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Yi J, Wang L, Song J, Liu Y, Liu J, Zhang H, Lu J, Zheng X. Development of a machine learning-based model for predicting individual responses to antihypertensive treatments. Nutr Metab Cardiovasc Dis 2024; 34:1660-1669. [PMID: 38555240 DOI: 10.1016/j.numecd.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND AIMS Personalized antihypertensive drug selection is essential for optimizing hypertension management. The study aimed to develop a machine learning (ML) model to predict individual blood pressure (BP) responses to different antihypertensive medications. METHODS AND RESULTS We used data from a pragmatic, cluster-randomized trial on hypertension management in China. Each patient's multiple visit records were included, and two consecutive visits were paired as the index and subsequent visits. The least absolute shrinkage and selection operator method was used to select index visit variables for predicting subsequent BP. The dataset was randomly divided into training and test sets in a 7:3 ratio. Model performance was evaluated using mean absolute error (MAE) and R-square in the test set. A total of 19,013 hypertension management visit records (6282 patients) were included. The mean age of the study population was 63.9 years, and 2657 (42.3%) were females. A total of 12 phenotypical features (age, sex, smoking within seven days, body mass index, waist circumference, index visit systolic BP, diastolic BP, heart rate, comorbidities of diabetes, dyslipidemia, coronary heart disease, and stroke), together with currently taking any prescribed antihypertensive medication regimens and visits time interval were selected to build the model. The Extreme Gradient Boost model performed best among all candidate algorithms, with an MAE of 8.57 mmHg and an R2 = 0.28 in the test set. CONCLUSION The ML techniques exhibit significant potential for predicting individual responses to antihypertensive treatments, thereby aiding clinicians in achieving optimal BP control safely and efficiently. TRIAL REGISTRATION ClinicalTrials.gov, NCT03636334. Registered July 3, 2018, https://clinicaltrials.gov/study/NCT03636334.
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Affiliation(s)
- Jiayi Yi
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lili Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiali Song
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yanchen Liu
- National Clinical Research Center for Cardiovascular Diseases, Coronary Artery Disease Center, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Haibo Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiapeng Lu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Coronary Artery Disease Center, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China.
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Palomo-Piñón S, Antonio-Villa NE, García-Cortés LR, Moreno-Noguez M, Alcocer L, Álvarez-López H, Cardona-Muñoz EG, Chávez-Mendoza A, Díaz-Díaz E, Enciso-Muñoz JM, Galván-Oseguera H, Rosas-Peralta M. Patients Living With Arterial Hypertension in Mexico: First Insights of The Mexican Registry of Arterial Hypertension (RIHTA Study). Am J Hypertens 2024; 37:503-513. [PMID: 38466237 PMCID: PMC11176274 DOI: 10.1093/ajh/hpae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Arterial hypertension is a significant cause of morbidity and mortality in Mexico. However, there is limited evidence to understand blood pressure management and cardiometabolic profiles. Here, we aim to assess the prevalence of controlled and uncontrolled blood pressure, as well as the prevalence of cardiometabolic risk factors among patients from the Mexican Registry of Arterial Hypertension (RIHTA). METHODS We conducted a cross-sectional analysis of participants living with arterial hypertension registered on RIHTA between December 2021 and April 2023. We used both the 2017 ACC/AHA and 2018 ESC/ESH thresholds to define controlled and uncontrolled arterial hypertension. We considered eleven cardiometabolic risk factors, which include overweight, obesity, central obesity, insulin resistance, diabetes, hypercholesterolemia, hypertriglyceridemia, low HDL-C, high LDL-C, low-eGFR, and high cardiovascular disease (CVD) risk. RESULTS In a sample of 5,590 participants (female: 61%, n = 3,393; median age: 64 [IQR: 56-72] years), the prevalence of uncontrolled hypertension varied significantly, depending on the definition (2017 ACC/AHA: 59.9%, 95% CI: 58.6-61.2 and 2018 ESC/ESH: 20.1%, 95% CI: 19.0-21.2). In the sample, 40.43% exhibited at least 5-6 risk factors, and 32.4% had 3-4 risk factors, chiefly abdominal obesity (83.4%, 95% CI: 82.4-84.4), high LDL-C (59.6%, 95% CI: 58.3-60.9), high CVD risk (57.9%, 95% CI: 56.6-59.2), high triglycerides (56.2%, 95% CI: 54.9-57.5), and low HDL-C (42.2%, 95% CI: 40.9-43.5). CONCLUSIONS There is a high prevalence of uncontrolled hypertension interlinked with a high burden of cardiometabolic comorbidities in Mexican adults living with arterial hypertension, underscoring the urgent need for targeted interventions and better healthcare policies to reduce the burden of the disease in our country.
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Affiliation(s)
- Silvia Palomo-Piñón
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Ciudad de México, México
| | | | - Luis Rey García-Cortés
- Coordinación de Planeación y Enlace Institucional, Jefatura de Servicios de Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Instituto Mexicano del Seguro Social, Estado de México, Oriente, México
| | - Moises Moreno-Noguez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Familiar No. 55 Zumpango, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Estado de México, México
| | - Luis Alcocer
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Ángeles del Pedregal, Ciudad de México, México
| | - Humberto Álvarez-López
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Puerta de Hierro Andares, Zapopan, Jalisco, México
| | - Ernesto G Cardona-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Adolfo Chávez-Mendoza
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Enrique Díaz-Díaz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Manuel Enciso-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital General Zacatecas "Luz González Cosio", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Zacatecas, Zacatecas, México
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
| | - Héctor Galván-Oseguera
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Martín Rosas-Peralta
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Titular Academia Nacional de Medicina, Ciudad de México, México
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Jiang Y, Wang K, Mei X, Zhou Y. The potential Role of CYP2D6*10(c.100 C>T) Gene Polymorphism in Kidney Injury of Patients with Hypertension Complicated with Non-Elevated Cystatin C. Cardiovasc Toxicol 2024:10.1007/s12012-024-09880-3. [PMID: 38867055 DOI: 10.1007/s12012-024-09880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
This study aims to investigate the potential role of CYP2D6*10 (c.100 C>T) gene polymorphism in renal function injury among hypertensive patients without elevated cystatin C. A cohort of hypertensive patients without elevated cystatin C was enrolled between 2021 and 2024 in the Fourth Affiliated Hospital of Soochow University, and their peripheral venous blood was used for total RNA extraction and CYP2D6*10 genotype analysis. Based on kidney injury status, patients were categorized into two groups, hypertensive patients with kidney injury (n = 94) and those without (n = 893). General characteristics such as age, gender and hyperlipemia were compared between the two groups. Multiple genotype models were investigated between the two groups, including allele models, dominant models, recessive models, co-dominant models, and super-dominant models. The results revealed that in the co-dominant gene model (CC vs. CT vs. TT), the risk of hypertension combined with renal injury was lower with the CT genotype compared to the CC genotype (Odds Ratio (OR) = 0.55, 95% Confidence Interval (CI) = 0.32-0.93, p = 0.02). In the overdominance model (CC + TT vs. CT), the risk of hypertension and renal injury in CC and CT genotypes was 0.42 times lower than that in the CT genotype (OR = 0.42, 95% CI = 0.27-0.64, p < 0.001). This study proposes CYP2D610 gene polymorphism as a potential predictor of renal function injury in hypertensive patients with normal cystatin C levels.
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Affiliation(s)
- Yufeng Jiang
- Department of Cardiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Institute for Hypertension of Soochow University, Suzhou, 215000, China
| | - Kuangyi Wang
- Department of Cardiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Institute for Hypertension of Soochow University, Suzhou, 215000, China
| | - Xiaofei Mei
- Department of Cardiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Institute for Hypertension of Soochow University, Suzhou, 215000, China
| | - Yafeng Zhou
- Department of Cardiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215000, China.
- Institute for Hypertension of Soochow University, Suzhou, 215000, China.
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Nyame S, Boateng D, Heeres P, Gyamfi J, Gafane-Matemane LF, Amoah J, Iwelunmor J, Ogedegbe G, Grobbee D, Asante KP, Klipstein-Grobusch K. Community-Based Strategies to Improve Health-Related Outcomes in People Living With Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Glob Heart 2024; 19:51. [PMID: 38883258 PMCID: PMC11177843 DOI: 10.5334/gh.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/18/2024] [Indexed: 06/18/2024] Open
Abstract
Background Individuals living with hypertension are at an increased risk of cardiovascular- and cerebrovascular-related outcomes. Interventions implemented at the community level to improve hypertension control are considered useful to prevent cardiovascular and cerebrovascular events; however, systematic evaluation of such community level interventions among patients living in low- and middle-income countries (LMICs) is scarce. Methods Nine databases were searched for randomized controlled trials (RCTs) and cluster randomized control trials (cRCTs) implementing community level interventions in adults with hypertension in LMICs. Studies were included based on explicit focus on blood pressure control. Quality assessment was done using the Revised Cochrane Risk of Bias tool for randomized trials (ROBS 2). Results were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Fixed-effect meta-analyses were conducted for studies that reported continuous outcome measures. Results We identified and screened 7125 articles. Eighteen studies, 7 RCTs and 11 cRCTs were included in the analysis. The overall summary effect of blood pressure control was significant, risk ratio = 1.48 (95%CI = 1.40-1.57, n = 12). Risk ratio for RCTs was 1.68 (95%CI = 1.40-2.01, n = 5), for cRCTs risk ratio = 1.46 (95%CI = 1.32-1.61, n = 7). For studies that reported individual data for the multicomponent interventions, the risk ratio was 1.27 (95% CI = 1.04-1.54, n = 3). Discussion Community-based strategies are relevant in addressing the burden of hypertension in LMICs. Community-based interventions can help decentralize hypertension care in LMIC and address the access to care gap without diminishing the quality of hypertension control.
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Affiliation(s)
- Solomon Nyame
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Kintampo Health Research Centre, Ghana
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Pauline Heeres
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Joyce Gyamfi
- Department of Global Health, New York University School of Global Public Health, New York University, New York, NY, USA
| | - Lebo F. Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, North-West Province, South Africa
| | | | - Juliet Iwelunmor
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
| | - Diederick Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | | | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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5
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Camara A, Koné A, Millimono TM, Sow A, Kaké A, Preux PM, Balde MD, Jesus P. Prevalence, risks factors, and control of hypertension in Guinean older adults in 2021: a cross-sectional survey. BMC Public Health 2024; 24:1530. [PMID: 38844883 PMCID: PMC11157834 DOI: 10.1186/s12889-024-18936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND The incidence of arterial hypertension increases with the aging of the population, but its magnitude remains insufficiently assessed. The aim of this study was to investigate the prevalence of hypertension and associated factors in elderly people in Guinea. METHODS Data were obtained from a cross-sectional general population survey, conducted among people aged ≥ 60 years. A stratified enumeration area random sample survey was conducted in the four natural regions of Guinea from February to April 2021. This study included an interview on sociodemographic data, and a clinical examination. Hypertension was defined as systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥ 90mmHg or previous diagnosis of hypertension (with or without antihypertensive medication). Hypertension control was defined as blood pressure below 140/90 mmHg during treatment. Age-standardized prevalence was calculated, and logistic regression was used to examine factors associated with hypertension. RESULTS A total of 1698 adults (1079 men, mean age: 71.6 ± 9.4 years) had at least two blood pressure measurements. The standardized prevalence of hypertension was 61.4% [95% CI: 61.3-61.6], ranging from 52% in Middle Guinea to 67% in Upper Guinea, and was higher in women (65.2%: 65.0-65.4) than in men (59.1%:58.9-59.3). Among those with hypertension, 46.7% were unaware of their condition before the survey and 49.6% were on treatment and only 18.5% had controlled hypertension. Whatever the residence (rural or urban), increasing age, being unmarried, working as a trader or functionary, jobless, living in upper Guinea, low monthly income, intake of extra salt, known diabetic, overweight, and obesity increased the risk of hypertension. In urban area, female sex (AOR: 1.14: 1.12-1.17), living in lower Guinea (AOR: 3.08: 2.97-3.20), being Maninka (AOR: 1.26: 1.21-1.31), being Nguerze (AOR: 1.71: 1.63-1.81) increased the risk of hypertension, but living in forest Guinea (AOR: 0.88: 0.83-0.93), being Soussou (AOR: 0.88: 0.85-0.92) decreased the risk. In rural area, living in forest Guinea (AOR: 2.14: 2.03-2.26), being Soussou (AOR: 1.14: 1.12-1.17) increased the risk of hypertension, but female sex (AOR: 0.96: 0.94-0.98), living in lower Guinea (AOR: 0.87: 0.85-0.89), being Maninka (AOR: 0.94: 0.92-0.97), being Nguerze (AOR: 0.50: 0.47-0.52) decreased the risk. CONCLUSION Hypertension is a major problem in the elderly population in Guinea, and the level of treatment and control in elderly with known hypertension is inadequate. The place of hypertension among cardiovascular diseases and the identification of associated factors underlines the need to develop innovative approaches to control this major risk factor.
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Affiliation(s)
- Alioune Camara
- Department of Public Health, Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, BP: 1017, CP:030, Guinea.
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea.
| | - Alpha Koné
- Department of Cardiology, Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Thierno Mamadou Millimono
- Department of Public Health, Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, BP: 1017, CP:030, Guinea
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Inserm U1094, IRD U270, CHU Limoges, Univ. Limoges, Limoges, France
| | - Abdoulaye Sow
- Department of Public Health, Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, BP: 1017, CP:030, Guinea
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Amadou Kaké
- National Program of Prevention and Control of Non-Communicable Diseases, Ministry of Health Public Hygiene, Conakry, Guinea
| | - Pierre-Marie Preux
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Inserm U1094, IRD U270, CHU Limoges, Univ. Limoges, Limoges, France
| | - Mamadou Dadhi Balde
- Department of Cardiology, Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Pierre Jesus
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Inserm U1094, IRD U270, CHU Limoges, Univ. Limoges, Limoges, France
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6
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Kalaria R, Maestre G, Mahinrad S, Acosta DM, Akinyemi RO, Alladi S, Allegri RF, Arshad F, Babalola DO, Baiyewu O, Bak TH, Bellaj T, Brodie‐Mends DK, Carrillo MC, Celestin K, Damasceno A, de Silva RK, de Silva R, Djibuti M, Dreyer AJ, Ellajosyula R, Farombi TH, Friedland RP, Garza N, Gbessemehlan A, Georgiou EE, Govia I, Grinberg LT, Guerchet M, Gugssa SA, Gumikiriza‐Onoria JL, Hogervorst E, Hornberger M, Ibanez A, Ihara M, Issac TG, Jönsson L, Karanja WM, Lee JH, Leroi I, Livingston G, Manes FF, Mbakile‐Mahlanza L, Miller BL, Musyimi CW, Mutiso VN, Nakasujja N, Ndetei DM, Nightingale S, Novotni G, Nyamayaro P, Nyame S, Ogeng'o JA, Ogunniyi A, de Oliveira MO, Okubadejo NU, Orrell M, Paddick S, Pericak‐Vance MA, Pirtosek Z, Potocnik FCV, Raman R, Rizig M, Rosselli M, Salokhiddinov M, Satizabal CL, Sepulveda‐Falla D, Seshadri S, Sexton CE, Skoog I, George‐Hyslop PHS, Suemoto CK, Thapa P, Udeh‐Momoh CT, Valcour V, Vance JM, Varghese M, Vera JH, Walker RW, Zetterberg H, Zewde YZ, Ismail O. The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact. Alzheimers Dement 2024; 20:4290-4314. [PMID: 38696263 PMCID: PMC11180946 DOI: 10.1002/alz.13836] [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: 10/31/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/04/2024]
Abstract
Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.
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Grants
- P30AG066506 National Institute of Aging (NIA)
- P01 HD035897 NICHD NIH HHS
- R13 AG066391 NIA NIH HHS
- International Society for Neurochemistry
- National Council for Scientific and Technological Development
- R01 AG075775 NIA NIH HHS
- Bluefield Project, the Olav Thon Foundation, the Erling-Persson Family Foundation, Stiftelsen för Gamla Tjänarinnor, Hjärnfonden, Sweden
- U19 AG074865 NIA NIH HHS
- UH3 NS100605 NINDS NIH HHS
- R01AG072547 Multi partner Consortium for Dementia Research in Latino America-Dominican Republic (LATAM-FINGERS)
- ASP/06/RE/2012/18 University of Sri Jayewardenepura, Sri Lanka
- D43 TW011532 FIC NIH HHS
- UF1 NS125513 NINDS NIH HHS
- 2019-02397 Swedish Research Council
- FLR/R1/191813 UK Royal Society/African Academy of Sciences
- R01 AG054076 NIA NIH HHS
- GOK: Government of Karnataka
- R56 AG074467 NIA NIH HHS
- R21 AG069252 NIA NIH HHS
- RF1 AG059421 NIA NIH HHS
- R56 AG061837 NIA NIH HHS
- Global Brain Health Institute (GBHI)
- 1R01AG068472-01 National Institute of Aging (NIA)
- FCG/R1/201034 UK Royal Society/African Academy of Sciences
- Appel à Projet des Equipes Émergentes et Labellisées scheme (APREL)
- Alzheimer's Drug Discovery Foundation (ADDF)
- R01 AG062588 NIA NIH HHS
- 1R01AG070883 University of Wisconsin, Madison
- U01 HG010273 NHGRI NIH HHS
- R25 TW011214 FIC NIH HHS
- ASP/06/RE/2013/28 University of Sri Jayewardenepura, Sri Lanka
- R01 AG052496 NIA NIH HHS
- R01 AG080468 NIA NIH HHS
- RBM: Rotary Bangalore Midtown
- U19 AG068054 NIA NIH HHS
- ADSF-21-831376-C Alzheimer Drug Discovery Foundation
- ADSF-21-831377-C Alzheimer Drug Discovery Foundation
- Canadian Institute of Health Research
- U19 AG078558 NIA NIH HHS
- 1P30AG066546-01A1 National Institutes of Health (NIH)
- RF1 AG059018 NIA NIH HHS
- National Research Foundation (NRF)
- P30 AG062422 NIA NIH HHS
- LSIPL: M/s Lowes Services India Private Limited
- UKDRI-1003 UK Dementia Research Institute at UCL
- U19AG074865 Multi partner Consortium for Dementia Research in Latino America-Dominican Republic (LATAM-FINGERS)
- P01 AG019724 NIA NIH HHS
- National Institute for Health and Care Research, United Kingdom
- R01 AG066524 NIA NIH HHS
- RF1 AG063507 NIA NIH HHS
- WCUP/Ph.D./19B 2013 University of Sri Jayewardenepura (USJ), Sri Lanka
- WCUP/Ph.D./19/2013 University of Sri Jayewardenepura (USJ), Sri Lanka
- GBHI ALZ UK-21-724359 Pilot Award for Global Brain Health Leaders
- R01AG080468-01 National Institute of Aging (NIA)
- U01 AG058589 NIA NIH HHS
- R01 AG057234 NIA NIH HHS
- SP/CIN/2016/02) Ministry of Primary Industries, Sri Lanka
- R01 AG072547 NIA NIH HHS
- U01 AG051412 NIA NIH HHS
- P30 AG059305 NIA NIH HHS
- Alzheimer's Association, USA
- R35 AG072362 NIA NIH HHS
- R01 NS050915 NINDS NIH HHS
- P30 AG066546 NIA NIH HHS
- 2022-01018 Swedish Research Council
- U19 AG063893 NIA NIH HHS
- ALFGBG-71320 Swedish State Support for Clinical Research
- U01 AG052409 NIA NIH HHS
- 1R13AG066391-01 National Institutes of Health (NIH)
- R01 AG21051 NIH and the Fogarty International Center [FIC]
- DP1AG069870 National Institutes of Health (NIH)
- Marie Skłodowska-Curie
- U19 AG078109 NIA NIH HHS
- Chinese Neuroscience Society, China
- RF1 AG061872 NIA NIH HHS
- DP1 AG069870 NIA NIH HHS
- P30 AG066506 NIA NIH HHS
- Wellcome Trust
- U01HG010273 Multi partner Consortium for Dementia Research in Latino America-Dominican Republic (LATAM-FINGERS)
- JPND2021-00694 European Union Joint Programme - Neurodegenerative Disease Research
- ASP/06/RE/2010/07 University of Sri Jayewardenepura, Sri Lanka
- Rainwater Charitable Foundation - The Bluefield project to cure FTD, and Global Brain Health Institute
- 101053962 European Union's Horizon Europe
- R01 AG058464 NIA NIH HHS
- R01 AG068472 NIA NIH HHS
- Michael J. Fox Foundation for Parkinson's Research, USA
- UL1 TR001873 NCATS NIH HHS
- SG-21-814756 National Institutes of Health (NIH)
- 201809-2016862 Alzheimer Drug Discovery Foundation
- UK National Health Service, Newcastle University,
- R01 AG058918 NIA NIH HHS
- National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre
- Wellcome Trust, UK
- ADSF-21-831381-C Alzheimer Drug Discovery Foundation
- Health Professionals Education Partnership Initiative Ethiopia
- ANR-09-MNPS-009-01 French National Research Agency
- R01 AG062562 NIA NIH HHS
- AXA Research Fund
- ICMR: Indian Council for Medical Research
- R01 AG070883 NIA NIH HHS
- International Society for Neurochemistry
- French National Research Agency
- AXA Research Fund
- National Center for Advancing Translational Sciences
- National Council for Scientific and Technological Development
- Swedish Research Council
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Affiliation(s)
- Raj Kalaria
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Gladys Maestre
- Departments of Neuroscience and Human GeneticsUniversity of Texas Rio Grande ValleyOne W. University BlvdBrownsvilleTexasUSA
| | - Simin Mahinrad
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Daisy M. Acosta
- Universidad Nacional Pedro Henriquez Urena (UNPHU)Santo DomingoDominican Republic
| | - Rufus Olusola Akinyemi
- Neuroscience and Ageing Research UnitInstitute for Advanced Medical Research and TrainingCollege of MedicineUniversity of IbadanIbadanOyoNigeria
| | - Suvarna Alladi
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBengaluruKarnatakaIndia
| | - Ricardo F. Allegri
- Fleni Neurological InstituteBuenos AiresArgentina
- Department of NeurosciencesUniversidad de la Costa (CUC)BarranquillaColombia
| | - Faheem Arshad
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBengaluruKarnatakaIndia
| | | | | | | | | | | | - Maria C. Carrillo
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Kaputu‐Kalala‐Malu Celestin
- Department of NeurologyCentre Neuropsychopathologique (CNPP)Kinshasa University Teaching HospitalUniversity of KinshasaKinshasaRepublic Democratic of the Congo
| | | | - Ranil Karunamuni de Silva
- Interdisciplinary Centre for Innovation in Biotechnology and NeuroscienceFaculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
- Institute for Combinatorial Advanced Research and Education (KDU‐CARE)General Sir John Kotelawala Defence UniversityRatmalanaSri Lanka
| | - Rohan de Silva
- Reta Lila Weston Institute and Department of ClinicalMovement NeuroscienceUCL Queen Square Institute of NeurologyLondonUK
| | - Mamuka Djibuti
- Partnership for Research and Action for Health (PRAH)TbilisiGeorgia
| | | | - Ratnavalli Ellajosyula
- Cognitive Neurology ClinicManipal Hospitaland Annasawmy Mudaliar HospitalBengaluruKarnatakaIndia
- Manipal Academy of Higher Education (MAHE)ManipalKarnatakaIndia
| | | | | | - Noe Garza
- Department of Neuroscience and Human GeneticsUniversity of Texas Rio Grande ValleyHarlingenTexasUSA
| | - Antoine Gbessemehlan
- Inserm U1094, IRD U270University of LimogesCHU Limoges, EpiMaCT ‐ Epidemiology of Chronic Diseases in Tropical ZoneInstitute of Epidemiology and Tropical NeurologyOmegaHealthLimogesFrance
- Inserm, Bordeaux Population Health Research CenterUniversity of BordeauxBordeauxFrance
| | - Eliza Eleni‐Zacharoula Georgiou
- Department of PsychiatryPatras University General HospitalFaculty of Medicine, School of Health SciencesUniversity of PatrasPatrasGreece
| | - Ishtar Govia
- Caribbean Institute for Health ResearchThe University of the West Indies, JamaicaWest IndiesJamaica
- Institute for Global HealthUniversity College LondonLondonUK
| | - Lea T. Grinberg
- Department of Neurology and PathologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of PathologyUniversity of Sao PauloR. da Reitoria, R. Cidade UniversitáriaSão PauloSao PauloBrazil
| | - Maëlenn Guerchet
- Inserm U1094, IRD U270University of LimogesCHU Limoges, EpiMaCT ‐ Epidemiology of Chronic Diseases in Tropical ZoneInstitute of Epidemiology and Tropical NeurologyOmegaHealthLimogesFrance
| | - Seid Ali Gugssa
- Department of NeurologySchool of MedicineAddis Ababa UniversityAddis AbabaEthiopia
| | | | - Eef Hogervorst
- Loughborough UniversityLoughboroughUK
- Respati UniversityYogyakartaIndonesia
| | | | - Agustin Ibanez
- Latin American Institute for Brain Health (BrainLat)Universidad Adolfo IbanezPeñalolénSantiagoChile
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Cognitive Neuroscience Center (CNC)Universidad de San Andrés, and National Scientific and Technical Research Council (CONICET)VictoriaProvincia de Buenos AiresArgentina
| | - Masafumi Ihara
- Department of NeurologyNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Thomas Gregor Issac
- Centre for Brain ResearchIndian Institute of Science (IISc)BengaluruKarnatakaIndia
| | - Linus Jönsson
- Department of NeurobiologyCare Science and Society, section for NeurogeriatricsKarolinska Institute, SolnavägenSolnaSweden
| | - Wambui M. Karanja
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Brain and Mind InstituteAga Khan UniversityNairobiKenya
| | - Joseph H. Lee
- Sergievsky CenterTaub Institute for Research on Alzheimer's Disease and the Aging BrainDepartments of Neurology and EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Iracema Leroi
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
| | | | - Facundo Francisco Manes
- Institute of Cognitive and Translational Neuroscience (INCYT)INECO FoundationFavaloro UniversityBuenos AiresArgentina
| | - Lingani Mbakile‐Mahlanza
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- University of BotswanaGaboroneBotswana
| | - Bruce L. Miller
- Department of NeurologyMemory and Aging CenterUniversity of California San Francisco Weill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | | | - Victoria N. Mutiso
- Africa Mental Health Research and Training FoundationNairobiKenya
- Department of PsychiatryUniversity of NairobiNairobiKenya
- World Psychiatric Association Collaborating Centre for Research and TrainingNairobiKenya
| | | | - David M. Ndetei
- Africa Mental Health Research and Training FoundationNairobiKenya
- Department of PsychiatryUniversity of NairobiNairobiKenya
- World Psychiatric Association Collaborating Centre for Research and TrainingNairobiKenya
| | - Sam Nightingale
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Gabriela Novotni
- University Clinic of NeurologyMedical Faculty University Ss Cyril and Methodius Institute for Alzheimer's Disease and NeuroscienceSkopjeNorth Macedonia
| | - Primrose Nyamayaro
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Faculty of Medicine and Health SciencesUniversity of ZimbabweHarareZimbabwe
| | - Solomon Nyame
- Kintampo Health Research CentreGhana Health ServiceHospital RoadNear Kintampo‐north Municipal HospitalKintampoGhana
| | | | | | - Maira Okada de Oliveira
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Department of Psychiatry at Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Cognitive Neurology and Behavioral Unit (GNCC)University of Sao PauloR. da Reitoria, R. Cidade UniversitáriaSão PauloSao PauloBrazil
| | - Njideka U. Okubadejo
- Neurology UnitDepartment of MedicineFaculty of Clinical SciencesCollege of MedicineUniversity of LagosYabaLagosNigeria
| | - Martin Orrell
- Institute of Mental HealthUniversity of NottinghamNottinghamUK
| | - Stella‐Maria Paddick
- Newcastle UniversityNewcastle upon TyneUK
- Gateshead Health NHS Foundation TrustSheriff HillTyne and WearUK
| | - Margaret A. Pericak‐Vance
- John P Hussman Institute for Human GenomicsMiller School of MedicineUniversity of MiamiCoral GablesFloridaUSA
- Dr. John T Macdonald Foundation Department of Human GeneticsUniversity of Miami Miller School of MedicineCoral GablesFloridaUSA
| | - Zvezdan Pirtosek
- Faculty of MedicineUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Felix Claude Victor Potocnik
- Old Age Psychiatry Unit, Depth PsychiatryStellenbosch UniversityWestern Cape, Stellenbosch CentralStellenboschSouth Africa
| | - Rema Raman
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mie Rizig
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyQueen SquareLondonUK
| | - Mónica Rosselli
- Department of PsychologyCharles E. Schmidt College of ScienceFlorida Atlantic UniversityBoca RatonFloridaUSA
- Florida Alzheimer's Disease Research CenterGainesvilleFloridaUSA
| | | | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative DiseasesUniversity of Texas Health Sciences CenterSan AntonioTexasUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyFraminghamMassachusettsUSA
| | - Diego Sepulveda‐Falla
- Molecular Neuropathology of Alzheimer's DiseaseInstitute of NeuropathologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and South Texas ADRCUT Health San AntonioSan AntonioTexasUSA
- University of Texas Health Sciences CenterSan AntonioTexasUSA
| | - Claire E. Sexton
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Ingmar Skoog
- Institute of Neuroscience and FysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Peter H. St George‐Hyslop
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Cambridge Institute for Medical Research and Department of Clinical NeurosciencesSchool of Clinical MedicineUniversity of CambridgeAddenbrookes Biomedical CampusTrumpingtonCambridgeUK
- Department of Medicine (Neurology)Temerty Faculty of MedicineUniversity of Torontoand University Health Network27 King's College CirTorontoOntarioCanada
| | - Claudia Kimie Suemoto
- Division of GeriatricsUniversity of Sao Paulo Medical SchoolR. da Reitoria, R. Cidade UniversitáriaSão PauloSao PauloBrazil
| | - Prekshy Thapa
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
| | - Chinedu Theresa Udeh‐Momoh
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- FINGERS Brain Health Institutec/o Stockholms SjukhemStockholmSweden
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of NeurobiologyCare Sciences and Society (NVS)Division of Clinical GeriatricsKarolinska Institute, SolnavägenSolnaSweden
- Imarisha Centre for Brain health and AgingBrain and Mind InstituteAga Khan UniversityNairobiKenya
| | - Victor Valcour
- Memory and Aging CenterDepartment of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jeffery M. Vance
- John P Hussman Institute for Human GenomicsMiller School of MedicineUniversity of MiamiCoral GablesFloridaUSA
| | - Mathew Varghese
- St. John's Medical CollegeSarjapur ‐ Marathahalli Rd, beside Bank Of Baroda, John Nagar, KoramangalaBengaluruKarnatakaIndia
| | - Jaime H. Vera
- Department of Global Health and InfectionBrighton and Sussex Medical SchoolBrightonUK
| | - Richard W. Walker
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Henrik Zetterberg
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiologythe Sahlgrenska Academy at the University of GothenburgGöteborgSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
- Department of Neurodegenerative DiseaseUCL Institute of NeurologyQueen Square, Queen SquareLondonUK
- UK Dementia Research Institute at UCLUniversity College LondonLondonUK
- Hong Kong Center for Neurodegenerative DiseasesClear Water BayHong KongChina
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Yared Z. Zewde
- Department of NeurologySchool of MedicineAddis Ababa UniversityAddis AbabaEthiopia
| | - Ozama Ismail
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
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7
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Cieślik M, Strobel SD, Bryniarski P, Twardowska H, Chmielowski A, Rudek M, Felkle D, Zięba K, Kaleta K, Jarczyński M, Nowak B, Bryniarski K, Nazimek K. Hypotensive drugs mitigate the high-sodium diet-induced pro-inflammatory activation of mouse macrophages in vivo. Biomed Pharmacother 2024; 175:116648. [PMID: 38677242 DOI: 10.1016/j.biopha.2024.116648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024] Open
Abstract
Nowadays, there is an increasing emphasis on the need to alleviate the chronic inflammatory response to effectively treat hypertension. However, there are still gaps in our understanding on how to achieve this. Therefore, research on interaction of antihypertensive drugs with the immune system is extremely interesting, since their therapeutic effect could partly result from amelioration of hypertension-related inflammation, in which macrophages seem to play a pivotal role. Thus, current comprehensive studies have investigated the impact of repeatedly administered hypotensive drugs (captopril, olmesartan, propranolol, carvedilol, amlodipine, verapamil) on macrophage functions in the innate and adaptive immunity, as well as if drug-induced effects are affected by a high-sodium diet (HSD), one of the key environmental risk factors of hypertension. Although the assayed medications increased the generation of reactive oxygen and nitrogen intermediates by macrophages from standard fed donors, they reversed HSD-induced enhancing effects on macrophage oxidative burst and secretion of pro-inflammatory cytokines. On the other hand, some drugs increased macrophage phagocytic activity and the expression of surface markers involved in antigen presentation, which translated into enhanced macrophage ability to activate B cells for antibody production. Moreover, the assayed medications augmented macrophage function and the effector phase of contact hypersensitivity reaction, but suppressed the sensitization phase of cell-mediated hypersensitivity under HSD conditions. Our current findings contribute to the recognition of mechanisms, by which excessive sodium intake affects macrophage immune activity in hypertensive individuals, and provide evidence that the assayed medications mitigate most of the HSD-induced adverse effects, suggesting their additional protective therapeutic activity.
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Affiliation(s)
- Martyna Cieślik
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Spencer D Strobel
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Paweł Bryniarski
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Hanna Twardowska
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Adam Chmielowski
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Michał Rudek
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Dominik Felkle
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Katarzyna Zięba
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Konrad Kaleta
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Mateusz Jarczyński
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Bernadeta Nowak
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Krzysztof Bryniarski
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland
| | - Katarzyna Nazimek
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., Krakow 31-121, Poland.
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8
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Choi D, Im HB, Choi SJ, Han D. Safety classification of herbal medicine use among hypertensive patients: a systematic review and meta-analysis. Front Pharmacol 2024; 15:1321523. [PMID: 38881876 PMCID: PMC11176523 DOI: 10.3389/fphar.2024.1321523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/27/2024] [Indexed: 06/18/2024] Open
Abstract
Background The use of herbal medicines (HMs) for the treatment of hypertension (HTN) is increasing globally, but research on the potential adverse effects and safety of HMs in HTN patients is limited. Therefore, this systematic review and meta-analysis aim to determine the global prevalence of HM usage among HTN patients and assess the safety of identified herbs based on current scientific evidence. Methods The PubMed/MEDLINE, EMBASE (Ovid), and Cumulated Index to Nursing and Allied Health Literature (CINAHL) databases were searched for cross-sectional studies on the use of HM among HTN patients. Our review includes studies published in English up to the year 2023. After extracting and appraising the data from the studies, a meta-analysis was conducted using the Stata version 16.0 to estimate the pooled prevalence of HM use in patients with HTN (PROSPERO: CRD42023405537). The safety classification of the identified HM was done based on the existing scientific literature. Results This study analyzed 37 cross-sectional studies from 21 countries and found that 37.8% of HTN patients used HM to manage their health. The prevalence of HM use varied significantly based on publication year and geographical region. Among the 71 identified herbs, Allium sativum L., Hibiscus sabdariffa L., and Olea europaea L. were the most commonly used. However, four herbs were identified as contraindicated, 50 herbs required caution, and only 11 herbs were considered safe for use. Conclusion The study highlights the potential risks of toxicities and adverse effects associated with HM use in the treatment of HTN. Ensuring patient safety involves using safe HMs in appropriate doses and avoiding contraindicated HMs. Future research should focus on identifying commonly used herbs, especially in resource-limited countries with poor HTN management, and additional clinical research is required to assess the toxicity and safety of commonly used HMs.
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Affiliation(s)
- Dain Choi
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, Republic of Korea
- Institute of Health Services Management, Hanyang University, Seoul, Republic of Korea
| | - Hyea Bin Im
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, Republic of Korea
- Institute of Health Services Management, Hanyang University, Seoul, Republic of Korea
| | - Soo Jeung Choi
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, Republic of Korea
- Institute of Health Services Management, Hanyang University, Seoul, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Dongwoon Han
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, Republic of Korea
- Institute of Health Services Management, Hanyang University, Seoul, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
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9
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Birhanu MM, Zengin A, Joshi R, Evans RG, Kalyanram K, Kartik K, Riddell MA, Suresh O, Srikanth VK, Arabshahi S, Thomas N, Thrift AG. Risk factors for incident cardiovascular events and their population attributable fractions in rural India: The Rishi Valley Prospective Cohort Study. Trop Med Int Health 2024; 29:377-389. [PMID: 38403844 DOI: 10.1111/tmi.13981] [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] [Indexed: 02/27/2024]
Abstract
OBJECTIVE We prospectively determined incident cardiovascular events and their association with risk factors in rural India. METHODS We followed up with 7935 adults from the Rishi Valley Prospective Cohort Study to identify incident cardiovascular events. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) with 95% confidence intervals (95% CI) for associations between potential risk factors and cardiovascular events. Population attributable fractions (PAFs) for risk factors were estimated using R ('averisk' package). RESULTS Of the 4809 participants without prior cardiovascular disease, 57.7% were women and baseline mean age was 45.3 years. At follow-up (median of 4.9 years, 23,180 person-years [PYs]), 202 participants developed cardiovascular events, equating to an incidence of 8.7 cardiovascular events/1000 PYs. Incidence was greater in those with hypertension (hazard ratio [HR] [95% CI] 1.73 [1.21-2.49], adjusted PAF 18%), diabetes (1.96 [1.15-3.36], 4%) or central obesity (1.77 [1.23, 2.54], 9%) which together accounted for 31% of the PAF. Non-traditional risk factors such as night sleeping hours and number of children accounted for 16% of the PAF. CONCLUSIONS Both traditional and non-traditional cardiovascular risk factors are important contributors to incident cardiovascular events in rural India. Interventions targeted to these factors could assist in reducing the incidence of cardiovascular events.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, New Delhi, India
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Velandai K Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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10
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Wang YRJ, Yang K, Wen Y, Wang P, Hu Y, Lai Y, Wang Y, Zhao K, Tang S, Zhang A, Zhan H, Lu M, Chen X, Yang S, Dong Z, Wang Y, Liu H, Zhao L, Huang L, Li Y, Wu L, Chen Z, Luo Y, Liu D, Zhao P, Lin K, Wu JC, Zhao S. Screening and diagnosis of cardiovascular disease using artificial intelligence-enabled cardiac magnetic resonance imaging. Nat Med 2024; 30:1471-1480. [PMID: 38740996 PMCID: PMC11108784 DOI: 10.1038/s41591-024-02971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
Cardiac magnetic resonance imaging (CMR) is the gold standard for cardiac function assessment and plays a crucial role in diagnosing cardiovascular disease (CVD). However, its widespread application has been limited by the heavy resource burden of CMR interpretation. Here, to address this challenge, we developed and validated computerized CMR interpretation for screening and diagnosis of 11 types of CVD in 9,719 patients. We propose a two-stage paradigm consisting of noninvasive cine-based CVD screening followed by cine and late gadolinium enhancement-based diagnosis. The screening and diagnostic models achieved high performance (area under the curve of 0.988 ± 0.3% and 0.991 ± 0.0%, respectively) in both internal and external datasets. Furthermore, the diagnostic model outperformed cardiologists in diagnosing pulmonary arterial hypertension, demonstrating the ability of artificial intelligence-enabled CMR to detect previously unidentified CMR features. This proof-of-concept study holds the potential to substantially advance the efficiency and scalability of CMR interpretation, thereby improving CVD screening and diagnosis.
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Affiliation(s)
| | - Kai Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Wen
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Pengcheng Wang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Yuepeng Hu
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Yongfan Lai
- School of Engineering, University of Science and Technology of China, Hefei, China
| | - Yufeng Wang
- Department of Computer Science, Stony Brook University, New York, NY, USA
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Siyi Tang
- School of Medicine, Stanford University, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Angela Zhang
- School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, School of Medicine (Division of Cardiology), Stanford University, Stanford, CA, USA
| | - Huayi Zhan
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuyu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujuan Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixiang Dong
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yining Wang
- Peking Union Medical College Hospital, Beijing, China
| | - Hui Liu
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Lei Zhao
- Beijing Anzhen Hospital, Beijing, China
| | | | - Yunling Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Zixian Chen
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Yi Luo
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dongbo Liu
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Pengbo Zhao
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA
| | - Keldon Lin
- Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
| | - Joseph C Wu
- School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, School of Medicine (Division of Cardiology), Stanford University, Stanford, CA, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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11
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Harun Z, Shahar S, You YX, Abdul Manaf Z, Abdul Majid H, Chin CY, Haron H, Michael V, Mohamad H, Mohd Yazid SFZ, Abdul Manan M, Wan Ibadullah WZ, Brown MK, He FJ, MacGregor GA. Salt reduction policy for out of home sectors: a supplementary document for the salt reduction strategy to prevent and control non-communicable diseases (NCDS) in Malaysia 2021-2025. Health Res Policy Syst 2024; 22:49. [PMID: 38637888 PMCID: PMC11025221 DOI: 10.1186/s12961-024-01124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/17/2024] [Indexed: 04/20/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the major cause of death among Malaysians. Reduction of salt intake in populations is one of the most cost-effective strategies in the prevention of CVDs. It is very feasible as it requires low cost for implementation and yet could produce a positive impact on health. Thus, salt reduction initiatives have been initiated since 2010, and two series of strategies have been launched. However, there are issues on its delivery and outreach to the target audience. Further, strategies targeting out of home sectors are yet to be emphasized. Our recent findings on the perceptions, barriers and enablers towards salt reduction among various stakeholders including policy-makers, food industries, food operators, consumers and schools showed that eating outside of the home contributed to high salt intake. Foods sold outside the home generally contain a high amount of salt. Thus, this supplementary document is being proposed to strengthen the Salt Reduction Strategy to Prevent and Control Non-communicable Diseases (NCDs) for Malaysia 2021-2025 by focussing on the strategy for the out-of-home sectors. In this supplementary document, the Monitoring, Awareness and Product (M-A-P) strategies being used by the Ministry of Health (MOH) are adopted with a defined outline of the plan of action and indicators to ensure that targets could be achieved. The strategies will involve inter-sectoral and multi-disciplinary approaches, including monitoring of salt intake and educating consumers, strengthening the current enforcement of legislation on salt/sodium labelling and promoting research on reformulation. Other strategies included in this supplementary document included reformulation through proposing maximum salt targets for 14 food categories. It is hoped that this supplementary document could strengthen the current the Salt Reduction Strategy to Prevent and Control NCDs for Malaysia 2021-2025 particularly, for the out-of-home sector, to achieve a reduction in mean salt intake of the population to 6.0 g per day by 2025.
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Affiliation(s)
- Zaliha Harun
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
- Lincoln University College-Medical Campus, 2, Jalan Stadium SS 7/15, Ss 7, 47301, Petaling Jaya, Selangor, Malaysia
| | - Suzana Shahar
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Yee Xing You
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- School of Health and Rehabilitation Sciences, AECC University College, Bournemouth, BH5 2DF, United Kingdom
| | - Chia Yook Chin
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 47500, Subang Jaya, Selangor Darul Ehsan, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Viola Michael
- Ministry of Health (MOH), Block A, Chancery Place, Precinct 15, 62050, Putrajaya, Malaysia
| | - Hamdan Mohamad
- Ministry of Health (MOH), Block E3, Complex E, Federal Government Administrative Centre, 62590, Putrajaya, Malaysia
| | | | - Musaalbakri Abdul Manan
- Food Science and Technology Research Centre, Malaysia Agricultural Research and Development Institute, Serdang, Selangor, Malaysia
| | | | - Mhairi K Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
| | - Graham A MacGregor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
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Espeche WG, Marin M, Romero C, Renna N, Vissani S, Blanco G, Pantalena SP, Cesario D, Diez E, Grasso C, Garzon E, Barochiner J, Ruise M, Minetto J, Mazzei N, Ramirez E, Rojas M, Carrera Ramos P, Gimenez MS, Rivarola M, Rada N, Deffacci A, Leiva Sisnieguez BC, Vissani J, Bercovsky R, Tenuta MA, Martinez C, Cerri G, Salazar R, Graziani L, Cornavaca T, Salazar MR. [Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study]. HIPERTENSION Y RIESGO VASCULAR 2024; 41:78-86. [PMID: 38418299 DOI: 10.1016/j.hipert.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/24/2023] [Accepted: 02/04/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. METHODS A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. RESULTS A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. CONCLUSION The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.
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Affiliation(s)
- W G Espeche
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - M Marin
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Sección de Hipertensión, Hospital Italiano de San Justo, Buenos Aires, Argentina
| | - C Romero
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; School of Medicine, Emory University School of Medicine, Atlanta, EE. UU
| | - N Renna
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - S Vissani
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Centro de Especialidades Neurológicas y Rehabilitación (CENYR) San Luis, San Luis, Argentina
| | - G Blanco
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Consultorios, Instituto Médico Prometeo, Mar del Plata, Buenos Aires, Argentina
| | - S P Pantalena
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología, Centro Modelo en Cardiología, San Miguel de Tucumán, Tucumán, Argentina
| | - D Cesario
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología, Hospital Villa Constitución, Santa Fe, Argentina
| | - E Diez
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Instituto de Medicina y Biología Experimental de Cuyo - UNCuyo - CONICET, Mendoza, Argentina
| | - C Grasso
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina
| | - E Garzon
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología, Hospital Privado de Córdoba, Córdoba, Argentina
| | - J Barochiner
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Sección de Hipertensión arterial, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - M Ruise
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología CCV, Clínica Yunes, Santiago del Estero, Argentina
| | - J Minetto
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina.
| | - N Mazzei
- Universidad Maimónides, Buenos Aires, Argentina
| | - E Ramirez
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - M Rojas
- Centro de Especialidades Neurológicas y Rehabilitación (CENYR) San Luis, San Luis, Argentina
| | - P Carrera Ramos
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - M S Gimenez
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - M Rivarola
- Consultorios, Instituto Médico Prometeo, Mar del Plata, Buenos Aires, Argentina
| | - N Rada
- Consultorios, Instituto Médico Prometeo, Mar del Plata, Buenos Aires, Argentina
| | - A Deffacci
- Núcleo de Innovación y Desarrollo de Oportunidades, Municipalidad de Mendoza, Mendoza, Argentina
| | - B C Leiva Sisnieguez
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - J Vissani
- Centro de Especialidades Neurológicas y Rehabilitación (CENYR) San Luis, San Luis, Argentina
| | - R Bercovsky
- Consultorios, Instituto Médico Prometeo, Mar del Plata, Buenos Aires, Argentina
| | - M A Tenuta
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - C Martinez
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - G Cerri
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - R Salazar
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - L Graziani
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - T Cornavaca
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología, Hospital Privado de Córdoba, Córdoba, Argentina
| | - M R Salazar
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
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GNAZÉGBO A, KARIDIOULA HA, SYLLA A, BONY KÉ, KOFFI YT, TOURÉ A, KONÉ BAK, KOUAMÉASSOUAN AÉ. [Evaluation of the management of hypertension among stroke patients in a neurology department of Côte d'Ivoire]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2024; 4:mtsi.v4i1.2024.366. [PMID: 38846129 PMCID: PMC11151912 DOI: 10.48327/mtsi.v4i1.2024.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/12/2023] [Indexed: 06/09/2024]
Abstract
Introduction Reducing blood pressure after stroke is important to prevent recurrent stroke, but we have no data about the control of blood pressure in our context. The purpose of this study was to assess management of hypertension among post-stroke patients in a neurology department. Method It was a retrospective study involving hypertensive stroke patients. They were followed up at 1, 3, 6 and 12 months after discharge. Results 141 patients fulfilled the inclusion criteria. The mean age was 61 years. Almost all patients (94.3%) received a dual antihypertensive therapy combining mainly an ACE inhibitor and a diuretic (70.2%). During follow-up, only 76 patients were assessed at M1, 50 at M3, 44 at M6 and 42 at M12. The average monthly cost of antihypertensive treatment was 13,771 CFA francs (21 euros). Non-adherence to antihypertensive medication were mostly noted in widows, patients without occupation, those with low education and no health insurance. At one year, blood pressure was controlled in 80% of the 42 patients still present. Non-control of blood pressure was related to poor therapeutic compliance (p<0.05). Conclusion This study highlights follow-up issues in hypertensive post-stroke patients with a high number of lost to follow-up. Blood pressure was controlled in patients who were regularly followed and adherent to antihypertensive treatment.
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Affiliation(s)
- Any GNAZÉGBO
- Service de neurologie, Centre hospitalier universitaire de Bouaké, Côte d'Ivoire
| | | | - Assata SYLLA
- Service de neurologie, Centre hospitalier universitaire de Bouaké, Côte d'Ivoire
| | - Kotchi Élysée BONY
- Service de neurologie, Centre hospitalier universitaire de Bouaké, Côte d'Ivoire
| | | | - Aïcha TOURÉ
- Service de neurologie, Centre hospitalier universitaire de Bouaké, Côte d'Ivoire
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Baklouti M, Mejdoub Y, Tombohindy MG, Ketata N, Jdidi J, Triki F, Yaich S, Abid L. Impact of Therapeutic Education on the Management of High Blood Pressure: A Quasi-experimental Survey From Southern Tunisia. Crit Pathw Cardiol 2024; 23:30-35. [PMID: 37831463 DOI: 10.1097/hpc.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The prevalence of arterial hypertension (HTA) was continuously increased with a low percentage of pressure control blood pressure among treated patients. Therapeutic education (TE) was one of the inventive methods in the management of high blood pressure (HBP) worldwide. The objective was to assess the impact of TE on the control and management of HBP. METHODS This was a quasi-experimental study consisting of an intervention, a pretest, and a post-test evaluation. This study was conducted in the external consultation service of cardiology CHU HEDI CHAKER of Sfax during over a period of 4 months (November 2021-March 2022). RESULTS In total, 35 of the patients (50%) were women with a sex ratio of 1. The mean age was 63.33 ± 8.91 years. We noted a statistically significant decrease on both systolic and diastolic blood pressure blood pressure values after TE among educated patients (135.3 ± 9.77 vs. 141.9 ± 10.9; P = 0.010) and (75 [70-80] vs. 80 [75-80]; P = 0.002), respectively. We found a significantly good knowledge about HBP definition (Odds ratio [OR] = 3.4; P = 0.022), HBP symptoms (OR = 9.1; P < 0.001), and HBP complications (OR = 12.3; P < 0.001) among educated patients. A significant association was noted between educated patients and low daily salt consumption after TE (OR = 2.7; P = 0.048). Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation Educated patients had significantly more adequate auto-control devise use (OR = 1.01; P = 0.028). Moreover, the respect of therapeutic compliance was statistically more important among educated patients (OR = 3.7; P = 0.028). CONCLUSIONS Our results showed that the TE training session is an operative intervention to improve HBP management. Thus, integrating TE therapy in daily care should be continuous and should be exhaustive to all cardiovascular and all chronic diseases.
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Affiliation(s)
- Mouna Baklouti
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Yosra Mejdoub
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | | | - Nouha Ketata
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Jihen Jdidi
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Faten Triki
- Cardiology Department Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Sourour Yaich
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Leila Abid
- Cardiology Department Hedi Chaker University Hospital, University of Sfax, Tunisia
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Wan S, Pan D, Su M, Wang S, Wang Y, Xu D, Sun J, Xie W, Wang X, Yan Q, Xia H, Yang C, Sun G. Association between socio-demographic factors, lifestyle, eating habits and hypertension risk among middle-aged and older rural Chinese adults. Nutr Metab Cardiovasc Dis 2024; 34:726-737. [PMID: 38161126 DOI: 10.1016/j.numecd.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND AIMS Hypertension is a global health issue with increasing prevalence. This study aimed to understand the epidemiological characteristics and influencing factors of hypertension in rural Chinese populations and help develop effective prevention and control strategies. METHODS AND RESULTS This cross-sectional study used database from the Early Diagnosis and Early Treatment Project of Esophageal Cancer conducted in a rural population from September 2012 to December 2017. A total of 10,111 subjects aged 35-75 years residing in Huai'an District, Huai'an City, Jiangsu Province for at least three years were included. Unconditional univariate and multivariate logistic regression models were performed to evaluate the association between socio-demographic information, lifestyle habits, dietary characteristics and the risk of hypertension. The prevalence of hypertension was 34.32 % in this rural population. Men and older individuals are more likely to have hypertension when compared with women and young individuals, respectively. Factors associated with an increased risk of hypertension included: fast eating speed, a high-salt diet (both currently and ten years ago), a high-spicy diet ten years ago, high BMI, poor educational attainment, preference for fatty meats, hot diet, green tea drinking, intake of pickled potherb mustard and corn flour, family smoking and alcohol consumption. Light smoking in males, consumption of fruits, adzuki bean, and pork liver were associated with reduced risk of hypertension. CONCLUSIONS The study identified some factors, including eat habits and lifestyle, associated with hypertension risk, and highlighted the need for targeted policies and interventions in rural China to address potential risk factors for hypertension.
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Affiliation(s)
- Shiyun Wan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, PR China
| | - Da Pan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, PR China.
| | - Ming Su
- Huai'an District Center for Disease Control and Prevention, 223200, Huai'an, PR China
| | - Shaokang Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, PR China; School of Medicine, Xizang Minzu University, 712082, Xianyang, PR China
| | - Yuanyuan Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, PR China
| | - Dengfeng Xu
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, PR China
| | - Jihan Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, PR China
| | - Wei Xie
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, PR China
| | - Xin Wang
- Huai'an District Center for Disease Control and Prevention, 223200, Huai'an, PR China
| | - Qingyang Yan
- Huai'an District Center for Disease Control and Prevention, 223200, Huai'an, PR China
| | - Hui Xia
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, PR China
| | - Chao Yang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, PR China; Wuxi School of Medicine, Jiangnan University, 214122, Wuxi, PR China
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, PR China.
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Chaturvedi A, Zhu A, Gadela NV, Prabhakaran D, Jafar TH. Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases. Hypertension 2024; 81:387-399. [PMID: 38152897 PMCID: PMC10863660 DOI: 10.1161/hypertensionaha.123.21354] [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] [Indexed: 12/29/2023]
Abstract
High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled blood pressure and cardiovascular disease (CVD) deaths. Despite improvements in high-income countries, disparities persist, notably in the United States, where Black individuals face up to 4× higher CVD mortality than White individuals. Social determinants of health encompass complex, multidimensional factors linked to an individual's birthplace, upbringing, activities, residence, workplaces, socioeconomic and environmental structures, and significantly affect health outcomes, including hypertension and CVD. This review explored how social determinants of health drive disparities in hypertension and related CVD morbidity from a socioecological and life course perspective. We present evidence-based strategies, emphasizing interventions tailored to specific community needs and cross-sector collaboration to address health inequalities rooted in social factors, which are key elements toward achieving the United Nations' Sustainable Development Goal 3.4 for reducing premature CVD mortality by 30% by 2030.
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Affiliation(s)
- Abhishek Chaturvedi
- Georgetown University, MedStar Washington Hospital Center, Washington, DC (A.C.)
| | - Anqi Zhu
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (A.Z., T.H.J.)
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India (D.P.)
- Public Health Foundation of India, Gurugram, India (D.P.)
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (A.Z., T.H.J.)
- Aga Khan University, Karachi, Pakistan (T.H.J.)
- Duke Global Health Institute, Durham, NC (T.H.J.)
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Xu H, Zhao Y, Tan R, Li M, Yu C, Rui D, Li J, Xiong Y, Zheng W. Association of consumption of sugar-sweetened beverages with elevated blood pressure among college students in Yunnan Province, China. Public Health Nutr 2024; 27:e85. [PMID: 38418286 DOI: 10.1017/s1368980024000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Although some studies have examined the association between eating behaviour and elevated blood pressure (EBP) in adolescents, current data on the association between sugar-sweetened beverages (SSB) and EBP in adolescents in Yunnan Province, China, are lacking. SETTING Cluster sampling was used to survey freshmen at a college in Kunming, Yunnan Province, from November to December. Data on SSB consumption were collected using an FFQ measuring height, weight and blood pressure. A logistic regression model was used to analyse the association between SSB consumption and EBP, encompassing prehypertension and hypertension with sex-specific analyses. PARTICIPANTS The analysis included 4781 college students. RESULTS Elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected in 35·10 % (1678/4781) and 39·34 % (1881/4781) of patients, respectively. After adjusting for confounding variables, tea beverage consumption was associated with elevated SBP (OR = 1·24, 95 % CI: 1·03, 1·49, P = 0·024), and carbonated beverage (OR = 1·23, 95 % CI: 1·04, 1·45, P = 0·019) and milk beverage (OR = 0·81, 95 % CI: 0·69, 0·95, P = 0·010) consumption was associated with elevated DBP in college students. Moreover, fruit beverage (OR = 1·32, 95 % CI: 1·00, 1·75, P = 0·048) and milk beverage consumption (OR = 0·69, 95 % CI: 0·52, 0·93, P = 0·014) was associated with elevated DBP in males. CONCLUSION Our findings indicated that fruit and milk beverage consumption was associated with elevated DBP in males, and no association was observed with EBP in females.
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Affiliation(s)
- Honglv Xu
- School of Medicine, Kunming University, Kunming, Yunnan650214, China
- Community Nursing Research Team of Kunming University, Kunming, Yunnan650214, China
| | - Yun Zhao
- Department of Infection Control, Yan'an Hospital of Kunming City, Kunming650051, China
| | - Rui Tan
- Department of Infection Control, Yan'an Hospital of Kunming City, Kunming650051, China
| | - Min Li
- The First People's Hospital of Kunming, Kunming, Yunnan650100, China
| | - Chunjie Yu
- The First People's Hospital of Kunming, Kunming, Yunnan650100, China
| | - Danyun Rui
- School of Medicine, Kunming University, Kunming, Yunnan650214, China
- Community Nursing Research Team of Kunming University, Kunming, Yunnan650214, China
| | - Jiangli Li
- School of Medicine, Kunming University, Kunming, Yunnan650214, China
- Community Nursing Research Team of Kunming University, Kunming, Yunnan650214, China
| | - Yuan Xiong
- School of Medicine, Kunming University, Kunming, Yunnan650214, China
- Community Nursing Research Team of Kunming University, Kunming, Yunnan650214, China
| | - Weibin Zheng
- Baoshan Center for Disease Control and Prevention, Baoshan, Yunnan678100, China
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Pang L, Kottu L, Guo Z, Ma M, Wang H, Zhao Y, Tang M, Shi Y, Liu W, Wu X, Song J, Sun M, Merkus D, Ferdous MM, He L, Duo L. A tryst of 'blood pressure control- sex- comorbidities': the odyssey of basic public health services in Yunnan in quest for truth. BMC Public Health 2024; 24:490. [PMID: 38365657 PMCID: PMC10870683 DOI: 10.1186/s12889-023-17157-7] [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: 03/28/2023] [Accepted: 11/04/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The Basic Public Health Service (BPHS), a recently announced free healthcare program, aims to combat the most prevalent Noncommunicable Disease-"Hypertension" (HTN)-and its risk factors on a nationwide scale. In China, there is a rife that HTN less impacts women during their lifetime. We, therefore, aimed to evaluate the sex disparity in hypertension patients with comorbidities among south-west Chinese and the contribution of BPHS to address that concern. METHODS We have opted for a multistage stratified random sampling method to enroll hypertensive patients of 35 years and older, divided them into BPHS and non-BPHS groups. We assessed the sex disparity in HTN patients with four major comorbidities- Dyslipidemia, Diabetes Mellitus (DM), Cardiovascular Disease (CVD), and Chronic Kidney Disease (CKD), and descriptive data were compiled. Odds ratios from logistic regression models estimated the effectiveness of BPHS in the management of HTN with comorbidities. RESULTS Among 1521 hypertensive patients,1011(66.5%) were managed in the BPHS group. The proportion of patients who had at least one comorbidity was 70.7% (95% confidence interval [CI]: 66.3-76.8%), patients aged 65 years and older were more likely to have coexisting comorbidities. Participants who received the BPHS showed significant blood pressure (BP) control with two comorbidities (odds ratio [OR] = 2.414, 95% CI: 1.276-4.570), three or more (OR = 5.500, 95%CI: 1.174-25.756). Patients with dyslipidemia and DM also benefited from BPHS in controlling BP (OR = 2.169, 95% CI: 1.430-3.289) and (OR = 2.785, 95%CI: 1.242-6.246), respectively. In certain high-income urban survey centers, there was sex differences in the HTN management provided by BPHS, with men having better BP control rates than women. CONCLUSIONS Perhaps this is the first study in China to succinctly show the effectiveness and sex disparity regarding "management of hypertensive comorbidities". This supports that the BPHS program plays a pivotal role in controlling BP, therefore should recommend the national healthcare system to give women a foremost priority in BPHS, especially to those from low-socioeconomic and low-scientific literacy regions.
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Affiliation(s)
- Linhong Pang
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Lakshme Kottu
- Division of Experimental Cardiology, Erasmus university medical center, 3015GD, Rotterdam, The Netherlands
| | - Zihong Guo
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Min Ma
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Huadan Wang
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Yajing Zhao
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Mingjing Tang
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Yi Shi
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Wei Liu
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Xia Wu
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Junjie Song
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Manli Sun
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Daphne Merkus
- Division of Experimental Cardiology, Erasmus university medical center, 3015GD, Rotterdam, The Netherlands
- Walter Brendel Center of Experimental Medicine (WBex), LMU, 81377, Munich, Germany
| | - Md Misbahul Ferdous
- The Third People's Hospital of Longgang District, 518083, Shenzhen, China.
- Lepu Medical Technology (Beijing) Co., Ltd, 102200, Beijing, China.
| | - Liping He
- School of Public Health, Kunming Medical University, 650500, Kunming, China.
| | - Lin Duo
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China.
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McNulty LK, Stoutenberg M, Kolkenbeck-Ruh A, Harrison A, Mmoledi T, Katiyo D, Mhlaba M, Kubheka D, Ware LJ. Examining the referral of patients with elevated blood pressure to health resources in an under-resourced community in South Africa. BMC Public Health 2024; 24:412. [PMID: 38331796 PMCID: PMC10854044 DOI: 10.1186/s12889-023-17359-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/28/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Low-and-middle income countries face a disproportionate burden of non-communicable diseases (NCDs) that threaten to overwhelm under-resourced health systems. Community health workers (CHWs) can promote NCD prevention, reach patients, and connect them to local community health resources; however, little has been done to examine how referrals to these resources are utilized by community members. The purpose of this study is to examine the use of referrals to community-based health resources and investigate the factors influencing patient utilization of referrals connecting them to appropriate health resources for elevated blood pressure (BP). METHODS CHWs conducted home visits, which included BP screening and brief counseling, with community members in Soweto, South Africa. Participants with elevated (systolic BP: 121-139/ diastolic BP: 81-89 mmHg) or high (≥ 140/90 mmHg) BP were referred to either a local, community-based physical activity (PA) program managed by a non-governmental organization or local health clinics. The number of participants that received and utilized their referrals was tracked. Follow-up interviews were conducted with individuals given a referral who: (1) went to the PA program, (2) did not go to the PA program, (3) went to a clinic, and (4) did not go to a clinic. Interviews were transcribed and analyzed to identify common themes and differences between groups regarding their decisions to utilize the referrals. RESULTS CHWs visited 1056 homes, with 1001 community members consenting to the screening; 29.2% (n = 292) of adults were classified as having optimal BP (≤120/80 mmHg), 35.8% (n = 359) had elevated BP, and 35.0% (n = 350) had high BP. One hundred and seventy-three participants accepted a referral to the PA program with 46 (26.6%) enrolling. Five themes emerged from the interviews: (1) prior knowledge and thoughts on BP, (2) psychosocial factors associated with BP control, (3) perception about receiving the referral, (4) contextual factors influencing referral utilization, and (5) perceived benefits of utilizing the referral. CONCLUSION CHWs can successfully increase community members' access to health resources by providing appropriate referrals. However, greater attention needs to address community members' barriers and hesitancy to utilize health resources.
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Affiliation(s)
- Lia K McNulty
- Department of Kinesiology, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mark Stoutenberg
- Department of Kinesiology, College of Public Health, Temple University, Philadelphia, PA, USA
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, Gauteng, South Africa
- Department of Sport and Exercise Sciences, Faculty of Social Sciences and Health, Durham University, Durham, UK
| | - Andrea Kolkenbeck-Ruh
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Harrison
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Phila Sonke Wellness Initiative, Dobsonville Stadium, Dobsonville, Johannesburg, South Africa
| | - Thabiso Mmoledi
- Phila Sonke Wellness Initiative, Dobsonville Stadium, Dobsonville, Johannesburg, South Africa
| | - Daniel Katiyo
- SA MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
- Wits Health Hubb, Wits Health Consortium, Johannesburg, South Africa
| | - Mimi Mhlaba
- SA MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
- Wits Health Hubb, Wits Health Consortium, Johannesburg, South Africa
| | - Delisile Kubheka
- SA MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
- Wits Health Hubb, Wits Health Consortium, Johannesburg, South Africa
| | - Lisa J Ware
- SA MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.
- Wits Health Hubb, Wits Health Consortium, Johannesburg, South Africa.
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20
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Nguyen THT, Bui TT, Lee J, Choi KS, Cho H, Oh JK. Socioeconomic inequality in health-related quality of life among Korean adults with chronic disease: an analysis of the Korean Community Health Survey. Epidemiol Health 2024; 46:e2024018. [PMID: 38228085 PMCID: PMC11099595 DOI: 10.4178/epih.e2024018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES Health-related quality of life is crucial for people dealing with chronic illness. This study investigated the quality of life in individuals with 5 common chronic conditions in Korea. We also analyzed socioeconomic factors such as education, income, occupation, and urbanization to identify determinants of inequality. METHODS Using 2016 Korea Community Health Survey data, we examined individuals aged 30 or older with chronic diseases (diabetes, hypertension, cardiovascular disease, hyperlipidemia, arthritis) using the EuroQol 5-Dimension 3 Level tool. We analyzed the associations between socioeconomic factors (education, income, occupation, urbanization) and quality of life using descriptive statistics and regression analysis. Inequality indices (relative inequality index, absolute inequality index) were used to measure inequality in quality of life. RESULTS Individuals with higher income levels showed a 1.95-fold higher likelihood of a better quality of life than those with the lowest income. The lowest income group had higher odds of mobility (adjusted odds ratio [aOR], 2.2), self-care (aOR, 2.1), activity limitations (aOR, 2.4), pain/discomfort (aOR, 1.8), and anxiety/depression (aOR, 2.3). Educational disparities included a 3-fold increase in mobility and daily activity problems for those with elementary or lower education. Well-educated participants had a 1.94 times higher quality of life, with smaller differences in anxiety/depression and self-management. The income gap accounted for 14.1% of variance in quality-of-life disparities. CONCLUSIONS Addressing socioeconomic disparities in the quality of life for individuals with chronic diseases necessitates tailored interventions and targeted health policies. This research informs policymakers in developing focused initiatives to alleviate health inequities. It emphasizes the importance of mental health support and ensuring affordable, accessible healthcare services.
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Affiliation(s)
- Thi Huyen Trang Nguyen
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Thi Tra Bui
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jinhee Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Hyunsoon Cho
- Department of Cancer AI & Digital Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jin-Kyoung Oh
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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21
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Fifita SST, Nonaka D, Cama MT, Filise MI. Factors associated with undiagnosed hypertension among Tongan adults: a cross-sectional study. Trop Med Health 2024; 52:4. [PMID: 38163919 PMCID: PMC10759494 DOI: 10.1186/s41182-023-00570-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Hypertension is responsible for many premature deaths worldwide. However, many individuals with hypertension remain undiagnosed. Tonga is one of the countries that has had a steep increase in hypertension, thus undiagnosed hypertension could also be increasing. Purpose of this study was to assess the prevalence and factors associated with undiagnosed hypertension among Tongan adults. METHODS This cross-sectional study used data collected from conveniently sampled 473 participants using electronic questionnaire and digital sphygmomanometer through household visits between February and March 2023. Inclusion criteria were age of 18-65 years, residence in the villages for at least six months, and not being pregnant. Fisher's exact test and mixed-effect logistic regression were performed using the EZR software to assess the association between undiagnosed hypertension and predictor variables. RESULTS The prevalence of undiagnosed hypertension was 22.4% (106/473). Five variables that were significantly associated with undiagnosed hypertension in Fisher's exact test were included in the multivariate logistic regression. Overall, only three variables remained significant. First, participants who never had their blood pressure measured had higher prevalence compared to those who had it checked recently (33.3% vs. 19.1%); odds ratio: 2.24). Secondly, participants who were not aware of the risk of developing hypertension were significantly more likely to have undiagnosed hypertension compared to those who were aware (27.9% vs. 16.7%; odds ratio: 1.81). Lastly, middle-aged participants (30-49 years) and older (50-65 years), were significantly more likely to have undiagnosed hypertension compared to those who were 18-29 years old (30.0% and 23.7% vs. 11.8%; odds ratio: 3.58 and 3.38 vs. 1.00). CONCLUSION The prevalence of undiagnosed hypertension could be substantial among Tongan adults, implicating a need to address this issue by doing further research and review current public health work to address hypertension in Tonga. Undiagnosed hypertension was associated with having no experience of blood pressure measurement, lack of awareness about hypertension, and age. Tongan government should provide people with more opportunities to have their blood pressure measured and to improve their awareness.
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Affiliation(s)
- Seini Siahi Talanoafoou Fifita
- Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan.
- Faculty of Nursing and Health Sciences, Tonga National University, Nuku'alofa, Tonga.
| | - Daisuke Nonaka
- Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | - Mele Tilema Cama
- Faculty of Nursing and Health Sciences, Tonga National University, Nuku'alofa, Tonga
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Vijayakumar V, Boopalan D, Ravi P, Chidambaram Y, Anandhan A, Muthupandi P, Shanmugam P, Kuppusamy M, Karuppasamy G. Effect of massage on blood pressure in patients with hypertension: A meta-analysis. J Bodyw Mov Ther 2024; 37:109-114. [PMID: 38432790 DOI: 10.1016/j.jbmt.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Hypertension (HTN) is a chronic medical condition that affects 1.13 billion people globally. Successful management of HTN is accomplished through both pharmacological and non-pharmacological interventions. Massage therapy, a widely practiced complementary and alternative medicine therapy that alleviates physical discomfort and promotes overall well-being. The current meta-analysis aims to evaluate the effect of massage on blood pressure in patients with HTN. METHODS Electronic databases, including PubMed, Prospero, Scopus, ClinicalTrials.gov, Embase, and the Cochrane Library, were searched from their inception up to March 2021. All experimental trials that met the (PICO) criteria were included. The primary outcome of the study was blood pressure. A meta-analysis was conducted using a random-effects model to generate a summary of treatment effects, expressed as the effect size (Standardized Mean Difference - SMD), along with a 95% Confidence Interval (CI). RESULTS Six studies were included in the review, in which 290 patients participated, 148 were in the experimental group and 142 in the control group. Meta-analysis showed a minimal reduction of systolic blood pressure (SMD: -0.65 mmHg, 95% CI: -4.75, 3.55) and diastolic blood pressure (SMD: -0.68 mmHg, 95% CI: -2.43, 1.06) with considerable heterogeneity (I2> 94%). CONCLUSION The findings demonstrated that massage therapy resulted in a minimal reduction in blood pressure among patients with hypertension. To suggest massage as an effective intervention to reduce blood pressure further randomized control trials are recommended. Additionally, the literature is limited and still emerging, further large prospective studies with long follow-ups are warranted to verify the findings from this meta-analysis.
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Affiliation(s)
- Venugopal Vijayakumar
- Department of Yoga, Govt. Yoga & Naturopathy Medical College & Hospital, The Tamilnadu Dr.MGR Medical University, Chennai- 600106 India
| | | | - Poornima Ravi
- Sri Ramachandra Institute of Higher Education and Research, Chennai India
| | - Yogapriya Chidambaram
- Department of Naturopathy, Govt. Yoga and Naturopathy Medical College and Hospital, The Tamilnadu Dr.MGR Medical University, Chennai-600106, India
| | - Akila Anandhan
- Department of Acupuncture & Energy Medicine, Govt. Yoga & Naturopathy Medical College & Hospital, The Tamilnadu Dr.MGR Medical University, Chennai- 600106 India
| | - Pandiaraja Muthupandi
- Department of Naturopathy, Govt. Yoga and Naturopathy Medical College and Hospital, The Tamilnadu Dr.MGR Medical University, Chennai-600106, India
| | - Poonguzhali Shanmugam
- Department of Community Medicine, Govt. Yoga & Naturopathy Medical College & Hospital, The Tamilnadu Dr.MGR Medical University, Chennai- 600106 India
| | - Maheshkumar Kuppusamy
- Department of Physiology, Govt. Yoga & Naturopathy Medical College & Hospital, The Tamilnadu Dr.MGR Medical University, Chennai- 600106 India.
| | - Govindasamy Karuppasamy
- Department of Physical Education and Sports Sciences, College of Science and Humanities, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
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Sarfika R, Sulistiawati, Afriyanti E, Saifudin IMMY. Self-care behavior among adult patients with hypertension in Padang, West Sumatra, Indonesia: A cross-sectional study. BELITUNG NURSING JOURNAL 2023; 9:595-602. [PMID: 38130680 PMCID: PMC10731429 DOI: 10.33546/bnj.2915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023] Open
Abstract
Background Self-care behavior is crucial in preventing chronic diseases, such as hypertension, which has become highly prevalent in Indonesia. Hypertension, often referred to as the "silent killer" due to its asymptomatic nature, can easily go unnoticed. Neglecting its treatment can lead to severe complications, including heart disease, heart failure, and stroke. Despite adults with hypertension feeling well, embracing self-care behavior, including making healthy lifestyle choices, disease management, and enhancing life quality, remains essential. Objective This study aimed to describe the self-care behavior of adult patients with hypertension in Indonesia. Methods A cross-sectional study design was employed, involving 270 participants selected through consecutive sampling. Data were collected between 15 March and 4 April 2023, using the Hypertension Blood Pressure Self Care Profile (HBP-SCP) questionnaire in six public healthcare centers in Padang City, West Sumatra, Indonesia. The data were analyzed using descriptive analysis, Mann-Whitney, and Kruskal-Wallis tests. Results The self-care behavior among adult patients with hypertension was at a moderate level (Mean = 49.78, SD = 6.64), and it had significant differences according to ethnicity (p = 0.041), marital status (p = 0.017), and body mass index (p = 0.008). Conclusion The findings highlight the influence of diverse ethnic backgrounds, various marital statuses, and differing body mass index levels, which may lead to distinct approaches to managing hypertension. These results offer valuable insights for nurses and other healthcare professionals to develop comprehensive strategies to enhance self-care among adult patients with hypertension.
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Affiliation(s)
- Rika Sarfika
- Mental Health and Community Department, Faculty of Nursing, Universitas Andalas, Padang, West Sumatra, Indonesia
| | - Sulistiawati
- Faculty of Nursing, Universitas Andalas, Padang, West Sumatra, Indonesia
| | - Esi Afriyanti
- Medical and Surgical Department, Faculty of Nursing, Universitas Andalas, Padang, West Sumatra, Indonesia
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Kengne AP, Brière JB, Le Nouveau P, Kodjamanova P, Atanasov P, Kochoedo M, Irfan O, Khan ZM. Impact of single-pill combinations versus free-equivalent combinations on adherence and persistence in patients with hypertension and dyslipidemia: a systematic literature review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2023:1-11. [PMID: 38088763 DOI: 10.1080/14737167.2023.2293199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Hypertension is a leading cause of death and disease burden followed by dyslipidemia. Their asymptomatic nature leads to low adherence and persistence to treatments. A systematic literature review (SLR) investigated the impact of single-pill-combinations (SPC) compared to free-equivalent combination (FEC) on adherence, persistence, clinical outcomes, healthcare resource utilization (HCRU), and patient-reported outcomes, in patients with hypertension, dyslipidemia, or both. METHODS MEDLINE, MEDLINE-IN-PROCESS, Embase, and Cochrane were searched from inception until 11 May 2021, for studies comparing SPC against FEC in patients with hypertension and/or dyslipidemia. Patient characteristics, study design, therapies, measures of adherence or persistence, clinical outcomes, and follow-up were extracted. RESULTS Among 52 studies identified in the SLR, 27 (n = 346,030 patients) were included in the meta-analysis. SPCs were associated with significantly improved adherence compared with FEC, as assessed through medication-possession-ratio ≥80% (odds ratio (OR) 0.42, p < 0.01) and proportion of days covered ≥80% (OR 0.45, p < 0.01). SPC also improved persistence (OR 0.44, p < 0.01) and systolic blood pressure (SBP) reduction (mean difference -1.50, p < 0.01) compared with the FEC. CONCLUSIONS SPC use resulted in significantly improved adherence, persistence, and SBP levels compared with FEC in patients with hypertension. The findings support SPC use in reducing the burden of hypertension and dyslipidemia.
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Affiliation(s)
- André Pascal Kengne
- A Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Petya Kodjamanova
- Health Economics and Market Access, Amaris Consulting, Sofia, Bulgaria
| | - Petar Atanasov
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Maryse Kochoedo
- Health Economics and Market Access, Amaris Consulting, Montréal, Canada
| | - Omar Irfan
- Health Economics and Market Access, Amaris Consulting, Toronto, Canada
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Alfaqeeh M, Alfian SD, Abdulah R. Factors Associated with Hypertension Among Adults: A Cross-Sectional Analysis of the Indonesian Family Life Survey. Vasc Health Risk Manag 2023; 19:827-836. [PMID: 38108024 PMCID: PMC10723179 DOI: 10.2147/vhrm.s438180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Hypertension (HTN) poses a significant health risk for Indonesia's large population. Underlying factors contributing to this disease are not fully understood at a national level. Therefore, this study aimed to evaluate factors associated with HTN in Indonesia. Patients and Methods This study used data from the Indonesian Family Life Survey-5, a 2014 national cross-sectional population-based survey of individuals aged 15 years and older. The mean arterial pressure (MAP) value was determined from three blood pressure measurements taken by trained nurses using Omron digital sphygmomanometers. The respondent was classified as hypertensive when the MAP value was at least 100. The study summarised the socio-demographic factors (age, gender, marital status, ethnicity and occupation status) and lifestyle habits (smoking, sleep quality, physical activity) with descriptive statistics. The potential associations between these factors and HTN were assessed using logistic regression analysis. The results were reported in terms of odds ratios (OR) with a 95% confidence interval (CI). Results The study included 32,670 respondents; 31.2% of them had HTN. Factors that were more likely associated with HTN were being <65 years old, being married (OR 1.257, 95% CI 1.170-1.352) and being smoker (OR 1.297, 95% CI 1.198-1.404), while being male (OR 0.677, 95% CI: 0.625-0.733) and doing no physical activity (OR 0.870, 95% CI: 0.813-0.930) were less likely to be associated with HTN. Conclusion This study indicates that there are associations between certain socio-demographic factors and lifestyle habits with HTN in Indonesia. This information may help policymakers and healthcare providers to develop effective strategies in order to control HTN in Indonesia, thereby improving the overall health and well-being of the population.
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Affiliation(s)
- Mohammed Alfaqeeh
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
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Honglv X, Wei W, Min W, Junyu C, Chunjie Y, Min L, Dehui L, Jiai W, Yinghong J. A decision tree model of hypertension among college students in Yunnan Province, China. Blood Press 2023; 32:2243337. [PMID: 37559253 DOI: 10.1080/08037051.2023.2243337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Previous studies have indicated that the prevalence rate of hypertension in adolescents is high, but it has not received much attention and the influencing factors are unclear, especially in Yunnan Province, China. MATERIALS AND METHODS A cluster sampling method was used to investigate 4781 freshmen in a college in Kunming, Yunnan Province from November to December. Demographic and lifestyle data were collected using questionnaires, and height, weight and blood pressure were measured. Decision tree model of hypertension in college students was established by Chi-square automatic interactive detection method. RESULTS Prevalence of prehypertension of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected in 33.9% and 32.1%, respectively. Prevalence of hypertension of SBP and DBP was detected in 1.2% and 7.2%, respectively. The hypertension and prehypertension decision tree of SBP has gender (χ2 = 728.64, p < .001) at the first level and body mass index (BMI) (boys: χ2 = 55.98, p < .001; girls: χ2 = 79.58, p < .001) at the second level. The hypertension and prehypertension decision tree of DBP has gender (χ2 = 381.83, p < .001) at the first level, BMI (boys: χ2 = 40.54, p < .001; girls: χ2 = 48.79, p < .001) at the second level, only children (χ2 = 6.43, p = .04) and red wine consumption (χ2 = 8.17, p = .017) at the third level. CONCLUSIONS The present study suggests that gender, BMI, only children and red wine consumption were the main factors affecting hypertension in college students in southwest border areas of China.
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Affiliation(s)
- Xu Honglv
- School of Medicine, Kunming University, Kunming, China
- Community Nursing Research Team of Kunming University, Kunming, China
| | - Wang Wei
- Department of Emergency, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wang Min
- Department of Emergency, The First People's Hospital of Yunnan Province, Kunming, China
| | - Chen Junyu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu Chunjie
- The First People's Hospital of Kunming, Kunming, China
| | - Li Min
- The First People's Hospital of Kunming, Kunming, China
| | - Liu Dehui
- Campus Hospital, Kunming University, Kunming, China
| | - Wang Jiai
- School of Medicine, Kunming University, Kunming, China
- Community Nursing Research Team of Kunming University, Kunming, China
| | - Jiang Yinghong
- School of Medicine, Kunming University, Kunming, China
- Community Nursing Research Team of Kunming University, Kunming, China
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Zhang Z, Shi G, Xing Y, Men K, Lei J, Ma Y, Zhang Y. Examining the potential impacts of intensive blood pressure treatment on the socioeconomic inequity in hypertension prevalence in China: a nationally representative cross-sectional study. Hypertens Res 2023; 46:2746-2753. [PMID: 37789112 DOI: 10.1038/s41440-023-01441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023]
Abstract
Few studies focused on the equity of hypertension prevalence before and after the diagnostic threshold change. The study aimed to analyze the 130/80 mmHg hypertension diagnostic threshold on the equity of hypertension prevalence in China. The baseline survey data from the China Health and Retirement Longitudinal Study (CHARLS) conducted from 2011 to 2012 were utilized to evaluate the impact of the 130/80 mmHg diagnostic threshold on the equity of hypertension prevalence in China using the concentration index and its decomposition which was an index reflecting the health inequality caused by social and economic factors. The prevalence of hypertension was 41.56% and 57.33% under the diagnostic thresholds of 140/90 mmHg and 130/80 mmHg, respectively. The concentration index for hypertension prevalence in China was -0.017 (95%CI: -0.028, -0.006) under the 140/90 mmHg threshold and -0.010 (95%CI: -0.018, -0.002) under the 130/80 mmHg threshold. Concentration index decomposition analysis of hypertension prevalence diagnosed at both diagnostic thresholds showed that age, BMI, and economic status contributed more to the inequitable situation of hypertension prevalence. Higher age, higher BMI, and poorer economic status increased the inequity of hypertension prevalence. No significant difference in the increase in hypertension among individuals of different economic status after implementing the blood pressure control standard (130/80 mmHg), and the prevalence of hypertension in the region did not show a significant bias towards the low economic status population. Therefore, implementing this standard will not increase the risk of hypertension prevalence biased toward people of low economic status. Implementing the 130/80 mmHg diagnostic threshold will not increase the risk of hypertension prevalence biased towards people of low economic status.
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Affiliation(s)
- Zhuo Zhang
- School of Health Services Management, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Guoshuai Shi
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China.
| | - Yuan Xing
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Ke Men
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Jing Lei
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Yonghong Ma
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Yijia Zhang
- School of Health Services Management, Xi'an Medical College, Xi'an, Shaanxi, China
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Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol 2023; 22:1160-1206. [PMID: 37827183 PMCID: PMC10715732 DOI: 10.1016/s1474-4422(23)00277-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars. Disability-adjusted life-years (DALYs) The sum of the years of life lost as a result of premature mortality from a disease and the years lived with a disability associated with prevalent cases of the disease in a population. One DALY represents the loss of the equivalent of one year of full health On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases. Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Mayowa O Owolabi
- Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Centre, Ibadan, Nigeria.
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Ghosh PK, Harun MGD, Shanta IS, Islam A, Jannat KKE, Mannan H. Prevalence and determinants of hypertension among older adults: A comparative analysis of the 6th and 8th national health surveys of Bangladesh. PLoS One 2023; 18:e0292989. [PMID: 37844103 PMCID: PMC10578599 DOI: 10.1371/journal.pone.0292989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Hypertension is a major public health concern in low-and middle-income countries. A nationwide Health, Population, and Nutrition Sector Development Program in Bangladesh has been shown to be effective in resource-poor settings. This article aims to investigate whether the prevalence and determinants of adult hypertension changed from 2011 to 2018. METHODS The determinants of adult hypertension were assessed in 2011 and 2018 data of Bangladesh Demographic and Health surveys. These two surveys included both men and women over the age of 34 years and measured their blood pressure, weight, height, and other covariates. For both surveys, we estimated the age-standard prevalence of hypertension and relative, attributable and mediated risk of determinants of hypertension using hierarchical mixed-effects sequential Poisson regression models. RESULTS The prevalence of adult hypertension increased by 10.9% from 29.5% in 2011 to 40.4% in 2018. The nationwide awareness program on the Health, Population and Nutrition Sector changed the risks associated with hypertension determinants over the years. During 2011, Socio-economic status (SES) was a major distal determinant of adult hypertension, explaining 21% of population-attributable risk (ART). However, other factors accounted for 90% of risk, mainly by excessive body weight (51%) and awareness of hypertension (39%). In contrast, SES only explained 16% of ART risk, with 97% of the risk mediated by excessive body weight (55%) and awareness of hypertension (41%). CONCLUSION The study results highlight that hypertension among older adult was significantly increased over the six-year period. Specially, the socio-economic status, awareness of hypertension and excessive body weight were the significant determinants. Being awareness of hypertension and excessive body weight changed the causal pathways of socio-economic status. The results also highlight the value of studying the effect of non-communicable disease awareness programs to enhance our comprehension of factors influencing health.
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Affiliation(s)
- Probir Kumar Ghosh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Ireen Sultana Shanta
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ausraful Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kaniz Khatun E. Jannat
- Doctoral student, School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Haider Mannan
- Translation Health Research Institute, Western Sydney University, Campbelltown Campus, Sydney, NSW, Australia
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Fan J, Ma W, Liu J, Li W, Wang W, Gu J, Zhou B. Associations between socioeconomic status and stroke in American adults: A population-based study. Prev Med Rep 2023; 35:102354. [PMID: 37588881 PMCID: PMC10425931 DOI: 10.1016/j.pmedr.2023.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/18/2023] Open
Abstract
Stroke is an acute cerebrovascular disease that can lead to disability and death. This study aimed to investigate the relationship between socioeconomic status (SES) and stroke. SES was evaluated by two variables: poverty to income ratio (PIR) and education level. In this multi-subject study, we collected data from the National Health and Nutrition Examination Survey (NHANES) database between 2009 and 2018, and finally 22,792 adults (≥20 years old) were included in the study. We proceeded with weighted multivariate logistic regression analysis as well as subgroup analysis. When analyzing the effect of PIR on stroke alone, the results showed that an increase in PIR levels was associated with a decrease in stroke incidence (OR = 0.764 95% CI: (0.711, 0.820), p < 0.001). The multivariate analysis presented a decline in stroke incidence in the highest quartile PIR group compared to the lowest quartile PIR group (OR = 0.296 95% CI: (0.214, 0.409), P<0.001). Our results indicated that PIR is a protective factor for stroke, but there are exceptions in this relationship among different people. Hence, it is imperative that policymakers, healthcare providers, and clinicians take into account the inequality distribution of SES among adults while developing and executing stroke prevention and treatment strategies.
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Affiliation(s)
- Jinming Fan
- Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Wuqin Ma
- Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Junbin Liu
- Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Wenhan Li
- Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Wenhao Wang
- Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Jinyan Gu
- Department of Scientific Research, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Bin Zhou
- Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
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Jobe M, Mactaggart I, Hydara A, Kim MJ, Bell S, Badjie O, Bittaye M, Perel P, Prentice AM, Burton MJ. Evaluating the hypertension care cascade in middle-aged and older adults in The Gambia: findings from a nationwide survey. EClinicalMedicine 2023; 64:102226. [PMID: 37767194 PMCID: PMC10520336 DOI: 10.1016/j.eclinm.2023.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Background Hypertension is a major public health problem in sub-Saharan Africa with poor treatment coverage and high case-fatality rates. This requires assessment of healthcare performance to identify areas where intervention is most needed. To identify areas where health resources should be most efficiently targeted, we assessed the hypertension care cascade i.e., loss and retention across the various stages of care, in Gambian adults aged 35 years and above. Methods This study was embedded within the nationally representative 2019 Gambia National Eye Health Survey of adults ≥35 years. We constructed a hypertension care cascade with four categories: prevalence of hypertension (defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, and/or current use of medication prescribed for hypertension); those aware of their diagnosis; those treated; and those with a controlled blood pressure (defined as blood pressure <140/90 mmHg). Analyses were age- and sex-standardised to the population structure of The Gambia. Logistic regression was used to assess the socio-demographic factors associated with prevalence, awareness, treatment and control of hypertension. Findings Of 9171 participants with data for blood pressure, the prevalence of hypertension was 47.0%. Among people with hypertension, the prevalence of awareness was 54.7%, the prevalence of hypertension treatment was 32.5%, and prevalence of control was 10.0% with little difference between urban and rural residence. The cascade of care performance was better in women. However, there was no difference in achieving blood pressure control between men and women who were receiving treatment. Female sex, older age and higher body mass index were associated with higher hypertension awareness whilst having an occupation compared to being unemployed was associated with higher odds of being treated. Patients in the underweight category had higher odds of achieving blood pressure control. Interpretation There is a high prevalence of hypertension and low performance of the health care system that impact on the hypertension care cascade among middle-aged and older adults in The Gambia. Addressing the full cascade will be paramount especially in reducing the mounting prevalence and improving diagnosis of patients with hypertension, where the greatest dividends will be gained. Funding The Queen Elizabeth Diamond Jubilee Trust, Wellcome Trust.
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Affiliation(s)
- Modou Jobe
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, UK
| | - Abba Hydara
- Sheikh Zayed Regional Eye Care Centre, Kanifing, The Gambia
| | - Min J. Kim
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzannah Bell
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Omar Badjie
- Directorate of Health Promotion & Education, Ministry of Health, The Gambia
| | - Mustapha Bittaye
- Directorate of Health Services, Ministry of Health, The Gambia
- Department of Obstetrics and Gynaecology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Das S, Goswami V, Chandel S. Normal weight central obesity and hypertension in India: Cross-sectional finding from LASI, 2017-19. Nutr Metab Cardiovasc Dis 2023; 33:1888-1898. [PMID: 37544873 DOI: 10.1016/j.numecd.2023.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/14/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIM The current public health guidelines for preventing and managing obesity still emphasize the importance of maintaining a normal Body Mass Index, while paying little attention to central obesity, which is common among the general population. Normal Weight Central Obesity (NWCO) is a less explored risk factor for hypertension in India. Therefore, this study aims to investigate the prevalence of NWCO and its association with hypertension in India. METHODS AND RESULTS The cross-sectional study used data from the Longitudinal Aging Study in India (LASI), 2017-19, which included 54,016 participants (22,438 men and 31,578 women). Hypertension was evaluated following the JNC-VIII guidelines for the detection, evaluation, and treatment of hypertension. Anthropometric measurements were taken to identify NWCO. The study found that NWCO was more prevalent among women (33.9%) than men (17.8%), while men had a higher prevalence of hypertension (47.6%) than women (43.8%). In India, the state of Haryana had the highest proportion of NWCO among men (26.4%), while Kerala had the highest proportion among women (39.1%). Binary logistic regression analysis showed that NWCO was significantly associated with an increased risk of hypertension. The odds ratio (aOR) was 1.57 (95% CI 1.45-1.67, p < 0.001) in men and 1.53 (95% CI 1.43-1.63, p < 0.001) in women, compared to normal-weight study participants. CONCLUSIONS The study emphasizes the importance of considering central obesity in individuals with a normal BMI when assessing cardiovascular risk, particularly for hypertension. State-specific data can help identify high-risk areas and facilitate targeted prevention and treatment strategies.
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Affiliation(s)
- Sayani Das
- Department of Health Research, International Institute of Health Management Research, New Delhi 110075, India.
| | - Vaidehi Goswami
- Department of Anthropology, University of Delhi, Delhi 110007, India
| | - Shivani Chandel
- Department of Anthropology, University of Delhi, Delhi 110007, India
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Gala P, Kamano JH, Vazquez Sanchez M, Mugo R, Orango V, Pastakia S, Horowitz C, Hogan JW, Vedanthan R. Cross-sectional analysis of factors associated with medication adherence in western Kenya. BMJ Open 2023; 13:e072358. [PMID: 37669842 PMCID: PMC10481848 DOI: 10.1136/bmjopen-2023-072358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES Poor medication adherence in low-income and middle-income countries is a major cause of suboptimal hypertension and diabetes control. We aimed to identify key factors associated with medication adherence in western Kenya, with a focus on cost-related and economic wealth factors. SETTING We conducted a cross-sectional analysis of baseline data of participants enrolled in the Bridging Income Generation with Group Integrated Care study in western Kenya. PARTICIPANTS All participants were ≥35 years old with either diabetes or hypertension who had been prescribed medications in the past 3 months. PRIMARY AND SECONDARY OUTCOME MEASURES Baseline data included sociodemographic characteristics, wealth and economic status and medication adherence information. Predictors of medication adherence were separated into the five WHO dimensions of medication adherence: condition-related factors (comorbidities), patient-related factors (psychological factors, alcohol use), therapy-related factors (number of prescription medications), economic-related factors (monthly income, cost of transportation, monthly cost of medications) and health system-related factors (health insurance, time to travel to the health facility). A multivariable analysis, controlling for age and sex, was conducted to determine drivers of suboptimal medication adherence in each overarching category. RESULTS The analysis included 1496 participants (73.7% women) with a mean age of 60 years (range 35-97). The majority of participants had hypertension (69.2%), 8.8% had diabetes and 22.1% had both hypertension and diabetes. Suboptimal medication adherence was reported by 71.2% of participants. Economic factors were associated with medication adherence. In multivariable analysis that investigated specific subtypes of costs, transportation costs were found to be associated with worse medication adherence. In contrast, we found no evidence of association between monthly medication costs and medication adherence. CONCLUSION Suboptimal medication adherence is highly prevalent in Kenya, and primary-associated factors include costs, particularly indirect costs of transportation. Addressing all economic factors associated with medication adherence will be important to improve outcomes for non-communicable diseases. TRIAL REGISTRATION NUMBER NCT02501746.
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Affiliation(s)
- Pooja Gala
- Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Manuel Vazquez Sanchez
- Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Richard Mugo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Vitalis Orango
- Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy Nursing and Health Sciences, West Lafayette, Indiana, USA
| | - Carol Horowitz
- Medicine and Population Health Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph W Hogan
- Biostatistics, Brown University, Providence, Rhode Island, USA
| | - Rajesh Vedanthan
- Medicine and Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Wu J, Jiao B, Zhao J. Gender Disparities in Blood Pressure and the Role of Body Mass Index: A Birth Cohort Analysis in China. J Epidemiol Glob Health 2023; 13:485-494. [PMID: 37302107 PMCID: PMC10468457 DOI: 10.1007/s44197-023-00127-y] [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: 02/22/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND The slow decline in cardiovascular disease (CVD) mortality and the stagnant or increasing hypertension prevalence in low- and middle-income countries necessitate investigation. Evolving gender disparities suggested that male cardiovascular health disadvantage may be preventable, offering potential for enhancing population cardiovascular health. Despite global body mass index (BMI) increases, its role in shaping the gender disparities remains underexplored. OBJECTIVE This study investigated the birth cohort dynamics of gender disparities in systolic/diastolic blood pressure (SBP/DBP) in China, one of the world's largest low- and middle-income countries, and explored the potential role of BMI in explaining the changing gender disparities. METHODS Data from the China Health and Nutrition Survey (1991-2015) were analyzed using multilevel growth-curve models to estimate gender- and cohort-specific SBP/DBP trajectories among individuals born between 1950 and 1975. RESULTS Men had higher SBP and DBP than women at the sample's mean age of 41.7 years. The gender disparities in SBP and DBP increased with each successive one-year cohort from 1950 to 1975 by 0.14 mm Hg and 0.09 mm Hg, respectively. Adjusting for BMI reduced the increasing gender disparities in SBP and DBP by 31.9% and 34.4%, respectively. CONCLUSION Chinese men experienced a greater increase in SBP/DBP across successive cohorts compared to women. The increasing gender disparities in SBP/DBP were partially attributable to a greater BMI increase across cohorts among men. Given these findings, prioritizing interventions that aim to reduce BMI, particularly among men, could potentially alleviate the burden of CVD in China through lowering SBP/DBP.
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Affiliation(s)
- Jinjing Wu
- Asian Demographic Research Institute, Shanghai University, Shanghai, 200444, China
| | - Boshen Jiao
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, 02115, USA
| | - Jiaying Zhao
- RSSS Building, 146 Ellery Crescent, School of Demography, ANU College of Arts and Social Sciences, The Australian National University, Acton ACT, Canberra, 2601, Australia.
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Rios FJ, Montezano AC, Camargo LL, Touyz RM. Impact of Environmental Factors on Hypertension and Associated Cardiovascular Disease. Can J Cardiol 2023; 39:1229-1243. [PMID: 37422258 DOI: 10.1016/j.cjca.2023.07.002] [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: 04/24/2023] [Revised: 06/24/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023] Open
Abstract
Hypertension is the primary cause of cardiovascular diseases and is responsible for nearly 9 million deaths worldwide annually. Increasing evidence indicates that in addition to pathophysiologic processes, numerous environmental factors, such as geographic location, lifestyle choices, socioeconomic status, and cultural practices, influence the risk, progression, and severity of hypertension, even in the absence of genetic risk factors. In this review, we discuss the impact of some environmental determinants on hypertension. We focus on clinical data from large population studies and discuss some potential molecular and cellular mechanisms. We highlight how these environmental determinants are interconnected, as small changes in one factor might affect others, and further affect cardiovascular health. In addition, we discuss the crucial impact of socioeconomic factors and how these determinants influence diverse communities with economic disparities. Finally, we address opportunities and challenges for new research to address gaps in knowledge on understanding molecular mechanisms whereby environmental factors influence development of hypertension and associated cardiovascular disease.
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Affiliation(s)
- Francisco J Rios
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
| | - Augusto C Montezano
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Livia L Camargo
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
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Kobashi Y, Haque SE, Amir I, Sakisaka K, Mubassara S, Tsubokura M. Examination of Cluster Groups of Risk Behaviors and Beliefs Associated with Non-Communicable Diseases with Latent Class Analysis: A Cross-Sectional Study in Rural Bangladesh. Healthcare (Basel) 2023; 11:2279. [PMID: 37628477 PMCID: PMC10454554 DOI: 10.3390/healthcare11162279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
This cross-sectional observational study examined the cluster groups of risk behaviors and beliefs associated with non-communicable diseases (NCDs) and the demographic factors that influence these cluster groups. The questionnaire survey was conducted in Lohagara Upazila in Narail District, Bangladesh and included basic demographics and items associated with NCDs. The inclusion criteria for the participants in this study included those who were aged between 20 and 80 years and both sexes. The survey items were based on risk behavior, belief, and improvement behavior. To identify the several cluster groups based on NCD-related behavior and belief patterns, a log-likelihood latent class analysis was conducted. Then, a multinomial regression analysis was performed to identify the factor associated with each cluster group. Of the 600 participants, 231 (38.5%) had hypertension, 87 (14.5%) had diabetes, and 209 (34.8%) had a body mass index of 25 or more. Finally, risk behaviors and beliefs associated with NCDs were classified into three cluster groups: (1) very high-risk group (n = 58); (2) high-risk group (n = 270); and (3) moderate-risk group (n = 272). The very high-risk group was significantly associated with female gender, older age, fewer years spent in education, and the absence of daily medication compared to the moderate-risk group. Educational interventions in rural Bangladesh should be immediately implemented to improve the risk behaviors and beliefs associated with NCDs.
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Affiliation(s)
- Yurie Kobashi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City 960-1295, Fukushima, Japan; (I.A.); (M.T.)
- Global Exchange Center, Fukushima Medical University School of Medicine, Fukushima City 960-1295, Fukjushima, Japan
- Health Equity Research Institute, Abiko City 270-1168, Chiba, Japan
| | | | - Isamu Amir
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City 960-1295, Fukushima, Japan; (I.A.); (M.T.)
| | - Kayako Sakisaka
- Faculty of International Liberal Arts, Kaichi International University, Kashiwa-City 277-0005, Chiba, Japan;
| | - Sanzida Mubassara
- Department of Botany, Jahangirnagar University, Savar Union 1342, Bangladesh;
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City 960-1295, Fukushima, Japan; (I.A.); (M.T.)
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Sebastião CS, Sacomboio E, Francisco NM, Cassinela EK, Mateus A, David Z, Pimentel V, Paixão J, Neto de Vasconcelos J, Morais J. Blood pressure pattern among blood donors exposed to SARS-CoV-2 in Luanda, Angola: A retrospective study. Health Sci Rep 2023; 6:e1498. [PMID: 37599663 PMCID: PMC10432586 DOI: 10.1002/hsr2.1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background and Aims SARS-CoV-2 infection is a public health concern. Several aspects related to the pattern of infection remain unclear. This study aimed to investigate the blood pressure pattern among blood donors exposed to SARS-CoV-2 in Luanda, Angola, a sub-Saharan African country. Methods We performed a retrospective analysis containing 343 blood donors from December 2019 to September 2020. Parametric tests compared means while χ 2 and logistic regression checked features associated with high blood pressure and were considered significant when p < 0.05. Results The mean age of blood donors was 32.2 ± 8.81 years (ranging from 18 to 61 years) and 93% of the men's gender. Overall, 4.7% of the studied population had been exposed to SARS-CoV-2. High blood pressure prevalence increased from unexposed to exposed SARS-CoV-2 (6.7%-18.8%, p = 0.071). SARS-CoV-2 exposure increase systole (131 ± 12.2 mmHg to 136 ± 14.2 mmHg, p = 0.098), diastole (79.9 ± 9.53 mmHg to 84.2 ± 12.7 mmHg, p = 0.086), pulse in beats per minute (72.0 ± 11.1 to 73.7 ± 8.50, p = 0.553), and decrease donating time (6.31 ± 3.72 min to 5.48 ± 1.61 min, p = 0.371). Chances of having high blood pressure were high [OR: 3.20 (95% confidence interval [CI]: 0.85-12.1), p = 0.086] in exposed SARS-CoV-2. Donors exposed to SARS-CoV-2 with abnormal donation time increased from the donor up to 40 years to over 40 years (from 35.7% to 50%, p = 0.696). The mean systolic, diastolic, and pulse pressure were higher for non-O donors (p > 0.05). A significant link was observed, between the Rhesus factor and blood pressure status (p = 0.032). Conclusion We showed important variations in blood pressure indices of the Angolan population exposed to SARS-CoV-2. Older age and non-O blood groups appear to be important biological factors for SARS-CoV-2 infection, as well as the risk of developing cardiovascular disease after or during SARS-CoV-2 exposure. Further studies assessing the impact on cardiovascular functions with ongoing or long-term SARS-CoV-2 exposure in individuals from resource-limited countries should be considered.
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Affiliation(s)
- Cruz S. Sebastião
- Instituto Nacional de Investigação em Saúde (INIS)LuandaAngola
- Centro de Investigação em Saúde de Angola (CISA)CaxitoAngola
- Instituto de Ciências da Saúde (ICISA)LuandaAngola
- Global Health and Tropical Medicine (GHTM)Instituto de Higiene e Medicina Tropical (IHMT)LisbonPortugal
| | - Euclides Sacomboio
- Instituto Nacional de Investigação em Saúde (INIS)LuandaAngola
- Instituto de Ciências da Saúde (ICISA)LuandaAngola
- Centro de EstudosInvestigação Cientifica e Pós‐graduação (CEIP)LuandaAngola
| | | | - Edson K. Cassinela
- Centro de EstudosInvestigação Cientifica e Pós‐graduação (CEIP)LuandaAngola
- Centro Nacional de Investigação Científica (CNIC)LuandaAngola
| | - António Mateus
- Instituto Nacional de Investigação em Saúde (INIS)LuandaAngola
| | - Zinga David
- Instituto Nacional de Investigação em Saúde (INIS)LuandaAngola
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM)Instituto de Higiene e Medicina Tropical (IHMT)LisbonPortugal
| | - Joana Paixão
- Instituto Nacional de Investigação em Saúde (INIS)LuandaAngola
| | - Jocelyne Neto de Vasconcelos
- Instituto Nacional de Investigação em Saúde (INIS)LuandaAngola
- Centro de Investigação em Saúde de Angola (CISA)CaxitoAngola
| | - Joana Morais
- Instituto Nacional de Investigação em Saúde (INIS)LuandaAngola
- Global Health and Tropical Medicine (GHTM)Instituto de Higiene e Medicina Tropical (IHMT)LisbonPortugal
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Zhong VW, Yu D, Zhao L, Yang Y, Li X, Li Y, Huang Y, Ding G, Wang H. Achievement of Guideline-Recommended Targets in Diabetes Care in China : A Nationwide Cross-Sectional Study. Ann Intern Med 2023; 176:1037-1046. [PMID: 37523704 DOI: 10.7326/m23-0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Nationwide achievement of guideline-recommended diabetes care targets has not been comprehensively assessed in China. OBJECTIVE To estimate the proportions of adults with diabetes achieving major clinical risk factor control, body mass index (BMI), lifestyle, and dietary targets specified in the Chinese diabetes guidelines. DESIGN Nationwide cross-sectional survey. SETTING China, 2015 to 2017. PARTICIPANTS A national sample of 8401 adults with self-reported diabetes and a subset of 3531 with dietary data. MEASUREMENTS The assessed targets included 1) ABC targets (individualized hemoglobin A1c [HbA1c] target; blood pressure [BP] <130/80 mm Hg; and low-density lipoprotein cholesterol [LDL-C] level <2.6 or <1.8 mmol/L [<100 or <70 mg/dL], depending on the presence of atherosclerotic cardiovascular disease), 2) BMI below 24 kg/m2, 3) lifestyle targets (not currently smoking or drinking, guideline-recommended leisure time activity level, and sleep duration of 7 to 8 hours), and 4) dietary targets (50% to 65% of energy from carbohydrate, 15% to 20% from protein, 20% to 30% from fat, ≥14 g of fiber per 1000 kcal, and <2000 mg of sodium per day). RESULTS The proportion of adults with self-reported diabetes achieving each ABC target was 64.1% (95% CI, 61.4% to 66.8%) for HbA1c, 22.2% (CI, 20.2% to 24.1%) for BP, and 23.9% (CI, 21.9% to 25.9%) for LDL-C. The proportion achieving a BMI below 24 kg/m2 was 32.2% (CI, 30.3% to 34.2%). The proportion achieving each lifestyle target was 75.8% (CI, 73.9% to 77.7%) for smoking, 66.7% (CI, 64.4% to 69.1%) for drinking, 17.9% (CI, 15.8% to 20.1%) for leisure time activity, and 52.0% (CI, 49.6% to 54.3%) for sleep duration. The proportion achieving each dietary target was 39.1% (CI, 36.0% to 42.2%) for carbohydrate, 20.1% (CI, 16.9% to 23.3%) for protein, 20.5% (CI, 17.6% to 23.4%) for fat, 9.0% (CI, 7.0% to 10.9%) for sodium, and 2.5% (CI, 1.3% to 3.6%) for fiber. Only 4.4% (CI, 3.5% to 5.2%) of participants achieved all 3 ABC targets, 5.1% (CI, 4.3% to 6.0%) achieved all 4 lifestyle targets, and 4 participants achieved all 5 dietary targets. LIMITATIONS Self-reported data and age of the data. CONCLUSION Achievement of guideline-recommended diabetes care targets in Chinese adults with self-reported diabetes was exceedingly low. The findings highlight the need for immediate national health actions to improve diabetes care. PRIMARY FUNDING SOURCE Shanghai Municipal Education Commission, National Key R&D Program of the People's Republic of China, and the National Health Commission of the People's Republic of China.
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Affiliation(s)
- Victor W Zhong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China (V.W.Z., X.L., Y.H.)
| | - Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China (D.Y., L.Z., Y.Y., Y.L., G.D.)
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China (D.Y., L.Z., Y.Y., Y.L., G.D.)
| | - Yuxiang Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China (D.Y., L.Z., Y.Y., Y.L., G.D.)
| | - Xiaoguang Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China (V.W.Z., X.L., Y.H.)
| | - Yuge Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China (D.Y., L.Z., Y.Y., Y.L., G.D.)
| | - Yue Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China (V.W.Z., X.L., Y.H.)
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China (D.Y., L.Z., Y.Y., Y.L., G.D.)
| | - Hui Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, and Institute of Digital Medicine, Shanghai Jiao Tong University, Shanghai, China (H.W.)
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Parati G, Ochoa JE, Lackland DT. Easier Access to Antihypertensive Treatment: The Key for Improving Blood Pressure Control in Sub-Saharan Africa? Hypertension 2023; 80:1624-1627. [PMID: 37470770 DOI: 10.1161/hypertensionaha.123.20872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiology, San Luca Hospital, Milan, Italy (G.P. and J.E.O.)
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.)
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiology, San Luca Hospital, Milan, Italy (G.P. and J.E.O.)
| | - Daniel T Lackland
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC (D.T.L.)
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Xu AR, Jin Q, Shen Z, Zhang J, Fu Q. Association between the risk of hypertension and triglyceride glucose index in Chinese regions: a systematic review and dose-response meta-analysis of a regional update. Front Cardiovasc Med 2023; 10:1242035. [PMID: 37583585 PMCID: PMC10424922 DOI: 10.3389/fcvm.2023.1242035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Background Triglyceride-glucose (TyG) index has been reported to be associated with various cardiovascular diseases in recent years. However, the conclusive association between the TyG index and hypertension was not established in the last meta-analysis. Furthermore, it remains unclear whether a linear relationship exists between these two variables. Methods We conducted a comprehensive search of the CNKI, VIP, WanFang Data, CBM, PubMed, EMbase, Web of Science, and The Cochrane Library databases up until May 10, 2023, to identify relevant studies conducted in China. We used Stata version 17.0 and Rstudio version 4.2.1 to analyze the data and assess the association between the TyG index and the risk of hypertension, as well as the dose-response relationship between these two variables. We will select either a random-effects model or a fixed-effects model based on the results of the heterogeneity tests and report 95% confidence intervals accordingly. Results In the end, our analysis encompassed 22 studies involving a total of 668,486 participants, comprising 12 cross-sectional studies and 10 cohort studies. Meta-analysis results showed: Analysis of data from China revealed that an elevated TyG index was associated with a higher risk of developing hypertension, as indicated by an OR/HR of 1.36 [95%CI (1.28-1.45) I2 = 69.0% P < 0.001]. Through meta-regression analysis of multiple covariates, we found that study type, study region, sample size, database source, and study quality score, the above five variables were able to explain 63.0% of the total heterogeneity. The results of the dose-response Meta-analysis showed: The TyG index has a linear relationship with the risk of developing hypertension, as indicated by non-significant coefficients of higher-order terms in the nonlinear model (P > 0.05). The linear trend analysis showed that for every one-unit increase in the TyG index, the risk of developing hypertension increased by 1.5 times [1.532 95%CI (1.294, 1.813) P < 0.001]. However, this result is influenced by the number of studies included in the dose-response analysis and requires further corroboration. Conclusion In the Chinese region, there was an independent association between TyG index and the risk of developing hypertension, with a linear trend. However, the results of the linear trend need to be corrected by the more number of related studies. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023425836.
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Affiliation(s)
- An-ran Xu
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qiuyu Jin
- Department of Gastroenterology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Zhisheng Shen
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jiaqi Zhang
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qiang Fu
- Medical Diagnosis Teaching and Research Room, The College of Basic Medicine of Heilongjiang University of Chinese Medicine, Harbin, China
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Ouyang F, Wells JC, Zhang GH, Du K, Wang X, Shen L, Luo ZC, Zhang J. Maternal Prenatal Factors and Child Adiposity in Associations with Cardiometabolic Risk Factors in Term-Born Chinese Children at the Age of 2 Years. Nutrients 2023; 15:3342. [PMID: 37571278 PMCID: PMC10421441 DOI: 10.3390/nu15153342] [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: 06/09/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
Early growth has long-lasting associations with adult metabolic health. However, the association of adiposity with cardiometabolic risk factors in toddlers remains poorly understood. This study aimed to examine the association of maternal prenatal factors and child adiposity with child cardiometabolic risk factors among boys and girls aged 2 years. This was a birth cohort study of 549 term-born children in Shanghai, China, with follow-up data at the age of 2-years. Child anthropometric and adiposity measurements included weight, length, and skinfold thickness (triceps, subscapular, and abdominal). Child cardiometabolic risk factors included random morning plasma glucose, serum insulin, lipids, and systolic and diastolic blood pressure (SBP, DBP). At 2 years, overweight/obesity (weight-for-length z score, ZWFL > 2) was associated with 12.6 (95%CI 7.7, 17.4) mmHg higher SBP, and 7.9 (4.1, 11.8) mmHg higher DBP in boys, with similar results observed in girls. Maternal hypertensive disorders of pregnancy were associated with 3.0 (0.1, 5.8) higher SBP, 3.17 (0.90, 5.44) mmHg higher DBP, 0.24 (0.01,0.47) mmol/L higher plasma glucose, and 0.26 (0.01,0.51) mmol/L higher serum triglycerides after adjustment for child age, sex, and ZWFL. Maternal hypertensive disorders of pregnancy and child overweight/obesity were associated with higher SBP and DBP at the age of 2 years.
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Affiliation(s)
- Fengxiu Ouyang
- Ministry of Education and Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jonathan C. Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Research Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Guang-Hui Zhang
- Department of Clinical Laboratory Test, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Kun Du
- Department of Clinical Laboratory Test, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xia Wang
- Ministry of Education and Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Lixiao Shen
- Ministry of Education and Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Zhong-Cheng Luo
- Ministry of Education and Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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Qian J, Chen Y, Lu D, Ma J, Liu K. The prevalence, disability-adjusted life years, and mortality of hypertensive heart disease and its attributable risk factors: results from the Global Burden Disease study 2019. Arch Med Sci 2023; 19:1186-1200. [PMID: 37732060 PMCID: PMC10507767 DOI: 10.5114/aoms/169477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/11/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction No survey has evaluated hypertensive heart disease (HHD) burden with statistics from the Risk Factors Study, Injuries, and the Global Burden of Diseases (GBD) 2019. Material and methods The evaluated annual percentage changes (EAPCs) were obtained to assess the trend in prevalence standardized by age, mortality rates standardized by age, and DALYs standardized by age between 1990 and 2019. We also evaluated the contribution of risk factors to HHD-associated DALYs and mortality. Results Between 1990 and 2019, the worldwide prevalence rate standardized by age increased (EAPC = 0.17; 95% confidence interval (CI) 0.15 to 0.18), but the death rate standardized by age (EAPC = -0.74; 95% CI: -0.91 to -0.57) and DALYs standardized by age rate decreased (EAPC = -1.02; 95% CI: -1.18 to -0.86). The prevalence rate of HHD standardized by age increased the most in the high-middle areas of SDI (EAPC = 0.43). The biggest increases in the prevalence rate standardized by age were in Andean Latin America (EAPC = 0.43), Western Sub-Saharan Africa (EAPC = 0.30), and the Middle East and North Africa (EAPC = 0.24). The largest decrease in mortality that could be attributed to rate and DALYs in both sexes between 1990 and 2019 was consistent with a high BMI. Conclusion The worldwide prevalence rate standardized by age increased during 1990-2019, especially in Andean Latin America, North Africa, the Middle East, and Western Sub-Saharan Africa. Future HHD prevention tactics should be focused on males, high-risk areas, and control of high BMI.
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Affiliation(s)
- Jili Qian
- Department of Cardiovascular Medicine, Yuyao People’s Hospital, Ningbo, Zhejiang, China
| | - Yingqun Chen
- Department of General Practice, Yuyao People’s Hospital, Ningbo, Zhejiang, China
| | - Donghui Lu
- Emergency Trauma Department, Yuyao People’s Hospital, Ningbo, Zhejiang, China
| | - Jiner Ma
- Department of Geriatrics, Yuyao People’s Hospital, Ningbo, Zhejiang, China
| | - Kuikui Liu
- Department of Geriatrics, Yuyao People’s Hospital, Ningbo, Zhejiang, China
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Ogungbe O, Cazabon D, Moran AE, Neupane D, Himmelfarb CD, Edward A, Pariyo GW, Appel LJ, Matsushita K, Hongwei Z, Tong L, Dessie GA, Worku A, Choudhury SR, Jubayer S, Bhuiyan MR, Islam S, Osi K, Odu J, Obagha EC, Ojji D, Huffman MD, Commodore-Mensah Y. Landscape of team-based care to manage hypertension: results from two surveys in low/middle-income countries. BMJ Open 2023; 13:e072192. [PMID: 37487684 PMCID: PMC10373743 DOI: 10.1136/bmjopen-2023-072192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES Team-based care is essential for improving hypertension outcomes in low-resource settings. We assessed perceptions of country representatives and healthcare workers (HCWs) on team-based hypertension care in low/middle-income countries. DESIGN Two cross-sectional surveys. SETTING The first survey (Country Profile Survey) was conducted in 17 countries and eight in-country regions: Algeria, Bangladesh, Burundi, Chile, China (Beijing, Henan, Shandong), Cuba, Ethiopia, India (Kerala, Madhya Pradesh, Maharashtra, Punjab, Telangana), Nepal, Nigeria, Philippines, Saint Lucia, Sri Lanka, Thailand, Turkey, Uganda and Vietnam. The second survey (HCW Survey) was conducted in four countries: Bangladesh, China, Ethiopia and Nigeria. PARTICIPANTS Using convenience sampling, participants for the Country Profile Survey were representatives from 17 countries and eight in-country regions, and the HCW Survey was administered to HCWs in Bangladesh, China, Ethiopia and Nigeria. OUTCOME MEASURES Country-level use of team-based hypertension care framework, comprising administrative, basic and advanced clinical tasks. Current practices of different HCW cadres, perspectives on team-based management of hypertension, barriers and facilitators. RESULTS In the Country Profile Survey, all (23/23, 100%) countries/regions surveyed integrated team-based care for basic clinical hypertension management tasks, less for advanced tasks (7/23, 30%). In the HCW Survey, 854 HCWs participated, 47% of whom worked in rural settings. Most HCWs in the sample acknowledged the value of team-based hypertension care. Although there were slight variations by country in the study sample, overall, barriers to team-based hypertension care were identified as inadequate training (83%); regulatory issues (76%); resistance by patients (56%), physicians (42%) and nurses (40%). Facilitators identified were use of treatment algorithms (94%), telehealth/m-health technology (92%) and adequate compensation for HCWs (80%). CONCLUSIONS Our findings revealed key lessons for health systems and governments regarding team-based care implementation. Specifically, policies to facilitate additional training, optimise HCWs' roles within care teams, use of hypertension treatment protocols and telehealth/m-health technology will be essential to promote team-based care.
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Affiliation(s)
| | | | - Andrew E Moran
- Resolve to Saves Lives, New York, New York, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kunihiro Matsushita
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Addisu Worku
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Shamim Jubayer
- National Heart Foundation of Bangladesh, Dhaka, Bangladesh
- Dental Public Health, University Dental College and Hospital, Dhaka, Bangladesh
| | | | - Shahinul Islam
- National Heart Foundation of Bangladesh, Dhaka, Bangladesh
| | - Kufor Osi
- Resolve to Saves Lives, New York, New York, USA
| | - Joseph Odu
- Resolve to Saves Lives, New York, New York, USA
| | | | - Dike Ojji
- Department of Internal Medicine, University of Abuja, Abuja, Nigeria
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mark D Huffman
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Edward A, Kalyesubula R, Pariyo G, Kyazze AP, Hu X, Appel LJ, Matsushita K. Self-paced online learning to improve knowledge competencies for hypertension among medical students in Uganda: A pre-post study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001609. [PMID: 37459296 PMCID: PMC10351720 DOI: 10.1371/journal.pgph.0001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
The growing burden of hypertension (HT) is projected to reach 1.56 billion globally by 2025 and is an increasing public health concern, even for low- and middle-income countries (LMIC) like Uganda, where the prevalence of HT is 31.5%. The objective of this study was to test the effectiveness of a freely available HT online course on knowledge competencies for medical students in Uganda. The online course was developed by a multidisciplinary team at Johns Hopkins University to address HT control in resource-constrained healthcare settings. Students in the 3rd, 4th, and 5th years of medical school were randomly selected to participate in the online course. Pre and post knowledge tests were administered using an online survey system. Of the 201 invited students, 121 (60.2%) completed the study. Significant improvements in mean knowledge scores were evident following the online course completion for Module 1, Fundamentals of HT (21.9±2.5 to 23.7±2.5, p<0.001), and Module 2, Basics of HT Management (14.9±3.3 to 18.5±4.3, p<0.001). No statistically significant differences were evident by gender or school year. Students who took a shorter duration to complete the course had significantly higher mean score improvement between pre- and post-test (mean score improvement 7.0 if <4 weeks, 3.6 if 4-8 weeks, and 3.7 if >8 weeks, p<0.003). Students recognized information on blood pressure measurement (32.2%) and HT management (22.3%) as the most important concept addressed in the course. A self-paced online course, complementing medical school training, improved knowledge on HT burden and management in Uganda.
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Affiliation(s)
- Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Robert Kalyesubula
- Departments of Medicine and Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew Peter Kyazze
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Xiao Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lawrence J. Appel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Craig A, Mtintsilana A, Mapanga W, Dlamini SN, Norris SA. Socioeconomic position, perceived weight, lifestyle risk, and multimorbidity in young adults aged 18 to 35 years: a Multi-country Study. BMC Public Health 2023; 23:1360. [PMID: 37454042 PMCID: PMC10349474 DOI: 10.1186/s12889-023-16234-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Multimorbidity-risk is established early in life, therefore reducing modifiable risk factors such as overweight or obesity may, in part, tackle the burden of multimorbidity in later life. METHODS We made use of a cross-sectional online survey that included young adults (18-35yrs old) from three countries - Kenya, South Africa, and the United Kingdom (n = 3000). Information pertaining to socio-demographic, health, lifestyle, and perceived weight was collected. Additionally, the sum of affirmed morbidities was used to determine a morbidity score. Likewise, a lifestyle risk score was calculated based on information obtained from questions surrounding four unhealthy lifestyle behaviours, namely current smoking, alcohol consumption, physical inactivity, and overweight/obese weight status as a confirmed clinic condition. We further explored differences in socioeconomic position, and the prevalence of perceived weight, multimorbidity, and lifestyle risk factors between the three countries. We also determined the odds ratio of multimorbidity with perceived weight as a main predictor variable. We furthermore performed a generalised structural equation model to determine whether the association between socioeconomic position and multimorbidity was mediated via perceived weight and/or lifestyle risk. RESULTS Socioeconomic position, weight perceptions, lifestyle risk, and multimorbidity varied significantly across the different economic countries. Higher morbidity (by > 11.9%) and lifestyle risk (by > 20.7%) scores were observed in those who reported an overweight weight perception when compared to those with an underweight or normal weight perception. In pooled analyses, the odds ratio in developing 2 or more morbidities increased multiple times in those who perceived themselves as overweight (all models: OR ≥ 2.241 [95% CI ≥ 1.693; ≥ 2.966] p < 0.001), showing a larger odds ratio with high significance in those who reported 3 or more morbidities (all models: OR ≥ 3.656 [95% CI ≥ 2.528; ≥ 5.286] p < 0.001). Furthermore, this study showed that an overweight weight perception partially mediated (p ≤ 0.001) the association between socioeconomic position and multimorbidity. CONCLUSIONS This study confirmed poorer health outcomes in those who perceived themselves as overweight. The findings from this study further emphasise the importance of targeted intervention strategies directed at raising weight-related awareness and potentiating risk factors, specifically in those who reside in lower economic developed countries.
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Affiliation(s)
- Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Asanda Mtintsilana
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Witness Mapanga
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Noncommunicable Disease Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
| | - Siphiwe N Dlamini
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, Global Health Research Institute, University of Southampton, Southampton, UK
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Mohammed SAD, Liu H, Baldi S, Wang Y, Chen P, Lu F, Liu S. Antihypertensive, antioxidant, and renal protective impact of integrated GJD with captopril in spontaneously hypertensive rats. Sci Rep 2023; 13:10944. [PMID: 37414816 PMCID: PMC10326066 DOI: 10.1038/s41598-023-38020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023] Open
Abstract
Hypertension is the most prevalent chronic disease World-wide, and the leading preventable risk factor for cardiovascular disease (CVD). Few patients accomplish the objective of decreasing blood pressure and avoiding hypertensive target organ damage after treatments with antihypertensive agents which opens the door for other treatments, such as herbal-and antihypertensive combination therapy. Captopril (CAP), as a-pril which inhibits angiotensin converting enzyme has long been used in the management of hypertension and CVD. Gedan Jiangya Decoction (GJD) is known for antihypertensive effects in prior studies. The research is aimed to determine whether GJD in combination with captopril has antihypertensive, kidney protective, antioxidant, and vasoactive effects in spontaneously hypertensive rats (SHR). Regular measurements of systolic and diastolic blood pressure (SBP and DBP), and body weight were monitored weekly. H&E staining was utilized to examine histopathology. The combined effects were studied using ELISA, immunohistochemistry, and qRT-PCR. Significant reductions in SBP, DBP, aortic wall thickness, and improvement in renal tissue were observed following GJD + CAP treatment, with increased serum levels of NO, SOD, GSH-Px, and CAT and decreases in Ang II, ET-1, and MDA. Similarly, GJD + CAP treatment of SHR's significantly decreased ET-1 and AGTR1 mRNA and protein expression while increasing eNOS mRNA and protein expression in thoracic aorta and kidney tissue. In conclusion, the present investigation found that GJD + CAP treatment decreases SHR blood pressure, improves aorta remodeling and renal protection, and that this effect could be attributable, in part, due to antioxidant and vascular tone improvement.
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Affiliation(s)
- Shadi A D Mohammed
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
- School of Pharmacy, Lebanese International University, 18644, Sana'a, Yemen
| | - Hanxing Liu
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
| | - Salem Baldi
- Research Center of Molecular Diagnostics and Sequencing, Axbio Biotechnology (Shenzhen) Co., Ltd., Shenzhen, 518057, Guangdong, China
| | - Yu Wang
- Institute of Traditional Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
| | - Pingping Chen
- Institute of Traditional Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
| | - Fang Lu
- Institute of Traditional Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
| | - Shumin Liu
- Institute of Traditional Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China.
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Viggiano J, Coutinho D, Clark-Cutaia MN, Martinez D. Effects of a high salt diet on blood pressure dipping and the implications on hypertension. Front Neurosci 2023; 17:1212208. [PMID: 37465583 PMCID: PMC10350516 DOI: 10.3389/fnins.2023.1212208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
High blood pressure, also known as hypertension, is a major risk factor for cardiovascular disease. Salt intake has been shown to have a significant impact on BP, but the mechanisms by which it influences the blood pressure dipping pattern, and 24-h blood pressure remains controversial. This literature review aims to both summarize the current evidence on high salt diet induced hypertension and discuss the epidemiological aspects including socioeconomic issues in the United States and abroad. Our review indicates that a high salt diet is associated with a blunted nocturnal blood pressure dipping pattern, which is characterized by a reduced decrease in blood pressure during the nighttime hours. The mechanisms by which high salt intake affects blood pressure dipping patterns are not fully understood, but it is suggested that it may be related to changes in the sympathetic nervous system. Further, we looked at the association between major blood pressure and circadian rhythm regulatory centers in the brain, including the paraventricular nucleus (PVN), suprachiasmatic nucleus (SCN) and nucleus tractus solitarius (nTS). We also discuss the underlying social and economic issues in the United States and around the world. In conclusion, the evidence suggests that a high salt diet is associated with a blunted, non-dipping, or reverse dipping blood pressure pattern, which has been shown to increase the risk of cardiovascular disease. Further research is needed to better understand the underlying mechanisms by which high salt intake influences changes within the central nervous system.
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Affiliation(s)
- Jesse Viggiano
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Dominic Coutinho
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | | | - Diana Martinez
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
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Tsuro U, Oladimeji KE, Pulido-Estrada GA, Apalata TR. The Effect of Cardiorespiratory Exercise in the Prevention and Treatment of Hypertension among HIV-Infected Individuals on Antiretroviral Therapy in Mthatha, South Africa. Healthcare (Basel) 2023; 11:1836. [PMID: 37444670 DOI: 10.3390/healthcare11131836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The prevalence of hypertension among people living with HIV (PLHIV) on antiretroviral therapy (ART) is concerning. Physical activity is a proposed approach for managing and avoiding hypertension in this population. While cardiorespiratory exercises (CET) have been efficacious in the general population, its effectiveness in PLHIV on ART, especially in the study setting, in Mthatha is unknown. Consequently, the purpose of this study was to see if CET improves cardiorespiratory fitness in HAART-treated PLHIV with blood flow restriction (BFR) in Mthatha, South Africa. A quasi-experimental study with 98 participants (49 of whom were cases) was carried out. Cases were participants assigned to the CET intervention group that comprised of concurrent training as it included both aerobic and resistance exercise, matched on age and gender. The relationship between CET and hypertension was assessed using logistic regression after adjusting for possible confounding variables. At baseline, there was no significant difference between the physical characteristics of the two groups, and after the intervention, there was a significant difference. Obesity and central adiposity were identified as strong risk factors for hypertension. The findings also indicated that a reduction in waist circumference and body mass index had a significant positive association with hypertension treatment amongst the intervention group (p < 0.05). According to the results of the study, CET has the potential to be an efficient and economical non-pharmacological intervention for the management and control of hypertension in PLHIV. However, further study is required to establish how long, how intense, and what kind of exercise is best for this population.
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Affiliation(s)
- Urgent Tsuro
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, Eastern Cape, South Africa
| | - Kelechi Elizabeth Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, Eastern Cape, South Africa
- College of Graduate Studies, University of South Africa, Johannesburg 0001, Gauteng, South Africa
| | | | - Teke Ruffin Apalata
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, Eastern Cape, South Africa
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Longkumer I, Yadav S, Rajkumari S, Saraswathy KN. Trends in hypertension prevalence, awareness, treatment, and control: an 8-year follow-up study from rural North India. Sci Rep 2023; 13:9910. [PMID: 37337044 DOI: 10.1038/s41598-023-37082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Abstract
Hypertension is a major contributor to global CVD burden. LMICs including India is challenged with rising hypertension prevalence, yet limited studies are available on temporal change and incidence among community-cohorts. This study aimed to describe trends in hypertension prevalence, awareness, treatment, and control over 8 years among a rural community-cohort from Haryana, India. The study also lends towards an analysis of incidence. Adults ≥ 30 years (N = 1542) recruited during baseline cross-sectional study between 2011 and 2014 were followed up after a median 8.1 years. At endline, demographic/lifestyle characteristics and blood pressure were re-examined. Overall median SBP significantly increased from 120 mmHg at baseline to 125.5 mmHg at endline (p < 0.001), while hypertension prevalence increased from 34.4% (95% CI 32.0-36.9) to 40.4% (95% CI 37.5-43.4) (p = 0.002). Age-standardized hypertension incidence was 30.2% (95% CI 26.7-35.2) over 8 years. Among hypertensive group, awareness, treatment, and control increased from 9.6, 8.8 and 5.0% to 31.8, 27.3 and 9.6% (p < 0.05), respectively. Increasing trend in SBP and hypertension prevalence was observed as the cohort ages. This increase is supported by the high incidence of hypertension. Nevertheless, our study highlights positive trends in hypertension care cascade but poor control, suggesting that this trend may not be adequately impactful to reduce hypertension burden.
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Affiliation(s)
- Imnameren Longkumer
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Suniti Yadav
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Sunanda Rajkumari
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Kallur Nava Saraswathy
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India.
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Zhang S, Li Y, Xu X, Xu R, Zhang L, Wan X, Yao Z, Sun Y, Liu Y, Bin J, Wang Z, Li S, Yang P, Xu X, Liang W, Gao X, Li X, Jia M, Ma G, Gu X, Hong C. Efficacy and safety of single-pill amlodipine/losartan versus losartan in patients with inadequately controlled hypertension after losartan treatment: a multicenter, double-blind, randomized phase III clinical trial. Front Cardiovasc Med 2023; 10:1177166. [PMID: 37404731 PMCID: PMC10315825 DOI: 10.3389/fcvm.2023.1177166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023] Open
Abstract
Objective Single-pill amlodipine besylate (AML) plus losartan (LOS) has been used to treat inadequately controlled hypertension after antihypertensive monotherapy; however, relevant data in China are limited. This study aimed to compare the efficacy and safety of single-pill AML/LOS and LOS alone in Chinese patients with inadequately controlled hypertension after LOS treatment. Methods In this multicenter, double-blind, randomized, controlled phase III clinical trial, patients with inadequately controlled hypertension after 4 weeks of LOS treatment were randomized to receive daily single-pill AML/LOS (5/100 mg, AML/LOS group, N = 154) or LOS (100 mg, LOS group, N = 153) tablets for 8 weeks. At weeks 4 and 8 of treatment, sitting diastolic and systolic blood pressure (sitDBP and sitSBP, respectively) and the BP target achievement rate were assessed. Results At week 8, the sitDBP change from baseline was greater in the AML/LOS group than in the LOS group (-8.84 ± 6.86 vs. -2.65 ± 7.62 mmHg, P < 0.001). In addition, the AML/LOS group also showed greater sitDBP change from baseline to week 4 (-8.77 ± 6.60 vs. -2.99 ± 7.05 mmHg) and sitSBP change from baseline to week 4 (-12.54 ± 11.65 vs. -2.36 ± 10.33 mmHg) and 8 (-13.93 ± 10.90 vs. -2.38 ± 12.71 mmHg) (all P < 0.001). Moreover, the BP target achievement rates at weeks 4 (57.1% vs. 25.3%, P < 0.001) and 8 (58.4% vs. 28.1%, P < 0.001) were higher in the AML/LOS group than those in the LOS group. Both treatments were safe and tolerable. Conclusion Single-pill AML/LOS is superior to LOS monotherapy for controlling BP and is safe and well tolerated in Chinese patients with inadequately controlled hypertension after LOS treatment.
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Affiliation(s)
- Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Ying Li
- Department of Cardiology, Shanghai East Hospital, Shanghai, China
| | - Xin Xu
- Department of Cardiology, Wuxi No.2 People’s Hospital, Wuxi, China
| | - Rui Xu
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Linchao Zhang
- Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China
- Department of Cardiology, Liuzhou People’s Hospital, Liuzhou, China
| | - Xiaoqun Wan
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhuhua Yao
- Department of Cardiology, Tianjin People’s Hospital, Tianjin, China
| | - Yuemin Sun
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yong Liu
- Department of Cardiology, Tianjin 4th Center Hospital, Tianjin, China
| | - Jianping Bin
- Department of Cardiology, Nanfang Hospital, Guangzhou, China
| | - Zhen Wang
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuren Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Ping Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Xiping Xu
- Department of Cardiology, Yueyang Central Hospital, Yueyang, China
| | - Weidong Liang
- Department of Cardiology, The First People’s Hospital of Nanning, Nanning, China
| | - Xiaohong Gao
- Department of Cardiology, Beijing Pinggu Hospital, Beijing, China
| | - Xiaodong Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Min Jia
- Department of Cardiology, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Guang Ma
- Department of Cardiology, Baoding NO.2 Central Hospital, Baoding, China
| | - Xiang Gu
- Department of Cardiology, Subei People’s Hospital, Yangzhou, China
| | - Chang Hong
- Department of Cardiology, PKUCare Luzhong Hospital, Zibo, China
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