Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991

Burden and predictors of hypertension in India: results of SEEK (Screening and Early Evaluation of Kidney Disease) study

Background

Hypertension (HTN) is one of the major causes of cardiovascular morbidity and mortality. The objective of the study was to investigate the burden and predictors of HTN in India.

Methods

6120 subjects participated in the Screening and Early Evaluation of Kidney disease (SEEK), a community-based screening program in 53 camps in 13 representative geographic locations in India. Of these, 5929 had recorded blood pressure (BP) measurements. Potential predictors of HTN were collected using a structured questionnaire for SEEK study.

Results

HTN was observed in 43.5% of our cohort. After adjusting for center variation (p < 0.0001), predictors of a higher prevalence of HTN were older age ≥40 years (p < 0.0001), BMI of ≥ 23 Kg/M² (p < 0.0004), larger waist circumference (p < 0.0001), working in sedentary occupation (p < 0.0001), having diabetes mellitus (p < 0.0001), having proteinuria (p < 0.0016), and increased serum creatinine (p < 0.0001). High school/some college education (p = 0.0016), versus less than 9th grade education, was related with lower prevalence of HTN. Of note, proteinuria and CKD were observed in 19% and 23.5% of HTN subjects. About half (54%) of the hypertensive subjects were aware of their hypertension status.

Conclusions

HTN was common in this cohort from India. Older age, BMI ≥ 23 Kg/M², waist circumference, sedentary occupation, education less, diabetes mellitus, presence of proteinuria, and raised serum creatinine were significant predictors of hypertension. Our data suggest that HTN is a major public health problem in India with low awareness, and requires aggressive community-based screening and education to improve health.

Is it a new approach for treating senile hypertension with kidney-tonifying chinese herbal formula? A systematic review of randomized controlled trials

OBJECTIVE

To assess the effect of kidney-tonifying (KT) Chinese herbal formula for senile hypertension (SH).

METHODS

A total of five databases (CENTRAL, Pubmed, CBM, CNKI, and VIP) were searched for published and unpublished randomized controlled trials (RCTs) up to November 30th, 2013. We included RCTs that confoundedly addressed the effect of KT formula in the treatment of SH.

RESULTS

Six studies involving 527 people were included. There was no evidence that KT formula alone had superior effects to antihypertensive drugs in systolic blood pressure (MD: -3.70 (-11.47, 4.07); P = 0.35) and diastolic blood pressure (MD: -3.00 (-7.26, -1.26); P = 0.17). However, there was evidence that KT formula combined with antihypertensive drugs was a better treatment option than antihypertensive drugs alone in systolic blood pressure (WMD: -8.69 (-12.35, -5.02); P < 0.00001) but no significant difference in diastolic blood pressure (WMD: -1.32 (-7.93, -5.30); P = 0.7). In addition, after several weeks of treatment, the level of blood lipid, endothelin, blood urea nitrogen, and creatinine decreased significantly (P < 0.05).

CONCLUSION

Compared with antihypertensive drugs alone, KT formula combined with antihypertensive drugs may provide more benefits for patients with SH. The large-scale high-quality trials are warranted in future.

Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association

BACKGROUND AND PURPOSE

Stroke mortality has been declining since the early 20th century. The reasons for this are not completely understood, although the decline is welcome. As a result of recent striking and more accelerated decreases in stroke mortality, stroke has fallen from the third to the fourth leading cause of death in the United States. This has prompted a detailed assessment of the factors associated with the change in stroke risk and mortality. This statement considers the evidence for factors that have contributed to the decline and how they can be used in the design of future interventions for this major public health burden.

METHODS

Writing group members were nominated by the committee chair and co-chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiological studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize evidence and to indicate gaps in current knowledge. All members of the writing group had the opportunity to comment on this document and approved the final version. The document underwent extensive American Heart Association internal peer review, Stroke Council leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee.

RESULTS

The decline in stroke mortality over the past decades represents a major improvement in population health and is observed for both sexes and for all racial/ethnic and age groups. In addition to the overall impact on fewer lives lost to stroke, the major decline in stroke mortality seen among people <65 years of age represents a reduction in years of potential life lost. The decline in mortality results from reduced incidence of stroke and lower case-fatality rates. These significant improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions. Although it is difficult to calculate specific attributable risk estimates, efforts in hypertension control initiated in the 1970s appear to have had the most substantial influence on the accelerated decline in stroke mortality. Although implemented later, diabetes mellitus and dyslipidemia control and smoking cessation programs, particularly in combination with treatment of hypertension, also appear to have contributed to the decline in stroke mortality. The potential effects of telemedicine and stroke systems of care appear to be strong but have not been in place long enough to indicate their influence on the decline. Other factors had probable effects, but additional studies are needed to determine their contributions.

CONCLUSIONS

The decline in stroke mortality is real and represents a major public health and clinical medicine success story. The repositioning of stroke from third to fourth leading cause of death is the result of true mortality decline and not an increase in mortality from chronic lung disease, which is now the third leading cause of death in the United States. There is strong evidence that the decline can be attributed to a combination of interventions and programs based on scientific findings and implemented with the purpose of reducing stroke risks, the most likely being improved control of hypertension. Thus, research studies and the application of their findings in developing intervention programs have improved the health of the population. The continued application of aggressive evidence-based public health programs and clinical interventions is expected to result in further declines in stroke mortality.

Sustained release of prindopril erbumine from its chitosan-coated magnetic nanoparticles for biomedical applications

The preparation of magnetic nanoparticles coated with chitosan-prindopril erbumine was accomplished and confirmed by X-ray diffraction, TEM, magnetic measurements, thermal analysis and infrared spectroscopic studies. X-ray diffraction and TEM results demonstrated that the magnetic nanoparticles were pure iron oxide phase, having a spherical shape with a mean diameter of 6 nm, compared to 15 nm after coating with chitosan-prindopril erbumine (FCPE). Fourier transform infrared spectroscopy study shows that the coating of iron oxide nanoparticles takes place due to the presence of some bands that were emerging after the coating process, which belong to the prindopril erbumine (PE). The thermal stability of the PE in an FCPE nanocomposite was remarkably enhanced. The release study showed that around 89% of PE could be released within about 93 hours by a phosphate buffer solution at pH 7.4, which was found to be of sustained manner governed by first order kinetic. Compared to the control (untreated), cell viability study in 3T3 cells at 72 h post exposure to both the nanoparticles and the pure drug was found to be sustained above 80% using different doses.

What teen mothers know

In the United States, low-income or minority populations tend toward earlier births than the more advantaged. In disadvantaged populations, one factor that may exert pressure toward early births is "weathering," or pervasive health uncertainty. Are subjective perceptions of health related to fertility timing? Drawing on a small sample of intensive interviews with teenage mothers-to-be, I suggest that low-income African American teenagers may expect uncertain health and short lifespans. Where family economies and caretaking systems are based on kin networks, such perceptions may influence the decision to become a young mother. Heuristic typologies of ways socially situated knowledge may contribute to the reproduction of fertility timing practices contrast the experiences of poor African American interviewees, working class white interviewees, and middle-class teens who typically postpone childbearing.

Hypertension prevalence, awareness, treatment, control and associated factors in a developing southern Chinese population: analysis of serial cross-sectional health survey data 2002-2010

BACKGROUND

The aim of this study was to investigate trends in the distribution, prevalence, awareness, treatment, and control of hypertension in a Chinese population that has had the fastest growing gross domestic product in the world over the past 3 decades.

METHODS

Four standardized cross-sectional health surveys were conducted between 2002 and 2010 in a population consisting of 85 million residents in Guangdong Province. Multistage cluster sampling was adopted to recruit representative samples. The data were obtained through on-site health examinations and face-to-face interviews.

RESULTS

The aging trend in this population was not significant (P = 0.17) during the survey period, whereas body mass index/waist circumference increased significantly (P = 0.047 for body mass index and P < 0.001 for waist circumference). The age-standardized prevalence of hypertension increased from 10.5% to 13.3%, averaging a 0.35% increase per year. A higher risk was observed in younger residents over the survey period. Awareness and treatment increased by 22.0% and 19.0%, respectively, in the rural areas, whereas there was no significant change in the urban area (the corresponding figures were 1.8% and -3.1%, respectively). There was no improvement in hypertension control (the age-standardized control prevalence in 2002 was 50.3%, whereas it was 43.2% in 2010).

CONCLUSIONS

The prevalence of hypertension increased slightly in this population with the fastest economic development. This increase mirrored the trend of increasing obesity. Awareness and treatment of hypertension have improved in the rural areas, although there were no significant changes in the urban areas. The prevalence of awareness and treatment remains at unacceptably low levels, suggesting that urgent and aggressive strategies are necessary to improve hypertension control and intervention.

Child health in the United States: recent trends in racial/ethnic disparities

In the United States, race and ethnicity are considered key social determinants of health because of their enduring association with social and economic opportunities and resources. An important policy and research concern is whether the U.S. is making progress toward reducing racial/ethnic inequalities in health. While race/ethnic disparities in infant and adult outcomes are well documented, less is known about patterns and trends by race/ethnicity among children. Our objective was to determine the patterns of and progress toward reducing racial/ethnic disparities in child health. Using nationally representative data from 1998 to 2009, we assessed 17 indicators of child health, including overall health status, disability, measures of specific illnesses, and indicators of the social and economic consequences of illnesses. We examined disparities across five race/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic Asian, and non-Hispanic other). We found important racial/ethnic disparities across nearly all of the indicators of health we examined, adjusting for socioeconomic status, nativity, and access to health care. Importantly, we found little evidence that racial/ethnic disparities in child health have changed over time. In fact, for certain illnesses such as asthma, black-white disparities grew significantly larger over time. In general, black children had the highest reported prevalence across the health indicators and Asian children had the lowest reported prevalence. Hispanic children tended to be more similar to whites compared to the other race/ethnic groups, but there was considerable variability in their relative standing.

Racial disparities in functional disability among older women with newly diagnosed nonmetastatic breast cancer

BACKGROUND

This study sought to assess racial differences in functional disability among older women with nonmetastatic breast cancer.

METHODS

In this cross-sectional study, between April 2008 and December 2012, women aged ≥ 65 years with newly diagnosed stage I through III breast cancer were recruited from ambulatory oncology clinics at an academic center. Prior to receiving any adjuvant treatment, participants completed a comprehensive geriatric assessment. The primary outcome was functional disability, defined as dependency in any basic or instrumental activity of daily living, categorized as "yes" or "no." Logistic regression analyses were undertaken.

RESULTS

The study enrolled 190 women whose mean age was 75.0 years at diagnosis (standard deviation = 7.0, range = 65-93 years). Thirty-two percent were African American (AA), and 39% had functional disability. Controlling for age, participants with functional disability were more likely to be AA (versus non-Hispanic white), odds ratio = 4.19, 95% confidence interval = 2.12-8.27. Fifty-nine percent of the racial difference in functional disability was explained by a higher prevalence of lower income and education among AAs. In addition, the higher prevalence of chronic medical conditions and obesity among AAs, after accounting for socioeconomic factors, further explained 40% of the black-white difference in functional disability.

CONCLUSIONS

Among older women with newly diagnosed nonmetastatic breast cancer, functional disability is highly prevalent, and AAs are disproportionately affected. Interventions to optimize the functional status of at-risk individuals, particularly AAs, during and after cancer treatment may improve treatment tolerance and overall survival outcomes.

Impact of diabetes mellitus on arterial stiffness in a representative sample of an urban Brazilian population

BACKGROUND

Independent of other cardiovascular (CV) risk factors, increased arterial stiffness has been established as a predictor of morbidity and mortality. The main aim of this study was to investigate the impact of diabetes on arterial stiffness in a representative sample of an urban Brazilian population plus Amerindians.

METHODS

A total of 1,415 individuals from the general population were randomly selected plus 588 Amerindians from a native community in Brazil. In addition, a sub-sample of 380 individuals from the general population had 5-year follow-up data. Pulse wave velocity (PWV) was measured with a non-invasive automatic device (Complior, Colson; Garges les Gonesses, France) and increased arterial stiffness was defined as PWV ≥ 12 m/s.

RESULTS

In the overall group, diabetic individuals had higher frequencies of increased arterial stiffness and hypertension. They also had higher values of PWV, body mass index, total cholesterol, triglycerides, systolic and diastolic blood pressures compared to non-diabetic individuals (p < 0.01). In an analysis stratified by hypertension, PWV values and increased arterial stiffness frequency were higher in diabetic individuals in both groups (hypertensive and non-hypertensive) (p < 0.05). Furthermore, higher risk for increased arterial stiffness was observed in the diabetic individuals from the overall group (OR = 2.27; CI = 1.47-3.52, p < 0.001) and from the hypertensive group (OR = 2.70; CI = 1.58-4.75, p < 0.001), adjusted for covariates. Regarding the ethnic stratification, diabetic individuals from Amerindian, White, and Mulatto (mixed-race) groups had higher PWV values and a greater frequency of increased arterial stiffness compared to non-diabetic individuals. Both diabetic and non-diabetic individuals had higher PWV values after 5 years. There was no significant difference in the 5-year PWV progression in diabetic compared to non-diabetic individuals.

CONCLUSIONS

These results confirm, in a sample of Brazilian population, that the presence of diabetes is associated with increased arterial stiffness and it may contribute in part to increased cardiovascular risk in diabetic patients.

Predictors of uncontrolled hypertension in the Stroke Belt

Inadequate control of high systolic blood pressure in older adults has been largely attributable to poor control of overall hypertension (HTN). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines emphasize the importance of controlling isolated systolic HTN in older adults. The study examined demographics, self-reported health information, and clinical measures as predictors of uncontrolled HTN among individuals taking antihypertensive medications. The Community Initiative to Eliminate Stroke, a stroke risk factor screening and prevention project, collected data in two North Carolina counties. Statistical modeling of predictors included odds ratios (ORs) and logistic regression analyses. Of the 2663 participants, 43.5% and 22.8% had uncontrolled systolic and diastolic HTN, respectively. African Americans were more likely to have uncontrolled systolic (60%) or diastolic HTN (70.9%) compared with whites (40% and 29.1%, respectively). Participants 55 years and older were more likely to have uncontrolled systolic HTN compared with younger individuals. Regression analyses showed that race (OR, 1.239; P=.00), age (OR, 1.683; P=.00), and nonadherence with medications (OR, 2.593; P=.00) were significant predictors of uncontrolled systolic HTN. Future interventions should focus on improving management of isolated systolic HTN in older adults and African Americans to increase overall control of HTN.

Association of systolic blood pressure and pulse pressure with carotid intima thickness in elderly Japanese patients

Many studies have demonstrated that increased carotid intima-media thickness (IMT) is related to future cardiovascular events and is influenced by cardiovascular risk factors such as sex, hypertension, diabetes, and hypercholesterolemia. Although aging is a well-known risk factor for an increase in carotid IMT, few studies have investigated which factors influence carotid IMT in the very elderly. In the present study, we investigated the relationship of pulse pressure (PP), blood pressure (BP), and its variability (six consecutive visits) with carotid IMT among 240 high-risk elderly in whom risk factors were managed clinically (average age was 79 ± 5 years). In the simple correlation, mean systolic BP (SBP) had a positive correlation with IMT and max IMT (P = .012 and P = .045), as did PP (P = .018 and P = .004), but did not diastolic BP or standard deviation of BP and coefficient of variation of BP. In multiple regression analyses, mean SBP and mean PP were each determinants of both IMT and max IMT, when each parameter was added separately to the regression model. We concluded that high SBP and wide PP still have an influence on increased carotid IMT in the very elderly Japanese patients.

Trends of hypertension prevalence, awareness, treatment and control in rural areas of northern China during 1991-2011

This study aims to investigate the trends in prevalence, awareness, treatment and control of hypertension among rural residents aged 35-74 years in northern China during the country's rapid economic development from 1991 to 2011. Two surveys, conducted in 1991 and 2011, included 2196 and 1939 participants aged 35-74 years from same villages in Ji County, Tianjin of China, respectively. The prevalence of hypertension, adjusted by age and gender using the world standard population in 2000, increased 30% (39.9% vs 51.7%) between 1991 and 2011. The increase was greatest (68%) in women aged 35-44 years. Meanwhile, the prevalence of stage II hypertension increased by 75% overall, with a 4-fold increase in men aged 45-54 years. Although the awareness, treatment and control of hypertension increased significantly during the same period, they remained unacceptably poor. In conclusion, the community-based surveys showed that the prevalence of hypertension in rural residents of northern China aged 35-74 years increased rapidly over the past 20 years, and most dramatically in young women. Efforts in the primary prevention of hypertension, particularly for young women, and promoting education for hypertension awareness, treatment and control are of paramount importance in rural China.

[Prevalence of hypertension in El-Menia oasis, Algeria, and metabolic characteristics in population]

INTRODUCTION

El-Menia is an oasis located in the middle of Algerian Sahara. The drinking water in this oasis has low sodium content. The objectives of this study were to estimate the prevalence of hypertension, to describe the metabolic characteristics of population study and to assess the factors associated with blood pressure levels.

METHODS

A cross sectional study was conducted in 2010. Subjects (n=722) were selected from individuals aged 40 years or older by random cluster sampling. Blood pressure measurements, combined with a clinical questionnaire, and standard blood samples for the detection of dyslipidemia and diabetes mellitus, were collected.

RESULTS

Sixty-seven percent of subjects were females and 18% were black. The mean age was 58.5 ± 13.2 years. The prevalence of hypertension was 50.2%: 49.7% in females and 51.3% in males. The factors associated with presence of hypertension following a logistic multivariate regression were age, skin colour, waist circumference, and plasma glucose. The treatment and control of hypertension were 41% and 20% respectively.

CONCLUSIONS

The prevalence oh hypertension was high in this oasis and the rate of treatment control was low. Our findings suggest that appropriate healthcare should be given to hypertensive subjects, including a better information on hypertension.

Community-based primary prevention programs decrease the rate of metabolic syndrome among socioeconomically disadvantaged women

BACKGROUND

Metabolic Syndrome (MetSyn) is one of the strongest predictors of type 2 diabetes (DM2) and cardiovascular disease (CVD). It is associated with a 4- to 10-fold increased risk of DM2 and a 2- to 3-fold increased risk of CVD. Low income and minority women have some of the highest rates of MetSyn. This study examines the effect of a unique, community based, primary prevention program on the rates of MetSyn and health habits.

METHODS

Sixty-four low income and minority women were enrolled in the HAPPY (Health Awareness and Primary Prevention in Your neighborhood) Heart Program in an eastern suburb of Boston. Over these 2 years, patients were evaluated by an interdisciplinary medical team: their primary physician, cardiologist, nutritionist, physical therapist, and health coach. The rate of MetSyn was measured at baseline, year 1, and year 2. Comparisons were made either using the paired t test for normally distributed variables or the Wilcoxon Sign test for non-normal variables.

RESULTS

The rate of MetSyn fell from 64.7% at baseline to 34.9% at year 1 (p=0.01) and 28.2% at year 2 (p<0.001). This was driven by increases in high-density lipoprotein (HDL-C) (p<0.001) and decreases in blood pressure (p=0.05). Fasting blood glucose trended down, but the hemoglobin A1c (HbA1c) reached significance (decreasing from 6 to 5.8, p<0.01). Nutrition and exercise habits trended toward improvement. There were significant decreases in anxiety (p<0.001), depression (p=0.006) and stress (p=0.002).

CONCLUSION

This lifestyle intervention program is effective at decreasing MetSyn in a socioeconomically disadvantaged, largely minority, female population. This program also decreases anxiety, stress, and depression among participants.

Hypertension and hypertension-related disease in mongolia; findings of a national knowledge, attitudes and practices study

BACKGROUND

Mongolia has a high and increasing burden of hypertension and related disease, with cardiovascular diseases among the leading causes of death. Yet little is known about the knowledge, attitudes and practices of the Mongolian population with regards to blood pressure. With this in mind, a national Non-Communicable Diseases knowledge, attitudes and practices survey on blood pressure was implemented in late 2010. This paper reports on the findings of this research.

METHODS

Using a multi-stage, random cluster sampling method 3450 participant households were selected from across Mongolia. This survey was interviewer-administered and included demographic and socio-economic questions. Sample size was calculated using methods aligned with the World Health Organization STEPS surveys.

RESULTS

One fifth of participants reported having never heard the term 'blood pressure'. This absence of health knowledge was significantly higher in men, and particularly younger men. The majority of participants recognised high blood pressure to be a threat to health, with a higher level of risk awareness among urban individuals. Education level and older age were generally associated with a heightened knowledge and risk perception. Roughly seven in ten participants were aware of the relationship between salt and blood pressure. Exploring barriers to screening, participants rated a 'lack of perceived importance' as the main deterring factor among fellow Mongolians and overall, participants perceived medication and exercise as the only interventions to be moderately effective at preventing high blood pressure.

CONCLUSION

Rural populations; younger populations; men; and less educated populations, all with lower levels of knowledge and risk perception regarding hypertension, present those most vulnerable to it and the related health outcomes. This research intimates major health knowledge gaps in sub-populations within Mongolia, regarding health-risks related to hypertension.

Prevalência e fatores associados à pressão arterial elevada, seu conhecimento e tratamento em idosos no sul do Brasil

O objetivo foi estimar a prevalência e investigar os fatores associados à pressão arterial elevada, seu conhecimento e tratamento em idosos de Florianópolis, Santa Catarina, Brasil. Trata-se de estudo transversal de base populacional e amostra complexa. A pressão arterial elevada foi definida pela medida do nível pressórico ou uso de anti-hipertensivo, ou diagnóstico prévio. A associação dos desfechos com as variáveis independentes foi verificada pela regressão de Poisson. Foram entrevistados 1.705 idosos. Desses, 84,6% apresentaram pressão arterial elevada, 77,5% estavam cientes da doença e 79,1% a tratavam. A prevalência associou-se à dependência funcional e idade e índice de massa corporal (IMC) elevados. Idosos do sexo feminino, idade e IMC elevados, pior percepção em saúde e consulta médica recente estavam mais cientes da doença. O tratamento associou-se a sexo masculino, dependência funcional, pior percepção em saúde e consulta médica recente. Ainda que políticas públicas em saúde devam ser universais, é preciso considerar a desigual distribuição da pressão arterial elevada na população, direcionando-se ações de prevenção, diagnóstico e garantia de tratamento.

Epidemiology of ischaemic heart disease in sub-Saharan Africa

BACKGROUND

The epidemiology of ischaemic heart disease (IHD) in sub-Saharan Africa (SSA) remains largely enigmatic. Major obstacles to our understanding of the condition include lack of reliable health statistics, particularly cause-specific mortality data, inadequate diagnostic capabilities, shortage of physicians and cardiologists, and misguided opinions.

METHODS

This review of the epidemiology of ischaemic heart disease in sub-Saharan Africa involved a systematic bibliographic MEDLINE search of published data on IHD in SSA over the past century. Search words included epidemiology, ischaemic (coronary) heart disease, myocardial infarction, cardiovascular risk factors and sub-Saharan Africa. Selected data are presented on the prevalence of cardiovascular risk factors and mortality from ischaemic heart disease from different countries representing the main regions of the continent.

RESULTS

Although IHD in SSA remains relatively uncommon, its prevalence is predicted to rise in the next two decades due to the rising prevalence of risk factors, especially hypertension, diabetes, overweight and obesity, physical inactivity, increased tobacco use and dyslipidaemia. It is estimated that age-standardised mortality rates for IHD will rise by 27% in African men and 25% in women by 2015, and by 70 and 74%, respectively by 2030.

CONCLUSION

Ischaemic heart disease remains relatively uncommon in SSA, despite an increasing prevalence of risk factors, but its incidence is rising. The pace and direction of economic development, rates of urbanisation, and changes in life expectancy resulting from the impact of pre-transitional diseases and violence will be major determinants of the IHD epidemic in SSA. The best window of opportunity for prevention of the emerging epidemic of ischaemic heart disease in sub-Saharan Africa is now.

The treatment of hypertension: a remarkable success story

One of the most successful public health programs in the past century provides an example of what can be accomplished when the government, the private sector, academia, and community organizations work together. The results of 4 decades of activities of the National High Blood Pressure Education Program (NHBPEP) can be measured in several ways. The publics' awareness, treatment, and control have increased remarkably. Hypertension is the primary reason adults visit physicians. Age-adjusted mortality for heart disease and stroke has declined by 70% and 80%, respectively, since the beginning of the program. The decline in heart and stroke deaths is seen in both sexes and blacks and whites, and is particularly evident in people who reside in the southeastern portion of the United States, which once had the highest mortality rates of stroke in the United States. This dramatic decrease in strokes and heart disease has occurred despite the substantial increase in obesity and diabetes in the United States.

Changes in the prevalence, treatment and control of hypertension in Germany? A clinical-epidemiological study of 50.000 primary care patients

Introduction

Medical societies have developed guidelines for the detection, treatment and control of hypertension (HTN). Our analysis assessed the extent to which such guidelines were implemented in Germany in 2003 and 2001.

Methods

Using standardized clinical diagnostic and treatment appraisal forms, blood pressure levels and patient questionnaires for 55,518 participants from the cross-sectional Targets and Essential Data for Commitment of Treatment (DETECT) study (2003) were analyzed. Physician’s diagnosis of hypertension (HTN_doc) was defined as coding hypertension in the clinical appraisal questionnaire. Alternative definitions used were physician’s diagnosis or the patient’s self-reported diagnosis of hypertension (HTN_doc,pat), physician’s or patient’s self-reported diagnosis or a BP measurement with a systolic BP≥140 mmHg and/or a diastolic BP≥90 (HTN_doc,pat,bp) and diagnosis according to the National Health and Nutrition Examination Survey (HTN_NHANES). The results were compared with the similar German HYDRA study to examine whether changes had occurred in diagnosis, treatment and adequate blood pressure control (BP below 140/90 mmHg) since 2001. Factors associated with pharmacotherapy and control were determined.

Results

The overall prevalence rate for hypertension was 35.5% according to HTN_doc and 56.0% according to NHANES criteria. Among those defined by NHANES criteria, treatment and control rates were 56.0% and 20.3% in 2003, and these rates had improved from 55.3% and 18.0% in 2001. Significant predictors of receiving antihypertensive medication were: increasing age, female sex, obesity, previous myocardial infarction and the prevalence of comorbid conditions such as coronary heart disease (CHD), hyperlipidemia and diabetes mellitus (DM). Significant positive predictors of adequate blood pressure control were CHD and antihypertensive medication. Inadequate control was associated with increasing age, male sex and obesity.

Conclusions

Rates of treated and controlled hypertension according to NHANES criteria in DETECT remained low between 2001 and 2003, although there was some minor improvement.

Lercanidipine effect on polymorphonuclear leukocyte-related inflammation and insulin resistance in essential hypertension patients

INTRODUCTION

Inflammation, insulin resistance, and oxidative stress (OS) are among the mechanisms that have been implicated in the pathogenesis of essential hypertension (EH). Peripheral polymorphonuclear leukocytes (PMNLs) are primed in EH patients, releasing uncontrolled superoxide anions contributing to OS in these patients. PMNL priming correlates with insulin resistance and PMNL intracellular calcium ([Ca(2+)]i). Recent studies have attributed additional anti-ischemic and antioxidative characteristics to the antihypertensive drug, lercanidipine, a third-generation calcium-channel blocker. The purpose of this study was to evaluate the possible nontraditional effect of 2 months of lercanidipine treatment on insulin resistance and on PMNL-related inflammation in EH patients.

METHODS

Non-smoking EH patients with untreated mild-to-moderate high blood pressure (BP) were included. Low-grade inflammation was reflected by PMNL apoptosis and by white blood cell (WBC) and PMNL counts. Systemic inflammation was measured by plasma fibrinogen, C-reactive protein (CRP), and transferrin and albumin levels. Fasting serum insulin levels served as a marker of insulin resistance.

RESULTS

Two months of lercanidipine treatment showed a significant decrease in BP, WBC, and PMNL counts, PMNL apoptosis, CRP, and serum insulin levels, and a significant increase in serum albumin levels. Rates of superoxide release from PMNLs, WBC and PMNL counts, and insulin levels positively correlated with mean arterial BP values.

CONCLUSION

The use of lercanidipine can be favorable in EH patients due to its combined anti-PMNL priming and anti-inflammatory effects, in addition to its antihypertensive characteristics.

Awareness, attitude, and distribution of high blood pressure among health professionals

BACKGROUND

BP control is suboptimal Worldwide. Little is known about attitudes of health professionals toward their BP status.

AIM

To estimate awareness, attitudes, and distribution of blood pressure among health professionals.

STUDY DESIGN

Prospective cross-sectional survey.

METHODS

Study was conducted among health professionals in two tertiary hospitals in Riyadh, KSA during December 2010. Socio-demographics, risk factors for high BP, awareness, and adherence to treatment were recorded.

RESULTS

Six hundred and seventy-two subjects, 66.6% females, mean age 36.2 + 13.9 years. Prevalence of Hypertension (HTN) was 28%. 114 (60.6%) patients had self reported HTN in HTN group while 74 (11%) of total study population, were not aware that they have HTN which was detected on screening. Stress and lack of formal exercise were prevalent risk factors for HTN, present in 44.1% and 36.1%, of patients, respectively, while obesity was present in 19.4%. Many participants were not aware of recently recommended target value of blood pressure. 22.3% patients were irregular for their follow-up. 12.2% patients were not adherent to the treatment. Isolated systolic hypertension was more common in men. A point of serious concern was that relatively young health professionals, who were not known to be hypertensive did not monitor their BP, found to have HTN.

CONCLUSION

Suboptimal awareness and lack of adherence to the treatment for BP among health professionals is of serious concern, for increased chances of cardiovascular events. Physical exercise, correction of obesity and compliance with treatment may reduce the risk of HTN-related adverse outcome in this special subset of the population.

Stroke prevention: managing modifiable risk factors

Prevention plays a crucial role in counteracting morbidity and mortality related to ischemic stroke. It has been estimated that 50% of stroke are preventable through control of modifiable risk factors and lifestyle changes. Antihypertensive treatment is recommended for both prevention of recurrent stroke and other vascular events. The use of antiplatelets and statins has been shown to reduce the risk of recurrent stroke and other vascular events. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are indicated in stroke prevention because they also promote vascular health. Effective secondary-prevention strategies for selected patients include carotid revascularization for high-grade carotid stenosis and vitamin K antagonist treatment for atrial fibrillation. The results of recent clinical trials investigating new anticoagulants (factor Xa inhibitors and direct thrombin inhibitors) clearly indicate alternative strategies in stroke prevention for patients with atrial fibrillation. This paper describes the current landscape and developments in stroke prevention with special reference to medical treatment in secondary prevention of ischemic stroke.

Impact of the number of blood pressure measurements on blood pressure classification in US adults: NHANES 1999-2008

Clinical guidelines recommend averaging ≥ 2 blood pressure (BP) measurements on each visit. Only one BP is measured on many clinical visits, especially if the value is <120/<80 mm Hg, ie, normal. The impact of this practice on accurate assignment of BP category is incompletely defined. Data were analyzed from 22,641 adults 18 years and older who had 3 BP readings in the National Health and Nutrition Examination Surveys 1999-2008. BP category defined by initial measurement was compared with the category determined by mean of the first and second, first through third, and second and third readings. Among 8553 nonhypertensive patients with initial BP <120/<80 mm Hg, 2.9%, 3.3%, and 6.7%, respectively, were reclassified as prehypertensive, ie, BP 120-139/80-89 mm Hg, and two patients as stage 1 hypertension (140-159/90-99 mm Hg). In 733 treated hypertensive patients with initial BP <120/<80 mm Hg, 5.1%-8.9% were reclassified as prehypertensive and only one patient as hypertensive. Among nonhypertensive and hypertensive patients with initial BP in the prehypertensive range, 8.0%-23.6% were reclassified as normal. Among stage 1 and 2 hypertensive patients based on initial BP, 18.2%-33.5% were reclassified to lower BP categories. By multivariable logistic regression, older age and higher systolic and diastolic BP were associated with reclassification to a lower BP category. In nonhypertensive and hypertensive patients with normal initial BP values, one BP measurement appears adequate as <10% are re-classified as prehypertensive and <0.5% as hypertensive. In contrast, patients with an initial BP above normal are often reclassified to a lower category, which supports recommendations for additional measurements.

Association of acculturation and country of origin with self-reported hypertension and diabetes in a heterogeneous Hispanic population

Background

Hispanics are the fasting growing population in the U.S. and disproportionately suffer from chronic diseases such as hypertension and diabetes. Little is known about the complex interplay between acculturation and chronic disease prevalence in the growing and increasingly diverse Hispanic population. We explored the association between diabetes and hypertension prevalence among distinct U.S. Hispanic subgroups by country of origin and by degree of acculturation.

Methods

We examined the adult participants in the 2001, 2003, 2005, and 2007 California Health Interview Survey (CHIS). Using weighted logistic regression stratified by nativity, we measured the association between country of origin and self-reported hypertension and diabetes adjusting for participants’ demographics, insurance status, socio-economic status and degree of acculturation measured by citizenship, English language proficiency and the number of years of residence in the U.S.

Results

There were 33,633 self-identified Hispanics (foreign-born: 19,988; U.S.-born: 13,645). After multivariable adjustment, we found significant heterogeneity in self-reported hypertension and diabetes prevalence among Hispanic subgroups. Increasing years of U.S. residence was associated with increased disease prevalence. Among all foreign-born subgroups, only Mexicans reported lower odds of hypertension after adjustment for socioeconomic and acculturation factors. Both U.S.-born and foreign-born Mexicans had higher rates of diabetes as compared to non-Hispanic whites.

Conclusions

We found significant heterogeneity among Hispanics in self-reported rates of hypertension and diabetes by acculturation and country of origin. Our findings highlight the importance of disaggregation of Hispanics by country of origin and acculturation factors whenever possible.

Impact of Literacy on the Prevalence, Awareness, Treatment andControl of Hypertension in Iran

INTRODUCTION

Hypertension is an important global health concern claiming 7.1 million lives annually. Literacy, as an essential element of the health education, and its relationship with health has previously been studied. However, few studies have been conducted on the association between literacy and health outcomes. To assess the association between educational level and hypertension, awareness and hypertension control in the north of Iran were the main objectives of this study.

METHODS

The present study was a population-based cross-sectional study carried out on 3497 subjects aged 15-65 years using stratified and cluster sampling. Interviewers recorded the data using a multidimensional questionnaire, including blood pressure level. Blood pressure was measured three times with 5-minute intervals and defined based on JNC-7.

RESULTS

Totally, 21.2 %(741 cases) of our patients suffered from hypertension and illiterate people were significantly more aware of their disease (P=0.011). Among the aware group, at least 89.6% (435 cases) used one method to control their disease; this however was not statistically significant among the educational levels. Control of hypertension was significantly greater in college educated group than in illiterate group (32.4% vs. 68.8%; P=0.001). Logistic regression analysis revealed that illiteracy is a risk factor for hypertension (P<0.001).

CONCLUSION

In spite of the fact that awareness in illiterate people was high, the rate of hypertension control was low in this group. Prevention, detection, treatment, and control of hypertension especially in illiterate people should receive high priority.

Association between C-reactive protein and blood pressure in a cohort of elderly Muscovites: epidemiological study data

Background. The elevation of blood pressure (BP) affects the development of vascular inflammation. At the same time, it has been suggested that inflammation itself could be an independent risk factor (RF) of arterial hypertension (AH) development. Aim. To investigate whether the association between increased levels of C-reactive protein (CRP) and AH is independent from classical RFs. Material and methods. The data were obtained during a crosssectional survey of 1876 Muscovites (47,9% men) aged ≥55 years, who participated in the prospective study “Stress, Ageing, and Health in Russia”. In all participants, socio-demographic characteristics, health behaviours, parameters of anthropometry and rest electrocardiography (ECG) were assessed. The levels of BP and blood lipids were also measured. The outcome variable was an increase in CRP levels (>3 mg/l). Statistical methods included logistic regression; the risk estimates were presented as odds ratios (OR) and 95% confidence intervals (CI). Results. There was a positive link between AH and CRP levels of >3 mg/l. After adjustment for age and sex, OR of increased CRP levels in hypertensive participants vs. their AH-free peers was 1,688 (95% CI 1,323-2,154; p=0,0001). In the final model (adjustment for age, sex, educational level, smoking, alcohol consumption, abdominal obesity, high atherogenicity index, and coronary heart disease, CHD), this effect remained statistically significant (OR 1,450; 95% CI 1,127-1,864; p=0,004). Conclusion. In elderly Muscovites, a positive association between increased CRP levels and the elevation of BP was independent from RFs and CHD.

P.R4810K, a polymorphism of RNF213, the susceptibility gene for moyamoya disease, is associated with blood pressure

BACKGROUND

Moyamoya disease-an idiopathic vascular disorder of intracranial arteries-is often accompanied by hypertension. RNF213 has been identified as a susceptibility gene for moyamoya disease. In the present study, the association of p.R4810K (G>A) with blood pressure (BP) was investigated in a Japanese population.

METHODOLOGY/PRINCIPAL FINDINGS

Three independent study populations, the Nyukawa (n = 984), Noshiro (n = 2,443) and Field (n = 881) studies, joined this study. BP, body weight and height were measured. Past and present symptoms and disease and medication histories were assessed by interview. Associations of p.R4810K (rs112735431, ss179362673) of RNF213 with BP were investigated. Two linkage disequilibrium blocks were constructed for moyamoya patients with p.R4810K (n = 140) and the general population (n = 384) using 39 single nucleotide polymorphisms (SNPs) spanning 390 kb around RNF213. A total of 60 carriers (3 for AA genotype and 57 for GA genotype) were found in these samples, and the minor allele frequencies were 1.4 % in the Nyukawa and Field studies and 0.2 % in the Noshiro study. Regression analyses adjusted for age, sex and body mass index based on an additive model demonstrated significant associations with systolic BP (mmHg/allele): β (standard error) was 8.2 (2.9) in the Nyukawa study (P = 4.7 × 10(-3)), 18.7 (5.4) in the Noshiro study (P = 4.6 × 10(-4)) and 8.9 (2.0) (P = 1.0 × 10(-5)) in the three populations. In contrast, diastolic BP showed significant associations only in the Noshiro study. Linkage disequilibrium blocks contained none of the BP-associated proxy SNPs reported by previous studies.

CONCLUSIONS/SIGNIFICANCE

Our study suggests that p.R4810K of RNF213 is associated strongly with systolic BP.

Associations among physician advice, physical activity, and socio-demographic groups in older Spanish adults

This study examined the relationship between medical advice to engage in physical activity with type of demand required by physical activity and demographic variables. A cross-sectional study was developed, featuring a questionnaire on physicians' advice, and type of demand. The questionnaire was completed by a probability and nationwide sample of older adults in Spain (n = 933, M = 74.1, range 65-93), randomly selected using multistage sampling. More physically active older adults have, more often than the less active, received physicians' advice to engage in physical activity. There is a significant relationship between medical advice and type of demand (p < .01) and age (p < .05). However, no relationship was found between physician medical advice and gender, social class, or income. Physicians can effectively promote physical activity among sedentary older adults through appropriate advice. Consequently, health authorities should promote physicians' advising older patients to pursue physical activity.

Microneurographic research in women

This article reviews microneurographic research on sympathetic neural control in women under both physiological and pathophysiological conditions across the lifespan. Specifically, the effects of sex, age, race, the menstrual cycle, oral contraceptives, estrogen replacement therapy, and normal pregnancy on neural control of blood pressure in healthy women are reviewed. In addition, sympathetic neural activity during neurally mediated (pre)syncope, the Postural Orthostatic Tachycardia Syndrome (POTS), obesity, the Polycystic Ovary Syndrome (PCOS), gestational hypertension, and preeclampsia, chronic essential hypertension, heart failure, and myocardial infarction in women are also reviewed briefly. It is suggested that microneurographic studies provide valuable information regarding autonomic circulatory control in women of different ages and in most cases, excessive sympathetic activation is associated with specific medical conditions regardless of age and sex. In some situations, sympathetic inhibition or withdrawal may be the underlying mechanism. Information gained from previous and recent microneurographic studies has significant clinical implications in women's health, and in some cases could be used to guide therapy if more widely available.

Awareness of kidney disease and relationship to end-stage renal disease and mortality

BACKGROUND

Often, patients with chronic kidney disease are reported to be unaware of it. We prospectively evaluated the association between awareness of kidney disease to end-stage renal disease and mortality.

METHODS

We utilized 2000-2009 data from the National Kidney Foundation's Kidney Early Evaluation Program. Mortality was determined by cross reference to the Social Security Administration Death Master File and development of end stage by cross reference with the United States Renal Data System.

RESULTS

Of 109,285 participants, 28,244 (26%) had chronic kidney disease defined by albuminuria or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2). Only 9% (n=2660) reported being aware of kidney disease. Compared with those who were not aware, participants aware of chronic kidney disease had lower eGFR (49 vs 62 mL/min/1.73 m(2)) and a higher prevalence of albuminuria (52% vs. 46%), diabetes (47% vs 42%), cardiovascular disease (43% vs 28%), and cancer (23% vs 14%). Over 8.5 years of follow-up, aware participants compared with those unaware had a lower rate of survival for end stage (83% and 96%) and mortality (78% vs 81%), P <.001. After adjustment for demographics, socioeconomic factors, comorbidity, and severity of kidney disease, aware participants continued to demonstrate an increased risk for end-stage renal disease (hazard ratio 1.37; 95% confidence interval, 1.07-1.75; P <.0123) and mortality (hazard ratio 1.27; 95% confidence interval, 1.07-1.52; P <.0077) relative to unaware participants with chronic kidney disease.

CONCLUSIONS

Among patients identified as having chronic kidney disease at a health screening, only a small proportion had been made aware of their diagnosis previously by clinicians. This subgroup was at a disproportionately high risk for mortality and end-stage renal disease.

Effects of androgens on cardiovascular remodeling

Androgens, the male sex hormones, exert various biological effects on many target organs through the transcriptional effects of the nuclear androgen receptor (AR). ARs are expressed not only in classical target organs, such as the brain, genital organs, bone, and skeletal muscles, but also in the cardiovascular system. Because the female sex hormones estrogens are well-known to protect against cardiovascular disease, sex has been considered to have a significant clinical impact on cardiovascular mortality. However, the influence of androgens on the cardiovascular system has not been fully elucidated. To clarify this issue, we analyzed the effects of administration of angiotensin II and doxorubicin, an anticancer agent, in a loading model in male wild-type and AR-deficient mice. In this review, we focus on the actions of androgens as potential targets for the prevention of cardiovascular diseases in males.

Effects of a hypertension management program by Seongcheon primary health care post in South Korea: an analysis of changes in the level of knowledge of hypertension in the period from 2004 to 2009

The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in Goseong-gun, Gangwon province, South Korea. Preliminary interviews were conducted with all the residents prior to their enrollment in the health care post's hypertension management program. After 5 years of program operation, follow-up interviews were carried out with the same population. A total of 207 participants who completed both interviews were used in the final analysis. First, only the hypertensive group who participated in the program exhibited a significant difference in the level of knowledge. Second, educational level was associated with the level of knowledge in the entire group. Third, the effects of the program differed by gender, with men demonstrating more significant variations in knowledge upon participating in the program. For effective use of resources, considering that the effects of a hypertension education programs worked differently for groups, more customized hypertension management programs need to be targeted at each group to improve the effectiveness of hypertension education programs.

Angiotensin converting enzyme 2 contributes to sex differences in the development of obesity hypertension in C57BL/6 mice

OBJECTIVE

Obesity promotes hypertension, but it is unclear if sex differences exist in obesity-related hypertension. Angiotensin converting enzyme 2 (ACE2) converts angiotensin II (AngII) to angiotensin-(1-7) (Ang-[1-7]), controlling peptide balance. We hypothesized that tissue-specific regulation of ACE2 by high-fat (HF) feeding and sex hormones contributes to sex differences in obesity-hypertension.

METHODS AND RESULTS

HF-fed females gained more body weight and fat mass than males. HF-fed males exhibiting reduced kidney ACE2 activity had increased plasma angiotensin II levels and decreased plasma Ang-(1-7) levels. In contrast, HF-fed females exhibiting elevated adipose ACE2 activity had increased plasma Ang-(1-7) levels. HF-fed males had elevated systolic and diastolic blood pressure that were abolished by losartan. In contrast, HF-fed females did not exhibit increased systolic blood pressure until females were administered the Ang-(1-7) receptor antagonist, D-Ala-Ang-(1-7). Deficiency of ACE2 increased systolic blood pressure in HF-fed males and females, which was abolished by losartan. Ovariectomy of HF-fed female mice reduced adipose ACE2 activity and plasma Ang-(1-7) levels, and promoted obesity-hypertension. Finally, estrogen, but not other sex hormones, increased adipocyte ACE2 mRNA abundance.

CONCLUSIONS

These results demonstrate that tissue-specific regulation of ACE2 by diet and sex hormones contributes to sex differences in obesity-hypertension.

The association between blood pressure and incident Alzheimer disease: a systematic review and meta-analysis

BACKGROUND

Many epidemiologic studies have considered the association between blood pressure (BP) and Alzheimer disease, yet the relationship remains poorly understood.

METHODS

In parallel with work on the AlzRisk online database (www.alzrisk.org), we conducted a systematic review to identify all epidemiologic studies meeting prespecified criteria reporting on the association between hypertension, systolic BP, or diastolic BP and incident Alzheimer disease. When possible, we computed summary measures using random-effects models and explored potential heterogeneity related to age at BP assessment.

RESULTS

Eighteen studies reporting on 19 populations met the eligibility criteria. We computed summary relative risks (RR(Σ)) for 3 measures of BP: hypertension (RR(Σ) = 0.97 [95% confidence interval = 0.80-1.16]); a 10-mm Hg increase in systolic BP (RR(Σ) = 0.95 [0.91-1.00]); and a 10-mm Hg increase in diastolic BP (RR(Σ) = 0.94 [0.85-1.04]). We were unable to compute summary estimates for the association between categories of systolic or diastolic BP and Alzheimer disease; however, there did not appear to be a consistent pattern across studies. After stratifying on age at BP assessment, we found a suggestion of an inverse association between late-life hypertension and Alzheimer disease and a suggestion of an adverse association between midlife diastolic hypertension and Alzheimer disease.

CONCLUSIONS

Based on existing epidemiologic research, we cannot determine whether there is a causal association between BP and Alzheimer disease. Selection bias and reverse causation may account for the suggested inverse association between late-life hypertension on Alzheimer disease, but, given the expected direction of these biases, they are less likely to account for the suggestion that midlife hypertension increases risk. We advocate continuing systematic review; the AlzRisk database entry on this topic (www.alzrisk.org), which was completed in parallel with this work, will be updated as new studies are published.

Epidemiology of hypertension in Serbia: results of a National Survey

BACKGROUND

We evaluated the prevalence of high blood pressure and the level of awareness, treatment, and control of hypertension in a Serbian population.

METHODS

A cross-sectional study of an adult population was carried out across Serbia in 2006. The study involved 14 204 adults aged 20 years or older. Interviews and measurements of blood pressure were performed at participants' homes.

RESULTS

Overall, 47% of the Serbian adult population had hypertension: 25.3% had stage 1 hypertension and 18.1% had stage 2 hypertension. Only 58.0% of the hypertensive population were aware that they had the disease, and 60.4% were receiving medical treatment. Among those receiving medical treatment, only 20.9% had a blood pressure within the normal range. One in 10 participants with hypertension were not treated because, among other reasons, they thought treatment was unnecessary (55.3%) or they lacked money for medication (19.3%).

CONCLUSIONS

The prevalence of undiagnosed and untreated hypertension is high in the adult population of Serbia. Further action is required to hasten detection and treatment of high blood pressure. Attention should be directed toward educational programs that improve knowledge, attitudes, and awareness of hypertension among adults.

Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States

BACKGROUND

Recently, the American Heart Association developed a set of 7 ideal health metrics that will be used to measure progress toward their 2020 goals for cardiovascular health. The objective of the present study was to examine how well these metrics predicted mortality from all causes and diseases of the circulatory system in a national sample of adults in the United States.

METHODS AND RESULTS

We used data from 7622 adults ≥20 years of age who participated in the National Health and Nutrition Examination Survey from 1999 to 2002 and whose mortality through 2006 was determined via linkage to the National Death Index. For the dietary and glycemic metrics, we used alternative measures. During a median follow-up of 5.8 years, 532 deaths (186 deaths resulting from diseases of the circulatory system) occurred. About 1.5% of participants met none of the 7 ideal cardiovascular health metrics, and 1.1% of participants met all 7 metrics. The number of ideal metrics was significantly and inversely related to mortality from all causes and diseases of the circulatory system. Compared with participants who met none of the ideal metrics, those meeting ≥5 metrics had a reduction of 78% (adjusted hazard ratio, 0.22; 95% confidence interval, 0.10-0.50) in the risk for all-cause mortality and 88% (adjusted hazard ratio, 0.12; 95% confidence interval, 0.03-0.57) in the risk for mortality from diseases of the circulatory system.

CONCLUSION

The number of ideal cardiovascular health metrics is a strong predictor of mortality from all causes and diseases of the circulatory system.

Incidence of hypertension in Korea: 5-year follow-up study

Limited data are available about the incidence of hypertension over the 5-yr in non-hypertensive subjects. The study subjects were 1,806 subjects enrolled in a rural area of Daegu, Korea for a cohort study from August to November 2003. Of them, 1,287 (71.3%) individuals had another examination 5 yr later. To estimate the incidence of hypertension, 730 non-hypertensive individuals (265 males; mean age = 56.6 ± 11.1 yr-old) at baseline examination were analyzed in this study. Hypertension was defined as either a new diagnosis of hypertension or self-reports of newly initiated antihypertensive treatment; prehypertension was if the systolic blood pressure was 120-139 mmHg and/or diastolic blood pressure was 80-89 mmHg. During the 5-yr follow-up, 195 (26.7%) non-hypertensive individuals developed incident hypertension. The age-adjusted 5-yr incidence rates of hypertension were 22.9% (95% confidence interval [CI] = 19.9-29.0) in overall subjects, 22.2% (95% CI = 17.2-27.2) in men, and 24.3% (95% CI = 20.4-28.2) in women. The incidence rates of hypertension significantly increased with age. In the multivariate analysis, prehypertension (Odds ratio [OR] 2.25; P < 0.001) and older age (OR 2.26; P = 0.010) were independent predictors for incident hypertension. In this rapidly aging society, population-based preventive approach to decrease blood pressure, particularly in subjects with prehypertension, is needed to reduce hypertension.