Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding WHO

Post-fire phenology in a campo sujo vegetation in the Urucum plateau, Mato Grosso do Sul, Brazil

Studies on the herbaceous and sub-shrub layer of cerrado showed the occurrence of modifications in its composition between different regions, demonstrating sensibility to changes in climate, soil and intensity of fires, among other factors. The aim of this study was to describe the phenological variation in a campo sujo vegetation in the Urucum plateau. We established eight transects of 250 m each, 50 m apart. We sampled all flowering and fruiting species located at least three meters from each side of the transect. Beginning in October 2007, one month after an accidental fire occurred in the study site, we analysed flowering and fruiting plants in the transects' area. The intensity of the flowering and fruiting phenophases was not uniformly distributed. This study provide us information about the possible fire influence on the reproductive patterns of the community, presenting flowering peaks in October and November, two months after this event. Regression analysis with monthly rainfall also provides us information about the influence of climate data on the flowering and fruiting peaks

Structure, distribution of species and inundation in a riparian forest of Rio Paraguai, Pantanal, Brazil

A phytosociological study was conducted in a riparian forest of the Rio Paraguai near Corumba and Ladario in the state of Mato Grosso do Sul, Brazil. The topographic distribution of species was correlated with durations of the river's seasonal floodings and the cumulative time of flooding between 1974 and 1995. One hundred and eight contiguous 10 x 10 m plots were systematically established. All individuals with more than 15 cm of girth at breast height (gbh = 1.3 m) were sampled. A total of 695 individuals distributed among 37 species, 35 genera and 23 families were found. The Shannon index (H') for species diversity was 2.7. The highest importance value (IV) was found for Inga vera ssp. affinis, followed by Triplaris gardneriana, Ocotea diospyrifolia, Crataeva tapia and Vochysia divergens. The plots were classified into two groups according to their distance from the margin, applying Ward's method of classification and principal coordinate analysis (PCO) on the same Bray Curtis distance matrix. The topical environments were divided into four bands by Two-Way Indicator Species Analysis (TWINSPAN), and the species were also grouped into four groups. Flooding in these groups ranged from regular inundation in all 23 years of the historical series of the Ladario gauge to sporadic flooding for a maximum of 2 consecutive years. (C) 2005 Elsevier GmbH. All rights reserved.200211913

Structure of arboreal and herbaceous strata in a neotropical seasonally flooded monodominant savanna of Tabebuia aurea

Large areas in the Pantanal wetland are covered by monodominant formations, e.g. typical landscapes with local names such as “paratudal”, dominated by T. aurea. Studies on structure of these formations generally include only woody strata, consequently the species richness registered is usually low due to the absence of the ‘ground layer’ of herbaceous and others low species. We recorded 13 species, 12 genera and 11 families for the arboreal stratum. Considering arboreal flora without the dominant (T. aurea) individuals showed great establishment in relation to the flood level between 35 – 45 cm while the individuals of the dominant species of 30 – 45 cm. The diameter distribution revealed that the population of T. aurea did not show the reverse J curve, the usual pattern for species in constant regeneration, also evidenced in inconstant Licourt quotient, indicating an episodic recruitment that could lead to future changes in structure. In the herbaceous strata we recorded 78 species, included in 62 genera and 27 families. Using plots method we sampled 46 species, 40 genera and 22 families, while in line interception we found 65 species distributed in 57 genera and 26 families. The floristic similarity of Sørensen between both methods was 59.4%, with 33 species in common, and the method of line interception was more efficient in detecting richness, with 35% more species found in the same time. According to the methods of plots and line interception applied on the woody stratum, our results gave similar detailed information on the structure of this type of savanna, and in spite of being monodominant it shows high species richness when the herbaceous stratum is taken into account. Plots and line interception methods showed similar results for the woody stratum and high species richness of the herbaceous stratum

Plant diversity of the Pantanal wetland

This is a review of current studies in diversity of the flora and main vegetation types in the Brazilian Pantanal. The flora of this wetland, nearly 2,000 species, constitutes a pool of elements of wide distribution and from more or less adjacent phytogeographic provinces, such as Cerrado, dry seasonal forests, Chaco, Amazonia and Atlantic Forest. The most numerous group includes wide-distribution species, mainly herbs, while the second contingent comes from the Cerrado. Endemic plants are rare, numbering only seven. The vegetation of the sedimentary floodplain is a mosaic of aquatics, floodable grasslands, riparian forests, savannas (cerrados), cerrado woodlands, dry forests, and a large area of mono-dominant savannas, and pioneer woodlands. The main vegetation types are briefly described with their characteristic species, and their estimated areas are given according to the latest mapping

Wildfire and smoke association with COVID-19 cases in the Pantanal wetland, Brazil

OBJECTIVE: In 2020, Brazil experienced two concurrent public health challenges related to respiratory disease: wildfires and increased mortality due to the coronavirus (COVID-19) pandemic. Smoke from these wildfires contributed to a variety of air pollutants, including fine particulate matter (PM2.5). The present study aims to investigate the effects of environmental and socio-economic factors on COVID-19 hospitalisation in the Pantanal. STUDY DESIGN: Ecological retrospective study. METHODS: We applied a multilevel negative binomial model to relate monthly hospitalisation data with environmental variables. RESULTS: We showed that monthly PM2.5 concentration levels had the greatest influence on the increase in hospitalisations by COVID-19 in the elderly (23 % increase). The Gini index, a coefficient that reflects income inequalities, also had a positive association with COVID-19 hospitalisations (18 % increase). Higher temperatures and humidity were protective factors, showing a 15 % and 14 % decrease in hospitalisations, respectively. The results of the present study suggest that high PM2.5 exposure contributed to the increase in COVID-19 hospitalisations, as did the social inequalities of each municipality. CONCLUSIONS: The present study highlights the importance of gathering evidence supported by multiple information sources to guide decision-making and identify populations needing better public health systems