Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens. 2014;32:1170-1177. [PMID: 24621804 PMCID: PMC4011565 DOI: 10.1097/hjh.0000000000000146]

Association of Mbo I-RFLP at the Renin Locus (rs2368564) with Essential Hypertension

Several lines of experimental and clinical evidence have alluded a pivotal role of renin in blood pressure homeostasis and therefore a relevance of molecular variants of the renin gene and essential hypertension have been speculated. This study was designed to evaluate the pattern, alliance and risk of renin Mbo I (10631A>G; rs2368564) polymorphism at the locus intron 9 for a possible role in modulating essential hypertension in adult population from Gujarat (India). A total of 257 consecutively enrolled essential hypertensive patients and 270 controls were genotyped using polymerase chain reaction-restriction fragment length polymorphism method for the selected marker. Suitable descriptive statistics was used for different variables. Genotypic (x(2) 10.43, p 0.0054) and allelic (x(2) 11.46, p 0.0007) distribution of this SNP displayed significant differences between cases and controls with an increased frequency of the A allele (x(2) 6.275; p 0.0122) and A/A geno-type (x(2) 8.247; p 0.0041) in hypertensive individuals. However, it showed no deviation from Hardy-Weinberg equilibrium in either affected or control group. A significant association was found in the A/A variant of rs2368564 with essential hypertension (p 0.0032), along with a statistically significant increase in odds of hypertension (OR 1.69; CI 1.46-2.28; p 0.02), even after confounding factors were adjusted in multiple logistic regression analysis and is substantiated by inter-genotypic variations in the mean systolic and diastolic blood pressure in patients. In conclusion, renin 10631A>G gene mutation at the ninth intron play critical roles in BP (dys)regulation and can be implicated in an individual's susceptibility for hypertension.

Incidence and Clinical Outcome of Patients with Hypertensive Acute Ischemic Stroke: An Update from Tertiary Care Center of Central India

Introduction:

We evaluated the incidence and clinical outcome of patients with hypertensive acute ischemic stroke (AIS) admitted to a tertiary care center in Central India. In addition, we examined the status of stroke biomarkers namely neuron-specific enolase (NSE), glial specific protein (S-100ββ), and inter-α-trypsin inhibitor heavy chain 4(ITIH4) in the serum of patients suffering from AIS with hypertension (HTN) and without HTN.

Methods:

A total of 104 patients with AIS were enrolled for the study. Clinical outcome and stroke biomarker levels were evaluated in them at the time of hospital discharge and then followed at 12 months and 18 months after hospital discharge.

Results:

HTN is a major risk factor associated with 67%(70.104) of patients with AIS. Multivariate analysis suggests higher odds of 4.088(95%Cl, 0.721–23.179) and 2.437(95%Cl, 0.721–23.179) for 12 and 18 months outcome in patients with AIS and HTN, respectively. Serum NSE and S-100ββ decreased at the time of discharge as compared to admission level in improved patients suffering from AIS with or without HTN, whereas levels of ITIH4 peptides 2 and 7 increased at the time of discharge (compared to its admission level) only in improved patients with AIS regardless of HTN or non-HTN condition.

Conclusion:

HTN is one of the major risk factors associated with higher risk of AIS as well as long-term unfavourable outcome after AIS in Central India region. NSE, S-100ββ, and ITIH4 were found to be independent predictors of outcome in patients with AIS irrespective of HTN and non-HTN condition.

Hypertension in Malaysia: An Analysis of Trends From the National Surveys 1996 to 2011

This study aimed to determine trends in prevalence, awareness, and control of hypertension in Malaysia and to assess the relationship between socioeconomic determinants and prevalence of hypertension in Malaysia.The distribution of hypertension in Malaysia was assessed based on available data in 3 National Health and Morbidity Surveys (NHMSs) and 1 large scale non-NHMS during the period of 1996 to 2011. Summary statistics was used to characterize the included surveys. Differences in prevalence, awareness, and control of hypertension between any 2 surveys were expressed as ratios. To assess the independent associations between the predictors and the outcome variables, regression analyses were employed with prevalence of hypertension as an outcome variable.Overall, there was a rising trend in the prevalence of hypertension in adults ≥30 years: 32.9% (30%-35.8%) in 1996, 42.6% (37.5%-43.5%) in 2006, and 43.5% (40.4%-46.6%) in 2011. There were significant increase of 32% from 1996 to 2011 (P < 0.001) and of 29% from 1996 to 2006 (P < 0.05), but only a small change of 1% from 2006 to 2011 (P = 0.6). For population ≥18 years, only a 1% increase in prevalence of hypertension occurred from the 2006 NHMS (32.2%) to the 2011 NHMS (32.7%) (P = 0.25). A relative increase of 13% occurred in those with primary education (P < 0.001) and a 15% increase was seen in those with secondary education (P < 0.001). The rate of increase in the prevalence of hypertension in the population with income level RM 3000-3999 was the highest (18%) during this period. In general, the older age group had higher prevalence of hypertension in the 2006 and 2011 NHMSs. The prevalence peaked at 74.1% among population aged 65 to 69 years in the 2011 NHMS. Both the proportion of awareness and the control of hypertension in Malaysia improved from 1996 to 2006. A change in the control of hypertension was 13% higher in women than in men.The findings suggest that the magnitude of hypertension in Malaysia needs additional attention. Strengthening the screening for hypertension in primary health-care settings in the high-risk groups and frequent health promotion to the community to enhance individual awareness and commitment to healthy living would be of immense value.

Burden of Self-Reported Noncommunicable Diseases in 26 Villages of Anand District of Gujarat, India

Introduction. Noncommunicable diseases (NCDs) account for 53% of deaths and 44% of disability adjusted life years lost in India. A survey was undertaken to measure the prevalence of tobacco and alcohol use and self-reported NCDs in a rural community in western part of India. Methodology. Trained Village Health Workers did the survey in the years 2012-13 under supervision. The data was collected for five NCDs, namely, hypertension, diabetes mellitus, cancer, heart disease, and mental illnesses. Results. 18,269 households with a population of 89755 were covered. Prevalence of any form of tobacco use in the age group of >20 years was 34.5 and 52.7% and 15.2% in males and females, respectively. Prevalence of any NCD was 5.3% with a slightly higher prevalence in females (5.4%) than males (5.2%) in the age group of 20-69 years. Prevalence of NCD multimorbidity (≥2 NCDs) was 0.7% in the age group of 20-69 years. 80.7% of hypertensives and 94.9% of diabetics were taking treatment. More females than males were taking antihypertensive treatment. Conclusion. Tobacco use was high. Prevalence of NCDs was less than that reported in other studies. Data generated from this study can be useful in planning a community based NCD programme.

Association between tooth loss and hypertension among a primarily rural middle aged and older Indian adult population

BACKGROUND

Studies in high-income countries have reported associations between tooth loss and hypertension. There is however a lack of evidence on this association from South Asian countries especially India. The current study aimed to assess the association between self-reported tooth loss and hypertension in a primarily rural middle-aged and older Indian population.

METHODS

A secondary analysis of cross-sectional data from the Longitudinal Ageing Study of India - pilot survey was conducted on 1,486 adults aged 45 years and above from four states of India. The primary outcome was self-reported hypertension and the main explanatory variable was self-reported tooth loss. Multivariable logistic regression models estimated the association between hypertension and tooth loss after controlling for confounders including age, sex, marital status, area of residence, educational attainment, tobacco use, alcohol use, physical activity, and self-reported diabetes.

RESULTS

Compared to those without any tooth loss, individuals with partial tooth loss had 1.62 times (95% CI: 1.12-2.35) higher odds of being hypertensive after adjustment of confounders including age, sex, marital status, area of residence, educational attainment, tobacco use, alcohol use, physical activity, and self-reported diabetes. The crude significant association (OR: 2.54; 95% CI: 1.50-4.29) between edentulousness and hypertension became nonsignificant and attenuated after adjustment of potential confounders (fully adjusted model OR: 1.33; 95% CI: 0.72-2.44).

CONCLUSION

Partial tooth loss was associated with a higher probability of hypertension among dentate middle-aged and older adults in four states of India.

Prevalence of Hypertension in Boloor Diabetes Study (BDS-II) and its Risk Factors

INTRODUCTION

Hypertension is a major public health problem in India and worldwide. Since hypertension is often asymptomatic, it commonly remains undetected, leading to serious complications if untreated. Hypertension is one of the leading causes of end stage renal disease. It doubles the risk of developing coronary artery disease, increases the risk of congestive heart failure by four folds and that of cerebrovascular disease and stroke by seven folds. Hypertension is directly responsible for 57% of all stroke deaths and 42% of coronary heart disease deaths in India.

AIM

To identify prevalence and risk factors for hypertension in a semi urban population of Mangalore, who participated in Boloor Diabetes Study (BDS-II).

MATERIALS AND METHODS

This cross-sectional study was conducted on 551 subjects aged ≥ 20 years who were randomly selected. Hypertension was diagnosed and classified according to Joint National Committee 7 (JNC) criteria. Blood pressure was measured by a doctor using calibrated sphygmomanometer. Anthropometric measurements, lipid and glucose estimations were done for all subjects. Statistical analysis was done using Chi-square test and student's t-test (unpaired). Multivariate logistic regression analysis was done using hypertension as dependent variable and the various risk factors as independent variables.

RESULTS

Overall prevalence of hypertension in the community was 41% (227/551) (40.9% in men, 41.3% in women). Prehypertension was found in 40% (223/551) (45.4% in men, 38.1% in women), and only 18.3% (101/551) had normal blood pressure. Stage I hypertension was seen in 29.7% (164/551) (28.9% in men, 30.1% in women). Stage II hypertension was seen in 11.4% (63/551) (12% in men, 11% in women). Age, obesity, diabetes, serum cholesterol and serum triglycerides were strongly associated with hypertension. Only 46% (254/551) of the hypertensive subjects were aware that they were hypertensive.

CONCLUSION

Prevalence of hypertension was high in this population. Nearly 54% were unaware of their hypertensive status. Prevalence increased with age, obesity, diabetic status and dyslipidemia. Nearly half of subjects were prehypertensives. This study highlights the need for regular screening coupled with educational programmes to detect, improve awareness and optimally treat hypertension in the community to reduce cardiovascular and renal complications.

Hypertension

Raised blood pressure is the biggest single contributor to the global burden of disease and to global mortality. The numbers of people affected and the prevalence of high blood pressure worldwide are expected to increase over the next decade. Preventive strategies are therefore urgently needed, especially in less developed countries, and management of hypertension must be optimised. Genetic advances in some rare causes of hypertension have been made lately, but the aggregate effect on blood pressure of all the genetic loci identified to date is small. Hence, intervention on key environmental determinants and effective implementation of trial-based therapies are needed. Three-drug combinations can control hypertension in about 90% of patients but only if resources allow identification of patients and drug delivery is affordable. Furthermore, assessment of optimal drug therapy for each ethnic group is needed.

Hypertension in a Brazilian urban slum population

Low- and middle-income countries account for the majority of hypertension disease burden. However, little is known about the distribution of this illness within subpopulations of these countries, particularly among those who live in urban informal settlements. A cross-sectional hypertension survey was conducted in 2003 among 5649 adult residents of a slum settlement in the city of Salvador, Brazil. Hypertension was defined as either an elevated arterial systolic (≥140 mmHg) or diastolic (≥90 mmHg) blood pressure. Sex-specific multivariable models of systolic blood pressure were constructed to identify factors associated with elevated blood pressure. The prevalence of hypertension in the population 18 years and older was 21% (1162/5649). Men had 1.2 times the risk of hypertension compared with women (95% confidence intervals (CI), 1.05, 1.36). Increasing age and lack of any schooling, particularly for women, were also significantly associated with elevated blood pressure (p < 0.05). There was also a direct association between men who were black and an elevated blood pressure. Among those who were hypertensive, 65.5% were aware of their condition, and only 36.3% of those aware were actively using anti-hypertensive medications. Men were less likely to be aware of their diagnosis or to use medications (p < 0.01 for both) than women. The prevalence of hypertension in this slum community was lower than reported frequencies in the non-slum population of Brazil and Salvador, yet both disease awareness and treatment frequency were low. Further research on hypertension and other chronic non-communicable diseases in slum populations is urgently needed to guide prevention and treatment efforts in this growing population.

Comparison of amlodipine with cilnidipine on antihypertensive efficacy and incidence of pedal edema in mild to moderate hypertensive individuals: A prospective study

To compare amlodipine with cilnidipine on antihypertensive efficacy and incidence of pedal edema in hypertensive individuals. This was a three months prospective, observational study done at the tertiary care center of Karnataka, India. A total number of 60 (n = 60) newly diagnosed hypertensives (≥140/90) of either gender, attending outpatient department of medicine, were included in the study. Out of 60 patients, 30 patients who have been prescribed tablet amlodipine 5–10 mg/day and the other 30 who have been prescribed tablet cilnidipine 10–20 mg/day orally by the consulting physician, depending upon the severity of hypertension were followed every fortnight, screened for the presence of pedal edema and blood pressure control over a period of 3 months. Antihypertensive efficacy between two groups was compared by unpaired t-test and incidence of pedal edema was compared by Fisher's exact test. Of 30 patients in the amlodipine group, 19 patients presented with pedal edema (63.3%) and 2 patients (6.66%) in cilnidipine group presented with pedal edema during the study period. There was a significant difference in the incidence of pedal edema between amlodipine and cilnidipine group (P < 0.05), but no significant difference was found in the antihypertensive efficacy of amlodipine and cilnidipine (P > 0.05). Both amlodipine and cilnidipine have shown equal efficacy in reducing blood pressure in hypertensive individuals. But cilnidipine being N-type and L-type calcium channel blocker, associated with lower incidence of pedal edema compared to only L-type channel blocked by amlodipine.

Agriculture, health, and wealth convergence: bridging traditional food systems and modern agribusiness solutions

The causes of many vexing challenges facing 21st-century society are at the nexus of systems involved in agriculture, health and wealth production, consumption, and distribution. Using food as a test bed, and on the basis of emerging roadmaps that set achievable objectives over a 1- to 3-year horizon, we introduce this special feature with convergence thinking and practice at its core. Specifically, we discuss academic papers structured around four themes: (1) evidence for a need for convergence and underlying mechanisms at the individual and societal levels; (2) strategy for mainstreaming convergence as a driver of business engagement and innovation; (3) convergence in policy and governance; (4) convergence in metrics and methods. Academic papers under each theme are accompanied by a roadmap paper reporting on the current status of concrete transformative convergence-building projects associated with that theme. We believe that the insights provided by these papers have the potential to enable all actors throughout society to singly and collectively work to build supply and demand for nutritious food, in both traditional and modern food systems, while placing the burdens of malnutrition and ill health on their core strategic agendas.

Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial

Background

Randomized control trials from the developed world report that clinical decision support systems (DSS) could provide an effective means to improve the management of hypertension (HTN). However, evidence from developing countries in this regard is rather limited, and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center (PHC) settings.

Methods and Results

We performed a cluster randomized trial to test the effectiveness and cost‐effectiveness of a clinical DSS among Indian adult hypertensive patients (between 35 and 64 years of age), wherein 16 PHC clusters from a district of Telangana state, India, were randomized to receive either a DSS or a chart‐based support (CBS) system. Each intervention arm had 8 PHC clusters, with a mean of 102 hypertensive patients per cluster (n=845 in DSS and 783 in CBS groups). Mean change in systolic blood pressure (SBP) from baseline to 12 months was the primary endpoint. The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow‐up, adjusted for age, sex, height, waist, body mass index, alcohol consumption, vegetable intake, pickle intake, and baseline differences in blood pressure, was −6.59 mm Hg (95% confidence interval: −12.18 to −1.42; P=0.021). The cost‐effective ratio for CBS and DSS groups was $96.01 and $36.57 per mm of SBP reduction, respectively.

Conclusion

Clinical DSS are effective and cost‐effective in the management of HTN in resource‐constrained PHC settings.

Clinical Trial Registration

URL: http://www.ctri.nic.in. Unique identifier: CTRI/2012/03/002476.

Prevalence and risk factors of hypertension in myanmar: a systematic review and meta-analysis

Hypertension (HPT) is the most common condition seen in primary care that can lead to health consequences and death if not detected early and treated appropriately.This study aimed to synthesize the prevalence, awareness, and control of HPT, and investigate the risk factors for HPT in Myanmar.We performed a meta-analysis of observational studies. Relevant studies were searched in electronic databases. The methodological quality of the included studies was assessed in 3 domains: selection bias, measurement bias, and bias related to data analysis. The overall prevalence and proportions was calculated using random-effect model of DerSimonian-Laird method. To identify the risk factors for HPT in Myanmar, we entered the ratio measures of the (adjusted) effect as a log odds ratio (OR) and the standard error of the log OR using generic inverse-variance weighting method. For stability of results, we performed leave-one-study-out sensitivity analysis by omitting individual studies one at a time from the meta-analysis.Seven studies (n = 20,901) were included in this analysis. Overall prevalence of HPT in Myanmar was 22% (95% confidence interval (CI): 14%-31.7%, I: 99.6%), stratified as 21.5% (95% CI: 14.1%-29.9%, I: 98.7%) in men and 22.7% (95% CI: 10.8%-34.6%, I: 99.5%) in women. Overall, prevalence of HPT increased with an advancing age of the participants. The proportions of awareness and controlled HPT were 55% (95% CI: 43%-67%, I: 97.7%) and 11% (95% CI: 6%-15%, I: 93.8%), respectively. A weak but significant association was observed between HPT and alcohol drinking (summary OR: 1.38, 95% CI: 1.14%-1.65, I: 0%) and smoking (summary OR: 1.32, 95% CI: 1.0%-1.74, I: 50%). In sensitivity analysis, when a study that made confirmation of HPT by the former World Health Organization criteria was dropped, the prevalence increased to 26% (95% CI: 20.8%-32.1%, I: 98.1%).HPT was considerably prevalent in Myanmar, while the levels of awareness and controlled HPT were low. Health promotion strategy tailored to the education on modifiable risk factors and establishment of blood pressure screening in primary health care context would be of immense value. Upcoming well-powered studies, using the standardized research design and covering more regions of the country are recommended.

Whole-of-society monitoring framework for sugar, salt, and fat consumption and noncommunicable diseases in India

India has experienced a rising prevalence of cardiometabolic risk factors in the past 15 years: the prevalence of diabetes has increased from 5.9% to 9.1%, hypertension from 17.2% to 29.2%, and obesity from 4% to 15%. The increase is among all socioeconomic groups and in urban and rural populations, though the quantum of change varies. A concomitant increase in per capita consumption of sugar from 22 to 55.3 g/day and total fat from 21.2 to 54 g/day was observed, with significant differences between states of high and low human development index (HDI). Per capita consumption of sugar, salt, and fat is consistently and significantly associated with overweight and obesity but variably associated with the occurrence of hypertension and diabetes. Market research shows that approximately 50-60% of total salt, sugar, and fat in Indian markets is procured by bulk purchasers, generally for manufacturing processed food items. This sector of the Indian economy is among the fastest growing, with several policy incentives. It is not clear from most of the data sets whether available information on per capita sugar, salt, and fat consumption has considered the contribution of processed and ready-to-eat food items. The unprecedented changes of rapid urbanization, mechanization, and globalization demand close monitoring of social, developmental, and economic determinants. This paper provides pieces of evidence to justify a whole-of-society (WoS) framework for monitoring the inputs, processes, and behavioral components of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) in India.