Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran

Social determinants of health and hypertension screening among women in The Gambia: an evaluation of 2019-2020 demographic and health survey data

Hypertension is a leading modifiable risk factor for morbidity and mortality among women in Sub-Saharan Africa. Social determinants of health (SDH) are associated with sex-based differences in access to preventative screenings globally. Little research has assessed the influence of SDH on screening for hypertension among women in The Gambia. The aim of this study was to identify SDH associated with the utilization of hypertension screening among women in The Gambia. Data was examined from the 2019-2020 Gambia Demographic and Health Survey. Weighted multivariate logistic was used to identify whether SDH were associated with hypertension screening. Among 4116 women, over one-fifth (21.1%) had not been screened for hypertension in their lifetime. In fully adjusted models, older age, rural residence, higher than secondary educational attainment, employment, identification with specific ethnic groups, richer wealth status, parity (1 or more), and antenatal care visits increased the likelihood of lifetime hypertension screening. Women who indicated that others made their healthcare decisions for them (partners or someone else) were significantly less likely to have been screened for hypertension in their lifetime than women who made their healthcare decisions alone (adjusted odds ratio = 0.552, 95% confidence interval = (0.384-0.794)). SDH influence access to screening for hypertension among women in The Gambia. Initiatives may need to address the role of SDH to improve access and uptake of hypertension screening.

Association between adult education, brain volume and dementia risk: longitudinal cohort study of UK Biobank participants

Less childhood education is a potentially modifiable risk factor for developing incident dementia but it is not known if education in later life is protective. We sought to add to previous work by testing the association between adult education and brain volume as well as exploring the impact of continuing adult education versus intermittent participation. We used data from participants of the UK Biobank cohort, with no prevalent dementia who were asked about adult education participation at baseline and at follow-up. Dementia status was ascertained from self-report or electronic health records. Cox proportional hazards models were built to estimate hazard ratios (HRs) between participation in adult education and dementia risk. In 499,337 participants aged between 40 and 69 at baseline with 13.2 years mean follow-up, in analyses adjusted for age, sex, education, deprivation, ethnicity, hypertension, diabetes, ethnicity, obesity, smoking, alcohol use, physical inactivity and social isolation, we replicated previous findings of a protective effect of adult education on dementia risk (HR 0.82, 95% CI 0.74-0.90, P < 0.001), and showed a trend towards protection against dementia if adult education was continued rather than intermittent. Additionally, adult education did not impact on total brain volume (coefficient - 657.4, 95% CI - 2795.1 to 1480.3, P = 0.547) but it was associated with increased hippocampal volume (coefficient 33.9, 95% CI 8.9 to 59.0, P = 0.008) indicating a potential mechanism for protection against dementia. We have added evidence indicating that continuing adult education participation may be beneficial, although numbers for this analysis were very small. Analysis of brain volume indicated that adult education may have a protective effect by preserving hippocampal size or slowing volume loss, in line with the cognitive reserve hypothesis.

An Examination of the Agreement between Self-reported Diabetes and Paraclinical Tests, Medical Records, and Clinical Examinations: Insights from the Shahedieh Cohort Study, Yazd, Iran

Introduction

Many researchers utilize self-reports to evaluate the prevalence of diseases. However, the accuracy of these self-reports remains uncertain in various studies. The objective of this particular study was to validate self-reported cases of diabetes among adults aged 35-70 years participating in the Shahedieh Cohort Study (SHCS).

Methods

This cross-sectional study was conducted using data from the first phase of SHCS during 2015-2017. The study included 1000 Iranian adults aged 35-70 years. The Gold standard for diabetes was determined by measuring fasting blood sugar (FBS) and evaluating the history of treatment and use of diabetes medications. To assess self-report validity, various statistical indices such as sensitivity, specificity, positive and negative predictive values (NPVs), accuracy, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and AUC were used. The agreement between self-reported diabetes and the gold standard was assessed using kappa statistics. All statistical analyses were performed using SPSS version 13 and R 4.3.1 software.

Results

The study findings indicated that the prevalence of diabetes was 18% according to self-report and 19.9% according to the gold standard measurement. The self-report accuracy was 95.67%. There was perfect agreement (kappa=0.86) between the self-report and gold standard criteria. The AUC, sensitivity and specificity of self-reported diabetes were 0.937, 93.82% and 96.08%, respectively. Additionally, the results suggested that the self-report of diabetes was more valid in individuals with a normal body mass index (BMI) and without a family history of diabetes in first-degree relatives.

Conclusion

The results showed that in the absence of diabetes control programs, self-report of diabetes is reliable and recommended.

Validity of self-reported hypertension and associated factors among Vietnamese adults: a cross-sectional study

BACKGROUND

This study aims to determine the validity of self-reported hypertension and identify factors affecting the disagreement between self-reported hypertension and objective measures of blood pressure among adults in Vietnam.

MATERIALS AND METHODS

A total of 4,219 people aged 18 and older reported their hypertension status and had their blood pressure measured. The inter-reliability between self-reported and measured hypertension was assessed using Cohen's Kappa statistics. Univariate and multivariate logistic regressions were used to examine the affecting factors of disagreement.

RESULT

Self-reported hypertension prevalence was 13.2% (557/4,219), while measured hypertension was 20.9% (881/4,219). An agreement between self-reported and measured data was moderate for the hypertension of participants (κ = 0.39, 95% CI 0.36-0.43). Self-reported hypertension showed high specificity (93.9%) (95% CI 93.0-94.7) but low sensitivity (40.1%; 95 CI 36.8-43.4). The percentage of disagreement in hypertension (number of false positives and false negatives between self-reported and measured data) among adults in Vietnam was 17.3%.

CONCLUSION

Our findings showed there was a high disagreement percentage of hypertension between self-reported and measured data. This is the first report of this issue to warn of health risks if high blood pressure is not detected early. The disagreement of hypertension was observed more frequently in men, people older than 40, minority ethnic groups, farmers, and people with a BMI greater than 25 kg/m2.

Understanding Cognitive Deficits in People with High Blood Pressure

High blood pressure is associated with an elevated risk of dementia. However, much less is known about how high blood pressure is related to cognitive deficits in domains including episodic memory, semantic verbal fluency, fluid reasoning, and numerical ability. By analyzing data from 337 participants (57.39% female) with a history of clinical high blood pressure diagnosis with a mean age of 48.78 ± 17.06 years and 26,707 healthy controls (58.75% female) with a mean age of 45.30 ± 15.92 years using a predictive normative modeling approach and one-sample t-tests, the current study found that people with high blood pressure have impaired immediate (t(259) = -4.71, p < 0.01, Cohen's d = -0.08, 95% C.I. [-0.11, -0.05]) and delayed word recall (t(259) = -7.21, p < 0.01, Cohen's d = -0.11, 95% C.I. [-0.15, -0.08]) performance. Moreover, people with high blood pressure also exhibited impaired performance in the animal naming task (t(259) = -6.61, p < 0.0001, Cohen's d = -0.11, 95% C.I. [-0.15, -0.08]), and number series (t(259) = -4.76, p < 0.01, Cohen's d = -0.08, 95% C.I. [-0.11, -0.05]) and numeracy tasks (t(259) = -4.16, p < 0.01, Cohen's d = -0.06, 95% C.I. [-0.09, -0.03]) after controlling for demographic characteristics. Clinicians and health professionals should consider including these tasks as part of the neuropsychological assessment for people with high blood pressure, to detect their cognitive deficits. Moreover, they should also come up with ways to improve cognitive performance in people with high blood pressure.

Self-Reported Hypertension and Associated Factors Among Adults in Butambala District, Central Uganda: A Community-Based Prevalence Study

Background

The prevalence of hypertension (HTN) differs among regions and income groups, showing a substantial increase in low- and middle-income countries. The development of hypertension is modulated by modifiable lifestyle factors, and uncontrolled hypertension poses a risk for the onset of cardiovascular diseases.

Objective

To determine the community-level point-prevalence and factors associated with self-reported HTN among adults in Butambala district, central Uganda.

Methods

A community-based cross-sectional study was conducted among adults aged ≥18 years in Budde subcounty, central Uganda. Data on sociodemographic characteristics and behavior were collected using a semistructured questionnaire. Self-reported HTN was assessed using a single question: "Do you have high blood pressure?" Bivariate and multivariate logistic regression analyses were performed to identify predictors of self-reported HTN.

Results

A total of 565 participants (53.5% female) with a median age of 38 years (IQR: 26-52) were included in the study. The prevalence of self-reported hypertension was 18.9%. Factors independently associated with HTN were age 60 years or older (aOR: 2.9, 95% CI: 1.64-5.23, p<0.001), female sex (aOR: 3.3, 95% CI: 2.3-6.3, p<0.001), being widowed (aOR: 10.4, 95% CI: 1.25-87.14, p=0.03), secondary (aOR: 0.4, 95% CI: 0.20-0.85, p=0.016) and tertiary (aOR: 0.2, 95% CI: 0.09-0.64, p=0.005) education, unemployment (aOR: 3.0, 95% CI: 1.11-7.96, p=0.03), tobacco use (aOR: 2.9, 95% CI: 1.83-4.53, p<0.001), having had at least one blood pressure measurement during antenatal visit (aOR: 4.7, 95% CI: 1.97-11.33, p<0.001) or medical checkup (aOR: 10.7, 95% CI: 6.06-18.

Conclusion

We observed a high prevalence of self-reported HTN affecting approximately one in five participants. More efforts are required to enhance routine screening, health education, and accessibility to HTN services in rural areas, with a particular emphasis on implementing HTN prevention and control strategies to effectively reduce the prevalence of HTN.

Sex-Specific Contributions of Alcohol and Hypertension on Everyday Cognition in Middle-Aged and Older Adults

Background: Separate lines of research have linked hypertension and alcohol use disorder to cognition among adults. Despite known sex differences in both of these conditions, studies examining associations on cognition are limited. We aimed to determine whether hypertension impacts the relationship between alcohol use and everyday subjective cognition and whether sex moderates this relationship in middle-aged and older adults. Materials and Methods: Participants (N = 275) 50+ years of age, who reported drinking, completed surveys measuring alcohol use (Alcohol Use Disorder Identification Test consumption items), self-reported history of hypertension, and everyday subjective cognition (Cognitive Failures Questionnaire [CFQ]). Regression was used to test a moderated moderation model examining independent and interactive roles of alcohol use, hypertension, and sex on cognition (CFQ scores: total, memory, distractibility, blunders, and names). Analyses controlled for age, years of education, race, body mass index, smoking status, depressive symptoms, global subjective sleep quality, number of prescription medication used, and number of comorbid medical conditions. Results: Sex moderated the interactive associations of hypertension and alcohol use frequency on CFQ-distractibility. Specifically, in women with hypertension, more alcohol use was associated with greater CFQ-distractibility (B = 0.96, SE = 0.34, p = 0.005). Discussion: Sex moderates the interactive association of hypertension and alcohol use on some aspects of subjective cognition in mid-to-late life. In women with hypertension, alcohol use may exacerbate problems with attentional control. Further exploration of sex- and or gender-specific mechanisms underlying these is warranted.

National and regional prevalence rates of hypertension in Saudi Arabia: A descriptive analysis using the national survey data

Background

Limited studies have examined the prevalence of hypertension (HTN) at the national and regional levels in Saudi Arabia. Therefore, this study aimed to examine the national and regional prevalence of HTN in the Saudi population.

Methods

This study used the data from household health survey carried out by the General Authority for Statistics in 2017. It included 24,012 households representing the Saudi population across all 13 administrative regions. The diagnosis of HTN was confirmed by a self-reported history of a physician diagnosed HTN.

Results

The prevalence of HTN was 9.2% among Saudi population aged 15 years and older. It was relatively higher in women (10.0%) than in men (8.5%). The prevalence of HTN increased with advancing age (aged 65 years and older), accounting for 55.3% in women and 48.0% in men; its prevalence was relatively low among the younger age group, accounting for 0.1% in those aged 15–19 years. A large difference was found in the prevalence of HTN between regions, ranging from 6.0% in Najran region to 10.0% in Makkah region.

Conclusion

This study reported the national and regional prevalence of HTN among Saudi adults using a representative sample with large variations in the prevalence rates according to age, sex, and regions. Older age, men, and Makkah region had higher prevalence of HTN. Our findings will help determine the etiological factors, identify the priorities for healthcare, and generate initiatives for policymakers, and develop preventive and therapeutic strategies for HTN.

Psychotic-like experiences are associated with physical disorders in general population: A cross-sectional study from the NESARC II

BACKGROUND

Psychotic-like experiences (PLEs) constitute subthreshold symptoms of psychotic disorders, and belong to five distinct dimensions: Positive, Negative, Depressive, Mania and Disorganization. PLEs are associated with various psychiatric disorders. However, few studies examined their association with physical disorders.

OBJECTIVE

Our aims were (1) to assess the associations between various physical disorders and PLEs in a U.S. representative sample, and (2) to examine these associations according to the five dimensions of PLEs.

METHOD

We used data from the wave II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II), a large national sample representative of the US population (N = 34,653). Participants were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule 4. Twenty-two PLEs were examined. Lifetime prevalence and adjusted Odds-Ratio (aOR) reflecting the association of sixteen physical disorders (including notably metabolic conditions and heart diseases) with PLEs were calculated.

RESULTS

All studied physical disorders were associated with the presence of PLEs. Particularly the presence of any physical condition, any heart disease and diabetes were more frequent in participants with at least one PLE compared with the group without any PLE (aOR = 1.74, 95% CI = 1.62-1.87, aOR = 1.44, 95% CI = 1.33-1.55 and aOR = 1.38, 95% CI = 1.24-1.54, respectively). Almost all physical disorders were associated with the five dimensions of PLEs.

CONCLUSIONS

PLEs were associated with a large range of physical disorders, with a gradual dose effect. To assess PLEs in the general population could help with the screening of subjects with physical disorders.

Validity of self-reported hypertension and related factors in the adult population: Preliminary results from the cohort in the west of Iran

This study aimed to investigate the validity of self-reported hypertension and related factors in the Dehgolan Prospective Cohort Study (DehPCS). Data were obtained from 3996 participants aged 35-70 years in the enrolment phase of DehPCS. Self-reported hypertension and sociodemographic factors were collected by well-trained interviewers before hypertension diagnosis based on the reference criteria. The history of anti-hypertensive medication use and/or systolic blood pressure ≥140 (mmHg), or diastolic blood pressure ≥90 (mmHg) were considered as hypertension. Disagreement between self-reported and reference measures was assessed using sensitivity, specificity, positive, and negative predictive values (PPV and NPV), and kappa values. Binary and multinomial logistic regressions were used to investigate the correlates of validity of self-reported hypertension. The hypertension prevalence based on self-reports and the reference criteria was 19.49% and 21.60%, respectively. An acceptable percentage of kappa agreement value of 68.7% and relatively good overall agreement of 89.8% were found. Self-reported hypertension was guaranteed moderate sensitivity of 72.0% and high specificity of 94.5%, as well as the NPV and PPV of 92/7% and 77/9%, respectively. The chances of false-positive and false-negative reporting increased with older age, higher BMI, and a family history of hypertension. Being female, older age, higher BMI, concurrent diabetes, and stronger family ties to hypertension patients significantly increased the chance of reporting true positives relative to true negatives. Although, self-reported hypertension has an acceptable validity and can be used as a valid tool for screening epidemiological studies, it needs to be investigated because its validity is affected by age, gender, family history of hypertension, and other socio-demographic characteristics.

Identifying factors associated with of blood pressure using Structural Equation Modeling: evidence from a large Kurdish cohort study in Iran

BACKGROUND

Identifying the risk factors leading to hypertension can help explain why some populations are at a greater risk for developing hypertension than others. The present study seeks to identify the association between the risk factors of hypertension in 35- to 65-year-old participants in western Iran.

METHODS

This cross-sectional study was conducted on 9705 adults from baseline data of Ravansar Non-Communicable Disease (RaNCD) cohort study, in the west region of Iran. Each of the latent variables were confirmed by confirmatory factor analysis. Using Structural Equation Modeling (SEM), we assessed the direct and indirect effects of factors associated with blood pressure.

RESULTS

Socioeconomic status (SES), physical activity, mean of serum lipids, obesity, diabetes and family history of hypertension had a diverse impact on the blood pressure, directly and (or) indirectly. The standardized total effect of SES, physical activity, mean of serum lipids, and obesity were -0.09 vs. -0.14, -0.04 vs. -0.04, 0.13 vs. 0.13 and 0.24 vs. 0.15 in men and women, respectively. Diabetes had a direct relationship with the blood pressure in women (0.03).

CONCLUSION

With regard to control of high blood pressure, public health interventions must target obesity, lifestyle and other risk related to nutritional status such as hyperlipidemia and hyperglycemia in Iranian population and among those with higher SES.

Determinants of self-reported hypertension among women in South Africa: evidence from the population-based survey

Background

Hypertension (HTN), characterized by an elevation of blood pressure, is a serious public health chronic condition that significantly raises the risks of heart, brain, kidney, and other diseases. In South Africa, the prevalence of HTN (measured objectively) was reported at 46.0% in females, nonetheless little is known regarding the prevalence and risks factors of self-reported HTN among the same population. Therefore, the aim of this study was to examine determinants of self-reported HTN among women in South Africa.

Methods

The study used data obtained from the 2016 South African Demographic and Health Survey. In total, 6,027 women aged ≥ 20 years were analyzed in this study. Self-reported HTN was defined as a case in which an individual has not been clinically diagnosed with this chronic condition by a medical doctor, nurse, or health worker. Multiple logistic regression models were employed to examine the independent factors of self-reported HTN while considering the complex survey design.

Results

Overall, self-reported HTN was reported in 23.6% (95% confidence interval [CI], 23.1–24.1) of South African women. Being younger (adjusted odds ratio [aOR], 0.04; 95% CI, 0.03–0.06), never married (aOR, 0.69; 95% CI, 0.56–0.85), and not covered by health insurance (aOR, 0.74; 95% CI, 0.58–0.95) reduced the odds of self-reported HTN. On the other hand, being black/African (aOR, 1.73; 95% CI, 1.17–2.54), perception of being overweight (aOR, 1.72; 95% CI, 1.40–2.11), and perception of having poor health status (aOR, 3.53; 95% CI, 2.53–5.21) and the presence of other comorbidities (aOR, 7.92; 95% CI, 3.63–17.29) increased the odds of self-reported HTN.

Conclusions

Self-reported HTN was largely associated with multiple sociodemographic, health, and lifestyle factors and the presence of other chronic conditions. Health promotion and services aiming at reducing the burden of HTN in South Africa should consider the associated factors reported in this study to ensure healthy aging and quality of life among women.

Maternal perinatal hypertensive disorders and parenting in infancy

Maternal mental health strongly influences parenting during infancy. However, it is unclear whether maternal physical health conditions in the perinatal period may also impact parenting. Examining the association of hypertensive disorders - a common physical health problem in pregnancy - with subsequent parenting behaviors is an important first step in understanding the connection between maternal physical health and parenting during this critical developmental period. This study evaluated whether hypertensive disorders of pregnancy (HDP) and hypertensive disorders (HD) diagnosed after the birth of the infant were associated with parenting self-efficacy, parenting stress, and observed parental responsiveness during mother-infant interactions at 6 and 12 months postpartum among a sample of racially and ethnically diverse mothers and their infants (N = 295). Results showed that mothers with an HDP or HD diagnosis had lower levels of parenting self-efficacy, higher levels of parenting stress, and lower levels of observed parental responsiveness compared to mothers without an HDP or HD diagnosis. Given that women with childhood adversity are at higher risk for experiencing HDP/HD and may have more difficulties with parenting compared to women without childhood adversity, we utilized a sample of mothers wherein most had experienced at least one form of adversity in their childhoods. Exploratory analyses revealed that HDP/HD moderated the relation between early life experiences and parenting outcomes in all but one model. Associations between HDP/HD and parenting are discussed, with implications for how we understand maternal physical health as a determinant of parenting in the perinatal period.

Barriers to effective hypertension management in rural Bihar, India: A cross-sectional, linked supply- and demand-side study

Effective management of hypertension in low- and middle-income settings is a persistent public health challenge. This study examined supply- and demand-side barriers to receiving quality care and achieving effective hypertension management in rural Bihar, India. A state-representative household survey collected information from adults over 30 years of age on characteristics of the hypertension screening, diagnosis, and management services they received. A linked provider assessment determined the percent of providers who provided quality hypertension care (i.e., had a functioning BP measurement device, measured a patient's BP, could correctly diagnose hypertension, had at least one first-line antihypertension medication, and could prescribe correctly based on standard guidelines). Patients were linked with their provider to determine the quality-adjusted coverage of hypertension management and logistic regression analysis was conducted to determine characteristics associated with receiving quality care. A total of 14,386 patients and 390 providers were studied. Nearly a quarter (22.5%) of adults had never had their BP measured before and 8.1% of adults reported a previous hypertension diagnosis. Less than one third (31.0%) of all interviewed providers demonstrated ability to provide quality hypertension care, and quality varied between provider types (14.8% of private homeopathic, 25.2% of informal, 40.0% of private modern medicine, and 60.0% of public providers gave quality care). While 95.8% of diagnosed individuals received some treatment, only 10.9% of patients received care from quality local providers. Nearly 45% of individuals with hypertension received care from non-local providers. Individuals from the general caste with comorbidities living in villages with more high-quality providers were most likely to receive quality care from a local provider. Whereas the coverage of services for individuals diagnosed with hypertension is high, the quality of these services is suboptimal for economically and socially vulnerable populations, which limits effective management and control of hypertension in rural Bihar. Efforts should be targeted towards providers to initiate quality treatment upon diagnosis, including correct prescription of antihypertensives.

Socioeconomic inequalities in prevalence, awareness, treatment and control of hypertension: evidence from the PERSIAN cohort study

BACKGROUND

Elevated blood pressure is associated with cardiovascular disease, stroke and chronic kidney disease. In this study, we examined the socioeconomic inequality and its related factors in prevalence, Awareness, Treatment and Control (ATC) of hypertension (HTN) in Iran.

METHOD

The study used data from the recruitment phase of The Prospective Epidemiological Research Studies in IrAN (PERSIAN). A sample of 162,842 adults aged >  = 35 years was analyzed. HTN was defined according to the Joint National Committee)JNC-7(. socioeconomic inequality was measured using concentration index (Cn) and curve.

RESULTS

The mean age of participants was 49.38(SD =  ± 9.14) years and 44.74% of the them were men. The prevalence of HTN in the total population was 22.3%(95% CI: 20.6%; 24.1%), and 18.8%(95% CI: 16.8%; 20.9%) and 25.2%(95% CI: 24.2%; 27.7%) in men and women, respectively. The percentage of awareness treatment and control among individuals with HTN were 77.5%(95% CI: 73.3%; 81.8%), 82.2%(95% CI: 70.2%; 81.6%) and 75.9%(95% CI: 70.2%; 81.6%), respectively. The Cn for prevalence of HTN was -0.084. Two factors, age (58.46%) and wealth (32.40%), contributed most to the socioeconomic inequality in the prevalence of HTN.

CONCLUSION

The prevalence of HTN was higher among low-SES individuals, who also showed higher levels of awareness. However, treatment and control of HTN were more concentrated among those who had higher levels of SES, indicating that people at a higher risk of adverse event related to HTN (the low SES individuals) are not benefiting from the advantage of treatment and control of HTN. Such a gap between diagnosis (prevalence) and control (treatment and control) of HTN needs to be addressed by public health policymakers.

Validity of self-reported hypertension in India: Evidence from nationally representative survey of adult population over 45 years

Self‐reported measures of health, in the context of developed countries, are well‐researched and commonly regarded as reliable predictors of the underlying health of the population. However, the validity of these measures is under‐researched and questionable in the context of low‐ and middle‐income countries. The authors used Longitudinal Ageing Study in India (LASI) survey data from India to compare self‐reported hypertension with biometrically‐measured hypertension. The results are reported in terms of sensitivity, specificity, and kappa as a measure of agreement. Logistic regression was undertaken to examine the characteristics of those who were unaware of their hypertensive status. Our analysis showed a low sensitivity of 56% and a high specificity of 90.5%. Agreement between self‐reported data and biometric measurement of hypertension was observed to be moderate (κ = 0.48). Large variations were observed among states and sub‐groups. The odds of false negative reporting of hypertension were lower in the individuals with higher age, high education, and greater wealth status. The authors conclude that self‐reported hypertension has important limitations and may be a source of systematic bias. It is recommended that planning and policy‐making in India be based more on an objective assessment of hypertension.

Risk factors, ethnicity and dementia: A UK Biobank prospective cohort study of White, South Asian and Black participants

BACKGROUND

Our knowledge of the effect of potentially modifiable risks factors on people developing dementia is mostly from European origin populations. We aimed to explore if these risk factors had similar effects in United Kingdom (UK) White, South Asian and Black UK Biobank participants recruited from 2006-2010 and followed up until 2020.

METHODS

We reviewed the literature to 25.09.2020 for meta-analyses identifying potentially modifiable risk factors preceding dementia diagnosis by ≥10 years. We calculated prevalence of each identified risk factor and association with dementia for participants aged ≥55 at registration in UK Biobank. We calculated hazard ratios using Cox regression for each risk factor, stratified by ethnic group, and tested for differences using interaction effects between each risk factor and ethnicity.

FINDINGS

We included education, hearing loss, hypertension, obesity, excess alcohol consumption, physical inactivity, smoking, high total cholesterol, depression, diabetes, social isolation, and air pollution as risks. Out of 294,162 participants, there were 287,806 White, 3590 South Asian and 2766 Black people, followed up for up to 14.8 years, with a total follow-up time of 3,392,095 years. During follow-up, 5,972 people (2.03%) developed dementia. Risk of dementia was higher in Black participants than White participants (HR for dementia compared to White participants as reference 1.43, 95% CI 1.16-1.77, p = 0.001) but South Asians had a similar risk. Association between each risk factor and dementia was similar in each ethnic group with no evidence to support any differences.

INTERPRETATION

We find that Black participants were more likely to develop dementia than White participants, but South Asians were not. Identified risk factors in White European origin participants had a similar effect in Black and South Asian origin participants. Volunteers in UK Biobank are not representative of the population and interaction effects were underpowered so further work is needed.

Examining elevated blood pressure and the effects of diabetes self-management education on blood pressure among a sample of Marshallese with type 2 diabetes in Arkansas

INTRODUCTION

Hypertension is a leading risk factor for heart attack and stroke. Undiagnosed hypertension increases the risk of heart attack and stroke. The risk of hypertension is increased for those with type 2 diabetes mellitus (T2DM). Diabetes self-management education (DSME) has been shown to be effective at improving clinical outcomes, including reducing blood pressure, but few studies have evaluated the effects of DSME for Native Hawaiians and Pacific Islanders.

METHODS

This study examined the baseline prevalence of diagnosed hypertension and undiagnosed high blood pressure and differences in health care access between those with diagnosed hypertension versus undiagnosed high blood pressure. The sample consisted of 221 Marshallese adults with T2DM participating in a DSME randomized controlled trial in northwest Arkansas. The study also examined the effects of DSME interventions on participants' blood pressure, comparing an Adapted-Family DSME with a Standard DSME.

RESULTS

Nearly two-thirds of participants had blood pressure readings indicative of hypertension, and of those, over one-third were previously undiagnosed. The frequency of doctor visits was significantly lower for those with undiagnosed high blood pressure. There were no differences in health insurance coverage or forgone medical care between those with undiagnosed high blood pressure versus diagnosed hypertension. Across all participants, a significant reduction in systolic blood pressure occurred between baseline and post intervention, and a significant reduction in diastolic blood pressure occurred between baseline and post-intervention, 6 months, and 12 months post-intervention. No differences were observed by study arm.

CONCLUSION

This study is the first to document the prevalence of diagnosed hypertension and undiagnosed high blood pressure, as well as the effects of DSME on blood pressure among a sample of Marshallese adults with T2DM.

Food insecurity and hypertension: A systematic review and meta-analysis

Background

Food insecurity (FIS) is an important public health issue associated with cardiovascular risk. Given the association of FIS with diets of poorer nutritional quality and higher salt intake as well as chronic stress, numerous studies have explored the link between FIS and hypertension. However, no systematic review or meta-analysis has yet to integrate or analyze the existing literature.

Methods

We performed a wide and inclusive search of peer-reviewed quantitative data exploring FIS and hypertension. A broad-terms, systematic search of the literature was conducted in PubMed, Embase, Scopus, and Web of Science for all English-language, human studies containing primary data on the relationship between FIS and hypertension. Patient population characteristics, study size, and method to explore hypertension were extracted from each study. Effect sizes including odds ratios and standardized mean differences were extracted or calculated based on studies’ primary data. Comparable studies were combined by the random effects model for meta-analyses along with assessment of heterogeneity and publication bias.

Results

A total of 36 studies were included in the final analyses. The studies were combined into different subgroups for meta-analyses as there were important differences in patient population characteristics, methodology to assess hypertension, and choice of effect size reporting (or calculability from primary data). For adults, there were no significantly increased odds of elevated blood pressures for food insecure individuals in studies where researchers measured the blood pressures: OR = 0.91 [95%CI: 0.79, 1.04; n = 29,781; Q(df = 6) = 7.6; I² = 21%]. This remained true upon analysis of studies which adjusted for subject BMI. Similarly, in studies for which the standardized mean difference was calculable, there was no significant difference in measured blood pressures between food secure and FIS individuals: g = 0.00 [95%CI: -0.04, 0.05; n = 12,122; Q(df = 4) = 3.6; I² = 0%]. As for retrospective studies that inspected medical records for diagnosis of hypertension, there were no significantly increased odds of hypertension in food insecure adults: OR = 1.11 [95%CI: 0.86, 1.42; n = 2,887; Q(df = 2) = 0.7; I² = 0%]. In contrast, there was a significant association between food insecurity and self-reports of previous diagnoses of hypertension: 1.46 [95%CI: 1.13, 1.88; n = 127,467; Q(df = 7) = 235; I² = 97%]. Only five pediatric studies were identified which together showed a significant association between FIS and hypertension: OR = 1.44 [95%CI: 1.16, 1.79; n = 19,038; Q(df = 4) = 5.7; I² = 30%]. However, the small number of pediatric studies were not sufficient for subgroup meta-analyses based on individual study methodologies.

Discussion

In this systematic review and meta-analysis, an association was found between adult FIS and self-reported hypertension, but not with hypertension determined by blood pressure measurement or chart review. Further, while there is evidence of an association between FIS and hypertension among pediatric subjects, the limited number of studies precluded a deeper analysis of this association. These data highlight the need for more rigorous and longitudinal investigations of the relationship between FIS and hypertension in adult and pediatric populations.

Racial/Ethnic Differences in Cardiometabolic Risk in a Community Sample of Sexual Minority Women

Purpose: To examine the intersection of sexual identity and race/ethnicity on self-reported cardiometabolic risk in sexual minority women (SMW). Methods: Data from the Chicago Health and Life Experiences of Women study were analyzed. Logistic regression models examined racial/ethnic differences in cardiometabolic risk (including obesity, hypertension, and diabetes) in SMW, accounting for psychosocial and behavioral factors. A variable accounting for the intersection of sexual identity and race/ethnicity was added to regression models (White lesbian women were the reference group). Results: The analytic sample included 601 SMW (237 White, 219 Black, 145 Latina). Black (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI]=1.48-5.94) and Latina (AOR 2.30, 95% CI=1.18-4.48) SMW had higher rates of lifetime trauma than White SMW. Black SMW reported higher rates of obesity (AOR 3.05, 95% CI=1.91-4.88), hypertension (AOR 1.99, 95% CI=1.08-3.66), and diabetes (AOR 3.77, 95% CI=1.46-9.74) relative to White SMW. Intersectional analyses revealed that Black lesbian (AOR 2.94, 95% CI=1.74-4.97) and Black bisexual (AOR 3.43, 95% CI=1.69-6.96) women were more likely to be obese than White lesbian women. Black lesbian women also reported higher rates of hypertension (AOR 2.09, 95% CI=1.08-4.04) and diabetes (AOR 3.31, 95% CI=1.26-8.67) than White lesbian women. No differences in cardiometabolic risk were found between Latina and White SMW. Conclusion: This study extends previous research on racial/ethnic differences in cardiometabolic risk among SMW. Prevention strategies are needed to reduce cardiometabolic risk in Black SMW. Findings highlight the need for cardiovascular disease research in SMW that incorporates longitudinal designs and objective measures.

Treatment of amphetamine abuse/use disorder: a systematic review of a recent health concern

OBJECTIVES

The study systematically reviewed the effectiveness of pharmacological treatments alone or combined with brief cognitive-behavioural therapy (BCBT) for treating Iranian amphetamine abusers. The secondary aim was to review the efficacy of BCBT alone or combined with pharmacological treatments for treating amphetamine abusers in the world.

EVIDENCE ACQUISITION

Published trials were considered for inclusion. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, Cochrane Drugs and Alcohol Group's Specialised Register of Trials, Embase, CINAHL, Scopus, PsychINFO, Iran Medex, Magiran and the Scientific Information Database were searched (January 2001 to March 2019). The reference lists of included studies were hand searched for more information. A systematic literature search in eight databases produced 10 trials.

RESULTS

Risperidone reduced positive psychotic symptoms while aripiprazole reduced negative psychotic symptoms. Methylphenidate reduced craving and depression compared with placebo. Topiramate reduced addiction severity and craving for methamphetamine abuse compared with placebo. Buprenorphine reduced methamphetamine craving more than methadone. Haloperidol and risperidone reduced psychosis. Riluzole reduced craving, withdrawal, and depression compared with placebo. Abstinence from amphetamine or reduction in amphetamine abuse was confirmed in four BCBT studies and one study which applied BCBT with a pharmacological treatment which were stable between two and 12-months. Other changes in BCBT studies were as follows: reduced polydrug use; drug injection, criminality and severity of amphetamine dependence at six-month follow-up; improved general functioning; mental health; stage of change as well as improved motivation to change in a pharmacological + BCBT study.

CONCLUSION

A review of trials indicates that pharmacological treatments and BCBT in a research setting outperform control conditions in treating amphetamines abuse and associated harms. Large-scale studies should determine if both treatments can be effective in clinical settings.