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Cífková R, Strilchuk L. Sex differences in hypertension. Do we need a sex-specific guideline? Front Cardiovasc Med 2022; 9:960336. [PMID: 36082119 PMCID: PMC9445242 DOI: 10.3389/fcvm.2022.960336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/03/2022] [Indexed: 01/02/2023] Open
Abstract
Hypertension is the most prevalent cardiovascular disorder and the leading cause of death worldwide in both sexes. The prevalence of hypertension is lower in premenopausal women than in men of the same age, but sharply increases after the menopause, resulting in higher rates in women aged 65 and older. Awareness, treatment, and control of hypertension are better in women. A sex-pooled analysis from 4 community-based cohort studies found increasing cardiovascular risk beginning at lower systolic blood pressure thresholds for women than men. Hormonal changes after the menopause play a substantial role in the pathophysiology of hypertension in postmenopausal women. Female-specific causes of hypertension such as the use of contraceptive agents and assisted reproductive technologies have been identified. Hypertensive disorders in pregnancy are associated with increased risk of maternal, fetal, and neonatal morbidity and mortality, as well as with a greater risk of developing cardiovascular disease later in life. Hypertension-mediated organ damage was found to be more prevalent in women, thus increasing the cardiovascular risk. Sex differences in pharmacokinetics have been observed, but their clinical implications are still a matter of debate. There are currently no sufficient data to support sex-based differences in the efficacy of antihypertensive treatment. Adverse drug reactions are more frequently reported in women. Women are still underrepresented in large clinical trials in hypertension, and not all of them report sex-specific results. Therefore, it is of utmost importance to oblige scientists to include women in clinical trials and to consider sex as a biological variable.
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Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital, Prague, Czechia
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
- *Correspondence: Renata Cífková
| | - Larysa Strilchuk
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital, Prague, Czechia
- Department of Therapy No 1, Medical Diagnostics, Hematology and Transfusiology, Lviv Danylo Halytsky National Medical University, Lviv, Ukraine
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McAlister FA, Mian R, Oldgren J, Wallentin L, Ezekowitz M, Yusuf S, Connolly SJ, Healey JS. Hypertension prevalence but not control varies across the spectrum of risk in patients with atrial fibrillation: A RE-LY atrial fibrillation registry sub-study. PLoS One 2020; 15:e0226259. [PMID: 31940361 PMCID: PMC6961825 DOI: 10.1371/journal.pone.0226259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although hypertension is the most common risk factor for atrial fibrillation (AF), whether blood pressure (BP) control varies across the spectrum of stroke risk in patients with AF or by adequacy of their thromboprophylaxis management is unclear. METHODS We examined data from the RE-LY AF registry conducted at 164 emergency departments (EDs) in 47 countries between December 2007 and October 2011. RESULTS Of the 15,400 patients in the registry, we analyzed the 9929 (mean age 67.5 years, 51.9% men) with a prior history of AF and complete BP data. While 6508 (66.5%) AF patients had hypertension, the prevalence varied widely depending on comorbidity profiles: from 45.4% in those without other cardiovascular risk factors to 82.5% in those with AF and diabetes. Although 93.9% of AF patients with hypertension were on at least one antihypertensive agent, fewer than half had BP levels ≤ 140/90 with no difference across risk profiles: 45.9% of those with NVAF and CHADS2 scores of 1 and 45.6% of those with NVAF and CHADS2 scores of 2 or more (46.9% and 45.3% for CHA2DS2-VASc scores of 1 versus 2 or more). BP control rates were not significantly better in those NVAF patients receiving guideline concordant thromboprophylaxis management (47.2%, aOR 1.03, 95%CI 0.89-1.20) than in those not receiving guideline-concordant antithrombotic therapy (45.3%). CONCLUSIONS Hypertension was common in patients with AF but BP control rates were sub-optimal and varied little across the spectrum of stroke risk or by adequacy of thromboprophylaxis. This highlights the need for an increased focus on total atherosclerotic risk rather than just thromboprophylaxis management in AF patients.
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Affiliation(s)
- Finlay A. McAlister
- Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- * E-mail:
| | - Rajibul Mian
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Jonas Oldgren
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Wallentin
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Michael Ezekowitz
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Stuart J. Connolly
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Canada
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Frequency of blood pressure and estimated glomerular filtration rate monitoring in patients affected by hypertension: a retrospective study with 176 565 patients in Germany. Blood Press Monit 2018; 23:85-90. [PMID: 29351104 DOI: 10.1097/mbp.0000000000000311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the frequency of blood pressure (BP) and estimated glomerular filtration rate (eGFR) monitoring in hypertension patients followed in primary care practices in Germany. PATIENTS AND METHODS This study included patients who had received at least two hypertension diagnoses (ICD-10: I10) in 2016. The primary outcome of this study was the frequency of BP and eGFR monitoring in patients with hypertension in the year 2016. The impact of the different demographic and clinical variables on the likelihood of receiving at least two BP and at least one eGFR tests was analyzed using multivariate logistic regression models. These two cutoff values were selected on the basis of the recommendations of the European Society of Hypertension and the European Society of Cardiology. RESULTS This study included 176 565 patients, 53.0% of whom were women. The mean age was 68.2 years (SD=13.3 years). The mean number of BP tests was 1.9 (SD=3.1), whereas the mean number of eGFR tests was 0.2 (SD=0.8) in 2016. Only 33.7 and 9.1% of the population received at least two BP tests and one eGFR test, respectively. Older age (>60 years), comorbidities (particularly diabetes, hyperlipidemia, and renal insufficiency), and the number of antihypertensive treatments were associated with higher odds of receiving at least two BP and at least one eGFR tests, whereas the duration of hypertension was associated negatively with these odds. CONCLUSION The frequency of BP and eGFR monitoring was low in Germany in 2016. Several demographic and clinical variables had a significant impact on this frequency.
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Wu D, Mansoor G, Kempf C. Clinical attributes, treatment, and control in hypertension (CATCH)-a French and Italian longitudinal patient database study. Clin Hypertens 2016; 21:18. [PMID: 26893928 PMCID: PMC4750805 DOI: 10.1186/s40885-015-0029-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 07/10/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Hypertension, a risk factor for cardiovascular disease (CVD), is frequently associated with other CVD risk factors. Despite recent improvement in blood pressure (BP) control in Europe, a substantial proportion of patients fail to achieve BP targets. Methods This retrospective cohort study used longitudinal patient databases (LPDs) in France and Italy to examine CVD risk profiles, treatment patterns, and BP goal attainment in hypertensive patients treated in real-world clinical practice between 2007 and 2008. Overall, 147,964 and 140,189 eligible patients from LPDs in France and Italy, respectively, were prescribed an antihypertensive medication in 2007. Results Among patients with hypertension with other risk factors (France 88 %, Italy 83 %), the most prevalent risk factors were being elderly (France 66.9 %, Italy 70. 9 %), followed by hypertension combined with dyslipidemia (France 36.7 %, Italy 23.9 %) and isolated systolic hypertension (France 32.5 %, Italy 24.2 %). The odds ratios for target BP attainment were significantly (p < 0.001) higher in patients with hypertension without other risk factors vs patients with hypertension with other risk factors (1.41 [95 % confidence interval 1.35, 1.48] in France; 1.38 [1.31, 1.46] in Italy). The odds of BP control were significantly lower for patients with vs patients without an associated CVD risk factor (range 0.54 to 1.10 France; 0.59 to 1.17 Italy). Discussion This study demonstrates that the majority of treated hypertensive patients in France and Italy have at least one additional CVD risk factor. Despite treatment with antihypertensive medications, blood pressure attainment was substantially less optimal in patients with an associated CVD risk factor compared to patients without an associated CVD risk factor. Electronic supplementary material The online version of this article (doi:10.1186/s40885-015-0029-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Wu
- Merck &Co., Inc., Kenilworth, NJ USA ; Global Health Outcomes, Merck & Co., Inc., 600 Corporate Drive, CRB-205, Cokesbury, NJ 08833 USA
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Prevalence of Obesity and Its Influence on Achievement of Cardiometabolic Therapeutic Goals in Chinese Type 2 Diabetes Patients: An Analysis of the Nationwide, Cross-Sectional 3B Study. PLoS One 2016; 11:e0144179. [PMID: 26726883 PMCID: PMC4699817 DOI: 10.1371/journal.pone.0144179] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/13/2015] [Indexed: 02/05/2023] Open
Abstract
Background There are few data on the prevalence of obesity and its influence on achieving blood glucose, blood pressure, and blood lipid (3B) goals in Chinese type 2 diabetes outpatients. Methods Patient demographic data, anthropometric measurements, medications, and blood glucose and lipid profiles of 24,512 type 2 diabetes patients from a large, geographically diverse study (CCMR-3B) were analyzed. Using cut-points for body mass index (BMI) and waist circumference (WC) recommended by the Working Group on Obesity in China, overweight and obesity were defined as BMIs of 24–27.9kg/m2 and ≥28.0kg/m2. Central obesity was defined as a waist circumference ≥80cm in women and ≥85cm in men. The 3B therapeutic goals were HbA1c<7.0%, BP<140/90mmHg and LDL-C<2.6mmol/L. Results Overall, 43.0% of type 2 diabetes patients were overweight and 16.7% were obese; 13.3% of overweight and and10.1% of obese patients achieved all the 3B target goals. Overweight or obese patients were less likely to achieve 3B goals than those with normal BMIs. More than a half the overweight or obese patients (69.6%) were centrally obese. Patients with abdominal obesity were less likely to achieve cardiometabolic targets than those without abdominal obesity. In multivariate logistic regression analysis, female, higher BMI and waist circumference, smoking, drinking, sedentary lifestyle, and longer diabetes duration were significantly correlated with failure to achieve 3B control goals. Conclusions Obesity is highly prevalent and associated with poor 3B control in Chinese type 2 diabetes patients. In clinical practice, more attention and resources should focus on weight loss for such patients.
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Nag T, Ghosh A. Cardiovascular disease risk factor clustering among rural adult population in West Bengal, India. Obes Res Clin Pract 2015; 10:124-32. [PMID: 26008793 DOI: 10.1016/j.orcp.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/29/2015] [Accepted: 05/01/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to find out the prevalence of cardiovascular disease (CVD) risk factor clustering in a rural adult population of West Bengal, India. METHODS This cross-sectional study was carried out among 1007 participants (645 males and 362 females) aged ≥20 years in a rural community. All participants were grouped: Group I (20-39 years); Group II (40-59 years); Group III (≥60 years). Anthropometric measures were collected using standard techniques. Metabolic profiles and blood pressure were also measured. RESULTS Mean of minimum waist circumference (MWC), waist-hip ratio (WHR), trunk-extremity ratio (TER), fat free mass (FFM), basal metabolic rate (BMR), intra-abdominal visceral fat (IVF) and arm muscle area (AMA) was found to be higher among males in comparison to females, whereas, the mean of body mass index (BMI), maximum hip circumference (MHC), waist-height ratio (WHtR), sum of four skinfolds (∑SF4), percentage of body fat (%BF), fat mass (FM), insulin, HOMA-IR and arm fat area (AFA) was higher in females. 37% of individuals (males 25% and females 49%) with high triglyceride (TG) also had low high density lipoprotein (HDL), whereas, 25% individuals (males 25% and females 24%) with overweight also had high fasting blood glucose (FBG). The prevalence of high systolic blood pressure (SBP) among individuals having high %BF was higher in the age groups of 40-59 years for both sexes. CONCLUSION The study showed that prevalence of CVD risk factor clustering is high in the study population and warranted early intervention to safeguard the cardiovascular health of the nation.
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Affiliation(s)
- Tanmay Nag
- Biomedical Research Laboratory, Department of Anthropology, Visva Bharati University, Santiniketan, West Bengal, India
| | - Arnab Ghosh
- Biomedical Research Laboratory, Department of Anthropology, Visva Bharati University, Santiniketan, West Bengal, India.
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Tziomalos K, Giampatzis V, Baltatzi M, Efthymiou E, Psianou K, Papastergiou N, Magkou D, Bougatsa V, Savopoulos C, Hatzitolios AI. Sex-specific differences in cardiovascular risk factors and blood pressure control in hypertensive patients. J Clin Hypertens (Greenwich) 2014; 16:309-12. [PMID: 24621371 PMCID: PMC8031745 DOI: 10.1111/jch.12289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/06/2014] [Accepted: 01/16/2014] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease (CVD) and cardiovascular risk factors are frequently undertreated in women. However, it is unclear whether the prevalence of additional cardiovascular risk factors and the total cardiovascular risk differ between hypertensive men and women. There are also limited data regarding rates of blood pressure control in the two sexes outside the United States. The authors aimed to compare the cardiovascular risk profile between sexes. A total of 1810 hypertensive patients (40.4% men, age 56.5±13.5 years) attending the hypertension outpatient clinic of our department were studied. Men were more frequently smokers than women and were more heavy smokers than the latter. Serum high-density lipoprotein cholesterol levels were lower and serum triglyceride levels were higher in men. On the other hand, abdominal obesity and chronic kidney disease were more prevalent in women. The estimated cardiovascular risk was higher in men than in women but the prevalence of established CVD did not differ between the sexes. The percentage of patients with controlled hypertension and the number of antihypertensive medications were similar in men and women. In conclusion, hypertensive men have more adverse cardiovascular risk factor profile and greater estimated cardiovascular risk than women. However, the prevalence of established CVD does not differ between sexes. These findings further reinforce current guidelines that recommend that management of hypertension and of other cardiovascular risk factors should be as aggressive in women as in men in order to prevent cardiovascular events.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
| | - Maria Baltatzi
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
| | - Elias Efthymiou
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
| | - Konstantia Psianou
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
| | - Natalia Papastergiou
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
| | - Dimitra Magkou
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
| | - Vagia Bougatsa
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
| | - Christos Savopoulos
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
| | - Apostolos I. Hatzitolios
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA University HospitalThessalonikiGreece
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McAlister FA, Robitaille C, Gillespie C, Yuan K, Rao DP, Grover S, Dai S, Johansen H, Joffres M, Loustalot F, Campbell N. The impact of cardiovascular risk-factor profiles on blood pressure control rates in adults from Canada and the United States. Can J Cardiol 2013; 29:598-605. [PMID: 23454038 DOI: 10.1016/j.cjca.2012.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It is unclear whether blood pressure control varies across the spectrum of atherosclerotic risk. METHODS We used data from nonpregnant adults who had fasted laboratory samples drawn for the 2007-2009 cycle of the Canadian Health Measures Survey (CHMS) or the 2005-2008 US National Health and Nutrition Examination Survey (NHANES). RESULTS The 1692 CHMS subjects and 3541 NHANES participants were demographically similar (aged a mean of 45 years), although NHANES participants exhibited higher obesity rates (33.8% vs. 22.2%, P < 0.001). Over 80% of CHMS and NHANES subjects with hypertension had at least 1 other cardiovascular risk factor. As the number of atherosclerotic risk factors increased, hypertension prevalence increased, but blood pressure control rates improved (from 48% among hypertensives with no other risk factors in CHMS to 77% among those with 3 or more risk factors, and from 35% to 53% in NHANES). However, the converse was not true: The distribution of Framingham risk scores for those subjects with "controlled hypertension" was nearly identical to the distribution among those adults with uncontrolled hypertension in both CHMS and NHANES and substantially higher than scores in normotensive subjects. CONCLUSIONS Although control of blood pressure was better in patients with multiple atherosclerotic risk factors, hypertensives with controlled blood pressures exhibited risk-factor profiles similar to those of participants with uncontrolled blood pressures. This suggests the need, in educational messaging and therapy decision making, for an increased focus on total atherosclerotic risk rather than just blood pressure control.
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Affiliation(s)
- Finlay A McAlister
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Banegas JR, Graciani A, de la Cruz-Troca JJ, León-Muñoz LM, Guallar-Castillón P, Coca A, Ruilope LM, Rodríguez-Artalejo F. Achievement of cardiometabolic goals in aware hypertensive patients in Spain: a nationwide population-based study. Hypertension 2012; 60:898-905. [PMID: 22949530 DOI: 10.1161/hypertensionaha.112.193078] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008-2010 a total of 11 957 individuals representative of the Spanish population aged≥18 years. Information on cardiometabolic characteristics was collected at the participants' homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index<25 kg/m2, 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c<6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein<115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-developed, free-access healthcare system, achievement of many cardiometabolic goals among hypertensives is poor. Moreover, a serious deficiency in hypertension awareness and in the effectiveness of some lifestyle interventions among aware hypertensives is present. Greater effort is needed in the management of coexisting risk factors and on lifestyle medical advice to improve the cardiometabolic health of hypertensives.
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Affiliation(s)
- José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and Hypertension Unit, Hospital Doce de Octubre, c/Arzobispo Morcillo 2, 28029 Madrid, Spain.
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Raisch DW, Feeney P, Goff DC, Narayan KMV, O'Connor PJ, Zhang P, Hire DG, Sullivan MD. Baseline comparison of three health utility measures and the feeling thermometer among participants in the Action to Control Cardiovascular Risk in Diabetes trial. Cardiovasc Diabetol 2012; 11:35. [PMID: 22515638 PMCID: PMC3395556 DOI: 10.1186/1475-2840-11-35] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 04/19/2012] [Indexed: 11/17/2022] Open
Abstract
Background Health utility (HU) measures are used as overall measures of quality of life and to determine quality adjusted life years (QALYs) in economic analyses. We compared baseline values of three HUs including Short Form 6 Dimensions (SF-6D), and Health Utilities Index, Mark II and Mark III (HUI2 and HUI3) and the feeling thermometer (FT) among type 2 diabetes participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. We assessed relationships between HU and FT values and patient demographics and clinical variables. Methods ACCORD was a randomized clinical trial to test if intensive controls of glucose, blood pressure and lipids can reduce the risk of major cardiovascular disease (CVD) events in type 2 diabetes patients with high risk of CVD. The health-related quality of life (HRQOL) sub-study includes 2,053 randomly selected participants. Interclass correlations (ICCs) and agreement between measures by quartile were used to evaluate relationships between HU’s and the FT. Multivariable regression models specified relationships between patient variables and each HU and the FT. Results The ICCs were 0.245 for FT/SF-6D, 0.313 for HUI3/SF-6D, 0.437 for HUI2/SF-6D, 0.338 for FT/HUI2, 0.337 for FT/HUI3 and 0.751 for HUI2/HUI3 (P < 0.001 for all). Common classification by quartile was found for the majority (62%) of values between HUI2 and HUI3, which was significantly (P < 0.001) higher than between other HUs and the FT: SF-6D/HUI3 = 40.8%, SF-6D/HUI2 = 40.9%, FT/HUI3 = 35.0%, FT/HUI2 = 34.9%, and FT/SF-6D = 31.9%. Common classification was higher between SF-6D/HUI2 and SF-6D/HUI3 (P < 0.001) than between FT/SF-6D, FT/HUI2, and FT/HUI3. The mean difference in HU values per patient ranged from −0.024 ± 0.225 for SF-6D/ HUI3 to −0.124 ± 0.133 for SF-6D/HUI2. Regression models were significant; clinical and demographic variables explained 6.1% (SF-6D) to 7.7% (HUI3) of the variance in HUs. Conclusions The agreements between the different HUs were poor except for the two HUI measures; therefore HU values derived different measures may not be comparable. The FT had low agreement with HUs. The relationships between HUs and demographic and clinical measures demonstrate how severity of diabetes and other clinical and demographic factors are associated with HUs and FT measures. Trial registration ClinicalTrials.gov Identifier: NCT00000620
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Affiliation(s)
- Dennis W Raisch
- University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM 87131, USA.
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Cardiovascular disease risk factor patterns and their implications for intervention strategies in Vietnam. Int J Hypertens 2012; 2012:560397. [PMID: 22500217 PMCID: PMC3303616 DOI: 10.1155/2012/560397] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 10/20/2011] [Accepted: 11/01/2011] [Indexed: 11/18/2022] Open
Abstract
Background. Data on cardiovascular disease risk factors (CVDRFs) in Vietnam are limited. This study explores the prevalence of each CVDRF and how they cluster to evaluate CVDRF burdens and potential prevention strategies.
Methods. A cross-sectional survey in 2009 (2,130 adults) was done to collect data on behavioural CVDRF, anthropometry and blood pressure, lipidaemia profiles, and oral glucose tolerance tests. Four metabolic CVDRFs (hypertension, dyslipidaemia, diabetes, and obesity) and five behavioural CVDRFs (smoking, excessive alcohol intake, unhealthy diet, physical inactivity, and stress) were analysed to identify their prevalence, cluster patterns, and social predictors. Framingham scores were applied to estimate the global 10-year CVD risks and potential benefits of CVD prevention strategies. Results. The age-standardised prevalence of having at least 2/4 metabolic, 2/5 behavioural, or 4/9 major CVDRF was 28%, 27%, 13% in women and 32%, 62%, 34% in men. Within-individual clustering of metabolic factors was more common among older women and in urban areas. High overall CVD risk (≥20% over 10 years) identified 20% of men and 5% of women—especially at higher ages—who had coexisting CVDRF. Conclusion. Multiple CVDRFs were common in Vietnamese adults with different clustering patterns across sex/age groups. Tackling any single risk factor would not be efficient.
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Hypertension control and cardiometabolic risk: a regional perspective. Cardiol Res Pract 2012; 2012:925046. [PMID: 22242212 PMCID: PMC3254169 DOI: 10.1155/2012/925046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 11/01/2011] [Indexed: 12/17/2022] Open
Abstract
Background. We investigated the association between blood pressure control and common cardiometabolic risk factors from a global and regional perspective. Methods. In the present analysis of a large cross-sectional i-SEARCH study, 17.092 outpatients receiving antihypertensive treatment were included in 26 countries. According to clinical guidelines for the management of arterial hypertension, patients were classified based on the level of seated systolic/diastolic blood pressure (SBP/DBP). Uncontrolled hypertension was defined as SBP/DBP ≥140/90 mmHg for non-diabetics, and ≥130/80 mmHg for diabetics. Results. Overall, mean age was 63.1 years, 52.8% were male, and mean BMI was 28.9 kg/m2. Mean SBP/DBP was 148.9/87.0 mmHg, and 76.3% of patients had uncontrolled hypertension. Diabetes was present in 29.1% with mean HbA1c of 6.8%. Mean LDL-cholesterol was 3.2 mmol/L, HDL-cholesterol 1.3 mmol/L, and triglycerides 1.8 mmol/L; 49.0% had hyperlipidemia. Patients with uncontrolled hypertension had a higher BMI (29.4 versus 28.6 kg/m2), LDL-cholesterol (3.4 versus 3.0 mmol/L), triglycerides (1.9 versus 1.7 mmol/L), and HbA1c (6.8 versus 6.7%) than those with controlled blood pressure (P < 0.0001 for all parameters). Conclusions. Among outpatients treated for arterial hypertension, three quarters had uncontrolled blood pressure. Elevated SBP/DBP and uncontrolled hypertension were associated with increasing BMI, LDL-cholesterol, triglycerides, and HbA1c, both globally and regionally.
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Erdine S. Olmesartan/amlodipine: blood pressure lowering and beyond in special populations. Ther Adv Cardiovasc Dis 2012; 6:31-44. [PMID: 22222315 DOI: 10.1177/1753944711432902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Clinical studies and population-based analyses show that in patients with hypertension, the majority cannot control their blood pressure (BP) by treatment with a single antihypertensive agent. Combining agents from different antihypertensive classes with complementary modes of action significantly increases efficacy and is a treatment strategy recommended by European treatment guidelines, particularly in patients at high cardiovascular risk. The combinations of antihypertensive agents recommended by the European guidelines include an angiotensin receptor blocker (ARB) with a calcium channel blocker (CCB). The single-pill combination formulation of the ARB olmesartan medoxomil plus the CCB amlodipine is an effective and well-tolerated treatment that provides greater blood pressure lowering and control than the component monotherapies and favours compliance by not increasing pill burden. Importantly, the efficacy and tolerability of olmesartan plus amlodipine is not affected by age, gender, hypertension severity, diabetes status, race or body mass index. Additional blood pressure lowering effects are observed with stepwise uptitration of olmesartan plus amlodipine with or without hydrochlorothiazide, with more patients achieving blood pressure goals. In addition, olmesartan plus amlodipine has demonstrated effects beyond BP lowering by showing beneficial effects on markers of inflammation, endothelial dysfunction and oxidative stress, as well as metabolic improvements and a reduction in new-onset diabetes incidence in hypertensive patients with metabolic syndrome.
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Affiliation(s)
- Serap Erdine
- Department of Cardiology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey.
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Vyssoulis GP, Karpanou EA, Liakos CI, Kyvelou SMG, Tzamou VE, Michaelides AP, Triantafyllou AI, Spanos PG, Stefanadis CI. Cardiovascular risk factor(s) prevalence in Greek hypertensives. Effect of gender and age. J Hum Hypertens 2011; 26:443-51. [PMID: 21633378 DOI: 10.1038/jhh.2011.55] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to determine cardiovascular (CV) risk factors (RFs) and target organ damage clustering in 21280 Greek hypertensives stratified by gender and age. Glycemic and lipid profile were determined, left ventricular mass index, estimated gromerular filtration rate (eGFR), 10-years CV risk according to Framingham risk score (FRS) and HeartScore (HS) were calculated. Only 10.2% of patients had no concomitant RFs, 53.1% had one (48.8% dyslipidemia, 3.4% smoking, 0.9% diabetes), 32.9% had two (26% dyslipidemia and smoking, 6.6% dyslipidemia and diabetes, 0.3% smoking and diabetes) and 3.7% had all four traditional RFs. Obesity was present in 30%, metabolic syndrome in 38%, low eGFR in 24% and left ventricular hypertrophy in 49%. Mean FRS risk was 35% for males, 24.1% for females whereas in high risk (>20%) were 68.7 and 50.7%, respectively (P<0.0001). Mean HS risk was 8.4% for males, 6.2% for females whereas in high risk (>5%) were 48.6 and 36.2%, respectively (P<0.0001). Age was correlated to pulse pressure, eGFR, left ventricular mass index and CV risk (P<0.0001). Ageing increased the risk difference between genders for total (P=0.001) but not for fatal events (P=nonsignificant). In conclusion, as RFs cluster in hypertensives, CV risk calculation should guide treatment decisions.
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Affiliation(s)
- G P Vyssoulis
- 1st Cardiology Clinic, Hypertension Unit, University of Athens Medical School, Hippokration Hospital, Athens, Greece
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McAlister FA, Wilkins K, Joffres M, Leenen FHH, Fodor G, Gee M, Tremblay MS, Walker R, Johansen H, Campbell N. Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades. CMAJ 2011; 183:1007-13. [PMID: 21576297 DOI: 10.1503/cmaj.101767] [Citation(s) in RCA: 193] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Analyses of medication databases indicate marked increases in prescribing of antihypertensive drugs in Canada over the past decade. This study was done to examine the trends in the prevalence of hypertension and in control rates in Canada between 1992 and 2009. METHODS Three population-based surveys, the 1986-1992 Canadian Heart Health Surveys, the 2006 Ontario Survey on the Prevalence and Control of Hypertension and the 2007-2009 Canadian Health Measures Survey, collected self-reported health information from, and measured blood pressure among, community-dwelling adults. RESULTS The population prevalence of hypertension was stable between 1992 and 2009 at 19.7%-21.6%. Hypertension control improved from 13.2% (95% confidence interval [CI] 10.7%-15.7%) in 1992 to 64.6% (95% CI 60.0%-69.2%) in 2009, reflecting improvements in awareness (from 56.9% [95% CI 53.1%-60.5%] in 1992 to 82.5% [95% CI 78.5%-86.0%] in 2009) and treatment (from 34.6% [95% CI 29.2%-40.0%] in 1992 to 79.0% [95% CI 71.3%-86.7%] in 2009) among people with hypertension. The size of improvements in awareness, treatment and control were similar among people who had or did not have cardiovascular comorbidities Although systolic blood pressures among patients with untreated hypertension were similar between 1992 and 2009 (ranging from 146 [95% CI 145-147] mm Hg to 148 [95% CI 144-151] mm Hg), people who did not have hypertension and patients with hypertension that was being treated showed substantially lower systolic pressures in 2009 than in 1992 (113 [95% CI 112-114] v. 117 [95% CI 117-117] mm Hg and 128 [95% CI 126-130] v. 145 [95% CI 143-147] mm Hg). INTERPRETATION The prevalence of hypertension has remained stable among community-dwelling adults in Canada over the past two decades, but the rates for treatment and control of hypertension have improved markedly during this time.
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Baruth M, Wilcox S, Egan BM, Dowda M, Laken M, Warren TY. Cardiovascular disease risk factor clustering among African American adults. Ethn Dis 2011; 21:129-134. [PMID: 21749014 PMCID: PMC3758907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES Although the co-occurrence of multiple risk factors increases the risk of cardiovascular disease (CVD) morbidity/mortality, few studies have examined the prevalence of risk factor clustering among African Americans in community-based faith settings. This study examined the prevalence and clustering of CVD risk factors in a sample of church members from South Carolina. DESIGN Cross-sectional analysis of baseline data from a faith-based intervention, Faith, Activity, and Nutrition (FAN). SETTING African Methodist Episcopal churches in four geographically-defined districts in South Carolina. PARTICIPANTS 1119 church members. MAIN OUTCOME MEASURES Self-reported presence or absence of healthcare provider diagnosed diabetes, high cholesterol, and hypertension. Objectively measured blood pressure, height, and weight (body mass index) were also taken. The prevalence of single, multiple, and clustering of risk factors was computed. RESULTS 62% of participants were obese, 64% had hypertension, 23% had diabetes, and 39% had high cholesterol; 15% had no risk factors, 24% had 1 risk factor, 30% had 2 risk factors, 22% had 3 risk factors, and 10% had 4 risk factors. The most common clusters of risk factors were: obese and hypertensive (18%), obese, hypertensive and hypercholesterolemic (13%), and obese, hypertensive, hypercholesterolemic, and diabetic (10%). CONCLUSIONS The prevalence of risk factors and risk factor clustering in church members in South Carolina is exceedingly high. Culturally-relevant behavioral interventions targeting risk factor reduction in this population should be a public health goal.
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Affiliation(s)
- Meghan Baruth
- Department of Exercise Science, University of South Carolina, Columbia 29208, USA.
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Felício JS, de Souza ACCB, Kohlmann N, Kohlmann O, Ribeiro AB, Zanella MT. Nocturnal blood pressure fall as predictor of diabetic nephropathy in hypertensive patients with type 2 diabetes. Cardiovasc Diabetol 2010; 9:36. [PMID: 20704750 PMCID: PMC2928765 DOI: 10.1186/1475-2840-9-36] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/13/2010] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypertensive patients with reduced blood pressure fall (BPF) at night are at higher risk of cardiovascular events (CVE). METHODS We evaluated in hypertensive diabetic patients, if a reduced nocturnal BPF can precedes the development of diabetic nephropathy (DN). We followed 70 patients with normal urinary albumin excretion (UAE) for two years. We performed 24-hours ambulatory BP monitoring in baseline and at the end of the study. RESULTS Fourteen (20%) patients (GI) developed DN (N = 11) and/or CVE (n = 4). Compared to the remaining 56 patients (GII) in baseline, GI had similar diurnal systolic (SBP) and diastolic BP (DBP), but higher nocturnal SBP (138 +/- 15 vs 129 +/- 16 mmHg; p < 0.05) and DBP (83 +/- 12 vs 75 +/- 11 mmHg; p < 0,05). Basal nocturnal SBP correlated with occurrence of DN and CVE (R = 0.26; P < 0.05) and with UAE at the end of the study (r = 0.3; p < 0.05). Basal BPF (%) correlated with final UAE (r = -0.31; p < 0.05). In patients who developed DN, reductions occurred in nocturnal systolic BPF (12 +/- 5 vs 3 +/- 6%, p < 0,01) and diastolic BPF (15 +/- 8 vs 4 +/- 10%, p < 0,01) while no changes were observed in diurnal SBP (153 +/- 17 vs 156 +/- 16 mmHg, NS) and DBP (91 +/- 9 vs 90 +/- 7 mmHg, NS). Patients with final UAE < 20 microg/min, had no changes in nocturnal and diurnal BP. CONCLUSIONS Our results suggests that elevations in nocturnal BP precedes DN and increases the risk to develop CVE in hypertensive patients with T2DM.
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Affiliation(s)
- João S Felício
- Endocrinology Division - UFPA - Universidade Federal do Pará, Belém, Brazil
| | | | - Nárcia Kohlmann
- Endocrinology and Nephrology Divisions - UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Oswaldo Kohlmann
- Endocrinology and Nephrology Divisions - UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arthur B Ribeiro
- Endocrinology and Nephrology Divisions - UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria T Zanella
- Endocrinology and Nephrology Divisions - UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
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