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

Validity of self-reported hypertension and associated factors among Vietnamese adults: a cross-sectional study

BACKGROUND

This study aims to determine the validity of self-reported hypertension and identify factors affecting the disagreement between self-reported hypertension and objective measures of blood pressure among adults in Vietnam.

MATERIALS AND METHODS

A total of 4,219 people aged 18 and older reported their hypertension status and had their blood pressure measured. The inter-reliability between self-reported and measured hypertension was assessed using Cohen's Kappa statistics. Univariate and multivariate logistic regressions were used to examine the affecting factors of disagreement.

RESULT

Self-reported hypertension prevalence was 13.2% (557/4,219), while measured hypertension was 20.9% (881/4,219). An agreement between self-reported and measured data was moderate for the hypertension of participants (κ = 0.39, 95% CI 0.36-0.43). Self-reported hypertension showed high specificity (93.9%) (95% CI 93.0-94.7) but low sensitivity (40.1%; 95 CI 36.8-43.4). The percentage of disagreement in hypertension (number of false positives and false negatives between self-reported and measured data) among adults in Vietnam was 17.3%.

CONCLUSION

Our findings showed there was a high disagreement percentage of hypertension between self-reported and measured data. This is the first report of this issue to warn of health risks if high blood pressure is not detected early. The disagreement of hypertension was observed more frequently in men, people older than 40, minority ethnic groups, farmers, and people with a BMI greater than 25 kg/m2.

Adult hypertensive rats are more prone to gut microflora perturbation and fibrosis in response to moderate restraint stress

Hypertension (HTN) is a common endpoint for numerous cardiovascular diseases, the prevalence of which has been quickly increasing due to a wide range of reasons. Previous research has found that following stress, ELISA and 16S rDNA sequencing indicated substantial changes in plasma cytokines or hormones, as well as alterations in gut microbiota in juvenile hypertensive rats. However, it remains still unclear how such interaction modifications affect microbial populations and organismal function. Stress-related hormones show a significant drop. Similar to earlier research, the stress group had dramatically increased release of pro-inflammatory cytokines such as IL-17. Importantly, a unified collection of tools that allows for deep and comprehensive colonic structural investigation has been developed. Stress may limit the transition of macrophages (Mφs) to M1Mφs while increasing the transfer to M2Mφs. Evidence highlighted that tight junction proteins were decreased along with enhancement in intestinal permeability. Morphological analysis revealed that the SHR-S group exhibited considerably higher levels of morphological alterations and fibrosis in colon, heart, and thoracic aorta tissues.Significant improvements in bacteria linked with short-chain fatty acid synthesis, such as Prevotella and Ruminococcus, were discovered by metagenomic analysis. Adult hypertensive rats are more susceptible to gut microbiota disruption and fibrosis as a result of mild restraint stress. This might contribute to some innovative ideas for HTN both treatment and prevention.

Improving hypertension awareness and management in Vietnam through a community-based model

Hypertension prevalence in Vietnam is high, but few people are aware of their disease status. Detection, diagnosis, and treatment are limited, so new approaches are needed to improve awareness and manage the condition, especially at the primary health care level. The Communities for Healthy Hearts programme operated in four districts of Ho Chi Minh City, with the aim of increasing awareness and ensuring linkage to care. Interventions focused on extending services beyond health facilities to convenient community locations; training cadres of community volunteers to screen, refer, and follow up with clients; training health workers in facilities to diagnose, educate, and manage patients referred from the community; and supporting the process with digital case tracking. Community-based blood pressure screenings took place in client homes, commune health stations, and non-traditional sites such as coffee shops, dentists' offices, marketplaces, neighbourhood watch/security posts, and tailor shops. In total, 121,273 adults aged 40 and older were screened. Of these, 25.1% had elevated blood pressure or a previous hypertension diagnosis and were referred to health facilities. Of those referred, 56.2% were confirmed to have hypertension, and of those confirmed, 75.2% were treated. Of those treated, 51.0% achieved blood pressure control, a favourable outcome over past programmes.

Type 2 diabetes and hypertension in Vietnam: a systematic review and meta-analysis of studies between 2000 and 2020

OBJECTIVES

The objective of this study was to determine the level of type 2 diabetes (T2DM) and hypertension (HTN) in Vietnam and to assess the trend and recommend the future direction of prevention research efforts.

DESIGN

We searched scientific literature, databases including PubMed, EMBASE, CINHAL and Google Scholar; grey literature and reference lists for primary research published, nation database websites between 1 January 2000 and 30 September 2020. We adapted the modified Newcastle Ottawa Scale for assessing the quality of the study, as recommended by the Cochrane Collaboration.

RESULTS

In total, 83 studies met our inclusion criteria, representing data of approximately 239 034 population of more than 15 years of age in Vietnam. The findings show that prevalence rates varied widely across studies, from 1.0% to 29.0% for T2DM and 2.0% to 47.0% for HTN. For the total study period, pooled prevalence of T2DM and HTN in Vietnam for all studies was 6.0% (95% CI: 4.0% to 7.0%) and 25% (95% CI: 19% to 31%), respectively. Prevalence rate of both T2DM and HTN was higher among the male population compared with female counterpart.

CONCLUSION

There is evidence of a rising trend of HTN and T2DM prevalence in Vietnam. Future research should focus on the major drivers, incidence and prognosis of T2DM and HTN. Policy approaches should base upon the trends of T2DM and HTN in Vietnam over the last 20 years and pay more attention on the effective interventions to combat T2DM and HTN. In our study, we included both English and Vietnamese language articles and seems that majority of the articles came from Vietnamese language.

PROSPERO REGISTRATION NUMBER

CRD42020182959.

Prevalence and determinants of non-communicable disease risk factors among adult population of Kathmandu

BACKGROUND

According to WHO, the deaths due to NCDs in Nepal have soared from 60% of all deaths in 2014 to 66% in 2018. The study assessed the prevalence and determinants of non-communicable disease risk factors among adult population of Kathmandu.

MATERIALS AND METHODS

A community based cross-sectional study was conducted from September 2019 to February 2020 among 18-69 years adults residing in municipalities of Kathmandu district. Multi-stage random sampling technique was used to select 245 subjects who were interviewed using WHO NCD STEPS instrument. Chi-square test and logistic regression analysis were done to explore the determinants of NCD risk factors.

RESULTS

The prevalence of current smoking, alcohol consumption, low intake of fruits and vegetables and low physical activity was found to be 22%, 31%, 93.9% and 10.2% respectively. More than half (52.2%) of the participants were overweight or obese and the prevalence of raised blood pressure was 27.8%. Smoking was associated significantly with male gender (AOR = 2.37, CI: 1.20-5.13) and respondents with no formal schooling (AOR: 4.33, CI: 1.50-12.48). Similarly, the odds of alcohol consumption were higher among male gender (AOR: 2.78, CI: 1.47-5.26), people who were employed (AOR: 2.30, CI: 1.13-4.82), and those who belonged to Chhetri (AOR: 2.83, CI: 1.19-6.72), Janajati (AOR: 6.18, CI: 2.74-13.90), Dalit and Madhesi, (AOR: 7.51, CI: 2.13-26.35) ethnic groups. Furthermore, respondents who were aged 30-44 years (AOR: 5.15, CI: 1.91-13.85) and 45-59 years (AOR: 4.54 CI: 1.63-12.66), who were in marital union (AOR: 3.39, CI: 1.25-9.13), and who belonged to Janajati (AOR: 3.37, CI: 1.61-7.04), Dalit and Madhesi (AOR: 4.62, CI: 1.26-16.86) ethnic groups were more likely to be associated with overweight or obesity. Additionally, the odds of raised blood pressure were higher among people who were of older age (AOR: 6.91, CI: 1.67-28.63) and those who belonged to Janajati ethnic group (AOR: 3.60, CI: 1.46-8.87) after multivariate analysis.

CONCLUSION

The findings of the study highlighted high prevalence of behavioral and metabolic risk factors, which varied on different socio-demographic grounds. Thus, population specific health promotion interventions centered on public health interests is recommended to reduce risk factors of NCDs.

Reference data among general population and known-groups validity among hypertensive population of the EQ-5D-5L in Vietnam

Purpose

This study aims to provide EQ-5D-5L population norms among the general population in Vietnam and to test EQ-5D-5L’ construction validity among people living with hypertension there.

Methods

Descriptive statistics of the five dimensions and five levels, EQ-VAS and EQ-5D-5L indexes were categorised into gender and age groups for the EQ-5D-5L population norms. Known-groups testing was set for lower EQ-5D-5L outcomes among people who were aware of their hypertensive status, females, people with more comorbidities, less education, older ages, and higher body mass indexes. Level of confident interval was 95%.

Results

The mean EQ-VAS and EQ-5D-5L indexes were 81.10 (SD: 13.35) and 0.94 (SD: 0.09) among the general population. The EQ-5D-5L outcomes were better among younger people, males, people with more education, employees, and single people. Respondents reported fewer problems with self-care and usual activities and tend to have problems at higher levels across older ages. The known-group testing showed statistically significant results. The mean EQ-VAS and EQ-5D-5L indexes of people in the diagnosed hypertensive group (71.48 and 0.94, respectively) were statistically significantly smaller than they were in the non-hypertensive and undiagnosed hypertensive group (76.65 and 0.97; 76.95 and 0.96 accordingly). Statistically significant associations of lower EQ-5D-5L indexes and EQ-VAS were found among people diagnosed for hypertension, people suffering from an incremental comorbidity, and obese people.

Conclusion

This study has provided EQ-5D-5L population norms for the general population and evidence for known-groups validity of the EQ-5D-5L instrument among hypertensive people in Vietnam.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02959-2.

Dietary Salt Reduction, Prevalence of Hypertension and Avoidable Burden of Stroke in Vietnam: Modelling the Health and Economic Impacts

Dietary salt reduction has been recommended as a cost-effective population-wide strategy to prevent cardiovascular disease. The health and economic impact of salt consumption on the future burden of stroke in Vietnam is not known.

Objective: To estimate the avoidable incidence of and deaths from stroke, as well as the healthy life years and healthcare costs that could be gained from reducing salt consumption in Vietnam.

Methods: This was a macrosimulation health and economic impact assessment study. Data on blood pressure, salt consumption and stroke epidemiology were obtained from the Vietnam 2015 STEPS survey and the Global Burden of Disease study. A proportional multi-cohort multistate lifetable Markov model was used to estimate the impact of achieving the Vietnam national salt targets of 8 g/day by 2025 and 7 g/day by 2030, and to the 5 g/day WHO recommendation by 2030. Probabilistic sensitivity analysis was conducted to quantify the uncertainty in our projections.

Results: If the 8 g/day, 7 g/day, and 5 g/day targets were achieved, the prevalence of hypertension could reduce by 1.2% (95% uncertainty interval [UI]: 0.5 to 2.3), 2.0% (95% UI: 0.8 to 3.6), and 3.5% (95% UI: 1.5 to 6.3), respectively. This would translate, respectively, to over 80,000, 180,000, and 257,000 incident strokes and over 18,000, 55,000, and 73,000 stroke deaths averted. By 2025, over 56,554 stroke-related health-adjusted life years (HALYs) could be gained while saving over US$ 42.6 million in stroke healthcare costs. By 2030, about 206,030 HALYs (for 7 g/day target) and 262,170 HALYs (for 5 g/day target) could be gained while saving over US$ 88.1 million and US$ 122.3 million in stroke healthcare costs respectively.

Conclusion: Achieving the national salt reduction targets could result in substantial population health and economic benefits. Estimated gains were larger if the WHO salt targets were attained and if changes can be sustained over the longer term. Future work should consider the equity impacts of specific salt reduction programs.