Indian College of Radiology and Imaging Evidence-Based Guidelines for Interventions in Portal Hypertension and Its Complications

Portal hypertension is a complication of chronic liver disease. Various radiological interventions are being done to aid in the diagnosis of portal hypertension; further, an interventional radiologist can offer various treatments for the complications of portal hypertension. Diagnosis of portal hypertension in its early stage may require hepatic venous pressure gradient measurement. Measurement of gradient also guides in diagnosing the type of portal hypertension, measuring response to treatment and prognostication. This article attempts to provide evidence-based guidelines on the management of portal hypertension and treatment of its complications.

Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study

Background Hypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management. Methods and findings We designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017–2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%–46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%–56.5%) had been diagnosed, 38.9% (95% CI 38.1%–39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%–32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14–1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61–0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68–1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86–1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00–1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10–1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p < 0.001) improvement in hypertension management from 2010 to 2017–2019. The limitations of this study include the pilot sample being relatively small and that it recruited from only 4 states. Conclusions Although considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment.

A large-scale health survey for a pilot project to reduce the health disparity in Samho-dong, Ulsan Metropolitan City: Results and implications

Introduction: This study conducted a large-scale health survey in Namg-gu, Ulsan Metropolitan City. In specific, the survey results of Samho-dong, one of the 14 dongs in Nam-gu, and the rest of Nam-gu were compared. Also, the results were compared with the Community Health Survey results for implications.Methods: A total of 2,036 people participated in the large-scale survey. Descriptive analysis was performed to examine the socio-demographic characteristics of these two participant groups. The Chi-Square test or Fisher’s exact test was executed to identify differences between the two groups and the results were compared to the 2014-2019 Community Health Surveys results.Results: The exposure rate of secondhand smoke in public areas and the subjective obesity awareness rate were statistically significantly higher in Samho-dong residents than non-Samho-dong residents in Nam-gu. The same patterns of statistical significance were also observed in the rate of high mental stress, the rate of hypertension diagnosis (≥30), and the annual rate of unmet healthcare needs. Compared with the six-year cumulative data of Community Health Surveys, the rate of hypertension diagnosis (≥30) and the rate of diabetes diagnosis (≥30) of Samho-dong residents were lower than that of Community Health Surveys.Conclusions: It is suggested to prioritize designating smoking zones, strengthening mental health services, and operating chronic disease management programs in Samho-dong. The findings of this study support the need for large-scale surveys on the health status of local areas to reduce health disparities and serve as a foundation to reduce them.

Prevalence and inequality in persistent undiagnosed, untreated, and uncontrolled hypertension: Evidence from a cohort of older Mexicans

Hypertension is the leading risk factor for cardiovascular diseases (CVDs) and substantial gaps in diagnosis, treatment and control signal failure to avert premature deaths. Our aim was to estimate the prevalence and assess the socioeconomic distribution of hypertension that remained undiagnosed, untreated, and uncontrolled for at least five years among older Mexicans and to estimate rates of transition from those states to diagnosis, treatment and control. We used data from a cohort of Mexicans aged 50+ in two waves of the WHO Study on Global AGEing and adult health (SAGE) collected in 2009 and 2014. Blood pressure was measured, hypertension diagnosis and treatment self-reported. We estimated prevalence and transition rates over five years and calculated concentration indices to identify socioeconomic inequalities using a wealth index. Using probit models, we identify characteristics of those facing the greatest barriers in receiving hypertension care. More than 60 percent of individuals with full item response (N = 945) were classified as hypertensive. Over one third of those undiagnosed continued to be in that state five years later. More than two fifths of those initially untreated remained so, and over three fifths of those initially uncontrolled failed to achieve continued blood pressure control. While being classified as hypertensive was more concentrated among the rich, missing diagnosis, treatment and control were more prevalent among the poor. Men, singles, rural dwellers, uninsured, and those with overweight were more likely to have persistent undiagnosed, untreated, and uncontrolled hypertension. There is room for improvement in both hypertension diagnosis and treatment in Mexico. Clinical and public health attention is required, even for those who initially had their hypertension controlled. To ensure more equitable hypertension care and effectively prevent premature deaths, increased diagnosis and long-term treatment efforts should especially be directed towards men, singles, uninsured, and those with overweight.

Hypertension Diagnosis, Treatment, and Control among Older Chinese: Trends in the Hypertension Care Cascade

Hypertension is a major risk factor for cardiovascular disease, which is the leading cause of death in China. Older persons are at higher risk of elevated blood pressure and are more likely to have insufficient hypertension care, including delayed diagnosis and poor management. However, we know little about hypertension care among older Chinese at a population level. We use a nationally representative sample of older adults from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015 (n = 9,083), to clarify the hypertension care cascade for the older population in China by specifying the level of diagnosis, treatment, and control of hypertension. We then examine the characteristics of those (1) who received appropriate hypertension care and (2) whose care improved over time. Diagnosis and care improved between 2011 and 2015. Among those with hypertension, 55% and 67% were diagnosed in 2011 and 2015 respectively; 46% and 60% were treated with modern medication; and 20% and 29% were effectively controlled. Those who had higher income (OR=1.52; P&lt;0.01) or obese (OR=2.43; P&lt;0.001) were relatively more likely to be diagnosed, while those living in the western region (OR=0.65; P&lt;0.01) or living in urban areas with a rural hukou (OR=0.54; P&lt;0.01) were less likely. Persons age 75+ (OR=0.55; P&lt;0.05) were less likely to have their blood pressure controlled, while those who had higher income (OR=1.50; P&lt;0.05) were more likely. The improvement from 2011 to 2015 in hypertension care was concentrated among those that are obese or living in the West.

Twenty-Four–Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals

Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBP MAP/DBPcal ), or bSBP/diastolic blood pressure (cSBP SBP/DBPcal ), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBP MAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBP SBP/DBPcal , respectively. We pragmatically propose as upper normal limit for 24-hour cSBP MAP/DBPcal 135 mm Hg and for 24-hour cSBP SBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBP SBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBP MAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.

Effect of Pharmacist Home Visits on Weight Control in Overweight Elderly Hypertensive African American Patients: Managing Your Blood Pressure (My Bp) Program

Objective: The objective was to investigate the effect of a home-based pharmacy intervention on body mass index (BMI) in a cohort of older hypertensive overweight African American (AA) patients. Design: A secondary analysis of data collected in a community-based intervention study. Setting: Community-based. Participants: AA patients, ≥ 65 years old, residing independently, with hypertension diagnosis and BMI ≥ 25. Interventions: During a 6month period, patients received 1) two in-home pharmacist-led consultations on weight management, 2) bi-weekly telephone counseling, and 3) health education strategies. Main Outcome Measures: BMIs at baseline and 6 months; stages of behavioral change in diet and exercise based on the Transtheoretical Model. Results: At baseline and 6-month follow-up, a total of 153 participants had BMI ≥ 25 and received a completed assessment of behavioral stages. Participants’ mean age was 74.2 years. A reduction of BMI from 31.7 (obese) at baseline to 29.8 (overweight) at 6-months (p=0.0008) was observed. For every stage of improvement in diet, there was a reduction of 1.24 points in BMI (p=0.008). For every stage of progress in exercise, there was a reduction of 0.77 points in BMI (p=0.013). Conclusion: Pharmacists-led in-home consultations coupled with telephone follow-ups and health education strategies may improve lifestyle and lower BMIs in this cohort. Further studies are needed to investigate these strategies on weight management in geriatric patients with chronic illnesses.