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Gupta R, Gaur K, Ahuja S, Anjana RM. Recent studies on hypertension prevalence and control in India 2023. Hypertens Res 2024; 47:1445-1456. [PMID: 38379011 DOI: 10.1038/s41440-024-01585-y] [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: 08/22/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 02/22/2024]
Abstract
Hypertension is the most important chronic disease risk factor in India. Recent epidemiological studies have reported that hypertension is increasing in India with a more rapid increase in rural and young populations. Fifth National Family Health Survey (NFHS-5) and Indian Council of Medical Research-INDIAB surveys have reported that there are substantial geographic variations in hypertension prevalence with greater prevalence in more developed states and districts of the country. There is a high prevalence of young-age hypertension, especially in the less developed states. The incidence of adverse events from hypertension-related cardiovascular disease is significantly greater in India than in more developed countries. A low level of hypertension awareness, treatment, and control, especially in rural and underserved urban populations is an important finding. In this narrative review, we highlight recent nationwide studies and unique features of hypertension in India and suggest strategies for better hypertension management and control.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology & Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, India.
- Research Board, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India.
| | - Kiran Gaur
- Department of Statistics, Mathematics and Computer Science, Government SKN Agriculture University, Jobner, Jaipur, India
| | - Shiva Ahuja
- Department of Orthodontics, Jaipur Dental College, Jaipur, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Research Centre, Chennai, India
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Li SJ, Miles T, Vasisht I, Dere H, Agyekum C, Massoud R. Breaking barriers: assessing the impact of clinical quality improvements on reducing health disparities in hypertension care among Mumbai's urban slums. BMJ Open Qual 2024; 13:e002716. [PMID: 38806206 PMCID: PMC11138264 DOI: 10.1136/bmjoq-2023-002716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/13/2024] [Indexed: 05/30/2024] Open
Abstract
The clinical quality improvement initiatives, led by the organisation's Health Equity Working Group (HEWG), aim to support healthcare providers to provide equitable, quality hypertension care worldwide. After coordinating with the India team, we started monitoring the deidentified patient data collected through electronic health records between January and May 2021. After stratifying data by age, sex and residence location, the team found an average of 55.94% of our hypertensive patients control their blood pressure, with an inequity of 11.91% between male and female patients.The objective of this study was to assess the effectiveness of using clinical quality improvement to improve hypertension care in the limited-resourced, mobile healthcare setting in Mumbai slums. We used the model for improvement, developed by Associates in Process Improvement. After 9-month Plan-Do-Study-Act (PDSA) cycles, the average hypertensive patients with controlled blood pressure improved from 55.94% to 89.86% at the endpoint of the initiative. The gender gap reduced significantly from 11.91% to 2.19%. We continued to monitor the blood pressure and found that the average hypertensive patients with controlled blood pressure remained stable at 89.23% and the gender gap slightly increased to 3.14%. Hypertensive patients have 6.43 times higher chance of having controlled blood pressure compared with the preintervention after the 9-month intervention (p<0.001).This paper discusses the efforts to improve hypertension care and reduce health inequities in Mumbai's urban slums. We highlighted the methods used to identify and bridge health inequity gaps and the testing of PDSA cycles to improve care quality and reduce disparities. Our findings have shown that clinical quality improvement initiatives and the PDSA cycle can successfully improve health outcomes and decrease gender disparity in the limited-resource setting.
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Affiliation(s)
- Shang Ju Li
- Monitoring and Evaluation, AmeriCares Foundation Inc, Stamford, Connecticut, USA
| | - Thomas Miles
- Monitoring and Evaluation, AmeriCares Foundation Inc, Stamford, Connecticut, USA
| | - Itisha Vasisht
- Programs, Americares India Foundation, Mumbai, Maharaṣṭra, India
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Prajapati AK, Jain S, Kumar S, Bano T, Gautam NS, Singh G, Ruchi. Prevalence of hypertension, screening, awareness, and associated risk factors in teaching institution of Etawah District, Uttar Pradesh: A cross-section study. J Family Med Prim Care 2024; 13:2037-2043. [PMID: 38948635 PMCID: PMC11213406 DOI: 10.4103/jfmpc.jfmpc_1835_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/26/2023] [Accepted: 02/04/2024] [Indexed: 07/02/2024] Open
Abstract
Background Hypertension is one of the leading causes of death worldwide, affecting over one billion people. It is responsible for roughly half of all heart disease and stroke-related deaths globally. Because hypertension does not cause any symptoms on its own, it is commonly referred to as "the silent killer." Objective This study aimed to determine (1) the prevalence of hypertension and its associated risk factors and (2) the level of awareness of hypertension status among study participants. Material and Methods A facility-based cross-sectional analytical study was conducted for 3 months during January-March 2023 at the teaching institution in Etawah District, Uttar Pradesh. It was conducted among 392 study participants who were ≥18 years old. Data were collected through a predesigned, pretested, semi-structured questionnaire, and anthropometric measurement was determined using standard guidelines. Results The overall prevalence of hypertension screening was 69.4% (male: 33.8% and female: 66.2%), respectively. The majority of hypertensives were found in female participants. Tobacco and alcohol consumption, obesity, physical inactivity, stress and strain, and an unhealthy diet were also associated with hypertension. Among 392 study participants, only 67 (24.6%) were aware of their hypertension status. Conclusion We conclude that hypertension has been described as an "Iceberg disease" as those who suffer are usually unaware and hence usually seek healthcare services at a very late stage. Preventive measures should be needed to improve hypertension screening, awareness, treatment, and control.
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Affiliation(s)
- Ajay Kumar Prajapati
- Department of Community Medicine, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Seema Jain
- Department of Community Medicine, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Sanjeev Kumar
- Department of Community Medicine, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Tanveer Bano
- Department of Community Medicine, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Neelam S. Gautam
- Department of Community Medicine, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Ganesh Singh
- Department of Community Medicine, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Ruchi
- Doctor, Ayurveda, Chaudhary Brahm Prakash Ayurved Charak Sansthan, New Delhi, India
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Chinnaiyan S, Dharmaraj A, Palanisamy B. Prevalence and Associated Risk Factors of Hypertension Among Tribal Population Aged 15-49 in India: Evidence from National Family Health Survey, 2019-2021. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02005-0. [PMID: 38625664 DOI: 10.1007/s40615-024-02005-0] [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: 02/01/2024] [Revised: 03/16/2024] [Accepted: 04/07/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Approximately 10% of non-communicable diseases (NCDs) can be attributed to hypertension. The prevalence of hypertension is steadily increasing among urban, rural, and tribal populations alike. There has been a growing incidence of hypertension within underprivileged groups; however, there is a scarcity of research focusing on the risks of hypertension within Indian tribes. The current study aimed to estimate the pooled prevalence of hypertension among tribes and the risk factors of hypertension. METHODS This study uses data from the fifth phase of the National Family Health Survey (NFHS-5) in India, covering 2,843,917 individuals in 636,699 households. A total of 69,176 individuals belonging to tribal communities aged between 15 and 49, encompassing both males and females, have been incorporated into our study. The study utilized bivariate and multivariable binary logistic regression analyses, which were conducted using the R statistical software. RESULTS Among 69,176 tribal populations between 15 and 49 years, the overall prevalence of hypertension was 12.54% (8676/69176; 95% CI, 12.29%, 12.79%). The prevalence of hypertension among males was 16.4% and 12.07% among females. Age, gender, education, marital status, smoking, and alcohol consumption were found to be the significant predictors of hypertension among tribes. CONCLUSION The rising prevalence and potential dangers of hypertension within Indian tribes highlight their epidemiological transition burdened by significant cardiometabolic health concerns, necessitating prompt and ongoing monitoring and surveillance.
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Affiliation(s)
- Saravanan Chinnaiyan
- SRM Institute of Science and Technology (Deemed to Be University), Chennai, India
| | - Aravind Dharmaraj
- SRM Institute of Science and Technology (Deemed to Be University), Chennai, India
- Department of Biostatistics, Christian medical college, Vellore, India
| | - Bharathi Palanisamy
- SRM Institute of Science and Technology (Deemed to Be University), Chennai, India.
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Gobezie MY, Hassen M, Tesfaye NA, Solomon T, Demessie MB, Fentie Wendie T, Tadesse G, Kassa TD, Berhe FT. Prevalence of uncontrolled hypertension and contributing factors in Ethiopia: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1335823. [PMID: 38660480 PMCID: PMC11040565 DOI: 10.3389/fcvm.2024.1335823] [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: 11/09/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Background Uncontrolled hypertension (HTN) is a major risk factor for cardiovascular and cerebrovascular disease. The prevalence of HTN in the Ethiopian adult population is almost 20%.This study aimed to determine the prevalence of uncontrolled HTN and its contributing factors among patients with HTN in Ethiopia undergoing treatment. Methods Electronic bibliographic databases such as PubMed, Google Scholar, Hinari (Research4Life), Embase, and Scopus were searched for original records in the English language that assessed HTN control in Ethiopia and were available before 29 June 2023. The data were extracted using a format prepared in Microsoft Excel and exported to the software STATA 17.0 for analysis. The study protocol was registered at PROSPERO with the reference number CRD42023440121. Results A total of 26 studies with 9,046 patients with HTN were included in the systematic review and meta-analysis, of which 11 studies were used to assess factors contributing to uncontrolled blood pressure (BP) in patients in Ethiopia. The estimated prevalence of uncontrolled HTN in the population of Ethiopia is 51% [95% confidence interval (CI), 42%-60%]. The subgroup analysis, based on the assessment tools, region, and follow-up period, revealed that the prevalence of uncontrolled BP was highest following the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) (89%; 95% CI: 87%-91%) and in Addis Ababa (58%; 95% CI: 40%-76%), and the lowest proportion of uncontrolled BP was in the 3-month follow-up period (34%; 95% CI: 29%-39%). The presence of diabetes mellitus showed the highest impact (pooled odds ratio: 5.19; CI: 1.41-19.11) for uncontrolled HTN. The univariate meta-regression method confirmed that the sample size, year of publication, and subgroups were not sources of heterogeneity in the pooled estimates. Egger's regression test did not indicate the presence of publication bias. Conclusion More than half of the hypertensive patients in Ethiopia have uncontrolled BP. Diabetes mellitus, advanced age, male sex, and the presence of comorbidities are among the factors contributing to uncontrolled HTN in Ethiopia. The concerned bodies working in this area should implement interventional strategies and recommendations that might be helpful in achieving optimal BP in hypertensive patients. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440121, PROSPERO (CRD42023440121).
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Affiliation(s)
- Mengistie Yirsaw Gobezie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Minimize Hassen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nuhamin Alemayehu Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tewodros Solomon
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mulat Belete Demessie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Teklehaimanot Fentie Wendie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getachew Tadesse
- Department of Statistics, College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Fentaw Tadese Berhe
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Public Health & Economics Modeling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
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Hadaye RS, Dey A. A cross-sectional study to assess the occupational health hazards among fisherwomen in a metropolitan city. J Family Med Prim Care 2024; 13:1271-1277. [PMID: 38827708 PMCID: PMC11141954 DOI: 10.4103/jfmpc.jfmpc_1325_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 06/04/2024] Open
Abstract
Context Research on the working conditions and health hazards of fishing communities in developing countries is scarce. Aims 1) To assess the occupational health hazards among women fish vendors. 2) To understand the morbidity profile in them. 3) To analyze various challenges faced by them at the workplace in this occupation. 4) To suggest various measures including ergonomic solutions that they can take to reduce these health hazards. Settings and Design Community-based observational cross-sectional study. Methods and Material Eight fish markets comprising women fish vendors working for more than one year (age > 30 years) in Mumbai were selected. A cluster sampling method was used. The sample size was 225. The period of the study was 2 years. Statistical Analysis Used Chi-square test. Results The majority of study subjects had diabetes mellitus (24%) and were overweight (54.7%). Of all participants, 55.1% had musculoskeletal pain of which low back pain (69; 30.7%) was most common. There was a significant association between musculoskeletal pain status and mode of carrying boxes, χ2 (1) =56.35 as well as with duration of occupation, χ2 (3) =89.67, P < 0.001. Of all participants, 90.2% got injured of which the majority had incisional wounds (124; 61.1%). Of all participants, 55.1% suffered from skin infections of which the majority (28; 12.4%) had itching and redness of hands and legs. There was a significant association between skin infections and duration of occupation, χ2 (3) =140.53 as well as with the use of gloves (63.2% participants), χ2 (1) =20.395, P < 0.001. Conclusions Various measures including ergonomic solutions that women fish vendors can take to reduce these health hazards need to be addressed.
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Affiliation(s)
- Rujuta S. Hadaye
- Department of Community Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Aditi Dey
- Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Ram CVS, Muruganathan A, S M, Kumar M K. Indian Clinician's Perspective on the Approach to the Management of Hypertension: A Cross-Sectional Study. Cureus 2024; 16:e57435. [PMID: 38699103 PMCID: PMC11063652 DOI: 10.7759/cureus.57435] [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] [Accepted: 01/22/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Hypertension (HTN) is considered one of the most frequent life-threatening noncommunicable illnesses. Because HTN has a significant public health impact on cardiovascular health status and healthcare systems in India, it is critical to study Indian clinicians' approaches to HTN management. Methodology This was a cross-sectional, multicentric, non-interventional, and single-visit study that aimed to gather data from across India and examine sociodemographic characteristics and clinician treatment choices in the management of HTN in Indian individuals. As a result, building an information platform about HTN is critical to preventing and controlling this growing burden. Results A total of 5298 patients were recruited in the study from 1061 study centers across India. Among the study patients, 66.67% were females with a mean age of 53.95 ± 14.4, and 66.28% of hypertensive patients presented comorbidities. Among the known risk factors for HTN, 2227 (44.5%) were smokers, while 2587 (51.7%) had sedentary lifestyles. A family history of HTN in either one or both parents was seen in 1076 (21.50%) patients. In management, 40.40% of patients were on anti-hypertensive monotherapy. Amlodipine (41.8%) in monotherapy and amlodipine + metoprolol (32.34%) in combination therapy were the most commonly prescribed antihypertensive. Conclusion Management of HTN can be improved by imparting patient education and awareness about the need for medication compliance, lifestyle modifications, and regular follow-up clinic visits.
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Affiliation(s)
- C Venkat S Ram
- Hypertension and Blood-Pressure Management Clinic, Apollo Hospitals, Hyderabad, IND
| | - A Muruganathan
- Department of Public Health, Shristy AG Hospital, Tirupur, IND
| | - Manjula S
- Department of Medical Services, Micro Labs Ltd, Bengaluru, IND
| | - Krishna Kumar M
- Department of Medical Services, Micro Labs Ltd, Bengaluru, IND
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Hirani MM, Gandhi R, Thakkar DG, Kateshiya N, Murugan Y. Investigating the Prevalence and Predictors of Uncontrolled Hypertension: A Cross-Sectional Study in Gujarat, India. Cureus 2024; 16:e59036. [PMID: 38800155 PMCID: PMC11128033 DOI: 10.7759/cureus.59036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Uncontrolled hypertension is a major public health concern that contributes significantly to cardiovascular morbidity and mortality. Treatment of hypertension prevents and reduces cardiovascular morbidity, notably a 40% reduction in risk of stroke and a 15% reduction in risk of myocardial infarction. Understanding the prevalence and predictors of uncontrolled hypertension is crucial for developing targeted interventions. OBJECTIVE This study aimed to determine the prevalence of uncontrolled hypertension and identify potential predictors among patients attending the Non-Communicable Disease (NCD) clinic of a tertiary care center in Gujarat, India. METHODS A cross-sectional study involving 732 adult patients with hypertension was conducted. Sociodemographic data, lifestyle factors, anthropometric measurements, and comorbidities were assessed. Blood pressure was measured using standardized protocols, and uncontrolled hypertension was defined as a systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Univariate and multivariate logistic regression analyses were performed to identify predictors of uncontrolled hypertension. RESULTS The prevalence of uncontrolled hypertension was 60.2% (95% CI: 56.7%-63.7%). In the multivariate analysis, increasing age (adjusted OR: 1.21, 95% CI: 1.05-1.39), increased body mass index (adjusted OR: 1.49, 95% CI: 1.27-1.75), diabetes (adjusted OR: 1.68, 95% CI: 1.20-2.35), chronic kidney disease (adjusted OR: 2.11, 95% CI: 1.22-3.65), and current smoking status (adjusted OR: 1.83, 95% CI: 1.14-2.93) were identified as independent predictors of uncontrolled hypertension. CONCLUSION This study revealed a high prevalence of uncontrolled hypertension in this tertiary care setting. Age, obesity, diabetes, chronic kidney disease, and smoking were identified as significant predictors. Targeted interventions addressing these modifiable risk factors and comorbidities are crucial for improving blood pressure control and reducing the burden of hypertension-related complications.
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Affiliation(s)
- Mehjabin M Hirani
- General Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
| | - Rohankumar Gandhi
- Community and Family Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
| | - Dipenkumar G Thakkar
- Preventive and Social Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
| | - Nilesh Kateshiya
- Internal Medicine, Guru Gobind Government Hospital, Jamnagar, IND
| | - Yogesh Murugan
- Family Medicine, Guru Gobind Government Hospital, Jamnagar, IND
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Seenappa K, Kulothungan V, Mohan R, Mathur P. District-Wise Heterogeneity in Blood Pressure Measurements, Prehypertension, Raised Blood Pressure, and Their Determinants Among Indians: National Family Health Survey-5. Int J Public Health 2024; 69:1606766. [PMID: 38562553 PMCID: PMC10982880 DOI: 10.3389/ijph.2024.1606766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Objective: The objective of the study was to determine the prevalence and determinants of ever-measured blood pressure, prehypertension, and raised blood pressure at national, state and district levels in India. Methods: We analysed data from the National Family Health Survey (NFHS-5), on 743,067 adults aged 18-54 years. The sample consisted of 87.6% females and 12.4% males. We estimated prevalence rates and determined adjusted odds ratios for various dependent variables related to blood pressure. Geographical variations were visualized on the map of India, and multivariate logistic regression was employed at state and district levels, with significance set at p < 0.05. Results: The prevalence of ever-measured blood pressure varied widely, from 30.3% to 98.5% across districts, with southern and northern regions showing higher rates. Prehypertension affected 33.7% of the population, with varying prevalence across districts. Raised blood pressure was there in 15.9%, with notably higher rates in southern region (16.8%). Determinants included age, gender, education, wealth, lifestyle, obesity, and blood glucose levels. Conclusion: These findings demonstrate the subnational variations in blood pressure, can guide evidence-based interventions at the state and district level, towards reducing the burden of raised blood pressure and enhancing overall population health.
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Affiliation(s)
| | | | | | - Prashant Mathur
- Indian Council of Medical Research-National Centre for Disease Informatics and Research (ICMR-NCDIR), Bengaluru, Karnataka, India
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Ahuja N, Bhardwaj P, Pathania M, Sethi D, Kumar A, Parchani A, Chandel A, Phadke A. Yoga Nidra for hypertension: A systematic review and meta-analysis. J Ayurveda Integr Med 2024; 15:100882. [PMID: 38484438 PMCID: PMC10950755 DOI: 10.1016/j.jaim.2023.100882] [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: 05/19/2023] [Revised: 10/05/2023] [Accepted: 12/15/2023] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Hypertension is a prevalent chronic condition that affects a substantial proportion of the world's population. Medications are commonly prescribed for hypertension management, but non-pharmacological interventions like yoga are gaining popularity. OBJECTIVE The purpose of this systematic review and meta-analysis is to assess the efficacy of Yoga Nidra (YN) for the management of hypertension. METHODS A systematic review and meta-analysis of clinical trials, i.e., non-randomized and randomized controlled trials (RCTs) was conducted to investigate the effects of YN on hypertension. PubMed, the Cochrane Library, SCOPUS, and EBSCO were searched for relevant studies published up to September 2022. The quality of the included studies was assessed using the Cochrane risk of bias tool. The primary outcome measure was the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after YN intervention, analyzed as weighted mean difference (WMD), in comparison to control groups. The random-effects model was used for the meta-analysis. Risk of bias was assessed for RCTs and non-RCTs using Cochrane's RoB-2 and ROBINS-I tools, respectively. RESULTS Five RCTs and three Non-RCTs involving a total of 482 participants (239 for YN vs 243 for controls) were included in this review. The meta-analysis indicated that YN significantly reduced SBP (WMD = 12.03 mm Hg, 95% CI [7.12, 16.93], Z = 4.80, p < 0.00001) and DBP (WMD = 6.32 mm Hg, 95% CI [3.53, 9.12], Z = 4.43, p < 0.00001) compared to control groups. The overall risk of bias for the three RCTs was high, whereas for the five non-RCTs, one had an overall moderate risk while the other four had an overall serious risk of bias. DISCUSSION This systematic review and meta-analysis provides evidence supporting the efficacy of YN as a complementary therapy for hypertension management. YN is a safe, cost-effective, and easily accessible intervention that primarily relies on interoception and induces a deep relaxation response in practitioners, aiding them in coping with various components of high blood pressure, such as stress, vascular inflammation, peripheral vascular resistance, etc. Our understanding of the mechanisms of YN is constantly evolving, and there is a need for further research to fully explore and appreciate the significance of this ancient science and its potential efficacy on BP. Considering the results and the multifactorial role of YN, it can act as a safe and reliable adjuvant therapy to complement the pharmacological treatment of hypertension. However, further studies with larger sample sizes, longer follow-up periods, and homogenous populations are warranted. CONCLUSION This meta-analysis suggests that YN is effective in reducing SBP and DBP, particularly in individuals with hypertension. The results highlight the potential of YN as a complementary therapy for hypertension management. Healthcare providers may consider recommending YN to patients with hypertension as an adjuvant therapy to medication. Further studies are required to identify standardized optimal forms and durations of YN best suited for hypertension management.
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Affiliation(s)
- Navdeep Ahuja
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Praag Bhardwaj
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Monika Pathania
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
| | - Dilasha Sethi
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana - SVYASA, Bangaluru, Karnataka, India
| | - Arjun Kumar
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashwin Parchani
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akshita Chandel
- Dept. of General Medicine, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Aashish Phadke
- Division of Endocrine and Metabolic Disorders - Lifestyle Modulations and Yoga Modules, Kasturba Health Society - Medical Research Centre, Mumbai, Maharashtra, India
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Pakhan AA, Jawade S, Boob MA, Somaiya KJ. Impact of Pulsed Electromagnetic Field Therapy and Aerobic Exercise on Patients Suffering With Hypertension: A Systematic Review. Cureus 2024; 16:e56414. [PMID: 38638759 PMCID: PMC11024783 DOI: 10.7759/cureus.56414] [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: 08/14/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Hypertension is a major preventable risk factor for cardiovascular disease. This review evaluates the effects of pulsed electromagnetic field (PEMF) therapy and aerobic exercise on blood pressure (BP) levels in hypertensive patients. This study incorporated research conducted between 2012 and 2020 that was found through a systematic literature search. The measures used to estimate the improvement in BP include the BP measurements, quality-of-life (QOL) scale, and plasma nitric oxide (NO) level. The examination of the review comprised eight studies. These encompassed studies involving individuals with a systolic BP (SBP) above 140 mmHg and a diastolic BP (DBP) above 90 mmHg; those falling within the age range of 40 to 60 years, including both genders; and patients on antihypertensive medications. The review of selected articles concluded that PEMF therapy and aerobic exercise positively impact BP among individuals with hypertension. Aerobic exercises of moderate intensity including brisk walking, jogging, and cycling type of aerobic exercises help reduce BP and maintain patients' physical fitness. PEMF therapy is a complementary approach that affects the biological system and potential health, positively impacting BP. Results indicate that PEMF therapy can be a nonpharmacological method to manage BP in clinical populations. More thorough research is necessary to understand the best dosage, long-term effects, and comparison between PEMF therapy and aerobic exercise.
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Affiliation(s)
- Arjavi A Pakhan
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapna Jawade
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manali A Boob
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamya J Somaiya
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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12
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Sakthivel M, Jayaseelan V, Chinnakali P, Hamide A, Surendran G, Krishnamoorthy Y. Prevalence of Selected Cardiovascular Risk Factors and Their Associated Factors among People Living with HIV/AIDS in India. Indian J Community Med 2024; 49:308-315. [PMID: 38665444 PMCID: PMC11042137 DOI: 10.4103/ijcm.ijcm_583_22] [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: 07/05/2022] [Accepted: 12/22/2023] [Indexed: 04/28/2024] Open
Abstract
Background Low- and middle-income countries face the dual problem of infectious and non-infectious diseases. Persons living with HIV/AIDS (PLHIV) are also at risk of cardiovascular diseases. Hence, we did this study to determine the prevalence of cardiovascular risk factors (CVRF) among PLHIV and to find the factors associated with it. Methods We carried out a cross-sectional analytical study among all adults aged ≥18 years registered at a facility-integrated anti-retroviral therapy center in Puducherry, India, from September 2016 to February 2018. After obtaining informed consent, we interviewed the participants to assess physical activity, alcohol, and tobacco use. We measured weight, height, abdominal circumference, and blood pressure, with biochemical investigations such as blood glucose and lipid profile. Results Of the total 316 adults PLHIV studied, the most common cardiovascular risk factor found was dyslipidemia (82.7%), followed by inadequate physical activity (74.4%). Other behavioral risk factors studied, such as current tobacco use and current alcohol use, showed a prevalence of 12.8% and 5.4%, respectively, among male participants. The prevalence of hypertension among adult PLHIV studied was 15.8%, and diabetes was 12.3%. In the multivariate analysis, diabetes, and hypertension were significantly associated with age and literacy. Obesity was found to be associated with diabetes and abdominal obesity with dyslipidemia. Conclusion Dyslipidemia was the most common cardiovascular risk factor, followed by inadequate physical inactivity among PLHIV. Regular screening with blood glucose, blood pressure, and lipid profile, and timely cross-referrals can help in the early detection of CVRF among PLHIV and hence improve their quality of life through appropriate treatment.
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Affiliation(s)
- Manikandanesan Sakthivel
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Venkatachalam Jayaseelan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Abdoul Hamide
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gayathri Surendran
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Yuvaraj Krishnamoorthy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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13
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Dalal J, Chandra P, Chawla R, Kumar V, Abdullakutty J, Natarajan V, Naqvi SMH, Gaurav K, Rathod R, Dhanaki G, Kotak B, Shah S. Clinical and Demographic Characteristics of Patients with Coexistent Hypertension, Type 2 Diabetes Mellitus, and Dyslipidemia: A Retrospective Study from India. Drugs Real World Outcomes 2024; 11:167-176. [PMID: 38038836 DOI: 10.1007/s40801-023-00400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Coexisting hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia (triple disease) can lead to greater risk of cardiovascular morbidity and mortality. The present study sought to comprehend the prevalence, demographic traits, clinical traits, and treatment patterns in Indian patients with these coexisting conditions. METHODS An electronic medical record (EMR)-based, retrospective, multicenter, cross-sectional study was conducted, and data were collected for patients who were diagnosed with coexistent hypertension, T2DM, and dyslipidemia. Baseline patient variables evaluated were the percentage of patients with triple comorbidity, demographic characteristics, diagnostic laboratory parameters, and treatment pattern details. RESULTS Data from 4793 centers (clinics) were included, with a total of 6,722,173 patients. Of these, 427,835 (6.36%) patients were found to have coexistent hypertension, T2DM, and dyslipidemia. Most of the patients belonged to the 40-64 year age group (62.10%) and were males (57.00%), while 27.40% patients had a body mass index (BMI) within normal limits, 43.30% patients were pre-obese, and 20.90% patients were class 1 obese. Further, 3402 patients (0.80%) had a recorded history of smoking. Mean glycated hemoglobin (HbA1c) for the patients included in the study was 8.35 ± 1.96 g%. Mean systolic blood pressure (SBP) was 138.81 ± 19.59 mm Hg, while mean diastolic blood pressure (DBP) was 82.17 ± 10.35 mm Hg; 27.60% cases had SBP < 130 mm Hg, while 28.37% cases had DBP < 80 mm Hg. The mean low-density lipoprotein (LDL), total cholesterol, and high-density lipoprotein (HDL) in mg/dl were 98.38 ± 40.39, 174.75 ± 46.73, and 44.5 ± 10.05, respectively. Of the enrolled cases, 55.64% had serum LDL below 100 mg/dl, 72.03% cases had serum cholesterol below 200 mg/dl, and 44.15% males and 71.77% females had serum HDL below the normal prescribed range. The most common monotherapy used for managing hypertension was angiotensin receptor blockers (ARB) (24.80%), followed by beta-blockers (24.30%). The most common combinations administered for management of hypertension were antihypertensives with diuretics (14.30%), followed by ARB plus calcium channel blockers (CCB) (13.30%). For dyslipidemia, the majority of patients (56.60%) received lipid-lowering medication in combination with drugs for other comorbidities. The most common antidiabetic agents prescribed were biguanides (74.60%). CONCLUSIONS Coexistence of triple disease is not uncommon in the Indian population, with middle-aged patients diagnosed as pre-obese and obese being affected more commonly and receiving treatment for the same. The present study highlights that, though there are medications against the three chronic conditions, the rate of uncontrolled cases of hypertension, T2DM, and dyslipidemia remains high. Coexistence of triple disease increases the risk of cardiovascular and renal complications, which need to be closely monitored and effectively treated.
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Affiliation(s)
| | | | | | | | | | - Vidhya Natarajan
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India.
| | | | - Kumar Gaurav
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Rahul Rathod
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Gauri Dhanaki
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Bhavesh Kotak
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Snehal Shah
- Department of Clinical Insights, HealthPlix Technologies, Bengaluru, India
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14
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Tripathi V, Talukdar D, Tripathi M, Teelucksingh S. Prevalence and associated factors of undiagnosed hypertension among women aged 15-49 years in India: an analysis of National Family Health Survey-4 data. J Hum Hypertens 2024; 38:245-256. [PMID: 37968456 DOI: 10.1038/s41371-023-00876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
Hypertension is a major risk factor for cardiovascular diseases globally. Fortunately, there is a vast armamentarium of effective therapeutic options at our disposal so undiagnosed hypertension represents a missed opportunity. In a previous analysis [1] of the NFHS-4 dataset for the prevalence and risk factors for undiagnosed hypertension and its associated risk factors among Indian women aged 15-49 years, we had overestimated prevalence by inclusion of self-reported cases. We have since retracted when this anomaly was highlighted [2]. We have now re-analyzed the same database and here present these data. The current analysis shows that the overall prevalence of undiagnosed hypertension was 8.05% among women aged 15-49 years in India. In rural areas, it was 7.89% compared with 8.38% for urban areas. Factors associated with undiagnosed hypertension in rural and urban areas were age, BMI, wealth quintiles, educational level, religion, caste and geographical zones. Nearly half the women aged 15-49 years in India with hypertension are unaware and this has implications for personal and reproductive health.
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Affiliation(s)
- Vrijesh Tripathi
- Department of Mathematics and Statistics, Faculty of Science and Technology, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago.
| | - Debjyoti Talukdar
- Department of Medical Research, Mkhitar Gosh Armenian-Russian International University, 3, 7 Sebastia Street, Yerevan, 0099, Armenia
| | - Mallika Tripathi
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
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Rahman ARA, Magno JDA, Cai J, Han M, Lee HY, Nair T, Narayan O, Panyapat J, Van Minh H, Khurana R. Management of Hypertension in the Asia-Pacific Region: A Structured Review. Am J Cardiovasc Drugs 2024; 24:141-170. [PMID: 38332411 PMCID: PMC10973088 DOI: 10.1007/s40256-023-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/10/2024]
Abstract
This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin-angiotensin-aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential.
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Affiliation(s)
- Abdul R A Rahman
- An Nur Specialist Hospital, Jalan Gerbang Wawasan 1, Seksyen 15, 43650, Bandar Baru Bangi, Selangor, Malaysia.
| | - Jose Donato A Magno
- Division of Cardiovascular Medicine, Philippine General Hospital, Cardiovascular Institute, University of the Philippines College of Medicine, Angeles University Foundation Medical Center, Angeles, Philippines
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, Beijing, People's Republic of China
| | - Myint Han
- Grand Hantha International Hospital, Yangon, Myanmar
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Chongno-gu, Seoul, 03080, South Korea
| | - Tiny Nair
- PRS Hospital, Trivandrum, Kerala, India
| | - Om Narayan
- The Northern Hospital, 185 Cooper St., Epping, VIC, 3122, Australia
| | - Jiampo Panyapat
- Bhumibol Adulyadej Hospital, 171 Paholyothin Road, Saimai, Bangkok, 10220, Thailand
| | - Huynh Van Minh
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue, 530000, Vietnam
| | - Rohit Khurana
- The Harley Street Heart and Vascular Center, Gleneagles Hospital, Singapore, 258500, Singapore
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16
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Samitinjay A, Vaishnavi K, Gongireddy R, Kulakarni SC, Panuganti R, Vishwanatham C, Manikanta AK, Biswas R. Understanding clinical complexity in organ and organizational systems: Challenges local and global. J Eval Clin Pract 2024; 30:316-329. [PMID: 37335625 DOI: 10.1111/jep.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Complexity in healthcare systems has been arbitrarily defined as tasks or systems ranging from complicated to intractable, with a general view of these not being 'simple'. Complexity in healthcare systems in first-world countries has been well elucidated, however, data from third-world countries is still scant. MATERIALS AND METHODS: We present four cases each from three different organ systems-chronic kidney disease, alcohol use disorder, and heart failure-in the backdrop of our healthcare organization. We present our analysis of the complexities faced clinically and, in our local healthcare system which led to these events. RESULTS Analysis of these cases showed that patients with chronic kidney disease had vertebral-spinal pathologies due to poor infection control measures during haemodialysis. All these patients were young with a long history of secondary hypertension. In patients with alcohol use disorder, a common theme of how government regulations and peer pressure promote alcohol use is analysed. In the four patients with unexplained heart failure, vascular health is viewed as a fractal dimension and the various factors affecting vascular health are elaborated. CONCLUSION Complexities exist clinically in making a diagnosis, and organizationally, in the variables and nodes dictating patient outcomes. Clinical complexities cannot be simplified but have to be navigated in an optimized way to improve clinical outcomes.
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Affiliation(s)
- Aditya Samitinjay
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | - Karnati Vaishnavi
- Department of General Medicine, Government Medical College, Sangareddy, India
| | | | - Sai Charan Kulakarni
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | - Raveen Panuganti
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | - Chandana Vishwanatham
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | | | - Rakesh Biswas
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
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López-Bueno R, Núñez-Cortés R, Calatayud J, Salazar-Méndez J, Petermann-Rocha F, López-Gil JF, Del Pozo Cruz B. Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis. Cardiovasc Res 2024; 120:13-33. [PMID: 38033266 DOI: 10.1093/cvr/cvad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Cardiovascular health (CVH) is a critical issue for global health. However, no previous study has determined the prevalence of cardiovascular risk factors based on the American Heart Association's (AHA) Life's Essential 8 (LE8). Therefore, we aimed to estimate the global prevalence of the eight cardiovascular risk factors identified in the LE8. A systematic search of systematic reviews with meta-analysis on cardiovascular risk factors covering data reported between 2000 and 2019 was conducted on PubMed, Epistemonikos, and the Cochrane Library until 1 May 2023. After applying exclusion criteria, 79 studies remained in the final selection for the narrative synthesis in the systematic review, of which 33 of them were used in the meta-analysis which included 2 555 639 participants from 104 countries. The overall pooled prevalence of cardiovascular risk factors was as follows: insufficient physical activity, 26.3% (95% CI 2.3%-63.4%), no adherence to a healthy diet, 34.1% (95% CI 5.8%-71.2%), nicotine exposure, 15.4% (95% CI 10.4%-21.2%), insufficient sleep quality, 38.5% (95% CI 14.0%-66.7%), obesity, 17.3% (95% CI 6.1%-32.6%), dyslipidemia, 34.1% (95% CI 33.8%-34.4%), diabetes, 12.0% (95% CI 7.0%-18.2%), and hypertension, 29.4% (95% CI 23.3%-35.8%). These results warrant prevention strategies aimed at reducing insufficient sleep quality, and no adherence to a healthy diet as leading cardiovascular risk factors worldwide. The high prevalence of hypertension among children and adults is concerning and should also be adequately addressed through global policies.
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Affiliation(s)
- Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Fanny Petermann-Rocha
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | | | - Borja Del Pozo Cruz
- Faculty of Education, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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18
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Bijender, Kumar S, Soni A, Yadav R, Singh SP, Kumar A. Noninvasive Blood Pressure Monitoring via a Flexible and Wearable Piezoresistive Sensor. ACS OMEGA 2024; 9:6355-6365. [PMID: 38375497 PMCID: PMC10876045 DOI: 10.1021/acsomega.3c04786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024]
Abstract
In the present global context, continuous blood pressure (BP) monitoring is paramount in addressing the global mortality rates attributed to hypertension. Achieving precise insights into the human cardiovascular system necessitates accurate measurement of BP, and the accuracy depends on the faithful recording of oscillations or pulsations. This task ultimately depends on the caliber of the pressure sensor embedded in the BP device. In this context, we have fabricated a flexible resistive pressure sensor based on reduced graphene oxide (rGO) and a polydimethylsiloxane (PDMS) sponge that is highly flexible and sensitive. The designed device operates effectively with a minimal bias voltage of 500 mV, at which point it showed its maximum relative change in current, reaching approximately 25%. Additionally, the sensing device showed a notable change in resistance values, exhibiting almost 100% change in resistance when subjected to a pressure of 400 mmHg and high sensitivity of 0.27 mmHg-1. After promising outcomes were obtained during static pressure measurement, the sensor was used for BP monitoring in humans. The sensor accurately traced the oscillometric waveform (OMW) for distinct systolic blood pressure (SBP) and diastolic blood pressure (DBP) combinations to cover a range of medical situations, including hypotension, standard or normal, and hypertension. The values of SBP, DBP, and MAP were derived from the sensor's output using the MAA technique, and the errors in these values concerning the simulator and the traditional BP monitor follow the universal AAMI/ESH/ISO protocols. Bland-Altman (B&A) correlation and scatter plots were used to compare the sensor's results and further validate the proposed sensor. The sensor showed the mean and standard deviation error in the SBP, DBP, and MBP of -0.2 ± 5.9, -0.5 ± 7, and -0.9 ± 4.7 mmHg when compared with the noninvasive blood pressure (NIBP) simulator. The pulse rate (PR) was also calculated from the same OMW for the specified value of 80 beats per minute (bpm) given by the simulator and reported a mean PR value of ∼81 bpm, close to the reference value. The findings show that the flexible resistive sensing device can accurately measure BP and replace the existing sensors of BP devices.
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Affiliation(s)
- Bijender
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Shubham Kumar
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Amit Soni
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Rimjhim Yadav
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Surinder P. Singh
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Ashok Kumar
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
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Kaur A, Dhoat PS, Kaur N, Sahoo SS. Knowledge, Awareness, and Determinants of Medication Adherence in Hypertensive Patients: A Hospital-Based Cross-sectional Study in North India. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S118-S121. [PMID: 38595606 PMCID: PMC11000863 DOI: 10.4103/jpbs.jpbs_406_23] [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: 07/11/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 04/11/2024] Open
Abstract
Background Knowledge and awareness studies reveal the basic information of the community and the misconceptions in relation to practices of a disease. The identification of such factors is important as they directly influence the health care-related interventions. Hypertension is one of the emerging noncommunicable diseases (NCDs) globally. So, we conducted this study to assess the status of our community regarding hypertension. Materials and Methods The study was conducted on 300 hypertensive patients to assess the knowledge and awareness by a hypertension fact questionnaire. Medication adherence was assessed in the same group of patients by Hill-Bone scale-a uniform scale used worldwide. Results Our study revealed a greater number of females with hypertension as compared to males and a maximum number of patients being in the age-group of 61-70 years and belonging to rural areas. Most of the patients had a secondary education as a highest educational qualification with only 10% of patients being postgraduates. A fair number of patients had a good knowledge and awareness about their disease, and most of the respondents accounted forgetfulness as a main reason for nonadherence to therapy over other reasons. Conclusion Our population has good knowledge and awareness about their disease despite not having very good educational qualifications, and we need to strengthen our healthcare programs for even more greater dissemination of information.
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Affiliation(s)
- Amandeep Kaur
- Department of General Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Preeti S. Dhoat
- Department of General Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Navdeep Kaur
- Department of Radiodiagnosis, All India Institute of Medical Sciences Bathinda, Punjab, India
| | - Soumya S. Sahoo
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Punjab, India
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20
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Sivanantham P, Anandraj J, Mathan Kumar S, Essakky S, Gola A, Kar SS. Predictors of Control Status of Hypertension in India: A Systematic Review and Meta-analysis. JOURNAL OF PREVENTION (2022) 2024; 45:27-45. [PMID: 38087106 DOI: 10.1007/s10935-023-00756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
Predictors of hypertension (HTN) control status have not been well understood in India. This information is crucial for policymakers and program managers to devise newer HTN control strategies and implement relevant policies and programs. Therefore, we undertook this meta-analysis to estimate the effect of various factors on the control status of HTN in India. We systematically searched PubMed and Embase for observational studies and community-based trials published between April 2013 and March 2021 conducted among people (≥ 15 years) with hypertension in India. Quality of studies was assessed using Newcastle Ottawa (NO) scale. Meta-analysis was performed using random effects model. We reported the effect of various factors on the prevalence of controlled HTN using pooled odds ratio (OR) with 95% confidence interval (CI). Of the 842 studies screened, we analyzed nine studies that included 2,441 individuals. Based on the NO scale, majority (90%) of studies had a low risk of bias. The odds of having controlled HTN were significantly higher among women (OR 1.78, 95% CI 1.62-1.95), those aged > 45 years (OR 1.69, 95% CI 1.44-1.97), and those residing in urban parts of India (OR 1.74; 95% CI 1.48-2.03). These measures varied considerably across different regions of the country. Very few studies reported data on the relationship between behavioural risk factors of non-communicable diseases (NCDs) and HTN control status. We did not find any statistically significant differences between behavioural risk factors of NCDs and HTN control status. To improve HTN control in India, the ongoing/newer HTN control programs need to target men, those aged 15-45, and rural residents. Future studies on HTN control determinants should report disaggregated data and use standardized definitions for behavioral risk factors to enhance reliability and comprehensiveness of findings on the determinants of HTN control in future reviews.
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Affiliation(s)
- Parthibane Sivanantham
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeyanthi Anandraj
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Mathan Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Saravanan Essakky
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anurag Gola
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
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21
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Jambarsang S, Soodejani MT, Tate R, Sefidkar R. How well do obesity indices predict undiagnosed hypertension in the Persian cohort (Shahedieh) adults community population of all ages? Health Sci Rep 2024; 7:e1897. [PMID: 38405171 PMCID: PMC10885643 DOI: 10.1002/hsr2.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/28/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Background and Aims Hypertension is the leading preventable risk factor for cardiovascular disease, chronic kidney disease and cognitive impairment, and mortality and disability worldwide. Since prevention, early detection, and treatment of blood pressure improve public health, the aim of present study was to determine the best obesity indices and estimate the optimal cut-off point for each one to predict the risk of elevated/stage 1 and undiagnosed hypertension in the population of center of Iran based on American ACC/AHA 2020 guidelines. Methods This cross-sectional study was performed on 9715 people who enrolled in 2018 in Persian Adult Cohort in Shahedieh area of Yazd, Iran in 2018. The anthropometric indices including body mass index (BMI) and waist circumference (WC), wrist circumference, hip circumference, waist-to-hip ratio, and waist-to height ratio of individuals, were extracted. The receiver operating characteristic curve was utilized to determine the optimum cut-off point of each anthropometric index to predict hypertension stages and compare their predictive power by age-sex categories. Statistical analysis was done using SPSS version 23.0. Results The results showed that BMI has the best predictive power to recognize the risk of elevated/stage 1 hypertension for female (area under the curve [AUC] = 0.72 and optimal cut-off = 30.10 kg/m2) and WC for male (AUC = 0.66 and optimal cut-off = 93.5 cm) in 35-45 age group. BMI had the best predictive power for the risk of undiagnosed hypertension for 35-45 years old male (AUC = 0.73 and optimal cut-off = 28.90 kg/m2) and female (AUC = 0.75 and optimal cut-off = 5.10 kg/m2), and hip circumference revealed similar predictive power for female as well (AUC = 0.75 and optimal cut-off = 112 cm). Conclusion Based on our findings, BMI and WC, which are simple, inexpensive, and noninvasive means, are the best markers to predict the risk of elevated/stage 1 and undiagnosed hypertension in young Iranians. It shows that the approach of reducing hypertension prevalence through primary prevention, early detection, and enhancing its treatment is achievable.
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Affiliation(s)
- Sara Jambarsang
- Center for Healthcare Data Modeling, Departments of Biostatistics and EpidemiologyShahid Sadoughi University of Medical SciencesYazdIran
| | - Moslem Taheri Soodejani
- Center for Healthcare Data Modeling, Departments of Biostatistics and EpidemiologyShahid Sadoughi University of Medical SciencesYazdIran
| | - Robert Tate
- Centre on AgingUniversity of ManitobaWinnipegCanada
- Department of Community Health Sciences, Max Rady College of MedicineUniversity of ManitobaWinnipegCanada
| | - Reyhane Sefidkar
- Center for Healthcare Data Modeling, Departments of Biostatistics and EpidemiologyShahid Sadoughi University of Medical SciencesYazdIran
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Ding Z, Qu X, Li C. Digital economy and high-quality development of the healthcare industry. Front Public Health 2024; 12:1331565. [PMID: 38282760 PMCID: PMC10820708 DOI: 10.3389/fpubh.2024.1331565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
The high-quality development of the healthcare industry is of great significance for improving people's health and promoting the construction of a harmonious society. This paper focuses on the relationship between the development of China's digital economy and the high-quality development of the healthcare industry. Based on the panel data of 30 provinces in China from 2011 to 2020, this paper empirically studies whether the development of the digital economy promotes the high-quality development of the healthcare industry. This study finds that the development of digital economy has significantly promoted the high-quality development of the medical and health industry. The results of this study are still valid after a series of robustness tests including variable substitution, sample adjustment, and endogenous problem mitigation. Heterogeneity analysis shows that the effect of this policy is more significant in the eastern region and southern areas. The results of spatial econometric analysis show that the development of digital economy has obvious spatial spillover effect. The research in this paper can provide reference for developing countries to enhance the development level of digital health industry and improve people's lives.
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Affiliation(s)
- Zijing Ding
- School of Economic and Management, Wuhan University, Wuhan, China
| | - Xinyue Qu
- School of Economic and Management, Wuhan University, Wuhan, China
| | - Chen Li
- School of Management, Shanghai University of Engineering Science, Shanghai, China
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Alhaque Roomi MHA, Srivastava A, Girdhar N, Jha C, Thakur S. A Study of the Correlation Between Screen Time and Hypertension Among Young Adults in North India: A Cross-Sectional Analysis. Cureus 2024; 16:e51667. [PMID: 38313899 PMCID: PMC10838163 DOI: 10.7759/cureus.51667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Hypertension is a major risk factor for coronary artery disease. Due to the increased accessibility of smartphones over the past decade, there has been an increase in the screen time of adolescents and young adults. However, the relationship between screen time and hypertension has not been adequately studied. Our study aims to find a correlation between screen time and blood pressure (BP) among young adults. METHODS A cross-sectional analysis was performed on a sample of medical students (n = 210) from New Delhi, India. Participants' screen time was monitored over three weeks and BP was recorded using a standardized sphygmomanometer by auscultatory method. Exclusion criteria included known cases of hypertension (with or without ongoing treatment), smokers > five pack year, heavy alcoholics, and participants having sleep time of less than seven hours or more than nine hours per day. Screen time was correlated with BP readings using standard statistical methods. RESULTS Participants with screen time >390 minutes (six hours and 30 minutes), >420 minutes (seven hours), and >480 minutes (eight hours) had higher odds of elevated BP (OR: 1.86, 95% CI: 1.05-3.30; OR: 1.86, 95% CI: 1.04-3.30; OR: 1.87, 95% CI: 1.02-3.43, respectively) compared to students with screen time <390 minutes. The findings were consistent after excluding participants with high BMI based on the WHO and Asia-Pacific criteria, which also showed higher odds of elevated BP with screen time >390 minutes (OR: 3.21, 95% CI: 1.58-6.49 and OR: 3.92, 95% CI: 1.49-10.31, respectively). Regression analysis showed no significant linear correlation between screen time and BP (p > 0.05). However, a significant association was observed between BMI and elevated BP (p < 0.001). CONCLUSION This study revealed an association exists between screen time and BP.
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Affiliation(s)
| | - Abhishyant Srivastava
- Internal Medicine, Dr. Baba Saheb Ambedkar Medical College & Hospital, New Delhi, IND
| | - Narinder Girdhar
- Medicine, Dr. Baba Saheb Ambedkar Medical College & Hospital, New Delhi, IND
| | - Chaitannya Jha
- Internal Medicine, Dr. Baba Saheb Ambedkar Medical College & Hospital, New Delhi, IND
| | - Shashwat Thakur
- Internal Medicine, Dr. Baba Saheb Ambedkar Medical College & Hospital, New Delhi, IND
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24
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Sharma A, Basera DS, Suri V, Singh SM. A Study of Hypertension and Related Biophysical and Health-related Lifestyle Behaviors in Patients Suffering from Schizophrenia. Ann Neurosci 2024; 31:28-35. [PMID: 38584984 PMCID: PMC10996874 DOI: 10.1177/09727531231158451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 04/09/2024] Open
Abstract
Background Schizophrenia is a life-shortening disease. The standardized mortality ratio has been higher than that of the general population, and it has doubled what it was 3-4 decades ago. This rise is mostly attributed to the increased cardiovascular risk associated with high second-generation antipsychotic (SGA) use. Evidence from the first-generation antipsychotic (FGA) era shows a lower prevalence of hypertension (HTN) but data regarding SGAs is scarce. Purpose The purpose of the study was to assess the prevalence of HTN and related factors using standardized methodology in patients with schizophrenia on treatment with SGAs. Methods A cross-sectional study through convenient sampling was done. Blood pressure, anthropometry, physical activity, and health-related lifestyle factors were assessed using the standard World Health Organization (WHO) methodology of cardiovascular survey methods and the Global Physical Activity Questionnaire (GPAQ) version 2. The prevalence of HTN, obesity, inadequate physical activity, and other demographic and clinical correlates like antipsychotic use, duration of illness, and family history of non-communicable diseases (NCDs) were studied. Results The prevalence of HTN is 20.50%, and it increases with age. SGAs with the use of a single agent are the most common. In total, 45.50% of persons with schizophrenia have a positive family history of a NCD; 22.00% and 07.50% are current tobacco and alcohol users, respectively; and 70% have abdominal obesity, and 54% have generalized obesity. Waist circumference, obesity, and family history of NCDs are significant correlates of HTN. A family history of NCDs is the most significant predictor. Conclusion The prevalence of HTN is lower than that of the general population despite the high prevalence of SGA use, obesity, and inadequate physical activity.
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Affiliation(s)
- Akhilesh Sharma
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devendra Singh Basera
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vikas Suri
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubh Mohan Singh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kumar S, Yadav S, Kumar A. Accuracy of oscillometric-based blood pressure monitoring devices: impact of pulse volume, arrhythmia, and respiratory artifact. J Hum Hypertens 2024; 38:45-51. [PMID: 37620413 DOI: 10.1038/s41371-023-00856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
An oscillometric waveform (OMW) envelope-based blood pressure (BP) monitoring device is widely used to monitor blood pressure and prevent hypertension and adverse cardiovascular events. At present, all primary care physicians and clinicians widely recommend oscillometric-based BP devices. The consumer selects the device based on their own decision, without knowing whether the device is validated or not, resulting in over- or under-treatment of hypertension. It is imperative that each device must comply with international protocols. In this study, we have investigated the accuracy of inflation and deflation-based oscillometric BP monitoring devices in the case of sinus rhythm (SR). Since different health conditions of the patient affect the oscillometric waveform, which can affect the device's accuracy, in such cases, many BP monitors are skeptical of succeeding in the norms of international protocols. Therefore, this study also aims to calculate the accuracy of these devices in various health conditions and measure the effect of pulse volume, arrhythmia, and respiratory artifact on it using a non-invasive blood pressure (NIBP) simulator. We found that the oscillometric BP devices failed to measure the correct blood pressure in several clinical conditions.
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Affiliation(s)
- Shubham Kumar
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi, 110012, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Sanjay Yadav
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi, 110012, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Ashok Kumar
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi, 110012, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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26
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Garg S, Dewangan M, Nanda P, Sahu A, Xalxo L, Bebarta KK, Gupta V, Quereishi MJ, Sahu AK, Tandan P. Impact of community health workers on improving identification and primary care of hypertension among the urban poor - findings from Chhattisgarh state of India. BMC PRIMARY CARE 2023; 24:272. [PMID: 38093191 PMCID: PMC10717607 DOI: 10.1186/s12875-023-02231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Hypertension is a major health problem globally and in India. Around 60% of people with hypertension in India are not aware that they have the condition. Less than 30% of individuals with hypertension are on treatment. Existing studies have indicated that community health workers (CHWs) can play a useful role in expanding the care for hypertension. Evaluations are needed to study the impact when an intervention is implemented by the government in its existing large-scale CHW programme to improve the identification, regular follow-up and medication adherence for hypertension. METHODS Chhattisgarh state implemented a pilot intervention to improve screening and follow-up for hypertension by equipping Mitanin-CHWs to measure blood pressure (BP). The study design involved an intervention-group and a comparison-group of urban slum population. The survey covered 5974 individuals (30-79 years age) in intervention-group and 5131 in comparison-group. Multivariate analysis was conducted to find out the effect of intervention on the desired outcomes. RESULTS In intervention-group, 80.2% of the individuals (30-79 years age) had been screened for hypertension whereas the proportion was 37.9% in comparison-group. For 47.0% of individuals in intervention-group, Mitanin CHW was the provider who measured BP for the first time. Around 16.3% of individuals in intervention-group and 9.5% in comparison-group had been diagnosed with hypertension. Around 85.9% of hypertension cases in intervention-group and 77.0% in comparison-group were on treatment. BP had been measured in preceding 30 days for 81.8% of hypertension-cases in intervention-group and 64.3% in comparison-group. Around 70.3% of hypertension-cases in intervention-group and 55.1% in comparison-group had taken their complete medication for last seven days. Multivariate analysis showed that CHW intervention was associated significantly with improvements in all the desired outcomes. CONCLUSION Equipping the CHWs to measure BP was effective in increasing the screening and identification of hypertension, regular measurement of BP of individuals with hypertension and the adherence to medication. This shows the potential if the one-million strong work-force of Accredited-Social-Health-Activists (ASHA) CHWs in India gets equipped for this role. Governments need to provide a stronger policy push to get this materialised.
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Grants
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Chhattisgarh, Raipur, India.
| | | | - Prabodh Nanda
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | - Ashu Sahu
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | - Lalita Xalxo
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | | | - Vishnu Gupta
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | | | - Anand Kumar Sahu
- State Programme Management Unit, National Health Mission, Chhattisgarh, Raipur, India
| | - Pradeep Tandan
- State Programme Management Unit, National Health Mission, Chhattisgarh, Raipur, India
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Feng W, Yun W, Le W, Zhi-guo X, Hai-ying Y, Shu-fang W, Zhen-yan W, Yi-zhu C, Quan S, Jing-xian F. The influence of demographic and lifestyle factors on blood donation delay among student population: a retrospective study. Front Public Health 2023; 11:1297472. [PMID: 38125844 PMCID: PMC10731257 DOI: 10.3389/fpubh.2023.1297472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objective This study analysed blood donation deferral trends, reasons and demographic/lifestyle characteristics among students in Huzhou City. The aim was to understand the health status of students and reduce the deferral rate. Methods Data on blood donation deferral among students in Huzhou City from 2018 to 2022 were collected and analysed. Deferral trends and main reasons were investigated. Using demographic and lifestyle data from 2,619 cases in 2022, a risk prediction model for deferral was constructed. Results The deferral rate among students in Huzhou City from 2018 to 2022 was 12.60% (p = 0.000, 95%CI: 12.14-13.06%), showing a significant increasing trend. Temporary deferral was the main reason, with alanine aminotransferase (ALT), blood pressure (BP) and haemoglobin (Hb) as the main deferral factors. ALT had a deferral rate of 5.23% (4.92-5.53%), BP 3.30% (3.06-3.55%), and Hb 2.92% (2.68-3.15%). Demographic and lifestyle characteristics in 2022 showed no significant differences between education level, household registration and deferral rate (p > 0.05). However, age, sex, blood donation history, sleep quality, diet and mental state had variable effects on ALT, BP, and Hb deferrals (p < 0.05). Logistic regression showed that sex, blood donation history, sleep quality, diet and mental status were independent risk factors for ALT deferral (p < 0.05), with odds ratios (ORs) of 5.057, 2.735, 1.594, 3.679, and 1.957, respectively. Age, blood donation history, sleep quality and mental state were independent risk factors for BP deferral (p < 0.05), with ORs of 0.256, 3.658, 6.042, and 1.812, respectively. Gender, blood donation history and diet were independent risk factors for Hb deferral (p < 0.05), with ORs of 0.244, 0.542, and 3.103, respectively. Conclusion Students' health problems require attention. Effective health education should improve self-health management and pre-donation health behaviour to encourage regular blood donation.
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Affiliation(s)
- Wang Feng
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
| | - Wang Yun
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
| | - Wang Le
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
| | - Xu Zhi-guo
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
| | - Yang Hai-ying
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
| | - Wu Shu-fang
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
| | - Wei Zhen-yan
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
| | - Chen Yi-zhu
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
| | - Sun Quan
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
| | - Fei Jing-xian
- Huzhou Central Blood Station, Huzhou, Zhejiang, China
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Verma N, Matsushita N, Salman E, Ohkubo T, Imai Y. GeogRaphic and socioecoNomic Distribution of real-world Indian data of home blood pressure monitoring (GRAND Study): Study protocol for an observational study in 18 medical centers across India. J Clin Hypertens (Greenwich) 2023; 25:1105-1134. [PMID: 37909858 PMCID: PMC10710551 DOI: 10.1111/jch.14713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/19/2023] [Accepted: 08/01/2023] [Indexed: 11/03/2023]
Abstract
One-fourth of death in India is attributed to cardiovascular disease (CVD) and more than 80% is related to ischemic heart disease and stroke. The main risk factor for CVD is hypertension. Every third person in India suffers from hypertension and the prevalence increased drastically in the past 20 years, especially among the youngest age group of 20 and 44 years. Regardless of being under anti-hypertension medication, the blood pressure (BP) control rate in the country is still low ranging between 6% and 28% only. Assessing the "true BP control rate" should be performed using both clinic BP measurement and out-of-office BP measurement as the latter shows better prognosis for patients' hypertension and CVD outcomes. Home blood pressure monitoring (HBPM) shows superiority over ambulatory BP measurement as multiple measurements can be collected at the patient's convenience. Only limited evidence on HBPM in India is available and it's either lacking in hypertension participants or of a small sample size. This study will investigate the real BP control status among 2000 hypertensive patients from 18 centers in 12 states across Pan-India. The outcome of this study will emphasize the value of establishing BP control management practice guidelines suitable for physicians and help policymakers in building proper strategies for hypertension management to reduce the CVD burden on the health situation in India.
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Affiliation(s)
- Narsingh Verma
- Department of PhysiologyOfficiating Head Department of Family MedicineKing George's Medical UniversityLucknowIndia
| | - Noriko Matsushita
- Global Medical AffairsAsia Pacific RegionalOmron Healthcare Singapore, Pte. Ltd.Alexandra TechnoParkSingapore
| | - Ebtehal Salman
- Technical Development HQClinical Development DepartmentOmron Healthcare Co., Ltd.MukoKyotoJapan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public HealthTeikyo University School of MedicineItabashi‐kuTokyoJapan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood PressureStation Plaza BuildingSendaiMiyagiJapan
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Bera OP, Mondal H, Bhattacharya S. Empowering Communities: A Review of Community-Based Outreach Programs in Controlling Hypertension in India. Cureus 2023; 15:e50722. [PMID: 38234936 PMCID: PMC10793189 DOI: 10.7759/cureus.50722] [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] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
India's epidemiological shift from communicable to non-communicable diseases (NCDs) signifies the impact of healthcare advancements and changing lifestyles. Despite declines in infectious diseases, challenges related to chronic conditions such as cardiovascular diseases and diabetes have risen. Approximately one in four Indian adults has hypertension, with only 12% maintaining controlled blood pressure. To meet the 25% relative reduction target in hypertension prevalence by 2025, India must enhance treatment access and public health initiatives. A global report underscores the urgency of preventing, detecting, and managing hypertension, especially in low- and middle-income countries like India, where 188.3 million adults are estimated to have hypertension. Loss to follow-up persists in both communicable and non-communicable diseases, driven by factors such as stigma and socioeconomic barriers. Community outreach programs have proven effective, incorporating mobile health interventions, community health worker engagement, and door-to-door screenings. Hypertension management faces similar challenges, with community outreach tailored to lifestyle factors and cultural beliefs showing promise. The comprehensive strategy to control hypertension involves strengthening primary healthcare centers, promoting wellness centers, and capacitating Community Health Officers. While community-led, tech-enabled private sector interventions can screen and manage NCDs, integration with the public health system is crucial for widespread adoption and cost-effectiveness. In conclusion, tailored strategies, such as community outreach integrated into healthcare systems, are essential to address loss to follow-up and enhance health management success in both communicable and non-communicable diseases.
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Affiliation(s)
- Om Prakash Bera
- Health Systems Strengthening Unit, Global Health Advocacy Incubator, Washington, DC, USA
| | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Sudip Bhattacharya
- Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Thout SR, Yu J, Santos JA, Hameed M, Coyle DH. Dietary intakes of hypertensive patients in rural India: Secondary outcomes of a randomised, double-blind, controlled trial. DIALOGUES IN HEALTH 2023; 2:100109. [PMID: 38515467 PMCID: PMC10953904 DOI: 10.1016/j.dialog.2023.100109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/10/2023] [Accepted: 01/31/2023] [Indexed: 03/23/2024]
Abstract
Background Hypertension is highly prevalent in India; however, little is known about the dietary intakes of those living with hypertension, particularly in rural areas. The primary aim was to assess the dietary intakes of individuals living in rural India with self-reported history of hypertension. As secondary analyses, we explored the dietary impact of a salt substitute in this population group. Materials and methods This study used data from a large randomised controlled trial conducted in seven villages across rural India. Participants received either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride) to replace all home salt use. Dietary intake at baseline and end-of-trial was assessed using 24-h dietary recalls. A range of dietary outcomes were assessed including energy intake, macronutrient intake and overall diet quality according to the Alternate Healthy Eating Index (AHEI). Results A total of 454 participants were included in the analysis. At baseline, mean (SE) energy intakes in regular salt group and salt substitute group were similar at 5240 (110) kJ/day and 5120 (106) kJ/day, respectively. This was largely attributable to intakes of carbohydrates (74.4% of total energy intakes for regular salt group vs 75.4% for the salt substitute group) followed by total fat (15.8% vs 15.4%) and protein (10.4% vs 10.3%). Both groups also had similar AHEI scores at baseline, with mean (SE) total scores equating to 33.0 (0.4) (out of a total 90) for the regular salt group and 32.7 (0.4) for the salt substitute group. Both groups received lowest AHEI scores across the following components: vegetables, fruit and wholegrains. At baseline, the mean (SE) intakes of sodium across the regular salt and salt substitute groups were similar at 2349 (67) mg/day and 2396 (64) mg/day, respectively. In the salt substitute group, there was a significant reduction in total sodium intakes over time (-264 mg/day, 95% CI, -442 to -85), driven by the use of the salt substitute. Conclusion This study found individuals with hypertension living in rural India had poor dietary intakes, including low intakes of fruits, vegetables and wholegrains, and high intakes of sodium. Salt substitutes may be an effective strategy for reducing sodium intake in this population group.
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Affiliation(s)
- Sudhir Raj Thout
- The George Institute for Global Health India, Punjagutta, Hyderabad, India
| | - Jie Yu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Md Hameed
- The George Institute for Global Health India, Punjagutta, Hyderabad, India
| | - Daisy H. Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Bhatia M, Dixit P, Kumar M, Dwivedi LK. A longitudinal study of incident hypertension and its determinants in Indian adults aged 45 years and older: evidence from nationally representative WHO-SAGE study (2007-2015). Front Cardiovasc Med 2023; 10:1265371. [PMID: 38034379 PMCID: PMC10682706 DOI: 10.3389/fcvm.2023.1265371] [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: 07/22/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Hypertension (HT) is a leading cause of mortality and morbidity in developing countries. This study aimed to estimate the incidence of HT among adults aged 45 years and older in India and its associated risk factors. Methods This study used longitudinal data from the Indian sample of the first and second waves of the World Health Organization Study on Global Ageing and Adult Health (WHO-SAGE). A bivariate analysis using Pearson's chi-square test was done to examine the associations of individual, lifestyle, and household characteristics with HT status reported in Wave 2. Incident HT changes were analyzed by adjusting for various covariates in the generalized estimating equation (logit link function) with an exchangeable correlation matrix and robust standard errors. Results The study found that during the 8-year period from 2007 to 2015, the incidence of HT in individuals aged 45 years and over was 20.8%. Pre-hypertensive individuals had an overall incidence rate of 31.1 per 1,000 [95% confidence interval (CI): 26.20-35.9] and a 2.24 times higher odds ratio: 2.24 (95% CI: 1.65-3.03) of developing incident HT compared to those who were normotensive. Adults aged 45 years and older, overweight/obese individuals, and women were more at risk of incident HT. Conclusion One in five individuals had developed HT over 8 years, with a greater risk of incident HT among women than men. Pre-hypertensive individuals were at a greater risk of developing incident HT compared to normotensive individuals. The study recommends comprehensive and effective management of pre-HT to tackle the burden of HT.
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Affiliation(s)
- Mrigesh Bhatia
- Department of Health Policy, London School of Economics, London, United Kingdom
| | - Priyanka Dixit
- Centre for Health and Social Sociences, Tata Institute of Social Sciences, Mumbai, India
| | | | - Laxmi Kant Dwivedi
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
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Garg A, Murphy A, Krishna A, Sahoo SK, Huffman MD, Kishore SP, Shivashankar R. Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 35:357-363. [PMID: 37167513 DOI: 10.25259/nmji_35_6_357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines lists (EMLs) at the national and subnational levels in India and by rapid appraisal of the existing policies and processes of drug procurement. Methods We assessed the inclusion of six classes of medicines for CVDs in the recent and publicly available national and subnational EMLs from July to September 2018 in the states of Telangana and Madhya Pradesh. We examined the drug procurement and distribution policies and processes using documentary review and five key informant interviews between March and June 2018. Results The WHO's EML, India's national EML, and 21 of 28 publicly available (75%) Indian state and Union Territory EMLs included all six classes of essential medicines for CVDs. However, some medicines were not included in the policy packages of essential medicines meant for primary health centres. Both the states used centralized tendering and decentralized distribution as part of the public sector drug procurement process. The requirement was based on the previous year's consumption. The approximate time between procurement planning and distribution was 7-8 months in both the states. Conclusion Substantial variation exists in the selection of drugs for CVDs in EMLs at the subnational level in India. Improving forecasting techniques for requirement of medicines and reducing time lags between forecasting and distribution to health facilities may allow for better access to essential medicines.
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Affiliation(s)
- Ankur Garg
- Centre for Chronic Disease Control, New Delhi, India
| | - Adrianna Murphy
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago
- Division of Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Roopa Shivashankar
- Centre for Chronic Disease Control, New Delhi, India
- Resolve to Save Lives, Gurugram, Haryana, India
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Singh MM, Basu S, Lalwani H, Rao S, Maheshwari V, Garg S, Sharma N. Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey. BMC Public Health 2023; 23:2116. [PMID: 37891517 PMCID: PMC10612386 DOI: 10.1186/s12889-023-17021-8] [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: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Hypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India. METHODS This was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant. RESULTS We included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82). CONCLUSIONS Hypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity.
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Affiliation(s)
| | - Saurav Basu
- Indian Institute of Public Health - Delhi, Public Health Foundation of India, New Delhi, India.
| | - Heena Lalwani
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
| | - Shivani Rao
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Vansh Maheshwari
- Indian Institute of Public Health - Delhi, Public Health Foundation of India, New Delhi, India
| | - Sandeep Garg
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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Varghese JS, Venkateshmurthy NS, Sudharsanan N, Jeemon P, Patel SA, Thirumurthy H, Roy A, Tandon N, Narayan KMV, Prabhakaran D, Ali MK. Hypertension Diagnosis, Treatment, and Control in India. JAMA Netw Open 2023; 6:e2339098. [PMID: 37870834 PMCID: PMC10594142 DOI: 10.1001/jamanetworkopen.2023.39098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/10/2023] [Indexed: 10/24/2023] Open
Abstract
Importance Hypertension is a major cause of morbidity and mortality worldwide. Previous efforts to characterize gaps in the hypertension care continuum-including diagnosis, treatment, and control-in India did not assess district-level variation. Local data are critical for planning, implementation, and monitoring efforts to curb the burden of hypertension. Objective To examine the hypertension care continuum in India among individuals aged 18 to 98 years. Design, Setting, and Participants The nationally representative Fifth National Family Health Survey study was conducted in 2 phases from June 17, 2019, to March 21, 2020, and from November 21, 2020, to April 30, 2021, among 1 895 297 individuals in 28 states, 8 union territories, and 707 districts of India. Exposures District and state of residence, urban classification, age (18-39, 40-64, and ≥65 years), sex, and household wealth quintile. Main Outcomes and Measures Hypertension was defined as a self-reported diagnosis or a newly measured blood pressure of 140/90 mm Hg or more. The proportion of individuals diagnosed (self-reported), the proportion of individuals treated among those diagnosed (self-reported medication use), and the proportion of individuals with blood pressure control among those treated (blood pressure <140/90 mm Hg [aged 18-79 years] or <150/90 mm Hg [aged ≥80 years]) were calculated based on national guidelines. Age-standardized estimates of treatment and control were also provided among the total with hypertension. To assess differences in the care continuum between or within states (ie, between districts), the variance was partitioned using generalized linear mixed models. Results Of the 1 691 036 adult respondents (52.6% women; mean [SD] age, 41.6 [16.5] years), 28.1% (95% CI, 27.9%-28.3%) had hypertension, of whom 36.9% (95% CI, 36.4%-37.3%) received a diagnosis. Among those who received a diagnosis, 44.7% (95% CI, 44.1%-45.3%) reported taking medication (corresponding to 17.7% [95% CI, 17.5%-17.9%] of the total with hypertension). Among those treated, 52.5% (95% CI, 51.7%-53.4%) had blood pressure control (corresponding to 8.5% [95% CI, 8.3%-8.6%] of the total with hypertension). There were substantial variations across districts in blood pressure diagnosis (range, 6.3%-77.5%), treatment (range, 8.7%-97.1%), and control (range, 2.7%-76.6%). Large proportions of the variation in hypertension diagnosis (94.7%), treatment (93.6%), and control (97.3%) were within states, not just between states. Conclusions and Relevance In this cross-sectional survey study of Indian adults, more than 1 in 4 people had hypertension, and of these, only 1 in 3 received a diagnosis, less than 1 in 5 were treated, and only 1 in 12 had blood pressure control. National mean values hide considerable state-level and district-level variation in the care continuum, suggesting the need for targeted, decentralized solutions to improve the hypertension care continuum in India.
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Affiliation(s)
- Jithin Sam Varghese
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Nikkil Sudharsanan
- Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Shivani A. Patel
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Harsha Thirumurthy
- Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - K. M. Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Center for Chronic Disease Control, New Delhi, India
| | - Mohammed K. Ali
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Grover S, Anand T, Kishore J, Sinha D, Malhotra S, Dhawan P, Goel S. Hypertension and its correlates among pregnant women consuming tobacco in India: Findings from the National Family health Survey-4. Prev Med Rep 2023; 35:102281. [PMID: 37576846 PMCID: PMC10413145 DOI: 10.1016/j.pmedr.2023.102281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 08/15/2023] Open
Abstract
Background Hypertension (high blood pressure) during pregnancy has significant implications on maternal and perinatal morbidity and mortality. Tobacco use during pregnancy amplifies this burden and increases the risk of hypertensive disorders along with adverse birth outcomes. The current study aimed to evaluate the joint risk atpopulation-level of tobacco use and hypertension among pregnant women in India. Methodology Data of 32,428 "currently pregnant" women aged 15-49 years was obtained from the National Family Health Survey (NFHS-4) 2015-16to estimate bivariate (tobacco user vs. non-user) and binomial logistic regression analysis in order to get odds ratios of having hypertension. The analysis included socio-demographic variables such as the respondent's age, type of residence, wealth index, and education status. Results Prevalence of hypertension among pregnant tobacco users (7.5%) was significantly higher than that of non-users (6.1%). The unadjusted odds of having hypertension were 1.17 (95% CI: 1.02-1.35) times among tobacco users than non-users and increased with age (p < 0.001) and in rural areas (p = 0.02) after adjusting for other covariates. However, it varied inversely with education status (p > 0.05; NS) and wealth quintile (p = 0.01). Conclusion The present study identifies the higher co-existence of hypertension among tobacco-using pregnant women and highlights the need for tobacco control/cessation and hypertension prevention and management during pregnancy considering socio-demographic disparities.
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Affiliation(s)
- Shekhar Grover
- Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Tanu Anand
- Indian Council of Medical Research, New Delhi, India
| | | | - D.N. Sinha
- School of Preventive Oncology, Patna, India
| | - Sumit Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sonu Goel
- PGIMER, Chandigarh, India
- Public Health Master’s Program, School of Medicine and Health Research Institute (HRI), University of Limerick, Ireland, UK
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V M S, Malhotra S, Gupta S, Goswami K, Salve HR. Prevalence and Associated Factors of Hypertension Among Adolescents in a Rural Community of North India. Cureus 2023; 15:e47934. [PMID: 38034166 PMCID: PMC10685057 DOI: 10.7759/cureus.47934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND AIM Hypertension exerts a substantial burden on the healthcare system in India. Recent literature suggests hypertension to be a rising health problem not only in adults but also in adolescents. The early diagnosis of hypertension in adolescents and timely interventions are key in reducing the burden of hypertension-related morbidity and mortality in later life. This study aimed to estimate the prevalence and factors associated with hypertension among adolescents residing in a rural community in north India. MATERIALS AND METHODS This was a community-based cross-sectional study done in Ballabgarh, Haryana. A computer-generated random sample of 600 adolescents was drawn through a sampling frame of adolescents (10-19 years) listed in the Health Management Information System. House visits were made and a semi-structured interview schedule was used. Blood pressure was measured using a digital blood pressure (BP) apparatus (OMRON digital BP monitor, three readings) with age-appropriate cuffs, and hypertension was defined using the American Academy of Pediatrics 2017/Indian Academy of Pediatrics 2022 criteria. Age-adjusted BMI was calculated using AnthroPlus software (Geneva, Switzerland: WHO). The prevalence of hypertension was reported with a 95% confidence interval. Bivariate and multivariate logistic regression was done to determine the association of hypertension with the associated factors. RESULTS In this study, 550 adolescents participated, of which 284 (51.6%) were males. The overall prevalence of hypertension was 18.9% (95% CI: 15.8-22.4%), stage 1 hypertension 17.3% (95% CI: 14.3-20.7%), and stage 2 hypertension 1.6% (95% CI: 0.8-3.1%). The participants aged 15-19 years (adjusted OR: 2.40, 95% CI: 1.51-3.80) compared to adolescents aged 10-14 years, and those who were overweight/obese (adjusted OR: 3.93, 95% CI: 2.14-7.20) compared to those with normal weight had significantly greater odds; whereas the female sex had lesser odds (adjusted OR: 0.49, 95% CI: 0.32-0.81) of having hypertension compared to male adolescents. CONCLUSION Approximately one-fifth of the participants in this study had hypertension, highlighting the need for interventions including lifestyle modification and active case finding targeting adolescents.
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Affiliation(s)
- Sumna V M
- Preventive Medicine, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Sumit Malhotra
- Epidemiology and Public Health, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Sanjeev Gupta
- Preventive Medicine, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Kiran Goswami
- Epidemiology and Public Health, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Harshal R Salve
- Epidemiology and Public Health, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
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Babu BV, Hazarika CR, Raina SK, Masoodi SR, Basappa YC, Thomas N, Kerketta AS, Jebasingh FK. Hypertension Prevalence, Awareness, Treatment, Control and Risk Factors in Tribal Population of India: a Multi-Centric Cross-Sectional Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01817-w. [PMID: 37768536 DOI: 10.1007/s40615-023-01817-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 09/29/2023]
Abstract
The prevalence of hypertension is increasing in the tribal population of India. Lifestyle modifications, including dietary changes and acculturation, are the main reasons for the high prevalence of hypertension among the Indian indigenous (tribal) population. This paper reports hypertension prevalence, awareness, treatment, control and risk factors among tribes in five districts of different geographical zones of India. A cross-sectional study was conducted among the adult tribal population of 7590 from these states. Data related to blood pressure, anthropometry, demographic and behavioural variables were collected with prior consent from the participants. The prevalence of hypertension is 34.0% and 28.3% among men and women, respectively. Of the total hypertensives, 27.5% were aware of their hypertension status; of them, 83.9% were receiving treatment, and blood pressure was in control among 33.5% of patients who were receiving treatment. Age, alcohol intake, sedentary lifestyle, Particularly Vulnerable Tribal Groups status and body mass index are found to be significantly associated with the prevalence of hypertension. The prevalence of hypertension is high among these tribal populations, which could be due to modernization and acculturation. Awareness and treatment-seeking behaviour are poor. Hence, early screening, awareness campaigns for seeking treatment, and health promotion are immediately required. Comprehensive health promotion programs need to promote lifestyle modification and re-orientation of the primary health care system to improve availability and accessibility to hypertension screening and treatment.
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Affiliation(s)
- Bontha V Babu
- Socio-Behavioral, Health Systems and Implementation Research Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, India.
| | - Chaya R Hazarika
- Socio-Behavioral, Health Systems and Implementation Research Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Sunil K Raina
- Department of Community Medicine, Dr Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Shariq R Masoodi
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | | | - Felix K Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
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Rajadhyaksha GC, Reddy H, Singh AK, Oomman A, Adhyapak SM. The Indian registry on current patient profiles & treatment trends in hypertension (RECORD): One year interim analysis. Indian J Med Res 2023; 158:244-255. [PMID: 37861623 PMCID: PMC10720968 DOI: 10.4103/ijmr.ijmr_3096_21] [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: 10/20/2021] [Indexed: 10/21/2023] Open
Abstract
Background & objectives In India, hypertension constitutes a significant health burden. This observational, non-interventional, prospective study was conducted in five centres across India to evaluate the current clinical practices for the management of hypertension. Methods Participants were enrolled if they were newly diagnosed with essential hypertension or had pre-existing hypertension and were on the same therapeutic plan for the previous three months. At baseline, three months, six months, and one year, information on the patient and their treatment regimen was documented, and their quality of life (QoL) was evaluated. Results A total of 2000 individuals were enrolled in this study, with a mean age of 54.45 yr. Of these, 55.7 per cent (n=1114) were males, and 957 (47.85%) were newly diagnosed with hypertension, while 1043 (52.15%) had pre-existing hypertension. Stage 2 hypertension (systolic blood pressure (BP) >140 or diastolic BP ≥90 mmHg) accounted for more than 70 per cent of the participants (70.76% of pre-existing and 76.29% of newly diagnosed); the average duration of pre-existing hypertension was 68.72 months. Diabetes (31.6%) and dyslipidaemia (15.8%) were the most common comorbidities. In 43.3 per cent of the participants, monotherapy was used, and in 56.7 per cent (70.55% fixed-dose combination), combination therapy was used. Telmisartan (31.6%), amlodipine (35.2%), and a combination of the two (27.1%) were the most commonly prescribed treatment regimens. At three months, six months, and one year, treatment modifications were observed in 1.4, 1.05, and 0.23 per cent of the participants receiving monotherapy and 2.74, 4.78 and 0.35 per cent receiving combination therapy, respectively. In both groups, the proportion of individuals with controlled hypertension (≤140/90 mmHg) increased by more than 30 per cent after a year. At one year, physical and emotional role functioning, social functioning, and health improved considerably. Interpretation & conclusions Combination therapy for hypertension is increasingly preferred at the time of initial diagnosis. The efficacy, safety, and tolerance of the recommended medications were reflected by improvements in the QoL and the minimal changes in the therapeutic strategy required.
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Affiliation(s)
| | - Himanshu Reddy
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Amresh Kumar Singh
- Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abraham Oomman
- Department of Cardiology, Apollo Hospitals, Chennai, Tamil Nadu, India
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Sivanantham P, S. MK, Essakky S, Singh M, Ghosh S, Mehndiratta A, Kar SS. Cost-effectiveness of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India. PLoS One 2023; 18:e0285542. [PMID: 37624838 PMCID: PMC10456130 DOI: 10.1371/journal.pone.0285542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/25/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs. OBJECTIVE To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India. METHODS We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with ≥10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged ≥40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses. RESULTS The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; ₹ 8,656) and single-stage (US$ 1073; ₹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario. CONCLUSION In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels.
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Affiliation(s)
- Parthibane Sivanantham
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Mathan Kumar S.
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Saravanan Essakky
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | | | | | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Mukhopadhyay P, De M, Lahiri S, Sarkar M, Haldar A. Evaluation of community-based care delivered by primary healthcare providers in management of hypertension in a rural area of West Bengal. J Family Med Prim Care 2023; 12:1685-1691. [PMID: 37767422 PMCID: PMC10521822 DOI: 10.4103/jfmpc.jfmpc_2435_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 09/29/2023] Open
Abstract
Background Lifestyle modifications and medication compliance are key strategies. Objectives To evaluate the effect of community-based care delivered by trained primary healthcare providers in management of hypertension. Materials and Methods A longitudinal study was conducted between two groups of newly diagnosed hypertensive patients to evaluate the impact of an educational intervention. Six blocks in a district were chosen with pairwise matching. All primary healthcare providers of one block in each pair were randomized to receive the intervention and the other was controlled. Next screening for risk factors, detection of hypertension, counseling, and follow-up care were provided. The patients within the control group received usual care as per clinician's discretion. A total of 227 patients in the "study" group and 230 patients in the "control" group were recruited from 12 subcenters selected randomly. Data analysis was done by χ2 test, t test, and GLM analysis using SPSS 16. Results Patients in the intervention blocks demonstrated a statistically significant mean reduction in SBP of 16.14 ± 0.82 and DBP by 11.65 ± 0.53 compared to 9.83 ± 1.02 and 7.68 ± 0.66, respectively, in the control blocks after adjusting for age, sex, and baseline blood pressure at one-year follow-up. Regarding lifestyle-related cardiovascular risk factors, statistically significant differences were found in favor of the intervention group. Conclusion The study supports and reinforces the utilization of trained primary healthcare providers under the NPCDCS program in screening and promoting blood pressure control by preventive services to hypertensive patients in the community.
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Affiliation(s)
- Prianka Mukhopadhyay
- Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
| | - Maumita De
- Department of Community Medicine, NRS Medical College, Kolkata, West Bengal, India
| | - Surajit Lahiri
- Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
| | - Manisha Sarkar
- Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
| | - Anima Haldar
- Department of Community Medicine, ID and BG Hospital, Beliaghata, Kolkata, West Bengal, India
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Pakhare A, Lahiri A, Shrivastava N, Subba KN, Veera Durga Kurra V, Joshi A, Atal S, Khadanga S, Joshi R. Status of Hypertension Control in Urban Slums of Central India: A community Health Worker-Based Two-Year Follow-Up. Adv Biomed Res 2023; 12:197. [PMID: 37694241 PMCID: PMC10492608 DOI: 10.4103/abr.abr_266_22] [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: 08/09/2022] [Revised: 04/10/2023] [Accepted: 04/26/2023] [Indexed: 09/12/2023] Open
Abstract
Background Hypertension (HTN) is a leading cause of cardiovascular diseases and its control is poor. There is heterogeneity in levels of blood pressure control among various population subgroups. The present study was conducted within the framework of the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in India. It aims to estimate the proportion of optimal blood pressure control and identify factors associated with uncontrolled HTN consequent to initial screening. Materials and Methods We assembled a cohort of individuals with HTN confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen accredited social health activists were trained from within these slums. Individuals with HTN were linked to primary care providers and followed up for the next two years. Obtaining optimal blood pressure control (defined as SBP <140 and DBP <90 mm of Hg) was a key outcome. Results Of a total of 6174 individuals, 1571 (25.4%) had HTN, of which 813 were previously known and 758 were newly detected during the baseline survey. Two-year follow-up was completed for 1177 (74.9%). Blood pressure was optimally controlled in 301 (26%) at baseline and in 442 (38%) individuals at two years (an absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical inactivity, higher body mass index, and newly diagnosed HTN were significantly associated with uncontrolled blood pressure. Conclusion We found about six of every ten individuals with HTN were on treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.
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Affiliation(s)
- Abhijit Pakhare
- Department of Community and Family Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Anuja Lahiri
- Department of Community and Family Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Neelesh Shrivastava
- Department of Sociology, Barkatullah University, Bhopal, Madhya Pradesh, India
| | - Krishna N. Subba
- Department of Community and Family Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | | | - Ankur Joshi
- Department of Community and Family Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Shubham Atal
- Department of Pharmacology, AIIMS, Bhopal, Madhya Pradesh, India
| | - Sagar Khadanga
- Department of General Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Rajnish Joshi
- Department of General Medicine, AIIMS, Bhopal, Madhya Pradesh, India
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Nayak G, Ghosal S, Ghosal J, Dutta A. What causes concordance of hypertension between spouses in India? Identifying a critical knowledge gap from a nationally representative cross-sectional sample of 63,020 couples aged 15 + years. BMC Public Health 2023; 23:1434. [PMID: 37501082 PMCID: PMC10373271 DOI: 10.1186/s12889-023-16379-z] [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: 03/09/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Hypertension, a critical risk factor for cardiovascular diseases, is found to cluster between spouses due to within-couple aggregation of antecedent environmental risk factors, either through assortative mating or cohabitation. However, majority of the evidence of spousal concordance of hypertension is from Caucasoid couples from western societies, whereas marriage, partner selection, and post-marital roles of husband and wives are very different in Indian society. Therefore, we aimed to comprehensively examine the phenomenon of spousal concordance of hypertension in Indian couples. METHOD Couples from Longitudinal Ageing Study in India Wave 1 (n = 10,994) and National Family Health Survey Round 5 (n = 52,026) represented 15 years + Indian spouses. Hypertension was defined when systolic and/or diastolic blood pressure was > 139 and > 89 mmHg respectively, and/or if the individual was previously diagnosed or on anti-hypertensive medication. Odds Ratios (OR) estimated the within-couple concordance of hypertension while adjusting for five environmental risk factors of hypertension: individual-level body mass index, education and caste, and household-level wealth and place of residence. RESULT OR marginally attenuated from 1.84 (95% Confidence Interval: 1.77, 1.92) to 1.75 (1.68, 1.83) after adjustment, signifying negligible explanation by environmental risk factors, and plausibility of "novel" risk factors. Concordance continued to weaken with age (OR: 2.25 (2.02, 2.52) in < 30 versus 1.36 (1.20, 1.53) in ≥ 60 years). CONCLUSION Our study underscores two critical knowledge gaps: first, the identity of "novel" risk factors of hypertension and second, the mechanism behind weakening of concordance with age. Future research should explore these novel risk factors rigorously and try to modify them. Also, primary healthcare policy of the country should focus on couples in addition to individuals for hypertension and cardiovascular disease screening and management.
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Affiliation(s)
| | - Shishirendu Ghosal
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Jyoti Ghosal
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India
- KIIT School Public Health, KIIT Deemed to Be University, Bhubaneswar, Odisha, India
| | - Ambarish Dutta
- Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, Odisha, 751013, India.
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Venugopal V, Lennqvist R, Latha PK, Shanmugam R, Krishnamoorthy M, Selvaraj N, Balakrishnan R, Omprashant R, Purty AJ, Bazroy J, Glaser J, Jakobsson K. Occupational Heat Stress and Kidney Health in Salt Pan Workers. Kidney Int Rep 2023; 8:1363-1372. [PMID: 37441492 PMCID: PMC10334398 DOI: 10.1016/j.ekir.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Work in heat affects millions of workers. Although kidney function in agricultural workers is increasingly researched, nonagricultural studies are scarce. In coastal salt pans, the absence of occupational exposures to pesticides and other toxicants allows assessment of heat stress alone. Methods Seven Indian salt pans were surveyed from 2017 to 2020. Job-specific workload was assessed. Heat stress was characterized as exceeding the wet bulb globe temperature (WBGT)-threshold limit value (TLV) for high and moderate workloads. Preshift and postshift heart rates (HRs), tympanic temperatures, and urine specific gravity (USG) were measured for 352 workers, as were sweat rates (SwR), serum creatinine (SCr), serum uric acid, and urine dipstick. Estimated glomerular filtration rate (eGFR; ml/min per 1.73 m2) was computed. Heat-strain symptoms were assessed using questionnaires. Results The mean WBGT was 30.5 ± 1.3 °C (summer) and 27.8 ± 1.9 °C (winter). Water intake during the workday was low, median was one Litre, and most workers (87%) exceeded the TLV for heat stress. Dehydration-related symptoms were frequent in those with high-heat stress, as were cross-shift increases in temperature (≥1°C; 15%), a high USG (≥1.020; 28%), and a high SwR (≥1 l/h; 53%). An eGFR of 60 to 89 ml/min per 1.73 m2 was observed in 41% of all workers examined, and 7% had eGFR below 60 ml/min per 1.73 m2. The odds ratio for eGFR <90 ml/min per 1.73 m2 in workers exceeding the TLV, compared to workers below this limit, adjusted for age and gender was 2.9 (95% CI: 1.3-6.4). Conclusion Workplace interventions to prevent heat stress and dehydration in the salt pans and other at-risk industries are urgently required. The findings strengthen the notion that high-heat stress and limited hydration is a risk factor for kidney dysfunction.
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Affiliation(s)
- Vidhya Venugopal
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Robin Lennqvist
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - PK Latha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Rekha Shanmugam
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Manikandan Krishnamoorthy
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Nandhini Selvaraj
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Rajagurusamy Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - R. Omprashant
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Anil Jacob Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Joy Bazroy
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- La Isla Network, Washington, USA
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Rakesh PS, Renjini BA, Mohandas S, Menon J, Numpelil M, Sreedevi A, Vasudevan B. Hypertension in urban slums of southern India: Burden, awareness, health seeking, control and risk factor profile. Indian Heart J 2023; 75:258-262. [PMID: 37328137 PMCID: PMC10421987 DOI: 10.1016/j.ihj.2023.06.004] [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: 07/20/2022] [Revised: 05/14/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Hypertension is the leading risk factor for global disease burden. Inequalities in health among urban poor and non-poor is a matter of concern. The current study was done to estimate the prevalence of hypertension and to describe the health seeking and risk factor profile of people with hypertension in the urban slums of Kochi, Kerala, India. METHODS Blood pressure of 5980 adults from 20 randomly selected slums were measured by door to door survey by trained nurses as a part of baseline assessment for a cluster randomised controlled trial. RESULTS Prevalence of hypertension was found to be 34.8% (95% CI 33.5-34.9). Among those with hypertension, 66.9% were aware of their hypertensive status, of which 75.8% were initiated on treatment for hypertension. Proportion of hypertensive in the population who had their blood pressure under control was 24.5%. Among hypertensive, 53% were obese, 25.1% had diabetes mellitus, 14% had history of hospitalisation for high blood pressure. Of them, 60.3% had a per capita salt consumption above 8 g/day and 47.5% of them reported sitting for more than 8 h on a usual day. Mean monthly out of pocket expenditure for treatment of hypertension was $9(Median $8, IQR $16). CONCLUSION One in three adults in urban slums of Kochi had hypertension. High rates of obesity, salt intake, physical inactivity prevails among the people with hypertension. Awareness, treatment initiation and control rate of hypertension are lower in urban slums as compared to non-slum urban areas. Slums require additional attention to ensure equitable and universal access to hypertension control.
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Affiliation(s)
- P S Rakesh
- Centre for Public Health, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India; Bernard Lown Scholar, Department of Global Health & Population, Harvard T H Chan School of Public Health, Boston, USA
| | - B A Renjini
- Amrita Urban Health Center; Executive MPH scholar, Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India.
| | - Sreelakshmi Mohandas
- Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India
| | - Jaideep Menon
- Bernard Lown Scholar, Department of Global Health & Population, Harvard T H Chan School of Public Health, Boston, USA; Department of Preventive Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India
| | | | - Aswathy Sreedevi
- Bernard Lown Scholar, Department of Global Health & Population, Harvard T H Chan School of Public Health, Boston, USA; Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India
| | - Beena Vasudevan
- Centre for Public Health, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India
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Anjana RM, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das AK, Joshi S, Bajaj S, Jabbar PK, Das HK, Kumar A, Dhandhania VK, Bhansali A, Rao PV, Desai A, Kalra S, Gupta A, Lakshmy R, Madhu SV, Elangovan N, Chowdhury S, Venkatesan U, Subashini R, Kaur T, Dhaliwal RS, Mohan V. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol 2023; 11:474-489. [PMID: 37301218 DOI: 10.1016/s2213-8587(23)00119-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and inter-regional variations. METHODS The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program-Adult Treatment Panel III guidelines. FINDINGS A total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2-12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9-16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8-37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9-30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7-41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9-84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1. INTERPRETATION The prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India. FUNDING Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations & Diabetes Complications, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Das
- Department of General Medicine & Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Shashank Joshi
- Department of Diabetology & Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | | | | | - Ajay Kumar
- Department of Diabetology, Diabetes Care and Research Centre, Patna, Bihar, India
| | | | - Anil Bhansali
- Department of Endocrinology, Gini Health, Mohali, Punjab, India
| | - Paturi Vishnupriya Rao
- Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ankush Desai
- Department of Endocrinology, Goa Medical College, Bambolim, Goa, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Arvind Gupta
- Department of Diabetology, Jaipur Diabetes Research Centre, Jaipur, Rajasthan, India
| | - Ramakrishnan Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Nirmal Elangovan
- Department of Research Operations & Diabetes Complications, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) & SSKM Hospital, Kolkata, West Bengal, India
| | | | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Non-Communicable Disease Division, Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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Reddy Peddi D, Pallekonda H, Reddy V. Evaluation of the Prevalence and Risk Factors of Drug-Related Problems in Hypertension and Type 2 Diabetes Mellitus Patients at a Tertiary Care Hospital: A Cross-Sectional Study. Cureus 2023; 15:e42775. [PMID: 37663988 PMCID: PMC10469343 DOI: 10.7759/cureus.42775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/05/2023] Open
Abstract
Background Drug-related problems (DRPs) potentially interfere with the desired treatment goals which may lead to increased healthcare costs, morbidity, and mortality. Despite the negative consequences of DRPs, there is a lack of comprehensive research on their prevalence and risk factors, particularly in chronic diseases such as hypertension and type 2 diabetes mellitus (DM). This study aims to evaluate the prevalence and contributing factors of DRPs among hypertension, type 2 DM, and hypertension with type 2 DM in the outpatient general medicine department. Methodology A hospital-based, prospective, observational study was conducted over three months. DRPs were classified using the Helper-Strand classification. The potential risk factors contributing to DRPs were assessed using binary and multinomial logistic regression methods. A p-value <0.05 was considered statistically significant. Results Among the 236 study participants, DRPs were more prevalent in males, and the mean age of the participants was 51.73 ± 9.47 years. DRPs were found in 76% of the study participants, and the mean number of DRPs per patient was 1.16 ± 0.45. Among the identified DRPs, suboptimal therapeutic goals (33%) were the most frequently observed, followed by ineffective drugs (32%), medication non-adherence (23%), and drug-drug interaction (5%). Therapeutic duplication and overdose were less commonly encountered as DRPs. The presence of comorbidity (adjusted odds ratio (AOR) = 5.77), and smoking (AOR = 21.07) were found to be significant risk factors (p < 0.05) contributing to DRPs. Conclusions DRPs are more prevalent in hypertension, type 2 DM, and hypertension with type 2 DM. Age range (40-60 years), comorbidity, and smoking were found to be associated with a higher incidence of DRPs. The implementation of a multidisciplinary team approach involving clinical pharmacists and physicians can effectively identify the prevalence and determine the associated risk factors of DRPs and subsequently may help employ targeted interventions to mitigate the development of DRPs.
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Affiliation(s)
- Divya Reddy Peddi
- Department of Pharmacy Practice, Arya College of Pharmacy, Osmania University, Sangareddy, IND
| | - Hephzibha Pallekonda
- Department of Pharmacy Practice, Arya College of Pharmacy, Osmania University, Sangareddy, IND
| | - Vikas Reddy
- Department of General Medicine, Government District Hospital, Sangareddy, IND
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Shanmugapriya S, Thangavelu S, Shukkoor AA, Janani P, Monisha R, Scaria VE. Prescribing patterns and pharmacoeconomic analysis of antihypertensive drugs in South Indian population: A cross-sectional study. Perspect Clin Res 2023; 14:114-122. [PMID: 37554244 PMCID: PMC10405530 DOI: 10.4103/picr.picr_122_22] [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: 06/03/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Global evidence-based recommendations for hypertension management are periodically updated, and ensuring adherence to the guidelines is imperative. Furthermore, the current high prevalence of hypertension effectuates a high health-care cost. Purpose To evaluate the prescribing patterns of antihypertensive drugs and other factors affecting blood pressure (BP) with the objective of assessing the proportion of patients achieving the target BP and to perform a pharmacoeconomic analysis in a South Indian population. Materials and Methods In a cross-sectional study, 650 patients previously diagnosed with hypertension and already on treatment with one or more drugs were included. A prospective interview of patients was done using a prevalidated questionnaire on various factors in BP control. Prescribing patterns and pharmacoeconomic analyses, namely, cost acquisition, cost of illness, and cost-effectiveness analyses were carried out. Results Of 650 subjects, 257 (39.54%) achieved the target BP, while 393 (60.46%) did not. A significant association of age, occupational status, monthly family income, and area of residence in addition to physical activity and diet scores, with achieving target BP was noted. A significantly higher cost of anti-hypertensive drug treatment in achieving target BP (P = 0.02) was observed. Among patients who achieved target BP, 37.35% were on monotherapy and 48.25% on multiple drug therapy compared to 46.31% and 35.62%, respectively, in patients who did not. Average cost-effectiveness ratio were found to be Rs. 20.45 and Rs. 57.27, respectively, for single and multiple drug therapies, with incremental cost-effectiveness of Rs. 194.14 per additional patient treated with multiple free drug combinations. Conclusion This study identified the anti-hypertensive prescribing pattern and provided insight into the various pharmacoeconomic factors that play a significant role in attaining target BP in the treated population.
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Affiliation(s)
- S Shanmugapriya
- Department of Pharmacology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Saravanan Thangavelu
- Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Aashiq Ahamed Shukkoor
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - P Janani
- Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India
| | - R Monisha
- Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India
| | - Varsha Elsa Scaria
- Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India
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Radithia D, Subarnbhesaj A, Ayuningtyas NF, Bakti RK, Mahdani FY, Pratiwi AS, Ayunnisa N, Putri SF, Pramitha SR. Oral hyperpigmentation as an adverse effect of highly active antiretroviral therapy in HIV patients: A systematic review and pooled prevalence. J Clin Exp Dent 2023; 15:e561-e570. [PMID: 37519321 PMCID: PMC10382165 DOI: 10.4317/jced.60195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/22/2023] [Indexed: 08/01/2023] Open
Abstract
Background Human Immunodeficiency Virus (HIV) infects patients via CD4+ cells which are later be destroyed subsequently causing the deteriotation of immune system. HIV generally manifests in the oral cavity as the first indicating sign and a marker of disease progression. HAART medications are used to reduce the incidence of oral manifestations, however it can also generate adverse effects in the oral cavity including oral hyperpigmentation. This review aimed to estimate the prevalence of oral hyperpigmentation which affect individual quality of life as a side effect of HAART. Material and Methods This systematic review applied Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020. Literature search was performed in ScienceDirect, PubMed, and Scopus by combining terms such as highly active antiretroviral therapy, oral manifestation, epidemiology or prevalence published between January 1998 to March 2022. Results Of 108 articles, eleven articles were included for systematic review and meta-analysis. The pooled prevalence of oral hyperpigmentation in HAART patients was 25% (95% CI: 11%, 38%; I2: 99%). Subgroup analysis based on geographical location showed varied result may be due to the type and duration of HAART used in study population. The most widely used type of ARV was from the NRTI group (n=7) and the study with the shortest duration showed the lowest oral hyperpigmentation prevalence (n=7). Conclusions There is an increased prevalence of oral hyperpigmentation by the use of HAART. Future study should investigate the correlation between HAART duration and the degree of oral hyperpigmentation. Key words:HAART, oral hyperpigmentation; pooled prevalence.
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Affiliation(s)
- Desiana Radithia
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Ajiravudh Subarnbhesaj
- Department of Oral Biomedical Science, Division of Oral Diagnosis, Faculty of Dentistry, Khon Kaen University, 40002, Thailand
| | | | - Reiska-Kumala Bakti
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Fatma-Yasmin Mahdani
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Aulya-Setyo Pratiwi
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Naqiya Ayunnisa
- Bachelor Dental Science Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Salsabila-Fitriana Putri
- Bachelor Dental Science Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Selviana-Rizky Pramitha
- Oral Medicine Specialist Study Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
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Upadhyay J, S NN, Shetty S, Saoji AA, Yadav SS. Effects of Nadishodhana and Bhramari Pranayama on heart rate variability, auditory reaction time, and blood pressure: A randomized clinical trial in hypertensive patients. J Ayurveda Integr Med 2023; 14:100774. [PMID: 37499590 PMCID: PMC10388195 DOI: 10.1016/j.jaim.2023.100774] [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: 02/27/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is a chronic elevation of arterial blood pressure (BP) due to environmental and lifestyle factors. The lifelong treatment protocol causes poor adherence to anti-hypertensive drugs. Nadi Shodhana and Bhramari pranayama are the most effective yogic treatment for the management of HTN. OBJECTIVES This study was done to assess and compare the immediate effect of Nadi Shodhana and Bhramari Pranayama on HRV and ART in hypertensive individuals. Thus, to understand the effectiveness of specific pranayama on hypertension. METHODOLOGY This study is a randomized, comparative study design. The hundred participants were recruited into two groups 1 (n = 50) and 2 (n = 50). The study was conducted on pre-diagnosed patients with HTN, from the inpatient department of SDM Nature Cure Hospital, Shanthivana. Group 1 was asked to practice Nadi Shodhana Pranayama and Group-2 was asked to practice Bhramari Pranayama for 20 min. The patients were assessed for Heart Rate Variability & Auditory Reaction Time before and immediately after the intervention. RESULTS Nadi Shodhana Pranayama showed a significant decrease in ART (p = 0.01) and Bhramari Pranayama showed a highly significant decrease in ART (p < 0.00001). Whereas there was no statistically significant difference in both the groups in HRV parameters. CONCLUSION The study showed that both Nadi Shodhana and Bhramari Pranayama can be effective in balancing the sympathovagal tone. Thus, Nadi Shodhana and Bhramari Pranayama can be practised for the management of essential hypertension.
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Affiliation(s)
- Junu Upadhyay
- Sri Dharmasthala Manjunatheshwara College of Naturopathy and Yogic Sciences, Ujire, DK, India.
| | - Nandish N S
- Sri Dharmasthala Manjunatheshwara College of Naturopathy and Yogic Sciences, Ujire, DK, India
| | - Shivaprasad Shetty
- Sri Dharmasthala Manjunatheshwara College of Naturopathy and Yogic Sciences, Ujire, DK, India
| | | | - Sunil Singh Yadav
- Maharishi Aurobindo Subharti College and Hospital of Naturopathy and Yogic Sciences, Swami Vivekanand Subharti University, Meerut, India
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Vasanthakumari P, Kumarakuru K, Yousuff N. The Efficacy of Virtual-based Nutritional Interventions on Knowledge, Attitude, and Practices of Individuals with Hypertension: A Comparative Study Analysis. J Midlife Health 2023; 14:184-190. [PMID: 38312759 PMCID: PMC10836442 DOI: 10.4103/jmh.jmh_53_23] [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: 03/28/2023] [Revised: 06/27/2023] [Accepted: 07/22/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Hypertension (HTN) is multifactorial, complex disorder predictable to affect all genders and foremost preventable risk factor for blood pressure and cardiovascular diseases. Objectives The present study was assessing the knowledge, attitude, and practices (KAPs) regarding HTN and creating the awareness of its better management among the hypertensive population through nutrition education intervention. Methodology A total of 82 participants were selected and questionnaire was used to elicit sociodemographic profile and KAP regarding HTN and its management. Nutrition education intervention was carried out through the online mode. Results and Discussion Results observed in preintervention between knowledge with attitude in experimental group and control group (r =+0.273 and r =+0.271), practice (r =+0.275 and r =+0.263), and attitude with practice (r =+0.521 and r =+0.186) were positive correlation similarly postintervention of both group obtained significant positive correlation. The statistical analysis of various sociodemographic factors of pre and postintervention in the experimental group and control group revealed a significant improvement in the mean posttest scores of KAP. Meanwhile, various sociodemographic factors obtained had nonsignificant (P > 0.005) in experimental group; a control group of pretest and posttest reported significant differences (P < 0.05). The posttest total mean score on nutritional knowledge and practice in the experimental group also showed a large significant (P < 0.05) increase when compared to the pretest mean score. There was no significant improvement in the total mean scores in any dimensions of the control group. Conclusion The study therefore helped the experimental group subjects in improving their overall knowledge about the importance of nutrition in HTN and also instilled positive attitude and practices toward the management of HTN through lifestyle modifications.
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Affiliation(s)
- P Vasanthakumari
- Department of Nutrition and Dietetics, Food Science and Nutrition, Mount Carmel College, Autonomous, Bengaluru, Karnataka, India
| | - K Kumarakuru
- Department of Food Science and Nutrition, School of Life Sciences, Nehru Arts and Science College, Coimbatore, Tamil Nadu, India
| | - Noorain Yousuff
- Department of Nutrition and Dietetics, Food Science and Nutrition, Mount Carmel College, Autonomous, Bengaluru, Karnataka, India
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