Gender disparities in midlife hypertension: a review of the evidence on the Arab region

The burden of Cardiovascular diseases in Jordan: a longitudinal analysis from the global burden of disease study, 1990-2019

BACKGROUND

Cardiovascular Disease (CVD) is the leading cause of mortality worldwide. While countries in the Arab world continue to lack public health data and be severely understudied in health research, previous research has shown that compared to 1990, CVDs had a higher burden of disease in the Arab World in 2010. Jordan, a middle-income Arab country, is profiled with unique attributes such as a dual-sector healthcare system, political stability, and its role as a haven for refugees and migrants. These distinctive factors emphasize Jordan's suitability as a case study. This investigation aims to quantify CVD burden in Jordan and identify risk factors, contributing to a broader understanding of health challenges in the Arab region and beyond.

METHODS

The Global Burden of Disease (GBD) dataset was used to estimate prevalence, death, and disability-adjusted life-years (DALYs) as age-standardized rates from 1990 to 2019. We calculated percentage change for nine specific CVDs and reported trends by gender and age groups. Additionally, data on twelve a priori selected behavioral, clinical, and environmental risk factors attributing to overall age-standardized CVDs DALY were reported per 100,00 population.

RESULTS

In 2019, the age-standardized CVD prevalence, death, and DALYs rates in Jordan were 7980 (95% uncertainty interval [UI] 7629, 8360), 248 (95% UI 211, 288), and 4647 (95% UI 4028, 5388), respectively. Despite an increase in the absolute number of mortality and prevalence, between 1990 and 2019, the age-standardized prevalence, death, and DALYs rates all decreased by 5.5%, 45.1%, and 46.7%, respectively. In 2019, the leading risk factors contributing to overall age-standardized CVDs DALY per 100,000 population were high systolic blood pressure, high BMI, dietary risks, and high LDL cholesterol.

CONCLUSION

Despite decreasing burden rate of CVDs in Jordan between 1990 and 2019, CVDs remain the leading cause of mortality in Jordan, with an increase in the total number of prevalence and mortality. Overall, this contributes to increased healthcare costs. Further research is required to quantify the burden of CVDs and understand it better. Intervention measures and policies tailored to specific CVDs should be designed to reduce the burden of CVDs in Jordan.

Diabetes, Hypertension, and Comorbidity among Bangladeshi Adults: Associated Factors and Socio-Economic Inequalities

Diabetes, hypertension, and comorbidity are still crucial public health challenges that Bangladeshis face. Nonetheless, very few studies have been conducted to examine the associated factors, especially the socioeconomic inequalities in diabetes, hypertension, and comorbidity in Bangladesh. This study explored the prevalence of, factors connected with, and socioeconomic inequalities in diabetes, hypertension, and comorbidity among Bangladeshi adults. We used the Bangladesh Demographic and Health Survey (BDHS) data set of 2017−2018. A total of 12,136 (weighted) Bangladeshi adults with a mean age of 39.5 years (±16.2) participated in this study. Multilevel (mixed-effect) logistic regression analysis was employed to ascertain the determinants of diabetes, hypertension, and comorbidity, where clusters were considered as a level-2 factor. The concentration curve (CC) and concentration index (CIX) were utilized to investigate the inequalities in diabetes, hypertension, and comorbidity. The weighted prevalence of diabetes, hypertension, and comorbidity was 10.04%, 25.70%, and 4.47%, respectively. Age, body mass index, physical activity, household wealth status, and diverse administrative divisions were significantly associated with diabetes, hypertension, and comorbidity among the participants. Moreover, participants’ smoking statuses were associated with hypertension. Women were more prone to hypertension and comorbidity than men. Diabetes (CIX: 0.251, p < 0.001), hypertension (CIX: 0.071, p < 0.001), and comorbidity (CIX: 0.340, p < 0.001) were higher among high household wealth groups. A pro-wealth disparity in diabetes, hypertension, and comorbidity was found. These inequalities in diabetes, hypertension, and comorbidity emphasize the necessity of designing intervention schemes geared towards addressing the rising burden of these diseases.

Trends in the prevalence and associated factors of prediabetes and diabetes in Bangladesh: Evidence from population-based cross-sectional surveys

AIMS

Diabetes is a major health problem in Bangladesh, but nationally representative studies on its trends and associated factors are scarce to guide policy formulation. Therefore, the study aims to determine trends in the prevalence and associated factors of prediabetes and diabetes in Bangladesh.

METHODS

The study included two population-based cross-sectional surveys from Bangladesh Demographic and Health Survey (n = 7,505 in 2011 and n = 11,959 in 2017-18). Chi-square association tests were performed to determine the associated factors. Logistic regression models (univariate and multivariable) were used to estimate unadjusted and adjusted relative risks of having diabetes, reported with odds ratios. Age-adjusted prevalence was also reported for both surveys.

RESULTS

The overall age-adjusted prevalence of prediabetes and diabetes decreased from 52.77% (95% CI: 52.61-52.92) and 10.43% (95% CI: 10.33-10.53) in 2011 to 34.10% (95% CI: 33.43-34.78) and 8.50% (95% CI: 8.11-8.90) in 2017-18. Compared to males, females had a higher odds of diabetes in 2011, but in 2017-18 a significant inverse result was observed. In both surveys, the odds of prediabetes and diabetes increased with advancing age, obesity, better wealth status, and hypertension.

CONCLUSION

The study shows that the prevalence of prediabetes and diabetes is high in Bangladesh despite decreasing trends. Therefore, the study recommends promoting healthy lifestyles and regular screening for non-communicable diseases.

Prevalence, trends and associated factors of hypertension and diabetes mellitus in Bangladesh: Evidence from BHDS 2011 and 2017–18

The evolving pandemic of non-communicable diseases like hypertension, diabetes mellitus are globally on the rise, and the trend is also escalating in Bangladesh. We aimed to assess the prevalence trend and associated factors of hypertension (HTN), diabetes mellitus (DM), and hypertension- diabetes mellitus combined (HDC) among Bangladeshi adults from 2011 to 2018. Two nationally representative cross-sectional data from Bangladesh Demographic and Health Survey (BDHS): 2011 and 2017–18 were utilized. According to baseline characteristics, the average annual rate of change (AARC) was applied to quantify the annual rate of increase/decrease in HTN, DM, and HDC from 2011 to 2018. The prevalence ratios of HTN, DM, and HDC were assessed through modified Poisson regression with robust error variance (PR, 95% Confidence Interval (CI)). The data were prepared in SPSS version 23 and exported to Stata version 13 for further analysis. Among 11,686 participants, the overall mean age of the study participants was 52.79 years, Standard Deviation (SD)±12.99, and 42.28% were female. From 2011–2018, HTN, DM, and HDC prevalence in Bangladesh has increased by 13, 3.2, and 3.1 percentage points, respectively. The average annual rate of increase was observed in the HTN and HDC prevalence by all socio-economic and demographic categories during 2011–2018. The prevalence of HDC among Chittagong residents was approximately double in 2018: 3.95% (2011) versus 6.59% (2018). Increased age, inactive workers, overweight adults, and adults in wealthy families were common risk factors associated with HTN, DM, and HDC in Bangladesh. The prevalence of developing HTN and HDC was significantly higher among adults aged ≥ 70 years (PR: 2.70, 95% CI: 2.42–3.00; PR: 2.97, 95% CI: 2.08–4.24, respectively). A comprehensive approach of different stakeholders is required to develop appropriate strategies, including appropriate weight management, adequate physical activity, and healthier food habits. Health agencies should take initiatives to spread awareness among people at an early age, but special attention is needed for older people and those at risk for NCDs.

Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure

Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.

Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis

Background

Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines.

Methods

Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate.

Results

Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government.

Conclusions

Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07124-6.

"You're acting womanish!" A qualitative descriptive study of the experiences of African American women in menopausal transition

This study explores how African American women understand and experience menopausal transition. Data were collected from 14 women in individual interviews and a focus group of seven participants. Transcripts were analyzed using content analysis. Black Feminist Thought and Womanist Thought were the frameworks used to understand the experiences of participants. Key themes emerged including silence as a form of survival, resilience amidst the chaos, socialization for self-preservation and empowerment, and reshaping and reclaiming womanhood. African American women need to be approached from a culturally sensitive care model to address their care during this phase and to optimize health outcomes.

The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control

BACKGROUND

Hypertension is a leading risk factor for mortality and morbidity globally and in the Arab world. We summarize the evidence on awareness, treatment, and control of hypertension, to assess the extent of gaps in the hypertension continuum of care. We also assess the influence of gender and other social determinants at each level of the cascade of care.

METHODS

We searched MEDLINE and SSCI databases for studies published between 2000 and 2017, reporting the rates of awareness, treatment or control of hypertension and/or their determinants in the Arab region. We included sources on both general populations and on clinical populations. The review process was based on the PRISMA guidelines. We present rates on the three stages of the care cascade corresponding to (1) awareness (2) treatment and (3) control of blood pressure, and estimated the losses that occur when moving from one stage to another. We also take stock of the evidence on social determinants and assess the statistical significance of gender differences in awareness, treatment and control.

RESULTS

Data from 73 articles were included. Substantial proportions of hypertensives were lost at each step of the hypertension care continuum, with more missed opportunities for care resulting from lack of awareness of hypertension and from uncontrolled blood pressure. More than 40% and 19% of all hypertensive individuals were found to be unaware and to have uncontrolled blood pressure, respectively, but among individuals diagnosed with hypertension, less than 21% were untreated. Awareness rates were higher among women than men but this advantage was not consistently translated into better blood pressure control rates among women.

CONCLUSIONS

This analysis of the cascade of care indicates that barriers to proper diagnosis and adequate control are greater than barriers to delivery of treatment, and discusses potential factors that may contribute to the gaps in delivery.

Impact of dietary patterns, individual and workplace characteristics on blood pressure status among civil servants in Bida and Wushishi communities of Niger State, Nigeria

The global burden estimate of hypertension is alarming and results in several million deaths annually. A high incidence of sudden deaths from cardiovascular diseases in the civil workforce in Nigeria is often reported. However, the associations between Dietary Patterns (DPs), individual, and workplace characteristics of hypertension among this workforce have not been fully explored. This study aimed to identify DP in the Bida and Wushishi Communities of Niger State and establish its relationship with hypertension along with other individual and workplace characteristics. Factor analysis was used to establish DP, Chi-square test to identify their relationships with hypertension, and logistic regression to determine the predictor risk factors. The prevalence of hypertension was 43.7%; mean weight, height, and body fat were: 72.8±15 kg, 166±8.9 mm and 30.4%, respectively. Three DPs: “Efficient Diet,” “Local diet,” and “Energy Boost Diet” were identified. The factor loading scores for these factors were divided into quintiles Q1–Q5; none of them had a significant effect on hypertension status. Conversely, increase in age, the Ministry, Department, and Agency (MDA) of employment, frequency of eating in restaurants, and obesity were identified as significant risk factors. After adjusting for confounders (age, body mass index, MDA, and eating habits), a high score (Q5) in “efficient diet pattern” was significantly related to a lower likelihood of hypertension than a low score (Q1). The prevalence of hypertension among the participants was relatively very high. An increase in age and working in educational sector were risk factors associated with hypertension. Therefore, it is recommended that civil servants engage in frequent exercise and undergo regular medical checkups, especially as they get older. These findings highlight the need for large-scale assessment of the impact of variables considered in this study on hypertension, among the civil workforce across Niger state and Nigeria.

Time-to-onset of treatment for hypertension and hyperlipidaemia in South African diabetes mellitus patients: A survival analysis using medicine claims data

WHAT IS KNOWN AND OBJECTIVE

Hypertension and hyperlipidaemia have high prevalence among diabetics and increase patients' risk of cardiovascular diseases, ultimately affecting prognosis negatively. Medicine claims data have gained prominence in the study of drug-related events and outcomes. There is paucity of publications on the time-to-onset of treatment for these conditions among South African diabetics using secondary data. This study aims to determine the time-to-onset of treatment for hypertension and hyperlipidaemia among diabetics using a South African medicine claims data.

METHODS

Survival analysis was conducted using retrospective data of patients enrolled continuously with a Pharmaceutical Benefit Management (PBM) company in South Africa from 1 January 2008 to 31 December 2016. We identified patients based on International Classification of Diseases, Tenth Revision (ICD-10) diagnoses codes for type 2 diabetes mellitus (E11) who were receiving antidiabetic medication according to the National Pharmaceutical Product Index (NAPPI) codes provided by the Monthly Index of Medical Specialities (MIMS) classification code 19.1 (N = 2996). Among these patients, we then selected those who had ICD-10 codes for hypertension (I10, I11, I12, I13, I15, O10 and O11) who were receiving antihypertensive medications, and those who had hyperlipidaemia (E78.5), who received antihyperlipidaemics during the study period. Data were extracted using SAS^® system version 9.4 classification codes. The Kaplan-Meier approach, used to compare the survival experience of patients who commenced treatment for hypertension and hyperlipidaemia, was conducted using IBM^® SPSS^® version 25. The time to the commencement of treatment of hypertension and hyperlipidaemia among the diabetics were measured in days. With 2008 serving as the index year, we followed up on patients until 31 December 2016.

RESULTS AND DISCUSSION

A total of 494 patients with an average age of 53.5 (SD 11.1) years were included in the study, 34.8% of whom were females. Prevalence of hyperlipidaemia and hypertension among patients were 35.0% and 45.6%, respectively. Average time-to-onset of treatment for hyperlipidaemia was 2684.4 (SD 42.2) days compared to 2434.2 (SD 47.6) days for hypertension. There was no statistically significant difference in age and sex among patients who started treatment for either of these conditions during the study (P = 0.404; Cohen's d = 0.132 for hyperlipidaemia and P = 0.644, Cohen's d = 0.059 for hypertension).

WHAT IS NEW AND CONCLUSION

Within an average of 6 years after an index period of 1 year free of disease, diabetics may commence treatment for hyperlipidaemia, hypertension or both. With all significant data appropriately captured, medicine claims data can be effectively used in survival analysis to determine time-to-onset of treatment for hyperlipidaemia and hypertension among diabetics.

Sex-specific prevalence, inequality and associated predictors of hypertension, diabetes, and comorbidity among Bangladeshi adults: results from a nationwide cross-sectional demographic and health survey

OBJECTIVES

To determine the sex-specific prevalence, inequality and factors associated with healthcare utilisation for diabetes mellitus (DM), hypertension and comorbidity among the adult population of Bangladesh.

STUDY DESIGN

This study analysed cross-sectional nationwide Bangladesh Demographic and Health Survey data from 2011. Comorbidity was defined as the coexistence of both DM and hypertension. Several socioeconomic and demographic factors such as age, sex, education, geographic location, administrative division, employment status, education and wealth index were considered as major explanatory variables. Inequality in prevalence and healthcare utilisation was measured using the 'Lorenz curve'. Adjusted multiple logistic regression models were performed to observe the effects of different factors and reported as adjusted ORs (AORs) with 95% CIs. A p value of <0.05 was adopted as the level of statistical significance.

SETTING

The study was conducted in Bangladesh.

PARTICIPANTS

A total of 7521 adult participants with availability of biomarkers information were included.

RESULTS

The mean age of the study participants was 51.4 years (SD ±13.0). The prevalence of hypertension, diabetes and comorbidity were 29.7%, 11.0% and 4.5% respectively. Socioeconomic inequality was observed in the utilisation of healthcare services. A higher prevalence of hypertension and comorbidity was significantly associated with individuals aged >70 years (AOR 7.0, 95% CI 5.0 to 9.9; AOR 6.7, 95% CI 3.0 to 14.9). The risk of having hypertension, diabetes and comorbidity were significantly higher among more educated, unemployed as well as among individuals from Khulna division.

CONCLUSIONS

The study revealed a rising prevalence of hypertension, diabetes and comorbidity with inequality in service utilisation. A joint effort involving public, private and non-governmental organisations is necessary to ensure improved accessibility in service utilisation and to reduce the disease burden.

Systolic and diastolic blood pressure percentiles by age and gender in Northeastern Iran

Hypertension (HTN) is a major risk factor for coronary artery disease. Its frequency is increasing globally. The aim of our study was to evaluate the reference range of blood pressure (BP) in the Iranian population stratified for age and gender. A total of 1449 subjects without diabetes, CVD, dyslipidemia, HTN history and with a normal BMI (18.5 ≤ BMI<25) were recruited in the present study. Participants were enrolled from the Mashhad stroke and heart atherosclerotic disorder study. Anthropometric indices and demographic data were collected by two health care specialists. A quantile regression model was used to estimate the expected systolic BP (SBP) and diastolic BP (DBP) at specific ages. A P-value of <.05 was considered significant for all analyses. All statistical analyses were performed using R (version 3.4.1) and SPSS software. The population included more men than women (51.6% vs. 48.4%). The mean and standard deviation of age in men (47.5 ± 8.4) was 2 years higher than women (45.63 ± 7.9; P < .001). SBP and DBP were higher in men than women (P < .001). By using a quantile regression model, we concluded that the 5th to 90th percentile of SBP in men, aged 30-69 years, ranged from 95 to 148.08 mm Hg and in women ranged from 86.66 to 140 mm Hg. The 5th to 90th percentile of DBP in men, aged 30-69 years, ranged from 60 to 91.66 mm Hg and in women ranged from 60 to 91.22 mm Hg. We have, for the first time, established the BP percentiles (1st, 5th, 10th, 50th, 90th, 95th, 99th) in an Iranian population stratified by age and gender. These data suggest that a local program for health promotion is necessary for the early identification of HTN in adults aged ≥30 years.