ABSTRACT
Objectives We evaluated trends in hypertension prevalence, awareness, treatment and control in an Indian urban population over 25 years. Trends were projected to year 2030 to determine attainment of World Health Organization (WHO) Global Monitoring Framework targets. Methods Adult participants (n = 7440, men 4237, women 3203) enrolled in successive population based studies in Jaipur, India from years 1991 to 2015 were evaluated for hypertension prevalence, awareness, treatment and control. The studies were performed in years 1991–93 (n = 2212), 1999–01 (n = 1123), 2003–04 (n = 458), 2006–07 (n = 1127), 2009–10 (n = 739) and 2012–15 (n = 1781). Descriptive statistics are reported. We used logarithmic forecasting to year 2030 and compared outcomes to WHO target of 25% lower prevalence and >50% control. Results The age-adjusted hypertension prevalence (%) among adults in successive studies increased from 29.5, 30.2, 36.5, 42.1, 34.4 to 36.1 (R2 = 0.41). Increasing trends were observed for hypertension awareness (13, 44, 49, 44, 49, 56; R2 = 0.63); treatment in all (9, 22, 38, 34, 41, 36; R2 = 0.68) and aware hypertensives (61, 66, 77, 79, 70, 64; R2 = 0.46); and control in all (2, 14, 13, 18, 21, 21; R2 = 0.82), aware (12, 33, 27, 46, 37, 37; R2 = 0.54) and treated (9, 20, 21, 48, 36, 49; R2 = 0.80) hypertensive participants. Projections to year 2030 show increases in prevalence to 44% (95% CI 43–45), awareness to 82% (81–83), treatment to 62% (61–63), and control to 36% (35–37). Conclusion Hypertension prevalence, awareness, treatment and control rates are increasing among urban populations in India. Better awareness is associated with greater control. The rates of increase are off-target for WHO Global Monitoring Framework and UN Sustainable Development Goals.
ABSTRACT
OBJECTIVE: The impact of rising population-wide obesity on cardiovascular risk factors has not been well studied in low-income countries. To correlate the prevalence of obesity with risk factors we performed epidemiological studies in India. METHODS: Multiple cross-sectional epidemiological studies, Jaipur Heart Watch (JHW), were performed in India in rural and urban locations. From these cohorts, subjects aged 20-59 years (men 4102, women 2872) were included. Prevalence of various risk factors: smoking/tobacco use, overweight/obesity (body mass index > or = 25 kg/m2) truncal obesity (waist:hip > or = 0.95 men, > or = 0.85 women), hypertension, dyslipidemias, metabolic syndrome and diabetes was determined. Trends were examined using least squares regression. RESULTS: Smoking/tobacco use was more in rural men (50.0% vs 40.6%) and urban women (8.9% vs 4.5%, p < 0.01). Obesity, truncal obesity, hypertension, hypercholesterolemia, diabetes, and metabolic syndrome were more in urban cohorts (p < 0.001). Age-adjusted prevalence (%) of obesity in various cohorts, rural JHW, and urban JHW-1, JHW-2, JHW-3, and JHW-4 respectively, in men was 9.4, 21.1, 35.6, 54.0, and 50.9 (r2 = 0.92, p = 0.009) and in women 8.9, 15.7, 45.1, 61.5, and 57.7 (r2 = 0.88, p = 0.018). Prevalence of truncal obesity in men was 3.2, 19.6, 39.6, 41.4, and 31.1 (r2 = 0.60, p = 0.124) and in women 10.1, 49.5, 42.1, 51.7, and 50.5 (r2 = 0.56, p = 0.1467). In successive cohorts increasing trends were observed in the prevalence of hypertension (r2 = 0.93, p = 0.008) and metabolic syndrome (r2 = 0.99, p = 0.005) with weaker trends for hypercholesterolemia (r2 = 0.41, p = 0.241) and diabetes (r2 = 0.79, p = 0.299) in men. In women, significant trends were observed for hypertension (r2 = 0.98, p = 0.001) and weaker trends for others. Increase in generalized obesity correlated significantly with hypertension (two-line regression r2, men 0.91, women 0.88), hypercholesterolemia (0.53, 0.44), metabolic syndrome (0.87, 0.94) and diabetes (0.84, 0.93). Truncal obesity correlated less strongly with the risk factors like hypertension (0.50, 0.57), hypercholesterolemia (0.88, 0.61), metabolic syndrome (0.76, 0.33), and diabetes (0.75, 0.33). CONCLUSIONS: In Asian Indian subjects, escalating population-wide generalized obesity correlates strongly with increasing cardiovascular risk factors.
Subject(s)
Adult , Body Mass Index , Cardiovascular Diseases/epidemiology , Cohort Studies , Cross-Sectional Studies , Female , Health Surveys , Humans , India , Male , Middle Aged , Obesity/complications , Prevalence , Risk Factors , Young AdultABSTRACT
El mecanismo preciso responsable de la isquemia silenciosa del miocardio no se ha establecido, pero los datos disponibles sugieren que tanto un aumento en la demanda de oxigeno como una disminucion en el flujo sanguineo coronario pueden ser los causantes. Los estudios indican que mas de 60 minutos de isquemia silenciosa durante un control, electrocardiografico ambulatorio se correlaciona con un incremento en la frecuencia de infarto del miocardio, muerte de origen cardiaco y sintomas recurrentes que requieren revascularizacion coronaria. Aun en pacientes con episodios mas cortos y repetidos de isquemia silenciosa es posible el desarrollo de pequenas areas de necrosis subendocardica, que terminan eventualmente en una disfuncion progresiva del ventriculo izquierdo, lo cual aumenta el riesgo subsiguiente de mortalidad. La terapia antianginosa, aunque sea efectiva en el control de sintomas, no elimina la isquemia sileciosa. Se requieren estudios adicionales de la patogenesis de la isquemia sileciosa antes de poder establecer un plan efectivo de tratamiento