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1.
Medicine (Baltimore) ; 98(36): e16894, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490374

RESUMO

Hypertension is a common global health problem including China. This study aimed to assess the prevalence and awareness of hypertension, and evaluate risk factors associated with hypertension among multi-ethnic population in northwest China using a random sampling cross-sectional data.A cross-sectional survey was conducted between 2014 and 2015 as part of a nationwide survey using stratified four-stage random sampling in Xinjiang. Hypertension was defined as mean systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥140/90 mm Hg and/or taking anti-hypertensive medication. In addition, the prevalence of hypertension (SBP ≥ 130 or DBP ≥ 80 mm Hg) was also estimated according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) High Blood Pressure Guideline. Awareness of hypertension was based on self-report. An optimized risk score model was used to assess the risk and determine the predictive power of risk factors on hypertension.Totally 6722 subjects aged ≥18 years were enrolled and prevalence of hypertension was 24.3%, while the prevalence of hypertension based on the 2017 ACC/AHA guideline was approximately twice as high as that based on 2010 Chinese guideline (37.6%). Among individuals with hypertension, 55.5% were aware of their condition. Six potential factors were estimated to be associated with increased risk of hypertension including age, ethnicity, marital status, body mass index (BMI), waistline circumference, and comorbidity. In the analyses of calculated risk score, BMI ≥ 28.0 corresponded to the highest risk score of 23 points. The area under the receiver operation curve for the multivariable prediction model was 0.803 (95%CI: 0.789-0.813).There is a considerable prevalence of hypertension among Xinjiang adults, northwest China; awareness of hypertension is low. Excess weight loss may be a vital strategy for controlling hypertension, particularly if accompanied with other preventive measures in this region.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hipertensão/etnologia , Hipertensão/terapia , Perda de Peso , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Glicemia , Índice de Massa Corporal , Pesos e Medidas Corporais , China/epidemiologia , Comorbidade , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
2.
J Natl Black Nurses Assoc ; 30(1): 1-6, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31465678

RESUMO

African-American women have an increased risk of developing cardiovascular disease as a result of uncontrolled hypertension. Despite treatment guidelines that recommend lifestyle changes to manage hypertension, dietary lifestyle changes remain low. Lifestyle modification with the DASH (Dietary Approaches to Stop Hypertension) was integrated into the current treatment plan to reduce blood pressure to target (<120/80 mm Hg). The mean pre-Dash SBP (147.44 mm Hg)/(86.33 DBP) compared to mean post-Dash SBP (142.43 mm Hg)/(81.57 mmHg DBP) yielded a 5-mm Hg reduction in SBP and 4-mm Hg decrease in DBP. The Wilcoxon Signed Rank, a nonparametric test was used to determine statistical significance. A p value of <0.05 is considered statistically significant. As a result, the DASH Diet did not elicit a statistically significant change in BP (z = -1.355, p = 0.176). The DASH Diet lifestyle modification is an effective adjunct in the management of hypertension and must continue throughout all phases of treatment.


Assuntos
Afro-Americanos/psicologia , Abordagens Dietéticas para Conter a Hipertensão/etnologia , Hipertensão/dietoterapia , Hipertensão/etnologia , Afro-Americanos/estatística & dados numéricos , Feminino , Humanos , Resultado do Tratamento
3.
BMC Public Health ; 19(1): 991, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340788

RESUMO

BACKGROUND: High-sensitivity C-reactive protein (hs-CRP) is a common risk factor for developing cardiovascular disease. However, there has been no study reporting the relationship between hs-CRP and blood pressure in Yi adults. The aim of this study is to investigate the association between hs-CRP and blood pressure in Yi adults. METHODS: In this cross-sectional study, included subjects were 2916 Yi migrants or farmers aged 20-80 years, recruited by using a stratified cluster sampling method from Liangshan Yi Autonomous Prefecture of Sichuan Province in 2014. The directed acyclic graphs(DAG) was used to select a minimal sufficient adjustment sets of variables which would identification the unconfounded effect of hs-CRP and hypertension. Multiple linear and multinomial logit analysis were used to estimate the effect of hs-CRP on SBP/DBP/MAP/PP and the prevalence of prehypertension/hypertension after adjustment for the relevant confounders. RESULTS: The median level of hs-CRP was 1.20 (0.50-3.06)mg/L in Yi migrants, and 0.84(0.36-2.52) mg/L in Yi farmers, and the prevalence of high hs-CRP was 23.25%. For hs-CRP > 3 mg/L group, the adjusted PP tended to have lower values (ß = - 1.49, 95%CI: - 2.49--0.49, P = 0.0034) compared with < 1 mg/L group. After adjusting for confounders, there were no significant association between hs-CRP and prehypertension/hypertension (P > 0.05). CONCLUSIONS: Our results suggest that high hs-CRP is prevalent in Yi people, and this study does not support hs-CRP as a risk factor of prehypertension or hypertension.


Assuntos
Pressão Sanguínea , Proteína C-Reativa/análise , Grupos Étnicos/estatística & dados numéricos , Hipertensão/epidemiologia , Pré-Hipertensão/epidemiologia , Migrantes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/etnologia , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Pré-Hipertensão/etnologia , Prevalência , Fatores de Risco , Adulto Jovem
4.
BMC Public Health ; 19(1): 892, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286920

RESUMO

BACKGROUND: Few population-based studies of Arab American health behaviors and outcomes exist outside of Michigan. We aimed to provide prevalence estimates of health behaviors and outcomes for Arab Americans and compare them to non-Hispanic Whites in California. METHODS: We used data from the 2003-2016 California Health Interview Surveys. We determined Arab American ethnicity using an algorithm that considered place of birth of the respondent or parent and use of Arabic language at home. Survey-weighted frequencies, chi-squared statistics, and logistic regression analyses were used to compare Arab Americans and non-Hispanic Whites on socioeconomic indicators, health behaviors and health outcomes. Multivariable models were adjusted for age, education level, and insurance status. RESULTS: Arab Americans had higher prevalence of no insurance, living below the federal poverty level, and home ownership than non-Hispanic Whites despite high levels of education and low unemployment prevalence. Arab Americans had reduced odds of alcohol consumption (OR: 0.33, 95% CI: 0.24, 0.45), binge drinking (OR: 0.28, 95% CI: 0.19, 0.40), and suicidal ideation (OR: 0.41, 0.25, 0.66) when compared to non-Hispanic Whites in multivariable models. Arab Americans had decreased odds of hypertension (OR: 0.64, 95% CI: 0.50, 0.83) and increased odds of diabetes (OR: 2.03, 95% CI: 1.23, 3.34) when compared to non-Hispanic Whites in multivariable models. CONCLUSIONS: Arab Americans in California participate in less risky health behaviors and have better health outcomes than non-Hispanic Whites, except with regards to diabetes. Future work aiming to understand the health of Arab Americans should allow for self-identification and less reliance on country of origin and language use at home for sample selection.


Assuntos
Árabes/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/etnologia , California/epidemiologia , Distribuição de Qui-Quadrado , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Feminino , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Hipertensão/epidemiologia , Hipertensão/etnologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores Socioeconômicos
5.
BMC Public Health ; 19(1): 843, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253116

RESUMO

BACKGROUND: To determine the prevalence of hypertension and investigate sociodemographic correlates in an indigenous Kuna community living on the San Blas islands of Panama. METHODS: Data was collected from adults using a paper-based survey using a cross sectional study design. Blood pressure was measured, and hypertension defined at two cut-points: 130/80 mmHg and 140/90 mmHg. Individuals with undiagnosed hypertension had a blood pressure measurement that indicated hypertension, however, the individual had not been told by a doctor they had hypertension. Whereas individuals with diagnosed hypertension had been told by a healthcare provider that they had hypertension. Univariate tests compared diagnosed and undiagnosed hypertension by sociodemographic categories and logistic regression models tested individual correlates adjusting for all sociodemographic factors. RESULTS: Two hundred and eleven adult indigenous Kuna participated in the study. Overall prevalence of hypertension was 6.2% (95%CI:3.32-10.30) as defined by 140/90 mmHg, and 16.6% (95%CI:11.83-22.31) as defined by 130/80 mmHg. Hypertension was significantly higher in men (31.6, 95% CI:19.90-45.24, compared to 11.0, 95% CI:6.56-17.09). Individuals with low income were 3 times more likely to be hypertensive (OR = 3.13, 95% CI:1.02-9.60) and 3.5 times more likely to have undiagnosed hypertension (OR = 3.42, 95% CI:1.01-11.52); while those with moderate income were 6 times more likely to be hypertensive (OR = 7.37, 95% CI:1.76-30.90) compared to those who were poor. CONCLUSION: The prevalence of diagnosed and undiagnosed hypertension is higher in men and those with higher income. Investigating these factors remains vitally important in helping improve the health of the Kuna through targeted interventions to address chronic disease.


Assuntos
Hipertensão/etnologia , Índios Centro-Americanos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Panamá/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 666-669, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238616

RESUMO

Objective: To analyze the prevalence and risk factors of hypertension combined with diabetes in the middle to elder population in the Nan'an district of Chongqing, and to provide evidence for formulating relevant prevention and control strategies. Methods: Middle or elder adults were enrolled by a Stratified multistage cluster sampling method. Questionnaire survey and the related measurements were conducted. The epidemiology of hypertension combined with diabetes was analyzed descriptively, and the risk or protective factors were analyzed by logistic regression method. Results: A total of 24 792 people were surveyed, with 1 547 patients identified as having hypertension combined with diabetes. The overall prevalence rate appeared as 6.2%, of which 6.0% in males and 6.4% in females, respectively. The prevalence of hypertension combined with diabetes in the general population was increasing with age (χ(2)=343.766, P<0.001). Factors as age, education, smoking, marital status, exercise, BMI, triglyceride, total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol were related to the prevalence of hypertension and diabetes. High density lipoprotein cholesterol appeared as a protective factor for hypertension combined with diabetes (OR=0.817, 95%CI: 0.715-0.934). Age, education, low density lipoprotein cholesterol and lack of exercise all appeared as risk factors for hypertension combined with diabetes (P<0.05), respectively. Conclusions: The prevalence rate of hypertension combined with diabetes in the middle or elder adults in Nan'an of Chongqing seemed high. Attention should be paid to the health status of people being elderly, overweight or obese, low cultural level, smoking, triglyceride abnormality, total cholesterol abnormality and high low density lipoprotein cholesterol, so as to reduce the risk on hypertension combined with diabetes.


Assuntos
Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Idoso , China/epidemiologia , Diabetes Mellitus/etnologia , Feminino , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Obesidade , Prevalência , Fatores de Risco
7.
Wei Sheng Yan Jiu ; 48(2): 173-178, 2019 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-31133091

RESUMO

OBJECTIVE: To analyze the epidemiological characteristics and clustering of cardiometabolic risk factors in people 60 years old and above, and to explore the influence of population economic factors on them. METHODS: The database of China Health and Nutrition Survey in 2015 was used. Basic information(age, gender), anthropometric data(height, weight and waist size), blood biochemical data and demographic data(occupation, income, education level and geographic location) were included. A multi-stage stratified cluster random sampling was adopted, the county, city, village and suburban village as the basic survey points. Twenty families were randomly selected from each survey site, and all family members were investigated. A total of 3276 people aged 60 years and above were selected as subjects, with the proportion of males was 46. 8%, and the average age was 68 years. According to the definition of the metabolic syndrome released by the International Diabetes Federation(IDF) in 2005, there were five cardiometabolic risk factors, central obesity, raised triglycerides(TG), reduced high density lipoprotein-cholesterol(HDL-C), raised blood pressure and raised plasma glucose. Existing of 2 or more risk factors in a person at the same time was recognized as a risk factor clustering. Multivariate logistic regression model was used to analyze the relationship between socioeconomic factors and metabolic risk factors. RESULTS: In elderly of 15 provinces(regions, municipalities) of China, the prevalence of central obesity, raised blood pressure, raised plasma glucose, raised TG and reduced HDL-C were 57. 8%, 71. 3%, 25. 0%, 27. 6% and 40. 1% respectively. Multivariate Logistic regression analysis showed there were more risk of central obesity(OR=3. 66, 95%CI 3. 16-4. 26), raised TG(OR=1. 60, 95%CI 1. 36-1. 88) and reduced HDL-C(OR=2. 77, 95%CI 2. 38-3. 23)in women than those in men, and less risk of raised blood pressure(OR=0. 84, 95%CI 0. 0. 72-0. 99) in women than those in men. Elderly in the eastern region were significantly more likely to suffer from raised blood pressure(OR=1. 45, 95%CI 1. 20-1. 76) and raised plasma glucose(OR=1. 38, 95%CI 1. 14-1. 67) than those in the mid region. A correlation was found between gender, education level, regions and metabolic risk factors(P<0. 05). Income and metabolic risk factors clustering were positively correlated(P<0. 05). CONCLUSION: The problem of elevated blood pressure and central obesity in cardiometabolic risk factors were more prominent in the 15 provinces(regions, municipalities) of China. The elderly which was female, in eastern region, had high income or education level relatively had higher risk of risk factors clustering, which should be focused on prevention and control.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Hipertensão/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Idoso , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/etnologia , China/epidemiologia , HDL-Colesterol , Cidades , Feminino , Humanos , Hipertensão/etnologia , Masculino , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/etnologia , Prevalência , Fatores de Risco , Triglicerídeos
8.
Ter Arkh ; 91(1): 71-77, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31090375

RESUMO

AIM: To evaluate the association of a complex of cardiovascular risk factors and genetic markers with the development of high albuminuria among patients with arterial hypertension in the population of Mountain Shoriya, taking into account ethnicity. MATERIALS AND METHODS: A clinical epidemiological study of a compactly residing population in remote areas of Mountain Shoria was carried out. 1409 people were examined [901 people - representatives of the indigenous nationality (Shorians), 508 people - representatives of non-indigenous nationality (90% of them are Caucasians)]. Hypertension was diagnosed according to the National Guidelines of the Russian Society of Cardiology/the Russian Medical Society on Arterial Hypertension (2010). All patients underwent clinical, laboratory and instrumental investigation. To study the state of the kidneys, the concentration (the presence of elevated levels) of albumin (albuminuria) in the morning portion of urine by an immunoturbidimetric method was analyzed. Polymorphisms of genes ACE (I/D, rs4340), АGT (c.803T>C, rs699), AGTR1 (А1166С, rs5186), ADRB1 (с.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677С>Т, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) were tested using PCR. RESULTS: In the group of shors with arterial hypertension, high albuminuria was associated with polymorphisms of the ACE genes (OR=2.05), ADRA2B (OR=6.00), elevated triglyceride level (OR=2.86), decreased index of cholesterol of high density lipoproteins (OR=5.57) and increased index of low density lipoproteins (OR=2.49); in the new population - with polymorphisms of the AGTR1 genes (OR=8.66), ADRA2B (OR=6.53), MTHFR (OR=7.16), obesity (OR=2.72), and abdominal obesity (OR=3.14). CONCLUSION: The primary predictors determining the development of high albuminuria among patients with arterial hypertension in both ethnic groups were genetic ones. In addition to them, non-genetic risk factors also contributed to the development of this organ damage to the kidneys: age and lipid metabolism disorders in representatives of indigenous nationality; age and abdominal obesity in the examined patients non-indigenous nationality.


Assuntos
Albuminas/metabolismo , Albuminúria/etnologia , Doenças Cardiovasculares/genética , Grupos Étnicos/genética , Hipertensão/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Peptidil Dipeptidase A/genética , Receptor Tipo 1 de Angiotensina/genética , Receptores Adrenérgicos alfa 2/genética , Albuminúria/genética , Doenças Cardiovasculares/etnologia , Marcadores Genéticos , Predisposição Genética para Doença , Humanos , Hipertensão/etnologia , Lipoproteínas HDL/metabolismo , Obesidade Abdominal/etnologia , Reação em Cadeia da Polimerase , Polimorfismo Genético , Fatores de Risco , Federação Russa/epidemiologia , Triglicerídeos/metabolismo
9.
High Blood Press Cardiovasc Prev ; 26(3): 239-246, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31020550

RESUMO

INTRODUCTION: Hypertension (HT) is considered as a major determinant of cardiovascular complications. However, few studies have addressed HT prevalence among adults aged 60 years and older in the northern mountainous region of Vietnam. AIM: To determine the prevalence of HT and its risk factors in the elderly in that area. METHODS: A cross-sectional study was conducted in a study area in the northern of Vietnam. We interviewed 354 adults aged 60 years or over who were randomly selected, and then measured their blood pressure. RESULTS: The overall HT prevalence was 62.15%. The isolated systolic hypertension (ISH) prevalence was 22.88%. There was a slight decrease in the proportion of HT by stage 1, stage 2 and stage 3 respectively. The univariate and multivariate logistic regression analysis indicated some risk factors for HT including age groups, body mass index (BMI) and waist-hip ratio (WHR) (p < 0.05). Furthermore, we also found that the risk factors of ISH was obesity status classified by BMI category and WHR (p < 0.05). In particularly, the ethnicity was statistically significantly associated with ISH. CONCLUSION: Our data showed a high prevalence of hypertension in the elderly in studied area. The risk factors for HT and ISH among studied subjects included age groups, ethnic groups, BMI and WHR. Hence, these findings are important for policy-making related to launch public health prevention and control campaigns for hypertension among older adults in the northern mountainous region of Vietnam.


Assuntos
Hipertensão/etnologia , Saúde da População Rural/etnologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Índice de Massa Corporal , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Obesidade/fisiopatologia , Prevalência , Medição de Risco , Fatores de Risco , Vietnã/epidemiologia , Relação Cintura-Quadril
10.
Artigo em Inglês | MEDLINE | ID: mdl-30934733

RESUMO

Literature supports an association between work and cardiovascular disease in adults. The objective of this study was to examine the relationship between current work status and elevated blood pressure in Hispanic adolescents. Participants were students in Hidalgo County, located along the Texas-Mexico border. Participants enrolled in the cohort study in ninth grade with assessments completed once a year for up to three years. Participants completed a self-report survey, while staff measured height, weight, waist circumference, blood pressure, and were screened for acanthosis nigricans. A generalized linear regression model with a logit link function was constructed to assess current work status and elevated blood pressure. Of the 508 participants, 29% had elevated blood pressure, which was associated with being male and other chronic disease indicators (e.g., acanthosis nigricans, overweight/obesity). The mean probability for elevated blood pressure was higher among currently working adolescents compared to those who were not. Findings were statistically significant (p < 0.05) at baseline. The findings illustrate that a large proportion of adolescents along the Texas-Mexico border may have elevated blood pressure and that working may be associated with it. Subsequent research is needed to confirm these findings, as well as to identify the mechanism for how work may increase hypertension in adolescents.


Assuntos
Hispano-Americanos/estatística & dados numéricos , Hipertensão/etnologia , Acantose Nigricans/epidemiologia , Adolescente , Fatores Etários , Pressão Sanguínea , Peso Corporal , Doenças Cardiovasculares , Estudos de Coortes , Feminino , Humanos , Masculino , México , Sobrepeso/epidemiologia , Fatores Sexuais , Texas/epidemiologia , Circunferência da Cintura
11.
Artigo em Inglês | MEDLINE | ID: mdl-30959858

RESUMO

Background: Uncontrolled hypertension (HTN) and medication nonadherence are more prominent among Hispanics compared to non-Hispanic whites and African Americans. Advances in wireless health technology enable real-time monitoring of medication adherence (MA) and blood pressure (BP), facilitating timely patient⁻provider communication including tailored reinforcement/motivational feedback to patients and quicker titration changes by providers. The purpose of the current study was to conduct a 9-month smartphone-enabled efficacy trial addressing MA and BP control among Hispanic adults with uncontrolled HTN and poor MA. Methods: The research design was a 9-month, two-arm efficacy trial including an experimental (Smartphone Med Adherence Stops Hypertension, SMASH) group and an enhanced standard care (ESC) group. SMASH participants utilized a SMASH app which interfaced with a Bluetooth-enabled BP monitor for BP self-monitoring and an electronic medication tray. The ESC participants received text messages including links to PDFs and brief video clips containing healthy lifestyle tips for attention control. Results: Participants were 54 Hispanic adults (mean age: 46.5 years) with uncontrolled HTN. They were randomly assigned to either the SMASH (n = 26) or ESC group (n = 28). At baseline, no participants had controlled systolic BP (SBP). Baseline group averages for SBP between the SC and SMASH groups did not differ (150.7 and 152.3 mmHg, respectively; p = 0.53). At the 1, 3, 6, and 9-month time points, SBP averages were significantly lower in the SMASH versus SC groups (month 1: 125.3 vs. 140.6; month 3: 120.4 vs. 137.5, month 6: 121.2 vs. 145.7 mmHg; month 9: 121.8 vs. 145.7, respectively; all p-values <0.01). At months 3, 6, and 9 there was a significant difference between the percentage of participants meeting the 7th Joint National Committee cutoffs for SBP control in the SC and SMASH groups (month 3: 62.5 vs. 92.0%; month 6: 57.9 and 94.4%, month 9: 27.8 and 92.3%, respectively; all p-values ≤0.01). Average medical regimen adherence, as indicated by timestamped medication intake and BP monitoring for the SMASH group, ranged from 89.1 to 95.2% across the 9-month trial. Conclusion: Our findings indicate that our culturally tailored smartphone-enabled medical regimen self-management program may be an effective solution for the promotion of MA, resulting in statistically and clinically significant reductions in SBP among Hispanic adults with uncontrolled HTN.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Adesão à Medicação/etnologia , Telemedicina , Adulto , Características Culturais , Feminino , Hispano-Americanos , Humanos , Hipertensão/etnologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Autogestão , Smartphone , Mensagem de Texto
12.
Niger J Clin Pract ; 22(4): 558-565, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30975963

RESUMO

Background: Despite evidence linking depression to poor blood pressure (BP) control and increased hypertension-related morbidity and mortality, there is paucity of data about depression among patients with hypertension in sub-Saharan Africa. We assessed factors associated with depression among patients with hypertension in Ghana and Nigeria. Subjects and Methods: Patients with hypertension were recruited from four hospitals: In Ghana, Korle Bu Teaching Hospital (n = 120), and in Nigeria, the University of Port Harcourt Teaching Hospital, the Lagos State General Hospital, and the University College Hospital Ibadan (n = 237). Demographic, socioeconomic, psychosocial, and clinical factors which predicted depression among the study cohort were assessed by logistic regression. Depression and beliefs about medications were assessed with the Patient Health Questionnaire (PHQ-9) and the Beliefs about Medication Questionnaire, respectively. Depression was regarded as PHQ-9 score >4. Results: The mean ages of the Ghanaian and Nigerian cohort were 57.0 ± 13.7 years (58.3% female) and 56.4 ± 12.9 years (57.0% female), respectively. Prevalence of depression was 41.7% and 26.6% among the Ghanaian and Nigerian cohorts, respectively. Significant predictors of depression in the Nigerian cohort were age in years [OR 0.97 (0.95-0.99)], concern about medications [OR 1.15 (1.03-1.30)], and poor BP control [OR 2.06 (1.09-3.88)]. Young age was the only independent predictor of depression in the Nigerian cohort. In the Ghanaian cohort, none of the factors significantly predicted depression. Conclusion: Prevalence of depression is high among patients with hypertension in Ghana and Nigeria. Screening and treatment of depression among patients with hypertension in Ghana and Nigeria may have important implications for improving outcomes.


Assuntos
Comparação Transcultural , Depressão/epidemiologia , Hipertensão/epidemiologia , Adolescente , Adulto , Idoso , Pressão Sanguínea , Determinação da Pressão Arterial , Comorbidade , Estudos Transversais , Depressão/diagnóstico , Depressão/etnologia , Feminino , Gana/epidemiologia , Hospitais de Ensino , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Fatores de Risco , Inquéritos e Questionários
13.
Int J Health Policy Manag ; 8(3): 150-157, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30980631

RESUMO

BACKGROUND: Vietnam's network of commune health centers (CHCs) have historically managed acute infectious diseases and implemented national disease-specific vertical programs. Vietnam has undergone an epidemiological transition towards non-communicable diseases (NCDs). Limited data exist on Vietnamese CHC capacity to prevent, diagnose, and treat NCDs. In this paper, we assess NCD service readiness, availability, and utilization at rural CHCs in 3 provinces in northern Vietnam. METHODS: Between January 2014 and April 2014, we conducted a cross-sectional survey of a representative sample of 89 rural CHCs from 3 provinces. Our study outcomes included service readiness, availability of equipment and medications, and utilization for five NCD conditions: hypertension, diabetes, chronic pulmonary diseases, cancer, and mental illnesses. RESULTS: NCD service availability was limited, except for mental health. Only 25% of CHCs indicated that they conducted activities focused on NCD prevention. Patient utilization of CHCs was approximately 223 visits per month or 8 visits per day. We found a statistically significant difference (P<.05) for NCD service availability, medication availability and CHC utilization among the 3 provinces studied. CONCLUSION: This is the first multi-site study on NCD service availability in Vietnam and the first study in a mountainous region consisting predominately of ethnic minorities. Despite strong government support for NCD prevention and control, Vietnam's current network of CHCs has limited NCD service capacity.


Assuntos
Serviços de Saúde Comunitária/normas , Instalações de Saúde/normas , Acesso aos Serviços de Saúde , Doenças não Transmissíveis/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde , Serviços de Saúde Rural/normas , Estudos Transversais , Diabetes Mellitus/etnologia , Diabetes Mellitus/terapia , Grupos Étnicos , Recursos em Saúde , Humanos , Hipertensão/etnologia , Hipertensão/terapia , Pneumopatias/etnologia , Pneumopatias/terapia , Transtornos Mentais/etnologia , Transtornos Mentais/terapia , Neoplasias/etnologia , Neoplasias/terapia , Doenças não Transmissíveis/etnologia , Preparações Farmacêuticas/provisão & distribução , População Rural , Inquéritos e Questionários , Vietnã
14.
N Engl J Med ; 380(25): 2429-2439, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-30883050

RESUMO

BACKGROUND: The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood-pressure control in these patients has not been established. METHODS: In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or was taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12.5 mg of hydrochlorothiazide, 5 mg of amlodipine plus 4 mg of perindopril, or 4 mg of perindopril plus 12.5 mg of hydrochlorothiazide for 2 months. Doses were then doubled (10 and 25 mg, 10 and 8 mg, and 8 and 25 mg, respectively) for an additional 4 months. The primary end point was the change in the 24-hour ambulatory systolic blood pressure between baseline and 6 months. RESULTS: The mean age of the patients was 51 years, and 63% were women. Among the 621 patients who underwent 24-hour blood-pressure monitoring at baseline and at 6 months, those receiving amlodipine plus hydrochlorothiazide and those receiving amlodipine plus perindopril had a lower 24-hour ambulatory systolic blood pressure than those receiving perindopril plus hydrochlorothiazide (between-group difference in the change from baseline, -3.14 mm Hg; 95% confidence interval [CI], -5.90 to -0.38; P = 0.03; and -3.00 mm Hg; 95% CI, -5.8 to -0.20; P = 0.04, respectively). The difference between the group receiving amlodipine plus hydrochlorothiazide and the group receiving amlodipine plus perindopril was -0.14 mm Hg (95% CI, -2.90 to 2.61; P=0.92). Similar differential effects on office and ambulatory diastolic blood pressures, along with blood-pressure control and response rates, were apparent among the three groups. CONCLUSIONS: These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months. (Funded by GlaxoSmithKline Africa Noncommunicable Disease Open Lab; CREOLE ClinicalTrials.gov number, NCT02742467.).


Assuntos
Anlodipino/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Hidroclorotiazida/administração & dosagem , Hipertensão/tratamento farmacológico , Perindopril/administração & dosagem , Adulto , África ao Sul do Saara , Grupo com Ancestrais do Continente Africano , Idoso , Anlodipino/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Combinação de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Hidroclorotiazida/efeitos adversos , Hipertensão/etnologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Perindopril/efeitos adversos , Método Simples-Cego
15.
Prev Chronic Dis ; 16: E36, 2019 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-30925142

RESUMO

INTRODUCTION: Neighborhood characteristics such as racial segregation may be associated with hypertension, but studies have not examined these relationships using spatial models appropriate for geographically patterned health outcomes. The objectives of our study were to 1) evaluate the geographic heterogeneity of hypertension; 2) describe whether and how patient-level risk factors and racial isolation relate to geographic heterogeneity in hypertension; and 3) examine cross-sectional associations of hypertension with racial isolation. METHODS: We obtained electronic health records from the Duke Medicine Enterprise Data Warehouse for 2007-2011. We linked patient data with data on racial isolation determined by census block of residence. We constructed a local spatial index of racial isolation for non-Hispanic black patients; the index is scaled from 0 to 1, with 1 indicating complete isolation. We used aspatial and spatial Bayesian models to assess spatial variation in hypertension and estimate associations with racial isolation. RESULTS: Racial isolation ranged from 0 (no isolation) to 1 (completely isolated). A 0.20-unit increase in racial isolation was associated with 1.06 (95% credible interval, 1.03-1.10) and 1.11 (95% credible interval, 1.07-1.16) increased odds of hypertension among non-Hispanic black and non-Hispanic white patients, respectively. Across Durham, census block-level odds of hypertension ranged from 0.62 to 1.88 among non-Hispanic black patients and from 0.32 to 2.41 among non-Hispanic white patients. Compared with spatial models that included patient age and sex, residual heterogeneity in spatial models that included age, sex, and block-level racial isolation was 33% lower for non-Hispanic black patients and 20% lower for non-Hispanic white patients. CONCLUSION: Racial isolation of non-Hispanic black patients was associated with increased odds of hypertension among both non-Hispanic black and non-Hispanic white patients. Further research is needed to identify latent spatially patterned factors contributing to hypertension.


Assuntos
Hipertensão/etnologia , Características de Residência/estatística & dados numéricos , Segregação Social , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Análise Espacial , Adulto Jovem
16.
Int J Mol Sci ; 20(5)2019 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-30832344

RESUMO

Hypertension is the leading cause of cardiovascular disease in the United States, affecting up to one-third of adults. When compared to other ethnic or racial groups in the United States, African Americans and other people of African descent show a higher incidence of hypertension and its related comorbidities; however, the genetics of hypertension in these populations has not been studied adequately. Several genes have been identified to play a role in the genetics of hypertension. They include genes regulating the renin-aldosterone-angiotensin system (RAAS), such as Sodium Channel Epithelial 1 Beta Subunit (SCNN1B), Armadillo Repeat Containing 5 (ARMC5), G Protein-Coupled Receptor Kinase 4 (GRK4), and Calcium Voltage-Gated Channel Subunit Alpha1 D (CACNA1D). In this review, we focus on recent genetic findings available in the public domain for potential differences between African Americans and other populations. We also cover some recent and relevant discoveries in the field of low-renin hypertension from our laboratory at the National Institutes of Health. Understanding the different genetics of hypertension among various groups is essential for effective precision-guided medical therapy of high blood pressure.


Assuntos
Afro-Americanos/genética , Hipertensão/genética , Canais de Cálcio Tipo L/genética , Canais Epiteliais de Sódio/genética , Quinase 4 de Receptor Acoplado a Proteína G/genética , Humanos , Hipertensão/etnologia , Proteínas Supressoras de Tumor/genética
17.
Front Biosci (Schol Ed) ; 11: 136-160, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30844741

RESUMO

African-American (AA) women are more likely to die from breast cancer (BC), at any age, compared to European-American women. Although breakthroughs in pre-clinical studies have resulted in potentially actionable targets in AA BC, drugs that were rationally designed for these targets have performed poorly in clinical trials. Challenges with interpatient and intratumoral heterogeneity, lack of drug sensitivity and specificity, suboptimal biomarker cut-offs, lack of drug response predictive biomarkers, drug side effects, high costs of drug development, and under-representation of AAs in clinical trials complicate the development of targeted therapies for AA BC patients. Accumulating evidence suggests that racial disparities exist in non-genetic risk factors that can alter genetic and epigenetic programs to promote breast tumorigenesis. Herein, we present a "roadmap" that addresses non-genetic risk factors that are suspected to contribute to the racial disparity in BC mortality. Increased targeting of these non-genetic risk factors may proffer a safer and more economical route to alleviating the racially disparate burden in BC.


Assuntos
Neoplasias da Mama/etnologia , Neoplasias da Mama/genética , Afro-Americanos/genética , Consumo de Bebidas Alcoólicas , Biomarcadores , Tamanho Corporal , Mama/patologia , Neoplasias da Mama/tratamento farmacológico , Características Culturais , Diabetes Mellitus/etnologia , Diabetes Mellitus/genética , Escolaridade , Disruptores Endócrinos , Grupo com Ancestrais do Continente Europeu/genética , Medo , Feminino , Disparidades nos Níveis de Saúde , Terapia de Reposição Hormonal , Humanos , Hipertensão/complicações , Hipertensão/etnologia , Hipertensão/genética , Seguro Saúde , Estilo de Vida , Menarca , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/etnologia , Obesidade/genética , Religião , Características de Residência , Fatores de Risco , Sono , Estresse Psicológico , Transportes
18.
Lipids Health Dis ; 18(1): 57, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832679

RESUMO

BACKGROUND: Evidence regarding the relationship between estimated glomerular filtration rate (eGFR) and arterial stiffness is limited, and the data analysis is not sufficient to clarify the true relationship between the two. We aimed to investigate the relationship between eGFR and brachial-ankle pulse wave velocity (baPWV) in Japanese. METHODS: The present study was a cross-sectional study. Nine hundred twelve Japanese men and women, aging 24-84 years old, received a health medical check-up program including the results from baPWV inspection and various standardized questionnaires in a health examination center in Japan. The main outcome measures included eGFR, baPWV, fatty liver and postmenopausal status. Abdominal ultrasonography was used to diagnose fatty liver. Postmenopausal state was defined as beginning 1 year after the cessation of menses. RESULTS: The average age of the 912 selected participants was 51.5 ± 9.6 years old, and about 57.6% of them were male. The participants' eGFR distribution was median 69.29 (min 39, max 122.28). The results of multivariate linear regression showed eGFR was not independently associated with baPWV after adjusting potential confounders (ß = - 1.11, 95%CI -2.25 to 0.03), this is inconsistent with the result of eGFR (quartile) as a categorical variable (p for trend was 0.038). A non-linear relationship was detected between eGFR and baPWV, whose point was 77.05. The effect sizes and the confidence intervals of the left and right sides of inflection point were - 2.80 (- 4.41 to - 1.19) and 1.84 (- 0.50, 4.17), respectively. Subgroup analysis showed, the change in the elderly population is more pronounced (P for interaction = 0.018; - 2.83 with ≤60 year vs - 6.12 with > 60 year). The same trend was also seen in hypertensive people (P for interaction = 0.018; - 4.55 with hypertension vs - 0.82 with non-hypertension). CONCLUSION: The relationship between eGFR and baPWV is non-linear. eGFR was negatively related to baPWV when eGFR is less than 77.05.


Assuntos
Fígado Gorduroso/fisiopatologia , Taxa de Filtração Glomerular , Hipertensão/fisiopatologia , Rigidez Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço/métodos , Grupo com Ancestrais do Continente Asiático , Estudos Transversais , Fígado Gorduroso/diagnóstico por imagem , Fígado Gorduroso/etnologia , Feminino , Nível de Saúde , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/etnologia , Japão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pós-Menopausa/fisiologia , Análise de Onda de Pulso , Ultrassonografia
19.
Genet Epidemiol ; 43(4): 402-413, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30770579

RESUMO

Hypertension is a complex disorder caused by genetic and environmental risk factors. Recently, genome-wide association studies (GWASs) identified more than 100 genetic variants for blood pressure traits and hypertension. However, the interactions between these genetic variants and environmental factors have not been systematically investigated. Therefore, we examined the interaction between genetic and environmental risk factors in blood pressure traits using the genetic risk score (GRS). Two Korean community-based cohorts, Cohort I (KARE; N = 8,840) and Cohort II (CAVAS; N = 9,599), were used for this study, and GRSs were calculated from 42 GWAS single-nucleotide polymorphisms (SNPs) that were validated for their association in these cohorts. We calculated GRSs in both ways by considering the effect sizes of each SNP (weighted GRS) and not considering the effect sizes (unweighted GRS). The unweighted GRS was strongly associated with systolic blood pressure, diastolic blood pressure, and hypertension (p = 9.03 × 10 -47 , p = 9.41 × 10 -48 , and p = 3.22 × 10 -55 by meta-analysis, respectively) and the weighted GRS showed the similar results. The environmental factors of body mass index, waist circumference, and drinking status were significantly associated with blood pressure traits, and the interaction between these factors and GRSs were examined. However, no interactions were found with either the GRS or the individual SNPs considered for the GRS. Our findings show that it is challenging to find GRS-environment interactions regarding blood pressure traits.


Assuntos
Pressão Sanguínea/genética , Interação Gene-Ambiente , Hipertensão/etnologia , Hipertensão/genética , Característica Quantitativa Herdável , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/genética , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , República da Coreia/epidemiologia , Características de Residência/estatística & dados numéricos , Fatores de Risco
20.
Cardiovasc J Afr ; 30(1): 34-40, 2019 Jan/Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-30720841

RESUMO

INTRODUCTION: Hypertension, particularly in black populations, is often accompanied by augmented sympathetic nervous system activity and suppressed renin activity, indicative of possible blood pressure (BP) dysregulation. The potential role of the interrelationship between the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system in the context of low-renin conditions is unclear. We therefore explored whether surrogate measures of sympathetic activity [noradrenaline, 24-hour heart rate (HR) and percentage (%) dipping of night-time HR] relate to renin, aldosterone and aldosterone-to-renin ratio (ARR) in black and white South Africans. METHODS: We included black (n = 127) and white (n = 179) males and females aged 20-63 years. We measured 24-hour BP and HR, and calculated night-time dipping. We determined renin and aldosterone levels in plasma and calculated ARR. Noradrenaline and creatinine levels were determined in urine and the noradrenaline:creatinine ratio was calculated. RESULTS: More blacks had low renin levels (80.3%) compared to whites (58.7%) (p < 0.001). In univariate and after multivariate analyses the following significant associations were evident in only the black group: HR dipping was associated negatively with aldosterone level (ß = -0.18, p = 0.024) and ARR (ß = -0.20, p = 0.011), while 24-hour HR was associated positively with renin level (ß = 0.20, p = 0.024). Additionally, there was a borderline significant positive association between noradrenaline:creatinine ratio and aldosterone level (ß = 0.19, p = 0.051). CONCLUSIONS: The observed associations between surrogate measures of sympathetic nervous system activity and components of the RAAS in the black group suggest that the adverse effects of aldosterone and its ratio to renin on the cardiovascular system may be coupled to the effects of the sympathetic nervous system.


Assuntos
Aldosterona/sangue , Pressão Sanguínea , Sistema Cardiovascular/inervação , Hipertensão/sangue , Sistema Renina-Angiotensina , Renina/sangue , Sistema Nervoso Simpático/fisiopatologia , Adulto , Grupo com Ancestrais do Continente Africano , Biomarcadores/sangue , Biomarcadores/urina , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano , Creatinina/urina , Grupo com Ancestrais do Continente Europeu , Feminino , Frequência Cardíaca , Humanos , Hipertensão/diagnóstico , Hipertensão/etnologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Norepinefrina/urina , África do Sul/epidemiologia , Fatores de Tempo , Adulto Jovem
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