Risk Factors of Hypertension in Low- and Middle-income Countries: A Prompt Portray

Advances in Human Biology, Journal Year: 2024, Volume and Issue: unknown

Published: May 25, 2024

The World Health Organization (WHO) defined hypertension, correspondingly recognised as elevated or upraised blood pressure (BP), an ailment in which the vessels have persistently raised to 140/90 mmHg grander.[1,2] WHO appraised globally that 1.28 billion adults aged 30–79 years are suffering from and majority (two-thirds) of them breathe low- middle-income countries (LMICs).[2] Mills et al., 2000, reported pervasiveness high BP amongst was sky-high LMICs (31.5%, 1.04 people) than high-income (28.5%, 349 million people).[3] It has been estimated 8.5 people died because hypertension related issues 2015, these fatal cases, 88% individuals LMICs.[4] alarming issue is around 46% hypertensive subjects not cognizant they disease.[2] Only 42% diagnosed receive pharmacological intervention.[2] In addition, recent years, upper trend primary observed paediatric age group, particularly adolescents.[5-8] According American Heart Association, overall prevalence children 2%–5%, obesity, along with lack physical activity, dominant determinant for development hypertension,[9] this may lead end-organ damage like adults.[10] 'People poor tend less access health services those better-off countries, within services'.[11] Cabieses Bird mounting substantiation on ingress healthcare LMICs, confesses unfairness utilising public management systems. These inequalities exist both amidst within, most marginalised communities facing maximum hurdles way healthcare.[12] After that, humanising currently considered a global issue.[13,14] Schutte 2021, times, patients considerably LMICs. only 33.33% aware their disease, approximately 8% controlled proper therapeutic intervention.[15] Essential topmost principal element menace ischaemic heart additional cardiovascular diseases (CVDs), cerebrovascular accident, chronic renal impairment, major neurocognitive disorder, mild cognitive disorder neurological diseases.[16-21] Multiple studies foremost avertable basis CVD-related death disease encumbrance.[3,22-24] Assembly 2013 planned reduce by 25% 2025 2010.[3,25-27] elements raise possibility [Figure 1].[28] Some features adjustable,[29,30] other probability aspects, example, increasing age,[31] race ethnicity,[32] ancestral tree,[33] transmitted heritable[34] sex,[35-37] cannot be altered.[28] Lifestyle determined factor modifiable risk hypertension.[38] National Institute Care Excellence identified four amendable lifestyle increase developing hypertension.[39] Those factors 'regular aerobic exercise reduction salt, alcohol smoking'.[39] Other minimisation overweight consistent control restraint drinking implementation dietary approaches stop (DASH) style food regimen comprising restricted Na + salt consumption possess beneficial effects subjects.[40-42]Figure 1: multiple blood. This figure drawn premium version BioRender (https://biorender.com/. Accessed 12 April 2024) agreement license number NY26OU012D. Image credit: Rahnuma Ahmad.Individuals gaining excess weight, especially visceral adiposity, substantial cause hypertension. 65%–78% essential concurrently obesity (as weird extreme fat accumulation).[43-45] Overweight strongly related, but also cardiovascular,[46] kidney diseases,[47,48] metabolic[49,50] carcinoma[51] precipitously befitted leading worldwide risk.[52-54] conducted diverse populations almost every part globe association between body mass index (BMI) (>30 kg/m2) virtually linear.[55-58] Mayo Clinic routine activity continues help maintain weight management. Slimming down well-known approach Even dropping 2.3 kilograms 5 pounds takes hypertension.[59,60] advised do 2½–5 h 1¼–2½ moderate vigorous per week.[61] One more study recommended distressed motivated involved practice, swimming, jogging walking, at least 30–45 min day.[62] Whichever action escalates, respiratory rates cogitated activity.[59,60] Hegde Solomon, such diet sedentary (deskbound job) triggering develop causing considerable morbidity, mortality burden.[61] showed regular lowers cardiac remodelling.[63] Diet factors.[64] Increased reduces peripheral arterial resistance, possibly neurohormonal structural responses decreased adrenergic increases diameter lumen.[65] Green 2017, improves flow cuts back vascular wall tension, luminal stress pressure.[66] changes convert width stiffness. physiology restored, coronary mesenteric arteries.[66,67] Aerobic inhibits reactive oxidative pro-inflammatory signals. Consequently, inflammatory effect curtailed.[68] Accordingly, it endothelial physiology,[69,70] parasympathetic activity[71] function.[72] BMI,[73,74] renin–angiotensin system activity,[75,76] insulin resistance[76-79] finally enhances compliance 2].[80,81] advocated non-pharmacological strategies, DASH manage hypertension.[82-86]Figure 2: various mechanisms aids normal. 14 IT26P57 LH5. Ahmad. ROS: Reactive oxygen species.Various research invariably shows implications excessive hypertension.[87,88] Nonetheless, mode regarding alcohol-induced still well explained.[87] Alcohol sequel, raises rate, output systolic diastolic BP.[87,89,90] Minimisation intake first strategy BP.[87,91,92] one avert long-lasting hypertension.[87,93,94] rate cases events[95] metabolic syndrome (MetS).[96] Raised envisioned imperative constituent MetS.[96-98] Over 85% MetS, even non-existence diabetes mellitus, hypertension.[99] Control decreases MetS-associated morbidity mortality.[100] Therefore, should through pharmacological[101,102] intervention strategies equal importance.[82,103-105]Figure 3 illustrates findings editorial.Figure 3: critical study. XX26OTQZ2 L. WHO: Organization, LMICs: Low- BMI: Body index, CVD: Cardiovascular CVA: Cerebrovascular NICE: Excellence, DASH: Dietary species.Consent publication author reviewed approved final agreed accountable all aspects work, including any accuracy integrity issues. Disclosure declares financial involvement affiliations organisation, entity directly indirectly subject matter materials presented article. includes honoraria, expert testimony, employment, ownership stocks options, patents grants received pending royalties. Data availability Information editorial taken freely available sources. Authorship contribution All authors contributed significantly whether conception, design, utilisation, collection, analysis interpretation data areas. They participated article's drafting, revision review, gave approval would published, decided journal article submitted made responsible decision held work. Financial support sponsorship Nil. Conflicts interest There no conflicts interest.

Language: Английский

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Commentary on: ‘Cuspidi C., et al. Left ventricular systolic dysfunction in obesity: a meta-analysis of speckle tracking echocardiographic studies’

Journal of Hypertension, Journal Year: 2024, Volume and Issue: 42(8), P. 1309 - 1310

Published: June 27, 2024

The main aim of the study by Cuspidi et al. [1], published in present issue Journal Hypertension, was to provide results a meta-analysis studies that evaluated cardiac function obese patients speckle tracking echocardiography; authors' conclusion calculation left ventricular (LV) global longitudinal strain (GLS) may identify early/limited/subtle LV systolic dysfunction ejection fraction standard echocardiography unable [1]. There are few doubts strain-based imaging techniques (and specifically speckle-tracking echocardiography) have been shown possess clinical utility variety settings [2]. In particular, three-dimensional (3D) be regarded as an advanced technique designed for myocardial deformation analysis based on 3D data sets [3]. has potential overcome some intrinsic limitations two-dimensional did not consider separately two approaches, probably due relative low number using tracing obesity, being relatively younger still undergoing technological developments Assessment GLS from considered, any case, sensitive and feasible method overcomes many [4], including reproducibility issues serial testing detection pathologically remodeled hearts [4]. Although were raised about role obesity independent cardiovascular risk factor, thus leading hypothesize 'obesity paradox', because observation paradoxically better outcomes older [5], even those with chronic heart failure [6], there is general agreement fact condition causes morphological functional alterations involving system, remodeling epicardial fat accumulation, endothelial coronary microvascular [7]. These can represent substrates different diseases, such atrial fibrillation, artery disease, sudden death, both preserved reduced Notably, al.[1] affirm their suggest should incorporated into routine work-up aimed obesity-mediated subclinical damage multiimaging modalities required appropriate recognition typically associated remains, at least my opinion, most cost-effective human hypertension, very prevalent phenotype, hypertrophy, despite therapeutic interventions nearly two-third hypertensive surveys [8], rarely assessed real-life situations [9]. fact, again al., indicate that, echocardiographic assessment, absolute mass, mass index wall thickness calculated only 45.5, 24.6 12.3% cases, respectively. Parameters diastolic filling measured two-thirds cases estimation E/A ratio provided less than 20% examinations This study, although performed 2008, shows, therefore, large majority routinely order detect do report qualifying geometry quantitative assessment morphology practice. It is, probable difficulties also which moreover, perceived risky hypertension population; addition, serious subjects owing poor acoustic window attenuation artifacts. general, excess adiposity challenging interpretation diagnostic accuracy [10]. If it seems so difficult obtain useful information echocardiography, widely available easy perform, suggestion performing (a more complex commonly approach) could actually prove inapplicable real world might 'flight Icarus'. conclusion, choice tests depends knowledge methods limitations, patient management tailored according evaluation availability

Language: Английский

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The Critical Role of Comorbidities in Managing Heart Failure with Preserved Ejection Fraction (HFpEF)

ESC Heart Failure, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 16, 2024

Heart failure with preserved ejection fraction (HFpEF) represents an increasingly prevalent and challenging phenotype of heart (HF), primarily due to the multitude comorbidities that both contribute its pathogenesis complicate management. As population ages diagnostic measures advance, rate HFpEF diagnosis is on rise, revealing a complex clinical picture where HF often coexists other chronic conditions. It essential distinguish between complications directly related independent diseases co-occur in same patients, as this distinction fundamental tailoring individualized therapeutic strategies.1-6 Comorbidities not only exacerbate disease's severity but also accelerate decline functional status according NYHA classification, amplifying adverse treatment outcomes, including increased mortality hospitalization rates.2, 3, 7 This editorial highlights intricate interplay common comorbidities, emphasizing need for holistic approach patient management context. One key challenge managing differentiating it from conditions mimic presentation, such infiltrative cardiomyopathies, coronary artery disease, lung non-cardiac like anxiety, depression, severe obesity, physical deconditioning. Misdiagnosis or delayed can lead ineffective treatments unnecessary interventions. Following structured algorithms accurately identify optimize pathways. To address these complexities, we have developed dedicated virtual issue ESC Failure, compiling significant research encouraging contributions advance understanding improve strategies patients. most widely recognized associated atrial fibrillation (AF), which affects roughly two-thirds association coincidental based shared pathophysiological mechanisms risk factors.8 AF patients worsens exertional limitations symptom burden compared those sinus rhythm, higher rates cardiovascular rehospitalization.9 Importantly, while may increase sudden death, accelerates progression, impacting each stage disease. Furthermore, there are sex-specific survival differences among AF, observed men despite prevalence condition group. Thus, effective crucial, although no standardized guidelines currently exist. Catheter ablation shows promise potential intervention alleviation quality life improvement, yet efficacy appears lower than reduced (HFrEF). Further needed refine unique phenotype.10-12 In recent decades, impact adipose tissue health has been extensively studied, highlighting role pathophysiology. HFpEF, obesity contributes dysfunction through neurohormonal activation, hemodynamic overload, oxidative stress, low-grade inflammation. Epidemiological studies reveal more commonly HFrEF, particularly Europe North America, highest. Interestingly, different subgroups exhibit distinct characteristics; younger (<64 years) typically male present poorer glycemic control, whereas older (>65 predominantly female comorbidities. underscores critical factor driver specifically.5, 13, 14 The interaction further complicated by presence additional kidney disease (CKD), obstructive pulmonary (COPD), various forms anemia, sleep apnea (OSA), independently prognosis. recognition modifiable prompted interest pharmacological interventions, GLP-1 agonists, shown HFpEF-related obesity. These medications reductions C-reactive protein (CRP) levels, declines NT-proBNP concentrations, weight loss, decreases loop diuretics control symptoms. Patients agonists report improvements exercise tolerance severity, validating their management.15, 16 Another crucial area concern assessment comorbidity poor outcomes. Recent suggest who recover anemic state maintain stable hemoglobin levels within first-year post-discharge experience better outcomes whose anemia worsens. Factors sex, COPD, renal function improved status, advanced age, low body mass index, frailty, initial predict deterioration. findings highlight targeted monitoring elderly highly Adjusting targets below conventional WHO thresholds could precise population, acknowledging challenges presents management.17 cross-sectional study dysfunction—even at mild levels—and diastolic dysfunction, well (HFpEF). was factors, suggesting early impairment elevated cardiac filling pressures, precursor symptomatic failure. females though were found function. Notably, correlated E/e' ratios, indicator even after excluding participants existing point high-risk individuals, focusing factors pressure volume management, systemic inflammation, potentially prevent progression HFpEF. value utilizing new, race-neutral equations estimating glomerular filtration (eGFR), enhances precision across diverse populations. Given prior focused populations fills gap, underscoring importance comprehensive assessments impairment. Future investigations warranted explore whether therapies RAAS inhibitors, SGLT2 anti-inflammatory agents offer protective benefits against dysfunction.18 Lastly, intersection stroke demanding close attention. stroke, first 30 days post-HF during episodes acute decompensated (ADHF). heightened HF-related AF. Moreover, extends beyond overt events include silent brain lesions. Conversely, suffer ischemic strokes, either pre-existing decompensation triggered stroke. Stroke frequently caused cardioembolism, hypoperfusion-related relevant. procoagulant HF, encompassing slow blood flow, endothelial coagulation, multidisciplinary manage effectively.19, 20 summary, mere secondary issues play pivotal absence specific, comorbid offers viable strategy enhance Current emphasize recognizing non-cardiovascular urging alone. We hope special Failure inspires continued invites delve into connections ultimately aiming care growing population. All authors declare conflict interest.

Language: Английский

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