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.
Background: The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction.
Objective:
To reveal the association of high level of serum uric acid and telomere length in 10-year prospective study using the data from Belarusian national representative survey.
Design and method:
In 2007/2008 a 10-year prospective analysis of 3500 randomized individuals living in a district of Vitebsk started (coverage of the survey was 97.9%). In 2012/2013 there was a second screening of this population (coverage of the survey was 84.3%) respectively. In 2017/2018 a 10-years prospective analysis included subjects with newly diagnosed hypertension in the second screening. Examination of these patients included standard questionnaires for detection of cardiovascular risk factors, measurements of blood pressure, blood chemistry, electrocardiography, echocardiography, ultrasound examination of brachiocephalic vessels, real-time PCR for the detection telomere length of peripheral blood lymphocytes.
Results:
We examined population of 2171 persons with normal blood pressure and 1257 persons with hypertension in 2007/2008. 286 new cases of hypertension developed in 5 years (14,4% of men and 12,2% of women). According to multifactorial regression analysis we revealed significant positive relationship between the frequency of new cases of hypertension and IV quartile of serum uric acid level (339–527 mmol/l) (df = 1; c2Wald = 5,1; p < 0,05) as well as other risk factors, adjusted for age and sex. Regression analysis of 170 randomized subjects showed that the IV quartile of uric acid level (339–527 mmol/l), determined at first screening, was associated with the I quartile of telomere length in 10 years in subjects with newly diagnosed hypertension adjusted for age and sex (df = 1; c2Wald = 4,9; p < 0,05).
Conclusions:
Level of serum uric acid > = 339 mmol/l was a risk factor for the development hypertension in 5 years in randomized urban population and detection of lower level of telomere length in 10 years in persons with new cases of hypertension.
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