The Burden of Undiagnosed Hypertension and Associated Risk Factors among Adults in a Rural Community in Imo Sate, South-East Nigeria

Background: Cardiovascular diseases are the leading cause of death globally and hypertension is a major contributor to this burden. Many people with hypertension have poorly controlled blood pressure and up to half of the adults with hypertension are unaware of their hypertensive status due to factors that bother on poor management and poor screening approaches. The implication is that people who have poor access to healthcare especially those in the rural communities are at increased risk of cardiovascular complications and all-cause mortality. Unfortunately, not much has been done to ascertain the burden of undiagnosed hypertension and associated risk factors in rural communities in Nigeria. Methods: We conducted a community-based cross-sectional study in a rural community in Imo State, Nigeria, on burden of undiagnosed hypertension with participants recruited via a multi-stage sampling method. An interviewer-administered questionnaire was used, and standardized instruments were applied to obtain, process and analyze the data. Tests of association between the independent variables and outcome were conducted using logistic regression. P-value of Results: A total of 380 adults participated in the study. The mean age was 44.2 years. The prevalence of undiagnosed hypertension was 35.8%. Logistic regression revealed that age, with the respondents in the age groups 26 - 35 years (OR = 10.647, 1.910 - 59.345, p-value = 0.007), 36 - 45 (OR = 3.680, 1.263 - 10.723, p-value = 0.017), 46 - 55 years (OR = 2.737, 1.114 - 6.727, p-value = 0.039), 56 - 65 years old (OR = 3.384, 1.610 - 7.115, p-value = 0.001);and being married (OR = 3.846, 1.118 - 13.233, p-value = 0.033), were independent risk factors for undiagnosed hypertension. Conclusion: The prevalence of undiagnosed hypertension in the rural population of South-East Nigeria is high. Younger age (26 - 35 years) had the highest odds of risk for occurrence of hypertension. Also being married was identified as a risk factor for undiagnosed hypertension.

Status,outcome,and related factors of postpartum hypertension in the Shanghai community

BACKGROUND Postpartum hypertension poses a considerable health risk.Despite research on gestational hypertension,comprehensive studies focusing on postpartum hypertension in communities are limited.Understanding its prevalence and associated risk factors is crucial for effective prevention and management.AIM To provide insights for postpartum hypertension’s prevention and management.METHODS In total,3297 women who gave birth between June 2021 and December 2022 in Xuhui District,Shanghai were selected.Blood pressure was measured thrice within one month post-delivery during home visits.Eighty-six women with hypertension were followed up for four months to analyze hypertension persistence and its related risk factors.A predictive model for persistent postpartum hypertension was established and verified using the Nomo diagram model.RESULTS Hypertension prevalence 1 month post-delivery was 2.61%(86/3297).Among the 86 pregnant women,32(37.21%)had persistent hypertension at four months post-delivery.Multivariate logistic regression analysis revealed that older age[odds ratio(OR)=1.212;95%confidence interval(CI):1.065–1.380]and higher pre-pregnancy body mass index(BMI)(OR=1.188;95%CI:1.006–1.404)were associated with hypertension(OR=10.781;95%CI:1.006–1.404)during pregnancy.A 95%CI of 1.243–93.480 is a risk factor for persistent postpartum hypertension.The Nomograph model accurately predicted the risk of persistent postpartum hypertension,demonstrating high precision.CONCLUSION In Xuhui,older age,higher pre-pregnancy BMI,and gestational hypertension are risk factors for persistent postpartum hypertension.Our prediction model can identify high-risk individuals,thereby improving patient quality of life.

Exploring the Effects of Health Education and Chronic Disease Management Nursing in the Management of Hypertension in Elderly Patients in the Community

Objective:To explore the effects of health education and chronic disease management nursing in elderly community patients with hypertension,in order to provide scientific evidence for improving the health management level of these patients.Methods:Sixty-four elderly hypertension patients treated at this hospital between March 2022 and March 2024 were selected and randomly divided into two groups,with 32 patients in each group.One group received conventional management,designated as the control group,while the other group received a combined management strategy involving health education and chronic disease management,designated as the experimental group.The study compared the management outcomes of the two groups to evaluate the value of the combined management approach in elderly hypertensive patients in the community.Results:The study found that the experimental group showed significantly lower systolic blood pressure(SBP),diastolic blood pressure(DBP),and scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)compared to the control group,with statistically significant differences(P<0.05).Additionally,the experimental group demonstrated significantly higher scores in disease cognition levels regarding awareness of normal blood pressure ranges,prevention of complications,identification of high-risk factors,and healthy lifestyle practices,with statistically significant differences(P<0.05).Moreover,the experimental group showed significantly better rates of self-management behaviors,such as quitting smoking and alcohol,self-monitoring of blood pressure,dietary control,regular medication adherence,and consistent exercise,compared to the control group,with statistically significant differences(P<0.05).Conclusion:This study indicates that a combined management model integrating health education and chronic disease management effectively improves the emotional state of elderly hypertensive patients in the community,significantly enhances their disease cognition levels,and boosts their self-management abilities.Furthermore,this model can effectively lower patients’blood pressure,thereby achieving better health management outcomes for elderly hypertensive patients in the community.

Evaluation of the Effectiveness of Community Pharmacy Services on Rational Medication Use in Elderly Patients with Hypertension and Diabetes

Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life.

Community Health Management and Nursing Strategies for Elderly Hypertension

Objective:To explore the therapeutic effects of community health management and nursing strategies for elderly hypertensive patients.Methods:A total of 64 elderly hypertensive patients who were treated in our hospital from March 2020 to March 2021 were selected.The control group took conventional care and guidance.The research group carried out community health management and nursing strategy guidance on the basis of the control group.Then compare the blood pressure levels of the two groups of patients before and after nursing and the patients’satisfaction with nursing.Results:Through comparison,it can be seen that the diastolic and systolic blood pressure levels of the study group and the control group are not significantly different before nursing.After nursing,the diastolic blood pressure of the patients in the study group was 81.22.1 mmHg and the systolic blood pressure was 126.58.7 mmHg.The diastolic blood pressure of the control group was 90.55.4 mmHg and the systolic blood pressure was 136.412.9 mmHg.There are obvious differences in the comparison of the two sets of data.By comparing the two groups of patients’satisfactions with nursing care,it can be seen that among the 32 patients in the study group:31 were very satisfied and basically satisfied,with a satisfaction rate of 96.87%.Among the 32 patients in the control group,28 were very satisfied and basically satisfied,with a satisfaction rate of 87.5%.The data of the two groups of patients are clearly comparable.Conclusion:Through community health management and nursing strategies,the satisfaction and treatment effect of elderly hypertensive patients can be improved,thereby contributing to the recovery of patients.

Effectiveness of Adherence to Standardized Hypertension Management by Primary Health Care Workers in China:a Cross-sectional Survey 3 Years after the Healthcare Reform

The standardized hypertension management provided by primary health care workers is an important part of China＇s recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.

Meta-Analysis the Quality of General Practitioners Management for Elderly Patients with Hypertension in China

Background: Among Chinese adults aged 35 - 75 years, nearly half have hypertension and the prevalence of hypertension is increased with age. But older patients with high systolic pressure and high pulse pressure could not be cured, and will have greater cardiovascular morbidity. This study aims to evaluate the effectiveness of general practitioners (GP) management for Chinese elderly hypertension, and explore reasonable and effective blood pressure management pattern. Methods: We searched the published literature for randomized controlled trials designed to improve blood pressure with community care management delivered by general practitioners or nurses, compared with usual care. Major outcome measures were systolic and diastolic blood pressure;the percentage of patients whose blood pressures are under control with community care management and Revman 5.3 was used in this study. Results: Pooled data from all 13 researches showed a lower outcome diastolic blood pressure (SMD = &minus;0.95, 95% CI (&minus;1.23, &minus;0.67)) and systolic blood pressure (SMD = &minus;1.17, 95% CI (&minus;1.52, &minus;0.81)) respectively in favor of community management. Pooled data from all 11 researches showed a higher percentage of patients with blood pressure under control in favor of community management (OR = 3.85, 95% CI (1.58, 9.37)) and the difference between treatment group and control group on blood pressure control ratio had statistical significance (Z = 2.97, P Conclusions: General practitioners’ management in Chinese elderly hypertension is effective, and complies with the advanced hypertension management guidelines. The multi-patterns are supposed to adopt community blood pressure monitoring and team-based general practitioners.

The Treatment of Essential Hypertension Based on Health Education

Objective: To investigate the treatment effect of essential hypertension based on health education. Methods: A randomized controlled field intervention trial was used in this study, patients with essential hypertension treated in community health services were subjects investigated, and psychological intervention should be carried out based on pharmaceutical services, to evaluate the effect of psychological intervention model based on pharmaceutical care on blood pressure control and overall health improvement in patients with essential hypertension. Results: Before treatment, systolic and diastolic blood pressure had no significant difference between two groups, P > 0.05. After treatment, SBP and DBP in two groups were significantly decreased compared to that before treatment in the same group. After treatment, SBP and DBP in the intervention group were significantly decreased compared with normal group, P 0.05). After treatment, the scores of the physiological health subscale and the total scale of the control group, the scores of each subscale and the total amount of the intervention group were significantly higher than those before the same group, the difference was statistically significant (P Conclusion: Under the background of the new round of medical and health system reforms, this model will help health workers and community residents establish new types of doctor-patient relationship and improve the quality of life of chronic diseases such as hypertension.

Health Status of Urban Medium-Low-Income Elderly at the Community

Background: Nonagenarians are uncommon in our population. The study aim was to profile physical mobility, declared health problems, hypertension and diabetes frequency, awareness, treated and good control in urban low-income elders. Method: The study had cross-sectional design in population sample. Subjects were urban men and women older than 59 years at the medium low income stratum at a developing country. Survey was carried out from October 2008 to October 2009. All elder dwellers in randomly selected houses were surveyed;clinical exam after consent. Good Control: Systolic/Diastolic Results: There were 162 elders, 53 (32.7%) were male, 99 (61.1%) were younger than 70 years. Forty nine (30.2%) had impaired mobility;among them 20 (55.6%) were bed or home restricted, and 29 (44.4%) needed help to go out. Unstable health condition was found in 36 (22.2%), with significantly more men 19 (52.8%) vs 34 (27.0%), X2 = 8.5, df1, P 0.05. The frequency, proportions for: known diagnosis, on treatment, and good control were 75 (69.4%), 55 (73.3%), 45 (60.0%) and 12 of 45 (26.7%) for hypertension;53 (49.1%), 47 (88.7%), 42 (79.2%) and 9 of 42 (21.4%) for diabetes. The most frequent unstable conditions were cardiovascular. Conclusions: Data suggest unstable health no association with the oldest old. The small proportion in good control of Diabetes and/or hypertension could explain the large frequency of elders with unstable health and prevention of reaching nonagenarian age.

Effectiveness of lifestyle intervention for hypertension in Shanghai communities: Results from the Shanghai Hypertension Detail Management Program

A community-based multi-center randomized controlled trial was conducted to evaluate the effectiveness of blood pressure control for hypertension patients in communities in urban Shanghai by integrated intervention.At present,patients(n=1395)from four communities have completed follow-up for one year,including the intervention group(n=921)and usual care group(n=474).The intervention programs included disease manage-ment by a care manager.Blood pressure of each patient was measured regularly.Compared with the control group,the net change of mean systolic blood pressure(SBP)was–6.75(95%CI:–7.79 to–5.71,P<0.001)mmHg,mean diastolic blood pressure(DBP)was–4.29(95%CI:–5.08 to–3.49,P<0.001)mmHg,and mean pulse pressure(PP)was–2.46(95%CI:–3.50 to–1.43,P<0.001)mmHg in the intervention group.The net change extent was larger in patients with regular pharmacological treatment than in those with irregular pharmacological treatment or non-pharmacological treat-ment.The measures of integrated intervention for hypertension patients in communities can lower signifi-cantly not only SBP and DBP,but also PP.It is suggested that measures of integrated intervention can decrease the risk of cardiovascular diseases in hypertension patients.

Availability and social determinants of community health management service for patients with chronic diseases:An empirical analysis on elderly hypertensive and diabetic patients in an eastern metropolis of China

Objective:This study aimed to determine the availability of community health management services and the relevant social determinants for elderly patients with chronic diseases.Methods:All data were obtained from the 2013 random sampling household survey on an elderly population conducted by the School of Public Health of Peking University in an eastern metropolis in China.Information from the database of the above survey involving 1495 hypertensive or diabetic patients>60 years of age,as representatives of the city,were included.The study described the availability of follow-up services by community doctors among elderly hypertensive and diabetic patients during the 12 months before the survey.An ordinal multinomial logistic regression model was used to conduct the analysis on the influence of socio-economic background upon such availability.Results:Eighty-one percent of hypertensive patients and 84.7%of diabetic patients had not received any follow-up service from community doctors within 12 months prior to the survey.Among elderly hypertensive patients,those registered as non-agricultural household members,those with high and above-average income,as well as management personnel of government agencies,enterprises,and social programs have a greater chance of accepting follow-up service by community doctors because of their relatively higher socio-economic rankings.Among elderly diabetic patients,such socio-economic factors had no significant influence on the availability of the follow-up service for chronic diseases.Conclusion:The coverage of community health management services for elderly hypertensive and diabetic patients needs improvement.More effort should focus on promoting the availability of community health management services for elderly hypertensive patients,especially those with lower socio-economic status.

Public health perspectives on noise and cardiovascular disease

Introduction: Emerging research suggests that noise impacts human health beyond simply the auditory system. There have been recent amendments to acceptable noise level thresholds within the occupational setting and new European Union directives for noise in the community from air and road sources. The purpose of this review will be to assess the relationship between noise and cardiovascular disease in different settings. Methods: A literature review was conducted using PubMed on noise and more cardiovascular disease endpoints. All studies published in the English language between 2000-present were included. Studies on noise annoyance were excluded. Results: There is a strong positive association between occupational noise exposure and cardiovascular outcomes. There is a moderate association with noise in the community setting from road sources and a weak association with aircraft noise. The strength of the association across settings is dependent on the outcome type, interaction with age and sex of subjects, and time of measurement. Road source noise had the strongest association with myocardial infarction, notably in women during night exposures. The association with hypertension and road noise, when stratified by sex, was significant in men during night-time exposures and in pregnant older women. Only nighttime aircraft noise was associated with statistically significant findings in adults. All sources of noise demonstrate a dose response relationship, which peaks at different noise thresholds. Occupational noise exposure had the strongest association with noise > 85 dB (A) and duration of exposure. Conclusion: There is sufficient evidence to warrant the precautionary public health principle to reduce noise at the population levels for industry workers through stronger legislation, regular compliance inspections, and health promotion. Where population wide noise legislation has not yet been enacted, noise exposure reduction at the individual level may be beneficial.

Testing the value of simple arterial blood pressure measurements in a Greek children’s hospital

Arterial hypertension begins in childhood and may continue, without intervention, throughout adulthood with severe health sequelae.The base of timely diagnosis is the systematic blood pressure (BP) measurement. Background: The study aims at revealing the level of parental and community awareness and testing the value of a simple measurement in uncovering children who need further assessment when performing an in-hospital BP screening. Methods: BP was measured in 600 children (0 - 17 yr, mean age 5.1 ± 4.3 yr) at a Children’s hospital. Parents were asked to fill in a specially structured questionnaire. Results: In 47.2% of the subjects (40.1% of them were Greeks and 60.6% foreigners), BP had never been checked before (p arterial BP had never been checked before. Surprisingly, a health certificate was issued for school purposes for 81.2% of the schoolchildren of this study, and 75.3% of the enrolled children were allowed to participate in sports clubs without first checking BP. Moreover, parents demonstrated a low level of alertness with respect to paediatric hypertension. Conclusions: Simple arterial BP measurements can ensure early detection and thus early referral to specialists.

A non-linear relationship between age and atrial fibrillation in Chinese community hypertensive patients

Background Whilst aging is well recognized to be the most significant risk factor for the development of atrial fibrillation(AF),AF also affects young person in whom it is frequently symptomatic and troublesome.The relationship between age and prevalence of AF among patients with hypertension remains uncertain.Methods A retrospective cross-sectional study was conducted in consecutively enrolled hypertensive patients aging more than 18 years old from January 1,2013,to December 31,2013,at the Guangdong community in China. AF was systematically screened and diagnosed by rest 12-lead electrocardiogram(ECG)or self-reported. Univariate and multivariate logistic regression,two-piecewise linear regression model and generalized additive model were performed to evaluate the relationship between age and AF. Results There were 7808 participants including 3678(47.1%)men and 4130(52.9%)women(mean age of 62.3 years old)and 78 cases of AF were identified,including 42 men(53.8%). Both univariate and multivariate logistic regression illustrated that age was positively correlated with AF whether age was analyzed as a continuous(all P <0.0001)or categorical(P for trend <0.001)variable. A non-linear correlation was detected after adjusting for potential confounders and the inflection points were 40 and 60 years. Conclusions The relationship between age and AF is non-linear. Age < 40 years is a protective factor for AF,while age > 60 years is significantly correlated with a higher risk of AF.[S Chin J Cardiol 2019;20(3):146-155]