Current status of hypertension prevalence, treatment and control rate among young and middle-aged population in China / 中华心血管病杂志

Objective: To estimate the prevalence, awareness, treatment and control rate of hypertension among young and middle-aged population in China. Methods: The analysis was based on the results of 2012-2015 China Hypertension Survey, which was a cross-sectional stratified multistage random sampling survey. A total of 229 593 subjects were included in the final analysis. The data including sex, age, living in urban and rural areas, prevalence of hypertension, history of stroke, family history of coronary heart disease and drinking, physical examination, heart rate were collected. Hypertension was defined as mean systolic blood pressure (SBP) ≥140 mmHg (1 mmHg=0.133 kPa), and (or) diastolic blood pressure (DBP) ≥90 mmHg, and (or) self-report a history of hypertension, and (or) use of antihypertensive medicine within 2 weeks before survey. Prehypertension was defined as SBP between 120-139 mmHg, and (or) DBP between 80-89 mmHg. Control of hypertension was considered for hypertensive individuals with SBP<140 mmHg and DBP<90 mmHg. The prevalence of prehypertension, hypertension, awareness, treatment, control rate were calculated, and the control rate among those with antihypertensive medication was also calculated. Results: The prevalence of prehypertension and hypertension was 43.8% (95%CI: 42.3%-45.4%), and 22.1% (95%CI: 20.8%-23.3%), respectively. The prevalence of prehypertension and hypertension was significantly higher among male than female across different age groups. The awareness, treatment, control rate of hypertension and control rate among treated hypertensive participants were 43.8%, 33.2%, 16.7%, and 40.2%, respectively. The prevalence was higher, and the control rate was lower among individuals with higher heart rate. Conclusion: The prevalence of prehypertension and hypertension among young and middle-aged population is high, the awareness, treatment and control rate need to be further improved in this population. The prevention and treatment of hypertension should be strengthened in the future to improve the control rate of hypertension in China.

Fatores associados à pré-hipertensão e hipertensão arterial em trabalhadores de saúde que atuam em serviços de alta complexidade / Factors associated with prehypertension and hypertension among healthcare workers working in high-complexity services

Resumo Objetivou-se estimar a prevalência e fatores associados à pré-hipertensão e hipertensão arterial entre trabalhadores de saúde que atuam em setores de alta complexidade para pacientes críticos e crônicos. Foi realizado um estudo epidemiológico, transversal com 490 trabalhadores de saúde da macrorregional do norte de Minas Gerais, Brasil. A variável dependente pressão arterial foi categorizada em normal, pré-hipertensão e hipertensão. Para análise múltipla, foi utilizada a Regressão Logística Multinomial. A prevalência da hipertensão arterial foi de 21,8% e da pré-hipertensão foi de 25,9%. As chances de se desenvolver a hipertensão arterial e a pré hipertensão foram maiores nos profissionais do sexo masculino, com idade ≥40 anos, em trabalhadores com vínculo empregatício concursado e naqueles obesos ou com sobrepeso. O uso de medicamento contínuo e o trabalho no turno noturno estiveram associados à hipertensão e pré-hipertensão, respectivamente. A prevalência de hipertensão arterial no grupo de trabalhadores foi menor do que a da população brasileira. São necessários estudos com trabalhadores desse grupo e investimentos em medidas preventivas e que incentivem a mudança para um estilo de vida saudável.

Abstract The objective was to estimate the prevalence and factors associated with prehypertension and hypertension among health workers who work in high-complexity services for critically-ill and chronic patients. An epidemiological, cross-sectional study was carried out with 490 health workers in the macroregional region of Northern Minas Gerais, Brazil. The dependent variable blood pressure (BP) was categorized as normal BP, prehypertension and hypertension. Multinomial Logistic Regression was used for the multiple analysis. The prevalence of arterial hypertension was 21.8% and that of prehypertension was 25.9%. The chances of developing arterial hypertension and prehypertension were higher in male professionals, aged ≥40 years, in civil servant workers and those who were obese or overweight. The use of continuous medication and night shift work were associated with hypertension and prehypertension, respectively. The prevalence of arterial hypertension in the group of workers was lower than that of the Brazilian population. It is necessary to carry out studies with workers from this group and investments are required in preventive measures that encourage a change to a healthy lifestyle.

Prevalencia de hipertensión enmascarada en niños con factores de riesgo para el desarrollo de hipertensión arterial / Prevalence of masked hypertension among children with risk factors for arterial hypertension

Introducción. La hipertensión enmascarada (HE) en niños se define por registros de presión arterial normal en la consulta y elevados fuera de ella. El monitoreo ambulatorio de presión arterial de 24 horas (MAPA) permite su diagnóstico. Existe poca información sobre su prevalencia en nuestra población. Objetivo. Estimar la prevalencia de HE en niños con factores de riesgo para el desarrollo de hipertensión arterial. Material y método. Estudio prospectivo, observacional, corte transversal. Se incluyeron en forma consecutiva pacientes asistidos en el Hospital General de Niños P. de Elizalde entre 1/7/2015 y 1/12/2016, de 5 a 11 años, con presión arterial normal y, al menos, un factor de riesgo para hipertensión arterial. Se realizó MAPA durante 24 horas (SpaceLabs 90207/90217). Muestra estimada: 110 pacientes. Se contó con las aprobaciones pertinentes. Resultados. Se incluyeron 110 pacientes, edad de 8,7 ± 1,8 años, 60 mujeres. Tiempo de MAPA: 23,18 ± 1,8 horas. Tenían antecedentes neonatales 23 pacientes; todos tenían, al menos, un antecedente personal (los más frecuentes, ingesta aumentada de sal y obesidad); 101 tenían, al menos, un antecedente familiar. El MAPA permitió identificar a 10 pacientes con HE (9,1%; IC 95%: 5,1-15,9); 7 con hipertensión nocturna aislada (6,4%; IC 95%: 3,1-23,5) y 28, prehipertensión (25,4%; IC 95%: 18,2-34,3). Los 10 pacientes con HE fueron 7 varones, 9 obesos y con, al menos, un antecedente familiar. Conclusión. La prevalencia de HE en niños con factores de riesgo de desarrollar hipertensión arterial fue cercana al 10%.

Introduction. Masked hypertension (MH) in children is defined as normal office blood pressure values and high values outside the clinical setting. The 24-hour ambulatory blood pressure monitoring (ABPM) is helpful for diagnosis. There is little information on MH prevalence in our population. Objective. To estimate the prevalence of MH in children with risk factors for arterial hypertension. Material and method. Prospective, observational, cross-sectional study. Patients seen at Hospital General de Niños "P. de Elizalde" between July 1st, 2015 and December 1st, 2016, aged 5-11 years, with normal blood pressure and at least one risk factor for arterial hypertension were included in consecutive order. A 24-hour ABPM was done (SpaceLabs 90207/90217). Estimated sample: 110 patients. All relevant authorizations were obtained. Results. One hundred and ten patients aged 8.7 ± 1.8 years were included; 60 were girls. ABPM duration: 23.18 ± 1.8 hours. Twenty-three patients had neonatal history; all had at least one factor corresponding to personal history (the most common ones were increased salt intake and obesity); 101 had at least one factor corresponding to family history. ABPM helped to identify 10 patients with MH (9.1%; 95% confidence interval --1;CI--3;: 5.1-15.9); 7 had isolated nocturnal hypertension (6.4%; 95% CI: 3.1-23.5) and 28 had prehypertension (25.4%; 95% CI: 18.234.3). Among the 10 patients with MH, 7 were boys, 9 were obese and had at least one factor corresponding to family history. Conclusion. The prevalence of MH in children with risk factors for arterial hypertension was close to 10%.

Dépistage de la préhypertension dans la population adulte consultant dans les structures de santé de la circonscription de Bouzareah

Introduction : l'hypertension artérielle(HTA), première cause de morbi-mortalité dans le monde, est codée selon la classification internationale des maladies (CIM) par trois caractères « I10 ». Son état précurseur qui est la préhypertension (PHTA), a une prévalence mondiale d'environs 30%, et est associée à un risque cardiovasculaire (RCV) élevé . Néanmoins, son épidémiologie n'est pas encore étudiée dans notre pays. L'objectif de notre travail était de déterminer la prévalence et les facteurs déterminants de la PHTA chez les consultants en médecine générale à l'EPSP de Bouzareah, ainsi que le profil métabolique et vasculaire des patients recrutés. Patients et méthodes : Une étude descriptive de type transversal a été menée sur un échantillon de 1086 adultes âgés de 18ans et plus, non connus hypertendus, consultants les médecins généralistes de l'EPSP de Bouzareah. Ils ont bénéficié d'un dépistage de la PHTA (définie par le JNCVII comme une pression systolique entre 120-139mmhg et une pression diastolique entre 80-89 mmhg) et de l'HTA(une pression systolique ≥140 mmhg et une pression diastolique ≥90 mmhg). Les facteurs de RCV associés ont été recueillis par un questionnaire lors de la consultation. La taille, le poids et le périmètre abdominal ont été mesurés, tandis que la pression artérielle est mesurée à deux reprises avec prise en compte de la moyenne des deux. Tous les patients inclus dans l'étude ont bénéficié dans un deuxième temps d'un bilan biologique(un lipidogramme, une fonction rénale, un calcul du ratio albuminurie/créatinine, une épreuve d'hyperglycémie provoquée par voie orale), un monitoring ambulatoire de la pression artérielle et la recherche des marqueurs de risque vasculaire à savoir la vitesse de l'onde de pouls (VOP), l'épaisseur intima media carotidienne(EIM) et l'index de pression systolique à la cheville (IPS). Résultats : Nous avons identifié 399 individus en PHTA (36,7%) et 172 nouveaux hypertendus (15,8%). La prévalence de la PHTA était plus importante chez les hommes que chez les femmes(49,7 vs 31,5% ; p<10-3) ; elle était aussi plus importante dans les classes d'âge inferieures à 60ans. Les préhypertendus avaient un sex-ratio de 0,64 et un âge moyen de 42,3±13,9 ans. Les facteurs de RCV les plus prévalents chez les préhypertendus étaient la sédentarité (47,4 %), le surpoids (35.8%) et l'obésité (31,8), suivis par le tabac (19,3%), la dyslipidémie (17,3%) et le diabète (13%). Selon l'ATPIII, 6,4% des hommes et 39,1% des femmes avaient un périmètre abdominal élevé, ces chiffres augmentaient à 24,4% et 67% respectivement selon l'IDF. Ce paramètre était nettement plus important que celui mesuré chez les normotendus (85,10±10,58 cm vs 77,8±10,463cm ; p<10-6), et il en était de même pour l'indice de masse corporelle (IMC) (27,7±5,39 vs 25,5±5,249 kg/m2; p<10-6). Le score de Framingham était estimé en moyenne à 6,08±5,54, et élevé chez 16,4% des patients. Selon l'ATPIII, 25% des préhypertendus présentaient un syndrome métabolique ; cette proportion passait à 36,3% selon l'IDF. L'analyse de régression logistique a démontré que le sexe masculin, l'âge en progression, l'IMC et le périmètre abdominal étaient les principaux facteurs déterminants de la PHTA dans notre population. Nous avons par ailleurs diagnostiqué 13 nouveaux diabétiques, 52 pré diabétiques et 143 patients avec une HTA masquée. Pour les marqueurs de RCV, la VOP était élevée dans 60,5 % des cas, l'EIM dans 9,6 % des cas et l'IPS était bas chez 7,5 % des cas. A noter que 90 préhypertendus (32,1%) étaient en insuffisance rénale chronique Conclusion : Notre étude a réussi à démontrer que la PHTA, entité méconnue dans notre pays, est fréquente et grave, justifiant une surveillance systématique de la tension artérielle et une évaluation du RCV, surtout chez les sujets en surcharge pondérale. Le rôle important de la perte du poids dans la prise en charge de la PHTA nous parait plus que jamais essentiel, ainsi que le contrôle des autres

Pré-hipertensão arterial em comunidades quilombolas do sudoeste da Bahia, Brasil / Arterial prehypertension in slave-descendant communities in southeast Bahia State, Brazil / Pre-hipertensión arterial en comunidades quilombolas del sudoeste de Bahía, Brasil

Resumo: A pré-hipertensão arterial é precursora da hipertensão arterial e fator de risco para doenças cardiovasculares. Populações vulneráveis estão mais propensas a esse tipo de agravo devido às dificuldades de acesso aos serviços de saúde. Pesquisa anterior realizada em comunidades quilombolas reportou elevada prevalência de hipertensão arterial. Este trabalho teve por objetivo estimar a prevalência de pré-hipertensão em quilombolas e avaliar fatores associados. Trata-se de um estudo transversal de base populacional realizado com indivíduos com 18 anos ou mais. A pré-hipertensão foi definida como pressão arterial sistólica ≥ 121mmHg e < 140mmHg e/ou diastólica ≥ 81mmgH e < 90mmHg. Empregou-se análise multivariada valendo-se de regressão de Poisson com variância robusta. Também foram calculadas frações atribuíveis populacionais (FAPs) para os fatores associados modificáveis. A prevalência de pré-hipertensão foi de 55% (IC95%: 50,2-59,7). O sexo masculino (RP = 1,54), a escolaridade de 1-4 anos completos de estudos (RP = 1,44) e as categorias de IMC sobrepeso (RP = 1,39) e obesidade (RP = 1,87) apresentaram associação positiva com a pré-hipertensão. Maiores frações atribuíveis foram observadas entre os indivíduos com escolaridade de 1-4 anos de estudos (13,7%) e entre os classificados com sobrepeso (9,35%) e obesidade (4,6%). A prevalência de pré-hipertensão nas comunidades quilombolas foi elevada, e sua identificação pode permitir o rastreamento e a sensibilização de um grupo com maior risco cardiovascular e de progressão para a hipertensão arterial. Observa-se a necessidade de amplo acesso a serviços de saúde e ações específicas voltadas à orientação, prevenção e promoção da saúde nessa população.

Abstract: Arterial prehypertension is a precursor of arterial hypertension and a risk factor for cardiovascular diseases. Vulnerable populations are more prone to this condition due to difficulties in access to health services. A previous study in quilombola communities (descendants of African slaves) reported a high prevalence of arterial hypertension. The current study aimed to estimate the prevalence of arterial prehypertension in quilombolas and to assess associated factors. This was a cross-sectional population-based study in individuals 18 years and older. Prehypertension was defined as arterial systolic pressure ≥ 121mmHg and < 140mmHg and/or diastolic ≥ 81mmHg and < 90mmHg. Multivariate Poisson regression with robust variance was used. Population-attributable fractions (PAF) were also calculated for the modifiable associated factors. Prevalence of prehypertension was 55% (95%CI: 50.2-59.7). Male gender (PR = 1.54), 1 to 4 complete years of schooling (PR = 1.44), and BMI classified as overweight (PR = 1.39) and obesity (PR = 1.87) showed positive association with prehypertension. Higher attributable fractions were observed in individuals with 1 to 4 years of schooling (13.7%) and those classified as overweight (9.35%) and obese (4.6%). Prevalence of prehypertension in quilombola communities was high, and its identification may allow screening and awareness-raising in a group with increased risk of cardiovascular disease and progression to full-blown hypertension. The study highlights the need for broad access to health services and specific measures for orientation, prevention, and health promotion in this population.

Resumen: La pre-hipertensión arterial es precursora de la hipertensión arterial y un factor de riesgo para enfermedades cardiovasculares. Las poblaciones vulnerables están más propensas a este tipo de problema de salud, debido a sus dificultades de acceso a los servicios de salud. La investigación anterior, realizada en comunidades quilombolas, reportó una elevada prevalencia de hipertensión arterial. Este trabajo tuvo como objetivo estimar la prevalencia de pre-hipertensión en quilombolas y evaluar sus factores asociados. Se trata de un estudio transversal de base poblacional, realizado con individuos con 18 años o más. La pre-hipertensión se definió como presión arterial sistólica ?≥ 121mmHg y < 140mmHg y/o diastólica ≥ 81mmHg y < 90mmHg. Se empleó un análisis multivariado, valiéndose de la regresión de Poisson con estimación robusta de la variancia. También se calcularon Fracciones Atribuibles Poblacionales (FAP) para los factores asociados modificables. La prevalencia de pre-hipertensión fue de un 55% (IC95%: 50,2-59,7). El sexo masculino (RP = 1,54), una escolaridad de 1 a 4 años completos de estudios (RP = 1,44) y las categorías de IMC sobrepeso (RP = 1,39) y obesidad (RP = 1,87) presentaron una asociación positiva con la pre-hipertensión. Mayores fracciones atribuibles se observaron entre los individuos con escolaridad de 1 a 4 años de estudios (13,7%) y entre los clasificados con sobrepeso (9,35%) y obesidad (4,6%). La prevalencia de pre-hipertensión en las comunidades quilombolas fue elevada, y su identificación puede permitir el rastreo y sensibilización de un grupo con mayor riesgo cardiovascular y con progresión hacia la hipertensión arterial. Se observa la necesidad de un amplio acceso a servicios de salud y acciones específicas dirigidas a la orientación, prevención y promoción de la salud en esa población.

A Study of the Association of Abdominal Obesity,Dyslipidemia and Glycemic Status in Pre-hypertensive Young Adults of a Medical University.

Aim : To study the co-relation between pre-hypertension and abdominal obesity, dyslipidemia and glycemic status in young adults of a medical university. Objective : 1) To study the prevalence of pre-hypertension among the young adults of a medical university. 2) To co-relate prehypertension with other factors such as abdominal obesity, dyslipidemia and glycemic status. Methods : This study was conducted in Acharya Vinoba Bhave Rural Hospital, JN Medical College, Wardha .The students of Jawaharlal Nehru College were the participants for this study. Each participant was examined only after the undertaking of their informed consent. Students who fulfilled the criteria of prehypertensives as per the criteria of JNC, 7 where included in this study. A total of 55 students who were prehypertensive were included in the study. These 55 participants where further examined for anthropometric parameters like height, weight, body mass index (BMI) and waist hip ratio (WHR). For statistical analysis Chi - Square statistic method was employed. Results : The study showed that the prevalence of pre-hypertension was quite high (75%). There was a strong co-relation of pre-hypertension with BMI and WHR, and pre-hypertension was more prevalent in males as compared to females (49.8% versus 46.7%). Conclusion :Medical students are advised to adopt lifestyle changes to prevent the risk of future cardiovascular morbidity.

First report on simplified diagnostic criteria for pre-hypertension and hypertension in a national sample of adolescents from the Middle East and North Africa: the CASPIAN-III study / Primeiro relatório sobre critérios de diagnóstico simplificado para pré-hipertensão e hipertensão em uma amostra nacional de adolescentes do Oriente Médio e da África do Norte: o estudo CASPIAN-III

OBJECTIVE: This study aimed to simplify the diagnostic criteria of pre-hypertension (pre-HTN) and hypertension (HTN) in the pediatric age group, and to determine the accuracy of these simple indexes in a nationally-representative sample of Iranian children and adolescents. METHOD: The diagnostic accuracy of the indexes of systolic blood pressure-to-height ratio (SBPHR) and diastolic BPHR (DBPHR) to define pre-HTN and HTN was determined by the area under the curve of the receiver operator characteristic curves. RESULTS: The study population consisted of 5,738 Iranian students (2,875 females) with mean (SD) age of 14.7 (2.4) years. The prevalences of pre-HTN and HTN were 6.9% and 5.6%. The optimal thresholds for defining pre-HTN were 0.73 in males and 0.71 in females for SBPHR, and 0.47 in males and 0.45 in females for DBPHR, respectively. The corresponding figures for HTNwere 0.73, 0.71, 0.48, and 0.46, respectively. In both genders, the accuracies of SBPHR and DBPHR in diagnosing pre-HTN and HTN were approximately 80%. CONCLUSIONS: BPHR is a valid, simple, inexpensive, and accurate tool to diagnose pre-HTN and HTN in adolescents. The optimal thresholds of SBPHR and DBPHR were consistent with the corresponding figures in other populations of children and adolescents with different racial and ethnic backgrounds. Thus, it is suggested that the use of these indexes can be generalized in programs aiming to screen elevated blood pressure in the pediatric age group. .

OBJETIVO: Este estudo visa simplificar os critérios de diagnóstico da pré-hipertensão (pré-HTA) e hipertensão (HTA) na faixa etária pediátrica e determinar a precisão desses índices simple sem uma amostra nacionalmente representativa de crianças e adolescentes iranianos. MÉTODO: A precisão diagnóstica dos índices de relação pressão arterial sistólica/altura (RPASA) e RPAA diastólica (RPADA) para definir a pré-HTA e HTA foi determinada pela área sob as curvas de características de operação do receptor. RESULTADOS: A população estudada contou com 5738 alunos iranianos (2875 meninas) com idade média (DP) de 14,7 (2,4) anos. A prevalência de pré-HTA e HTA foi 6,9% e 5,6%. Os limites ideais para a definição de pré-HTA foram 0,73 em meninos e 0,71 em meninas com relação à RPASA e 0,47 em meninos e 0,45 em meninas com relação à RPADA, respectivamente. Os valores correspondentes com relação à HTA foram 0,73, 0,71, 0,48 e 0,46, respectivamente. Em ambos os gêneros, a precisão de RPASA e RPADA no diagnóstico de pré-HTA e HTA foi de aproximadamente 80%. CONCLUSÕES: A RPAA é uma ferramenta válida, simples, barata e precisa no diagnóstico da pré-HTA e HTA em adolescentes. Os limites ideais de RPASA e RPADA foram compatíveis comos números correspondentes em outra população de crianças e adolescentes com diferentes históricos raciais e étnicos, assim, sugerimos que a utilização desses índices possa ser generalizada em programas de triagem com relação à PA elevada na faixa etária pediátrica. .

Pré-hipertensão e hipertensão em adultos de Florianópolis: estudo de base populacional / Prehypertension and hypertension among adults in a metropolitan area in Southern Brazil: population-based study / Pre-hipertensión e hipertensión en adultos de Florianópolis (Brasil): estudio de base poblacional

OBJETIVO: Estimar a prevalência e os fatores associados de pré-hipertensão e hipertensão arterial em adultos. MÉTODOS: Estudo transversal, de base populacional, com 1.720 adultos em Florianópolis, SC, de setembro de 2009 a janeiro de 2010. Informações demográficas, socioeconômicas, comportamentos relacionados à saúde, medidas antropométricas, morbidades e autopercepção de saúde foram coletadas por meio de entrevistas domiciliares. Níveis de pressão arterial sistólica e diastólica foram avaliados. Adicionalmente perguntou-se sobre a ingestão de medicamentos e diagnóstico médico para hipertensão. A variável dependente foi categorizada em normal, pré-hipertensão e hipertensão arterial. A regressão logística politômica múltipla foi empregada com uso do modelo Logit multinomial. RESULTADOS: A prevalência de pré-hipertensão e hipertensão arterial foi de 36,1% (IC95% 33,3;38, 8) e 40,1% (IC95% 36,6;43,5), respectivamente. A análise de regressão politômica múltipla revelou que a pré-hipertensão esteve associada a homens, cor de pele preta, faixa etária acima de 50 anos, inativos fisicamente no lazer e com pré-obesidade. A hipertensão arterial esteve associada a homens, cor de pele preta, faixa etária acima de 40 anos, tercil intermediário de renda per capita, escolaridade menor que 12 anos, inativos fisicamente, pré-obesidade, obesidade, circunferência da cintura elevada e percepção negativa do estado de saúde. CONCLUSÕES: Para controlar a hipertensão arterial na população adulta de Florianópolis, é urgente haver políticas públicas eficazes para o combate à pré-hipertensão.

OBJECTIVE: To assess the prevalence and factors associated with prehypertension and hypertension among adults. METHODS: Population-based cross-sectional study carried out with a sample of 1,720 adults in the city of Florianópolis, southern Brazil, from September 2009 to January 2012. Information on demographic and socioeconomic factors, health-related behaviors, anthropometric measures, morbidities, and self-rated health was collected through household interviews. Systolic and diastolic blood pressure levels were also assessed as well as use of antihypertensive medications and medical diagnosis of hypertension. The dependent variable was categorized as normal blood pressure, prehypertension and hypertension. Polytomous multiple logistic regression analysis was performed with use of a multinomial logit model. RESULTS: The overall prevalence of prehypertension and hypertension was 36.1% (95%CI 33.3;38.8) and 40.1% (95%CI 36.6, 43.5), respectively. The polytomous regression analysis showed that prehypertension was significantly associated with males, black skin, 50 - 59 years of age, leisure-time physical inactivity, and pre-obesity. Hypertension was associated with males, 40 years of age or more, intermediary tertile of per capita family income, less than 12 years of schooling, leisure-time physical inactivity, pre-obesity, obesity, abdominal obesity, and negative self-rated health. CONCLUSIONS: It is pressing to introduce effective public health policies to control hypertension among adult population in Florianópolis, Southern Brazil.

OBJETIVO: Estimar la prevalencia y los factores asociados de pre-hipertensión e hipertensión arterial en adultos. MÉTODOS: Estudio transversal, de base poblacional, con 1.720 adultos en Florianópolis, SC, Brasil, de septiembre de 2009 a enero de 2010. Informaciones demográficas, socioeconómicas, comportamientos relacionados a la salud, medidas antropométricas, morbilidades y autopercepción de salud fueron colectadas por medio de entrevistas domiciliares. Niveles de presión arterial sistólica y diastólica fueron evaluados. Adicionalmente, se preguntó sobre la ingesta de medicamentos y diagnóstico médico para hipertensión. La variable dependiente fue categorizada en normal, pre-hipertensión e hipertensión arterial. La regresión logística politómica múltiple fue empleada con uso del modelo Logit multinomial. RESULTADOS: La prevalencia de pre-hipertensión e hipertensión arterial fue de 36,1% (IC95% 33,3;38,8) y 40,1% (IC95% 36,6;43,5), respectivamente. El análisis de regresión politómico multivariable reveló que la pre-hipertensión estuvo asociada a hombres de color de piel negra, grupo etario encima de 50 años, inactivos físicamente en momentos de ocio y con pre-obesidad. La hipertensión arterial estuvo asociada a hombres, de color de piel negra, grupo etario encima de 40 años, tercil intermediario de renta per capita, escolaridad menor de 12 años, inactivos físicamente, pre-obesidad, obesidad, circunferencia de la cintura elevada y percepción negativa del estado de salud. CONCLUSIONES: Para controlar la hipertensión arterial en la población adulta de Florianópolis, es urgente aplicar políticas públicas eficaces para combatir la pre-hipertensión.

Size at birth and blood pressure in young adults: findings from a Brazilian birth cohort study / Tamanho ao nascer e pressão arterial em adultos jovens: achados de uma coorte de nascimentos brasileira

OBJECTIVE: To describe the prevalence of borderline blood pressure (BBP) and hypertension (HT) among young adults and to assess the association between size at birth and BBP/HT. METHODS: Data were collected from the fi rst Ribeirão Preto Birth Cohort Study conducted in the city of Ribeirão Preto, southeastern Brazil, that started in 1978-1979. Of the 6,827 singletons born in hospitals, 2,060 were assessed at 23-25 years of age. Blood samples were collected, an anthropometric assessment was performed, and information was obtained regarding occupation, schooling, life habits and chronic diseases. Blood pressure (BP) was classifi ed as: 1) BBP: systolic BP (SBP) ≥ 130 mm Hg and < 140 mm Hg and/or diastolic BP (DBP) ≥ 85 mm Hg and < 90 mm Hg; and 2) HT: SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg. A polytomic logistic regression model was used. RESULTS: BBP prevalence was 13.5% (males: 23.2%) and HT prevalence 9.5% (males: 17.7%). BBP was independently associated with male gender (relative risk [RR] 8.84; 95%CI 6.09;12.82); birth length ≥ 50 cm (RR 1.97; 1.04;3.73); body mass index (BMI) ≥ 30 kg/m2 (RR 3.23; 2.02;5.15); and high waist circumference (RR 1.61; 1.13;2.29), while HT was associated with male gender (RR 15.18; 8.92;25.81); BMI ≥ 30 kg/m2 (RR 3.68; 2.23;6.06); high waist circumference (RR 2.68; 1.77;4.05); and elevated blood glucose (RR 2.55; 1.27; 5.10), but not with birth length. CONCLUSIONS: The prevalence of BBP and HT among young adults of this cohort was higher in males than females. Greater birth length was associated with BBP, but not with HT, whereas birth weight was not associated with either BBP or HT. Adult risk factors explained most of the increase in the levels of BBP and HT.

OBJETIVO: Descrever a prevalência de pressão arterial limítrofe (PAL) e hipertensão (HT) entre adultos jovens e avaliar a associação entre tamanho ao nascer e PAL/HT. MÉTODOS: Dados foram coletados do primeiro estudo brasileiro de coorte de nascimentos em Ribeirão Preto (sudeste do Brasil), iniciado em 1978/79. De 6.827 recém-nascidos de parto único hospitalar, 2.060 foram avaliados aos 23/25 anos. Foram realizadas coleta de sangue, avaliação antropométrica e obtidas informações sobre ocupação, escolaridade, hábitos de vida e doenças crônicas. Pressão arterial (PA) foi classificada em: 1) PAL: PA sistólica (PAS) ≥ 130 e < 140 mm Hg e/ou PA diastólica (PAD) ≥ 85 e < 90 mmHg; 2) HT: PAS ≥ 140 e/ou PAD ≥ 90 mm Hg. Foi aplicado modelo de regressão logística politômica. RESULTADOS: A prevalência de PAL foi de 13,5% (homens 23,2%) e a de HT, 9,5% (homens 17,7%). PAL foi independentemente associada com sexo masculino (RR 8,84; IC95%: 6,09;12,82), comprimento ao nascer ≥ 50 cm (RR 1,97; 1,04; 3,73), índice de massa corporal (IMC) ≥ 30 kg/m² (RR 3,23; 2,02; 5,15) e circunferência de cintura alterada (RR 1,61; 1,13;2,29), enquanto HT associou-se com sexo masculino (RR 15,18; 8,92;25,81), IMC ≥ 30 kg/m² (RR 3,68; 2,23;6,06), circunferência de cintura alterada (RR 2,68; 1,77;4,05) e glicemia elevada (RR 2,55; 1,27;5,10), mas não com comprimento ao nascer. CONCLUSÕES: As prevalências de PAL e HT entre os adultos jovens dessa coorte foram maiores em homens que em mulheres. Maior comprimento ao nascer foi associado com PAL, mas não com HT, enquanto peso ao nascer não foi associado com PAL ou HT. Fatores de risco do adulto explicaram a maioria dos aumentos de PAL ou HT.

Prevalence of prehypertension in young military adults & its association with overweight & dyslipidaemia.

Background & objectives: Estimation of prevalence of prehypertension in a population and its association with risk factors of cardiovascular disease is important to design preventive programmes. This cross-sectional study was carried out in a healthy military population to assess the prevalence of prehypertension and its association with risk factors such as overweight, abdominal adiposity and dyslipidaemia. Methods: The study included 767 participants (130 officers and 637 from other ranks). The blood pressure, serum triglycerides and serum cholesterol (total, HDL and LDL) were assessed along with anthropometric measurements such as height, weight, waist-hip ratio in apparently healthy military personnel. Information on smoking, alcohol intake, dietary habits and physical activity was collected using pretested questionnaire. Prehypertension was defined as systolic blood pressure (SBP) 120-139 mm Hg and diastolic blood pressure (DBP) 80-89 mm Hg. Results: The overall prevalence of prehypertension was high (about 80%). The prevalence of other risk factors such as overweight (BMI>23 kg/m2), serum total cholesterol > 200 mg/dl, serum LDL cholesterol > 130 mg/dl, serum HDL cholesterol <40 mg/dl, serum triglyceride > 150 mg/dl in the total group was 30, 22, 22, 67, and 14 per cent, respectively. Most of the personnel undertook moderate or heavy exercise. A significantly higher proportion of individuals with prehypertension had clinical and behavioural risk factors such as overweight, dyslipidaemia and adverse dietary practices like saturated fat and added salt intake. On multivariate logistic regression analysis, prehypertension had significant positive association with BMI>23 kg/m2 (OR 1.75), age (OR 1.89), serum triglyceride >150 mg/dl (OR 2.25)and serum HDL cholesterol <40 mg/dl (OR 1.51). Interpretation & conclusions: The high prevalence of prehypertension and its association with overweight and dyslipidaemia in this young, physically active military population indicates an urgent need for targeted interventions to reduce the cardiovascular risk.

Riesgo cardiovascular en pacientes prehipertensos en un hospital de tercer nivel / Cardiovascular risk in prehypertensive patients in a hospital of third level

Se buscó establecer el impacto de la prehipertensión como causa de eventos cardiovasculares en pacientes del Hospital Universitario San Jorge de Pereira. Se incluyeron pacientes no identificados previamente como hipertensos o que recibieran tratamiento para tal condición y que clasificaran con cifras tensionales sistólicas entre 120 y 139 mmHg y diastólicas entre 80 y 89 mmHg. Del total de prehipertensos se determinó que el 43.4% ingresaron con eventos cardiovasculares, siendo las más prevalentes el evento cerebrovascular y el infarto agudo de miocardio. Se refuerza la indicación de definir la prehipertensión como factor de riesgo a identificar y tratar haciendo énfasis especial en cambios terapéuticos en estilo de vida

An research has been developed with the subject to evaluate the impact of side effects of prehypertension as cardiovascular events on patients of the university hospital San Jorge in the city of Pereira, they include patients non previously identified as hypertensive or who been receiving treatment for that condition and classify with systolic blood pressure between 120 and 139 mmHg and diastolic between 80 and 89 mmHg. From the research where found that 43.4% was ingress with cardiovascular events been more significant stroke and acute coronary syndrome. Those results enhance the indication of defining prehypertension as risk factor to identify and emphasize on therapeutically changes on life style. Within research limitations were found that the time factor was a limitation to increase the samples, which could be important for future research

Prehypertension in Jamaica: a review of data from recent studies / Prehipertensión en Jamaica: revisión de datos de estudios recientes

Prehypertension is defined as a systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg in patients not on medication for hypertension. Recent studies have shown that prehypertension has a high prevalence in both western and eastern countries and is associated with cardiovascular disease (CVD) risk factors, incident CVD and CVD mortality. We reviewed data from ongoing epidemiological studies in Jamaica in order to provide an update on the prevalence and predictors of prehypertension in Jamaica. Studies included were the Jamaica Health and Lifestyle Surveys (2000-2001 and 2007-2008), the Jamaica Youth Risk and Resiliency Behaviour Survey 2006, the 1986 Jamaica Birth Cohort Study and the Spanish Town Cohort Study. The prevalence of prehypertension in the most recent national survey was 35% (95% CI 33, 38%). Prevalence was higher in men compared to women (42% versus 29%). Jamaicans with prehypertension were more likely to have other CVD risk factors and were three times more likely to develop hypertension compared with persons with a normal blood pressure. Prevalence was also high among youth, particularly males. Longitudinal analysis from the 1986 birth cohort suggested that prehypertnsion may be more common in persons with low birthweight or short birth length. Physicians and public health practitioners should recognize the increased CVD risk associated with prehypertension and should begin to institute CVD prevention measures in persons with prehypertension. Sex differences and the early onset of prehypertension in men require further exploration.

La prehipertensión se define como una tensión arterial sistólica de 120-139 mmHg o tensión arterial diastólica de 80-89 mmHg en pacientes que no se hallan bajo medicación a causa de hipertensión. Estudios recientes han mostrado que la hipertensión tiene una alta prevalencia tanto en los países occidentales como en los orientales, hallándose asociada con factores de riesgo de la enfermedad cardiovascular (ECV), ECV incidente y la mortalidad por ECV. Se examinan los datos de los estudios epidemiológicos en curso en Jamaica para ofrecer una actualización acerca de la prevalencia y los predictores de la prehipertensión en Jamaica. Los estudios incluidos fueron las encuestas sobre salud y estilo de vida Jamaica Health and Lifestyle Surveys (2000-2001 y 2007-2008), la encuesta Jamaica Youth Risk and Resiliency Behaviour Survey 2006 sobre las conductas de resiliencia y riesgo de los jóvenes, el estudio de cohorte 1986 Jamaica Birth Cohort Study sobre los nacimientos, y finalmente el llamado Spanish Town Cohort Study. La prevalencia de la prehipertensión en la encuesta nacional más reciente fue de 35% (95% CI 33, 38%). La prevalencia fue más alta en los hombres en comparación con las mujeres (42% frente a 29%). Los jamaicanos con prehipertensión presentaban una mayor probabilidad de tener otros factores de riesgo de ECV, y tenían una probabilidad tres veces mayor de desarrollar hipertensión en comparación con las personas de presión arterial normal. La prevalencia fue también alta entre los jóvenes, particularmente entre los varones. El análisis longitudinal de la cohorte de nacimientos de 1986 sugirió que la hipertensión puede ser más común en las personas con bajo peso al nacer o corta longitud al nacer. Los médicos y los practicantes de salud pública deben reconocer el aumento de riesgo de ECV asociado con la prehipertensión, y deben empezar a instituir medidas de prevención de ECV en personas con prehipertensión. Las diferencias de sexo y el comienzo temprano de la prehipertensión en los hombres requieren ser explorada ulteriormente.

Progression from prehypertension to hypertension in a jamaican cohort: incident hypertension and its predictors / Progresión de la prehipertensión a la hipertensión en una cohorte jamaicana: la hipertensión incidente y sus predictores

OBJECTIVES: To estimate the incidence of hypertension in people with and without prehypertension and determine the factors that predict progression to hypertension. METHODS: Data from a cohort of 25-74-year old residents of Spanish Town , Jamaica, were analysed. All participants completed a structured questionnaire and had blood pressure (BP), anthropometric measurements and venous blood sampling performed by trained personnel. Blood Pressure was classified using the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) criteria. RESULTS: 708 persons who had the required data and were not hypertensive at baseline were included in this analysis. Mean follow-up time was 4.1 years; 28.7% of prehypertensive participants developed hypertension compared to 6.2% of normotensiveparticipants. The unadjusted incidence rate ratio (IRR [95% CI]) for progression among prehypertensive compared to normotensive participants was 4.62[2.96, 7.43]. Among males, the rate of progression to hypertension was significantly higher for those 45-64 years old and those who were current smokers. Among females, progression was higher for age groups 25-44 years, 45-64 years, those who were overweight (BMI > 25), obese (BMI > 30) and current smokers. In multivariate models, prehypertension, female gender, overweight status and older age remained significantly associated with progression to hypertension among the combined prehypertensive and normotensive groups. IRR [95% CI] were: prehypertension, 3.45 [2.18-5.45]; female gender, 1.81 [1.12, 2.94]; overweight, 1.87 [1.15, 2.94]; age 45-64 years, 1.73 [1.08, 2.76]; age > 65 years 2.39 #91;1.31, 4.34]. CONCLUSIONS: Prehypertension is associated with a three-fold increase in the incidence of hypertension. Higher BMI, age and female gender also independently predict the development of hypertension.

OBJETIVOS: Calcular la tasa de incidencia de hipertensión en las personas con y sin prehipertensión y determinar los factores que predicen la progresión a la hipertensión. MÉTODOS: Se analizaron los datos de una cohorte de residentes de 25-74 años de edad, de Spanish Town, Jamaica. Todos los participantes llenaron una encuesta estructurada. Asimismo se les midió la presión arterial (PA), se les realizó mediciones antropométricas, y se les recogió muestras de sangre por parte de un personal técnico calificado. La presión arterial fue clasificada usando criterios del Séptimo Informe del Comité Conjunto Nacional para la Prevención, Detección, Evaluación y Tratamiento de la Presión Arterial Alta (JNC-7). RESULTADOS: 708 personas que tenían los datos requeridos y no eran hipertensas según los datos de base, fueron incluidas en este análisis. El tiempo promedio de seguimiento fue de 4.1 años; 28.7% de los participantes prehipertensos desarrollaron hipertensión en comparación con 6.2% de participantes normotensos. La razón de tasas de incidencia sin ajustar (RTI [95% CI]) para la progresión entre prehipertensos en comparación con los participantes normotensos fue 4.62 [2.96, 7.43]. Entre los varones, la tasa de progresión a la hipertensión fue significativamente más alta para los de 45-64 años y los fumadores. Entre las hembras, la progresión fue más alta para los grupos etarios de 25-44 años, y 45-64 años, los que tenían sobrepeso (IMC = 25), los obesos (IMC = 30) y los fumadores. En los modelos multivariantes, la prehipertensión, el género femenino, la condición de sobrepeso, y un mayor número de años de edad, permanecieron significativamente asociados con la progresión a la hipertensión entre los grupos combinados de prehipertensos y normotensos. Las RTI [95% CI] fueron: la prehipertensión, 3.45 [2.18-5.45]; el género femenino, 1.81 [1.12,2.94]; el sobrepeso, 1.87 [1.15,2.94]; la edad 45-64 años, 1.73[1.08,2.76]; la edad > 65 años 2.39 [1.31,4.34]. CONCLUSIONES: La prehipertensión se halla asociada con un triple aumento de la incidencia de la hipertensión. El IMC más alto, la edad, y el género femenino predicen también independientemente el desarrollo de la hipertensión.

Presión arterial en adolescentes mexicanos: clasificación, factores de riesgo e importancia / Classifying Mexican adolescents' high blood pressure, associated factors and importance

Objetivo Determinar características de riesgo y frecuencia de niveles de presión sanguínea de acuerdo a dos criterios clasificatorios: 7° Comité Nacional Conjunto (JNC-7) y 4° Reporte del grupo de trabajo para el diagnostico, evaluación y tratamiento de la hipertensión arterial en niños y adolescentes. En un grupo de escolares de 12 a 16 años de la ciudad de León, México. Métodos Estudio observacional, descriptivo, transversal de 458 adolescentes varones. Previo consentimiento informado de padres y estudiantes, se determino la presión arterial de acuerdo a normas internacionales y se aplico cuestionario para captación de datos clínico-epidemiológicos de los alumnos investigados. Posteriormente se clasifican niveles de presión arterial (normotensos, prehipertensos, e hipertensos) de acuerdo con los criterios JNC7 y del 4o Reporte del grupo de trabajo para el diagnostico, evaluación y tratamiento de la hipertensión arterial en niños y adolescentes. Resultados Se detectaron, según los criterios JNC-7 y 4° Reporte: 61,3 y 68,7 por ciento normotensos, 34,9 y 20,7 por ciento prehipertensos, y 3,7 y 10,4 por ciento hipertensos. 71 y 66 por ciento con antecedentes familiares de diabetes e hipertensión; 22 por ciento con sobrepeso y obesidad y 24 por ciento con antecedentes de ingesta de alcohol. Conclusiones Se sugiere utilizar el criterio del 4° Reporte para su aplicación en la clínica, mientras que el JNC 7 para estudios epidemiológicos. Destaca el concepto de prehipertensión y su tamizaje temprano para la prevención de la hipertensión arterial. Su aceptación, facilitará el desarrollo de acciones efectivas y eficaces de promoción de salud en cambios del estilo de vida.

Objective Determining characteristics regarding risk and high blood pressure (HBP) frequency in a group of 12 to 16 year-old students from the city of León, Mexico, according to two types of classification: the 7th Joint National Committee (JNC-7) and 4th report of the working group for diagnosis, evaluation and treatment of HBP in children and adolescents. Methods This was an observational, descriptive cross-sectional study of 458 male students. HBP was determined according to international standards after parents and students' informed consent had been obtained and they answered a questionnaire for recording clinical-epidemiological data. Blood pressure levels were classified as being normal, pre-HBP and hyper-HBP in accordance with the guidelines issued by the 7th National Joint Committee for detecting, evaluating and treating HBP (JNC-7) and the 4th report of the working group for diagnosis, evaluation and treatment of HBP in children and adolescents. Results 61.3 percent and 68.7 percent were found to have normal blood pressure, 34.9 percent and 20.7 percent were pre-HBP and 3.7 percent and 10.4 percent hyper-HBP according to JNC-7 and 4th report guidelines, respectively, whilst 71 percent and 66 percent had a family background of diabetes and HBP, 22 percent were overweight and obese and 24 percent had a background of alcohol consumption. Conclusions It is suggested that 4th report guidelines should be adopted in clinical practice whilst JNC-7 guidelines should be used for epidemiological studies. Accepting the pre-HBP concept and its early detection for preventing HBP will facilitate effective health promotion regarding changes in lifestyle.