Hypertension in Alaska natives: Association with overweight,glucose intolerance,diet and mechanized activity

Objective. Determine the prevalence of hypertension in Alaska Natives and evaluate risk factors.

Design. Population‐based univariate and multivariate analysis of blood pressure in 1124 Alaska Natives over 20 years of age.

Results. The sample had mean: age 45 years, body mass index 27, systolic pressure 123 mmHg and diastolic pressure 73 mmHg. The age‐adjusted rate of hypertension ≥ 160/95 mmHg was 9.1% and 6.8% among Athabascan Indians and Yup'ik Eskimos, respectively. After controlling for age and sex there was significantly more hypertension among Athabascan Indians (OR=1.53, CI = 1.07–2.2, p = 0.019) compared to Yup'ik Eskimos. Race was significantly associated with blood pressure 3 ≥ 140/90 when controlled for age and overweight (p = 0.07, OR = 0.78, CI = 0.69–0.95). The presence of hypertension was significantly associated with the following: intake of non‐indigenous food (p = 0.01); mechanized activities (p = 0.01); and glucose intolerance in both women (p = 0.043) and men (p = 0.001). Multiple regression analysis revealed age (OR = 1.06, CI= 1.05–1.08) and overweight in both men (OR = 3.02, Cl= 1.85–4.93) and women (OR = 2.76, CI= 1.81–4.19) to be significantly associated with BP ≥ 140/ 90.

Conclusion. Hypertension is no longer rare in Alaska Natives and is associated with overweight, non‐indigenous diet, mechanized activities, and glucose intolerance.     

Hypertension prevalence and age-related changes of blood-pressure in semi-nomadic and urban Oromos of Ethiopia

We evaluated the prevalence of hypertension and the age-related behaviour of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in a wide sample of male and female Ethiopian Oromos living in rural or pre-industrial urbanized settings. Blood pressure (BP) was measured in the sitting position after 5 min rest in 5277 Oromos. In the group, 4928 were semi-nomadic shepherds, while 349 came from a town of 60,000 inhabitants where they were involved in low-technology jobs. The first subgroup was composed of 2482 men and 2446 women. All subjects were divided into 3 age groups: 15–44, 45–64, and 65 years. Body weight (BW) and the Quetelet index (QI) were matched to BP levels using Pearson's method. In semi-nomadic men, SBP was 121.4±8.4 mmHg versus 132.4±10.4 mmHg in urban men (p<0.001). In women, SBP was 120.5±7.9 mmHg versus 128.1±10.1 mmHg (p<0.001). The prevalence of hypertension was 0.40% in the semi-nomadic and 3.15% in the urban population. In the latter, significant increases in BW and QI were found, which were significantly correlated to both SBP and DBP. In semi-nomadic men, a 5.33% increase in SBP and a 5.22% in DBP was found between age groups 1 and 2 (p<0.001 in both). In urban men the increase was 4.77% and 3.41% respectively (p<0.001). In both male populations no difference in SBP and DBP was observed between age groups 2 and 3. In semi-nomadic women however, a progressive rise in SBP (4.84% between age groups 1 and 2,p<0.001; 1.86% between groups 2 and 3,p<0.001) and DBP (4.26% between age groups 1 and 2,p<0.001; 2.72% between groups 2 and 3,p<0.001) was present. Similar differences in SBP and DBP were evident between urban women of age groups 1 and 2. Due to social reasons, women for group 3 were not available in the urban setting. In conclusion, this study shows a very low prevalence of hypertension in a semi-nomadic group and about an 8-fold increase in the urban population. SBP and DBP are significantly higher in the urban setting and in both men and women the increase is related to BW. Moreover, SBP and DBP progressively increase with age in women but not in men.     

Serum 25-hydroxyvitamin D3, parathyroid hormone and blood pressure in an elderly cohort from Germany: a cross-sectional study

Background

Although several studies indicate a link between vitamin D status and blood pressure (BP), the results are inconsistent. The purpose of this study is to investigate whether in predominantly non-obese elderly people without vitamin D deficiency or very high intact parathyroid hormone (iPTH) levels serum 25-hydroxyvitamin D₃ [25(OH)D₃] and iPTH are independently associated with BP.

Methods

Cross-sectional data of 132 non-institutionalised subjects (90 women and 42 men, aged 66- 96 years) from Giessen, Germany, were analysed. Serum 25(OH)D₃ and iPTH were measured by an electrochemiluminescence immunoassay and BP was determined with a sphygmomanometer. We performed univariate and multiple regression analyses to examine the influence of 25(OH)D₃ and iPTH on BP with adjustments for age, body composition and lifestyle factors.

Results

While iPTH had no impact on BP, 25(OH)D₃ was negatively associated with systolic BP in men, but not in women. After splitting the cohort into antihypertensive medication users and non-users, 25(OH)D₃ was a significant predictor for systolic and diastolic BP only in men not receiving antihypertensive medicine, even after multiple adjustment. Adjustment for 25(OH)D₃ resulted in an inverse association of iPTH with diastolic BP also only in men without intake of antihypertensive medicine.

Conclusions

In elderly men without vitamin D deficiency and not taking antihypertensive medicine, 25(OH)D₃ may be a negative determinant of BP, independent of iPTH, body composition and lifestyle factors. Furthermore, iPTH may be an independent negative determinant of diastolic BP in men not taking antihypertensive medicine.     

Age-, sex-, and diagnosis-specific incidence rate of medically certified long-term sick leave among private sector employees: The Japan Epidemiology Collaboration on Occupational Health (J-ECOH) study

Background

Long-term sick-leave is a major public health problem, but data on its incidence in Japan are scarce. We aimed to present reference data for long-term sick-leave among private sector employees in Japan.

Age-Stratified Analysis of the Impact of Hypertension on National Health Insurance Medical Expenditures in Ibaraki,Japan

Background

This retrospective cohort study examined the sex- and age-specific impact of hypertension on medical expenditures.

Methods

In 2006, we analyzed the medical expenditure records of 42 426 Japanese National Health Insurance beneficiaries (16 169 men, 26 257 women) who lived in Ibaraki, Japan, were aged 40 to 69 years, and underwent health checkups in 2002. Blood pressure was classified into 4 categories according to the criteria outlined in the seventh report of the Joint National Committee.

Results

The difference in median total expenditure between the hypertension categories and the normotension category was 119 585 yen (140 360 yen vs 20 775 yen) for men aged 40 to 54 years, 126 160 yen (204 070 yen vs 77 910 yen) for men aged 55 to 69 years, 125 495 yen (158 025 yen vs 32 530 yen) for women aged 40 to 54 years, and 122 370 yen (208 700 yen vs 86 330 yen) for women aged 55 to 69 years. The median total and outpatient medical expenditures markedly differed between patients with stage 1 hypertension and stage 2 hypertension (which included people on antihypertensive medication) in both sexes and all age subgroups. The median total and outpatient medical expenditures were higher among women than among men in all blood pressure categories.

Conclusions

The impact of hypertension on medical expenditures was similar in all age groups. Therefore, from the perspective of medical economics, prevention of the onset of hypertension seems equally important for all age subgroups.Key words: hypertension, medical expenditure, health expenditure, age groups     

Managing Hypertension in the Elderly: A Common Chronic Disease with Increasing Age

Background

Hypertension increases with age, affecting approximately 66% of the elderly population (aged ≥65 years). By the year 2030, 1 of 5 Americans will be aged ≥65 years. A number of placebo-controlled clinical trials have demonstrated that blood pressure (BP) control reduces cardiovascular events in elderly patients, even in those aged >80 years. Despite advances in medical care, hypertension control rates remain low, especially in the elderly population.

Objective

The goal of this article is to review the information that addresses hypertension in the elderly and current strategies that can facilitate improvement in the management of this common, chronic, and life-threatening condition, which is often undertreated or inappropriately managed.

Discussion

The goals and strategies of treating hypertension in the elderly population are different from, and more challenging than, those in younger patients. Lifestyle modification is effective in this population, but it is difficult to maintain. Many antihypertensive medications are available, with thiazide diuretics being the preferred first-line treatment. Beta-blockers and alpha-blockers are generally not recommended in this population. A majority of older patients will require 2 or 3 antihypertensive medications to reach BP goal. This article reviews current data on hypertensive treatment in the elderly and summarizes the strategies and challenges healthcare providers face when dealing with this population.

Conclusion

Understanding the strategies and challenges that apply to the management of hypertension in the US elderly population can help providers and payers better address the growing need for improving the management of this condition in the elderly, because their numbers are expected to increase dramatically in the coming decades.Hypertension, defined as systolic blood pressure (BP) ≥140 mm Hg, diastolic BP ≥90 mm Hg, increases with age, affecting more than 50% of patients aged ≥60 years, and approximately 66% of those aged ≥65 years.1–3 It is well known that by 2030, 1 of 5 Americans is expected to be 65 years or older. Hypertension is the number one diagnosis in the ambulatory setting, and is one of the top diagnoses in the nursing home.4 Data from the Framingham Heart Study suggest that patients who are normotensive at age 55 years have a 90% lifetime risk of developing hypertension.5Between 1988–1994 and 2005–2008, the prevalence of hypertension increased among patients aged ≥65 years.6 The use of antihypertensive medications also increased during that period.6 As life expectancy continues to rise, approaching 75 years for men and 80 years for women, the use of antihypertensive medications in the elderly will intensify.6 Approximately 10% of the current US total annual drug expenditure is spent on antihypertensive medications.7 In 2009, the total direct and indirect costs attributable to hypertension in the United States were estimated to be $73.4 billion.8     

Hypertension and combinations of cardiovascular risk factors. An epidemiologic case-control study in an adult population in Guadeloupe (FWI)

Our aim was to quantify the association between hypertension and four well-known cardiovascular risk factors (obesity, dyslipidemia, high blood glucose, smoking) and to determine the extent of their combinations in hypertensive subjects in an adult population in Guadeloupe (FWI). A case–control study was conducted in 1999. Odds ratios (ORs) and 95% confidence interval (95% CI) of hypertension according to cardiovascular risk factors were calculated by a logistic regression model. In all, 4210 subjects were included in the study: 2105 hypertensives and 2105 age and sex matched non-hypertensive controls. In the hypertensives, obesity (30%) was the most frequent risk factor followed by dyslipidemia (23.2%), current smoking (11.5%) and high blood glucose (8.2%). But, prevalence of current smokers was higher in normotensives (13.9 vs. 11.5%, p < 0.01). Among cases, 44.5% had no risk factor other than hypertension. The proportion of subjects with multiple risks factors (2) was higher in hypertensives than in controls (55.5 vs. 6.5%, p < 0.001) and higher in women than in men in cases (58.1 vs. 51.8%, p = 0.005). The adjusted ORs (95% CI) of hypertension were 2.41 (2.02–2.88) for obesity, 1.39 (1.16–1.66) for dyslipidemia and 1.67 (1.20–2.32) for high blood glucose. Our study documents the high prevalence of combinations of cardiovascular risk factors in hypertensive subjects in Guadeloupe and confirms the need of a global risk approach in prevention and treatment of hypertension.     

Blood and Urine Cadmium,Blood Pressure,and Hypertension: A Systematic Review and Meta-analysis

Background

Cadmium exposure has been inconsistently related to blood pressure.

Objectives

We updated and reevaluated the evidence regarding the relationships of blood cadmium (BCd) and urine cadmium (UCd) with blood pressure (BP) and hypertension (HTN) in nonoccupationally exposed populations.

Data sources and extraction

We searched PubMed and Web of Science for articles on BCd or UCd and BP or HTN in nonoccupationally exposed populations and extracted information from studies that provided sufficient data on population, smoking status, exposure, outcomes, and design.

Data synthesis

Twelve articles met inclusion criteria: eight provided data adequate for comparison, and five reported enough data for meta-analysis. Individual studies reported significant positive associations between BCd and systolic BP (SBP) among nonsmoking women [β = 3.14 mmHg per 1 μg/L untransformed BCd; 95% confidence interval (CI), 0.14–6.14] and among premenopausal women (β = 4.83 mmHg per 1 nmol/L log-transformed BCd; 95% CI, 0.17–9.49), and between BCd and diastolic BP (DBP) among women (β = 1.78 mmHg comparing BCd in the 90th and 10th percentiles; 95% CI, 0.64–2.92) and among premenopausal women (β = 3.84 mmHg per 1 nmol/L log-transformed BCd; 95% CI, 0.86–6.82). Three meta-analyses, each of three studies, showed positive associations between BCd and SBP (p = 0.006) and DBP (p < 0.001) among women, with minimal heterogeneity (I² = 3%), and a significant inverse association between UCd and HTN among men and women, with substantial heterogeneity (I² = 80%).

Conclusion

Our results suggest a positive association between BCd and BP among women; the results, however, are inconclusive because of the limited number of representative population-based studies of never-smokers. Associations between UCd and HTN suggest inverse relationships, but inconsistent outcome definitions limit interpretation. We believe a longitudinal study is merited.     

Serum uric acid and risk for development of hypertension and impaired fasting glucose or Type II diabetes in Japanese male office workers

We examined the association of serum uric acid (SUA) with development of hypertension (blood pressure 140/90 mmHg and/or medication for hypertension) and impaired fasting glucose (IFG) (a fasting plasma glucose level 6.1–6.9 mmol/l) or Type II (non-insulin-dependent) diabetes (a fasting plasma glucose level 7.0 mmol/l and/or medication for diabetes) over a 6-year follow-up among 2310 Japanese male office workers aged 35–59 years who did not have hypertension, IFG, Type II diabetes, or past history of cardiovascular disease at study entry. After controlling for potential predictors of hypertension and diabetes, the relative risk for hypertension compared with quintile 1 of SUA level was 1.27 [95% confidence interval (CI): 1.00–1.62] for quintile 2, 1.34 (95% CI: 1.08–1.74) for quintile 3, 1.48 (95% CI: 1.18–1.89) for quintile 4, and 1.58 (95% CI: 1.26–1.99) for quintile 5 (p for trend <0.001). The respective multivariate-adjusted relative risks for IFG or Type II diabetes compared with quintile 1 of SUA level were 1.55 (95% CI: 0.95–2.63), 1.62 (95% CI: 0.98–2.67), 1.61 (95% CI: 1.01–2.58), and 1.78 (95% CI: 1.11–2.85) (p for trend = 0.030). The association between SUA level and risk for hypertension and IFG or Type II diabetes was stronger among men with a body mass index (BMI) <24.2 kg/m² than among men with a BMI 24.2 kg/m², although the absolute risk was greater in more obese men. These results indicate that SUA level is closely associated with an increased risk for hypertension and IFG or Type II diabetes.     

Prevalence, awareness, treatment, and control of hypertension in Japanese rural communities]

BACKGROUND: In Japan, a national survey indicated that only 7% of hypertensive patients had a blood pressure less than 140/90 mmHg. There have been no reports of studies investigating all of the prevalence of hypertension, the percentage of subjects who are aware of hypertension, the percentage being treated, and the percentage that are well-controlled (awareness, treatment and control, respectively) among hypertensives in the Japanese general population. OBJECTIVE: To investigate the prevalence of hypertension, and awareness, treatment and control of hypertension among hypertensives in a Japanese rural population. DESIGN: A cross-sectional analysis of base-line data of the Jichi Medical School Cohort Study. SETTING: Twelve rural communities is 8 prefectures in Japan. PARTICIPANTS: Community-dwelling people who participated in the health examination program in 1992-1995. MAIN OUTCOME MEASURES: Blood pressure (BP) measured once in the sitting position after a 5-minute rest using oscillometric automatic BP monitors (BP203RV-II; Nippon Colin, Japan), and history of hypertension assessed using a self-administered questionnaire. RESULTS: We analyzed data from 11,302 subjects (4,415 men and 6,887 women). The mean (standard deviation) age was 55(12) years for men and 55(11) years for women. Mean systolic BP and diastolic BP levels were, respectively, 131(21) mmHg and 79(12) mmHg for men and 128(21) mmHg and 76(12) mmHg for women. Prevalence of hypertension (systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or on antihypertensive medication) was 37% for men and 33% for women. Percentages for awareness (on medication or present past history), treatment and control (both systolic BP < 140 mmHg and diastolic BP < 90 mmHg) were, respectively, 39%, 27% and 10% for men and 46%, 38% and 13% for women. CONCLUSIONS: About one third of the study popUlation were hypertensive, and awareness, treatment and control of hypertension among the hypertensives were 43%, 34% and 12%, respectively. Less than half of the hypertensives were well-controlled even when measurement bias was considered. In the rural Japanese population, improvements are required with regard to awareness, treatment and control of hypertension.     

Body composition, ethnicity and alcohol consumption as determinants for the development of blood pressure in a birth cohort of young middle-aged men

Aim: To investigate the development of blood pressure (BP) determinants over a period of 6 years in a birth cohort of middle-aged Swedish men. Methods: Men born 1953 and 1954 living in Helsingborg, Southern Sweden, were surveyed at 37, 40 and 43 years of age. Baseline participation rate was 68% (n = 991). S-Cholesterol, HDL-Cholesterol, systolic and diastolic blood pressure (SBP and DBP) and anthropomorphic measurements were collected and a questionnaire covering ethnicity, smoking, leisure time physical activity (LTPA) and alcohol consumption was completed. Results: At these surveys, SBP means were: 131, 132, 135 mm Hg and DBP were 83, 83 and 85 mm Hg respectively. Body mass index (BMI), waist hip ratio (WHR), S-Cholesterol and alcohol consumption consistently showed cross-sectional positive associations with SBP and DBP. One mmol/L higher S-Cholesterol at baseline predicted an increase in SBP by 1.16 mm Hg (confidence interval, CI: 0.25; 2.07) over 6 years. At age 40, there was a 4.4 mm Hg (p < 0.020) difference in SBP and a 2.64 mm Hg (p < 0.056) difference in DBP means between the low and high alcohol consumption. Corresponding differences at age 43 were SBP 5.28 mm Hg (p < 0.023) and DBP 5.4 mm Hg (p < 0.000). Men born in Sweden had a higher baseline SBP ( = 4 mm Hg, CI: 2.11; 6.35) and showed a higher 6 year increase in SBP (2.80 mm Hg CI: 0.07; 5.53) than men born abroad. Conclusions: Body composition, ethnicity and alcohol consumption are strong determinants for the development of BP. These findings have to be considered in strategies for primary prevention of hypertension in younger middle-aged men.     

Gender Differences in Hypertension Control Among Older Korean Adults: Korean Social Life,Health, and Aging Project

Objectives:

Controlling blood pressure is a key step in reducing cardiovascular mortality in older adults. Gender differences in patients’ attitudes after disease diagnosis and their management of the disease have been identified. However, it is unclear whether gender differences exist in hypertension management among older adults. We hypothesized that gender differences would exist among factors associated with hypertension diagnosis and control among community-dwelling, older adults.

Methods:

This cross-sectional study analyzed data from 653 Koreans aged ≥60 years who participated in the Korean Social Life, Health, and Aging Project. Multiple logistic regression was used to compare several variables between undiagnosed and diagnosed hypertension, and between uncontrolled and controlled hypertension.

Results:

Diabetes was more prevalent in men and women who had uncontrolled hypertension than those with controlled hypertension or undiagnosed hypertension. High body mass index was significantly associated with uncontrolled hypertension only in men. Multiple logistic regression analysis indicated that in women, awareness of one’s blood pressure level (odds ratio [OR], 2.86; p=0.003) and the number of blood pressure checkups over the previous year (OR, 1.06; p=0.011) might influence the likelihood of being diagnosed with hypertension. More highly educated women were more likely to have controlled hypertension than non-educated women (OR, 5.23; p=0.013).

Conclusions:

This study suggests that gender differences exist among factors associated with hypertension diagnosis and control in the study population of community-dwelling, older adults. Education-based health promotion strategies for hypertension control might be more effective in elderly women than in elderly men. Gender-specific approaches may be required to effectively control hypertension among older adults.     

Prevalence of obesity in an elderly Hungarian population

Background: There are few cross-sectional population-based studies on obesity in Hungary. Aim of this study was to characterize the prevalence, associated diseases and metabolic laboratory parameters for obesity in men and women in Budapest, Hungary. Methods: A random sample of 641 persons (307 males and 334 females) aged 50 years and over were recruited from a population register in Budapest. Subjects were interviewed, had height and weight measured in standard fashion. Those who were obese (BMI > 30.0 kg/m²) were matched individually with non-obese subjects. Altogether 101 pairs (48 women and 53 men pairs) were taking part and these subjects had blood taken for amount of serum glucose, lipids and uric acid. Results: The mean age of men and women was 65.0 (SD = 9.1) years and 64.6 (SD = 8.9) years, respectively. The prevalence of obesity was 18.1% in men and 15.4% in women (p < 0.05). In both sexes the mean body mass index was higher at age of 50–64 years than at older ages [in men 27.2 (SD = 3.7) kg/m² vs. 26.7 (SD = 3.3) kg/m², p = 0.286 and in women 26.7 (SD = 4.2) kg/m² vs. 25.4 (SD = 4.0) kg/m², p = 0.005]. Body mass index was higher in men than in women at all ages. In the case–control study the mean age of obese and non-obese individuals were 63.1 (SD = 7.8) years and 63.2 (SD = 7.9) years, respectively. Obesity was significantly associated with a history of diabetes mellitus (18 vs. 7%, p < 0.05) and hypertension (48 vs. 28%, p < 0.05). Compared to the non-obese, those who were obese had a higher level of serum uric acid (311 ± 102 vs. 280 ± 96mol/l, p < 0.05) and triglyceride (2.67± 1.95 vs. 1.86 ± 0.95 mmol/l, p < 0.05). Conclusion: The high prevalence of obesity both in elderly men and women and its strong association with chronic diseases causes economical and social burden for Hungary. Strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.     

Gender differences among homeless people in Tehran,Iran

Aim

Gender differences among homeless people may affect the frequency of their risky behaviours. This study was conducted to evaluate the behaviour patterns of homeless men and women in Tehran and compare the probable differences.

Subject and methods

In this study, 593 homeless people were recruited from five centres that house homeless people in Tehran, the capital city of Iran. A researcher-designed questionnaire was used to study behavioural patterns.

Results

In this study, homeless people (513 males and 80 females, all Iranian nationals) were enrolled in the study from June to August 2012. Mean age and mean duration of homelessness among women (35.46 and 12.68 months) were lower than those among men (42.74 and 56.85 months) (p?=?0.001). Although lifetime history of incarceration in men was higher than in women (p?=?0.002), mean duration of imprisonment in the last 10 years in men (21.25 months) and women (17.76 months) was not statistically different (p?=?0.07). Accommodation locality in the past 6 months varied between men and women. Women were current drug users more often than men were (61.53 % versus 45.26 %) (p?=?0.02). The type of drug consumption in women (methamphetamine) differed from that of men (opium and heroin). More men had a history of injecting drugs than did women (30.02 % versus 12.30 %) (p?=?0.003). Condom use at the last sexual encounter was reported to be higher in women compared to men (74.60 % versus 26.62 %) (p?=?0.001).

Conclusion

This study showed notable differences in behaviour patterns between homeless men and women and also indicated that homeless people in Tehran exhibit many risky behaviours.     

Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy

Background

Albuminuria and glomerular filtration rate (GFR), two factors linked to kidney and vascular function, may influence longitudinal blood pressure (BP) responses to complex antihypertensive drug regimens.

Methods

We reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.

Results

Mean patient age was 57-years, 89% of patients were African American, and 69% were women. Mean patient systolic/diastolic BP (SBP/DBP) at baseline was 171/98 mmHg while taking an average of 3.3 antihypertensive medications. At baseline, 27% of patients had estimated (e)GFR <60 ml/min/1.73², 28% had micro-albuminuria (30–300 mg/g) and 16% had macro-albuminuria (>300 mg/g). The average longitudinal BP decline over the observation period (mean 7.2 visits) was 25/12 mmHg. In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73² predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001). Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.

Conclusions

These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.     

Distribution of and factors contributing to chronic kidney disease in a middle-aged working population

Objectives

To clarify the distribution of chronic kidney disease (CKD) and the factors contributing to its development and progression in middle-aged Japanese workers/employees.

Methods

This was a retrospective study involving 3,964 men and 2,698 women aged 35–64 years in 2009 who had been followed-up until 2003. Data on proteinuria determined with a dipstick and glomerular filtration rate estimated from serum creatinine concentration (eGFR) were collected in the annual health check-ups.

Results

Proteinuria was detected in 2.9 and 1.1 % of the men and women, respectively, and total CKD was detected in 16.0 and 16.1 % of the men and women respectively. Moderate or severe CKD associated a high risk of cardiovascular diseases and end-stage kidney disease was found mostly in the male subjects [2.0 (men) vs. 0.6 % (women)]. High-risk CKD was found in 3.3 % of the men aged 55–64 years. A body mass index (BMI) of ≥30, hypertension, diabetes mellitus (DM), current smoking and some job types were independently related to the development of proteinuria, while age, BMI, hypertriglyceridemia, and job types were related to total CKD. The development of high-risk CKD was related to preceding mild CKD signs of reduced eGFR and proteinuria as well as to hypertension, DM, smoking, and job type.

Conclusions

Chronic kidney disease was found in 16 % of middle-aged workers with an equal prevalence in both sexes, while high-risk CKD was found mostly in men, of whom 3.3 % were aged 55–64 years. Obesity, hypertension, DM, smoking and some job types were related to the development and progression of CKD.     

Screening for gestational diabetes mellitus in northeastern Turkey (Trabzon City)

Objective: The purposes of this study were to determine the prevalence of gestational diabetes mellitus (GDM) in Trabzon city of Turkey and to identify appropriate risk factors for gestational diabetes in pregnant mothers. Research design and methods: Eight hundred and seven adult pregnant women were screened for GDM with a 1-hour, 50 g oral glucose challenge test (GCT). Three-hour, 100 g oral glucose tolerance tests (GTTs) were performed on screen-positive women. Results: Of the 807 pregnancies screened, 59 (7.3%) had an initial oral GCT result of 140 mg/dl. Diagnostic testing with the oral GTT was performed on the 59 screen-positive gravid women. Of those tested, 10 were diagnosed with GDM on the basis of greater 2 criteria over 3 hours, for a prevalence of 1.23%. Significant associations were found between age, body mass index (BMI) and GDM positivity (p < 0.01 and p < 0.05; respectively). The prevalence of GDM was associated with diastolic blood pressure (DBP) and weeks' gestation (p < 0.05). There was no significant association between increased BMI, systolic blood pressure, number of pregnancies and GDM positivity. In addition, the birth weights of the babies born to mothers with GDM were significantly higher than those of the non-diabetic healthy mothers' babies (p < 0.001). Conclusions: The prevalence of GDM in a Turkish population was low. The prevalence of GDM showed an increase with the ages of pregnant women, gestational age and DBP. This study demonstrates that the universal screening for GDM is not mandatory in our pregnant population. The cost of universal screening may be prohibitive in our population. Large prospective studies are needed to better analyze outcome data and efficacy of screening in adult pregnancies.     

Magnitude of Hypotension Based on Office and Ambulatory Blood Pressure Monitoring: Results From a Cohort of 5066 Treated Hypertensive Patients Aged 80 Years and Older

Background and objective

Elderly patients can be particularly susceptible to the adverse effects of excessive blood pressure (BP) lowering by antihypertensive treatment. The identification of hypotension is thus especially important. Ambulatory BP monitoring (ABPM) is a more accurate technique than office for classifying BP status. This study examined the prevalence of hypotension and associated demographic and clinical factors among very old treated hypertensive patients undergoing ABPM.

Relationship between hyperuricemia and other cardiovascular disease risk factors among adult males in Taiwan

Hyperuricemia is associated with cardiovascular disease risk factors such as obesity, impaired glucose tolerance, hypertension, and hyperlipidemia. However, this relationship between serum uric acid (SUA) concentrations and cardiovascular disease (CVD) is a controversial one, especially among males. The purpose of this study is to evaluate the association between SUA concentrations and other CVD risk factors among adult males in Taiwan. After multi-stage sampling procedures, we randomly selected 1743 Taiwanese males with a mean age of 35 years (from 22 to 54) in this study. Anthropometric, blood pressure and biochemical variables, including serum uric acid, glucose, total cholesterol and triglyceride concentrations, were measured. Among the study population, the mean SUA concentration was 6.5 ± 1.5 mg/dl. There were 290 (16.6%) subjects with SUA concentrations 8.0 mg/dl (defined as hyperuricemia). Compared to normouricemic subjects, hyperuricemic subjects had significantly greater age-adjusted body weight (75.3 vs. 69.2 kg, p < 0.001), body mass index (BMI, 25.5 vs. 23.6 kg/m², p < 0.001), higher blood pressure (BP, 120.2 vs. 115.2 mmHg for systolic BP and 78.5 vs. 75.3 mmHg for diastolic BP, both p < 0.001) and blood lipid concentrations (193.8 vs. 182.1 mg/dl for total cholesterol and 123.7 vs. 94.4 mg/dl for triglycerides, both p < 0.001). SUA concentration was positively correlated with body weight, BMI, BP and serum lipid concentrations (all p < 0.001). In multivariate regression analyses, after adjusting for potential confounders, SUA concentration was significantly positively associated with diastolic BP, serum total cholesterol and triglyceride concentrations. An increase of 1 mg/dl of SUA was associated with a 2.1 mg/dl elevation in serum total cholesterol (p < 0.001) and a 5.4 mg/dl increase in triglyceride (p < 0.001). From this study, we found that hyperuricemia in subjects is associated with being overweight, and having high blood pressure and hyperlipidemia. There is a significantly positive association between SUA concentration and other CVD risk factors among adult males in Taiwan.