International Journal of Hypertension The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Review of and Updates on Hypertension in Obstructive Sleep Apnea Sun, 24 Sep 2017 00:00:00 +0000 Obstructive sleep apnea (OSA) is a prevalent sleep disorder as is hypertension (HTN) in the 21st century with the rising incidence of obesity. Numerous studies have shown a strong association of OSA with cardiovascular morbidity and mortality. There is overwhelming evidence supporting the relationship between OSA and hypertension (HTN). The pathophysiology of HTN in OSA is complex and dependent on various factors such as sympathetic tone, renin-angiotensin-aldosterone system, endothelial dysfunction, and altered baroreceptor reflexes. The treatment of OSA is multifactorial ranging from CPAP to oral appliances to lifestyle modifications to antihypertensive drugs. OSA and HTN both need prompt diagnosis and treatment to help address the growing cardiovascular morbidity and mortality due to these two entities. Masood Ahmad, Devan Makati, and Sana Akbar Copyright © 2017 Masood Ahmad et al. All rights reserved. Comparison between Central and Brachial Blood Pressure in Hypertensive Elderly Women and Men Wed, 20 Sep 2017 06:33:40 +0000 Aim. To compare the values of central and brachial systemic blood pressure (SBP) between women and men over 60 years of age with systemic arterial hypertension. Methods. This study was a quantitative, descriptive, cross-sectional study with elderly patients admitted to and selected from spontaneous and scheduled demand at basic health units in Uberlândia, Minas Gerais, Brazil, between March 2013 and March 2014. We included 69 study participants and compared central and brachial SBP using a Sphygmocor® XCEL device (AtCor Medical, Sydney, Australia). Results. Significant differences were found in the blood pressure values of the whole population in the central versus brachial systolic blood pressure (SP) [140(21) versus 153(23) mmHg] and in the central versus brachial pulse pressure (PP) [55(18) versus 70(18) mmHg]. Additionally, females exhibited higher blood pressure levels than males [central SP 144(23) versus 134(16) mmHg and brachial SP 161(26) versus 148(18) mmHg and central PP 62(17) versus 45(14) mmHg and brachial PP 80(21) versus 63(15) mmHg, resp.]. Conclusion. Elderly women exhibited higher blood pressure values than elderly hypertensive men. Bruno Bordin Pelazza and Sebastião Rodrigues Ferreira Filho Copyright © 2017 Bruno Bordin Pelazza and Sebastião Rodrigues Ferreira Filho. All rights reserved. The Effects of Socioeconomic Determinants on Hypertension in a Cardiometabolic At-Risk European Country Mon, 28 Aug 2017 06:32:41 +0000 Background. A relationship has been established between socioeconomic status and hypertension. The aim of this study was to determine the prevalence of hypertension and to explore the links between hypertension and socioeconomic factors in the adult population of Malta. Methods. A national representative cross-sectional health examination study was performed between 2014 and 2016. Sociodemographic and medical history data was gathered by validated questionnaires while blood pressure was measured. Prevalence rates of known hypertension, newly hypertension, and global hypertension were calculated. Associations between sociodemographic characteristics and hypertension were identified through logistic regression models. Results. Hypertension contributed to 30.12% (CI 95%: 28.71–31.57) of the study population, with a male preponderance. The majority was known hypertensive (73.59% CI 95%: 71.01–76.02), with only three-quarters on medication. Multivariant analyses showed that increasing age and body mass index, male gender, and living in Gozo, Western district, and Northern Harbour district were associated with having hypertension. Conclusion. Hypertension is a problem in Malta especially in the male population and with increasing age and body mass index. Education did not exhibit any associated risk for having hypertension, which is inconsistent with the literature, while habitat localities played a role in hypertension development. Sarah Cuschieri, Josanne Vassallo, Neville Calleja, Nikolai Pace, and Julian Mamo Copyright © 2017 Sarah Cuschieri et al. All rights reserved. Predictors of Hypertension in a Population of Undergraduate Students in Sierra Leone Thu, 03 Aug 2017 09:41:03 +0000 We report on the first survey of hypertension in undergraduates in Sierra Leone. Levels of hypertension (12%) and obesity (4%) appear low compared to the general population but given the rapid increase of both and the expectation that many graduates will enter the formal employment sector and a sedentary lifestyle, there is still cause for concern. We measured their BMI (body mass index) and used a questionnaire to investigate demographic and lifestyle choices. In agreement with most authorities, we found that BMI and age were statistically significant predictors of systolic and diastolic blood pressure but that the explanatory power was low ( to 0.27). Men may be more sensitive than women to an increase in BMI on blood pressure (). We failed to find statistically significant relationships with ethnicity, religion, stress, course of study, levels of physical activity, diet, smoking, or consumption of caffeine and alcohol. Family history of hypertension, consumption of red palm oil, and self-diagnosed attacks of typhoid fever were close to conventional levels of significance (). We intend to use this as a baseline for longitudinal studies to assess risks and suggest appropriate public health action. Aiah Lebbie, Richard Wadsworth, Janette Saidu, and Camilla Bangura Copyright © 2017 Aiah Lebbie et al. All rights reserved. Nebivolol Attenuates Neutrophil Lymphocyte Ratio: A Marker of Subclinical Inflammation in Hypertensive Patients Thu, 27 Jul 2017 00:00:00 +0000 Background. High value of neutrophil lymphocyte ratio (NLR) is a strong independent predictor and biomarker of ongoing vascular inflammation in various cardiovascular disorders. Objective. The main focus of the study is to investigate the effect of nebivolol on NLR in mild to moderate hypertensive patients in comparison with metoprolol. In addition, BMI, blood pressure, TLC count, blood sugar, and lipid profile were also assayed before and after treatment. Materials and Methods. In this 12-week prospective double-blinded randomized study, 120 patients with mild to moderate hypertension were randomly divided into two groups to prescribed daily dose of tab nebivolol 5–10 mg and metoprolol 50–100 mg, respectively, for 12 weeks. The data were analyzed using SPSS 16 software. Results. A total of 100 patients completed the study. Both drugs lowered blood pressure significantly, nebivolol 20.5/10.5 and metoprolol 22.5/11.2 from baseline. Regarding inflammation, nebivolol reduced total leukocyte count and neutrophil count and increased lymphocyte count as compared to metoprolol. Similarly, nebivolol but not metoprolol significantly reduced NLR ratio . Nebivolol improved lipid profile and blood sugar compared to metoprolol, but values were nonsignificant. Conclusion. Nebivolol has a strong impact on reducing NLR, a marker of subclinical inflammation in hypertensive patients. Moreover NLR can be used as a disease and drug monitoring tool in these patients. Mazhar Hussain, Muhammad Saeed, Muhammad Zafar Majeed Babar, Moazzam Ali Atif, and Lubna Akhtar Copyright © 2017 Mazhar Hussain et al. All rights reserved. Hypertension Management in Brazil: Usual Practice in Primary Care—A Meta-Analysis Sun, 02 Jul 2017 00:00:00 +0000 Knowing the usual clinical practice is relevant for evaluations in health care and economic policies of management of hypertension. This study aimed to describe the usual management of hypertension in the Brazilian primary healthcare system through a systematic review and meta-analysis. The search of population-based studies conducted in Brazil was undertaken using PubMed, EMBASE, and Brazilian databases. Eligible studies were those conducted in adults with hypertension (blood pressure (BP) ≥ 140/90 mmHg or using BP lowering drugs). Three datasets’ data were analyzed: SESI study (in Brazilian workers); HIPERDIA (Brazilian Registration and Monitoring of Hypertensive and Diabetic Patients Program); and a population-based study. Meta-analysis has been performed using the fixed and random effect models. A total of 11 studies or data sets were included in the systematic review. Hypertensive individuals had, on average, 2.6 medical visits annually and 18.2% were on diuretics ( hypertensive patients) and 16.2% on ACE inhibitors ( hypertensive patients). BP control rate ranged from 43.7 to 67.5%; 35.5% had measured total cholesterol and 36.5% determined fasting plasma glucose in the previous 12 months. Thiazide diuretics and ACE inhibitors were the most used BP lowering medications as single drugs, but the control rate of hypertension is insufficient. Rafael V. Picon, Juvenal S. Dias-da-Costa, Flavio D. Fuchs, Maria Teresa A. Olinto, Niteesh K. Choudhry, and Sandra C. Fuchs Copyright © 2017 Rafael V. Picon et al. All rights reserved. Target Organ Damage and the Long Term Effect of Nonadherence to Clinical Practice Guidelines in Patients with Hypertension: A Retrospective Cohort Study Tue, 13 Jun 2017 06:35:51 +0000 Background. There was limited published data on target organ damage (TOD) and the effect of nonadherence to practice guidelines in Ethiopia. This study determined TOD and the long term effect of nonadherence to clinical guidelines on hypertensive patients. Methods. An open level retrospective cohort study has been employed at cardiac clinic of Gondar university hospital for a mean follow-up period of 78 months. Multivariate Cox regression was conducted to test associating factors of TOD. Results. Of the total number of 612 patients examined, the overall prevalence of hypertensive TOD was 40.3%. The presence of comorbidities, COR = 1.073 [1.01–1.437], AOR = 1.196 [1.174–1.637], and nonadherence to clinical practice guidelines, COR = 1.537 [1.167–2.024], AOR = 1.636 [1.189–2.251], were found to be predicting factors for TOD. According to Kaplan-Meier analysis patients who were initiated on appropriate medication tended to develop TOD very late: Log Rank [11.975 ()]. Conclusion. More than forty percent of patients acquired TOD which is more significant. Presence of comorbidities and nonadherence to practice guidelines were correlated with the incidence of TOD. Appropriate management of hypertension and modification of triggering factors are essential to prevent complications. Tadesse Melaku Abegaz, Yonas Getaye Tefera, and Tamrat Befekadu Abebe Copyright © 2017 Tadesse Melaku Abegaz et al. All rights reserved. Herbal and Alternative Medicine Use in Tanzanian Adults Admitted with Hypertension-Related Diseases: A Mixed-Methods Study Sun, 28 May 2017 00:00:00 +0000 Background. Hypertension is increasingly common in sub-Saharan Africa where traditional medicine use is also common. We conducted a hospital-based, mixed-methods study to determine prevalence, pattern, and correlates of herbal and alternative medicine use in Tanzanian adults hospitalized with hypertension. Methods. A standardized questionnaire was administered. In-depth interviews were performed on a subset of participants. Factors associated with herbal medicine use were determined by logistic regression. The association between traditional medicine uses and allopathic medication adherence was determined using ordinal logistic regression. Qualitative data were analyzed according to grounded theory. Results. Of 213 adults enrolled, 52 (24.4%) reported using herbs during the previous month and 47 (22.1%) reported concurrent use of herbs and allopathic medicines. Lower educational level, nonprofessional employment, and lack of health insurance were significantly associated with herbal medicine use. Alternative medicines use was not associated with lower medication adherence. Qualitative interviews identified several important themes including reasons for herbal medicine use. Conclusion. The use of traditional medicines is very common among patients with hypertension. Adults from low socioeconomic status, those with misunderstandings about hypertension, and those without health insurance were more likely to take herbs. Open, nonjudgmental communication between healthcare workers and patients regarding use of traditional medicines must be encouraged in Africa. Anthony Liwa, Rebecca Roediger, Hyasinta Jaka, Amina Bougaila, Luke Smart, Stacey Langwick, and Robert Peck Copyright © 2017 Anthony Liwa et al. All rights reserved. Brain Oscillations Elicited by the Cold Pressor Test: A Putative Index of Untreated Essential Hypertension Tue, 09 May 2017 00:00:00 +0000 Objective. Essential hypertension is associated with reduced pain sensitivity of unclear aetiology. This study explores this issue using the Cold Pressor Test (CPT), a reliable pain/stress model, comparing CPT-related EEG activity in first episode hypertensives and controls. Method. 22 untreated hypertensives and 18 matched normotensives underwent 24-hour ambulatory blood pressure monitoring (ABPM). EEG recordings were taken before, during, and after CPT exposure. Results. Significant group differences in CPT-induced EEG oscillations were covaried with the most robust cardiovascular differentiators by means of a Canonical Analysis. Positive correlations were noted between ABPM variables and Delta (1–4 Hz) oscillations during the tolerance phase; in high-alpha (10–12 Hz) oscillations during the stress unit and posttest phase; and in low-alpha (8–10 Hz) oscillations during CPT phases overall. Negative correlations were found between ABPM variables and Beta2 oscillations (16.5–20 Hz) during the posttest phase and Gamma (28.5–45 Hz) oscillations during the CPT phases overall. These relationships were localised at several sites across the cerebral hemispheres with predominance in the right hemisphere and left frontal lobe. Conclusions. These findings provide a starting point for increasing our understanding of the complex relationships between cerebral activation and cardiovascular functioning involved in regulating blood pressure changes. Christos Papageorgiou, Efstathios Manios, Eleftheria Tsaltas, Eleni Koroboki, Maria Alevizaki, Elias Angelopoulos, Meletios-Athanasios Dimopoulos, Charalabos Papageorgiou, and Nikolaos Zakopoulos Copyright © 2017 Christos Papageorgiou et al. All rights reserved. Prevalence, Awareness, Treatment, and Control of Hypertension among Chinese First-Generation Migrants and Italians in Prato, Italy: The CHIP Study Thu, 13 Apr 2017 00:00:00 +0000 Data on health needs of Chinese living in the South of Europe are lacking. To compare prevalence, awareness, treatment, control, and risk factors for hypertension between Chinese migrants and Italian adults, a sample of 1200 first-generation Chinese migrants and 291 native Italians aged 35–59 years living in Prato (Italy) was recruited in a community-based participatory cross-sectional survey. Primary outcome measure was hypertension, diagnosed for blood pressure values ≥ 140/90 mmHg or current use of antihypertensive medications. Associations with exposures (including age, gender, body mass index, waist, education level, total cholesterol, and triglycerides) were examined using logistic regression. When compared with Italians, Chinese had higher hypertension prevalence (27.2% versus 21.3%, ), with comparable levels of awareness (57.4% and 48.4%) but lower treatment rates (70.6% and 90.0%, resp.). In both ethnic groups age and parental history of hypertension were predictors of awareness and treatment, body mass index being predictor of hypertension diagnosis. In Chinese participants, where the optimum cut-off point for body mass index was ≥23.9 kg/m2, the sensibility and specificity prediction for hypertension were 61.7% and 59.8%, respectively (area under the ROC curve = 0.629). Implementation of specific, culturally adapted health programs for the Chinese community is now needed. Pietro A. Modesti, Maria Calabrese, Ilaria Marzotti, Hushao Bing, Danilo Malandrino, Maria Boddi, Sergio Castellani, and Dong Zhao Copyright © 2017 Pietro A. Modesti et al. All rights reserved. Excess of Aminopeptidase A in the Brain Elevates Blood Pressure via the Angiotensin II Type 1 and Bradykinin B2 Receptors without Dipsogenic Effect Wed, 22 Mar 2017 00:00:00 +0000 Aminopeptidase A (APA) cleaves angiotensin (Ang) II, kallidin, and other related peptides. In the brain, it activates the renin angiotensin system and causes hypertension. Limited data are available on the dipsogenic effect of APA and pressor effect of degraded peptides of APA such as bradykinin. Wistar-Kyoto rats received intracerebroventricular (icv) APA in a conscious, unrestrained state after pretreatment with (i) vehicle, (ii) 80 g of telmisartan, an Ang II type-1 (AT1) receptor blocker, (iii) 800 nmol of amastatin, an aminopeptidase inhibitor, and (iv) 1 nmol of HOE-140, a bradykinin B2 receptor blocker. Icv administration of 400 and 800 ng of APA increased blood pressure by 12.6 ± 3.0 and 19.0 ± 3.1 mmHg, respectively. APA did not evoke drinking behavior. Pressor response to APA was attenuated on pretreatment with telmisartan (vehicle: 22.1 ± 2.2 mmHg versus telmisartan: 10.4 ± 3.2 mmHg). Pressor response to APA was also attenuated with amastatin and HOE-140 (vehicle: 26.5 ± 1.1 mmHg, amastatin: 14.4 ± 4.2 mmHg, HOE-140: 16.4 ± 2.2 mmHg). In conclusion, APA increase in the brain evokes a pressor response via enzymatic activity without dipsogenic effect. AT1 receptors and B2 receptors in the brain may contribute to the APA-induced pressor response. Takuto Nakamura, Masanobu Yamazato, Akio Ishida, and Yusuke Ohya Copyright © 2017 Takuto Nakamura et al. All rights reserved. Burden of Hypertension in the Capital of Afghanistan: A Cross-Sectional Study in Kabul City, 2015 Tue, 03 Jan 2017 10:40:36 +0000 Background. This study had the objective to assess the prevalence and associated factors of hypertension in an urban setting, Kabul city, Afghanistan. Materials and Methods. The World Health Organization’s STEP-wise approach was adopted and used in Kabul in November 2015. The study analyzed a sample of 1172 adults in the age group of 25–70 years. Demographic, socioeconomic, and behavior data were collected using a structured questionnaire. Fasting venous blood sample was collected to assess the lipid profile and fasting blood sugar. Results. The study showed that the prevalence of hypertension among adult Kabul citizens was 32.3%. From this figure, 599 (51.1%) were females and 573 (48.9%) males with a mean age of years. Illiteracy rate was 49.6% and 77.5% were married. Smoking in adults were 8.1% and mouth snuff users were 9.8%. More than half (57.6%) of the study respondents were overweight and obese and 9.1% were recorded having raised blood sugar. In the multivariate logistic regression analysis, age, general obesity, central obesity, smoking, moderate physical activity, and taking fruits 3 days or less weekly were statistically significant predictors of hypertension. Conclusions. Burden of hypertension is increasing in main urban settings in Afghanistan. Integrated intervention focusing in main modifiable risk factors is needed to detect and prevent hypertension. Khwaja Mir Islam Saeed Copyright © 2017 Khwaja Mir Islam Saeed. All rights reserved. Renal Urotensin II System Plays Roles in the Regulation of Blood Pressure in Dahl Salt-Resistant Rat Mon, 19 Dec 2016 13:52:13 +0000 Introduction. Dahl salt-resistant (SR) animal models are similar to peritoneal dialysis patients with fluid volumes overload with normal blood pressure in hemodynamic profiles. We will verify the roles of UII in the regulation of blood pressure in these animal models. Methodology. The Dahl salt-sensitive (SS) and SR rats and UII receptor gene knocked out (KO) mice were placed on a high-salt diet. Renal tissues were performed for the expression of UII in Dahl groups. Results. After high-salt diet for 6 weeks, the systolic blood pressure (SBP) in SR group was significantly lower, accompanied with higher urinary UII levels, higher 24-hour urinary sodium excretion, and higher urinary creatinine clearance in the SR rats in comparison to SS group. The expressions of UII and UT were both upregulated in the kidney tissues of SR group in comparison to SS group (). After high-salt diet for 8 weeks, the SBP of the KO group is significantly higher than that of the wild type group. Conclusion. We first demonstrate that renal UII system can play important roles in the regulation of blood pressure in Dahl SR rats which can be highly correlated to its effect on renal tubular sodium absorption. Fei Wu, Guanjong Chen, Aihua Zhang, Yang Yu, Minhua Fan, and Chaoshu Tang Copyright © 2016 Fei Wu et al. All rights reserved. A Community-Based Assessment of Hypertension and Some Other Cardiovascular Disease Risk Factors in Ngaoundéré, Cameroon Wed, 14 Dec 2016 13:43:26 +0000 Background and Objective. Cardiovascular diseases are primary causes of death worldwide with well documented risk factors whose varying impacts added to the complexity in CVD management dictate the need for region-specific studies. We aimed at investigating the interactions between CVD risk factors and hypertension in Ngaoundéré. Methods. A cross-sectional survey was carried out from March to August 2014. Sociodemographic, fasting blood glucose, blood pressure, and anthropometric data were recorded. Statistical analyses were carried out using SAS software version 9.1. Results. 700 adults resident in Ngaoundéré for at least two years consented and were included in the survey. Abdominal obesity, physical inactivity, and hypertension were the dominant risk factors recording 51.1%, 35.4%, and 20.4%, respectively. The prevalence of hyperglycaemia, tobacco consumption, obesity, and alcohol consumption was 5.6%, 8.3%, 9.6%, and 18.1%, respectively. Advanced age, hyperglycaemia, a divorced marital status, and alcohol consumption were independent determinants of high blood pressure. Conclusion. Physical inactivity, abdominal obesity, and hypertension were the most prevalent CVD risk factors, and the role of advanced age and hyperglycaemia in the occurrence of high blood pressure was reiterated. Health programs need to focus on effective screening, prevention, and control of CVDs in the Adamawa Region and Cameroon at large. Olivier Pancha Mbouemboue, Diana Derew, Jacques Olivier Ngoufack Tsougmo, and Marcel Tangyi Tamanji Copyright © 2016 Olivier Pancha Mbouemboue et al. All rights reserved. Hypertension, an Emerging Problem in Rural Cameroon: Prevalence, Risk Factors, and Control Thu, 08 Dec 2016 11:27:30 +0000 Background. Despite the increasing trends suggesting that hypertension is a growing public health problem in developing countries, studies on its prevalence, associated risk factors, and extent of blood pressure control have been inequitably done in urban and rural communities in these countries. We therefore aimed to determine the prevalence of hypertension and extent of blood pressure control in rural Cameroon. Methods. This was a community-based cross-sectional study conducted in rural Cameroon (the Moliwe Health Area). Participants aged 21 years and above were recruited by a probability proportional to size multistage sampling method, using systematic sampling for household selection and random sampling for participant selection. Blood pressure, weight, and height were measured by standard methods. Hypertension was defined as BP ≥ 140/90 mmHg. Results. The prevalence of hypertension among the 733 participants recruited was 31.1% (95% CI: 27.8–34.6) and 71% (95% CI: 58.7–81.7) of these hypertensive patients were newly diagnosed. Only 21.2% (95% CI: 12.1–33.3) of known hypertensives had a well controlled BP. Age, obesity, low educational status, and being married were associated with HTN after adjusting for confounders. Conclusions. The high prevalence of hypertension and inadequate BP control among known hypertensives in rural Cameroon warrants greater sensitization and regular screening to reduce hypertension-related morbidity and mortality. Walters Tabi Arrey, Christian Akem Dimala, Julius Atashili, Josephine Mbuagbaw, and Gottlieb Lobe Monekosso Copyright © 2016 Walters Tabi Arrey et al. All rights reserved. Changes in Blood Pressure Levels and Antihypertensive Medication Use before and after Renal Transplantation among Patients in Nairobi, Kenya: A Comparative Cross-Sectional Study Wed, 07 Dec 2016 10:11:53 +0000 Objectives. To determine the changes in blood pressure levels and antihypertensive medication use in the postrenal transplantation period compared to pretransplantation one. Methods. A comparative cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital, a national referral hospital in Kenya. Sociodemographic details, blood pressure levels, and antihypertensive medication use before and after renal transplantation were noted. Changes in mean blood pressure levels and mean number of antihypertensive medications after renal transplantation were determined using paired -test. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Compared to the pretransplant period, significantly lower mean systolic and diastolic blood pressure levels after transplantation were noted (mean SBP 144.5 mmHg versus 131.8 mmHg; mean DBP 103.6 mmHg versus 83.5 mmHg in the pre- and posttransplant periods, respectively, ). Mean number of antihypertensive medications also reduced significantly after transplantation, with an average of 3.3 (±1.6) versus 2.1 (±0.9) in the pre- and posttransplant periods, respectively (). Conclusion. There is a significant reduction in blood pressure levels and number of antihypertensive medications used after renal transplantation. The positive impact of renal transplantation on blood pressure control should be confirmed using prospective cohort studies of patients with end stage renal disease who then undergo renal transplantation. Mary N. Kubo, Joshua K. Kayima, Anthony J. Were, Mohammed S. Ezzi, Seth O. McLigeyo, and Elijah N. Ogola Copyright © 2016 Mary N. Kubo et al. All rights reserved. Awareness, Treatment, and Control of Hypertension in Primary Health Care and Secondary Referral Medical Outpatient Clinic Settings at Enugu, Southeast Nigeria Tue, 06 Dec 2016 12:30:59 +0000 Essential hypertension is the most common noncommunicable disease (NCD), affecting more than half the adult population in many countries and being the major NCD contributor to the double burden of disease in developing countries. We undertook a survey of the hypertension awareness, treatment, and control in primary and secondary referral health care clinics in Enugu, Nigeria, and compared these data with those obtained in local community surveys. The prevalence of hypertension in the primary care clinic (9.2%) was lower than in a previously reported community survey (42.2%), while, in the referral clinic, 70.3% of patients attending were hypertensive. Hypertension awareness rates were 91.9%, 29.4%, and 93.2% in these respective health care settings. Treatment and control rates (89.9% and 72.9%) were better in the secondary care clinic than in the primary care centre (87.7% and 46.0%). (Chi-square analysis confirmed statistically significant differences between these rates ().) These data may form a useful index of health care system effectiveness in Nigeria. Possible reasons for the differences observed and effective strategies to address the waxing pandemic of hypertension are discussed. Chioli Chijioke, Raphael Anakwue, Teddy Okolo, Esther Ekwe, Chukwuemeka Eze, Charles Agunyenwa, Nnamdi Nwosu, Christopher Amah, Kenneth Nwadike, and Udunma Chijioke Copyright © 2016 Chioli Chijioke et al. All rights reserved. The Hypertension of Hemophilia Is Not Explained by the Usual Cardiovascular Risk Factors: Results of a Cohort Study Mon, 14 Nov 2016 13:47:45 +0000 Background. The etiology of the high prevalence of hypertension among patients with hemophilia (PWH) remains unknown. Methods. We compared 469 PWH in the United States with males from the National Health and Nutrition Examination Survey (NHANES) to determine whether differences in cardiovascular risk factors can account for the hypertension in hemophilia. Results. Median systolic and diastolic BP were higher in PWH than NHANES () for subjects not taking antihypertensives. Those taking antihypertensives showed similar differences. Differences in both systolic and diastolic BP were especially marked among adults <30 years old. Differences between PWH and NHANES persisted after adjusting for age and risk factors (body mass index, renal function, cholesterol, smoking, diabetes, Hepatitis C, and race). Conclusions. Systolic and diastolic BP are higher in PWH than in the general male population and especially among PWH < 30 years old. The usual cardiovascular risk factors do not account for the etiology of the higher prevalence of hypertension in hemophilia. New investigations into the missing link between hemophilia and hypertension should include age of onset of hypertension and hemophilia-specific morbidities such as the role of inflammatory joint disease. Richard F. W. Barnes, Thomas J. Cramer, Afrah S. Sait, Rebecca Kruse-Jarres, Doris V. K. Quon, and Annette von Drygalski Copyright © 2016 Richard F. W. Barnes et al. All rights reserved. Prevalence of Hypertension and Its Associated Risk Factors among 34,111 HAART Naïve HIV-Infected Adults in Dar es Salaam, Tanzania Sun, 30 Oct 2016 12:12:28 +0000 Background. Elevated blood pressure has been reported among treatment naïve HIV-infected patients. We investigated prevalence of hypertension and its associated risk factors in a HAART naïve HIV-infected population in Dar es Salaam, Tanzania. Methods. A cross-sectional analysis was conducted among HAART naïve HIV-infected patients. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg. Overweight and obesity were defined as body mass index (BMI) between 25.0–29.9 kg/m2 and ≥30 kg/m2, respectively. We used relative risks to examine factors associated with hypertension. Results. Prevalence of hypertension was found to be 12.5%. After adjusting for possible confounders, risk of hypertension was 10% more in male than female patients. Patients aged ≥50 years had more than 2-fold increased risk for hypertension compared to 30–39-years-old patients. Overweight and obesity were associated with 51% and 94% increased risk for hypertension compared to normal weight patients. Low CD4+ T-cell count, advanced WHO clinical disease stage, and history of TB were associated with 10%, 42%, and 14% decreased risk for hypertension. Conclusions. Older age, male gender, and overweight/obesity were associated with hypertension. Immune suppression and history of TB were associated with lower risk for hypertension. HIV treatment programs should screen and manage hypertension even in HAART naïve individuals. Marina Njelekela, Alfa Muhihi, Akum Aveika, Donna Spiegelman, Claudia Hawkins, Catharina Armstrong, Enju Liu, James Okuma, Guerino Chalamila, Sylvia Kaaya, Ferdinand Mugusi, and Wafaie Fawzi Copyright © 2016 Marina Njelekela et al. All rights reserved. Safety and Antihypertensive Effect of Selara® (Eplerenone): Results from a Postmarketing Surveillance in Japan Mon, 24 Oct 2016 11:00:59 +0000 Prospective postmarketing surveillance of Selara (eplerenone), a selective mineralocorticoid receptor antagonist, was performed to confirm its safety and efficacy for hypertension treatment in Japan. The change in blood pressure after initiation of eplerenone treatment was also examined. Patients with essential hypertension who were eplerenone-naïve were recruited regardless of the use of other antihypertensive drugs. For examination of changes in blood pressure, patients were excluded if eplerenone was contraindicated or used off-label. Patients received 50–100 mg of eplerenone once daily and were observed for 12 weeks. No treatments including antihypertensive drugs were restricted during the surveillance period. Across Japan, 3,166 patients were included for safety analysis. The incidence of adverse drug reactions was 2.4%. The major adverse drug reactions observed were hyperkalemia (0.6%), dizziness, renal impairment, and increased serum potassium (0.2% each). The mean systolic blood pressure decreased from  mmHg to  mmHg at week 12, and the mean diastolic blood pressure decreased from  mmHg to  mmHg. There were no significant new findings regarding the type or incidence of adverse reactions, and eplerenone had a clinically significant antihypertensive effect, leading to favorable blood pressure control. Shoko Takahashi, Megumi Hiramatsu, Shinichi Hotta, Yukie Watanabe, Osamu Suga, Yutaka Endo, and Isamu Miyamori Copyright © 2016 Shoko Takahashi et al. 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.