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OBJECTIVE: A high office blood pressure (BP) is associated with cognitive decline. However, evidence of 24-h ambulatory BP monitoring is limited, and no studies have investigated whether longitudinal changes in 24-h BP are associated with cognitive decline. We aimed to test whether higher longitudinal changes in 24-h ambulatory BP measurements are associated with cognitive decline. METHODS: We included 437 dementia-free participants from the Maracaibo Aging Study with prospective data on 24-h ambulatory BP monitoring and cognitive function, which was assessed using the selective reminding test (SRT) and the Mini-Mental State Examination (MMSE). Using multivariate linear mixed regression models, we analyzed the association between longitudinal changes in measures of 24-h ambulatory BP levels and variability with cognitive decline. RESULTS: Over a median follow-up of 4 years (interquartile range, 2-5 years), longitudinal changes in 24-h BP level were not associated with cognitive function (Pâ≥â0.09). Higher longitudinal changes in 24-h and daytime BP variability were related to a decline in SRT-delayed recall score; the adjusted scores lowered from -0.10 points [95% confidence interval (CI), -0.16 to -0.04) to -0.07 points (95% CI, -0.13 to -0.02). We observed that a higher nighttime BP variability during follow-up was associated with a decline in the MMSE score (adjusted score lowered from -0.08 to -0.06 points). CONCLUSION: Higher 24-h BP variability, but not BP level, was associated with cognitive decline. Prior to or in the early stages of cognitive decline, 24-h ambulatory BP monitoring might guide strategies to reduce the risk of major dementia-related disorders including Alzheimer's disease.
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Cardiovascular diseases continue to be the main cause of death in Venezuela, and hypertension is the principal risk factor. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. May Measurement Month 2021 included 46 732 participants with a mean age of 56.4 years (SD 14.4), 57.9% of whom were female. The percentage with hypertension was 60.3% (57.9% of females and 63.7% of males), 82.3% (84.8% of females and 79.2% of males) were aware, and 80.2% were taking antihypertensive medication. Of those on antihypertensive medication, 44.2% (41.2% of females and 48.2% of males) were not controlled [blood pressure (BP) ≥ 140/≥90â mmHg], with 61.3% receiving one drug, 30.0% two drugs, and 8.7% three or more drugs. 87.5% of those on treatment reported taking it regularly. Conditions associated with higher BP levels include fewer years of education, having a previous diagnosis of hypertension, and women who were hypertensive during a previous pregnancy. Physical activity and pregnancy were conditions associated with lower BP levels. A previous positive COVID-19 test was reported in 11.1%, and one or more COVID-19 vaccinations reported in 22.7% of participants. Of those on antihypertensive medication, 78.8% reported their treatment was not affected by COVID-19. Results are consistent with previous MMM campaigns and indicate that the screening campaign is feasible and useful to identify hypertension even in exceptional conditions such as the COVID-19 pandemic.
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BACKGROUND: Evidence shows that high 24-h blood pressure (BP) variability increases cardiovascular risk. We investigated whether 24-h BP variability relates to mortality and cardiovascular risk due to inherent variability and/or hypertensive loads in 24-h BP. METHODS: A total of 1,050 participants from the Maracaibo Aging Study (mean age, 66 years; women, 67.2%) underwent 24-h ambulatory BP monitoring and were followed between 2001 and 2016. To evaluate inherent BP variability, we used average real variability (ARV) as it captures variability among consecutive BP readings. 24-h systolic BP load was the proportion (%) of systolic BP readings ≥130 mm Hg during the daytime and ≥110 during the nighttime. Our primary endpoint was total mortality and major adverse cardiovascular endpoints (MACE). Statistics included Cox proportional models. RESULTS: During a median follow-up of 8.3 years, 299 participants died and 210 experienced MACE. Each +2 mm Hg (corresponding to 1-standard deviation) higher 24-h systolic ARV (mean value, 9.0â ±â 2.0 mm Hg) was associated with higher hazard ratios (HRs) for mortality by 1.28-fold (95% confidence interval [CI], 1.14-1.43) and for MACE by 1.24-fold (95% CI, 1.08-1.42). Each 30% higher 24-h systolic BP load (median value, 63%) was associated with mortality and MACE with HRs of 1.29 (95% CI, 1.15-1.46) and 1.28 (95% CI, 1.10-1.48); respectively. After models were additionally adjusted by BP level, only ARV was associated with mortality (HR, 1.17; 95% CI, 1.04-1.33) and MACE (HR, 1.16; 95% CI, 1.00-1.34). CONCLUSIONS: High ARV and hypertensive loads in 24-h systolic BP were associated with mortality and cardiovascular risk, however, only ARV is associated independently of the BP level.
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Doenças Cardiovasculares , Hipertensão , Humanos , Feminino , Idoso , Pressão Sanguínea/fisiologia , Fatores de Risco , Hipertensão/complicações , Monitorização Ambulatorial da Pressão Arterial , Fatores de Risco de Doenças CardíacasRESUMO
Background: Twenty-four-hour and nighttime blood pressure (BP) levels are more strongly associated with cardiovascular risk than office or daytime BP measurements. However, it remains undocumented which of the office and ambulatory BP measurements have the strongest association and predictive information in relation to the presence of type I, or arteriolosclerosis type, cerebral small vessel diseases (CSVD). Methods: A subset of 429 participants from the Maracaibo Aging Study [aged ≥40 years (women, 73.7%; mean age, 59.3 years)] underwent baseline brain magnetic resonance imaging (MRI) to visualize CSVD, which included log-transformed white matter hyperintensities (log-WMH) volume and the presence (yes/no) of lacunes, cerebral microbleeds (CMB), or enlarged perivascular spaces (EPVS). Linear and logistic regression models were applied to examine the association between CSVD and each +10-mmHg increment in the office and ambulatory systolic BP measurements. Improvement in the fit of nested logistic models was assessed by the log-likelihood ratio and the generalized R 2 statistic. Results: Office and ambulatory systolic BP measurements were related to log-WMH (ß-correlation coefficients ≥0.08; P < 0.001). Lacunes and CMB were only associated with ambulatory systolic BP measurements (odds ratios [OR] ranged from 1.31 [95% confidence interval, 1.10-1.55] to 1.46 [1.17-1.84], P ≤ 0.003). Accounted for daytime systolic BP, both the 24-h (ß-correlation, 0.170) and nighttime (ß-correlation, 0.038) systolic BP measurements remained related to log-WMH. When accounted for 24-h or daytime systolic BP levels, the nighttime systolic BP retained the significant association with lacunes (ORs, 1.05-1.06; 95% CIs, ≥1.01 to ≤ 1.13), whereas the 24-h and daytime systolic BP levels were not associated with lacunes after adjustments for nighttime systolic BP (ORs, ≤ 0.88; 95% CI, ≥0.77 to ≤ 1.14). On top of covariables and office systolic BP, ambulatory systolic BP measurements significantly improved model performance (1.05% ≥ R 2 ≤ 3.82%). Compared to 24-h and daytime systolic BP, nighttime systolic BP had the strongest improvement in the model performance; for WMH (1.46 vs. 1.05%) and lacunes (3.06 vs. ≤ 2.05%). Conclusions: Twenty-four-hour and nighttime systolic BP were the more robust BP measurements associated with CSVD, but the nighttime systolic BP level had the strongest association. Controlling ambulatory BP levels might provide additional improvement in the prevention of CSVD.
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BACKGROUND: Mean arterial pressure (MAP) drives ocular perfusion. Excessive 24-h MAP variability relates to glaucoma, however, whether this is due to dips or increases in the blood pressure (BP) is undocumented. We investigated the association of open-angle glaucoma (OAG) in relation to the 5 largest MAP dips/increases over 24-h, henceforth called dips/blips. METHODS: In the Maracaibo Aging Study (MAS), 93 participants aged ≥40 y (women, 87.1%; mean age, 61.9 y) underwent baseline ophthalmological and 24-h ambulatory BP monitoring assessments. OAG was the presence of optic nerve damage and visual field defects. Statistical methods included logistic regression and the generalized R2 statistic. For replication, 48 OAG cases at the Leuven Glaucoma Clinic were matched with 48 controls recruited from Flemish population. RESULTS: In the MAS, 26 participants had OAG. OAG compared to non-OAG participants experienced longer and deeper dips (116.5 vs. 102.7 minutes; to 60.3 vs. 66.6 mm Hg; -21.0 vs. -18.0 mm Hg absolute or 0.79 vs. 0.81 relative dip compared to the preceding reading). The adjusted odds ratios associated with dip measures ranged from 2.25 (95% confidence interval [CI], 1.31-4.85; Pâ =â 0.009) to 3.39 (95% CI, 1.36-8.46; Pâ =â 0.008). On top of covariables and 24-MAP level/variability, the dip measures increased the model performance (Pâ ≤â 0.025). Blips did not associate with OAG. The case-control study replicated the MAS observations. CONCLUSIONS: Dips rather than increases in the 24-h MAP level were associated with increased risk for OAG. An ophthalmological examination combined with 24-h BP monitoring might be precautious steps required in normotensive and hypertensive patients at risk of OAG.
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Glaucoma de Ângulo Aberto , Doenças do Nervo Óptico , Pressão Arterial , Estudos de Casos e Controles , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Pressão Intraocular , Pessoa de Meia-Idade , Nervo Óptico , Doenças do Nervo Óptico/diagnósticoRESUMO
Hypoperfusion of the optic nerve might be involved in the pathogenesis of normal-tension glaucomatous optic neuropathy (GON). Mean arterial pressure (MAP) drives ocular perfusion, but no previous studies have addressed the risk of GON in relation to blood pressure (BP) variability, independent of BP level. In a cross-sectional study, 93 residents of Maracaibo, Venezuela, underwent optical coherence tomography, visual field assessments and 24-h ambulatory BP monitoring between 2011 and 2016. We investigated the association of normal-tension GON with or without visual field defects with reading-to reading variability of 24-h MAP, as captured by variability independent of the MAP level (VIMmap). Odds ratios (ORs) were adjusted for 24-h MAP level and for a propensity score of up to five risk factors. Among the 93 participants (87.1% women; mean age, 61.9 years), 26 had open-angle normal-tension GON at both eyes; 14 had visual field defects; and 19 did not have visual field defects. The OR ratios for normal-tension GON, expressed per 1-SD increment in VIMmap (2 mm Hg), were 2.17 (95% confidence interval, 1.33-3.53) unadjusted; 2.20 (1.35-3.61) adjusted for 24-h MAP level only; 1.93 (1.10-3.41) with additional adjustment for age, educational attainment, high-density lipoprotein (HDL) cholesterol and office hypertension; and 1.95 (1.10-3.45) in models including intraocular pressure. We confirmed our a priori hypothesis that BP variability, most likely operating via hypoperfusion of the optic nerve, is associated with normal-tension GON. 24-H ambulatory BP monitoring might therefore help stratify the risk of normal-tension GON.
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Glaucoma , Doenças do Nervo Óptico , Envelhecimento , Pressão Sanguínea , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervo ÓpticoRESUMO
The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.
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Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Pressão Sanguínea , Determinação da Pressão Arterial , Humanos , Hipertensão/diagnóstico , Sociedades MédicasRESUMO
BACKGROUND: Venezuela is in the throes of a complex humanitarian crisis that is one of the worst in decades to impact any country outside of wartime. This case analysis describes the challenges faced by the ongoing Maracaibo Aging Study (MAS) during the deteriorating conditions in Venezuela. When the MAS began in 1997, it focused on memory-related disorders. Since then, strategic planning and proactive community participation allowed us to anticipate and address logistical, funding, and ethical challenges, and facilitated the enrollment and retention of more than 2500 subjects over 55 years of age. All participants, who are residents of the city of Maracaibo, Venezuela, underwent various assessments on several occasions. Here, we discuss how our approach to implementing a longitudinal, population-based study of age-related conditions has allowed our research program to continue throughout this period of political, economic, and social upheaval. DISCUSSION: As the social context in Venezuela became more complicated, new challenges emerged, and strategies to sustain the study and participation were refined. We identified five main mechanisms through which the evolving humanitarian crisis has affected implementation of the MAS: 1) community dynamics; 2) morale of researchers, staff, and participants; 3) financial feasibility; 4) components of the research process; and 5) impact on the health of staff, participants, and their families. Strategies to compensate for the impact on these components were implemented, based on inputs from community members and staff. Improved communication, greater involvement of stakeholders, broadening the scope of the project, and strengthening international collaboration have been the most useful strategies. Particular demands emerged, related to the increased mortality and comorbidities of participants and staff, and deterioration of basic services and safety. CONCLUSION: Although the MAS has faced numerous obstacles, it has been possible to continue a longitudinal research project throughout the humanitarian crisis, because our research team has engaged the community deeply and developed a sense of mutual commitment, and also because our project has provided funding to help keep researchers employed, somewhat attenuating the brain drain.
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Participação da Comunidade , Hispânico ou Latino , Envelhecimento , Humanos , Pesquisadores , VenezuelaRESUMO
Cardiovascular diseases are the main cause of death in Venezuela. Raised blood pressure (BP) accompanied by diabetes mellitus, obesity, lipid abnormalities, and tobacco usage are the biggest contributors to mortality. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. MMM2019 included 24 672 subjects (mean age: 54.7 years, SD 25.2, 63.1% female). The proportion with hypertension was 48.9%; 14.3% were unknown hypertensives, 35.5% of those who receiving treatment had uncontrolled hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg); when considering all hypertensives, 53.3% were controlled. Sixty per cent of those on anti-hypertensive medication were on monotherapy, 27.7% were on two, and 7.7% were on three or more drugs. Body mass index, calculated for the total population, was on average 25.6 (SD: 4.8) kg/m2. 16.2% of participants were classified as obese, 34.0% as overweight, and 4.0% were classified as underweight. Diabetes mellitus was reported by 9.4%, smoking by 7.3%, and 10.5% reported drinking alcohol regularly. Conditions associated with higher BP levels were obesity, diabetes mellitus, and women with a history of hypertension during a previous pregnancy. These results are consistent with the two previous MMM campaigns and indicate that repeated screening can routinely identify hypertension. There is an urgent need for Venezuela to implement programmes of detection, treatment, and control not only for hypertension but also for other common cardiovascular risk factors.
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Cardiovascular diseases, mainly coronary heart disease and stroke, are the main cause of death in Venezuela; hypertension is the primary risk factor. The May Measurement Month (MMM) study is a global initiative aimed at raising awareness of elevated blood pressure (BP). The previous MMM 2017 campaign showed 48.9% of participants had hypertension, higher than previous Venezuelan epidemiological studies. The MMM 2018 campaign included 28 649 participants screened [mean age: 54.2 (SD 15.13) years; female 62.8%] carried out mainly in pharmacies in 61 sites. Physical measurements included height, weight, and BP, taken in sitting position three times. After multiple imputations, 48.4% had hypertension, of which 87.7% were aware of their diagnosis. Of the individuals not receiving antihypertensive medication, 14.0% had hypertension and 33.7% of those receiving treatment had uncontrolled hypertension. Overall, the percentage of hypertensives with controlled hypertension was 54.8%. Body mass index was calculated for the total population, and it was on average 25.2 (SD: 4.65) kg/m2. Of all, 14.2% was classified as obese and 32.6% as overweight; meanwhile 4.8% as underweight. Diabetes was reported by 9.5%. These results suggest that repeated screening like the MMM campaign can routinely identify hypertension and consequently implement programmes of treatment in Venezuela, also other common risk factors, like obesity or diabetes.
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BACKGROUND: Dementia of the Alzheimer's type (DAT) impacts Hispanics disproportionately, with almost a twofold elevated risk of developing DAT, as well as earlier onset of the disease, than in non-Hispanic Whites. However, the role of main risk factors for DAT, such as APOE-É4 and blood pressure (BP) levels, remains uncertain among Hispanics. OBJECTIVE: To investigate the association of APOE-É4 and BP levels, measures with 24-h ambulatory BP monitoring, with incidence of DAT in an elderly cohort of Hispanics. METHODS: 1,320 participants from the Maracaibo Aging Study, free of dementia at the baseline, and with ambulatory BP measurements and APOE genotype available were included. Adjusted Cox proportional models were performed to examine 1) the incidence of DAT and 2) the relationship between BP levels and DAT according to APOE genotypes. Models were adjusted by competing risk of death before the onset of DAT. Model performance was assessed by likelihood test. RESULTS: The average follow-up time was 5.3 years. DAT incidence was 5.8 per 1000 person-year. APOE-É4 carriers had a higher risk of DAT. In unadjusted analyses, conventional, 24-h, and nighttime systolic BP levels were significantly higher in participants who developed DAT and of APOE-É4 carriers (p < 0.05). After adjustment for competing risks, only higher nighttime systolic BP was associated with DAT incidence, but only among subjects carrying APOE-É4. CONCLUSION: In this Hispanic population, both APOE-É4 genotype and assessment of nocturnal systolic BP (rather than diurnal or office BP) were necessary to estimate DAT risk.
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Doença de Alzheimer/genética , Apolipoproteína E4/genética , Pressão Sanguínea/genética , Ritmo Circadiano/genética , Demência/genética , Genótipo , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/etnologia , Demência/diagnóstico , Demência/etnologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Venezuela/etnologiaRESUMO
Cardiovascular diseases, mainly coronary heart disease and stroke, are the first cause of death in Venezuela; and hypertension is the main risk factor. May Measurement Month (MMM) is a global initiative aimed at raising awareness of elevated blood pressure (BP) and to act as a temporary solution to the lack of regular screening programmes. Some representative studies indicate prevalence of hypertension in Venezuela between 24 and 39%, and control rate around 20%. Sixty-four sites were included to participate in MMM, mainly in pharmacies. Physical measurements included height, weight, and abdominal circumference. Blood pressure was measured in the sitting position three times after resting for 5 min, 1 min apart, using validated oscillometric devices. 21 644 individuals were screened. After multiple imputation, 10 584 individuals [48.9% (50.7% male; 47.7% female)] had hypertension. Of individuals not receiving antihypertensive medication, 1538 (12.2%) were hypertensive. Of individuals receiving antihypertensive medication, 2974 (32.9%) had uncontrolled BP. About 16% had obesity calculated by body mass index; 43.8% of women and 20.7% of men had abdominal obesity. This was the largest BP screening carried out in Venezuela, in which 48.9% of the individuals had elevated BP, untreated hypertension was 12.2%, and one-third of subjects taking treatment were not controlled. About 16% had obesity by body mass index, and abdominal obesity is more common in women. These results suggest that repeated screening like MMM17 can identify hypertension in important numbers and can also evaluate programmes of hypertension treatment and control in Venezuela.
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Se examinó la asociación entre el estrés psicológico (EP) y la prehiperten sión (PH) en adolescentes. La muestra estuvo conformada por 690 adolescentes: 260 varones y 430 hembras, con una media de edad de 15 años, (DE=1,5), a quienes se les determinó su presión arterial (PA) en la escuela, en posición sentada y usando el método oscilométrico (Dinamap). Todos, sin excepción, completaron una encuesta sobre eventos de vida y evaluación de ajuste social, ambas escalas asociadas con estresores vitales en adolescentes. Los partici pantes se clasificaron de acuerdo a los niveles de PA en prehipertensos (PH) y normotensos (N). La presencia de EP se evaluó como graves acontecimientos estresantes en su vida. Se utilizó la prueba de Chi cuadrado para estudiar la asociación entre EP y la presencia de PH. Los resultados arrojaron la presencia de EP en 70 varones (26,9%) y 155 hembras (36,0%), mientras que la prevalencia de prehipertensión fue de 9,2% (n=24) en varones y 3,5% (n=15) en hembras. Al aplicar la prueba estadística de Chi cuadrado en todos los adolescentes no se demostró asociación significativas entre EP y la condición de prehipertensión (PH con EP = 15 vs. N con EP = 24 (P = 0,42)). Sin embargo, al clasificar los sujetos por género, se encontró una asociación significativa entre EP y PH en las hembras (PH con EP = 9 vs. N con EP = 6, (P = 0,04)). El resultado anterior sugiere que, a edades tempranas, las mujeres pueden ser más vulnerables que los hombres al EP como un factor determinante a la condición de PH.
The article examines the association between psychological stress (PS) and prehypertension (PH) in 690 adolescents, 260 males and 430 females, whose average age was 15.2 years (SD = 1.5). Their blood pressure (BP) was measured on separate days at school, by the oscillometric method (Dinamap) in a seating position. All of them completed a survey assessing life events and social readjustment (both scales associated with life stressors in adolescen ce). Participants were classified according to BP levels in prehypertensive (PH) and normoten sive (N). The presence of PS was evaluated as severe stressful life events. The Chi-square test was used to study the association between PS and the presence of PH. The results showed the presence of PH in 9.2% (n = 24) in males and 3.5% (n = 15) in females, while the presence of PS ocurred in 70 males (26.9%) and 155 females (36.0%).When applied to the whole data, the Chi-square statistical test showed no association between PS and the condition of prehyperten sion (PH with PS = 15 vs. N with PS = 24, (P= 0.42)). However, when subjects were classified by gender, there was a significant association between PS and PH in female adolescents (PH with PS = 9 vs N with PS = 6 (P = 0.04)). This result suggests that, at early ages, female adolescents may be more vulnerable than males to PS as a determining factor to the condition of PH.
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Adolescente , Criança , Feminino , Humanos , Masculino , Estresse Psicológico/complicações , Pré-Hipertensão/etiologia , Estudos TransversaisRESUMO
The article examines the association between psychological stress (PS) and prehypertension (PH) in 690 adolescents, 260 males and 430 females, whose average age was 15.2 years (SD = 1.5). Their blood pressure (BP) was measured on separate days at school, by the oscillometric method (Dinamap) in a seating position. All of them completed a survey assessing life events and social readjustment (both scales associated with life stressors in adolescence). Participants were classified according to BP levels in prehypertensive (PH) and normotensive (N). The presence of PS was evaluated as severe stressful life events. The Chi-square test was used to study the association between PS and the presence of PH. The results showed the presence of PH in 9.2% (n = 24) in males and 3.5% (n = 15) in females, while the presence of PS ocurred in 70 males (26.9%) and 155 females (36.0%).When applied to the whole data, the Chi-square statistical test showed no association between PS and the condition of prehypertension [PH with PS = 15 vs. N with PS = 24, (P= 0.42)]. However, when subjects were classified by gender, there was a significant association between PS and PH in female adolescents [PH with PS = 9 vs N with PS = 6 (P = 0.04)]. This result suggests that, at early ages, female adolescents may be more vulnerable than males to PS as a determining factor to the condition of PH.
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Pré-Hipertensão/etiologia , Estresse Psicológico/complicações , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , MasculinoRESUMO
OBJECTIVE: The Ambulatory blood pressure Registry TEleMonitoring of hypertension and cardiovascular rISk project was designed to set up an international registry including clinic blood pressure (CBP) and ambulatory blood pressure (ABP) measurements in patients attending hypertension clinics in all five continents, aiming to assess different daily life hypertension types. METHODS: Cross-sectional ABP, CBP and demographic data, medical history and cardiovascular risk profile were provided from existing databases by hypertension clinics. Hypertension types were evaluated considering CBP (≥140/90âmmHg) and 24-h ABP (≥130/80âmmHg). RESULTS: Overall, 14â143 patients from 27 countries across all five continents were analyzed (Europe 73%, Africa 3%, America 9%, Asia 14% and Australia 2%). Mean age was 57â±â14 years, men 51%, treated for hypertension 46%, cardiovascular disease 14%, people with diabetes 14%, dyslipidemia 33% and smokers 19%. The prevalence of hypertension was higher by CBP than by ABP monitoring (72 vs. 60%, Pâ<â0.0001). Sustained hypertension (elevated CBP and ABP) was detected in 49% of patients. White-coat hypertension (WCH, elevated CBP with normal ABP) was more common than masked hypertension (elevated ABP with normal CBP) (23 vs. 10%; Pâ<â0.0001). Sustained hypertension was more common in Europe and America and in elderly, men, obese patients with cardiovascular comorbidities. WCH was less common in Australia, America and Africa, and more common in elderly, obese women. Masked hypertension was more common in Asia and in men with diabetes. Smoking was a determinant for sustained hypertension and masked hypertension. CONCLUSION: Our analysis showed an unbalanced distribution of WCH and masked hypertension patterns among different continents, suggesting an interplay of genetic and environmental factors, and likely also different healthcare administrative and practice patterns.
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Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Hipertensão/classificação , Hipertensão/epidemiologia , Adulto , África/epidemiologia , Idoso , Ásia/epidemiologia , Austrália/epidemiologia , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Sistema de Registros , Fatores de Risco , Estados Unidos , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/epidemiologiaRESUMO
We evaluated the cost-effectiveness of administering a daily "polypill" consisting of three antihypertensive drugs, a statin, and aspirin to prevent cardiovascular disease among high-risk patients in Latin America. We found that the lifetime risk of cardiovascular disease could be reduced by 15 percent in women and by 21 percent in men if the polypill were used by people with a risk of cardiovascular disease equal to or greater than 15 percent over ten years. Attaining this goal would require treating 26 percent of the population at a cost of $34-$36 per quality-adjusted life-year. Offering the polypill to women at high risk and to men age fifty-five or older would be the best approach and would yield acceptable incremental cost-effectiveness ratios. The polypill would be very cost-effective even in the country with the lowest gross national income in our study. However, policy makers must weigh the value of intervention with the polypill against other interventions, as well as their country's willingness and ability to pay for the intervention.
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Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/economia , Aspirina/administração & dosagem , Aspirina/economia , Doenças Cardiovasculares/prevenção & controle , Países em Desenvolvimento , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Sinvastatina/administração & dosagem , Sinvastatina/economia , Idoso , Atenolol/administração & dosagem , Atenolol/economia , Doenças Cardiovasculares/economia , Estudos de Coortes , Análise Custo-Benefício , Combinação de Medicamentos , Feminino , Humanos , América Latina , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Ramipril/administração & dosagem , Ramipril/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Inibidores de Simportadores de Cloreto de Sódio/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio/economiaRESUMO
BACKGROUND: Limited knowledge on the prevalence and distribution of risk factors impairs the planning and implementation of cardiovascular prevention programs in the Latin American and Caribbean (LAC) region. METHODS AND FINDINGS: Prevalence of hypertension, diabetes mellitus, abnormal lipoprotein levels, obesity, and smoking were estimated from individual-level patient data pooled from population-based surveys (1998-2007, n=31,009) from eight LAC countries and from a national survey of the United States (US) population (1999-2004) Age and gender specific prevalence were estimated and age-gender adjusted comparisons between both populations were conducted. Prevalence of diabetes mellitus, hypertension, and low high-density lipoprotein (HDL)-cholesterol in LAC were 5% (95% confidence interval [95% CI]: 3.4, 7.9), 20.2% (95% CI: 12.5, 31), and 53.3% (95% CI: 47, 63.4), respectively. Compared to LAC region's average, the prevalence of each risk factor tended to be lower in Peru and higher in Chile. LAC women had higher prevalence of obesity and low HDL-cholesterol than men. Obesity, hypercholesterolemia, and hypertriglyceridemia were more prevalent in the US population than in LAC population (31 vs. 16.1%, 16.8 vs. 8.9%, and 36.2 vs. 26.5%, respectively). However, the prevalence of low HDL-cholesterol was higher in LAC than in the US (53.3 vs. 33.7%). CONCLUSIONS: Major cardiovascular risk factors are highly prevalent in LAC region, in particular low HDL-cholesterol. In addition, marked differences do exist in this prevalence profile between LAC and the US. The observed patterns of obesity-related risk factors and their current and future impact on the burden of cardiovascular diseases remain to be explained.
Assuntos
Doenças Cardiovasculares/epidemiologia , Obesidade/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Doenças Cardiovasculares/sangue , Chile/epidemiologia , Colesterol/sangue , HDL-Colesterol/sangue , Colômbia/epidemiologia , Costa Rica/epidemiologia , República Dominicana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade/sangue , Peru/epidemiologia , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Triglicerídeos/sangue , Estados Unidos/epidemiologia , Venezuela/epidemiologia , Adulto JovemRESUMO
Studies have highlighted the association between insulin resistance (IR) and several cardiovascular (CV) risk factors, including hypertension (HTN), obesity, dyslipidemia (i.e. high triglyceride and low HDL-cholesterol) and glucose intolerance, in a cluster known as the metabolic syndrome (MS). There are few data on the frequency of the MS and dyslipidemia in developing countries, and none in South America. To estimate the prevalence of the MS and its components in Zulia State, Venezuela, and to establish associated demographic and clinical factors, we evaluated 3108 Hispanic men and women aged 20 years or older from a cross-sectional survey of a random representative sample from each health district in Zulia State, Venezuela (1999-2001). Prevalence of the MS and dyslipidemia was defined according to the National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATP III) criteria. The age-adjusted prevalence of MS and dyslipidemia was 31.2% and 24.1%, respectively, with higher rates in men than in women. Prevalence rates increased with age and with the degree of obesity. MS prevalence was lower in Amerindian (17.%) compared to Black (27.2%), White (33.3%) and Mixed (37.4%) men, but no differences were found among women. Overall, low HDL-cholesterol (65.3%), abdominal obesity (42.9%) and HTN (38.1%) were the most frequent MS components. After adjusting for age, sex and race groups, family history of diabetes, obesity and HTN were associated with the MS. Sedentary lifestyle also increased the risk of MS, event after adjusting for the same covariates, obesity and the degree of IR. These results suggest that MS is found in approximately one-third of the Venezuelan adult population in Zulia State, with higher prevalence in men related to the presence of dyslipidemia. Lifestyle interventions in MS subjects are needed in Venezuela to halt the burden of CV disease and diabetes.
Assuntos
Hiperlipidemias/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , População Negra , Feminino , Hispânico ou Latino , Humanos , Indígenas Sul-Americanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Venezuela/epidemiologia , População BrancaRESUMO
The Maracaibo Aging Study is a longitudinal, population-based, one-step multidisciplinary study of age-related diseases, with a particular focus on memory-related disorders, among subjects over 55 years living in a neighborhood of the city of Maracaibo, Venezuela. Three phases were scheduled for this study. First, a door-to-door survey was conducted in order to build a registry and to obtain general and sociodemographic characteristics. During the second phase, information regarding changes in the abilities of the subjects was collected. The third phase consisted of a full neuropsychiatric examination, cardiovascular evaluation, nutritional assessment, neuropsychological testing, routine laboratory tests and genetic analysis. 3,657 subjects were surveyed between January and August, 1998. There were more women than men, and the average number of years of formal education was low, particularly among women. The limitations and strengths of the study are discussed.
Assuntos
Envelhecimento , Doenças Cardiovasculares/epidemiologia , Transtornos Cognitivos/epidemiologia , Demência/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Transtornos Cognitivos/diagnóstico , Comorbidade , Demência/diagnóstico , Demografia , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estado Nutricional , Projetos Piloto , Estudos Prospectivos , Inquéritos e Questionários , Venezuela/epidemiologiaRESUMO
Con el propósito de analizar los factores nutricionales y metabólicos de riesgo de enfermedades cardiovasculares (ECV) presentes en un grupo de individuos de la ciudad de Maracaibo, se realizó este estudio en 209 voluntarios entre 20 y 89 años (145 mujeres y 64 hombres), a quienes se les practicó: a) evaluación antropométrica: índice de masa corporal (IMC) y cociente cintura cadera (CCC) y examen físico: presión arterial sistólica (PAS) y diastólica (PAD); b) evaluación dietética (recordatorio de 24 horas) y c) evaluación bioquímica: glicemia (GLI), triglicéridos (TG), colesterol total (COL), HDL-C, LDL-C y VLDL-C, por métodos enzimáticos. Se investigó además: edad, antecedentes familiares de alteraciones metabólicas (A.F.A.M.), hábito tabáquico, hábito alcohólico, actividad física. Más del 50 por ciento de los sujetos estudiados tuvo un IMC > 25; 64 por ciento de mujeres presentó un valor de CCC > 0,8; 34 y 28 por ciento de hombres y mujeres respectivamente tuvieron un alto consumo de grasa (A.C.G.); 36 por ciento de hombres tuvieron hipertrigliceridemia y niveles elevados de VLDL-C; las HDL-C estuvieron disminuidas en 41 por ciento de las mujeres y 30 por ciento de los hombres; los A.F.A.M. ocuparon una alta frecuencia (85 por ciento en mujeres y 78 por ciento en hombres) seguido por el sedentarismo (64 y 79 por ciento en hombres y mujeres respectivamente); la edad afectó de manera significativa (p < 0.05) los valores de CCC, PAS, PAD, GLI, COL, TG, HDL-C, LDL y VLDL-C; la dieta resultó hipocalórica, hiperproteica, normograsa e hipohidrocarbonada. Se concluye que la población estudiada puede ser considerada a riesgo de ECV, ya que tanto los factores nutricionales y metabólicos, así como los otros factores de riesgo analizados, estuvieron presentes en un elevado porcentaje de individuos estudiados