1
|
Yang D, Tao S, Shao M, Huang L, Xiao X, Zhang J, Yao R, Sun Z. Effectiveness of exercise training on arterial stiffness and blood pressure among postmenopausal women: a systematic review and meta-analysis. Syst Rev 2024; 13:169. [PMID: 38956626 PMCID: PMC11221034 DOI: 10.1186/s13643-024-02589-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The acute and long-term benefits of exercise training on cardiovascular health have been well established. The systematic review and meta-analysis aimed to systematically assess the effectiveness of exercise training on arterial stiffness and blood pressure among postmenopausal women with elevated blood pressure. METHODS A comprehensive search was conducted on PubMed, Embase, Web of Science, ProQuest, Cochrane Library, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov website from inception to September 30, 2023, to identify the randomized controlled trials (RCTs), which evaluated the effectiveness of exercise training on arterial stiffness and blood pressure in postmenopausal women. Standardized mean differences (SMD), weighted mean differences (WMD), and 95% confidence intervals (95% CIs) were calculated using random/fixed effects models. Quality assessment was performed using the modified Jadad scale and the Cochrane Risk of Bias Tool. Sensitivity analysis and subgroup analysis were conducted based on drug dosage, treatment duration, and age of administration to further explore potential heterogeneity. Funnel plots were performed to assess publication bias and Begg's regression test was carried out for funnel plot asymmetry. RESULTS Twenty-two RCTs involving 1978 participants were included in the quantitative analysis. The mean quality of eligible studies was 4.2 out of 7 based on the modified Jadad scale. The results indicated that exercise training had a significant effect on reducing brachial-ankle pulse wave velocity [MD = - 0.69, 95%CI (- 1.11, - 0.27), P = 0.001], decreasing augmentation index (AIx) [MD = - 6.00, 95%CI (- 6.39, - 5.61), P < 0.00001] and AIx normalized to a heart rate of 75 beats per minute (AIx@75%) [MD = - 7.01, 95%CI - 7.91 to - 6.12, P < 0.00001], lowering systolic blood pressure [MD = - 6.19, 95%CI - 9.24 to - 3.15, P < 0.0001], diastolic blood pressure [MD = - 3.57, 95%CI (- 6.10, - 1.03), P = 0.006) and pulse pressure [MD = - 8.52, 95%CI (- 16.27, - 0.76), P = 0.03]. Subgroup analysis revealed that baseline blood pressure levels had a large impact on the effect of exercise training. CONCLUSIONS The systematic review and meta-analysis suggested that exercise training may ameliorate arterial stiffness and reduce blood pressure in postmenopausal women with elevated blood pressure. However, the optimal mode of exercise training that improves arterial stiffness and blood pressure in this population requires further investigation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021211268.
Collapse
Affiliation(s)
- Deshuang Yang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Shiyi Tao
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Mingjing Shao
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China.
| | - Li Huang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Xiang Xiao
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jin Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Ruiqi Yao
- Department of Internal Medicine, Shenzhen Nanshan Chinese Medicine Hospital, Guangdong, China
| | - Ziyi Sun
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
2
|
Li SJ, Miles T, Vasisht I, Dere H, Agyekum C, Massoud R. Breaking barriers: assessing the impact of clinical quality improvements on reducing health disparities in hypertension care among Mumbai's urban slums. BMJ Open Qual 2024; 13:e002716. [PMID: 38806206 PMCID: PMC11138264 DOI: 10.1136/bmjoq-2023-002716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/13/2024] [Indexed: 05/30/2024] Open
Abstract
The clinical quality improvement initiatives, led by the organisation's Health Equity Working Group (HEWG), aim to support healthcare providers to provide equitable, quality hypertension care worldwide. After coordinating with the India team, we started monitoring the deidentified patient data collected through electronic health records between January and May 2021. After stratifying data by age, sex and residence location, the team found an average of 55.94% of our hypertensive patients control their blood pressure, with an inequity of 11.91% between male and female patients.The objective of this study was to assess the effectiveness of using clinical quality improvement to improve hypertension care in the limited-resourced, mobile healthcare setting in Mumbai slums. We used the model for improvement, developed by Associates in Process Improvement. After 9-month Plan-Do-Study-Act (PDSA) cycles, the average hypertensive patients with controlled blood pressure improved from 55.94% to 89.86% at the endpoint of the initiative. The gender gap reduced significantly from 11.91% to 2.19%. We continued to monitor the blood pressure and found that the average hypertensive patients with controlled blood pressure remained stable at 89.23% and the gender gap slightly increased to 3.14%. Hypertensive patients have 6.43 times higher chance of having controlled blood pressure compared with the preintervention after the 9-month intervention (p<0.001).This paper discusses the efforts to improve hypertension care and reduce health inequities in Mumbai's urban slums. We highlighted the methods used to identify and bridge health inequity gaps and the testing of PDSA cycles to improve care quality and reduce disparities. Our findings have shown that clinical quality improvement initiatives and the PDSA cycle can successfully improve health outcomes and decrease gender disparity in the limited-resource setting.
Collapse
Affiliation(s)
- Shang Ju Li
- Monitoring and Evaluation, AmeriCares Foundation Inc, Stamford, Connecticut, USA
| | - Thomas Miles
- Monitoring and Evaluation, AmeriCares Foundation Inc, Stamford, Connecticut, USA
| | - Itisha Vasisht
- Programs, Americares India Foundation, Mumbai, Maharaṣṭra, India
| | | | | | | |
Collapse
|
3
|
Parvin S, Akter S, Hossain MI, Ali MS, Soni MSM. Residential variations in hypertension prevalence and trends among adults in Bangladesh. RESEARCH IN HEALTH SERVICES & REGIONS 2024; 3:3. [PMID: 39177903 DOI: 10.1007/s43999-024-00040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/15/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Hypertension is a widespread and life-threatening condition globally, with its prevalence increasing rapidly, particularly among adults. This study aims to examine the trend in adult hypertension prevalence and associated risk factors in both urban and rural areas of Bangladesh from 2011 to 2018. METHODS Nationally representative cross-sectional data from the Bangladesh Demographic and Health Survey was used at two time points, 2011 and 2018. In our study, we used a two-step approach for variable selection, combining traditional statistical methods (χ 2 test) with a machine learning algorithm (Boruta algorithm).. This study also employed two different multivariate binary logistic regression models to identify the risk factors that are most closely connected to the presence of hypertension (respectively for urban and rural locations). RESULTS According to the study, hypertension has been on the rise in Bangladesh. In 2011, over a third of adults (38.7%) in urban Bangladesh had hypertension, a number that rose by 22.6% in 2017-18. Though rural areas had a lower hypertension prevalence in 2011 (36%), it surged to 64% in 2017-18, surpassing the rate in urban areas. The results of the multivariate analysis showed that age, gender, education, wealth status, area, and survey year had a significant influence on the determinants of hypertension status in connection to place of residence. According to the odds ratio, the prevalence was significantly higher among older respondents, female respondents, wealthy families and higher-educated respondents. CONCLUSION A large proportion of Bangladesh's adult population suffers from hypertension. A health education program is required to develop appropriate strategies, including appropriate weight control, appropriate physical activity, and healthier eating habits. Health authorities should take initiatives to spread awareness among people, particularly at an older age.
Collapse
Affiliation(s)
- Shahanaj Parvin
- Department of Statistics, Jagannath University, Dhaka, Bangladesh
| | - Salma Akter
- Department of Statistics, Jagannath University, Dhaka, Bangladesh.
| | - Md Ismail Hossain
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka, 1212, Bangladesh
| | - Md Sabuj Ali
- Department of Statistics, Hajee Mohammad Danesh Science and Technology University, Dinajpur, Bangladesh
| | | |
Collapse
|
4
|
Dos Reis EC, de Freitas Monteiro EL, Meneguci J, Rodrigues P, Palma A, Virtuoso Junior JS, Passos SRL, Borges Dos Santos MA. Body mass index and sex differences for mortality in hospitalized COVID-19 patients: a path analysis using a brazilian national database. BMC Public Health 2023; 23:1655. [PMID: 37644418 PMCID: PMC10464316 DOI: 10.1186/s12889-023-16218-1] [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: 09/04/2022] [Accepted: 06/29/2023] [Indexed: 08/31/2023] Open
Abstract
Previous studies have shown that associations between obesity and other comorbidities favor worse outcomes in COVID-19. However, it is not clear how these factors interrelate and whether effects on men and women differ. We conducted an observational, cross-sectional study using a national COVID-19 inpatient database. We studied differences in direct and indirect effects of obesity and comorbidities according to sex and body mass index (BMI) categories in hospitalized COVID-19 patients in Brazil using path analysis models and logistic regression. For men, path analysis showed a direct association between BMI and death and a negative correlation of death and chronic cardiovascular disease (CCD). For women, the association of BMI and death was indirect, mediated by admission to the ICU and comorbidities and association with CCD was non-significant. In the logistic regression analyses, there was a positive association between death and BMI, age, diabetes mellitus, kidney and lung diseases and ICU admission. We highlight the need to consider the distinct impact of obesity and sex on COVID-19, of monitoring of BMI and of the design for specific male-targeted approaches to manage obesity.
Collapse
Affiliation(s)
- Erika Cardoso Dos Reis
- Escola de Nutrição, Departamento de Nutrição Clínica e Social, Universidade Federal de Ouro Preto, Minas Gerais, Rua Dois, Campus Morro do Cruzeiro, Ouro Preto, Ouro Preto, MG, CEP 35.400-000, Brasil.
| | - Elma Lúcia de Freitas Monteiro
- Universidade Federal do Triângulo Mineiro. Programa de Pós Graduação em Atenção à Saúde, Av. Frei Paulino, nº 30 - Bairro Abadia, Uberaba, Minas Gerais, CEP: 38025-180, Brasil
| | - Joilson Meneguci
- Universidade Federal do Triângulo Mineiro. Programa de Pós Graduação em Atenção à Saúde, Av. Frei Paulino, nº 30 - Bairro Abadia, Uberaba, Minas Gerais, CEP: 38025-180, Brasil
| | - Phillipe Rodrigues
- Escola de Educação Física e Desportos, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 540 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro - RJ, Rio de Janeiro, RJ, CEP: 21941-599, Brasil
| | - Alexandre Palma
- Universidade Federal do Triângulo Mineiro. Programa de Pós Graduação em Atenção à Saúde, Av. Frei Paulino, nº 30 - Bairro Abadia, Uberaba, Minas Gerais, CEP: 38025-180, Brasil
| | - Jair Sindra Virtuoso Junior
- Universidade Federal do Triângulo Mineiro, Programa de Pós Graduação em Atenção à Saúde, Av. Frei Paulino, nº 30 - Bairro Abadia, Uberaba, Minas Gerais, CEP: 38025-180, Brasil
| | - Sonia Regina Lambert Passos
- Instituto Nacional de Infectologia Evandro Chagas (INI/FIOCRUZ), Av. Brasil, 4036, sala 201 A - Manguinhos, Rio de Janeiro, CEP: 21040-360, Brasil
| | | |
Collapse
|
5
|
Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Weisner CM, Satre DD, Grant RW, Elson J, Ross TB, Awsare S, Lu Y, Metz VE, Sterling SA. 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. BMJ Open 2023; 13:e064088. [PMID: 36657762 PMCID: PMC9853251 DOI: 10.1136/bmjopen-2022-064088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Constance M Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Joseph Elson
- Permanente Medical Group, San Francisco, California, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| |
Collapse
|
6
|
Awareness, treatment, and practices of lifestyle modifications amongst diagnosed hypertensive patients attending the tertiary care hospital of Karachi: A cross-sectional study. Ann Med Surg (Lond) 2022; 82:104587. [PMID: 36268382 PMCID: PMC9577521 DOI: 10.1016/j.amsu.2022.104587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/31/2022] [Accepted: 09/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background Methods Results Conclusion Data regarding the awareness of lifestyle modifications in the general hypertensive population of Pakistan is scarce. Out of 425 hypertensive patients, 70.7% had uncontrolled hypertension. Age and female gender were the only risk factors significantly associated with uncontrolled hypertension. Most of the patients are on treatment and still not controlled, and thus could be considered under treatment. Interventions should be considered and implemented to potentially increase the control rates.
Collapse
|
7
|
Grover A, Venkatesh U, Ghai G, Babu V, Aggarwal S, Singh R, Chinnakali P, Kishore J, Singh MP, Goel S, Durga R, Yashwanth RD, Kishore S. Prevalence and associated factors for awareness of hypertension in India: Findings from national survey-4. J Family Med Prim Care 2022; 11:5766-5775. [PMID: 36505569 PMCID: PMC9731052 DOI: 10.4103/jfmpc.jfmpc_173_22] [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: 01/21/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background Despite the fact that hypertension is increasing, merely 50% are aware of the disease. Being aware of hypertension is important to control it. Aim The study's objective was to estimate the level of hypertension awareness in India and explore its associated sociodemographic factors. Materials and Methods The data collected in National Family Health Survey 4 (2015-2016) among men aged 15-54 years and women aged 15-49 years were analyzed. Taking awareness of hypertension as an outcome variable, descriptive analysis, and multivariable logistic regression model were performed, by gender. Results Of 1,41,215 hypertensive individuals analyzed, 34.7% of men and 53.6% of women were aware of being hypertensive. The control among those aware was 67.1% in men and 74.6% in women. The awareness varied among states ranging from 29.6% in Chhattisgarh to 75.6% in Tamil Nadu. The multivariable logistic regression model explained the awareness of hypertension in males increased with age (odds ratios [OR]: 0.226 for 95% confidence interval [CI]: 0.139-0.366 for 25-29 years of age increased to 0.599 for 95% CI: 0.48-0.74 for 40-44 years of age), education (OR of 0.66 for 95% CI: 0.51-0.85 for primary increased to 0.69 for 95% CI: 0.54-0.89 for secondary school level), and wealth status (OR of 0.407 for 95% CI: 0.309-0.535 for poor wealth quintile increased to 1.030 for 95% CI: 0.863-1.230 for the richest wealth quintile). For women, the awareness increased with age (OR of 0.306 for 95% CI: 0.119- 0.791 for the age of 20-24 years increased to 0.736 for 95% CI: 0.570-0.951 for the age of 45-49 years) and wealth status (OR of 0.28 for 95% CI: 0.18-0.44 for poor wealth quintile increased to 1.262 for 95% CI: 0.859-1.855 for the richest wealth quintile). Conclusion Improving access to hypertension screening and awareness especially among men, with lower wealth and younger age is needed.
Collapse
Affiliation(s)
- Ashoo Grover
- Division of Non Communicable Disease, Indian Council of Medical Research, New Delhi, India
| | - U. Venkatesh
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Glory Ghai
- Department of Community Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Vignitha Babu
- Department of Community Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sumit Aggarwal
- Division of Epidemiology & Communicable Disease, Indian Council of Medical Research, New Delhi, India
| | - Ravinder Singh
- Division of Non Communicable Disease, Indian Council of Medical Research, New Delhi, India
| | | | - Jugal Kishore
- Department of Community Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mahendra Pratap Singh
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India,Address for correspondence: Dr. Sonu Goel, Professor of Health Management, Department of Community Medicine and School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India. Adjunct Clinical Associate Professor, Public Health Masters Program School of Medicine and Health Research Institute (HRI), University of Limerick, Ireland. E-mail:
| | - R Durga
- Department of Paediatric and Prevention Dentistry, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | | | - Surekha Kishore
- Executive Director, All India Institute of Medical Sciences, Gorakhpur, India
| |
Collapse
|
8
|
Prevalence, trends and associated factors of hypertension and diabetes mellitus in Bangladesh: Evidence from BHDS 2011 and 2017–18. PLoS One 2022; 17:e0267243. [PMID: 35503777 PMCID: PMC9064112 DOI: 10.1371/journal.pone.0267243] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/04/2022] [Indexed: 12/12/2022] Open
Abstract
The evolving pandemic of non-communicable diseases like hypertension, diabetes mellitus are globally on the rise, and the trend is also escalating in Bangladesh. We aimed to assess the prevalence trend and associated factors of hypertension (HTN), diabetes mellitus (DM), and hypertension- diabetes mellitus combined (HDC) among Bangladeshi adults from 2011 to 2018. Two nationally representative cross-sectional data from Bangladesh Demographic and Health Survey (BDHS): 2011 and 2017–18 were utilized. According to baseline characteristics, the average annual rate of change (AARC) was applied to quantify the annual rate of increase/decrease in HTN, DM, and HDC from 2011 to 2018. The prevalence ratios of HTN, DM, and HDC were assessed through modified Poisson regression with robust error variance (PR, 95% Confidence Interval (CI)). The data were prepared in SPSS version 23 and exported to Stata version 13 for further analysis. Among 11,686 participants, the overall mean age of the study participants was 52.79 years, Standard Deviation (SD)±12.99, and 42.28% were female. From 2011–2018, HTN, DM, and HDC prevalence in Bangladesh has increased by 13, 3.2, and 3.1 percentage points, respectively. The average annual rate of increase was observed in the HTN and HDC prevalence by all socio-economic and demographic categories during 2011–2018. The prevalence of HDC among Chittagong residents was approximately double in 2018: 3.95% (2011) versus 6.59% (2018). Increased age, inactive workers, overweight adults, and adults in wealthy families were common risk factors associated with HTN, DM, and HDC in Bangladesh. The prevalence of developing HTN and HDC was significantly higher among adults aged ≥ 70 years (PR: 2.70, 95% CI: 2.42–3.00; PR: 2.97, 95% CI: 2.08–4.24, respectively). A comprehensive approach of different stakeholders is required to develop appropriate strategies, including appropriate weight management, adequate physical activity, and healthier food habits. Health agencies should take initiatives to spread awareness among people at an early age, but special attention is needed for older people and those at risk for NCDs.
Collapse
|
9
|
Consolazio D, Gattoni ME, Russo AG. Exploring gender differences in medication consumption and mortality in a cohort of hypertensive patients in Northern Italy. BMC Public Health 2022; 22:768. [PMID: 35428215 PMCID: PMC9013154 DOI: 10.1186/s12889-022-13052-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background This paper aims to assess the presence of gender differences in medication use and mortality in a cohort of patients affected exclusively by hypertension, in 193 municipalities in the Lombardy Region (Northern Italy), including Milan's metropolitan area. Methods A retrospective cohort study was conducted (N = 232,507) querying administrative healthcare data and the Register of Causes of Death. Hypertensive patients (55.4% women; 44.6% men) in 2017 were identified; gender differences in medication use (treatment, 80% compliance) and deaths (from all causes and CVDs) were assessed at two-year follow-ups in logistic regression models adjusted for age class, census-based deprivation index, nationality, and pre-existing health conditions. Models stratified by age, deprivation index, and therapeutic compliance were also tested. Results Overall, women had higher odds of being treated, but lower odds of therapeutic compliance, death from all causes, and death from CVDs. All the outcomes had clear sex differences across age classes, though not between different levels of deprivation. Comparing patients with medication adherence, women had lower odds of death from all causes than men (with a narrowing protective effect as age increased), while no gender differences emerged in non-compliant patients. Conclusions Among hypertensive patients, gender differences in medication consumption and mortality have been found, but the extent to which these are attributable to a female socio-cultural disadvantage is questionable. The findings reached, with marked age-dependent effects in the outcomes investigated, suggest a prominent role for innate sex differences in biological susceptibility to the disease, whereby women would take advantage of the protective effects of their innate physiological characteristics, especially prior to the beginning of menopause. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13052-9.
Collapse
|
10
|
Rahman S, Amit S, Kafy AA. Gender disparity in telehealth usage in Bangladesh during COVID-19. SSM - MENTAL HEALTH 2022; 2:100054. [PMID: 35036972 PMCID: PMC8752120 DOI: 10.1016/j.ssmmh.2021.100054] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background and aims Telehealth allows healthcare workers to see patients virtually in locations that were not accessible previously, which has reduced cost and time and saved lives. The research aims to examine gender disparity among telehealth usage during the pandemic in 2020. This study will leverage a timely national experiment to evaluate the users of telehealth across the Bangladeshi population. Methods We obtained de-identified data for 200 patients among outpatient telehealth visits from Global Health Data Exchange as it captured telehealth use throughout Bangladesh. Results The analysis showed that male patients had a higher dependency on telehealth than female patients. 14% of the female patients opted for telehealth visits only with 57% cases of missed doses of medication, compared to males with 20% of them choosing telehealth visits and 29% missing their doses of medication. We found that the youngest age group, 16–25, had the highest dependence on telehealth compared to any other age group, and the lowest dependence was among the oldest age group of 45 years and above. Conclusions There was a strong association between telehealth use and gender disparity with p value = 0.02 < 0.05. Longitudinal and geographical data are needed to understand more about the gender disparities and impact in telehealth utilizations.
Collapse
Affiliation(s)
- Saanjaana Rahman
- Center for Enterprise and Society, University of Liberal Arts Bangladesh (ULAB), Dhanmondi, Dhaka, 1209, Bangladesh
- Population Health Sciences, Cornell University, NY, USA
| | - Sajid Amit
- Center for Enterprise and Society, University of Liberal Arts Bangladesh (ULAB), Dhanmondi, Dhaka, 1209, Bangladesh
| | - Abdulla-Al Kafy
- ICLEI South Asia, Rajshahi City Corporation, Rajshahi, 6200, Bangladesh
- Department of Urban & Regional Planning, Rajshahi University of Engineering & Technology, Rajshahi, 6203, Bangladesh
| |
Collapse
|
11
|
Abba MS, Nduka CU, Anjorin S, Mohamed SF, Agogo E, Uthman OA. Influence of contextual socioeconomic position on hypertension risk in low- and middle-income countries: disentangling context from composition. BMC Public Health 2021; 21:2218. [PMID: 34872517 PMCID: PMC8647420 DOI: 10.1186/s12889-021-12238-x] [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] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension has emerged as the single most significant modifiable risk factor for cardiovascular disease and death worldwide. Resource-limited settings are currently experiencing the epidemiological transition from infectious diseases to chronic non-communicable diseases, primarily due to modifications in diet and lifestyle behaviour. The objective of this study was to examine the influence of individual-, community- and country-level factors associated with hypertension in low- and middle-income countries (LMICs). Methods Multivariable multi-level logistic regression analysis was applied using 12 Demographic and Health Survey (DHS) datasets collected between 2011 and 2018 in LMICs. We included 888,925 respondents (Level 1) nested within 33,883 neighbourhoods (Level 2) from 12 LMICs (Level 3). Results The prevalence of hypertension ranged from 10.3% in the Kyrgyz Republic to 52.2% in Haiti. After adjusting for the individual-, neighbourhood- and country-level factors, we found respondents living in the least deprived areas were 14% more likely to have hypertension than those from the most deprived areas (OR = 1.14, 95% CI 1.10 to 1.17). We observed a significant variation in the odds of hypertension across the countries and the neighbourhoods. Approximately 26.3 and 47.6% of the variance in the odds of hypertension could be attributed to country- and neighbourhood-level factors, respectively. We also observed that respondents moving to a different neighbourhood or country with a higher risk of hypertension had an increased chance of developing hypertension, the median increase in their odds of hypertension was 2.83-fold (95% CI 2.62 to 3.07) and 4.04- fold (95% CI 3.98 to 4.08), respectively. Conclusions This study revealed that individual compositional and contextual measures of socioeconomic status were independently associated with the risk of developing hypertension. Therefore, prevention strategies should be implemented at the individual level and the socioeconomic and contextual levels to reduce the burden of hypertension.
Collapse
Affiliation(s)
- Mustapha S Abba
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
| | - Chidozie U Nduka
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK
| | - Seun Anjorin
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK
| | - Shukri F Mohamed
- Academic Unit of Primary Care (AUPC) and the NIHR Global Health Research Unit on Improving Health in Slums, University of Warwick, Coventry, UK.,Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya.,Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emmanuel Agogo
- Resolve to Save Lives, Country Office Nigeria, Abuja, Nigeria
| | - Olalekan A Uthman
- Warwick Centre for Global Health Research, The University of Warwick, Coventry, CV4 7AL, UK.,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.,Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
12
|
Changes in prevalence and risk factors of hypertension among adults in Bangladesh: An analysis of two waves of nationally representative surveys. PLoS One 2021; 16:e0259507. [PMID: 34855768 PMCID: PMC8638884 DOI: 10.1371/journal.pone.0259507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Bangladesh is one of the countries where the prevalence of non-communicable diseases (NCDs) such as hypertension is rising due to rising living standards, sedentary lifestyles, and epidemiological transition. Among the NCDs, hypertension is a major risk factor for CVD, accounting for half of all coronary heart disease worldwide. However, detailed research in this area has been limited in Bangladesh. The objective of the study was to estimate changes in the prevalence and risk factors of hypertension among Bangladeshi adult population. The study also sought to identify socioeconomic status-related inequality of hypertension prevalence in Bangladesh. Methods Cross-sectional analysis was conducted using nationally representative two waves of the Bangladesh Demographic and Health Survey (BDHS) in 2011 and 2017–18. Survey participants were adults 18 years or older- which included detailed biomarker and anthropometric measurements of 23539 participants. The change in prevalence of hypertension was estimated, and adjusted odds ratios were obtained using multivariable survey logistic regression models. Further, Wagstaff decomposition method was also used to analyze the relative contributions of factors to hypertension. Results From 2011 to 2018, the hypertension prevalence among adults aged ≥35 years increased from 25.84% to 39.40% (p<0.001), with the largest relative increase (97%) among obese individuals. The prevalence among women remained higher than men whereas the relative increase among men and women were 75% and 39%, respectively. Regression analysis identified age and BMI as the independent risk factors of hypertension. Other risk factors of hypertension were sex, marital status, education, geographic region, wealth index, and diabetes status in both survey years. Female adults had significantly higher hypertension risk in both survey years in the overall analysis in, however, in the subgroup analysis, the gender difference in hypertension risk was not significant in rural 2011 and urban 2018 samples. Decomposition analysis revealed that the contributions of socio-economic status related inequality of hypertension in 2011 were46.58% and 20.85% for wealth index and BMI, respectively. However, the contributions of wealth index and BMI have shifted to 12.60% and 55.29%, respectively in 2018. Conclusion The prevalence of hypertension among Bangladeshi adults has increased significantly, and there is no subgroup where it is decreasing. Population-level approaches directed at high-risk groups (overweight, obese) should be implemented thoroughly. We underscore prevention strategies by following strong collaboration with stakeholders in the health system of the country to adopt healthy lifestyle choices.
Collapse
|
13
|
Shehab A, Bhagavathula AS, AlHajri N. Sex differences in the antihypertensive treatment and risk of uncontrolled hypertension in 5308 hypertensive patients in the United Arab Emirates. Blood Press Monit 2021; 26:333-340. [PMID: 34001757 DOI: 10.1097/mbp.0000000000000539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sex differences in the antihypertensive medications used to control blood pressure and risk factor control in hypertensive patients is poorly understood. METHODS We conducted a retrospective review of the patients newly diagnosed with hypertension registered for treatment in 52 outpatient settings across Abu Dhabi province between 1 January and 31 December 2017. We explored sex differences in risk factors and treatment management over 6 months of the follow-up period of each patient. Multiple logistic regression models were used to identify factors associated with poor BP control. RESULTS A total of 5308 patients (2559 men and 2849 women) were identified. We observed an increase in SBP and DBP levels in men (1.72/1.13 mmHg) and only SBP in women (0.87/-0.021 mmHg) with increased incidence of comorbidities overtime. The overall BP control was suboptimal (65%) (<140/90 mmHg) with no significant difference between women (65.3%) and men (64.2%). In men with dyslipidemia, use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker with diuretics and in women, only calcium channel blockers showed higher for BP control. Factors significantly associated with poor BP control in men are being overweight and obese, and dyslipidemia in men. After the age of 50, women in contrast to men, with dyslipidemia and heart rate >80 beats per minute are less likely to maintain hypertension control. CONCLUSION Sex-specific analysis indicated that BP control among United Arab Emirates men and women was suboptimal (65%). Interventions aiming to achieve better control of BP in hypertensive patients with metabolic syndrome should be emphasized.
Collapse
Affiliation(s)
| | - Akshaya Srikanth Bhagavathula
- Institute of Public Health, College of Medicine and Health Sciences, College of Medicine and Health Sciences, UAE University, Al Ain
| | - Noora AlHajri
- Department of Epidemiology and Population Health, Khalifa University, Abu Dhabi, UAE
| |
Collapse
|
14
|
Al Kibria GM, Gupta RD, Nayeem J. Prevalence, awareness, and control of hypertension among Bangladeshi adults: an analysis of demographic and health survey 2017-18. Clin Hypertens 2021; 27:17. [PMID: 34465390 PMCID: PMC8408995 DOI: 10.1186/s40885-021-00174-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/27/2021] [Indexed: 01/02/2023] Open
Abstract
Background The prevalence of hypertension is increasing in Bangladesh, however, few recent studies investigated the proportion of people and factors associated with prevalence, awareness, and control of this condition in this country. This study investigated these among Bangladeshi adults. Methods Using Bangladesh Demographic and Health Survey 2017–18 data, a cross-sectional study was conducted. Multilevel logistic regression analysis was employed after descriptive analysis and prevalence estimation. Results Among 12,926 persons (mean age: 40 years, 57% women), the prevalence of hypertension was 27.4% (n = 3551), it was 28.4 and 26.2% among females and males, respectively. Among hypertensive people, about 42.4% (n = 1508) people were aware of having it, 48.7% among females and 33.5% among males. Of the 1313 people who were taking antihypertensive medication, only 33.8% (n = 443) had controlled hypertension, 34.7 and 31.7% among females and males, respectively. Among the studied factors associated with hypertension, people with older age, female gender, overweight/obesity, diabetes, richer wealth quintiles, and residence in some administrative divisions had higher odds of hypertension (p < 0.05). However, the odds of awareness was lower among younger people, males, and people without overweight/obesity, diabetes, or richer wealth quintiles. Odds of controlled hypertension was also lower among people with older age and higher among college-educated people. Conclusion This study identified several important factors associated with prevalence, awareness, and control of hypertension. It is important to address these factors with nationwide prevention and control programs. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-021-00174-2.
Collapse
Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Jannatun Nayeem
- Chattagram International Dental College and Hospital, Chittagong, Bangladesh
| |
Collapse
|
15
|
Boitchi AB, Naher S, Pervez S, Anam MM. Patients' understanding, management practices, and challenges regarding hypertension: A qualitative study among hypertensive women in a rural Bangladesh. Heliyon 2021; 7:e07679. [PMID: 34401563 PMCID: PMC8353286 DOI: 10.1016/j.heliyon.2021.e07679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/25/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hypertension, as one of the main predisposing factors of many non-communicable diseases, is generally underdiagnosed among women with a significant uncontrolled rate. This study explores the understanding, management practice and challenges related to hypertension among hypertensive women in rural Bangladesh. Methods A qualitative study was conducted among hypertensive rural women at Kumarkhali Upazilla, Kushtia, Bangladesh, using purposive and snowball sampling technique. Data was collected through in-depth interviews among twenty-three hypertensive women until they reached saturation. Data were analyzed thematically. Results Findings of the study found that a small number of participants perceived the symptoms, risk factors, management and treatment of hypertension based on biomedical understanding. Also, their awareness level and adherence to preventive practices reflected a significant gap between biomedical preventive practices and local practices. A substantial number of participants preferred home management and alternative treatment for hypertension over the medication adherence and hospital treatment. This investigation revealed that poor socio-economic conditions, such as financial insufficiency, and, gender-based negligence impacted women's perception of and practice for hypertension and resulted in risky hypertension management behaviors. Conclusion Based on the study, formulation of a comprehensive health education program for creating awareness, provisioning of significant interventions services related to hypertensive care are needed. Further intensive research is needed at the community-level to manage this chronic disease. Lack of awareness and underestimation of hypertension is prevalent more than a quarter of the adult world population. Knowledge gap about symptoms, risk factors, and management practices of hypertension are predominant among participants. Study participants prefer the self-management practices of hypertension without taking medication. Financial hardship, forgetfulness in taking medication, anxiety, and stigmas create challenges to manage hypertension. Comprehensive, integrated and structured intervention programs should be develop to control hypertension.
Collapse
Affiliation(s)
- Anika Bushra Boitchi
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Shabnam Naher
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.,Graduate Assistant, Department of Health Science, University of Alabama, Tuscaloosa, USA
| | - Sabbir Pervez
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Md Mujibul Anam
- Department of Anthropology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.,Research Fellow, Department of Rural Health, The University of Melbourne, Australia
| |
Collapse
|
16
|
Luca CT, Crisan S, Cozma D, Negru A, Lazar MA, Vacarescu C, Trofenciuc M, Rachieru C, Craciun LM, Gaita D, Petrescu L, Mischie A, Iurciuc S. Arterial Hypertension: Individual Therapeutic Approaches-From DNA Sequencing to Gender Differentiation and New Therapeutic Targets. Pharmaceutics 2021; 13:pharmaceutics13060856. [PMID: 34207606 PMCID: PMC8229802 DOI: 10.3390/pharmaceutics13060856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
The aim of this paper is to provide an accurate overview regarding the current recommended approach for antihypertensive treatment. The importance of DNA sequencing in understanding the complex implication of genetics in hypertension could represent an important step in understanding antihypertensive treatment as well as in developing new medical strategies. Despite a pool of data from studies regarding cardiovascular risk factors emphasizing a worse prognosis for female patients rather than male patients, there are also results indicating that women are more likely to be predisposed to the use of antihypertensive medication and less likely to develop uncontrolled hypertension. Moreover, lower systolic blood pressure values are associated with increased cardiovascular risk in women compared to men. The prevalence, awareness and, most importantly, treatment of hypertension is variable in male and female patients, since the mechanisms responsible for this pathology may be different and closely related to gender factors such as the renin–angiotensin system, sympathetic nervous activity, endothelin-1, sex hormones, aldosterone, and the immune system. Thus, gender-related antihypertensive treatment individualization may be a valuable tool in improving female patients’ prognosis.
Collapse
Affiliation(s)
- Constantin-Tudor Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Simina Crisan
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Correspondence: (S.C.); (M.T.)
| | - Dragos Cozma
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Alina Negru
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Mihai-Andrei Lazar
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristina Vacarescu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Mihai Trofenciuc
- Department of Cardiology, “Vasile Goldis” Western University of Arad, Bulevardul Revoluției 94, 310025 Arad, Romania
- Multidisciplinary Heart Research Center, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Correspondence: (S.C.); (M.T.)
| | - Ciprian Rachieru
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Internal Medicine Department, County Emergency Hospital, 5 Gheorghe Dima Street, 300079 Timisoara, Romania
- Advanced Research Center in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Laura Maria Craciun
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
| | - Dan Gaita
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Lucian Petrescu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Alexandru Mischie
- Invasive Cardiology Unit, Centre Hospitalier de Montluçon, 03100 Montluçon, France;
| | - Stela Iurciuc
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.-T.L.); (D.C.); (A.N.); (M.-A.L.); (C.V.); (C.R.); (L.M.C.); (D.G.); (L.P.); (S.I.)
- Angiogenesis Research Center, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| |
Collapse
|
17
|
Umuerri EM, Aiwuyo HO. Prevalence and correlates of prehypertension and hypertension among adults in Delta State, Nigeria: a cross-sectional community-based study. Ghana Med J 2021; 54:48-57. [PMID: 32863413 PMCID: PMC7445701 DOI: 10.4314/gmj.v54i1.8] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background There are indications that prehypertension precedes hypertension. Like hypertension, it is associated with increased cardiovascular risk. Objective To determine the prevalence, awareness and correlates of prehypertension and hypertension among adults in Delta State, Nigeria. Methods This was a cross-sectional study. We recruited adults aged ≥18 years from two communities in Delta State, Nigeria, using the multi-stage sampling technique. The study instrument was a modified WHO-STEPS questionnaire. Prehypertension and hypertension were defined using the JNC-7 criteria. Ethical approval was obtained before the recruitment of participants. Results Of the 852 adults studied, the mean (±SD) age was 42.64 (±16.07) years, females (55.9%) and urban dwellers (55.8%). The prevalence of prehypertension and hypertension were 42.5% and 29.3%, respectively; both were higher among urban dwellers. The peak age-group for prehypertension and hypertension were 25-34 and 35-44 years, respectively. Awareness of hypertension was low; 12.0% (102/852). Blood pressure category significantly correlated with age, body mass index, place of residence, level of education, employment status and fruit intake. Conclusion The prevalence of prehypertension and hypertension in this study were high. Based on the premise that prehypertension is a precursor of hypertension and occurred more among youths, the higher prevalence of prehypertension gives an inkling to rising prevalence of hypertension. Funding Nil.
Collapse
Affiliation(s)
- Ejiroghene M Umuerri
- Department of Medicine, Delta State University, PMB 01, Abraka, Nigeria.,Cardiology Unit, Department of Medicine, Delta State University Teaching Hospital, PMB 07, Oghara, Nigeria
| | - Henry O Aiwuyo
- Cardiology Unit, Department of Medicine, Delta State University Teaching Hospital, PMB 07, Oghara, Nigeria
| |
Collapse
|
18
|
The Influence of Anthropometric Indices and Intermediary Determinants of Hypertension in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115646. [PMID: 34070454 PMCID: PMC8197532 DOI: 10.3390/ijerph18115646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
Hypertension is a major public health burden in Bangladesh. However, studies considering the underlying multifaceted risk factors of this health condition are sparse. The present study concurrently examines anthropometric parameters and intermediary factors influencing hypertension risk in Bangladesh. Using the 2018 World Health Organisation (WHO) STEPwise approach to non-communicable disease risk factor surveillance (STEPS) study conducted in Bangladesh and involving 8019 nationally representative adult respondents, bivariate and multivariate logistic regression analyses were performed to determine the association between anthropometrics, other intermediary factors and hypertension. The regression results were presented using the odds ratio (OR) and adjusted odds ratio (AOR) at 95% confidence intervals (CIs). The risk of hypertension was higher among females and males who were 40 years and older. However, among females, those who were age 60 years and older were more than twice and thrice more likely to be hypertensive compared to those in the younger age groups (18–39, 40–59). Females who were obese (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]) or had high waist circumference [WC] were twice as likely to be hypertensive. Males and females who were physically active, consuming more fruits and vegetables daily and educated had lower odds of developing hypertension. Key findings suggest that the association between anthropometric indices (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]), waist circumference [WC]), other intermediary determinants (e.g., education, physical activity) and hypertension exist across gender and with increasing age among adults in Bangladesh. Developing appropriate public health interventions (e.g., regular assessment of anthropometric parameters) for early identification of the risk and pattern of hypertension through appropriate screening and diagnosis is required to meet the specific health needs of the adult Bangladesh population.
Collapse
|
19
|
Lawal OM, Enikuomehin A, Otubogun F. The Diagnostic Yield of Routine Electrocardiography in Hypertension and Implications for Care in a Southwestern Nigerian Practice. Int J Gen Med 2021; 14:1421-1427. [PMID: 33907446 PMCID: PMC8068488 DOI: 10.2147/ijgm.s282117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/10/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Nigeria, like other developing nations, has an increasing burden of hypertension. Electrocardiography is an integral part of the diagnostic work-up for the newly diagnosed hypertensive subjects. The aim of this study was to determine the diagnostic yield of electrocardiography in hypertensive patients of a southwestern Nigerian hospital. PATIENTS AND METHODS This was a retrospective descriptive study of electrocardiographs of hypertensive patients over a six-year period. Electrographic variables of interest were cardiac rhythm and rate, left ventricular hypertrophy (LVH), left atrial enlargement (LAE), T wave abnormalities, cardiac axis, blocks, complexes, QT segment abnormalities, atrial fibrillation (AF)/flutter, supraventricular tachycardia and pre-excitation syndrome. The Pearson's chi square was used to test for differences across age groups (15-44yrs, 45-64yrs and >65yrs) and between male and female subjects with the significance level set at 5% (p< 0.05). RESULTS Hypertension was the indication for 40% of electrocardiographs completed and comprised of 3713 electrocardiograms (ECG) over a six-year period. The commonest abnormalities were left axis deviation (LAD) (32.2%), LVH (20.7%), rhythm abnormalities (16.7%) and LAE (14.5%). The diagnostic yield (presence of at least one electrographic abnormality) was 51% in 15-44 yrs age group, 64% in middle aged and 76.5% in the >65 yrs age group. While the male subjects in this study had a slightly increased likelihood of having an abnormal finding (odds ratio 1.18: 95% CI 1.02-1.35), the odds ratio for an abnormal ECG in subjects younger than 45 years was 0.48 (95% CI 0.41-0.57). CONCLUSION The diagnostic yield of electrocardiography in this study was considerable, although lowest in subjects younger than 45 years and increased with age. This may reflect an increased burden and earlier onset of hypertension and its complications. This should also engender prompt and aggressive management of hypertension, especially in the elderly in whom the cardiovascular complications from hypertension is most severe.
Collapse
Affiliation(s)
- Olutoyin Morenike Lawal
- Department of Internal Medicine, University of Medical Sciences Teaching Hospital Complex, Akure, Ondo State, Nigeria
- Department of Internal Medicine, University of Medical Sciences, Ondo, Ondo State, Nigeria
| | - Adenike Enikuomehin
- Department of Internal Medicine, University of Medical Sciences Teaching Hospital Complex, Akure, Ondo State, Nigeria
- Department of Internal Medicine, University of Medical Sciences, Ondo, Ondo State, Nigeria
| | - Folajimi Otubogun
- Department of Internal Medicine, University of Medical Sciences, Ondo, Ondo State, Nigeria
- Department of Internal Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| |
Collapse
|
20
|
Ho BK, Omar MA, Sooryanarayana R, Ghazali SS, Zainal Abidin SBI, Krishnapillai A, Ariaratnam S, Tohit NM, Majid NLBA, Yusof MFBM. Trends in population blood pressure and prevalence, awareness, treatment and control of hypertension among older persons: The 2006 & 2015 National Health and Morbidity Survey in Malaysia. PLoS One 2020; 15:e0238780. [PMID: 32911521 PMCID: PMC7482969 DOI: 10.1371/journal.pone.0238780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertension is one of the most important risk factors for cardiovascular diseases. Thus, it is an important public health challenge worldwide. In Malaysia, only a few studies have focused on the trends of hypertension specifically for the aging population. In view of the rapid growth of the elderly population in Malaysia, there is an urgent need to explore the condition of hypertension in this aging population. Hence, the objectives of this study were to determine the trends of population mean systolic and diastolic blood pressure (BP) levels, the prevalence, awareness, treatment and control of hypertension, and its' associated factors among older persons in two cross-sectional national surveys that were conducted in 2006 and 2015 in Malaysia. METHODS This was a subanalysis of secondary data collected from the two cross-sectional national population-based surveys conducted in Malaysia in 2006 and 2015. Adults aged 60 and older who had participated in these two surveys were included in the study. RESULTS A total of 4954 (2295 males and 2659 females) and 3790 (1771 males and 2019 females) respondents completed the hypertension module surveys in 2006 and 2015, respectively. The mean age of the respondents was 68.5±6.9 years in 2006 and 68.6±7.1 years in 2015 and the difference was not significant. The prevalence of hypertension significantly reduced from 73.8% in 2006 to 69.2% in 2015 (p<0.001). Among the respondents with hypertension, the awareness, treatment and control of hypertension significantly increased from 49.7% to 60.2%, 86.7% to 91.5% and 23.3% to 44.8%, respectively, from 2006 to 2015. Logistic regression analysis showed that female sex and unemployed/retiree were significantly associated with higher hypertension prevalence in both 2006 and 2015. Being unemployed/ retiree was significantly associated with higher awareness of hypertension in both 2006 and 2015. In both 2006 and 2015, Chinese ethnicity were significantly associated with higher awareness and control of hypertension. CONCLUSIONS The mean population BP levels and hypertension prevalence among the elderly population in Malaysia have reduced significantly over the past decade. Although the awareness, treatment and control of hypertension among older adults have improved significantly, the awareness and control rates remain suboptimal. As population aging is inevitable, appropriate public health programs and optimal treatment strategies targeting this vulnerable group are urgently needed to improve the overall awareness and control of hypertension and to prevent hypertension-related complications.
Collapse
Affiliation(s)
- Bee Kiau Ho
- Bandar Botanic Health Center, Bandar Botanic, Klang, Selangor, Malaysia
| | - Mohd Azahadi Omar
- Sector for Biostatistic & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | | | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | | | - Ambigga Krishnapillai
- Department of Family Medicine, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
| | - Suthahar Ariaratnam
- Department of Psychiatry, Faculty of Medicine, Universiti Technologi MARA (UiTM), Selayang Campus, Batu Caves, Selangor, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nur Liana bt Abdul Majid
- Sector for Biostatistic & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Muhammad Fadhli bin Mohd Yusof
- Sector for Biostatistic & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| |
Collapse
|
21
|
Kee YK, Kim M, Oh J, Oh HJ, Ryu D. Sex differences in the blood pressure level associated with increased risks of cardiovascular events: a Korean nationwide population-based cohort study. J Clin Hypertens (Greenwich) 2020; 22:1638-1646. [PMID: 33245619 PMCID: PMC8030021 DOI: 10.1111/jch.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022]
Abstract
Hypertension is a leading risk factor for cardiovascular events and death. Despite differences in clinical implications of hypertension between men and women, guidelines establishing optimal blood pressure (BP) targets are still debated. The aim of this study was to investigate sex differences in the BP level associated with increased risks of major adverse cardiac and cerebral events (MACCEs) among antihypertensive-treated patients. Using data from the Korean National Health Insurance Service-National Sample Cohort, we enrolled antihypertensive-treated patients and divided them into four categories: Group 1: SBP < 120 and DBP < 80 mm Hg; Group 2: 120 ≤ SBP < 130 and DBP < 80 mm Hg; Group 3: 130 ≤ SBP < 140 or 80 ≤ DBP < 90 mm Hg; and Group 4: SBP ≥ 140 or DBP ≥ 90 mm Hg. We performed time-dependent cox regression analysis to investigate sex differences in the BP levels that increased the risk of MACCEs. Most of the 98 267 patients fell into Group 3 (53.2% men and 52.8% women) and Group 4 (30.5% men and 28.1% women). During 8.34 ± 2.07 years, there were 8,813 MACCEs and 791 deaths. The incidences of MACCEs and death tended to increase as the BP increased in both sexes. Compared to Group 1, the risk of MACCEs significantly increased only in Group 4 for men, while it significantly increased in Groups 3 and 4 for women. This study shows that there are sex differences in the BP level at which the risk of MACCEs increases. Our finding suggests that sex should be significantly considered when determining the optimal BP target in patients undergoing hypertension treatment.
Collapse
Affiliation(s)
- Youn Kyung Kee
- Department of Internal MedicineKangdong Sacred Heart HospitalSeoulKorea
| | - Min‐ho Kim
- Ewha Institute of Convergence MedicineEwha Womans University Mokdong HospitalSeoulKorea
| | - Jongmin Oh
- Department of Occupational and Environmental MedicineSchool of Medicine, Ewha Womans UniversitySeoulKorea
| | - Hyung Jung Oh
- Ewha Institute of Convergence MedicineEwha Womans University Mokdong HospitalSeoulKorea
- Department of NephrologySheikh Khalifa Specialty HospitalUAE
| | - Dong‐Ryeol Ryu
- Research Institute for Human Health InformationEwha Womans University Mokdong HospitalSeoulKorea
- Department of Internal MedicineSchool of MedicineEwha Womans UniversitySeoulKorea
- Tissue Injury Defense Research CenterCollege of MedicineEwha Womans UniversitySeoulKorea
| |
Collapse
|
22
|
Haider MR, Das Gupta R. Inequalities in undiagnosed hypertension among adult Nepalese population: Evidence from a nationally representative survey. Int J Cardiol Hypertens 2020; 5:100026. [PMID: 33447755 PMCID: PMC7803054 DOI: 10.1016/j.ijchy.2020.100026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION With one in every five adults suffering from hypertension and three-fifth of these patients undiagnosed, Nepal faces an enormous problem of undiagnosed hypertension. This study aims to assess the prevalence and determinants of undiagnosed hypertension in Nepal and to examine the extent of socioeconomic inequalities in undiagnosed hypertension in Nepal. METHODS This study used the nationally representative Nepal Demographic and Health Survey 2016 data. Undiagnosed hypertension was defined having systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mmHg and being told two or more times by health professionals to lower/control blood pressure. Multiple logistic regression analysis was used for identifying determinants associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (CI). RESULTS The study results show that out of total 2831 hypertensive patients, 1611 (56.9%) were undiagnosed. In the adjusted model, older age, overweight/obesity, higher wealth quintiles had less odds of being undiagnosed. Male gender and residing in Province 7 had higher odds of being undiagnosed. Overall CI showed that poor patients were disproportionately affected by undiagnosed hypertension (CI: 0.21, Standard Error (SE) of CI: 0.03). The poor (Q1)-to-rich (Q5) ratio was 1.57 showed again that poorest patients in Nepal had higher prevalence of undiagnosed hypertension than richest patients. CONCLUSION Poor patients are disproportionately affected by undiagnosed hypertension in Nepal. Awareness should be created specially among the poor wealth quintiles regarding checking blood pressure regularly. Innovative implementation strategies required to be developed to detect undiagnosed case and provide treatment accordingly.
Collapse
Affiliation(s)
- Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Grover Center W333, 1 Ohio University Drive, Athens, OH, 45701, USA
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA
| |
Collapse
|
23
|
Hossain FB, Adhikary G, Chowdhury AB, Shawon MSR. Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys. Clin Hypertens 2019; 25:28. [PMID: 31890277 PMCID: PMC6911698 DOI: 10.1186/s40885-019-0134-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although there has been a well-established association between overweight-obesity and hypertension, whether such associations are heterogeneous for South Asian populations, or for different socioeconomic groups is not well-known. We explored the associations of overweight and obesity using South Asian cut-offs with hypertension, and also examined the relationships between body mass index (BMI) and hypertension in various socioeconomic subgroups. METHODS We analysed the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and Nepal, with a total of 821,040 men and women. Hypertension was defined by 2017 ACC/AHA cut-offs and by Joint National Committee 7 (JNC7) cut-offs for measured blood pressure and overweight and obesity were defined by measured height and weight. We used multiple logistic regressions to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension for overweight and obesity as well as for each 5-unit increase in BMI. RESULTS The prevalence of hypertension using JNC7 cut-offs among participants increased by age in all three countries. The prevalence ranged from 17.4% in 35-44 years to 34.9% in ≥55 years in Bangladesh, from 4.6% in 18-24 years to 28.6% in 45-54 years in India, and from 3.8% in 18-24 years to 39.2% in ≥55 years in Nepal. Men were more likely to be hypertensive than women in India and Nepal, but not in Bangladesh. Overweight and obesity using both WHO and South Asian cut-offs were associated with higher odds of hypertension in all countries. For each 5 kg/m2 increase in BMI, the ORs for hypertension were 1.79 (95% CI: 1.65-1.93), 1.59 (95% CI: 1.58-1.61), and 2.03 (95% CI: 1.90-2.16) in Bangladesh, India, and Nepal, respectively. The associations between BMI and hypertension were consistent across various subgroups defined by sex, age, urbanicity, educational attainment and household's wealth index. CONCLUSIONS Our study shows that the association of BMI with hypertension is stronger for South Asian populations at even lower cut-offs points for overweight and obesity. Therefore, public health measures to reduce population-level reduction in BMI in all population groups would also help in lowering the burden of hypertension.
Collapse
Affiliation(s)
| | | | | | - Md Shajedur Rahman Shawon
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Oxford, OX3 7LF UK
| |
Collapse
|
24
|
Gender differences in hypertension awareness, antihypertensive use and blood pressure control in Nepalese adults: findings from a nationwide cross-sectional survey. J Biosoc Sci 2019; 52:412-438. [PMID: 31466532 DOI: 10.1017/s0021932019000531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective of this cross-sectional study was to determine the gender differences in hypertension awareness, antihypertensive use and blood pressure (BP) control among the adult Nepalese population (≥18 years) using data from the nationally representative Nepal Demographic and Health Survey 2016. A weighted sample of 13,393 adults (5620 males and 7773 females) was included in the final analysis. After conducting descriptive analyses with the selective explanatory variable, multivariable logistic regression analysis was performed to assess the association between the outcome variable and the explanatory variables. The strength of the association was expressed in adjusted odds with 95% confidence intervals. A higher proportion of women had their BP checked (87.7% females vs 73.0% males, p<0.001) and were aware of their raised BP (43.9% females vs 37.1% males, p<0.001) compared with men. Although female hypertensive individuals had a higher prevalence of antihypertensive medication use than their male counterparts (50.1% females vs 47.5% males), a higher proportion of male hypertensive participants had their BP controlled (49.2% females vs 53.5% males). Women with the poorest wealth index had a lower prevalence of antihypertensive use than their male counterparts. The odds of having their own BP measured increased with age among men but decreased with age among women. The household wealth index was positively associated with the odds of BP measurement, awareness of own BP and antihypertensive use. This study revealed that although women had a higher prevalence of hypertension awareness and antihypertensive medication use, the practice did not translate into better BP control. Inequality in antihypertensive medication use was observed among the poorest wealth quintiles. Public health programmes in Nepal should focus on reducing these inequalities. Further research is needed to learn why females have poorer control of BP, despite having higher antihypertensive medication use.
Collapse
|
25
|
Wang J, Jiang W, Sharma M, Wu Y, Li J, You N, Ding Z, Zhao X, Chen H, Tang H, Zhou X, Li X. Sex differences in antihypertensive drug use and blood pressure control. Postgrad Med J 2019; 95:295-299. [PMID: 31171709 DOI: 10.1136/postgradmedj-2019-136513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/26/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hypertension is the most important modifiable cardiovascular risk factor. Epidemiological studies have shown the benefits of lowering blood pressure (BP), but BP control is a major challenge. Furthermore, there are significant sex differences in antihypertensive drug use and BP control. This study examined sex differences in antihypertensive drug use and BP control, with the aim of reducing the complications of hypertension and improving quality of life. METHODS The study was performed in our outpatient hypertension clinic, and included 1529 patients without secondary hypertension or comorbidities. The study, investigated BP control rates and patterns of antihypertensive drug use in male and female. All data were collected using structured questionnaires and patient measurements. RESULTS The study included 713 males and 816 females in this study. Fewer females had hypertension in the younger age group (16.2% vs 11.6%; p>0.05), but this difference disappeared in middle-aged (47.8% vs 49.9 %; p<0.05) and elderly age groups (36.0% vs 38.5%; p<0.05). BP control rates differed between males and females (35.6% in male, 31.9% in female, p<0.01). There was an overall difference in BP control rates between males and females (35.6% in males, 31.9% in females, p<0.01). In this aged 18-44 years, angiotensin converting enzyme inhibitors (ACEIs) showed the best control rate in males, while calcium channel blockers (CCBs) were least effective (61.5% with ACEIs, 28.6% with CCBs; p<0.05). In this aged 45-64 years, diuretics (DUs) showed the best control rate in females, while CCBs were least effective (47.5% with DUs, 28.3% with CCBs; p<0.05). CONCLUSIONS Sex plays an important role in BP control. In those aged 18-44 years, males using ACEIs showed best control rates. In those aged 45-64 years, females using DUs showed best control rates. Our study provides a basis with the selection of antihypertensive drugs according to sex and age.
Collapse
Affiliation(s)
- Junwen Wang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Weihong Jiang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Manju Sharma
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yuyan Wu
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jiayin Li
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Nana You
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zewen Ding
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiexiong Zhao
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Huilin Chen
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Huiting Tang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoyu Zhou
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaogang Li
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
26
|
Song JJ, Ma Z, Wang J, Chen LX, Zhong JC. Gender Differences in Hypertension. J Cardiovasc Transl Res 2019; 13:47-54. [PMID: 31044374 DOI: 10.1007/s12265-019-09888-z] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/09/2019] [Indexed: 12/26/2022]
Abstract
Hypertension is the leading risk factor for global mortality and morbidity and remains the major preventable cause of cardiovascular diseases. Gender differences in risk factors and awareness, treatment, and control of hypertension have been well established in humans. There are significant differences in epidemiology and clinical characteristic of hypertension between men and women. Moreover, gender differences are linked with several specific types of hypertension, including postmenopausal hypertension, white coat hypertension, masked hypertension, and hypertensive disorders of pregnancy. Gender differences have been implicated in the prevalence and determinants of hypertension and prehypertension whereas the control rate is similar between men and women taking antihypertensive medication. Importantly, distinct roles of the angiotensin-converting enzyme 2/Apelin signaling, sex hormone, endothelin-1, and sympathetic nervous activity contribute to sex differences in blood pressure control. This review summarizes gender differences in clinical features and determinants of hypertension and the underlying mechanisms responsible for hypertension.
Collapse
Affiliation(s)
- Juan-Juan Song
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zheng Ma
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Juan Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin-Xi Chen
- Institute of Pharmacy and Pharmacology, University of South China, Hengyang, 421001, China
| | - Jiu-Chang Zhong
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| |
Collapse
|
27
|
Al Kibria GM, Burrowes V, Choudhury A, Sharmeen A, Swasey K. Sex differences in prevalence and associated factors of prehypertension and hypertension among Bangladeshi adults. Int J Cardiol Hypertens 2019; 1:100006. [PMID: 33447740 PMCID: PMC7803050 DOI: 10.1016/j.ijchy.2019.100006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 12/13/2022] Open
Abstract
Globally, complications of raised blood pressure are fundamental public health issues. There has been limited research if prevalence and risk factors vary by sex in many countries, including Bangladesh. We stratified the prevalence and associated factors of prehypertension and hypertension according to sex in Bangladesh. This cross-sectional study analyzed the Bangladesh Demographic and Health Survey 2011 data. After estimating prevalence according to sex, multilevel logistic regression was applied to obtain associated factors. This study analyzed data of 3876 males and 3962 females aged ≥35 years. The prevalence of hypertension was 19.4% (95% confidence interval [CI]: 18.0-21.0) among males and 31.9% (95% CI: 30.1-33.6) among females. Among both males and females, prevalence and odds of hypertension increased with age, overweight/obesity, diabetes, upper wealth status, and residence in some divisions. Education level was a significant positive correlate of hypertension for males only. Males and females had similar prevalence of prehypertension, 27.2% (95% CI: 25.6-28.8) and 27.6% (95% CI: 26.0-29.2), respectively. Characteristics such as older age, overweight/obesity, and diabetes were associated with higher prevalence and odds of prehypertension among females; prehypertension among males was associated with advancing age, overweight/obesity, education level, wealth status, and division of residence. In Bangladesh, almost half of the males and females could have increased risks of complications resulting from hypertension and prehypertension. Addressing the characteristics associated with higher prevalence or odds of these conditions is crucial. Several common risk factors indicate that a common prevention and control strategy could work for both sexes.
Collapse
Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Vanessa Burrowes
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Allysha Choudhury
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Atia Sharmeen
- School of Community Health and Policy, Morgan State University, Baltimore, MD 21251, USA
| | - Krystal Swasey
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| |
Collapse
|
28
|
Malik FTN, Ishraquzzaman M, Kalimuddin M, Mamun MAA, Huq TS, Choudhury SR, Ahmed N, Badiuzzaman M, Alim A, Karim MR, Beaney T, Xia X, Poulter NR, Hussain AHME, Malik A. May Measurement Month (MMM) 2017: an analysis of blood pressure screening results in Bangladesh-South Asia. Eur Heart J Suppl 2019; 21:D21-D24. [PMID: 31043868 PMCID: PMC6479416 DOI: 10.1093/eurheartj/suz078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 11/18/2022]
Abstract
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. Based on the findings of the non-communicable disease Risk Factors Survey Bangladesh 2010, the prevalence of hypertension in adults 25 years or older in Bangladesh is 20.1%. The Bangladesh Demographic Health Survey, 2011 showed that approximately 50% of those affected are unaware of their hypertensive condition. The May Measurement Month 2017 (MMM17) is a global initiative of the International Society of Hypertension (ISH) aimed at raising awareness of high BP. We participated in MMM17 to raise awareness of hypertension screening and identify those with elevated BP who were unaware, and those on treatment with still uncontrolled hypertension. Following the standard protocol designed by the ISH, we participated in MMM17, an opportunistic cross-sectional survey of volunteers aged ≥18. It was carried out in May 2017. BP measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Data were collected from 35 screening sites in 33 districts in Bangladesh. Personnel from several government and non-government organizations volunteered in this huge event. A total of 11 418 individuals were screened during MMM17, of which 5401 (47.3%) were found to have hypertension. Of 8365 individuals not receiving anti-hypertensive medication, 2348 (28.1%) were hypertensive. Of 3053 individuals receiving anti-hypertensive medication, 1594 (52.2%) had uncontrolled BP. MMM17 was the largest BP screening campaign undertaken in Bangladesh. This study suggests that opportunistic screening can identify significant numbers of people with raised BP. A periodic public health programme at a national level needs to be initiated to increase hypertension detection and control rate and thus for the prevention of cardiovascular diseases.
Collapse
Affiliation(s)
- Fazila-Tun-Nesa Malik
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Plot 7/2, Section 2, Mirpur, Dhaka, 1216, Bangladesh
| | - Mir Ishraquzzaman
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Plot 7/2, Section 2, Mirpur, Dhaka, 1216, Bangladesh
| | - Mohammad Kalimuddin
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Plot 7/2, Section 2, Mirpur, Dhaka, 1216, Bangladesh
| | - Mohammad Abdullah Al Mamun
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Plot 7/2, Section 2, Mirpur, Dhaka, 1216, Bangladesh
| | - Tawfiq Shahriar Huq
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Plot 7/2, Section 2, Mirpur, Dhaka, 1216, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Plot 7/2, Section 2, Mirpur, Dhaka, 1216, Bangladesh
| | - Nazir Ahmed
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Plot 7/2, Section 2, Mirpur, Dhaka, 1216, Bangladesh
| | - Mohammad Badiuzzaman
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Plot 7/2, Section 2, Mirpur, Dhaka, 1216, Bangladesh
| | - Abdul Alim
- Non-Communicable Disease Control Programme, Directorate General of Health Services, Mohakhali Dhaka, 1212 Bangladesh
| | - Mohammad Rizwanul Karim
- Non-Communicable Disease Control Programme, Directorate General of Health Services, Mohakhali Dhaka, 1212 Bangladesh
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - A H M Enayet Hussain
- Non-Communicable Disease Control Programme, Directorate General of Health Services, Mohakhali Dhaka, 1212 Bangladesh
| | - Abdul Malik
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Plot 7/2, Section 2, Mirpur, Dhaka, 1216, Bangladesh
| |
Collapse
|
29
|
Siew ED, Parr SK, Wild MG, Levea SL, Mehta KG, Umeukeje EM, Silver SA, Ikizler TA, Cavanaugh KL. Kidney Disease Awareness and Knowledge among Survivors ofAcute Kidney Injury. Am J Nephrol 2019; 49:449-459. [PMID: 30995659 PMCID: PMC6679978 DOI: 10.1159/000499862] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) survivors are at risk for chronic kidney disease, recurrent AKI, and cardiovascular disease. The transition from hospital to ambulatory care is an opportunity to reduce these sequelae by launching self-care plans through effective patient education. How well AKI survivors are informationally prepared to apply kidney-specific self-care is unknown. The purpose of this study was to identify awareness and disease-specific knowledge among AKI survivors. METHODS We performed a cross-sectional survey of AKI-related awareness and knowledge in 137 patients with Kidney Disease Improving Global Outcomes Stage II or III AKI near the time of hospital discharge. Patients were asked (1) "Did you experience AKI while in the hospital?" and (2) "Do you have a problem with your kidney health?" Objective knowledge of AKI was evaluated with a 15-item adapted version of the validated Kidney Knowledge Survey that included topics such as common causes, risk factors, and how AKI is diagnosed. RESULTS Median age was 54 (interquartile range 43-63) and 81% were white. Eighty percent of patients were unaware that they had experienced AKI and 53% were both unaware they had experienced AKI or had a "problem with their kidneys." Multivariable logistic regression identified being male and lack of nephrology consult as predictors of unawareness with ORs of 3.92 (95% CI 1.48-10.33) and 5.10 (95% CI 1.98-13.13), respectively. Less than 50% recognized nonsteroidal anti-inflammatory drugs, contrast, or phosphate-based cathartics as risk factors for AKI. Two-thirds of patients did not agree that they knew a lot about AKI and more than 80% desired more information. CONCLUSIONS Most patients with moderate to severe AKI are unaware of their condition, lack understanding of risk factors for recurrent AKI, and desire more information. Patient-centered communication to optimize awareness, understanding, and care will require coordinated educational strategies throughout the continuum of AKI care.
Collapse
Affiliation(s)
- Edward D Siew
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA,
- Tennessee Valley Healthcare System, Veteran's Health Administration, Nashville, Tennessee, USA,
| | - Sharidan K Parr
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
- Tennessee Valley Healthcare System, Veteran's Health Administration, Nashville, Tennessee, USA
| | - Marcus G Wild
- Vanderbilt University, Department of Psychological Sciences, Nashville, Tennessee, USA
| | - Swee-Ling Levea
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kermaan G Mehta
- Department of Surgery, New York Methodist Hospital, Brooklyn, New York, USA
| | - Ebele M Umeukeje
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
- Vanderbilt Center for Effective Health Communication, Nashville, Tennessee, USA
| | - Samuel A Silver
- Division of Nephrology, Queen's University, Kingston, Ontario, Canada
| | - T Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
- Tennessee Valley Healthcare System, Veteran's Health Administration, Nashville, Tennessee, USA
| | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
- Tennessee Valley Healthcare System, Veteran's Health Administration, Nashville, Tennessee, USA
- Vanderbilt Center for Effective Health Communication, Nashville, Tennessee, USA
| |
Collapse
|
30
|
Qu Z, Parry M, Liu F, Wen X, Li J, Zhang Y, Wang D, Li X. Self-management and blood pressure control in China: a community-based multicentre cross-sectional study. BMJ Open 2019; 9:e025819. [PMID: 30898823 PMCID: PMC6528047 DOI: 10.1136/bmjopen-2018-025819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study explored the relationship between self-management and blood pressure (BP) control in China. DESIGN A cross-sectional study. SETTING Eight community health centres from four cities in the Northeast (Shenyang), Northwest (Xi'an), Southwest (Chengdu) and South (Changsha) of China. PARTICIPANTS A total of 873 adults with hypertension, including 360 men and 513 women. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg. OUTCOME MEASUREMENTS BP control was the primary outcome variable. This was categorised as good control if individuals with hypertension reduced their BP to <140/90 mm Hg, otherwise, it was categorised as poor control. Secondary outcomes included self-management, defined as: (1) context or condition-specific factors or physical/social environments (eg, age, sex, marital status, education, personal income and health insurance) and (2) process or knowledge/beliefs, self-regulation skills/abilities and social facilitation (eg, treatment, diet, exercise and risk factor management). Data were analysed using logistic regression models using SPSS V.20. RESULTS A total of 67.1% (n=586) participants had poor BP control. Limited outpatient care benefits in mainly rural residents (OR 2.26, 95% CI 1.06 to 4.81) and longer disease duration (OR 1.03, 95% CI 1.01 to 1.04) were associated with poor BP control. Self-management practices reduced the odds of having poor BP control (OR 0.98, 95% CI 0.97 to 0.99). CONCLUSIONS The individual and family self-management theory can serve as an effective theory for understanding the key contexts, processes and outcomes essential for BP control in China. Future research should evaluate the effect of a self-management intervention (eg, self-monitoring, medication adherence, regular and routine doctor visits, and social supports) for BP control in China using a multisite cluster randomised controlled trial. Sex and gender difference, cost and patient-reported outcomes should also be examined.
Collapse
Affiliation(s)
- Zhan Qu
- School of Nursing, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Fang Liu
- School of Nursing, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China
| | - Xiulin Wen
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jieqiong Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yanan Zhang
- School of Public Health, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China
| |
Collapse
|
31
|
Biswas T, Townsend N, Islam MS, Islam MR, Das Gupta R, Das SK, Mamun AA. Association between socioeconomic status and prevalence of non-communicable diseases risk factors and comorbidities in Bangladesh: findings from a nationwide cross-sectional survey. BMJ Open 2019; 9:e025538. [PMID: 30867202 PMCID: PMC6429850 DOI: 10.1136/bmjopen-2018-025538] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES This study aimed to examine the prevalence and distribution in the comorbidity of non-communicable diseases (NCDs) among the adult population in Bangladesh by measures of socioeconomic status (SES). DESIGN This was a cross-sectional study. SETTING This study used Bangladesh Demographic and Health Survey 2011 data. PARTICIPANTS Total 8763 individuals aged ≥35 years were included. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were diabetes mellitus (DM), hypertension (HTN) and overweight/obesity. The study further assesses factors (in particular SES) associated with these comorbidities (DM, HTN and overweight/obesity). RESULTS Of 8763 adults, 12% had DM, 27% HTN and 22% were overweight/obese (body mass index ≥23 kg/m2). Just over 1% of the sample had all three conditions, 3% had both DM and HTN, 3% DM and overweight/obesity and 7% HTN and overweight/obesity. DM, HTN and overweight/obesity were more prevalent those who had higher education, were non-manual workers, were in the richer to richest SES and lived in urban settings. Individuals in higher SES groups were also more likely to suffer from comorbidities. In the multivariable analysis, it was found that individual belonging to the richest wealth quintile had the highest odds of having HTN (adjusted OR (AOR) 1.49, 95% CI 1.29 to 1.72), DM (AOR 1.63, 95% CI 1.25 to 2.14) and overweight/obesity (AOR 4.3, 95% CI 3.32 to 5.57). CONCLUSIONS In contrast to more affluent countries, individuals with NCDs risk factors and comorbidities are more common in higher SES individuals. Public health approaches must consider this social patterning in tackling NCDs in the country.
Collapse
Affiliation(s)
- Tuhin Biswas
- Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Long Pocket Precinct, 80 Meiers Road, QLD 4068, Brisbane, Australia
| | | | - Md Saimul Islam
- Departmnet of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Rajibul Islam
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Rajat Das Gupta
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Centre for Science of Implementation and Scale-Up, BRAC James P Grant School of Public Health, BRAC university, Dhaka, Bangladesh
| | - Sumon Kumar Das
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Long Pocket Precinct, 80 Meiers Road, QLD 4068, Brisbane, Australia
| |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW The review is a short discussion of sex/gender differences in blood pressure control with a focus on gender differences in hypertension awareness, prevalence, and treatment, the new American College of Cardiology/American Heart Association Guidelines, and recent discoveries in animal models and humans on mechanisms responsible for sex/gender differences in hypertension. RECENT FINDINGS Hypertension awareness is greater in women than men, the prevalence of hypertension is higher in men than women until after menopause, and although the American College of Cardiology/American Heart Association Guidelines recommend similar treatment for men and women, this is not currently the case in practice. New studies into mechanisms responsible for sex/gender differences in hypertension include the role of the kidneys, the renin-angiotensin system, relaxin, and developmental programming. SUMMARY Specific guidelines for hypertension treatment in women and men have yet to be developed. However, numerous animal and human studies have shown differences in the mechanisms responsible for blood pressure control between the sexes. Thus more research into the sex/gender differences in mechanisms responsible for hypertension are needed to determine the best treatment options that will reduce the risk of hypertension and subsequent cardiovascular diseases in both genders.
Collapse
|
33
|
Qiu C, Chen S, Yao Y, Zhao Y, Xin Y, Zang X. Adaption and validation of Nijmegen continuity questionnaire to recognize the influencing factors of continuity of care for hypertensive patients in China. BMC Health Serv Res 2019; 19:79. [PMID: 30696430 PMCID: PMC6352379 DOI: 10.1186/s12913-019-3915-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/17/2019] [Indexed: 12/05/2022] Open
Abstract
Background Continuity of care (COC) has become a primary point of concern for care providers in both developed and developing countries, which is regarded as the “cornerstone of care” and an “essential element” of good health care. A robust and proper instrument is of necessity to identify problems and evaluate intervention aimed at improving continuity of care. This study aimed to adapt Nijmegen continuity questionnaire (NCQ) into a Chinese version (NCQ-C) and to delineate the status of COC as well as explore its influencing factors for hypertensive patients in China. Methods A forward-back-translation procedure was adopted for the determination of the adaption of NCQ. Then a total of 448 patients completed questionnaires and 24-h ambulatory blood pressure monitoring (ABPM). Proper indexes were calculated to test the reliability and validity of NCQ-C. Logistic analysis were used to detect the influencing factors of COC. Results The NCQ-C had excellent intraclass correlation coefficient of 0.855 and internal consistency of seven dimensions varied from 0.907 to 0.944. The item-content validity index ranged from 0.71 to 1.00. For construct validity, seven-factor structure was confirmed as original questionnaire and all the fit indices indicated acceptable levels. Gender, education level, medical insurance and frequency of family visits, blood pressure level, depression status as well as general health perception were demonstrated to be statistically related to COC. Conclusions In addition, all the parameters of ABPM were negatively significant with COC. The NCQ-C has shown acceptable level of reliability and validity. The related factors of COC should arouse care providers’ attention.
Collapse
Affiliation(s)
- Chen Qiu
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China
| | - Shixiang Chen
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China
| | - Ying Yao
- Department of Emergency, Tianjin Medical University General Hospital, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China
| | - Yi Xin
- Department of Cardiology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China.
| |
Collapse
|
34
|
Alves D, Santos Z, Amado M, Craveiro I, Delgado AP, Correia A, Gonçalves L. Low potassium and high sodium intakes: a double health threat to Cape Verdeans. BMC Public Health 2018; 18:995. [PMID: 30092771 PMCID: PMC6085717 DOI: 10.1186/s12889-018-5911-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/27/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cape Verde presents a high rate of cardiovascular diseases. Low potassium and high sodium intakes are related to cardiovascular diseases. However, studies regarding these two micronutrients continue to be rare in African urban settings. This work aims to estimate potassium and sodium intakes and to analyse the self-reported salt intake by gender and by type of urban area in the city of Praia - the capital of Cape Verde. METHODS In the first stage (n = 1912), an intra-urban study was designed in two types of urban areas (formal and informal), using a sampling strategy based on random selection of geographical coordinates, in order to apply a questionnaire. In a second stage, a 24-h dietary recall and anthropometric measurements were performed by local nutritionists. Potassium and sodium intakes were estimated for 599 participants (149 men and 450 women). Non-parametric methods (including quantile regression) were used in the statistical analysis. RESULTS In informal areas, a higher percentage of women reported having hypertension (31.0%) compared to formal areas (19.7%). Based on 24-h dietary recall, median potassium intake for men was 2924.2 mg/day and for women and 2562.6 mg/day. Almost 70.0% of men and 80.0% of women ingested less than the recommended 3510 mg/day of potassium. In informal areas, men and women presented high medians of sodium intakes compared to formal areas (men: 4131.2 vs 3014.6 mg/day and women: 3243.4 vs 2522.4 mg/day). On the other hand, the percentage of participants exceeding 2000 mg/day for sodium was high (≥70.8%), even for participants that self-reported low-salt intake. Quantile regression models revealed effects of the type of urban area and gender in the potassium and sodium intakes, at least, in some quartiles, accounting for age, academic qualifications, and professional situation. CONCLUSIONS A low potassium intake and a high sodium intake were found in Praia. Thus, efficient health education campaigns and health promotion are needed and should be tailored considering gender and urban areas.
Collapse
Affiliation(s)
- Daniela Alves
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Global Health and Tropical Medicine, GHTM, IHMT-UNL, Lisbon, Portugal
| | - Zélia Santos
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Miguel Amado
- Civil Enginnering Research and Inovation for Sustainability, CERis, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Isabel Craveiro
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Global Health and Tropical Medicine, GHTM, IHMT-UNL, Lisbon, Portugal
| | - António Pedro Delgado
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Direção Nacional da Saúde, Ministério da Saúde, Praia, Cape Verde
| | - Artur Correia
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Comité de Coordenação Combate à SIDA, Ministério da Saúde, Praia, Cape Verde
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Global Health and Tropical Medicine, GHTM, IHMT-UNL, Lisbon, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|