Prevalence estimates for hypertension in Latin America and the Caribbean: are they useful for surveillance?

Hypotensive Effect of Hydroalcoholic Ziziphus jujuba Extract on Normotensive Rats

Objective:

Ziziphus jujuba (Z.J) is a medicinal plant with several properties such as antioxidant, antibacterial, hypnotic and wound healing activity. It also has lowering blood pressure effect and people use it to treat hypertension. In the present study, the effect of hydroalcoholic extract of Z.J on cardiovascular parameters in the normotensive rats was investigated.

Methods:

Animal groups include: 1) Sham, only cannulation of artery 2) saline, received saline for four weeks 3-5) Z.J groups (100, 200 and 400 mg/kg) that treated with Z.J via gavage for four weeks. In the experiment day (28th Day) femoral artery of all rats cannulated and Systolic Blood Pressure (SBP), Mean Atrial Pressure (MAP) and Heart Rate (HR) recorded by a power lab system. The weight of animal in all groups also was recorded in the beginning and the last day of experiment.

Results:

There was no significant difference in HR, SBP and MAP parameters between sham and control groups. The SBP and MAP in higher doses of Z.J (200 and 400 mg) significantly decreased compared to control group. The HR only in dose 200 mg of Z.J significantly decreased than the control group.

Conclusion:

The results of present study show that hydroalcoholic extract of Z.J has an inhibitory effect on basal cardiovascular parameters and its best effects have been shown in dose 200 mg/kg.

Cardiovascular health and cognitive function among Mexican older adults: cross-sectional results from the WHO Study on Global Ageing and Adult Health

ABSTRACTObjectives:To assess the association between cardiovascular health and cognitive function among Mexican older adults.

DESIGN

Nationally representative cross-sectional survey.

SETTING

Households in Mexico.

PARTICIPANTS

Individuals aged 50 years and older (n = 1,492) from the Mexico-SAGE project Wave 1.

MEASUREMENTS

A continuous and a categorical index of cardiovascular health was calculated based on exercise, smoking, body mass index, and blood pressure ranging from 0 to 4. Cognitive function was obtained by averaging the standardized scores (z scores) of five psychometric tests. Associations were conducted using linear regression.

RESULTS

The continuous index of cardiovascular health was not associated with cognitive function. Using the categorical index, participants with the best levels of cardiovascular (score of 4) health performed better on global cognitive function than groups with lower cardiovascular health (scores of 0, 0.41 SD; 1, 0.39 SD; and 2, 0.56 SD). The association was moderated by age, reaching significance only among those 50-64 years old.

CONCLUSIONS

If longitudinal research confirms these findings, results would suggest that dementia-related policies in Mexico need to focus on achieving optimal levels of cardiovascular health, especially in midlife.

The effects of unripe grape extract on systemic blood pressure and serum levels of superoxide dismutase, malondialdehyde and nitric oxide in rat

Backgrounds:

The new lifestyle increases the incidence of hypertension. In Iranian folk medicine, it is believed that Verjuice obtained by unripe grape (Vitis vinifera) could control blood pressure. We tested the effects of unripe grape extract (UGE) in blood pressure alteration, serum antioxidant level and aorta endothelial permeability in rats.

Materials and Methods:

Four groups of rats were treated daily by placebo and three different doses of UGE (50, 150 and 300 mg/kg/day). Four weeks later, the animals were anesthetized and catheterized. The direct mean arterial, systolic and diastolic pressures (MAP, SP and DP) were recorded. The endothelial permeability was determined and the serum levels of superoxide dismutase (SOD), malonaldialdehyde (MDA) and nitrite were measured.

Results:

High dose of UGE increased MAP and SP significantly (P < 0.05) when compared with the control group. Decrease of MDA and increase of SOD and nitrite also were detected statistically in animals treated with high dose of UGE (P < 0.05). No difference in aorta endothelial permeability was observed between the groups.

Conclusion:

The effect of UGE on blood pressure was dose dependent. High dose of UGE increased MAP and SP although its antioxidant activity was significantly high. Such observation mechanisms need to be defined.

The incidence of hypertension and the follow-up rate in a sample of population over 30 years old in kashan 2013

INTRODUCTION

Studies indicate that hypertension is prevalent in Iran, however, the reports are heterogeneous. The aim of this study was to estimate the incidence of hypertension and the rate of follow-up in a sample of population over 30 years old in Kashan city.

METHODS

A descriptive study was conducted on people screened for hypertension in the project of "monitoring the health of Iranian population" in Kashan city at April 2013. Among all completed screening forms, 5000 forms were selected randomly. Required data were extracted from these forms and were recorded on a checklist that was consisted of 9 questions on demographics characteristics and 10 questions about follow-up. Descriptive statistics, independent sample t-test, paired t-test and pearson correlation coefficient was used to analyze the data.

RESULTS

Totally, 5% of the enrolled people had a systolic blood pressure over 140 mmHg and a diastolic pressure over 90 mmHg. Only 92 subjects with high blood pressure were available via telephone. Also, 42.42% of cases refused to answer. From all subjects who were available and answered the study questions, 50% had been referred to a physician after 5.17 (6.05) days. Of these, 52.2% were diagnosed as being hypertensive. Lacking time was the main reason for non-referral.

CONCLUSION

The incidence of hypertension was less than other studies but the rate of follow-up was low. Nurses and Iranian nursing organization are suggested to conduct a nationwide screening and follow-up project to improve the rate of early diagnosis and help people in better management of hypertension.

Prevalence of hypertension in an Iranian population

BACKGROUND

The prevalence of HTN varies considerably worldwide. This study was carried out to illustrate the prevalence of hypertension in a group of Iranian population based on the data gathered for Iranian Multi-centric Osteoporosis Studies (IMOS).

METHODS

This study analyzes the systolic and diastolic blood pressure from the IMOS, a multi-centric cross-sectional study carried out on apparently healthy men and women in urban areas of major Iranian cities to study bone health.

RESULTS

Overall, 26.21% of the studied cases were estimated to be hypertensive; the condition was more prevalent among older males. Each year increase in age was associated with 1.070 higher risk of developing hypertension.

CONCLUSION

Hypertension is quite prevalent among Iranian population and the prevalence of the condition is rising in the context of progressive rise in age and BMI.

Hypertension control in brazilian publications

Hypertension is a major public health problem due to its high prevalence and cardiovascular complications. Its treatment is aimed at reducing cardiovascular morbidity and mortality, its goal being to maintain blood pressure levels below 140/90 mm Hg. Hypertension control in Brazil is low, and nationwide rates are unknown. The objective of this review was to provide an overview on hypertension control in Brazil from publications in a database. We identified 45 publications. In population-based studies, the highest control rate (57.6%) was reported in a multicenter study in 100 municipalities and the city of São José do Rio Preto, São Paulo state (52.4%), while the lowest rates (around 10%) were identified in microregions of the Rio Grande do Sul state and in the city of Tubarão, Santa Catarina state. In conclusion, the studies assessed showed a wide variation in hypertension control rates. It is worth noting that the comparison between studies was a major limiting factor, because of the different methods used.

The effects of unripe grape extract on systemic blood pressure, nitric oxide production, and response to angiotensin II administration

Background:

Hypertension is the most common disease in the world. In Iranian folk medicine, unripe grape juice has been used as antihypertention remedy, but no data is documented for this popular belief. This study was designed to determine the effect of unripe grape extract (UGE) on blood pressure and the response to angiotensin II in rat.

Materials and Methods:

Unripe grape was collected, air dried, and extracted and concentrated. Four groups of Wistar rats received single doses of 125, 250, and 500 mg/kg of UGE or saline, respectively. The direct blood pressure and the serum nitrite level were measured one hour post UGE administration. The animals also were subjected to the infusion of various angiotensin II concentrations (100, 300, and 1000 μg/kg/min), and blood pressure was determined.

Results:

Mean arterial, systolic, and diastolic pressures (MAP, SP, and DP) in all UGE treated groups were less than the control group, but only at the dose of 125 mg/kg (Group 1) they were significantly different (P < 0.05). The level of nitrite in groups 1-3 were significantly greater than the control group (P < 0.05). No significant differences were detected for the MAP, SP, and DP to different concentrations of angiotensin II among these groups.

Conclusion:

UGE potentially attenuate MAP, SP, and DP via vasodilatation induced by nitric oxide production.

Pré-hipertensão e hipertensão em adultos de Florianópolis: estudo de base populacional

OBJETIVO: Estimar a prevalência e os fatores associados de pré-hipertensão e hipertensão arterial em adultos. MÉTODOS: Estudo transversal, de base populacional, com 1.720 adultos em Florianópolis, SC, de setembro de 2009 a janeiro de 2010. Informações demográficas, socioeconômicas, comportamentos relacionados à saúde, medidas antropométricas, morbidades e autopercepção de saúde foram coletadas por meio de entrevistas domiciliares. Níveis de pressão arterial sistólica e diastólica foram avaliados. Adicionalmente perguntou-se sobre a ingestão de medicamentos e diagnóstico médico para hipertensão. A variável dependente foi categorizada em normal, pré-hipertensão e hipertensão arterial. A regressão logística politômica múltipla foi empregada com uso do modelo Logit multinomial. RESULTADOS: A prevalência de pré-hipertensão e hipertensão arterial foi de 36,1% (IC95% 33,3;38, 8) e 40,1% (IC95% 36,6;43,5), respectivamente. A análise de regressão politômica múltipla revelou que a pré-hipertensão esteve associada a homens, cor de pele preta, faixa etária acima de 50 anos, inativos fisicamente no lazer e com pré-obesidade. A hipertensão arterial esteve associada a homens, cor de pele preta, faixa etária acima de 40 anos, tercil intermediário de renda per capita, escolaridade menor que 12 anos, inativos fisicamente, pré-obesidade, obesidade, circunferência da cintura elevada e percepção negativa do estado de saúde. CONCLUSÕES: Para controlar a hipertensão arterial na população adulta de Florianópolis, é urgente haver políticas públicas eficazes para o combate à pré-hipertensão.

Relationship between asthma and high blood pressure among adolescents in Aracaju, Brazil

BACKGROUND

Asthma has been linked to cardiovascular diseases (CVDs) and related risk factors such as hypertension in adults. It is unclear whether the relationship between asthma and hypertension found among adults is also observed in adolescents. Hence, the authors examined asthma and its association with prehypertension and hypertension among adolescents in Aracaju, Brazil.

METHODS

Data on asthma and blood pressure were collected among 1002 adolescents age 12 to 17 years old in 15 public schools, 5 municipal schools, and 10 private schools. Asthma data were ascertained by the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire. Sex-, age-, and height-specific percentile levels were used to define prehypertension (90-94th percentile) and hypertension (>or=95th percentile).

RESULTS

The prevalence of asthma was 20.6% in boys and 27.7% in girls. Among boys, the prevalence rates of prehypertension and hypertension were 26.7% and 17.0%, respectively. Among girls, the rates of prehypertension and hypertension were 14.3% and 12.9%, respectively. There were no statistically significant associations between asthma and prehypertension, and hypertension, even after adjusting for age, social economic status, physical activity, and body mass index (BMI) in both boys (prehypertension: odds ratio [OR] = 1.35, 95% confidence interval [CI]: 0.80-2.27; hypertension: OR = 0.60, 95% CI: 0.29-1.23) and girls (prehypertension: OR = 0.71, 95% CI: 0.40-1.28; hypertension: OR = 1.07, 95% CI: 0.60-1.94).

CONCLUSIONS

These results suggest no association between asthma and high blood pressure in adolescents. More prospective studies are needed to establish whether hypertension becomes more pronounced at a specific age in asthmatics, and if so, the possible factors that may contribute to this.

Cardiovascular disease in Latin American women

Cardiovascular disease is a leading cause of death and disability in adults in Latin America. Women are more affected by these diseases than by all forms of cancer. Latin American countries have experienced rapid and uneven socioeconomic changes with a significant effect on lifestyle, demographic and health-related indicators. Differences in methodological approaches make it difficult to compare studies and health statistics across countries in the region. According to available statistics, female population in Latin American countries have lower mortality rate from coronary heart disease and higher mortality rate from cerebrovascular disease than North America. Current rates of obesity and type 2 diabetes are alarming in female in some countries. The high prevalence of risk factors forecasts an increase in cardiovascular disease for the coming decades in this region of the world. More systematic and sustained efforts for research, education, surveillance, prevention, early detection and affordable treatment are required across all Latin American countries to improve health conditions for adult population and particularly for women, who are more affected by obesity and diabetes. This article reviews the available information on cardiovascular disease and related risk factors in Latin American countries with a focus on female and to provide a brief description of selected multinational and national efforts to study and prevent this threat.

Hypertension in Mexico and among Mexican Americans: prevalence and treatment patterns

Increased social and economic integration across the US-Mexican borders has led to important new developments in public health. Lower levels of cardiovascular mortality have been observed among Mexican Americans (MAs) although few direct comparisons have been undertaken with Mexico. Using survey data in the respective countries we examined blood pressure (BP) levels, hypertension prevalence and patterns of awareness, treatment and control in Mexico and among MAs. A national representative sample of the adult population from Mexico collected in 2000 (N=49 294), and data on 8688 MA participants in the 1999-2004 National Health and Nutrition Examination survey from the United States were available for analysis. US-born MAs and those born in Mexico were analysed separately in the US data. Lack of direct standardization of methods between surveys necessitated statistical adjustment of BP values. Analyses were based on persons aged 25-64 in each country. Sex- and age-adjusted mean systolic/diastolic BPs were 122/80, 119/71 and 120/73 in Mexicans, immigrant MAs and US-born MAs, respectively. The prevalences of hypertension (BP > or = 140/90 or treatment) were 33, 17 and 22%. Hypertension control rates were 3.7, 32.1 and 37.9%, in the same groups. Awareness and treatment rates were 25 and 13% in Mexico and 54 and 46% among MAs in the United States, respectively. Hypertension appears to be more common in Mexico than among Mexican immigrants to the United States. Despite relatively low access to health insurance in the United States, hypertension control increased over the course of this migration.

CARMELA: assessment of cardiovascular risk in seven Latin American cities

OBJECTIVE

This cross-sectional, population-based observational study using stratified multistage sampling assessed the prevalence of cardiovascular risk factors and carotid plaques and measured carotid intima-media thickness in individuals living in major cities in 7 Latin American countries.

PATIENTS AND METHODS

The study comprised individuals (n=11,550) aged 25 to 64 years, living in Barquisimeto, Bogota, Buenos Aires, Lima, Mexico City, Quito, and Santiago. Data on anthropometric parameters, blood pressure, fasting glucose, total and high-density lipoprotein cholesterol, triglycerides, carotid intima-media thickness, carotid plaque, and smoking status were collected through household interviews and clinical, biochemical, and sonographic measurements.

RESULTS

The overall prevalence rates (ranges across cities) were as follows: hypertension (> or = 140/90 mm Hg or pharmacologic treatment), 18% (9%-29%); hypercholesterolemia (total cholesterol > or = 240 mg/dL), 14% (6%-20%); diabetes (glycemia > or = 126 mg/dL or self-reported diabetes), 7% (4%-9%); metabolic syndrome, 20% (14%-27%); obesity (body mass index > or = 30 kg/m2), 23% (18%-27%); smoking, 30% (22%-45%); and plaque, 8% (5%-14%). The mean intima-media thickness was 0.65 mm (0.60-0.74 mm).

CONCLUSION

The prevalence of hypertension mirrored the world average in 3 cities but was lower in the rest. Hypercholesterolemia was highly prevalent even in countries of different socioeconomic levels. The prevalence of diabetes was similar to that in the developed countries. Tobacco use in women living in Santiago and Buenos Aires was among the world's highest. Intima-media thickness and carotid plaque prevalences varied widely.

Glucose intolerance and other cardiovascular risk factors in Haiti (PREDIAH)

AIMS

To assess the prevalence of diabetes and other forms of glucose intolerance and to examine their relationship with some cardiovascular risk factors in a population representative of the capital of Haiti.

METHODS

This cross-sectional survey was conducted in the metropolitan area of Port-au-Prince, Haiti. A population-based sample of 1620 adults was randomly selected using a two-stage cluster method, stratified in 3 age groups: 20-39, 40-64 and > or =65 years of age. Diagnosis of diabetes and pre-diabetes (IFG and IGT) was based on the 2003 Expert Committee criteria.

RESULTS

The total response rate was 69%. The age-standardized prevalence of diabetes was 4.8% in men and 8.9% in women (P=0.0014), with, overall, 70.6% of previously diagnosed cases. Standardized for the Segi world population aged 30-64 years, its prevalence was 7.4% in men and 11.1% in women (NS). The age-standardized prevalence of pre-diabetes was 6.4% in men and 8.0% in women (NS). Hypertension was found in 48.7% in men and 46.5% in women (NS). Its rates in people > or =40 years old were 69.1% in men and 67.2% in women (NS). Abdominal obesity was strongly independently associated with diabetes and pre-diabetes in both genders. Hypertension was shown to be risk factor for pre-diabetes and total glucose intolerance in women. High education was associated with lower risk of diabetes in men.

CONCLUSION

Prevalence of diabetes and pre-diabetes is moderately high in Port-au-Prince, Haiti. In people aged > or =40 years, the rate of normal blood pressure is less than 25%. Intervention programs to prevent simultaneously and manage diabetes and hypertension are imperative, and prevention strategies through lifestyle modifications should be cost-effective.

Success in control of hypertension in a low-resource setting: the Cuban experience

BACKGROUND

Pharmacologic control of hypertension is an essential component of the current strategy to control cardiovascular diseases. Much concern has been focused in recent years on the challenge that cardiovascular disease poses for developing countries. Available medical therapies should be equally effective in low- and high-resource settings; however, this has not yet been demonstrated. Cuba has a well-organized primary-care system and has made reduction of cardiovascular diseases a priority, particularly through detection and treatment of hypertension.

METHODS

To determine current hypertension control rates a population-based sample of 1667 persons aged 15-74 years was examined in the city of Cienfuegos.

RESULTS

The prevalence of hypertension, weighted to the age structure of the sampled population, was 20%. Among all hypertensives, 78% were previously aware of the condition, 61% were currently taking medications, and 40% had systolic/diastolic blood pressures < 140/90 mmHg (men = 29%, women = 49%). Among treated hypertensives, 62% had blood pressures < 140/90 mmHg.

DISCUSSION

The level of control documented in this survey is higher than reported previously from population surveys in other countries. If confirmed in broader samples in Cuba, these findings would suggest that effective control of hypertension is highly feasible in low-resource settings.

End-stage renal disease prevention strategies in Latin America

Latin America (LA), defined here as the countries in the Western hemisphere located south of the United States, is a region with a total population of nearly 520,000,000 that increases 1.5% annually and has a human development index of 0.77. The countries that form this region present extreme contrasts. These contrasts are first and foremost within the countries themselves, because extremes of wealth and poverty are present in their social and economic fabric. In addition, in LA a vast variety of government modalities and political systems are represented. Therefore, in order for prevention strategies to be effective, they need to be tailored to the specific characteristics and idiosyncrasies of individual nations. This article will address the following aspects: first, a broad outline of the basic health statistics in LA, with focus on treatment of end-stage renal disease and its derived economic burden. Data from LA countries will be contrasted with 95% confidence interval of corresponding data from 10 industrialized countries (Canada, France, Germany, Italy, Japan, United Kingdom, United States, Spain, Sweden, and Switzerland). Second, we will discuss the prevalence of some risk factors for end-stage renal disease in the nations of the region. For this reason, we will focus on data that provide reliable information. Finally, we will consider general guidelines for the implementation of prevention strategies that may have common applicability in LA countries.

Cardiovascular disease and associated risk factors in Cuba: prospects for prevention and control

OBJECTIVES

An adequate description of the trends in cardiovascular disease (CVD) is not available for most of the developing world. Cuba provides an important exception, and we sought to use available data to offer insights into the changing patterns of CVD there.

METHODS

We reviewed Cuban public health statistics, surveys, and reports of health services.

RESULTS

CVD has been the leading cause of death since 1970. A 45% reduction in heart disease deaths was observed from 1970 to 2002; the decline in stroke was more limited. There are moderate prevalences of all major risk factors.

CONCLUSIONS

The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD.

A public health framework for chronic disease prevention and control

Chronic noncommunicable diseases are leading causes of death and disability in many developing countries. Several low-income countries lack mortality and morbidity data and do not yet know their burden of noncommunicable diseases. Cost studies are scarce, but in middle-income countries such as those of Latin America and the Caribbean, the cost of illness not only represents much of the direct costs of medical care, but also has an impact on family disposable income. Studies have reported that in low-resource settings, given incomplete health coverage and partial insurance, out-of-pocket expenses are high. Persons with chronic conditions, in many instances, have to forego care because of their inability to pay. Poverty and chronic noncommunicable diseases have a two-way interaction. These conditions warrant attention from poverty-reduction programs. Evidence shows that to have an impact on the burden of chronic diseases, action must occur at three levels: population-wide policies, community activities, and health services. The latter includes both preventive services and appropriate care for persons with chronic conditions. A public health approach embodies a systems perspective, containing the continuum of prevention and control, from determinants to care. In this framework it is critical to identify and address interactions and interventions that connect between and among the three levels of action.

Congestive heart failure in Latin America: the next epidemic

Coronary artery disease is the main cause of congestive heart failure (CHF) in all populations. Latin American countries (LAC) are undergoing the first phase of an epidemic of coronary artery disease that probably will lead to an increased incidence of CHF. The progressive implementation of successful interventions, such as early reperfusion and rehabilitation programs, should increase the survival of patients with acute myocardial infarction and the population at high risk of CHF. The increasing prevalence of risk factors, such as diabetes, hypertension, and obesity, and the ageing of the population may also contribute to a rising incidence of CHF in LAC. Moreover, infectious diseases such as Chagas disease and rheumatic heart disease, known causes of CHF, are still frequent in this population and additionally contribute to the incidence of CHF. If timely preventive interventions are not implemented, CHF could become one of the main contributors to the burden of morbidity, mortality, and health costs in LAC. Properly conducted clinical and epidemiologic studies are needed to identify, implement, and evaluate preventive strategies that are likely to succeed within the specific context of LAC.