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

Mecanismos de transferência de massa na desidratação osmótica de goiaba em soluções de sacarose, sucralose e açúcar invertido Mass transfer mechanisms during the osmotic dehydration of guava in sucrose, sucralose and inverted sugar solutions

O objetivo deste trabalho foi avaliar o efeito da concentração de soluções de sacarose, sucralose e açúcar invertido sobre a cinética da desidratação osmótica de pedaços de goiaba. Frações de 1/12 do fruto foram imersas em soluções de sacarose a 0,5 e 0,4 g mL-1; de sacarose a 0,3 g mL-1 + sucralose a 0,2 g L-1 e em xarope de açúcar invertido, a 50 ºC, por 2 h, sob agitação de 60 min. A solução de açúcar invertido promoveu maior perda de água e redução de massa nas amostras de goiaba submetidas à desidratação osmótica. O melhor desempenho foi obtido para o tratamento em solução de sacarose a 0,4 g mL-1; com perda de água e redução de massa semelhantes aos valores obtidos na imersão em solução de sacarose a 0,5 g mL-1 e ganho de sólidos similar ao observado em solução de sacarose a 0,3 g mL-1.The present work aimed at investigating the effect of sucrose, sucralose and inverted sugar solutions on the kinetics of osmotic dehydration of guava pieces. The fruits were cut in twelfths and immersed in sucrose solutions at 0.5 and 0.4 g mL-1; of sucrose at 0.3 g mL-1 + sucralose at 0.2 g L-1 and in inverted sugar syrup for 2 h at 50 ºC, under agitation of 60 min. The undiluted inverted sugar solution promoted the highest levels of water loss and weight reduction in osmo-dehydrated guava pieces. The best overall performance was achieved by immersing guava pieces in sucrose solutions at 0.4 g mL-1 which led to water loss and mass reduction of similar values attained with sucrose solutions at 0.5 g mL-1; whereas maintaining the same level of solids gain achieved with sucrose solutions at 0.3 g mL-1

In situ immune response and mechanisms of cell damage in central nervous system of fatal cases microcephaly by Zika virus

Abstract Zika virus (ZIKV) has recently caused a pandemic disease, and many cases of ZIKV infection in pregnant women resulted in abortion, stillbirth, deaths and congenital defects including microcephaly, which now has been proposed as ZIKV congenital syndrome. This study aimed to investigate the in situ immune response profile and mechanisms of neuronal cell damage in fatal Zika microcephaly cases. Brain tissue samples were collected from 15 cases, including 10 microcephalic ZIKV-positive neonates with fatal outcome and five neonatal control flavivirus-negative neonates that died due to other causes, but with preserved central nervous system (CNS) architecture. In microcephaly cases, the histopathological features of the tissue samples were characterized in three CNS areas (meninges, perivascular space, and parenchyma). The changes found were mainly calcification, necrosis, neuronophagy, gliosis, microglial nodules, and inflammatory infiltration of mononuclear cells. The in situ immune response against ZIKV in the CNS of newborns is complex. Despite the predominant expression of Th2 cytokines, other cytokines such as Th1, Th17, Treg, Th9, and Th22 are involved to a lesser extent, but are still likely to participate in the immunopathogenic mechanisms of neural disease in fatal cases of microcephaly caused by ZIKV