Sukru Sindel

Prevalence, awareness, treatment and control of hypertension in Turkey (the PatenT study) in 2003.

Objective To determine the distribution of blood pressure (BP) and prevalence, awareness, treatment and control of hypertension in Turkey (PatenT). Design A population-based cross-sectional epidemiology survey was carried out in 2003. Setting Twenty-six cities from seven geographical provinces of Turkey, with proportional representation of urban and rural populations. Participants A two-stage stratified sampling method was used to select a sample of the adult population over 18 years of age. The total number of participants was 4910. Interventions Data collection and BP measurements were conducted by specifically trained physicians in the households of the participants. Main outcome measures The mean systolic and diastolic BP levels, distribution of blood pressure, prevalence of hypertension (mean systolic BP ≥ 140 mmHg or mean diastolic BP ≥ 90 mmHg, or previously diagnosed and/or taking antihypertensive drugs), awareness, treatment and control of hypertension were assessed. Results The overall age-adjusted and sex-adjusted prevalence of hypertension in Turkey was 31.8%, and it was higher in women than in men (36.1 versus 27.5%, P < 0.001). In the whole group, 32.2% had never had their BP measured. Overall, 40.7% of those with hypertension were aware of their diagnosis, only 31.1% were receiving pharmacologic treatment and only 8.1% had their BP under control. The subjects who were aware and treated had a control ratio of 20.7%. Conclusions PatenT data indicate that hypertension is a highly prevalent but inadequately managed health problem in Turkey. There is an urgent need for population-based strategies to improve the prevention, early detection and control of hypertension.

The relationship between hypertension and salt intake in Turkish population: SALTURK study

Abstract This population-based epidemiological study was aimed to evaluate the daily salt intake and its relation to blood pressure in a representative group of Turkish population. The enrolled normotensive and hypertensive individuals (n = 1970) completed a questionnaire including demographics, dietary habits, hypertension awareness and drug usage. Blood pressure was measured and to estimate salt consumption, 24-h urine samples were collected. The daily urinary sodium excretion was 308.3 ± 143.1 mmol/day, equal to a salt intake of 18.01 g/day. Salt intake was higher in obese participants, rural residents, participants with lower education levels and elderly. A positive linear correlation between salt intake and systolic and diastolic blood pressures was demonstrated (r = 0.450, p = 0.020; r = 0.406, p = 0.041; respectively), and each 100 mmol/day of salt intake resulted in 5.8 and 3.8 mmHg increase in systolic and diastolic blood pressures, respectively. Salt intake and systolic blood pressure was significantly correlated in normal weight individuals (r = 0.257, p < 0.01). The Turkish population consumes a great amount of salt; salt intake and blood pressure was positively correlated. Efforts in sodium restriction are therefore crucial in the management of hypertension as part of national and global health policies.

Hypertension incidence in Turkey (HinT): a population-based study.

Objective Hypertension incidence is an important determinant of hypertension prevalence and progression. Few studies have been published on hypertension incidence in developing countries despite the high prevalence observed. The aim of this study was to investigate the incidence of hypertension in Turkey. Methods The study was designed as an epidemiological cohort study which included the population of the Prevalence, awareness, treatment and control of hypertension in Turkey (PatenT) Study which had 4910 volunteers. Blood pressure measurements were performed three times and a questionnaire was used to obtain data on the present status of hypertension with regards to distributions and alterations of risk factors. Results In the present study, 4008 (81.6%) participants of the PatenT Study population were contacted after 4 years. After excluding 173 dead and 67 pregnant individuals, the study cohort comprised of 3768 individuals. The overall 4-year incidence rate of hypertension was 21.4%; it reached a maximum of 43.3% in individuals over 65 years of age. Age, initial blood pressure category, and body mass index were the best predictors of the hypertension incidence rate. Multivariate logistic regression analysis revealed that age, obesity, alcohol consumption, and living in rural areas were significant predictors of hypertension. Conclusion Follow-up periods scheduled considering age, initial blood pressure category, and body mass index are important for the early determination of hypertension. As there are limited data regarding hypertension incidence in developing countries, the results of data collected in this study might serve as a model.

Relationship between sleep complaints and proinflammatory cytokines in haemodialysis patients

Background:  Sleep complaints are common in end‐stage renal disease. We aimed to investigate the relationship between sleep‐related complaints and inflammatory cytokines in haemodialysis (HD) patients, and also the effects of HD on sleep patterns and cytokine levels.

An Association Between Inflammatory State and Left Ventricular Hypertrophy in Hemodialysis Patients

This study was performed to investigate the potential relationship between left ventricular hypertrophy (LVH) and proinflammatory cytokines in hemodialysis (HD) patients and the effect of HD on cytokine production. Serum interleukin 1 beta (IL-1 β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) measurements and echocardiographic studies were performed in 35 stable HD patients. A variety of probable risk factors for LVH including age, HD duration, blood pressure (BP), body mass index, lipid profile, hemoglobin, albumin, parathormone and homocysteine levels were also investigated. Additionally, the effect of HD procedure on cytokine levels was evaluated. Predialysis serum levels of IL-1β, IL-6, TNF-α, and homocysteine in HD patients were compared with 12 healthy subjects. Left ventricular hypertrophy was demonstrated in 20 (57%) of HD patients by echocardiography. Left ventricular mass index (LVMI) was correlated positively with systolic BP (r = 0.556, p = 0.001), diastolic BP (r = 0.474, p = 0.004), and serum levels of TNF-α (r = 0.446, p = 0.009).Multiple regression analysis showed that systolic BP and TNF-α levels were significant independent predictors of LVH. No relationship was observed between LVH and other parameters. The mean predialysis serum level of IL-6 was significantly higher in HD patients compared to healthy controls (15.7 ± 8.7 vs. 7.3 ± 0.7 pg/mL, p = 0.001). Predialysis serum levels of TNF-α in HD patients were higher when compared to healthy subjects, but the difference was not statistically significant (8.3 ± 3 vs. 7 ± 1.45 pg/mL, respectively, p > 0.05). However, serum levels of IL-6 and TNF-α significantly elevated after HD, when compared to predialysis levels (from 15.7 ± 8.7 to 17.8 ± 9.5 pg/mL, p = 0.001 and from 8.3 ± 3.0 to 9.9 ± 3.5 pg/mL p = 0.004, respectively). As a conclusion, in addition to BP, proinflammatory cytokines, TNF-α in particular, seem to be associated with LVH in ESRD patients.

Uric Acid is an Important Predictor for Hypertensive Early Atherosclerosis

IntroductionThe association between hyperuricemia and cardiovascular disease in hypertensive subjects is controversial. Attempts to elucidate the possible association between hyperuricemia and early atherosclerosis in hypertensive patients may provide alternative prevention or therapy targets for future cardiovascular events.MethodsA total of 67 hypertensive and 30 healthy subjects underwent B-mode ultrasonography to measure carotid intima media thickness (C-IMT). All biochemical analyses were assessed by local laboratories using standard laboratory methods.ResultsC-IMT, serum uric acid (UA) levels, and mean arterial blood pressure (MBP) levels were significantly higher in hypertensive population compared to healthy subjects (P<0.001). Among hypertensive subjects, high sensitivity C-reactive protein (hs-CRP), C-IMT, and proteinuria levels were significantly higher in hyperuricemic patients compared to normouricemic participants (for all, P<0.05). Age (r=0.28, P=0.02), MBP (r=0.34, P=0.04), hs-CRP (r=0.58, P=0.006), proteinuria (r=0.58, P=0.007), estimated glomerular filtration rate (r=−0.35, P=0.02), and UA (r=0.31, P=0.02) levels were significantly associated with C-IMT levels. Multiple linear regression analysis using C-IMT as a dependent variable showed that age (beta=0.84, P=0.03) and UA levels (beta=−0.87, P=0.02) were independently associated with C-IMT.ConclusionHyperuricemia is an independent predictor for early atherosclerosis in hypertensive subjects with normal renal function. Therefore, the optimal control of UA may provide further benefits in preventing atherosclerosis and hypertensive end-organ injury.

Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012.

Objectives: The study aimed to assess the current epidemiology of hypertension, including its prevalence, the awareness of the condition and its treatment and control, in Turkey to evaluate changes in these factors over the last 10 years by comparing the results with the prevalence, awareness, treatment, and control of hypertension in Turkey (PatenT) study data (2003), as well as to assess parameters affecting awareness and the control of hypertension. Methods: The PatenT 2 study was conducted on a representative sample of the Turkish adult population (n = 5437) in 2012. Specifically trained staff performed the data collection. Hypertension was defined as mean SBP or DBP at least 140/90 mmHg, previously diagnosed disease or the use of antihypertensive medication. Awareness and treatment were assessed by self-reporting, and control was defined as SBP/DBP less than 140/90 mmHg. Results: Although the prevalence of hypertension in the PatenT and PatenT 2 surveys was stable at approximately 30%, hypertension awareness, treatment, and control rates have improved in Turkey. Overall, 54.7% of hypertensive patients were aware of their diagnosis in 2012 compared with 40.7% in 2003. The hypertension treatment rate increased from 31.1% in 2003 to 47.4% in 2012, and the control rate in hypertensives increased from 8.1% in 2003 to 28.7% in 2012. The rate of hypertension control in treated patients improved between 2003 (20.7%) and 2012 (53.9%). Awareness of hypertension was positively associated with older age, being a woman, residing in an urban area, a history of parental hypertension, being a nonsmoker, admittance by a physician, presence of diabetes mellitus, and being obese or overweight; it was inversely associated with a higher amount of daily bread consumption. Factors associated with better control of hypertension were younger age, female sex, residing in an urban area, and higher education level in Turkey. Conclusion: Although some progress has been made in recognizing hypertension from 2003 to 2012, there is still a large population of untreated or inadequately treated hypertensives in Turkey. Strengthening of population-based efforts to improve the prevention, early detection, and treatment of hypertension is needed.

Predictive markers of asymptomatic atherosclerosis in end-stage renal disease patients

Objective: Uremia is associated with accelerated atherosclerosis and increased cardiovascular mortality in patients with end-stage renal disease (ESRD). Cardiac injury markers, such as myoglobin, creatine kinase-MB (CK-MB), or troponins, frequently used to recognize acute coronary events, may be falsely elevated in this patient group. In this study, our aim was to (i) test serum levels of myoglobin, CK-MB, and troponin I (cTnI) in ESRD patients without coronary artery disease (CAD) and compare the results with healthy controls and (ii) to investigate the association between these markers and carotid artery intima–media thickness (CA–IMT), high-sensitive C-reactive protein (hs-CRP), and serum uric acid (SUA) levels in ESRD patients. Materials and methods: Fifty-two ESRD patients (25 hemodialysis and 27 peritoneal dialysis) and 17 healthy controls were included in the study. Serum levels of myoglobin, CK-MB, and cTnI were measured and ultrasonographic CA–IMT was determined in all participants. SUA and hs-CRP levels were only measured in the ESRD group. Results: Serum myoglobin, CK-MB levels, and the mean CA–IMT were significantly higher in ESRD group (p < 0.01), whereas cTnI levels were not different compared to healthy controls (p = 0.70). There was also a positive correlation between CA–IMT and cTnI levels (p = 0.003, r = 0.35) and CA–IMT and hs-CRP (p = 0.03, r = 0.30) or SUA levels (p = 0.003, r = 0.43). Conclusion: cTnI may serve as a more sensitive marker in detecting cardiovascular events in patients with renal failure. Besides the traditional risk factors of atherosclerosis, cTnI, hs-CRP, and SUA may have a predictive role in recognizing premature atherosclerosis in ESRD patients.

Peritonitis due to Lactococcus lactis in a CAPD patient

Lactococcus lactis is a Gram-positive bacterium, commonly used in the dairy industry. Although Lactococcus lactis is known to be non-pathogenic for humans, it can cause infection in immunocompromized patients. We report a case of peritonitis due to L. lactis in a continuous ambulatory peritoneal dialysis patient, which is the second reported case in the literature.

The relationship of visfatin levels to inflammatory cytokines and left ventricular hypertrophy in hemodialysis and continuous ambulatory peritoneal dialysis patients.

Visfatin was recently defined as an adipocytokine; however, the pathophysiological role of visfatin is not completely understood. A few studies suggest that visfatin may be a new proinflammatory adipocytokine. The aim of the present study was to compare serum visfatin levels between hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients and evaluate the relationship between visfatin levels to IL-6, TNF-α, and left ventricular hypertrophy. Serum visfatin, IL-6, and TNF-α levels were measured by using the ELISA method, and echocardiographic evaluations were performed in 31 hemodialysis patients, 30 CAPD patients, and 21 healthy volunteers. Serum visfatin levels were higher in the CAPD group (265.27 ± 387.86 ng/mL) than hemodialysis (97.68 ± 244.96 ng/mL,) and control (41.33 ± 48.87 ng/mL) groups (p = 0.04, p = 0.01, respectively). No significant difference was observed between the hemodialysis and control groups. In univariate analysis, visfatin levels were positively correlated with IL-6 (r = 0.24, p = 0.03), TNF-α (r = 0.34, p = 0.002), and BMI (r = 0.26, p = 0.03) and negatively correlated with some left ventricular diastolic parameters [Em and Em/Am (r = −0.305, p = 0.01), (r = −0.251, p = 0.03), respectively]. No relationship was found between visfatin and left ventricular mass index. In the linear regression analysis, visfatin levels independently related with TNF-( (β = 0.369, p = 0.001) and IL-6 (β = 0.284, p = 0.015). This study has found significantly higher levels of serum visfatin in CAPD patients when compared to healthy individuals. Increased visfatin levels seem to associate with proinflammatory cytokines such as IL-6 or TNF-α. As for the effects of on left ventricular structure and functions, visfatin might have negative effects on left ventricular diastolic function parameters but have no effects on left ventricular mass index.