Epidemiology of Resistant Hypertension in Canada

BackgroundResistant hypertension is associated with cardiovascular morbidity and mortality. The objective of this study was to estimate the prevalence of apparent treatment-resistant hypertension in Canadian adults and examine the characteristics of those affected.MethodsA nationally representative cross-sectional study was conducted with the use of Canadian Health Measures Survey (2007-2017) data. The frequency of respondents with uncontrolled blood pressure despite 3 or more antihypertensive medications of different drug classes (and at least 1 agent being a diuretic), or treatment with 4 or more agents regardless of blood pressure, was determined.ResultsA total of 245,700 people were identified to have apparent treatment-resistant hypertension, representing 5.3% (95% confidence interval [CI] 4.5%–6.2%) of adults treated for hypertension in Canada. Respondents who had uncontrolled blood pressure with 3 or more antihypertensive drugs were more likely women (55.8%, 95% CI 41.1%-70.4%), 70 years of age or older (45.3% 95% CI 32.8%-57.9%), and overweight or obese (84.2%, 95% CI 72.3%-96.1%). Respondents with apparent treatment-resistant hypertension also had a high likelihood of chronic kidney disease (36.0%, 95% CI 21.4%-50.6%), diabetes (35.2%, 95% CI 21.7%-48.7%), dyslipidemia (68.0%, 95% CI 55.2%-80.8%), and history of heart attack (9.9%, 95% CI 4.8%-15.1%) or stroke (7.1%, 95% CI 0-14.4%).ConclusionsDespite being prescribed at least 3 antihypertensive drugs, a considerable proportion of Canadians, especially women, have difficulty achieving blood pressure control, predisposing them to a higher risk of cardiovascular complications and death.     

Hypertension Prevalence,Awareness, Treatment,and Control in Selected LMIC Communities: Results From the NHLBI/UHG Network of Centers of Excellence for Chronic Diseases

BackgroundHypertension is the leading cause of cardiovascular disease and premature death worldwide. The prevalence of this public health problem is increasing in low- and middle-income countries (LMICs) in both urban and rural communities.ObjectiveThe aim of this study was to examine hypertension prevalence, awareness, treatment, and control in adults 35 to 74 years of age from urban and rural communities in LMICs in Africa, Asia, and South America.MethodsThe authors analyzed data from 7 population-based cross-sectional studies in selected communities in 9 LMICs that were conducted between 2008 and 2013. Age- and sex-standardized prevalence rates of pre-hypertension and hypertension were calculated. The prevalence rates of awareness, treatment, and control of hypertension were estimated overall and by subgroups of age, sex, and educational level.ResultsIn selected communities, age- and sex-standardized prevalence rates of hypertension among men and women 35 to 74 years of age were 49.9% (95% confidence interval [CI]: 42.3% to 57.4%) in Kenya, 54.9% (95% CI: 51.3% to 58.4%) in South Africa, 52.5% (95% CI: 50.1% to 54.8%) in China, 32.5% (95% CI: 31.7% to 33.3%) in India, 42.3% (95% CI: 40.4% to 44.2%) in Pakistan, 45.4% (95% CI: 43.6% to 47.2%) in Argentina, 39.9% (95% CI: 37.8% to 42.1%) in Chile, 19.2% (95% CI: 17.8% to 20.5%) in Peru, and 44.1% (95% CI: 41.6% to 46.6%) in Uruguay. The proportion of awareness varied from 33.5% in India to 69.0% in Peru, the proportion of treatment among those who were aware of their hypertension varied from 70.8% in South Africa to 93.3% in Pakistan, and the proportion of blood pressure control varied from 5.3% in China to 45.9% in Peru.ConclusionsThe prevalence of hypertension varies widely in different communities. The rates of awareness, treatment, and control also differ in different settings. There is a clear need to focus on increasing hypertension awareness and control in LMICs.     

Prevalence, awareness, treatment, and control of hypertension among Canadian adults with diabetes, 2007 to 2009

Background

Prior national surveys suggested that treatment and control of hypertension were poor in individuals with diabetes. Using measured blood pressures, we estimated prevalence, awareness, treatment, and control of hypertension between 2007 and 2009 among Canadians with diabetes and sought to determine whether a treatment gap still exists for individuals with diabetes.

Methods

Using data from cycle 1 of the Canadian Health Measures Survey, estimates of hypertension prevalence, awareness, treatment, and control were described and compared between individuals with and without self-reported diabetes.

Results

Three-quarters of individuals reporting diabetes also had hypertension; of these, 89% (95% confidence interval [CI], 80%-98%) were aware, 88% (95% CI, 81%-94%) were treated, and 56% (95% CI, 45%-66%) were controlled to < 130/80 mm Hg. Among those treated with pharmacotherapy, 39% (95% CI, 31%-48%) were using monotherapy, 29% (95% CI, 18%-40%) were taking 2 medications, and 31% (95% CI, 22%-39%) were taking 3 or more medications; control to < 130/80 mm Hg was achieved by 63% (95% CI, 53%-74%). Among those treated, individuals with diabetes were significantly less likely to be treated to their recommended target (< 130/80 mm Hg) compared with individuals without diabetes (< 140/90 mm Hg; odds ratio_adjusted 0.3; 95% CI, 0.2-0.6).

Conclusions

Hypertension treatment and control among people with diabetes have improved in Canada during the past 2 decades. Nonetheless, nearly half of people with diabetes are above the treatment target. Health care professionals should continue to increase their efforts in supporting patients with diabetes in achieving blood pressure control, with emphasis on lifestyle management and pharmacotherapy.     

Factors associated with lack of awareness and uncontrolled high blood pressure among Canadian adults with hypertension

Background

Approximately 17% of Canadians with high blood pressure were unaware of their condition, and of Canadians aware of having the condition, approximately 1 in 5 have uncontrolled high blood pressure despite high rates of pharmacotherapy. The objectives of the current study are to estimate the prevalence of resistant hypertension and examine factors associated with (1) lack of awareness and (2) uncontrolled hypertension despite pharmacotherapy.

Methods

Using the 2007-2009 Canadian Health Measures Survey (N = 3473, aged 20-79 years) and logistic regression, we quantified relationships between characteristics and (1) presence of hypertension, (2) lack of awareness (among those with hypertension), and (3) uncontrolled high blood pressure (among those treated for hypertension).

Results

Older age, lowest income, and less than high school education were associated with presence of hypertension. Men (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2) and adults < 60 years (OR, 1.7; 95% CI, 1.1-2.6) were more likely than others to be unaware. Among those aged 60+ years, women were more likely than men to have uncontrolled high blood pressure (OR, 2.4; 95% CI, 1.1-5.2) despite treatment. Elevated systolic blood pressure was the issue in over 90% of women and 80% of men with uncontrolled hypertension. Depending on the definition employed, 4.4% (95% CI, 2.4-6.4) to 7.8% (95% CI, 6.0-9.6) of the population with hypertension had resistant hypertension.

Conclusions

Messaging or interventions encouraging screening may be helpful for all younger Canadian adults and men; programs encouraging blood pressure control may help older women.     

Prevalence,Awareness, Treatment,and Control of Hypertension among Adult Residents of Tehran: The Tehran Cohort Study

Background:High levels of blood pressure (BP) remain undetected and poorly controlled in large segments of the population leading to an enormous burden in terms of disease and mortality.Objective:We aimed to assess the prevalence, awareness, treatment, and control of hypertension in Tehran.Methods:We used the data of 8,296 adults aged ≥35 years from the Tehran Cohort Study who were enrolled between May 2016 and February 2019. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, self-report, and/or current antihypertensive medication use. The age- and sex-weighted prevalence of hypertension and high normal BP was calculated using the 2016 national census. Furthermore, awareness, treatment, and control of hypertension were analyzed.Results:The mean age of the participants was 53.8 ±12.75 years, and 54.0% were women. The weighted prevalence of hypertension and high normal BP were 36.5% and 12.2%, respectively. Among hypertensive individuals, 68.2% were aware of hypertension, 53.3% were receiving medication, and 40.4% had adequate BP control. The awareness, treatment, and control of hypertension were significantly higher in women (72.2% vs. 63.4% [P < 0.001], 55.1% vs 51.1% [P = 0.020], and 42.7% vs. 37.7% [P = 0.004], respectively) and this gap considerably increased with advancing age. Hypertension was more prevalent in northern Tehran but with a better treatment rate and control in the same regions.Conclusion:Despite the high prevalence of hypertension in the adult population of Tehran, the rates of awareness, treatment, and control of hypertension are unsatisfactory and demand comprehensive strategies to improve this situation, especially in younger men.     

Regional impact of updated guidelines on prevalence and distribution of blood pressure categories for hypertension in India: Results from the National Family Health Survey 4

IntroductionIn 2017, the American College of Cardiology/American Heart Association revised guidelines for diagnosis and management of hypertension in adults. The regional impact of the updated guidelines on the prevalence of hypertension in India is unknown.MethodsData from nationally representative Indian households were analyzed to estimate the regional prevalence of hypertension according to the old and the new guidelines in men (age 18–54 years) and women (age 18–49 years). The old guidelines defined hypertension as a systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg or treatment. The new guidelines define hypertension as a systolic blood pressure of ≥130 mmHg or diastolic blood pressure of ≥80 mmHg or treatment. We calculated the increase in the prevalence of hypertension among the states and union territories of India (hereafter “states”).ResultsAmong 679,712 participants (85.6% women), the median age was 31 years (interquartile range 24, 40) and was comparable among men and women (33 vs. 31 years, respectively). The overall weighted prevalence according to old and new guidelines was 18.5% (95% CI 18.2, 18.7) and 43.0% (95% CI 42.8, 43.3), respectively. There was a significant increase in hypertension prevalence, both among men and women, and across all regions. The northeast region of the country had the highest prevalence.ConclusionThe overall prevalence of hypertension significantly increases with the new compared to the old guidelines, however, the regional heterogeneity of prevalence of hypertension is maintained.     

National trends in prevalence,awareness, treatment,and control of hypertension among adults in Mongolia from 4 cross-sectional surveys in 2005, 2009, 2013, and 2019

This study aimed to analyze trends in the prevalence, awareness, treatment, and control of hypertension and associated factors in persons 15 years and older from 2005 to 2019 in Mongolia.National data were analyzed from 21,342 people (≥15 years) who participated in 4 cross-sectional STEPwise Approach to NCD Risk Factor Surveillance surveys in Mongolia (2005, 2009, 2013, or 2019) and had complete blood pressure measurements. The prevalence, awareness, treatment, and control of hypertension were calculated using sociodemographic factors within each study year. Logistic regression was employed to assess the associations between sociodemographic and health factors and status of hypertension, awareness, treatment, and control by study year and pooled sample.Trend analyzes showed that the prevalence of hypertension decreased significantly from 28.4% in 2005 to 23.2% in 2019 (P < .001). The prevalence of awareness among hypertensives remained unchanged, the treatment among aware decreased, and the control rate increased. In adjusted logistic regression analysis with the pooled sample, male sex (adjusted odds ratio [AOR]: 1.49, 95% confidence intervals [CI]: 1.32–1.68), older age (≥45 years) (AOR: 5.90, 95% CI: 4.90–7.10), obesity (AOR: 4.29, 95% CI: 3.77–4.88), more frequent alcohol use (≥1–2 days/week) (AOR: 1.69, 95% CI: 1.39–2.05) were positively, and higher educational level (≥12 years) (AOR: 0.77, 95% CI: 0.68–0.87) and urban residence (AOR: 0.84, 95% CI: 0.74–0.97) were negatively associated with hypertension prevalence.The prevalence of hypertension among Mongolian adults has decreased in recent years. Levels of hypertension awareness were unchanged, treatment decreased, and control increased. Increased health promotion, detection, and treatment of hypertension in Mongolia are indicated.     

Prevalence and management of prehypertension and hypertension by geographic regions of Thailand: the Third National Health Examination Survey, 2004

OBJECTIVE: To determine the prevalence of prehypertension and hypertension, and management of hypertension, by geographic regions of Thailand. METHODS: Using a stratified, multistage sampling design, data from a nationally representative sample of 39 290 individuals aged > or = 15 years were collected by interview, physical examination and blood sample. RESULTS: The prevalence of hypertension and prehypertension weighted to the national 2004 population was 22.0% [95% confidence interval (CI) = 20.5-23.6] and 32.8% (95% CI = 31.5-34.1), respectively, with a higher prevalence in men compared to women. Hypertension was more common in urban compared to rural men, but similar between urban and rural women. Despite some variation, the prevalence of hypertension and prehypertension was relatively uniform across geographical regions. Of those identified as having hypertension in the survey, 69.8% (95% CI = 67.8-71.7) were unaware that they had hypertension. Although the majority of those who were aware (78.2%; 95% CI = 75.8-80.5) had taken blood pressure-lowering drugs in the last 2 weeks, of these only 36.6% (95% CI = 33.3-40.0) had blood pressure < 140/90 mmHg. Rural populations and those from the economically poorer Northeast region were more likely to be unaware that they had hypertension. CONCLUSION: Compared to previous surveys, the prevalence of hypertension and prehypertension is rising rapidly, and is spread relatively evenly across regions of Thailand. Levels of awareness of hypertension were low across the country. A challenging task remains in improving screening, treatment and control of hypertension at the same time as promoting healthier lifestyles.     

Impact of a community based intervention program on awareness,treatment and control of hypertension in a rural Panchayat,Kerala, India

ObjectiveCommunity based intervention to control hypertension is extremely limited in India. We conducted this study to find the effectiveness of a community based intervention program on the awareness, treatment and control of hypertension.MethodsA baseline survey was conducted among 4627 adults aged ≥30 years (men 44%) selected by cluster sampling. Information was collected using a structured interview schedule by trained local volunteers. They measured weight, height, waist circumference and blood pressure using standard protocol. The volunteers monitored blood pressure at least once a month and educated the people in neighborhood groups on the need for regular medication and reducing risk factors of hypertension for a period of six years. A post intervention survey was conducted among 2263 adults aged ≥30 years (men 49%). Stepwise logistic regression analysis was done to find the odds of change in awareness, treatment and control of hypertension.ResultsThe odds of awareness (OR 4.18, 95% CI 3.44–5.08), treatment (OR 3.44 CI 2.81–4.22) and control (OR 4.39 CI 3.36–5.73) of hypertension increased significantly in the post intervention survey compared to the baseline survey. Baseline hypertension prevalence of 34.9% (CI 33.8–36.1) was reduced to 31.0% (CI 29.1–32.9) in the post intervention survey based on age adjusted analysis.ConclusionOur community based intervention using trained community based volunteers could increase awareness, treatment and control of hypertension among adult hypertensives.     

Prevalence and associated factors of cardiovascular diseases among men and women aged 45 years and above: Analysis of the longitudinal ageing study in India, 2017–2019

ObjectiveEpidemiological studies on the prevalence and associated factors of cardiovascular diseases (CVDs) representative of all states of India among middle-aged and elderly are not much reported. The present study estimates the prevalence and associated factors of cardiovascular diseases across Indian states among men and women aged ≥45 years.MethodsWe used data from the Longitudinal Ageing Study in India wave 1 (2017–2019), which included a final analytical sample size of 56,935 adults and their spouses aged 45 years and above. We estimated CVDs prevalence for sociodemographic and behavioural variables, and multivariable logistic regression was used to assess the association between behavioural factors and CVDs in both men and women.ResultsThe prevalence of CVDs was 5.2% among adults ≥45 years (women: 4.6%; men: 5.9%), hypertension was 46.7% (women:48.9%; men:44%). Men and women have a similar prevalence of diabetes (11.9%) and cholesterol (2.3%). Prevalence of physical inactivity was 30.3% (women:27%; men:34.1%). Hypertension (adjusted odds ratio; aOR women:2.60, 95% CI: 2.08–3.25, men:1.88, 95% CI 1.54–2.29), hypercholesterolemia (aOR women:1.70; 95% CI 1.07–2.69, men 3.55; 95% CI 2.66–4.74), diabetes (aOR women:2.53; 95% CI 1.83–3.51, men:1.77 95% CI 1.44–2.17), obesity, physical inactivity, and smoking in men were significantly associated with CVDs.ConclusionThe prevalence of CVDs and lifestyle risk factors among middle-aged and elderly poses severe concerns regarding noncommunicable disease (NCD) healthcare services provided in a lower-middle-income country like India. The key to preventing CVDs is controlling hypertension, diabetes, hypercholesterolemia, and increasing physical activity among adults aged ≥45 years.     

Prevalence, awareness, treatment and control of hypertension in employees of factories of Northern Greece: the Naoussa study

The objective of this study was to examine the prevalence and the levels of awareness, control, and treatment of hypertension in workers, technicians and clerks of factories of the city of Naoussa. A total of 1976 employees in 19 units were examined. From those, 1937 (1045 men and 892 women), 15-73 years of age, were included in the analysis. Every employee was examined twice with 1 week's interval between the two examinations. Analysis was performed using the 140/90 mmHg hypertension threshold. In every visit, three blood pressure (BP) measurements were taken with at least 1-min interval between them. In the analysis only the average BP of the second clinic visit was used. In total, hypertension prevalence was 30.5% (32.1% for men and 28.7% for women respectively, P=0.10). The levels of awareness, treatment, and control of hypertension in hypertensive patients were 18.6%, 11.8%, and 2.2%, respectively. The levels of awareness and treatment differed significantly between men and women (13.4 vs 25.4%, P<0.001 and 9.6 vs 14.8%, P<0.05), but there was no difference in the levels of control (1.5 vs 3.1%, P=0.18). Hypertension prevalence, awareness, and treatment differed also between patients <45 and > or =45 years of age (22.0 vs 53.2%, P<0.001, 9.7 vs 28.4%, P<0.001 and 6.5 vs 17.7%, P<0.001, respectively). In conclusion, the prevalence of hypertension in our study's population is high, while the levels of awareness, treatment, and control are disappointing and should be significantly improved. There is also a difference in awareness and treatment in favour of women compared to men and in favour of patients >/=45 years of age compared to those <45 years of age.     

Smoking and Asthma in Men and Women with Normal Weight,Overweight, and Obesity

Background. There is a complex interrelationship among smoking, body weight, and asthma. It needs to be clarified whether smoking is related to an increased risk of asthma after taking into account for relative body weight. Objective. To examine the association between cigarette smoking and the prevalence of asthma in Canadian men and women with normal weight, overweight, and obesity. Methods. The analysis was based on data from 112,830 Canadians aged 18 years or more who participated in a national survey in 2007–2008. A questionnaire covered the information on prevalent asthma, smoking status, height, weight, and other factors. Logistic regression analysis was used to determine the association between smoking and the prevalence of asthma stratified by sex and body mass index (BMI). Results. The crude prevalence of asthma was 6.6% for men and 9.3% for women. After adjustment for covariates, the odds ratios (ORs) for current smoking associated with asthma was 1.20 [95% confidence interval (CI): 1.01–1.43] for men with normal weight, 0.98 (95% CI: 0.81, 1.18) for overweight men, and 1.02 (95% CI: 0.80–1.30) for obese men. For women, the corresponding adjusted ORs were 1.41 (95% CI: 1.23–1.62), 1.27 (95% CI: 1.05–1.54), and 1.28 (95% CI: 1.03–1.59), respectively. Conclusion. Current smoking was significantly associated with prevalent asthma in all women regardless of their relative body weight. In men, however, the association was only observed in those with under- or normal weight.     

Prevalence,awareness, treatment,and control of hypertension in Bangladesh: Findings from National Demographic and Health Survey, 2017–2018

The purpose of this study was to estimate the age‐standardised prevalence, awareness, treatment, and control of hypertension and to identify their risk factors in Bangladeshi adults. Data from 12 904 adults aged 18–95 years, available from the most recent nationally representative 2017–2018 Bangladesh Demographic and Health Survey were used. Hypertension was defined as having systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, and/or taking anti‐hypertensive drugs to control blood pressure. Age‐standardized prevalence of hypertension and management were estimated with direct standardisation. A multilevel mixed‐effects Poisson regression model with a robust variance was used to identify risk factors associated with hypertension and its awareness, treatment, and control. The overall age‐standardized prevalence of hypertension was 26.2% (95% CI, 25.5‐26.9); (men: 23.5%, women: 28.9%). Among those with hypertension (n = 3531), 36.7% were aware that they had the condition, and only 31.1% received anti‐hypertensive medication. The prevalence of controlled hypertension was 12.7% among those with hypertension and 43.6% among those treated for hypertension (n = 1306). Factors independently associated with hypertension were increasing age, higher body mass index, being women, having diabetes, and residing in selected administrative divisions. A declining trend of hypertension control was observed with increasing age and low education. Hypertension is highly prevalent (one in four) in Bangladeshi adults, while awareness, treatment, and control are low. Irrespective of the risks associated with hypertension and its management, programs to increase its awareness, treatment, and control should be given high priority in reducing hypertension prevalence and improving hypertension control in Bangladesh.     

Hypertension prevalence,control and survivorship in an Afro-Caribbean population

OBJECTIVE: To evaluate the prevalence, distribution, awareness, treatment and control of hypertension in an Afro-Caribbean population, and their relationship to 4-year survival.DESIGN Population-based prospective cohort study. SETTING AND PARTICIPANTS: Simple random sample of Barbados-born citizens (4709 persons; 84% participation), with 4-year follow-up. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hypertension prevalence, awareness, treatment and control were evaluated at baseline. Four-year cumulative mortality was assessed by the product-limit method and relative risk of mortality by the Cox proportional hazards method. RESULTS: Mean systolic (SBP) and diastolic (DBP) blood pressure were higher among black than white participants. In the black population, age-specific prevalence of hypertension increased from 32.7% in men and 34.0% in women at 40-49 years of age to 63.4% in men and 85.5% in women at ages 80 years and older, with an overall prevalence of 55.4%. Hypertension awareness, treatment and control rates were 62.5, 53.8 and 18.5%, respectively. Compared to DBP 80 mmHg, the presence of a DBP between 80 and 84 mmHg, 100-109 mmHg and > or = 110 mmHg was associated with adjusted death rate ratios of 1.6, 1.7 and 2.0, respectively. Systolic blood pressure was not related to the risk of cardiovascular mortality, after adjustment for age or other potential confounders. Hypertensives were at modestly increased risk of 4-year cardiovascular mortality [RR = 1.4; 95% confidence inteval (CI) (1.0, 2.0)], while treated uncontrolled hypertensives were at increased risk of all cause [RR = 1.4; 95% CI (1.0, 1.9)] and cardiovascular [RR = 1.6; 95% CI (1.1, 2.5)] mortality. CONCLUSIONS: High rates of hypertension in this population coexist with conservative levels of treatment and low rates of blood pressure control. In contrast to other reports, elevated SBP was not independently associated with increased risk of cardiovascular mortality. The modest impact of elevated blood pressure might partly explain the comparatively lower hypertension-related mortality rates in populations of Caribbean-origin. Treated uncontrolled hypertensives are at increased risk of early mortality, signaling the need for strict blood pressure control in this group.     

Associação da Hipertensão com a Gravidade e a Mortalidade de Pacientes Hospitalizados com COVID-19 em Wuhan,China: Estudo Unicêntrico e Retrospectivo

BackgroundCoronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide.ObjectiveTo investigate the association between hypertension and severity/mortality in hospitalized patients with COVID-19 in Wuhan, China.MethodsA total of 337 patients diagnosed with COVID-19 at the Seventh Hospital of Wuhan City, from January 20 to February 25, 2020, were enrolled and analyzed in a retrospective, single-center case study. The significance level adopted in the statistical analysis was 0.05.ResultsOf the 337 patients with confirmed diagnosis of COVID-19, 297 (87.8%) were discharged from the hospital and 40 patients (22.9%) died. The median age was 58 years (range, 18-91 years). There were 112 (33.2%) patients diagnosed with hypertension at admission (median age, 65.0 years [range, 38-91 years]; 67 [59.8%, 95%CI: 50.6%-69.0%] men, p=0.0209). Patients with hypertension presented a significantly higher portion of severe cases (69 [61.6%, 95%CI:52.5%-70.8%] vs. 117 [52.0%, 95%CI: 45.4%-58.6%] in severe patients and 23 [19.3%, 95%CI:12.9%-28.1%] vs. 27 [12.0%, 95%CI: 7.7%-16.3%] in critical patients, p=0.0014) and higher mortality rates (20 [17.9%, 95%CI: 10.7%-25.1%] vs. 20 [8.9%, 95%CI: 5.1%-12.6%, p=0.0202). Moreover, hypertensive patients presented abnormal levels of multiple indicators, such as lymphopenia, inflammation, heart, liver, kidney, and lung function at admission. The hypertension group still displayed higher levels of TnT and creatinine at approaching discharge.ConclusionHypertension is strongly associated with severity or mortality of COVID-19. Aggressive treatment may be considered for COVID-19 patients with hypertension, especially regarding cardiac and kidney injury.     

Prevalence,awareness, treatment,and control of hypertension in Nigeria in 1995 and 2020: A systematic analysis of current evidence

Improved understanding of the current burden of hypertension, including awareness, treatment, and control, is needed to guide relevant preventative measures in Nigeria. A systematic search of studies on the epidemiology of hypertension in Nigeria, published on or after January 1990, was conducted. The authors employed random‐effects meta‐analysis on extracted crude hypertension prevalence, and awareness, treatment, and control rates. Using a meta‐regression model, overall hypertension cases in Nigeria in 1995 and 2020 were estimated. Fifty‐three studies (n = 78 949) met our selection criteria. Estimated crude prevalence of pre‐hypertension (120‐139/80‐89 mmHg) in Nigeria was 30.9% (95% confidence interval [CI]: 22.0%‐39.7%), and the crude prevalence of hypertension (≥140/90 mmHg) was 30.6% (95% CI: 27.3%‐34.0%). When adjusted for age, study period, and sample, absolute cases of hypertension increased by 540% among individuals aged ≥20 years from approximately 4.3 million individuals in 1995 (age‐adjusted prevalence 8.6%, 95% CI: 6.5‐10.7) to 27.5 million individuals with hypertension in 2020 (age‐adjusted prevalence 32.5%, 95% CI: 29.8‐35.3). The age‐adjusted prevalence was only significantly higher among men in 1995, with the gap between both sexes considerably narrowed in 2020. Only 29.0% of cases (95% CI: 19.7‐38.3) were aware of their hypertension, 12.0% (95% CI: 2.7‐21.2) were on treatment, and 2.8% (95% CI: 0.1‐5.7) had at‐goal blood pressure in 2020. Our study suggests that hypertension prevalence has substantially increased in Nigeria over the last two decades. Although more persons are aware of their hypertension status, clinical treatment and control rates, however, remain low. These estimates are relevant for clinical care, population, and policy response in Nigeria and across Africa.     

Modifiable and Non-modifiable Factors Associated with Low Awareness of Hypertension Treatment in Indonesia: A Cross-Sectional Population-Based National Survey

Introduction:Low awareness about hypertension treatment is recognized as a significant cause of treatment failure. Therefore, identifying its underlying factors is essential for developing effective intervention strategies. This study aims to identify the modifiable and non-modifiable factors associated with low awareness about hypertension treatment.Method:This national, cross-sectional, population-based survey used publicly available data from the Indonesian Family Life Survey (IFLS-5) for 2014 among respondents with hypertension aged ≥15 years. Depression and insomnia, as modifiable factors, were assessed using the Centre for Epidemiologic Studies—Depression (CES-D) and the Patient-Recorded Outcomes Measurement Information System (PROMIS) questionnaire, respectively. Non-modifiable factors, such as sociodemographic information, were obtained from self-reported data. Logistic regression analysis was used to assess the association between these factors and low awareness about hypertension treatment. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported.Result:The study recruited 7,920 respondents, the majority of whom were female (53.8%) and aged <60 years (71.1%). The prevalence of low awareness of hypertension treatment was 87.1% (51.8% in women and 48.2% in men). Being an elderly (OR: 1.60, 95%CI 1.36–1.88), being irregularly blood pressure control (OR: 4.40, 95% CI 3.78–5.13), having depressive symptoms (OR: 1.35, 95% CI 1.12–1.62), having insomnia (OR: 1.31, 95% CI 1.11–1.53), and having low satisfaction with health care (OR: 1.28, 95% CI 1.08–1.51) were associated with low awareness of hypertension treatment. Surprisingly, respondents with strong religiosity (OR: 1.62; 95% CI 1.25–2.09) were more likely to display low awareness of hypertension treatment.Conclusion:The main factors associated with low awareness of hypertension treatment are modifiable. Thus, health care professionals should integrate more patient-specific factors when designing tailored interventions.     

Trends of COPD in Spain: Changes Between Cross Sectional Surveys 1997, 2007 and 2017

IntroductionWe aim to describe the changes in prevalence and risk factors associated to chronic obstructive pulmonary disease (COPD) in Spain, comparing three population-based studies conducted in three timepoints.MethodsWe compared participants from IBERPOC conducted in 1997, EPISCAN conducted in 2007 and EPISCAN II in 2017. COPD was defined as a postbronchodilator FEV₁/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio <0.70, according to GOLD criteria; subsequently, also as the FEV₁/FVC below the lower limit of normal (LLN).ResultsCOPD prevalence in the population between 40 and 69 years decreased from 21.6% (95% CI 20.7%–23.2%) in 1997 to 8.8% (95% CI 8.2%–9.5%) in 2017, a 59.2% decline (p < 0.001).In 2007, the prevalence was 7.7% (95% CI 6.8%–8.7%) with an upward trend of 1.1 percentage points in 2017 (p = 0.073). Overall COPD prevalence decreased in men and women, although a significant increase was observed in the last decade in females (p < 0.05). Current smokers significantly increased in the last decades (25.4% in 1997, 29.1% in 2007 and 23.4% in 2017; p < 0.001). Regrettably, COPD underdiagnosis was constantly high, 77.6% in 1997, 78.4% in 2007, and to 78.2% in 2017 (p = 0.95), higher in younger ages (40–49 yrs and 50–59 yrs) and also higher in women than in men in all three studies (p < 0.05).ConclusionsWe report a significant reduction of 59.2% in the prevalence of COPD in Spain from 1997 to 2017 in subjects aged 40–69 years. Our study highlights the significant underdiagnosis of COPD, particularly sustained in women and younger populations.     

Prevalence-correlates-awareness-treatment and control of hypertension in kumarakom, kerala: baseline results of a community-based intervention program

BACKGROUND, Hypertension is one of the major causes of cardiovascular morbidity and mortality. However, awareness, treatment, and control of hypertension remain major challenges worldwide. In this article, we present the baseline prevalence of hypertension from an ongoing intervention program for its control in a community-based sample in Kerala, Southern India. METHODS, We measured blood pressure, body weight, and height of 4955 individuals above the age of 30 yers (men;2159:mean-age: 50 years) and collected information on alcohol use, tobacco use, and other demographic variables using a pre-tested structured questionnaire. RESULTS, The overall prevalence of hypertension (JNC-VII) was 36.7% ( 95% CI:35.5-38.0; men: 36.0% and women 37.2% ) in multipile logistic regression analysis, a body mass index of >/=25 kg/m(2) was associated with a 1.65-fold (95% CI:1.37-1.98) prevalence of hypertension compared to a body mass index <25kg/m(2). Individuals with diabetes mellitus had 2.10 higher odds of hypertension prevalence (95% CI: 1.62-2.73) compared to people wihtout diabetes mellitus. Participants with increased waist circumference (90 cm in men, 85 cm in women) were 1.84 times more likely to be hypertensive compared to those with normal waist circumference (95% CI: 1.55-2.19). Among hypertensives, 24% were aware of the condition, 20% were on treatment, and 6.4% achieved effective blood pressure control. CONCLUSION, A higher body mass index, increased waist circumference, and self-reported diabetes mellitus were the important correlates of hypertension in our community-based sample. Our data emphasize the importance of educational interventions and appropriate lifestyle modifications that target increased body mass index and waist circumference to reduce the community burden of hypertension.     

Prevalence,awareness, treatment,and control of hypertension among Chinese working population: results of a workplace-based study

We investigated the prevalence, awareness, treatment, and control of hypertension and the related risk factors among Chinese working population. From 2012 to 2013, a total of 37,856 employees aged 18–60 years from 61 workplaces were sampled. Standard questionnaire surveys and physical examinations were undertaken. Multilevel logistic regression models were performed to identify the risk factors. Overall, the age-standardized prevalence of hypertension was 23.3% (95% confidence interval [CI]: 22.9%–23.7%). Among the hypertensives, 47.8% (95% CI: 46.8%–48.8%) were aware of their condition, 20.6% (95% CI: 19.8%–21.4%) were in treatment, but only 8.5% (95% CI: 7.9%–9.1%) had controlled hypertension. White-collar employees had a lower odds of hypertension compared with the blue-collar (odds ratio: 0.77, 95% CI: 0.71–0.84), whereas the state-owned enterprise employees had a higher odds compared with their private enterprise counterparts (odds ratio: 1.69, 95% CI: 1.07–2.65). Lower awareness and treatment were associated with being younger, higher education, and those from workplace without affiliated hospital. Higher occupation status individuals were more likely to be treated but no sign of better control. There is substantial room for improvement in hypertension diagnosis and treatment among the employees. Effective intervention programs are urgently needed at the workplaces.