Mental health problems and hypertension in the elderly: Review from the HOPE Asia Network

The "triple burden" of aging population, hypertension, and mental health problems making elderly in Asia is more vulnerable. There is evidence of a bidirectional relationship between mental health and hypertension, which results in lower quality of life, lower rate of treatment adherence, and higher mortality among elderly individuals. It is essential to overcome known barriers and care for the elderly with high-risk factors in order to address these burdens. This review revealed that elderly with hypertension were more likely to suffer from depression and anxiety. Therefore, debunking myths, creating awareness regarding mental health, and increasing access to mental health resources through holistic community-based programs would greatly reduce such problems and optimize the chances of success in controlling hypertension-related problems.

Comparison of guidelines for the management of hypertension: Similarities and differences between international and Asian countries; perspectives from HOPE-Asia Network

Guidelines on the management of hypertension have been developed by various professional bodies and institutions to primarily address the issues of diagnosis, treatment, and control in order to rationalize and improve the management of hypertension. Hypertension guidelines across the world have recently been updated following the new and controversial lower blood pressure threshold of ≥130/80 mmHg for the diagnosis of hypertension adopted by the Americans. While there are differences between the major as well as between the Asian national guidelines, there were also many similarities. This paper discusses and highlights the differences and similarities between the major international guidelines of the American College of Cardiology/American Heart Association, of the European Society of Cardiology/European Society of Hypertension, and of the International Society of Hypertension and also compares them with the Asian guidelines.

Going to war on COVID-19: Mobilizing an academic nephrology group practice

Aim

The COVID‐19 pandemic poses unprecedented operational challenges to nephrology divisions in every country as they cope with COVID‐19‐related kidney disease in addition to regular patient care. Although general approaches have been proposed, there is a lack of practical guidance for nephrology division response in a hospital facing a surge of cases. Here, we describe the specific measures that our division has taken in the hope that our experience in Singapore may be helpful to others.

Methods

Descriptive narrative.

Results

A compilation of operational responses to the COVID‐19 pandemic taken by a nephrology division at a Singapore university hospital.

Conclusion

Nephrology operational readiness for COVID‐19 requires a clinical mindset shift from usual standard of care to a crisis exigency model that targets best outcomes for available resources. Rapid multi‐disciplinary efforts that evolve flexibly with the local dynamics of the outbreak are required.

A valuable experience and operational response to COVID‐19 pandemic threat by a nephrology division at a Singapore university hospital. This article gives good example of shift of clinical mindset from usual standard of care to a crisis exigency model that targets best outcomes for available resources.

Assessing kidney function in Asia

An equation for accurate estimation of the glomerular filtration rate (GFR) is vital for staging and directing the treatment of chronic kidney disease (CKD), which is a source of considerable morbidity and mortality around the world. The Modification of Diet for Renal Disease (MDRD) equation, which includes a racial coefficient, is commonly used. The MDRD equation has been validated in Caucasian populations, but modifying the racial coefficient for Asian countries has resulted in substantially different values that may not be due to race alone. Moreover, it is sometimes difficult to define race, particularly in multi-ethnic populations and among offspring of inter-ethnic marriages. Furthermore, the precision of the MDRD equation is poorer at the early stages of CKD. New markers, such as cystatin C, and new equations may be needed to accurately assess wider ranges of GFR in multi-ethnic countries. We review the development of GFR-estimating equations from an Asian perspective.

The choice of estimating equations for glomerular filtration rate significantly affects the prevalence of chronic kidney disease in a multi-ethnic population during health screening

BACKGROUND

Patients present to the National University Hospital of Singapore and select one of several health screening packages after counselling. The prevalence of chronic kidney disease (CKD) in this population when different glomerular filtration rate (GFR) estimating equations are used has not been examined.

METHODS

Demographic data and urinalyses of patients from 2000 to 2005 were extracted from laboratory computer databases and analysed. CKD was classified into stages according to the US National Kidney Foundation guidelines by eGFR (mL/min per 1.73 m(2)) using the four-variable Modification of Diet in Renal Disease equation. GFR of ethnic Chinese was also estimated using Ma's equation 8 (cGFR). Stage 1 and normal (eGFR or cGFR > 90) was discriminated by urinary microscopy or dipstick for proteinuria, albuminuria, hematuria or leukocyturia.

RESULTS

There were 3979 screenings (55.9% males, 61.9% Chinese). Means: age = 47.0 +/- 12.3 years, creatinine = 80.1 +/- 26.5 micromol/L, eGFR = 89.6 +/- 19.7, cGFR = 110.8 +/- 23.8 and (eGFR + cGFR) = 102.5 +/- 24.9. By eGFR in all patients, the prevalence of CKD was 45.7%, 50.6%, 3.3%, 0.3% and 0.08% for stages normal or 1, 2, 3, 4 and 5, respectively. For Chinese patients only, eGFR and cGFR resulted in a different distribution (eGFR%/cGFR%): 24.9/50.5, 15.2/29.3, 56.8/19.7, 3/0.8, 0.2/0.2, 0/0 for stages 'Normal', 1, 2, 3, 4 and 5, respectively (P < 0.001).

CONCLUSION

The prevalence of moderate to severe CKD (stage 3 to 5) in patients presenting for health screening in Singapore was 3.7%. Notably, the prevalence of mild to moderate CKD (stages 1, 2 and 3) in Chinese patients was affected significantly by the choice of GFR estimating equation.

Aortic and mitral valve endocarditis caused by Gemella morbillorum in a haemodialysis patient

Gemella morbillorum is part of the commensal flora of the upper respiratory tract, intestinal tract and genitourinary tract. On rare occasions, it causes endocarditis. We report a 67-year-old Chinese man with end-stage renal disease on maintenance intermittent haemodialysis, who developed Gemella morbillorum endocarditis complicated by severe aortic and mitral regurgitation. Most cases of Gemella morbillorum endocarditis have satisfactory outcomes with antibiotics or surgical treatment.