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Mehra A, Sangwan G, Grover S, Kathirvel S, Avasthi A. Prevalence of Psychiatric Morbidity and Cognitive Impairment among Patients Attending the Rural Noncommunicable Disease Clinic. J Neurosci Rural Pract 2020; 11:585-592. [PMID: 33144795 PMCID: PMC7595800 DOI: 10.1055/s-0040-1715540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective
This study aimed to assess the prevalence of cognitive impairment and psychiatric morbidity among the patients attending the rural noncommunicable disease clinic after controlling for various confounders (i.e., psychological morbidity, obesity, gender, level of education, duration of the illness and age).
Materials and Methods
One-hundred twenty-four patients were evaluated on the Hindi Mental State Examination for the cognitive function, Physical Health Questionnaire-9 for depression, and Generalized Anxiety Disorder-7 for anxiety disorders.
Results
About one-fourth (26.6%) of the participants had cognitive impairment. The prevalence of cognitive impairment was more among patients with hypertension (35.5%) as compared with the diabetes mellitus (13.6%) and those with comorbid hypertension and diabetes mellitus (26.6%). About one of the participants had depression (35.5%) and 29% of the patients had anxiety disorder. No significant difference was found in the level of cognitive deficits between those with hypertension and diabetes mellitus, when the confounding factors were not taken into account in the analysis. However, after controlling for psychiatric morbidity, obesity, gender, level of education, duration of the illness and age, those with hypertension were found to have significantly higher level of cognitive impairment compared with those with diabetes mellitus. A higher level of dysfunction was seen in the domains of orientation, registration, attention, recall, language, and visuospatial domains.
Conclusion
Present study suggests that patients of hypertension have higher level of cognitive impairment, when compared with those with diabetes mellitus, even after controlling for various confounders. Lack of difference between the two groups can be accounted by the confounding variables.
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Affiliation(s)
- Aseem Mehra
- Department of Psychiatry, Postgraduate Institute Medical Education and Research, Chandigarh, Punjab, India
| | - Garima Sangwan
- Department of Community Medicine and School of Public Health, Postgraduate Institute Medical Education and Research, Chandigarh, Punjab, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute Medical Education and Research, Chandigarh, Punjab, India
| | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Postgraduate Institute Medical Education and Research, Chandigarh, Punjab, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute Medical Education and Research, Chandigarh, Punjab, India
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Sun YV, Liu C, Staimez L, Ali MK, Chang H, Kondal D, Patel S, Jones D, Mohan V, Tandon N, Prabhakaran D, Quyyumi AA, Narayan KMV, Agrawal A. Cardiovascular disease risk and pathophysiology in South Asians: can longitudinal multi-omics shed light? Wellcome Open Res 2020; 5:255. [DOI: 10.12688/wellcomeopenres.16336.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in South Asia, with rapidly increasing prevalence of hypertension, type 2 diabetes and hyperlipidemia over the last two decades. Atherosclerotic CVD (ASCVD) affects South Asians earlier in life and at lower body weights, which is not fully explained by differential burden of conventional risk factors. Heart failure (HF) is a complex clinical syndrome of heterogeneous structural phenotypes including two major clinical subtypes, HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). The prevalence of HF in South Asians is also rising with other metabolic diseases, and HFpEF develops at younger age and leaner body mass index in South Asians than in Whites. Recent genome-wide association studies, epigenome-wide association studies and metabolomic studies of ASCVD and HF have identified genes, metabolites and pathways associated with CVD traits. However, these findings were mostly driven by samples of European ancestry, which may not accurately represent the CVD risk at the molecular level, and the unique risk profile of CVD in South Asians. Such bias, while formulating hypothesis-driven research studies, risks missing important causal or predictive factors unique to South Asians. Importantly, a longitudinal design of multi-omic markers can capture the life-course risk and natural history related to CVD, and partially disentangle putative causal relationship between risk factors, multi-omic markers and subclinical and clinical ASCVD and HF. In conclusion, combining high-resolution untargeted metabolomics with epigenomics of rigorous, longitudinal design will provide comprehensive unbiased molecular characterization of subclinical and clinical CVD among South Asians. A thorough understanding of CVD-associated metabolomic profiles, together with advances in epigenomics and genomics, will lead to more accurate estimates of CVD progression and stimulate new strategies for improving cardiovascular health.
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203
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Nadhamuni S, Gupta G, Mullath R, Sridhar S. Leveraging Technology to Enable Effective Preventive Screening of NCDs at Population Scale: Initial Observations. J Indian Inst Sci 2020. [DOI: 10.1007/s41745-020-00199-w] [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]
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204
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Daniel RA, Haldar P, Prasad M, Kant S, Krishnan A, Gupta SK, Kumar R. Prevalence of hypertension among adolescents (10-19 years) in India: A systematic review and meta-analysis of cross-sectional studies. PLoS One 2020; 15:e0239929. [PMID: 33022021 PMCID: PMC7537899 DOI: 10.1371/journal.pone.0239929] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/15/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite the well-known short-term and long-term ill effects of elevated blood pressure in children and adolescents, pooled data on its burden among Indian adolescents have not yet been synthesized. OBJECTIVES We did a systematic review with meta-analysis to calculate the pooled prevalence of hypertension among adolescents (10-19 years) in India. METHODS We searched PubMed, Embase, Cochrane library, Google Scholar and IndMed, and included cross-sectional studies reporting data on hypertension prevalence among 10 to19 years old and published in English language from their inception till 1st March 2020. Modified New castle Ottawa scale was used to assess risk of bias based on research design, recruitment strategy, response rate and reliability of outcome determination. A random effects model was used to estimate pooled prevalence, and heterogeneity was assessed using Cochrane's Q statistic test of heterogeneity and I2 statistic. To explore the heterogeneity, we did a meta-regression, and sub-group analyses based on region, study setting and number of blood pressure readings. RESULTS Out of 25 studies (pooled sample of 27,682 participants) six studies were of high, eighteen of moderate, and one was of low quality. The prevalence of hypertension across studies ranged from 2% to 20.5%, with a pooled estimate of 7.6% (95% CI: 6.1 to 9.1%), I2 = 96.6% (p-value <0.001). Sub-group analysis restricted only to the western India demonstrated a smaller heterogeneity (I2 = 18.3%). In univariate model of meta-regression, diagnostic criteria was significantly associated with pooled prevalence (-4.33, 95%CI: -7.532, -1.134). CONCLUSION The pooled prevalence of hypertension among adolescent in India is 7.6% with substantial heterogeneity between the studies. To tackle the high prevalence of hypertension among adolescents, early detection by screening under school health programme and opportunistic screening at Paediatric OPD should be implemented by Policy makers.
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Affiliation(s)
- Roy Arokiam Daniel
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manya Prasad
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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205
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Prabhakaran D, Mandal S, Krishna B, Magsumbol M, Singh K, Tandon N, Narayan KMV, Shivashankar R, Kondal D, Ali MK, Reddy KS, Schwartz JD. Exposure to Particulate Matter Is Associated With Elevated Blood Pressure and Incident Hypertension in Urban India. Hypertension 2020; 76:1289-1298. [PMID: 32816598 PMCID: PMC7484465 DOI: 10.1161/hypertensionaha.120.15373] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ambient air pollution, specifically particulate matter of diameter <2.5 μm, is reportedly associated with cardiovascular disease risk. However, evidence linking particulate matter of diameter <2.5 μm and blood pressure (BP) is largely from cross-sectional studies and from settings with lower concentrations of particulate matter of diameter <2.5 μm, with exposures not accounting for myriad time-varying and other factors such as built environment. This study aimed to study the association between long- and short-term ambient particulate matter of diameter <2.5 μm exposure from a hybrid spatiotemporal model at 1-km×1-km spatial resolution with longitudinally measured systolic and diastolic BP and incident hypertension in 5342 participants from urban Delhi, India, within an ongoing representative urban adult cohort study. Median annual and monthly exposure at baseline was 92.1 μg/m3 (interquartile range, 87.6-95.7) and 82.4 μg/m3 (interquartile range, 68.4-107.0), respectively. We observed higher average systolic BP (1.77 mm Hg [95% CI, 0.97-2.56] and 3.33 mm Hg [95% CI, 1.12-5.52]) per interquartile range differences in monthly and annual exposures, respectively, after adjusting for covariates. Additionally, interquartile range differences in long-term exposures of 1, 1.5, and 2 years increased the risk of incident hypertension by 1.53× (95% CI, 1.19-1.96), 1.59× (95% CI, 1.31-1.92), and 1.16× (95% CI, 0.95-1.43), respectively. Observed effects were larger in individuals with higher waist-hip ratios. Our data strongly support a temporal association between high levels of ambient air pollution, higher systolic BP, and incident hypertension. Given that high BP is an important risk factor of cardiovascular disease, reducing ambient air pollution is likely to have meaningful clinical and public health benefits.
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Affiliation(s)
- Dorairaj Prabhakaran
- Center for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
| | - Siddhartha Mandal
- Center for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
| | - Bhargav Krishna
- Public Health Foundation of India, New Delhi, India
- Harvard TH Chan School of Public Health, Harvard University, Boston, USA
| | | | - Kalpana Singh
- Center for Chronic Disease Control, New Delhi, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Dimple Kondal
- Center for Chronic Disease Control, New Delhi, India
| | - Mohammed K. Ali
- Rollins School of Public Health, Emory University, Atlanta, USA
| | | | - Joel D Schwartz
- Harvard TH Chan School of Public Health, Harvard University, Boston, USA
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206
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Differential Effects of Combination of Renin-Angiotensin-Aldosterone System Inhibitors on Central Aortic Blood Pressure: A Cross-Sectional Observational Study in Hypertensive Outpatients. Cardiovasc Ther 2020; 2020:4349612. [PMID: 32983258 PMCID: PMC7495159 DOI: 10.1155/2020/4349612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/05/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background Central aortic blood pressure (CABP) indices, central hemodynamics, and arterial stiffness are better predictors of cardiovascular events as compared with brachial cuff pressure measurements alone. The present study is aimed at assessing the effects of different antihypertensive drug combination regimens involving renin-angiotensin-aldosterone system (RAAS) inhibitors on CABP indices in Indian patients with hypertension. Methods This was a cross-sectional, single-center study conducted in patients treated for hypertension for >6 weeks using different treatment regimens involving the combination of RAAS inhibitors with drugs from other classes. CABP indices, vascular age, arterial stiffness, and central hemodynamics were measured in patients using the noninvasive Agedio B900 device (IEM, Stolberg, Germany) and compared between different treatment regimens. Results A total of 199 patients with a mean age of 54.22 ± 10.15 years were enrolled, where 68.8% had hypertension for over three years and 50.25% had their systolic blood pressure (SBP) < 140 mmHg. Combination treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was given to 77.9% and to 20.1% patients, respectively. The mean vascular age was higher than the actual age (58.13 ± 12.43 vs. 54.22 ± 10.15, p = 0.001). The SBP and diastolic blood pressure (DBP) levels in patients treated with ACEI-based combinations were lower than those in patients treated with ARB-based combinations (p < 0.05). The mean central pulse pressure amplification, augmentation pressure, and augmentation index were lower in patients treated with ACEI-based combinations than those treated with other treatments (p = 0.001). In a subgroup analysis, patients given perindopril and calcium channel blockers (CCBs) or diuretics had significantly lower CABP and pulse wave velocity than those given other treatments (p < 0.05). A total of 6.5% patients experienced any side effects. Conclusion The majority of central hemodynamic parameters, including vascular age, were found to improve more effectively in patients treated with ACEIs than with ARBs. Our results indicate a gap between routine clinical practice and evidence-based guidelines in Indian settings and identify a need to reevaluate the current antihypertensive prescription strategy.
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207
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Martinez-Amezcua P, Haque W, Khera R, Kanaya AM, Sattar N, Lam CSP, Harikrishnan S, Shah SJ, Kandula NR, Jose PO, Narayan KMV, Agyemang C, Misra A, Jenum AK, Bilal U, Nasir K, Cainzos-Achirica M. The Upcoming Epidemic of Heart Failure in South Asia. Circ Heart Fail 2020; 13:e007218. [PMID: 32962410 DOI: 10.1161/circheartfailure.120.007218] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Currently, South Asia accounts for a quarter of the world population, yet it already claims ≈60% of the global burden of heart disease. Besides the epidemics of type 2 diabetes mellitus and coronary heart disease already faced by South Asian countries, recent studies suggest that South Asians may also be at an increased risk of heart failure (HF), and that it presents at earlier ages than in most other racial/ethnic groups. Although a frequently underrecognized threat, an eventual HF epidemic in the densely populated South Asian nations could have dramatic health, social and economic consequences, and urgent interventions are needed to flatten the curve of HF in South Asia. In this review, we discuss recent studies portraying these trends, and describe the mechanisms that may explain an increased risk of premature HF in South Asians compared with other groups, with a special focus on highly relevant features in South Asian populations including premature coronary heart disease, early type 2 diabetes mellitus, ubiquitous abdominal obesity, exposure to the world's highest levels of air pollution, highly prevalent pretransition forms of HF such as rheumatic heart disease, and underdevelopment of healthcare systems. Other rising lifestyle-related risk factors such as use of tobacco products, hypertension, and general obesity are also discussed. We evaluate the prognosis of HF in South Asian countries and the implications of an anticipated HF epidemic. Finally, we discuss proposed interventions aimed at curbing these adverse trends, management approaches that can improve the prognosis of prevalent HF in South Asian countries, and research gaps in this important field.
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Affiliation(s)
- Pablo Martinez-Amezcua
- Johns Hopkins Bloomberg School of Public Health (P.M.-A., W.H.), Johns Hopkins University, Baltimore, MD
| | - Waqas Haque
- Johns Hopkins Bloomberg School of Public Health (P.M.-A., W.H.), Johns Hopkins University, Baltimore, MD.,Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (R.K.).,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (R.K.)
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom (N.S.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (C.S.P.L.).,Duke-National University of Singapore (C.S.P.L.).,University Medical Centre, Groningen, the Netherlands (C.S.P.L.)
| | - Sivadasanpillai Harikrishnan
- Heart Failure Association of India (S.H.).,National Center of Research and Excellence in Heart Failure, ICMR (S.H.).,Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum (S.H.)
| | - Sanjiv J Shah
- Bluhm Cardiovascular Institute and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Namratha R Kandula
- Northwestern University, Feinberg School of Medicine, Chicago, IL (N.R.K.)
| | - Powell O Jose
- Sutter Davis Hospital, Sutter Medical Center, Sacramento, CA (P.O.J.)
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University and Emory University School of Medicine, Atlanta, GA (K.M.V.N.)
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, the Netherlands (C.A.)
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India (A.M.).,National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India (A.M.).,Diabetes Foundation India, New Delhi, India (A.M.)
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, University of Oslo, Institute of Health and Society, Norway (A.K.J.)
| | - Usama Bilal
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA (U.B.)
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (K.N., M.C.-A.).,Center for Outcomes Research, Houston Methodist, Houston, TX (K.N., M.C.-A.)
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (K.N., M.C.-A.).,Center for Outcomes Research, Houston Methodist, Houston, TX (K.N., M.C.-A.)
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208
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Khan MY, Pandit S, Ray S, Mohan JC, Srinivas BC, Ramakrishnan S, Mane A, Mehta S, Shah S. Effectiveness of Amlodipine on Blood Pressure Control in Hypertensive Patients in India: A Real-World, Retrospective Study from Electronic Medical Records. Drugs Real World Outcomes 2020; 7:281-293. [PMID: 32901435 PMCID: PMC7581658 DOI: 10.1007/s40801-020-00211-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The effectiveness of amlodipine has been reported in clinical trials in India. However, real-world data on the effectiveness of amlodipine in India is limited. OBJECTIVE To provide real-world evidence regarding the effectiveness of amlodipine as monotherapy or in combination with other antihypertensive drugs (AHDs) in Indian patients with essential hypertension. METHODS Electronic medical record data of adult patients who were diagnosed with essential hypertension (≥ 140/90 mmHg) and were prescribed amlodipine as monotherapy or add-on therapy were retrospectively analyzed. Patients were classified based on the number of AHD classes prescribed on initiation of amlodipine. Change in systolic (SBP) and diastolic (DBP) blood pressure from baseline was the primary endpoint. Evaluation of proportion of patients who achieved treatment goals as per 2018 European Society of Cardiology/European Society of Hypertension guidelines was the secondary endpoint. Readings were obtained before initiating amlodipine and after at least a month of therapy with amlodipine. RESULTS Among the 462 included patients, the majority (90.7%) were on amlodipine monotherapy or amlodipine + 1AHD. Mean (95% confidence interval [CI]) change in the amlodipine monotherapy group was: SBP (- 12.1 [- 14.9, - 9.3] mmHg) and DBP (- 7.5 [- 8.9, - 6.1] mmHg) and mean (95% CI) change in the amlodipine + 1AHD group was: SBP (- 17.8 [- 21.0, - 14.6] mmHg) and DBP (- 9.5 [- 11.0, - 8.0] mmHg) (P < 0.001 for all). SBP and DBP goals were achieved by 31.4% and 42.9% of patients on amlodipine monotherapy and by 38.9% and 51.8% of patients on amlodipine + 1AHD, respectively. Among patients aged ≤ 45 years, mean (95% CI) change in the amlodipine monotherapy group was: SBP (- 11.7 [- 16.0, - 7.4] mmHg; P < 0.001) and DBP (- 7.2 [- 9.7, - 4.7] mmHg; P < 0.001) and mean (95% CI) change in the amlodipine + 1AHD group was: SBP (- 14.6 [- 21.9, - 7.3] mmHg; P < 0.05) and DBP (- 10.6 [- 14.8, - 6.4] mmHg; P < 0.01). SBP and DBP goals were achieved by 35.4% and 33.8% of patients on amlodipine monotherapy and by 48.0% and 56.0% of patients on amlodipine + 1AHD, respectively. Among patients aged ≥ 65 years, mean (95% CI) change in the amlodipine monotherapy group was: SBP (- 13.9 [- 20.2, - 7.6] mmHg; P < 0.01) and DBP (- 8.5 [- 11.4, - 5.7] mmHg; P < 0.001) and mean (95% CI) change in the amlodipine + 1AHD group was: SBP (- 22.4 [- - 28.8, - 16.0] mmHg; P < 0.001) and DBP (- 10.8 [- 14.0, - 7.6] mmHg; P < 0.001). SBP and DBP goals were achieved by 25.5% and 13.7% of patients on amlodipine monotherapy and by 29.8% and 14.0% of patients on amlodipine + 1AHD. CONCLUSION Amlodipine prescribed as monotherapy or add-on therapy during routine clinical practice significantly reduced BP in ≤ 45- and ≥ 65-year-old Indian patients with mild to moderate hypertension, emphasizing that amlodipine may be a good candidate for BP control in Indian patients with essential hypertension in these age groups.
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Affiliation(s)
- Mohammed Yunus Khan
- Dr. Reddy's Laboratories Ltd., 7-1-27, Ameerpet, Hyderabad, Telangana, 500016, India.
| | - Sucheta Pandit
- Dr. Reddy's Laboratories Ltd., 7-1-27, Ameerpet, Hyderabad, Telangana, 500016, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | - B C Srinivas
- Sri Jayadeva Institute of Cardiology, Bengaluru, Karnataka, India
| | - Santosh Ramakrishnan
- Magna Centres for Obesity Diabetes and Endocrinology, BTM 2nd Stage, Bengaluru, Karnataka, India
| | - Amey Mane
- Dr. Reddy's Laboratories Ltd., 7-1-27, Ameerpet, Hyderabad, Telangana, 500016, India
| | - Suyog Mehta
- Dr. Reddy's Laboratories Ltd., 7-1-27, Ameerpet, Hyderabad, Telangana, 500016, India
| | - Snehal Shah
- Healthplix Ltd., Bengaluru, Karnataka, India
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209
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Rauniyar SK, Rahman MM, Rahman MS, Abe SK, Nomura S, Shibuya K. Inequalities and risk factors analysis in prevalence and management of hypertension in India and Nepal: a national and subnational study. BMC Public Health 2020; 20:1341. [PMID: 32883278 PMCID: PMC7469349 DOI: 10.1186/s12889-020-09450-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertension is one of the leading risk factors for cardiovascular diseases in India and Nepal. Socio-economic disparity in these two countries has created wide gap in management of hypertension. However, inequalities in prevalence and management (awareness, treatment, and control) of hypertension is poorly assessed. This study analyzes the risk factors associated with prevalence and management of hypertension in India and Nepal and assesses the wealth-and education-based inequalities in them. METHODS This study used data from the Demographic and Health Survey; a cross-sectional survey conducted between January 2015 to December 2016 in India and June 2016 to January 2017 in Nepal. A total of 787,713 individuals in India and 14,454 individuals in Nepal aged between 15 and 49 years were included in the study. Respondents were classified as being hypertensive if their systolic blood pressure (SBP) readings were at least 140 mmHg or diastolic blood pressure (DBP) readings were at least 90 mmHg, or if they reported currently taking anti-hypertensive medication. Multilevel logistic regression models with random intercepts at household-and community-levels were used to identify the risk factors associated with prevalence and management of hypertension. For inequality assessment, slope index and relative index of inequalities in prevalence and management of hypertension were estimated. RESULTS Overall prevalence of hypertension in India and Nepal were 11.4% (95% confidence interval (CI), 11.4-11.5) and 19.6% (95% CI, 18.9-20.2), respectively. Less than one-third of the hypertensive population received treatment and below 20% among them had their blood pressure controlled. In both countries, wealth-and education-based inequalities in awareness, treatment, and control of hypertension were significantly high in urban and rural areas. CONCLUSION Wealth- and education-based inequalities in prevalence and management of hypertension were high among different socio-economic groups at national and sub-national levels. Tailored strategies are required to effectively manage hypertension in different regions by considering socio-economic and demographic factors.
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Affiliation(s)
- Santosh Kumar Rauniyar
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Md Mizanur Rahman
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Md Shafiur Rahman
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sarah Krull Abe
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Institute for Population Health Science, King's College London, London, UK
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210
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Patil RS, Shetty LH, Krishnan S, Trivedi AS, Raghu TR, Manjunath CN. Profile of coronary artery disease in indian rural youth (< 35 yrs). Indian Heart J 2020; 72:394-397. [PMID: 33189200 PMCID: PMC7670274 DOI: 10.1016/j.ihj.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/19/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022] Open
Abstract
AIMS To study the risk factors, clinical and angiographic profile of Indian rural youth (under 35yrs) presenting with Premature Coronary Artery Disease (PCAD). SUBJECTS and Methods: The PCAD registry had 1628 patients who were aged below 35 years, of which 681 patients satisfied the entry criteria. The data was analysed by statistical software R version 3.5.0. RESULTS The study enrolled 681 patients after satisfying the entry criteria. The mean age of patients was 30.85 years. There were 405 (59.5%) aged between 30 and 35 yrs, 205 (30.1%) between 25 and 30 yrs, 64 (9.4%) between 20 and 25 yrs and 7 (1.0%) were aged less than 20 yrs. Majority of them were males, 617 (90.6%). Nearly 411 (60.4%) were smokers, 56patients (8.2%) were diabetics and 97 (14.2%) were hypertensives. Around 441 (64.8%) patients had low HDL cholesterol levels and 218 (32.0%) had elevated triglyceride levels. Abdominal obesity was seen in 443 (65.1%) patients. Most common clinical presentation was ST elevation myocardial infarction (STEMI) seen in 536 (78.7%) patients. Around 40% patients had recanalized/non obstructive/thrombotic/normal coronaries on coronary angiogram. CONCLUSIONS Conventional risk factors such as smoking, low HDL levels and abdominal obesity play a major role in the causation of premature coronary artery disease among the rural youth. Thrombotic milieu in the coronaries was commonly noted in coronary angiograms. Lack of awareness, combined with urbanisation of rural lifestyle could be responsible for increasing incidence of premature coronary artery disease in rural youth.
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Affiliation(s)
- Rahul S Patil
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - Laxmi H Shetty
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - Shanmugam Krishnan
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - Anindya Sundar Trivedi
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - T R Raghu
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - C N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
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211
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Kalyani CV, Mirza AA, Sharma SK, Saxena V, Rohilla KK, Dakshinamurthy S. Undiagnosed elevated blood pressure and its life style related risk factors among adults: Cross sectional survey. J Family Med Prim Care 2020; 9:4962-4968. [PMID: 33209829 PMCID: PMC7652113 DOI: 10.4103/jfmpc.jfmpc_679_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 07/01/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Globally, high blood pressure (BP) is a main health problem among adult population. High BP is considered as a major risk factor which may lead to many cardiovascular diseases. Globally, it is also the leading cause of death. According to the American Heart Association, a BP of 120/80 mm of Hg is a normal range but when the systolic blood pressure ≥130 and diastolic blood pressure ≥80, it is always labeled as hypertension. OBJECTIVES In the present study, the researchers wanted to identify the prevalence of undiagnosed elevated blood pressure in the adult population of Uttarakhand, India and also try to explore its lifestyle-related risk factors. METHODS This study was an exploratory survey with a cross-sectional design. Data were collected from 440 participants by using the cluster sampling technique. RESULTS The male:female ratio among participants was 1:4 and most of the participants were aged 25-30 years. The study found that the prevalence of high blood pressure was 26%, in which marginal elevated BP prevalence was 16%, hypertension stage I was 7%, and hypertension Stage II was 3% which is significantly higher in number at a young age. Lifestyle-related risk factors showed a significant association of hypertensive status with gender, consumption of balanced diet, and personal habits. This increases the chances of elevated blood pressure in young adults. CONCLUSION All health professionals must be sensitized for elevated blood pressure problems among the young adult populations. Elevated blood pressure should be considered as a warning alarm at an early age when prescribing any medication and during any invasive procedure. Awareness should be created among public regarding elevated blood pressure issues at a younger age and motivate people to adopt a healthy and stress-free lifestyle.
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Affiliation(s)
- C. Vasantha Kalyani
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anissa A. Mirza
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suresh K. Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vartika Saxena
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kusum K. Rohilla
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Jothi S, KG H, Lesley N, Vijayan M, Haridas Anupama S, Mathew M, Parthasarathy R, Sundarajan S, P N, Kumaraswamy L, Abraham G. A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis. Semin Dial 2020; 33:388-393. [DOI: 10.1111/sdi.12907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Swathi Jothi
- Madras Medical Mission Hospital Chetpet, Chennai India
| | - Hareesh KG
- St.Gregorios Hospital Parumala Thiruvalla India
| | - Nancy Lesley
- Madras Medical Mission Hospital Chetpet, Chennai India
| | | | | | - Milly Mathew
- Madras Medical Mission Hospital Chetpet, Chennai India
- Pondicherry Institute of Medical Sciences Kalapet Puduchery India
| | | | | | - Nagarajan P
- Madras Medical Mission Hospital Chetpet, Chennai India
| | | | - Georgi Abraham
- Madras Medical Mission Hospital Chetpet, Chennai India
- Pondicherry Institute of Medical Sciences Kalapet Puduchery India
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213
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Maheshwari A, Verma N, Bhardwaj S, Jose AP, Bhalla S, More A, Patil M, Gupta A, Gupta BK, Takalkar A, Gupta P, Pandey N, Patil V, Beaney T, Ster AC, Poulter NR. May Measurement Month 2018: an analysis of blood pressure screening campaign results in India. Eur Heart J Suppl 2020; 22:H62-H65. [PMID: 32884473 PMCID: PMC7455263 DOI: 10.1093/eurheartj/suaa030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hypertension (HTN) is the greatest attributable risk factor for cardiovascular disease in India. Recent studies have reported the crude prevalence of HTN in India to be 25.3%. In the May Measurement Month (MMM) screening campaign of 2017 conducted in India, 31.8% had HTN. In order to ratify earlier results, and further understand the awareness and control levels of HTN in India, organizations that participated in MMM 2017 decided to participate in the MMM global screening initiative of the International Society of Hypertension for a 2nd consecutive year. A total of 345 234 individuals were screened in MMM 2018. There were more than 1000 screening locations that included hospitals, clinics, workplaces, and special health camps organized across the country. After applying multiple imputation, a total of 111 462 (32.3%) individuals had HTN of whom 63 415 (55.6%) were aware of HTN and 61 646 (55.3%) were on antihypertensive medicines, out of which 15 583 (25.3%) were uncontrolled. Overall 57 864 (41.3%) hypertensives were uncontrolled. About half (44.7%) of hypertensive population in India were not on treatment. Around two-thirds (65.7%, n = 226 924) had not measured their blood pressure (BP) in last 12 months and 64% measured their BP for the first time in their life during the campaign, which strongly indicates the need for large scale awareness drives. This study suggests that opportunistic periodic public health screening at a national level is needed to increase HTN detection, treatment, control, and countrywide awareness in highly populated nations like India.
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Affiliation(s)
- Anuj Maheshwari
- Department of General Medicine, Babu Banarasi Das University, Lucknow, Uttar Pradesh 226028, India
- Indian Society of Hypertension, King George's Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh 226003, India
| | - Narsingh Verma
- Indian Society of Hypertension, King George's Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh 226003, India
- Department of Physiology, KGMU, Lucknow, Uttar Pradesh, India
| | - Shipra Bhardwaj
- Indian Society of Hypertension, King George's Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh 226003, India
- Dr RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun P Jose
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Plot 47, Sector 44, Gurugram, Haryana 122002, India
| | - Sandeep Bhalla
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Plot 47, Sector 44, Gurugram, Haryana 122002, India
| | - Arun More
- Rural Health Progress Trust, Murud, Maharashtra 413510, India
| | - Mansi Patil
- Indian Association of Parenteral and Enteral Nutrition - Pune Chapter, Pune, Maharashtra 411019, India
| | - Amit Gupta
- Promhex Multispecialty Hospital Sector P-2, Omega 1, Greater Noida, Uttar Pradesh, India
| | - Bal Kishen Gupta
- S.P. Medical College & A.G. of Hospitals, Bikaner, Rajasthan, India
| | | | - Priyanka Gupta
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Plot 47, Sector 44, Gurugram, Haryana 122002, India
| | - Nikki Pandey
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Plot 47, Sector 44, Gurugram, Haryana 122002, India
| | - Vishal Patil
- Indian Association of Parenteral and Enteral Nutrition - Pune Chapter, Pune, Maharashtra 411019, India
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
| | - Anca Chis Ster
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
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Chacko S, Jeemon P. Role of family support and self-care practices in blood pressure control in individuals with hypertension: results from a cross-sectional study in Kollam District, Kerala. Wellcome Open Res 2020; 5:180. [PMID: 33305010 PMCID: PMC7713892 DOI: 10.12688/wellcomeopenres.16146.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Despite the availability of effective drugs, blood pressure (BP) control rate is sub-optimal in individuals with hypertension in low- and middle-income countries (LMICs). The role of self-care in the management of BP is less studied in LMIC settings. Methods: We conducted a community-based, cross-sectional study in individuals with hypertension in Kollam district, Kerala. A multistage cluster sampling method was used for the selection of study participants. We measured self-care by using an adapted Hypertension Self-Care Activity Level Effects (H-SCALE) scale. Descriptive statistics were used to summarise the data and logistic regression analysis was conducted to identify factors associated with BP control. Results: In total, 690 individuals with hypertension (women=60%) and a mean age of 57±8 years participated in the study. More than half (54%) of the participants were adherent to anti-hypertensive medications. However, the adherence rate was much lower for the dietary approach to stop hypertension (DASH) diet (12.8%), recommended level of physical activity (24%) and weight management (11.4%). Overall BP control was achieved in two of five individuals (38.4%, 95% CI: 34.7-42.0%). Among self-care activities, adherence to medications (AOR: 1.8, 95% CI: 1.3-2.5), DASH diet (AOR: 1.5, 95% CI: 1.0-2.4), and non-smoking status (AOR: 3.3, 95% CI: 1.7-6.4) were associated with control of BP. Additionally, good family support to self-care (AOR: 1.9, 95% CI: 1.1-3.1) was associated with better control of BP. Conclusion: In individuals with hypertension, the BP control rate is achieved in two of five individuals. Adoption of self-care activities are sub-optimal. Both family support and adherence to self-care activities are associated with BP control. Family based interventions to improve adherence to self-care activities could have a significant public health impact in achieving better population-level BP control rates in Kerala, India.
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Affiliation(s)
- Susanna Chacko
- Achutha Menon Centre for Health Sciences Studies, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Sciences Studies, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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215
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Talukdar D, Tripathi M, Tripathi V, Teelucksingh S. Prevalence and associated factors of undiagnosed hypertension among women aged 15-49 years in India: an analysis of National Family Health Survey-4 data. J Hum Hypertens 2020; 35:726-740. [PMID: 32704029 DOI: 10.1038/s41371-020-0384-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/05/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022]
Abstract
Hypertension is a major risk factor for cardiovascular disease globally. Although Indian studies have addressed the prevalence of hypertension and its associated factors, this study focuses upon women in the reproductive age group, 15-49 years, who have undiagnosed hypertension. We use NFHS-4 data for secondary analyses of prevalence and factors associated with undiagnosed hypertension among women aged 15-49 years in India. Multiple logistic regression was undertaken to identify associated factors. Our analyses showed that overall prevalence of undiagnosed hypertension was 18.69% among women aged 15-49 years in India. In rural areas, it was 17.09% compared and 21.73% in urban areas. By comparison, only 8.86% self-reported a diagnosis of hypertension. Factors associated with undiagnosed hypertension were age, less than or more than normal BMI, higher wealth quintiles, no education, religion, caste, and geographical zones. Almost one in five women aged 15-49 years in India has undiagnosed hypertension with implications for personal and reproductive health.
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Affiliation(s)
| | - Mallika Tripathi
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
| | - Vrijesh Tripathi
- Department of Mathematics and Statistics, Faculty of Science and Technology, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago.
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
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216
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Krishna A, Pathni AK, Sharma B, Shivashankar R, Shrivastava S, Hering D. A perspective of private health care providers in the state of Madhya Pradesh on adopting key strategies of the India hypertension control initiative. J Clin Hypertens (Greenwich) 2020; 22:1321-1327. [PMID: 33289944 DOI: 10.1111/jch.13944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/01/2022]
Abstract
The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities. This study assessed the perspective of private physicians (PPs) on adopting the core strategies of the IHCI in Bhopal district of Madhya Pradesh. A semi-structured interview was purposely applied to 30 PPs to obtain their opinions on standardized hypertension treatment protocols, patient-centered services, and easy-to-use information system in their private practices. Verbatim data were recorded and analyzed thematically. Only 11 PPs followed the state hypertension treatment protocol. Among the remaining 19 PPs, the major reasons for not adopting protocol were (1) limited availability of single component hypertension drugs, (2) preferences for fixed dose combinations (FDCs), and (3) fear of either losing patients due to a lack of immediate blood pressure control or causing drug-related adverse effects. None of the interviewed doctors had resources to provide patient-centered care and use a digital health information system. Overall, the interviewed doctors identified that free supply of hypertension treatment protocol drugs, inclusion of FDCs in treatment protocol, increasing number of staff for follow-up visits, and patient education, IT-based solutions for patient records, employee incentives, and need for national data sharing policies are the key actions to accelerate the adoption of IHCI strategies in the private sector. This exploratory qualitative study suggests that engagement of private sector in the IHCI is feasible. Plans to expand the IHCI to the private sector should consider ensuring the wider availability of hypertension treatment protocol drugs and developing a simple user-friendly digital platform for patient monitoring.
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Affiliation(s)
| | | | | | | | | | - Dagmara Hering
- Lancet Commission on Hypertension Group.,Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
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217
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Linkages between occupation and elevated blood pressure among men in India: a cross-sectional study. Int J Public Health 2020; 65:835-846. [PMID: 32676706 DOI: 10.1007/s00038-020-01411-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The study aims to examine the linkages between occupation and elevated blood pressure among men aged 25-54 years in India. METHODS The study is based on the National Family Health Survey India, 2015-16. Age-standardized prevalence rates, χ2 tests and multivariable ordered logistic regression models were used to fulfill the study objectives. RESULTS In India, more than five out of hundred men of age group 25-54 years are suffering from moderately or severely elevated blood pressure levels. The findings depict an occupation wise inequality in the elevated blood pressure levels. Men belonging to professional-managerial-technical (PR = 6.42 per 100 men) and sales (PR = 6.10 per 100 men) occupational groups are facing a much higher burden. From the fitted multivariable ordered logistic models, we found that highly educated-unemployed and married-unemployed men were found to be at higher risk of elevated blood pressure levels. CONCLUSIONS The study found linkages between the occupation of men and elevated blood pressure levels in India. Urgent attention is needed to the vulnerable occupational groups like professional-technical-managerial, clerical, and sales with a special focus to the unemployed cohort of the country.
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218
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Madavanakadu Devassy S, Webber M, Scaria L, Amuthavalli Thiyagarajan J, Fendt-Newlin M, Joubert J, Benny AM, Nannatt A, Joubert L. Social and behavioural risk factors in the prevention and management of cardiovascular disease in Kerala, India: a catchment area population survey. BMC Cardiovasc Disord 2020; 20:327. [PMID: 32641078 PMCID: PMC7346640 DOI: 10.1186/s12872-020-01595-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality in India. Social and behavioural factors are strongly interrelated in the prevention and control of CVD. The ability to make lifestyle changes to control hypertension and diabetes (major risk factors for CVD) is determined by factors such as education, gender, caste, poverty, and urbanicity. This study aimed to improve our understanding of the inter-relationship of social and behavioural factors in the management of elevated serum glucose and high blood pressure and co-morbid mental health conditions. METHODS A population-based catchment area cross sectional survey was conducted in Kerala, India. Data were collected from residents aged over 30 years (n = 997) using standardized tools and clinical measures. We performed latent class analysis incrementally to extract homogeneous latent classes of individuals based on their responses to social and behavioural risk factors in the survey. Using structural equation models, we assessed the mediating effect of depression and anxiety, and social or behavioural risk factors, on management of high blood pressure and raised serum glucose levels. RESULTS The prevalence of high blood pressure and blood glucose in the sample was 33 and 26% respectively. Latent class analysis found three clusters of risk factors. One had a predominance of behavioural characteristics, another of social risk factors and the third was a low risk group. Age, female sex, and marital status had an effect on high blood pressure and high glucose, though were mediated by mental health, social and behavioural risk factors. CONCLUSIONS Interventions to improve the management of risk factors for CVD need to address social risk factors and be sensitive to the needs of population sub-groups that may require additional support to access health services. An integration of social and health services may be required to achieve this.
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Affiliation(s)
- Saju Madavanakadu Devassy
- Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O, Kalamassery, Kochi, Kerala, 683 104, India
| | - Martin Webber
- International Centre for Mental Health Social Research, Department of Social Policy and Social Work, University of York, York, Heslington, YO10 5DD, UK.
| | - Lorane Scaria
- Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O, Kalamassery, Kochi, Kerala, 683 104, India
| | - Jotheeswaran Amuthavalli Thiyagarajan
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Meredith Fendt-Newlin
- International Centre for Mental Health Social Research, Department of Social Policy and Social Work, University of York, York, Heslington, YO10 5DD, UK.,World Health Organization, Ankara, Turkey
| | | | - Anuja Maria Benny
- Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O, Kalamassery, Kochi, Kerala, 683 104, India
| | - Anjana Nannatt
- Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O, Kalamassery, Kochi, Kerala, 683 104, India
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Determinants of hypertension in Nepal using odds ratios and prevalence ratios: an analysis of the Demographic and Health Survey 2016. J Biosoc Sci 2020; 53:522-530. [PMID: 32611458 DOI: 10.1017/s0021932020000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This cross-sectional study investigated the factors associated with hypertension among Nepalese adults aged 18 years or above using data from the Nepal Demographic and Health Survey 2016. Prevalence ratios (PRs) and odds ratios (ORs) were obtained using log-binomial regression and logistic regression, respectively. Initially, unadjusted PRs and ORs were obtained. The variables that yielded a significance level below 0.2 in unadjusted analyses were included in the multivariable analysis. The overall prevalence of hypertension among the 13,393 participants (58% male and 61.2% urban) was 21.1% (n = 2827). In the adjusted analysis, those aged 30-49 years (adjusted PR [APR]: 3.1, 95% Confidence Interval (CI): 2.6, 3.7; adjusted OR [AOR]: 3.6, 95% CI: 2.9, 4.5), 50-69 years (APR: 5.3, 95% CI: 4.4, 6.6; AOR: 8.2, 95% CI: 6.4, 10.4) and ≥70 years (APR: 7.3, 95% CI: 5.8, 9.2; AOR: 13.6, 95% CI: 10.1, 18.3) were more likely to be hypertensive than younger participants aged 18-29 years. Males (APR: 1.3, 95% CI: 1.2, 1.4; AOR: 1.5, 95% CI: 1.3, 1.7), overweight/obese participants (APR: 1.8, 95% CI: 1.7, 2.0; AOR: 2.4, 95% CI: 2.2, 2.8) and those in the richest wealth quintile (APR: 1.3, 95% CI: 1.1, 1.5; AOR: 1.5, 95% CI: 1.1, 1.9) had higher prevalences and odds of hypertension than their female, normal weight/underweight and poorest wealth quintile counterparts, respectively. Those residing in Province 4 (APR: 1.2, 95% CI: 1.0, 1.5; AOR: 1.4, 95% CI: 1.1, 1.8) and Province 5 (APR: 1.2, 95% CI: 1.0, 1.4; AOR: 1.3, 95% CI: 1.1, 1.7) were more likely to be hypertensive than those residing in Province 1. The point estimate was inflated more in magnitude by ORs than by PRs, but the direction of association remained the same. Public health programmes in Nepal aimed at preventing hypertension should raise awareness among the elderly, males, individuals in the richest wealth quintile and the residents of Provinces 4 and 5.
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220
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Mohanty S, Nagarathna R, Metri K, Patil S, Kumar S, Singh A, Nagendra HR. Trends of Hypertension and Neurological Diseases in India: A Nationwide Survey Reporting the Distribution Across Geographical Areas. Ann Neurosci 2020; 27:162-168. [PMID: 34556955 PMCID: PMC8455011 DOI: 10.1177/0972753120987457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hypertension has remained an imperative risk factor for cardiovascular and cerebrovascular diseases, increasing the national burden of premature deaths over the decades. PURPOSE There is limited data on the prevalence of hypertension and its distribution across all geographic regions in India. This nationwide survey was conducted in 2017 to assess the prevalence of hypertension and prehypertension among the Indian adults. METHODS A multilevel stratified cluster sampling technique, with a random selection among the urban and rural populations, was adopted to achieve a sample of 70,031 adults from 24 states and 4 union territories. Blood pressure was measured twice using automated oscillometric machines with a minimum of 3-min gap, and the average was recorded. This was later categorized into prehypertension (elevated blood pressure) and hypertension subgroups as defined by the new 2017 American Heart Association guidelines. RESULTS The prevalence of prehypertension and hypertension in our study population across all ages was found to be 18.2% and 24%, respectively. Prehypertension was common at a younger age, whereas the prevalence of hypertension was higher in the older age groups. The urban population (24.4%) and males (24.7%) were positively associated with prehypertension and hypertension. The western zone had the highest prevalence of hypertension, whereas the eastern population had the lowest. CONCLUSION Our study revealed an alarmingly high prevalence of hypertension, accounting up to one hypertensive in every four adults in India. There is a need for more robust national strategies for identifying and treating hypertension to reduce the national and the global burden of hypertension by 25% before 2025.
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Affiliation(s)
- Sriloy Mohanty
- Centre of Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Raghuram Nagarathna
- Arogyadhama, Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnataka, India
| | - Kashinath Metri
- Department of Yoga, Central University of Rajasthan, Kishangarh, Rajasthan, India
| | - Suchitra Patil
- Department of Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnataka, India
| | - Sanjay Kumar
- Department of Health, Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karanataka, India
| | - Amit Singh
- Department of Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnataka, India
| | - Hongasandra R Nagendra
- Department of Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnataka, India
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Socio-economic and reproductive concomitants of abdominal adiposity and hypertension: A study on Bengali-speaking Hindu women of Habra, North 24 Parganas, West Bengal, India. ANTHROPOLOGICAL REVIEW 2020. [DOI: 10.2478/anre-2020-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Obesity and hypertension have become a global epidemic among the women, especially as they experience additional stressful events compared to men. The epidemiology of these two metabolic disorders is regulated by various biological, socio-economic, reproductive and lifestyle factors related to women. However, inconsistency in the nature and magnitude of the effects of these traits indicates exploring the areas where little emphasis has been given. In this context, the present study attempted to determine the effect of socio-economic and reproductive traits on hypertension and abdominal adiposity among women living in the North 24 Parganas district of West Bengal, India. Data on socio-demographic and reproductive traits were collected from 319 adult women from both rural and urban sectors of Habra block I. Anthropometric measurements and Blood pressure levels were measured following standard protocols. Results highlighted that the prevalence of obese individuals and hypertensive individuals were 73.4 and 50.5 per cent respectively. Women with low income (OR=0.51) were at lower risk and post-menopausal women (OR=1.71) were at higher risk of developing abdominal adiposity. The risk of developing hypertension increased with higher educational attainment (OR=2.43). Post-menopausal women (OR=0.46) and shifting workers (OR=0.40) were at lower risk of developing hypertension. The risk also decreased with increased age (OR=0.96). Present study revealed that menopause is a significant event to predict abdominal adiposity and hypertension among Bengali-speaking Hindu women.
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Dakshinamurthy S, Saxena V, Kumari R, Mirza AA, Dhar M. Prevalence of hypertension and associated cardiometabolic risk factors in urban Rishikesh, Uttarakhand. J Family Med Prim Care 2020; 9:2931-2939. [PMID: 32984151 PMCID: PMC7491824 DOI: 10.4103/jfmpc.jfmpc_54_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/12/2020] [Accepted: 03/30/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Hypertension is one of the leading causes of premature death worldwide and is a major risk factor for cardiovascular disease and all-of them cause mortality. Out of the estimated 1.13 billion people who have hypertension, less than 1 in 5 people have it under control. Aim and Objectives: To study the prevalence of hypertension and associated risk factors in the urban population of Rishikesh and the association of hypertension with other determinants. Methodology: A community based cross-sectional study was conducted in an urban area of Rishikesh. The World Health Organization (WHO) steps instrument and protocol was used for the assessment of risk factors and measurements. i.e. anthropometry and blood pressure. Sample size was calculated to be 478. Data was entered and analyzed using SPSS Version 20.0. Appropriate statistical tests were done. A P value of < 0.05 was considered significant. Results: The prevalence of hypertension in urban Rishikesh is 32.4%. The prevalence in male and female is 34.5% and 31.3% respectively. Among hypertensives 45.8% had hypertriglyceridemia, 32.2% had low high-density lipoproteins (HDL), 52.25% had fasting blood glucose more than 100, and 55.4% were obese individuals. Multivariate logistic regression analysis identified that age, waist circumference, body mass index, triglycerides level, and physical activity were independently associated with hypertension. Conclusions: As the prevalence of hypertension and cardiometabolic risk factors were higher, necessary health interventions were required to reduce the morbidity/mortality of the disease.
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Affiliation(s)
| | - Vartika Saxena
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ranjeeta Kumari
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anissa Atif Mirza
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Minakshi Dhar
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Control of hypertension among teachers in schools in Kerala (CHATS-K), India. Indian Heart J 2020; 72:416-420. [PMID: 33189204 PMCID: PMC7670257 DOI: 10.1016/j.ihj.2020.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 01/05/2023] Open
Abstract
Objective We investigated the prevalence, awareness, treatment, control of hypertension and the factors associated with hypertension prevalence and control among school teachers in Kerala, India. Methods We surveyed 2216 school teachers in Thiruvananthapuram district of Kerala as part of the control of hypertension among teachers in schools in Kerala (CHATS-K), India. We used World Health Organization STEPS tools for non-communicable diseases risk factor surveillance. Blood pressure, weight and height were measured using standard protocols. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg, or self-reported current antihypertensive medication. Controlled hypertension was defined as SBP<140 and DBP<90 mmHg. Separate multivariate analysis was done for finding the associated factors with prevalence and control of hypertension. Results Age adjusted hypertension prevalence was 14.6%. Men, those with self-reported diabetes, having family history of hypertension and overweight were more likely to have higher prevalence of hypertension compared to their counterparts. Among hypertensives 62% were aware, 49% on treatment and 34% achieved adequate control. Hypertension control was significantly higher among women, diabetics and overweight individuals compared to their counterparts. Conclusions A higher level of hypertension control among school teachers in this study indicates an attainable level of hypertension control in the general population of the state. Teachers, with their highly regarded place in the social construct of the country and the state, could thus be used as role models for hypertension control for the general population in the state.
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Rai RK, Kumar C, Singh PK, Singh L, Barik A, Chowdhury A. Incidence of Prehypertension and Hypertension in Rural India, 2012-2018: A Sex-Stratified Population-Based Prospective Cohort Study. Am J Hypertens 2020; 33:552-562. [PMID: 32149333 DOI: 10.1093/ajh/hpaa034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/20/2020] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND India is home to the largest number of hypertensive individuals, and factors responsible for the incidence of hypertension are poorly understood. This study examines predictors of transition to different stages of hypertension-incidence of hypertension, incidence of prehypertension, and incidence of prehypertension to hypertension. METHODS Population-based survey data from the Birbhum Population Project, located in West Bengal, India were used. A cohort of 8,977 individuals (male: 3,934, female: 5,043), participated in the 2012-13 survey, and were followed up for resurvey in 2017-18. The Seventh Report of the Joint National Committee (JNC 7) guidelines were followed to define hypertension. Bivariate and multivariate Poisson regression analyses were conducted to attain the study objective. RESULTS The incidence of hypertension, prehypertension among males (7.9% and 45.3%, respectively) is higher than that among females (5.9% and 32.7%, respectively). However, the incidence of prehypertension to hypertension is lower among males (23.6%) than among females (33.6%). Among both sexes, with age, the incidence of hypertension, and incidence of prehypertension to hypertension appeared to increase, whereas incidence of prehypertension among females increased with age. Findings indicate a diverse gradient of socioeconomic, behavioral, and anthropometric characteristics influencing the incidence of different stages of hypertension. CONCLUSIONS With a focus on females and the richest individuals, this study proposes that an appropriate intervention be designed in keeping with the socioeconomic, behavioral gradient of incidence of different stages of hypertension. The role of anthropometric indicators in hypertension is proposed to be further studied for better population-based screening.
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Affiliation(s)
- Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Economics, and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Chandan Kumar
- Department of Policy Studies, TERI School of Advanced Studies, New Delhi, India
| | - Prashant Kumar Singh
- Division of Preventive Oncology, ICMR National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Lucky Singh
- ICMR National Institute of Medical Statistics, New Delhi, India
| | - Anamitra Barik
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Chest Clinic—Suri District Hospital, and Niramoy TB Sanatorium, Suri, West Bengal, India
| | - Abhijit Chowdhury
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Department of Hepatology—School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
- Indian Institute of Liver and Digestive Sciences, Kolkata, West Bengal, India
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226
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Prevalence of hypertension among Indian adults: Results from the great India blood pressure survey. Indian Heart J 2020; 72:217. [PMID: 32768029 PMCID: PMC7411092 DOI: 10.1016/j.ihj.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/21/2022] Open
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227
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Padmanabhan R, Singh RG, Unni G, Desai B, Hiremath SK, Jain V, Bhawal S, Gulati S, Shete M, Nair R, Prakash S, Kher V, Bhattacharya B. Multidisciplinary Consensus Document on the Management of Uncontrolled Hypertension in India. High Blood Press Cardiovasc Prev 2020; 27:215-223. [PMID: 32382998 DOI: 10.1007/s40292-020-00385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/25/2020] [Indexed: 11/25/2022] Open
Abstract
Cardiovascular disease is predicted to be the largest cause of death and disability in India by 2020. Hypertension (HT), one of the main contributing factors, presents a significant public health burden. Inability to achieve adequate blood pressure (BP) control results in uncontrolled hypertension (UHT). The prevalence of UHT is high in India, with only about 9-20% of patients achieving target BP goals. Presently, there are no guidelines specific to UHT, which if left uncontrolled can lead to resistant HT, chronic kidney disease and other complications of HT. A multidisciplinary panel, comprising of specialists in cardiology, nephrology and internal medicine, was convened to address the diagnosis and management of UHT in the Indian population. The panel identified key points concerning UHT and discussed management recommendations in the Indian clinical setting.
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Affiliation(s)
- R Padmanabhan
- Department of Nephrology, SRM Medical College and Hospital, Chennai, Tamil Nadu, India.
| | - Rana Gopal Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Govindan Unni
- Department of Cardiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Bhupen Desai
- Department of Cardiology, Karuna Hospital, Borivali West, Mumbai, Maharashtra, India
| | | | - Vidyut Jain
- Department of Cardiology, Choithram Hospital and Research Center, Indore, India
| | - Saikat Bhawal
- Consultant Physician and Diabetologist, Ashok Nursing Home Private Limited, Kolkata, West Bengal, India
| | - Sanjeev Gulati
- Department of Nephrology, Fortis Hospitals, New Delhi, India
| | - Mukesh Shete
- Department of Nephrology, Apex Kidney Care, Mumbai, Maharashtra, India
| | - Ramesh Nair
- Department of Medicine, Lakshmi Hospital, Diwans Road, Ernakulam, Kerala, India
| | - Sunil Prakash
- Department of Nephrology, BLK Super Specialty Hospital, New Delhi, India
| | - Vijay Kher
- Chairman, Department of Nephrology, Medanta Kidney and Urology Institute, Haryana, India
| | - Bijan Bhattacharya
- Department of Nephrology, Ruby General Hospital, Kolkata, West Bengal, India
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228
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Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, Ramirez A, Schlaich M, Stergiou GS, Tomaszewski M, Wainford RD, Williams B, Schutte AE. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension 2020; 75:1334-1357. [PMID: 32370572 DOI: 10.1161/hypertensionaha.120.15026] [Citation(s) in RCA: 1605] [Impact Index Per Article: 401.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Thomas Unger
- From the CARIM - School for Cardiovascular Diseases, Maastricht University, the Netherlands (T.U.)
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Italy (C.B.)
| | - Fadi Charchar
- Federation University Australia, School of Health and Life Sciences, Ballarat, Australia (F.C.).,University of Melbourne, Department of Physiology, Melbourne, Australia (F.C.).,University of Leicester, Department of Cardiovascular Sciences, United Kingdom (F.C.)
| | - Nadia A Khan
- University of British Columbia, Vancouver, Canada (N.A.K.).,Center for Health Evaluation and Outcomes Sciences, Vancouver, Canada (N.A.K.)
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, United Kingdom (N.R.P.)
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India (D.P.).,Centre for Chronic Disease Control, New Delhi, India (D.P.).,London School of Hygiene and Tropical Medicine, United Kingdom (D.P.)
| | - Agustin Ramirez
- Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.R.)
| | - Markus Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth (M.S.).,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.N.)
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Greece (G.S.S.)
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom (M.T.).,Division of Medicine and Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust Manchester, United Kingdom (M.T.)
| | - Richard D Wainford
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, MA (R.D.W.).,The Whitaker Cardiovascular Institute, Boston University, MA (R.D.W.).,Department of Health Sciences, Boston University Sargent College, MA (R.D.W.)
| | - Bryan Williams
- University College London, NIHR University College London, Hospitals Biomedical Research Centre, London, United Kingdom (B.W.)
| | - Aletta E Schutte
- Faculty of Medicine, University of New South Wales, Sydney, Australia (A.E.S.).,The George Institute for Global Health, Sydney, Australia (A.E.S.).,Hypertension in Africa Research Team (A.E.S.), North-West University, Potchefstroom, South Africa.,South African MRC Unit for Hypertension and Cardiovascular Disease (A.E.S.), North-West University, Potchefstroom, South Africa
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229
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Fakhri M, Sarokhani D, Ghiasi B, Dehkordi AH. Prevalence of Hypertension in Cardiovascular Disease in Iran: Systematic Review and Meta-Analysis. Int J Prev Med 2020; 11:56. [PMID: 32577186 PMCID: PMC7297428 DOI: 10.4103/ijpvm.ijpvm_351_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/12/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypertension is a major cause of noncommunicable diseases such as cardiovascular disease. Therefore, this study aimed to estimate the prevalence of hypertension in cardiovascular patients in Iran by meta-analysis. METHODS The search was carried out using authentic Persian and English keywords in national and international databases including IranMedex, Scientific Information Database (SID), Magiran, IranDoc, Medlib, ScienceDirect, PubMed , Scopus, Cochrane, Embase, Web of Science, and Google Scholar search engine without any time limitation until 2017. Heterogeneity of studies was assessed using I2 statistic . Data were analyzed using STATA 11.1. RESULTS In 66 reviewed studies with a sample of 111,406 participants, the prevalence of hypertension was 44% in Iranian patients with cardiovascular disease 67%(95%CI: 38%-49%) in women and 42% in men. The prevalence of systolic hypertension in cardiac patients was 25%, diastolic 20%, diabetes 27%, and overexposure 43%. The prevalence of hypertension was 44% in patients with coronary artery disease, 50% in myocardial infarction, 33% in aortic aneurysm, and 44% in cardiac failure. CONCLUSIONS Hypertension has a higher prevalence in women with cardiovascular disease than men, and it increases with age. Among patients with cardiovascular disease, myocardial infarction patients have the highest levels of hypertension. The prevalence of systolic hypertension in cardiac patients is higher than diastolic hypertension.
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Affiliation(s)
- Moloud Fakhri
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Diana Sarokhani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Bahareh Ghiasi
- Department of Nephrology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Hasanpour Dehkordi
- Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord, Iran
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230
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Prevalence, Awareness, Treatment, and Control of Hypertension and Its Associated Risk Factors: Results from Baseline Survey of SWADES Family Cohort Study. Int J Hypertens 2020; 2020:4964835. [PMID: 32351729 PMCID: PMC7178468 DOI: 10.1155/2020/4964835] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 12/18/2022] Open
Abstract
Methods In this prospective family-based cohort study, 573 families were included with a total of 997 participants aged 30 years and above. Baseline interviews were conducted in participant's homes using a combination of self-structured and standardized questionnaire. Blood pressure and plasma glucose were assessed for each participant. Results The prevalence of hypertension was 43%. It was slightly higher in women than men (43.7% vs. 41.4%). The mean systolic blood pressure in the hypertensive population was 141.9 mmHg and mean diastolic blood pressure was 85.3 mmHg. In total, 78% (86.2% in women, 62.9% in men) of the participants were aware of their hypertension. Among those aware, 60.4% (63.5% in women, 52.6% in men) of the participants were on treatment, and hypertension was controlled in 75.1% (77.5% women, 68% in men) of the participants on treatment. The prevalence of hypertension was higher among persons with comorbidities (diabetes 64.5%, transient ischemic attack 54.7%, and heart disease 64.4%). Prevalence was lower among persons who did regular vigorous intensity exercise versus those who did moderate intensity exercise (32% vs. 45.7%) and among nonsmokers versus smokers (42.2% vs. 46.6%). Conclusion The prevalence of hypertension in Kerala is high. Although awareness is quite high, there is a need to improve the number of persons with hypertension taking treatment.
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Thrift AG, Ragavan RS, Riddell MA, Joshi R, Thankappan KR, Chow C, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Suresh O, Mini GK, Ismail J, Gamage DG, Hasan A, Srikanth VK, Thomas N, Maulik PK, Guggilla RK, Evans RG. Hypertension in Rural India: The Contribution of Socioeconomic Position. J Am Heart Assoc 2020; 9:e014486. [PMID: 32223389 PMCID: PMC7428634 DOI: 10.1161/jaha.119.014486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Various indicators of socioeconomic position (SEP) may have opposing effects on the risk of hypertension in disadvantaged settings. For example, high income may reflect sedentary employment, whereas greater education may promote healthy lifestyle choices. We assessed whether education modifies the association between income and hypertension in 3 regions of South India at different stages of epidemiological transition. Methods and Results Using a cross‐sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Rishi Valley. Sampling was stratified by age group and sex. We measured blood pressure and anthropometry and administered a questionnaire to identify lifestyle factors and SEP, including education, literacy, and income. Logistic regression was used to assess associations between various components of SEP and hypertension, and interaction analyses were used to determine whether educational attainment modified the association between income and hypertension. Trivandrum, the region of highest SEP, had the greatest prevalence of hypertension, whereas Rishi Valley, the lowest SEP region, had the least. Overall, greater income was associated with greater risk of hypertension. In interaction analyses, there was no evidence that educational attainment modified the association between income and hypertension. Conclusions Education is widely considered to ameliorate the risk of hypertension in high‐income countries. Why this effect is absent in rural India merits investigation.
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Affiliation(s)
- Amanda G Thrift
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | | | - Michaela A Riddell
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | - Rohina Joshi
- The George Institute for Global Health University of New South Wales Australia
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, India
| | - Clara Chow
- The George Institute for Global Health University of New South Wales Australia.,Department of Cardiology Westmead Hospital Sydney Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health University of Melbourne Carlton Australia
| | - Ajay S Mahal
- School of Public Health and Preventative Medicine Monash University Melbourne Australia.,Nossal Institute for Global Health Melbourne School of Population and Global Health University of Melbourne Carlton Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - Oduru Suresh
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia.,Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - G K Mini
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, India.,Global Institute of Public Health Ananthapuri Hospitals and Research Institute Trivandrum Kerala India
| | - Jordan Ismail
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | | | - Aniqa Hasan
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | - Velandai K Srikanth
- Peninsula Clinical School Central Clinical School Monash University Frankston Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India
| | - Pallab K Maulik
- George Institute for Global Health New Delhi India.,George Institute for Global Health-Oxford University Oxford United Kingdom
| | - Rama K Guggilla
- Department of Population Medicine and Civilization Diseases Prevention Faculty of Medicine With the Division of Dentistry and Division of Medical Education in English Medical University of Bialystok Bialystok Poland
| | - Roger G Evans
- Cardiovascular Disease Program Biomedicine Discovery Institute, and Department of Physiology Monash University Melbourne Australia
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232
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Amare F, Hagos B, Sisay M, Molla B. Uncontrolled hypertension in Ethiopia: a systematic review and meta-analysis of institution-based observational studies. BMC Cardiovasc Disord 2020; 20:129. [PMID: 32160859 PMCID: PMC7066819 DOI: 10.1186/s12872-020-01414-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background Uncontrolled hypertension is one of the major risk factors of cardiovascular and cerebrovascular diseases. The prevalence of hypertension in Ethiopia is expected to reach up to 30%. The aim of this study was to determine the prevalence of uncontrolled hypertension among hypertensive patients on treatment in Ethiopia. Methods Electronic databases and search engines including EMBASE (Ovid), PubMed/Medline, and Google Scholar were searched for original records in the English language addressing hypertension control in Ethiopia from 2000 to 2018. Data were extracted using a format prepared in Microsoft Excel and exported to STATA 15.0 software for analyses. The study protocol is registered at PROSPERO with reference number ID: CRD42018116336. Results A total of 13 studies with 5226 hypertension patients were included for systematic review and meta-analysis. The pooled prevalence of uncontrolled hypertension in Ethiopia was 48% (95% confidence interval (CI): 36, 61%). The result of the sub-group analysis, based on the year of publications, revealed that the prevalence of uncontrolled BP was highest in 2016 (63%; CI: 60, 67%) and in 2015 (59%; CI: 53, 65%). Univariate meta-regression revealed that sampling distribution was not a source of heterogeneity for the pooled estimate as well as the sub group analysis. Conclusion The prevalence of uncontrolled hypertension was high in Ethiopia. This alarming public health issue fuels the ever-increasing cardiovascular and cerebrovascular diseases. The ministry of health has to design a policy and implementation mechanisms to reduce uncontrolled hypertension prevalence and improve awareness on blood pressure control.
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Affiliation(s)
- Firehiwot Amare
- Clinical Pharmacy Unit, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Bisrat Hagos
- Social Pharmacy Unit, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Pharmacology Unit, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bereket Molla
- Clinical Pharmacy Unit, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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233
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Chia Y, Kario K, Turana Y, Nailes J, Tay JC, Siddique S, Park S, Shin J, Buranakitjaroen P, Chen C, Divinagracia R, Hoshide S, Minh HV, Sison J, Soenarta AA, Sogunuru GP, Sukonthasarn A, Teo BW, Verma N, Zhang Y, Wang T, Wang J. Target blood pressure and control status in Asia. J Clin Hypertens (Greenwich) 2020; 22:344-350. [PMID: 31742891 PMCID: PMC8029870 DOI: 10.1111/jch.13714] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022]
Abstract
It is widely accepted that hypertension constitutes a significant cardiovascular risk factor and that treating high blood pressure (BP) effectively reduces cardiovascular risk. An important issue in Asia is not just the high prevalence of hypertension, particularly in some countries, but also the low level of awareness and treatment rates in many regions. The 2017 update of the American College of Cardiology/American Heart Association hypertension guidelines raised the question about which BP threshold should be used to diagnose and treat hypertension. Although there is a theoretical rationale for a stricter BP criterion in Asia given the ethnic-specific features of hypertension in the region, the majority of countries in Asia have retained a diagnostic BP threshold of ≥140/90 mm Hg. Although lowering thresholds might make theoretical sense, this would increase the prevalence of hypertension and also markedly reduce BP control rates. In addition, there are currently no data from robust randomized clinical trials of the benefits of the lower targets in preventing cardiovascular disease and reducing cardiovascular risk, particularly in high-risk patients and especially for Asian populations. There is also no defined home BP treatment target level for an office BP treatment target of 130/80 mm Hg. However, in this regard, in the interim, lifestyle modifications, including reducing body weight and salt intake, should form an important part of hypertension management strategies in Asia, while studies on treating at lower BP threshold level in Asians and getting to lower BP targets will be helpful to inform and optimize the management of hypertension in the region.
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Affiliation(s)
- Yook‐Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yuda Turana
- Department of NeurologyFaculty of MedicineAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center IncQuezon CityPhilippines
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingapore CitySingapore
| | | | - Sungha Park
- Division of CardiologyCardiovascular HospitalYonsei Health SystemSeoulKorea
| | - Jinho Shin
- Faculty of Cardiology ServiceHanyang University Medical CenterSeoulKorea
| | - Peera Buranakitjaroen
- Department of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Chen‐Huan Chen
- Department of MedicineFaculty of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Romeo Divinagracia
- University of the East Ramon Magsaysay Memorial Medical Center IncQuezon CityPhilippines
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Huynh Van Minh
- Department of Internal MedicineUniversity of Medicine and PharmacyHue UniversityHueVietnam
| | - Jorge Sison
- Department of MedicineMedical Center ManilaManilaPhilippines
| | - Arieska Ann Soenarta
- Department Cardiology and Vascular MedicineUniversity of Indonesia‐National Cardiovascular CenterHarapan KitaJakartaIndonesia
| | - Guru Prasad Sogunuru
- MIOT International HospitalChennaiIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | | | - Boon Wee Teo
- Division of NephrologyDepartment of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore CitySingapore
| | - Narsingh Verma
- Department of PhysiologyFaculty of MedicineKing George's Medical UniversityLucknowIndia
| | - Yuqing Zhang
- Divisions of Hypertension and Heart FailureFu Wai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Tzung‐Dau Wang
- Division of CardiologyDepartment of Internal MedicineNational Taiwan University Hospital and College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Ji‐Guang Wang
- Department of HypertensionCentre for Epidemiological Studies and Clinical TrialsThe Shanghai Institute of HypertensionShanghai Key Laboratory of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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234
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Abstract
Large population-based surveys by the Government of India and several other regional studies have reconfirmed the coexisting burden of over- and undernutrition. While time trends from the 2nd, 3rd and 4th rounds of the National Family Health Survey show declining trends in the prevalence of the underweight, it also highlights increasing rates in the overweight/obesity. Dose-response relationships with different micro- and macronutrient consumption with overweight/obesity prevalence have been established. In this context, it was attempted to identify the specific diet pattern and socio-behavioural determinants of overnutrition along with its combat strategies. This review highlights that while the proportion of chronic energy deficiency is decreasing in India, the intake of micronutrients and food groups continues to be below the recommended dietary allowance set by the Indian Council of Medical Research. Distal factors that determine the nutritional imbalance among Indians are presented under (i) household contextual factors, (ii) peer and socio-cultural influencers, and (iii) business and neighbourhood environment. Accumulation of such factors increases the density of obesogenic environment around individuals. Further, the review offers action points at individual, society and policy levels, presented in a 'logframe matrix' for bringing convergence actions across sectors in consultation with programme managers from different ministries/departments.
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Affiliation(s)
- Prashant Mathur
- National Centre for Disease Informatics & Research, Indian Council of Medical Research, Bengaluru, India
| | - Rakesh Pillai
- INCLEN Institute of Global Health, The INCLEN Trust International, New Delhi, India
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235
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Sogunuru GP, Mishra S. Asian management of hypertension: Current status, home blood pressure, and specific concerns in India. J Clin Hypertens (Greenwich) 2020; 22:479-482. [DOI: 10.1111/jch.13798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 02/02/2023]
Affiliation(s)
| | - Surabhi Mishra
- Department of Cardiology MIOT international hospital Chennai India
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236
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Gamage DG, Riddell MA, Joshi R, Thankappan KR, Chow CK, Oldenburg B, Evans RG, Mahal AS, Kalyanram K, Kartik K, Suresh O, Thomas N, Mini GK, Maulik PK, Srikanth VK, Arabshahi S, Varma RP, Guggilla RK, D’Esposito F, Sathish T, Alim M, Thrift AG. Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India: A cluster randomised controlled trial. PLoS Med 2020; 17:e1002997. [PMID: 31895945 PMCID: PMC6939905 DOI: 10.1371/journal.pmed.1002997] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND New methods are required to manage hypertension in resource-poor settings. We hypothesised that a community health worker (CHW)-led group-based education and monitoring intervention would improve control of blood pressure (BP). METHODS AND FINDINGS We conducted a baseline community-based survey followed by a cluster randomised controlled trial of people with hypertension in 3 rural regions of South India, each at differing stages of epidemiological transition. Participants with hypertension, defined as BP ≥ 140/90 mm Hg or taking antihypertensive medication, were advised to visit a doctor. In each region, villages were randomly assigned to intervention or usual care (UC) in a 1:2 ratio. In intervention clusters, trained CHWs delivered a group-based intervention to people with hypertension. The program, conducted fortnightly for 3 months, included monitoring of BP, education about hypertension, and support for healthy lifestyle change. Outcomes were assessed approximately 2 months after completion of the intervention. The primary outcome was control of BP (BP < 140/90 mm Hg), analysed using mixed effects regression, clustered by village within region and adjusted for baseline control of hypertension (using intention-to-treat principles). Of 2,382 potentially eligible people, 637 from 5 intervention clusters and 1,097 from 10 UC clusters were recruited between November 2015 and April 2016, with follow-up occurring in 459 in the intervention group and 1,012 in UC. Mean age was 56.9 years (SD 13.7). Baseline BP was similar between groups. Control of BP improved from baseline to follow-up more in the intervention group (from 227 [49.5%] to 320 [69.7%] individuals) than in the UC group (from 528 [52.2%] to 624 [61.7%] individuals) (odds ratio [OR] 1.6, 95% CI 1.2-2.1; P = 0.001). In secondary outcome analyses, there was a greater decline in systolic BP in the intervention than UC group (-5.0 mm Hg, 95% CI -7.1 to -3.0; P < 0.001) and a greater decline in diastolic BP (-2.1 mm Hg, 95% CI -3.6 to -0.6; P < 0.006), but no detectable difference in the use of BP-lowering medications between groups (OR 1.2, 95% CI 0.8-1.9; P = 0.34). Similar results were found when using imputation analyses that included those lost to follow-up. Limitations include a relatively short follow-up period and use of outcome assessors who were not blinded to the group allocation. CONCLUSIONS While the durability of the effect is uncertain, this trial provides evidence that a low-cost program using CHWs to deliver an education and monitoring intervention is effective in controlling BP and is potentially scalable in resource-poor settings globally. TRIAL REGISTRATION The trial was registered with the Clinical Trials Registry-India (CTRI/2016/02/006678).
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Affiliation(s)
- Dilan Giguruwa Gamage
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Michaela A. Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Rohina Joshi
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, New Delhi, India
| | - Kavumpurathu R. Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Clara K. Chow
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Roger G. Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Ajay S. Mahal
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gomathyamma K. Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Pallab K. Maulik
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, New Delhi, India
- George Institute for Global Health, Oxford University, Oxford, United Kingdom
| | - Velandai K. Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ravi P. Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Rama K. Guggilla
- George Institute for Global Health, New Delhi, India
- Department of Population Medicine and Civilization Diseases Prevention, Faculty of Medicine, Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, Bialystok, Poland
| | - Fabrizio D’Esposito
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Mohammed Alim
- George Institute for Global Health, New Delhi, India
- University of Central Lancashire, Preston, United Kingdom
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- * E-mail:
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237
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Satish P, Khetan A, Raithatha S, Bhende P, Josephson R. Response to letter by Visaria et al regarding our article, “Standardizing hypertension management in a primary care setting in India through a protocol based model.”. Indian Heart J 2020; 72:59-60. [PMID: 32423564 PMCID: PMC7231870 DOI: 10.1016/j.ihj.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
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238
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Deora S, Mathur D, Kaushik A, Bhardwaj P, Singh K. Awareness, medication adherence, and diet pattern among hypertensive patients attending teaching institution in western Rajasthan, India. J Family Med Prim Care 2020; 9:2342-2349. [PMID: 32754499 PMCID: PMC7380809 DOI: 10.4103/jfmpc.jfmpc_193_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/13/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Objectives: Hypertension is an important disease of public health concern. Awareness and medication adherence with diet modification have an important effect on the control of blood pressure and its associated morbidity and mortality. Therefore, this study was conducted to assess the awareness of hypertension, medication adherence, and dietary pattern in hypertensive population of western Rajasthan. Materials and Methods: The study was hospital based cross-sectional. Blood pressure measurements were taken in a sitting position in right arm after a 5-min rest using nonmercury sphygmomanometer and required cuff size. A prevalidated and pretested questionnaire for the assessment of awareness of hypertension was used. Results: Out of the total 384 patients, the majority of the patients were males (62.5%). There was a statistically significant difference found in awareness of hypertension among rural and urban patients. Nonadherence to antihypertensive medications was seen more in males (60.0%) as compared to females (40.0%). The most common reason for nonadherence was found to be forgetfulness (27.6%) followed by poor knowledge about the hypertension and ignorance of long-term treatment (22.9%). Out of the total hypertensive patient studied, 54.9% were taking normal salt intake and 45.1% of the subjects were found to be taking excess intake of salt. Interpretation and Conclusions: In the present study, good awareness about hypertension was found with urban patients. Among all the variables, education and employment status showed a positive and significant association with awareness. The most common reason of poor adherence was found to be forgetfulness behavior followed by poor knowledge and lack of awareness about hypertension.
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239
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Singh A, Shah A, Narain J. Hypertension and COVID-19: A public health perspective. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_34_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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240
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Varanasi R, Kolli R, Rai Y, Ramesh D, Kiranmayee RGR, Chandra Reddy GR, Baig H, Patole T, Srivastava P, Bhalaerao R, Chaudhary A, Kumar A, Sarathy V, Jayasri GR, Sachdeva G, Jain S, Sharma N, Amsole S, Oinam A, Oberai P, Manchanda R. Effects of individualised homoeopathic intervention in Stage I essential hypertension: A single-blind, randomised, placebo-controlled trial. INDIAN JOURNAL OF RESEARCH IN HOMOEOPATHY 2020. [DOI: 10.4103/ijrh.ijrh_93_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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241
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Kalkonde Y, Deshmukh M, Nila S, Jadhao S, Bang A. Effect of a community-based intervention for cardiovascular risk factor control on stroke mortality in rural Gadchiroli, India: study protocol for a cluster randomised controlled trial. Trials 2019; 20:764. [PMID: 31870394 PMCID: PMC6929484 DOI: 10.1186/s13063-019-3870-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Stroke has emerged as a leading cause of death in rural India. However, well-tested healthcare interventions to reduce stroke mortality in rural under-resourced settings are lacking. The aim of this study is to evaluate the effect of a community-based preventive intervention on stroke mortality in rural Gadchiroli, India. METHODS The study is a two-arm, parallel group, cluster randomised controlled trial in which 32 villages will be randomised to the intervention and the enhanced usual care (EUC) arm. In the intervention arm, individuals ≥50 years of age will be screened for hypertension, diabetes and stroke by trained Community Health Workers (CHWs). Screened individuals who are positive will be referred to a mobile outreach clinic which will visit the intervention villages periodically. A physician in the clinic will confirm the diagnosis, provide guideline-based treatment and follow up patients. The CHWs will make home visits once a month to ensure medication compliance and counsel patients to reduce salt consumption and quit tobacco and alcohol. In the EUC arm, households will be provided information on the ill effects of tobacco use and steps to quit it. Individuals from both the arms will have access to the government's national programme for the prevention and control of non-communicable diseases, where treatment for hypertension, diabetes and preventive treatment after stroke is available at the nearest primary health centres (PHCs). The intervention will be implemented for 3.5 years. The primary outcome will be a reduction in stroke mortality in the last 2.5 years of the intervention. DISCUSSION This trial will provide important information regarding the feasibility and effect of a community-based preventive intervention package on stroke mortality in a rural under-resourced setting and can inform India's non-communicable diseases prevention and control programme. If successful, such an intervention can be scaled up in the rural regions of India and other countries. TRIAL REGISTRATION Clinical Trials Registry of India: CTRI/2015/12/006424. Registered on 8 December 2015.
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Affiliation(s)
- Yogeshwar Kalkonde
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
| | - Mahesh Deshmukh
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
| | - Sindhu Nila
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
| | - Sunil Jadhao
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
| | - Abhay Bang
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
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242
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Mini GK, Sarma PS, Thankappan KR. Cluster randomised controlled trial of behavioural intervention program: a study protocol for control of hypertension among teachers in schools in Kerala (CHATS-K), India. BMC Public Health 2019; 19:1718. [PMID: 31864339 PMCID: PMC6925901 DOI: 10.1186/s12889-019-8082-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 12/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background Control of blood pressure among hypertensives is a major challenge around the world. Interventions for improving hypertension control in India are very limited. This paper describes the protocol for a cluster randomized controlled trial of efficacy of behavioural intervention on control of hypertension among school teachers in Kerala. Methods A total of 92 schools are randomised to intervention and control group in Kerala. A baseline survey was conducted in all schools to assess the prevalence of hypertension and its risk factors among school teachers in Thiruvananthapuram district of Kerala state, India. Teachers in both sets of schools will receive a leaflet containing details on the importance of controlling hypertension. With the objective of improving control of hypertension, the intervention schools will additionally receive self-management education and behavioural intervention programs delivered by trained intervention managers along with measurement of weight, waist circumference and blood pressure. This intervention program will be developed based on the findings of the baseline survey and selected components of successful models of hypertension control from previous research done in similar settings. The intervention will be given for 3 months after which a post-survey will be conducted among teachers of both control and intervention schools. The primary outcome is change in control of hypertension and secondary outcome is the change in behavioural risk factors of hypertension both in the control and intervention groups. Discussion This is the first comprehensive study looking at the efficacy of behavioural intervention on hypertension control among school teachers in Kerala, India. This study is likely to provide an upper estimate of behavioural intervention on hypertension control since teachers are reported to have one of the highest compliance rates of behavioural intervention. Trial registration This trial was prospectively registered with the Clinical Trials Registry of India [CTRI/2018/01/011402] on 18 January 2018.
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Affiliation(s)
- G K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India. .,Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, 695024, India. .,Women's Social and Health Studies Foundation, Trivandrum, Kerala, 695029, India.
| | - P S Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - K R Thankappan
- Department of Public Health and Community Medicine, Central University Kerala, Kasaragod, Tejaswini Hills, Periye, Kerala, 671320, India
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243
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Abstract
OBJECTIVES This is the first attempt to provide estimates on the prevalence of hypertension at the national, state and district level, a prerequisite for designing effective interventions. Besides, the study aims to identify the risk factors of hypertension. DESIGN We analysed cross-sectional survey data from the fourth round (2015-2016) of National Family Health Survey (NFHS). NFHS was conducted between January 2015 and December 2016, gathering information on a range of indicators including blood pressure. The age adjusted prevalence of hypertension was calculated for state comparison, while multilevel logistic regression analysis was done to assess the correlates of hypertension. SETTING AND PARTICIPANTS India (2015-2016; n=811 917) aged 15-49. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is hypertension, which has been defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. RESULTS The age-adjusted prevalence of hypertension in India was 11.3% (95% CI 11.16% to 11.43%) among persons aged between 15 and 49 and was four percentage points higher among males 13.8% (95% CI 13.46% to 14.19%) than among females 10.9% (95% CI 10.79% to 11.06%). Persons in the urban location (12.5%, 95% CI 12.25% to 12.80%) had a marginally higher prevalence than persons in rural location (10.6%, 95% CI 10.50% to 10.78%). The proportion of population suffering from hypertension varied greatly between states, with a prevalence of 8.2% (95% CI 7.58% to 8.85%) in Kerala to 20.3% (95% CI 18.81% to 21.77%) in Sikkim. Advancing age, obesity/overweight, male sex, socioeconomic status and consumption of alcohol were found to be the major predictors of hypertension. CONCLUSIONS Hypertension prevalence is now becoming more concentrated among the poor. Policy measures should be taken to improve the hazardous working conditions and growing social pressures of survival responsible for 'life-style' changes such as consumption of high calorie food and alcohol.
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Affiliation(s)
- Soumitra Ghosh
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Manish Kumar
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
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244
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Satish P, Khetan A, Barbhaya D, Agarwal M, Madan Mohan SK, Josephson R, Webel AR. A qualitative study of facilitators and barriers to cardiovascular risk factor control in a semiurban population in India. J Family Med Prim Care 2019; 8:3773-3778. [PMID: 31879612 PMCID: PMC6924214 DOI: 10.4103/jfmpc.jfmpc_492_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/22/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular (CV) risk factors like diabetes and hypertension are poorly controlled in both rural and urban India. This study was designed to identify the reasons for suboptimal control in a semiurban population in India. A total of 70 participants from the Study to Expand Heart Associated Treatments (SEHAT) trial, conducted in West Bengal, India. We qualitatively examined perspectives regarding CV risk factor control using focus group discussions based on the theory of reasoned action. Qualitative content analysis was used to analyze prevailing themes. Participants demonstrated a generalized knowledge of healthy lifestyle practices but lacked insight into disease-specific prevention methods. We further noticed significant gaps in the translation of existing knowledge into behavior. While personal and systemic barriers exist, factors like high patient motivation and a deep sense of trust in providers can potentially be harnessed to improve risk factor control in the community. We identified key facilitators and barriers to CV risk factor control in the community using a knowledge attitude behavior approach. Our findings provide direction for the development of community-based CV risk reduction models.
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Affiliation(s)
- Priyanka Satish
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Aditya Khetan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44122, USA
| | - Dweep Barbhaya
- Department of Pharmacology, Seth G S Medical College, Mumbai, Maharashtra, India
| | - Manyoo Agarwal
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sri Krishna Madan Mohan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44122, USA
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44122, USA
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44122, USA
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245
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Nag K, Karmakar N, Ghosh B, Datta A. An Epidemiological Study on the Assessment of Cardiovascular Health Status among Adults in an Urban Area of Teliamura Municipality Area, Khowai, Tripura. Indian J Community Med 2019; 44:332-336. [PMID: 31802795 PMCID: PMC6881879 DOI: 10.4103/ijcm.ijcm_386_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: In India, cardiovascular disease (CVD) is the largest cause of mortality and morbidity in all regions of the country. Now, to reduce the burden of CVD in our country, we first need to assess cardiovascular health status of the adult population. Objective: The aim of this study is to assess cardiovascular health status among adults and to find the influence of sociodemographic factors on it. Methodology: In a cross-sectional study, cardiovascular health status of 100 sampled adult population of urban area of Teliamura Municipality area, Tripura, was assessed using a pre-designed and pre-tested semi-structured schedule from July 2017 to August 2017. Samples were taken from the adult population by simple random sampling. Collected data were compiled and analyzed using the Statistical Package for the Social Sciences (SPSS 16.0.). The Chi-square and Fisher's exact test were applied to find association. Results: The mean age of the study participants was 44.89 (±13.76) years, comprised 52.0% males and 48% females. Hypertension was seen among 58% of the study population and 77% had ideal (<100 mg/dl) level of fasting blood sugar (FBS). The present study showed obesity, hypertension, high level of total cholesterol, high level of FBS was mostly prevalent among 42–61 years age group. Married people were more obese, hypertensive compared to unmarried. Conclusion: Middle age group population were worst affected by high blood pressure, high blood sugar, poor body mass index, and poor level of cholesterol. Healthy lifestyle measures might reduce the burden of CVD which could be evaluated in future research.
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Affiliation(s)
- Kaushik Nag
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| | - Nabarun Karmakar
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| | - Bivek Ghosh
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| | - Anjan Datta
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
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Cilnidipine loaded transfersomes for transdermal application: Formulation optimization, in-vitro and in-vivo study. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.101303] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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247
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Satish P, Khetan A, Raithatha S, Bhende P, Josephson R. Standardizing hypertension management in a primary care setting in India through a protocol based model. Indian Heart J 2019; 71:375-380. [PMID: 32035519 PMCID: PMC7013193 DOI: 10.1016/j.ihj.2019.11.257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/26/2019] [Accepted: 11/16/2019] [Indexed: 01/13/2023] Open
Abstract
Hypertension is a leading cause of death in India. Control rates of hypertension are abysmal, even for people on treatment. There are a number of barriers to adequate control of hypertension in India, including therapeutic inertia and the lack of a systematic, simplified approach. Standardizing hypertension management through an evidence based model that sets thresholds for diagnosis, treatment goals, follow up intervals and choice of drugs can lead to improved management of hypertension in an individual hospital or health system. In this paper, we summarize the evidence for such a model, and adapt it to the Indian context, focusing on maximizing effectiveness, safety and ease of use by a non-expert. This model can be utilized by individual practitioners, hospitals, primary health centers (PHCs) and the Health and Wellness Centers (HWCs) under the Ayushman Bharat initiative.
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Affiliation(s)
- Priyanka Satish
- Department of Medicine, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Aditya Khetan
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
| | - Shyamsundar Raithatha
- Department of Community Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Punam Bhende
- Department of Internal Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
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Screening for hypertension: an elevated office blood pressure measurement is valuable, adding an automated one is even better. Blood Press Monit 2019; 24:123-129. [PMID: 30998552 DOI: 10.1097/mbp.0000000000000382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previous studies have examined the relevance of hypertension (HTN) screening in walk-in clinics. So far, no valid algorithm has been proposed on how to integrate HTN screening in this context. The aim of our study was to assess, in a walk-in clinic setting, the HTN screening strategy for performing an automated office blood pressure (AOBP) measurement following an initially high office blood pressure (OBP) measurement. PATIENTS AND METHODS Included participants were adults with nonemergent medical conditions and an initial walk-in clinic OBP between systolic 140 and/or diastolic 90 mmHg and systolic 180 and/or diastolic 110 mmHg. AOBP was performed with patients unattended. The 24-h ambulatory blood pressure measurement (ABPM) was used as the diagnostic threshold. RESULTS Fifty participants were included in the study. The overall HTN prevalence as confirmed by the 24-h ABPM was 46% [95% confidence interval (CI): 32.19-59.81]. After an elevated OBP, AOBP over diagnostic thresholds occurred in 32 patients and were confirmed by ABPM in 20 participants, leading to a 62.5% positive predictive value (95% CI: 51.5-72.3%). Measurements under the AOBP diagnostic threshold occurred in 18 patients and were confirmed by ABPM in 15 participants, leading to a negative predictive value of 83.3% (95% CI: 62.3-93.8%). CONCLUSION In a walk-in clinic, an elevated OBP is a useful screening tool due its ability to recognize nearly one in two patients as actually hypertensive. Adding an AOBP makes it possible to specify what course of action to take. This ultimately results in better targeting of patients for an ABPM referral.
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Sarma PS, Sadanandan R, Thulaseedharan JV, Soman B, Srinivasan K, Varma RP, Nair MR, Pradeepkumar AS, Jeemon P, Thankappan KR, Kutty RV. Prevalence of risk factors of non-communicable diseases in Kerala, India: results of a cross-sectional study. BMJ Open 2019; 9:e027880. [PMID: 31712329 PMCID: PMC6858196 DOI: 10.1136/bmjopen-2018-027880] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of non-communicable disease (NCD) risk factors in Kerala. DESIGN A community-based, cross-sectional survey. PARTICIPANTS In 2016-2017 a multistage, cluster sample of 12 012 (aged 18-69 years) participants from all 14 districts of Kerala were studied. MAIN OUTCOME MEASURES NCD risk factors as stipulated in the WHO's approach to NCD risk factors surveillance were studied. Parameters that were studied included physical activity score, anthropometry, blood pressure (BP), and fasting blood glucose (FBG) and morning urine sample to estimate dietary intake of salt. RESULTS The mean age was 42.5 years (SD=14.8). Abdominal obesity was higher in women (72.6%; 95% CI 70.7 to 74.5) compared with men (39.1%; 95% CI 36.6 to 41.7), and also higher among urban (67.4%; 95% CI 65.0 to 69.7) compared with rural (58.6%; 95% CI 56.6 to 60.5) residents. Current use of tobacco and alcohol in men was 20.3% (95% CI 18.6 to 22.1) and 28.9% (95% CI 26.5 to 31.4), respectively. The estimated daily salt intake was 6.7 g/day. The overall prevalence of raised BP was 30.4% (95% CI 29.1 to 31.7) and raised FBG was 19.2% (95% CI 18.1 to 20.3). Raised BP was higher in men (34.6%; 95% CI 32.6 to 36.7) compared with women (28%; 95% CI 26.4 to 29.4), but was not different between urban (33.1%; 95% CI 31.3 to 34.9) and rural (29.8%; 95% CI 28.3 to 31.3) residents. Only 12.4% of individuals with hypertension and 15.3% of individuals with diabetes were found to have these conditions under control. Only 13.8% of urban and 18.4% of rural residents did not have any of the seven NCD risk factors studied. CONCLUSION Majority of the participants had more than one NCD risk factor. There was no rural-urban difference in terms of raised BP or raised FBG prevalence in Kerala. The higher rates of NCD risk factors and lower rates of hypertension and diabetes control call for concerted primary and secondary prevention strategies to address the future burden of NCDs.
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Affiliation(s)
- P S Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Rajeev Sadanandan
- Department of Health and Family Welfare, Government of Kerala, Thiruvananthapuram, Kerala, India
| | - Jissa Vinoda Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Kannan Srinivasan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - R P Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Manju R Nair
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - A S Pradeepkumar
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Raman V Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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The Prevalence of Overweight, Obesity, Hypertension, and Diabetes in India: Analysis of the 2015-2016 National Family Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203987. [PMID: 31635366 PMCID: PMC6843936 DOI: 10.3390/ijerph16203987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 02/06/2023]
Abstract
Overweight, obesity, hypertension, and diabetes increase the risk of non-communicable diseases and all-cause mortality worldwide. Previous studies have not determined the prevalence of these conditions/diseases throughout India. Therefore, this study was aimed to address this limitation. Data on these conditions/diseases among men and women aged ≥ 18 years were obtained from the fourth National Family Health Survey conducted throughout India between January 2015 and December 2016. The prevalence and prevalence rate per 100,000 population were calculated at the national level and by age group, sex, and type of residence for each state and union territory. The national prevalence of overweight, obesity, hypertension, and diabetes were 14.6%, 3.4%, 5.2%, and 7.1%, respectively. The highest prevalence of these conditions/diseases at the national level was seen among those aged 35–49 years (54 years for men), especially women living in urban areas. In India, 1 out of every 7, 29, 19, and 14 individuals at the national level had overweight, obesity, hypertension, and diabetes, respectively—between 2015 and 2016. These results are important for the healthcare system and government policies in the future. Moreover, targeted efforts are required to establish public health strategies for the prevention, management, and treatment of these conditions/diseases throughout India.
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