High Hypertension Research Articles

The role of patient's systemic characteristics and plateletcrit in developing toxic anterior segment syndrome after uneventful phaco surgery: A case-control study.

To compare the systemic and ocular characteristics and laboratory findings of patients developing toxic anterior segment syndrome (TASS) after uneventful phaco surgery with unaffected subjects undergoing the same surgery in the same session. A retrospective case-control study. The study group consisted of 26 eyes of 26 patients who underwent uneventful phaco surgery and who went on to develop TASS, while the control group included 39 subjects who had routine phaco surgery in the same session by the same surgeon. The sterilization stages of reusable instruments, disposable instruments, and compositions were recorded. The preoperative systemic diseases, complete blood count parameters, glycosylated hemoglobin (HbA1c), biochemical parameters, thyroid hormone profiles, and the surgical features were compared between the two groups. Type 2 diabetes mellitus (DM), systemic hypertension (HT), hyperlipidemia, chronic ischaemic heart disease, and chronic renal failure were significantly more common in the TASS group (p<0.05). Proliferative diabetic retinopathy was also more frequent in the TASS group (p=0.003). Mean HbA1c% values, white blood cell count, neutrophil/lymphocyte ratio, platelet counts, platelet distribution width, and plateletcrit parameters were significantly higher in the TASS group (p<0.05). Multivariate logistic regression analysis revealed that a high plateletcrit level (p=0.001, odds ratio [95% CI]; 22.27 [3.36-147.76]) and systemic HT (p=0.044, odds ratio [95% CI]; 7.13 [1.05-48.12]) are independently associated with the development of TASS. Although TASS may arise as a result of insufficient sterilization of instruments or intraocular solutions, patient factors may also contribute to its development. Systemic vascular disorders such as uncontrolled type 2 DM, systemic hypertension, and hyperlipidemia may increase the risk of TASS after uneventful phaco surgery. Abnormal parameters associated with systemic inflammation, such as higher plateletcrit level, may facilitate the development of TASS. These findings may be a predicting factor of TASS development for uneventful cataract surgeries.

Development of vascular complications and bladder carcinoma in diabetics using pioglitazone: A five-year Indian review

BackgroundPioglitazone has better cardiovascular outcomes and a questionable relationship with bladder carcinoma in diabetes mellitus, type II (DM-2). We sought to evaluate the role of pioglitazone in the Indian population. MethodsThis is a retrospective study at an academic medical center in India. All DM-2 patients in 2008 with a new prescription of pioglitazone were age- and gender-matched with non-users. We excluded patients with gestational DM or DM type I. They were followed forward for five years and demographic data, micro- and macro-vascular complications, mortality, and bladder carcinoma were recorded. Two-tailed p≤0.05 was considered statistically significant. ResultsTwo cohorts of 260 patients, with mean age of 58±11 years with 413 (79.4%) males, were followed for five years. Pioglitazone users had higher hypertension, obesity, DM-2 family history (all p<0.003), and use of insulin and oral hypoglycemics (all p<0.0001) in comparison to non-users. HbA1c was not different between groups. Over five years, pioglitazone users had lesser retinopathy and myocardial infarctions (all p<0.01). Five cases of bladder carcinoma were noted, all in the pioglitazone group, however without statistical significance. Baseline variables, including mean daily pioglitazone dose, were not statistically different between patients with and without bladder carcinoma. Nephropathy and MI were independent predictors for development of bladder carcinoma within pioglitazone users. ConclusionsPioglitazone users had significantly lesser myocardial infarctions and retinopathy despite more difficult to control DM 2. In an age- and gender-matched cohort of users and non-users, pioglitazone did not contribute to development of bladder cancer in the Indian population.

Safety of the Up-titration of Nifedipine GITS and Valsartan or Low-dose Combination in Uncontrolled Hypertension: the FOCUS Study

PurposeDoubling the dose of antihypertensive drugs is necessary to manage hypertension in patients whose disease is uncontrolled. However, this strategy can result in safety issues. This study compared the safety and efficacy of up-titration of the nifedipine gastrointestinal therapeutic system (GITS) with up-titration of valsartan monotherapy; these were also compared with low-dose combinations of the two therapies. MethodsThis prospective, open-label, randomized, active-controlled, multicenter study lasted 8 weeks. If patients did not meet the target blood pressure (BP) after 4 weeks of treatment with low-dose monotherapy, they were randomized to up-titration of the nifedipine GITS dose from 30 mg (N30) to 60 mg or valsartan from 80 mg to 160 mg or they were randomized to receive a low-dose combination of N30 and valsartan 80 mg for another 4 weeks. BP variability was assessed by using the SD or the %CV of the short-term BP measured at clinic. FindingsOf the 391 patients (20~70 years with stage II or higher hypertension) screened for study inclusion, 362 patients who had 3 BP measurements were enrolled. The reduction in the mean systolic/diastolic BP from baseline to week 4 was similar in both low-dose monotherapy groups with either N30 or valsartan 80 mg. BP variability (SD) was unchanged with either therapy, but the %CV was slightly increased in the N30 group. There was no significant difference in BP variability either in SD or %CV between responders and nonresponders to each monotherapy despite the significant difference in the mean BP changes. The up-titration effect of nifedipine GTS from 30 to 60 mg exhibited an additional BP reduction, but this effect was not shown in the up-titration of valsartan from 80 to 160 mg. Although the difference in BP was obvious between high-dose nifedipine GTS and valsartan, the BP variability was unchanged between the 2 drugs and was similar to the low-dose combinations. There was a low rate of adverse events in all treatment groups. In addition, escalating the dose of either nifedipine GITS or valsartan revealed a similar occurrence of adverse effects with low-dose monotherapy or the low-dose combination. ImplicationsCompared with up-titration of the angiotensin receptor blocker valsartan, up-titration of the calcium channel blocker nifedipine GITS provided no additional increased safety concerns and revealed better mean reductions in BP without affecting short-term BP variability. ClinicalTrials.gov identifier: NCT01071122.

Sleep duration and dietary macronutrient consumption can modify the cardiovascular disease for Korean women but not for men.

BackgroundAlthough the association between cardiovascular disease (CVD) and sleep duration is generally recognized, the results are inconsistent, and investigations examining the effects of seep duration and diet on CVD are rare.MethodsThe gender-difference in the effect of the sleep duration on Framingham risk score (FRS)-related factors, 10‐year predicted CVD risk, and dietary consumption was analyzed in 14,111 subjects (Men n = 5,727; Women n = 8,384) aged ≥20 from the Korean National Health and Nutrition Examination Survey.ResultsThe gender difference in the CVD risk factors according to sleep duration was observed. Only women with short sleep durations (<7 h/day) exhibited elevated FRS factors, such as systolic blood pressures (SBP) (P < 0.001), diastolic blood pressures (DBP) (P = 0.008), and the proportion of hypertension (HTN) treatments (P < 0.001), but not for men. Moreover, the 10-year predicted CVD risk, as evaluated with the FRS, was higher in women with short sleep durations (P < 0.001). Women with short sleep durations consumed significantly more dietary carbohydrates (CHO) than those with normal sleep durations (P < 0.001). Additionally, the ORs for intermediate and high 10-year predicted CVD risks and CVD–related factors, such as high age, elevated SBP, and HTN treatment, significantly increased with short sleep durations among women [OR (95 % CI) = 1.709 (1.359–2.149) for CVD risk, 1.976 (1.756–2.224) for high age, 1.535 (1.291–1.826) for elevated SBP, and 1.515 (1.320–1.739) for HTN treatment].ConclusionsShort sleep duration influenced dietary carbohydrate consumption and elevated FRS-related factors as well as 10-year predicted CVD risk. Our findings demonstrated that the CVD risk has been potentially modified by short sleep durations and greater CHO consumptions.

Is there any relationship between different phenotypes of metabolic syndrome and cardiovascular mortality rate?

Background:This study aimed to focus on different phenotypes of metabolic syndrome (MetS) and their impact on the cardiovascular disease (CVD) events among a sample of the Iranian population.Materials and Methods:The Isfahan cohort study is a population-based, on-going longitudinal study of adults aged 35 years old or more, living in urban and rural areas of three counties in central Iran namely Isfahan, Najafabad and Arak. Participants were selected by multistage random sampling and were recruited to reflect the age, sex and urban/rural distribution of the community. The sample was restricted to subjects with MetS based on the National Cholesterol Education Program Adult Treatment Panel III criteria and no history of coronary heart disease, stroke, or cancer at the time of the baseline clinical examination.Results:Among different phenotypes of MetS components, clustering of high triglycerides (TGs), low high-density lipoprotein (HDL) and abdominal obesity (ABO) was the most related to the all-cause mortality among women and followed in order by high TGs, hypertension (HTN) and ABO. In men, the highest rate of all-cause mortality was related to high TGs, low HDL, and HTN. Clustering of four components (high TGs, low HDL and HTN and obesity) is the most related to all-cause mortality in the both sexes (12.1% in men, and 21.5% in women).Conclusion:This study showed different phenotypes of MetS related with all-cause mortality rate and existing HTN in the phenotype of MetS increased the incidence of CVD mortality.

Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial

Malignant pleural mesothelioma is an aggressive cancer with poor prognosis, linked to occupational asbestos exposure. Vascular endothelial growth factor is a key mitogen for malignant pleural mesothelioma cells, therefore targeting of vascular endothelial growth factor might prove effective. We aimed to assess the effect on survival of bevacizumab when added to the present standard of care, cisplatin plus pemetrexed, as first-line treatment of advanced malignant pleural mesothelioma. In this randomised, controlled, open-label, phase 3 trial, we recruited patients aged 18-75 years with unresectable malignant pleural mesothelioma who had not received previous chemotherapy, had an Eastern Cooperative Oncology Group performance status of 0-2, had no substantial cardiovascular comorbidity, were not amenable to curative surgery, had at least one evaluable (pleural effusion) or measurable (pleural tumour solid thickening) lesion with CT, and a life expectancy of >12 weeks from 73 hospitals in France. Exclusion criteria were presence of central nervous system metastases, use of antiaggregant treatments (aspirin ≥325 mg per day, clopidogrel, ticlopidine, or dipyridamole), anti-vitamin K drugs at a curative dose, treatment with low-molecular-weight heparin at a curative dose, and treatment with non-steroidal anti-inflammatory drugs. We randomly allocated patients (1:1; minimisation method used [random factor of 0·8]; patients stratified by histology [epithelioid vs sarcomatoid or mixed histology subtypes], performance status score [0-1 vs 2], study centre, or smoking status [never smokers vs smokers]) to receive intravenously 500 mg/m(2) pemetrexed plus 75 mg/m(2) cisplatin with (PCB) or without (PC) 15 mg/kg bevacizumab in 21 day cycles for up to six cycles, until progression or toxic effects. The primary outcome was overall survival (OS) in the intention-to treat population. Treatment was open label. This IFCT-GFPC-0701 trial is registered with ClinicalTrials.gov, number NCT00651456. From Feb 13, 2008, to Jan 5, 2014, we randomly assigned 448 patients to treatment (223 [50%] to PCB and 225 [50%] to PC). OS was significantly longer with PCB (median 18·8 months [95% CI 15·9-22·6]) than with PC (16·1 months [14·0-17·9]; hazard ratio 0·77 [0·62-0·95]; p=0·0167). Overall, 158 (71%) of 222 patients given PCB and 139 (62%) of 224 patients given PC had grade 3-4 adverse events. We noted more grade 3 or higher hypertension (51 [23%] of 222 vs 0) and thrombotic events (13 [6%] of 222 vs 2 [1%] of 224) with PCB than with PC. Addition of bevacizumab to pemetrexed plus cisplatin significantly improved OS in malignant pleural mesothelioma at the cost of expected manageable toxic effects, therefore it should be considered as a suitable treatment for the disease. Intergroupe Francophone de Cancérologie Thoracique (IFCT).

Abstract 11621: History of Asthma Increases the Risk for Incident Cardiovascular Disease in Postmenopausal Women

Hypothesis and Objectives: The state of chronic Inflammation associated with asthma may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between history of asthma and CVD in a cohort of postmenopausal women. Methods: Study participants are postmenopausal women (n= 90,168) who are free of cardiovascular disease at baseline, evaluated from 1993-1998. We used self-report of physician diagnosed asthma to define the exposure. Information on treatment for asthma in addition to CVD risk factors were collected. The association between asthma and the incidence of CVD and coronary heart disease (CHD) was evaluated using cox proportional hazards models. Results: Among 90,168 women in the study sample, 6,921 (7.68%) reported asthma at baseline. Baseline characteristics were similar between the asthma and no asthma groups although asthmatics were more obese (36% vs 27%; p&lt;0.0001) and had higher hypertension rates (38% vs 31%; p&lt;0.0001). As compared to the no asthma group with CVD and CHD rates of 8,078 (9.7%) and 5,800 (6.97%), respectively, the asthma group had higher rates of CVD and CHD, 803 (11.6%) and 595 (8.6%) respectively. When adjusted to age plus all CVD risk factors, the HR for CVD events was 1.21 (95% CI 1.12-1.31) and for CHD events was 1.24 (95% CI 1.14 - 1.36). The association remained significant in different models (see table). Conclusion: Asthma was associated with a modestly increased risk for CVD and CHD in postmenopausal women. Further studies needed to explore this association.

Playing a role in secondary prevention in the ED: longitudinal study of patients with asymptomatic elevated blood pressures following a brief education intervention: a pilot study

Uncontrolled hypertension contributes significantly to cardiovascular morbidity and mortality and is more frequently encountered among patients presenting to the emergency department (ED).1,2 Approximately 50% of patients with previously undiagnosed hypertension who present with elevated blood pressures in the ED will continue to have BP elevations one week after being discharged to home.3 Hypertensive patients presenting to the ED are a particularly high-risk group with >50% with stage II or higher hypertension (SBP ≥160 or DBP ≥100).1 Significant percentages of elevated blood pressures in the ED are incidental findings and not related to the patient's chief complaints. Incidental hypertension represents a quandary for the emergency physician who cannot guarantee follow-up treatment.4,5 Several studies have found that only 7–25% of ED patients with elevated BP are given instructions for outpatient BP follow-up.3–5 Currently, there is no risk assessment or stratification based upon blood pressure assessment performed on hypertensive patients prior to discharge from the emergency department. The emergency medicine literature does not provide definitive recommendations on screening tests for patients with asymptomatic elevated blood pressures.6 Published guidelines regarding the management of these patients only recommend referral of these patients for close primary care follow-up within 48–72 h.6 These same guidelines also urge future research related to the optimal screening for this patient population in the ED.6 The purpose of this study was to determine the progression of subclinical heart disease in an urban ED population with asymptomatic elevated blood pressure and examine the correlation with blood pressure changes after a brief ED hypertension education intervention.

The evaluation of relationship between abo blood groups and cardiovascular risk factors in patients with acute myocardial infarction in durres population

Introduction: Cardiovascular (CV) diseases are the most important causes of morbidity and mortality in many developing and developed countries. An association between ABO blood groups (BGs) and the risk of coronary artery disease (CAD) has been known for many years, although there have not been enough surveys to prove it. However, it is not yet known how significant the association between the ABO BGs and CAD is in the clinical practice. Aim: The aim was to investigate a possible association of ABO (BGs) and CV risk factors among the patients with acute myocardial infarction (AMI) in Durres population. Materials and Methods: This transversal prospective study included 239 patients with AMI admitted to in the Cardiology Department, Regional Hospital of Durres, Albania between January 2012 and August 2013. In patients with AMI were collected data on risk factors such as smoking, age, gender, hypertension (HTN) and blood lipids, diabetes, obesity, family history and previous myocardial infarction(MI). Participants provided blood samples for cholesterol, glucose (fasting blood sugar) and BGs. Standard 12-lead electrocardiograms were obtained immediately after admission. The location and complication of AMI were assessed. Data was analyzed on SPSS version 16 and a P Results: In the present study of 239 patients, 32.6% (78) had BG O, 38,1% (91) had BG A, 17.2%(41) had BG B and 12.1%(29) had BG AB. Of the total of 239, 52,3% (125) were smoker, 66,9% (160) were hypertensive, 51.4% (123) were obese, 30.5% (73) had diabetes mellitus (DM), 71,1% (170) had high serum cholesterol level, 37.6% (90) had positive family history and mean age was 66.1 ΁ 21 years. In individuals the incidence of AMI was higher in those with BG A than in those with other BG P 0.001. AMI was less frequent in BG AB. The frequency of CV risk factors was similar in patients with different BGs. However, the patients with BG A had a higher incidence of high serum cholesterol level, diabetes and HTN than those with the other BGs but not a statistically significant difference P > 0.05. There were no significant differences between BGs in location of AMI. No significant differences were found between BGs and complications in acute myocardial infarction. Conclusions: Blood group A is related to the higher incidence of AMI, high serum cholesterol level, HTN and DM, while the results did not provide convincing evidence that any BGs were strongly associated with HTN, diabetes and location of MI. Association of ABO BGs distribution with CV risk factors, CAD and MI needs to be clarified with multicenter, prospective and large-scale studies.

Ramucirumab: successfully targeting angiogenesis in gastric cancer.

Gastric cancer is the fourth most common cancer globally and represents the second most common cause of cancer-related mortality. Early detection, aggressive surgical resection, and postoperative adjuvant therapy have led to survival improvement for early-stage gastric cancer, particularly in Asian countries. Unfortunately, advanced gastric cancer continues to pose a formidable challenge with few gains being reported recently. Trastuzumab was the first targeted agent to be approved for the treatment of advanced gastric cancer in 2010. The failure of the AVAGAST trial was a setback for antiangiogenic therapy for this disease. Ramucirumab is a monoclonal antibody that binds to VEGF-R2 and prevents its activation. The recent REGARD trial was a randomized phase III trial of ramucirumab vs. placebo for patients with advanced, pretreated gastric cancer that met its primary endpoint of increased overall survival. The toxicity of ramucirumab was modest in this setting, with an increased risk of grade 3 or higher hypertension (8% vs. 3%, with ramucirumab and placebo, respectively). The subsequent RAINBOW trial of paclitaxel plus ramucirumab vs. paclitaxel plus placebo for advanced pretreated gastric cancer confirmed the survival advantage of this antiangiogenic agent in gastric cancer. Ramucirumab is the first FDA-approved therapy for advanced gastric cancer after prior chemotherapy.

Higher hypertension risk in pregnancy using donated eggs

Higher hypertension risk in pregnancy using donated eggs

Development of hypertension within 2 weeks of initiation of sorafenib for advanced hepatocellular carcinoma is a predictor of efficacy.

Sorafenib is an agent that inhibits vascular endothelial growth factor and is associated with onset or worsening of hypertension in some patients. We conducted a retrospective analysis of whether the development of hypertension during sorafenib treatment of advanced hepatocellular carcinoma could be a predictor of anti-cancer efficacy. The study included 38 patients with advanced hepatocellular carcinoma who had received sorafenib for at least 1 month between January 2010 and December 2012. A retrospective analysis of the efficacy of sorafenib was conducted by dividing the patients into two groups-a hypertension group, presenting with grade 2 or higher hypertension according to the Common Terminology Criteria for Adverse Events (CTCTE) version 4.0; and a non-hypertension group, which included all other patients. This study evaluated the occurrence of hypertension within 2 weeks of initiation of therapy in order to avoid any treatment duration bias. Images were evaluated using the modified Response Evaluation Criteria in Solid Tumors. The response rate, time to progression, and overall survival were assessed. Twenty-two patients (58 %) developed grade 2 or higher hypertension within 2 weeks of initiation of therapy. The response rate was significantly higher in the hypertension group. Median time to progression was 153 days in the hypertension group versus 50.5 days in the non-hypertension group, which was significantly longer in the hypertension group. Moreover, median overall survival was 1,329 days in the hypertension group versus 302 days in the non-hypertension group, which was significantly longer in the hypertension group. Hypertension within 2 weeks of initiation of therapy may be a predictor of the anti-cancer efficacy of sorafenib when used for the treatment of advanced hepatocellular carcinoma.

Association between arterial stiffness and risk of coronary artery disease.

Objective: To investigate the role of Brachial ankle Pulse Wave Relocity (baPWV) and cfPWV on the risk of Coronary artery disease and the interaction between baPWV and risk factors of Coronary artery disease (CAD). Methods: A case-control study was conducted at Department of Emergency, SunYat-Sen memorial Hospital, China. We collected 332 cases with coronary artery disease and 328 subjects without CAD between February 2012 and October 2013. A multivariate logistic regression analysis was performed to analyze the risk factors of CAD. Results: CAD subjects were more likely to be old age, and have higher BMI, waist-hip ratio, hypertension, fasting glucose, TG, carotid-femoral PWV (cfPWV) and baPWV, and CAD subjects had a lower TC, HDL–C and LDL-C. We found that older age, smoking, higher hypertension, TC, TG, HDL-C, LDL-C, carotid-femoral PWV (CfPWV) and baPWV were associated with risk of CAD. baPWV had significant interaction with age, TC, TG, HDL-C and LDL-C, carotid-femoral PWV (cfWV) was correlated with age, HDL-C and LDL-C. Conclusion: This study showed that baPWV and cfPWV are two independent factors for the risk of Coronary artery disease, and baPWV and cfPWV have interaction with age, TC, TG, HDL-C and LDL-C.

Contribution of alcohol to hypertension mortality in Russia.

Background. Hypertension (HTN) is reported to be the leading contributor to premature death globally. Considerable research evidence suggests that excessive alcohol intake (binge drinking) is an independent risk factor for HTN. It was repeatedly emphasized that binge drinking is a major contributor to a high cardiovascular mortality rate in Russia. Objective. The aim of this study was to examine the aggregate-level relation between alcohol consumption and HTN mortality rates in Russia. Method. Age-standardized sex-specific male and female HTN mortality data for the period 1980–2005 and data on overall alcohol consumption were analyzed by means of ARIMA (autoregressive integrated moving average) time-series analysis. The level of alcohol consumption per capita has been estimated using the indirect method based on alcohol psychoses incidence rate and employing ARIMA time-series analysis. Results. Alcohol consumption was significantly associated with both male and female HTN mortality rates: a 1-liter increase in overall alcohol consumption would result in a 6.3% increase in the male HTN mortality rate and in a 4.9% increase in female HTN mortality rate. The results of the analysis suggest that 57.5% of all male HTN deaths and 48.6% of all female HTN deaths in Russia could be attributed to alcohol. Conclusions. The outcomes of this study provide support for the hypothesis that alcohol is an important contributor to the high HTN mortality rate in the Russian Federation. The findings from the present study have important implications with to regards HTN mortality prevention, indicating that a restrictive alcohol policy can be considered as an effective measure of prevention in countries with a higher rate of alcohol consumption.

Impact of Waist Circumference and Body Mass Index on Risk of Cardiometabolic Disorder and Cardiovascular Disease in Chinese Adults: A National Diabetes and Metabolic Disorders Survey

BackgroundWe updated the prevalence of obesity and evaluated the clinical utility of separate and combined waist circumference (WC) or body mass index (BMI) category increments in identifying cardiometabolic disorder (CMD) and cardiovascular disease (CVD) risk in Chinese adults.Methods and Findings46,024 participants aged ≥20 years, a nationally representative sample surveyed in 2007–2008, were included in this analysis. Taking the cutoffs recommended by the Chinese Joint Committee for Developing Chinese Guidelines (JCDCG) and the Working Group on Obesity in China (WGOC) into account, the participants were divided into four WC and four BMI groups in 0.5-SD increments around the mean, and 16 cross-tabulated combination groups of WC and BMI. 27.1%, 31.4%, and 12.2% of Chinese adults are centrally obese, overweight, or obese according to JCDCG and WGOC criteria. After adjustment for confounders, after a 1-SD increment, WC is associated with a 1.7-fold or 2.2-fold greater risk of having DM or DM plus dyslipidemia than BMI, while BMI was associated with a 2.3-fold or 1.7-fold higher hypertension or hypertension plus dyslipidemia risk than WC. The combination of WC and BMI categories had stronger association with CMD risk, i.e., the adjusted ORs (95% CI) of having DM, hypertension, and dyslipidemia for the combined and separate highest WC and BMI categories were 2.19 (1.96–2.44) vs 1.88 (1.67–2.12) and 1.12 (0.99–1.26); 5.70 (5.24–6.19) vs 1.51 (1.39–1.65) and 1.69 (1.57–1.82); and 3.73 (3.42–4.07) vs 2.16 (1.98–2.35) and 1.33 (1.25–1.40), respectively. The combination of WC and BMI categories was more likely to identify individuals with lower WC and lower BMI at CVD risk, even after the effects of CMD were controlled (all P<0.05).ConclusionCentral obesity, overweight, and obesity are epidemic in Chinese adults. The combination of WC and BMI measures is superior to the separate indices in identifying CMD and CVD risk.

“Health divide” between indigenous and non-indigenous populations in Kerala, India: Population based study

BackgroundThe objective of this study is to investigate the magnitude and nature of health inequalities between indigenous (Scheduled Tribes) and non-indigenous populations, as well as between different indigenous groups, in a rural district of Kerala State, India.MethodsA health survey was carried out in a rural community (N = 1660 men and women, 18–96 years). Age- and sex-standardised prevalence of underweight (BMI < 18.5 kg/m2), anaemia, goitre, suspected tuberculosis and hypertension was compared across forward castes, other backward classes and tribal populations. Multi-level weighted logistic regression models were used to estimate the predicted prevalence of morbidity for each age and social group. A Blinder-Oaxaca decomposition was used to further explore the health gap between tribes and non-tribes, and between subgroups of tribes.ResultsSocial stratification remains a strong determinant of health in the progressive social policy environment of Kerala. The tribal groups are bearing a higher burden of underweight (46.1 vs. 24.3%), anaemia (9.9 vs. 3.5%) and goitre (8.5 vs. 3.6%) compared to non-tribes, but have similar levels of tuberculosis (21.4 vs. 20.4%) and hypertension (23.5 vs. 20.1%). Significant health inequalities also exist within tribal populations; the Paniya have higher levels of underweight (54.8 vs. 40.7%) and anaemia (17.2 vs. 5.7%) than other Scheduled Tribes. The social gradient in health is evident in each age group, with the exception of hypertension. The predicted prevalence of underweight is 31 and 13 percentage points higher for Paniya and other Scheduled Tribe members, respectively, compared to Forward Caste members 18–30 y (27.1%). Higher hypertension is only evident among Paniya adults 18–30 y (10 percentage points higher than Forward Caste adults of the same age group (5.4%)). The decomposition analysis shows that poverty and other determinants of health only explain 51% and 42% of the health gap between tribes and non-tribes for underweight and goitre, respectively.ConclusionsPolicies and programmes designed to benefit the Scheduled Tribes need to promote their well-being in general but also target the specific needs of the most vulnerable indigenous groups. There is a need to enhance the capacity of the disadvantaged to equally take advantage of health opportunities.

OCEANS: A Randomized, Double-Blind, Placebo-Controlled Phase III Trial of Chemotherapy With or Without Bevacizumab in Patients With Platinum-Sensitive Recurrent Epithelial Ovarian, Primary Peritoneal, or Fallopian Tube Cancer

This randomized, multicenter, blinded, placebo-controlled phase III trial tested the efficacy and safety of bevacizumab (BV) with gemcitabine and carboplatin (GC) compared with GC in platinum-sensitive recurrent ovarian, primary peritoneal, or fallopian tube cancer (ROC). Patients with platinum-sensitive ROC (recurrence ≥ 6 months after front-line platinum-based therapy) and measurable disease were randomly assigned to GC plus either BV or placebo (PL) for six to 10 cycles. BV or PL, respectively, was then continued until disease progression. The primary end point was progression-free survival (PFS) by RECIST; secondary end points were objective response rate, duration of response (DOR), overall survival, and safety. Overall, 484 patients were randomly assigned. PFS for the BV arm was superior to that for the PL arm (hazard ratio [HR], 0.484; 95% CI, 0.388 to 0.605; log-rank P < .0001); median PFS was 12.4 v 8.4 months, respectively. The objective response rate (78.5% v 57.4%; P < .0001) and DOR (10.4 v 7.4 months; HR, 0.534; 95% CI, 0.408 to 0.698) were significantly improved with the addition of BV. No new safety concerns were noted. Grade 3 or higher hypertension (17.4% v < 1%) and proteinuria (8.5% v < 1%) occurred more frequently in the BV arm. The rates of neutropenia and febrile neutropenia were similar in both arms. Two patients in the BV arm experienced GI perforation after study treatment discontinuation. GC plus BV followed by BV until progression resulted in a statistically significant improvement in PFS compared with GC plus PL in platinum-sensitive ROC.

Stress, cortisol, and nighttime blood pressure dipping in nonhypertensive Black American women.

Black American women have among the highest hypertension (HTN) rates in the world. Research suggests that nighttime might be a critical period of vulnerability for the development of HTN in Blacks. In the present study, personal factors (age, body fat, income, family history), psychological factors (stress, emotions, and John Henryism), and physiological factors (salivary cortisol and blood pressure [BP]) were explored in 30 Black women, ages 26-51 years. Data were collected in participants' homes. BP was monitored while participants were awake and asleep. Cortisol samples were obtained within the first hour after awakening. The usual pattern for BP is a drop or dipping of 10-20% during sleep; however, the BP for about a third of the subjects did not dip adequately during sleep. Though not statistically significant, this nondipping was clinically relevant and was associated with positive family history of HTN, more stress, lower positive and higher negative affect scores, and higher early morning cortisol levels. These findings add to the HTN risk profile and support the need to further explore the relationship between nondipping nighttime BP and cardiovascular disease in Black women.

A Nation At Risk For Wider Health Disparities

A Nation At Risk For Wider Health Disparities

A cardiovascular disease risk factor screening program designed to reach rural residents of Maine, USA

Cardiovascular disease is the leading cause of death in many countries and a particular burden to rural communities. Hypertension and diabetes are risk factors for cardiovascular disease, but screening for them is suboptimal, particularly in rural settings. Thus screening programs targeting rural dwellers may be important. This article reports the findings of a blood pressure (BP) and blood glucose screening program conducted from a mobile van that visited community events including agricultural fairs across Maine, U.S.A. to bring screening to rural Mainers. The study objectives were to determine: (1) if the screening program was successful at reaching rural Mainers; (2) if rural screenees had a different risk of hypertension or diabetes compared with non-rural screenees; and (3) what characteristics of a community event predict that a screening conducted at that event will reach a high fraction of rural residents. The van visited events from 2006-2009 conducting voluntary BP and blood glucose screenings. Results were analyzed by the rurality of the town of residence of the screenees, the rurality of location of the screening event, and the type of screening event (agricultural fair vs other). Systolic BP of 140 mmHg or greater or diastolic BP of 90 mmHg or greater was considered to be hypertension, and systolic BP of 120-139 mmHg or diastolic BP 80-89 mmHg as pre-hypertension. Blood glucose of 140-199 mg/dL was considered to be pre-diabetes and blood glucose of 200 mg/dL or greater as diabetes. Rurality was divided into urban, sub-urban, large rural town, and small rural town/ isolated rural based on Rural Urban Commuting Codes (RUCAs), assigned by zip code. Mean BP and blood glucose values were compared across residence rurality categories by ANOVA, the distribution of screening values into normal/ abnormal categories was compared across residence rurality categories by chi2 test, and the impact of type and rurality of location of screening event on the residence of screenees was assessed with analysis by regression with categorical variables. Over 4 years, 2451 Mainers from 254 towns were screened at 42 events located in 28 towns. Seventy-six percent of screenees lived in rural areas and screenees were more likely to live in rural areas compared with all Maine residents (p < 0.001). Rurality of residence impacted hypertension risk (p = 0.001) but not diabetes risk. Screenees from large rural towns had the highest mean systolic BPs and rural-dwellers had higher hypertension or pre-hypertension risk compared with urban/ sub-urban dwellers. Conducting screenings at agricultural fairs (p = 0.003) and in rural areas (p = 0.001) were independent predictors of attracting more rural screenees. Holding cardiovascular risk factor screenings in locations that are culturally appropriate and geographically convenient for an at-risk population are common approaches; however, their effectiveness is seldom tested. The results show that both the type of event at which the screening is conducted and the rurality of location of that event help attract rural screenees, and that it is possible for a screening program to reach a population significantly more rural than the population of the state and one that has an elevated hypertension risk.