Global Brief on Hypertension: Silent Killer, Global Public Health Crisis
01 Mar 2013-Vol. 24, Iss: 1, pp 2-2
About: The article was published on 2013-03-01. It has received 631 citations till now. The article focuses on the topics: Public health.
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University of Southern Denmark1, North-West University2, New York City Department of Health and Mental Hygiene3, Centers for Disease Control and Prevention4, Paris Descartes University5, Ottawa Hospital Research Institute6, Eduardo Mondlane University7, University of Glasgow8, French Institute of Health and Medical Research9, University of Western Australia10, University of Valencia11, The George Institute for Global Health12, Ghent University Hospital13, University of Perugia14, Menzies Research Institute15, Oslo University Hospital16, Shanghai Jiao Tong University17
TL;DR: The Commission has identified ten essential and achievable goals and ten accompanying, mutually additive, and synergistic key actions that—if implemented effectively and broadly—will make substantial contributions to the management of blood pressure globally.
604 citations
TL;DR: An efficient algorithm based on the pulse arrival time (PAT) for the continuous and cuffless estimation of the systolic BP, diastolic blood pressure (DBP), and mean arterial pressure (MAP) values is presented.
Abstract: Goal : Continuous blood pressure (BP) monitoring can provide invaluable information about individuals’ health conditions. However, BP is conventionally measured using inconvenient cuff-based instruments, which prevents continuous BP monitoring. This paper presents an efficient algorithm, based on the pulse arrival time (PAT), for the continuous and cuffless estimation of the systolic BP, diastolic blood pressure (DBP), and mean arterial pressure (MAP) values. Methods : The proposed framework estimates the BP values through processing vital signals and extracting two types of features, which are based on either physiological parameters or whole-based representation of vital signals. Finally, the regression algorithms are employed for the BP estimation. Although the proposed algorithm works reliably without any need for calibration, an optional calibration procedure is also suggested, which can improve the system's accuracy even further. Results : The proposed method is evaluated on about a thousand subjects using the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS) standards. The method complies with the AAMI standard in the estimation of DBP and MAP values. Regarding the BHS protocol, the results achieve grade A for the estimation of DBP and grade B for the estimation of MAP. Conclusion : We conclude that by using the PAT in combination with informative features from the vital signals, the BP can be accurately and reliably estimated in a noninvasive fashion. Significance : The results indicate that the proposed algorithm for the cuffless estimation of the BP can potentially enable mobile health-care gadgets to monitor the BP continuously.
402 citations
TL;DR: In this article, the effect of a reduction in alcohol consumption on the change in blood pressure in adults was assessed using a systematic review and meta-analysis, which reported a quantifiable change in average alcohol consumption that lasted at least 7 days and a corresponding change in the blood pressure.
Abstract: Summary Background Although it is well established that heavy alcohol consumption increases the risk of hypertension, little is known about the effect of a reduction of alcohol intake on blood pressure. We aimed to assess the effect of a reduction in alcohol consumption on change in blood pressure stratified by initial amount of alcohol consumption and sex in adults. Methods In this systematic review and meta-analysis, we searched MedLine, Embase, CENTRAL, and ClinicalTrials.gov from database inception up to July 13, 2016, for trials investigating the effect of a change of alcohol consumption on blood pressure in adults using keywords and MeSH terms related to alcohol consumption, blood pressure, and clinical trials, with no language restrictions. We also searched reference lists of identified articles and published meta-analyses and reviews. We included full-text articles with original human trial data for the effect of a change of alcohol consumption on blood pressure in adults, which reported a quantifiable change in average alcohol consumption that lasted at least 7 days and a corresponding change in blood pressure. We extracted data from published reports. We did random-effects meta-analyses stratified by amount of alcohol intake at baseline. All meta-analyses were done with Stata (version 14.1). For the UK, we modelled the effect of a reduction of alcohol consumption for 50% of the population drinking more than two standard drinks per day (ie, 12 g pure alcohol per drink). Findings 36 trials with 2865 participants (2464 men and 401 women) were included. In people who drank two or fewer drinks per day, a reduction in alcohol was not associated with a significant reduction in blood pressure; however, in people who drank more than two drinks per day, a reduction in alcohol intake was associated with increased blood pressure reduction. Reduction in systolic blood pressure (mean difference −5·50 mm Hg, 95% CI −6·70 to −4·30) and diastolic blood pressure (–3·97, −4·70 to −3·25) was strongest in participants who drank six or more drinks per day if they reduced their intake by about 50%. For the UK, the results would translate into more than 7000 inpatient hospitalisations and 678 cardiovascular deaths prevented every year. Interpretation Reducing alcohol intake lowers blood pressure in a dose-dependent manner with an apparent threshold effect. Implementation of effective alcohol interventions in people who drink more than two drinks per day would reduce the disease burden from both alcohol consumption and hypertension, and should be prioritised in countries with substantial alcohol-attributable risk. Funding National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH).
286 citations
TL;DR: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare.
Abstract: Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal and child morbidity. There have been significant strides with improving the public health system, and addressing current inequalities, in recent years with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance (NHI), programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to Standard Treatment Guidelines and Essential Medicines Lists with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities. Conclusion: Overall, there are an appreciable number of ongoing activities within the public health system in South Africa to try and ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research.
233 citations
Cites background from "Global Brief on Hypertension: Silen..."
...However, there continues to be concern over the level of education of patients and the subsequent impact on adherence to the medicines provided (WHO, 2013; Adebolu and Naidoo, 2014; Nielsen et al., 2017; Rampamba et al., 2017)....
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TL;DR: In China many cases of hypertension are going undetected and untreated, even though the health system appears to deliver effective care to individuals who are aware of their hypertension.
Abstract: Objective To monitor hypertension prevalence, awareness, treatment and control in China two to three years after major reform of the health system. Methods Data from a national survey conducted in 2011–2012 among Chinese people aged 45 years or older – which included detailed anthropometric measurements – were used to estimate the prevalence of hypertension and the percentages of hypertensive individuals who were unaware of, receiving no treatment for, and/or not controlling their hypertension well. Modified Poisson regressions were used to estimate relative risks (RRs). Findings At the time of the survey, nearly 40% of Chinese people aged 45 years or older had a hypertensive disorder. Of the individuals with hypertension, more than 40% were unaware of their condition, about 50% were receiving no medication for it and about 80% were not controlling it well. Compared with the other hypertensive individuals, those who were members of insurance schemes that covered the costs of outpatient care were more likely to be aware of their hypertension (adjusted RR, aRR: 0.737; 95% confidence interval, CI: 0.619–0.878) to be receiving treatment for it (aRR: 0.795; 95% CI: 0.680–0.929) and to be controlling it effectively (aRR: 0.903; 95% CI: 0.817–0.996). Conclusion In China many cases of hypertension are going undetected and untreated, even though the health system appears to deliver effective care to individuals who are aware of their hypertension. A reduction in the costs of outpatient care to patients would probably improve the management of hypertension in China.
177 citations