We evaluated the prevalence, awareness, treatment, and control of hypertension (defined as a systolic blood pressure [BP]) ≥140 mm Hg, diastolic BP ≥90 mm Hg, or a self-reported use of an antihypertensive agent) among US adults, stratified by race/ethnicity. This analysis included 16 531 nonpregnant US adults (≥18 years) in the three National Health and Nutrition Examination Survey cycles between 2013 and 2018. Race/ethnicity was defined by self-report as White, Black, Hispanic, Asian, or other Americans. Among 76 910 050 (74 449 985–79 370 115) US adults with hypertension, 48.6% (47.3%–49.8%, unadjusted) have controlled BP. When compared with BP control rates for White adults (49.0% [46.8%–51.2%], age-adjusted), BP control rates are lower in Black (39.2%, adjusted odds ratio [aOR], 0.71 [95% CI, 0.59–0.85], P <0.001), Hispanic (40.0%, aOR, 0.71 [95% CI, 0.58–0.88], P =0.003), and Asian (37.8%, aOR, 0.68 [95% CI, 0.55–0.84], P =0.001) Americans. Black adults have higher hypertension prevalence (45.3% versus 31.4%, aOR, 2.24 [95% CI, 1.97–2.56], P <0.001) but similar awareness and treatment rates as White adults. Hispanic adults have similar hypertension prevalence, but lower awareness (71.1% versus 79.1%, aOR, 0.72 [95% CI, 0.58–0.89], P =0.005) and treatment rates (60.5% versus 67.3%, aOR, 0.78 [95% CI, 0.66–0.94], P =0.010) than White adults. Asian adults have similar hypertension prevalence, lower awareness (72.5% versus 79.1%, aOR, 0.75 [95% CI, 0.58–0.97], P =0.038) but similar treatment rates. Black, Hispanic, and Asian Americans have different vulnerabilities in the hypertension control cascade of prevalence, awareness, treatment, and control. These differences can inform targeted public health efforts to promote health equity and reduce the burden of hypertension in the United States.
Rosacea is a common, chronic skin disease that is currently incurable. Although environmental factors influence rosacea, the genetic basis of rosacea is not established. In this genome-wide association study, a discovery group of 22,952 individuals (2,618 rosacea cases and 20,334 controls) was analyzed, leading to identification of two significant single-nucleotide polymorphisms (SNPs) associated with rosacea, one of which replicated in a new group of 29,481 individuals (3,205 rosacea cases and 26,262 controls). The confirmed SNP, rs763035 (P=8.0 × 10−11 discovery group; P=0.00031 replication group), is intergenic between HLA-DRA and BTNL2. Exploratory immunohistochemical analysis of HLA-DRA and BTNL2 expression in papulopustular rosacea lesions from six individuals, including one with the rs763035 variant, revealed staining in the perifollicular inflammatory infiltrate of rosacea for both proteins. In addition, three HLA alleles, all MHC class II proteins, were significantly associated with rosacea in the discovery group and confirmed in the replication group: HLA-DRB1*03:01 (P=1.0 × 10−8 discovery group; P=4.4 × 10−6 replication group), HLA-DQB1*02:01 (P=1.3 × 10−8 discovery group; P=7.2 × 10−6 replication group), and HLA-DQA1*05:01 (P=1.4 × 10−8 discovery group; P=7.6 × 10−6 replication group). Collectively, the gene variants identified in this study support the concept of a genetic component for rosacea, and provide candidate targets for future studies to better understand and treat rosacea.
31Aspirin is one of the most frequently used drugs worldwide and is generally considered effective 32 for the secondary prevention of cardiovascular disease (CVD). In contrast, the role of aspirin in 33 primary prevention of CVD is controversial. Early trials evaluating aspirin for primary 34 prevention, conducted before the turn of the millennium, suggested possible reductions in MI 35 and stroke, although not mortality, and an increased risk of bleeding. In an effort to balance the 36 risks and benefits of aspirin, international guidelines on primary prevention of CVD have 37 typically recommended aspirin only when there is a substantial 10-year risk of CV events. 38 However, recent, large randomized clinical trials of aspirin for the primary prevention of CVD 39 demonstrate little or no benefit and possible harm. In this narrative review, we reappraise the role 40 of aspirin in primary prevention of CVD contextualizing data from historical and contemporary 41 trials. 42 43 1897 ( Figure). 2 51 Almost a century later, in 1974, a randomized controlled trial showed a non-significant 52 reduction in deaths amongst patients with a recent myocardial infarction (MI) who were assigned 53 to aspirin 330mg/day. 3 This launched a series of trials that resulted in widespread acceptance of 54 aspirin for the secondary prevention of major adverse cardiovascular events (MACE). 4-11 55Enthusiasm for aspirin led to further randomized controlled trials investigating whether aspirin 56 might be effective for the primary prevention of cardiovascular disease (CVD). [12][13][14][15][16][17] Several 57 primary prevention trials, mostly conducted before the turn of the millennium, suggested 58 reduction in MI and stroke, although not mortality 16 , and at a cost of increased bleeding 59 events. 12-15 These findings influenced guidelines, which recommended prescribing aspirin for 60 primary CVD prevention in high-risk individuals. [18][19][20] Aspirin is now one of the most widely 61 used medications. In the U.S. alone, it is estimated that 35.8 million adults are taking aspirin for 62 the primary prevention of CVD, often without consulting their physicians. 23 63 Despite aspirin's popularity, its use for the primary prevention of CVD is controversial. 64Indeed, the U.S. Food and Drug Administration (FDA) has never approved the labeling of 65 aspirin for this purpose. The European Medicines Agency (EMA) have not addressed this 66 4 question. Furthermore, recent clinical trial data have placed the utility of aspirin for the primary 67 prevention of CVD back under scrutiny due to their neutral results 24,25 or evidence of harm. 26 In 68 this article, we summarize the mechanism of action, review historical and contemporary trials 69 evaluating aspirin, and reflect on future directions for aspirin in the prevention of CVD. 70 71 Search Strategy and Selection Criteria 72PubMed was used to identify relevant references using the search terms "aspirin", and "primary 73 prevention". We also searched all of the references in recent systemati...
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