The burden of hypertension and kidney disease in Northeast India: the Institute for Indian Mother and Child noncommunicable diseases project.

Chronic noncommunicable diseases (NCDs) such as hypertension, atherosclerosis, acute myocardial infarction, stroke, diabetes, obesity, and chronic kidney disease are the major cause of death not only in high income, but also in medium and low income countries. Hypertension and diabetes, the most common causes of chronic kidney disease, are particularly common in southeast Asian Countries. Because early intervention can markedly slow the progression of these two killer diseases, assessment of their presence through screening and intervention program is a priority. We summarize here results of the screening activities and the perspectives of a noncommunicable diseases project started in West Bengal, India, in collaboration with the Institute for Indian Mother and Child (IIMC), a nongovernmental voluntary organization committed to promoting child and maternal health. We started investigating hypertension and chronic kidney disease with screen in school-age children and in adults >30 years old. We found a remarkable prevalence of hypertension, even in underweight subjects, in both children and adult populations. A glomerular filtration rate <60 mL/min was found in 4.1% of adult subjects significantly higher than that of 0.8% to 1.4% reported 10 years ago. Increased awareness and intervention projects to identify NCDs and block their progression are necessary in all countries.

Hypertension and kidney function in an adult population of West Bengal, India: role of body weight, waist circumference, proteinuria and rural area living.

AIM: Hypertension (HTN) and chronic kidney disease (CKD) are important emerging problems in low-income countries, with an increasing number of patients dying from their consequences. METHODS: A project for investigating these issues was carried out in West Bengal, India, in 2536 adult subjects. Body mass index (BMI) was classified using traditional and new cut-offs identified by the World Health Organization for Asian populations. HTN was classified according to the Joint National Committee 7 and CKD according to presence of estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m(2) . RESULTS: Normal BMI (Asian reference) was found in 41.5% of subjects, while 33.4% were underweight, 19.3% overweight and 5.8% obese. Prevalence of stage 1 and 2 HTN was 39.4%. Proteinuria (urine dipstick >1+) was present in 7.7% of the sample. In a subsample of 1526 subjects, eGFR of less than 60 mL/min per 1.73 m(2) was found in 4.2%. At multivariate analysis, factors associated with HTN were weight classes (P<0.001), presence of proteinuria (P<0.001) and family history of HTN (P=0.028), while living in rural areas was associated with lower risk for HTN (P=0.003). eGFR was inversely related to BMI (P=0.03), the presence of proteinuria (P<0.001) and HTN (P<0.003), and directly related to living in rural areas (P=0.003). CONCLUSION: High prevalence of HTN was found in subjects with very limited access to health care in West Bengal. HTN was more common in overweight individuals, but also affected normal weight and underweight subjects in a significant part of the tested population. Preventive medicine should be a strong priority in this setting.

High prevalence of hypertension in normal and underweight Indian children.

BACKGROUND: Childhood hypertension is an established predictor of adult hypertension and organ damage, an underestimated problem in developing countries. The aim of the study was to assess the prevalence of arterial hypertension, as well as the relationship of blood pressure values and weight class and urinary abnormalities in 1176 children (aged 5-12 years) from a suburban area south of Kolkata, India. METHOD: Arterial blood pressure, height, weight and waist circumference were measured. Weight class was defined according to the tables of the International Obesity Task Force. Urinalysis was performed with reagent strips to detect glucosuria, microhematuria and proteinuria. RESULTS: The majority of children (74.7%) were underweight and 5.2% had systolic and/or diastolic blood pressure values higher or equal to the 95th percentile, according to the National High Blood Pressure Education Program normograms. Hypertension had a high prevalence both in underweight children (4.3%) and in normal-weight children (6.9%) and significantly increased in the rare overweight children (4/20, 20%). A fraction of 8.5% of hypertensive children had urinary abnormalities (microhematuria only) vs. 12.5% in nonhypertensive children (P value 0.36). CONCLUSION: Prevalence of hypertension in North-Eastern Indian children is higher than in Western countries and only partly associated to weight class. Causes of hypertension do not seem to be related to overt kidney disease and remain to be elucidated.

Video-assisted thoracic surgical resection of giant cardiac lipoma: a case report.

We describe the case of a 73-year-old man, with a history of previous coronary artery by-pass, who presented at our division for new onset of angina, hypotension and dyspnea due to a primary giant para-cardiac lipoma. The success of complete resection of the mass achieved by means of video-assisted thoracic surgical procedure demonstrated the efficacy and safeness of this method in the treatment of benign cardiac tumours.