May Measurement Month 2021: an analysis of blood pressure screening results from Venezuela.

Cardiovascular diseases continue to be the main cause of death in Venezuela, and hypertension is the principal risk factor. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. May Measurement Month 2021 included 46 732 participants with a mean age of 56.4 years (SD 14.4), 57.9% of whom were female. The percentage with hypertension was 60.3% (57.9% of females and 63.7% of males), 82.3% (84.8% of females and 79.2% of males) were aware, and 80.2% were taking antihypertensive medication. Of those on antihypertensive medication, 44.2% (41.2% of females and 48.2% of males) were not controlled [blood pressure (BP) ≥ 140/≥90 mmHg], with 61.3% receiving one drug, 30.0% two drugs, and 8.7% three or more drugs. 87.5% of those on treatment reported taking it regularly. Conditions associated with higher BP levels include fewer years of education, having a previous diagnosis of hypertension, and women who were hypertensive during a previous pregnancy. Physical activity and pregnancy were conditions associated with lower BP levels. A previous positive COVID-19 test was reported in 11.1%, and one or more COVID-19 vaccinations reported in 22.7% of participants. Of those on antihypertensive medication, 78.8% reported their treatment was not affected by COVID-19. Results are consistent with previous MMM campaigns and indicate that the screening campaign is feasible and useful to identify hypertension even in exceptional conditions such as the COVID-19 pandemic.

Research on aging during the Venezuelan humanitarian crisis: the experience of the Maracaibo aging study.

BACKGROUND: Venezuela is in the throes of a complex humanitarian crisis that is one of the worst in decades to impact any country outside of wartime. This case analysis describes the challenges faced by the ongoing Maracaibo Aging Study (MAS) during the deteriorating conditions in Venezuela. When the MAS began in 1997, it focused on memory-related disorders. Since then, strategic planning and proactive community participation allowed us to anticipate and address logistical, funding, and ethical challenges, and facilitated the enrollment and retention of more than 2500 subjects over 55 years of age. All participants, who are residents of the city of Maracaibo, Venezuela, underwent various assessments on several occasions. Here, we discuss how our approach to implementing a longitudinal, population-based study of age-related conditions has allowed our research program to continue throughout this period of political, economic, and social upheaval. DISCUSSION: As the social context in Venezuela became more complicated, new challenges emerged, and strategies to sustain the study and participation were refined. We identified five main mechanisms through which the evolving humanitarian crisis has affected implementation of the MAS: 1) community dynamics; 2) morale of researchers, staff, and participants; 3) financial feasibility; 4) components of the research process; and 5) impact on the health of staff, participants, and their families. Strategies to compensate for the impact on these components were implemented, based on inputs from community members and staff. Improved communication, greater involvement of stakeholders, broadening the scope of the project, and strengthening international collaboration have been the most useful strategies. Particular demands emerged, related to the increased mortality and comorbidities of participants and staff, and deterioration of basic services and safety. CONCLUSION: Although the MAS has faced numerous obstacles, it has been possible to continue a longitudinal research project throughout the humanitarian crisis, because our research team has engaged the community deeply and developed a sense of mutual commitment, and also because our project has provided funding to help keep researchers employed, somewhat attenuating the brain drain.

May Measurement Month 2019: an analysis of blood pressure screening results from Venezuela, Latin America.

Cardiovascular diseases are the main cause of death in Venezuela. Raised blood pressure (BP) accompanied by diabetes mellitus, obesity, lipid abnormalities, and tobacco usage are the biggest contributors to mortality. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. MMM2019 included 24 672 subjects (mean age: 54.7 years, SD 25.2, 63.1% female). The proportion with hypertension was 48.9%; 14.3% were unknown hypertensives, 35.5% of those who receiving treatment had uncontrolled hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg); when considering all hypertensives, 53.3% were controlled. Sixty per cent of those on anti-hypertensive medication were on monotherapy, 27.7% were on two, and 7.7% were on three or more drugs. Body mass index, calculated for the total population, was on average 25.6 (SD: 4.8) kg/m2. 16.2% of participants were classified as obese, 34.0% as overweight, and 4.0% were classified as underweight. Diabetes mellitus was reported by 9.4%, smoking by 7.3%, and 10.5% reported drinking alcohol regularly. Conditions associated with higher BP levels were obesity, diabetes mellitus, and women with a history of hypertension during a previous pregnancy. These results are consistent with the two previous MMM campaigns and indicate that repeated screening can routinely identify hypertension. There is an urgent need for Venezuela to implement programmes of detection, treatment, and control not only for hypertension but also for other common cardiovascular risk factors.

Results of May Measurement Month 2018 campaign in Venezuela.

Cardiovascular diseases, mainly coronary heart disease and stroke, are the main cause of death in Venezuela; hypertension is the primary risk factor. The May Measurement Month (MMM) study is a global initiative aimed at raising awareness of elevated blood pressure (BP). The previous MMM 2017 campaign showed 48.9% of participants had hypertension, higher than previous Venezuelan epidemiological studies. The MMM 2018 campaign included 28 649 participants screened [mean age: 54.2 (SD 15.13) years; female 62.8%] carried out mainly in pharmacies in 61 sites. Physical measurements included height, weight, and BP, taken in sitting position three times. After multiple imputations, 48.4% had hypertension, of which 87.7% were aware of their diagnosis. Of the individuals not receiving antihypertensive medication, 14.0% had hypertension and 33.7% of those receiving treatment had uncontrolled hypertension. Overall, the percentage of hypertensives with controlled hypertension was 54.8%. Body mass index was calculated for the total population, and it was on average 25.2 (SD: 4.65) kg/m2. Of all, 14.2% was classified as obese and 32.6% as overweight; meanwhile 4.8% as underweight. Diabetes was reported by 9.5%. These results suggest that repeated screening like the MMM campaign can routinely identify hypertension and consequently implement programmes of treatment in Venezuela, also other common risk factors, like obesity or diabetes.

Nighttime Blood Pressure Interacts with APOE Genotype to Increase the Risk of Incident Dementia of the Alzheimer's Type in Hispanics.

BACKGROUND: Dementia of the Alzheimer's type (DAT) impacts Hispanics disproportionately, with almost a twofold elevated risk of developing DAT, as well as earlier onset of the disease, than in non-Hispanic Whites. However, the role of main risk factors for DAT, such as APOE-ɛ4 and blood pressure (BP) levels, remains uncertain among Hispanics. OBJECTIVE: To investigate the association of APOE-ɛ4 and BP levels, measures with 24-h ambulatory BP monitoring, with incidence of DAT in an elderly cohort of Hispanics. METHODS: 1,320 participants from the Maracaibo Aging Study, free of dementia at the baseline, and with ambulatory BP measurements and APOE genotype available were included. Adjusted Cox proportional models were performed to examine 1) the incidence of DAT and 2) the relationship between BP levels and DAT according to APOE genotypes. Models were adjusted by competing risk of death before the onset of DAT. Model performance was assessed by likelihood test. RESULTS: The average follow-up time was 5.3 years. DAT incidence was 5.8 per 1000 person-year. APOE-ɛ4 carriers had a higher risk of DAT. In unadjusted analyses, conventional, 24-h, and nighttime systolic BP levels were significantly higher in participants who developed DAT and of APOE-ɛ4 carriers (p < 0.05). After adjustment for competing risks, only higher nighttime systolic BP was associated with DAT incidence, but only among subjects carrying APOE-ɛ4. CONCLUSION: In this Hispanic population, both APOE-ɛ4 genotype and assessment of nocturnal systolic BP (rather than diurnal or office BP) were necessary to estimate DAT risk.

Results of the May Measurement Month 2017: blood pressure campaign in Venezuela-Americas.

Cardiovascular diseases, mainly coronary heart disease and stroke, are the first cause of death in Venezuela; and hypertension is the main risk factor. May Measurement Month (MMM) is a global initiative aimed at raising awareness of elevated blood pressure (BP) and to act as a temporary solution to the lack of regular screening programmes. Some representative studies indicate prevalence of hypertension in Venezuela between 24 and 39%, and control rate around 20%. Sixty-four sites were included to participate in MMM, mainly in pharmacies. Physical measurements included height, weight, and abdominal circumference. Blood pressure was measured in the sitting position three times after resting for 5 min, 1 min apart, using validated oscillometric devices. 21 644 individuals were screened. After multiple imputation, 10 584 individuals [48.9% (50.7% male; 47.7% female)] had hypertension. Of individuals not receiving antihypertensive medication, 1538 (12.2%) were hypertensive. Of individuals receiving antihypertensive medication, 2974 (32.9%) had uncontrolled BP. About 16% had obesity calculated by body mass index; 43.8% of women and 20.7% of men had abdominal obesity. This was the largest BP screening carried out in Venezuela, in which 48.9% of the individuals had elevated BP, untreated hypertension was 12.2%, and one-third of subjects taking treatment were not controlled. About 16% had obesity by body mass index, and abdominal obesity is more common in women. These results suggest that repeated screening like MMM17 can identify hypertension in important numbers and can also evaluate programmes of hypertension treatment and control in Venezuela.

Prehipertensión: la influencia del estrés psicológico en adolescentes / Prehipertension: influence of psychological stress in adolescents

Se examinó la asociación entre el estrés psicológico (EP) y la prehiperten sión (PH) en adolescentes. La muestra estuvo conformada por 690 adolescentes: 260 varones y 430 hembras, con una media de edad de 15 años, (DE=1,5), a quienes se les determinó su presión arterial (PA) en la escuela, en posición sentada y usando el método oscilométrico (Dinamap). Todos, sin excepción, completaron una encuesta sobre eventos de vida y evaluación de ajuste social, ambas escalas asociadas con estresores vitales en adolescentes. Los partici pantes se clasificaron de acuerdo a los niveles de PA en prehipertensos (PH) y normotensos (N). La presencia de EP se evaluó como graves acontecimientos estresantes en su vida. Se utilizó la prueba de Chi cuadrado para estudiar la asociación entre EP y la presencia de PH. Los resultados arrojaron la presencia de EP en 70 varones (26,9%) y 155 hembras (36,0%), mientras que la prevalencia de prehipertensión fue de 9,2% (n=24) en varones y 3,5% (n=15) en hembras. Al aplicar la prueba estadística de Chi cuadrado en todos los adolescentes no se demostró asociación significativas entre EP y la condición de prehipertensión (PH con EP = 15 vs. N con EP = 24 (P = 0,42)). Sin embargo, al clasificar los sujetos por género, se encontró una asociación significativa entre EP y PH en las hembras (PH con EP = 9 vs. N con EP = 6, (P = 0,04)). El resultado anterior sugiere que, a edades tempranas, las mujeres pueden ser más vulnerables que los hombres al EP como un factor determinante a la condición de PH.

The article examines the association between psychological stress (PS) and prehypertension (PH) in 690 adolescents, 260 males and 430 females, whose average age was 15.2 years (SD = 1.5). Their blood pressure (BP) was measured on separate days at school, by the oscillometric method (Dinamap) in a seating position. All of them completed a survey assessing life events and social readjustment (both scales associated with life stressors in adolescen ce). Participants were classified according to BP levels in prehypertensive (PH) and normoten sive (N). The presence of PS was evaluated as severe stressful life events. The Chi-square test was used to study the association between PS and the presence of PH. The results showed the presence of PH in 9.2% (n = 24) in males and 3.5% (n = 15) in females, while the presence of PS ocurred in 70 males (26.9%) and 155 females (36.0%).When applied to the whole data, the Chi-square statistical test showed no association between PS and the condition of prehyperten sion (PH with PS = 15 vs. N with PS = 24, (P= 0.42)). However, when subjects were classified by gender, there was a significant association between PS and PH in female adolescents (PH with PS = 9 vs N with PS = 6 (P = 0.04)). This result suggests that, at early ages, female adolescents may be more vulnerable than males to PS as a determining factor to the condition of PH.

Prehipertension: influence of psychological stress in adolescents.

The article examines the association between psychological stress (PS) and prehypertension (PH) in 690 adolescents, 260 males and 430 females, whose average age was 15.2 years (SD = 1.5). Their blood pressure (BP) was measured on separate days at school, by the oscillometric method (Dinamap) in a seating position. All of them completed a survey assessing life events and social readjustment (both scales associated with life stressors in adolescence). Participants were classified according to BP levels in prehypertensive (PH) and normotensive (N). The presence of PS was evaluated as severe stressful life events. The Chi-square test was used to study the association between PS and the presence of PH. The results showed the presence of PH in 9.2% (n = 24) in males and 3.5% (n = 15) in females, while the presence of PS ocurred in 70 males (26.9%) and 155 females (36.0%).When applied to the whole data, the Chi-square statistical test showed no association between PS and the condition of prehypertension [PH with PS = 15 vs. N with PS = 24, (P= 0.42)]. However, when subjects were classified by gender, there was a significant association between PS and PH in female adolescents [PH with PS = 9 vs N with PS = 6 (P = 0.04)]. This result suggests that, at early ages, female adolescents may be more vulnerable than males to PS as a determining factor to the condition of PH.

Major cardiovascular risk factors in Latin America: a comparison with the United States. The Latin American Consortium of Studies in Obesity (LASO).

BACKGROUND: Limited knowledge on the prevalence and distribution of risk factors impairs the planning and implementation of cardiovascular prevention programs in the Latin American and Caribbean (LAC) region. METHODS AND FINDINGS: Prevalence of hypertension, diabetes mellitus, abnormal lipoprotein levels, obesity, and smoking were estimated from individual-level patient data pooled from population-based surveys (1998-2007, n=31,009) from eight LAC countries and from a national survey of the United States (US) population (1999-2004) Age and gender specific prevalence were estimated and age-gender adjusted comparisons between both populations were conducted. Prevalence of diabetes mellitus, hypertension, and low high-density lipoprotein (HDL)-cholesterol in LAC were 5% (95% confidence interval [95% CI]: 3.4, 7.9), 20.2% (95% CI: 12.5, 31), and 53.3% (95% CI: 47, 63.4), respectively. Compared to LAC region's average, the prevalence of each risk factor tended to be lower in Peru and higher in Chile. LAC women had higher prevalence of obesity and low HDL-cholesterol than men. Obesity, hypercholesterolemia, and hypertriglyceridemia were more prevalent in the US population than in LAC population (31 vs. 16.1%, 16.8 vs. 8.9%, and 36.2 vs. 26.5%, respectively). However, the prevalence of low HDL-cholesterol was higher in LAC than in the US (53.3 vs. 33.7%). CONCLUSIONS: Major cardiovascular risk factors are highly prevalent in LAC region, in particular low HDL-cholesterol. In addition, marked differences do exist in this prevalence profile between LAC and the US. The observed patterns of obesity-related risk factors and their current and future impact on the burden of cardiovascular diseases remain to be explained.

Prevalence and risk factors associated with the metabolic syndrome and dyslipidemia in White, Black, Amerindian and Mixed Hispanics in Zulia State, Venezuela.

Studies have highlighted the association between insulin resistance (IR) and several cardiovascular (CV) risk factors, including hypertension (HTN), obesity, dyslipidemia (i.e. high triglyceride and low HDL-cholesterol) and glucose intolerance, in a cluster known as the metabolic syndrome (MS). There are few data on the frequency of the MS and dyslipidemia in developing countries, and none in South America. To estimate the prevalence of the MS and its components in Zulia State, Venezuela, and to establish associated demographic and clinical factors, we evaluated 3108 Hispanic men and women aged 20 years or older from a cross-sectional survey of a random representative sample from each health district in Zulia State, Venezuela (1999-2001). Prevalence of the MS and dyslipidemia was defined according to the National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATP III) criteria. The age-adjusted prevalence of MS and dyslipidemia was 31.2% and 24.1%, respectively, with higher rates in men than in women. Prevalence rates increased with age and with the degree of obesity. MS prevalence was lower in Amerindian (17.%) compared to Black (27.2%), White (33.3%) and Mixed (37.4%) men, but no differences were found among women. Overall, low HDL-cholesterol (65.3%), abdominal obesity (42.9%) and HTN (38.1%) were the most frequent MS components. After adjusting for age, sex and race groups, family history of diabetes, obesity and HTN were associated with the MS. Sedentary lifestyle also increased the risk of MS, event after adjusting for the same covariates, obesity and the degree of IR. These results suggest that MS is found in approximately one-third of the Venezuelan adult population in Zulia State, with higher prevalence in men related to the presence of dyslipidemia. Lifestyle interventions in MS subjects are needed in Venezuela to halt the burden of CV disease and diabetes.

The Maracaibo Aging Study: population and methodological issues.

The Maracaibo Aging Study is a longitudinal, population-based, one-step multidisciplinary study of age-related diseases, with a particular focus on memory-related disorders, among subjects over 55 years living in a neighborhood of the city of Maracaibo, Venezuela. Three phases were scheduled for this study. First, a door-to-door survey was conducted in order to build a registry and to obtain general and sociodemographic characteristics. During the second phase, information regarding changes in the abilities of the subjects was collected. The third phase consisted of a full neuropsychiatric examination, cardiovascular evaluation, nutritional assessment, neuropsychological testing, routine laboratory tests and genetic analysis. 3,657 subjects were surveyed between January and August, 1998. There were more women than men, and the average number of years of formal education was low, particularly among women. The limitations and strengths of the study are discussed.

Factores nutricionales y metabólicos como riesgo de enfermedades cardiovasculares en una población adulta de la ciudad de Maracaibo, Estado Zulia, Venezuela / Nutritional and metabolic risk factors as cardiovascular diseases among an adult population of Maracaibo, Venezuela

Con el propósito de analizar los factores nutricionales y metabólicos de riesgo de enfermedades cardiovasculares (ECV) presentes en un grupo de individuos de la ciudad de Maracaibo, se realizó este estudio en 209 voluntarios entre 20 y 89 años (145 mujeres y 64 hombres), a quienes se les practicó: a) evaluación antropométrica: índice de masa corporal (IMC) y cociente cintura cadera (CCC) y examen físico: presión arterial sistólica (PAS) y diastólica (PAD); b) evaluación dietética (recordatorio de 24 horas) y c) evaluación bioquímica: glicemia (GLI), triglicéridos (TG), colesterol total (COL), HDL-C, LDL-C y VLDL-C, por métodos enzimáticos. Se investigó además: edad, antecedentes familiares de alteraciones metabólicas (A.F.A.M.), hábito tabáquico, hábito alcohólico, actividad física. Más del 50 por ciento de los sujetos estudiados tuvo un IMC > 25; 64 por ciento de mujeres presentó un valor de CCC > 0,8; 34 y 28 por ciento de hombres y mujeres respectivamente tuvieron un alto consumo de grasa (A.C.G.); 36 por ciento de hombres tuvieron hipertrigliceridemia y niveles elevados de VLDL-C; las HDL-C estuvieron disminuidas en 41 por ciento de las mujeres y 30 por ciento de los hombres; los A.F.A.M. ocuparon una alta frecuencia (85 por ciento en mujeres y 78 por ciento en hombres) seguido por el sedentarismo (64 y 79 por ciento en hombres y mujeres respectivamente); la edad afectó de manera significativa (p < 0.05) los valores de CCC, PAS, PAD, GLI, COL, TG, HDL-C, LDL y VLDL-C; la dieta resultó hipocalórica, hiperproteica, normograsa e hipohidrocarbonada. Se concluye que la población estudiada puede ser considerada a riesgo de ECV, ya que tanto los factores nutricionales y metabólicos, así como los otros factores de riesgo analizados, estuvieron presentes en un elevado porcentaje de individuos estudiados

Relación entre monitoreo ambulatorio de presión arterial de 24 horas y alteraciones en la memoria reciente de adultos mayores de 55 años / Ambulatory blood pressure monitorzation statement with recent memory disturbs in adults oldness than 55 years

Presentamos un grupo poblacional, de coherte transversal que incluyó 402 personas de uno u otro sexo, con edades igual o mayor de 55 años, provenientes de la parroquia Santa Lucía de la ciudad de Maracaibo. Se les practicaron pruebas neuropsicológicas para evaluar memoria reciente: subpruebas de memoria total (MT) y memoria a largo plazo (MLP) del test de recuerdo selectivo de Bushke y Fuld; según los resultados de estas pruebas se clasificaron en dos grupos: con memoria reciente alterada y con memoria reciente normal. También se les práctico determinaciones antropométricas como peso (Kg), talla (m), índice de masa corporal (peso/talla²) según Quetelot. La presión arterial casual (P.A.C) fue determinada por método oscilométrico con Dinamap Critikon, en brazo derecho de paciente sentado, con brazalete adecuado, según la circunferencia bronquial. A todos los pacientes se les colocó un aparato (M.A.P.A) debidamente programado para registros cada 15 minutos de horas de vigilia (6am - 11pm) y cada 30 minutos durante el sueño (11 pm - a 6 am). Obtuvimos los siguientes resultados: 1) las variaciones de la P.A sistólica determinada por M.A.P.A están asociadas con alteraciones de la memoria reciente en mayores de 55 años. 2) Los valores de la P.A sistólica durante el sueño con mejores predictores de alteraciones de la memoria reciente. 3) Las determinaciones de P.A casual no guardaron correlación con trastornos de la memoria. 4) Proponemos la utilización del MAPA en mayores de 55 años para la pesquisa de alteraciones de la función cognitiva temprana