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Fenny AP, Otieku E, Owusu Achiaw S, Okoe Boye B, Asenso-Boadi F, Addo-Cobbiah V, Musah M. Impact of COVID-19 on the management of hypertension: a perspective on disease severity, service use patterns and expenditures from Ghana's health insurance claims data. J Hum Hypertens 2024:10.1038/s41371-024-00924-3. [PMID: 38902509 DOI: 10.1038/s41371-024-00924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
Hypertension is a leading cause of morbidity in Ghana and other sub-Saharan African countries, but management has historically suffered from the fragility of health systems in these countries. This has been exacerbated by the COVID-19 pandemic and its associated measures. Our study examines and quantifies the effect of the pandemic on the management of hypertension in Ghana by determining changes in disease severity and presentation, as well as changes in health service use patterns and expenditures. We used cross-sectional data to perform an impact evaluation of COVID-19 on hypertension management before and during the pandemic. We employed statistical tests including t-tests, z-tests, and exact Poisson tests to estimate and compare hypertension episode intensity and related claim expenditures before and during the pandemic using medical claims data from Ghana's National Health Insurance Authority database. The study duration includes a 12-month reference/pre-pandemic period (March 2019-February 2020) relative to the target/pandemic period (March 2020-February 2021). We observed that although there was a 20% reduction in the number of hypertension claimants in the pandemic year, there was an increase in hypertension severity as measured by the number of hypertension episodes per claimant. There was also an 18.64% or $22.88 (95% CI: $21-$25, p = 0.01042) increase in the average cost per hypertension claimant in the pandemic year. The increase in episodes per claimant had the largest financial impact on the average cost per claimant. The findings from our studies are relevant for future policymaking and strategy implementation for hypertension control in Ghana.
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Affiliation(s)
- Ama Pokuaa Fenny
- Institute of Statistical, Social, and Economic Research (ISSER), University of Ghana, Accra, Ghana
| | - Evans Otieku
- Institute of Statistical, Social, and Economic Research (ISSER), University of Ghana, Accra, Ghana
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Samuel Owusu Achiaw
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, United Kingdom.
| | | | | | | | - Mariam Musah
- National Health Insurance Authority, Accra, Ghana
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2
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Bos P, Wouters E, Danhieux K, van Olmen J, Remmen R, Klipstein-Grobusch K, Boateng D, Buffel V. Unravelling the Belgian cascade of hypertension care and its determinants: insights from a cross-sectional analysis. BMC Public Health 2024; 24:1559. [PMID: 38872180 DOI: 10.1186/s12889-024-19010-x] [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: 12/24/2023] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Hypertension is a major risk factor for cardiovascular disease and all-cause mortality worldwide. Despite the widespread availability of effective antihypertensives, blood pressure (BP) control rates remain suboptimal, even in high-income countries such as Belgium. In this study, we used a cascade of care approach to identify where most patients are lost along the continuum of hypertension care in Belgium, and to assess the main risk factors for attrition at various stages of hypertension management. METHODS Using cross-sectional data from the 2018 Belgian Health Interview Survey and the Belgian Health Examination Survey, we estimated hypertension prevalence among the Belgian population aged 40-79 years, and the proportion that was (1) screened, (2) diagnosed, (3) linked to care, (4) in treatment, (5) followed up and (6) well-controlled. Cox regression models were estimated to identify individual risk factors for being unlinked to hypertension care, untreated and not followed up appropriately. RESULTS The prevalence of hypertension based on self-reported and measured high BP was 43.3%. While 98% of the hypertensive population had their BP measured in the past 5 years, only 56.7% were diagnosed. Furthermore, 53.4% were linked to care, 49.8% were in treatment and 43.4% received adequate follow-up. Less than a quarter (23.5%) achieved BP control. Among those diagnosed with hypertension, males, those of younger age, without comorbidities, and smokers, were more likely to be unlinked to care. Once in care, younger age, lower BMI, financial hardship, and psychological distress were associated with a higher risk of being untreated. Finally, among those treated for hypertension, females, those of younger age, and without comorbidities were more likely to receive no adequate follow-up. CONCLUSION Our results show that undiagnosed hypertension is the most significant barrier to BP control in Belgium. Health interventions are thus needed to improve the accurate and timely diagnosis of hypertension. Once diagnosed, the Belgian health system retains patients fairly well along the continuum of hypertension care, yet targeted health interventions to improve hypertension management for high-risk groups remain necessary, especially with regard to improving treatment rates.
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Affiliation(s)
- Philippe Bos
- Department of Sociology, University of Antwerp, Antwerp, Belgium.
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Katrien Danhieux
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Roy Remmen
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Daniel Boateng
- Julius Global Health, Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Veerle Buffel
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
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Basu S, Yudkin JS, Jawad M, Ghattas H, Hamad BA, Jamaluddine Z, Safadi G, Ragi ME, Ahmad RES, Vamos EP, Millett C. Reducing non-communicable diseases among Palestinian populations in Gaza: A participatory comparative and cost-effectiveness modeling assessment. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003168. [PMID: 38696423 PMCID: PMC11065248 DOI: 10.1371/journal.pgph.0003168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/02/2024] [Indexed: 05/04/2024]
Abstract
We sought to assess the effectiveness and cost-effectiveness of potential new public health and healthcare NCD risk reduction efforts among Palestinians in Gaza. We created a microsimulation model using: (i) a cross-sectional household survey of NCD risk factors among 4,576 Palestinian adults aged ≥40 years old in Gaza; (ii) a modified Delphi process among local public health experts to identify potentially feasible new interventions; and (iii) reviews of intervention cost and effectiveness, modified to the Gazan and refugee contexts. The survey revealed 28.6% tobacco smoking, a 40.4% prevalence of hypertension diagnosis (with a 95.6% medication treatment rate), a 25.6% prevalence of diabetes diagnosis (with 95.3% on treatment), a 21.9% prevalence of dyslipidemia (with 79.6% on a statin), and a 9.8% prevalence of asthma or chronic obstructive pulmonary disease (without known treatment). A calibrated model estimated a loss of 9,516 DALYs per 10,000 population over the 10-year policy horizon. The interventions having an incremental cost-effectiveness ratio (ICER) less than three times the GDP per capita of Palestine per DALY averted (<$10,992 per DALY averted)(<$10,992 per DALY averted) included bans on tobacco smoking in indoor and public places [$34 per incremental DALY averted (95% CI: $17, $50)], treatment of asthma using low dose inhaled beclometasone and short-acting beta-agonists [$140 per DALY averted (95% CI: $77, $207)], treatment of breast cancer stages I and II [$730 per DALY averted (95% CI: $372, $1,100)], implementing a mass media campaign for healthier nutrition [$737 per DALY averted (95% CI: $403, $1,100)], treatment of colorectal cancer stages I and II [$7,657 per DALY averted (95% CI: $3,721, $11,639)], and (screening with mammography [$17,054 per DALY averted (95% CI: $8,693, $25,359)]). Despite high levels of NCD risk factors among Palestinians in Gaza, we estimated that several interventions would be expected to reduce the loss of DALYs within common cost-effectiveness thresholds.
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Affiliation(s)
- Sanjay Basu
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, United States of America
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - John S. Yudkin
- Division of Medicine, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Hala Ghattas
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | | | - Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gloria Safadi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Marie-Elizabeth Ragi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Raeda El Sayed Ahmad
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Eszter P. Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
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Pan P, Yang Y, He S, Zhao G, Chen XP. The effects of initial and subsequent overweight or obesity on hypertension in the middle age. J Clin Hypertens (Greenwich) 2024; 26:525-531. [PMID: 38552194 PMCID: PMC11088430 DOI: 10.1111/jch.14804] [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: 09/18/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 05/12/2024]
Abstract
The aims of our study were to examine whether initial or subsequent adiposity status had a greater effect on hypertension. We collected data in 1992 and again in 2007 from the same group of 597 individuals in the middle age. The subjects were classified into four groups: individuals with a normal body mass index (BMI) in 1992 and 2007 were in Group I; those with a normal BMI in 1992, but became overweight or obese in 2007 were in Group II; those who were overweight or obese in 1992, but had a normal BMI in 2007 were in Group III; and those who were overweight or obese in 1992 and 2007 were in Group IV. Their demographic data were recorded. The relationship between adiposity status and hypertension was analyzed using logistic regression model. The cumulative incidence of hypertension was 35.5%, 56.3%, 50.0%, and 65.1% for Group I to IV, respectively. Compared with Group I, after adjusted factors, the hazard ratio (HR) was 1.80 for Group II (P = .001), 1.40 for Group III (P = .150), and 2.31 for Group IV (P < .001). Adiposity status in 2007 could predict hypertension (OR = 2.5, P < .001), as opposed to the initial adiposity status (P = .148). Subsequently adiposity status could have major effects on hypertension. Our society is very short of public health resources, particularly in developing countries, we should pay more attention to current adiposity status and encourage middle-aged people to lose weight.
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Affiliation(s)
- Pei Pan
- Department of Cardiovascular, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Yang
- Department of Cardiovascular, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Sen He
- Department of Cardiovascular, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gang Zhao
- Department of Cardiovascular, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Ping Chen
- Department of Cardiovascular, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Talukder A, Sara SS, Khan ZI, Yadav UN, Mistry SK, Biswas T, Alam A, Ali MW, Jannat Z, Haseen F, Uddin MJ, Gray DJ, Ahmed T, Kelly M, Islam SMS, Sarma H. Prevalence and determinants of hypertension in South-Asian Urban Communities: findings from Demographic and Health Surveys (DHS) data of South Asian countries. J Hum Hypertens 2024; 38:257-266. [PMID: 38049636 DOI: 10.1038/s41371-023-00879-x] [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: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023]
Abstract
Hypertension increases risk of stroke and other cardiovascular diseases, however, its prevalence and determinants in South Asian urban communities using country representative community-based datasets is lacking. This study evaluated prevalence of hypertension and it's determinants among urban residents of three South Asian countries. Urban population data from demographic and health surveys in Bangladesh, India, and Nepal were extracted. Hypertension prevalence was defined as systolic/diastolic blood pressure ≥ 140/ 90 mmHg. Age, education, wealth, physical activity, alcohol, BMI were considered as risk factors associated with the increased risk of hypertension. We performed binary logistic regression and calculated adjusted Odds Ratios (AOR) with 95% confidence interval (CI) to assess factors related to hypertension. Hypertension prevalence was 37.4% in India, 25.1% in Bangladesh and 18.4% in Nepal. Prevalence increased with age in all settings. Females had reduced odds of hypertension in Bangladesh (AOR 0.75; CI: 0.69, 0.81) and Nepal (AOR 0.62; CI: 0.54, 0.71), but higher risk in India (AOR 2.54; CI: 2.45, 2.63). Low education, caffeine consumption, obesity was associated with higher prevalence of hypertension in all three countries. Smokers had increased odds of hypertension in India (AOR 1.11; CI: 1.06, 1.15) and Nepal (AOR 1.23; 1.02, 1.47). Overall, hypertension prevalence is high in all three countries. Modifiable socioeconomic and lifestyle factors (education, wealth index, smoking status, caffeine consumption and BMI) associated with hypertension. Comprehensive hypertension pacific and sensitive interventions (including behavioral modification treatments and timely screening and access to health care) are urgently needed to prevent and control hypertension among urban populations in South Asia.
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Affiliation(s)
- Ashis Talukder
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 2600, Australia.
- Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh.
| | | | | | - Uday Narayan Yadav
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, 2600, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW, Australia
| | - Sabuj Kanti Mistry
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
- Department of Public Health, Daffodil International University, Dhaka, 1207, Bangladesh
| | - Tuhin Biswas
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, Brisbane, QLD, Australia
| | - Ariful Alam
- Health Nutrition, Population and Nutrition Program, BRAC, Dhaka, 1212, Bangladesh
| | - Md Wazid Ali
- Health System and Population Studies Division, icddr,b (International Centre for Diarrhoeal Disease Research), Dhaka, 1212, Bangladesh
| | - Zerin Jannat
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68-Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Fariha Haseen
- Department of Public Health & Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1212, Bangladesh
| | - Md Jasim Uddin
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68-Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Darren J Gray
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 2600, Australia
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 2600, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
| | - Haribondhu Sarma
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 2600, Australia
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6
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Tripathi V, Talukdar D, Tripathi M, Teelucksingh S. Prevalence and associated factors of undiagnosed hypertension among women aged 15-49 years in India: an analysis of National Family Health Survey-4 data. J Hum Hypertens 2024; 38:245-256. [PMID: 37968456 DOI: 10.1038/s41371-023-00876-0] [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: 12/08/2022] [Revised: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
Hypertension is a major risk factor for cardiovascular diseases globally. Fortunately, there is a vast armamentarium of effective therapeutic options at our disposal so undiagnosed hypertension represents a missed opportunity. In a previous analysis [1] of the NFHS-4 dataset for the prevalence and risk factors for undiagnosed hypertension and its associated risk factors among Indian women aged 15-49 years, we had overestimated prevalence by inclusion of self-reported cases. We have since retracted when this anomaly was highlighted [2]. We have now re-analyzed the same database and here present these data. The current analysis shows that the overall prevalence of undiagnosed hypertension was 8.05% among women aged 15-49 years in India. In rural areas, it was 7.89% compared with 8.38% for urban areas. Factors associated with undiagnosed hypertension in rural and urban areas were age, BMI, wealth quintiles, educational level, religion, caste and geographical zones. Nearly half the women aged 15-49 years in India with hypertension are unaware and this has implications for personal and reproductive health.
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Affiliation(s)
- Vrijesh Tripathi
- Department of Mathematics and Statistics, Faculty of Science and Technology, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago.
| | - Debjyoti Talukdar
- Department of Medical Research, Mkhitar Gosh Armenian-Russian International University, 3, 7 Sebastia Street, Yerevan, 0099, Armenia
| | - Mallika Tripathi
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
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7
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Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LCC, Farzadfar F, Gurung MS, Guwatudde D, Houehanou YCN, Malta DC, Martins JS, Saeedi Moghaddam S, Mwangi KJ, Norov B, Sturua L, Zhumadilov Z, Bärnighausen T, Davies JI, Flood D, Marcus ME, Theilmann M, Vollmer S, Manne-Goehler J, Atun R, Sudharsanan N, Verguet S. Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries. Nat Med 2024; 30:414-423. [PMID: 38278990 DOI: 10.1038/s41591-023-02769-8] [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: 04/19/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Abstract
Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.
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Affiliation(s)
- Dorit Talia Stein
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marissa B Reitsma
- Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Kokou Agoudavi
- Noncommunicable Disease Program, Ministry of Health, Lomé, Togo
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Silver Bahendeka
- MKPGMS-Uganda Martyrs University, Kampala, Uganda
- St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Deborah Carvalho Malta
- Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Soares Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Díli, Timor-Leste
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Kibachio Joseph Mwangi
- World Health Organization, Pretoria, South Africa
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
| | - Maja E Marcus
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sebastian Vollmer
- Department of Economics & Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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8
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Oronti IB, Iadanza E, Pecchia L. Hypertension Diagnosis and Management in Africa Using Mobile Phones: A Scoping Review. IEEE Rev Biomed Eng 2024; 17:197-211. [PMID: 35763465 DOI: 10.1109/rbme.2022.3186828] [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: 11/10/2022]
Abstract
Target 3.4 of the third Sustainable Development Goal (SDG) of the United Nations (UN) General Assembly proposes to reduce premature mortality from non-communicable diseases (NCDs) by one-third. Epidemiological data presented by the World Health Organization (WHO) in 2016 show that out of a total of 57 million deaths worldwide, approximately 41 million deaths occurred due to NCDs, with 78% of such deaths occurring in low-and-middle-income countries (LMICs). The majority of investigations on NCDs agree that the leading risk factor for mortality worldwide is hypertension. Over 75% of the world's mobile phone subscriptions reside in LMICs, hence making the mobile phone particularly relevant to mHealth deployment in Africa. This study is aimed at determining the scope of the literature available on hypertension diagnosis and management in Africa, with particular emphasis on determining the feasibility, acceptability and effectiveness of interventions based on the use of mobile phones. The bulk of the evidence considered overwhelmingly shows that SMS technology is yet the most used medium for executing interventions in Africa. Consequently, the need to define novel and superior ways of providing effective and low-cost monitoring, diagnosis, and management of hypertension-related NCDs delivered through artificial intelligence and machine learning techniques is clear.
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9
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Zanuzzi MG, Garzon ME, Cornavaca MT, Bernabeu F, Albertini RA, Ellena G, Romero CA. Social determinants of blood pressure control in a middle-income country in Latin America. J Biosoc Sci 2024; 56:50-62. [PMID: 36794341 DOI: 10.1017/s0021932023000044] [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: 02/17/2023]
Abstract
Blood pressure (BP) control is a key intervention to decrease cardiovascular diseases (CVD), the main cause of death in low and middle-income countries (MIC). Scarce data on the determinants of BP control in Latin America are available. Our objective is to explore the role of gender, age, education, and income as social determinants of BP control in Argentina, a MIC with a universal health care system. We evaluated 1184 persons in two hospitals. Blood pressure was measured using automatic oscillometric devices. We selected those patients treated for hypertension. The average BP of less than 140/90 mmHg was considered a controlled BP. We found 638 hypertensive individuals, of whom 477 (75%) were receiving antihypertensive drugs, and of those, 248 (52%) had controlled BP. The prevalence of low education was more frequent in uncontrolled patients (25.3% vs. 16.1%; P < .01). We did not find association between household income, gender, and BP control. Older patients had less BP control (44% of those older than 75 years vs. 60.9% of those younger than 40; test for trend P < .05). Multivariate regression indicates low education (OR 1.71 95% CI [1.05, 2.79]; P = .03) and older age (OR 1.01; 95% IC [1.00, 1.03]) as independent predictors of the lack of BP control. We conclude that rates of BP control are low in Argentina. In a MIC with a universal health care system low education and old age but not household income are independent predictors of the lack of BP control.
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Affiliation(s)
- Matias G Zanuzzi
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Maria E Garzon
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Maria Teresita Cornavaca
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Francisco Bernabeu
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Ricardo A Albertini
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Gustavo Ellena
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Argentina
| | - Cesar A Romero
- Servicio de Clinica Medica, Hospital Privado Universitario de Córdoba, Argentina
- Global Health Initiative, Henry Ford Hospital, Detroit, MI, USA
- Hypertension and Vascular Research Division, Internal Medicine Department, Henry Ford Hospital, Detroit, MI, USA
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10
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Hotea I, Sirbu C, Plotuna AM, Tîrziu E, Badea C, Berbecea A, Dragomirescu M, Radulov I. Integrating (Nutri-)Metabolomics into the One Health Tendency-The Key for Personalized Medicine Advancement. Metabolites 2023; 13:800. [PMID: 37512507 PMCID: PMC10384896 DOI: 10.3390/metabo13070800] [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: 06/15/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Metabolomics is an advanced technology, still under development, with multiple research applications, especially in the field of health. Individual metabolic profiles, the functionality of the body, as well as its interaction with the environment, can be established using this technology. The body's response to various external factors, including the food consumed and the nutrients it contains, has increased researchers' interest in nutrimetabolomics. Establishing correlations between diet and the occurrence of various diseases, or even the development of personalized nutrition plans, could contribute to advances in precision medicine. The interdependence between humans, animals, and the environment is of particular importance today, with the dramatic emergence and spread of zoonotic diseases, food, water and soil contamination, and the degradation of resources and habitats. All these events have led to an increase in risk factors for functional diseases, burdening global health. Thus, this study aimed to highlight the importance of metabolomics, and, in particular, nutrimetabolomics, as a technical solution for a holistic, collaborative, and precise approach for the advancement of the One Health strategy.
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Affiliation(s)
- Ionela Hotea
- Faculty of Veterinary Medicine, University of Life Sciences "King Mihai I" from Timisoara, Calea Aradului, No. 119, 300645 Timisoara, Romania
| | - Catalin Sirbu
- Faculty of Veterinary Medicine, University of Life Sciences "King Mihai I" from Timisoara, Calea Aradului, No. 119, 300645 Timisoara, Romania
| | - Ana-Maria Plotuna
- Faculty of Veterinary Medicine, University of Life Sciences "King Mihai I" from Timisoara, Calea Aradului, No. 119, 300645 Timisoara, Romania
| | - Emil Tîrziu
- Faculty of Veterinary Medicine, University of Life Sciences "King Mihai I" from Timisoara, Calea Aradului, No. 119, 300645 Timisoara, Romania
| | - Corina Badea
- Faculty of Veterinary Medicine, University of Life Sciences "King Mihai I" from Timisoara, Calea Aradului, No. 119, 300645 Timisoara, Romania
| | - Adina Berbecea
- Faculty of Agriculture, University of Life Sciences "King Mihai I" from Timisoara, Calea Aradului, No. 119, 300645 Timisoara, Romania
| | - Monica Dragomirescu
- Faculty of Bioengineering of Animal Resources, University of Life Sciences "King Mihai I" from Timisoara, Calea Aradului, No. 119, 300645 Timisoara, Romania
| | - Isidora Radulov
- Faculty of Agriculture, University of Life Sciences "King Mihai I" from Timisoara, Calea Aradului, No. 119, 300645 Timisoara, Romania
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11
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Kumar SM, Anandraj J, Sivanatham P, Essakky S, Nain J, Talukdar R, Loganathan V, Kar SS. Control status of hypertension in India: systematic review and meta-analysis. J Hypertens 2023; 41:687-698. [PMID: 36883453 DOI: 10.1097/hjh.0000000000003381] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND AND AIMS Uncontrolled hypertension is a major risk factor for cardiovascular diseases (CVDs). The present study aimed to conduct a systematic review and meta-analysis to estimate the pooled prevalence of control status of hypertension in India. METHODS AND RESULTS We carried out systematic search (PROSPERO No.: CRD42021239800) in PubMed and Embase published between April 2013 and March 2021 followed by meta-analysis with random-effects model. The pooled prevalence of controlled hypertension was estimated across geographic regions. The quality, publication bias and heterogeneity of the included studies were also assessed. We included 19 studies with 44 994 hypertensive population, among which 17 studies had low risk of bias. We found statistically significant heterogeneity ( P ≤ 0.05) and absence of publication bias among the included studies. The pooled prevalence of control status among patients with hypertension was 15% (95% CI: 12-19%) and among those under treatment was 46% (95% CI: 40-52%). The control status among patients with hypertension was significantly higher in Southern India 23% (95% CI: 16-31%) followed by Western 13% (95% CI: 4-16%), Northern 12% (95% CI: 8-16%), and Eastern India 5% (95% CI: 4-5%). Except for Southern India, the control status was lower among the rural areas compared with urban areas. CONCLUSION We report high prevalence of uncontrolled hypertension in India irrespective of treatment status, geographic regions and urban and rural settings. There is urgent need to improve control status of hypertension in the country.
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Affiliation(s)
- S Mathan Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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12
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Dong L, Wang Y, Xu J, Zhou Y, Sun G, Ji D, Guo H, Zhu B. Association of multiple anthropometric indices with in 944,760 elderly Chinese people. Epidemiol Health 2023; 45:e2023046. [PMID: 37080727 PMCID: PMC10593587 DOI: 10.4178/epih.e2023046] [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: 12/27/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES The aims of this study were to update the latest data on the prevalence of hypertension (HTN) in the elderly Chinese population and to assess relationships between new anthropometric indices and HTN. METHODS Data were obtained from the Basic Public Health Service (BPHS) survey for Jiangsu Province, China. A total of 944,760 people aged 65 years and older were included in this study. Blood pressure was measured by trained investigators. Body weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), conicity index (COI), body roundness index (BRI), and a body shape index (ABSI) were included in the analysis as anthropometric indices. Logistic regression analysis and restricted cubic splines were used to evaluate the association of anthropometric indices with HTN. RESULTS The prevalence of HTN among elderly residents of Jiangsu Province was 64.7% (95% confidence interval, 64.6 to 64.8). After adjusting for multiple covariates, all anthropometric indices except ABSI showed significant non-linear positive dose-response associations with HTN across sex (pnonlinear<0.001). Among participants with BMI <28 kg/m2, abnormal weight, WC, WtHR, BRI, COI, and ABSI were positively associated with HTN. CONCLUSIONS The prevalence of HTN in the elderly in Jiangsu Province is gradually increasing. It is necessary to consider the combination of ABSI and COI with BMI for screening elderly individuals for HTN in follow-up prospective studies.
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Affiliation(s)
- Lirong Dong
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yuanyuan Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Jinshui Xu
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yang Zhou
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Dakang Ji
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Haijian Guo
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Baoli Zhu
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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13
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Brindley C, Van Ourti T, Capuno J, Kraft A, Kudymowa J, O'Donnell O. Risk factor contributions to socioeconomic inequality in cardiovascular risk in the Philippines: a cross-sectional study of nationally representative survey data. BMC Public Health 2023; 23:689. [PMID: 37046247 PMCID: PMC10092926 DOI: 10.1186/s12889-023-15517-x] [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: 10/06/2022] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Primary prevention of cardiovascular diseases (CVD) increasingly relies on monitoring global CVD risk scores. Lack of evidence on socioeconomic inequality in these scores and the contributions that specific risk factors make to this inequality impedes effective targeting of CVD prevention. We aimed to address this evidence gap by measuring and decomposing socioeconomic inequality in CVD risk in the Philippines. METHODS We used data on 8462 individuals aged 40-74 years from the Philippines National Nutrition Survey and the laboratory-based Globorisk equation to predict 10-year risk of a CVD event from sex, age, systolic blood pressure, total cholesterol, high blood glucose, and smoking. We used a household wealth index to proxy socioeconomic status and measured socioeconomic inequality with a concentration index that we decomposed into contributions of the risk factors used to predict CVD risk. We measured socioeconomic inequalities in these risk factors and decomposed them into contributions of more distal risk factors: body mass index, fat share of energy intake, low physical activity, and drinking alcohol. We stratified by sex. RESULTS Wealthier individuals, particularly males, had greater exposure to all risk factors, with the exception of smoking, and had higher CVD risks. Total cholesterol and high blood glucose accounted for 58% and 34%, respectively, of the socioeconomic inequality in CVD risk among males. For females, the respective estimates were 63% and 69%. Systolic blood pressure accounted for 26% of the higher CVD risk of wealthier males but did not contribute to inequality among females. If smoking prevalence had not been higher among poorer individuals, then the inequality in CVD risk would have been 35% higher for males and 75% higher for females. Among distal risk factors, body mass index and fat intake contributed most to inequalities in total cholesterol, high blood sugar, and, for males, systolic blood pressure. CONCLUSIONS Wealthier Filipinos have higher predicted CVD risks and greater exposure to all risk factors, except smoking. There is need for a nuanced approach to CVD prevention that targets anti-smoking programmes on the poorer population while targeting diet and exercise interventions on the wealthier.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands.
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Tom Van Ourti
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
| | - Joseph Capuno
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Aleli Kraft
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Jenny Kudymowa
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Rethink Priorities, Frankfurt, Germany
| | - Owen O'Donnell
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
- Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
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14
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Chen J, Yan M, Suolang D, Han M, Baima Y, Mi F, Chen L, Guan H, Cai H, Zhao X, Liu Q. Mediation Effect of Obesity on the Association of Age at Menarche With Blood Pressure Among Women in Southwest China. J Am Heart Assoc 2023; 12:e027544. [PMID: 36847068 PMCID: PMC10111443 DOI: 10.1161/jaha.122.027544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Previous studies have been inconsistent about the association between age at menarche and high blood pressure. Little is known about such association across a wide range of menarcheal ages in less developed ethnic minority regions in China. We aimed to explore the association between age at menarche and high blood pressure (BP; ≥140/90 mm Hg) and to examine the mediating effect of obesity and the moderating effect of menopausal status on this association. Methods and Results A total of 45 868 women from the baseline data of the CMEC (China Multi-Ethnic Cohort) were included in this study. Binary logistic regression was used to analyze the relationship between age at menarche and high BP, and the mediation model was used to evaluate the mediating effects of body mass index and waist circumference on the association of age at menarche with high BP. The mean age at enrollment and age at menarche of participants in our study were 49.3 (SD=10.7) and 14.7 (SD=2.1) years, respectively. Late menarche was associated with a lower risk of high BP (odds ratio, 0.831 [95% CI, 0.728-0.950]). The risk of high BP decreased by 3.1% with each year's delay in the onset of menarche (P for trend <0.001). Body mass index and waist circumference could partially mediate the association of age at menarche and high BP with the indirect effect of body mass index (odds ratio, 0.998 [95% CI, 0.997-0.998]) and waist circumference (odds ratio, 0.999 [95% CI, 0.998-0.999]). In addition, the mediation effects were modified by the status of menopause. Conclusions Women with late menarche have a lower risk of high BP, and obesity could be one of the important mediators. Obesity prevention is an efficient strategy to reduce the association between age at menarche and high BP, especially in premenopausal women.
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Affiliation(s)
- Jiayi Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University Chengdu China
| | - Mingxia Yan
- West China School of Public Health and West China Fourth Hospital, Sichuan University Chengdu China
| | - Deji Suolang
- Tibet Center for Disease Control and Prevention Lhasa China
| | - Mingming Han
- Chengdu Center for Disease Control and Prevention Chengdu China
| | | | - Fei Mi
- School of Public Health Kunming Medical University Kunming China
| | - Liling Chen
- Chongqing Municipal Center for Disease Control and Prevention Chongqing China
| | - Han Guan
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education Guizhou Medical University Guiyang China
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center Vanderbilt University School of Medicine Nashville TN
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University Chengdu China
| | - Qiaolan Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University Chengdu China
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15
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Liu YH, Chen SC, Lee WH, Chen YC, Hsu PC, Tsai WC, Lee CS, Lin TH, Hung CH, Kuo CH, Su HM. Prognostic Factors of New-Onset Hypertension in New and Traditional Hypertension Definition in a Large Taiwanese Population Follow-up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16525. [PMID: 36554404 PMCID: PMC9779332 DOI: 10.3390/ijerph192416525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The aim of this study was to determine the predictors of new-onset hypertension when the definition of hypertension is changed from the traditional definition (140/90 mmHg) to a new definition (130/80 mmHg). Using data from the Taiwan Biobank, a total of 17,072 and 21,293 participants in the new and traditional definition groups were analyzed, respectively. During a mean follow-up period of 3.9 years, 3641 and 3002 participants developed hypertension in the new and traditional definition groups, respectively. After multivariable analysis, older age (OR, 1.035; 95% CI, 1.030 to 1.039; p < 0.001), male sex (OR, 1.332; 95% CI, 1.194 to 1.486; p < 0.001), high systolic blood pressure (SBP) (OR, 1.067; 95% CI, 1.062 to 1.073; p < 0.001), high diastolic blood pressure (DBP) (OR, 1.048; 95% CI, 1.040 to 1.056; p < 0.001), high heart rate (OR, 1.007; 95% CI, 1.002 to 1.012; p = 0.004), high body mass index (BMI) (OR, 1.091; 95% CI, 1.077 to 1.106; p < 0.001), high fasting glucose (OR, 1.004; 95% CI, 1.001 to 1.006; p = 0.002), and high triglycerides (OR, 1.001; 95% CI, 1.000 to 1.001; p = 0.004) were significantly associated with new-onset hypertension in the new definition group. In the traditional definition group, the predictors of new-onset hypertension were older age (OR, 1.038; 95% CI, 1.032 to 1.043; p < 0.001), high SBP (OR, 1.078; 95% CI, 1.072 to 1.084; p < 0.001), high DBP (OR, 1.039; 95% CI, 1.031 to 1.046; p < 0.001), high heart rate (OR, 1.005; 95% CI, 1.000 to 1.010; p = 0.032), high BMI (OR, 1.072; 95% CI, 1.058 to 1.087; p < 0.001), high fasting glucose (OR, 1.003; 95% CI, 1.000 to 1.005; p = 0.020), low cholesterol (OR, 0.998; 95% CI, 0.997 to 0.999; p = 0.004), high triglycerides (OR, 1.001; 95% CI, 1.000 to 1.001; p = 0.001), and low estimated glomerular filtration rate (eGFR) (OR, 0.995; 95% CI, 0.993 to 0.997; p < 0.001). In conclusion, older age, high SBP and DBP, high heart rate, high BMI, high fasting glucose, and high triglycerides were useful predictors of new-onset hypertension in both the new and traditional definition groups. However, male sex was a significant predictor of new-onset hypertension only in the new definition group, and low cholesterol and low eGFR were significant predictors of new-onset hypertension only in the traditional definition group. Hence, changing the diagnostic cut-off value for hypertension may have a significant impact on the association of some clinical and laboratory parameters with new-onset hypertension.
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Affiliation(s)
- Yi-Hsueh Liu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 80708, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 80708, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Wen-Hsien Lee
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 80708, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ying-Chih Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 80708, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Wei-Chung Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chih-Hsing Hung
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 80708, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ho-Ming Su
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 80708, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Ntenda PAM, El-Meidany WMR, Tiruneh FN, Motsa MPS, Nyirongo J, Chirwa GC, Kapachika A, Nkoka O. Determinants of self-reported hypertension among women in South Africa: evidence from the population-based survey. Clin Hypertens 2022; 28:39. [PMCID: PMC9664601 DOI: 10.1186/s40885-022-00222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Hypertension (HTN), characterized by an elevation of blood pressure, is a serious public health chronic condition that significantly raises the risks of heart, brain, kidney, and other diseases. In South Africa, the prevalence of HTN (measured objectively) was reported at 46.0% in females, nonetheless little is known regarding the prevalence and risks factors of self-reported HTN among the same population. Therefore, the aim of this study was to examine determinants of self-reported HTN among women in South Africa.
Methods
The study used data obtained from the 2016 South African Demographic and Health Survey. In total, 6,027 women aged ≥ 20 years were analyzed in this study. Self-reported HTN was defined as a case in which an individual has not been clinically diagnosed with this chronic condition by a medical doctor, nurse, or health worker. Multiple logistic regression models were employed to examine the independent factors of self-reported HTN while considering the complex survey design.
Results
Overall, self-reported HTN was reported in 23.6% (95% confidence interval [CI], 23.1–24.1) of South African women. Being younger (adjusted odds ratio [aOR], 0.04; 95% CI, 0.03–0.06), never married (aOR, 0.69; 95% CI, 0.56–0.85), and not covered by health insurance (aOR, 0.74; 95% CI, 0.58–0.95) reduced the odds of self-reported HTN. On the other hand, being black/African (aOR, 1.73; 95% CI, 1.17–2.54), perception of being overweight (aOR, 1.72; 95% CI, 1.40–2.11), and perception of having poor health status (aOR, 3.53; 95% CI, 2.53–5.21) and the presence of other comorbidities (aOR, 7.92; 95% CI, 3.63–17.29) increased the odds of self-reported HTN.
Conclusions
Self-reported HTN was largely associated with multiple sociodemographic, health, and lifestyle factors and the presence of other chronic conditions. Health promotion and services aiming at reducing the burden of HTN in South Africa should consider the associated factors reported in this study to ensure healthy aging and quality of life among women.
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Diendéré J, Kaboré J, Bosu WK, Somé JW, Garanet F, Ouédraogo PV, Savadogo AA, Millogo A, Zeba AN. A comparison of unhealthy lifestyle practices among adults with hypertension aware and unaware of their hypertensive status: results from the 2013 WHO STEPS survey in Burkina Faso. BMC Public Health 2022; 22:1601. [PMID: 35999516 PMCID: PMC9396908 DOI: 10.1186/s12889-022-14026-7] [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: 05/08/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We compared the prevalence of unhealthy lifestyle factors between the hypertensive adults who were aware and unaware of their hypertensive status and assessed the factors associated with being aware of one's hypertension among adults in Burkina Faso. METHODS We conducted a secondary analysis of data from the World Health Organization Stepwise approach to surveillance survey conducted in 2013 in Burkina Faso. Lifestyle factors analysed were fruits and vegetables (FV) consumption, tooth cleaning, alcohol and tobacco use, body mass index and physical activity. RESULTS Among 774 adults living with hypertension, 84.9% (95% CI: 82.2-87.3) were unaware of their hypertensive status. The frequencies of unhealthy lifestyle practices in those aware vs. unaware were respectively: 92.3% vs. 96.3%, p = 0.07 for not eating, at least, five FV servings daily; 63.2% vs. 70.5%, p = 0.12 for not cleaning the teeth at least twice a day; 35.9% vs. 42.3%, p = 0.19 for tobacco and/or alcohol use; 53.9% vs. 25.4%, p = 0.0001 for overweight/obesity and 17.1% vs, 10.3%, p = 0.04 for physical inactivity. In logistic regression analysis, older age, primary or higher education, being overweight/obese [adjusted odds ratio (aOR) = 3.2; p < 0.0001], intake of adequate FV servings daily (aOR = 2.9; p = 0.023) and non-use of alcohol and tobacco (aOR = 0.6; p = 0.028) were associated with being aware of one's hypertensive status. CONCLUSION Undiagnosed hypertension was very high among Burkinabè adults living with hypertension. Those aware of their hypertension diagnosis did not necessarily practise healthier lifestyles than those not previously aware of their hypertension. Current control programmes should aim to improve hypertension awareness and promote risk reduction behaviour.
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Affiliation(s)
- Jeoffray Diendéré
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso.
| | - Jean Kaboré
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - William Kofi Bosu
- Department of Public Health and Research, West African Health Organisation (WAHO), Bobo-Dioulasso, Burkina Faso
| | - Jérome Winbetouréfâ Somé
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Franck Garanet
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS) Unité de Kaya, Kaya, Burkina Faso
| | | | - Abdoul Aziz Savadogo
- Université Nazi Boni/Institut Supérieur des Sciences de la Santé (INSSA), Bobo-Dioulasso, Burkina Faso
| | - Athanase Millogo
- Université Joseph Ki-Zerbo/Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Augustin Nawidimbasba Zeba
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
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Kohori Segawa H, Uematsu H, Dorji N, Wangdi U, Dorjee C, Yangchen P, Kunisawa S, Sakamoto R, Imanaka Y. Social and behavioral factors related to blood pressure measurement: A cross-sectional study in Bhutan. PLoS One 2022; 17:e0271914. [PMID: 35976922 PMCID: PMC9385017 DOI: 10.1371/journal.pone.0271914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/08/2022] [Indexed: 11/19/2022] Open
Abstract
Cardiovascular disease is a leading cause of death in the Kingdom of Bhutan, and early detection of hypertension is critical for preventing cardiovascular disease. However, health-seeking behavior, including blood pressure measurement, is infrequently investigated in Bhutan. Therefore, this study investigated factors related to blood pressure measurement in Bhutan. We performed a secondary data analysis of a target population of 1,962 individuals using data from the “2014 Bhutan STEPS survey data”as a cross-sectional study. Approximately 26% of those with hypertension who were detected during the STEPS survey had never had their blood pressure measured. Previous blood pressure measurement was significantly associated with age and working status in men (self-employed [odds ratio (OR): 0.219, 95% CI: 0.133–0.361], non-working [OR: 0.114, 95% CI: 0.050–0.263], employee [OR: 1.000]). Previous blood pressure measurement was significantly associated with higher income in women (Quartile-2 [OR: 1.984, 95% CI: 1.209–3.255], Quartile-1 [OR: 2.161, 95% CI: 1.415–3.299], Quartile-4 [OR: 1.000]). A family history of hypertension (OR: 2.019, 95% CI: 1.549–2.243) increased the likelihood of having experienced a blood pressure measurement in both men and women. Multivariate logistic regression showed that people with unhealthy lifestyles (high salt intake [adjusted odds ratio (AOR): 0.247, 95% confidence interval (CI): 0.068–0.893], tobacco use [AOR: 0.538, 95% CI: 0.380–0.761]) had a decreased likelihood of previous blood pressure measurement. To promote the early detection of hypertension in Bhutan, we suggest that more attention be paid to low-income women, non-working, self-employed, and low-income men, and a reduction of barriers to blood pressure measurement. Before the STEPS survey, a substantial number of hypertensive people had never had their blood pressure measured or were unconcerned about their health. As a result, we propose that early blood pressure monitoring and treatment for people with hypertension or at higher risk of hypertension be given increased emphasis.
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Affiliation(s)
- Hiromi Kohori Segawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- Kokoro Research Center, Kyoto University, Kyoto City, Kyoto, Japan
| | - Hironori Uematsu
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Nidup Dorji
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Kingdom of Bhutan
| | - Ugyen Wangdi
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Kingdom of Bhutan
| | - Chencho Dorjee
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Kingdom of Bhutan
| | - Pemba Yangchen
- Non-Communicable Diseases Division, Ministry of Health in Bhutan, Thimphu, Kingdom of Bhutan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Ryota Sakamoto
- Centre for Southeast Asian Studies, Kyoto University, Kyoto City, Kyoto, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- * E-mail:
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Mohanty P, Patnaik L, Nayak G, Dutta A. Gender difference in prevalence of hypertension among Indians across various age-groups: a report from multiple nationally representative samples. BMC Public Health 2022; 22:1524. [PMID: 35948916 PMCID: PMC9364494 DOI: 10.1186/s12889-022-13949-5] [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: 05/16/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Prevalence of hypertension increases with age, but there is a general perception in India that women are less affected at every stage of life, although empiric evidence hardly exists regarding gender difference in hypertension in Indians of different ages. Therefore, we aimed to examine the gender difference in hypertension among Indians across various age-groups; and the contribution of variation in body mass index (BMI) to this difference. Methods Data were analysed after combining National Family Health Survey 4 (n = 294,584 aged 35–49 years) and Study of Ageing and Health wave 2 (n = 7118 aged 50 + years) datasets (NFHS-SAGE). Longitudinal Ageing Study of India (LASI) dataset (n = 65,900 aged > 45years) was analysed to replicate the results. Hypertension was defined if systolic and diastolic blood pressure was > 89 and/or > 139 respectively and/or if there was a history of anti-hypertensive medication. Descriptive summaries were tabulated and plotted to examine the gender difference in hypertension in various age-groups (35–39,40–44, 45–49, 50–54, 55–59, 60–64, 65–69, ≥ 70). Odds Ratios (ORs) from logistic regression models estimated the age gradient of hypertension and their male-female difference, adjusted for Body Mass Index (BMI). Results Males had a higher prevalence of hypertension up to 50 years; after that, females had higher rates. The estimates of age gradient, expressed as ORs, were 1.02 (1.02, 1.02) in males versus 1.05(1.05, 1.06) in females (p < 0.001) in NFHS-SAGE and 1.01(1.01, 1.02) in males versus 1.04(1.03, 1.04)in females (p < 0.001) in LASI;these differences marginally changed after adjustment with BMI. Conclusion This is perhaps the first study to comprehensively demonstrate that cardio-metabolic risk in Indian females surpasses males after 50 years of age, “busting the myth” that Indian females are always at much lower risk than males; and this evidence should inform the Indian healthcare system to prioritise older women for screening and treatment of hypertension. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13949-5.
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Affiliation(s)
- Parimala Mohanty
- Department of Community Medicine, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Lipilekha Patnaik
- Department of Community Medicine, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Gayatri Nayak
- Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, India
| | - Ambarish Dutta
- Indian Institute of Public Health, Public Health Foundation of India, Address-Plot No- 267/3408, JaydevVihar, Mafair Lagoon Road, Odisha, 751013, Bhubaneswar, India.
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20
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Prevalence and Associations of Hypertension in Sri Lankan Adults: Estimates from the SLHAS 2018–19 Survey Using JNC7 and ACC/AHA 2017 Guidelines. Glob Heart 2022; 17:50. [PMID: 36051322 PMCID: PMC9354554 DOI: 10.5334/gh.1135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/28/2022] [Indexed: 11/20/2022] Open
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21
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Tong J, An X, Zhao L, Qu P, Tang X, Chen M, Liang X. Combining multiaspect factors to predict the risk of childhood hypertension incidence. J Clin Hypertens (Greenwich) 2022; 24:1015-1025. [PMID: 35866196 PMCID: PMC9380136 DOI: 10.1111/jch.14544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/07/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022]
Abstract
Childhood hypertension has become a global public health issue due to its increasing prevalence and association with cerebral‐cardiovascular disease in adults. In this study, we developed a predictive model for childhood hypertension based on environmental and genetic factors to identify at‐risk individuals. Eighty children diagnosed with childhood hypertension and 84 children in the control group matched by sex and age from an established cohort were included in a nested case–control study. We constructed a multiple logistic regression model to analyze the factors associated with hypertension and applied the 10‐fold cross‐validation method to verify the prediction stability of the model. Childhood hypertension was found positively correlated with triglyceride level ≥150 mg/dL; low‐density lipoprotein cholesterol level ≥110 mg/dL; body mass index Z score; waist‐to‐height ratio Z score; and red blood cell count (all P < .01) and negatively correlated with the relative expression level of retinol acyltransferase; relative expression level of vitamin D receptor; and dietary intake of fiber, vitamin C and copper (all P < .05) in this study. BMI Z score, triglyceride ≥150 mg/dL, RBC count, VDR/β‐actin and LRAT/β‐actin ratios were used to construct the predictive model. The area under the receiver operating characteristic curve was 94.45% (95% CI = 89.35%∼98.65%, P < .001). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were all above 80% in both the training and validation sets. In conclusion, this model can predict the risk of childhood hypertension and could provide a theoretical basis for early prevention and intervention to improve the cardiovascular health of children.
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Affiliation(s)
- Jishuang Tong
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Xizhou An
- Hematology and Oncology Department, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Zhao
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Ping Qu
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Xian Tang
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Min Chen
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Xiaohua Liang
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
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22
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Basu S, Engtipi K, Kumar R. Determinants of adherence to antihypertensive treatment among patients attending a primary care clinic with limited medical armamentarium in Delhi, India: A qualitative study. Chronic Illn 2022; 18:295-305. [PMID: 32938210 DOI: 10.1177/1742395320959418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine perspectives on reasons for non-adherence to antihypertensive therapy and its socioeconomic determinants among patients attending a primary care center in a low-income area in Delhi, India. METHODS We conducted in-depth interviews with a total of 30 patients having hypertension at a primary care facility located in a low-income urban area in Delhi. RESULTS All the participants were aware that hypertension was a serious illness, and medication intake was necessary throughout life to prevent uncontrolled hypertension. All participants in varying quantities practiced salt restriction, but the consumption of fresh fruit and vegetables was low primarily due to economic reasons. The participants were unable to differentiate the concept of exercise from physical activity. Medication adherence was suboptimal, and significant reasons for non-adherence were forgetfulness, carelessness and running out of drug stocks. Blood pressure control was also suboptimal in a majority of the participants, but combination therapy was restricted due to limited medical armamentarium at the clinic. Laboratory investigations for monitoring target end-organ damage were either delayed or not conducted in most participants. DISCUSSION Hypertensive patients undergoing treatment at primary care facilities often report suboptimal medical adherence and treatment outcomes, with socioeconomic causes being a major driver of non-adherence.
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Affiliation(s)
- Saurav Basu
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Kajok Engtipi
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Rajesh Kumar
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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23
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Islam SMS, Talukder A, Awal MA, Siddiqui MMU, Ahamad MM, Ahammed B, Rawal LB, Alizadehsani R, Abawajy J, Laranjo L, Chow CK, Maddison R. Machine Learning Approaches for Predicting Hypertension and Its Associated Factors Using Population-Level Data From Three South Asian Countries. Front Cardiovasc Med 2022; 9:839379. [PMID: 35433854 PMCID: PMC9008259 DOI: 10.3389/fcvm.2022.839379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/11/2022] [Indexed: 12/13/2022] Open
Abstract
BackgroundHypertension is the most common modifiable risk factor for cardiovascular diseases in South Asia. Machine learning (ML) models have been shown to outperform clinical risk predictions compared to statistical methods, but studies using ML to predict hypertension at the population level are lacking. This study used ML approaches in a dataset of three South Asian countries to predict hypertension and its associated factors and compared the model's performances.MethodsWe conducted a retrospective study using ML analyses to detect hypertension using population-based surveys. We created a single dataset by harmonizing individual-level data from the most recent nationally representative Demographic and Health Survey in Bangladesh, Nepal, and India. The variables included blood pressure (BP), sociodemographic and economic factors, height, weight, hemoglobin, and random blood glucose. Hypertension was defined based on JNC-7 criteria. We applied six common ML-based classifiers: decision tree (DT), random forest (RF), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), logistic regression (LR), and linear discriminant analysis (LDA) to predict hypertension and its risk factors.ResultsOf the 8,18,603 participants, 82,748 (10.11%) had hypertension. ML models showed that significant factors for hypertension were age and BMI. Ever measured BP, education, taking medicine to lower BP, and doctor's perception of high BP was also significant but comparatively lower than age and BMI. XGBoost, GBM, LR, and LDA showed the highest accuracy score of 90%, RF and DT achieved 89 and 83%, respectively, to predict hypertension. DT achieved the precision value of 91%, and the rest performed with 90%. XGBoost, GBM, LR, and LDA achieved a recall value of 100%, RF scored 99%, and DT scored 90%. In F1-score, XGBoost, GBM, LR, and LDA scored 95%, while RF scored 94%, and DT scored 90%. All the algorithms performed with good and small log loss values <6%.ConclusionML models performed well to predict hypertension and its associated factors in South Asians. When employed on an open-source platform, these models are scalable to millions of people and might help individuals self-screen for hypertension at an early stage. Future studies incorporating biochemical markers are needed to improve the ML algorithms and evaluate them in real life.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Melbourne, VIC, Australia
- *Correspondence: Sheikh Mohammed Shariful Islam
| | - Ashis Talukder
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Md. Abdul Awal
- Electronics and Communication Engineering Discipline, Khulna University, Khulna, Bangladesh
| | | | - Md. Martuza Ahamad
- Department of Computer Science and Engineering, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Benojir Ahammed
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Lal B. Rawal
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC, Australia
| | - Jemal Abawajy
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Liliana Laranjo
- Faculty of Medicine and Health, Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia
| | - Clara K. Chow
- Faculty of Medicine and Health, Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Melbourne, VIC, Australia
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Kohli-Lynch CN, Erzse A, Rayner B, Hofman KJ. Hypertension in the South African public healthcare system: a cost-of-illness and burden of disease study. BMJ Open 2022; 12:e055621. [PMID: 35193918 PMCID: PMC8867372 DOI: 10.1136/bmjopen-2021-055621] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To quantify the health and economic burden of hypertension in the South African public healthcare system. SETTING All inpatient, outpatient and rehabilitative care received in the national public healthcare system. PARTICIPANTS Adults, aged ≥20 years, who receive care in the public healthcare system. OUTCOMES Worksheet-based models synthesised data from multiple sources to estimate the burden of disease, direct healthcare costs, and societal costs associated with hypertension. Results were disaggregated by sex. RESULTS Approximately 8.22 million (30.8%, 95% CI 29.5% to 32.1%) South African adults with no private health insurance have hypertension. Hypertension was estimated to cause 14 000 (95% CI 11 100 to 17 200) ischaemic heart disease events, 13 300 (95% CI 10 600 to 16 300) strokes and 6100 (95% CI 4970 to 7460) cases of chronic kidney disease annually. Rates of hypertension, hypertension-related stroke and hypertension-related chronic kidney disease were greater for women compared with men.The direct healthcare costs associated with hypertension were estimated to be ZAR 10.1 billion (95% CI 8.98 to 11.3 billion) or US$0.711 billion (95% CI 0.633 to 0.793 billion). Societal costs were estimated to be ZAR 29.4 billion (95% CI 26.0 to 33.2 billion) or US$2.08 billion (95% CI 1.83 to 2.34 billion). Direct healthcare costs were greater for women (ZAR 6.11 billion or US$0.431 billion) compared with men (ZAR 3.97 billion or US$0.280 billion). Conversely, societal costs were lower for women (ZAR 10.5 billion or US$0.743 billion) compared with men (ZAR 18.9 billion or US$1.33 billion). CONCLUSION Hypertension exerts a heavy health and economic burden on South Africa. Establishing cost-effective best practice guidelines for hypertension treatment requires further research. Such research will be essential if South Africa is to make progress in its efforts to implement universal healthcare.
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Affiliation(s)
- Ciaran N Kohli-Lynch
- SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
- Center for Health Services & Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - B Rayner
- Division of Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Karen J Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
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25
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Widyaningsih V, Febrinasari RP, Pamungkasari EP, Mashuri YA, Sumardiyono S, Balgis B, Koot J, Landsman-Dijkstra J, Probandari A. Missed opportunities in hypertension risk factors screening in Indonesia: a mixed-methods evaluation of integrated health post (POSBINDU) implementation. BMJ Open 2022; 12:e051315. [PMID: 35190419 PMCID: PMC8862503 DOI: 10.1136/bmjopen-2021-051315] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To assess the implementation and contextual barriers of POSBINDU, a community-based activity focusing on screening of non-communicable diseases (NCDs), mainly hypertension and diabetes, in Indonesia. DESIGN This was a concurrent mixed-methods study, with a cross-sectional analysis of secondary data and focus group discussions (FGDs) on stakeholder of POSBINDU. SETTING The study was conducted in seven districts in three provinces in Indonesia, with approximately 50% of the primary healthcare (PHC) were selected as areas for data collection (n PHC=100). PARTICIPANTS From 475 POSBINDU sites, we collected secondary data from 54 224 participants. For the qualitative approach, 21 FGDs and 2 in-depth interviews were held among a total of 223 informants. PRIMARY OUTCOMES AND MEASURES Proportion of POSBINDU visitors getting the hypertension screening and risk factors' assessment, and barriers of POSBINDU implementation. RESULTS Out of the 114 581 POSBINDU visits by 54 224 participants, most (80%) were women and adults over 50 years old (50%) showing a suboptimal coverage of men and younger adults. Approximately 95.1% of visitors got their blood pressure measured during their first visit; 35.3% of whom had elevated blood pressure. Less than 25% of the visitors reported to be interviewed for NCDs risk factors during their first visit, less than 80% had anthropometric measurements and less than 15% had blood cholesterol examinations. We revealed lack of resources and limited time to perform the complexities of activities and reporting as main barrier for effective hypertension screening in Indonesia. CONCLUSIONS This study showed missed opportunities in hypertension risk factors screening in Indonesia. The barriers include a lack of access and implementation barriers (capability, resources and protocols).
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Affiliation(s)
| | | | | | | | | | - Balgis Balgis
- Public Health, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Jaap Koot
- Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Ari Probandari
- Public Health, Universitas Sebelas Maret, Surakarta, Indonesia
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Setiadi AP, Widiyastuti S, Mariati IGAD, Sunderland B, Wibowo YI. Socioeconomic impacts on medication adherence among patients with hypertension: A multicentre cross-sectional study in Lombok, Indonesia. PHARMACIA 2022. [DOI: 10.3897/pharmacia.69.e78441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Socioeconomic impacts on adherence are understudied, particularly in disadvantaged areas. This study aimed to evaluate socioeconomic factors on medication adherence among patients with hypertension in Lombok, Indonesia. A cross-sectional survey was conducted in all six public hospital outpatient clinics in Lombok in 2017. Data was obtained using a validated questionnaire to which the Morisky Green Levine Adherence Scale (MGLS) questionnaire was used to assess medication adherence. Binary logistic regression was performed to determine independent socioeconomic associations. A total of 693 patients with hypertension were included (response rate 84%). The majority had low adherence (76.2%). Significant independent associations were reported between setting and education with adherence (rural versus urban setting: odds ratio 3.54, p<0.001; primary versus university level education: odds ratio 5.39, p<0.001). Socioeconomic associations provide some basis for the development of patient and population-based interventions to improve adherence among patients with hypertension in Indonesia, particularly in disadvantaged areas.
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Mohanty SK, Upadhyay AK, Shekhar P, Kämpfen F, O'Donnell O, Maurer J. Missed opportunities for hypertension screening: a cross-sectional study, India. Bull World Health Organ 2022; 100:30-39B. [PMID: 35017755 PMCID: PMC8722631 DOI: 10.2471/blt.21.287007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To assess missed opportunities for hypertension screening at health facilities in India and describe systematic differences in these missed opportunities across states and sociodemographic groups. Methods We used nationally representative survey data from the 2017-2018 Longitudinal Ageing Study in India to estimate the proportion of adults aged 45 years or older identified with hypertension and who had not been diagnosed with hypertension despite having visited a health facility during the previous 12 months. We estimated age-sex adjusted proportions of missed opportunities to diagnose hypertension, as well as actual and potential proportions of diagnosis, by sociodemographic characteristics and for each state. Findings Among those identified as having hypertension, 22.6% (95% confidence interval, CI: 21.3 to 23.8) had not been diagnosed despite having recently visited a health facility. If these opportunities had been realized, the prevalence of diagnosed hypertension would have increased from 54.8% (95% CI: 53.5 to 56.1) to 77.3% (95% CI: 76.2 to 78.5). Missed opportunities for diagnosis were more common among individuals who were poorer (P = 0.001), less educated (P < 0.001), male (P < 0.001), rural (P < 0.001), Hindu (P = 0.001), living alone (P = 0.028) and working (P < 0.001). Missed opportunities for diagnosis were more common at private than at public health facilities (P < 0.001) and varied widely across states (P < 0.001). Conclusion Opportunistic screening for hypertension has the potential to significantly increase detection of the condition and reduce sociodemographic and geographic inequalities in its diagnosis. Such screening could be a first step towards more effective and equitable hypertension treatment and control.
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Affiliation(s)
- Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai 400088, India
| | | | - Prashant Shekhar
- R4D India project, International Institute for Population Sciences, Mumbai, India
| | - Fabrice Kämpfen
- School of Economics, University College Dublin, Dublin, Ireland
| | - Owen O'Donnell
- Erasmus School of Economics, Erasmus University, Rotterdam, Netherlands
| | - Jürgen Maurer
- Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
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Strategies to address non-communicable diseases in the Commonwealth of Independent States countries: a scoping review. Prim Health Care Res Dev 2022; 23:e73. [DOI: 10.1017/s1463423622000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Aim:
The aim of this study is to review the literature in Commonwealth of Independent States (CIS) countries with regard to their response to non-communicable diseases (NCDs) and the implementation of the World Health Organization (WHO) Package of Essential Non-communicable (PEN) disease interventions for primary health care.
Background:
NCDs are estimated to account from 62% to 92% of total deaths in CIS countries. Current management of NCDs in CIS countries is focused on specialists and hospital care versus primary health care (PHC) as recommended by the WHO.
Methods:
This paper uses a scoping review of published and grey literature focusing on diabetes and hypertension in CIS countries. These two conditions are chosen as they represent a large burden in CIS countries and are included in the responses proposed by the WHO PEN.
Findings:
A total of 96 documents were identified and analysed with the results presented using the WHO Health System Building Blocks. Most of the publications identified focused on the service delivery (41) and human resources (20) components, while few addressed information and research (17), and only one publication was related to medical products. As for their disease of focus, most studies focused on hypertension (14) and much less on diabetes (3). The most studies came from Russia (18), followed by Ukraine (21) and then Kazakhstan (12). Only two countries Moldova and Kyrgyzstan have piloted the WHO PEN. Overall, the studies identified highlight the importance of the PHC system to better control and manage NCDs in CIS countries. However, these present only strategies versus concrete interventions. One of the main challenges is that NCD care at PHC in CIS countries continues to be predominantly provided by specialists in addition to focusing on treatment versus preventative services.
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Heizhati M, Li N, Zhang D, Abulikemu S, Chang G, Hong J, Maimaiti N, Hu J, Wang L, Duiyimuhan G. Government-Expert Joint Intervention with Treatment Algorithm and Improved Hypertension Management and Reduced Stroke Mortality in a Primary-Care Setting. Int J Hypertens 2021; 2021:9661576. [PMID: 34691775 PMCID: PMC8531792 DOI: 10.1155/2021/9661576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
Hypertension management is suboptimal in the primary-care setting of developing countries, where the burden of both hypertension and cardiovascular disease is huge. Therefore, we conducted a government-expert joint intervention in a resource-constrained primary setting of Emin, China, between 2014 and 2016, to improve hypertension management and reduce hypertension-related hospitalization and mortality. Primary-care providers were trained on treatment algorithm and physicians for specialized management. Public education was delivered by various ways including door-to-door screening. Program effectiveness was evaluated using screening data by comparing hypertension awareness, treatment, and control rates and by comparing hypertension-related hospitalization and total cardiovascular disease (CVD) and stroke mortality at each phase. As results, 313 primary-health providers were trained to use the algorithm and 3 physicians attended specialist training. 1/3 of locals (49490 of 133376) were screened. Compared to the early phase, hypertension awareness improved by 9.3% (58% vs. 64%), treatment by 11.4% (39% vs. 44%), and control rates by 33% (10% vs. 15%). The proportion of case/all-cause hospitalization was reduced by 35% (4.02% vs. 2.60%) for CVD and by 17% (3.72% vs. 3.10%) for stroke. The proportion of stroke/all-cause death was reduced by 46% (21.9% in 2011-2013 vs. 15.0% in 2014-2016). At the control area, the proportion of case/all-cause mortality showed no reduction. In conclusion, government-expert joint intervention with introducing treatment algorithm may improve hypertension control and decrease related hospitalization and stroke mortality in underresourced settings.
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Affiliation(s)
- Mulalibieke Heizhati
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
| | - Delian Zhang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
| | - Suofeiya Abulikemu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
| | - Guijuan Chang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
| | - Jing Hong
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
| | - Nuerguli Maimaiti
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
| | - Junli Hu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
| | - Lei Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
| | - Gulinuer Duiyimuhan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research China, No. 91 Tianchi Road, Urumqi 830001, Xinjiang, China
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Mohanty SK, Pedgaonkar SP, Upadhyay AK, Kämpfen F, Shekhar P, Mishra RS, Maurer J, O’Donnell O. Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study. PLoS Med 2021; 18:e1003740. [PMID: 34428221 PMCID: PMC8425529 DOI: 10.1371/journal.pmed.1003740] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/08/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lack of nationwide evidence on awareness, treatment, and control (ATC) of hypertension among older adults in India impeded targeted management of this condition. We aimed to estimate rates of hypertension ATC in the older population and to assess differences in these rates across sociodemographic groups and states in India. METHODS AND FINDINGS We used a nationally representative survey of individuals aged 45 years and over and their spouses in all Indian states (except one) in 2017 to 2018. We identified hypertension by blood pressure (BP) measurement ≥140/90 mm Hg or self-reported diagnosis if also taking medication or observing salt/diet restriction to control BP. We distinguished those who (i) reported diagnosis ("aware"); (ii) reported taking medication or being under salt/diet restriction to control BP ("treated"); and (iii) had measured systolic BP <140 and diastolic BP <90 ("controlled"). We estimated age-sex adjusted hypertension prevalence and rates of ATC by consumption quintile, education, age, sex, urban-rural, caste, religion, marital status, living arrangement, employment status, health insurance, and state. We used concentration indices to measure socioeconomic inequalities and multivariable logistic regression to estimate fully adjusted differences in these outcomes. Study limitations included reliance on BP measurement on a single occasion, missing measurements of BP for some participants, and lack of data on nonadherence to medication. The 64,427 participants in the analysis sample had a median age of 57 years: 58% were female, and 70% were rural dwellers. We estimated hypertension prevalence to be 41.9% (95% CI 41.0 to 42.9). Among those with hypertension, we estimated that 54.4% (95% CI 53.1 to 55.7), 50.8% (95% CI 49.5 to 52.0), and 28.8% (95% CI 27.4 to 30.1) were aware, treated, and controlled, respectively. Across states, adjusted rates of ATC ranged from 27.5% (95% CI 22.2 to 32.8) to 75.9% (95% CI 70.8 to 81.1), from 23.8% (95% CI 17.6 to 30.1) to 74.9% (95% CI 69.8 to 79.9), and from 4.6% (95% CI 1.1 to 8.1) to 41.9% (95% CI 36.8 to 46.9), respectively. Age-sex adjusted rates were lower (p < 0.001) in poorer, less educated, and socially disadvantaged groups, as well as for males, rural residents, and the employed. Among individuals with hypertension, the richest fifth were 8.5 percentage points (pp) (95% CI 5.3 to 11.7; p < 0.001), 8.9 pp (95% CI 5.7 to 12.0; p < 0.001), and 7.1 pp (95% CI 4.2 to 10.1; p < 0.001) more likely to be aware, treated, and controlled, respectively, than the poorest fifth. CONCLUSIONS Hypertension prevalence was high, and ATC of the condition were low among older adults in India. Inequalities in these indicators pointed to opportunities to target hypertension management more effectively and equitably on socially disadvantaged groups.
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Affiliation(s)
- Sanjay K. Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
- * E-mail:
| | - Sarang P. Pedgaonkar
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
| | | | - Fabrice Kämpfen
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | | | - Jürgen Maurer
- Institute of Health Economics and Management, Department of Economics, University of Lausanne, Switzerland
| | - Owen O’Donnell
- Erasmus School of Economics & Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Heizhati M, Li N, Shi Q, Yao X, Zhang D, Zhou K, Wang M, Hu J, Duiyimuhan G, Jiang W, Hong J, Sun L. Effects of Simplified Antihypertensive Treatment Algorithm on Hypertension Management and Hypertension-Related Death in Resource-Constricted Primary Care Setting between 1997 and 2017. Int J Hypertens 2021; 2021:9920031. [PMID: 34336267 PMCID: PMC8294957 DOI: 10.1155/2021/9920031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/08/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Hypertension management is poor in primary care settings of developing countries, where 75% of hypertensives are living. Exploring better ways to improve hypertension management and to decrease stroke and CVD death is needed such as introducing treatment algorithm. Therefore, we selected intervention counties from Xinjiang, an underdeveloped region in China, and introduced antihypertensive treatment algorithm, comprising locally available and affordable agents, to primary health providers since 1998. Program effects were evaluated using the data collected in various ways including cross-sectional screenings to population ≥30 years between 1998 and 2015 by comparing treatment and control rates of hypertension, changes in blood pressure (BP) levels and distribution, and proportion of case/total and NCD death for CVD and stroke. Compared to 1998-2000, treatment rate was improved by 2.78 fold (11.2% vs. 32.1%, P < 0.001), and the overall and treated control rate were improved by 53.5 fold (0.2% vs. 10.7%, P < 0.001) and by 16.8 fold (2.0% vs. 33.5%, P < 0.001), respectively, in 2015. Mean SBP and DBP showed a net reduction by 33.7 mmHg (181.3 vs. 147.6 mmHg) and 21.3 mmHg (106.3 vs. 85.0 mmHg), respectively, in 2015, compared to 1998-2000 (P < 0.001), and stage III hypertension was reduced by 75.2% (33.5 vs. 8.3%, P < 0.001). Compared to 1997-1999, stroke/NCD death was reduced by 34.1% in 2015-2017 (31.7 vs. 20.9%, P = 0.006) in the intervention counties whereas by 7.5% in control county. Introduction of treatment algorithm helps improve hypertension management and reduce stroke death in resource-constricted primary settings.
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Affiliation(s)
- Mulalibieke Heizhati
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Nanfang Li
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Qiaoyan Shi
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Xiaoguang Yao
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Delian Zhang
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Keming Zhou
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Menghui Wang
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Junli Hu
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Gulinuer Duiyimuhan
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Wen Jiang
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Jing Hong
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Le Sun
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
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Kirschbaum TK, Theilmann M, Sudharsanan N, Manne-Goehler J, Lemp JM, De Neve JW, Marcus ME, Ebert C, Chen S, Aryal KK, Bahendeka SK, Norov B, Damasceno A, Dorobantu M, Farzadfar F, Fattahi N, Gurung MS, Guwatudde D, Labadarios D, Lunet N, Rayzan E, Saeedi Moghaddam S, Webster J, Davies JI, Atun R, Vollmer S, Bärnighausen T, Jaacks LM, Geldsetzer P. Targeting Hypertension Screening in Low- and Middle-Income Countries: A Cross-Sectional Analysis of 1.2 Million Adults in 56 Countries. J Am Heart Assoc 2021; 10:e021063. [PMID: 34212779 PMCID: PMC8403275 DOI: 10.1161/jaha.121.021063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background As screening programs in low‐ and middle‐income countries (LMICs) often do not have the resources to screen the entire population, there is frequently a need to target such efforts to easily identifiable priority groups. This study aimed to determine (1) how hypertension prevalence in LMICs varies by age, sex, body mass index, and smoking status, and (2) the ability of different combinations of these variables to accurately predict hypertension. Methods and Results We analyzed individual‐level, nationally representative data from 1 170 629 participants in 56 LMICs, of whom 220 636 (18.8%) had hypertension. Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or reporting to be taking blood pressure–lowering medication. The shape of the positive association of hypertension with age and body mass index varied across world regions. We used logistic regression and random forest models to compute the area under the receiver operating characteristic curve in each country for different combinations of age, body mass index, sex, and smoking status. The area under the receiver operating characteristic curve for the model with all 4 predictors ranged from 0.64 to 0.85 between countries, with a country‐level mean of 0.76 across LMICs globally. The mean absolute increase in the area under the receiver operating characteristic curve from the model including only age to the model including all 4 predictors was 0.05. Conclusions Adding body mass index, sex, and smoking status to age led to only a minor increase in the ability to distinguish between adults with and without hypertension compared with using age alone. Hypertension screening programs in LMICs could use age as the primary variable to target their efforts.
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Affiliation(s)
- Tabea K Kirschbaum
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Michaela Theilmann
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases Massachusetts General HospitalHarvard Medical School Boston MA
| | - Julia M Lemp
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Maja E Marcus
- Department of Economics and Centre for Modern Indian Studies University of Goettingen Germany
| | - Cara Ebert
- RWI-Leibniz Institute for Economic Research Berlin Germany
| | - Simiao Chen
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany.,Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Krishna K Aryal
- Monitoring Evaluation and Operational Research Project Abt Associates Kathmandu Nepal
| | | | | | | | - Maria Dorobantu
- Cardiology Department Emergency Hospital of Bucharest Romania
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Nima Fattahi
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Mongal S Gurung
- Health Research and Epidemiology Unit Policy and Planning Division Ministry of Health Thimphu Bhutan
| | - David Guwatudde
- Department of Epidemiology and Biostatistics School of Public Health Makerere University Kampala Uganda
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto Porto Portugal
| | - Elham Rayzan
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Jacqui Webster
- The George Institute for Global HealthUniversity of New South Wales Sydney Australia
| | - Justine I Davies
- Institute of Applied Health Research University of Birmingham United Kingdom.,Centre for Global Surgery Department of Global Health Stellenbosch University Cape Town South Africa.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit Faculty of Health Sciences School of Public Health University of the Witwatersrand Johannesburg South Africa
| | - Rifat Atun
- Department of Global Health and Population Harvard T.H. Chan School of Public Health Boston MA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies University of Goettingen Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany.,Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Lindsay M Jaacks
- Department of Global Health and Population Harvard T.H. Chan School of Public Health Boston MA.,Public Health Foundation of India New Delhi India.,Global Academy of Agriculture and Food Security The University of Edinburgh Midlothian United Kingdom
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany.,Division of Primary Care and Population Health Department of Medicine Stanford University Stanford CA
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Guerrero-Díaz DV, Hernández-Vásquez A, Montoya-Rivera WC, Rojas-Roque C, Chacón Díaz MA, Bendezu-Quispe G. Undiagnosed hypertension in Peru: analysis of associated factors and socioeconomic inequalities, 2019. Heliyon 2021; 7:e07516. [PMID: 34296015 PMCID: PMC8282964 DOI: 10.1016/j.heliyon.2021.e07516] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/13/2021] [Accepted: 07/05/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine the factors associated and measure the socioeconomic inequalities in people with undiagnosed hypertension in Peru. MATERIALS AND METHODS An observational, cross-sectional, analytical study was performed using data from the 2019 Demographic and Family Health Survey (ENDES, acronym in Spanish) database. The dependent variable was the presence of undiagnosed hypertension (mean systolic blood pressure ≥140 mmHg and/or mean diastolic blood pressure ≥90 mmHg in the two blood pressure measurements and with no prior diagnosis of hypertension by a health care professional). Adjusted prevalence ratios were estimated to determine the factors associated with undiagnosed hypertension. The socioeconomic inequality in undiagnosed hypertension was estimated using concentration curves and the Erreygers concentration index. RESULTS 67.2% of 3697 persons with hypertension had not been diagnosed. Non-diagnosis of hypertension was more prevalent in men who were residents of the Coast and in inhabitants residing at more than 3000 m above sea level. Being 50 years of age or older, having health insurance, being obese and having diabetes mellitus were associated with a lower prevalence of undiagnosed hypertension. Inequality of the non-diagnosis of hypertension was found to be concentrated in the poorest population. CONCLUSIONS At least one out of every two adult Peruvians with hypertension have not been diagnosed with this condition. Socioeconomic inequality was found, as well as socio-demographic and health-related factors associated with undiagnosed hypertension. Our findings identify some population subgroups in which interventions for screening and treatment of hypertension should be prioritized in order to reduce both inequalities and complications of hypertension among the most vulnerable.
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Affiliation(s)
| | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | | | | | | | - Guido Bendezu-Quispe
- Universidad Privada Norbert Wiener, Centro de Investigación Epidemiológica en Salud Global, Lima, Peru
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Gityamwi NA, H. Hart K, Engel B. A Cross-Sectional Analysis of Dietary Intake and Nutritional Status of Patients on Haemodialysis Maintenance Therapy in a Country of Sub-Saharan Africa. Int J Nephrol 2021; 2021:1826075. [PMID: 34055412 PMCID: PMC8147542 DOI: 10.1155/2021/1826075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 11/23/2022] Open
Abstract
Malnutrition is common among dialysis patients, but there is insufficient literature on the problem from resource-poor settings of the sub-Saharan region. We conducted a cross-sectional investigation of dietary intake and nutritional status of haemodialysis (HD) patients to inform the current status of this population group in the region. HD patients aged ≥18 years, with dialysis vintage of ≥3 months, at one nephrology unit in Tanzania were assessed for their habitual diet and nutrient intake. Anthropometric measures and biochemistry tests were also performed. The diet was predominantly starchy food based, accompanied by a limited selection of vegetables. Fruits and animal protein were also minimally consumed (1 portion/day each). Fruit consumption was higher in females than males (median (25th, 75th) = 2 (1, 2.3) versus 0.5 (0, 1.7) portions, p = 0.008). More than 70% of participants had suboptimal measures for protein and energy intake, dietary iron, serum albumin, muscle mass, and hand grip strength (HGS). Inadequacies in protein and energy intake and dialysis clearance (URR) increased with the increase in body weight/BMI and other specific components (MAMC and FMI). Consumption of red meats correlated significantly and positively with serum creatinine (r = 0.46, p = 0.01), potassium (r = 0.39, p = 0.03), and HGS (r = 0.43, p = 0.02) and was approaching significance for a correlation with serum iron (r = 0.32, p = 0.07). C-RP correlated negatively with albumin concentration (r = -0.32, p = 0.02), and participants with C-RP within acceptable ranges had significantly higher levels of haemoglobin (p = 0.03, effect size = -0.28). URR correlated negatively with haemoglobin concentration (r = -0.36, p = 0.02). Patients will benefit from improved nutritional services that deliver individually tailored and culturally practical dietary advice to enable them to make informed food choices whilst optimizing disease management.
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Affiliation(s)
- Nyangi A. Gityamwi
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Kathryn H. Hart
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Barbara Engel
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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35
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Boateng GO, Lartey ST, Baiden P, Si L, Biritwum RB, Kowal P, Magnussen CG, Ben Taleb Z, Palmer AJ, Luginaah I. Measuring Hypertension Progression With Transition Probabilities: Estimates From the WHO SAGE Longitudinal Study. Front Public Health 2021; 9:571110. [PMID: 33898368 PMCID: PMC8058215 DOI: 10.3389/fpubh.2021.571110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 03/10/2021] [Indexed: 01/21/2023] Open
Abstract
This paper assessed the transition probabilities between the stages of hypertension severity and the length of time an individual might spend at a particular disease state using the new American College of Cardiology/American Heart Association hypertension blood pressure guidelines. Data for this study were drawn from the Ghana WHO SAGE longitudinal study, with an analytical sample of 1884 across two waves. Using a multistate Markov model, we estimated a seven-year transition probability between normal/elevated blood pressure (systolic ≤ 129 mm Hg & diastolic <80 mm Hg), stage 1 (systolic 130-139 mm Hg & diastolic 80-89 mm Hg), and stage 2 (systolic ≥140mm Hg & diastolic≥90 mm Hg) hypertension and adjusted for the individual effects of anthropometric, lifestyle, and socio-demographic factors. At baseline, 22.5% had stage 1 hypertension and 52.2% had stage 2 hypertension. The estimated seven-year transition probability for the general population was 19.0% (95% CI: 16.4, 21.8) from normal/elevated blood pressure to stage 1 hypertension, 31.6% (95% CI: 27.6, 35.4%) from stage 1 hypertension to stage 2 hypertension, and 48.5% (45.6, 52.1%) for remaining at stage 2. Other factors such as being overweight, obese, female, aged 60+ years, urban residence, low education and high income were associated with an increased probability of remaining at stage 2 hypertension. However, consumption of recommended servings of fruits and vegetables per day was associated with a delay in the onset of stage 1 hypertension and a recovery to normal/elevated blood pressure. This is the first study to show estimated transition probabilities between the stages of hypertension severity across the lifespan in sub-Saharan Africa. The results are important for understanding progression through hypertension severity and can be used in simulating cost-effective models to evaluate policies and the burden of future healthcare.
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Affiliation(s)
- Godfred O. Boateng
- Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, Arlington, TX, United States
| | - Stella T. Lartey
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Lei Si
- The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
| | | | - Paul Kowal
- World Health Organization, Geneva, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, NSW, Australia
| | - Costan G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, Arlington, TX, United States
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, ON, Canada
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Ma T, Fu Q, Mei Q, Tu Z, Zhang L. Extraction optimization and screening of angiotensin-converting enzyme inhibitory peptides from Channa striatus through bioaffinity ultrafiltration coupled with LC-Orbitrap-MS/MS and molecular docking. Food Chem 2021; 354:129589. [PMID: 33773481 DOI: 10.1016/j.foodchem.2021.129589] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 11/25/2022]
Abstract
Channa striatus is high-protein food with many health functions. This study aimed to prepare, screen and identify the angiotensin-converting enzyme inhibition peptides (ACEIPs) from C. striatus hydrolysates by response surface methodology and bioaffinity ultrafiltration coupled with LC-Orbitrap-MS/MS and molecular docking. The optimal conditions for preparing ACEIPs were hydrolysis temperature 55 °C, hydrolysis time 3 h, pH 9, solid-liquid ratio 1:20 g/mL, and enzyme addition 5%, the ACE inhibition and molecular weight distribution of obtained hydrolysate was 54.35% and 8770-160 Da, respectively. Seven novel ACEIPs were screened through the established high-throughput screening approach, among which, EYFR and LPGPGP showed the strongest ACE inhibition with the IC50 value of 179.2 and 186.3 μM, respectively (P > 0.05). Molecular docking revealed that three and ten hydrogen bonds were formed between ACE and LPGPGP and EYFR, respectively, S1 and S2 were the major active pockets, but the major driving forces varied.
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Affiliation(s)
- Tianxin Ma
- National R&D Center for Freshwater Fish Processing, Engineering Research Center of Freshwater Fish High-value Utilization of Jiangxi Province, College of Life Science, Jiangxi Normal University, Nanchang, Jiangxi 330022, China
| | - Qiaoqin Fu
- National R&D Center for Freshwater Fish Processing, Engineering Research Center of Freshwater Fish High-value Utilization of Jiangxi Province, College of Life Science, Jiangxi Normal University, Nanchang, Jiangxi 330022, China
| | - Qianggen Mei
- National R&D Center for Freshwater Fish Processing, Engineering Research Center of Freshwater Fish High-value Utilization of Jiangxi Province, College of Life Science, Jiangxi Normal University, Nanchang, Jiangxi 330022, China
| | - Zongcai Tu
- National R&D Center for Freshwater Fish Processing, Engineering Research Center of Freshwater Fish High-value Utilization of Jiangxi Province, College of Life Science, Jiangxi Normal University, Nanchang, Jiangxi 330022, China; State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi 330047, China.
| | - Lu Zhang
- National R&D Center for Freshwater Fish Processing, Engineering Research Center of Freshwater Fish High-value Utilization of Jiangxi Province, College of Life Science, Jiangxi Normal University, Nanchang, Jiangxi 330022, China.
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Bosu WK, Bosu DK. Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis. PLoS One 2021; 16:e0248137. [PMID: 33667277 PMCID: PMC7935309 DOI: 10.1371/journal.pone.0248137] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension is a major health problem in Ghana, being a leading cause of admissions and deaths in the country. In the context of a changing food and health policy environment, we undertook a systematic review (PROSPERO registration number: CRD42020177174) and a meta-analysis of the prevalence of adult hypertension, and its awareness and control in Ghana. METHODS We searched major databases including PubMed, Embase as well as Google Scholar and online digital collections of public universities of Ghana to locate relevant published and unpublished community-based articles up till April 2020. FINDINGS Eighty-five articles involving 82,045 apparently-healthy subjects aged 15-100 years were analyzed. In individual studies, the prevalence of hypertension, defined in most cases as blood pressure ≥ 140/90 mmHg, ranged from 2.8% to 67.5%. The pooled prevalence from the meta-analysis was 27.0% (95% CI 24.0%-30.0%), being twice as high in the coastal (28%, 95% CI: 24.0%-31.0%) and middle geo-ecological belts (29%, 95% CI: 25.0%-33.0%) as in the northern belt (13%, 95% CI: 7.0%-21.0%). The prevalence was similar by sex, urban-rural residence or peer-review status of the included studies. It did not appear to vary over the study year period 1976-2019. Of the subjects with hypertension, only 35% (95% CI: 29.0%-41.0%) were aware of it, 22% (95% CI: 16.0%-29.0%) were on treatment and 6.0% (95% CI: 3.0%-10.0%) had their blood pressure controlled. Sensitivity analyses corroborated the robust estimates. There was, however, high heterogeneity (I2 = 98.7%) across the studies which was partly explained by prevalent obesity in the subjects. CONCLUSION More than one in four adults in Ghana have hypertension. This high prevalence has persisted for decades and is similar in rural and urban populations. With the low awareness and poor control of hypertension, greater investments in cardiovascular health are required if Ghana is to meet the global target for hypertension.
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Affiliation(s)
- William Kofi Bosu
- Department of Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Burkina Faso
| | - Dary Kojo Bosu
- Department of Paediatrics, St Dominic’s Hospital, Akwatia, Ghana
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Prevalence and Correlates of Hypertension Unawareness among Lebanese Adults: The Need to Target Those “Left Behind”. Int J Hypertens 2021. [DOI: 10.1155/2021/8858194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. Hypertension unawareness is context-specific, and our understanding of factors associated with it has implications on primary healthcare practices locally and contributes to achieving cardiovascular disease (CVD) targets, globally. In this study, we examine the prevalence and correlates of hypertension unawareness among adult Lebanese population. Methods. The study sample included a nationally representative sample of 2214 adults ≥25 years of age from the Noncommunicable Disease (NCD) Risk Factor WHO-STEPS cross-sectional survey conducted in Lebanon. In the first step, hypertension was assessed based on reported morbidity using face-to-face interviews, and in the second step, based on blood pressure (BP) measurement. We defined hypertension prevalence as systolic/diastolic blood pressure ≥140/90 mmHg and/or ongoing treatment for hypertension. Hypertension unawareness was described as lack of prior knowledge of hypertensive status. Those responding negatively to the face-to-face interview question “whether they had ever been told by a health worker that they have hypertension” were labelled as “apparently healthy.” Results. Overall prevalence of hypertension was 30.7%. A total of 369 subjects were unaware of their condition, representing 51.8% of all hypertensives and 15.9% of the apparently healthy. Multivariable analysis controlling for a number of confounders showed that, among apparently healthy participants, insurance coverage and contact with healthcare services were not associated with higher likelihood for hypertension awareness. Among all hypertensives, hypertension unawareness was significantly higher in the young, those with BMI <25 kg/m2 (adjusted OR (aOR): 2.52; 95% CI: 1.35–4.69), no CVD (aOR: 3.30; 95% CI: 1.74–6.29), and participants with no reported family history of hypertension (aOR: 4.87; 95% CI: 2.89–8.22), compared to their counterparts. Conclusion. In Lebanon, unawareness of hypertension occurred in those clinically least perceived to be at risk. These findings are key for optimizing current screening practices and informing NCD prevention efforts in the country and contribute to achieving global targets of the SDGs of “leaving no one behind.”
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Underdiagnosis of Isolated Systolic and Isolated Diastolic Hypertension. Am J Cardiol 2021; 141:56-61. [PMID: 33285092 DOI: 10.1016/j.amjcard.2020.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
Systolic and diastolic hypertension independently predict the risk of adverse cardiovascular events. It remains unclear how systolic pressure, diastolic pressure, and other patient characteristics influence the initial diagnosis of hypertension. Here, we use a cohort of 146,816 adults in a large healthcare system to examine how elevated systolic and/or diastolic blood pressure measurements influence initial diagnosis of hypertension and how other patient characteristics influence the diagnosis. Thirty-four percent of the cohort were diagnosed with hypertension within 1 year. In multivariable logistic regression of the diagnosis of hypertension, controlling for covariates, isolated systolic hypertensive measures (odds ratio [OR] 0.42 [95% confidence interval {CI} 0.41 to 0.43]) and isolated diastolic hypertensive measures (OR 0.32 [95% CI 0.31 to 0.33]) were less likely to lead to hypertension diagnosis when compared with combined hypertensive measures. Higher levels of systolic blood pressure had a greater impact on hypertension diagnosis (OR 1.77 [95% CI 1.75 to 1.79] per Z-score) than did higher levels of diastolic blood pressure (OR 1.34 [95% CI 1.32 to 1.36] per Z-score). Older age, non-white race/ethnicity, and medical comorbidities all predicted the establishment of a diagnosis of hypertension. Isolated systolic and isolated diastolic hypertension are underdiagnosed in clinical practice, and several patient-centered factors also strongly influence whether a diagnosis is made. In conclusion, our findings uncover a care gap that can be closed with increased attention to the independent influence of systolic and diastolic hypertension and the various patient-centered factors that may impact hypertension diagnosis.
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Ameh S. Evaluation of an integrated HIV and hypertension management model in rural south africa: a mixed methods approach. Glob Health Action 2021; 13:1750216. [PMID: 32316885 PMCID: PMC7191904 DOI: 10.1080/16549716.2020.1750216] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: A summary of Soter Ameh's PhD thesis titled, 'An integrated HIV and hypertension management model in rural South Africa: A mixed methods approach' is presented here. In responding to the dual high burden of non-communicable diseases (NCDs) and HIV in South Africa, the national government initiated an integrated chronic disease management (ICDM) model in health facilities as a pilot programme. The aim of the ICDM model is to leverage the successes of the innovative HIV treatment programme for NCDs to improve the quality of care and health outcomes of adult patients.Objectives: The specific objectives of this study were to: (1) determine the quality of care provided in the integrated model in 2013, (2) describe patients' and operational managers' perceptions of quality of care in the integrated model in 2013, and (3) assess effectiveness of the integrated model in controlling CD4 counts (>350 cells/mm3) and blood pressure (<140/90 mmHg) of patients from 2011 to 2013.Methods: A combination of quantitative and qualitative methods was used to assess and describe the quality of care in the model. Effectiveness of the model in controlling patients' blood pressure (BP) and CD4 counts was assessed in selected PHC facilities in the Bushbuckridge municipality in Mpumalanga province, South Africa.Results: The findings showed the suboptimal quality of care in five of the eight priority dimensions of care used as leverage for the NCD programme. The ICDM model had a small but significant effect on BP control for hypertension patients receiving treatment.Conclusions: The HIV programme needs to be more extensively leveraged for hypertension treatment to achieve an optimal BP control in the study area. These findings could have policy relevance for low- and middle-income countries currently undertaking proof of concept studies to demonstrate the feasibility of implementing an integrated chronic disease care model.
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Affiliation(s)
- Soter Ameh
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Gobal Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Paul GK, Rahman MM, Hamiduzzaman M, Farhana Z, Mondal SK, Akter S, Naznin S, Islam MN. Hypertension and its physio-psychosocial risks factors in elderly people: a cross-sectional study in north-eastern region of Bangladesh. J Geriatr Cardiol 2021; 18:75-82. [PMID: 33613661 PMCID: PMC7868910 DOI: 10.11909/j.issn.1671-5411.2021.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
- Gowranga Kumar Paul
- Department of Statistics, Mawlana Bhashani Science and Technology University, Santosh, Tangail-1902, Bangladesh
| | | | - Mohammad Hamiduzzaman
- Flinders University Rural Health SA, College of Medicine & Public Health, Flinders University, South Australia, Australia
| | - Zaki Farhana
- Bangladesh Bank-The Central Bank of Bangladesh, Bangladesh
| | - Somaresh Kumar Mondal
- Department of Statistics, Mawlana Bhashani Science and Technology University, Santosh, Tangail-1902, Bangladesh
| | - Saleha Akter
- Asian University of Bangladesh, Dhaka, Bangladesh
| | - Shayla Naznin
- Department of Statistics, Mawlana Bhashani Science and Technology University, Santosh, Tangail-1902, Bangladesh
| | - Md. Nazrul Islam
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 2021; 18:785-802. [PMID: 34050340 PMCID: PMC8162166 DOI: 10.1038/s41569-021-00559-8] [Citation(s) in RCA: 487] [Impact Index Per Article: 162.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.
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Domènech-Abella J, Mundó J, Miret M, Ayuso-Mateos JL, Sánchez-Niubò A, Abduljabbar AS, Haro JM, Olaya B. From childhood financial hardship to late-life depression: socioeconomic pathways. Aging Ment Health 2021; 25:86-93. [PMID: 31597461 DOI: 10.1080/13607863.2019.1671313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Childhood financial hardship is associated with depression throughout the life course, including older adulthood. However, it is still unclear the extent to which occupation, education level and household income are mediators of this association. We aimed to examine the association between childhood financial hardship and late-life depression, and potential socioeconomic mediators using community-based data. METHODS A nationally representative sample of 3623 non-institutionalized older Spanish adults aged 50+ was used. The associations between childhood financial hardship and depression, socioeconomic mediator variables and confounding variables such as chronic physical conditions, number of close people, and loneliness, were assessed through logistic regression models. Mediation analyses of socioeconomic variables were carried out. RESULTS Older Spanish adults who experienced a poor childhood financial situation were nine times more likely to obtain a lower level of education than those with a good childhood financial situation, and about three times more likely to suffer from depression. Participants' education level mediated about 35-40% of the association between childhood financial hardship and late-life depression whereas we found no significant mediation effect of household income and occupation skill. CONCLUSION Improving access to the educational system during the life course might result in a reduction in the prevalence of depression in the general population of older adults and particularly among individuals with low socioeconomic status.
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Affiliation(s)
- Joan Domènech-Abella
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Department of Sociology, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Mundó
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain
| | - Marta Miret
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Albert Sánchez-Niubò
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain.,Kind Saud University, Riyadh, Saudi Arabia
| | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Dieteren CM, O'Donnell O, Bonfrer I. Prevalence and inequality in persistent undiagnosed, untreated, and uncontrolled hypertension: Evidence from a cohort of older Mexicans. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000114. [PMID: 36962148 PMCID: PMC10021230 DOI: 10.1371/journal.pgph.0000114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/18/2021] [Indexed: 12/21/2022]
Abstract
Hypertension is the leading risk factor for cardiovascular diseases (CVDs) and substantial gaps in diagnosis, treatment and control signal failure to avert premature deaths. Our aim was to estimate the prevalence and assess the socioeconomic distribution of hypertension that remained undiagnosed, untreated, and uncontrolled for at least five years among older Mexicans and to estimate rates of transition from those states to diagnosis, treatment and control. We used data from a cohort of Mexicans aged 50+ in two waves of the WHO Study on Global AGEing and adult health (SAGE) collected in 2009 and 2014. Blood pressure was measured, hypertension diagnosis and treatment self-reported. We estimated prevalence and transition rates over five years and calculated concentration indices to identify socioeconomic inequalities using a wealth index. Using probit models, we identify characteristics of those facing the greatest barriers in receiving hypertension care. More than 60 percent of individuals with full item response (N = 945) were classified as hypertensive. Over one third of those undiagnosed continued to be in that state five years later. More than two fifths of those initially untreated remained so, and over three fifths of those initially uncontrolled failed to achieve continued blood pressure control. While being classified as hypertensive was more concentrated among the rich, missing diagnosis, treatment and control were more prevalent among the poor. Men, singles, rural dwellers, uninsured, and those with overweight were more likely to have persistent undiagnosed, untreated, and uncontrolled hypertension. There is room for improvement in both hypertension diagnosis and treatment in Mexico. Clinical and public health attention is required, even for those who initially had their hypertension controlled. To ensure more equitable hypertension care and effectively prevent premature deaths, increased diagnosis and long-term treatment efforts should especially be directed towards men, singles, uninsured, and those with overweight.
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Affiliation(s)
- C M Dieteren
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - O O'Donnell
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
| | - I Bonfrer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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The impact of glycated hemoglobin on risk of hypertension: a Mendelian randomization study using UK Biobank. J Hypertens 2020; 38:38-44. [PMID: 31386636 DOI: 10.1097/hjh.0000000000002210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Observational studies suggest higher glycated hemoglobin (HbA1c) associated with higher hypertension risk although these associations could be confounded. We examined the relation using a Mendelian randomization design in a large Biobank, the UK Biobank. METHODS We identified 38 single nucleotide polymorphisms (SNPs) strongly and independently related to HbA1c from a large genome wide association study (n = 123 665) and applied them to the UK Biobank (n = 376 644). We used inverse variance weighting (IVW) to assess the relation of HbA1c with risk of hypertension (defined using the American College of Cardiology/American Heart Association 2017 guidelines), and SBP and DBP. Sensitivity analyses included Mendelian randomization-Egger, weighted median, Mendelian randomization pleiotropy residual sum and outlier and exclusion of pleiotropic SNPs. RESULTS HbA1c was not clearly associated with hypertension risk using IVW (odds ratio 1.11, 95% confidence interval 0.76-1.62) in the main analysis. However, Mendelian randomization pleiotropy residual sum and outlier suggested potential horizontal pleiotropy. After excluding potentially invalid SNPs, HbA1c was associated with hypertension risk (IVW odds ratio 1.22 per %, 95% confidence interval 1.01-1.46), with consistent estimates from sensitivity analyses. HbA1c was positively associated with SBP in some, but not all analyses, albeit with directionally consistent estimates. The relation with DBP was unclear. CONCLUSION Our study suggests HbA1c may increase hypertension risk and could be one underlying mechanistic pathway between HbA1c and coronary artery disease risk.
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Sudharsanan N, Chen S, Garber M, Bärnighausen T, Geldsetzer P. The Effect Of Home-Based Hypertension Screening On Blood Pressure Change Over Time In South Africa. Health Aff (Millwood) 2020; 39:124-132. [PMID: 31905068 DOI: 10.1377/hlthaff.2019.00585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There is considerable policy interest in home-based screening campaigns for hypertension in many low- and middle-income countries. However, it is unclear whether such efforts will result in long-term population-level blood pressure improvements without more comprehensive interventions that strengthen the entire hypertension care continuum. Using multiple waves of the South African National Income Dynamics Study and the regression discontinuity design, we evaluated the impact of home-based hypertension screening on two-year change in blood pressure. We found that the home-based screening intervention resulted in important reductions in systolic blood pressure for women and younger men. We did not find evidence of an effect on systolic blood pressure for older men or on diastolic blood pressure for either sex. Our results suggest that home-based hypertension screening may be a promising strategy for reducing high blood pressure in low- and middle-income countries, but additional research and policy efforts are needed to ensure that such strategies have maximum reach and impact.
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Affiliation(s)
- Nikkil Sudharsanan
- Nikkil Sudharsanan ( nikkil. sudharsanan@uni-heidelberg. de ) is lead of the Population Health and Development research group at the Heidelberg Institute of Global Health, Heidelberg University, in Germany
| | - Simiao Chen
- Simiao Chen is head of the research unit, Health and Population Economics, Heidelberg Institute of Global Health, Heidelberg University
| | - Michael Garber
- Michael Garber is a PhD candidate in the Department of Epidemiology, Rollins School of Public Health, Emory University, in Atlanta, Georgia
| | - Till Bärnighausen
- Till Bärnighausen is the Alexander von Humboldt University Professor and director of the Heidelberg Institute of Global Health, Heidelberg University. He is also senior faculty at the Africa Health Research Institute, in Somkhele, South Africa, and an adjunct professor of global health at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Pascal Geldsetzer
- Pascal Geldsetzer is an instructor in the Division of Primary Care and Population Health, Department of Medicine, Stanford University, in California
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Syndemic thinking in large-scale studies: Case studies of disability, hypertension, and diabetes across income groups in India and China. Soc Sci Med 2020; 295:113503. [DOI: 10.1016/j.socscimed.2020.113503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022]
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Prevalence and Risk Factors of Hypertension Among Young Adults in Albania. High Blood Press Cardiovasc Prev 2020; 28:35-48. [PMID: 33113094 DOI: 10.1007/s40292-020-00419-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hypertension is one of the major risk factors for cardiovascular disease and the leading cause of death worldwide. Hypertension was defined as systolic or diastolic blood pressure according to Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (ACC/AHA) rules. AIM The aims of this study was to determine the difference in hypertension prevalence and its risk factors using ACC/AHA rule, and compared its result with JNC7 rule. METHODS Data were collected using two-stage stratified cluster sample of households from 2017/18 Albanian Demographic and Health Survey. Data were analyzed using the descriptive and multivariate logistic regression model. RESULTS Among 15,003 respondents aged 15-49 years, the overall prevalence of hypertension was 63.48% and 16.24%, as per ACC/AHA and JNC7 rules, respectively with an absolute increase of prevalence by 47.3% (CI 46.4-48.2%). According to the ACC/AHA rule, in most of the categories of the respondents, the prevalence of hypertension was 40% higher compared with the JNC7 rule. In multivariate analysis, age, education, richest respondents, number of living children (≥ 3), health insurance and gender had significant (p < 0.05) impact on hypertension for both rules. Besides, the middle and richer wealth index, religion, and physically active work had also significant (p < 0.05) impact on hypertension for JNC7 rules. CONCLUSIONS Newly established ACC/AHA rule led to a significant increase in the proportion of hypertension among the Albanian populations. Similarly, there was a significant difference in the impact of some socioeconomic factors on hypertension as per both rules. Implementation of the prevention and control programs of hypertension are required to increase the awareness of the bad impact of hypertension.
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MiRNAs, lncRNAs, and circular RNAs as mediators in hypertension-related vascular smooth muscle cell dysfunction. Hypertens Res 2020; 44:129-146. [DOI: 10.1038/s41440-020-00553-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/20/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022]
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Muhihi AJ, Anaeli A, Mpembeni RNM, Sunguya BF, Leyna G, Kakoko D, Kessy AT, Mwanyika Sando M, Njelekela M, Urassa DP. Prevalence, Awareness, Treatment, and Control of Hypertension among Young and Middle-Aged Adults: Results from a Community-Based Survey in Rural Tanzania. Int J Hypertens 2020; 2020:9032476. [PMID: 32963821 PMCID: PMC7491449 DOI: 10.1155/2020/9032476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypertension, which is the single most important risk factor for CVDs, is increasing at an alarming rate in most developing countries. This study estimated the prevalence, awareness, treatment, and control of hypertension among young and middle-aged adults in rural Morogoro, Tanzania. Furthermore, it explored factors associated with both prevalence and awareness of hypertension. METHODS A cross-sectional survey was conducted as part of the cluster randomized controlled study of community health workers (CHWs) interventions for reduction of blood pressure in a randomly selected sample of young and middle-aged population in rural Morogoro. Sociodemographics, lifestyle-related factors, history of diagnosis, and treatment for hypertension were collected using a questionnaire adopted from the STEPS survey tool. Blood pressure, height, and weight were measured at home following standard procedures. Descriptive statistics were used to estimate prevalence, awareness, treatment, and control of hypertension. Multiple logistic regression models were used to assess determinants of hypertension and awareness. RESULT The prevalence of hypertension was 29.3% (95% CI: 27.7-31.0). Among individuals with hypertension, only 34.3% were aware of their hypertension status. Only around one-third (35.4%) of those who were aware of their hypertension status were currently on antihypertensive medication. Hypertension control was attained in only 29.9% among those on medications. Older age (p < 0.001), use of raw table salt (p < 0.001), and being overweight/obese (p < 0.001) were associated with hypertension. Predictors of awareness of hypertension status were older age, being a female, higher socioeconomic status, use of raw table salt, a history of diabetes, and overweight/obesity (all p < 0.001). Alcohol drinking was associated with low awareness for hypertension status (p < 0.001). CONCLUSION There is high prevalence of hypertension with low rates of awareness, treatment, and control among young and middle-aged adults in rural Tanzania. Community-level health promotion and screening campaigns for hypertension and other CVD risk factors should be intensified.
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Affiliation(s)
- Alfa J. Muhihi
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
- Africa Academy for Public Health, Plot # 802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
- The Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amani Anaeli
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Rose N. M. Mpembeni
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Bruno F. Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Deodatus Kakoko
- Department of Behavioral Sciences, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Anna Tengia Kessy
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Mary Mwanyika Sando
- Africa Academy for Public Health, Plot # 802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Marina Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
- Deloitte Consulting Limited, Aris House, Plot # 152, Haile Selassie Road, Oysterbay, Dar es Salaam, Tanzania
| | - David P. Urassa
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
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