Hypertension is the leading cause of cardiovascular disease and premature death worldwide. Owing to the widespread use of antihypertensive medications, global mean blood pressure (BP) has remained constant or has decreased slightly over the past four decades. By contrast, the prevalence of hypertension has increased, especially in low- and middle-income countries (LMICs). Estimates suggest that 31.1% of adults (1.39 billion) worldwide had hypertension in 2010. The prevalence of hypertension among adults was higher in LMICs (31.5%, 1.04 billion people) than in high-income countries (28.5%, 349 million people). Variations in the levels of risk factors for hypertension, such as high sodium intake, low potassium intake, obesity, alcohol consumption, physical inactivity and unhealthy diet, may explain some of the regional heterogeneity in hypertension prevalence. Despite the increasing prevalence, the proportions of hypertension awareness, treatment and BP control are low, particularly in LMICs, and few comprehensive assessments of the economic impact of hypertension exist. Future studies are warranted to test implementation strategies for hypertension prevention and control, especially in low-income populations, and to accurately assess the prevalence and financial burden of hypertension worldwide. Hypertension is the leading global cause of cardiovascular disease and premature mortality. In this Review, the authors describe the prevalence, awareness, treatment and control of hypertension worldwide, as well as risk factors for hypertension and the financial burden of this disease.

The global epidemiology of hypertension.

Satoshi Umemura ● Hisatomi Arima ● Shuji Arima ● Kei Asayama ● Yasuaki Dohi ● Yoshitaka Hirooka ● Takeshi Horio ● Satoshi Hoshide ● Shunya Ikeda ● Toshihiko Ishimitsu ● Masaaki Ito ● Sadayoshi Ito ● Yoshio Iwashima ● Hisashi Kai ● Kei Kamide ● Yoshihiko Kanno ● Naoki Kashihara ● Yuhei Kawano ● Toru Kikuchi ● Kazuo Kitamura ● Takanari Kitazono ● Katsuhiko Kohara ● Masataka Kudo ● Hiroo Kumagai ● Kiyoshi Matsumura ● Hideo Matsuura ● Katsuyuki Miura ● Masashi Mukoyama ● Satoko Nakamura ● Takayoshi Ohkubo ● Yusuke Ohya ● Takafumi Okura ● Hiromi Rakugi ● Shigeyuki Saitoh ● Hirotaka Shibata ● Tatsuo Shimosawa ● Hiromichi Suzuki ● Shori Takahashi ● Kouichi Tamura ● Hirofumi Tomiyama ● Takuya Tsuchihashi ● Shinichiro Ueda ● Yoshinari Uehara ● Hidenori Urata ● Nobuhito Hirawa

The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019)

Prevention and Control of Hypertension: JACC Health Promotion Series

Obesity, Metabolic syndrome and cardiovascular disease

Recent findings have provided a molecular basis for the combined contributions of multifaceted risk factors for the onset of multiple sclerosis (MS). MS appears to start as a chronic dysregulation of immune homeostasis resulting from complex interactions between genetic predispositions, infectious exposures, and factors that lead to pro-inflammatory states, including smoking, obesity, and low sun exposure. This is supported by the discovery of gene-environment (GxE) interactions and epigenetic alterations triggered by environmental exposures in individuals with particular genetic make-ups. It is notable that several of these pro-inflammatory factors have not emerged as strong prognostic indicators. Biological processes at play during the relapsing phase of the disease may result from initial inflammatory-mediated injury, while risk factors for the later phase of MS, which is weighted toward neurodegeneration, are not yet well defined. This integrated review of current evidence guides recommendations for clinical practice and highlights research gaps.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.50862

Environmental and genetic risk factors for MS: an integrated review.

Survival rate of AIDS disease and mortality in HIV-infected patients: a meta-analysis

Importance Increased dietary potassium intake is thought to be associated with low blood pressure (BP). Whether potassium supplementation may be used as an antihypertensive agent is a question that should be answered. Objective To assess the effect of oral potassium supplementation on blood pressure in patients with primary hypertension. Search methods We searched Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials until October 2016. We also screened reference lists of articles and previous reviews. We applied no language restrictions. Selection criteria We included randomized placebo-controlled clinical trials addressing the effect of potassium supplementation on primary hypertension for a minimum of 4 weeks. Data collection and analysis We extracted data on systolic and diastolic BP (SBP and DBP) at the final follow-up. We explored the heterogeneity across studies using Cochran's test and I2 statistic and assessed the probability of publication bias using Begg's and Egger's tests. We reported the mean difference (MD) of SBP and DBP in a random-effects model. Results We found a total of 9059 articles and included 23 trials with 1213 participants. Compared to placebo, potassium supplementation resulted in modest but significant reductions in both SBP (MD -4.25 mmHg; 95% CI: -5.96 to -2.53; I2 = 41%) and DBP (MD -2.53 mmHg; 95% CI: -4.05 to -1.02; I2 = 65%). According to the change-score analysis, based on 8 out of 23 trials, compared to baseline, the mean changes in SBP (MD -8.89 mmHg; 95% CI: -13.67 to -4.11) and DBP (MD -6.42 mmHg; 95% CI: -10.99 to -1.84) was significantly higher in the intervention group than the control group. Conclusions Our findings indicated that potassium supplementation is a safe medication with no important adverse effects that has a modest but significant impact BP and may be recommended as an adjuvant antihypertensive agent for patients with essential hypertension.

Oral potassium supplementation for management of essential hypertension: A meta-analysis of randomized controlled trials.

Background Despite our awareness of the significant effect of smoking on multiple sclerosis (MS), there was a serious lack of information about the effect of different types of smoking habit on MS as well as the dose-response relationship between smoking and MS, but this gap was addressed by this meta-analysis. Methods Major electronic databases, including PubMed, Web of Science and Scopus were searched until July 2015. Epidemiological studies addressing the association between smoking and MS were enrolled. The heterogeneity across studies was investigated by Q-test and I2 statistic. The probability of publication bias was explored using Begg's and Egger's tests. The results were expressed as odds ratio (OR) with 95% confidence intervals (CI) using a random effects model. Results We identified a total of 10 687 references and included 34 studies involving 623 852 participants. Compared with nonsmokers, the OR estimate of MS was 1.46 (1.33, 1.59) among ever smokers, 1.57 (1.34, 1.80) among current smokers, 1.36 (1.27, 1.46) among ex-smokers and 1.12 (0.87, 1.36) among passive smokers. In addition, analyzing the effect of cigarette pack-year on MS indicated that the OR estimate of MS was 1.34 (1.06, 1.61) for 1-5 cigarette pack-years, 1.56 (1.15, 1.97) for 6-10 cigarette pack-years, 1.74 (1.16, 2.33) for 11-15 cigarette pack-years and 1.46 (0.49, 2.43) for more than 15 cigarette pack-years. Conclusions Smoking habits are significantly associated with MS, although the association is not very strong. However, there is a dose-response relationship between the smoking habits and MS.

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Effect of smoking on multiple sclerosis: a meta-analysis

Background
Antibodies against hepatitis B surface antigen (HBsAg) wane over time following hepatitis B immunisation; hence, it is unclear whether people vaccinated in three-dose or four-dose schedules of the hepatitis B vaccine are still immune when the hepatitis B surface antibody (anti-HBs) level in their body is undetectable, or lower than the level usually considered protective. This question may potentially be answered indirectly by measuring the anamnestic immune response to a booster dose of vaccine. The term 'booster' (or revaccination) refers to an additional dose of hepatitis B vaccine (HBV) given some time post-primary vaccination to induce immune memory and improve protection against hepatitis B virus (HBV) infection.

Objectives
To assess the benefits and harms of booster dose hepatitis B vaccination, more than five years after the primary vaccination, for preventing HBV infection in healthy individuals previously vaccinated with the hepatitis B vaccine, and with hepatitis B surface antibody (anti-HBs) levels below 10 mIU/mL.

Search methods
We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded, conference databases, and reference lists of articles to January 2016. We also contacted authors of articles. In addition, we searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (May 2016).

Selection criteria
Randomised clinical trials addressing anamnestic immune response to a booster dose of hepatitis B vaccine, more than five years after the primary vaccination, in apparently healthy participants, vaccinated in a three-dose or four-dose schedule of the hepatitis B vaccine during the primary vaccination, without receiving an additional dose or immunoglobulin.

Data collection and analysis
Both review authors decided if the identified studies met the inclusion criteria or not. Primary outcomes included the proportion of participants with anamnestic immune response in non-protected participants and signs of HBV infection. Secondary outcomes were the proportion of participants that developed local and systemic adverse events following a booster dose injection. We planned to report the weighted proportion with 95% confidence intervals (CIs).

Main results
There were no eligible randomised clinical trials fulfilling the inclusion criteria of this review.

Authors' conclusions
We were unable to include any randomised clinical trials on the topic; only randomised clinical trials will be able to provide an answer as to whether a booster dose vaccination is able to protect against hepatitis B infection.

/pdf/booster-dose-vaccination-for-preventing-hepatitis-b-2znhv1s59o.pdf

Booster dose vaccination for preventing hepatitis B

Background A 25% relative reduction in the prevalence of hypertension is a global target. This meta-analysis estimated the effect of excess weight loss on hypertension. Methods We searched PubMed, Web of Science and Scopus until January 2016. We included prospective cohort studies addressing the association between overweight/obesity and hypertension. We expressed the strength of association using risk ratio and the excess risk using attributable risk fraction with 95% CI based on the random-effects model. Results We found 7617 references and included 10 studies with 173 828 participants. Compared with normal weight, the risk ratio of hypertension was 1.52 (1.37, 1.67; 9 studies, I2 = 82.4%) for overweight and 2.17 (1.84, 2.50; 9 studies, I2 = 88.9%) for obesity. The excess risk of hypertension attributable to overweight was 32% (24%, 40%; 8 studies, I2 = 85.5%) and that attributable to obesity was 47% (40%, 54%; 8 studies, I2 = 88.2%). That means, excess weight loss may reduce the risk of hypertension by between 24% and 40% in people who are overweight and by between 40% and 54% in people who are obese. Conclusions Excess weight loss is a vital strategy for controlling hypertension and is sufficient for achieving the global target, particularly if it is accompanied with other preventive measures.

/pdf/how-much-excess-weight-loss-can-reduce-the-risk-of-503m9ilz16.pdf

Elham Hooshmand

Papers

Survival rate of AIDS disease and mortality in HIV-infected patients: a meta-analysis

Oral potassium supplementation for management of essential hypertension: A meta-analysis of randomized controlled trials.

Effect of smoking on multiple sclerosis: a meta-analysis

Booster dose vaccination for preventing hepatitis B

How much excess weight loss can reduce the risk of hypertension