Diagnostic Criteria For Hypertension Research Articles

An Age Study on Adopting Adult Hypertension Standards in Chinese Mature Children and Adolescents

Abstract OBJECTIVE To determine age cutoff values for the use of adult hypertension diagnostic criteria in children and adolescents, and to evaluate the consistency and screening effect of the adult criteria with the sex-, age-, and height-specific blood pressure reference (gold standard). METHODS A literature review and expert consultation were used to determine age cutoff value. In children above the cutoff age, the China Child and Adolescent Cardiovascular Health Survey was used to compare the consistency and screening effect between the adult criteria and the gold standard, and Beijing Blood Pressure Study was used to evaluate the predictive value of childhood hypertension diagnosed by adult criteria and gold criteria for hypertension and subclinical cardiovascular damage in adulthood. RESULTS (i) Adult criteria can be used to evaluate hypertension for children aged 16 and above. (ii) Among adolescents aged 16 and above, the adult standard has lower sensitivity (21.1%) but higher specificity (100.0%) compared with the gold standard, with a consensus rate of over 80.0%. And the predictive ability of the adult standard for subclinical cardiovascular health damage in adulthood is also similar to that of the gold standard. CONCLUSIONS Sixteen years can be used as a cutoff point for the adoption of adult hypertension diagnostic criteria in children, and it has a certain degree of simplicity and accuracy.

20 years on – the measurement of blood pressure and detection of hypertension in children and adolescents: a national descriptive survey

In 1997 a survey identified a general lack of standardisation of blood pressure (BP) measurement and little consensus on the criteria for diagnosing hypertension amongst paediatricians. We have conducted a new online survey in 2021, to compare clinical practice between the two time periods. A national quality improvement survey was approved by the GAPRUKI committee and then circulated to consultant-grade general paediatricians. 125 analysable replies from 34 different sites were received and compared with the 1997 data. 106 (84.8%) reported clinic nurse involvement in BP measurement, more than twice than reported previously (40.6%). Most paediatricians (53.6%) now rely on oscillometric devices, whereas the mercury sphygmomanometer was favoured previously (82.7%). If assessing BP manually (n = 89), most (79.8%) now use Korotkoff phase V as the auscultatory endpoint for diastolic BP (phase IV was previously used (52.1%)). Diagnostic criteria of hypertension, the criteria (≥95th centile for gender, age and height) were constant, and 100% of paediatricians diagnosed it using systolic BP, but only 43 (34.4%) used diastolic BP, a decrease from 79.4% previously. Ambulatory BP Monitoring was six times more available than in 1997 (81.6% vs 13.6%). Similar to previous findings, only 12 (9.6%) paediatricians would manage hypertensive patients themselves, however 82 (72.6%) would keep general paediatric input. There have been important changes in the assessment of BP in children, including increased nurse involvement and greater use of technology. However, fewer paediatricians are responding to high diastolic pressures than twenty years ago.

Dosing time optimization of antihypertensive medications by including the circadian rhythm in pharmacokinetic-pharmacodynamic models.

Blood pressure (BP) follows a circadian variation, increasing during active hours, showing a small postprandial valley and a deeper decrease during sleep. Nighttime reduction of 10-20% relative to daytime BP is defined as a dipper pattern, and a reduction of less than 10%, as a non-dipper pattern. Despite this BP variability, hypertension's diagnostic criteria and therapeutic objectives are usually based on BP average values. Indeed, studies have shown that chrono-pharmacological optimization significantly reduces long-term cardiovascular risk if a BP dipper pattern is maintained. Changes in the effect of antihypertensive medications can be explained by circadian variations in their pharmacokinetics (PK) and pharmacodynamics (PD). Nevertheless, BP circadian variation has been scarcely included in PK-PD models of antihypertensive medications to date. In this work, we developed PK-PD models that include circadian rhythm to find the optimal dosing time (Ta) of first-line antihypertensive medications for dipper and non-dipper patterns. The parameters of the PK-PD models were estimated using global optimization, and models were selected according to the lowest corrected Akaike information criterion value. Simultaneously, sensitivity and identifiability analysis were performed to determine the relevance of the parameters and establish those that can be estimated. Subsequently, Ta parameters were optimized to maximize the effect on BP average, BP peaks, and sleep-time dip. As a result, all selected models included at least one circadian PK component, and circadian parameters had the highest sensitivity. Furthermore, Ta with which BP>130/80 mmHg and a dip of 10-20% are achieved were proposed when possible. We show that the optimal Ta depends on the therapeutic objective, the medication, and the BP profile. Therefore, our results suggest making chrono-pharmacological recommendations in a personalized way.

Correlates of Hypertension among Persons Living with HIV at Livingstone Central Hospital: A Crosssectional study

Background: Persons living with HIV (PLWH) are more likely to develop hypertension and cardiovascular disease than the HIV-negative population. The new hypertension guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC) lowered the definition of hypertension from systolic and diastolic blood pressure (BP) of ≥ 140/90mmHg to ≥ 130/80, respectively. This study was aimed at determining the prevalence and factors associated with hypertension in PLWH in Livingstone using the new hypertension diagnostic criteria.
 Methods: This was a cross-sectional study. We recruited 226 antiretroviral treated PLWH attending routine visits. Socio-demographic, health and clinical data including BP readings were collected. Interviewer-structured questionnaires adapted from the World Health Organization Stepwise approach to Surveillance ( WHO STEPs) and the international physical activity questionnaire (IPAQ) were used to collect data. Statistical evaluations were employed to elucidate relationships between hypertension and all response variables.
 Results: The prevalence of hypertension using the old and new guidelines was 16% and 42%, respectively. Factors significantly associated with increased and reduced odds of developing hypertension after adjustments in multivariate logistic regression were age, body mass index (BMI), employment status, fasting blood sugar (FBS) and table salt consumption, respectively (p<0.05 for all). Using the new AHA/ACC criteria for hypertension shifted the prevalence from 16% (old criteria) to 42%.
 Conclusion: The prevalence of hypertension in PLH in Livingstone was 42% and the major risk factors associated with hypertensionin PLWH wereincreasing age, BMI and FBS. We recommend the inclusion of FBS in routine measurements in PLWH. The AHA/ ACC new guidelines should be reenforced in low-cost settings to increase the treatment ofh ypertension among PLWH.

Correlates of Hypertension among Persons Living with HIV at Livingstone Central Hospital: A Crosssectional study

Background: Persons living with HIV (PLWH) are more likely to develop hypertension and cardiovascular disease than the HIV-negative population. The new hypertension guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC) lowered the definition of hypertension from systolic and diastolic blood pressure (BP) of ≥ 140/90mmHg to ≥ 130/80, respectively. This study was aimed at determining the prevalence and factors associated with hypertension in PLWH in Livingstone using the new hypertension diagnostic criteria.
 Methods: This was a cross-sectional study. We recruited 226 antiretroviral treated PLWH attending routine visits. Socio-demographic, health and clinical data including BP readings were collected. Interviewer-structured questionnaires adapted from the World Health Organization Stepwise approach to Surveillance ( WHO STEPs) and the international physical activity questionnaire (IPAQ) were used to collect data. Statistical evaluations were employed to elucidate relationships between hypertension and all response variables.
 Results: The prevalence of hypertension using the old and new guidelines was 16% and 42%, respectively. Factors significantly associated with increased and reduced odds of developing hypertension after adjustments in multivariate logistic regression were age, body mass index (BMI), employment status, fasting blood sugar (FBS) and table salt consumption, respectively (p<0.05 for all). Using the new AHA/ACC criteria for hypertension shifted the prevalence from 16% (old criteria) to 42%.
 Conclusion: The prevalence of hypertension in PLH in Livingstone was 42% and the major risk factors associated with hypertensionin PLWH wereincreasing age, BMI and FBS. We recommend the inclusion of FBS in routine measurements in PLWH. The AHA/ ACC new guidelines should be reenforced in low-cost settings to increase the treatment ofh ypertension among PLWH.

2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension.

Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Despite the positive correlations between blood pressure (BP) levels and later CV events since BP levels as low as 100/60 mmHg have been reported in numerous epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years. The publication of both the SPRINT and STEP trials (comprising > 8,500 Caucasian/African and Chinese participants, respectively) provided evidence to shake this 140/90 mmHg dogma. Another dogma regarding hypertension management is the dependence on office (or clinic) BP measurements. Although standardized office BP measurements have been widely recommended and adopted in large-scale CV outcome trials, the practice of office BP measurements has never been ideal in real-world practice. Home BP monitoring (HBPM) is easy to perform, more likely to be free of environmental and/or emotional stress, feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events, compared to routine office BP measurements. In the 2022 Taiwan Hypertension Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS), we break these two dogmas by recommending the definition of hypertension as ≥ 130/80 mmHg and a universal BP target of < 130/80 mmHg, based on standardized HBPM obtained according to the 722 protocol. The 722 protocol refers to duplicate BP readings taken per occasion ("2"), twice daily ("2"), over seven consecutive days ("7"). To facilitate implementation of the guidelines, a series of flowcharts encompassing assessment, adjustment, and HBPM-guided hypertension management are provided. Other key messages include that: 1) lifestyle modification, summarized as the mnemonic S-ABCDE, should be applied to people with elevated BP and hypertensive patients to reduce life-time BP burden; 2) all 5 major antihypertensive drugs (angiotensin-converting enzyme inhibitors [A], angiotensin receptor blockers [A], β-blockers [B], calcium-channel blockers [C], and thiazide diuretics [D]) are recommended as first-line antihypertensive drugs; 3) initial combination therapy, preferably in a single-pill combination, is recommended for patients with BP ≥ 20/10 mmHg above targets; 4) a target hierarchy (HBPM-HMOD- ambulatory BP monitoring [ABPM]) should be considered to optimize hypertension management, which indicates reaching the HBPM target first and then keeping HMOD stable or regressed, otherwise ABPM can be arranged to guide treatment adjustment; and 5) renal denervation can be considered as an alternative BP-lowering strategy after careful clinical and imaging evaluation.

Identification of histopathological and clinical spectrum of diabetic kidney disease based on an unsupervised hierarchical clustering analysis of elderly autopsy specimens.

Diabetic kidney disease (DKD), a chronic kidney disease caused by diabetes and other comorbidities, is the leading cause of end-stage renal disease. The pathogenesis of DKD is diverse and influenced by various causes, some but not all of which cause proteinuria. Some factors such as hypertension can modify DKD. Therefore, the spectrum of DKD is difficult to elucidate and remains unsolved. This study aims to classify and characterize DKD. We examined autopsy specimens from type 2 diabetes mellitus (DM) (n=44) and non-DM (n=21) groups. The frequency of interstitial fibrosis and tubular atrophy was higher in patients with proteinuric DKD than in those with non-proteinuric DKD. The presence of polar vasculosis was associated with hypertension in DKD. In addition, an unsupervised hierarchical clustering analysis revealed the spectrum of renal histopathology findings for more-proteinuric and less-proteinuric DKD. With changes in the diagnostic criteria for hypertension and advances in antihypertensive drugs, the pathogenesis of DKD may be changing. Furthermore, a decision tree model suggested how diabetes, hypertension, and dyslipidemia interacted in predicting the characteristics of DKD. Polar vasculosis is a good indicator of the presence of DM and hypertension. Furthermore, the histopathological and clinical spectrum of DKD were related to the interaction of diabetes, hypertension, and dyslipidemia. These histopathological and clinical results may help to show the range of patient characteristics when conducting clinical trials and could help to determine whether chronic kidney disease is caused by DM or some other cause.

Arterial hypertension in children and adolescents: a modern view at the problem (a literature review). Part 1

The analysis of modern national and foreign literature on the prevalence, causes, mechanisms, and criteria of hypertension in children and adolescents was carried out. The aim of the study was to provide modern data on the epidemiology, risk factors, mechanisms of development and diagnostic criteria for hypertension in children and adolescents, based on a review of scientific sources. Materials and methods. A search was conducted in the scientific-metric systems Google Scolar, PubMed, Cohrane Database from 2011 to 2021 using the following keywords: epidemiology, risk factors for systemic hypertension, mechanisms of development, coronavirus disease, adolescents, criteria for diagnostics of systemic arterial hypertension. Conclusions. Scientific sources of the last decade have identified the main risk factors and the most common mechanisms of hypertension, systematized approaches to classification as well as diagnostic criteria for the disease at a young age. This disease has recently become more common among children younger than 18 years varying from 2 % to 20 % of cases. It is worth noting that the coronavirus pandemic has brought about changes in the study of hypertension in children and adults, serving as a leading factor of severe course and mortality, but research on this matter is currently under way. The significance of certain pathogenetic factors in the genesis of different variants of arterial hypertension in children has not been fully identified up to date, and further study on their relationship with hemodynamic parameters in children and adolescents is needed. Generally, scientists around the world are focusing their attention on early diagnosis of elevated blood pressure in childhood, while the process is reversible, to prevent complications and a more severe course of the disease.

Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure.

There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring. Relevant international experts completed three rounds of a modified Delphi questionnaire. For each item, the predefined cutoff for group consensus was ≥70% agreement, with 60% to 70% considered to warrant reconsideration at the subsequent round, and <60% considered insufficient to warrant consideration. Of 230 experts, 137 completed the first round and 114 (114/137, 83.2%) completed all three. For out-of-office BP monitoring, there was consensus that home BP monitoring (HBPM) should be chosen; instructions given, pairs of BP values taken, opportunity given for women to qualify values they do not regard as valid, and BP considered evaluated when ≥25% of values are above a cutoff. For HBPM, BP should be taken at least 2 to 3 d/wk, at minimum in the morning; however, many factors may affect frequency and timing. Experts endorsed a clinic BP <140/90 mm Hg as normal. While not reaching consensus, most agreed that HBPM values should be lower than clinic BP. Among those, HBPM <135/85 mm Hg was considered normal. There was consensus that white coat hypertension warrants: HBPM at least 1 d/wk before 20 weeks, 2 to 3 d/wk after 20 weeks or if persistent hypertension develops, and symptom monitoring (ie, headache, visual symptoms, and right upper quadrant/epigastric pain). Consensus-based diagnostic criteria and monitoring strategies should inform clinical care and research, to facilitate evaluation of out-of-office BP monitoring on pregnancy outcomes.

Альдостеронсинтаза, поліморфізм її гена CYP11B2 при артеріальній гіпертензії і асоційованих з нею кардіоваскулярних захворюваннях (огляд літератури)

В огляді надані дані зарубіжної та вітчизняної літератури щодо патогенетичної ролі альдостерону, рівнів альдостеронсинтази і поліморфізмів гена даного ферменту у хворих на різні форми артеріальної гіпертензії, при асоційованих з нею захворюваннях серця і судин, фібриляції передсердь, метаболічному синдромі, патології нирок, головного мозку. Розглядаються функції альдостерону, рівнів альдостеронсинтази і поліморфізмів гена даного ферменту в серцево-судинному ремоделюванні, можливості застосування даних маркерів для диференційно-діагностичних цілей, перспективи терапевтичного використання інгібіторів альдостеронсинтази серед різних категорій хворих з ознаками артеріальної гіпертензії.

Effectiveness of Body Roundness Index (BRI) and a Body Shape Index (ABSI) in Predicting Hypertension: A Systematic Review and Meta-Analysis of Observational Studies.

Introduction: The body roundness index (BRI) and a body shape index (ABSI) are novel anthropometric indices established to determine both the amount visceral adipose tissue and body fat. Objective: to investigate whether BRI and ABSI are better predictors of hypertension than body mass index (BMI), waist circumference (WC) or waist-to-height ratio (WHtR). Methods: A systematic search was conducted in the Scopus, PubMed and Web of Science databases up until 31 December 2020. Results: The estimated pooled area under curve [AUC (95% CI)] for BRI [0.67 (0.65–0.70)] for the prediction of hypertension were superior to that of ABSI (0.58 (0.56–0.60)), similar to that of BMI [0.67 (0.64–0.69)], and lower than those WC [0.68 (0.66–0.70)] and WHtR [0.68 (0.66–0.71)]. Nevertheless, the difference of BRI compared to WC and WHtR in the context of predicting hypertension was non-significant. ABSI was significantly lower (p < 0.05) than BRI, BMI, WC and WHtR. Similar findings were observed with the summary receiver operating characteristic curve (AUC-SROC). There were no significant differences between subgroups according to type of population or diagnostic criteria of hypertension. The diagnostic odds ratio (dORs) proved that increased BRI and ABSI were related with an elevated hypertension risk. Conclusions: BRI and ABSI have discriminatory power for hypertension in adult women and men from different populations. Although, WHtR and WC provided the best performance when assessing hypertension, no significant differences were found for BRI. Finally, BRI was significantly better predictor of hypertension than ABSI.

A Health Information Quality Assessment Tool for Korean Online Newspaper Articles: Development Study.

BackgroundConcern regarding the reliability and accuracy of the health-related information provided by online newspaper articles has increased. Numerous criteria and items have been proposed and published regarding the quality assessment of online information, but there is no standard quality assessment tool available for online newspapers.ObjectiveThis study aimed to develop the Health Information Quality Assessment Tool (HIQUAL) for online newspaper articles.MethodsWe reviewed previous health information quality assessment tools and related studies and accordingly developed and customized new criteria. The interrater agreement for the new assessment tool was assessed for 3 newspaper articles on different subjects (colorectal cancer, obesity genetic testing, and hypertension diagnostic criteria) using the Fleiss κ and Gwet agreement coefficient. To compare the quality scores generated by each pair of tools, convergent validity was measured using the Kendall τ ranked correlation.ResultsOverall, the HIQUAL for newspaper articles comprised 10 items across 5 domains: reliability, usefulness, understandability, sufficiency, and transparency. The interrater agreement for the article on colorectal cancer was in the moderate to substantial range (Fleiss κ=0.48, SE 0.11; Gwet agreement coefficient=0.74, SE 0.13), while for the article introducing obesity genetic testing it was in the substantial range, with values of 0.63 (SE 0.28) and 0.86 (SE 0.10) for the two measures, respectively. There was relatively low agreement for the article on hypertension diagnostic criteria at 0.20 (SE 0.10) and 0.75 (SE 0.13), respectively. Validity of the correlation assessed with the Kendall τ showed good correlation between tools (HIQUAL vs DISCERN=0.72, HIQUAL vs QUEST [Quality Evaluation Scoring Tool]=0.69).ConclusionsWe developed a new assessment tool to evaluate the quality of health information in online newspaper articles, to help consumers discern accurate sources of health information. The HIQUAL can help increase the accuracy and quality of online health information in Korea.

Estimated Prevalence of Hypertension and Undiagnosed Hypertension in a Large Inpatient Population: A Cross-sectional Observational Study.

BackgroundHypertension is a major cause of morbidity and mortality. In community populations the prevalence of hypertension, both in diagnosed and undiagnosed states, has been widely reported. However, estimates for the prevalence of hospitalized patients with average blood pressures (BPs) that meet criteria for the diagnosis of hypertension are lacking. We aimed to estimate the prevalence of patients in a UK hospital setting, whose average BPs meet current international guidelines for hypertension diagnosis.MethodsWe performed a retrospective cross-sectional observational study of patients admitted to adult wards in 4 acute hospitals in Oxford, United Kingdom, between March 2014 and April 2018.ResultsWe identified 41,455 eligible admitted patients with a total of 1.7 million BP measurements recorded during their hospital admissions. According to European ESC/ESH diagnostic criteria for hypertension, 21.4% (respectively 47% according to American ACC/AHA diagnostic criteria) of patients had a mean BP exceeding the diagnostic threshold for either Stage 1, 2, or 3 hypertension. Similarly, 5% had a mean BP exceeding the ESC/ESH (respectively 13% had a mean BP exceeding the ACC/AHA) diagnostic criteria for hypertension, but no preexisting diagnostic code for hypertension or a prescribed antihypertensive medication during their hospital stay.ConclusionsLarge numbers of hospital inpatients have mean in-hospital BPs exceeding diagnostic thresholds for hypertension, with no evidence of diagnosis or treatment in the electronic record. Whether opportunistic screening for in-hospital high BP is a useful way of detecting people with undiagnosed hypertension needs evaluation.

Incorporating the American College of Cardiology/American Heart Association hypertension diagnostic criteria into metabolic syndrome criteria will significantly increase the prevalence of metabolic syndrome among college students

The purpose of this study was to examine the impact that the revised American College of Cardiology/American Heart Association (ACC/AHA) hypertension diagnostic criteria would have on the prevalence of metabolic syndrome (MBS) among college students. Students completed an objective health assessment between September 2015 and April 2018 that involved the assessment of abdominal girth, blood glucose, lipids, and blood pressure (BP). Data of 5681 students (60.1% Men; 21 ± 1 years) who had all MBS risk factors assessed were analyzed to compare differences between old and new diagnostic criteria and identify which component of BP best predicts metabolic risk factors. The prevalence of MBS increased by 40.6% and 104.5% with the change to ACC/AHA criteria from the AHA/National Heart Lung and Blood Institute and theSeventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP criteria, respectively. The greatest relative increase in the prevalence of MBS was observed among women. Systolic BP and diastolic BP were significant predictors of abdominal obesity, and diastolic BP was a significant predictor of elevated triglycerides. Changes in hypertension diagnostic criteria had a significant impact on MBS prevalence. This is positive as it will allow earlier identification of young adults at risk of developing various noncommunicable diseases, but the ability of colleges to identify and then intervene to improve the health of at-risk students remains unclear. Furthermore, findings indicate that BP may hold utility as a cost-effective predictor of certain metabolicrisk factors in the absence of efficient, accurate, and affordable alternatives.

Blood pressure phenotypes in young patients with type 1 diabetes

Aim. To study phenotypes of clinic and 24-hour ambulatory blood pressure (BP), to determine their associations with arterial stiffness parameters, and to assess global cardiovascular risk (CVR) in young patients with type 1 diabetes (T1D).Material and methods. The presented cross-sectional single-center study included 81 T1D patients without a history of hypertension (HTN) and other cardiovascular diseases (CVD) (men — 39%; median age — 27 years; median duration of T1D — 6 years). All participants underwent a routine clinical and laboratory testing, measurement of clinic and 24-hour ambulatory BP (BPLab Vasotens), assessment of central BP and arterial stiffness parameters using applanation tonometry technique. BP phenotypes were analyzed with diagnostic criteria for HTN by ESC/ESH 2018 guidelines. CVR was assessed using the SCORE 10-year risk calculator (ESC 2019). The differences were considered significant at p&lt;0,05.Results. The prevalence of true HTN was 6,2%, masked HTN — 38,3%. Isolated nocturnal HTN was revealed in 30,7% of patients with clinic BP &lt;140/90 mm Hg. The subgroup with masked HTN was dominated by patients with normal clinic BP (58,1%) and in most cases was characterized by isolated diastolic BP increase (64,5%). Masked HTN was associated with a higher carotid-femoral pulse wave velocity (PWV) (median — 7,2 versus 6,3 m/s, p=0,002). The most common profiles of nocturnal BP decrease were non-dipper (63.9%) and night-picker (16.6%). High and very high CVR was recorded in 87,7% of patients. Conclusion. Hypertension occurs in 44,5% of young patients with type 1 diabetes and is characterized by a high prevalence of masked isolated nocturnal HTN and non-dipping. Masked HTN is associated with a higher carotid-femoral PWV. High and very high 10-year CVR was recorded in 87,7% of patients.

Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline on the prevalence of hypertension in young Saudi women.

The diagnostic criteria for hypertension have recently been redefined by the American College of Cardiology/ American Heart Association (ACC/AHA). Data on the new prevalence of hypertension in different countries are emerging, but none, to date, from Saudi Arabia. This study aimed to determine the impact of the 2017 ACC/AHA hypertension guideline on the prevalence and determinants of hypertension in young Saudi women. 518 female college students, 17-29 years of age were prospectively enrolled in a survey during the period from January 1, 2016, to April 15, 2016 at Princess Nourah University. The participants completed a previously validated questionnaire, that assessed their risk factors for hypertension, and their blood pressure, weight and height were measured. Application of the 2017 ACC/AHA diagnostic criteria resulted in approximately 7-fold increase in the prevalence of hypertension, from 4.1% to 27.1% (P < 0.001). At a cut-off value of ≥140/90, hypertension was significantly associated with increased age, increased body mass index (BMI), increased heart rate, history of chronic illnesses, prior diagnosis with diabetes mellitus and family history of hypertension. Whereas, with the ≥130/80 cut-off value, only increased BMI and heart rate were significant predictors (P < 0.001). The prevalence of hypertension markedly increased among young adult Saudi women with the 2017 ACC/AHA classification for hypertension, and the main predictors were increased BMI and heart rate. Further studies on the new prevalence and predictors of hypertension in the Saudi population are warranted. This information is important for healthcare authorities to plan cost effective screening, prevention and control programmes.

An exploratory study on the quality of patient screening and counseling for hypertension management in Tanzania.

BackgroundThe global burden of hypertension, currently estimated at 1 billion, is a leading Non-Communicable Disease (NCD) in Sub Saharan Africa. In Tanzania, the reported prevalence of hypertension is 25%. Inherent limitations of the healthcare system to control hypertension include inadequate provider knowledge, system capacity, medication access, and patient awareness, all of which hinder effective screening and disease management. To assess the quality of hypertension screening and patient counseling, we conducted a study in an ambulatory setting in Tanzania.MethodsObservations of patient screening were conducted on 69 adult patients during routine outpatient care and screening camps. In addition, 33 healthcare providers participated in a pre-post knowledge assessment after observing instructional training videos.ResultsPatient observations indicated that blood pressure (BP) measurement was explained to 65% of patients, and 77% of the measurements were made with mercury sphygmomanometers. For several aspects of BP measurement, nurses performed better than doctors: patient’s arm supported on a flat surface (doctors, 58% vs nurses 67%, p<0.05), and patient’s back was supported (doctors, 50% vs nurses 88%, p<0.01). Among those diagnosed with hypertension, 7% were prescribed medications, 14% were advised on reduced salt during cooking, 29% on reduced salt consumption, 21% on reduced consumption of sodium rich foods, 21% on reducing caloric intake, 21% on increasing physical activity, and 43% were informed about follow up appointments. Provider knowledge assessments showed critical gaps in consequences of hypertension, 1st line medicines, and awareness of guidelines at baseline. Following the instructional videos there were improvements in some aspects: diagnostic criteria for hypertension (pre 45% vs post 91%, p<0.001) and counseling for controlling hypertension (pre 30% vs post 58%, p<0.01).ConclusionEnhancing knowledge and performance competencies of health providers at the primary care level is a critical prerequisite for effective hypertension management in low resource settings.

Changes in Hypertension Diagnostic Criteria Enhance Early Identification of at Risk College Students

ABSTRACT The revised (ACC/AHA) hypertension diagnostic criteria were intended to facilitate early identification and intervention among those with hypertension to improve patient health and lessen burden on the healthcare system. The purpose of this study was to examine fitness, anthropometric, and blood profile differences between college students who were or were not reclassified as hypertensive using the revised hypertension diagnostic criteria. Students completed an objective fitness assessment between September 2015 and April 2018. A total of 2724 students (71% men; 21 ± 1 yr) who were classified as prehypertensive under the old (JCN7) diagnostic criteria were included in the analyses. Men reclassified as having stage 1 hypertension using the ACC/AHA diagnostic criteria had a significantly higher body mass index (26.48 vs 25.66 kg·m−2, P &lt; 0.001), and body fat percentage (17.30% vs 16.15%, P &lt; 0.001), abdominal girth (33.58 vs 32.81 in. P &lt; 0.001), and lower predicted aerobic fitness (36.20 vs 37.63 mL·kg−1⋅min−1, P &lt; 0.001) compared with those who remained classified as prehypertensive (i.e., elevated). Women reclassified as having stage 1 hypertension using the ACC/AHA diagnostic criteria had a significantly higher body mass index (25.28 vs 24.46 kg·m−2, P = 0.015), and body fat percentage (28.63% vs 27.26%, P = 0.005), abdominal girth (30.10 vs 29.38 in. P = 0.011), and lower predicted aerobic fitness (34.07 vs 35.19 mL·kg−1⋅min−1, P = 0.031) compared with those who remained classified as prehypertensive. Blood profiles did not differ between those who were and those who were not reclassified as hypertensive for either sex. The odds of being reclassified varied from 3% to 7% based on the increase of a unit in each body composition variable and predicted aerobic fitness for both sexes. HDL was only predictive among men, and LDL was only predictive among women. The change in hypertension diagnostic criteria had the intended impact, as an increased number of college students with poorer fitness and less favorable anthropometric profiles were diagnosed as having hypertension.

Relationship Between Testosterone Deficiency and the Cardiovascular Risk Ractors, Diabetes and Hypertension

Background and objective Testosterone deficiency (TD) increases the incidence of cardiovascular risk factors such as diabetes and hypertension. Conversely, TD is reported in people with obesity and diabetes. Therefore, this study examines the relationship between TD, diabetes, and hypertension by following a longitudinal design. Material and methods In this study, 2242 (1490 middle-aged and 752 elderly) healthy men were followed up for 8 years and the incidence of hypertension or diabetes was determined. The diagnostic criteria for hypertension were systolic pressure &ge;140 mmHg and diastolic pressure &ge;90 mmHg, and the criterion for diabetes was a fasting blood glucose level &ge;126 mg/dL; the men who took medication for hypertension or diabetes were considered diseased. The threshold for TD was 2.5 ng/mL of serum testosterone. Subsequently, the relative risk (RR) of disease according to the testosterone level was analyzed. In addition, the RR of TD according to glucose and blood pressure levels was analyzed for men with normal testosterone at the initial examination. Results The TD incidence rates were 12.2 and 16.8% for middle-aged and elderly men, respectively. Among the middle-aged men, the diabetes incidence rates were 11.7 and 5.7% in the TD and non-TD (NTD) groups, respectively; the RR of diabetes increased by 1.771 times in the TD group relative to the NTD group (p&lt;0.001). Among the elderly men, the RR of hypertension and diabetes increased by 1.573 and 1.649 times, respectively, in the TD group, compared to the NTD group. Among those with normal testosterone levels at the initial examination, prehypertension (PHTN) increased the RR of TD by 2.421 and 3.091 times for middle-aged and elderly men, respectively, compared to those with normal blood pressure. Moreover, an impaired fasting glucose level at baseline increased the RR of TD by 1.710 times in middle-aged men and 2.187 times in elderly men, compared to those with normal glucose levels. Conclusion In men, TD increased the risk of diabetes and hypertension, which are cardiovascular risk factors.

Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension.

BackgroundOn high-resolution computed tomography (HRCT), pulmonary artery (PA) dimensions may hint at the presence of pulmonary hypertension. We aimed to determine how accurately various measures of the PA, as viewed on HRCT, predict right heart catheterisation (RHC)-confirmed pulmonary hypertension.MethodsWe retrospectively reviewed patients who had HRCT and RHC between 2010 and 2018. Analyses considered respiratory cycle, pulmonary hypertension diagnostic criteria, time between HRCT and RHC, and subgroup analysis in interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD).ResultsOf 620 patients, 375 had pulmonary hypertension. For pulmonary hypertension (defined as mean PA pressure (mPAP) ≥25 mmHg) and from HRCT performed within 60 days of RHC, main PA diameter (MPAD) ≥29 mm had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 88%, 42%, 0.70 and 0.70, respectively, while ratio of the diameter of the PA to the diameter of the ascending aorta (PA:Ao) ≥1.0 showed 53%, 85%, 0.84 and 0.54, respectively. In general, results were similar when the interval between HRCT and RHC varied from 7 to 60 days and when measured on expiratory images. In ILD, the sensitivity of MPAD was higher; in COPD, the specificity of PA:Ao was higher. There was moderately positive correlation between mPAP and inspiratory MPAD, PA:Ao, right PA diameter (RPAD), left PA diameter (LPAD) and (RPAD+LPAD)/2 (r=0.48, 0.51, 0.34, 0.34 and 0.36, respectively), whereas there was weak negative correlation between mPAP and PA angle (r= −0.24).ConclusionsFindings on HRCT may assist in the diagnosis of RHC-confirmed pulmonary hypertension. MPAD ≥29 mm had high sensitivity and PA:Ao ≥1.0 had high specificity. Compared with the entire cohort, MPAD had greater sensitivity in ILD and PA:Ao had higher specificity in COPD.