Prevalence, awareness, treatment and control of high blood pressure in the elderly according to the ethnic group. Colombian survey

A prospective longitudinal approach to examine the association between social position in childhood, adolescence, and adulthood with the control of hypertension during adulthood

Introduction

Hypertension is one of the main concerns in public health, since it is related with increased morbidity, and potential years of life lost in addition to loss of quality of life. This study aimed to assess: (1) the distribution of indicators of life course SEP in a cohort of Colombian patients with hypertension and (2) to assess the association of life course SEP and control of hypertension among this cohort of patients.

Methods

Data were obtained using the baseline survey of 258 patients from the Social Determinants and Inequities in the Control of Blood Hypertension Program (ProDSICHA). Mother occupation and housing conditions were measured with the Event History Calendar. Mother educational level was measured with the questionnaire developed by the Project on Ethnicity and Race in Latin America (PERLA). Socioeconomic position during adulthood was measured using education, occupation, and income level based in the MacArthur Network.

Results

The group with a higher lifelong social position and the group of lower lifelong social position showed better control of hypertension (OR = 1.21; p <0.05; OR = 1.33; p < .05, respectively) compared to those whose social position throughout life varied the most. No statistical differences were found in the relations between single lifetime social position variables, and hypertension control in the three time points analyzed.

Discussion

These findings warrant further research to deeper our understanding on the role of a multidimensional and cumulative approach of social position in hypertension control.

The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review

Hypertension is a major risk factor for cardiovascular disease and the leading cause of death in Colombia. While the rate of hypertension awareness in Colombia is generally high, rates of treatment initiation, adherence, and blood pressure (BP) control are suboptimal. Major international hypertension guidelines recommend starting treatment with a combination of antihypertensive agents, and the use of a single-pill combination (SPC) to maximize adherence. In contrast, Colombian hypertension guidelines recommend starting treatment with diuretic monotherapy in most patients, and only initiating combination therapy in those with BP > 160/100 mmHg. Therefore, the aim of the current narrative review is to examine the rationale for using SPCs to treat hypertension in Colombia, in the context of the major issues for BP control there. There is evidence of widespread therapeutic inertia in hypertension management, particularly in primary care, in Colombia. Moreover, combination therapy, angiotensin-converting enzyme inhibitors, and long-acting calcium channel blockers, which are internationally recommended as first-line drug therapies, are underutilized there. Adherence to antihypertensive therapy is low in Colombia and may be enhanced by use of SPCs as well as better patient education and follow-up. While there are promising national initiatives to improve BP management, more needs to be done by individual physicians. Antihypertensive SPCs are available on the national essential medicines list and may help to overcome some of the problems with suboptimal adherence, therapeutic inertia, and low rates of BP control that contribute to the high cardiovascular death rate in Colombia.

Reporting of blood pressure levels and self-monitoring practices: a survey among outpatients diagnosed with hypertension in Bogotá, Colombia

BACKGROUND

Routine blood pressure (BP) self-monitoring is recommended for patients already diagnosed with hypertension. How often these patients can report their BP levels is unknown, particularly in low-and-middle income countries.

METHODS

We surveyed (January 2021 to May 2022) representative samples of patients with established diagnosis of hypertension from 3 health care networks (involving 74 outpatient clinics) and 2 university hospitals in Bogotá, Colombia. Trained health care professionals conducted a telephone survey including questions on demographics, medical history, and general understanding about hypertension and its potential complications. The outcome variables were the self-report of participant's BP levels (primary) and monitoring practices among participants.

RESULTS

Out of 2609 consecutively contacted patients sampled from institutional records, 2323 were invited and 1566 (mean age 66.5, SD = 12.1 years, 74.4% females, 64.0% living low socio-economic strata) gave consent to participate. While 66% of participants had over 5 years of diagnosis, 39.5% had most (≥ 60%) of their follow-up visits with the same doctor. Overall, 645 (41.5%, 95%CI 39.1 -43.9) participants reported their BP levels. This proportion was independent of time from diagnosis, but higher among those of younger age, living in higher socio-economic strata, having more years of education and using more information technologies. Also, more patients reported their BP levels if seen ≥ 60% of the times by the same physician (43.4% Vs. 36.7%). Those reporting closer BP self-monitoring more often used electronic devices, received 2 + medications, and had better knowledge about hypertension.

CONCLUSION

A minority of hypertensive patients seen in Bogotá were aware of their own BP levels. Those in such capacity were in a better social position, more often seen by the same doctor, knew their condition better and handled more complex treatments. Hypertensive patients from Bogotá may benefit from a more continuous medical care, patient education programs and promoting BP home monitoring.

Spatial variation of cardiovascular mortality in Cali, Colombia, between 2010 and 2017

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of mortality worldwide and in Colombia. The analysis of CVD mortality has been mainly relied on individual factors and rates, but occurrence is also related to contextual conditions. Understanding the distribution of CVD in a region will contribute to implement more focused-preventive and care interventions.

METHODS

Using the national mortality register established by the Department of National Statistics, standardized rates and spatial distribution of CVD mortality were estimated for Cali, Colombia, between 2010-2017. Global and local spatial aggregation was assessed using the Geary's C test and for each district standardized mortality ratios smoothed by the Bayesian empirical were estimated.

RESULTS

Over the period, CVD was the main cause of mortality with 28,804 deaths accounting for 23,8% of total deaths. The global CVD mortality rate varied from 235.9 to 257.4 per 100.000 habitants, with an average increase of 9.1% in the percentage change. The main cause of mortality were hypertensive diseases following by ischemic heart diseases and stroke. The standardized mortality ratios smoothed by the Bayesian empirical method showed that the districts 7, 13, 14, 15 and 16 located at the eastern area with the lowest socio-economic strata and the district 22 at the south of the city with the highest socio-economic strata had the high risks of CVD mortality. All these areas were at the boundary of the city. The the lowest risk was observed in districts 1 and 2 at the northwest area with the upper socio-economic strata. Over the study period, a spatial autocorrelation was found in the districts 1,9 10, 11, 12, 13, 14, 15, 19, and 21 by using the Geary's C test. The highest significant spatial association was found in the districts 1 and 21.

CONCLUSION

Of 22 districts in Cali, the highest risk of CVD mortality was found in three at the lowest and one in the upper socio-economic strata between 2013 and 2017. Over the period a global spatial aggregation was identified due mainly to districts peripherical located suggesting that there could be contextual conditions influencing the risk. Therefore, there is a need for considering local conditions to prevent CVD mortality.

Hipertensión arterial y riesgo cardiovascular

Introducción: la hipertensión arterial es una de las principales enfermedades a nivel mundial y constituye una importante causa de morbilidad y mortalidad para países de bajos y medianos ingresos. Objetivo: determinar la importancia epidemiológica de la hipertensión arterial como factor de riesgo cardiovascular en diferentes estudios realizados a nivel mundial, en Latinoamérica y Colombia. Metodología: se realizó una búsqueda de la literatura científica en las bases de datos de PudMed/Medline, Scielo, LILACS, así como también en revistas médicas y textos publicados por el Ministerio de Salud y Protección Social de Colombia. Discusión y conclusiones: más de 90% de los pacientes hipertensos padecen la forma primaria de la enfermedad, la cual está asociada con un aumento de la resistencia vascular periférica. Las características socioeconómicas de los países y el nivel educativo individual se relacionan con la prevalencia y el manejo adecuado de esta patología. El aumento en la prevalencia de las enfermedades crónicas, sumado a eventos históricos de importancia, fueron determinantes para el desarrollo de estudios epidemiológicos mundiales como el Framingham Heart Study. En América Latina y en Colombia se han realizado diferentes estudios que permiten establecer datos relacionados con la hipertensión arterial, demostrando cifras alarmantes en cuanto al conocimiento, tratamiento y control de esta condición, por lo cual, surge la necesidad de establecer programas para la detección de pacientes hipertensos con el fin de generar estrategias que disminuyan de manera significativa las enfermedades cardiovasculares.

Effectiveness of CoronaVac and BNT162b2 COVID-19 mass vaccination in Colombia: A population-based cohort study

Background

In February 2021, Colombia began mass vaccination against COVID-19 using mainly BNT162b2 and CoronaVac vaccines. We aimed to estimate vaccine effectiveness (VE) to prevent COVID-19 symptomatic cases, hospitalization, critical care admission, and deaths in a cohort of 796,072 insured subjects older than 40 years in northern Colombia, a setting with a high SARS-CoV-2 transmission.

Methods

We identified individuals vaccinated between March 1st of 2021 and August 15th of 2021. We included symptomatic cases, hospitalizations, critical care admissions, and deaths in patients with confirmed COVID-19 as main outcomes. We calculated VE for each outcome from the hazard ratio in Cox proportionally hazards regressions (adjusted by age, sex, place of residence, diabetes, human immunodeficiency virus, cancer, hypertension, tuberculosis, neurological diseases, and chronic renal disease), with 95% confidence intervals (CI).

Findings

A total of 719,735 insured participants of 40 and more years were followed. We found 21,545 laboratory-confirmed symptomatic COVID-19 among unvaccinated population, along with 2874 hospitalizations, 1061 critical care admissions, and 1329 deaths, for a rate of 207.2 per million person-days, 27.1 per million person-days, 10.0 per million person-days, and 12.5 per million person-days, respectively. We found CoronaVac was not effective for any outcome in subjects above 80 years old; but for people 40-79 years of age, we found two doses of CoronaVac reduced hospitalization (33.1%; 95% CI, 14.5-47.7), critical care admission (47.2%; 95% CI, 18.5-65.8), and death (55.7%; 95% CI, 32.5-70.0). We found BNT162b2 was effective for all outcomes in the entire population of subjects above 40 years of age, significantly declining for subjects ≥80 years.

Interpretation

Two doses of either CoronaVac in population between 40 and 79 years of age, or BNT162b2 among vaccinated above 40 years old significantly reduced deaths of confirmed COVID-19 in a cohort of individuals from Colombia. Vaccine effectiveness for CoronaVac and BNT162b2 declined with increasing age.

Funding

UK National Institute for Health Research, the European Union's Horizon 2020 research and innovation programme, and the Bill & Melinda Gates Foundation.

Ethnic Differences in the Prevalence of Hypertension in Colombia: Association With Education Level

BACKGROUND

A higher prevalence of hypertension is reported among Afro-descendants compared with other ethnic groups in high-income countries; however, there is a paucity of information in low- and medium-income countries.

METHODS

We evaluated 3,745 adults from 3 ethnic groups (552 White, 2,746 Mestizos, 447 Afro-descendants) enrolled in the prospective population-based cohort study (PURE)-Colombia. We assessed associations between anthropometric, socioeconomic, behavioral factors, and hypertension.

RESULTS

The overall prevalence of hypertension was 39.2% and was higher in Afro-descendants (46.3%) than in Mestizos (37.6%) and Whites (41.5%), differences that were due to the higher prevalence in Afro-descendant women. Hypertension was associated with older age, increased body mass index, waist circumference and waist-to-hip ratio, independent of ethnicity. Low education was associated with hypertension in all ethnic groups, and particularly in Afro-descendants, for whom it was the factor with the strongest association with prevalence. Notably, 70% of Afro-descendants had a low level of education, compared with 52% of Whites-26% of Whites were university graduates while only 7% of Afro-descendants were. We did not find that education level alone had a mediator effect, suggesting that it is not a causal risk factor for hypertension but is an indicator of socioeconomic status, itself an important determinant of hypertension prevalence.

CONCLUSIONS

We found that a higher prevalence of hypertension in Colombian Afro-descendants than other ethnic groups. This was principally associated with their lower mean educational level, an indicator of lower socioeconomic status.

Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure

Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.

Handgrip Strength-Related Factors in a Colombian Hypertensive Population: A Cross-Sectional Study

(1) Background: This study determined the factors associated with manual grip strength in people with high blood pressure (HBP); (2) Methods: 219 subjects participated in this cross-sectional study, which evaluated muscle strength (manual dynamometer), sociodemographic factors, clinical characteristics, level of physical activity (International Physical Activity Questionnaire-IPAQ score), and depression (Zung's Depression Self-Rating Scale); (3) Results: The bivariate analysis found that handgrip strength in people with HPB was associated with sex (p = 0.000), age (p = 0.000), ethnicity (p = 0.019), smoking habits (p = 0.037), alcohol consumption (p = 0.004), diastolic blood pressure (p = 0.012), weight (p = 0.000), height (p = 0.000), measurement of waist circumference (p = 0.002), depression (p = 0.041), and IPAQ score (p = 0.000). Regardless of being male or female, handgrip strength was associated with age (p = 0.009), IPAQ (p = 0.000), weight (p = 0.038), height (p = 0.000), DPB units (p = 0.043), and depression (p = 0.020). The multivariate generalized linear gamma regression model showed that the coefficient with the greatest weight, regardless of sex, was age (p = 0.043), level of physical activity (24% more at high level than at low level, p = 0.031), and depression (moderate/severe depression level) associated with lower handgrip strength (p = 0.025); (4) Conclusions: Handgrip strength showed an association with level of physical activity, age, and level of depression in a middle-aged population with HBP.

Continuity of Care and the Control of High Blood Pressure at Colombian Primary Care Services

Continuity of care (COC) has been associated with lower mortality and hospitalizations and higher high blood pressure (HBP) control rates. This evidence mainly came from high income countries. We aimed to identify conditions associated with controlled HBP, particularly COC, in primary care services (PCSs) affiliated to two health insurances in Colombia, a low-median income country. A longitudinal observational study was carried out using clinical records of hypertensive adults >18 years with ≥4 clinic visits attending a contributive and a subsidized PCS in Cali (Colombia) between 2013 and 2014. Subsidized PCSs were for unemployment people and those at low socio-economic position and contributive for formal workers. COC was measured using the Bice and Boxerman index. Logistic regression models were performed to quantify the relation between COC and controlled HBP (blood pressure <140/90 mmHg). Between 2013 and 2014, among 8797 hypertensive people identified, 1358 were included: 935 (68.8%) and 423 (31.1%) from the contributive and subsidized PCSs, respectively. 856 (62.3%) were women and had a mean age of 67.7 years (SD 11.7). All people were on antihypertensive treatment. Over the study period, 522 (38.4%) people had controlled HBP, 410 (43.9%) in the contributive and 112 (26.5%) in subsidized PCSs. An increase in 1 unit of the COC index is associated with a 161% higher probability of having HBP controlled (OR, 2.61; 95% CI, 1.25–5.44). The odds of having controlled HBP increased as the number of visits rose; for example, people at the fourth visit had a 34% (OR, 1.34; 95% CI, 1.08–1.66) higher probability of reaching the target. Continuity of care was positively associated with controlled HBP. The strengthening of COC can improve the observed low HBP control rates and reduce health inequalities.

Factors associated with treatment and control of hypertension among elderly adults in Shenzhen, China: a large-scale cross-sectional study

OBJECTIVE

Hypertension has become the leading cause of death worldwide. Data on hypertension management among Shenzhen elderly are sparse. Our study aims to investigate treated and controlled hypertension in Shenzhen elderly, and identify relevant predictors.

DESIGN

A cross-sectional study.

SETTING

Communities in Shenzhen, Guangdong, China.

PARTICIPANTS

A cross-sectional study was conducted. We employed a convenience sampling method to select participants; 124 007 participants aged 65 years and older were recruited from January to December 2018 at local community health centres in Shenzhen.

MAIN OUTCOME MEASURES

Data on treatment, control and influencing factors of hypertension were obtained from a standard questionnaire, physical measurements and biochemical analyses.

RESULTS

Prevalence of hypertension was 55.8% among the sample population. Among this group of hypertensive patients, those undergoing hypertension treatment and those with hypertension under control were 54.4% and 32.3%, respectively. Employing multivariate analysis, significant associations were found between treatment and older age, junior high school education and above (OR=1.25, p＜0.05), being widowed rather than being married or cohabiting (OR=1.28, p＜0.05), engaging in physical activity (OR=1.14, p＜0.05), ex-smoker (OR=1.19, p＜0.05), habitual drinker (OR=0.72, p＜0.05), history of cardiovascular disease (CVD) (OR=2.20, p＜0.05) and comorbidities, with a higher probability for those with obesity (OR=1.89, p＜0.05), central obesity (OR=1.10, p＜0.05), diabetes (OR=1.49, p＜0.05) or dyslipidaemia (OR=1.20, p＜0.05). Male sex (OR=0.91, p＜0.05), junior high school education and above (OR=1.28, p＜0.05), engaging in physical activity (OR=1.06, p＜0.05), history of CVD (OR=1.82, p＜0.05) and individuals who had diabetes (OR=1.52, p＜0.05) or dyslipidaemia (OR=1.05, p＜0.05) were associated with increased likelihood of control. Aged 80 years and older (OR=0.93, p＜0.05), habitual drinker (OR=0.73, p＜0.05) and central obesity (OR=0.94, p＜0.05) were negatively associated with control of hypertension.

CONCLUSIONS

We found a high prevalence of hypertension, but a low prevalence of treatment and control among Shenzhen elderly.

Prevalence, awareness, treatment, and control of diabetes and hypertension among elderly persons in a rural area of Ballabgarh, Haryana

BACKGROUND

In India, from 1971 to 2011, the proportion of elderly population has increased from 5.3% to 8.6%. According to the National Sample Survey, 60^th round (2004), out of every 1000 elderly persons living in rural India, 40 were estimated to be diabetic, and 36 were estimated to be hypertensive. The objective of the study was to find the prevalence of diabetes and hypertension in elderly persons in a rural area of Ballabgarh, Haryana, and to assess the awareness, treatment, and control among them.

METHOD

A total of 420 persons aged 60 years and above were selected by simple random sampling. House-to-house visit was done. A pretested interview schedule was administered. Blood pressure was measured using digital blood pressure machine. Two milliliters of venous blood was collected in vials for HbA1c estimation.

RESULTS

Of the 420 participants, 386 were available for blood pressure measurement, and 374 were available for HbA1c estimation. The prevalence of diabetes was 21.7%, and that of hypertension was 50.3%. Among diabetics, 45.7% were aware, of which, 94.6% were treated, and among them, 34.3% had their blood sugar under control. Among hypertensives, 58.8% were aware, of which, 96.5% were treated, and of the treated participants, 24.5% had controlled blood pressure.

CONCLUSION

The high prevalence, low awareness, and low proportion of controlled diseased population highlights the importance of strengthening primary care and improving awareness about diabetes and hypertension among elderly persons in rural areas.