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Background Chronic kidney disease (CKD) is an important contributor to morbidity and mortality from noncommunicable diseases. We aimed to examine the longitudinal trajectories in risk factors, estimate their impact on CKD burden in China from 1991 to 2011, and project trends in the next 20 years. Methods We used data from a cohort of the China Health and Nutrition Survey and applied the comparative risk assessment method to estimate the number of CKD events attributable to all non-optimal levels of each risk factors. Results In 2011, current smoking was the leading individual attributable factor for CKD burden in China responsible for 7.9 (95% CI, 7.5-8.3) million CKD cases with a population-attributable fraction of 8.7% (95% CI, 6.0-11.6), while the rates of smoking have reduced and may have mitigated the increase in CKD. High triglyceride (TG) and high systolic blood pressure (SBP) were the leading metabolic risk factors responsible for 6.8 (95% CI, 6.4-7.1) million and 5.8 (95% CI, 5.5-6.1) million CKD-attributable cases, respectively. Additionally, the number of CKD cases associated with high body mass index (BMI), high diastolic blood pressure (DBP), high plasma glucose, and low high-density lipoprotein cholesterol (HDL-C) was 5.4 (95% CI, 5.1-5.6), 3.9 (95% CI, 3.7-4.1), 3.0 (95% CI, 2.8-3.1) and 2.6 (95% CI, 2.5-2.8) million, respectively. Conclusions Current smoking, high TG, and high SBP were the top three risk factors that contributed to CKD burden in China. Increased BMI, DBP, plasma glucose, and decreased HDL-C were also associated with the increase in CKD burden.

Cox regression is a type of survival analysis that can be implemented with proportional hazard models or duration models. In the survival analysis data, there is a possibility that the data has ties, so it is necessary to use several approaches in estimating the parameters, namely the breslow, efron, and exact approaches. In this study, the Cox proportional hazard regression was used as a method of analysis for knowing the factors that influence the survival time on chronic kidney patients undergoing hemodialysis therapy. Based on the analysis that has been done, the best model is obtained with an exact approach and the factors that influence the survival time of hemodialysis patients are systolic blood pressure, hemoglobin level, and dialysis time. Hemodialysis patients who have high systolic blood pressure have a chance of failing to survive 12,950 times than normal systolic blood pressure.While the hemodialysis patient hemoglobin level increases, the hemodialysis patients chances of failing to survive is 0,6681 times less. Hemodialysis patients who received dialysis therapy with a dialysis time of more than four hours had 0.237 times the chance of failing to survive than patients with a dialysis time of less than or equal to 4 hours.Keywords: Cox Regression ,Survival, Ties, Hemodialysis.

Calcific aortic valve disease (CAVD) is associated with increased morbidity and mortality. We aimed to elucidate the 30-year epidemiology of CAVD globally. Global CAVD incidence, prevalence, and deaths increased 3.51-, 4.43-, and 1.38-fold from 1990 to 2019, respectively, without any decreasing trends, even after age standardization. In 2019, Slovenia had the highest age-standardized rate (ASR) of CAVD incidence (62.21/100,000 persons) and prevalence (1,080.06/100,000) whereas Cyprus had the highest ASR of deaths (8.20/100,000). Population aging was an important contributor to incidence. Compared with women, more men had CAVD and men had earlier peaks in disease prevalence. High systolic blood pressure, diet high in sodium, and lead exposure were the main risk factors for deaths owing to CAVD. The estimated annual percentage change, a measure to estimate the variation of ASR, was significantly associated with the ASR and sociodemographic index (SDI) in 2019 for incidence and prevalence across all 204 countries and territories (all p

To explore distribution and epidemic characteristics of CVD in followed-up HP patients. Using the Hypertension Follow-up Management System database in Jiading district in Shanghai. We designed a retrospective cohort study that included all followed-up hypertension patients between 2002 and 2020. The endpoint was the occurrence of CVD confirmed by the hospital; otherwise, the patients were tracked until September 30, 2020. Record information of every patient has been collected in the registration card and each followed-up record. Among 223,097 observational followed-up HP patients, the total number of person years of observation was 4,244,421.25 person-year, 11,143 patients had developed CVD from hypertension before the deadline, the total incidence density was 0.00263 per person-year (male 0.00292; female 0.00238) and the complication ratio of CVD in HP patients was 4.99% (male 5.25%; female 4.76%) during follow-up period. The proportion of ischemic cerebrovascular, hemorrhagic cerebrovascular and unclassified stroke was respectively 71.18%, 5.95% and 22.87% in hypertensive CVD. Complication ratio of CVD increased with age, the group under 30 was 0, and the group over 70 was the highest (6.90%). The complication ratio of grad I, grad II and grad III blood pressure were respectively 4.79%, 4.96% and 6.13%. The complication ratio was 4.92% in only high systolic blood pressure patients; 17.23% in only high diastolic blood pressure patients; 4.59% in high systolic and diastolic blood pressure patients. The peak of complication ratio of CVD was 9–10 years after the registered and followed-up. The proportion of CVD cases in HP patients from April to June was the largest in the four seasons; the proportion of patients from October to December was the minimum. HP patient was prone to falling cerebrovascular disease; the main type of disease was cerebral infarction. Complication ratio in male incidence was higher than that in female. The complication ratio of CVD increased with age, blood pressure and duration of HP patients. It had seasonal characteristics, which was relatively high from April to June within year.

Background Worldwide, high systolic blood pressure is the leading risk factor for deaths and disability-adjusted life-years but has been historically under-detected. This study aimed to quantify differences between estimated and practice-detected prevalences of hypertension across English general practices, and to determine how variations in detected prevalence could be explained by population-level and service-level factors. Methods Descriptive statistics, pair wise correlations between the independent variables and a multivariable regression analysis were undertaken. In the regression model, the outcome was detected hypertension prevalence, adjusted for estimated prevalence, person-related and disease-related determinants of illness and characteristics of general practices. Results Detected prevalence was substantially lower than estimated prevalence (mean difference 16.23%; standard deviation 2.88%). Higher detected prevalence was associated with increased deprivation, increased non-white ethnicity and urban location. Lower detected prevalence was associated with larger list sizes, more general practitioners and being located in the South outside London. The final multivariable model’s adjusted R2 value was 0.75. Conclusions Substantial under-detection of hypertension is widespread across England. Independent of estimated prevalence, factors associated with greater morbidity and population density predicted higher detected prevalence. Identifying patients with undetected hypertension and coordinating care for these patients will require further resources and logistical support in community settings.

Summary Background Non-communicable diseases (NCDs) cause a large burden of disease globally. Some infectious diseases cause an increased risk of developing specific NCDs. Although the NCD burden from some infectious causes has been quantified, in this study, we aimed to more comprehensively quantify the global burden of NCDs from infectious causes. Methods In this modelling study, we identified NCDs with established infectious risk factors and infectious diseases with long-term non-communicable sequelae, and did narrative reviews between April 11, 2018, and June 10, 2020, to obtain relative risks (RRs) or population attributable fractions (PAFs) from studies quantifying the contribution of infectious causes to NCDs. To determine infection-attributable burden for the year 2017, we applied estimates of PAFs to estimates of disease burden from the Global Burden of Disease Study (GBD) 2017 for pairs of infectious causes and NCDs, or used estimates of attributable burden directly from GBD 2017. Morbidity and mortality burden from these conditions was summarised with age-standardised rates of disability-adjusted life-years (DALYs), for geographical regions as defined by the GBD. Estimates of NCD burden attributable to infectious causes were compared with attributable burden for the groups of risk factors with the highest PAFs from GBD 2017. Findings Globally, we quantified 130 million DALYs from NCDs attributable to infection, comprising 8·4% of all NCD DALYs. The infection–NCD pairs with the largest burden were gastric cancer due to H pylori (14·6 million DALYs), cirrhosis and other chronic liver diseases due to hepatitis B virus (12·2 million) and hepatitis C virus (10·4 million), liver cancer due to hepatitis B virus (9·4 million), rheumatic heart disease due to streptococcal infection (9·4 million), and cervical cancer due to HPV (8·0 million). Age-standardised rates of infection-attributable NCD burden were highest in Oceania (3564 DALYs per 100 000 of the population) and central sub-Saharan Africa (2988 DALYs per 100 000) followed by the other sub-Saharan African regions, and lowest in Australia and New Zealand (803 DALYs per 100 000) followed by other high-income regions. In sub-Saharan Africa, the proportion of crude NCD burden attributable to infectious causes was 11·7%, which was higher than the proportion of burden attributable to each of several common risk factors of NCDs (tobacco, alcohol use, high systolic blood pressure, dietary risks, high fasting plasma glucose, air pollution, and high LDL cholesterol). In other broad regions, infectious causes ranked between fifth and eighth in terms of crude attributable proportions among the nine risks compared. The age-standardised attributable proportion for infectious risks remained highest in sub-Saharan Africa of the broad regions, but age-standardisation caused infectious risks to fall below dietary risks, high systolic blood pressure, and fasting plasma glucose in ranked attributable proportions within the region. Interpretation Infectious conditions cause substantial NCD burden with clear regional variation, and estimates of this burden are likely to increase as evidence that can be used for quantification expands. To comprehensively avert NCD burden, particularly in low-income and middle-income countries, the availability, coverage, and quality of cost-effective interventions for key infectious conditions need to be strengthened. Efforts to promote universal health coverage must address infectious risks leading to NCDs, particularly in populations with high rates of these infectious conditions, to reduce existing regional disparities in rates of NCD burden. Funding Leona M and Harry B Helmsley Charitable Trust.

This study aimed to evaluate the accuracy and performance of modified blood pressure-to-height ratio (MBPHR) for identifying high blood pressure (HBP) in a large population of children. This multicentric cross-sectional study was conducted on a nationally representative sample of 7349 Iranian students aged 7-12 years living in 30 provinces in Iran. High systolic blood pressure and diastolic blood pressure were defined according to the 2017 American Academy of Pediatrics (AAP) guidelines. The BP-to height ratio (BPHR) was calculated as BP (mmHg)/height (cm), MBPHR3 as BP (mmHg)/(height (cm) + 3 (13-age)), and MBPHR7 as BP (mmHg)/(height (cm) + 7 (13-age). The receiver-operating characteristic curve analysis was used to evaluate the performance of these three ratios for identification of HBP in children compared to the 2017 AAP guidelines as the gold standard. Mean age of participants was 12.29 ± 3.15 years and 3736 (50.8%) were girls. The prevalence of HBP was 11.9% (11.5% in boys, 12.3% in girls). The area under the curve (AUC) was higher for MSBPHR3/MDBPHR3 (0.97/0.98) than MSBPHR7/MDBPHR7 (0.96/0.97) and SBPHR/DBPHR (0.96/0.95) for identifying high Systolic and diastolic BP. The optimal cut-off points for MSBPHR3/MDBPH, MSBPHR7/MDBPHR7, and SBPHR/DBPHR were 0.76/0.50, 0.69/0.46, and 0.81/0.52 respectively. Negative predictive value was nearly perfect for three ratios (≥98%). Positive predictive value was higher for MBPHR3 (52.7%) than MBPHR7 (51.0%) and BPHR (39.8%). Overall, MBPHR3 had better performance than MBPHR7 and BPHR for identification of HBP in Iranian children and it may improve early hypertension recognition and control in primary screening.

Objetivo: Avaliar o risco cardiovascular pelo escore de risco de Framinghan (ERF) e seus possíveis fatores associados em uma unidade básica de saúde (UBS) na região Norte do Brasil. Métodos: Estudo transversal realizado com 55 usuários hipertensos cadastrados em uma UBS, entre setembro de 2018 e fevereiro de 2019, no município de Nova Mamoré, Roraima, Brasil. O ERF foi classificado em três categorias: baixo risco ( 20%/10). A análise de regressão logística multinomial foi utilizada para examinar a associação da variável dependente ERF com as variáveis sociodemográficas, comportamentais, antropométricas e bioquímicas. Resultados: Observou-se que os usuários apresentaram níveis pressóricos de hipertensão arterial sistêmica (HAS) elevados (76,4%), exibindo alta prevalência de descontrole da HAS. A exposição a fatores de risco cardiovascular pelo ERF foi elevada, destacando os componentes da SME. Encontraram-se as prevalências de risco baixo (25,5%), intermediário (32,7%) e alto (41,8%). Os fatores associados ao risco de doença cardiovascular (DCV) foram: sexo masculino, idoso, inativo, excesso de peso, triglicerídeo elevado, pressão arterial sistólica elevada, glicemia em jejum elevada e circunferência da cintura elevada. Conclusão: O estudou apresentou níveis pressóricos de hipertensão elevados e alto risco para eventos cardiovasculares, segundo o ERF, nos componentes três e quatro, associados ao sexo masculino, à população idosa, ao excesso de peso, ao aumento dos níveis de triglicerídeos, à pressão arterial sistólica, à glicemia em jejum e à circunferência abdominal.

We aimed to estimate the effects of a lifelong exposure to high systolic blood pressure (SBP) on left ventricular (LV) structure and function using Mendelian randomization. A total of 5596 participants of the UK Biobank were included for whom cardiovascular magnetic resonance imaging and genetic data were available. Major exclusion criteria included nonwhite ethnicity, major cardiovascular disease, and body mass index >30 or 2 . A genetic risk score to estimate genetically predicted SBP (gSBP) was constructed based on 107 previously established genetic variants. Manual cardiovascular magnetic resonance imaging postprocessing analyses were performed in 300 individuals at the extremes of gSBP (150 highest and lowest). Multivariable linear regression analyses of imaging biomarkers were performed using gSBP as continuous independent variable. All analyses except myocardial strain were validated using previously derived imaging parameters in 2530 subjects. The mean (SD) age of the study population was 62 (7) years, and 52% of subjects were female. Corrected for age, sex, and body surface area, each 10 mm Hg increase in gSBP was significantly ( P P =0.002) increase in LV mass and with 2.80% (SE, 0.97; P =0.004) increase in LV global radial strain. In the validation cohort, after correction for age, sex, and body surface area, each 10 mm Hg increase in gSBP was associated with 5.27 g (SE, 1.50; P

Objective The aim of this study was to estimate the prevalence of renal insufficiency using estimated glomerular filtration rate (eGFR) among adult outpatients with normal SCr. Results A total of 414 patients with normal SCr were included in the study. Mean GFR (ml/min/1.73 m2) was 116.8 ± 43.5 using the MDRD equation and 90.5 ± 33.1 by the C–G formula. According to the MDRD formula, mild renal insufficiency (i.e. eGFR 60–89.9 ml/min/1.73 m2) was found in 21.5% of the patients and moderate renal insufficiency (i.e. eGFR 30–59.9 ml/min/1.73 m2) was found in 7.7%. According to the Cockcroft–Gault (C–G) formula, mild renal insufficiency was found in 38.2% and moderate renal insufficiency in 16.9% of the patients with normal SCr. In multivariate analysis, older age, female sex, a family history of kidney disease or other chronic diseases and high systolic blood pressure were associated with prevalent renal insufficiency depending on the formula used to estimate GFR. This study demonstrates the substantial prevalence of impaired renal function among Ethiopian adult outpatients with normal SCr. Including calculated estimates of GFR in routine laboratory reporting may help to facilitate the identification and thus optimal management of patients with renal insufficiency.

Ginseng possesses a wide spectrum of medicinal effects and has widely been used in traditional medicine for thousands of years. In this study, the antihypertensive effect of Korean wild simulated ginseng in spontaneously hypertensive rats was investigated. Three groups of hypertensive rats—a group without wild simulated ginseng treatment; another group treated with 100 mg of wild simulated ginseng extract/kg of body weight; and the other group treated with 200 mg of wild simulated ginseng extract/kg of body weight were tested over 8 weeks. The two wild simulated ginseng-treated groups showed significantly (p

Objective To quantify in-hospital systolic blood pressure variability among patients with intracerebral hemorrhage, determine the association between high systolic blood pressure variability (HSBPV) and 90-day severe disability or death, and examine the association between pre-hospital factors and HSBPV. Methods Adult, radiologically confirmed, intracerebral hemorrhage patients enrolled in a multi-site cohort were included. Using a semi-automated algorithm, systolic blood pressure values recorded from routine non-invasive systolic blood pressure monitoring in critical and acute care settings were extracted for the duration of hospitalization. Inter and intra-patient systolic blood pressure variability was quantified using generalized estimating equation methods. Modified Poisson and logistic regression models were fit to determine the association between HSBPV and 90-day severe disability or death and between pre-hospital characteristics and HSBPV, respectively. Results A total of 566 patients managed at four certified stroke centers were included. Over 120,000 systolic blood pressure readings were analyzed, and a standard deviation (SD) of 13.0 was parameterized as a cut-off point to categorize HSBPV. Patients with HSBPV had a greater risk of 90-day severe disability or death (relative risk: 1.20, 95% confidence interval: 1.04–1.39), after controlling for age, pre-morbid functional status, and other disease severity measures. Greater likelihood of in-hospital HSBPV was independently observed in elderly, female patients, and in patients with high admission systolic blood pressure. Conclusion Quantification of HSBPV is feasible utilizing routinely collected systolic blood pressure readings, and a singular cut-off parameter for systolic blood pressure variability demonstrated association with 90-day severe disability or death. Elderly, female, and patients with high admission systolic blood pressure may be more likely to demonstrate HSBPV during hospitalization.

In a recent article in this journal, we discussed diabetes and Cardiovascular disease (CVD) risks in Indians living abroad. The article was written to complement the information that was published by an elite group of the American Heart Association (AHA);-”the council members of the various subcommittees.” In the journal Circulation, AHA published a scientific statement about the CVD risk of Indians living in the USA. In the June issue of the journal PLoS Medicine, The George Institute for Global Health (GIGH), Sydney, Australia, with collaborators from; Harvard T. H. Chan School of Public Health, USA; Department of Economics, University of Gottingen, Heidelberg University, Germany; School of Public Health Johannesburg, South Africa; King's College London, UK, Indian Institute of Public Health, and Public Health Foundation of India, have published a one of a kind article on, “Geographic and sociodemographic variation of CVD disease risk in India: A cross-sectional study of 797,540 adults.” I am writing this article, as a complement to the topic reviewed by the George Institutes of Global Health and associates and other expert groups. The specific objectives of this academic exercise by the GIGH were, to determine how the CVD risk- and the factors that determine risk varies among states in India, by rural-urban location, and by individual-level sociodemographic characteristics. Rajeev Gupta and associates from Jaipur, under the aegis of South Asian Society on Atherosclerosis and Thrombosis, did a study in 2012, on “Regional variations in CVD risk in India: India heart watch.” The researchers found a wide regional variation in CVD mortality. They concluded, “that although no nationwide study of risk factors exists, there were significant state-level and rural-urban level differences in major CVD risk factors such as smoking, obesity, central adiposity, hypertension, hypercholesterolemia, and diabetes. They also stressed the need for uniform protocols, to assess the regional differences. Whereas, the report by the GIGH Collaborators group, did pooled analysis of CVD risk for 797,540 adults across India, and identified important variation in risk among individuals living in different States. According to them, CVD risk was the highest in the northern (Himachal Pradesh, Uttarakhand), northeastern (West Bengal, Nagaland, Manipur, and Mizoram), and Southern States (Kerala, Andhra Pradesh) of India. CVD risk was found to be higher in urban areas, that too among males, while mean body mass index was higher among wealthy, blood glucose, high systolic blood pressure was common in poor people of middle and older age. We have access to data from three important studies, related to the variation of CVD risk in Indians living in India, as well as abroad. It is high time, that we use these data to develop guidelines, guidance statements, novel clinical studies for validating safety and efficacy of complementary therapies for early risk factors such as oxidative stress, inflammation, and endothelial dysfunction, put together integrated noninvasive diagnostic platforms for risk assessment, risk prediction, and reduction or reversal of metabolic diseases. Having said that, I would like to emphasize the need for a national platform, to address the issues related to this very important public health problem, and to coordinate the prevention strategies.

Background An understanding of the risk factors contributing to disease burden is critical for determining research priorities and informing national health policy. We aimed to identify the risk factor trends in Canada. Methods As part of the Global Burden of Disease (GBD) study (1990-2016), we conducted an analysis of country-level estimates for Canada to assess the burden of diseases and injuries attributable to risk factors. For both 1990 and 2016, metabolic, environmental and behavioural risk factors were ranked according to their contribution to disability-adjusted life years (healthy years of life lost), total deaths and years lived with disability. Results In 2016, the risk factors accounting for the largest percentage of disability-adjusted life years in Canada were (1) tobacco, (2) diet, (3) high body mass index, (4) high fasting plasma glucose, (5) high systolic blood pressure, (6) alcohol and drug use, (7) occupational risks, (8) high total cholesterol, (9) impaired kidney function and (10) air pollution. Risk factor rankings remained similar from 1990 to 2016 despite some substantial declines in burden, including a 47% (± 3%) decline in the age-standardized disability-adjusted life years rate attributable to tobacco since 1990. Risk factors with an increasing contribution to disability-adjusted life years rates from 1990 to 2016 included high body mass index, high fasting plasma glucose and alcohol and drug use. Interpretation Metabolic and behavioural risk factors, including modifiable factors such as tobacco use and diet, remain the leading risk factors contributing to the burden of diseases and injuries in Canada. This work identifies priorities and targets for reducing premature death and disability burden in Canada.

Hypertension is the major risk factor for cardiovascular disease (CVD)—the leading global cause of death.1 2 High systolic blood pressure (SBP) is the top health risk factor for the global burden of disease.2 3 The CVD mortality and morbidity benefits of antihypertensive medications are well established, and their use to treat hypertension is increasing worldwide.4 5 These trends will continue as the American Heart Association (AHA) and American College of Cardiology (ACC) recently established lower blood pressure (BP) thresholds for treatment.6 Exercise was rated in the AHA/ACC report as one of the best non-pharmacological approaches to treat hypertension because aerobic exercise training lowers BP 5–8 mm Hg among adults with hypertension.6 7 The magnitude of these BP reductions may lower CVD risk by 4%–22% and stroke by 6%–41%,4 8 and reduce the resting BP of adults with hypertension into normal ranges. Accordingly, professional organisations from around the world recommend adults with hypertension participate in 30–60 min/day of moderate to vigorous intensity aerobic exercise, such as walking or jogging, on most days of the week with the recommendations for resistance training less consistent9 (table 1). View this table: Table 1 Professional Committee Exercise Recommendations for Hypertension (adapted from Pescatello et al 9) Despite the well documented BP benefits of medications and exercise to treat hypertension, the 2018 Physical Activity Guidelines Advisory Committee (PAGAC) noted in their …

Hypertension has become the greatest risk factor for death in elderly populations. As factors influencing cardiovascular disease, indoor environmental parameters pose potential risks for older adults. In this study, elderly residents in Dalian (Liaoning Province, China) urban dwellings were selected as the research subjects, and the environmental parameters of the dwellings’ main activity rooms and the blood pressure parameters of the older adults were measured. Based on the Long Short-Term Memory (LSTM) deep learning algorithm and Bayesian fitting method, a hypertension disease model was established using the long-term environmental parameters to predict the hypertension risk of older adults in their building’s environment. The results showed that temperature, humidity, and some air quality parameters had an impact on blood pressure under single environmental factor, and the comprehensive environmental risks of high systolic blood pressure, high diastolic blood pressure, and high blood pressure were 16.44%, 0%, and 16.44% for the male elderly and 14.11%, 7.14%, and 17.55% for the female elderly, respectively. By comparing the results for the blood pressure measurement and prediction, it can be observed that the risk error of hypertension obtained by the algorithm maintains the variables’ relationship, and the result of the algorithm is reliable in this period. This technology can provide a basis for measuring environmental parameters and will be conducive to the development of an ecological smart building environment.

Resumo Fundamento: A obesidade afeta a adolescência, podendo levar à síndrome metabólica (SM) e disfunção endotelial, um marcador precoce de risco cardiovascular. Apesar de a obesidade ser fortemente associada à síndrome da apneia obstrutiva do sono (SAOS), ainda não está claro o papel da SAOS na função endotelial em adolescentes obesos. Objetivo: Investigar se a obesidade durante a adolescência leva à SM e/ou SAOS e causa disfunção endotelial nesses indivíduos. Além disso, estudamos a possível associação dos fatores de risco para SM e do índice de apneia e hipopneia (IAH) com disfunção endotelial. Métodos: Estudamos 20 adolescentes obesos sedentários (AO; 14,2±1,6 anos, 100,9±20,3kg), e 10 adolescentes eutróficos (AE, 15,2±1,2 anos, 54,4±5,3kg) pareados por sexo. Avaliamos os fatores de risco para SM (critérios da Federação Internacional de Diabetes), função vascular (dilatação mediada pelo fluxo, DMF), capacidade funcional (VO2pico) e presença de SAOS (IAH > 1 evento/hora, pela polissonografia). Consideramos um p1event/h, by polysomnography). We considered statistically significant a P

Background Left ventricular hypertrophy (LVH) in hypertensive patients indicates an ongoing disease process involving the heart. Different electrocardiography (ECG) criteria were investigated; however, the results were conflicting. Objective To evaluate different ECG criteria in diagnosis of LVH in hypertensive patients using echocardiography as a gold standard. Methods A hospital based cross sectional observational study which included 140 adult patients with a history of hypertension. Patients were assessed for LVH using five ECG criteria: Romhilt-Estes, SokoloweLyon, Cornell voltage, Gubnere Ungerleider and Peguero-Lo Presti. Echocardiography was used to determine the left ventricular mass index for the patients. The sensitivity and specificity of each ECG criterion was determined considering echocardiography as a gold standard. Results According to the echocardiographic results, 83 patients (59.29%) were found to have LVH. Age over 40 years, overweight and obesity, high systolic blood pressure (>170 mmHg) and using of antihypertensive drugs were significantly associated with the increased risk of LVH. All included ECG criteria showed low sensitivity and high specificity in detection of LVH in hypertensive patients. There were no significant differences in the efficiency of different ECG criteria in discrimination between mild, moderate and severe cases of LVH. Conclusion LVH is very common among hypertensive patients, and the sensitivity of ECG criteria is low for these criteria to be clinically used for detection of LVH with high specificity, in which Cornell criterion is the best in detection.

Background The burden of ischemic heart disease (IHD) is high. There is limited information on the burden of IHD in identified high risk areas like Central Asia (CA) which is comprised of Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, Mongolia, Uzbekistan and Tajikistan. This study addresses the burden of IHD in CA at the regional and country levels. Methods Using data from the latest iteration of the Global Burden of Disease Study (GBD), this study provides age-adjusted mortality, prevalence, and Disability Adjusted Life Years (DALYs) of IHD by sex in the CA region, and national levels for countries in this region from 1990 to 2017. Results The CA region has a higher IHD burden than the rest of the world over the studied period. Amongst the countries within this region, age-standardized mortality and DALY rates in Uzbekistan are the highest not only in CA but worldwide, while Armenia consistently has the lowest IHD burden in CA. Unhealthy diet, high systolic blood pressure and LDL-cholesterol are the risk factors with the highest attributable IHD DALYs. Conclusion Increasing burden of IHD over time in CA can be partially explained by the economic crisis in the 1990s. There is considerable variation in IHD DALY rates among countries in the CA region. The reasons for such differences are likely multifactorial such as differences in risk factors distribution, health care effectiveness, political, social and economic factors.

Background: Increased arterial stiffness caused by elevated Blood Pressure (BP) can be indicated by the Cardio-ankle Vascular Index (CAVI). However, the relationship between arterial stiffness and BP is complex. In addition, changes in BP may contribute to increased risk of cardiovascular disease associated with abnormal lipid profiles. So far, results from published studies have been inconclusive. Objectives: To evaluate lipid profiles and BP, and their association with CAVI values in elderly participants. Methods: The study included 95 elderly Thai individuals. Anthropometric data, lipid profiles, and BP and CAVI values were established. Participants were then divided into low-CAVI (CAVI < 9, n = 50) and high-CAVI groups (CAVI ≥ 9, n = 45). Stepwise linear and logistic regression models were used. Results: The high-CAVI group had significantly higher BP and hypertension levels, than the low-CAVI group. The mean age of the high-CAVI group was also higher (≥65 years). CAVI value was positively correlated with Systolic Blood Pressure (SBP) and Pulse Pressure (PP) in the high-CAVI group. Stepwise multiple regression analysis showed SBP (β = 0.43, p < 0.01) and hip circumference (β = −0.23, p = 0.01) were associated with CAVI values. Logistic regression of the high-CAVI indices showed that the Odds Ratios (ORs) for the factors of age ≥65 years, obesity, hypertension and dyslipidemia were 7.35 (95% CI 2.42–22.36, p < 0.01), 0.20 (95% CI 0.64–0.67, p < 0.01) 4.72 (95% CI 1.67–13.32, p < 0.01), and 4.84 (95% CI 1.42–16.46, p = 0.01), respectively. Conclusion: A higher SBP level was correlated with a high-CAVI value in elderly people.

The problem of high systolic blood pressure (sBP) combined with low diastolic blood pressure (dBP) requires attention because sBP is directly and continuously related to the most important criterion, i.e., all-cause mortality, whereas dBP becomes inversely related to it after the age of 50–60 years. The European Society of Cardiology and European Society of ­Hypertension (ESC/ESH) 2018 guidelines for hypertension (HTN) are helpful because they recommend a lower safety cut-off for in-treatment dBP. To prevent tissue hypoperfusion, these guidelines recommend that dBP should be ≥70 mm Hg during treatment. A patient with very elevated sBP (e.g., 220 mm Hg) and low dBP (e.g., 65 mm Hg) is difficult to treat if one strictly follows the guidelines. In this situation, the sBP is a clear indication for antihypertensive treatment, but the dBP is a relative contraindication (as it is

Cardiovascular diseases (CVD) are a major cause of death and a public health threat. To report the burden of CVD in Mexico at a national and subnational scale from 1990 to 2017 as well as risk factors driving these changes. Following the 2017 global burden of disease study, mortality, disability-adjusted life-years (DALYs), and risk factors of CVD were examined according to 10 subcategories. The CVD burden of disease decreased between 1990 and 2017 in Mexico as a whole and in all states, with the higher decrease located in the north and central regions. Ischemic heart disease accounted for almost two-thirds of the total number of deaths from CVD and caused the highest DALY rate. The leading CVD risk factors were high systolic blood pressure, dietary risks, high LDL cholesterol, high BMI, and high fasting plasma glucose level. These results allow the establishment of priorities, policy development, and implementation to decrease the CVD burden and can provide a benchmark for states to focus on key risk factors, improve the quality of health care, and reduce health care costs.

Introduction: There has been increasing evidence that higher systolic blood pressure variability (SBPV) is related to unfavorable outcomes in patients with stroke. We explored the relation between SBPV and clinical outcomes after reperfusion therapy; intravenous thrombolysis (IVT) and endovascular therapy (EVT). Methods: We retrieved data of consecutive patients with acute ischemic stroke (AIS) treated with reperfusion therapy from our prospective stroke registry between October 2005 and December 2018. We calculated the following five SBPV during 24 hours after IVT or EVT; mean, standard deviation (SD), coefficient of variation (CV), successive variation (SV), and average real variability (ARV). Clinical outcomes included unfavorable outcomes as modified Rankin Scale (mRS) score 3-6 at 3 months and symptomatic intracranial hemorrhage (sICH) as any hemorrhage with neurological deterioration of 4 points of more on the National Institute of Health Stroke Scale (NIHSS). Successful reperfusion was indicated with early neurological improvements of 4 points of more on the NIHSS after IVT alone or Thrombolysis in Cerebral Infarction scores of 2b or 3 after EVT alone or EVT combined with IVT. Results: Among 933 patients with premorbid mRS scores of 0-1 (72±12 years; 316 women), 426 patients with unfavorable outcomes and 35 patients with sICH were observed. In adjusted analyses, all measures of SBPV but CV were related to unfavorable outcomes, while all measures of SBPV but mean SBP were related to sICH. In 566 patients with successful reperfusion, 228 patients with unfavorable outcomes and 10 patients with sICH were observed. In adjusted analyses, all measures of SBPV but mean SBP were positively related to unfavorable outcomes, while no measures of SBPV were independently related to sICH (table). Conclusion: High SBPV after successful reperfusion therapy contributed to unfavorable outcomes, suggesting high SBPV after reperfusion therapy might need more attention.

Background: Hypertension, low-density lipoprotein (LDL) hypercholesterolemia, diabetes, obesity, smoking and physical inactivity are the six major, independent and modifiable risk factors for ischemic heart disease (IHD). This article provides updated worldwide population statistics for these six factors. Methods: An electronic search was performed in the Global Health Data Exchange (GHDx) registry, using the keywords “high body-mass index” AND “high fasting plasma glucose” AND “high LDL cholesterol” AND “high systolic blood pressure” AND “low physical activity” AND “smoking” combined with “ischemic heart disease” and “deaths”. Results: The absolute number of IHD deaths attributable to each of these six risk factors has increased between 1990–2017. Mortality for high body mass index (BMI) exhibited the sharpest increase (+1.84-fold), followed by high fasting plasma glucose (+1.74-fold), high systolic blood pressure and low physical activity (both +1.48-fold) and high LDL cholesterol (+1.41-fold). The increase of IHD mortality for smoking remained marginal. High systolic blood pressure is responsible for the largest number of deaths for IHD (32.4%), followed by high LDL cholesterol (25.1%), high fasting plasma glucose (15.0%), high BMI (10.8%), smoking (10.7%) and low physical activity (5.9%). In most circumstances, the impact of cardiovascular risk factors on mortality for IHD is similar between genders except for smoking, which has larger impact in men, and low physical inactivity, which exhibits a borderline significantly larger impact in women. The age-related impact on IDH mortality of all factors follows a similar pattern, with curves in men anticipating those in women, and larger impact occurring after 50 years of age. The geographical impact on IDH mortality of all factors is heterogeneous. Conclusions: Targeted healthcare interventions shall be scaled up around this evolving epidemiology.

International audience; BACKGROUND: Norepinephrine is the first-line vasoactive drug in septic shock. As underdosages or overdosages can be harmful for patients, it seems useful to maintain the mean arterial pressure (MAP) within preset bounds. OBJECTIVES: We sought to assess whether adjusted MAP alarms could improve MAP control in patients with septic shock. METHODS: We conducted a quasi-experimental before-and-after study. During two consecutive periods, data on MAP control were obtained from patients with septic shock (n = 50/period) treated with norepinephrine over more than 24 h. The norepinephrine administration protocol, including prescription of the MAP target range (e.g., 65-75 mmHg), was identical during the two periods. During the first period (control group), the preset alarms of the monitor were used (i.e., low and high systolic blood pressure alarms set at 90 and 160 mmHg, respectively). During the second period, adjusted MAP alarms were implemented, with upper and lower bounds corresponding to the prescribed MAP target range (MAP-Alarm group). The primary end point was the percentage of time outside the desired MAP target range during the first 24 h of norepinephrine infusion. RESULTS: Baseline characteristics were not significantly different. The primary end point was significantly lower in the MAP-Alarm group than in the control group (25 ± 13% versus 51 ± 18%, respectively; p \textless 0.01). MAP was higher than the target 14 ± 11% of the time in the MAP-Alarm group versus 37 ± 17% in the control group (p \textless 0.01) and lower than the target 11 ± 9% of the time in the MAP-Alarm versus 21 ± 22% in the control group (p \textless 0.05). There was no significant difference between the two groups with regard to the dose of norepinephrine, duration of norepinephrine administration, and survival. CONCLUSIONS: These results suggest that adjusting MAP alarms to the desired MAP target range could dramatically improve the percentage of time spent within MAP targets in patients with septic shock but does not reduce exposure to norepinephrine.

High systolic blood pressure (SBP) remains the major cause of premature death globally despite advances in pharmacological treatment.1 2 The global direct medical costs associated with hypertension treatment are estimated at $370 billion/year worldwide, with the healthcare savings from effective management of this condition projected at about $100 billion/year.3 Unfortunately, relatively little attention is given to non-pharmacological strategies, including structured exercise interventions. A recent network meta-analysis of randomised controlled trials (RCTs) published in the BJSM4 aimed to compare the effects of exercise interventions and medications on SBP. We highlight the key findings of this network meta-analysis that are particularly relevant for clinical practice and health policy. Sin financiación 13.800 JCR (2020) Q1, 1/88 Sport Sciences 4.329 SJR (2020) Q1, 40/2448 Medicine (miscellaneous) No data IDR 2019 UEM

Background: High blood pressure (BP) or hypertension is considered one of the top global disease burden risk factors. In November 2017, the ACC/AHA and other organizations announced a new hypertension guideline of 130/80 mmHg. Data and Methods: We evaluate the effects of BP on increases in medical expenditures using transformation tobit models and a dataset containing 175,123 medical checkups and 6,312,125 receipts from 88,211 individuals in three health insurance societies. The sample period was April 2013 to March 2016. We first created a database of combined checkup results and medical expenditures. The power transformation tobit model was then used to remove the effects of other variables, and we investigated the relation between medical expenditures and BP, especially systolic BP (SBP). Results: We observed negative effects of SBP on medical expenditures. The results raise uncertainty about the reliability of the new guideline, at least for SBP. Although the simple correlation coefficient of medical expenditures and SBP was positive, the sign of the SBP estimate became negative when a variable representing obesity was included. In terms of other medical checkup items, while LDL is considered the “bad” cholesterol, it reduced medical expenditures. Conclusion: Our results did not support the new 2017 ACC/AHA guideline for SBP. A wide and careful range of reviews not only for heart diseases but also for other disease types will be absolutely necessary. New studies to verify the guideline should also be conducted. Limitations: The dataset was observatory, the sample period only 3 years, and we could not complete a time-series analysis of individuals.

The study was designed to establish an experimental models of metabolic syndrome that adequately mimic metabolic syndrome criteria as determined by NCEP ATP III. Eighteen Male Sprague dawley rats, 2 - 3 months old were used in the study. Combination of high fat and high sucrose (HFHS) diet for eight weeks and streptozotocin (STZ) injection in the second week was administered to induce metabolic syndrome. The body weight and biochemical parameters (blood glucose, triglyceride, HDL-cholesterol) were measured every 2 weeks. The rats with blood glucose (>126mg/dL), triglyceride (TG) (>150mg/dL), high systolic blood pressure (≥140 mmHg), and reduced HDL levels (

Stroke is a principal cause of mortality in China and Japan. High systolic blood pressure (SBP) was considered a chief risk factor for stroke mortality. Herein, we evaluated temporal trends of high SBP-attributable stroke mortality in China and Japan between 1990 and 2017. Data on stroke mortality were retrieved from the Global Burden of Disease Study 2017 (GBD 2017). Using the age-period-cohort method, we computed overall net drifts, local drifts, longitudinal age curves, and cohort/period rate ratios (RRs) for high SBP-attributable stroke mortality. The age-standardized mortality rates (ASMRs) displayed decreasing trends for high SBP-attributable stroke mortality. The annual net drift values were − 1.4% and − 3.5% in Chinese men and women versus − 3.1% and − 4.9% in Japanese men and women. The local drift values in both countries were