25-Year trends in hypertension prevalence, awareness, treatment, and control in an Indian urban population: Jaipur Heart Watch

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.

Obesity is major determinant of coronary risk factors in India: Jaipur Heart Watch studies.

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.

Clinical and scanning electron microscopic assessments of porcelain and ceromer resin veneers.

PURPOSE: Recently available Ceromer resin materials are promising for fabrication of esthetic anterior laminates and provices an alternative, cost effective treament modality to porcelain laminates for discolored anterior anterior teeth. It was proposed to study the esthetic quality and surface finish of veneers fbricated from ceromer resin and compare it with the standard porcelain veneers, both clinically as well as by scanning electron microscope (SEM) at baseline and at 12 months. If found comparable, ceromer resin veneer could provide an alternative to porcelain veneers which is an expensive technique for a developing country like India. MATERIALS AND METHODS: Seventy-two veneers, 36 porcelain and 36 ceromer were placed in 12 subjects who were studied at 0, 6 and 12 months for clinical acceptability, and at 0 and 12 months for SEM assessment. The restorations were luted with Opal luting composite and Scotchbond multipurpose system; polyvinyl siloxane was used as the impression material. The clinical assessment was made using modified United Public Health Services criteria, whereas the SEM assessment was made by quantitative analysis of the marginal fit and surface characteristics of the two veneering materials. RESULTS: Ceromer exhibited good anatomical form during the study period, but depicted changes in color, surface appearance, marginal adaptation, increased marginal discoloration, and tissue response. Inability to achieve a good finish with high gloss was a major drawback of the ceromer. Porcelain exhibited better esthetics, marginal adaptation, finish qualities, and tissue response. The SEM showed good to excellent marginal fit at baselinne in ceromer and porcelain veneers, but loss of luting resin at the margins was evident in both the materials after 12 months, leading to visible gaps in a number of veneer restorations. Ceromer veneers exhibited poor surface characteristics in several restorations, which further degraded in an oral conditions over 12 months. CONCLUSION: Veneering is an effective mode of treating discolored teeth. Ceromer veneers exhibited deterioration of surface finish and increased marginal discolouration over a period of 12 months. Clinically ceromer veneers were less acceptable to the patients than porcelain veneers. Porcelain out-scored ceromer as a permanent mode of treatment for discolored teeth, as over a period of 12 months it yielded good clinical results in comparison to ceromer.