1
|
Gauthier V, Cottel D, Amouyel P, Dallongeville J, Meirhaeghe A. Large disparities in 28-day case fatality by stroke subtype: data from a French stroke registry between 2008 and 2017. Eur J Neurol 2021; 28:2208-2217. [PMID: 33942445 PMCID: PMC8252764 DOI: 10.1111/ene.14876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The objectives of the present analysis were to assess 28-day stroke case fatality according to the stroke aetiology and to identify associated factors. METHODS All stroke events in adults aged ≥35 years between 2008 and 2017 were collected in a population-based stroke registry in northern France. RESULTS Out of a total of 2933 strokes, there were 479 (16%) haemorrhagic strokes and 2454 (84%) ischaemic strokes; the 28-day case fatality rates were 48% and 15%, respectively. Three-quarters of the 28-day case fatalities occurred within 6 days of the event for haemorrhagic strokes and within 16.5 days for ischaemic strokes. After an ischaemic stroke, the case fatality rate was higher for women (18%) than for men (12%, p < 0.0001); however, this difference disappeared after adjustment for age. Cardioembolic strokes (34%) and strokes of undetermined cause (33%) were the most common ischaemic subtypes, with case fatality rates of 16% and 18%, respectively. Large artery atherosclerosis (11%) and lacunar strokes (10%) were less common, and both types had a case fatality rate of 3%. Age at the time of the event and stroke severity were both significantly associated with case fatality. For some types of stroke, a history of cardiovascular events and residence in a nursing home were associated with a poor prognosis. Medical care in a neurology ward was inversely associated with case fatality, for all stroke subtypes. CONCLUSIONS In northern France, post-stroke case fatality remains high, especially for haemorrhagic stroke. Being treated in a neurology ward improved survival by around 80%.
Collapse
Affiliation(s)
- Victoria Gauthier
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Dominique Cottel
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Philippe Amouyel
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Jean Dallongeville
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Aline Meirhaeghe
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| |
Collapse
|
2
|
Fenech G, Vallée A, Cherfan M, Kab S, Goldberg M, Zins M, Blacher J. Poor Awareness of Hypertension in France: The CONSTANCES Population-Based Study. Am J Hypertens 2020; 33:543-551. [PMID: 32202627 DOI: 10.1093/ajh/hpaa018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/07/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We aimed to assess the hypertension (HTN) awareness and associated factors in France. METHODS We conducted a cross-sectional analysis using data from the CONSTANCES population-based cohort involving 87,808 volunteer participants included between 2012 and 2018. HTN was defined as average blood pressure (BP) over 140/90 or use of BP medication, awareness as self-reported HTN. Multivariable logistic regression models were used to identify the associated factors. RESULTS Overall, 27,160 hypertensive participants (men = 16,569) above 18 years old were analyzed. Hypertension awareness rate was 37.5%. In the multivariable regression model, awareness was predicted by female gender, age, prior cardiovascular disease (CVD), presence of diabetes mellitus (DM), presence of chronic kidney disease (CKD), level of education, and obesity or overweight. Older participants (P < 0.001), females (P < 0.001), participants with comorbidities (P < 0.001), were more likely to be aware when compared with younger participants, males and participants without comorbidities, respectively. The unawareness among participants without cardiometabolic factors (CMF, i.e., CVD, DM, CKD) was higher than participants with CMF (67% vs. 41%, respectively, P < 0.001). Moreover, some differences appeared in both genders in the association between awareness of HTN and health and lifestyle factors. CONCLUSION Our findings show that HTN awareness is low. Particular attention should be given to young men without comorbidities as these characteristics were predictors of poor awareness. Immediate action is required to improve HTN awareness in France.
Collapse
Affiliation(s)
- Goël Fenech
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, Paris, France
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Alexandre Vallée
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, Paris, France
| | - Michelle Cherfan
- Nutritional Epidemiology Research Unit (EREN), Inserm U1153, Inra U1125, Cnam, Crnh, Paris 13 University Sorbonne Paris Cite, Bobigny, France
- Faculty of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Sofiane Kab
- Population-Based Epidemiological Cohorts Unit, Inserm, UMS011, Villejuif, France
| | - Marcel Goldberg
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Population-Based Epidemiological Cohorts Unit, Inserm, UMS011, Villejuif, France
| | - Marie Zins
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Population-Based Epidemiological Cohorts Unit, Inserm, UMS011, Villejuif, France
| | - Jacques Blacher
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, Paris, France
- Nutritional Epidemiology Research Unit (EREN), Inserm U1153, Inra U1125, Cnam, Crnh, Paris 13 University Sorbonne Paris Cite, Bobigny, France
| |
Collapse
|
3
|
Gender differences in the association between socioeconomic status and hypertension in France: A cross-sectional analysis of the CONSTANCES cohort. PLoS One 2020; 15:e0231878. [PMID: 32311000 PMCID: PMC7170232 DOI: 10.1371/journal.pone.0231878] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background Hypertension prevalence increases when socioeconomic status decreases but gender differences in the relationship between socioeconomic status and hypertension have been less studied. This work aimed to explore the pattern of associations between three indicators of socioeconomic status at individual, household, and municipal levels with hypertension across genders in a large sample of French adults from the CONSTANCES cohort. Methods Using data at inclusion from 59 805 participants (52% women) aged 25–69 years and recruited between 2012 and 2015, multilevel log-Poisson regressions with robust variance estimates were used to assess the associations of Relative Index of Inequality in education, monthly income per consumption unit and residential deprivation with hypertension. Modifying effects of gender and age in those associations were tested. Results Hypertension prevalence was higher in men than in women. Steep socioeconomic gradients of hypertension were observed for the three socioeconomic indicators in both genders and from the youngest to the oldest age class. Socioeconomic inequalities, especially educational inequalities, were larger among women than men: Relative Index of Inequality for highest versus lowest education among the 25–34 years were 0.43 [95%-confidence interval = 0.28–0.67] in women and 0.70 [95%-confidence interval = 0.53–0.92] in men. With increasing age, socioeconomic gradients of hypertension eased in men and even more in women so that gender differences decreased. Conclusions In this cross-sectional analysis of a large sample of adults, prevalence of hypertension was higher in men than in women. Moreover, socioeconomic status and especially education displayed a stronger association with hypertension prevalence in women compared to men. Reducing inequalities in hypertension may require gender-specific approaches.
Collapse
|
4
|
Manios Y, Mavrogianni C, Lambrinou CP, Cardon G, Lindström J, Iotova V, Tankova T, Civeira F, Kivelä J, Jancsó Z, Shadid S, Tsochev K, Mateo-Gallego R, Radó S, Dafoulas G, Makrilakis K, Androutsos O. Two-stage, school and community-based population screening successfully identifies individuals and families at high-risk for type 2 diabetes: the Feel4Diabetes-study. BMC Endocr Disord 2020; 20:12. [PMID: 32164646 PMCID: PMC7066727 DOI: 10.1186/s12902-019-0478-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/19/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The implementation of population screening and early prevention strategies targeting individuals at high-risk for type 2 diabetes (T2D) seems to be a public health priority. The current work aimed to describe the screening procedure applied in the Feel4Diabetes-study and examine its effectiveness in identifying individuals and families at high risk, primarily for T2D and secondarily for hypertension, among vulnerable populations in low to middle-income countries (LMICs) and high-income countries (HICs) across Europe. METHODS A two-stage screening procedure, using primary schools as the entry-point to the community, was applied in low socioeconomic status (SES) regions in LMICs (Bulgaria-Hungary), HICs (Belgium-Finland) and HICs under austerity measures (Greece-Spain). During the first-stage screening via the school-setting, a total of 20,501 parents (mothers and/or fathers) of schoolchildren from 11,396 families completed the Finnish Diabetes Risk Score (FINDRISC) questionnaire, while their children underwent anthropometric measurements in the school setting. Parents from the identified "high-risk families" (n = 4484) were invited to participate in the second-stage screening, including the measurement of fasting plasma glucose (FPG) and blood pressure (BP). In total, 3153 parents participated in the second-stage screening (mean age 41.1 ± 5.6 years, 65.8% females). RESULTS Among parents who attended the second-stage screening, the prevalence of prediabetes (as defined by impaired fasting glucose; FPG 100-125 mg/dl) and T2D (FPG > 126 mg/dl) was 23.2 and 3.0% respectively, and it was found to be higher in the higher FINDRISC categories. The percentage of undiagnosed T2D among the participants identified with T2D was 53.5%. The prevalence of high normal BP (systolic BP 130-139 mmHg and/ or diastolic BP 85-89 mmHg) and hypertension (systolic BP ≥ 140 mmHg and/ or diastolic BP ≥ 90 mmHg) was 14 and 18.6% respectively, which was also higher in the higher FINDRISC categories. The percentage of cases not receiving antihypertensive treatment among the participants identified with hypertension was 80.3%. CONCLUSION The findings of the current study indicate that the two-stage school and community-based screening procedure followed, effectively identified high-risk individuals and families in vulnerable populations across Europe. This approach could be potentially scalable and sustainable and support initiatives for the early prevention of T2D and hypertension. TRIAL REGISTRATION The Feel4Diabetes-intervention is registered at https://clinicaltrials.gov/ (NCT02393872; date of trial registration: March 20, 2015).
Collapse
Affiliation(s)
- Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Christina-Paulina Lambrinou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jaana Lindström
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - Fernando Civeira
- Growth, Exercise, Nutrition and Development Research Group, School of Health Science, University of Zaragoza, Zaragoza, Spain
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Zoltán Jancsó
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Samyah Shadid
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | - Rocío Mateo-Gallego
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), CIBERCV, Zaragoza, Spain
| | - Sándorné Radó
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - George Dafoulas
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | | |
Collapse
|
5
|
Meirhaeghe A, Montaye M, Biasch K, Huo Yung Kai S, Moitry M, Amouyel P, Ferrières J, Dallongeville J. Coronary heart disease incidence still decreased between 2006 and 2014 in France, except in young age groups: Results from the French MONICA registries. Eur J Prev Cardiol 2020; 27:1178-1186. [DOI: 10.1177/2047487319899193] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Over the past few decades decreases in coronary heart disease morbidity and mortality rates have been observed throughout the western world. We sought to determine whether the acute coronary event rates had decreased between 2006 and 2014 among French adults, and whether there were sex and age-specific differences. Methods We examined the French MONICA population-based registries monitoring the Lille urban area in northern France, the Bas-Rhin county in north-eastern France and the Haute Garonne county in south-western France. All acute coronary events among men and women aged 35–74 were collected. Results Over the study period, the age-standardised attack rates decreased in both men (annual percentage change −1.5%, P = 0.0006) and women (annual percentage change −2.1%, P = 0.002). Also, the age-standardised incidence rates decreased in both men (annual percentage change −0.9%, P = 0.03) and women (annual percentage change −1.8%, P = 0.002) due to decreases in the 65–74 year age group. In men, age-standardised mortality rates decreased by 3.5% per year ( P = 0.0004), especially in the 55–64 and 65–74 year age groups. In women, these rates decreased by 4.3% per year ( P = 0.0009), particularly in the 35–44 and 65–74 year age groups. We also observed significant decreases in case fatality among both men (annual percentage change −1.7%, P < 0.0001) and women (annual percentage change −1.9%, P = 0.009). Conclusions Downward trends in acute coronary event attack, incidence and mortality rates were observed between 2006 and 2014 in men and women. This effect was age dependent and was primarily due to decreases in the 65–74 year age group. There were no substantial declines in the younger age groups except for mortality in young women. Prevention measures still need to be strengthened, particularly in young adults.
Collapse
Affiliation(s)
- Aline Meirhaeghe
- INSERM, UMR1167, RID-AGE, Risk Factors and Molecular Determinants of Aging-Related Diseases, Université de Lille, Centre Hosp. Univ Lille, Institut Pasteur de Lille, France
| | - Michèle Montaye
- INSERM, UMR1167, RID-AGE, Risk Factors and Molecular Determinants of Aging-Related Diseases, Université de Lille, Centre Hosp. Univ Lille, Institut Pasteur de Lille, France
| | - Katia Biasch
- Faculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, France
| | - Samantha Huo Yung Kai
- INSERM, UMR1027, Paul Sabatier University Toulouse III, France
- Department of Public Health, Toulouse University Hospital, France
| | - Marie Moitry
- Faculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, France
- Department of Public Health, Strasbourg University Hospital, France
| | - Philippe Amouyel
- INSERM, UMR1167, RID-AGE, Risk Factors and Molecular Determinants of Aging-Related Diseases, Université de Lille, Centre Hosp. Univ Lille, Institut Pasteur de Lille, France
| | - Jean Ferrières
- INSERM, UMR1027, Paul Sabatier University Toulouse III, France
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, France
| | - Jean Dallongeville
- INSERM, UMR1167, RID-AGE, Risk Factors and Molecular Determinants of Aging-Related Diseases, Université de Lille, Centre Hosp. Univ Lille, Institut Pasteur de Lille, France
| |
Collapse
|
6
|
Mounier-Vehier C, Madika AL. [Post-menopausal hypertension: Detecting, treating, accompany, prevent]. Presse Med 2019; 48:1288-1294. [PMID: 31727484 DOI: 10.1016/j.lpm.2019.09.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/14/2019] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Abstract
Menopause is associated with a significant increase in arterial and metabolic risk. Systolic hypertension is common in post-menopausal women. Measurement of blood pressure should be repeated systematically at each visit. Ambulatory blood pressure measurements should be encouraged, especially to detect nocturnal hypertension and to prevent more efficiently women at risk. Self-testing of hypertension by home blood pressure should be encouraged at menopause. Antihypertensive treatment should be initiated after ambulatory blood pressure monitoring in association with reinforced lifestyle. Furthermore, global level of cardiovascular risk should take into account before starting antihypertensive treatment. There are no women specificities in the choice of the initial treatment except thiazide diuretics which should be preferred in osteoporotic women. In hypertensive women and with disabling climacteric symptoms under 60 and within 10 years after the onset of menopause, post-menopausal hormone therapy can be offered in absence of arterial or venous contraindications. A preliminary discussion between gynecologist, cardiologist and general practionner is necessary before deciding to treat a post-menopausal women for her climacteric symptoms. A clear information on the benefit-risk balance of post-menopausal hormone therapy should be given to the women. The information should be recorded in the medical file. Cooperation between cardiologists, gynecologists and general practionners should be promoted in France, to optimize the care pathways in these women at risk and to improve medical practices.
Collapse
Affiliation(s)
- Claire Mounier-Vehier
- CHU Lille, institut cœur poumon, médecine vasculaire et HTA, 59000 Lille, France; Université Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France.
| | - Anne-Laure Madika
- CHU Lille, institut cœur poumon, médecine vasculaire et HTA, 59000 Lille, France; Université Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France
| |
Collapse
|
7
|
Liu J, Lu X, Chen L, Huo Y. Expert consensus on the management of hypertension in the young and middle-aged Chinese population. Int J Clin Pract 2019; 73:e13426. [PMID: 31573725 DOI: 10.1111/ijcp.13426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/21/2019] [Indexed: 11/30/2022] Open
Abstract
Hypertension, defined as blood pressure (BP) ≥140/90 mmHg, is one of the most common, yet reversible, risk factors for cardiovascular disease (CVD). Globally, 9.40 million people died from hypertension in 2010, accounting for 17.8% of total deaths; disability-adjusted life years (DALYs) caused by hypertension were 170 million person-years, or 7.0% of the total global DALYs.1 Data from China showed that hypertension accounted for 24.6% of all deaths, and 12.0% of total DALYs,2 and the direct medical cost of hypertension in China has reached 36.6 billion yuan per year.3.
Collapse
Affiliation(s)
- Jing Liu
- Peking University People's Hospital Ringgold standard institution, Department of Cardiology, Beijing, China
| | - Xinzheng Lu
- The First Affiliated Hospital of Nanjing Medical University, Department of Cardiology, Nanjing, China
| | - Luyuan Chen
- Guangdong General Hospital Ringgold standard institution, Deparment of Cardiology, Guangzhou, China
| | - Yong Huo
- Peking University People's Hospital Ringgold standard institution, Department of Cardiology, Beijing, China
| |
Collapse
|
8
|
|
9
|
Neufcourt L, Deguen S, Bayat S, Paillard F, Zins M, Grimaud O. Geographical variations in the prevalence of hypertension in France: Cross-sectional analysis of the CONSTANCES cohort. Eur J Prev Cardiol 2019; 26:1242-1251. [PMID: 30971123 DOI: 10.1177/2047487319842229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS While international variations in the prevalence of hypertension are well described, less is known about intra-national disparities and their determinants. We wanted to describe the variations in hypertension prevalence within France and to determine how much lifestyle and socioeconomic factors contributed to explain these regional variations. METHODS Participants (62,247 French adults aged 18 to 69 years) were recruited in the 16 centres of the CONSTANCES study between 2012 and 2015. Hypertension was defined as blood pressure higher than 140/90 mmHg and/or taking antihypertensive medications. The contribution of lifestyle and socioeconomic factors to hypertension prevalence variations among centres was examined using sequential hierarchical logistic models. RESULTS Hypertension prevalence was 37.3% (95% confidence interval (CI) = 36.6-38.0) in men and 23.2% (95% CI = 22.7-23.8) in women. Hypertension prevalence rates varied by almost two-fold among centres (1.9 in men, 1.6 in women) with the highest prevalence in the north and the east of France. Body mass index was strongly associated with hypertension in women (odds ratio (OR)1-unit increase = 1.11 (95% CI = 1.11-1.12)) and was the highest contributor to between-centre variations (27% in women), followed by socioeconomic characteristics (e.g. ORhigh versus low education = 0.85 (95% CI = 0.83-0.87), contributing to 14% of variations in women). Together, family history of hypertension, body mass index, education, occupation and residential area socioeconomic level explained about 30% and 40% of between-centre variations in men and women, respectively. CONCLUSION Hypertension prevalence greatly varies among French regions and this is partly explained by known lifestyle and socioeconomic factors. Nevertheless, these variations and all the hypertension determinants have not been fully deciphered yet.
Collapse
Affiliation(s)
- Lola Neufcourt
- 1 University Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, Rennes, France
| | - Séverine Deguen
- 2 EHESP, IPLESP (Institut Pierre-Louis d'Epidémiologie et de Santé Publique) UMR S 1136, Rennes, France
| | - Sahar Bayat
- 1 University Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, Rennes, France
| | - François Paillard
- 3 CHU Pontchaillou - Centre de Prévention Cardio-vasculaire, Pôle CPV, Rennes, France
| | - Marie Zins
- 4 Paris Descartes University, Paris, France.,5 Population-Based Epidemiological Cohorts Unit, UMS 011, INSERM-UVSQ, Paris, France
| | - Olivier Grimaud
- 1 University Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, Rennes, France
| |
Collapse
|
10
|
Perindopril 3.5 mg/amlodipine 2.5 mg versus renin–angiotensin system inhibitor monotherapy as first-line treatment in hypertension. J Hypertens 2018; 36:1915-1920. [DOI: 10.1097/hjh.0000000000001766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
11
|
Chen Y, Sillaire AR, Dallongeville J, Skrobala E, Wallon D, Dubois B, Hannequin D, Pasquier F. Low Prevalence and Clinical Effect of Vascular Risk Factors in Early-Onset Alzheimer's Disease. J Alzheimers Dis 2018; 60:1045-1054. [PMID: 28984595 PMCID: PMC5676853 DOI: 10.3233/jad-170367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Determinants of early-onset Alzheimer’s disease (EOAD) are not well known. In late-onset AD, vascular risk factors (VRFs) are associated with earlier clinical manifestation. Objective: The objective of this study was to assess the putative association between VRFs and EOAD. Methods: We studied participants with dementia meeting criteria for EOAD (recruited into the French CoMAJ prospective cohort study from 1 June 2009 to 28 February 2014) and age-, gender-matched controls (ratio 1:3, drawn randomly from the French MONA-LISA population-based survey between 2005 and 2007). Demographic data, VRFs, comorbidities, treatments, and APOE genotypes were compared in multivariable logistic regression analyses. Results: We studied 102 participants with dementia (mean±standard deviation age: 59.5±3.8; women: 59.8%) and 306 controls. Compared with controls, EOAD participants had spent less time in formal education (9.9±2.9 versus 11.7±3.8 y; p < 0.0001), were less likely to be regular alcohol consumers (p < 0.0001), had a lower body mass index (–2 kg/m2; p < 0.0004), and a lower mean systolic blood pressure (–6.2 mmHg; p = 0.0036). The prevalence of APOE ɛ4 allele was higher in participants with dementia than in controls (50% versus 29.4%; p = 0.0002), as was the prevalence of depression (48% versus 32%; p < 0.001). Similar results were observed in multivariable analysis. Compared with EOAD participants lacking VRFs, EOAD participants with at least one VRF had a higher prevalence of depression (29.6% versus 53.3%, respectively; p = 0.03). Conclusion: The prevalence of VRFs is not elevated in EOAD patients (in contrast to older AD patients). Extensive genetic testing should be considered more frequently in the context of EOAD.
Collapse
Affiliation(s)
- Yaohua Chen
- University Lille, INSERM U1171 (Degenerative and Vascular Cognitive Disorders), Lille, France.,CHU Lille, Memory Clinic, Lille University Medical Center, Lille, France.,CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France
| | - Adeline Rollin Sillaire
- University Lille, INSERM U1171 (Degenerative and Vascular Cognitive Disorders), Lille, France.,CHU Lille, Memory Clinic, Lille University Medical Center, Lille, France.,CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France
| | | | - Emilie Skrobala
- University Lille, INSERM U1171 (Degenerative and Vascular Cognitive Disorders), Lille, France.,CHU Lille, Memory Clinic, Lille University Medical Center, Lille, France
| | - David Wallon
- CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France.,University Rouen, INSERM U1079 (IRIB), Rouen, France
| | - Bruno Dubois
- CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France.,Institute of Memory and Alzheimer's Disease (IM2A), UMR S1127, AP-HP, Pitié-Salpêtrière University Hospital, Pierre et Marie Curie University, Paris, France
| | - Didier Hannequin
- CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France.,University Rouen, INSERM U1079 (IRIB), Rouen, France
| | - Florence Pasquier
- University Lille, INSERM U1171 (Degenerative and Vascular Cognitive Disorders), Lille, France.,CHU Lille, Memory Clinic, Lille University Medical Center, Lille, France.,CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France
| | | |
Collapse
|
12
|
Systemic blood pressure at exercise in hypoxia in hypertensive and normotensive patients. J Hypertens 2018; 35:2402-2410. [PMID: 28704259 DOI: 10.1097/hjh.0000000000001479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The current study aimed to determine whether acute hypoxia exposure in laboratory conditions associated with exercise induces an increase in systemic blood pressure (BP) in normotensive and hypertensive patients, and whether hypertensive patients are more prone to develop severe acute mountain sickness (sAMS). Finally, to determine if BP changes at exercise in acute hypoxia in hypertensive patients are predictive factors for sAMS. METHODS From 2012 to 2015, 852 normotensive and 106 hypertensive patients went through an acute hypoxia exercise test before a sojourn at high altitude. A subgroup of 228 normotensive was selected to match age, sex ratio, body weight and BMI and compared with the hypertensive group. RESULTS In normotensive and hypertensive patients, for a given workload, BP was higher in hypoxia than in normoxia, whereas, for a given heart rate, it was lower in hypoxia than in normoxia. Hypertensive patients treated by beta-blockers showed lower arterial oxygen saturation (vs. other treatments) and blunted cardiac and ventilatory responses to hypoxia at exercise. Based on questionnaires filled out at high altitude, hypertensive patients were not more prone than normotensive patients to develop sAMS. During the laboratory acute hypoxic exercise test, hypertensive patients suffering from sAMS, although taking acetazolamide showed similar BP than hypertensive patients without sAMS and without acetazolamide. DISCUSSION AND CONCLUSION We hypothesize that acute hypoxia with exercise in laboratory conditions induces a peripheral vasodilation that balances vasoconstriction and tachycardia centrally induced through the adrenergic system. Hypertensive and normotensive patients behave similarly during exercise in acute hypoxia. Acute hypoxia does not exacerbate the exercise-induced increase in BP. BP variation, during the acute hypoxia exercise test, is not a useful predictor of intolerance to high altitude. Based on laboratory tests in acute hypoxia, hypertensive patients may not be at higher risk to develop sAMS at high altitude.
Collapse
|
13
|
Rochette C, Graillon T, Albarel F, Morange I, Dufour H, Brue T, Castinetti F. Increased Risk of Persistent Glucose Disorders After Control of Acromegaly. J Endocr Soc 2017; 1:1531-1539. [PMID: 29308447 PMCID: PMC5740518 DOI: 10.1210/js.2017-00334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/20/2017] [Indexed: 01/19/2023] Open
Abstract
Purpose: Combining surgery and medical treatments allows the control of growth hormone hypersecretion in 80% of cases. Our objective was to determine the rate of acromegaly comorbidities once hypersecretion of growth hormone is controlled. Methods: Our retrospective monocentric study was based on 130 patients followed on a regular basis, with acromegaly controlled by medical treatments or cured by surgery or radiation technique. Our main outcome measures were the prevalence of major metabolic complications of acromegaly (diabetes, hypertension, low-density lipoprotein cholesterol, triglycerides) at diagnosis and last follow-up in comparison with French epidemiological data. Results: As expected, controlling hypersecretion significantly improved the metabolic complications of acromegaly. However, the proportion of patients having at least one metabolic complication of acromegaly at last follow-up (mean, 72 months after remission) was 27% for altered glucose tolerance or diabetes, 39% for hypertension, 34.3% for hypercholesterolemia, and 13.3% for hypertriglyceridemia. Interestingly, our data showed that diabetes was the only comorbidity different with a higher prevalence in patients in remission versus a general population of a similar median age (21.6% vs 6.9%, respectively). Conclusions: The follow-up of glucose disorders needs to be maintained on a long-term basis in patients controlled for acromegaly.
Collapse
Affiliation(s)
- Claire Rochette
- Aix-Marseille Université, Centre National de la Recherche Scientifique, CRN2M Unité Mixte de Recherche 7286 and Assistance Publique-Hopitaux de Marseille, Department of Endocrinology, La Conception Hospital, National Reference Center for Rare Pituitary Diseases, 13005 Marseille, France
| | - Thomas Graillon
- Aix-Marseille Université, and Assistance Publique-Hopitaux de Marseille, Department of Neurosurgery, La Timone Hospital, 13005 Marseille, France
| | - Frederique Albarel
- Aix-Marseille Université, Centre National de la Recherche Scientifique, CRN2M Unité Mixte de Recherche 7286 and Assistance Publique-Hopitaux de Marseille, Department of Endocrinology, La Conception Hospital, National Reference Center for Rare Pituitary Diseases, 13005 Marseille, France
| | - Isabelle Morange
- Aix-Marseille Université, Centre National de la Recherche Scientifique, CRN2M Unité Mixte de Recherche 7286 and Assistance Publique-Hopitaux de Marseille, Department of Endocrinology, La Conception Hospital, National Reference Center for Rare Pituitary Diseases, 13005 Marseille, France
| | - Henry Dufour
- Aix-Marseille Université, and Assistance Publique-Hopitaux de Marseille, Department of Neurosurgery, La Timone Hospital, 13005 Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Centre National de la Recherche Scientifique, CRN2M Unité Mixte de Recherche 7286 and Assistance Publique-Hopitaux de Marseille, Department of Endocrinology, La Conception Hospital, National Reference Center for Rare Pituitary Diseases, 13005 Marseille, France
| | - Frederic Castinetti
- Aix-Marseille Université, Centre National de la Recherche Scientifique, CRN2M Unité Mixte de Recherche 7286 and Assistance Publique-Hopitaux de Marseille, Department of Endocrinology, La Conception Hospital, National Reference Center for Rare Pituitary Diseases, 13005 Marseille, France
| |
Collapse
|
14
|
The incidence of hypertension and its risk factors in the German adult population: results from the German National Health Interview and Examination Survey 1998 and the German Health Interview and Examination Survey for Adults 2008-2011. J Hypertens 2017; 35:250-258. [PMID: 27846042 DOI: 10.1097/hjh.0000000000001151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze incident hypertension and its risk factors based on 11.9 years follow-up of a recent National Examination Survey cohort in Germany. METHODS Out of 7124 participants of the German National Health Interview and Examination Survey 1998 (GNHIES98), 640 had died at follow-up 2008-2011 and 3045 were reexamined as part of the German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). Baseline and follow-up included standardized blood pressure (BP) measurements. Hypertension was defined as BP of at least 140/90 mmHg or intake of antihypertensive medication in participants with known hypertension. RESULTS Out of 2231 GNHIES98-DEGS1 participants aged 18-79 years without hypertension in 1998, 26.2% developed hypertension within a mean of 11.9 (range 10.0-14.1) years (men 29.0%, women 23.4%). In univariate analysis, hypertension incidence was positively associated with age, BMI, initial BP levels, pulse pressure, and alcohol consumption. Comorbidities such as diabetes and hyperlipidemia increased the chance to develop hypertension. In the multivariate model, initial SBP and DBP levels had the strongest influence on the development of future hypertension (7% increase in men and 5% in women per mmHg SBP). The percentage of aware, treated, and controlled hypertensive patients were 75.8, 62.1, and 50.3% in men and 83.8, 73.3, and 59.0% in women. CONCLUSION The high 11.9-year incidence in all age groups points to the lifelong potential for prevention of hypertension.
Collapse
|
15
|
Abstract
Objectives: The study aimed to assess the current epidemiology of hypertension, including its prevalence, the awareness of the condition and its treatment and control, in Turkey to evaluate changes in these factors over the last 10 years by comparing the results with the prevalence, awareness, treatment, and control of hypertension in Turkey (PatenT) study data (2003), as well as to assess parameters affecting awareness and the control of hypertension. Methods: The PatenT 2 study was conducted on a representative sample of the Turkish adult population (n = 5437) in 2012. Specifically trained staff performed the data collection. Hypertension was defined as mean SBP or DBP at least 140/90 mmHg, previously diagnosed disease or the use of antihypertensive medication. Awareness and treatment were assessed by self-reporting, and control was defined as SBP/DBP less than 140/90 mmHg. Results: Although the prevalence of hypertension in the PatenT and PatenT 2 surveys was stable at approximately 30%, hypertension awareness, treatment, and control rates have improved in Turkey. Overall, 54.7% of hypertensive patients were aware of their diagnosis in 2012 compared with 40.7% in 2003. The hypertension treatment rate increased from 31.1% in 2003 to 47.4% in 2012, and the control rate in hypertensives increased from 8.1% in 2003 to 28.7% in 2012. The rate of hypertension control in treated patients improved between 2003 (20.7%) and 2012 (53.9%). Awareness of hypertension was positively associated with older age, being a woman, residing in an urban area, a history of parental hypertension, being a nonsmoker, admittance by a physician, presence of diabetes mellitus, and being obese or overweight; it was inversely associated with a higher amount of daily bread consumption. Factors associated with better control of hypertension were younger age, female sex, residing in an urban area, and higher education level in Turkey. Conclusion: Although some progress has been made in recognizing hypertension from 2003 to 2012, there is still a large population of untreated or inadequately treated hypertensives in Turkey. Strengthening of population-based efforts to improve the prevention, early detection, and treatment of hypertension is needed.
Collapse
|
16
|
Giroud M, Delpont B, Daubail B, Blanc C, Durier J, Giroud M, Béjot Y. Temporal Trends in Sex Differences With Regard to Stroke Incidence: The Dijon Stroke Registry (1987-2012). Stroke 2017; 48:846-849. [PMID: 28275198 DOI: 10.1161/strokeaha.116.015913] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/04/2017] [Accepted: 01/25/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We evaluated temporal trends in stroke incidence between men and women to determine whether changes in the distribution of vascular risk factors have influenced sex differences in stroke epidemiology. METHODS Patients with first-ever stroke including ischemic stroke, spontaneous intracerebral hemorrhage, subarachnoid hemorrhage, and undetermined stroke between 1987 and 2012 were identified through the population-based registry of Dijon, France. Incidence rates were calculated for age groups, sex, and stroke subtypes. Sex differences and temporal trends (according to 5-year time periods) were evaluated by calculating incidence rate ratios (IRRs) with Poisson regression. RESULTS Four thousand six hundred and fourteen patients with a first-ever stroke (53.1% women) were recorded. Incidence was lower in women than in men (112 versus 166 per 100 000/y; IRR, 0.68; P<0.001), especially in age group 45 to 84 years, and for both ischemic stroke and intracerebral hemorrhage. From 1987 to 2012, the lower incidence of overall stroke in women was stable (IRR ranging between 0.63 and 0.72 according to study periods). When considering stroke subtype, a slight increase in the incidence of ischemic stroke was observed in both men (IRR, 1.011; 95% confidence interval, 1.005-1.016; P=0.001) and women (IRR, 1.013; 95% confidence interval, 1.007-1.018; P=0.001). The sex gap in incidence remained unchanged in ischemic stroke and intracerebral hemorrhage. Conversely, the lower subarachnoid hemorrhage incidence in women vanished with time because of an increasing incidence. CONCLUSIONS The sex gap in stroke incidence did not change with time except for subarachnoid hemorrhage. Despite lower rates, more women than men experience an incident stroke each year because of a longer life expectancy.
Collapse
Affiliation(s)
- Marie Giroud
- From the Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (Marie Giroud, B. Delpont, B. Daubail, C.B., J.D., Maurice Giroud, Y.B.); and Department of Neurology, CH William Morey, Chalon-sur-Saône, France (Marie Giroud)
| | - Benoit Delpont
- From the Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (Marie Giroud, B. Delpont, B. Daubail, C.B., J.D., Maurice Giroud, Y.B.); and Department of Neurology, CH William Morey, Chalon-sur-Saône, France (Marie Giroud)
| | - Benoit Daubail
- From the Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (Marie Giroud, B. Delpont, B. Daubail, C.B., J.D., Maurice Giroud, Y.B.); and Department of Neurology, CH William Morey, Chalon-sur-Saône, France (Marie Giroud)
| | - Christelle Blanc
- From the Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (Marie Giroud, B. Delpont, B. Daubail, C.B., J.D., Maurice Giroud, Y.B.); and Department of Neurology, CH William Morey, Chalon-sur-Saône, France (Marie Giroud)
| | - Jérôme Durier
- From the Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (Marie Giroud, B. Delpont, B. Daubail, C.B., J.D., Maurice Giroud, Y.B.); and Department of Neurology, CH William Morey, Chalon-sur-Saône, France (Marie Giroud)
| | - Maurice Giroud
- From the Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (Marie Giroud, B. Delpont, B. Daubail, C.B., J.D., Maurice Giroud, Y.B.); and Department of Neurology, CH William Morey, Chalon-sur-Saône, France (Marie Giroud)
| | - Yannick Béjot
- From the Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (Marie Giroud, B. Delpont, B. Daubail, C.B., J.D., Maurice Giroud, Y.B.); and Department of Neurology, CH William Morey, Chalon-sur-Saône, France (Marie Giroud).
| |
Collapse
|
17
|
Gabet A, Chatignoux E, Ducimetière P, Danchin N, Olié V. Differential trends in myocardial infarction mortality over 1975–2010 in France according to gender: An age-period-cohort analysis. Int J Cardiol 2016; 223:660-664. [PMID: 27567235 DOI: 10.1016/j.ijcard.2016.07.194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/28/2016] [Indexed: 11/15/2022]
Affiliation(s)
- A Gabet
- Department of Chronic Diseases and Injuries, The French Public Health Agency, Saint Maurice, France.
| | - E Chatignoux
- Department of Chronic Diseases and Injuries, The French Public Health Agency, Saint Maurice, France
| | | | - N Danchin
- Department of Cardiology, European Georges-Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris-Descartes University, Paris, France
| | - V Olié
- Department of Chronic Diseases and Injuries, The French Public Health Agency, Saint Maurice, France
| |
Collapse
|
18
|
|
19
|
Prevalencia, diagnóstico, tratamiento y control de la hipertensión arterial en España. Resultados del estudio Di@bet.es. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.11.036] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
20
|
Cournot M, Lenclume V, Le Moullec N, Debussche X, Doussiet E, Fagot-Campagna A, Favier F. Prevalence, treatment and control of hypertension in La Réunion: the RÉDIA population-based cohort study. Blood Press 2016; 26:39-47. [PMID: 27195533 DOI: 10.1080/08037051.2016.1182854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A better knowledge of prevalence, management and determinants of hypertension is needed in regions in epidemiological transition to adapt the strategies of public health screening and prevention, and to reduce the burden of cardiovascular diseases. We conducted a prospective cohort study including 4610 participants aged between 18 and 69 years and representative of the general population of La Réunion, a French overseas island located in the western Indian Ocean. The median time between inclusion and follow-up was 7.4 years. Blood pressure data at baseline and follow-up of 3087 participants were analyzed. We found a high prevalence of hypertension, especially in women (36.7% [34.5-39.0]) and in men (40.3% [37.6-43.0]) and in the under 30s (17.1% [14.0-20.5]), with an increase of 10% at follow-up. Treatment rates were very low in men (19.5% versus 39.1% in women) as was awareness of their condition (25.7% versus 44.6%). Blood pressure control rates were similar (18% at baseline and 34% at follow-up for both sexes). Diagnosis of hypertension at follow-up among subjects normotensive at baseline was independently associated with obesity at baseline (relative risk (RR) = 1.40 [1.12-1.75] for BMI between 27 and 30 kg/m2 and 1.72 [1.33-2.25] for BMI ≥30 kg/m2 as compared with BMI <27 kg/m2) and HbA1C (RR =1.12 [1.05-1.19] per %), suggesting a prominent role of insulin resistance in our population. Our study provides original data that cannot be assimilated to any existing model and should guide the implementation of original community-based programs in such countries.
Collapse
Affiliation(s)
- Maxime Cournot
- a CHU de La Réunion, Centre d'Investigations Cliniques , Saint Denis , France.,b INSERM, CIC 1410 , Saint Pierre , France.,c INSERM, UMR 1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI) , Sainte-Clotilde , France.,d Centre Hospitalier Gabriel Martin, Service de cardiologie , Saint-Paul , France
| | | | - Nathalie Le Moullec
- e CHU de La Réunion, Service d'endocrinologie, diabétologie et nutrition , Saint-Pierre , France
| | - Xavier Debussche
- f CHU de La Réunion, Service d'endocrinologie et diabétologie , Saint-Denis , France
| | | | - Anne Fagot-Campagna
- g Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés , Paris , France
| | - François Favier
- b INSERM, CIC 1410 , Saint Pierre , France.,e CHU de La Réunion, Service d'endocrinologie, diabétologie et nutrition , Saint-Pierre , France
| |
Collapse
|
21
|
Kogure M, Tsuchiya N, Hozawa A, Nakaya N, Nakamura T, Miyamatsu N, Tanaka H, Wakabayashi I, Higashiyama A, Okuda N, Takashima N, Fujiyoshi A, Kadota A, Ohkubo T, Okamura T, Ueshima H, Okayama A, Miura K. Does the flushing response modify the relationship between alcohol intake and hypertension in the Japanese population? NIPPON DATA2010. Hypertens Res 2016; 39:670-9. [PMID: 27169399 DOI: 10.1038/hr.2016.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/22/2016] [Accepted: 03/20/2016] [Indexed: 11/09/2022]
Abstract
The influence of alcohol intake on hypertension may vary depending on the flushing response, but this relationship has not been confirmed. The relationship between alcohol intake and hypertension was examined according to the flushing response in a representative sample of the Japanese population. Participants in the National Health and Nutrition Survey in 2010 were asked to participate in the baseline survey of NIPPON DATA2010. Here, we investigated the relationship between alcohol intake and hypertension according to the flushing response. Statistical analyses were performed in a cross-sectional manner using multiple logistic regression models after adjusting for age, body mass index, smoking status, present illness of diabetes mellitus and present illness of dyslipidemia. Of the 1139 men and 1263 women, 659 and 463, respectively, had hypertension. Among the men, alcohol intake was positively associated with hypertension, regardless of the flushing response (P for linear trend both <0.05). This positive relationship was observed for both users and non-users of antihypertensive drugs. No interaction with the flushing response was observed (P for interaction=0.360). In women, although the direction differed between flushers and non-flushers, the association between alcohol intake and hypertension was not significant, regardless of flushing response. In conclusion, In Japanese men, alcohol intake was positively associated with hypertension in a manner that was not influenced by the flushing response.
Collapse
Affiliation(s)
- Mana Kogure
- Division of Personalized Prevention and Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naho Tsuchiya
- Division of Personalized Prevention and Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Hozawa
- Division of Personalized Prevention and Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Nakaya
- Division of Personalized Prevention and Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiro Nakamura
- Division of Personalized Prevention and Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan
| | - Hideo Tanaka
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Hyogo, Japan
| | | | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan
| | - Naoyuki Takashima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| |
Collapse
|
22
|
Roten L, Derval N, Maury P, Mahida S, Pascale P, Leenhardt A, Jesel L, Deisenhofer I, Kautzner J, Probst V, Rollin A, Ruidavets JB, Ferrières J, Sacher F, Heg D, Scherr D, Komatsu Y, Daly M, Denis A, Shah A, Hocini M, Jaïs P, Haïssaguerre M. Benign vs malignant inferolateral early repolarization: Focus on the T wave. Heart Rhythm 2016; 13:894-902. [DOI: 10.1016/j.hrthm.2015.11.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Indexed: 12/19/2022]
|
23
|
Menéndez E, Delgado E, Fernández-Vega F, Prieto MA, Bordiú E, Calle A, Carmena R, Castaño L, Catalá M, Franch J, Gaztambide S, Girbés J, Goday A, Gomis R, López-Alba A, Martínez-Larrad MT, Mora-Peces I, Ortega E, Rojo-Martínez G, Serrano-Ríos M, Urrutia I, Valdés S, Vázquez JA, Vendrell J, Soriguer F. Prevalence, Diagnosis, Treatment, and Control of Hypertension in Spain. Results of the Di@bet.es Study. ACTA ACUST UNITED AC 2016; 69:572-8. [PMID: 26979767 DOI: 10.1016/j.rec.2015.11.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/27/2015] [Indexed: 01/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Di@bet.es is a national study designed to estimate the prevalence of diabetes mellitus and other cardiovascular risk factors in the Spanish adult population. The prevalence of hypertension and the degree to which it is recognized, treated, and controlled are described. METHODS The study included a sample of the Spanish population with 5048 adults aged ≥ 18 years. Patients were questioned and examined, with 3 blood pressure readings while seated and at rest to calculate the mean of the 3 readings. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or prescription for antihypertensive drug therapy. RESULTS Hypertension was found in 42.6% of the Spanish adult population aged ≥ 18 years and was more common among men (49.9%) than women (37.1%). The prevalence was higher among prediabetics (67.9%) and diabetics (79.4%). Undiagnosed hypertension was identified in 37.4% of patients and was more common in men (43.3%) than in women (31.5%). Among patients with known hypertension, 88.3% were receiving drug therapy. Well-controlled blood pressure was found in only 30% and was more common among women (24.9%) than men (16%). CONCLUSIONS The prevalence of hypertension in Spain is high, and a considerable percentage of hypertensive patients have still not been diagnosed. Hypertension is associated with diabetes and prediabetes, and although drug therapy is increasingly common, the degree of control has not improved and remains low. Population campaigns should be developed and promoted for hypertension prevention, detection, and treatment.
Collapse
Affiliation(s)
- Edelmiro Menéndez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain.
| | - Elías Delgado
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | | | - Miguel A Prieto
- Centro de Salud de Vallobín, Servicio de Salud del Principado de Asturias, Oviedo, Asturias, Spain
| | - Elena Bordiú
- Laboratorio de Endocrinología, Hospital Universitario San Carlos, Madrid, Spain
| | - Alfonso Calle
- Servicio de Endocrinología y Nutrición, Hospital Universitario San Carlos, Madrid, Spain
| | - Rafael Carmena
- Servicio de Medicina y Endocrinología, Hospital Clínico Universitario de Valencia, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Valencia, Spain
| | - Luis Castaño
- Grupo de Investigación en Diabetes, Hospital Universitario de Cruces, UPV-EHU, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), San Vicente de Barakaldo, Vizcaya, Spain
| | - Miguel Catalá
- Servicio de Medicina y Endocrinología, Hospital Clínico Universitario de Valencia, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Valencia, Spain
| | - Josep Franch
- Atención Primaria, EAP Raval Sud, Institut Català de la Salut, Red GEDAPS, Unitat de Suport a la Recerca (IDIAP-Fundació Jordi Gol), Barcelona, Spain
| | - Sonia Gaztambide
- Grupo de Investigación en Diabetes, Hospital Universitario de Cruces, UPV-EHU, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), San Vicente de Barakaldo, Vizcaya, Spain
| | - Juan Girbés
- Unidad de Diabetes, Hospital Arnau de Vilanova, Valencia, Spain
| | - Albert Goday
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, Spain
| | - Ramón Gomis
- Unidad de Diabetes y Endocrinología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | | | - María Teresa Martínez-Larrad
- Laboratorio de Lípidos y Diabetes, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Inmaculada Mora-Peces
- Servicio Normalizado de Urgencias de La Laguna, Atención Primaria, Servicio Canario de Salud, Sta. Cruz de Tenerife, Spain
| | - Emilio Ortega
- Unidad de Diabetes y Endocrinología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Gemma Rojo-Martínez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Carlos Haya (IBIMA), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Málaga, Spain
| | - Manuel Serrano-Ríos
- Laboratorio de Lípidos y Diabetes, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Inés Urrutia
- Grupo de Investigación en Diabetes, Hospital Universitario de Cruces, UPV-EHU, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), San Vicente de Barakaldo, Vizcaya, Spain
| | - Sergio Valdés
- Servicio de Endocrinología y Nutrición, Hospital Universitario Carlos Haya (IBIMA), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Málaga, Spain
| | | | - Joan Vendrell
- Servicio de Endocrinología y Nutrición, Hospital Universitario Joan XXIII, Institut d'Investigacions Sanitàries Pere Virgili, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Tarragona, Spain
| | - Federico Soriguer
- Servicio de Endocrinología y Nutrición, Hospital Universitario Carlos Haya (IBIMA), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Málaga, Spain
| |
Collapse
|
24
|
Yin WH, Chen P, Yeh HI, Wang KY, Hung YJ, Tseng WK, Wen MS, Wu TC, Wu CC, Cheng SM, Chen JW. Combination With Low-dose Dextromethorphan Improves the Effect of Amlodipine Monotherapy in Clinical Hypertension: A First-in-human, Concept-proven, Prospective, Dose-escalation, Multicenter Study. Medicine (Baltimore) 2016; 95:e3234. [PMID: 27015224 PMCID: PMC4998419 DOI: 10.1097/md.0000000000003234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The combination of low rather than high dose of dextromethorphan (DXM) with amlodipine (AM) could improve blood pressure (BP) reduction in hypertensive animals. The study aimed to evaluate the feasibility of different doses of DXM combined with standard AM treatment in clinical hypertension.This was a prospective, 14-week, dose-escalation, multicenter study. After 2-week run-in period with AM 5 mg/day, hypertensive patients who got the BP goal of 140/90 mmHg kept receiving AM monotherapy for another 12 weeks. The nonresponders, while kept on AM 5 mg/day, received additional DXM treatment for 3 sequential dose-titrated periods with initially 2.5 mg/day, followed by 7.5 mg/day, and finally 30 mg/day. Each period was for 4 weeks. The patients at BP goal after each treatment period were defined as the responders and kept on the same combination till the end of the study. The responder rate of each treatment period was recorded. The changes of BP and serum antioxidant/endothelial markers between week 14 and week 2 were evaluated.Of the 103 patients initially enrolled, 89 entered the treatment period. In the 78 patients completing the study, 31 (40%) at BP goal after 2-week AM run-in kept on AM monotherapy (DXM0). The addition of 2.5 (DXM2.5) and 7.5 mg/day (DXM7.5) of DXM enabled BP goal achievement in 22 (47%) nonresponders to AM monotherapy including 16 (29%) with DXM2.5 and 6 (18%) with DXM7.5. Only 4 patients (16%) reached BP goal with the combination of DXM 30 mg/day (DXM30). Overall, 73% of the 78 patients reached BP goal at the end of the 14-week study. Mean systolic BP was reduced by 7.9% ± 7.0% with DXM2.5 (P < 0.001) and by 5.4% ± 2.4% with DXM7.5 (P = 0.003) respectively at week 14 from that at week 2, which was unchanged in either DXM0 or DXM30 group. Besides, the effects of combination treatment were particularly significant in the patients with impaired endothelial function suggested by reduced serum NOx level at baseline.Accordingly, the combination with low dose of DXM was feasible to improve BP control in patients who failed to achieve the BP goal by standard AM monotherapy. The benefit effects might be significant especially in patients with impaired endothelial function.
Collapse
Affiliation(s)
- Wei-Hsian Yin
- From the Heart Center, Cheng-Hsin General Hospital (W-HY); Faculty of Medicine, National Yang-Ming University (W-HY); Institute of Pharmacology, National Yang-Ming University (J-WC); TSH Biopharm Corporation Ltd (PC); Department of Medicine, Mackay Memorial Hospital, Taipei (H-IY); Division of Cardiology, Taichung Veterans General Hospital (K-YW); Department of Internal Medicine, Chung San Medical University, Taichung (K-YW); Division of Endocrinology and Metabolism (Y-JH); Division of Cardiology, Tri-Service General Hospital, Taipei (S-MC); Department of Cardiology, E-DA Medical University Hospital, Kaohsiung (W-KT); Department of Cardiology, Chang Gung Memorial Hospital Linkou, Taoyuan (M-SW); Division of Cardiology, Taipei Veterans General Hospital (T-CW, J-WC); Department of Internal Medicine, National Taiwan University Hospital (C-CW); and Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC (J-WC)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Ragot S, Beneteau M, Guillou-Bonnici F, Herpin D. Prevalence and management of hypertensive patients in clinical practice: Cross-sectional registry in five countries outside the European Union. Blood Press 2016; 25:104-16. [DOI: 10.3109/08037051.2015.1110922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
26
|
The persisting gender gap in hypertension management and control in Germany: 1998 and 2008-2011. Hypertens Res 2016; 39:457-66. [PMID: 26818655 DOI: 10.1038/hr.2016.5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 01/13/2023]
Abstract
Hypertension is a major risk factor for cardiovascular morbidity; therefore, its control is very important. International Guidelines recommend the same hypertension management in men and women; however, studies suggest that management of hypertension differs. This study explores gender-age disparities in the management and control of hypertension in Germany in 1998 and 2008-2011. Data from the German Health Examination Surveys (GNHIES98 1998, n=7124 and DEGS1 2008-2011, n=7988, age 18-79 years), including standardized blood pressure measurements and Anatomical Therapeutic Chemical medication codes, were analyzed by gender and two age groups. For 1998 and 2008-2011 in Germany, the gender gap in hypertension management persisted without significant changes. Hypertensive men in 2008-2011 had lower awareness of their condition (78.3 vs. 86.8%), less treatment for hypertension (65.3 vs. 79.2%), less control of hypertension (45.4 vs. 57.5%) and less treatment among those aware of their condition (83.9 vs. 91.5%) than did women. These gender differences were greater in younger compared with older adults (18-54 years vs. 55-79 years). No gender differences were observed in control of hypertension among those treated in 1998; however, subsequent improvement was less in younger men compared with the other age-gender groups, leading to a new gender gap in 18-54-year olds (women 84.8%, men 63.9%). Younger women used more β-blockers and less angiotensin-converting enzyme inhibitors (ACEI) than younger men. Factors positively associated with control among those treated for hypertension in the younger group were being a woman, using β-blockers or using ACEI, or angiotensin-receptor blockers. In the older group, diabetes was negatively associated with control of hypertension, whereas having cardiovascular comorbidities was positively associated. Gender disparities in hypertension management and control still exist in Germany but may be masked because they are age-dependent.
Collapse
|
27
|
Sarganas G, Knopf H, Grams D, Neuhauser HK. Trends in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension in Germany. Am J Hypertens 2016; 29:104-13. [PMID: 25968124 DOI: 10.1093/ajh/hpv067] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/14/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hypertension is a major risk factor for morbidity and mortality, therefore its control is of great importance. In this study we compare the use of antihypertensive medication among adults with hypertension in Germany 1998 and 2008-2011 and determine factors associated with use and control. METHODS Data from German Health Examination Surveys (GNHIES98 1998, n = 7,124 and DEGS1 2008-2011 n = 7,988, age 18-79 years) including standardized blood pressure (BP) measurements and Anatomical Therapeutic Chemical (ATC) medication codes were analyzed. RESULTS The use of antihypertensive medication among adults with hypertension in Germany increased from 54% to 72% in 1 decade. In 2008-2011, 67% of users were treated with polytherapy. The most commonly used antihypertensive class in 1998 was diuretics (43%) and in 2008-2011 beta-blockers (54%). Ramipril and metoprolol are currently the most commonly used monotherapy agents, while ramipril in combination with hydrochlorothiazide is the most frequent polytherapy. Being a woman, older age, having statutory health insurance, diabetes, coronary heart disease (CHD), stroke, and obesity were positively associated with antihypertensive use. The control rate among treated increased from 42% to 72%. Young women (18-54 years) had better control compared to older women or to men. Having CHD or stroke was positively associated with BP control. CONCLUSIONS Increased and improved antihypertensive use might be a main contributor to the decrease in BP observed in Germany in the last decade. However, there are still socio-demographic and health disparities in hypertension treatment and control.
Collapse
Affiliation(s)
- Giselle Sarganas
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany.
| | - Hildtraud Knopf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Daniel Grams
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hannelore K Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| |
Collapse
|
28
|
Jaffre A, Ruidavets JB, Nasr N, Guidolin B, Ferrieres J, Larrue V. Tobacco Use and Cryptogenic Stroke in Young Adults. J Stroke Cerebrovasc Dis 2015; 24:2694-700. [PMID: 26481958 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Cryptogenic stroke is the leading subtype of ischemic stroke in the young. We sought to evaluate the association between traditional cardiovascular risk factors and cryptogenic stroke by using a case-control study. METHODS Patients aged 18-54 years, consecutively treated for first-ever cryptogenic ischemic stroke in an academic stroke unit, were compared with subjects from the general population living in the same geographic area. Control subjects were matched for age and sex with patients. We further evaluated the association between significant risk factors and nonobstructive (<50% stenosis) carotid plaque and thrombus among patients with cryptogenic stroke. Odds ratios [OR] were calculated using logistic regression analysis. RESULTS A total of 155 patients with cryptogenic stroke (66.4% men, mean age 43.5 years [SD 8.4]) were included in the study. Cryptogenic stroke was associated with current tobacco use (42.6% in patients versus 23.9% in control subjects; OR = 2.38, 95% confidence interval [CI] 1.40-4.05, P = .002). Current tobacco use was associated with nonobstructive carotid plaque (OR = 6.22; 95% CI, 2.43-15.9; P = .001) and nonobstructive carotid thrombus (OR = 13.7; 95% CI, 1.42-132.7; P = .03) among the patients. CONCLUSION Our case-control study showed a strong link between current tobacco use and cryptogenic stroke in young adults.
Collapse
Affiliation(s)
- Aude Jaffre
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France.
| | - Jean Bernard Ruidavets
- Department of Epidemiology and INSERM U1027, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Nathalie Nasr
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Brigitte Guidolin
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Jean Ferrieres
- Department of Epidemiology and INSERM U1027, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Vincent Larrue
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| |
Collapse
|
29
|
Regional variations in hypertension prevalence and management in Germany: results from the German Health Interview and Examination Survey (DEGS1). J Hypertens 2015; 32:1405-13; discussion 1414. [PMID: 24834980 DOI: 10.1097/hjh.0000000000000211] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study analyzed regional differences in blood pressure (BP) distribution and management in Germany 2008-2011 in a nationwide study. METHODS The analyses were based on standardized BP measurements and anatomical therapeutic chemical classification-coded medication from the population-based German Health Interview and Examination Survey (DEGS1) 2008-2011 (N = 7074, 18-79 years, 180 study points, five regions: Central-East, South, Central-West, North-West, and North-East). Regional differences were tested between the region with the highest and lowest values. RESULTS Regional variations were observed in mean SBP, mean DBP, and the prevalence of hypertension in both sexes, as well as awareness, treatment, and control in men. Differences in blood pressure (in mmHg) between Central-East, the region with the highest BP level and the region with the lowest BP level, were SBP 3.2 and DBP 2.5 in men and SBP 4.5 and DBP 2.4 in women. In Central-East 39% of men and 40% of women had hypertension, versus 30% of men in the North-West and 26% of women in the South. The percentage of aware, treated, and controlled men ranged between 92, 78, and 56% in the North-East and 74, 59, and 41% in the South, respectively. After multivariate adjustment for sociodemographic variables and hypertension risk factors, geographical differences persisted for hypertension prevalence in women and hypertension awareness and treatment in men. CONCLUSION So far, national surveys allowed only BP comparisons along the former East-West border and showed more elevated BP in the East. New analyses suggest regional differences with both the most and the least favorable results in the two neighboring parts of former East Germany.
Collapse
|
30
|
Trends in Cardiovascular Disease Risk Factor Prevalence and Estimated 10-Year Cardiovascular Risk Scores in a Large Untreated French Urban Population: The CARVAR 92 Study. PLoS One 2015; 10:e0124817. [PMID: 25906186 PMCID: PMC4408033 DOI: 10.1371/journal.pone.0124817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 03/18/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Surveys measuring effectiveness of public awareness campaigns in reducing cardiovascular disease (CVD) incidence have yielded equivocal findings. The aim of this study was to describe cardiovascular risk factors (CVRFs) changes over the years in an untreated population-based study. METHODS Between 2007 and 2012, we conducted a screening campaign for CVRFs in men aged 40 to 65 yrs and women aged 50 to 70 yrs in the western suburbs of Paris. Data were complete for 20,324 participants of which 14,709 were untreated. RESULTS The prevalence trend over six years was statistically significant for hypertension in men from 25.9% in 2007 to 21.1% in 2012 (p=0.002) and from 23% in 2007 to 12.7% in 2012 in women (p<0.0001). The prevalence trend of tobacco smoking decreased from 38.6% to 27.7% in men (p=0.0001) and from 22.6% to 16.8% in women (p=0.113). The Framingham 10-year risk for CVD decreased from 13.3 ± 8.2 % in 2007 to 11.7 ± 9.0 % in 2012 in men and from 8.0 ± 4.1 % to 5.9 ± 3.4 % in women. The 10-year risk of fatal CVD based on the European Systematic COronary Risk Evaluation (SCORE) decreased in men and in women (p <0.0001). CONCLUSIONS Over a 6-year period, several CVRFs have decreased in our screening campaign, leading to decrease in the 10-year risk for CVD and the 10-year risk of fatal CVD. Cardiologists should recognize the importance of community prevention programs and communication policies, particularly tobacco control and healthier diets to decrease the CVRFs in the general population.
Collapse
|
31
|
Veliz-Rojas L, Mendoza-Parra S, Barriga O. Adherencia terapéutica y control de los factores de riesgo cardiovasculares en usuarios de atención primaria. ENFERMERÍA UNIVERSITARIA 2015. [DOI: 10.1016/j.reu.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
32
|
Omega-3 index levels and associated factors in a middle-aged French population: the MONA LISA-NUT Study. Eur J Clin Nutr 2014; 69:436-41. [PMID: 25335443 DOI: 10.1038/ejcn.2014.219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 08/23/2014] [Accepted: 09/03/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES The omega-3 index (the summed percentage content of eicosapentaenoic and docosahexaenoic acids in red blood cells) is associated with a lower risk of fatal coronary heart disease and sudden cardiac death. We aimed to determine which socio-demographic, behavioural or clinical factors are independently associated with the omega-3 index and the extent to which seafood consumption mediates the index's association with socio-economic status (SES). SUBJECTS/METHODS As part of the cross-sectional MONA LISA-NUT survey (2005-2007), gas chromatography was used to analyse the red blood cell fatty acid composition in 503 French subjects aged 35-64 years. Dietary data were collected by trained dieticians via a validated food frequency questionnaire and a prospective 3-day food record. Risk factors were estimated with standardised measurements and questionnaires. SES was assessed through the self-reported educational and income tax levels. RESULTS The mean ± s.d. omega-3 index was 6.02 ± 1.75%. In the best parsimonious predictive model (which explained 32% of the variability in the omega-3 index), age, educational level and seafood servings were significantly and positively associated with the index. In contrast, waist circumference and smoking were inversely associated with the index. In a mediation analysis that took account of all these factors, seafood servings explained about 40% of the association between educational level and the omega-3 index. Similar results were obtained for the income tax level. CONCLUSIONS The inverse association between SES and omega-3 index is largely explained (40%) by an insufficient seafood intake. It remains to be seen which other factors mediate this association.
Collapse
|
33
|
Boussuges A, Chaumet G. Hypertension and risk of immersion pulmonary edema. Int J Cardiol 2014; 174:873. [PMID: 24820747 DOI: 10.1016/j.ijcard.2014.04.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Alain Boussuges
- IRBA, French Armed Biomedical Research Institute, Brétigny sur Orge, France; UMR-MD2, Aix-Marseille University, Marseille, France.
| | | |
Collapse
|
34
|
Babiker FA, Elkhalifa LA, Moukhyer ME. Awareness of hypertension and factors associated with uncontrolled hypertension in Sudanese adults. Cardiovasc J Afr 2014; 24:208-12. [PMID: 24217260 PMCID: PMC3767941 DOI: 10.5830/cvja-2013-035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 05/10/2013] [Indexed: 11/21/2022] Open
Abstract
Background The incidence of hypertension (HTN) has increased rapidly in the Sudan in the last few years. The aim of this study was to determine the prevalence of uncontrolled HTN and the risk factors associated with it in Sudanese adults. Methods This study was cross sectional. Data were collected using structured questionnaires filled in during interviews with subjects visiting referral clinics in Khartoum, the capital city of Sudan. Blood pressure (BP) was measured using a digital sphygmomanometer. A digital balance was used for determination of body weight and a traditional cloth tape measure was used for measuring height, for calculation of body mass index. Results This study included 200 subjects, 46% male and 54% female. In the whole study, 82% of subjects (p < 0.001) were on hypertension drug treatment. Of these, 64% had their BP controlled to normal standards set by the World Health Organistion (< 140/90 mmHg). The prevalence of uncontrolled BP was significantly (p < 0.001) higher in males (61%) compared to females (15%). When the risk factors of HTN were considered, 54% of the subjects had a positive family history of HTN and 52% were smokers. Uncontrolled BP was found to be significantly (p < 0.001) higher in smoking males (43%) compared to females (4%). It was also high in people with higher education (55%) and workers (41%). In these groups, when genders were considered separately, uncontrolled hypertension was significantly (p < 0.01) higher in males than females with higher education (67 and 40%, respectively), and in workers (86 and 10%, respectively). Uncontrolled HTN was associated with overweight and obesity in 45 and 29% of the subjects, respectively. Most of the interviewed subjects were not aware of the consequences of HTN and its associated risk factors. Conclusions Uncontrolled HTN was associated with risk factors of HTN and lifestyle, and was more prominent in the male gender. The ignorance of the interviewed subjects about HTN, its associated risk factors, changes in lifestyle and adherence to taking the medication may have been a major factor in the prevalence of uncontrolled HTN.
Collapse
Affiliation(s)
- Fawzi A Babiker
- Department of Physiology, Faculty of Medicine, Kuwait University, Kuwait
| | | | | |
Collapse
|
35
|
Seidowsky A, Massy ZA, Metzger M, Stengel B. Hypertension résistante et maladie rénale chronique : épidémiologie et pronostic. Nephrol Ther 2014; 10:137-44. [DOI: 10.1016/j.nephro.2013.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 12/20/2013] [Accepted: 12/30/2013] [Indexed: 11/30/2022]
|
36
|
Tuppin P, Ricci-Renaud P, de Peretti C, Fagot-Campagna A, Alla F, Danchin N, Allemand H. Frequency of cardiovascular diseases and risk factors treated in France according to social deprivation and residence in an overseas territory. Int J Cardiol 2014; 173:430-5. [DOI: 10.1016/j.ijcard.2014.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/09/2014] [Indexed: 02/07/2023]
|
37
|
Giovannelli J, Dallongeville J, Wagner A, Bongard V, Laillet B, Marecaux N, Ruidavets JB, Haas B, Ferrieres J, Arveiler D, Simon C, Dauchet L. Validation of a Short, Qualitative Food Frequency Questionnaire in French Adults Participating in the MONA LISA-NUT Study 2005-2007. J Acad Nutr Diet 2014; 114:552-61. [DOI: 10.1016/j.jand.2013.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 06/26/2013] [Indexed: 11/29/2022]
|
38
|
Cortés-Hernández DE, Lundelin KJ, Picazzo-Palencia E, de la Cruz JJ, Sánchez JJ, Banegas JR. The burden of blood-pressure-related cardiovascular mortality in Mexico. Int J Hypertens 2014; 2014:427684. [PMID: 24678416 PMCID: PMC3941157 DOI: 10.1155/2014/427684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/28/2013] [Indexed: 01/13/2023] Open
Abstract
This study shows that in Mexico, a country at an advanced stage in the epidemiologic transition, with the national burden of disease dominated by noncommunicable diseases, elevated blood pressure is a major clinical and public health problem. 31.7% of the Mexican individuals aged 50 and over had systolic hypertension, and 47.3% were at systolic prehypertensive levels. Also, approximately half of all cardiovascular deaths that occurred annually in the population of Mexico aged ≥50 years are attributable to above optimal levels of systolic blood pressure. We think these estimates may help order health priorities in Mexico (and other middle-income countries) at a time when the costs of medical care take a considerable share of the gross national product in most countries.
Collapse
Affiliation(s)
- Dora E. Cortés-Hernández
- Department of Public Health and Preventive Medicine, School of Medicine and Center for Research and Development on Health Science, Universidad Autónoma de Nuevo Leon, 64460 Monterrey, NL, Mexico
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ, CIBER in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Krista J. Lundelin
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ, CIBER in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Esteban Picazzo-Palencia
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ, CIBER in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Institute for Social Research, Center for Research and Development on Health Science, Faculty of Accounting and Business Administration, Universidad Autónoma de Nuevo León, 64460 Monterrey, NL, Mexico
| | - Juan J. de la Cruz
- Department of Public Health and Preventive Medicine, School of Medicine and Center for Research and Development on Health Science, Universidad Autónoma de Nuevo Leon, 64460 Monterrey, NL, Mexico
| | - José J. Sánchez
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ, CIBER in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - José R. Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ, CIBER in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| |
Collapse
|
39
|
How are physicians prescribing the direct renin inhibitor aliskiren in the management of essential hypertension? A French observational study. J Hypertens 2014; 31:1491-6; discussion 1496. [PMID: 24006041 DOI: 10.1097/hjh.0b013e328360f716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this French observational study was to evaluate how the direct renin inhibitor aliskiren is being prescribed to treat hypertension by primary care providers (PCPs) and office-based cardiologists. METHODS Each participating physician included the first three consecutive hypertensive patients who had been prescribed aliskiren at least 4 weeks beforehand and noted whether aliskiren was prescribed: alone or as part of a combination; as first-line therapy, to replace another drug or as an add-on therapy. RESULTS Five thousand, four hundred and eleven patients were analyzed [mean age, 63; 58% men; 24% diabetic; mean blood pressure (BP) 148/85 mmHg]. A total of 23.6% of patients had a controlled BP. Aliskiren was prescribed alone in 49.4% patients and as part of a combination in 50.6% (bitherapy 28.3%, tritherapy 14.7%, and quadri+therapy 7.6%), at the higher recommended dosage (300 mg daily) to two-thirds of cases. Aliskiren replaced another drug in 71.9% [mainly an angiotensin receptor blocker (ARB) or an angiotensin-converting enzyme inhibitor (ACEi)] and was added to an existing regimen in 22.5%. For bitherapy, aliskiren was combined with a diuretic (D; 39%) or a calcium channel blocker (CCB; 32%). For tritherapy, it was prescribed with CCB and D in 28% and β-blocker and D in 26%. In 8.9% of patients, aliskiren was prescribed with an ACEi or an ARB. CONCLUSION French physicians are generally following the current prescribing recommendations for aliskiren, but the place of this new class of antihypertensive in the management of essential hypertension will become clearer with longer experience, especially concerning effective doses and combinations.
Collapse
|
40
|
Pretorean T, Claisse G, Delsart P, Caudrelier T, Devos P, Mounier-Vehier C. [A specific questionnaire to evaluate therapeutic inertia in hypertensive patients: a pilot study]. JOURNAL DES MALADIES VASCULAIRES 2014; 39:4-13. [PMID: 24119421 DOI: 10.1016/j.jmv.2013.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/22/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Therapeutic inertia (TI) is a recent concept still unknown by many physicians. In chronic diseases such as hypertension, it is defined as the tendency of physicians not to increase or change antihypertensive medications when the target blood pressure is not reached. Acting on TI could improve blood pressure control in France. METHOD This was a single-center prospective pilot study conducted by hypertension specialist physicians at the University Cardio-Vascular Center in Lille (France). It was conducted between March and June 2011. Data was collected from 161 hypertensive patients (mean age: 61.64±11.18 years; 98 (60.9%) male; 75 secondary prevention patients). Each physician completed a questionnaire on therapeutic inertia. TI was defined as a consultation in which treatment change was indicated (systolic blood pressure [BP]≥140 and/or diastolic BP≥90mmHg in all patients), but did not occur, with absence of an adapted justification of this choice. We considered as an adapted justification: a white coat effect demonstrated by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring; scheduled reassessment of the BP by ABPM; recent change in antihypertensive treatment (less than 4 weeks); hospitalization needed for complete evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage in patients with grade 1 or 2 hypertension. Our study aimed to evaluate rates of TI, to identify factors associated with TI, and to test the TI questionnaire. RESULTS Therapeutic inertia as defined in this study occurred in 11 consultations (8.3%) of the 133 hypertensive patients having uncontrolled BP above or equal to 140 and/or 90mmHg. Significant factors associated with TI were older age (Z=2.35, P<0.05) and sleep apnea syndrome (χ(2)=8.33, P<0.05). The absence of ambulatory blood pressure monitoring before the consultation (χ(2)=4.28, 0.1>P>0.05) and the number of consultations (Z=1.92, 0.1>P>0.05) exhibited a significant trend to be associated with TI. CONCLUSIONS Although the rate of TI was low in our study conducted in a specialized center, a well-accepted definition of therapeutic inertia would be useful for further study. The feasibility of using the questionnaire tested with this study shows that this measurement tool could help physicians become more aware of TI, both in the hospital and primary care setting. Further multicenter studies are needed for validation.
Collapse
Affiliation(s)
- T Pretorean
- Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France.
| | - G Claisse
- Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France
| | - P Delsart
- Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France
| | - T Caudrelier
- Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France
| | - P Devos
- Délégation à la recherche, CHRU de Lille, 59037 Lille cedex, France
| | - C Mounier-Vehier
- Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France
| |
Collapse
|
41
|
Affiliation(s)
- Giuseppe Mancia
- From the Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca and Istituto Auxologico Italiano, Milano, Italy (G.M.); Clinica Medica,Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); and Multimedica, Sesto SanGiovanni (Milano), Italy (G.G.)
| | - Guido Grassi
- From the Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca and Istituto Auxologico Italiano, Milano, Italy (G.M.); Clinica Medica,Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); and Multimedica, Sesto SanGiovanni (Milano), Italy (G.G.)
| |
Collapse
|
42
|
Pouchain D, Lièvre M, Huas D, Lebeau JP, Renard V, Bruckert E, Girerd X, Boutitie F. Effects of a multifaceted intervention on cardiovascular risk factors in high-risk hypertensive patients: the ESCAPE trial, a pragmatic cluster randomized trial in general practice. Trials 2013; 14:318. [PMID: 24083783 PMCID: PMC3849945 DOI: 10.1186/1745-6215-14-318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice. The ESCAPE trial aimed to determine whether a multifaceted intervention focused on general practitioners (GPs), could increase significantly the proportion of hypertensive patients at high risk in primary prevention who achieved all their recommended therapeutic targets. METHODS A pragmatic, cluster randomized trial involving 257 GPs randomized by region. The GPs in the intervention group had a one-day training session and were given an electronic blood pressure measurement device and a short recommendation leaflet. Along with usual follow-up, they focused one consultation on hypertension and other cardiovascular risk factors every six months for two years. They also received feedback at baseline and at one year on their patients' clinical and biological parameters. Main outcome measures were change in the proportion of patients achieving all their therapeutic targets and each individual therapeutic target at two years, and quality of life. RESULTS 1,832 high-risk hypertensive patients were included. After two years, the proportion of patients achieving all their therapeutic targets increased significantly in both groups, but significantly more in the intervention group: OR (odds-ratio) 1.89, (95% confidence interval (CI) 1.09 to 3.27, P = 0.02). Significantly more patients achieved their blood pressure targets in the intervention group than in the usual care group: OR 2.03 (95% CI 1.44 to 2.88, P < 0.0001). Systolic and diastolic blood pressures decreased significantly more in the intervention group than in the usual care group, by 4.8 mmHg and 1.9 mmHg, respectively (P < 0.0001 for both). There were no significant difference changes in physical and mental quality of life between groups. CONCLUSION An easy-to-perform, multifaceted intervention targeting only GPs increased significantly the proportion of high-risk hypertensive patients in primary prevention achieving their recommended therapeutic targets. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov, number NCT00348855.
Collapse
Affiliation(s)
- Denis Pouchain
- Service de Pharmacologie Clinique, Université Claude Bernard, CNRS UMR 5558, rue Guillaume Paradin, BP 8071, Lyon Cedex 08, 69376,, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Affiliation(s)
- Giuseppe Mancia
- Department of Health Sciences, University of Milano-Bicocca and Istituto Auxologico Italiano, Milan, Italy.
| | | |
Collapse
|
44
|
Boledovičová M, Hendl J, Lišková L, Slamková A, Matoulek M, Stránská Z, Svačina Š, Velemínský M. Blood pressure relation to body composition and age: analysis of a nurse-led investigation and consultation program. Med Sci Monit 2013; 19:612-7. [PMID: 23887144 PMCID: PMC3728227 DOI: 10.12659/msm.883984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Blood pressure (BP) increases with age and obesity. We have assessed the relative contribution of age and fatness to BP regulation in a healthy population investigated by nurse practitioners. MATERIAL AND METHODS Preventive investigation and counseling was offered at the entrance hall of the regional authority´s office in the town of Nitra by 2 nursing specialists who investigated 120 men and 276 women. In men the mean body mass index (BMI) was 26.8 kg/m2, mean weight was 84.4 kg, mean fat percentage was 23.3, mean age was 46.1 years, mean systolic BP was 133.1 mmHg, and mean diastolic BP was 82.5 mmHg. In women the mean BMI was 24.8 kg/m2, mean weight was 67.3 kg, mean fat percentage was 29.4, mean age was 45.4 years, mean systolic BP was 127.7 mmHg, and mean diastolic BP was 78.5 mmHg. Correlation analysis was performed and in multiple regression analysis we used BP values as the dependent variable and fat percentage and age as independent variables. Normality of variables distribution was checked and found satisfactorily. RESULTS Most of the subjects had an untreated component of metabolic syndrome. There was a correlation between BP values, age, and percent body fat. BP was regulated only to a certain degree by fatness and age, with the influence being relatively small. Our results showed that BP was more influenced by fatness than age, and body fatness was more related to higher systolic than to diastolic BP. CONCLUSIONS Age and fatness could explain BP values by only 3-30%, although BP was more influenced by fatness than by age. Nurse practitioners can effectively detect and motivate people with metabolic syndrome.
Collapse
Affiliation(s)
- Mária Boledovičová
- Constantine the Philosopher University, Faculty of Social Sciences and Health Care Nitra, Slovakia
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Lê J, Dallongeville J, Wagner A, Arveiler D, Haas B, Cottel D, Simon C, Dauchet L. Attitudes toward healthy eating: a mediator of the educational level–diet relationship. Eur J Clin Nutr 2013; 67:808-14. [DOI: 10.1038/ejcn.2013.110] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 11/09/2022]
|
46
|
Tuppin P, Ricci-Renaud P, de Peretti C, Fagot-Campagna A, Gastaldi-Menager C, Danchin N, Alla F, Allemand H. Antihypertensive, antidiabetic and lipid-lowering treatment frequencies in France in 2010. Arch Cardiovasc Dis 2013; 106:274-86. [PMID: 23769402 DOI: 10.1016/j.acvd.2013.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/28/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The frequencies of treatment for cardiovascular risk factors are poorly documented in large populations, particularly according to the presence or absence of cardiovascular disease (CVD). AIMS To assess frequencies of reimbursements for antihypertensive, lipid-lowering and antidiabetic medications in France among national health insurance beneficiaries in 2010 and their associations according to age, sex, French regions, level deprivation and the presence of certain CVD. METHODS Treatment frequencies were calculated among the beneficiaries (58 million people) on the basis of reimbursements for three specific categories of medicinal products in 2010. The presence of CVD was defined by a diagnosis associated with chronic disease status and hospital stays in 2010. RESULTS Among people aged greater or equal to 20years, treatment frequencies were 22% (men 20% vs. women 23%) for antihypertensives, 15% (14% vs. 16%) for lipid-lowering agents and 6% (6% vs. 5%) for antidiabetic medications. These frequencies were, respectively, 33%, 23% and 8% in patients aged greater or equal to 40years and 55%, 38% and 14% in patients aged greater or equal to 60 years. The frequency of at least one treatment for at least one of the three risk factors was 41% in patients aged greater or equal to 40 years and 66% in patients aged greater or equal to 60 years. Among patients aged greater or equal to 20 years, 22% were treated for at least one risk factor in the absence of CVD and 3% were treated for at least one risk factor in the presence of CVD. Regional differences were observed, with higher frequencies of antihypertensive and antidiabetic use in the North, North-East and Overseas regions. Treatment frequencies increased with level of deprivation, especially for antidiabetics. CONCLUSION This national study more clearly defines treatment frequencies and the populations and regions with the highest treatment frequencies.
Collapse
Affiliation(s)
- Philippe Tuppin
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Biino G, Parati G, Concas MP, Adamo M, Angius A, Vaccargiu S, Pirastu M. Environmental and genetic contribution to hypertension prevalence: data from an epidemiological survey on Sardinian genetic isolates. PLoS One 2013; 8:e59612. [PMID: 23527229 PMCID: PMC3603911 DOI: 10.1371/journal.pone.0059612] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/15/2013] [Indexed: 01/19/2023] Open
Abstract
Background and Objectives Hypertension represents a major cause of cardiovascular morbidity and mortality worldwide but its prevalence has been shown to vary in different countries. The reasons for such differences are still matter of debate, the relative contributions given by environmental and genetic factors being still poorly defined. We estimated the current prevalence, distribution and determinants of hypertension in isolated Sardinian populations and also investigated the environmental and genetic contribution to hypertension prevalence taking advantage of the characteristics of such populations. Methods and Results An epidemiological survey with cross-sectional design was carried out measuring blood pressure in 9845 inhabitants of 10 villages of Ogliastra region between 2002 and 2008. Regression analysis for assessing blood pressure determinants and variance component models for estimating heritability were performed. Overall 38.8% of this population had hypertension, its prevalence varying significantly by age, sex and among villages taking into account age and sex structure of their population. About 50% of hypertensives had prior cardiovascular disease. High blood pressure was independently associated with age, obesity related factors, heart rate, total cholesterol, alcohol consumption, low education and smoking status, all these factors contributing more in women than in men. Heritability was 27% for diastolic and 36% for systolic blood pressure, its contribution being significantly higher in men (57%) than in women (46%). Finally, the genetic correlation between systolic and diastolic blood pressure was 0.74, indicating incomplete pleiotropy. Conclusion Genetic factors involved in the expression of blood pressure traits account for about 30% of the phenotypic variance, but seem to play a larger role in men; comorbidities and environmental factors remain of predominant importance, but seem to contribute much more in women.
Collapse
Affiliation(s)
- Ginevra Biino
- Institute of Population Genetics, National Research Council of Italy, Sassari, Italy.
| | | | | | | | | | | | | |
Collapse
|
48
|
Bongard V, Dallongeville J, Arveiler D, Ruidavets JB, Amouyel P, Wagner A, Ferrières J. Attainment of low-density lipoprotein cholesterol target in the French general population according to levels of cardiovascular risk: Insights from the MONA LISA study. Arch Cardiovasc Dis 2013; 106:93-102. [PMID: 23527913 DOI: 10.1016/j.acvd.2012.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/08/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Controlling low-density lipoprotein (LDL)-cholesterol concentration is of tremendous importance to reduce cardiovascular risk. AIMS To investigate the attainment of LDL-cholesterol targets recommended in French and European guidelines on cardiovascular prevention, according to levels of cardiovascular risk. METHODS Participants aged 35 to 74 years (n=4609) were randomly selected from the general population of three French regions. A standardized data collection was performed to assess cardiovascular risk as described in the French and European guidelines. RESULTS Overall, 17.5% of participants were considered to be at high risk and 25.4% at high or very high risk, according to the French and European guidelines, respectively. Only 1.2% of participants with no cardiovascular risk factors according to the French guidelines had an LDL-cholesterol concentration above the recommended target, whereas 82.5% of high-risk subjects did not attain their goal (70.8% among high-risk subjects receiving lipid-lowering therapy). Among untreated people, the median reduction in LDL-cholesterol needed to reach target ranged from 6.6% (lowest-risk groups) to 36.0% (highest-risk subjects). When risk was classified according to the European guidelines, the majority of participants did not reach the recommended LDL-cholesterol targets, irrespective of their level of risk or lipid-lowering therapy. CONCLUSION In a majority of primary prevention candidates with multiple risk factors and in most high-risk subjects, LDL-cholesterol targets recommended by French guidelines are not being achieved, either because of insufficient treatment or because subjects are not recognized as being at risk. More stringent targets proposed by the European guidelines are not being achieved in most cases.
Collapse
Affiliation(s)
- Vanina Bongard
- Département d'épidémiologie, économie de la santé et santé publique, UMR1027 Inserm, université Toulouse 3, Toulouse, France
| | | | | | | | | | | | | |
Collapse
|
49
|
Graciani A, León-Muñoz LM, Guallar-Castillón P, Rodríguez-Artalejo F, Banegas JR. Cardiovascular Health in a Southern Mediterranean European Country. Circ Cardiovasc Qual Outcomes 2013; 6:90-8. [DOI: 10.1161/circoutcomes.112.967893] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
There are no published data on cardiovascular health from a national representative sample in a European country.
Methods and Results—
Data were taken from a cross-sectional study among 11 408 persons representative of the Spanish population ≥18 years of age during 2008 to 2010. Information was collected at participants’ homes through structured questionnaires, physical examination, and fasting blood samples, which were centrally analyzed. The American Heart Association has defined ideal cardiovascular health as the simultaneous presence of 4 health behaviors (nonsmoking, body mass index <25 kg/m
2
, physical activity at goal, and diet consistent with current recommendations) and 4 health factors (nonsmoking, untreated total cholesterol <200 mg/dL, untreated blood pressure <120/80 mm Hg, and untreated fasting glucose <100 mg/dL) in the absence of clinical cardiovascular disease and diabetes mellitus. Only 0.2% of subjects attained ideal values for all 7 cardiovascular disease health metrics and 3.4% and 15.3% for at least 6 and 5 metrics, respectively. The percentage of subjects who achieved the 4 ideal lifestyles was lower than that for the 4 ideal health factors (0.7% versus 8.1%). Lack of ideal diet was the most frequent health metrics (88.9%). In general, ideal levels of cardiovascular disease health metrics were more frequent in younger subjects, women, and those with higher education.
Conclusion—
Cardiovascular health in Spain is poor, particularly lifestyles. This illustrates the low effectiveness of public health efforts addressing cardiovascular prevention and the need to improve preventive healthcare services. Given that coronary mortality in Spain is low compared with other Western countries, the factors responsible for this situation should be investigated.
Collapse
Affiliation(s)
- Auxiliadora Graciani
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ–CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Luz M. León-Muñoz
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ–CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pilar Guallar-Castillón
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ–CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ–CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - José R. Banegas
- From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ–CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| |
Collapse
|
50
|
Prevalence, awareness, treatment and control of hypertension in adults with diagnosed diabetes: the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). J Hum Hypertens 2012; 27:381-7. [PMID: 23223084 DOI: 10.1038/jhh.2012.56] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We evaluated the prevalence, awareness, treatment and control of hypertension in Korean adults with diagnosed diabetes using nationally representative data. Among subjects aged ≥30 years who participated in the Fourth Korea National Health and Nutrition Examination Survey in 2007 and 2008, a total of 745 subjects (336 men and 409 women) with a previous diagnosis of diabetes mellitus were analyzed. The prevalence of hypertension in adults with diagnosed diabetes was 55.5%. The rates of awareness, treatment and control were 88.0, 94.2, and 30.8%, respectively. Compared with the general population, the prevalence of hypertension in adults with diagnosed diabetes was higher in all age groups in both genders. Factors independently associated with a high prevalence of hypertension included being male, increasing age, single, <9 years of education, the presence of chronic kidney disease risk, hypercholesterolemia (≥240 mg dl(-1)) and high body mass index (≥25 kg m(-2)). Regular medical screening was positively associated with hypertension control, whereas a high triglyceride level (≥150 mg dl(-1)) was inversely associated. A high prevalence and a low control rate of hypertension in adults with diagnosed diabetes suggest that stringent efforts are needed to control blood pressure in diabetic patients.
Collapse
|