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Seitshiro SE, Aluko OS, Steinberg WJ. Effect of adult day care centre attendance on hypertension management. S Afr Fam Pract (2004) 2024; 66:e1-e4. [PMID: 39221730 PMCID: PMC11369611 DOI: 10.4102/safp.v66i1.5961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Hypertension (HT) silently threatens one in three adults, especially older adults, who struggle with blood pressure (BP) control because of limited health access, poor adherence to medication and failure to make lifestyle changes. This increases their risk for heart disease, kidney failure and dementia. Fortunately, adult day care centres (ADCCs) offer hope. These community facilities provide daytime care, including health support services, social activities and exercise. This study investigated the perceived effect of adult daycare centre attendance on BP control and treatment adherence. METHODS A mainly descriptive study at MUCPP Community Health Centre (CHC) in Bloemfontein, South Africa, between July 2020 and September 2020, used questionnaires researchers completed during interviews. The researchers approached 372 hypertensive patients of a minimum of 60 years old and at least 2 years since being diagnosed. RESULTS Of the 90 who attended ADCCs, 71.1% had controlled hypertension compared to 51.4% of those who did not. While treatment adherence showed no difference, a positive association between ADCC attendance and BP control is evident. CONCLUSION The findings suggest a promising link between ADCC attendance and improved BP control in older adults with hypertension. Adult Day Care Centres warrant further exploration as it seems to be an encouraging support intervention for this vulnerable population.Contribution: This study highlights the positive impact ADCCs have on hypertension management in older adults, urging increased physician awareness and patient referrals.
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Affiliation(s)
- Sentebaleng E Seitshiro
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein.
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Jones LM, Moss KO, Mitchell J, Still C, Hawkins J, Tang E, Wright KD. Challenges to dietary hypertension self-management as described by a sample of African American older adults. Worldviews Evid Based Nurs 2022; 19:64-72. [PMID: 35064763 PMCID: PMC9701083 DOI: 10.1111/wvn.12555] [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: 10/17/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hypertension rates are disproportionately higher among Black or African Americans (Black/African American) compared to other racial and ethnic groups in the United States. However, research on self-management strategies to control hypertension through healthy eating such as the Dietary Approaches to Stop Hypertension (DASH), and ketogenic diets has underexplored the use of dietary strategies among older Black/African American adults. In reporting contemporary challenges with implementing dietary strategies targeting blood pressure control among Black/African American older adults living with hypertension, this study addresses a clear need. AIMS Prior research has only partially addressed the challenges older Black/African Americans face in implementing and maintaining dietary strategies to control hypertension, therefore the current study aimed to address this gap by reporting contemporary challenges, as reported by a sample of Black/African American older adults living with hypertension. METHODS Nineteen Black/African American older adults living with hypertension participated in a focus group. An interview guide with open-ended questions on dietary approaches to self-management hypertension was used to guide data collection. Responses were audio-recorded, transcribed verbatim, and interpreted using qualitative thematic analysis. RESULTS Study participants were 71.6 years (SD = 8.3), 87.1% were women, and all were self-identified as Black/African American. Overall, participants shared that they were interested in improving their hypertension self-management skills. They expressed uncertainty about dietary strategies related in part to a lack of knowledge about incorporating or excluding certain foods and adhering to complex dietary recommendations. Participants also related financial concerns about accessing the recommended foods to control hypertension and expressed confusion about how to manage hypertension alongside other comorbidities. LINKING EVIDENCE TO ACTION This study highlights several barriers that Black/African American older adults face (lack of dietary knowledge, lack of financial resources, and unique barriers to managing multiple comorbid health conditions), which often pose simultaneous and intersecting barriers to managing hypertension using existing evidence-based dietary strategies.
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Affiliation(s)
- Lenette M. Jones
- University of Michigan, School of Nursing, Department of Health Behavior and Biological Sciences, 400 N. Ingalls Room 2180, Ann Arbor, MI 48109
| | - Karen O. Moss
- The Ohio State University College of Nursing, Center for Healthy Aging, Self-Management and Complex Care, 1585 Neil Avenue, Columbus, OH 43210
| | - Jamie Mitchell
- University of Michigan, School of Social Work. 1080 S. University Ave. 3847 SSWB, Ann Arbor, MI 48109
| | - Carolyn Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University
| | - Jaclynn Hawkins
- University of Michigan, School of Social Work. 1080 S. University Ave. 4708 SSWB, Ann Arbor, MI 48109
| | - Emily Tang
- University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Kathy D. Wright
- The Ohio State University College of Nursing Center for Healthy Aging, Self-Management and Complex Care, Discovery Themes-Chronic Brain Injury, The Ohio State University1585 Neil Avenue, Columbus, Ohio 43210
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Vaudin A, Wambogo E, Moshfegh AJ, Sahyoun NR. Sodium and Potassium Intake, the Sodium to Potassium Ratio, and Associated Characteristics in Older Adults, NHANES 2011-2016. J Acad Nutr Diet 2021; 122:64-77. [PMID: 34303635 DOI: 10.1016/j.jand.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sodium, potassium, and the balance between these 2 nutrients are associated with hypertension and cardiovascular disease, and prevalence of these conditions increases with age. However, limited information is available on these intakes among older adults. OBJECTIVE Our aim was to explore the socioeconomic and health factors associated with usual sodium and potassium intakes and the sodium to potassium (Na:K) ratio of older adults. DESIGN This was a cross-sectional, secondary analysis of the 2011-2012, 2013-2014, and 2015-2016 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING This study included the data of 5,104 adults 50 years and older, with at least one reliable 24-hour dietary recall and an estimated glomerular filtration rate ≥60 mL/min/1.73 m2. MAIN OUTCOME MEASURES Sodium and potassium intake, as absolute intake, density (per 1,000 kcal) and ratio of Na:K intake. STATISTICAL ANALYSES We used t tests and χ2 tests to examine significant differences in intakes on a given day by characteristics. Linear and logistic regression models were used to assess associations of socioeconomic and health characteristics with usual sodium and potassium intakes, determined using the National Cancer Institute method. RESULTS Only 26.2% of participants consumed <2,300 mg sodium (16.2% of men and 35.2% of women) and 36.0% of men and 38.1% of women consumed at least 3,400 mg and 2,600 mg of potassium, respectively. Fewer than one-third of participants consumed a Na:K ratio of <1.0. Women, those with lower blood pressure, and those with a lower body mass index were more likely to have a ratio <1.0. CONCLUSIONS Participants consumed too much sodium and not enough potassium, based on current recommendations. A higher Na:K ratio was significantly associated with established risk factors for cardiovascular disease. The study findings suggest that more research on cardiovascular health should include both sodium and potassium, as well as balance between these nutrients.
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Vitamin D and blood pressure control among hypertensive adults: results from NHANES 2001-2014. J Hypertens 2020; 38:150-158. [PMID: 31503133 DOI: 10.1097/hjh.0000000000002231] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Observational evidence supports an inverse association between hypovitaminosis D and blood pressure (BP), but intervention data have failed to demonstrate beneficial effects of vitamin D supplementation on BP. Following the downwards redefinition of hypertension treatment targets and the need to better identify individuals at greater risk for uncontrolled BP, our aim was to test the association of serum vitamin D levels with the definition of uncontrolled BP according to European guidelines in treated hypertensive adults. METHODS We retrospectively analyzed cross-sectional, nationally representative data from treated hypertensive adults aged at least 18 years with available serum 25 (OH)D measurements. BP was examined as continuous (mmHg) and categorical (at or above treatment goal, as recommended by guidelines) variable; BP means and odds ratios for uncontrolled BP according to vitamin D levels were calculated using progressively adjusted models. RESULTS Treated hypertensive adults with vitamin D deficiency had higher mean BP (+2.4/3.5 mmHg; P < 0.01) and 25-29% higher risk of uncontrolled BP compared to those with vitamin levels at least 75 nmol/l. These results were confirmed across age, sex, and racial/ethnic strata. Vitamin D insufficiency was associated with higher BP by 0.5/2.4 mmHg, but not with an increased risk of uncontrolled hypertension. CONCLUSIONS 25 (OH)D levels might indicate host-specific features related to poor BP control. The attempt to use a biomarker of exposure as an indicator of need for treatment risks to be misleading.
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Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient's experience. Eur Geriatr Med 2020; 11:369-381. [PMID: 32297271 DOI: 10.1007/s41999-020-00313-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/17/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Medication non-adherence represents a socially relevant challenge, particularly when interlinked to multiple chronic diseases and polypharmacy. Non-adherence rates affect treatment efficacy and increase health care costs. The aim of the study was to identify factors influencing medication adherence in the older adults through a systematic review of qualitative studies on patients' experience. METHODS Two electronic databases were searched for qualitative studies on medication adherence in chronic diseases (hypertension, heart disease, COPD, asthma) involving people aged 65 + . The systematic review was performed according to the PRISMA statement guidelines, employing theoretical frameworks of the ABC Taxonomy of patient adherence and Three Factor model of determinants of behaviour. RESULTS The initial database search identified 1234 records, of which 39 studies were considered eligible. Most of the studies focused on hypertension and were conducted in English-speaking countries. According to the ABC Taxonomy, Persistence and Implementation were the most often considered phases. Considering the Three Factor model, the most often reported themes were Information and Strategies upon being adherent. Stemming from the review findings and the patients' narratives, a new integrated model was proposed. It reports the patient's decisional flowchart describing barriers and facilitators (personal, social and environmental) to adherence. CONCLUSION Medication adherence is a complex and multifaceted process. The implementation of theoretical frameworks along with a patient-centred perspective may provide clinicians with useful suggestions for clinical practice, enhancing the patient's ability to adhere.
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Burke SL, Cadet T, Maddux M. Chronic Health Illnesses as Predictors of Mild Cognitive Impairment Among African American Older Adults. J Natl Med Assoc 2018; 110:314-325. [PMID: 30126555 PMCID: PMC6108440 DOI: 10.1016/j.jnma.2017.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/14/2017] [Accepted: 06/21/2017] [Indexed: 12/19/2022]
Abstract
Approximately 5.5 million individuals are diagnosed with Alzheimer's disease (AD) dementia, a number which includes those with mild cognitive impairment and asymptomatic individuals with biomarkers of AD. There is a higher incidence of mild cognitive impairment (MCI) in African American populations as compared to White populations, even when controlling for sociodemographic factors. The existing body of ethnically/racially targeted research on MCI has been limited by few studies with the ability to generalize to African American communities. This study sought to examine whether medical conditions which occur at a higher rate in African American individuals increase the hazard of subsequent MCI development. A secondary data analysis of the National Alzheimer's Coordinating Center Uniform Data Set was employed to examine the associations between health conditions (congestive heart failure, traumatic brain injury, diabetes, hypertension, hypercholesterolemia, B12 deficiency, thyroid disease) and their relationship to MCI. The analytic sample included 2847 participants with 9872 observations. Binary logistic generalized estimating equation modeling was used to examine repeated measures over the course of 1-11 observations. Education was associated with MCI development, specifically those with some college or college graduates (p < 0.001) and more than college (p = 0.002). Female sex was associated with development of MCI (p < 0.001). African Americans with traumatic brain injury (TBI) were more likely to develop MCI (p < 0.001) compared to those with no reports of a TBI. Inactive thyroid conditions decreased the risk of MCI development (p = 0.005) compared to those without thyroid disease. Though vascular factors are often attributed to higher mortality and neurodegeneration in African Americans, congestive heart failure, diabetes, high cholesterol, hypertension, diabetes, nor seizures were associated with an increased risk of MCI development. Findings from this study provide formative data to develop targeted interventions for subsets of the African American community, including those with higher educational levels, those with TBI, and those with a history of thyroid disease. While it may not be possible to prevent MCI development, it is possible to modify lifestyle behaviors contributing to these health conditions, such as falls that are often experienced by older adults. Practitioners can increase awareness, knowledge, and resources relevant to clients.
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Affiliation(s)
- Shanna L Burke
- Florida International University, Robert Stempel College of Public Health and Social Work, School of Social Work, 11200 S.W. 8th Street, AHC5 564 Miami, FL 33199, USA.
| | - Tamara Cadet
- Simmons College School of Social Work, HSDM-Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, USA
| | - Marlaina Maddux
- Florida International University, Robert Stempel College of Public Health and Social Work, School of Social Work, 11200 S.W. 8th Street, AHC5 564 Miami, FL 33199, USA
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Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study. J Gen Intern Med 2018; 33:455-462. [PMID: 29330643 PMCID: PMC5880772 DOI: 10.1007/s11606-017-4281-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/24/2017] [Accepted: 12/14/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND African Americans are especially at risk of hypertension and dementia. Antihypertensive medications reduce the risk of cardiovascular events, but may also reduce the risk of dementia. OBJECTIVE To assess the longitudinal effects of antihypertensive medications and blood pressure on the onset of incident dementia in a cohort of African Americans. DESIGN Prospective cohort. PARTICIPANTS 1236 community-dwelling patients from an inner-city public health care system, aged 65 years and older, with a history of hypertension but no history of dementia, and who had at least three primary care visits and a prescription filled for any medication. MAIN MEASURES Blood pressure was the average of three seated measurements. Dementia was diagnosed using a two-stage design, with a screening evaluation every 2 to 3 years followed by a comprehensive in-home clinical evaluation for those with a positive screen. Laboratory, inpatient and outpatient encounter data, coded diagnoses and procedures, and medication records were derived from a health information exchange. KEY RESULTS Of the 1236 hypertensive participants without dementia at baseline, 114 (9%) developed incident dementia during follow-up. Individuals prescribed any antihypertensive medication (n = 816) were found to have a significantly reduced risk of dementia (HR = 0.57, 95% CI 0.37-0.88, p = 0.0114) compared to untreated hypertensive participants (n = 420). When this analysis was repeated including a variable indicating suboptimally treated blood pressure (> 140 mmHg systolic or >90 mmHg diastolic), the effect of antihypertensive medication was no longer statistically significant (HR = 0.65, 95% CI 0.32-1.30, p = 0.2217). CONCLUSIONS Control of blood pressure in older adult African American patients with hypertension is a key intervention for preventing dementia, with similar benefits from most of the commonly available antihypertensive medications.
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Still CH, Rodriguez CJ, Wright JT, Craven TE, Bress AP, Chertow GM, Whelton PK, Whittle JC, Freedman BI, Johnson KC, Foy CG, He J, Kostis JB, Lash JP, Pedley CF, Pisoni R, Powell JR, Wall BM. Clinical Outcomes by Race and Ethnicity in the Systolic Blood Pressure Intervention Trial (SPRINT): A Randomized Clinical Trial. Am J Hypertens 2017; 31:97-107. [PMID: 28985268 PMCID: PMC5861531 DOI: 10.1093/ajh/hpx138] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/28/2017] [Accepted: 08/02/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Systolic Blood Pressure Intervention Trial (SPRINT) showed that targeting a systolic blood pressure (SBP) of ≤ 120 mm Hg (intensive treatment) reduced cardiovascular disease (CVD) events compared to SBP of ≤ 140 mm Hg (standard treatment); however, it is unclear if this effect is similar in all racial/ethnic groups. METHODS We analyzed SPRINT data within non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic subgroups to address this question. High-risk nondiabetic hypertensive patients (N = 9,361; 30% NHB; 11% Hispanic) 50 years and older were randomly assigned to intensive or standard treatment. Primary outcome was a composite of the first occurrence of a myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or CVD death. RESULTS Average postbaseline SBP was similar among NHW, NHB, and Hispanics in both treatment arms. Hazard ratios (HRs) (95% confidence interval) (intensive vs. standard treatment groups) for primary outcome were 0.70 (0.57-0.86), 0.71 (0.51-0.98), 0.62 (0.33-1.15) (interaction P value = 0.85) in NHW, NHB, and Hispanics. CVD mortality HRs were 0.49 (0.29-0.81), 0.77 (0.37-1.57), and 0.17 (0.01-1.08). All-cause mortality HRs were 0.61 (0.47-0.80), 0.92 (0.63-1.35), and 1.58 (0.73-3.62), respectively. A test for differences among racial/ethnic groups in the effect of treatment assignment on all-cause mortality was not significant (Hommel-adjusted P value = 0.062) after adjustment for multiple comparisons. CONCLUSION Targeting a SBP goal of ≤ 120 mm Hg compared to ≤ 140 mm Hg led to similar SBP control and was associated with similar benefits and risks among all racial ethnic groups, though NHBs required an average of ~0.3 more medications. CLINICAL TRIALS REGISTRATION Trial Number NCT01206062, ClinicalTrials.gov Identifier at https://clinicaltrials.gov/ct2/show/NCT01206062.
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Affiliation(s)
- Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, USA
| | - Carlos J Rodriguez
- Wake Forest School of Medicine/Department of Epidemiology and Prevention, Section on Cardiovascular Medicine, USA
| | - Jackson T Wright
- School of Medicine, Case Western Reserve University, USA
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, USA
| | - Timothy E Craven
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, USA
| | - Adam P Bress
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, USA
| | - Glenn M Chertow
- Stanford University School of Medicine, Division of Nephrology, USA
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, USA
| | - Jeffrey C Whittle
- Department of Medicine, Medical College of Wisconsin, Milwaukee and Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, USA
| | - Capri G Foy
- Department Social Sciences and Health Policy, School of Medicine, Wake Forest University, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, USA
| | - James P Lash
- Department of Medicine, University of Illinois Chicago, USA
| | | | - Roberto Pisoni
- Department of Medicine, Medical University of South Carolina, USA
| | - James R Powell
- Division of General Internal Medicine, Brody School of Medicine, East Carolina University, USA
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Husain A, Lin FC, Tuttle LA, Olsson E, Viera AJ. The Reproducibility of Racial Differences in Ambulatory Blood Pressure Phenotypes and Measurements. Am J Hypertens 2017; 30:961-967. [PMID: 28531258 PMCID: PMC5861555 DOI: 10.1093/ajh/hpx079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/04/2016] [Accepted: 04/21/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined the reproducibility of differences in ambulatory blood pressure (BP) monitoring (ABPM) phenotypes and other parameters (sustained hypertension, masked hypertension, nocturnal hypertension, and nondipping) between African Americans and Whites. METHODS A total of 420 participants untreated for hypertension attended 2 research visits 1 week apart during which traditional office BP averages and ABPM session averages were determined. We computed percent agreement in ABPM phenotypes across the 2 visits stratified by race and associated kappa statistics with 95% confidence intervals. RESULTS Whites on average were older, more likely to be male, and had a higher body mass index. There was no significant difference in sleep quality as defined by sleep diary between the 2 races. There were also no significant differences between races in the proportions of participants with sustained hypertension, sustained normotension, or masked hypertension at either testing session. The prevalence of nocturnal hypertension was 59% vs. 75% (P = 0.012) at session 1 and 59% vs. 73% (P = 0.024) at session 2 for Whites and African Americans, respectively, with moderate reproducibility for both (kappas 0.45 and 0.44). Nocturnal BP nondipping had a prevalence 29% vs. 53% (P < 0.001) at session 1 and 29% vs. 47% (P = 0.004) at session 2 for Whites and African Americans, respectively, with fair reproducibility (kappas 0.28 and 0.29). CONCLUSIONS Our findings support that African Americans indeed exhibit a greater preponderance of abnormal nocturnal BP patterns than Whites. Our work is some of the first to demonstrate that these abnormal patterns are modestly reproducible.
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Affiliation(s)
- Aamir Husain
- University of North Carolina at Chapel Hill School of Medicine
| | - Feng-Chang Lin
- University of North Carolina at Chapel Hill Department of Biostatistics and NC TraCS Institute, Chapel Hill, North Carolina, USA
| | - Laura A Tuttle
- University of North Carolina at Chapel Hill Department of Family Medicine, Chapel Hill, North Carolina, USA
| | - Emily Olsson
- University of North Carolina at Chapel Hill Department of Family Medicine, Chapel Hill, North Carolina, USA
| | - Anthony J Viera
- University of North Carolina at Chapel Hill Department of Family Medicine, Chapel Hill, North Carolina, USA
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Gao F, Liu X, Wang X, Chen S, Shi J, Zhang Y, Wu S, Cai J. Changes in Cardiovascular Health Status and the Risk of New-Onset Hypertension in Kailuan Cohort Study. PLoS One 2016; 11:e0158869. [PMID: 27434049 PMCID: PMC4951012 DOI: 10.1371/journal.pone.0158869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/23/2016] [Indexed: 12/29/2022] Open
Abstract
American Heart Association cardiovascular health metrics are intimately related to cardiovascular diseases. Acting as a key independent risk factor for high morbidity and mortality of cardiovascular diseases, hypertension and its relationship between health status get urgent attention. While the influence of individual health status changes and the future risk of new-onset hypertension is rarely understood, the present study applied this construct to assess the changes of cardiovascular health status and the morbidity of hypertension in Kailuan cohort study in north China. The Cardiovascular Health Score (CHS) was evaluated by the follow-ups of 2006–2007, 2008–2009, 2010–2011 and 2012–2013. The study population (n = 19381) was divided into 5 groups based on the changes in their CHS score between the first two follow-ups (△CHS) of 2006–2007 and 2008–2009 (≤-2, -1, 0, 1, ≥2). The morbidity of hypertension was collected during 2010–2011 and 2012–2013 follow-ups. Data analysis showed that during a median follow-up of 3.79±0.96 years, morbidity of hypertension had a graded relationship with △CHS. As △CHS scored from low to high, the standardized morbidity of hypertension for all participants were 81.40, 75.47, 68.37, 71.43 and 83.13 per 1000 person-year, respectively. An increased △CHS score of 1 was associated with a 10% decrease in the future risk of new-onset hypertension(HR: 0.90, 95% CI: 0.88–0.92). In conclusion, there was a strong inverse relationship between the incidence of new-onset hypertension and elevation of cardiovascular health metrics. Population-wide prevention, especially the promotion of lifestyle improvements, is critical to reducing the morbidity of new-onset hypertension.
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Affiliation(s)
- Fei Gao
- Department of Opthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xiaoxue Liu
- Department of Cardiology, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
| | - Xizhu Wang
- Department of Cardiology, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
| | - Shouhua Chen
- Department of Health Care Center, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Jihong Shi
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Ying Zhang
- Department of Ultrasonography, Hospital Affiliated to North China University of Science and Technology, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Jun Cai
- Department of Hypertension, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Mafolasire A, Yao X, Nawaf C, Suarez-Sarmiento A, Chow WH, Zhao W, Corley D, Hofmann JN, Purdue M, Adeniran AJ, Shuch B. Racial disparities in renal cell carcinoma: a single-payer healthcare experience. Cancer Med 2016; 5:2101-8. [PMID: 27228559 PMCID: PMC4884637 DOI: 10.1002/cam4.755] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/29/2016] [Accepted: 04/02/2016] [Indexed: 01/20/2023] Open
Abstract
Significant racial disparities in survival for renal cell carcinoma (RCC) exist between white and black patients. Differences in access to care and comorbidities are possible contributors. To investigate if racial disparities persist when controlling for access to care, we analyzed data from a single-payer healthcare system. As part of a case-control study within the Kaiser Permanente Northern California system, pathologic and clinical records were obtained for RCC cases (2152 white, 293 black) diagnosed from 1998 to 2008. Patient demographics, comorbidities, tumor characteristics, and treatment status were compared. Overall survival and disease-specific survival (DSS) were calculated by the Kaplan-Meier method. A Cox proportion hazards model estimated the independent associations of race, comorbidity, and clinicopathologic variables with DSS. We found that compared to white patients, black patients were diagnosed at a younger age (median 62 vs. 66 years, P < 0.001), were more likely to have papillary RCC (15% vs. 5.2%, P < 0.001), and had similar rates of surgical treatment (78.8% vs. 77.9%, P = 0.764). On multivariate analysis, advanced American Joint Committee on Cancer (AJCC) stage, lack of surgical treatment, larger tumor size, and higher grade were predictors of worse DSS. Race was not an independent predictor of survival. Therefore, we conclude that within a single healthcare system, differences in characteristics of black and white patients with RCC persist; black patients had different comorbidities, were younger, and had decreased tumor stage. However, unlike other series, race was not an independent predictor of DSS, suggesting that survival differences in large registries may result from barriers to healthcare access and/or comorbidity rather than disease biology.
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Affiliation(s)
| | - Xiaopan Yao
- Yale Center for Analytical Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Cayce Nawaf
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | | | - Wong-Ho Chow
- Department of Epidemiology, Anderson Cancer Center, Houston, Texas
| | - Wei Zhao
- Kaiser Permanente Division of Research, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Douglas Corley
- Kaiser Permanente Division of Research, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Jonathan N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Mark Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Adebowale J Adeniran
- Department of Pathology, Yale School of Medicine, Yale University, New Heaven, Connecticut
| | - Brian Shuch
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
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Norris KC, Brown AF. The Highs and Lows of Blood Pressure Targets in Elderly Adults and Other High-Risk Populations. J Am Geriatr Soc 2015; 63:2139-41. [PMID: 26480976 DOI: 10.1111/jgs.13699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Keith C Norris
- Division of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, California
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, California
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Still CH, Craven TE, Freedman BI, Van Buren PN, Sink KM, Killeen AA, Bates JT, Bee A, Contreras G, Oparil S, Pedley CM, Wall BM, White S, Woods DM, Rodriguez CJ, Wright JT. Baseline characteristics of African Americans in the Systolic Blood Pressure Intervention Trial. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2015; 9:670-9. [PMID: 26320890 PMCID: PMC4573272 DOI: 10.1016/j.jash.2015.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 01/13/2023]
Abstract
The Systolic Blood Pressure Intervention Trial (SPRINT) will compare treatment to a systolic blood pressure goal of <120 mm Hg to treatment to the currently recommended goal of <140 mm Hg for effects on incident cardiovascular, renal, and neurologic outcomes including cognitive decline. The objectives of this analysis are to compare baseline characteristics of African American (AA) and non-AA SPRINT participants and explore factors associated with uncontrolled blood pressure (BP) by race. SPRINT enrolled 9361 hypertensive participants aged older than 50 years. This cross-sectional analysis examines sociodemographics, baseline characteristics, and study measures among AAs compared with non-AAs. AAs made up 31% of participants. AAs (compared with non-AAs) were younger and less frequently male, had less education, and were more likely uninsured or covered by Medicaid. In addition, AAs scored lower on the cognitive screening test when compared with non-AAs. Multivariate logistic regression analysis found BP control rates to <140/90 mm Hg were higher for AAs who were male, had higher number of chronic diseases, were on diuretic treatment, and had better medication adherence. SPRINT is well poised to examine the effects of systolic blood pressure targets on clinical outcomes as well as predictors influencing BP control in AAs.
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Affiliation(s)
- Carolyn H Still
- Division of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Case Medical Center, Cleveland, OH, USA; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
| | - Timothy E Craven
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Peter N Van Buren
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kaycee M Sink
- Wake Forest School of Medicine, Section on Geriatrics and Gerontology, Winston-Salem, NC, USA
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey T Bates
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Alberta Bee
- Division of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Gabriel Contreras
- Nephrology Department, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carolyn M Pedley
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Barry M Wall
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Suzanne White
- Department of Internal Medicine, Northeast Ohio Neighborhood Health Services, Inc, Cleveland, OH, USA
| | - Delia M Woods
- Department of Medicine, Nephrology Division, Vanderbilt University, Nashville, TN, USA
| | - Carlos J Rodriguez
- Department of Epidemiology and Prevention, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jackson T Wright
- Division of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Case Medical Center, Cleveland, OH, USA; Department of Nephrology and Hypertension, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
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