May Measurement Month 2017: an analysis of blood pressure screening results from the United Kingdom and the Republic of Ireland-Europe.

Elevated blood pressure (BP), or hypertension, is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and acting as a stimulus to improving screening programmes worldwide. In the United Kingdom (UK) nearly 1 in 5 people, and in the Republic of Ireland (RoI) 3 out of 10, have hypertension, of which a large proportion remains undiagnosed. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed a standardized protocol. Screenings sites in hospitals, universities, shopping centres, workplaces, sports clubs, community centres, GP practices, and pharmacies were set up across the UK and RoI as part of this initiative. Seven thousand seven hundred and fourteen individuals were screened during MMM17. After multiple imputation, 3099 (40.3%) had hypertension. Of individuals not receiving antihypertensive medication, 1406 (23.4%) were hypertensive. Of individuals receiving antihypertensive medication, 682 (40.5%) had uncontrolled BP. MMM17 was the largest BP screening campaign ever undertaken in the UK and RoI. These data prove for the first time that a relatively inexpensive, volunteer based, convenience sampling of screening BP in the community identified two out of five individuals as hypertensive, with one in four not receiving treatment. Of major concern is that these data demonstrate that of those individuals receiving treatment, two out of five still did not have controlled BP.

Perspectiva clínica sobre el tratamiento antihipertensivo en adultos con hipertensión grado 1 y riesgo cardiovascular bajo a moderado: consulta internacional de expertos

[RESUMEN]. La hipertensión arterial es el principal factor de riesgo de la carga global de las enfermedades. Una pregunta en debate es si la hipertensión arterial grado 1 (140–159/90–99 mm Hg) con riesgo cardiovascular (RCV) total bajo (mortalidad cardiovascular < 1% a los 10 años) a moderado (mortalidad cardiovascular > 1% y < 5% a los 10 años) debe ser tratada con agentes antihipertensivos. Un proceso de consulta virtual internacional fue realizado para resumir las opiniones de los expertos seleccionados. Después del análisis holístico de todos los elementos epidemiológicos, clínicos, psicosociales y de salud pública, este proceso de consulta llegó al siguiente consenso para adultos hipertensos < 80 años de edad: 1) La interrogante, de si el tratamiento medicamentoso en la hipertensión grado 1 debe ser precedido por un periodo de algunas semanas o meses, durante el cual solo se recomienden medidas sobre el estilo de vida no está basada en evidencia, pero el consenso de opinión es reservar un periodo para solo cambios en el estilo de vida únicamente en los pacientes con hipertensión grado 1 “aislada” (hipertensión grado 1 no complicada con RCV total absoluto bajo, y sin otros factores de RCV mayores ni modificadores del riesgo). 2) El inicio del tratamiento antihipertensivo medicamentoso en pacientes con hipertensión grado 1 y RCV absoluto moderado no debe demorarse. 3) Los hombres ≥ 55 años y las mujeres ≥ 60 años con hipertensión grado 1 no complicada deben ser automáticamente clasificados dentro de la categoría de RCV total absoluto moderado, incluso en ausencia de otros factores de riesgo mayores y modificadores del riesgo. 4) Las estatinas deben tenerse en cuenta junto con la terapia antihipertensiva, independientemente de los valores de colesterol, en pacientes con hipertensión grado 1 y RCV moderado.

[ABSTRACT]. Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99 mmHg) with low (cardiovascular mortality < 1% at 10 years) to moderate (cardiovascular mortality > 1% and < 5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged < 80 years: (1) The question of whether drug treatment in grade 1 should be preceded by a period of some weeks or months during which only life style measures are recommended cannot be evidence based, but the consensus opinion is to have a period of lifestyle alone reserved only to patients with grade 1 “isolated” hypertension (grade 1 uncomplicated hypertension with low absolute total CVR, and without other major CVR factors and risk modifiers). (2)The initiation of antihypertensive drug therapy in grade 1 hypertension with moderate absolute total CVR should not be delayed. (3) Men ≥ 55 years and women ≥ 60 years with uncomplicated grade1 hypertension should automatically be classified within the moderate absolute total CVR category, even in the absence of other major CVR factors and risk modifiers. (4) Statins should be considered along with blood-pressure lowering therapy, irrespective of cholesterol levels, in patients with grade 1 hypertensive with moderate CVR.

Clinical Perspective on Antihypertensive Drug Treatment in Adults With Grade 1 Hypertension and Low-to-Moderate Cardiovascular Risk: An International Expert Consultation.

Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99mmHg) with low (cardiovascular mortality <1% at 10 years) to moderate (cardiovascular mortality ≥1% and <5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged <80 years: (1) The question of whether drug treatment in grade 1 should be preceded by a period of some weeks or months during which only lifestyle measures are recommended cannot be evidence based, but the consensus opinion is to have a period of lifestyle alone reserved only to patients with grade 1 "isolated" hypertension (grade 1 uncomplicated hypertension with low absolute total CVR, and without other major CVR factors and risk modifiers). (2) The initiation of antihypertensive drug therapy in grade 1 hypertension with moderate absolute total CVR should not be delayed. (3) Men ≥55 years and women ≥60 years with uncomplicated grade 1 hypertension should automatically be classified within the moderate absolute total CVR category, even in the absence of other major CVR factors and risk modifiers. (4) Statins should be considered along with blood-pressure lowering therapy, irrespective of cholesterol levels, in patients with grade 1 hypertensive with moderate CVR.

Low serum testosterone and increased diastolic ocular perfusion pressure: a risk for retinal microvasculature.

BACKGROUND: Low levels of testosterone in men and changes in retinal microvascular calibre are both associated with hypertension and cardiovascular disease risk. Sex hormones are also associated with blood flow in microvascular beds which might be a key intermediate mechanism in the development of hypertension. Whether a direct association between endogenous testosterone and retinal microvascular calibre exists is currently unknown. We aimed to determine whether testosterone is independently associated with ocular perfusion via a possible association with retinal vascular calibre or whether it plays only a secondary role via its effect on blood pressure in a bi-ethnic male cohort. PROBANDS AND METHODS: A total of 72 black and 81 white men (28-68 years of age) from the follow-up phase of the Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study were included in this sub-study. Ambulatory pulse pressure and intraocular perfusion pressures were obtained, while metabolic variables and testosterone were measured from fasting venous blood samples. Retinal vascular calibre was quantified from digital photographs using standardised protocols. RESULTS: The black men revealed a poorer cardiometabolic profile and higher pulsatile pressure (>50 mm Hg), intraocular pressure and diastolic ocular perfusion pressure than the white men (p≤0.05). Only in the white men was free testosterone positively associated with retinal calibre, i.e. arterio-venular ratio and central retinal arterial calibre and inversely with central retinal venular calibre. These associations were not found in the black men, independent of whether pulse pressure and ocular perfusion pressure were part of the model. CONCLUSIONS: These results suggest an independent, protective effect of testosterone on the retinal vasculature where an apparent vasodilatory response in the retinal resistance microvessels was observed in white men.

Progression of cardiovascular risk factors in black Africans: 3 year follow up of the SABPA cohort study.

Recent work identified a high prevalence of modifiable risk factors for cardiovascular disease (CVD) among urban black South Africans. The aim was to track the progression of CVD risk factors in a multi-ethnic sample of South Africans. Participants were 173 black (aged 47.5 ± 7.8 yrs) and 186 white teachers (aged 49.6 ± 9.9 yrs) that were examined at baseline and 3 years follow-up. Blacks demonstrated a substantially higher prevalence of composite CVD burden (defined as history of physician diagnosed heart disease, use of anti-hypertensives, anti-diabetic, or statin medications at either time point) compared to whites (49.1 vs. 32.0%, p = 0.012) respectively. After controlling for baseline, the black participants demonstrated greater increases in 24 h systolic and diastolic blood pressure, total cholesterol, fasting glucose, fibrinogen, D-dimer, and waist circumference in comparison with whites. In summary, an adverse progression of CVD risk factors was observed in the whole sample, although to a larger degree in black participants. Aggressive treatment strategies for controlling risk factors in black Africans are needed to reduce the increasing burden of CVD in South Africa.

Testosterone and acute stress are associated with fibrinogen and von Willebrand factor in African men: the SABPA study.

BACKGROUND: Low testosterone, acute and chronic stress and hypercoagulation are all associated with hypertension and hypertension-related diseases. The interaction between these factors and future risk for coronary artery disease in Africans has not been fully elucidated. In this study, associations of testosterone, acute cardiovascular and coagulation stress responses with fibrinogen and von Willebrand factor in African and Caucasian men in a South African cohort were investigated. METHODS: Cardiovascular variables were studied by means of beat-to-beat and ambulatory blood pressure monitoring. Fasting serum-, salivary testosterone and citrate coagulation markers were obtained from venous blood samples. Acute mental stress responses were evoked with the Stroop test. RESULTS: The African group demonstrated a higher cardiovascular risk compared to Caucasian men with elevated blood pressure, low-grade inflammation, chronic hyperglycemia (HbA1c), lower testosterone levels, and elevated von Willebrand factor (VWF) and fibrinogen levels. Blunted testosterone acute mental stress responses were demonstrated in African males. In multiple regression analyses, higher circulating levels of fibrinogen and VWF in Africans were associated with a low T environment (R(2) 0.24-0.28; p≤0.01), but only circulating fibrinogen in Caucasians. Regarding endothelial function, a low testosterone environment and a profile of augmented α-adrenergic acute mental stress responses (diastolic BP, D-dimer and testosterone) were associated with circulating VWF levels in Africans (Adj R(2) 0.24; p<0.05). CONCLUSIONS: An interdependence between acute mental stress, salivary testosterone, D-dimer and vascular responses existed in African males in their association with circulating VWF but no interdependence of the independent variables occurred with fibrinogen levels.

Carotid cross-sectional wall area is significantly associated with serum leptin levels, independent of body mass index: the SABPA study.

Hypertension and obesity are serious health burdens in sub-Saharan Africa. Urbanized Africans seem to be more susceptible to the development of these diseases than Caucasians. Current research suggests that leptin may be an important contributor to the development of hypertension and atherosclerosis. The aim of this study was to investigate leptin levels and their associations with cardiovascular function in urbanized Africans and Caucasians. Serum leptin, ambulatory blood pressure and carotid intima-media thickness were measured, and the cross-sectional wall area (CSWA) was calculated. The results showed that Africans had higher leptin levels (P<0.001), ambulatory blood pressure (P<0.001), carotid intima-media thickness (P<0.01) and CSWA (P<0.01) than Caucasians. As we found no interaction between ethnicity and gender for the association between leptin and the cardiovascular variables, we focused mainly on the total group of Africans and Caucasians. In single, partial and multiple regression analyses, positive associations of ambulatory systolic blood pressure (ß=0.256; P<0.001), diastolic blood pressure (ß=0.143; P=0.012), pulse pressure (ß=0.327; P<0.001) and CSWA (ß=0.107; P=0.038) with leptin were observed. Even after adjusting for body mass index (BMI), the association between CSWA (ß=0.107; P=0.038) and leptin remained. Our findings therefore suggest that leptin may contribute to the development of atherosclerosis, independent of BMI.

The Finnish Diabetes Risk Score is associated with insulin resistance and progression towards type 2 diabetes.

OBJECTIVE: The Finnish Diabetes Risk Score (FINDRISC) questionnaire is a practical screening tool to estimate the diabetes risk and the probability of asymptomatic type 2 diabetes. In this study we evaluated the usefulness of the FINDRISC to predict insulin resistance in a population at increased diabetes risk. DESIGN: Data of 771 and 526 participants in a cross-sectional survey (1996) and a cohort study (1997-2000), respectively, were used for the analysis. Data on the FINDRISC and oral glucose tolerance test parameters were available from each participant. The predictive value of the FINDRISC was cross-sectionally evaluated using the area under the curve-receiver operating characteristics method and by correlation analyses. A validation of the cross-sectional results was performed on the prospective data from the cohort study. RESULTS: The FINDRISC was significantly correlated with markers of insulin resistance. The receiver operating characteristics-area under the curve for the prediction of a homeostasis model assessment insulin resistance index of more than five was 0.78 in the cross-sectional survey and 0.74 at baseline of the cohort study. Moreover, the FINDRISC at baseline was significantly associated with disease evolution (P < 0.01), which was defined as the change of glucose tolerance during the 3 yr follow-up. CONCLUSIONS: The results indicate that the FINDRISC can be applied to detect insulin resistance in a population at high risk for type 2 diabetes and predict future impairment of glucose tolerance.