Predictors of hypertension in an urban Indian population

BACKGROUND, Several studies have reported that the increased risk of hypertension is mainly due to alcohol intake, lack of physical activity, nutritional factors like high fat intake, anthropometric parameters like body weight and waist-to-hip ratio, and metabolic disorders like diabetes mellitus. However, the extensive review of literature suggests that in different parts of the world, the predictive risk factors are associated with risk of hypertension in different combinations.The main objectives of this study were to determine the predictors of hypertension in an urban population of India, using the variables depicting lifestyle, nutrition, and environment. METHODS AND RESULTS, Secondary data collected through a cross-sectional survey in a population proportionate sample were analyzed. Sample size was calculated using prevalence of one of the predictors (obesity) from previous studies.Subjects aged between 15 and 54 years, residing in New Delhi for at least one year were included in the study (n = 494). The WHO STEPS instrument for noncommunicable disease risk factors (Core and Expanded version 1.2) was used for data col-lection.Bivariate logistic regression analysis showed that hypertensive individuals were twice more likely to be male, of significantly higher age, and more likely, had received college education.The full model of logistic regression analysis showed that sex, age, education, weight, and pulse rate were significant predictors of hypertension. CONCLUSION, The most parsimonious regression model included age, sex, educational status, body mass index, physical inactivity, and hip girth as predictors of hypertension. Risk of hypertension may be predicted early in a population by suitable screening procedures.     

The impact of changes in population blood pressure on hypertension prevalence and control in China

In China, there are approximately 250 million adults who have hypertension with low rates of awareness, treatment and control. Changes in lifestyles at a population level have the potential to enhance or deteriorate the prevention and control of hypertension. We used data from a regional hypertension survey to examine the impact of 2/1 mm Hg decreases or increases in population blood pressure on hypertension prevalence, and rates of unawareness of the hypertension diagnosis, treatment, and control. The primary analysis was based on the average blood pressure of respondents from three visits and a diagnostic threshold of 140/90 mm Hg for hypertension. Secondary analyses examined average blood pressure from the first survey visit and also a diagnostic threshold of 130/80 mm Hg for hypertension. The baseline hypertension prevalence was 33.4%, and rates of unawareness of the hypertension diagnosis, treatment, and control were 74.2%, 25.8%, and 9.7%, respectively. Decreases or increases in blood pressure by 10/5 mm Hg resulted in changes in hypertension prevalence (22.1% vs 53.4%) and rates of unawareness of the diagnosis (60.9% vs 83.8%), treatment (39.1% vs 16.2%), and control (21.2% vs 3.6%), respectively. Similar trends were seen in the secondary analyses. Population changes in lifestyle could have a very large impact on the prevalence and control of hypertension in China. The results support implementation of programs to improve population lifestyles while implementing health services policies to enhance the clinical management of hypertension.     

Distribution of blood pressure levels and prevalence of hypertension among adult population of Tomsk

Cross-sectional study of distribution of blood pressure levels and prevalence of hypertension among adult 25-64 year old nonorganized population of Tomsk revealed unfavorable epidemiological situation and stressed necessity of implementation of populational strategy of prevention of hypertension.     

Arthritis beliefs and self-care in an urban American Indian population

OBJECTIVE: To describe beliefs and self-care strategies of American Indians with chronic arthritis joint pain. METHOD: In-depth interviews were conducted with a convenience sample of urban-dwelling American Indians (n = 56) concerning self-care and beliefs about arthritis; objective measures of arthritis disease activity were obtained through standardized interview protocols. RESULTS: Joint pain was not generally assumed to be arthritis nor directly related to aging. Belief that chronic pain affecting multiple joints was a serious and unexpected condition oriented American Indians' decisions to seek medical attention. However, verbal communications about pain may be subtle or under emphasized. Few coping strategies were used to control either chronic or episodic pain. CONCLUSIONS: Chronic arthritis pain may not be optimally managed in this population. Cultural assessment should recognize that American Indian patients may understate serious symptoms. Community educational interventions should target this population to enhance self-care, pain management, and communication of arthritis symptoms to physicians.     

Prevalence of metabolic syndrome in an Indian urban population

OBJECTIVES: To determine prevalence of the metabolic syndrome using United States Adult Treatment Panel-3 (ATP-3) guidelines in an urban Indian population. METHODS: Randomly selected adults >20 years were studied using stratified sampling. Target study sample was 1800 with population proportionate distribution (men 960, women 840). Evaluation of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Subjects (1123; response 62.4%) were examined, fasting blood samples were available in 1091 (532 men, 559 women) and analysed for prevalence of metabolic syndrome. Atherosclerosis risk factors were determined using the current guidelines. Metabolic syndrome was diagnosed when any three of the following were present: central obesity, raised triglycerides >/=150 mg/dl (>/=1.7 mmol/l), low high-density lipoprotein (HDL) cholesterol, blood pressure >/=130/>/=85 mm Hg, and diabetes or fasting glucose >110 mg/dl (>6.1 mmol/l). Intergroup comparisons were performed using t-test or chi-square test. RESULTS: Metabolic syndrome was present in 345 (31.6%) subjects; prevalence was 122 (22.9%) in men and 223 (39.9%) in women (p<0.001); the age-adjusted prevalence was 24.9%, 18.4% in men and 30.9% in women. There was a significant age-related increase in its prevalence (Mantel-Haenzel chi(2) for trend p<0.05). Prevalence of components of metabolic syndrome in men and women was: central obesity (waist, men >102 cm, women >88 cm) in 116 (25.6%) and 246 (44.0%); low HDL cholesterol (men<40 mg/dl, <1.0 mmol/l), women<50 mg/dl, <1.3 mmol/l) in 292 (54.9%) and 504 (90.2%); high triglycerides >/=150 mg/dl (>/=1.7 mmol/l) in 172 (32.3%) and 160 (28.6%); and impaired fasting glucose or diabetes in 90 (16.9%) and 90 (16.1%). The prevalence of physical inactivity, hypertension, hypercholesterolemia (>/=200 mg/dl, >/=5.2 mmol/l) and high LDL cholesterol (>/=130 mg/dl, >/=3.4 mmol/l) was greater in the metabolic syndrome group in both men and women (p<0.05). CONCLUSIONS: There is a high prevalence of metabolic syndrome in an urban Indian population. Focus of cardiovascular prevention should be at this high-risk group.     

Rising prevalence of NIDDM in an urban population in India

Summary A survey conducted in 1988–1989, in the city of Madras, South India, showed that the prevalence of diabetes mellitus in adults was 8.2 % and prevalence of impaired glucose tolerance (IGT) was 8.7 %. The present survey was another cross-sectional study conducted 5 years later in the same urban area to study the temporal changes in the prevalence of diabetes and IGT. The two sample populations surveyed were similar in age structure and socioeconomic factors. In the second survey in 1994–1995, a total of 2183 subjects, 1081 men and 1102 women, with a mean age of 40 ± 12 years were tested by an oral glucose tolerance test; fasting and 2-h post-glucose plasma glucose were measured. Anthropometric measurements, details of physical activity and clinical history of diabetes were recorded. Age-standardised prevalence of diabetes had increased to 11.6 % from 8.2 % in 1989 and IGT was 9.1 %, similar to 8.7 % in 1989. Multiple regression analysis showed age, waist : hip ratio, body mass index (BMI) and female sex were correlated to diabetes. Family history of diabetes showed interaction with age and BMI. Prevalence of IGT correlated to age, BMI and waist : hip ratio. This study highlights the rising trend in the prevalence of non-insulin-dependent diabetes (NIDDM) in urban Indians. The persistent high prevalence of IGT may also be a predictor of a further increase in NIDDM in the future. No significant differences in the anthropometric data were noted in this compared to the previous study. [Diabetologia (1997) 40: 232–237] Received: 24 April 1996 and in final revised form: 31 October 1996     

High prevalence of giardiasis in an urban population in Niger

A sample of 2569 persons (1190 m, 1379 f) from Niamey (population 329,000), Niger, showed a giardiasis prevalence of 28.5%. The prevalence was similar between males and females and highest in the age range 3-29 years.     

Ethnic differences in blood pressure and the prevalence of hypertension in England

The objective of this study was to examine the prevalence of hypertension and mean blood pressures among Afro-Caribbeans and South-Asians in England compared with Caucasians. Data from the Birmingham Factory Screen, Birmingham INTERSALT volunteers, and four West Midlands churches were combined into a single database (n = 2853), since all three studies employed identical methods. The cohort comprised 2169 (76%) Caucasians (71% men); 453 (16%) Afro-Caribbean (60% men); and 231 (8%) South-Asian men. The results were that overall prevalence of hypertension (> or =160/95 mm Hg or taking antihypertensives) was greater in both Afro-Caribbean men (31%) and women (34%) (both P < 0.001), compared with Caucasians (19% and 13% respectively), while South-Asian men had a similar overall prevalence to Caucasians (16%). Compared with Caucasians, Afro-Caribbeans had significantly higher mean systolic blood pressure, with higher mean diastolic blood pressures evident among Afro-Caribbean women. After adjustment for age, body mass index, smoking, and weekly alcohol intake, the odds ratios (95% CI) for being hypertensive were 1.56 (1.14 to 2.13; P = 0.005) and 2.40 (1.51 to 3.81; P = 0.0002) for Afro-Caribbean men and women, respectively and 1.31 (0.88 to 1.97; P = 0.19) for South-Asian men, compared with Caucasians. In conclusion the prevalence of hypertension and mean blood pressures are higher among Afro-Caribbeans compared with Caucasians. South-Asian men had similar rates of hypertension and mean blood pressures to Caucasians.     

Isolated systolic hypertension in an elderly Danish population. Prevalence and daytime ambulatory blood pressure

Isolated systolic hypertension (ISH) is a major risk factor for cardiovascular complications. Nevertheless, data on the prevalence in a representative population do not seem to be available. The prevalence of ISH and the white coat effect was thus studied in a cross-sectional survey of 2806 inhabitants aged 70-80 years. In untreated subjects, the prevalence of ISH was 17.4% (95% CI 14.9-20.2) in women and 13.5% (95% CI 11.3-15.9) in men using clinic blood pressure at first visit. The prevalence increased significantly with age. The prevalence was reduced to 10.4% when using the average of all-visits clinic blood pressures. By a simulation model, it was demonstrated that his reduction mainly resulted from a regression towards the mean. Average all-visits clinic blood pressure was 172.6 ±10.4/81.1±6.0 mmHg. Less than one-third of those with all-visit ISH had sustained ISH. Identifying subjects with sustained ISH requires measurements in more than three visits.     

Severe inpatient hypertension prevalence and blood pressure response to antihypertensive treatment

Severe hypertension (HTN) that develops during hospitalization is more common than admission for HTN; however, it is poorly studied, and treatment guidelines are lacking. Our goal is to characterize hospitalized patients who develop severe HTN and assess blood pressure (BP) response to treatment. This is a multi‐hospital retrospective cohort study of adults admitted for reasons other than HTN who developed severe HTN. The authors defined severe inpatient HTN as the first documented BP elevation (systolic BP > 180 or diastolic BP > 110) at least 1 hour after admission. Treatment was defined as receiving antihypertensives (intravenous [IV] or oral) within 6h of BP elevation. As a measure of possible overtreatment, the authors studied the association between treatment and time to mean arterial pressure (MAP) drop ≥ 30% using the Cox proportional hazards model. Among 224 265 hospitalized adults, 10% developed severe HTN of which 40% were treated. Compared to patients who did not develop severe HTN, those who did were older, more commonly women and black, and had more comorbidities. Incident MAP drop ≥ 30% among treated and untreated patients with severe HTN was 2.2 versus 5.7/1000 person‐hours. After adjustment, treated versus. untreated patients had lower rates of MAP drop ≥ 30% (hazard rate [HR]: 0.9 [0.8, 0.99]). However, those receiving only IV treatment versus untreated had greater rates of MAP drop ≥ 30% (1.4 [1.2, 1.7]). Overall, the authors found that clinically significant MAP drop is observed among inpatients with severe HTN irrespective of treatment, with greater rates observed among patients treated only with IV antihypertensives. Further research is needed to phenotype inpatients with severe HTN.     

Increased blood pressure variability in pheochromocytoma compared to essential hypertension patients

OBJECTIVE: Catecholamines are responsible for short and long-lasting blood pressure (BP) elevations in pheochromocytoma. We investigated whether in patients with pheochromocytoma this catecholamine excess would result in higher BP variability in comparison with patients suffering from essential hypertension (EH). DESIGN: We examined retrospectively 54 (26 treated with alpha1-blockers) patients with pheochromocytoma (30 patients also investigated after tumour removal) and 108 (42 treated with alpha1-blockers) patients with EH. They all underwent 24-h ambulatory BP monitoring. To assess the BP variability, coefficient of BP variability (SD of average BP/average BP) was used. RESULTS: In subjects with pheochromocytoma, a higher coefficient of BP variability was shown compared with EH during the 24-h period (0.12 +/- 0.03 versus 0.10 +/- 0.02, P = 0.003 for systolic BP in the treated group) and mainly during the daytime (0.11/0.13 +/- 0.04/0.03 versus 0.09/0.11 +/- 0.03/0.04, P = 0.007/0.06 for systolic/diastolic BP in the untreated group and 0.12/0.13 +/- 0.04/0.04 versus 0.09/0.12 +/- 0.04/0.02, P < 0.001/0.01 in the treated group). Tumour removal resulted in a decrease of the previously increased 24-h (0.11 +/- 0.03 versus 0.10 +/- 0.03, P = 0.04) and daytime (0.11 +/- 0.03 versus 0.09 +/- 0.03, P = 0.03) coefficient of systolic BP variation. Twenty-seven subjects with pheochromocytoma and inverted circadian BP rhythm (night-time BP > daytime BP) had a significantly higher 24-h (0.13 +/- 0.03 versus 0.10 +/- 0.03, P < 0.001 for systolic BP) and daytime coefficient of BP variation (0.13/0.15 +/- 0.04/0.03 versus 0.09/0.12 +/- 0.02/0.02, P < 0.001/<0.001) and also a higher occurrence of the isolated excretion of norepinephrine (14 versus seven subjects, P = 0.05) compared with the 27 subjects with pheochromocytoma without inverted circadian BP rhythm. CONCLUSION: The excess of catecholamines in patients with pheochromocytoma is associated with higher long-term BP variability in comparison with patients suffering from EH especially in subjects with inverted circadian BP rhythm. Tumour removal resulted in the amelioration of the previously increased BP variability.     

Hypertension in a black population: prevalence and biosocial determinants of high blood pressure in a group of urban Nigerians

AIMS: To define the prevalence of hypertension, a major cause of morbidity and mortality in blacks, and related biosocial factors in an urban African population group. METHODS: The setting was that of a civil service population in Ibadan, a major city in Southwestern Nigeria. Nine hundred and ninety-eight civil servants selected by multistage sampling participated in the survey. Biosocial data including smoking history, alcohol use and level of physical activity; anthropometry, blood pressure and plasma glucose measurements were obtained. Diagnosis of hypertension was based on blood pressure of > or =160/95 mm Hg or known hypertensive on treatment. RESULTS: The overall prevalence rate of hypertension was 10.3% (CI, 8.4%, 12.2%), rates of 13.9% and 5.3% were obtained in men and women respectively in spite of a much higher rate of generalised obesity in the latter. Hypertension was associated with higher salary grade level, but there was no relationship found with regular exercise, smoking and alcohol. Obesity (body mass index (BMI) > or =30 kg/m2) was associated with hypertension only in women. A two-sided t-test demonstrated age, waist circumference, waist to hip ratio (WHR) and plasma glucose level as significant variables. In multivariate ANOVA models of systolic blood pressures, age, male sex and BMI were highly significant factors (P < 0.0001) and plasma glucose was also significant (P < 0.016); the same variables (except plasma glucose) were associated with diastolic blood pressures. In logistic regression models the variables which predicted hypertension were WHR, plasma glucose, age, sex and family history of diabetes. CONCLUSIONS: Prevalence of hypertension in the study was comparable to recently reported rates in urban Nigeria and similar populations in Africa. The biosocial determinants of hypertension in the urban black population were age, male gender, higher socio-economic status, BMI, plasma glucose, generalised and central adiposity. Regional fat distribution was a stronger predictor of hypertension than generalised obesity in the population.     

Nighttime road-traffic noise and arterial hypertension in an urban population.

Commonly used daytime measurements in previous investigations on community noise and arterial hypertension (AH) may be a source of exposure bias, as urban residents spend most of their daytime hours out of the home on workdays. For this reason, we focused on the relation of nighttime noise and AH. A cross-sectional study was performed on a sample of 2,503 (995 men and 1,508 women) adult residents of a downtown Belgrade municipality. The inclusion criteria were a period of residence longer than 10 years and a bedroom oriented toward the street. The exclusion criteria were a high level of noise annoyance at work and diseases related to AH. Noise measurements were performed in all 70 streets of the municipality. The streets were grouped into noisy areas (equivalent noise level [Leq]>45 dB(A)) and quiet areas (Leq< or =45 dB(A)). The residents were interviewed in regard to antihypertensive therapy. Subjects who responded that they had not received such therapy were contacted for blood pressure measurements with mercury sphygmomanometer. Possible confounding factors: family history of AH, age, body mass index, smoking habits, physical activity and alcohol consumption were controlled for. The proportions of men with AH in the noisy and quiet areas were 23.6% and 17.5%, respectively. The adjusted odds ratio (OR) for AH was 1.58; the 95% confidence interval (CI) ranged from 1.03-2.42; and the probability value was 0.038, when men living in quiet streets were taken as a reference category. This relation was statistically insignificant for women: adjusted OR: 0.90; 95% CI: 0.59-1.38; p: 0.644. This cross-sectional study showed that nighttime urban road-traffic noise might be related to occurrence of AH in men.     

Arterial hypotension: prevalence of low blood pressure in the general population using ambulatory blood pressure monitoring

BACKGROUND: Chronic constitutional hypotension has been described in a proportion of the population, and has a symptom complex ascribed to it. The true prevalence of low blood pressure in the normal population has not been defined. AIM OF STUDY: This study was undertaken to determine the prevalence of low blood pressure states, as measured using ambulatory blood pressure monitoring, in a general population cohort, and to determine the association between low blood pressure and clinical and demographic variables. PATIENT POPULATION: The population enrolled were a cohort of mainly urban dwelling Irish subjects, either employees or spouses of employees of a major national bank. METHODS: Subjects had an ambulatory blood pressure monitor fitted between 09.00 and 12.00 and wore the monitor for 24 hours. The subjects also filled out a detailed lifestyle questionnaire, and kept an activity diary. Blood was drawn for serum electrolyte estimation. RESULTS: A total of 254 subjects were included, 49% of whom demonstrated hypotensive events. Hypotensive means and individual hypotensive values were more frequently found in women, and occurred in a group of individuals with a distinct body habitus, specifically thin subjects, with a lower creatinine suggesting a smaller muscle mass. Hypotensive events in these subjects were associated with a low risk cardiovascular profile, in that subjects who displayed these events had a lower blood pressure, a lower weight and were less likely to have a positive family history of hypertension or vascular disease. CONCLUSION: Hypotension is common in the general population and is associated with a distinct body habitus. It carries a generally benign cardiovascular risk factor profile.     

The prevalence of rheumatoid arthritis in an urban population of Izmir-Turkey

OBJECTIVE: To estimate the prevalence of rheumatoid arthritis (RA) in an urban area in Izmir, Turkey. METHODS: The study was conducted in the Balcova and Narlidere districts of Izmir and a total of 2,887 people aged 20 years or older were contacted with a 98.2% acceptance rate. Nine medical doctors administered an RA questionnaire by face-to-face interview. Subjects reporting a history of swelling in at least 2 joints lasting more than 4 continuous weeks or a history of a diagnosis of rheumatoid arthritis, inflammatory joint rheumatism or joint rheumatism were considered as screening positive and they were invited to come in for an examination. RA cases were defined by the 1987 American College of Rheumatology (ACR) criteria modifiedfor use in population studies. RESULTS: A total of 301 subjects (243 women, 58 men), or 10.6% of those who received the questionnaire were screening positive. 240 (79.7%) of these agreed to undergo a clinical examination either in the clinic or at home. Among these, 14 (12 female, 2 male) patients fulfilled the ACR criteria for RA. The prevalence of RA was 0.49% (95% CI 0.27-0.83) in the total population interviewed, 0.77% (95% CI 0.40-1.35) in women and 0.15% (95%CI 0.02-0.60) in men. The age- and sex-adjusted prevalence for the general population was estimated as 0.36%. Five of the 14 RA (36%) cases had not been diagnosed previously CONCLUSION: These data are consistent with the results of other Mediterranean countries. A significant proportion of RA cases remain undiagnosed in the community.