Risk Factor For High Blood Pressure Research Articles

Barriers and enablers to salt intake reduction in Australian adults with high blood pressure.

High dietary salt intake is a known risk factor for hypertension. However, Australians continue to consume excessive amounts of salt. The purpose of this study was to identify barriers, enablers and strategies to reduce salt in a sample of Australian adults with hypertension. This was a qualitative study. Participants were asked a set of open-ended questions during focus groups conducted between October 2020 and April 2021. Sessions were recorded and transcribed. Using an inductive approach, the transcript data from the focus groups were thematically analysed. This involved checking accuracy, becoming familiar with the data, coding responses based on questions, identifying themes through common patterns and validating themes by grouping similar questions that represented the data and study aim effectively. Thirty-one adults (55 % females) with high blood pressure participated in the focus group discussions. Participants demonstrated good knowledge of high blood pressure risk factors but lacked an understanding of recommended salt intake levels and sources of hidden salt. Challenges in reducing salt intake included the limited availability of low-salt commercial foods. Participants suggested improved food labelling and the use of technology-based interventions to promote healthier choices. Findings highlight the need for behavioural interventions, policy reforms and collaborations between the government, food industries and health organisations to address high salt intake in the population.

The prevalence and risk factors associated with hypertension subtypes among ethnic Dai adults in rural China

This study was conducted from June to September 2020 and conducted a population-based study of 2149 rural Dai residents aged 50 years or above in Xishuangbanna. The definition of hypertension was a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, or a current treatment plan with an antihypertensive medication. High blood pressure (HBP) included the following subtypes: SDH, ISH and IDH. All participants were interviewed, had physical examinations performed, and had blood pressure measurements taken. Multivariable logistic regression analysis was applied to analyse the risk factors forhypertension. The prevalence of HBP was 43.2 %. The subtype-specific prevalence of hypertension was 16.5 % for SDH, 24.2 % for ISH and 2.5 % for IDH. Among hypertensive participants, 38.2 % were SDH, 56.0 % were ISH and 5.8 % were IDH. Older age is a risk factor for HBP and ISH. Obesity, smoking, drinking and history of hypertension are risk factors for HBP and its subtypes including SDH and ISH (OR >1). Among all the hypertensive participants, only 25.0 % of the participants were aware of their hypertension while 34.7 % of SDH participants, 20.0 % of ISH participants and 9.3 % of IDH participants knew the individual subtype of hypertension. Among Dai people, the prevalence of hypertension is high, while the awareness and the rate of adequate treatment of hypertension is low. ISH stood out as the most prevalent type ofHBP among the rural elderly. Rising ageing population in China, ISH remains an important public health problem and a challenging management issue in rural China.

FEASIBILITY OF SCHOOL-BASED SCREENING FOR HIGH BLOOD PRESSURE IN CHILDREN: THE HEALTHY HEARTS @ SCHOOL STUDY

Objective: High blood pressure (BP) in childhood is associated with end organ damage and cardiovascular events in mid-adulthood. Community-based BP screening may improve equitable access and awareness, but robust methodology is required. Accordingly, our aim was to assess the acceptability and feasibility of a two-stage school-based BP screening program incorporating targeted 24-hour ambulatory blood pressure monitoring (ABPM). Design and method: One-hundred-ninety-eight children (59% male, 7.6–12.7 years) in grades 3-6 were recruited from three primary schools in Melbourne, Australia. Following an education session for all children in these grades, BP was measured five times in students after parental consent, using the auscultatory method, alternating between arms and after five minutes of rest. Those with an average BP >85th percentile (AAP thresholds) or a risk factor for high BP had these measurements repeated two weeks later, along with ABPM. Families and students also completed an optional questionnaire post-program. Results: At the first assessment, 11 (5.6%) and 10 (5.0%) had elevated or hypertensive BP respectively (14.6% combined if using just the first measure). Fifty-nine (29.8%) were selected for the second assessment (including 10 with obesity, 15 born premature, four with a history of congenital heart disease, and nine with BP >85th percentile, but <90th percentile), of which 52 attended. ABPM indicated that 11 (5.6%) and five (2.5%) had white coat hypertension based on assessment one and two respectively, three (1.5%) had sustained hypertension (based on either assessment stage), and two (1%) had masked hypertension. Three additional participants each had either high BPs during school assessment but did not undertake, or had inconclusive, ABPMs. Overall, 11 (5.6%) were referred to a doctor for medical follow-up. The majority of students (67%) reported that ABPM was tolerable (‘bothersome’ score <8/10 for day and/or night). 96% of families approved of the program and 90% welcomed it as part of their child's schooling. Conclusions: These data indicate that a school-based BP screening program is acceptable and feasible, and that measuring BP on multiple occasions, and with targeted ABPM, is pivotal for minimising false positives and unnecessary referrals.

Prevalence of and Factors Associated With High Blood Pressure at 15 Years of Age: A Birth Cohort Study.

Arterial hypertension is the greatest cause of morbidity and mortality worldwide. Our aim was to investigate the prevalence of and factors associated with high blood pressure (HBP) among adolescents. The Pelotas 2004 Birth Cohort included 4231 newborns from hospital births in Pelotas, Brazil. A digital automatic OMRON sphygmomanometer (model HEM 742) was used to measure blood pressure on 3 occasions (at 6, 11, and 15 years of age). Those with blood pressure ≥95th percentile for age, height, and sex on each of the 3 occasions were considered as presenting HBP. Independent variables included family (income and history of arterial hypertension), maternal (schooling, age, pregestational body mass index, and smoking during pregnancy), and adolescent characteristics at birth (sex, skin color, gestational age, intrauterine growth, and systolic and diastolic genetic factors), and at 15 years (sleep, physical activity, sodium intake, screen time, work, body mass index, fat mass index, fat-free mass index, growth pattern, and puberty status). The prevalence of HBP (95% CI) was calculated. Crude and adjusted odds ratios (ORs) stratified by sex were obtained by logistic regression. A total of 1417 adolescents with complete information on blood pressure on the 3 occasions were analyzed. The prevalence of HBP was 3.2% (95% CI, 1.9%-4.5%) in female adolescents and 4.3% (95% CI, 2.8%-5.8%) in male adolescents. Female adolescents with a family history of arterial hypertension had a 3 times higher chance of HBP than their counterparts (OR, 3.1 [95% CI, 1.26-7.54]). In male adolescents, excessive maternal pregestational weight was associated with a 2.3-fold increase in the chance of HBP. In both sexes, excessive adolescent weight was associated with HBP (ORs, 3.5 and 5.0, for female and male adolescents, respectively). A higher fat mass index and fat-free mass index in female (ORs, 1.4 and 1.2, respectively) and male adolescents (ORs, 2.5 and 3.0, respectively) increased the chance of HBP. Among male adolescents, the chance of HBP was higher among those with rapid weight gain between 48 months and 6 years and between 6 and 11 years and rapid height gain between 6 and 11 years. Higher fat mass in both sexes and rapid weight gain in male adolescents are risk factors for HBP in adolescents aged 15 years, potentially amenable to prevention.

How is Obstructive Sleep Apnea Associated with High Blood Pressure and Diabetes Mellitus Type 2? Clues from a Two-Step Mendelian Randomized Study.

Obstructive sleep apnea (OSA), high blood pressure (HBP), and type 2 diabetes mellitus (T2DM) have a close clinical relationship, but whether and how OSA affects HBP and T2DM is unclear. Two-step, two-sample Mendelian randomization techniques were applied using single-nucleotide polymorphisms as genetic instruments for exposure and mediators, thus minimizing bias due to confounding factors and reverse causality. The total effect of OSA on HBP and T2DM was categorized into direct and mediating effects based on the mediating factors. Two-sample MR analysis showed that OSA increased the risk of HBP (odds ratio [OR] = 1.010, 95% confidence interval [CI], 1.002-1.018; P = 0.0121) and T2DM (OR = 1.140, 95% CI, 1.059-1.228; P = 0.0005). In the process of OSA caused by HBP, sex hormone-binding globulin (SHBG) (female, 4.47% mediation; male, 2.76% mediation), total testosterone (TT) (male, 3.72% mediation), bioavailable testosterone (BioT) (female, 7.74% mediation), high-density lipoprotein cholesterol (HDL-C) (3.25% mediation), and apolipoprotein A1 (ApoA1) (1.31% mediation) were individual contributors. SHBG (female, 4.10% mediation; male, 1.58% mediation), TT (male, 3.69% mediation), BioT (female, 2.58% mediation), HDL-C (3.32% mediation), ApoA1 (2.14% mediation), and omega-6 fatty acids (2.33% mediation) may have mediating roles to varying degrees in the process of OSA caused by T2DM. This MR study showed that OSA is a risk factor for HBP and T2DM, and the evaluation of mediators may help further reveal the specific mechanism by which OSA causes HBP and T2DM.

Using Complementary and Integrative Medicine to Treat High Blood Pressure in African Americans in the United States: Impact of Knowledge, Beliefs, Attitudes, and Behaviors

Background: African Americans have the highest prevalence of high blood pressure (HBP) in the United States, but the lowest blood pressure control rates among all major racial/ethnic groups. This study examined the extent to which African Americans use home remedies to treat HBP and assessed their knowledge, beliefs, attitudes, and behaviors regarding such use. Materials and Methods: This study utilized a descriptive, exploratory, cross-sectional, and correlational research design. We determined the association between knowledge, beliefs, attitudes, and behaviors and use of home remedies among participants using a principal investigator-developed online questionnaire entitled the Beliefs about Hypertension Survey (BHS). Results: Reliability for the BHS representing all four dependent variables was good (Cronbach's α = 0.848). The study sample was 254 African Americans with and without HBP (79.9% females; 83% aged 30–59). Participants were more willing to use home remedies to treat rather than to prevent HBP, with 58% of participants with HBP reporting current use of home remedies as treatment. Results of the Multivariate Analysis of Variance test indicated statistical significance (P = 0.000) only for the behavior variable (α = 0.05), with no significant differences found between participants with and without HBP with respect to knowledge, beliefs, and attitudes. Conclusion: The results suggest that diagnosis of HBP increases African Americans' willingness to use home remedies, but this group needs more education about the effects and risk factors of HBP. Further evidence-based studies will help to increase knowledge and acceptance of home remedies as a viable treatment option for HBP.

Excess Global Blood Pressure Associated With Fine Particulate Matter Air Pollution Levels Exceeding World Health Organization Guidelines

Excess Global Blood Pressure Associated With Fine Particulate Matter Air Pollution Levels Exceeding World Health Organization Guidelines

Associations of maternal gestational hypertension with high blood pressure and overweight/obesity in their adolescent offspring: a retrospective cohort study

Maternal hypertensive disorders during pregnancy may have an impact on fetal development and the health of the offspring in later life. The aim of the study was to evaluate the associations of maternal gestational hypertension (GH) with high blood pressure (HBP) (prehypertension/hypertension) and overweight/obesity in their adolescent offspring at the age of 12 to 15 years. We analyzed data of 4819 participants born in Kaunas city during 1995–1998 who were included in the study “Prevalence and Risk Factors of HBP in 12–15-Year-Old Lithuanian Children and Adolescents”. The diagnosis of maternal gestational hypertension was obtained from medical records. Associations of maternal GH with their offspring’s HBP and overweight/obesity in adolescence were assessed by multivariate logistic regression analysis. Among 4819 adolescents of 12–15 years of age, 25.7% had HBP, 12% had overweight, and 2.5% had obesity. Of 4819 mothers, 92.3% were normotensive during pregnancy, and 7.7% had GH. In the multivariate analysis after adjustment for age, sex, birth weight, adolescent BMI, and maternal pre/early pregnancy BMI, adolescent offspring born to mothers with GH had higher odds of prehypertension, hypertension, and prehypertension/hypertension (aOR 1.58; 95% CI 1.13–2.22; aOR 1.87; 95% CI 1.41–2.47; and aOR 1.76, 95% CI 1.39–2.24; respectively), compared to the offspring of normotensive mothers. After adjustment for age, sex, birth weight, and maternal pre/early pregnancy BMI, a significant association was found between maternal GH and the offspring’s overweight/obesity in adolescence (aOR 1.41; 95% CI 1.04–1.91). The findings of this study suggest that maternal GH is associated with an increased odds of HBP (prehypertension and hypertension, both separately and combined) and overweight/obesity in their offspring during adolescence.

Can the level of adherence to the Mediterranean diet affect blood pressure? a systematic review and meta-analysis of observational studies

Rationale: High Blood Pressure (BP) constitutes a common and serious medical condition which is rising globally, despite the fact high BP is among the easily preventable factors for cardiovascular, renal, brain and other diseases. Modifiable risk factors of high BP include unhealthy dietary patterns, presence of obesity, excess alcohol consumption and lack of physical activity. Data in regard to the different types of diets show that Mediterranean diet (MD) is associated with healthy levels of BP. In this study we aimed to investigate the impact of the level of adherence to MD in BP.

Impact of the level of adherence to the Mediterranean Diet on blood pressure: A systematic review and meta-analysis of observational studies

High blood pressure (BP) constitutes a common and serious medical condition which is rising globally, and is among preventable factors for cardiovascular, renal, brain and other diseases. Modifiable risk factors of high BP include unhealthy dietary patterns, presence of obesity, excess alcohol consumption and lack of physical activity. Data in regard to the different types of diets show that Mediterranean diet (MD) is associated with healthy levels of BP. In this study we aimed to investigate the impact of the level of adherence to MD in BP. A systematic literature search (up to 08.2021) in PubMed, Scopus, Embase, Web of Science, Cochrane and Google Scholar databases was conducted, and 54 observational studies were included. Systolic blood pressure (SBP) was found to be lower in the high adherence to MD group SMD:-0.08, (95%CI:-0.15,-0.02) whereas no differences regarding diastolic blood pressure (DBP) were observed between the high and low adherence to MD groups [SMD:-0.07, (95%CI:-0.13, 0.00)]. Mean DBP of all included studies for both high and low adherence groups were in healthy levels (<90mmHg). Higher adherence to MD could positively influence SBP, but further research is needed in this field due to the heterogeneous definitions of low/high adherence and the type of studies used (observational).

Prevalence and Socioeconomic Factors of Diabetes and High Blood Pressure Among Women in Kenya: A Cross-Sectional Study

BackgroundThe emerging burden of high blood pressure (HBP) and diabetes in sub-Saharan Africa will create new challenges to health systems in African countries. There is a scarcity of studies that have reported associations of diabetes and HBP with socioeconomic factors on women within the population. We assessed the prevalence and socioeconomic factors of diabetes and high blood pressure among women in Kenya.MethodsWe analysed cross-sectional data from the 2014 Kenya Demographic and Health Survey. Subjects were women aged 15–49 years. Self-reported status of HBP and diabetes was used to measure the prevalences. The association between educational and wealth index with HBP and diabetes was assessed by multivariable binary logistic regression.ResultsThe prevalences of self-reported HBP and diabetes were 9.4% and 1.3%, respectively. Women with secondary [aOR = 1.53; 95% CI = 1.15–2.02] and primary [aOR = 1.48; 95% CI = 1.15–1.92] levels of education were more likely to report having HBP, compared to those with no formal education. However, there was no significant association between educational level and self-reported diabetes. In terms of wealth quintile, we found that women with higher wealth quintile were more likely to report having HBP and diabetes compared to those with poorest wealth quintile. Specifically, the highest odds of self-reported HBP was found among women with richest wealth quintile compared to those with poorest wealth quintile [aOR = 2.22; 95% CI = 1.71–2.88]. Also, women with poorer wealth quintile were more likely to have self-reported diabetes compared to those with poorest wealth quintile [aOR = 1.89; 95% CI = 1.08–2.38].ConclusionThe prevalence of HBP and diabetes was low among women in Kenya. Household wealth status was associated with HBP and diabetes. No causation can be inferred from the data; hence, longitudinal studies focusing on health-related behaviour associated with NCDs are recommended. Proper dissemination of health information regarding the risk factors for HBP and diabetes may prove to be beneficial for NCD prevention programmes.

Low-level exposure to lead, mercury, arsenic, and cadmium, and blood pressure among 8-17-year-old participants of the 2009–2016 National Health and Nutrition Examination Survey

BackgroundDysregulation of systolic, diastolic blood pressure (SBP, DBP), and pulse pressure (PP) in children may predict elevated blood pressure (BP) in adulthood. Toxicant exposure is widely studied as a risk factor for high BP in adults, but not in children. We assessed the joint associations between lead (Pb), mercury (Hg), arsenic (As), and cadmium (Cd) exposure and SBP, DBP, and PP among 8-17 year-old participants (n = 1642) of the 2009–2016 National Health and Nutrition Examination Survey (NHANES). MethodsParticipants with at least two BP measures were included. Urinary As and Cd were adjusted for urinary creatinine concentrations. Blood Pb, Hg, and urinary As, Cd were natural log-transformed. Bayesian Kernel Machine Regression (BKMR) analyses were conducted to assess the associations between the toxicant mixture and BP measures. Multivariable regression models assessed the associations between individual toxicants, and the four toxicants simultaneously with each of the outcomes. Interactions with sodium intake were tested. ResultsExposure to all toxicants was low, with median (5%, 95%) level: Pb, 0.57 (0.26, 1.60) μg/dL; Hg, 0.37 (0.19, 2.12) μg/L; As, 5.61 (1.37, 33.2) μg/g creatinine, Cd, 0.06 (0.03, 0.23) μg/g creatinine. Toxicant mixture showed a statistically significant, inverse association with DBP, but not other BP measures. Linear regressions revealed no association between toxicants, individually or together, and BP measures. No evidence of interaction of sodium intake with any of the toxicants was observed. ConclusionsIn a nationally representative sample of 8–17 year-olds, we found suggestive inverse association of the mixture of low-level Pb, Hg, As, and Cd, with DBP. Longitudinal studies with multiple toxicants are needed to understand the interactive effects of toxicants on children's BP.

Validity of anthropometric indices in predicting high blood pressure risk factors in Iranian children and adolescents: CASPIAN-V study.

Anthropometric indices have been used as indicators for predicting hypertension (HTN) in children and adolescents but it is not clear which anthropometric measures are a better index for identifying elevated blood pressure (EBP) risk factors in pediatric population. Body mass index (BMI), waist circumference (WC), weight-height ratio (WHR), a body shape index (ABSI) and blood pressure were measured in 14008 children and adolescents aged 7-18years in a national school-aged survey CASPIN V. Hypertension (HTN) was defined according to the 2017 American Academy of Pediatrics guidelines, using the 95th percentile. The predictive power of anthropometric indices for HTN risk factors was examined using receiver operating characteristic (ROC) analyses. Multivariate logistic regression analysis was used to compare areas under ROC curves (AUCs) among the four anthropometric indices. BMI, WC, WHR, and ABSI were significantly higher in adolescents than in children. EBP was more prevalent in boys (7.2%) than girls (5.5%), whereas the prevalence of HTN was higher in girls (11.3%) than boys 10.4%. Prevalence odds ratio was around 2 for BMI, WC, and WHR with AUCs scores of nearly 0.6 to predict EBP in both children and adolescents of both sexes. Thus, the ability of BMI z-score, WC, WHR or ASBI to identify Iranian children and adolescents at higher risk of EBP was week. WC, WHR or ASBI in combination with BMI did not improve predictive power to identify subjects at higher risk of EBP.

An Assessment of the Relationship between Anthropometric Parameters and Blood Pressure among Polokwane Private School Children.

High blood pressure (HBP) among children and adolescents has been associated with elevated risk of cardiovascular diseases later in life. The aim of this study was to determine the relationship between body composition and blood pressure among Polokwane private school children. Mean body fat % was significantly (P < 0.05) higher in girls (23.74) than the boys (16.77). There was a significant (P < 0.05) association between systolic blood pressure (BP) and waist circumference (WC) unadjusted (OR = 1.125) and adjusted (OR = 1.097) for age and gender. This study included a total of 1665 children and adolescents (846 boys and 819 girls) aged 5 to 15 years old. Anthropometric measurements including weight, height, hip circumference (HC) and waist circumference (WC) were taken according to standard procedures. Descriptive statistics were done to determine the prevalence of hypertension and mean of all the variables. Pearson correlation, linear regression and logistic regression were all done to determine the association between blood pressure (BP) and the anthropometric measurements. All statistical analysis were done using SPSS. There was a significant association between body composition and blood pressure among Polokwane Private School children. Lowering the risk factors of high BP in children and adolescents will lower their risk of cardiovascular diseases in adulthood.

Associations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: a cross-sectional study

The purpose of the present study was to examine the associations between body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and high blood pressure (HBP), and to determine which anthropometric parameters can best predict HBP among Lithuanian adolescents aged 12–15 years. Data from the survey of “Prevalence and Risk Factors of HBP in 12–15-Year-Old Lithuanian Children and Adolescents (Study 1, 2010–2012)” were used; a total of 7,457 respondents (3,494 boys and 3,963 girls) were included in this analysis. Adolescents with BP above the 90th percentile were measured on two different occasions. Logistic regression analysis was used to assess the associations and to calculate odds ratios. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of the three anthropometric parameters to predict HBP. The adjusted odds ratios (aOR) in the highest quartiles of BMI, WC, and WHtR were statistically significant for both sexes separately (reference group – the first quartile): in boys, prehypertension – 4.91, 4.09, and 1.59; hypertension – 7.96, 6.44, and 2.81; and prehypertension/hypertension – 6.85, 5.65, and 2.37, respectively; and in girls, prehypertension – 3.42, 2.70, and 1.66; hypertension – 5.71, 3.54, and 2.90; and prehypertension/hypertension – 4.62, 3.17, and 2.31, respectively). According to the analyses of the ROC curve, BMI z-score provided the largest area under the curve (AUC) value, followed by WC z-score, while WHtR z-score showed the lowest AUC value in predicting elevated BP in both sexes separately. Among Lithuanian adolescents aged 12–15 years, both anthropometric indices – BMI and WC (but particularly BMI) – showed stronger associations with HBP and were better for the prediction of HBP, compared to WHtR.

Sex Differences in Blood Pressure Hemodynamics in Middle-Aged Adults With Overweight and Obesity

High blood pressure (BP) is the strongest modifiable risk factor for cardiovascular disease. Overweight/obesity is a major risk factor of high BP. Multiple sex differences exist in mechanistic pathways that increase BP in overweight/obesity. They may result in a sex-specific pattern of BP hemodynamics-males and females may vary in the relative contributions of stroke volume, total peripheral resistance (TPR), and heart rate to higher BP. We investigated this possibility in a population-based sample of middle-aged adults (36-65 years). The total sample (n=618) included 289 males and 329 females; 79% of males and 66% of females were overweight. In all, we measured BP, stroke volume, TPR, and heart rate beat-by-beat during a 52-minute protocol that included changes in posture and mental stress. We assessed the relative contributions of stroke volume, TPR, and heart rate to BP at each minute of the protocol. We observed marked sex differences in BP hemodynamics in overweight/obese individuals: the main determinant of higher BP was TPR in males (49% versus only 35% in females, P=0.008), whereas it was stroke volume in females (51% versus only 35% in males, P=0.006). These sex differences were most apparent when standing or sitting at rest. No such differences were seen in normal-weight individuals in whom the main determinant of higher BP was TPR in both sexes. Our study suggests that, in middle-aged adults, marked sex differences exist in BP hemodynamics, contributing to high BP in overweight/obese but not normal-weight individuals. As such, this study may contribute to precision medicine in hypertension.

Lipid profile and cardiovascular risk of participants in the lipid measurement program in the industrial park in Höchst

Cardiovascular (CV) diseases are still the most frequent cause of death in industrial nations. Employer-initiated screening of the CV risk could make an early contribution to optimization of the prevention strategies. In a cross-sectional study the CV risk profile (e.g., dyslipidemia, hypertension, smoking, diabetes mellitus and familial disposition) of 1436 employees at the industrial park in Frankfurt Höchst was analyzed. The total risk was estimated using the PROCAM score. Ahypercholesterolemia (low-density lipoprotein, LDL >130 mg/dl) was detected in 36% of the participants. Of the high-risk participants (myocardial infarct, apoplexy and/or diabetes) 23.7% (n = 9/38) were in the target range for LDL as defined by the European Society of Cardiology (ESC) of below 70 mg/dl, 18.4% (n = 7) had levels between 70 and 100 mg/dl and 57.9% (n = 22) had levels of more than 100 mg/dl. In addition, more than half of the subjects (53.2%) had increased blood pressure values (defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). The prevalence of diabetes (blood sugar >126 mg/dl) was very low (1.3%) as was the frequency of manifest CV diseases (1.4% myocardial infarct or apoplexy, 2.9% stabile angina pectoris or peripheral arterial occlusive disease, PAOD). The data confirm that the risk factors high blood pressure and dyslipidemia are widespread and the achievement of target values is insufficient, particularly with ahigh risk of CV. Behavioral therapeutic and/or pharmaceutical measures should be instigated in order to better exploit the high preventive potential for carriers of these risk factors.

Association between ATP2B1 and CACNB2 polymorphisms and high blood pressure in a population of Lithuanian children and adolescents: a cross-sectional study

ObjectivesRecently, genome-wide associated studies have identified several genetic loci that are associated with elevated blood pressure and could play a critical role in intracellular calcium homeostasis. The aim of this...

NHS Western Isles - Involving our Patients: Faster Access to Treatment for Hypertension in Primary Care

Introduction: Hypertension is the single most common risk factor for both cardiovascular and overall disease burden and mortality worldwide, medical treatment of hypertension mitigates this risk.1 Around 7 million people in the UK have undiagnosed hypertension and therefore do not know that they are at risk.2 Timely and accurate diagnosis of hypertension can improve clinical outcomes; patients waiting over a month and a half post high reading demonstrate progressively worse outcomes than those treated more promptly.3 NICE recommends ambulatory blood pressure monitoring (ABPM) to confirm or exclude a diagnosis of hypertension.4 However acknowledging that some patients find ABPM uncomfortable, home blood pressure monitoring is recommended as a suitable alternative4 which patients generally find a positive experience.5 Case for Change: Some NHS Western Isles patients are referred to secondary care for ABPM and in concordance nationally, delays were encountered and subsequently time to treatment initiation was prolonged with an increased number of patient contacts both clinically and administratively. The time between identifying a raised blood pressure and treatment leaves the patient unmanaged and vulnerable to exacerbation before treatment has commenced. Patients also had to make several journeys both to the practice and hospital with the communication process largely being paper led. In parallel, many (but not all) people wish to be more informed and involved with their own care, challenging the traditional divide between patients and professionals, and offering opportunities for better health through increased prevention and supported self-care.6 It is also recognised that by improving patients’ access to home monitoring, patients increase their interaction with, and understanding of their condition.7,8 This created an opportunity for NHS Western Isles to combine patient willingness to become more involved in their health with the benefits of supported home monitoring to provide their patients with the opportunity to play a key role in improving their own health outcomes. Based on previous evidence8 Florence9 was identified as the NHS owned clinically driven interactive self management tool that could enable a safe and effective transition to a 7 day home blood pressure monitoring pathway. Following clinical approval locally, home monitoring via Florence was offered to patients attending the pilot practice demonstrating a raised blood pressure. Impact: The redesigned pathway is now complete in 7 days from identification to treatment initiation and maximises opportunities for home monitoring to improve patient safety and engagement over the period; both patient and clinician experience has been positive. Thorough evaluation has taken place with the initial cohort of 13 patients (aged 26-73) years saving: 19 follow-up appointments (primary care) 71 patient contacts 44 patient journeys Identifying 4 cases of white coat hypertension Outcomes Demonstrated Patient: Faster diagnosis or exclusion of hypertension reduced patient uncertainty Confidence and ability to self-manage improved with convenient reminders to take readings and clinically approved advice once blood pressure readings submitted. Engagement in condition and/or symptoms improved Improved patient acceptance of new or increased medication A safe, supported alternative to ABPM providing patient choice in treatment planning Reduction in patient travel Clinician: Immediate initiation, faster access to diagnostic data to initiate treatment Real time access to accessible and exportable data to expedite and evidence treatment decisions. Improved patient safety during diagnostic process AF screening increased via monitors provided by the practice Supports development of a nurse-led service System: Reduced handoffs improved patient flow Reduction in patient contacts More cost effective pathway Reduction in administrative processes improves productivity Opportunity to support the delivery of person centred care when treatment planning Comments: The outcomes from the initial cohort confirmed that redesigned pathway provides sustainable and scalable learning for further adoption across primary care adding significant benefits to traditional ABPM or non-supported home monitoring practice. With a small proportion of the clinical time released reallocated to diagnostic result analysis, the application could also be extended to support diagnosis or monitoring of other conditions where patients can be supported to submit readings or symptoms from home. This was the first model within Scotland reviewing hypertension diagnosis pathways with Florence which formed the basis for a large scale implementation in NHS Lanarkshire. NHS Western Isles are collaborating with Scottish Centre for Telehealth and Telecare and NHS24 on a national pathway based on this methodology which has been adopted as part of a national evaluation model.

Evolution of the magnitude of stroke at the teaching hospital of Bobo-Dioulasso

Background Strokes are more and more frequent in the world, particularly in Africa. The evolution of their magnitude remains still poorly documented in the context of Burkina Faso, particularly in Bobo-Dioulasso. That is why this study was conducted to clarify the epidemiology of stroke and its risk factors in order to raise the alarm. Objective Investigate the evolution of the magnitude of stroke and its risk factors at the Teaching Hospital of Bobo-Dioulasso between 2009 and 2013. Methods It was a descriptive transversal type, retrospective collection, covering the period from January 1st 2009 to December 31st 2013. It focused on the medical records of adults admitted to hospital for stroke with (confirmed cases) or without brain scanner confirmation (not confirmed cases). Results The number of the included cases was 967. The average age was 61.06 years more or less 14.35 years, with a sex ratio of 1.58. They were on average 05.55% of admissions annually within the services involved in their care. Their number and their proportion among admissions have increased in overall during the period. Confirmed cases represented 34.23% of all the cases, with 38.37% of hemorrhagic strokes. When they had been well documented, the risk factors such as high blood pressure, smoking and diabetes were found respectively in 75.80%, 22.46% and 07.46% of all cases. The frequency of arterial hypertension and diabetes had an overall growing trend also. Conclusion Strokes are more and more frequent in Bobo-Dioulasso, just like its main risk factors high blood pressure and diabetes. It is urgent to prevent the latter in order to reduce the extent of the stroke.