scholarly journals Relative Telomere Length and Cardiovascular Risk Factors

Biomolecules ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. 192 ◽  
Author(s):  
Moritz Koriath ◽  
Christian Müller ◽  
Norbert Pfeiffer ◽  
Stefan Nickels ◽  
Manfred Beutel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Telomere Length ◽  
Ldl Cholesterol ◽  
Smoking Status ◽  
Hdl Cholesterol ◽  
Population Based ◽  
Relative Telomere Length

(1) Background: Telomeres are repetitive DNA sequences located at the extremities of chromosomes that maintain genetic stability. Telomere biology is relevant to several human disorders and diseases, specifically cardiovascular disease. To better understand the link between cardiovascular disease and telomere length, we studied the effect of relative telomere length (RTL) on cardiovascular risk factors in a large population-based sample. (2) Methods: RTL was measured by a real-time quantitative polymerase chain reaction in subjects of the population-based Gutenberg Health Study (n = 4944). We then performed an association study of RTL with known cardiovascular risk factors of smoking status as well as systolic and diastolic blood pressure, body mass index (BMI), LDL cholesterol, HDL cholesterol, and triglycerides. (3) Results: A significant correlation was shown for RTL, with age as a quality control in our study (effect = −0.004, p = 3.2 × 10−47). Analysis of the relation between RTL and cardiovascular risk factors showed a significant association of RTL in patients who were current smokers (effect = −0.016, p = 0.048). No significant associations with RTL were seen for cardiovascular risk factors of LDL cholesterol (p = 0.127), HDL cholesterol (p = 0.713), triglycerides (p = 0.359), smoking (p = 0.328), diastolic blood pressure (p = 0.615), systolic blood pressure (p = 0.949), or BMI (p = 0.903). In a subsequent analysis, we calculated the tertiles of RTL. No significant difference across RTL tertiles was detectable for BMI, blood pressure, lipid levels, or smoking status. Finally, we studied the association of RTL and cardiovascular risk factors stratified by tertiles of age. We found a significant association of RTL and LDL cholesterol in the oldest tertile of age (effect = 0.0004, p = 0.006). (4) Conclusions: We determined the association of relative telomere length and cardiovascular risk factors in a population setting. An association of telomere length with age, current smoking status, as well as with LDL cholesterol in the oldest tertile of age was found, whereas no associations were observed between telomere length and triglycerides, HDL cholesterol, blood pressure, or BMI.

scholarly journals Patterns of Cardiovascular Risk Factors in Old Age and Survival and Health Status at 90

2020 ◽  
Vol 75 (11) ◽  
pp. 2207-2214
Author(s):  
Michelle C Odden ◽  
Andreea M Rawlings ◽  
Alice M Arnold ◽  
Mary Cushman ◽  
Mary L Biggs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Old Age ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Lower Likelihood

Abstract Background The population age 90 years and older is the fastest growing segment of the U.S. population. Only recently is it possible to study the factors that portend survival to this age. Methods Among participants of the Cardiovascular Health Study, we studied the association of repeated measures of cardiovascular risk factors measured over 15–23 years of follow-up and not only survival to 90 years of age, but also healthy aging outcomes among the population who reached age 90. We included participants aged 67–75 years at baseline (n = 3,613/5,888) to control for birth cohort effects, and followed participants until death or age 90 (median follow-up = 14.7 years). Results Higher systolic blood pressure was associated with a lower likelihood of survival to age 90, although this association was attenuated at older ages (p-value for interaction <.001) and crossed the null for measurements taken in participants’ 80’s. Higher levels of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and body mass index (BMI) were associated with greater longevity. Among the survivors to age 90, those with worse cardiovascular profile (high blood pressure, LDL cholesterol, glucose, and BMI; low HDL cholesterol) had lower likelihood of remaining free of cardiovascular disease, cognitive impairment, and disability. Conclusion In summary, we observed paradoxical associations between some cardiovascular risk factors and survival to old age; whereas, among those who survive to very old age, these risk factors were associated with higher risk of adverse health outcomes.

Abstract P200: Validity of self-reported hypothyroidism: Associations with cardiovascular risk factors in the CARDIA Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Pamela J Schreiner ◽  
Sherita Golden ◽  
Na Zhu ◽  
Martha Daviglus
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Cardiovascular Risk Factors ◽  
Smoking Status ◽  
Geometric Mean ◽  
Hdl Cholesterol ◽  
Thyroid Stimulating Hormone

BACKGROUND: Hypothyroidism (HYPOT), defined as having low levels of free thyroxine and elevated levels of thyroid-stimulating hormone (TSH), is a common condition linked to many adverse cardiovascular risk factors. Observational studies often rely on self-reported medical history that may or may not accurately reflect the presence of a condition or its adequate control. METHODS: We examined the association between self-reported HYPOT and levels of risk factors commonly altered by HYPOT using the Year 25 (2010-2011) CARDIA Study data. Systolic blood pressure, total, LDL- and HDL-cholesterol, triglycerides, body mass index (BMI), and Center for Epidemiologic Studies Depression (CES-D) score were measured using standardized methods. Crude means or geometric means were compared by HYPOT status with t-tests. Least-squared means adjusted for age, race, sex, center, smoking status, education, and BMI were estimated by HYPOT status using linear regression, and repeated with additional adjustment for levothyroxine or synthyroid use. RESULTS: After excluding 48 cases of hyperthyroidism, 4.6% (131/2851) of participants self-reported having HYPOT; mean age was 50.1 years, 55.3% were women, and 52.4% were white. Compared to those without HYPOT, those with HYPOT were more likely to be white (75.6% vs. 51.3%) and women (85.5% vs. 53.9%); crude mean systolic blood pressure was lower (114.9 vs. 120.3 mmHg, p=0.0002) and HDL-c was higher (61.7 vs. 57.9 mg/dL, p=0.03). After multivariable adjustment ( Table ), only BMI and triglycerides differed by HYPOT status. Adjustment for thyroid medication use did not materially alter mean differences. CONCLUSION: Self-reported hypothyroidism was inconsistently associated with risk factors commonly altered by thyroid abnormalities, regardless of medication status. These data suggest that TSH measurement is necessary to accurately identify individuals with low thyroid function leading to risk factor disturbances. Multivariable-adjusted mean risk factor levels by self-reported HYPOT status YES (n=131) NO (n=2720) p-difference SBP (mmHg) 118.6 120.9 0.17 Total cholesterol (mg/dL) 194.1 191.0 0.39 HDL-c (mg/dL) 57.4 57.4 0.97 LDL-c (mg/dL) 109.4 110.6 0.74 Triglycerides (mg/dL) * 114.5 100.5 0.021 BMI (kg/m 2 ) 31.5 30.0 0.05 CES-D score 10.8 9.6 0.12 * geometric mean

Abstract P011: Cardiovascular Risk Factors and Longevity

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Michelle C Odden ◽  
Andreea Rawlings ◽  
Alice Arnold ◽  
Mary Cushman ◽  
Mary Lou Biggs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Cardiovascular Risk Factors ◽  
Old Age ◽  
Repeated Measures ◽  
Ldl Cholesterol ◽  
Low Cardiovascular Risk

Introduction: Cardiovascular disease is the leading cause of mortality in old age, yet there is limited research on the patterns of cardiovascular risk factors that predict survival to 90 years. Hypothesis: The patterns of cardiovascular risk factors that portend longevity will differ from those that confer low cardiovascular risk. Methods: We examined repeated measures of blood pressure, LDL-cholesterol, and BMI from age 67 and survival to 90 years in the Cardiovascular Health Study (CHS). CHS is a prospective study of 5,888 black and white adults in two waves (1989-90 and 1992-93) from Medicare eligibility lists in four counties in the U.S. We restricted to participants aged 67 to 75 years at baseline to control for birth cohort effects and examined repeated measures of cardiovascular risk factors throughout the late-life course. We fit logistic regression models to predict survival to age 90 using generalized estimating equations, and modeled the risk factors as linear, a linear spline, and clinically relevant categories. Models were adjusted for demographics and medication use, and we also examined whether the association of each risk factor with longevity varied by the age of risk factor measurement. Best fit models are presented. Results: Among 3,645 participants in the birth cohort, 1,160 (31.8%) survived to 90 by June 16 th , 2015. Higher systolic blood pressure in early old age was associated with reduced odds for longevity, but there was an interaction with age such that the association crossed the null at 80 years. (Table) Among those with LDL-cholesterol <130 mg/dL, higher LDL-cholesterol was associated with greater longevity; at levels above 130 mg/dL there was no association between LDL-cholesterol and longevity. BMI had a u-shaped association with longevity. Conclusions: In summary, the patterns of risk factors that predict longevity differ from that considered to predict low cardiovascular risk. The risk of high systolic blood pressure appears to depend on the age of blood pressure measurement.

Abstract 3448: Differences in the Associations between Various Ultrasound-Based Markers of Peripheral Atherosclerosis at Carotid and Femoral Levels and Risk factors in a general Middle-Aged Population

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Patrick O Yerly ◽  
Nicolas Rodondi ◽  
Fred Paccaud ◽  
Pierre Vogt ◽  
Pascal Bovet
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Intima Media Thickness ◽  
Plaque Morphology ◽  
Middle Aged ◽  
Plaque Area

Introduction: Ultrasound detection of sub-clinical atherosclerosis (ATS) is a useful mean to identify subjects at high risk of cardiovascular (CV) events. Most studies have evaluated intima-media thickness (IMT) at the carotid artery level, but plaque-based markers (plaque thickness, plaque area) as well as the femoral artery level have been proposed as valid alternatives. The superiority of one method upon the others has not been demonstrated. The aim of this study is to compare the relationships between five indicators of ATS (IMT, mean / maximal plaque thickness, mean / maximal plaque area) at both carotid and femoral levels and conventional cardiovascular risk factors (CVRF) in a population-based sample of middle-aged adults. Methods: High resolution B-mode ultrasound was performed in both right and left carotid and femoral arteries on 496 consecutive participants aged 45– 64 randomly selected from the general population. A plaque was defined as a focal IMT thickening ≥ 1.2 mm. CVRF included age, sex, current smoking, systolic blood pressure, LDL-cholesterol, HDL-cholesterol, and diabetes. Results : All CVRF were associated, independently of age, with each of the ATS markers at femoral level but only LDL-cholesterol and systolic blood pressure were consistently associated with ATS markers at carotid level. The table shows the adjusted R-squared values in a multivariate model with all CVRF. Variance (adjusted R 2 ) in predicting any of the ATS markers was larger at femoral than carotid levels. At both carotid and femoral levels, the CVRF accounted for more variance in predicting plaque-based markers than IMT. Conclusion: The stronger association of CVRF with ATS markers at the femoral than carotid levels and with plaque-based markers than with IMT suggest that markers assessed at femoral level and based on plaque morphology might be the most useful tools for assessing cardiovascular risk. These findings need to be confirmed in prospective studies with CV events.

scholarly journals A Mediterranean diet supplemented with dairy foods improves markers of cardiovascular risk: results from the MedDairy randomized controlled trial

2018 ◽  
Vol 108 (6) ◽  
pp. 1166-1182 ◽  
Author(s):  
Alexandra T Wade ◽  
Courtney R Davis ◽  
Kathryn A Dyer ◽  
Jonathan M Hodgson ◽  
Richard J Woodman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
At Risk ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Mediterranean Diet ◽  
Hdl Cholesterol ◽  
Mean Difference ◽  
Dairy Foods ◽  
Randomized Controlled

ABSTRACT Background The Mediterranean diet (MedDiet) offers benefits to cardiovascular health but may not meet Western recommendations for calcium and dairy intake, which could impede long-term adoption. Objective The current study aimed to determine the effect of a MedDiet supplemented with dairy foods on cardiovascular risk factors. Design A randomized, controlled, crossover design compared a MedDiet with 3–4 daily servings of dairy (MedDairy) and a low-fat (LF) control diet. Forty-one participants aged ≥45 y and at risk of cardiovascular disease (CVD) were randomly allocated to their first intervention, either the MedDairy or LF diet. Participants followed each intervention for 8 wk, and an 8-wk washout period separated interventions. The primary outcome was home-measured systolic blood pressure (SBP) assessed in the morning, afternoon, and evening. Secondary outcomes included clinic-measured blood pressure (morning), body composition, blood lipids, C-reactive protein (CRP), plasma glucose, serum insulin, and the Framingham Risk Score. Results Compared with the LF intervention, the MedDairy intervention resulted in a significantly lower morning SBP (mean difference: −1.6 mm Hg; 95% CI: −2.8, −0.4 mm Hg; P = 0.01), lower morning diastolic blood pressure (mean difference: −1.0; 95% CI: −1.7, −0.2 mm Hg; P = 0.01) and clinic SBP (mean difference: −3.5 mm Hg; 95% CI: −6.4, −0.7 mm Hg; P = 0.02), significantly higher HDL cholesterol (mean difference: 0.04 mmol/L; 95% CI: 0.01, 0.06 mmol/L; P < 0.01), lower triglycerides (mean difference: = −0.05 mmol/L; 95% CI: −0.08, −0.01 mmol/L; P < 0.01), and lower ratio of total to HDL cholesterol (mean difference: −0.4; 95% CI: −0.6, −0.2; P < 0.001). No effects were observed for other outcome measures. Conclusions Following a MedDiet with additional dairy foods led to significant changes in markers of cardiovascular risk over 8 wk. The MedDiet supplemented with dairy may be appropriate for an improvement in cardiovascular risk factors in a population at risk of CVD. This trial was registered at anzctr.org.au as ACTRN12616000309482.

scholarly journals Depressive symptoms and C-reactive protein: The Cardiovascular Risk in Young Finns Study

2006 ◽  
Vol 36 (6) ◽  
pp. 797-805 ◽  
Author(s):  
MARKO ELOVAINIO ◽  
LIISA KELTIKANGAS-JÄRVINEN ◽  
LAURA PULKKI-RÅBACK ◽  
MIKA KIVIMÄKI ◽  
SAMPSA PUTTONEN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Depressive Symptoms ◽  
Cardiovascular Risk ◽  
Contraceptive Use ◽  
Depressive Symptomatology ◽  
Smoking Status ◽  
Hdl Cholesterol ◽  
Population Based ◽  
Young Finns Study

Background. We tested the hypothesis that depressive symptoms in healthy young adults would be associated with elevated levels of C-reactive proteins (CRP).Method. We studied the association between depressive symptoms and CRP in 1201 young adults, as a part of the on-going population-based Cardiovascular Risk in Young Finns Study. Depressive symptoms were determined by responses to a revised version of Beck's Depression Inventory in 1992 and 2001. CRP and other known cardiac risk factors were measured in 2001.Results. Higher depressive symptomatology in 1992 and in 2001 and their means score were related to higher CRP levels (B's range from 0·24 to 0·21, p<0·001). These relationships persisted after separate adjustments for various risk factors including sex, age, education, oral contraceptive use, dietary fat, physical activity, alcohol consumption, smoking status, LDL-cholesterol, HDL-cholesterol, systolic blood pressure and history of acute infectious disease. Adjustments for obesity and triglycerides levels, however, somewhat attenuated the relationship between depressive symptoms and CRP.Conclusions. We concluded that higher levels of depressive symptoms are associated with higher levels of CRP, but this association may largely be attributable to obesity or triglycerides.

scholarly journals The Association Between High-Density Lipoprotein Cholesterol Level and Some Cardiovascular Risk Factors in Patients Referring to the Heart Clinic of Birjand, Iran, During 2016 - 2017

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Bita Bijari ◽  
Toba Kazemi ◽  
Adib Movahedi ◽  
Mahmoud Zardast ◽  
Reyhane Hoshyar
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
High Density Lipoprotein ◽  
Cardiovascular Risk Factors ◽  
Cholesterol Level ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
Hdl Cholesterol

Background: High-density lipoprotein cholesterol (HDL-C) as an invaluable predictor is used to determine the risk of heart diseases and evaluate the effectiveness of lipid-lowering therapies. Objectives: In this study, we aimed to investigate the association between HDL cholesterol level and some cardiovascular risk factors in the patients referring to the Heart Clinic of Birjand, Iran, during 2016 - 2017. Methods: In this cross-sectional study, 410 patients referring to the Heart Clinic of Birjand, Iran, during 2016 - 2017 were selected. Then using a questionnaire, complete demographic and biochemical data were collected and statistically analyzed for assessing the effects of some lifestyle factors such as the diet and physical activity on the serum level of HDL. Finally, all the results were analyzed by SPSS software (version 15). Results: In our study, the majority of dyslipidemic people had low levels of HDL (58.8%). Most of the participants were in a poor health condition according to BMI and physical activity, in a moderate health status in terms of smoking and cholesterol and fasting blood glucose (FBS) levels, and finally in the ideal health group in terms of the diet and blood pressure. The HDL level was significantly associated with physical activity, FBS, BMI, and blood pressure (P < 0.05). Conclusions: Considering the association between persistent cardiovascular risk factors and HDL cholesterol level, encouraging people to adopt a healthy lifestyle can help prevent cardiac diseases.

scholarly journals Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials

BMJ ◽  
2020 ◽  
pp. m696 ◽  
Author(s):  
Long Ge ◽  
Behnam Sadeghirad ◽  
Geoff D C Ball ◽  
Bruno R da Costa ◽  
Christine L Hitchcock ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Blood Pressure ◽  
Weight Loss ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Cardiovascular Risk Factors ◽  
Diastolic Blood Pressure ◽  
Hdl Cholesterol ◽  
Randomised Trials

Abstract Objective To determine the relative effectiveness of dietary macronutrient patterns and popular named diet programmes for weight loss and cardiovascular risk factor improvement among adults who are overweight or obese. Design Systematic review and network meta-analysis of randomised trials. Data sources Medline, Embase, CINAHL, AMED, and CENTRAL from database inception until September 2018, reference lists of eligible trials, and related reviews. Study selection Randomised trials that enrolled adults (≥18 years) who were overweight (body mass index 25-29) or obese (≥30) to a popular named diet or an alternative diet. Outcomes and measures Change in body weight, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, systolic blood pressure, diastolic blood pressure, and C reactive protein at the six and 12 month follow-up. Review methods Two reviewers independently extracted data on study participants, interventions, and outcomes and assessed risk of bias, and the certainty of evidence using the GRADE (grading of recommendations, assessment, development, and evaluation) approach. A bayesian framework informed a series of random effects network meta-analyses to estimate the relative effectiveness of the diets. Results 121 eligible trials with 21 942 patients were included and reported on 14 named diets and three control diets. Compared with usual diet, low carbohydrate and low fat diets had a similar effect at six months on weight loss (4.63 v 4.37 kg, both moderate certainty) and reduction in systolic blood pressure (5.14 mm Hg, moderate certainty v 5.05 mm Hg, low certainty) and diastolic blood pressure (3.21 v 2.85 mm Hg, both low certainty). Moderate macronutrient diets resulted in slightly less weight loss and blood pressure reductions. Low carbohydrate diets had less effect than low fat diets and moderate macronutrient diets on reduction in LDL cholesterol (1.01 mg/dL, low certainty v 7.08 mg/dL, moderate certainty v 5.22 mg/dL, moderate certainty, respectively) but an increase in HDL cholesterol (2.31 mg/dL, low certainty), whereas low fat (−1.88 mg/dL, moderate certainty) and moderate macronutrient (−0.89 mg/dL, moderate certainty) did not. Among popular named diets, those with the largest effect on weight reduction and blood pressure in comparison with usual diet were Atkins (weight 5.5 kg, systolic blood pressure 5.1 mm Hg, diastolic blood pressure 3.3 mm Hg), DASH (3.6 kg, 4.7 mm Hg, 2.9 mm Hg, respectively), and Zone (4.1 kg, 3.5 mm Hg, 2.3 mm Hg, respectively) at six months (all moderate certainty). No diets significantly improved levels of HDL cholesterol or C reactive protein at six months. Overall, weight loss diminished at 12 months among all macronutrient patterns and popular named diets, while the benefits for cardiovascular risk factors of all interventions, except the Mediterranean diet, essentially disappeared. Conclusions Moderate certainty evidence shows that most macronutrient diets, over six months, result in modest weight loss and substantial improvements in cardiovascular risk factors, particularly blood pressure. At 12 months the effects on weight reduction and improvements in cardiovascular risk factors largely disappear. Systematic review registration PROSPERO CRD42015027929.

scholarly journals Low prevalence of hypertension with pharmacological treatments and associated factors

2013 ◽  
Vol 47 (2) ◽  
pp. 301-308 ◽  
Author(s):  
Helena Gama ◽  
Albertino Damasceno ◽  
Carla Silva-Matos ◽  
Domingos Diogo ◽  
Ana Azevedo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Pharmacological Treatment ◽  
Disease Risk ◽  
Smoking Status ◽  
Antihypertensive Drug Therapy ◽  
Pharmacological Management ◽  
Traditional Medicines

OBJECTIVE: To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS: In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS: Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS: The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.

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