Päivi E. Korhonen

Health-related quality of life and awareness of hypertension.

Background It has been shown that individuals with hypertension have poorer health-related quality of life (HRQoL) than normotensive individuals. However, little is known about the impact of high blood pressure and the awareness to have hypertension on HRQoL. Methods In this cross-sectional population-based study, we evaluated 901 cardiovascular risk patients aged 45 to 70 years without serious comorbidities. Hypertension was detected in 497 (55%) of the patients, in whom 137 (28%) had previously undiagnosed hypertension confirmed with home blood pressure measurement. Before the diagnosis of hypertension was made, the patients filled Short-Form Health Survey (SF-36) to assess their HRQoL. Glucose homeostasis was assessed with 2 h oral glucose tolerance test. Results Patients who were aware of their hypertension had lower scores in physical functioning and general health than patients without hypertension and patients who were unaware of hypertension. There were no differences for mental components of SF-36 between these study groups. The prevalence of obesity and newly diagnosed type 2 diabetes was higher in patients with known hypertension than among other study groups. Conclusion Impaired HRQoL in hypertensive patients might be secondary to the awareness of hypertension, adverse drug effects, newly diagnosed type 2 diabetes or obesity, not high blood pressure per se.

endothelial function in a cardiovascular risk population with borderline ankle-brachial index

Introduction: The diagnosis of peripheral arterial disease (PAD) can be made by measuring the ankle–brachial index (ABI). Traditionally ABI values > 1.00–1.40 have been considered normal and ABI ≤ 0.90 defines PAD. Recent studies, however, have shown that individuals with ABI values between 0.90–1.00 are also at risk of cardiovascular events. We studied this cardiovascular risk population subgroup in order to determine their endothelial function using peripheral arterial tonometry (PAT). Methods: We selected 66 individuals with cardiovascular risk and borderline ABI. They all had hypertension, newly diagnosed glucose disorder, metabolic syndrome, obesity, or a ten year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System (SCORE). Subjects with previously diagnosed diabetes or cardiovascular disease were excluded. Endothelial function was assessed by measuring the reactive hyperemia index (RHI) from fingertips using an Endo-PAT device. Results: The mean ABI was 0.95 and mean RHI 2.11. Endothelial dysfunction, defined as RHI < 1.67, was detected in 15/66 (23%) of the subjects. There were no statistically significant differences in RHI values between subjects with different cardiovascular risk factors. The only exception was that subjects with impaired fasting glucose (IFG) had slightly lower RHI values (mean RHI 1.91) than subjects without IFG (mean RHI 2.24) (P = 0.02). Conclusions: In a cardiovascular risk population with borderline ABI nearly every fourth subject had endothelial dysfunction, indicating an elevated risk of cardiovascular events. This might point out a subgroup of individuals in need of more aggressive treatment for their risk factors.

Ankle-brachial index is lower in hypertensive than in normotensive individuals in a cardiovascular risk population.

Background Hypertension is an established risk factor for peripheral arterial disease (PAD), but the prevalence of this condition in hypertensive patients without comorbidities is unknown. Methods In this study, we assess the prevalence and factors associated with PAD, and the usefulness of ankle–brachial index (ABI) in evaluating cardiovascular risk in hypertensive patients without cardiovascular or renal disease or previously known diabetes mellitus. We measured ABI in 972 nonclaudicant patients with hypertension, newly diagnosed glucose disorders, metabolic syndrome, obesity or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System. Results The prevalence of PAD (defined as ABI ≤0.90) and borderline PAD (defined as ABI 0.91–1.00) in hypertensive patients was 7.3% (39/532) and 23.7% (126/532), respectively. In a multivariate model, hypertension remained an independent factor associated with PAD (adjusted odds ratio 3.20; 95% confidence interval 1.56–6.58). There was no association between PAD and metabolic risk factors. SBP and pulse pressure increased linearly across subgroups of ABI (normal 0.91–1.00 and ≤0.90) in hypertensive patients (P < 0.001). Conclusion Subclinical PAD is common in hypertensive patients even without comorbidities. The measurement of ABI is an efficient method to identify patients with increased cardiovascular risk and worth performing to hypertensive patients, particularly those with pulse pressure above 65 mmHg. Uniform criterions of defining PAD and borderline PAD would aid physicians in clinical decision-making.

Waist circumference home measurement—a device to find out patients in cardiovascular risk

BACKGROUND New strategies are needed to prevent the global epidemic of diabetes and subsequent rise in cardiovascular diseases. We describe a community-based, two-stage screening strategy using home waist circumference measurement and a risk factor questionnaire as a primary screening tool. METHODS We mailed a tape for measurement of waist and a risk factor questionnaire to every inhabitant aged 45-70 years living in the rural town of Harjavalta in Finland. Thereafter we performed an oral glucose tolerance test, anthropometric variables and blood pressure of subjects having at least one risk factor for type 2 diabetes or cardiovascular disease. People with previously known diabetes or vascular disease were excluded. RESULTS Seventy-three percent (2085/2856) of the invited inhabitants participated, and 84% of the respondents had at least one pre-specified risk factor. Waist circumference >or=80 cm in women and >or=94 cm in men (n = 1168), positive metabolic syndrome criteria of the International Diabetes Federation (n = 681) or the Finnish Diabetes Risk Score questionnaire >or=12 points (n = 697) identified 95, 92 and 63% of the new cases of type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively. CONCLUSION The International Diabetes Federation criteria for elevated waist circumference are very sensitive but lack specificity in diagnosing glucose disorders. The criteria for metabolic syndrome and the Finnish Diabetes Risk Score questionnaire are more efficient tools for the selection of patients for further risk stratification in general practise.

Ankle−brachial index and health-related quality of life

Background: Data from population studies using ankle⊟brachial index (ABI) measurement to screen patients for peripheral arterial disease (PAD) demonstrate that most patients with PAD have no symptoms or atypical symptoms besides classical intermittent claudication. We aimed at comparing health-related quality of life and ABI in a cohort of cardiovascular risk persons in a general population. Methods: SF-36 questionnaire was completed and ABI measured from 915 individuals aged 45−70 years with hypertension, metabolic syndrome, pre-diabetes, newly detected diabetes, body mass index ≥30 kg/m2, or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation (SCORE) system. None of the subjects had symptoms of intermittent claudication. Results: The prevalence of PAD (defined as ABI ≤0.90) and borderline PAD (defined as ABI 0.91−1.00) were 5% (95% CI 4−7%) and 20% (95% CI 18⊟23%), respectively. Patients with PAD had significantly lower quality of life dimension scores for physical functioning, role-physical, general health, and vitality than subjects with normal ABI. Among those with borderline PAD, quality of life was reduced on the general health perception compared to subjects with normal ABI. Conclusion: Health-related quality of life of individuals with asymptomatic or atypical PAD or borderline PAD is worse than that of individuals with normal ABI. The level of ABI is independently related to physical functioning.

Target organ damage and cardiovascular risk factors among subjects with previously undiagnosed hypertension

Background Little is known about the prevalence of target organ damage in previously undiagnosed hypertension. Design Cross-sectional population survey. Methods We measured ankle–brachial index (ABI), estimated glomerular filtration rate (eGFR), electrocardiographically determined left ventricular hypertrophy (ECG-LVH), and cardiometabolic risk factors in subjects with previously undiagnosed hypertension (n = 138) and normotensive (n = 440) risk subjects, who had metabolic syndrome, glucose disorders, body mass index ≥30 kg/m2 or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation (SCORE) system. None of the subjects had established cardiovascular or renal disease or previously diagnosed diabetes. Results There was no difference (p = 0.68) among the studied age-groups in the prevalence of previously undiagnosed hypertension, and no interaction (p = 0.10) was found between sex and age groups. Evidence of subclinical organ damage defined as ECG-LVH, ABI ≤0.90, or eGFR <60 ml/min/1.73 m2 were found in 22% of the subjects with previously undiagnosed hypertension, and 8% of the non-hypertensive risk persons (p < 0.001). The prevalence of renal insufficiency did not differ between the study groups. Majority of the subjects with previously undiagnosed hypertension also have multiple cardiometabolic risk factors. Conclusions Among subjects with previously undiagnosed hypertension, one in five patients had evidence of subclinical target organ damage, and three in four patients may be regarded as having high cardiovascular risk.

Factors modifying the effect of blood pressure on erectile function.

Objective: To assess factors modifying the effect of blood pressure on erectile function. Methods: Nine hundred and twenty-four men at risk for cardiovascular disease or diabetes, but without manifested chronic diseases, were identified in a population survey carried out in south-western Finland during 2005–2007. The main outcome measures were hypertension status, sociodemographic and lifestyle factors, International Index of Erectile Function 5-item questionnaire, and Becks Depression Inventory. Results: When adjusted with age, cohabiting status, waist circumference, and education, the association of hypertension and erectile dysfunction was not statistically significant. Presence of depressive symptoms increased the adjusted odds ratios of erectile dysfunction by 2.44 [95% confidence interval (CI) 1.57–3.80] in normotensive men, by 7.62 (95% CI 1.89–30.65) in previously undiagnosed hypertensive patients, and by 2.04 (95% CI 0.87–4.78) in medically treated hypertensive patients. Conclusions: Hypertension per se does not predispose men to erection problems. Instead, psychological factors are the critical component to consider in men suffering from erectile dysfunction.

High-Intensity Physical Activity, Stable Relationship, and High Education Level Associate with Decreasing Risk of Erectile Dysfunction in 1,000 Apparently Healthy Cardiovascular Risk Subjects

INTRODUCTION Erectile dysfunction (ED) is especially common in men with cardiovascular diseases (CVDs). However, the data are scarce concerning populations without manifested CVD. AIM The aim of this study was to describe factors associated with ED, especially those associated with decreasing risk of ED, in men with cardiovascular risk factors but without CVD, diabetes, or chronic renal disease. METHODS In 2004 to 2007, a cross-sectional population-based sample of men 45 to 70 years old in two rural towns in Finland was collected. Men with previously diagnosed CVD, diabetes, or kidney disease were not invited to the study. In total 1,000 eligible men with cardiovascular risk factors, i.e., central obesity, high scores in the Finnish Diabetes Risk Score, high blood pressure, antihypertensive medication, or family history of coronary heart disease, myocardial infarction, or stroke, were included in the analysis. Questionnaires, clinical measurements, and laboratory tests were obtained. The prevalence of ED was studied comparing the means, and risk factors were studied using multivariate logistic regression analysis. MAIN OUTCOME MEASURES The rate of ED was defined by the International Index of Erectile Function short form (IIEF-5) and by two questions (2Q) about the ability to achieve and to maintain an erection. RESULTS The prevalence of ED was 57% or 68% using IIEF-5 or 2Q, respectively. Age (odds ratio [OR]: up to 9.16; 95% confidence interval [CI], 5.00-16.79; P < 0.001), smoking (OR: 1.41; 95% CI, 1.04-1.91; P = 0.028), depressive symptoms (OR: 4.04 for moderate and severe; 95% CI,1.22-13.45; P = 0.001), high-intensity physical activity (OR: 0.50; 95% CI, 0.29-0.86; P = 0.045), high education (OR: 0.52; 95% CI, 0.33-0.83; P = 0.013), and stable relationship (OR: 0.43; 95% CI, 0.21-0.88; P = 0.046) were associated with ED. CONCLUSIONS In apparently healthy men with cardiovascular risk factors, decreasing risk of ED is associated with high-intensity physical activity, stable relationship, and high education level.

Impaired glucose metabolism and health related quality of life

AIMS We aimed at investigating whether different categories of glucose tolerance have any effect on a persons HRQoL. METHODS Population-based cross-sectional study conducted as a community sample of apparently healthy middle-aged individuals living in Western Finland. The subjects of the study, 1383 individuals, aged 45-70 years, had at least one cardiovascular risk factor but no previous diagnoses of either diabetes or cardiovascular disease. They completed health related quality of life (HRQoL) questionnaire before the oral glucose tolerance test (OGTT) was performed to diagnose the gategories of glucose tolerance. RESULTS Persons with newly diagnosed type 2 diabetes (NDM) had lower scores for physical functioning, general health and emotional role than subjects with normal glucose tolerance. CONCLUSION The results of the HRQoL questionnaire demonstrated that NDM is negatively associated with HRQoL, but prediabetes - IFG or IGT - does not.

Time to change the glomerular filtration rate estimating formula in primary care

BACKGROUND The most commonly used equation for estimated glomerular filtration rate (eGFR) is nowadays the four-variable Modification of Diet in Renal Disease (MDRD) equation. This formula was derived from patients with non-diabetic chronic kidney disease (CKD) with mean GFR 40 ml/min. METHODS We compared the MDRD study equation and the recently developed Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation by applying the two formulas in 1747 middle-aged cardiovascular risk persons in primary care. RESULTS The prevalence of renal insufficiency defined as eGFR<60 ml/min was 6.7% (95% CI 5.6-8.0) according to the MDRD formula, and 3.6% (95% CI 2.8-4.6) according to the CKD-EPI formula. The subjects who were classified as having CKD according to the MDRD equation, but no-CKD according to the CKD-EPI formula, were mostly women (86%) and slightly younger than the subjects having CKD according to both formulas. CONCLUSION The characteristics of the subjects commonly treated in primary care resemble more closely the population from which the CKD-EPI than the MDRD study equation was derived from. Thus, we suppose that in general practice, the CKD-EPI equation is more suitable for estimating renal function than the MDRD equation.