Early detection, care and control of hypertension and diabetes in South Africa: A community-based approach

Background: Non-communicable diseases (NCDs) are a major public health concern with raised blood pressure and glucose emerging as leading causes of death and disability. Aim: This community-based demonstration project using community caregivers (CCGs) trained in screening for hypertension and diabetes aimed at improving early detection and linkage to care and management. Setting: The project was conducted in KwaZulu-Natal province. Methods: The CCGs were trained in NCD-related health education, promotion and screening for hypertension and diabetes using an accredited programme. The CCGs screened community members for hypertension and diabetes using three screening methods: door-to-door visits, community campaigns and workplaces. Results: Twenty-five CCGs received the accredited NCD training. A total of 10 832 community members were screened for hypertension and 6481 had their blood glucose measured. Of those screened, 29.7% and 4.4%, respectively, had raised blood pressure (≥ 140/90 mmHg) and blood glucose (≥ 11.0 mmol/L) who required referral to a primary healthcare facility. More than one in five (21.0%, n = 1448), of those with no previous hypertension diagnosis, were found to have raised blood pressure at screening, representing newly detected cases. Less than a third (28.5%) of patients referred to the facilities for raised blood pressure actually presented themselves for a facility assessment, of which 71.8% had their hypertension diagnosis confirmed and were advised to continue, adjust or initiate treatment. Similarly, 29.1% of patients referred to the facilities for raised blood glucose presented themselves at the facility, of which 71.4% received a confirmatory diabetes diagnosis. Conclusion: Community caregivers played an important role in early detection of raised blood pressure and raised blood glucose, and in referring patients to primary care

Intima-media thickness of femoral arteries and carotids among an adult hypertensive Nigerian population: a case­control study to assess their use as surrogate markers of atherosclerosis

Background: Increased intima-media thickness (IMT) is an established and important surrogate marker for atherosclerosis. Intima-media thickening in the femoral arteries occur earlier and reflect the true extent of generalized atherosclerosis better than in the carotids. Aims: To study the ultrasound-detected morphological changes in the common femoral versus carotid artery wall. Patients and Methods: A case-control study design was used, with 61 adult hypertensive as cases and 61 age-, sex- and BMI-matched normotensive as controls. Variables were participants' characteristics, cardiovascular risk factors, and ultrasonographically evaluated IMT of the carotid and femoral arteries. Results: A total of 122 participants were studied. The mean femoral IMT in hypertensives and controls on the right and left was 0.63 ± 0.07mm vs. 0.52 ± 0.06mm [P < 0.0001] and 0.69 ± 0.0 mm vs. 0.55 ± 0.05mm [P < 0.0001]. Also, the mean carotid IMT among hypertensives and controls on the right =0.80 ±0.15mm vs. 0.64 ± 0.06mm [P < 0.0001], and 0.91 ± 0.22mm vs. 0.65 ± 0.06mm [P < 0.0001] on the left. Significant correlation was observed between IMT and age (B = 0.006, P < 0.001 and B = 0.003, P < 0.001), hypertension (B = 0.205, P < 0.001 and B = 0.122, p<0.001), and duration of hypertension (B = 0.02, P < 0.001 and B = 0.006, P = 0.02) the femoral and carotid arteries respectively. Conclusion: The femoral and the carotid artery show similar significantly increased IMT in hypertensive adults. The femoral IMT appears to be a good surrogate marker of atherosclerosis among hypertensive Nigerians

Prevalence and Effects of Various Risk Factors Influencing the Blood Pressure Values.

Aim: Hypertension is major cardiovascular risk factor contributing to all cause mortality. The present study was aimed to determine the impact of socio-demographic variables and risk factors on the blood pressures (BP) of the subjects. Place and Duration of the Study: A cross sectional study was conducted at Ex- Servicemen Contributory Health Scheme (ECHS) Polyclinic, Sultanpur Lodhi, Kapurthala, India from June to Oct, 2013. Methodology: All retired defense personnel and their family members (N= 351) who attended polyclinic during study period were recruited to assess physical activity, body mass index, dietary habits, alcohol, family history, sleep, stress, over the counter (OTC) medications, employment status, and education as determinants of BP. The results were analyzed by Chi Square test with statistically significance of P value <0.05. Results: The frequency of high BP as per JNC VII guidelines was observed as 47.90% with higher range in females (51.19%) than males (48.80%). The frequency significantly increased with age >50years (88.08%; P<0.001), unemployment status (76.19%; P<0.05) and low education levels (37.50%; P<0.05). An association of high BP with inadequate sleep (35.11%; P<0.05), sedentary lifestyle (63.69%), alcohol (26.78%), positive family history (36.30%), stress (20.83%), non-vegetarian dietary habits (44.64%), increased BMI (67.26%; P<0.05) and OTC medications misuse (15.47%) was found. Half of the subjects were diagnosed with high BP for more than five years (49.40%), two-third had controlled (67.26%) and compliant (69.64%) status, and more than two-third had awareness about their diagnosis of high BP (83.60%). The uncontrolled status, non-compliance towards treatment, and low awareness level regarding high blood pressure values was found among 32.73%, 30.35% and 08.19% of subjects, respectively. Conclusion: This rising frequency of high BP and its associated factors must be monitored, treated and controlled by appropriate preventive and therapeutic approaches including lifestyle modifications, Dietary Approach to Stop Hypertension, weight loss and maintenance, physical activity, stress management and pharmacotherapy.

A Study of Hypertension and Obesity Among the Adult Population in a Rural Area Near NCT Delhi.

Background: The burden of non-communicable diseases (NCDs) in India is substantial and is estimated to increase, in rural areas too. Objectives: To study hypertension and obesity among the adult population in a rural area near Delhi. Materials/methods: A complete enumeration of the total population was done in Mandola village of Uttar Pradesh by conducting a house to house survey. After collecting information based data, the height, weight and blood pressure of all available family members were recorded as per standard procedures. Results: Data was collected from a total of 1124 persons. While there were 15.5% current smokers, 4.4% were consumers of alcohol. The prevalence of current smoking was 35.4% among the males and 3.3% among the females. It was observed that 20.2% of the males and 27.2% females were obese. Among the females, obesity was more likely among the housewives (p<0.001) and those of older age (p<0.001). The proportion of hypertensives was 16.0% in males and 13.0% in females. Among the males, hypertension was more common among the smokers than non-smokers (18.5% vs. 14.5%) and among current alcohol users than non-users (22.4% vs. 15.1%). We found several subjects, of both genders, who had both hypertension as well as obesity. Conclusion: The present study has shown that the burden of NCDs such as hypertension and obesity is quite substantial in a rural population.

Lipoprotein(a) in Essential Hypertension Patients.

Background: Lipoprotein(a) [Lp(a)] is an important and independent cardiovascular risk factor, but its role in the development of coronary vascular disease in hypertensives have conflicting results. Adequate studies have not been conducted on the Lp(a) in essential hypertensive patients. Aims and Objectives: In the present study, we aimed to investigate the possible relationship between plasma Lp (a) and lipid levels in essential hypertensive patients. Materials and Methods: A total of 30 essential arterial hypertensive patients were studied and compared with 30 controls matched in terms of age, sex and body mass index. Results: It was seen that mean level of Total Cholesterol, Triglyceride, Very Low Density Lipoprotein-Cholesterol and Low Density Lipoprotein-Cholesterol were elevated in hypertensive patients as compared to controls, but the levels were not statistically significant. Taking 30 mg/dl as the cut off value of Lp(a), majority of the patients had levels more than 30 mg/dl (P<0.001) when compared to controls. Conclusion: This study indicates that significantly elevated serum Lp(a) level can be a independent risk factor for coronary vascular diseases in essential hypertensive patients.