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Elendu C, Amaechi DC, Elendu TC, Amaechi EC, Elendu ID. Dependable approaches to hypertension management: A review. Medicine (Baltimore) 2024; 103:e38560. [PMID: 38875433 PMCID: PMC11175961 DOI: 10.1097/md.0000000000038560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
Hypertension, a prevalent chronic condition characterized by elevated blood pressure, is a significant global health burden, contributing to approximately 7.5 million premature deaths annually. While existing literature predominantly focuses on conventional treatment modalities, this paper offers unique insights into dependable approaches to hypertension management. Drawing upon epidemiological data, it highlights the increasing prevalence of hypertension across diverse populations, emphasizing demographic disparities and regional variations. This article underscores the need for tailored interventions considering individual risk profiles and socioeconomic determinants. Beyond conventional lifestyle modifications and pharmacological therapies, it explores emerging trends such as mindfulness-based interventions and integrative medicine in hypertension management. Additionally, it discusses the role of digital health technologies and telemedicine in enhancing patient engagement and remote monitoring, optimizing treatment outcomes. Furthermore, the paper addresses the evolving landscape of personalized medicine and genomic advancements in predicting individual responses to antihypertensive therapies, advocating for precision medicine approaches. This paper advocates for a holistic and patient-centered approach to hypertension management by offering a comprehensive overview of established and emerging strategies. It underscores the importance of interdisciplinary collaboration, continuous education, and innovative research endeavors to address the multifaceted challenges posed by hypertension and improve global cardiovascular health outcomes.
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Campbell NRC, McKay DW, Petrella R, Kaczorowski J. The Urgent Need to Re-establish a Health Coalition Focused on Hypertension Prevention and Control in Canada. Can J Cardiol 2024; 40:610-612. [PMID: 38416078 DOI: 10.1016/j.cjca.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 02/29/2024] Open
Affiliation(s)
- Norm R C Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Donald W McKay
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Robert Petrella
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia. Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montréal, Montréal, Québec, Canada
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Ordunez P, Campbell NRC, DiPette DJ, Jaffe MG, Rosende A, Martinez R, Gamarra A, Lombardi C, Parra N, Rodriguez L, Rodriguez Y, Brettler J. HEARTS in the Americas: Targeting Health System Change to Improve Population Hypertension Control. Curr Hypertens Rep 2024; 26:141-156. [PMID: 38041725 PMCID: PMC10904446 DOI: 10.1007/s11906-023-01286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. RECENT FINDINGS Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.
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Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA.
| | - Norm R C Campbell
- Department of Medicine, Libin Cardiovascular Institute, The University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Donald J DiPette
- University of South Carolina and University of South Carolina School of Medicine, Columbia, SC, USA
| | - Marc G Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, CA, USA
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Natalia Parra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Libardo Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Yenny Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Jeffrey Brettler
- Southern California Permanente Medical Group, Department of Health Systems Science, Regional Hypertension Program, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA
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Ordunez P, Campbell NRC, DiPette DJ, Jaffe MG, Rosende A, Martínez R, Gamarra A, Lombardi C, Parra N, Rodríguez L, Rodríguez Y, Brettler J. [HEARTS in the Americas: targeting health system change to improve population hypertension controlHEARTS nas Américas: impulsionar mudanças no sistema de saúde para melhorar o controle da hipertensão arterial na população]. Rev Panam Salud Publica 2024; 48:e17. [PMID: 38464870 PMCID: PMC10924616 DOI: 10.26633/rpsp.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 03/12/2024] Open
Abstract
Purpose of review HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. Recent findings Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Summary Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.
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Affiliation(s)
- Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Norm R. C. Campbell
- Departamento de MedicinaInstituto Cardiovascular LibinUniversidad de CalgaryCalgaryAB T2N 1N4CanadáDepartamento de Medicina, Instituto Cardiovascular Libin, Universidad de Calgary, Calgary, AB T2N 1N4, Canadá.
| | - Donald J. DiPette
- Universidad de Carolina del SurFacultad de Medicina de la Universidad de Carolina del SurColumbiaEstados Unidos de AméricaUniversidad de Carolina del Sur y Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América.
| | - Marc G. Jaffe
- Departamento de EndocrinologíaThe Permanente Medical GroupCentro Médico de San Francisco de Kaiser PermanenteSan FranciscoEstados Unidos de AméricaDepartamento de Endocrinología, The Permanente Medical Group, Centro Médico de San Francisco de Kaiser Permanente, San Francisco, Estados Unidos de América.
| | - Andrés Rosende
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Ramón Martínez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Angelo Gamarra
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Cintia Lombardi
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Natalia Parra
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Libardo Rodríguez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Yenny Rodríguez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Jeffrey Brettler
- Southern California Permanent Medical GroupDepartamento de Ciencias de Sistemas de SaludPrograma Regional de Hipertensión, Facultad de Medicina Bernard J. Tyson de Kaiser PermanentePasadenaEstados Unidos de AméricaSouthern California Permanent Medical Group, Departamento de Ciencias de Sistemas de Salud, Programa Regional de Hipertensión, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América.
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Charchar FJ, Prestes PR, Mills C, Ching SM, Neupane D, Marques FZ, Sharman JE, Vogt L, Burrell LM, Korostovtseva L, Zec M, Patil M, Schultz MG, Wallen MP, Renna NF, Islam SMS, Hiremath S, Gyeltshen T, Chia YC, Gupta A, Schutte AE, Klein B, Borghi C, Browning CJ, Czesnikiewicz-Guzik M, Lee HY, Itoh H, Miura K, Brunström M, Campbell NR, Akinnibossun OA, Veerabhadrappa P, Wainford RD, Kruger R, Thomas SA, Komori T, Ralapanawa U, Cornelissen VA, Kapil V, Li Y, Zhang Y, Jafar TH, Khan N, Williams B, Stergiou G, Tomaszewski M. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens 2024; 42:23-49. [PMID: 37712135 PMCID: PMC10713007 DOI: 10.1097/hjh.0000000000003563] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.
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Affiliation(s)
- Fadi J. Charchar
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
- Department of Physiology, University of Melbourne, Melbourne, Australia
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Priscilla R. Prestes
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Charlotte Mills
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang
- Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Francine Z. Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Liffert Vogt
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Louise M. Burrell
- Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia
| | - Lyudmila Korostovtseva
- Department of Hypertension, Almazov National Medical Research Centre, St Petersburg, Russia
| | - Manja Zec
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA
- Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad
- Hypertension and Nutrition, Core Group of IAPEN India, India
| | - Martin G. Schultz
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | | | - Nicolás F. Renna
- Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza, Argentina
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Canada
| | - Tshewang Gyeltshen
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abhinav Gupta
- Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, India
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, New South Wales, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Britt Klein
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy
| | - Colette J. Browning
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Marta Czesnikiewicz-Guzik
- School of Medicine, Dentistry and Nursing-Dental School, University of Glasgow, UK
- Department of Periodontology, Prophylaxis and Oral Medicine; Jagiellonian University, Krakow, Poland
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hiroshi Itoh
- Department of Internal Medicine (Nephrology, Endocrinology and Metabolism), Keio University, Tokyo
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Norm R.C. Campbell
- Libin Cardiovascular Institute, Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Praveen Veerabhadrappa
- Kinesiology, Division of Science, The Pennsylvania State University, Reading, Pennsylvania
| | - Richard D. Wainford
- Department of Pharmacology and Experimental Therapeutics, The Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston
- Division of Cardiology, Emory University, Atlanta, USA
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Shane A. Thomas
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Takahiro Komori
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Vikas Kapil
- William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, BRC, Faculty of Medicine and Dentistry, Queen Mary University London
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Chinese Hypertension League, Beijing, China
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nadia Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Bryan Williams
- University College London (UCL), Institute of Cardiovascular Science, National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester
- Manchester Academic Health Science Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
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Sivanantham P, S. MK, Essakky S, Singh M, Ghosh S, Mehndiratta A, Kar SS. Cost-effectiveness of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India. PLoS One 2023; 18:e0285542. [PMID: 37624838 PMCID: PMC10456130 DOI: 10.1371/journal.pone.0285542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/25/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs. OBJECTIVE To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India. METHODS We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with ≥10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged ≥40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses. RESULTS The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; ₹ 8,656) and single-stage (US$ 1073; ₹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario. CONCLUSION In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels.
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Affiliation(s)
- Parthibane Sivanantham
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Mathan Kumar S.
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Saravanan Essakky
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | | | | | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Watanabe J, Kotani K, Iwazu Y, Gugliucci A. Paraoxonase 1 Activity and Renal Replacement Therapy for Chronic Renal Failure: A Meta-Analysis. J Clin Med 2023; 12:5123. [PMID: 37568524 PMCID: PMC10419928 DOI: 10.3390/jcm12155123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Chronic renal failure (CRF) is associated with the development of cardiovascular disease (CVD). Paraoxonase 1 (PON1), an antioxidant enzyme, shows cardioprotective properties and has been proposed as a therapeutic marker for CRF. A systematic analysis of the literature assessing the association between PON1 activity and renal replacement therapy (RRT) of CRF is currently lacking. Therefore, we set out to perform a meta-analysis of the available data on PON1 in RRT of CRF. We searched three electronic databases for studies on PON1 activity in CRF patients with RRT such as hemodialysis (HD), peritoneal dialysis (PD), or renal transplantation (RTx), published before June 2023. A random-effects and network meta-analysis were performed. A total of 53 studies were eligibly identified. Compared to CRF patients without RRT, RTx patients had higher paraoxonase activity (standard mean difference (SMD), 1.76, 95% confidence interval (CI), 0.76-2.75), followed by HD (SMD, 0.73; 95% CI, 0.02-1.45) and PD patients. Likewise, RTx patients had higher arylesterase activity (SMD, 1.84, 95% CI, 0.18-3.50), followed by HD and PD patients. Also, paraoxonase activity was increased after HD (SMD, 0.59, 95% CI, 0.16-1.03). In conclusion, the overall data demonstrated that PON1 activity is higher in CRF patients with RRT, particularly RTx, followed by that of HD and PD. Measuring PON1 activity can also be included to the paraclinical toolbox for the management of RRT, in addition to the understanding of CRF-related pathophysiology. Regarding the selection of RRT types and their potential to prevent CVD, more research is required.
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Affiliation(s)
- Jun Watanabe
- Division of Community and Family Medicine, Jichi Medical University, Tochigi 329-0498, Japan;
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Tochigi 329-0498, Japan;
| | - Yoshitaka Iwazu
- Division of Anti-Aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi 329-0498, Japan;
| | - Alejandro Gugliucci
- Glycation, Oxidation and Disease Laboratory, Touro University California, Vallejo, CA 94592, USA
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Gabulova R, Marzà-Florensa A, Rahimov U, Isayeva M, Alasgarli S, Musayeva A, Gahramanova S, Ibrahimov F, Aliyev F, Imanov G, Rasulova R, Vaartjes I, Klipstein-Grobusch K, Graham I, Grobbee DE. Risk factors in cardiovascular patients: Challenges and opportunities to improve secondary prevention. World J Cardiol 2023; 15:342-353. [PMID: 37576543 PMCID: PMC10415862 DOI: 10.4330/wjc.v15.i7.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease (CVD). The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II study is a clinical audit of the recording and management of CHD risk factors. It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology (ESC). Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate. Azerbaijan is a country in the South Caucasus, a region at a very high risk for CVD. AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku (Azerbaijan). METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021. Information on demographics, risk factors, physical and laboratory data, and medications was collected using a standard questionnaire in consecutive patients aged ≥ 18 years with established CHD during outpatient visits. Data from 687 patients (mean age 59.6 ± 9.58 years; 24.9% female) were included in the study. RESULTS Only 15.1% of participants were involved in cardiac rehabilitation programs. The rate of uncontrolled risk factors was high: Systolic blood pressure (BP) (SBP) (54.6%), low-density lipoprotein cholesterol (LDL-C) (86.8%), diabetes mellitus (DM) (60.6%), as well as overweight (66.6%) and obesity (25%). In addition, significant differences in the prevalence and control of some risk factors [smoking, body mass index (BMI), waist circumference, blood glucose (BG), and SBP] between female and male participants were found. The cardiovascular health index score (CHIS) was calculated from the six risk factors: Non- or ex-smoker, BMI < 25 kg/m2, moderate/vigorous physical activity, controlled BP (< 140/90 mmHg; 140/80 mmHg for patients with DM), controlled LDL-C (< 70 mg/dL), and controlled BG (glycohemoglobin < 7% or BG < 126 mg/dL). Good, intermediate, and poor categories of CHIS were identified in 6%, 58.3%, and 35.7% of patients, respectively (without statistical differences between female and male patients). CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and, in particular, the control rate of BP, are insufficient. Given the fact that patients with different comorbid pathologies are at a very high risk, this is of great importance in the management of such patients. This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures, especially in the regions at a high risk for CVD. A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.
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Affiliation(s)
- Rahima Gabulova
- Teaching-Therapeutical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan.
| | - Anna Marzà-Florensa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Uzeyir Rahimov
- Department of Cardiology, Baku Medical Plaza, Baku AZ1014, Azerbaijan
| | - Mahluga Isayeva
- Department of CHD and Arrhythmias, Scientific-Research Institute of Cardiology, Baku AZ1072, Azerbaijan
| | - Shahana Alasgarli
- Department of Cardiology, Central Clinic Hospital, Baku AZ1006, Azerbaijan
| | - Afag Musayeva
- Heart Center, Baku Health Center, Baku AZ1072, Azerbaijan
| | - Sona Gahramanova
- Teaching-Therapeutical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
| | - Firdovsi Ibrahimov
- Department of Cardiology, Central Clinic Hospital, Baku AZ1006, Azerbaijan
| | - Farid Aliyev
- Heart Center, Baku Health Center, Baku AZ1072, Azerbaijan
| | - Galib Imanov
- Teaching-Surgical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
| | - Rahmana Rasulova
- Department of Public Health, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Ian Graham
- Department of Cardiology, Trinity College Dublin, Dublin Dublin-2, Ireland
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
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9
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Khan T, Moran AE, Perel P, Whelton PK, Brainin M, Feigin V, Kostova D, Richter P, Ordunez P, Hennis A, Lackland DT, Slama S, Pineiro D, Martins S, Williams B, Hofstra L, Garg R, Mikkelsen B. The HEARTS partner forum-supporting implementation of HEARTS to treat and control hypertension. Front Public Health 2023; 11:1146441. [PMID: 37554732 PMCID: PMC10405076 DOI: 10.3389/fpubh.2023.1146441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths annually). In 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in their quest to prevent and control CVD. HEARTS is the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum, led by WHO, brings together the following 11 partner organizations: American Heart Association (AHA), Center for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO). The partners support countries in their implementation of the HEARTS technical package in various ways, including providing technical expertise, catalytic funding, capacity building and evidence generation and dissemination. HEARTS has demonstrated the feasibility and acceptability of a public health approach, with more than seven million people already on treatment for hypertension using a simple, algorithmic HEARTS approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD. Proposed future HEARTS Partner Forum activities are related to more concrete information sharing between partners and among countries, expanded areas of partner synergy, support for implementation, capacity building, and advocacy with country ministries of health, professional societies, academy and civil societies organizations. Advancing toward the shared goals of the HEARTS partners will require a more formal, structured approach to the forum and include goals, targets and published reports. In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD mortality and achieving global sustainable development goals (SDGs).
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Affiliation(s)
- Taskeen Khan
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Andrew E. Moran
- Resolve to Save Lives, New York, NY, United States
- Department of Medicine, Columbia University, New York, NY, United States
| | - Pablo Perel
- Centre for Global Chronic Conditions, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- World Heart Federation, Geneva, Switzerland
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
- World Hypertension League, New Orleans, LA, United States
| | - Michael Brainin
- Department of Clinical Neurology, Danube University, Krems, Austria
- World Stroke Organization, Geneva, Switzerland
| | - Valery Feigin
- World Stroke Organization, Geneva, Switzerland
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deliana Kostova
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Non-communicable Diseases and Mental Health, Atlanta, GA, United States
| | - Patricia Richter
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Non-communicable Diseases and Mental Health, Atlanta, GA, United States
| | - Pedro Ordunez
- Pan American Health Organization/World Health Organization, Washington, DC, United States
| | - Anselm Hennis
- Pan American Health Organization/World Health Organization, Washington, DC, United States
| | - Daniel T. Lackland
- World Hypertension League, New Orleans, LA, United States
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Slim Slama
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Daniel Pineiro
- World Heart Federation, Geneva, Switzerland
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sheila Martins
- World Stroke Organization, Geneva, Switzerland
- Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bryan Williams
- International Society of Hypertension, Essex, United Kingdom
| | - Leonard Hofstra
- Amsterdam UMC—Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Renu Garg
- Resolve to Save Lives, New York, NY, United States
| | - Bente Mikkelsen
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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10
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Campbell NRC, Martinez R, Ordunez P. The Estimated Impact of Changes in Population Hypertension Control on Cardiovascular Disease in Canada From 2000 to 2017. Can J Cardiol 2023; 39:886-888. [PMID: 36931621 DOI: 10.1016/j.cjca.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Affiliation(s)
- Norm R C Campbell
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
| | - Ramon Martinez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Pedro Ordunez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
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11
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Prado P, Gamarra Á, Rodríguez L, Brettler J, Farrell M, Girola ME, Malcolm T, Martínez R, Molina V, Moran AE, Neupane D, Rosende A, Valdés González Y, Mukhtar Q, Ordunez P. [Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health carePlataforma de monitoramento e avaliação do programa HEARTS nas Américas: melhoria dos programas de controle da hipertensão de base populacional na atenção primária à saúde]. Rev Panam Salud Publica 2023; 47:e90. [PMID: 37223327 PMCID: PMC10202337 DOI: 10.26633/rpsp.2023.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 05/25/2023] Open
Abstract
HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.
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Affiliation(s)
- Patric Prado
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Ángelo Gamarra
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Libardo Rodríguez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Jeffrey Brettler
- Departamento de Ciencias de Sistemas de SaludFacultad de Medicina Bernard J. Tyson de Kaiser PermanentePasadenaEstados Unidos de AméricaDepartamento de Ciencias de Sistemas de Salud, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América.
| | - Margaret Farrell
- Resolve to Save LivesNueva YorkEstados Unidos de AméricaResolve to Save Lives, Nueva York, Estados Unidos de América.
| | - María E. Girola
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Taraleen Malcolm
- Organización Panamericana de la SaludPuerto EspañaTrinidad y TobagoOrganización Panamericana de la Salud, Puerto España, Trinidad y Tobago.
| | - Ramón Martínez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Virginia Molina
- Organización Panamericana de la SaludCiudad de MéxicoMéxicoOrganización Panamericana de la Salud, Ciudad de México, México.
| | - Andrew E. Moran
- Resolve to Save LivesNueva YorkEstados Unidos de AméricaResolve to Save Lives, Nueva York, Estados Unidos de América.
| | - Dinesh Neupane
- Departamento de EpidemiologíaEscuela de Salud Pública Bloomberg de la Universidad Johns HopkinsBaltimoreEstados Unidos de AméricaDepartamento de Epidemiología, Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins, Baltimore, Estados Unidos de América.
| | - Andrés Rosende
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Yamilé Valdés González
- Hospital Universitario General Calixto GarcíaComisión Nacional Técnica Asesora del Programa de Hipertensión ArterialLa HabanaCubaHospital Universitario General Calixto García, Comisión Nacional Técnica Asesora del Programa de Hipertensión Arterial, La Habana, Cuba.
| | - Qaiser Mukhtar
- División de Protección de la Salud MundialCentros para el Control y la Prevención de EnfermedadesAtlantaEstados Unidos de AméricaDivisión de Protección de la Salud Mundial, Centros para el Control y la Prevención de Enfermedades, Atlanta, Estados Unidos de América.
| | - Pedro Ordunez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
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12
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Damigou E, Kouvari M, Chrysohoou C, Barkas F, Kravvariti E, Pitsavos C, Skoumas J, Michelis E, Liberopoulos E, Tsioufis C, Sfikakis PP, Panagiotakos DB. Lifestyle Trajectories Are Associated with Incidence of Cardiovascular Disease: Highlights from the ATTICA Epidemiological Cohort Study (2002-2022). Life (Basel) 2023; 13:life13051142. [PMID: 37240787 DOI: 10.3390/life13051142] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
The study aimed to assess the trajectories of lifestyle characteristics and their association with 20-year cardiovascular disease (CVD) incidence. In 2002, 3042 Greek adults (aged: 45 (12) years) free of CVD were enrolled. In 2022, the 20-year follow-up was performed on 2169 participants; of those, 1988 had complete data for CVD. The 20-year CVD incidence was 3600 cases/10,000 individuals; the man-to-woman ratio was 1.25, with the peak difference in the 35-45 age group (i.e., 2.1); however, a reversal of the trend was observed in the age-groups 55-65 and 65-75, with a resumption of an almost equal incidence in those >75 years. In multi-adjusted analysis, age, sex, abnormal waist circumference, hypercholesterolemia, hypertension, and diabetes were positively associated with 20-year CVD risk, explaining 56% of the excess CVD risk, whereas an additional 30% was attributed to lifestyle trajectories; being physically active throughout life-course and being close to the Mediterranean diet were protective, while continuous smoking was detrimental against CVD risk. Mediterranean diet adherence protected against CVD development even if not sustained, while quitting smoking or engaging in physical activities during the 20-year observation did not offer any significant protection. A life-course personalized approach that is cost-effective and long-term sustained is needed to prevent CVD burden.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Fotios Barkas
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - John Skoumas
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelinos Michelis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
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13
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Rosende A, DiPette DJ, Martinez R, Brettler JW, Rodriguez G, Zuniga E, Ordunez P. HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings. Front Cardiovasc Med 2023; 10:1102482. [PMID: 37180772 PMCID: PMC10169833 DOI: 10.3389/fcvm.2023.1102482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Background HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. It is implemented in 24 countries and over 2,000 primary healthcare facilities. This paper describes the results of a multicomponent, stepwise, quality improvement intervention designed by the HEARTS in the Americas to support advances in hypertension treatment protocols and evolution towards the Clinical Pathway. Methods The quality improvement intervention comprised: 1) the use of the appraisal checklist to evaluate the current hypertension treatment protocols, 2) a peer-to-peer review and consensus process to resolve discrepancies, 3) a proposal of a clinical pathway to be considered by the countries, and 4) a process of review, adopt/adapt, consensus and approval of the clinical pathway by the national HEARTS protocol committee. A year later, 16 participants countries (10 and 6 from each cohort, respectively) were included in a second evaluation using the HEARTS appraisal checklist. We used the median and interquartile scores range and the percentages of the maximum possible total score for each domain as a performance measure to compare the results pre and post-intervention. Results Among the eleven protocols from the ten countries in the first cohort, the baseline assessment achieved a median overall score of 22 points (ICR 18 -23.5; 65% yield). After the intervention, the overall score reached a median of 31.5 (ICR 28.5 -31.5; 93% yield). The second cohort of countries developed seven new clinical pathways with a median score of 31.5 (ICR 31.5 -32.5; 93% yield). The intervention was effective in three domains: 1. implementation (clinical follow-up intervals, frequency of drug refills, routine repeat blood pressure measurement when the first reading is off-target, and a straightforward course of action). 2. treatment (grouping all medications in a single daily intake and using a combination of two antihypertensive medications for all patients in the first treatment step upon the initial diagnosis of hypertension) and 3. management of cardiovascular risk (lower BP thresholds and targets based on CVD risk level, and the use of aspirin and statins in high-risk patients). Conclusion This study confirms that this intervention was feasible, acceptable, and instrumental in achieving progress in all countries and all three domains of improvement: implementation, blood pressure treatment, and cardiovascular risk management. It also highlights the challenges that prevent a more rapid expansion of HEARTS in the Americas and confirms that the main barriers are in the organization of health services: drug titration by non-physician health workers, the lack of long-acting antihypertensive medications, lack of availability of fixed-doses combination in a single pill and cannot use high-intensity statins in patients with established cardiovascular diseases. Adopting and implementing the HEARTS Clinical Pathway can improve the efficiency and effectiveness of hypertension and cardiovascular disease risk management programs.
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Affiliation(s)
- Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Donald J. DiPette
- School of Medicine Columbia, University of South Carolina, Columbia, SC, United States
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Jeffrey W. Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
- Southern California Permanente Medical Group, Los Angeles, CA, United States
| | - Gonzalo Rodriguez
- Consultant for HEARTS in the Americas, PAHO/WHO Office in Argentina, Buenos Aires, Argentina
| | - Eric Zuniga
- Antofagasta Health Service, University of Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
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14
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Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, Alsaid J, Neupane D, Kario K, Beheiry H, Brouwers S, Burger D, Charchar FJ, Cho MC, Guzik TJ, Haji Al-Saedi GF, Ishaq M, Itoh H, Jones ESW, Khan T, Kokubo Y, Kotruchin P, Muxfeldt E, Odili A, Patil M, Ralapanawa U, Romero CA, Schlaich MP, Shehab A, Mooi CS, Steckelings UM, Stergiou G, Touyz RM, Unger T, Wainford RD, Wang JG, Williams B, Wynne BM, Tomaszewski M. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res 2023; 119:381-409. [PMID: 36219457 PMCID: PMC9619669 DOI: 10.1093/cvr/cvac130] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
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Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease; North-West University, Hoffman Street, Potchefstroom 2520, South Africa
- SAMRC Development Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Jafar Alsaid
- Ochsner Health System, New Orleans, Louisiana, USA
- Queensland University, Brisbane, Queensland, Australia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hind Beheiry
- International University of Africa, Khartoum, Sudan
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
- Department of Physiology and Anatomy, University of Melbourne, Melbourne, Victoria, Australia
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth Muxfeldt
- University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
| | - Augustine Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - Cesar A Romero
- Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Perth, Western Australia, Australia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ching Siew Mooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - U Muscha Steckelings
- Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Thomas Unger
- CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - Brandi M Wynne
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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15
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Reiss AB, Ahmed S, Johnson M, Saeedullah U, De Leon J. Exosomes in Cardiovascular Disease: From Mechanism to Therapeutic Target. Metabolites 2023; 13:479. [PMID: 37110138 PMCID: PMC10142472 DOI: 10.3390/metabo13040479] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. In recent decades, clinical research has made significant advances, resulting in improved survival and recovery rates for patients with CVD. Despite this progress, there is substantial residual CVD risk and an unmet need for better treatment. The complex and multifaceted pathophysiological mechanisms underlying the development of CVD pose a challenge for researchers seeking effective therapeutic interventions. Consequently, exosomes have emerged as a new focus for CVD research because their role as intercellular communicators gives them the potential to act as noninvasive diagnostic biomarkers and therapeutic nanocarriers. In the heart and vasculature, cell types such as cardiomyocytes, endothelial cells, vascular smooth muscle, cardiac fibroblasts, inflammatory cells, and resident stem cells are involved in cardiac homeostasis via the release of exosomes. Exosomes encapsulate cell-type specific miRNAs, and this miRNA content fluctuates in response to the pathophysiological setting of the heart, indicating that the pathways affected by these differentially expressed miRNAs may be targets for new treatments. This review discusses a number of miRNAs and the evidence that supports their clinical relevance in CVD. The latest technologies in applying exosomal vesicles as cargo delivery vehicles for gene therapy, tissue regeneration, and cell repair are described.
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Affiliation(s)
- Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA
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16
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Picone DS, Peterson GM, Jackson SL, Campbell NRC, Delles C, Olsen MH, Padwal R, Schutte AE, Sharman JE. Perceptions of pharmacists on the quality of automated blood pressure devices: a national survey. J Hum Hypertens 2023; 37:235-240. [PMID: 35314763 PMCID: PMC9995266 DOI: 10.1038/s41371-022-00670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 11/09/2022]
Abstract
A recent study found that only 23.8% of blood pressure (BP) devices available for purchase from Australian pharmacies were validated for accuracy. The extent to which pharmacists are aware of this, and other issues related to the accuracy of BP devices, is not known and gathering this information was the aim of this study. An online survey of Australian pharmacists was distributed via the Pharmaceutical Society of Australia between 1 October and 25 November 2020. Questions were focused on the views of pharmacists related to the accuracy of BP devices. Two hundred and ten pharmacists completed the survey. The accuracy of BP devices sold by pharmacists was considered 'quite' or 'extremely important' to most respondents (94%). However, most respondents (90%) were unaware that less than one-quarter of BP devices sold by Australian pharmacies were validated, and this was 'quite' or 'extremely surprising' to many (69%). Many respondents (64%) associated a particular brand of BP device with greater accuracy. There was low awareness on proper ways to identify accurate BP devices, such as checking reputable online databases (43%). BP devices were stocked in respondents' pharmacies based on perceived quality (50%), accuracy (40%), or as determined by the pharmacy chain (36%). In conclusion, providing accurate BP devices to consumers is important to pharmacists, but they were generally unaware that most devices available from pharmacies were not validated for accuracy. Pharmacist education, alongside advocacy for policies including regulations and strategic action, is required to ensure only validated BP devices are sold in Australia.
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Affiliation(s)
- Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Shane L Jackson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark.,Centre for Individualized Medicine in Arterial Diseases, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia.,Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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17
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Country experiences on the path to exclusive use of validated automated blood pressure measuring devices within the HEARTS in the Americas Initiative. J Hum Hypertens 2023; 37:120-125. [PMID: 35817799 PMCID: PMC9957722 DOI: 10.1038/s41371-022-00706-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 11/09/2022]
Abstract
The aim of the HEARTS in the Americas initiative is to promote the adoption of global best practices in the prevention and control of cardiovascular diseases, and improve the control of hypertension. HEARTS is being implemented in 21 countries and a diverse set of actions and measures are in progress to improve exclusive access in primary health care facilities to automated blood pressure measuring devices that have been validated for accuracy. The purpose of this manuscript is to illustrate these efforts, mainly in the regulatory and public procurement arena, and to present information on common challenges and solutions identified. Examples from six countries confirm the need for not only a robust regulatory framework to increase availability of validated automated blood pressure measuring devices but also a comprehensive strategic approach that involves relevant stakeholders, includes a multi-pronged approach and is associated with a national program to prevent and control non communicable diseases.
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18
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Ordunez P, Lombardi C, Picone DS, Brady TM, Campbell NRC, Moran AE, Padwal R, Rosende A, Whelton PK, Sharman JE. HEARTS in the Americas: a global example of using clinically validated automated blood pressure devices in cardiovascular disease prevention and management in primary health care settings. J Hum Hypertens 2023; 37:126-129. [PMID: 35273326 PMCID: PMC9957723 DOI: 10.1038/s41371-022-00659-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA.
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Tammy M Brady
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Norm R C Campbell
- Departments of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | | | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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19
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Jiapaer Z, Li C, Yang X, Sun L, Chatterjee E, Zhang L, Lei J, Li G. Extracellular Non-Coding RNAs in Cardiovascular Diseases. Pharmaceutics 2023; 15:pharmaceutics15010155. [PMID: 36678784 PMCID: PMC9865796 DOI: 10.3390/pharmaceutics15010155] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Cardiovascular diseases (CVDs) remain the world's leading cause of death despite the best available healthcare and therapy. Emerging as a key mediator of intercellular and inter-organ communication in CVD pathogenesis, extracellular vesicles (EVs) are a heterogeneous group of membrane-enclosed nano-sized vesicles released by virtually all cells, of which their RNA cargo, especially non-coding RNAs (ncRNA), has been increasingly recognized as a promising diagnostic and therapeutic target. Recent evidence shows that ncRNAs, such as small ncRNAs, circular RNAs, and long ncRNAs, can be selectively sorted into EVs or other non-vesicular carriers and modulate various biological processes in recipient cells. In this review, we summarize recent advances in the literature regarding the origin, extracellular carrier, and functional mechanisms of extracellular ncRNAs with a focus on small ncRNAs, circular RNAs, and long ncRNAs. The pathophysiological roles of extracellular ncRNAs in various CVDs, including atherosclerosis, ischemic heart diseases, hypertension, cardiac hypertrophy, and heart failure, are extensively discussed. We also provide an update on recent developments and challenges in using extracellular ncRNAs as biomarkers or therapeutical targets in these CVDs.
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Affiliation(s)
- Zeyidan Jiapaer
- College of Life Science & Technology, Xinjiang University, Urumqi 830046, China
- Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, Urumqi 830046, China
| | - Chengyu Li
- College of Life Science & Technology, Xinjiang University, Urumqi 830046, China
- Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, Urumqi 830046, China
| | - Xinyu Yang
- Fangshan Hospital Beijing University of Chinese Medicine, Beijing 102400, China
| | - Lingfei Sun
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Emeli Chatterjee
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Lingying Zhang
- College of Life Science & Technology, Xinjiang University, Urumqi 830046, China
- Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, Urumqi 830046, China
| | - Ji Lei
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: (J.L.); (G.L.)
| | - Guoping Li
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: (J.L.); (G.L.)
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20
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Ordunez P, Campbell NR, Giraldo Arcila GP, Angell SY, Lombardi C, Brettler JW, Rodríguez Morales YA, Connell KL, Gamarra A, DiPette DJ, Rosende A, Jaffe MG, Rodríguez L, Piñeiro DJ, Martínez R, Sharman JE. HEARTS en las Américas: innovaciones para mejorar el manejo de la hipertensión y del riesgo cardiovascular en la atención primaria. Rev Panam Salud Publica 2022; 46:e197. [PMID: 36284552 PMCID: PMC9578652 DOI: 10.26633/rpsp.2022.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/15/2022] [Indexed: 11/24/2022] Open
Abstract
La Iniciativa Mundial HEARTS. es la iniciativa emblemática de la Organización Mundial de la Salud para reducir la carga de las enfermedades cardiovasculares, la principal causa de muerte y discapacidad en todo el mundo. La Iniciativa HEARTS en las Américas es la adaptación regional que propone usar HEARTS como modelo para el manejo del riesgo de enfermedades cardiovasculares, incluida la hipertensión, y la diabetes en la atención primaria de salud en la Región de las Américas para el año 2025. Esta iniciativa está iniciando su sexto año de aplicación y ya incluye a 22 países y 1 380 centros de atención primaria de salud. Este informe tiene tres objetivos. En primer lugar, describir cómo surgió la Iniciativa HEARTS en las Américas y cuáles son sus principales elementos. En segundo lugar, resumir las principales innovaciones logradas para catalizar la iniciativa y mantener su aplicación. Entre estas innovaciones se encuentran: a) la introducción de factores impulsores del control de la hipertensión; b) el desarrollo de una vía clínica integral y práctica; c) la elaboración de una estrategia para mejorar la precisión de la medición de la presión arterial; d) la creación de un marco de seguimiento y evaluación; y e) la elaboración de un conjunto estandarizado de recursos de capacitación y formación. En tercer lugar, en este informe se examinan las futuras prioridades de la iniciativa. El objetivo de poner en marcha estas soluciones innovadoras y pragmáticas es crear un sistema de salud más efectivo y trasladar el enfoque de los programas cardiovasculares y de hipertensión del nivel de atención altamente especializada a la atención primaria de salud. Además, HEARTS en las Américas puede servir como modelo para unas prácticas más integrales, efectivas y sostenibles en la prevención y el tratamiento de las enfermedades no transmisibles.
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Affiliation(s)
- Pedro Ordunez
- Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América
| | - Norm R.C. Campbell
- Departamento de Medicina, Fisiología y Farmacología y Ciencias de Salud de la Comunidad, Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Canadá
| | - Gloria P. Giraldo Arcila
- Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América
| | - Sonia Y. Angell
- Departamento de Epidemiología, Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins, Baltimore, Estados Unidos de América
| | - Cintia Lombardi
- Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América
| | - Jeffrey W. Brettler
- Departamento de Ciencias de Sistemas de Salud, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América
| | - Yenny A. Rodríguez Morales
- Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América
| | - Kenneth L. Connell
- Facultad de Ciencias Médicas, Campus de Cave Hill, Universidad de las Indias Occidentales, St Michael, Barbados
| | - Angelo Gamarra
- Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América
| | - Donald J. DiPette
- Departamento de Medicina, Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América
| | - Andres Rosende
- Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América
| | - Marc G. Jaffe
- Departamento de Endocrinología, Centro Médico Kaiser Permanente de San Francisco, San Francisco, Estados Unidos de América
| | - Libardo Rodríguez
- Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América
| | - Daniel J. Piñeiro
- Departamento de Medicina Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ramón Martínez
- Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América
| | - James E. Sharman
- Instituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Australia
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21
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[Synthesis of evidence and recommendations: guidelines for the pharmacological treatment of arterial hypertension in adultsSíntese de evidências e recomendações: diretrizes para o tratamento farmacológico da hipertensão arterial em adultos]. Rev Panam Salud Publica 2022; 46:e172. [PMID: 36177299 PMCID: PMC9512685 DOI: 10.26633/rpsp.2022.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Arterial hypertension (high blood pressure) is one of the most prevalent chronic noncommunicable diseases. It is a cause of cardiovascular disease and is the leading attributable cause of death in the Region of the Americas. Objectives Synthesize the recommendations developed by the World Health Organization (WHO) to improve the quality of care and health outcomes of adults with high blood pressure, and address aspects of implementing these recommendations. Methods A synthesis was conducted of the recommendations contained in the WHO Guideline for the pharmacological treatment of hypertension in adults. In addition, a systematic search for studies carried out in the Region of the Americas was conducted in PubMed, Lilacs, Health Systems Evidence, Epistemonikos, and gray literature in order to identify barriers, facilitators, and implementation strategies. Results Ten recommendations were made for adults with high blood pressure. Implementation barriers, facilitators, and strategies were identified, and indicators were created for assessing treatment adherence and outcomes. Conclusions The formulated recommendations aim to provide guidance on how to approach the pharmacological treatment of hypertension in adults, except pregnant women, as well as considerations for implementation of the recommendations in Latin America and the Caribbean.
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22
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Champagne BM, Antonio Ochoa E, Khanchandani HS, Schoj V. Civil society’s role in improving hypertension control in Latin America. Rev Panam Salud Publica 2022; 46:e165. [PMID: 36128471 PMCID: PMC9482131 DOI: 10.26633/rpsp.2022.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
Despite effort in Latin America to implement the HEARTS initiative, hypertension control is still inadequate. There are many advances in the medical and technical arena, but little to promote political and systemic change. The vibrant civil society that has advanced policy change in tobacco control, food policy, and other public health initiatives can make a crucial contribution to prioritize hypertension control in the political agenda, ensure sustainable funding, promote the procurement of affordable and effective medications, and expand community demand for action. The recommended first step for civil society’s involvement is to analyze the political landscape to design an advocacy plan. The political landscape includes a legal analysis, policy mapping, stakeholders mapping, identifying obstacles, mapping community strategies, and risk assessment. The second step is to define policy goals and an advocacy strategy. Based on experience, there would be two main policy goals: to increase political will to make hypertension a top priority, securing necessary resources; and strengthen community awareness and social demand for action. The third step is to develop and implement the advocacy plan with the tools familiar to civil society, including building a case for support, advocacy towards decision makers, media advocacy, coalition building, countering the opposition, and civil society monitoring and accountability. To jumpstart this approach, there should be incentives for civil society and a transition for transferring competencies to a new arena. The results would be more sustainable and scalable hypertension control, better health outcomes, and advances toward the 2030 Sustainable Development Goals and universal health coverage.
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Affiliation(s)
| | | | | | - Verónica Schoj
- Global Health Advocacy Incubator, Washington DC, United States of America
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23
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Prado P, Gamarra A, Rodriguez L, Brettler J, Farrell M, Girola ME, Malcolm T, Martinez R, Molina V, Moran AE, Neupane D, Rosende A, González YV, Mukhtar Q, Ordunez P. Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health care. Rev Panam Salud Publica 2022; 46:e161. [PMID: 36133432 PMCID: PMC9484330 DOI: 10.26633/rpsp.2022.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT
HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.
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Affiliation(s)
- Patric Prado
- Pan American Health Organization. Washington, DC, USA
| | | | | | - Jeffrey Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, United States of America
| | | | | | - Taraleen Malcolm
- Pan American Health Organization, Port of Spain, Trinidad and Tobago
| | | | | | | | - Dinesh Neupane
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | | | - Yamilé Valdés González
- University Hospital General Calixto García, National Technical Advisory Committee on Hypertension, Havana, Cuba
| | - Qaiser Mukhtar
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Pedro Ordunez
- Pan American Health Organization. Washington, DC, USA
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24
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Jaffe MG, DiPette DJ, Campbell NR, Angell SY, Ordunez P. Developing population-based hypertension control programs. Rev Panam Salud Publica 2022; 46:e153. [PMID: 36128474 PMCID: PMC9473451 DOI: 10.26633/rpsp.2022.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
Hypertension remains the leading cause of cardiovascular disease globally despite the availability of safe and effective treatments. Unfortunately, many barriers exist to controlling hypertension, including a lack of effective screening and awareness, an inability to access treatment and challenges with its management when it is treated. Addressing these barriers is complex and requires engaging in a systematic and sustained approach across communities over time. This analysis aims to describe the key elements needed to create an effective delivery system for hypertension control. A successful system requires political will and supportive leadership at all levels of an organization, including at the point of care delivery (office or clinic), in the health care system, and at regional, state and national levels. Effective screening and outreach systems are necessary to identify individuals not previously diagnosed with hypertension, and a system for follow up and tracking is needed after people are diagnosed. Implementing simple protocols for treating hypertension can reduce confusion among providers and increase treatment efficiency. Ensuring easy access to safe, effective and affordable medications can increase blood pressure control and potentially decrease health care system costs. Task-sharing among members of the health care team can expand the services that are delivered. Finally, monitoring of and reporting on the performance of the health care team are needed to learn from those who are doing well, disseminate ideas to those in need of improvement and identify individual patients who need outreach or additional care. Successful large-scale hypertension programs in different settings share many of these key elements and serve as examples to improve systems of hypertension care delivery throughout the world.
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Affiliation(s)
- Marc G. Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, California, USA
| | - Donald J. DiPette
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Norman R.C. Campbell
- Department of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Y. Angell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pedro Ordunez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, D.C., USA
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Campbell NRC, Padwal R, Tsuyuki RT, Leung AA, Bell A, Kaczorowski J, Tobe SW. Ups and downs of hypertension control in Canada: critical factors and lessons learned. Rev Panam Salud Publica 2022; 46:e141. [PMID: 36071924 PMCID: PMC9440728 DOI: 10.26633/rpsp.2022.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
As the leading risk for death, population control of increased blood pressure represents a major challenge for all countries of the Americas. In the early 1990’s, Canada had a hypertension control rate of 13%. The control rate increased to 68% in 2010, accompanied by a sharp decline in cardiovascular disease. The unprecedented improvement in hypertension control started around the year 2000 when a comprehensive program to implement annually updated hypertension treatment recommendations started. The program included a comprehensive monitoring system for hypertension control. After 2011, there was a marked decrease in emphasis on implementation and evaluation and the hypertension control rate declined, driven by a reduction in control in women from 69% to 49%. A coalition of health and scientific organizations formed in 2011 with a priority to develop advocacy positions for dietary policies to prevent and control hypertension. By 2015, the positions were adopted by most federal political parties, but implementation has been slow. This manuscript reviews key success factors and learnings. Some key success factors included having broad representation on the program steering committee, multidisciplinary engagement with substantive primary care involvement, unbiased up to date credible recommendations, development and active adaptation of education resources based on field experience, extensive implementation of primary care resources, annual review of the program and hypertension indicators and developing and emphasizing the few interventions important for hypertension control. Learnings included the need for having strong national and provincial government engagement and support, and retaining primary care organizations and clinicians in the implementation and evaluation.
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Affiliation(s)
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ross T. Tsuyuki
- Faculty of Pharmacology, University of Alberta, Edmonton, Canada
| | | | - Alan Bell
- Department of Family Medicine, University of Toronto, Toronto, Canada
| | - Janusz Kaczorowski
- Department of Family Medicine, University of Montreal and CRCHUM, Montreal, Canada
| | - Sheldon W Tobe
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Rosende A, DiPette D, Brettler J, Rodríguez G, Zuniga E, Connell K, Ordunez P. HEARTS in the Americas appraisal checklist and clinical pathway for comprehensive hypertension management in primary care. Rev Panam Salud Publica 2022; 46:e125. [PMID: 36071921 PMCID: PMC9440731 DOI: 10.26633/rpsp.2022.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/16/2022] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT
Cardiovascular diseases are the leading cause of mortality and morbidity in the Region of the Americas, and hypertension represents its main risk factor. However, population hypertension control rates in the Region are poor. Global Hearts is the World Health Organization's flagship initiative to reduce the burden of cardiovascular diseases. HEARTS in the Americas Initiative is its regional adaptation that seeks to be the cardiovascular disease risk management model, including hypertension and diabetes, in primary health care throughout the Americas by 2025.
HEARTS in the Americas is being implemented in 22 countries and over 2 095 primary care centers. All implementing countries have defined their treatment protocols, and HEARTS in the Americas has supported continuous improvement. Because WHO recently released the 2021 Guideline for the Pharmacological Treatment of Hypertension in Adults and HEARTS in the Americas introduced the key drivers for hypertension control, the initiative generated a methodology to help countries update and strengthen their treatment protocols.
This article describes the process of developing the treatment protocol appraisal checklist and defines the resulting clinical pathway. This tool can help countries and primary care centers to improve their protocols by identifying the improvement points and upgrading clinical pathways.
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Affiliation(s)
- Andres Rosende
- Pan American Health Organization, Washington, D.C., United States of America
| | - Donald DiPette
- University of South Carolina, Columbia, United States of America
| | - Jeffrey Brettler
- Southern California Permanente Medical Group, Los Angeles, United States of America
| | | | - Eric Zuniga
- University of Antofagasta, Antofagasta, Chile
| | | | - Pedro Ordunez
- Pan American Health Organization, Washington, D.C., United States of America
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Parati G, Lackland DT, Campbell NRC, Ojo Owolabi M, Bavuma C, Mamoun Beheiry H, Dzudie A, Ibrahim MM, El Aroussy W, Singh S, Varghese CV, Whelton PK, Zhang XH. How to Improve Awareness, Treatment, and Control of Hypertension in Africa, and How to Reduce Its Consequences: A Call to Action From the World Hypertension League. Hypertension 2022; 79:1949-1961. [PMID: 35638381 DOI: 10.1161/hypertensionaha.121.18884] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertension is the leading preventable risk factor for cardiovascular diseases and disability globally. In low- and middle-income countries hypertension has a major social impact, increasing the disease burden and costs for national health systems. The present call to action aims to stimulate all African countries to adopt several solutions to achieve better hypertension management. The following 3 goals should be achieved in Africa by 2030: (1) 80% of adults with high blood pressure in Africa are diagnosed; (2) 80% of diagnosed hypertensives, that is, 64% of all hypertensives, are treated; and (3) 80% of treated hypertensive patients are controlled. To achieve these aims, we call on individuals and organizations from government, private sector, health care, and civil society in Africa and indeed on all Africans to undertake a few specific high priority actions. The aim is to improve the detection, diagnosis, management, and control of hypertension, now considered to be the leading preventable killer in Africa.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences; and Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.)
| | - Daniel T Lackland
- Division of Translational Neurosciences and Population Studies, Medical University of South Carolina, Charleston (D.T.L.)
| | - Norman R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (N.R.C.C.)
| | - Mayowa Ojo Owolabi
- Faculty of Clinical Sciences; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria (M.O.O.)
| | - Charlotte Bavuma
- Kigali University Teaching Hospital, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda (C.B.)
| | - Hind Mamoun Beheiry
- Faculty of Nursing Sciences; Physiology Department, Faculty of Medicine; International University of Africa (IUA), Sudan (H.M.B.)
| | - Anastase Dzudie
- Faculty of Medicine and biomedical sciences, University of Yaounde 1, Cameroon (A.D.)
| | | | | | - Sandhya Singh
- Director; Cluster: Non-Communicable Diseases, National Department of Health, South Africa (S.S.)
| | - Cherian V Varghese
- Department of Noncommunicable Disease, World Health Organization, Geneva, Switzerland (C.V.V.)
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana (P.K.W.)
| | - Xin-Hua Zhang
- Beijing Hypertension League Institute, China (X.-H.Z.)
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Ordunez P, Campbell NR, Giraldo Arcila GP, Angell SY, Lombardi C, Brettler JW, Rodriguez Morales YA, Connell KL, Gamarra A, DiPette DJ, Rosende A, Jaffe MG, Rodriguez L, Piñeiro DJ, Martinez R, Sharman JE. HEARTS in the Americas: innovations for improving hypertension and cardiovascular disease risk management in primary care. Rev Panam Salud Publica 2022; 46:e96. [PMID: 35855441 PMCID: PMC9288223 DOI: 10.26633/rpsp.2022.96] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/15/2022] [Indexed: 12/11/2022] Open
Abstract
Global Hearts is the flagship initiative of the World Health Organization to reduce the burden of cardiovascular diseases, the leading cause of death and disability worldwide. HEARTS in the Americas Initiative is the regional adaptation that envisions HEARTS as the model for cardiovascular disease risk management, including hypertension and diabetes, in primary health care in the Americas by 2025. This initiative is entering its sixth year of implementation and now includes 22 countries and 1 380 primary health care centers. The objectives of this report are three-fold. First, it describes the emergence and the main elements of HEARTS in the Americas. Secondly, it summarizes the main innovations developed to catalyze and sustain implementation of the initiative. These innovations include: a) introduction of hypertension control drivers; b) development of a comprehensive and practical clinical pathway; c) development of a strategy to improve the accuracy of blood pressure measurement; d) creation of a monitoring and evaluation platform; and e) development of a standardized set of training and education resources. Thirdly, this report discusses future priorities of the initiative. The goal of implementing these innovative and pragmatic solutions is to create a more effective health system and shift the focus of cardiovascular and hypertension programs from the highly specialized care level to primary health care. In addition, HEARTS in the Americas can serve as a model for more comprehensive, effective, and sustainable noncommunicable disease prevention and treatment practices.
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Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Norm R.C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Gloria P. Giraldo Arcila
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Sonia Y. Angell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Jeffrey W. Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, United States of America
| | - Yenny A. Rodriguez Morales
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Kenneth L. Connell
- Faculty of Medical Sciences, Cave Hill Campus, University of the West Indies, St Michael, Barbados
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Donald J. DiPette
- Department of Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Marc G. Jaffe
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, San Francisco, United States of America
| | - Libardo Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Daniel J. Piñeiro
- Department of Medicine. University of Buenos Aires, Buenos Aires, Argentina
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Xu X, Wang Y, Li Y, Zhang B, Song Q. The future Landscape of macrophage research in cardiovascular disease: a bibliometric analysis. Curr Probl Cardiol 2022; 47:101311. [PMID: 35810847 DOI: 10.1016/j.cpcardiol.2022.101311] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/03/2022]
Abstract
Cardiovascular disease (CVD) refers to a group of diseases involving the heart or blood vessels and is currently the leading cause of morbidity and mortality in many countries around the world and poses a serious economic burden. Macrophages are key effectors of inflammatory and innate immune responses, and their aberrant expression contributes to the development of various types of CVD.This study retrieved articles published from 1990-2022 on macrophages in CVD from the Web of Science core collection, based on CiteSpace and VOSviewer on these literature The annual output, countries and regions, institutions, authors, core journals, keywords and co-cited literature were analyzed. A total of 7,197 articles and reviews were retrieved, with a general upward trend despite slight fluctuations in annual publications. Europe, the United States and Asia are the main countries and regions publishing articles, especially the United States, with the highest number of articles (2,581), citations (173,692) and H-index (197), which also has the world's largest number of elite institutions, professional The country also has the world's largest number of elite institutions, professional researchers and high-impact journals, and is the leading country in this field of research. Keywords "inflammation", "immunology", "autophagy", "lipid-peroxidation" are the main pathogenesis of CVD caused by macrophages. "NLRP3", "nf kappa b" and "TNF-α" are the most frequently studied signalling pathways. Atherosclerosis, myocarditis and myocardial injury are the most studied disease types in this field. In addition, the study of macrophage-related CVD induced by COVID-19 seems to be a recent hot topic, and the mechanisms involved are mainly macrophage polarization, inflammatory factor storm, ACE2 and so on. The present study reveals hot spots and new trends in research on macrophages in CVD, which can provide scholars with key information in this field of research and help further explore new research directions.
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Affiliation(s)
- Xia Xu
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yajiao Wang
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yumeng Li
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Bingxuan Zhang
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Qingqiao Song
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Ordunez P, Lombardi C, Picone DS, Brady TM, Campbell NRC, Moran AE, Padwal R, Rosende A, Whelton PK, Sharman JE. HEARTS en las Américas: un ejemplo mundial del uso de dispositivos automatizados de medición de la presión arterial validados clínicamente en la prevención y el manejo de las enfermedades cardiovasculares en entornos de atención primaria de salud. Rev Panam Salud Publica 2022; 46:e50. [PMID: 35573113 PMCID: PMC9097929 DOI: 10.26633/rpsp.2022.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pedro Ordunez
- Departamento de Enfermedades No Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América. Orcid: https://orcid.org/0000-0002-9871-6845
| | - Cintia Lombardi
- Departamento de Enfermedades No Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América. Orcid: https://orcid.org/0000-0001-7376-7243
| | - Dean S Picone
- Instituto Menzies de Investigación Médica Universidad de Tasmania Hobart Australia Instituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Australia. Orcid: https://orcid.org/0000-0002-4760-1634
| | - Tammy M Brady
- Departamento de Pediatría División de Nefrología Escuela de Medicina de la Universidad Johns Hopkins Baltimore Estados Unidos de América Departamento de Pediatría, División de Nefrología, Escuela de Medicina de la Universidad Johns Hopkins, Baltimore, Estados Unidos de América. Orcid: https://orcid.org/0000-0002-1315-6747
| | - Norm R C Campbell
- Departamentos de Medicina Fisiología y Farmacología y Ciencias de la Salud Comunitaria Instituto Cardiovascular Libin de Alberta Canadá Departamentos de Medicina, Fisiología y Farmacología y Ciencias de la Salud Comunitaria, Instituto Cardiovascular Libin de Alberta, Canadá. Orcid: https://orcid.org/0000-0002-1093-4742
| | - Andrew E Moran
- Resolve to Save Lives Nueva York Estados Unidos de América Resolve to Save Lives, Nueva York, Estados Unidos de América. Orcid: https://orcid.org/0000-0003-3554-0085
| | - Raj Padwal
- Departamento de Medicina Universidad de Alberta Edmonton Canadá Departamento de Medicina, Universidad de Alberta, Edmonton, Canadá. Orcid: https://orcid.org/0000-0003-3541-2817
| | - Andrés Rosende
- Departamento de Enfermedades No Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América. Orcid: https://orcid.org/0000-0001-8173-0686
| | - Paul K Whelton
- Departamento de Epidemiología Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane Nueva Orleans Estados Unidos de América Departamento de Epidemiología, Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane, Nueva Orleans, Estados Unidos de América. Orcid: https://orcid.org/0000-0002-2225-383X
| | - James E Sharman
- Instituto Menzies de Investigación Médica Universidad de Tasmania Hobart Australia Instituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Australia. Orcid: https://orcid.org/0000-0003-2792-0811
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Brettler JW, Giraldo Arcila GP, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, De la Rosa MJ, Maldonado J, Neira Ojeda C, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, Valdes Gonzalez Y, Wood PW, Zuniga E, Ordunez P. [Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation GroupFactores impulsores y métodos de puntuación para mejorar el control de la hipertensión en la práctica clínica de la atención primaria: recomendaciones del grupo de innovación de HEARTS en las Américas]. Rev Panam Salud Publica 2022; 46:e68. [PMID: 35573115 PMCID: PMC9097925 DOI: 10.26633/rpsp.2022.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Fundamentos. As doenças cardiovasculares (DCV) são as principais causas de morbimortalidade nas Américas, e a hipertensão arterial (HÁ) é o fator de risco modificável mais importante. Porém, as taxas de controle da HA continuam baixas, e a mortalidade por DCV está estagnada ou aumentando após décadas de redução contínua. Em 2016, a Organização Mundial da Saúde (OMS) lançou o pacote de medidas técnicas HEARTS para melhorar o controle da HA. A Organização Pan-Americana da Saúde (OPAS) criou a iniciativa HEARTS nas Américas para melhorar a gestão do risco cardiovascular (RCV), com ênfase no controle da HA. Até agora, essa iniciativa foi implementada em 21 países. Métodos. Para impulsionar a implementação, recrutou-se um grupo multidisciplinar de profissionais para selecionar impulsionadores-chave do controle da HA com base em evidências e elaborar um scorecard completo para monitorar sua implementação em unidades de atenção primária à saúde (APS). O grupo estudou sistemas de saúde com alto desempenho que haviam conseguido atingir um alto nível de controle da HA por meio de programas de melhoria da qualidade focados em medidas específicas de processo, com feedback regular para os profissionais das unidades de saúde. Resultados. Os oito fatores impulsionadores incluídos na seleção final foram categorizados em cinco domínios principais: (1) diagnóstico (exatidão da medição da pressão arterial e avaliação do RCV); (2) tratamento (protocolo padronizado de tratamento e intensificação do tratamento); (3) continuidade do cuidado e acompanhamento; (4) modelo de atenção (atendimento baseado em equipe, renovação da prescrição); e (5) sistema de avaliação do desempenho. Em seguida, os fatores impulsionadores e as recomendações foram transformados em medidas de processo, gerando dois scorecards inter-relacionados integrados ao sistema de monitoramento e avaliação da Iniciativa HEARTS nas Américas. Interpretação. O foco nesses impulsionadores-chave da HA e nos scorecards resultantes orientará o processo de melhoria da qualidade para atingir as metas de controle, a nível populacional, dos centros de saúde participantes nos países que estão implementando a iniciativa HEARTS.
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Affiliation(s)
- Jeffrey W Brettler
- Southern California Permanente Medical Group Los Angeles EUA Southern California Permanente Medical Group, Los Angeles, EUA.,Departamento de Ciências de Sistemas de Saúde Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena EUA Departamento de Ciências de Sistemas de Saúde, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, EUA
| | - Gloria P Giraldo Arcila
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
| | - Teresa Aumala
- Centro de Atenção Primária à Saúde Ministério da Saúde, Centro de Salud Conocoto Quito Equador Centro de Atenção Primária à Saúde, Ministério da Saúde, Centro de Salud Conocoto, Quito, Equador
| | - Allana Best
- Ministério da Saúde Porto de Espanha Trinidad e Tobago Ministério da Saúde, Porto de Espanha, Trinidad e Tobago
| | - Norm Rc Campbell
- Departamento de Medicina Fisiologia e Farmacologia e Ciências da Saúde Comunitária Libin Cardiovascular Institute of Alberta Calgary Canadá Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde Comunitária, Libin Cardiovascular Institute of Alberta, Calgary, Canadá
| | - Shana Cyr
- Ministério da Saúde Bem-Estar e Idosos Castries Santa Lúcia Ministério da Saúde, Bem-Estar e Idosos, Castries, Santa Lúcia
| | - Angelo Gamarra
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
| | - Marc G Jaffe
- Departamento de Endocrinologia The Permanente Medical Group Kaiser San Francisco Medical Center San Francisco EUA Departamento de Endocrinologia, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, EUA
| | - Mirna Jimenez De la Rosa
- Escola de Saúde Pública Faculdade de Ciências da Saúde Universidad Autónoma de Santo Domingo República Dominicana Escola de Saúde Pública, Faculdade de Ciências da Saúde, Universidad Autónoma de Santo Domingo, República Dominicana.,Oficina Escuela de Salud Publica Ciudad Universitaria Universidad Autónoma de Santo Domingo Distrito Nacional República Dominicana Oficina Escuela de Salud Publica, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Distrito Nacional, República Dominicana
| | - Javier Maldonado
- Organização Pan-Americana da Saúde Bogotá Colômbia Organização Pan-Americana da Saúde, Bogotá, Colômbia
| | - Carolina Neira Ojeda
- Departamento de Doenças Não Transmissíveis Ministério da Saúde Santiago do Chile Chile Departamento de Doenças Não Transmissíveis, Ministério da Saúde, Santiago do Chile, Chile
| | - Modesta Haughton
- Organização Pan-Americana da Saúde Ancón Panamá Organização Pan-Americana da Saúde, Ancón, Panamá
| | - Taraleen Malcolm
- Organização Pan-Americana da Saúde Porto de Espanha Trinidad e Tobago Organização Pan-Americana da Saúde, Porto de Espanha, Trinidad e Tobago
| | - Vivian Perez
- Organização Pan-Americana da Saúde Lima Peru Organização Pan-Americana da Saúde, Lima, Peru
| | - Gonzalo Rodriguez
- Organização Pan-Americana da Saúde Ciudad Autónoma de Buenos Aires Buenos Aires Argentina Organização Pan-Americana da Saúde, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andres Rosende
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
| | - Yamile Valdes Gonzalez
- Comitê Técnico Consultivo Nacional de Hipertensão Arterial Hospital Universitário "General Calixto García" Havana Cuba Comitê Técnico Consultivo Nacional de Hipertensão Arterial, Hospital Universitário "General Calixto García", Havana, Cuba
| | - Peter W Wood
- Departamento de Medicina Divisão de Medicina Interna Geral University of Alberta Edmonton Canadá Departamento de Medicina, Divisão de Medicina Interna Geral, University of Alberta, Edmonton, Canadá
| | - Eric Zuniga
- Servicio de Salud Antofagasta Universidad de Antofagasta Antofagasta Chile Servicio de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. [2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the AmericasDiretrizes de 2021 da Organização Mundial da Saúde sobre o tratamento medicamentoso da hipertensão arterial: repercussões para as políticas na região das Américas]. Rev Panam Salud Publica 2022; 46:e54. [PMID: 35573116 PMCID: PMC9097923 DOI: 10.26633/rpsp.2022.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
Las enfermedades cardiovasculares son la principal causa de muerte en la Región de las Américas y la hipertensión es la causa de más del 50% de ellas. En la Región, más de una cuarta parte de las mujeres adultas y cuatro de cada diez hombres adultos tienen hipertensión y su diagnóstico, tratamiento y control son deficientes. En el 2021, la Organización Mundial de la Salud (OMS) publicó directrices actualizadas sobre el tratamiento farmacológico de la hipertensión en personas adultas. En este artículo se destaca el papel facilitador de la iniciativa mundial HEARTS de la OMS y la iniciativa HEARTS en las Américas para catalizar la implementación de estas directrices, a la vez que se proporciona asesoramiento específico sobre políticas para dicha implementación y se destaca la necesidad de adoptar un enfoque estratégico general para el control de la hipertensión. Los autores instan a quienes abogan por la salud y a los responsables de las políticas a priorizar la prevención y el control de la hipertensión para mejorar la salud y el bienestar de la población, y a reducir las disparidades de salud en relación con las enfermedades cardiovasculares dentro de la población y entre las poblaciones de la Región de las Américas.
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Affiliation(s)
- Norm R C Campbell
- Departamento de Medicina Fisiología y Farmacología y Ciencias de Salud de la Comunidad Instituto Cardiovascular Libin de Alberta Universidad de Calgary Calgary Canadá Departamento de Medicina, Fisiología y Farmacología y Ciencias de Salud de la Comunidad, Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Canadá.,Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Melanie Paccot Burnens
- Departamento de Enfermedades no Transmisibles Ministerio de Salud de Chile Santiago de Chile Chile Departamento de Enfermedades no Transmisibles, Ministerio de Salud de Chile, Santiago de Chile, Chile
| | - Paul K Whelton
- Departamento de Epidemiología Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane Nueva Orleans Estados Unidos de América Departamento de Epidemiología, Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane, Nueva Orleans, Estados Unidos de América
| | - Sonia Y Angell
- Departamento de Medicina Universidad de Columbia Colegio de Médicos y Cirujanos Vagelos Nueva York Estados Unidos de América Departamento de Medicina, Universidad de Columbia, Colegio de Médicos y Cirujanos Vagelos, Nueva York, Estados Unidos de América
| | - Marc G Jaffe
- Departamento de Endocrinología Centro Médico Kaiser Permanente de San Francisco San Francisco Estados Unidos de América Departamento de Endocrinología, Centro Médico Kaiser Permanente de San Francisco, San Francisco, Estados Unidos de América
| | - Jennifer Cohn
- Departamento de Medicina Interna Escuela de Medicina Universidad de Pensilvania Filadelfia Estados Unidos de América Departamento de Medicina Interna, Escuela de Medicina, Universidad de Pensilvania, Filadelfia, Estados Unidos de América
| | - Alfredo Espinosa Brito
- Departamento de Medicina Interna Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos Cienfuegos Cuba Departamento de Medicina Interna, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Departamento de Investigación en Enfermedades Crónicas Centro de Excelencia en Salud Cardiovascular para América del Sur Instituto de Efectividad Clínica y Sanitaria Buenos Aires Argentina Departamento de Investigación en Enfermedades Crónicas, Centro de Excelencia en Salud Cardiovascular para América del Sur, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Departamento de Ciencias de Sistemas de Salud Grupo Médico Permanente del Sur de California Escuela de Medicina Kaiser Permanente Bernard J. Tyson Los AngelesPasadena Estados Unidos de América Departamento de Ciencias de Sistemas de Salud, Grupo Médico Permanente del Sur de California, Los Ángeles, California, Escuela de Medicina Kaiser Permanente Bernard J. Tyson, Pasadena, Estados Unidos de América
| | - Edward J Roccella
- Programa Nacional de Educación sobre la Hipertensión Arterial de los Estados Unidos (Ret.) Instituto Nacional del Corazón los Pulmones y la Sangre Institutos Nacionales de Salud Bethesda Estados Unidos de América Programa Nacional de Educación sobre la Hipertensión Arterial de los Estados Unidos (Ret.) Instituto Nacional del Corazón, los Pulmones y la Sangre, Institutos Nacionales de Salud, Bethesda, Estados Unidos de América
| | | | - Andres Rosende
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. [2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the Region of the AmericasDirectrices de la Organización Mundial de la Salud del 2021 sobre el tratamiento farmacológico de la hipertensión: implicaciones de política para la Región de las Américas]. Rev Panam Salud Publica 2022; 46:e55. [PMID: 35573114 PMCID: PMC9097927 DOI: 10.26633/rpsp.2022.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A doença cardiovascular (DCV) é a principal causa de morte nas Américas, e a pressão arterial elevada é responsável por mais de 50% dos casos de DCV. Nas Américas, mais de um quarto das mulheres adultas e quatro de cada dez homens adultos têm hipertensão arterial, sendo que diagnóstico, tratamento e controle estão abaixo do ideal. Em 2021, a Organização Mundial da Saúde (OMS) divulgou uma atualização das diretrizes para o tratamento medicamentoso da hipertensão arterial em adultos. Esta publicação ressalta o papel facilitador da iniciativa Global HEARTS da OMS e da iniciativa HEARTS nas Américas para catalisar a implementação dessas diretrizes, oferece recomendações específicas de políticas para sua implementação e enfatiza a necessidade de uma abordagem estratégica abrangente para o controle da hipertensão arterial. Os autores clamam para que tanto as pessoas que advogam pela Saúde, quanto as autoridades responsáveis, priorizem a prevenção e o controle da hipertensão arterial como forma de melhorar a saúde e o bem-estar das populações e reduzir as disparidades de saúde cardiovascular dentro das populações das Américas e entre elas.
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Affiliation(s)
- Norm R C Campbell
- Departamento de Medicina Fisiologia e Farmacologia e Ciências da Saúde Comunitária Libin Cardiovascular Institute of Alberta University of Calgary Calgary Canadá Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde Comunitária, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canadá.,Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, EUA
| | - Melanie Paccot Burnens
- Chefe do Departamento de Doenças Não Transmissíveis Ministério da Saúde do Chile Santiago Chile Chefe do Departamento de Doenças Não Transmissíveis, Ministério da Saúde do Chile, Santiago, Chile
| | - Paul K Whelton
- Departamento de Epidemiologia Tulane University School of Public Health and Tropical Medicine Nova Orleans EUA Departamento de Epidemiologia, Tulane University School of Public Health and Tropical Medicine, Nova Orleans, EUA
| | - Sonia Y Angell
- Departamento de Medicina Columbia University Vagelos College of Physicians and Surgeons Nova York EUA Departamento de Medicina, Columbia University Vagelos College of Physicians and Surgeons, Nova York, EUA
| | - Marc G Jaffe
- Departamento de Endocrinologia Kaiser Permanente San Francisco Medical Center San Francisco EUA Departamento de Endocrinologia, Kaiser Permanente San Francisco Medical Center, San Francisco, EUA
| | - Jennifer Cohn
- Departamento de Medicina Interna Escola de Medicina University of Pennsylvania Filadélfia EUA Departamento de Medicina Interna, Escola de Medicina, University of Pennsylvania, Filadélfia, EUA
| | - Alfredo Espinosa Brito
- Departamento de Medicina Interna Hospital "Dr. Gustavo Aldereguía Lima" Cienfuegos Cuba Departamento de Medicina Interna, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Departamento de Pesquisa em Doenças Crônicas Centro de Excelencia en Salud Cardiovascular para América del Sur, CESCAS Instituto de Efectividad Clínica y Sanitaria, IECS Buenos Aires Argentina Departamento de Pesquisa em Doenças Crônicas, Centro de Excelencia en Salud Cardiovascular para América del Sur, CESCAS, Instituto de Efectividad Clínica y Sanitaria, IECS, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Departamento de Ciências de Sistemas de Saúde Southern California Permanente Medical Group Kaiser Permanente Bernard J. Tyson School of Medicine Los AngelesPasadena EUA Departamento de Ciências de Sistemas de Saúde, Southern California Permanente Medical Group, Los Angeles; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, EUA
| | - Edward J Roccella
- Programa Nacional de Educação em Hipertensão Arterial dos Estados Unidos (emérito) Instituto Nacional do Coração Pulmão e Sangue, Institutos Nacionais de Saúde Bethesda EUA Programa Nacional de Educação em Hipertensão Arterial dos Estados Unidos (emérito), Instituto Nacional do Coração, Pulmão e Sangue, Institutos Nacionais de Saúde, Bethesda, EUA
| | | | - Andres Rosende
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, EUA
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, EUA
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Ordunez P, Tajer C, Gaziano T, Rodríguez YA, Rosende A, Jaffe MG. [The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health careO aplicativo HEARTS: uma ferramenta clínica para o gerenciamento de risco cardiovascular e hipertensão na atenção primária à saúde]. Rev Panam Salud Publica 2022; 46:e46. [PMID: 35573118 PMCID: PMC9097924 DOI: 10.26633/rpsp.2022.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
HEARTS en las Américas es la adaptación regional de la iniciativa Global HEARTS de la Organización Mundial de la Salud, que será el modelo para el manejo del riesgo de las enfermedades cardiovasculares (ECV) en la atención primaria de salud en la Región de las Américas para el año 2025. Ya se ha implementado en 21 países y 1045 centros de atención primaria de salud en toda América Latina y el Caribe. Se ha adoptado un enfoque de salud pública y de sistemas de salud para introducir sistemáticamente intervenciones simplificadas en el nivel de la atención primaria de salud que se centran en el control de la hipertensión como punto de entrada clínico. En este artículo se presenta una aplicación nueva y mejorada cuyo componente principal es la calculadora de riesgo de ECV y de manejo de la hipertensión. Se resume el enfoque de evaluación del riesgo y la metodología utilizada por la Organización Mundial de la Salud para actualizar sus tablas de riesgo cardiovascular del 2019; se describe la aplicación, su uso, su funcionalidad y su proceso de validación; y se presenta un conjunto de recomendaciones prácticas para optimizar el manejo del riesgo de ECV y de la hipertensión, mediante el uso de la aplicación en la práctica clínica. La aplicación HEARTS es una herramienta sólida para mejorar la calidad de la atención prestada en los centros de atención primaria. La creación y difusión de la aplicación HEARTS es un paso esencial en el camino hacia la eliminación de las ECV prevenibles en la Región de las Américas.
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Affiliation(s)
- Pedro Ordunez
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América. ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Carlos Tajer
- Hospital El Cruce Néstor Kirchner Buenos Aires Argentina Hospital El Cruce Néstor Kirchner, Buenos Aires, Argentina ORCID 0000-0002-6787-66511
| | - Thomas Gaziano
- Harvard T.H. Chan School of Public Health Boston Estados Unidos de América Harvard T.H. Chan School of Public Health, Boston, Estados Unidos de América. ORCID 0000-0002-5985-345X
| | - Yenny A Rodríguez
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América. ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Andrés Rosende
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América. ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Marc G Jaffe
- Kaiser Permanente San Francisco Medical Center San Francisco Estados Unidos de América Kaiser Permanente San Francisco Medical Center, San Francisco, Estados Unidos de América. ORCID 0000-0002-5049-7815
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Brettler JW, Giraldo Arcila GP, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, De la Rosa MJ, Maldonado J, Neira Ojeda C, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, Valdes Gonzalez Y, Wood PW, Zuñiga E, Ordunez P. [Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation GroupFatores impulsionadores e scorecards para melhorar o controle da hipertensão arterial na atenção primária: recomendações do Grupo de Inovação da Iniciativa HEARTS nas Américas]. Rev Panam Salud Publica 2022; 46:e56. [PMID: 35573117 PMCID: PMC9097922 DOI: 10.26633/rpsp.2022.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Antecedentes. Las enfermedades cardiovasculares (ECV) son la principal causa de morbilidad y mortalidad en la Región de las Américas y la hipertensión es el factor de riesgo modificable asociado más importante. Sin embargo, las tasas de control de la hipertensión siguen siendo bajas y la mortalidad por ECV está estancada o en aumento después de décadas de reducción continua. En el 2016, la Organización Mundial de la Salud (OMS) presentó el paquete técnico HEARTS para mejorar el control de la hipertensión. La Organización Panamericana de la Salud (OPS) diseñó la iniciativa HEARTS en las Américas para mejorar el control del riesgo de ECV, que hace hincapié en el control de la hipertensión y que, hasta la fecha, se ha implementado en 21 países. Métodos. Para avanzar en la implementación, se creó un grupo interdisciplinario de profesionales de la salud con el objetivo de seleccionar los factores impulsores claves del control de la hipertensión basados en la evidencia y diseñar un método de puntuación integral para dar seguimiento a su implementación en los centros de atención de salud primaria (APS). El grupo estudió los sistemas de salud de alto desempeño que logran un control elevado de la hipertensión mediante programas de mejora de la calidad que se centran en medidas específicas con respecto a los procesos, con retroalimentación regular a los prestadores en los centros de salud. Resultados. Los ocho factores impulsores finales seleccionados se clasificaron en cinco dominios principales: 1) diagnóstico (exactitud de la medición de la presión arterial y evaluación del riesgo de ECV); 2) tratamiento (protocolo de tratamiento e intensificación del tratamiento estandarizados); 3) continuidad de la atención y seguimiento; 4) sistema de prestación del tratamiento (atención basada en un trabajo en equipo, reposición de la medicación) y 5) sistema para la evaluación del desempeño. Los factores impulsores y las recomendaciones se tradujeron en medidas con respecto a los procesos, lo que llevó a dos métodos de puntuación integrados e interconectados en el sistema de seguimiento y evaluación del programa HEARTS en las Américas. Conclusiones. El enfoque que se centra en estos factores impulsores clave de la hipertensión y los métodos de puntuación resultantes servirá de guía para el proceso de mejora de la calidad con objeto de alcanzar los objetivos de control a nivel poblacional en los centros de salud participantes de los países que implementan el programa HEARTS.
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Affiliation(s)
- Jeffrey W Brettler
- Kaiser Permanente del Sur de California Los Ángeles Estados Unidos de América Kaiser Permanente del Sur de California, Los Ángeles, Estados Unidos de América.,Departamento de Ciencias de Sistemas de Salud Facultad de Medicina Bernard J. Tyson de Kaiser Permanente Pasadena Estados Unidos de América Departamento de Ciencias de Sistemas de Salud, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América
| | - Gloria P Giraldo Arcila
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
| | - Teresa Aumala
- Centro de Atención Primaria de Salud Ministerio de Salud Centro de Salud Conocoto Quito Ecuador Centro de Atención Primaria de Salud, Ministerio de Salud, Centro de Salud Conocoto, Quito, Ecuador
| | - Allana Best
- Ministerio de Salud Puerto España Trinidad y Tabago Ministerio de Salud, Puerto España, Trinidad y Tabago
| | - Norm Rc Campbell
- Departamento de Medicina Fisiología y Farmacología y Ciencias de Salud Comunitaria Instituto Cardiovascular Libin de Alberta Calgary Canadá Departamento de Medicina, Fisiología y Farmacología y Ciencias de Salud Comunitaria, Instituto Cardiovascular Libin de Alberta, Calgary, Canadá
| | - Shana Cyr
- Ministerio de Salud Bienestar y Asuntos de la Tercera Edad Castries Santa Lucía Ministerio de Salud, Bienestar y Asuntos de la Tercera Edad, Castries, Santa Lucía
| | - Angelo Gamarra
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
| | - Marc G Jaffe
- Departamento de Endocrinología Grupo Médico Permanente Centro Médico de San Francisco Kaiser San Francisco Estados Unidos de América Departamento de Endocrinología, Grupo Médico Permanente, Centro Médico de San Francisco Kaiser, San Francisco, Estados Unidos de América
| | - Mirna Jimenez De la Rosa
- Escuela de Salud Pública Facultad de Ciencias de la Salud Universidad Autónoma de Santo Domingo Santo Domingo Dominican Republic Escuela de Salud Pública, Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana.,Oficina Escuela de Salud Pública Ciudad Universitaria Universidad Autónoma de Santo Domingo Santo Domingo República Dominicana Oficina Escuela de Salud Pública, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana
| | - Javier Maldonado
- Organización Panamericana de Salud Bogotá Colombia Organización Panamericana de Salud, Bogotá, Colombia
| | - Carolina Neira Ojeda
- Departamento de Enfermedades no Transmisibles Ministerio de Salud Santiago de Chile Chile Departamento de Enfermedades no Transmisibles, Ministerio de Salud, Santiago de Chile, Chile
| | - Modesta Haughton
- Organización Panamericana de Salud Ancon Panamá Organización Panamericana de Salud, Ancon, Panamá
| | - Taraleen Malcolm
- Organización Panamericana de la Salud Puerto España Trinidad y Tabago Organización Panamericana de la Salud, Puerto España, Trinidad y Tabago
| | - Vivian Perez
- Organización Panamericana de Salud Lima Perú Organización Panamericana de Salud, Lima, Perú
| | - Gonzalo Rodriguez
- Organización Panamericana de la Salud Ciudad Autónoma de Buenos Aires Argentina Organización Panamericana de la Salud, Ciudad Autónoma de Buenos Aires, Argentina
| | - Andres Rosende
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
| | - Yamile Valdes Gonzalez
- Comité Técnico Asesor Nacional sobre Hipertensión Hospital Universitario "General Calixto García" La Habana Cuba Comité Técnico Asesor Nacional sobre Hipertensión, Hospital Universitario "General Calixto García", La Habana, Cuba
| | - Peter W Wood
- Departamento de Medicina División de Medicina Interna General Universidad de Alberta Edmonton Canadá Departamento de Medicina, División de Medicina Interna General, Universidad de Alberta, Edmonton, Canadá
| | - Eric Zuñiga
- Servicios de Salud Antofagasta Universidad de Antofagasta Antofagasta Chile Servicios de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. 2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas. LANCET REGIONAL HEALTH. AMERICAS 2022; 9:None. [PMID: 35711684 PMCID: PMC9107389 DOI: 10.1016/j.lana.2022.100219] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised blood pressure accounts for over 50% of CVD. In the Americas over a quarter of adult women and four in ten adult men have hypertension and the diagnosis, treatment and control are suboptimal. In 2021, the World Health Organization (WHO) released an updated guideline for the pharmacological treatment of hypertension in adults. This policy paper highlights the facilitating role of the WHO Global HEARTS initiative and the HEARTS in the Americas initiative to catalyze the implementation of this guideline, provides specific policy advice for implementation, and emphasizes that an overarching strategic approach for hypertension control is needed. The authors urge health advocates and policymakers to prioritize the prevention and control of hypertension to improve the health and wellbeing of their populations and to reduce CVD health disparities within and between populations of the Americas.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 1403 - 29th Street NW, Calgary, AB T2N 2T9, Canada.,Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Melanie Paccot Burnens
- Head of the Department of Non-Communicable Diseases, Ministry of Health in Chile, Santiago, Chile
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Sonia Y Angell
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Marc G Jaffe
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Jennifer Cohn
- Department of Internal Medicine, School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Alfredo Espinosa Brito
- Department of Internal Medicine, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Department of Research in Chronic Diseases, Center of Excellence for Cardiovascular Health, CESCAS, Institute for Clinical Effectiveness and Health Policy, IECS, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Department of Health Systems Science, Southern California Permanente Medical Group, Los Angeles, California, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Edward J Roccella
- United States National High Blood Pressure Education Program (Ret.) National Heart, Lung and Blood Institute National Institutes of Health Bethesda, MD, USA
| | | | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Brettler JW, Arcila GPG, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, la Rosa MJD, Maldonado J, Ojeda CN, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, González YV, Wood PW, Zúñiga E, Ordunez P. Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation Group. LANCET REGIONAL HEALTH. AMERICAS 2022; 9:None. [PMID: 35711685 PMCID: PMC9121401 DOI: 10.1016/j.lana.2022.100223] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Americas, and hypertension is the most significant modifiable risk factor. However, hypertension control rates remain low, and CVD mortality is stagnant or rising after decades of continuing reduction. In 2016, the World Health Organization (WHO) launched the HEARTS technical package to improve hypertension control. The Pan American Health Organization (PAHO) designed the HEARTS in the Americas Initiative to improve CVD risk management, emphasizing hypertension control, to date implemented in 21 countries. Methods To advance implementation, an interdisciplinary group of practitioners was engaged to select the key evidence-based drivers of hypertension control and to design a comprehensive scorecard to monitor their implementation at primary care health facilities (PHC). The group studied high-performing health systems that achieve high hypertension control through quality improvement programs focusing on specific process measures, with regular feedback to providers at health facilities. Findings The final selected eight drivers were categorized into five main domains: (1) diagnosis (blood pressure measurement accuracy and CVD risk evaluation); (2) treatment (standardized treatment protocol and treatment intensification); (3) continuity of care and follow-up; (4) delivery system (team-based care, medication refill), and (5) system for performance evaluation. The drivers and recommendations were then translated into process measures, resulting in two interconnected scorecards integrated into the HEARTS in the Americas monitoring and evaluation system. Interpretation Focus on these key hypertension drivers and resulting scorecards, will guide the quality improvement process to achieve population control goals at the participating health centers in HEARTS implementing countries. Funding No funding to declare.
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Affiliation(s)
- Jeffrey W Brettler
- Southern California Permanente Medical Group, Los Angeles, CA, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Gloria P Giraldo Arcila
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Teresa Aumala
- Primary Health Care Center, Ministry of Health, Centro de Salud Conocoto, Quito, Ecuador
| | - Allana Best
- Ministry of Health, Park Street, Port of Spain, Trinidad and Tobago
| | - Norm Rc Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Shana Cyr
- Ministry of Health, Wellness & Elderly Affairs, Sir Stanislaus James Building, Waterfront, Castries, Saint Lucia
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Marc G Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, CA, USA
| | - Mirna Jimenez De la Rosa
- School of Public Health, Faculty of Health Sciences, Universidad Autónoma de Santo Domingo, Dominican Republic.,Oficina Escuela de Salud Pública, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Distrito Nacional, Dominican Republic
| | | | - Carolina Neira Ojeda
- Department of Noncommunicable Diseases, Ministry of Health, Santiago de Chile, Chile
| | | | - Taraleen Malcolm
- Pan American Health Organization (PAHO), Port of Spain, Trinidad and Tobago
| | - Vivian Perez
- Pan American Health Organization,(PAHO), Lima, Peru
| | - Gonzalo Rodriguez
- Pan American Health Organization, (PAHO), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Yamilé Valdés González
- National Technical Advisory Committee on Hypertension, University Hospital "General Calixto García", Havana, Cuba
| | - Peter W Wood
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eric Zúñiga
- Health Services Antofagasta, Servicio de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
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Ordunez P, Tajer C, Gaziano T, Rodriguez YA, Rosende A, Jaffe MG. The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health care. Rev Panam Salud Publica 2022; 46:e12. [PMID: 35355690 PMCID: PMC8959249 DOI: 10.26633/rpsp.2022.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/06/2022] [Indexed: 12/14/2022] Open
Abstract
HEARTS in the Americas is the regional adaptation of the World Health Organization’s Global Hearts Initiative, which will be the model for risk management for cardiovascular disease (CVD) in primary health care in the Region of the Americas by 2025. It has already been implemented in 21 countries and 1045 primary health care centers throughout Latin America and the Caribbean. It takes a public health and health systems approach to systematically introduce simplified interventions at the primary health care level and focuses on hypertension as a clinical entry point. This paper introduces a new, improved application (app), the main component of which is the calculator for CVD risk and hypertension management. The paper summarizes the risk assessment approach and the methodology used by the World Health Organization to update its cardiovascular risk charts in 2019; describes the app, its use, functionality and validation process; and provides a set of practical recommendations for optimizing CVD risk and hypertension management by using the app in clinical practice. The HEARTS app is a powerful tool to improve the quality of care provided in primary health settings. The creation and dissemination of the HEARTS app is an essential step in the journey towards eliminating preventable CVD in the Americas.
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Affiliation(s)
- Pedro Ordunez
- Pan American Health Organization Washington, DC United States of America ORCID 0000-0002-9871-6845 ORCID 0000-0003-2026-572X ORCID 0000-0001-8173-0686 Pan American Health Organization, Washington, DC, United States of America; ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Carlos Tajer
- Hospital El Cruce Néstor Kirchner Buenos Aires Argentina ORCID 0000-0002-6787-6651 Hospital El Cruce Néstor Kirchner, Buenos Aires, Argentina; ORCID 0000-0002-6787-6651
| | - Thomas Gaziano
- Harvard T.H. Chan School of Public Health Boston United States of America ORCID 0000-0002-5985-345X Harvard T.H. Chan School of Public Health, Boston, United States of America; ORCID 0000-0002-5985-345X
| | - Yenny A Rodriguez
- Pan American Health Organization Washington, DC United States of America ORCID 0000-0002-9871-6845 ORCID 0000-0003-2026-572X ORCID 0000-0001-8173-0686 Pan American Health Organization, Washington, DC, United States of America; ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Andres Rosende
- Pan American Health Organization Washington, DC United States of America ORCID 0000-0002-9871-6845 ORCID 0000-0003-2026-572X ORCID 0000-0001-8173-0686 Pan American Health Organization, Washington, DC, United States of America; ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Marc G Jaffe
- Kaiser Permanente San Francisco Medical Center San Francisco United States of America ORCID 0000-0002-5049-7815 Kaiser Permanente San Francisco Medical Center, San Francisco, United States of America; ORCID 0000-0002-5049-7815
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39
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Xu D, Feng M, Chu Y, Wang S, Shete V, Tuohy KM, Liu F, Zhou X, Kamil A, Pan D, Liu H, Yang X, Yang C, Zhu B, Lv N, Xiong Q, Wang X, Sun J, Sun G, Yang Y. The Prebiotic Effects of Oats on Blood Lipids, Gut Microbiota, and Short-Chain Fatty Acids in Mildly Hypercholesterolemic Subjects Compared With Rice: A Randomized, Controlled Trial. Front Immunol 2021; 12:787797. [PMID: 34956218 PMCID: PMC8697019 DOI: 10.3389/fimmu.2021.787797] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 01/14/2023] Open
Abstract
Phytochemicals derived from oats are reported to possess a beneficial effect on modulating dyslipidemia, specifically on lowering total and LDL cholesterol. However, deeper insights into its mechanism remain unclear. In this randomized controlled study, we assigned 210 mildly hypercholesterolemic subjects from three study centers across China (Beijing, Nanjing, and Shanghai) to consume 80 g of oats or rice daily for 45 days. Plasma lipid profiles, short chain fatty acids (SCFAs), and fecal microbiota were measured. The results showed that total cholesterol (TC) and non-high-density lipoprotein cholesterol (non-HDL-C) decreased significantly with both oats and rice intake after 30 and 45 days. The reduction in TC and non-HDL-C was greater in the participants consuming oats compared with rice at day 45 (p = 0.011 and 0.049, respectively). Oat consumption significantly increased the abundance of Akkermansia muciniphila and Roseburia, and the relative abundance of Dialister, Butyrivibrio, and Paraprevotella, and decreased unclassified f-Sutterellaceae. In the oat group, Bifidobacterium abundance was negatively correlated with LDL-C (p = 0.01, r = −0.31) and, TC and LDL-C were negatively correlated to Faecalibacterium prausnitzii (p = 0.02, r = −0.29; p = 0.03, r = −0.27, respectively). Enterobacteriaceae, Roseburia, and Faecalibacterium prausnitzii were positively correlated with plasma butyric acid and valeric acid concentrations and negatively correlated to isobutyric acid. HDL-C was negatively correlated with valeric acid (p = 0.02, r = −0.25) and total triglyceride (TG) was positively correlated to isovaleric acid (p = 0.03, r = 0.23). Taken together, oats consumption significantly reduced TC and LDL-C, and also mediated a prebiotic effect on gut microbiome. Akkermansia muciniphila, Roseburia, Bifidobacterium, and Faecalibacterium prausnitzii, and plasma SCFA correlated with oat-induced changes in plasma lipids, suggesting prebiotic activity of oats to modulate gut microbiome could contribute towards its cholesterol-lowering effect.
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Affiliation(s)
- Dengfeng Xu
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Meiyuan Feng
- Department of R&D Life Science, PepsiCo, Inc., Shanghai, China
| | - YiFang Chu
- Department of R&D Life Science, PepsiCo, Inc., Barrington, IL, United States
| | - Shaokang Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Varsha Shete
- Department of R&D Life Science, PepsiCo, Inc., Barrington, IL, United States
| | - Kieran M Tuohy
- Department of Food Quality and Nutrition, Research Innovation Centre, Fondazione Edmund Mach, Trento, Italy
| | - Feng Liu
- Department of R&D Life Science, PepsiCo, Inc., Shanghai, China
| | - Xirui Zhou
- Department of R&D Life Science, PepsiCo, Inc., Shanghai, China
| | - Alison Kamil
- Department of R&D Life Science, PepsiCo, Inc., Barrington, IL, United States
| | - Da Pan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Hechun Liu
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Xian Yang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Chao Yang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Baoli Zhu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Na Lv
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Qian Xiong
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Xin Wang
- Department of Nutrition and Functional Food Research, Beijing Research Institute for Nutritional Resources, Beijing, China
| | - Jianqin Sun
- Department of Clinical Nutrition, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Yuexin Yang
- National Institute for Nutrition and Health, Center for Disease Control and Prevention, Beijing, China
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40
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Al-Makki A, DiPette D, Whelton PK, Murad MH, Mustafa RA, Acharya S, Beheiry HM, Champagne B, Connell K, Cooney MT, Ezeigwe N, Gaziano TA, Gidio A, Lopez-Jaramillo P, Khan UI, Kumarapeli V, Moran AE, Silwimba MM, Rayner B, Sukonthasan A, Yu J, Saraffzadegan N, Reddy KS, Khan T. Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary. Hypertension 2021; 79:293-301. [PMID: 34775787 PMCID: PMC8654104 DOI: 10.1161/hypertensionaha.121.18192] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.
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Affiliation(s)
- Akram Al-Makki
- Indiana University Health Arnett, Lafayette (A.A.-M.).,Indiana University School of Medicine - West Lafayette (A.A.-M.).,College of Pharmacy, Purdue University, West Lafayette, IN (A.A.-M.)
| | - Donald DiPette
- Department of Medicine, University of South Carolina School of Medicine, University of South Carolina, Columbia (D.D.)
| | - Paul K Whelton
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (P.K.W.)
| | - M Hassan Murad
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (M.H.M.)
| | - Reem A Mustafa
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City (R.A.M.).,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada (R.A.M.)
| | - Shrish Acharya
- Indiana University Health Arnett, Lafayette (A.A.-M.).,Department of Internal Medicine, Colonial War Memorial Hospital and National Medicine and Therapeutics Committee, Ministry of Health, Fiji (S.A.)
| | - Hind Mamoun Beheiry
- Faculty of Nursing Sciences, International University of Africa (IUA), Khartoum, Sudan (H.M.B.)
| | - Beatriz Champagne
- Coalition for Americas' Health/Coalición América Saludable CLAS, representing civil society organizations in Latin America, Dallas, TX (B.C.)
| | - Kenneth Connell
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, St. Michael, Barbados (K.C.)
| | | | | | - Thomas Andrew Gaziano
- Harvard Medical School, Boston, MA (T.A.G.).,Brigham and Women's Hospital, Boston, MA (T.A.G.)
| | - Agaba Gidio
- Mulago National Referral Hospital, Kampala, Uganda (A.G.)
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia (P.L.-J.)
| | - Unab I Khan
- Department of Family Medicine, The Aga Khan University, Pakistan (U.I.K.)
| | - Vindya Kumarapeli
- Directorate of Non-Communicable Diseases, Ministry of Health, Colombo, Sri Lanka (V.K.)
| | - Andrew E Moran
- Global Hypertension Control, Resolve to Save Lives, an initiative of Vital Strategies, NY (A.E.M.).,Division of General Medicine, Columbia University Irving Medical Centre, NY (A.E.M.)
| | - Margaret Mswema Silwimba
- University Teaching Hospital (Adult), Lusaka, Zambia and Faculty of Pharmacy, Lusaka Apex Medical University (M.M.S.)
| | - Brian Rayner
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa (B.R.)
| | - Apichard Sukonthasan
- Department of Medicine, Bangkok Hospital Chiang Mai, Mueang Chiang Mai, Thailand (A.S.)
| | - Jing Yu
- Hypertension Center, Department of Cardiology, Lanzhou University Second Hospital, China (J.Y.)
| | - Nizal Saraffzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Iran (N.S.).,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada (N.S.)
| | | | - Taskeen Khan
- Department of Non-Communicable Diseases, World Health Organization, Geneva, Switzerland (T.K.).,Department of Public Health Medicine, University of Pretoria, Gauteng, South Africa (T.K.)
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Abstract
Several important findings bearing on the prevention, detection, and management of hypertension have been reported since publication of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. This review summarizes and places in context the results of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics covered include blood pressure measurement, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and blood pressure threshold for drug therapy, lifestyle and pharmacological management, treatment target blood pressure goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches. Presenting new information in each of these areas has the potential to increase hypertension awareness, treatment, and control which remain essential for the prevention of cardiovascular disease and mortality in the future.
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Affiliation(s)
- Robert M Carey
- Department of Medicine, University of Virginia Health System, Charlottesville (R.M.C)
| | - Jackson T Wright
- Department of Medicine, Case-Western Reserve University School of Medicine, Cleveland, OH (J.T.W.)
| | - Sandra J Taler
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (S.J.T.)
| | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University, New Orleans, LA (P.K.W.)
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