Association of Alcohol Intake With Hypertension in Type 2 Diabetes Mellitus: The ACCORD Trial

National treatment guidelines poorly achieved among older subjects with type 2 diabetes - call to action!

OBJECTIVE

To assess risk factors and factors associated with nonachievement of the treatment target levels among 75-year-old Finns with type 2 diabetes (T2D).

DESIGN

Cross-sectional study.

SETTING

Outpatient.

SUBJECTS

Seventy-five-year-old participants of the Turku Senior Health Clinic Study (N = 1296) with T2D (n = 247).

MAIN OUTCOME MEASURES

Nonachievement of fasting blood glucose (FBG), low-density lipoprotein (LDL-C), and blood pressure (BP) levels set by the national treatment guidelines.

RESULTS

Nonachievement rates of FBG, BP and LDL-C were 47%, 85%, and 47%, respectively. Non-usage of T2D medication was negatively (adjusted OR 0.38, 95% CI 0.16-0.88) and central obesity positively (1.88, 1.09-3.24) related to nonachievement of FBG target level; alcohol use was positively (3.71, 1.04-13.16) and decreased self-rated health negatively (0.34, 0.12-0.97) related to the nonachievement of BP target level. Nonachievement of LDL-C target level was positively related to poor financial status (3.50, 1.19-10.28) and non-use of lipid-lowering medication (7.70, 4.07-14.56).

CONCLUSIONS

Nonachievement rates of the national treatment goals were high among older T2D patients, and nonachievement was related to use of medication, obesity, alcohol use, poor health, and poor financial status. We emphasize the importance of customized target setting by risk factor levels and active treatment.

Dietary approach for the treatment of arterial hypertension in patients with diabetes mellitus

The association of hypertension and diabetes mellitus is extremely common, increasing the mortality risk of patients, mainly by cardiovascular causes. Regarding the blood pressure (BP) targets to be achieved, most guidelines suggest levels of 130 mmHg for SBP and of 80 mmHg for DBP. Dietary modifications are quite effective, and many studies suggest that decreasing sodium intake and increasing potassium ingestion are both valuable practices for reducing BP. This can be achieved by stimulating the ingestion of lacteous products, vegetables, and nuts. As for the ideal pharmacologic treatment for hypertension, either calcium channel blockers, diuretics or angiotensin-system blockers can be the first class of drug to be used. In this review, we summarize the evaluation of patients with diabetes mellitus and hypertension, and discuss the available therapeutic approaches, with emphasis on evidence-based dietary recommendations.

Prevalence and factors associated with hypertension among peoples living with HIV in East Africa, a systematic review and meta-analysis

BACKGROUND

In recent years, improved access to effective antiretroviral therapy has meant that people living with human immune virus are living longer than before. The burden of non-communicable diseases particularly, hypertension parallels with the increase in age. Although hypertension screening is thought to be an effective indicator of overall health status and paves the way for early interventions in peoples living with human immune virus, the exact prevalence of hypertension in this population remained unknown. We aimed to report the prevalence of hypertension and examine the factors associated with hypertension among people living with human immune virus in East Africa.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Science Direct, Scopus, Cochrane library, and Google Scholar databases for studies published until January 1, 2023. The search period was from January 10/2023, to February 10/ 2023. Random-effect models were used to calculate the pooled prevalence of hypertension. Subgroup analyses were conducted to explore potential heterogeneity. The Funnel plot and Egger's test were used to assess publication bias.

RESULT

A total of 15 studies with 10,916 individuals were included in the present meta-analysis. The pooled prevalence of hypertension among people living with human immune virus was19.75% (95% CI, 16.07%-23.42%)),). The prevalence of hypertension was not differed between studies conducted 2014- 2019 and, studies conducted 2020-2022. The prevalence of hypertension was lowest in Ethiopia (16.13%) and highest in Tanzania (26.76%). Alcohol consumption (Adjusted Odds Ratio (AOR): 3.39, 95% CI: 2.35-4.43), diabetes (AOR: 2.64, 95% CI: 1.89-3.39), longer duration of HIV (AOR: 1.72, 95% CI: 1.15-2.3), male sex (AOR: 1.62, 95% CI: 1.43-1.8), obesity (AOR: 2.89, 95% CI: 1.94-3.84), and older age (AOR: 2.25, 95% CI: 2.0-2.5), were the factors associated with the presence of hypertension in people living with human immune virus.

CONCLUSION

Our study shows that one in five peoples living with human immune virus have hypertension causing symptoms and impairment, therefore requiring treatment. Designing effective health screening and hypertension management intervention programs helps to prevent the occurrence of hypertension and promotes peoples' overall quality of life.

Predicting the risk of hypertension using machine learning algorithms: A cross sectional study in Ethiopia

BACKGROUND AND OBJECTIVES

Hypertension (HTN), a major global health concern, is a leading cause of cardiovascular disease, premature death and disability, worldwide. It is important to develop an automated system to diagnose HTN at an early stage. Therefore, this study devised a machine learning (ML) system for predicting patients with the risk of developing HTN in Ethiopia.

MATERIALS AND METHODS

The HTN data was taken from Ethiopia, which included 612 respondents with 27 factors. We employed Boruta-based feature selection method to identify the important risk factors of HTN. The four well-known models [logistics regression, artificial neural network, random forest, and extreme gradient boosting (XGB)] were developed to predict HTN patients on the training set using the selected risk factors. The performances of the models were evaluated by accuracy, precision, recall, F1-score, and area under the curve (AUC) on the testing set. Additionally, the SHapley Additive exPlanations (SHAP) method is one of the explainable artificial intelligences (XAI) methods, was used to investigate the associated predictive risk factors of HTN.

RESULTS

The overall prevalence of HTN patients is 21.2%. This study showed that XGB-based model was the most appropriate model for predicting patients with the risk of HTN and achieved the accuracy of 88.81%, precision of 89.62%, recall of 97.04%, F1-score of 93.18%, and AUC of 0. 894. The XBG with SHAP analysis reveal that age, weight, fat, income, body mass index, diabetes mulitas, salt, history of HTN, drinking, and smoking were the associated risk factors of developing HTN.

CONCLUSIONS

The proposed framework provides an effective tool for accurately predicting individuals in Ethiopia who are at risk for developing HTN at an early stage and may help with early prevention and individualized treatment.

Association of alcohol consumption with all-cause mortality, new-onset stroke, and coronary heart disease in patients with abnormal glucose metabolism-Findings from a 10-year follow-up of the REACTION study

BACKGROUND

Type 2 diabetes mellitus (T2DM) and diabetic complications threaten human health seriously. Healthy lifestyles can lower the risk of cardiovascular disease (CVD) and long-term complications. However, the relationship between alcohol consumption and CVD mortality is still controversial, and there is a lack of evidence from large-scale longitudinal studies in the Chinese population. Based on the REACTION study (Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal Study), this paper explores the association between alcohol consumption and all-cause mortality, stroke, and coronary heart disease (CHD) in patients with abnormal glucose metabolism during a 10-year follow-up period to provide evidence for lifestyle counselling for these patients.

METHODS

First, baseline data were collected from the REACTION study cohort in Changchun, Jilin Province, China, in 2011-2012. A questionnaire survey was performed among patients with abnormal glucose metabolism aged over 40 years. The frequency of their alcohol intake, the type of alcohol, and the amount of alcohol consumed daily were surveyed. Physical and biochemical examinations were also performed. Then, through the Primary Public Health Service System of Jilin Province, we collected outcomes during the 10-year follow-up up to October 1, 2021, including all-cause mortality, stroke, and CHD. Next, we conducted logistic regression to analyze the relationship between baseline alcohol consumption and 10-year outcomes, and risk ratio (RR) and 95% CI were calculated by adjusting for different clinical indicators. A p value < 0.05 was considered statistically significant.

RESULTS

A total of 4855 patients with T2DM and prediabetes (35.2% men and 64.8% women) were included in the baseline analysis. Outcomes of 3521 patients during the 10-year follow-up were obtained, including 227 deaths, 296 new-onset strokes and 445 new-onset CHD. Occasional drinking (less than once a week) was associated with a reduced 10-year all-cause mortality, with an RR of 0.511 (95% CI [0.266, 0.982]) after adjustment for age, gender, medical history, and lifestyles and an RR of 0.50 (95% CI [0.252, 0.993]) in a fully adjusted model including additional biochemical indicators. In addition, heavy alcohol consumption (≥30 g/day for men and ≥15 g/day for women) was significantly associated with an increased incidence of stroke, with an RR of 2.503 (95% CI [1.138, 5.506]) after the adjustment for age, gender, medical history, lifestyles, and biochemical indicators. No significant association was found between alcohol consumption and new-onset CHD.

CONCLUSIONS

For patients with abnormal glucose metabolism, occasional drinking (less than once a week) reduces the risk of all-cause mortality, while heavy alcohol consumption (≥30 g/day for men and ≥15 g/day for women) significantly increases the risk of new-onset stroke. They should avoid heavy alcohol intake, but light alcohol consumption or occasional drinking is acceptable. Additionally, it is crucial to control blood glucose and blood pressure and keep performing physical activities.

Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study

OBJECTIVES

To evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D).

DESIGN

A population-based observational study using electronic health records data.

SETTING

An integrated healthcare system that implemented system-wide alcohol screening, BI and referral to treatment in adult primary care.

PARTICIPANTS

Adult primary care patients with hypertension (N=72 979) or T2D (N=19 642) who screened positive for unhealthy alcohol use between 2014 and 2017.

MAIN OUTCOME MEASURES

We examined four drinking outcomes: changes in heavy drinking days/past 3 months, drinking days/week, drinks/drinking day and drinks/week from baseline to 12-month follow-up, based on results of alcohol screens conducted in routine care. Health outcome measures were changes in measured systolic and diastolic blood pressure (BP) and BP reduction ≥3 mm Hg at 18-month follow-up. For patients with T2D, we also examined change in glycohaemoglobin (HbA1c) level and 'controlled HbA1c' (HbA1c<8%) at 18-month follow-up.

RESULTS

For patients with hypertension, those who received BI had a modest but significant additional -0.06 reduction in drinks/drinking day (95% CI -0.11 to -0.01) and additional -0.30 reduction in drinks/week (95% CI -0.59 to -0.01) at 12 months, compared with those who did not. Patients with hypertension who received BI also had higher odds for having clinically meaningful reduction of diastolic BP at 18 months (OR 1.05, 95% CI 1.00 to 1.09). Among patients with T2D, no significant associations were found between BI and drinking or health outcomes examined.

CONCLUSIONS

Alcohol BI holds promise for reducing drinking and helping to improve health outcomes among patients with hypertension who screened positive for unhealthy drinking. However, similar associations were not observed among patients with T2D. More research is needed to understand the heterogeneity across diverse subpopulations and to study BI's long-term public health impact.

Sociodemographic and behavioral factors associated with controlled hypertension after 9 years of observation of a PURE Poland cohort study

Introduction

Despite some improvement in awareness and treatment of hypertension, blood pressure control is still below expectations in Poland. The aim of the study was to analyze the secular trend of hypertension prevalence in the PURE Poland cohort study over 9 years of observation and to analyze factors associated with controlled HT.

Methods

The study group consisted of 1,598 participants enrolled in a Prospective Urban and Rural Epidemiological Study (PURE), who participated both in baseline (2007-2010) and 9-year follow-up (2016-2019). Hypertension was ascertained on the basis of (1) self-reported hypertension previously diagnosed by the physician, (2) self-reported anti-hypertensive medication, and/or (3) an average of two blood pressure measurements ≥140 mmHg systolic BP and/or ≥90 mmHg diastolic BP.

Results

The prevalence of hypertension increased from 69.4% at baseline to 85.9% at 9-year follow-up. The chance of HT was 8.6-fold higher in the oldest vs. the youngest age group [OR 8.55; CI 4.47-16.1]. Male sex increased the chance for hypertension over 3-fold [OR 3.23; CI 2.26-4.73]. Obesity, according to BMI, increased the chance of HT 8-fold [OR 8.01; CI 5.20-12.8] in comparison with normal body weight. Male sex decreased the chance of controlled HT after 9 years [OR 0.68; CI 0.50-0.92]. There was no statistically significant association between controlled HT and age or place of residence. Higher and secondary education increased the chance of controlled HT over 2-fold in comparison with primary education [OR 2.35; CI 1.27-4.34, OR 2.34; CI 1.33-4.11]. Obesity significantly decreased the chance of controlled HT after 9 years in comparison with normal body weight [OR 0.54; CI 0.35-0.83].

Conclusion

Factors significantly increasing the chance for controlled hypertension after 9 years were female sex, secondary and tertiary education, normal body weight, and avoiding alcohol drinking. Changes in lifestyle, with special emphasis on maintaining normal body weight, should be the basis of prevention and control of HT.

Prevalence of hypertension among individuals with diabetes and its determinants: Evidences from the National Family Health Survey 2015-16, India

BACKGROUND

The incidence of Diabetes mellitus (DM) has escalated in recent decades, and the risk of diabetes-related mortality has increased dramatically due to the co-existence of hypertension (HTN). DM and HTN, having similar aetiology and disease mechanism, are influenced by lifestyle factors and greatly contribute to critical health complications.

AIM

The present study attempted to explore the co-existence of DM-HTN and the potential determinants considering rapid upsurge of both the diseases.

SUBJECTS AND METHODS

National Family Health Survey data were used, which included 7092 adult diabetic individuals, to find out the prevalence rate of HTN in diabetic persons in India. Appropriate statistical analyses were performed to accomplish the study objectives.

RESULTS

Prevalence rate of HTN in diabetic individuals was approximately 37%. Higher BMI was associated with DM-HTN co-existence. In males, increased age, higher BMI, alcohol consumption, poorest wealth index, and non-smoking (tobacco) were the significant determinants of the co-existence of DM-HTN, while in females, they were increased age, higher BMI, and geographical region.

CONCLUSION

This study unveiled the significance of healthy lifestyle maintenance and equitable health care services to prevent HTN among the diabetics, along with promotion of the awareness and management of DM and HTN through appropriate pharmacological treatments.

Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association

Cardiovascular disease remains the leading cause of death in patients with diabetes. Cardiovascular disease in diabetes is multifactorial, and control of the cardiovascular risk factors leads to substantial reductions in cardiovascular events. The 2015 American Heart Association and American Diabetes Association scientific statement, "Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence," highlighted the importance of modifying various risk factors responsible for cardiovascular disease in diabetes. At the time, there was limited evidence to suggest that glucose-lowering medications reduce the risk of cardiovascular events. At present, several large randomized controlled trials with newer antihyperglycemic agents have been completed, demonstrating cardiovascular safety and reduction in cardiovascular outcomes, including cardiovascular death, myocardial infarction, stroke, and heart failure. This AHA scientific statement update focuses on (1) the evidence and clinical utility of newer antihyperglycemic agents in improving glycemic control and reducing cardiovascular events in diabetes; (2) the impact of blood pressure control on cardiovascular events in diabetes; and (3) the role of newer lipid-lowering therapies in comprehensive cardiovascular risk management in adults with diabetes. This scientific statement addresses the continued importance of lifestyle interventions, pharmacological therapy, and surgical interventions to curb the epidemic of obesity and metabolic syndrome, important precursors of prediabetes, diabetes, and comorbid cardiovascular disease. Last, this scientific statement explores the critical importance of the social determinants of health and health equity in the continuum of care in diabetes and cardiovascular disease.

Consumption of Alcoholic Beverages Associated With Physical Health Status in Adults: Secondary Analysis of the Health Information National Trends Survey Data

INTRODUCTION

Alcohol consumption constitutes one of the main modifiable risk factors that contribute to the increase in the global burden of non-communicable diseases (NCDs). The objective of this study was to determine the effects of the consumption of alcoholic beverages on the state of physical health and its equivalence according to gender.

METHODS

Cross-sectional data from the Health Information National Trends Survey (HINTS) of the National Cancer Institute (NCI) (n = 3865), collected during 2020 were used. Structural equation modeling was applied to assess the fit of the model, which included the prediction of measures of alcohol consumption in physical health and the equivalence of measurements of the proposed structural model in men and women.

RESULTS

The proposed structural model reported adequate goodness-of-fit indices (SBχ²/gl = 3.817, CFI = 0.984, TLI = 0.968, RMSEA [90% CI] = 0.027 [0.016-0.039]; SRMR = 0.016). Frequent alcohol consumption had a negative effect on physical health (b = -0.13, P < .01). Similarly, occasional alcohol consumption negatively predicted elevated BMI and chronic conditions such as, diabetes, hypertension, CVD, and cancer (b = -0.09, P < .01). In addition, drinking patterns of alcoholic beverages affect physical health in equal ways for men and women.

CONCLUSION

The findings highlight that frequent and occasional alcohol consumption significantly affected physical health in a negative way. Future interventions could address ways to encourage the adoption of a healthy lifestyle to reduce the risks of chronic conditions derived from excessive alcohol consumption.

Alcohol Consumption and Systemic Hypertension (from the Third National Health and Nutrition Examination Survey)

Epidemiological studies have established the association between excessive alcohol consumption and systemic hypertension (SH). However, there are conflicting reports of the association of low to moderate alcohol consumption with SH. The objective of the study was to examine the associations of alcohol consumption and blood pressure categories using the 2017 American College of Cardiology/American Heart Association high blood pressure guidelines. This analysis included 17,059 participants from the Third National Health and Nutrition Examination Survey. Alcohol consumption was ascertained by way of a questionnaire. Blood pressure (mm Hg) was measured during the in-home interview and the participant's visit to the mobile examination center. We used multivariable logistic regression models to examine cross-sectional associations of alcohol consumption and blood pressure categories based on new American College of Cardiology/American Heart Association High Blood Pressure guidelines. Models were adjusted for age, gender, income, and cardiovascular risk factors. Compared with never drinkers, moderate drinkers (7 to 13 drinks/week) had increased odds of prevalent stage 1 and stage 2 SH (odds ratio [95% confidence interval] 1.51 [1.22 to 1.87] and 1.55 [1.20 to 2.00]). Similarly, there were significantly higher odds of prevalent stage 1 and stage 2 SH among heavy drinkers (≥14 drinks/week) (odds ratio [95% confidence interval] 1.65 [1.33 to 2.05] and 2.46 [1.93 to 3.14]). We did not find any association between alcohol consumption and elevated blood pressure category. Response bias must be considered because alcohol consumption was self-reported. Our study indicates the need for further research to understand the potential mechanisms by which alcohol consumption increases the risk of SH. In conclusion, this analysis from a population-based survey showed an association between moderate and heavy alcohol consumption and a higher prevalence of SH.

Demographics and clinical characteristics of alcohol-related admissions in a tertiary care hospital in Qatar: Does age matter?

BACKGROUND

Alcohol consumption is a major cause of acute and chronic health conditions associated with comorbidities and traumatic injuries, despite its partial prohibition in some countries. Moreover, alcohol-related hospital admissions increase the burden on the healthcare system. More than 80% of the population in Qatar comprises expatriates. This study aimed to analyze the demographics and clinical characteristics of subjects with alcohol-related emergency department (ED) visits/hospitalization with respect to different age groups in a single tertiary hospital in Qatar.

METHODS

It is a retrospective observational study of adult patients who visited the ED at Hamad General Hospital between January 2013 and March 2015 and were screened positive for alcohol use. Collected data included sociodemographic characteristics, blood alcohol concentration (BAC), pattern of admission, previous medical history, laboratory investigations, treatment, hospital course, and mortality. Data were compared with respect to the distribution of age groups such as < 25, 25-34, 35-44, 45-54, and >55 years.

RESULTS

In total, 1506 consecutively admitted patients screened positive for alcohol use were included in the study; the majority of them were males (95.6%), non-Qatari nationals (71.1%), and aged 35-44 years (30.9%). The age groups 35-44 years and 45-54 years showed the highest median BAC ([0.24 interquartile range (IQR: 0.14-0.33)] and [0.24 (IQR: 0.13-0.33)], respectively) as compared to the other age groups (P = 0.001). The pattern of hospital admission, sociodemographic status, presence of comorbidities, laboratory investigations, and mortality showed specific age-related distribution. Particularly, young adults were more likely to have a previous ED visit due to trauma, whereas older patients' previous hospital admissions were mostly related to various underlying comorbidities.

CONCLUSION

This study highlighted the patterns of age and clinico-epidemiological status of patients with alcohol-attributable hospital admissions. Our study showed that alcohol consumption was higher among the working-age group. Further studies are needed to investigate changes in the alcohol consumption patterns that may help plan for allocation of health resources and prevention of alcohol-related problems.

Consensus and Controversy in the Debate over the Biphasic Impact of Alcohol Consumption on the Cardiovascular System

In the past few decades, research has focused on the importance of addressing modifiable risk factors as a means of lowering the risk of cardiovascular disease (CVD), which represents the worldwide leading cause of death. For quite a long time, it has been considered that ethanol intake has a biphasic impact on the cardiovascular system, mainly depending on the drinking pattern, amount of consumption, and type of alcoholic beverage. Multiple case-control studies and meta-analyses reported the existence of a "U-type" or "J-shaped" relationship between alcohol and CVD, as well as mortality, indicating that low to moderate alcohol consumption decreases the number of adverse cardiovascular events and deaths compared to abstinence, while excessive alcohol use has unquestionably deleterious effects on the circulatory system. However, beginning in the early 2000s, the cardioprotective effects of low doses of alcohol were abnegated by the results of large epidemiological studies. Therefore, this narrative review aims to reiterate the association of alcohol use with cardiac arrhythmias, dilated cardiomyopathy, arterial hypertension, atherosclerotic vascular disease, and type 2 diabetes mellitus, highlighting literature disagreements over the risk and benefits of low to moderate drinking on the cardiovascular system.

Association of Alcohol Intake With Hypertension in Type 2 Diabetes Mellitus: The ACCORD Trial

Background Heavy alcohol consumption has a well-established association with hypertension. However, doubt persists whether moderate alcohol consumption has a similar link. This relationship is not well-studied in patients with diabetes mellitus. We aimed to describe the association of alcohol consumption with prevalent hypertension in participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial. Methods and Results Alcohol consumption was categorized as none, light (1-7 drinks/week), moderate (8-14 drinks/week), and heavy (≥15 drinks/week). Blood pressure was categorized using American College of Cardiology/American Heart Association guidelines as normal, elevated blood pressure, stage 1 hypertension, and stage 2 hypertension. Multivariable logistic regression was used to explore the association between alcohol consumption and prevalent hypertension. A total of 10 200 eligible participants were analyzed. Light alcohol consumption was not associated with elevated blood pressure or any stage hypertension. Moderate alcohol consumption was associated with elevated blood pressure, stage 1, and stage 2 hypertension (odds ratio [OR], 1.79; 95% CI, 1.04-3.11, P=0.03; OR, 1.66; 95% CI, 1.05-2.60, P=0.03; and OR, 1.62; 95% CI, 1.03-2.54, P=0.03, respectively). Heavy alcohol consumption was associated with elevated blood pressure, stage 1, and stage 2 hypertension (OR, 1.91; 95% CI, 1.17-3.12, P=0.01; OR, 2.49; 95% CI, 1.03-6.17, P=0.03; and OR, 3.04; 95% CI, 1.28-7.22, P=0.01, respectively). Conclusions Despite prior research, our findings show moderate alcohol consumption is associated with hypertension in patients with type 2 diabetes mellitus and elevated cardiovascular risk. We also note a dose-risk relationship with the amount of alcohol consumed and the degree of hypertension.