The Effects of Socioeconomic Determinants on Hypertension in a Cardiometabolic At-Risk European Country

A Good Night's Sleep in Malta in 2023: A Cross-sectional Study Exploring Sleep Quality and its Determinants via Social Media

BACKGROUND

Sleep quality is affected by a plethora of different factors, although its relationship with chronic diseases is still unclear. This study explored perceived sleep quality and its associated determinants among the adult population of Malta. Study Design: A cross-sectional study.

METHODS

An anonymous online survey was distributed through social media targeting adults residing in Malta. Data pertaining to socio-demographic, medical history, lifestyle, well-being, sleep, and daytime sleepiness were gathered, and descriptive, univariant, and multiple binary logistic regression modelling analyses were performed.

RESULTS

A total of 855 adults responded, out of whom 35.09% (95% confidence interval [CI]: 31.90, 38.41) reported sleep difficulties, especially females (81.33%; 95% CI: 76.36, 85.49), while 65.33% (95% CI: 59.61, 70.65) reported suffering from chronic disease(s). Sleep problems were positively associated with multimorbidity (odds ratio [OR]: 2.17; 95% CI: 1.38, 3.40; P=0.001), sleeping<6 hours (OR: 3.79; 95% CI: 1.54, 9.30; P=0.040), and the presence of moderate anxiety symptoms (OR: 1.99; 95% CI: 1.10, 3.59; P=0.020). They were also related to the presence of mild (OR: 2.25; 95% CI: 1.46, 3.45; P=0.001), moderate (OR: 2.40; 95% CI: 1.24, 4.64; P=0.010), and moderately severe (OR: 15.35; 95% CI: 4.54, 31.86; P=0.001) depressive symptoms after adjusting for confounders.

CONCLUSION

Chronic conditions, including anxiety and depression, along with short sleep duration, appear to contribute to poor sleep quality in Malta. A multifaceted approach is required to deal with the issue holistically and safeguard the health of current and future generations.

Risk factors of previously undiagnosed and known untreated hypertension among patients with Type-2 diabetes mellitus

Objectives

To find the risk factors of previously undiagnosed and known untreated hypertension among patients with Type- 2 diabetes mellitus.

Methods

The cross-sectional analytical study was conducted at Diabetes Clinic of Sir Ganga Ram Hospital Lahore during Oct-Dec 2021. Total 153 known diabetics were enrolled using convenience sampling. Patients (n=24) with ischemic heart disease, hepatitis or missing information excluded. Data from 129 cases of Type-2 diabetes presenting with and without hypertension analyzed using SPSS. Binary logistic regression analyses were performed to calculate the adjusted odds ratios.

Result

Mean age of all diabetics (n=129) was 49.0±10.7 years. The participation of females was higher than males (65.1% vs. 34.9%). The frequency of hypertension, previously undiagnosed hypertension and known untreated hypertension was 58.1%, 25.3% and 19.6%, respectively. Among risk factors, frequency of high intake of salt was 67.4%, sedentary lifestyle was 65.1%, obesity was 37.2%, and poor glycemic control was 58.9%. Young age [aOR=2.01, 95.0% CI 0.53-7.61], low family income <20000 PKR/month [aOR=2.70, 95.0% CI 0.92-7.96], high intake of salt [aOR=3.22, 95.0% CI 0.98-10.61], elevated total cholesterol [aOR=3.68, 95.0% CI 0.85-15.85], poor glycemic control [aOR=3.28, 95.0% CI 0.51-21.13], and overweight/ obesity [aOR=9.07, 95.0% CI 1.6-51.39] had higher risk of previously undiagnosed or known untreated HTN.

Conclusions

Prevalence of previously undiagnosed and known untreated hypertension is high among Type-2 diabetics. Strict compliance to diabetes care guidelines is much needed to minimize the risk of undiagnosed and untreated hypertension.

Socioeconomic Macro-Level Determinants of Hypertension: Ecological Analysis of 138 Low- and Middle-Income Countries

AIM

To assess the relative importance of major socioeconomic determinants of population health on the burden of hypertension in Low-and-Middle-Income Countries (LMICs).

METHODS

Country-level data from 138 countries based on World Development Indicators 2020 were used for correlation and linear regression analyses of eight socioeconomic predictors of hypertension: current health expenditure, domestic general government health expenditure per capita, GDP per capita, adult literacy rate, unemployment rate, urban population, multidimensional poverty index, and total population.

RESULTS

The median prevalence of age-standardised hypertension was 25.8% across the 138 countries, ranging from 13.7% in Peru to 33.4% in Niger. For every 10% increase in the unemployment rate, the prevalence of hypertension increased by 2.70%. For every 10% increase in the percentage of people living in urban areas, hypertension was reduced by 0.63%.

CONCLUSIONS

The findings revealed that countries with high GDP, more investment in health and an improved multidimensional poverty index have a lower prevalence of hypertension.

Associations between a Subjective Living Environment and Quality of Life among People with Arterial Hypertension-Results from the Hamburg City Health Study

Hypertension is a global public health concern and an important contributor to cardiovascular disease. It remains disputed how important life circumstances are for the etiology of hypertension. Thus, the aim of this study is to assess the spatial variation of hypertension within an urban population and to investigate the association with the quality of life of city dwellers and their subjective evaluation of their residential district, as well as their home environment, using the example of Hamburg, Germany. In this cross-sectional study, the first 10,000 participants from the Hamburg City Health Study (HCHS) were analysed. Only participants who had resided at the current address for a minimum of five years were considered. In the descriptive analysis, participants with and without arterial hypertension were compared considering various parameters. The subjective quality of the living environment was obtained using an appropriate subjective living environment index. Quality of life was mapped using the EuroQol Group quality of life questionnaire (EQ-5D) score and the two (mental and physical health) scores of the Short Form Health Questionnaire SF-8. The Gini-coefficient was used to quantify the regional economic variation within Hamburg. Linear and logistic regression analyses were performed. Regional levels were 68 city district clusters in Hamburg. The analysis included n = 8192 participants living at least five years in Hamburg at the time of participation in the HCHS. There was a spatial variation in the prevalence of arterial hypertension within Hamburg. Prevalence rates between city district clusters ranged from 50.0% to 88.5%. The results showed that city district clusters with a worse subjective perception of the living environment were partly associated with an increased prevalence of arterial hypertension. Furthermore, a negative association was observed between arterial hypertension prevalence and the sociodemographic status of participants in the city district clusters. Thus, participants with a high level of education suffered less frequently from arterial hypertension than participants with a rather low level of education. The subjective living environment index and quality of life were significantly related to the occurrence of arterial hypertension; however, more extensive and detailed studies are necessary to derive possible clinical implications.

Examining the effects of individual and neighbourhood socioeconomic status/wealth on hypertension among women in the Greater Accra Region of Ghana

Hypertension is one of the leading causes of morbidity and mortality among women in sub-Saharan Africa. Although research on the relationship between individual-level socioeconomic status (SES) and hypertension exists, to the best of our knowledge, limited empirical studies examined the effects of neighbourhood-level SES/wealth on the risks of living with hypertension in Ghana. Using data from the 2009 Women's Health Study of Accra (WHSA-II), and applying multilevel logistic regression, this study investigates the effects of both individual and neighbourhood wealth status on hypertension among women in the Greater Accra Region of Ghana. The results show that individual-level SES/wealth is a significant determinant of hypertension among Ghanaian women in Accra. Specifically, wealthy women are more likely to be hypertensive compared to poorer women. However, the effect of neighbourhood SES/wealth was attenuated after adjusting for individual-level SES/wealth. These findings suggest that it is important to develop health promotion programs targeted at a segment of SES group in the prevention, control and management of hypertension among women in the Greater Accra Region of Ghana.

Determinants of Newly-Diagnosed Raised Blood Pressure: The Malaysian Context

Background

Raised blood pressure, also known as hypertension (HPT), has been a distressing health concern among Malaysians. An upward trend is found on the prevalence of newly-diagnosed HPT, contributing to the high number of overall hypertensive patients in Malaysia. To understand the cause and reduce the economic burden caused by HPT, current research aims to examine the dependency among sociodemographic and behavioural determinants of newly-diagnosed HPT among Malaysians.

Methods

The current study uses secondary data from the Fifth National Health and Morbidity Survey (NHMS V) 2015, a population based cross-sectional study. This study uses the Bayesian Network (BN) modelling to design and build a ‘causal’ model and identify potential determinants and their respective conditional probability on the prevalence of newly-diagnosed HPT among Malaysians.

Results

This study shows that Malaysians with newly-diagnosed HPT are directly affected by the age and body mass index (BMI). Additionally, household income, sex, marital status, ethnicity, strata, education levels, occupation, fruit intake, vegetable intake, smoking status, physical activity and plain water intake indirectly affect the incidence of the newly-diagnosed HPT.

Conclusion

These results may be helpful in implementing appropriate policies to prevent and monitor the increasing prevalence of newly-diagnosed HPT among adults in Malaysia.

Environmental exposure to metals and the risk of high blood pressure: a cross-sectional study from NHANES 2015-2016

Exposure to metal pollution can be caused from inhalation, ingestion, or absorption from air, water, or food. Chronic exposure to trace amounts of metals can lead to high blood pressure, or hypertension, and other chronic diseases. The rationale of our study was to determine if there was a correlation between nineteen forms of urinary metal concentrations and high blood pressure, defined as ≥ 130 mm Hg systolic or ≥ 80 mm Hg diastolic, in the adult US population, to understand the possible impacts of metal exposure on humans. Five types of urinary arsenic species and fourteen types of urinary metals were studied to examine their correlation with high blood pressure. We used the dataset from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) for the study. A specialized complex survey design analysis package was used in analyzing the NHANES data. We used pairwise t tests and the logit regression models to study the correlation between urinary arsenic (five types) and urinary metal (fourteen types) concentrations and high blood pressure. The total study population analyzed included 4037 adults aged 20 years and older, of whom 57.9% of males and 51.7% of females had high blood pressure. Urinary arsenous acid (OR: 2.053, 95% CI: 1.045, 4.035), tin (OR: 1.983, 95% CI: 1.169, 3.364), and cesium (OR: 2.176, 95% CI: 1.013, 4.675) were associated with increased odds of high blood pressure. The other four types of urinary arsenic and twelve types of urinary metals were not associated with high blood pressure. Our results determined that exposure to environmental metals such as arsenous acid, tin, and cesium can be associated with high blood pressure. Further investigation is suggested to support our findings.

Prevalence and predictors of different patterns of hypertension among adults aged 20-60 years in rural communities of Southeast Nigeria: a cross-sectional study

BACKGROUND

Hypertension, a major cardiovascular disease risk factor exists several years without symptoms. Few data exist on prevalence and predictors of hypertension among apparently healthy Nigerian adults. This makes it difficult for policy-makers to concentrate efforts to control emerging health burden of the disease. This study assessed prevalence and predictors of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and combined systolic and diastolic hypertension (CSDH).

METHODS

Cross-sectional survey design was employed in the study of 517 adult participants (20-60 years) in a rural setting. Selection of the respondents was through multistage sampling which involved systematic, proportionate and simple random sampling. Data on socio-demographic characteristics, blood pressure, height, weight, and waist circumference were collected. Frequencies, T-test, analysis of variance and Chi square were used in statistical analysis. Bivariate and multivariate logistic regressions were used to evaluate variables associated with different patterns of hypertension with significance accepted at P < 0.05. Frequencies, percentages, crude and adjusted odd ratios were reported. Statistical Product and Service Solutions version 21.0 was used in statistical analysis.

RESULTS

ISH (10.6%), IDH (18.2%) and CSDH (37.8%) were observed among the participants. ISH was less likely among 20-29 year-olds (adjusted odds ratio (aOR) = 0.35, 95% confidence interval (C.I.) = 0.13-0.94), 30-39 year-olds (aOR = 0.30, 95% C.I. = 0.11-0.82) and those with abdominal obesity (aOR = 0.12, 95% C.I. = 0.03-0.56). Participants who perceived their health status as good (aOR = 3.80, 95% C.I. = 1.29-11.18) and excellent (aOR = 5.28, 95% C.I. = 1.54-18.07) were respectively 3.80 and 5.28 times more likely to have ISH. Those with secondary education had significantly higher likelihood for IDH (aOR = 2.05, 95% = 1.02-4.14) whereas self-perceived poor health status (aOR = 0.24, 95% C.I. = 0.09-0.65), absence of obesity (aOR = 0.10, 95% C.I. = 0.01-0.81) and general obesity (aOR = 0.35, 95% C.I. = 0.17-0.72) were associated with reduced risk for IDH. Secondary (aOR = 0.60, 95% C.I. = 0.36-0.99) and tertiary (aOR = 0.49, 95% C.I. = 0.28-0.85) education were associated with reduced risk for CSDH but combined obesity (aOR = 4.39, 95% C.I. = 2.25-8.58) increased the risk for CSDH by 4.

CONCLUSION

ISH, IDH and CSDH were problems among the adults with age, obesity, self-perception of good/excellent health status and low education level as significant predictors. Health and nutrition education to prevent comorbidities and cerebrovascular accidents are recommended.

Insight into the Attitudes and Experiences of Adults with Non-Communicable Diseases a Year into the COVID-19 Pandemic: The Malta Experience

Introduction

Non-communicable diseases (NCDs) have been a global epidemic long before the advent of COVID-19. Understandably, with the onset of COVID-19, health priorities shifted. The aim of this study was to explore the impact of COVID-19 through attitudes and experiences on the health and well-being of the Malta adult population suffering from NCDs, a year into COVID-19.

Methods

An anonymous survey was distributed online between February 1 and 26, 2021 using Google Forms^®. This assessed the impact of COVID-19 on medical care, intention to take a COVID-19 vaccine, and whether COVID-19 was acquired. Quantitative and qualitative analyses were performed.

Results

Out of the 1,034 participants, 34.82% (95% CI, 31.97–37.77; n = 360) reported to suffer from NCDs (single NCD, n = 276; 2 NCDs, n = 56; 3 NCDs, n = 28) with 6.94% (95% CI, 4.71–10.09) of these reported acquiring COVID-19. Since COVID-19, the NCD population visited the general practitioners less (47%) than those without NCDs (32%) (p ≤ 0.001). With a consensus of concern and fear, “I rather skip check-ups than risk getting COVID-19 in waiting room or clinic.” Postponement and cancellations of medical appointments were reported: “had to do blood tests privately as health centre was not doing them” and “delayed treatment and still awaiting further appointments that were postponed more than once.” The majority intended to take COVID-19 vaccine.

Conclusions

It is clear that individuals with NCDs have experienced a general negative effect on their medical care. It's recommended that a dual action strategy is embraced to ensure that both NCDs and COVID-19 are treated simultaneously, leaving no one behind.

Characterisation of body size phenotypes in a middle-aged Maltese population

Obesity is increasingly recognised as being a heterogeneous disease. Some obese individuals may present a metabolically healthy profile (metabolically healthy obese (MHO)), while some normal weight individuals exhibit an adverse cardiometabolic phenotype (metabolically unhealthy normal weight individuals (MUHNW)). The objectives of the present study were to examine the prevalence and associated characteristics of the different body composition phenotypes within a Maltese cohort. This was a cross-sectional analysis involving 521 individuals aged 41 ± 5 years. The metabolically unhealthy state was defined as the presence of ≥2 metabolic syndrome components (NCEP-ATPIII parameters), while individuals with ≤1 cardiometabolic abnormalities were classified as metabolically healthy. Overall, 70 % of the studied population was overweight or obese and 30⋅7 % had ≥2 cardiometabolic abnormalities. The prevalence of MHO and MUHNW was 10⋅7 and 2⋅1 %, respectively. Individuals with the healthy phenotype were more likely to consume alcohol, participate in regular physical activity and less likely to be smokers. While the MHO phenotype had similar values for waist, hip and neck circumferences, waist-hip ratio and insulin resistance when compared with MUHNW individuals, there was a lower proportion of MHO subjects having a high fasting plasma glucose, hypertriglyceridaemia or low HDL-C when compared with the unhealthy lean individuals. A high prevalence of the metabolically unhealthy phenotype was observed in this relatively young population which may result in significant future cardiovascular disease burden if timely assessment and management of modifiable risk factors are not implemented. Furthermore, the present study suggests that the MHO phenotype is not totally benign as previously thought.

Insight into the Occurrence of Common Non-communicable Diseases at a Population Level and the Potential Impact During the Coronavirus Pandemic - a Need for a Syndemic Healthcare Approach?

People suffering from non-communicable diseases (NCDs) are at an increased risk for severe Covid-19. The aim was to determine the burden of common NCDs at a population level, assess Covid-19 impact while exploring whether a syndemic approach is merited to deal with NCDs and Covid-19. Baseline data from a Malta national representative survey. Individuals with type 2 diabetes (T2DM), hypertension, cardiovascular disease, dyslipidaemia and overweight-obese status were considered. Prevalence for single disease and multimorbidity were used to estimate population burden. Covid-19 impact at a population level was estimated through local Covid-19 infectivity rates. Years of life lost (YLL) and mortality rate were calculated using Covid-19 data and compared to corresponding NCDs data reported by global burden of disease (GBD) study. Half the study population (n = 3947) had a single NCD while a third had multimorbidity. Of these, 6.55% were estimated to be at risk of Covid-19 and require admission. Covid-19 YLL over 12 months was 5228.54 years, which is higher than the estimated YLL for hypertension and T2DM by GBD study for Malta. Health systems and policies should be re-focused to accommodate both Covid-19 and NCDs simultaneously through a targeted syndemic approach with primary healthcare playing a central role.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s42399-021-01064-2.

Epidemiological characteristics of hypertension, impaired fasting capillary glucose and their comorbidity: a retrospective cross-sectional population-based study of rural adolescents in Southeast Nigeria

OBJECTIVE

To assess the prevalence of hypertension, impaired fasting capillary glucose (IFCG) and coexistence of both as well as determinants of these conditions among rural adolescents.

DESIGN

A retrospective cross-sectional population-based study.

SETTING

Three rural communities in southeast Nigeria.

PARTICIPANTS

A total of 401 adolescents (10 - 19 years) selected through a five-stage sampling technique completed the study. Sick adolescents, pregnant and nursing adolescent mothers were excluded.

PRIMARY OUTCOME MEASURES

Prevalence and determinants of hypertension, IFCG and comorbidity of both were assessed through weight, height, blood pressure, fasting capillary glucose measurements and statistical analysis.

RESULTS

Prehypertension (10.7%), hypertension alone (12.7%), IFCG alone (11.0%), diabetes (0.2%) and hypertension with IFCG (6.2%) were prevalent among the adolescents. The adolescents aged 15 - 19 years were less likely to be affected by hypertension alone (adjusted OR (AOR)=0.36, 95% CI 0.18 to 0.74, p<0.01). The likelihood of having hypertension alone was three times higher among those who smoked any substance (AOR=3.43, 95% CI 1.34 to 8.78, p<0.05) and 2.85 times higher among those who consumed alcohol (AOR=2.85, 95% CI 1.33 to 6.10, p<0.01). Meal skipping (AOR=2.69, 95% CI 1.16 to 6.25, p<0.05), consumption of fried/baked snacks (AOR=15.46, 95% CI 1.62 to 147.37, p<0.05) and vegetables (AOR=2.27, 95% CI 1.11 to 4.66, p<0.05) were also significant risk factors of hypertension alone. Skipping meals (AOR=2.15, 95% CI 0. 93 to 4.99, p>0.05) and longer than 7 hours of night sleep (AOR=1.88, 95% CI 0.94 TO 3.73, p>0.05) increased the risk of IFCG alone by twofold. Female adolescents (AOR=0.29, 95% CI 0.10 to 0.78, p<0.05) and those who consumed fried/baked snacks (AOR=0.09, 95% CI 0.02 to 0.37, p<0.01) were less likely to have hypertension with IFPG than males and those who consumed non-fried/baked snacks, respectively.

CONCLUSION

This study reported relatively low prevalence of hypertension alone, IFCG alone, hypertension with IFCG and epidemiological characteristics that can become focus of interventions to curtail the emergence of cardiovascular events at an early age. Awareness creation through health and nutrition education is emphasised.

At-risk population for COVID-19: multimorbidity characteristics of a European small Island state

OBJECTIVES

Multimorbidity, defined as the co-occurrence of at least two chronic diseases, is a common occurrence with ageing and a recognised public health concern, especially during the COVID-19 pandemic. The multimorbidity population is more susceptible to the virus, its complications, and death. The study aimed to explore the multimorbidity characteristics and their associations at a population level for the first time in Malta. Such data enables adequate priority and policy planning due to COVID-19's predilection for this population.

STUDY AND METHODS

Baseline data was collected from 3,947 adults recruited between 2014-2016 through a cross-sectional study. A single-stage sampling strategy was implemented and stratified by age (18 -70 years), sex and locality. Participants were invited to attend a health examination survey consisting of a questionnaire, anthropometric and biological measurements. Descriptive (chi-square) and analytic (regression modelling) statistics were used to determine the characteristics and associations of the multimorbidity population. The chronic diseases considered for multimorbidity were type 2 diabetes, obesity, hypertension, myocardial infraction, coronary heart disease and dyslipidaemia.

RESULTS

Multimorbidity was present in 33% (95% confidence interval 31.54-34.47) of the study population, with a male predominance. Hypertension and myocardial infarction were the commonest multimorbidity combination from a young age group (20-30 years). Low socio-economic status and residing on the island of Gozo were positively associated with multimorbidity.

CONCLUSION

Multimorbidity in Malta was evident from a young age, with the highest occurrence among the low socio-economic status and residents of Gozo, bringing forward the need for preventive action. An adaptive healthcare system and policies are recommended to prevent, support, and manage multimorbidity non-communicable diseases while bracing for the current COVID-19 pandemic.

Adherence to the Mediterranean Diet in Maltese Adults

Background: Populations living in Mediterranean islands are experiencing a nutrition transition process from traditional to Westernized dietary patterns. No information on this matter regarding individuals living in Malta have been published to date. The aim of this study was to assess the level of adherence of the Maltese people to the Mediterranean diet and which factors were associated with it. Methods: A nationwide cross-sectional study was conducted in the island of Malta between 2014 and 2016. A literature-based Mediterranean diet adherence score was used to assess the level of adherence to the dietary pattern. Results: Out of 3947 adults, the overall Mediterranean diet adherence score mean was 7.19 (SD 1.91): being female, non-smoker, and having older age was associated with higher adherence to the Mediterranean diet. Less clear pattern of association was found for educational and occupational status, for which medium educational level and a high occupational level were associated with lower adherence to Mediterranean diet. Higher adherence was finally associated with consumption of healthier food groups (more rice and dark bread and less pasta and white bread; more all plant-food groups and fish, less animal-food sources, including fast foods; more light cheeses and yogurt were more frequently consumed among higher adherent individuals in spite of regular ones). Conclusions: Adherence to the Mediterranean diet in Malta is lower than in those of populations living in companion Mediterranean islands. Given the lack of data on this topic, further studies should be conducted among the Maltese people and public health nutrition interventions should be planned to improve current eating habits toward more traditional dietary patterns.

Obesity population at risk of COVID-19 complications

Introduction

Global public health is challenged by two concurrent epidemics; COVID-19 and obesity. Considering the global prevalence of obesity, exploring relationships with COVID-19 are of clinical importance. The aim was to provide a comprehensive summary and recommendations on this relationship between COVID-19 and obesity.

Method

A literature search was performed to prepare a narrative review of COVID-19 and obesity.

Results

An obesity state promotes chronic inflammation, vitamin D deficiency, hinders immunity and causes mechanical lung compression. These increase susceptibilities to COVID-19 infection, complications including the requirement of invasive ventilation. Existing co-morbidities enhances these complications. Preventive measures of social distancing and self-isolation may increase stigmatisation and psychological deterrents. Hence, special recommendations targeting this vulnerable population are required.

Conclusion

The obese population is a COVID-19 vulnerable group, requiring special attention during this pandemic to avoid complications and healthcare systems burden. Lacking COVID-19 vaccination, regular physical activity and a healthy diet are recommended with attention to mental health. A prolonged quarantine duration and administration of prophylactic vitamin D may be considered.

Prevalence and Risk Factors of Hypertension Among Young Adults in Albania

INTRODUCTION

Hypertension is one of the major risk factors for cardiovascular disease and the leading cause of death worldwide. Hypertension was defined as systolic or diastolic blood pressure according to Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (ACC/AHA) rules.

AIM

The aims of this study was to determine the difference in hypertension prevalence and its risk factors using ACC/AHA rule, and compared its result with JNC7 rule.

METHODS

Data were collected using two-stage stratified cluster sample of households from 2017/18 Albanian Demographic and Health Survey. Data were analyzed using the descriptive and multivariate logistic regression model.

RESULTS

Among 15,003 respondents aged 15-49 years, the overall prevalence of hypertension was 63.48% and 16.24%, as per ACC/AHA and JNC7 rules, respectively with an absolute increase of prevalence by 47.3% (CI 46.4-48.2%). According to the ACC/AHA rule, in most of the categories of the respondents, the prevalence of hypertension was 40% higher compared with the JNC7 rule. In multivariate analysis, age, education, richest respondents, number of living children (≥ 3), health insurance and gender had significant (p < 0.05) impact on hypertension for both rules. Besides, the middle and richer wealth index, religion, and physically active work had also significant (p < 0.05) impact on hypertension for JNC7 rules.

CONCLUSIONS

Newly established ACC/AHA rule led to a significant increase in the proportion of hypertension among the Albanian populations. Similarly, there was a significant difference in the impact of some socioeconomic factors on hypertension as per both rules. Implementation of the prevention and control programs of hypertension are required to increase the awareness of the bad impact of hypertension.

Country-level interventions for the prevention and management of hypertension through the modification of social determinants of health: a systematic review protocol

BACKGROUND

Hypertension is one of the public health challenges. Various risk factors are associated with hypertension, including social demographics, geographical location, health behaviours, and social stress. Interventions in the social determinants of health can improve hypertension and health promotion. Accordingly, different sectors such as agriculture, housing, education, and transportation should cooperate. This systematic review examines policies as a set of activities and actions/interventions aimed at the modification of the social determinants of health to prevent hypertension.

METHODS

A systematic search will be conducted in Medline (via Ovid), PubMed, EMBASE, Cochrane Library, ProQuest Dissertations & Theses, and scientific Persian databases including SID and Magiran. There will be no time restriction. The quality of selected studies will be assessed using an appropriate Joanna Briggs Institute (JBI) Critical Appraisal Checklists according to the type of studies. Two independent researchers will carry out screening and quality assessment. Disagreement between two researchers will be resolved by a third party.

DISCUSSION

Recommendations will be made for policymakers in order to make better evidence-based decisions about the prevention and management of hypertension with regard to the social determinants of health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020152298.

COVID-19 panic, solidarity and equity-the Malta exemplary experience

Aim

The coronavirus (SARS-CoV-2) pandemic is a global crisis, with more than 2 million of the world's population infected. Public health authorities across the world are working endlessly to contain the situation. The small nation of Malta has been applauded by the World Health Organization (WHO) Regional Director for Europe for the instituted escalated public health measures that have kept (up till the time of writing) the COVID-19 spread contained with low transmission rate. The aim of this overview is to give a comprehensive summary of the COVID-19 situation, measures, legislations and initiatives for containment, management and safeguarding the Maltese nation that were taken.

Subject and method

A literature search was conducted using the Google search engine and Maltese online newspapers.

Results

To date (22nd April 2020), the COVID-19 situation in Malta is a total confirmed cases of 444, of which 276 are active cases, 165 have recovered and there were three deaths. Various measures were taken early on, from travel bans to prohibition of more than three-person gatherings, backed up with penalties. Both public and private sectors are working together to ensure containment and provision of services to the population. Solidarity has spread across the country.

Conclusion

A number of timely measures have been taken. However, it is down to the nation to continue to follow the restrictions and regulations instituted by the Superintendent of Public Health in conjunction with the health division and the government to overcome this pandemic together.

Hypertension in Relation to Dioxins and Polychlorinated Biphenyls from the Anniston Community Health Survey Follow-Up

BACKGROUND

In 2014, we conducted a longitudinal study [Anniston Community Health Survey (ACHS II)] 8 y after the baseline (ACHS I).

OBJECTIVES

We investigated the relationship between persistent chlorinated compounds and hypertension in residents living around the former polychlorinated biphenyl (PCB) production plant in Anniston, Alabama. We also examined the potential role of inflammatory cytokines in those with hypertension.

METHODS

A total of 338 participants had their blood pressure measured and medications recorded, gave a blood sample, and completed a questionnaire. Prevalent hypertension was defined as taking antihypertensive medication or having systolic blood pressure >140 mmHg and/or diastolic pressure >90 mmHg; incident hypertension used similar criteria in those who developed hypertension since the baseline in 2005-2007. PCB congeners were categorized into structure-activity groups, and toxic equivalencies (TEQs) were calculated for dioxin-like compounds. Descriptive statistics, logistic and linear regressions, as well as Cox proportional hazard models, were used to analyze the associations between exposures and hypertension.

RESULTS

Prevalent hypertension (78%) in ACHS II showed statistically significant adjusted odds ratios (ORs) for PCBs 74, 99, 138, 153, 167, 177, 183, and 187, ranging from 2.18 [95% confidence interval (CI): 1.10, 4.33] to 2.76 (95% CI: 1.14, 6.73), as well as for two estrogenic-like PCB groups, and the thyroid-like group [ORs ranging from 2.25 (95% CI: 1.07, 4.75) to 2.54 (95% CI: 1.13, 5.74)]. Furthermore, analysis of quartiles demonstrated a monotonic relationship for dioxin-like non-ortho (non-o)-PCB TEQs [fourth vs. first quartile: 3.66 (95% CI: 1.40, 9.56)]. Longitudinal analyses of incident hypertension supported those positive associations. The results were strongest for the di-o-PCBs [hazard ratio (HR)=1.93 (95% CI: 0.93, 4.00)] and estrogenic II PCB group [HR=1.90 (95% CI: 0.96, 3.78)] but were weaker for the dioxin TEQs.

DISCUSSION

Findings supportive of positive associations were reported for dioxin-like mono-o- and non-o-PCBs as well as for nondioxin-like estrogenic and thyroid-like congeners with prevalent and incident hypertension, suggesting that multiple pathways may be involved in hypertension development. https://doi.org/10.1289/EHP5272.

The Risk Factors for Undiagnosed and Known Hypertension among Malaysians

Background

The prevalence of known hypertension has resulted from the progression of undiagnosed hypertension. This study is targeted to examine and compare the risk factors based on the estimated odds ratios of modifiable and non-modifiable risk factors on different outcome levels of hypertension.

Methods

A nationwide representative secondary data from the Fourth National Health of Morbidity Survey (NHMS IV) which consists of 24,632 non-institutionalised Malaysian population conducted by the Ministry of Health in 2011 has been used. Odds ratio (OR) with 95% confidence interval has been estimated using multinomial logistic regression.

Results

Obese and overweight respondents exhibit increased likelihood of having undiagnosed and known hypertension. Physically inactive, ex-smokers and unclassified drinkers are found having higher likelihood to have known hypertension. However, current drinkers are found to have higher likelihood of having undiagnosed hypertension. Elderly, retirees, home makers and lower educated respondents are shown higher odds to have undiagnosed hypertension. Likewise, the likelihood of having known hypertension has been found to increase among the elderly and other Bumiputra.

Conclusion

Through this research, significant predictors which consist of obese and overweight respondents, current drinkers, older respondents (above 65 years old) and primary educated respondents are having higher likelihood to have undiagnosed hypertension.

Closing the gap - Is type 2 diabetes awareness enough to prevent the growing epidemic?

BACKGROUND

Diabetes mellitus is a public health burden requiring a multi-sectorial approach including adequate population awareness to tackle this epidemic. The study was aimed to determine the level of diabetes awareness among a high-risk dysglycaemic population in relation to socio-demographic, lifestyle and family history of diabetes as well as to body mass index (BMI) and blood pressure measurements. Furthermore, the authors strived to explore any relationships between diabetes awareness and an oral glucose tolerance test dysglycaemia diagnosis.

METHOD

Participants obtaining impaired fasting blood glucose in a representative health examination survey were invited to undergo an oral glucose tolerance test (OGTT). During the OGTT session, participants were invited to take part in a diabetes awareness questionnaire as well as have their weight, height and blood pressure measured. Association between awareness scores and different parameters (age, gender, education, residential district, smoking, alcohol habit, family history, BMI and blood pressure) were explored.

RESULTS

Being a female, ageing, non-smoker and having a family history of diabetes had a positive association with adequate diabetes awareness. Even though generally good awareness was present, the majority of the participants were obese, with an elevated blood pressure and obtained a dysglycaemic status post OGTT.

CONCLUSION

Diabetes awareness solely does not appear to engage individuals in preventive initiatives. Behavioural changes are required but these are only established after the motivational action gap has been overcome. Empowering community diabetes mellitus screening programs targeting the environment, social gradients and cultural norms while engaging in preventive interventions are recommended.

AHU377+Valsartan (LCZ696) Modulates Renin-Angiotensin System (RAS) in the Cardiac of Female Spontaneously Hypertensive Rats Compared With Valsartan

BACKGROUND

Hypertension is a major cause of death and morbidity worldwide and is increasing in prevalence. The Renin-angiotensin system (RAS) is the most common mechanism involved in the pathophysiology of hypertension. Understanding the mechanism of the pathophysiologic processes will help direct potential therapeutic strategies to treat hypertension and improve cardiac function. Recently, a novel drug LCZ696 containing both an angiotensin receptor blocker valsartan and a neprilysin inhibitor (AHU377) has shown a promising effect on the treatment of hypertension. However, the effects of LCZ696 on the expression of main components of RAS, namely, angiotensin-converting enzyme (ACE), angiotensin-converting enzyme 2 (ACE2), angiotensin II type 1 receptor (AT1 R), angiotensin II type 2 receptor (AT2 R), and angiotensin (1-7) receptor/Mas receptor (MasR) remain unclear. The aim of the present study was to evaluate the effects of LCZ696 on the protective arms of RAS in the cardiac tissue when compared with valsartan under the equal inhibition of AT1 R. We hypothesized that the superior effects of LCZ696 may contribute to its greater effect on the RAS than valsartan.

MATERIALS AND METHODS

Sixteen-week-old female spontaneously hypertensive rats (SHRs) were used in this study. Wistar-Kyoto (WKY) rats were used as controls. All rats were randomly divided into LCZ696 (n = 10), valsartan (n = 10), SHR (n = 10), and WKY (n = 10) groups under a 12-hour dark and 12-hour light cycle and provided with regular chow diet and water. The tail-cuff method was performed to measure blood pressure. Cardiac function was assessed by echocardiography.

RESULTS

The blood pressure value was lower in LCZ696 than valsartan in SHR after 12 weeks of treatment. Further, LCZ696 inhibits the ACE and AT1 R protein expression in the cardiac of SHR and significantly upregulate the protective axis of RAS components, including ACE2, MasR, and AT2 R. Left ventricular AT2 R messenger RNA (mRNA) expression was higher in the LCZ696+SHR group compared with valsartan. In addition, real-time polymerase chain reaction analysis revealed that LCZ696 enhanced the mRNA expression of antihypertensive components AT2 R, ACE2, and MasR and decreased the expression of AT1 R. However, only AT2 R and ACE2 mRNA expressions have a statistical difference between the LCZ696 and valsartan groups. No difference was observed in the mRNA expression of ACE and MasR. The stronger positive signal of transforming growth factor β in the left ventricle was inhibited in each administrated group compared with SHR groups.

CONCLUSIONS

LCZ696 ameliorates the vasoconstrictor axis of the RAS AT1 R and stimulate the protective arm effectors, ACE2 and AT2 R, as well as reverses the compensatory upregulation of neuronal nitric oxide synthase and endothelial nitric oxide synthase in SHR. These findings suggest the mechanistic insight of the cardiac-protective and greater hypotensive effects of LCZ696.

The interaction of dyslipidaemia with glycaemia in an adult population study

Purpose

Individuals with dysglycaemic are prone to dyslipidaemia. Understanding the dyslipidaemic status of dysglycaemic individuals is essential for monitoring and early prevention. The aim was to assess the control of lipidaemia by glycaemic status in a representative adult population.

Methods

A retrospective health examination survey was performed on a sample of adults (n = 3947) in Malta in 2014-6. Sociodemographic data, biochemistry blood tests and anthropometric measurements were gathered. Statistical analysis was performed to evaluate the lipidaemic status and its control across the glycaemic spectrum (normoglycemic, impaired fasting glucose individuals, new diabetics and known diabetics).

Results

The prevalence of uncontrolled dyslipidaemia was 7.75% (CI 95%: 6.69-8.63), among whom 6.97% (CI 95%: 6.21-7.81) were naïve dyslipidaemic. A progressive elevation in both LDL-C and total cholesterol but not triglycerides was present among uncontrolled dyslipidaemia individuals across the glycaemic spectrum. Global dyslipidaemia was present in 19.26% (CI 95%: 18.05-20.52) of the total general population and in 46.59% (CI 95%: 40.49-52.69%) of known diabetics. Most individuals irrespective of lipid status were normoglycaemic.

Conclusions

Dyslipidaemia occurs in the presence of insulin resistance. Dyslipidaemia predominated in the normoglycaemic state irrespective of statins use, indicating the need to manage dyslipidaemia prior to dysglycaemia.

The Prevalence and Social Determinants of Hypertension among Adults in Indonesia: A Cross-Sectional Population-Based National Survey

BACKGROUND

Hypertension is the most significant avoidable cause of morbidity and mortality, yet nationally representative adult data on Indonesia have not been available. The study aimed at assessing the prevalence and determinants of hypertension, including sociodemographic variables, weight status, health behaviour, and psychosocial stress and support risk factors.

METHODS

The Indonesia Family Life Survey (IFLS-5) interviewed and examined in a national population-based cross-sectional study 29965 individuals aged 18 years and older, mean age 43.3 years (SD=15.3). Blood pressure, body height and weight, dietary behaviour, physical activity, tobacco use, and psychosocial variables were measured. Logistic regression analyses were used to estimate determinants of hypertension by gender.

RESULTS

The prevalence of hypertension among study participants was 33.4 % (95 % CI: 32.7-34.0), among males 31.0% (95% CI: 30.2, 31.9), and among females 35.4% (95% CI: 34.6, 36.3). Among hypertensives, 42.9% were aware, 11.5% were treated, and 14.3% were controlled. In fully adjusted analyses, in both men and women, older age, no or elementary education, being overweight or obese, and having visited an outpatients health facility in the past 4 weeks were positively associated hypertension. Significant linear relationships of hypertension were found with age (P for trend <0.001) and body mass index (BMI) (P for trend < 0.001). In addition, among men having quit tobacco use and depressive symptoms were positively associated with hypertension, while current tobacco use was negatively associated with hypertension. Moreover, among women lower subjective economic status was associated with hypertension.

CONCLUSIONS

The prevalence of hypertension was high and awareness was low, and treatment and control were very low. Significant multilevel public health interventions are urgently needed to improve the diagnosis, treatment, and control of hypertension in Indonesia.