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Sangaleti CT, Lentsck MH, da Silva DC, Machado A, Trincaus MR, Vieira MCU, Pelazza BB, Colombo FMC. Polypharmacy, potentially inappropriate medications and associated factors among older adults with hypertension in primary care. Rev Bras Enferm 2023; 76Suppl 2:e20220785. [PMID: 38088658 PMCID: PMC10704688 DOI: 10.1590/0034-7167-2022-0785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE to identify the prevalence and associations of polypharmacy and potentially inappropriate medication use among older adults with hypertension treated in primary care. METHODS a cross-sectional study carried out with older adults with hypertension treated at a Family Health Strategy unit. Data collection included analysis of medical records, interviews and multidimensional assessment of older adults. Socio-demographic information and clinical variables were collected. Statistical analysis was performed by multiple logistic regression. RESULTS polypharmacy prevalence was 38.09%, and potentially inappropriate medication (PIM), 28.57%. There was a significant association between polypharmacy and PIM use, altered sleep and ethnicity. PIM use was associated with polypharmacy, worse family functioning, and absence of a caregiver. Cognitive decline reduces the prevalence of these medications. CONCLUSIONS polypharmacy and PIM use among older adults with hypertension represent a problem in this population, especially among the most vulnerable.
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Fotouhi F, Shahidi A, Hashemi H, Saffarpour M, Yekta A, Esmaieli R, Esteki T, Derakhshan HB, Khabazkhoob M. Hypertension prevalence in Iran's elderly according to new criteria: the Tehran Geriatric Eye Study. J Diabetes Metab Disord 2023; 22:1489-1498. [PMID: 37975137 PMCID: PMC10638178 DOI: 10.1007/s40200-023-01272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/27/2023] [Indexed: 11/19/2023]
Abstract
Purpose To determine the prevalence of hypertension in a population above 60 years of age and its relationship with demographic and anthropometric factors. Methods A cross-sectional population-based study was conducted in 2019. Using a multistage random cluster sampling, 160 clusters were selected from 22 districts of Tehran. All participants were interviewed to collect demographic, anthropometric, and socioeconomic information. Then, systolic (SBP) and diastolic (DBP) blood pressures were measured under standard conditions twice, 10 min apart. A third measurement was performed if the two measurements showed a difference of ≥ 10 mmHg in SBP or ≥ 5 mmHg in DBP. Hypertension was defined as a SBP > 130 mmHg or a DBP > 80 mmHg (new criteria), being a known case of hypertension, or use of blood pressure lowering medications. Results Of 3791 invitees, 3310 participated in the study (87.3%). The mean age of the participants was 68.25 ± 6.54 years (60-97 years). The prevalence of hypertension was 81.08% (95% CI: 79.57-82.59) in the whole sample; 82.96% (95% CI: 81.02-84.91) in females, and 79.15% (95% CI: 76.6 -81.69) in males. The prevalence of hypertension ranged from 75.47% (95% CI: 72.65-78.29) in the age group 60-64 years to 88.40% (95% CI: 83.71-93.08) in the age group ≥ 80 years. The prevalence of hypertension unawareness was 32.84% (95% CI: 30.82-34.86). The highest and lowest prevalence of hypertension was seen in illiterate subjects (89.41%) and those with a university education (77.14%), respectively. According to the multiple logistic regression analysis, older age, lower education level, obesity and overweight, neck circumference, and diabetes were significantly associated with the prevalence of hypertension. Conclusion A significant percentage of Iranian elderly have hypertension and one of every 3 affected individuals is unaware of their disease. Considering the population aging in Iran, urgent and special attention should be paid to the elderly population. Caring for the elderly, informing families, and using non-traditional screening methods are recommended by families at the first level and policymakers at the macro level.
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Affiliation(s)
- Farid Fotouhi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Shahidi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mahshid Saffarpour
- Department of Restorative Dentistry, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roghayeh Esmaieli
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taraneh Esteki
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoon Bana Derakhshan
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Prevalence of Excess Sodium Intake and Their Corresponding Food Sources in Adults from the 2017–2018 Brazilian National Dietary Survey. Nutrients 2022; 14:nu14194018. [PMID: 36235671 PMCID: PMC9571186 DOI: 10.3390/nu14194018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022] Open
Abstract
Excessive sodium intake has been related to high blood pressure, a central risk factor for cardiovascular disease. In the present work, updated estimates of sodium intake, the main food sources, and the prevalence of excessive intakes in a nationwide multi-ethnic sample of Brazilian adults (2017–2018 Brazilian National Dietary Survey) were presented. Based on two 24-h recalls adjusted for the within-person variation, the overall median of sodium intake was 2432 mg. The prevalence of adults exceeding the recommended limits (tolerable upper limit, UL, and the chronic disease risk reduction cut-off point, CDRR) was 61% and 56%, respectively. The median sodium intake and proportion of individuals above the limits varied according to the subgroups evaluated. Males and adults (20–29 years) presented the highest excessive sodium intakes, and consequently, lowest adherence rates to UL and CDRR recommendations. The top food sources of sodium were white bread and toast (12.3%), beans (11.6%), white rice (10.6%), beef (7.7%), and poultry meat (5.5%). Given the health benefits of dietary sodium reduction, it would be advisable to enhance the current national initiatives of awareness and educational campaigns’ combined efforts to reduce sodium in processed foods to effectively decrease this micronutrient intake across the Brazilian population.
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de Almeida Faria ACR, Dall'Agnol JF, Gouveia AM, de Paiva CI, Segalla VC, Baena CP. Risk factors for cognitive decline in type 2 diabetes mellitus patients in Brazil: a prospective observational study. Diabetol Metab Syndr 2022; 14:105. [PMID: 35897033 PMCID: PMC9327152 DOI: 10.1186/s13098-022-00872-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) patients are twice as likely to develop dementia. The study's goal was to evaluate cognitive performance and risk factors for cognitive decline in this population. METHODS Prospective observational study was conducted with 400 T2DM adults, of whom, during routine baseline and follow-up appointments, had socio-demographic, clinical, and laboratory data collected, and underwent physical examination, screening for depression symptoms (Patient Health Questionaire-9-PHQ-9), and cognitive tests: Mini-Mental State Examination (MMSE), Semantic Verbal Fluency Test, Trail Making Test A/B, and Word Memory Tests. Each cognitive test score was converted to a z-score and its average resulted in a new variable called Global Cognitive z-Score [GCS(z)]. Averages of the cognitive test scores and GCS(z) at both moments were compared by the Student's T-Test for paired samples. Multivariate binary logistic regression models were built to assess the association of GCS(z) < zero with risk factors for cognitive decline at the baseline and follow-up. RESULTS After exclusions, 251 patients were eligible, being 56.6% female, mean age of 61.1 (± 9.8) years, 12.6 (± 8.9) years of DM duration, and 7.6 (± 4.2) years of school education. Follow-up had 134 patients reevaluated and took place after a mean of 18.4(± 5.0) months. Eleven (14%) patients with a GCS(z) ≥ 0 at baseline turned into a GCS(z) < 0 at follow-up. There were no significant differences between the means of cognitive test scores and GCS(z) at the two evaluation moments. At the baseline, the multivariate logistic regression model identified five risk factors associated with GCS(z) < zero: age ≥ 65 years, schooling ≤ 6 years, arterial hypertension, depression symptoms, and diabetic retinopathy (DR), with odds ratio (OR) and 95% confidence interval (CI95%) respectively: 5.46 (2.42-12.34); 12.19 (5.62-26.46); 2.55 (0.88-7.39); 3.53 (1.55-8.07) e 2.50 (1.18-5.34). At follow-up, the risk factors for GCS(z) < zero were: schooling ≤ 6 years, DM duration ≥ 10 years, depression symptoms, arterial hypertension, and cardiovascular disease (CVD), OR and CI95% respectively: 10.15 (3.68-28.01); 2.68 (0.96-7.48); 4.92 (1.77-13.70); 7.21 (1.38-35.71) e 5.76 (1.93-17.18). CONCLUSIONS Based on our results, cognitive evaluation and follow-up should be incorporated on the routine of T2DM patients, especially for those with advanced age, low education level, prolonged DM duration, arterial hypertension, depression symptoms, CVD, and DR.
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Affiliation(s)
- Ana Cristina Ravazzani de Almeida Faria
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, 80215-901, Brazil
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Joceline Franco Dall'Agnol
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, 80215-901, Brazil
| | - Aline Maciel Gouveia
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Clara Inácio de Paiva
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | | | - Cristina Pellegrino Baena
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, 80215-901, Brazil.
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Thakur JS, Nangia R. Prevalence, Awareness, Treatment, and Control of Hypertension and Diabetes: Results From Two State-Wide STEPS Survey in Punjab and Haryana, India. Front Public Health 2022; 10:768471. [PMID: 35387189 PMCID: PMC8978601 DOI: 10.3389/fpubh.2022.768471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background India which is home to more than one sixth of the world's population, accounts for more than two thirds of total deaths due to non-communicable diseases (NCD). Out of this, hypertension and diabetes are the most common NCDs. Awareness, treatment, and control of hypertension and diabetes remains a major challenge despite various national programs being run to curb the rising burden NCDs. In order to fill the knowledge gap, awareness, treatment, and control of diabetes and hypertension were studied by using data from the STEPS survey among the adult population in two major northern Indian states of Punjab and Haryana. Methods Two state-wide NCD risk factors surveys were conducted using WHO STEPS methodology among 5,127 individuals in Punjab and 5,078 individuals in Haryana aged 18-69 years in the year 2014-15 and 2016-18. Standardized questionnaire was used to determine the behavioral risk factors in step one followed by anthropometric measurements for physical risk factors in step two and in the third step serum and urine samples were collected for biochemical risk factors. Results The prevalence of hypertension in Punjab was 40.1% while that in Haryana was 26.2%. In Punjab, only 48.3% of the hypertensive were aware of their condition, 30.9% were on treatment while only 18.3% of the cases were controlled. While in Haryana 33.4% of the respondents were aware of their condition, 26.3% are on treatment while only 12% of the cases were controlled. Similarly, the prevalence of diabetes was 14.3 and 15.1% in Punjab and Haryana, respectively. In Punjab 34.2% of diabetics were aware of their condition, 28.2% were on treatment while only 14.2% of the cases were controlled. The awareness and control rates in Haryana were similar to that in Punjab. 29.5% of the respondents were aware of their condition, 22.4% were on treatment while only 13.8% of the cases of diabetes were controlled. Family history of diabetes and hypertension was found to be associated with higher odds of being aware, on treatment and controlled blood glucose and blood pressure levels in both Punjab and Haryana. Discussion Hypertension and diabetes are a major public health problem in Punjab and Haryana and awareness, treatment and control rates are low which require specific interventions with a focus on access to treatment, regular follow up for better control. There is an urgent need to effectively implement the existing national NCD programmes in these states in India.
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Affiliation(s)
- J S Thakur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ria Nangia
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Santana GBDA, Leal TC, de Paiva JPS, da Silva LF, Santos LG, de Oliveira TF, Mesquita RDR, Gomes JA, de Souza CDF, Rodrigues AKBF. Temporal Trend of Mortality Due to Ischemic Heart Diseases in Northeastern Brazil (1996-2016): An Analysis According to Gender and Age Group. Arq Bras Cardiol 2021; 117:51-60. [PMID: 34320068 PMCID: PMC8294739 DOI: 10.36660/abc.20200222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/31/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ischemic heart disease (IHD) is the leading cause of death among cardiovascular diseases (CVD). OBJECTIVE To describe the sociodemographic profile and analyze the trend in the mortality rate due to IHD, according to sex and by age group, in the states of the Northeast region of Brazil, from 1996 to 2016. METHODS Ecological study involving IHD mortality in the northeastern states. Variables analyzed: sex, age, education, marital status, ICD-10 category and state of residence. Crude and standardized rates were calculated. Death data were collected from the Mortality Information System (SIM) and population data from the Brazilian Institute of Geography and Statistics (IBGE). In temporal analyzes the regression model by inflection points was used, with the calculation of annual percent change (APC) and average annual percent change of the period (AAPC). A 95% confidence interval and a significance level of 5% were considered. RESULTS 405916 deaths due to IHD were registered in the northeast region during the study period. The death profile is characterized by men (n=229006; 56,42%), elderly (n=301379; 74,25%), race/color brown (n=197936; 48,76%), elementary or <4 years at school (n=232599; 57,30%) and married (n=179599; 44,25%). There was an unusual highlight to the increase in the annual growth rate in the age group of adolescents (AAPC: 5,2%, p <0.01). The standardized regional mortality rate grew from 30,7 per 100,000 inhabitants in 1996 to 53.8 per 100,000 in 2016 (AAPC 2.8%; p<0.01). All nine states presented a statistically significant growth trend, with emphasis on Maranhão (AAPC 7,6%; p<0.01) and Piauí (AAPC 6,0%; p<0.01). CONCLUSION The prevalent observed profile was male, elderly, race/color brown, low education level and married. Mortality due to IHD presented an upward trend in all states, although with an uneven pattern among the federated units.
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Affiliation(s)
| | - Thiago Cavalcanti Leal
- Universidade Federal de AlagoasMaceióALBrasilUniversidade Federal de Alagoas, Maceió, AL - Brasil
| | | | | | - Lucas Gomes Santos
- Universidade Federal de AlagoasMaceióALBrasilUniversidade Federal de Alagoas, Maceió, AL - Brasil
| | | | - Rodrigo da Rosa Mesquita
- Universidade Federal de AlagoasMaceióALBrasilUniversidade Federal de Alagoas, Maceió, AL - Brasil
| | - Jéssica Alves Gomes
- Universidade Federal de AlagoasMaceióALBrasilUniversidade Federal de Alagoas, Maceió, AL - Brasil
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Coelho JC, Guimarães MCDLP, de Campos CL, Florido CF, da Silva GV, Pierin AMG. Blood pressure control of hypertensive patients followed in a high complexity clinic and associated variables. J Bras Nefrol 2021; 43:207-216. [PMID: 33617623 PMCID: PMC8257288 DOI: 10.1590/2175-8239-jbn-2020-0133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Arterial hypertension is a disease that has a high impact on cardiovascular mortality and morbidity; however, it is still insufficiently controlled. OBJECTIVES To assess hypertension control in patients seen at a specialized clinic and to identify associated variables. METHOD Cross-sectional study involving the analysis of medical records from 782 patients treated in a highly complex outpatient clinic. Inclusion criteria: age ≥18 years, diagnosed with hypertension, in treatment ≥6 months. Patients with secondary hypertension (104) and incomplete data (64) were excluded. The main outcome was blood pressure control (systolic <140 and diastolic <90 mmHg). The independent variables studied were: sociodemographic and clinical characteristics (use of drugs, comorbidities and laboratory tests). Pearson's χ2 tests, Fisher's test, Student's t and Wilcoxon-Mann-Whitney tests were performed in the bivariate analysis and logistic regression in the multiple analyses, adopting p≤0.05. RESULTS The prevalence of hypertensive control was 51.1%. It was associated with a lack of control: body mass index (OR = 1.038; 95% CI = 1.008 - 1.071), history of stroke (OR = 0.453; 95% CI = 0.245 - 0.821), left ventricular hypertrophy (OR = 1.765; 95% CI = 1.052 - 3.011), and number of medications (OR = 1.082; 95% CI = 1.033 - 1.136). CONCLUSION About half of the hypertensive patients had their blood pressure controlled; clinical variables and target organ damage were associated with the control.
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Gupta S, Kumar R, Kalaivani M, Nongkynrih B, Kant S, Gupta SK. Prevalence, awareness, treatment, and control of diabetes and hypertension among elderly persons in a rural area of Ballabgarh, Haryana. J Family Med Prim Care 2020; 9:777-782. [PMID: 32318419 PMCID: PMC7113922 DOI: 10.4103/jfmpc.jfmpc_1057_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 01/04/2023] Open
Abstract
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, 60th 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.
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Affiliation(s)
- Sunanda Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Malachias MVB. The Challenges of Controlling Arterial Hypertension in the Elderly. Arq Bras Cardiol 2019; 112:279-280. [PMID: 30916190 PMCID: PMC6424041 DOI: 10.5935/abc.20190020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Marcus Vinicius Bolivar Malachias
- Faculdade de Ciências Médicas de Minas Gerais da
Fundação Educacional Lucas Machado, Belo Horizonte, MG - Brazil
- Instituto de Hipertensão Arterial de Minas Gerais, Belo
Horizonte, MG - Brazil
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