Marta Pereira

Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries.

Objective To systematically review quantitative differences in the prevalence, awareness, treatment and control of hypertension between developed and developing countries over the past 6 years. Methods We searched Medline [prevalence AND awareness AND treatment AND control AND (hypertension OR high blood pressure)] for population-based surveys. Prevalence, awareness, treatment and control of hypertension were compared between men and women, and between developing and developed countries, adjusting for age. The proportions of awareness, treatment and control were defined relative to the total number of hypertensive patients. Results We identified 248 articles, of which 204 did not fulfill inclusion criteria. The remaining articles reported data from 35 countries. Among men, the mean prevalence, awareness, treatment and control of hypertension were 32.2, 40.6, 29.2 and 9.8%, respectively, in developing countries and 40.8, 49.2, 29.1 and 10.8%, respectively, in developed countries. Among women, the mean prevalence, awareness, treatment and control of hypertension were 30.5, 52.7, 40.5, and 16.2%, respectively, in developing countries and 33.0, 61.7, 40.6 and 17.3%, respectively, in developed countries. After adjusting for age, the prevalence of hypertension among men was lower in developing than in developed countries (difference, −6.5%; 95% confidence interval, −11.3 to −1.8%). Conclusion There were no significant differences in mean prevalence, awareness, treatment and control of hypertension between developed and developing countries, except for a higher prevalence among men in developed countries. The prevalence, awareness, treatment and control of hypertension in developing countries are coming closer to those in developed countries.

Trends of BMI and prevalence of overweight and obesity in Portugal (1995–2005): a systematic review

OBJECTIVE Locale-specific data on BMI and overweight/obesity are necessary to understand how the obesity epidemic is evolving in each setting. We aimed to describe the temporal trends of mean BMI and prevalences of overweight/obesity in studies that evaluated Portuguese adults and older people. DESIGN Systematic review, conducted via a PubMed search up to January 2011 and independent reference screening and data extraction. Twenty-one eligible studies were identified. Data were extracted from the published reports and obtained from the authors of seven of the largest studies. Adjusted ecological estimates of mean BMI and prevalences of overweight/obesity were computed by linear regression. RESULTS Between 1995 and 2005, when using data obtained from anthropometric measurements, overweight prevalence increased by 3·2 % and 3·5 % and obesity prevalence by 7·4 % and 1·3 % among women and men, respectively, while mean BMI did not vary meaningfully. When using self-reported information, mean BMI increased by 0·8 kg/m2 and 0·9 kg/m2, overweight prevalence by 3·5 % and 3·7 % and obesity prevalence by 5·8 % and 5·5 % among women and men, respectively. Results from the 20-year-old conscripts (1960-2000) showed a marked increase in these outcomes in the last decades. CONCLUSIONS Our results show an important increase in overweight/obesity in younger ages. The trends in the indicators derived from self-reported data suggest an increase in awareness of the importance of overweight/obesity among the population.

Trends in hypertension prevalence (1990–2005) and mean blood pressure (1975–2005) in Portugal: a systematic review

Aims. We aimed to describe the temporal trends of the mean blood pressure and prevalence of hypertension in studies that evaluated Portuguese adults. Methods. Pubmed was searched and 42 eligible studies were identified. Reference screening and data extraction were conducted independently by two researchers. We fitted linear regression models to compute ecological estimates of hypertension prevalence and mean blood pressure, adjusting for sex, age and significant interaction terms. Results. Between 1990 and 2005, the prevalence of hypertension defined as blood pressure ≥140/90 mmHg and/or drug treatment remained approximately constant in young adults and decreased in middle-aged and older adults, whereas the prevalence of self-reported hypertension increased 0.4% per year (95% confidence interval 0.1–0.7) overall. Between 1975 and 2005, mean systolic and diastolic blood pressures decreased in middle-aged and older adults, reaching a 32-mmHg decrease in systolic blood pressure among women at average age 70. Conclusion. The trends in the last decades show a decrease in blood pressure levels, probably attributable to increasing awareness and a higher treatment proportion. Although this absolute trend in blood pressure parallels the observed in other high income European countries, Portugal maintains its position above the mean levels in other Western settings.

Epidemiology of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Colonization Among Patients and Healthcare Workers in a Portuguese Hospital: A Pre-intervention Study Toward the Control of MRSA

This two-year study investigated the epidemiology of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) among patients and healthcare workers (HCWs) in two wards with a high frequency of MRSA isolation, at Hospital Geral de Santo António (HGSA), Portugal. Three point-prevalence surveys per year were carried out. A case-control approach was used to identify potential risk factors associated with MRSA carriage among patients. Incidence rates and risk factors of MRSA carriage among HCWs who were negative at the baseline observation were estimated. Prevalence of MRSA carriage among 276 patients screened was 5.1%. Admission to HGSA or attendance to the Diabetic Foot Outpatient Unit (DFOU) of HGSA within the past 12 months, and previous MRSA isolation were significant risk factors for MRSA carriage. Among HCWs (n = 126), the prevalence of MRSA carriage was 4.8% and the incidence rate was 61/1000 person-years. Nurses and nurse aids were the HCW categories with the highest risk of becoming colonized with MRSA over time (p = 0.01). One HCW chronically colonized was detected. Molecular typing revealed a clonal identity for isolates recovered from patients and HCWs of the same wards, with 88.6% of isolates belonging to the EMRSA-15 (ST22-MRSA-IV) clone.

International differences in acute coronary syndrome patients’ baseline characteristics, clinical management and outcomes in Western Europe: the EURHOBOP study

Objective We aimed to describe current characteristics of patients admitted for acute coronary syndrome (ACS) in Western Europe and to analyse whether international in-hospital mortality variations are explained by differences in patients’ baseline characteristics and in clinical management. Methods We studied a population-based longitudinal cohort conducted in Finland, France, Germany, Greece, Portugal and Spain, and comprising 12 231 consecutive ACS patients admitted in 53 hospitals between 2008 and 2010. Baseline characteristics, clinical management and inhospital outcomes were recorded. Contextual effect of country on death was analysed through multilevel analysis. Results Of all patients included, 8221 (67.2%) had NSTEMI (non-ST-elevation myocardial infarction), and 4010 (32.8%) had STEMI (ST-elevation myocardial infarction). Inhospital mortality ranged from 15.1% to 4.9% for German and Spanish STEMI patients, and from 6.8% to 1.9% for Finnish and French NSTEMI patients (p<0.001 for both). These international variations were explained by differences in patients’ baseline characteristics (older patients more likely to have cardiogenic shock in Germany) and in clinical management, with differences in rates of thrombolysis (less performed in Germany) and primary percutaneous coronary intervention (high in Germany, low in Greece). A remaining contextual effect of country was identified after extensive adjustment. Conclusions Inhospital mortality rates of STEMI and NSTEMI patients were two to three times higher in Finland, Germany and Portugal than in Greece and Spain, with intermediate values for France. Differences in baseline characteristics and clinical management partly explain differences in outcome. Our data also suggest an impact of the healthcare system organisation.

Incidence of hypertension in a prospective cohort study of adults from Porto, Portugal.

BackgroundDuring the past 30 years, Portugal has been described as one of the countries with highest median blood pressure levels in Europe, but the incidence of hypertension is unknown. The aim of this study was to estimate the incidence of hypertension, according to socio-demographic characteristics and lifestyles.MethodsA population-based cohort of randomly selected dwellers from Porto, Portugal, aged ≥18 years, was assembled in 1999–2003 (EPIPorto study) and 796 hypertension-free individuals (62.6% women) were reassessed after a median of 3.8 years. Hypertension was defined as blood pressure ≥140/90 mmHg and/or antihypertensive drug therapy. Incidence rate ratios (IRR) were estimated using Poisson regression.ResultsThe overall incidence rate was 47.3 [95% confidence interval (95% CI): 40.5-55.5] per 1000 person-years. Among women, the incidence was 43.4 (35.6-53.1) and among men 52.7 (41.3-68.0) per 1000 person-years. The incidence was lower in women up to 60 years and much higher among women above 60 (110.0 vs. 64.4 per 1000 person-years among men, p for age-sex interaction=0.032). Participants with higher education had a lower risk of becoming hypertensive (≥13 years vs. ≤4 years: RR=0.70, 95% CI, 0.46-1.08, p for linear trend <0.001), independently of age and sex. Overweight and obesity were associated with a 1.67-fold and 2.44-fold increased risk of hypertension, respectively, independently of age, sex and education.ConclusionsIn this urban Portuguese population the incidence rate of hypertension was high, with new cases occurring predominantly among older subjects, the less educated and those with overweight-obesity. Despite recent progresses in blood pressure related outcomes, the risk of hypertension remains higher in Portugal than in other developed countries.

Trends in the prevalence of smoking in Portugal: a systematic review

BackgroundUnderstanding the dynamics of smoking at the population level is essential for the planning and evaluation of prevention and control measures. We aimed to describe trends in the prevalence of smoking in Portuguese adults by sex, age-group and birth cohort.MethodsPubMed was searched from inception up to 2011. Linear regression was used to assess differences in prevalence estimates according to the type of population sampled, and to estimate time trends of smoking prevalence considering only the results of studies on nationally representative samples of the general population.ResultsThirty eligible studies were identified. There were statistically significant differences in the prevalence estimates according to the types of population sampled in the original studies. Between 1987 and 2008, the prevalence of smoking increased significantly among women aged ≤ 70 years; the steepest increase was observed in those aged 31–50 and 51–70 years (from 4.6% and 0.1% in 1988, respectively, to 16.4% and 4.5% in 2008, respectively). The prevalence of smoking increased in all birth cohorts, except for those born before 1926. In the same period, among men, smoking decreased in all age-groups, with steepest declines in those aged ≤ 30 years (from 41.8% in 1988 to 28.8% in 2008) and those aged ≥ 71 years (from 15.1% in 1988 to 4.6% in 2008). The prevalence of smoking declined among men of all birth cohorts.ConclusionsThis study provides robust evidence to place Portuguese women at stage II and men at the later stages of the tobacco epidemic.

Role of physical activity and diet in incidence of hypertension: a population-based study in Portuguese adults

Background/Objectives:To evaluate longitudinally the role of physical activity (PA) (type and intensity) and diet (measured using DASH score, nutrients and food intake) in hypertension incidence.Subjects/Methods:As part of the EPIPorto study, 549 participants (⩾40 years), resident in Porto, Portugal, at risk of developing hypertension, were evaluated. Blood pressure (BP) measurements were obtained twice (1999–2003 and 2005–2008), with a median interval of 3.8 years. Hypertension was defined as systolic BP⩾140 mm Hg and/or diastolic BP⩾90 mm Hg, and/or if the subjects were under anti-hypertensive therapy. Validated questionnaires were used to assess usual PA and dietary intake during the previous year. Poisson regression was used to calculate the incident rate ratios (IRRs) and respective 95% confidence intervals (95% CIs).Results:In our population, the crude incidence rate (95% confidence interval (CI)) per 100 person-years of hypertension was 6.23 (5.26–7.20). After adjustment for several confounders, an inverse, though not significant, association was found across increasing tertiles of leisure-time PA and IRR (95% CI): 1 (reference); 0.77 (0.51–1.16); and 0.74 (0.48–1.11). No significant associations between the DASH score and hypertension incidence were observed. However, potassium intake (mg/1000 kcal) was shown to be inversely associated with hypertension development (upper tertile: >1863.0 for women and >1657.2 for men) vs first tertile (IRR=0.65 (0.44–0.96), P for trend=0.025). Additionally, in multivariate analysis, a significantly inverse association between the consumption of fruits/vegetables/pulses and hypertension incidence was found (upper vs first tertile: IRR=0.61 (0.40–0.93), P for trend=0.024).Conclusions:In Portuguese adults, after adjustment for several confounders, the development of hypertension was inversely associated with potassium and fruits/vegetables/pulses intake. A dose–response is inherent to these inverse associations.

Changing patterns of cardiovascular diseases and cancer mortality in Portugal, 1980–2010

BackgroundCardiovascular diseases and cancer are jointly responsible for more than half all deaths in Portugal. They also share some important risk factors and act as mutual competing risks. We aimed firstly to describe time trends in death rates and years of life lost due to cardiovascular diseases and cancer in the Portuguese population from 1980 to 2010; and secondly to quantify the contribution of the variation in population and age structure, and age-independent “risk” by cardiovascular or oncological causes to the change in the corresponding number of deaths.MethodsWe estimated the annual percent change in age-standardized mortality rates from cardiovascular diseases and cancer, in each sex. The specific contribution of demographic changes (due to changes in population size and in population age structure) and the variation in the age-independent “risk” of dying from the disease to the observed trends in the number of deaths was quantified using the tool RiskDiff. Years of life lost were computed using the Global Burden of Disease method.ResultsAmong men, the mortality rate from all cardiovascular diseases was more than two-fold higher than cancer mortality in 1980. However, three decades later mortality from cancer surpassed cardiovascular diseases. After 2005, the years of life lost from cancer were also higher than from cardiovascular diseases. Among women, despite the decrease in death rates, cardiovascular diseases remained the leading cause of death in 2010 and their absolute burden was higher than that of cancers across the whole period, mainly due to more events in older women.ConclusionsIn Portugal, the 20th century witnessed a dramatic decrease in the cardiovascular disease mortality and YLL, and the transition towards cancer. In more recent years, the highest burdens of disease came from cancers in men and from cardiovascular diseases in women.

Long-term survival, autonomy, and quality of life of elderly patients undergoing aortic valve replacement.

Abstract  Aims: We reviewed the long‐term survival, autonomy, and quality of life (QoL) of elderly patients undergoing aortic valve replacement (AVR). Methods: Records of patients ≥75 years old that underwent AVR from 2002 to 2006 were retrospectively analyzed. Functional status was classified with Barthel Index (BI). QoL was presumed as the self‐perception of well‐being after AVR. Independent predictors of mortality were identified using the Cox proportional hazards model. Results: We included 114 patients, with a mean age of 78.5 ± 2.5 years. Seventy (59.8%) patients were females. Mean additive and logistic EuroSCORE were 7 ± 2 and 9 ± 7, respectively. Follow‐up on vital status was achieved for 113 (99.1%) patients after a mean period of 47.2 ± 23.4 months. Twenty‐seven (23.7%) patients died (including three operative deaths). Survival up to one, three, and five years of follow‐up was 94.4%, 86.7%, and 76.1%, respectively. Multivariate analysis showed that pulmonary hypertension and diabetes were independent predictors of all‐cause mortality. Information on BI score and QoL was obtained for 77 (89.5%) and patients. Among those, 69 (89.6%) were autonomous according to BI and 72 (93.5%) considered having had an improvement in QoL. Conclusion: Patients ≥75 years old undergoing AVR presented good medium‐term survival. Predictors of an adverse outcome were significant pulmonary hypertension and diabetes. At follow‐up, most achieved improvement of QoL and remained autonomous. These results stress that excellent long‐term outcomes with AVR can be achieved in appropriately selected elderly patients. (J Card Surg 2012;27:20–23)