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Tanglai W, Jeamjitvibool T, Chen P, Lockwood MB, Cajita M. Gender and Sex-Based Differences in Hypertension Risk Factors Among Non-Hispanic Asian Adults in the United States. J Cardiovasc Nurs 2025; 40:280-289. [PMID: 39330764 DOI: 10.1097/jcn.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
INTRODUCTION The prevalence of hypertension (HTN) is rising at an accelerated rate, and it remains the primary factor contributing to cardiovascular illnesses. Sex can serve as an influencing factor, leading to variations in the factors affecting HTN. OBJECTIVE This study aimed to investigate gender and sex differences in the prevalence of HTN and explore the associations between HTN and 4 categories of risk factors: demographics, habits or lifestyle, body measurement, and laboratory blood results among non-Hispanic Asians in the United States. METHODS This secondary analysis included non-Hispanic Asian adults aged 18 years or older from the 2017 to 2018 National Health and Nutrition Examination Surveys. RESULTS Among the 815 participants, 35% of men (140 of 399) and 37% (154 of 416) of women had HTN ( P = .610). The mean age for men is 46.03 ± 16.9 years, whereas the mean age for women is 49.24 ± 16.8 years. After regression analysis, advancing age, increased body mass index, and increased serum uric acid were significant predictors of HTN in both sexes. However, men developed HTN earlier compared with women. Marital status and increased fasting glucose were only significant in men. Compared with their never-married counterparts, men who were currently married or living with a partner had lower odds of having HTN (odds ratio, 0.28; P = .034). CONCLUSIONS There was no significant difference in the prevalence of HTN between the sexes. Age, body mass index, and serum uric acid were significant risk factors in both men and women. Meanwhile, marital status and fasting glucose were only significant in men.
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Escobar MF, Benitez-Díaz N, Blanco-Londoño I, Cerón-Garcés C, Peña-Zárate EE, Guevara-Calderón LA, Libreros-Peña L, Galindo JS. Synthesis of evidence for managing hypertensive disorders of pregnancy in low middle-income countries: a scoping review. BMC Pregnancy Childbirth 2024; 24:622. [PMID: 39354425 PMCID: PMC11443752 DOI: 10.1186/s12884-024-06796-2] [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] [Received: 04/05/2024] [Accepted: 08/29/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertensive disorders of pregnancy (HDPs) remain one of the leading causes of maternal mortality globally, especially in Low- and middle-income countries (LMICs). To reduce the burden of associated morbidity and mortality, standardized prompt recognition, evaluation, and treatment have been proposed. Health disparities, barriers to access to healthcare, and shortage of resources influence these conditions. We aimed to synthesize the literature evidence for the management of HDPs in LMICs. METHODS A scoping review was conducted in five databases (PubMed, Web of Science, Epistemonikos, Clinical Key and, Scielo) using MeSh terms, keywords, and Boolean connectors. We summarized the included studies according to the following categories: study design, objectives, settings, participant characteristics, eligibility criteria, interventions, assessed outcomes, and general findings. RESULTS Six hundred fifty-one articles were retrieved from the literature search in five databases. Following the selection process, 65 articles met the predefined eligibility criteria. After performing a full-text analysis, 27 articles were included. Three themes were identified from the articles reviewed: prevention of HDPs, management of HDPs (antihypertensive and non-hypertensive management) and pregnancy monitoring and follow-up. The topics were approached from the perspective of LMICs. CONCLUSIONS LMICs face substantial limitations and obstacles in the comprehensive management of HDPs. While management recommendations in most LMICs align with international guidelines, several factors, including limited access to crucial medications, unavailability of diagnostic tests, deficiencies in high-quality healthcare infrastructure, restrictions on continuing professional development, a shortage of trained personnel, community perceptions of preeclampsia, and outdated local clinical practice guidelines, impede the comprehensive management of patients. The development and implementation of protocols, standardized guides and intervention packages are a priority.
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Affiliation(s)
- María Fernanda Escobar
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia.
- Facultad de Ciencias de La Salud, Universidad Icesi, Calle 18 No. 122 -135, Cali, Colombia.
| | - Nicole Benitez-Díaz
- Facultad de Ciencias de La Salud, Universidad Icesi, Calle 18 No. 122 -135, Cali, Colombia
| | | | - Catalina Cerón-Garcés
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia
| | - Evelyn E Peña-Zárate
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia
| | - Lizbeth A Guevara-Calderón
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia
| | - Laura Libreros-Peña
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia
| | - Juan Sebastián Galindo
- Facultad de Ciencias de La Salud, Universidad Icesi, Calle 18 No. 122 -135, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia
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Philip R, Janssen C, Jose A, Beaney T, Clarke J. An assessment of variation in quality of hypertension guidelines across income settings using the AGREE II tool. Wellcome Open Res 2024; 9:526. [PMID: 39606620 PMCID: PMC11599801 DOI: 10.12688/wellcomeopenres.22699.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2024] [Indexed: 11/29/2024] Open
Abstract
Background Hypertension affects over one billion people worldwide, posing a significant global health burden. Clinical practice guidelines could play a key role in guiding healthcare providers in improving hypertension management. However, how the quality of hypertension CPGs differs across country income settings is not well understood. This study aims to explore variation in the quality of hypertension CPGs, comparing low-, middle-, and high-income countries, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Methods A Medline and grey literature search was conducted to identify hypertension CPGs in English from every country from January 2012 to September 2022. Two reviewers independently assessed and scored each CPG against the AGREE II tool. Results were described and the Kruskal-Wallis test was used to test for statistically significant difference in the domain scores across country income groups. Results Forty-three CPGs were included for analysis from across income settings. Guidelines from HICs scored higher in four out of the six domains. The highest scoring domain was 4: "clarity and presentation" (median score 83%), the lowest scoring was domain 6 "editorial independence" (median score 0%). Statistically significant differences between income settings were observed for domain 3 "rigour of development" (p <0.001), domain 4 "clarity and presentation" (p = 0.03) and domain 6 "editorial independence" (p = 0.04). Conclusions Whilst some variation exists in guideline quality across country income levels, the greatest degree of variation exists across the domains of the AGREE II tool. Global efforts to improve the quality of hypertension guidelines should focus on the transparent statement of editorial independence of guideline committees and apply rigorous replicable methods in the authoring of guidelines. Establishing national and international communities of practice to collaborate across income settings may reduce duplication of resource, allow for shared learning and promote the development of high-quality hypertension CPGs.
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Affiliation(s)
- Richu Philip
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, England, UK
- Imperial College London Department of Primary Care and Public Health, London, England, UK
| | - Carolina Janssen
- Amsterdam UMC Location AMC Department of Cardiology, Amsterdam, North Holland, The Netherlands
| | - Arun Jose
- Centre for Chronic Disease Control, New Delhi, India
| | - Thomas Beaney
- Imperial College London Department of Primary Care and Public Health, London, England, UK
| | - Jonathan Clarke
- Imperial College London Department of Mathematics, London, England, UK
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Kraft AD, Capuno JJ, Calicdan KGR, Cruz GT, O'Donnell O. Missed opportunities for hypertension screening of older people in the Philippines: cross-sectional analysis of nationally representative individual-level data. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 50:101188. [PMID: 39296578 PMCID: PMC11407953 DOI: 10.1016/j.lanwpc.2024.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 09/21/2024]
Abstract
Background Guidelines recommend routine blood pressure measurement at health facilities. We estimated the potential for opportunistic screening for hypertension at health facilities to change the level and distribution of diagnosed hypertension in the older population of the Philippines. Methods We used a representative, nationwide sample of Filipinos aged 60 years and older and classified respondents as a) hypertensive if they had high (≥140/90 mm Hg) blood pressure (BP) or were taking BP medication, b) diagnosed if told have high BP by a doctor, and c) a missed opportunity for diagnosis if they were hypertensive, undiagnosed and had an outpatient visit to a health facility in the past 12 months. We assumed c) would be diagnosed if health facilities operated opportunistic screening. We estimated percentages of hypertensives diagnosed and with a missed opportunity overall, by wealth quintile and covariates, with age-sex and, then, full adjustment. Findings We estimated that opportunistic screening at health facilities would increase the percentage of hypertensives diagnosed from 62.7% (95% CI: 58.2, 67.0) to 74.4% (95% CI: 70.9, 77.6). The increase would be larger in richer groups due to lower (private) healthcare utilization by poorer, undiagnosed hypertensives. Interpretation Opportunistic screening for hypertension, if effectively implemented at health facilities, would substantially increase diagnosis but exacerbate inequality unless barriers discouraging poorer, older Filipinos from accessing outpatient and primary care were lowered. Funding Economic Research Institute for ASEAN and East Asia, Swiss Agency for Development and Cooperation/Swiss National Science Foundation grant 400640_160374.
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Affiliation(s)
- Aleli D Kraft
- School of Economics, University of the Philippines Diliman, Philippines
| | - Joseph J Capuno
- School of Economics, University of the Philippines Diliman, Philippines
| | | | - Grace T Cruz
- Population Institute, University of the Philippines Diliman, Philippines
| | - Owen O'Donnell
- School of Health Policy & Management, School of Economics, Erasmus University Rotterdam, the Netherlands
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Sukonthasarn A, Borghi C, Chan YH, Cheng F, Choi HI, Mehta R, Le B, Lim IH, Lin TH, Rosman A, Tiksnadi BB, Manolis A. East meets West: Bringing the ESH 2023 hypertension guidelines into Asia. Eur J Intern Med 2024; 127:25-30. [PMID: 38960822 DOI: 10.1016/j.ejim.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/07/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
Hypertension remains a major problem worldwide, especially across the Asia-Pacific region, which reports high prevalence rates and slow improvements in treatment rate and blood pressure (BP) control rate. Asian patients with hypertension may also vary with regard to phenotype and the epidemiology of the complications of hypertension, especially when compared with Western patients. Given these differences, Western guidelines may not necessarily be applicable to countries in the Asia Pacific. This narrative review aims to provide a critical comparison between the recently published European Society of Hypertension (ESH) 2023 guidelines and existing local guidelines in select Asian countries, offer expert opinion on how to fill gaps in the ESH 2023 guidelines for hypertension in the Asian context, and examine the need for harmonisation of hypertension guidelines worldwide. This review focuses on the definition and diagnosis of hypertension, the treatment thresholds and targets, and recommendations on the use of pharmacotherapy.
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Affiliation(s)
| | - Claudio Borghi
- Department of Cardiovascular Medicine, Department of Cardiac, Thoracic and Vascular Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | - Hyo-In Choi
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Binh Le
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Ing Haan Lim
- Mount Elizabeth Hospital Singapore, Singapore, Singapore
| | - Tsing-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Badai Bhatara Tiksnadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
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Dela Rosa JGL, Catral CDM, Reyes NA, Opiso DMS, Ong EP, Ornos EDB, Santos JR, Quebral EPB, Callanta MLJ, Oliva RV, Tantengco OAG. Current status of hypertension care and management in the Philippines. Diabetes Metab Syndr 2024; 18:103008. [PMID: 38640838 DOI: 10.1016/j.dsx.2024.103008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
AIMS In this paper, we discuss the existing data on the burden of hypertension in the Philippines and present the status of management, prevention, and control of hypertension in the country. METHODS A literature review was conducted to synthesize the status of hypertension care in the Philippines. RESULTS Hypertension continues to contribute to the country's leading causes of death. Similar to the global trend, almost half of hypertensive Filipinos are still not aware of their condition, and only 27 % have it under control. The prevalence of hypertension has steadily increased from 22 % in 1993 to 25.15 % in 2013. The 2020 Philippine Society for Hypertension clinical practice guideline defines hypertension as an office BP of 140/90 mm Hg or above following the proper standard BP measurement. During the past decade, monotherapy has been the mode of treatment in more than 80 % of Filipino patients. This could also explain why the BP control rates have been low. The most prevalent complications of hypertension in the Philippines were stroke (11.6 %), ischemic heart disease (7.7 %), chronic kidney disease (6.30 %), and hypertensive retinopathy (2.30 %). Hypertension causes economic tolls on patients, from the cost of drugs to hospitalization and complications. Hospitalization from hypertensive complications can easily wipe out the savings of middle-class families and is catastrophic for lower-income Filipinos. CONCLUSION In this review, we summarize the existing data on the burden of hypertension among Filipinos and the risk factors associated with the disease. We present the current screening tools, diagnostics, treatment, and prevention strategies for hypertension in the Philippines. Lastly, we propose solutions to meet the global targets of hypertension management and help relieve the growing burden of this disease.
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Affiliation(s)
| | | | | | - Danna Mae S Opiso
- College of Medicine, University of the Philippines, Ermita, Manila, Philippines
| | - Erika P Ong
- College of Medicine, University of the Philippines, Ermita, Manila, Philippines
| | - Eric David B Ornos
- Department of Medical Microbiology, College of Public Health, University of the Philippines, Ermita, Manila, Philippines
| | - Jerico R Santos
- Department of Medical Microbiology, College of Public Health, University of the Philippines, Ermita, Manila, Philippines
| | - Elgin Paul B Quebral
- Department of Medical Microbiology, College of Public Health, University of the Philippines, Ermita, Manila, Philippines
| | - Maria Llaine J Callanta
- Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines, Ermita, Manila, Philippines
| | - Raymond V Oliva
- Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines, Ermita, Manila, Philippines; Department of Medicine, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines
| | - Ourlad Alzeus G Tantengco
- Department of Physiology, College of Medicine, University of the Philippines, Ermita, Manila, Philippines; Department of Biology, College of Science, De La Salle University, Manila, Philippines.
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Xu X, Zeng L, Jha V, Cobb LK, Shibuya K, Appel LJ, Neal B, Schutte AE. Potassium-Enriched Salt Substitutes: A Review of Recommendations in Clinical Management Guidelines. Hypertension 2024; 81:400-414. [PMID: 38284271 PMCID: PMC10863666 DOI: 10.1161/hypertensionaha.123.21343] [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] [Indexed: 01/30/2024]
Abstract
Excess dietary sodium intake and insufficient dietary potassium intake are both well-established risk factors for hypertension. Despite some successful initiatives, efforts to control hypertension by improving dietary intake have largely failed because the changes required are mostly too hard to implement. Consistent recent data from randomized controlled trials show that potassium-enriched, sodium-reduced salt substitutes are an effective option for improving consumption levels and reducing blood pressure and the rates of cardiovascular events and deaths. Yet, salt substitutes are inconsistently recommended and rarely used. We sought to define the extent to which evidence about the likely benefits and harms of potassium-enriched salt substitutes has been incorporated into clinical management by systematically searching guidelines for the management of hypertension or chronic kidney disease. We found incomplete and inconsistent recommendations about the use of potassium-enriched salt substitutes in the 32 hypertension and 14 kidney guidelines that we reviewed. Discussion among the authors identified the possibility of updating clinical guidelines to provide consistent advice about the use of potassium-enriched salt for hypertension control. Draft wording was chosen to commence debate and progress consensus building: strong recommendation for patients with hypertension-potassium-enriched salt with a composition of 75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, unless they have advanced kidney disease, are using a potassium supplement, are using a potassium-sparing diuretic, or have another contraindication. We strongly encourage clinical guideline bodies to review their recommendations about the use of potassium-enriched salt substitutes at the earliest opportunity.
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Affiliation(s)
- Xiaoyue Xu
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
| | - Ling Zeng
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, India (V.J.)
- School of Public Health, Imperial College London, United Kingdom (V.J., B.N.)
- Prasanna School of Public Health, Manipal Academy of Higher Education, India (V.J.)
| | | | | | - Lawrence J. Appel
- Department of Epidemiology, Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Bruce Neal
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- School of Public Health, Imperial College London, United Kingdom (V.J., B.N.)
| | - Aletta E. Schutte
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
- Department of Paediatrics, Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (A.E.S)
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Rahman ARA, Magno JDA, Cai J, Han M, Lee HY, Nair T, Narayan O, Panyapat J, Van Minh H, Khurana R. Management of Hypertension in the Asia-Pacific Region: A Structured Review. Am J Cardiovasc Drugs 2024; 24:141-170. [PMID: 38332411 PMCID: PMC10973088 DOI: 10.1007/s40256-023-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/10/2024]
Abstract
This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin-angiotensin-aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential.
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Affiliation(s)
- Abdul R A Rahman
- An Nur Specialist Hospital, Jalan Gerbang Wawasan 1, Seksyen 15, 43650, Bandar Baru Bangi, Selangor, Malaysia.
| | - Jose Donato A Magno
- Division of Cardiovascular Medicine, Philippine General Hospital, Cardiovascular Institute, University of the Philippines College of Medicine, Angeles University Foundation Medical Center, Angeles, Philippines
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, Beijing, People's Republic of China
| | - Myint Han
- Grand Hantha International Hospital, Yangon, Myanmar
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Chongno-gu, Seoul, 03080, South Korea
| | - Tiny Nair
- PRS Hospital, Trivandrum, Kerala, India
| | - Om Narayan
- The Northern Hospital, 185 Cooper St., Epping, VIC, 3122, Australia
| | - Jiampo Panyapat
- Bhumibol Adulyadej Hospital, 171 Paholyothin Road, Saimai, Bangkok, 10220, Thailand
| | - Huynh Van Minh
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue, 530000, Vietnam
| | - Rohit Khurana
- The Harley Street Heart and Vascular Center, Gleneagles Hospital, Singapore, 258500, Singapore
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Sianoya AC, Nicodemus NA, Dalmacio LMM. Targeting the Filipino gut microbiota in the management of hypertension. Egypt Heart J 2024; 76:7. [PMID: 38270758 PMCID: PMC10811302 DOI: 10.1186/s43044-024-00440-2] [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: 09/06/2023] [Accepted: 01/19/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Hypertension is a major health problem in the Philippines, being the second leading disease and the second leading factor driving the most death and disability in the country. Despite efforts made toward increasing awareness, improving availability of medications, and strengthening patient adherence, more than 7 in every 10 hypertensive Filipinos still have uncontrolled hypertension. MAIN BODY In the recent years, the role of gut microbiota in hypertension has been highlighted, with studies showing alterations in the gut microbiota of hypertensive individuals and its positive effect on the pharmacokinetics of some antihypertensive drugs. CONCLUSIONS These findings show how gut microbiota can be an important but possibly overlooked consideration in the management of hypertension in the Philippines. Clinicians might benefit from maximizing the relationship between gut microbiota and hypertension to achieve good BP control and ultimately address the burden of uncontrolled hypertension in the country.
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Affiliation(s)
- Abraham C Sianoya
- College of Medicine, University of the Philippines Manila, Manila, Philippines.
| | - Nemencio A Nicodemus
- Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Leslie Michelle M Dalmacio
- Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines Manila, Manila, Philippines
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Wang TD, Ohkubo T, Bunyi ML, Chadachan VM, Chia YC, Kario K, Kim CH, Lin HJ, Matsushita N, Park S, Salman E, Sukonthasarn A, Tay JC, Tien HA, Tomar I, Turana Y, Van Minh H, Verma N, Wander GS, Wang JG, Zhou Y, Imai Y. Current realities of home blood pressure monitoring from physicians' perspectives: results from Asia HBPM survey 2020. Hypertens Res 2023; 46:1638-1649. [PMID: 37041412 PMCID: PMC10319632 DOI: 10.1038/s41440-023-01259-1] [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] [Received: 11/22/2022] [Revised: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 04/13/2023]
Abstract
Uncontrolled hypertension is a significant problem in many parts of Asia. Effective management is essential to reduce the burden of hypertension. Home blood pressure monitoring (HBPM) is a promising tool that can aid in the diagnosis and management of hypertension. Experts from 11 countries/regions in Asia conceptualized a large-scale survey to examine the current realities of HBPM. A cross-sectional survey was conducted among health care professionals from China, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam between November 2019 and June 2021. Physicians' responses were summarized using descriptive statistics. A total of 7945 physicians participated in the survey. Among all respondents, 50.3% and 33.5% viewed HBPM as highly recognized by physicians and patients in their country/region, respectively. Lack of understanding of HBPM and concern with the accuracy and reliability of HBPM devices were identified as key barriers to HBPM recognition. Nearly all physicians (95.9%) reported recommending HBPM to their patients; however, they reported less than 50% of their patients measured home blood pressure (HBP). Among physicians who recommended HBPM, only 22.4% and 54.1% cited HBP diagnostic threshold values and timing of taking antihypertensive drugs that were consistent with available guidelines, respectively. The survey reveals that the recognition of HBPM as a valuable tool to diagnose and manage hypertension is suboptimal in most parts of Asia. Despite high recommendation of HBPM to hypertensive patients by physicians, there are considerable discrepancies between guidelines recommendations and practice realities. The recognition of HBPM as a valuable tool for the diagnosis and management of hypertension is suboptimal among both physicians and patients in Asia. A clear and consistent guidance for proper HBPM practice and use of validated and calibrated HBP monitors are among the top priorities to support the integration of HBPM into daily patient care. HBPM: home blood pressure monitoring, HBP: home blood pressure.
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Affiliation(s)
- Tzung-Dau Wang
- Cardiovascular Center and Divisions of Hospital Medicine and Cardiology, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhong-Shan South Road, 100225, Taipei City, Taiwan, ROC.
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Ma Lourdes Bunyi
- Dr. HB Calleja Heart and Vascular Institute, St. Luke's Medical Center, 279 E. Rodriguez Sr. Avenue, Quezon City, 1102, Philippines
| | | | - Yook Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 5 Jalan Universiti, Bandar Sunway, 47500, Selangor Darul Ehsan, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, 50910, Kuala Lumpur, Malaysia
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 (baekchilsipsam) beo, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Hung-Ju Lin
- Cardiovascular Center and Divisions of Hospital Medicine and Cardiology, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhong-Shan South Road, 100225, Taipei City, Taiwan, ROC
| | - Noriko Matsushita
- Asia Pacific Global Medical Affairs, Omron Healthcare Singapore, Pte. Ltd., 438B Alexandra Road #08-01/02, Alexandra TechnoPark, 119968, Singapore
| | - Sungha Park
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Division of Cardiology, 50-1 Yonsei Ro Seodaemungu Ludlow Faculty Building, Seoul, 03722, Republic of Korea
| | - Ebtehal Salman
- Asia Pacific Global Medical Affairs, Omron Healthcare Co., Ltd., 53, Kunotsubo, Terado-cho, Muko, Kyoto, 617-0002, Japan
| | - Apichard Sukonthasarn
- Department of Medicine, Bangkok Hospital Chiang Mai, 88/8 Moo6, Tumbol Nong Pa Khrang, Amphur Muang Chiang Mai, Chiang Mai, 50000, Thailand
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433, Singapore
| | - Hoang Anh Tien
- Cardiovascular Department, Hue University of Medicine and Pharmacy, Hue university, Hue, 06 Ngo Quyen, Vinh Ninh District, Hue city, Thua Thien Hue province, 52000, Vietnam
| | - Isha Tomar
- Asia Pacific Global Medical Affairs, Omron Healthcare India Private Ltd., 6th Floor, B-Block, Sewa Tower, Plot No. 19, Sector-18, Udyog Vihar, Gurugram, Haryana, 122008, India
| | - Yuda Turana
- Department of Neurology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya no 2, North Jakarta, 14440, Indonesia
| | - Huynh Van Minh
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen, Vinh Ninh District, Hue city, Thua Thien Hue province, 52000, Vietnam
| | - Narsingh Verma
- Professor Department of Physiology, Officiating Head Department of Family Medicine, King George's Medical University Lucknow, Lucknow, 226003, India
| | - Gurpreet Singh Wander
- Professor & Head of Cardiology, Dayanand Medical College & Hospital Unit Hero DMC Heart Institute, Ludhiana, 141001, Punjab, India
| | - Ji-Guang Wang
- Department of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin 2nd Road 197, Shanghai, 200025, China
| | - Yi Zhou
- Department of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin 2nd Road 197, Shanghai, 200025, China
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, 13-18, Station Plaza Building, Futsukamachi, Aobaku, Sendai, Miyagi, 980-0802, Japan
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Agreement regarding overcoming hypertension in the Asian Hypertension Society Network 2022. Hypertens Res 2023; 46:3-8. [PMID: 36229522 DOI: 10.1038/s41440-022-00994-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 02/03/2023]
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Ulep VGT, Uy J, Casas LD. What explains the large disparity in child stunting in the Philippines? A decomposition analysis. Public Health Nutr 2022; 25:2995-3007. [PMID: 34602121 PMCID: PMC9991861 DOI: 10.1017/s136898002100416x] [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] [Received: 01/06/2021] [Revised: 09/12/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE About one-third of under-five Filipino children are stunted, with significant socio-economic inequality. This study aims to quantify factors that explain the large gap in stunting between poor and non-poor Filipino children. DESIGN Using the 2015 Philippine National Nutrition Survey, we conducted a linear probability model to examine the determinants of child stunting and then an Oaxaca-Blinder decomposition to explain the factors contributing to the gap in stunting between poor and non-poor children. SETTING Philippines. PARTICIPANTS 1881 children aged 6-23 months participated in this study. RESULTS The overall stunting prevalence was 38·5 % with a significant gap between poor and non-poor (45·0 % v. 32·0 %). Maternal height, education and maternal nutrition status account for 26 %, 18 % and 17 % of stunting inequality, respectively. These are followed by quality of prenatal care (12 %), dietary diversity (12 %) and iron supplementation in children (5 %). CONCLUSIONS Maternal factors account for more than 50 % of the gap in child stunting in the Philippines. This signifies the critical role of maternal biological and socio-economic circumstances in improving the linear growth of children.
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Affiliation(s)
- Valerie Gilbert T Ulep
- Philippine Institute for Development Studies, 18F Three Cyberpod Centris – North Tower, EDSA Cor. Quezon Avenue, Quezon City, Philippines
- Ateneo Policy Center, School of Government, Ateneo de Manila University, Quezon City, Philippines
| | - Jhanna Uy
- Philippine Institute for Development Studies, 18F Three Cyberpod Centris – North Tower, EDSA Cor. Quezon Avenue, Quezon City, Philippines
- Health Sciences Program, School of Science and Engineering, Ateneo de Manila University, Quezon City, Philippines
| | - Lyle Daryll Casas
- Philippine Institute for Development Studies, 18F Three Cyberpod Centris – North Tower, EDSA Cor. Quezon Avenue, Quezon City, Philippines
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