Epidemiology and global burden of hypertension

ESC CardioMed ◽  
2018 ◽  
pp. 290-297
Author(s):  
George A. Mensah
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Systolic Blood Pressure ◽  
Low Income ◽  
Population Based ◽  
Pooled Analysis ◽  
Low Income Countries ◽  
Preventable Risk Factor ◽  
Sub Saharan

Hypertension is the most powerful, independent, preventable risk factor for death and disability from cardiovascular diseases. It is also a leading risk factor for all-cause mortality and the largest contributor to global disability-adjusted life years (DALYs). In 2015, exposure to high systolic blood pressure (BP) accounted for 10.7 million deaths (33.2% of deaths attributed to all risk factors) and nearly 212 million DALYs or 20.9% of DALYs from all risk factors. Epidemiological research over the past half-century has confirmed that the risk from hypertension is strong, continuous, graded, and doubles for each increment of 20 mmHg systolic blood pressure (BP) or 10 mmHg diastolic BP in adults, without evidence of a threshold down to BPs as low as 115/75 mmHg. In children and adolescents, hypertension prevalence is increasing (in concert with the continuing epidemic of obesity) and raised BP in adolescents remains the strongest predictor of hypertension in adults. Over the last 25 years, the global age-standardized summary exposure to hypertension has increased for men but not for women. A pooled analysis of 1479 population-based measurements covering more than 19 million participants over four decades showed that the number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015. Most of the increase occurred in low- and middle-income countries. Globally, the highest BP levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa while BP levels have remained persistently high in central and eastern Europe.

scholarly journals Quantifying the under-estimation of cervical Cancer in remote regions of Tanzania

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mariah P. Gesink ◽  
Robert M. Chamberlain ◽  
Julius Mwaiselage ◽  
Crispin Kahesa ◽  
Kahima Jackson ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Low Income ◽  
Population Based ◽  
Capital City ◽  
Low Income Countries ◽  
Treatment Center ◽  
Large Country ◽  
Number Of Patients ◽  
Sub Saharan ◽  
Radiotherapy Treatment

Abstract Background Cervical cancer is the most common cancer among women in Sub-Saharan countries, including Tanzania. While early detection and diagnosis are available in some parts of this large country, radiotherapy has been only available at the Ocean Road Cancer Institute (ORCI), in the capital city of Dar es Salaam and is just starting in a few regions. Methods The objective of this study was to compare the observed incidence of cervical cancer for the two remote regions of Mwanza in western Tanzania and Mbeya in southern Tanzania, based on their patients treated at the ORCI from 2011 to 2014. Results: The number patients referred and treated at ORCI were (120 from Mwanza, and 171 from Mbeya, representing 24.6 and 32.8% of the patients histopathologically confirmed in the two sites, respectively. The results showed significant underestimation of cervical cancer in the two regions. The vast majority of patients who were histopathologically-confirmed in their local regions (73.92% from Mwanza and 65.1% from Mbeya), but did not receive the needed radiotherapy treatment at the ORCI. The estimated incidence for the two regions based on the number of patients treated at the ORCI were underestimated by 53.9% for Mwanza and 68.9% for Mbeya. Conclusions Local establishment of radiotherapy treatment facilities in remote regions in Tanzania and similar other low-income countries is essential for providing effective treatment and improving survival of diagnosed cervical cancer patients. Linkage between the records of local remote hospitals and the main cancer treatment center in the capital city can also help support the emerging the population-based cancer registry at ORCI.

scholarly journals Changing Epidemiology of Acute Respiratory Infections in Under-Two Children in Dhaka, Bangladesh

2022 ◽  
Vol 9 ◽  
Author(s):  
Karine Vidal ◽  
Shamima Sultana ◽  
Alberto Prieto Patron ◽  
Irene Salvi ◽  
Maya Shevlyakova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Low Income ◽  
Respiratory Infections ◽  
Monsoon Season ◽  
Low Income Countries ◽  
Health Study ◽  
Acute Respiratory Infections ◽  
Respiratory Pathogens ◽  
Prevention Measures

Objectives: Risk factors for acute respiratory infections (ARIs) in community settings are not fully understood, especially in low-income countries. We examined the incidence and risk factors associated with ARIs in under-two children from the Microbiota and Health study.Methods: Children from a peri-urban area of Dhaka (Bangladesh) were followed from birth to 2 years of age by both active surveillance of ARIs and regular scheduled visits. Nasopharyngeal samples were collected during scheduled visits for detection of bacterial facultative respiratory pathogens. Information on socioeconomic, environmental, and household conditions, and mother and child characteristics were collected. A hierarchical modeling approach was used to identify proximate determinants of ARIs.Results: Of 267 infants, 87.3% experienced at least one ARI episode during the first 2 years of life. The peak incidence of ARIs was 330 infections per 100 infant-years and occurred between 2 and 4 months of age. Season was the main risk factor (rainy monsoon season, incidence rate ratio [IRR] 2.43 [1.92–3.07]; cool dry winter, IRR 2.10 [1.65–2.67] compared with hot dry summer) in the first 2 years of life. In addition, during the first 6 months of life, young maternal age (<22 years; IRR 1.34 [1.01–1.77]) and low birth weight (<2,500 g; IRR 1.39 [1.03–1.89]) were associated with higher ARI incidence.Conclusions: Reminiscent of industrialized settings, cool rainy season rather than socioeconomic and hygiene conditions was a major risk factor for ARIs in peri-urban Bangladesh. Understanding the causal links between seasonally variable factors such as temperature, humidity, crowding, diet, and ARIs will inform prevention measures.

Abstract P011: Cardiovascular Risk Factors and Longevity

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Michelle C Odden ◽  
Andreea Rawlings ◽  
Alice Arnold ◽  
Mary Cushman ◽  
Mary Lou Biggs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Cardiovascular Risk Factors ◽  
Old Age ◽  
Repeated Measures ◽  
Ldl Cholesterol ◽  
Low Cardiovascular Risk

Introduction: Cardiovascular disease is the leading cause of mortality in old age, yet there is limited research on the patterns of cardiovascular risk factors that predict survival to 90 years. Hypothesis: The patterns of cardiovascular risk factors that portend longevity will differ from those that confer low cardiovascular risk. Methods: We examined repeated measures of blood pressure, LDL-cholesterol, and BMI from age 67 and survival to 90 years in the Cardiovascular Health Study (CHS). CHS is a prospective study of 5,888 black and white adults in two waves (1989-90 and 1992-93) from Medicare eligibility lists in four counties in the U.S. We restricted to participants aged 67 to 75 years at baseline to control for birth cohort effects and examined repeated measures of cardiovascular risk factors throughout the late-life course. We fit logistic regression models to predict survival to age 90 using generalized estimating equations, and modeled the risk factors as linear, a linear spline, and clinically relevant categories. Models were adjusted for demographics and medication use, and we also examined whether the association of each risk factor with longevity varied by the age of risk factor measurement. Best fit models are presented. Results: Among 3,645 participants in the birth cohort, 1,160 (31.8%) survived to 90 by June 16 th , 2015. Higher systolic blood pressure in early old age was associated with reduced odds for longevity, but there was an interaction with age such that the association crossed the null at 80 years. (Table) Among those with LDL-cholesterol <130 mg/dL, higher LDL-cholesterol was associated with greater longevity; at levels above 130 mg/dL there was no association between LDL-cholesterol and longevity. BMI had a u-shaped association with longevity. Conclusions: In summary, the patterns of risk factors that predict longevity differ from that considered to predict low cardiovascular risk. The risk of high systolic blood pressure appears to depend on the age of blood pressure measurement.

P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kane ◽  
P Cavagna ◽  
I B Diop ◽  
B Gaye ◽  
J B Mipinda ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Low Income ◽  
Democratic Republic ◽  
Antihypertensive Drugs ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sub Saharan

Abstract Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p<0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p<0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p<0.01). Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

scholarly journals Curtailing Covid-19 on a Dollar-a-Day in Malawi: Implications for the Ongoing Pandemic

2021 ◽  
Author(s):  
Iliana V. Kohler ◽  
Fabrice Kämpfen ◽  
Alberto Ciancio ◽  
James Mwera ◽  
Victor Mwapasa ◽  
...  
Keyword(s):  
Public Health ◽  
Low Income ◽  
Population Based ◽  
Community Leadership ◽  
Pivotal Role ◽  
Low Income Countries ◽  
Effective Response ◽  
Trust In Institutions ◽  
Primary Prevention Strategy ◽  
Sub Saharan

AbstractUtilizing population-based data from the Covid-19 phone survey (N = 2, 262) of the Malawi Longitudinal Study of Families and Health (MLSFH) collected during June 2nd–August 17th, 2020, we investigate behavioral, economic and social responses to Covid-19 and focus on the crucial role that community leadership and trust in institutions play towards shaping these responses. We argue that the effective response of Malawi to limit the spread of the virus was facilitated by the engagement of local leaders to mobilize communities to adapt and adhere to Covid-19 prevention strategies. Village heads (VHs) played pivotal role in shaping individual’s knowledge about the pandemic and the adaption of preventive health behaviors and were crucial for mitigating the negative economic and health consequences of the pandemic. We further show that trust in institutions is of particular importance in shaping individuals’ behavior during the pandemic, and these findings highlight the pivotal role of community leadership in fostering better compliance and adoption of public health measures essential to contain the virus. Overall, our findings point to distinctive patterns of pandemic response in a low-income sub-Saharan African rural population that emphasized local leadership as mediators of public health messages and policies. These lessons from the first pandemic wave remain relevant as in many low-income countries behavioral responses to Covid-19 will remain the primary prevention strategy for a foreseeable future.

scholarly journals Survival to Age 90 in Men: The Tromsø Study 1974–2018

2019 ◽  
Vol 16 (11) ◽  
pp. 2028
Author(s):  
Tormod Brenn
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
High Blood Pressure ◽  
Low Income ◽  
Population Based ◽  
Individual Risk ◽  
High Cholesterol ◽  
Related Data ◽  
The Impact

The 738 oldest men who participated in the first survey of the population-based Tromsø Study (Tromsø 1) in Norway in 1974 have now had the chance to reach the age of 90 years. The men were also invited to subsequent surveys (Tromsø 2–7, 1979–2016) and have been followed up for all-cause deaths. This study sought to investigate what could be learned from how these men have fared. The men were born in 1925–1928 and similar health-related data from questionnaires, physical examination, and blood samples are available for all surveys. Survival curves over various variable strata were applied to evaluate the impact of individual risk factors and combinations of risk factors on all-cause deaths. At the end of 2018, 118 (16.0%) of the men had reached 90 years of age. Smoking in 1974 was the strongest single risk factor associated with survival, with observed percentages of men reaching 90 years being 26.3, 25.7, and 10.8 for never, former, and current smokers, respectively. Significant effects on survival were also found for physical inactivity, low income, being unmarried, high blood pressure, and high cholesterol. For men with 0–4 of these risk factors, the percentages reaching 90 years were 33.3, 24.9, 12.4, 14.4, and 1.5, respectively. Quitting smoking and increasing physical activity before 55 years of age improved survival significantly. Men should refrain from smoking and increase their physical activity, especially those with low income, those who are unmarried, and those with high blood pressure and high cholesterol.

Association of low serum concentration of bilirubin with increased risk of coronary artery disease

1994 ◽  
Vol 40 (1) ◽  
pp. 18-23 ◽  
Author(s):  
H A Schwertner ◽  
W G Jackson ◽  
G Tolan
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Systolic Blood Pressure ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Smoking History ◽  
Artery Disease

Abstract We examined serum bilirubin and various liver-function enzymes as possible risk factors for angiographically documented coronary artery disease (CAD). The studies involved a "training" set of 619 men for whom complete data on all risk factors considered were available, and a "test" set of 258 men for whom some risk factor data were not available. In both study groups, the liver enzymes were not related to CAD; however, In[total bilirubin] was inversely and statistically significantly related to the presence of CAD, both univariately and multivariately after adjustment for the established risk factors of age, total cholesterol, high-density lipoprotein cholesterol, smoking history, and systolic blood pressure. A 50% decrease in total bilirubin was associated with a 47% increase in the odds of being in a more severe CAD category. Our data suggest that serum bilirubin is an inverse and independent risk factor for CAD, with an association equivalent in degree to that of systolic blood pressure.

scholarly journals The Prevalence of the Metabolic Syndrome and Its Risk Factors in a Middle-Aged Swedish Population — Mainly a Function of Overweight?

2008 ◽  
Vol 7 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Gunilla Hollman ◽  
Margareta Kristenson
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Risk Factor ◽  
Waist Circumference ◽  
Hdl Cholesterol ◽  
Population Based ◽  
Middle Aged ◽  
Swedish Population ◽  
The Metabolic Syndrome

Background: The prevalence of obesity, one risk factor for developing the metabolic syndrome (MS), has increased during the last decades. It has therefore been assumed that the prevalence of MS would also increase. Aims: The aim was to analyse the prevalence of MS and its risk factors in a middle-aged Swedish population. Methods: Data were obtained between 2003 and 2004 from a random population based sample of 502 men and 505 women, 45–69 years old. Measures of plasma glucose, serum lipids, blood pressure, weight, height, waist circumference and self-reported data concerning presence of disease, medication and lifestyle were obtained. Results: The prevalence of MS was 14.8% among men and 15.3% among women, with an increase by age among women only, 10% to 25% ( p = 0.029). Among individuals with MS the most frequent risk factor was large waist circumference, present in 85% of men and 99% of women, followed by high blood pressure, high triglycerides, high glucose and HDL cholesterol (38% and 47% respectively). Conclusion: The prevalence of MS was 15%, increasing with age only among women. Overweight was a dominant characteristic, and only half of the individuals with MS had glucose/HDL cholesterol levels beyond defined cut points of the syndrome.

scholarly journals Distribution and risk profile of atrial fibrillation patterns among women and men from the general population

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M J Tilly ◽  
Z Lu ◽  
S Geurts ◽  
M A Ikram ◽  
M P M De Maat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
General Population ◽  
Population Based ◽  
Mixed Effect ◽  
Duration Of Symptoms ◽  
Men And Women

Abstract Background In a clinical setting, atrial fibrillation (AF) subgroups are defined, including paroxysmal, persistent, and permanent AF. These subgroups differ in terms of clinical characteristics, management strategy, and long-term outcomes. Application of clinical classifications in population-based settings is challenging as they are based on the duration of symptoms, recurrence, and treatment. Purpose We aim to develop an objective and standardized classification for AF patterns in the general population and examine the associated cardiovascular risk profiles and outcomes for the identified AF patterns. Methods Participants with only one reported AF episode were categorized as single-documented AF, if at least two separate AF episodes were reported as multiple-documented AF and as longstanding persistent AF if at least two consecutive ECG's at the research center showed AF, not followed by an ECG showing sinus rhythm. We fitted mixed effect models with age as time scale to characterize sex-specific cardiovascular risk factor trajectories preceding each AF pattern. We further used Cox proportional hazard modelling to describe the risk of coronary heart disease (CHD), heart failure (HF), stroke, and all-cause mortality following AF. Results We included 14,620 men and women aged ≥45 years. 1137 participants were categorized as single-documented AF, 208 as multiple-documented AF, and 57 as longstanding persistent AF. We identified significant differences in the preceding trajectories of weight, body mass index, systolic blood pressure, diastolic blood pressure, waist circumference, hip circumference, and waist-hip ratio with various AF patterns. In general, both men and women with persistent-elevated levels of these risk factors were prone to longstanding persistent AF. AF was associated with a large risk for subsequent CHD, HF, stroke, and mortality in the general population. Among the different AF patterns, single-documented AF conferred the largest risk of CHD [hazard ratio, 95% confidence interval: 1.92 (1.19–3.03)] and mortality [1.70 (1.41–2.07)] as compared to multiple-documented AF, and as compared to longstanding persistent AF [1.45 (0.72–2.90) and 3.66 (2.25–5.95), respectively]. Conclusion We developed a classification for AF patterns within a general population. We identified differences in risk factor trajectories preceding each AF pattern, which implies differences in pathophysiological mechanisms underlying AF. Participants with single-documented AF showed worse prognosis than those with multiple AF episodes. This might be due to the subgroup definition, since participants should live for a longer period of time to be categorized in the multiple-documented AF and longstanding persistent AF groups. This can also imply that participants suffering from multiple AF episodes are more frequently monitored, and treated for other risk factors. However, this could also suggest that singular AF episodes are not as innocent as commonly thought. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): - Erasmus MC Mrace grant. - Netherlands Organization for the Health Research and Development (ZonMw) Figure 1 Figure 2. Progosis of various AF patterns

scholarly journals Cardiovascular Risk Factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis

2020 ◽  
Author(s):  
Geofrey Musinguzi ◽  
Rawlance Ndejjo ◽  
Isaac Ssinabulya ◽  
Hilde Bastiaens ◽  
Harm van Marwijk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Low Income ◽  
Small Area ◽  
Sub Saharan Africa ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Generalized Linear Modelling ◽  
Sub Saharan

Abstract Introduction Sub-Saharan Africa (SSA) is experiencing an increasing burden of Cardiovascular Diseases (CVDs). Modifiable risk factors including hypertension, diabetes, obesity, central obesity, sedentary behaviours, smoking, poor diet (characterised by inadequate vegetable and fruit consumption), and psychosocial stress are attributable to the growing burden of CVDs. Small geographical area mapping and analysis of these risk factors for CVD is lacking in most of sub-Saharan Africa and yet such data has the potential to inform monitoring and exploration of patterns of morbidity, health-care use, and mortality, as well as the epidemiology of risk factors. In the current study, we map and describe the distribution of the CVD risk factors in 20 parishes in two neighbouring districts in Uganda. Methods A baseline survey benchmarking a type-2 hybrid stepped wedge cluster randomised trial design was conducted in December 2018 and January 2019. A sample of 4372 adults aged 25-70 years was drawn from 3689 randomly selected households across 80 villages in 20 parishes in Mukono and Buikwe districts in Uganda. Descriptive statistics and generalized linear modelling controlled for clustering were conducted for this analysis in Stata 13.0, and a visual map showing risk factor distribution developed in QGIS. Results Mapping the prevalence of selected CVD risk factors indicated substantial gender and small area geographic heterogeneity. Patterns and clustering were observed for some major risk factors for CVDs including hypertension, physical inactivity, smoking, and risk factor combination. Prevalence of unhealthy diet was very high across all parishes with no significant observable differences across areas. Conclusion Modifiable cardiovascular risk factors are common in this low income context. Moreover, across small area geographic setting, it appears significant differences in distribution of risk factors exist. These differences suggest that underlying drivers such as sociocultural, environmental and economic determinants may be promoting or inhibiting the observed risk factor prevalences which should be further explored.

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