Factors associated with prevalence, awareness, treatment and control of hypertension in urban adults from 33 communities in China: the CHPSNE Study

Obesity and hypertension from a public health perspective in a small remote island of Okinawa, Japan

This study investigated the relationship between obesity and hypertension from a public health perspective in a small remote island of Okinawa where obesity is prevalent. A cross-sectional study was conducted in 456 residents aged ≥18 years in Yonaguni island who underwent an annual health check-up and the Yonaguni dietary survey in 2022. Each participant responded to our original questionnaire and provided further dietary survey data via the Yonaguni municipal government. The odds ratio for hypertension was calculated in the obese group, using a logistic regression model with the non-obese group serving as the reference. Hypertension was defined as a systolic blood pressure ≥140 mmHg, a diastolic blood pressure ≥90 mmHg measured on an automated sphygmomanometer, and/or taking anti-hypertensive agents, while obesity was defined as a body mass index ≥25 kg/m2. The proportion of hypertension associated with obesity among all hypertensive subjects was calculated. The prevalence of obesity and hypertension was 54.3% and 49.0% in the 208 male subjects and 32.3% and 43.6% in the 248 female subjects, respectively. The odds ratio for hypertension in the obese group was 3.73 (95% confidence interval, 1.93-7.20) for men and 4.13 (2.06-8.29) for women after adjusting for age, alcohol drinking habit, behavior for lowering salt intake, and smoking habit. Hypertension in 49.5% (95% confidence interval, 29.4%-63.9%) of males and 37.9% (22.6%-50.2%) of females was associated with obesity in this island. Some areas of Japan could be urgently required to address obesity for preventing cardiovascular disease. A community-based, cross-sectional study in 456 residents aged ≥18 years in Yonaguni island, Okinawa prefecture, Japan.

Systematic literature review and meta-analysis of cardiovascular risk factor management in selected Asian countries

Aim: There is a need to understand the management status of hypertension, dyslipidemia/hypercholesterolemia, and diabetes mellitus in the Asia-Pacific region (APAC). Methods: We conducted a systematic literature review and meta-analysis to summarize the awareness, treatment, and/or control rates of these risk factors in adults across 11 APAC countries/regions. Results: We included 138 studies. Individuals with dyslipidemia had the lowest pooled rates compared with those with other risk factors. Levels of awareness with diabetes mellitus, hypertension, and hypercholesterolemia were comparable. Individuals with hypercholesterolemia had a statistically lower pooled treatment rate but a higher pooled control rate than those with hypertension. Conclusion: The management of hypertension, dyslipidemia, and diabetes mellitus was suboptimal in these 11 countries/regions.

Prevalence and factors associated with treatment and control of hypertension among adults with hypertension in Myanmar

BACKGROUND

Due to a dearth in the number of studies conducted in low- and middle-income countries, this study aimed to identify the prevalence and determinants of the treatment and control of hypertension among patients with hypertension in Myanmar.

METHODS

This community-based cross-sectional study was conducted among 410 adults who were registered for hypertensive treatment in health centers in Myitkyina Township, Kachin State, Myanmar. Multiple logistic regression was used to identify the associated factors.

RESULTS

The prevalence of treatment and control of hypertension was 48.1% and 20.5%, respectively. The factors associated with treatment were age (OR=2.60 for 46-60 y and OR=2.29 for 61-70 y compared with 30-45 y), ethnicity (OR=1.87), monthly family income (OR=1.90), comorbidity (OR=2.33), knowledge (OR=2.63) and adherence to physical activity (OR=1.86). Controlled hypertension was associated with age (OR=3.03 for 46-60 y and OR=2.27 for 61-70 y compared with 30-45 y), education (OR=1.81), comorbidity (OR=1.67) and adherence to medication (OR=3.45).

CONCLUSIONS

The prevalence of treated and controlled hypertension was relatively low in this study. To improve the prevalence of hypertension treatment and control in this study population, effective and culturally sensitive intervention programs under universal health coverage should be established with an emphasis on individuals with lower educational attainment and younger ages.

Factors associated with awareness, treatment and control of hypertension among 3579 hypertensive adults in China: data from the China Health and Nutrition Survey

BACKGROUND

The prevalence of hypertension is high and rising in China, but most people with hypertension do not have their blood pressure under control. This study investigated hypertension awareness, treatment, and control and their associated factors among Chinese adults.

METHODS

Data collected from the 2011 China Health and Nutrition Survey (CHNS) from 12,991 Chinese adults were used. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, self-reported prior diagnosed hypertension, or taking antihypertensive medications. Hypertension awareness, treatment, and control were defined as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure < 140/90 mmHg, respectively. Multivariate logistic regression was performed to examine factors associated with hypertension awareness, treatment, and control.

RESULTS

Overall, 3579 (27.6%) of the CHNS adult participants had hypertension, of whom 55.7% were aware of their diagnosis, 46.5% were treated with antihypertensive medications, but only 20.3% had their blood pressure under control. Higher hypertension treatment was associated with older age (OR = 2.57; 95%CI, 1.65-4.02), urban residency (1.50; 1.14-1.97), living in the Eastern region (1.52; 1.14-2.01), and being overweight/obese (1.99; 1.39-2.84). Hypertension awareness was associated with similar factors as hypertension treatment but was also associated with being female (1.37, 1.12-1.66). Poor hypertension control was associated with being overweight/obese (0.56; 0.42-0.76) and minority ethnicity (0.52; 0.31-0.86).

CONCLUSION

Hypertension is a major public health challenge in China. The prevalence of hypertension awareness, treatment, and control are still low despite existing public health policies and programs to reduce the burden of hypertension. More intensive hypertension screening and treatment programs are warranted in China.

The Prevalence and Risk Factors of Hypertension among the Urban Population in Southeast Asian Countries: A Systematic Review and Meta-Analysis

The trend of global prevalence for hypertension has been dramatically increasing for the past two decades in Southeast Asian countries. A systematic review aiming to assess the prevalence of hypertension and its risk factors among the urban population in Southeast Asian countries was conducted. We performed database searches of PubMed and Web of Science and performed meta-analysis to determine the pooled prevalence estimate. The overall pooled prevalence estimate of hypertension for Southeast Asian urban population was 33.82%. Among this, 33.98% of hypertension was reported in the community and 32.45% among adolescents in school. The common risk factors that we found were male, ethnicity, education and socioeconomic level, body mass index, waist circumference, smoking, and dyslipidaemia. The review indicates an urgent need for primary and secondary prevention activities. Therefore, a multisectoral and intersectoral approach and collaboration should be undertaken to improve the overall health outcomes of all populations in all Southeast Asian countries.

The prevalence and predictors of pre-hypertension and hypertension in Kherameh cohort study: a population based study on 10,663 persons in south of Iran

Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD) mortality and morbidity among Iranians. The present study aimed to estimate the prevalence of pre-HTN and HTN and some of its related factors in south of Iran. This cross-sectional survey was conducted on the data of the Persian cohort study in Kherameh. The participants consisted of 10,663 people aged 40-70 years. HTN was defined as either systolic/diastolic blood pressure (SBP/DBP) ≥140/90 mmHg or taking medications. Pre-HTN was defined as SBP = 120-139 mmHg and/or DBP = 80-89 mmHg. The logistic regression method was used to identify the factors associated with pre-HTN and HTN. The age-standardized prevalence rate (ASPR) of pre-HTN was 19.66% (95% CI: 19.45-19.86%) and 18.59% (95% CI: 18.36-18.83%) in males and females, respectively. Also, the ASPR of HTN was 21.44 (95% CI: 21.22-21.65%) in males and 33.53% (95% CI: 33.22-33.85%) in females. Male gender, old age, being unemployed, low education level, high body mass index (BMI), no smoking, diabetes, cerebro-cardiovascular disease, suffering from another chronic disease, family history of CVD, and negative family history of cancer and other chronic diseases were independently associated with pre-HTN (p < 0.05). All variables, except for gender, smoking, and family history of cancer, were significantly associated with HTN. Drug abuse was also correlated to HTN (p < 0.05). This study revealed the increased prevalence of HTN in rural and urban areas. Therefore, the health system needs to develop strategies to raise the accessibility of screening and diagnostic services.

Patterns of Raised Blood Pressure in Vietnam: Findings from the WHO STEPS Survey 2015

This study aims to describe the prevalence of raised blood pressure and the situation of management for raised blood pressure among the adult population in Vietnam. It also aims to examine the association between diversified socioeconomic and behavioral factors of raised blood pressure and awareness of raised blood pressure. Data were obtained from the STEPS survey conducted in Vietnam in 2015. Survey sample was nationally representative with a total of 3,856 people aged 18-69 years old. The study outcomes included raised blood pressure and awareness of and control of raised blood pressure. Multiple logistic regression was used to examine the association of socioeconomic and behavior risk factors with the outcome variables. The overall prevalence of raised blood pressure in Vietnam in 2015 was 18.9% (95% CI: 17.4%-20.6%). The prevalence of raised blood pressure was higher among men. Significantly correlated factors with raised blood pressure were age, sex, body mass index, and diabetes status. Levels of awareness of raised blood pressure were higher among the older age group and overweight people and lower among ethnic minority groups. Raised blood pressure in Vietnam is a serious problem due to its magnitude and the unacceptably high unawareness rate in the population. Public health actions dealing with the problems of raised blood pressure are urgent, while taking into account its relationship with sex and socioeconomic status. It is clear that the interventions should address all people in society, with a focus on disadvantaged groups which are the rural and ethnic minority peoples.

Trends and Inequalities in the Health Care and Hypertension Outcomes in China, 2011 to 2015

Background: Hypertension is one of the most significant and common risk factors for cardiovascular disease, yet it remains poorly controlled in China. This study aims to examine trends and socioeconomic inequalities in the management of hypertension between 2011 and 2015 in China and to investigate the association between antihypertensive medication treatment and reduction of blood pressure, using nationally representative data. Methods: Concentration curve and concentration index were used to assess socioeconomic-related inequalities in hypertension care and health service utilisation. The fixed-effects analysis was performed to measure the impact of medication treatment on reduction of blood pressure among people with hypertension by using linear regression models. Results: Among hypertensive individuals, there were growing trends in the rates of awareness and treatment from 55.87% and 48.44% in 2011, to 68.31% in 2013 and 61.97% in 2015, respectively. The proportion of hypertension control was still below 30%. The fixed-effects models indicated that medication treatment was statistically significant and associated with the patients' systolic blood pressure (β: -13.483; 95% CI: -15.672, -11.293) and diastolic blood pressure (β: -5.367; 95% CI: -6.390, -4.344). Conclusions: China has made good progress in the hypertension diagnosis, medication treatment and coverage of health services over the last 10 years; however, pro-rich inequalities in hypertension care still exist, and there is considerable progress to be made in the prevention, treatment and effective control of hypertension.

Measuring Spatial Patterns of Health Care Facilities and Their Relationships with Hypertension Inpatients in a Network-Constrained Urban System

There is evidence of a strong correlation between inequality in health care access and disparities in chronic health conditions. Equal access to health care is an important indicator for overall population health, and the urban road network has a significant influence on the spatial distribution of urban service facilities. In this study, the network kernel density estimation was applied to detect the hot spots of health care service along the road network of Shenzhen, and we further explored the influences of population and road density on the aggregate intensity distributions at the community level, using spatial stratified heterogeneity analyses. Then, we measured the spatial clustering patterns of health care facilities in each of the ten districts of Shenzhen using the network K-function, and the interrelationships between health care facilities and hypertension patients. The results can be used to examine the reasonability of the existing health care system, which would be valuable for developing more effective prevention, control, and treatment of chronic health conditions. Further research should consider the influence of nonspatial factors on health care service access.

Differences in prevalence of hypertension and associated risk factors in urban and rural residents of the northeastern region of the People's Republic of China: A cross-sectional study

Background

Hypertension is a significant global public health problem and recognized as an important risk factor for cardiovascular diseases. This study was designed to assess the current prevalence of hypertension and to explore risk factors associated with hypertension by urban and rural status to guide the prevention and control of hypertension in Jilin province.

Methods

A multi-stage stratified random cluster sampling method was used to obtain data on hypertension, which was investigated by physical examination and face-to-face questionnaire in July 2014-December 2015. Sample data were analyzed by complex weighted statistical analysis to estimate blood pressure levels and prevalence of hypertension in the province. Multivariable logistic regression analysis was used to identify factors influencing hypertension rates.

Results

The prevalence of hypertension was significantly higher in rural areas than urban areas (25.93% versus 22.73%, respectively). The rates of hypertension known (46.7% versus 38.1%, respectively), control (13.7% versus 5.0%, respectively), and controlled among treated subjects (38.3% versus 17.5%, respectively) were higher in urban areas than in rural areas (all p < 0.001), while the treatment rate was not statistically significantly different between urban and rural areas (35.9% versus 28.4%, respectively). After adjusting for demographic covariates, hypertension prevalence in rural areas was still significantly greater than in urban areas (adjusted OR = 1.22; 95%CI: 1.10, 1.36; p < 0.001). Common risk factors for hypertension among urban and rural residents included older age; male; married; employed; less education; overweight/obese; greater abdominal waist circumference; family history of hypertension, stroke, or coronary heart disease; current smoker; alcohol consumption; higher visceral adiposity index; and higher body fat percentage.

Conclusions

This study identified an increased risk for hypertension in rural regions of Jilin province, suggesting that rural hypertension screening and treatment guidelines should receive greater attention.

The Association of ADRB1 and CYP2D6 Polymorphisms With Antihypertensive Effects and Analysis of Their Contribution to Hypertension Risk

BACKGROUND

Genetic factors have a vital influence on the pathogenesis of hypertension. In this retrospective study, we aimed to evaluate the association of ADRB1 and CYP2D6 polymorphisms with antihypertensive effects and perform an analysis of their contribution to hypertension risk.

METHODS

A total of 261 healthy individuals and 261 essential hypertension patients treated with metoprolol for 12 weeks were enrolled. ADRB1 and CYP2D6 genotypes were identified by xTAG liquid chip technology. We used multivariate logistic regression and a generalized linear mixed model to assess hypertension-related risk factors.

RESULTS

The allele frequencies of ADRB1 and CYP2D6 variants were 59.8% and 64.6% in the essential hypertension group and 70.3% and 65.9% in the controls, respectively. The genotype and allele distribution of ADRB1 were significantly different between the 2 groups (P < 0.05), but there was no significant difference in CYP2D6 distribution (P = 0.91 and 0.88). By logistic regression analysis, high fasting plasma glucose, smoking, high triglyceride and the Gly/Gly polymorphism in Arg389Gly ADRB1 all emerged as independent risk factors for hypertension. Additionally, the ADRB1 genotype played a major role in the antihypertensive effect of metoprolol and the patients with the Gly389Gly genotype showed a significantly better response to metoprolol than did those with a heterozygous ADRB1 mutation (Arg389Gly) (P = 0.027).

CONCLUSIONS

The results demonstrate that Gly/Gly polymorphism in Arg389Gly ADRB1 was an independent risk factor together with high fasting plasma glucose, smoking and high triglyceride; moreover, the patients who carried the Gly389Gly genotype had a significantly improved metoprolol antihypertensive effect than those with ADRB1.

Hypertension prevalence, awareness, treatment, control, and associated factors in Southwest China: an update

OBJECTIVES

The study was conducted to investigate the prevalence, awareness, treatment, control, and risk factors of hypertension in Chongqing Province in Southwest China.

METHODS

Multistage, stratified, random cluster sampling scheme was adopted to recruit representative samples. All of the selected study participants completed a questionnaire and physical examinations. Multivariable logistic regression models were used to identify the associated factors.

RESULTS

Overall, 14 420 study participants (men = 7186) above 18 years were enrolled. The overall hypertension prevalence was 23.9%, with rural residents having a higher prevalence than urban residents (26.0 vs. 21.6%, P < 0.001). The awareness, treatment, control, and control among treated patients were 44.1, 36.6, 8.5, and 23.3%, respectively. Elderly women inhabiting urban areas had better awareness and treatment. The urban and rural areas differed in control (12.9 vs. 5.1%, P < 0.001). Age, sex, alcohol consumption, family history of hypertension, overweight/obesity, visceral adipose index, and body fat percentage were identified as risk factors for hypertension in both areas. Education levels, smoking, and daily salt intake were correlated with hypertension only among rural residents, and central obesity was correlated with hypertension only among urban residents. Sex, rurality, age, education level, alcohol consumption, overweight/obesity, central obesity, visceral adipose index, and body fat percentage were identified as associated factors of awareness, treatment, and control.

CONCLUSION

During the past decade, there is an increasing prevalence of hypertension in the general population in Chongqing Province. The levels of awareness, treatment, and control have improved, but remain extremely low. More aggressive strategies should thus be adopted.

Age-Period-Cohort Analysis of Stroke Mortality in China: Data From the Global Burden of Disease Study 2013

BACKGROUND AND PURPOSE

Stroke has been the leading cause of death in China. The aim of this study is to assess the long-term trends of stroke mortality in China between 1994 and 2013.

METHODS

The mortality data were obtained from the GBD 2013 (Global Burden of Disease Study 2013) and were analyzed with the age-period-cohort framework.

RESULTS

We found that the net drift was -2.665% (95% confidence interval, -2.854% to -2.474%) per year for men and -4.064% (95% confidence interval, -4.279% to -3.849%) per year for women, and the local drift values were below 0 in all age groups (P<0.05 for all) in both sexes during the period of 1994 to 2013. In the same birth cohort, the risk of death from stroke rose exponentially with age for both sexes after controlling for period deviations. The estimated period and cohort relative risks were found in similar monotonic downward patterns (significantly with P<0.05 for all) for both sexes, with more quickly decreasing for women than for men during the whole period (significantly with P<0.05 for both).

CONCLUSIONS

The decreased mortality rates of stroke in China are likely to be related to improvements in medical care and techniques, spectacular economic growth and fast urbanization, and better early life nutrition conditions of Chinese people. Besides, better education and better awareness of stroke-related knowledge in successive generations could also probably play a role.

Association between hypertension and deep vein thrombosis after orthopedic surgery: a meta-analysis

Background

We aimed to analyze the association between hypertension and deep vein thrombosis (DVT) after orthopedic surgery.

Methods

Relevant studies were identified by a search of PubMed, Embase, China National Knowledge Infrastructure, Wanfang, the Chinese Biomedical Literature, and Weipu database until December 2015. The association between hypertension and DVT after orthopedic surgery was assessed by pooled odds ratios (ORs) and 95 % confidence intervals (CIs). Heterogeneity was evaluated by the Chi-square test based on Q statistic and I² statistics. Finally, publication bias was evaluated by Egger’s test.

Results

A total of 16 articles with 68,955 males and 53,057 females were eventually identified. Studies yielded effects for homogeneous (Q = 38.41, P = 0.0008, and I² = 60.9 %). Meta-analysis showed that hypertension was associated with DVT orthopedic surgery (OR 2.89, 95 % CI 2.18–3.83, Z = 7.38, P < 0.05). No statistical evidence of publication bias was found among studies (t = 1.90, P = 0.08). The funnel plot was symmetry, and the results were reliable.

Conclusions

Hypertension may promote DVT after orthopedic surgery, and may be an important risk factor of DVT occurrence.

Disparities in Hypertension Prevalence, Awareness, Treatment and Control between Bouyei and Han: Results from a Bi-Ethnic Health Survey in Developing Regions from South China

Hypertension is highly prevalent in low-income population. This study aims to investigate ethnic disparities in hypertension and identify modifiable factors related to its occurrence and control in developing regions in South China. Blood pressure was measured in the Bouyei and Han populations during a community-based health survey in Guizhou, 2012. A multistage stratified sampling method was adopted to recruit Bouyei and Han aged from 20 to 80 years. Taking mixed effects into consideration, multilevel logistic models with random intercept were used for data analysis. The prevalence rates of hypertension were 35.3% for the Bouyei and 33.7% for the Han. Among the hypertensive participants, 30.1% of the Bouyei and 40.2% of the Han were aware of their hypertensive conditions, 19.7% of the Bouyei and 31.1% of the Han were receiving treatment, and only 3.6% of the Bouyei and 9.9% of the Han had their blood pressure under control. Age-sex standardized rates of awareness, treatment, and control were consistently lower in the Bouyei than the Han. Such ethnic disparities were more evident in the elderly population. Avoidance of excessive alcohol consumption and better education were favorable lifestyle for reduction in risk of hypertension. Moderate physical activity improved control of hypertension in Bouyei patients under treatment. Conclusively, hypertension awareness, treatment, and control were substantially lower in Bouyei than Han, particularly in the elderly population. Such ethnic disparities indicate that elderly Bouyei population should be targeted for tailored interventions in the future.

FACTORS AND ESTIMATION OF RISK FOR CARDIOVASCULAR DISEASES AMONG PATIENTS IN PRIMARY HEALTH CARE IN CENTRAL SERBIA

AIM

Cardiovascular diseases present major cause of morbidity and mortality in the world as well as in Central Serbia. The aim of this study is to analyze the frequency of risk factors and estimate risk for the development of cardiovascular diseases.

METHODS

The database was collected from health records of the Health Centre in Kragujevac. The following parameters were observed: gender and age, smoking, anthropometrical measurements and Body Mass Index, the value of systolic and diastolic blood pressure, diabetes, levels of cholesterol, and triglycerids in blood serum. The estimation of risk for developing the fatal cardiovascular disease during the period of ten years is determined according to SCORE system model. The statistical package SPSS version 18.0 was used for the statistical analysis.

RESULTS

The study sample consisted of 1,053 people, 505 men and 548 women. 68.8% of people were overweight and obese, arterial hypertension was noted in 72.6%, and diabetes type II in 13.3% of people. 67.6% of people had a high level of total cholesterol in blood serum and 39.6% of people had a high level of triglycerids in blood serum. The metabolic syndrome was noted in 44.3%, and 3 or more risk factors for cardiovascular disease were noted in 65% of the population. We determined a significant statistic difference for age, smoking, nutritional status, dyslipidemia, and diabetes.

CONCLUSION

The high incidence of potentially modifiable risk factors for cardiovascular disease gives a possibility to apply prevention measures for promotion and preservation of health.

Knowledge, Treatment, Control, and Risk Factors for Hypertension among Adults in Southern Iran

Hypertension is the first and the most common risk factor to diseases such as cardiovascular, stroke, and renal diseases. The aim of this study was to determine the factors relevant to hypertension knowledge, treatment, and control in southern Iran. In this cross-sectional study, conducted in Kohgiluye Boyer-Ahmad province, south of Iran, a total of 1836 hypertension patients were randomly selected to participate voluntarily in the study. Hypertension treatment and its control were defined during study. In addition, knowledge about hypertension was measured by hypertension knowledge level scale (HK-LS). Treatment rates were 75.5 and 37.7 percent for female and male, respectively. Habitat, education, income, family history with hypertension, smoking, and time of diagnosis to the disease were found to be related to the treatment of the disease. Control rates were 30.7 and 31.4 for males and females, respectively. Habitat, education, and time of diagnosis to the disease were related to control. Over 50 percent of patients had average knowledge on hypertension. Considering the low rate of control and knowledge on hypertension among patients, health care providers should reinforce their services to improve appropriate knowledge level among elders and, also, plan comprehensive programs to promote health in order to encourage patients change and reform their life style.

Trends in Prevalence, Awareness, Treatment and Control of Hypertension during 2001-2010 in an Urban Elderly Population of China

OBJECTIVE

As the most important risk factors of cardiovascular disease, pre-hypertension and hypertension are important public health challenges. Few studies have focused on the trends of pre-hypertension and hypertension specifically for the aging population in China. Given the anticipated growth of the elderly population in China, there is an urgent need to document the conditions of pre-hypertension and hypertension in this aging population.

METHODS

We conducted two cross-sectional surveys of Chinese adults aged ≥60 years in 2001 and 2010. A total of 2,272 (943 males, 1,329 females) and 2,074 (839 males, 1,235 females) participants were included in the two surveys, respectively.

RESULTS

The age- and sex-standardized prevalence of hypertension significantly increased from 60.1% to 65.2% from the 2001 to the 2010 survey. Among the participants with hypertension, the awareness, treatment and control of hypertension all significantly increased from 69.8% to 74.5%, 50.3% to 63.7%, and 15.3% to 30.3%, respectively, from 2001 to 2010. A logistic regression showed that a higher education level, a higher BMI, a family history of hypertension and doctor-diagnosed cardiovascular disease were significantly associated with hypertension awareness and treatment.

CONCLUSION

Hypertension prevalence increased rapidly between the years surveyed. Although the awareness, treatment and control of hypertension improved significantly, the values of these variables remained low. More attention should be given to the elderly because the population is aging worldwide, and urgent action, optimal treatment approaches and proper public health strategies must be taken to prevent and manage hypertension.

Systolic hypertension: an increasing clinical challenge in Asia

Systolic hypertension, the predominant form of hypertension in patients aged over 50-60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications.

Blood pressure level and hypertension awareness and control differ by marital status, sex, and ethnicity: a population-based study

BACKGROUND

Population-based studies about factors associated with blood pressure (BP) levels and hypertension awareness and control are lacking in Israel. We aimed to identify covariables of BP level (across the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) categories) and hypertension awareness and control.

METHODS

Participants (n = 763; aged 25-74 years) were randomly selected from the population registry and stratified by sex, age, and ethnicity (Arab or Jewish). Sociodemographic, lifestyle, chronic morbidity, drug therapy, and measured anthropometric and BP data were collected. Hypertension was defined as physician diagnosis, antihypertension drug therapy, or systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg.

RESULTS

Standardized hypertension prevalence was 32.5%. Age and body mass index were positively associated with being in a higher JNC-7 category. In multivariable analysis, the association between gender and JNC-7 category depended upon marital status. Of those with hypertension (n = 315), 66.0% were aware of their status, and 26.0% exhibited adequate BP control. Using "aware-and-controlled" as the outcome reference category, the odds ratio (OR) of being aware and uncontrolled was 1.9 (95% confidence interval (CI) = 1.3-2.9) for 10-year age increment. The OR of being unaware and uncontrolled was 5.6 (95% CI = 2.0-15.8) for Arabs vs. Jews, 5.6 (95% CI = 1.4-22.3) for single/divorced vs. married participants, 3.9 (95% CI = 1.7-9.2) for those with <3 visits to the family physician per year, and 0.1 (95% CI = 0.02-0.4) for those with self-reported cardiovascular disease.

CONCLUSIONS

Sociodemographic factors and primary healthcare service utilization are associated with hypertension awareness and control. Specially focused outreach may be needed to improve hypertension awareness among Arabs, certain subgroups not traditionally considered to be at high risk, and those who have less contact with the healthcare system.

Inflammatory co-morbidities in HIV+ individuals: learning lessons from healthy ageing

Increased life expectancy due to improved efficacy of cART has uncovered an increased risk of age-related morbidities in HIV+ individuals and catalyzed significant research into mechanisms driving these diseases. HIV infection increases the risk of non-communicable diseases common in the aged, including cardiovascular disease, neurocognitive decline, non-AIDS malignancies, osteoporosis, and frailty. These observations suggest that HIV accelerates immunological ageing, and there are many immunological similarities with the aged, including shortened telomeres, accumulation of senescent T cells and altered monocyte phenotype/function. However, the most critical similarity between HIV+ individuals and the elderly, which most likely underpins the heightened risk of non-communicable diseases, is chronic inflammation and associated immune activation. Here, we review the similarities between HIV+ individuals and the aged regarding the pathogenesis of inflammatory diseases, the current evidence for mechanisms driving these processes and discuss current and potential therapeutic strategies for addressing inflammatory co-morbidity in HIV+ infection.

Salt intake, knowledge of salt intake, and blood pressure control in Chinese hypertensive patients

A cross-sectional study involving 2502 subjects was conducted to evaluate salt intake, knowledge of salt intake, and blood pressure control in hypertensive patients. The blood pressure control rate was 33.5% among the hypertensive patients. Of the patients, 69.9% had salt intake higher than 6 g/d. Overall 35.0% knew the recommended salt intake, and 94.9% knew that "excess salt intake can result in hypertension." Altogether, 85.8% of patients had received health education related to a low-salt diet at some time. Patients who consumed less than 6 g/d of salt had a higher control rate than those who consumed more than 6 g/d (48.7% vs. 27.0%; χ(2) = 111.0; P < .001). Patients with knowledge of the recommended salt intake had a higher control rate than those without (45.8% vs. 26.9%; χ(2) = 91.3; P < .001). Our findings suggest a high salt intake and low blood pressure control rate among Chinese hypertensive patients. Knowledge of recommended salt intake is inappropriate for patients with education of a low-salt diet.

Health system strengthening and hypertension awareness, treatment and control: data from the China Health and Retirement Longitudinal Study

OBJECTIVE

To monitor hypertension prevalence, awareness, treatment and control in China two to three years after major reform of the health system.

METHODS

Data from a national survey conducted in 2011-2012 among Chinese people aged 45 years or older - which included detailed anthropometric measurements - were used to estimate the prevalence of hypertension and the percentages of hypertensive individuals who were unaware of, receiving no treatment for, and/or not controlling their hypertension well. Modified Poisson regressions were used to estimate relative risks (RRs).

FINDINGS

At the time of the survey, nearly 40% of Chinese people aged 45 years or older had a hypertensive disorder. Of the individuals with hypertension, more than 40% were unaware of their condition, about 50% were receiving no medication for it and about 80% were not controlling it well. Compared with the other hypertensive individuals, those who were members of insurance schemes that covered the costs of outpatient care were more likely to be aware of their hypertension (adjusted RR, aRR: 0.737; 95% confidence interval, CI: 0.619-0.878) to be receiving treatment for it (aRR: 0.795; 95% CI: 0.680-0.929) and to be controlling it effectively (aRR: 0.903; 95% CI: 0.817-0.996).

CONCLUSION

In China many cases of hypertension are going undetected and untreated, even though the health system appears to deliver effective care to individuals who are aware of their hypertension. A reduction in the costs of outpatient care to patients would probably improve the management of hypertension in China.

The healthcare burden of hypertension in Asia

As the leading global risk for mortality, hypertension (HT) is a common healthcare problem in the world. The total number of patients with HT is likely to grow in the next few decades as the population age and the prevalence of obesity and diabetes increase. HT, as a major modifiable risk factor for cardiovascular disease, results in more deaths than any other risk factors, including diabetes and cigarette smoking. High prevalence, inadequate awareness, suboptimal treatment and low rate of achieving guideline-recommended target blood pressure control are key factors leading to severe cardiovascular complications that impose a heavy socioeconomic burden, especially in developing countries. Asia is the world's largest and most populous continent with approximately 4.3 billion people, hosting 60% of the world's current human population, and has a high growth rate. Asia differs very widely from the West with regard to ethnic groups, cultures, environments, economics, historical ties and government systems. Therefore, the purpose of this review is to comprehensively summarise the epidemiology, treatment practice and the status of control of HT in different Asian countries in order to guide the future prevention and management in this part of the world.

Hypertension Management and Lifestyle Changes Following Screening for Hypertension in an Asian Low Socioeconomic Status Community: A Prospective Study

Introduction: This study investigated the effect of an access-enhanced intervention on hypertension screening and management, as well as on health behaviours among newly diagnosed hypertensives, in a multi-ethnic low socioeconomic status (SES) community. Factors associated with hypertension screening, treatment, and control in the community were also determined. Materials and Methods: The study involved all residents aged ≥40 years in 2 public rental housing precincts (low SES), between 2009 and 2011, who were followed-up prospectively for 1 year after a 6-month community-based intervention comprising a 3-month access-enhanced screening component and a 3-month follow-up (outreach) component. Blood pressure was measured at baseline and follow-up. Multivariate Cox regression determined predictors of hypertension management at follow-up. Results: The follow-up rate was 80.9% (467/577). At baseline, 60.4% (282/467) were hypertensive; 53.5% (151/282) were untreated; 54.2% (71/131) uncontrolled. One year later, postintervention, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age independently predicted treatment (adjusted relative risk, aRR = 1.98, CI, 1.08 to 3.65); majority ethnicity (aRR = 1.76, CI, 1.05 to 2.96), employment (aRR = 1.85, CI, 1.26 to 2.80) and newly treated hypertension (aRR=1.52, CI, 1.01 to 2.32) predicted control. A total of 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Cost and misperceptions were common barriers to screening and treatment. Newly diagnosed hypertensives were also less likely to go for additional cardiovascular screening (aRR = 0.54, CI, 0.29 to 0.99). Conclusion: An access-enhanced intervention had some success in improving hypertension management within low SES communities; however, it was less successful in improving cardiovascular risk management, especially in encouraging lifestyle changes and additional cardiovascular screening amongst newly diagnosed hypertensives. Key words: Cardiovascular screening, Control, Treatment

Factors associated with prevalence, awareness, treatment and control of hypertension among adults in Southern China: a community-based, cross-sectional survey

The aim of this study was to investigate factors associated with prevalence, awareness, treatment and control of hypertension in southern China. A cross-sectional, population-based survey was conducted in 180 villages across 15 counties in southern China from July to November 2010. Totally, 17437 persons completed all of the questionnaires, measurement examination and blood specimen collection. Adjusted rate of hypertension was 22.59% (95%CI: 22.52%-22.66%), for men 23.36% (95%CI: 23.25%-23.47%) and for women 21.77% (95%CI: 21.68%-21.86%). Multivariate logistic regression showed that old age, education attainment, alcohol use, diabetes, obesity, high TC and high TG were associated with hypertension. Among the hypertensive individuals, 54.33% were aware of their hypertension, and 46.34% were currently taking antihypertensive medication, but only 18.26% had their blood pressure controlled. Among all the hypertensive subjects, awareness was more common in those who were female, living in the urban, old age, low education attainment, diabetes, overweight, obese, Low HDL-C. Among the subjects aware of their diagnosis of hypertension, medication treatment was more common in those living in the urban, old age, nonsmoker and diabetes. Among the individuals who receiving medication treatment, controlled hypertension were less common in those living in the urban, young age, low education attainment, overweight and obese. Despite high rate of hypertension, awareness, treatment and control of hypertension still need to be strengthened.

China's biggest, most neglected health challenge: Non-communicable diseases

Background

Over the past two decades, international health policies focusing on the fight against the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), malaria, and those diseases that address maternal and child health problems, among others, have skewed disease control priorities in China and other Asian countries. Although these are important health problems, an epidemic of chronic, non-communicable diseases (NCDs) in China has accounted for a much greater burden of disease due to the ongoing rapid socioeconomic and demographic transition.

Discussion

Although NCDs currently account for more than 80% of the overall disease burden in China, they remain very low on the nation’s disease control priorities, attracting marginal investment from central and local governments. This leaves the majority of patients with chronic conditions without effective treatment. International organizations and national governments have recognized the devastating social and economic consequences caused by NCDs in low- and middle-income countries, including China. Yet, few donor-funded projects that address NCDs have been implemented in these countries over the past decade. Due to a lack of strong support from international organizations and national governments for fighting against NCDs, affected persons in China, especially the poor and those who live in rural and less developed regions, continue to have limited access to the needed care. Costs associated with frequent health facility visits and regular treatment have become a major factor in medical impoverishment in China. This article argues that although China's ongoing health system reform would provide a unique opportunity to tackle current public health problems, it may not be sufficient to address the emerging threat of NCDs unless targeted steps are taken to assure that adequate financial and human resources are mapped for effective control and management of NCDs in the country.

Summary

The Chinese government needs to develop a domestically-driven and evidence-based disease control policy and funding priorities that respond appropriately to the country’s current epidemiological transition, and rapid sociodemographic and lifestyle changes.

1999-2009 Trends in prevalence, unawareness, treatment and control of hypertension in Geneva, Switzerland

Background

There are no time trends in prevalence, unawareness, treatment, and control of hypertension in Switzerland. The objective of this study was to analyze these trends and to determine the associated factors.

Methods/Findings

Population-based study conducted in the Canton of Geneva, Switzerland, between 1999 and 2009. Blood pressure was measured thrice using a standard protocol. Hypertension was defined as mean systolic or diastolic blood pressure ≥140/90 mmHg or self-reported hypertension or anti-hypertensive medication. Unawareness, untreated and uncontrolled hypertension was determined by questionnaires/blood pressure measurements. Yearly age-standardized prevalences and adjusted associations for the 1999–2003 and 2004–2009 survey periods were reported. The 10-year survey included 9,215 participants aged 35 to 74 years. Hypertension remained stable (34.4%). Hypertension unawareness decreased from 35.9% to 17.7% (P<0.001). The decrease in hypertension unawareness was not paralleled by a concomitant absolute increase in hypertension treatment, which remained low (38.2%). A larger proportion of all hypertensive participants were aware but not treated in 2004–2009 (43.7%) compared to 1999–2003 (33.1%). Uncontrolled hypertension improved from 62.2% to 40.6% between 1999 and 2009 (P = 0.02). In 1999–2003 period, factors associated with hypertension unawareness were current smoking (OR = 1.27, 95%CI, 1.02–1.59), male gender (OR = 1.56, 1.27–1.92), hypercholesterolemia (OR = 1.31, 1.20–1.44), and older age (OR 65–74yrs vs 35–49yrs  = 1.56, 1.21–2.02). In 1999–2003 and 2004–2009, obesity and diabetes were negatively associated with hypertension unawareness, high education was associated with untreated hypertension (OR = 1.45, 1.12–1.88 and 1.42, 1.02–1.99, respectively), and male gender with uncontrolled hypertension (OR = 1.49, 1.03–2.17 and 1.65, 1.08–2.50, respectively). Sedentarity was associated with higher risk of hypertension and uncontrolled hypertension in 1999–2003.

Conclusions

Hypertension prevalence remained stable since 1999 in the canton of Geneva. Although hypertension unawareness substantially decreased, more than half of hypertensive subjects still remained untreated or uncontrolled in 2004–2009. This study identified determinants that should guide interventions aimed at improving hypertension treatment and control.