Background Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. Methods Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Results Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02–1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01–1.13], diabetes (OR = 1.18, 95% CI [1.11–1.25], Smoking (OR = 1.15, 95% CI [1.05–1.25]), Obesity (OR = 1.14, 95% CI[1.07–1.21]), management in public sector (OR = 1.25, 95% CI [1.16–1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48–1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84–0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8–0.93]), salt restriction (OR = 0.48, 95% CI [0.45–0.51]), drug compliance (OR = 0.57, 95% CI[0.52–0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71–0.84]) are strong predictors of blood pressure control. Conclusion NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.
Background Coronary artery disease remains the most common cause of morbidity and mortality in the general population. Several studies in developed countries have reported a gender-related difference in ST-segment elevation myocardial infarction (STEMI) in terms of risk factors, clinical presentation, delays in management, therapeutic modalities, and in-hospital as well as one-year outcomes. Data from non-developed countries about women with STEMI remain rare. We therefore aimed through this study to investigate the baseline characteristics of STEMI in Tunisian women compared to men and to determine the impact of gender difference on STEMI complications, in-hospital mortality, and one-year follow-up outcomes. Methods All patients presenting to our center for STEMI between January 2001 and January 2021 were retrospectively enrolled in this analysis. Clinical features, therapeutic management, and in-hospital as well as one-year outcomes were compared between women and men. Predictive factors of in-hospital mortality in women were determined. Results Out of 1670 STEMI hospitalizations, 359 (21.4%) were female. Compared to male, female had higher rates of hypertension (51.5% vs. 24.4%, p < 0.001), diabetes (50.1% vs. 32.2%, p < 0.001), and obesity (63.8% vs. 55%, p = 0.003). The clinical presentation was characterized by less prevalent inaugural chest pain (58.8% vs. 68.6%, p < 0.001). Atypical symptoms were significantly higher in women compared to men (55.2% vs. 5%, p<0.001). On admission, women had higher prevalence of anemia, renal failure, and hyperglycemia compared to men. Primary percutaneous coronary intervention (pPCI) was the reperfusion strategy of choice in 37.9% of women vs. 33.1% of men (p=0.02). Women were significantly less likely to receive thrombolysis (p = 0.004), with a significantly less prevalent successful thrombolysis (55.6% vs. 67.2%, p=0.013). In-hospital mortality was markedly higher in women compared to men (12.8% vs. 7.3%, p=0.001). Compared to surviving women (n = 313), those who died (n = 46) frequently had more diabetes and hypertension (65.2% vs. 47.9%, p= 0.02 and 67.4% vs. 49.2%, p = 0.02, respectively). New-onset atrial fibrillation, acute left heart failure, cardiogenic shock, ventricular tachycardia, and atrioventricular block markedly occurred in women who died (52.2% vs. 23.3%, p=<0.001; 17.4% vs. 1.9%, p < 0.001; 19.6% vs. 8.3%, p = 0.016; 15.2% vs. 1.6%, p < 0.001 and 34.8% vs. 10.2%, p < 0.001, respectively). Conclusion Compared to men, Tunisian women presenting for STEMI had higher prevalence of risk factors and atypical symptoms. Women had more in-hospital complications and mortality.
Objective:to assess features and in-hospital prognosis in STEMI patients treated by PPCI and presenting reduced or preserved LVEF.In-hospital mortality and complications were compared between patients with preserved or reduced LVEFDesign and method:All patients admitted for STEMI between 2000 and 2019 and treated by PPCI were enrolled. On-admission echocardiography was performed in all patients after PPCI to determine LVEF.In-hospital mortality and complications were compared between patients with preserved or reduced LVEFResults:A total of 725 was studied. Mean age was 59.1 ± 12.2 years old and 148 (20.4%) were female. Diabetes, hypertension, obesity and tobacco consumption represented 36%, 26.9%, 41.1% and 67.7% respectively. Reduced LVEF< 50% was diagnosed in 324 patients (44.7%). In-hospital mortality was significantly higher in patients with reduced LVEF compared to patients with preserved LVEF on-admission. In-hospital outcomes including atrial fibrillation, ventricle tachycardia and fibrillation, atrioventricular block and pericardial effusion were significantly higher in reduced LVEF.Preserved LVEFReduced LVEFPFEMALE GENDER75 (18.7%)73 (22.5%)0.2Elderly >░75░years old41 (10.2%)42 (13%)0.2Diabetes123 (30.7%)138 (42.6%)0.001Hypertension104 (25.9%)91 (28.1%)0.5Tobacco285 (71.1%)206 (63.6%)0.03Renal failure19 (4.7%)32 (9.9%)0.007Acute right ventricle dysfunction6 (1.5%)33 (10.2%)<░0.001Atrial fibrillation9 (2.2%)34 (10.5%)<░0.001Ventricular tachycardia1 (0.2%)20 (6.2%)<░0.001Ventricular fibrillation3 (0.7%)24 (7.4%)<░0.001Atrioventricular block068 (21%)<░0.001Pericardial effusion8 (2%)25 (7.7%)<░0.001In-hospital mortality2 (0.5%)53 (16.4%)<░0.001Conclusions:Patients presented STEMI managed by PCI and presenting reduced LVEF on admission are more exposed to in-hospital mortality and complications.
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