Chu Pak Lau

Prevalence, Awareness, Treatment, and Control of Hypertension Among United States Adults 1999–2004

Detection of hypertension and blood pressure control are critically important for reducing the risk of heart attacks and strokes. We analyzed the trends in the prevalence, awareness, treatment, and control of hypertension in the United States in the period 1999–2004. We used the National Health and Nutrition Examination Survey 1999–2004 database. Blood pressure information on 14 653 individuals (4749 in 1999–2000, 5032 in 2001–2002, and 4872 in 2003–2004) aged ≥18 years was used. Hypertension was defined as blood pressure ≥140/90 mm Hg or taking antihypertensive medications. The prevalence of hypertension in 2003–2004 was 7.3±0.9%, 32.6±2.0%, and 66.3±1.8% in the 18 to 39, 40 to 59, and ≥60 age groups, respectively. The overall prevalence was 29.3%. When compared with 1999–2000, there were nonsignificant increases in the overall prevalence, awareness, and treatment rates of hypertension. The blood pressure control rate was 29.2±2.3% in 1999–2000 and 36.8±2.3% in 2003–2004. The age-adjusted increase in control rate was 8.1% (95% CI: 2.4 to 13.8%; P=0.006). The control rates increased significantly in both sexes, non-Hispanic blacks, and Mexican Americans. Among the ≥60 age group, the awareness, treatment, and control rates of hypertension had all increased significantly (P≤0.01). The improvement in blood pressure control is encouraging, although the prevalence of hypertension has not declined.

Components of the metabolic syndrome predictive of its development: A 6-year longitudinal study in Hong Kong Chinese

Objective  To investigate which of the components of the metabolic syndrome best predict its development.

Meta-analysis of large outcome trials of angiotensin receptor blockers in hypertension

Angiotensin receptor blockers (ARBs), also known as sartans, block the activation of angiotensin type 1 receptors and have a recognised role in the treatment of heart failure and nephropathy. Since 2002, there have been three major outcome trials of ARBs in hypertension. We performed a meta-analysis to evaluate the impact of ARB on major outcomes. Randomised controlled trials of ARBs in hypertensive subjects with an average follow-up of at least 2 years and at least 100 major cardiovascular events were included. For each trial, the ARB used, number and characteristics of subjects, baseline and change in blood pressure, cardiovascular and noncardiovascular outcomes were recorded. Three trials involving 29 375 subjects were included in the meta-analysis. In Losartan Intervention For Endpoint (LIFE) and Study on Cognition and Prognosis in the Elderly (SCOPE) but not in Valsartan Antihypertensive Long-term Use Evaluation trial (VALUE), an ARB reduced the occurrence of the primary end point and stroke compared to control. Compared to other antihypertensive drugs, ARB treatment was associated with no significant change in all-cause mortality (relative risk ratio (RRR) 0.96, 95% CI: 0.88–1.06, P=0.45). There was an increase in myocardial infarction (RRR, 1.12, 95% CI: 1.01–1.26, P=0.041), but a decrease in new-onset diabetes mellitus (RRR, 0.80, 95% CI: 0.74–0.86, P<0.0000001). In conclusion, the reduction in new-onset diabetes partly offsets any increase in the risk of myocardial infarction. Most hypertensive patients require more than one class of drugs. Small differences in treatment outcome should not over-ride the importance of good blood pressure control.

Association between plasma alkaline phosphatase and C-reactive protein in Hong Kong Chinese.

Abstract Background: Alkaline phosphatase (ALP) is a biomarker for hepatobiliary and skeletal diseases. It is also raised in sepsis. In atherosclerotic plaques, ALP is expressed. Similar to C-reactive protein (CRP), it may be another marker of systemic inflammation. Therefore, we investigated their association in a Hong Kong Chinese population. Methods: Plasma ALP and CRP were measured in 205 subjects (110 men, 95 women; age 55.2±11.6 years) in the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 cohort. Results: The blood levels of ALP and CRP were significantly correlated (r=0.30, p<0.001), which was due to a significant correlation in women (r=0.43, p<0.001). In a multivariate model, CRP level was related to ALP (β=0.18, p=0.008). After adjusting for confounding factors and other liver enzymes, the relationship between ALP and CRP remained significant in women (β=0.28, p=0.019), but in men, ALP was not an independent determinant of CRP levels. Conclusions: ALP may be another marker of systemic inflammation, especially in women. Whether it provides clinical information additional to CRP requires further study. Clin Chem Lab Med 2008;46:523–7.

Smoking, Alcohol Drinking and Non-Fatal Coronary Heart Disease in Hong Kong Chinese

PURPOSE To examine whether smoking, alcohol drinking and other risk factors were associated with non-fatal coronary heart disease (CHD) in Hong Kong Chinese. METHODS A case control study was carried out with 598 CHD hospital cases (431 men, 167 women) and 1100 community controls (663 men, 437 women). Standardized questionnaires were used and blood lipids were measured using standard methods. RESULTS Stepwise logistic regression models showed adjusted odds ratios (AOR) of 3.36 [95% confidence interval (CI): 2.35 to 4.81] for smoking and 0.32 (95% CI: 0.22 to 0.45) for alcohol drinking in men, and 6.50 (95% CI: 2.61 to 16.19) and 0.15 (95% CI: 0.08 to 0.30), respectively, in women. The OR increased with decreasing levels of high-density lipoprotein cholesterol (HDL) and increasing levels of triglycerides. No patterns were observed for body mass index (BMI), total and low-density lipoprotein cholesterol (LDL). The protective effect of drinking was observed for different types of drinks and frequency of drinking, although few drank alcohol more than 3 days per week. CONCLUSIONS Smoking was a strong risk factor and moderate alcohol drinking was a protective factor for CHD, and low HDL and high triglyceride levels were important risk factors in Hong Kong Chinese.

High density lipoprotein‐cholesterol levels increase with age in American women but not in Hong Kong Chinese women

Objectives  High‐density lipoprotein (HDL) cholesterol is a powerful cardiovascular risk factor. Important gender and ethnic differences in plasma HDL levels exist and warrant investigation.