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Dhungana RR, Pandey AR, Bista B, Joshi S, Devkota S. Prevalence and Associated Factors of Hypertension: A Community-Based Cross-Sectional Study in Municipalities of Kathmandu, Nepal. Int J Hypertens 2016; 2016:1656938. [PMID: 27293880 PMCID: PMC4880705 DOI: 10.1155/2016/1656938] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/24/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. This study aimed to assess the prevalence and associated factors of hypertension in newly declared municipalities of Kathmandu, Nepal. Design, Settings, and Participants. This was a community-based cross-sectional study conducted in the municipalities of Kathmandu District, Nepal, between January and July 2015. Study participants were aged 18 to 70 years, residing permanently in the study sites. Municipalities, Wards, households, and respondents were selected randomly. Results. Of the 587 participants, 58.8% were females, mean (SD) age was 42.3 (13.5) years, 29.3% had no formal education, 35.1% were Brahmins, and 41.2% were homemakers. Prevalence of hypertension was 32.5% (95% CI: 28.7-36.3). Age, gender, education, ethnicity, occupation, smoking, alcohol consumption, physical activity, diabetes, menopausal history, and family history of cardiovascular disease (CVD) and hypertension were significantly associated with hypertension. In multivariable analysis, smoking, alcohol consumption, physical activity, body mass index, and diabetes were identified as significant explanatory variables for hypertension. Conclusion. This study demonstrated that the people living in newly established municipalities of Kathmandu, Nepal, have a high burden of hypertension as well as its associated factors. Therefore, community-based preventive approaches like lifestyle modification and early detection and treatment of hypertension might bring a substantial change in tackling the burden effectively.
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Affiliation(s)
| | | | | | - Suira Joshi
- Ministry of Health and Population, Kathmandu, Nepal
| | - Surya Devkota
- Manmohan Cardiothoracic, Vascular and Transplant Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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152
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The effects of alcohol on ambulatory blood pressure and other cardiovascular risk factors in type 2 diabetes. J Hypertens 2016; 34:421-8; discussion 428. [DOI: 10.1097/hjh.0000000000000816] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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153
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Predictors of Hypertension in Survivors of the Great East Japan Earthquake, 2011: A Cross-sectional Study. Prehosp Disaster Med 2016; 31:17-26. [DOI: 10.1017/s1049023x15005440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroductionMany survivors of a major disaster die shortly after the event. Hypertension (HT) is one of the most important risk factors for these disaster-related diseases. An urgent need exists to establish methods to detect disaster survivors with HT and start medication immediately, as those with no injuries or symptoms may not be examined and medical teams cannot measure all survivors’ blood pressure (BP) because they often do not have sufficient time.ObjectiveThe goals of this report were: (1) to evaluate the importance of taking antihypertensive drugs continuously for patients with HT during the sub-acute phase after a major earthquake, when patients cannot attend a clinic because of destruction of the local infrastructure; and (2) to establish simple and reliable predictors to detect evacuees with HT, who require clinical examination and treatment at evacuation shelters or in their homes after a major earthquake.MethodsMedical rounds were performed at evacuation shelters in Iwate Prefecture after the Great East Japan Earthquake. Forty evacuees were enrolled in a cross-sectional study. The effect of taking antihypertensive drugs continuously was evaluated and predictors of HT in evacuees were identified using multiple logistic regression analysis.ResultsTwenty-eight evacuees were hypertensive (70%), nine of whom were asymptomatic (32%). Most evacuees who had discontinued antihypertensive medication (92%; 11/12) had very high BP, while those who had continued antihypertensive medication (80%; 8/10) were mildly hypertensive. The systolic BP of those who had discontinued antihypertensive drugs was significantly higher than that of those who had continued hypertensive drugs in the whole cohort (n=40), and also in evacuees diagnosed as having HT at evacuation shelters (n=28; P<.01 for both comparisons). A history of HT (adjusted odds ratio [aOR], 11.40; 95% confidence interval [CI], 1.03-126.08) or age >55 years (aOR, 1.10; 95% CI, 1.01-1.21) predicted HT with a sensitivity of 0.96 and specificity of 0.80.ConclusionsThe results of this study suggest that continuity of antihypertensive medication prevents serious HT at evacuation shelters in the first 10 days after a major earthquake. Onsite medical rounds focusing on simple predictors in an early stage after disasters may be an effective means of detecting and treating hypertensive disaster victims before they succumb to a fatal disease.TanakaR, OkawaM, UjikeY. Predictors of hypertension in survivors of the Great East Japan Earthquake, 2011: a cross-sectional study. Prehosp Disaster Med. 2016;31(1):17–26.
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The impacts of obesity on the cardiovascular and renal systems: cascade of events and therapeutic approaches. Curr Hypertens Rep 2016; 17:7. [PMID: 25620635 DOI: 10.1007/s11906-014-0520-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is a neglected epidemic of both obesity and metabolic syndrome in industrialized and unindustrialized countries all over the globe. Both conditions are associated with a high incidence of other serious pathologies, such as cardiovascular and renal diseases. In this article, we review the potential underlying mechanisms by which obesity and metabolic syndrome promote hypertension, including changes in cardiovascular-renal physiology induced by leptin, the sympathetic nervous system, the renin-angiotensin-aldosterone system, insulin resistance, free fatty acids, natriuretic peptides, and proinflammatory cytokines. We also discuss the potential underlying mechanisms by which obesity promotes other cardiovascular and renal conditions, as well as available nonpharmacologic and pharmacologic approaches for treating obesity-induced hypertension. The findings presented herein suggest that adipocytes may be a key regulator of cardiovascular and renal function.
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155
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Liu Y, Huang J, Xu G, He S, Zhang J, Wang X, Cai H, Shen Y. Prevalence and Determinants of Metabolic Syndrome-identified by Three Criteria among Men in Rural China: A Population-based Cross-sectional Study Conducted during 2007-2008. J Nutr Health Aging 2016; 20:574-82. [PMID: 27102798 DOI: 10.1007/s12603-015-0615-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to estimate MS prevalence according to three criteria and its risk factors among men in rural China. DESIGN Cross-sectional study. SETTING The Nantong Metabolic Syndrome Study (NMSS) was conducted during 2007-2008 in Nantong, China. PARTICIPANTS 6997 male participants aged 18-74 years. MEASUREMENTS In person interviews, blood glucose and lipid measurements were accomplished. RESULTS The prevalence of MS was 12.86%, 8.55% and 15.28% according to IDF, ATPIII and ATPIII-modified criteria, respectively. The IDF and ATP III-modified criteria agreed only moderately with ATP III criteria (κ= 0.56 and 0.68), whereas ATP III-modified and the IDF criteria agreed perfectly (κ= 0.90). Vigorous occupational physical activity was associated with a low prevalence of MS with Odds ratio (OR) of 0.58 (95% confidence interval (CI): 0.45-0.74). Beer drinkers (alcohol ≤ 6.2 g/day) and rice wine drinkers (alcohol ≤ 9.0 g/day) had about 34% and 33% low risks of developing MS respectively, compared with non-drinkers. OR of MS was 1.95 (95% CI: 1.39-2.73) in men who had familial history of at least two diseases, including hypertension and diabetes, compared with men without familial history of those diseases. CONCLUSIONS Our data suggested that MS is highly prevalent among men in rural China. Family history of diabetes and hypertension is a risk factor in MS development. Physical activity, rice wine and beer consumption are associated with a significantly lower risk.
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Affiliation(s)
- Y Liu
- Yi Shen, Department of Epidemiology and Medical Statistics, Nantong University, Nantong, Jiangsu, China 226019 E-mail: ; Hui Cai, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, USA E-mail:
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156
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Sarganas G, Knopf H, Grams D, Neuhauser HK. Trends in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension in Germany. Am J Hypertens 2016; 29:104-13. [PMID: 25968124 DOI: 10.1093/ajh/hpv067] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/14/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hypertension is a major risk factor for morbidity and mortality, therefore its control is of great importance. In this study we compare the use of antihypertensive medication among adults with hypertension in Germany 1998 and 2008-2011 and determine factors associated with use and control. METHODS Data from German Health Examination Surveys (GNHIES98 1998, n = 7,124 and DEGS1 2008-2011 n = 7,988, age 18-79 years) including standardized blood pressure (BP) measurements and Anatomical Therapeutic Chemical (ATC) medication codes were analyzed. RESULTS The use of antihypertensive medication among adults with hypertension in Germany increased from 54% to 72% in 1 decade. In 2008-2011, 67% of users were treated with polytherapy. The most commonly used antihypertensive class in 1998 was diuretics (43%) and in 2008-2011 beta-blockers (54%). Ramipril and metoprolol are currently the most commonly used monotherapy agents, while ramipril in combination with hydrochlorothiazide is the most frequent polytherapy. Being a woman, older age, having statutory health insurance, diabetes, coronary heart disease (CHD), stroke, and obesity were positively associated with antihypertensive use. The control rate among treated increased from 42% to 72%. Young women (18-54 years) had better control compared to older women or to men. Having CHD or stroke was positively associated with BP control. CONCLUSIONS Increased and improved antihypertensive use might be a main contributor to the decrease in BP observed in Germany in the last decade. However, there are still socio-demographic and health disparities in hypertension treatment and control.
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Affiliation(s)
- Giselle Sarganas
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany.
| | - Hildtraud Knopf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Daniel Grams
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hannelore K Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
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157
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Buijsse B, Jacobs DR, Steffen LM, Kromhout D, Gross MD. Plasma Ascorbic Acid, A Priori Diet Quality Score, and Incident Hypertension: A Prospective Cohort Study. PLoS One 2015; 10:e0144920. [PMID: 26683190 PMCID: PMC4684305 DOI: 10.1371/journal.pone.0144920] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/25/2015] [Indexed: 11/19/2022] Open
Abstract
Vitamin C may reduce risk of hypertension, either in itself or by marking a healthy diet pattern. We assessed whether plasma ascorbic acid and the a priori diet quality score relate to incident hypertension and whether they explain each other's predictive abilities. Data were from 2884 black and white adults (43% black, mean age 35 years) initially hypertension-free in the Coronary Artery Risk Development in Young Adults Study (study year 10, 1995-1996). Plasma ascorbic acid was assessed at year 10 and the diet quality score at year 7. Eight-hundred-and-forty cases of hypertension were documented between years 10 and 25. After multiple adjustments, each 12-point (1 SD) higher diet quality score at year 7 related to mean 3.7 μmol/L (95% CI 2.9 to 4.6) higher plasma ascorbic acid at year 10. In separate multiple-adjusted Cox regression models, the hazard ratio of hypertension per 19.6-μmol/L (1 SD) higher ascorbic acid was 0.85 (95% CI 0.79-0.92) and per 12-points higher diet score 0.86 (95% CI 0.79-0.94). These hazard ratios changed little with mutual adjustment of ascorbic acid and diet quality score for each other, or when adjusted for anthropometric variables, diabetes, and systolic blood pressure at year 10. Intake of dietary vitamin C and several food groups high in vitamin C content were inversely related to hypertension, whereas supplemental vitamin C was not. In conclusion, plasma ascorbic acid and the a priori diet quality score independently predict hypertension. This suggests that hypertension risk is reduced by improving overall diet quality and/or vitamin C status. The inverse association seen for dietary but not for supplemental vitamin C suggests that vitamin C status is preferably improved by eating foods rich in vitamin C, in addition to not smoking and other dietary habits that prevent ascorbic acid from depletion.
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Affiliation(s)
- Brian Buijsse
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Daan Kromhout
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Myron D. Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, United States of America
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158
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Shin HY, Linton JA, Shim JY, Kang HT. Cancer survivors aged 40 years or elder are associated with high risk of chronic kidney disease: the 2010-2012 Korean National Health and Nutrition Examination Survey. Asian Pac J Cancer Prev 2015; 16:1355-60. [PMID: 25743798 DOI: 10.7314/apjcp.2015.16.4.1355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of cancer survivors is increasing globally and recently, higher rates of comorbidities in cancer survivors have been reported. However, no studies have investigated whether cancer survivors have a higher risk of chronic kidney disease (CKD). Accordingly, our study evaluated the association between cancer survivors and the risk of CKD using the 2010-2012 Korean National Health and Nutrition Examination Survey. MATERIALS AND METHODS A total of 11,407 participants aged 40 years and over were categorized into two groups according to cancer experience. Multiple variables were compared and the odds ratios (ORs) for CKD prevalence were calculated using a weighted logistic regression analysis between the two groups. RESULTS Cancer survivors were older than were those in the non-cancer group, on average, the percentages of glomerular filtration rate(GFR) lower than 60mL/min/1.73m2, proteinuria, and CKD were significantly higher in cancer survivors when compared to controls. Weighted logistic regression analyses demonstrated that cancer survivors had a higher risk for CKD after adjusting for multiple variables (OR (95% confidence interval), 2.88 (1.48- 5.59)). CONCLUSIONS Our study demonstrated a possible association between CKD and cancer survival in Korean adults. Identifying and correcting risk factors for cancer survivors would positively affect prevention of CKD and result in a better cancer prognosis.
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Affiliation(s)
- Hyun-Young Shin
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea E-mail :
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159
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Jackson SE, van Jaarsveld CH, Beeken RJ, Gunter MJ, Steptoe A, Wardle J. Four-year stability of anthropometric and cardio-metabolic parameters in a prospective cohort of older adults. Biomark Med 2015; 9:109-22. [PMID: 25689899 DOI: 10.2217/bmm.14.78] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM To examine the medium-term stability of anthropometric and cardio-metabolic parameters in the general population. MATERIALS & METHODS Participants were 5160 men and women from the English Longitudinal Study of Ageing (age ≥50 years) assessed in 2004 and 2008. Anthropometric data included height, weight, BMI and waist circumference. Cardio-metabolic parameters included blood pressure, serum lipids (total cholesterol, HDL, LDL, triglycerides), hemoglobin, fasting glucose, fibrinogen and C-reactive protein. RESULTS Stability of anthropometric variables was high (all intraclass correlations >0.92), although mean values changed slightly (-0.01 kg weight, +1.33 cm waist). Cardio-metabolic parameters showed more variation: correlations ranged from 0.43 (glucose) to 0.81 (HDL). The majority of participants (71-97%) remained in the same grouping relative to established clinical cut-offs. CONCLUSION Over a 4-year period, anthropometric and cardio-metabolic parameters showed good stability. These findings suggest that when no means to obtain more recent data exist, a one-time sample will give a reasonable approximation to average levels over the medium-term, although reliability is reduced.
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Affiliation(s)
- Sarah E Jackson
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, UK
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160
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Collart F, de Timary P, Dom G, Dor BD, Duprez D, Lengelé JP, Matthys F, Peuskens H, Rehm J, Stärkel P. Alcohol-induced hypertension: an important healthcare target in Belgium. Acta Clin Belg 2015; 70:389-95. [PMID: 26135944 DOI: 10.1179/2295333715y.0000000039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Excessive alcohol intake is one of the leading causes of premature death in Europe and particularly in Belgium. Belgian people are consuming more alcohol per year than the European average. It is well established that excessive alcohol consumption is a significant predictor of the development of hypertension (HTN). Two million adults in Belgium suffer from HTN and this number will increase to three million by 2025. Less than 50% of Belgian people treated for HTN are well-controlled. Alcohol reduction in patients with HTN can significantly lower systolic and diastolic blood pressure. After reviewing the epidemiology of HTN and alcohol disorders in Belgium, this paper will focus on the rationale for alcohol screening and brief intervention in primary care. It will also describe the barriers to alcohol screening, and what could be the benefits of alcohol screening for our healthcare system. The authors believe that early identification through alcohol screening and brief intervention in general practice can help to improve the management of patients with HTN, to reach the targets of the WHO Global Action Plan, i.e., a 25% relative reduction in the risk of premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases. They are also convinced that this would allow achieving major healthcare savings.
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Affiliation(s)
- F Collart
- 1 Department of Nephrology, CHU/UVC Brugmann , Brussels, Belgium
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161
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McLean G, Murray E, Band R, Saunderson K, Hanlon P, Little P, McManus RJ, Yardley L, Mair FS. Digital Interventions to Promote Self-Management in Adults With Hypertension: Protocol for Systematic Review and Meta-Analysis. JMIR Res Protoc 2015; 4:e133. [PMID: 26589728 PMCID: PMC4704904 DOI: 10.2196/resprot.4648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/14/2015] [Accepted: 09/20/2015] [Indexed: 01/06/2023] Open
Abstract
Background Digital interventions, defined as any intervention accessed and taking input from patients in the form of a computer/Web-based program or mobile phoned-based app, can potentially help empower patients to self-manage long-term conditions such as hypertension. Importantly, digital interventions have the potential to provide patients with personalized information and support for active involvement in treatment as well as cost saving. Objective The purpose of this systematic review is to synthesize the evidence for using digital interventions to support patient self-management of hypertension, and determine their impact on control and reduction of blood pressure, other clinical outcomes, quality of life, medication adherence, health service utilization, and economic benefits. Methods A systematic search of bibliographic databases including Medline, Embase, CINAHL, and PsycINFO will be undertaken. Abstracts and citations will be independently screened by 2 researchers against predetermined inclusion criteria. Any disagreements will be resolved by discussion and further consideration of the inclusion criteria. Only randomized controlled trials which have been published in peer peer-reviewed journals with a diagnosis of hypertension will be considered. Inclusion criteria will be (1) adults (age ≥ 18 years) with hypertension (as defined by the primary authors); (2) an interactive digital intervention compared with usual care; and (3) outcomes of objectively measured change in blood pressure. Data extraction from identified articles will be undertaken by 2 independent reviewers using a uniform template. The main outcomes are systolic blood pressure (SBP) and diastolic blood pressure (DBP), and quality of life indicators. Secondary outcomes include cost- effectiveness, medication adherence, emotional well-being, and physical activity. Risk of bias of included studies will be assessed using the Cochrane tool. Results Our research is currently ongoing. Data will be summarized narratively, and if possible, meta-analyses will be performed to assess the impact of the interventions on outcomes. Conclusions By summarizing and synthesizing available data, this review will help inform policy on the use of digital interventions for self-management of hypertension and will clarify areas for further research. Trial Registration Prospero 2014: CRD42014010268; http://www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42014010268 (Archived by WebCite at http://www.webcitation.org/6c5alQQJL)
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Affiliation(s)
- Gary McLean
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
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162
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Bress AP, Tanner RM, Hess R, Colantonio LD, Shimbo D, Muntner P. Generalizability of SPRINT Results to the U.S. Adult Population. J Am Coll Cardiol 2015; 67:463-72. [PMID: 26562046 DOI: 10.1016/j.jacc.2015.10.037] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/22/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In SPRINT (Systolic Blood Pressure Intervention Trial), a systolic blood pressure (SBP) goal of <120 mm Hg resulted in lower cardiovascular disease (CVD) risk compared with an SBP goal of <140 mm Hg. OBJECTIVES The purpose of this study was to estimate the prevalence, number, and characteristics of U.S. adults meeting SPRINT eligibility criteria and determine the broader population to whom SPRINT could be generalized. METHODS We conducted a cross-sectional, population-based study using data from the National Health and Nutrition Examination Survey, 2007 to 2012. The SPRINT inclusion criteria were age ≥50 years, SBP 130 to 180 mm Hg depending on the number of antihypertensive medication classes being taken, and high CVD risk (history of coronary heart disease, estimated glomerular filtration rate of 20 to 59 ml/min/1.73 m(2), 10-year CVD risk ≥15%, or age ≥75 years). Exclusion criteria were diabetes, history of stroke, >1 g in 24 h of proteinuria daily, heart failure, estimated glomerular filtration rate <20 ml/min/1.73 m(2), or receiving dialysis. Treated hypertension was defined by self-reported use of medication to lower blood pressure with ≥1 class of antihypertensive medication identified through a pill bottle review. RESULTS Overall, 7.6% (95% confidence interval [CI]: 7.0% to 8.3%) or 16.8 million (95% CI: 15.7 to 17.8 million) U.S. adults, and 16.7% (95% CI: 15.2% to 18.3%) or 8.2 million (95% CI: 7.6 to 8.8 million) adults with treated hypertension met the SPRINT eligibility criteria. Among both the overall U.S. population and adults with treated hypertension, the percentage meeting SPRINT eligibility criteria increased with older age, was higher among males than females, and was higher among non-Hispanic whites compared with non-Hispanic blacks or Hispanics. Of U.S. adults eligible for SPRINT, 51.0% (95% CI: 47.8% to 54.1%) or 8.6 million (95% CI: 8.0 to 9.1 million) were not treated for hypertension. CONCLUSIONS A substantial percentage of U.S. adults meet the eligibility criteria for SPRINT.
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Affiliation(s)
- Adam P Bress
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah
| | - Rikki M Tanner
- School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel Hess
- Departments of Population Health Sciences and Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Lisandro D Colantonio
- School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daichi Shimbo
- Department of Medicine, Columbia University, New York, New York
| | - Paul Muntner
- School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
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163
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Gual A, Zarco J, Colom Farran J, Rehm J. [Early screening and brief intervention in alcohol misuse to improve the treatment of hypertension in primary care]. Med Clin (Barc) 2015; 146:81-5. [PMID: 26520609 DOI: 10.1016/j.medcli.2015.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Antoni Gual
- Unidad de Alcohología, Servicio de Psiquiatría, Instituto de Neurociencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | - José Zarco
- Centro de Salud Ibiza, Servicio Madrileño de Salud, Madrid, España
| | - Joan Colom Farran
- Subdirección General de Drogodependencias, Agencia de Salud Pública de Cataluña, Departamento de Salud, Generalitat de Cataluña, Barcelona, España
| | - Jürgen Rehm
- Unidad de Investigación Epidemiológica, Psicología Clínica y Psicoterapia, Universidad Tecnológica de Dresde, Dresde, Alemania; Centre for Addiction and Mental Health, Toronto, Canadá
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164
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Ezzati M, Obermeyer Z, Tzoulaki I, Mayosi BM, Elliott P, Leon DA. Contributions of risk factors and medical care to cardiovascular mortality trends. Nat Rev Cardiol 2015; 12:508-30. [PMID: 26076950 PMCID: PMC4945698 DOI: 10.1038/nrcardio.2015.82] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ischaemic heart disease, stroke, and other cardiovascular diseases (CVDs) lead to 17.5 million deaths worldwide per year. Taking into account population ageing, CVD death rates are decreasing steadily both in regions with reliable trend data and globally. The declines in high-income countries and some Latin American countries have been ongoing for decades without slowing. These positive trends have broadly coincided with, and benefited from, declines in smoking and physiological risk factors, such as blood pressure and serum cholesterol levels. These declines have also coincided with, and benefited from, improvements in medical care, including primary prevention, diagnosis, and treatment of acute CVDs, as well as post-hospital care, especially in the past 40 years. These variables, however, explain neither why the decline began when it did, nor the similarities and differences in the start time and rate of the decline between countries and sexes. In Russia and some other former Soviet countries, changes in volume and patterns of alcohol consumption have caused sharp rises in CVD mortality since the early 1990s. An important challenge in reaching firm conclusions about the drivers of these remarkable international trends is the paucity of time-trend data on CVD incidence, risk factors throughout the life-course, and clinical care.
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Affiliation(s)
- Majid Ezzati
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Ziad Obermeyer
- Department of Emergency Medicine, Harvard Medical School, Neville House, 75 Francis Street, Boston, MA 02115, USA
| | - Ioanna Tzoulaki
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Main Building, Observatory, Cape Town 7925, South Africa
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - David A Leon
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Sciences, London School of Hygiene &Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Abstract
More than one in four American adults consume alcohol in quantities exceeding recommended limits. One in 12 have an alcohol use disorder marked by harmful consequences. Both types of alcohol misuse contribute to acute injury and chronic disease, making alcohol the third largest cause of preventable death in the United States. Alcohol misuse alters the management of common conditions from insomnia to anemia. Primary care providers should screen adult patients to identify the full spectrum of alcohol misuse. A range of effective treatments are available - from brief counselling interventions and mutual help groups to medications and behavioral therapies.
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Affiliation(s)
- Douglas Berger
- General Medicine Service, VA Puget Sound, Seattle, WA 98108, USA; Department of Medicine, University of Washington, Seattle, WA 98101, USA.
| | - Katharine A Bradley
- Department of Medicine, University of Washington, Seattle, WA 98101, USA; Department of Health Services, University of Washington, Seattle, WA 98101, USA; Group Health Research Institute, Seattle, WA, USA; VA Health Services Research & Development (HSR&D) and Center of Excellence in Substance Abuse Treatment and Education (CESATE), Seattle, WA, USA
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166
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Helm L, Macdonald IA. Impact of beverage intake on metabolic and cardiovascular health. Nutr Rev 2015; 73 Suppl 2:120-9. [DOI: 10.1093/nutrit/nuv049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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167
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Whitman IR, Pletcher MJ, Vittinghoff E, Imburgia KE, Maguire C, Bettencourt L, Sinha T, Parsnick T, Tison GH, Mulvanny CG, Olgin JE, Marcus GM. Perceptions, Information Sources, and Behavior Regarding Alcohol and Heart Health. Am J Cardiol 2015; 116:642-6. [PMID: 26092272 DOI: 10.1016/j.amjcard.2015.05.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
Despite the equipoise regarding alcohol's cardiovascular effects and absence of relevant rigorous controlled trials, the lay press frequently portrays alcohol as "heart healthy." The public perception of alcohol's heart effects, the sources of those perceptions, and how they may affect behavior are unknown. We performed a cross-sectional analysis of data obtained from March 2013 to September 2014 from consecutive participants enrolled in the Health eHeart Study. Of 5,582 participants, 1,707 (30%) viewed alcohol as heart healthy, 2,157 (39%) viewed it as unhealthy, and 1,718 (31%) were unsure. Of those reporting alcohol as heart healthy, 80% cited lay press as a source of their knowledge. After adjustment, older age (odds ratio 1.11), higher education (odds ratio 1.37), higher income (odds ratio 1.07), US residence (odds ratio 1.63), and coronary artery disease (odds ratio 1.51) were associated with perception of alcohol as heart healthy (all p <0.003). Ever smokers (odds ratio 0.76, p = 0.004) and those with heart failure (odds ratio 0.5, p = 0.01) were less likely to cite alcohol as heart healthy. Those perceiving alcohol as heart healthy consumed on average 47% more alcohol on a regular basis (95% confidence interval 27% to 66%, p <0.001). In conclusion, of >5,000 consecutive Health eHeart participants, approximately 1/3 believed alcohol to be heart healthy, and the majority cited the lay press as the origin of that perception. Those with a perception of alcohol as heart healthy drink substantially more alcohol.
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168
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Shen J, Wilmot KA, Ghasemzadeh N, Molloy DL, Burkman G, Mekonnen G, Gongora MC, Quyyumi AA, Sperling LS. Mediterranean Dietary Patterns and Cardiovascular Health. Annu Rev Nutr 2015; 35:425-49. [DOI: 10.1146/annurev-nutr-011215-025104] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jia Shen
- Emory Clinical Cardiovascular Research Institute,
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia 30322;
| | - Kobina A. Wilmot
- Emory Clinical Cardiovascular Research Institute,
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia 30322;
| | - Nima Ghasemzadeh
- Emory Clinical Cardiovascular Research Institute,
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia 30322;
| | - Daniel L. Molloy
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia 30322;
| | - Gregory Burkman
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia 30322;
| | - Girum Mekonnen
- Emory Clinical Cardiovascular Research Institute,
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia 30322;
| | - Maria C. Gongora
- Emory Clinical Cardiovascular Research Institute,
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia 30322;
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research Institute,
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia 30322;
| | - Laurence S. Sperling
- Emory Clinical Cardiovascular Research Institute,
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia 30322;
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169
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Tshitenge S, Mabuza LH. A survey of risk factors associated with hypertension in the adult population of Kang, Kgalagadi North, Botswana. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2014.976963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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170
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Molina PE, Gardner JD, Souza-Smith FM, Whitaker AM. Alcohol abuse: critical pathophysiological processes and contribution to disease burden. Physiology (Bethesda) 2015; 29:203-15. [PMID: 24789985 DOI: 10.1152/physiol.00055.2013] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Alcohol abuse; the most common and costly form of drug abuse, is a major contributing factor to many disease categories. The alcohol-attributable disease burden is closely related to the average volume of alcohol consumption, with dose-dependent relationships between amount and duration of alcohol consumption and the incidence of diabetes mellitus, hypertension, cardiovascular disease, stroke, and pneumonia. The frequent occurrence of alcohol use disorders in the adult population and the significant and widespread detrimental organ system effects highlight the importance of recognizing and further investigating the pathophysiological mechanisms underlying alcohol-induced tissue and organ injury.
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Affiliation(s)
- Patricia E Molina
- Department of Physiology and Alcohol and Drug Abuse Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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171
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Knott CS, Coombs N, Stamatakis E, Biddulph JP. All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ 2015; 350:h384. [PMID: 25670624 PMCID: PMC4353285 DOI: 10.1136/bmj.h384] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To examine the suitability of age specific limits for alcohol consumption and to explore the association between alcohol consumption and mortality in different age groups. DESIGN Population based data from Health Survey for England 1998-2008, linked to national mortality registration data and pooled for analysis using proportional hazards regression. Analyses were stratified by sex and age group (50-64 and ≥ 65 years). SETTING Up to 10 waves of the Health Survey for England, which samples the non-institutionalised general population resident in England. PARTICIPANTS The derivation of two analytical samples was based on the availability of comparable alcohol consumption data, covariate data, and linked mortality data among adults aged 50 years or more. Two samples were used, each utilising a different variable for alcohol usage: self reported average weekly consumption over the past year and self reported consumption on the heaviest day in the past week. In fully adjusted analyses, the former sample comprised Health Survey for England years 1998-2002, 18,368 participants, and 4102 deaths over a median follow-up of 9.7 years, whereas the latter comprised Health Survey for England years 1999-2008, 34,523 participants, and 4220 deaths over a median follow-up of 6.5 years. MAIN OUTCOME MEASURE All cause mortality, defined as any death recorded between the date of interview and the end of data linkage on 31 March 2011. RESULTS In unadjusted models, protective effects were identified across a broad range of alcohol usage in all age-sex groups. These effects were attenuated across most use categories on adjustment for a range of personal, socioeconomic, and lifestyle factors. After the exclusion of former drinkers, these effects were further attenuated. Compared with self reported never drinkers, significant protective associations were limited to younger men (50-64 years) and older women (≥ 65 years). Among younger men, the range of protective effects was minimal, with a significant reduction in hazards present only among those who reported consuming 15.1-20.0 units/average week (hazard ratio 0.49, 95% confidence interval 0.26 to 0.91) or 0.1-1.5 units on the heaviest day (0.43, 0.21 to 0.87). The range of protective effects was broader but lower among older women, with significant reductions in hazards present ≤ 10.0 units/average week and across all levels of heaviest day use. Supplementary analyses found that most protective effects disappeared where calculated in comparison with various definitions of occasional drinkers. CONCLUSIONS Beneficial associations between low intensity alcohol consumption and all cause mortality may in part be attributable to inappropriate selection of a referent group and weak adjustment for confounders. Compared with never drinkers, age stratified analyses suggest that beneficial dose-response relations between alcohol consumption and all cause mortality may be largely specific to women drinkers aged 65 years or more, with little to no protection present in other age-sex groups. These protective associations may, however, be explained by the effect of selection biases across age-sex strata.
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Affiliation(s)
- Craig S Knott
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ngaire Coombs
- Physical Activity Research Group, Department of Epidemiology and Public Health, University College London, London, UK Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Emmanuel Stamatakis
- Physical Activity Research Group, Department of Epidemiology and Public Health, University College London, London, UK Charles Perkins Centre, University of Sydney, Sydney, Australia Exercise Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Jane P Biddulph
- Department of Epidemiology and Public Health, University College London, London, UK
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172
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Whelton PK. Treatment: special conditions. Prevention/public health strategies. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2015; 9:161-165. [PMID: 25660366 DOI: 10.1016/j.jash.2015.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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173
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Anchala R, Kaptoge S, Pant H, Di Angelantonio E, Franco OH, Prabhakaran D. Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial. J Am Heart Assoc 2015; 4:e001213. [PMID: 25559011 PMCID: PMC4330052 DOI: 10.1161/jaha.114.001213] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Randomized control trials from the developed world report that clinical decision support systems (DSS) could provide an effective means to improve the management of hypertension (HTN). However, evidence from developing countries in this regard is rather limited, and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center (PHC) settings. Methods and Results We performed a cluster randomized trial to test the effectiveness and cost‐effectiveness of a clinical DSS among Indian adult hypertensive patients (between 35 and 64 years of age), wherein 16 PHC clusters from a district of Telangana state, India, were randomized to receive either a DSS or a chart‐based support (CBS) system. Each intervention arm had 8 PHC clusters, with a mean of 102 hypertensive patients per cluster (n=845 in DSS and 783 in CBS groups). Mean change in systolic blood pressure (SBP) from baseline to 12 months was the primary endpoint. The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow‐up, adjusted for age, sex, height, waist, body mass index, alcohol consumption, vegetable intake, pickle intake, and baseline differences in blood pressure, was −6.59 mm Hg (95% confidence interval: −12.18 to −1.42; P=0.021). The cost‐effective ratio for CBS and DSS groups was $96.01 and $36.57 per mm of SBP reduction, respectively. Conclusion Clinical DSS are effective and cost‐effective in the management of HTN in resource‐constrained PHC settings. Clinical Trial Registration URL: http://www.ctri.nic.in. Unique identifier: CTRI/2012/03/002476.
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Affiliation(s)
- Raghupathy Anchala
- Public Health Foundation of India - Indian Institute of Public Health, Hyderabad, India (R.A., H.P.) Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (R.A., S.K., E.D.A.)
| | - Stephen Kaptoge
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (R.A., S.K., E.D.A.)
| | - Hira Pant
- Public Health Foundation of India - Indian Institute of Public Health, Hyderabad, India (R.A., H.P.)
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (R.A., S.K., E.D.A.)
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands (O.H.F.)
| | - D Prabhakaran
- Public Health Foundation of India, New Delhi, India (P.) Center for Chronic Disease Control, New Delhi, India (P.)
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174
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Development and validation of the Hypertension Self-care Profile: a practical tool to measure hypertension self-care. J Cardiovasc Nurs 2014; 29:E11-20. [PMID: 24088621 DOI: 10.1097/jcn.0b013e3182a3fd46] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Adequate self-care is crucial for blood pressure control. A number of hypertension (HBP) self-care instruments are available, but existing tools do not capture all the critical domains of HBP self-care and have limited evidence of reliability and validity. OBJECTIVE The purpose of this study was to develop and validate a new tool--the HBP Self-Care Profile (HBP SCP)--in a sample of inner-city residents. METHODS The HBP SCP encompasses comprehensive domains of HBP self-care behaviors. Guided by 2 validated theoretical approaches--Orem's self-care model and Motivational Interviewing--the HBP SCP includes 3 scales that can be used together or independently: Behavior, Motivation, and Self-efficacy. The sample included 213 English-speaking inner-city residents with HBP (mean age, 68.6 years; 76.1% women; 81.7% African American). RESULTS Item-total correlations ranged from 0.20 to 0.63 for Behavior, 0.46 to 0.70 for Motivation, and 0.40 to 0.74 for Self-efficacy, meeting the cutoff set a priori at 0.15. Internal consistency reliability coefficients ranged from 0.83 to 0.93. Concurrent and construct validities of the HBP SCP were achieved by significant correlations between HBP SCP scales and theoretically selected instruments (P < .05 for all correlation coefficients). The HBP SCP-Behavior scale also successfully discriminated between those with or without blood pressure control (P < .05). CONCLUSIONS The reliability and validity of the HBP SCP were supported in this sample of inner-city residents with HBP. The high reliability estimates and strong evidence of validity should allow researchers to use the HBP SCP to assess and identify gaps in HBP self-care behavior, motivation, and self-efficacy. Future research is warranted to evaluate the HBP SCP in diverse ethnic and age samples of hypertensive patient populations.
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175
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Mpinda J, Tumbo J, Govender I, Mills B. The knowledge and beliefs of hypertensive patients attending Katleho District Hospital in Free State province, South Africa, about their illness. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786190.2014.953887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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176
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Hypertension, alcohol drinking and stroke incidence: a population-based prospective cohort study among inner Mongolians in China. J Hypertens 2014; 32:1091-6; discussion 1096. [PMID: 24577411 DOI: 10.1097/hjh.0000000000000142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effect of hypertension and alcohol drinking on stroke incidence and whether alcohol drinking would increase the risk of stroke in hypertension participants among Inner Mongolians. METHODS A prospective cohort study from June 2003 to July 2012 was conducted among 2535 people aged 20 years and older from Inner Mongolia, China. We categorized the participants into four subgroups according to blood pressure and drinking status. The cumulative risks of stroke among the four subgroups were estimated with the Kaplan-Meier curves and compared by log-rank test. Cox proportional hazards models and receiver operating characteristic (ROC) curves were employed to evaluate the association between hypertension, alcohol drinking and stroke incidence. RESULTS A total of 120 stroke patients were observed during the follow-up period. The multivariate-adjusted hazard ratios (95% confidential intervals) of stroke for nonhypertension/drinkers, hypertension/nondrinkers and hypertension/drinkers were 1.03 (0.48-2.22), 2.64 (1.45-4.81) and 2.89 (1.55-5.39), respectively, compared with nonhypertension/nondrinkers. The area under ROC curve (AUC) for a model containing hypertension and drinking status along with conventional factors (AUC = 0.684) was significantly (P = 0.005) larger than one containing only conventional factors (AUC = 0.660). CONCLUSION These findings suggest that hypertension is an independent risk factor of stroke in Inner Mongolians. Drinkers with hypertension seem to be more susceptible to stroke; larger-sample prospective cohort studies are still required to examine the cumulative effect of drinking and hypertension on stroke incidence.
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177
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Development of a risk prediction model for incident hypertension in a working-age Japanese male population. Hypertens Res 2014; 38:419-25. [PMID: 25391458 DOI: 10.1038/hr.2014.159] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 08/28/2014] [Accepted: 09/11/2014] [Indexed: 02/07/2023]
Abstract
The aim of this study was to develop a risk prediction model for incident hypertension in a Japanese male population. Study participants included 15,025 nonhypertensive Japanese male workers (mean age, 38.8±8.9 years) who underwent an annual medical checkup at a company. The participants were followed-up for a median of 4.0 years to determine new-onset hypertension, defined as a systolic blood pressure (BP) ⩾140 mm Hg, a diastolic BP ⩾90 mm Hg, or the initiation of antihypertensive medication. Participants were divided into the following two cohorts for subsequent analyses: the derivation cohort (n=12,020, 80% of the study population) and the validation cohort (n=3005, the remaining 20% of the study population). In the derivation cohort, a multivariate Cox proportional hazards model demonstrated that age, body mass index, systolic and diastolic BP, current smoking status, excessive alcohol intake and parental history of hypertension were independent predictors of incident hypertension. Using these variables, a risk prediction model was constructed to estimate the 4-year risk of incident hypertension. In the validation cohort, the risk prediction model demonstrated high discrimination ability and acceptable calibration, with a C-statistic of 0.861 (95% confidence interval 0.844, 0.877) and a modified Hosmer-Lemeshow χ2 statistic of 15.2 (P=0.085). A risk score sheet was constructed to enable the simple calculation of the approximate 4-year probability of incident hypertension. In conclusion, a practical risk prediction model for incident hypertension was successfully developed in a working-age Japanese male population.
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178
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Toda A, Ishizaka Y, Tani M, Yamakado M. Current dietary salt intake of Japanese individuals assessed during health check-up. Hypertens Res 2014; 38:163-8. [PMID: 25354779 DOI: 10.1038/hr.2014.154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/16/2014] [Accepted: 08/27/2014] [Indexed: 11/09/2022]
Abstract
Excess salt intake is a risk factor for increased blood pressure (BP) and hypertension. To prevent hypertension, the reduction of salt intake is promoted in many countries. For people with hypertension or cardiovascular disease (CVD), a more severe restriction of salt intake is indispensable. Japanese individuals consume high quantities of salt, and it is thus important to determine the degree to which the salt intake of these individuals has been restricted. Here, we investigated the current level of salt consumption of Japanese individuals using data obtained during annual health check-ups. A total of 10 762 individuals were assessed who underwent annual health check-ups at our institution in 2011. The estimated daily salt intake (EDSI) was calculated using spot urine samples. The average EDSI was 7.83±2.02 g per day. BP increased in proportion to the EDSI, and multivariate logistic regression analysis showed that the EDSI was a significant and independent risk factor for hypertension. The average EDSI of the subjects with hypertension or a history of CVD was higher than that of the subjects without these diseases. The subjects who drank more heavily showed higher EDSIs. This study demonstrated that the average EDSI of the subjects needing to restrict their salt intake because of past or present illnesses was high. To achieve adherence to the recommended reduction of salt intake, more efforts are required.
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Affiliation(s)
- Akiko Toda
- Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuko Ishizaka
- Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mizuki Tani
- Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital, Tokyo, Japan
| | - Minoru Yamakado
- Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital, Tokyo, Japan
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179
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Abstract
Secondary hypertension (SH) often implies a correctable form of nonessential hypertension. Often certain clinical clues prompt a more extensive evaluation of the causes of the hypertension. Renovascular disease, intrinsic renal disease, primary hyperaldosteronism, and obstructive sleep apnea represent the most common causes of SH. This article defines the disorder and details its epidemiology, prevalence, pathophysiology, physical findings, and treatment strategies.
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Affiliation(s)
- Raghavesh Pullalarevu
- Division of Nephrology, Department of Medicine, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
| | - Ghulam Akbar
- Division of Nephrology, Department of Medicine, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
| | - Geoffrey Teehan
- Division of Nephrology, Department of Medicine, Lankenau Institute of Medical Research, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA.
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180
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Effects of vitamin E, vitamin C and polyphenols on the rate of blood pressure variation: results of two randomised controlled trials. Br J Nutr 2014; 112:1551-61. [PMID: 25234339 DOI: 10.1017/s0007114514002542] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High blood pressure (BP) variability, which may be an important determinant of hypertensive end-organ damage, is emerging as an important predictor of cardiovascular health. Dietary antioxidants can influence BP, but their effects on variability are yet to be investigated. The aim of the present study was to assess the effects of vitamin E, vitamin C and polyphenols on the rate of daytime and night-time ambulatory BP variation. To assess these effects, two randomised, double-blind, placebo-controlled trials were performed. In the first trial (vitamin E), fifty-eight individuals with type 2 diabetes were given 500 mg/d of RRR-α-tocopherol, 500 mg/d of mixed tocopherols or placebo for 6 weeks. In the second trial (vitamin C-polyphenols), sixty-nine treated hypertensive individuals were given 500 mg/d of vitamin C, 1000 mg/d of grape-seed polyphenols, both vitamin C and polyphenols, or neither (placebo) for 6 weeks. At baseline and at the end of the 6-week intervention, 24 h ambulatory BP and rate of measurement-to-measurement BP variation were assessed. Compared with placebo, treatment with α-tocopherol, mixed tocopherols, vitamin C and polyphenols did not significantly alter the rate of daytime or night-time systolic BP, diastolic BP or pulse pressure variation (P>0·05). Treatment with the vitamin C and polyphenol combination resulted in higher BP variation: the rate of night-time systolic BP variation (P= 0·022) and pulse pressure variation (P= 0·0036) were higher and the rate of daytime systolic BP variation was higher (P= 0·056). Vitamin E, vitamin C or grape-seed polyphenols did not significantly alter the rate of BP variation. However, the increase in the rate of BP variation suggests that the combination of high doses of vitamin C and polyphenols could be detrimental to treated hypertensive individuals.
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181
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Albarwani S, Al-Siyabi S, Tanira MO. Prehypertension: Underlying pathology and therapeutic options. World J Cardiol 2014; 6:728-43. [PMID: 25228952 PMCID: PMC4163702 DOI: 10.4330/wjc.v6.i8.728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/08/2014] [Accepted: 06/14/2014] [Indexed: 02/06/2023] Open
Abstract
Prehypertension (PHTN) is a global major health risk that subjects individuals to double the risk of cardiovascular disease (CVD) independent of progression to overt hypertension. Its prevalence rate varies considerably from country to country ranging between 21.9% and 52%. Many hypotheses are proposed to explain the underlying pathophysiology of PHTN. The most notable of these implicate the renin-angiotensin system (RAS) and vascular endothelium. However, other processes that involve reactive oxygen species, the inflammatory cytokines, prostglandins and C-reactive protein as well as the autonomic and central nervous systems are also suggested. Drugs affecting RAS have been shown to produce beneficial effects in prehypertensives though such was not unequivocal. On the other hand, drugs such as β-adrenoceptor blocking agents were not shown to be useful. Leading clinical guidelines suggest using dietary and lifestyle modifications as a first line interventional strategy to curb the progress of PHTN; however, other clinically respected views call for using drugs. This review provides an overview of the potential pathophysiological processes associated with PHTN, abridges current intervention strategies and suggests investigating the value of using the "Polypill" in prehypertensive subjects to ascertain its potential in delaying (or preventing) CVD associated with raised blood pressure in the presence of other risk factors.
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Affiliation(s)
- Sulayma Albarwani
- Sulayma Albarwani, Sultan Al-Siyabi, Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Sultan Al-Siyabi
- Sulayma Albarwani, Sultan Al-Siyabi, Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Musbah O Tanira
- Sulayma Albarwani, Sultan Al-Siyabi, Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
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182
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Abstract
Elevated blood pressure arises from a combination of environmental and genetic factors and the interactions of these factors. A substantial body of evidence from animal studies, epidemiologic studies, meta-analyses, and randomized controlled trials has demonstrated that certain dietary patterns and individual dietary elements play a prominent role in the development of hypertension. Changes in diet can lower blood pressure, prevent the development of hypertension, and reduce the risk of hypertension-related complications. Dietary strategies for the prevention of hypertension include reducing sodium intake, limiting alcohol consumption, increasing potassium intake, and adopting an overall dietary pattern such as the DASH (Dietary Approaches to Stop Hypertension) diet or a Mediterranean diet. In order to reduce the burden of blood pressure-related complications, efforts that focus on environmental and individual behavioral changes that encourage and promote healthier food choices are warranted.
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183
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Anderson P, Wojnar M, Jakubczyk A, Gual A, Reynolds J, Segura L, Sovinova H, Csemy L, Kaner E, Newbury-Birch D, Fornasin A, Struzzo P, Ronda G, van Steenkiste B, Keurhorst M, Laurant M, Ribeiro C, do Rosário F, Alves I, Scafato E, Gandin C, Kolsek M. Managing Alcohol Problems in General Practice in Europe: Results from the European ODHIN Survey of General Practitioners. Alcohol Alcohol 2014; 49:531-9. [DOI: 10.1093/alcalc/agu043] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kim HJ, Kim JH, Choe WH, Kwon SY, Lee CH. Alcoholic fatty liver disease elevates estimated coronary heart disease risk to levels comparable with those of nonalcoholic fatty liver disease in the Korean population: a cross-sectional study. Clin Mol Hepatol 2014; 20:154-61. [PMID: 25032181 PMCID: PMC4099330 DOI: 10.3350/cmh.2014.20.2.154] [Citation(s) in RCA: 5] [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] [Received: 04/01/2014] [Revised: 05/12/2014] [Accepted: 05/20/2014] [Indexed: 12/20/2022] Open
Abstract
Background/Aims A close relationship has been established between nonalcoholic fatty liver disease (NAFLD) and an elevated risk of coronary heart disease (CHD), but little is known about the association between alcoholic fatty liver disease (AFLD) and CHD risk. The aim of this study was to determine whether AFLD is associated with elevated CHD risk. Methods We retrospectively enrolled 10,710 subjects out of 11,469 individuals who visited the Konkuk University Health Care Center for a routine health checkup in 2010. AFLD was diagnosed made when the usual amount of alcohol consumption exceeded 210 g/week in males and 140 g/week in females for the previous 2 years and when hepatic steatosis was detected by liver ultrasonography. The 10-year risk for CHD was estimated using the Framingham Risk Score. Results Hepatic steatosis was diagnosed in 4,142 of the 10,710 individuals (38.7%); the remainder (i.e., n=6,568) became the control group. The 4,142 individuals with hepatic steatosis were divided into two groups: NAFLD (n=2,953) and AFLD (n=1,189). The risk of CHD was higher in AFLD (6.72±0.12) than in the control group (5.50±0.04, P<0.001), and comparable to that in NAFLD (7.32±0.07, P=0.02). Conclusions Individuals with AFLD have an elevated 10-year risk of CHD that is comparable to those with NAFLD. Therefore, AFLD should be considered a significant risk for future CHD, and preventive measures should be considered earlier.
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Affiliation(s)
- Hai Jin Kim
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Han Kim
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Won Hyeok Choe
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - So Young Kwon
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Chang Hong Lee
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Rittmueller SE, Frey MS, Williams EC, Sun H, Bryson CL, Bradley KA. Association between alcohol use and cardiovascular self-care behaviors among male hypertensive Veterans Affairs outpatients: a cross-sectional study. Subst Abus 2014; 36:6-12. [PMID: 24964087 DOI: 10.1080/08897077.2014.932318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Alcohol use is associated with health behaviors that impact cardiovascular outcomes in patients with hypertension, including avoiding salt, exercising, weight management, and not smoking. This study examined associations between varying levels of alcohol use and self-reported cardiovascular health behaviors among hypertensive Veterans Affairs (VA) outpatients. METHODS Male outpatients with self-reported hypertension from 7 VA sites who returned mailed questionnaires (N = 11,927) were divided into 5 levels of alcohol use: nondrinking, low-level use, and mild, moderate, and severe alcohol misuse based on AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) scores (0, 1-3, 4-5, 6-7, and 8-12, respectively). For each category, adjusted logistic regression models estimated the prevalence of patients who self-reported avoiding salt, exercising, controlling weight, or not smoking, and the composite of all four. RESULTS Increasing level of alcohol use was associated with decreasing prevalence of avoiding salt, controlling weight, not smoking, and the combination of all 4 behaviors (P values all <.001). A linear trend was not observed for exercise (P =.83), which was most common among patients with mild alcohol misuse (P =.01 relative to nondrinking). CONCLUSIONS Alcohol consumption is inversely associated with adherence to cardiovascular self-care behaviors among hypertensive VA outpatients. Clinicians should be especially aware of alcohol use level among hypertensive patients.
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Long-term alcohol consumption is an independent risk factor of hypertension development in northern China: evidence from Kailuan study. J Hypertens 2014; 31:2342-7. [PMID: 24029874 DOI: 10.1097/hjh.0b013e3283653999] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of the present study was to determine the impact of alcohol consumption on the incidence of hypertension. METHODS A total of 32,389 male coal mine workers from Kailuan Coal Group in northern China (Kailuan study), free of hypertension, myocardial infarction, stroke, transient ischemia attack and cancer, were followed up every 2 years for 4 years. The average alcohol intake during the past year was reported as baseline. RESULTS During 4 years of follow-up, 9151 out of 32,389 workers developed hypertension categorically. At the end of the follow-up, the cumulative incidence of hypertension in relation to daily alcoholic intake of none, 1-24, 25-49, 50-99, 100-149 and at least 150 g was 25.03, 28.82, 30.10, 37.07, 40.14 and 42.49%, respectively. After adjusting for age, we found that the relative risk of hypertension in those who were never exposed to alcohol was the lowest, with the group 25-49 g/day being the next. This trend was unchanged after adjustment for age, exercise, smoking status, job type and salt intake. After further adjustment for BMI, history of high cholesterol and diabetes mellitus, a positive, linear association between alcohol consumption and the risk of hypertension was found. Models stratified by baseline SBP (<120 and 120-139 mmHg) or DBP (<80 and 80-89 mmHg) did not alter the trend. CONCLUSION The Kailuan study demonstrates that long-term alcohol intake is an independent risk factor of incident hypertension in a large cohort of coal mine workers. Even light-to-moderate alcohol consumption increases the risk of incident hypertension.
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187
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Wilson GB, Wray C, McGovern R, Newbury-Birch D, McColl E, Crosland A, Speed C, Cassidy P, Tomson D, Haining S, Howel D, Kaner EFS. Intervention to reduce excessive alcohol consumption and improve comorbidity outcomes in hypertensive or depressed primary care patients: two parallel cluster randomized feasibility trials. Trials 2014; 15:235. [PMID: 24947447 PMCID: PMC4076249 DOI: 10.1186/1745-6215-15-235] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/27/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Many primary care patients with raised blood pressure or depression drink potentially hazardous levels of alcohol. Brief interventions (BI) to reduce alcohol consumption may improve comorbid conditions and reduce the risk of future alcohol problems. However, research has not established their effectiveness in this patient population. This study aimed to establish the feasibility of definitive trials of BI to reduce excessive drinking in primary care patients with hypertension or mild to moderate depression. METHODS Thirteen general practices in North East England were randomized to the intervention or control arm of one of two parallel pilot trials. Adult patients drinking excessively and diagnosed with hypertension or mild-to-moderate depression received the Alcohol Use Disorders Identification Test (AUDIT) by postal survey. Consenting respondents scoring more than 7 on AUDIT (score range 0 to 40) received brief alcohol consumption advice plus an information leaflet (intervention) or an information leaflet alone (control) with follow-up at six months. Measurements included the numbers of patients eligible, recruited, and retained, and the AUDIT score and systolic/diastolic blood pressure of each patient or the nine-item Patient Health Questionnaire (PHQ-9) score. Acceptability was assessed via practitioner feedback and patient willingness to be screened, recruited, and retained at follow-up. RESULTS In the hypertension trial, 1709 of 33,813 adult patients (5.1%) were eligible and were surveyed. Among the eligible patients, 468 (27.4%) returned questionnaires; 166 (9.6% of those surveyed) screened positively on AUDIT and 83 (4.8% of those surveyed) were recruited (50.0% of positive screens). Sixty-seven cases (80.7% of recruited patients) completed follow-up at six months. In the depression trial, 1,044 of 73,146 adult patients (1.4%) were eligible and surveyed. Among these eligible patients, 215 (20.6%) responded; 104 (10.0% of those surveyed) screened positively on AUDIT and 29 (2.8% of those surveyed) were recruited (27.9% of positive screens). Nineteen cases (65.5% of recruited patients) completed follow-up at six months. CONCLUSIONS Recruitment and retention rates were higher in the hypertension trial than in the depression trial. A full brief intervention trial appears feasible for primary care patients with hypertension who drink excessively. High AUDIT scores in the depression trial suggest the importance of alcohol intervention in this group. However, future work may require alternative screening and measurement procedures. TRIAL REGISTRATION Current Controlled Trials ISRCTN89156543; registered 21 October 2013.
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Affiliation(s)
- Graeme B Wilson
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Catherine Wray
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Dorothy Newbury-Birch
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Ann Crosland
- Department of Pharmacy, Health and Well-being, Sunderland University, Chester Road, Sunderland SR1 3SD, UK
| | - Chris Speed
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Paul Cassidy
- Teams Medical Practice, Watson Street, Gateshead NE8 2PQ, UK
| | - Dave Tomson
- Collingwood Health Group, Brookland Terrace, North Tyneside NE29 8EA, UK
| | - Shona Haining
- NHS North of England Commissioning Support Unit, Goldcrest Way, Newcastle upon Tyne NE15 8NY, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Eileen FS Kaner
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
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Modesti PA, Agostoni P, Agyemang C, Basu S, Benetos A, Cappuccio FP, Ceriello A, Del Prato S, Kalyesubula R, O’Brien E, Kilama MO, Perlini S, Picano E, Reboldi G, Remuzzi G, Stuckler D, Twagirumukiza M, Van Bortel LM, Watfa G, Zhao D, Parati G. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings. J Hypertens 2014; 32:951-60. [PMID: 24577410 PMCID: PMC3979828 DOI: 10.1097/hjh.0000000000000125] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 02/06/2023]
Abstract
The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.
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Affiliation(s)
- Pietro A. Modesti
- Department of Clinical and Experimental Medicine, University of Florence, Florence
| | | | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanjay Basu
- University of California, San Francisco, California, USA
| | - Athanase Benetos
- INSERM UMR S1116, Université de Lorraine, Vandoeuvre-les-Nancy, Nancy, France
| | - Francesco P. Cappuccio
- University of Warwick, Warwick Medical School, and University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Antonio Ceriello
- Institut d’Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Stefano Del Prato
- Section of Metabolic Diseases and Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche ‘Mario Negri’, Bergamo, Italy
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
| | - Marc Twagirumukiza
- Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Luc M. Van Bortel
- Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | | | - Dong Zhao
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Gianfranco Parati
- Department of Health Sciences, University of Milano-Bicocca
- Department of Cardiology, S. Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
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189
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Jaubert MP, Jin Z, Russo C, Schwartz JE, Homma S, Elkind MSV, Rundek T, Sacco RL, Di Tullio MR. Alcohol consumption and ambulatory blood pressure: a community-based study in an elderly cohort. Am J Hypertens 2014; 27:688-94. [PMID: 24363276 DOI: 10.1093/ajh/hpt235] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although heavy alcohol consumption is associated with hypertension, the impact of lighter consumption on blood pressure (BP) is controversial. The protective effect of light alcohol consumption on cardiovascular disease described in previous studies could be, in part, mediated by effects of alcohol on BP. However, only a few studies investigating the association between alcohol and BP included elderly subjects, despite their higher risk of hypertension sequelae. Accordingly, we evaluated the relationship between alcohol consumption and 24-hour ambulatory BP in a community-based elderly cohort. METHODS Among the participants in the Cardiac Abnormalities and Brain Lesion study, 553 subjects (mean age = 70.6 ± 9.6 years) who underwent 24-hour ambulatory BP monitoring were examined. Alcohol consumption was categorized as (i) none (reference; <1 drink/month); (ii) very light consumption (1 drink/month to 1 drink/week); (iii) light consumption (2 drinks/week to 1 drink/day); (iv) moderate-to-heavy consumption (>1 drink/day). Former drinkers were excluded. RESULTS After adjustment for relevant covariables, mean values of daytime diastolic BP (DBP), nighttime DBP, and 24-hour DBP were significantly higher in moderate-to-heavy drinkers than in the reference group, whereas systolic BP parameters were not significantly different across consumption groups. Daytime systolic BP and DBP variability (SD of the measurements) were significantly lower in very light drinkers than in the reference group, independent of potential confounders. CONCLUSIONS Moderate-to-heavy alcohol consumption was associated with higher DBP values. Very light alcohol consumption was associated with reduced daytime BP variability. The latter association may contribute to the known beneficial cardiovascular effects of light alcohol consumption.
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190
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Cois A, Ehrlich R. Analysing the socioeconomic determinants of hypertension in South Africa: a structural equation modelling approach. BMC Public Health 2014; 14:414. [PMID: 24885860 PMCID: PMC4021547 DOI: 10.1186/1471-2458-14-414] [Citation(s) in RCA: 40] [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: 12/23/2013] [Accepted: 04/22/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Epidemiological research has long observed a varying prevalence of hypertension across socioeconomic strata. However, patterns of association and underlying causal mechanisms are poorly understood in sub-Saharan Africa. Using education and income as indicators, we investigated the extent to which socioeconomic status is linked to blood pressure in the first wave of the National Income Dynamics Study--a South African longitudinal study of more than 15,000 adults--and whether bio-behavioural risk factors mediate the association. METHODS In a cross-sectional analysis, structural equation modelling was employed to estimate the effect of socioeconomic status on systolic and diastolic blood pressure and to assess the role of a set of bio-behavioural risk factors in explaining the observed relationships. RESULTS After adjustment for age, race and antihypertensive treatment, higher education and income were independently associated with higher diastolic blood pressure in men. In women higher education predicted lower values of both diastolic and systolic blood pressure while higher income predicted lower systolic blood pressure. In both genders, body mass index was a strong mediator of an adverse indirect effect of socioeconomic status on blood pressure. Together with physical exercise, alcohol use, smoking and resting heart rate, body mass index therefore contributed substantially to mediation of the observed relationships in men. By contrast, in women unmeasured factors played a greater role. CONCLUSION In countries undergoing epidemiological transition, effects of socioeconomic status on blood pressure may vary by gender. In women, factors other than those listed above may have substantial role in mediating the association and merit investigation.
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Affiliation(s)
- Annibale Cois
- School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
| | - Rodney Ehrlich
- School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
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192
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Jennings C, Kotseva K, De Bacquer D, Hoes A, de Velasco J, Brusaferro S, Mead A, Jones J, Tonstad S, Wood D. Effectiveness of a preventive cardiology programme for high CVD risk persistent smokers: the EUROACTION PLUS varenicline trial. Eur Heart J 2014; 35:1411-20. [DOI: 10.1093/eurheartj/ehu051] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Catriona Jennings
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
| | - Kornelia Kotseva
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
| | - Dirk De Bacquer
- Unit of Epidemiology and Preventive Medicine, Department of Public Health, Ghent University, Gent 9000, Belgium
| | - Arno Hoes
- University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Jose de Velasco
- Servicio Cardiologie, Hospital General Universitario, Valencia, Spain
| | - Silvio Brusaferro
- Department of Medical and Biological Sciences, University of Udine, AOUD S M Della Miserciordi Udine, Italy
| | - Alison Mead
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
| | - Jennifer Jones
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Ullevål, Oslo N-0407, Norway
| | - David Wood
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
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193
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Zheng L, Sun Z, Zhang X, Li J, Hu D, Chen J, Sun Y. Predictive value for the rural Chinese population of the Framingham hypertension risk model: results from Liaoning Province. Am J Hypertens 2014; 27:409-14. [PMID: 24308978 DOI: 10.1093/ajh/hpt229] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A prediction model from the US Framingham Heart Study (FHS) population has been established to estimate an individual's risk of developing hypertension. However, this model has not been widely tested in other cohorts. In this study, we examined the predictive capability of the FHS prediction model in a rural Chinese population. METHODS A total of 24,434 rural Chinese adults aged ≥35 years, without prevalent hypertension, diabetes mellitus, stroke, and coronary heart disease at baseline, were followed for the incidence of hypertension. Standard clinical examinations of blood pressure, weight and height, smoking status, and parental history of hypertension were observed biennially. RESULTS The mean age was 47.9 (SD = 10.2) years, and 49.5% of subjects were women. During a median 4.8 years of follow-up, we recorded a total of 8,675 incident hypertension cases. The cumulative 2-year and 4-year hypertension incidence rates were 7.7% and 25.6%, respectively. The C statistics for the 2-year and 4-year incidences of hypertension were 0.537 (95% confidence interval (CI) = 0.524-0.550) and 0.610 (95% CI = 0.602-0.618) for the FHS model, respectively. The Hosmer-Lemeshow χ(2) test results for 2-year and 4-year incidence of hypertension were 2,287.7 (P < 0.0001) and 8,227.1 (P < 0.0001), respectively. Sensitivity analysis indicates that the FHS prediction model still has a poor performance, although the predictive ability was better than for the overall population. CONCLUSIONS The FHS hypertension prediction model is not a valid tool with which to estimate the risk of incidence of hypertension among the rural Chinese population. A new hypertension risk equation for the rural Chinese population is needed.
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Affiliation(s)
- Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
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194
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Park JE, Jung H, Lee JE. Dietary pattern and hypertension in Korean adults. Public Health Nutr 2014; 17:597-606. [PMID: 23442232 PMCID: PMC10282319 DOI: 10.1017/s1368980013000219] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 10/29/2012] [Accepted: 01/04/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the dietary pattern associated with hypertension and pre-hypertension among Korean male and female adults. DESIGN Cross-sectional study from a representative sample of the Korean population. SETTING The Korea National Health and Nutrition Examination Survey IV, which was conducted in 2007 and 2008. SUBJECTS Males and females (n 5308) over the age of 20 years. RESULTS Scores for three major dietary patterns ('whole food', 'Western' and 'drinking') were generated using a factor analysis of thirty predefined food groups based on the food items consumed. We used polytomous logistic regression analyses to obtain odds ratios and 95% confidence intervals for pre-hypertension and hypertension. Participants with a high drinking pattern score (moderate to high alcohol intake, salted fermented seafood intake) had a significantly higher prevalence of pre-hypertension or hypertension than those with a lower drinking pattern score; odds for the top quintile v. the bottom quintile were OR = 1·56 (95% CI 1·23, 1·99; P trend = 0·001) for pre-hypertension and OR = 3·05 (95% CI 2·12, 4·40; P trend < 0·001) for hypertension. The whole food pattern was not associated with either pre-hypertension or hypertension, while the Western pattern was associated with the prevalence of hypertension only among men. CONCLUSIONS Our finding warrants further prospective studies to examine whether alcohol drinking and salty food consumption increase the risk of developing hypertension in Koreans.
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Affiliation(s)
- Jong Eun Park
- Department of Food and Nutrition, Sookmyung Women's University, 52 Hyochangwon gil, Yongsan gu, Seoul 140-742, Republic of Korea
| | - Hyeyoung Jung
- Department of Food and Nutrition, Sookmyung Women's University, 52 Hyochangwon gil, Yongsan gu, Seoul 140-742, Republic of Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Sookmyung Women's University, 52 Hyochangwon gil, Yongsan gu, Seoul 140-742, Republic of Korea
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Abramson BL, Melvin RG. Cardiovascular risk in women: focus on hypertension. Can J Cardiol 2014; 30:553-9. [PMID: 24786446 DOI: 10.1016/j.cjca.2014.02.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/22/2014] [Accepted: 02/23/2014] [Indexed: 11/30/2022] Open
Abstract
Hypertension is a major concern in women, contributing to the risk for morbidity and mortality and the development of cardiovascular disease (CVD), heart attack, and stroke. A woman's risk for the development of hypertension increases with age. Although it also affects younger women, hypertension is prevalent in approximately 60% of women >65 years of age. In addition to age, there are specific risk factors and lifestyle contributors for the development of hypertension in women, including obesity, ethnicity, diabetes, and chronic kidney disease. Risk reduction strategies need to be used to help reduce hypertension; maintaining a healthy body weight through diet and exercise, reduced sodium intake, and lower alcohol intake are a few of the approaches for hypertension risk reduction in women. There are several proposed mechanisms for the development of hypertension that are unique to women and pertain to the aging-related elevated risk for hypertension resulting from falling estrogen levels during menopause. Oral contraceptives, pre-eclampsia and polycystic ovary syndrome are special considerations concerning the development and progression of hypertension in women. There are significant awareness issues and care gaps in the treatment of hypertension in women. Therefore, these problems must be faced and efforts need to be taken to resolve the issues surrounding the treatment and control of hypertension in women.
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Affiliation(s)
- Beth L Abramson
- University of Toronto, Cardiac Prevention Centre and Women's Cardiovascular Health, St Michael's Hospital, Toronto, Ontario, Canada.
| | - Rochelle G Melvin
- University of Toronto, Cardiac Prevention Centre and Women's Cardiovascular Health, St Michael's Hospital, Toronto, Ontario, Canada
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Sutamtewagul G, Dumrongmoncolgul N, Kijsirichareanchai K, Gadwala S, Arvandi A, Suarez J, Meyerrose G. Effect of Alcohol Intake in Patients with Hypertension Currently on Medication Treatment. ALCOHOLISM TREATMENT QUARTERLY 2014. [DOI: 10.1080/07347324.2013.833785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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197
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Schulte MT, Hser YI. Substance Use and Associated Health Conditions throughout the Lifespan. Public Health Rev 2014; 35:https://web-beta.archive.org/web/20150206061220/http://www.publichealthreviews.eu/upload/pdf_files/14/00_Schulte_Hser.pdf. [PMID: 28366975 PMCID: PMC5373082 DOI: 10.1007/bf03391702] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A life stage perspective is necessary for development of age-appropriate strategies to address substance use disorders (SUDs) and related health conditions in order to produce better overall health and well-being. The current review evaluated the literature across three major life stages: adolescence, adulthood, and older adulthood. FINDINGS 1) Substance use is often initiated in adolescence, but it is during adulthood that prevalence rates for SUDs peak; and while substance involvement is less common among older adults, the risk for health complications associated with use increases. 2) Alcohol, tobacco, marijuana, and, increasingly, prescription medications, are the most commonly misused substances across age groups; however, the use pattern of these and other drugs and the salient impact vary depending on life stage. 3) In terms of health outcomes, all ages are at risk for overdose, accidental injury, and attempted suicide. Adolescents are more likely to be in vehicular accidents while older adults are at greater risk for damaging falls. Adulthood has the highest rates of associated medical conditions (e.g., cancer, sexually transmitted disease, heart disease) and mental health conditions (e.g., bipolar disorder, anxiety disorders, antisocial personality disorder). CONCLUSION Prolonged heavy use of drugs and/or alcohol results in an array of serious health conditions. Addressing SUDs from a life stage perspective with assessment and treatment approaches incorporating co-occurring disorders are necessary to successfully impact overall health.
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Affiliation(s)
- Marya T. Schulte
- UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
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198
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Simino J, Sung YJ, Kume R, Schwander K, Rao DC. Gene-alcohol interactions identify several novel blood pressure loci including a promising locus near SLC16A9. Front Genet 2013; 4:277. [PMID: 24376456 PMCID: PMC3860258 DOI: 10.3389/fgene.2013.00277] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/22/2013] [Indexed: 01/11/2023] Open
Abstract
Alcohol consumption is a known risk factor for hypertension, with recent candidate studies implicating gene-alcohol interactions in blood pressure (BP) regulation. We used 6882 (predominantly) Caucasian participants aged 20-80 years from the Framingham SNP Health Association Resource (SHARe) to perform a genome-wide analysis of SNP-alcohol interactions on BP traits. We used a two-step approach in the ABEL suite to examine genetic interactions with three alcohol measures (ounces of alcohol consumed per week, drinks consumed per week, and the number of days drinking alcohol per week) on four BP traits [systolic (SBP), diastolic (DBP), mean arterial (MAP), and pulse (PP) pressure]. In the first step, we fit a linear mixed model of each BP trait onto age, sex, BMI, and antihypertensive medication while accounting for the phenotypic correlation among relatives. In the second step, we conducted 1 degree-of-freedom (df) score tests of the SNP main effect, alcohol main effect, and SNP-alcohol interaction using the maximum likelihood estimates (MLE) of the parameters from the first step. We then calculated the joint 2 df score test of the SNP main effect and SNP-alcohol interaction using MixABEL. The effect of SNP rs10826334 (near SLC16A9) on SBP was significantly modulated by both the number of alcoholic drinks and the ounces of alcohol consumed per week (p-values of 1.27E-08 and 3.92E-08, respectively). Each copy of the G-allele decreased SBP by 3.79 mmHg in those consuming 14 drinks per week vs. a 0.461 mmHg decrease in non-drinkers. Index SNPs in 20 other loci exhibited suggestive (p-value ≤ 1E-06) associations with BP traits by the 1 df interaction test or joint 2 df test, including 3 rare variants, one low-frequency variant, and SNPs near/in genes ESRRG, FAM179A, CRIPT-SOCS5, KAT2B, ADCY2, GLI3, ZNF716, SLIT1, PDE3A, KERA-LUM, RNF219-AS1, CLEC3A, FBXO15, and IGSF5. SNP-alcohol interactions may enhance discovery of novel variants with large effects that can be targeted with lifestyle modifications.
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Affiliation(s)
- Jeannette Simino
- Division of Biostatistics, Washington University School of MedicineSt. Louis, MO, USA
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199
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Abstract
Hypertension affects one in three adults in Turkey and the United States. Only half are treated for this condition and only 10–20% is controlled. Dietary modifications such as salt restriction, moderation of alcohol drinking, and a diet rich in fruits, vegetables, and legumes and low in snacks, sweets, meat, and saturated fat are helpful in the treatment of hypertension. Consumption of dark chocolate is also associated with a drop in systolic blood pressure. Individual dietary factors that may reduce blood pressure include increased intakes of potassium, calcium, fish oil, fiber, and milk-based and vegetable-based protein.
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Affiliation(s)
- Soner Duman
- Department of Internal Medicine, Ege University Medical School , Bornova, İzmir, Turkey
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200
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Kim HI, Song Y, Kim WY, Lee JE. Association of adherence to the seventh report of the Joint National Committee guidelines with hypertension in Korean men and women. Nutr Res 2013; 33:789-95. [DOI: 10.1016/j.nutres.2013.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 07/13/2013] [Accepted: 07/19/2013] [Indexed: 11/24/2022]
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