Magister Artium - MA / Hypertension is estimated to a ect 20 million people in South Africa, with lifestyle factors predisposing certain individuals to this condition disease (Hughes et al., 2013). The prevalence rate of hypertension is higher in areas with low socio-economic status, with women more at risk of developing it than men. Current research suggests that 60-80% of people in South Africa use 'traditional'- most often plant based - medicines at some point for their primary healthcare needs (WHO, 2008; Hughes et al., 2013). In rural and underprivileged areas, such as the community of Nuwerus in the Western Cape Province, the use of herbal medicines and its practices are maintained in an ageing population. This study looks at the ways in which the elderly and the home based care workers of Nuwerus understand hypertension. I focus on the transition from hypertension to high blood pressure and how the two concepts overlap in Nuwerus. I highlight the way the elderly maintain their sense of vitality. I also look at concepts of resilience and vitality to unpack the personal, religious and social dimensions of old age. I focus on the various activities the elderly participate in to unpack the subtle ways with which they push the boundaries of old age consequently challenging conventional notions of health and wellness amongst the aged. The vigour with which the elderly go about their everyday life is what ultimately makes them the pillars and knowledge holders of the community. / National Research Foundation (NRF)

Sushi, von Willebrand factor type A, epidermal growth factor and pentraxin domain containing 1 (SVEP1) is an extracellular matrix protein which may bind to cell surface molecules such as integrins. A non-synonymous single amino acid polymorphism in the Svep1 gene is associated with a 14% increased risk of coronary heart disease, a 13% higher risk of type 2 diabetes and a 1mmHg increase in systolic blood pressure. Expression of the SVEP1 gene is increased in the kidney in the Cyp1a1mRen2 rat model of diabetes and hypertension previously developed in our lab. SVEP1 is also known to be upregulated in human diabetic nephropathy and is upregulated in rodent models of renal fibrosis. I hypothesized that Svep1 played a role in renal fibrosis, diabetes and blood pressure. Hence, the primary goal of this thesis was to investigate the role of SVEP1 and in the pathogenesis of diabetes, hypertension and renal fibrosis. Svep1 gene expression is increased in the kidney in the DOCA-salt-angII-uninephrectomy model of hypertension and following UUO. SVEP1 hemizygous mice showed no differences in expression of pro-fibrotic genes after UUO compared to wildtype littermates. No overt metabolic phenotype was exhibited by the Svep1 hemizygous mice, however there was a significant decrease in fat depot weights after high fat diet (HFD) and a significant increase in blood glucose concentrations during the glucose tolerance test at the 12 week time point in hemizygous Svep1 mice compared with wild-type controls. After telemetry analysis of blood pressure no difference was seen in blood pressure but SVEP1+/-animals had an increased heart rate of 100 beats per minute compared to wildtype animals. Svep1 expression is increased in the kidney in models of hypertension and fibrosis, however loss of one Svep1 allele did not alter the severity of fibrosis in the UUO model or significantly alter glucose tolerance after high fat diet. However, the high fat diet experiment was a pilot study and should be repeated with a larger number of animals. In addition, generation of a mouse with the human point mutation could determine the mechanisms by which this extracellular matrix protein confers risk of diabetes and hypertension.

Strong evidence has linked dietary sodium intake to blood pressure, but the effects of sodium intake on cardiovascular diseases (CVD) outcomes remain elusive, especially for older population. We examined the association between estimated usual sodium intake and CVD and all-cause mortality in a nationally representative sample of 4068 US adults aged 51 and older surveyed in 1988-1994. After a mean follow-up of 12.9 years from 1988 to 2006, 1680 participants died: 734 from CVD; 392 from ischemic heart disease (IHD); and 144 from stroke. In the Cox proportional models adjusted for sociodemographic variables and CVD risk factors, sodium intake was not significantly associated with all-cause, CVD, IHD and stroke mortality. No significant interactions were observed between sodium intake and sex, race/ethnicity, hypertension status, body mass index or physical activity for any of the outcomes studied. However, among Mexican-Americans sodium intake was significantly and linearly associated with CVD mortality.

In 2019, there were about seventy-million Americans with uncontrolled high blood pressure (BP) or hypertension (HTN) (Kitt, Fox, Tucker & McManus, 2019). Hypertension is the leading cause of preventable deaths worldwide (Stephen, Halcomb, McInnes, Batterham & Zwar, 2019). Uncontrolled HTN contributes to stroke, myocardial infarction, and renal failure, and is the most modifiable risk factor for heart disease and death (American Academy of Family Physicians [AAFP], 2019; Oparil & Schmider, 2015). Patients living in rural America have an increased prevalence of HTN and their access to preventative health services is lower (Buford, 2016; Caldwell, Ford, Wallace, Wang & Takahashi, 2016). The increased prevalence of HTN in rural communities does not positively correlate with optimized blood pressure control, which poses a gap in care (Buford, 2016). A multidisciplinary collaboration between registered nurses (RNs) and providers may improve patient outcomes (Ford et al., 2018). The implementation of a collaborative HTN Clinic in a rural setting had the potential to improve BP outcomes by increasing access to services. The practice improvement project established a HTN Clinic as a collaborative effort between RNs and providers in a rural community. Providers and RNs were educated via modules regarding the protocol and participants took surveys before and after implementation to determine effectiveness and if the HTN Clinic should continue after conclusion of the practice improvement project. The HTN Clinic intervention implemented education for hypertensive patients with an emphasis on medication compliance and lifestyle modifications, as well as medication adjustments through nurse-led protocols. Despite a short duration of implementation and evaluation, positive results were observed. All HTN Clinic patients had improvement in BP measures and were controlled by the end of the four-week implementation period. Overall, patient access, wait times for appointments, and BP measures for all hypertensive patients improved after implementation. The providers’ and nurses’ knowledge increased through completion of a detailed curriculum. The provider and RN surveys indicated support for continuing the HTN Clinic to improve HTN management and clinic providers felt that the HTN Clinic helped improve their time with patients and quality metrics.

Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%-5% in the United States and may be higher in certain ethnic groups. Primary hypertension once felt to be rare in children is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements therapeutic lifestyle changes and pharmacologic therapies.

Yes / There is an increased evidence for treating hypertension by a combination of two or more drugs. Increasing the number of daily intake of tablets has been reported to negatively affect the compliance of patients. Therefore, numerous fixed dose combinations (FDCs) have been introduced to the market. However, the inherent rigid nature of FDCs does not allow the titration of the dose of each single component for an individual patient's needs. In this work, flexible dose combinations of two anti-hypertensive drugs in a single bilayer tablet with a range of doses were fabricated using dual fused deposition modelling (FDM) 3D printer. Enalapril maleate (EM) and hydrochlorothiazide (HCT) loaded filaments were produced via hot-melt extrusion (HME). Computer software was utilised to design sets of oval bi-layer tablets of individualised doses. Thermal analysis and x-ray diffractometer (XRD) indicated that HCT remained crystalline in the polymeric matrix whilst EM appeared to be in an amorphous form. The interaction between anionic EM and cationic methacrylate polymer may have contributed to a drop in the glass transition temperature (Tg) of the filament and obviated the need for a plasticiser. Across all tablet sets, the methacrylate polymeric matrix provided immediate drug release profiles. This dynamic dosing system maintained the advantages of FDCs while providing a superior flexibility of dosing range, hence offering an optimal clinical solution to hypertension therapy in a patient-centric healthcare service.

Introduction: The World Health Organisation (WHO) defines overweight and obesity as a condition in which an abnormal or excessive fat accumulation exists to an extent in which health and well-being are impaired. The most recent South African National Health and Nutrition Examination Survey (SANHANES) reported that the prevalence of overweight and obesity, according to body mass index (BMI) classification, in all South African women was significantly higher than in men (24.8% and 39.2% compared to 20.1% and 10.6% for women and men, respectively). Blood pressure is often increased in obese patients and is probably the most common co-morbidity associated with obesity. Currently approximately one third (30.4%) of the adult South African population has hypertension. Hypertension is responsible for a significant percentage of the high rates of cardiovascular disease and stroke in South Africa. Limited South African data are available regarding the agreement between the measures of adiposity, including BMI, waist circumference (WC) and percentage body fat (%BF), and the association with high blood pressure. Measures of adiposity were found in previous research to be ethnicity, age and gender specific. Measuring %BF to classify adiposity takes body composition into account and is a more physiological measurement of obesity than BMI. Objective: This study aimed to investigate the agreement between adiposity classified by BMI categories and %BF cut-off points, and the association between the different measures of adiposity and high blood pressure. Method: A representative sample of black women (n=435), aged 29 years to 65 years from Ikageng in the North West Province of South Africa were included in this cross-sectional epidemiological study. Socio-demographic questionnaires were completed. Pregnancy and HIV tests were performed and those with positive test results or those who declined HIV testing were excluded. Weight and height were measured and BMI was calculated. WC, %BF using dual-energy X-ray absorptiometry (DXA), and blood pressure were measured. Results: The prevalence of overweight (BMI 25.0 kg/m² – 29.9 kg/m²) was 24.4% and obesity (BMI ≥ 30kg/m²) was 52.4%. High blood pressure was found to be present in more than two thirds of the study participants (68.5%). In this study BMI, WC and %BF as measures of adiposity were significantly correlated. There were significant agreements between combined overweight/obesity that was defined by %BF (≥35.8% 29-45 years; ≥37.7% ≥50 years) and BMI ≥ 25kg/m² (ᵡ²=199.0, p<0.0001; κ=0.68, p<0.0001), and between the presence of high %BF and obesity only, that was defined by BMI ≥ 30 kg/m² (ᵡ²=129.1, p<0.0001; κ=0.48, p<0.0001). The effect size of the agreement between the WHO BMI category for combined overweight/obesity and %BF cut-off points according to the kappa value of κ=0.68 was substantial (κ range 0.61-0.80). The effect size of the agreement between the WHO BMI category for obesity only and %BF cut-off points according to the kappa value of κ=0.48 was moderate (κ range 0.41-0.60). No association was found between high blood pressure and BMI categorised combined overweight/obesity (ᵡ²=3.19; p=0.74), but a significant association was found between high blood pressure and BMI categorised obesity only (ᵡ²=4.10; p=0.043). A significantly increased odds ratio (OR) of high blood pressure existed in the obesity BMI category (OR=1.52; p=0.045) as opposed to the overweight/obesity BMI category (OR=1.51; p=0.075). There were significant associations between high blood pressure and WC ≥ 80cm (ᵡ²=10.9; p=0.001; OR=2.08; p=0.001), WC ≥ 92cm (ᵡ²=20.1; p<0.0001; OR=1.79; p=0.011) and %BF above the age-specific cut-off points (ᵡ²=6.61; p=0.010; OR=1.70; p=0.011). Discussion and conclusion: This study found that in a sample of black urban South African women significant agreements existed between adiposity defined by %BF cut-off points for combined overweight/obesity and both WHO BMI categorised combined overweight/obesity (BMI ≥ 25 kg/m2) and obesity only (BMI ≥ 30 kg/m2), respectively. A stronger agreement was found between WHO categorised combined overweight/obesity and %BF. Furthermore, this study concluded that the BMI category according to the WHO cut-off point for overweight/obesity had insufficient sensitivity to detect the presence of high blood pressure, and that the BMI category according to the WHO cut-off point for obesity alone could detect the presence of high blood pressure. The WHO BMI classification for obesity, in contrast to the WHO BMI classification for combined overweight/obesity, is therefore appropriate to classify these black South African women at increased risk for high blood pressure. The WC and %BF cut-off points used which were specific to ethnicity, age and gender, had significant associations with high blood pressure and have good capacity to detect high blood pressure. In this study abdominal obesity as defined by the South African cut-off point of WC ≥ 92 cm had a stronger association with high blood pressure, than the international cut-off point (WC ≥ 80 cm). The South African cut-off point is, therefore, more appropriate to screen black South African women for increased risk for high blood pressure. The study therefore concluded that a stronger agreement was found between WHO categorised combined overweight/obesity and %BF than with obesity only (BMI ≥ 30 kg/m2). To ensure consistency and accuracy, and to take body composition into consideration, it is recommended that, where possible, in clinical practice the appropriate WC and %BF cut-off points together with BMI categories should be used as measures of adiposity for diagnosis of overweight and obesity and to screen or detect an increased risk for high blood pressure. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2015

Introduction: The World Health Organisation (WHO) defines overweight and obesity as a condition in which an abnormal or excessive fat accumulation exists to an extent in which health and well-being are impaired. The most recent South African National Health and Nutrition Examination Survey (SANHANES) reported that the prevalence of overweight and obesity, according to body mass index (BMI) classification, in all South African women was significantly higher than in men (24.8% and 39.2% compared to 20.1% and 10.6% for women and men, respectively). Blood pressure is often increased in obese patients and is probably the most common co-morbidity associated with obesity. Currently approximately one third (30.4%) of the adult South African population has hypertension. Hypertension is responsible for a significant percentage of the high rates of cardiovascular disease and stroke in South Africa. Limited South African data are available regarding the agreement between the measures of adiposity, including BMI, waist circumference (WC) and percentage body fat (%BF), and the association with high blood pressure. Measures of adiposity were found in previous research to be ethnicity, age and gender specific. Measuring %BF to classify adiposity takes body composition into account and is a more physiological measurement of obesity than BMI. Objective: This study aimed to investigate the agreement between adiposity classified by BMI categories and %BF cut-off points, and the association between the different measures of adiposity and high blood pressure. Method: A representative sample of black women (n=435), aged 29 years to 65 years from Ikageng in the North West Province of South Africa were included in this cross-sectional epidemiological study. Socio-demographic questionnaires were completed. Pregnancy and HIV tests were performed and those with positive test results or those who declined HIV testing were excluded. Weight and height were measured and BMI was calculated. WC, %BF using dual-energy X-ray absorptiometry (DXA), and blood pressure were measured. Results: The prevalence of overweight (BMI 25.0 kg/m² – 29.9 kg/m²) was 24.4% and obesity (BMI ≥ 30kg/m²) was 52.4%. High blood pressure was found to be present in more than two thirds of the study participants (68.5%). In this study BMI, WC and %BF as measures of adiposity were significantly correlated. There were significant agreements between combined overweight/obesity that was defined by %BF (≥35.8% 29-45 years; ≥37.7% ≥50 years) and BMI ≥ 25kg/m² (ᵡ²=199.0, p<0.0001; κ=0.68, p<0.0001), and between the presence of high %BF and obesity only, that was defined by BMI ≥ 30 kg/m² (ᵡ²=129.1, p<0.0001; κ=0.48, p<0.0001). The effect size of the agreement between the WHO BMI category for combined overweight/obesity and %BF cut-off points according to the kappa value of κ=0.68 was substantial (κ range 0.61-0.80). The effect size of the agreement between the WHO BMI category for obesity only and %BF cut-off points according to the kappa value of κ=0.48 was moderate (κ range 0.41-0.60). No association was found between high blood pressure and BMI categorised combined overweight/obesity (ᵡ²=3.19; p=0.74), but a significant association was found between high blood pressure and BMI categorised obesity only (ᵡ²=4.10; p=0.043). A significantly increased odds ratio (OR) of high blood pressure existed in the obesity BMI category (OR=1.52; p=0.045) as opposed to the overweight/obesity BMI category (OR=1.51; p=0.075). There were significant associations between high blood pressure and WC ≥ 80cm (ᵡ²=10.9; p=0.001; OR=2.08; p=0.001), WC ≥ 92cm (ᵡ²=20.1; p<0.0001; OR=1.79; p=0.011) and %BF above the age-specific cut-off points (ᵡ²=6.61; p=0.010; OR=1.70; p=0.011). Discussion and conclusion: This study found that in a sample of black urban South African women significant agreements existed between adiposity defined by %BF cut-off points for combined overweight/obesity and both WHO BMI categorised combined overweight/obesity (BMI ≥ 25 kg/m2) and obesity only (BMI ≥ 30 kg/m2), respectively. A stronger agreement was found between WHO categorised combined overweight/obesity and %BF. Furthermore, this study concluded that the BMI category according to the WHO cut-off point for overweight/obesity had insufficient sensitivity to detect the presence of high blood pressure, and that the BMI category according to the WHO cut-off point for obesity alone could detect the presence of high blood pressure. The WHO BMI classification for obesity, in contrast to the WHO BMI classification for combined overweight/obesity, is therefore appropriate to classify these black South African women at increased risk for high blood pressure. The WC and %BF cut-off points used which were specific to ethnicity, age and gender, had significant associations with high blood pressure and have good capacity to detect high blood pressure. In this study abdominal obesity as defined by the South African cut-off point of WC ≥ 92 cm had a stronger association with high blood pressure, than the international cut-off point (WC ≥ 80 cm). The South African cut-off point is, therefore, more appropriate to screen black South African women for increased risk for high blood pressure. The study therefore concluded that a stronger agreement was found between WHO categorised combined overweight/obesity and %BF than with obesity only (BMI ≥ 30 kg/m2). To ensure consistency and accuracy, and to take body composition into consideration, it is recommended that, where possible, in clinical practice the appropriate WC and %BF cut-off points together with BMI categories should be used as measures of adiposity for diagnosis of overweight and obesity and to screen or detect an increased risk for high blood pressure. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2015

Hypertension is the leading cause of cardiovascular diseases worldwide. There is evidence of the rising incidence and prevalence of chronic diseases of lifestyle in developing countries. Physical activity has been regarded as a commonly accepted modality for treating hypertension. The aim of this study was to determine if physical activity levels are associated with hypertension among employees of Kigali Institute Science and Technology in Kigali,Rwanda. A quantitative, cross- sectional design was used and all staff members (325 employees) of Kigali Institute of Science and Technology (KIST) represented the study population. Random sampling was used to determine the study sample. Data was collected by means of a self-administered questionnaire adopted from The International Physical Activity Questionnaire (IPAQ).Data analysis was done using Statistical Package for Social Sciences (SPSS) software version 15.0. Descriptive statistics using frequencies, percentages, means, and standard deviations and inferential statistics using Chi-square tests were employed. The data were presented with use tables,figures,graphs, and pie charts. Ethical issues including obtaining permission for conducting the study, informe consent,anonymity,confidentiality, voluntary participation, and the right to withdraw from the study was observed in this study. The study found a prevalence of 34% participants with hypertension. The prevalence of hypertension was associated with age, smoking, drinking alcohol, suffering for diabetes mellitus, and body mass index (BMI). Over one-fifth of the participants in the physically active group were hypertensive while 68% of the participants in the physically inactive group were hypertensive. This study shows that hypertension status is strongly associated with physical activity levels [X² = 20.381 with (P<0.001)]. The study further showed that smoking and suffering from diabetes mellitus were also associated with levels of physical activity (P = 0.003 and p = 0.004 respectively). The current study concludes that physical activity is needed for employees at Kigali Institute of Science and Technology as part of preventive measures for chronic diseases of lifestyle. Therefore, the recommendations were proposed to various categories of people and stakeholders to be actively involved in the promotion of physical activity among employees of Kigali Universities in Rwanda. / Magister Scientiae (Physiotherapy) - MSc(Physio)

L’hypertension pulmonaire (PH) compliquant la bronchopneumopathie chronique obstructive (BPCO) est associée à une augmentation du risque de décès. Le remodelage vasculaire pulmonaire en est la principale cause ; ce remodelage est le résultat de la combinaison des effets de l'hypoxie alvéolaire, d’une inflammation et de la perte du lit vasculaire pulmonaire. Sur le plan anatomique, on observe un épaississement de l’intima dû à une prolifération des cellules musculaires lisses (CML). Ces anomalies sont sous la dépendance du transporteur de la sérotonine (5-HTT). La quantité d’ARN messager du 5- HTT des CML humaines en culture est significativement plus élevée chez les sujets homozygotes pour la forme longue du promoteur de 5-HTT (LL), par rapport aux sujets hétérozygotes (LS) ou homozygotes pour la forme courte (SS), notamment en condition hypoxique. La pression artérielle pulmonaire (PAP) est significativement plus élevée chez les patients homozygotes LL (moy. 34 ± (ET)13 mm Hg), par rapport aux autres patients (22 ± 4 mm Hg et 23 ± 5 mm Hg ; p<0,001). Nous avons également observé que l’interleukine 6 (IL- 6) sérique est corrélée à la PAP (r=0,39 ; p< 0,001). De plus, un polymorphisme fonctionnel du gène codant pour l’IL-6 G(–174)C est associé dans sa forme homozygote GG à une HP plus fréquente (Odds Ratio ajusté= 4.32; [Intervalle de confiance à 95%, 1.96-9.54]) et une PAP significativement plus élevée. En conclusion, la prolifération des CML artérielles pulmonaires dans la BPCO est dépendante du 5-HTT et de l’inflammation. Cette prolifération est en partie induite par l’hypoxie alvéolaire entraînant un remodelage des petites artères et artérioles pulmonaires / The lung high blood pressure complicating (PH) the obstructive chronic bronchopneumopathie ( BPCO) is associated with an increase of the risk of death(deaths). The lung vascular reshaping is the main cause; this reshaping is the result(profit) of the combination(overall) of the effects of the alveolar hypoxie, the inflammation and the loss of the lung vascular bed