1
|
Lamloum D, Fassio F, Osetinsky B, Tediosi F. Care Cascades for Hypertension in Low-Income Settings: A Systematic Review and Meta-Analysis. Int J Public Health 2023; 68:1606428. [PMID: 37901590 PMCID: PMC10600349 DOI: 10.3389/ijph.2023.1606428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objective: High blood pressure is the leading risk factor for cardiovascular disease. The hypertension care cascade (HCC) is increasingly being used to evaluate the effectiveness of interventions. This systematic review aims to examine HCC in low-income settings. Methods: The search strategy included articles published between January 2010 and April 2023. We excluded studies with incomplete HCC, on fragile patients or aged <18 years, reviews. We used the MOOSE guideline. Five researchers retrieved data on the survey year, country, population, HCC and diagnostic methods for hypertension. We used JBI Critical Appraisal Tools for quality assessment. Results: Ninety-five articles were analyzed. Average hypertension prevalence was 33% (95% CI: 31%-34%), lower in LICs than in LMICs (25% vs. 34%). The overall mean awareness of hypertension was 48% (95% CI: 45%-51%), its treatment was 35% (95% IC: 32%-38%) and its control 16% (95% CI: 14%-18%). In almost all steps, percentages were lower in LICs and in Sub-Saharan Africa. Conclusion: Trends in HCC vary between countries, with poorer performance in LICs. This review highlights the need for interventions tailored to low-income settings in order to improve hypertension care.
Collapse
Affiliation(s)
- Demetrio Lamloum
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Brianna Osetinsky
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
2
|
Rezaianzadeh A, Jafari F, Ghoddusi Johari M, Karami H. Awareness, Treatment, and Control of Hypertension among 10663 Adults Based on the Baseline Data of the Kherameh Cohort Study. J Tehran Heart Cent 2023; 18:102-108. [PMID: 37637280 PMCID: PMC10459349 DOI: 10.18502/jthc.v18i2.13319] [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: 07/28/2022] [Accepted: 02/13/2023] [Indexed: 08/29/2023] Open
Abstract
Background A comprehensive strategy to reduce the complications of hypertension (HTN) should include prevention approaches, such as increasing awareness, early diagnosis, and adequate treatment. The present study aimed to assess awareness, treatment, and control of HTN and their related factors in Kherameh, Iran. Methods This cross-sectional study was performed on 10 663 individuals aged between 40 and 70 years using the Kherameh cohort data. HTN was defined as either systolic/diastolic blood pressure ≥140/90 mmHg or taking medications. Logistic regression was used to investigate the relationship between awareness, treatment, and control of HTN and demographic factors, comorbidities, and a family history of diseases. Results Out of 10 663 participants, 4719 (44.3%) were men, and the average age of the participants was 51.94±8.27 years. The rates of the prevalence, awareness, treatment, and control of HTN were 27.7% (95% CI, 26.86 to 28.54), 80.3% (95% CI, 79.56 to 81.04), 78% (95% CI, 77.22 to 78.78), and 53.6% (95% CI, 52.66 to 54.54), respectively. Age, gender, body mass index, and cardiovascular disease were associated with all the dependent variables in the regression model. Additionally, occupation, diabetes, chronic diseases, a history of cardiovascular disease in first and second-degree relatives and a history of chronic diseases in second-degree relatives were related to all the dependent variables except for treatment. Conclusion A high percentage of the patients were aware of their disease, but a smaller proportion were on medication. Consequently, about half the patients had blood pressure below 140/90 mmHg.
Collapse
Affiliation(s)
- Abbas Rezaianzadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Jafari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hamed Karami
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
3
|
Mohanty P, Patnaik L, Nayak G, Dutta A. Gender difference in prevalence of hypertension among Indians across various age-groups: a report from multiple nationally representative samples. BMC Public Health 2022; 22:1524. [PMID: 35948916 PMCID: PMC9364494 DOI: 10.1186/s12889-022-13949-5] [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: 05/16/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Prevalence of hypertension increases with age, but there is a general perception in India that women are less affected at every stage of life, although empiric evidence hardly exists regarding gender difference in hypertension in Indians of different ages. Therefore, we aimed to examine the gender difference in hypertension among Indians across various age-groups; and the contribution of variation in body mass index (BMI) to this difference. Methods Data were analysed after combining National Family Health Survey 4 (n = 294,584 aged 35–49 years) and Study of Ageing and Health wave 2 (n = 7118 aged 50 + years) datasets (NFHS-SAGE). Longitudinal Ageing Study of India (LASI) dataset (n = 65,900 aged > 45years) was analysed to replicate the results. Hypertension was defined if systolic and diastolic blood pressure was > 89 and/or > 139 respectively and/or if there was a history of anti-hypertensive medication. Descriptive summaries were tabulated and plotted to examine the gender difference in hypertension in various age-groups (35–39,40–44, 45–49, 50–54, 55–59, 60–64, 65–69, ≥ 70). Odds Ratios (ORs) from logistic regression models estimated the age gradient of hypertension and their male-female difference, adjusted for Body Mass Index (BMI). Results Males had a higher prevalence of hypertension up to 50 years; after that, females had higher rates. The estimates of age gradient, expressed as ORs, were 1.02 (1.02, 1.02) in males versus 1.05(1.05, 1.06) in females (p < 0.001) in NFHS-SAGE and 1.01(1.01, 1.02) in males versus 1.04(1.03, 1.04)in females (p < 0.001) in LASI;these differences marginally changed after adjustment with BMI. Conclusion This is perhaps the first study to comprehensively demonstrate that cardio-metabolic risk in Indian females surpasses males after 50 years of age, “busting the myth” that Indian females are always at much lower risk than males; and this evidence should inform the Indian healthcare system to prioritise older women for screening and treatment of hypertension. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13949-5.
Collapse
Affiliation(s)
- Parimala Mohanty
- Department of Community Medicine, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Lipilekha Patnaik
- Department of Community Medicine, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Gayatri Nayak
- Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, India
| | - Ambarish Dutta
- Indian Institute of Public Health, Public Health Foundation of India, Address-Plot No- 267/3408, JaydevVihar, Mafair Lagoon Road, Odisha, 751013, Bhubaneswar, India.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Ismail IM, Nandy S, Adhikari S, Tm R, Gupta D, M D, Ranjan A, Aboobacker A. Time to Switch to 'Rule of Three-Quarters' from 'Rule of Halves' in Hypertension? A Descriptive Study from Dakshina Kannada, South India. Cureus 2021; 13:e13142. [PMID: 33692916 PMCID: PMC7937012 DOI: 10.7759/cureus.13142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background ‘Rule of halves’ depicts the overall picture of hypertension that prevails in a community. This study was taken up to understand if the traditional ‘rule of halves’ of hypertension still prevails or is it time to shift to the proposed ‘rule of three-quarters’. The objectives of the study were: to estimate (i) the prevalence of hypertension among adult residents of Madani Nagar rural community in the Dakshina Kannada district of Karnataka state in southern India, (ii) the proportion who are aware of their disease among hypertensive patients, (iii) the proportion who are on treatment among those who are aware of their disease, and (iv) the proportion having adequate blood pressure control among those on treatment. Materials and methods This was a cross-sectional study carried out in Madani Nagar, Dakshina Kannada from February to April 2020. Complete enumeration method was followed and all adults aged ≥ 18 years who consented were included in the study. Data collection was done using a pre-validated questionnaire and blood pressure was recorded as per World Health Organization guidelines. Results A total of 661 individuals were enrolled in the study. The prevalence of hypertension was 29.2%. Only 55.4% of hypertensive patients were aware that they had the disease, and among them, 96.3% were on treatment. Among those on treatment, 58.3% had adequate control of blood pressure. Conclusion The hypertension pattern of the community leans more towards the traditional ‘rule of halves’ of hypertension and it is still a long way ahead until the proposed ‘rule of three-quarters’ can be achieved.
Collapse
Affiliation(s)
| | | | | | - Revathi Tm
- Community Medicine, Yenepoya Medical College, Mangaluru, IND
| | - Dhruv Gupta
- Community Medicine, Yenepoya Medical College, Mangaluru, IND
| | - Deeptha M
- Community Medicine, Yenepoya Medical College, Mangaluru, IND
| | - Awnish Ranjan
- Community Medicine, Yenepoya Medical College, Mangaluru, IND
| | | |
Collapse
|
6
|
Nadar SK, Al-Riyami H, Al-Riyami A, Al-Lawati H, Panakkal B, Mohammed S, Nagaraju GB, Sharma SN, Abdulkader MM, Beaney T, Ster AC, Poulter NR. May Measurement Month 2018: an analysis of blood pressure screening results from Oman. Eur Heart J Suppl 2020; 22:H100-H103. [PMID: 32884484 PMCID: PMC7455257 DOI: 10.1093/eurheartj/suaa039] [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] [Indexed: 12/04/2022]
Abstract
As per WHO estimates, around 17% of the adult Omani population are hypertensive. However, people with hypertension are often unaware of the diagnosis, and so the May Measurement Month (MMM) programme was set up to raise awareness of the importance of blood pressure (BP) screening. A cross-sectional screening of BP of subjects aged 18 years or more was carried out in May 2018 at various sites in Muscat, Oman. Screening sites were set up at the reception areas of participating hospitals, and at a few public areas such as shopping malls and workplaces of the volunteers. Blood pressure was measured according to a standardized protocol, and hypertension was defined as per the 2018 European Society of Hypertension guidelines. The data were analysed centrally by the MMM project team. A total of 12 689 individuals (mean age 40.6 ± 12.5 years, 72% male) were screened. The crude mean BP of the second and third readings (where three readings were taken, n = 4 738) was 127.1/79.2 mmHg. After multiple imputations, the average age and sex standardized BP was 127.3/80.2 mmHg. Of all participants, 29.8% had hypertension. There were 1 983 patients with a previous diagnosis of hypertension, of whom 1 810 were on antihypertensive medication. A further 1 973 subjects were newly diagnosed with hypertension. Of those on antihypertensive medication, 34.9% had uncontrolled BP readings. Screening programmes such as MMM are useful to identify persons with undiagnosed hypertension. However, more educational activities are required to increase the public awareness regarding the dangers of hypertension.
Collapse
Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, 123, Oman
| | - Hassan Al-Riyami
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, 123, Oman
| | - Adil Al-Riyami
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, 123, Oman
| | - Hatim Al-Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, 123, Oman
| | - Benny Panakkal
- Department of Medicine, Badar Al-Samaa Hospital, Ruwi, Muscat, Oman
| | - Shafeek Mohammed
- Department of Medicine, Badar Al-Samaa Hospital, Ruwi, Muscat, Oman
| | - G B Nagaraju
- Department of Medicine, Badar Al-Samaa Hospital, Ruwi, Muscat, Oman
| | - S N Sharma
- Department of Medicine, Badar Al-Samaa Hospital, Ruwi, Muscat, Oman
| | | | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.,Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road London W6 8RP, UK
| | - Anca Chis Ster
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| |
Collapse
|
7
|
Salaroli LB, Cattafesta M, Petarli GB, Ribeiro SAV, Soares ACDO, Zandonade E, Bezerra OMDPA, Mill JG. Prevalence and factors associated with arterial hypertension in a Brazilian rural working population. Clinics (Sao Paulo) 2020; 75:e1603. [PMID: 32785573 PMCID: PMC7410352 DOI: 10.6061/clinics/2020/e1603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/28/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine the prevalence of hypertension and associated factors in farmers in a rural region of Brazil. METHODS A cross-sectional study was conducted involving a sample of 790 farmers who were residents of Espírito Santo, Brazil. RESULTS The prevalence of hypertension was 35.8% (95%CI: 32.5-39.1%, n=283); however, it was higher in men (36.6%, n=151, p<0.001) and in those with excess weight (48.9%, n=197, p<0.001). Of the 283 hypertensive patients, 125 (44.2%) did not use antihypertensive drugs. In men, lower level of schooling (p=0.004), working in the field for fewer daily hours (p<0.001), and having greater abdominal adiposity (p=0.039) were associated with the presence of increased blood pressure. In women, age (p=0.002), lower schooling (p=0.021), and increased central adiposity (p=0.003) were independent predictors of blood pressure. CONCLUSION The highest prevalence of hypertension was observed in men, with elevated blood pressure being strongly associated with social and economic factors. In women, the association with the classic factors (age, increase in abdominal adiposity, and low schooling) was stronger. In addition, most hypertensive patients are not adequately diagnosed or treated.
Collapse
Affiliation(s)
- Luciane Bresciani Salaroli
- Programa de Pos-graduacao em Saude Coletiva, Universidade Federal do Espirito Santo, Vitoria, ES, BR
- Programa de Pos-graduacao em Nutricao e Saude, Universidade Federal do Espirito Santo, Vitoria, ES, BR
- *Corresponding author. E-mail:
| | - Monica Cattafesta
- Programa de Pos-graduacao em Saude Coletiva, Universidade Federal do Espirito Santo, Vitoria, ES, BR
| | - Glenda Blaser Petarli
- Programa de Pos-graduacao em Saude Coletiva, Universidade Federal do Espirito Santo, Vitoria, ES, BR
| | | | | | - Eliana Zandonade
- Programa de Pos-graduacao em Saude Coletiva, Universidade Federal do Espirito Santo, Vitoria, ES, BR
| | | | - José Geraldo Mill
- Programa de Pos-graduacao em Saude Coletiva, Universidade Federal do Espirito Santo, Vitoria, ES, BR
- Programa de Pos-graduacao em Fisiologia, Universidade Federal do Espirito Santo, Vitoria, ES, BR
| |
Collapse
|
8
|
Kalkonde Y, Deshmukh M, Nila S, Jadhao S, Bang A. Effect of a community-based intervention for cardiovascular risk factor control on stroke mortality in rural Gadchiroli, India: study protocol for a cluster randomised controlled trial. Trials 2019; 20:764. [PMID: 31870394 PMCID: PMC6929484 DOI: 10.1186/s13063-019-3870-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Stroke has emerged as a leading cause of death in rural India. However, well-tested healthcare interventions to reduce stroke mortality in rural under-resourced settings are lacking. The aim of this study is to evaluate the effect of a community-based preventive intervention on stroke mortality in rural Gadchiroli, India. METHODS The study is a two-arm, parallel group, cluster randomised controlled trial in which 32 villages will be randomised to the intervention and the enhanced usual care (EUC) arm. In the intervention arm, individuals ≥50 years of age will be screened for hypertension, diabetes and stroke by trained Community Health Workers (CHWs). Screened individuals who are positive will be referred to a mobile outreach clinic which will visit the intervention villages periodically. A physician in the clinic will confirm the diagnosis, provide guideline-based treatment and follow up patients. The CHWs will make home visits once a month to ensure medication compliance and counsel patients to reduce salt consumption and quit tobacco and alcohol. In the EUC arm, households will be provided information on the ill effects of tobacco use and steps to quit it. Individuals from both the arms will have access to the government's national programme for the prevention and control of non-communicable diseases, where treatment for hypertension, diabetes and preventive treatment after stroke is available at the nearest primary health centres (PHCs). The intervention will be implemented for 3.5 years. The primary outcome will be a reduction in stroke mortality in the last 2.5 years of the intervention. DISCUSSION This trial will provide important information regarding the feasibility and effect of a community-based preventive intervention package on stroke mortality in a rural under-resourced setting and can inform India's non-communicable diseases prevention and control programme. If successful, such an intervention can be scaled up in the rural regions of India and other countries. TRIAL REGISTRATION Clinical Trials Registry of India: CTRI/2015/12/006424. Registered on 8 December 2015.
Collapse
Affiliation(s)
- Yogeshwar Kalkonde
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
| | - Mahesh Deshmukh
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
| | - Sindhu Nila
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
| | - Sunil Jadhao
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
| | - Abhay Bang
- Society for Education, Action and Research in Community Health (SEARCH), Shodhgram, Post-Chatgaon, Taluka-Dhanora, District-Gadchiroli, Maharashtra 442605 India
| |
Collapse
|