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Palomo-Piñón S, Antonio-Villa NE, García-Cortés LR, Moreno-Noguez M, Alcocer L, Álvarez-López H, Cardona-Muñoz EG, Chávez-Mendoza A, Díaz-Díaz E, Enciso-Muñoz JM, Galván-Oseguera H, Rosas-Peralta M. Patients Living With Arterial Hypertension in Mexico: First Insights of The Mexican Registry of Arterial Hypertension (RIHTA Study). Am J Hypertens 2024; 37:503-513. [PMID: 38466237 PMCID: PMC11176274 DOI: 10.1093/ajh/hpae024] [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: 10/16/2023] [Revised: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Arterial hypertension is a significant cause of morbidity and mortality in Mexico. However, there is limited evidence to understand blood pressure management and cardiometabolic profiles. Here, we aim to assess the prevalence of controlled and uncontrolled blood pressure, as well as the prevalence of cardiometabolic risk factors among patients from the Mexican Registry of Arterial Hypertension (RIHTA). METHODS We conducted a cross-sectional analysis of participants living with arterial hypertension registered on RIHTA between December 2021 and April 2023. We used both the 2017 ACC/AHA and 2018 ESC/ESH thresholds to define controlled and uncontrolled arterial hypertension. We considered eleven cardiometabolic risk factors, which include overweight, obesity, central obesity, insulin resistance, diabetes, hypercholesterolemia, hypertriglyceridemia, low HDL-C, high LDL-C, low-eGFR, and high cardiovascular disease (CVD) risk. RESULTS In a sample of 5,590 participants (female: 61%, n = 3,393; median age: 64 [IQR: 56-72] years), the prevalence of uncontrolled hypertension varied significantly, depending on the definition (2017 ACC/AHA: 59.9%, 95% CI: 58.6-61.2 and 2018 ESC/ESH: 20.1%, 95% CI: 19.0-21.2). In the sample, 40.43% exhibited at least 5-6 risk factors, and 32.4% had 3-4 risk factors, chiefly abdominal obesity (83.4%, 95% CI: 82.4-84.4), high LDL-C (59.6%, 95% CI: 58.3-60.9), high CVD risk (57.9%, 95% CI: 56.6-59.2), high triglycerides (56.2%, 95% CI: 54.9-57.5), and low HDL-C (42.2%, 95% CI: 40.9-43.5). CONCLUSIONS There is a high prevalence of uncontrolled hypertension interlinked with a high burden of cardiometabolic comorbidities in Mexican adults living with arterial hypertension, underscoring the urgent need for targeted interventions and better healthcare policies to reduce the burden of the disease in our country.
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Affiliation(s)
- Silvia Palomo-Piñón
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Ciudad de México, México
| | | | - Luis Rey García-Cortés
- Coordinación de Planeación y Enlace Institucional, Jefatura de Servicios de Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Instituto Mexicano del Seguro Social, Estado de México, Oriente, México
| | - Moises Moreno-Noguez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Familiar No. 55 Zumpango, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Estado de México, México
| | - Luis Alcocer
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Ángeles del Pedregal, Ciudad de México, México
| | - Humberto Álvarez-López
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Puerta de Hierro Andares, Zapopan, Jalisco, México
| | - Ernesto G Cardona-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Adolfo Chávez-Mendoza
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Enrique Díaz-Díaz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Manuel Enciso-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital General Zacatecas "Luz González Cosio", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Zacatecas, Zacatecas, México
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
| | - Héctor Galván-Oseguera
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Martín Rosas-Peralta
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Titular Academia Nacional de Medicina, Ciudad de México, México
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Calderon-Ocon V, Cueva-Peredo F, Bernabe-Ortiz A. Prevalence, trends, and factors associated with hypertensive crisis among Peruvian adults. CAD SAUDE PUBLICA 2024; 40:e00155123. [PMID: 38381865 PMCID: PMC10877693 DOI: 10.1590/0102-311xen155123] [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: 08/16/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 02/23/2024] Open
Abstract
There are few studies focused on the epidemiology of hypertensive crisis at the population level in resource-constrained settings. This study aimed to determine the prevalence and trends over time of hypertensive crisis, as well as the factors associated with this condition among adults. A secondary data analysis was carried out using the Peruvian Demographic and Family Health Survey (ENDES). Hypertensive crisis was defined based on the presence of systolic (≥ 180mmHg) or diastolic (≥ 110mmHg) blood pressure, regardless of previous diagnosis or medication use. The factors associated with our outcome were evaluated using multinomial logistic regression, and the trend of hypertensive crisis was evaluated using the Cochrane-Armitage test. Data from 260,167 participants were analyzed, with a mean age of 44.2 (SD: 16.9) years and 55.5% were women. Hypertension prevalence was 23% (95%CI: 22.7-23.4) and, among them, 5.7% (95%CI: 5.4-5.9) had hypertensive crisis, with an overall prevalence of 1.5% (95%CI: 1.4-1.6). From 2014 to 2022, a significant decrease in the prevalence of hypertensive crisis was observed, from 1.7% in 2014 to 1.4% in 2022 (p = 0.001). In the multivariable model, males, increasing age, living in urban areas, high body mass index, and self-reported type 2 diabetes were positively associated with hypertensive crisis, whereas higher educational level, socioeconomic status, and high altitude were inversely associated. There is a need to improve strategies for the diagnosis, treatment, and control of hypertension, especially hypertensive crisis.
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Pirkle CM, Guerra RO, Gómez F, Belanger E, Sentell T. Socioecological Factors Associated with Hypertension Awareness and Control Among Older Adults in Brazil and Colombia: Correlational Analysis from the International Mobility in Aging Study. Glob Heart 2023; 18:66. [PMID: 38162526 PMCID: PMC10756159 DOI: 10.5334/gh.1282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024] Open
Abstract
Background Hypertension awareness and control are understudied among older adults in middle-income countries, with limited work contextualizing awareness and control across layers of influence (individual to the community). Research on hypertension in Latin America is acknowledged as insufficient. Objectives This study applies the socioecological model (SEM) to examine individual, interpersonal, institutional, and community factors related to hypertension awareness and control in older adults residing in Brazil and Colombia. It identifies groups of older adults more likely to be unaware of their condition and/or to have challenges achieving hypertension control. Methods We analyzed International Mobility in Aging Study data of 803 community-dwelling adults 65-74 years from study sites in the two most populous countries in South America. The study framework was the socioecological model. Logistic regression models identified factors associated with hypertension awareness and control. Conclusions Hypertension was prevalent in both samples (>70%), and awareness was high (>80%). Blood pressure control among diagnosed respondents was low: 30% in Brazil and 51% in Colombia. Factors across the socioecological model were associated with awareness and control, with notable differences across countries. Those with diabetes (OR 4.19, 95%CI 1.64-10.71) and insufficient incomes (OR: 1.85, 95%CI 1.03-3.31) were more likely to be aware of their hypertension. In Colombia, those reporting no community activity engagement were less likely to be aware compared to those reporting community activities. In Brazil, it was the opposite. Women (OR 1.66, 95%CI 1.12-2.46) and those reporting strolling shops and stores (OR 1.80, 95% CI 1.09-3.00) were significantly more likely to have their hypertension under control. In Brazil, those 70-75 were significantly less likely to have their hypertension under control compared to their younger counterparts. In Colombia, this was not observed. This paper highlights the importance of theory-based studies within unique Latin American contexts on hypertension and suggests novel opportunities for intervention.
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Affiliation(s)
- Catherine M. Pirkle
- Office of Public Health Studies, University of Hawaiʻi at Mānoa, 1960 East-West Road, BioMed T102A, Honolulu, HI 96822-2319, US
| | - Ricardo Oliveira Guerra
- Universidade Federal do Rio Grande do Norte, Departamento de Fisioterapia, Campus Universitário –Av. Salgado Filho S/N. 59078 970, Natal-RN Brasil, BR
| | - Fernando Gómez
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, CO
- Sede Principal Calle 65 No 26
| | - Emmanuelle Belanger
- Department of Health Services, Policy & Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 South Main Street, 6Floor, Providence, RI, US
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawaiʻi at Mānoa, 1960 East-West Road, BioMed D209E, Honolulu, HI 96822-2319, US
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Zambrano AK, Cadena-Ullauri S, Guevara-Ramírez P, Ruiz-Pozo VA, Tamayo-Trujillo R, Paz-Cruz E, Ibarra-Rodríguez AA, Doménech N. Genetic diet interactions of ACE: the increased hypertension predisposition in the Latin American population. Front Nutr 2023; 10:1241017. [PMID: 37964928 PMCID: PMC10640988 DOI: 10.3389/fnut.2023.1241017] [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: 06/15/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Hypertension is one of the primary risk factors associated with cardiovascular diseases (CVDs). It is a condition that affects people worldwide, and its prevalence is increasing due to several factors, such as lack of physical activity, population aging, and unhealthy diets. Notably, this increase has primarily occurred in low and middle-income countries (LMICs). In Latin America, approximately 40% of adults have been diagnosed with hypertension. Moreover, reports have shown that the Latin American genetic composition is highly diverse, and this genetic background can influence various biological processes, including disease predisposition and treatment effectiveness. Research has shown that Western dietary patterns, which include increased consumption of red meat, refined grains, sugar, and ultra-processed food, have spread across the globe, including Latin America, due to globalization processes. Furthermore, a higher than recommended sodium consumption, which has been associated with hypertension, has been identified across different regions, including Asia, Europe, America, Oceania, and Africa. In conclusion, hypertension is a multifactorial disease involving environmental and genetic factors. In Latin America, hypertension prevalence is increasing due to various factors, including age, the adoption of a "Westernized" diet, and potential genetic predisposition factors involving the ACE gene. Furthermore, identifying the genetic and molecular mechanisms of the disease, its association with diet, and how they interact is essential for the development of personalized treatments to increase its efficacy and reduce side effects.
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Affiliation(s)
- Ana Karina Zambrano
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Santiago Cadena-Ullauri
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Patricia Guevara-Ramírez
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Viviana A. Ruiz-Pozo
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Rafael Tamayo-Trujillo
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Elius Paz-Cruz
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | | | - Nieves Doménech
- Instituto de Investigación Biomédica de A Coruña (INIBIC)-CIBERCV, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidad da Coruña (UDC), La Coruña, Spain
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Coelho DM, de Souza Andrade AC, Silva UM, Lazo M, Slesinski SC, Quistberg A, Diez-Roux AV, de Lima Friche AA, Caiaffa WT. Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis. BMC Public Health 2023; 23:1532. [PMID: 37568082 PMCID: PMC10416382 DOI: 10.1186/s12889-023-16480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Despite global interest in gender disparities and social determinants of hypertension, research in urban areas and regions with a high prevalence of hypertension, such as Latin America, is very limited. The objective of this study was to examine associations of individual- and area-level socioeconomic status with hypertension in adults living in 230 cities in eight Latin America countries. METHODS In this cross-sectional study, we used harmonized data from 109,184 adults (aged 18-97 years) from the SALURBAL (Salud Urbana en America Latina/Urban Health in Latin America) project. Hypertension was assessed by self-report. Individual-, sub-city- and city-level education were used as proxies of socioeconomic status. All models were stratified by gender. RESULTS Higher individual-level education was associated with lower odds of hypertension among women (university education or higher versus lower than primary: odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.61-0.74) but higher odds among men (OR = 1.65; 95%CI 1.47-1.86), although in men an inverse association emerged when measured blood pressure was used (OR = 0.86; 95%CI 0.76-0.97). For both genders, living in sub-city areas with higher educational achievement was associated with higher odds of hypertension (OR per standard deviation [SD] = 1.07, 95%CI = 1.02-1.12; OR = 1.11 per SD, 95%CI = 1.05-1.18, for women and men, respectively). The association of city-level education with hypertension varied across countries. In Peru, there was an inverse association (higher city level education was associated with lower odds of hypertension) in women and men, but in other countries no association was observed. In addition, the inverse association of individual-level education with hypertension became stronger (in women) or emerged (in men) as city or sub-city education increased. CONCLUSION The social patterning of hypertension differs by gender and by the level of analysis highlighting the importance of context- and gender-sensitive approaches and policies to reduce the prevalence of hypertension in Latin America.
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Affiliation(s)
- Débora Moraes Coelho
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil.
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil.
| | - Amanda Cristina de Souza Andrade
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
- Institute of Public Health, Federal University of Mato Grosso, Avenida Fernando Corrêa 2367, Cuiabá, 78060-900, Brazil
| | - Uriel Moreira Silva
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
| | - Mariana Lazo
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - S Claire Slesinski
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Alex Quistberg
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Ana V Diez-Roux
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Amélia Augusta de Lima Friche
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
| | - Waleska Teixeira Caiaffa
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
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Londoño Agudelo E, Battaglioli T, Díaz Piñera A, Rodríguez Salvá A, Smekens T, Achiong Estupiñán F, Carbonell García I, Van der Stuyft P. Effectiveness of a provider and patient-focused intervention to improve hypertension management and control in the primary health care setting in Cuba: a controlled before-after study. BMC PRIMARY CARE 2023; 24:10. [PMID: 36641434 PMCID: PMC9840256 DOI: 10.1186/s12875-022-01959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Implementation research to improve hypertension control is scarce in Latin America. We assessed the effectiveness of an intervention aimed at primary care practitioners and hypertensive patients in a setting that provides integrated care through an accessible network of family practices. METHODS We conducted in Cardenas and Santiago, Cuba, a controlled before-after study in 122 family practices, which are staffed with a doctor and a nurse. The intervention comprised a control arm (usual care), an arm with a component targeting providers (hypertension management workshops), and an arm with, on top of the latter, a component targeting patients (hypertension schools). To evaluate the effect, we undertook a baseline survey before the intervention and an endline survey sixteen months after its start. In each survey, we randomly included 1400 hypertensive patients. Controlled hypertension, defined as a mean systolic and diastolic blood pressure below 140 and 90 mmHg, respectively, was the primary endpoint assessed. We performed linear and logistic regression with a Generalized Estimating Equations approach to determine if the proportion of patients with controlled hypertension changed following the intervention. RESULTS Seventy-three doctors, including substitutes, and 54 nurses from the 61 intervention family practices attended the provider workshops, and 3308 patients -51.6% of the eligible ones- participated in the hypertension schools. Adherence to anti-hypertensive medication improved from 42% at baseline to 63% at the endline in the intervention arms. Under the provider intervention, the proportion of patients with controlled hypertension increased by 18.9%, from 48.7% at baseline to 67.6% at endline. However, adding the component that targeted hypertensive patients did not augment the effect. Compared to patients in the control arm, the adjusted OR of having controlled hypertension was 2.36 (95% CI, 1.73-3.22) in the provider and 2.00 (95% CI, 1.68-2.37) in the provider plus patient intervention arm. CONCLUSIONS The intervention's patient component remains to be fine-tuned. Still, we demonstrate that it is feasible to substantially improve hypertension outcomes by intervention at the primary care level, despite an already relatively high control rate.
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Affiliation(s)
- Esteban Londoño Agudelo
- grid.412881.60000 0000 8882 5269Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia, Calle 62 #52-59, Medellín, Colombia ,grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University. Campus UZ-Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium ,grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000 Antwerp, Belgium ,grid.411140.10000 0001 0812 5789Facultad de Medicina, Universidad CES, Calle 10A #22-04, Medellín, Colombia
| | - Tullia Battaglioli
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000 Antwerp, Belgium
| | - Addys Díaz Piñera
- grid.493388.d0000 0004 0461 1191Centro de Epidemiología y Salud Ambiental, Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta No. 1158 e/ Llinás y Clavel, Centro Habana, 10300 La Habana, Cuba
| | - Armando Rodríguez Salvá
- grid.493388.d0000 0004 0461 1191Centro de Epidemiología y Salud Ambiental, Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta No. 1158 e/ Llinás y Clavel, Centro Habana, 10300 La Habana, Cuba
| | - Tom Smekens
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000 Antwerp, Belgium
| | | | - Isabel Carbonell García
- Centro Provincial de Higiene y Epidemiología, Calle J No. 1 entre 1ra y 2da Reparto Sueño, Santiago de Cuba, Cuba
| | - Patrick Van der Stuyft
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University. Campus UZ-Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Faghy MA, Yates J, Hills AP, Jayasinghe S, da Luz Goulart C, Arena R, Laddu D, Gururaj R, Veluswamy SK, Dixit S, Ashton REM. Cardiovascular disease prevention and management in the COVID-19 era and beyond: An international perspective. Prog Cardiovasc Dis 2023; 76:102-111. [PMID: 36693488 PMCID: PMC9862672 DOI: 10.1016/j.pcad.2023.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Despite some indicators of a localized curtailing of cardiovascular disease (CVD) prevalence, CVD remains one of the largest contributors to global morbidity and mortality. While the magnitude and impact of the coronavirus disease 2019 (COVID-19) pandemic have yet to be realized in its entirety, an unquestionable impact on global health and well-being is already clear. At a time when the global state of CVD is perilous, we provide a continental overview of prevalence data and initiatives that have positively influenced CVD outcomes. What is clear is that despite attempts to address the global burden of CVD, there remains a lack of collective thinking and approaches. Moving forward, a coordinated global infrastructure that, if developed with appropriate and relevant key stakeholders, could provide significant and longstanding benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical perspectives must be underpinned by unified approaches that maximize public health.
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Affiliation(s)
- Mark A Faghy
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK; Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - James Yates
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK
| | - Andrew P Hills
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Sisitha Jayasinghe
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Ross Arena
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK; Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America
| | - Rachita Gururaj
- Department of Physiotherapy, Ramaiah Medical College, Bengaluru, India
| | - Sundar Kumar Veluswamy
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physiotherapy, Ramaiah Medical College, Bengaluru, India
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, King Khalid University, Saudi Arabia
| | - Ruth E M Ashton
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America
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Mirahmadizadeh A, Vali M, Hassanzadeh J, Dehghani SP, Razeghi A, Azarbakhsh H. Mortality Rate and Years of Life Lost due to Hypertension in the South of Iran between 2004 and 2019: A Population-Based Study. Int J Hypertens 2022; 2022:7759699. [PMID: 36483311 PMCID: PMC9726258 DOI: 10.1155/2022/7759699] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/03/2022] [Accepted: 11/20/2022] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Hypertension is known worldwide as a preventable significant risk factor for cardiovascular diseases and their mortality. This study was designed to determine the mortality rate and years of life lost (YLL) due to hypertension in Fars Province. METHOD In this cross-sectional study, we extracted all death reports due to hypertension based on age, gender, and the year of death based on ICD-10 from the EDRS system (Electronic Death Registration System). The YLL analysis due to premature death related to hypertension was executed by the 2015 YLL template from WHO in EXCEL 2016 software. To examine the trend of crude and standardized mortality rates and YLL rates for different years, joinpoint regression was used based on the log-linear model. RESULTS In the 16 years that the study was done (2004-2019), 13443 death cases occurred in the Fars Province, 51.0% of which (6859 cases) were in females and 48.5% (6515 cases) of which were in the 80+ age group. Total YLL due to hypertension in these 16 years of study was 61,344 (1.9 per 1000) in males, 64,903 (2.1 per 1000) in females, and 126,247 (2.0 in 1000) in both genders. According to the joinpoint regression analysis, the 16-year trend of YLL rate due to premature mortality was increasing: the average annual percent change (AAPC) was 4.9% (95% CI -2.6 to 12.85, p value=0.205) for males and 8.4% (95% CI 5.2 to 11.7, p value <0.001) for females. CONCLUSION Considering the increasing trend in crude and standardized mortality rates and YLL due to hypertension, it is important for policymakers and decision makers of Health Policy Centers to promote and inform people about the importance of hypertension control and to familiarize them with proper, preventive interventions such as the importance of a healthy diet, routine physical activity, and routine learning programs for different groups in the society especially for people at a higher risk of hypertension.
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Affiliation(s)
- Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jafar Hassanzadeh
- Research Center for Health Sciences, Institute of Health, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ahmadreza Razeghi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Ortiz P, Vásquez Y, Arévalo E, Van der Stuyft P, Londoño Agudelo E. Gaps in Hypertension Management in a Middle-Income Community of Quito-Ecuador: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105832. [PMID: 35627369 PMCID: PMC9141875 DOI: 10.3390/ijerph19105832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Optimal hypertension care and control at population level significantly reduces cardiovascular morbidity and mortality. The study objective was to measure the gaps in the diagnosis, care, and control of hypertension in residents of an urban community in Quito, Ecuador. A cross-sectional population-based study with a sample of 2160 persons was performed using a survey and direct blood pressure measurement. Logistical regression models were used for analyzing factors associated with the gaps, expressed as percentages. The prevalence of hypertension was 17.6% [CI 95% 17.3–17.9%]. The diagnosis gap was 6.1% [CI 95% 5.9–6.2%] among the entire population and 34.5% [CI 95% 33.7–35.3%] among persons with hypertension. No access gaps were detected; whereas the follow-up gap was 22.7% [CI 95% 21.8–23.6%] and control gap reached 43.5% [CI 95% 42.6–44.2%]. Results indicated that being male, older than 64 years, an employee, without health insurance, and not perceiving a need for healthcare, increased the risk of experiencing these gaps. Data showed appropriate access to health services and high coverage in the diagnosis was due to the application of a community and family healthcare model. Notwithstanding, we found significant gaps in the follow-up and control of hypertensive patients, especially among older males, which should warrant the attention of the Ministry of Health.
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Affiliation(s)
- Patricia Ortiz
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito 170143, Ecuador; (Y.V.); (E.A.)
- Consortium Latin-American Network for Multidisciplinary Research on Chronic Non-Communicable Diseases, Medellin 050010, Colombia; (P.V.d.S.); (E.L.A.)
- Departamento de Pediatría, Obstetricia y Ginecología y de Medicina Preventiva, Universidad Autónoma de Barcelona, 08193 Barcelona, Spain
- Correspondence:
| | - Yajaira Vásquez
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito 170143, Ecuador; (Y.V.); (E.A.)
- Consortium Latin-American Network for Multidisciplinary Research on Chronic Non-Communicable Diseases, Medellin 050010, Colombia; (P.V.d.S.); (E.L.A.)
| | - Esperanza Arévalo
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito 170143, Ecuador; (Y.V.); (E.A.)
- Consortium Latin-American Network for Multidisciplinary Research on Chronic Non-Communicable Diseases, Medellin 050010, Colombia; (P.V.d.S.); (E.L.A.)
| | - Patrick Van der Stuyft
- Consortium Latin-American Network for Multidisciplinary Research on Chronic Non-Communicable Diseases, Medellin 050010, Colombia; (P.V.d.S.); (E.L.A.)
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Esteban Londoño Agudelo
- Consortium Latin-American Network for Multidisciplinary Research on Chronic Non-Communicable Diseases, Medellin 050010, Colombia; (P.V.d.S.); (E.L.A.)
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
- Department of Public Health, Institute of Tropical Medicine, 2000 Antwerp, Belgium
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín 50010, Colombia
- Facultad de Medicina, Universidad CES, Medellín 0510, Colombia
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10
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Luxardo R, Ceretta L, González-Bedat M, Ferreiro A, Rosa-Diez G. The Latin American Dialysis and Renal Transplantation Registry: report 2019. Clin Kidney J 2022; 15:425-431. [PMID: 35211302 PMCID: PMC8862045 DOI: 10.1093/ckj/sfab188] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to the burden of disease it causes and the difficulty in accessing treatment. LA has a total population of 652 million people living in 20 countries that occupy an area of 19.2 million km2. The Latin American Dialysis and Renal Transplantation Registry (LADRTR), founded in 1991, has collected data and reports on patients receiving kidney replacement therapy (KRT) since 1993. This article summarizes the registry data for 2019. Methods Participating countries complete an annual survey collecting aggregated data on incident and prevalent patients on KRT in all modalities. The different treatment modalities considered were hemodialysis (HD), peritoneal dialysis (PD) and living functioning kidney graft (LFG). National gross domestic product per capita (GDP, expressed in US dollars) and life expectancy at birth (LEB) corresponding to the year 2019 were collected from the World Bank Data Bank. Prevalence and incidence were compared with previous years and were also correlated with GDP and LEB. Results On 31 December 2019 a total of 432 610 patients were in KRT in LA, corresponding to an overall unadjusted prevalence of 866 per million population (pmp). Regarding treatment modality, 66.7% of the prevalent patients were treated with HD and 9.3% with PD while 24% of the patients had an LFG. A total of 85 224 patients started KRT in LA, representing a total unadjusted incidence rate of 168 pmp. Diabetic nephropathy as a cause of CKD continues to be a relevant percentage (36%) and five countries reported CKD of nontraditional causes. The kidney transplant rate in the region was 22 pmp, varying from 1 to >60 pmp. The total prevalence of KRT correlated positively with GDP per capita (r2 = 0.6, P < 0.01) and LEB (r2 = 0.23, P < 0.05). The overall incidence rate also significantly correlated with GDP (r2 = 0.307, P < 0.05). The overall unadjusted mortality rate was 13%. Conclusion Accessibility to KRT is still limited in LA. It is necessary to continue the efforts made by each country and the Latin American Society of Nephrology and Hypertension to guarantee equal access to treatment.
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Affiliation(s)
- Rosario Luxardo
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
- Hospital Italiano de Buenos Aires, Nephrology, Buenos Aires, Argentina
| | - Laura Ceretta
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
| | - María González-Bedat
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
- Sociedad Latinoamericana de Nefrología e Hipertensión, Panama City, Panama
| | - Alejandro Ferreiro
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
- Universidad de la Republica Uruguay, Centro de Nefrología. Facultad de Medicina, Montevideo, Uruguay
| | - Guillermo Rosa-Diez
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
- Hospital Italiano de Buenos Aires, Nephrology, Buenos Aires, Argentina
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Wang J, Lin H, Chiavaroli V, Jin B, Yuan J, Huang K, Wu W, Dong G, Derraik JGB, Fu J. High Prevalence of Cardiometabolic Comorbidities Among Children and Adolescents With Severe Obesity From a Large Metropolitan Centre (Hangzhou, China). Front Endocrinol (Lausanne) 2022; 13:807380. [PMID: 35663319 PMCID: PMC9160715 DOI: 10.3389/fendo.2022.807380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to describe the clinical characteristics of children and adolescents with obesity, and the prevalence of cardiometabolic comorbidities over 10 years in this population from a large metropolitan centre in China. METHODS This was a cross-sectional study (2008-2017) of patients aged <18 years with obesity [body mass index (BMI) ≥ 95th percentile for age and sex] enrolled at the Department of Endocrinology, Children's Hospital of Zhejiang University School of Medicine (Hangzhou, Zhejiang Province). Clinical assessments included anthropometry, blood pressure, liver ultrasound, lipid profile, oral glucose tolerance test, and uric acid. For examination of outcomes, our study cohort was stratified by sex and age bands (<10 vs. ≥10 years), with the study period also split into two strata (2008-2012 and 2013-2017). RESULTS A total of 2,916 patients (1,954 boys and 962 girls) were assessed at a mean age of 10.5 years. Patients almost invariably presented severe obesity (median BMI SDS = 2.98; Q1 = 2.60, Q3 = 3.39). Obesity-related comorbidities were common among boys and girls, including type 2 diabetes mellitus (2.6% and 3.6%, respectively), abnormal glycaemia (33.6% and 35.5%, respectively), hypertension (33.9% and 32.0%, respectively), dyslipidaemia (35.2% and 39.6%, respectively), hyperuricaemia (16.2% and 8.3%, respectively), acanthosis nigricans (71.9% and 64.0%, respectively), abnormal liver function (66.9% and 47.0%, respectively), and non-alcoholic fatty liver disease (NAFLD) (63.8% and 45.1%, respectively); 38.7% of boys and 44.4% of girls aged ≥10 years had metabolic syndrome. Notably, the incidence of many cardiometabolic comorbidities was in 2013-2017 compared to 2008-2012. For example, rates of hypertension among boys aged <10 years and aged ≥10 years rose from 28.4% and 26.5% to 48.0% and 35.8%, respectively, and in girls from 20.3% and 20.8% to 41.7% and 39.6%, respectively. In 2013-2017, 9.5% of girls in the older group had metabolic syndrome compared to 2.2% in 2008-2013. CONCLUSIONS We observed a high incidence of obesity-related cardiometabolic comorbidities among Chinese children and adolescents with severe obesity over 10 years. It was particularly concerning that rates of several comorbidities rose markedly over the study period, highlighting the need to address the obesity epidemic early in life (in China and elsewhere) to prevent the development of obesity-related comorbidities and, subsequently, of overt disease.
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Affiliation(s)
- Jinling Wang
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hu Lin
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Valentina Chiavaroli
- Neonatal Intensive Care Unit, Pescara Public Hospital, Pescara, Italy
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Binghan Jin
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jinna Yuan
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ke Huang
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wei Wu
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guanping Dong
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - José G. B. Derraik
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Environmental and Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- *Correspondence: Junfen Fu, ; José G. B. Derraik,
| | - Junfen Fu
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- *Correspondence: Junfen Fu, ; José G. B. Derraik,
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Changes in the Sodium Content of Foods Sold in Four Latin American Countries: 2015 to 2018. Nutrients 2021; 13:nu13114108. [PMID: 34836362 PMCID: PMC8624930 DOI: 10.3390/nu13114108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022] Open
Abstract
In 2015, the Pan American Health Organization (PAHO) published sodium targets for packaged foods, which included two distinct levels: one “regional” and one “lower” target. Changes to the sodium content of the food supply in Latin American Countries (LAC) has not been evaluated. A repeated cross-sectional study used food label data from 2015 (n = 3859) and 2018 (n = 5312) to determine changes in the proportion of packaged foods meeting the PAHO sodium targets and the distribution in the sodium content of foods in four LAC (Argentina, Costa Rica, Paraguay, Peru). Foods were classified into the 18 food categories in the PAHO targets. The proportion of foods meeting the regional targets increased from 82.9% to 89.3% between 2015 and 2018 (p < 0.001). Overall, 44.4% of categories had significant decreases in mean sodium content. Categories with a higher proportion of foods meeting the regional and lower targets in 2018 compared to 2015 (p < 0.05) were breaded meat and poultry, wet and dry soups, snacks, cakes, bread products, flavored cookies and crackers, and dry pasta and noodles. While positive progress has been made in reducing the sodium content of foods in LAC, sodium intakes in the region remain high. More stringent targets are required to support sodium reduction in LAC.
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13
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Londoño Agudelo E, Pérez Ospina V, Battaglioli T, Taborda Pérez C, Gómez-Arias R, Van der Stuyft P. Gaps in hypertension care and control: a population-based study in low-income urban Medellin, Colombia. Trop Med Int Health 2021; 26:895-907. [PMID: 33938098 PMCID: PMC8453502 DOI: 10.1111/tmi.13599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess hypertension prevalence and the extent and associated factors of hypertension diagnosis, follow-up, treatment and control gaps in low-income urban Medellin, Colombia. METHODS We randomly sampled 1873 adults aged 35 or older. Unaware hypertensive individuals were defined as those without previous diagnosis whose average blood pressure was equal to or above 140/90 mmHg. For aware hypertensive patients, control was delimited as average blood pressure below 140/90 if under 59 years old or diabetic, and as less than 150/90 otherwise. We used logistic regression to identify care gap-associated factors. RESULTS Hypertension prevalence was 43.5% (95% CI 41.2-45.7). We found 28.2% aware and 15.3% unaware hypertensive individuals, which corresponds to a 35.1% (95% CI 31.9-38.5) underdiagnosis. This gap was determined by age, sex, education and lifestyle factors. 14.4% (95% CI 11.6-17.6) of aware hypertensive patients presented a follow-up gap, 93.4% (95% CI 90.9-95.2) were prescribed antihypertensive drugs, but 38.9% (95% CI 34.7-43.3) were not compliant. The latter was strongly associated with follow-up. The hypertension control gap in aware hypertensive patients, 39.0% (95% CI: 34.9-43.2), was associated with being older, having diabetes, weakly adhering to pharmacological treatment and receiving poor non-pharmacological advice. Overall, 60.4% (95% CI 57.0-63.8) of aware and unaware hypertensive participants had either diagnosed but uncontrolled or undiagnosed hypertension. CONCLUSIONS We found high hypertension prevalence coupled with, from an international perspective, encouraging awareness and control figures. Still, there remains ample room for improvement. Our findings can assist in designing integrated primary healthcare measures that further strengthen equitable and effective access to hypertension care and control.
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Affiliation(s)
- Esteban Londoño Agudelo
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.,Facultad de Medicina, Universidad CES, Medellín, Colombia
| | | | - Tullia Battaglioli
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Rubén Gómez-Arias
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.,Facultad de Medicina, Universidad CES, Medellín, Colombia
| | - Patrick Van der Stuyft
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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14
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Arredondo A, Recamán AL, Suarez-Herrera JC, Cuadra SM. Recent trends for the management of hypertension in older adults in Latin America in the context of universal coverage: Evidence from Mexico. Int J Health Plann Manage 2020; 36:579-586. [PMID: 33368667 DOI: 10.1002/hpm.3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 11/08/2022] Open
Abstract
Taking the Mexican case as a tracer of what is happening in Latin America on public health, we estimate the recent changes and challenges for the management of hypertension in older adults in the context of universal health coverage. The population base was 200, and 308 reported cases of older adults with hypertension. The cost-evaluation method used was based on the instrumentation and consensus technique. Regarding epidemiological changes for 2016 versus 2018, there is an increase of 21% (CI: 95%, p < 0.001). Comparing the economic impact in 2016 versus 2018 (CI: 95%, p < 0.001), the increase is 33%. The total amount estimated for hypertension in 2018 (in US dollars) was $ 1,896,520,273. It includes $ 898,064,979 as direct costs and $ 998,455,294 as indirect costs. The recent trends show that the financial requirements for the coming years do not guarantee the effectiveness of the coverage rates required for the elderly. In terms of catastrophic expenditure, the challenge is not minor, the greatest economic burden is for the pocket of patients and their families.
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Affiliation(s)
- Armando Arredondo
- Center for Health System Research, National Institute of Public Health, Cuernavaca, México
| | | | - José Carlos Suarez-Herrera
- Department of Strategy, Entrepreneurship and Sustainable Development, KEDGE Business School, Marseille, France
| | - Silvia Magali Cuadra
- Center for Health System Research-National Institute of Public Health, Cuernavaca, México
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Vargas EA, Patel RB, Medina-Lezama J, Chirinos DA. Depressive Symptoms Are Associated with Reduced Cardiac Function Among Hispanics: Results from the PREVENCION Study. Int J Behav Med 2020; 28:531-539. [PMID: 33170471 DOI: 10.1007/s12529-020-09941-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Depressive symptoms are common among patients with heart failure and are often associated with adverse outcomes, including re-hospitalization and mortality. However, little is known about the association between depressive symptoms and subclinical markers of heart failure and cardiac function in community-based samples and little research has focused on South American Hispanics. The current study examined the cross-sectional association between depressive symptoms and cardiac function in South American Hispanic community-based adults. METHODS Participants included 527 adults enrolled in the Peruvian Study of Cardiovascular Disease (PREVENCION). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). Markers of cardiac function were assessed by impedance cardiography and included cardiac output, cardiac index, stroke volume, and stroke volume index. Several multiple regression analyses were used to examine the association between depressive symptoms and markers of cardiac function. RESULTS In adjusted analyses, depressive symptoms were associated with reduced cardiac output, cardiac index, stroke volume, and stroke volume index. These associations remained significant between depressive symptoms and cardiac output (β = - 0.106, p = 0.014), cardiac index (β = - 0.099, p = 0.029), and stroke volume (β = - 0.095, p = 0.022), and a trend was still observed between depressive symptoms and stroke index (β = - 0.083, p = 0.061), even after having controlled for demographic factors (age, gender, education), cardiovascular risk factors (smoking status, body mass index, low- and high-density lipoprotein cholesterol, triglycerides, fasting glucose, serum creatinine), and comorbidities (diabetes mellitus, hypertension, hypercholesterolemia). CONCLUSIONS In the PREVENCION sample tested, depressive symptoms were independently associated with cardiac function among Hispanic adults, even above and beyond pertinent factors such as demographic factors, cardiovascular risk factors, and comorbidities. Future studies should determine whether depressive symptoms are prospectively associated with systolic dysfunction, and examine the bio-behavioral pathways of this association.
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Affiliation(s)
- Emily A Vargas
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 Lake Shore Dr, Chicago, IL, 60611, USA.
| | - Ravi B Patel
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 Lake Shore Dr, Chicago, IL, 60611, USA
| | | | - Diana A Chirinos
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 Lake Shore Dr, Chicago, IL, 60611, USA
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Hessel P, Rodríguez-Lesmes P, Torres D. Socio-economic inequalities in high blood pressure and additional risk factors for cardiovascular disease among older individuals in Colombia: Results from a nationally representative study. PLoS One 2020; 15:e0234326. [PMID: 32516351 PMCID: PMC7282633 DOI: 10.1371/journal.pone.0234326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/24/2020] [Indexed: 12/19/2022] Open
Abstract
Background Studies in high-income countries have documented a consistent gradient between socio-economic status (SES) and high blood pressure (HBP), a key risk factor for cardiovascular disease (CVD). However, evidence from Latin American countries (LA) remains comparatively scarce and inconclusive. Data Data for 3,984 individuals came from a nationally representative survey of individuals aged 60 years or above in Colombia (Encuesta de Salud, Bienestar y Envejecimiento) (SABE) conducted in 2015. SES was measured by educational achievement and household assets. CVD risk factors included objectively measured HBP and body mass index (BMI), as well as behaviors (smoking, alcohol consumption, fruit and vegetables intake, and physical activity). Methods Bivariate methods and multivariate regression models were used to assess associations between SES with HBP as well as additional risk factors for CVD. Results Individuals with lower SES have significantly higher risk of suffering from HBP. Compared to those with no formal education, individuals with secondary or post-secondary education have a 37% lower risk of HBP (odds ratio [OR] = 0.63, P-value<0.001). Being in the highest asset quartile (most affluent) is associated with a 44% lower risk (OR = 56, P-value = 0.001) of HBP compared to those in the lowest asset quartile (most deprived). Individuals with lower SES are more likely to smoke, not engage in regular physical activity and not regularly consume fruits or vegetables. In contrast, individuals with higher SES are more likely to consume alcohol and, those with more assets, more likely to be obese. Conclusions Among older Colombians there exists a marked SES gradient in HBP as well as several additional risk factors for CVD. The results highlight the importance of a public health approach towards HBP and additional CVD risk factors that takes into account the specific conditions of older individuals, especially among disadvantaged groups.
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Affiliation(s)
- Philipp Hessel
- University of the Andes, Alberto Lleras Camargo School of Government, Bogotá, Colombia
- * E-mail:
| | | | - David Torres
- University of the Andes, Alberto Lleras Camargo School of Government, Bogotá, Colombia
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Sánchez RA, Boggia J, Peñaherrera E, Barroso WS, Barbosa E, Villar R, Cobos L, Hernández Hernández R, Lopez J, Octavio JA, Parra Carrillo JZ, Ramírez AJ, Parati G. Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper-accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020. J Clin Hypertens (Greenwich) 2020; 22:527-543. [PMID: 32049441 PMCID: PMC8030035 DOI: 10.1111/jch.13816] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
Abstract
Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long-term follow-up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24-h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower-income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.
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Affiliation(s)
- Ramiro A. Sánchez
- Arterial Hypertension and Metabolic UnitUniversity Hospital, Favaloro, FoundationBuenos AiresArgentina
| | - José Boggia
- Unidad de HipertensiónCentro de NefrologíaHospital Dr. Manuel QuintelaUniversidad de la RepúblicaMontevideoUruguay
| | | | | | - Eduardo Barbosa
- Hypertension League Hospital San FranciscoComplexo Ermandade Santa Casa de Porto AlegrePorto AlegreBrazil
| | | | | | - Rafael Hernández Hernández
- Hypertension and Cardiovascular Risk Factors ClinicSchool of MedicineUniversidad Centro Occidental Lisandro AlvaradoBarquisimetoVenezuela
| | - Jesús Lopez
- Unidad de Hipertension ArterialHospital Universitario Dr. Jose M. VargasSan CristobalTachiraVenezuela
| | - José Andrés Octavio
- Department of Experimental CardiologyTropical Medicine InstituteUniversidad Central de VenezuelaCaracasVenezuela
| | | | - Agustín J. Ramírez
- Arterial Hypertension and Metabolic UnitUniversity Hospital, Favaloro, FoundationBuenos AiresArgentina
| | - Gianfranco Parati
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
- Cardiology UnitIstituto Auxologico ItalianoIRCCSSan Luca HospitalMilanItaly
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18
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Gómez-Álvarez E, Verdejo J, Ocampo S, Ruiz E, Martinez-Rios MA. Reaching blood pressure guideline targets with the CNIC polypill in patients with a previous cardiovascular event in Mexico: a post hoc analysis of the SORS study. Future Cardiol 2019; 16:53-60. [PMID: 31850802 DOI: 10.2217/fca-2019-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To determine the effectiveness of Centro Nacional de Investigaciones Cardiovasculares (CNIC)-polypill (acetylsalicylic acid 100 mg, ramipril 5/10 mg, simvastatin 40 mg) in achieving blood pressure (BP) goals. Patients & methods: A multicenter, observational, one cohort, prospective study. BP targets were analyzed in patients with cardiovascular disease after 12-months treatment with the CNIC polypill. Results: A total of 572 patients (59.4 ± 13.9 years, 57.3% men) were analyzed. At baseline, BP was 147.1 ± 18.1/88.3 ± 10.6 mmHg, 97.1% of patients were taken renin-angiotensin system inhibitors, 5.4% calcium antagonists, 1.9% diuretics and 13.1% β-blockers. The proportion of patients who achieved BP targets increased from 20.1 to 55.4% (p < 0.001). Conclusion: In routine practice, switching from usual care to the CNIC-polypill in patients with cardiovascular disease could facilitate achieving BP goals.
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Affiliation(s)
| | - Juan Verdejo
- Instituto de Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | | | - Emilio Ruiz
- Medical Affairs Department, Ferrer Internacional, Barcelona, Spain
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19
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Flores-Reséndiz C, Soto-Piña AE, Valdés-Ramos R, Benítez-Arciniega AD, Tlatempa-Sotelo P, Guadarrama-López AL, Martínez-Carrillo BE, Pulido-Alvarado CC. Association Between Cardiovascular Risk Factors and Stress Hormones With Cognitive Performance in Mexican Adolescents. J Pediatr Psychol 2019; 44:208-219. [PMID: 30272242 DOI: 10.1093/jpepsy/jsy074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 08/25/2018] [Indexed: 11/13/2022] Open
Abstract
Objective The objective of this study was to determine whether cardiovascular disease (CVD) risk factors and stress hormones are associated with cognitive performance in Mexican adolescents. Methods This was a cross-sectional study including 139 Mexican adolescents 10-14 years old. Participants were divided into three categories: 0, 1-2, and ≥3 CVD risk factors. These factors included: high-density lipoprotein-cholesterol (HDL-C) <40 mg/dl; waist circumference (WC) ≥90th percentile for age and sex, systolic or diastolic blood pressure ≥90th percentile for age, sex, and height; and triacylglycerols (TGs) ≥110 mg/dl. Low-density lipoprotein-cholesterol (LDL-C), very low-density lipoprotein-cholesterol (VLDL-C), total cholesterol, cortisol, and plasma catecholamines were measured as well. Furthermore, attention, memory, and executive functions were evaluated using a validated test for Spanish-speaking individuals (Neuropsi). Results Adolescents in the three risk categories did not show significant differences in Neuropsi test performance tasks; however, they presented different lipid and plasma norepinephrine concentrations. TG and VLDL-C were inversely associated with memory (r = -0.19, **p < .01). Multivariate regression analysis showed consistently that TG/HDL-C ratio was inversely related to attention-memory general score (standardized β = -0.99, t = -2.30, p = .023), memory (standardized β = -0.83, t = -2.08, p = .039), and attention-executive functions (standardized β = -1.02, t = -2.42, p = .017). Plasma epinephrine levels presented an inverse and weak relation to the attention-executive functions score (standardized β = -0.18, t = -2.19, p = .030). Conclusions Cognitive performance is not completely dependent on the accumulation of risk factors, but instead on the combination of strong predictors of CVD like waist to height ratio, TG/HDL-C, and VLDL-C. Plasma norepinephrine and epinephrine have a stronger association with cognition and CVD risk than dopamine and cortisol.
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20
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Santana BDS, Rodrigues BS, Stival MM, Volpe CRG. Arterial hypertension in the elderly accompanied in primary care: profile and associated factors. ESCOLA ANNA NERY 2019. [DOI: 10.1590/2177-9465-ean-2018-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: to analyze blood pressure control in elderly hypertensives accompanied by a Basic Health Unit of the Federal District, determining the sociodemographic profile and the associated risk factors. Method: this is a cross-sectional study with 133 elderly hypertensive patients. Variables related to sociodemographic factors, life habits, clinical factors and adherence to drug therapy were evaluated through the application of semistructured instruments and validated scales. Results with p <0.05 were considered significant. Results: the elderly presented controlled blood pressure (56.4%) predominantly. The majority of the participants were female and women also had a higher rate of uncontrolled blood pressure (86.2%). Older age was associated with higher blood pressure values (p = 0.031). Alcoholism (p = 0.020) and mean body mass index of 33.0 (p <0.000) were factors associated with hypertension adherence to therapy had more controlled values of systolic and diastolic blood pressure. Conclusion and implications for the practice: it was verified that there is a strong association between the risk factors discussed and the lack of control of the blood pressure of elderly hypertensive, especially with regard to advanced age, alcoholism, obesity and overweight, and it is necessary to reorient the planning and strategies of promotion of health and prevention of diseases directed at the elderly hypertensive in the scope of primary health care.
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21
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Vargas-Uricoechea H, Cáceres-Acosta MF. Blood pressure control and impact on cardiovascular events in patients with type 2 diabetes mellitus: A critical analysis of the literature. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 31:31-47. [PMID: 30274771 DOI: 10.1016/j.arteri.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/07/2018] [Accepted: 07/18/2018] [Indexed: 12/22/2022]
Abstract
High blood pressure in individuals with type2 diabetes mellitus increases the risk of cardiovascular events. The international management guidelines recommend starting pharmacological treatment with blood pressure values >140/90mmHg. However, there is no optimal cut-off point from which cardiovascular events can be reduced without causing adverse events. A blood pressure range of >130/80 to <140/90mmHg seems to be adequate. These values can be achieved through non-pharmacological (diet, exercise) and pharmacological interventions (using drugs that have been shown to reduce cardiovascular events). The choice of one or several drugs must be individualised, according to factors including, ethnicity, age, and associated comorbidities, among others.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- Grupo de estudio de enfermedades metabólicas, Facultad Ciencias de la Salud, Departamento de Medicina Interna, Universidad del Cauca, Popayán, Cauca, Colombia.
| | - Manuel Felipe Cáceres-Acosta
- Grupo de estudio de enfermedades metabólicas, Facultad Ciencias de la Salud, Departamento de Medicina Interna, Universidad del Cauca, Popayán, Cauca, Colombia
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22
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Ruilope LM, Nunes Filho ACB, Nadruz W, Rodríguez Rosales FF, Verdejo-Paris J. Obesity and hypertension in Latin America: Current perspectives. HIPERTENSION Y RIESGO VASCULAR 2018; 35:70-76. [PMID: 29361428 DOI: 10.1016/j.hipert.2017.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/14/2017] [Indexed: 12/30/2022]
Abstract
In the countries of Central America, South America and the Caribbean, there has been a dramatic rise in obesity, the metabolic syndrome, hypertension and other cardiovascular risk factors in the last few decades. Epidemiological evidence highlights a consistent correlation between obesity and hypertension, and the presence of obesity predisposes an individual to a greater risk of hypertension although the mechanisms remain unclear. Obesity and hypertension are two key drivers of the cardio-renal disease continuum, and patients with uncontrolled cardiovascular risk in their mid-life will likely have an increased risk of clinical cardiovascular and renal outcomes in old age. This article summarizes the current status for the prevalence and consequences of obesity and hypertension in Latin America, with the aim of initiating a call to action to all stakeholders for greater implementation of primary prevention strategies, particularly in the young.
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Affiliation(s)
- L M Ruilope
- "Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular", Universidad Autónoma de Madrid, Spain; Hypertension Unit, Institute of Research i+12: Hypertension and Cardiovascular Risk Group, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
| | - A C B Nunes Filho
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - W Nadruz
- Department of Internal Medicine, University of Campinas, Cidade Universitária Zeferino Vaz, 13081-970 Campinas, SP, Brazil
| | | | - J Verdejo-Paris
- Instituto Nacional de Cardiologia "Ignacio Chávez", Mexico City, Mexico
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