Optimal Control Of Hypertension Research Articles

Gambaran Tekanan Darah serta Korelasinya Terhadap Usia di Rukun Warga 008 Keluruhan Cipondoh Makmur

Introduction: Hypertension is one of the most common diseases in the world, and its increasing every year. Age is one of many risk factors in hypertension. As we get older, our blood vessels tend to lose some of their elasticity and become stiffer. This can put us at risk for developing high blood pressure, also known as hypertension. It's important to take care of our cardiovascular health as we age to reduce the risk of developing this condition.Purpose: To study the correlation between blood pressure and age.Method: This was a descriptive study conducted in Cipondoh Makmur, Tangerang. The non-random consecutive sampling was used as the sampling technique, and it will be presented as descriptive data. Spearman correlation tests were used to correlate blood pressure and age if the data distribution is not normal.Result: There were 103 individuals who met the criteria, with an average age of 51.71 (12.80) years, mean systolic blood pressure of 126.2 (22.25) mmHg, and mean diastolic blood pressure of 74.46 (11.49) mmHg. A significant correlation between age and systolic blood pressure was observed (p-value: 0.001; r: 0.323, indicating a weak association), while no significant correlation was found between age and diastolic blood pressure.Conclusion: The physiological aging process is an unavoidable risk factor for hypertension. It is crucial to Increase awareness about the importance of a healthy lifestyle and optimal hypertension control.
 

Health systems interventions for hypertension management and associated outcomes in Sub-Saharan Africa: A systematic review.

Hypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores the health system interventions on hypertension management and associated outcomes in SSA. The World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and October 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for the risk of bias using the tools from the Joanna Briggs Institute. Twelve studies clustered in 8 SSA countries met the inclusion criteria. Two thirds (8/12) of the included studies had low risk of bias. Most interventions focused on health workforce factors such as providers' knowledge and task shifting of hypertension care to unconventional health professionals (n = 10). Other health systems interventions addressed the supply and availability of medical products and technology (n = 5) and health information systems (n = 5); while fewer interventions sought to improve financing (n = 3), service delivery (n = 1), and leadership and governance (n = 1) aspects of the health systems. Health systems interventions showed varied effects on blood pressure outcomes but interventions targeting multiple aspects of health systems were likely associated with improved blood pressure outcomes. The general limitations of the overall body of literature was that studies were likely small, with short duration, and underpowered. In conclusion, the literature on health systems internventions addressing hypertension care are limited in quantity and quality. Future studies that are adequately powered should test the effect of multi-faceted health system interventions on hypertension outcomes with a special focus on financing, leadership and governance, and service delivery interventions since these aspects were least explored.

Clinical effect of carotid stenting on cognitive abilities - possible evaluation using candidates for biomarkers.

Micro- and macrovascular consequences of atherosclerosis, arterial hypertension, dyslipidemia, and smoking can affect neurotransmission and markers for neuronal activity. The potential direction and specifics are under study. It is also known that optimal control of hypertension, diabetes, and dyslipidemia in midlife may positively affect cognitive functioning later in life. However, the role of hemodynamically significant carotid stenoses in neuronal activity markers and cognitive functioning is still being debated. With the increased use of interventional treatment for extracranial carotid disease, the question of whether it might affect neuronal activity indicators and whether we can stop or even reverse the path of cognitive deterioration in patients with hemodynamically severe carotid stenoses naturally emerges. The existing state of knowledge provides us with ambiguous answers. We sought the literature for possible markers of neuronal activity that can explain any potential difference in cognitive outcomes and guide us in the assessment of patients throughout carotid stenting. The combination of biochemical markers for neuronal activity with neuropsychological assessment and neuroimaging may be important from practical point of view and may provide the answer to the question for the consequences of carotid stenting for long-term cognitive prognosis.

TIME-TO-OPTIMAL CONTROL OF HYPERTENSION USING KAPLAN-MEIER ESTIMATOR, COX PROPORTIONAL HAZARD AND WEIBULL MODEL

Hypertension is a worldwide public health challenge. The study investigated the time it takes to attain an optimal control of hypertension and the major factors that influence the control in Specialist Hospital, Sokoto.
 A retrospective cohort study was conducted involving 300 patient records. The population consisted all hypertensive patients on follow-ups at Specialist Hospital Sokoto from1st February, 2015 to 1st February, 2021.Statistical Package for the Social Sciences version 20 and R software were used for descriptive, Kaplan-Meier estimator, Cox Proportional Regression (CPH) Model and Weibull Regression Model analyses.
 Hypertensive patients attain an optimal control after a median survival time of 40.43 (at 95% CI: 33.67- 47.19) months (3.37 years) and mean survival time of 44.18 (CI: 37.24-51.12) months (3.68 years). The CPH analysis revealed that the factors that influenced an optimal control of hypertension were body mass index (BMI) (P <0.001), number of anti-hypertensive drugs (P <0.001), place of residence (P = 0.030). similarly, the Weibull model revealed that the factors that affected an optimal control of hypertension were BMI (P <0.01), number of anti-hypertensive drugs (P <0.001), place of residence (P = 0.042) and educational status (P = 0.036).
 In conclusion, BMI, number of anti-hypertensive drugs, Place of residence, Educational status. should be watched out during management of hypertensive patients. This also call for an extension of this study through a prospective design to be able to measure the effect of other factors in the achievement of optimal control of hypertension

Barriers to Optimal Hypertension Control among Adults: A Cross Sectional Study

OBJECTIVES:
 The purpose of the study was to assess factors resisting control of hypertension in adults.
 METHODOLOGY:
 A descriptive cross-sectional study was carried out from 1st of December 2020 till 31st of March 2021 at Hayatabad Medical Complex (HMC) Peshawar Pakistan. The study selected 377 participants by non-probability convenient sampling technique to find out barrier to optimal blood pressure control among adult patients visiting to HMC. Data was collected through an adopted questionnaire based on a study conducted in Rwanda district hospitals. Analysis was carried through SPPS version 22.0.
 RESULTS:
 In sample of 377 participants, 54.64% were male and 45.36% were female having mean age 55.28±10.09 years. 66.6% of the participants did not know about the harmful effects of having high blood pressure. Majority 72.4% of the participants often forget to take medication and 50.7% stop to take medication without prior consultation.
 CONCLUSION:
 Different barriers to optimal hypertension control were identified which include inadequate knowledge of the consequences of poor hypertension control, poor adherence to medication, poor diet management and unhealthy lifestyle.

Reconciling Systolic Blood Pressure Intervention Trial with Eighth Joint National Commission: a nuanced view of optimal hypertension control in the chronic kidney disease population.

Universally lowering blood pressure (BP) may adversely affect some populations especially in the older population. Recent landmark trials revealed cardiovascular benefits of tight controlling systolic BP (SBP) more than several recent BP targets. Implementing the evidence from the studies and guidelines in some populations is reviewed. Eighth Joint National Commission (JNC-8) on hypertension issued conservative guidelines that provided an evolutionary change to BPcontrol in the elderly. However, intensive BP control with SBP < 120 mmHg in Systolic Blood Pressure Intervention Trial (SPRINT) focuses on the improvement of cardiovascular and cerebrovascular outcomes. Although increasingly guidelines are trending toward the SPRINT results, it is noteworthy that not all populations show a favorable outcome with intensive BP control given hypotensive risks to memory, kidney function, orthostasis, and morbidity risks. Some populations may benefit from implementing the more intensive SBP target, whereas others such as elderly hypertensive patients may benefit from a more liberal SBP target. In the spirit of 'Primum non Nocere', we call for and suggest that a marriage of both SPRINT and JNC-8 recommendations be undertaken to champion the most cardiovascular protections for the greatest number of patients possible whereas preventing complications in vulnerable populations such as the elderly. Among the chronic kidney disease (CKD) population, SBP < 120 mmHg may not necessarily lead to favorable CKD outcomes.

Combined antihypertensive and psychocorrective therapy in patients with arterial hypertension and anxiety-depressive disorders: are there any advantages?

Relevance. Arterial hypertension (AH) and anxiety-depressive disorders (ADD) are comorbid pathologies that are common in clinical practice. At the same time, the possibility of including an antidepressant in antihypertensive therapy for optimal control of hypertension, as well as to ensure a vasoprotective effect, has not been studied enough.&#x0D; Aim. To compare the effect of traditional antihypertensive therapy and therapy, including an antidepressant, on indicators of the daily profile of blood pressure (BP), stiffness of the vascular wall and central aortic pressure (CAP), the severity of anxiety and depression, as well as on cognitive function (CF) in patients AH and ADD.&#x0D; Materials and methods. The study included 90 patients with AH and ADD, who were randomized into two groups: group 1 patients who received a fixed combination of an angiotensin II receptor blocker and a diuretic, a b-blocker and an antidepressant; group 2 persons who took only three-component antihypertensive therapy. Before and after 24 weeks, all patients underwent a general clinical examination, 24-hour BP monitoring ABPM (BpLab Vasotens, Petr Telegin, Russia) with an assessment of the daily profile of BP, CAP and vascular stiffness. In addition, testing was carried out on the HADS, CES-D scales; CF were rated according to the Montreal scale.&#x0D; Results. In the group of patients treated with an antidepressant, it was noted that the target BP level was achieved more quickly when lower doses of angiotensin II receptor blockers were prescribed. After 6 months of therapy in both groups, there was a comparable positive dynamics of the main indicators of ABPM. In group 1, a statistically more pronounced decrease in both peripheral and CAP at night was recorded. In both groups of patients, a decrease in the augmentation index was noted; however, a statistically significant improvement in the parameters of the speed of propagation of the pulse wave in the aorta and the time of propagation of the reflected wave was recorded only in persons receiving antidepressant. In group 1, there was a regression of ADD, as well as a significant improvement in CF.&#x0D; Conclusions. The use of sertraline as part of a combination antihypertensive therapy in patients with AH and ADD contributed to a more rapid achievement of target BP values, a significant improvement in ABPM (especially at night), vascular wall stiffness and CAP. It is also important that the appointment of sertraline was accompanied by a regression of anxiety-depressive symptoms, an improvement in CF.

Prevalence, Awareness, Treatment, and Poor Control of Hypertension Among Young American Adults: Race-Stratified Analysis of the National Health and Nutrition Examination Survey

ObjectiveTo evaluate the race-stratified trends for prevalence, awareness, treatment, and control of hypertension in young American adults aged 18 to 44 years. Patients and MethodsThe National Health and Nutrition Examination Survey data from 2005–2016 for adults aged 18 to 44 years was used to calculate age-adjusted (using 2005, 2010, and 2015 US Census population proportions) weighted trends in prevalence, awareness, treatment, and control of hypertension among non-Hispanic white, non-Hispanic black, and Mexican-American participants as per the 2017 American College of Cardiology/American Heart Association guidelines. Trends were estimated by logistic regression models including demographic, socioeconomic, health care access, and Bonferroni correction for multiple comparisons as covariates. ResultsAmong 15,171 young American adults, stable trends for the prevalence, awareness, treatment, and control of hypertension was seen in all racial groups (Plinear trend>.05 for all). The prevalence from 2013 to 2016 was highest in non-Hispanic blacks (30.7%; 95% CI, 27.3 to 34.0%), followed by non-Hispanic whites (21.9%; 95% CI, 19.6 to 24.1%), and Mexican Americans (21.9%; 95% CI, 18.6 to 25.1%). The awareness was stable at ∼43.2% in non-Hispanic blacks, ∼34.8% in non-Hispanic whites, and ∼28.4% in Mexican Americans from 2005 to 2008 through 2013 to 2016. The stable treatment rates at nearly 34.4%, 23.7%, and 20.6%, were seen in non-Hispanic black, non-Hispanic white, and Mexican-Americans, respectively. The optimal control of hypertension was seen in 14.5% (95% CI, 12.1 to 17.0%) non-Hispanic blacks, 12.2% (95% CI, 10.3 to 14.0%) non-Hispanic whites, and 10.3% (95% CI, 7.1 to 13.5%) Mexican Americans from 2013 to 2016. ConclusionNearly one in every three non-Hispanic young black and one in every five young Mexican American and non-Hispanic white adults have hypertension. Our race-stratified analyses highlight the categorical need to improve the abysmal control of hypertension which is approximately 1 in 10 young adults.

Cross-Sectional Study on the Management and Control of Hypertension Among Migrants in Primary Care: What Is the Impact of Segmented Health Insurance Schemes?

BackgroundInformation is scarce regarding the impact of fragmented health insurance schemes on the management and control of hypertension among migrants in primary care. This study aimed to investigate the relationship between insurance status and management and control of hypertension among migrants in primary care and to examine whether social capital could facilitate migrants’ participation in local health insurance schemes.Methods and ResultsA site‐based, cross‐sectional, face‐to‐face patient survey was administered in Shenzhen, China. Hypertensive primary care users who were migrants were selected using a systematic sampling design. The participants covered by local health insurance schemes were more likely than those without coverage to be managed by primary care facilities (82.6% versus 62.0%; odds ratio=2.63, 95% CI 1.41‐4.89) and to take antihypertensive medications (87.9% versus 76.4%; odds ratio=2.38, 95% CI 1.34‐4.24), and they had higher scores in first contact use (3.49 versus 3.23; β=0.17, 95% CI 0.05‐0.29) and continuity of care (3.17 versus 3.02; β=0.11, 95% CI 0.01‐0.21). The participants covered by local insurance schemes had higher scores in perceived generalized trust than their counterparts (4.23 versus 3.95; β=0.16, 95% CI 0.09‐0.40). The hypertension control rate was also higher among the participants with local health insurance coverage (48.8% versus 42.2%; odds ratio=1.38, 95% CI 1.02‐2.12).ConclusionsIn conclusion, local health insurance schemes are associated with optimal control of hypertension for migrants compared with social health insurance schemes. Our study implies that one form of social capital, namely perceived general trust, contributes to migrant hypertensive patients’ participation in local health insurance schemes.

Glycaemic, blood pressure and low-density lipoprotein-cholesterol control among patients with diabetes mellitus in a specialised clinic in Botswana: a cross-sectional study.

ObjectiveControl of glycaemic, hypertension and low-density lipoprotein-cholesterol (LDL-C) among patients with type 2 diabetes mellitus (T2DM) is vital for the prevention of cardiovascular diseases. The current study was an audit of glycaemic, hypertension and LDL-C control among ambulant patients with T2DM in Botswana. Also, the study aimed at assessing factors associated with attaining optimal glycaemic, hypertension and LDL-C therapeutic goals.DesignA cross-sectional study.SettingA specialised public diabetes clinic in Gaborone, Botswana.ParticipantsPatients with T2DM who had attended the clinic for ≥3 months between August 2017 and February 2018.Primary outcome measureThe proportion of patients with optimal glycaemic (HbA1c<7%), hypertension (blood pressure <140/90 mm Hg) and LDL-C (<1.8 mmol/L) control.ResultsThe proportions of patients meeting optimal targets were 32.3% for glycaemic, 54.2% for hypertension and 20.4% for LDL-C. Age≥ 50 years was positively associated with optimal glycaemic control (adjusted OR [AOR] 5.79; 95% CI 1.08 to 31.14). On the other hand, an increase in diabetes duration was inversely associated with optimal glycemic control (AOR 0.91; 95% CI 0.85 to 0.98). Being on an ACE inhibitor was inversely associated with optimal hypertension control (AOR 0.35; 95% CI 0.14 to 0.85). Being female was inversely associated with optimal LDL-C control (AOR 0.24; 95% CI (0.09 - 0.59).ConclusionPatients with T2DM in Gaborone, Botswana, presented with suboptimal control of recommended glycaemic, hypertension and LDL-C targets. These findings call for urgent individual and health systems interventions to address key determinants of the recommended therapeutic targets among patients with diabetes in this setting.

Gender differences in outcomes after aortic aneurysm surgery should foster further research to improve screening and prevention programmes.

Background Gender-related biases in outcomes after thoracic aortic surgery are an important factor to consider in the prevention of potential complications related to aortic diseases and in the analysis of surgical results. Methods The aim of this study is to provide an up-to-date review of gender-related differences in the epidemiology, specific risk factors, outcome, and screening and prevention programmes in aortic aneurysms. Results Female patients affected by aortic disease still have worse outcomes and higher early and late mortality than men. It is difficult to plan new specific strategies to improve outcomes in women undergoing major aortic surgery, given that the true explanations for their poorer outcomes are as yet not clearly identified. Some authors recommend further investigation of hormonal or molecular explanations for the sex differences in aortic disease. Others stress the need for quality improvement projects to quantify the preoperative risk in high-risk populations using non-invasive tests such as cardiopulmonary exercise testing. Conclusions The treatment of patients classified as high risk could thus be optimised before surgery becomes necessary by means of numerous strategies, such as the administration of high-dose statin therapy, antiplatelet treatment, optimal control of hypertension, lifestyle improvement with smoking cessation, weight loss and careful control of diabetes. Future efforts are needed to understand better the gender differences in the diagnosis, management and outcome of aortic aneurysm disease, and for appropriate and modern management of female patients.

Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study

IntroductionSub-Saharan Africa is particularly vulnerable to the growing global burden of hypertension, but epidemiological studies are limited and barriers to optimal management are poorly understood. Therefore, we undertook a community-based...

Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study

BackgroundNurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses’ knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH).MethodsA pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses’ satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management.ResultsA total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses’ knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention.ConclusionsFindings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana.Trial registrationTrial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.

Hypertension and Ischemic Heart Disease in Women.

Ischemic heart disease (IHD) is the most important cause of mortality worldwide. Although the awareness of cardiovascular risk factors and IHD in women has increased over the last decades, mortality rates are still higher in women than in men. Among traditional cardiovascular risk factors, hypertension is associated with a greater risk for IHD in women as compared to men. In this review, discuss gender differences in epidemiology and pathophysiology of hypertension and its impact on the incidence and outcomes of IHD in women. We also, discuss some "women conditions" such as hypertensive disorders in pregnancy (HDP) and polycystic ovarian syndrome (PCOS). Even though this is not a systematic review, English-language studies on MEDLINE and the Cochrane Database of Systematic reviews were searched for consultation and analysis. Hypertension display different epidemiological patterns in men and women. Studies have shown that hypertension has a different proatherogenic effects in men and women. Hypertension has a direct effect on microcirculation, but estrogens have a protective role in this regard in premenopausal women. However, after the decline in estrogen levels, women are exposed to the same cardiovascular risk as males. Postmenopausal women exhibit a greater burden of cardiovascular risk factors, which together with microvascular dysfunction and smaller and stiffer arteries conducts to the worse prognosis observed in women with IHD. "Women specific conditions" such as HDP and PCOS affects 10% of pregnant women and women in reproductive age, respectively. These conditions are associated with increased risk of hypertension and IHD later in life. Although women are more aware of their hypertension, cardiovascular mortality is higher in hypertensive women with comorbid IHD. Yet these gender disparities in outcomes seem to be attenuated with effective therapy. The pathophysiology of IHD is gender specific, women with ischemic symptoms presenting less often with coronary obstructive disease, and more frequently with dysfunction of the coronary microcirculation. Optimal control of hypertension could attenuate gender related differences in mortality in this population.

A Narrative Synthesis of the Health Systems Factors Influencing Optimal Hypertension Control in Sub-Saharan Africa.

IntroductionIn sub-Saharan Africa (SSA), an estimated 74.7 million individuals are hypertensive. Reducing the growing burden of hypertension in sub-Saharan Africa will require a variety of strategies one of which is identifying the extent to which actions originating at the health systems level improves optimal management and control.Methods and ResultsWe conducted a narrative synthesis of available papers examining health systems factors influencing optimal hypertension in SSA. Eligible studies included those that analyzed the impact of health systems on hypertension awareness, treatment, control and medication adherence. Twenty-five articles met the inclusion criteria and the narrative synthesis identified the following themes: 1) how physical resources influence mechanisms supportive of optimal hypertension control; 2) the role of human resources with enabling and/or inhibiting hypertension control goals; 3) the availability and/or use of intellectual resources; 4) how health systems financing facilitate and/or compromise access to products necessary for optimal hypertension control.ConclusionThe findings highlight the need for further research on the health systems factors that influence management and control of hypertension in the region.

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Objective: Hypertension is a major risk factor for the atherosclerosis. The main objectives of cardiovascular disease (CVD) prevention are to reduce morbidity and mortality, improve quality of life, and increase the chances of a longer life expectancy. Optimal hypertension control is very important in cardiovascular risk reduction in patients with diagnosed coronary artery disease, after PCI or CABG intervention. Objective: To analyze the level of theorethical knowledge of the aims of control of the CV risk factors in patients with established coronary artery disease (CAD) and to evaluate the accomplishment of the optimal arterial pressure control. Design and method: 116 consecutive patients with established CAD (acute myocardial infarction and ischaemia and patients following revascularisation by angioplasty or coronary artery surgery) were enrolled in the study. They were interviewed a year after diagnosis of the CAD about optimal blood pressure level. All of them had arterial blood pressure measurement during physical examination. Results: The mean age was 58+/-7 years. Mean arterial pressure was 134+/-86 mm Hg. Arterial tension higher than optimal (SBP < or equal 130 mmHg, DBP < or equal 80 mmHg) was registered in 68 patients (66.1%). Females had significantly better control of the arterial tension, p < 0.05. Mean body mass index was 24.7+/-5.3. Even 88.8 % (103 patients) claimed to know target values of the blood pressure. Among them just 41.7 % of them (43 patients) claimed correct values (SBP< 130 mmHg and DBP <80 mmHg), 36% of them (37 patients) claimed higher values and 23 patients (22.3%) of them claimed even lower values. 95.1 % of them (98 patients) knew that no cigarettes are allowed in their condition and 15 patients (14.9 %) stated that up to 5 cigarettes are allowed. Conclusions: Blood pressure control in patients with established CAD should be more effective. Theorethical knowledge about optimal blood pressure level in these patients should be improved.

Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa.

BackgroundIn West Africa, hypertension, once rare, has now emerged as a critical health concern and the trajectory is upward and factors are complex. The true magnitude of hypertension in some West African countries, including in-depth knowledge of underlying risk factors is not completely understood. There is also a paucity of research on adequate systems-level approaches designed to mitigate the growing burden of hypertension in the region.AimsIn this review, we thematically synthesize available literature pertaining to the prevalence of hypertension in West Africa and discuss factors that influence its diagnosis, treatment and control. We aimed to address the social and structural determinants influencing hypertension in the sub-region including the effects of urbanization, health infrastructure and healthcare workforce.FindingsThe prevalence of hypertension in West Africa has increased over the past decade and is rising rapidly with an urban-rural gradient that places higher hypertension prevalence on urban settings compared to rural settings. Overall levels of awareness of one’s hypertension status remain consistently low in West African. Structural and economic determinants related to conditions of poverty such as insufficient finances have a direct impact on adherence to prescribed antihypertensive medications. Urbanization contributes to the increasing incidence of hypertension in the sub-region and available evidence indicates that inadequate health infrastructure may act as a barrier to optimal hypertension control in West Africa.ConclusionGiven that optimal hypertension control in West Africa depends on multiple factors that go beyond simply modifying the behaviors of the individuals alone, we conclude by discussing the potential role systems-thinking approaches can play to achieve optimal control in the sub-region. In the context of recent advances in hypertension management including new therapeutic options and innovative solutions to expand health workforce so as to meet the high demand for healthcare, the success of these strategies will rely on a new understanding of the complexity of human behaviors and interactions most aptly framed from a systems-thinking perspective.

Prevalence of cardiovascular risk factors among rural population of elderly in Wardha district

BackgroundCardiovascular diseases (CVD) are a leading cause of mortality among adults in India, and their risk factors (tobacco, hypertension, diabetes, overweight, and obesity) are common. Most risk-factor surveys have focused on young and middle aged adults. We measured the prevalence of risk factors for CVD among elderly (age 60 years or more) in rural India. Methods and resultsIn a door-to-door cross-sectional survey we did a non-laboratory based assessment of risk factors (smoking or tobacco use in any form, diabetes mellitus, either known or newly detected hypertension, abnormal waist-hip-ratio, or a high body mass index) among elderly living in 23 villages in rural central India. Laboratory based assessment of risk factors was done in those who had two or more of the five measured conventional risk factors. We compared the distribution of risk factors between men and women. Among 2424 elderly included in the study (51% women, mean age 67), the prevalence of smokeless tobacco use was 50.8% (95% CI 48.1–52.8; smoking 10.5% (95% CI 9.3–11.8); and hypertension46.3% (95% CI 44.3–48.4). Only 10.2% participants were previously known to have had hypertension, and remaining 36.1% were detected to be hypertensive during the survey. A total of 8.2%(95% CI 7.0–9.5) participants were overweight and 4.1% (95% CI 3.3–4.9) had central obesity. The prevalence of dyslipidemia in those who underwent blood based tests was 40.6% (95% CI 36.5–44.9); and hyperglycemia 4.9% (95% CI 3.2–7.1). ConclusionsStrategies to reduce the risk of cardiovascular disorders among elderly should be focused on reducing tobacco use and early detection and optimal control of hypertension.

A Systematic Review of Recent Clinical Practice Guidelines on the Diagnosis, Assessment and Management of Hypertension

BackgroundDespite the availability of clinical practice guidelines (CPGs), optimal hypertension control is not achieved in many parts of the world; one of the challenges is the volume of guidelines on this topic and their variable quality. To systematically review the quality, methodology, and consistency of recommendations of recently-developed national CPGs on the diagnosis, assessment and the management of hypertension.Methodology/Principal FindingsMEDLINE, EMBASE, guidelines' websites and Google were searched for CPGs written in English on the general management of hypertension in any clinical setting published between January 2006 and September 2011. Four raters independently appraised each CPG using the AGREE-II instrument and 2 reviewers independently extracted the data. Conflicts were resolved by discussion or the involvement of an additional reviewer. Eleven CPGs were identified. The overall quality ranged from 2.5 to 6 out of 7 on the AGREE-II tool. The highest scores were for “clarity of presentation” (44.4% −88.9%) and the lowest were for “rigour of development” (8.3%–30% for 9 CGPs). None of them clearly reported being newly developed or adapted. Only one reported having a patient representative in its development team. Systematic reviews were not consistently used and only 2 up-to-date Cochrane reviews were cited. Two CPGs graded some recommendations and related that to levels (but not quality) of evidence. The CPGs' recommendations on assessment and non-pharmacological management were fairly consistent. Guidelines varied in the selection of first-line treatment, adjustment of therapy and drug combinations. Important specific aspects of care (e.g. resistant hypertension) were ignored by 6/11 CPGs. The CPGs varied in methodological quality, suggesting that their implementation might not result in less variation of care or in better health-related outcomes.Conclusions/SignificanceMore efforts are needed to promote the realistic approach of localization or local adaptation of existing high-quality CPGs to the national context.

Remission of proteinuria and preservation of renal function in patients with renal AA amyloidosis secondary to rheumatoid arthritis

Renal AA amyloidosis presents as a life-threatening disease in patients with rheumatoid arthritis (RA). Although several newly developed immunosuppressive drugs have been tried, patients often progress to end-stage renal failure with unsatisfactory survival rate. A total of nine consecutive cases of severe nephrotic renal AA amyloidosis presented to us. Complete remission of proteinuria was observed in four cases (responders), and the remaining five reached the end point of haemodialysis or death (non-responders); these groups were retrospectively compared. The patients were treated with immunosuppressants, biological drugs and anti-hypertensive drugs. Levels of serum creatinine (S-Cr), urinary protein-creatinine ratio (UP/UCr), blood pressure (BP) and C-reactive protein (CRP) were measured. Histological characteristics of renal amyloid deposition and extent of kidney injury were also scored. Prior to treatment, clinical data (S-Cr, UP/UCr, BP and CRP) and histological severity (glomerular sclerosis, tubulointerstitial injury and extent of amyloid deposition) observed in the renal biopsy specimen were not significantly different between the groups. Following therapeutic intervention, proteinuria disappeared (UP/UCr <0.3) in responders within 12 ± 5.4 months but persisted in non-responders. Consequently, renal function stabilized in responders, but it deteriorated in all non-responders. Strict inflammatory control along with optimal control of hypertension was achieved in responders during the treatment. Regardless of histological severity, intensive therapeutic intervention that includes strict inflammatory control and optimal control of hypertension may change the histology-predicted prognosis of RA-associated renal AA amyloidosis.