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    Dietary sources of high sodium intake in Turkey: SALTURK II
    (Mdpi Ag, 2017) Erdem, Yunus; Akpolat, Tekin; Derici, Ülver; Şengül, Şule; Ertürk, Şehsuvar; Ulusoy, Şükrü; Arıcı, Mustafa
    Previous research has shown daily salt intakes in Turkey to be far above the recommended limits. Knowing the sources of dietary salt could form a basis for preventive strategies aimed towards salt reduction. This study aimed to investigate dietary sources of salt in Turkey. A sub-group (n = 657) was selected from the PatenT2 study population, which represented the urban and rural areas of 4 major cities (Ankara, Istanbul, Izmir, and Konya). A questionnaire inquiring about sociodemographic characteristics, medical histories, detailed histories of diet, and salt consumption was completed. Participants were asked to collect a 24-h urine sample and to record their food intake (dietary recall) on the same day. Of 925 participants selected, 657 (71%) provided accurate 24-h urine collections, based on creatinine excretion data. The mean daily 24-h urinary sodium excretion was 252.0 +/- 92.2 mmol/day, equal to daily salt intake of 14.8 +/- 5.4 g. Of the 657 participants with accurate 24-h urine collections, 464 (70%) provided fully completed dietary recalls. Among these 464 participants, there was a significant difference between the 24-h urinary sodium excretion-based salt intake estimation (14.5 +/- 5.1 g/day) and the dietary recall-based salt intake estimation (12.0 +/- 7.0 g/day) (p < 0.001). On the other hand, a positive correlation was obtained between the dietary recall-based daily salt intake and 24-h urinary sodium excretion-based daily salt intake (r = 0.277, p < 0.001). Bread was the main source of salt (34%) followed by salt added during cooking and preparing food before serving (30%), salt from various processed foods (21%), and salt added at the table during food consumption (11%). Conclusively, this study confirmed a very high salt intake of the adult population in four major cities in Turkey. The present findings support the emerging salt reduction strategy in Turkey by promoting lower salt content in baked bread, and less salt use in habitual food preparation and during food consumption in the home.
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    Does blood pressure variability affect hypertension development in pre-hypertensive patients?
    (Oxford Academic, 2021) Özkan, Gülsüm; Ulusoy, Şükrü; Arıcı, Mustafa; Derici, Ülver; Akpolat, Tekin; Şengül, Şule
    Background: Blood pressure variability (BPV) is associated with end organ damage and cardiovascular outcomes in hypertensive patients. Pre-hypertensive patients frequently develop hypertension (HT). The purpose of the present study was to evaluate the effect of BPV on the development of HT. Methods: Two hundred seven pre-hypertensive patients from the Cappadocia cohort were monitored over two years, and 24-h ambulatory blood pressure monitoring (24-h ABPM), office and home BP measurements were subsequently performed at four to six-month intervals. BPV was calculated as average real variability (ARV) from 24-h ABPM data, home and office BP measurements at first visit. The relationship was evaluated between baseline ARV and the development of HT. Results: HT was diagnosed in 25.60% of subjects. Baseline 24-h ABPM systolic blood pressure (SBP)ARV and diastolic blood pressure (DBP)ARV and home SBP ARV were significantly higher in patients who developed HT than the other patients (p 0.006, 0.001 and 0.006, respectively). Baseline 24h-ABPM SBPARV and home SBPARV exceeding the 90 th percentile were identified as parameters affecting development of HT at logistic regression analysis. Conclusion: In conclusion, our prospective observational cohort study showed that short-term BPV in particular can predict the development of HT in the pre-hypertensive population.
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    Home sphygmomanometers can help in the control of blood pressure: a nationwide field survey
    (Nature Publishing Group, 2018) Akpolat, Tekin; Arıcı, Mustafa; Şengül, Şule; Derici, Ülver; Ulusoy, Şükrü; Ertürk, Şehsuvar; Erdem, Yunus
    Home blood pressure monitoring (HBPM), which integrates patients into their treatment program, is a self-management tool. The prevalence of home sphygmomanometer ownership and patient compliance with HBPM guidelines are not well known, especially in developing and underdeveloped countries. The aims of this study were to measure the prevalence of home sphygmomanometer ownership among hypertensive subjects through a nationwide field survey (PatenT2), to investigate the validation of sphygmomanometers and consistency of the user arm circumference and cuff size of the upper-arm device owned, as well as to compare blood pressure (BP) readings between hypertensive subjects who have or do not have a sphygmomanometer. Sample selection was based on a multistratified proportional sampling procedure to select a nationally representative sample of the adult population (n = 5437). Of 1650 hypertensive subjects, 332 (20.1%) owned a device, but the percentage of patients who owned a sphygmomanometer was 28.8% among patients who were aware of their hypertension (260/902). The usage of wrist devices and nonvalidated devices is common, and selection of an appropriate cuff size is ignored. Linear-regression analysis showed that owning a BP monitor is associated with decreases of 3.7 mmHg and 2.8 mmHg for systolic and diastolic BPs, respectively. Many patients do not own a sphygmomanometer. The decrease of systolic and diastolic BPs among BP monitor owners is a striking finding. The implementation of a hypertension care program consisting of sphygmomanometer reimbursement and training of patients in its use for HBPM might be costeffective.
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    Which out-of-office measurement technique should be used for diagnosing hypertension in prehypertensives?
    (Nature Publishing Group, 2020) Ulusoy, Şükrü; Özkan, Gülsüm; Arıcı, Mustafa; Derici, Ülver; Akpolat, Tekin; Şengül, Şule; Yılmaz, Rahmi; Ertürk, Şehsuvar; Erdem, Yunus
    Hypertension (HT) is diagnosed with high office blood pressure (BP), although confirmation with the addition of out-of-office measurements is currently recommended. However, insufficient data are available concerning the use of out-of-office BP measurement techniques for the diagnosis of HT in the prehypertensive population. The aim of the present study was to determine which out-of-office measurements yielded earlier and more frequent detection of development of HT in prehypertensive patients. Two hundred seven prehypertensive patients under monitoring in the Cappadocia cohort were included in the study. Office BP was measured five times at 1-min intervals, followed by 24-h ambulatory BP monitoring (24-h ABPM). Home BP measurement (HBPM) was performed five times, at the same times in the morning and evening, at 1-min intervals for 1 week. The same procedure was carried out at 4-6-month intervals for ~2 years. HT was diagnosed in 25.6% of subjects, masked HT in 11.1%, and white coat HT in 2.9%, while 23.7% remained prehypertensive and 36.7% became normotensive. Briefly, 56.6% of the patients with HT were diagnosed with office plus 24-h ABPM, 13.2% with office plus HBPM, and 30.2% with office plus HBPM and 24-h ABPM. Office with 24-h ABPM yielded statistically significantly more diagnoses (p < 0.001). In conclusion, our prospective observational study evaluated the usefulness of out-of-office BP measurements in confirming diagnosis of HT in prehypertensive patients. The findings show that 24-h ABPM detected HT earlier and more frequently in this high-risk population.