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Prentice A, Jarjou LM, Goldberg GR, Schoenbuchner SM, Moore SE, Ward KA, Cole TJ. Effects of maternal calcium supplementation on offspring blood pressure and growth in childhood and adolescence in a population with a low-calcium intake: follow-up study of a randomized controlled trial. Am J Clin Nutr 2024; 119:1443-1454. [PMID: 38839195 PMCID: PMC11196864 DOI: 10.1016/j.ajcnut.2024.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The World Health Organization recommends calcium supplementation (1500-2000 mg/d) during pregnancy for women with a low-calcium intake. OBJECTIVES The purpose of this study was to investigate whether pregnancy calcium supplementation affects offspring blood pressure and growth in The Gambia where calcium intakes are low (300-400 mg/d). METHODS Follow-up of offspring born during a randomized controlled trial of pregnancy calcium supplementation (ISRCTN96502494, 1996-2000) in which mothers were randomly assigned to 1500 mg Ca/d (Ca) or placebo (P) from 20 wk pregnancy to delivery. Offspring were enrolled at age 3 y in studies where blood pressure and anthropometry were measured under standardized conditions at approximately 2-yearly intervals. Mean blood pressure and growth curves were fitted for females and males separately, using the longitudinal SuperImposition by Translation and Rotation (SITAR) mixed effects model. This generates 3 individual-specific random effects: size, timing, and intensity, reflecting differences in size, age at peak velocity, and peak velocity through puberty relative to the mean curve, respectively. RESULTS Five hundred twenty-three singleton infants were born during the trial (maternal group assignment: Ca/P = 259/264). Four hundred ninety-one were enrolled as children (females: F-Ca/F-P = 122/129 and males: M-Ca/M-P = 119/121) and measured regularly from 3.0 y to mean age 18.4 y; 90% were measured on ≥8 occasions. SITAR revealed differences in the systolic blood pressure and height curves between pregnancy supplement groups in females, but not in males. F-Ca had lower systolic blood pressure than F-P at all ages (size = -2.1 ± SE 0.8 mmHg; P = 0.005) and lower peak height velocity (intensity = -2.9 ± SE 1.1%, P = 0.009). No significant pregnancy supplement effects were seen for other measures. CONCLUSIONS This study showed, in female offspring, that pregnancy calcium supplementation may lower systolic blood pressure and slow linear growth in childhood and adolescence, adding to evidence of offspring sexual dimorphism in responses to maternal supplementation. Further research is warranted on the long-term and intergenerational effects of antenatal supplementations. This trial was registered at ISRCTN Registry as ISRCTN96502494.
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Affiliation(s)
- Ann Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom; MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
| | - Landing Ma Jarjou
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia
| | - Gail R Goldberg
- MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom
| | - Simon M Schoenbuchner
- MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom; Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sophie E Moore
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; Department of Women and Children's Health, Kings College London, London, United Kingdom
| | - Kate A Ward
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Tim J Cole
- Department of Population, Policy and Practice Research and Teaching, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Konlan KD, Konlan KD, Abdulai JA, Saah JA, Doat AR, Amoah RM, Mohammed I. The relationship between trust, belief and adherence among patients who complain of hypertension in Ghana. Nurs Open 2023; 10:6205-6214. [PMID: 37211746 PMCID: PMC10415991 DOI: 10.1002/nop2.1855] [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: 04/26/2022] [Revised: 04/30/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023] Open
Abstract
AIM We determined the relationship between trust, belief and adherence among patients who complain of hypertension in Ghana. DESIGN A cross-sectional design was used. METHOD We sampled 447 Ghanaians with hypertension receiving care at the Korle Bu Teaching Hospital. Data were collected using a pre-tested self-administered questionnaire. Data analyses were conducted with the aid of Stata 15.0. RESULTS There is low belief and trust in the biomedical treatment for hypertension. Only 36.9% of the respondents said they adhered to treatment with females expressing higher level of adherence. Trust and belief in allopathic care were associated with adherence to treatment. It is recommended that health workers identify effective ways of improving patients' trust in the allopathic care for hypertension through teaching and re-enforcement models to enhance treatment adherence and reduce the complications of hypertension. Patient or Public Contribution.
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Affiliation(s)
- Kennedy Dodam Konlan
- Department of Adult Health, School of Nursing and MidwiferyUniversity of GhanaLegonGhana
| | - Kennedy Diema Konlan
- Department of Public Health Nursing, School of Nursing and MidwiferyUniversity of Health and Allied SciencesHoGhana
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Ojangba T, Boamah S, Miao Y, Guo X, Fen Y, Agboyibor C, Yuan J, Dong W. Comprehensive effects of lifestyle reform, adherence, and related factors on hypertension control: A review. J Clin Hypertens (Greenwich) 2023. [PMID: 37161520 DOI: 10.1111/jch.14653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 05/11/2023]
Abstract
Despite the effectiveness of currently available antihypertensive medications, there is still a need for new treatment strategies that are more effective in certain groups of hypertensive and for additional resources to combat hypertension. However, medication non-adherence was previously recognized as a major problem in the treatment of hypertension. The mechanisms behind the positive impacts of lifestyle changes might occur in different ways. In comparison with other studies, the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials. However, in this review, the attitudinal lifestyle modifications and barriers to blood pressure control were elaborated on. An effective method for reducing blood pressure (BP) and preventing cardiovascular events with antihypertensive medications has been outlined. Maintaining healthy lifestyle factors (body mass index, diet, smoking, alcohol consumption, sodium excretion, and sedentary behavior) could lower systolic blood pressure BP by 3.5 mm Hg and reduce the risk of cardiovascular disease (CVD) by about 30%, regardless of genetic susceptibility to hypertension. Conducting a lifestyle intervention using health education could improve lifestyle factors, such as reducing salt, sodium, and fat intake, changing eating habits to include more fruits and vegetables, not smoking, consuming less alcohol, exercising regularly, maintaining healthy body weight, and minimizing stressful conditions. Each behavior could affect BP by modulating visceral fat accumulation, insulin resistance, the renin-angiotensin-aldosterone system, vascular endothelial function, oxidative stress, inflammation, and autonomic function. Evidence of the joint effect of antihypertensive medications and lifestyle reforms suggests a pathway to reduce hypertension.
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Affiliation(s)
- Theodora Ojangba
- Department of Social Science and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
- Henan Research Center for HTA, Zhengzhou, China
- Department of Food Science and Technology, University for Development Studies, Tamale, Ghana
| | - Solomon Boamah
- Department of Food Science and Technology, University for Development Studies, Tamale, Ghana
- College of Plant Protection, Gansu Agricultural University, Lanzhou, China
| | - Yudong Miao
- Department of Social Science and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
- Henan Research Center for HTA, Zhengzhou, China
| | - Xinghong Guo
- Department of Social Science and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
- Henan Research Center for HTA, Zhengzhou, China
| | - Yifei Fen
- Department of Social Science and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
- Henan Research Center for HTA, Zhengzhou, China
| | - Clement Agboyibor
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Jingjing Yuan
- College of Plant Protection, Gansu Agricultural University, Lanzhou, China
| | - Wenyong Dong
- Department of Hypertension, People's Hospital of Zhengzhou University, Zhengzhou, China
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Batte A, Gyagenda JO, Otwombe K, Muhindo R, Bagasha P, Kiggundu D, Aujo JC, Atuhe DM, Kansiime G, Hussein R, Namuyimbwa L, Mukasa SL, Kabuye A, Mukasa J, Sekasanvu E, Kalyesubula R. Prevalence and predictors of hypertension among adults in Mbarara City, Western Uganda. Chronic Illn 2023; 19:132-145. [PMID: 34786975 DOI: 10.1177/17423953211058408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The study aim was to evaluate the prevalence and predictors of hypertension among an urban adult population in Mbarara city, Western Uganda. METHODS We evaluated blood pressure measurements, social demographic and clinical parameters of adults living in Mbarara city, Uganda. These parameters were extracted from medical records of adults who participated in the Uganda World Kidney Day 2020 health screening activities. A total of 302 adults were evaluated for hypertension using the American College of Cardiology/American Heart Association 2017 (blood pressure threshold 130/80 mmHg) and International Society of Hypertension 2020 guidelines (threshold 140/90 mmHg). RESULTS The mean age of the participants was 42.5 years (standard deviation: 15.1) and majority were male 195/302 (64.6%). Using American College of Cardiology/American Heart Association 2017 guidelines, 156/302 (51.7%) adults were newly diagnosed with hypertension compared to 68/302 (22.5%) newly diagnosed with hypertension using International Society of Hypertension 2020 guidelines. Only 23/302 (7.6%) were on treatment. Based on American College of Cardiology/American Heart Association 2017 guidelines, age ≥40 years and overweight/obesity were statistically significant predictors of hypertension (p < 0.05 for all) at multivariate analysis. Using the International Society of Hypertension 2020 guidelines, age ≥40 years predicted hypertension. DISCUSSION The prevalence of hypertension is high among this urban adult population irrespective of the guidelines used, highlighting the need for hypertension prevention interventions.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Joseph Ogavu Gyagenda
- Nephrology Unit, Department of Medicine, 281437St Francis Hospital Nsambya Kampala, Kampala, Uganda.,Uganda Martyrs University School of Medicine, Kampala, Uganda
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, 37708University of the Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, Faculty of Health Sciences, 37708University of the Witwatersrand, South Africa
| | - Rose Muhindo
- Department of Internal Medicine, 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Peace Bagasha
- Department of Nephrology, 249321Mulago National Referral Hospital, Kampala, Uganda
| | - Daniel Kiggundu
- Department of Nephrology, 249321Mulago National Referral Hospital, Kampala, Uganda
| | - Judith Caroline Aujo
- Department of Nephrology, 249321Mulago National Referral Hospital, Kampala, Uganda
| | - David Martin Atuhe
- Nephrology Unit, Department of Medicine, 281437St Francis Hospital Nsambya Kampala, Kampala, Uganda
| | - Grace Kansiime
- Department of Nephrology, 249321Mulago National Referral Hospital, Kampala, Uganda
| | | | - Lydia Namuyimbwa
- Department of Physiology, 323124Kabale University, Kabale, Uganda
| | | | | | - Joseph Mukasa
- 585446Health Life promotion Africa, Limited, Kampala, Uganda
| | | | - Robert Kalyesubula
- Department of Physiology, 58589Makerere University College of Health Sciences, Kampala, Uganda
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Sáiz-Vazquez O, Puente-Martínez A, Pacheco-Bonrostro J, Ubillos-Landa S. Blood pressure and Alzheimer's disease: A review of meta-analysis. Front Neurol 2023; 13:1065335. [PMID: 36712428 PMCID: PMC9874700 DOI: 10.3389/fneur.2022.1065335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Background Alzheimer's disease (AD) is a neurological disorder of unknown cause, resulting in the death of brain cells. Identifying some of the modifiable risk factors for AD could be crucial for primary prevention and could lead to a reduction in the incidence of AD. Objective This study aimed to perform a meta-meta-analysis of studies in order to assess the effect of blood pressure (BP) on the diagnosis of AD. Method The search was restricted to meta-analyses assessing high systolic BP (SBP) and diastolic BP (DBP) and AD. We applied the PRISMA guidelines. Results A total of 214 studies were identified from major databases. Finally, five meta-analyses (52 studies) were analyzed in this review. Results confirm that high SBP is associated with AD. The exploration of parameters (sex, age, study design, region, and BP measurements) shows that only region significantly moderates the relationship between BP and AD. Asian people are those whose SBP levels >140 mmHg are associated with AD. BP is associated with AD in both people aged ≤65 years and those aged ≥65 years and in cross-sectional and longitudinal studies. In the case of DBP, only women are at a higher risk of AD, particularly when its levels are >90. Conclusion SBP is associated with both cerebrovascular disease and AD. Therefore, future studies should use other uncontrolled factors, such as cardiovascular diseases, diabetes, and stroke, to explain the relationship between SBP and AD.
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Affiliation(s)
- Olalla Sáiz-Vazquez
- Department of Occupational Therapy, Faculty of Health Science, University of Burgos, Burgos, Spain
| | - Alicia Puente-Martínez
- Department of Social Psychology and Anthropology, Faculty of Social Sciences, University of Salamanca (USAL), Salamanca, Spain
| | - Joaquín Pacheco-Bonrostro
- Department of Applied Economy, Faculty of Economics and Business Sciences, University of Burgos, Burgos, Spain
| | - Silvia Ubillos-Landa
- Department of Social Psychology, Faculty of Health Science, University of Burgos, Burgos, Spain,*Correspondence: Silvia Ubillos-Landa ✉
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Wei L, Hu S, Gong X, Ahemaiti Y, Zhao T. Diagnosis of covert coarctation of the aorta in adolescents. Front Pediatr 2023; 11:1101607. [PMID: 37025297 PMCID: PMC10070858 DOI: 10.3389/fped.2023.1101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Objectives By reviewing the diagnostic process for adolescents with coarctation of the aorta (CoA) in our institution, we analyzed the reasons for delayed diagnosis of CoA. We also proposed a diagnostic protocol to improve the detection rate of CoA. Methods In this retrospective study, we included 48 patients aged 12-18 years who were diagnosed with CoA in our hospital from January 2000 to November 2022. Clinical data from involved cases in local hospitals and our institution were collected. Results All patients had blood pressure (BP) measurements in upper and lower extremities in our institution. They all had hypertension, 29 (60.4%) of whom had known histories of the same. BP in the upper limbs of 47 (97.9%) patients was ≥20 mmHg higher than that in the lower limbs, and BP in the upper limb of 1 (2.1%) patient was greater than 0 and less than 20 mmHg than that in the lower limb. Echocardiography (ECHO) was performed in all patients, computed tomography (CT) or magnetic resonance imaging (MRI) was performed in 44 patients (91.7%). There were 38 (79.2%) patients who visited local hospitals. Among them, a total of 20 (52.6%) patients had their right upper extremity BP measured, 18 (47.4%) only had their left upper extremity BP measured, and 16 (42.1%) had their lower extremity BP measured. ECHO was performed in 27 (56.2%) patients and CT/MRI was performed in 18 (37.5%) patients. The detection rate for CT/MRI was 100%, and those of ECHO were 72.9% and 18.5% at our institution and a local hospital, respectively. Forty-eight (100%) and 23 (60.5%) patients were detected in our institution and local hospitals (P < 0.0001). Conclusion We recommend measuring BP in the bilateral upper extremities. Measurement of BP in the lower extremities is recommended if hypertension is diagnosed. MRI/CT is recommended when BP in the upper extremity is greater than that in the lower extremity.
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Estimating the changing burden of disease attributable to high sodium intake in South Africa for 2000, 2006 and 2012. S Afr Med J 2022; 112:627-638. [DOI: 10.7196/samj.2022.v112i8b.16490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 11/08/2022] Open
Abstract
Background. Elevated sodium consumption is associated with increased blood pressure, a major risk factor for cardiovascular and chronic kidney disease.Objectives. To quantify the deaths and disability-adjusted life years (DALYs) attributed to high sodium intake in persons aged ≥25 years in South Africa (SA) for 2000, 2006 and 2012.Methods. Comparative risk assessment (CRA) methodology was used and population attributable fractions (PAFs) of high sodium intake, mediated through high blood pressure (BP), for cardiovascular and chronic kidney disease were estimated. This was done by taking the difference between the PAF for elevated systolic BP (SBP) based on the estimated SBP level in the population and the PAF based on the estimated SBP that would result if sodium intake levels were reduced to the theoretical minimum risk exposure level (1 g/day) according to population group and hypertension categories. A meta-regression based on data from nine national surveys conducted between 1998 and 2017 was used to estimate the prevalence of hypertension by age, sex and population group. Relative risks identified from international literature were used and the difference in PAFs was applied to local burden estimates from the second South African National Burden of Disease Study. Age-standardised rates were calculated using World Health Organization (WHO) standard population weights. The attributable burden was also estimated for 2012 using an alternative target of 2 g/day proposed in the National Strategic Plan for the Prevention and Control of Non-communicable Diseases (NSP).Results. High sodium intake as mediated through high SBP was estimated to cause 8 071 (95% uncertainty interval (UI) 6 542 - 15 474) deaths in 2012, a drop from 9 574 (95% UI 8 158 - 16 526) in 2006 and 8 431 (95% UI 6 972 - 14 511) in 2000. In 2012, ischaemic heart disease caused the highest number of deaths in persons (n=1 832), followed by haemorrhagic stroke (n=1 771), ischaemic stroke (n=1 484) and then hypertensive heart disease (n=1 230). Ischaemic heart disease was the highest contributor to deaths for males (27%), whereas for females it was haemorrhagic stroke (23%). In 2012, 1.5% (95% UI 1.3 - 2.9) of total deaths and 0.7% (95% UI 0.6 - 1.2) of total DALYs were attributed to high sodium intake. If the NSP target of <2 g/day sodium intake had been achieved in 2012, ~2 943 deaths and 48 870 DALYs would have been averted.Conclusion. Despite a slight decreasing trend since 2006, high sodium intake mediated through raised BP accounted for a sizeable burden of disease in 2012. Realising SA’s target to reduce sodium intake remains a priority, and progress requires systematic monitoring and evaluation.
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Das S, Debnath M, Das S, Sarkar S, Rumana AS. Association of overweight and obesity with hypertension, diabetes and comorbidity among adults in Bangladesh: evidence from nationwide Demographic and Health Survey 2017-2018 data. BMJ Open 2022; 12:e052822. [PMID: 35793916 PMCID: PMC9260812 DOI: 10.1136/bmjopen-2021-052822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The study aimed to determine the association of overweight and obesity with hypertension, diabetes and comorbidity among the adults of Bangladesh. STUDY DESIGN This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017-2018. The main outcome variables were hypertension, diabetes and comorbidity. Comorbidity was defined as the coexistence of hypertension and diabetes. Overweight and obesity, as measured by body mass index, were the main explanatory variables. The strength of the association was determined using the adjusted multiple logistic regression models. SETTING Rural and urban areas in Bangladesh. PARTICIPANTS The study included a total of 11 881 adults (5241 men and 6640 women) aged 18 years or older. RESULTS The prevalence of hypertension, diabetes and comorbidity among the sample population were 28.5%, 9.9% and 4.5%, respectively. Among the respondents, 20.1% were overweight and 4.1% were obese. The risk of hypertension was 2.47 times more likely in the overweight group (adjusted OR (AOR) 2.47; 95% CI 2.22 to 2.75) and 2.65 times more likely in the obese group (AOR 2.65; 95% CI 2.16 to 3.26) compared with the normal or underweight group. Adults who were overweight and obese had 59% (AOR 1.59; 95% CI 1.37 to 1.84) and 88% (AOR 1.88; 95% CI 1.46 to 2.42) higher odds of having diabetes, respectively, than normal or underweight adults. Moreover, the risk of comorbidity was 2.21 times higher in overweight adults (AOR 2.21; 95% CI 1.81 to 2.71) and 2.86 times higher in obese adults (AOR 2.86; 95% CI 2.09 to 3.91) compared with normal or underweight adults. CONCLUSIONS Using large-scale nationally representative data, we found that overweight and obesity were significantly associated with hypertension, diabetes and comorbidity. So, nationally representative data can be used for programme planning to prevent and treat these chronic conditions.
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Affiliation(s)
- Sukanta Das
- Department of Statistics, Begum Rokeya University, Rangpur, Bangladesh
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Manabika Debnath
- Department of Marketing, Begum Rokeya University, Rangpur, Bangladesh
| | - Sunanda Das
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
- Department of Management Science and Statistics, The University of Texas, San Antonio, Texas, USA
| | - Snigdha Sarkar
- Department of Statistics, Begum Rokeya University, Rangpur, Bangladesh
| | - Afrin Sadia Rumana
- Department of Business Administration in Accounting and Information Systems, Faculty of Business Studies, Bangladesh University of Professionals, Dhaka, Bangladesh
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Exploring the type of social support available to aged male hypertensive clients in Ghana. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
To explores the social support available to aged hypertensive male clients in a municipality in Ghana.
Methods
The inclusion criteria were as follows: age ≥60 years and are known hypertensive patients. Data were collected from 186 selected aged male hypertensive patients for 3 months. The questionnaire was self-developed and open-ended. The data were processed and analyzed using SPSS version 23. Some of the variables were subjected to statistical tests and ranks in the order of importance to respondents. The enrolled respondents were allowed to participate in the study after their informed consent was obtained. It was evident that respondents do not obtain much support or help in taking care of their condition.
Results
The result revealed that the repondents has no support to help take care of their condition as evident by the responses in the study. The scores on average mean for some variables are (AM = 2.25, SD = 0.381) more than the test value of 2.50. Some of these supports were on feeding support (M = 3.97, SD = 0.278, n = 186), health support (M = 2.87, SD = 0.167, n = 186), and cleaning support (M = 2.59, SD = 0.868, n = 186). Supports such as clothing, socialization, medication, washing, transportation, and financial support were lacking.
Conclusions
Based on the finding that certain forms of support were lacking, the study concludes that steps undertaken by the government, community, religious bodies, and family toward improving these supports can be of immense help for aged male hypertensive patients living in the Ejura-Sekyedumase municipality.
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Prevalence, trends and associated factors of hypertension and diabetes mellitus in Bangladesh: Evidence from BHDS 2011 and 2017–18. PLoS One 2022; 17:e0267243. [PMID: 35503777 PMCID: PMC9064112 DOI: 10.1371/journal.pone.0267243] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/04/2022] [Indexed: 12/12/2022] Open
Abstract
The evolving pandemic of non-communicable diseases like hypertension, diabetes mellitus are globally on the rise, and the trend is also escalating in Bangladesh. We aimed to assess the prevalence trend and associated factors of hypertension (HTN), diabetes mellitus (DM), and hypertension- diabetes mellitus combined (HDC) among Bangladeshi adults from 2011 to 2018. Two nationally representative cross-sectional data from Bangladesh Demographic and Health Survey (BDHS): 2011 and 2017–18 were utilized. According to baseline characteristics, the average annual rate of change (AARC) was applied to quantify the annual rate of increase/decrease in HTN, DM, and HDC from 2011 to 2018. The prevalence ratios of HTN, DM, and HDC were assessed through modified Poisson regression with robust error variance (PR, 95% Confidence Interval (CI)). The data were prepared in SPSS version 23 and exported to Stata version 13 for further analysis. Among 11,686 participants, the overall mean age of the study participants was 52.79 years, Standard Deviation (SD)±12.99, and 42.28% were female. From 2011–2018, HTN, DM, and HDC prevalence in Bangladesh has increased by 13, 3.2, and 3.1 percentage points, respectively. The average annual rate of increase was observed in the HTN and HDC prevalence by all socio-economic and demographic categories during 2011–2018. The prevalence of HDC among Chittagong residents was approximately double in 2018: 3.95% (2011) versus 6.59% (2018). Increased age, inactive workers, overweight adults, and adults in wealthy families were common risk factors associated with HTN, DM, and HDC in Bangladesh. The prevalence of developing HTN and HDC was significantly higher among adults aged ≥ 70 years (PR: 2.70, 95% CI: 2.42–3.00; PR: 2.97, 95% CI: 2.08–4.24, respectively). A comprehensive approach of different stakeholders is required to develop appropriate strategies, including appropriate weight management, adequate physical activity, and healthier food habits. Health agencies should take initiatives to spread awareness among people at an early age, but special attention is needed for older people and those at risk for NCDs.
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Calas L, Subiros M, Ruello M, Hassani Y, Gabet A, Angue M, Pointeau O, Olié V, Grave C. Hypertension prevalence, awareness, treatment and control in 2019 in the adult population of Mayotte. Eur J Public Health 2022; 32:408-414. [PMID: 35195255 PMCID: PMC9159308 DOI: 10.1093/eurpub/ckac015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Mayotte is a French overseas territory with significant socio-economic and health challenges. This study updates the prevalence of hypertension in Mayotte to estimate the awareness, treatment and control of this disease and identify any associated factors. METHODS Data were taken from the cross-sectional Unono Wa Maore survey conducted in Mayotte in 2019. Analyses were based on the adult population aged 18-69 years who underwent a clinical examination with at least two blood pressure measurements (n = 2620). RESULTS In 2019, the prevalence of hypertension was estimated at 38.4% (36.1-40.7%) in the Mayotte population aged 18-69 years. The prevalence was similar in men (38.5%) and women (38.3%; P = 0.95). The prevalence of certain risk factors was high, with 75% of hypertensives being overweight or obese, 13% reporting diabetes and 69% being occupationally inactive. Among the hypertensives, 48% was aware of their diagnosis, with women more likely to be aware than men (P < 0.0001). Of those who were aware, 45% were treated pharmacologically and 49% reported engaging in physical activity to lower their blood pressure. The control rate was 30.2% among pharmacologically treated hypertensives. Overall, 80% of hypertensive patients had too high blood pressure during the survey's clinical examination. CONCLUSION The prevalence of hypertension remains high in Mayotte, where certain risk factors like obesity are particularly common in the population. Awareness, treatment and control remain insufficient. Primary prevention measures, access to a healthy food, and screening and treatment of hypertension should be encouraged by targeting the most affected populations.
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Affiliation(s)
- Lucinda Calas
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Marion Subiros
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Marc Ruello
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Youssouf Hassani
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Amélie Gabet
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Marion Angue
- Department of Cardiology, Centre Hospitalier de Mayotte, Mamoudzou, France
| | - Odile Pointeau
- Department of Cardiology, Centre Hospitalier de Mayotte, Mamoudzou, France
| | - Valérie Olié
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
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12
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Prihartono NA, Fitria L, Ramdhan DH, Fitriyani F, Fauzia S, Woskie S. Determinants of Hypertension amongst Rice Farmers in West Java, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1152. [PMID: 35162176 PMCID: PMC8834778 DOI: 10.3390/ijerph19031152] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 02/01/2023]
Abstract
The hypertension rate in Indonesia has increased significantly in the past five years, but there is limited information about the hypertension risk of farmers. Our study assesses the prevalence of hypertension in this population and examines the proportional risk of various work environment and lifestyle factors among farmers. A cross-sectional study was conducted in high and low heat stress agriculture areas of West Java, Indonesia. There were 354 male farmers aged 25 to 73 years old who participated in the study. We measured blood pressure and used a questionnaire on self-reported use of anti-hypertension drugs or diagnosis by a medical professional to define hypertension. We assessed occupational factors including farming methods, heat stress and pesticide use, and personal factors including obesity, food intake, smoking status, alcohol consumption. Multivariate analysis was used to evaluate factors potentially associated with prevalence of hypertension. Forty-six percent of farmers experience hypertension. Farming in a location with higher heat stress (WBGT) was significantly associated with increased risk of hypertension (adjusted prevalence ratio (aPR) 1.41, 95% confidence interval (CI) 1.01, 1.95). Farmers who used pesticide sprayers had an increased risk of hypertension (aPR 1.90, 95% CI 0.93, 3.87). No personal/lifestyle characteristics were significantly associated with hypertension, although ever smoking and ever consuming alcohol had an increased prevalence of hypertension. This study shows the importance of work environmental factors in the prevalence of hypertension and the necessity of public health education, identification and treatment of this "silent killer" among Indonesian farmers.
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Affiliation(s)
| | - Laila Fitria
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia; (L.F.); (S.F.)
| | - Doni Hikmat Ramdhan
- Department of Occupational Health and Safety, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia;
| | - Fitriyani Fitriyani
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia;
| | - Sifa Fauzia
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia; (L.F.); (S.F.)
| | - Susan Woskie
- Department of Public Health, University of Massachusetts Lowell, One University Ave, Lowell, MA 01854-2867, USA;
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13
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Appiah F, Ameyaw EK, Oduro JK, Baatiema L, Sambah F, Seidu AA, Ahinkorah BO, Budu E. Rural-urban variation in hypertension among women in Ghana: insights from a national survey. BMC Public Health 2021; 21:2150. [PMID: 34819048 PMCID: PMC8611890 DOI: 10.1186/s12889-021-12204-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background Hypertension is one of the leading causes of cardiovascular morbidities in Ghana and represents a major public health concern. There is dearth of information on the rural-urban disparity in hypertension among women in Ghana. Therefore, this study aimed at examining the rural-urban variation in hypertension among women in Ghana. Methods We extracted data from the women’s file of the 2014 Ghana Demographic and Health Survey. The sample included 9333 women aged 15–49 with complete data on hypertension. The analysis was done using Pearson Chi-square and binary logistic regression at 95% confidence interval. The results of the binary logistic regression were presented as Odds Ratios (ORs) and Adjusted Odds Ratios (AORs). Statistical significance was set at p < 0.05. Results Hypertension prevalence among urban and rural residents were 9.5% and 5.1% respectively. Rural women had lower odds of hypertension [OR = 0.59; 95% CI = 0.52, 0.67] compared to urban women, however, this was insignificant in the adjusted model [aOR = 0.84; 95% CI = 0.70, 1.00]. The propensity to be hypertensive was lower for women aged 15–19 [aOR = 0.07; 95% CI = 0.05, 0.11]. The poorest were less likely to be hypertensive [aOR = 0.63; 95% CI = 0.45, 0.89]. Single women were also less probable to have hypertension [aOR = 0.66; 95% CI = 0.46, 0.97]. Conclusions Women from urban and rural areas shed similar chance to be hypertensive in Ghana. Therefore, the health sector needs to target women from both areas of residence (rural/urban) when designing their programmes that are intended to modify women’s lifestyle in order to reduce their risks of hypertension. Other categories of women that need to be prioritised to avert hypertension are those who are heading towards the end of their reproductive age, richest women and the divorced.
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Affiliation(s)
- Francis Appiah
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana. .,Department of Social Sciences, Berekum College of Education, Berekum, Bono Region, Ghana.
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Joseph Kojo Oduro
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Linus Baatiema
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana.,Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana
| | - Francis Sambah
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Department of Estate Management, Takoradi Technical University, Takoradi, Ghana.,Centre For Gender and Advocacy, Takoradi Technical University, P. O. Box 256, Takoradi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Eugene Budu
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana
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14
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Heizhati M, Li N, Wang L, Hong J, Li M, Yang W, Yao L, Lin M, Pan F, Yang Z, Wang Z, Abudereyimu R. Association of Hypertension with Mild Cognitive Impairment in Population from Less-Developed Areas of Multiethnic Northwest China. Neuroepidemiology 2021; 55:407-415. [PMID: 34515156 DOI: 10.1159/000517956] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Relationship between hypertension and mild cognitive impairment (MCI) remains undetermined in population from less-developed regions. We aimed to explore whether hypertension is associated with MCI in this specific population. METHODS In this cross-sectional study, we enrolled subjects aged ≥18 years using multistage random sampling from Emin, China, in 2019. Participants underwent questionnaires and data collection including mini-mental state examination (MMSE) and blood pressure measurement. RESULTS Finally, 31,329 subjects were included, with 11,270 hypertensives. Compared with normotensive subjects, hypertensives were characterized by significantly older age (55.19 ± 12.25 vs. 43.26 ± 12.71), more men (52.5% vs. 42.9%), low education attainment (≤primary education: 42.4% vs. 26.3%), more abdominal obesity (39.7% vs. 19.1%), poor sleep quality (39.1% vs. 28.7%), and chronic kidney disease (6.6% vs. 3.4%, p for all <0.001). Prevalence of MCI in hypertensives was significantly higher than that of normotensive subjects (24.3% vs. 15.6%, p < 0.001). Multivariate logistic regression analysis showed in a fully adjusted model that the odds for MCI were significantly increased in hypertensives than in normotensive population (OR = 1.19, 95% CI: 1.09, 1.30, p < 0.001) and independent of all the parameters studied including age, education level, and stroke. In the age-stratified regression model, presence of hypertension significantly increased the odds of MCI by 1.17-fold (95% CI: 1.03, 1.33, p = 0.020) and by 1.22-fold (95% CI: 1.04, 1.44, p = 0.016) in middle-aged and elderly population. Sensitivity analysis of excluding those with stroke history showed that hypertension was still a risk factor for MCI in total, middle-aged, and elderly population. CONCLUSION Hypertension is in independent negative association with MCI in middle-aged and elderly population from underdeveloped regions.
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Affiliation(s)
- Mulalibieke Heizhati
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Lin Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Jing Hong
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Mei Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Wenbo Yang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Ling Yao
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Mengyue Lin
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Fengyu Pan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Zhikang Yang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Zhongrong Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Reyila Abudereyimu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
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15
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Memiah P, Nkinda L, Majigo M, Opanga Y, Humwa F, Inzaule S, Abubakar M, Oduor P, Zuheri A, Lema S, Kamau A, Baribwira C, Biadgilign S. Hypertension and Associated Inflammatory Markers Among HIV-Infected Patients in Tanzania. J Interferon Cytokine Res 2021; 41:291-301. [PMID: 34410876 DOI: 10.1089/jir.2021.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
There remains a dearth of data regarding the association between chronic inflammation and hypertension (HTN) in sub-Saharan Africa, a region that accounts for >70% of the global burden of HIV infection. Therefore, we assessed the levels of biomarkers among HIV+ individuals and its associations with HTN in Tanzania. A cross-sectional study was conducted at one of the largest clinics in Tanzania and data from 261 HIV+ patients were analyzed. Standardized tools were used to collect data. Blood pressure was measured using Omron® M2 blood pressure monitor. Enzyme-linked immunosorbent assay was used to test for inflammatory markers [C-reactive protein (CRP), interleukin (IL)-6, IL-18, soluble tumor necrosis factor receptor type I (sTNFRI), sTNFRII]. Bivariate and multivariable analysis was conducted to examine association between the biomarkers and HTN. We further conducted age-sex-alcohol-adjusted models to control for any confounders. The prevalence of HTN was 43% with a high prevalence reported in female (70%) participants and those older than 55 years of age (77%). Being women, older than 55 years of age, married, and being overweight was associated with HTN. The highest correlations were observed between TNR2 and CRP (ɤ = 0.13, P = 0.044), and TNR2 and IL-18 (ɤ = 0.13, P = 0.034). Participants who had elevated CRP levels were 2 times more likely to experience HTN in the age-adjusted model [odds ratio (OR) = 3.5, 95% confidence interval (CI) = 1.1-11.3], age-sex-adjusted model (OR = 3.3, 95% CI = 1.0-10.9), and the full model (OR = 2.9, 95% CI = 0.8-10.0). Our study shows that high CRP levels are significantly associated with the higher prevalence of HTN notwithstanding all other markers, which showed a positive association with HTN despite not being significant. These findings point to the importance of creating awareness, education, and screening for HTN among HIV patients in high epidemic countries. More rigorous studies are needed to know the exact pathway mechanisms of inflammation in HIV patients.
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Affiliation(s)
- Peter Memiah
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lillian Nkinda
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Yvonne Opanga
- Department of Monitoring Evaluation and Research, Amref Health Africa, Nairobi, Kenya
| | - Felix Humwa
- Global Program for Research Teaching-University of California San Francisco, Nairobi, Kenya
| | - Seth Inzaule
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maghimbi Abubakar
- Center for International Health, Education, and Biosecurity (CIHEB), Institute of Human Virology, University of Maryland School of Medicine in Tanzania, Dar es Salaam, Tanzania
| | - Patience Oduor
- Center for International Health, Education, and Biosecurity (CIHEB), Institute of Human Virology, University of Maryland School of Medicine in Tanzania, Dar es Salaam, Tanzania
| | - Aisha Zuheri
- Infectious Disease Centre, Tanzania, Dar es Salaam, Tanzania
| | - Steven Lema
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Kamau
- Institute for Development Studies, University of Nairobi, Nairobi, Kenya
| | - Cyprien Baribwira
- PUniversity of Maryland School of Medicine in Rwanda, Kigali, Rwanda
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16
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Kataria Golestaneh A, Clarke JM, Appelbaum N, Gonzalvez CR, Jose AP, Philip R, Poulter NR, Beaney T. The factors influencing clinician use of hypertension guidelines in different resource settings: a qualitative study investigating clinicians' perspectives and experiences. BMC Health Serv Res 2021; 21:767. [PMID: 34344382 PMCID: PMC8336017 DOI: 10.1186/s12913-021-06782-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/07/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Hypertension accounts for the greatest burden of disease worldwide, yet hypertension awareness and control rates are suboptimal, especially within low- and middle-income countries. Guidelines can enable consistency of care and improve health outcomes. A small body of studies investigating clinicians' perceptions and implementation of hypertension guidelines exists, mostly focussed on higher income settings. This study aims to explore how hypertension guidelines are used by clinicians across different resource settings, and the factors influencing their use. METHODS A qualitative approach was employed using convenience sampling and in-depth semi-structured interviews. Seventeen medical doctors were interviewed over video or telephone call from March to August 2020. Two clinicians worked in low-income countries, ten in middle-income countries, and five in high-income countries. Interviews were recorded, transcribed, and coded inductively. Reflexive thematic analysis was used. RESULTS Themes were generated at three levels at which clinicians perceived influencing factors to be operating: healthcare worker, healthcare worker interactions with patients, and the wider health system. Within each level, influencing factors were described as barriers to and facilitators of guideline use. Variation in factors occurred across income settings. At the healthcare worker level, usability of guidelines, trust in guidelines, attitudes and views about guidelines' purpose, and relevance to patient populations were identified as themes. Influencing factors at the health system level were accessibility of equipment and medications, workforce, and access to healthcare settings. Influences at the patient level were clinician perceived patient motivation and health literacy, and access to, and cost of treatment, although these represented doctors' perceptions rather than patient perceived factors. CONCLUSIONS This study adds a high level global view to previous studies investigating clinician perspectives on hypertension guideline use. Guidelines should be evidence-based, regularly updated and attention should be given to increasing applicability to LMICs and a range of healthcare professionals.
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Affiliation(s)
- Amelia Kataria Golestaneh
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, W6 8RP, London, UK
| | - Jonathan M Clarke
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
| | - Nicholas Appelbaum
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Arun P Jose
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Richu Philip
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, W6 8RP, London, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, W6 8RP, London, UK.
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17
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Konkor I, Dogoli MA, Kuuire V, Wilson K. Examining the Relationship Between Occupational Physical Activity and Hypertension Status: Evidence from the Ghana WHO Study on Global Ageing and Adult Health. Ann Work Expo Health 2021; 65:1050-1060. [PMID: 34089319 DOI: 10.1093/annweh/wxab035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/18/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
The employment landscape has changed significantly over the past few years in emerging economies including Ghana where many people are rapidly transitioning from livelihood activities that originally involved physical exertion to work environments where performance of duties are mostly non-physical. Working under non-active conditions could, however, exacerbate the risk of developing chronic diseases that are increasingly becoming problematic in many developing countries. Drawing on a cross-sectional nationally representative sample data of 4425 adult Ghanaian workers collected by the WHO Study on Global Ageing and Adult Health in developing countries, we examined the relationship between occupational physical activity and hypertensive status. We employed the complementary log-log analysis technique to build nested models with results presented in odds ratios. After controlling for several relevant variables, the results show that performing sedentary related work (AOR = 1.23, CI = 1.06-1.42) is significantly associated with a higher likelihood of being hypertensive compared with those whose work involved moderate physical activity. Other factors that were significantly associated with being hypertensive included tobacco use (AOR = 1.33, CI = 1.05-1.70), living in an urban environment (AOR = 1.15, CI = 1.01-1.32), and being a female (AOR = 1.18, CI = 1.01-1.37) and being an older person. Policies on reducing the risk of developing chronic conditions especially hypertension need to recognize the contributions of the work environment in emerging developing economies.
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Affiliation(s)
- Irenius Konkor
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Maurice Anfaara Dogoli
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON N2L, Canada
| | - Vincent Kuuire
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, ON, Canada
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18
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Wang L, Li N, Heizhati M, Li M, Pan F, Yang Z, Wang Z, Abudereyimu R. Prevalence and predictive nomogram of depression among hypertensive patients in primary care: A cross-sectional study in less developed Northwest China. Medicine (Baltimore) 2021; 100:e24422. [PMID: 33530241 PMCID: PMC7850745 DOI: 10.1097/md.0000000000024422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/01/2021] [Indexed: 01/05/2023] Open
Abstract
Hypertensive patients commonly co-exist persistent depressive symptoms. However, these issues are not always identified, especially in primary health care, which may worsen the prognosis of hypertension. Therefore, the aim of this study was to determine the prevalence and risk factor of depression, and to develop risk nomogram of depression in hypertensive patients from primary health care Northwest China.We used a stratified multistage random sampling method to obtain 1856 hypertensives subjects aged ≥18 years in Xinjiang between April and October 2019. The subjects were randomly divided into a training set (n = 1299) and a validation set (n = 557). Depression was evaluated by Hospital Anxiety and Depression Scale (HADS), with a cut-off score ≥8. Using the least absolute shrinkage and selection operator (LASSO) regression model, we identified optimized risk factors of depression in the training set, followed by the establishment of prediction nomogram. The discriminative ability, calibration, and clinical usefulness of nomogram were assessed. The results were verified by internal validation in validation set.13.7% hypertensive subjects displayed depression. Seven independent risk factors of depression were identified and entered into the nomogram including age, region, ethnicity, marital status, physical activity, sleep quality, and control of hypertension. The nomogram displayed robust discrimination with an AUC of 0.760 [95% confidence interval (CI): 0.724-0.797)] and 0.761 (95%CI: 0.702-0.819), and good calibration in training set and validation set, respectively. The decision curve analysis and clinical impact curve demonstrated clinical usefulness of predictive nomogram.There is a considerable prevalence of depression in patients with hypertension from primary care of Xinjiang, Northwest China. Our nomogram may help primary care providers assess the risk of depression in patients with hypertension.
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Affiliation(s)
- Lin Wang
- Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research Urumqi, Xinjiang, China
| | - Nanfang Li
- Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research Urumqi, Xinjiang, China
| | - Mulalibieke Heizhati
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research Urumqi, Xinjiang, China
| | - Mei Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research Urumqi, Xinjiang, China
| | - Fengyu Pan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research Urumqi, Xinjiang, China
| | - Zhikang Yang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research Urumqi, Xinjiang, China
| | - Zhongrong Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research Urumqi, Xinjiang, China
| | - Reyila Abudereyimu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research Urumqi, Xinjiang, China
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19
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Involvement of Muscarinic Receptors in Hypotensive and Diuretic Effects of Aqueous Soluble Fraction from Asphodelus tenuifolius Cav. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6653270. [PMID: 33510806 PMCID: PMC7822673 DOI: 10.1155/2021/6653270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 02/06/2023]
Abstract
Background. Asphodelus tenuifolius Cav. (Asphodelaceae) is widely used in Pakistan traditional medicine as a hypotensive and diuretic agent. Despite the cardioprotective effects described for A. tenuifolius, the mechanisms involved in its probable hypotensive and diuretic effects have never been evaluated. Firstly, different extracts from A. tenuifolius seeds were obtained, and their antioxidant profiles and chemical constituents by LC-DAD-were determined, including molecular networking by the GNPS platform. Then, to evaluate changes in blood pressure, different groups of anesthetized normotensive rats were intravenously treated with the crude extract (AT-Cr, 1-50 mg/kg), aqueous (AS-AT, 1-25 mg/kg), n-butanol (BS-AT, 1-50 mg/kg), and dichloromethane fraction (DS-AT, 1-80 mg/kg). The diuretic effects of AT-Cr, AS-AT, BS-AT, and DS-AT at 100, 200, and 300 mg/kg, p.o. doses, were also evaluated in comparison with hydrochlorothiazide (HCTZ, 10 mg/kg, p.o). The urinary volume, sodium, potassium, and pH were estimated in the sample collected for 6 h from saline-loaded rats. Using pharmacological antagonists or inhibitors, we determine the involvement of acetylcholine, prostaglandins, and nitric oxide in A. tenuifolius-induced hypotensive and diuresis action. In addition, the activities of angiotensin-converting enzyme, erythrocyte carbonic anhydrase, and renal Na+/K+/ATPase were evaluated in vitro. Acute treatment with crude extract and fractions of A. tenuifolius exhibited significant hypotensive and diuretic potential in normotensive rats. However, AS-AT produced the most potent and significant dose-dependent hypotension and diuretic effects in normotensive rats. Previous treatment with atropine significantly reduced the hypotensive and diuretic action of AS-AT, but pretreatment with indomethacin or L-NAME did not affect these effects. Moreover, the 7-day treatment with AS-AT did not reduce activities of serum angiotensin-converting enzyme, erythrocyte carbonic anhydrase, and renal Na+/K+/ATPase. AS-AT showed four major compound node clusters, which included sugars, alkaloids, nucleoside, amino acid, and glycosylated flavonoids. This research supports and extends the traditional use of A. tenuifolius as a hypotensive and diuretic agent. The results showed that AS-AT from A. tenuifolius could present compounds responsible for hypotensive and diuretic activities through the activation of muscarinic receptors.
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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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21
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The U-shaped association between achieved blood pressure and risk of cardiovascular events and mortality in elderly and younger patients. J Hypertens 2020; 38:1559-1566. [PMID: 32618882 DOI: 10.1097/hjh.0000000000002434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The main objective is to assess the appropriate level of achieved SBP and DBP to prevent cardiovascular events. METHODS We used the National Sample Cohort from the National Health Insurance Service in Korea and analyzed data of 44 462 hypertensive patients aged 20--84 years. Achieved SBP and DBP were categorized according to average achieved SBP (<120, 120-129, 130-139, 140-149, and ≥150 mmHg) and DBP (<70, 70-79, 80-89, 90-99, and ≥100 mmHg). We examined the association between achieved BP and composite outcome including cardiovascular death, admission of stroke, myocardial infarction, or heart failure, and all-caused death in elderly aged more than 65 years and in younger patients. RESULTS After a median follow-up of 6.8 years, achieved SBP less than 120 mmHg and at least 150 mmHg in elderly and younger patients, respectively, were significantly associated with a higher risk of composite outcome than achieved SBP of 120-129 mmHg. Cox's proportional hazard analysis showed that the association between achieved SBP and risk of composite outcome and all-cause death had U-shaped relationships and identified a nadir of SBP of 135.6 and 128.9 mmHg, respectively, for composite outcome and 135.1 and 131.4 mmHg, respectively, for all-cause death in elderly and younger patients. CONCLUSION Compared with SBP of 120-129 mmHg, not only low achieved SBP of less than 120 mmHg but also high BP are associated with risk of adverse cardiovascular event and all-cause death in both elderly and younger patients with a distinct U-shaped relationship.
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Woodham NS, Taneepanichskul S, Somrongthong R, Kitsanapun A, Sompakdee B. Effectiveness of a Multidisciplinary Approach Intervention to Improve Blood Pressure Control Among Elderly Hypertensive Patients in Rural Thailand: A Quasi-Experimental Study. J Multidiscip Healthc 2020; 13:571-580. [PMID: 32694916 PMCID: PMC7340360 DOI: 10.2147/jmdh.s254286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose Uncontrolled blood pressure among Thai elderly hypertensive patients is a significant public health issue in primary health care facilities under the Universal Health Coverage Scheme in Thailand. This study examines the effectiveness of a multidisciplinary approach intervention to improve blood pressure control among elderly persons in rural Thailand. Patients and Methods This was quasi-experimental study conducted on 200 elderly persons who receive care for hypertension at primary health care facility in rural areas of Thailand. Participants were assigned to either the intervention or control groups. The intervention group was subjected to a multidisciplinary approach intervention program. This program included community-based care for hypertension, family-supportive care for hypertension, antihypertension medication adherence education program, the use of a reminder electronic pill box, and monthly pill counts and blood pressure measurements. The intervention continued for three months. The control group received care for hypertension at the hypertension clinic of the health center. Three measurements were taken at baseline, one month, and three months after the intervention. Data analysis included descriptive statistics and independent sample t-tests. Repeated-measure analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were used to compare the differences between the two groups. Results At one month and three months after the intervention, the multidisciplinary approach intervention controlled blood pressure more effectively compared with the control group. Furthermore, the intervention group had lower systolic and diastolic blood pressure compared with the control group (P-value < 0.001). Conclusion These results suggest that the multidisciplinary approach intervention can be effective in controlling blood pressure in elderly hypertensive patients. Future studies should investigate a cost-effective means of integrating multidisciplinary approach interventions in routine hypertension care for elderly hypertensive patients.
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Affiliation(s)
| | | | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Guo B, Shi Z, Zhang W, Zhao H, He K, Hu X, Gan Y, Shi S, Tian Q. Trajectories of body mass index (BMI) and hypertension risk among middle-aged and elderly Chinese people. J Hum Hypertens 2020; 35:537-545. [PMID: 32581292 DOI: 10.1038/s41371-020-0368-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/29/2020] [Accepted: 06/09/2020] [Indexed: 11/09/2022]
Abstract
This study aimed to identify heterogeneity in BMI trajectories and evaluate the impact of BMI trajectories on the risk of hypertension in middle-aged and elderly Chinese people. After data screening, 28, 706 residents' e-health records from 2010 to 2018, including basic personal information, lifestyle and health, were finally included in this population-based longitudinal study. By latent class growth modeling, we identified 12 BMI trajectories: "underweight-increase I (A1)" and "underweight-increase II (A2)"; "normal weight-stable (B1)", "normal weight-decrease (B2)", "normal weight-increase I (B3)" and "normal weight-increase II (B4)"; "overweight-stable (C1)", "overweight-decrease (C2)" and "overweight-increase (C3)"; and "obese-stable I (D1)", "obese-decrease (D2)" and "obese-stable II (D3)". By Cox proportional hazards models, we found that the risk of hypertension in the BMI stable group was lower than that in the BMI increasing trajectory group and higher than that in the BMI decreasing group. For the underweight and normal weight groups, the risk of hypertension was related not only to the magnitude of BMI growth, but also to the rate of growth. For overweight and obesity groups, the risk of hypertension was higher in the high-level stable BMI group than in the low-level stable BMI group. Therefore, for underweight and normal weight people, weight growth and growth rate should be controlled; for overweight and obese people, health education or targeted weight loss exercise should be taken to reduce weight as much as possible to prevent hypertension.
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Affiliation(s)
- Bingxin Guo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Kexue Avenue 100, Zhengzhou, 450001, Henan, China
| | - Zhan Shi
- Department of Pharmacy, People's Hospital of Zhengzhou, Huanghe Road 33, Zhengzhou, 450003, Henan, China
| | - Wenli Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Kexue Avenue 100, Zhengzhou, 450001, Henan, China
| | - Hao Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Kexue Avenue 100, Zhengzhou, 450001, Henan, China
| | - Kun He
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Kexue Avenue 100, Zhengzhou, 450001, Henan, China
| | - Xueqi Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Kexue Avenue 100, Zhengzhou, 450001, Henan, China
| | - Yuan Gan
- Department of Pharmacy, Fuwai Central China Cardiovascular Hospital, Fuwai Avenue 1, Zhengzhou, 450000, Henan, China
| | - Songhe Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Kexue Avenue 100, Zhengzhou, 450001, Henan, China.
| | - Qingfeng Tian
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
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Gala P, Moshokgo V, Seth B, Ramasuana K, Kazadi E, M'buse R, Pharithi S, Gobotsamang K, Szymanowski P, Kerobale RO, Balekile K, Tshimbalanga J, Tieng'o J, Tapela N, Barak T. Medication Errors and Blood Pressure Control Among Patients Managed for Hypertension in Public Ambulatory Care Clinics in Botswana. J Am Heart Assoc 2020; 9:e013766. [PMID: 31955639 PMCID: PMC7033820 DOI: 10.1161/jaha.119.013766] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The prevalence of hypertension in low‐ and middle‐income countries is rapidly increasing, with most cases undiagnosed and many poorly controlled among those diagnosed. Medication reconciliation studies from high‐income countries have demonstrated a high occurrence of antihypertensive medication errors and a strong association between medication errors and inadequate blood pressure control, but data from low‐ and middle‐income countries are lacking. Methods and Results We conducted a cross‐sectional study from April to October 2018 of adult patients on pharmacologic management for known hypertension at 7 public health facilities in Kweneng East District, Botswana. Our aims included to evaluate the frequency of uncontrolled hypertension, the frequency and type of medication errors causing discrepancies between patient‐reported and prescribed antihypertensive medications, and the association between medication errors and uncontrolled hypertension. Descriptive analyses and multivariable logistic regression were used. The prevalence of uncontrolled hypertension was 55% among 280 enrolled adult patients, and 95 (34%) had ≥1 medication error. The most common errors included patients taking medications incorrectly (11.1%; 31/280), patients omitting medications (7.9%; 22/280), and unfilled prescriptions caused by pharmacy stock outs (7.5%%; 21/280). Uncontrolled hypertension was significantly associated with having ≥1 medication error compared with no errors (adjusted odds ratio, 3.26; 95% CI, 1.75–6.06; P<0.001). Conclusions Medication errors are strongly associated with poor blood pressure control in this setting. Further research is warranted to assess whether medication reconciliation and other low‐cost interventions addressing root causes of medication errors can improve the control of hypertension and other chronic conditions in low‐ and middle‐income countries.
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Affiliation(s)
- Pooja Gala
- Section of Hospital Medicine Department of General Medicine University of Chicago IL
| | | | - Bhavna Seth
- Department of Medicine Beth Israel Deaconess Hospital Boston MA
| | - Kegomoditswe Ramasuana
- Department of Medicine Scottish Livingstone Hospital Molepolole Botswana.,Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | - Emmanuel Kazadi
- Department of Medicine Scottish Livingstone Hospital Molepolole Botswana.,Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | - Rudy M'buse
- Department of Medicine Scottish Livingstone Hospital Molepolole Botswana.,Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | - Solomon Pharithi
- Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | | | | | - Ruth Olyn Kerobale
- Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | | | - Jacques Tshimbalanga
- Department of Medicine Kweneng East District Management Team Molepolole Botswana.,Department of Medicine Thamaga Hospital Thamaga Botswana
| | - Jane Tieng'o
- Department of Medicine Scottish Livingstone Hospital Molepolole Botswana.,Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership Gaborone Botswana.,University of Oxford United Kingdom
| | - Tomer Barak
- Department of Medicine Beth Israel Deaconess Hospital Boston MA.,Botswana Harvard AIDS Institute Partnership Gaborone Botswana.,Department of Medicine Scottish Livingstone Hospital Molepolole Botswana
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Brackmann LK, Buck C, Nyangasa MA, Kelm S, Sheikh M, Hebestreit A. Anthropometric and Biochemical Predictors for Hypertension in a Cross-Sectional Study in Zanzibar, Tanzania. Front Public Health 2019; 7:338. [PMID: 31824908 PMCID: PMC6881248 DOI: 10.3389/fpubh.2019.00338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 10/29/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Aim of this study was to describe the proportion of hypertension among Zanzibari of different age-groups and to detect possible correlates of this non-communicable disease. Methods: In 2013 a cross-sectional survey was conducted in Unguja Island, Zanzibar. A total of 235 randomly selected households, including 1,229 (2 to 95 years) eligible study participants, were examined. Association between objectively assessed obesity markers, salt intake and hypertension were investigated. Estimates of 24 h sodium and potassium excretion from a single morning spot urine specimen were calculated and used as surrogate for salt intake. The association between overweight/obesity and hypertension in different age-groups was assessed in multilevel logistic regression models. Further associations between salt intake and hypertension were analyzed. Results: Measures of systolic and diastolic blood pressure as well as proportion of overweight/obesity and hypertension both increased with age. Overweight and obesity were significantly associated with hypertension in adults. Moreover, thinness seems to be associated with hypertension as well. We observed a significantly reduced chance of hypertension for higher urinary sodium-to-potassium compared to a lower ratio in children. Conclusion: Overweight/obesity and hypertension were highly prevalent (>47% of adults >40 years are overweight or obese and >69% are hypertensive in the same age group) in our sample. Weight status was confirmed as a correlate of high blood pressure in our sample from Zanzibar, Tanzania. To early and effectively prevent related severe cardiovascular outcomes, screening strategies but also monitoring strategies are required for this population.
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Affiliation(s)
- Lara Kim Brackmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Epidemiological Methods and Etiological Research, Bremen, Germany
| | - Christoph Buck
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Biometry and Data Mangement, Bremen, Germany
| | - Maria Adam Nyangasa
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Epidemiological Methods and Etiological Research, Bremen, Germany
| | - Soerge Kelm
- Center for Biomolecular Interactions Bremen, Faculty for Biology and Chemistry, University Bremen, Bremen, Germany
| | - Mohammed Sheikh
- Environmental Analytical Chemistry and Eco-toxicology Lab, State University of Zanzibar, Zanzibar, Tanzania
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Epidemiological Methods and Etiological Research, Bremen, Germany
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Zhu T, Xue J, Jiang Y, Wang J, Weng W, Chen S. Social Support and Depression Related to Older Adults' Hypertension Control in Rural China. Am J Geriatr Psychiatry 2019; 27:1268-1276. [PMID: 31147243 PMCID: PMC6778510 DOI: 10.1016/j.jagp.2019.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study aimed to investigate association between social support and hypertension (HTN) control in rural China older adults, and to what extent depression mediates this relationship. The authors hypothesized that depression severity mediated the relationship between social support and HTN control. METHODS Data for the analyses were obtained from baseline data from a randomized controlled clinical trial of a collaborative depression care management intervention conducted in rural villages of China, with older adults with comorbid depression and HTN. Data included baseline assessments of 2,351 subjects aged 60 years and older, whose blood pressure and depression severity were measured using a calibrated manual sphygmomanometer and the 17-item Hamilton Depression Rating Scale (HDRS-17), respectively. Social support was measured using the 20-item Medical Outcomes Study-Social Support Survey. RESULTS Uncontrolled HTN was associated with older age (t[df = 2349] = 3.16; p < 0.01), higher HDRS-17 score (t[df = 1488] = 5.89; p < 0.001), and lower social support (t[df = 2349] = 5.37; p < 0.001). A significant indirect effect of social support via depression severity in relation to HTN control (a × b = -0.04[0.01]), bootstrap p = 0.0015, and 95% confidence interval (-0.07, -0.02), accounting for 11% of the effect of social support on HTN control. CONCLUSION These findings imply that social support impacts HTN control directly and indirectly through depression. Intervention approaches such as primary care-based collaborative care models should address social support to achieve greater outcomes for depression and HTN management.
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Affiliation(s)
- Tingfei Zhu
- Department of Psychology and Behavior Sciences, Zhejiang University, NO 148 Tianmushan Road, Xixi Campus of Zhejiang University, Hangzhou, Zhejiang, 310028, China
| | - Jiang Xue
- Department of Psychology and Behavior Sciences, Zhejiang University, NO 148 Tianmushan Road, Xixi Campus of Zhejiang University, Hangzhou, Zhejiang, 310028, China
| | - Yuxing Jiang
- Department of Psychology and Behavior Sciences, Zhejiang University, NO 148 Tianmushan Road, Xixi Campus of Zhejiang University, Hangzhou, Zhejiang, 310028, China
| | - Jiayu Wang
- Department of Psychology and Behavior Sciences, Zhejiang University, NO 148 Tianmushan Road, Xixi Campus of Zhejiang University, Hangzhou, Zhejiang, 310028, China
| | - Wenqi Weng
- Department of Psychology and Behavior Sciences, Zhejiang University, NO 148 Tianmushan Road, Xixi Campus of Zhejiang University, Hangzhou, Zhejiang, 310028, China
| | - Shulin Chen
- Department of Psychology and Behavior Sciences, Zhejiang University, Hangzhou, Zhejiang, China.
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Sibomana JP, McNamara RL, Walker TD. Patient, clinician and logistic barriers to blood pressure control among adult hypertensives in rural district hospitals in Rwanda: a cross-sectional study. BMC Cardiovasc Disord 2019; 19:231. [PMID: 31638907 PMCID: PMC6805529 DOI: 10.1186/s12872-019-1203-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/24/2019] [Indexed: 11/06/2022] Open
Abstract
Background Hypertension management in rural, resource-poor settings is difficult. Detailed understanding of patient, clinician and logistic factors which pose barriers to effective blood pressure control could enable strategies to improve control to be implemented. Methods This cross-sectional, multifactorial, observational study was conducted at four rural Rwandan district hospitals, examining patient, clinician and logistic factors. Questionnaires were administered to consenting adult outpatient hypertensive patients, obtaining information on sociodemographic factors, past management for hypertension, and adherence (by Morisky Medication Adherence 8-item Scale (MMAS-8). Treating clinicians identified local difficulties in providing hypertension management from a standard World Health Organisation list and nominated their preferred treatment regimens. Blood pressure measurements and other clinical data were collected during the study visit and used to determine blood pressure control, according to goals from JNC-8 guidelines. Medication availability and cost at each hospital’s pharmacy were reviewed as logistic barriers to treatment. Results The 112 participating patients were 80% female, with only 41% having completed primary education. Self-reported adherence by the MMAS-8 was high in 77% (86/112) and significantly associated) with literacy, lack of medication side effects and the particular hospital and pharmacy attended (all p < 0.05). However, of 89 patients with blood pressure data, only 26 (29%) had achieved goal blood pressure. No patient factor were statistically associated with poor blood pressure control. Among 30 participating clinicians, deficiencies in knowledge were evident; 43% (13/30) and 37% (11/30) chose a loop diuretic as their prescribed medication and as an ideal medication, respectively, for a newly diagnosed hypertensive patient without comorbidities, counter to JNC 8 recommendations, and 50% (15/30) identified clinician non-adherence to hypertension guidelines as a barrier. In the pharmacies, common anti-hypertensive medications were affordably available (> 6 out of 8 examined medications available in all pharmacies, cost <US$0.50 per month); however, clinicians perceived medication cost and availability to be barriers to care. Conclusions Clinician-based factors are a major barrier to blood pressure control in rural district hospitals in Rwanda, and blood pressure control overall was poor. Patient and logistic barriers to blood pressure were not evident in this study.
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Affiliation(s)
- J P Sibomana
- Department of Internal Medicine, University of Rwanda, BP 111, Muhanga, Southern Province, Rwanda.
| | - R L McNamara
- Yale University School of Medicine, New Haven, CT, USA
| | - T D Walker
- Department of Internal Medicine, University of Rwanda, BP 111, Muhanga, Southern Province, Rwanda.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Ali N, Akram R, Sheikh N, Sarker AR, Sultana M. Sex-specific prevalence, inequality and associated predictors of hypertension, diabetes, and comorbidity among Bangladeshi adults: results from a nationwide cross-sectional demographic and health survey. BMJ Open 2019; 9:e029364. [PMID: 31530600 PMCID: PMC6756587 DOI: 10.1136/bmjopen-2019-029364] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To determine the sex-specific prevalence, inequality and factors associated with healthcare utilisation for diabetes mellitus (DM), hypertension and comorbidity among the adult population of Bangladesh. STUDY DESIGN This study analysed cross-sectional nationwide Bangladesh Demographic and Health Survey data from 2011. Comorbidity was defined as the coexistence of both DM and hypertension. Several socioeconomic and demographic factors such as age, sex, education, geographic location, administrative division, employment status, education and wealth index were considered as major explanatory variables. Inequality in prevalence and healthcare utilisation was measured using the 'Lorenz curve'. Adjusted multiple logistic regression models were performed to observe the effects of different factors and reported as adjusted ORs (AORs) with 95% CIs. A p value of <0.05 was adopted as the level of statistical significance. SETTING The study was conducted in Bangladesh. PARTICIPANTS A total of 7521 adult participants with availability of biomarkers information were included. RESULTS The mean age of the study participants was 51.4 years (SD ±13.0). The prevalence of hypertension, diabetes and comorbidity were 29.7%, 11.0% and 4.5% respectively. Socioeconomic inequality was observed in the utilisation of healthcare services. A higher prevalence of hypertension and comorbidity was significantly associated with individuals aged >70 years (AOR 7.0, 95% CI 5.0 to 9.9; AOR 6.7, 95% CI 3.0 to 14.9). The risk of having hypertension, diabetes and comorbidity were significantly higher among more educated, unemployed as well as among individuals from Khulna division. CONCLUSIONS The study revealed a rising prevalence of hypertension, diabetes and comorbidity with inequality in service utilisation. A joint effort involving public, private and non-governmental organisations is necessary to ensure improved accessibility in service utilisation and to reduce the disease burden.
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Affiliation(s)
- Nausad Ali
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Raisul Akram
- Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Nurnabi Sheikh
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
| | | | - Marufa Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
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Gender differences in hypertension awareness, antihypertensive use and blood pressure control in Nepalese adults: findings from a nationwide cross-sectional survey. J Biosoc Sci 2019; 52:412-438. [PMID: 31466532 DOI: 10.1017/s0021932019000531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective of this cross-sectional study was to determine the gender differences in hypertension awareness, antihypertensive use and blood pressure (BP) control among the adult Nepalese population (≥18 years) using data from the nationally representative Nepal Demographic and Health Survey 2016. A weighted sample of 13,393 adults (5620 males and 7773 females) was included in the final analysis. After conducting descriptive analyses with the selective explanatory variable, multivariable logistic regression analysis was performed to assess the association between the outcome variable and the explanatory variables. The strength of the association was expressed in adjusted odds with 95% confidence intervals. A higher proportion of women had their BP checked (87.7% females vs 73.0% males, p<0.001) and were aware of their raised BP (43.9% females vs 37.1% males, p<0.001) compared with men. Although female hypertensive individuals had a higher prevalence of antihypertensive medication use than their male counterparts (50.1% females vs 47.5% males), a higher proportion of male hypertensive participants had their BP controlled (49.2% females vs 53.5% males). Women with the poorest wealth index had a lower prevalence of antihypertensive use than their male counterparts. The odds of having their own BP measured increased with age among men but decreased with age among women. The household wealth index was positively associated with the odds of BP measurement, awareness of own BP and antihypertensive use. This study revealed that although women had a higher prevalence of hypertension awareness and antihypertensive medication use, the practice did not translate into better BP control. Inequality in antihypertensive medication use was observed among the poorest wealth quintiles. Public health programmes in Nepal should focus on reducing these inequalities. Further research is needed to learn why females have poorer control of BP, despite having higher antihypertensive medication use.
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Gafane-Matemane LF, Mokae NL, Breet Y, Malan L. Relation of the renin-angiotensin-aldosterone system with potential cardiac injury and remodelling: the SABPA study. Blood Press 2019; 29:31-38. [PMID: 31339379 DOI: 10.1080/08037051.2019.1645587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The renin-angiotensin-aldosterone system (RAAS) plays an important role in maintaining hemodynamic homeostasis. Ethnic disparities exist regarding RAAS activity due to sympathetic activity and sodium-water retention, however the implications thereof on cardiac damage is unknown. This study investigated the associations of cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NTproBNP) and subclinical LVH with components of the RAAS (renin, aldosterone and aldosterone-to-renin ratio (ARR)) and copeptin in a black and white South African cohort.Materials and methods: The study population consisted of 305 participants (black = 139, white = 166) aged 20-62 years. Serum cTnT, NTproBNP, Cornell product, components of the RAAS (active renin, aldosterone and ARR) and copeptin were determined.Results: The black group had lower renin (p < 0.001) and higher ARR (p < 0.001), cTnT (p = 0.015) and Cornell product compared to whites (all p < 0.001). NTproBNP and copeptin were similar between the groups. After forward stepwise adjustments for multiple confounders, inverse associations of cTnT with renin (β = -0.17, p = 0.018) and aldosterone (β = -0.14, p = 0.048) as well as an inverse association between NTproBNP and aldosterone (β = -0.25, p < 0.001) were observed in the white population only. In the black group cTnT associated positively with renin (β = 0.16, p = 0.040) and copeptin (β = 0.21, p = 0.020) and inversely with ARR (β = -0.15, p = 0.047). Additionally, NTproBNP associated positively with copeptin (β = 0.18, p = 0.045). No correlations were observed between the RAAS and Cornell product in any of the groups.Conclusions: Our findings suggest that RAAS, together with cardiac stress may function differently in cardiac damage and remodelling in the two ethnic groups; which may influence treatment in clinical practice.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Nametsegang L Mokae
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Yolandi Breet
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Leone Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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Kiber M, Wube M, Temesgen H, Woyraw W, Belay YA. Prevalence of hypertension and its associated factors among adults in Debre Markos Town, Northwest Ethiopia: community based cross-sectional study. BMC Res Notes 2019; 12:406. [PMID: 31307528 PMCID: PMC6631738 DOI: 10.1186/s13104-019-4431-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 07/05/2019] [Indexed: 12/02/2022] Open
Abstract
Objective To assess the prevalence and associated factors of hypertension among adults in Debre Markos town, Northwest Ethiopia. A community based cross sectional study design was employed. Systematic random sampling was used to select 456 study participants. Analysis was performed using SPSS version 20. Binary logistic regression was fitted to show the association between dependent variable and independent variables. Result A total of 57 (12.5%) individuals had hypertension in Debre Markos town. Being female [AOR 3.78, 95% CI 1.56, 9.147], consuming animal source fat [AOR 6.28, 95% CI 2.63, 14.99], family history of hypertension [AOR 4.88, 95% CI 1.99, 12.015], age greater than 50 years [AOR 3.31, 95% CI 1.00, 10.99], body mass index ≥ 25 kg/m2 [AOR 4.70, 95% CI 1.99, 11.06], excess salt consumption [AOR 6.49, 95% CI 2.83,14.89] and alcohol consumers [AOR 3.19, 95% CI 1.13, 8.99] were found to be statistically significant factors associated with hypertension. The prevalence of hypertension in Debre Markos town is still a public health problem. Being female sex, consuming animal source fat, family history of hypertension, excess salt consumption age greater than 50 years and body mass index > 25 kg/m2 were significant factors of hypertension. Therefore, health sectors should take actions to tackle these modifiable risk factors.
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Affiliation(s)
- Mihretie Kiber
- Debre Markos Referral Hospital, P.O. Box 269, Debre Markos, Ethiopia
| | - Moges Wube
- Department of Public Health, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Habtamu Temesgen
- Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Wubetu Woyraw
- Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Yihalem Abebe Belay
- Department of Public Health, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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Victória Pereira S, Valentim M, Feijão A, Gonçalves M, Oliveira P, Neto M, Manuel C, João A, Mbala C, Tinta D, Beaney T, Xia X, Poulter NR, Fernandes M. May Measurement Month 2017: an analysis of blood pressure screening in Angola-Sub-Saharan Africa. Eur Heart J Suppl 2019; 21:D5-D7. [PMID: 31043863 PMCID: PMC6479424 DOI: 10.1093/eurheartj/suz049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. There is increasing prevalence of hypertension in developing countries leading to increased risk of adverse outcomes. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. In Angola, 17 481 individuals were screened in six provinces with an average BP of 126/78 mmHg. After multiple imputation, 6022 (34.5%) had hypertension. Of individuals not receiving antihypertensive medication, 4080 (26.3%) were hypertensive. Of those receiving antihypertensive medication, 1159 (59.7%) had uncontrolled BP. MMM17 was the largest BP screening campaign undertaken in Angola. These results suggest that there is still a significant percentage of patients who are not medicated and possibly require medication, and more than half of the hypertensive patients do not have controlled BP demonstrating the need for a more targeted and comprehensive screening of BP and more effective treatment.
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Affiliation(s)
- Savarino Victória Pereira
- Serviço de Cardiologia - Hospital Américo Boavida Avenida Hoji ya Henda, Luanda, República de Angola
| | | | | | - Mauer Gonçalves
- Serviço de Cardiologia - Hospital Américo Boavida Avenida Hoji ya Henda, Luanda, República de Angola
| | | | | | | | | | | | | | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Mário Fernandes
- Serviço de Cardiologia - Hospital Américo Boavida Avenida Hoji ya Henda, Luanda, República de Angola
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Rossetto C, Soares JV, Brandão ML, Rosa NGD, Rosset I. Causes of hospital admissions and deaths among Brazilian elders between 2005 and 2015. Rev Gaucha Enferm 2019; 40:e20190201. [DOI: 10.1590/1983-1447.2019.20190201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/10/2019] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE To analyze the ranking and percentage variation of the main causes of hospital admissions and death of Brazilian elders between 2005 and 2015, according to gender and age groups. METHOD Retrospective and temporal analysis study. The six main causes of hospitalization and death of elders were collected in DATASUS according to sex and age groups (60 ~ 79, ≥80) in 2017. RESULTS Heart Failure (2005) and pneumonia (2015) were the two main causes of hospital admissions in both sexes and age groups, except for the younger group. Acute Myocardial Infarction was the main cause of death in 2005 and 2015. The second cause in the overall ranking was the Stroke in 2005 and Pneumonia in 2015. CONCLUSION Circulatory and respiratory diseases were the main causes of hospital admissions and death among the elderly, highlighting the impotant increase in pneumonia as a cause of morbimortality.
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Mulinari-Santos G, de Souza Batista FR, Kirchweger F, Tangl S, Gruber R, Okamoto R. Losartan reverses impaired osseointegration in spontaneously hypertensive rats. Clin Oral Implants Res 2018; 29:1126-1134. [DOI: 10.1111/clr.13376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 06/20/2018] [Accepted: 08/11/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Gabriel Mulinari-Santos
- Department of Oral Surgery and Integrated Clinic, Araçatuba Dental School; Universidade Estadual Paulista “Júlio de Mesquita Filho”; Araçatuba Brazil
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, School of Dentistry; Medical University of Vienna; Vienna Austria
- Austrian Cluster for Tissue Regeneration; Vienna Austria
- Department of Oral Biology, Dental School; Medical University of Vienna; Vienna Austria
| | - Fábio Roberto de Souza Batista
- Department of Oral Surgery and Integrated Clinic, Araçatuba Dental School; Universidade Estadual Paulista “Júlio de Mesquita Filho”; Araçatuba Brazil
| | - Franziska Kirchweger
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, School of Dentistry; Medical University of Vienna; Vienna Austria
- Austrian Cluster for Tissue Regeneration; Vienna Austria
| | - Stefan Tangl
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, School of Dentistry; Medical University of Vienna; Vienna Austria
- Austrian Cluster for Tissue Regeneration; Vienna Austria
| | - Reinhard Gruber
- Austrian Cluster for Tissue Regeneration; Vienna Austria
- Department of Oral Biology, Dental School; Medical University of Vienna; Vienna Austria
- Department of Periodontology, School of Dental Medicine; University of Bern; Bern Switzerland
| | - Roberta Okamoto
- Department of Basic Science, Araçatuba Dental School; Universidade Estadual Paulista “Júlio de Mesquita Filho”; Araçatuba Brazil
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Craig LS, Gage AJ, Thomas AM. Prevalence and predictors of hypertension in Namibia: A national-level cross-sectional study. PLoS One 2018; 13:e0204344. [PMID: 30235324 PMCID: PMC6147578 DOI: 10.1371/journal.pone.0204344] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/05/2018] [Indexed: 11/19/2022] Open
Abstract
Background Hypertension has been identified as the single greatest contributor to the global burden of disease and mortality, with estimates suggesting that the highest levels of blood pressure have shifted from high-income countries to low-income countries in sub-Saharan Africa. While evidence suggests a remarkably high prevalence of hypertension among urban residents in Namibia, national estimates to inform on the country-level burden are lacking. This study estimates the prevalence and predictors of hypertension among Namibian adults. Methods The analysis is based on 1,795 women and 1,273 men aged 35–64 years from the nationally-representative 2013 Namibia Demographic and Health Survey. Odds radios and 95% confidence intervals were estimated using logistic regression. Results The age-standardized prevalence of hypertension was 46.0% (men vs. women: 46.1% vs. 46.0%). Mean systolic and diastolic blood pressures for the total population were 128.8 mmHg (95% CI 127.8–129.7) and 83.1 mmHg (95% CI 82.5–83.7), respectively. Mean systolic blood pressure was significantly lower among women (men vs. women: 130.9 mmHg vs. 127.4 mmHg; p<0.001). There were no statistically significant differences in mean diastolic blood pressure between men and women. Older age, urban residence, and being either overweight or obese were positively associated with the odds of hypertension (p<0.01). For women, the odds of hypertension were also significantly increased for those who were diabetic (i.e. had a fasting blood glucose level greater than 7.0 mmol/L) and reduced for those with higher levels of education. Conclusion The prevalence of hypertension among Namibian adults is high and associated with metabolic and socio-demographic factors. Future research examining disease comorbidity and behavioral risk factors could better inform on the disease burden and help target resources to optimize prevention and control.
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Affiliation(s)
- Leslie S. Craig
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Anastasia J. Gage
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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Akutey R, Der R, Owusu‐Daaku F, Baiden F. Using community pharmacies to expand access to screening for noncommunicable diseases in suburban Ghana-A facility-based survey on client needs and acceptability. Health Sci Rep 2018; 1:e79. [PMID: 30623102 PMCID: PMC6266575 DOI: 10.1002/hsr2.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 05/25/2018] [Accepted: 06/28/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Many of the 28 million deaths from noncommunicable diseases (NCDs) in low- and middle-income countries each year could be prevented through early detection and intervention. The introduction of screening for NCDs in community pharmacies (CPs) in Ghana could enhance access to early detection. METHODS We surveyed clients in three districts in suburban Ghana to assess perceived need for screening, willingness to be screened in CPs, and willingness to receive NCD health promotion information through text messages (NCD m-Health). We performed regression analysis to identify predictors of NCD m-Health acceptability. RESULTS We interviewed 330 clients in six CPs, 134 (42.3%) of whom were females. The median age was 34 years (interquartile range, 27-43). Fifty-four (16.4%) had no formal education. Although most respondents knew obesity (74.9%), smoking (81.9%), and excessive dietary salt (91.7%) were risk factors for NCDs, only 27.0% knew family history carried similar risk. Most respondents, 61.6% and 70.6%, respectively, had not had their weight and blood pressure (BP) checked for more than 12 months. These included about a third of respondents who were known hypertensives. Similarly, 71.3% of 80 participants with a family history of hypertension had not had their BPs checked. Screening for NCDs in CPs and the sending of NCD m-Health messages was deemed acceptable to 98.5% and 83.1% of the participants, respectively. Formal education beyond junior high school (Grade 9) was the strongest independent predictor of NCD m-Health acceptance (OR = 4.77; 95% CI, 1.72-13.18; P value < 0.01). One hundred and twenty-five (39.4%) participants indicated they would consider unsolicited NCD m-Health messages an invasion of their privacy. CONCLUSION An urgent need exists to promote access to NCD screening in these communities. Its introduction into CPs is acceptable to nearly all the clients surveyed. The introduction of NCD m-Health as an accompaniment requires consideration for the privacy of clients.
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Affiliation(s)
- Richard Akutey
- Epidemiology UnitEnsign College of Public HealthKpong, E/RGhana
| | - Reina Der
- Epidemiology UnitEnsign College of Public HealthKpong, E/RGhana
| | - Frances Owusu‐Daaku
- Department of Pharmacy PracticeKwame Nkrumah University of Science and TechnologyKumasiAshanti RegionGhana
| | - Frank Baiden
- Epidemiology UnitEnsign College of Public HealthKpong, E/RGhana
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene & Tropical MedicineLondonUK
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Manus MB, Bloomfield GS, Leonard AS, Guidera LN, Samson DR, Nunn CL. High prevalence of hypertension in an agricultural village in Madagascar. PLoS One 2018; 13:e0201616. [PMID: 30114223 PMCID: PMC6095505 DOI: 10.1371/journal.pone.0201616] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/18/2018] [Indexed: 01/19/2023] Open
Abstract
Elevated blood pressure presents a global health threat, with rates of hypertension increasing in low and middle-income countries. Lifestyle changes may be an important driver of these increases in blood pressure. Hypertension is particularly prevalent in African countries, though the majority of studies have focused on mainland Africa. We collected demographic and health data from 513 adults living in a community in rural Madagascar. We used generalized linear mixed models to assess body mass index (BMI), age, sex, and attributes related to household composition and lifestyle as predictors of blood pressure and hypertension. The prevalence of hypertension in this cohort was 49.1% (both sexes combined: N = 513; females: 50.3%, N = 290; males: 47.5%, N = 223). Blood pressure, as well as hypertensive state, was positively associated with age and BMI. Lifestyle and household factors had no significant relationships with blood pressure. The prevalence of hypertension was similar to that found in urban centers of other African countries, yet almost double what has been previously found in Madagascar. Future research should investigate the drivers of hypertension in rural communities worldwide, as well as the lifestyle, cultural, and genetic factors that underlie variation in hypertension across space and time.
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Affiliation(s)
- Melissa B. Manus
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, United States of America
| | - Gerald S. Bloomfield
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Ashley Sobel Leonard
- Department of Biology, Duke University, Durham, North Carolina, United States of America
| | - Laura N. Guidera
- Department of Biology, Duke University, Durham, North Carolina, United States of America
| | - David R. Samson
- Department of Anthropology, University of Toronto, Mississauga, Canada
| | - Charles L. Nunn
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, United States of America
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Mehrabian F, Farmanbar R, Mahdavi-Roshan M, Omidi S, Aghebati R. The Effect of Nutrition Education Based on DASH Diet on Blood Pressure and Dietary Adherence Among Patients With Hypertension. CASPIAN JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.29252/cjhr.3.2.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Shoaib Hamrah M, Hassan Hamrah M, Ishii H, Suzuki S, Hussain Hamrah M, Edris Hamrah A, Elias Dahi A, Yisireyili M, Kano N, Takeshita K, Hashem Hamrah M, Sakamoto J, Murohara T. Left ventricular hypertrophy and proteinuria in patients with essential hypertension in Andkhoy, Afghanistan. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:249-255. [PMID: 29915442 PMCID: PMC5995742 DOI: 10.18999/nagjms.80.2.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 01/04/2018] [Indexed: 12/15/2022]
Abstract
Left ventricular hypertrophy (LVH) and proteinuria are known as independent predictors of cardiovascular death in hypertension. However, LVH and its association with proteinuria have not been investigated in adult hypertensive patients in Afghanistan. The objective of this research was to determine the prevalence of LVH and the correlation between LVH and proteinuria among the Afghan adult hypertensive population visiting an outpatient clinic in Afghanistan. We retrospectively evaluated 789 hypertensive patients (mean age is 56 years and 46% were men) who visited the clinic between December 2014 and August 2016. Patient characteristics and laboratory and clinical findings were recorded. The rate of LVH among hypertensive patients was 54.4%. Patients with proteinuria had a significantly higher LVH percentage compared to those without proteinuria (73.2% versus 55.8%; P<0.001). There was a significant correlation between LVH and proteinuria among hypertensive patients (r=0.182, P<0.001). Based on a multivariate regression analysis, age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.05), proteinuria (OR, 1.69; 95% CI, 1.19-2.41), and female sex (OR, 0.09; 95% CI, 0.06-0.13) were significant factors. In conclusion, the prevalence of LVH was more than 50% in the Afghan adult hypertensive population. This study indicates that there is a significant relationship between LVH detected by ECG and the presence of proteinuria among such subjects.
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Affiliation(s)
| | - Mohammad Hassan Hamrah
- Dr.Mohammad Hashem Hamrah's Curative Clinic, Andkhoy, Afghanistan
- College of Stomatology, Kunduz University, Kunduz, Afghanistan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mohammad Hussain Hamrah
- Dr.Mohammad Hashem Hamrah's Curative Clinic, Andkhoy, Afghanistan
- Arya University Faculty of Medicine, Mazar-i-Sharif, Afghanistan
| | | | - Ahmad Elias Dahi
- Dr.Mohammad Hashem Hamrah's Curative Clinic, Andkhoy, Afghanistan
| | - Maimaiti Yisireyili
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoaki Kano
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyosuke Takeshita
- Department of Clinical Laboratory, Nagoya University Hospital, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Liao W, Jahandideh F, Fan H, Son M, Wu J. Egg Protein-Derived Bioactive Peptides: Preparation, Efficacy, and Absorption. ADVANCES IN FOOD AND NUTRITION RESEARCH 2018; 85:1-58. [PMID: 29860972 DOI: 10.1016/bs.afnr.2018.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The hen's egg is an important protein source of human diet. On average one large egg contains ~6g protein, which contributes to ~11% of daily protein intake. As a high-quality protein, egg proteins are well recognized as excellent sources of bioactive peptides. The objectives of this chapter are to introduce generation, bioactivities, and absorption of egg protein-derived bioactive peptides. Research on egg protein-derived bioactive peptides has been progressed during the past decades. Enzymatic hydrolysis is the major technique to prepare bioactive peptides from egg protein. Quantitative structure-activity relationships-aided in silico prediction is increasingly applied as a promising tool for efficient prediction of novel bioactive peptides. A number of bioactive peptides from egg proteins have been characterized for antioxidant, immunomodulatory, antihypertensive, antidiabetic, anticancer, and antimicrobial activities. Egg protein-derived peptides that can improve bone health have been reported as well. However, molecular mechanisms of many peptides are not fully understood. The stability and absorption routes, bioavailability, safety, and production of bioactive peptides await further investigation.
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Affiliation(s)
- Wang Liao
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Forough Jahandideh
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Hongbing Fan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Myoungjin Son
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Jianping Wu
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada; Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada.
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Fabris ALDS, Mulinari-Santos G, Hassumi JS, Freire AR, Faverani LP, Gruber R, Okamoto R. Morphometric and histologic characterization of alveolar bone from hypertensive patients. Clin Implant Dent Relat Res 2017; 19:1106-1113. [DOI: 10.1111/cid.12548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- André Luís da Silva Fabris
- Department of Surgery and Integrated Clinic; Araçatuba Dental School, UNESP-Universidade Estadual Paulista “Júlio de Mesquita Filho”; Araçatuba São Paulo Brazil
| | - Gabriel Mulinari-Santos
- Department of Surgery and Integrated Clinic; Araçatuba Dental School, UNESP-Universidade Estadual Paulista “Júlio de Mesquita Filho”; Araçatuba São Paulo Brazil
| | - Jaqueline Suemi Hassumi
- Division of Anatomy, Department of Basic Science; Araçatuba Dental School, UNESP-Universidade Estadual Paulista “Júlio de Mesquita Filho”; Araçatuba São Paulo Brazil
| | - Alexandre Rodrigues Freire
- Department of Morphology; Piracicaba Dental School, State University of Campinas; Piracicaba São Paulo Brazil
| | - Leonardo Perez Faverani
- Department of Surgery and Integrated Clinic; Araçatuba Dental School, UNESP-Universidade Estadual Paulista “Júlio de Mesquita Filho”; Araçatuba São Paulo Brazil
| | - Reinhard Gruber
- Department of Oral Biology, School of Dentistry; Medical University of Vienna; Vienna Austria
- Department of Periodontology, School of Dental Medicine; University of Bern; Bern Switzerland
| | - Roberta Okamoto
- Division of Anatomy, Department of Basic Science; Araçatuba Dental School, UNESP-Universidade Estadual Paulista “Júlio de Mesquita Filho”; Araçatuba São Paulo Brazil
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Accessing clinical services and retention in care following screening for hypertension and diabetes among Malawian adults: an urban/rural comparison. J Hypertens 2017; 34:2172-9. [PMID: 27552644 DOI: 10.1097/hjh.0000000000001070] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Interventions to impact on the burden of chronic noncommunicable diseases, such as hypertension and diabetes, include screening of asymptomatic adults, but little is known about the subsequent course of clinical care. We report on the uptake of referral for clinical assessment and retention in care, following a large urban/rural population screening program in Malawi. METHODS Adult residents were screened for raised blood pressure and raised fasting blood glucose at a demographic surveillance site in rural Karonga District and in urban Area 25, Lilongwe with well supported chronic care clinics. Successful uptake was defined as presenting for clinical assessment within 6 weeks of referral, and nonattenders were followed at home. Logistic regression was used to examine association of uptake with demographic and clinical factors. Retention was assessed using survival analysis techniques. RESULTS A total of 27 305 participants were screened for hypertension and diabetes between May 2013 and September 2015. Of these, 4075 (14.9%) were referred for suspected hypertension (3640), diabetes (172), or both (263). Among those referred, 2480 (60.9%), reported for clinical assessment. Factors associated with uptake of care included being female, rural residency, older age, unemployment, prior medication, and diabetes. Retention, for those enrolled in care following a formal clinical assessment, was associated with the final diagnosis following clinical assessment, rural residency, and older age. CONCLUSION Screening for hypertension and diabetes identifies large numbers of individuals who need further clinical assessment, but strategies are needed to ensure better linkage and retention into care.
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Mafutha NG, Mogotlane S, De Swardt H. Development of a Hypertension Health Literacy Assessment Tool for use in primary healthcare clinics in South Africa, Gauteng. Afr J Prim Health Care Fam Med 2017; 9:e1-e8. [PMID: 28828872 PMCID: PMC5566124 DOI: 10.4102/phcfm.v9i1.1305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 04/05/2017] [Accepted: 04/09/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hypertension is a universal risk factor for cardiovascular morbidity and mortality in both the ageing and obese populations and patients must be literate in hypertension health issues to participate actively in the management of their disease. Little research has been done to investigate hypertension health literacy levels among South Africans. AIM To develop a Hypertension Heath Literacy Assessment Tool to establish patients' comprehension of the health education they receive in primary healthcare (PHC) clinics in Tshwane, Gauteng, South Africa. SETTING PHC clinics in Tshwane, Gauteng, South Africa. METHODS The design was quantitative, descriptive and contextual in nature. The study population comprised health promoters who were experts in the field of health, documents containing hypertension health education content and individuals with hypertension. Participants were conveniently and purposefully selected. A modified Delphi technique was used to develop and validate the Hypertension Health Literacy Assessment Tool (HHLAT). To ensure validity and reliability of the HHLAT, the tool was administered to 195 participants concurrently with the Learning Ability Battery (LAB). RESULTS There was a strong positive (F = 76.0, p < 0.0001, R2 = 28.25%) correlation between the LAB and the HHLAT. The HHLAT indicated that only 37 (19%) of the patients with hypertension had poor hypertension health literacy levels. CONCLUSION The HHLAT is a valid tool that can be used in busy PHC clinics as it takes less than two minutes to administer. This tool can inform the healthcare worker on the depth of hypertension health education to be given to the patient, empowering the patient and saving time in PHC facilities.
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Rahman M, Williams G, Al Mamun A. Gender differences in hypertension awareness, antihypertensive use and blood pressure control in Bangladeshi adults: findings from a national cross-sectional survey. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2017; 36:23. [PMID: 28545582 PMCID: PMC5445516 DOI: 10.1186/s41043-017-0101-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/12/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Bangladesh is facing an epidemiological transition with a growing burden of non-communicable diseases. Traditionally, hypertension and associated complications in women receive less recognition, and there is a dearth of related publications. The study aims to explore gender differences in high blood pressure awareness and antihypertensive use in Bangladeshi adults at the community level. Another objective is to identify factors associated with uncontrolled hypertension among antihypertensive users. METHODS Data from the Bangladesh Demographic and Health Survey (BDHS 2011) was analysed. From a nationally representative sample of 3870 males and 3955 females, aged ≥35 years, blood pressure and related information were collected following WHO guidelines. Logistic regression models were used to estimate adjusted odds ratio (AOR) for factors affecting blood pressure awareness, antihypertensive use and uncontrolled hypertension among males and females taking antihypertensive medications. All analyses were weighted according to the complex survey design. RESULTS Women were more likely to have their blood pressure measured (76% vs. males 71%, p < 0.001) and to be 'aware' about their own high BP (55% vs. males 43%, p < 0.001). No gender difference was observed in antihypertensive medication use among those who were aware of their own high BP (females 67%, males 65%, p = 0.39). Non-working females were less likely to use antihypertensive (67% vs. non-working males 77%, p < 0.05). Poor women were worse off compared with poor males in antihypertensive medication use. One-in-three antihypertensive medication users had stage 2 hypertension (SBP ≥160/DBP ≥100 mmHg). Female sex, older age, increased wealth, higher BMI and certain geographical regions were associated with poor blood pressure control among antihypertensive medication users. CONCLUSIONS BP check-ups and hypertension awareness were higher among women than men but did not translate into better antihypertensive medication practice. Gender disadvantage and inequity were observed in antihypertensive medication use. Our findings reiterate the importance of sex-disaggregated analysis and reporting. Policy makers should explore the uncontrolled hypertension burden and geographical variations in Bangladesh.
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Affiliation(s)
- Muntasirur Rahman
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD 4006 Australia
| | - Gail Williams
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD 4006 Australia
| | - Abdullah Al Mamun
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD 4006 Australia
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Ralapanawa U, Dharmaratne SD, Jayawickreme K, Ekanayake M. Epidemiology of newly diagnosed hypertensives in a tertiary care hospital in a developing country. Clin Exp Hypertens 2017; 39:251-256. [PMID: 28448192 DOI: 10.1080/10641963.2016.1246563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cardiovascular diseases are the main cause of death in most countries and the past two decades have shown a global increase. Hypertension (HTN) was found to be the leading risk factor in 2010 as qualified by Disability Adjusted Life Years. Epidemiological studies in this regard in Sri Lanka are scarce. Thus, describing epidemiological patterns of HTN in the Sri Lankan population will help policy makers in planning preventive healthcare programs and aid in preparing strategies to cope with the increasing demand for healthcare facilities. METHODS This is a cross-sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka, among newly diagnosed hypertensives according to the JNC 7 report, attending the hypertensive clinic through referral. Data were collected by an interviewer administered structured questionnaire, and epidemiological patterns were analyzed. RESULTS Among 244 newly diagnosed hypertensives, the mean age was 58.3 years (SD = 12.3) and the majority were females. 66.8% had stage 2 HTN (>160 mmHg) at the time of first presentation to a tertiary care center. There was no statistically significant difference of the stage of HTN based on sex, education level, occupation, marital status, consumption of alcohol, and smoking. CONCLUSION Majority of the population had very high blood pressure at first diagnosis, indicating delay in the detection of HTN at an early stage. Therefore, measures to increase the probability of early detection of HTN will be useful in reducing morbidity and mortality associated with HTN.
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Affiliation(s)
- Udaya Ralapanawa
- a Department of Medicine , University of Peradeniya , Peradeniya , Sri Lanka
| | - Samath D Dharmaratne
- b Department of Community Medicine , University of Peradeniya , Peradeniya , Sri Lanka
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Fernandes LAB, Cestario EDES, Cosenso-Martin LN, Vilela-Martin JF, Yugar-Toledo JC, Fuchs FD. Chlorthalidone Plus Amiloride Reduces the Central Systolic Blood Pressure in Stage 1 Hypertension Patients. Cardiol Res 2017; 7:196-201. [PMID: 28197292 PMCID: PMC5295510 DOI: 10.14740/cr481w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hypertension reduction strategies use blood pressure in the brachial artery as the primary endpoint. Individuals who achieve the target blood pressure reduction with antihypertensive treatment have residual cardiovascular risk attributed to the difference in pressure between the aorta and brachial artery. Antihypertensive treatment affects the intrinsic properties of the vascular wall and arterial stiffness markers and consequently the central pressure. Recent publications stress the importance of adequate control of the central compared to peripheral blood pressure. Related clinical implications suggest that individuals with normal peripheral but high central blood pressure should not receive antihypertensive drugs that act on the central pressure. Therefore, they are at greater cardiovascular risk. The aim of the study was to evaluate the effect of treatment with a thiazide diuretic versus losartan on the central blood pressure in stage 1 hypertensive patients. METHODS Twenty-five patients were randomized to the chlorthalidone 25 mg/amiloride 5 mg group (q.d.) and 25 patients received losartan 50 mg (b.i.d). The central systolic blood pressure (CSBP) and augmentation index (AIx 75) were assessed using applanation tonometry. The paired t-test was used to compare the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), CSBP and AIx 75 between the thiazide and losartan groups at baseline and after 6 months of treatment. RESULTS Significant reductions in CSBP (123.3 ± 14.2 vs. 113.4 ± 111.4, P = 0.0103) and AIx 75 (87.7 ± 9.6 vs. 83.8 ± 8.9, P = 0.0289) were observed after 6 months of drug treatment with chlorthalidone 25 mg/amiloride 5 mg (q.d.). The administration of losartan 50 mg (b.i.d) did not reduce the CSBP and there were insignificant changes in the AIx 75. CONCLUSIONS Six-month treatment of chlorthalidone/amiloride but not losartan reduces the CSBP and AIx 75 in adults with stage 1 hypertension.
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Affiliation(s)
| | | | - Luciana Neves Cosenso-Martin
- Endocrinology Division of the Internal Medicine Department, State Medical School of Sao Jose Rio Preto, SP (FAMERP), Brazil
| | - Jose Fernando Vilela-Martin
- Hypertension Clinic, Department of Internal Medicine, State Medical School of Sao Jose do Rio Preto (FAMERP), Sao Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Hypertension Clinic, Department of Internal Medicine, State Medical School of Sao Jose do Rio Preto (FAMERP), Sao Paulo, Brazil
| | - Flavio Danni Fuchs
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Huang Y, Liu XL, Wen J, Huang LH, Lu Y, Miao RJ, Liu X, Li Y, Xing XW, Yuan H. Downregulation of the β1 adrenergic receptor in the myocardium results in insensitivity to metoprolol and reduces blood pressure in spontaneously hypertensive rats. Mol Med Rep 2016; 15:703-711. [PMID: 28000860 PMCID: PMC5364866 DOI: 10.3892/mmr.2016.6038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 09/08/2016] [Indexed: 01/08/2023] Open
Abstract
The β1‑adrenergic receptor (AR) is the primary β‑AR subtype in the heart and is the target of metoprolol (Met), which is commonly used to treat angina and hypertension. Previous studies have revealed a positive correlation between the methylation levels of the adrenoreceptor β1 gene (Adrb1) promoter in the myocardium with the antihypertensive activity of Met in spontaneously hypertensive rats (SHR), which affects β1‑AR expression in H9C2 cells. The aim of the present study was to investigate the effects of myocardial β1‑AR downregulation using short‑hairpin RNA (shRNA) against Adrb1 on the antihypertensive activity of Met in SHR. Recombinant adeno‑associated virus type 9 (rAAV9) vectors carrying Adrb1 shRNA (rAAV9‑Adrb1) or a negative control sequence (rAAV9‑NC) were generated and used to infect rat hearts via the pericardial cavity. The results of reverse transcription‑quantitative polymerase chain reaction, immunohistochemistry and western blotting analyses demonstrated that cardiac β1‑AR expression in the rAAV9‑Adrb1 group was significantly downregulated when compared with the rAAV9‑NC group (P<0.001, P<0.001 and P=0.032, respectively). In addition, a greater reduction in systolic blood pressure (SBP) was observed in the rAAV9‑NC group compared with the rAAV9‑Adrb1 group following Met treatment (P=0.035). Furthermore, downregulation of myocardial β1‑AR was associated with a significant decrease in SBP (P<0.001). In conclusion, these data suggest that suppression of β1‑AR expression in the myocardium reduces SBP and sensitivity to Met in SHR.
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Affiliation(s)
- Yun Huang
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Xiao-Li Liu
- Department of Pharmacy, The Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan 410013, P.R. China
| | - Jia Wen
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Li-Hua Huang
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Yao Lu
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Ru-Jia Miao
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Xing Liu
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Ying Li
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Xiao-Wei Xing
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Hong Yuan
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
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Irazola VE, Gutierrez L, Bloomfield G, Carrillo-Larco RM, Dorairaj P, Gaziano T, Levitt NS, Miranda JJ, Ortiz AB, Steyn K, Wu Y, Xavier D, Yan LL, He J, Rubinstein A. Hypertension Prevalence, Awareness, Treatment, and Control in Selected LMIC Communities: Results From the NHLBI/UHG Network of Centers of Excellence for Chronic Diseases. Glob Heart 2016; 11:47-59. [PMID: 27102022 PMCID: PMC4843831 DOI: 10.1016/j.gheart.2015.12.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Hypertension is the leading cause of cardiovascular disease and premature death worldwide. The prevalence of this public health problem is increasing in low- and middle-income countries (LMICs) in both urban and rural communities. OBJECTIVE The aim of this study was to examine hypertension prevalence, awareness, treatment, and control in adults 35 to 74 years of age from urban and rural communities in LMICs in Africa, Asia, and South America. METHODS The authors analyzed data from 7 population-based cross-sectional studies in selected communities in 9 LMICs that were conducted between 2008 and 2013. Age- and sex-standardized prevalence rates of pre-hypertension and hypertension were calculated. The prevalence rates of awareness, treatment, and control of hypertension were estimated overall and by subgroups of age, sex, and educational level. RESULTS In selected communities, age- and sex-standardized prevalence rates of hypertension among men and women 35 to 74 years of age were 49.9% (95% confidence interval [CI]: 42.3% to 57.4%) in Kenya, 54.9% (95% CI: 51.3% to 58.4%) in South Africa, 52.5% (95% CI: 50.1% to 54.8%) in China, 32.5% (95% CI: 31.7% to 33.3%) in India, 42.3% (95% CI: 40.4% to 44.2%) in Pakistan, 45.4% (95% CI: 43.6% to 47.2%) in Argentina, 39.9% (95% CI: 37.8% to 42.1%) in Chile, 19.2% (95% CI: 17.8% to 20.5%) in Peru, and 44.1% (95% CI: 41.6% to 46.6%) in Uruguay. The proportion of awareness varied from 33.5% in India to 69.0% in Peru, the proportion of treatment among those who were aware of their hypertension varied from 70.8% in South Africa to 93.3% in Pakistan, and the proportion of blood pressure control varied from 5.3% in China to 45.9% in Peru. CONCLUSIONS The prevalence of hypertension varies widely in different communities. The rates of awareness, treatment, and control also differ in different settings. There is a clear need to focus on increasing hypertension awareness and control in LMICs.
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Affiliation(s)
- Vilma E Irazola
- Centro de Excelencia en Salud Cardiovascular para el Cono Sur, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
| | - Laura Gutierrez
- Centro de Excelencia en Salud Cardiovascular para el Cono Sur, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Prabhakaran Dorairaj
- Public Health Foundation of India, Gurgaon, India; Centre for Chronic Disease Control, Gurgaon, India
| | - Thomas Gaziano
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA, USA; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - J Jaime Miranda
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe Ortiz
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Krisela Steyn
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China; Peking University Clinical Research Institute, Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Denis Xavier
- St. John's Medical College and Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - Lijing L Yan
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China; Duke Global Health Institute and Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Jiang He
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Adolfo Rubinstein
- Centro de Excelencia en Salud Cardiovascular para el Cono Sur, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Crampin AC, Kayuni N, Amberbir A, Musicha C, Koole O, Tafatatha T, Branson K, Saul J, Mwaiyeghele E, Nkhwazi L, Phiri A, Price AJ, Mwagomba B, Mwansambo C, Jaffar S, Nyirenda MJ. Hypertension and diabetes in Africa: design and implementation of a large population-based study of burden and risk factors in rural and urban Malawi. Emerg Themes Epidemiol 2016; 13:3. [PMID: 26839575 PMCID: PMC4736489 DOI: 10.1186/s12982-015-0039-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/04/2015] [Indexed: 02/01/2023] Open
Abstract
Background The emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases. There are few data on distribution of risk factors and outcomes in the region to inform an effective public health response. A comprehensive research programme is being developed aimed at accurately documenting the burden and drivers of NCDs in urban and rural Malawi; to design and test intervention strategies. The programme includes population surveys of all people aged 18 years and above, linking individuals with newly diagnosed hypertension and diabetes to healthcare and supporting clinical services. The successes, challenges and lessons learnt from the programme to date are discussed. Results Over 20,000 adults have been recruited in rural Karonga and urban Lilongwe. The urban population is significantly younger and wealthier than the rural population. Employed urban individuals, particularly males, give particular recruitment challenges; male participation rates were 80.3 % in the rural population and 43.6 % in urban, whilst female rates were 93.6 and 75.6 %, respectively. The study is generating high quality data on hypertension, diabetes, lipid abnormalities and risk factors. Conclusions It is feasible to develop large scale studies that can reliably inform the public health approach to diabetes, cardiovascular disease and other NCDs in Sub-Saharan Africa. It is essential for studies to capture both rural and urban populations to address disparities in risk factors, including age structure. Innovative approaches are needed to address the specific challenge of recruiting employed urban males.
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Affiliation(s)
- Amelia Catharine Crampin
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Alemayehu Amberbir
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Olivier Koole
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Keith Branson
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Amos Phiri
- Karonga Prevention Study, Karonga, Malawi
| | - Alison Jane Price
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Shabbar Jaffar
- London School of Hygiene and Tropical Medicine, London, UK
| | - Moffat Joha Nyirenda
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
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Zhang W, Wang L, Chen Y, Tang F, Xue F, Zhang C. Identification of Hypertension Predictors and Application to Hypertension Prediction in an Urban Han Chinese Population: A Longitudinal Study, 2005-2010. Prev Chronic Dis 2015; 12:E184. [PMID: 26513440 PMCID: PMC4663898 DOI: 10.5888/pcd12.150192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Research suggests that targeting high-risk, nonhypertensive patients for preventive intervention may delay the onset of hypertension. We aimed to develop a biomarker-based risk prediction model for assessing hypertension risk in an urban Han Chinese population. Methods We analyzed data from 26,496 people with hypertension to extract factors from 11 check-up biomarkers. Then, depending on a 5-year follow-up cohort, a Cox model for predicting hypertension development was built by using extracted factors as predictors. Finally, we created a hypertension synthetic predictor (HSP) by weighting each factor with its risk for hypertension to develop a risk assessment matrix. Results After factor analysis, 5 risk factors were extracted from data for both men and women. After a 5-year follow-up, the cohort of participants had an area under receiver operating characteristic curve (area under the curve [AUC]) with an odds ratio (OR) of 0.755 (95% confidence interval [CI], 0.746–0.763) for men and an OR of 0.801 (95% CI, 0.792–0.810) for women. After tenfold cross validation, the AUC was still high, with 0.755 (95% CI, 0.746–0.763) for men and 0.800 (95% CI, 0.791–0.810) for women. An HSP-based 5-year risk matrix provided a convenient tool for risk appraisal. Conclusion Hypertension could be explained by 5 factors in a population sample of Chinese urban Han. The HSP may be useful in predicting hypertension.
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Affiliation(s)
- Wenchao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Linping Wang
- Health Management Center, Shandong Provincial QianFoShan Hospital, Jinan, China
| | - Yafei Chen
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Fang Tang
- Health Management Center, Shandong Provincial QianFoShan Hospital, Jinan, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China>
| | - Chengqi Zhang
- Health Management Center, Shandong Provincial QianFoShan Hospital, Jinan 250014, China.
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