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- Ambient particulate matter exposure and red blood cell distribution width (RDW): results from a cross-sectional linkage study in PortugalPublication . Gaio, Vânia; Roquette, Rita; Matias Dias, Carlos; Nunes, BaltazarBACKGROUND AND AIM:Ambient particulate matter (PM) is now a well-established risk factor to develop cardiovasculardiseases. Multiple studies have linked PM exposure to cardiovascular events, but the pathophysiologic mechanisms linking theoccurrence of these events with PM exposure are still an area of intensive debate. red blood cell distribution width (RDW), a bloodparameter used to measure the variability sizes of the red blood cells, has been associated with a vast array of human pathologies,including cardiovascular diseases. The present study aims to estimate the long-term effect of PM10 exposure on RDW, in the adultPortuguese mainland population. METHODS:Our study was based on 2211 participants of the 1st Portuguese Health Examination Survey (INSEF, 2015) withavailable data on RDW parameter and living within a 30km radius of an air quality monitoring station from the air quality monitoringnetwork of the Portuguese Environment Agency with available PM10 measurements. Generalized linear models were used toassess the effect of 1-year PM10 exposure on RDW values. RESULTS:We found an association between long-term exposure to PM10 and RDW values (2.82% RDW increase per each 10μg/m3 PM10 increment, 95% CI: 0.62%; 5.02%), particularly among males (2.96% RDW increase per each 10 μg/m3 PM10increment, 95% CI: 0.80–5.12), which is well supported by the sensitivity analysis. CONCLUSIONS:To the best of our knowledge, this is the first study describing an association between ambient PM10 exposureand RDW values. It is uncertain whether changes in RDW due to PM10 exposure constitute an adverse health outcome. However,RDW has been identified as an independent prognostic biomarker of multiple cardiovascular diseases, therefore we consider thisresult to be of special relevance in particular to explain the effect of PM10 in triggering cardiovascular events.
- 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 participantsPublication . NCD Risk Factor Collaboration (NCD-RisC); Barreto, Marta; Nunes, BaltazarBackground: 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.