Is social support associated with hypertension control among Ghanaian migrants in Europe and non-migrants in Ghana? The RODAM study

Longitudinal Analysis of the Relationship Between Social Isolation and Hypertension in Early Middle Adulthood

BACKGROUND

Most studies have used cross-sectional or limited follow-up data to evaluate the relationship between social isolation (SI) and hypertension in older populations. The objective of this analysis was to examine the relationship between longitudinal SI and hypertension in a younger population.

METHODS AND RESULTS

The present analysis used data from waves I to V of the National Longitudinal Study of Adolescent to Adult Health (1994-2018) and logistic regression models to describe the association of timing, duration, and transitional patterns of SI with hypertension in early middle adulthood. Models were adjusted for demographic variables and adolescent socioeconomic and health-related confounders. SI was higher across life stages among individuals with hypertension (adolescence: 38% versus 35%, young adulthood: 52% versus 44%, and early middle adulthood: 61% versus 52%). Individuals who were socially isolated in young adulthood or early middle adulthood had greater odds of hypertension in early middle adulthood than those who were not (odds ratio [OR], 1.30 [95% CI, 1.07-1.56]; OR, 1.42 [95% CI, 1.15-1.76], respectively). Early middle adulthood hypertension was significantly associated with persistent SI across all life stages and for those who moved into persistent SI after adolescence (OR, 1.40 [95% CI, 1.02-1.93]; OR, 1.61 [95% CI, 1.18-2.19], respectively).

CONCLUSIONS

SI in young or early middle adulthood significantly increased the odds of hypertension, as did moving into SI and the accumulation of SI across life stages. Our analysis provides insights regarding timing for effective interventions to reduce hypertension earlier in the life course, which may prevent future adverse cardiovascular-related events.

Social determinants of hypertension and diabetes among African immigrants: the African immigrants health study

OBJECTIVE

To examine the association between social determinants of health, hypertension, and diabetes among African immigrants.

METHODS

The African Immigrant Health Study was a cross-sectional study of the health of African immigrants in the Baltimore-Washington Metropolitan Area. The outcomes of interest were self-reported diagnoses of hypertension and diabetes. Logistic regression was used to examine the relationship between educational status, employment, income, social support, health insurance, and self-reported diagnoses of hypertension and diabetes, adjusting for age, sex, and length of stay in the U.S.

RESULTS

A total of 465 participants with mean (±SD) age 47 (±11.5) years were included. Sixty percent were women, 64% had a college degree or higher, 83% were employed, 67% had health insurance, and 70% were married/cohabitating. Over half (60%) of the participants had lived in the United States for ≥ 10 years, and 84% were overweight/obese. The overall prevalence of hypertension and diabetes was 32% and 13%, respectively. The odds of diabetes was higher (aOR: 5.00, 95% CI: 2.13, 11.11) among those who were unemployed than among those who were employed, and the odds of hypertension was higher among those who had health insurance (aOR:1.73, 95% CI: 1.00, 3.00) than among those who did not.

CONCLUSIONS

Among African immigrants, those who were unemployed had a higher likelihood of a self-reported diagnosis of diabetes than those who were employed. Also, people who had health insurance were more likely to self-report a diagnosis of hypertension. Additional studies are needed to further understand the influence of social determinants of health on hypertension and diabetes to develop health policies and interventions to improve the cardiovascular health of African immigrants.

[Social, clinical and psychosocial determinants associated with uncontrolled arterial hypertension in older adults. SABE Survey Colombia 2016]

OBJECTIVE

To evaluate sociodemographic, clinical and psychosocial characteristics that are associated with uncontrolled arterial hypertension (HANC) in older adults in Colombia.

METHODS

Secondary analysis of data from the National Survey of Health, Welfare and Aging (SABE Colombia 2016), in which men and women aged 60 years or older in the country who were not institutionalized were interviewed. The dependent variable was uncontrolled hypertension (HANC) (≥140/90mm Hg). The SABE survey surveyed 23694 older adults; 11264 had a diagnosis of arterial hypertension (HTA) and were taking antihypertensive medication. On the other hand, 5106 older adults, randomly selected, had their blood pressure taken. Participants previously diagnosed with HTA under medical management with antihypertensives and who had had their blood pressure taken at the same time were included, resulting in a sample of 2656 participants. Sociodemographic, clinical and psychosocial characteristics were evaluated. Univariate, bivariate, and multivariate analyzes with logistic regression were performed.

RESULTS

One thousand one hundred eighty-eight (44.7%) participants presented HANC. A higher prevalence of HANC was observed in adults older than 74 years (OR 1.31; 95% CI 1.09-1.57) and lower prevalence in residents of urban areas (OR 0.55; 95% CI 0.42-0.71).

CONCLUSIONS

Age over 74 years and living in a rural area were identified as variables associated with inadequate blood pressure control in non-institutionalized older adults in Colombia.

Race, geographical location and other risk factors for hypertension: South African National Health and Nutrition Examination Survey 2011/12

BACKGROUND

Hypertension is the leading cardiovascular disease in Africa. It is increasing in prevalence due partly to the epidemiological transition that African countries, including South Africa, are undergoing. This epidemiological transition is characterised by a nutrition transition andurbanisation; resulting in behavioural, environmental and stress changes that are subject to racial and geographic divides. The South African National Health and Nutrition Examination Survey (SANHANES) examined the association of traditional risk factors; and less traditional risk factors such as race, geographical location, social stressors and psychological distress with hypertension in a national population-based sample of South Africans.

METHODS

Data were analysed on individuals ≥15 years who underwent a physical examination in the SANHANES (n = 7443). Hypertension was defined by blood pressure ≥140/90 mmHg or self-reported hypertension medication usage. Stepwise regression examined the association of demographic, socioeconomic, life stressors, and health risk factors with systolic blood pressure, diastolic blood pressure, and hypertension. Secondly, the risk factor associations and geographical location effects were investigated separately for the African race group.

RESULTS

Increasing age (AOR = 1.069, p < 0.001); male gender (AOR = 1.413, p = 0.037); diabetes (AOR = 1.66, p = 0.002); family history of high blood pressure (AOR = 1.721, p < 0.001); and normal weight, overweight and obesity (relative to underweight: AOR = 1.782, p = 0.008; AOR = 2.232, p < 0.001; AOR = 3.874, p < 0.001 respectively) were associated with hypertension. Amongst African participants (n = 5315) age (AOR = 1.068, p < 0.001); male gender (AOR = 1.556, p = 0.001); diabetes (AOR = 1.717, p = 0.002); normal weight, overweight and obesity (relative to underweight: AOR = 1.958, p = 0.006; AOR = 2.118, p = 0.002; AOR = 3.931, p < 0.001); family history of high blood pressure (AOR = 1.485, p = 0.005); and household crowding (AOR = 0.745, p = 0.037) were associated with hypertension. There was a significantly lower prevalence of hypertension in rural informal compared to urban formal settings amongst African participants (AOR = 0.611, p = 0.005). Other social stressors and psychological distress were not significantly associated with hypertension.

CONCLUSION

There was no significant association between social stressors or psychological distress and hypertension. However, the study provides evidence of high-risk groups for whom hypertension screening and management should be prioritised, including older ages, males, people with diabetes or with family history of hypertension, and Africans who live in urban formal localities.

The Effect of Social Support on Treatment Adherence in Hypertension in China

OBJECTIVE

Treatment nonadherence is a major problem in the management of hypertension. There are many factors influencing the treatment adherence of hypertensive patients. The aim of this study was to examine the effect of social support on the treatment adherence in hypertension in China.

PATIENTS AND METHODS

A total of 453 patients with hypertension hospitalized in a tertiary hospital in Xi'an, China were invited to participate in this cross-sectional study. Data were collected by "modified Chinese Hill-Bone compliance to high blood pressure therapy scale" and "Chinese Family Support Scale".

RESULTS

It was found that 31.1% of patients were adherent with their antihypertensive treatments. Gender, duration of antihypertensive drug used, number of antihypertensive drugs used and social support were independently associated with hypertensive treatment adherence. Social support was strongly and positively associated with the hypertensive treatment adherence (P<0.001, OR = 0.752, 95% CI: 0.678-0.833). Family social support was provided to hypertensive patients mainly through their nuclear family, that is spouses, partner or children. Treatment adherence of hypertensive patients was positively correlated to the three subgroups of social support. It was found that social support provided to patients from social resource (r=0.568) had greater impact on treatment adherence than that from kinship (r=0.364) and nuclear family (r=0.262).

CONCLUSION

Treatment adherence of patients with hypertension was found to increase positively as their social support increased. In addition to the support given to patients from nuclear family members, other social support especially professional agencies and community organizations should also be promoted and strengthened.

The effect of high blood pressure-health literacy, self-management behavior, self-efficacy and social support on the health-related quality of life of Kazakh hypertension patients in a low-income rural area of China: a structural equation model

Background

Health-Related Quality of Life (HRQoL) of hypertensive patients is not only affected by the disease itself but also by some subjective factors. Low health literacy is prevalent among ethnic minorities. Considering the Kazakh-Chinese people have the highest prevalence of hypertension in Xinjiang, and the High Blood Pressure-Health Literacy (HBP-HL) has not been included in the study of HRQoL. The synergistic effects and the potential mechanism HBP-HL, self-management behavior, therapeutic adherence, self-efficacy, social support on HRQoL remain unclear. This study aimed to introduce the HBP-HL, and develop a structural equation model (SEM) to identify the factors influencing of the HRQoL among Kazakh hypertensive patients.

Methods

The data was obtained by questionnaire survey and physical examination in 2015. Patients with hypertension were recruited through random cluster sampling in Kazakh settlements in Xinjiang. Firstly, the blood pressure was measured. Then the one-for-one household interviews were conducted by Kazakh investigators. The questionnaires regarding HBP-HL, HRQoL, self-management behavior, therapeutic adherence, self-efficacy, and social support were used to collect data. Finally, SEM was constructed, and p ≤ 0.05 was taken as significant.

Results

The data was analysed by SPSS18.0 and AMOS18.0 software. 516 Kazakh hypertension patients were recruited, and 94.4% of them had a relatively low HBP-HL score. The mean standardized scores of HRQoL, self-management, therapeutic adherence were poor; they were 63.5, 66.2, and 64.4, respectively. But 96.1% and 98.3% of the participants had high levels of self-efficacy and social support. The SEM of the HRQoL had a good overall fit (χ²/df = 2.078, AGFI = 0.944, GFI = 0.968, CFI = 0.947, IFI = 0.949, RMSEA = 0.046). The model indicated that the HBP-HL has the highest correlation with HRQoL, following with self-management behavior, social support, and self-efficacy.

Conclusions

Low HBP-HL is a major influenced factor of HRQoL among Kazakh hypertensive patients. Future programs should consider HBP-HL as the breakthrough point when designing targeting intervention strategies.