Use Of Antihypertensive Treatment Research Articles

Presence and development of diabetic retinopathy in 16 999 patients with type 1 diabetes in the Danish Registry of Diabetic Retinopathy.

To evaluate the five-year incidence of diabetic retinopathy (DR) and associated risk markers in patients with type 1 diabetes in the national Danish DR-screening programme. Based on national data, we included all 16 999 patients with type 1 diabetes in the Danish Registry of Diabetic Retinopathy, who attended the national screening programme in the period 2013-2018. According to the worse eye at first screening, DR was classified (levels 0-4) and linked with various national health registries to retrieve information on diabetes duration, systemic comorbidity, and medication. At first screening, median age and duration of diabetes were 45.0 and 16.7 years, and 57.5% were males. The prevalence and five-year incidences for DR and progression to proliferative DR (PDR) were 44.2%, 8.9% and 2.0%, respectively. In multivariable Cox models, the incidence endpoints were associated with duration of diabetes (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.63-1.89, and HR 2.04, 95% CI 1.73-2.40 per 10 years), moderately low Charlson Comorbidity Index score (HR 1.27, 95% CI 1.10-1.47, and HR 2.80, 95% CI 2.23-3.51), and use of blood pressure lowering medication (HR 1.20, 95% CI 1.05-1.36, and HR 1.98, 95% CI 1.53-2.57). In a study of all patients with type 1 diabetes from the Danish DR-screening programme, we identified duration of diabetes, systemic disease and use of anti-hypertensive treatment as consistent risk markers for incident and progressive DR.

Factors associated with progression of arterial stiffness in ischemic stroke survivors: the Norwegian Stroke in the Young Study

Background Progressive arterial stiffening may increase the risk of recurrent cardiovascular events in ischemic stroke survivors. Information about factors associated with progressive arterial stiffening during the follow-up of young patients with ischemic stroke is lacking. Methods Arterial stiffness by carotid-femoral pulse wave velocity (cf-PWV) and ambulatory 24-hour blood pressure (24hBP) were assessed in 81 women and 190 men ≤60 years of age included in the Norwegian Stroke in the Young (NOR-SYS) study 3 months and 5.5 years after the incident ischemic stroke, representing baseline and follow-up. Covariables of change in cf-PWV were identified using linear regression analysis. Results At baseline, women had less prevalent hypertension (53% vs. 69%, p < 0.05), and lower clinic and 24hBP than men, whereas age, obesity, and prevalence of smoking and antihypertensive drug treatment did not differ. During follow-up, systolic 24hBP remained unchanged, while diastolic 24hBP fell significantly (p < 0.01). Cf-PWV was lower in women both at baseline (7.3 m/s vs. 8.1 m/s) and at follow-up (7.3 m/s vs. 8.0 m/s, both p < 0.001), but the average change during follow-up did not differ between genders. In linear regression analysis, an increase in cf-PWV at the 5-year follow-up was associated with the presence of hypertension and lower cf-PWV at baseline, and higher systolic 24hBP and lack of use of antihypertensive treatment at follow-up (all p < 0.05). Conclusion In ischemic stroke survivors participating in the NOR-SYS study, the 5-year increase in cf-PWV did not differ between genders and was associated with higher systolic 24hBP and lack of antihypertensive treatment.

Association of low blood pressure and falls: An analysis of data from the Leiden 85-plus Study.

Falls and consequent injuries are prevalent in older adults. In this group, half of injury-related hospitalizations are associated with falls and the rate of falls increases with age. The evidence on the role of blood pressure and the use of antihypertensive treatment on the risk of falls remains unclear in oldest-old adults (≥85 years). To examine the association between systolic blood pressure (SBP) and incident falls with medical consequences in oldest-old adults and to analyse whether this association is modified by the use of antihypertensive treatments or the presence of cardiovascular disease. We analysed data from the Leiden 85-plus Study, a prospective, population-based cohort study with adults aged ≥85 years and a 5-year follow-up. Falls with medical consequences were reported by the treating physician of participants. We assessed the association between time-updated systolic blood pressure and the risk of falling over a follow-up period of five years using generalized linear mixed effects models with a binomial distribution and a logit link function. Subgroup analyses were performed to examine the role of antihypertensive treatment and the difference between participant with and without cardiovascular disease. We analysed data from 544 oldest-old adults, 242 (44.4%) of which used antihypertensives. In 81 individuals (15%) ≥1 fall(s) were reported during the follow-up period. The odds for a fall decreased by a factor of 0.86 (95% CI 0.80 to 0.93) for each increase in blood pressure by 10 mmHg. This effect was specific to blood pressure values above 130mmHg. We did not find any evidence that the effect would be modified by antihypertensive treatment, but that there was a tendency that it would be weaker in participants with cardiovascular disease (OR 0.81, 95% CI 0.72 to 0.90 per 10mmHg) compared to those without cardiovascular disease (OR 0.94, 95% CI 0.84 to 1.05 per 10mmHg). Our results point towards a possible benefit of higher blood pressure in the oldest-old with respect to falls independent of the use of antihypertensive treatments.

Ups and downs of conducting a national representative survey on hypertension during pandemic time: main results of SEPHAR IV.

This national representative survey sought to assess hypertension's prevalence, awareness, treatment and control in Romania. A representative sample (by age, sex and residence) of 1477 Romanian adults (51.19 ± 16.61 years, range 18-80 years, 59.9% women) was multimodally evaluated during two study visits. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg or previously diagnosed hypertension, regardless of BP. Awareness was defined by knowledge of previous hypertension diagnosis or of current use of antihypertensive treatment. Treatment was defined by antihypertensive medication taken at least 2 weeks prior to enrolment. Control was defined as SBP less than 140 mmHg and DBP less than 90 mmHg at both visits in treated hypertensive patients. Hypertension prevalence was 46% ( n = 680) consisting of 81.02% ( n = 551) known hypertensive patients and 18.98% ( n = 129) newly diagnosed hypertensive patients. Awareness, treatment and control of hypertension were: 81% ( n = 551), 83.8% ( n = 462) and 39.2% ( n = 181). Despite numerous pandemic-related obstacles in conducting a national survey, SEPHAR IV updates hypertension epidemiological data of a high-cardiovascular-risk Eastern-European population. This study confirms previous predictions of hypertension prevalence, treatment and control, which remain unfavourable because of unsatisfactory control of promoting factors.

Association of normal-weight central obesity with hypertension: a cross-sectional study from the China health and nutrition survey

BackgroundCentral obesity is associated with an increased risk of hypertension in the general population. However, little is known regarding the potential relationship between central obesity and the risk of hypertension among adults with a normal body mass index (BMI). Our aim was to assess the risk of hypertension among individuals with normal weight central obesity (NWCO) in a large Chinese population.MethodsWe identified 10 719 individuals aged 18 years or older from the China Health and Nutrition Survey 2015. Hypertension was defined by blood pressure measurements, physician diagnosis, or the use of antihypertensive treatment. Multivariable logistic regression was used to assess the association of obesity patterns, defined by BMI, waist circumference (WC) and waist hip ratio (WHR), with hypertension after adjusting for confounding factors.ResultsThe patients’ mean age was 53.6 ± 14.5 years, and 54.2% were women. Compared with individuals with a normal BMI but no central obesity, subjects with NWCO had a greater risk of hypertension (WC: OR, 1.49, 95% CI 1.14–1.95; WHR: OR, 1.33, 95% CI 1.08–1.65). Overweight-obese subjects with central obesity demonstrated the highest risk of hypertension after adjustment for potential confounders (WC: OR, 3.01, 95% CI 2.59–3.49; WHR: OR, 3.08, CI 2.6–3.65). Subgroup analyses showed that the combination of BMI with WC had similar findings to the overall population except for female and nonsmoking persons; when BMI was combined with WHR, a significant association of NWCO with hypertension was observed only in younger persons and nondrinkers.ConclusionsCentral obesity, as defined by WC or WHR, is associated with an increased risk of hypertension in Chinese adults with normal BMI, highlighting the need to combine measures in obesity-related risk assessment.

Dietary vitamin E intake and new-onset hypertension.

The association between dietary vitamin E intake and the risk of new-onset hypertension remains unknown. We aimed to evaluate the prospective relationship of dietary vitamin E intake with new-onset hypertension in the general Chinese population. A total of 12,177 adults without hypertension at baseline were enrolled from the China Health and Nutrition Survey. Dietary intake was measured by 3 consecutive 24 h dietary recalls at the individual level in combination with a weighing inventory taken over the same 3 days at the household level. The study outcome was new-onset hypertension, defined as a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, a diagnosis by a physician, or the use of antihypertensive treatment during follow-up. During a median follow-up duration of 6.1 years, 4269 participants developed new-onset hypertension. Overall, the association between dietary vitamin E intake and new-onset hypertension followed a reverse J-shaped curve (P for nonlinearity <0.001). Accordingly, when dietary vitamin E intake was assessed by quintiles, significantly higher risks of new-onset hypertension were found among participants in the first quintile (<18.75 mg/d: adjusted HR, 1.40; 95% CI, 1.29-1.52) and the fifth quintile (≥40.53 mg/d: adjusted HR, 1.18; 95% CI, 1.09-1.29) compared with those in the second-fourth quintiles (18.75 to <40.53 mg/d). Further adjustments for vitamin A, riboflavin, niacin, vitamin C, zinc, copper, and selenium intake or the intake of vegetables, fruits, legumes, grains, nuts, and vegetable oils did not substantially change the results. In conclusion, there was a reverse J-shaped association between dietary vitamin E intake and new-onset hypertension in general Chinese adults.

To help the family doctor: who and how to prescribe lercanidipine

Calcium channel blockers are widely used by doctors in everyday clinical practice. The article provides an overview of studies on the use of antihypertensive treatment and, based on their analysis, provides recommendations for the appointment of such therapy, with specific instructions on which drugs and in which pathology should be preferred. Special attention is paid to lercanidipine as a modern promising and affordable drug.

MO518: Chronic Kidney Disease in Primary Care and the Risk of Cardiovascular Comorbidity and Mortality

Abstract BACKGROUND AND AIMS The prevalence of chronic kidney disease (CKD) is increasing globally. Often, the condition develops silently over time, with no or only a few symptoms in earlier stages. Therefore, early recognition in primary care may have an important role in ensuring diagnosis and proper intervention. We aimed to determine the prevalence and outcome of CKD in a large primary care cohort in Denmark. METHOD We performed an observational cohort study using data from individuals above age 40 followed in primary care in the greater Copenhagen area between 2000 and 2015 and linked them to Danish health registries. A run-in period of 3 months was included to ensure stable conditions and rule out acute changes in eGFR at baseline. The date of the second measurement of eGFR during the study period was considered the subject's index date (baseline). Outcomes were relevant diagnoses such as stroke, myocardial infarction (MI), hospitalisations for heart failure (HHF) and peripheral artery disease (PAD) (last update 2018), all-cause mortality and cardiovascular mortality. Kidney function (eGFR) was estimated by the CKD-EPI formula based on serum creatinine and expressed in mL/min/1.73 m2. Conventional CKD groups are used with CKD 1 and 2 (normal—eGFR &amp;gt; 60 mL/min/1.73 m2) as reference groups for the hazard ratio estimates. Outcomes were presented as the number of events/100 person-years (PY). We conducted survival (all-cause mortality outcome) and competing risk (rest of the outcomes) analyses using the Cox proportional hazards model to calculate the (cause-specific) hazard ratios for the outcomes according to CKD group. We further explored the continuous associations between kidney function and the outcomes examined by using eGFR as a continuous variable with penalised splines. All models were adjusted for known risk factors (age, gender, diabetes, hypertension, existing CVD, heart failure, LDL cholesterol, use of antihypertensive treatment). RESULTS We included a population of 171 133 individuals. As expected, the majority (n = 157002) was in CKD 1 or 2 at the index date, and only a small proportion (0.05%) was in CKD stage 5. In general, event rates were low in CKD stages 1 and 2 and rose with higher stages of CKD. In the adjusted analyses, we observed a stepwise increase in hazard rates for every outcome with every increment in CKD stage (Fig. 1). This was confirmed by the continuous analysis. Compared with CKD stage 1 + 2, individuals in CKD stage 4 had approximately double the hazard rate of PAD, MI, cardiovascular and all-cause mortality. CONCLUSION Our data from a large primary care cohort demonstrate an early increase in risk for adverse outcomes already at CKD stage 3. This provides the basis and underlines the importance of studying early intervention in primary care.

Investigating the effects of antihypertensive medication use in AD patients using multi‐modal neuroimaging

AbstractBackgroundHypertension is a known risk factor for Alzheimer’s disease (AD). Both conditions cause significant irreversible damage to cerebral constituents that can result in a more severe AD phenotype. Although there are no effective treatments available for AD, hypertension is a modifiable risk factor and its detrimental effects can be alleviated with antihypertensive drug treatments and through primary prevention.MethodPatients with mild to moderate AD (N = 133) were divided into two groups to examine differences in cerebral constituents and cognitive function in patients who were medicated (n = 71) and unmedicated (n = 62) for hypertension. Within the medicated patient group, a post hoc analysis was conducted to examine differences in patients based on the class of antihypertensive treatment. We used multi‐modal neuroimaging to explore these differences in cerebral blood flow (CBF), white matter integrity, grey matter volume (GMV) and vascular burden.ResultNo differences were detected between the medicated and unmedicated AD patients in the multi‐modal comparisons, although the medicated group showed a slightly better cognitive profile than the unmedicated group, despite having a higher burden of cardiovascular comorbidities and similar blood pressure readings to the unmedicated group. In the post hoc analysis, AD patients who were on beta‐blockers only, presented with higher GMV, CBF and neuropsychological scores and also a lower vascular burden compared to AD patients on other classes of antihypertensive treatment or a combination of the two. In the post hoc analysis of the unmedicated AD patient subgroup, variability in pulse pressure (the difference between systolic and diastolic blood pressure) was linked with lower CBF in subcortical structures.ConclusionThe use of antihypertensive treatment in AD could mitigate progression of damage to cerebral constituents related to chronically elevated blood pressure. The class of antihypertensive treatment used has varied effects on cerebral constituents in AD patients, pointing towards the need for future longitudinal studies exploring these effects. Evidence from this study also suggests that implementation of antihypertensive treatment could be beneficial in AD patients with uncontrolled hypertension. Measures to promote early identification of comorbidities and targeted interventions could thus help reduce AD severity in patients.

Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study

ObjectiveIn Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe...

Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis in a large international audit

Abstract Background The cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is comparable to that of patients with diabetes mellitus (DM). Although several studies have indicated high prevalence's of DM in RA patients, little is known about how this affects their CVD risk. Objectives To examine indications for, and use of antihypertensive treatment (a-HT) and lipid-lowering therapy (LLT) in RA patients with DM (RA-DM) and RA patients without DM (RAwoDM). Further, to compare the prevalence of various types of CVD across RA-DM and RAwoDM. Methods The cohort was derived from the SUrvey of cardiovascular disease Risk Factor in patients with Rheumatoid Arthritis (SURF-RA), which was performed in 53 centres/17 countries in 5 world regions (West and East Europe; North and Latin America; and Asia) from 2014 - 2019. Indication for a-HT was defined as: 1) systolic/diastolic blood pressure (BP) ≥140/90 mm Hg, 2) self-reported hypertension, and/or 3) current use of a-HT. Indication for LLT was defined according to ESC guidelines. CVD risk estimates (by SCORE) were multiplied by 1.5 according to EULAR recommendations. Target treatment targets for BP and lipids were defined according to ESC guidelines applicable at the time data were recorded. Results Presence of comorbid DM was available in 10 602 (73.1%) of the 14 503 RA patients included in SURF-RA, of whom 75 and 1262 patients reported DM type 1 and type 2, respectively (total 1337 patients, 12.6%). Although less often current smokers, RA-DM patients were more often previous smokers, male sex and had higher body mass index compared to RAwoDM (p&amp;lt;0.0001 for all). a-HT (84.7% vs 62.3%) and LLT (100% vs 47.2%) were more frequently indicated in RA-DM than in RAwoDM patients (p&amp;lt;0.0001 for both). RA-DM were more likely than RAwoDM to receive a-HT on indication (60.4% vs 57.6%, p&amp;lt;0.0001), while the difference in LLT use on indication was not significantly different (45.7% vs 42.5%, p=0.06). Moreover, RA-DM compared to RAwoDM patients had more often reached treatment goals when on a-HT (60.7% vs 54.1%, p&amp;lt;0.0001) and LLT (62.8% vs 48.9%, p&amp;lt;0.0001). Finally, the risk of all recorded established CVD (coronary heart disease, stroke, peripheral artery disease and atrial fibrillation) was increased by a factor of 2 to 3 in RA-DM compared to RAwoDM (Figure). Conclusion The effect of RA and comorbid DM on CVD risk appears to be additive. While CVD preventive medications are more often indicated in RA-DM than in RAwoDM patients, they are also more likely to receive such therapy and to reach CVD preventive treatment goals. The latter finding may be due to more developed CVD preventive care in DM compared to RA patients. Improved CVD preventive systems for patients with RA are warranted. CVD in RA patients with and without DM Funding Acknowledgement Type of funding source: Other. Main funding source(s): Lilly

Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017

BackgroundTrend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003–2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17 years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators.MethodsWe used data from 2003, 2010, and 2017 Chilean national health surveys. Each year we assessed levels of (1) mean systolic (SBP) and diastolic (DBP) blood pressure, (2) hypertension prevalence (BP ≥ 140/90 mmHg or use of antihypertensive treatment), and (3) awareness, treatment, and control. Logistic regression on pooled data was used to assess trends in binary outcomes; linear regression was used to assess trends in continuous SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain antihypertensive treatment (self-reported versus medicine inventory). The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to re-define hypertension using lower thresholds (BP ≥ 130/80 mmHg).ResultsHypertension prevalence was 34.0, 32.0 and 30.8% in 2003, 2010 and 2017, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% versus 41% for treatment, P < 0.001; 34% versus 14% for control, P < 0.001), while levels of awareness were stable (66% versus 59%, P = 0.130). Awareness, treatment, and control levels were higher among females in 2003, 2010, and 2017 (P < 0.001). Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17 and 55% in absolute and relative terms, respectively.ConclusionsChile has experienced a positive population-wide lowering in blood pressure distribution which may be explained partly by a significant rise in levels of treated- and controlled-hypertension since 2003. Lowering the thresholds used to define elevated BP would substantially increase the financial public health challenge of further improving attainment levels at each step of the care cascade. Innovative and collaborative strategies are needed to improve hypertension management, especially among males.

Prevalence and predictors of post-stroke epilepsy among Ghanaian stroke survivors

BackgroundPost-stroke epilepsy (PSE) is associated with poorer quality of life, higher mortality, and greater health expenditures. We are unaware of any published reports on the frequency of and factors associated with PSE in Africa. PurposeTo assess the frequency and factors associated with PSE among Ghanaian stroke survivors. MethodsWe conducted a cross-sectional study of consecutive stroke survivors seen at an out-patient Neurology clinic enrolled into a stroke registry at a tertiary medical center in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details including diagnosis of post-stroke epilepsy, anti-epileptic medications, presence, treatment and control of vascular risk factors. Multivariate logistic regression models were constructed to identify factors associated with PSE. ResultsOf 1101 stroke patients encountered, 126 had PSE (frequency of 11.4%; 95% CI of 9.6–13.5%). Mean (± SD) age among PSE vs. non-PSE patients was 57.7 (± 15.2) vs. 58.7 (± 13.9) years. Factors independently associated with PSE were being male (aOR 1.94; 95% CI: 1.32–2.86), cortical ischemic strokes (1.79; 1.12–2.87), blood pressure > 130/80 mmHg (OR 2.26; 1.06–4.79), use of antihypertensive treatment (OR 0.43; 0.23–0.79). There was an inverted J-shaped curve association between number of classes of antihypertensive drugs prescribed and occurrence of PSE, with the lowest inflection point at 3 classes (OR 0.34; 0.17–0.68). ConclusionIn this convenience sample of ambulatory Ghanaian stroke survivors, one in ten had PSE. Further investigations to confirm and clarify the associations between the identified demographic and clinical characteristics are warranted.

Concomitant hypertension is associated with abnormal left ventricular geometry and lower systolic myocardial function in overweight participants: the FAT associated CardiOvasculaR dysfunction study.

We studied the impact of concomitant hypertension on left ventricular (LV) systolic myocardial function and geometry in apparently healthy women and men with increased BMI. We performed a cross-sectional analysis of 535 participants (59% women) with BMI greater than 27 kg/m without known cardiovascular disease enrolled in the FAT associated CardiOvasculaR dysfunction (FATCOR) study. Hypertension was defined as use of antihypertensive treatment or elevated 24-h ambulatory blood pressure. Abnormal LV geometry was identified as increased relative wall thickness and/or LV mass index. Systolic myocardial function was assessed by midwall shortening (MWS) and speckle tracking peak global longitudinal strain (GLS). Hypertensive participants were older (49 vs. 46 years), had higher BMI and waist circumference, higher prevalences of diabetes and abnormal LV geometry (29 vs. 16%), and lower GLS (-19 vs. -20%) and MWS (16.3 vs. 17.1%) compared with normotensive participants (all P < 0.01). In multivariable linear regression analyses, hypertension was associated with lower GLS (β=0.11, P = 0.035) and lower MWS (β=0.09, P = 0.029) independent of sex, diabetes, LV hypertrophy, ejection fraction, and waist circumference. Hypertension was also associated with presence of abnormal LV geometry [odds ratio 1.74 (95% confidence interval 1.04-2.89), P = 0.035) independent of the same confounders. When replacing waist circumference with BMI in the models, hypertension retained its association with lower myocardial function, whereas the association with abnormal LV geometry was attenuated. In participants with increased BMI without known clinical cardiovascular disease, concomitant hypertension was associated with lower systolic myocardial function and more abnormal LV geometry. URL: http://www.clinicaltrials.gov NCT02805478.

Nutraceuticals and blood pressure control: a European Society of Hypertension position document.

: High-normal blood pressure (BP) is associated with an increased risk of cardiovascular disease, however the cost-benefit ratio of the use of antihypertensive treatment in these patients is not yet clear. Some dietary components and natural products seems to be able to significantly lower BP without significant side effects. The aim of this position document is to highlight which of these products have the most clinically significant antihypertensive action and wheter they could be suggested to patients with high-normal BP. Among foods, beetroot juice has the most covincing evidence of antihypertensive effect. Antioxidant-rich beverages (teas, coffee) could be considered. Among nutrients, magnesium, potassium and vitamin C supplements could improve BP. Among nonnutrient-nutraceuticals, soy isoflavones could be suggested in perimenopausal women, resveratrol in insulin-resistant patients, melatonin in study participants with night hypertension. In any case, the nutracutical approach has never to substitute the drug treatment, when needed.

Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden

IntroductionCompression neuropathies (CN) in the upper extremity, the most common being carpal tunnel syndrome (CTS) and ulnar nerve entrapment (UNE), are frequent among patients with diabetes mellitus (DM). Earlier studies...

A Comparison of Four Cardiovascular Risk Assessment Instruments in Saudi Patients.

IntroductionSeveral cardiovascular risk calculators are available online to measure the probability of developing cardiovascular disease (CVD) without defining the appropriate population. In the current study, four risk assessment instruments were investigated with Saudi Arabian patients with CVD to identify the instrument with the best predictability. The chosen instruments were the Framingham Risk Score (FRS), Systematic Coronary Risk Evaluation (SCORE), American College of Cardiology/American Heart Association (ACC/AHA) Atherosclerotic Cardiovascular Disease Risk Estimator, and the United Kingdom score which is called QRISK®.MethodsSaudi patients, 40 years and older, with acute coronary syndrome, were recruited. Data related to age, gender, ethnicity, height, weight, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL), smoking status, diabetes mellitus, rheumatoid arthritis, chronic kidney disease, atrial fibrillation, heart attack in a first-degree relative, and use of antihypertensive treatment were recorded.ResultsOut of 129 patients, the ACC/AHA had higher predictability with low risk (26.3%) and high risk (66.7%) groups. The QRISK® was highly applicable (95.3%); however, the SCORE was not considered applicable (22.5%).ConclusionThe QRISK® is easy to implement and applicable in a population-based study, but the ACC/AHA is superior in predicting individuals with a high risk of CVD.

Prevalence, determinants and association of unawareness of diabetes, hypertension and hypercholesterolemia with poor disease control in a multi-ethnic Asian population without cardiovascular disease

BackgroundTo explore the prevalence and determinants of unawareness of diabetes, hypertension and hypercholesterolemia and its association with poor disease control in a multi-ethnic Asian population without cardiovascular disease (CVD).MethodsWe included 6904 Chinese, Malay and Indian individuals (mean age [SD] 58.2 [10.2] years; 52.6% female) with diabetes, hypertension and/or hypercholesterolemia from the cross-sectional population-based Singapore Epidemiology of Eye Diseases study (2004–2011). Diabetes was defined as random blood glucose ≥ 11.1 mmol/L or HbA1c > 6.5% or self-reported use of diabetes medication; hypertension as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or self-reported use of anti-hypertensive treatment; and hypercholesterolemia as total cholesterol ≥ 6.2 mmol/L or self-reported use of lipid-lowering medications. Unawareness was based on participants’ answers to the questions: “Did your medical practitioner ever tell you that you have diabetes/hypertension/high cholesterol?” The determinants of unawareness, and its association with poor disease control, were assessed using multivariable binary logistic regression models adjusted for known potential confounders.ResultsOf the 2380 (34.5%), 5386 (78.0%) and 3607 (52.2%) with diabetes, hypertension and hypercholesterolemia, respectively, unawareness rates were 30.7%, 43.1% and 40.9%, respectively. Having a higher BMI, particularly if obese, and Malay ethnicity were associated with greater unawareness of diabetes; Malay and Indian ethnicities and current smoking with greater unawareness of hypertension; and education ≤6 years, current smoking, and blue collar jobs or unemployment with greater unawareness of hypercholesterolemia (all P < 0.05). Lack of awareness of each condition was independently associated with poorer disease control in the case of hypertension and hypercholesterolemia, while the converse was true for diabetes (all P < 0.05).ConclusionsUnawareness of diabetes, hypertension, or hypercholesterolemia is high in Singapore, with risk factors varying across all three diseases, although Malay ethnicity is a consistent one. Unawareness was also associated with poor management for hypertension and hypercholesterolemia. Public health education and screening programs should target at-risk individuals, especially Malays, to reduce the likelihood of incident CVD.

Hypertension in aortic stenosis: relationship with revealed symptoms and functional measures on treadmill exercise.

The impact of hypertension on symptoms and functional capacity during exercise treadmill test (ETT) in apparently asymptomatic patients with aortic stenosis is poorly understood. A total of 314 patients (age 65 ± 12 years, 68% men) with moderate or severe asymptomatic aortic stenosis underwent baseline echocardiography and ETT. Hypertension was defined as a history of elevated blood pressure (BP), past or current treatment with antihypertensive agents or a BP at the baseline clinic visit more than 140/90 mmHg. There were 229 (73%) patients with hypertension who were older, more likely to have diabetes, hypercholesterolemia and coronary artery disease, larger left atrial diameters, higher left ventricular (LV) mass and a higher proportion of LV hypertrophy than normotensive patients. In a univariate logistic regression analysis hypertension and clinic SBP were not associated with revealed symptoms. In a multivariate logistic regression analysis, lower peak SBP [odds ratio (OR) 1.02;95% confidence interval (CI) 1.00-1.04, P = 0.017] and rapid early rise in heart rate (OR 15.03; 95% CI 6.23-36.24, P < 0.001) were associated with a higher risk of revealed symptoms while the use of antihypertensive treatment was associated with a lower risk of revealed symptoms (OR 0.40; 95% CI 0.18-0.89, P = 0.025), independent of age, obesity, LV ejection fraction and aortic valve area. In a linear regression analysis, after adjustment for age, sex and BMI, hypertension did not retain an association with lower metabolic equivalents (β = -0.06, P = 0.311). Hypertension in aortic stenosis patients was associated with a high cardiovascular disease burden, but did not interact with symptoms or functional capacity during ETT. Hypertension does not interfere with the clinical interpretation of exercise testing.

HYPERTENSION IS ASSOCIATED WITH MORE ABNORMAL LEFT VENTRICULAR GEOMETRY AND SYSTOLIC MYOCARDIAL DYSFUNCTION IN OVERWEIGHT AND OBESITY

Objective: To study the impact of hypertension on left ventricular (LV) geometry and systolic myocardial function in women and men with increased body mass index (BMI), but without known cardiovascular disease.Design and method: We performed a cross-sectional analysis of 535 participants (59% women) in the the FAT associated CardiOvasculaR dysfunction (FATCOR) study. Hypertension was defined as use of antihypertensive treatment or elevated 24-hour blood pressure. Abnormal LV geometry was identified as increased relative wall thickness or LV mass index by echocardiography. Systolic myocardial function was assessed by speckle tracking global longitudinal strain (GLS) and stress-corrected midwall shortening (scMWS). Obesity was defined as a BMI 30.0 kg/m2 or larger. Results: Hypertension was associated with older age, higher GLS, lower scMWS and higher prevalences of obesity and abnormal LV geometry (all p < 0.01) (Table). In multivariable regression analyses, hypertension was associated with higher (less negative) GLS (β=-0.16, p = 0.001), lower scMWS (β=-0.12, p = 0.009) and prevalent abnormal LV geometry (odds ratio 1.60 {95% confidence interval 1.01–2.53}, p = 0.047) independent of presence of obesity and older age. Conclusions: In women and men with increased BMI without known cardiovascular disease, hypertension was associated with more abnormal LV geometry and impaired systolic myocardial function.