Prevalence and Associated Factors of Prehypertension and Hypertension in Iranian Population: The Lifestyle Promotion Project (LPP)

Hypertension and global DNA methylation: a population-based study in rural, Punjab, India

Hypertension is a significant public health concern and a modifiable risk factor for increased mortality worldwide. It is reported to be influenced by gene-environment interactions and micronutrient intake. This study aims to understand the relationship between global DNA methylation levels and hypertension, independently and in the context of micronutrient status, among rural population in Punjab, India. A total of 2300 individuals, aged 30-75 years, (54.9% females) were screened for blood pressure. Of 2300 screened individuals, 900 (age sex matched 450 cases and 450 controls of hypertension) individuals were selected to examine the relationship between hypertension, global DNA methylation (5mC), and biochemicals (Folate, Vitamin B12, and Homocysteine). Folate, vitamin B12, and homocysteine levels were estimated using chemiluminescence technique. The ELISA-based colorimetric technique was used for performing peripheral blood leucocyte (PBL) global DNA methylation (5mC). Statistical analyses were performed using SPSS version 22.0. Hypertensives were found to have significantly lower levels of global DNA methylation than normotensives (0.65 vs. 0.72 respectively; p-value = 0.01*). Individuals in the 1st quartile of 5mC were at significantly (OR: 1.671; 95% CI: 1.206-2.315; p-value = 0.01*) increased risk for hypertension in comparison to those in the 4th quartile (reference). Further hypertensives on medication with controlled blood pressure (BP) were significantly hypermethylated as compared to hypertensives on medication with uncontrolled BP (0.70 vs. 0.62 respectively; p-value = 0.04*). Folate appeared to mediate global DNA methylation among hypertensives on medication-controlled BP. Further hypertension driven hypomethylation hints towards accelerated biological aging among younger hypertensives. Hypertension may be associated with Global DNA hypomethylation in the studied rural population of Punjab, India. Folate sufficiency may prove to be an aid in improving the methylation levels among the cases of hypertension who were on medication and had controlled BP.

Hypertension in India: a gender-based study of prevalence and associated risk factors

BACKGROUND

Hypertension, a major non-communicable disease, is responsible for a significant number of global deaths, including approximately 17.9 million yearly. The Global Burden of Disease 2019 (GBD 2019) estimates that 19% of global deaths are attributed to elevated blood pressure. India, with a population of over 1.4 billion, is facing a serious challenge in combating this silent killer. This study aims to analyze the gender-based prevalence of hypertension in India and explore its associated risk factors using data from the fifth National Family Health Survey (NFHS-5).

METHODS

NFHS-5 collected data from 636,699 households across all states and union territories. The study includes standardized blood pressure measurements for 17,08,241 individuals aged 15 and above. The data were analyzed using Stata, employing descriptive statistics for the assessment of the prevalence and binary logistic regression to identify predictors of hypertension.

RESULTS

The study found the overall prevalence of hypertension in India to be 22.6%, with men (24.1%) having a higher prevalence than women (21.2%). Prevalence increased with age, reaching 48.4% in individuals aged 60 and above. Urban residents had a slightly higher prevalence (25%) than rural residents (21.4%), indicating the rapid spread of hypertension across all populations. Regional variations were observed, with the highest prevalence in Sikkim (37.9%) and the lowest in Rajasthan (16.5%). Increasing age, urban residence, belonging to certain religions (Muslim and other than Hindu or Muslim), and being classified as Scheduled Tribes (ST) were associated with a higher likelihood of hypertension. Conversely, belonging to Scheduled Castes (SC) or Other Backward Classes (OBC), being currently unmarried, and having higher education were associated with a lower likelihood of hypertension. Wealth index analysis revealed that those in the richest quintile were more likely to have hypertension. Behavioural risk factors, such as alcohol consumption, overweight, obesity, increased waist circumference, and high blood glucose levels, are positively associated with hypertension.

CONCLUSION

Hypertension is a significant health burden in India, affecting both men and women. Age is the strongest non-modifiable predictor for both men and women. However, ageing women have higher odds of hypertension than ageing men, and this distinction becomes much more evident in their older ages. Obese women, based on BMI, have higher odds of hypertension than men. However, hypertension prevalence is slightly higher among men who are overweight or obese compared to women. BMI, waist circumference, random glucose level, alcohol use, and education level emerged as major predictors. Health education and awareness campaigns are critical to control the growing burden of hypertension in India. Policymakers must focus on preventive measures, targeting lifestyle changes and improved healthcare access for both men and women. By addressing these risk factors, India can make significant progress in controlling hypertension and reducing its impact on public health.

Prevalence of and Risk factors associated with hypertension: a community based- cross sectional study in Ndorwa West Health Sub District, Kabale district, southwestern Uganda

Background

Globally, one billion people have hypertension (HT), it kills 9.4 million people annually. Prevalence is higher in developed countries and is rapidly rising in developing countries, and approximately 31.5% of Ugandans have HT.

Objective

This study aimed to determine the prevalence of and risk factors associated with HT among adults aged 25-65 years in the Ndorwa West HSD, Kabale District.

Methods

A community-based cross-sectional survey was conducted with 381 adults aged 25-65 years in Ndorwa West HSD, using a modified WHO STEPwise approach to chronic disease risk factor surveillance. Chi-square tests with 95% Confidence Intervals (CI) and p-values less than 0.05, were used to assess the association between hypertension and associated factors. Odds Ratios (OR) with their corresponding 95% confidence intervals (95% CI) estimated the risk.

Results

The prevalence of HT and pre-HT in Ndorwa HSD was 28.3% and 45.7%, respectively. 61.8% (n = 243) were females and 36.1% (n = 142) were males with a mean age of 48.18 years and standard deviation of 11.5 years. The mean Body Mass Index (BMI) was 25.92 kg/m2 and the standard deviation was 3.69 kg/m2. Only Age (p = 0.010, OR = 1.81(1.14-2.87) and level of education (p = 0.04) were significantly associated with hypertension. age ≥ 45years increased the likelihood of developing HT by 0.81 times. Behavioral factors associated with HT included awareness of the BP status (p = 0.010, OR = 0.53(CI: 0.32-0.87),use of fats/oil for cooking (p = 0.02, OR = 1.73 (CI: 1.09-2.75)), reduced salt intake (p = 0.001, OR = 0.075(CI:0.01-0.55)), and overweight and obesity (BMI) level ( p = 0.010, OR = 1.77 (CI 1.12-2.80)). BMI ≥ 25kg/m2 increased the likelihood of developing HT by 0.77 times.

Conclusion

The prevalence of HT and pre-HT in this rapidly transitioning rural-urban population was high. The risk of CVDs is about 16 folds higher among pre-HT compared to no HT and doubles for every 10-mmHg increase in BP. Hence, the considerable risk and burden of HT and related CVDs that require a dire need to adopt strategies to prevent and control hypertension based on the identified associated risk factors in Ndorwa HSD.

Prevalence of Hypertension and Its Associated Risk Factors Among Adults Attending Medical Outpatient Clinics at Ibn Sina General Hospital Authority in Mukalla City, Yemen

BACKGROUND

Hypertension (HTN) is the most generally acknowledged modifiable risk factor for cardiovascular disease, cerebrovascular disease, and end-stage renal disease. Accordingly, the World Health Organization has listed HTN as the third greatest cause of death globally.

OBJECTIVES

The objective of this study was to assess the prevalence of HTN and its associated risk factors among adults attending medical clinics at Ibn Sina Hospital Authority in Mukalla City, Yemen.

METHODS

A cross-sectional descriptive survey was conducted using a self-administered questionnaire applied to 384 male and female adults aged ≥18 years attending Ibn Sina General Hospital Authority outpatient clinics in Mukalla City, Yemen, between December 2022 and May 2023. The participant's body weight, height, and waist circumference were measured. The data were analyzed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY). P values of <0.05 were considered statistically significant.

RESULTS

Among the 384 participants, 20.5% had HTN, and the remaining (79.5%) did not have HTN, with a substantial proportion (47.2%) reporting a positive family history of HTN. Diabetes mellitus was present in 16.1% of the participants, whereas dyslipidemia and other chronic diseases were reported by 9.3% and 15.8% of the participants, respectively. A total of 75.6% of the participants had never smoked, and 11.7% were past smokers. More than half of the participants (57.29%) had never chewed khat, 20.57% were former khat chewers, and 22.14% were currently chewing khat. Nutritional status, as indicated by body mass index, showed that 29.8% were overweight.

CONCLUSIONS

HTN was found to be prevalent among the study participants. However, the respondents' awareness of the problem and the overall control rates were very low. Certain factors, such as family history of HTN, diabetes mellitus, and high body mass index, were found to be associated with HTN. Therefore, intervention measures are warranted emphasizing modifiable risk factors to prevent HTN.

Computational investigation of the impact of potential AT2R polymorphism on small molecule binding

For more than a century, the renin-angiotensin system (RAS) has been acknowledged for playing a crucial part in the physiological control of arterial pressure, as well as sodium and fluid balance. It is now generally acknowledged that one of the receptor of RAS system i.e. angiotensin type 2 receptor (AT2R) functions as a repair system during pathophysiologic circumstances and performs a significant protective role. Efforts have been made previously to design suitable agonist and antagonist molecules to potentially modulate AT2R. One of the agonists and antagonists, named C21 and EMA401, has been studied in a number of pathological conditions. Additionally, a wide panel of single nucleotide polymorphisms (SNPs) has been reported for AT2R, which might potentially affect the efficacy of these molecules. Therefore, computational investigations have been carried out to analyze all the SNPs (1151) reported in NCBI to find potential SNPs affecting the active site of AT2R, as this domain is still unexplored. Structures of these polymorphic forms were modeled, and in silico drug interaction studies with C21 and EMA401 were carried out. The two mutants (rs868939201 and rs1042852794) that significantly affect the binding affinity as that of the wild type were subjected to molecular dynamics simulations. Our analysis of native and mutant AT2R and their complexes with C21 and EMA401 indicated that the occurrence of these mutations affects the conformation of the protein and has affected the binding of these ligand molecules. The study's findings will aid in the development of better, more versatile medications in the near future, and also in vitro and in vivo studies might be planned in accordance with recent findings.Communicated by Ramaswamy H. Sarma.

Prevalence of metabolic syndrome in East Azerbaijan-Iran and its determinants factors

Introduction

Metabolic syndrome (MetS) is a prevalent metabolic disorder with increasing prevalence attributed to extended life expectancy. This study aims to investigate MetS prevalence and its determinants in the East-Azerbaijan population.

Methods

Conducted as a cross-sectional study within the East Azerbaijan region, this research is based on a major Lifestyle Promotion Project. The study encompasses 700 participants aged 15 to 65 years, representing the general population and selected using probability proportional to size multistage stratified cluster sampling. MetS diagnoses were conducted using the adult Panel III criteria. Data on socio-demographics, smoking status, and physical activity levels were collected through questionnaires.

Results

Among participants, the mean age was 42.4±12.38 years, and the mean body mass index was 27.69±4.94 kg/m2. The MetS group exhibited higher mean age and body mass index compared to the non-MetS group (P<0.001). The prevalence of MetS in the population was 34.2%, with higher rates in females (37.1%) compared to males (30.5%), though this difference wasn't statistically significant (P=0.11). Notably, a substantial distinction was observed between the two groups regarding education levels (P<0.001).

Conclusion

The study reveals a significant association between increasing age and higher prevalence of MetS. Furthermore, lower educational levels were linked to an elevated prevalence of MetS. While other socio-demographic factors didn't demonstrate statistically significant relationships, these findings emphasize the importance of targeted interventions and education in mitigating MetS risks.

Prevalence and risk factors of diabetes mellitus and hypertension in North East Tunisia calling for efficient and effective actions

Diabetes and hypertension are a serious public health problem worldwide. In the last decades, prevalence of these two metabolic diseases has dramatically increased in the Middle East and North Africa region, especially in Tunisia. This study aimed to determine the prevalence of type 2 diabetes (T2D) and High Blood Pressure (HBP) in Zaghouan, a North-East region of Tunisia. To this end, an exploratory study with stratified random sampling of 420 participants has been carried out. Various data were collected. Blood samples and urine were drawn for biochemical assay. Then, all data were analyzed using the statistical R software. Results showed an alarming situation with an inter-regional difference in prevalence of obesity (50.0%, CI 95.0%), HBP (39.0%, CI 95.0%) and T2D (32.0%, CI 95.0%). This study allowed the discovery of 24, 17 and 2 new cases of T2D, HBP and T2D&HBP respectively. The association of some socio-economic factors and biochemical parameters with these chronic diseases has been highlighted. To conclude, the health situation in the governorate of Zaghouan requires urgent interventions to better manage the growing epidemic of non-communicable diseases (NCD) in the region. This study demonstrated the importance of engaging health policy makers in road mapping and implementing national NCD prevention programs.

A pragmatically before-after trial of tele-visits vs face-to-face visits for chronic patients during the COVID-19 pandemic: patient-reported adherence

BACKGROUND

During the COVID-19 pandemic, chronic patients are at a higher risk of contamination with the virus. Specific strategies are required to restrict these patients' exposure to contaminated areas and improve medication adherence. One suggested strategy is tele-visiting, which is effective for the continuity of care and medication adherence during the pandemic.

OBJECTIVE

The present study aimed to explore the effect of tele-visiting services via telephone on chronic patients' medication adherence before and after implementing a tele-visit program during the COVID-19 pandemic.

METHODS

All patients received the tele-visit twice on the phone during the study. To compare patients' medication adherence in face-to-face visits and tele-visit, an adapted version of the Morisky Medication Adherence Scale-8 was used. Paired-samples T-test was run to measure participants' medication adherence before and after the tele-visit program.

RESULTS

The tele-visit was run for 314 patients. The participants' adherence score before the intervention was 60.02, and after the intervention was 59.9. As the paired-sample T-test results showed, the difference between these two was not statistically significant. Moreover, medication adherence was not significantly associated with any of these variables: BMI, occupation, comorbidities, duration of disease, age, gender, marital status, and education level.

CONCLUSIONS

The present findings showed that chronic patients' medication adherence did not differ significantly in face-to-face visits and tele-visiting. During the Covid-19 pandemic, due to the effectiveness of tele-visiting services, they can be used effectively to lower the transmission rate of the disease and reduce healthcare providers' burden.

The Burden of Hypertension and Prehypertension in a Community Health Centre of Haryana

Background Hypertension (HTN) is endemic in India and it is considered a public health challenge in both economically developed and developing nations. Unfortunately, despite its high prevalence, its awareness, treatment, and control status are low in urban as well as rural Indian populations. Objectives To determine the burden of hypertension and prehypertension in a Community Health Center (CHC) and to find the association of hypertension with the age group and sex of study subjects. Methodology A cross-sectional study was carried out among 713 patients of age 20 years and above attending the Out Patient Department (OPD) of the Community Health Centre (CHC), Barwala in the Hisar district of Haryana. JNC 7 classification of blood pressure was used to diagnose hypertension. The collected data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Appropriate statistical tests were used. Result Out of the total patients enrolled, 200 (28.1%) were found to be hypertensives. The burden of prehypertension was further observed to be 28.1%. About (61.6%) of OPD patients were female. Among hypertensive patients, nearly half (48.8%) were in the age group of 60-80 years whereas the majority of the hypertensives (56%) were females. Conclusion In our study, more than 50 percent of OPD patients were found to have hypertension and pre-hypertension. Health-seeking behavior was more among females.

Prevalence of hypertension in Iran: An updated systematic review and meta-analysis of community-based studies

Background

Hypertension (HTN) is one of the primary risk factors for heart disease and stroke worldwide. The present meta-analysis was aimed to systematically review and statistically estimate the prevalence rate of pre-hypertension (PHTN) and HTN in the Iranian child/adolescent and adult age groups.

Methods

In this study, four International databases, including PubMed, Scopus, Web of Science, and Cochrane, as well as three Iranian databases, including SID, Magiran, and IranMedex, were separately investigated for articles published before January 2021. Also, we estimated the pooled effect size for the prevalence of PHTN and HTN in children/adolescent and adult age groups. Stata software (version 14.0) was used for all statistical analyses.

Results

From a total of 1185 articles found in database searches, fifty-one were included in the meta-analysis. The prevalence of HTN in the Iranian adult population was 26.26% (25.11 % and 26.22 % for women and men, respectively). Meanwhile, the prevalence of PHTN and HTN in the child/adolescent age group was 8.97% (95% CI 7.33 - 10.61) and 8.98% (95% CI 7.59 - 10.36), respectively.

Conclusions

This study provides information which can be used for various purposes, including study designing. Further nationwide surveys should be carried out to obtain accurate information on the HTN prevalence rate, particularly based on the American College of Cardiology /American Heart Association guidelines in the Iranian population.

Awareness, treatment, and practices of lifestyle modifications amongst diagnosed hypertensive patients attending the tertiary care hospital of Karachi: A cross-sectional study

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.

Geospatial epidemiology of hypertension and its risk factors in India: Findings from National Family Health Survey (2015-2016)

Background

The fourth round of National Family Health Survey (2015-2016) measured blood pressure for the first time and provided a unique opportunity of exploring trends in hypertension prevalence across states and districts for the first time.

Aim

This study will be the first in India to estimate the geospatial variation of hypertension among those in the 15-49 years age group in India.

Materials and Methods

Out of a total of 616,346 selected occupied households, 601,509 were successfully interviewed, giving a response rate of 98%. We adjusted the proportion of hypertension obtained by using national sample weights. We built a multivariable logistic regression model to assess the determinants of hypertension.

Results

The overall weighted prevalence of hypertension was 11.7%, and the prevalence was 11.1% in females and 11.0% in males. Urban areas had a higher prevalence (13.0%) compared to rural areas (11.0%). Those with no education (14.4%) and those who reported smoking (16.5%) had hypertension. Consumption of alcohol, fruits, and eggs was also found to be significantly related to hypertension.

Conclusion

Hypertension epidemic is spreading alarmingly in India across rural and urban populations. Disturbingly, the hypertension prevalence is now becoming more concentrated among the poor. This phenomenon has serious implications for the country's social and economic well-being. Urgent preventive measures need to be taken at a multidisciplinary level.

Prevalence and determinants of hypertension and associated comorbidities in non-pregnant women of reproductive age group (15-49 years): Evidence from National Family Health Survey (NFHS-4), India

Background

Hypertension in women is generally underestimated and undiagnosed as women are considered to be at a lower risk of cardiovascular disease than men in addition to gender-related differences in healthcare seeking behaviour and access to healthcare. As hypertension extends a substantial impact on the cardiovascular health of women and can pose an enormous burden on the healthcare systems in India, identification of its risk factors along with co-morbidities becomes necessary for planning of cardiovascular risk prevention, reduction and mitigation interventions.

Aim

This study aimed at estimating the prevalence and associated demographic and lifestyle risk factors of hypertension (HT) along with examining comorbidity patterns in women of reproductive age (15-49 years) in India.

Material and Methods

We analyzed data of 667,258 non-pregnant women of the reproductive age group (15-49 years) from the National Family Health Survey (NFHS)-4 dataset. We used maps to present the spatial patterns of HT in women across states and union territories and logistic regression modelling to identify associated factors.

Results

The overall prevalence of HT was 10.9% among women (15-49 years), with 60.7% of these having at least one comorbidity. While the prevalence of 'HT only' was higher in women 15-29 years of age (48.0%), the prevalence of HT with co-morbidities was higher in women aged ≥30 years (63.3%). Logistic regression analysis showed higher odds of 'HT and ³ two comorbidities' with age ³30 years (AOR 3.46, 95% CI 3.23-3.72), higher odds of 'HT only' with alcohol consumption (AOR 1.32, 95%CI 1.23-1.42), and higher odds of 'HT and one comorbidity' with BMI ³23 Kg/m² (AOR 1.17, 95%CI 1.14-1.21). Also, region-wise, the prevalence of HT was highest in the states of Uttar Pradesh (11.6%), Madhya Pradesh (8.0%), and Assam (6.9%).

Conclusion

The high prevalence of HT among women aged 15-49 years has serious medical, socio-economic, implications that warrant urgent and immediate gender-specific healthcare interventions. Along with lifestyle modifications, early and timely screening of HT, increasing awareness among young school-going girls, including rural areas, could flatten the HT population curve in India.

Prevalence of central obesity and its associated risk factors among adults in Southeast Ethiopia: A community-based cross-sectional study

BACKGROUND

Obesity and overweight are known public health problems that affect populations across the world. These conditions have been associated with a wide range of chronic diseases including type 2 diabetes mellitus, cardiovascular disease, and cancers. In Ethiopia, the literature regarding the burden of central (abdominal) obesity is scarce. This study aimed to fill this gap by assessing the prevalence and risk factors associated with central obesity among adults in Ethiopia.

METHODS

From May to July 2021, a community-based cross-sectional survey was conducted on a sample of 694 adults aged ≥18 years in administrative towns of Bale zone, Southeast Ethiopia. Multi-stage sampling followed by systematic random sampling was employed to identify study participants. Waist and hip circumferences were measured using standard protocols. The World Health Organization STEPS wise tool was used to assess risk factors associated with central obesity. Bi-variable and multi-variable binary logistic regression were used to identify factors associated with central obesity. Adjusted odds ratios (AOR) and their corresponding 95% confidence intervals (CI) have been reported to estimate the strength of associations.

RESULTS

The overall prevalence of central obesity using waist circumference was 39.01% [(95% CI: 35.36-42.76; 15.44% for men and 53.12% for women)]. Multi-variable binary logistic regression analysis revealed that female sex (AOR = 12.93, 95% CI: 6.74-24.79), Age groups: 30-39 years old (AOR = 2.8, 95% CI: 1.59-4.94), 40-49 years (AOR = 7.66, 95% CI: 3.87-15.15), 50-59 years (AOR = 4.65, 95% CI: 2.19-9.89), ≥60 years (AOR = 12.67, 95% CI: 5.46-29.39), occupational status like: housewives (AOR = 5.21, 95% CI: 1.85-14.62), self-employed workers (AOR = 4.63, 95% CI: 1.62-13.24), government/private/non-government employees (AOR = 4.68, 95% CI: 1.47-14.88), and skipping breakfast (AOR = 0.46, 95% CI: 0.23-0.9) were significantly associated with central obesity.

CONCLUSIONS

Abdominal obesity has become an epidemic in Bale Zone's towns in Southeastern Ethiopia. Female sex, age, being employed were positively associated with central obesity, while skipping breakfast was a protective factor.

Socio-economic Correlates of Body Mass Index, Blood Pressure and Contraceptive Use by Reproductive age-group Females

Background: Oral Contraceptive use, BP and BMI are strongly associated variables in terms of socio economic conditions.  Oral Contraceptives are an important and widely accepted contraceptive modality used throughout the world. Aim & Objective: This study aims to examine the effects of socio-economic factors on Body Mass Index (BMI), Blood pressure (BP) and contraceptive use by reproductive age-group females of Uttarakhand. Settings and Design: This study utilizes nationwide data from the Fourth National Family Health Survey (NFHS-IV). Methods and Material: Information was collected from Indian Institute of Population Sciences (IIPS) Mumbai and 17,300 women of Uttarakhand were considered for this study. Statistical analysis used: For inter age-group comparisons of blood pressure, BMI and socio-demographic indicators, analysis of variance (ANOVA) technique has been used. Results: The variation in mean age at menarche was found to be significant (p< 0.01, ANOVA). The numbers of live births over the women's total lifetime were lower in the younger age groups (p<0.01, ANOVA). Conclusions: The important findings of present study were that the use of contraceptive tended to have increased BMI and elevated blood pressure, even though the magnitude of these was little (equal to 4% and 40% respectively).

Modelling of South African Hypertension: Application of Panel Quantile Regression

Hypertension is one of the crucial risk factors for morbidity and mortality around the world, and South Africa has a significant unmet need for hypertension care. This study aims to establish the potential risk factors of hypertension amongst adults in South Africa attributable to high systolic and diastolic blood pressure over time by fitting panel quantile regression models. Data obtained from the South African National Income Dynamics Study (NIDS) Household Surveys carried out from 2008 to 2018 (Wave 1 to Wave 5) was employed to develop both the fixed effects and random effects panel quantile regression models. Age, BMI, gender (males), race, exercises, cigarette consumption, and employment status were significantly associated with either one of the BP measures across all the upper quantiles or at the 75th quantile only. Suggesting that these risk factors have contributed to the exacerbation of uncontrolled hypertension prevalence over time in South Africa.

Prevalence and associated risk factors of hypertension and pre-hypertension among the adult population: findings from the Dubai Household Survey, 2019

BACKGROUND

Minimal data is available on the prevalence and correlates of hypertension and prehypertension in Dubai. The study aims to measure the prevalence of hypertension and pre-hypertension and the associated socio-demographic characteristics, behavioral risk factors and comorbidities among the adult population of Dubai.

METHODS

This study used data from the Dubai Household Health Survey, 2019. A cross-sectional population survey based on a complex stratified cluster random design. The total eligible sample included 2530 adults (18+). Sociodemographic and behavioral factors were considered as independent covariates. The main study outcome variables, pre-hypertension and hypertension, were ordinal, with normotension as the reference group.

RESULTS

The overall prevalence of hypertension in adults was 32.5% (38.37% in males and 16.66% in females). Prehypertension was prevalent in 29.8% of adults in Dubai (28.85% in males and 32.31% in females). The multivariate logistic regression analysis revealed that age groups, gender, occupation, and high Body Mass Index were significantly associated with a higher risk of hypertension at the level of P < 0.05. No clear trend toward a higher correlation of hypertension was noted with the increase in age, except after the age of 50 years. Males were five- times more likely to be hypertensive than females. Participants enrolled in skilled and service works had a five times higher risk of hypertension, compared with the reference group (professionals). Obese subjects had a 5.47-times greater correlation of hypertension compared with normal-weight subjects. Physically active individuals were less likely to develop hypertension. For the correlates with prehypertension in the present analysis, skilled and service workers and those working in elementary jobs had a higher risk of prehypertension, compared with the reference group (professionals) Individuals with a status of overweight were associated with a higher prevalence of prehypertension compared with people of normal weight.

CONCLUSIONS

This study showed a high prevalence of prehypertension and hypertension among adults in Dubai. Some socio-demographic and behavioral risk factors were correlated with prehypertension and hypertension among the studied population. Interventions aiming at increasing public awareness about such risk factors are essential.

Quantitative Real-Time Analysis of Differentially Expressed Genes in Peripheral Blood Samples of Hypertension Patients

Hypertension (HTN) is considered one of the most important and well-established reasons for cardiovascular abnormalities, strokes, and premature mortality globally. This study was designed to explore possible differentially expressed genes (DEGs) that contribute to the pathophysiology of hypertension. To identify the DEGs of HTN, we investigated 22 publicly available cDNA Affymetrix datasets using an integrated system-level framework. Gene Ontology (GO), pathway enrichment, and transcriptional factors were analyzed to reveal biological information. From 50 DEGs, we ranked 7 hypertension-related genes (p-value < 0.05): ADM, ANGPTL4, USP8, EDN, NFIL3, MSR1, and CEBPD. The enriched terms revealed significant functional roles of HIF-1-α transcription; endothelin; GPCR-binding ligand; and signaling pathways of EGF, PIk3, and ARF6. SP1 (66.7%), KLF7 (33.3%), and STAT1 (16.7%) are transcriptional factors associated with the regulatory mechanism. The expression profiles of these DEGs as verified by qPCR showed 3-times higher fold changes (2−ΔΔCt) in ADM, ANGPTL4, USP8, and EDN1 genes compared to control, while CEBPD, MSR1 and NFIL3 were downregulated. The aberrant expression of these genes is associated with the pathophysiological development and cardiovascular abnormalities. This study will help to modulate the therapeutic strategies of hypertension.

Rosuvastatin, Perindopril and Ezetimibe loaded instant release buccal films: Development and in vitro characterization

BACKGROUND

Rosuvastatin Calcium and Ezetimibe are used to control cholesterol level while Perindopril Erbumine is used to treat hypertension. Hepatic metabolism reduces the therapeutic effect of these drugs.

OBJECTIVE

Instant release buccal films (IRBFs) could possibly be a solution to this issue. The objective of the study was to formulate IRBFs of Rosuvastatin Calcium, Perindopril Erbumine and Ezetimibe using solvent casting technique.

METHODS

Polymers used to prepare IRBFs included hydroxypropyl methylcellulose (HPMC E5), PEG 400 (as plasticizer) and Tween 80 (as surfactant). Solvent casting technique was used to fabricate the films, followed by their in-vitro analysis including high performance liquid chromatography (HPLC), X-ray diffraction (XRD), fourier transform infrared evaluation (FTIR), In-vitro dissolution, In-vitro disintegration, stability tests, scanning electron microscopy (SEM), folding fortitude, thickness evaluation, surface pH, tensile strength, weight variation and percentage moisture content.

RESULTS

Optical microscopy as well as SEM analysis displayed that the surfaces of IRBFs were smooth with uniform mixing of ingredients. IRBFs disintegrated within 15 seconds while on dissolution they exhibited instant drug release i.e. 100% release in 2 minutes.

CONCLUSIONS

The results show promising potential of IRBFs in drug delivery.

Baseline prevalence of high blood pressure and its predictors in a rural adult population of Bangladesh: Outcome from the application of WHO PEN interventions

This cross-sectional study estimated the prevalence of high blood pressure (BP) and examined its predictors at baseline following protocol 1 (actions 1 and 2) of World Health Organization (WHO) Package of Essential Noncommunicable Disease (PEN) Interventions in a selected rural area of Bangladesh. A total of 11 145 adults (both sex and age ≥ 18 years) completed both the questionnaire and clinical measurements at the household and community clinics, respectively. We defined high BP as systolic BP ≥ 120 mmHg or diastolic BP ≥ 80 mmHg, prehypertension (pre-HTN) as systolic BP 120-139 mmHg or diastolic BP 80-89 mmHg, and hypertension (HTN) as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg and/or anti-hypertensive drug intake for the raised BP. The prevalence of high BP was 51.2% (pre-HTN, 25.3%; HTN, 25.9%). Among them, the proportion of pre-HTN was higher among men (28.7%) while HTN was higher among women (27.4%). Other than fast food intake (pre-HTN, OR: 1.110, P = .063) and women sex (HTN, OR: 1.236, P < .001), the pre-HTN and HTN had higher odds for having same predictors as follows: age ≥ 40 years, family history of HTN, physical inactivity, central obesity, generalized obesity, and diabetes. In conclusion, the application of WHO PEN protocol 1 detected one-fourth of the rural adult population had pre-HTN and HTN respectively, and the common significant predictors of those were the age, family history of HTN, physical inactivity, generalized obesity, and diabetes.

Hypertension and pre-hypertension in Middle East and North Africa (MENA): A meta-analysis of prevalence, awareness, treatment, and control

Hypertension (HTN) is one of the most important public health challenges, especially in developing countries. Despite individual studies, information on the exact prevalence of prehypertension (pre-HTN) and HTN in the Middle East and North Africa (MENA) is lacking. This meta-analysis was conducted to evaluate prevalence of pre-HTN and HTN, awareness, treatment, and control in the MENA region. PubMed, Web of Science, and Scopus databases were searched from inception to April 30, 2021. Keywords included hypertension, pre-hypertension, awareness, treatment, and control. The quality of the included studies was evaluated using the Hoy scale. A random-effects model was evaluated based on overall HTN. The heterogeneity of the preliminary studies was evaluated using the I² test. A total of 147 studies involving 1,312,244 participants were included in the meta-analysis. Based on the results of the random-effects method (95% CI), the Prevalence of pre-HTN and HTN were 30.6% (95% CI: 25.2, 36.0%; I² = 99.9%), and 26.2% (95% CI: 24.6, 27.9%; I² = 99.8%), respectively. The prevalence of HTN awareness was 51.3% (95% CI: 47.7, 54.8; I² = 99.0%). The prevalence of HTN treatment was 47.0% (95% CI: 34.8, 59.2; I² = 99.9%). The prevalence of HTN control among treated patients was 43.1% (95% CI: 38.3, 47.9; I² = 99.3%). Considering the high prevalence of HTN, very low awareness, and poor HTN control in the region, more attention should be paid to preventive programs for HTN reduction.

Individual and community-level determinants of overweight and obesity among urban men: Further analysis of the Ethiopian demographic and health survey

Background

Overweight and obesity have become a serious public health problem in both developed and developing countries, particularly in urban areas. However, there are limited studies conducted to identify the risk factors of overweight and obesity in Ethiopia, especially among men. Therefore, this study aimed to assess individual and community level determinants of overweight and obesity among urban men in Ethiopia.

Methods

This study used the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A weighted sample of 2259 urban men aged 15–59 years were included in this analysis. A multilevel logistic regression model was used to assess the determinants of overweight and obesity among the study participants.

Results

Men aged 30–44 years old (AOR = 3.1, 95% CI: 2.3–4.11), 45–59 years old (AOR = 4.8, 95% CI: 3.4–6.9), married (AOR = 1.7, 95% CI: 1.3–2.2), with secondary education (AOR = 2.7, 95% CI: 1.6–4.7), with higher education (AOR = 3.6, 95% CI: 2.1–6.2), watching television at least once a week (AOR = 1.7, 95% CI: 1.1–2.7), being from high rich communities (AOR = 2.4, 95% CI: 1.5–3.7), and living in three metropolises (Addis Ababa, Harari, Diredawa) were more likely to be overweight or obese (AOR = 1.8, 95% CI: 1.1–2.9). However, currently unemployed men were less likely to be overweight or obese (AOR = 0.5, 95% CI: 0.3–0.7).

Conclusion

Being older age, being married, having higher educational status, having higher frequency of watching television, being residents of three metropolises (Addis Ababa, Harari, and Diredawa), and being from high rich communities were found to be predictors of overweight and obesity in Ethiopian men. Therefore, it is essential to design strategies and programs to reduce or prevent overweight and obesity with special focus on the identified risk factors.

Prevalence of hypertension and related risk factors in central Iran: Results from Yazd Health Study

BACKGROUND

The prevalence of hypertension (HTN) varies across countries due to differences in its related risk factors. This study aimed to investigate the prevalence of HTN and related risk factors among adults.

METHODS

This study was conducted on the data from the recruitment phase of Yazd Health Study. Using multi-stage random cluster sampling, 10000 adults of 20-69 years were selected. Self-reported HTN (diagnosed by a physician) was recorded in a home visit. Blood pressure (BP) was measured using a standard protocol and categorized based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and ýTreatment of High Blood Pressure (JNC-7) classification. T-test was used to examine the gender differences. Qualitative variables were presented as number (frequency). Chi-square test and bivariate logistic regression were carried out to determine the association between risk factors.

RESULTS

The response rate was 95% (n = 9975). The prevalence of positive history of HTN was 18.5%. The mean systolic and diastolic BP was 126.5 ± 18.4 and 80.2 ± 12.5 mmHg, respectively. The prevalence of HTN was 36.0% (95%CI: 35.1-36.9). Its prevalence reduced by high-education, physical activity, lower BMI, and lack of history of diabetes mellitus (DM) (P < 0.0001). HTN is less common in smokers (P < 0.0001). Logistic regression analysis showed that HTN was higher among men (OR: 1.83; 95%CI: 1.64-2.03), the elderly (OR: 5.15; 95%CI: 4.20-6.31), low-educated (OR: 1.40; 95%CI: 1.17-1.67), and diabetics (OR: 1.20; 95%CI: 1.05-1.38). The prevalence of HTN was 2 times higher in obeses. HTN did not have a significant relationship with inactivity, smoking, and hypercholesterolemia.

CONCLUSION

The prevalence of HTN was high. By identifying modifiable risk factors, health policymakers can prioritize intervention programs. It is necessary to inform younger adult groups how these factors can be managed through a healthy lifestyle and nutritional habits.

Long-term Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rate in the Middle East and North Africa: a Systematic Review and Meta-analysis of 178 Population-Based Studies

PURPOSE OF REVIEW

This study investigated and pooled the long-term trends in prevalence, awareness, treatment, and control of hypertension (HTN) in the Middle East and North Africa (MENA) region. In this systematic review and meta-analysis, we searched MEDLINE/PubMed, Web of Science, Google Scholar, EMBASE, and Scopus between database inception and November 2020. All cross-sectional studies that investigated the prevalence of pre-HTN, HTN, awareness, treatment, and control in the MENA counties were included. The selection study, data extraction, and quality assessment were conducted by two investigators independently. Heterogeneity between studies was assessed using Cochran's Q test and I-squared, and due to sever heterogeneity between studies, the random effect model was used to pool the estimates. Sensitivity analysis was performed to estimate the long-term trends in prevalence, awareness, treatment, and control rates of HTN according to definition of HTN as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for HTN.

RECENT FINDINGS

Overall, 178 studies met the inclusion criteria. Studies comprised 2,262,797 participants with a mean age of 45.72 ± 8.84 years. According to random effect model, the pooled prevalence of pre-HTN and HTN was 33% (95% CI 28, 39) and 26% (25, 27), respectively. Over the past three decades, prevalence of hypertension increased significantly in the region. The pooled awareness, treatment, and control rates were 50% (48, 53), 41% (38, 44), and 19% (17, 21), receptively. The pooled awareness, treatment, and control rates of HTN were lower significantly in men than women. According to definition of HTN as blood pressures above 140/90 mm Hg, over the past three decades, although the awareness and treatment rates did not change significantly, the control rates improved significantly in the region. The findings showed that HTN is a significant public health problem in the MENA region. Although there are low levels of pooled awareness, treatment, and control rates, the control rates improved over the past three decades in the region.

Prevalence and predictors of prehypertension and hypertension in adult population of rural Southern India-An epidemiological study

Introduction:

Hypertension is considered as one of the major health problem worldwide and the most important risk factor for non-communicable diseases.

Aims:

To estimate the prevalence and the risk factors of prehypertension and hypertension.

Methods and Material:

A community-based cross-sectional study was conducted among adult population of rural area of Chittoor District. WHO STEPS was applied for data collection from 1,742 study participants aged 18 years and above. Chi-square test, Fisher exact, and ANOVA test applied to find out the intragroup and intergroup variable association with raised blood pressure.

Results:

The overall prevalence of hypertension and prehypertension in our study was 21.5% [95% CI: (19.6–23.5)] and 42.8% [95% CI: (39.5–46.3)], respectively. Males had higher prevalence when compared to females. The mean systolic and diastolic blood pressure was 118.7 ± 17.6 mmHg and 77.1 ± 9.7 mmHg, respectively. The odds of being hypertensive was higher among older age group (OR: 3.83), male study participants (OR: 1.83), either widowed or separated (OR: 2.03), unemployed (OR: 1.51), and those who belonged to upper socioeconomic status (OR: 2.01). Those who were overweight (OR: 3.15), obese (OR: 2.55) and having central obesity (OR: 1.74), and also tobacco smokers (OR: 1.53) were having higher odds of hypertension. Significant association was found between hypertension and age, gender, marital status, body mass index, abdominal obesity, tobacco smoking, and physical inactivity.

Conclusion:

The prevalence of prehypertension and hypertension in this study was found to be high in rural area of Andhra Pradesh. There is a need to develop a community-based program, which would aim at minimizing the risk factors of hypertension.

A predictive model for identifying low medication adherence among older adults with hypertension: A classification and regression tree model

Various individual characteristics may affect medication adherence; however, few studies have investigated the effect of interrelationships among these various individual characteristics on medication adherence. This cross-sectional study explored the interrelationships among risk factors for medication adherence and established a predictive model of low medication adherence among older adults with hypertension. Convenience sampling was used to recruit 300 older adults with hypertension. The following parameters were recorded: demographic and disease characteristics, health beliefs, self-efficacy, social support, and medication adherence of antihypertensive drugs. Classification and regression tree (CART) analysis was performed to develop a predictive model of low medication adherence. The CART model revealed that health belief, disease duration, self-efficacy, and social support interacted to contribute to various pathways of low medication adherence. The predicted accuracy of the model was validated with a low misclassification rate of 26%. The proposed classification model can help identify risk cases with low medication adherence. Suitable health education programs based on these risk factors to manage and improve medication adherence for older adults with hypertension could be considered.

Gut permeability is associated with hypertension and measures of obesity but not with Endothelial Dysfunction in South African youth

Background

Though gut permeability has shown to be associated with measures of obesity and hypertension, its relationship with endothelial dysfunction, an early predictor for cardiovascular diseases remains unknown.

Objective

This study assessed the relationship between hypertension, measures of obesity, gut permeability and endothelial dysfunction.

Methods

A cross-sectional quantitative study which enrolled 151 South African youths was conducted. Anthropometric and blood pressure measurements were performed. Zonulin, a marker for gut permeability; adiponectin, an anti-inflammatory molecule, as well as asymmetric dimethylarginine (ADMA) and Nitric oxide (NO) which are markers for endothelialfunction were assayed.

Results

Approximately eighteen percent (17.88%) of the participants were hypertensive while 40.4% were pre-hypertensive. Adiponectin significantly increased in hypertensive subjects and negatively correlated (p<0.05) with measures of obesity but was not associated with gut permeability and endothelial dysfunction. Increased body mass index (BMI) and visceral fat (VF) predicted reduced adiponectin (inflammation). Zonulin was significantly higher (p<0.05) in hypertensive subjects and positively associated (p<0.05) with systolic blood pressure (SBP) in females. A positive relationship (p<0.05) was observed between zonulin and measurements of obesity. Moreover, zonulin negatively associated (p<0.05) with ADMA but positively associated (p<0.05) with NO in males. Increased VF and waist circumference predicted gut permeability.

Conclusion

Gut permeability was associated with hypertension and measures of obesity but not with markers of endothelial dysfunction in a South African youth population.

Joint modeling of blood pressure measurement and survival time of hypertension patients

Hypertension is a chronic disease that has a major health problem over the centuries due to its significant contribution to the global burden. The objective of this study was to examine the association of survival time and longitudinal Systolic Blood Pressure (SBP) measurement and finding potential barrier that affects SBP measurement and the survival time of hypertension patients. The study considered a cohort of 318 hypertension patients who were aged 18 years or older and were under follow-up from January 1, 2012, to February 30, 2020, at Arba Minch General Hospital. To analyze the data we employed linear mixed effect model, Weibull model, and joint modeling approach for longitudinal and survival data. The results from joint model analysis indicate that systolic blood pressure measurement is significantly associated with survival time of hypertension patients. The results from the longitudinal sub-model reveals that alcohol use, Khat intake, smoking tobacco, stages of hypertension diseases, adherence to treatment, related diseases, and family history had statistical significant relationship with mean change in the [Formula: see text] measurement. Furthermore, from the survival sub-model, we found the survival probability of hypertension patients was determined by family history, stages of hypertension disease, related diseases, and smoking tobacco. The analysis suggests that there is a strong association between SBP measurement and survival time of hypertension patients. Thus we recommend aggressive work by all concerned bodies towards awareness creation about the effect of potential barriers.

Genome-wide association study on blood pressure traits in the Iranian population suggests ZBED9 as a new locus for hypertension

High blood pressure is the heritable risk factor for cardiovascular and kidney diseases. Genome-wide association studies(GWAS) on blood pressure traits increase our understanding of its underlying genetic basis. However, a large proportion of GWAS was conducted in Europeans, and some roadblocks deprive other populations to benefit from their results. Iranians population with a high degree of genomic specificity has not been represented in international databases to date, so to fill the gap, we explored the effects of 652,919 genomic variants on Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Hypertension (HTN) in 7694 Iranian adults aged 18 and over from Tehran Cardiometabolic Genetic Study (TCGS). We identified consistent signals on ZBED9 associated with HTN in the genome-wide borderline threshold after adjusting for different sets of environmental predictors. Moreover, strong signals on ABHD17C and suggestive signals on FBN1 were detected for DBP and SBP, respectively, while these signals were not consistent in different GWA analysis. Our finding on ZBED9 was confirmed for all BP traits by linkage analysis in an independent sample. We found significant associations with similar direction of effects and allele frequency of genetic variants on ZBED9 with DBP (genome-wide threshold) and HTN (nominal threshold) in GWAS summary data of UK Biobank. Although there is no strong evidence to support the function of ZBED9 in blood pressure regulation, it provides new insight into the pleiotropic effects of hypertension and other cardiovascular diseases.

Sex differences in prevalence and risk factors of hypertension in India: Evidence from the National Family Health Survey-4

To estimate sex-specific prevalence and associated socio-economic, demographic, and lifestyle risk factors of hypertension in India. We used data from the National Family Health Survey (NFHS-4) of 2015-16. The analysis based on 6,99,686 women (15-49 years) and 1,12,122 men (15-54 years) whose blood pressure (BP) were measured during the survey. Bivariate distribution was used to show the prevalence of hypertension and, maps were used to present its spatial patterns. Logistic regression model was used to identify sex-specific association between risk factors and hypertension. Results show that the overall prevalence of hypertension was 16.32% among men and 11.56% among women. We also found that the prevalence of hypertension across selected socio-economic, demographic and lifestyle background characteristics and in a majority of the states was higher among men compared to women. Odds ratios from logistic regression analysis direct sex-related differences in risk factors. Hypertension increases with an increase in age and the risk is higher among older women (AOR, 5.58; 95% CI, 5.16-6.03 for women aged 40-49 and AOR, 4.24; 95% CI, 3.94-4.57 for men aged 50-54) compared to men. Education, types of jobs (specially technical, administrative and managerial), marital status and non-vegetarian diet were significantly associated with hypertension in men. While other than age; non-working, consumption of alcohol, and being a diabetic was found to be major risk factors for this disease among women. There are sex-related differences in prevalence as well as risk factors of hypertension in India. In order to prevent early developments of hypertension, awareness related to changing lifestyles such as a diet rich in fruits, vegetables as well as screening to control BP should be promoted among youths and adults in India. The study also recommends sex-specific approaches in health infrastructure and policies besides increasing public awareness.

Longitudinal association between physical activity and blood pressure, risk of hypertension among Chinese adults: China Health and Nutrition Survey 1991-2015

OBJECTIVES

To examine the effects of physical activity (PA) in adults with or without prehypertension at baseline on systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension risk by gender.

METHODS

A total of 5986 men and 6525 women (≥18 years old) without hypertension-related disease at baseline who attended surveys from China Health and Nutrition Survey (1991-2015) at least twice were selected. In terms of the nested data structure, three-level random intercept growth model and three-level logistic regression were used to estimate the relationship between the PA and SBP/DBP or hypertension risk.

RESULTS

The incidence of hypertension increased from 10.86% in 1991 to 20.34% in 2015, and the median of PA dropped from 408 MET·h/week in 1991 to 104 MET·h/week in 2015. After adjusting confounders, PA in the third and fourth quartiles decreased SBP (by 0.98 and 0.96 mm Hg, p < 0.05) and DBP (by 0.30 and 0.38 mm Hg, p < 0.05), and it reduced the odds of hypertension by 12 and 15% (p < 0.05), compared with PA in the lowest quartile. For normotensive women in the third quartile of PA and prehypertensive women in the fourth quartile of PA, the risk of hypertension was reduced 15 and 22%, compared with women in the lowest quartile of PA.

CONCLUSIONS

Physical activity should be improved to the relatively high level to be effective in controlling blood pressure. Normotensive women had an association between physical activity and SBP, DBP, and the risk of hypertension.

Socioeconomic determinants of hypertension and prehypertension in Peru: Evidence from the Peruvian Demographic and Health Survey

Background

Peru is a Latin American country with a significant burden of hypertension that presents worrying rates of disparities in socioeconomic determinants. However, there is a lack of studies exploring the association between those determinants, hypertension and prehypertension in Peruvian population.

Objective

We aimed to assess the association betwgeen socioeconomic determinants, hypertension and prehypertension using a nationally representative survey of Peruvians.

Methods

We performed a cross-sectional analysis of the Peruvian Demographic and Health Survey (2018), which is a two-staged regional-level representative survey. We used data from 33,336 people aged 15 and older. The dependent variable was blood pressure classification (normal, prehypertension and hypertension) following the Seventh Report of the Joint National Committee (JNC-7) on hypertension management. Independent variables were socioeconomic: age, sex, marital status, wealth index, health insurance, education, region and area of residence. Due to the nature of the dependent variable (more than two categories), we opted to use the multinomial regression model, adjusting the effect of the multistage sample using the svy command. We tested interactions with the adjusted Wald test.

Results

The prevalence of prehypertension and hypertension was 33.68% and 19.77%, respectively. Awareness was higher in urban than in rural areas (9.61% vs. 8.31%, p = 0.008). Factors associated with a higher prevalence ratio of both prehypertension and hypertension were age (ratios rose with each age group), male sex (prehypertension aRPR 5.15, 95%CI 4.63–5.73; hypertension aRPR 3.85, 95% CI 3.37–4.40) and abdominal obesity (prehypertension aRPR 2.11, 95%CI 1.92–2.31; hypertension aRPR 3.04, 95% CI 2.69–3.43). Factors with a lower prevalence ratio of both diseases were secondary education (prehypertension aRPR 0.76, 95%CI 0.60–0.95; hypertension aRPR 0.75, 95% CI 0.58–0.97), higher education (prehypertension aRPR 0.78, 95%CI 0.61–0.99; hypertension aRPR 0.62, 95% CI 0.46–0.82), being married/cohabiting (prehypertension aRPR 0.87, 95%CI 0.79–0.95; hypertension aRPR 0.77, 95% CI 0.68–0.87), richest wealth index (only prehypertension aRPR 0.76, 95%CI 0.63–0.92) and living in cities different to Lima (rest of the Coastline, Highlands and Jungle). Having health insurance (only hypertension aRPR 1.26, 95%CI 1.03–1.53) and current drinking (only prehypertension aRPR 1.15, 95%CI 1.01–1.32) became significant factors in rural areas.

Conclusions

We evidenced socioeconomic disparities among people with hypertension and prehypertension. Better health policies on reducing the burden of risk factors are needed, besides, policy decision makers should focus on hypertension preventive strategies in Peru.

Determinants of Overweight or Obesity among Men Aged 20-59 Years: A Case-Control Study Based on the 2016 Ethiopian Demographic and Health Survey

BACKGROUND

Evidence shows that overweight or obesity has become a major public health problem in both developed and developing countries. However, there are limited studies conducted to identify the risk factors of overweight or obesity in Ethiopia. Therefore, this study aimed to assess the determinants of overweight or obesity among men aged 20-59 years in Ethiopia.

METHODS

This study used the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A case-control study was conducted based on the EDHS data; cases were men who were overweight or obese, depending on their body mass index, and controls were men with normal body mass index. Bivariate and multivariate binary logistic regression was performed to assess the determinants of overweight or obesity among the study participants.

RESULTS

A total of 610 cases and 2440 controls were included in this study. Men aged 30-39 years (adjusted odds ratio (AOR) = 2.2, 95% CI: 1.6-3.0) and ≥40 years (AOR = 3.4, 95% CI: 2.5-4.7) had higher odds of being overweight or obese compared to men aged 20-29 years old. The likelihood of overweight or obesity was significantly higher among married men (AOR = 1.5, 95% CI: 1.1-2.0), living in urban areas (AOR = 3.1, 95% CI: 2.1-4.4), those in the rich wealth quintile (AOR = 1.9, 95% CI: 1.2-2.9), and those with primary (AOR = 1.6, 95% CI: 1.1-2.3), secondary (AOR = 2.6, 95% CI: 1.7-3.9), and higher education (AOR = 3.6, 95% CI: 2.4-5.6). Additionally, men watching television at least once a week had higher odds (AOR = 1.5, 95% CI: 1.1-2.1) of being overweight or obese.

CONCLUSION

Men in the higher wealth quintile, older age, married, higher educational status, watching television at least once a week, urban dwellers, residents of big cities such as Addis Ababa and Harari, and residents of low land like Afar were more likely to be overweight or obese. Therefore, it is essential to design strategies and programs to reduce or prevent overweight or obesity with a special focus on the identified risk factors.

Association between a novel dietary lipophilic index (LI) with metabolic phenotypes in a community-based study in Tabriz- Iran

BACKGROUND

Dietary fatty acids are important dietary determinants of metabolic disorders in human. However, it is important to develop an index that considers not only the amount of dietary fatty acids but also the structure, fluidity and melting point of them. In the current study we investigated the association between a novel dietary lipophilic index (LI) with metabolic profile and dyslipidemia in a community based study in Tabriz-Iran.

METHODS

Dietary data were collected using a validated, 79-food item, semi-quantitative food frequency questionnaire, and dietary LI was calculated. Anthropometric variables were measured and metabolic profile including blood sugar, serum lipids and liver enzymes were assessed. Metabolic syndrome was defined according to the adult treatment panel (ATP) III criteria.

RESULTS

The mean age of the participants was 42.53 ± 12.03 years and most of the participants were women. Mean of dietary LI was 34.99 ± 6.91. Higher dietary LI was associated with higher body mass index (BMI) (β = 0.17, P < 0.04), waist circumference (β = 0.18, P < 0.01) and systolic blood pressure (β = 0.27, P < 0.01). Also LI was increased with increasing waist circumference (0.001), low density lipoprotein cholesterol (LDL-C) (0.001), and negatively associated with high density lipoprotein cholesterol (HDL-C) (0.001).

CONCLUSION

The novel dietary LI was considered as a useful tool in prediction of cardio-metabolic risk factors including general and central obesity, dyslipidemia and metabolic syndrome in a population-based study in Iran. Further researches in other disease and populations could highlight the application of this index in clinical settings.

Lifestyle patterns and their nutritional, socio-demographic and psychological determinants in a community-based study: A mixed approach of latent class and factor analyses

Background

Lifestyle risk factors, such as unhealthy diet, physical inactivity or tobacco smoking can have detrimental effects on health and well-being. Therefore, it is important to examine multiple lifestyle risk factors instead of single ones. Cluster analysis allows the combination of single health behaviors in order to recognize distinguished behavior patterns. This study aimed to evaluate lifestyle patterns of general adult population in northwest of Iran with particular focus on dietary patterns, physical activity, and smoking status.

Methods

The current cross-sectional study consists of 525 adults aged 18–64 years from East-Azarbaijan Iran. Latent class analysis (LCA) was applied to recognize patterns of lifestyle behaviors with ingredients of diet, physical activity, and smoking status. Dietary intake was assessed using a validated food frequency questionnaire and dietary patterns were derived using factor analysis. Biochemical parameters including fasting blood sugar (FBS), serum lipids, liver enzyme and serum 25(OH)-D3 were measured with commercial ELIZA kits.

Results

Mean ages of participants were 42.90 ± 11.89 years. Using principal component analysis (PCA) three major dietary patterns were extracted including traditional dietary pattern (e.g. nuts and dry fruits), unhealthy dietary pattern (e.g. fast foods, refined grains) and the healthy dietary patterns (e.g. fruits, vegetables). Using LCA, three classes of lifestyles pattern were identified: 1^st class was characterized by a healthy dietary pattern, moderate physical activity, and low probability of smoking. 2^nd class was characterized by a traditional dietary pattern, low level of physical activity and low probability of smoking and 3^rd class was characterized by a unhealthy dietary pattern, low level of physical activity and low probability of smoking and further analysis found that there were significant differences in body mass index (BMI), Waist-to-hip ratio (WHR), FBS, Hemoglobin (Hb), education levels and anxiety status between classes (P <0.05).

Conclusion

This study attempts to classify Iranian adults by their own health behavior. Healthcare professionals should be aware of associations between different lifestyle risk factors and health promotion strategies should further focus on multiple behaviors at the same time. In our country, more studies about the adult population are needed to support the observed findings of our study and therefore allow for a certain generalization of the observations.

Prevalence of hypertension and associated cardiometabolic risk factors in urban Rishikesh, Uttarakhand

BACKGROUND

Hypertension is one of the leading causes of premature death worldwide and is a major risk factor for cardiovascular disease and all-of them cause mortality. Out of the estimated 1.13 billion people who have hypertension, less than 1 in 5 people have it under control.

AIM AND OBJECTIVES

To study the prevalence of hypertension and associated risk factors in the urban population of Rishikesh and the association of hypertension with other determinants.

METHODOLOGY

A community based cross-sectional study was conducted in an urban area of Rishikesh. The World Health Organization (WHO) steps instrument and protocol was used for the assessment of risk factors and measurements. i.e. anthropometry and blood pressure. Sample size was calculated to be 478. Data was entered and analyzed using SPSS Version 20.0. Appropriate statistical tests were done. A P value of < 0.05 was considered significant.

RESULTS

The prevalence of hypertension in urban Rishikesh is 32.4%. The prevalence in male and female is 34.5% and 31.3% respectively. Among hypertensives 45.8% had hypertriglyceridemia, 32.2% had low high-density lipoproteins (HDL), 52.25% had fasting blood glucose more than 100, and 55.4% were obese individuals. Multivariate logistic regression analysis identified that age, waist circumference, body mass index, triglycerides level, and physical activity were independently associated with hypertension.

CONCLUSIONS

As the prevalence of hypertension and cardiometabolic risk factors were higher, necessary health interventions were required to reduce the morbidity/mortality of the disease.

Prevalence and determinants of hypertension among students of the University of Kinshasa, Democratic Republic of Congo: a cross-sectional study

BACKGROUND

The 2017 ACC/AHA Guideline categorized blood pressure into 4 levels:normal (SBP<120 and DBP <80mm Hg), elevated (SBP of 120-129 or DBP< 80 mmHg) and stage 1 (SBP of 130-139 or DBP of 80-89 mm Hg) or 2 (SBP≥140 orDBP≥90mmHg). Compared with the JNC7 guideline, the 2017 ACC/AHA guideline recommends using lower SBP and DBP levels to define hypertension.

OBJECTIVE

To determine the prevalence of hypertension as well as associated factors among students of the University of Kinshasa.

METHODS

This was a cross-sectional study conducted at the University of Kinshasa and including 1 281 students aged between 18 and 30. Blood pressure was assessed according to the WHO STEPwise approach, which is a standardized method of data collection, analysis and dissemination for the surveillance of non-communicable diseases in WHO member countries. The Chi-square and Student's t-tests and a multivariate logistic regression analysis have been used to evaluate the results. Statistical analyses were done using IBM SPSS version 21.

RESULTS

The prevalence of hypertension according to the guidelines from the 2017 ACC/AHA and the JNC 7 was 26.4 % (CI 95%; 23.9 - 28.9) and 7.3 % (CI 95%; 5.8 - 8.8), respectively. The results of multivariate logistic regression analysis showed that smoking, alcohol abuse, overweight, male sex, age ≥ 24 years old and low physical activity were associated with hypertension (p < 0.0001).

CONCLUSION

At least one out of four students had hypertension. These data should encourage public health authorities to develop strategies for screening of BP and topromote the adoption of healthy lifestyle in young adults.

Associated Factors of Hypertension in Women and Men in Vietnam: A Cross-Sectional Study

Background: Hypertension is a direct cardiovascular disease risk. It causes a heavy burden on the healthcare system globally. We aim to assess hypertension occurrence and its associated factors among women and men in Vietnam. Methods: A cross-sectional study was conducted from January to February 2019 on 2203 community-dwelling women and men aged 18 years or above. Participants’ characteristics, comorbidity, behaviors, and physical measures were evaluated. Hypertension was classified as systolic/diastolic blood pressure ≥140/90 mmHg or using antihypertensive medication. We analyzed data using logistic regression models. Results: The prevalence of hypertension was 24.3% (20.9% in women, 29.1% in men). For women, older age (odds ratio, OR, 6.80–12.41; p < 0.001), income above the poverty line (OR, 0.64; p = 0.008), diabetes comorbid (OR, 2.98; p < 0.001), added salts consumption (OR, 1.80; p < 0.001), overweight/obesity (OR, 1.64; p = 0.005), abdominal obesity (OR, 2.07; p < 0.001) were associated with hypertension. For men, older age (OR, 2.67–5.92; p < 0.001), diabetes comorbid (OR, 2.25; p = 0.010), smoking (OR, 1.38; p = 0.046), and overweight/obesity (OR, 2.18; p < 0.001) were associated with hypertension. Conclusions: Hypertension is prevalent in Vietnamese people. The associated factors of hypertension are varied by gender.

Hypertension and Pre-Hypertension Among Iranian Adults Population: a Meta-Analysis of Prevalence, Awareness, Treatment, and Control

PURPOSE OF REVIEW

This meta-analysis and systematic review was conducted to evaluate hypertension and prehypertension prevalence, awareness, treatment, and control in Iranian adults population.

RECENT FINDINGS

In this study, six international and national databases were searched from inception until August 30, 2018. Forty-eight studies performed on 417,392 participants were included in the meta-analysis. Based on the results of random effect method (95% CI), the overall prevalence of pre-hypertension, hypertension, awareness, treatment, and control were 31.6% (95% CI 24.9, 38.3; I2 = 99.7%), 20.4% (95% CI 16.5, 24.4; I2 = 99.9%), 49.3% (95% CI 44.8, 53.8; I2 = 98.5%), 44.8% (95% CI 28.3, 61.2; I2 = 99.9%), 37.4% (95% CI 29.0, 45.8; I2 = 99.3%), respectively. Considering the increasing prevalence of pre-hypertension, hypertension, as well as more than half of the participants were unaware of their disease and were not treated, the results of the present study can help policy-makers to increase hypertension awareness, control, and treatment, especially in high-risk individuals.

The Effects of Smartphone Applications on Patients Self-care with Hypertension: A Systematic Review Study

Introduction:

High blood pressure or hypertension is one of the chronic diseases causing other serious diseases and syndromes. Active involvement of the patient in the management of the disease is crucial in improving self-care and clinical outcomes. Mobile technology is nowadays used widely to improve the self-care process in people with chronic diseases such as hypertension.

Aim:

The objective of this study was to provide an overview of the existing research evaluating the impact of mobile applications on the self-care of patients with hypertension.

Methods:

The Scopus and PubMed databases were investigated using a comprehensive search strategy from the beginning of 2010 to 2019. All controlled clinical trial studies as well as quasi-experimental studies used mobile as a device for improving the self-care and conducted on patients with hypertension were included in the study. The studies were reviewed by two independent individuals.

Results:

Out of 1032 studies found, 6 studies were finally reviewed after applying the inclusion criteria. Out of 6 studies reviewed, three studies confirmed the effect of using mobile applications on lowering blood pressure. Other studies reported a decline in blood pressure, while statistically significant were not shown.

Conclusion:

The results showed that mobile apps have positive potential on improving the self-care behavior of patients with hypertension, but the evidences presenting their impact are varied. Different reports for efficiency of mobile phone apps for the self-care modification was due to diverse condition of studies for mobile intervention on the patients with hypertension.

Prevalence and Associated Factors of Overweight or Obesity and Abdominal Obesity in Iranian Population: A Population-based Study of Northwestern Iran

BACKGROUND

This population-based study aimed at investigating the prevalence and associated factors of over-weight /obesity and abdominal obesity in Iran.

METHODS

The study population consists of 2818 inhabitant of the urban and regional area of East-Azerbaijan, Iran in 2015. The weight, height and waist circumferences were measured and the body mass index (BMI) and conicity index were calculated. The ANCOVA and logistic regression were used for statistical analysis.

RESULTS

Prevalence of overweight, obesity and abdominal obesity was 39.6%, 24%, and 76.4% respectively. Women showed the higher prevalence of obesity (32.2%) and abdominal obesity (81.4) than men (obesity: 15.1%; abdominal obesity: 68.6%). Age, marriage and family history of obesity were independent predictors of obesity in the population (P< 0.001). In men and women, nonsmokers (P<0.01) and subjects having more than two kids (P< 0.001) were also more expected to be overweight or obese and abdominally obese respectively.

CONCLUSION

More actions mostly focusing on education and physical activity levels, and changing eating habits are required.

Risk factors for prehypertension and their interactive effect: a cross- sectional survey in China

BACKGROUND

Individuals with prehypertension are at higher risk of developing hypertension and cardiovascular diseases, while the interaction between factors may aggravate prehypertension risk. Therefore, this study aimed to evaluate the risk factors for prehypertension in Chinese middle-aged and elderly adults, and explore the potentially interactive effect of evaluated factors.

METHODS

All the participants that came from a community based cross-sectional survey were investigated in Bengbu, China, by being interviewed with a questionnaire. Body mass index (BMI), Waist circumference (WC) and lipid accumulation product (LAP) that reflect participants' obesity were also calculated. In addition, logistic regression model was applied to explore the risk factors of prehypertension, followed by the assessment of the interactive effects between risk factors on prehypertension by the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI).

RESULTS

A total of 1777 participants were enrolled in this study, among which the prevalence of normtension, prehypertension and hypertension were 41.70%, 33.93% and 24.37% respectively. According to the multivariate logistic regression analysis, age (OR: 1.01, 95%CI: 1.00-1.02), smoking (OR: 1.67, 95%CI: 1.22-2.29), family history of cardiovascular diseases (OR: 1.52, 95%CI: 1.14-2.02), general obesity (OR: 1.51, 95%CI: 1.15-1.97) and LAP (OR: 2.58, 95%CI: 1.76-3.80) were all defined as the major factors that significantly related with the risk of prehypertension. When identifying prehypertension risk, the receiver-operating characteristics (ROC) curves (AUC) analysis indicated that LAP performed better than BMI in males (Z = 2.05, P = 0.03) and females (Z = 2.12, P = 0.03), but was superior to WC only in females (Z = 2.43, P = 0.01). What is more, there were significant interactive effects of LAP with family history of cardiovascular diseases (RERI: 1.88, 95%CI: 0.25-3.51; AP: 0.44, 95%CI: 0.20-0.69; SI: 2.37, 95%CI: 1.22-4.60) and smoking (RERI: 1.99, 95%CI: 0.04-3.93; AP: 0.42, 95%CI: 0.17-0.67; SI: 2.16, 95%CI: 1.68-4.00) on prehypertension risk. The value of AP (0.40, 95%CI: 0.03-0.77) also indicated a significant interaction between family history of cardiovascular diseases and smoking on prehypertension.

CONCLUSION

Prehypertension is currently prevalent in Chinese adults. This study indicated that age, family history of cardiovascular diseases, smoking, general obesity and LAP were significantly related with prehypertension risk. Furthermore, interactive effects on risk of prehypertension had been demonstrated in this study as well, which would help researchers to build strategy against prehypertension more comprehensively and scientifically.

Variability of metabolic risk factors associated with prehypertension in males and females: a cross-sectional study in China

INTRODUCTION

Prehypertension is highly prevalent. However, very few studies have evaluated the association of various metabolic risk factors in those with prehypertension and, more importantly, possible differences based on gender.

MATERIAL AND METHODS

Data of clinical characteristics were collected from 3891 subjects. Risk factors were analyzed by multiple logistic regression analysis. The areas under receiver operating characteristic curves were compared to assess the discriminatory value of metabolic parameters for predicting prehypertension.

RESULTS

The incidence of prehypertension was 55.9% (66.9% of men, 41.1% of women). Prehypertensives showed clusters of metabolic associations including changes in the levels of plasma high-density lipoprotein cholesterol (OR = 1.550), triglycerides (OR = 1.141) and fasting blood glucose (OR = 1.320) after adjusting for age, sex, body mass index and smoking. The metabolic associations also showed differences based on gender. For instance, higher total cholesterol (OR = 1.602) was the most evident risk factor in men with prehypertension, while higher triglycerides (OR = 1.314) and lower high-density lipoprotein cholesterol (OR = 1.729) were the main risk factors in women.

CONCLUSIONS

Our study suggests that risk associations of prehypertension show gender differences. These results emphasize the importance of health education, active management of blood pressure and timely and effective treatment of abnormal lipid profile in subjects with prehypertension.

Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran

OBJECTIVES

Hypertension (HTN) is an important risk factor for cardiovascular disease. Considering the importance of this disease for public health, this study was designed in order to determine the prevalence, awareness, treatment, control, and risk factors of HTN in the Iranian adult population.

METHODS

This cross-sectional study was conducted among 2,107 residents of Isfahan, Iran. Samples were selected through multi-stage random cluster sampling in 2015-2016. The outcome variable was HTN, determined by measuring blood pressure in the right arm via a digital arm blood pressure monitor. Awareness, treatment, and control of HTN were assessed by a validated and reliable researcher-developed questionnaire. Other demographic and clinical variables were assessed via a demographic questionnaire.

RESULTS

The overall prevalence of HTN was 17.3% (18.9 and 15.5% in men and women, respectively). The prevalence of HTN increased in both genders with age. The prevalence of awareness of HTN among people with HTN was 69.2%, of whom 92.4 and 59.9% were taking medication for HTN and had controlled HTN, respectively. Logistic regression identified age, body mass index, having diabetes and hyperlipidemia, and a positive family history of HTN as determinants of awareness of HTN.

CONCLUSIONS

The results showed that HTN was highly prevalent in the community, especially in men and in middle-aged and older adults. Approximately 30.8% of patients were unaware of their disease, and there was less awareness among younger adults. Despite the high frequency of taking medication to treat HTN, it was uncontrolled in more than 40.1% of patients. Health policy-makers should therefore consider appropriate preventive and therapeutic strategies for these high-risk groups.

Knowledge, attitude and practice of Iranian hypertensive patients regarding hypertension

Introduction: This study aimed at evaluating knowledge and awareness of hypertension and the risk factors for hypertension among hypertensive patients.

Methods: In this study, 110 hypertensive patients were enrolled and filled out two self-administered questionnaires. The first questionnaire was about the demographic characteristics and the second one was about the knowledge (n = 10), attitude (n = 9) and practice (n = 8). The internal consistency and the stability of the questionnaires were approved. The Mann-Whitney U test and Kruskal-Wallis and Spearman correlation coefficient were used for statistical analysis.

Results: Seventy-three percent of participants know the normal range of hypertension. Most of the participants truly knew that stress (87.3%), obesity (70.9%) and aging (48.2%) are risk factors for hypertension. About 60% of participants knew the complications of uncontrolled hypertension. About 82.7% of participants believed that after adaptation of body to hypertension, there is no need to use antihypertensive drug. About 13.6% of participants measured their blood pressure daily and 11.8% of them measured it once a month. The educational level of participants was significantly associated with knowledge score (P = 0.01). There was a significant correlation between knowledge (P < 0.001) and attitude and also attitude and practice (P < 0.001) scores.

Conclusion: These findings have important implications for developing proper and continuous self-management hypertension education programs in Iran which should mostly emphasize on the practical information about control and prevention programs.

Telephone based weight loss intervention: Relevance for developing countries

Obesity is a major public health challenge not only for developed but developing countries as well. The World Health Organization recommends the immediate use of effective, efficient and widely accessible weight loss interventions. Telephone based weight loss intervention could provide a cheaper and wider reach of obese participants. Previous systematic reviews on telephone based weight loss interventions either excluded studies that had obese participants with co-morbidities or were silent on their inclusion. Obese/overweight individuals with co-morbidities constitute an important population in any weight loss intervention study due to the strong association of obesity with major chronic health conditions. This paper, reviews the efficacy of telephone based weight loss intervention solely in overweight/obese individuals with obesity related diseases and discusses its relevance for developing countries.