High blood pressure in Latin America: a call to action

Rubinstein, Adolfo; Alcocer, Luis; Chagas, Antônio Carlos Palandri

doi:10.1177/1753944709338084

Cited by 27 publications

(28 citation statements)

References 81 publications

(116 reference statements)

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“…62 In this regard, this study extends existing research on hypertension in Latin American that has particularly focused on individual-level explanations using quantitative approaches. [63][64][65] Second, we engaged local actors in examining the contributions to hypertension across levels of an ecological model. Findings such as these are crucial in public health as they represent the particular social world of participants and extend the few studies aimed at directly exploring lay understandings of the causes of health risks and disparities, 66 as well as the role of place in framing a particular public health problem.…”

Section: Discussionmentioning

confidence: 99%

Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

2016

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Conditions in the social and physical environment influence population health and risk for CVD, including hypertension. These environmental conditions are influenced by the decisions of public officials, community leaders, and service providers. Examining the frames that local decision makers bring to understanding hypertension can provide important insights into the decisions that they make about strategies for addressing this problem in their jurisdiction. The goal of this study was to examine the frames that local decision makers in Quibdó, Colombia, bring to understanding hypertension risk, and in particular, whether and how they use frames that encompass associations between living conditions and hypertension risk. Data for this qualitative study were collected using a stratified sampling strategy. Semi-structured interviews were conducted in 2012 with 13 local decision makers and analyzed using a framework approach. Participants linked the structural conditions experienced in Quibdó, including displacement, limited economic opportunities, and the infrastructure of the city, to hypertension risk through multiple pathways, including behavioral risk factors for hypertension and physiologic responses to stress. They described the social patterning of these factors across socioeconomic, racial/ethnic, and gender hierarchies. Although several conditions associated with hypertension risk are widely distributed in the city's population, social processes of marginalization and stratification create additional disadvantages for those on the lower rungs of the social hierarchy.

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Section: Discussionmentioning

confidence: 99%

Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

2016

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“…Atherothrombosis is the main cause of chronic morbidity and mortality worldwide 1,2. This complex condition, pragmatically classified as coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease (PAD) according to disease location, is now becoming an important health strain in low‐ to medium‐income nations 3–6. For some Latin American countries, chronic vascular disease will become an unbearable burden in the near future 4–6.…”

Section: Introductionmentioning

confidence: 99%

Atherothrombotic Disease, Traditional Risk Factors, and 4‐Year Mortality in a Latin American Population: The REACH Registry

Cantú-Brito

Chiquete

Ruiz-Sandoval

et al. 2012

Clinical Cardiology

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Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated factors associated with 4-year all-cause mortality in a Latin American population at high risk. Hypothesis: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and cardiovascular mortality in this Latin American cohort. Methods: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued Health registry. Results: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease, and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%), hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension (89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality were congestive heart failure (hazard ratio [HR]: 3.81), body mass index <20 (HR: 2.32), hypertension (HR: 1.84), polyvascular disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were associated with a reduced risk. Conclusions: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin American cohort. Nearly one-third of the population with 3 symptomatic vascular-disease locations died at 4-year follow-up.The REACH registry is sponsored by sanofi, Bristol-Myers Squibb, and the Waksman Foundation (Tokyo, Japan). The REACH registry is endorsed by the World Heart Federation. The REACH registry enforces a no-ghostwriting policy.

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“…[67] In the ENCORE II study, significant improvements in coronary endothelial function that persisted for at least 2 years, and a positive, non-significant trend in reduction of atheroma volume were observed with nifedipine. [33,68] A non-significant trend towards a lower rate of mean intimal thickening with CCBs compared with diuretics was seen in two 3-or 4-year studies. [69,70] In VHAS, verapamil 240 mg once daily was compared with chlorthalidone 25 mg once daily.…”

Section: Additional Benefits Of Ccbsmentioning

confidence: 82%

“…Achieving these ambitious goals will require collaborative efforts by many groups, including policy-makers, international organizations, healthcare providers, schools, and society as a whole. [33] 3. Calcium Channel Blocker (CCB) Monotherapy: BP Control and Associated CV Risk Reduction When administered as monotherapy, CCBs have generally been shown to be at least as effective, if not more effective, compared with other hypertensive classes in terms of BP control in patients with hypertension.…”

Section: The Reality Of CV Risk In Latin Americamentioning

confidence: 99%

Use of Calcium Channel Blockers in Cardiovascular Risk Reduction

Alcocer

Boccadoro²,

Acosta

et al. 2010

American Journal Cardiovascular Drugs

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Cardiovascular disease (CVD) is a continuum that begins with the presence of several risk factors for CVD, including smoking, hypertension, obesity, diabetes mellitus, and high levels of cholesterol, and if unaddressed can result in premature death, ischemic heart disease, stroke, congestive heart failure, and end-stage renal disease. Hypertension is associated with a significant increase in cardiovascular (CV) morbidity and mortality, raising the risk of stroke, myocardial infarction, heart failure, kidney disease, and peripheral arterial disease. In Latin America, the prevalence of hypertension and other CV risk factors has become similar to that seen in more developed countries, increasing the proportion of the population at high risk for CVD and congestive heart failure; however, it is hypertension that is a key driving force behind CV risk in Latin America. Despite the existence of a wide range of antihypertensive agents, BP control and reductions in CV risk remain poor in Latin America and in Hispanics living in the US. Ethnic differences in treatment rates and disease awareness have been well documented. Studies have shown that calcium channel blockers (CCBs; calcium channel antagonists) are at least as effective in reducing BP and improving the CV risk profile as other classes of antihypertensive agents when administered as monotherapy. CCBs have also been shown to be effective when administered as part of combination therapy in both low- and high-risk hypertensive patients, suggesting that CCBs can easily be combined with other antihypertensive classes in order to achieve BP control and CV risk reduction. In patients with hypertension, coronary artery disease, and high cholesterol, CCBs have been associated with beneficial effects on a range of other aspects of the CV continuum, including the vasculature, coronary calcification, and progression of atherosclerosis. CCBs have also been shown to preserve renal function. Unlike diuretics and beta-adrenoreceptor antagonists, CCBs are metabolically neutral, inducing minimal changes in serum lipids and decreasing the incidence of new-onset diabetes compared with other antihypertensive agents. CCBs are well tolerated when administered as monotherapy or combination therapy, with long-acting formulations minimizing adverse events even further compared with short-acting formulations. These characteristics make CCBs an attractive option for the treatment of hypertension and CV risk in Latin America, which remain significant health issues in this region.

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High blood pressure in Latin America: a call to action

Cited by 27 publications

References 81 publications

Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

Atherothrombotic Disease, Traditional Risk Factors, and 4‐Year Mortality in a Latin American Population: The REACH Registry

Use of Calcium Channel Blockers in Cardiovascular Risk Reduction

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