Estimated Prevalence of Hypertension and Undiagnosed Hypertension in a Large Inpatient Population: A Cross-sectional Observational Study.
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ABSTRACT: Background
Hypertension is a major cause of morbidity and mortality. In community populations the prevalence of hypertension, both in diagnosed and undiagnosed states, has been widely reported. However, estimates for the prevalence of hospitalized patients with average blood pressures (BPs) that meet criteria for the diagnosis of hypertension are lacking. We aimed to estimate the prevalence of patients in a UK hospital setting, whose average BPs meet current international guidelines for hypertension diagnosis.Methods
We performed a retrospective cross-sectional observational study of patients admitted to adult wards in 4 acute hospitals in Oxford, United Kingdom, between March 2014 and April 2018.Results
We identified 41,455 eligible admitted patients with a total of 1.7 million BP measurements recorded during their hospital admissions. According to European ESC/ESH diagnostic criteria for hypertension, 21.4% (respectively 47% according to American ACC/AHA diagnostic criteria) of patients had a mean BP exceeding the diagnostic threshold for either Stage 1, 2, or 3 hypertension. Similarly, 5% had a mean BP exceeding the ESC/ESH (respectively 13% had a mean BP exceeding the ACC/AHA) diagnostic criteria for hypertension, but no preexisting diagnostic code for hypertension or a prescribed antihypertensive medication during their hospital stay.Conclusions
Large numbers of hospital inpatients have mean in-hospital BPs exceeding diagnostic thresholds for hypertension, with no evidence of diagnosis or treatment in the electronic record. Whether opportunistic screening for in-hospital high BP is a useful way of detecting people with undiagnosed hypertension needs evaluation.
SUBMITTER: Mahdi A
PROVIDER: S-EPMC8457434 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal.DesignThis study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured.SettingNepal.ParticipantsAdult patients with hypertension.ResultsAmong 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=-0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces.ConclusionsUndiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden.
| S-EPMC7534699 | biostudies-literature
Project description:Despite an increasing number of studies exploring prevalence of depression among hypertensive patients in high income countries, limited data is available from low and middle income countries, particularly Nepal. Our aim was to investigate the prevalence of undiagnosed (sub clinical) depression and associated risk factors among hypertensive patients attending a tertiary health care clinic in Nepal.The study was based on a cross-sectional study design, with 321 hypertensive patients attending the Out-Patient Department of a central hospital in Nepal. Blood measure was recorded via a mercury column sphygmomanometer. Depression levels were assessed using the Beck Depression Inventory-Ia (BDI) scale. Demographics and risk factors were assessed.The proportion of participants with undiagnosed depression was 15%. Multivariable analyses demonstrated an increase in BDI scores with increased aging. Approximately a 1 point increase in the BDI score was observed for each additional decade of aging in hypertensive patients. Additional factors associated with increased risk of depression included being female (4.28 point BDI score increase), smoking (5.61 point BDI score increase), being hypertensive with no hypertensive medication (4.46 point BDI score increase) and being illiterate (4.46 point BDI score increase).Among persons with hypertension in outpatient settings in Nepal, demographic (age, sex, education), behavioural (smoking,) and adherence factors (anti-hypertensive medication) were associated with undiagnosed depression. Screening programs in Nepal may assist early intervention in hypertensive patients with sub clinical depression.
| S-EPMC4324992 | biostudies-other
Project description:ObjectiveHypertension (HTN) is an important public health issue worldwide, associated with the rapid economic development and urbanisation over the last decades. This is especially the case in Shenzhen, which has benefited greatly from the reform and opening-up policies. However, there is limited information on the epidemiology of HTN in this region. This study was designed to investigate the prevalence, awareness, treatment and control of HTN and the associated factors among adult residents in Shenzhen, China.DesignPopulation-based, cross-sectional study.ParticipantsThrough the multistage stratified random sampling method, a representative sample of 10 043 urban population aged ≥18 years were selected. Three consecutive blood pressure (BP) readings were measured after resting for a 5 min seat by trained staff and HTN was defined as mean systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or self-reported current use of antihypertensive drugs. Participants were interviewed using a structured questionnaire. Anthropometric details, BP, blood and urine samples were also collected.Primary outcome measurePrevalence of HTN.ResultsOverall, the weighted prevalence of HTN among residents in Shenzhen was 19.2% (95% CI 18.5 to 20.0). Among patients with HTN, 55.0% (95% CI 52.9 to 57.1) were aware of their condition and 44.9% (95% CI 42.8 to 47.1) were taking antihypertensive medications, but only 21.7% (95% CI 20.0 to 23.5) achieved BP control. Among those who knew their HTN, 81.7% (95% CI 79.3 to 83.8) were under treatment and 48.3% (95% CI 45.1 to 51.5) were controlled among those with treated HTN. Male, older age, lower educational level, overweight and obesity, family history of HTN, tobacco smoking, alcohol intake, diabetes mellitus, dyslipidaemia and high uric acid were associated with HTN.ConclusionsHTN is a major public health concern in Shenzhen, which has low awareness, treatment and control rates, and is associated with several risk factors. Effective multifaceted implementation strategies are highly needed to combat the emerging burden of HTN.
| S-EPMC9214353 | biostudies-literature
Project description:BackgroundLittle is known about the impact of rare diseases on inpatient outcomes.ObjectiveTo compare outcomes of inpatients with 0, 1, or > 1 rare disease. A catalogue of 628 ICD-10 coded rare diseases was applied to count rare diseases.DesignRetrospective, cross-sectional study.Subjects165,908 inpatients, Swiss teaching hospital.Main measuresPrimary outcome: in-hospital mortality.Secondary outcomeslength of stay (LOS), intensive care unit (ICU) admissions, ICU LOS, and 30-day readmissions. Associations with single and combined rare diseases were analyzed by multivariable regression.Key resultsPatients with 1 rare disease were at increased risk of in-hospital death (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.67, 1.95), combinations of rare diseases showed stronger associations (OR 2.78; 95% CI 2.39, 3.23). Females with 1 rare disease had an OR of 1.69 (95% CI 1.50, 1.91) for in-hospital death, an OR of 2.99 (95% CI 2.36, 3.79) if they had a combination of rare diseases. Males had an OR of 1.85 (95% CI 1.68, 2.04) and 2.61 (95% CI 2.15, 3.16), respectively. Rare diseases were associated with longer LOS (for 1 and > 1 rare diseases: increase by 28 and 49%), ICU admissions (for 1 and > 1: OR 1.64 [95% CI 1.57, 1.71] and 2.23 [95% CI 2.01, 2.48]), longer ICU LOS (for 1 and > 1 rare diseases: increase by 14 and 40%), and 30-day readmissions (for 1 and > 1: OR 1.57 [95% CI 1.47, 1.68] and 1.64 [95% CI 1.37, 1.96]).ConclusionsRare diseases are independently associated with worse inpatient outcomes. This might be the first study suggesting even stronger associations of combined rare diseases with in-hospital deaths, increased LOS, ICU admissions, increased ICU LOS, and 30-day readmissions.
| S-EPMC7913458 | biostudies-literature
Project description:The study was primarily aimed at estimating the prevalence of hypertension and pre-hypertension and the risk factors of hypertension in the North Indian state of Punjab. It also aimed at assessing the magnitude of undiagnosed cases of hypertension in the community and ascertaining the blood pressure control status of those on treatment.A non-communicable disease risk factor survey (based on WHO-STEPS approach) was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. The study subjects were administered the WHO STEPS-questionnaire and also underwent anthropometric and blood pressure measurements.Overall prevalence of HTN among the study participants was found out to be 40.1% (95% CI: 38.8-41.5%) whereas prevalence of pre-hypertension, isolated diastolic and isolated systolic hypertension were 40.8% (39.5-42.2%), 9.2% (8.4-10.0%) and 6.5% (5.9-7.2%) respectively. Age group (45-69 years), male gender, social group, marital status, alcohol use, obesity and salt intake (> = 5 gms/day) were the risk factors significantly associated with HTN. Among all persons with HTN, only 30.1% were known case of HTN or on treatment, among whom nearly 61% had controlled blood pressure. Patients with uncontrolled BP were more frequently male, obese patients, with sedentary lifestyle and patients with diabetes.The study reported alarmingly high prevalence of hypertension, especially of undiagnosed or untreated cases amongst the adult population, a significant proportion of whom have uncontrolled blood pressure levels. This indicates the need for systematic screening and awareness program to identify the undiagnosed cases in the community and offer early treatment and regular follow up.
| S-EPMC5739392 | biostudies-literature
Project description:BackgroundMultimorbidity prevalence rates vary considerably depending on the conditions considered in the morbidity count, but there is no standardised approach to the number or selection of conditions to include.Methods and findingsWe conducted a cross-sectional study using English primary care data for 1,168,260 participants who were all people alive and permanently registered with 149 included general practices. Outcome measures of the study were prevalence estimates of multimorbidity (defined as ≥2 conditions) when varying the number and selection of conditions considered for 80 conditions. Included conditions featured in ≥1 of the 9 published lists of conditions examined in the study and/or phenotyping algorithms in the Health Data Research UK (HDR-UK) Phenotype Library. First, multimorbidity prevalence was calculated when considering the individually most common 2 conditions, 3 conditions, etc., up to 80 conditions. Second, prevalence was calculated using 9 condition-lists from published studies. Analyses were stratified by dependent variables age, socioeconomic position, and sex. Prevalence when only the 2 commonest conditions were considered was 4.6% (95% CI [4.6, 4.6] p < 0.001), rising to 29.5% (95% CI [29.5, 29.6] p < 0.001) considering the 10 commonest, 35.2% (95% CI [35.1, 35.3] p < 0.001) considering the 20 commonest, and 40.5% (95% CI [40.4, 40.6] p < 0.001) when considering all 80 conditions. The threshold number of conditions at which multimorbidity prevalence was >99% of that measured when considering all 80 conditions was 52 for the whole population but was lower in older people (29 in >80 years) and higher in younger people (71 in 0- to 9-year-olds). Nine published condition-lists were examined; these were either recommended for measuring multimorbidity, used in previous highly cited studies of multimorbidity prevalence, or widely applied measures of "comorbidity." Multimorbidity prevalence using these lists varied from 11.1% to 36.4%. A limitation of the study is that conditions were not always replicated using the same ascertainment rules as previous studies to improve comparability across condition-lists, but this highlights further variability in prevalence estimates across studies.ConclusionsIn this study, we observed that varying the number and selection of conditions results in very large differences in multimorbidity prevalence, and different numbers of conditions are needed to reach ceiling rates of multimorbidity prevalence in certain groups of people. These findings imply that there is a need for a standardised approach to defining multimorbidity, and to facilitate this, researchers can use existing condition-lists associated with highest multimorbidity prevalence.
| S-EPMC10072475 | biostudies-literature
Project description:Systemic arterial hypertension is the most prevalent chronic noncommunicable disease among older people. This study aimed to estimate the prevalence of hypertension in the elderly and to analyze factors associated with diagnosed, undiagnosed, and uncontrolled hypertension. This is a cross-sectional study of data from the SABE study-Health, Well-Being, and Aging Survey-a multiple-cohort study, obtained in 2010, composed of a probabilistic sample representative of the population of the São Paulo city aged ?60?years. Hypertension was self-reported or defined by increased blood pressure. Multinomial regression assessed factors associated with diagnosis and lack of diagnosis of hypertension (reference: no hypertension), and logistic regression assessed factors associated with uncontrolled hypertension (reference: controlled). The prevalence of hypertension was 79.5%, and in 51% of individuals with the condition, hypertension was uncontrolled. Undiagnosed hypertension was associated with nonwhite skin color (OR: 1.89, CI: 1.11-3.19), being uninsured (OR: 1.77, CI: 1.04-3.03), overweight (OR: 2.38, CI: 1.09-5.19), higher education (OR: 0.46, CI: 0.22-1.94), and ?1 chronic disease (OR: 0.28; CI: 0.13-0.58). Diagnosed hypertension was associated with age between 70 and 79?years (OR: 2.02, CI: 1.34-3.05), age ?80 (OR: 2.73, CI: 1.72-4.31), nonwhite skin color (OR: 1.48, CI: 1.01-2.18), being uninsured (OR: 1.70, CI: 1.18-2.47), at least one medical consultation in the last year (OR: 1.86, CI: 1.06-3.25), obesity (OR: 2.50, CI: 1.61-3.88), and ?1 chronic disease (OR: 2.81, CI: 1.94-4.08). Among those with hypertension, being uncontrolled was associated with widowhood (OR: 1.73, CI: 1.23-2.43), being uninsured (OR: 1.38, CI: 1.02-1.87), and female gender (OR: 0.61, CI: 0.43-0.87). The prevalence of hypertension was high in this population, and its diagnosis and control were associated with socioeconomic, demographic, and healthcare access factors.
| S-EPMC6745120 | biostudies-literature
Project description:ObjectiveCurrently, the prevalence of hypertension is mainly ascertained using a one-visit population survey, which may lead to overestimation. The purpose of this study was to assess the accuracy of hypertension prevalence determined by a one-visit population survey.MethodsFor this cross-sectional study, we continuously enrolled 1116 volunteers without a hypertension history in Hebei province from January 2018 to December 2019. The study population included 511 (45.80%) males and 605 (54.20%) females with a mean age of 48 years. The hypertension prevalence was assessed using two methods: one-visit screening and daytime ambulatory blood pressure (BP) monitoring. We directly compared the performances of daytime ambulatory BP monitoring and one-visit screening in the same group of subjects. In addition, we explored possible thresholds to improve the detection of hypertension.ResultsDuring the one-visit survey, the mean BP value was about 8 mmHg higher than that determined by daytime ambulatory BP monitoring. The prevalence of hypertension was 29.84% and 14.07% during the one-visit and daytime multiple visit surveys, respectively. The risk factors for overestimated hypertension were female sex, body mass index < 24.00 kg/m2, and diastolic BP of 100 mmHg. The positive predictive value of the one-visit population survey for diagnosing hypertension was 36.34%. Furthermore, receiver operating characteristic analysis showed that in males, the best diagnostic threshold for hypertension diagnosis was 148/96 mmHg.ConclusionThe hypertension prevalence was likely overestimated by 2-fold in the one-visit survey group compared to the daytime ambulatory BP monitoring group. Thus, the threshold for one-visit BP screening should be raised to 148/96 mmHg to improve the accuracy of hypertension diagnosis.
| S-EPMC9743587 | biostudies-literature
Project description:ObjectiveThe aim of this study was to determine the prevalence of Chlamydia trachomatis infection in undiagnosed young people aged between 15 and 24 years.Materials and methodsA convenience sample of 623 youths, with a mean (SD) age of 20.1 (2.2) years, was recruited from key spaces in the North Metropolitan area of Barcelona in Catalonia, Spain. Participants completed a 21-item questionnaire and provided a urine sample or vaginal swab for testing.ResultsThe most common age at the first sexual intercourse was 16 years (24.6%), followed by 15 years (21.3%). Only 32.6% reported always use of condoms, 49.2% sometimes, and 15.6% never. A positive test for chlamydia was found in 34 participants (5.5%; 95% CI, 3.8-7.5), with no difference by sex. A positive test was significantly more common among the participants who were working, who had been diagnosed with a sexually transmitted disease (STD) at some point in their life, and who used web pages/apps to find new sexual partners more than once a month. In the multivariate analysis, working status was an independent factor associated with chlamydial infection (adjusted odds ratio[OR], 8.88; 95% CI, 1.71-46.17), whereas not having been previously diagnosed with an STD (OR, 0.34; 95% CI, 0.07-1.49) and never using the Internet to find sexual partners (OR, 0.16; 95% CI, 0.03-080) were protective factors against chlamydial infection.ConclusionsThe prevalence of C. trachomatis infection was 5.5%. Working status, a previous diagnosis of STD, and use of the Internet to find new sexual partners were associated with chlamydial test positivity.
| S-EPMC9232277 | biostudies-literature
Project description:OBJECTIVES:This study aimed to elucidate the status of hypertension and to analyse the hypertension changes in prevalence, awareness, treatment and control rate among the portion of Chinese nursing staff based on the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) High Blood Pressure Guideline and the 2010 Chinese Guideline for the Management of Hypertension. DESIGN:Cross-sectional study. SETTING:512 medical institutions in 13 cities in Hebei Province. PARTICIPANTS:The candidates of registered nurses from 512 medical institutions in 13 cities in Hebei Province (N=143?772) were invited to participate in the survey, and few of them who refused to participate were excluded from the research group based on the reasons that 93?603 incumbent nurses at the age of 18-65 accepted to the survey and submitted questionnaires online. Undoubtedly, a response rate of 65.11% was achieved. After excluding 788 individuals with incomplete information in the questionnaires, 92?815 participants were included in the final analysis. MAIN OUTCOME MEASURES:The prevalence, awareness, treatment and control rates of hypertension. RESULTS:92?815 participants were included in the final analysis, among which consisted of 3677 men (3.96%) and 89?138 women (96.04%). The mean age of the participants was 31.65 (SD=7.47) years.We demonstrated that 26?875 nursing staff were diagnosed as having hypertension according to the new standard by the 2017 ACC/AHA guideline, more than 20?551 cases compared with the previous threshold on the 2010 Chinese guideline. The prevalence of hypertension among nursing staff was 28.96% in the context of the 2017 ACC/AHA guideline, 3.25 times higher than that (6.81%) evaluated by the criteria of the 2010 Chinese guideline. However, the awareness, treatment and control rate (13.50%, 10.73% and 0.81%) were 3.25, 3.22 and 17.48 times lower than those (57.37%, 45.30% and 14.97%) based on the 2010 Chinese guideline, respectively. CONCLUSIONS:This research illustrated that it was crucial to improve the awareness rate, drug treatment rate and control rate of hypertension for nurses. Meanwhile, according to the 2017 ACC/AHA guideline, the prevalence of hypertension in China will increase significantly, which poses a more severe challenge to the management of hypertension in China.
| S-EPMC6720136 | biostudies-literature