India Hypertension Control Initiative (IHCI) is an extensive program in India that involves the Indian Council of Medical Research, the Ministry of Health and Family Welfare (Government of India), the state governments of India, and World Health Organization Country Office for India (WHO-India). The IHCI is a multi-partner initiative carried forward systemically across various states. The states are categorized into Grade I and Grade II. There is the involvement of specialized teams of cardiovascular experts and health officials to insure precise execution and seamless healthcare service. The implementation of the free and easy-to-use mobile application and software, Simple (Resolve to Save Lives, New York City, United States), in the analysis and storage of data, is a novel step taken to insure safe record keeping and follow-ups. Emphasis is on the adoption of demography-specific interventional methods and drugs, and proper acquisition and storage of these drugs is the key step. Treatment modalities involve the adoption of medicines and lifestyle modifications as a combined recipe. Advancements have been made in the area of drug development like gene therapies but they seem to show low success rates at the given moment. Adoption of lifestyle modifications along with medications is the gold standard treatment option. This review article aims to shed light on the current status of IHCI, its milestones, and the future of the initiative in India.
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Ross S, Chadha K, Mishra S, Lewington S, Shepperd S, Gathani T. The burden of risk factors for non-communicable disease in rural Bihar, India: a comparative study with national health surveys. BMC Public Health 2022; 22:1538. [PMID: 35962330 PMCID: PMC9375264 DOI: 10.1186/s12889-022-13818-1] [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: 04/21/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of non-communicable diseases (NCDs) is increasing in rural India. The National Family Health Survey-5 (NFHS-5) provides estimates of the burden of NCDs and their risk factors in women aged 15-49 and men aged 15-54 years. The aim of this study is to estimate the prevalence of hypertension and body-mass index (BMI) in adults aged 35-70 years in rural India and to compare these estimates, where age ranges overlap, to routinely available data. METHODS The Non-Communicable Disease in Rural India (NCDRI) Study was a cross-sectional household survey of 1005 women and 1025 men aged 35-70 conducted in Bihar in July 2019. Information was collected on personal characteristics, self-reported medical history and physical measurements (blood pressure, height and weight). Prevalence estimates for hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or diagnosed and treated for hypertension), and for underweight (body-mass index < 18.5 kg/m2), normal weight (18.5-25.0 kg/m2) and overweight (≥ 25.0 kg/m2) were calculated. Where age ranges overlapped, estimates from the NCDRI Study were compared to the NFHS-5 Survey. RESULTS In the NCDRI Study, the estimated prevalence of hypertension was 27.3% (N = 274) in women and 27.6% (N = 283) in men aged 35-70, which was three-times higher in women and over two-times higher in men than in the NFHS-5 Survey. One-quarter (23.5%; N = 236) of women and one-fifth (20.2%; N = 207) of men in the NCDRI Study were overweight, which was approximately 1.5 times higher than in the NFHS-5 Survey. However, where age groups overlapped, similar age-standardized estimates were obtained for hypertension and weight in both the NCDRI Study and the NFHS-5 Survey. CONCLUSION The prevalence of NCDs in rural India is higher than previously reported due to the older demographic in our survey. Future routine national health surveys must widen the age range of participants to reflect the changing disease profile of rural India, and inform the planning of health services.
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Affiliation(s)
- Stephanie Ross
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | | | | | - Sarah Lewington
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Sasha Shepperd
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Toral Gathani
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK. .,Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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104
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Kayaroganam R, Sarkar S, Satheesh S, Tamilmani S, Sivanantham P, Kar SS. Profile of Non-communicable disease risk factors among nurses in a tertiary care hospital in South India. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:S1976-1317(22)00035-4. [PMID: 35952959 DOI: 10.1016/j.anr.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The work nature of nurses and the associated lifestyle changes put them at high risk of developing non-communicable diseases (NCDs). This study was conducted to estimate the prevalence of NCD risk factors among nurses working in a tertiary care hospital in Puducherry and to determine the associated factors among nurses. METHODS We conducted a cross-sectional study among all nurses (N=1217) in the tertiary care hospital aged between 21 and 60 from May 2019 to April 2020. We assessed NCDs behavioral, physical and biochemical risk factors using a self-administered questionnaire. The adjusted prevalence ratio was calculated using a generalized linear regression model to determine factors associated with NCD risk factors. RESULTS The response rate was 99% (1217/1229), and 77.5 % of the participants were women. Current tobacco use, and alcohol consumption were 1.5% (95% CI: 0.8-2.2) and 2.9% (95% CI: 2-3.9) respectively with significantly higher prevalence among men. Overweight or Obesity (BMI >23 kg/m2) was 77.7%, with a significantly higher prevalence among those aged ≥30 and married. Prevalence of hypertension was 14.4 % (95% CI: 12.5-16.4), and diabetes mellitus was 11.5 % (95% CI: 9.7-13.6) were significantly higher among those aged ≥50 years. One-third of nurses, 34.3% (95% CI: 31.6-37.1), had hypercholesterolemia, significantly higher among men. CONCLUSION We found a high prevalence of various NCD risk factors among the nurses. We highlight the urgent need for initiating health promotion interventions, especially to improve intake of healthy diet and physical activity among nurses aged ≥30 years.
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Affiliation(s)
- Rajarajan Kayaroganam
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Santhi Tamilmani
- Department of Nursing Services, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Parthibane Sivanantham
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu S Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
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105
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Urban-rural differences in hypertension prevalence in low-income and middle-income countries, 1990-2020: A systematic review and meta-analysis. PLoS Med 2022; 19:e1004079. [PMID: 36007101 PMCID: PMC9410549 DOI: 10.1371/journal.pmed.1004079] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 07/22/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The influence of urbanicity on hypertension prevalence remains poorly understood. We conducted a systematic review and meta-analysis to assess the difference in hypertension prevalence between urban and rural areas in low-income and middle-income countries (LMICs), where the most pronounced urbanisation is underway. METHODS AND FINDINGS We searched PubMed, Web of Science, Scopus, and Embase, from 01/01/1990 to 10/03/2022. We included population-based studies with ≥400 participants 15 years and older, selected by using a valid sampling technique, from LMICs that reported the urban-rural difference in hypertension prevalence using similar blood pressure measurements. We excluded abstracts, reviews, non-English studies, and those with exclusively self-reported hypertension prevalence. Study selection, quality assessment, and data extraction were performed by 2 independent reviewers following a standardised protocol. Our primary outcome was the urban minus rural prevalence of hypertension. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure as ≥90 mm Hg and could include use of antihypertensive medication, self-reported diagnosis, or both. We investigated heterogeneity using study-level and socioeconomic country-level indicators. We conducted meta-analysis and meta-regression using random-effects models. This systematic review and meta-analysis has been registered with PROSPERO (CRD42018091671). We included 299 surveys from 66 LMICs, including 19,770,946 participants (mean age 45.4 ± SD = 9 years, 53.0% females and 63.1% from rural areas). The pooled prevalence of hypertension was 30.5% (95% CI, 28.9, 32.0) in urban areas and 27.9% (95% CI, 26.3, 29.6) in rural areas, resulting in a pooled urban-rural difference of 2.45% (95% CI, 1.57, 3.33, I-square: 99.71%, tau-square: 0.00524, Pheterogeneity < 0.001). Hypertension prevalence increased over time and the rate of change was greater in rural compared to urban areas, resulting in a pooled urban-rural difference of 5.75% (95% CI, 4.02, 7.48) in the period 1990 to 2004 and 1.38% (95% CI, 0.40, 2.37) in the period 2005 to 2020, p < 0.001 for time period. We observed substantial heterogeneity in the urban-rural difference of hypertension, which was partially explained by urban-rural definition, probably high risk of bias in sampling, country income status, region, and socioeconomic indicators. The urban-rural difference was 5.67% (95% CI, 4.22, 7.13) in low, 2.74% (95% CI, 1.41, 4.07) in lower-middle and -1.22% (95% CI, -2.73, 0.28) in upper-middle-income countries in the period 1990 to 2020, p < 0.001 for country income. The urban-rural difference was highest for South Asia (7.50%, 95% CI, 5.73, 9.26), followed by sub-Saharan Africa (4.24%, 95% CI, 2.62, 5.86) and reversed for Europe and Central Asia (-6.04%, 95% CI, -9.06, -3.01), in the period 1990 to 2020, p < 0.001 for region. Finally, the urban-rural difference in hypertension prevalence decreased nonlinearly with improvements in Human Development Index and infant mortality rate. Limitations included lack of data available from all LMICs and variability in urban and rural definitions in the literature. CONCLUSIONS The prevalence of hypertension in LMICs increased between 1990 and 2020 in both urban and rural areas, but with a stronger trend in rural areas. The urban minus rural hypertension difference decreased with time, and with country-level socioeconomic development. Focused action, particularly in rural areas, is needed to tackle the burden of hypertension in LMICs.
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106
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Muhammad T, Paul R, Rashmi R, Srivastava S. Examining sex disparity in the association of waist circumference, waist-hip ratio and BMI with hypertension among older adults in India. Sci Rep 2022; 12:13117. [PMID: 35907951 PMCID: PMC9338983 DOI: 10.1038/s41598-022-17518-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/26/2022] [Indexed: 11/12/2022] Open
Abstract
Hypertension is a public health issue touted as a “silent killer” worldwide. The present study aimed to explore the sex differential in the association of anthropometric measures including body mass index, waist circumference, and waist-hip ratio with hypertension among older adults in India. The study used data from the Longitudinal Aging Study in India (LASI) conducted during 2017–18. The sample contains 15,098 males and 16,366 females aged 60 years and above. Descriptive statistics (percentages) along with bivariate analysis were presented. Multivariable binary logistic regression analyses were used to examine the associations between the outcome variable (hypertension) and putative risk or protective factors. About 33.9% of males and 38.2% of females aged 60 years and above suffered from hypertension. After adjusting for the socioeconomic, demographic and health-behavioral factors, the odds of hypertension were 1.37 times (CI: 1.27–1.47), significantly higher among older adults who were obese or overweight than those with no overweight/obese condition. Older adults with high-risk waist circumference and waist-hip ratio had 1.16 times (CI: 1.08–1.25) and 1.42 times (CI: 1.32–1.51) higher odds of suffering from hypertension, respectively compared to their counterparts with no high-risk waist circumference or waist-hip ratio. The interaction effects showed that older females with overweight/obesity [OR: 0.84; CI: 0.61–0.74], high-risk waist circumference [OR: 0.89; CI: 0.78–0.99], and high-risk waist-hip ratio [OR: 0.90; CI: 0.83–0.97] had a lower chance of suffering from hypertension than their male counterparts with the similar anthropometric status. The findings suggested a larger magnitude of the association between obesity, high-risk waist circumference, high-risk waist-hip ratio and prevalent hypertension among older males than females. The study also highlights the importance of measuring obesity and central adiposity in older individuals and using such measures as screening tools for timely identification of hypertension.
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Affiliation(s)
- T Muhammad
- International Institute for Population Sciences, Mumbai, 400088, India
| | - Ronak Paul
- International Institute for Population Sciences, Mumbai, 400088, India
| | - Rashmi Rashmi
- International Institute for Population Sciences, Mumbai, 400088, India
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Peng M, Shi X, Zhu L, Wang Z. Follow-up management service and health outcomes of hypertensive patients in China: A cross-sectional analysis from the national health service survey in Jiangsu province. Front Public Health 2022; 10:956711. [PMID: 35958831 PMCID: PMC9360537 DOI: 10.3389/fpubh.2022.956711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Hypertension is a major cause of early mortality worldwide. Health follow-up management services can encourage patients with hypertension to improve their health behavior and outcomes. However, a lack of studies on the relationship between specific factors of follow-up management and both subjective and objective health outcome among hypertensive patients exists. The current study investigated the relationship between service content, frequency, mode, and institutions of follow-up management and health outcomes among Chinese hypertensives. Methods Data were obtained from the sixth National Health Service Survey (NHSS) of Jiangsu Province, which was conducted in 2018. Descriptive statistics were used to analyze the sample characteristics and the utilization of follow-up management services. Both multiple linear regression and logistic regression were used to estimate the association of follow-up management service and other factors with hypertensives' subjective and objective health outcomes. Result Some respondents (19.30%) reported hypertension, and 75.36% of these patients obtained follow-up management services. Hypertensive patients' subjective health outcome self-reported health status and objective health outcome blood pressure (BP) control were found to be significantly associated with follow-up management services. The outcomes were both significantly improved by a high frequency of management services, a high level of follow-up providers, the mode of visiting healthcare facilities and/or calling, and receiving instructions on medication use. However, inquiring about patients' symptoms was negatively associated with self-reported health status and BP control. In addition, BP measurement was significantly and positively associated with hypertensive patients' self-reported health status; the patients receiving lifestyle guidance were more likely to have their BP levels under control. Conclusions Hypertension management strategies should further focus on the frequency of healthcare follow-up management via categorization of the follow-up services and appropriate adjustment of service delivery modes to optimize health follow-up management for hypertensives further improve their outcomes. Meanwhile, complementary policies are also needed to address other socioeconomic factors that can promote good health conditions for hypertension patients.
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Affiliation(s)
- Mingyao Peng
- School of Health Policy Management, Nanjing Medical University, Nanjing, China
| | - Xinyi Shi
- School of Health Policy Management, Nanjing Medical University, Nanjing, China
| | - Lin Zhu
- School of Health Policy Management, Nanjing Medical University, Nanjing, China
| | - Zhonghua Wang
- School of Health Policy Management, Nanjing Medical University, Nanjing, China
- The Public Health Policy and Management Innovation Research Team, Nanjing Medical University, Nanjing, China
- Center for Global Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Zhonghua Wang
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108
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Mishra P, Dash N, Sahu SK, Kanaujia V, Sharma K. Malignant Hypertension and the Role of Ophthalmologists: A Review Article. Cureus 2022; 14:e27140. [PMID: 36017304 PMCID: PMC9392986 DOI: 10.7759/cureus.27140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Malignant hypertension (MHT) is a sudden and severe increase in systemic blood pressure (BP) associated with advanced bilateral retinopathy. It comes under a broader term, called hypertensive emergency, where an acute rise in BP results in end-organ damage. The condition usually requires hospital admission and intensive care management. Although there are lots of sophisticated machines and laboratory tests present to diagnose various organ damage, the role of ophthalmologists will still be at the top. A record of the acute rise of BP to a defining level and simple ophthalmoscopy with high clinical suspicion can save a patient’s life and preserve target organ function by timely referral. So, every ophthalmologist should be aware of this dangerous condition. In this review, we have tried to compile all the current knowledge regarding malignant hypertension that an ophthalmologist may require in day-to-day practice.
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Marmamula S, Kumbham TR, Shidhaye R, Modepalli SB, Barrenkala NR, Yellapragada R, Keeffe J. Multimorbidity and multi-disability among the elderly in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES). Sci Rep 2022; 12:11779. [PMID: 35821044 PMCID: PMC9276822 DOI: 10.1038/s41598-022-15943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
We report prevalence and risk factors for multimorbidity and multi-disability among elderly people in residential care in the Hyderabad region in South India. In total, 1182 elderly (aged ≥ 60) participants were examined in 41 homes for the aged centres. Detailed interviews were conducted by trained personnel to collect personal and demographic information. A questionnaire was used to assess the history of non-communicable diseases and Washington Disability Questionnaire (WDQ) was administered to assess disabilities. The mean age of the participants was 75.0 years (SD 8.8 years; range: 60-108 years), 35.4% were men, 20.3% had no formal education, 60.7% had school education and 19% had higher education. The prevalence of multimorbidity was 37.6% (95% CI: 34.8-40.4). Prevalence of multi-disability was 23.6% (95% CI: 21.2-26.3; n = 270). In total, 857 (72.5%) participants reported using at least one medication for NCDs. Over a third of the elderly in residential care had multimorbidity, and a quarter of them had multi-disability. A holistic health care system that comprises health and wellness coupled with rehabilitation to address disabilities is needed to achieve healthy aging in elderly in homes for the aged in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India.
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.
- Department of Biotechnology, Wellcome Trust India Alliance, L V Prasad Eye Institute, Hyderabad, India.
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Navya Rekha Barrenkala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Jill Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
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Boro B, Banerjee S. Decomposing the rural-urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India. BMC Public Health 2022; 22:1310. [PMID: 35799143 PMCID: PMC9264707 DOI: 10.1186/s12889-022-13664-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/20/2022] [Indexed: 12/30/2022] Open
Abstract
Background Although awareness and treatment rates of hypertension have significantly improved in recent years, the prevalence of undiagnosed and untreated hypertension remains a major public health concern for Indian policymakers. While the urban–rural variation in the prevalence, diagnosis, control, and treatment of hypertension is reasonably well-documented, the explanation behind such variation remains poorly understood given the dearth of studies conducted on exploring the determinants of the rural–urban gap in the prevalence of undiagnosed, untreated, and uncontrolled hypertension in India. In view of this research gap, our paper aims to decompose the inter-group differences between rural and urban areas in undiagnosed, untreated, and undertreated hypertension among older adults in India into the major contributing factors. Methods Nationally representative data collected in the Longitudinal Ageing Study of India, Wave-1 (2017–18), was utilized for this study. Maximum-likelihood binary logistic-regression models were employed to capture the crude and adjusted associations between the place of residence and prevalence of undiagnosed, untreated, and undertreated hypertension. Fairlie’s decomposition technique was used to decompose the inter-group differences between rural and urban residents in the prevalence of undiagnosed, untreated, and undertreated hypertension among the older population in India, into the major contributing factors, in order to explore the pathways through which these differences manifest. Results The overall prevalence rates of undiagnosed, untreated, and undertreated hypertension among older adults were 42.3%, 6%, and 18.7%, respectively. However, the prevalence of undiagnosed and untreated hypertension was higher in rural areas, by 12.4 and 1.7 percentage-points, respectively, while undertreated hypertension was more prevalent in the urban areas (by 7.2 percentage-points). The decomposition analysis explained roughly 41% and 34% of the urban advantage over rural areas in the case of undiagnosed and untreated hypertension, while it explained 51% of the urban disadvantage in respect of undertreated hypertension. The rural–urban differentials in education and comorbidities accounted for the majority of the explained rural disadvantage in the prevalence of undiagnosed hypertension, explaining 13.51% and 13.27% of the gap, respectively. The regional factor was found to be the major driver behind urban advantage in the prevalence of untreated hypertension, contributing 37.47% to the overall gap. In the case of undertreated hypertension, education, comorbidities, and tobacco consumption were the major contributors to the urban–rural inequality, which accounted for 12.3%, 10.6%, and 9.8% of the gap, respectively. Conclusion Socio-economic and lifestyle factors seemed to contribute significantly to the urban–rural gap in undiagnosed, untreated and undertreated hypertension in India among older adults. There is an urgent need of creating awareness programmes for the early identification of hypertensive cases and regular treatment, particularly in under-serviced rural India. Interventions should be made targeting specific population groups to tackle inequality in healthcare utilization.
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Affiliation(s)
- Bandita Boro
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Shreya Banerjee
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India.
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111
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Chopra H, Pancholia A, Desai BN, Sinha AK, Dabhade D, Newale S. Beta-Adrenergic Blockade: Is It the Prudent Choice against Sympathetic Overdrive in Patients with Hypertension or Heart Failure? JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1759804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
AbstractThe development of hypertension and heart failure is correlated with the hyperactivation of the sympathetic nervous system. Beta-blockers are often considered a good therapeutic option in such clinical scenarios. However, the choice of β-blocker is a concern because of certain aspects like associated metabolic disturbances with their usage. Metoprolol has been reported to have the potential to alleviate sympathetic overdrive in patients with hypertension and heart failure. S-Metoprolol is the chirally pure β-blocker with favorable pharmacological features, improved safety profile, and allied clinical advantages versus racemic metoprolol; given this, can it be an effective therapeutic option against sympathetic overdrive in patients with hypertension and/or heart failure is not fully recognized yet. In this review, we attempted to discuss the current facts around sympathetic overdrive linked with hypertension as well as heart failure and pertaining pharmacological intervention with a focus on β-blockers in these clinical situations with an emphasis on the likely beneficial role of S-metoprolol.
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Affiliation(s)
- H.K Chopra
- Department of Cardiology, Medanta Moolchand Heart Institute - Moolchand Medcity, New Delhi, India
| | - A.K Pancholia
- Department of Medicine and Preventive Cardiology, Arihant Hospital and Research Center, Indore, Madhya Pradesh, India
| | - Bhupen N. Desai
- Department of Cardiology, Desai Heart Care Clinic, Mumbai, Maharashtra, India
| | - Ajay K. Sinha
- Department of Clinical Cardiology and Research, Jaiprabha Medanta Super Speciality Hospital, Patna, Bihar, India
| | - Dhammdeep Dabhade
- Department of Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, India
| | - Sanket Newale
- Department of Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, India
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Chauhan VS, Bansal M, Sharma V, Gupta R. Prevalence and Risk Factors of Hypertension among Police Personnel of District Gwalior- A Cross Sectional Study. Indian J Community Med 2022; 47:379-385. [PMID: 36438512 PMCID: PMC9693942 DOI: 10.4103/ijcm.ijcm_1154_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/28/2022] [Indexed: 06/06/2023] Open
Abstract
CONTEXT Hypertension is an emerging public health problem due to its high prevalence and association with cardiovascular and overall morbidity and mortality. Police personnel constitute a special occupational group with exposure to violence and stress at work, which affects their health directly and indirectly. METHODOLOGY A cross-sectional study was conducted to find out the prevalence of hypertension and its relation with respect to police duty profile along with other risk factors among the police personnel of the Gwalior district stationed at various police stations. RESULTS In total, 402 police personnel were included in the study. Forty (14.7%) participants reported that they had h/o hypertension, while 26 (9.5%) reported that they were diagnosed as hypertensive in recent 1-2 months. As per the findings of our study, 273 (67.91%) participants come out to be hypertensive; among them, 207 (75.8%) were diagnosed in the current study. With increase in hierarchy, more police personnel suffered with hypertension. CONCLUSIONS Long duty hours, higher rank, prolonged service duration, and inappropriate eating habits are the significant factors for the high prevalence of hypertension in police personnel.
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Affiliation(s)
| | - Manoj Bansal
- Department of Community Medicine, GR Medical College Gwalior, Madhya Pradesh, India
| | - Vikash Sharma
- Department of Community Medicine, Government Medical College, Ratlam, Madhya Pradesh, India
| | - Rajesh Gupta
- District Health Officer, Shivpuri, Madhya Pradesh, India
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Barure R, Shanthaiah DM, Atluri S, Channabasappa S, Kolla G, Reddy SLS, Sarathi V. High Prevalence of Additional Cardiovascular Risk Factors in Eastern-Indian Young Adults with Type 2 Diabetes Mellitus. Indian J Endocrinol Metab 2022; 26:372-375. [PMID: 36185959 PMCID: PMC9519843 DOI: 10.4103/ijem.ijem_155_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS The American Diabetes Association recommends statin therapy for young type 2 diabetes mellitus (T2DM) adults only if one additional cardiovascular (CV) risk factor coexists. The data regarding CV risk factors in young Indian T2DM adults is limited. Hence, we assessed the prevalence of CV risk factors in young adults with T2DM from eastern India. METHODS In this cross-sectional study, diabetic medical health check records of eastern-Indian T2DM patients performed between March 2018 and March 2019 were retrospectively reviewed and the relevant data of T2DM patients (n = 3564) including CV risk factors [serum LDL-cholesterol of ≥100 mg/dL, hypertension (>140/90 mmHg), smoking, chronic kidney disease (eGFR of <60 ml/min), microalbumin to creatinine ratio of ≥30 mg/mg, and obesity/overweight (body mass index ≥23 kg/m2)] were analysed. RESULTS There were 3280 T2DM patients from eastern India and 679 (20.7%) were ≤40 years of age. Overweight/obesity (74.3%) and serum LDL-cholesterol of ≥100 mg/dL (69.2%) were the two most common additional CV risk factors. At least one additional CV risk factor was present in 576 (95.36%) patients, whereas at least two additional CV risk factors were present in 409 (67.7%) patients. At least one non-obesity/overweight CV risk factor was present in 472 (78.1%) patients. CONCLUSIONS The study demonstrates a high prevalence of additional CV risk factors in young eastern-Indian adults with T2DM. Hence, there is a need for an intensive approach to managing the CV risk factors in young Indian adults with T2DM.
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Affiliation(s)
- Ramdas Barure
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | | | - Sridevi Atluri
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Shivaprasad Channabasappa
- Department of Endocrinology, Sapthagiri Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Gautam Kolla
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - S. L. Sagar Reddy
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
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Sharma AK, Singh P. Implementation research: The need of the hour. Indian J Public Health 2022; 66:321-322. [PMID: 36149112 DOI: 10.4103/ijph.ijph_1169_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Formative research creates evidence. Evidence-based interventions are implemented in community settings. In the past, evidence-based interventions have failed to get desired outcomes. The tuberculosis control program despite being evidence based did not succeed at the beginning. Similarly, evidence-based treatment of hypertension and diabetes has not yet controlled these diseases. This is where the role of implementation research (IR) starts. IR either as part of evidence-based research or independently should be a part of health programs so that the program shall be able to ensure feasibility, fidelity, penetration, acceptability, sustainability, efficiency, effectiveness, and equity.
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Affiliation(s)
- Arun Kumar Sharma
- Director, ICMR-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Poonam Singh
- Senior Project Fellow, ICMR-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
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Krishnan A, Khurana S, Sharma S, Menon GR. Estimates of major non-communicable disease risk factors for India, 2010 & 2015: A summary of evidence. Indian J Med Res 2022; 156:56-63. [PMID: 36510898 PMCID: PMC9903385 DOI: 10.4103/ijmr.ijmr_3275_20] [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] [Indexed: 12/15/2022] Open
Abstract
Background & objectives The National Monitoring Framework for the prevention and control of NCDs in India has set targets for reduction of risk factors relative to the measure recorded in 2010. Estimates for 2010 and 2015 were established using meta-analyses in the absence of a national risk factor survey till 2017. Methods We searched national survey reports and also articles published in English from India between 2008 and 2017 in PubMed, Google Scholar and Cochrane review databases for specific risk factors among 18-69 yr Indians. Quality of studies was evaluated using Joanna-Briggs tool, but all studies were included in analyses. Estimates for each of the eight strata by age, gender and place of residence, respectively, were generated. MetaXL was used to calculate the pooled estimate for 2010 and 2015 using a random effects model. Strata-specific estimates were combined to arrive at national estimate using population weight of each stratum. The credibility of the estimates was determined using four parameters - average Briggs score; representativeness of the contributing studies and precision and stability of the estimates. Results The estimates [95% confidence interval (CI)] for 2010 for different risk factors were as follows: current alcohol use, 15.7 per cent (13.2-18.2); current tobacco use, 27 per cent (21.4-32.6); household solid fuel use, 61.5 per cent (50.2-72.5); physical inactivity, 44.2 per cent (37.8-50.6); obesity, seven per cent (3.8-10.2) and raised blood pressure, 20.2 per cent (18.4-22.1). In 2015, compared to 2010, tobacco use showed a relative decline of 18 per cent, household solid fuel use of nine per cent and physical inactivity of 15 per cent. The estimates were stable for alcohol use, raised blood pressure and obesity between 2010 and 2015. All estimates varied between moderate and high degrees of credibility. Interpretation & conclusions The estimates are consistent with other available estimates and with current national-level initiatives focused on tobacco control and improving access to clean fuel. These estimates can be used to monitor progress on non-communicable disease risk factor targets for India.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India,For correspondence: Dr Anand Krishan, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India e-mail:
| | | | - Shweta Sharma
- Division of Noncommunicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Geetha R. Menon
- ICMR-National Institute of Medical Statistics, New Delhi, India
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Nayak D, Nahar K, Bhalerao R, Kaur L, Parveen T, Bhalla R, Michael J, Sharma S, Singh P, Jainab A, Ram H, Chaudhuri A, Parvin U, Jain N, Khurana A. Effectiveness of Arsenicum album 30C in Prevention of COVID-19 in Individuals Residing in Containment Zones of Delhi-A Prospective, Community-based, Parallel Cohort Study. HOMEOPATHY 2022; 111:261-270. [PMID: 35768003 DOI: 10.1055/s-0042-1745755] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This work was designed as undertaken to evaluate the protective effect of Arsenicum album 30C against COVID-19. DESIGN The work was designed as a prospective parallel cluster cohort study. INTERVENTION Participants were enrolled in a homeopathy intervention (HI) cohort (who received Arsenicum album) or in a non-intervention (NI) cohort (who received no systematic intervention) from COVID-19 containment areas of Delhi. Individuals of age 5 years or above were given four medicated pills of Arsenicum album 30C, while those from 1 to 5 years old were given two medicated pills in each dose. RESULTS The analysis included 10,180 individuals residing in 11 COVID-19 containment areas in Delhi, out of which 6,590 individuals were in the HI cohort and 3,590 individuals were in the NI cohort. The overall protective effect of Arsenicum album 30C was 83.43% (95% confidence interval [CI], 76.77 to 88.17): 45 cases per 6,590 (8.34 per 10,000 person-weeks) in the Arsenicum album 30C group versus 143 cases per 3,590 (45.01 per 10,000 person-weeks) in the NI cohort. The protective effect of Arsenicum album 30C against laboratory confirmed COVID-19 was 74.40% (95% CI, 55.08 to 85.41): 18 cases per 6,590 (3.32 per 10,000 person-weeks) in the Arsenicum album 30C group versus 38 cases per 3,590 (11.85 per 10,000 person-weeks) in the NI cohort. CONCLUSION The use of Arsenicum album 30C was associated with some protection against probable and laboratory-confirmed COVID-19 in a containment-zone setting. Randomized controlled trials are needed to confirm or refute these results.
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Affiliation(s)
- Debadatta Nayak
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Karanpreet Nahar
- Department of Clinical Research, Dr. D.P Rastogi Central Research Institute of Homoeopathy, Noida, Uttar Pradesh, India
| | - Rupali Bhalerao
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Lovepreet Kaur
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Tabassum Parveen
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Ruchika Bhalla
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - James Michael
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Swati Sharma
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Parul Singh
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Afsana Jainab
- Department of Clinical Research, State Homoeopathic Dispensary, Pataria, Patwai PHC, District-Rampur, Uttar Pradesh, India
| | - Hanuman Ram
- Department of Materia Medica, Madhav Homoeopathic Medical College& Hospital, Madhav Hills, Opposite Banas River, Abu Road, Rajasthan, India
| | - Abhishek Chaudhuri
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Ummesalma Parvin
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Nidhi Jain
- Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
| | - Anil Khurana
- Department of Clinical Research, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India
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Automated Diagnosis and Assessment of Cardiac Structural Alteration in Hypertension Ultrasound Images. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5616939. [PMID: 35685669 PMCID: PMC9168207 DOI: 10.1155/2022/5616939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Abstract
Hypertension (HTN) is a major risk factor for cardiovascular diseases. At least 45% of deaths due to heart disease and 51% of deaths due to stroke are the result of hypertension. According to research on the prevalence and absolute burden of HTN in India, HTN positively correlated with age and was present in 20.6% of men and 20.9% of women. It was estimated that this trend will increase to 22.9% and 23.6% for men and women, respectively, by 2025. Controlling blood pressure is therefore important to lower both morbidity and mortality. Computer-aided diagnosis (CAD) is a noninvasive technique which can determine subtle myocardial structural changes at an early stage. In this work, we show how a multi-resolution analysis-based CAD system can be utilized for the detection of early HTN-induced left ventricular heart muscle changes with the help of ultrasound imaging. Firstly, features were extracted from the ultrasound imagery, and then the feature dimensions were reduced using a locality sensitive discriminant analysis (LSDA). The decision tree classifier with contourlet and shearlet transform features was later employed for improved performance and maximized accuracy using only two features. The developed model is applicable for the evaluation of cardiac structural alteration in HTN and can be used as a standalone tool in hospitals and polyclinics.
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118
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Basu S, Engtipi K, Kumar R. Determinants of adherence to antihypertensive treatment among patients attending a primary care clinic with limited medical armamentarium in Delhi, India: A qualitative study. Chronic Illn 2022; 18:295-305. [PMID: 32938210 DOI: 10.1177/1742395320959418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine perspectives on reasons for non-adherence to antihypertensive therapy and its socioeconomic determinants among patients attending a primary care center in a low-income area in Delhi, India. METHODS We conducted in-depth interviews with a total of 30 patients having hypertension at a primary care facility located in a low-income urban area in Delhi. RESULTS All the participants were aware that hypertension was a serious illness, and medication intake was necessary throughout life to prevent uncontrolled hypertension. All participants in varying quantities practiced salt restriction, but the consumption of fresh fruit and vegetables was low primarily due to economic reasons. The participants were unable to differentiate the concept of exercise from physical activity. Medication adherence was suboptimal, and significant reasons for non-adherence were forgetfulness, carelessness and running out of drug stocks. Blood pressure control was also suboptimal in a majority of the participants, but combination therapy was restricted due to limited medical armamentarium at the clinic. Laboratory investigations for monitoring target end-organ damage were either delayed or not conducted in most participants. DISCUSSION Hypertensive patients undergoing treatment at primary care facilities often report suboptimal medical adherence and treatment outcomes, with socioeconomic causes being a major driver of non-adherence.
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Affiliation(s)
- Saurav Basu
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Kajok Engtipi
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Rajesh Kumar
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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Anjana RM, Unnikrishnan R, Deepa M, Venkatesan U, Pradeepa R, Joshi S, Saboo B, Das AK, Bajaj S, Bhansali A, Madhu SV, Dhandhania VK, Jabbar PK, Jain SM, Gupta A, Chowdhury S, Ali MK, Nirmal E, Subashini R, Kaur T, Dhaliwal RS, Tandon N, Mohan V. Achievement of guideline recommended diabetes treatment targets and health habits in people with self-reported diabetes in India (ICMR-INDIAB-13): a national cross-sectional study. Lancet Diabetes Endocrinol 2022; 10:430-441. [PMID: 35461575 DOI: 10.1016/s2213-8587(22)00072-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is little information on comprehensive diabetes care comprising glycaemic, lipid, and blood pressure control in India; therefore, we aimed to assess the achievement of treatment targets among adults with self-reported diabetes. METHODS The Indian Council of Medical Research (ICMR)-India Diabetes (INDIAB) study is a cross-sectional, population-based survey of adults aged 20 years or older in all 30 states and union territories of India. We used a stratified multistage sampling design, sampling states in a phased manner, and selected villages in rural areas and census enumeration blocks in urban areas. We used a three-level stratification method on the basis of geography, population size, and socioeconomic status for each state. For the outcome assessment, good glycaemic control was defined as HbA1c of less than 7·0% (A), blood pressure control was defined as less than 140/90 mm Hg (B), and the LDL cholesterol target was defined as less than 100 mg/dL (C). ABC control was defined as the proportion of individuals meeting glycaemic, blood pressure, and LDL cholesterol targets together. We also performed multiple logistic regression to assess the factors influencing achievement of diabetes treatment targets. FINDINGS Between Oct 18, 2008, and Dec 17, 2020, 113 043 individuals (33 537 from urban areas and 79 506 from rural areas) participated in the ICMR-INDIAB study. For this analysis, 5789 adults (2633 in urban areas and 3156 in rural areas) with self-reported diabetes were included in the study population. The median age was 56·1 years (IQR 55·7-56·5). Overall, 1748 (weighted proportion 36·3%, 95% CI 34·7-37·9) of 4834 people with diabetes achieved good glycaemic control, 2819 (weighted proportion 48·8%, 47·2-50·3) of 5698 achieved blood pressure control, and 2043 (weighted proportion 41·5%, 39·9-43·1) of 4886 achieved good LDL cholesterol control. Only 419 (weighted proportion 7·7%) of 5297 individuals with self-reported diabetes achieved all three ABC targets, with significant heterogeneity between regions and states. Higher education, male sex, rural residence, and shorter duration of diabetes (<10 years) were associated with better achievement of combined ABC targets. Only 951 (weighted proportion 16·7%) of the study population and 227 (weighted proportion 36·9%) of those on insulin reported using self-monitoring of blood glucose. INTERPRETATION Achievement of treatment targets and adoption of healthy behaviours remains suboptimal in India. Our results can help governments to adopt policies that prioritise improvement of diabetes care delivery and surveillance in India. FUNDING Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ulagamathesan Venkatesan
- Department of Biostatistics, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajendra Pradeepa
- Department of Research Operations, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Shashank Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Banshi Saboo
- Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Ashok Kumar Das
- Department of General Medicine and Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | | | | | - Sunil M Jain
- TOTALL, Diabetes Thyroid Hormone Research Institute, Indore, India
| | | | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - Mohammed K Ali
- Department of Epidemiology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elangovan Nirmal
- Department of Research Operations, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Tanvir Kaur
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India.
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Zou L, Zhang M, Fu W, Liu Y, Wen J, Lu Z. Meta-analysis on the association between the frequency of tooth brushing and hypertension risk. J Clin Hypertens (Greenwich) 2022; 24:689-697. [PMID: 35641122 PMCID: PMC9180317 DOI: 10.1111/jch.14498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
It is unclear whether the frequency of tooth brushing affects the risk of hypertension; thus, we conducted the first meta-analysis to focus on this topic. In this meta-analysis, we systematically searched the PubMed, Scopus, and Web of Science databases from their inception to October 2021 to identify eligible studies, while reference lists from retrieved review paper were also reviewed. We then conducted a meta-analysis of the highest compared with the lowest tooth brushing frequency, along with a dose-response meta-analysis, to explore this association. Subgroup and sensitivity analyses were conducted to identify the sources of heterogeneity. Publication bias was evaluated using Begg's and Egger's tests. We found eight relevant studies, three cohort and five cross-sectional, involving a total of 274 124 patients. Compared to the highest tooth brushing frequency, the lowest increased the risk of hypertension by 84.0% (OR 1.84; 95% CI, 1.44-2.35). Furthermore, a nonlinear dose-response relationship was observed (P < .05). The exclusion of any studies did not significantly alter the combined risk estimate, and no publication bias was detected. In conclusions, we report that epidemiological evidence supports the hypothesis that a lower frequency of tooth brushing is significantly associated with a higher risk of hypertension. Preventive interventions, such as adopting a good oral health routine, should be encouraged to maintain good general health.
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Affiliation(s)
- Li Zou
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mingye Zhang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenning Fu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, China
| | - Yifang Liu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wen
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Mattar SAM, Kan JYL, Goh OQM, Tan Y, Kumaran SS, Shum KL, Lee G, Balakrishnan T, Zhu L, Chong CJ, Woong NL, Lam AYR, Kang ML. COVID-19 pandemic unmasking cardiovascular risk factors and non-communicable diseases among migrant workers: a cross-sectional study in Singapore. BMJ Open 2022; 12:e055903. [PMID: 35613819 PMCID: PMC9125380 DOI: 10.1136/bmjopen-2021-055903] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES This study aims to report the prevalence of cardiovascular risk factors (CVRFs) and other non-communicable diseases among migrant workers in Singapore admitted for COVID-19 infection, to highlight disease burden and the need for changes in health screening and healthcare delivery in this unique population. SETTING The study was conducted in the largest tertiary hospital in Singapore. DESIGN Retrospective cross-sectional study. PARTICIPANTS 883 migrant workers who had mild or asymptomatic COVID-19 infection admitted to three isolation wards between 6 April 2020 and 31 May 2020 were included in this study. OUTCOME MEASURES The outcome measures were the prevalence of pre-existing and newly diagnosed comorbid conditions and the prevalence of CVRFs-diabetes mellitus, hypertension and hyperlipidaemia-and non-communicable diseases at the time of discharge. The OR of having specific CVRFs depending on country of origin was generated via multivariate logistic regression analysis. RESULTS The median age of our study population was 45 years. 17.0% had pre-existing conditions and 25.9% received new diagnoses. Of the new diagnoses, 15.7% were acute medical conditions and 84.3% chronic medical conditions. The prevalence of CVRFs was higher in Southeast Asian and South Asian migrant workers compared with Chinese. The prevalence of non-communicable diseases on discharge was highest among Southeast Asians (49.4%). CONCLUSIONS The COVID-19 outbreak in a large number of migrant workers in Singapore unmasked a significant disease burden among them, increasing stakeholders' interests in their welfare. Moving forward, system-level changes are necessary to deliver healthcare sustainably and effect improvements in migrant workers' health.
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Affiliation(s)
| | | | | | - Yuyang Tan
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | | | - Koin Lon Shum
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Guozhang Lee
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | | | - Ling Zhu
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | | | | | | | - Mei Ling Kang
- Department of Internal Medicine, Singapore General Hospital, Singapore
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Hypertension treatment cascade in India: results from National Noncommunicable Disease Monitoring Survey. J Hum Hypertens 2022; 37:394-404. [PMID: 35513442 PMCID: PMC10156594 DOI: 10.1038/s41371-022-00692-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/21/2022] [Accepted: 04/07/2022] [Indexed: 12/17/2022]
Abstract
Hypertension is a major risk factor for ischemic heart disease and stroke. We estimated prevalence, awareness, treatment, and control of hypertension along with its determinants in India. We used data from the National NCD Monitoring Survey-(NNMS-2017-2018) which studied one adult (18-69 years) from a representative sample of households across India and collected information on socio-demographic variables, risk factors for NCDs and treatment practices. Blood pressure was recorded digitally and hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg or currently on medications. Awareness was defined as being previously diagnosed with hypertension by a health professional; on treatment as taking a dose of medication once in the last 14 days and; control as SBP < 140 mmHg and DBP < 90 mmHg. Multivariate Logistic regression was performed to estimate determinants. Out of 10,593 adults with a blood pressure measurement (99.4%), 3017 (28.5%; 95% CI: 27.0-30.1) were found to have hypertension. Of these hypertensives, 840 (27.9%; 95% CI: 25.5-30.3) were aware, 438 (14.5%; 95% CI: 12.7-16.5) were under treatment and, 379 (12.6%; 95% CI: 11.0-14.3) were controlled. Significant determinants of awareness were being in the age group 50-69 years (aOR 2.45 95% CI: 1.63-3.69), women (1.63; 95% CI: 1.20-2.22) and from higher wealth quintiles. Those in the age group 50-69 (aOR 4.80; 95% CI: 1.74-13.27) were more likely to be under treatment. Hypertension control was poorer among urban participants (aOR 0.55; 95% CI: 0.33-0.90). Significant regional differences were noted, though without any clear trend. One-fifth of the patients were being managed at public facilities. The poor population-level hypertension control needs strengthening of hypertension services in the Universal Health Coverage package.
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Priyadarsini Satapathy S, Kumari Panda S, Chandra Panda P, Lakra K, Charan Panda S, Dhawan P, Goel S. Association of tobacco with hypertension in adult females: Evidence from National Family Health Survey-IV for an aspirational Indian state. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sreelal TP, Thulaseedharan JV, Nair S, Ravindran RM, Vijayakumar K, Varma RP. Hypertension control in Kerala, India: a prescription-based study at primary and secondary level health care institutions. Indian Heart J 2022; 74:296-301. [PMID: 35644270 PMCID: PMC9453055 DOI: 10.1016/j.ihj.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
Objective We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India. Methods This cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression. Results Totally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50–2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy. Conclusions In this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.
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Affiliation(s)
- Thekkumkara Prabhakaran Sreelal
- DM Wayanad Institute of Medical Sciences (WIMS) Medical College, Wayanad, Kerala, 673577, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India
| | - Jissa Vinoda Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sanjeev Nair
- Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, 680596, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India
| | - Rekha Melathuparambil Ravindran
- State Health Systems Resource Centre - Kerala, Thiruvananthapuram, Kerala, 695014, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India
| | | | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India.
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Lu Y, Lan T. Global, regional, and national burden of hypertensive heart disease during 1990-2019: an analysis of the global burden of disease study 2019. BMC Public Health 2022; 22:841. [PMID: 35473603 PMCID: PMC9044894 DOI: 10.1186/s12889-022-13271-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hypertensive heart disease (HHD) is a major public health issue worldwide. We analyzed the global, regional, and national burden of HHD between the years 1990 and 2019 in relation to age, gender, and socioeconomic factors. Methods The prevalence and death rates, the disability adjusted life-years (DALY), and the corresponding age-standardized rates of HHD were extracted from the Global Burden of Disease study 2019. The epidemiological trends were evaluated by calculating the estimated annual percentage changes (EAPC) of the above variates. Results A total of 19.60 million HHD cases were documented in 2019 compared to 7.82 million in 1990, corresponding to an EAPC of 0.17. Contrarily, the global age-standardized death rate (ASDR) and age-standardized DALYs decreased with respective EAPCs of − 0.74 and − 1.02. HHD mostly occurred in people aged over 65. The disease burden of HHD varied considerably between countries, and univariate linear regression indicated that many socioeconomic variables had significantly negative correlations with age-standardized DALY rate. Conclusion HHD cases have increased over the last three decades; however the mortality rate has declined. Multi-faceted improvements in health, education and income could help to alleviate the disease burden of HHD, specially in some regions with lower socio-demographic index and higher ASDR. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13271-0.
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Affiliation(s)
- Yunyan Lu
- Department of Cardiology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Tian Lan
- Department of Breast Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, People's Republic of China.
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Geevar Z, Krishnan MN, Venugopal K, Sanjay G, Harikrishnan S, Mohanan PP, Mini GK, Thankappan KR. Prevalence, Awareness, Treatment, and Control of Hypertension in Young Adults (20-39 Years) in Kerala, South India. Front Cardiovasc Med 2022; 9:765442. [PMID: 35509277 PMCID: PMC9058086 DOI: 10.3389/fcvm.2022.765442] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We sought to study the prevalence of hypertension and the levels of awareness, treatment and control of hypertension in the young adults in Kerala, India compared to older adults. Methods We identified 1,221 young adults (men 36.7%) in the age group 20-39 years from the 5,150 participants of the Cardiological Society of India Kerala Coronary artery disease (CAD) and its Risk factors Prevalence (CSI Kerala CRP) Study. We determined prevalence and levels of awareness, treatment and control of hypertension among them compared to older adults. Results We found that among the young adults, 11.2% had hypertension and 33.3% had prehypertension. Hypertension was nearly three times more prevalent among men than women (20.5 vs. 7.5% p < 0.001) while in older adults there was no difference between men and women in its prevalence. Male sex (OR 3.36, 95% CI 2.15-5.25 p-value <0.001), urban residence (OR 2.21, 95% CI 1.52-3.22 p-value <0.001), abdominal obesity (OR 1.74, 95% CI 1.06-2.87 p-value 0.028) and hypercholesterolemia (OR 1.64 95% CI 1.12-2.40 p-value 0.011) were significant factors favoring hypertension in the young adults. Awareness and treatment of hypertension were significantly poor among younger adults compared to older adults. In young adults, awareness, treatment and control of hypertension were significantly lower among men compared to women (23.9 vs. 51.7% p-value 0.001, 12.0 vs. 25.9% p-value 0.045, and 18.5 vs. 37.9% p-value 0.012, respectively). Participants who had checked blood pressure at least once during the previous year had significantly better awareness and treatment (58.7 vs. 24.0% and 41.3 vs. 19.2%, respectively). Conclusions We found that one eighth of young subjects had hypertension with three times higher prevalence of hypertension among men compared to women. Awareness, treatment and control of hypertension were less among young adults and worse in young men compared to young women. Identifying hypertension and measures to control it are important and should be specifically targeted to young men.
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Affiliation(s)
| | | | | | - Ganesh Sanjay
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - S. Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | - G. K. Mini
- Department of Public Health, Global Institute of Public Health, Thiruvananthapuram, India
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Mishra VK, Srivastava S, Muhammad T, Murthy PV. Relationship between tobacco use, alcohol consumption and non-communicable diseases among women in India: evidence from National Family Health Survey-2015-16. BMC Public Health 2022; 22:713. [PMID: 35410193 PMCID: PMC8996590 DOI: 10.1186/s12889-022-13191-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/01/2022] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Based on an increased prevalence of diabetes, asthma and hypertension among women in reproductive age, understanding the risk factors of non-communicable diseases (NCDs) is crucial to inform policy and program interventions to address the problem. In this study, we empirically assessed the associations of behavioural factors such as alcohol consumption and tobacco use and a variety of socioeconomic characteristics with prevalence of NCDs in adult women. METHODS The data were derived from the National Family Health Survey conducted in 2015-16. The effective sample size for the present paper was 699,686 women aged 15-49 years in India. Descriptive statistics along with bivariate analysis were conducted to find the preliminary results. Additionally, multivariable logistic regression analysis was conducted to find the relationship between NCDs and behavioural factors such as alcohol consumption and tobacco use. Moreover, population attributable risk was estimated in the present study. RESULTS It was revealed that 15.9% of women had any of the NCDs. A proportion of 0.8% of women smoked tobacco whereas 5.5% of women consumed smokeless tobacco. Also, a proportion of 1.2% of women consumed alcohol in the current study. The odds of having NCDs among women who smoked tobacco, consumed smokeless tobacco and consume alcohol were 16, 8 and 20% significantly higher than the odds of having NCDs among women who did not smoke tobacco, consume smokeless tobacco and consume alcohol respectively. The population attributable risk of having NCDs was 1.8% (p < 0.001) for women who smoked, 0.8% (p < 0.001) for women who consumed smokeless tobacco and 2.2% (p < 0.001) for women who consumed alcohol. Besides, the odds of having NCDs among overweight and obese women were 2.25 and 3.60 times greater than the odds of having NCDs among women who were underweight. CONCLUSION The findings revealed that smoking and using smokeless tobacco and alcohol consumption were risk factors of NCDs in women. The findings also alarm the focus of maternal and child health programs on NCDs' risk factors like maternal obesity, due to their adverse health consequences on their children too. Also, the coexistence of higher levels of tobacco use and alcohol consumption requires different strategies to address the vulnerability of women towards NCDs, including screening and early detection of NCDs especially among those who smoke or chew tobacco and consume alcohol.
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Affiliation(s)
- Vivek K. Mishra
- Department of Population Studies, Sri Venkateswara University, Tirupati, Andhra Pradesh 517 502 India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - T. Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - P. V. Murthy
- Department of Population Studies and Social Work, College of Arts, Sri Venkateswara University, Tirupati, Andhra Pradesh 517502 India
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Thakur JS, Nangia R. Prevalence, Awareness, Treatment, and Control of Hypertension and Diabetes: Results From Two State-Wide STEPS Survey in Punjab and Haryana, India. Front Public Health 2022; 10:768471. [PMID: 35387189 PMCID: PMC8978601 DOI: 10.3389/fpubh.2022.768471] [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: 08/31/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background India which is home to more than one sixth of the world's population, accounts for more than two thirds of total deaths due to non-communicable diseases (NCD). Out of this, hypertension and diabetes are the most common NCDs. Awareness, treatment, and control of hypertension and diabetes remains a major challenge despite various national programs being run to curb the rising burden NCDs. In order to fill the knowledge gap, awareness, treatment, and control of diabetes and hypertension were studied by using data from the STEPS survey among the adult population in two major northern Indian states of Punjab and Haryana. Methods Two state-wide NCD risk factors surveys were conducted using WHO STEPS methodology among 5,127 individuals in Punjab and 5,078 individuals in Haryana aged 18-69 years in the year 2014-15 and 2016-18. Standardized questionnaire was used to determine the behavioral risk factors in step one followed by anthropometric measurements for physical risk factors in step two and in the third step serum and urine samples were collected for biochemical risk factors. Results The prevalence of hypertension in Punjab was 40.1% while that in Haryana was 26.2%. In Punjab, only 48.3% of the hypertensive were aware of their condition, 30.9% were on treatment while only 18.3% of the cases were controlled. While in Haryana 33.4% of the respondents were aware of their condition, 26.3% are on treatment while only 12% of the cases were controlled. Similarly, the prevalence of diabetes was 14.3 and 15.1% in Punjab and Haryana, respectively. In Punjab 34.2% of diabetics were aware of their condition, 28.2% were on treatment while only 14.2% of the cases were controlled. The awareness and control rates in Haryana were similar to that in Punjab. 29.5% of the respondents were aware of their condition, 22.4% were on treatment while only 13.8% of the cases of diabetes were controlled. Family history of diabetes and hypertension was found to be associated with higher odds of being aware, on treatment and controlled blood glucose and blood pressure levels in both Punjab and Haryana. Discussion Hypertension and diabetes are a major public health problem in Punjab and Haryana and awareness, treatment and control rates are low which require specific interventions with a focus on access to treatment, regular follow up for better control. There is an urgent need to effectively implement the existing national NCD programmes in these states in India.
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Affiliation(s)
- J S Thakur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ria Nangia
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Achieving the Latest American Heart Association and American College of Cardiology Therapeutic Goals for Hypertension With Combination Therapy and Its Effects on Blood Pressure and Central Hemodynamic Parameters. Am J Cardiol 2022; 168:78-82. [PMID: 35063267 DOI: 10.1016/j.amjcard.2021.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 01/03/2023]
Abstract
The present United States and European treatment guidelines recommend that antihypertensive therapy be initiated with a combination of agents from different classes to facilitate the achievement of control of blood pressure (BP). This prospective, randomized, open-label study was conducted at 3 tertiary hospitals in India to evaluate the effects of combination therapy with an angiotensin receptor blocker and a calcium antagonist on office BP and central hemodynamic parameters in patients with untreated hypertension or uncontrolled BP (>130/>80 mm Hg) during treatment with antihypertensive monotherapy. Patients were randomized to treatment with telmisartan 40 mg/day + amlodipine 5 mg/day or telmisartan 40 mg/day + cilnidipine 10 mg/day. Change from baseline to 8 weeks of treatment was assessed for seated office BP, ambulatory BP monitoring, and seated central hemodynamics (central BP, aortic augmentation index, central aortic augmentation pressure, and pulse wave velocity). A total of 94 of 96 enrolled patients completed the study. From baseline to 8 weeks a significant decrease was observed in both telmisartan + amlodipine and telmisartan + cilnidipine groups for mean BP (148.0 ± 12.80 to 124.0 ± 10.4 and 144.5 ± 10.2 to 123.0 ± 10.0 mm Hg, respectively; both p <0.001); in only telmisartan + amlodipine group for mean central aortic systolic and diastolic BP (131.1 ± 19.1 to 119.7 ± 14.9 mm Hg [p <0.001] and 93.3 ± 12.0 to 89.2 ± 14.6 mm Hg [p = 0.0008], respectively) and for central aortic pulse wave velocity (7.6 ± 1.4 to 7.2 ± 1.3 m/s, p = 0.0011); in only telmisartan + cilnidipine group for aortic augmentation index (27.5 ± 14.6 to 22.3 ± 12.2; p = 0.0178). Heart rate was unchanged in both treatment groups. Combination therapy with an angiotensin receptor blocker and a calcium antagonist effectively reduced BP to below the new <130/80 mm Hg target and had favorable effects on central hemodynamics.
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Mulchandani R, Babu GR, Kaur A, Singh R, Lyngdoh T. Factors associated with differential COVID-19 mortality rates in the SEAR nations: a narrative review. IJID REGIONS 2022; 3:54-67. [PMID: 35720145 PMCID: PMC8882069 DOI: 10.1016/j.ijregi.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/09/2023]
Abstract
Objectives Since December 2019, the world has been grappling with the COVID-19 pandemic, which has caused severe loss of lives, the breakdown of health infrastructure, and disruption of the global economy. There is growing evidence on mortality patterns in high-income countries. However, similar evidence from low/middle-income nations is lacking. Our review aimed to describe COVID-19 mortality patterns in the WHO-SEAR nations, and explore the associated factors in order to explain such trends. Methods A systematic and comprehensive search was undertaken in PubMed and Google Scholar to obtain maximum hits on COVID-19 mortality and its determinants in the SEAR, using a combination of MeSH terms and Boolean operators. The data were narratively synthesized in detail under appropriate themes. Results Our search identified 6411 unique records. Mortality patterns were described in terms of important demographical and epidemiological indicators. Gaps in available evidence and paucity of adequate research in this area were also highlighted. Conclusions This review examined significant contributors to COVID-19 mortality across SEAR nations, while emphasizing issues relating to insufficient studies and data quality, and reporting challenges and other concerns in resource-constrained settings. There is a compelling need for more work in this area, to help inform decision making and improve public-health response.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, India
| | - Giridhara R Babu
- Indian Institute of Public Health-Bengaluru, Public Health Foundation of India, Bengaluru, India
- Senior Fellow, DBT-Wellcome Trust-India Alliance
| | - Avinash Kaur
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, India
| | - Ranjana Singh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, India
| | - Tanica Lyngdoh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, India
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
- Corresponding author: Dr Tanica Lyngdoh, Scientist ‘E’, Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India, Tel: +91 9560048416.
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Chakraborty S, Rai RK, Biswas AK, Barik A, Gurung P, Praveen D. Health care seeking behaviour and financial protection of patients with hypertension: A cross-sectional study in rural West Bengal, India. PLoS One 2022; 17:e0264314. [PMID: 35213621 PMCID: PMC8880395 DOI: 10.1371/journal.pone.0264314] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Elevated blood pressure or hypertension is responsible for around 10 million annual deaths globally, and people residing in low and middle-income countries are disproportionately affected by it. India is no exception, where low rate of treatment seeking for hypertension coupled with widespread out-of-pocket payments (OOPs) have been a challenge. This study assessed the pattern of health care seeking behaviour and financial protection along with the associated factors among hypertensive individuals in rural West Bengal, India. Method and findings A cross-sectional study was conducted in Birbhum district of the state of West Bengal, India, during 2017–2018, where 300 individuals were recruited randomly from a list of hypertensives in a population cohort. Healthcare seeking for hypertension and related financial protection in terms of–OOPs and expenses relative to monthly per-capita family expenditure, were analysed. Findings indicated that 47% of hypertensives were not on treatment. Among those under treatment, 80% preferred non-public facilities, and 91% of them had wide-spread OOPs. Cost of medication was a major share of expenses followed by transportation cost to access public health care facility. Multivariable logistic regression analysis indicated longer duration of disease (adjusted odds ratio (aOR): 5.68, 95% Confidence Interval (CI) 1.24–25.99) and health care seeking from non-public establishment (aOR: 34.33, CI: 4.82–244.68) were associated with more incident of OOPs. Linear regression with generalized linear model revealed presence of co-morbidities (adjusted coefficient (aCoeff)10.28, CI: 4.96,15.61) and poorer economic groups (aCoeffpoorest 11.27, CI 3.82,18.71; aCoefflower-middle 7.83, CI 0.65,15.00 and aCoeffupper-middle 7.25, CI: 0.80,13.70) had higher relative expenditure. Conclusion This study suggests that individuals with hypertension had poor health care seeking behaviour, preferred non-public health facilities and had suboptimal financial protection. Economically poorer individuals had higher burden of health expenditure for treatment of hypertension, which indicated gaps in equitable health care delivery for the control of hypertension.
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Affiliation(s)
- Sandipta Chakraborty
- Institute of Public Health, Kalyani, West Bengal, India
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, West Bengal, India
| | - Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Economics, University of Goettingen, Goettingen, Germany
- Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
- * E-mail:
| | | | - Anamitra Barik
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Suri District Hospital, Suri, West Bengal, India
| | | | - Devarsetty Praveen
- Primary Health Care Research, The George Institute for Global Health, Hyderabad, Telangana, India
- Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Kothavale A, Puri P, Sangani PG. Quantifying population level hypertension care cascades in India: a cross-sectional analysis of risk factors and disease linkages. BMC Geriatr 2022; 22:98. [PMID: 35114935 PMCID: PMC8815207 DOI: 10.1186/s12877-022-02760-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/11/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypertension is associated with higher morbidity and mortality burden, and is reported to pose severe repercussions on those above the age of 60 years. Despite the growing concern, empirical evidence providing nationally representative estimates of hypertension care cascades for the elderly population are inadequate in India. Therefore, the present study aims to quantify the magnitude of hypertension care cascades, identify the co-morbidities attributed to hypertension and recognize lifestyle modifications to reduce the instances of uncontrolled blood pressure among the elderly population in India. METHOD This study employed data on 28,109 elderly individuals from the Longitudinal Ageing Study in India, 2017-18. Descriptive and multivariable analyses were performed to identify the burden and correlates of hypertension and uncontrolled blood pressure levels. Population Attributable Risk was computed to identify deteriorating health implications and recognize viable solutions to improve the situation. RESULTS The findings suggest that elderly experiences loss at all stages of hypertension care, namely, at the level of measured hypertension (72.5%), diagnosis/awareness (57.3%), treatment (50.5%), and control (27.5%). The highest dip was observed at the level of blood pressure control. The findings hint towards the linkages between socio-economic, demographic, and lifestyle factors with hypertension and uncontrolled blood pressure levels. Caste, religion, living arrangement, MPCE quintile, residence, family history of hypertension, working status, and alcohol consumption were the significant predictors of uncontrolled hypertension. The findings quantified the proportion of diseased cases attributed to hypertension, and highlighted essential contributors of overall and uncontrolled hypertension. CONCLUSIONS There is an urgent need to improve access to cost-effective anti-hypertensive prescriptions to curtail the increasing burden of uncontrolled blood pressure and some other co-morbid diseases. Thus, if apprehended cautiously, findings from this study can serve to design practical approaches aimed at control, prevention, and management of hypertension among the elderly population of India.
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Affiliation(s)
- Ajinkya Kothavale
- International Institute for Population Sciences, Govandi Station Road, Deonar, Maharashtra 400088 Mumbai, India
| | - Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Deonar, Maharashtra 400088 Mumbai, India
| | - Purvi G. Sangani
- International Institute for Population Sciences, Govandi Station Road, Deonar, Maharashtra 400088 Mumbai, India
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Routray SS, Ray GK, Prakash S, Sahu A, Naik A, Mukherjee S. Impact of COVID-19 on blood donor deferral patterns during the COVID-19 pandemic: A retrospective analysis. Vox Sang 2022; 117:656-663. [PMID: 35114023 DOI: 10.1111/vox.13240] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Blood donor deferral is an essential tool for blood safety. The ongoing COVID-19 pandemic has adversely affected blood transfusion services all over the world. But its impact on donor deferral rate and the pattern is unclear in light of the new donor deferral policy due to the COVID-19 pandemic. MATERIALS AND METHODS This retrospective study was divided into pre-COVID and COVID (15 March 2019-14 March 2021). All the deferred donors were divided into six different categories: (1) medical causes, (2) surgical causes, (3) drugs and vaccination, (4) risk of transfusion-transmitted diseases, (5) miscellaneous causes and (6) flu-like symptoms. In addition, COVID-related deferrals were also incorporated. All these above categories along with the donor demography were analysed by SPSS software version 25. RESULTS The donor deferral rate was 17.03% and 12.74% during the pre-COVID and COVID periods, respectively. During the pre-COVID period, Category 3 deferrals and during COVID period, Category 6 deferrals were significantly higher. A reversal in pattern with increased blood pressure (40.2% vs. 24.04%) over-riding low haemoglobin (34.77% vs. 55.5%) was noted in the Category 1 deferral during the COVID period. Category 1 deferral was more in middle-aged adults as compared to young and old adults (p < 0.05). Among middle-aged adults, deferral due to flu-like symptoms was also significantly more during the COVID period (p < 0.05). CONCLUSION COVID-19 significantly affected the donor pool and changed the pattern of donor deferral. Understanding donor deferral patterns may help in identifying targeted donor populations and planning donor recruitment strategies in future pandemic crises.
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Affiliation(s)
- Suman Sudha Routray
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Gopal Krushna Ray
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Satya Prakash
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ansuman Sahu
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Archana Naik
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Somnath Mukherjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
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Health System Performance for Multimorbid Cardiometabolic Disease in India: A Population-Based Cross-Sectional Study. Glob Heart 2022; 17:7. [PMID: 35174048 PMCID: PMC8815445 DOI: 10.5334/gh.1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 12/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The prevalence of multimorbidity in low- and middle-income countries (LMICs) is thought to be rising rapidly. Research on the state of healthcare for multimorbidity in LMICs is needed to provide an impetus for integration of care across conditions, a baseline to monitor progress, and information for targeting of interventions to those most in need. Focusing on multimorbid cardiometabolic disease in India, this study thus aimed to determine 1) the proportion of adults with co-morbid diabetes and hypertension who successfully completed each step of the chronic disease care continuum from diagnosis to control for both conditions, and 2) how having additional cardiovascular disease (CVD) risk factors is associated with health system performance along the care continuum for diabetes, hypertension, and co-morbid diabetes and hypertension. Methods: Using a nationally representative household survey carried out in 2015 and 2016 among women aged 15–49 years and men aged 15–54 years, we created a ‘cascade of care’ for diabetes, hypertension, and co-morbid diabetes and hypertension by determining the proportion of those with the condition who had been diagnosed, were on treatment, and achieved control. We used Poisson regression with a robust error structure to estimate how having additional cardiovascular disease (CVD) risk factors (diabetes, hypertension, current smoking, and obesity) was associated with reaching each cascade step for diabetes, hypertension, and co-morbid diabetes and hypertension. Findings: Seven hundred thirty-four thousand seven hundred ninety-four adults were included in the analysis. Among individuals with co-morbid diabetes and hypertension, 28·8% (95% CI, 26·7%–31·0%), 16·1% (95% CI, 14·4%–17·9%), and 3·7% (95% CI, 2·8%–4·9%) – with these proportions varying between states by a factor of 4·8, 7·9, and 56·8 – were aware, treated, and achieved control of both conditions, respectively. Men, adults with lower household wealth, and those living in rural areas were less likely to reach each cascade step. Having additional CVD risk factors generally did not increase the probability of reaching each cascade step for diabetes, hypertension, and co-morbid diabetes and hypertension, except that having concurrent diabetes increased the probability of successfully transitioning through the hypertension care cascade. Interpretation: While varying widely between states and population groups, health system performance for co-morbid diabetes and hypertension is generally low in India, and there appears to be little integration of care across CVD risk factors. Funding: European Research Council.
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Maksimov SA, Balanova YA, Shalnova SA, Muromtseva GA, Kapustina AV, Drapkina OM. Regional living conditions and the prevalence, awareness, treatment, control of hypertension at the individual level in Russia. BMC Public Health 2022; 22:202. [PMID: 35094684 PMCID: PMC8801098 DOI: 10.1186/s12889-022-12645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The objective of our study was to investigate the associations of characteristics inherent in large Russian Federation (RF) regions with prevalence, awareness, treatment and control of hypertension at the individual level.
Methods
Regional characteristics were obtained from the official website of the Federal State Statistics Service of the RF. We employed principal component analysis to reduce the dimensionality of data, which allowed defining five integral regional indices. Prevalence, awareness, treatment and control of hypertension were assessed from the data of the cross-sectional stage of ESSE-RF study conducted in 2013–2014. The final sample included 19,791 patients from 12 RF regions. Generalized estimating equations were used to identify the associations of regional indices with prevalence, awareness, treatment and control of hypertension at the individual level, taking into consideration nested data structures (study subjects in the regions).
Results
The index characterizing deterioration of social living conditions and societal marginalization exhibited positive associations with the prevalence of hypertension among men (OR = 1.18; 95% CI: 1.05–1.32) and elderly people (OR = 1.16; 95% CI: 1.02–1.32). Moreover, deterioration in the social environment was associated with a reduction in treatment (OR = 0.76; 95% CI: 0.64–0.90) and control of hypertension (OR = 0.79; 95% CI: 0.69–0.90). Hypertension awareness was directly connected with demographic crisis (OR = 1.13; 95% CI: 1.02–1.25) and augmented industrial development (OR = 1.15; 95% CI: 1.01–1.33) in the regions. The association of regional living conditions with the prevalence of hypertension is relatively weak, compared to predictors at the individual level, but this influence is important for awareness, treatment and control of hypertension.
Conclusion
The study contributed to evaluating the associations of the vital characteristics inherent in population of large RF regions with arterial hypertension prevalence, as well as with awareness, treatment and control of this disease. Our results provided original insights from the standpoint of cardiovascular disease epidemiology in the RF, as well as in the context of investigating the impact of living conditions on population health.
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Mini GK, Sathish T, Sarma PS, Thankappan KR. Effectiveness of a School-Based Educational Intervention to Improve Hypertension Control Among Schoolteachers: A Cluster-Randomized Controlled Trial. J Am Heart Assoc 2022; 11:e023145. [PMID: 35023346 PMCID: PMC9238527 DOI: 10.1161/jaha.121.023145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background The control of hypertension is low in low- and middle-income countries like India. We evaluated the effects of a nurse-facilitated educational intervention in improving the control rate of hypertension among school teachers in India. Methods and Results This was a cluster-randomized controlled trial involving 92 schools in Kerala, which were randomly assigned equally into a usual care group and an intervention group. Participants were 402 school teachers (mean age, 47 years; men, 29%) identified with hypertension. Participants in both study groups received a leaflet containing details of a healthy lifestyle and the importance of regular intake of antihypertensive medication. In addition, the intervention participants received a nurse-facilitated educational intervention on hypertension control for 3 months. The primary outcome was hypertension control. Key secondary outcomes included systolic blood pressure, diastolic blood pressure, and the proportion of participants taking antihypertensive medications. For the primary outcome, we used mixed-effects logistic regression models. Two months after a 3-month educational intervention, a greater proportion of intervention participants (49.0%) achieved hypertension control than the usual care participants (38.2%), with an odds ratio of 1.89 (95% CI, 1.06-3.35), after adjusting for baseline hypertension control. The odds of taking antihypertensive medications were 1.6 times higher in the intervention group compared with the usual care group (odds ratio, 1.62; 95% CI, 1.08-2.45). The reduction in mean systolic blood pressure was significantly greater in the intervention group by 4.2 mm Hg (95% CI, -7.2 to -1.1) than in the usual care group. Conclusions A nurse-facilitated educational intervention was effective in improving the control and treatment rates of hypertension as well as reducing systolic blood pressure among schoolteachers with hypertension. Registration URL: https://www.ctri.nic.in; Unique Identifier: CTRI/2018/01/011402.
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Affiliation(s)
- G K Mini
- Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala India.,Global Institute of Public Health, Ananthapuri Hospitals, and Research Institute Trivandrum Kerala India.,Women's Institute for Social and Health Studies (WISHS)Women's Social and Health Studies Foundation Trivandrum Kerala India
| | | | - Prabhakaran Sankara Sarma
- Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala India
| | - Kavumpurathu Raman Thankappan
- Department of Public Health and Community Medicine Central University of Kerala, KasaragodTejaswini Hills Periye Kerala India
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Parashar A, Willeboordse M, Gupta AK, van Schayck OCP. Effect of brief interventions to promote behavior change on clinical outcomes of selected non-communicable diseases - The World Health Organization (WHO) package of essential non-communicable disease (PEN) interventions for primary health care settings- study protocol of a quasi-experimental study. Contemp Clin Trials 2022; 113:106675. [PMID: 34999281 DOI: 10.1016/j.cct.2022.106675] [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: 08/19/2021] [Revised: 12/05/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The World Health Organization designed a minimum set of interventions, the World Health Organization Package of Essential Noncommunicable disease interventions (WHO PEN), for detection, prevention, treatment, and care of Non-communicable diseases (NCDs) in resource constraint settings. This intervention study examines the effectiveness of the integration of components of WHO PEN protocols on improved clinical outcomes among patients of cardiovascular disease and diabetes mellitus in urban and rural primary health care settings. METHODS In this quasi-experimental study (pre-test post-test control group design), trained non-physician health workers will provide behavior change interventions regarding four major NCD risk factors, i.e., tobacco use, excessive alcohol intake, physical inactivity, an unhealthy diet; using 'Brief Advice' to the NCD patients enrolled in the experimental arm. The health centers in the control arm will provide the usual care to all the NCD patients. The intervention will last for six months, and the two groups will be followed up at two months, four months, and six months since enrolment in the study. RESULTS The primary outcome is improved mean blood pressure levels and the proportion of patients with controlled blood pressure levels. The secondary outcomes assess medication adherence, self-reported reductions in tobacco and alcohol intake, consumption of a heart-healthy diet, and regular physical activity. DISCUSSION This intervention trial will provide evidence for the utility of individual-level behavioral interventions for adequate management of NCDs. TRIAL REGISTRATION Clinical Trial Registry of India: CTRI/2018/12/016707.
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Affiliation(s)
- Anupam Parashar
- Department of Community Medicine, Indira Gandhi Medical College Shimla India, Maastricht University Ph.D. student, Maastricht, the Netherlands.
| | - Maartje Willeboordse
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Anmol Kumar Gupta
- Department of Community Medicine, Indira Gandhi Medical College Shimla, India
| | - Onno C P van Schayck
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Uncontrolled hypertension in a rural population of Jammu and Kashmir. Indian Heart J 2022; 74:484-487. [PMID: 36460055 PMCID: PMC9773274 DOI: 10.1016/j.ihj.2022.11.012] [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: 09/02/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022] Open
Abstract
AIM Evaluation of the status of uncontrolled hypertension in diagnosed hypertensives who had been advised drug treatment in the rural areas of 6 districts in Jammu & Kashmir (J&K) and also the risk factors associated with it. METHODS The study was a cross-sectional observational study conducted between August 2020 to July 2021 in the form of health camps in six government health centres in 6 different rural districts. The camps were focussed on patients with hypertension, diabetes with or without heart disease. The areas included Machil in Kupwara, Khan Sahib in Budgam, Rajpora and Hawal in Pulwama, Rainawari in the Srinagar, Banihal in Ramban, and Jagti in Jammu. Enrolled patients were examined for body weight, blood pressure (BP), random blood sugar and serum lipid profile. The definition of hypertension was as per the eighth Joint National Committee (JNC-8) guidelines. RESULTS A total of 600 patients (50.1% males) were evaluated. Of these 335 (55%) had history of being diagnosed hypertension and had been recommended drugs for BP control Male: Female ratio 1:0.8.211(63.5%) of these had un controlled blood pressures on measurement. Two or more drugs had been prescribed in 65 (30.8%) patients, 34 (16%) were taking only single drug and 112(53%) were not on any drug. Uncontrolled hypertension was seen more often in age group of 40-60 years (49%), subjects more than 60 years had it in 40%. The comparison of risk factors between patients with diagnosed hypertension with those without it revealed use of tobacco, consumption of salted tea, presence of diabetes, dyslipidaemia as significant factors for the presence of uncontrolled hypertension. CONCLUSION Uncontrolled hypertension in known patients prescribed drugs is highly prevalent in the rural population of J&K. Steps to mitigate this problem are needed on top priority.
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Bhoyar AP, Mahale R, Kamble N, Holla V, Pal PK, Yadav R. Spectrum of Movement Disorder Emergencies in a Tertiary Care Center in India: A Prospective Observational Study. Ann Indian Acad Neurol 2022; 25:890-896. [PMID: 36561002 PMCID: PMC9764897 DOI: 10.4103/aian.aian_295_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/07/2022] [Accepted: 05/08/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Movement disorders can present in emergency services in an acute severe form which can be life threatening if not recognized. The relative frequency and spectrum of movement disorder emergencies have not been studied extensively. We studied the frequency, spectrum, and outcome of patients presenting with movement disorders emergencies. Methods This was a prospective, descriptive single center study. Patients presenting with acute movement disorders to the neurology emergency services of the institute during the study period from April 2019 to June 2021 were analyzed. Results A total of 71 patients presented with acute movement disorders during the study period. Out of them, 65 patients had hyperkinetic and 6 patients had hypokinetic movement disorders emergencies. Fifteen patients were below the age of 18 years. Chorea (59.1%) was the most common movement disorder emergencies followed by dystonia and myoclonus in adults. Dystonia (33.3%) was the common movement disorder emergencies in children. Hyperglycemia followed by stroke was the most common etiology of acute movement disorders. Conclusion This study brings out some novel findings on the movement disorders emergencies in Indian scenario. Chorea was the most common movement disorder emergencies presenting to the neurology emergency services. Early recognition and management of movement disorders emergencies help in reducing morbidity.
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Affiliation(s)
- Abhishek P. Bhoyar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vikram Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India,Address for correspondence: Dr. Ravi Yadav, Professor, Department of Neurology, First Floor, Neurosciences Faculty Block, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru - 560 029, Karnataka, India. E-mail:
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Lee J, Wilkens J, Meijer E, Sekher TV, Bloom DE, Hu P. Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study. PLoS Med 2022; 19:e1003855. [PMID: 34982770 PMCID: PMC8726460 DOI: 10.1371/journal.pmed.1003855] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/26/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Hypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management. METHODS AND FINDINGS We designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017-2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%-46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%-56.5%) had been diagnosed, 38.9% (95% CI 38.1%-39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%-32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14-1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61-0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68-1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86-1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00-1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10-1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p < 0.001) improvement in hypertension management from 2010 to 2017-2019. The limitations of this study include the pilot sample being relatively small and that it recruited from only 4 states. CONCLUSIONS Although considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment.
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Affiliation(s)
- Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, United States of America
- Department of Economics, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
| | - Jenny Wilkens
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, United States of America
| | - Erik Meijer
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, United States of America
| | - T. V. Sekher
- International Institute for Population Sciences, Mumbai, India
| | - David E. Bloom
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Peifeng Hu
- Division of Geriatric Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
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Sukumar GM, Dagar V, Kupatira K, Banandur PS, Gopalkrishna G. Incidence and Risk for Hypertension among Regular Medical Examination Attendee Cohort in an Automobile Industry. A Cox- Regression Analysis Model. Indian J Occup Environ Med 2022; 26:9-15. [PMID: 35571540 PMCID: PMC9106117 DOI: 10.4103/ijoem.ijoem_307_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction With nearly 1,612,505 industrial workers in Karnataka, controlling hypertension among them is necessary to reduce subsequent non-communicable diseases (NCDs). However, information on prevalence, incidence, and risk for hypertension among industrial workers is limited. Objectives To estimate the prevalence, incidence proportion, incidence rate, and risk for hypertension among annual medical examination [AME] attendee cohort between 2010 and 2014 in an automobile industry in India. Materials and Methods Longitudinal record analysis (cohort approach) of 640 regular AME attendees between 2010 and 2014 was performed to estimate incidence and incidence rates. Cox regression was conducted to estimate the risk for hypertension in the study period. Necessary permission and ethics clearance was obtained. Results and Conclusion The prevalence of hypertension significantly increased from 8.8% in 2010 to 26.6% in 2014. The small increase in mean blood pressure (BP) resulted in large increases in the prevalence of hypertension. The incidence rate increased from 6.5 per 1000 person-months of observation in 2012 to 14.5 in 2014. No significant risk for hypertension was observed for the work department and type of plant. Results indicate a rising burden of hypertension with no specific risks associated with different work departments or types of plants. AME data is a utility value to monitor hypertension trends among employees and evaluate the effectiveness of worksite health programs to reduce hypertension.
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Affiliation(s)
- Gautham Melur Sukumar
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India,Address for correspondence: Dr. Gautham Melur Sukumar, Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru - 560 029, Karnataka, India. E-mail:
| | - Vaishali Dagar
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Kowshik Kupatira
- Chief Medical Officer, Occupational Health Unit, Autombile Industry Pvt Limited, Industry, Bidadi, Karnataka, India
| | - Pradeep S. Banandur
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Gururaj Gopalkrishna
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
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142
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Desai I, Kumar N. Movement Disorder Emergencies: When "Too Much" or "Too Little" Movement Needs Urgent Attention!! Ann Indian Acad Neurol 2022; 25:801-802. [PMID: 36561020 PMCID: PMC9764903 DOI: 10.4103/aian.aian_708_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ishita Desai
- Department of Neurology, Teerthanker Mahaveer University Hospital, Moradabad, Uttar Pradesh, India
| | - Niraj Kumar
- Department of Neurology and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,Address for correspondence: Dr. Niraj Kumar, Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. E-mail:
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143
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Mirdamadi A, Abrishamkar R, Kargaran A. Comparing outcomes of clonidine and captopril in patients with hypertensive urgency: A randomized clinical trial. ARYA ATHEROSCLEROSIS 2022; 18:1-6. [PMID: 36818154 PMCID: PMC9931607 DOI: 10.48305/arya.v18i1.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 02/24/2023]
Abstract
BACKGROUND Hypertension (HTN) is the second leading risk factor for death and disability. One fourth of healthcare in Eastern Europe and Central Asia is being spent on blood pressure (BP)-related diseases. An important situation in patients with high BP is hypertensive crisis (BP > 180/120 mmHg), which is divided to hypertensive emergency and urgency. Therefore, here, we decided to compare the effect of captopril and clonidine in patients with hypertensive urgencies, and their side effects. METHODS This was a parallel-group randomized clinical trial. Patients, who referred to emergency ward with any symptoms of hypertensive crisis, underwent a careful history taking and clinical examination. Individuals with systolic BP (SBP) ≥ 180 mmHg or diastolic BP (DBP) ≥ 110 mmHg with no evidence of end organ damage were randomly assigned into two interventions, clonidine and captopril. 25% decrease in BP was considered as ideal relief. RESULTS Regarding the duration of response to treatment drugs, patients who received clonidine relieved significantly faster than those who received captopril (P = 0.016). Moreover, the frequencies of side effects such as headache, dizziness/vertigo, dry mouth, and drowsiness in the clonidine group were significantly lower than captopril group (P < 0.05). CONCLUSION Patients in clonidine group relieved sooner and experienced fewer side effects. Therefore, this study suggests clonidine as a more effective therapeutic for hypertensive urgency compared with captopril.
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Affiliation(s)
- Ahmad Mirdamadi
- Associate Professor, Department of Cardiology, Najafabad Branch, Islamic Azad University, Isfahan, Iran
| | - Rana Abrishamkar
- Medical Practitioner, Najafabad Branch, Islamic Azad University, Isfahan, Iran,Address for correspondence: Rana Abrishamkar; Medical Practitioner, Najafabad Branch, Islamic Azad University, Isfahan, Iran
| | - Afrooz Kargaran
- Medical Practitioner, Najafabad Branch, Islamic Azad University, Isfahan, Iran
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144
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Effect of Yoganidra on Blood Pressure, Hs-CRP, and Lipid Profile of Hypertensive Subjects: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2858235. [PMID: 35003295 PMCID: PMC8739171 DOI: 10.1155/2021/2858235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/28/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
Background Yoganidra is a systematic method of promoting a state of complete physical, mental, and emotional relaxation. It is a safe, inexpensive, and very effective method of management of hypertension when used along with standard pharmacological therapy. This study aims to assess the effect of yoganidra on blood pressure (both systolic blood pressure (SBP) and diastolic blood pressure (DBP)), Hs-CRP, and lipid profile of hypertensive subjects at the time of enrollment (subjects that are hypertensive at the time of enrollment). Methods Both treated and untreated subjects (n = 74) with hypertension (blood pressure ≥140/90 mmHg) and age between 35 and 70 years were included in this study after obtaining ICMR-NIN-IEC approval and written informed consent from all subjects. Subjects with critical illness and/or psychological disturbances were excluded from this study. The subjects in the experimental group (n = 31) practiced yoganidra for 45 minutes daily for 12 weeks under strict supervision. There was no intervention in the control group (n = 43). Weekly blood pressure was recorded in the experimental group, whereas it was performed at baseline and at endpoint for control groups. Hs-CRP and lipid profile were estimated at baseline and endpoint for both the groups. Results A significant reduction in mean SBP from 142.9 mm Hg (SD ± 16.46) to 118.68 mm Hg (SD ± 9.21; p value 0.0001) and DBP from 89.84 mm Hg (SD ± 10.42) to 77.03 mm Hg (SD ± 6.47: p value 0.0001) was observed among the experimental group after 12 weeks of yoganidra practice when compared with the control group. A significant reduction in mean Hs-CRP (2.21 ± 1.49 to 1.06 ± 0.82 mg/L, p < 0.001∗∗∗) was observed among the experimental group. There were no significant differences between triglycerides and total cholesterol levels, whereas LDL-C and HDL-C showed a trend of improvement in the experimental group after intervention. Conclusions In this pilot study, we observed a significant reduction in blood pressure and Hs-CRP in the yoganidra group compared with the control group. There were no significant side effects observed in the intervention group during the study period.
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145
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Dalal JJ, Kerkar P, Guha S, Dasbiswas A, Sawhney JPS, Natarajan S, Maddury SR, Kumar AS, Chandra N, Suryaprakash G, Thomas JM, Juvale NI, Sathe S, Khan A, Bansal S, Kumar V, Reddi R. Therapeutic adherence in hypertension: Current evidence and expert opinion from India. Indian Heart J 2021; 73:667-673. [PMID: 34861979 PMCID: PMC8642659 DOI: 10.1016/j.ihj.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 12/01/2022] Open
Abstract
Hypertension (HTN) is a globally prevalent non-communicable disease contributing significantly to cardiovascular (CV) morbidity and mortality. In achieving control of HTN, therapeutic adherence plays a crucial role. Studies from India identify varying rates of adherence to antihypertensive medications. Multiple factors determine treatment adherence in HTN. In India, factors such as lower socioeconomic status, health literacy, asymptomatic nature of disease, forgetfulness, cost of medications, and duration of HTN determine the adherence. An excellent physician-patient relationship incorporating adequate counseling along with the use of other methods can identify poor adherence. Improving adherence necessitates incorporating a multipronged approach with strategies directed at physicians, patients, and health systems. With innovation in therapeutics, the pharmaceutical sector can contribute significantly to improve adherence. Furthermore, increasing adherence to lifestyle interventions can help achieve better HTN control and improve CV outcomes. In the Indian context, more emphasis is necessary on patient education, enhanced physician-patient relationship and communication, increased access to health care, and affordability in improving therapeutic adherence in HTN.
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Affiliation(s)
- Jamshed J Dalal
- Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
| | - Prafulla Kerkar
- Department of Cardiology, KEM Hospital, Mumbai, Maharashtra, India.
| | | | - Arup Dasbiswas
- Department of Cardiology, NRS Medical College, Kolkata, West Bengal, India.
| | - J P S Sawhney
- Dept. of Cardiology, Sir Ganga Ram Hospital, New Delhi, India.
| | | | | | | | | | | | - Joy M Thomas
- Dr. Joy Thomas Heart Care, Bharathi Salai, Mugappair West, Chennai, India.
| | - N I Juvale
- Department of Cardiology, Saifee Hospital, Mumbai, India.
| | | | - Aziz Khan
- Crescent Hospital & Heart Centre, Dhantoli, Nagpur, Maharashtra, India.
| | - Sandeep Bansal
- Department of Cardiology, Safdarjung Medical College, Delhi, India.
| | | | - Rajshekhar Reddi
- Department of Neurology, Max Superspecialty Hospital, Saket, New Delhi, India.
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146
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Bonsang E, Caroli E, Garrouste C. Gender heterogeneity in self-reported hypertension. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101071. [PMID: 34757302 DOI: 10.1016/j.ehb.2021.101071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 06/13/2023]
Abstract
We investigate the gender gap in hypertension misreporting using the French Constances cohort. We show that false negative reporting of hypertension is more frequent among men than among women, even after conditioning on a series of individual characteristics. As a second step, we investigate the causes of the gender gap in hypertension misreporting. We show that women go to the doctor more often than men do and that they have better knowledge of their family medical history. Once these differences are taken into account, the gender gap in false negative reporting of hypertension is reversed. This suggests that information acquisition and healthcare utilisation are crucial ingredients in fighting undiagnosed male hypertension.
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Affiliation(s)
- Eric Bonsang
- Université Paris-Dauphine, Université PSL, LEDA, CNRS, IRD, 75016 PARIS, FRANCE.
| | - Eve Caroli
- Université Paris-Dauphine, Université PSL, LEDA, CNRS, IRD, 75016 PARIS, FRANCE and IZA
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147
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Jain N, Pathania M, Bahurupi Y. Assessment of Sleep Quality and Quality of Life in Hypertensive Subjects at a Tertiary Care Hospital in Uttarakhand, India. Int J Prev Med 2021; 12:158. [PMID: 35070191 PMCID: PMC8724674 DOI: 10.4103/ijpvm.ijpvm_465_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/21/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hypertension is a leading risk factor for cardiovascular diseases with prevalence of 33% in urban and 25% in rural population in India. Studies have suggested that hypertension significantly affects the sleep quality and quality of life of subjects. Therefore, this study aimed to establish a correlation between sleep quality, quality of life, and hypertension in Uttarakhand. METHODS This observational cross-sectional study was carried out on hypertensive subjects at a tertiary care hospital in Uttarakhand following ethics approval. After taking consent from participants, blood pressure and anthropometric measurements were recorded. Then, their sleep quality and quality of life was assessed using Pittsburgh sleep quality index (PSQI) and WHO-QOL BREF questionnaire respectively. Statistical analysis was then carried out to correlate these parameters. RESULTS 168 participants were recruited for this study, with 43.5% males and 56.5% females. It was found that 77.4% of these subjects were having poor sleep quality with the mean global PSQI score as 7.90 ± 3.713. These subjects assessed their Quality of life to be worst in physical domain (12.68 ± 3.13), followed by psychological, social relationship domain and environment domain. A significant association was found between sleep quality and different stages of hypertension (P value = 0.039) but quality of life and stages of hypertension have no significant association (P value > 0.05). CONCLUSIONS Sleep quality, quality of life and blood pressure are correlated. So, clinicians should also focus on improving their patient's sleep quality and quality of life besides pharmacological treatment.
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Affiliation(s)
- Neha Jain
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Monika Pathania
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,Address for correspondence: Dr. Monika Pathania, Department of Medicine, AIIMS Rishikesh, Uttarakhand, India. E-mail:
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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148
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Balouchi A, Rafsanjani MHAP, Al-Mutawaa K, Naderifar M, Rafiemanesh H, Ebadi A, Ghezeljeh TN, Shahraki-Mohammadi A, Al-Mawali A. Hypertension and pre-hypertension in Middle East and North Africa (MENA): A meta-analysis of prevalence, awareness, treatment, and control. Curr Probl Cardiol 2021; 47:101069. [PMID: 34843808 DOI: 10.1016/j.cpcardiol.2021.101069] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023]
Abstract
Hypertension (HTN) is one of the most important public health challenges, especially in developing countries. Despite individual studies, information on the exact prevalence of prehypertension (pre-HTN) and HTN in the Middle East and North Africa (MENA) is lacking. This meta-analysis was conducted to evaluate prevalence of pre-HTN and HTN, awareness, treatment, and control in the MENA region. PubMed, Web of Science, and Scopus databases were searched from inception to April 30, 2021. Keywords included hypertension, pre-hypertension, awareness, treatment, and control. The quality of the included studies was evaluated using the Hoy scale. A random-effects model was evaluated based on overall HTN. The heterogeneity of the preliminary studies was evaluated using the I2 test. A total of 147 studies involving 1,312,244 participants were included in the meta-analysis. Based on the results of the random-effects method (95% CI), the Prevalence of pre-HTN and HTN were 30.6% (95% CI: 25.2, 36.0%; I2 = 99.9%), and 26.2% (95% CI: 24.6, 27.9%; I2 = 99.8%), respectively. The prevalence of HTN awareness was 51.3% (95% CI: 47.7, 54.8; I2 = 99.0%). The prevalence of HTN treatment was 47.0% (95% CI: 34.8, 59.2; I2 = 99.9%). The prevalence of HTN control among treated patients was 43.1% (95% CI: 38.3, 47.9; I2 = 99.3%). Considering the high prevalence of HTN, very low awareness, and poor HTN control in the region, more attention should be paid to preventive programs for HTN reduction.
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Affiliation(s)
- Abbas Balouchi
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Kholoud Al-Mutawaa
- Senior consultant community Medicine, Head of Non-communicable Disease Department, Ministry of Public Health, Doha, Qatar
| | - Mahin Naderifar
- Department of Nursing, Zabol University of Medical Sciences, Zabol, Iran
| | | | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Azita Shahraki-Mohammadi
- Assistant Professor of Medical Library and Information Sciences, Department of medical library and information sciences, Paramedical school, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Adhra Al-Mawali
- Director/Centre of Studies & Research, Ministry of Health, Oman.
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149
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Arshad F, MM S, Paplikar A, Rajendran S, Kalkonde Y, Alladi S. Vascular cognitive impairment in India: Challenges and opportunities for prevention and treatment. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 3:100034. [PMID: 36324418 PMCID: PMC9616277 DOI: 10.1016/j.cccb.2021.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/22/2021] [Accepted: 11/23/2021] [Indexed: 06/16/2023]
Abstract
The burden of vascular contribution to cognitive impairment and dementia is substantially high in India. There are approximately 5.3 million dementia patients in India and nearly 40% are estimated to be due to vascular dementia. Several factors pose unique challenges to reducing the burden of vascular dementia and vascular cognitive impairment (VCI) in India. Wide heterogeneity in vascular risk factor profile, diversity in socioeconomic, ethnic and dietary factors, as well as regional and rural-urban differences impact uniform implementation of preventive and therapeutic strategies. There is limited evidence on the natural history of vascular disease from longitudinal cohorts in India. Additionally, the lack of advanced brain imaging and genetic information pose challenges to understanding pathophysiology and treatment response to VCI in India. Efforts are now being made to implement programmes to reduce cardiovascular risk and VCI at the population level. Cognitive and functional measures appropriate to the diverse linguistic and educational context have been developed to diagnose VCI across India. Multicentric clinical and research cohorts of stroke are also being established. Filling research gaps and developing intervention strategies for the Indian context are crucial to address the growing burden of VCI.
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Affiliation(s)
- Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Samim MM
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Srijithesh Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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150
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Riddell MA, Mini GK, Joshi R, Thrift AG, Guggilla RK, Evans RG, Thankappan KR, Chalmers K, Chow CK, Mahal AS, Kalyanram K, Kartik K, Suresh O, Thomas N, Maulik PK, Srikanth VK, Arabshahi S, Varma RP, D'Esposito F, Oldenburg B. ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable. Front Med (Lausanne) 2021; 8:771822. [PMID: 34881267 PMCID: PMC8645590 DOI: 10.3389/fmed.2021.771822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability. Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact. Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision. Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up. Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].
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Affiliation(s)
- Michaela A. Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - G. K. Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Rohina Joshi
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- George Institute for Global Health, New Delhi, India
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Rama K. Guggilla
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Roger G. Evans
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Kavumpurathu R. Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Department of Public Health & Community Medicine, Central University of Kerala, Kasaragod, India
| | - Kate Chalmers
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Clara K. Chow
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Ajay S. Mahal
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Rishi Valley Rural Health Centre, Chittoor, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Pallab K. Maulik
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- George Institute for Global Health, New Delhi, India
| | - Velandai K. Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Ravi P. Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Fabrizio D'Esposito
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute and Larobe University, Melbourne, VIC, Australia
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