Risk factors for hypertension in a population-based sample of postmenopausal women in Kolkata, West Bengal, India.
TL;DR: Apo B and WC were the strongest risk factors for predicting hypertension among postmenopausal women in Kolkata.
Abstract: Hypertension is a major public health problem worldwide. However, limited information is available regarding the risk factors for hypertension in postmenopausal women, particularly in urban populations in developing countries such as India. To investigate whether adiposity measures, serum lipids and lipoproteins as well as fasting plasma glucose can predict the risk of hypertension in a population based sample of postmenopausal women in Kolkata, India, we conducted a cross-sectional study of 415 postmenopausal women (aged 40 to 85), selected by cluster sampling from 12 wards of Kolkata. After multivariate adjustment, apolipoprotein B (apo B) and waist circumference (WC) showed the strongest association with hypertension. The risk of hypertension in the highest tertile compared with the lowest tertile was 2.57 (95% confidence interval = 1.00-6.61) for apo B and 2.55 (95% confidence interval = 1.07-6.06) for WC. Apo B and WC were the strongest risk factors for predicting hypertension among postmenopausal women in Kolkata.
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TL;DR: A region-specific (urban and rural parts of north, east, west, and south India) systematic review and meta-analysis of the prevalence, awareness, and control of hypertension among Indian patients have not been done before and about 33% urban and 25% rural Indians are hypertensive.
Abstract: textBackground: A region-specific (urban and rural parts of north, east, west, and south India) systematic review and meta-analysis of the prevalence, awareness, and control of hypertension among Indian patients have not been done before. Methods: Medline, Web of Science, and Scopus databases from 1950 to 30 April 2013 were searched for 'prevalence, burden, awareness, and control of blood pressure (BP) or hypertension (140 SBP and or 90 DBP) among Indian adults' (18 years). Of the total 3047 articles, 142 were included. Results: Overall prevalence for hypertension in India was 29.8% (95% confidence interval: 26.7-33.0). Significant differences in hypertension prevalence were noted between rural and urban parts [27.6% (23.2-32.0) and 33.8% (29.7-37.8); P=0.05]. Regional estimates for the prevalence of hypertension were as follows: 14.5% (13.3-15.7), 31.7% (30.2-33.3), 18.1% (16.9-19.2), and 21.1% (20.1-22.0) for rural north, east, west, and south India; and 28.8% (26.9-30.8), 34.5% (32.6-36.5), 35.8% (35.2-36.5), and 31.8% (30.4-33.1) for urban north, east, west, and south India, respectively. Overall estimates for the prevalence of awareness, treatment, and control of BP were 25.3% (21.4-29.3), 25.1% (17.0-33.1), and 10.7% (6.5-15.0) for rural Indians; and 42.0% (35.2-48.9), 37.6% (24.0-51.2), and 20.2% (11.6-28.7) for urban Indians. Conclusion: About 33% urban and 25% rural Indians are hypertensive. Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.
665 citations
Cites background from "Risk factors for hypertension in a ..."
...We noticed close to a two-fold increase in risk for HTN among Indians when they smoked [8,33,52], orally consumed khaini and tobacco [63], had extra salt intake in their food [63], had a sedentary lifestyle [64], were centrally obese [8,33,42,52,57], had BMI at least 25 [8,23,36,52,57], and consumed alcohol [22,36,63,64]....
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...Four [38–41], four [10,21,39,42], 10 [27,39,43–50], and seven studies [35,39,51–56] reported on the prevalence of HTN among adult Indians from urban parts of north India, east India, west India, and south India, respectively....
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...Risk factors Eleven studies [8,23,25,33,36,42,52,53,57,63,64] reported on the risk factors associated with HTN (see table S3, supplemental digital content, http://links....
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TL;DR: Clinical DSS are effective and cost‐effective in the management of HTN in resource‐constrained PHC settings in resource-constrainingPHC settings.
Abstract: Background Randomized control trials from the developed world report that clinical decision support systems (DSS) could provide an effective means to improve the management of hypertension (HTN). However, evidence from developing countries in this regard is rather limited, and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center (PHC) settings. Methods and Results We performed a cluster randomized trial to test the effectiveness and cost‐effectiveness of a clinical DSS among Indian adult hypertensive patients (between 35 and 64 years of age), wherein 16 PHC clusters from a district of Telangana state, India, were randomized to receive either a DSS or a chart‐based support (CBS) system. Each intervention arm had 8 PHC clusters, with a mean of 102 hypertensive patients per cluster (n=845 in DSS and 783 in CBS groups). Mean change in systolic blood pressure (SBP) from baseline to 12 months was the primary endpoint. The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow‐up, adjusted for age, sex, height, waist, body mass index, alcohol consumption, vegetable intake, pickle intake, and baseline differences in blood pressure, was −6.59 mm Hg (95% confidence interval: −12.18 to −1.42; P =0.021). The cost‐effective ratio for CBS and DSS groups was $96.01 and $36.57 per mm of SBP reduction, respectively. Conclusion Clinical DSS are effective and cost‐effective in the management of HTN in resource‐constrained PHC settings. Clinical Trial Registration URL: http://www.ctri.nic.in. Unique identifier: CTRI/2012/03/002476.
59 citations
TL;DR: It is suggested that changes in WC, apoB and IR accompanying menopause lead to a greater prevalence of hypertension in postmenopausal women.
Abstract: This study aimed to evaluate the association of abdominal obesity, apolipoprotein and insulin resistance (IR) with the risk of hypertension in postmenopausal women. We analyzed a total of 242 women aged between 35 and 70 years. Blood pressure (BP), anthropometric indices, lipid profile, fasting glucose, insulin, C-reactive protein (CRP) and apolipoprotein concentrations were measured. Homeostasis model assessment (HOMA) was used to assess IR. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg or current treatment with antihypertensive drugs. Women with hypertension showed significantly higher mean values of age, SBP and DBP, waist circumference (WC), fasting plasma glucose (FPG), insulin, HOMAIR and the apolipoprotein B (apoB). When analyses were done according to the menopausal status, higher prevalence of hypertension was observed in postmenopausal women (72.8% vs. 26.0%, p < 0.001) compared to their premenopausal counterparts. Postmenopausal women showed also significantly higher mean values of SBP and DBP, WC, HOMAIR and apoB. Multivariate linear regression analysis revealed that SBP was significantly affected by WC (p = 0.034), apoB (p = 0.038) and log HOMAIR (p = 0.007) in postmenopausal women. The interaction models revealed significant interaction between WC, apoB and log HOMAIR (WC×apoB×log HOMAIR) on SBP (p = 0.001) adjusted for age. In a multivariate logistic regression, adjusting for age and apoB, WC (p = 0.001), log HOMAIR (p = 0.007) and menopause (p = 0.008) were significantly associated with higher risk for hypertension. These results suggest that changes in WC, apoB and IR accompanying menopause lead to a greater prevalence of hypertension in postmenopausal women.
17 citations
Cites background from "Risk factors for hypertension in a ..."
...This association could be explained by the fact that accumulation of abdominal fat occurred after menopause increases apoB and leads to hypertension in menopause (36,38)....
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TL;DR: Assessment of the prevalence and spectrum of hypertension and its association with selected demographic factors in an area of urban Varanasi found presence of hypertension increased significantly with advancing age.
Abstract: Background: Non communicable diseases (NCDs) are the leading cause of death in WHO South East Asian Region and the rising trend is attributed to a variety of factors viz smoking, sedentary life style etc. Hypertension is considered as the principle risk factor for heart attack and stroke. The main objective was to assess the prevalence and spectrum of hypertension and its association with selected demographic factors in an area of urban Varanasi. Methods: This cross- sectional community based study was undertaken in a selected area of urban Varanasi. The study sample comprised of subjects 25 years and above. After obtaining ethical clearance and taking consent from study subjects, they were specifically interviewed for selected demographic characteristics using pre designed and pre tested proforma. Their blood pressure was measured using electronic BP machine following standard technique. The data was entered in personal computer and analyzed with SPSS. Results: Out of 611 subjects, 314 (51.4%) subjects were male and 297 (48.6%) were female. 51.7% and 20.0% subjects were categorized as normal and pre hypertensive respectively. As much as 19.6% and 8.7% subjects were in stage 1 and stage 2 hypertension. Presence of hypertension increased significantly (p<0.001) with advancing age. Conclusions: Hypertension is a significant problem in study subjects. Nearly one fifth of the subjects were in pre hypertensive stage. Preventive strategies should be directed to them for positive impact.
7 citations
TL;DR: A significant proportion of women entering the menopause present incident hypertension and this is mostly associated with obesity and insulin resistance.
Abstract: Introduction: We aimed to investigate the incidence of hypertension and to identify potential risk factors in healthy, non-diabetic recently postmenopausal Greek women with normal renal function.Pa...
4 citations
References
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TL;DR: A method for estimating the cholesterol content of the serum low-density lipoprotein fraction (Sf0-20) is presented and comparison of this suggested procedure with the more direct procedure, in which the ultracentrifuge is used, yielded correlation coefficients of .94 to .99.
Abstract: A method for estimating the cholesterol content of the serum low-density lipoprotein fraction (Sf0-20) is presented. The method involves measurements of fasting plasma total cholesterol, triglyceride, and high-density lipoprotein cholesterol concentrations, none of which requires the use of the preparative ultracentrifuge. Comparison of this suggested procedure with the more direct procedure, in which the ultracentrifuge is used, yielded correlation coefficients of .94 to .99, depending on the patient population compared.
30,622 citations
"Risk factors for hypertension in a ..." refers methods in this paper
...LDL-cholesterol (LDL-C) was calculated using the formula: LDL-C = Total cholesterol − HDL-C − (TG/5).(13) Non-HDL-C was calculated as total cholesterol minus HDL-C....
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TL;DR: Dairy therapy remains the first line of treatment of high blood cholesterol, and drug therapy is reserved for patients who are considered to be at high risk for CHD, and the fundamental approach to treatment is comparable.
Abstract: THE SECOND report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II, or ATP II) presents the National Cholesterol Education Program's updated recommendations for cholesterol management. It is similar to the first in general outline, and the fundamental approach to treatment of high blood cholesterol is comparable. This report continues to identify low-density lipoproteins (LDL) as the primary target of cholesterol-lowering therapy. As in the first report, the second report emphasizes the role of the clinical approach in primary prevention of coronary heart disease (CHD). Dietary therapy remains the first line of treatment of high blood cholesterol, and drug therapy is reserved for patients who are considered to be at high risk for CHD. However, the second report contains new features that distinguish it from the first. These include the following: Increased emphasis on See also pp 3002 and 3009.
28,495 citations
Boston University1, Rush University Medical Center2, University of Tennessee Health Science Center3, University of Michigan4, University at Buffalo5, University of Mississippi6, University of Miami7, University of Alabama at Birmingham8, Case Western Reserve University9, National Institutes of Health10
TL;DR: The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated, and empathy builds trust and is a potent motivator.
Abstract: "The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure" provides a new guideline
for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of
more than 140 mm Hg is a much more important cardiovascular disease
(CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75
mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive
at 55 years of age have a 90% lifetime risk for developing hypertension; (3)
Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80
to 89 mm Hg should be considered as prehypertensive and require health-promoting
lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should
be used in drug treatment for most patients with uncomplicated hypertension,
either alone or combined with drugs from other classes. Certain high-risk
conditions are compelling indications for the initial use of other antihypertensive
drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor
blockers, β-blockers, calcium channel blockers); (5) Most patients with
hypertension will require 2 or more antihypertensive medications to achieve
goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes
or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal
BP, consideration should be given to initiating therapy with 2 agents, 1 of
which usually should be a thiazide-type diuretic; and (7) The most effective
therapy prescribed by the most careful clinician will control hypertension
only if patients are motivated. Motivation improves when patients have positive
experiences with and trust in the clinician. Empathy builds trust and is a
potent motivator. Finally, in presenting these guidelines, the committee recognizes
that the responsible physician's judgment remains paramount.
24,988 citations
TL;DR: It was found that the system of phenol and 4-amino phenazone is well suited to the determination of glucose and the development of phosphatase is described.
Abstract: the oxygen acceptors originally used were 0 tolidine, benzidine and o-dianisidine. It has since been established that these three substances are carcinogens and many alternative oxygen acceptors have been suggested. Any dye showing oxidation-reduction properties or any dye formed by oxidation, such as those used in colour photography, are potentially useful but it is obviously advantageous to use reagents which have high stability. For manual work on blood a two-solution technique is desirable, one solution being used to precipitate the protein and the other to develop the colour. The development of such a method will now be described. In the determination of phosphatase, use is made of the fact that phenol in the presence of an oxidising reagent gives a purple colour with 4-amino phenazone. The possibility that the H.Oz released in the reaction of glucose oxidase with glucose could act as the oxidising agent was investigated and it was found that the system of phenol and 4-amino phenazone is well suited to the determination of glucose. By suitable adjustment of conditions the colour develops completely in 10 minutes, being stable thereafter for at least 30 minutes. Using a single-solution phosphotungstic acid precipitant containing phenol to precipitate blood protein the only other solution required is one containing glucose oxidase, peroxidase and 4-amino phenazone. These solutions contain azide as preservative; azide has no effect on the rate of colour development. In the micro and macro automated methods, the two solutions required are a diluent containing 4-amino phenazone and a colour reagent containing glucose oxidase, peroxidase and phenol.
4,548 citations
Book•
01 Jan 1983
TL;DR: This guide to laboratory tests describes the different types of tests that can be carried out in the laboratory and some of the techniques used to perform these tests are straightforward to use.
Abstract: General Clinical Tests. Amino Acids. Blood Bank. Carbohydrates. Complement Factors. Electrolytes. Endocrinology. Enzymology. Erythrocyte Enzymes. Hematology. Hemostasis. Hepatitis Testing. Immunology. Interferences. Internationally Recommended Units. Laboratory Values During Pregnancy. Lipids. Renal Function. Pancreatic and Gastric Function. Porphyrins. Proteins. Toxicology. Trace Metals. Tumor Markers. Urine Screening Tests. Vitamins. Molecular Pathology. Therapeutic Drugs. Microbiology.
2,105 citations