MyMedR

Displaying publications 61 - 80 of 149 in total

Abstract:

Sort:

Fulltext Mental health problems and hypertension in the elderly: Review from the HOPE Asia Network

Turana Y, Tengkawan J, Chia YC, Shin J, Chen CH, Park S, et al.

J Clin Hypertens (Greenwich), 2021 Mar;23(3):504-512.
PMID: 33283971 DOI: 10.1111/jch.14121

The "triple burden" of aging population, hypertension, and mental health problems making elderly in Asia is more vulnerable. There is evidence of a bidirectional relationship between mental health and hypertension, which results in lower quality of life, lower rate of treatment adherence, and higher mortality among elderly individuals. It is essential to overcome known barriers and care for the elderly with high-risk factors in order to address these burdens. This review revealed that elderly with hypertension were more likely to suffer from depression and anxiety. Therefore, debunking myths, creating awareness regarding mental health, and increasing access to mental health resources through holistic community-based programs would greatly reduce such problems and optimize the chances of success in controlling hypertension-related problems.
Fulltext Measurement accuracy and reliability of self-reported versus measured weight and height among adults in Malaysia: Findings from a nationwide blood pressure screening programme

Chia YC, Ching SM, Ooi PB, Beh HC, Chew MT, Chung FFL, et al.

PLoS One, 2023;18(1):e0280483.
PMID: 36649290 DOI: 10.1371/journal.pone.0280483

Most studies reporting prevalence of obesity use actual weight and height measurements. Self-reported weight and height have been used in epidemiological studies as they have been shown to be reliable, convenient, and inexpensive alternatives to actual measurements. However, the accuracy of self-reported weight and height might vary in different regions because of the difference in health awareness and social influences. This study aims to determine the accuracy and reliability of self-reported weight and height compared to actual measured weight and height among adults in Malaysia. This was a cross-sectional study conducted at the community level during blood pressure screening campaigns. Participants self-reported their weight and height in a questionnaire survey. Their weight and height were validated using measurements by researchers on the same setting. Body mass index (BMI) was defined as underweight (<18.5kg/m2), normal (18.5-22.9 kg/m2), overweight (23-27.4 kg/m2) and obesity (≥27.5 kg/m2). Bland-Altman analysis, intraclass correlation coefficients and weighted Kappa statistics were used to assess the degree of agreement between self-reported and measured weight and height. A total of 2781 participants were recruited in this study. The difference between the mean self-reported and measured weight and height were 0.4 kg and 0.4 cm respectively. Weighted Kappa statistics analysis showed that there was a substantial agreement between the BMI classifications derived from self-reported and actual measurement (ҡ = 0.920, p<0.001). There was no marked difference in the sensitivity and specificity of self-reported BMI among Malaysian adults by gender. We observed substantial agreement between self-reported and measured body weight and height within a sample of Malaysian adults. While self-reported body weight showed weaker agreement with actual measurements particularly for obese and overweight individuals, BMI values derived from self-reported weight and height were accurate for 88.53% of the participants. We thus conclude that self-reported height and weight measures may be useful for tracking and estimating population trends amongst Malaysian adults.
Fulltext May Measurement Month 2019: an analysis of blood pressure screening results from Malaysia

Chia YC, Devaraj NK, Chook JB, Chew MT, Ooi PB, Mohamed M, et al.

Eur Heart J Suppl, 2021 May;23(Suppl B):B98-B100.
PMID: 34054370 DOI: 10.1093/eurheartj/suab058

Despite hypertension remaining the leading cause of death worldwide, awareness of hypertension and its control rate is still suboptimal in Malaysia. This study aims to determine the proportion of both diagnosed and undiagnosed hypertension, awareness and its control rate during the yearly May Measurement Month (MMM) campaign that has been coordinated by the International Society of Hypertension. Participants aged ≥18 years were recruited at various screening sites namely universities, health facilities, shopping malls, and other sites. Participant's socio-demographic, environmental, and lifestyle data were captured using a questionnaire. Three blood pressure (BP) readings as well as anthropometric measurements were obtained from all participants. The mean of the second and third BP readings was used in analyses. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. A total of 3062 participants were recruited. The proportion with hypertension in our study was 18.7% (n = 572). The proportion who were aware of their BP status was 63.2%. More than half (57.2%) of the hypertensives were on antihypertensive medication and 70.3% of those treated were controlled. In conclusion, in this BP screening campaign, one in five were hypertensive with almost two thirds aware of their hypertensive status. BP control among those who are taking medications was high at 70% but under 60% of hypertensives were on treatment. Hypertension screening programmes are important to promote awareness and control of hypertension as well as to reduce the devastating complications associated with this disorder.
May Measurement Month 2018: an analysis of blood pressure screening results from Malaysia

Chia YC, Ching SM, Devaraj NK, Chew BN, Ooi PB, Mohamed M, et al.

Eur Heart J Suppl, 2020 Aug;22(Suppl H):H83-H85.
PMID: 32884479 DOI: 10.1093/eurheartj/suaa035

Hypertension continues to be the top global killer, contributing to over 10 million deaths annually. As prevalence and unawareness of hypertension remain high in Malaysia, this study was aimed to screen more individuals to identify those with undiagnosed hypertension. Respondents aged ≥18 years were recruited through opportunistic sampling at various screening sites including health clinics, hospitals, student health centres, universities, community halls, shopping malls, as well as through other health screening campaigns. Each respondent completed a questionnaire on socio-demographic, environmental, and lifestyle data. Anthropometric measurements as well as three blood pressure (BP) measurements were obtained from all participants. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. The total number of participants was 4866. The mean age of the participants was 39.8 (17.6) years with 61.1% female participants. Of the 4866 participants, 1405 (28.9%) had hypertension. The proportion of those aware of their hypertension status was 76.3% (1073/1405). The proportion of those with hypertension on medication was 71% (998/1405). Of those receiving antihypertensive treatment, 62.4% (623/998) had controlled BP. The proportion of hypertension in this study was 28.9%. The awareness rate of 76.3% compares favourably to a previously reported national level of 43.2%. Hence, BP screening programmes may be effective at increasing awareness and should be conducted annually.
Fulltext May Measurement Month 2017 blood pressure screening: findings from Malaysia-South-East Asia and Australasia

Chia YC, Ching SM, Chew BN, Devaraj NK, Siti Suhaila MY, Tay CL, et al.

Eur Heart J Suppl, 2019 Apr;21(Suppl D):D77-D79.
PMID: 31043885 DOI: 10.1093/eurheartj/suz061

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. However there are still many individuals, particularly in many countries in Asia, who have poor BP control. In Malaysia, less than two-fifths have achieved BP control. We participated in BP screening in Malaysia in conjunction with the May Measurement Month 2017 (MMM17), a global initiative by the International Society of Hypertension (ISH) aimed at screening more individuals for earlier detection of hypertension. A nationwide screening of adults aged ≥18 was carried out through health campaigns at clinics, hospitals, during family day events, and charity runs from 1 April 2017 to 31 May 2017 in 42 centres. We used the detailed protocol provided by ISH for data collection. A total of 4116 individuals were screened during MMM17. After multiple imputation, 32.4% (n = 1317/4059) had hypertension. Out of this, 63.9% (842/1317) of those with hypertension were on treatment. Of individuals receiving antihypertensive medication with an imputed BP, 59.5% (n = 496/834) of them had controlled BP. MMM17 was the largest organized BP screening campaign undertaken by health professionals in Malaysia. This study identified that 32.4% of screened individuals had hypertension and 59.5% individuals with treated hypertension had achieved BP control.
Fulltext Massive open online courses (MOOCs) for continuing medical education - why and how?

Setia S, Tay JC, Chia YC, Subramaniam K

Adv Med Educ Pract, 2019;10:805-812.
PMID: 31572042 DOI: 10.2147/AMEP.S219104

Continuing medical education (CME) is meant to not only improve clinicians' knowledge and skills but also lead to better patient care processes and outcomes. The delivery of CME should be able to encourage the health providers to accept new evidence-based practices, and discard or discontinue less effective care. However, continuing use of expensive yet least effective and inappropriate tools and techniques predominates for CME delivery. Hence, the evidence shows a disconnect between evidence-based recommendations and real-world practice - borne out by less than optimal patient outcomes or treatment targets not being met especially in low- to middle-income countries. There is an ethical and professional obligation on CME-providers and decision-makers to safeguard that CME interventions are appraised not only for their quality and effectiveness but also for cost-effectiveness. The process of learning needs to be engaging, convenient, user-friendly and of minimal cost, especially where it is most needed. Today's technology permits these characteristics to be integrated, along with further enhancement of the engagement process. We review the literature on the mechanics of CME learning that utilizes today's technology tools and propose a framework for more engaging, efficient and cost-effective approach that implements massive open online courses for CME, adapted for the twenty-first century.
Fulltext Manpower cost for a hypertension health campaign: A cross-sectional study

Beh HC, Wong PF, Chew BN, Chia YC

Malays Fam Physician, 2023;18:66.
PMID: 38111833 DOI: 10.51866/oa.3l4

INTRODUCTION: The overall prevalence of hypertension is high, and many people are unaware of their condition. Screening campaigns can effectively identify this group of patients. The study aimed to determine the cost of manpower for a health campaign for detecting undiagnosed hypertension and the prevalence of hypertension.
METHOD: This cross-sectional study was conducted at two health centres. Sociodemographic characteristics, hypertension and treatment statuses were recorded. Blood pressure (BP) was measured by either doctors or nurses using automated BP machines. The cost of manpower was calculated as the average salaries of manpower during the 3-day health campaign divided by the total number of days. The final sum was the cost of detecting undiagnosed hypertension.
RESULTS: A total of 2009 participants median age = 50 (IQR = 18-91) were included in the study. The overall prevalence of hypertension was 41.4% (n=832). Among the patients with hypertension, 49.2% (n=409) were unaware of their hypertension status. Conversely, 21.1% (n=423) were known to have hypertension, among whom 97.4% (n=412) were on medications. Among those who were on medications, 49% (n=202) had good BP control. The average total cost of manpower during the 3-day health campaign was RM 5019.80 (USD 1059). The cost of detecting an individual with elevated BP was RM 12.27 (USD 2.59).
CONCLUSION: The prevalence of hypertension and unawareness is high. However, the average cost of manpower to detect an individual with elevated BP is low. Therefore, regular public health campaigns aiming to detect undiagnosed hypertension are recommended.
Mandarin version of the Leeds Dyspepsia Questionnaire: A valid instrument for assessing symptoms in Asians

Leow HR, Ching SM, Sujarita R, Yap CF, Chia YC, Ho SH, et al.

J Dig Dis, 2014 Nov;15(11):591-6.
PMID: 25139629 DOI: 10.1111/1751-2980.12183

OBJECTIVE:
To develop and validate a Mandarin version of the Leeds Dyspepsia Questionnaire (M-LDQ) in Asian patients with dyspepsia.

METHODS:
The M-LDQ was developed according to standardized methods. The validity, internal consistency, test-retest reliability and responsiveness of the instrument were evaluated in both primary and secondary care patients.

RESULTS:
A total of 184 patients (mean age 54.0 ± 15.8 years, of whom 59% were women and 72.3% of whom had at least secondary level education) were recruited between August 2012 and March 2013, from both primary (n = 100) and secondary care clinics (n = 84). Both the internal consistency of all components of the M-LDQ (Cronbach's α 0.79) and test-retest reliability (Spearman's correlation coefficient 0.78) were good. The M-LDQ was valid in diagnosing dyspepsia in primary care (area under the receiver operating characteristics curve 0.84) and was able to discriminate between secondary and primary care patients (median cumulative LDQ score 13.0 vs 3.0, P < 0.0001). Among eight patients with organic dyspepsia, the median M-LDQ score reduced significantly from 21.0 (pretreatment) to 9.5 (4 weeks post-treatment) (P < 0.0001).

CONCLUSION:
The M-LDQ is a valid and responsive instrument for assessing ethnic Chinese adults with dyspepsia.

KEYWORDS:
Mandarin; ethnic Chinese; functional dyspepsia; outcome measure; questionnaire; validation
Long-term visit-to-visit variability of systolic blood pressure and decline in renal function in hypertensive patients over 15 years [Abstract OS 37-05]

Lim HM, Chia YC, Ching SM

J Hypertens, 2016 Sep;34 Suppl 1 - ISH 2016 Abstract Book:e406.
PMID: 27754262

Conference abstract:
We aim to examine the relationship between visit-to-visit systolic blood pressure variability (BPV) and decline in renal function in patients with hypertension and determine the level of systolic BPV that contribute to significant renal function decline.
Long-Term Visit-to-Visit Blood Pressure Variability and Renal Function Decline in Patients With Hypertension Over 15 Years

Chia YC, Lim HM, Ching SM

J Am Heart Assoc, 2016 11 07;5(11).
PMID: 27821404

BACKGROUND: Visit-to-visit variability of systolic blood pressure (SBP) has been shown to contribute to cardiovascular events and all-cause mortality. However, little is known about its long-term effect on renal function. We aim to examine the relationship between visit-to-visit blood pressure variability (BPV) and decline in renal function in patients with hypertension and to determine the level of systolic BPV that is associated with significant renal function decline.
METHODS AND RESULTS: This is a 15-year retrospective cohort study of 825 hypertensive patients. Blood pressure readings every 3 months were retrieved from the 15 years of clinic visits. We used SD and coefficient of variation as a measure of systolic BPV. Serum creatinine was captured and estimated glomerular filtration rate was calculated at baseline, 5, 10, and 15 years. The mean SD of SBP was 14.2±3.1 mm Hg and coefficient of variation of SBP was 10.2±2%. Mean for estimated glomerular filtration rate slope was -1.0±1.5 mL/min per 1.73 m2 per year. There was a significant relationship between BPV and slope of estimated glomerular filtration rate (SD: r=-0.16, P<0.001; coefficient of variation: r=-0.14, P<0.001, Pearson's correlation). BPV of SBP for each individual was significantly associated with slope of estimated glomerular filtration rate after adjustment for mean SBP and other confounders. The cutoff values estimated by the receiver operating characteristic curve for the onset of chronic kidney disease for SD of SBP was 13.5 mm Hg and coefficient of variation of SBP was 9.74%.
CONCLUSIONS: Long-term visit-to-visit variability of SBP is an independent determinant of renal deterioration in patients with hypertension. Hence, every effort should be made to reduce BPV in order to slow down the decline of renal function.
Long term visit-to-visit variability of systolic blood pressure and cardiovascular disease events in a primary care setting: a 10-year retrospective cohort study [Abstract OS 04-05]

Ching SM, Chia YC, Lim HM

J Hypertens, 2016 Sep;34 Suppl 1 - ISH 2016 Abstract Book:e56.
PMID: 27753921

Conference abstract:
OBJECTIVE: This study aims to determine the relationship of long term visit to visit variability (VVV) of SBP and cardiovascular disease (CVD) in a primary care setting.
DESIGN AND METHOD: This is a retrospective study of a cohort of 1416 patients over a period of 10 years (1998-2007). Demographic data, three monthly clinic BP readings and CVD events were captured from patient records. We derived the mean BP and VVV of SBPs for each subject and divided them into three groups defined as non hypertension, developed hypertension along the 10-year follow-up and persistent hypertension. We examined differences in cardiovascular events across these groups.
RESULTS: Mean age of the participants at baseline was 56.5 ± 10.1 years, 34.6% were males. Table 1 describes mean SBP, BPV and CVD events of the study population.Those with both low mean SBP and low BPV have the lowest CVD events, conversely those with both high mean SBP and high BPV have highest CVD events. In those patients with the same mean SBP, whether high or low, those with higher BPV have more events than those with lower BPV. However patients with low mean SBP but high BPV have more CVD events compared with those patients with high mean SBP but low BPV (p = 0.04) suggesting BPV is more important than mean SBP in causing CVD events.We used ROC of VVV SBP to identify the cut off point of 12.9 mmHg as the indicator for increase in CVD events.
CONCLUSIONS: In our study, we found that patients with hypertension have higher BPV than normotensive subjects. Furthermore those with higher BPV also had more CVD events. As such, we should prioritize lowering not only mean systolic BP but lowering BPV as well. Long term VVV SBP should be another target in the management of patients with hypertension.
Fulltext Long sleep duration and cardiovascular disease: Associations with arterial stiffness and blood pressure variability

Matsubayashi H, Nagai M, Dote K, Turana Y, Siddique S, Chia YC, et al.

J Clin Hypertens (Greenwich), 2021 03;23(3):496-503.
PMID: 33377597 DOI: 10.1111/jch.14163

Although short and long sleep duration are both risk factors of cardiovascular disease (CVD), the recent meta-analyses have been shown that long sleep duration was closely associated with CVD mortality. While the specific mechanism underlying the association between long sleep duration and CVD remains unclear, long sleep duration was shown to be associated with arterial stiffness and blood pressure variability (BPV) in many Asian populations. This review article will focus on the pathophysiology of long sleep duration, arterial stiffness, BPV and their effects on CVD. To set the stage for this review, we first summarize the current insights for the relationship between long sleep duration and CVD in relation to arterial stiffness and BPV.
Fulltext Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Charchar FJ, Prestes PR, Mills C, Ching SM, Neupane D, Marques FZ, et al.

J Hypertens, 2024 Jan 01;42(1):23-49.
PMID: 37712135 DOI: 10.1097/HJH.0000000000003563

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.
Lateral Flow Assay Based on Paper-Hydrogel Hybrid Material for Sensitive Point-of-Care Detection of Dengue Virus

Choi JR, Yong KW, Tang R, Gong Y, Wen T, Yang H, et al.

Adv Healthc Mater, 2017 Jan;6(1).
PMID: 27860384 DOI: 10.1002/adhm.201600920

Paper-based devices have been broadly used for the point-of-care detection of dengue viral nucleic acids due to their simplicity, cost-effectiveness, and readily observable colorimetric readout. However, their moderate sensitivity and functionality have limited their applications. Despite the above-mentioned advantages, paper substrates are lacking in their ability to control fluid flow, in contrast to the flow control enabled by polymer substrates (e.g., agarose) with readily tunable pore size and porosity. Herein, taking the benefits from both materials, the authors propose a strategy to create a hybrid substrate by incorporating agarose into the test strip to achieve flow control for optimal biomolecule interactions. As compared to the unmodified test strip, this strategy allows sensitive detection of targets with an approximately tenfold signal improvement. Additionally, the authors showcase the potential of functionality improvement by creating multiple test zones for semi-quantification of targets, suggesting that the number of visible test zones is directly proportional to the target concentration. The authors further demonstrate the potential of their proposed strategy for clinical assessment by applying it to their prototype sample-to-result test strip to sensitively and semi-quantitatively detect dengue viral RNA from the clinical blood samples. This proposed strategy holds significant promise for detecting various targets for diverse future applications.
Fulltext Knowledge on the action to be taken and recognition of symptoms of stroke in a community: findings from the May Measurement Month 2017 blood pressure screening Programme in Malaysia

Ching S, Chia YC, Chew BN, Soo MJ, Lim HM, Sulaiman WAW, et al.

BMC Public Health, 2019 Nov 29;19(1):1602.
PMID: 31783831 DOI: 10.1186/s12889-019-7922-7

BACKGROUND: Information regarding the knowledge on the action to be taken during stroke and good recognition of stroke symptoms is mandatory in helping to plan out educational strategies to deliver health education to the community.
METHODS: This is a cross-sectional study of adults aged 18 and above attending a blood pressure screening program in community in conjunction with May Measurement Month 2017 in Malaysia. A structured self-administered questionnaire was given to the participants who gave verbal consent. Data analysis was done using SPSS v. 23 and multiple logistic regression was used to identify the determinants of knowledge on actions to be taken during stroke and recognition of stroke symptoms.
RESULTS: Out of 4096 respondents, 82.9-92.1% of them able to recognise the common stroke symptoms. and 74.2% of the study respondents will go to hospital within 4.5 h of stroke onset. According to binomial logistic regression analyses, adults aged 45 years old and above (OR 1.39 95%CI 1.01-1.92), being Malay (OR 1.74, 95% CI 1.27-2.40), being non-smokers (OR = 2.491, 95% CI: 1.64-3.78), hypertensives (OR: 1.57, 95% CI: 1.02-2.42)and diabetics (OR: 2.54, 95% CI:1.38-4.69) are determinants of right actions to be taken during stroke. Meanwhile, respondents aged 45 years old and older (OR = 1.68, 95% CI: 1.39-2.03), being Malay (OR = 1.49, 95% CI: 1.24-1.79), hypertensive (OR = 1.32, 95% CI: 1.04-1.66) and those who had a previous history of stroke (OR = 2.25, 95% CI: 1.01-5.00) are determinants of good recognition of stroke symptoms.
CONCLUSIONS: The overall knowledge of stroke in our study population was good. Older age, being Malay, non-smokers, hypertensives and diabetics are determinants of right actions to be taken during stroke. Meanwhile, older age, being Malay, hypertensive and those who had a previous history of stroke are determinants of good recognition of stroke symptoms.
Fulltext It is strongly recommended to not conduct, fund, or publish research studies that use spot urine samples with estimating equations to assess individuals' sodium (salt) intake in association with health outcomes: a policy statement of the World Hypertension League, International Society of Hypertension and Resolve to Save Lives

Campbell NRC, Whelton PK, Orias M, Cobb LL, Jones ESW, Garg R, et al.

J Hypertens, 2023 May 01;41(5):683-686.
PMID: 36723484 DOI: 10.1097/HJH.0000000000003385

Spot urine samples with estimating equations have been used to assess individuals' sodium (salt) intake in association with health outcomes. There is large random and systematic error in estimating sodium intake using this method and spurious health outcome associations. Substantial controversy has resulted from false claims the method is valid. Hence, the World Hypertension League, International Society of Hypertension and Resolve to Save Lives, supported by 21 other health organizations, have issued this policy statement that strongly recommends that research using spot urine samples with estimating equations to assess individuals' sodium (salt) intake in association with health outcomes should not be conducted, funded or published. Literature reviews on the health impacts of reducing dietary sodium that include studies that have used spot and short duration timed urine samples with estimating equations need to explicitly acknowledge that the method is not recommended to be used and is associated with spurious health outcome associations.
Fulltext Isolated systolic hypertension in Asia

Tsai TY, Cheng HM, Chuang SY, Chia YC, Soenarta AA, Minh HV, et al.

J Clin Hypertens (Greenwich), 2021 03;23(3):467-474.
PMID: 33249701 DOI: 10.1111/jch.14111

Isolated systolic hypertension (ISH) is the most common type of essential hypertension in the elderly and young adults. With rapid industrialization and population aging, the prevalence of ISH in Asia will rise substantially. Asian populations have distinct epidemiological features, risk factors and are especially vulnerable to ISH. There is a pressing need for Asian countries to formulate their unique strategies for control of ISH. In this review, we focus on the (1) epidemiology and pathophysiology, (2) risk factors and impact on outcomes, and (3) treatment goal and strategy for ISH in Asia.
Fulltext Interleukin 6 and Development of Heart Failure With Preserved Ejection Fraction in the General Population

Chia YC, Kieneker LM, van Hassel G, Binnenmars SH, Nolte IM, van Zanden JJ, et al.

J Am Heart Assoc, 2021 06;10(11):e018549.
PMID: 33998283 DOI: 10.1161/JAHA.120.018549

Background The cause of heart failure with preserved ejection fraction (HFpEF) is poorly understood, and specific therapies are lacking. Previous studies suggested that inflammation plays a role in the development of HFpEF. Herein, we aimed to investigate in community-dwelling individuals whether a higher plasma interleukin 6 (IL-6) level is associated with an increased risk of developing new-onset heart failure (HF) over time, and specifically HFpEF. Methods and Results We performed a case-cohort study based on the PREVEND (Prevention of Renal and Vascular End-Stage Disease) study, a prospective general population-based cohort study. We included 961 participants, comprising 200 participants who developed HF and a random group of 761 controls. HF with reduced ejection fraction or HFpEF was defined on the basis of the left ventricular ejection fraction of ≤40% or >40%, respectively. In Cox proportional hazard regression analyses, IL-6 levels were statistically significantly associated with the development of HF (hazard ratio [HR], 1.28; 95% CI, 1.02-1.61; P=0.03) after adjustment for key risk factors. Specifically, IL-6 levels were significantly associated with the development of HFpEF (HR, 1.59; 95% CI, 1.16-2.19; P=0.004), whereas the association with HF with reduced ejection fraction was nonsignificant (HR, 1.05; 95% CI, 0.75-1.47; P=0.77). In sensitivity analyses, defining HFpEF as left ventricular ejection fraction ≥50%, IL-6 levels were also significantly associated with the development of HFpEF (HR, 1.47; 95% CI, 1.04-2.06; P=0.03) after adjustment for key risk factors. Conclusions IL-6 is associated with new-onset HFpEF in community-dwelling individuals, independent of potential confounders. Our findings warrant further research to investigate whether IL-6 might be a novel treatment target to prevent HFpEF.
Fulltext Insights on home blood pressure monitoring in Asia: Expert perspectives from 10 countries/regions

Wang JG, Bunyi ML, Chia YC, Kario K, Ohkubo T, Park S, et al.

J Clin Hypertens (Greenwich), 2021 Jan;23(1):3-11.
PMID: 33043574 DOI: 10.1111/jch.14074

Hypertension is one of the most powerful modifiable risk factors for cardiovascular disease. It is usually asymptomatic and therefore essential to measure blood pressure regularly for the detection of hypertension. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to monitor blood pressure and facilitate effective diagnosis of hypertension. It is useful to identify the masked or white-coat hypertension. There is also increasing evidence that supports the role of HBPM in guiding antihypertensive treatment, and improving treatment compliance and hypertension control. In addition, HBPM has also shown prognostic value in predicting cardiovascular events. Despite these benefits, the use of HBPM in many parts of Asia has been reported to be low. An expert panel comprising 12 leading experts from 10 Asian countries/regions convened to share their perspectives on the realities of HBPM. This article provides an expert summary of the current status of HBPM and the key factors hindering its use. It also describes HBPM-related initiatives in the respective countries/regions and presents strategies that could be implemented to better support the use of HBPM in the management of hypertension.
Improving Hypertension Outcome Measurement in Low- and Middle-Income Countries

Zack R, Okunade O, Olson E, Salt M, Amodeo C, Anchala R, et al.

Hypertension, 2019 05;73(5):990-997.
PMID: 30929516 DOI: 10.1161/HYPERTENSIONAHA.118.11916

High blood pressure is the leading modifiable risk factor for mortality, accounting for nearly 1 in 5 deaths worldwide and 1 in 11 in low-income countries. Hypertension control remains a challenge, especially in low-resource settings. One approach to improvement is the prioritization of patient-centered care. However, consensus on the outcomes that matter most to patients is lacking. We aimed to define a standard set of patient-centered outcomes for evaluating hypertension management in low- and middle-income countries. The International Consortium for Health Outcomes Measurement convened a Working Group of 18 experts and patients representing 15 countries. We used a modified Delphi process to reach consensus on a set of outcomes, case-mix variables, and a timeline to guide data collection. Literature reviews, patient interviews, a patient validation survey, and an open review by hypertension experts informed the set. The set contains 18 clinical and patient-reported outcomes that reflect patient priorities and evidence-based hypertension management and case-mix variables to allow comparisons between providers. The domains included are hypertension control, cardiovascular complications, health-related quality of life, financial burden of care, medication burden, satisfaction with care, health literacy, and health behaviors. We present a core list of outcomes for evaluating hypertension care. They account for the unique challenges healthcare providers and patients face in low- and middle-income countries, yet are relevant to all settings. We believe that it is a vital step toward international benchmarking in hypertension care and, ultimately, value-based hypertension management.

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links