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Suzuki Y, Kaneko H, Okada A, Komuro J, Mizuno A, Fujiu K, Jo T, Takeda N, Morita H, Nishiyama A, Yano Y, Node K, Yasunaga H, Komuro I. Awareness of Being Prescribed Antihypertensive Medications and Cardiovascular Outcomes. Circ J 2024; 88:1639-1646. [PMID: 38569871 DOI: 10.1253/circj.cj-24-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Hypertension is a major cause of cardiovascular disease (CVD). In patients with hypertension, unawareness of the disease often results in poor blood pressure control and increases the risk of CVD. However, data in nationwide surveys regarding the proportion of unaware individuals and the implications of such on their clinical outcomes are lacking. We aimed to clarify the association between unawareness of being prescribed antihypertensive medications among individuals taking antihypertensive medications and the subsequent risk of developing CVD. METHODS AND RESULTS This retrospective cohort study analyzed data from the JMDC Claims Database, including 313,715 individuals with hypertension treated with antihypertensive medications (median age 56 years). The primary endpoint was a composite of myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation. Overall, 19,607 (6.2%) individuals were unaware of being prescribed antihypertensive medications. During the follow-up period, 33,976 composite CVD endpoints were documented. Despite their youth, minimal comorbidities, and the achievement of better BP control with a reduced number of antihypertensive prescriptions, unawareness of being prescribed antihypertensive medications was associated with a greater risk of developing composite CVD. Hazard ratios of unawareness of being prescribed antihypertensive medications were 1.16 for myocardial infarction, 1.25 for angina pectoris, 1.15 for stroke, 1.36 for heart failure, and 1.28 for atrial fibrillation. The results were similar in several sensitivity analyses, including the analysis after excluding individuals with dementia. CONCLUSIONS Among individuals taking antihypertensive medications, assessing the awareness of being prescribed antihypertensive medications may help identify those at high risk for CVD-related events.
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Affiliation(s)
- Yuta Suzuki
- Department of Cardiovascular Medicine, The University of Tokyo
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Advanced Cardiology, The University of Tokyo
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo
| | - Jin Komuro
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Cardiology, Keio University School of Medicine
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Cardiovascular Medicine, St. Luke's International Hospital
- Leonard Davis Institute for Health Economics, University of Pennsylvania
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Advanced Cardiology, The University of Tokyo
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University
| | - Yuichiro Yano
- Department of General Medicine, Juntendo University Faculty of Medicine
- Department of Family Medicine and Community Health, Duke University
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo
- International University of Health and Welfare
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Mundagowa PT, Zambezi P, Muchemwa-Munasirei P. The prevalence and determinants of blood pressure control among hypertension patients in eastern Zimbabwe: A cross-sectional study. PLoS One 2024; 19:e0293812. [PMID: 38451890 PMCID: PMC10919662 DOI: 10.1371/journal.pone.0293812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/19/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Uncontrolled blood pressure (BP), also known as hypertension, is a leading cause of morbidity and mortality globally. Lowering the elevated BP can significantly reduce one's risk for cardiovascular diseases. This study aimed to ascertain the determinants of BP control among hypertension patients. METHODS The data analyzed were from the exploratory survey of the Home Management of Hypertension (HoMHyper) project in eastern Zimbabwe. Hypertension patients were selected from the Chronic Disease Registers of five public health clinics using simple random sampling. A pretested interviewer-administered questionnaire was used to collect data, and the patient's BP was measured. The primary outcome, BP control, was used as a categorical variable (controlled vs. uncontrolled) to conduct a bivariate analysis. Variables significant at p<0.2 were included in the multivariable logistic regression analysis to control for confounding. Statistical significance in the final model was set at p<0.05. RESULTS Data from 321 hypertension patients were analyzed; their mean age was 62.3±11.9 years. The prevalence of controlled BP was 41.4% (95% Confidence interval-CI = 36.0%-46.9%). After adjusting for confounding, patients' residence and medication stocks were associated with BP control. Patients who resided in high-density suburbs had higher odds of uncontrolled BP than those who resided in middle- and low-density suburbs (Adjusted odds ratios-AOR = 2.5; 95% CI = 1.4-4.4; p<0.01). Hypertension patients who experienced medication stockouts over the last six months had higher odds of uncontrolled BP than patients who did not experience stockouts (AOR = 1.8; 95% CI = 1.1-2.9). CONCLUSION BP control among hypertension patients was suboptimal. Patient residence and antihypertensive medication stockouts were independent predictors of blood pressure control. We recommend exploring sustainable financing through private-public partnerships to ensure the availability of subsidized antihypertensive medication.
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Affiliation(s)
- Paddington Tinashe Mundagowa
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Pemberai Zambezi
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
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Sivanantham P, Anandraj J, Mathan Kumar S, Essakky S, Gola A, Kar SS. Predictors of Control Status of Hypertension in India: A Systematic Review and Meta-analysis. JOURNAL OF PREVENTION (2022) 2024; 45:27-45. [PMID: 38087106 DOI: 10.1007/s10935-023-00756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
Predictors of hypertension (HTN) control status have not been well understood in India. This information is crucial for policymakers and program managers to devise newer HTN control strategies and implement relevant policies and programs. Therefore, we undertook this meta-analysis to estimate the effect of various factors on the control status of HTN in India. We systematically searched PubMed and Embase for observational studies and community-based trials published between April 2013 and March 2021 conducted among people (≥ 15 years) with hypertension in India. Quality of studies was assessed using Newcastle Ottawa (NO) scale. Meta-analysis was performed using random effects model. We reported the effect of various factors on the prevalence of controlled HTN using pooled odds ratio (OR) with 95% confidence interval (CI). Of the 842 studies screened, we analyzed nine studies that included 2,441 individuals. Based on the NO scale, majority (90%) of studies had a low risk of bias. The odds of having controlled HTN were significantly higher among women (OR 1.78, 95% CI 1.62-1.95), those aged > 45 years (OR 1.69, 95% CI 1.44-1.97), and those residing in urban parts of India (OR 1.74; 95% CI 1.48-2.03). These measures varied considerably across different regions of the country. Very few studies reported data on the relationship between behavioural risk factors of non-communicable diseases (NCDs) and HTN control status. We did not find any statistically significant differences between behavioural risk factors of NCDs and HTN control status. To improve HTN control in India, the ongoing/newer HTN control programs need to target men, those aged 15-45, and rural residents. Future studies on HTN control determinants should report disaggregated data and use standardized definitions for behavioral risk factors to enhance reliability and comprehensiveness of findings on the determinants of HTN control in future reviews.
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Affiliation(s)
- Parthibane Sivanantham
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeyanthi Anandraj
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Mathan Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Saravanan Essakky
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anurag Gola
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
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Lamloum D, Fassio F, Osetinsky B, Tediosi F. Care Cascades for Hypertension in Low-Income Settings: A Systematic Review and Meta-Analysis. Int J Public Health 2023; 68:1606428. [PMID: 37901590 PMCID: PMC10600349 DOI: 10.3389/ijph.2023.1606428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objective: High blood pressure is the leading risk factor for cardiovascular disease. The hypertension care cascade (HCC) is increasingly being used to evaluate the effectiveness of interventions. This systematic review aims to examine HCC in low-income settings. Methods: The search strategy included articles published between January 2010 and April 2023. We excluded studies with incomplete HCC, on fragile patients or aged <18 years, reviews. We used the MOOSE guideline. Five researchers retrieved data on the survey year, country, population, HCC and diagnostic methods for hypertension. We used JBI Critical Appraisal Tools for quality assessment. Results: Ninety-five articles were analyzed. Average hypertension prevalence was 33% (95% CI: 31%-34%), lower in LICs than in LMICs (25% vs. 34%). The overall mean awareness of hypertension was 48% (95% CI: 45%-51%), its treatment was 35% (95% IC: 32%-38%) and its control 16% (95% CI: 14%-18%). In almost all steps, percentages were lower in LICs and in Sub-Saharan Africa. Conclusion: Trends in HCC vary between countries, with poorer performance in LICs. This review highlights the need for interventions tailored to low-income settings in order to improve hypertension care.
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Affiliation(s)
- Demetrio Lamloum
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Brianna Osetinsky
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Kumar SM, Anandraj J, Sivanatham P, Essakky S, Nain J, Talukdar R, Loganathan V, Kar SS. Control status of hypertension in India: systematic review and meta-analysis. J Hypertens 2023; 41:687-698. [PMID: 36883453 DOI: 10.1097/hjh.0000000000003381] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND AND AIMS Uncontrolled hypertension is a major risk factor for cardiovascular diseases (CVDs). The present study aimed to conduct a systematic review and meta-analysis to estimate the pooled prevalence of control status of hypertension in India. METHODS AND RESULTS We carried out systematic search (PROSPERO No.: CRD42021239800) in PubMed and Embase published between April 2013 and March 2021 followed by meta-analysis with random-effects model. The pooled prevalence of controlled hypertension was estimated across geographic regions. The quality, publication bias and heterogeneity of the included studies were also assessed. We included 19 studies with 44 994 hypertensive population, among which 17 studies had low risk of bias. We found statistically significant heterogeneity ( P ≤ 0.05) and absence of publication bias among the included studies. The pooled prevalence of control status among patients with hypertension was 15% (95% CI: 12-19%) and among those under treatment was 46% (95% CI: 40-52%). The control status among patients with hypertension was significantly higher in Southern India 23% (95% CI: 16-31%) followed by Western 13% (95% CI: 4-16%), Northern 12% (95% CI: 8-16%), and Eastern India 5% (95% CI: 4-5%). Except for Southern India, the control status was lower among the rural areas compared with urban areas. CONCLUSION We report high prevalence of uncontrolled hypertension in India irrespective of treatment status, geographic regions and urban and rural settings. There is urgent need to improve control status of hypertension in the country.
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Affiliation(s)
- S Mathan Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Yeh EJ, Grigolon RB, Rodrigues SR, A Bueno AP. Systematic literature review and meta-analysis of cardiovascular risk factor management in selected Asian countries. J Comp Eff Res 2023; 12:e220085. [PMID: 36861459 PMCID: PMC10402804 DOI: 10.57264/cer-2022-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Abstract
Aim: There is a need to understand the management status of hypertension, dyslipidemia/hypercholesterolemia, and diabetes mellitus in the Asia-Pacific region (APAC). Methods: We conducted a systematic literature review and meta-analysis to summarize the awareness, treatment, and/or control rates of these risk factors in adults across 11 APAC countries/regions. Results: We included 138 studies. Individuals with dyslipidemia had the lowest pooled rates compared with those with other risk factors. Levels of awareness with diabetes mellitus, hypertension, and hypercholesterolemia were comparable. Individuals with hypercholesterolemia had a statistically lower pooled treatment rate but a higher pooled control rate than those with hypertension. Conclusion: The management of hypertension, dyslipidemia, and diabetes mellitus was suboptimal in these 11 countries/regions.
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Modifiable and Non-modifiable Factors Associated with Low Awareness of Hypertension Treatment in Indonesia: A Cross-Sectional Population-Based National Survey. Glob Heart 2022; 17:56. [PMID: 36051316 PMCID: PMC9389957 DOI: 10.5334/gh.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Low awareness about hypertension treatment is recognized as a significant cause of treatment failure. Therefore, identifying its underlying factors is essential for developing effective intervention strategies. This study aims to identify the modifiable and non-modifiable factors associated with low awareness about hypertension treatment. Method: This national, cross-sectional, population-based survey used publicly available data from the Indonesian Family Life Survey (IFLS-5) for 2014 among respondents with hypertension aged ≥15 years. Depression and insomnia, as modifiable factors, were assessed using the Centre for Epidemiologic Studies—Depression (CES-D) and the Patient-Recorded Outcomes Measurement Information System (PROMIS) questionnaire, respectively. Non-modifiable factors, such as sociodemographic information, were obtained from self-reported data. Logistic regression analysis was used to assess the association between these factors and low awareness about hypertension treatment. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Result: The study recruited 7,920 respondents, the majority of whom were female (53.8%) and aged <60 years (71.1%). The prevalence of low awareness of hypertension treatment was 87.1% (51.8% in women and 48.2% in men). Being an elderly (OR: 1.60, 95%CI 1.36–1.88), being irregularly blood pressure control (OR: 4.40, 95% CI 3.78–5.13), having depressive symptoms (OR: 1.35, 95% CI 1.12–1.62), having insomnia (OR: 1.31, 95% CI 1.11–1.53), and having low satisfaction with health care (OR: 1.28, 95% CI 1.08–1.51) were associated with low awareness of hypertension treatment. Surprisingly, respondents with strong religiosity (OR: 1.62; 95% CI 1.25–2.09) were more likely to display low awareness of hypertension treatment. Conclusion: The main factors associated with low awareness of hypertension treatment are modifiable. Thus, health care professionals should integrate more patient-specific factors when designing tailored interventions.
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Thakre S, Anjankar A, Singh A, Kumar T. National Hypertension Guidelines: A Review of the India Hypertension Control Initiative (IHCI) and Future Prospects. Cureus 2022; 14:e27997. [PMID: 36134089 PMCID: PMC9469808 DOI: 10.7759/cureus.27997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/14/2022] [Indexed: 11/05/2022] Open
Abstract
Hypertension is a silent killer; however, the treatment of hypertension is simple, effective, readily available, and needs to be continued lifelong. It is a significant health problem that is included under the umbrella of non-communicable disease conditions and has a strong alliance with cardiovascular morbidity and mortality. The India Hypertension Control Initiative (IHCI) is an extensive program in India that involves the Indian Council of Medical Research, the Ministry of Health and Family Welfare (Government of India), the state governments of India, and World Health Organization Country Office for India (WHO-India). The IHCI is a multi-partner initiative carried forward systemically across various states. The states are categorized into Grade I and Grade II. There is the involvement of specialized teams of cardiovascular experts and health officials to insure precise execution and seamless healthcare service. The implementation of the free and easy-to-use mobile application and software, Simple (Resolve to Save Lives, New York City, United States), in the analysis and storage of data, is a novel step taken to insure safe record keeping and follow-ups. Emphasis is on the adoption of demography-specific interventional methods and drugs, and proper acquisition and storage of these drugs is the key step. Treatment modalities involve the adoption of medicines and lifestyle modifications as a combined recipe. Advancements have been made in the area of drug development like gene therapies but they seem to show low success rates at the given moment. Adoption of lifestyle modifications along with medications is the gold standard treatment option. This review article aims to shed light on the current status of IHCI, its milestones, and the future of the initiative in India.
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Social determinants of hypertension in high-income countries: A narrative literature review and future directions. Hypertens Res 2022; 45:1575-1581. [PMID: 35859023 PMCID: PMC9296364 DOI: 10.1038/s41440-022-00972-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
Hypertension is a leading cause of cardiovascular disease and despite established strategies to lower blood pressure, the control of hypertension remains poor. This is true even in high-income countries with well-established welfare and medical systems. Among the social factors associated with hypertension (i.e., social determinants of hypertension, SDHT), individual socioeconomic status (SES), including education, income, and occupation, can be crucial for hypertension management (prevalence, awareness, treatment, and control). This article reviews the findings of recently published studies that examined the association between SES and hypertension management in high-income countries. It also discusses social prescribing, which targets social isolation and loneliness as modifiable SDHT to improve hypertension management. Conceptual framework of social determinants of hypertension![]()
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Prasad GVR, Bhamidi V. Managing cardiovascular disease risk in South Asian kidney transplant recipients. World J Transplant 2021; 11:147-160. [PMID: 34164291 PMCID: PMC8218347 DOI: 10.5500/wjt.v11.i6.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/12/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.
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Affiliation(s)
- G V Ramesh Prasad
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
| | - Vaishnavi Bhamidi
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
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Man REK, Gan AHW, Fenwick EK, Gan ATL, Gupta P, Sabanayagam C, Tan N, Wong KH, Wong TY, Cheng CY, Lamoureux EL. Prevalence, determinants and association of unawareness of diabetes, hypertension and hypercholesterolemia with poor disease control in a multi-ethnic Asian population without cardiovascular disease. Popul Health Metr 2019; 17:17. [PMID: 31806040 PMCID: PMC6896313 DOI: 10.1186/s12963-019-0197-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/06/2019] [Indexed: 01/08/2023] Open
Abstract
Background To explore the prevalence and determinants of unawareness of diabetes, hypertension and hypercholesterolemia and its association with poor disease control in a multi-ethnic Asian population without cardiovascular disease (CVD). Methods We included 6904 Chinese, Malay and Indian individuals (mean age [SD] 58.2 [10.2] years; 52.6% female) with diabetes, hypertension and/or hypercholesterolemia from the cross-sectional population-based Singapore Epidemiology of Eye Diseases study (2004–2011). Diabetes was defined as random blood glucose ≥ 11.1 mmol/L or HbA1c > 6.5% or self-reported use of diabetes medication; hypertension as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or self-reported use of anti-hypertensive treatment; and hypercholesterolemia as total cholesterol ≥ 6.2 mmol/L or self-reported use of lipid-lowering medications. Unawareness was based on participants’ answers to the questions: “Did your medical practitioner ever tell you that you have diabetes/hypertension/high cholesterol?” The determinants of unawareness, and its association with poor disease control, were assessed using multivariable binary logistic regression models adjusted for known potential confounders. Results Of the 2380 (34.5%), 5386 (78.0%) and 3607 (52.2%) with diabetes, hypertension and hypercholesterolemia, respectively, unawareness rates were 30.7%, 43.1% and 40.9%, respectively. Having a higher BMI, particularly if obese, and Malay ethnicity were associated with greater unawareness of diabetes; Malay and Indian ethnicities and current smoking with greater unawareness of hypertension; and education ≤6 years, current smoking, and blue collar jobs or unemployment with greater unawareness of hypercholesterolemia (all P < 0.05). Lack of awareness of each condition was independently associated with poorer disease control in the case of hypertension and hypercholesterolemia, while the converse was true for diabetes (all P < 0.05). Conclusions Unawareness of diabetes, hypertension, or hypercholesterolemia is high in Singapore, with risk factors varying across all three diseases, although Malay ethnicity is a consistent one. Unawareness was also associated with poor management for hypertension and hypercholesterolemia. Public health education and screening programs should target at-risk individuals, especially Malays, to reduce the likelihood of incident CVD.
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Affiliation(s)
- Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Alvin Hong Wei Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Alfred Tau Liang Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Nicholas Tan
- National University of Singapore, Singapore, Singapore
| | - Kah Hie Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,National University of Singapore, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,National University of Singapore, Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,National University of Singapore, Singapore, Singapore.
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Awareness of hypertension and related factors in northeastern China: a cross-sectional study. J Hum Hypertens 2019; 34:43-50. [PMID: 31548618 DOI: 10.1038/s41371-019-0263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/26/2019] [Accepted: 07/17/2019] [Indexed: 12/13/2022]
Abstract
Timely awareness of hypertension is among the most crucial components in reducing the burden of hypertension. However, there is limited information about the awareness of hypertension in northern China. Therefore, in this cross-sectional study, we aimed to investigate the awareness of hypertension and its associated factors in the Jilin province in China; the study was conducted between July 2014 and December 2015 in four cities and four rural counties in the Jilin province as part of a national study. A stratified multistage random-sampling method was used to select a representative sample: a total of 15,206 participants aged ≥15 years were initially recruited, among which 14,956 were finally included in the survey. The awareness of hypertension in the Jilin province was found to be 42.3%. Moreover, the awareness of hypertension was associated with age, sex, region, marital status, body mass index, and family history of hypertension or coronary artery disease. Employment was associated with a lower awareness in rural areas, whereas high education was associated with a higher awareness in urban areas. Policies targeting specific subgroups may be helpful in increasing the awareness of hypertension in the Jilin province.
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Teshome DF, Demssie AF, Zeleke BM. Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia. PLoS One 2018; 13:e0196535. [PMID: 29718964 PMCID: PMC5931630 DOI: 10.1371/journal.pone.0196535] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Controlling blood pressure (BP) leads to significant reduction in cardiovascular risks and associated deaths. In Ethiopia, data is scarce about the level and determinants of optimal BP control among hypertensive patients. This study aimed to assess the prevalence and associated factors of optimal BP control among hypertensive patients attending at a district hospital. METHODS A hospital-based, cross-sectional study was conducted among 392 hypertensive patients who were on treatment and follow-up at a district hospital. A structured questionnaire adopted from WHO approach was prepared to collect the data. Medication adherence was measured by the four-item Morisky Green Levine Scale, with a score ≥3 defined as "good adherence". Blood pressure was measured, and optimal BP control was 0DEFined as systolic BP < 140 mmHg and diastolic BP<90 mmHg. Both binary and multivariable logistic regressions models were fitted to identify correlates of optimal BP control. All statistical tests were two-sided and a p values <0.05 was considered for statistical significance. RESULTS The mean age of the participants was 58 years (SD±13 years). Over half (53.8%) were females. Three quarters (77.3%) of the participants were adherent to their medications. The overall proportion of participants with optimally controlled BP was 42.9%.Female sex (Adjusted Odd Ratio(AOR) = 1.94, 95% CI: 1.15, 3.26), age older than 60 years (AOR = 2.95, 95% CI: 1.18, 7.40), consumption of vegetables on most days of the week (AOR = 2.16, 95% CI: 1.25, 3.73), physical activity (AOR = 4.85, 95% CI: 2.39, 9.83), and taking less than three drugs per day (AOR = 3.04, 95% CI: 1.51, 6.14) were positively associated with optimally controlled BP. Poor adherence to medications (AOR = 0.18, 95% CI: 0.09, 0.35), having asthma comorbidity (AOR = 0.33, 95% CI:0.12, 0.88) and use of top added salt on a plate (AOR = 0.20, 95% CI:0.11, 0.36) were negatively associated with optimal BP control. CONCLUSION A higher proportion of hypertensive patients remain with un-controlled BP. Modifiable risk factors including poor adherence to medications, lack of physical exercise, adding salt into meals, being on multiple medications and comorbidities were significantly and independently associated with poor BP control. Evidence-based, adherence-enhancing and healthy life style interventions should be implemented.
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Affiliation(s)
- Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Amsalu Feleke Demssie
- Department of Health Service Management and Health Economics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Berihun Megabiaw Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
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Wu J, Li T, Song X, Sun W, Zhang Y, Liu Y, Li L, Yu Y, Liu Y, Qi C, Liu B. Prevalence and distribution of hypertension and related risk factors in Jilin Province, China 2015: a cross-sectional study. BMJ Open 2018; 8:e020126. [PMID: 29599392 PMCID: PMC5875623 DOI: 10.1136/bmjopen-2017-020126] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/15/2018] [Accepted: 02/21/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the prevalence and distribution of hypertension and its related factors in Jilin province, China. DESIGN A cross-sectional study in four cities and four rural counties in Jilin as part of a national Chinese study. PARTICIPANTS AND SETTING A total of 15 206 participants who were ≥15 years old and were selected using a stratified multistage random sampling method. MAIN OUTCOME MEASURES The prevalence of hypertension. RESULTS The prevalence of hypertension in Jilin province was 24.7%. Moreover, the prevalence of hypertension increased with age in both sexes, and was higher in men than in women. The modifiable factors that were associated with hypertension were body mass index, smoking and alcohol drinking. The risk factors identified are similar to those in southern China, except smoking, which has no association with hypertension prevalence in the South. CONCLUSIONS Age, sex, body mass index, smoking and alcohol drinking were risk factors of hypertension. Control of these related risk factors, especially smoking, may be helpful in the treatment and management of hypertension in Jilin province.
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Affiliation(s)
- Junduo Wu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Tianyi Li
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Xianjing Song
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Wei Sun
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Yangyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yingyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Longbo Li
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Yunpeng Yu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Yihang Liu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Chao Qi
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Bin Liu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
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Abstract
Hypertension (HTN) is a chronic medical condition that commonly affects the aging population worldwide. The prevalence of HTN is increasing in developing countries and is one of the leading causes of death in older individuals. HTN results from a complex interplay of genetic and environmental factors. Besides, HTN can result in various other health complications such as stroke and chronic kidney diseases, if not treated. Although various studies have explained the underlying mechanisms in the pathogenesis of HTN, limited information is available on their biomarkers. MicroRNAs (miRNAs) are RNA molecules that have been recognized as key regulators for HTN. miR-21 is a common microRNA that is has been reported to be significantly upregulated in HTN individuals. Hence, miR-21 can be a potential therapeutic target for HTN. The number of studies related to miR-21 on hypertension is limited. Therefore, the main thrust of this paper is to provide an overview of the current clinical evidence and significance of miR-21 in HTN.
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Social disparities explain differences in hypertension prevalence, detection and control in Colombia. J Hypertens 2017; 34:2344-2352. [PMID: 27662189 DOI: 10.1097/hjh.0000000000001115] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Hypertension is the principal risk factor for cardiovascular diseases. The global Prospective Urban Rural Epidemiology study showed that the levels of awareness, treatment and control of this condition are very low worldwide and show large regional variations related to a country's income index. The aim of the present analysis was to identify associations between sociodemographic, geographic, anthropometric, behavioral and clinical factors and the awareness, treatment and control of hypertension within Colombia - a high-middle income country which participated in the global Prospective Urban Rural Epidemiology study. METHODS AND RESULTS The sample comprised 7485 individuals aged 35-70 years (mean age 50.8 years, 64% women). Mean SBP and DBP were 129.12 ± 21.23 and 80.39 ± 11.81 mmHg, respectively. The overall prevalence of hypertension was 37.5% and was substantially higher amongst participants with the lowest educational level, who had a 25% higher prevalence (<0.001). Hypertension awareness, treatment amongst those aware, and control amongst those treated were 51.9, 77.5 and 37.1%, respectively. The prevalence of hypertension was higher amongst those with a higher BMI (<0.001) or larger waist-hip ratio (<0.001). Being male, younger, a rural resident and having a low level of education was associated with significantly lower hypertension awareness, treatment and control. The use of combination therapy was very low (27.5%) and was significantly lower in rural areas and amongst those with a low income. CONCLUSION Overall Colombia has a high prevalence of hypertension in combination with very low levels of awareness, treatment and control; however, we found large variations within the country that appear to be associated with sociodemographic disparities.
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박지은, 김홍수, Sung-il Cho, 류연희. Factors Associated with Controlled Hypertension by Sex and Macro Level: A Systematic Review. ACTA ACUST UNITED AC 2016. [DOI: 10.15709/hswr.2016.36.2.581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Prevalence, Awareness, Treatment, Control and Risk Factors Associated with Hypertension among Adults in Southern China, 2013. PLoS One 2016; 11:e0146181. [PMID: 26784948 PMCID: PMC4718602 DOI: 10.1371/journal.pone.0146181] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/13/2015] [Indexed: 12/05/2022] Open
Abstract
To investigate the prevalence, awareness, treatment, control of hypertension and their associated factors in southern China. A cross-sectional survey was conducted in 5 cities of urban areas and 5 counties of rural areas in Southern China in 2013, a stratified multistage random sampling method was used to select a representative sample. Recruitment included a total of 19254 participants aged 15 or older. Socio-demographic profiles, examinations were administrated on each subject. Multilevel logistic regression models were used to identify the risk factors of hypertension, awareness, treatment, and control. Overall, the prevalence of hypertension and pre-hypertension are 24.59% and 32.11%, respectively in southern China. Among all the hypertensive patients, 67.43% were aware of their condition, 55.76% took anti-hypertension medication recent two weeks, and 30.79% had their blood pressure controlled. Compared with male, female hypertensive patients had higher rates of hypertension awareness, treatment and control. Age, gender, marital status, living areas, education, BMI, waist circumference, visceral adipose index (VAI), high body fat percentage (BFP) and family hypertension history correlated with the prevalence of hypertension. SBP/DBP increased with VAI and BFP increasing. There is an increasing prevalence of hypertension and high pre-hypertension in the general population in southern China, but levels of awareness, treatment, and control remain relatively low, especially for young and middle-aged population. Innovative strategies including of adopting appropriate anti-hypertensive medication therapy and healthy lifestyles should be taken.
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Fallah Z, Kelishadi R, Heshmat R, Motlagh ME, Ardalan G, Kasaeian A, Asayesh H, Qorbani M. A nationwide report on blood pressure of children and adolescents according to socioeconomic status: The CASPIAN-IV study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:646-55. [PMID: 26622253 PMCID: PMC4638066 DOI: 10.4103/1735-1995.166210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Hypertension is a major leading factor for global burden of diseases. Blood pressure (BP) tracks from childhood to adulthood. So, it is important to investigate its aff ecting factors. In this study we aimed to compare the BP status in the Iranian pediatric population according to the socioeconomic status (SES) of their living area. Materials and Methods: In this nationwide study, a representative sample of 14,880 students, aged 6-18 years was chosen by multistage random cluster sampling from 30 provinces in Iran. Anthropometric indices and BP were measured. A validated questionnaire, including the questions of the World Health Organization Global School-based Student Health Survey was completed. Findings were compared across the four regions of the country, categorized based on their elevating SES: Southeast, north-northeast, west, and central. Results: Participants consisted of 13,486 children and adolescents, that is, a participation rate of 90.6%, composed of 49.2% girls and 75.6% urban residents. The mean (standard deviation) age of participants was 12.47 (3.36) years. The region with highest SES (central) had the lowest rate of high BP (HBP), that is, 3.0% (95% of confidence interval [CI]: 2.4-3.9), and the region with lowest SES (southeast) had the highest rate, that is, 7.4% (4.4-12.2). The mean (95% CI) values of systolic BP for the four regions from lowest to highest SES were 100.5 (99.6-101.3), 100.9 (100.3-101.4), 101.7 (101.3-102), and 101.7 (101.2-102.1) mmHg. The corresponding mean Diastolic BP values were as follows: 65.4 (64.6-66.1), 63.4 (62.9-63.8), 65.6 (65.3-65.8), and 64.4 (64.0-64.7) mmHg. Conclusion: We found significant differences in mean BP and the frequency of HBP according to the SES of the living area. Further studies are necessary to find the underlying factors resulting in such differences.
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Affiliation(s)
- Zahra Fallah
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran ; Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Gelayol Ardalan
- Department of School Health, Bureau of Population, Family and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Amir Kasaeian
- Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Noncommunicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran ; Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Composite Measures of Individual and Area-Level Socio-Economic Status Are Associated with Visual Impairment in Singapore. PLoS One 2015; 10:e0142302. [PMID: 26555141 PMCID: PMC4640712 DOI: 10.1371/journal.pone.0142302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/20/2015] [Indexed: 12/18/2022] Open
Abstract
Purpose To investigate the independent relationship of individual- and area-level socio-economic status (SES) with the presence and severity of visual impairment (VI) in an Asian population. Methods Cross-sectional data from 9993 Chinese, Malay and Indian adults aged 40–80 years who participated in the Singapore Epidemiology of eye Diseases (2004–2011) in Singapore. Based on the presenting visual acuity (PVA) in the better-seeing eye, VI was categorized into normal vision (logMAR≤0.30), low vision (logMAR>0.30<1.00), and blindness (logMAR≥1.00). Any VI was defined as low vision/blindness in the PVA of better-seeing eye. Individual-level low-SES was defined as a composite of primary-level education, monthly income<2000 SGD and residing in 1 or 2-room public apartment. An area-level SES was assessed using a socio-economic disadvantage index (SEDI), created using 12 variables from the 2010 Singapore census. A high SEDI score indicates a relatively poor SES. Associations between SES measures and presence and severity of VI were examined using multi-level, mixed-effects logistic and multinomial regression models. Results The age-adjusted prevalence of any VI was 19.62% (low vision = 19%, blindness = 0.62%). Both individual- and area-level SES were positively associated with any VI and low vision after adjusting for confounders. The odds ratio (95% confidence interval) of any VI was 2.11(1.88–2.37) for low-SES and 1.07(1.02–1.13) per 1 standard deviation increase in SEDI. When stratified by unilateral/bilateral categories, while low SES showed significant associations with all categories, SEDI showed a significant association with bilateral low vision only. The association between low SES and any VI remained significant among all age, gender and ethnic sub-groups. Although a consistent positive association was observed between area-level SEDI and any VI, the associations were significant among participants aged 40–65 years and male. Conclusion In this community-based sample of Asian adults, both individual- and area-level SES were independently associated with the presence and severity of VI.
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Yang L, Xu X, Yan J, Yu W, Tang X, Wu H, Parkin CL. Analysis on associated factors of uncontrolled hypertension among elderly hypertensive patients in Southern China: a community-based, cross-sectional survey. BMC Public Health 2014; 14:903. [PMID: 25178313 PMCID: PMC4247067 DOI: 10.1186/1471-2458-14-903] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 08/21/2014] [Indexed: 01/08/2023] Open
Abstract
Background The prevalence of hypertension in China has risen dramatically in recent decades, but it is not well understood if hypertension is adequately controlled in the elderly population in Southern China. A provincial survey was performed in order to estimate the prevalence of hypertension control and the associated factors in the elderly population. Methods A cross-sectional survey was conducted in 6 community health service centers across 12 counties in Southern China from October 2010 to April 2011. Recruitment included a total of 10644 hypertensive subjects aged 60 or older. Basic lab tests and physical examinations were administrated on each subject. In addition, each subject completed a standardized questionnaire. Results The 10644 participants (mean age of 70.3 years) included 5527 women (51.9%), 5117 men (48.1%), 3148 overweight subjects (29.57%), 846 (7.95%) obese subjects, 1654 smokers (15.54%) and 1750 consumers of alcohol (16.44%). The control, treatment and awareness of hypertension were 44.6%, 50.3% and 46.3%, respectively. Most treated hypertensives (68.57%) used combination therapy of antihypertensive medications, and those using long-acting antihypertensive medications had a higher rate of adequately controlled hypertension. Results showed that elderly, living in rural and suburban areas, low education level, family history of hypertension, smoking, excessive salt consumption, lack of physical activity, overweight, obese and diabetes were associated with uncontrolled hypertension. Conclusions Lack of adequate hypertension control is relatively high among the elderly in Southern China. Hypertension awareness and early treatment are needed in this population, especially among suburban population, as well as adopting appropriate antihypertensive medication therapy and healthy lifestyles. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-903) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Xiaoling Xu
- Zhejiang provincial center for cardio-cerebrovascular diseases control and prevention, Zhejiang hospital, 12 Lingyin Road, Hangzhou, Zhejiang 310013, China.
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Yu S, Guo X, Yang H, Zheng L, Sun Y. An update on the prevalence of metabolic syndrome and its associated factors in rural northeast China. BMC Public Health 2014; 14:877. [PMID: 25159694 PMCID: PMC4153886 DOI: 10.1186/1471-2458-14-877] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/29/2014] [Indexed: 01/08/2023] Open
Abstract
Background The last study reported the prevalence of Metabolic Syndrome (MetS) in rural Northeast China was conducted approximately ten years ago. We aimed to update the data on the prevalence and epidemiological features of MetS in rural Northeast China. Methods This survey was conducted from July 2012 to August 2013. In this study, a total of 11,496 residents from the rural Northeast China were randomly selected and examined. MetS was defined according to the ATPIII-modified criteria. Data regarding the demographic and lifestyle characteristics and the blood biochemical indexes of these participants were collected by well-trained personnel. Results The prevalence of MetS was 39.0% and was more prevalent in women than in men (45.6% vs. 31.4%, P < 0.001). Elevated blood pressure was the most common metabolic disorder in both genders (71.7% in males and 63.3% in females). Only 11.2% and 9.6% of males and females, respectively, in this study had no metabolic disorders. Multivariate logistic regression, after adjusting for possible confounders, revealed the following factors that increased the risk of MetS: being female, older age, having more than one child, a family income of >20,000 CNY per year, longer sleep duration (>9 h/d), chronic disease status, frequent consumption of beans or bean products and frequent tea drinking. Completion of education through middle school, moderate physical activity and smoking were correlated with lower rates of MetS. Conclusion The prevalence of MetS was high in the rural areas of China, especially among females. In addition to some of the more conventional risk factors associated with MetS, including age, sex, annual income and educational status, we also found that having more than one child and frequent consumption of tea and beans were risk factors for MetS, while smoking was a common factor among those that did not have MetS in rural Northeast China.
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Affiliation(s)
| | | | | | | | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, 110001 Shenyang, Liaoning, China.
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Busingye D, Arabshahi S, Subasinghe AK, Evans RG, Riddell MA, Thrift AG. Do the socioeconomic and hypertension gradients in rural populations of low- and middle-income countries differ by geographical region? A systematic review and meta-analysis. Int J Epidemiol 2014; 43:1563-77. [PMID: 24867304 DOI: 10.1093/ije/dyu112] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Of the 1 billion people with hypertension globally, two-thirds reside in low- and middle-income countries (LMICs). The risk of hypertension in LMICs is thought to be positively associated with socioeconomic status (SES). However, recent studies have provided data inconsistent with this concept. Thus, we assessed the association between SES and hypertension in rural populations of LMICs. Further, we explored whether this association differs according to geographical region. METHODS Through a search of databases we identified population-based studies that presented risk estimates for the association between SES, or any of its proxies, and hypertension. Meta-analyses were conducted using a random effects model. RESULTS Overall, no association was detected between educational status and hypertension, whereas a positive association was observed with income. Interestingly, educational status was inversely associated with hypertension in East Asia {effect size [ES] 0.82 [95% confidence interval (CI) 0.78, 0.87]} but positively associated in South Asia [ES 1.28 (95% CI 1.14, 1.43)]. Higher income, household assets or social class were positively associated with hypertension in South Asia whereas no association was detected in East Asia and Africa. Compared with other occupations, farmers or manual labourers were associated with a lower risk for hypertension. Further, in regions such as Latin America, few studies were identified that fulfilled our inclusion criteria. CONCLUSIONS We provide evidence that the association between hypertension and SES in rural populations of LMICs in Asia varies according to geographical region. This has important implications for targeting intervention strategies aimed at high-risk populations in different geographical regions.
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Affiliation(s)
- Doreen Busingye
- Department of Medicine and Department of Physiology, Monash University, Melbourne, Australia and Florey Neuroscience Institutes, Heidelberg, Victoria, Australia
| | - Simin Arabshahi
- Department of Medicine and Department of Physiology, Monash University, Melbourne, Australia and Florey Neuroscience Institutes, Heidelberg, Victoria, Australia
| | - Asvini K Subasinghe
- Department of Medicine and Department of Physiology, Monash University, Melbourne, Australia and Florey Neuroscience Institutes, Heidelberg, Victoria, Australia
| | - Roger G Evans
- Department of Medicine and Department of Physiology, Monash University, Melbourne, Australia and Florey Neuroscience Institutes, Heidelberg, Victoria, Australia
| | - Michaela A Riddell
- Department of Medicine and Department of Physiology, Monash University, Melbourne, Australia and Florey Neuroscience Institutes, Heidelberg, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine and Department of Physiology, Monash University, Melbourne, Australia and Florey Neuroscience Institutes, Heidelberg, Victoria, Australia Department of Medicine and Department of Physiology, Monash University, Melbourne, Australia and Florey Neuroscience Institutes, Heidelberg, Victoria, Australia
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