Sociodemographic and behavioral factors associated with controlled hypertension after 9 years of observation of a PURE Poland cohort study.

Introduction: Despite some improvement in awareness and treatment of hypertension, blood pressure control is still below expectations in Poland. The aim of the study was to analyze the secular trend of hypertension prevalence in the PURE Poland cohort study over 9 years of observation and to analyze factors associated with controlled HT. Methods: The study group consisted of 1,598 participants enrolled in a Prospective Urban and Rural Epidemiological Study (PURE), who participated both in baseline (2007-2010) and 9-year follow-up (2016-2019). Hypertension was ascertained on the basis of (1) self-reported hypertension previously diagnosed by the physician, (2) self-reported anti-hypertensive medication, and/or (3) an average of two blood pressure measurements ≥140 mmHg systolic BP and/or ≥90 mmHg diastolic BP. Results: The prevalence of hypertension increased from 69.4% at baseline to 85.9% at 9-year follow-up. The chance of HT was 8.6-fold higher in the oldest vs. the youngest age group [OR 8.55; CI 4.47-16.1]. Male sex increased the chance for hypertension over 3-fold [OR 3.23; CI 2.26-4.73]. Obesity, according to BMI, increased the chance of HT 8-fold [OR 8.01; CI 5.20-12.8] in comparison with normal body weight. Male sex decreased the chance of controlled HT after 9 years [OR 0.68; CI 0.50-0.92]. There was no statistically significant association between controlled HT and age or place of residence. Higher and secondary education increased the chance of controlled HT over 2-fold in comparison with primary education [OR 2.35; CI 1.27-4.34, OR 2.34; CI 1.33-4.11]. Obesity significantly decreased the chance of controlled HT after 9 years in comparison with normal body weight [OR 0.54; CI 0.35-0.83]. Conclusion: Factors significantly increasing the chance for controlled hypertension after 9 years were female sex, secondary and tertiary education, normal body weight, and avoiding alcohol drinking. Changes in lifestyle, with special emphasis on maintaining normal body weight, should be the basis of prevention and control of HT.

The Challenges of Implementing a Text Message Intervention to Promote Behavioral Change in Primary Care Patients With Hypertension and Diabetes

Abstract Background Controlling blood pressure and glycemic levels is a challenge that requires innovative solutions. Objective To assess the feasibility of implementing a text message intervention among low-income primary care patients, as well as to assess self-reported behavioral change. Methods A set of 200 text messages was developed on healthy eating, physical activity, adherence, and motivation. Participants from Vale do Mucuri, MG, Brazil diagnosed with diabetes or hypertension or undergoing screening for those diseases, received 5 to 8 messages per week for 6 months. They answered a questionnaire to report their satisfaction and behavioral changes. Results Of the 136 patients, 117 (86.0%) answered the questionnaire. Most reported that the messages were very useful (86.3%), easy to understand (90.6%), and were very helpful for behavioral change (65.0%); 84.6% reported that they had started eating healthier. The most frequent reported lifestyle changes were: improved diet quality (85.5%), reduced portions (65.8%), and weight loss (56.4%). The majority of patients shared the messages (60.7%) with family or other acquaintances, considered the number of messages to be adequate (89.7%) and would recommend the program to others (95.7%). Conclusion An intervention based on text messages to promote behavioral change in patients with hypertension or diabetes in primary care is feasible in low-resource settings. Future studies are needed to assess the program's long-term effects on clinical outcomes.

Religious Leaders as Trusted Messengers in Combatting Hypertension in Rural Tanzanian Communities.

BACKGROUND: Hypertension is a growing public health emergency in rural sub-Saharan Africa. Based on the known influence of religious leaders in rural sub-Saharan Africa and our prior research, we explored perspectives of religious leaders on hypertension and potential strategies to improve hypertension control in their communities. METHODS: We conducted 31 in-depth interviews with Christian (n = 17) and Muslim (n = 14) religious leaders in rural Tanzania. Interviews focused on religious leaders' perceptions of hypertension and how they could play a role in promoting blood pressure reduction. We used interpretative phenomenological analysis, a qualitative research method, to understand religious leaders' perspectives on, and experiences with, hypertension. RESULTS: Three main themes emerged during analysis. First, we found that perceptions about causes, treatment, and complications of hypertension are influenced by religious beliefs. Second, religious beliefs can enable engagement with hypertension care through religious texts that support the use of biomedical care. Third, religious leaders are enthusiastic potential partners for promoting hypertension control in their communities. These themes were consistent between religion and gender of the religious leaders. CONCLUSIONS: Religious leaders are eager to learn about hypertension, to share this knowledge with others and to contribute to improved health in their communities.

Prevalence of Systemic Arterial Hypertension and Associated Factors Among Adults from the Semi-Arid Region of Pernambuco, Brazil / Prevalência e Fatores Associados à Hipertensão Arterial Sistêmica em Adultos do Sertão de Pernambuco, Brasil

Abstract Background: Systemic arterial hypertension is a substantial public health problem responsible for millions of deaths per year worldwide. However, little is known about the epidemiology of this disease in areas distant from large urban centers in Brazil. Such information is necessary to plan health promotion strategies. Objective: To estimate the prevalence of hypertension and determine its associated factors in adults residing in the semi-arid region of the state of Pernambuco, Northeastern Brazil. Method: This is a cross-sectional study conducted with a random sample of male and female adults. Individuals with systolic blood pressure ≥ 140 mm/Hg and/or diastolic blood pressure ≥ 90 mm/Hg and those who reported being under treatment with antihypertensive drugs were considered hypertensive. We collected data on demographic, socioeconomic, behavioral, and anthropometric characteristics, as well as health and nutrition. The statistical analysis used Pearson's chi-square test, the chi-square test for trend, and multivariate Poisson regression analysis. A p-value < 0.05 in the final model was considered indicative of statistical significance. Results: The sample consisted of 416 individuals, and the prevalence of hypertension was 27.4% (95%CI 23.2 - 32.0). In the final model, the independent predictors of hypertension were age of 40 years or older (p = 0.000), low economic class (p = 0.007), smoking (p = 0.023), overweight determined by the body mass index (p = 0.003), and reduced glucose tolerance/diabetes mellitus (p = 0.012). Conclusion: The prevalence of hypertension was high and related to important risk factors. Thus, prevention and control strategies are recommended.

Resumo Fundamento: A hipertensão arterial sistêmica (HAS) constitui grande problema de saúde pública, responsável por milhões de mortes por ano no mundo. Apesar disso e frente à necessidade de informações para o delineamento de estratégias de promoção da saúde, pouco se conhece sobre a epidemiologia da doença em regiões distantes dos grandes centros urbanos brasileiros. Objetivo: Estimar a prevalência e verificar os aspectos associados à HAS em adultos do sertão de Pernambuco, Brasil. Métodos: Estudo de delineamento transversal, com uma amostra aleatória de adultos de ambos os sexos. Foram considerados hipertensos aqueles que apresentaram pressão arterial sistólica ≥ 140 mmHg e/ou diastólica ≥ 90 mmHg, além daqueles que relataram estar em tratamento com anti-hipertensivos. Informações demográficas, socioeconômicas, comportamentais, antropométricas e de saúde e nutrição foram coletadas. Foram aplicados os testes do 2 de Pearson, c2 para tendência e a regressão multivariada de Poisson. No modelo final, foi considerada significância estatística quando p < 0,05. Resultados: A amostra foi composta por 416 indivíduos e a prevalência de HAS foi de 27,4% (IC95% 23,2 - 32,0). No modelo final, foram identificados como preditores independentes da HAS a faixa etária a partir dos 40 anos (p = 0,000), classe econômica baixa (p = 0,007), tabagismo (p = 0,023), excesso de peso pelo índice de massa corporal (p = 0,003) e adultos com tolerância à glicose diminuída/diabetes mellitus (p = 0,012). Conclusão: A prevalência de HAS é elevada e se relaciona com fatores de risco importantes, logo, são recomendáveis ações de prevenção e controle.

Hypertension Prevalence, Treatment and Control in Older Adults in a Brazilian Capital City / Prevalência, Tratamento e Controle da Hipertensão Arterial em Idosos de uma Capital Brasileira

Abstract Background: The diagnosis, treatment and control of arterial hypertension are fundamental for a reduction in cardiovascular outcomes, especially in the elderly. In Brazil, there are few studies that specifically identified these rates in the elderly population. Objective: To verify rates of prevalence, treatment and control of hypertension in elderly people living in the urban area of a Brazilian capital city. Methods: A cross-sectional, population-based, randomized, cluster-based study with 912 non-institutionalized elderly individuals (≥ 60 years), living in urban areas in the city of Goiania, Midwest Brazil. Predictor variables were: age, gender, socioeconomic and lifestyle aspects. Blood pressure measurements were performed at home; patients were considered as having arterial hypertension when SBP and/or DBP ≥ 140/90 mmHg or when using antihypertensive drugs (dependent variable). Rates of hypertension treatment and control were evaluated. Variable association analyses were performed by multivariate logistic regression and level of significance was set at 5%. Results: The prevalence of arterial hypertension was 74.9%, being higher (78.6%) in men (OR 1.4, 95% CI: 1.04-1.92); the treatment rate was 72.6%, with higher rates being observed in smokers (OR 2.06, 95% CI: 1.28-3.33). The rate of hypertension control was 50.8%,being higher in women (OR 1.57, 95% CI: 1.19-2.08). Conclusion: The prevalence rates were high. Treatment and control rates were low and associated with gender, age and lifestyle, indicating the need for early and individual interventions.

Resumo Fundamento: O diagnóstico, tratamento e controle da hipertensão arterial são fundamentais para a redução de eventos cardiovasculares, especialmente em idosos. No Brasil são escassos os estudos que identificaram essas taxas especificamente na população idosa. Objetivo: Verificar a prevalência, taxas de tratamento e controle da hipertensão arterial entre idosos da zona urbana de uma capital brasileira. Métodos: Estudo transversal de base populacional, com amostragem aleatória por conglomerado, realizado com 912 idosos (maiores de 60 anos), residentes na zona urbana de Goiânia. Variáveis preditoras: idade, sexo, aspectos socioeconômicos e estilo de vida. Medidas da pressão arterial (PA) realizada em domicílio; hipertensão arterial (HA) igual a PA sistólica e/ou diastólica maior ou igual a 140/90mmHg ou usando anti-hipertensivos (variável dependente). Foram avaliadas taxas de tratamento e controle de HA. Análise de associação dos desfechos com regressão logística multivariada e nível de significância de 5%. Resultados: Prevalência de hipertensão arterial total foi de 74,9%, sendo maior entre os homens 78,6% (OR 1,4; IC95%1,04-1,92); A taxa de tratamento foi de 72,6%, com taxas superiores entre os fumantes (OR 2,06; IC 95% 1,28-3,33). A taxa de controle total foi de 50,8%, maior entre as mulheres (OR 1,57; IC 95% 1,19- 2,08). Conclusões: As taxas de prevalência foram elevadas. Taxas de tratamento e controle foram baixas e mostraram associação com sexo, faixa etária e estilo de vida, indicando necessidade de intervenções precoces e individuais.

Cross-cultural adaptation of Hypertension Knowledge Test into European Portuguese

ABSTRACT We aim to validate a European-Portuguese version of the Hypertension Knowledge Test (HKT) questionnaire and examine its factorial structure with a confirmatory factor analysis (CFA). A process of translation and back-translation was performed. A cross-sectional study was developed in which all adult patients taking at least one antihypertensive drug were invited to participate. Data on personal and family history were collected, and the HKT, Strelec, and the Batalla questionnaires were administered. We enrolled 304 patients with a mean age of 68.12±10.83 years. The mean score of HKT was 15.33±2.79. CFA indicated that the construct being tested was unidimensional, and Cronbach's alpha (α=0.65) showed that the instrument had an acceptable internal consistency. When evaluating concurrent validity, HKT was significantly correlated with the Batalla and Strelec scores. Thus, the Portuguese version of HKT (HKT-pt-PT) can be used either in research or in clinical practice. With this version, a potential standard exists to evaluate knowledge about hypertension, which could avoid the practice of using non-validated questionnaires in Portugal and allow the cross-sectional and longitudinal comparability of studies.

Hypertension a priority?

PIP: Hypertension (HT) in Africa has recently been the subject of an exchange of correspondence in the British Medical Journal (BMJ). It was argued in one paper that its treatment should be a priority and that one death could be prevented for every US$1800 spent upon antihypertensive drugs. One letter writer argued that the figure was an underestimate and could not compare in terms of cost-effectiveness with, for example, epilepsy treatment at around $20/year. A better approach, however, would be to urge patients with HT to eat less salt and to restrict drug treatment to those with symptoms or complications. Another writer went further, noting what little money is available to African patients and hospitals, and that one cannot realistically expect a peasant farmer to spend $40/year on a drug for a disease which causes him no suffering. A simple rural hospital could save lives from many conditions, each at a fraction of the cost of antihypertensive drug treatment. Nonetheless, other writers to the BMJ argue that stroke and cerebrovascular disease in Africa are likely to become more common and that it is extremely important that cost-effective approaches are found to control HT in developing countries.^ieng

Coping with hypertension in pregnancy.

PIP: Hypertension is the most common medical complication of pregnancy in South Africa and a major cause of maternal and perinatal morbidity and mortality worldwide. At King Edward VIII Hospital in Durban, 18% of all admissions to the obstetric unit have some degree of high blood pressure. Hypertension in its most severe form produces convulsions, proteinuria, and edema and may lead to fetal and maternal death. High-risk groups for preeclampsia are teenage mothers, primigravidas, and women with a history of elevated blood pressure, previous preeclampsia, molar pregnancies, multiple pregnancies, or hydrops fetalis. Methods used to prevent preeclampsia include a low-salt diet supplemented with calcium, magnesium, zinc, fish, and pharmacological manipulation. In developing countries, prevention and detection of preeclampsia is difficult since women seek antenatal care late in their pregnancies. In Durban, the average gestational age at first antenatal attendance is 28 weeks, and 80% of patients presenting with eclampsia have defaulted antenatal care. Treatment includes admission to hospital to establish the etiology of the hypertension and maternal renal function tests . Fetal condition is a sensitive index of hypertension and is judged by 1) clinical evidence of fetal growth, 2) weekly antepartum cardiotocography, and 3) ultrasonographic screening. Patients are managed according to three clinical groups: 1) those identified before 36 weeks, 2) those identified after 36 weeks, and 3) patients in hypertensive crisis. Dihydralazine is the drug of choice for imminent eclampsia. If the patients has a ripe cervix, delivery is induced with 6-8 hours. Steroid contraception use in the older hypertensive patient should be avoided because of possible development of atherosclerosis and stroke. Puerperal tubal ligations in the hypertensive patient ought to be avoided because of the risks of thromboembolic phenomena and pulmonary embolism. Methyldopa is the treatment of choice in cases of moderate to severe hypertension. Intravenous dihydralazine is relatively safe for the rapid reduction of high blood pressure.^ieng

What can be done at different levels of the health care system.

PIP: In countries where maternal mortality is high, more than 80% of maternal deaths are the result of anemia, hemorrhage, infection, hypertensive disorders, obstructed labor, and abortion. A table is presented showing what can be done at different levels of the health care system to prevent and treat each complication. It also highlights the connections, such as communication and transport, between communities, health centers, and hospitals. Strengthening such connections facilitates access to care and improves the quality of care through better supervision. The table aims to define the main responsibilities of all involved in building a successful safe motherhood program. At the community level, it indicates what women can do and shows essential minimal service provision at health centers and hospitals. At the national level, it sets some of the training and legal priorities for policymakers.^ieng

Patient exposition and provider explanation in routine interviews and hypertensive patients' blood pressure control.

Hypertensive patients' expressing themselves in their own words (Exposition) and providers' giving information (Explanation) during medical interviews were hypothesized to be associated with subsequent blood pressure control. Transcripts of routine return visits to clinics in low-income areas of Houston, TX, were coded using the Verbal Response Modes (VRM) system. VRM indexes of Patient Exposition and Provider Explanation were tested in relation to systolic and diastolic blood pressure obtained during home interviews 2 weeks after the clinic visits. Patient Exposition was significantly correlated with reductions in systolic and diastolic blood pressure from clinic visit to home interview, and Provider Explanation was significantly correlated with lower diastolic blood pressure at home interview. The results suggest that patients' and providers' verbal behavior in medical interviews should be included in predictive models of blood pressure control.

PIP: Analysis of the transcriptions of 217 patients' visits to community health centers in low-income areas of Houston, Texas, for hypertension treatment suggests at least a partial correlation between patients' expressing themselves in their own words (exposition) and providers' giving information on the one hand and subsequent lowered blood pressure on the other hand. Verbal Response Mode indexes of Patient Exposition and Provider Explanation were tested in relation to systolic and diastolic blood pressure obtained during home visits 2 weeks after the medical interview. The patients' amount of talking using their own words in the medical history segment of the health center visit was significantly correlated with reductions in blood pressure from clinic to home visit, but not with blood pressure levels at the clinic or the home interview. Providers' percentage of giving objective information in the conclusion segment of the clinical interview was significantly associated with lower blood pressure at the home interview, but not with clinic levels or with change from clinic to home visit. These trends remained even after controlling for patient age, sex, ethnicity, and for provider differences. This is believed to be the 1st empirical evidence of an association between blood pressure and characteristics of the medical interview. Overall, they suggest that greater attention should be given to patient-provider verbal interaction variables in designing blood pressure control programs.

[Prevention of cerebrovascular circulatory disorders]. / Prophylaxe zerebraler Durchblutungsstörungen.

On reviewing the literature, the meaning of risk factors causing stroke as well as their therapy or elimination as an effective prevention of cerebro-vascular disease is pointed out. Hypertension increases the risk of apoplexy by the fourfold, with regard to the diastolic values of blood pressure by the fivefold up to the tenfold. Consistent therapy of hypertension decreases significantly the incidence of cerebral apoplectic attacks. Manifested diabetes mellitus and even reduced glucose tolerance raise the risk of stroke by the threefold, even though factors frequently associated with diabetes (hypertension, overweight, hyperlipoidaemia) are taken into consideration. Hyperlipidaemia, hypercholesteraemia, and hypertriglyceridaemia stipulate an increase of the incidence of stroke by the twofold to the threefold. Morbidity rate rises if these abnormalities coincide with further risk factors (hypertension, reduced glucose tolerance, smoking cigarettes, hypertrophy of left heart-ECG), up to the sixfold. Nicotine consumption alone increases the risk of cerebral apoplectic attacks in relation to age, by the threefold up to the fivefold. In combination with the use of hormonal contraceptive drugs, the risk of morbidity rate in women rises to the sevenfold. Overweight of more than 30% aggravates twice the risk of stroke. Heart diseases of different kind increase the risk of apoplectic attacks by the twofold; in combination with hypertension by the fivefold. The intake of oral contraceptive drugs causes an increase of cerebral thrombo-embolic attacks by the threefold up to the fivefold, where by a relation to the content of oestrogen and to the disturbances of haemorheology is proven.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: The literature points out the meaning of risk factors causing stroke as well as their therapy or elimination as an effective prevention of cerebrovascular disease. Hypertension increases the risk of apoplexy by 4-fold, with regard to the diastolic values of blood pressure by the 5-fold up to the 10-fold. Consistent hypertension therapy decreases significantly the incidence of cerebral apoplectic attacks. Manifested diabetes mellitus and even reduced glucose tolerance raise the risk of stroke by the 3-fold, even though factors frequently associated with diabetes are taken into consideration. Hyperlipidemia, hypercholesteremia, and hypertriglyceridemia stipulate an increase of stroke incidence by the 2-fold to the 3-fold. Morbidity rate rises if these abnormalities coincide with further risk factors, up to the 6-fold. Nicotine consumption alone increases the risk of cerebral apoplectic attacks in relation to age, by the 3-fold up to the 5-fold. In combination with the use of hormonal contraceptive drugs, the risk of morbidity rate in women rises to the 7-fold. Overweight of more than 30% aggravates twice the risk of stroke. Heart diseases of different kind increase the risk of apoplectic attacks by the 2-fold, in combination with hypertension by the 5-fold. The intake of oral contraceptives (OCs) causes an increase of cerebral thromboembolic attacks by the 3-fold up to the 5-fold, whereby a relation to estrogen content and to hemorheology disturbances is proven. Blood coagulation disturbances, especially hypercoagulability with increase of blood level of fibrinogen, fibrin, and enhanced adhesiveness of thrombocytes in cerebrovascular disease are proven to be valid. By combination of various risk factors apoplexy risk is additionally increased. The possibility of surgical and neurosurgical prophylactic treatment in all stages of cerebral ischemia, caused by occlusive disease of the cartoid, vertebral, and intracranial arteries, exists in 75% of patients. With regard to the longterm results of patients with extraintracranial bypass surgery, due to stenosis or occlusion of the carotid artery in its high cervical or intracranial course, or of the middle cerebral artery, the operated group clearly was better than the nonoperated group in frequency of cerebral ischemia recurrence. The therapeutic effect of inhibitors of thrombocytic aggregates and of anticoagulants for the chemotherapeutic prevention of cerebral ischemia, is proven for acetylsalicylic acid and derivatives of coumarin. Both diminish significantly the rate of cerebral ischemia when compared with placebo-treated control groups.

Systemic hypertension: prevention and treatment of target organ catastrophe.

PIP: This review describes current management of acute hypertension in the University of Cincinnati Hospitals and emphasizes prevention of recurrent vascular incidents. Careful management of hypertension involves: 1) accurate measurement of recumbent and standing blood pressure to document definite abnormality, severity of disease, and need for antihypertensive medication; 2) concise history and physical examination to identify the possible role of medication in blood pressure elevation; 3) compilation of a laboratory database for evaluating target organ function; and 4) discussion with the patient concerning the physician's findings, treatment plan, and risks of untreated hypertension. In the patient with antecedent hypertension cerebral crisis usually results from ruptured berry aneurysm, massive intracerebral hemorrhage, lacunar hemorrhage in critical areas, large artery occlusion, or hypertensive encephalopathy. Principal elements in managing accelerated or malignant hypertension include a careful history to determine duration of disease, symptoms, and current drug therapy. Oral contraceptives (OCs) and other drugs may sharply escalate otherwise stable hypertension. Cerebral hemorrhage dissecting and ruptured or aortic aneurysms account for the majority of sudden hypertension-related deaths, and hypertension is the leading cause of left ventricular failure causing pulmonary edema. Hypertension complicates pregnancy in several settings including the primigravida without antecedent hypertension. It can also be a complicating factor in the primigravida with known antecedent hypertension. Initial management of most hypertensive pregnancies requires observation, usually in a hospital. Most patients exhibit a fall in blood pressure during the 1st 2 trimesters, but antihypertensive medication (diuretics, reserpine, hydralazine, and methyldopa) have been administered without complications. OC medication is the most prevalent cause of hypertension in young women. Revision of estrogen-gestagen dosage formulas, shortened periods of administration, and periodic blood pressure measurement have diminished the incidence of OC associated hypertension. Emergency surgery situations, renal transplantation, diabetic nephropathy, and coronary disease are also discussed.^ieng