The World Hypertension League: where now and where to in salt reduction

Anterior Circulation Acute Ischemic Stroke in the Plateau of China: Risk Factors and Clinical Characteristics

Background and Purpose

Acute ischemic stroke has a high incidence in the plateau of China. It has unique characteristics compared to the plains, and the specific relationship with altitude has not yet been appreciated. This study aimed to investigate the specificity of the plateau's anterior circulation acute ischemic stroke in China.

Methods

To retrospectively collect clinical data of patients with first-episode acute ischemic stroke in the anterior circulation in Tianjin and Xining city. The differences in clinical presentation, laboratory, and imaging examinations were compared.

Results

Patients at high altitudes showed a significant trend toward lower age (61.0 ± 10.2 vs. 64.8 ± 8.1, P = 0.010) and had a history of dyslipidemia, higher levels of inflammatory markers, erythrocytosis, and alcohol abuse. The main manifestations were higher diastolic blood pressure (85.5 ± 14.0 mmHg vs. 76.8 ± 11.6 mmHg, P < 0.001), triglycerides [2.0 (1.8) mmol/L vs. 1.3 (0.9) mmol/L, P < 0.001], CRP [4.7 (4.4) mg/L vs. 2.1 (1.9) mg/L, P < 0.001], homocysteine levels [14.5 (11.7) μmol/L vs. 11.2 (5.2) μmol/L, P < 0.001]; larger infarct volume [3.5 (4.8) cm³ vs. 9.0 (6.9) cm³, P < 0.001] and worse prognosis. Patients at high altitudes had higher atherosclerotic indexes in cIMT and plaque than those in plains.

Conclusions

The natural habituation and genetic adaptation of people to the particular geo-climatic environment of the plateau have resulted in significant differences in disease characteristics. Patients with the anterior circulation acute ischemic stroke in the plateau show more unfavorable clinical manifestations and prognosis. This study provides a preliminary interpretation of the effects of altitude and suggests developing preventive and therapeutic protocol measures that are more appropriate for the plateau of China.

Characteristics of Cerebral Stroke in the Tibet Autonomous Region of China

It is well known that cerebrovascular disease has become an important cause of adult death and disability. Strikingly, the Tibet Autonomous Region (TAR) ranks on the top in China for the incidence of stroke. To help explain this phenomenon, we have searched for and analyzed stroke-related literature for the TAR in the past 2 decades and have referenced reports from other regions at similar altitudes. This article focuses on epidemiology features, risk factors, and pathogenesis of stroke in the TAR in an effort to generate a better understanding of the characteristics of stroke in this region. The special plateau-related factors such as its high elevation, limited oxygen, the high incidence of hypertension, smoking, and the unique dietary habits of the region are correlated with the high incidence of stroke. In addition to these factors, the pathogenesis of stroke in this high-altitude area is also unique. However, there is no established explanation for the unique occurrence and high incidence of stroke in the TAR. Our study provides an important rationale not only for the clinic to prevent and treat this disease, but also for the government to develop appropriate health policies for the prevention of stroke in the TAR.

Integrating the development agenda with noncommunicable disease prevention in developing countries: a quasi-experimental study on inter-sectoral action and its impact on self-reported salt consumption-the INPARD study

Background

The determination of behaviours that lead to noncommunicable diseases (NCDs), such as high dietary salt intake, are multifactorial. The prevention of NCDs, including the promotion of healthy dietary choice, including low salt intake, therefore requires multisectoral working. Although the need of a multisectoral approach to risk factor modification has been globally accepted, there is minimal evidence for its application in the real world.

Methods

This quasi-experimental trial was designed to study the impact of a community led multisectoral approach to integrate nutrition prevention into the development agenda, in two districts in Sri Lanka, a lower-middle income country undergoing a phase of rapid socioeconomic development.

Results

Results from logistic regression found that those living in the district (Ampara) that identified salt intake as a health issue had significantly higher odds (OR =1.4; 95% CI =1.1, 1.9) of high salt consumption (>5 grams/day) at baseline compared to control areas (Kurunegala), in multivariable models. Post-intervention, individuals in this district had lower odds (OR =0.6; 95% CI =0.4, 0.9) of consuming high levels of salt in all models, including multivariable models whilst controlling for baseline high salt consumption.

Conclusions

The findings from this study demonstrate the positive impact in improved diet, in reduced salt consumption, through a community led multisectoral intervention, in areas in which the community identified high salt consumption as a health issue. These findings demonstrate that multisectoral approaches can be effective in the real world setting and highlight the need to engage with many stakeholders, including targeted communities throughout their development and implementation.

Controlling Hypertension to Prevent Target Organ Damage: Perspectives from the World Hypertension League President

The evidence from epidemiological and observational studies over the past five decades consistently identify a significant association of blood pressure level and disease risks for both sexes, all races and cultures, as well as all age groups. The evidence is strong such that clinical guidelines and intervention programs focus on blood pressure management and lower blood pressure levels for primary and secondary stroke prevention supported and promoted by numerous organizations including the World Hypertension League. These comprehensive components of population risk reduction are ideal models for the clinical medicine and population health partnership, and timely for global implementation. The accelerated decline in blood pressure-related outcomes (eg, stroke mortality), which began in the 1970s in the US and Western countries, included models for aggressive detection, treatment and control strategies for hypertension. These strategies can be implemented on a global scale to respond to the global risks from blood pressure, which is developing in the most vulnerable populations.