341 research outputs found
Application of Framingham risk estimates to ethnic minorities in United Kingdom and implications for primary prevention of heart disease in general practice : cross sectional population based study
Objective To compare the 10 year risk of coronary
heart disease (CHD), stroke, and combined
cardiovascular disease (CVD) estimated from the
Framingham equations.
Design Population based cross sectional survey.
Setting Nine general practices in south London.
Population 1386 men and women, age 4059 years,
with no history of CVD (475 white people, 447 south
Asian people, and 464 people of African origin), and
a subgroup of 1069 without known diabetes, left
ventricular hypertrophy, peripheral vascular disease,
renal impairment, or target organ damage.
Main outcome measures 10 year risk estimates.
Results People of African origin had the lowest 10
year risk estimate of CHD adjusted for age and sex
(7.0%, 95% confidence interval 6.5 to 7.5) compared
with white people (8.8%, 8.2 to 9.5) and south Asians
(9.2%, 8.6 to 9.9) and the highest estimated risk of
stroke (1.7% (1.5 to 1.9), 1.4% (1.3 to 1.6), 1.6% (1.5 to
1.8), respectively). The estimate risk of combined
CVD, however, was highest in south Asians (12.5%,
11.6 to 13.4) compared with white people (11.9%,
11.0 to 12.7) and people of African origin (10.5%, 9.7
to 11.2). In the subgroup of 1069, the probability that
a risk of CHD >15% would identify risk of combined
CVD >20% was 91% in white people and 81% in
both south Asians and people of African origin. The
use of thresholds for risk of CHD of 12% in south
Asians and 10% in people of African origin would
increase the probability of identifying those at risk to
100% and 97%, respectively.
Conclusion Primary care doctors should use a lower
threshold of CHD risk when treating mild
uncomplicated hypertension in people of African or
south Asian origin
Blood pressure control by home monitoring : meta-analysis of randomised trials
Objective To determine the effect of home blood pressure
monitoring on blood pressure levels and proportion of people
with essential hypertension achieving targets.
Design Meta-analysis of 18 randomised controlled trials.
Participants 1359 people with essential hypertension allocated
to home blood pressure monitoring and 1355 allocated to the
"control" group seen in the healthcare system for 2-36 months.
Main outcome measures Differences in systolic (13 studies),
diastolic (16 studies), or mean (3 studies) blood pressures, and
proportion of patients achieving targets (6 studies), between
intervention and control groups.
Results Systolic blood pressure was lower in people with
hypertension who had home blood pressure monitoring than
in those who had standard blood pressure monitoring in the
healthcare system (standardised mean difference 4.2 (95%
confidence interval 1.5 to 6.9) mm Hg), diastolic blood pressure
was lower by 2.4 (1.2 to 3.5) mm Hg, and mean blood pressure
was lower by 4.4 (2.0 to 6.8) mm Hg. The relative risk of blood
pressure above predetermined targets was lower in people with
home blood pressure monitoring (risk ratio 0.90, 0.80 to 1.00).
When publication bias was allowed for, the differences were
attenuated: 2.2 ( − 0.9 to 5.3) mm Hg for systolic blood pressure
and 1.9 (0.6 to 3.2) mm Hg for diastolic blood pressure.
Conclusions Blood pressure control in people with
hypertension (assessed in the clinic) and the proportion
achieving targets are increased when home blood pressure
monitoring is used rather than standard blood pressure
monitoring in the healthcare system. The reasons for this are
not clear. The difference in blood pressure control between the
two methods is small but likely to contribute to an important
reduction in vascular complications in the hypertensive
population
A community programme to reduce salt intake and blood pressure in Ghana
Background
In Africa hypertension is common and stroke is increasing. Detection, treatment and control of high blood pressure (BP) is limited. BP can be lowered by reducing salt intake. In Africa salt is added to the food by the consumer, as processed food is rare. A population-wide approach with programmes based on health education and promotion is thus possible.
Methods
We carried out a community-based cluster randomised trial of health promotion in 1,013 participants from 12 villages (628 women, 481 rural dwellers); mean age 55 years to reduce salt intake and BP. Average BP was 125/74 mmHg and urinary sodium (UNa) 101 mmol/day. A health promotion intervention was provided over 6 months to all villages. Assessments were made at 3 and 6 months. Primary end-points were urinary sodium excretion and BP levels.
Results
There was a significant positive relationship between salt intake and both systolic (2.17 mmHg [95% CI 0.44 to 3.91] per 50 mmol of UNa per day, p < 0.001) and diastolic BP (1.10 mmHg [0.08 to 1.94], p < 0.001) at baseline. At six months the intervention group showed a reduction in systolic (2.54 mmHg [-1.45 to 6.54]) and diastolic (3.95 mmHg [0.78 to 7.11], p = 0.015) BP when compared to control. There was no significant change in UNa. Smaller villages showed greater reductions in UNa than larger villages (p = 0.042). Irrespective of randomisation, there was a consistent and significant relationship between change in UNa and change in systolic BP, when adjusted for confounders. A difference in 24-hour UNa of 50 mmol was associated with a lower systolic BP of 2.12 mmHg (1.03 to 3.21) at 3 months and 1.34 mmHg (0.08 to 2.60) at 6 months (both p < 0.001).
Conclusion
In West Africa the lower the salt intake, the lower the BP. It would appear that a reduction in the average salt intake in the whole community may lead to a small but significant reduction in population systolic BP
Rapid iododeboronation with and without gold catalysis: application to radiolabelling of arenes
Radiopharmaceuticals incorporating radioactive iodine in combination with SPECT imaging play a key role in nuclear medicine, with applications in drug development and disease diagnosis. Despite this importance, there are relatively few general methods for incorporating radioiodine into small molecules. Here we describe a rapid, air- and moisture-stable ipso-iododeboronation procedure using NIS, in the non-toxic and green solvent dimethyl carbonate. The fast reaction and mild conditions of the gold-catalysed method led to the development of a highly efficient process for radiolabelling of arenes, which constitutes the first example of an application of homogenous gold catalysis to selective radiosynthesis. This has been exemplified with an effective synthesis of radiolabelled meta-[125I]iodobenzylguanidine, a radiopharmaceutical used for the imaging and therapy of human norepinephrine transporter-expressing tumours
Differences Between Blacks and Whites With Coronary Heart Disease in Initial Symptoms and in Delay in Seeking Care
BACKGROUND: Mortality rates for coronary heart disease are higher in blacks than in whites. OBJECTIVES: To examine differences between blacks and whites in the manifestation of symptoms of coronary heart disease and in delay in seeking treatment. METHODS: Patients were directly observed as they came to an emergency department with symptoms suggestive of coronary heart disease. The sample included 40 blacks and 191 whites with a final diagnosis of angina or acute myocardial infarction. RESULTS: After controlling for pertinent demographic and clinical characteristics, logistic regression analysis revealed that blacks were more likely than whites to have shortness of breath (odds ratio = 3.16; 95% CI = 1.49-6.71; P = .003) and left-sided chest pain (odds ratio = 2.55; 95% CI = 1.10-5.91; P =.03). Blacks delayed a mean of 26.8 hours (SD = 30.3; median = 11 hours), whereas whites delayed a mean of 24.4 hours (SD = 41.7; median = 5 hours) in seeking care. Mean delay time was not significantly different for blacks and whites; differences in median delay time were of borderline significance (P = .05). CONCLUSIONS: Blacks were more likely than whites to have shortness of breath and left-sided chest pain as the presenting symptoms of coronary heart disease. Differences in delay in seeking treatment were not significant, although blacks tended to delay longer than did whites. The relatively small number of blacks may account for the lack of observed racial differences in both initial symptoms and in delay in seeking treatment
Common mental disorders and ethnicity in England : the EMPIRIC Study
Background. There is little population-based evidence on ethnic variation in the most common
mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among
representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani
individuals living in England using a standardized clinical interview.
Method. Cross-sectional survey of 4281 adults aged 16–74 years living in private households
in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized
clinical interview.
Results. Ethnic differences in the prevalence of CMD were modest, and some variation with age
and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a
statistically significant degree among Irish [adjusted rate ratios (RR) 2.09, 95% CI 1.16–2.95,
p=0.02] and Pakistani (adjusted RR 2.38, 95% CI 1.25–3.53, p=0.02) men aged 35–54 years, even
after adjusting for differences in socio-economic status. Higher rates of CMD were also observed
among Indian and Pakistani women aged 55–74 years, compared to White women of similar age.
The prevalence of CMD among Bangladeshi women was lower than among White women,
although this was restricted to those not interviewed in English. There were no differences in rates
between Black Caribbean and White samples.
Conclusions. Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had
significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD
among Bangladeshi women contrasted with high levels of socio-economic deprivation among this
group. Further study is needed to explore reasons for this variation
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