Prevalence,awareness, treatment and control of hypertension among adults 50 years and older in Dakar,Senegal

Background

Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Despite these facts, no study on the prevalence, awareness, treatment and control on arterial hypertension in Senegal has been conducted, specifically among elderly people.

Methods

Five hundred people aged 50 years and older, living in the city of Dakar were interviewed. This sample was constructed using the combined quota method in order to strive for representativeness of the target population.

Results

Prevalence of hypertension was 65.4% in our sample. Half of those suffering from high blood pressure were aware of their problem and among the latter, 70% said they were on treatment. However, of these, only 17% had controlled arterial blood pressure. The only factor associated with awareness, treatment and control of hypertension was the frequency of doctor visits.

Conclusion

Improving follow-up health checks of older adults are necessary to limit the consequences of hypertension in Dakar.     

Prevalence of cardiovascular risk factors in an urban area of Togo: a WHO STEPS-wise approach in Lome,Togo

Objective

To determine the prevalence of hypertension and other cardiovascular risk factors in the general adult population of Lome.

Methods

A cross-sectional household survey was conducted in Lome from October 2009 to January 2010, which focused on hypertension and other cardiovascular risk factors in 2 000 subjects 18 years and older. The World Health Organisation’s STEPS-wise approach on non-communicable diseases was used. During the first session, blood pressure (BP) was measured on three successive occasions, one minute apart, and the mean was recorded. A second measurement session was done three weeks later in patients with BP ≥ 140/90 mmHg during the first session. Hypertension was defined as BP > 140/90 mmHg after the second session, or on antihypertensive treatment. The other risk factors were studied by clinical and blood analysis.

Results

We found 532 hypertensive patients out of a total of 2 000 subjects. The prevalence of hypertension was 26.6%. The mean age of hypertensive patients was 45 ± 10 years, ranging from 18 to 98 years. The prevalence of other cardiovascular risk factors was: stress (43%), sedentary lifestyle (41%), hypercholesterolaemia (26%), obesity (25.2%), hypertriglyceridaemia (21%), smoking (9.3%), alcohol use (11%) and diabetes (7.3%).

Conclusions

The prevalence of hypertension and other cardiovascular risk factors in the population of Lome is high. These findings should draw the attention of authorities to define a national policy to combat hypertension and other cardiovascular risk factors.     

Prevalence of diabetes mellitus and associated cardiovascular risk factors in an adult urban population in Paraguay

A cross-sectional study was conducted on a 20–74-year-old population in an urban white-Hispanic population in Paraguay to determine the prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT), and associated cardiovascular disease (CVD) risk factors. In total 1606 subjects completed the study (response rate 80.3%; 1094 women, 512 men). The overall prevalences were: DM 6.5 %, IGT 11.3 %, hypertension 17.1 %, and obesity 31.6% with more obesity in women (35.7 % vs 22.8 %, p < 0.05). Age-standardized prevalences were: DM 6.5 %, IGT 13.5 % in females and DM 5.5 %, IGT 7.2 % in males. DM and IGT subjects had two or more CV risk factors significantly more often than the normal population. In conclusion, DM, IGT, hypertension, and obesity are common in this South American Hispanic urban population, particularly in women. Public health measures, such as lifestyle education, are required to decrease these non-communicable diseases. © 1998 John Wiley & Sons, Ltd.     

Prevalence of hypertension and cardiovascular risk factors among long‐term AIDS survivors: A report from the field

HIV infection is associated with increased risk and progression of cardiovascular disease (CVD), yet little is known about the prevalence of CVD risk factors among long‐term AIDS survivors in resource‐limited settings. Using routinely collected data, we conducted a retrospective study to describe the prevalence of CVD risk factors among a cohort of HIV‐infected patients followed for over 10 years in Port‐au Prince, Haiti. This cohort includes 910 adults who initiated antiretroviral therapy (ART) between 2003 and 2004 and remained in care between 2014 and 2016 when routine screening for CVD risk factors was implemented at a large clinic in Haiti. A total of 397 remained in care ≥10 years and received screening. At ART initiation, 59% were female, median age was 38 years (IQR 33‐44), and median CD4 count was 117 cells/mm³ (IQR 34‐201). Median follow‐up time from ART initiation was 12.1 years (IQR 11.7‐12.7). At screening, median CD4 count was 574 cells/mm³ (IQR 378‐771), and 84% (282 of 336 screened) had HIV‐1 RNA < 1000 copies/mL. Seventy‐four percent of patients had at least 1 risk factor including 58% (224/385) with hypertension, 8% (24/297) diabetes, 43% (119/275) hypercholesterolemia, 8% (20/248) active smoking, and 10% (25/245) obesity. Factors associated with hypertension were age (adjusted OR 1.06, P < .001) and weight at screening (adjusted OR 1.02, P = .019). Long‐term AIDS survivors have a high prevalence of CVD risk factors, primarily hypertension. Integration of cardiovascular screening and management into routine HIV care is needed to maximize health outcomes among aging HIV patients in resource‐limited settings.     

机关人群高血压调查及危险因素分析

目的探讨江苏省南京市省级机关、市级机关人群高血压流行水平及其主要危险因素，为高血压的防治提供一定的依据。方法采用问卷等方式对2622名机关干部进行流行病学调查，以是否发生高血压为因变量，按所得数据进行危险因素分析。结果在2622名调查者中，高血压患者827例，患病率为31．5％，男性患病率（36．3％）高于女性患病率（24．1％）（P〈0．01）。随年龄增加患病率明显增加，影响我省机关人群高血压的独立危险因素为年龄、体质量指数、腰围、空腹胰岛素、低密度脂蛋白胆固醇、空腹血糖。结论改变生活方式，有效预防和控制包括超重和肥胖等在内的高血压发病危险因素，是目前急需解决的公共卫生问题。     

Glycaemic control and cardiovascular risk factors in Type 2 diabetes: a population-based study

The objective of this study was to estimate the prevalence of poor glycaemic control and cardiovascular risk factors in an Italian population-based cohort of subjects with Type 2 diabetes mellitus (DM). Out of a cohort of 1967 subjects (estimated completeness of ascertainment 80 %), 1574 (80 %) were investigated, and adherence to targets for control of the European NIDDM Policy Group assessed. Prevalence of poor glycemic control (HbA_1c > = 8) was 47.7 %. Obesity was present in 23.4 % of the cohort, hypertension in 83.4 %, hypertriglyceridaemia (>2.26 mM) in 19.3 %, hypercholesterolaemia (>6.46 mM) in 25.5 %, and low HDL-cholesterol (<0.90 mM in men and <1.03 mM in women) in 13.7 %. Only 153 (9.7 %) subjects were free from other disorders. Subjects were treated as follows: 26.2 % exclusively by general practitioners; 13.3 %, 69.9 %, 10.9 %, and 5.9 % with diet, oral hypoglycaemic drugs, insulin, and both, respectively. Multiple linear regression analysis showed associations between HbA_1c and fibrinogen (p < 0.001), total cholesterol (p = 0.006), and triglycerides (p = 0.04), independent of age, sex, duration of diabetes, and antidiabetic treatment. Neither BMI nor blood pressure were associated with HbA_1c. In conclusion, this Italian population-based cohort of subjects with Type 2 DM showed a high prevalence of poor glycaemic control, high consumption of oral hypoglycaemic drugs, and an independent association between glycaemic control and cardiovascular risk factors (fibrinogen, total cholesterol, and triglycerides). The presence of obesity or hypertension was not significantly associated with glycaemic control. © 1998 John Wiley & Sons, Ltd.     

Impaired fasting glycaemia resembles impaired glucose tolerance with regard to cardiovascular risk factors: population-based, cross-sectional study of risk factors for cardiovascular disease.

AIMS: To compare subjects with impaired glucose tolerance and impaired fasting glucose in relation to risk factors for developing cardiovascular disease. METHODS: A total of 1374 patients (678 female, 696 male) listed with a general practice clinic in Denmark were given an oral glucose tolerance test, a physical examination, and a self-administered questionnaire. Risk factors for cardiovascular disease were assessed for 90 participants (48 female, 42 male) with impaired glucose tolerance (including 12 subjects (1 female and 11 male), who also fulfilled criteria for impaired fasting glycaemia) and 51 subjects (20 female, 31 male) with impaired fasting glycaemia (World Health Organization 1999 criteria). RESULTS: There were no statistical differences with regard to known risk factors for cardiovascular disease between participants with isolated impaired fasting glycaemia and those with impaired glucose tolerance. CONCLUSIONS: We found noticeable similarities in the cardiovascular risk factor profile in subjects with impaired fasting glycaemia and in subjects with impaired glucose tolerance in our population. When planning screening initiatives, it seems relevant to take into account people with impaired fasting glycaemia as well as those with impaired glucose tolerance.     

高动物蛋白饮食对高血压患者血管功能及心血管危险因素的影响

目的 调查高血压患者的生活方式,了解高动物蛋白饮食对血管功能和颈动脉内膜中层厚度等心血管危险因素的影响。方法 在我院心血管门诊选取符合纳入标准的高血压患者88例,通过问卷调查方式获取参与者的一般生活方式,检测肱动脉血流介导的血管舒张功能（FMD）和肱踝脉搏波传导速度,同时收集患者颈动脉内膜中层厚度（IMT）等一般临床资料,分析高动物蛋白饮食与血管功能及颈动脉内膜中层厚度等心血管危险因素的相关性。结果 男性52例,女性36例,年龄中位数42 (38, 53)岁。平均动脉压中位数106 (97, 112) mmHg,最高平均动脉压中位数123 (116, 132) mmHg。FMD中位数5.1 (3.8, 7.3)%,IMT中位数0.9 (0.8, 1.2) mm。在日常饮食中,偏向于高动物蛋白饮食的39例,比较均衡的36例;高动物蛋白饮食与FMD显著负相关,与IMT显著正相关;而且,动物蛋白摄入量较大的受试者倾向于存在更大的心血管风险。结论 高血压患者在接受有效降压治疗的同时,应采取健康的生活方式,均衡饮食,避免过高的动物蛋白摄入量,可能有助于降低心血管疾病风险。     

Arterial cardiovascular risk factors and venous thrombosis: results from a population-based, prospective study (the HUNT 2)

Background

An explanation for the increased risk of myocardial infarction and stroke in patients with venous thrombosis is lacking. The objective of this study was to investigate whether risk factors for arterial cardiovascular disease also increase the risk of venous thrombosis.

Design and Methods

Cases who had a first venous thrombosis (n=515) and matched controls (n=1,505) were identified from a population-based, nested, case-cohort study (the HUNT 2 study) comprising 71% (n=66,140) of the adult residents of Nord-Trøndelag County in Norway.

Results

The age- and sex-adjusted odds ratio of venous thrombosis for subjects with concentrations of C-reactive protein in the highest quintile was 1.6 (95% confidence interval: 1.2–2.2) compared to subjects with C-reactive protein in the lowest quintile. This association was strongest in subjects who experienced venous thrombosis within a year after blood sampling with a three-fold increased risk of participants in the highest versus the lowest quintile. Having first degree relatives who had a myocardial infarction before the age of 60 years was positively associated with venous thrombosis compared to not having a positive family history [odds ratio 1.3 (95% confidence interval: 1.1–1.6)]. Subjects with blood pressure in the highest quintile had half the risk of developing venous thrombosis compared to subjects whose blood pressure was in the lowest quintile. There were no associations between the risk of venous thrombosis and total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triglycerides, glucose or smoking. We confirmed the positive association between obesity and venous thrombosis.

Conclusions

C-reactive protein and a family history of myocardial infarction were positively associated with subsequent venous thrombosis. Blood pressure was inversely correlated to venous thrombosis. These findings should be confirmed by further investigations.     

血浆纤维蛋白原与原发性高血压合并危险因素及血压的相关性研究

目的探讨合并不同心血管危险因素的原发性高血压(EH)患者血浆纤维蛋白原(FIB)的变化。方法收集1995—2006年福建医科大学附属第一医院心内科EH患者1300例,按合并心血管危险因素情况分为单纯EH组(196例)、EH合并1个危险因素组(442例)、EH合并2个危险因素组(433例)和EH合并3个及以上危险因素组(229例);根据是否合并代谢综合征(MS)将高血压患者分为EH+MS组(496例)和EH+nonMS组(804例),比较FIB的变化。结果单纯EH患者FIB明显低于合并心血管危险因素的各组EH患者[(3.17±0.89)g/L对(3.37±0.93)g/L、(3.48±0.96)g/L和(3.84±1.13)g/L,P<0.05],高血压合并3个及以上危险因素组FIB显著高于合并1个或2个危险因素组(P<0.05)。EH+MS组较EH+nonMS组FIB显著升高[(3.59±1.01)对(3.38±0.98)g/L,P<0.05)]。调整其他影响因素后,1级、2级和3级EH患者间FIB差异无统计学意义(3.41 g/L、3.42 g/L和3.52 g/L),无心血管危险因素的单纯EH患者在调整其他影响因素后1级、2级和3级EH组间FIB分别为3.15 g/L、3.22 g/L和3.26 g/L,差异无统计学意义。结论 FIB与血压无明显相关性,与EH合并的危险因素密切相关。     

楚雄市心血管疾病流行病学及相关危险因素调查

目的：探索楚雄市人群心血管疾病流行病学及相关危险因素水平,为综合防治提供科学依据。方法：采用多阶段抽样的方法,抽取辖区15个乡镇和4个社区医疗卫生服务中心,18岁及以上居民2397人进行了心血管疾病危险因素随机抽样调查。结果：人群高血压患病率20.5%;高血压知晓率为59.35%;冠心病患病率为1.9%;脑卒中患病率0.3%。人群吸烟率为18.69%,其中男性居民和女性居民的吸烟率分别为36.33%和1.64%;被调查人群中超重401人,超重率为16.7%,肥胖58人,肥胖率为2.4%;空腹血糖受损者占11.4%;糖尿病患病率17.8%;结论：本地区上述危险因素水平均相当突出 ,采取社区综合防治措施 ,进行有效控制已刻不容缓。     

Prevalence and significance of cardiovascular risk factors in a large cohort of patients with familial hypercholesterolaemia

OBJECTIVE: Patients with familial hypercholesterolaemia (FH) vary widely in terms of onset of cardiovascular disease (CVD). DESIGN: The association between cardiovascular risk factors and prevalent CVD was examined in a cross-sectional study in order to elucidate their contribution to atherogenesis. SETTING AND SUBJECTS: Patients were recruited from 37 Dutch Lipid Clinics. The diagnosis of FH was based on a uniform diagnostic protocol, confirmed by DNA analysis in 62% of the cases. All patients were investigated free from any lipid-lowering drug for at least 6 weeks. MAIN OUTCOME MEASURES: Differences in lipids, lipoproteins and other risk factors for CVD were analysed in FH patients with and without CVD. RESULTS: A total of 526 patients were assessed and more than 37% had a history of CVD with a mean age of onset of 46.8 years. Mean LDL cholesterol (LDL-C) levels were severely elevated (8.38 +/- 2.13 mmol L-1). In univariate analysis, age, presence of hypertension or diabetes, body mass index, triglycerides (TG) and low HDL cholesterol (HDL-C) were all significantly associated with CVD. Also in multivariate analysis, all these risk factors, except TG and diabetes, were significantly linked to CVD. CONCLUSION: A high CVD risk in this large well-documented characterized sample of FH patients is not only conferred by elevated LDL-C but also by low HDL-C.     

Prevalence,risk factors,and management of uncontrolled hypertension among patients with diabetes: A hospital-based cross-sectional study

AimsThis research examines the prevalence of uncontrolled hypertension and associated risk factors among patients with diabetes in Saudi Arabia.MethodsA hospital-based, cross-sectional study was used in patients with diabetes and hypertension attending outpatient diabetes clinics in King Khaled Hospital and Prince Sultan Center for Health Care in Al-Kharj, Riyadh. Patients’ information, data on hypertension, type of treatment, and comorbidities were captured through electronic medical records. Uncontrolled hypertension was defined as blood pressure (BP) measurements greater than or equal to 140/90 mmHg. Antihypertensive medication use among these patients was analyzed. Multivariate analysis was performed to detect the associated factors of uncontrolled hypertension.ResultsOf 1178 outpatients‬ with diabetes who were included in the study sample, uncontrolled hypertension presented in 846 (71.8%). Most patients were on two antihypertensive medications, and the most frequently used was calcium channel blockers, followed by angiotensin-converting enzyme inhibitors. Individuals most likely to have uncontrolled hypertension were those older than 65 years (OR 1.99, 95%CI: 1.059, 3.77), male (OR = 1.51, 95%CI: 1.031, 2.22), and obese (OR = 2.39, 95%CI: 1.63, 3.504), with two (OR = 3.894, 95% CI: 2.481, 6.114) or three or more comorbidities (OR = 4.020, 95% CI: 2.510, 6.439), and with polypharmacy (OR = 1.814, 95% CI: 1.238, 2.656).ConclusionThe extent of uncontrolled hypertension among patients with diabetes in the study sample was found to be high. Age, sex, obesity, number of comorbidities, and polypharmacy are the most important correlates with increased risk of uncontrolled hypertension.     

Association between plasma renin activity and metabolic cardiovascular risk factors in essential hypertension

Objectives. To study the relationships between plasma renin activity and metabolic cardiovascular risk factors in patients with essential hypertension.
Subjects and design. Patients with uncomplicated essential hypertension ( n =36) with a diastolic blood pressure of 95–115 mmHg were studied. Assessment of plasma renin activity (PRA) related to urinary sodium excretion was used to define subgroups with high ( n =12), medium ( n =16) and low renin profiles ( n =8).
Main outcome measures. Fasting plasma lipid levels were determined. Glucose, insulin and C-peptide responses to standard oral glucose tolerance test (OGTT) were measured.
Results. Patients with high PRA had higher levels of plasma cholesterol (6.13±0.81 versus 4.67±0.7 mmol L^-1, P <0.05) and triglycerides (2.14±0.18 versus 0.98±0.13 mmol L^-1, P <0.05), than the low PRA group. HDL-cholesterol levels were lower in the high renin group than in the low renin group (1.05±0.04 versus 1.26±0.09 mmol L^-1, P <0.05). Insulin and C-peptide sums were higher in high PRA group (33.8±1.2 versus 25.1±0.9 and 2.6±0.3 versus 1.9±0.4 ng L^-1, P <0.05), than in the low PRA group.
Conclusions. Essential hypertensive patients with a high renin profile display more pronounced dyslipidaemia and higher levels of plasma insulin than patients with a low renin profile. This may be one explanation for higher incidence of cardiovascular disease previously reported in high PRA group.     

The contribution of classical risk factors to cardiovascular disease in familial hypercholesterolaemia: data in 2400 patients

OBJECTIVE: To determine the contribution of classical risk factors to the development of cardiovascular disease (CVD) in patients with heterozygous familial hypercholesterolaemia (FH). DESIGN: A retrospective, multi-centre, cohort study. Extensive data were collected by scrutinizing medical records and the use of questionnaires. Multivariate Cox regression was used to study the relationship between potential risk factors and the occurrence of CVD. SETTING AND SUBJECTS: We included 2400 FH patients from 27 Dutch lipid clinics. The diagnosis of FH was based upon the presence of a low-density lipoprotein receptor mutation or upon strict clinical criteria. MAIN OUTCOME MEASURES: Cardiovascular mortality and CVD. RESULTS: During 112.943 person-years, 782 (32.6%) patients had had at least one cardiovascular event. Male gender (RR 2.82, 95% CI 2.37-3.36), smoking (RR 1.67, 95% CI 1.40-1.99), hypertension (RR 1.36, 95% CI 1.06-1.75), diabetes mellitus (RR 2.19, 95% CI 1.36-3.54), low HDL-C (RR 1.37, 95% CI 1.15-1.63) and elevated lipoprotein(a) levels (RR 1.50, 95% CI 1.20-1.79) proved to be independent CVD risk factors. These six risk factors explained 18.7% of the variation in the occurrence of CVD. CONCLUSIONS: Male gender, smoking, hypertension, diabetes mellitus, HDL cholesterol and lipoprotein(a) levels proved to be important risk factors for CVD in FH patients. In addition to the routine institution of statin therapy, controlling these factors needs special attention in the management of this disorder.     

Prevalence of isolated diastolic hypertension and associated risk factors among adults in Kanpur, India

BackgroundIsolated diastolic hypertension (IDH) is a largely unrecognized subtype of hypertension, more commonly seen in the younger age group.Aims(1) To determine the prevalence of IDH in the adult population of Kanpur district. (2) To study the associated risk factors of IDH.MethodsA community-based cross-sectional study was conducted in 801 subjects, aged 20 years and above, using multistage stratified random sampling technique.ResultsThe prevalence of IDH was 4.5%, which was 6.2% in men and 3.1% in women. A significant proportion of IDH was seen in the 40–49 years age group. Multivariate logistic regression analysis of the associated risk factors showed that gender, physical activity and BMI were significantly associated with IDH.ConclusionIsolated diastolic hypertension is an emerging problem in developing countries. IDH is more common among men, sedentary individuals and those with a higher BMI.     

Impact of obstructive sleep apnea on blood pressure and cardiovascular risk factors in Japanese men: A cross-sectional study in work-site group

It has been shown that obstructive sleep apnea (OSA) is related to hypertension and cardiovascular disease; however, the prevalence of OSA in general population and the impact of it on blood pressure especially in Japan has not been well determined. We have conducted a screening test for OSA from 2003 to 2011. In addition, a cross-sectional analysis was performed in 2012 to determine the association of OSA and cardiovascular risk factors in Japanese men (18–69 years of age; mean age, 44.4 ± 0.2). The study group consisted of 2208 male employees, and OSA was evaluated by using the 4% oxygen desaturation index and apnea-hypopnea index (AHI). The prevalence of mild-to-moderate (5≤AHI<30) and severe (AHI≥30) OSA in the studied subjects were 7.1%, and 6.1%, respectively. Among the 135 severe OSA subjects, 105 (77.8%) had been treated with continuous positive airway pressure. Both systolic and diastolic blood pressures (DBP) were significantly increased in the subjects with severe OSA compared with those without OSA. These associations in DBP remained observed after adjustment for age, body mass index (BMI), estimated glomerular filtration rate, HbA_1c, current alcohol intake, current smoking habits, and OSA treatment. DBP in severe OSA subjects were significantly increased in 1807 subjects who were not treated for hypertension or OSA. However, the levels of blood pressures were not decreased by OSA treatment. These results suggest that the prevalence of OSA is relatively high in middle-aged Japanese men and that blood pressures were elevated in the subjects with severe OSA.     

单中心老年心血管病危险因素控制现状分析

目的了解老年患者心血管病危险因素控制现状。方法选择我院老年内科住院治疗的疑诊冠心病的老年患者256例,测定血糖、血脂水平,进行24h动态血压监测,根据相关指南推荐的血压、血糖及血脂达标值判断达标情况。根据冠状动脉造影结果将入选者分为冠心病组208例与非冠心病组48例,比较2组上述危险因素控制情况。结果 256例患者中,209例(81.6%)合并高血压,24h、昼间及夜间平均血压达标率分别为75.1%、82.8%和59.3%;99例(38.7%)合并糖尿病,血糖达标率70.7%;154例(60.2%)合并血脂异常,LDL-C达标率41.4%。冠心病组与非冠心病组血压、血糖达标率比较,差异无统计学意义(P>0.05),冠心病组LDL-C达标率低于非冠心病组,差异有统计学意义(38.5%vs 54.2%,P<0.05)。结论老年心血管病高危患者中,血压、血糖达标率高,LDL-C达标率较低,尤其心血管病极高危的冠心病患者LDL-C达标率更低,应重视老年患者心血管病风险评估,并进一步加强对血脂的干预力度。