Burden Of Hypertension Research Articles

Predicting Childhood and Adolescence Hypertension: Analysis of Predictors Using Machine Learning.

There has been a substantial burden of hypertension in children and adolescents. Given the availability of primary prevention strategies, it is important to determine predictors for early identification of children and adolescents at risk of hypertension. This study aims to attempt and validate machine learning (ML) algorithms for accurately predicting blood pressure (BP) status (normal, prehypertension, and hypertension) over 1- and 3-year periods, identifying key predictors without compromising model performance. We included a population-based cohort of primary 1 to secondary 6 students (typically aged 6 to 18years) during the academic years of 1995 to 1996 and 2019 to 2020 in Hong Kong. Thirty-six easy-assessed predictors were initially model childhood BP status. Multiple ML algorithms, decision tree, random forest, k-nearest neighbor, eXtreme Gradient Boosting (XGBoost), and multinomial logistic regression (MLR), were used. Model evaluation was performed by various accuracy metrics. The Shapley Additive Explanations (SHAP) was used to identify key features for both predictions. A total of 923 301 and 602 179 visit pairs were used for the 1- and 3-year predictions, respectively. XGBoost demonstrated the highest prediction accuracies for 1-year (macro-area under the receiver operating characteristic curve [AUROC] = 0.92, micro-AUROC = 0.91) and 3-year (macro-AUROC = 0.91, micro-AUROC = 0.90) periods. The traditional MLR approach had the lowest accuracies for 1- (macro-AUROC = 0.70, micro-AUROC = 0.68) and 3-year (macro-AUROC = 0.70, micro-AUROC = 0.68) predictions. The SHAP values identified 17 key predictors without the need for direct BP measurements or laboratory tests. ML prediction models can accurately predict childhood prehypertension and hypertension at 1 and 3years, independent of BP and laboratory measurements. The identified key predictors may inform areas for personalized prevention in hypertension.

Impact of health education on knowledge retention among caregivers of hypertensive patients: A prospective cross-sectional study in rural Malawi.

Hypertension is a widespread and life-threatening condition affecting one-third of adults globally. In low- and middle-income countries, like Malawi, the burden of hypertension is escalating due to inadequate healthcare resources and lifestyle changes. Family members often become primary caregivers, playing a crucial role in managing hypertension through support and adherence to treatment. This study examined caregivers' knowledge retention by evaluating their pre- and post-health education knowledge levels. This was a prospective cross-sectional study in Neno, Malawi, a rural setting. 422 caregivers were enrolled from the Integrated Chronic Care Clinic (IC3). A structured questionnaire was used to collect baseline, post-health education, and week six data. Using SPSS V 22.0, comparison of knowledge, attitude, and practices (KAP) scores, correlation between KAP and between KAP and social demographic characteristics were done using Wilcoxon signed-rank test, Pearson correlation, and independent t-test respectively. Among the 422 caregivers who participated in the study, 267 (63.2%) were females and mean age was 44.94 years. The baseline mean knowledge level score was 9.5 (38.0%) and rose to 21.08 (84.3%) p = 0.000 immediate post-health education and a 2.1% decrease 20.54 (82.2%) p<0.001 at week six from the immediate post health education score. Attitude improved from 16.76 (93.1%) at baseline to 17.74 (98.6%) at the six-week mark. Similarly, the mean practice score rose from 25.24 (78.9%) at baseline to 27.42 (85.7%) at week six. There was a positive correlation between KAP while age had a negative correlation with knowledge (r = -0.146; p = 0.003). There was a significant difference between different education levels on knowledge retention p = 0.009. There was a positive and good knowledge retention among caregivers of hypertensive patients after health education at the week six mark. With improved knowledge and the ability to retain it resulting in improved attitude and practices, caregivers are a cornerstone for continued and improved hypertension care for the patients.

Countries with Fewer Procedures for Cardiovascular Disease Management Face Greater Premature Mortality from Noncommunicable Diseases

Abstract Background: The rate at which low- and middle-income countries (LMICs) are transitioning into high-burden states for noncommunicable diseases (NCDs) is currently posing a global health security threat. Not only cardiovascular disease (CVD) occurs earlier in these countries but also it is likely that individuals do not have access to adequate management procedures. The present study was undertaken to find the effect of availability of procedures for CVD management on premature mortality in NCDs and to juxtapose this with the prevalence of two main risk factors, hypertension and diabetes. Methods: The World Health Organization’s Global Health Observatory data were used, which include health-related data on its 194 member states. The correlation matrix was constructed for risk factors, income classification, availability of CVD management procedures, and premature NCD mortality. Multiple linear regression was done to find the association between availability of management procedures, income classification, and premature NCD mortality. Results: A negative correlation was observed between premature NCD mortality and income group and between premature NCD mortality and availability of CVD management procedures. Countries possessing fewer procedures for CVD management suffered a greater burden of premature NCD mortality, and this was in the form of a strong linear association. Income class and availability of CVD management procedures both independently affected premature NCD mortality. Each unit increase in income class and number of CVD management procedures reduced the premature NCD mortality by 7.9 and 2.8 units, respectively. The impact of both these factors on premature NCD mortality was statistically significant. Countries with higher prevalence of hypertension were seen to be possessing fewer CVD management procedures. Income groups also demonstrated disparities, with high-income countries bearing less burden of hypertension and having more ubiquitous CVD management resources. Conclusion: The present study found that availability of CVD management procedures, such as thrombolysis, coronary bypass/stenting, and acute stroke care and rehabilitation, significantly reduce premature NCD mortality across the world. Countries that face higher burden of premature NCD mortality are not only the ones that are least prepared to manage them but also the ones that bear the greatest prevalence of risk factors like hypertension and diabetes. Making procedures for NCD management available in LMICs must be put on high priority on the global health agenda.

Adherence to Hypertension Medication in Older People: Empirical Research Quantitative.

This study aimed to investigate the factors influencing medication adherence in community-dwelling Chinese older adults with hypertension. Empirical research-quantitative; Cross-sectional study Methods: A cross-sectional survey was conducted from September to December 2021, in which participants completed a self-administered questionnaire with detailed their demographic information. The Morisky Medication Adherence Scale-8, the Pittsburgh Sleep Quality Index, and the 10-item Kessler Psychological Distress Scale were used to assess medication adherence, sleep quality, and psychological well-being, respectively. Multivariate logistic regression analysis was performed with medication adherence as the dependent variable to identify factors influencing adherence. The study included 867 patients with hypertension, comprising 566 women and 301 men with a mean age of 70.89 ± 7.50 years. Results indicated that 53.9% of participants exhibited high medication adherence, while 24.5% and 21.7% demonstrated medium and low adherence levels, respectively. Multiple logistic regression analysis revealed that individuals in the 50-59 age group had lower medication adherence compared to those aged 80 years and older (odds ratio [OR]: 0.468, 95% confidence interval [CI]: 0.245,0.894). In addition, participants with a primary school education or less (OR: 0.152, 95% CI: 0.095,0.245) and those living alone (OR: 0.362, 95% CI: 0.228, 0.575) exhibited poorer medication adherence. Conversely, living in an urban area was associated with better adherence (OR: 2.131, 95% CI: 1.402, 3.239, p < 0.001). Our study showed that participants' medication adherence was below the desired level. It was observed that older adults, those with a junior high school education or higher, and those living in urban areas with their children had better medication adherence. These identified predictors may help to identify individuals at high risk of poor adherence, enabling the implementation of effective interventions to reduce the global burden of hypertension.

Heart failure with preserved ejection fraction: incidence and impact on mortality in patients with secondary tricuspid regurgitation

Abstract Introduction Secondary tricuspid regurgitation (STR) is a highly prevalent valve disease. STR and Heart Failure with preserved Ejection Fraction (HFpEF) share common features including exertional intolerance and high burden of atrial fibrillation (AF) and pulmonary hypertension (PH), making it challenging to disentangle HFpEF from TR. The incidence of clinically-recognized HFpEF in STR and its impact on mortality are not well established. Purposes To define the incidence of newly diagnosed HFpEF and its impact on mortality in a cohort of patients with significant STR and to evaluate the likelihood of a larger hidden burden of HFpEF. Methods Patients with a first diagnosis of ≥moderate-severe STR between 2004-2019 at our institution were retrospectively included. Patients with left ventricle ejection fraction &amp;lt;50%, left-sided valve diseases, and intracardiac device leads were excluded. HFpEF was identified by manual chart review as well as by use of ICD codes. The estimated prevalence of HFpEF was evaluated using an H2FPEF score ≥6, which corresponds to a ≥90% probability of having HFpEF. Results Of 2118 patients (mean age 70 ± 14, 36% females), 1057 (50%) had systemic hypertension (HTN) and 1091 (51%) had AF, with median 2.3 years of follow-up. From this cohort, 536 (25%) patients were diagnosed with HFpEF based upon chart review during the follow up period, while ICD diagnosis was only present in fewer than 50% of these patients (254). High H2FPEF score was present in 880 patients (41.5%), of whom 383 received a chart diagnosis of HFpEF, while 153 patients with H2FPEF score &amp;lt;6 received a chart HFpEF diagnosis. The cumulative incidence of chart-based diagnosis of HFpEF was 20.8% (N=158) at 1-year and 38.6% (N=273) at 5-years in patients with an H2FPEF score ≥6 and 5.5%(N=60) at 1-year and 11.1%(N=111) at 5-years in those with a score &amp;lt;6 (Figure). In Cox regression analyses, the diagnosis of HFpEF during follow-up was associated with increased mortality (HR 2.14, CI 1.86-2.46, p &amp;lt; 0.001) after adjusting for age, sex, body mass index, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, diuretics, HTN, pulmonary hypertension, chronic kidney disease and AF. Conclusions The incidence of clinically documented HFpEF in a cohort of patients with significant STR at index evaluation is high (25%). Use of ICD code underestimates clinical recognition, with the actual burden of HFpEF probably being even greater, as indicated by an H2FPEF score ≥ 6. Among those with significant STR, HFpEF diagnosis is an independent risk factor for mortality.

Prevalence of Hypertension in Outpatient Consultations in a Cardiology Department in West Africa in Dakar, Senegal According to &amp;quot;MY MEASURE MONTH&amp;quot;

Objectives: This study, conducted as part of the &amp;quot;My Measure Month&amp;quot; program in collaboration with the French Society of Hypertension, aimed to investigate the prevalence of hypertension, emphasize the importance of measuring blood pressure. Methodology: This was an observational and cross-sectional study conducted over one month in the outpatient department of a center specialized in hypertension management. The study included patients aged over 18 years. We examined hypertension data (duration, treatments, compliance) and cardiovascular risk factors. Blood pressure was measured. Three measurements were taken at one-minute intervals. In the bivariate analysis, a p-value ≤ 0.05 was considered statistically significant. Results: The prevalence of hypertension was 45.6%. Hypertension was more frequent in women (54.2%), and the most represented age group was 50 to 70 years, with a prevalence exceeding 70% in patients over 70 years old. In our sample, 13% of patients not previously known to be hypertensive had elevated blood pressure readings. Successive measurements showed variations in hypertension grades, with a progressive decrease in patients with grade II and III hypertension. Among hypertensive patients, 93% had no coverage for their medications. Most patients were on pharmacological treatment, but a significant proportion remained uncontrolled (36.2%), especially those on dual therapy. Bivariate analysis showed that age ≥ 65 years, smoking, dyslipidemia and heart failure were significantly associated with hypertension. Conclusion: An integrated strategy for prevention, screening, and treatment is crucial to reduce the burden of hypertension in this population, improve the quality of life for hypertensive patients.

Depression and Incident Hypertension: The Strong Heart Family Study.

Compared with White Americans, American Indian adults have disproportionately high depression rates. Previous studies in non-American Indian populations report depression as common among people with uncontrolled hypertension, potentially interfering with blood pressure control. Few studies have examined the association of depressive symptoms with hypertension development among American Indians despite that population's high burden of depression and hypertension. We examined the association of depressive symptoms with incident hypertension in a large cohort of American Indians. We studied 1,408 American Indian participants in the Strong Heart Family Study, a longitudinal, ongoing, epidemiologic study assessing cardiovascular disease and its risk factors among American Indian populations. Depressive symptoms were assessed by using the Center for Epidemiological Studies-Depression (CES-D) scale, 2001-2003. At each study examination in 2001-2003 and 2007-2009, blood pressure was measured 3 times. The average of the last 2 measurements taken at baseline and follow-up examinations was used for analyses. Incident hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg, or use of hypertension medications at follow-up. To account for within-family correlation, we used generalized estimating equations to examine the association of depressive symptoms with incident hypertension. During follow-up, 257 participants developed hypertension. Participants with symptoms consistent with depression (CES-D ≥16) at baseline had 54% higher odds of developing hypertension during follow-up (OR = 1.54; 95% CI, 1.06-2.23) compared with those without depression (CES-D <16) at baseline after adjustment for other risk factors. These data suggest that participants who experienced symptoms consistent with depression were at increased odds of incident hypertension.

SOCIOCULTURAL DETERMINANTS OF HYPERTENSION MANAGEMENT IN PAKISTAN

Background: Hypertension, defined as sustained elevated blood pressure (systolic ≥130 mm Hg and/or diastolic ≥90 mm Hg), is a leading global health concern, significantly contributing to cardiovascular diseases, kidney failure, and mortality. In low- and middle-income countries like Pakistan, where healthcare systems are under-resourced, sociocultural factors pose significant barriers to effective hypertension management. This study investigates the sociocultural determinants influencing hypertension management in Thatta, a rural district of Pakistan, to inform culturally appropriate healthcare interventions. Objective: To explore the sociocultural determinants affecting adherence to hypertension management among patients in rural Thatta, Pakistan. Methods: A descriptive cross-sectional study was conducted among 260 hypertensive patients attending the outpatient department of Civil Hospital Thatta. Participants were selected using simple random sampling. Data were collected through pre-tested questionnaires and analyzed using SPSS version 29. Inclusion criteria consisted of adults aged ≥18 years with a confirmed diagnosis of hypertension, while individuals with severe comorbidities were excluded. Ethical approval was obtained, and informed consent was secured from all participants before data collection. Results: The majority of participants were aged 36-45 years (31.2%) and male (63.1%). Traditional high-salt foods were identified as a major barrier by 47.3% of participants, while 11% relied on traditional remedies over prescribed medications. Social gatherings contributed to non-compliance in 30% of cases, and 6% of women cited cultural norms limiting physical activity as barriers. Lower educational attainment and lack of social support further impeded adherence to treatment guidelines, with 43.8% having completed matriculation and only 2.3% holding postgraduate qualifications. Conclusion: Sociocultural factors, including dietary habits, reliance on traditional medicine, gender-specific barriers, and limited education, significantly influence hypertension management in Thatta. Addressing these barriers through culturally sensitive and context-specific interventions is essential to improve patient outcomes and reduce the burden of hypertension in similar rural settings.

High Blood Pressure among Young Adults Aged 18 - 45 Years Presenting for Care to a Health Center in Karongi District in Rwanda

Hypertension is a major global health challenge, significantly contributing to morbidity and mortality. This study investigates the prevalence and associated risk factors of hypertension among young adults aged 18 – 45 years in Karongi District, Rwanda, to inform effective prevention and management strategies. Hypertension prevalence serves as a critical measure of community health, with further epidemiological data needed to address treatment gaps, elevated prevalence rates, and suboptimal blood pressure control. The study also aims to promote routine blood pressure monitoring and highlight the efficacy of lifestyle interventions, including reduced salt intake, regular physical activity, weight loss, alcohol moderation, and smoking cessation, in managing hypertension. A cross-sectional analytical design was employed, utilizing patient questionnaires and observation checklists at Rubengera Health Center. Data analysis was conducted using STATA version 15, with logistic regression identifying factors influencing hypertension. The study found an overall hypertension prevalence of 30.3%, with 9.09% representing newly diagnosed cases, consistent with trends in African populations. Significant sociodemographic factors included older age, lower education levels, urban residence, and marital status, with higher prevalence among married and widowed individuals. Key lifestyle contributors were high saturated fat intake, low physical activity, and excessive salt consumption, while regular exercise and a balanced diet were protective factors. The study concludes that hypertension is a prevalent health issue among young adults in Karongi District, driven by both sociodemographic and lifestyle factors. It underscores the need for data-driven strategies for hypertension management and control, providing essential insights for health planners in estimating disease burden and designing targeted interventions. Recommendations include public awareness campaigns, early detection initiatives, and policy measures addressing unhealthy dietary habits and physical inactivity. Further research is encouraged to examine the impact of occupation, gender, marital transitions, and intervention efficacy in reducing hypertension prevalence. These efforts aim to mitigate the burden of hypertension in Rwanda, contributing to improved health outcomes and population well-being. Keywords: Hypertension, Prevalence, Risk factors, Lifestyle interventions, Sociodemographic factors, Management strategies

Dietary Sources of Sodium in Nigerian Adults From 3 Geographic Regions: A Population-Based Cross-Sectional Study.

Background To address the growing burden of hypertension and related diseases, Nigeria seeks to reduce excess dietary sodium through policymaking. The current study aims to describe the levels and sources of dietary sodium intake among Nigerian adults to inform targeted policies for reducing sodium intake. Methods From June 2023 to July 2023, adults aged 18 to 70 years old were recruited from the Federal Capital Territory, Kano States, and Ogun States to participate in a population-based, cross-sectional non-communicable diseases survey. Data were also collected to assess levels and dietary sources of sodium through four 24-hour dietary recalls by trained study personnel with 90.7% response rate. Concurrent 24-hour urine sodium data were collected. The primary analyses included the distribution of sodium intake and sources of sodium, overall and by sex and state. Results were adjusted to the Nigerian population. Multivariate regression models evaluated associations between baseline sociodemographic factors and sodium intake. Results Among 537 participants, 365 (68.0%) were female, and median (Interquartile range) age was 38 (27, 48) years. Adjusted median (IQR) daily sodium intake according to 24-hour dietary recalls was 3,803 (2,663, 5,085) mg per day with higher intake reported among males (males: 3,878 [2,663, 5,032] mg/dl; females: 3,415 [2,373, 4,689], p<.0001). Two-thirds (67.0%) of the sodium intake was from home-cooked meals. Nearly half (48.7%) of sodium came from discretionary sources, including 21.4% from bouillon. Salt and yaji spice added at the table accounted for 9.1% of sodium intake and was highest among females (18.8%) and males (13.7%) in Kano. On the other hand, sodium from street food was highest in males (35.9%) and females (34.2%) in Ogun. After adjustment, older participants and those with higher education had lower daily sodium intake compared to younger participants and those with less education, respectively. Results were similar when excluding individuals with cardiovascular disease or hypertension. Conclusions Adults in the Federal Capital Territory, Kano, and Ogun consume nearly twice the recommended level of dietary sodium. Most dietary sodium intake came from home cooked foods, nearly half of which came from discretionary sources, which has important policy implications for SHAKE package implementation. Registration number: NCT04765865.

Long-term trends in the burden of pulmonary arterial hypertension in China and worldwide: new insights based on GBD 2021.

Pulmonary arterial hypertension (PAH) poses a significant health challenge globally, with China experiencing a notable increase in its burden. Understanding the trends and factors contributing to PAH is crucial for developing effective public health strategies. This study utilized data from the Global Burden of Disease (GBD) 2021 database to estimate the burden of PAH in China and worldwide from 1990 to 2021. A Bayesian age-period-cohort (BAPC) model was employed to analyze differences in PAH burden across age, gender, and time periods, and to project global epidemiological trends until 2036. From 1990 to 2021, the incidence and prevalence of PAH in China increased by 80.59% and 86.74%, respectively. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) showed an annual percentage change (AAPC) of -0.07% and 0.25%, respectively. Conversely, the age-standardized disability-adjusted life year (DALY) rate and age-standardized mortality rate (ASMR) have been declining since 1990, with AAPC of -1.90% and -1.26%, respectively. Females and the 50-70 years age group experienced a higher PAH burden compared to males. Projections indicate that ASPR, ASMR, and age-standardized death rate (ASDR) will stabilize with minimal variation over the next decade. The findings highlight the age-related burden of PAH in China, particularly affecting older populations and women. The projected stabilization of PAH metrics over the next decade underscores the need for continued monitoring and targeted interventions. This study's comprehensive analysis of PAH burden over three decades provides valuable insights for policymakers and healthcare providers, necessitating concerted efforts to address this critical health issue.

Consensus recommendations for diagnosis and management of pulmonary arterial hypertension patients in Egypt

Background The burden of pulmonary arterial hypertension (PAH) in Egypt is quite comparable to the global burden. Nonetheless, there is a lack of clear national guidance on the screening, treatment, and diagnosis of PAH in Egypt. This consensus aimed at summarizing and adapting to the updated guidelines for the diagnosis and treatment of PAH by combining available evidence from the Egyptian practice according to Egyptian experts’ opinions. Methods A three-step modified Delphi method was adopted to develop the present consensus, which consisted of two rounds of voting and in-between virtual meeting. Seven specialized experts from Egyptian PH expert referral centers were invited. Results The consensus provided 71 statements for the screening, diagnosis, and management of PAH, which considered the resources availability and the infrastructure of the healthcare system in Egypt. Besides, the experts highlighted several unmet medical needs pertaining to the diagnosis and management of PAH in Egypt. Conclusion There is a need to establish a national registry that covers all Egyptian PAH centers as well as standardized patients’ databases in these centers. This should be coupled with the development of screening algorithms tailored to the Egyptian setting. To develop such national screening algorithms, cost-effectiveness studies should be conducted in Egypt to better understand optimal screening frequency and the best use of algorithms. Concerning the management of PAH in Egypt, experts emphasized the role of real-world evidence in investigating the current treatment options for PAH in Egypt to improve the understanding of using these therapies in the real world. Likewise, educational programs and workshops should ensure effective physician–patient communication to promote greater patient satisfaction and higher adherence to medications.

Overview of the Burden and Challenges of Hypertension in Asia-Pacific

There remains great heterogeneity in the availability of data and approaches in managing hypertension in Asia-Pacific. A narrative review was performed to better understand the epidemiology of hypertension and challenges in hypertension care provision regionally. The data obtained were discussed under five domains: epidemiology; hospitalisation and financial impact; medication prescription; national guidelines, societies and measures; and barriers and challenges in managing hypertension. Sixteen countries were included, with the prevalence of hypertension ranging between 10.6% and 48.3%. Rates of undiagnosed, untreated and uncontrolled hypertension were alarming throughout the region, with various factors from the five major domains contributing to this, such as urbanisation, gender and socioeconomic status. Data on care provision were generally sparse. Although various measures and policies exist in individual countries to help combat hypertension, challenges have also been identified: some are systemic, while others appear more granular and culturally influenced. Collaboration between stakeholders between countries is crucial to effectively tackle these issues.

Factors influencing access, quality and utilisation of primary healthcare for patients living with hypertension in West Africa: a scoping review

ObjectivesHypertension is one of the most prevalent non-communicable diseases in West Africa, which responds to effective primary care. This scoping review explored factors influencing primary care access, utilisation and quality...

Hypertension and its Associated Factors in a Middle-Aged Population

Background: Hypertension is a major risk factor for cardiovascular diseases, chronic kidney disease, and dementia. Early detection and management are crucial for preventing these complications. However, many people lack awareness regarding their blood pressure. The study aimed to assess the prevalence of hypertension and its associated factors in rural communities. Methods: This cross-sectional study was conducted among 525 middle-aged (35-60 years) residents of the Rupa Rural Municipality, Nepal, from August to December 2020. Chi-square test and multivariate logistic regression were performed to identify the factors associated with hypertension at a 5% level of significance.Results: More than half (50.9%) of the respondents had normal to elevated systolic pressure, while only one-third (33.9%) had normal to elevated diastolic pressure. Only 47.4% of the hypertensive participants were aware of their hypertensive condition. Being a male (aOR: 1.903; 95% CI: 1.184-3.030), in middle age of 45-55 years (aOR: 2.002; 95% CI: 1.152-3.478), having basic education (aOR: 2.014; 95% CI:1.174-3.455), currently consuming alcohol (aOR: 1.923; 95% CI: 1.095-3.375), and being overweight/ obese (aOR: 1.899; 95% CI: 1.262-2.859) were identified as significant factors associated with hypertension.Conclusions: The studys findings emphasize the urgency of interventions to improve awareness of hypertension and its management to improve health outcomes. Targeted interventions will have an opportunity to reduce the burden of hypertension which is an important risk factor for cardiovascular diseases among the middle-aged population.Keywords: cardiovascular disease; hypertension; Nepal; prevalence; risk factors.

Renal Denervation: A Promising Alternative for Medications to Ameliorate the Physical and Mental Burden of Hypertension, A Narrative Review

: Hypertension is the most significant modifiable risk factor for cardiovascular disease (CVD) and is associated with substantial negative effects on both individual and societal levels. Renal denervation (RDN) has been established as a safe and effective medical intervention for treating resistant hypertension, with approval from the Food and Drug Administration and endorsement by guidelines such as those of the European Society of Cardiology (2023) and the American Heart Association. However, with the advent of various types of RDN methods, including radiofrequency-, ultrasound-, and alcohol-based techniques, debates have intensified regarding their comparative efficacy and safety. Additionally, researchers have expanded their focus to consider outcomes beyond hypertension management. Most studies have demonstrated that this non-pharmacologic treatment significantly improves systolic and diastolic 24-hour ambulatory and office blood pressure in both the short- and long-term. Despite these findings, the social and psychological impacts of RDN on a broader scale have been less frequently discussed. Given the high burden of hypertension and its complications, such as cardiovascular and cerebrovascular events, this intervention could substantially enhance the quality of life and mental health of affected populations. Non-adherence to antihypertensive medications remains a critical challenge, driven by factors such as side effects, pregnancy, financial constraints, psychiatric disorders, and polypharmacy with its associated consequences. Renal denervation, by improving blood pressure control, offers the potential to enhance quality of life and reduce the incidence of severe physical and mental health conditions. This study provides a comprehensive perspective on this advanced treatment, emphasizing its impact on individual and societal well-being, physical health, and mental health.

Meeting clean air targets could reduce the burden of hypertension among women of reproductive age in India.

Air pollution is one of the leading risk factors for hypertension globally. However, limited epidemiological evidence exists in developing countries, specifically with indigenous health data and for fine particulate matter (PM2.5) composition. Here, we addressed this knowledge gap in India. Using a logistic regression model, we estimated the association between hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) prevalence among women of reproductive age (WRA, 15-49 years) from the fifth round of the National Family Health Survey and long-term exposure to PM2.5 and its composition, after adjusting for confounders. We also explored the moderating effects of socioeconomic indicators through a multiplicative interaction with PM2.5. Hypertension prevalence increased by 5.2% (95% uncertainty interval: 4.8%-5.7%) for every 10 μg/m3 increase in ambient PM2.5 exposure. Significant moderating effects were observed among smokers against nonsmokers and for various sociodemographic parameters. Among PM2.5 species, every interquartile range increase in black carbon (BC) and sulphate exposure was significantly associated with higher odds of hypertension than for organic carbon and dust. We estimated that achieving the National Clean Air Program target and World Health Organization air quality guidelines can potentially reduce hypertension prevalence by 2.42% and 4.21%, respectively. Our results demonstrate that increasing ambient PM2.5 exposure is associated with a higher prevalence of hypertension among WRA in India. The risk is not uniform across various PM2.5 species and is higher with BC and sulphate. Achieving clean air targets can substantially reduce the hypertension burden in this population.

Trends and levels of the global, regional, and national burden of pulmonary arterial hypertension from 1990 to 2021: findings from the global burden of disease study 2021

BackgroundPulmonary arterial hypertension (PAH) is a severe and progressive lung disease that significantly impairs patients’ health and imposes heavy clinical and economic burdens. Currently, there is a lack of comprehensive epidemiological analysis on the global burden and trends of PAH.MethodsWe estimated the prevalence, mortality, disability-adjusted life years (DALYs) of PAH from 1990 to 2021 using the results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). The average annual percentage changes were used to estimate the trends of PAH across 21 regions and 204 countries and territories.ResultsFrom 1990 to 2021, the number of prevalent cases and deaths associated with PAH worldwide increased by 81.5 and 48.4%. However, the age-standardized prevalence rate of PAH remained relatively stable, while the age-standardized mortality rate and DALYs declined. In 2021, the global age-standardized prevalence rate of PAH was 2.28 per 100,000, with 1.78 per 100,000 in males and 2.75 per 100,000 in females. The age-standardized mortality rate of PAH globally was 0.27 per 100,000, and the age-standardized DALYs was 8.24 per 100,000. Among the 21 regions, Western Europe had the highest age-standardized prevalence rate (3.56 per 100,000), while North Africa and the Middle East had the highest age-standardized mortality rate (0.44 per 100,000) and DALYs (14.81 per 100,000). Additionally, older individuals and females are at higher risk of PAH. The age-standardized mortality rate and DALYs associated with PAH increase with age, peaking in the 95+ age group. As the sociodemographic index increased, the age-standardized prevalence rates showed an upward trend, while both the age-standardized mortality rates and DALYs exhibited a downward trend.ConclusionFrom 1990 to 2021, the overall trend of PAH burden presents regional and national variations and differs by age, sex, and sociodemographic index. These findings emphasize the importance of implementing targeted interventions to alleviate the burden of PAH.

Burden of Cardio-Cerebrovascular and Renal Diseases Attributable to Systolic Hypertension in France in 2021.

Hypertension is the most common chronic disease and a major modifiable risk factor for cardio-cerebrovascular and renal diseases. This study estimated the national burden of hypertension, defined as systolic blood pressure ≥140 mm Hg, on morbidity and mortality in 2021 in France. For all diseases causally associated with hypertension (cardiovascular diseases, chronic kidney diseases, and dementia), the number and proportion of cases attributable to hypertension in adults aged ≥35 years were estimated using population attributable fractions. Age- and sex-specific population attributable fractions were computed using the distribution of hypertension in the French population. These population attributable fractions were applied to nationwide statistics for mortality, hospitalizations, disease prevalence, years of life lost, years of life lived with disability, and disability-adjusted years of life. The largest population attributable fractions were for ischemic heart disease and hemorrhagic stroke, with over 40% of cases attributable to hypertension. Overall, >385 000 patients were hospitalized due to hypertension, with 3.7 million hospitalizations and 6.2 million hospital days (all hospitalizations, including 3.4 million for chronic kidney disease) and including 390 000 overnight hospitalization. In 2021, >1.15 million individuals lived with ischemic heart disease attributable to hypertension, 1.26 million with chronic kidney diseases, and 358 033 with heart failure. Among 184 059 annual deaths from cardiovascular diseases, dementia, and chronic kidney diseases, 30% (55 280 deaths) were attributable to hypertension. Hypertension accounted for 8.5% of all deaths and 498 052 years of life lost. In France, despite near-universal health coverage and free health care access, the burden attributable to hypertension remains high.

Pathway to care, treatment and disease burden of pulmonary arterial hypertension: a real-world survey of physicians and patients in Latin America

ObjectivesTo investigate clinical characteristics, symptom profile, testing practices, treatment patterns and quality of life (QoL) among patients with pulmonary arterial hypertension (PAH) in Latin America.DesignData from the Adelphi Real World...