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Bazoukis G, Loscalzo J, Hall JL, Bollepalli SC, Singh JP, Armoundas AA. Impact of Social Determinants of Health on Cardiovascular Disease. J Am Heart Assoc 2025; 14:e039031. [PMID: 40035388 DOI: 10.1161/jaha.124.039031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
An increasing number of studies have shown the impact of social determinants of health (SDoHs) on different cardiovascular outcomes. SDoHs influence the regional incidence of heart failure, heart failure outcomes, and heart failure readmission rates; can prevent use of advanced heart failure therapies in minorities with an indication for their use; can influence the incidence of coronary artery disease and peripheral artery disease outcomes; and can also prevent providing equal quality of care to all patients with myocardial infarction. In the setting of arrhythmias, specific SDoHs can increase the incidence of atrial fibrillation and adversely affect major outcomes in these patients. In congenital heart diseases, SDoHs can affect major outcomes, as well. In conclusion, SDoHs significantly impact cardiovascular morbidity and death and specific outcomes of patients with cardiovascular disease. Policy measures that aim to improve those SDoHs that negatively affect health outcomes hold promise for improving cardiovascular outcomes at individual and population levels.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology Larnaca General Hospital Larnaca Cyprus
- European University of Cyprus Medical School Nicosia Cyprus
| | - Joseph Loscalzo
- Department of Medicine Brigham and Women's Hospital Boston MA USA
| | | | | | - Jagmeet P Singh
- Cardiology Division, Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA USA
| | - Antonis A Armoundas
- Cardiovascular Research Center Massachusetts General Hospital Boston MA USA
- Broad Institute, Massachusetts Institute of Technology Cambridge MA USA
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Nobakht N, Afshar Y, Vaseghi M, Li Z, Donangelo I, Lavretsky H, Mok T, Han CS, Nicholas SB. Hypertension Management in Women With a Multidisciplinary Approach. Mayo Clin Proc 2025; 100:514-533. [PMID: 39736047 PMCID: PMC12013344 DOI: 10.1016/j.mayocp.2024.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 08/25/2024] [Accepted: 10/11/2024] [Indexed: 12/31/2024]
Abstract
Current clinical practice guidelines were established by several organizations to guide the diagnosis and treatment of hypertension in men and women in a similar manner despite data demonstrating differences in underlying mechanisms. Few publications have provided a contemporary and comprehensive review focused on characteristics of hypertension that are unique to women across their life spectrum. We performed a computerized search using PubMed, OVID, EMBASE, and Cochrane library databases between 1995 and 2023 that highlighted relevant clinical studies, challenges to the management of hypertension in women, and multidisciplinary approaches to hypertension control in women, including issues unique to racial and ethnic minority groups. Despite our current understanding of underlying mechanisms and strategies to manage hypertension in women, numerous challenges remain. Here, we discuss potential factors contributing to hypertension in women, differences related to effects of lifestyle modifications and drug therapy between men and women, the impact of sleep, and the importance of recognizing disparities in socioeconomic conditions and access to care. This review outlines several opportunities for future studies to fill gaps in knowledge to achieve optimal control of hypertension in women using a multidisciplinary approach, particularly related to sex-specific treatment approaches while considering socioeconomic conditions and life stages from premenopause through the transition to menopause.
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Affiliation(s)
- Niloofar Nobakht
- Division of Nephrology, Department of Medicine, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Zhaoping Li
- Division of Clinical Nutrition, Department of Medicine, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Ines Donangelo
- Division of Endocrinology, Department of Medicine, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Thalia Mok
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Christina S Han
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Susanne B Nicholas
- Division of Nephrology, Department of Medicine, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA
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Zhu Y, Wu S, Qiu W, Wang J, Feng Y, Chen C. Social Determinants of Health, Blood Pressure Classification, and Incident Stroke Among Chinese Adults. JAMA Netw Open 2024; 7:e2451844. [PMID: 39714839 DOI: 10.1001/jamanetworkopen.2024.51844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2024] Open
Abstract
Importance Although cumulative evidence suggests that higher blood pressure (BP) and a greater burden of social determinants of health (SDOH) are associated with an increased risk of stroke, few studies have examined whether SDOH burden modifies the association between BP and stroke risk. Objective To evaluate whether the association between BP classification and stroke risk differs by SDOH burden among Chinese adults. Design, Setting, and Participants In this cohort study, analyses were conducted among 90 850 participants in the prospective subcohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, with recruitment from January 1, 2016, to December 31, 2020. Participants without cardiovascular diseases and with complete data were included and followed up for stroke events until June 30, 2023. Exposures Social determinants of health burden was defined using 5 components: educational attainment, economic stability, health care access, social support, and urban vs rural residence. Blood pressure was categorized according to the 2017 American College of Cardiology/American Heart Association BP guideline. Main Outcomes and Measures Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of BP classification with incident stroke stratified by SDOH burden groups. Results The study included 90 850 participants (median age, 54.0 years [IQR, 46.0-62.0 years]; 55 390 women [61.0%]). During a median follow-up of 5.0 years (IQR, 4.1-5.8 years), 4408 incident stroke events were recorded. Compared with normal BP, elevated BP (HR, 1.33 [95% CI, 1.17-1.52]), stage 1 hypertension (HR, 1.60 [95% CI, 1.43-1.78]), and stage 2 hypertension (HR, 1.79 [95% CI, 1.61-2.00]) were associated with stroke among participants with high SDOH burden, while only stage 2 hypertension (HR, 1.52 [95% CI, 1.20-1.93]) was associated with stroke among those with low SDOH burden, with a significant multiplicative interaction of SDOH burden and BP classification (P = .03). Participants with high SDOH burden and stage 2 hypertension had the highest risk of stroke compared with participants with low SDOH burden and normal BP (HR, 2.13 [95% CI, 1.75-2.60]). Conclusions and Relevance This study suggests that higher BP levels, even at lower stages of hypertension, pose a greater stroke risk for individuals with high SDOH burden. Early surveillance and intervention for high BP should be emphasized in socioeconomically disadvantaged populations.
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Affiliation(s)
- Yanchen Zhu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shiping Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Weida Qiu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jiabin Wang
- Global Health Research Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Hypertension Laboratory, Cardiovascular Disease Center of Guangdong Province, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chaolei Chen
- Hypertension Laboratory, Cardiovascular Disease Center of Guangdong Province, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Nain P, Stabellini N, Makram OM, Rast J, Yerraguntla S, Gopu G, Bhave A, Seth L, Patel V, Jiang S, Malik S, Shetewi A, Montero AJ, Cullen J, Agarwal N, Wang X, Ky B, Baldassarre LA, Weintraub NL, Harris RA, Guha A. Adverse social determinants of health elevate uncontrolled hypertension risk: a cardio-oncology prospective cohort study. JNCI Cancer Spectr 2024; 8:pkae064. [PMID: 39115393 PMCID: PMC11368120 DOI: 10.1093/jncics/pkae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/14/2024] [Accepted: 06/25/2024] [Indexed: 09/03/2024] Open
Abstract
The role of social determinants of health (SDOH) in controlling hypertension (HTN) in cancer patients is unknown. We hypothesize that high SDOH scores correlate with uncontrolled HTN in hypertensive cancer patients. In our prospective study, patients completed the Protocol for Responding to & Assessing Patients' Assets, Risks & Experiences questionnaire. After integrating home and clinic blood pressure readings, uncontrolled HTN was defined as systolic blood pressure greater than or equal to 140 mm Hg and/or diastolic blood pressure greater than or equal to 90 mm Hg. Using Cox regression, we analyzed the impact of SDOH on HTN control, adjusting for relevant factors. The study involved 318 participants (median age 66.4, median follow-up 166 days, SDOH score 6.5 ± 3.2), with stress, educational insecurity, and social isolation as prevalent adverse SDOH. High SDOH scores led to 77% increased risk of uncontrolled HTN (adjusted hazards ratio = 1.77; 95% confidence interval = 1.10 to 2.83, P = .018). Urban residents with high SDOH scores were at an even greater risk. Identifying SDOH and mitigating underlying factors may help control HTN, the most typical disease process treated in all cardio-oncology clinics.
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Affiliation(s)
- Priyanshu Nain
- Department of Medicine, Division of Cardiology, and Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Nickolas Stabellini
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Division of Hematology and Oncology, Department of Medicine, University Hospitals/Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Omar M Makram
- Department of Medicine, Division of Cardiology, and Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Johnathan Rast
- Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | | | - Gaurav Gopu
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Aditya Bhave
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Lakshya Seth
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Vraj Patel
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Stephanie Jiang
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Sarah Malik
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Ahmed Shetewi
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Alberto J Montero
- Division of Hematology and Oncology, Department of Medicine, University Hospitals/Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jennifer Cullen
- Cancer Population Sciences, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Neeraj Agarwal
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Xiaoling Wang
- Georgia Prevention Institute, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Bonnie Ky
- Department of Biostatistics, Epidemiology, & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren A Baldassarre
- Section of Cardiovascular Medicine, Department of Medicine and Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Neal L Weintraub
- Department of Medicine, Division of Cardiology, and Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Ryan A Harris
- Georgia Prevention Institute, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Avirup Guha
- Department of Medicine, Division of Cardiology, and Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Acharya S, Neupane G, Seals A, KC M, Giustini D, Sharma S, Taylor YJ, Palakshappa D, Williamson JD, Moore JB, Bosworth HB, Pokharel Y. Self-Measured Blood Pressure-Guided Pharmacotherapy: A Systematic Review and Meta-Analysis of United States-Based Telemedicine Trials. Hypertension 2024; 81:648-657. [PMID: 38189139 PMCID: PMC11213974 DOI: 10.1161/hypertensionaha.123.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/25/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The optimal approach to implementing telemedicine hypertension management in the United States is unknown. METHODS We examined telemedicine hypertension management versus the effect of usual clinic-based care on blood pressure (BP) and patient/clinician-related heterogeneity in a systematic review/meta-analysis. We searched United States-based randomized trials from Medline, Embase, CENTRAL, CINAHL, PsycINFO, Compendex, Web of Science Core Collection, Scopus, and 2 trial registries. We used trial-level differences in BP and its control rate at ≥6 months using random-effects models. We examined heterogeneity in univariable metaregression and in prespecified subgroups (clinicians leading pharmacotherapy [physician/nonphysician], self-management support [pharmacist/nurse], White versus non-White patient predominant trials [>50% patients/trial], diabetes predominant trials [≥25% patients/trial], and White patient predominant but not diabetes predominant trials versus both non-White and diabetes patient predominant trials]. RESULTS Thirteen, 11, and 7 trials were eligible for systolic and diastolic BP difference and BP control, respectively. Differences in systolic and diastolic BP and BP control rate were -7.3 mm Hg (95% CI, -9.4 to -5.2), -2.7 mm Hg (-4.0 to -1.5), and 10.1% (0.4%-19.9%), respectively, favoring telemedicine. Greater BP reduction occurred in trials where nonphysicians led pharmacotherapy, pharmacists provided self-management support, White patient predominant trials, and White patient predominant but not diabetes predominant trials, with no difference by diabetes predominant trials. CONCLUSIONS Telemedicine hypertension management is more effective than clinic-based care in the United States, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support. Non-White patient predominant trials achieved less BP reduction. Equity-conscious, locally informed adaptation of telemedicine interventions is needed before wider implementation.
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Affiliation(s)
- Sameer Acharya
- Department of Internal Medicine, Cayuga Medical Center, Ithaca, New York, USA
| | - Gagan Neupane
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Austin Seals
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Madhav KC
- Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Dean Giustini
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharan Sharma
- SCL Heart and Vascular Institute, Brighton, Colorado, USA
| | - Yhenneko J. Taylor
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - Deepak Palakshappa
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Jeff D. Williamson
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Justin B. Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Hayden B. Bosworth
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Yashashwi Pokharel
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
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Acharya S, Neupane G, Seals A, Madhav KC, Giustini D, Sharma S, Taylor YJ, Palakshappa D, Williamson JD, Moore JB, Bosworth HB, Pokharel Y. Heterogeneity of the Effect of Telemedicine Hypertension Management Approach on Blood Pressure: A Systematic Review and Meta-analysis of US-based Clinical Trials. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.14.23295587. [PMID: 37745417 PMCID: PMC10516092 DOI: 10.1101/2023.09.14.23295587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Telemedicine management of hypertension (TM-HTN) uses home blood pressure (BP) to guide pharmacotherapy and telemedicine-based self-management support (SMS). Optimal approach to implementing TM-HTN in the US is unknown. Methods We conducted a systematic review and a meta-analysis to examine the effect of TM-HTN vs. usual clinic-based care on BP and assessed heterogeneity by patient- and clinician-related factors. We searched US-based randomized clinical trials among adults from Medline, Embase, CENTRAL, CINAHL, PsycInfo, and Compendex, Web of Science Core Collection, Scopus, and two trial registries to 7/7/2023. Two authors extracted, and a third author confirmed data. We used trial-level differences in systolic BP (SBP), diastolic BP (DBP) and BP control rate at ≥6 months using random-effects models. We examined heterogeneity of effect in univariable meta-regression and in pre-specified subgroups [clinicians leading pharmacotherapy (physician vs. non-physician), SMS (pharmacist vs. nurse), White vs. non-White patient predominant trials (>50% patients/trial), diabetes predominant trials (≥25% patients/trial) and in trials that have majority of both non-White patients and patients with diabetes vs. White patient predominant but not diabetes predominant trials. Results Thirteen, 11 and 7 trials were eligible for SBP, DBP and BP control, respectively. Differences in SBP, DBP and BP control rate were -7.3 mmHg (95% CI: - 9.4, -5.2), -2.7 mmHg (-4.0, -1.5) and 10.1% (0.4%, 19.9%), respectively, favoring TM-HTN. More BP reduction occurred in trials with non-physician vs. physician led pharmacotherapy (9.3/4.0 mmHg vs. 4.9/1.1 mmHg, P<0.01 for both SBP/DBP), pharmacist vs. nurses provided SMS (9.3/4.1 mmHg vs. 5.6/1.0 mmHg, P=0.01 for SBP, P<0.01 for DBP), and White vs. non-White patient predominant trials (9.3/4.0 mmHg vs. 4.4/1.1 mmHg, P<0.01 for both SBP/DBP), with no difference by diabetes predominant trials. Lower BP reduction occurred in both diabetes and non-White patient predominant trials vs. White patient predominant but not diabetes predominant trials (4.5/0.9 mmHg vs. 9.5/4.2 mmHg, P<0.01 for both SBP/DBP). Conclusions TM-HTN is more effective than clinic-based care in the US, particularly when non-physician led pharmacotherapy and pharmacist provided SMS. Non-White patient predominant trials seemed to achieve lesser BP reduction. Equity conscious, locally informed adaptation of TM-HTN is needed before wider implementation. Clinical Perspective What Is New?: In this systematic review and meta-analysis of US-based clinical trials, we found that telemedicine management of hypertension (TM-HTN) was more effective in reducing and controlling blood pressure (BP) compared with clinic based hypertension (HTN) care.The BP reduction was more evident when pharmacotherapy was led by non-physician compared with physicians and HTN self-management support was provided by clinical pharmacists compared with nurses,Non-White patient predominant trials achieved lesser BP reductions than White patient predominant trials.What Are the Clinical Implications?: Before wider implementation of TM-HTN intervention in the US, locally informed adaptation, such as optimizing the team-based HTN care approach, can provide more effective BP control.Without equity focused tailoring, TM-HTN intervention implemented as such can exacerbate inequities in BP control among non-White patients in the US.
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Ferdinand KC, Charbonnet RM, Laurent J, Villavaso CD. Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions. Curr Opin Cardiol 2023; 38:304-310. [PMID: 37115906 DOI: 10.1097/hco.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW Hypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence, and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the increased burden of cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertension-associated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension. RECENT FINDINGS In this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidence-based pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity. SUMMARY In the final analysis, longstanding, unacceptable hypertension and CVD morbidity and mortality in U.S. NHB adults must be addressed. Appropriate TLC and evidence-based pharmacotherapy benefit all populations, especially NHB adults. Ultimately, novel community-based interventions and SMBP may help overcome the SDOH that cause hypertension disparities.
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Affiliation(s)
- Keith C Ferdinand
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine
| | - Rachel M Charbonnet
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine
| | - Jodie Laurent
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Chloe D Villavaso
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine
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Akinyelure OP, Jaeger BC, Oparil S, Carson AP, Safford MM, Howard G, Muntner P, Hardy ST. Social Determinants of Health and Uncontrolled Blood Pressure in a National Cohort of Black and White US Adults: the REGARDS Study. Hypertension 2023; 80:1403-1413. [PMID: 37082942 PMCID: PMC10330022 DOI: 10.1161/hypertensionaha.122.20219] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Determining the contribution of social determinants of health (SDOH) to the higher proportion of Black adults with uncontrolled blood pressure (BP) could inform interventions to improve BP control and reduce cardiovascular disease. METHODS We analyzed data from 7306 White and 7497 Black US adults taking antihypertensive medication from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003-2007). SDOH were defined using the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Uncontrolled BP was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. RESULTS Among participants taking antihypertensive medication, 25.4% of White and 33.7% of Black participants had uncontrolled BP. The SDOH included in the current analysis mediated the Black-White difference in uncontrolled BP by 33.0% (95% CI, 22.1%-46.8%). SDOH that contributed to excess uncontrolled BP among Black compared with White adults included low annual household income (percent-mediated 15.8% [95% CI, 10.8%-22.8%]), low education (10.5% [5.6%-15.4%]), living in a health professional shortage area (10.4% [6.5%-14.7%]), disadvantaged neighborhood (11.0% [4.4%-18.0%]), and high-poverty zip code (9.7% [3.8%-15.5%]). Together, the neighborhood-domain accounted for 14.1% (95% CI, 5.9%-22.9%), the health care domain accounted for 12.7% (95% CI, 8.4%-17.3%), and the social-context-domain accounted for 3.8% (95% CI, 1.2%-6.6%) of the excess likelihood of uncontrolled BP among Black compared with White adults, respectively. CONCLUSIONS SDOH including low education, low income, living in a health professional shortage area, disadvantaged neighborhood, and high-poverty zip code contributed to the excess likelihood of uncontrolled BP among Black compared with White adults.
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Affiliation(s)
| | - Byron C. Jaeger
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - April P. Carson
- Departments of Medicine and Population Health Science, University of Mississippi Medical Center, Jackson, MS
| | | | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Shakia T. Hardy
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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