RESUMO
Our aim was to quantify the association between hypertension and four well-known cardiovascular risk factors (obesity, dyslipidemia, high blood glucose, smoking) and to determine the extent of their combinations in hypertensive subjects in an adult population in Guadeloupe (FWI). A case-control study was conducted in 1999. Odds ratios (ORs) and 95% confidence interval (95% CI) of hypertension according to cardiovascular risk factors were calculated by a logistic regression model. In all, 4210 subjects were included in the study: 2105 hypertensives and 2105 age and sex matched non-hypertensive controls. In the hypertensives, obesity (30%) was the most frequent risk factor followed by dyslipidemia (23.2%), current smoking (11.5%) and high blood glucose (8.2%). But, prevalence of current smokers was higher in normotensives (13.9 vs. 11.5%, p < 0.01). Among cases, 44.5% had no risk factor other than hypertension. The proportion of subjects with multiple risks factors (< or = 2) was higher in hypertensives than in controls (55.5 vs. 6.5%,p < 0.001) and higher in women than in men in cases (58.1 vs. 51.8%, p = 0.005). The adjusted ORs (95% CI) of hypertension were 2.41 (2.02-2.88) for obesity, 1.39 (1.16-1.66) for dyslipidemia and 1.67 (1.20-2.32) for high blood glucose. Our study documents the high prevalence of combinations of cardiovascular risk factors in hypertensive subjects in Guadeloupe and confirms the need of a global risk approach in prevention and treatment of hypertension.
Assuntos
Glicemia/análise , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Fumar/epidemiologia , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , Guadalupe/epidemiologia , Humanos , Hiperlipidemias/complicações , Hipertensão/complicações , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Prevalência , Fatores de Risco , Fumar/efeitos adversos , Estatísticas não ParamétricasAssuntos
HDL-Colesterol/sangue , Adulto , Fatores Etários , Estudos Transversais , Feminino , Guadalupe/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
OBJECTIVES: To study blood pressure distribution according to the new classification criteria of the JNC VI. To study the other cardiovascular risk factors related to blood pressure stage. METHOD: A cross sectional survey was undertaken in a medical center in Guadeloupe in 1999. The study included 1016 consecutive adult subjects. Blood pressure measurements were done with an automated oscillometric method (dynamap). RESULTS: A total of 609 women and 407 men participated in the study. Hypertension (systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg or being on antihypertensive medication) was present in 326 subjects (32.1%). Hypertension was more frequently found in men than in women (p = 0.008). Over the whole sample, 53.1% had optimal or normal blood pressure, 14.9% had high normal blood pressure, 16.1% were stage 1 hypertension and 15.9% were stage 2 or 3 hypertension or were on antihypertensive medication. Prevalence of hypercholesterolemia (total cholesterol > or = 240 mg/dl) increased significantly with increasing blood pressure in men (p = 0.002) and women (p < 0.001). Prevalence of dyslipidemia (total cholesterolemia > or = 240 mg/dl or HDL-cholesterol < 35 mg/dl or currently receiving antihyperlipidemic therapy) increased significantly with increasing blood pressure in both sex (p < 0.001). The same trend was found for prevalence of obesity (BMI (30 kg/m2) in both sex (p < 0.01). CONCLUSION: In this population with a high prevalence of hypertension, we showed that hypercholesterolemia and obesity increased significantly with increasing blood pressure. We also showed that caring for high blood pressure should be part of a global caring of the patient looking for other cardiovascular risk factors.
Assuntos
Pressão Sanguínea , Hipertensão/epidemiologia , Adulto , Fatores Etários , Análise de Variância , Doenças Cardiovasculares/etiologia , Colesterol/sangue , HDL-Colesterol/sangue , Estudos Transversais , Interpretação Estatística de Dados , Diabetes Mellitus/epidemiologia , Feminino , Guadalupe/epidemiologia , Humanos , Hipercolesterolemia/epidemiologia , Hiperlipidemias/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Fatores Sexuais , Triglicerídeos/sangueRESUMO
BACKGROUND: Both diabetes and hypertension, two conditions that can lead to renal failure, have a high prevalence in Guadeloupe. OBJECTIVE: To determine the clinical and epidemiological features of diabetic patients on end stage renal failure and to evaluate their survival. PATIENTS AND METHOD: Data of the Guadeloupe Kidney registry were analysed for patients who began chronic dialysis during 1978-1997. Follow up information on survival status was obtained up to January 26(th) 1999. Cox proportional hazard analysis was used to determine the relative risk (RR) of death between levels of independant variables. RESULTS: There were 784 dialysis patients of whom 174 (22%) were diabetics. Among the latter, there were 97 women (55,7%), mean age at the start of dialysis was 60.6 years (range 26-83) and arterial hypertension was present before the start of dialysis in 67% of them. Median survival MS (95%CI) was significantly lower in diabetics 42 months (31-52) than in non diabetics 83 months (70-96), p<10(-4). In diabetics, the cumulative probability of survival was 83% (1 year) and 39% (5 years) and the RR of death (95% CI) were 1.90 (1.10-3.22) and 3.43 (2.00-5.87) for diabetics admitted in dialysis in age-class 55-64 years and 65-83 years, respectively, when that for age-class 54 years was set at 1. 00. The RR for diabetics was 1.67 (1.33-2.10) relative to non diabetics. CONCLUSION: Prospective studies are warranted to describe the role of comorbid conditions in diabetic patients survival. Prevention of degenerative complications should be a priority in this population.
Assuntos
Nefropatias Diabéticas/terapia , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Terapia de Substituição Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Nefropatias Diabéticas/mortalidade , Feminino , Guadalupe/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade , Modelos de Riscos Proporcionais , Sistema de Registros , Terapia de Substituição Renal/mortalidade , Análise de Sobrevida , Fatores de TempoRESUMO
The purpose of this study was to provide data on lipid distribution and to investigate the association between hypercholesterolemia and other factors. A cross-sectional survey of insured subjects in an Health Center of Guadeloupe in 1999. Data from a consecutive series of 1 010 individuals aged 18 years and older, collected during a 3 month-period, were used. Standardized interviews and measurements of blood lipid abnormalities and other cardiovascular risk factors were carried out. Overall, 27% had elevated total cholesterol (TC) levels above 200 mg/dL, 11.7% had TC levels above 240 mg/dL, 18.1% had LDL-C levels above160 mg/dL, 12.5% had HDL-C below 35 mg/dL and 2.7% had triglyceride levels above 200 mg/dL. Isolated low HDL-C was found in 22% of the subjects and 10.8% had both TC above 240 mg/dL and LDL-C above 160 mg/dL. Only 22% of the subjects with high TC were aware of their diagnosis and 5% were treated. The risk of having hypercholesterolemia above 200 mg/dL was independently and significantly higher in case of hypertension, age above 45 in men or 55 in women, body mass index above 30 and familial history of dyslipidemia. These findings document the first report on dyslipidemia in Guadeloupe. It showed that the prevalence of hypercholesterolemia and hypertriglyceridemia was lower than in developed countries, but markedly higher than in Africa. Modifications of lifestyle and adapted therapeutics are necessary to decrease cardiovascular mortality.