Therapeutic Inertia in the Management of Proteinuria Among Type 2 Diabetes Patients in Hong Kong Primary Care Setting: Prevalence and Associated Risk Factors

2020 ◽  
Author(s):  
FU LEUNG CHAN ◽  
XIAO RUI CATHERINE CHEN ◽  
YIM CHU LI
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Clinical Practice ◽  
Positive Association ◽  
Cross Sectional Study ◽  
Blood Pressure Reading ◽  
Cross Sectional ◽  
Therapeutic Inertia ◽  
Pressure Reading ◽  
Associated Risk Factors

Abstract Background: Proteinuria is a well-known predictor of poor renal and cardiovascular outcomes in T2DM patientsMethods: Objectives: To explore the prevalence of Therapeutic inertia (TI) on proteinuria management among T2DM patients in primary care and possible patients’ and doctors’ factors.Study design: Cross-sectional studySubjects: T2DM patients with microalbuminuria and macroalbuminuria from 1/1/2014 to 31/12/2015.Outcome assessments: The prevalence of TI on proteinuria management and its association patients’ factors and the working profile of the attending doctors.Results: 5, 163 (26.4%) patients had diabetic nephropathy (DMN) with micro- or macroalbuminuria. Among the sampled 385 patients with DMN, TI was found to be 40.3%. Doctor factors for higher TI rate include male sex and doctors with longer duration of clinical practice and who have never received any form of Family Medicine training. Patients factors include lower average systolic (SBP) and diastolic blood pressure reading. Patients’ SBP reading and microalbuminuria were negative association factor whereas doctor’s year of clinical practice being over 21 years and patients being treated with submaximal dose of medication were positive association factors to TI. Conclusions: TI is commonly present on proteinuria management among T2DM patients managed in the primary care. Patient’s systolic blood pressure reading, microalbuminuria level, Dr’s year of clinical practice and dose of ACEI/ARB were found to be associated with the presence of TI. Further study on the barriers and strategies to combat TI is needed to improve the clinical outcome among T2DM patients.

scholarly journals A cross sectional study of the prevalence of hypertension and associated risk factors in coastal Andhra Pradesh

2019 ◽  
Vol 7 (1) ◽  
pp. 317
Author(s):  
Gopalakrishna K. ◽  
Venkata R. S. Subrahmanya Sarma ◽  
Raghuram P. ◽  
Chowdary P. S. S. ◽  
Purnachandrarao K. ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Odds Ratio ◽  
Andhra Pradesh ◽  
Positive Association ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Public Health Burden ◽  
Level Data ◽  
Associated Risk Factors

Background: Hypertension (HTN) accounts for 9.4 million deaths worldwide every year. A rise in HTN is projected by the global burden of HTN 2005 study, it portrays a grim picture. Community level data for hypertension is scarce in Andhra Pradesh. A cross sectional study was conducted to know the prevalence of hypertension in Vijayawada.Methods: 1009 apparently healthy adults visiting the hospital accompanying patients in outpatient department were screened for hypertension by blood pressure recording. All measurements were obtained by automated blood pressure measuring (AOBPM) systems.Results: Of the total population screened, hypertension accounted for 42.5% (n=429). A multivariate analysis showed that hypertension is more common in age group >50 years [odds ratio (OR)=3.004, 95% confidence interval CI being=2.2707-3.9645], in diabetics (OR=2.9091, 95% CI=2.0595-4.1092), in males (odds ratio=1.3223, 95% CI=1.0214-1.7118) and in smokers (OR=1.7442, 95% CI=1.0469-2.9059). A linear positive association was found between obesity and hypertension. No significant association was found between hypertension and alcohol intake. This study also showed that awareness was present in only 44% and 37% had hypertension under control of known hypertensive subjects.Conclusions: This is the first cross sectional study done with AOBPM. Our study finds that hypertension is an important public health burden in coastal Andhra Pradesh with low awareness, treatment, and control. It implies that strategies need to be developed to improve effective primary care management of hypertension.

scholarly journals PREVALENCE OF OBESITY AND ITS ASSOCIATED RISK FACTORS AMONG POST- BASIC RENAL CARE NURSING STUDENTS

2019 ◽  
Vol 19 (1) ◽  
pp. 177-183
Author(s):  
Aung Myo Oo ◽  
Al-abed Ali A. Al-abed ◽  
Ohn MarLwin ◽  
Sowmya Sham Kanneppady ◽  
Sham Kishor Kanneppady
Keyword(s):  
Blood Pressure ◽  
Nursing Students ◽  
Healthy Lifestyle ◽  
Cross Sectional Study ◽  
Staff Nurses ◽  
Cross Sectional ◽  
Rate Of Increase ◽  
Prevalence Of Obesity ◽  
Associated Risk Factors ◽  
Care Nursing

Obesity is one of the most common, yet among the most neglected, public health problems around the world and it is strongly associated with various non-communicable diseases such as hypertension, diabetes mellitus and coronary artery diseases. Health care personal especially nurses play an important role in educating public to have healthy lifestyle. However, there is an alarming rate of increase in number of obesity among nursing students as well as staff nurses. Therefore, the aim of this study was to determine the anthropometric measurements and its associated risks among post-basic renal care nursing students. Total of 142 post-basic renal care nursing students of five intakes were included in this cross-sectional study. The result of the study showed that 52% of participants were either overweight or obese although most of them were below 40 years of age. Majority of overweight or obese students were Malays and 78% of them being female. We also observed an association of systolic blood pressure (SBP), diastolic blood pressure (DBP) and waist circumference (WC)with increasing body mass index (BMI) (P= 0.001, P= 0.001 and P<0.001) which were statistically significant. Wald criterion estimated that WC and DBP were the most important predictors of BMI in present study. Our study concluded that obesity is prevalent among post-basic renal care nursing students. Urgent and appropriate action should be taken to deter the growing problem of obesity among nursing students and to avoid its subsequent complications in Malaysia.

Prevalence of Hypertension and Associated Risk Factors Among Women in a Rural Community in Bangladesh: A Cross-Sectional Study

2021 ◽  
pp. 1-19
Author(s):  
Anika Boitchia ◽  
Shabnam Naher ◽  
Sabbir Pervez ◽  
Moyazzem Hossainc
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Rural Women ◽  
Cross Sectional Study ◽  
Uncontrolled Hypertension ◽  
Background Characteristics ◽  
Cross Sectional ◽  
The Mean ◽  
Associated Risk Factors ◽  
Structured Questionnaire

Abstract The purpose of this cross-sectional quantitative study was to identify the prevalence and associated risk factors of hypertension among rural women. Data collection was carried out between March to June 2019 among 380 women in Kumarkhali Upazila, Kushtia, Bangladesh. Participants were interviewed with a structured questionnaire including background characteristics, anthropometric measurements, prevalence, and risk factors of hypertension. IBM SPSS version 25 was used for analyzing the data. The prevalence of hypertension and prehypertension among the total participants was 21.3% and 17.1%, respectively. The mean systolic and diastolic blood pressure was 126.65 (±19.31) mmHg and 77.21 (±12.51) mmHg. Association was found between the prevalence of hypertension and participant’s age, marital status, educational level, body mass index, intake of raw salt, secondary smoking, stress, and diabetes (p<0.05). Among the diabetic women, prehypertension and hypertension prevailed as 26.3% and 55.3% respectively. The lowest risk of hypertension was found with limited raw salt (aOR: 1.42) and red meat (aOR: 0.05) consumption. Hypertension was more likely to affect overweight (aOR: 3.98) and women aged 55 to 64 years (aOR: 13.44). Thus, effective and integrated intervention agendas are required for women, which can improve the rate of diagnosis and prevent uncontrolled hypertension in Bangladesh. Keywords: Prevalence, hypertension, women, blood pressure, risk factor, Bangladesh

Abstract P334: The Relationship Between Urinary Sodium-to-Potassium Ratio And High Blood Pressure: TMM CommCohort Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Mana Kogure ◽  
Tomohiro Nakamura ◽  
Naho Tsuchiya ◽  
Takumi Hirata ◽  
Akira Narita ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Alcohol Intake ◽  
Positive Association ◽  
Cross Sectional Study ◽  
Analysis Of Covariance ◽  
Cross Sectional ◽  
High K ◽  
Prevention Of Hypertension ◽  
The Relationship ◽  
Low K

Introduction: Recently, the balance between sodium and potassium intake, i.e. sodium-to-potassium (Na/K) ratio, has received significant attention for prevention of hypertension. Previous studies reported the positive association between urinary Na/K (uNa/K) ratio and hypertension. However, even the same uNa/K ratio value, there might be high Na/ high K ratio or low Na/ low K ratio. Hypothesis: We assessed the hypothesis that blood pressure (BP) is higher in high Na/ high K group than that in low Na/ low K group even at the same uNa/K ratio in general population in cross-sectional study. Methods: The subjects were 20 to 74 years old who participated in The Tohoku Medical Megabank Project Community-based Cohort Study. Of these participants, we targeted 54,011 subjects (men: 20,505 women: 33,506 mean age: 59.9 years) who had information of BP, urinary Na and K. We estimated 24-h urinary excretion of Na and K using Tanaka formula. Urinary Na and K were each classified into quartiles (Na; Q1~Q4, K; Q1~Q4), and set all 16 groups of uNa/K ratio by combining Na and K respectively. To assess the relationship between casual uNa/K ratio and BP, we performed an analysis of covariance to calculate the adjusted mean systolic BP (SBP). We included covariate factors as age, sex, BMI and alcohol intake. We also assessed the relationship between uNa/K ratio and SBP using multiple regression analyses adjusted for covariate factors. We stratified the participants into two groups: ‘under treatment for hypertension’ (n=17,091) and ‘without treatment for hypertension (n=36,920)’. Results: The mean of uNa/K ratio for each group of Na (Q1)/K(Q1), Na (Q2)/K(Q2), Na (Q3)/K(Q3) and Na (Q4)/K(Q4) was all 4.0. As previous report showed, higher uNa/K ratio group showed higher SBP and lower uNa/K group showed lower BP. When we compared adjusted mean SBP of Na (Q1)/K(Q1) and Na (Q4)/K(Q4) the value were comparable, but the value were significantly higher in Na (Q4)/K(Q4) group (The adjusted mean SBP of Na (Q1)/K(Q1), Na (Q2)/K(Q2), Na (Q3)/K(Q3) and Na (Q4)/K(Q4) was 123.6, 124.9, 124.7 and 125.5 mmHg, respectively). The uNa/K was significantly positively associated with SBP independently of age, sex, BMI, and alcohol intake. The finding was unchanged the results in under treatment group. Conclusions: BP was significantly higher in high Na/ high K group than in low Na/ low K group even at the same uNa/K ratio. We suggested that not only increasing K intake but also reducing salt is important for preventing hypertension.

scholarly journals Prevalence and associated risk factors of hypertension among persons aged 15–49 in India: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e029714 ◽  
Author(s):  
Soumitra Ghosh ◽  
Manish Kumar
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Family Health ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Effective Interventions ◽  
Life Style Changes ◽  
Associated Risk Factors

ObjectivesThis is the first attempt to provide estimates on the prevalence of hypertension at the national, state and district level, a prerequisite for designing effective interventions. Besides, the study aims to identify the risk factors of hypertension.DesignWe analysed cross-sectional survey data from the fourth round (2015–2016) of National Family Health Survey (NFHS). NFHS was conducted between January 2015 and December 2016, gathering information on a range of indicators including blood pressure. The age adjusted prevalence of hypertension was calculated for state comparison, while multilevel logistic regression analysis was done to assess the correlates of hypertension.Setting and participantsIndia (2015–2016; n=811 917) aged 15–49.Primary and secondary outcome measuresThe primary outcome is hypertension, which has been defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg.ResultsThe age-adjusted prevalence of hypertension in India was 11.3% (95% CI 11.16% to 11.43%) among persons aged between 15 and 49 and was four percentage points higher among males 13.8% (95% CI 13.46% to 14.19%) than among females 10.9% (95% CI 10.79% to 11.06%). Persons in the urban location (12.5%, 95% CI 12.25% to 12.80%) had a marginally higher prevalence than persons in rural location (10.6%, 95% CI 10.50% to 10.78%). The proportion of population suffering from hypertension varied greatly between states, with a prevalence of 8.2% (95% CI 7.58% to 8.85%) in Kerala to 20.3% (95% CI 18.81% to 21.77%) in Sikkim. Advancing age, obesity/overweight, male sex, socioeconomic status and consumption of alcohol were found to be the major predictors of hypertension.ConclusionsHypertension prevalence is now becoming more concentrated among the poor. Policy measures should be taken to improve the hazardous working conditions and growing social pressures of survival responsible for ‘life-style’ changes such as consumption of high calorie food and alcohol.

scholarly journals Therapeutic inertia in proteinuria management among type 2 diabetes (T2DM) patients in primary care settings: prevalence and associated risk factors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
FU Leung Chan ◽  
Yim Chu Li ◽  
Xiao Rui Catherine Chen
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Clinical Practice ◽  
Stepwise Logistic Regression ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Case Register ◽  
Negatively Associated ◽  
Therapeutic Inertia ◽  
Primary Care Settings

Abstract Background Therapeutic inertia (TI), defined as physicians’ failure to increase therapy when treatment goals are unmet, is an impediment to chronic disease management. This study aimed to identify the prevalence of TI in proteinuria management among T2DM patients managed in primary care settings and to explore possible associating factors. Methods This was a cross-sectional study. T2DM patients with proteinuria (either microalbuminuria or macroalbuminuria) and had been followed up in 7 public primary care clinics of the Hospital Authority of Hong Kong from 1 Jan, 2014 to 31 Dec, 2015 were included. The prevalence of TI in proteinuria management and its association with patients’ demographic and clinical parameters and the working profile of the attending doctors were explored. Student’s t test and analysis of variance were used for analyzing continuous variables and Chi square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the association between TI and the significant variables from patients' and doctors' characteristics. Results Among the 22,644 T2DM patients identified in the case register, 5163 (26.4%) patients were found to have proteinuria. Among the sampled 385 T2DM patients with proteinuria, TI was identified in 155 cases, with a prevalence rate of 40.3%. Male doctor, doctor with longer duration of clinical practice and have never received any form of Family Medicine training were found to have a higher TI. Patients with microalbuminuria range and lower systolic and diastolic blood pressure (BP) were also found to have higher TI. Logistic regression study revealed that patients’ systolic BP level and microalbuminuria range of proteinuria were negatively associated with the presence of TI, whereas doctor’s year of clinical practice being over 20 years and patients being treated with submaximal dose of medication were positively associated with the presence of TI. Conclusions TI is commonly present in proteinuria management among T2DM patients, with a prevalence of 40.3% in primary care. Systolic BP and microalbuminuria range of urine ACR were negatively associated with the presence of TI, whereas submaximal ACEI/ARB dose and doctors practicing over 20 years were positively associated with the presence of TI. Further studies exploring the strategies to combat TI are needed to improve the clinical outcome of T2DM patients.

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