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Conway DS, Briggs FB, Mowry EM, Fitzgerald KC, Hersh CM. Racial disparities in hypertension management among multiple sclerosis patients. Mult Scler Relat Disord 2022; 64:103972. [PMID: 35728435 PMCID: PMC9308758 DOI: 10.1016/j.msard.2022.103972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/20/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertension adversely impacts the multiple sclerosis (MS) disease course and is more common among Black Americans. Disparities in care due to structural racism may lead to suboptimal hypertension detection and control in Black American MS patients. OBJECTIVES To determine if uncontrolled hypertension is more common in Black or White Americans with MS and whether race impacts the likelihood of receiving anti-hypertensive treatment. METHODS A retrospective cohort study was conducted using longitudinal data from American participants in the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) multi-institutional registry. Data was collected from 7 sites in the United States between May 2015 and November 2020. Patients with uncontrolled hypertension, defined as ≥2 blood pressure measurements ≥140/90 mmHg, were identified in the dataset. Racial differences in uncontrolled hypertension and odds of anti-hypertensive treatment were evaluated using logistic regression. Predictors of anti-hypertensive treatment in those with uncontrolled hypertension were determined by race. RESULTS The analysis included 10,673 MS patients, of whom 1,442 (13.5%) were Black Americans. Despite a lower mean age (45.7 vs. 49.2 years), Black Americans had a 31% increased odds of uncontrolled hypertension compared to White Americans. After adjustment for relevant covariates, mean systolic blood pressure was 1.84 mmHg (95% confidence interval=1.07-2.61) higher in Black Americans than White Americans, and mean diastolic blood pressure was 1.28 mmHg (95% confidence interval=0.74-1.82) higher. Black Americans were also more likely to be on anti-hypertensive therapy (OR=1.68, 95% confidence interval=1.30-2.18) and were exposed to an adjusted average of 0.61 (95% confidence interval=0.45-0.78) more anti-hypertensive treatments than White Americans (p<0.001). Age, comorbid diabetes mellitus, and comorbid hyperlipidemia were positively associated with use of anti-hypertensive treatments in all patients with uncontrolled hypertension. CONCLUSION Black American MS patients have significantly increased odds of uncontrolled hypertension, but also higher odds of receiving anti-hypertensive treatment.
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Affiliation(s)
- Devon S Conway
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation.
| | - Farren Bs Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine
| | - Ellen M Mowry
- Johns Hopkins Multiple Sclerosis Center, Johns Hopkins University School of Medicine
| | | | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation
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2
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The association between socioeconomic status and prevalence, awareness, treatment and control of hypertension in different ethnic groups. J Hypertens 2022; 40:897-907. [DOI: 10.1097/hjh.0000000000003092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Miranda R, Meeks KAC, Snijder MB, van den Born BJ, Fransen MP, Peters RJ, Stronks K, Agyemang C. Health literacy and hypertension outcomes in a multi-ethnic population: the HELIUS study. Eur J Public Health 2021; 30:545-550. [PMID: 31578555 DOI: 10.1093/eurpub/ckz174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hypertension disproportionately affects ethnic minority groups. Although health literacy may play role in these ethnic inequalities, little is known about the extent to which health literacy affects hypertension prevalence, awareness, treatment and control in different ethnic groups. Therefore, we assessed these associations in a multi-ethnic population. METHODS Baseline data from the HELIUS study were used including participants of Dutch (n = 1948), South-Asian Surinamese (n = 2054) and African Surinamese (n = 1932) origin aged 18-70 years, who lived in Amsterdam, the Netherlands, were fluent in Dutch and underwent health literacy assessment through the Rapid Estimate of Adult Literacy in Medicine-Dutch (REALM-D). The REALM-D was categorized either as low (<60 sumscore) or adequate (≥60 sumscore) health literacy. Participants completed questionnaires and underwent physical examination. RESULTS After adjusting for confounding variables, Dutch [odds ratio (OR) 2.02; 95% confidence interval (CI), 1.11-3.64] and African Surinamese (OR 1.36; 1.03-1.79) with low health literacy were more likely than those with adequate health literacy to have hypertension, whereas in South-Asian Surinamese this association was not significant. No significant associations were found between health literacy and hypertension awareness, treatment and control in any of the ethnic groups. CONCLUSION Findings indicate that health literacy is associated with hypertension prevalence in selected ethnic groups, but not with hypertension awareness, treatment and control. Targeting health literacy might be an entry point for tackling ethnic inequalities in hypertension prevalence. To substantially reduce these inequalities, further research is needed to explore other factors and pathways through which health literacy may impact hypertension outcomes in different ethnic groups.
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Affiliation(s)
- R Miranda
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - K A C Meeks
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - M B Snijder
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, the Netherlands
| | - B J van den Born
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Fransen
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - R J Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K Stronks
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - C Agyemang
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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4
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Beutel ME, Brähler E, Ernst M, Klein E, Reiner I, Wiltink J, Michal M, Wild PS, Schulz A, Münzel T, Hahad O, König J, Lackner KJ, Pfeiffer N, Tibubos AN. Noise annoyance predicts symptoms of depression, anxiety and sleep disturbance 5 years later. Findings from the Gutenberg Health Study. Eur J Public Health 2021; 30:516-521. [PMID: 32034913 DOI: 10.1093/eurpub/ckaa015] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cross-sectional studies have shown that noise annoyance is strongly associated with mental distress, however, its long-term effects on mental health is unknown. We therefore investigated whether noise annoyance predicts depression, anxiety and sleep disturbance in a large, representative sample 5 years later. METHODS We investigated longitudinal data of N = 11 905 participants of the Gutenberg Health Study, a population-based, prospective, single-centre cohort study in mid-Germany (age at baseline 35-74 years). Noise annoyance was assessed at baseline and 5-year follow-up (sources: road traffic, aircraft, railways, industrial, neighbourhood indoor and outdoor noise; and day vs. nighttime). Depression, anxiety and sleep disturbance were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-2. Participants suffering from depression, anxiety or sleep disturbance at baseline were excluded from the respective multivariate analyses of new onset at follow-up. RESULTS General noise annoyance remained stable. Daytime noise annoyance predicted new onset of depressive, anxiety symptoms (also nighttime annoyance) and sleep disturbance (beyond respective baseline scores). Additional predictors were female sex, lower age and low socioeconomic status (SES). Regarding specific sources, daytime baseline aircraft annoyance predicted depression and anxiety. Sleep disturbance was most consistently predicted by neighbourhood annoyance (baseline and follow-up) and follow-up annoyance by aircraft (night) and road traffic (day and night). CONCLUSIONS We identified current and past noise annoyances as risk factors for mental distress and sleep disturbance. Furthermore, women, younger adults and those with lower SES are particularly susceptible to noise annoyance. Our results indicate the need to provide regulatory measures in affected areas to prevent mental health problems.
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Affiliation(s)
- Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eva Klein
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Iris Reiner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Mainz, Germany
| | - Philipp S Wild
- DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Omar Hahad
- Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jochem König
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Perini W, Snijder MB, Agyemang C, Peters RJ, Kunst AE, van Valkengoed IG. Eligibility for cardiovascular risk screening among different ethnic groups: The HELIUS study. Eur J Prev Cardiol 2019; 27:1204-1211. [PMID: 31345055 PMCID: PMC7357181 DOI: 10.1177/2047487319866284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ethnic differences in the age-of-onset of cardiovascular risk factors may necessitate ethnic-specific age thresholds to initiate cardiovascular risk screening. Recent European recommendations to modify cardiovascular risk estimates among certain ethnic groups may further increase this necessity. AIMS To determine ethnic differences in the age to initiate cardiovascular risk screening, with and without implementation of ethnic-specific modification of estimated cardiovascular risk. METHODS We included 18,031 participants of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan background from the HELIUS study (Amsterdam). Eligibility for cardiovascular risk screening was defined as being eligible for blood pressure-lowering treatment, based on a combination of systolic blood pressure, estimated cardiovascular risk, and ethnic-specific conversion of estimated cardiovascular risk as recommended by European cardiovascular disease prevention guidelines. Age-specific proportions of eligibility were determined and compared between ethnic groups via logistic regression analyses. RESULTS Dutch men reached the specified threshold to initiate cardiovascular risk screening (according to Dutch guidelines) at an average age of 51.5 years. Among ethnic minority men, this age ranged from 39.8 to 52.4. Among Dutch women, the average age threshold was 53.4. Among ethnic minority women, this age ranged from 36.8 to 49.1. Age-adjusted odds of eligibility were significantly higher than in the Dutch among all subgroups, except among Moroccan men. Applying ethnic-specific conversion factors had minimal effect on the age to initiate screening in all subgroups. CONCLUSIONS Most ethnic minority groups become eligible for blood pressure-lowering treatment at a lower age and may therefore benefit from lower age-thresholds to initiate cardiovascular risk screening.
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Affiliation(s)
- Wilco Perini
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands.,Department of Cardiology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Marieke B Snijder
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Ron Jg Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Irene Gm van Valkengoed
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
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Noubiap JJ, Nansseu JR, Nkeck JR, Nyaga UF, Bigna JJ. Prevalence of white coat and masked hypertension in Africa: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2018; 20:1165-1172. [PMID: 29984891 PMCID: PMC8031123 DOI: 10.1111/jch.13321] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/02/2018] [Accepted: 04/15/2018] [Indexed: 02/28/2024]
Abstract
Data on masked hypertension (MH) and white-coat hypertension (WCH) in African populations are needed to estimate the true prevalence of hypertension in these populations because they have the highest burden of the disease. We conducted the first systematic review and meta-analysis that summarized available data on the prevalence of WCH and MH in Africa. We searched PubMed and Scopus to identify all the articles published on MH and WCH in populations living in Africa from inception to November 30, 2017. We reviewed each study for methodological quality. A random-effects model was used to estimate the prevalence of WCH and MH across studies. Eleven studies were included, all having a low-risk of bias. The prevalence of masked hypertension was 11% (95% CI: 4.7-19.3; 10 studies) in a pooled sample of 7789 individuals. The prevalence of WCH was 14.8% (95% CI: 9.4-21.1; 8 studies) in a pooled sample of 4451 individuals. There was no difference on the prevalence of WCH and MH between studies in which participants were recruited from the community and the hospital. The prevalence of MH was higher in urban areas compared to rural ones; there was no difference for WCH. WHC and MH seem to be frequent in African populations, suggesting the importance of out-of-clinic BP measurement in the diagnosis and management of patients with hypertension in Africa, especially in urban areas for MH.
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Affiliation(s)
- Jean Jacques Noubiap
- Department of MedicineGroote Schuur Hospital and University of Cape TownCape TownSouth Africa
| | - Jobert Richie Nansseu
- Department of Public HealthFaculty of Medicine and Biomedical SciencesUniversity of Yaoundé 1YaoundéCameroon
| | - Jan René Nkeck
- Department of Internal Medicine and sub‐SpecialtiesFaculty of Medicine and Biomedical SciencesUniversity of Yaoundé 1YaoundéCameroon
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and sub‐SpecialtiesFaculty of Medicine and Biomedical SciencesUniversity of Yaoundé 1YaoundéCameroon
| | - Jean Joel Bigna
- Department of Epidemiology and Public HealthCentre Pasteur of CameroonYaoundéCameroon
- Faculty of MedicineUniversity of Paris Sud XILe Kremlin‐BicêtreFrance
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7
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Ethnic disparities in treatment rates for hypertension and dyslipidemia: an analysis by different treatment indications: the Healthy Life in an Urban Setting study. J Hypertens 2018; 36:1540-1547. [PMID: 29771737 DOI: 10.1097/hjh.0000000000001716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Studies have reported ethnic disparities in treatment rates for cardiovascular risk factors. These studies are generally based on treatment indications defined by individual cardiovascular risk factors (ICRF). However, according to most European guidelines, preventive treatment for these risk factors is recommended only among those with sufficient overall cardiovascular risk (OCR). OBJECTIVE To determine ethnic disparities in treatment rates for hypertension and dyslipidemia among those with an indication for treatment based on ICRF and OCR. METHODS Using data of the HELIUS study, we determined the occurrence of cardiovascular risk factors and treatment rates among 11 357 participants from six ethnic backgrounds living in Amsterdam. Via logistic regression analyses, we determined ethnic differences in blood pressure (BP)-lowering or lipid-lowering treatment rates among those needing treatment based on ICRF (BP >140 mmHg and LDL >2.5 mmol/l, respectively) and on OCR (estimated overall 10-year cardiovascular disease risk according to SCORE). RESULTS Relative to the Dutch, ethnic minority men showed higher treatment rates for hypertension and dyslipidemia, regardless of whether OCR of ICRF recommendations for treatment were used. Ethnic minority women showed similar treatment rates relative to the Dutch based on OCR, but higher treatment rates based on ICRF recommendations (e.g. odds ratios for antihypertensive treatment ranged from 0.93 to 1.75 and from 1.26 to 1.93, respectively). CONCLUSION Treatment rates for hypertension and dyslipidemia are not lower among ethnic minority groups relative to the Dutch. In some cases, they are even higher, but these differences may be overestimated whenever using ICRF as treatment indication.
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9
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Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Sources of inaccuracy in the measurement of adult patients' resting blood pressure in clinical settings: a systematic review. J Hypertens 2017; 35:421-441. [PMID: 27977471 PMCID: PMC5278896 DOI: 10.1097/hjh.0000000000001197] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 09/13/2016] [Accepted: 11/05/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND To interpret blood pressure (BP) data appropriately, healthcare providers need to be knowledgeable of the factors that can potentially impact the accuracy of BP measurement and contribute to variability between measurements. METHODS A systematic review of studies quantifying BP measurement inaccuracy. Medline and CINAHL databases were searched for empirical articles and systematic reviews published up to June 2015. Empirical articles were included if they reported a study that was relevant to the measurement of adult patients' resting BP at the upper arm in a clinical setting (e.g. ward or office); identified a specific source of inaccuracy; and quantified its effect. Reference lists and reviews were searched for additional articles. RESULTS A total of 328 empirical studies were included. They investigated 29 potential sources of inaccuracy, categorized as relating to the patient, device, procedure or observer. Significant directional effects were found for 27; however, for some, the effects were inconsistent in direction. Compared with true resting BP, significant effects of individual sources ranged from -23.6 to +33 mmHg SBP and -14 to +23 mmHg DBP. CONCLUSION A single BP value outside the expected range should be interpreted with caution and not taken as a definitive indicator of clinical deterioration. Where a measurement is abnormally high or low, further measurements should be taken and averaged. Wherever possible, BP values should be recorded graphically within ranges. This may reduce the impact of sources of inaccuracy and reduce the scope for misinterpretations based on small, likely erroneous or misleading, changes.
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Affiliation(s)
- Noa Kallioinen
- School of Psychology, The University of Queensland, St. Lucia
| | - Andrew Hill
- School of Psychology, The University of Queensland, St. Lucia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Herston
| | | | - Helen E. Ward
- The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside
| | - Marcus O. Watson
- School of Psychology, The University of Queensland, St. Lucia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Herston
- School of Medicine, The University of Queensland Mayne Medical School, Herston, Queensland, Australia
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10
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Tanner RM, Shimbo D, Seals SR, Reynolds K, Bowling CB, Ogedegbe G, Muntner P. White-Coat Effect Among Older Adults: Data From the Jackson Heart Study. J Clin Hypertens (Greenwich) 2015; 18:139-45. [PMID: 26279070 DOI: 10.1111/jch.12644] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/26/2015] [Accepted: 06/28/2015] [Indexed: 01/13/2023]
Abstract
Many adults with elevated clinic blood pressure (BP) have lower BP when measured outside the clinic. This phenomenon, the "white-coat effect," may be larger among older adults, a population more susceptible to the adverse effects of low BP. The authors analyzed data from 257 participants in the Jackson Heart Study with elevated clinic BP (systolic/diastolic BP [SBP/DBP] ≥140/90 mm Hg) who underwent ambulatory BP monitoring (ABPM). The white-coat effect for SBP was larger for participants 60 years and older vs those younger than 60 years in the overall population (12.2 mm Hg, 95% confidence interval [CI], 9.2-15.1 mm Hg and 8.4 mm Hg, 95% CI, 5.7-11.1, respectively; P=.06) and among those without diabetes or chronic kidney disease (15.2 mm Hg, 95% CI, 10.1-20.2 and 8.6 mm Hg, 95% CI, 5.0-12.3, respectively; P=.04). After multivariable adjustment, clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white-coat effect. Studies are needed to investigate the role of ABPM in guiding the initiation and titration of antihypertensive treatment, especially among older adults.
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Affiliation(s)
- Rikki M Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Samantha R Seals
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - C Barrett Bowling
- Department of Veterans Affairs Medical Center, Atlanta, GA.,Department of Medicine, Emory University, Atlanta, GA
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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11
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Agyemang C, Kieft S, Snijder MB, Beune EJ, van den Born BJ, Brewster LM, Ujcic-Voortman JJ, Bindraban N, van Montfrans G, Peters RJ, Stronks K. Hypertension control in a large multi-ethnic cohort in Amsterdam, The Netherlands: the HELIUS study. Int J Cardiol 2015; 183:180-9. [PMID: 25679990 DOI: 10.1016/j.ijcard.2015.01.061] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/24/2014] [Accepted: 01/25/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Hypertension is a major problem among European ethnic minority groups. We assessed the current situation of hypertension prevalence and its management among a multi-ethnic population in Amsterdam, The Netherlands. METHODS Data from the HELIUS study were used including 12,974 participants (1871 Ghanaian, 2184 African Surinamese, 2278 South-Asian Surinamese, 2277 Turkish, 2222 Moroccan and 2142 Dutch origin people), aged 18-70 years. Comparisons among groups were made using proportions and age-adjusted prevalence ratios (PRs). RESULTS Hypertension prevalence ranged from 24% and 16% in Moroccan men and women to 52% and 62% in Ghanaian men and women. Except for Moroccan women, age-adjusted PR of hypertension was higher in all the ethnic minority groups than in Dutch. Among hypertensives, ethnic minority groups generally had higher levels of hypertension awareness and BP lowering treatment than Dutch. Moreover, prevalence rates for the prescription of more than one BP lowering drug were generally higher in African and South-Asian origin groups compared with Dutch origin people. By contrast, BP control levels were lower in all the ethnic groups than in Dutch, with control rates being significantly lower in Ghanaian men (26%, PR=0.49; 95% CI, 0.37-0.66) and women (45%, PR=0.64; 0.52-0.77), African-Surinamese men (30%, PR=0.61; 0.46-0.81) and women (45%, PR=0.72; 0.51-0.77), and South-Asian Surinamese men (43%, PR=0.77; 0.61-0.97) and women (47%, PR=0.76; 0.63-0.92) compared with Dutch men (53%) and women (61%). CONCLUSION Our findings indicate poor BP control in ethnic minority groups despite the high treatment levels. More work is needed to unravel the potential factors contributing to the poor control in order to improve BP control in ethnic minority groups, particularly among African and South-Asian origin groups.
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Affiliation(s)
- Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Suzanne Kieft
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke B Snijder
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik J Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan van den Born
- Department of Internal & Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lizzy M Brewster
- Department of Internal & Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Joanne J Ujcic-Voortman
- Public Health Service Amsterdam, Department of Epidemiology & Health Promotion, Amsterdam, The Netherlands
| | - Navin Bindraban
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Gert van Montfrans
- Department of Internal & Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ron J Peters
- Department of Cardiology, Academic Medical Center, University of Amsterdam
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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12
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The role of body weight, fat distribution and weight change in ethnic differences in the 9-year incidence of hypertension. J Hypertens 2014; 32:990-6; discussion 996-7. [DOI: 10.1097/hjh.0000000000000135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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13
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Agyemang C, Nicolaou M, Boateng L, Dijkshoorn H, van de Born BJ, Stronks K. Prevalence, awareness, treatment, and control of hypertension among Ghanaian population in Amsterdam, The Netherlands: the GHAIA study. Eur J Prev Cardiol 2012; 20:938-46. [PMID: 22679251 DOI: 10.1177/2047487312451540] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Migration from sub-Saharan Africa to industrialized countries has increased tremendously over the last few decades, yet very little is known about the health status of sub-Saharan African populations living in industrialized communities. The aim of this study was to assess prevalence, levels of awareness, treatment, and control of hypertension among the largest sub-Saharan African group (Ghanaians) living in the Netherlands. METHODS Cross-sectional study of Ghanaian adults aged 18-60 years in Amsterdam, the Netherlands. RESULTS The overall prevalence of hypertension was 55%. Of these, about half were aware of their condition, 45% were receiving antihypertensive medication, and 15% were controlled (blood pressure <140/90 mmHg). The prevalence rates of hypertension, awareness, and treatment were similar among males and females. However, males had a lower blood pressure control rate than females. Among all hypertensives, 22% of females had their blood pressure controlled compared with 5.8% in males: adjusted prevalence ratio (APR) 3.94 (95% CI 1.05-14.79). Among those receiving treatment for their hypertension, 48% of females were controlled compared with only 13% of males: APR 4.08 (95% CI 1.20-13.87). CONCLUSION Hypertension is a major problem among this recently migrated sub-Saharan African population. Furthermore, hypertension control rate is very low particularly in males. Urgent measures are needed to halt the increasing prevalence of hypertension and to improve hypertension control among these populations.
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Bainey KR, Norris CM, Gupta M, Southern D, Galbraith D, Knudtson ML, Graham MM. Altered health status and quality of life in South Asians with coronary artery disease. Am Heart J 2011; 162:501-6. [PMID: 21884867 DOI: 10.1016/j.ahj.2011.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 06/04/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND People of South Asian (SA) ancestry are susceptible to coronary artery disease (CAD). Although studies suggest that SA with CAD has a worse prognosis compared with Europeans, it is unknown whether corresponding differences in functional status and quality-of-life (QOL) measures exist. Accordingly, we compared symptoms, function, and QOL in SA and European Canadians with CAD using the Seattle Angina Questionnaire (SAQ). METHODS Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, an outcomes registry that captures patients undergoing cardiac catheterization in Alberta, Canada, we identified 635 SA and 18,934 European patients with angiographic CAD from January 1995 to December 2006 who reported health status outcomes using the SAQ at 1 year after the index catheterization. To obtain comparable clinical variables among SA and Europeans, we used a propensity score-matching technique. RESULTS One-year adjusted mean (SD) scores were significantly lower in SA compared with European Canadians for most SAQ domains: exertional capacity (75 [23] vs 80 [23], P = .011), anginal stability (77 [28] vs 77 [27], P = .627), anginal frequency (86 [23] vs 88 [20], P < .001), treatment satisfaction (86 [19] vs 89 [16], P < .001), and SAQ QOL (71 [24] vs 76 [21], P < .001). These results could not be accounted for by differences in baseline QOL scores or changes in health status from baseline to 1 year. CONCLUSION South Asian Canadians with established CAD have significantly worse health status outcomes at 1 year after angiography compared with European Canadians. Further studies are warranted to improve functional outcomes in SA with CAD.
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Mancia G, Bombelli M, Seravalle G, Grassi G. Diagnosis and management of patients with white-coat and masked hypertension. Nat Rev Cardiol 2011; 8:686-93. [PMID: 21826071 DOI: 10.1038/nrcardio.2011.115] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
White-coat hypertension is characterized by an elevation in clinic blood pressure but normal home or ambulatory blood-pressure values, whereas patients with masked hypertension have normal clinic blood pressure and elevated ambulatory or home blood-pressure load. Both white-coat and masked hypertension are frequent clinical entities that need appropriate recognition and a close diagnostic follow-up. White-coat and masked hypertension seem to be associated with organ damage and increased cardiovascular risk, although not invariably. In addition, patients with masked or white-coat hypertension have an increased risk of abnormalities affecting their glucose and lipid profiles. Therefore, the diagnosis of these conditions should be accurate and include the assessment of cardiovascular as well as of metabolic risk. Once diagnosed, first-line therapeutic interventions should be nonpharmacological and aim at lifestyle changes, but drug treatment can be indicated, particularly when the patient's cardiovascular risk profile is elevated or when target-organ damage is detected.
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Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Via Pergolesi 33, 20052 Monza, Italy. giuseppe.mancia@ unimib.it
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Liem SS, Oemrawsingh PV, Cannegieter SC, Le Cessie S, Schreur J, Rosendaal FR, Schalij MJ. Cardiovascular risk in young apparently healthy descendents from Asian Indian migrants in the Netherlands: the SHIVA study. Neth Heart J 2011; 17:155-61. [PMID: 19421361 DOI: 10.1007/bf03086238] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND.: Asian Indian migrants in the Western world are highly susceptible for ischaemic heart disease (IHD). Until now, most IHD risk studies were performed in first and second generation Asian Indian expatriates. For optimal prevention, knowledge of the cardiovascular risk profile of younger generations is crucial. METHOD.: In a cross-sectional study we assessed the prevalence of conventional IHD risk factors and Framingham risk score in asymptomatic third to seventh generation Asian Indian descendants, compared with Europeans. Subjects were classified as asymptomatic if they did not have documented IHD, diabetes, hypertension or high cholesterol. RESULTS.: A total of 1790 Asian Indians (45% men, age 35.9+/-10.7 years) and 370 native Dutch hospital employees (23% men, age 40.8+/-10.1 years) were recruited. Asian Indians had higher levels of total cholesterol, low-density lipoprotein, triglycerides, and lower high-density lipoprotein levels than the Dutch. Glucose intolerance was present in 7.1 vs. 0.5% men, and in 6.1 vs. 1.4% women (both p<0.001). Asian Indian women were more frequently obese (12 vs. 5%; p<0.001), and centrally obese (44 vs. 25%; p<0.001) as compared with the Dutch women. Prevalence of most of the conventional and modifiable cardiovascular risk factors in each ten-year age group was higher in Asian Indians compared with controls, which reflected in higher Framingham risk scores. CONCLUSION.: This study demonstrates the persistence of an unfavourable cardiovascular risk profile in young, third to seventh generation migrated Asian Indians and supports an aggressive screening and intervention strategy. (Neth Heart J 2009;17:155-61.).
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Affiliation(s)
- S S Liem
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Bainey KR, Jugdutt BI. Increased burden of coronary artery disease in South-Asians living in North America. Need for an aggressive management algorithm. Atherosclerosis 2009; 204:1-10. [DOI: 10.1016/j.atherosclerosis.2008.09.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 08/30/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
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Agyemang C, van Valkengoed I, van den Born BJ, Stronks K. Prevalence and determinants of prehypertension among African Surinamese, Hindustani Surinamese, and White Dutch in Amsterdam, the Netherlands: the SUNSET study. ACTA ACUST UNITED AC 2008; 14:775-81. [PMID: 18043298 DOI: 10.1097/hjr.0b013e32828621df] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Evidence suggests that prehypertension is associated with increased risk of cardiovascular mortality. Little is known about ethnic differences in prehypertension in Europe. We aimed to assess these ethnic differences and to determine the factors associated with prehypertension in Amsterdam, the Netherlands. DESIGN Cross-sectional study. METHODS Prehypertension was defined as having a blood pressure 120-139/80-89 mmHg. RESULTS The overall prevalence of prehypertension was 32.8% (men 37.9% and women 29.9%). The prevalence of prehypertension did not differ between the ethnic groups in men. African Surinamese and Hindustani Surinamese women, however, had a higher prevalence of prehypertension than White Dutch women. In multivariate logistic regression analysis, the odds ratios [95% confidence interval] for being prehypertensive were 2.25 (1.38-3.67; P<0.001) for African Surinamese and 2.06 (1.18-3.60; P<0.01) for Hindustani Surinamese women, compared with White Dutch women. BMI was strongly associated with prehypertension in both men and women. Total cholesterol was positively associated with prehypertension in women, whereas increased physical activity was negatively associated. The independent factors associated with prehypertension vary by ethnic group. In men, BMI was associated with prehypertension in the White Dutch, total cholesterol and low education in the African Surinamese, and fasting glucose in the Hindustani Surinamese. In women, total cholesterol was associated with prehypertension in the African Surinamese; the corresponding factor was the BMI in the Hindustani Surinamese. CONCLUSION Prehypertension is common in minority women. As a large proportion of people with prehypertension progress to clinical hypertension, targeting these people early with lifestyle-modification interventions aimed at weight loss, increased physical activity, and healthy dietary habits can provide important long-term benefits. The results indicate that the primary foci of such lifestyle interventions should vary between ethnic groups.
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Affiliation(s)
- Charles Agyemang
- Department of Social Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
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Agyemang C, Owusu-Dabo E. Prehypertension in the Ashanti region of Ghana, West Africa: an opportunity for early prevention of clinical hypertension. Public Health 2007; 122:19-24. [PMID: 17825331 DOI: 10.1016/j.puhe.2007.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Revised: 04/10/2007] [Accepted: 04/25/2007] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess prehypertension among Ghanaian adults in the Ashanti region of Ghana, West Africa. DESIGN Cross-sectional study. PARTICIPANTS There were 1431 participants aged 18 years or more. Prehypertension was defined as blood pressure of 120-139/80-89 mmHg. MAIN OUTCOME MEASURES Prehypertension. RESULTS Overall, 31% of the study population were normotensive, 40% were prehypertensive and 29% were hypertensive. Prehypertension was more common in non-hypertensive males than non-hypertensive females (66% vs 49%, P<0.001). Prehypertension was also more common in those aged 35 years compared with those aged <35 years (P<0.001), and in overweight and obese people compared with people of normal weight (P=0.03). In a multivariate logistic regression model, male sex [odds ratio (OR) 2.36; 95% confidence interval (CI) 1.77-3.15; P<0.001], age 35-49 years (OR 1.56; 95% CI 1.12-2.18; P<0.01) and 50 years (OR 2.13; 95% CI 1.33-3.42; P=0.002)], overweight (OR 1.61; 95% CI 1.09-2.36; P=0.02) and obesity (OR 2.71; 95% CI 1.40-5.24; P=0.003) were independently associated with higher odds of prehypertension, whilst current smoking (OR 0.36; 95% CI 0.16-0.81; P=0.01) was associated with lower odds of prehypertension. CONCLUSION Prehypertension is very common among non-hypertensive subjects in the Ashanti region of Ghana. As a large proportion of people with prehypertension will progress to clinical hypertension, targeting these people early with lifestyle modifications such as weight reduction may provide important long-term benefits.
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Affiliation(s)
- Charles Agyemang
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Agyemang C, Ujcic-Voortman J, Uitenbroek D, Foets M, Droomers M. Prevalence and management of hypertension among Turkish, Moroccan and native Dutch ethnic groups in Amsterdam, the Netherlands: the Amsterdam Health Monitor Survey. J Hypertens 2006; 24:2169-76. [PMID: 17053537 DOI: 10.1097/01.hjh.0000249693.73618.c9] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess ethnic differences in the prevalence and management of hypertension among Turkish, Moroccan and native Dutch ethnic groups in Amsterdam, the Netherlands. DESIGN A cross-sectional survey. PARTICIPANTS A random sample of 1304 adults aged 18 years and over. Of these, 39.2% were Dutch, 33.2% were Turkish and 27.6% were Moroccan. RESULTS The prevalence of hypertension was lower in Turkish (men 25.8% and women 22.2%) and Moroccan (men 26.1% and women 19.6%) than in Dutch individuals (men 48.8% and women 35.0%). Except for Turkish women, these differences persisted after adjustment for age and body mass index: the odds ratios (95% confidence interval) for being hypertensive were 0.47 (0.30-0.74; P < 0.001) for Turkish men, 0.48 (0.30-0.76; P < 0.001) for Moroccan men and 0.51 (0.28-0.94; P = 0.03) for Moroccan women. Only Moroccan hypertensive women were less likely than Dutch women to be aware of their condition 0.31 (0.11-0.81; P < 0.01) and to be treated 0.32 (0.12-0.88; P < 0.01) for hypertension. There were no differences in hypertension control between the ethnic groups in both men and women. CONCLUSION The lower prevalence of hypertension among Moroccan men may contribute to the low cardiovascular disease (CVD) mortality reported among this group in the Netherlands. The differential risks in CVD mortality between Moroccan men and women may partly result from the lower hypertension awareness and treatment rates in Moroccan women. Strategies aimed at improving the detection and treatment of hypertension among Moroccan women may improve the sex disparity in cardiovascular mortality between Moroccan men and women in the Netherlands.
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Affiliation(s)
- Charles Agyemang
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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Agyemang C, van Valkengoed I, Koopmans R, Stronks K. Factors associated with hypertension awareness, treatment and control among ethnic groups in Amsterdam, the Netherlands: the SUNSET study. J Hum Hypertens 2006; 20:874-81. [PMID: 16929341 DOI: 10.1038/sj.jhh.1002073] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We sought to determine factors associated with hypertension awareness, pharmacological treatment and control among ethnic groups in Amsterdam, The Netherlands. We analysed data on hypertensive subjects (Dutch n=130, Hindustani n=115 and African Surinamese n=225). After adjustments for important covariates, hypertension awareness was more common in Dutch people with abdominal obesity and family history of hypertension (FHH). Abdominal obesity was also associated with higher level of awareness in African Surinamese. Female sex, FHH and recent physician (general practitioner (GP)) visit were associated with higher level of awareness in both African and Hindustani Surinamese. Among the Dutch, hypertension treatment was more common in those with abdominal obesity, FHH and GP visit. Among Hindustanis, female sex, abdominal obesity and GP visit were positively associated with treatment of hypertension. Old age, female sex, FHH and GP visit were positively associated, whereas smoking was negatively associated with lower treatment in African Surinamese. High education and more physical activity were associated with better blood pressure (BP) control, whereas obesity was associated with poor BP control among the Dutch. Among African Surinamese, female sex and FHH were associated with better BP control, whereas abdominal obesity was associated with poor BP control. Only old age was associated with poor BP control in Hindustanis. In conclusion, our findings indicate that more attention is needed in promoting awareness and treatment among those with lower hypertension risk (i.e., normal body weight people and those without FHH), those without recent GP visits in all ethnic groups and African and Hindustani Surinamese men and smokers. More effort is also needed in hypertension control among Dutch people with low education, obesity and inadequate physical activity, African Surinamese men and those without FHH and old Hindustani people.
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Affiliation(s)
- C Agyemang
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Agyemang C. Rural and urban differences in blood pressure and hypertension in Ghana, West Africa. Public Health 2006; 120:525-33. [PMID: 16684547 DOI: 10.1016/j.puhe.2006.02.002] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Revised: 02/05/2006] [Accepted: 02/13/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hypertension, once rare in traditional African societies, is rapidly becoming a major public health problem. OBJECTIVE To assess urban and rural differences in blood pressure (BP) and hypertension, and to determine factors associated with BP in this sub-Saharan Africa population. STUDY DESIGN Cross-sectional survey. SETTING Ashanti region of Ghana, West Africa. PARTICIPANTS There were 1431 participants (644 males and 787 females). Of these, 578 were from the rural setting (237 males and 341 females) and 853 from the urban setting (407 males and 446 females). RESULTS Age-adjusted mean systolic and diastolic BP levels were lower in rural men than in urban men (129/75 versus 133/78, P<0.001). The mean systolic and diastolic BP levels were also lower in rural women than in urban women (126/76 versus 131/80, P<0.001). After adjustments for age, the odds ratios (95% CI) for being hypertensive were 1.9 (1.3-2.9; P<0.01) for urban men and 1.9 (1.3-2.8; P<0.0001) for urban women. Urban women were more likely than rural women to be aware of their hypertensive condition (odds ratio 2.3, 95% CI, 1.2-4.2; P<0.001). Treatment and control of hypertension did not differ between the groups in either men or women. In multiple linear regression analysis, age, urban dwelling, BMI and heart rate were independently associated with systolic and diastolic BP in both men and women. Smoking and alcohol consumption were independently associated with systolic and diastolic BP but only in men. CONCLUSION The findings of this study demonstrate that high BP (hypertension) is an important public health burden in both urban and rural settings in this sub-Saharan African population. Cost-effective public health measures are urgently needed to prevent high BP from becoming another public health burden.
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Affiliation(s)
- Charles Agyemang
- Institute of Health Policy and Management, Erasmus Medical Centre, Rotterdam, The Netherlands.
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