International Journal of Hypertension The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. An Analysis of Anthropometric Indicators and Modifiable Lifestyle Parameters Associated with Hypertensive Nephropathy Tue, 27 Sep 2016 14:05:54 +0000 The surge in prevalence of chronic noncommunicable diseases like hypertension and chronic kidney disease has been linked with modifiable lifestyle practices and increased body fat. This study sought to compare the association between different modifiable lifestyle practices, adiposity indices, renal function parameters, and hypertension as well as the predictive implications for levels of these parameters in target cardiac organ damage among an urban Ghanaian hypertensive population. Using a hospital-based case-control study design, 241 Ghanaian indigenes from the Kumasi metropolis were recruited for this study. The case group was made up of 180 hypertensives and 61 normotensives served as controls. In addition to sociodemographic data, standard haemodynamic, anthropometric, renal function, and cardiac organ damage assessments were done. The prevalence of chronic kidney disease (CKD) ranged from 13.3% to 16.6% depending on the equation used in estimating the glomerular filtration rate (eGFR). Percentage cluster distribution by chronic kidney disease was observed to be significantly tilted toward the upper quartiles (3rd and 4th) of the haemodynamic parameters measured. Chronic kidney disease was significantly higher among self-reported smokers and alcoholic hypertensives. In this urban population, adiposity was associated with hypertension and renal insufficiency. Chronic kidney disease was associated with hypertension and cardiac abnormalities. Christiana Aryee, William K. B. A. Owiredu, James Osei-Yeboah, Ellis Owusu-Dabo, Edwin F. Laing, and Isaac K. Owusu Copyright © 2016 Christiana Aryee et al. All rights reserved. Hypertension Impact on Health-Related Quality of Life: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China Wed, 17 Aug 2016 13:02:52 +0000 Hypertension is a major risk factor of cardiovascular disease in China, and yet little is known about health-related quality of life (HRQOL) and its associations with demographic and social-economic characteristics in middle-aged patients with hypertension. A cross-sectional survey was undertaken in Chongqing, China, using a multistage stratified random sampling methodology. Data was collected on 1,224 eligible adults, aged between 45 and 53 years, including the Medical Outcomes Survey Short Form-36 to measure HRQOL. Hypertension was associated with poor state of physical functioning, role-physical, bodily pain, general health, vitality, and social function ( for all). In multivariable analyses, education level, job conditions, average monthly income, smoking status, sleep quality, perception of relationship with family, childhood breastfeeding history, and body mass index were associated with domains of SF36 among those with hypertension ( for all). Hypertensive respondents with high education, marital status, breastfeeding, higher incomes, good quality of sleep, positive relationship with family, and higher body mass index have better HRQOL in middle-aged people with hypertension. Those unemployed had a better state of general health and had a poorer state of social function. Nonsmokers had a poorer state of bodily pain than smokers. This study provides detailed information of the implications for health care providers to gain a more complete picture of their hypertension patients’ health. Xianglong Xu, Yunshuang Rao, Zumin Shi, Lingli Liu, Cheng Chen, and Yong Zhao Copyright © 2016 Xianglong Xu et al. All rights reserved. Prevalence, Risk Factors, Awareness, and Treatment and Control of Hypertension in Mafia Island, Tanzania Wed, 20 Jul 2016 06:19:41 +0000 Introduction. The prevalence of hypertension in Africa ranges from 29.7% in Cameroon to 47% in South Africa. Only 10% receive treatment in Cameroon while 32% are on medications in Ghana. Control rates vary from 0.4% to 16.8%. This study was done to assess prevalence, risk factors, awareness, treatment, and control of hypertension in Mafia Island, Tanzania, which has never been documented before, so that necessary interventions can be undertaken accordingly. Methodology. Data was collected through questionnaires and anthropometric measurements were taken. Descriptive statistics were done and potential correlations were analyzed. Results. Out of 570 adults who were included in the study, 154 (27%) were aged 41–50 and the male-to-female ratio was 1 : 1.05. Almost half (49.5%) of the participants fit into the criteria of hypertension. Out of the 118 participants who were aware of having hypertension, 68 (57.6%) were currently taking medication. From those taking medication, only 14 (20.6%) had controlled hypertension. Conclusion. This study tried to show the extent of hypertension and find out risk factors which could explain the high prevalence of hypertension. This is very alarming and a dire need to raise awareness through health education, availability of screening, and treating and follow-up should be given priority. M. S. Muhamedhussein, Z. I. Nagri, and K. P. Manji Copyright © 2016 M. S. Muhamedhussein et al. All rights reserved. The Association between ESR and CRP and Systemic Hypertension in Sarcoidosis Tue, 28 Jun 2016 11:35:58 +0000 Introduction. The association between the level of systemic inflammation and systemic hypertension (sHTN) among subjects with sarcoidosis has not been previously explored. Methods. A retrospective study was conducted to investigate the relation between the level of systemic inflammation in sarcoidosis, measured by various serum inflammatory markers, and sHTN. Results. Among a total of 108 cases with sarcoidosis (mean age: 53.4 years, 76.9% females), 55 (50.9%) had sHTN and 53 (49.1%) were normotensive. ESR was highly associated with sHTN. The patients with sHTN had higher mean ESR levels compared with normotensives (48.8 ± 35 versus 23.2 ± 27 mm/hr, resp.; ). ROC curve analysis for ESR revealed an AUC value of 0.795 (95% CI: 0.692–0.897; ). With regard to CRP, there was a trend towards higher mean values in sHTN group (3.4 versus 1.7 mg/L; ) and significantly higher prevalence of sHTN in the highest CRP quartile compared to the lowest one (69.6% versus 30%; OR 4.95; ). ROC curve analysis for CRP revealed an AUC value of 0.644 (95% CI: 0.518–0.769; ). On multivariate analysis, ESR and the CRP remained independent predictors for sHTN among subjects with sarcoidosis. Conclusion. Systemic inflammation is associated with the presence of sHTN in sarcoidosis. Mehdi Mirsaeidi, Hesham R. Omar, Golnaz Ebrahimi, and Micheal Campos Copyright © 2016 Mehdi Mirsaeidi et al. All rights reserved. Socioeconomic Status and Hypertension among Teachers and Bankers in Addis Ababa, Ethiopia Sun, 22 May 2016 12:39:11 +0000 Background. The social and economic changes taking place in developing countries are influencing the pace at which hypertension and its risk factors are expanding. As opposed to the already established inverse association in developed nations, the association between socioeconomic status and hypertension in developing countries is poor and inconsistent. This study aims to determine the association between socioeconomic status and hypertension among teachers and bankers in Addis Ababa, Ethiopia. Methods. This study is based on a cross-sectional study conducted to assess the prevalence of NCDs in Addis Ababa, Ethiopia. The study was undertaken among workers of the Commercial Bank of Ethiopia and teachers of public schools in 2010. Results. Majority of participants were teachers (70.3%). Most of the respondents (54.1%) earn an annual income between 15,000 ETB and 48,000 ETB, and 51.9% of them have educational status of first degree and above. Among the socioeconomic factors income was strongly associated with the odds of having hypertension (AOR: 2.17 with 95% CI: 1.58–2.98). Conclusions. Higher burden of hypertension is observed among teachers and bankers in Addis Ababa, Ethiopia. Promotion of healthy behaviors and interventions that target higher income groups needs to be put in place. Girma Fikadu and Seblewengel Lemma Copyright © 2016 Girma Fikadu and Seblewengel Lemma. All rights reserved. Changes in Angiotensin Receptor Distribution and in Aortic Morphology Are Associated with Blood Pressure Control in Aged Metabolic Syndrome Rats Tue, 17 May 2016 07:46:31 +0000 The role of the renin-angiotensin system (RAS) in blood pressure regulation in MS during aging is unknown. It participates in metabolic syndrome (MS) and aging regulating vascular tone and remodeling. RAS might participate in a compensatory mechanism decreasing blood pressure and allowing MS rats to reach 18 months of age and it might form part of therapeutical procedures to ameliorate MS. We studied histological changes and distribution of RAS receptors in aortas of MS aged rats. Electron microscopy images showed premature aging in MS since the increased fibrosis, enlarged endothelium, and invasion of this layer by muscle cells that was present in control 18-month-old aortas were also found in 6-month-old aortas from MS rats. AT1, AT2, and Mas receptors mediate the effects of Ang II and Ang 1-7, respectively. Fluorescence from AT2 decreased with age in control and MS aortas, while fluorescence of AT1 increased in aortas from MS rats at 6 months and diminished during aging. Mas expression increased in MS rats and remained unchanged in control rats. In conclusion, there is premature aging in the aortas from MS rats and the elevated expression of Mas receptor might contribute to decrease blood pressure during aging in MS. Verónica Guarner-Lans, Elizabeth Soria-Castro, Rocío Torrico-Lavayen, Araceli Patrón-Soberano, Karla G. Carvajal-Aguilera, Vicente Castrejón-Tellez, and María Esther Rubio-Ruiz Copyright © 2016 Verónica Guarner-Lans et al. All rights reserved. Prevalence and Associated Factors of Hypertension: A Community-Based Cross-Sectional Study in Municipalities of Kathmandu, Nepal Thu, 12 May 2016 14:56:16 +0000 Objective. This study aimed to assess the prevalence and associated factors of hypertension in newly declared municipalities of Kathmandu, Nepal. Design, Settings, and Participants. This was a community-based cross-sectional study conducted in the municipalities of Kathmandu District, Nepal, between January and July 2015. Study participants were aged 18 to 70 years, residing permanently in the study sites. Municipalities, Wards, households, and respondents were selected randomly. Results. Of the 587 participants, 58.8% were females, mean (SD) age was 42.3 (13.5) years, 29.3% had no formal education, 35.1% were Brahmins, and 41.2% were homemakers. Prevalence of hypertension was 32.5% (95% CI: 28.7–36.3). Age, gender, education, ethnicity, occupation, smoking, alcohol consumption, physical activity, diabetes, menopausal history, and family history of cardiovascular disease (CVD) and hypertension were significantly associated with hypertension. In multivariable analysis, smoking, alcohol consumption, physical activity, body mass index, and diabetes were identified as significant explanatory variables for hypertension. Conclusion. This study demonstrated that the people living in newly established municipalities of Kathmandu, Nepal, have a high burden of hypertension as well as its associated factors. Therefore, community-based preventive approaches like lifestyle modification and early detection and treatment of hypertension might bring a substantial change in tackling the burden effectively. Raja Ram Dhungana, Achyut Raj Pandey, Bihungum Bista, Suira Joshi, and Surya Devkota Copyright © 2016 Raja Ram Dhungana et al. All rights reserved. Prevalence and Sociodemographic Determinants of Hypertension History among Women in Reproductive Age in Ghana Wed, 20 Apr 2016 08:52:16 +0000 Background. Hypertension is a global health problem. Yet, studies on hypertension rarely focus on women in Ghana. The purpose of this study is to ascertain the prevalence and sociodemographic determinants of hypertension history among Ghanaian women in reproductive age. Methods. This study used data from the 2014 Ghana Demographic and Health Survey. Bivariate and logistic regression analyses were carried out to ascertain the prevalence and determinants of hypertension history among the respondents. Results. The study found that the overall prevalence of hypertension history among the respondents was 7.5%; however, there were vast variations within most of the sociodemographic categories. Age, level of education, marital status, work status, and wealth status had a significant relationship with hypertension history among the respondents. Women in advanced age groups, highly educated, married, and widowed/divorced/separated, nonworking women, and women from wealthy households were at higher risk of having hypertension history. Conclusion. Myriads of sociodemographic factors determine the hypertension history of women in Ghana. It is therefore essential to target medical and psychosocial hypertension interventions at Ghanaian women in the higher risk groups. Samuel H. Nyarko Copyright © 2016 Samuel H. Nyarko. All rights reserved. Prevalence of Hypertension and Determination of Its Risk Factors in Rural Delhi Sun, 03 Apr 2016 14:47:56 +0000 Introduction. Hypertension is an important public health challenge in both economically developing and developed countries. It is one of the risk factors for cardiovascular mortality. Data is available on hypertension in urban population but few studies are reported in rural areas. Materials and Methods. It was a community based cross-sectional study conducted in two rural areas in Delhi among 1005 subjects selected using systematic random sampling method. WHO STEPS approach was used to collect data. Blood pressure, body mass index, and blood sugar were measured. Data analysis was done using SPSS version 16. Odds of hypertension among subjects with risk factors were calculated. value less than 0.05 was considered significant. Results. The prevalence of hypertension was 14.1% among study subjects. Hypertension was significantly higher in individuals more than 35 years than those less than 35 years. Hypertension was significantly higher in those who take alcohol and in subjects with raised total cholesterol level but in multivariate analysis only age, education, and cholesterol levels were independently associated with hypertension. Conclusion. There is significant burden of hypertension in rural areas in Delhi. Age, education, and cholesterol levels were independent risk factors of hypertension. Jugal Kishore, Neeru Gupta, Charu Kohli, and Neeta Kumar Copyright © 2016 Jugal Kishore et al. All rights reserved. Beneficial Effects of Dietary Nitrate on Endothelial Function and Blood Pressure Levels Mon, 21 Mar 2016 09:48:40 +0000 Poor eating habits may represent cardiovascular risk factors since high intake of fat and saturated fatty acids contributes to dyslipidemia, obesity, diabetes mellitus, and hypertension. Thus, nutritional interventions are recognized as important strategies for primary prevention of hypertension and as adjuvants to pharmacological therapies to reduce cardiovascular risk. The DASH (Dietary Approach to Stop Hypertension) plan is one of the most effective strategies for the prevention and nonpharmacological management of hypertension. The beneficial effects of DASH diet on blood pressure might be related to the high inorganic nitrate content of some food products included in this meal plan. The beetroot and other food plants considered as nitrate sources account for approximately 60–80% of the daily nitrate exposure in the western population. The increased levels of nitrite by nitrate intake seem to have beneficial effects in many of the physiological and clinical settings. Several clinical trials are being conducted to determine the broad therapeutic potential of increasing the bioavailability of nitrite in human health and disease, including studies related to vascular aging. In conclusion, the dietary inorganic nitrate seems to represent a promising complementary therapy to support hypertension treatment with benefits for cardiovascular health. Jenifer d’El-Rei, Ana Rosa Cunha, Michelle Trindade, and Mario Fritsch Neves Copyright © 2016 Jenifer d’El-Rei et al. All rights reserved. Adherence to Antihypertensive Medications in Iranian Patients Wed, 16 Mar 2016 11:04:50 +0000 Introduction. Appropriate adherence to medication is still a challenging issue for hypertensive patients. We determined adherence to antihypertensive(s) and its associated factors among 280 Iranian patients. Methods. They were recruited consecutively from private and university health centers and pharmacies in four cities. The validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) was administered to measure adherence. Results. Mean (±SD) overall MMAS-8 score was 5.75 (±1.88). About half of the sample (139 cases, 49.6%) showed low adherence (MMAS-8 score < 6). There was a negative linear association between the MMAS-8 score and systolic BP (, ) as well as diastolic BP (, ). In linear regression model, overweight/obesity (, ), previous history of admission to emergency services due to hypertensive crisis (, ), and getting medication directly from drugstore without refill prescription in hand (, ) were factors recognized to have statistically significant association with the MMAS-8 score. Conclusion. Antihypertensive adherence was unsatisfactory. We suggest that health care providers pay special attention and make use of the aforementioned findings in their routine visits of hypertensive patients to recognize those who are vulnerable to poor adherence. Azin Behnood-Rod, Omid Rabbanifar, Pirouz Pourzargar, Alireza Rai, Zahra Saadat, Habibollah Saadat, Yashar Moharamzad, and Donald E. Morisky Copyright © 2016 Azin Behnood-Rod et al. All rights reserved. Growing-Related Changes in Arterial Properties of Healthy Children, Adolescents, and Young Adults Nonexposed to Cardiovascular Risk Factors: Analysis of Gender-Related Differences Thu, 18 Feb 2016 14:31:28 +0000 The aims of our work were to determine normal aging rates for structural and functional arterial parameters in healthy children, adolescents, and young adults and to identify gender-related differences in these aging rates. Methods. 161 subjects (mean: 15 years (range: 4–28 years), 69 females) were studied. Subjects included had no congenital or chronic diseases, nor had they been previously exposed to traditional cardiovascular risk factors. Arterial parameters assessed were (1) central blood pressure (BP) and aortic pulse wave analysis, (2) arterial local (pressure-strain elastic modulus) and regional (pulse wave velocity, PWV) stiffness, and (3) arterial diameters and carotid intima-media thickness (CIMT). Simple linear regression models (age as the independent variable) were obtained for all the parameters and the resulting rates of change were compared between genders. Results. No gender-related differences were found in mean values of arterial structural and functional parameters in prepubertal ages (4–8 years), but they started to appear at ~15 years. Boys showed a greater rate of change for central systolic BP, central pulse pressure, CIMT, and carotid-femoral PWV. Conclusion. Gender-related differences in arterial characteristics of adults can be explained on the basis of different growing-related patterns between boys and girls, with no existing differences in prepubertal ages. S. Curcio, V. García-Espinosa, M. Arana, I. Farro, P. Chiesa, G. Giachetto, Y. Zócalo, and D. Bia Copyright © 2016 S. Curcio et al. All rights reserved. Determinants of Mean Blood Pressure and Hypertension among Workers in West Africa Tue, 02 Feb 2016 14:08:20 +0000 Background. This review was undertaken to estimate the mean blood pressure and evaluate its determinants as well as the determinants of hypertension among workers in West Africa. Methods. In a follow-up to an earlier study, a systematic search for articles published between 1980 and August 2015 was undertaken using major databases. Results. A total of 55 articles involving 34,919 different cadres of workers from six countries were retrieved. The mean systolic blood pressure (BP) ranged from  mmHg to  mmHg while the mean diastolic BP ranged from  mmHg to  mmHg. Population-wide prehypertension was common. The major determinants of mean BP and hypertension were similar and included male sex, older age group, higher socioeconomic status, obesity, alcohol consumption, plasma glucose, and sodium excretion. Ethnicity and educational level were inconsistently associated with hypertension. Workers at higher risk of cardiovascular event did not perceive themselves as such. Conclusion. The prevailing mean prehypertensive BP, low perception of risk, and clustering of risk factors call for interventions such as healthy diets, improved physical activity, and a favourable work environment. Successful models for improving the cardiovascular health of sedentary informal sector workers in Africa are urgently needed. William K. Bosu Copyright © 2016 William K. Bosu. All rights reserved. A Systematic Review and Meta-Analysis on the Association between Hypertension and Tinnitus Thu, 31 Dec 2015 09:25:59 +0000 Hypertension has been suggested to be one possible risk factor of tinnitus, but the association between hypertension and tinnitus remains uncertain. The authors performed a meta-analysis of the existing studies on the association between hypertension and tinnitus. We performed literature search of studies using SinoMed, CNKI, WanFang, PubMed, Scopus, Web of Science, and Google Scholar. Studies reported the odds ratio and 95% confidence interval (CI) (or provided sufficient information for calculation) of the association between hypertension and tinnitus were included. A total of 19 eligible studies with 20 effect estimates were used in this study. They included 63,154 participants with age ranging from 14 to 92. The pooled OR, which was pooled using a random effects model, was 1.37 (95% CI: 1.16 to 1.62). There was no evidence of publication bias ( for Begg’s test, for Egger’s test). By meta-regression, we found that study design may be one possible factor of heterogeneity. Sensitivity analysis found that the result was stable. This study suggests that hypertension might be one risk factor of tinnitus, and hypertension prevention and control might be helpful in preventing tinnitus. Pan Yang, Wenjun Ma, Yiqing Zheng, Haidi Yang, and Hualiang Lin Copyright © 2015 Pan Yang et al. All rights reserved. Knowledge, Treatment, Control, and Risk Factors for Hypertension among Adults in Southern Iran Wed, 09 Dec 2015 11:23:14 +0000 Hypertension is the first and the most common risk factor to diseases such as cardiovascular, stroke, and renal diseases. The aim of this study was to determine the factors relevant to hypertension knowledge, treatment, and control in southern Iran. In this cross-sectional study, conducted in Kohgiluye Boyer-Ahmad province, south of Iran, a total of 1836 hypertension patients were randomly selected to participate voluntarily in the study. Hypertension treatment and its control were defined during study. In addition, knowledge about hypertension was measured by hypertension knowledge level scale (HK-LS). Treatment rates were 75.5 and 37.7 percent for female and male, respectively. Habitat, education, income, family history with hypertension, smoking, and time of diagnosis to the disease were found to be related to the treatment of the disease. Control rates were 30.7 and 31.4 for males and females, respectively. Habitat, education, and time of diagnosis to the disease were related to control. Over 50 percent of patients had average knowledge on hypertension. Considering the low rate of control and knowledge on hypertension among patients, health care providers should reinforce their services to improve appropriate knowledge level among elders and, also, plan comprehensive programs to promote health in order to encourage patients change and reform their life style. Sayed Fazel Zinat Motlagh, Reza Chaman, Sayed Rashid Ghafari, Zafar Parisay, Mohamad Reza Golabi, Ahmad Ali Eslami, and Amin Babouei Copyright © 2015 Sayed Fazel Zinat Motlagh et al. All rights reserved. Sleep Disorders, Obesity, Hypertension, and Cardiovascular Risk Sun, 18 Oct 2015 06:41:00 +0000 Samy I. McFarlane, Olugbenga Ogedegbe, Amgad N. Makaryus, Charles Agyemang, and Girardin Jean-Louis Copyright © 2015 Samy I. McFarlane et al. All rights reserved. A Concept Mapping Study of Physicians’ Perceptions of Factors Influencing Management and Control of Hypertension in Sub-Saharan Africa Tue, 13 Oct 2015 11:53:10 +0000 Hypertension, once a rare problem in Sub-Saharan Africa (SSA), is predicted to be a major cause of death by 2020 with mortality rates as high as 75%. However, comprehensive knowledge of provider-level factors that influence optimal management is limited. The objective of the current study was to discover physicians’ perceptions of factors influencing optimal management and control of hypertension in SSA. Twelve physicians attending the Cardiovascular Research Training (CaRT) Institute at the University of Ghana, College of Health Sciences, were invited to complete a concept mapping process that included brainstorming the factors influencing optimal management and control of hypertension in patients, sorting and organizing the factors into similar domains, and rating the importance and feasibility of efforts to address these factors. The highest ranked important and feasible factors include helping patients accept their condition and availability of adequate equipment to enable the provision of needed care. The findings suggest that patient self-efficacy and support, physician-related factors, policy factors, and economic factors are important aspects that must be addressed to achieve optimal hypertension management. Given the work demands identified by physicians, future research should investigate cost-effective strategies of shifting physician responsibilities to well-trained no-physician clinicians in order to improve hypertension management. Juliet Iwelunmor, Sarah Blackstone, Joyce Gyamfi, Collins Airhihenbuwa, Jacob Plange-Rhule, Bamidele Tayo, Richard Adanu, and Gbenga Ogedegbe Copyright © 2015 Juliet Iwelunmor et al. All rights reserved. Provider Adherence to National Guidelines for Managing Hypertension in African Americans Tue, 13 Oct 2015 08:49:36 +0000 Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted. Jeanette Sessoms, Kathryn Reid, Ishan Williams, and Ivora Hinton Copyright © 2015 Jeanette Sessoms et al. All rights reserved. Correlation of Prehypertension with Left Ventricular Mass Assessed by Cardiac Magnetic Resonance Imaging Mon, 12 Oct 2015 11:53:39 +0000 Introduction. The purpose of this observational cross-sectional study was to assess left ventricular mass (LVM) in prehypertensive individuals in comparison to normotensives and to determine if central blood pressure (BP) correlates better with LVM index (LVMI) than brachial BP. Methods and Result. Brachial and central BP measurements were completed at first visit and at 4 weeks in 65 healthy volunteers who were at least 40 years old and not on medication. Subjects were divided into two groups of normotensives and prehypertensives based on JNC-7 criteria and LVM was obtained using cardiac magnetic resonance imaging. Prehypertensives had significantly higher LVMI compared to normotensives (). Brachial and central BP also both positively correlate with LVMI (, ; , , resp.) in both groups and neither method was superior to the other. After multivariate regression analysis and adjusting for cardiovascular risk factors, prehypertension remained an independent determinant of LVM. Conclusion. Prehypertension is associated with cardiovascular target organ damage, and central BP was not superior to brachial BP or vice versa for association with LVMI. Tarek M. Mousa, Oluwaseun A. Akinseye, Ketevan Berekashvili, and Olakunle O. Akinboboye Copyright © 2015 Tarek M. Mousa et al. All rights reserved. Factors Associated with Medication Nonadherence among Hypertensives in Ghana and Nigeria Mon, 05 Oct 2015 12:59:44 +0000 Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication nonadherence (MNA); our study therefore aimed to determine factors associated with MNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (), Ghana; and University of Port Harcourt Teaching Hospital, () Apapa General Hospital Lagos () and University College Hospital Ibadan (), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (, ), concern about medications (, ), and knowledge of hypertension (, ). MNA was associated with formal education () and use of herbal preparation (). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation. Vincent Boima, Adebowale Dele Ademola, Aina Olufemi Odusola, Francis Agyekum, Chibuike Eze Nwafor, Helen Cole, Babatunde L. Salako, Gbenga Ogedegbe, and Bamidele O. Tayo Copyright © 2015 Vincent Boima et al. All rights reserved. Low-Glycemic-Index Foods Can Decrease Systolic and Diastolic Blood Pressure in the Short Term Mon, 05 Oct 2015 06:53:00 +0000 Background. We aimed to compare the effects of low- and high-GI foods on 24-hour ambulatory blood pressure. Methods. This longitudinal study was performed on 30 women, aged 18 to 40 years, during 24 hours. In the first leg of study all recruited subjects were assigned to LGI period for 24 hours and, after a 2-week washout period, all subjects were assigned to HGI period. BP was measured every hour during the 24-hour monitoring. Results. After the intervention, there were significant decreases in SBP and DBP in the LGI period ( mmHg versus  mmHg for SBP and  mmHg versus  mmHg for DBP) ( and , resp.). However, in the HGI period, there was no significant change in SBP or DBP ( versus for SBP and versus for DBP) ( and , resp.). Conclusion. The results suggest that LGI foods may be beneficial in reducing 24-hour BP. Mina Hosseininasab, Abdolreza Norouzy, Mohsen Nematy, and Shokoufeh Bonakdaran Copyright © 2015 Mina Hosseininasab et al. All rights reserved. Micro and Macro Element Composition of Kalanchoe integra Leaves: An Adjuvant Treatment for Hypertension in Ghana Thu, 01 Oct 2015 16:06:25 +0000 Two samples, water extract and blended whole leaves, of fresh Kalanchoe integra leaves (Crassulaceae), a traditional antihypertensive medicine used in Ghana, were analyzed with Energy Dispersive X-Ray Fluorescence spectroscopy (EDXRF). Analysis revealed 12 macro and 26 micro elements in both extracts. Further quantitative assessment of the results for amounts of elements that are pharmacologically significant revealed that the amounts of calcium, potassium, and magnesium present in the extracts could be correlated to its traditional usage in managing hypertension and arrhythmias. However, heavy metals (lead and inorganic arsenic) detected in the extracts may pose a threat at doses normally used traditionally for the treatment of hypertension. S. Frimpong-Manso, I. J. Asiedu-Gyekye, J. P. Naadu, G. T. Magnus-Aryitey, A. K. Nyarko, D. Boamah, and M. Awan Copyright © 2015 S. Frimpong-Manso et al. All rights reserved. Associations of Short Sleep and Shift Work Status with Hypertension among Black and White Americans Thu, 01 Oct 2015 12:20:12 +0000 Objective. The purpose of this study was to investigate whether short sleepers (<6 hrs) who worked the non-day-shift were at greater likelihood of reporting hypertension and if these associations varied by individuals’ ethnicity. Methods. Analysis was based on the 2010 National Health Interview Survey (NHIS). A total of 59,199 American adults provided valid data for the present analyses (mean age = years; 51.5% were female). Respondents provided work schedule and estimated habitual sleep durations as well as self-report of chronic conditions. Results. Of the sample, 30.8% reported a diagnosis of hypertension, 79.1% reported daytime shift work, 11.0% reported rotating shift work, and 4.0% reported night shift work. Logistic regression analysis showed that shift work was significantly associated with hypertension among Blacks [OR = 1.35, CI: 1.06–1.72. ], but not among Whites [OR = 1.01, CI: 0.85–1.20, NS]. Black shift workers sleeping less than 6 hours had significantly increased odds of reporting hypertension [OR = 1.81, CI: 1.29–2.54, ], while their White counterparts did not [OR = 1.17, CI: 0.90–1.52, NS]. Conclusions. Findings suggest that Black Americans working the non-day-shift especially with short sleep duration have increased odds of reporting hypertension. Mirnova E. Ceïde, Abhishek Pandey, Joe Ravenell, Margaret Donat, Gbenga Ogedegbe, and Girardin Jean-Louis Copyright © 2015 Mirnova E. Ceïde et al. All rights reserved. Genetic Variants of C-5312T REN Increased Renin Levels and Diastolic Blood Pressure Response to Angiotensin Receptor Blockers Thu, 01 Oct 2015 11:47:13 +0000 Renin catalyzes the cleavage of angiotensinogen into angiotensin I. Genetic variant C-5312T of renin enhancer has been reported to increase in vitro renin gene transcription. However, no obvious in vivo study was performed to see the renin level in C-5312T when treated with angiotensin receptor blockers (ARB). Therefore, this study aimed to investigate the serum renin level and blood pressure response in ARB treated hypertensive patients. Single nucleotide polymorphism (SNP) of C-5312T was identified in 55 hypertensive patients by using multiplex PCR and renin serum level was assayed by ELISA. The data showed that the increase of serum renin levels after 5 months of ARB treatment was significantly higher in patients with CT/TT genotype (10 pg/mL) than those with CC genotype (4.08 pg/mL) (P = 0.025). Hypertensive patients with CT/TT genotypes also showed less diastolic pressure reduction than CC genotypes in hypertensive patients with valsartan treatment (P = 0.04) or telmisartan treatment (P = 0.03). Finally, these findings suggested that SNP of C-5312T REN enhancer might contribute to higher increased renin serum levels and less diastolic blood pressure response to ARB treatment. Mohammad Saifur Rohman, Ika Arum Dewi Satiti, Nashi Widodo, Mifetika Lukitasari, and Hidayat Sujuti Copyright © 2015 Mohammad Saifur Rohman et al. All rights reserved. Sleep Deficiency and Deprivation Leading to Cardiovascular Disease Thu, 01 Oct 2015 10:07:44 +0000 Sleep plays a vital role in an individual’s mental, emotional, and physiological well-being. Not only does sleep deficiency lead to neurological and psychological disorders, but also the literature has explored the adverse effects of sleep deficiency on the cardiovascular system. Decreased quantity and quality of sleep have been linked to cardiovascular disease (CVD) risk factors, such as hypertension, obesity, diabetes, and dyslipidemia. We explore the literature correlating primary sleep deficiency and deprivation as a cause for cardiovascular disease and cite endothelial dysfunction as a common underlying mechanism. Michelle Kohansieh and Amgad N. Makaryus Copyright © 2015 Michelle Kohansieh and Amgad N. Makaryus. All rights reserved. Epidemiology of Hypertension Stages in Two Countries in Sub-Sahara Africa: Factors Associated with Hypertension Stages Thu, 01 Oct 2015 07:32:24 +0000 Studies using the revised hypertension classification are needed to better understand epidemiology of hypertension across full distribution. The sociodemographic, biological, and health behavior characteristics associated with different stages of hypertension in Ghana and South Africa (SA) were studied using global ageing and adult health (SAGE), WAVE 1 dataset. Blood pressure was assessed for a total of 7545 respondents, 2980 from SA and 4565 from Ghana. Hypertension was defined using JNC7 blood pressure classification considering previous diagnosis and treatment. Multivariate multinomial logistic regression analysis using Stata version 12 statistical software was done to identify independent predictors. The weighted prevalence of prehypertension and hypertension in Ghana was 30.7% and 42.4%, respectively, and that of SA was 29.4% and 46%, respectively, showing high burden. After adjusting for the independent variables, only age (OR = 1.32, 95% CI: 1.14–1.53), income (OR = 1.9, 95% CI: 1.04–3.47), and BMI (OR = 1.16, 95% CI: 1.1–1.22) remained independent predictors for stage 1 hypertension in Ghana, while, for SA, age (OR = 2.27, 95% CI: 1.53–3.36), sex (OR = 0.28, 95% CI: 0.08–1), and BMI (OR = 1.15, 95% CI: 1.07–1.25) were found to be independent predictors of stage 1 hypertension. Healthy lifestyle changes and policy measures are needed to promptly address these predictors. Kirubel Zemedkun Gebreselassie and Mojgan Padyab Copyright © 2015 Kirubel Zemedkun Gebreselassie and Mojgan Padyab. All rights reserved. Implications of Renal Denervation Therapy in Patients with Sleep Apnea Wed, 30 Sep 2015 13:59:03 +0000 Obstructive sleep apnea (OSA) syndrome is a prevalent condition characterized by repeated episodes of obstruction of the upper airway, leading to intermittent hypoxemia and important endothelial and anatomical dysfunctions that cause cardiovascular and cerebrovascular disease. The finding of the relationship between OSA and hypertension, especially resistant hypertension (RHT), has increased the interest in therapeutic strategies that affect renal sympathetic activity in these patients. The observational studies published until now demonstrated that renal denervation therapy can reduce the severity of OSA syndrome. Renal sympathetic denervation (RDN) could be a future therapeutic possibility for conditions other than RHT, such as atrial fibrillation, heart failure, obesity, and OSA syndrome, where renal sympathetic system plays an important physiological role. The aim of this review was to elucidate the implications of renal sympathetic activity in OSA syndrome. Fernando Jaén-Águila, José Antonio Vargas-Hitos, and Juan Diego Mediavilla-García Copyright © 2015 Fernando Jaén-Águila et al. All rights reserved. Renin-Angiotensin System Genes Polymorphisms and Essential Hypertension in Burkina Faso, West Africa Mon, 17 Aug 2015 09:49:59 +0000 Objective. This study aimed to investigate the association between three polymorphisms of renin-angiotensin system and the essential hypertension in the population of Burkina Faso. Methodology. This was a case-control study including 202 cases and 204 matched controls subjects. The polymorphisms were identified by a classical and a real-time PCR. Results. The AGT 235M/T and AT1R 1166A/C polymorphisms were not associated with the hypertension while the genotype frequencies of the ACE I/D polymorphism between patients and controls (DD: 66.83% and 35.78%, ID: 28.22% and 50.98%, II: 4.95% and 13.24%, resp.) were significantly different (p < 10−4). The genotype DD of ACE gene (OR = 3.40, p < 0.0001), the increasing age (OR = 3.83, p < 0.0001), obesity (OR = 4.84, p < 0.0001), dyslipidemia (OR = 3.43, p = 0.021), and alcohol intake (OR = 2.76, p < 0.0001) were identified as the independent risk factors for hypertension by multinomial logistic regression. Conclusion. The DD genotype of the ACE gene is involved in susceptibility to hypertension. Further investigations are needed to better monitor and provide individualized care for hypertensive patients. Daméhan Tchelougou, Jonas K. Kologo, Simplice D. Karou, Valentin N. Yaméogo, Cyrille Bisseye, Florencia W. Djigma, Djeneba Ouermi, Tegwindé R. Compaoré, Maléki Assih, Virginio Pietra, Patrice Zabsonré, and Jacques Simpore Copyright © 2015 Daméhan Tchelougou et al. All rights reserved. Preeclampsia Is Associated with Increased Central Aortic Pressure, Elastic Arteries Stiffness and Wave Reflections, and Resting and Recruitable Endothelial Dysfunction Thu, 13 Aug 2015 12:11:25 +0000 Introduction. An altered endothelial function (EF) could be associated with preeclampsia (PE). However, more specific and complementary analyses are required to confirm this topic. Flow-mediated dilation (FMD), low-flow-mediated constriction (L-FMC), and hyperemic-related changes in carotid-radial pulse wave velocity (PWVcr) offer complementary information about “recruitability” of EF. Objectives. To evaluate, in healthy and hypertensive pregnant women (with and without PE), central arterial parameters in conjunction with “basal and recruitable” EF. Methods. Nonhypertensive (HP) and hypertensive pregnant women (gestational hypertension, GH; preeclampsia, PE) were included. Aortic blood pressure (BP), wave reflection parameters (AIx@75), aortic pulse wave velocity (PWVcf) and PWVcr, and brachial and common carotid stiffness and intima-media thickness were measured. Brachial FMD and L-FMC and hyperemic-related change in PWVcr were measured. Results. Aortic BP and AIx@75 were elevated in PE. PE showed stiffer elastic but not muscular arteries. After cuff deflation, PWVcr decreased in HP, while GH showed a blunted PWVcr response and PE showed a tendency to increase. Maximal FMD and L-FMC were observed in HP followed by GH; PE did not reach significant arterial constriction. Conclusion. Aortic BP and wave reflections as well as elastic arteries stiffness are increased in PE. PE showed both “resting and recruitable” endothelial dysfunctions. Juan Torrado, Ignacio Farro, Yanina Zócalo, Federico Farro, Claudio Sosa, Santiago Scasso, Justo Alonso, and Daniel Bia Copyright © 2015 Juan Torrado et al. All rights reserved. Blood Pressure Response to Zofenopril or Irbesartan Each Combined with Hydrochlorothiazide in High-Risk Hypertensives Uncontrolled by Monotherapy: A Randomized, Double-Blind, Controlled, Parallel Group, Noninferiority Trial Wed, 05 Aug 2015 15:21:08 +0000 In this randomized, double-blind, controlled, parallel group study (ZENITH), 434 essential hypertensives with additional cardiovascular risk factors, uncontrolled by a previous monotherapy, were treated for 18 weeks with zofenopril 30 or 60 mg plus hydrochlorothiazide (HCTZ) 12.5 mg or irbesartan 150 or 300 mg plus HCTZ. Rate of office blood pressure (BP) response (zofenopril: 68% versus irbesartan: 70%; ) and 24-hour BP response (zofenopril: 85% versus irbesartan: 84%; ) was similar between the two treatment groups. Cardiac and renal damage was equally reduced by both treatments, whereas the rate of carotid plaque regression was significantly larger with zofenopril. In conclusion, uncontrolled monotherapy treated hypertensives effectively respond to a combination of zofenopril or irbesartan plus a thiazide diuretic, in terms of either BP response or target organ damage progression. Ettore Malacco, Stefano Omboni, and Gianfranco Parati Copyright © 2015 Ettore Malacco et al. All rights reserved.