Disparities in hypertension control advice according to smoking status

Time Trends in Comorbidity and Management of Hypertension and Self-reported Diabetes: A 15-Year Nationwide Longitudinal Study in China

BACKGROUND

To examine time trends in comorbidity of hypertension and self-reported type 2 diabetes mellitus (T2DM) and their diagnosis, treatment, and management in China during 2000-2015 and study factors associated with these outcomes.

METHODS

Longitudinal data collected from the China Health and Nutrition Survey (CHNS) during 2000-2015 were analyzed. 143, 351, and 338 had both hypertension and self-reported T2DM were selected in 2000, 2011, and 2015, respectively. Average systolic blood pressure (SBP) and diastolic blood pressure (DBP) and hypertension prevalence among T2DM participants, and treatment and control of hypertension and self-reported T2DM among participants with both conditions were examined for all and by sex and weight status. Poisson regression model assessed the associations.

RESULTS

From 2000 to 2015, among participants with self-reported T2DM, hypertension prevalence dropped from 88.4% to 83.0% and blood pressures decreased (P < 0.05). Men and overweight/obese participants had greater decreases in hypertension prevalence and DBP, while women had a larger decrease in SBP than men. Over time, among participants with both hypertension and self-reported T2DM, rates of hypertension treatment (45.3%-57.7%), hypertension control (3.0%-10.9%), and self-reported T2DM treatment (90.0%-95.6%) increased (all P < 0.001). Older, women, ever-smoking, heavier drinking, better income level, higher education level, and obesity had higher rates of prevalence, treatment, and control of hypertension, and self-reported T2DM treatment among participants with both hypertension and self-reported T2DM.

CONCLUSIONS

Rates of hypertension treatment and control among participants with both hypertension and self-reported T2DM have improved in recent years, but were still low.

Effectiveness and Adherence to Treatment with Perindopril/Indapamide/Amlodipine Single-Pill Combination in a Greek Population with Hypertension

BACKGROUND

Despite the overwhelming evidence and the established benefits of antihypertensive treatment, adherence to treatment remains low.

OBJECTIVE

To assess the adherence to treatment with a perindopril/indapamide/amlodipine single-pill combination (SPC), its effectiveness on blood pressure (BP) reduction, as well as the safety and tolerability of this SPC over a 4-month treatment period.

METHODS

This multicenter, non-interventional study prospectively included 2285 hypertensive patients on perindopril/indapamide/amlodipine SPC. The data were recorded at baseline, 1 month, and 4 months.

RESULTS

Of the 2285 hypertensive patients included in the study, 50.5% were at "high/very high risk". Mean systolic (SBP)/diastolic (DBP) decreased from 162.3 ± 13.3/93.1 ± 9.3 mmHg at baseline to 129.7 ± 8.3/78.6 ± 7.1 mmHg at 4 months (p < 0.001). Patients with higher baseline BP levels showed greater BP reduction. Patients with hypertension stages 1, 2, and 3 showed mean SBP/DBP reductions of 21.5/10.4 mmHg, 34.2/14.7 mmHg, and 51.2/22.5 mmHg, respectively, at study end (p < 0.001). Only 26 patients (1.1%) prematurely discontinued treatment (0.58% due to an adverse reaction or event).

CONCLUSIONS

Perindopril/indapamide/amlodipine SPC decreased BP levels rapidly and significantly. The degree of BP reduction was associated with the severity of hypertension and/or with total cardiovascular risk at baseline. Simplifying the drug regimen by using this SPC improved adherence and showed excellent tolerability.

Daily physical activity of Brazilian carriers of arterial hypertension: a transversal analysis

OBJECTIVE

To describe the profile of the practice of physical activity in the daily life of Brazilian adults with arterial hypertension and to analyze whether the practice performed complies with the recommendations of the World Health Organization.

METHODS

Cross-sectional data were obtained from the Surveillance System of Risk Factors and Protection for Chronic Noncommunicable Diseases of 2014, involving 40,853 adults aged 18 years and over in all Brazilian capitals, interviewed by telephone survey.

RESULTS

Walking, soccer and water aerobics were the main modalities of exercise and sport practiced. The weekly volume of effort led 35% of practitioners to reach the recommended goal of the World Health Organization. The low weekly frequency of activities stood out among hypertensives who did not reach the goal.

CONCLUSION

Health services should clarify the need for regularity of physical activity for hypertensive individuals to benefit substantially.

Effects of a worksite tobacco control intervention in India: the Mumbai worksite tobacco control study, a cluster-randomised trial

OBJECTIVES

We assessed a worksite intervention designed to promote tobacco control among workers in the manufacturing sector in Greater Mumbai, India.

METHODS

We used a cluster-randomised design to test an integrated health promotion/health protection intervention, the Healthy, Safe, and Tobacco-free Worksites programme. Between July 2012 and July 2013, we recruited 20 worksites on a rolling basis and randomly assigned them to intervention or delayed-intervention control conditions. The follow-up survey was conducted between December 2013 and November 2014.

RESULTS

The difference in 30-day quit rates between intervention and control conditions was statistically significant for production workers (OR=2.25, p=0.03), although not for the overall sample (OR=1.70; p=0.12). The intervention resulted in a doubling of the 6-month cessation rates among workers in the intervention worksites compared to those in the control, for production workers (OR=2.29; p=0.07) and for the overall sample (OR=1.81; p=0.13), but the difference did not reach statistical significance.

CONCLUSIONS

These findings demonstrate the potential impact of a tobacco control intervention that combined tobacco control and health protection programming within Indian manufacturing worksites.

TRIAL REGISTRATION NUMBER

NCT01841879.

Receiving and adhering to lifestyle modification counseling for hypertension: disparities between smokers and nonsmokers

Hypertensive patients who smoke are in particular need of lifestyle modification counseling because they are at increased risk for poorer outcomes. The authors examined whether hypertensive smokers were more or less likely than nonsmokers to report receiving recommendations for diet, salt intake, exercise, alcohol use, and medication and whether receipt of recommendations was differentially associated with lifestyle changes among smokers vs nonsmokers. In an analysis of data from the 2011 Behavioral Risk Factor Surveillance System on a representative sample of hypertensive adults from 9 US states (N=23,093), smokers were less likely than nonsmokers to report being told by a provider to exercise (odds ratio [OR], 0.66; P<.001) and change their diet (OR, 0.83; P<.05). Receiving dietary recommendations was more strongly associated with self-reported dietary improvements among smokers (OR, 7.08; P<.001) compared with nonsmokers (OR, 4.17; P<.001) P<.01. Delivery of counseling may vary by smoking status. When provided, lifestyle counseling may be equally or more effective for smokers compared with nonsmokers.

Preconception care: the perfect opportunity for health care providers to advise lifestyle changes for hypertensive women

PURPOSE

To provide estimates for prevalence of health care provider advice offered to reproductive-aged women and to assess their association with behavior change.

DESIGN

Cross-sectional study using the 2009 Behavioral Risk Factor Surveillance System. Setting. Nineteen states/areas.

SUBJECTS

Women aged 18 to 44 years with a self-reported history of hypertension or current antihypertensive medication use (n = 2063).

MEASURES

Self-reported hypertension; sociodemographic and health care access indicators; and provider advice and corresponding self-reported behavior change to improve diet, limit salt intake, exercise, and reduce alcohol use.

ANALYSIS

We estimated prevalence and prevalence ratios for receipt of provider advice and action to change habits. We calculated 95% confidence interval (CI) and used χ(2) tests to assess associations.

RESULTS

Overall, 9.8% of reproductive-aged women had self-reported hypertension; most reported receiving advice to change eating habits (72.9%), reduce salt intake (74.6%), and exercise (82.1%), and most reported making these changes. Only 44.7% reported receiving advice to reduce alcohol intake. Women who received provider advice were more likely to report corresponding behavior change compared to those who did not (prevalence ratios ranged from 1.3 [95% CI, 1.2-1.5, p < .05] for exercise to 1.6 [95% CI, 1.4-1.8, p < .05] for reducing alcohol use.

CONCLUSION

Health care providers should routinely advise hypertensive reproductive-aged women about lifestyle changes to reduce blood pressure and improve pregnancy outcomes.

Effects of a tobacco control intervention for teachers in India: results of the Bihar school teachers study

OBJECTIVES

We assessed a school-based intervention designed to promote tobacco control among teachers in the Indian state of Bihar.

METHODS

We used a cluster-randomized design to test the intervention, which comprised educational efforts, tobacco control policies, and cessation support and was tailored to the local social context. In 2009 to 2011, we randomly selected 72 schools from participating school districts and randomly assigned them in blocks (rural or urban) to intervention or delayed-intervention control conditions.

RESULTS

Immediately after the intervention, the 30-day quit rate was 50% in the intervention and 15% in the control group (P = .001). At the 9-month postintervention survey, the adjusted 6-month quit rate was 19% in the intervention and 7% in the control group (P = .06). Among teachers employed for the entire academic year of the intervention, the adjusted 6-month abstinence rates were 20% and 5%, respectively, for the intervention and control groups (P = .04).

CONCLUSIONS

These findings demonstrate the potent impact of an intervention that took advantage of social resources among teachers, who can serve as role models for tobacco control in their communities.

Interactions of several lipid-related gene polymorphisms and cigarette smoking on blood pressure levels

The interactions of single nucleotide polymorphisms (SNPs) and cigarette smoking on blood pressure levels are limited. The present study was undertaken to detect nine lipid-related SNPs and their interactions with cigarette smoking on blood pressure levels. Genotyping of ATP-binding cassette transporter A1 (ABCA-1) V825I, acyl-CoA:cholesterol acyltransferase-1 (ACAT-1) rs1044925, low density lipoprotein receptor (LDL-R) AvaⅡ, hepatic lipase gene (LIPC) -250G>A, endothelial lipase gene (LIPG) 584C>T, methylenetetrahydrofolate reductase (MTHFR) 677C>T, proprotein convertase subtilisin-like kexin type 9 (PCSK9) E670G, peroxisome proliferator-activated receptor delta (PPARD) +294T>C, and Scavenger receptor class B type 1 (SCARB1) rs5888 was performed in 935 nonsmokers and 845 smokers. The interactions were detected by factorial regression analysis. The frequencies of genotypes (ACAT-1 and LIPG), alleles (ABCA-1), and both genotypes and alleles (LDL-R, LIPC, PPARD and SCARB1) were different between nonsmokers and smokers (P < 0.05-0.001). The levels of pulse pressure (PP, ABCA-1), and systolic, diastolic blood pressure (SBP, DBP) and PP (LIPC) in nonsmokers were different among the genotypes (P < 0.01-0.001). The levels of SBP (ABCA-1, ACAT-1, LIPG and PCSK9), DBP (ACAT-1, LDL-R, LIPC, PCSK9 and PPARD), and PP (LIPC, LIPG, MTHFR and PCSK9) in smokers were different among the genotypes (P < 0.01-0.001). The SNPs of ABCA-1, ACAT-1 and PCSK9; ACAT-1, LDL-R, MTHFR and PCSK9; and ABCA-1, LIPC, PCSK9 and PPARD were shown interactions with cigarette smoking to influence SBP, DBP and PP levels (P < 0.05-0.001); respectively. The differences in blood pressure levels between the nonsmokers and smokers might partly result from different interactions of several SNPs and cigarette smoking.