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Binth Siraj M, Khan AA, Jahangir U, Hashimi A, Ahmad Y, Husain N. Evaluation of the efficacy of hydro-alcoholic extract of Evolvulus alsinoides L. for the treatment of primary hypertension - A randomized controlled trial. JOURNAL OF ETHNOPHARMACOLOGY 2024; 323:117661. [PMID: 38159824 DOI: 10.1016/j.jep.2023.117661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 07/11/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Evolvulus alsinoides L. (Sankhaholi) has been traditionally used in Unani (Greco-Arabic) medicine to treat diverse cardiovascular disorders. Notably, preclinical and clinical investigations have substantiated its remarkable potential as an antihypertensive agent. AIM OF THE STUDY The aim of this study was to compare the efficacy of hydroalcoholic extract of Evolvulus alsinoides L. and ramipril in treating hypertension using a higher dose of the test drug within the recommended limit. MATERIALS AND METHODS In this open-label randomized controlled trial, 57 participants (29 in the test group, 28 in the control group) completed the 42-day study. The test group received 630 mg of dried hydro-alcoholic extract of Evolvulus alsinoides L. in capsule form orally once daily, while the control group received 5 mg of Ramipril orally once daily. Participants in both groups were advised to adhere to the Dietary Approaches to Stop Hypertension (DASH) eating plan in terms of diet and lifestyle adjustments recommended by JNC-8. The primary outcome measures were changes in systolic and diastolic blood pressure as well as changes in plasma levels of hsCRP and IL6. Secondary outcome measures included changes in symptoms such as palpitations, giddiness, headaches, fatigue and shortness of breath. Headaches, palpitations, and giddiness were assessed using a customized Visual Analog Scale (VAS) graded as "none," "mild," "moderate," and "severe". Fatigue was assessed on a binary scale as either absent or present, and dyspnea was assessed using the modified Medical Research Council (mMRC) scale for breathlessness. Both primary and secondary outcomes were assessed at baseline and each follow-up visit (2nd week, 4th week, and 6th week) until the completion of the trial. RESULTS At the end of the trial, the mean differences for the primary outcomes were as follows:SBP:-1.8895%CI:-4.82,1.05,p=0.203,d=0.33, DBP: -2.8395%CI:-4.67,-0.10,p=0.003,d=0.8, hsCRP: -1.4095%CI:-2.80,-0.003,p=0.49,d=0.53, and IL6: -88.6795%CI:-148.90,-28.43,p=0.005,d=0.78. No statistically significant differences were observed between the two groups for any of the secondary outcomes. CONCLUSIONS Based on the preliminary results, it can be inferred that the hydro-alcoholic extract of Evolvulus alsinoides L. exhibits significant antihypertensive potential, comparable to that of ramipril. Furthermore, it appears that Evolvulus alsinoides L. may be more effective than ramipril in reducing the biochemical markers of inflammation associated with primary hypertension. However, additional research is required to validate these findings.
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Affiliation(s)
- Mantasha Binth Siraj
- Dept. of Pathology, Hayat Unani Medical College and Research Centre, Lucknow, 226101, Uttar Pradesh, India.
| | - Asim Ali Khan
- Dept. of Medicine (Unani), School of Unani Medical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
| | - Umar Jahangir
- Dept. of Amraz-e-Jild wa Tazeeniyat, School of Unani Medical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
| | - Ayshah Hashimi
- Research Associate, Central Research Unit (Unani), Meerut, Uttar Pradesh, 250001, India.
| | - Yasmeen Ahmad
- Dept. of Medicine (Unani), School of Unani Medical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
| | - Nazim Husain
- Research Officer, Regional Research Instiute of Unani Medicine, Silchar, Assam, 788014, India.
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Mekonen HH, Gebru TH, Kiros KG, Gebrehiwot TG, Tesfamichael YA. Undiagnosed hypertension and associated factors among adult population in central zone of Tigray, Northern Ethiopia 2020: A cross-sectional study. Health Sci Rep 2024; 7:e2052. [PMID: 38655424 PMCID: PMC11035904 DOI: 10.1002/hsr2.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims Undiagnosed hypertension is a major risk factor for cardiovascular diseases and complications such as heart attack and stroke. Limited information is available on the prevalence of undiagnosed hypertension and its associated factors in Ethiopia, particularly in the study setting. This study aimed to assess the prevalence of undiagnosed hypertension and its associated factors in the central zone of Tigray, Northern Ethiopia. Methods A community-based cross-sectional study was conducted from April 1 to May 31, 2020. A pretested structured questionnaire was used and both face-to-face interview and physical measurement were used to collect the data. Blood pressure was measured on two different days for each study participant, and an average of the measurements were taken. In addition, 736 participants were included in this study, through a systematic random sampling technique. Data were analyzed using SPSS version 23. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with undiagnosed hypertension. Adjusted odds ratios and 95% confidence intervals were used to show the strength of the association and declare statistical significance at p < 0.05. Results In the study, the mean age of the participants was 51.9 (standard deviation: 17.9) years old. Prevalence of undiagnosed hypertension was found 15.4% (N = 113). The factors associated with undiagnosed hypertension were being divorced (adjusted odds ratio [AOR] = 15.2, 95% confidence interval [CI]: 8.2-28.3), alcohol consumption (AOR = 2.07, 95% CI: 1.22-3.51), not eating fruits (AOR = 4.1, 95% CI: 2.37-7.08), not eating vegetables (AOR = 3.47, 95% CI: 2.02-5.96) and poor knowledge (AOR = 3.05, 95% CI: 2.75-7.83). Conclusion Around one in six study participants had undiagnosed hypertension. Being divorced, drinking alcohol, not eating fruits, not consuming vegetables, and having poor knowledge of hypertension were significant factors. Public health interventions, like providing adequate hypertension health information, frequent screening, and implementation of an appropriate intervention for particular factors, are critical for reducing the burden of undiagnosed hypertension.
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Affiliation(s)
- Haftea Hagos Mekonen
- Department of Nursing, College of Medicine and Health ScienceAdigrat UniversityTigrayEthiopia
| | - Tsegu Hailu Gebru
- Department of Nursing, College of Medicine and Health ScienceAdigrat UniversityTigrayEthiopia
| | - Kbrom Gemechu Kiros
- Department of Nursing, College of Medicine and Health ScienceAdigrat UniversityTigrayEthiopia
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Seenappa K, Kulothungan V, Mohan R, Mathur P. District-Wise Heterogeneity in Blood Pressure Measurements, Prehypertension, Raised Blood Pressure, and Their Determinants Among Indians: National Family Health Survey-5. Int J Public Health 2024; 69:1606766. [PMID: 38562553 PMCID: PMC10982880 DOI: 10.3389/ijph.2024.1606766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Objective: The objective of the study was to determine the prevalence and determinants of ever-measured blood pressure, prehypertension, and raised blood pressure at national, state and district levels in India. Methods: We analysed data from the National Family Health Survey (NFHS-5), on 743,067 adults aged 18-54 years. The sample consisted of 87.6% females and 12.4% males. We estimated prevalence rates and determined adjusted odds ratios for various dependent variables related to blood pressure. Geographical variations were visualized on the map of India, and multivariate logistic regression was employed at state and district levels, with significance set at p < 0.05. Results: The prevalence of ever-measured blood pressure varied widely, from 30.3% to 98.5% across districts, with southern and northern regions showing higher rates. Prehypertension affected 33.7% of the population, with varying prevalence across districts. Raised blood pressure was there in 15.9%, with notably higher rates in southern region (16.8%). Determinants included age, gender, education, wealth, lifestyle, obesity, and blood glucose levels. Conclusion: These findings demonstrate the subnational variations in blood pressure, can guide evidence-based interventions at the state and district level, towards reducing the burden of raised blood pressure and enhancing overall population health.
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Affiliation(s)
| | | | | | - Prashant Mathur
- Indian Council of Medical Research-National Centre for Disease Informatics and Research (ICMR-NCDIR), Bengaluru, Karnataka, India
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Tripathi V, Talukdar D, Tripathi M, Teelucksingh S. Prevalence and associated factors of undiagnosed hypertension among women aged 15-49 years in India: an analysis of National Family Health Survey-4 data. J Hum Hypertens 2024; 38:245-256. [PMID: 37968456 DOI: 10.1038/s41371-023-00876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
Hypertension is a major risk factor for cardiovascular diseases globally. Fortunately, there is a vast armamentarium of effective therapeutic options at our disposal so undiagnosed hypertension represents a missed opportunity. In a previous analysis [1] of the NFHS-4 dataset for the prevalence and risk factors for undiagnosed hypertension and its associated risk factors among Indian women aged 15-49 years, we had overestimated prevalence by inclusion of self-reported cases. We have since retracted when this anomaly was highlighted [2]. We have now re-analyzed the same database and here present these data. The current analysis shows that the overall prevalence of undiagnosed hypertension was 8.05% among women aged 15-49 years in India. In rural areas, it was 7.89% compared with 8.38% for urban areas. Factors associated with undiagnosed hypertension in rural and urban areas were age, BMI, wealth quintiles, educational level, religion, caste and geographical zones. Nearly half the women aged 15-49 years in India with hypertension are unaware and this has implications for personal and reproductive health.
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Affiliation(s)
- Vrijesh Tripathi
- Department of Mathematics and Statistics, Faculty of Science and Technology, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago.
| | - Debjyoti Talukdar
- Department of Medical Research, Mkhitar Gosh Armenian-Russian International University, 3, 7 Sebastia Street, Yerevan, 0099, Armenia
| | - Mallika Tripathi
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
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Nduka SO, Emeneka OC, Nduka IJ, Onunkwo JC. Cardiovascular risk screening: a 10-year prediction cross-sectional study in a Nigerian agrarian community. Pan Afr Med J 2024; 47:59. [PMID: 38646134 PMCID: PMC11032074 DOI: 10.11604/pamj.2024.47.59.38486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/12/2023] [Indexed: 04/23/2024] Open
Abstract
Introduction cardiovascular disease (CVD) is a major public health issue with a high global death rate and a significant death contribution from low-and middle-income countries. Modifiable and non-modifiable risk factors assessment and screening are important in their effective prevention and control. This study was designed to screen and assess cardiovascular risk factors in an agrarian community in Nigeria and to predict their 10-year CVD risk. Methods this was a cross-sectional study carried out in the Umueri community in Anambra State, Nigeria. Each participant responded to an epidemiologic survey using the World Health Organization (WHO) cardiovascular risk factors assessment tool with point-of-care screening procedures. The risk assessment for 10-year CV risk was conducted using region-specific WHO/ISH charts. Patients´ characteristics were analyzed and presented in frequencies and percentages. Results the mean age, systolic blood pressure, fasting plasma glucose, and total cholesterol of the study population were 54 years ± 1.27, 132 mmHg ± 2.088, 130 mg/dl ± 4.608, and 215 mg/dl ± 10.355 respectively. However, 98 (48.8%) have never had their blood pressure checked. About a quarter of the population had a high predicted risk of developing CVD within 10 years. Conclusion most of the assessed cardiovascular risk factors in the community are on average above the normal ranges and their probability risk of developing CVD within the next 10 years is high.
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Affiliation(s)
- Sunday Odunke Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Obinna Chris Emeneka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Ifeoma Jovita Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Jude Chinedu Onunkwo
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
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Sivanantham P, Anandraj J, Mathan Kumar S, Essakky S, Gola A, Kar SS. Predictors of Control Status of Hypertension in India: A Systematic Review and Meta-analysis. JOURNAL OF PREVENTION (2022) 2024; 45:27-45. [PMID: 38087106 DOI: 10.1007/s10935-023-00756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
Predictors of hypertension (HTN) control status have not been well understood in India. This information is crucial for policymakers and program managers to devise newer HTN control strategies and implement relevant policies and programs. Therefore, we undertook this meta-analysis to estimate the effect of various factors on the control status of HTN in India. We systematically searched PubMed and Embase for observational studies and community-based trials published between April 2013 and March 2021 conducted among people (≥ 15 years) with hypertension in India. Quality of studies was assessed using Newcastle Ottawa (NO) scale. Meta-analysis was performed using random effects model. We reported the effect of various factors on the prevalence of controlled HTN using pooled odds ratio (OR) with 95% confidence interval (CI). Of the 842 studies screened, we analyzed nine studies that included 2,441 individuals. Based on the NO scale, majority (90%) of studies had a low risk of bias. The odds of having controlled HTN were significantly higher among women (OR 1.78, 95% CI 1.62-1.95), those aged > 45 years (OR 1.69, 95% CI 1.44-1.97), and those residing in urban parts of India (OR 1.74; 95% CI 1.48-2.03). These measures varied considerably across different regions of the country. Very few studies reported data on the relationship between behavioural risk factors of non-communicable diseases (NCDs) and HTN control status. We did not find any statistically significant differences between behavioural risk factors of NCDs and HTN control status. To improve HTN control in India, the ongoing/newer HTN control programs need to target men, those aged 15-45, and rural residents. Future studies on HTN control determinants should report disaggregated data and use standardized definitions for behavioral risk factors to enhance reliability and comprehensiveness of findings on the determinants of HTN control in future reviews.
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Affiliation(s)
- Parthibane Sivanantham
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeyanthi Anandraj
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Mathan Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Saravanan Essakky
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anurag Gola
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
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Elias S, Dadi TK. Prevalence of Undiagnosed Hypertension and Associated Factors among Adults in Mizan-Aman Town, Bench Sheko Zone, Southwest Ethiopia: A Community-Based Cross-Sectional Study. Adv Med 2023; 2023:2746284. [PMID: 37469806 PMCID: PMC10352527 DOI: 10.1155/2023/2746284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/27/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
Objectives This study aimed to assess the prevalence of undiagnosed hypertension and associated factors among people aged 18 years and above in Mizan-Aman town of Bench Sheko Zone in Southwest Ethiopia. Study Design. A community-based cross-sectional study design was carried out among people aged 18 years old and above from April 1 to 30, 2021, in Mizan Aman town. Methods A community-based cross-sectional study design was carried out among people aged 18 years old and above from April 1 to 30, 2021, in Mizan Aman town. Seven hundred fifty-nine subjects were selected by the multistage sampling technique. A structured pretested STEPwise questionnaire was used to interview the participants. Data entry and analysis were done using EpiData 3.1 and SPSS version 25 statistical software, respectively. Descriptive analysis was undertaken, and the results were presented using frequency tables, graphs, and statistical summaries. The dependent variable has a dichotomized response of yes and no, and hence binary logistic regression was used to predict a dependent variable based on independent variables, and predictors having p ≤ 0.25 on the bivariable analysis were considered as candidates for the multivariable analysis. Odds ratios with their 95% confidence intervals were calculated to measure the strength of association, and finally a p value <0.05 was considered statistically significant. Result The prevalence of undiagnosed hypertension was 14.8% with 95% CI [12.3-15.6]. Older age (AOR = 3.1, 95% CI [1.5-6.5]), male (AOR = 2.2, 95% CI [1.3-3.9]), low physical activity (AOR = 3.9, 95% CI [1.8-8.3]), low consumption of fruit and vegetable (AOR = 4.5, 95% CI [2.4-8.8]), and higher BMI (AOR = 2.7, 95% CI [1.6-4.6]) were significantly associated with undiagnosed hypertension. Conclusion The current study outlined that the prevalence of undiagnosed hypertension was high in the study area. In addition, most of the risk factors identified were modifiable, and hence community-based preventive approaches like lifestyle modification, increasing awareness, and strengthening routine screening at primary health service facilities resulted in a substantial change in tackling the burden effectively.
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Affiliation(s)
- Sebsibe Elias
- Public Health Department, College of Health Sciences, Mizan-Aman College of Health Science, Mizan-Aman, Ethiopia
| | - Teshome Kabeta Dadi
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Meshram N, Verma N, Shrivastava N, Prasad MA, Jain K, Shinkar SV. Assessment of Prevalence of Hypertension and its Risk Factors among Adult Tribal Population Residing in Lohandiguda Block of Bastar District of Chhattisgarh. Indian J Community Med 2023; 48:588-594. [PMID: 37662129 PMCID: PMC10470565 DOI: 10.4103/ijcm.ijcm_936_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/06/2023] [Indexed: 09/05/2023] Open
Abstract
Background Hypertension is known as the silent killer. It comprehends the top rank in non-infectious disease amongst adults; accountable for the deaths every year across the world. It is essential to consider the individual impact of risk factors and their impact on hypertension. This study thus elicited the socio-demographic characteristics, the prevalence of hypertension and associated risk factors, and its impact on adults with hypertension. To estimate the hypertension prevalence and its associated risk factors among adult tribal populations aged 25-60 years residing in Lohandiguda block of Bastar district of Chhattisgarh. Material and Methods A community-based cross-sectional analytical study was used and the setting was done at the field practice area under the three primary health centers of Lohandiguda block, Bastar district of Chhattisgarh. It was carried out among 330 adult tribes residing for ≥1 year in the present locality. Data was collected by door-to-door visits through pre-designed, pretested, semi-structured questionnaire via face-to-face interview method and anthropometric measurement was done by using standard guidelines. The sampling method was multistage sampling. IBM SPSS STATISTICS-20.0 (IBM Corp., Armonk, NY, USA) software. Results The overall prevalence of pre-hypertension and hypertension among tribal subjects was 34.9% and 47.3%, respectively. Of total hypertensive 27.3% were having stage-1 hypertension, 13.9% were having stage-2 hypertension and 6.0% were already diagnosed cases. Risk factors found in multivariate analysis are occupation (unemployed 0.012), frequency of smokeless tobacco used per day (0.,017) and central obesity (0.000). Conclusions As hypertension is a multi-factorial disease the study found strong predictors like occupation, frequency of smokeless tobacco per day and having central obesity with significant difference.
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Affiliation(s)
- Nisha Meshram
- Department of Community Medicine in Bharat Ratna Late Shri Atal Bihari Vajpeyee Memorial Medical College- Rajnandgaon, Chhattisgarh, India
| | - Nirmal Verma
- Department of Community Medicine in Pt. JawaharLal Nehru Memorial Medical College, Raipur, Chhattisgarh, India
| | - Neha Shrivastava
- Department of Community Medicine in Government Medical College, Mahasamund, Chhattisgarh, India
| | - Manish A. Prasad
- Department of Community Medicine in Shri Balaji Institute of Medical Science, Raipur, Chhattisgarh, India
| | - Kamlesh Jain
- Department of Community Medicine in Pt. JawaharLal Nehru Memorial Medical College, Raipur, Chhattisgarh, India
| | - Swapnil V. Shinkar
- Department of Community Medicine in Symbiosis Medical College for Women, Pune, Maharashtra, India
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Kumar SM, Anandraj J, Sivanatham P, Essakky S, Nain J, Talukdar R, Loganathan V, Kar SS. Control status of hypertension in India: systematic review and meta-analysis. J Hypertens 2023; 41:687-698. [PMID: 36883453 DOI: 10.1097/hjh.0000000000003381] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND AND AIMS Uncontrolled hypertension is a major risk factor for cardiovascular diseases (CVDs). The present study aimed to conduct a systematic review and meta-analysis to estimate the pooled prevalence of control status of hypertension in India. METHODS AND RESULTS We carried out systematic search (PROSPERO No.: CRD42021239800) in PubMed and Embase published between April 2013 and March 2021 followed by meta-analysis with random-effects model. The pooled prevalence of controlled hypertension was estimated across geographic regions. The quality, publication bias and heterogeneity of the included studies were also assessed. We included 19 studies with 44 994 hypertensive population, among which 17 studies had low risk of bias. We found statistically significant heterogeneity ( P ≤ 0.05) and absence of publication bias among the included studies. The pooled prevalence of control status among patients with hypertension was 15% (95% CI: 12-19%) and among those under treatment was 46% (95% CI: 40-52%). The control status among patients with hypertension was significantly higher in Southern India 23% (95% CI: 16-31%) followed by Western 13% (95% CI: 4-16%), Northern 12% (95% CI: 8-16%), and Eastern India 5% (95% CI: 4-5%). Except for Southern India, the control status was lower among the rural areas compared with urban areas. CONCLUSION We report high prevalence of uncontrolled hypertension in India irrespective of treatment status, geographic regions and urban and rural settings. There is urgent need to improve control status of hypertension in the country.
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Affiliation(s)
- S Mathan Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Yeh EJ, Grigolon RB, Rodrigues SR, A Bueno AP. Systematic literature review and meta-analysis of cardiovascular risk factor management in selected Asian countries. J Comp Eff Res 2023; 12:e220085. [PMID: 36861459 PMCID: PMC10402804 DOI: 10.57264/cer-2022-0085] [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: 05/06/2022] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Abstract
Aim: There is a need to understand the management status of hypertension, dyslipidemia/hypercholesterolemia, and diabetes mellitus in the Asia-Pacific region (APAC). Methods: We conducted a systematic literature review and meta-analysis to summarize the awareness, treatment, and/or control rates of these risk factors in adults across 11 APAC countries/regions. Results: We included 138 studies. Individuals with dyslipidemia had the lowest pooled rates compared with those with other risk factors. Levels of awareness with diabetes mellitus, hypertension, and hypercholesterolemia were comparable. Individuals with hypercholesterolemia had a statistically lower pooled treatment rate but a higher pooled control rate than those with hypertension. Conclusion: The management of hypertension, dyslipidemia, and diabetes mellitus was suboptimal in these 11 countries/regions.
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Zavala GA, Haidar-Chowdhury A, Prasad-Muliyala K, Appuhamy K, Aslam F, Huque R, Khalid H, Murthy P, Nizami AT, Rajan S, Shiers D, Siddiqi N, Siddiqi K, Boehnke JR. Prevalence of physical health conditions and health risk behaviours in people with severe mental illness in South Asia: multi-country cross-sectional survey. BJPsych Open 2023; 9:e43. [PMID: 36815449 PMCID: PMC9970179 DOI: 10.1192/bjo.2023.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND People with severe mental illness (SMI) die earlier than the general population, primarily because of physical disorders. AIMS We estimated the prevalence of physical health conditions, health risk behaviours, access to healthcare and health risk modification advice in people with SMI in Bangladesh, India and Pakistan, and compared results with the general population. METHOD We conducted a cross-sectional survey in adults with SMI attending mental hospitals in Bangladesh, India and Pakistan. Data were collected on non-communicable diseases, their risk factors, health risk behaviours, treatments, health risk modification advice, common mental disorders, health-related quality of life and infectious diseases. We performed a descriptive analysis and compared our findings with the general population in the World Health Organization (WHO) 'STEPwise Approach to Surveillance of NCDs' reports. RESULTS We recruited 3989 participants with SMI, of which 11% had diabetes, 23.3% had hypertension or high blood pressure and 46.3% had overweight or obesity. We found that 70.8% of participants with diabetes, high blood pressure and hypercholesterolemia were previously undiagnosed; of those diagnosed, only around half were receiving treatment. A total of 47% of men and 14% of women used tobacco; 45.6% and 89.1% of participants did not meet WHO recommendations for physical activity and fruit and vegetable intake, respectively. Compared with the general population, people with SMI were more likely to have diabetes, hypercholesterolemia and overweight or obesity, and less likely to receive tobacco cessation and weight management advice. CONCLUSIONS We found significant gaps in detection, prevention and treatment of non-communicable diseases and their risk factors in people with SMI.
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Affiliation(s)
| | | | - Krishna Prasad-Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Faiza Aslam
- Institute of Psychiatry, Rawalpindi Medical University, Pakistan
| | | | - Humaira Khalid
- Institute of Psychiatry, Rawalpindi Medical University, Pakistan
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Asad T Nizami
- Institute of Psychiatry, Rawalpindi Medical University, Pakistan
| | - Sukanya Rajan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, UK; and School of Medicine, Keele University, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, UK; Hull York Medical School, UK; and Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, UK; and Hull York Medical School, UK
| | - Jan R Boehnke
- Department of Health Sciences, University of York, UK; and School of Health Sciences, University of Dundee, UK
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12
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Li Q, Li N, Liang X, Liu Y, Chen L, Lao H, Wei S, Xiao J, Qi X. The study of antecedent clinical manifestations of hypertensive heart disease in cohort of hypertension. Aging (Albany NY) 2023; 15:1890-1917. [PMID: 36812472 PMCID: PMC10085586 DOI: 10.18632/aging.204510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/17/2021] [Indexed: 02/21/2023]
Abstract
Hypertensive heart disease presents increasing morbidity and mortality worldwide, however, the data about its epidemics and its specific symptoms in hypertension patients is scarce. To assess the frequency and correlated symptoms of hypertensive heart disease, 800 hypertension patients were randomly recruited for this study per the guidelines of the American College of Cardiology. The diagnosis of heart disease and its typical symptoms (palpitation and angina) were analyzed for the frequency of hypertensive heart disease in hypertension cohort. Cross-tabulation analysis was used to study the correlation between psychiatric indexes (annoy, amnesia, irritableness, depression, anxiety, and fear) and palpitation, the correlation between physical disorders (backache, lumbar debility, and numbness of limbs) and palpitation, and the correlation between symptoms (dizziness, daze, headache, and tinnitus) and palpitation presented in hypertensive patients. It was found that around half of patients suffered hypertensive heart disease, which correlated to certain physical and mental symptoms. Significant correlation exists between palpitation and annoy / amnesia. Significant correlation exists between palpitation and backache / lumbar debility / numbness of limbs; and significant correlation exists between palpitation and dizziness / daze / headache / tinnitus. These results provide clinical insights into the modifiable antecedent clinical conditions which are risk factors for hypertensive heart disease in elderly and will help improve early management of this disease.
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Affiliation(s)
- Qian Li
- The American Academy of Tradition Chinese Medicine Inc. Roseville, MN 55113, USA
| | - Na Li
- Qingdao Fifth People’s Hospital, Qingdao 266002, Shandong, China
| | - Xiao Liang
- Saint Mary’s University of Minnesota, Minneapolis, MN 55404, USA
| | - Yanjie Liu
- Department of Neck-Shoulder-Lumbocrural Pain Treatment, Yantai Hospital of Traditional Chinese Medicine, Yantai 264013, Shandong, China
| | - Li Chen
- Department of Science and Education, Shandong Provincial Third Hospital, Jinan 250031, Shandong, China
| | - Huimin Lao
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan 250011, Shandong, China
| | - Sheng Wei
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong, China.,Key Laboratory of Traditional Chinese Medicine Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong, China
| | - Jun Xiao
- The Macrohard Institute of Health, Roseville, MI 48066, USA
| | - Xiaoqiang Qi
- The Macrohard Institute of Health, Roseville, MI 48066, USA.,University of Missouri-Columbia, Columbia, MO 65212, USA
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13
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Koya SF, Pilakkadavath Z, Chandran P, Wilson T, Kuriakose S, Akbar SK, Ali A. Hypertension control rate in India: systematic review and meta-analysis of population-level non-interventional studies, 2001-2022. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 9:100113. [PMID: 37383035 PMCID: PMC10305851 DOI: 10.1016/j.lansea.2022.100113] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 06/30/2023]
Abstract
Background Hypertension is a significant contributor to mortality in India. Achieving better hypertension control rate at the population level is critical in reducing cardiovascular morbidity and mortality. Methods Hypertension control rate was defined as the proportion of patients with their blood pressure under control (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg). We conducted a systematic review and meta-analysis of community-based, non-interventional studies published after 2001 that reported hypertension control rates. We searched PubMed, Embase, and Web of Science databases, and grey literature, and extracted data using a common framework, and summarized the study characteristics. We conducted random-effects meta-analysis using untransformed hypertension control rates and reported the overall summary estimates and subgroup estimates of control rates as percentages and 95% confidence intervals. We also conducted mixed-effects meta-regression with sex, region, and study period as covariates. The risk of bias was assessed, and level of evidence was summarized using SIGN-50 methodology. The protocol was pre-registered with PROSPERO, CRD42021267973. Findings The systematic review included 51 studies (n = 338,313 hypertensive patients). 21 studies (41%) reported poorer control rates among males than females, and six studies (12%) reported poorer control rates among rural patients. The pooled hypertension control rate in India during 2001-2020 was 17.5% (95% CI: 14.3%-20.6%)-with significant increase over the years, reaching 22.5% (CI: 16.9-28.0%) in 2016-2020. Sub-group analysis showed significantly better control rates in the South and West regions, and significantly poorer control rates among males. Very few studies reported data on social determinants or lifestyle risk factors. Interpretation Less than one-fourth of hypertensive patients in India had their blood pressure under control during 2016-2020. Although the control rate has improved compared to previous years, substantial differences exist across regions. Very few studies have examined the lifestyle risk factors and social determinants relevant to hypertension control in India. The country needs to develop and evaluate sustainable, community-based strategies and programs to improve hypertension control rates. Funding Not applicable.
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Affiliation(s)
| | | | - Praseeda Chandran
- Department of Community Medicine, Government Medical College, Manjeri, India
- Department of Community Medicine, Kannur Medical College, Anjarakandy, India
| | - Tom Wilson
- Department of Community Medicine, Government Medical College, Manjeri, India
| | | | - Suni K. Akbar
- KIMS Al-Shifa Specialty Hospital, Perinthalmanna, India
| | - Althaf Ali
- Department of Community Medicine, Government Medical College, Manjeri, India
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, India
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14
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Muacevic A, Adler JR, Hamide A. Supplementation of Water-Soluble Vitamins Reduces Hyperhomocysteinemia, Insulin Resistance, and High-Sensitivity C-reactive Protein in Prehypertension Subjects. Cureus 2023; 15:e33481. [PMID: 36751256 PMCID: PMC9901180 DOI: 10.7759/cureus.33481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Prehypertensives are at higher risk of developing cardiovascular diseases. Hyperhomocysteinemia, insulin resistance, and increased high-sensitivity C-reactive protein (hs-CRP) are independent risk factors for the development of cardiovascular complications. In prehypertensives, specific therapeutic approaches can be implemented at the earliest to prevent the onset of overt hypertension. So the present study was performed to study the effect of supplementation of water-soluble vitamins on cardiovascular risk factors like homocysteine, insulin resistance, and C-reactive protein in prehypertensive subjects. METHODS Sixty prehypertensive subjects were recruited into the study based on inclusion and exclusion criteria and randomized into two groups of 30 each. One group was given a placebo and the other was given water-soluble vitamins for four months. Serum homocysteine, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and hs-CRP were assayed. RESULTS After four months of treatment with water-soluble vitamins, there was a significant decrease in levels of serum homocysteine, hs-CRP, and HOMA-IR when compared to placebo treatment. After four months of treatment, there was a significant decrease in the levels of hs-CRP, homocysteine, and HOMA-IR in groups treated with water-soluble vitamins compared to the basal levels. CONCLUSION In subjects with prehypertension, supplementation of water-soluble vitamins decreases the level of homocysteine, insulin resistance, and hs-CRP.
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Singh H, Sharma S, Kathiresan J, Bhatt G, Goel S. Tobacco use and uncontrolled hypertension among Indian men: Insights from the National Family He alth Survey (NFHS-4), 2015-2016. J Family Med Prim Care 2022; 11:5792-5798. [PMID: 36505642 PMCID: PMC9731014 DOI: 10.4103/jfmpc.jfmpc_163_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/06/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background Tobacco use is a modifiable risk factor for developing cardiovascular diseases, of which hypertension is a major killer. Uncontrolled hypertension (UHT) is a major public health concern that exerts a financial and service burden on the health system. Aim The current analysis aimed to determine the association between tobacco use and UHT among Indian males. Material and Methods Data from the 4th National Family Health Survey (NFHS) of 1,04,120 men aged 15-54 years were used. We estimated the adjusted prevalence ratio for having UHT among reported tobacco users and non-users. Results The prevalence of UHT was the lowest (41.02%) among those who did not consume tobacco in any form. Among tobacco users, those smoking tobacco had the highest prevalence (53.53%) of UHT followed by those using both smoked and smokeless forms of tobacco (43.84%) and those using only smokeless forms of tobacco (42.26%). Factors significantly associated with UHT were alcohol consumption (aPR: 1.30; 95% CI: 1.19-1.43), belonging to the richer wealth quintile (richest quintile- aPR: 1.27; 95% CI: 1.05-1.38), being overweight (aPR: 3.14, 95% CI: 2.35-4.21), and being obese (aPR: 2.89, 95% CI: 2.12-.94). Higher educational status was significantly protective against UHT (aPR: 0.75; 95% CI: 0.63-0.88). Conclusions Tobacco use is significantly associated with hypertension in Indian men. Addressing tobacco control and prevention of UHT remain the cornerstones for achieving the SDG target 3.4 by 2030, which aims to reduce premature mortality from NCDs by a third by 2030 relative to 2015 levels.
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Affiliation(s)
- Harshvardhan Singh
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
| | - Shailja Sharma
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
| | | | - Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, 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 - 160 012, India. Adjunct Clinical Associate Professor, Public Health Masters Program School of Medicine and Health Research Institute (HRI), University of Limerick, Ireland. E-mail:
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16
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Bhimarasetty MD, Pamarthi K, Prasad Kandipudi KL, Padmasri Y, Nagaraja SB, Khanna P, Goel S. Hypertension among women in reproductive age in India: Can we predict the risk? An analysis from National Family Health Survey (2015-2016). J Family Med Prim Care 2022; 11:5857-5864. [PMID: 36505580 PMCID: PMC9731032 DOI: 10.4103/jfmpc.jfmpc_176_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: 02/02/2022] [Accepted: 03/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background Hypertension in women of reproductive age group is of special concern because of the vulnerability of women to pregnancy-induced hypertension apart from socio-cultural vulnerability. Aim The objective of the study was to identify the predictors for hypertension among Indian women and to develop a risk score which would provide an opportunity for early detection and appropriate action. Material and Methods This study was based on the data collected in National Family Health Survey in 2015-2016. Women in India of 15-49 years were the study population. Data were analysed using SPSS v17. Logistic regression analysis was carried and expressed as odds ratio with 95% confidence intervals to identify predictors of hypertension. The risk score for hypertension was developed after shrinkage of variables and by using regression coefficients obtained by standard Logistic Regression Model. Results Among 6,87,230 women between 15 and 49 years, 77,788 (11.3%) were hypertensive. The study results revealed that there was an increasing trend in the prevalence of hypertension (26.5%) with increasing age, and with increasing weight (23.4%). Urban areas (12.3% vs 10.9%), alcoholics (19.2%) and various forms of tobacco users (14.8%) had more prevalence of hypertension. Conclusion Age, residing in urban area, consuming tobacco products, consumption of alcohol, non-vegetarian diet and overweight, were found to be the significant predictor variables, and were used to develop the Risk Prediction score using logistic regression model.
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Affiliation(s)
| | - Kiran Pamarthi
- Department of Community Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | | | - Yalamanchili Padmasri
- Department of Community Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | | | - Poonam Khanna
- 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, 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 Master’s Program, School of Medicine and Health Research Institute (HRI), University of Limerick, Ireland. Honorary Professor, Faculty of Human and Health Sciences, Swansea University, United Kingdom. E-mail:
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17
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Virk A, Samdarshi N, Saini P, Mohapatra A, Sahoo S, Goel S. 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. J Family Med Prim Care 2022; 11:5865-5873. [PMID: 36505567 PMCID: PMC9730949 DOI: 10.4103/jfmpc.jfmpc_162_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: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Amrit Virk
- Department of Community Medicine, Adesh Medical College and Hospital, Shahabad (M), Haryana, India
| | - Narottam Samdarshi
- Department of Community Medicine, Adesh Medical College and Hospital, Shahabad (M), Haryana, India
| | - Parmal Saini
- Department of Community Medicine, Adesh Medical College and Hospital, Shahabad (M), Haryana, India
| | - Archisman Mohapatra
- Executive Director, Generating Research Insights for Development (GRID) Council, Noida, Uttar Pradesh, India
| | - Soumya Sahoo
- Department of Community Medicine AIIMS Bathinda, Punjab, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Sonu Goel, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
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18
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Pengpid S, Peltzer K. National trends in prevalence, awareness, treatment, and control of hypertension among adults in Mongolia from 4 cross-sectional surveys in 2005, 2009, 2013, and 2019. Medicine (Baltimore) 2022; 101:e30140. [PMID: 35984124 PMCID: PMC9388008 DOI: 10.1097/md.0000000000030140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to analyze trends in the prevalence, awareness, treatment, and control of hypertension and associated factors in persons 15 years and older from 2005 to 2019 in Mongolia. National data were analyzed from 21,342 people (≥15 years) who participated in 4 cross-sectional STEPwise Approach to NCD Risk Factor Surveillance surveys in Mongolia (2005, 2009, 2013, or 2019) and had complete blood pressure measurements. The prevalence, awareness, treatment, and control of hypertension were calculated using sociodemographic factors within each study year. Logistic regression was employed to assess the associations between sociodemographic and health factors and status of hypertension, awareness, treatment, and control by study year and pooled sample. Trend analyzes showed that the prevalence of hypertension decreased significantly from 28.4% in 2005 to 23.2% in 2019 (P < .001). The prevalence of awareness among hypertensives remained unchanged, the treatment among aware decreased, and the control rate increased. In adjusted logistic regression analysis with the pooled sample, male sex (adjusted odds ratio [AOR]: 1.49, 95% confidence intervals [CI]: 1.32-1.68), older age (≥45 years) (AOR: 5.90, 95% CI: 4.90-7.10), obesity (AOR: 4.29, 95% CI: 3.77-4.88), more frequent alcohol use (≥1-2 days/week) (AOR: 1.69, 95% CI: 1.39-2.05) were positively, and higher educational level (≥12 years) (AOR: 0.77, 95% CI: 0.68-0.87) and urban residence (AOR: 0.84, 95% CI: 0.74-0.97) were negatively associated with hypertension prevalence. The prevalence of hypertension among Mongolian adults has decreased in recent years. Levels of hypertension awareness were unchanged, treatment decreased, and control increased. Increased health promotion, detection, and treatment of hypertension in Mongolia are indicated.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Karl Peltzer
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- *Correspondence: Karl Peltzer, Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan (e-mail: )
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Innovative mobile-health led participatory approach to comprehensive screening and treatment of diabetes (IMPACT diabetes): rationale, design, and baseline characteristics. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Background
India has 66 million people with diabetes, of which a large proportion do not receive adequate care. The primary health centres can serve as platforms for early detection of diabetes and continuum of care.
Objectives
This project evaluates a community-level technology-enabled system-level intervention based around the community health workers and primary-care physicians. We hypothesize that incorporation of a mobile clinical decision support system, with other process-level changes will improve identification and management of individuals with diabetes in primary care settings.
Methods
A cluster-randomized trial in sixteen villages/peri-urban areas in Andhra Pradesh and Haryana will test the feasibility and preliminary effectiveness of this intervention. The effectiveness of the extended care intervention will be evaluated by the difference in HbA1c (glycosylated hemoglobin) measured at baseline and end-line between the two study arms. Qualitative interviews of physicians, ASHA, and community members will ascertain the intervention acceptability and feasibility.
Results
A total of 1785 adults (females: 53.2%; median age: 50 years) were screened. ASHAs achieved 100% completeness of data for anthropometric, blood-pressure, and blood-glucose measures. At baseline, 63% of the participants were overweight/obese, 27.8% had elevated blood pressure, 20.3% were at high-risk for cardiovascular disease (CVD), and 21.3% had elevated blood glucose. Half of the individuals with diabetes were newly diagnosed.
Conclusion
Technology enabled transfer of simple clinical procedures from physicians to nonphysician health workers can support the provision of healthcare in under-served communities. Community health workers can successfully screen and refer patients with diabetes and/or CVD to physicians in primary healthcare system.
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Hazazi A, Wilson A. Noncommunicable diseases and health system responses in Saudi Arabia: focus on policies and strategies. A qualitative study. Health Res Policy Syst 2022; 20:63. [PMID: 35698126 PMCID: PMC9195368 DOI: 10.1186/s12961-022-00872-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Noncommunicable diseases (NCDs) are responsible for an increasing disease and economic burden in Saudi Arabia, particularly those due to chronic diseases such as diabetes and cardiovascular disease. Efforts are being made to improve chronic disease control through greater prevention and disease management. This research examines the scope, comprehensiveness and perceived effectiveness of Saudi Arabia’s national policies and strategies to prevent and control NCDs and their risk factors. Methods Semi-structured interviews were conducted with 25 managers of the Ministry of Health in Saudi Arabia. The interviewees were public health leaders, national programme directors and programme implementation staff. The interviews were transcribed and coded into key themes. Results Interviewee responses indicated a belief that Ministry of Health programmes for the prevention and control of NCDs have achieved initial success, but have not yet been adequately evaluated. Interviewees reported faster development and implementation of policies for tobacco, sugar-sweetened drinks and obesity than for physical activity. Major challenges identified included inefficient programme management and low community awareness. There was a reported need for greater emphasis on health promotion and improving the effectiveness of existing multisectoral coordination. Conclusion Effective national NCD policies and strategies have a critical role to play in the control of chronic disease epidemics. In Saudi Arabia, opportunities exist to improve the policy and strategies in response to NCDs by establishing a comprehensive surveillance system and linking epidemiological surveillance with health programme evaluation, as well as using a multisectoral and integrated approach. For better management and control of NCDs, a cohesive multisectoral collaboration with a comprehensive surveillance programme and adequate evaluation is urgently needed.
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Affiliation(s)
- Ahmed Hazazi
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, No. 2W21/Level 2, Charles Perkins Centre D17, Sydney, NSW, 2006, Australia. .,Department of Public Health, Faculty of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia.
| | - Andrew Wilson
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, No. 2W21/Level 2, Charles Perkins Centre D17, Sydney, NSW, 2006, Australia
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21
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Zewudie BT, Geze Tenaw S, Solomon M, Mesfin Y, Abebe H, Mekonnen Z, Tesfa S, Chekole Temere B, Aynalem Mewahegn A, lankrew T, Sewale Y. The magnitude of undiagnosed hypertension and associated factors among HIV-positive patients attending antiretroviral therapy clinics of Butajira General Hospital, Gurage Zone, Southern Ethiopia. SAGE Open Med 2022; 10:20503121221094454. [PMID: 35509957 PMCID: PMC9058352 DOI: 10.1177/20503121221094454] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: The study aimed to assess the magnitude of undiagnosed hypertension, and its associated factors among adult HIV-positive patients receiving antiretroviral therapy at Butajira General Hospital, southern Ethiopia. Methods: We applied an institutional-based cross-sectional study design at Butajira General Hospital from 1 May to 1 July 2021. We used a systematic random sampling technique to select the total number of participants. A structured interviewer-administered questionnaire was applied to collect the data (sociodemographic characteristics, clinical-related factors, and lifestyle-related factors from the study participants. Data were entered using Epi-data version 3.1 and analyzed by statistical package for social science version 25. We applied a multivariable logistic regression analysis model to identify variables significantly associated with hypertension. Results: The study comprised 388 participants with 39 years (10.6 SD) as the mean age of the participants. Of the total participants, 235 (60.6%) were female. In this study the magnitude of undiagnosed hypertension among HIV-positive patients was 18.8% (95% CI: 14.7%–23.2%). Having comorbidity of diabetes mellitus (adjusted odds ratio = 5.29, 95% CI: 2.154, 12.99), habit of alcohol drinking (adjusted odds ratio = 2.909, 95% CI: 1.306, 6.481), duration of antiretroviral therapy ⩾ 5 years (adjusted odds ratio = 3.087, 95% CI: 1.558, 6.115), and age ⩾ 40 years (adjusted odds ratio = 2.642, 95% CI: 1.450, 4.813) were factors significantly associated with undiagnosed hypertension. Conclusions and recommendations: The magnitude of undiagnosed hypertension among HIV-positive patients attending the antiretroviral therapy clinic of Butajira General Hospital is high. The findings of this study implied that HIV-positive patients attending antiretroviral therapy clinics should be monitored routinely for hypertension; especially participants aged ⩾40 years, highly active antiretroviral therapy duration ⩾5 years, having diabetes mellitus comorbidity need more attention. Primary healthcare integration is also vital to enhance the health of HIV-positive patients on antiretroviral therapy.
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Affiliation(s)
- Bitew Tefera Zewudie
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Shegaw Geze Tenaw
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Mamo Solomon
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Yibeltal Mesfin
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Haimanot Abebe
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Zebene Mekonnen
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Shegaw Tesfa
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Bogale Chekole Temere
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Agerie Aynalem Mewahegn
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tadele lankrew
- Department of Nursing, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Yihenew Sewale
- Department of Nursing, College of Medicine and Health Science, Debre Birhan University, Debre Birhan, Ethiopia
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22
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Thakur JS, Nangia R. Prevalence, Awareness, Treatment, and Control of Hypertension and Diabetes: Results From Two State-Wide STEPS Survey in Punjab and Haryana, India. Front Public Health 2022; 10:768471. [PMID: 35387189 PMCID: PMC8978601 DOI: 10.3389/fpubh.2022.768471] [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: 08/31/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background India which is home to more than one sixth of the world's population, accounts for more than two thirds of total deaths due to non-communicable diseases (NCD). Out of this, hypertension and diabetes are the most common NCDs. Awareness, treatment, and control of hypertension and diabetes remains a major challenge despite various national programs being run to curb the rising burden NCDs. In order to fill the knowledge gap, awareness, treatment, and control of diabetes and hypertension were studied by using data from the STEPS survey among the adult population in two major northern Indian states of Punjab and Haryana. Methods Two state-wide NCD risk factors surveys were conducted using WHO STEPS methodology among 5,127 individuals in Punjab and 5,078 individuals in Haryana aged 18-69 years in the year 2014-15 and 2016-18. Standardized questionnaire was used to determine the behavioral risk factors in step one followed by anthropometric measurements for physical risk factors in step two and in the third step serum and urine samples were collected for biochemical risk factors. Results The prevalence of hypertension in Punjab was 40.1% while that in Haryana was 26.2%. In Punjab, only 48.3% of the hypertensive were aware of their condition, 30.9% were on treatment while only 18.3% of the cases were controlled. While in Haryana 33.4% of the respondents were aware of their condition, 26.3% are on treatment while only 12% of the cases were controlled. Similarly, the prevalence of diabetes was 14.3 and 15.1% in Punjab and Haryana, respectively. In Punjab 34.2% of diabetics were aware of their condition, 28.2% were on treatment while only 14.2% of the cases were controlled. The awareness and control rates in Haryana were similar to that in Punjab. 29.5% of the respondents were aware of their condition, 22.4% were on treatment while only 13.8% of the cases of diabetes were controlled. Family history of diabetes and hypertension was found to be associated with higher odds of being aware, on treatment and controlled blood glucose and blood pressure levels in both Punjab and Haryana. Discussion Hypertension and diabetes are a major public health problem in Punjab and Haryana and awareness, treatment and control rates are low which require specific interventions with a focus on access to treatment, regular follow up for better control. There is an urgent need to effectively implement the existing national NCD programmes in these states in India.
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Affiliation(s)
- J S Thakur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ria Nangia
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Gender and rural-urban differences in hypertension among youth in India: Insights from a large scale survey, 2015-16. J Biosoc Sci 2022; 55:523-537. [PMID: 35343405 DOI: 10.1017/s0021932022000141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hypertension is considered one of the most persistent public health issues and the single largest contributor to avoidable morbidity and mortality in India. This study aims to investigate the prevalence and risk factors of hypertension in youths (15-29 years) by gender and rural-urban place of residence. Data from the fourth round of the National Family and Health Survey - 2015-16 (n = 395,207) was utilised for the study. After estimation of the stratified prevalence of hypertension by various characteristics, multivariable logistic regression analysis was conducted to assess the correlates of hypertension. The results revealed that the prevalence of hypertension in youths at the national level varied from 9.16% (Meghalaya) to 3.34% (Delhi). The stratified analysis suggests pronounced gender differences in the prevalence of hypertension among youth with insignificant rural-urban differences, although the prevalence was higher in urban areas. Overall, the prevalence of hypertension was found higher for male youths living in urban areas (7.82%) and females in rural areas (5.08%). Concurrently, results from regression analysis also suggest higher odds of hypertension for males residing in urban areas for a variety of demographic, socioeconomic, and health-risk factors. Advancing age, having no education, living in the northeast region, being overweight/obese and high blood glucose level was significantly associated with a greater likelihood of hypertension for both the gender and place of residence. Public health awareness regarding blood pressure needs to be tailored differently for both males and females considering the place of residence. The study suggests that more research should focus on blood pressure/hypertension among children, adolescents and youth since they point towards adult blood pressure patterns.
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Bhattacharya S, Bera OP, Saleem SM, Hossain MM, Varshney DS, Kaur R, Rana RK, Tripathi S, Gokdemir O, Bacorro M, Mehta K, Singh A. Dietary salt consumption pattern as an antecedent risk factor for hypertension: Status, vision, and future recommendations. Clin Nutr ESPEN 2022; 47:422-430. [PMID: 35063238 DOI: 10.1016/j.clnesp.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/15/2021] [Accepted: 12/04/2021] [Indexed: 12/26/2022]
Abstract
Multiple salt reduction strategies have been devised from time to time, addressing the issues of hypertension without considering the other essential factors, like the variability of salt sensitivity from the person to person. In this paper, we discuss how high salt consumption is one modifiable risk factor associated with hypertension among Indians, and there needs to be updated cut-off values. A thorough literature search on salt consumption articles on well-known search engines like Cochrane Library, PubMed, Google Scholar and Embase electronic database revealed a paucity of data in this field for India. Several studies revealed that the mean salt intake among the Indian populations ranges between 5.22 and 42.30 g/day. Moreover, among other risk factors analysed, salt intake (≥ 5 gm/day) was significantly associated with the development of hypertension. Although the need to address reduced salt intake for primordial prevention of hypertension and related cardiovascular diseases (CVDs) in India is well acknowledged by the key stakeholders, social and cultural beliefs, unorganized food retail sector and lack of existing food policing are some of the potential barriers that affect the progress and employment of such effective strategies. Some multinational food companies have already research is warranted to evaluate the contextual barriers and facilitators and to adopt effective strategies to improve awareness among consumers, to encourage the endorsement of salt reduction by the food industry, and to facilitate the adoption of countrywide consumer-friendly food labelling. We concluded that salt consumption is high in India, although this assessment has been done primarily by subjective methods in India. People all across are recommended the same cut-off value of dietary salt consumption regardless of the diversity in dietary patterns and environmental conditions across the country. There is an urgent need to address these issues through evidence-based population research.
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Affiliation(s)
| | - Om Prakash Bera
- National Consultant, Global Health Advocacy Incubator, India
| | | | - Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A & M University, Texas, USA
| | | | - Ravneet Kaur
- Associate Professor of All India Institute of Medical Sciences, New Delhi, India
| | - Rishabh Kumar Rana
- Department of PSM, Patliputra Medical College and Hospital PMCH, Dhanbad, Jharkhand, India
| | | | - Ozden Gokdemir
- PhD Izmir University of Economics, Faculty of Medicine, Izmir, Turkey
| | - Madonna Bacorro
- Department of Family Medicine, University of Sto. Tomas Hospital, Espana, Manila, Philippines
| | - Kedar Mehta
- GMERS Medical College, Community Medicine, Gotri, Vadodara, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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Bhatt G, Goel S, Gupta R, Grover S, Medhi B. Evaluating the impact of culturally specific patient-centric behavioral intervention package versus usual care for tobacco cessation among patients attending noncommunicable disease clinics in North India: A single-blind trial pilot study protocol. Tob Use Insights 2022; 14:1179173X211056622. [PMID: 34987297 PMCID: PMC8721367 DOI: 10.1177/1179173x211056622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background In a low and middle-income country (LMIC) like India, non—communicable diseases (NCDs) contribute a major proportion (61.8%) of all causes of death. Out of this, 48% of cardiovascular diseases , 23% of Chronic Respiratory Diseases , and 10% of Cancer deaths are attributable to tobacco use. Tobacco use is a major risk factor for NCDs and thus, the tobacco cessation approach is a high priority intervention to combat complications and death among NCD patients. While several interventions are available for tobacco cessation, in resource constraint countries like India, the effectiveness of low-cost, culturally specific patient-centric tobacco cessation behavioral intervention holds a potential that needs to be evaluated. A newly developed evidence-based tobacco cessation intervention package will be compared with the existing/usual care provided under the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) at NCD clinics. Methods and design 2 arm, parallel-group randomized controlled trial. Participants Patients aged ≥30 years suffering from NCD, currently using tobacco, and attending NCD clinics in 2 districts of Punjab, India. Sample size A total of 200 participants meeting the selection criteria will be recruited. They will be allocated either to the intervention arm or control (usual care) arm (100 each) using block randomization. Intervention For the participants, there will be 4 face-to-face disease-specific cessation counseling sessions, disease-specific pamphlets, short text messages in vernacular language, that is, Punjabi. Follow-ups will be done at the third, sixth, ninth, and 12th months. Primary outcome Seven-day abstinence, biochemically verified by plasma cotinine levels. Secondary outcome Quit attempts, number of sticks/number of times of smokeless tobacco usage in a day, and stage of behavior change in tobacco users. Discussion This multicomponent culturally specific-patient-centric behavioral intervention package for tobacco cessation at NCD clinic settings focusing on the individual, family, and social environment could increase the outreach of cessation services using existing resources, thereby strengthening health systems and enhancing the quality of life of NCD patients. Trial registration The protocol for the study has been registered with the Clinical Trials Registry in India under the registration number CTRI/2018/01/011643.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Gupta
- Honorary Consultant, Tobacco Cessation, Department of Deaddiction, Santokba Durlabhji Memorial Hospital and Medical Research Institution, Jaipur, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Donato TAA, Silva RMA, Andrade ACDS, Kochergin CN, Medeiros DSD, Soares DA, Louzado JA, Silva KO, Cortes ML, Mistro S, Amorim WWCC, Oliveira MGGD, Bezerra VM. [Periodic occupational examination: an opportunity for diagnosis and monitoring of chronic noncommunicable diseases in men]. CAD SAUDE PUBLICA 2021; 37:e00298320. [PMID: 34816961 DOI: 10.1590/0102-311x00298320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/15/2021] [Indexed: 11/22/2022] Open
Abstract
The study aimed to estimate the prevalence of arterial hypertension as the principal marker of chronic noncommunicable diseases (NCDs) and to identify associated modifiable factors in male workers. Baseline data were used from a longitudinal study with a sample of 1,024 male workers 18 years or older in a municipality in Northeast Brazil. The marker for NCDs was arterial hypertension, defined as systolic pressure ≥ 140mmHg and/or diastolic pressure ≥ 90mmHg and/or prior diagnosis of arterial hypertension and/or use of antihypertensive medication. Poisson regression with robust variance was used, adopting hierarchical entry of variables. Population attributable fractions (PAFs) were calculated for the lifestyle variables to measure the impact of modifiable factors on workers' health. Prevalence of hypertension was 28.6% (95%CI: 25.9-31.5). Distal factors associated with hypertension were age > 40 years, black skin color, and family income ≥ 3 times the monthly minimum wage. Intermediate factors were alcohol abuse, smoking, high self-rated salt intake, and physical inactivity. Proximal factors were overweight and obesity. Calculation of PAFs showed that a reduction or elimination of unhealthy lifestyle habits and behaviors in this population group would reduce the prevalence of the target NCD, hypertension, by 56.1%. The identification of modifiable factors and the ways they can negatively impact male workers' health allows planning interventions in the workplace itself to reach the largest number of individuals, aimed at reducing the harmful effects of NCDs.
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Affiliation(s)
| | | | | | | | | | - Daniela Arruda Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | - José Andrade Louzado
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | - Kelle Oliveira Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | - Matheus Lopes Cortes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | - Sóstenes Mistro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | | | | | - Vanessa Moraes Bezerra
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
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Bhatia M, Kumar M, Dixit P, Dwivedi LK. Diagnosis and Treatment of Hypertension Among People Aged 45 Years and Over in India: A Sub-national Analysis of the Variation in Performance of Indian States. Front Public Health 2021; 9:766458. [PMID: 34778193 PMCID: PMC8585934 DOI: 10.3389/fpubh.2021.766458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cardiovascular disease (CVD) is the single largest contributor to non-communicable disease (NCD) deaths, with hypertension contributing to a significant proportion of these deaths. This study aims to provide estimates of the prevalence, awareness, treatment and control of hypertension at sub-national levels in India and identifies well and under-performing states with respect to the diagnosis and treatment of hypertension. Methods: The study utilises data from the Longitudinal Study of Ageing in India (LASI), a nationally representative survey of more than 72,000 individuals. Age-sex adjusted prevalence rates of self-reported hypertension was calculated using the direct standardisation method. Multivariable logistic regression was performed to assess the association of self-reported hypertension with the various individual co-morbidity, lifestyle, and household factors. Self-reported prevalence was compared with an objective measure of hypertension for each state, and funnel plots were constructed to assess the performance of states. Results: Our findings suggest that the overall prevalence of age-sex adjusted self-reported hypertension was 25.8% in India with significant variation among states. Results based on logistic regression confirm that those individuals who are elderly, obese, belong to a higher socio-economic group and have associated co-morbidities are at increased odds of reporting hypertension. Overall, 4 out of 10 adults over 45 years of age in India are not aware of their hypertensive condition, and of those who are aware, 73% are currently taking medication, and only 10% of these have their hypertension under control. Based on the performance, states were classified into high and low performing categories. States with an increased proportion of population below the poverty line had significantly lower performance with respect to the diagnosis of hypertension, whereas states with higher literacy rates and greater availability of specialist doctors at community health centres (CHCs) had significantly better performance with respect to treatment-seeking behaviour. Conclusion: The findings of this study and its policy implications are discussed. Based on state performance, strategies are proposed in terms selective targeting vs. population-based strategies. High impact states and sub-groups are identified where intense efforts are needed to tackle the growing menace of hypertension in India.
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Affiliation(s)
- Mrigesh Bhatia
- Department of Health Policy, London School of Economics, London, United Kingdom
| | - Manish Kumar
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Priyanka Dixit
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Laxmi Kant Dwivedi
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
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Chalwe JM, Mukherjee U, Grobler C, Mbambara SH, Oldewage-Theron W. Association between hypertension, obesity and dietary intake in post-menopausal women from rural Zambian communities. Health SA 2021; 26:1496. [PMID: 34522391 PMCID: PMC8424718 DOI: 10.4102/hsag.v26i0.1496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 05/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Amongst the cardiovascular risk (CVR) factors, hypertension (HT) and obesity appear to be prominent in post-menopausal women. The underlying mechanisms of HT development in menopause are not fully understood. AIM To determine the association between HT, obesity and dietary intakes in post-menopausal women from rural Zambia. SETTING This study was conducted in Twatasha Compound of Kitwe and Ndeke Community of Ndola. METHODS Blood pressure (BP), weight, height and dietary intakes (24-h recall) were measured in 153 women (> 50 years) from households. The South African Hypertension Society (SAHS), the World Health Organization (WHO) and estimated average requirements (EARs) guidelines were followed for HT, obesity and dietary intake definitions, respectively. Statistical Package for the Social Sciences (SPSS) version 26 was used for descriptive and inferential statistical analyses. RESULTS Prevalence of HT was 70%, whilst 37.25% and 28.10% of the participants were overweight and obese, respectively. The median interquartile range (IQR) dietary intakes showed inadequate intakes for most nutrients, except for carbohydrates (170 g [133; 225]). The total fat intake represented 14% of total energy intake. All median fatty acid intakes and sodium intakes (409 mg [169; 662]) were below the recommended levels. Only body mass index (BMI) correlated with HT (r = 0.268; p = 0.001). CONCLUSIONS Despite low dietary intakes, an alarming prevalence of HT and obesity was found in our population. Hormonal changes, a high energy-dense diet and poor treatment adherence, may be possible underlying factors. We recommend measures to better manage HT as a CVR factor. CONTRIBUTION This article supplements evidence on the prevalence of obesity-related hypertension in post-menopausal women and the link to dietary intake.
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Affiliation(s)
- Joseph M Chalwe
- Department of Health Sciences, Faculty of Applied and Computer Sciences, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Upasana Mukherjee
- Department of Nutritional Sciences, Faculty of Human Sciences, Texas Tech University, Lubbock, Texas, United States of America
| | - Christa Grobler
- Department of Health Sciences, Faculty of Applied and Computer Sciences, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Saidon H Mbambara
- Department of Biomedical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Faculty of Health Sciences, Texas Tech University, Lubbock, Texas, United States of America
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Grover S, Verma M, Singh T, Dahiya N, Nehra R. Screening for Abuse of Older Adults: A Study Done at Primary Health Care Level in Punjab, India. Indian J Psychol Med 2021; 43:312-318. [PMID: 34385724 PMCID: PMC8327867 DOI: 10.1177/0253717620928782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about elder abuse in the domestic environment. In lower-middle income countries like India, the demographic transition is throwing novel challenges. The older adults are relatively more vulnerable because of coexisting medical and psychological problems. Any form of abuse affects mental health and increases the chances of anxiety and depression among the older adults. The study aimed to assess the burden of abuse amongst older adults visiting a primary health care center of north India. METHODS This is secondary data analysis conducted on the data collected in the primary study between September 2017 and June 2018 in northern India among 311 older adult patients attending the noncommunicable disease clinic. Diabetes mellitus and hypertension were diagnosed as per standard guidelines. Vulnerability to Abuse Screening Scale (VASS) was used to assess elder abuse. Depression, anxiety, and loneliness were assessed by using the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, and University of California, Los Angeles (UCLA) loneliness 20-item scale, respectively. Multiple logistic regression was carried out to explore the factors associated with elder abuse after ruling out collinearity between independent variables. RESULTS About 24% of older adults experienced abuse in the last 12 months. One-fourth of the older adults reported vulnerability, nearly half reported coercion and dejection, and most of them reported experiencing dependence. Participants also had a high prevalence of anxiety (39%), depression (54%), and features suggestive of loneliness (38.6%). Multiple logistic regression analysis showed that abuse was predicted by educational status, per-capita income, and loneliness. CONCLUSION About one-fourth of the older adults experience abuse. This highlights the importance of routine screening of older adults at the primary care level.
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Affiliation(s)
- Sandeep Grover
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhur Verma
- Dept. of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
- Dept. of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarundeep Singh
- Dept. of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Dahiya
- Dept. of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Nehra
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Development of integrated model of communication for implementing media strategy to prevent hypertension in a northern state of India. J Hypertens 2021; 39:1333-1340. [PMID: 34074972 DOI: 10.1097/hjh.0000000000002792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Media plays a major role in inculcating positive changes or averting negative changes in health-related behaviors across populations. Although various mass media interventions have proven their effectiveness in changing individuals' behavior for various diseases and risk factors, current literature is limited regarding a conceptual framework/model for the prevention of hypertension and cardiovascular diseases. The present study describes the process of development and implementation of a comprehensive and need-based media strategy with an aim to generate politico-administrative support for strengthening hypertension services in the state of Punjab, India. METHODS The preparation of theoretical framework underwent two stages, that is, item generation and item reduction. The item generation involved extensive literature search, development of consensus among experts using Delphi technique and its validation. The item reduction involved the selection of models among existing communication and health promotion models, placement of items in the selected models and development of final conceptual framework model. RESULTS Based upon the review and expert's consensus, we zeroed in on three models of communication - communication campaign model, paid earned social owned model, and staircase model - in order to come up with the framework requisite for a systematic media strategy. The model focused upon context-specific messages involving both traditional and modern means and tools of communication. This model (conceptual framework) was the product of intense literature review followed by opinion of the experts from various disciplines such as medical professionals, public health specialists, communication experts, social scientists, politicians, bureaucrats, state-level representatives, media journalists and hypertensive patients. CONCLUSION The present model can effectively be used by the program implementers, educators and policy makers in similar settings.
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Kumar S, Kant R, Yadav P, Natarajan K, Bahurupi Y, Mishra A. A Community-Based Study on Waist-to-Height Ratio: An Indicator for Systolic Hypertension in a Rural Community of Hilly Region. Cureus 2021; 13:e16014. [PMID: 34336504 PMCID: PMC8320356 DOI: 10.7759/cureus.16014] [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] [Accepted: 06/28/2021] [Indexed: 11/05/2022] Open
Abstract
The prevalence of hypertension gradually becomes a serious public health threat as it is a very pertinent risk factor for cardiovascular and cerebrovascular diseases. This study aims to estimate the prevalence of isolated systolic hypertension (ISH) among the hilly region's rural community and identify the indicators of ISH among study participants. A community-based cross-sectional study was conducted among 1220 participants in the rural community of the hilly region. A multistage random sampling technique was applied to recruit the participants. Demographic and anthropometric dimensions were measured to analyze the outcome of the study. The participants' mean age was 44.42 ± 15.54 years, with a majority of 822 female participants (67.40%). The prevalence of ISH was found as 27.45%. A statistically significant positive correlation (p < 0.05) of the waist-to-height ratio (WHtR) and body mass index (BMI) were observed with systolic blood pressure (SBP) in male as well as female participants, whereas BMI and WHtR had no correlation with diastolic blood pressure (DBP). Among female participants, the area under the curve (AUC) for BMI and WHtR was 0.604 (95% confidence interval 0.565-0.643, p-value = 0.020*) and 0.622 (95% confidence interval 0.584-0.660, p-value = 0.020*), respectively. Among male participants, the AUC for BMI and WHtR was 0.574 and 0.592, respectively. Hence, it cannot be considered very satisfactory. The increasing prevalence of ISH in a rural community is also a public health concern. At the preliminary stage, anthropocentric measurements are the primary tool for a family physician while treating the patients. This study concluded that WHtR is a better indicator than BMI for systolic hypertension. Although we have not observed a strong correlation of WHtR with systolic hypertension, it is required to perform future research to support this study's evidence.
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Affiliation(s)
- Santosh Kumar
- Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Ravi Kant
- General Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.,College of Nursing, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Poonam Yadav
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Kavitha Natarajan
- Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Yogesh Bahurupi
- Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Ashutosh Mishra
- Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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Khandpur S, Bhardwaj M, Awasthi A, Newtonraj A, Purty AJ, Khanna T, Abraham G, Tiwari S. Association of kidney functions with a cascade of care for diabetes and hypertension in two geographically distinct Indian cohorts. Diabetes Res Clin Pract 2021; 176:108861. [PMID: 34022251 DOI: 10.1016/j.diabres.2021.108861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/16/2021] [Accepted: 05/08/2021] [Indexed: 11/27/2022]
Abstract
AIM Type 2 diabetes (T2DM) and hypertension (HTN) are the main modifiable risk factors of chronic kidney disease (CKD), among the known traditional and non-traditional risk factors. METHODS We determined the prevalence and care-cascade of these modifiable CKD-risk factors and their association with socioeconomic status in adjoining Lucknow and Puducherry cities of India. RESULTS 439 participants reported no CKD were recruited. Serum analysis revealed an Estimated Glomerular Filtration Rate (eGFR) ≥ 90 ml/min/1.73 m2 in 60.36% of the population. Of them, 55.85% had HTN and/or T2DM as CKD-risk factors; however, less than half of this population was unaware of their CKD-risk status. Awareness and treatment were significantly higher in Puducherry and were associated with literacy, occupation, and residence place. Although the CKD-risk population was about two times higher in Puducherry than Lucknow, the populations with mild-low eGFR were comparable in the two regions. Moreover, in Lucknow, mild-low eGFR and low awareness were more prevalent among the younger participants (<30 years), relative to Puducherry. CONCLUSIONS Despite a higher prevalence of CKD-risk factors in Puducherry, populations with mild-low eGFR were comparable to Lucknow. More heightened awareness and better care cascade for CKD-risk factors in Puducherry may prevent or delay eGFR reduction.
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Affiliation(s)
- Sukhanshi Khandpur
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Mansi Bhardwaj
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ashish Awasthi
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram 122002, India
| | - Ariarathinam Newtonraj
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | - Anil J Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | - Tripti Khanna
- Indian Council of Medical Research, Ramalingaswami Bhawan, New Delhi, India
| | - Georgi Abraham
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | - Swasti Tiwari
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
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Nandi M, Kurschner S, Wilcox K, Flood D, Montano CM, Barnoya J, Rohloff P, Chary A. Perceptions of chronic kidney disease among at-risk adults in rural Guatemala. Glob Public Health 2021; 16:623-638. [PMID: 33161879 PMCID: PMC8005433 DOI: 10.1080/17441692.2020.1839529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 09/23/2020] [Indexed: 11/11/2022]
Abstract
This qualitative study explores perceptions of chronic kidney disease (CKD) among adults with abnormal estimated glomerular filtration rate (eGFR) in Guatemala, where the burden of CKD is rising. Qualitative semi-structured interviews were conducted with 39 individuals screened for CKD and found to have abnormal eGFR (defined as <90 mL/min/1.73 m2, per Kidney Disease Improving Global Outcomes [KDIGO] guidelines). Interviews occurred in participants' homes in Spanish or Kaqchikel Mayan. Interview notes were coded for dominant themes through an inductive approach. Interviewees had limited awareness of diabetes and hypertension as CKD risk factors, but appreciated the progressive nature of the disease. While most reported willingness to pursue renal replacement therapies, if necessary, they anticipated economic and geographic barriers. Public health interventions should focus on the association between diabetes, hypertension, and CKD. Improvement of primary care and screening infrastructure is imperative in CKD prevention in low- and middle-income countries (LMICs).
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Affiliation(s)
- Meghna Nandi
- The Warren Alpert Medical School at Brown University, Rhode Island, USA
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
| | - Sophie Kurschner
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
| | - Katharine Wilcox
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
- Weill Cornell School of Medicine, New York, USA
| | - David Flood
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
- National Clinicians Scholars Program, University of Michigan, Ann Arbor, Michigan
| | - Carlos Mendoza Montano
- Institute of Nutrition of Central America and Panama (Instituto de Nutrición de Centroamérica y Panamá, INCAP), Guatemala
| | - Joaquin Barnoya
- Institute of Research and Higher Studies in Health Sciences (El Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, IECIS), Rafael Landívar University
| | - Peter Rohloff
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
- Department of Medicine, Department of Global Health Equity, Brigham and Women’s Hospital, Boston, USA
| | - Anita Chary
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
- Departments of Emergency Medicine, Massachusetts General Hospital, Brigham and Women’s Hospital, Boston, USA
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Jayanthi R, Girijasivam SP, Gaur A. Association of blood pressure and BMI to corrected QT interval in young adults. Can J Physiol Pharmacol 2021; 99:894-899. [PMID: 33517855 DOI: 10.1139/cjpp-2020-0520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hypertension is often associated with obesity. Uncontrolled hypertension can lead to uncorrected cardiac dysautonomia that makes cardiac repolarization abnormally prolonged. Modern dietary habits, stress, and bad lifestyle habits make young adults vulnerable to hazards of health. We planned to study the association of body mass index (BMI) and blood pressure (BP) with corrected QT (QTc) intervals in young adults. After obtaining the written informed consent, 171 subjects were randomly selected in the age group of 18-35 years. A general history and physical examination were done before recording the BMI and BP. A 12-lead electrocardiogram was recorded and QTc calculated using Bazett's formula. The values obtained were compared and statistical analysis done. Of the 171 subjects 14.03% were hypertensive. The QTc interval was found to be prolonged in females and it is prolonged with age, BMI, and BP. QTc was significantly increased among the prehypertensive and hypertensive group and with the overweight and (or) obese BMI group compared with the normotensives and normal BMI group suggesting an altered autonomic homeostasis. This warrants lifestyle modification at a younger age to reduce the cardiovascular risk.
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Affiliation(s)
- Ramkumar Jayanthi
- Department of Physiology, Chengalpattu Medical College, Chengalpattu, India
| | | | - Archana Gaur
- Department of Physiology, AIIMS Jodhpur, Jodhpur, India
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Hasan M, Khan MSA, Sutradhar I, Hossain MM, Hossaine M, Yoshimura Y, Choudhury SR, Sarker M, Mridha MK. Prevalence and associated factors of hypertension in selected urban and rural areas of Dhaka, Bangladesh: findings from SHASTO baseline survey. BMJ Open 2021; 11:e038975. [PMID: 33472770 PMCID: PMC7818822 DOI: 10.1136/bmjopen-2020-038975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE We implemented this study to report the prevalence and associated risk factors of hypertension among adult men and women aged >30 years residing in selected urban and rural areas of Dhaka division, Bangladesh. DESIGN Cross-sectional study. SETTING Two urban (Dhaka city north and Dhaka city south) and two rural (Narsinghdi and Gazipur district) areas of the Dhaka division. PARTICIPANTS A total of 4856 male and female participants were included in the final analysis, of whom 2340 (48.2%) were from urban and 2516 (51.8%) were from rural areas. PRIMARY OUTCOME Hypertension was the dependent variable for this study and was operationally defined as systolic blood pressure >140 mm of Hg and/or diastolic blood pressure >90 mm of Hg, and/or persons with already diagnosed hypertension. RESULTS The overall prevalence of hypertension was 31.0%, and the prevalence was higher among urban participants (urban: 36.9%, rural: 30.6%). Age (across all categories), female (urban-adjusted OR (AOR): 1.3, 95% CI: 1.0 to 1.5 and rural-AOR: 1.7, 95% CI: 1.4 to 2.1)), higher educational status (urban-AOR: 1.7, 95% CI: 1.3 to 2.2 and rural-AOR: 2.1, 95% CI: 1.5 to 3.1), inadequate physical activity (urban-AOR: 1.3, 95% CI: 1.0 to 1.7 and rural-AOR: 1.5, 95% CI: 1.2 to 1.9) and overweight/obesity (urban-AOR: 2.7, 95% CI: 2.1 to 3.3 and rural-AOR: 2.1, 95% CI: 1.7 to 2.5) were associated with hypertension in both urban and rural areas. Women who were not currently married during the survey had higher odds of hypertension only in the rural areas (rural-AOR: 1.8, 95% CI: 1.3 to 2.4), and respondents who were not working during the survey had higher odds of hypertension only in the urban areas (AOR: 1.7, 95% CI: 1.0 to 2.6). CONCLUSION Since the prevalence of hypertension was high in urban and rural areas, the government of Bangladesh should consider implementing hypertension prevention programmes focusing young population of Dhaka division. In addition, early screening programmes and management of hypertension need to be strengthened for people with hypertension in both the areas.
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Affiliation(s)
- Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Ipsita Sutradhar
- Centre for Science of Implementation and Scale-up, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Yukie Yoshimura
- Japan International Cooperation Agency, Chiyoda-ku, Tokyo, Japan
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Malabika Sarker
- Centre for Science of Implementation and Scale-up, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
| | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
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Jeelani A, Raja W, Ayub T, Khan SMS. Adherence to antihypertensive therapy and its determinants among patients attending primary care hospitals of Kashmir, India. J Family Med Prim Care 2021; 10:4153-4159. [PMID: 35136782 PMCID: PMC8797075 DOI: 10.4103/jfmpc.jfmpc_668_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Adherence to antihypertensive therapy is an important factor in determining the clinical course of hypertension. This study was planned to estimate adherence to antihypertensive therapy and its determinants among OPD patients attending two primary care hospitals in Kashmir valley. Methods: This study employed a cross-sectional study design. All subjects who reported to OPD between October and December 2020 and had been prescribed antihypertensive medications for at least 1 year were included. Sociodemographic information was collected on a pretested schedule and adherence to medications was assessed by using the-14 item Hill-Bone HBP Compliance to High Blood Pressure Therapy Scale (HB-HBP). Mann–Whitney test and Spearman’s rank correlation coefficient were used. Results: A total of 406 subjects were included in the final analysis with a mean age of 58 years for women and 56 years for men. The sample comprised 54% women. More than 60% of subjects were currently married, urban area residents, and belonged to middle strata of social class. The mean score obtained in the HB-MAS (maximum score 56) was 19.26 (SD ± 4.3). Subjects aged 60 years and above, those belonging to lower socioeconomic class, and subjects prescribed three or more drugs with more than once-daily dosing regimen had higher odds of having poor adherence. Conclusion: There is suboptimal adherence among OPD patients at primary care level. There is a need for enhanced counselling regarding medication adherence particularly for elderly, poor, illiterate persons and those prescribed multiple medicines with more than once-daily dosing.
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Mangal S, Baig V, Gupta K, Mangal D, Panwar R, Gupta R. e Health initiatives for screening and management of hypertension in Rural Rajasthan. J Family Med Prim Care 2021; 10:4553-4557. [PMID: 35280647 PMCID: PMC8884285 DOI: 10.4103/jfmpc.jfmpc_848_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/23/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022] Open
Abstract
Context: Electronic health (e health) initiatives are being employed in various health programs for disease monitoring. Very few such studies have been conducted in India, so this study was planned. Aims: Assess feasibility and usefulness of e health interventions for health workers, ASHA (accredited social health activist) in screening and management of hypertension. Setting and Design: Prospective observational cohort study. ASHA's were recruited in two selected villages of Rajasthan and trained to use this technology. Methods and Material: A web-based application was developed for use on portable device (tablet) to screen and diagnose hypertension, provide health education focused on diet, physical exercise and promote adherence to therapies by repeated sessions of one-to-one health education. Statistical analysis was done by Excel. Results: With the use of e health initiatives, among population above 18yrs, we found 19.1% hypertensives (464/2430) with 46.5% new cases of hypertension and 38.9 % (945/2430) prehypertensive. Mean age of hypertensives was 52.6 yrs. ± 15.2 and 36.8 yrs. ± 14.2 for prehypertensive and highly significant (p < 0.001). Mean systolic blood pressure level of hypertensives decreased from 147.14 Hg ±13.86 to 133.3 Hg ±13.07 and for prehypertensive from 123.18 mm Hg ± 4.5 to 117.55 mm Hg ± 6.9 after follow up, the difference in change was highly significant (P < 0.001). Also, could start 27.4% hypertensives on treatment, while 50.2% were already on treatment. Conclusion: Training ASHA worker in e health technology is feasible and can assist in screening and management of diseases.
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Berhe DA, Yenit MK, Baraki AG. The Burden of Hypertension and Associated Factors Among Adults Visiting the Adult Outpatient Department at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2016. Vasc Health Risk Manag 2020; 16:545-552. [PMID: 33364773 PMCID: PMC7751300 DOI: 10.2147/vhrm.s285900] [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: 10/11/2020] [Accepted: 12/09/2020] [Indexed: 01/13/2023] Open
Abstract
Background Hypertension is a global health concern that can lead to cardiovascular disease and death. In Ethiopia, the risks for cardiovascular disease have been increasing dramatically. But due to the high burden of communicable diseases, less emphasis is given to non-communicable diseases like hypertension. This study aimed to fill the information gap by determining the prevalence and the key determinants of hypertension in the study area. Methods Institution-based cross-sectional study was conducted in Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia from September to October 2016. A total of 414 adults visiting medical OPDs were selected using systematic random sampling. Data were collected by blood pressure measurements and a pre-tested structured questionnaire. Descriptive statistics were computed. Multivariable logistic regression analysis was used to determine the adjusted odds ratio with a 95% confidence interval. The goodness of fit of the model was also checked by Hosmer and Lemeshow test. Results The overall prevalence of hypertension in the study area was 38.9% (95% CI: 34.1-43.7). Age above 55 years (AOR = 3.33, 95% CI: 1.88-5.90), family history of hypertension (AOR = 2.71, 95% CI: 1.37-5.36), diabetes (AOR = 4.15, 95% CI 1.77-9.72), obesity (AOR = 5.50, 95% CI: 2.07-14.62), knee arthritis (AOR = 1.71, 95% CI: 1.24, 2.36), and not walking at least for 10 minutes continuously on daily basis (AOR = 2.86, 95% CI: 1.15 -7.12) were found to be independent predictors of hypertension. Conclusion Prevalence of hypertension was high in the study area, and a large proportion of them were also newly diagnosed. Factors like age, family history of hypertension, diabetes, obesity, knee arthritis, and exercise were found to be independent predictors of hypertension. Therefore, we recommend people who have these risk factors to have screening for hypertension.
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Affiliation(s)
- Daniel Awraris Berhe
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adhanom Gebreegziabher Baraki
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kalkonde Y, Jadhao S, Deshmukh M, Sen Gupta S, Bang A. Gaps in secondary prevention among stroke survivors in rural Gadchiroli, India: a community-based cross-sectional study. Wellcome Open Res 2020; 5:263. [PMID: 33313419 PMCID: PMC7721060 DOI: 10.12688/wellcomeopenres.16377.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/19/2023] Open
Abstract
Background: With epidemiological transition, stroke has emerged as a public health priority in rural India. However, population-level information on secondary prevention of stroke from rural areas of India and other low- and middle-income countries remains exceedingly rare. Methods: In a cross-sectional community-based survey, trained surveyors screened a well-defined population of 74,095 individuals living in 64 villages in Gadchiroli district of India for symptoms of stroke. A trained physician evaluated screen positive patients, diagnosed stroke, measured blood pressure and collected information on prior diagnosis of risk factors and current use of medications using a structured questionnaire. Results: A total of 265 stroke survivors were identified. Prior diagnosis of hypertension was made in 57.4%, diabetes in 9.8%, hyperlipidaemia in 0.4%, ischaemic heart disease in 1.5%. and atrial fibrillation in 1.1%. Blood pressure was uncontrolled (>140/90) in 46% of stroke survivors. Among men 71.2% used tobacco and 30% used alcohol, while among women 38.2% used tobacco and none used alcohol. Only 40.8% of stroke survivors were receiving antihypertensive medications, while 10.6% were on antiplatelet agents and 4.9% were on statins. In a multivariate analysis, age <50 years (OR 0.2, 95% CI 0.1-0.5), male sex (OR 0.2, 95% CI 0.2-0.8) and lower economic status (no assets vs four assets; OR 0.3, 95% CI 0.1-0.9) were associated with lower odds of receiving medications for secondary prevention of stroke. Conclusions: There were significant gaps in secondary prevention of stroke in rural Gadchiroli. Healthcare programmes for secondary prevention of stroke in rural areas will have to ensure that blood pressure is adequately controlled, alcohol and tobacco cessation is promoted and special attention is paid to those who are younger, men and economically weaker.
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Affiliation(s)
- Yogeshwar Kalkonde
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
| | - Sunil Jadhao
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
| | - Mahesh Deshmukh
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
| | - Shoummo Sen Gupta
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
| | - Abhay Bang
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
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Bragg-Gresham J, Thakur JS, Jeet G, Jain S, Pal A, Prasad R, Pennathur S, Saran R. Population-based comparison of chronic kidney disease prevalence and risk factors among adults living in the Punjab, Northern India and the USA (2013-2015). BMJ Open 2020; 10:e040444. [PMID: 33318117 PMCID: PMC7737106 DOI: 10.1136/bmjopen-2020-040444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES India is witnessing a disturbing growth in non-communicable diseases (NCDs), including chronic kidney disease (CKD). Recently, a WHO STEPS survey was conducted in the state of Punjab, India to collect data from the adult population on NCD risk factors. We sought to compare the prevalence of CKD and its risk factors between this large state in northern India and the USA. SETTING Samples were drawn from both locations, Punjab, India and the USA, using multistage stratified sampling designs to collect data representative of the general population. PARTICIPANTS Data from 2002 participants in the Punjab survey (2014-2015) and 5057 in the USA (National Health and Nutrition Examination Survey (NHANES; 2013-2014), between the ages of 18-69 years were examined. PRIMARY AND SECONDARY OUTCOME MEASURES Modified Poisson regression was employed to compare prevalence between the two samples for markers of CKD and its risk factors. All analyses used sampling weights. RESULTS The average age in the Punjab sample was significantly lower than the USA (38.3 vs 42.5 years, p<0.0001). While smoking and obesity were higher in the USA, hypertension was much more common in Punjab (48.2% vs 33.4%, p<0.0001). Significant differences were seen in the prevalence of CKD, with lower prevalence of eGFR <60 mL/min/1.73 m2 (2.0% vs 3.8%, p<0.0001), but markedly higher prevalence of albuminuria (46.7% vs 8.9%, p<0.0001) in Punjab. These differences could not be explained by traditional risk factors such as diabetes and hypertension. CONCLUSIONS We report a strikingly high prevalence of albuminuria in Punjab, India, compared with the USA. This requires further study and may have enormous public health implications for future burden of progressive CKD, end-stage kidney disease, morbidity, mortality and specifically for elevated risk or presence of cardiovascular disease in the northern state of Punjab, India.Funding came from the National Health Mission, Punjab, India, JST and the Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Affiliation(s)
- Jennifer Bragg-Gresham
- Internal Medicine-Division of Nephrology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - J S Thakur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Gursimer Jeet
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Sanjay Jain
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Arnab Pal
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Rajendra Prasad
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Subramaniam Pennathur
- Internal Medicine and Molecular and Integrative Physiology, Division of Nephrology, University of Michigan School of Public Health, Ann Arbor, India
| | - Rajiv Saran
- Internal Medicine-Division of Nephrology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Tsai TY, Cheng HM, Chuang SY, Chia YC, Soenarta AA, Minh HV, Siddique S, Turana Y, Tay JC, Kario K, Chen CH. Isolated systolic hypertension in Asia. J Clin Hypertens (Greenwich) 2020; 23:467-474. [PMID: 33249701 PMCID: PMC8029528 DOI: 10.1111/jch.14111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 11/04/2020] [Indexed: 01/09/2023]
Abstract
Isolated systolic hypertension (ISH) is the most common type of essential hypertension in the elderly and young adults. With rapid industrialization and population aging, the prevalence of ISH in Asia will rise substantially. Asian populations have distinct epidemiological features, risk factors and are especially vulnerable to ISH. There is a pressing need for Asian countries to formulate their unique strategies for control of ISH. In this review, we focus on the (1) epidemiology and pathophysiology, (2) risk factors and impact on outcomes, and (3) treatment goal and strategy for ISH in Asia.
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Affiliation(s)
- Tsung-Ying Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya Kuala, Lumpur, Malaysia
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Harapan Kita, University of Indonesia-National Cardiovascular Center, Jakarta, Indonesia
| | - Huynh Van Minh
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | | | - Yuda Turana
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Chen-Huan Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Wachamo D, Geleta D, Woldesemayat EM. Undiagnosed Hypertension and Associated Factors Among Adults in Hawela Tula Sub-City, Hawassa, Southern Ethiopia: A Community-Based Cross-Sectional Study. Risk Manag Healthc Policy 2020; 13:2169-2177. [PMID: 33116995 PMCID: PMC7573300 DOI: 10.2147/rmhp.s276955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 01/12/2023] Open
Abstract
Background Hypertension (HTN) is a major public health problem and often it is unnoticed. Undiagnosed HTN may lead to a high burden of cardiovascular diseases and complications such as stroke and heart attack. In this study, we aimed to assess the prevalence and associated factors of undiagnosed HTN. Methods From February to June 2019, a community-based cross-sectional study was conducted on 383 randomly selected adults in Hawela Tulla Sub-city, Hawassa, southern Ethiopia. Data were collected by pretested questionnaires, and physical measurements of weight, height and blood pressure were collected through standardized procedures adapted from WHO STEPS survey tools. Data entry and analysis were carried out using SPSS version 23 statistical software. Descriptive analysis and logistic regression models were used to describe the results. Logistic regression analysis results were declared statistically significant if the P-value was below 0.05 and the 95% CI did not cross the null value. Results The prevalence of undiagnosed HTN among the respondents was 12.3%. Only 152 (39.7%) of the study population knew the symptoms of HTN. Males (adjusted odds ratio [AOR] =2.5, 95% CI: 1.2, 5.2; P=0.016), people with a family history of HTN (AOR=2.7, 95% CI: 1.0, 7.0; P= 0.044), people who chewed khat (AOR=4.6, 95% CI: 2.0, 10.2; P<0.001), overweight or obese individuals (AOR=3.5, 95% CI: 1.7, 7.3; P=0.001) and people with diabetes mellitus (AOR=3.2, 95% CI: 1.1, 9.3; P=0.036) had a higher risk of undiagnosed HTN than their counterparts. Conclusion Identification of people with the risk factors of undiagnosed HTN and delivering health education to reduce the risky behaviors could reduce the burden and consequences of HTN. Integrating interventions at the community level may be important.
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Affiliation(s)
- Demelash Wachamo
- Hawassa College of Health Sciences, Department of Public Health, Hawassa, Ethiopia
| | - Dereje Geleta
- Hawassa University, College of Medicine and Health Sciences, School of Public Health, Hawassa, Ethiopia
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Gupta S, Virk A, Mittal A, Agarwal BK. Patterns and determinants of healthcare-seeking behavior among hypertensive patients in a rural population of north India: A mixed-method study. J Family Med Prim Care 2020; 9:2830-2836. [PMID: 32984134 PMCID: PMC7491806 DOI: 10.4103/jfmpc.jfmpc_200_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/13/2020] [Accepted: 04/07/2020] [Indexed: 12/03/2022] Open
Abstract
The prevalence of hypertension in india over the last 30 years is known to have increased rapidly. Hypertension is a chronic disease that needs to be managed within its sociological context as experienced by individuals. This study was conducted to identify the quantitative and qualitative determinants of healthcare-seeking behavior among hypertensive individuals in a rural population of north india.
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Affiliation(s)
- Shubham Gupta
- Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Amabala, Haryana, India
| | - Amrit Virk
- Community Medicine, Adesh Medical College and Hospital, Shahabad (M), Haryana, India
| | - Anshu Mittal
- Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Amabala, Haryana, India
| | - B K Agarwal
- Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Amabala, Haryana, India
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Kalyani CV, Mirza AA, Sharma SK, Saxena V, Rohilla KK, Dakshinamurthy S. Undiagnosed elevated blood pressure and its life style related risk factors among adults: Cross sectional survey. J Family Med Prim Care 2020; 9:4962-4968. [PMID: 33209829 PMCID: PMC7652113 DOI: 10.4103/jfmpc.jfmpc_679_20] [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: 04/22/2020] [Revised: 06/10/2020] [Accepted: 07/01/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Globally, high blood pressure (BP) is a main health problem among adult population. High BP is considered as a major risk factor which may lead to many cardiovascular diseases. Globally, it is also the leading cause of death. According to the American Heart Association, a BP of 120/80 mm of Hg is a normal range but when the systolic blood pressure ≥130 and diastolic blood pressure ≥80, it is always labeled as hypertension. OBJECTIVES In the present study, the researchers wanted to identify the prevalence of undiagnosed elevated blood pressure in the adult population of Uttarakhand, India and also try to explore its lifestyle-related risk factors. METHODS This study was an exploratory survey with a cross-sectional design. Data were collected from 440 participants by using the cluster sampling technique. RESULTS The male:female ratio among participants was 1:4 and most of the participants were aged 25-30 years. The study found that the prevalence of high blood pressure was 26%, in which marginal elevated BP prevalence was 16%, hypertension stage I was 7%, and hypertension Stage II was 3% which is significantly higher in number at a young age. Lifestyle-related risk factors showed a significant association of hypertensive status with gender, consumption of balanced diet, and personal habits. This increases the chances of elevated blood pressure in young adults. CONCLUSION All health professionals must be sensitized for elevated blood pressure problems among the young adult populations. Elevated blood pressure should be considered as a warning alarm at an early age when prescribing any medication and during any invasive procedure. Awareness should be created among public regarding elevated blood pressure issues at a younger age and motivate people to adopt a healthy and stress-free lifestyle.
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Affiliation(s)
- C. Vasantha Kalyani
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anissa A. Mirza
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suresh K. Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vartika Saxena
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kusum K. Rohilla
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Kokane AM, Joshi R, Kotnis A, Chatterjee A, Yadav K, Revadi G, Joshi A, Pakhare AP. Descriptive profile of risk factors for cardiovascular diseases using WHO STEP wise approach in Madhya Pradesh. PeerJ 2020; 8:e9568. [PMID: 32844055 PMCID: PMC7415222 DOI: 10.7717/peerj.9568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/28/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Periodic information on risk factor distribution is critical for public health response for reduction in non-communicable disease (NCDs). For this purpose, the WHO has developed STEPs wise approach. State representative population-based STEPS survey was last conducted in 2007-08 in seven states of In India. Since then no such work has been reported from low ETL states. This survey was carried out to assess the prevalence of risk factors associated with NCDs and the prevalence of NCDs in the low ETL state of Madhya Pradesh using the WHO STEPs approach. METHODS A total of 5680 persons aged 18-69 years were selected from the state of Madhya Pradesh using multi-stage cluster random sampling. Using the WHO STEPs approach, details were collected on demographics, STEP 1 variables (tobacco consumption, alcohol consumption, physical activity, diet), STEP 2 variables (weight, height, waist circumference, blood pressure) and STEP 3 variables (fasting blood glucose, blood cholesterol). RESULTS We found that 9.4% individuals smoked tobacco, 15.3% were overweight/obese, 22.3% had hypertension, and 6.8% have diabetes mellitus. As compared to women, men were less likely to be overweight or obese, but more likely to smoke tobacco, and have diabetes mellitus. Hypertension was also more common in men. Overall, about a fourth of all adults had three or more risk factors for cardiovascular disease. CONCLUSION The survey shows that a large section of the population from Madhya Pradesh is either suffering from NCDs or have risk factors which predispose them to acquire NCDs. This state representative survey provides benchmarking information for behavioural and biological risk factor distribution for recently scaled up National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS).
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Affiliation(s)
- Arun M. Kokane
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Rajnish Joshi
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Ashwin Kotnis
- Biochemistry, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Anirban Chatterjee
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Kriti Yadav
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - G Revadi
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Ankur Joshi
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Abhijit P. Pakhare
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
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Talukdar D, Tripathi M, Tripathi V, Teelucksingh S. Prevalence and associated factors of undiagnosed hypertension among women aged 15-49 years in India: an analysis of National Family Health Survey-4 data. J Hum Hypertens 2020; 35:726-740. [PMID: 32704029 DOI: 10.1038/s41371-020-0384-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/05/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022]
Abstract
Hypertension is a major risk factor for cardiovascular disease globally. Although Indian studies have addressed the prevalence of hypertension and its associated factors, this study focuses upon women in the reproductive age group, 15-49 years, who have undiagnosed hypertension. We use NFHS-4 data for secondary analyses of prevalence and factors associated with undiagnosed hypertension among women aged 15-49 years in India. Multiple logistic regression was undertaken to identify associated factors. Our analyses showed that overall prevalence of undiagnosed hypertension was 18.69% among women aged 15-49 years in India. In rural areas, it was 17.09% compared and 21.73% in urban areas. By comparison, only 8.86% self-reported a diagnosis of hypertension. Factors associated with undiagnosed hypertension were age, less than or more than normal BMI, higher wealth quintiles, no education, religion, caste, and geographical zones. Almost one in five women aged 15-49 years in India has undiagnosed hypertension with implications for personal and reproductive health.
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Affiliation(s)
| | - Mallika Tripathi
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
| | - Vrijesh Tripathi
- Department of Mathematics and Statistics, Faculty of Science and Technology, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago.
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
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Mohanty S, Nagarathna R, Metri K, Patil S, Kumar S, Singh A, Nagendra HR. Trends of Hypertension and Neurological Diseases in India: A Nationwide Survey Reporting the Distribution Across Geographical Areas. Ann Neurosci 2020; 27:162-168. [PMID: 34556955 PMCID: PMC8455011 DOI: 10.1177/0972753120987457] [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: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hypertension has remained an imperative risk factor for cardiovascular and cerebrovascular diseases, increasing the national burden of premature deaths over the decades. PURPOSE There is limited data on the prevalence of hypertension and its distribution across all geographic regions in India. This nationwide survey was conducted in 2017 to assess the prevalence of hypertension and prehypertension among the Indian adults. METHODS A multilevel stratified cluster sampling technique, with a random selection among the urban and rural populations, was adopted to achieve a sample of 70,031 adults from 24 states and 4 union territories. Blood pressure was measured twice using automated oscillometric machines with a minimum of 3-min gap, and the average was recorded. This was later categorized into prehypertension (elevated blood pressure) and hypertension subgroups as defined by the new 2017 American Heart Association guidelines. RESULTS The prevalence of prehypertension and hypertension in our study population across all ages was found to be 18.2% and 24%, respectively. Prehypertension was common at a younger age, whereas the prevalence of hypertension was higher in the older age groups. The urban population (24.4%) and males (24.7%) were positively associated with prehypertension and hypertension. The western zone had the highest prevalence of hypertension, whereas the eastern population had the lowest. CONCLUSION Our study revealed an alarmingly high prevalence of hypertension, accounting up to one hypertensive in every four adults in India. There is a need for more robust national strategies for identifying and treating hypertension to reduce the national and the global burden of hypertension by 25% before 2025.
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Affiliation(s)
- Sriloy Mohanty
- Centre of Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Raghuram Nagarathna
- Arogyadhama, Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnataka, India
| | - Kashinath Metri
- Department of Yoga, Central University of Rajasthan, Kishangarh, Rajasthan, India
| | - Suchitra Patil
- Department of Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnataka, India
| | - Sanjay Kumar
- Department of Health, Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karanataka, India
| | - Amit Singh
- Department of Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnataka, India
| | - Hongasandra R Nagendra
- Department of Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnataka, India
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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.
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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
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Prevalence, Awareness, Treatment, and Control of Hypertension and Its Associated Risk Factors: Results from Baseline Survey of SWADES Family Cohort Study. Int J Hypertens 2020; 2020:4964835. [PMID: 32351729 PMCID: PMC7178468 DOI: 10.1155/2020/4964835] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 12/18/2022] Open
Abstract
Methods In this prospective family-based cohort study, 573 families were included with a total of 997 participants aged 30 years and above. Baseline interviews were conducted in participant's homes using a combination of self-structured and standardized questionnaire. Blood pressure and plasma glucose were assessed for each participant. Results The prevalence of hypertension was 43%. It was slightly higher in women than men (43.7% vs. 41.4%). The mean systolic blood pressure in the hypertensive population was 141.9 mmHg and mean diastolic blood pressure was 85.3 mmHg. In total, 78% (86.2% in women, 62.9% in men) of the participants were aware of their hypertension. Among those aware, 60.4% (63.5% in women, 52.6% in men) of the participants were on treatment, and hypertension was controlled in 75.1% (77.5% women, 68% in men) of the participants on treatment. The prevalence of hypertension was higher among persons with comorbidities (diabetes 64.5%, transient ischemic attack 54.7%, and heart disease 64.4%). Prevalence was lower among persons who did regular vigorous intensity exercise versus those who did moderate intensity exercise (32% vs. 45.7%) and among nonsmokers versus smokers (42.2% vs. 46.6%). Conclusion The prevalence of hypertension in Kerala is high. Although awareness is quite high, there is a need to improve the number of persons with hypertension taking treatment.
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Rana J, Ahmmad Z, Sen KK, Bista S, Islam RM. Socioeconomic differentials in hypertension based on JNC7 and ACC/AHA 2017 guidelines mediated by body mass index: Evidence from Nepal demographic and health survey. PLoS One 2020; 15:e0218767. [PMID: 31986173 PMCID: PMC6984730 DOI: 10.1371/journal.pone.0218767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 01/02/2020] [Indexed: 01/30/2023] Open
Abstract
Background Unlike developed countries, higher socioeconomic status (SES-education, and wealth) is associated with hypertension in low and middle-income countries (LMICs) with limited evidence. We examined the associations between SES and hypertension in Nepal and the extent to which these associations vary by sex and urbanity. The body mass index (BMI) was examined as a secondary outcome and assessed as a potential mediator. Materials and methods We analyzed the latest Nepal Demographic and Health Survey data (N = 13,436) collected between June 2016 and January 2017, using a multistage stratified sampling technique. Participants aged 15 years or older from selected households were interviewed with an overall response rate of 97%. Primary outcomes were hypertension and normal blood pressure defined by the widely used Seventh Report of the Joint National Committee (JNC7) and the American College of Cardiology/American Heart Association (ACC/AHA) 2017. Results The prevalence of hypertension was higher in Nepalese men than women. The likelihood of being hypertensive was significantly higher in the higher education group compared with the lowest or no education group for men (OR 1.89 95% CI: 1.36, 2.61) and for women (OR 1.20 95% CI: 0.79, 1.83). People in the richest group were more likely to be hypertensive compared with people in the poorest group for men (OR 1.66 95% CI: 1.26, 2.19) and for women (OR 1.60 95% CI: 1.20, 2.12). The associations between SES (education) and hypertension were partially modified by sex and fully modified by urbanity. BMI mediated these associations. Conclusions The higher SES was positively associated with the higher likelihood of having hypertension in Nepal according to both JNC7 and ACC/AHA 2017 guidelines. These associations were mediated by BMI, which may help to explain broader socioeconomic differentials in cardiovascular disease (CVD) and related risk factors, particularly in terms of education and wealth. Our study suggests that the mediating factor of BMI should be tackled to diminish the risk of CVD in people with higher SES in LMICs.
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Affiliation(s)
- Juwel Rana
- Research and Innovation Department, South Asia Institute for Social Transformation (SAIST), Dhaka, Bangladesh
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- * E-mail:
| | - Zobayer Ahmmad
- Department of Sociology, University of Utah, Salt Lake City, Utah, United States of America
| | | | - Sanjeev Bista
- Advanced Biostatistics and Epidemiology, Ecole des Hautes Etudes en Sante Publique, Rennes, France
| | - Rakibul M. Islam
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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