Narine Movsisyan

Threshold for diagnosing hypertension by automated office blood pressure using random sample population data.

Objective: Manual office blood pressure (BP) is still recommended for diagnosing hypertension. However, its predictive value is decreased by errors in measurement technique and the white-coat effect. The errors can be eliminated by automated office BP (AOBP) measurement taking multiple readings with the participant resting quietly alone. Therefore, use of AOBP in clinical practice requires a threshold value for hypertension diagnosis. The aim of the present study was to determine an AOBP threshold corresponding to the 140/90 mmHg manual office BP using data from a large random population sample. Methods: In 2145 participants (mean age 47.3 ± 11.3 years) randomly selected from a Brno population aged 25–64 years, BP was measured using manual mercury and automated office sphygmomanometers. Results: Manual SBP (mean difference 6.39 ± 9.76 mmHg) and DBP (mean difference 2.50 ± 6.54 mmHg) were higher than the automated BP. According to polynomial regression, automated systole of 131.06 (95% confidence interval 130.43–131.70) and diastole of 85.43 (95% confidence interval 85.03–85.82) corresponded to the manual BP of 140/90 mmHg. Using this cut-off, the white-coat hypertension was present in 24% of participants with elevated manual BP, whereas 10% had masked hypertension and 11% masked uncontrolled hypertension. In individuals with masked uncontrolled hypertension, only AOBP was associated with the urinary albumin–creatinine ratio, whereas there was no association with manual BP. Conclusion: AOBP of 131/85 mmHg corresponds to the manual BP of 140/90 mmHg. This value may be used as a threshold for diagnosing hypertension using AOBP. However, outcome-driven studies are required to confirm this threshold.

Reducing Children’s Exposure to Secondhand Smoke at Home: A Randomized Trial

OBJECTIVE: To develop and test an intervention to reduce children’s exposure to secondhand smoke (SHS) at homes in Yerevan, Armenia. METHODS: A single-blind, randomized trial in 250 households with 2- to 6-year-old children tested an intensive intervention (counseling sessions, distribution of tailored educational brochures, demonstration of home air pollution, and 2 follow-up counseling telephone calls) against minimal intervention (distribution of standard leaflets). At baseline and 4-month follow-up, researchers conducted biomonitoring (children’s hair) and surveys. The study used paired t tests, McNemar’s test, and linear and logistic regression analyses. RESULTS: After adjusting for baseline hair nicotine concentration, child’s age and gender, the follow-up geometric mean (GM) of hair nicotine concentration in the intervention group was 17% lower than in the control group (P = .239). The GM of hair nicotine in the intervention group significantly decreased from 0.30 ng/mg to 0.23 ng/mg (P = .024), unlike in the control group. The follow-up survey revealed an increased proportion of households with smoking restrictions and decreased exposure of children to SHS in both groups. The adjusted odds of children’s less-than-daily exposure to SHS at follow-up was 1.87 times higher in the intervention group than in the control group (P = .077). The GM of mothers’ knowledge scores at follow-up was 10% higher in the intervention group than in the control group (P = .006). CONCLUSIONS: Intensive intervention is effective in decreasing children’s exposure to SHS through educating mothers and promoting smoking restrictions at home. However, superiority over minimal intervention to decrease children’s exposure was not statistically significant.

Smoking behavior, attitudes, and cessation counseling among healthcare professionals in Armenia

BackgroundSmoking cessation counseling by health professionals has been effective in increasing cessation rates. However, little is known about smoking cessation training and practices in transition countries with high smoking prevalence such as Armenia. This study identified smoking-related attitudes and behavior of physicians and nurses in a 500-bed hospital in Yerevan, Armenia, the largest cancer hospital in the country, and explored barriers to their effective participation in smoking cessation interventions.MethodsThis study used mixed quantitative and qualitative methods. Trained interviewers conducted a survey with physicians and nurses using a 42-item self-administered questionnaire that assessed their smoking-related attitudes and behavior and smoking cessation counseling training. Four focus group discussions with hospital physicians and nurses explored barriers to effective smoking cessation interventions. The focus group sessions were audio-taped, transcribed, and analyzed.ResultsThe survey response rate was 58.5% (93/159) for physicians and 72.2% (122/169) for nurses. Smoking prevalence was almost five times higher in physicians compared to nurses (31.2% vs. 6.6%, p < 0.001). Non-smokers and ex-smokers had more positive attitudes toward the hospital’s smoke-free policy compared to smokers (90.1% and 88.2% vs. 73.0%). About 42.6% of nurses and 26.9% of physicians reported having had formal training on smoking cessation methods. While both groups showed high support for routinely assisting patients to quit smoking, nurses more often than physicians considered health professionals as role models for patients.ConclusionsThis study was the first to explore differences in smoking-related attitudes and behavior among hospital physicians and nurses in Yerevan, Armenia. The study found substantial behavioral and attitudinal differences in these two groups. The study revealed a critical need for integrating cessation counseling training into Armenia’s medical education. As nurses had more positive attitudes toward cessation counseling compared to physicians, and more often reported having cessation training, they are an untapped resource that could be more actively engaged in smoking cessation interventions in healthcare settings.

Kardiovize Brno 2030, a prospective cardiovascular health study in Central Europe: Methods, baseline findings and future directions:

Background Atherosclerotic cardiovascular disease is highly prevalent in Eastern and Central Europe, where the incidence is the highest in the world. The Kardiovize Brno 2030 study was designed as a prospective cohort study to investigate the complex relationships of cardiovascular disease and outcomes with a range of biological, psychosocial, environmental, behavioral, and economic factors in an urban population of the Czech Republic. Methods We randomly selected a 1% sample of the city of Brno residents aged 25–64 years stratified by sex and age. The study assessed traditional and novel cardiovascular disease risk factors, including sociodemographic and smoking status, physical activity, diet, depression, stress, body fat, cardio-ankle vascular index, and intima media thickness, complemented by blood tests; biological samples were stored for future analyses. Results The study enrolled 2160 participants (54.8% women), with a mean age of 47 ± 11.3 years. They were mostly full-time employed (75.6%) and married (62.1%). Hyperlipidemia was highly prevalent (70.7% in men, and 67.1% in women, NS). Hypertension and diabetes mellitus were more prevalent in men than in women (54.3% vs. 38.7% and 7.1% vs. 3.5%, respectively, P < 0.001 for both). A total of 25.3% of men and 21.9% of women smoked, whereas 20.0% and 43.0% of men and 18.1% and 26.6% of women were obese and overweight, respectively. Conclusions Cardiovascular risk factors are highly prevalent in the city of Brno, an urban population from Central Europe. The Kardiovize Brno 2030 study will provide unique multidimensional and longitudinal cardiovascular health data from a region where epidemiological studies are scarce.

Reference values of cardio-ankle vascular index in a random sample of a white population:

Objectives: Cardio-ankle vascular index (CAVI), a parameter of arterial stiffness, has been increasingly used for cardiovascular risk estimation. Currently used CAVI reference values are derived from the Japanese population. It is not clear whether the same reference values can be used in the white population. The aim of the present study was to describe cardiovascular risk factors influencing CAVI and to establish CAVI reference values. Methods: A total of 2160 individuals randomly selected from the Brno city population aged 25–65 years were examined. Of these, 1347 patients were free from cardiovascular disease, nondiabetic and untreated by antihypertensive or lipid-lowering drugs, forming the reference value population. CAVI was measured using the VaSera VS-1000 device (Fukuda Denshi, Tokyo, Japan). Results: At each blood pressure (BP) level, there was a quadratic association between CAVI and age, except for a linear association in the optimal BP group. Although there was no association between BP and CAVI in younger patients, there was a linear association between CAVI and BP after 40 years of age. Reference values by age and sex were established. In each age group, except for the male 60–65-year group, reference values in our population were lower than in the Japanese one with the difference ranging from −0.29 to 0.21 for men, and from −0.38 to −0.03 for women. Conclusion: This is the first study providing CAVI reference values in a random sample of the white population. Our results suggest that the currently used values slightly overestimate CAVI in younger white, possibly underestimating cardiovascular risk.

Measuring Armenia's progress on the Tobacco Control Scale: an evaluation of tobacco control in an economy in transition, 2005–2009

Objectives This study aimed to measure the 5-year progress in the implementation of WHO Framework Convention on Tobacco Control (FCTC) in Armenia by applying the Tobacco Control Scale, a rapid assessment tool developed to assess the strength of tobacco control policies in Europe. Setting Armenia, an economy in transition, has extreme smoking rates among men (62.5%) despite acceding to FCTC in 2004. However, little research has been carried out to evaluate Armenias progress in tobacco control. Methods The Tobacco Control Scale total score was estimated for Armenia using the original methodology; however, a different source of data was used in estimating the subscores on tobacco price and tobacco control spending. Results Armenias total score on Tobacco Control Scale has considerably improved from 2005 to 2009, mostly due to larger health warnings and advertising ban, and increased public spending on tobacco control. The scores for smoke-free public places, advertising ban, health warnings and treatment categories were below the European average in 2005 and 2007, while the price score was higher. Neither total tobacco control score nor any of its components showed a significant predictive value in a simple regression analysis using the total score and subscores as predictors for log-transformed per capita tobacco consumption. Conclusions Higher than the European average price score for Armenia cannot be explained by the concept of affordability alone and may reflect a measurement error due to peculiarities of transition economies. The applicability of the Tobacco Control Scale could be limited to countries with mature economies, but not to transition countries such as Armenia with different social, political and economic environment. The scale modification, such as an adjustment for the policy enforcement and the effectiveness of public tobacco control spending along with alternative measures of affordability would be warranted to enhance its applicability in low-income and middle-income countries.

[PP.09.04] REFERENCE VALUES OF CARDIO-ANKLE VASCULAR INDEX IN A RANDOM SAMPLE OF A CAUCASIAN POPULATION

Objective: Cardio-ankle vascular index (CAVI), a parameter of arterial stiffness, has been increasingly used for cardiovascular risk estimation. Currently used CAVI reference values are based on the Japanese population. It is not clear whether the same reference values can be used in the Caucasian population. The aim of the present study was to describe cardiovascular risk factors influencing CAVI and to establish CAVI reference values. Figure. No caption available. Design and method: In total, 2160 individuals randomly selected from the Brno city population aged 25–65 years were examined. Of these, 1 347 subjects were free from cardiovascular disease, non-diabetic and untreated by anti-hypertensive or lipid-lowering drugs, forming the reference value population. CAVI was measured using the VaSera VS-1000 device. Results: At each blood pressure level, there was a quadratic association between CAVI and age, except for the linear association in the optimal blood pressure group. While there was no association between blood pressure and CAVI in younger subjects, there was a linear association between CAVI and blood pressure after 40 years of age. Reference values by age and gender were established. In each age group, except for the male 60–65 group, reference values in whites were lower than in the Japanese population with the difference ranging from -0.29 to 0.21 for males, and from -0.38 to -0.03 for females. Conclusions: This is the first study providing CAVI reference values in a random sample of the Caucasian population. Our results suggest that the currently used values slightly overestimate CAVI in younger whites, which may underestimate cardiovascular risk.