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Marchewka WM, Bryniarski KL, Marchewka JM, Popiołek I, Dębski G, Badacz R, Marchewka I, Podolec-Szczepara N, Jasiewicz-Honkisz B, Mikołajczyk TP, Guzik TJ. Sex-specific associations between the environmental exposures and low-grade inflammation and increased blood pressure in young, healthy subjects. Sci Rep 2024; 14:9588. [PMID: 38670971 PMCID: PMC11053153 DOI: 10.1038/s41598-024-59078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Long-term exposures to environmental factors including airborne as well as noise pollutants, are associated with cardiovascular risk. However, the influence of environmental pollution on the young population is controversial. Accordingly, we aimed to investigate the relationships between long-term exposures to different environmental factors and major cardiovascular and inflammatory parameters and biomarkers in young, healthy subjects. Representative sample of permanent residents of two cities differing in air and noise pollution levels, aged 15-21 years, were recruited. Krakow and Lublin, both located in southern Poland, were chosen in relation to their similarities in demographic and geopolitical characteristics, but differences in air pollution (higher in Krakow) and noise parameters (higher in Lublin). A total of 576 subjects were studied: 292 in Krakow and 284 in Lublin. All subjects underwent health questionnaire, blood pressure measurements and biomarker determinations. Inflammatory biomarkers, such as CRP, hs-CRP, fibrinogen as well as homocysteine were all significantly higher in subjects living in Krakow as opposed to subjects living in Lublin (for hsCRP: 0.52 (0.32-0.98) mg/l vs. 0.35 (0.22-0.67) mg/l; p < 0.001). Increased inflammatory biomarker levels were observed in Krakow in both male and female young adults. Interestingly, significant differences were observed in blood pressure between male and female subjects. Males from Krakow had significantly higher mean systolic blood pressure (127.7 ± 10.4 mm/Hg vs. 122.4 ± 13.0 mm/Hg; p = 0.001), pulse pressure (58.7 ± 8.9 mm/Hg vs. 51.4 ± 12.3 mm/Hg; p < 0.001) and lower heart rate (p < 0.001) as compared to males living in Lublin. This was not observed in young adult females. Long-term exposure to environmental factors related to the place of residence can significantly influence inflammatory and cardiovascular parameters, even in young individuals. Interestingly, among otherwise healthy young adults, blood pressure differences exhibited significant variations based on biological sex.
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Affiliation(s)
- Wojciech M Marchewka
- Department of Internal and Agricultural Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skarbowa 1, 31-121, Krakow, Poland
- Department of Radiology and Imaging Science, 5th Military Hospital, Krakow, Poland
| | - Krzysztof L Bryniarski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jakub M Marchewka
- Department of Physiotherapy, University of Physical Education, Krakow, Poland
- Department of Orthopedics and Trauma Surgery, 5th Military Hospital, Krakow, Poland
| | - Iwona Popiołek
- Department of Toxicology and Environmental Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Dębski
- Department of Radiology and Imaging Science, 5th Military Hospital, Krakow, Poland
| | - Rafał Badacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Ida Marchewka
- Department of Ophthalmology, Ludwik Rydygier Memorial Specialized Hospital, Krakow, Poland
| | | | - Barbara Jasiewicz-Honkisz
- Department of Internal and Agricultural Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skarbowa 1, 31-121, Krakow, Poland
| | - Tomasz P Mikołajczyk
- Department of Internal and Agricultural Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skarbowa 1, 31-121, Krakow, Poland
- Center for Medical Genomics OMICRON, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz J Guzik
- Department of Internal and Agricultural Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skarbowa 1, 31-121, Krakow, Poland.
- Center for Medical Genomics OMICRON, Jagiellonian University Medical College, Krakow, Poland.
- BHF Centre for Research Excellence, Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK.
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2
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Ewbank F, Gaastra B, Hall S, Galea I, Bulters D. Risk of subarachnoid haemorrhage reduces with blood pressure values below hypertensive thresholds. Eur J Neurol 2024; 31:e16105. [PMID: 37877683 DOI: 10.1111/ene.16105] [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: 05/25/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Hypertension is a known risk factor for subarachnoid haemorrhage (SAH). The aim of this study was to describe the relationship between blood pressure and SAH using a large cohort study and perform a meta-analysis of the published literature. METHODS Participants in the UK Biobank were followed up via electronic records until 31 March 2017. Cox proportional hazards models were used to analyse the association between baseline blood pressure (systolic blood pressure [SBP], diastolic blood pressure [DBP] and MABP [mean arterial blood pressure]) and subsequent aneurysmal SAH. Linearity was assessed by comparing models including and excluding cubic splines. Electronic databases were searched from inception until 11 February 2022 for studies reporting on blood pressure and SAH. RESULTS A total of 500,598 individuals were included with 539 (0.001%) suffering from aneurysmal SAH. Nonlinear models including cubic splines visually appeared linear between SBP of 110 and 180 mmHg and there was minimal difference in fit between linear and nonlinear models. When values were stratified, those with SBP 120-130 mmHg were at higher risk compared to those with SBP <120 mmHg (hazard ratio [HR] 1.41 [1.02, 1.95]). The meta-analysis demonstrated a similar increased risk of SAH in individuals with SBP 120-130 mmHg relative to those with <120 mmHg (HR 1.41 [1.17, 1.72]). A stepwise increase in risk was also seen at each subsequent threshold (130-140 mmHg: HR 1.85 [1.53, 2.24], 140-160 mmHg: HR 2.16 [1.57, 2.98], 160-180 mmHg: HR 2.81 [1.85, 4.29], >180 mmHg: HR 5.84 [1.94, 17.54]). CONCLUSIONS The rate of SAH increases linearly with higher SBP in the general population and specifically appears lower in those with SBP <120 mmHg.
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Affiliation(s)
- Frederick Ewbank
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Benjamin Gaastra
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Samuel Hall
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ian Galea
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Diederik Bulters
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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Jurek A, Krzesiński P, Uziębło-Życzkowska B, Witek P, Zieliński G, Kazimierczak A, Wierzbowski R, Banak M, Gielerak G. The patient's sex determines the hemodynamic profile in patients with Cushing disease. Front Endocrinol (Lausanne) 2023; 14:1270455. [PMID: 37886640 PMCID: PMC10598757 DOI: 10.3389/fendo.2023.1270455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Background Cushing disease (CD) may lead to accelerated cardiovascular remodeling and increased mortality. There are suspected differences in the mechanism of cardiovascular dysfunction between males and females with CD. The purpose of this study was to assess the effect of patient sex on the hemodynamic profile assessed via impedance cardiography and echocardiography in patients newly diagnosed with CD. Material and methods The 54 patients newly diagnosed with CD (mean age 41 years; 77.8% of females) who were included in this prospective clinical study underwent impedance cardiography to assess specific parameters (including systemic vascular resistance index [SVRI], total arterial compliance index [TACI], Heather index [HI], stroke index [SI], cardiac index [CI], velocity index [VI], and acceleration index [ACI]) and transthoracic echocardiography to assess heart chamber diameters and left ventricular systolic and diastolic function. Results Males with CD exhibited higher afterload, with higher SVRI (3,169.3 ± 731.8 vs. 2,339.3 ± 640.8 dyn*s*cm-5*m² in males and females, respectively; p=0.002), lower TACI (0.80 ± 0.30 vs. 1.09 ± 0.30 mL/mmHg*m2; p=0.008), and lower hemodynamic parameters of left ventricular function, with lower HI (9.46 ± 2.86 vs. 14.1 ± 5.06 Ohm/s2; p=0.0007), lower VI (35.1 ± 11.9 vs. 44.9 ± 13.1 1*1000-1*s-1; p=0.009), lower SI (36.5 ± 11.7 vs. 43.6 ± 9.57 mL/m2; p=0.04), lower CI (2.36 ± 0.46 vs. 3.17 ± 0.76 mL*m-2*min-1; p=0.0009), and lower ACI (50.4 ± 19.8 vs. 73.6 ± 25.0 1/100/s2; p=0.006). There were no significant differences between the sexes in left ventricular systolic or diastolic function assessed by echocardiography. Conclusion In comparison with females with CD, males with CD have a less favorable hemodynamic profile, with higher afterload and worse left ventricular function. Sex differences in cardiovascular system function should be taken into consideration in designing personalized diagnostic and therapeutic management of patients with CD.
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Affiliation(s)
- Agnieszka Jurek
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology, and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Zieliński
- Department of Neurosurgery, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Anna Kazimierczak
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Robert Wierzbowski
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Małgorzata Banak
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
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Islam SMS, Daryabeygi-Khotbehsara R, Ghaffari MP, Uddin R, Gao L, Xu X, Siddiqui MU, Livingstone KM, Siopis G, Sarrafzadegan N, Schlaich M, Maddison R, Huxley R, Schutte AE. Burden of Hypertensive Heart Disease and High Systolic Blood Pressure in Australia from 1990 to 2019: Results From the Global Burden of Diseases Study. Heart Lung Circ 2023; 32:1178-1188. [PMID: 37743220 DOI: 10.1016/j.hlc.2023.06.853] [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: 01/30/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND There is a dearth of comprehensive studies examining the burden and trends of hypertensive heart disease (HHD) and high systolic blood pressure (SBP) among the Australian population. We aimed to explore the burden of HHD and high SBP, and how they changed over time from 1990 to 2019 in Australia. METHODS We analysed data from the Global Burden of Disease study in Australia. We assessed the prevalence, mortality, disability-adjusted life-years (DALY), years lived with disability (YLD) and years of life lost (YLL) attributable to HHD and high SBP. Data were presented as point estimates with 95% uncertainty intervals (UI). We compared the burden of HHD and high SBP in Australia with World Bank defined high-income countries and six other comparator countries with similar sociodemographic characteristics and economies. RESULTS From 1990 to 2019, the burden of HHD and high SBP in Australia reduced. Age standardised prevalence rate of HHD was 119.3 cases per 100,000 people (95% UI 86.6-161.0) in 1990, compared to 80.1 cases (95% UI 57.4-108.1) in 2019. Deaths due to HDD were 3.4 cases per 100,000 population (95% UI 2.6-3.8) in 1990, compared to 2.5 (95% UI 1.9-3.0) in 2019. HHD contributed to 57.2 (95% UI 46.6-64.7) DALYs per 100,000 population in 1990 compared to 38.4 (95% UI 32.0-45.2) in 2019. Death rates per 100,000 population attributable to high SBP declined significantly over time for both sexes from 1990 (155.6 cases; 95% UI 131.2-177.0) to approximately one third in 2019 (53.8 cases; 95% UI 43.4-64.4). Compared to six other countries in 2019, the prevalence of HHD was highest in the USA (274.3%) and lowest in the UK (52.6%), with Australia displaying the third highest prevalence. Australia ranked second in term of lowest rates of deaths and third for lowest DALYs respectively due to high SBP. From 1990-2019, Australia ranked third best for reductions in deaths and DALYs due to HHD and first for reductions in deaths and DALYs due to high SBP. CONCLUSION Over the past three decades, the burden of HHD in Australia has reduced, but its prevalence remains relatively high. The contribution of high SBP to deaths, DALYs and YLLs also reduced over the three decades.
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Affiliation(s)
| | | | | | - Riaz Uddin
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Vic, Australia
| | - Lan Gao
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Vic, Australia
| | - Xiaoyue Xu
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Muhammad Umer Siddiqui
- Department of Internal Medicine, Thomas Jefferson University Hospital Philadelphia, PA, USA
| | | | - George Siopis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Vic, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Vic, Australia
| | - Rachel Huxley
- Faculty of Health, Deakin University, Geelong, Vic, Australia
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
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5
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Kim HS, Kim HJ. Sex differences in effect of patients-centered intervention on blood pressure in patients with hypertension. Sci Rep 2023; 13:13952. [PMID: 37626102 PMCID: PMC10457352 DOI: 10.1038/s41598-023-41286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/24/2023] [Indexed: 08/27/2023] Open
Abstract
Hypertension exhibits sex-related differences in its causes, symptoms, and complications. In this study, we aimed to confirm the efficacy of hypertension intervention by applying a patient-centered approach based on sex differences. We enrolled 95 hypertensive patients in this prospective quasi-experimental pretest-posttest study. The patient-centered lifestyle intervention included penalized nutrition and exercise education in 30-min one-on-one sessions. Before the intervention, we conducted a pretest to evaluate physical examination, behavioral status, quality of life (QoL), blood pressure (BP) measurements, and routine blood tests. The same evaluations were conducted again in a posttest after 3 months. After 3 months of patient-centered intervention, all patients showed a decrease in systolic BP by 2.87 mmHg and diastolic BP by 1.04 mmHg. However, there was no significant difference in BP between men and women after the 3-month follow-up. There were differences in lipid profiles based on sex, with total cholesterol and low-density lipoprotein cholesterol levels decreasing in men and increasing in women. Behavioral and QoL scores improved after the intervention; however, there was no significant difference based on sex. A patient-centered lifestyle intervention for hypertensive patients can effectively lower BP, and sex-specific risk factors affecting its efficacy have been identified.
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Affiliation(s)
- Hyun-Sun Kim
- Department of Nursing, College of Nursing, Eulji University, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do, 11923, Republic of Korea.
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6
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Ullah S, Khan S, Bazargan-Hejazi S, Ramirez E, Teklehaimanot S, Diab S, Bangash M, Shaheen M. Use and outcomes of antihypertensive medication treatment in the US hypertensive population: A gender comparison. Health Promot Perspect 2023; 13:140-146. [PMID: 37600544 PMCID: PMC10439450 DOI: 10.34172/hpp.2023.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/23/2023] [Indexed: 08/22/2023] Open
Abstract
Background Although effective antihypertensive medications have existed for decades, only about half of the hypertensive individuals are considered to have controlled blood pressure. Limited research studies have investigated gender disparity in the utilization and effectiveness of antihypertensive medications treatment. To examine the gender difference in antihypertensive medications' use and the effect of using antihypertensive medication treatment on blood pressure control among the U.S. adult with hypertension. Methods Analysis of National Health and Nutrition Examination Survey (NHANES) data from (1999-2012) including individuals≥18 years old with hypertension. Study variables included gender, age, race/ethnicity, obesity, smoking, comorbidities, treatment medication type, and continuity of care. We used multivariate logistic regression in STATA V14. The data is presented as adjusted odds ratios (ORs) and 95% confidence interval (CI). Results Of the 15719 participants, 52% were female. 49% of the antihypertensive medication users had their blood pressure under control (95% CI). In the adjusted logistic regression analysis, use of antihypertensive medications was found to be 12% greater in females as compared to males (OR=1.12; CI=1.02-1.22; P<0.05). No association between gender and blood pressure control was found. Blood pressure control was less likely achieved among 50 years or younger individuals, Blacks and Hispanics, obese, and those taking calcium channel blocker (CCB). Conclusion Hypertensive females are more likely than males to use antihypertensive medications. The effectiveness of treatment to control blood pressure is equal across males and females. Our findings have implications for practitioners to account gender-specific approaches when discussing adherence to hypertension medication treatment with their patients.
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Affiliation(s)
- Shakir Ullah
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Shahbaz Khan
- Ayub Medical College and Teaching Hospital, Abbottabad, Pakistan
| | - Shahrzad Bazargan-Hejazi
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
- Department of Psychiatry, Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Ernesto Ramirez
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Senait Teklehaimanot
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Sara Diab
- University of California, Irvine, CA, USA
| | - Maria Bangash
- Southern California University of Health and Sciences, CA, USA
| | - Magda Shaheen
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
- Department of Psychiatry, Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
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Agodi A, Maugeri A, Favara G, Magnano San Lio R, Puglisi M, Sinatra D, Liberti G, Barchitta M. Gender differences in comorbidities of patients with COVID-19: An Italian local register-based analysis. Heliyon 2023; 9:e18109. [PMID: 37483834 PMCID: PMC10362315 DOI: 10.1016/j.heliyon.2023.e18109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023] Open
Abstract
In the current COVID-19 pandemic scenario, it is still necessary to understand if differences exist between genders in terms of patients' characteristics and clinical outcomes. For this reason, we retrospectively analyzed data obtained from a local register-based dataset of all SARS-CoV-2 positive patients diagnosed in the province of Catania (Italy). The main aim of this analysis was to understand any differences between genders in the distribution of previous medical conditions, and to evaluate which of them posed individuals at higher risk of death. With this purpose, we analyzed data from 1424 patients with at least one underlying medical condition, who were tested positive for SARS-CoV-2 infection from February 2020 to December 2021. Overall, males were 59.5% of the total population and significantly younger than females (median ages: 68 years vs. 72 years; p = 0.011). The age distribution of cases by gender confirms that individuals from 70 to 79 years were the most affected in both genders. The comparison of underlying comorbidities by gender shows significant differences for diabetes (p < 0.001), other metabolic diseases (p = 0.006), and obesity (p = 0.019). Accordingly, multivariable logistic regression analysis confirmed that diabetes was more likely to be present in males than in females (p = 0.001), while other metabolic diseases and obesity were less likely to be present (p = 0.003 and p = 0.005, respectively). Although no difference in mortality was evident between genders (p = 0.141), both male and female COVID-19 patients had a significantly higher risk of death if they had comorbidities such as CVDs, kidney diseases, or chronic neurological diseases. Moreover, diabetes and chronic respiratory diseases were significant risk factors for COVID-19 mortality among men, whereas cancer was a significant contributor among women. Our findings confirm gender-differences in pre-existing medical conditions of COVID-19 patients, which may influence the risk of death. Further studies, however, are needed to understand physiological and pathological mechanisms underpinning these differences.
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Affiliation(s)
- Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Giuliana Favara
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Roberta Magnano San Lio
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Martina Puglisi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Dario Sinatra
- Provincial Health Authority (Azienda Sanitaria Provinciale, ASP) of Catania, Catania, Italy
| | - Giuseppe Liberti
- Provincial Health Authority (Azienda Sanitaria Provinciale, ASP) of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
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Nelson JT, Liu L. Pharmacoepidemiologic study of association between apparent treatment resistant hypertension, cardiovascular disease and interaction effect by sex and age. World J Cardiol 2023; 15:262-272. [PMID: 37274374 PMCID: PMC10237003 DOI: 10.4330/wjc.v15.i5.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND A limited number of studies have been conducted to test the magnitudes of the association between apparent treatment resistant hypertension (aTRH) and risk of cardiovascular disease (CVD).
AIM To investigate the association between aTRH and risk of CVD and examine whether sex and age modify this association.
METHODS We applied an observational analysis study design using data from the United States Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT recruited participants (n = 25516) from 625 primary care settings throughout the United States, Canada, Puerto Rico, and United States Virgin Islands, aged 55 and older with hypertension and at least one additional risk factor for heart disease. aTRH was assessed from the year 2 visit. CVD event was defined as one of the following from the year 2 follow-up visit: Fatal or non-fatal myocardial infarction, coronary revascularization, angina, stroke, heart failure, or peripheral artery disease. Cox proportional hazards regression was used to examine the effect of aTRH on CVD risk. Potential modifications of sex and age on this association were examined on the multiplicative scale by interaction term and additive scale by joint effects and relative excess risk for interaction.
RESULTS Of the total study participants (n = 25516), 5030 experienced a CVD event during a mean of 4.7 years follow-up. aTRH was associated with a 30% increase in risk of CVD compared to non-aTRH [hazards ratio (HR) = 1.3, 95%CI: 1.19-1.42]. Sex and age modified this relationship on both multiplicative and additive scales independently. Stratified by sex, aTRH was associated with a 64% increase in risk of CVD (HR = 1.64, 95%CI: 1.43–1.88) in women, and a 13% increase in risk of CVD (HR = 1.13, 95%CI: 1.01–1.27) in men. Stratified by age, aTRH had a stronger impact on the risk of CVD in participants aged < 65 (HR = 1.53, 95%CI: 1.32–1.77) than it did in those aged ≥ 65 (HR = 1.18, 95%CI: 1.05–1.32). Significant two-way interactions of sex and aTRH, and age and aTRH on risk of CVD were observed (P < 0.05). The observed joint effect of aTRH and ages ≥ 65 years (HR = 1.85, 95%CI: 1.22–2.48) in males was less than what was expected for both additive and multiplicative models (HR = 4.10, 95%CI: 3.63–4.57 and 4.88, 95%CI: 3.66–6.31), although three-way interaction of sex, age, and aTRH on the risk of CVD and coronary heart disease did not reach a statistical significance (P > 0.05).
CONCLUSION aTRH was significantly associated with an increased risk of CVD and this association was modified by both sex and age. Further studies are warranted to test these mechanisms.
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Affiliation(s)
- Julianne Theresa Nelson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, United States
| | - Longjian Liu
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, United States
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Tan YJD, Brooks DL, Wong KYH, Huang Y, Romero JR, Williams JS, Pojoga LH. Lysine-specific demethylase 1 deficiency modifies aldosterone synthesis in a sex-specific manner. J Endocrinol 2023; 256:JOE-22-0141. [PMID: 36327153 PMCID: PMC9855026 DOI: 10.1530/joe-22-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
Biologic sex influences the development of cardiovascular disease and modifies aldosterone (ALDO) and blood pressure (BP) phenotypes: females secrete more ALDO, and their adrenal glomerulosa cell is more sensitive to stimulation. Lysine-specific demethylase 1 (LSD1) variants in Africans and LSD1 deficiency in mice are associated with BP and/or ALDO phenotypes. This study, in 18- and 40-week-old wild type (WT) and LSD1+/- mice, was designed to determine whether (1) sex modifies ALDO biosynthetic enzymes; (2) LSD1 deficiency disrupts the effect of sex on these enzymes; (3) within each genotype, there is a positive relationship between ALDO biosynthesis (proximate phenotype), plasma ALDO (intermediate phenotype) and BP levels (distant phenotype); and (4) sex and LSD1 genotype interact on these phenotypes. In WT mice, female sex increases the expression of early enzymes in ALDO biosynthesis but not ALDO levels or systolic blood pressure (SBP). However, enzyme expressions are shifted downward in LSD1+/- females vs males, so that early enzyme levels are similar but the late enzymes are substantially lower. In both age groups, LSD1 deficiency modifies the adrenal enzyme expressions, circulating ALDO levels, and SBP in a sex-specific manner. Finally, significant sex/LSD1 genotype interactions modulate the three phenotypes in mice. In conclusion, biologic sex in mice interacts with LSD1 deficiency to modify several phenotypes: (1) proximal (ALDO biosynthetic enzymes); (2) intermediate (circulating ALDO); and (3) distant (SBP). These results provide entry to better understand the roles of biological sex and LSD1 in (1) hypertension heterogeneity and (2) providing more personalized treatment.
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Affiliation(s)
- Yi Jun Desmond Tan
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Medicine & Health Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Danielle L. Brooks
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly Yin Han Wong
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Medicine & Health Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Yuefei Huang
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose R. Romero
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan S. Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luminita H. Pojoga
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Jung H, Lee G, Lim K, Shin S. Association of milk consumption with management and incidence of hypertension among South Korean adults: A prospective analysis of the health examinees study cohort. Nutr Metab Cardiovasc Dis 2022; 32:2515-2525. [PMID: 36175315 DOI: 10.1016/j.numecd.2022.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND AIMS Studies have revealed a positive relationship between milk consumption and hypertension. However, few researchers have investigated the association between milk consumption and changes in blood pressure (BP) in South Korean adults. Therefore, we examined the association between milk intake and the management and risk of hypertension in South Korean adults. METHODS AND RESULTS Participants were selected from the Health Examinees study. The definition of hypertension was based on the guidelines of the Korean Society of Hypertension. The participants were divided into three groups according to changes between baseline and follow-up BP data. Milk consumption was assessed using food frequency questionnaires. In both men and women, the higher milk consumption group had increased odds of trends of BP improvement (OR: 1.249, 95% CI: 1.043-1.496, p for trend: 0.2271 in men; OR: 1.147, 95% CI: 1.014-1.297, p for trend: 0.0293 in women) and decreased odds of trends of worsening (OR: 0.861, 95% CI: 0.756-0.980, p for trend: <0.0001 in men, OR: 0.866, 95% CI: 0.794-0.943, p for trend: 0.0010 in women) compared to those of the non-consumption group. In the prospective study, milk intake was inversely associated with hypertension risk (HR: 0.900, 95% CI: 0.811-0.999, p for trend: 0.0076 in men; HR: 0.879, 95% CI: 0.814-0.949, p for trend: 0.0002 in women). CONCLUSION Increased intake of milk was inversely related to the risk of increased BP, with a decreased risk of hypertension events.
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Affiliation(s)
- Hyein Jung
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do 17546, South Korea
| | - Geongu Lee
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do 17546, South Korea
| | - Kyungjoon Lim
- Faculty of Medicine and Health, School of Medical Science, University of Sydney, NSW 2006, Australia
| | - Sangah Shin
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do 17546, South Korea.
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Abdu H, Seyoum G. Sex Differences in Stroke Risk Factors, Clinical Profiles, and In-Hospital Outcomes Among Stroke Patients Admitted to the Medical Ward of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. Degener Neurol Neuromuscul Dis 2022; 12:133-144. [PMID: 36304698 PMCID: PMC9595065 DOI: 10.2147/dnnd.s383564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A stroke is a vascular accident that affects both men and women. The threat of stroke and outcome status differ between the sexes. Such data are lacking in Ethiopia. Therefore, this study assessed sex differences in stroke risk factors, clinical profiles, and outcomes in the medical ward of Dessie comprehensive specialized hospital. METHODS A retrospective cross-sectional study was employed among stroke patients. Medical records with complete information and a confirmed diagnosis of stroke using imaging techniques were included in the study. Using simple random sampling, 344 medical records were selected, 312 of which fulfilled the inclusion criteria. Bivariate and multivariate logistic regression analyses and a chi-square test were employed. The frequency, percentage, and mean and standard deviation of the variables were described using descriptive statistics. Findings with a P-value <0.05 were considered statistically significant. RESULTS Most of the patients were above or equal to 45 years old in both sexes. A significantly higher number of male than female patients were aged less than 45 years (p-value-0.001). Younger age (AOR: 2.998, p = 0.000), cigarette smoking (AOR: 2.911, p = 0.009), and Khat chewing (AOR: 3.650, p = 0.001) were risk factors for stroke in males. A higher number of males presented with hemiplegia/hemiparesis 89 (28.5%), aphasia 45 (14.4%), and facial palsy 19 (6.1%). However, more females were unconscious (15.1%). Significant differences were not seen in the stroke outcomes. Furthermore, there were no apparent differences in risk factors for stroke-related mortality. CONCLUSION Males developed stroke at a younger age. Women were older at the time of stroke onset and presented unconscious. More males experienced hemiplegia/hemiparesis, aphasia, and facial palsy. Smoking, drinking, and khat chewing were risk factors for stroke in men. There were no gender differences in the stroke death rate. Therefore, educating the public about stroke risk factors, lifestyle modification, and conducting prospective research is required.
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Affiliation(s)
- Hussen Abdu
- Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia,Correspondence: Hussen Abdu, Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia, Tel +251-910916321, Email
| | - Girma Seyoum
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Alfhili MA, Alsughayyir J, Basudan AM, Ghneim HK, Alfaifi M, Alamri HS, Awan ZA, Algethami MR. Patterns of Dyslipidemia in the Anemic and Nonanemic Hypertensive Saudi Population: A Cross-Sectional Study. Int J Gen Med 2022; 15:7895-7906. [PMID: 36304671 PMCID: PMC9595128 DOI: 10.2147/ijgm.s379597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Risk factors of cardiovascular disease include dyslipidemia, hypertension (HTN), and anemia. Our objective is to assess the patterns of dyslipidemia in the anemic and non-anemic hypertensive Saudi population. Methods A retrospective, cross-sectional study of the gender, blood pressure, lipid markers, and CBC parameters of 3111 subjects, which were retrieved from the database of Al-Borg Medical Laboratories over a six-year period (2014-2019), was carried out. Means were compared among study groups and the prevalence, association, and diagnostic accuracy of lipid markers for HTN were evaluated. Results TG, LDL/HDL, and TG/HDL were significantly higher (P < 0.0001) in hypertensives. Anemia reduces TC and LDL (P < 0.0001) in both genders, and reduces all markers and increases HDL (P < 0.01) in male hypertensives. HTN was more prevalent in anemics with high TC than normal TC (38.23% vs 11.17%, P < 0.001) and in non-anemics with high TG than normal TG (56.31% vs 21.22%, P < 0.001). Furthermore, non-anemics with high TG/HDL had the highest risk for HTN (RR = 1.20, 95% CI = 1.1551-1.2473, P < 0.0001). Elevated TC (P = 0.0142), TG (P < 0.0001), TC/HDL (P < 0.0001), LDL/HDL (P < 0.0001), and TG/HDL (P < 0.0001), and low HDL (P < 0.0001) were risk factors for HTN as shown by ORs. In anemics, high TC/HDL, LDL/HDL, and TG/HDL were not. Importantly, only TG and TG/HDL had a discriminating capacity for HTN. Conclusion The anemic state of hypertensive Saudi patients influences dyslipidemia which warrants further investigation.
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Affiliation(s)
- Mohammad A Alfhili
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia,Correspondence: Mohammad A Alfhili, Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia, Tel +966-504-262-597, Email
| | - Jawaher Alsughayyir
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed M Basudan
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hazem K Ghneim
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alfaifi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Hassan S Alamri
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Zuhier A Awan
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
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Griffin BL, Bolch CA, Bourjeily G, Madsen TE, Hasnain M, McGregor AJ, Merhi BO, Pratt-Chapman ML, Romano M, Trott J, Tong I. Hypertension: Are Current Guidelines Inclusive of Sex and Gender? J Womens Health (Larchmt) 2022; 31:1391-1396. [PMID: 36178463 PMCID: PMC9836675 DOI: 10.1089/jwh.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Hypertension (HTN) accounts for one in five deaths of American women. Major societies worldwide aim to make evidence-based recommendations for HTN management. Sex- or gender-based differences exist in epidemiology and management of HTN; in this study, we aimed to assess sex- and gender-based language in major society guidelines. Materials and Methods: We reviewed HTN guidelines from four societies: the American College of Cardiology (ACC), the American College of Emergency Physicians (ACEP), the European Society of Cardiology (ESC), and the Eighth Joint National Committee (JNC8). We quantified the sex- and gender-based medicine (SGBM) content by word count in each guideline as well as identified the gender of guideline authors. Results: Two of the four HTN guidelines (ACC, ESC) included SGBM content. Of these two guidelines, there were variations in the quantity and depth of content coverage. Pregnancy had the highest word count found in both guidelines (422 words in ACC and 1,523 words in ESC), which represented 2.45% and 3.04% of the total words in each guideline, respectively. There was minimal coverage, if any, of any other life periods. The number of women authors did not impact the SGBM content within a given guideline. Conclusions: Current HTN management guidelines do not provide optimal guidance on sex- and gender-based differences. Inclusion of sex, gender identity, hormone therapy, pregnancy and lactation status, menopause, and advanced age in future research will be critical to bridge the current evidence gap. Guideline writing committees should include diverse perspectives, including cisgender and transgender persons from diverse racial and ethnic backgrounds.
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Affiliation(s)
- Brooke L. Griffin
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, USA
| | - Charlotte A. Bolch
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, USA
| | - Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- The Miriam Hospital, Women's Medicine Collaborative, Providence, Rhode Island, USA
| | - Tracy E. Madsen
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Memoona Hasnain
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Alyson J. McGregor
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Basma O. Merhi
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mandi L. Pratt-Chapman
- The George Washington University School of Medicine and Health Science, Washington, District of Columbia, USA
| | - Mary Romano
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Justina Trott
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Iris Tong
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- The Miriam Hospital, Women's Medicine Collaborative, Providence, Rhode Island, USA
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Wang J, Xi YX, Li JQ, Zhu WW. Gender difference in association between H-type hypertension and subcortical ischemic vascular disease. Front Aging Neurosci 2022; 14:998268. [PMID: 36247997 PMCID: PMC9560583 DOI: 10.3389/fnagi.2022.998268] [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: 07/19/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Subcortical ischemic vascular disease (SIVD) is a leading cause of vascular dementia. The present study tries to explore not only the gender-specific association between H-type hypertension and SIVD but also the indirect effects of H-type hypertension on cognition through the ischemic brain injury caused by SIVD. Materials and methods A total of 601 SIVD patients were included, comprising 322 males and 279 females. H-type hypertension was defined as hypertension accompanied with elevated serum total homocysteine (tHcy) level. The imaging manifestations of ischemic brain injury caused by SIVD were also evaluated, including white matter lesions (WML), lacunar infarction (LI) and brain atrophy (BA). Gender-specific subgroup analyses in association between H-type hypertension and SIVD were conducted, followed by a structural equation model based evaluation of the gender-specific mediating effects of SIVD on the relationship between H-type hypertension and cognition. Results For males, there was no noticeable difference in WML, LI and BA scores among control group, isolated hypertension group, isolated high tHcy group, and H-type hypertension group in most brain regions, but significant difference was found in all brain regions for females. Multiple regression analyses showed that H-type hypertension was significantly associated with WML, LI and BA for females, but not for males. For males, H-type hypertension mainly affected cognition through direct effect, while the H-type hypertension effect was mediated by ischemic brain injury caused by SIVD for females. Conclusion H-type hypertension was more closely related to SIVD for females than males, suggesting a gender-specific difference in association patterns between H-type hypertension and cognition.
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Affiliation(s)
- Juan Wang
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Yuan-Xue Xi
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Jia-Qi Li
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Wei-Wen Zhu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Wei-Wen Zhu,
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Ali N, Mohanto NC, Nurunnabi SM, Haque T, Islam F. Prevalence and risk factors of general and abdominal obesity and hypertension in rural and urban residents in Bangladesh: a cross-sectional study. BMC Public Health 2022; 22:1707. [PMID: 36076233 PMCID: PMC9461183 DOI: 10.1186/s12889-022-14087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/29/2022] [Indexed: 11/22/2022] Open
Abstract
Background Obesity and hypertension are global health concerns. Both are linked with increased risks of all-cause and cardiovascular mortality. Several early studies reported the prevalence of obesity and hypertension in Bangladeshi adults, but the associated factors in this country population are not clear yet. We aimed to estimate the prevalence and related risk factors of general and abdominal obesity and hypertension in rural and urban adults in Bangladesh. Methods In this cross-sectional study, data (n = 1410) was collected on rural (n = 626) and urban (n = 784) adults from eight divisional regions of Bangladesh. Both anthropometric and socio-demographic measurements were recorded in a standardized questionnaire form. General and abdominal obesity were defined based on WHO proposed cut-off values and hypertension was defined by SBP ≥ 140 mmHg and/or, DBP ≥ 90 mmHg and/or, intake of anti-hypertensive drugs at the time of data collection. Multivariable logistic regression analyses were performed to assess the relationship of general and abdominal obesity and hypertension with various factors. Results The overall prevalence of general obesity, abdominal obesity and hypertension was 18.2, 41.9 and 30.9%, respectively. The women had a higher prevalence of general obesity (25.2%), abdominal obesity (56.1%) and hypertension (32.3%) compared to the men (12.2, 29.0, and 29.7%, respectively). The prevalence of both general and abdominal obesity was higher in urban participants (21.7 and 46.6%, respectively) than in the rural participants (13.8 and 35.1%, respectively), whereas, the rural participants had a higher prevalence of hypertension (35.1%) compared to the urban participants (27.5%). In geographical region comparison, the prevalence of general and abdominal obesity and hypertension were higher in participants enrolled from Dhaka (30.8%), Khulna (63.6%) and Mymensingh (43.5%) regions, respectively compared to other regions. In regression analysis, increased age, place of residence and less physical activity were positively associated with the increased risk of both types of obesity and hypertension. The analysis also showed a significant positive association between high BMI and an increased risk of hypertension. Conclusion This study shows a high prevalence of obesity and hypertension in rural and urban adults. Increased age, inadequate physical activity and place of residence were significant determinants of general and abdominal obesity and hypertension. A comprehensive intervention program focusing on modifiable risk factors such as lifestyles and food habits is needed to increase awareness and prevent the burden of obesity and hypertension in the Bangladeshi population.
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Affiliation(s)
- Nurshad Ali
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh.
| | - Nayan Chandra Mohanto
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Shaikh Mirja Nurunnabi
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Tangigul Haque
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Farjana Islam
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
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Mohanty P, Patnaik L, Nayak G, Dutta A. Gender difference in prevalence of hypertension among Indians across various age-groups: a report from multiple nationally representative samples. BMC Public Health 2022; 22:1524. [PMID: 35948916 PMCID: PMC9364494 DOI: 10.1186/s12889-022-13949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Prevalence of hypertension increases with age, but there is a general perception in India that women are less affected at every stage of life, although empiric evidence hardly exists regarding gender difference in hypertension in Indians of different ages. Therefore, we aimed to examine the gender difference in hypertension among Indians across various age-groups; and the contribution of variation in body mass index (BMI) to this difference. Methods Data were analysed after combining National Family Health Survey 4 (n = 294,584 aged 35–49 years) and Study of Ageing and Health wave 2 (n = 7118 aged 50 + years) datasets (NFHS-SAGE). Longitudinal Ageing Study of India (LASI) dataset (n = 65,900 aged > 45years) was analysed to replicate the results. Hypertension was defined if systolic and diastolic blood pressure was > 89 and/or > 139 respectively and/or if there was a history of anti-hypertensive medication. Descriptive summaries were tabulated and plotted to examine the gender difference in hypertension in various age-groups (35–39,40–44, 45–49, 50–54, 55–59, 60–64, 65–69, ≥ 70). Odds Ratios (ORs) from logistic regression models estimated the age gradient of hypertension and their male-female difference, adjusted for Body Mass Index (BMI). Results Males had a higher prevalence of hypertension up to 50 years; after that, females had higher rates. The estimates of age gradient, expressed as ORs, were 1.02 (1.02, 1.02) in males versus 1.05(1.05, 1.06) in females (p < 0.001) in NFHS-SAGE and 1.01(1.01, 1.02) in males versus 1.04(1.03, 1.04)in females (p < 0.001) in LASI;these differences marginally changed after adjustment with BMI. Conclusion This is perhaps the first study to comprehensively demonstrate that cardio-metabolic risk in Indian females surpasses males after 50 years of age, “busting the myth” that Indian females are always at much lower risk than males; and this evidence should inform the Indian healthcare system to prioritise older women for screening and treatment of hypertension. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13949-5.
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Affiliation(s)
- Parimala Mohanty
- Department of Community Medicine, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Lipilekha Patnaik
- Department of Community Medicine, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Gayatri Nayak
- Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, India
| | - Ambarish Dutta
- Indian Institute of Public Health, Public Health Foundation of India, Address-Plot No- 267/3408, JaydevVihar, Mafair Lagoon Road, Odisha, 751013, Bhubaneswar, India.
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Liu B, Liu X, Wang Y, Dong X, Liao W, Huo W, Hou J, Li L, Wang C. Body Mass Index Mediates the Relationship between the Frequency of Eating Away from Home and Hypertension in Rural Adults: A Large-Scale Cross-Sectional Study. Nutrients 2022; 14:nu14091832. [PMID: 35565797 PMCID: PMC9104948 DOI: 10.3390/nu14091832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/17/2022] [Accepted: 04/25/2022] [Indexed: 12/21/2022] Open
Abstract
This study was conducted to investigate the association of eating away from home (EAFH) frequency with hypertension and to explore whether the association was mediated by BMI. A total of 29,611 participants were selected from the Henan Rural Cohort Study. Data on the frequency of EAFH were obtained by face-to-face questionnaires. The relationship between EAFH frequency and blood pressure was evaluated by linear regression. Logistic regression and restricted cubic spline were used to assess the association between EAFH frequency and hypertension, and the mediation effect of BMI on the relationship was performed. There were pronounced associations between the frequency of EAFH and blood pressure (P trend < 0.001) in the total population and men. Compared with the population with 0 times EAFH per week, the multivariate odds ratios (ORs) and 95% confidence intervals (95% CIs) for hypertension of the group with 7 times or more EAFH per week were 1.673 (1.482−1.889) for the total population and 1.634 (1.413−1.890) for men. A nonlinear dose-response relationship was detected between the frequency of EAFH and hypertension (p < 0.001), and the relationship was partially mediated by BMI. The proportion explained was 21.3% in the total population and 25.4% in men. The current study indicated that EAFH was associated with rising blood pressure and increased risk of hypertension and BMI partially mediated the relationship.
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Consolazio D, Gattoni ME, Russo AG. Exploring gender differences in medication consumption and mortality in a cohort of hypertensive patients in Northern Italy. BMC Public Health 2022; 22:768. [PMID: 35428215 PMCID: PMC9013154 DOI: 10.1186/s12889-022-13052-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background This paper aims to assess the presence of gender differences in medication use and mortality in a cohort of patients affected exclusively by hypertension, in 193 municipalities in the Lombardy Region (Northern Italy), including Milan's metropolitan area. Methods A retrospective cohort study was conducted (N = 232,507) querying administrative healthcare data and the Register of Causes of Death. Hypertensive patients (55.4% women; 44.6% men) in 2017 were identified; gender differences in medication use (treatment, 80% compliance) and deaths (from all causes and CVDs) were assessed at two-year follow-ups in logistic regression models adjusted for age class, census-based deprivation index, nationality, and pre-existing health conditions. Models stratified by age, deprivation index, and therapeutic compliance were also tested. Results Overall, women had higher odds of being treated, but lower odds of therapeutic compliance, death from all causes, and death from CVDs. All the outcomes had clear sex differences across age classes, though not between different levels of deprivation. Comparing patients with medication adherence, women had lower odds of death from all causes than men (with a narrowing protective effect as age increased), while no gender differences emerged in non-compliant patients. Conclusions Among hypertensive patients, gender differences in medication consumption and mortality have been found, but the extent to which these are attributable to a female socio-cultural disadvantage is questionable. The findings reached, with marked age-dependent effects in the outcomes investigated, suggest a prominent role for innate sex differences in biological susceptibility to the disease, whereby women would take advantage of the protective effects of their innate physiological characteristics, especially prior to the beginning of menopause. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13052-9.
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Yagoub U, Saiyed NS, Al Qahtani B, Al Zahrani AM, Birema Y, Al Hariri I. Investigating the incidence and risk factors of hypertension: A multicentre retrospective cohort study in Tabuk, Saudi Arabia. PLoS One 2022; 17:e0262259. [PMID: 34990492 PMCID: PMC8735626 DOI: 10.1371/journal.pone.0262259] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hypertension is a major global health concern affecting approximately 1.13 billion people worldwide, with most of them residing in developing countries. The aim of this study was to determine the incidence of different stages of hypertension and its associated modifiable and non-modifiable risk factors among patients in military-setting hospitals in Tabuk, Saudi Arabia. Methods This retrospective cohort study was conducted at two hospitals in Tabuk, Saudi Arabia. The data were collected from hospital electronic records from 1 January 2019 to 31 December 2019. The blood pressure levels of patients from the last three separate medical visits were recorded. Descriptive statistics and multinomial logistic regression were used for the data analysis. Results The study included 884 hypertensive patients. The incidences of stage of elevated BP, stage 1, stage 2, and hypertension crisis were 60.0, 29.5, 7.0, and 3.5 cases per 1000 persons. Multivariate analysis indicated that progression from the stage of elevated blood pressure to hypertension crisis was significantly associated with advanced age (odds ratio [OR] = 3.62, 95% confidence interval [CI] = 1.99–8.42), male sex (OR = 2.84, 95% CI: 0.57–5.92), and a positive family history of hypertension (OR = 1.95, 95% CI: 1.23–3.09). Other key determinants of the development of stage of elevated blood pressure to hypertension crisis were current smoking status (OR = 1.74, 95% CI: 1.23–4.76), and physical inactivity (OR = 6.48, 95% CI: 2.46–9.14). Conclusion The incidence stage of elevated blood pressure was high among the patients investigated at armed forces hospitals in Tabuk, Saudi Arabia. The logistic regression model proposed in the present study can be used to predict the development of different stages of hypertension. Age, sex, marital status, family history, smoking status, and physical activity play an important role in the development of hypertension. Better strategies to improve awareness, screening, treatment, and management of hypertension are required in Saudi Arabia.
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Affiliation(s)
- Umar Yagoub
- Research Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
- * E-mail:
| | - Nasrin S. Saiyed
- Research Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Bandar Al Qahtani
- Academic Affairs Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | | | - Yassir Birema
- Cardiology Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Ibrahim Al Hariri
- Family Medicine Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
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20
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Farrukh F, Abbasi A, Jawed M, Almas A, Jafar T, Virani SS, Samad Z. Hypertension in Women: A South-Asian Perspective. Front Cardiovasc Med 2022; 9:880374. [PMID: 36035921 PMCID: PMC9399392 DOI: 10.3389/fcvm.2022.880374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Hypertension is an important contributor to cardiovascular disease related morbidity and mortality. Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in both men and women. Materials and Methods Numerous databases, i.e., PubMed, ScienceDirect, etc., were searched using keywords to identify relevant studies to our narrative review. The findings from the most pertinent articles were summarized and integrated into our narrative review on hypertension in women. Results The pathophysiology of essential hypertension is still being delineated in both men and women; there are multiple sex specific factors in association with the development of hypertension in women, including age, combined oral contraceptives (COCs), polycystic ovarian syndrome (PCOS), preeclampsia, etc. There are several sex specific considerations in antihypertensives drug choices. Discussion Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in women. Medical treatment and adherence is uniquely challenging for South Asian women due to a variety of socio-cultural-economic factors. Further research is warranted to identify optimal sex-specific treatment options that will improve the control of hypertension and decrease the risk of subsequent cardiovascular disease in both genders.
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Affiliation(s)
| | - Amin Abbasi
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Misbah Jawed
- Medical College, Ziauddin University, Karachi, Pakistan
| | - Aysha Almas
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Tazeen Jafar
- Medical College, Aga Khan University, Karachi, Pakistan.,Baylor College of Medicine, Houston, TX, United States
| | | | - Zainab Samad
- Medical College, Aga Khan University, Karachi, Pakistan.,Department of Medicine, Duke University, Durham, NC, United States
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21
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Peired AJ, Campi R, Angelotti ML, Antonelli G, Conte C, Lazzeri E, Becherucci F, Calistri L, Serni S, Romagnani P. Sex and Gender Differences in Kidney Cancer: Clinical and Experimental Evidence. Cancers (Basel) 2021; 13:cancers13184588. [PMID: 34572815 PMCID: PMC8466874 DOI: 10.3390/cancers13184588] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Kidney cancer is a frequent malignant tumor that accounts for approximately 5% of all cancer incidences. It affects both males and females, but males are twice as likely to develop kidney cancer than females. Evidence shows that this discrepancy takes root in individual differences, such as genetics or pathologies that affect the patient. It is then reflected in the clinical characteristics of the tumors, as males have larger and more aggressive tumors. Understanding the sex- and gender-based differences in kidney cancer is essential to be able to offer patients individualized medicine that would better cover their needs in terms of prevention, diagnosis and treatment. Abstract Sex and gender disparities have been reported for different types of non-reproductive cancers. Males are two times more likely to develop kidney cancer than females and have a higher death rate. These differences can be explained by looking at genetics and genomics, as well as other risk factors such as hypertension and obesity, lifestyle, and female sex hormones. Examination of the hormonal signaling pathways bring further insights into sex-related differences. Sex and gender-based disparities can be observed at the diagnostic, histological and treatment levels, leading to significant outcome difference. This review summarizes the current knowledge about sex and gender-related differences in the clinical presentation of patients with kidney cancer and the possible biological mechanisms that could explain these observations. Underlying sex-based differences may contribute to the development of sex-specific prognostic and diagnostic tools and the improvement of personalized therapies.
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Affiliation(s)
- Anna Julie Peired
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
- Correspondence:
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, 50134 Florence, Italy; (R.C.); (S.S.)
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 50, 50134 Florence, Italy
| | - Maria Lucia Angelotti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Giulia Antonelli
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Carolina Conte
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Elena Lazzeri
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Francesca Becherucci
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, 50134 Florence, Italy; (R.C.); (S.S.)
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 50, 50134 Florence, Italy
| | - Paola Romagnani
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
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22
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Fukuda K, Matsuo R, Kamouchi M, Kiyuna F, Sato N, Nakamura K, Hata J, Wakisaka Y, Ago T, Imaizumi T, Kai H, Kitazono T. Day-by-Day Blood Pressure Variability in the Subacute Stage of Ischemic Stroke and Long-Term Recurrence. Stroke 2021; 53:70-78. [PMID: 34496621 DOI: 10.1161/strokeaha.120.033751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to determine whether variability of day-by-day blood pressure (BP) during the subacute stage of acute ischemic stroke is predictive of long-term stroke recurrence. METHODS We analyzed 7665 patients (mean±SD age: 72.9±13.1 years; women: 42.4%) hospitalized for first-ever ischemic stroke in 7 stroke centers in Fukuoka, Japan, from June 2007 to November 2018. BP was measured daily during the subacute stage (4-10 days after onset). Its mean and coefficient of variation (CV) values were calculated and divided into 4 groups according to the quartiles of these BP parameters. Patients were prospectively followed up for recurrent stroke or all-cause death. The cumulative event rate was calculated with the Kaplan-Meier method. We estimated the hazard ratios and 95% confidence intervals of the events of interest after adjusting for potential confounders and mean BP values using Cox proportional hazards models. The Fine-Gray model was also used to account for the competing risk of death. RESULTS With a mean (±SD) follow-up duration of 3.9±3.2 years, the rates of recurrent stroke and all-cause death were 3.9 and 9.9 per 100 patient-years, respectively. The cumulative event rates of recurrent stroke and all-cause death increased with increasing CVs of systolic BP and diastolic BP. The systolic BP CV was significantly associated with an increased risk of recurrent stroke after adjusting for multiple confounders and mean BP (hazard ratio [95% CI] for fourth quartile versus first quartile, 1.26 [1.05-1.50]); the risk of recurrent stroke also increased with an increasing systolic BP CV for nonfatal strokes (1.26 [1.05-1.51]) and when death was regarded as a competing risk (1.21 [1.02-1.45]). Similar associations were observed for the diastolic BP CV. CONCLUSIONS Day-by-day variability of BP during the subacute stage of acute ischemic stroke was associated with an increased long-term risk of recurrent stroke.
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Affiliation(s)
- Kenji Fukuda
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.).,Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan (K.F., T.I.)
| | - Ryu Matsuo
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Care Administration and Management (R.M., M.K., N.S.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management (R.M., M.K., N.S.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies (M.K., J.H., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumi Kiyuna
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Sato
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Care Administration and Management (R.M., M.K., N.S.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniyuki Nakamura
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies (M.K., J.H., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Epidemiology and Public Health (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tsutomu Imaizumi
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan (K.F., T.I.).,Fukuoka International University of Health and Welfare, Japan (T.I.)
| | - Hisashi Kai
- Department of Cardiology, Kurume University Medical Center, Japan (H.K.)
| | - Takanari Kitazono
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies (M.K., J.H., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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23
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Al Kibria GM, Gupta RD, Nayeem J. Prevalence, awareness, and control of hypertension among Bangladeshi adults: an analysis of demographic and health survey 2017-18. Clin Hypertens 2021; 27:17. [PMID: 34465390 PMCID: PMC8408995 DOI: 10.1186/s40885-021-00174-2] [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: 01/21/2021] [Accepted: 06/27/2021] [Indexed: 01/02/2023] Open
Abstract
Background The prevalence of hypertension is increasing in Bangladesh, however, few recent studies investigated the proportion of people and factors associated with prevalence, awareness, and control of this condition in this country. This study investigated these among Bangladeshi adults. Methods Using Bangladesh Demographic and Health Survey 2017–18 data, a cross-sectional study was conducted. Multilevel logistic regression analysis was employed after descriptive analysis and prevalence estimation. Results Among 12,926 persons (mean age: 40 years, 57% women), the prevalence of hypertension was 27.4% (n = 3551), it was 28.4 and 26.2% among females and males, respectively. Among hypertensive people, about 42.4% (n = 1508) people were aware of having it, 48.7% among females and 33.5% among males. Of the 1313 people who were taking antihypertensive medication, only 33.8% (n = 443) had controlled hypertension, 34.7 and 31.7% among females and males, respectively. Among the studied factors associated with hypertension, people with older age, female gender, overweight/obesity, diabetes, richer wealth quintiles, and residence in some administrative divisions had higher odds of hypertension (p < 0.05). However, the odds of awareness was lower among younger people, males, and people without overweight/obesity, diabetes, or richer wealth quintiles. Odds of controlled hypertension was also lower among people with older age and higher among college-educated people. Conclusion This study identified several important factors associated with prevalence, awareness, and control of hypertension. It is important to address these factors with nationwide prevention and control programs. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-021-00174-2.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Jannatun Nayeem
- Chattagram International Dental College and Hospital, Chittagong, Bangladesh
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24
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Osei-Yeboah J, Owusu-Dabo E, Owiredu WKBA, Lokpo SY, Agode FD, Johnson BB. Community burden of hypertension and treatment patterns: An in-depth age predictor analysis: (The Rural Community Risk of Non-Communicable Disease Study - Nyive Phase I). PLoS One 2021; 16:e0252284. [PMID: 34383770 PMCID: PMC8360602 DOI: 10.1371/journal.pone.0252284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study aimed to describe the burden, treatment patterns and, age threshold for predicting hypertension among rural adults in Nyive in the Ho Municipality of the Volta Region, Ghana. METHODS A population-based cross-sectional study design was employed. A total of 417 adults aged 20 years and above were randomly selected from households within the Nyive community. The WHO STEPwise approach for non-communicable diseases risk factor surveillance (STEPS) instrument was used to obtain socio-demographic and clinical information including age, gender, educational background, marital status, and occupation as well as hypertension treatment information. Blood pressure was measured using standard methods. The risk of hypertension and the critical age at risk of hypertension was determined using binary logistic regression model and the receiver-operator characteristics (ROC) analysis. RESULTS The direct and indirect age-standardized hypertension prevalence was higher in males (562.58/487.34 per 1000 residents) compared to the females (489.42/402.36 per 1000 residents). The risk of hypertension among the study population increased by 4.4% (2.9%-5.9% at 95% CI) for one year increase in age while the critical age at risk of hypertension was >39 years among females and >35 years among males. About 64(46.72%) of the hypertensive participants were not on treatment whereas only 42(30.66%) had their blood pressure controlled. CONCLUSION Rural hypertension is high among adults in Nyive. The critical age at risk of hypertension was lower among males. The estimated annual increase of risk of hypertension was 4.7% for females and 3.1% for males. High levels of undiagnosed and non-treatment of hypertension and low levels of blood pressure control exist among the rural folks.
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Affiliation(s)
- James Osei-Yeboah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - William K. B. A. Owiredu
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Clinical Biochemistry, Diagnostic Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sylvester Yao Lokpo
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Francis Delali Agode
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- Laboratory Department, Akatsi South District Hospital, Akatsi, Ghana
| | - Beatrice Bella Johnson
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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25
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Gedamu DK, Sisay W. Prevalence of Hypertension and Associated Factors Among Public Servants in North Wollo Zone, Amhara Region, Ethiopia, 2020. Vasc Health Risk Manag 2021; 17:363-370. [PMID: 34188478 PMCID: PMC8232868 DOI: 10.2147/vhrm.s298138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background The leading preventable risk factor for premature death and disability worldwide is hypertension. Globally, 31.1% of adults (1.39 billion people) have hypertension and 9.4 million deaths are recorded annually, accounting for 13% of overall mortality. Objective The objective of this study is to assess the prevalence of hypertension and associated factors among public servants in North Wollo Zone, Amhara Region, Ethiopia. Materials and Methods An institutional-based cross-sectional study was conducted among 627 public servants. To classify candidate variables for multivariable logistic regression, a binary logistic regression model was applied. In order to analyze factors associated with hypertension among participants, all variables with a P-value<0.2 were entered into the multivariable logistic regression model. In order to determine statistical significance, a p value of less than 0.05 was taken. The assumptions of Chi square and multi-collinearity were verified. For model fitness, the Hosmer–Lemeshow goodness-of-fit was checked. Results The total hypertension rate was 27.6% (95% CI: 24.1–31.3). The prevalence was higher in males 129 (32.5%) than in females 444 (19.1%). History of diabetes mellitus (AOR= 9.64, 95% CI: 3.20–29.30), age >35 years (AOR= 2.94, 95% CI: 1.91–4.51) and body mass index 25kg/m2 and above (AOR= 3.44, 95% CI: 2.21–5.34) have been found to be separately associated with hypertension. Conclusion and Recommendation Among public servants in the study setting (study area), hypertension has become a major public health issue. Half of the newly reported cases is hypertensive. The conclusion of this study calls for a more holistic approach to hypertension in terms of hypertension prevention, screening, and proper management.
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Affiliation(s)
- Demlie Kassa Gedamu
- Department of Public Health Emergency Management, North Wollo Zone, Amhara Regional Health Bureau, Woldia, Ethiopia
| | - Wullo Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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26
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Arigo D, Ainsworth MC, Pasko K, Brown MM, Travers L. Predictors of change in BMI over 10 years among midlife and older adults: Associations with gender, CVD risk status, depressive symptoms, and social support. Soc Sci Med 2021; 279:113995. [PMID: 33993009 PMCID: PMC8393364 DOI: 10.1016/j.socscimed.2021.113995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/10/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Change in BMI is recognized as a key health indicator among midlife and older adults, though predictors of BMI change in this group have received little attention. OBJECTIVE The aim of this study was to examine relations between hypothesized predictors (i.e., gender, cardiovascular disease [CVD] risk status, depressive symptoms, social support) and BMI change over 10 years, among midlife and older adults. METHODS Participants were adults ages 50-74 at baseline (N = 5,688, 64% women) who completed four assessments over 10 years. Gender, CVD risk status (i.e., diagnosis of hypertension, type 2 diabetes, or both), depressive symptoms, and perceived social support were assessed at baseline, and BMI was calculated from height and weight reports at all assessments. Multilevel models tested for concurrent and prospective relations between predictors and BMI change (effect size estimates as semipartial correlation coefficients, sr), as well as whether observed relations were further moderated by baseline BMI category (underweight, healthy weight, overweight, or obese). RESULTS Baseline BMI was higher among those with (vs. without) CVD risk, higher (vs. lower) depressive symptoms, and lower (vs. higher) social support; all of these relations were moderated by gender (ps < 0.05, srs 0.03-0.32). Moreover, BMI showed significant change over 10 years, and BMI variability during this time was higher among women (vs. men) and those with (vs. without) CVD risk (ps < 0.0001). BMI change also differed by CVD risk status, and this relation was moderated by gender, baseline depressive symptoms, and baseline BMI category (ps < 0.05, srs 0.03-0.08). CONCLUSIONS Although the predictors of interest were not associated with steady BMI decreases (which are associated with long term health risks for older adults), findings reveal unique patterns of change in BMI among subgroups of midlife and older adults, and may allow for early identification of those with noteworthy BMI changes after age 50.
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Affiliation(s)
- Danielle Arigo
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA; Department of Family Medicine, Rowan School of Osteopathic Medicine, One Medical Center Drive, Stratford, NJ, 08084, USA.
| | - M Cole Ainsworth
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
| | - Kristen Pasko
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
| | - Megan M Brown
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
| | - Laura Travers
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
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27
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Wang W, Sun P, Han F, Qu C. Sex Differences in Risk Factors for Transient Ischemic Attack in a Chinese Population. Front Neurol 2021; 12:615399. [PMID: 34025549 PMCID: PMC8134545 DOI: 10.3389/fneur.2021.615399] [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: 10/09/2020] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: This study aimed to collect and evaluate basic information of a stroke screening population in eastern China and to compare distribution differences in risk factors between males and females in a transient ischemic attack (TIA) population. Methods: A standardization of the risk factors for stroke was performed according to an implementation plan of stroke in a high-risk population screening and intervention project in Shandong Province. Of the 231,289 residents, 8,603 patients with a previous TIA were identified and risk factors in this cohort were analyzed for sex differences. Results: In our initial cohort of 231,289 residents, we found 3,390 men and 5,213 women with TIA, accounting for a prevalence of 3.1 and 4.2%, respectively. Risk factors for TIA were hypertension, atrial fibrillation, diabetes, smoking, lack of exercise, overweight, and family history of stroke. In our TIA cohort, we found that the prevalence of smoking was significantly higher in men (41.3%) compared with that found in women (4.2%). Further, hypertension (58.8 vs. 55.5%) and family history of stroke (22.3 vs. 20.0%) were more prevalent in men compared with women, whereas atrial fibrillation (AF) (14.7 vs. 16.4%), diabetes (11.1 vs. 13.2%), lack of exercise (27.2 vs. 28.0%), and overweight (29.5 vs. 35.7%) were less prevalent. Conclusions: In our TIA cohort from eastern China, we found significant sex differences for the risk factors of hypertension, atrial fibrillation, smoking, diabetes, and overweight.
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Affiliation(s)
- Wendi Wang
- Neurology Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Pei Sun
- Neurology Department, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengyue Han
- Neurology Department, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chuanqiang Qu
- Neurology Department, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Mumford EA, Liu W, Taylor BG, Ramey S. Profiles of US Law Enforcement Officers' Diagnosed Health Conditions: Results From a Probability-Based Sample of Officers. J Occup Environ Med 2021; 63:422-431. [PMID: 33560070 DOI: 10.1097/jom.0000000000002162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess comorbidity across five common health conditions. METHODS Surveys were collected from a probability-based sample of US law enforcement officers, and latent class models estimated for hypertension (HTN), high blood cholesterol (LDL), diabetes (DM), a gastrointestinal disorder (GI), and sleep apnea (SA). RESULTS The majority of officers (69.4%) were classified in a Healthy profile. One in four officers (23.7%) were classified in a LDL-HTN-DM profile. About 7% of officers were classified in a GI-SA-HTN profile. Age, sex, body mass index (BMI), exercise, and working a rotating shift assignment distinguished class membership. CONCLUSION Most officers reported good health. Law enforcement administrative or clinical assessments using readily accessible measures might be informative in identifying risk categories of need for more targeted prevention and treatment support.
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Affiliation(s)
- Elizabeth A Mumford
- National Opinion Research Center at the University of Chicago, Bethesda, Maryland (Dr Mumford, Dr Liu, Dr Taylor); University of Iowa, Iowa City, Iowa (Dr Ramey)
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Korshøj M, Hannerz H, Frikke-Schmidt R, Marott JL, Schnohr P, Clays E, Holtermann A. Occupational lifting and risk of hypertension, stratified by use of anti-hypertensives and age - a cross-sectional and prospective cohort study. BMC Public Health 2021; 21:721. [PMID: 33853574 PMCID: PMC8045338 DOI: 10.1186/s12889-021-10651-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Heavy occupational lifting is prevalent in the general working population and is sparsely reported to associate with hypertension, especially among older and hypertensive workers. We investigated if heavy occupational lifting is associated with hypertension and blood pressure (BP) in both cross-sectional and prospective study designs in the Copenhagen General Population Study, stratified by age, and use of anti-hypertensives. Methods Participation was conducted following the declaration of Helsinki and approved by the ethical committee (H-KF-01-144/01). By multivariable logistic and linear regression models, we investigated the association between heavy occupational lifting and hypertension, in a cross-sectional design (n = 67,363), using anti-hypertensives or BP ≥140/≥90 mmHg as outcome, and in a prospective design (n = 7020) with an above-median change in systolic BP (SBP) from baseline to follow-up and/or a shift from no use to use of anti-hypertensives as outcome, with and without stratification by age and use of anti-hypertensives. Results The odds ratio for hypertension was estimated at 0.97 (99% CI: 0.93–1.00) in the cross-sectional analysis, and at 1.08 (99% CI: 0.98–1.19) in the prospective analysis. The difference in SBP among workers with versus without heavy occupational lifting was estimated at − 0.29 mmHg (99% CI -0.82 – 0.25) in the cross-sectional and at 1.02 mmHg (99% CI -0.41 – 2.45) in the prospective analysis. No significant interaction between heavy occupational lifting and age, nor use of anti-hypertensives were shown. Conclusions Only the prospective analysis indicated heavy occupational lifting to increase the risk of hypertension. Further research on the association between occupational lifting and hypertension are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10651-w.
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Affiliation(s)
- Mette Korshøj
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark. .,Department of Occupational and Social Medicine, Holbæk Hospital, a part of Copenhagen University Hospital, Gl. Ringstedvej 4B, 4300, Holbæk, Denmark.
| | - Harald Hannerz
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Copenhagen University Hospital, Inge Lehmanns Vej 5, 2100, Copenhagen, Denmark.,Copenhagen General Population Study, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Jacob L Marott
- Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Peter Schnohr
- Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
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Sabuncu T, Sonmez A, Eren MA, Sahin I, Çorapçioğlu D, Üçler R, Akin Ş, Haymana C, Demirci İ, Atmaca A, Ersöz HÖ, Satman I, Bayram F. Characteristics of patients with hypertension in a population with type 2 diabetes mellitus. Results from the Turkish Nationwide SurvEy of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Hypertension Study). Prim Care Diabetes 2021; 15:332-339. [PMID: 33277201 DOI: 10.1016/j.pcd.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The present survey aimed to find out the demographical and clinical characteristics of patients with hypertension in a population with type 2 diabetes mellitus (T2DM) in Turkey. METHODS Patients with T2DM who were followed-up in tertiary endocrine units for at least last one year were recruited. Demographic, clinical and biochemical data of the patients were collected. Hypertension was defined as taking anti-hypertensive medications or having office arterial blood pressure (ABP) ≥140/90 mmHg or home ABP ≥ 130/80 mmHg. RESULTS A total of 4756 (58.9% women) diabetic patients were evaluated. The percentage of patients with hypertension was 67.5% (n = 3212). Although 87.4% (n = 2808) of hypertensive patients were under treatment, blood pressure was on target in 52.7% (n = 1479) of patients. Hypertension proportions were higher in woman (p = 0.001), older, more obese, and those who had longer diabetes duration, lower education levels, higher frequency of hypoglycemic events (all p < 0.001) and higher triglyceride levels (p = 0.003). LDL cholesterol level and the percentage of smokers were lower in hypertensive group than in non-hypertensive group (both p < 0.001). The percentage of macro and microvascular complications was higher in the hypertensive group than in the normotensive one (both p < 0.001). In multivariate logistic regression analysis, being a woman (OR: 1.26, 95% CI: 1.04-1.51, p = 0.016), smoking (OR: 1.38, 95% CI: 1.05-1.80, p = 0.020), regular physical activity (OR: 1.24, 95% CI: 1.01-1.53, p = 0.039) and the presence of macrovascular complications (OR: 1.38 95% CI: 1.15-1.65, p = 0.001) were the significant predictors of good ABP regulation. The ratios of masked and white coat hypertension were 41.2% and 5.7%, respectively. CONCLUSION Our findings indicate that two-thirds (67.5%) of adult patients with T2DM have hypertension. Co-existence of hypertension increases the frequency of macro and microvascular diabetic complications in these patients. Despite the critical role of hypertension in morbidity and mortality, only half of the patients have favorable ABP levels. Masked hypertension seems to be another important issue in this population.
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Affiliation(s)
- Tevfik Sabuncu
- Harran University, Faculty of Medicine, Department of Endocrinology and Metabolism, Sanliurfa, Turkey
| | - Alper Sonmez
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Mehmet Ali Eren
- Harran University, Faculty of Medicine, Department of Endocrinology and Metabolism, Sanliurfa, Turkey.
| | - Ibrahim Sahin
- Inonu University, Faculty of Medicine, Department of Endocrinology and Metabolism, Malatya, Turkey
| | - Demet Çorapçioğlu
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Rıfkı Üçler
- Van Yüzüncü Yıl University, Faculty of Medicine, Department of Endocrinology and Metabolism, Van, Turkey
| | - Şafak Akin
- Ankara Memorial Hospital, Ankara, Turkey
| | - Cem Haymana
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - İbrahim Demirci
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Ayşegül Atmaca
- On Dokuz Mayıs University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
| | - Halil Önder Ersöz
- Karadeniz Teknik University, Faculty of Medicine, Department of Endocrinology and Metabolism, Trabzon, Turkey
| | - Ilhan Satman
- Istanbul University, Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Fahri Bayram
- Erciyes University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkey
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Pamphlett R, Doble PA, Bishop DP. The Prevalence of Inorganic Mercury in Human Kidneys Suggests a Role for Toxic Metals in Essential Hypertension. TOXICS 2021; 9:67. [PMID: 33801008 PMCID: PMC8004013 DOI: 10.3390/toxics9030067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023]
Abstract
The kidney plays a dominant role in the pathogenesis of essential hypertension, but the initial pathogenic events in the kidney leading to hypertension are not known. Exposure to mercury has been linked to many diseases including hypertension in epidemiological and experimental studies, so we studied the distribution and prevalence of mercury in the human kidney. Paraffin sections of kidneys were available from 129 people ranging in age from 1 to 104 years who had forensic/coronial autopsies. One individual had injected himself with metallic mercury, the other 128 were from varied clinicopathological backgrounds without known exposure to mercury. Sections were stained for inorganic mercury using autometallography. Laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) was used on six samples to confirm the presence of autometallography-detected mercury and to look for other toxic metals. In the 128 people without known mercury exposure, mercury was found in: (1) proximal tubules of the cortex and Henle thin loops of the medulla, in 25% of kidneys (and also in the man who injected himself with mercury), (2) proximal tubules only in 16% of kidneys, and (3) Henle thin loops only in 23% of kidneys. The age-related proportion of people who had any mercury in their kidney was 0% at 1-20 years, 66% at 21-40 years, 77% at 41-60 years, 84% at 61-80 years, and 64% at 81-104 years. LA-ICP-MS confirmed the presence of mercury in samples staining with autometallography and showed cadmium, lead, iron, nickel, and silver in some kidneys. In conclusion, mercury is found commonly in the adult human kidney, where it appears to accumulate in proximal tubules and Henle thin loops until an advanced age. Dysfunctions of both these cortical and medullary regions have been implicated in the pathogenesis of essential hypertension, so these findings suggest that further studies of the effects of mercury on blood pressure are warranted.
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Affiliation(s)
- Roger Pamphlett
- Discipline of Pathology, Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney 2050, Australia
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Philip A. Doble
- Elemental Bio-Imaging Facility, School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney 2007, Australia; (P.A.D.); (D.P.B.)
| | - David P. Bishop
- Elemental Bio-Imaging Facility, School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney 2007, Australia; (P.A.D.); (D.P.B.)
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Hamarneh D, Alkhatib N, Denhaerynck K, Vancayzeele S, Brié H, MacDonald K, Abraham I. Gender-stratified hierarchical modeling of patient and physician determinants of antihypertensive treatment outcomes: pooled analysis of seven prospective real-world studies with 17,044 patients. Curr Med Res Opin 2021; 37:367-375. [PMID: 33467935 DOI: 10.1080/03007995.2021.1877124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Seven prospective real-world studies conducted in general practices in Belgium of antihypertensive treatment with valsartan-centric regimens were pooled to examine similarities and differences in determinants of blood pressure (BP) values (mmHg) and BP control rates between female and male patients. METHODS Pooled analysis of a total evaluable sample of 17,044 patients, including 8273 (48.5%) women and 8771 men (51.5%) treated over approximately 90 days with valsartan-centric regimens in second or later line. Hierarchical linear and logistic regressions were applied to identify patient- and physician-related determinants of BP outcomes and a potential physician class effect. RESULTS Reductions in BP (mmHg) over 90 days were similar for women and men, and so were changes in BP control rates. Approximately a quarter of the variance in 90 day BP values was attributable to a physician class effect. Both gender groups shared some patient- and physician-related determinants of BP outcomes, though often varying in degree of influence. Analyses also revealed gender-specific determinants. Among others, modifiable/manageable patient-related determinants included BP at hypertension diagnosis (proxy for time of diagnosis), risk factors, antihypertensive treatment and adherence; while among the physician-related determinants clinical experience in hypertension treatment was modifiable/manageable. CONCLUSION Valsartan-centric treatment regimens are associated with significant reductions in BP level and improvement in BP control in both women and men. The determinants revealed in modeling provide guidance to clinicians in the common and differential management of hypertension in female and male patients.
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Affiliation(s)
- Dina Hamarneh
- Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona, Tucson, AZ, USA
| | - Nimer Alkhatib
- Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona, Tucson, AZ, USA
- College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Kris Denhaerynck
- Matrix45, Tucson, AZ, USA
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | | | | | - Ivo Abraham
- Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona, Tucson, AZ, USA
- Matrix45, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Department of Family and Community Medicine, College of Medicine - Tucson, University of Arizona, Tucson, AZ, USA
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Longitudinal association between physical activity and blood pressure, risk of hypertension among Chinese adults: China Health and Nutrition Survey 1991-2015. Eur J Clin Nutr 2021; 75:274-282. [PMID: 32404900 DOI: 10.1038/s41430-020-0653-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine the effects of physical activity (PA) in adults with or without prehypertension at baseline on systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension risk by gender. METHODS A total of 5986 men and 6525 women (≥18 years old) without hypertension-related disease at baseline who attended surveys from China Health and Nutrition Survey (1991-2015) at least twice were selected. In terms of the nested data structure, three-level random intercept growth model and three-level logistic regression were used to estimate the relationship between the PA and SBP/DBP or hypertension risk. RESULTS The incidence of hypertension increased from 10.86% in 1991 to 20.34% in 2015, and the median of PA dropped from 408 MET·h/week in 1991 to 104 MET·h/week in 2015. After adjusting confounders, PA in the third and fourth quartiles decreased SBP (by 0.98 and 0.96 mm Hg, p < 0.05) and DBP (by 0.30 and 0.38 mm Hg, p < 0.05), and it reduced the odds of hypertension by 12 and 15% (p < 0.05), compared with PA in the lowest quartile. For normotensive women in the third quartile of PA and prehypertensive women in the fourth quartile of PA, the risk of hypertension was reduced 15 and 22%, compared with women in the lowest quartile of PA. CONCLUSIONS Physical activity should be improved to the relatively high level to be effective in controlling blood pressure. Normotensive women had an association between physical activity and SBP, DBP, and the risk of hypertension.
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Shin J, Ham D, Paik HY, Shin S, Joung H. Gender Differences in the Risk of Ischemic Heart Disease According to Healthcare Utilization and Medication Adherence among Newly Treated Korean Hypertensive Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1274. [PMID: 33572632 PMCID: PMC7908180 DOI: 10.3390/ijerph18031274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022]
Abstract
We aimed to investigate gender differences in ischemic heart disease (IHD) according to healthcare utilization and medication adherence among newly treated Korean hypertensive adults. The National Sample Cohort version 2.0 of the National Health Insurance Service was used for analysis. Newly treated hypertensive patients ≥ 20 years and without IHD in 2002 were selected from a population that underwent health examination during 2003-2006. Of those patients, 11,942 men and 11,193 women were analyzed and followed up for 10 years. We determined the association between IHD and healthcare utilization and medication adherence using the Cox proportional hazards model. Hypertensive women patients had a lower risk of IHD than men patients (hazard ratio [HR] = 0.93, 95% confidence interval [CI] 0.88-1.00). The IHD risk was increased in patients who visited healthcare providers > 12 times/person-year (HR = 2.97, 95% CI 2.79-3.17), paid high out-of-pocket expense/person-year (HR = 1.55, 95% CI 1.41-1.69), and had medication nonadherence (HR = 1.67, 95% CI 1.58-1.77). However, the risk was decreased in patients who used both urban and rural areas (HR 0.75, 95% CI 0.67-0.84) and mixed types of providers (HR = 0.93, CI 0.88-0.99). The risk of IHD was significantly different between men and women only in the visiting frequency to healthcare providers (men, HR = 3.21, 95% CI 2.93-3.52; women, HR = 2.78, 95% CI 2.53-3.04, p for interaction = 0.0188). In summary, the risk of IHD was similar according to healthcare utilization and medication adherence between men and women, except visiting frequency to healthcare providers.
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Affiliation(s)
- Jiae Shin
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea;
| | - Dongwoo Ham
- Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea;
| | - Hee Young Paik
- Center for Gendered Innovations in Science and Technology Research (GISTeR), Korea Federation of Women’s Science & Technology Associations, 22 Teheran-ro 7-gil, Gangnam-gu, Seoul 06130, Korea;
| | - Sangah Shin
- Department of Food and Nutrition, School of Food Science and Technology, Chung-Ang University, 4726 Seodong-daero, Daedeok-myeon, Gyeonggi-do, Anseong 17546, Korea
| | - Hyojee Joung
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea;
- Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea;
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Opoku S, Addo-Yobo E, Trofimovitch D, Opoku RB, Lasong J, Gan Y, Lu Z. Increased prevalence of hypertension in Ghana: New 2017 American College of Cardiology/American Hypertension Association hypertension guidelines application. J Glob Health 2020; 10:020408. [PMID: 33282222 PMCID: PMC7688293 DOI: 10.7189/jogh.10.020408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background We estimated the prevalence and socio-demographic risk factors of hypertension among Ghanaian adults as per the Joint National Committee 7 and the 2017 American College of Cardiology/American Hypertension Association hypertension thresholds used for diagnosis and treatment. Methods This cross-sectional analysis included 12 151 adults (8295 females and 3856 males) aged 18 years or older who participated in the 2014 Ghana Demographic and health Survey. Multiple logistic regression models were applied to obtain risk factors associated with hypertension as per both guidelines. Results Overall, 30.43% (n = 3698) and 11.48% (n = 1395) respondents had hypertension as per the 2017 ACC/AHA and JNC7 guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: 55-64 years (adjusted odds ratio (aOR) = 6.42, 95% confidence interval (CI): 4.70-8.77), 45-54 years (aOR = 5.72, 95% CI = 4.70-6.85), 3544 years (aOR = 3.91, 95% CI = 3.33-4.59), and 25-34 years (aOR = 2.05, 95% CI = 1.77-2.37) age groups. Males (aOR = 1.39, 95% CI = 1.23-1.53), and urban residents (aOR = 1.18, 95% CI = 1.05-1.38). All the above risk factors were significant according to the JNC7 guideline too. Factors positively associated with only the 2017 ACC/AHA guideline included: middle income (aOR = 1.20, 95% CI = 1.02-1.42) and richest (aOR = 1.36, 95% CI = 1.10-1.69) wealth quintiles, whereas manual (aOR = 1.37, 95% CI = 1.02-1.86) was positively associated with the JNC7 guidelines only. Conclusions We conclude that adopting the ACC/AHA guidelines would lead to a substantial increase in the prevalence of hypertension among Ghanaian adults, thus, hypertension prevention and control should be prioritized.
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Affiliation(s)
- Sampson Opoku
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Diana Trofimovitch
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Rebekah Bless Opoku
- Community 8, Number 3, Junior High School, Ghana Education Service, Tema, Ghana
| | - Joseph Lasong
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Machluf Y, Chaiter Y, Tal O. Gender medicine: Lessons from COVID-19 and other medical conditions for designing health policy. World J Clin Cases 2020; 8:3645-3668. [PMID: 32953842 PMCID: PMC7479575 DOI: 10.12998/wjcc.v8.i17.3645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
Gender-specific differences in the prevalence, incidence, comorbidities, prognosis, severity, risk factors, drug-related aspects and outcomes of various medical conditions are well documented. We present a literature review on the extent to which research in this field has developed over the years, and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens, guidelines and into gender-oriented preventive strategies and health policies. Subsequently, through the lens of gender, we describe these domains in detail for four selected medical conditions: Asthma, obesity and overweight, chronic kidney disease and coronavirus disease 2019. As some of the key gender differences become more apparent during adolescence, we focus on this developmental stage. Finally, we propose a model which is based on three influential issues: (1) Investigating gender-specific medical profiles of related health conditions, rather than a single disease; (2) The dynamics of gender disparities across developmental stages; and (3) An integrative approach which takes into account additional risk factors (ethnicity, socio-demographic variables, minorities, lifestyle habits etc.). Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines, already among adolescents, may reduce inequities, facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.
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Affiliation(s)
- Yossy Machluf
- Shamir Research Institute, University of Haifa, Kazerin 1290000, Israel
| | - Yoram Chaiter
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030100, Israel
| | - Orna Tal
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030100, Israel
- Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 7030100, Israel
- Department of Management, Program of Public Health and Health System Administration, Bar Ilan University, Ramat Gan 5290002, Israel
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Sergi G, Dianin M, Bertocco A, Zanforlini BM, Curreri C, Mazzochin M, Simons LA, Manzato E, Trevisan C. Gender differences in the impact of metabolic syndrome components on mortality in older people: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2020; 30:1452-1464. [PMID: 32600955 DOI: 10.1016/j.numecd.2020.04.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The influence of metabolic syndrome (MetS) on mortality may be influenced by age- and gender-related changes affecting the impact of individual MetS components. We investigated gender differences in the association between MetS components and mortality in community-dwelling older adults. METHODS AND RESULTS Prospective studies were identified through a systematic literature review up to June 2019. Random-effect meta-analyses were run to estimate the pooled relative risk (RR) and 95% confidence intervals (95% CI) of all-cause and cardiovascular (CV) mortality associated with the presence of MetS components (abdominal obesity, high triglycerides, low HDL cholesterol, high fasting glycemia, and high blood pressure) in older men and women. Meta-analyses considering all-cause (103,859 individuals, 48,830 men, 55,029 women; 10 studies) and CV mortality (94,965 individuals, 44,699 men, 50,266 women; 8 studies) did not reveal any significant association for abdominal obesity and high triglycerides in either gender. Low HDL was associated with increased all-cause (RR = 1.16, 95% CI: 1.02-1.32) and CV mortality (RR = 1.34, 95% CI: 1.03-1.74) among women, while weaker results were found for men. High fasting glycemia was associated with higher all-cause mortality in older women (RR = 1.35, 95% CI: 1.22-1.50) more than in older men (RR = 1.21, 95% CI: 1.13-1.30), and CV mortality only in the former (RR = 1.36, 95% CI: 1.04-1.78). Elevated blood pressure was associated with increased all-cause mortality (RR = 1.16, 95% CI: 1.03-1.32) and showed marginal significant results for CV death only among women. CONCLUSIONS The impact of MetS components on mortality in older people present some gender differences, with low HDL cholesterol, hyperglycemia, and elevated blood pressure being more strongly associated to all-cause and CV mortality in women.
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Affiliation(s)
- Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Marta Dianin
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Anna Bertocco
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Bruno M Zanforlini
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Chiara Curreri
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Mattia Mazzochin
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Leon A Simons
- UNSW Sydney, St Vincent's Hospital, Sydney, Australia
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy; Institute of Neuroscience, National Research Council, Padova, Italy
| | - Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
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Tang K, Zhang Y, Wang H, Tan SH, Bai L, Liu Y. Regional economic development, household income, gender and hypertension: evidence from half a million Chinese. BMC Public Health 2020; 20:901. [PMID: 32522178 PMCID: PMC7288507 DOI: 10.1186/s12889-020-09002-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hypertension may be influenced by multiple factors, including social and individual determinants. Regional and individual economic disparity in China is closely associated with such factors that may give rise to diverse health outcomes. This study examines the relationship between regional economic development, household income, gender and hypertension prevalence in China. METHODS This study utilized data from the China Kadoorie Biobank (CKB), a population-based study on half a million Chinese adults from 10 geographically distinct regions. Hypertension was identified by a measured systolic blood pressure/diastolic blood pressure ≥ 140/90 mmHg or receiving treatment. Regional economic development was inferred from GDP per capita at the time of the study. A logistic regression based method was used in calculating the prevalence of hypertension in different household income, regional economic development, and gender groups, adjusting for demographic, social-economic and lifestyle factors. RESULTS The prevalence of hypertension was the lowest in the medium GDP per capita areas in both male (31.62, 95% CI: 31.26-31.98%) and female (22.85, 95% CI: 22.50-23.19%) as compared to that in the low GDP per capita regions (male: 32.75, 95% CI 32.41-33.08%; female: 32.12, 95% CI: 31.78-32.47%) and high GDP per capita areas (male: 39.74, 95% CI: 39.33-40.16%; female: 35.19, 95% CI: 34.74-35.65%). There was an inverse relationship between hypertension and household income in the low and high GDP areas and an U-shaped association in the medium GDP per capita areas. Higher hypertension prevalence was observed in males across all GDP per capita areas. The negative correlation between hypertension and household income (across all GDP per captia areas) was stronger in females than in males. CONCLUSIONS The present study underlined the important influence of regional economic development, household income and gender on hypertension. Interventions for hypertension prevention and management should take into consideration the influence of sex difference and socioeconomic disparities at both micro- and macro- levels, in addition to a person-centered approach.
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Affiliation(s)
- Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China.
| | - Yu Zhang
- School of Health Humanities, Peking University Health Science Center, Beijing, China
| | - Hanyu Wang
- School of Health Humanities, Peking University Health Science Center, Beijing, China
| | - Shi Hui Tan
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Lin Bai
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Yuning Liu
- School of Public Health, Peking University Health Science Center, Beijing, China
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Akl C, Akik C, Ghattas H, Obermeyer CM. The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control. BMC Public Health 2020; 20:835. [PMID: 32493255 PMCID: PMC7268748 DOI: 10.1186/s12889-020-08678-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 04/08/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Hypertension is a leading risk factor for mortality and morbidity globally and in the Arab world. We summarize the evidence on awareness, treatment, and control of hypertension, to assess the extent of gaps in the hypertension continuum of care. We also assess the influence of gender and other social determinants at each level of the cascade of care. METHODS We searched MEDLINE and SSCI databases for studies published between 2000 and 2017, reporting the rates of awareness, treatment or control of hypertension and/or their determinants in the Arab region. We included sources on both general populations and on clinical populations. The review process was based on the PRISMA guidelines. We present rates on the three stages of the care cascade corresponding to (1) awareness (2) treatment and (3) control of blood pressure, and estimated the losses that occur when moving from one stage to another. We also take stock of the evidence on social determinants and assess the statistical significance of gender differences in awareness, treatment and control. RESULTS Data from 73 articles were included. Substantial proportions of hypertensives were lost at each step of the hypertension care continuum, with more missed opportunities for care resulting from lack of awareness of hypertension and from uncontrolled blood pressure. More than 40% and 19% of all hypertensive individuals were found to be unaware and to have uncontrolled blood pressure, respectively, but among individuals diagnosed with hypertension, less than 21% were untreated. Awareness rates were higher among women than men but this advantage was not consistently translated into better blood pressure control rates among women. CONCLUSIONS This analysis of the cascade of care indicates that barriers to proper diagnosis and adequate control are greater than barriers to delivery of treatment, and discusses potential factors that may contribute to the gaps in delivery.
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Affiliation(s)
- Christelle Akl
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| | - Carla Makhlouf Obermeyer
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
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Mancini M, Righetto M, Baggio G. Gender-Related Approach to Kidney Cancer Management: Moving Forward. Int J Mol Sci 2020; 21:E3378. [PMID: 32397685 PMCID: PMC7246979 DOI: 10.3390/ijms21093378] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022] Open
Abstract
Men are more frequently diagnosed with kidney cancer than women, with a more aggressive histology, larger tumors, a higher grade and stage, and worse oncological outcomes. Smoking habits and sex steroid hormones seem to have a possible role in explaining these gender disparities. Moreover, the expression of genes involved in tumor growth and immune response in kidney cancer varies between men and women, having an impact on the gender-related response to oncological therapy, such as anti-angiogenic drugs and immunotherapy. Recent advances have been made in our understanding of the molecular and genetic mechanisms involved in kidney cancer, which could partially explain the gender differences, and they are summarized in this paper. However, other key mechanisms, which fully clarify the striking clinical gender-related differences observed in kidney cancer, are not completely understood at present. We reviewed and summarized the most relevant publications about the relationship between gender and kidney cancer. Efforts should be made to progress in bench and clinical research on gender-related signatures and disparities, and their impact on the clinical management of kidney cancer.
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Affiliation(s)
- Mariangela Mancini
- Department of Surgical, Oncological and Gastroenterological Sciences, Urological Clinic, University of Padua, 35128 Padua, Italy;
| | - Marialaura Righetto
- Department of Surgical, Oncological and Gastroenterological Sciences, Urological Clinic, University of Padua, 35128 Padua, Italy;
| | - Giovannella Baggio
- Department of Molecular Medicine, School of Medicine and Surgery, University of Padua, 35128 Padua, Italy;
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Kalibala J, Pechère-Bertschi A, Desmeules J. Gender Differences in Cardiovascular Pharmacotherapy-the Example of Hypertension: A Mini Review. Front Pharmacol 2020; 11:564. [PMID: 32435193 PMCID: PMC7218117 DOI: 10.3389/fphar.2020.00564] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality worldwide in both sexes. Despite considerable progress in better understanding the patterns of disease in women, they are still often undertreated and benefit less from evidence-based treatment. Hypertension is a key contributor to CVD and is also one of the most potent risk factors for heart failure in women. Even with the wide variety of available drugs, blood pressure control is globally suboptimal. Current guidelines do not suggest differential treatment of hypertension for women; however, a growing body of research suggests gender dimorphism in the pathophysiology of hypertension and pharmacological response to cardiovascular drugs. The clinical relevance of theses sex-divergent effects of drugs is still under investigation. Owing to the exponential relationship between blood pressure and cardiovascular mortality, even a modest decrease in blood pressure or therapeutic adhesion could be clinically \relevant. In this review, we explore the known pharmacological and pharmacokinetic sex differences with special attention to the main classes of antihypertensive treatment. Current data shows frequently higher drug exposures in women and more frequent adverse drug reactions in all antihypertensive drug groups. As far as cardiovascular prevention is concerned, sex-specific data is often lacking in clinical trials, highlighting the necessity to further study CVD and their treatment in both men and women.
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Affiliation(s)
| | - Antoinette Pechère-Bertschi
- Division of Nephrology and Hypertension, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Faculty of Medicine, Geneva University, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology Pharmacology Emergency Medicine and Intensive Care, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Steventon JJ, Rosser AE, Hart E, Murphy K. Hypertension, Antihypertensive Use and the Delayed-Onset of Huntington's Disease. Mov Disord 2020; 35:937-946. [PMID: 32017180 PMCID: PMC7317197 DOI: 10.1002/mds.27976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/15/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background Hypertension is a modifiable cardiovascular risk factor implicated in neurodegeneration and dementia risk. In Huntington's disease, a monogenic neurodegenerative disease, autonomic and vascular abnormalities have been reported. This study's objective was to examine the relationship between hypertension and disease severity and progression in Huntington's disease. Methods Using longitudinal data from the largest worldwide observational study of Huntington's disease (n = 14,534), we assessed the relationship between hypertension, disease severity, and rate of clinical progression in Huntington's disease mutation carriers. Propensity score matching was used to statistically match normotensive and hypertensive participants for age, sex, body mass index, ethnicity, and CAG length. Results Huntington's disease patients had a lower prevalence of hypertension compared with age‐matched gene‐negative controls. Huntington's disease patients with hypertension had worse cognitive function, a higher depression score, and more marked motor progression over time compared with Huntington's disease patients without hypertension. However, hypertensive patients taking antihypertensive medication had less motor, cognitive, and functional impairment than Huntington's disease patients with untreated hypertension and a later age of clinical onset compared with untreated hypertensive patients and normotensive individuals with Huntington's disease. Conclusions We report the novel finding that hypertension and antihypertensive medication use are associated with altered disease severity, progression, and clinical onset in patients with Huntington's disease. These findings have implications for the management of hypertension in Huntington's disease and suggest that prospective studies of the symptomatic or disease‐modifying potential of antihypertensives in neurodegenerative diseases are warranted. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jessica J Steventon
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Maindy Road, Cardiff University, Cardiff, Wales, UK
| | - Anne E Rosser
- Neuroscience and Mental Health Research Institute and Brain Research and Intracerebral Neurotherapeutic (BRAIN) unit, School of Medicine, Cardiff University, Cardiff, Wales, UK.,Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, Wales, UK
| | - Emma Hart
- Bristol Heart Institute (BHI), Clinical Research and Imaging Centre, School of Physiology, Pharmacology and Neuroscience, Bristol University, Bristol, UK
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Maindy Road, Cardiff University, Cardiff, Wales, UK
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Walsh-Wilkinson E, Drolet MC, Arsenault M, Couet J. Sex differences in the evolution of left ventricle remodeling in rats with severe volume overload. BMC Cardiovasc Disord 2020; 20:51. [PMID: 32013884 PMCID: PMC6998357 DOI: 10.1186/s12872-020-01360-0] [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: 11/01/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Aortic valve regurgitation (AR) results in left ventricle (LV) volume overload (VO) leading to its dilation and hypertrophy (H). We study a rat model of severe AR induced by puncturing one or two leaflets using a catheter. Most of our studies were conducted in male animals. Recently, we started investigating if sex dimorphism existed in the AR rat model. We observed that AR females developed as much LVH as males but morphological remodeling differences were present. A head-to-head comparison of LV morphological and functional changes had never been performed in AR males (M) and females (F) using the latest modalities in cardiac imaging by echocardiography. Methods We performed a longitudinal study to evaluate the development of LV hypertrophy caused by chronic AR in male and female rats over 6 months. Sham-operated (sham) animals were used as controls. Results LV diastolic volumes (EDV) increased more over 6 months in sham males than in females (38% vs. 23% for EDV, both p < 0.01). AR resulted in significant LV dilation for both sexes (54% vs. 51% increase in EDV) vs. baseline values. Since normal cardiac growth was less in females, dilation from AR was relatively more important for them (88% (M) vs. 157% (F) increase in EDV over sham). AR caused LV wall thickening in both males and females. It happened sooner for AR females and was more important than in males (25% (M) vs. 56% (F) increase in septum thickness at 2 months and 10% (M) vs. 30% (F) at 6 months). We then evaluated if AR was associated with changes in LV strain using speckle-tracking 2D echocardiography. Global longitudinal strain remained similar between AR and sham animals. Circumferential strain was negatively modulated by AR but only in females and early after VO induction (13% (M) vs. 26% (F)). Conclusion AR resulted in more LV dilation and quicker wall thickening in female AR rats compared to males. Global circumferential strain was negatively modulated in AR females but not in males. AR also seemed to lead to a more spherical LV shape in females whereas; it kept mostly an ellipsoid shape in males. This can influence validity of mass estimation of the dilated LV in females by echocardiography.
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Affiliation(s)
- Elisabeth Walsh-Wilkinson
- Groupe de recherche en valvulopathies, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, Chemin Sainte-Foy, Québec City, G1V 4G5, Canada
| | - Marie-Claude Drolet
- Groupe de recherche en valvulopathies, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, Chemin Sainte-Foy, Québec City, G1V 4G5, Canada
| | - Marie Arsenault
- Groupe de recherche en valvulopathies, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, Chemin Sainte-Foy, Québec City, G1V 4G5, Canada
| | - Jacques Couet
- Groupe de recherche en valvulopathies, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, Chemin Sainte-Foy, Québec City, G1V 4G5, Canada.
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Huang J, Bao X, Xie Y, Zhang X, Peng X, Liu Y, Cheng M, Ma J, Wang P. Interaction of lipid accumulation product and family history of hypertension on hypertension risk: a cross-sectional study in the Southern Chinese population. BMJ Open 2019; 9:e029253. [PMID: 31784431 PMCID: PMC6924775 DOI: 10.1136/bmjopen-2019-029253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES This study aimed at investigating the applicability of a novel index based on waist circumference (WC) and triglyceride (TG) which was named lipid accumulation product (LAP) in the Southern Chinese population, and compared the predictive effects of LAP and other obesity indicators on hypertension risk. Moreover, this study investigated the interactive effects of LAP and family history of hypertension. METHODS A total number of 2079 of community-dwelling adults in Southern China were enrolled in this cross-sectional study. The participants underwent questionnaire surveys, anthropometric tests and laboratory examinations. Themultinomial logistic regression model and receiver operating characteristic curves, including LAP, body mass index (BMI), waist-to-hip ratio (WHR), WC and TG, were used to assess the association between hypertension risk and obesity indexes. The interaction effects were evaluated by relative excess risk of interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI). RESULTS Higher LAP levels have a relatively higher risk of having hypertension in both sexes (males: adjusted OR=2.79 per SD increase, 95% CI 1.43 to 5.44, p<0.001; females: adjusted OR=3.15, 95% CI 1.56 to 6.39, p<0.001). LAP (area under the curve=0.721; 95% CI 0.680 to 0.761) is a better indicator in identifying hypertension risk than BMI, WHR and TG in females, but WC performed better in males. A significant interaction between LAP and family history of hypertension was observed in males (RERI=1.652, 95% CI 0.267 to 3.037; AP=0.516, 95% CI 0.238 to 0.794; SI=3.998, 95% CI 0.897 to 17.820), but there is no statistically significant difference in females. CONCLUSIONS LAP significantly associates with hypertension risk in the Southern Chinese population. It has better performance than BMI, WHR and TG on predicting hypertension risk of the Southern Chinese female population. Moreover, LAP and family history of hypertension might synergistically increase the risk of hypertension.
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Affiliation(s)
- JunXuan Huang
- School of Public Health, Guangzhou Medical University, Guangzhou, China
- General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, China
| | - XinYu Bao
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - YiXian Xie
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - XiaoXia Zhang
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Xin Peng
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Yan Liu
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - MengJiao Cheng
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - JinXiang Ma
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - PeiXi Wang
- General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, China
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Madsen TE, Howard G, Kleindorfer DO, Furie KL, Oparil S, Manson JE, Liu S, Howard VJ. Sex Differences in Hypertension and Stroke Risk in the REGARDS Study: A Longitudinal Cohort Study. Hypertension 2019; 74:749-755. [PMID: 31405299 PMCID: PMC6741430 DOI: 10.1161/hypertensionaha.119.12729] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022]
Abstract
Little is known about whether the relationship between hypertension and ischemic stroke differs by sex. We examined sex differences in the association between hypertension severity and treatment and ischemic stroke risk. We used a longitudinal cohort study in the continental United States, with oversampling of black individuals and those living in the stroke belt. We included 26 461 participants recruited from 2003 to 2007 without prevalent stroke at baseline. The main outcome was incident ischemic stroke ascertained by telephone surveillance (with physician adjudication for suspected events). Proportional hazards regression was used to assess the sex-specific association between systolic blood pressure and stroke and between classes of antihypertensive medications and stroke after adjustment for age, race, sex, and age-by-race and sex-by-treatment interaction terms. A priori, P<0.10 was considered significant for interactions. Among participants (55.4% women, 40.2% black), there were 1084 confirmed ischemic stroke events. In the adjusted model, the risk of stroke per each level of hypertension (referent/systolic blood pressure <120 mm Hg/120-129 mm Hg/130-139 mm Hg/>140 mm Hg) was higher in women (hazard ratio, 1.25; 95% CI, 1.16-1.34) than men (hazard ratio, 1.14; 95% CI, 1.05-1.23; sex-systolic blood pressure interaction term, P=0.09). Compared with no medications, with each additional class of medications, stroke risk increased by 23% (hazard ratio, 1.23; 95% CI, 1.14-1.33) for women and 21% (hazard ratio, 1.21; 95% CI, 1.12-1.31) for men (P=0.79). Further work on the biological mechanisms for sex differences in stroke risk associated with hypertension severity and a need for sex-specific clinical guidelines may be warranted.
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Affiliation(s)
- Tracy E. Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
- Center for Global Cardiometabolic Health, Brown University School of Public Health, Providence, RI
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Dawn O. Kleindorfer
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati OH
| | - Karen L. Furie
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - JoAnn E. Manson
- Department of Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital/ Harvard Medical School, Boston, MA
| | - Simin Liu
- Center for Global Cardiometabolic Health, Brown University School of Public Health, Providence, RI
- Departments of Epidemiology, Medicine, and Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Virginia J. Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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Chen X, Kong C, Yu H, Gong J, Lan L, Zhou L, Gong J, Liu P, Xu L, Deng Q. Association between osteosarcopenic obesity and hypertension among four minority populations in China: a cross-sectional study. BMJ Open 2019; 9:e026818. [PMID: 31324680 PMCID: PMC6661579 DOI: 10.1136/bmjopen-2018-026818] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Osteosarcopenic obesity (OSO) may be associated with an increased prevalence of hypertension. The aim of this study was to examine the difference in the prevalence of OSO and hypertension among four minority populations in China and explore the relationship between OSO and hypertension by sex. DESIGN This study adopted a cross-sectional design. PARTICIPANTS In total, 1939 participants aged ≥50 years, including 459 Jing, 514 Maonan, 535 Hmong and 431 Yao participants from Guangxi Province, China, were included using stratified cluster random sampling. MAIN OUTCOME MEASURES The body composition, bone mineral density and blood pressure were measured by an MC-180 body composition analyser, Achilles Express ultrasound bone densitometer and OMRON HEM-1000 electronic sphygmomanometer, respectively. RESULTS The results showed that 65.77% of Hmong men, 58.79% of Hmong women, 54.82% of Maonan men, 50.00% of Maonan women, 41.92% of Jing men, 45.21% of Jing women, 53.66% of Yao men and 42.32% of Yao women suffered from hypertension. Compared with those among the normal group, the adjusted OR and 95% CI of age among the women with OSO was 3.15 (1.13 to 8.78). After adjusting for age, ethnicity, smoking status, alcohol consumption, physical activity and menopausal status, the women with OSO also had a higher OR (OR=3.18, 95% CI 1.14 to 8.88) for hypertension than those in the normal group. However, the ORs (95% CI) for hypertension in men with one or more components were not significant after adjusting for age and ethnicity. CONCLUSION These results suggest that OSO is a risk factor for hypertension, especially in women. Furthermore, the prevalence of OSO and hypertension in the present study displayed sex-specific and ethnic-specific differences among the four minority populations.
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Affiliation(s)
- Xingcai Chen
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
| | - Cunqing Kong
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
| | - Hongrong Yu
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
| | - Jiangu Gong
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
| | - Ling Lan
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
| | - Lining Zhou
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
| | - Jichun Gong
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
| | - Peng Liu
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
| | - Lin Xu
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
- Guangxi Colleges and Universities Key Laboratory of Human Development and Disease Research, Guangxi Medical University, Nanning, China
| | - Qiongying Deng
- Department of Human Anatomy, Guangxi Medical University, Nanning, China
- Guangxi Colleges and Universities Key Laboratory of Human Development and Disease Research, Guangxi Medical University, Nanning, China
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Gender Difference of the Relationship between Arterial Stiffness and Blood Pressure Variability in Participants in Prehypertension. Int J Hypertens 2019; 2019:7457385. [PMID: 31341663 PMCID: PMC6614963 DOI: 10.1155/2019/7457385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/02/2019] [Accepted: 05/28/2019] [Indexed: 12/15/2022] Open
Abstract
Aim. The association of pressure load with elasticity in vascular system has not been studied fully. We proposed a hypothesis whether gender could modify the association of blood pressure variability (BPV) and arterial stiffness assessed by carotid-femoral pulse wave velocity (CF-PWV) in prehypertensive patients. Methods. 24h ambulatory blood pressure monitoring (24h-ABPM) and CF-PWV were measured in 723 participants with prehypertension. Univariate and multivariate regression analyses of these clinical and biological parameters were performed in total population, male and female. Results. A total of 723 participants (mean age 59.76 ± 12.37years, male 329 and female 394) were enrolled into the study. Compared with female, body mass index (BMI), fasting plasma glucose (FPG), uric acid (UA), and homocysteine (HCY) were significantly higher (all p < 0.05). Arterial stiffness (CF-PWV, male versus female, 10.89 ± 2.50 versus 10.33 ± 2.13 m/s, p=0.004) and BPVs (male versus female, 24 h SBPV 13.2 ± 5.11 versus 13.03 ± 5.20; 24 h DBPV 10.34 ± 3.87 versus 9.64 ± 3.59; N SBPV 11.90 ± 6.60 versus 10.94 ± 4.79; N DBPV 9.64 ± 5.87 versus 8.20 ± 4.48, all p<0.05) were higher in male. Multivariable linear regression analysis showed that 24 h BPV were linearly and positively related to CF-PWV in total population (24h SBPV, B=0.033; 24 h DBPV, B=0.035, both P<0.05) and female (24h SBPV, B=0.041; 24h DBPV, B=0.067, both P<0.05) independent of traditional risk factors and medications. Conclusion. BPV was independently associated with arterial stiffness in total population and the relation was modified by gender. 24 h BPVs in prehypertensive patients were useful to identify the early arterial stiffness. Clinical Trials Registration. This trial was registered with Clinical Trials.gov Identifier: NCT02569268.
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Abstract
OBJECTIVES Evidence about sex differences in blood pressure (BP) at the time of acute stroke presentation is scarce. We aimed to summarize available data on sex differences in BP at the time of acute stroke presentation, including stratification by prior history of hypertension and stroke subtype. METHODS We performed a systematic literature search across MEDLINE and Embase, from inception to 21 December 2018, to identify all population-based observational studies that reported BP at the time of acute stroke presentation. We extracted data on patient demographics, stroke-type (ischaemic or haemorrhagic), stroke severity, vascular risk factors, and SBP and DBP at the time of stroke presentation. Wherever possible, data were pooled for meta-analysis with weighted mean difference (WMD) and corresponding 95% confidence intervals (CI) using random effects meta-analysis. RESULTS We included 128 138 stroke patients from 43 studies. Women had higher SBP at presentation than men (WMD, 1.46; 95% CI, 0.65-2.26); this difference was significant in ischaemic stroke (1.49; 0.25-2.72 mmHg), but not in intracerebral haemorrhage (0.19; -4.21 to 4.59 mmHg). Meta regression show that sex differences in SBP were consistent with increasing age, stroke severity, other comorbidities and medication history. CONCLUSION This systematic review and meta-analysis indicates that women have higher SBP at the time of presentation with acute stroke. These differences are consistent with sex differences in hypertension patterns in older age, and may be explained by the fact that women are more likely to have a premorbid hypertension. This highlights the need for effective sex-specific blood pressure control in patients at high risk for stroke.
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Al Kibria GM, Burrowes V, Choudhury A, Sharmeen A, Swasey K. Sex differences in prevalence and associated factors of prehypertension and hypertension among Bangladeshi adults. Int J Cardiol Hypertens 2019; 1:100006. [PMID: 33447740 PMCID: PMC7803050 DOI: 10.1016/j.ijchy.2019.100006] [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: 02/08/2019] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 12/13/2022] Open
Abstract
Globally, complications of raised blood pressure are fundamental public health issues. There has been limited research if prevalence and risk factors vary by sex in many countries, including Bangladesh. We stratified the prevalence and associated factors of prehypertension and hypertension according to sex in Bangladesh. This cross-sectional study analyzed the Bangladesh Demographic and Health Survey 2011 data. After estimating prevalence according to sex, multilevel logistic regression was applied to obtain associated factors. This study analyzed data of 3876 males and 3962 females aged ≥35 years. The prevalence of hypertension was 19.4% (95% confidence interval [CI]: 18.0-21.0) among males and 31.9% (95% CI: 30.1-33.6) among females. Among both males and females, prevalence and odds of hypertension increased with age, overweight/obesity, diabetes, upper wealth status, and residence in some divisions. Education level was a significant positive correlate of hypertension for males only. Males and females had similar prevalence of prehypertension, 27.2% (95% CI: 25.6-28.8) and 27.6% (95% CI: 26.0-29.2), respectively. Characteristics such as older age, overweight/obesity, and diabetes were associated with higher prevalence and odds of prehypertension among females; prehypertension among males was associated with advancing age, overweight/obesity, education level, wealth status, and division of residence. In Bangladesh, almost half of the males and females could have increased risks of complications resulting from hypertension and prehypertension. Addressing the characteristics associated with higher prevalence or odds of these conditions is crucial. Several common risk factors indicate that a common prevention and control strategy could work for both sexes.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Vanessa Burrowes
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Allysha Choudhury
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Atia Sharmeen
- School of Community Health and Policy, Morgan State University, Baltimore, MD 21251, USA
| | - Krystal Swasey
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
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Kim J, Kim J, Kang Y. Noodle consumption is positively associated with incident hypertension in middle-aged and older Korean women. Nutr Res Pract 2019; 13:141-149. [PMID: 30984358 PMCID: PMC6449545 DOI: 10.4162/nrp.2019.13.2.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/02/2018] [Accepted: 01/03/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND/OBJECTIVES This study examined the association between refined grain consumption by subtype and the incidence of hypertension from the Korean Genome and Epidemiology Study data. SUBJECTS/METHODS In total, 5,018 participants (2,439 men and 2,579 women) from 40 to 69 years without hypertension were recruited at the beginning (2001–2002). Blood pressure and antihypertensive medication use were assessed biennially for the incidence of hypertension during the 8-year follow-up period (2009–2010). Hypertension was diagnosed as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or antihypertensive medication use. Dietary intake including refined grains was assessed by a food frequency questionnaire at baseline and the follow-up (2005–2006). A multivariate Cox proportional hazard model was used to examine hazard ratios (HRs) and 95% confidence intervals (CIs) for incident hypertension according to refined-grain consumption. RESULTS A total of 1,377 cases of hypertension (710 men and 667 women) were newly ascertained. Frequent noodle consumers (≥ 5 servings/week) among the women had a 2.3-fold higher risk of hypertension than infrequent noodle consumers after adjustment for potential confounders (HR = 2.31, 95% CI = 1.33–4.01, P for trend = 0.0001). However, no significant association was found among the men. The intake of other refined grain products such as white rice and breads was not associated with the incidence of hypertension. CONCLUSIONS Frequent noodle consumption was positively associated with a risk of incident hypertension in South Korean women.
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Affiliation(s)
- Jiwon Kim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Gyeonggi 17104, Republic of Korea
| | - Jihye Kim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Gyeonggi 17104, Republic of Korea
| | - Yunhee Kang
- Center for Human Nutrition, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
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