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Kumar Roy T, Rahman M, Rahman MS, Halder N, Rashid MM. Is gender a factor in socioeconomic disparities in undiagnosed, and untreated hypertension in Bangladesh? J Clin Hypertens (Greenwich) 2024; 26:964-976. [PMID: 38953454 PMCID: PMC11301445 DOI: 10.1111/jch.14858] [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: 03/14/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
Our objectives were to ascertain the following: (1) the prevalence and socioeconomic distribution of hypertension (HTN), undiagnosed for HTN, and untreated cases of HTN-diagnosed individuals; (2) the relationship between SES and the prevalence of HTN, undiagnosed for HTN, and untreated for HTN; and (3) whether sex moderate this association. Data from the 2017-18 Bangladesh Demographic Health Survey were used. 11,776 participants who were 18 years of age or older responded to our analysis. The age-adjusted prevalence of HTN, undiagnosed for HTN, and untreated cases was 25.1%, 57.2%, and 12.3%. Compared to females, males were less likely to have HTN but more likely to have undiagnosed HTN. People in the rich SES groups had a higher odd of (adjusted odds ratio [aoR] 1.25; 95% confidence interval [CI] 1.08-3.45) of having HTN compared to those in the poor SES group. When compared to individuals in the poor SES group, those in the rich SES group had lower odds of undiagnosed (aoR 0.57; 95% CI 0.44-0.74) and untreated (aoR 0.56; 95% CI 0.31-0.98) for HTN. Sex moderated the association between SES and HTN prevalence, which showed that men from rich SES were more likely to suffer from HTN than men from poor SES. According to this study, the government and other pertinent stakeholders should concentrate more on developing suitable policy measures to reduce the risk of HTN, particularly for men in rich socioeconomic groups. They should also concentrate on screening and diagnosing HTN in socioeconomically disadvantaged populations, regardless of sex.
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Affiliation(s)
- Tapan Kumar Roy
- Department of Population Science and Human Resource DevelopmentUniversity of RajshahiRajshahiBangladesh
| | - Mosiur Rahman
- Department of Population Science and Human Resource DevelopmentUniversity of RajshahiRajshahiBangladesh
| | - Md. Sohanur Rahman
- Department of Population Science and Human Resource DevelopmentUniversity of RajshahiRajshahiBangladesh
| | - Nityananda Halder
- Department of Population Science and Human Resource DevelopmentUniversity of RajshahiRajshahiBangladesh
| | - Md Mamunur Rashid
- Department of Population ScienceJatiya Kabi Kazi Nazrul Islam UniversityMymensinghBangladesh
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Zhou Y, Luo D, Shao L, Yue Z, Shi M, Zhang J, Hui K, Xiong J, Duan M. Risk factors for acute postoperative hypertension in non-cardiac major surgery: a case control study. BMC Anesthesiol 2023; 23:167. [PMID: 37193947 DOI: 10.1186/s12871-023-02121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Acute postoperative hypertension (APH) is a common complication during the anesthesia recovery period that can lead to adverse outcomes, including cardiovascular and cerebrovascular accidents. Identification of risk factors for APH will allow for preoperative optimization and appropriate perioperative management. This study aimed to identify risk factors for APH. PATIENTS AND METHODS In this retrospective single-center study, 1,178 cases were included. Data was entered by two investigators, and consistency analysis was performed by another. Patients were divided into APH and non-APH groups. A predictive model was built by multivariate stepwise logistic regression. The predictive ability of the logistic regression model was tested by drawing the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Hosmer and Lemeshow goodness-of-fit (GOF) test was performed to reflect the goodness of fit of the model. Calibration curve was created to represent the relationship between predicted risk and observed frequency. Sensitivity analysis was performed to evaluate the robustness of the results. RESULTS Multivariate logistic regression analysis showed that age over 65 years (OR = 3.07, 95% CI: 2.14 ~ 4.42, P < 0.001), female patients (OR = 1.37, 95% CI: 1.02 ~ 1.84, P = 0.034), presence of intraoperative hypertension (OR = 2.15, 95% CI: 1.57 ~ 2.95, P < 0.001), and use of propofol in PACU (OR = 2.14, 95% CI: 1.49 ~ 3.06, P < 0.001) were risk factors for APH. Intraoperative use of dexmedetomidine (OR = 0.66, 95% CI: 0.49 ~ 0.89, P = 0.007) was a protective factor. Higher baseline SBP (OR = 0.90, 95% CI: 0.89 ~ 0.92, P < 0.001) also showed some correlation with APH. CONCLUSIONS The risk of acute postoperative hypertension increased with age over 65 years, female patients, intraoperative hypertension and restlessness during anesthesia recovery. Intraoperative use of dexmedetomidine was a protective factor for APH.
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Affiliation(s)
- Yaqing Zhou
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210019, China
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Dongxue Luo
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Luyi Shao
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210019, China
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Zichuan Yue
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Min Shi
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Jie Zhang
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Kangli Hui
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Jingwei Xiong
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Manlin Duan
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210019, China.
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
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Sakboonyarat B, Poovieng J, Srisawat P, Hatthachote P, Mungthin M, Rangsin R, Jongcherdchootrakul K. Prevalence, awareness, and control of hypertension and associated factors among Royal Thai Army personnel in Thailand from 2017 to 2021. Sci Rep 2023; 13:6946. [PMID: 37117457 PMCID: PMC10141845 DOI: 10.1038/s41598-023-34023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/22/2023] [Indexed: 04/30/2023] Open
Abstract
Hypertension (HTN) is a potential risk factor for cardiovascular diseases. We aimed to determine the prevalence, awareness, and control of HTN among RTA personnel in Thailand. We conducted a series of cross-sectional studies from 2017 to 2021. HTN was defined by systolic blood pressure (BP) ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg from a physical health examination, a history of HTN diagnosed by medical personnel, or taking antihypertensive medication. A total of 504,484 participants were included in the present study. The overall HTN prevalence was 29.4%. The prevalence of HTN among males was 30.5%, while it was 17.1% among females. Of the RTA personnel with HTN, 35.9% were aware of their condition. The overall control of HTN among RTA personnel with HTN was 15.8% in 2017 and 17.6% in 2021. Behavioral factors associated with HTN were current smoking, alcohol consumption, and sedentary behavior. A higher BMI was associated with higher HTN prevalence and HTN awareness but less likely to have controllable HTN. Male participants, younger individuals, current alcohol use, and sedentary behavior were associated with a lower prevalence of HTN awareness and controlled HTN. Current tobacco use was also associated with a lower prevalence of HTN awareness.
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Affiliation(s)
- Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Jaturon Poovieng
- Department of Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Phutsapong Srisawat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Panadda Hatthachote
- Department of Physiology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Mathirut Mungthin
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Kanlaya Jongcherdchootrakul
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.
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Taylor HA, Finkel T, Gao Y, Ballinger SW, Campo R, Chen R, Chen SH, Davidson K, Iruela-Arispe ML, Jaquish C, LeBrasseur NK, Odden MC, Papanicolaou GJ, Picard M, Srinivas P, Tjurmina O, Wolz M, Galis ZS. Scientific opportunities in resilience research for cardiovascular health and wellness. Report from a National Heart, Lung, and Blood Institute workshop. FASEB J 2022; 36:e22639. [PMID: 36322029 PMCID: PMC9703084 DOI: 10.1096/fj.202201407r] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
Exposure of biological systems to acute or chronic insults triggers a host of molecular and physiological responses to either tolerate, adapt, or fully restore homeostasis; these responses constitute the hallmarks of resilience. Given the many facets, dimensions, and discipline-specific focus, gaining a shared understanding of "resilience" has been identified as a priority for supporting advances in cardiovascular health. This report is based on the working definition: "Resilience is the ability of living systems to successfully maintain or return to homeostasis in response to physical, molecular, individual, social, societal, or environmental stressors or challenges," developed after considering many factors contributing to cardiovascular resilience through deliberations of multidisciplinary experts convened by the National Heart, Lung, and Blood Institute during a workshop entitled: "Enhancing Resilience for Cardiovascular Health and Wellness." Some of the main emerging themes that support the possibility of enhancing resilience for cardiovascular health include optimal energy management and substrate diversity, a robust immune system that safeguards tissue homeostasis, and social and community support. The report also highlights existing research challenges, along with immediate and long-term opportunities for resilience research. Certain immediate opportunities identified are based on leveraging existing high-dimensional data from longitudinal clinical studies to identify vascular resilience measures, create a 'resilience index,' and adopt a life-course approach. Long-term opportunities include developing quantitative cell/organ/system/community models to identify resilience factors and mechanisms at these various levels, designing experimental and clinical interventions that specifically assess resilience, adopting global sharing of resilience-related data, and cross-domain training of next-generation researchers in this field.
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Affiliation(s)
- Herman A. Taylor
- Cardiovascular Research Institute Morehouse School of Medicine, Atlanta, Georgia, USA
- Morehouse-Emory Cardiovascular Center for Health Equity, Atlanta, Georgia, USA
- Harvard Chan School of Public Health, Atlanta, Georgia, USA
- Emory School of Medicine, Atlanta, Georgia, USA
| | - Toren Finkel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yunling Gao
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Scott W. Ballinger
- University of Alabama Heersink School of Medicine, Birmingham, Alabama, USA
| | - Rebecca Campo
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rong Chen
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Sema4, Stamford, Connecticut, USA
| | - Shu Hui Chen
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Karina Davidson
- Feinstein Institutes for Medical Research, Northwell Health, New York, New York, USA
| | | | - Cashell Jaquish
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - George J. Papanicolaou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin Picard
- Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Pothur Srinivas
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Olga Tjurmina
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Wolz
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zorina S. Galis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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5
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Godbolt D, Opara I, Amutah-Onukagha N. Strong Black Women: Linking Stereotypes, Stress, and Overeating Among a Sample of Black Female College Students. JOURNAL OF BLACK STUDIES 2022; 53:609-634. [PMID: 36710718 PMCID: PMC9881457 DOI: 10.1177/00219347221087453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This qualitative study examines how the "Strong Black Woman" (SBW) label can have potentially negative health effects for African American/Black women that contribute to eating disorders. This study addresses the gap in literature on racial disparities that are present in understanding eating disorders that contribute to obesity and obesityrelated issues. Through semi-structured individual interviews conducted with (N = 11) Black female higher education students, participants were able to discuss how disorganized overeating patterns were associated with the emotional stress of being labeled a Strong Black Woman. Findings provide implications to clinicians, educators, and researchers by identifying stress inducing factors heightened by racist and sexist microaggressions that contribute to the mental and physical health of Black women. This study also adds to the limited literature on the intersection of racism and sexism that contribute to poor health outcomes in Black women.
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Affiliation(s)
- Dawn Godbolt
- National Partnership for Women & Families, Washington, DC, USA
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6
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Koo P, Muntner P, Hall ME, Gjelsvik A, McCool FD, Eaton CB. Relationship Between Risks for Obstructive Sleep Apnea, Resistant Hypertension, and Aldosterone Among African American Adults in the Jackson Heart Study. Am J Hypertens 2022; 35:875-883. [PMID: 35901013 PMCID: PMC9527775 DOI: 10.1093/ajh/hpac091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/02/2022] [Accepted: 07/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND African Americans have a higher prevalence of resistant hypertension compared with Caucasians. Racial differences in obstructive sleep apnea (OSA) and increased aldosterone level may explain the racial disparity in resistant hypertension prevalence. Therefore, the purpose of this study is to investigate if aldosterone level and hypertension status differ by risks for OSA (e.g., obesity, loud snoring, and daytime sleepiness) and how aldosterone level varies with hypertension severity and control among African Americans. METHODS A cross-sectional analysis was performed using baseline data on 5,052 African American adults in the Jackson Heart Study to investigate the relationships of interest using multivariable linear and multinomial logistic regression models adjusted for potential confounders. Risks for OSA were defined by a "risk score" consisting of the number of risks for OSA. RESULTS Of the 5,052 participants, 623 had no risks for OSA. Body mass index was the highest among those with a risk score of 6. About 39% of the sample had no hypertension, 29% had controlled hypertension, 26% had uncontrolled hypertension, and 6% had resistant hypertension. Higher odds of having uncontrolled hypertension or resistant hypertension were present in those with a higher risk score compared with those without risks for OSA. Log-aldosterone level increased with each additional risk for OSA (P-trend <0.05). Similarly, log-aldosterone also increased with more severe hypertension (P-trend <0.001). The highest aldosterone level was found in those with resistant hypertension that was inadequately controlled with medications. CONCLUSIONS Risks for OSA were positively associated with resistant hypertension and higher aldosterone level in African American adults.
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Affiliation(s)
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Michael E Hall
- Division of Cardiovascular Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Annie Gjelsvik
- Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island, USA
| | - Franklin Dennis McCool
- Division of Pulmonary, Critical Care, and Sleep Medicine, Memorial Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Charles B Eaton
- Department of Family Medicine and Epidemiology, Memorial Hospital of Rhode Island, Alpert Medical School of Brown University and Brown School of Public Health, Providence, Rhode Island, USA
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7
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Relation of Glycemic Status with Unrecognized MI and the Subsequent Risk of Mortality: The Jackson Heart Study. Am J Prev Cardiol 2022; 11:100348. [PMID: 35600110 PMCID: PMC9119819 DOI: 10.1016/j.ajpc.2022.100348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/20/2022] [Accepted: 05/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Almost 1/3 to 1/2 of initial myocardial infarctions (MI) may be silent or unrecognized (UMI), which forecasts future clinical events. Further, limited data exist to describe the potential risk for UMI in African-Americans. The relationship of glucose status with UMI was examined in the Jackson Heart Study: a cohort of African-American individuals. Methods and results At baseline, there were 5,073 participants with an initial 12-lead electrocardiogram (ECG) and fasting glucose measured. Of these participants, 106(2.1%) had a UMI, and 268(4.2%) had a recognized MI. This population consisted of 3,233 (63.7%) participants with normal fasting glucose (NFG), 533 (10.5%) with IFG, and 1,039 (20.4%) with DM. Logistic regression investigated the relationship between glucose status and UMI. Cox proportional hazard models determined the significance of all-cause mortality during follow-up by MI status. The sample was 65% female with a mean age of 55.3 ± 12.9 years. Over a mean follow-up of 10.4 years, there were 795 deaths. Relative to NFG, the crude odds ratio (OR) estimates for UMI at baseline with IFG and DM were 1.00(95% CI:0.48–2.14) and 3.22(2.15–4.81), respectively. With adjustment, DM continued to be significantly associated with UMI [2.30 (1.42–3.71)]. Overall, participants with a baseline UMI had an adjusted Hazard ratio (HR) of 2.00(1.39–2.78) of death compared to no prior MI. Compared to those with no MI, those with a recognizedMI had an adjusted HR of 1.70(1.31–2.17) for mortality. Conclusions DM is associated with UMI in African-Americans. Further, a UMI carried similar risk of death compared to those with a recognized MI.
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8
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Lyas C. It’s Not All Even. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Hu Y, Haessler JW, Manansala R, Wiggins KL, Moscati A, Beiser A, Heard-Costa NL, Sarnowski C, Raffield LM, Chung J, Marini S, Anderson CD, Rosand J, Xu H, Sun X, Kelly TN, Wong Q, Lange LA, Rotter JI, Correa A, Vasan RS, Seshadri S, Rich SS, Do R, Loos RJ, Longstreth WT, Bis JC, Psaty BM, Tirschwell DL, Assimes TL, Silver B, Liu S, Jackson R, Smoller S, Mitchell BD, Fornage M, Auer PL, Reiner AP, Kooperberg C. Whole-Genome Sequencing Association Analyses of Stroke and Its Subtypes in Ancestrally Diverse Populations From Trans-Omics for Precision Medicine Project. Stroke 2022; 53:875-885. [PMID: 34727735 PMCID: PMC8885789 DOI: 10.1161/strokeaha.120.031792] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is the leading cause of death and long-term disability worldwide. Previous genome-wide association studies identified 51 loci associated with stroke (mostly ischemic) and its subtypes among predominantly European populations. Using whole-genome sequencing in ancestrally diverse populations from the Trans-Omics for Precision Medicine (TOPMed) Program, we aimed to identify novel variants, especially low-frequency or ancestry-specific variants, associated with all stroke, ischemic stroke and its subtypes (large artery, cardioembolic, and small vessel), and hemorrhagic stroke and its subtypes (intracerebral and subarachnoid). METHODS Whole-genome sequencing data were available for 6833 stroke cases and 27 116 controls, including 22 315 European, 7877 Black, 2616 Hispanic/Latino, 850 Asian, 54 Native American, and 237 other ancestry participants. In TOPMed, we performed single variant association analysis examining 40 million common variants and aggregated association analysis focusing on rare variants. We also combined TOPMed European populations with over 28 000 additional European participants from the UK BioBank genome-wide array data through meta-analysis. RESULTS In the single variant association analysis in TOPMed, we identified one novel locus 13q33 for large artery at whole-genome-wide significance (P<5.00×10-9) and 4 novel loci at genome-wide significance (P<5.00×10-8), all of which need confirmation in independent studies. Lead variants in all 5 loci are low-frequency but are more common in non-European populations. An aggregation of synonymous rare variants within the gene C6orf26 demonstrated suggestive evidence of association for hemorrhagic stroke (P<3.11×10-6). By meta-analyzing European ancestry samples in TOPMed and UK BioBank, we replicated several previously reported stroke loci including PITX2, HDAC9, ZFHX3, and LRCH1. CONCLUSIONS We represent the first association analysis for stroke and its subtypes using whole-genome sequencing data from ancestrally diverse populations. While our findings suggest the potential benefits of combining whole-genome sequencing data with populations of diverse genetic backgrounds to identify possible low-frequency or ancestry-specific variants, they also highlight the need to increase genome coverage and sample sizes.
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Affiliation(s)
- Yao Hu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jeffrey W. Haessler
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Regina Manansala
- School of Public Health, University of Wisconsin–Milwaukee, Milwaukee, WI
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Arden Moscati
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexa Beiser
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | | | - Chloe Sarnowski
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Laura M. Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Jaeyoon Chung
- Department of Medicine, Boston University School of Medicine, Boston, MA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Sandro Marini
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Christopher D. Anderson
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA
| | - Huichun Xu
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Xiao Sun
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Tanika N. Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Quenna Wong
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Adolfo Correa
- Department of Pediatrics and Medicine, University of Mississippi Medical Center, Jackson, MS
| | | | - Sudha Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Genetics and Genomic Sciences, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ruth J.F. Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- The Mindich Child Health and Development Institute, The Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Departments of Epidemiology and Health Services, University of Washington, Seattle, WA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | | | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA
| | - Simin Liu
- Center for Global Cardiometabolic Health, Departments of Epidemiology, Medicine, and Surgery, Brown University, Providence, RI
| | - Rebecca Jackson
- Division of Endocrinology Diabetes and Metabolism, The Ohio State University, Columbus, OH
| | - Sylvia Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY
| | - Braxton D. Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD
| | - Myriam Fornage
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX
| | - Paul L. Auer
- School of Public Health, University of Wisconsin–Milwaukee, Milwaukee, WI
| | - Alex P. Reiner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Charles Kooperberg
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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Mendy VL, Rowell-Cunsolo T, Bellerose M, Vargas R, Enkhmaa B, Zhang L. Cardiovascular Disease Mortality in Mississippi, 2000-2018. Prev Chronic Dis 2022; 19:E09. [PMID: 35201975 PMCID: PMC8880103 DOI: 10.5888/pcd19.210385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading of cause of death in Mississippi. We explored trends in CVD death rates among adults in Mississippi aged 35 years or older to assess changes from 2000 through 2018. METHODS We extracted data from Mississippi Vital Statistics from 2000 through 2018. We used underlying cause-of-death codes from the International Classification of Diseases, Tenth Revision (ICD-10) to identify CVD deaths; we included all cases with codes I00-I09, I11, I13, I20-I51, I60-I69, and I70. We calculated age-adjusted CVD death rates for the overall population by age, race, sex, and race-by-sex groups. RESULTS Overall, the age-adjusted CVD death rate declined from 832.3 deaths per 100,000 population in 2000 to 550.5 deaths per 100,000 in 2018, a relative decline of 33.9% and an average annual decline of -2.3% (95% CI, -2.7% to -1.8%). Age-adjusted CVD death rates declined from 2000 through 2018 for all groups, but the magnitude of decline varied by subgroup (men, -2.0%; women, -2.6%; non-Hispanic Black, -2.4%; non-Hispanic White, -2.2%; non-Hispanic Black women, -3.0%; non-Hispanic White women, -2.5%; non-Hispanic Black men -2.1%; non-Hispanic White men -2.0%). Age-specific analysis indicated a significant average annual increase of 1.7% (95% CI, 0.6%-2.9%) from 2011 through 2018 for the group aged 55 to 64 years. CONCLUSION From 2000 through 2018, age-adjusted CVD death rates in Mississippi declined for all age/race/sex groups. However, the magnitude of decline varied by subgroup. Targeted interventions for CVD risk reduction are needed for adults aged 55 to 64 years in Mississippi, the only age group in which we observed a significant annual increase in CVD death rates.
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Affiliation(s)
- Vincent L Mendy
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Jackson State University, Jackson, Mississippi
- College of Health Sciences, School of Public Health, Department of Epidemiology and Biostatistics, 350 W Woodrow Wilson Dr, Jackson, MS 39213.
| | | | - Meghan Bellerose
- Columbia University Mailman School of Public Health, New York, New York
| | - Rodolfo Vargas
- Office of Health Data and Research, Mississippi State Department of Health, Jackson, Mississippi
| | - Byambaa Enkhmaa
- Department of Internal Medicine, School of Medicine, University of California, Davis, California
| | - Lei Zhang
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi
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Abstract
Hypertension is a worldwide problem with major impacts on health including morbidity and mortality, as well as consumption of health care resources. Nearly 50% of American adults have high blood pressure, and this rate is rising. Even with multiple antihypertensive drugs and aggressive lifestyle modifications, blood pressure is inadequately controlled in about 1 of 5 hypertensive individuals. This review highlights a hypothesis for hypertension that suggests alternative mechanisms for blood pressure elevation and maintenance. A better understanding of these mechanisms could open avenues for more successful treatments. The hypothesis accounts for recent understandings of the involvement of gut physiology, gut microbiota, and neuroinflammation in hypertension. It includes bidirectional communication between gut microbiota and gut epithelium in the gut-brain axis that is involved in regulation of autonomic nervous system activity and blood pressure control. Dysfunction of this gut-brain axis, including dysbiosis of gut microbiota, gut epithelial dysfunction, and deranged input to the brain, contributes to hypertension via inflammatory mediators, metabolites, bacteria in the circulation, afferent information alterations, etc resulting in neuroinflammation and unbalanced autonomic nervous system activity that elevates blood pressure. This in turn negatively affects gut function and its microbiota exacerbating the problem. We focus this review on the gut-brain axis hypothesis for hypertension and possible contribution to racial disparities in hypertension. A novel idea, that immunoglobulin A-coated bacteria originating in the gut with access to the brain could be involved in hypertension, is raised. Finally, minocycline, with its anti-inflammatory and antimicrobial properties, is evaluated as a potential antihypertensive drug acting on this axis.
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Affiliation(s)
- Elaine M Richards
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jing Li
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Bruce R Stevens
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mohan K Raizada
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, Florida, USA
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Van't Hof JR, Duval S, Luepker RV, Jones C, Hayes SN, Cooper LA, Patten CA, Brewer LC. Association of Cardiovascular Disease Risk Factors With Sociodemographic Characteristics and Health Beliefs Among a Community-Based Sample of African American Adults in Minnesota. Mayo Clin Proc 2022; 97:46-56. [PMID: 34996565 PMCID: PMC8765600 DOI: 10.1016/j.mayocp.2021.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/23/2021] [Accepted: 08/18/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess cardiovascular disease (CVD) and CVD risk factors and their association with sociodemographic characteristics and health beliefs among African American (AA) adults in Minnesota. METHODS A cross-sectional analysis was conducted of a community-based sample of AA adults enrolled in the Minnesota Heart Health Program Ask About Aspirin study from May 2019 to September 2019. Sociodemographic characteristics, health beliefs, and self-reported CVD and CVD risk factors were collected. Prevalence ratio (PR) estimates were calculated using Poisson regression modeling to assess the association between participants' characteristics and age- and sex-adjusted CVD risk factors. RESULTS The sample included 644 individuals (64% [412] women) with a mean age of 61 years. Risk factors for CVD were common: hypertension (67% [434]), hyperlipidemia (47% [301]), diabetes (34% [219]), and current cigarette smoking (25% [163]); 19% (119) had CVD. Those with greater perceived CVD risk had a higher likelihood of prevalent hyperlipidemia (PR, 1.34; 95% CI, 1.14 to 1.57), diabetes (PR, 1.61; 95% CI, 1.30 to 1.98), and CVD (PR 1.61; 95% CI, 1.16 to 2.23) compared with those with lower perceived risk. Trust in health care provider was high (83% [535]) but was not associated with CVD or CVD risk factors. CONCLUSION In this community sample of AAs in Minnesota, CVD risk factors were high, as was trust in health care providers. Those with greater CVD risk perceptions had higher CVD prevalence. Consideration of sociodemographic and psychosocial influences on CVD and CVD risk factors could inform development of effective cardiovascular health promotion interventions in the AA Minnesota community.
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Affiliation(s)
- Jeremy R Van't Hof
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN
| | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN
| | - Russell V Luepker
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | | | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN.
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Khan MN, Oldroyd JC, Chowdhury EK, Hossain MB, Rana J, Renzetti S, Islam RM. Prevalence, awareness, treatment, and control of hypertension in Bangladesh: Findings from National Demographic and Health Survey, 2017-2018. J Clin Hypertens (Greenwich) 2021; 23:1830-1842. [PMID: 34492733 PMCID: PMC8678656 DOI: 10.1111/jch.14363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to estimate the age-standardised prevalence, awareness, treatment, and control of hypertension and to identify their risk factors in Bangladeshi adults. Data from 12 904 adults aged 18-95 years, available from the most recent nationally representative 2017-2018 Bangladesh Demographic and Health Survey were used. Hypertension was defined as having systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, and/or taking anti-hypertensive drugs to control blood pressure. Age-standardized prevalence of hypertension and management were estimated with direct standardisation. A multilevel mixed-effects Poisson regression model with a robust variance was used to identify risk factors associated with hypertension and its awareness, treatment, and control. The overall age-standardized prevalence of hypertension was 26.2% (95% CI, 25.5-26.9); (men: 23.5%, women: 28.9%). Among those with hypertension (n = 3531), 36.7% were aware that they had the condition, and only 31.1% received anti-hypertensive medication. The prevalence of controlled hypertension was 12.7% among those with hypertension and 43.6% among those treated for hypertension (n = 1306). Factors independently associated with hypertension were increasing age, higher body mass index, being women, having diabetes, and residing in selected administrative divisions. A declining trend of hypertension control was observed with increasing age and low education. Hypertension is highly prevalent (one in four) in Bangladeshi adults, while awareness, treatment, and control are low. Irrespective of the risks associated with hypertension and its management, programs to increase its awareness, treatment, and control should be given high priority in reducing hypertension prevalence and improving hypertension control in Bangladesh.
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Affiliation(s)
- Md. Nuruzzaman Khan
- Department of Population ScienceJatiya Kabi Kazi Nazrul Islam UniversityMymensinghBangladesh
| | - John C. Oldroyd
- School of Behavioral and Health SciencesAustralian Catholic UniversityFitzroyVictoriaAustralia
| | - Enayet K. Chowdhury
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- School of Public HealthCurtin UniversityPerthWestern AustraliaAustralia
| | | | - Juwel Rana
- Department of Public Health, School of Health and Life SciencesNorth South UniversityDhakaBangladesh
- South Asian Institute for Social Transformation (SAIST)DhakaBangladesh
| | - Stefano Renzetti
- Department of Molecular and Translational MedicineUniversità degli Studi di BresciaBresciaItaly
| | - Rakibul M. Islam
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- South Asian Institute for Social Transformation (SAIST)DhakaBangladesh
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Mendy VL, Rowell-Cunsolo T, Bellerose M, Vargas R, Zhang L, Enkhmaa B. Temporal Trends in Hypertension Death Rate in Mississippi, 2000-2018. Am J Hypertens 2021; 34:956-962. [PMID: 33954415 DOI: 10.1093/ajh/hpab068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/17/2021] [Accepted: 04/21/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In Mississippi, hypertension as a leading cause of death moved from 15th in 2000 to 11th in 2018, but research on temporal trends is limited. We examined temporal trends in hypertension-related mortality among Mississippi adults by age, sex, and race. METHODS We extracted data on the number of deaths due to hypertension among adults aged 45 or older annually from 2000 to 2018 from Mississippi Vital Statistics. We used underlying cause-of-death codes from the International Classification of Diseases, Tenth Revision to identify hypertension deaths. We calculated the annual percentage change (trend segment) and average annual percentage change (AAPC) in age-adjusted hypertension death rates from 2000 to 2018 and examined differences in the AAPC by age, sex, and race. RESULTS From 2000 through 2018, the age-adjusted hypertension death rate increased annually by 3.0% (AAPC 3.0%, 95% confidence interval, 1.9%-4.0%) with 3 distinct time periods. There was an average annual increase in age-adjusted hypertension death rates for all subgroups, i.e., men, women, Blacks, Whites, White females, Black males, and White males. The highest magnitude of increase was among those aged 45-64 years (AAPC 6.0%), men (AAPC 4.5%), Whites (AAPC 3.5%), and White men (AAPC 6.2%) compared with other age groups, women, Blacks, and Black men, respectively. CONCLUSIONS For nearly 2 decades, there was an increase in age-adjusted hypertension death rates among Mississippi adults aged 45 years or older. Blood pressure lowering interventions that target hypertensive adults are needed.
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Affiliation(s)
- Vincent L Mendy
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, Mississippi, USA
| | - Tawandra Rowell-Cunsolo
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Meghan Bellerose
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Rodolfo Vargas
- Office of Health Data and Research, Mississippi State Department of Health, Jackson, Mississippi, USA
| | - Lei Zhang
- Office of Health Data and Research, Mississippi State Department of Health, Jackson, Mississippi, USA
| | - Byambaa Enkhmaa
- Department of Internal Medicine, School of Medicine, University of California Davis, Davis, California, USA
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15
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Weaver AM, Wang Y, Wellenius GA, Bidulescu A, Sims M, Vaidyanathan A, Hickson DA, Shimbo D, Abdalla M, Diaz KM, Seals SR. Long-Term Air Pollution and Blood Pressure in an African American Cohort: the Jackson Heart Study. Am J Prev Med 2021; 60:397-405. [PMID: 33478866 PMCID: PMC10388406 DOI: 10.1016/j.amepre.2020.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 09/21/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION African Americans are disproportionately affected by high blood pressure, which may be associated with exposure to air pollutants, such as fine particulate matter and ozone. METHODS Among African American Jackson Heart Study participants, this study examined associations between 1-year and 3-year mean fine particulate matter and ozone concentrations with prevalent and incident hypertension at Visits 1 (2000-2004, n=5,191) and 2 (2005-2008, n=4,105) using log binomial regression. Investigators examined associations with systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure using linear regression and hierarchical linear models, adjusting for sociodemographic, behavioral, and clinical characteristics. Analyses were conducted in 2017-2019. RESULTS No associations were observed between fine particulate matter or ozone concentration and prevalent or incident hypertension. In linear models, an IQR increase in 1-year ozone concentration was associated with 0.67 mmHg higher systolic blood pressure (95% CI=0.27, 1.06), 0.42 mmHg higher diastolic blood pressure (95% CI=0.20, 0.63), and 0.50 mmHg higher mean arterial pressure (95% CI=0.26, 0.74). In hierarchical models, fine particulate matter was inversely associated with systolic blood pressure (-0.72, 95% CI= -1.31, -0.13), diastolic blood pressure (-0.69, 95% CI= -1.02, -0.36), and mean arterial pressure (-0.71, 95% CI= -1.08, -0.33). Attenuated associations were observed with 1-year concentrations and at Visit 1. CONCLUSIONS Positive associations were observed between ozone and systolic blood pressure, diastolic blood pressure, and mean arterial pressure, and inverse associations between fine particulate matter and systolic blood pressure, diastolic blood pressure, and mean arterial pressure in an African American population with high (56%) prevalence of hypertension. Effect sizes were small and may not be clinically relevant.
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Affiliation(s)
- Anne M Weaver
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Chapel Hill, North Carolina; Department of Environmental Health, Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Yi Wang
- Department of Environmental Health, Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana.
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ambarish Vaidyanathan
- School of Civil & Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - DeMarc A Hickson
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, Mississippi
| | - Daichi Shimbo
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Marwah Abdalla
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Keith M Diaz
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Samantha R Seals
- Department of Mathematics and Statistics, University of West Florida, Pensacola, Florida
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16
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Wei J, Mi Y, Li Y, Xin B, Wang Y. Factors associated with awareness, treatment and control of hypertension among 3579 hypertensive adults in China: data from the China Health and Nutrition Survey. BMC Public Health 2021; 21:423. [PMID: 33648483 PMCID: PMC7919311 DOI: 10.1186/s12889-021-10417-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 02/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of hypertension is high and rising in China, but most people with hypertension do not have their blood pressure under control. This study investigated hypertension awareness, treatment, and control and their associated factors among Chinese adults. METHODS Data collected from the 2011 China Health and Nutrition Survey (CHNS) from 12,991 Chinese adults were used. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, self-reported prior diagnosed hypertension, or taking antihypertensive medications. Hypertension awareness, treatment, and control were defined as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure < 140/90 mmHg, respectively. Multivariate logistic regression was performed to examine factors associated with hypertension awareness, treatment, and control. RESULTS Overall, 3579 (27.6%) of the CHNS adult participants had hypertension, of whom 55.7% were aware of their diagnosis, 46.5% were treated with antihypertensive medications, but only 20.3% had their blood pressure under control. Higher hypertension treatment was associated with older age (OR = 2.57; 95%CI, 1.65-4.02), urban residency (1.50; 1.14-1.97), living in the Eastern region (1.52; 1.14-2.01), and being overweight/obese (1.99; 1.39-2.84). Hypertension awareness was associated with similar factors as hypertension treatment but was also associated with being female (1.37, 1.12-1.66). Poor hypertension control was associated with being overweight/obese (0.56; 0.42-0.76) and minority ethnicity (0.52; 0.31-0.86). CONCLUSION Hypertension is a major public health challenge in China. The prevalence of hypertension awareness, treatment, and control are still low despite existing public health policies and programs to reduce the burden of hypertension. More intensive hypertension screening and treatment programs are warranted in China.
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Affiliation(s)
- Junxiang Wei
- Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, China.
- Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
| | - Yang Mi
- Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, China
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bo Xin
- Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Youfa Wang
- Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
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Akinyelure OP, Sakhuja S, Colvin CL, Clark D, Jaeger BC, Hardy ST, Howard G, Cohen LP, Irvin MR, Tanner R, Carey RM, Muntner P. Cardiovascular Health and Transition From Controlled Blood Pressure to Apparent Treatment Resistant Hypertension: The Jackson Heart Study and the REGARDS Study. Hypertension 2020; 76:1953-1961. [PMID: 33131312 DOI: 10.1161/hypertensionaha.120.15890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Almost 1 in 5 US adults with hypertension has apparent treatment resistant hypertension (aTRH). Identifying modifiable risk factors for incident aTRH may guide interventions to reduce the need for additional antihypertensive medication. We evaluated the association between cardiovascular health and incident aTRH among participants with hypertension and controlled blood pressure (BP) at baseline in the Jackson Heart Study (N=800) and the Reasons for Geographic and Racial Differences in Stroke study (N=2316). Body mass index, smoking, physical activity, diet, BP, cholesterol and glucose, categorized as ideal, intermediate, or poor according to the American Heart Association's Life's Simple 7 were assessed at baseline and used to define cardiovascular health. Incident aTRH was defined by uncontrolled BP, systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg, while taking ≥3 classes of antihypertensive medication or controlled BP, systolic BP <130 mm Hg and diastolic BP <80 mm Hg, while taking ≥4 classes of antihypertensive medication at a follow-up visit. Over a median 9 years of follow-up, 605 (19.4%) participants developed aTRH. Incident aTRH developed among 25.8%, 18.2%, and 15.7% of participants with 0 to 1, 2, and 3 to 5 ideal Life's Simple 7 components, respectively. No participants had 6 or 7 ideal Life's Simple 7 components at baseline. The multivariable adjusted hazard ratios (95% CIs) for incident aTRH associated with 2 and 3 to 5 versus 0 to 1 ideal components were 0.75 (0.61-0.92) and 0.67 (0.54-0.82), respectively. These findings suggest optimizing cardiovascular health may reduce the pill burden and high cardiovascular risk associated with aTRH among individuals with hypertension.
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Affiliation(s)
- Oluwasegun P Akinyelure
- From the Department of Epidemiology (O.P.A., S.S., C.L.C., S.T.H., M.R.I., R.T., P.M.), University of Alabama at Birmingham
| | - Swati Sakhuja
- From the Department of Epidemiology (O.P.A., S.S., C.L.C., S.T.H., M.R.I., R.T., P.M.), University of Alabama at Birmingham
| | - Calvin L Colvin
- From the Department of Epidemiology (O.P.A., S.S., C.L.C., S.T.H., M.R.I., R.T., P.M.), University of Alabama at Birmingham
| | - Donald Clark
- Cardiovascular Division, University of Mississippi Medical Center, Jackson (D.C.)
| | - Byron C Jaeger
- Department of Biostatistics (B.C.J., G.H.), University of Alabama at Birmingham
| | - Shakia T Hardy
- From the Department of Epidemiology (O.P.A., S.S., C.L.C., S.T.H., M.R.I., R.T., P.M.), University of Alabama at Birmingham
| | - George Howard
- Department of Biostatistics (B.C.J., G.H.), University of Alabama at Birmingham
| | - Laura P Cohen
- Department of Medicine, The Columbia Hypertension Center, Columbia University Medical Center, New York, NY (L.P.C.)
| | - Marguerite R Irvin
- From the Department of Epidemiology (O.P.A., S.S., C.L.C., S.T.H., M.R.I., R.T., P.M.), University of Alabama at Birmingham
| | - Rikki Tanner
- From the Department of Epidemiology (O.P.A., S.S., C.L.C., S.T.H., M.R.I., R.T., P.M.), University of Alabama at Birmingham
| | - Robert M Carey
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA (R.M.C.)
| | - Paul Muntner
- From the Department of Epidemiology (O.P.A., S.S., C.L.C., S.T.H., M.R.I., R.T., P.M.), University of Alabama at Birmingham
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Hypertension among Mississippi Workers by Sociodemographic Characteristics and Occupation, Behavioral Risk Factor Surveillance System. Int J Hypertens 2020; 2020:2401747. [PMID: 32724672 PMCID: PMC7382734 DOI: 10.1155/2020/2401747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
In 2017, Mississippi had the third highest age-adjusted prevalence of hypertension in the United States. We estimated the prevalence of hypertension by sociodemographic characteristics and occupation and examined the association between hypertension with occupation and sociodemographic characteristics among Mississippi workers. We calculated adjusted prevalence and adjusted prevalence ratios (APRs) by sociodemographic characteristics and occupation among Mississippi adult workers. We analyzed combined 2013, 2015, and 2017 data from the Mississippi Behavioral Risk Factor Surveillance System for 6,965 workers in ten Standard Occupational Classification System major groups. Of the estimated 1.1 million Mississippi workers during the three survey years, 31.4% (95% confidence interval (CI), 30.0–32.8) had hypertension. The likelihood of having hypertension was significantly higher among workers aged 30–44 years, 45–64 years, blacks, and those classified as overweight and obese workers compared to their counterparts. The likelihood of having hypertension among workers in the fields of installation, repair and maintenance, and production were 26% higher (APR, 1.26; 95% CI, 1.03–1.55) and 33% higher (APR, 1.33; 95% CI, 1.11–1.58), respectively, than workers in all other occupational groups. Among Mississippi workers, hypertension prevalence varied by sociodemographic characteristics and occupational groups. Age, race, obesity status, installation, repair, maintenance, and production occupation groups are associated with an increased likelihood of hypertension. Novel and/or community-based or linked programs are needed that could target workers at risk of hypertension that are outside of a single-site workplace.
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Sims M, Glover LSM, Gebreab SY, Spruill TM. Cumulative psychosocial factors are associated with cardiovascular disease risk factors and management among African Americans in the Jackson Heart Study. BMC Public Health 2020; 20:566. [PMID: 32345300 PMCID: PMC7189712 DOI: 10.1186/s12889-020-08573-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. METHODS Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors. RESULTS After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16-1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01-1.52 and PR 1.13 95% CI 1.03-1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03-1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46-0.84). CONCLUSIONS Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, 350 W. Woodrow Wilson Avenue, Jackson, MS 39213, USA
| | - Lá Shauntá M. Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Tanya M. Spruill
- Department of Population Health, NYU School of Medicine, New York, USA
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Cain-Shields LR, Johnson DA, Glover L, Sims M. The association of goal-striving stress with sleep duration and sleep quality among African Americans in the Jackson Heart Study. Sleep Health 2020; 6:117-123. [PMID: 31734287 PMCID: PMC6995417 DOI: 10.1016/j.sleh.2019.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND African Americans (AAs) report a higher frequency of certain stressors over their lifetime which may impact biological processes that can impair sleep. For this reason, goal-striving stress (GSS), the difference between aspiration and achievement, weighted by disappointment, may contribute to poor sleep quality and suboptimal sleep duration among AAs. METHODS We completed a cross-sectional analysis using exam 1 data (2000-2004) from the Jackson Heart Study (JHS) (n=4943). GSS was self-reported and categorized in tertiles of low, moderate, and high. Participants self-reported the number of hours they slept each night and rated their sleep quality as (1) very poor to (5) excellent. Sleep duration categories included the following: short sleep (≤6 hours), normal sleep (7-8 hours) and long sleep (≥ 9 hours). Sleep quality was categorized as high (good/very good/excellent) and low (fair/poor). Relative risk ratios (RRRs 95% confidence intervals-CI) were estimated for sleep duration and sleep quality categories by GSS using logistic regression. RESULTS After full adjustment, there were no significant associations between GSS and sleep duration categories. However, participants who reported high (versus low) GSS had a 20% greater risk (1.20 95% CI: 1.01, 1.43) of low (versus high) sleep quality in the fully adjusted model. CONCLUSION The stress due to the deficit between goal aspiration and achievement was associated with poor sleep quality. Future investigations should examine the association of changes in GSS with changes in sleep duration and sleep quality.
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Affiliation(s)
- Loretta R Cain-Shields
- Department of Data Science, John D Bower School of Population Health, University of Mississippi Medical Center, 2500 North State St., Jackson, MS, 39216, USA.
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - LáShauntá Glover
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill NC, 27516, USA
| | - Mario Sims
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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Priyanti RP, Kholis AH, Asri A, Rifa'i R, Praningsih S. Family Experience in Dealing with Emergency Cardiovascular Disease. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Discusiion: The risk of cardiovascular disease has shifted. Cardiovascular disease initially only affected certain age groups but not with the current incidence of cardiovascular disease. This makes the community more susceptible to cardiovascular disease attacks. An attack of cardiovascular disease, in general, is only considered to be a cursory attack. The patients with high-risk factors must be supported by the ability of families to recognize and perform first aid in cardiovascular disease attacks. The purpose of this study was to understand the family's experience in dealing with emergency heart disease at home.Method: This study used qualitative research with a case study approach; 2 participants with family members who face emergency heart disease were selected. The data collection used semi-structured interview techniques using observation and field notes. The data analysis used Creswell's qualitative data analysis method.Result: The results of the study found 4 themes related to the family experience in dealing with emergency heart disease at home. The themes were knowledge, past experience, values and beliefs.Conclusion: The conclusion of the study is that the family experience when dealing with emergency heart disease is strongly influenced by the knowledge that forms a value and belief which then influences the attitudes involved in decision making.
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22
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Glover LM, Cain-Shields LR, Wyatt SB, Gebreab SY, Diez-Roux AV, Sims M. Life Course Socioeconomic Status and Hypertension in African American Adults: The Jackson Heart Study. Am J Hypertens 2020; 33:84-91. [PMID: 31420642 PMCID: PMC6931894 DOI: 10.1093/ajh/hpz133] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/23/2019] [Accepted: 08/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Limited research has examined the association of life-course socioeconomic status (SES) with hypertension prevalence and incidence in a large cohort of African Americans. METHODS Among 4,761 participants from the Jackson Heart Study (JHS), we examined the association of SES indicators with prevalent and incident hypertension. We used multivariable Poisson regression to estimate prevalence ratios (PR, 95% confidence interval-CI) of baseline (2000-2004) hypertension by adult (education, income, occupation, wealth) and childhood (mother's education) SES. Cox proportional hazards regression was used to estimate hazard ratios (HR, 95% CI) of incident hypertension by adult and childhood SES (2005-2013; 7.21 median years of follow-up). We also examined the association of childhood-to-adult SES mobility (parent-to-adult education) with prevalent and incident hypertension. Model 1 adjusted for age and sex. Model 2 added waist circumference, behaviors (smoking, alcohol, physical activity, diet), and diabetes prevalence. RESULTS High (vs. low) adult SES measures were associated with a lower prevalence of hypertension, with the exception of having a college degree and upper-middle income (PR: 1.04, 95% CI: 1.01, 1.07; PR: 1.05, 95% CI: 1.01, 1.09, respectively). Higher childhood SES was associated with a lower prevalence and risk of hypertension (PR: 0.83, 95%: CI 0.75, 0.91; HR: 0.76, 95% CI: 0.65, 0.89, respectively). Upward mobility and consistent high SES (vs. consistent low SES) from childhood to adulthood was associated with a greater prevalence, but lower incidence of hypertension. CONCLUSION Efforts to prevent hypertension among African Americans should consider childhood and current SES status.
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Affiliation(s)
- Láshauntá M Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA
| | - Loretta R Cain-Shields
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sharon B Wyatt
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Ana V Diez-Roux
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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23
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Weaver AM, Wang Y, Wellenius GA, Young B, Boyle LD, Hickson DA, Diamantidis CJ. Long-term exposure to ambient air pollution and renal function in African Americans: the Jackson Heart Study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2019; 29:548-556. [PMID: 30420726 PMCID: PMC6511484 DOI: 10.1038/s41370-018-0092-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/25/2018] [Accepted: 10/23/2018] [Indexed: 05/09/2023]
Abstract
Renal dysfunction is prevalent in the US among African Americans. Air pollution is associated with renal dysfunction in mostly white American populations, but has not been studied among African Americans. We evaluated cross-sectional associations between 1-year and 3-year fine particulate matter (PM2.5) and ozone (O3) concentrations, and renal function among 5090 African American participants in the Jackson Heart Study. We used mixed-effect linear regression to estimate associations between 1-year and 3-year PM2.5 and O3 and estimated glomerular filtration rate (eGFR), urine albumin/creatinine ratio (UACR), serum creatinine, and serum cystatin C, adjusting for: sociodemographic factors, health behaviors, and medical history and accounting for clustering by census tract. At baseline, JHS participants had mean age 55.4 years, and 63.8% were female; mean 1-year and 3-year PM2.5 concentrations were 12.2 and 12.4 µg/m3, and mean 1-year and 3-year O3 concentrations were 40.2 and 40.7 ppb, respectively. Approximately 6.5% of participants had reduced eGFR (< 60 mL/min/1.73m2) and 12.7% had elevated UACR (> 30 mg/g), both indicating impaired renal function. Annual and 3-year O3 concentrations were inversely associated with eGFR and positively associated with serum creatinine; annual and 3-year PM2.5 concentrations were inversely associated with UACR. We observed impaired renal function associated with increased O3 but not PM2.5 exposure among African Americans.
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Affiliation(s)
- Anne M Weaver
- Indiana University, Fairbanks School of Public Health, Department of Environmental Health, Indianapolis, IN, USA
| | - Yi Wang
- Indiana University, Fairbanks School of Public Health, Department of Environmental Health, Indianapolis, IN, USA.
| | | | - Bessie Young
- University of Washington, Division of Nephrology, Seattle, WA, USA
| | - Luke D Boyle
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - DeMarc A Hickson
- School of Public Health, Department of Epidemiology and Biostatistics, Jackson State University, Jackson, MS, USA
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24
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Gümüştakım RŞ, Ozkara A, Kahveci R, Döner Güner P, Ayhan Başer D, Dede F. Awareness, Treatment and Control Rates of Hypertensive Patients in Ankara. EURASIAN JOURNAL OF FAMILY MEDICINE 2019. [DOI: 10.33880/ejfm.2019080103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: It was aimed to evaluate the awareness levels of patients about hypertension, treatment and control rates.
Methods: The descriptive study included 203 patients between ages of 35–80 with a previous diagnosis of hypertension to the primary care outpatient clinic of Ankara Numune Training and Research Hospital in September 2011-January 2012. A 42-item questionnaire was used and 19 questions were used to determine the level of awareness among them. Nine measurements were in the office by the researcher and 12 measurements at home by the patient.
Results: 25.6% of the patients were males and 74.4% were females. The median age was 59 years (IQR=13). The section for scoring the awareness levels revealed following: 27.1% of patients were non-aware, 58.6% had a low level of awareness and 14.3% had a high level of awareness. 72.9% of the patients were aware, 93.1% were taking antihypertensive treatment, while 42.4% measured blood pressures both at home and at office are under control. Awareness level is related to diet, exercise, education, salt usage, blood pressure measurement frequency, doctor referral frequency, education and knowledge level about hypertension, blood pressure monitoring branch, antihypertensive treatment status, hypertension duration, number of antihypertensive drugs and regular usage rates; but hypertension control was only associated with salt use, antihypertensive treatment and number of antihypertensive drugs.
Conclusion: Hypertension is a common problem in our country and as we have seen in our studies, awareness rates are insufficient. Although the treatment rates are high, the control rates are not sufficient. This suggests that patients' compliance with treatment is not at the desired level. The most important thing to do in this regard is to raise awareness by increasing public awareness about hypertension. In this respect, primary care physicians have a great responsibility.
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Affiliation(s)
| | - Adem Ozkara
- Department of Family Medicine, Ankara Numune Training and Research Hospital
| | - Rabia Kahveci
- Department of Family Medicine, Ankara Numune Training and Research Hospital
| | | | - Duygu Ayhan Başer
- Department of Family Medicine, Hacettepe University School of Medicine
| | - Fatih Dede
- Department of Internal Medicine, Ankara Numune Training and Research Hospital
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25
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Mendy VL, Vargas R, Payton M, Sims JN, Zhang L. Trends in the Stroke Death Rate Among Mississippi Adults, 2000-2016. Prev Chronic Dis 2019; 16:E21. [PMID: 30767859 PMCID: PMC6395077 DOI: 10.5888/pcd16.180425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION On average, more than 1,700 people in Mississippi die from stroke annually, but data on trends by age, sex, and race in Mississippi are limited. We examined trends in the stroke death rate among adults in Mississippi aged 35 or older by age, sex, and race. METHODS We used Mississippi Vital Statistics data to calculate age-specific death rates for stroke among people in Mississippi aged 35 or older from 2000 to 2016. We identified cases according to underlying cause-of-death codes from the International Classification of Diseases, Tenth Revision (ICD-10). We used Joinpoint software to calculate annual percentage change (APC) and the average annual percentage change (AAPC) in death rates for stroke by age, sex, and race (non-Hispanic black and non-Hispanic white). RESULTS Among adults aged 35 or older, the age-adjusted stroke death rate declined 30.7% from 141.3 per 100,000 population in 2000 to 97.9 per 100,000 population in 2016, with an AAPC of -2.4% (95% confidence interval, -3.1% to -1.6%). Stroke death rates declined significantly among both men and women in the first trend segment (2000-2009 for men and 2000-2007 for women) but did not decline in the second trend segment (2009-2016 for men and 2007-2016 for women). Non-Hispanic black men had the smallest decline in stroke death rates during the full study period. Among people aged 55 to 64 and non-Hispanic white men, rates shifted from a significant annual decline during the first segment to a significant annual increase during the second segment. CONCLUSION Age-adjusted stroke death rates among adults in Mississippi aged 35 or older declined significantly between 2000 and 2016, but trends differed by age, race, and sex. Clinical and community interventions aimed at reducing stroke risk factors, particularly for adults aged 55 to 64, are needed in Mississippi.
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Affiliation(s)
- Vincent L Mendy
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, Mississippi.,Department of Epidemiology and Biostatistics, School of Public Health, 350 W Woodrow Wilson Dr, Jackson, MS 39213.
| | - Rodolfo Vargas
- Office of Health Data and Research, Mississippi State Department of Health, Jackson, Mississippi
| | - Marinelle Payton
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, Mississippi.,Center of Excellence in Minority Health and Health Disparities, Institute of Epidemiology and Health Services Research, School of Public Health, Jackson State University, Jackson, Mississippi
| | - Jennifer N Sims
- Department of Behavioral and Environmental Health, School of Public Health, Jackson State University, Jackson, Mississippi
| | - Lei Zhang
- Office of Health Data and Research, Mississippi State Department of Health, Jackson, Mississippi
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Jansen van Vuren E, Malan L, von Känel R, Lammertyn L, Cockeran M, Malan NT. Longitudinal changes of cardiac troponin and inflammation reflect progressive myocyte stretch and likelihood for hypertension in a Black male cohort: The SABPA study. Hypertens Res 2019; 42:708-716. [PMID: 30626934 DOI: 10.1038/s41440-018-0183-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/09/2022]
Abstract
Inflammation was cross-sectionally associated with subclinical wall remodeling and hypertension. Whether longitudinal changes (∆) in inflammation, myocyte injury (troponin T), and stretch (N-terminal-pro-B-type natriuretic peptide) are associated with hypertension and ECG left ventricular hypertrophy (ECG-LVH) is unclear. The first prospective analysis in Africa assessing these associations included a cohort of Black and White teachers (N = 338; aged 20-63 years). Fasting blood samples were obtained to measure tumor necrosis factor-alpha (TNF-α), cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Ambulatory blood pressure, 2-lead ECG and resting 10-lead ECG values were obtained. A higher mean hypertensive status (62%) was evident in Blacks compared to Whites (44%, p < 0.001). Over 3-years, NT-proBNP increased in both ethnic groups. No associations were evident in women or in White men. In Black men, ECG-LVH at follow-up was positively associated with baseline cTnT (Adj R2 0.43; β = 0.48; 95% CI 0.28-0.68, p < 0.001) and baseline SBP (Adj R2 0.43; β = 0.29; 95% CI 0.09-0.49, p = 0.006). In Black men, baseline TNF-α (OR = 1.49, 95% CI 1.05-2.14, p = 0.03) and decreased ΔTNF-α (OR = 2.07, 95% CI 1.26-3.40, p = 0.004) increased the likelihood for cTnT levels ≥ 4.2 ng/L. Here, baseline NT-proBNP (OR = 1.12, 95% CI 1.01-1.23, p = 0.03) and ΔNT-proBNP progression (OR = 1.09, 95% CI 1.00-1.81, p = 0.04) increased the likelihood for 24-h hypertension. In conclusion, chronically increased levels of markers of myocyte injury accompanied by progressive myocardial stretch, reflective of cardiac metabolic overdemand, may ultimately increase hypertension and ischemic heart disease risk in a cohort of Black males.
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Affiliation(s)
- Esmé Jansen van Vuren
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa
| | - Leoné Malan
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.
| | - Roland von Känel
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.,University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland
| | - Leandi Lammertyn
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.,North-West University, MRC Research Unit for Hypertension and Cardiovascular Disease, Potchefstroom, South Africa
| | - Marike Cockeran
- North-West University, Medicine Usage in South Africa (MUSA), Potchefstroom, South Africa
| | - Nicolaas T Malan
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa
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27
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Mwasongwe S, Min YI, Booth JN, Katz R, Sims M, Correa A, Young B, Muntner P. Masked hypertension and kidney function decline: the Jackson Heart Study. J Hypertens 2018; 36:1524-1532. [PMID: 29601413 PMCID: PMC5990961 DOI: 10.1097/hjh.0000000000001727] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypertension diagnosed by blood pressure (BP) measured in the clinic is associated with rapid kidney function decline (RKFD) and incident chronic kidney disease (CKD). The extent to which hypertension defined using out-of-clinic BP measurements is associated with these outcomes is unclear. METHODS We evaluated the association of any masked hypertension (daytime SBP/DBP ≥ 135/85 mmHg, night-time SBP/DBP ≥ 120/70 mmHg or 24-h SBP/DBP ≥ 130/80 mmHg) with RKFD and incident CKD among 676 African-Americans in the Jackson Heart Study with clinic-measured SBP/DBP less than 140/90 mmHg who completed ambulatory BP monitoring in 2000-2004. RKFD was defined as a decline in estimated glomerular filtration rate (eGFR) at least 30% and incident CKD was defined as development of eGFR less than 60 ml/min per 1.73 m with an at least 25% decline in eGFR between 2000-2004 and 2009-2013. RESULTS The mean age of participants was 57.6 years, 28.8% were men and 52.7% had any masked hypertension. After a median follow-up of 8 years, 13.8 and 8.6% of participants had RKFD and incident CKD, respectively. In unadjusted analyses, masked hypertension was associated with an increased odds for incident CKD [odds ratio (OR) 2.20, 95% confidence interval (CI) 1.22, 3.97]. This association remained statistically significant after adjustment for demographic characteristics, baseline eGFR and albumin-to-creatinine ratio (OR 1.95, 95% CI 1.04, 3.67) but was eliminated after propensity score adjustment (OR 1.62, 95% CI 0.87, 3.00). There was no association between masked hypertension and RKFD. CONCLUSION Masked hypertension may be associated with the development of CKD in African-Americans.
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Affiliation(s)
| | - Yuan-I Min
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi
| | - John N. Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ronit Katz
- Division of Nephrology, Kidney Research Institute, University of Washington
| | - Mario Sims
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi
| | - Adolfo Correa
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi
| | - Bessie Young
- Division of Nephrology, Kidney Research Institute, University of Washington
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
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28
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Mentz RJ, Greiner MA, Muntner P, Shimbo D, Sims M, Spruill TM, Banahan BF, Wang W, Mwasongwe S, Winters K, Correa A, Curtis LH, O'Brien EC. Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study. Am Heart J 2018; 200:51-59. [PMID: 29898849 PMCID: PMC6005189 DOI: 10.1016/j.ahj.2018.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 03/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Non-adherence to medications is common and leads to suboptimal outcomes. Non-adherence can be intentional (e.g., deciding to skip dosages) or unintentional (e.g., forgetting), yet few studies have distinguished these reasons. An improved understanding of the reasons for non-adherence could inform the development of effective interventions. METHODS AND RESULTS We analyzed data from African Americans in the Jackson Heart Study who were prescribed medications for one or more chronic conditions. Participants were grouped by patient-reported adherence with non-adherence categorized as being intentional, unintentional or both. We used modified Poisson regression models to examine the factors associated with types of non-adherence. Of 2933 participants taking medication, 2138 (72.9%) reported non-adherence with 754 (35.3%) reporting only unintentional non-adherence, 263 (12.3%) only intentional non-adherence, and 1121 (52.4%) both. Factors independently associated with intentional non-adherence included female sex and depressive symptoms while factors associated with unintentional non-adherence included younger age and separated relationship status. Unintentional and intentional non-adherence was more common among participants taking anti-arrhythmic and anti-asthmatic medications, respectively. Higher levels of global perceived stress was associated with both types of non-adherence. The adjusted models for intentional and unintentional non-adherence had c-statistics of 0.65 and 0.66, respectively, indicating modest discrimination. CONCLUSION Specific patient factors and individual medication classes were associated with distinct patterns of intentional and unintentional non-adherence, yet the overall modest discrimination of the models suggests contributions from other unmeasured factors. These findings provide a construct for understanding reasons for non-adherence and provide rationale to assess whether personalized interventions can improve adherence.
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Affiliation(s)
- Robert J Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Melissa A Greiner
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, NY, New York
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Tanya M Spruill
- Department of Population Health, NYU School of Medicine, New York, NY
| | - Benjamin F Banahan
- Center for Pharmaceutical Marketing and Management, University of Mississippi, Jackson, MS
| | - Wei Wang
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Stanford Mwasongwe
- Field Center, Jackson Heart Study, Jackson State University, Jackson, MS
| | - Karen Winters
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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29
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Nayor M, Stevenson MD, Musani SK, Xanthakis V, LaValley MP, Larson MG, Fox ER, Vasan RS. Incidence of cardiovascular disease in individuals affected by recent changes to US blood pressure treatment guidelines. J Hypertens 2018; 36:436-443. [PMID: 29084083 PMCID: PMC6062206 DOI: 10.1097/hjh.0000000000001570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We evaluated the incidence of cardiovascular disease (CVD) in individuals whose blood pressure (BP) management strategy would change with adoption of recent US hypertension guidelines in two large, community-based cohorts with different racial and geographic compositions: the Framingham and Jackson Heart Studies (FHS and JHS). METHODS We assigned 11 237 FHS (mean age 46, 53% women) and 2948 JHS (mean age 55, 69% women) participants free of CVD and chronic kidney disease to one of five categories representing different treatment recommendations between 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee and The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines. Absolute incidence rates (incidence rate; per 1000 person-years) and multivariable-adjusted hazard ratios were calculated for each group; cohort-specific results were combined using fixed effect meta-analysis. RESULTS CVD events occurred in 1047 FHS and 230 JHS participants during mean follow-up times of 11 and 8.9 years, respectively. Compared with individuals without hypertension, those with BP 140-149/<90 mmHg had increased risk for CVD regardless of treatment status [hazard ratio for untreated BP 140-149/<90 mmHg 1.96, 95% confidence interval (CI) 1.40-2.75; hazard ratio for treated BP 140-149/<90 mmHg 3.37, 95% CI 2.37-4.78]. The risk for those with treated BP 140-149/<90 mmHg was consistent in those aged at least 60 years (hazard ratio: 2.61, 95% CI 1.75-3.90). Statistical power was limited to evaluate the effect of diabetes. CONCLUSION Individuals with treated BP 140-149/<90 mmHg have increased risk of CVD compared with those without hypertension including in participants at least 60 years. The 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee recommendations to treat BP levels less aggressively may be associated with substantial residual CVD risk.
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Affiliation(s)
- Matthew Nayor
- Framingham Heart Study, Framingham, MA
- Brigham and Women’s Hospital, Division of Cardiovascular Medicine, Boston, MA
| | - Meredith D. Stevenson
- Framingham Heart Study, Framingham, MA
- Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Solomon K. Musani
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Vanessa Xanthakis
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Sections of Preventive Medicine & Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Michael P. LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Martin G. Larson
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Department of Mathematics and Statistics, Boston University, Boston, MA
| | - Ervin R. Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Ramachandran S. Vasan
- Framingham Heart Study, Framingham, MA
- Sections of Preventive Medicine & Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
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30
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Tanner RM, Shimbo D, Irvin MR, Spruill TM, Bromfield SG, Seals SR, Young BA, Muntner P. Chronic kidney disease and incident apparent treatment-resistant hypertension among blacks: Data from the Jackson Heart Study. J Clin Hypertens (Greenwich) 2017; 19:1117-1124. [PMID: 28921875 DOI: 10.1111/jch.13065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/31/2017] [Accepted: 06/04/2017] [Indexed: 01/13/2023]
Abstract
It is unclear whether black patients with chronic kidney disease (CKD) vs those without CKD who take antihypertensive medication have an increased risk for apparent treatment-resistant hypertension (aTRH). The authors analyzed 1741 Jackson Heart Study participants without aTRH taking antihypertensive medication at baseline. aTRH was defined as uncontrolled blood pressure while taking three antihypertensive medication classes or taking four or more antihypertensive medication classes, regardless of blood pressure level. CKD was defined as an albumin to creatinine ratio ≥30 mg/g or estimated glomerular filtration rate <60 mL/min/1.73 m2 . Over 8 years, 20.1% of participants without CKD and 30.5% with CKD developed aTRH. The multivariable-adjusted hazard ratio for aTRH comparing participants with CKD vs those without CKD was 1.45 (95% CI, 1.12-1.86). Participants with an albumin to creatinine ratio ≥30 vs <30 mg/g (hazard ratio, 1.44; 95% CI, 1.04-2.00) and estimated glomerular filtration rate of 45 to 59 mL/min/1.73 m2 and <45 vs ≥60mL/min/1.73 m2 (hazard ratio, 1.60 [95% CI, 1.16-2.20] and 2.05 [95% CI, 1.28-3.26], respectively) were more likely to develop aTRH.
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Affiliation(s)
- Rikki M Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanya M Spruill
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Samantha G Bromfield
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samantha R Seals
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bessie A Young
- Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Hypertension prevalence, awareness, treatment, control, and associated factors in Southwest China: an update. J Hypertens 2017; 35:637-644. [PMID: 27984338 DOI: 10.1097/hjh.0000000000001203] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The study was conducted to investigate the prevalence, awareness, treatment, control, and risk factors of hypertension in Chongqing Province in Southwest China. METHODS Multistage, stratified, random cluster sampling scheme was adopted to recruit representative samples. All of the selected study participants completed a questionnaire and physical examinations. Multivariable logistic regression models were used to identify the associated factors. RESULTS Overall, 14 420 study participants (men = 7186) above 18 years were enrolled. The overall hypertension prevalence was 23.9%, with rural residents having a higher prevalence than urban residents (26.0 vs. 21.6%, P < 0.001). The awareness, treatment, control, and control among treated patients were 44.1, 36.6, 8.5, and 23.3%, respectively. Elderly women inhabiting urban areas had better awareness and treatment. The urban and rural areas differed in control (12.9 vs. 5.1%, P < 0.001). Age, sex, alcohol consumption, family history of hypertension, overweight/obesity, visceral adipose index, and body fat percentage were identified as risk factors for hypertension in both areas. Education levels, smoking, and daily salt intake were correlated with hypertension only among rural residents, and central obesity was correlated with hypertension only among urban residents. Sex, rurality, age, education level, alcohol consumption, overweight/obesity, central obesity, visceral adipose index, and body fat percentage were identified as associated factors of awareness, treatment, and control. CONCLUSION During the past decade, there is an increasing prevalence of hypertension in the general population in Chongqing Province. The levels of awareness, treatment, and control have improved, but remain extremely low. More aggressive strategies should thus be adopted.
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Shamsi A, Nayeri ND, Esmaili M. Life experiences of patients before having hypertension: a qualitative study. Electron Physician 2017; 9:3925-3933. [PMID: 28461866 PMCID: PMC5407224 DOI: 10.19082/3925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/15/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Identification of causes of hypertension on the basis of the perspectives and experiences of patients is the key to success in health plans of these patients. The aim of this study was to describe the experiences of life before becoming hypertensive patients. Methods This qualitative study was conducted during August 2015 to April 2016. Twenty-seven hypertensive patients referred to hospitals affiliated to Tehran University of Medical Sciences were selected based on purposive sampling, and semi-structured in-depth interviews were conducted with them. The data were analyzed by the content analysis method and using qualitative data analysis software MAXqda 2011. Results Three main categories were extracted from data analysis. Patients experienced factors such as negligence and neglect, life stress, lack of healthy lifestyles and abuse awareness, spirituality abandonee in the main category of “personal experience,” factors such as family conflicts, heredity, inappropriate nutritional and life style in the main category of “family life,” and also factors such as job stress, economic problems, urbanization, chemical agents during the war in the main category of “social life.” Conclusions Based on the findings, patients before becoming hypertensive under the influence of their culture and beliefs had experienced many risk factors associated with hypertension. Comprehensive planning and appropriate to the cultural, social, and beliefs context about the prevention and correction of these factors is necessary.
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Affiliation(s)
- Afzal Shamsi
- M.SC. of Nursing Education, Ph.D. Student, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Ph.D. of Nursing Education, Professor, Nursing and Midwifery care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaili
- Ph.D. of Nursing Education, Assistant Professor, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Ma C. The evaluation of physical activity for community-dwelling patients with hypertension. J Clin Nurs 2017; 26:2712-2720. [PMID: 28231629 DOI: 10.1111/jocn.13781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES The study aimed to evaluate the proportion of Chinese patients with hypertension who meet the Chinese Hypertension Management Guideline recommendations for weekly physical activity and to determine possible associated factors that impact meeting the weekly physical activity recommendation. BACKGROUND Accurate evaluation of physical activity levels for hypertensive patients is important to determine patients' health outcomes and intervention measures. However, most of the evidence on the prevalence of physical activity comes from developed countries; therefore, studies from developing countries are needed. DESIGN Across-sectional design was adopted for the study. METHODS The participants were recruited using a convenience sampling method from three healthcare community centres in Guangzhou, southern China. The data were collected using self-report questionnaires. Ordinal logistic regression was used to test factors associated with meeting the weekly physical activity recommendation. RESULTS Two hundred and seventy-six (58.6%) hypertensive patients in our study did insufficient physical activity (<150 min/week). One hundred thirty-four (31.3%) patients achieved the weekly physical activity recommendation (≥150 min/week), and 52 (10.1%) met the recommendation for physical activity for additional health benefits (≥300 min/week). In the adjusted ordinal logistic regression analyses, patients over 60 years of age (OR = 1.35, p < .001), who were unemployed (OR = 1.24, p = .036), had lower blood pressure levels (OR = 0.88, p = .019) and no hypertension-related complications (OR = 1.18, p = .021), and regarded self-rated health as good or excellent (OR = 2.37, p = .018), had a higher likelihood of meeting the weekly physical activity recommendation. CONCLUSIONS Our results showed that the number of Chinese hypertensive patients meeting the weekly physical activity recommendation is suboptimal. Age, employment status, blood pressure, self-rated health and complications related to hypertension were associated with meeting the weekly physical activity recommendation. RELEVANCE TO CLINICAL PRACTICE The findings implied that hypertensive patients who did insufficient physical activity were subgroups that needed specific instructions in physical activity and motivation to take part in physical activity. Nurses should consider providing counselling and supervision to these patients.
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Affiliation(s)
- Chunhua Ma
- School of Nursing, Guangzhou Medical University, Guangzhou City, Guangdong Province, China
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Duboz P, Boëtsch G, Gueye L, Macia E. Hypertension in the Ferlo (Northern Senegal): prevalence, awareness, treatment and control. Pan Afr Med J 2017; 25:177. [PMID: 28292139 PMCID: PMC5326029 DOI: 10.11604/pamj.2016.25.177.10105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/25/2016] [Indexed: 11/27/2022] Open
Abstract
Introduction The aim of this article is to assess prevalence, awareness, treatment and control of hypertension in rural Senegal (Sahelian Ferlo region). Methods This study was carried out in 2015 on a population sample of 500 individuals living in the municipality of Tessekere, constructed using the quota method. Sociodemographic characteristics, hypertension, hypertension awareness, treatment and control, and body mass index of individuals were collected during face-to-face interviews. Statistical analyses used were Chi-square tests and binary logistic regressions. Results Prevalence of hypertension was 31.40%. Prevalence of awareness, treatment and control among hypertensives, were 43.31%, 24.84% and 11.46% respectively. Logistic regression showed that the prevalence and awareness of hypertension increased with age. Overweight and obese subjects were more often hypertensive, but did not differ from others in awareness and treatment. Conclusion Given the very high prevalence of hypertension in the region, a strategic approach to prevent and control hypertension is critically needed.
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Affiliation(s)
- Priscilla Duboz
- UMR 7268 ADèS, Téssékéré international Human-Environment Observatory, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine Secteur Nord Boulevard Pierre Dramard, 13955 Marseille cedex 15, France
| | - Gilles Boëtsch
- UMI 3189 Environnement, Santé, Sociétés CNRS/Université Cheikh Anta Diop/Université de Bamako/CNRST, Laboratoire de Physiologie Exploratoire et Fonctionnelle, Faculté de Médecine de Dakar, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Lamine Gueye
- UMI 3189 Environnement, Santé, Sociétés CNRS/Université Cheikh Anta Diop/Université de Bamako/CNRST, Laboratoire de Physiologie Exploratoire et Fonctionnelle, Faculté de Médecine de Dakar, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Enguerran Macia
- UMI 3189 Environnement, Santé, Sociétés CNRS/Université Cheikh Anta Diop/Université de Bamako/CNRST, Laboratoire de Physiologie Exploratoire et Fonctionnelle, Faculté de Médecine de Dakar, Université Cheikh Anta Diop, Dakar, Sénégal
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Weaver AM, Wellenius GA, Wu WC, Hickson DA, Kamalesh M, Wang Y. Residential distance to major roadways and cardiac structure in African Americans: cross-sectional results from the Jackson Heart Study. Environ Health 2017; 16:21. [PMID: 28270143 PMCID: PMC5341411 DOI: 10.1186/s12940-017-0226-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/28/2017] [Indexed: 05/03/2023]
Abstract
BACKGROUND Heart failure (HF) is a significant source of morbidity and mortality among African Americans. Ambient air pollution, including from traffic, is associated with HF, but the mechanisms remain unknown. The objectives of this study were to estimate the cross-sectional associations between residential distance to major roadways with markers of cardiac structure: left ventricular (LV) mass index, LV end-diastolic diameter, LV end-systolic diameter, and LV hypertrophy among African Americans. METHODS We studied baseline participants of the Jackson Heart Study (recruited 2000-2004), a prospective cohort of cardiovascular disease (CVD) among African Americans living in Jackson, Mississippi, USA. All cardiac measures were assessed from echocardiograms. We assessed the associations between residential distance to roads and cardiac structure indicators using multivariable linear regression or multivariable logistic regression, adjusting for potential confounders. RESULTS Among 4826 participants, residential distance to road was <150 m for 103 participants, 150-299 m for 158, 300-999 for 1156, and ≥1000 m for 3409. Those who lived <150 m from a major road had mean 1.2 mm (95% CI 0.2, 2.1) greater LV diameter at end-systole compared to those who lived ≥1000 m. We did not observe statistically significant associations between distance to roads and LV mass index, LV end-diastolic diameter, or LV hypertrophy. Results did not materially change after additional adjustment for hypertension and diabetes or exclusion of those with CVD at baseline; results strengthened when modeling distance to A1 roads (such as interstate highways) as the exposure of interest. CONCLUSIONS We found that residential distance to roads may be associated with LV end-systolic diameter, a marker of systolic dysfunction, in this cohort of African Americans, suggesting a potential mechanism by which exposure to traffic pollution increases the risk of HF.
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Grants
- HHSN268201300049C National Heart, Lung, and Blood Institute
- HHSN268201300047C National Heart, Lung, and Blood Institute
- R01 ES020871 NIEHS NIH HHS
- HHSN268201300050C National Heart, Lung, and Blood Institute
- HHSN268201300048C National Heart, Lung, and Blood Institute
- R21 NR013231 National Institute of Nursing Research
- HHSN268201300046C National Heart, Lung, and Blood Institute
- National Heart, Lung, and Blood Institute (US); National Institute on Minority Health and Health Disparities (US)
- National Institute of Nursing Research (US); National Institute on Minority Health and Health Disparities (US)
- National Institute of Environmental Health Sciences
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Affiliation(s)
- Anne M. Weaver
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., RG 6082, Indianapolis, IN 46202 USA
| | - Gregory A. Wellenius
- The School of Public Health at Brown University, 121 South Main Street, Providence, RI 02903 USA
| | - Wen-Chih Wu
- The School of Public Health at Brown University, 121 South Main Street, Providence, RI 02903 USA
| | - DeMarc A. Hickson
- Jackson State University School of Public Health Initiative, 350 West Woodrow Wilson Drive, Jackson Medical Mall, Suite 320, Jackson, MS 39213 USA
| | - Masoor Kamalesh
- Department of Cardiology, Richard L. Roudebush VA Medical Center, 1481 W 10th St., Indianapolis, IN 46202 USA
| | - Yi Wang
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., RG 6082, Indianapolis, IN 46202 USA
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Bidulescu A, Ferguson TS, Hambleton I, Younger-Coleman N, Francis D, Bennett N, Griswold M, Fox E, MacLeish M, Wilks R, Harris EN, Sullivan LW. Educational health disparities in hypertension and diabetes mellitus among African descent populations in the Caribbean and the USA: a comparative analysis from the Spanish town cohort (Jamaica) and the Jackson heart study (USA). Int J Equity Health 2017; 16:33. [PMID: 28222733 PMCID: PMC5320798 DOI: 10.1186/s12939-017-0527-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/01/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Studies have suggested that social inequalities in chronic disease outcomes differ between industrialized and developing countries, but few have directly compared these effects. We explored inequalities in hypertension and diabetes prevalence between African-descent populations with different levels of educational attainment in Jamaica and in the United States of America (USA), comparing disparities within each location, and between countries. METHODS We analyzed baseline data from the Jackson Heart Study (JHS) in the USA and Spanish Town Cohort (STC) in Jamaica. Participants reported their highest level of educational attainment, which was categorized as 'less than high school' (HS). Educational disparities in the prevalence of hypertension and diabetes were examined using prevalence ratios (PR), controlling for age, sex and body mass index (BMI). RESULTS Analyses included 7248 participants, 2382 from STC and 4866 from JHS, with mean age of 47 and 54 years, respectively (p < 0.001). Prevalence for both hypertension and diabetes was significantly higher in the JHS compared to STC, 62% vs. 25% (p < 0.001) and 18% vs. 13% (p < 0.001), respectively. In bivariate analyses there were significant disparities by education level for both hypertension and diabetes in both studies; however, after accounting for confounding or interaction by age, sex and BMI these effects were attenuated. For hypertension, after adjusting for age and BMI, a significant education disparity was found only for women in JHS, with PR of 1.10 (95% CI 1.04-1.16) for < HS vs > HS and 1.07 (95% CI 1.01-1.13) for HS vs > HS. For diabetes; when considering age-group and sex specific estimates adjusted for BMI, among men: significant associations were seen only in the 45-59 years age-group in JHS with PR 1.84 (95% CI 1.16-2.91) for < HS vs > HS. Among women, significant PR comparing < HS to > HS was seen for all three age-groups for JHS, but not in STC; PR were 3.95 (95% CI 1.94-8.05), 1.53 (95% CI 1.10-2.11) and 1.32 (95% CI 1.06-1.64) for 25-44, 45-59 and 60-74 age-groups, respectively. CONCLUSION In Jamaica, educational disparities were largely explained by age, sex and BMI, while in the USA these disparities were larger and persisted after accounting these variables.
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Affiliation(s)
- Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health – Bloomington, Bloomington, IN USA
| | - Trevor S. Ferguson
- Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies Jamaica
| | - Ian Hambleton
- Chronic Disease Research Centre, Tropical Medicine Research Institute, The University of the West Indies, Bridgetown, West Indies Barbados
| | - Novie Younger-Coleman
- Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies Jamaica
| | - Damian Francis
- Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies Jamaica
| | - Nadia Bennett
- Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies Jamaica
| | - Michael Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS USA
| | - Ervin Fox
- University of Mississippi Medical Center, Jackson, MS USA
| | - Marlene MacLeish
- Department of Medical Education, Morehouse School of Medicine, Atlanta, Georgia
| | - Rainford Wilks
- Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies Jamaica
| | - E. Nigel Harris
- The University of the West Indies, Kingston, West Indies Jamaica
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Randolph TC, Greiner MA, Egwim C, Hernandez AF, Thomas KL, Curtis LH, Muntner P, Wang W, Mentz RJ, O'Brien EC. Associations Between Blood Pressure and Outcomes Among Blacks in the Jackson Heart Study. J Am Heart Assoc 2016; 5:e003928. [PMID: 27927632 PMCID: PMC5210402 DOI: 10.1161/jaha.116.003928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/14/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND In 2014, new hypertension guidelines liberalized blood pressure goals for persons 60 years and older. Little is known about the implications for blacks. METHODS AND RESULTS Using data from 2000 through 2011 for 5280 participants in the Jackson Heart Study, a community-based black cohort in Jackson, Mississippi, we examined whether higher blood pressure was associated with greater risk of mortality and heart failure hospitalization, and whether the risk was the same across age groups. We investigated associations between baseline blood pressure and both mortality and heart failure hospitalization. We also tested for interactions between age and blood pressure in the mortality model. Median systolic and diastolic blood pressures at baseline were 125 mm Hg (25th-75th percentile, 114-137 mm Hg) and 79 mm Hg (72-86 mm Hg), respectively. Median follow-up was 9 years for mortality and 7 years for heart failure hospitalization. After multivariable adjustment, every 10 mm Hg increase in systolic blood pressure was associated with greater risks of mortality (hazard ratio, 1.12; 95% CI, 1.06-1.17) and heart failure hospitalization (1.07; 95% CI, 1.00-1.14). The mortality risk per 10 mm Hg increase in systolic blood pressure was greater in participants younger than 60 years (1.26; 95% CI, 1.13-1.42) than among participants 60 years and older (1.09; 95% CI, 1.03-1.15). CONCLUSIONS Adults in all age groups were at greater risk of mortality as systolic blood pressure increased. In the context of the 2014 hypertension guidelines, these findings should be considered when determining treatment goals in black patients.
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Affiliation(s)
- Tiffany C Randolph
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Melissa A Greiner
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Chidiebube Egwim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Kevin L Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL
| | - Wei Wang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Robert J Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
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Wang Y, Wellenius GA, Hickson DA, Gjelsvik A, Eaton CB, Wyatt SB. Residential Proximity to Traffic-Related Pollution and Atherosclerosis in 4 Vascular Beds Among African-American Adults: Results From the Jackson Heart Study. Am J Epidemiol 2016; 184:732-743. [PMID: 27789446 DOI: 10.1093/aje/kww080] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 07/14/2016] [Indexed: 01/16/2023] Open
Abstract
To our knowledge, no study has investigated the association of long-term exposure to traffic pollution with markers of atherosclerosis in 4 vascular beds simultaneously in an all-African-American cohort. Among participants in the Jackson Heart Study (Jackson, Mississippi; baseline mean age = 55.5 (standard deviation, 12.7) years), we used linear regression to estimate percent differences in carotid intima-media thickness (CIMT) at baseline (2004) and used modified Poisson regression (robust error variance) to estimate prevalence ratios for peripheral artery disease (PAD), coronary artery calcification (CAC), and abdominal aortic calcification (AAC) at the first follow-up visit (2005-2008) for persons living less than 150 m (versus more than 300 m) from major roadways, adjusting for confounders. Living less than 150 m from such roadways was associated with a significant 6.67% (95% confidence interval: 1.28, 12.35) increase in CIMT (4,800 participants). PAD prevalence among persons living less than 150 m from a major roadway was 1.17 (95% confidence interval: 0.73, 1.86) times that of persons living more than 300 m away (4,443 participants), but this result was not statistically significant. There was no association for CAC or AAC. The association with CIMT was stronger in participants with a cardiovascular disease history than in those without one (P = 0.04). We observed an association in the carotid vascular beds but not the coronary, abdominal, or peripheral vascular beds. Our results highlight the need to consider residential proximity to roadways as a potential cardiovascular disease risk factor for blacks.
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Macia E, Gueye L, Duboz P. Hypertension and Obesity in Dakar, Senegal. PLoS One 2016; 11:e0161544. [PMID: 27622534 PMCID: PMC5021383 DOI: 10.1371/journal.pone.0161544] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/08/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cardiovascular disease is a major public health problem in many sub-Saharan African countries, but data on the main cardiovascular risk factors-hypertension and obesity-are almost nonexistent in Senegal. The aims of this study were therefore (i) to report the prevalence, awareness, treatment and control of hypertension among adults in Dakar, (ii) to assess the prevalence of general and central obesity, and (iii) to analyze the association between hypertension and general and central obesity. METHODS A cross-sectional survey was carried out in 2015 on a representative sample of 1000 dwellers of the Senegalese capital aged 20-90. RESULTS The overall prevalence of hypertension was 24.7%. Among hypertensive respondents, 28.4% were aware of their condition; 16.0% were on antihypertensive medication; 4.9% had controlled blood pressure. The frequency of doctor visits was a significant predictor of awareness (OR = 2.16; p<0.05) and treatment (OR = 2.57; p<0.05) of hypertension. The prevalence of underweight, overweight and general obesity were 12.6%, 19.2% and 9.7% respectively. The prevalence of central obesity was 26% by WC and 39.8% by WHtR. General obesity and central obesity by WHtR significantly predicted HTN among men and women, but not central obesity by WC. CONCLUSIONS This study has demonstrated a high prevalence of hypertension in Dakar and a high prevalence of obesity among women-particularly among older women. The awareness, treatment, and effective control of hypertension are unacceptably low. The blood pressure of women with general obesity, and men with central obesity, in the community should be monitored regularly to limit the burden of cardiovascular disease in Senegal.
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Affiliation(s)
- Enguerran Macia
- UMI 3189 Environnement, santé, sociétés (CNRS / Université Cheikh Anta Diop / Université de Bamako / CNRST Burkina-Faso), Faculté de Médecine, de Pharmacie et d’Odontostomatologie, Dakar, Senegal
| | - Lamine Gueye
- UMI 3189 Environnement, santé, sociétés (CNRS / Université Cheikh Anta Diop / Université de Bamako / CNRST Burkina-Faso), Faculté de Médecine, de Pharmacie et d’Odontostomatologie, Dakar, Senegal
| | - Priscilla Duboz
- UMR 7268 Anthropologie, Droit, Ethique et Santé (CNRS / Aix-Marseille Université / EFS), Faculté de Médecine, Secteur Nord, CS 80011, Marseille Cedex 15, France
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Ford CD, Sims M, Higginbotham JC, Crowther MR, Wyatt SB, Musani SK, Payne TJ, Fox ER, Parton JM. Psychosocial Factors Are Associated With Blood Pressure Progression Among African Americans in the Jackson Heart Study. Am J Hypertens 2016; 29:913-24. [PMID: 26964661 DOI: 10.1093/ajh/hpw013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/22/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Research that examines the associations of psychosocial factors with incident hypertension among African Americans (AA) is limited. Using Jackson Heart Study (JHS) data, we examined associations of negative affect and stress with incident hypertension and blood pressure (BP) progression among AA. METHODS Our sample consisted of 1,656 normotensive participants at baseline (2000-2004) (mean age 47±12; 61% women). We investigated associations of negative affect (cynical distrust, anger-in, anger-out, and depressive symptoms) and stress (perceived stress, weekly stress inventory (WSI)-event, WSI-impact, and major life events) with BP progression (an increase by one BP stage as defined by JNC VII) and incident hypertension by examination 2 (2005-2008). Poisson regression analysis was utilized to examine the prevalence ratios (PRs; 95% confidence interval (CI)) of BP tracking and incident hypertension with psychosocial factors, adjusting for baseline age, sex, socioeconomic status (SES), and hypertension risk factors. RESULTS Fifty-six percentage of the sample (922 cases) had BP progression from 2005 to 2008. After adjustment for age, sex, and SES, a high anger-out score was associated with a 20% increased risk of BP progression compared to a low anger-out score (PR 1.20; 95% CI 1.05-1.36). High depressive symptoms score was associated with BP progression in the age, sex, and SES-adjusted model (PR 1.14; 95% CI 1.00-1.30). High WSI-event scores were associated with BP progression in the fully adjusted model (PR 1.21; 95% CI 1.04-1.40). We did not observe significant associations with any of the psychosocial measures and incident hypertension. CONCLUSIONS Psychosocial factors were associated with BP progression, with the strongest evidence for number of stressful events that occurred.
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Affiliation(s)
- Cassandra D Ford
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA;
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - John C Higginbotham
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Martha R Crowther
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Sharon B Wyatt
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Thomas J Payne
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ervin R Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jason M Parton
- Culverhouse College of Commerce and Business Administration, The University of Alabama, Tuscaloosa, Alabama, USA
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Abdalla M, Booth JN, Diaz KM, Sims M, Muntner P, Shimbo D. Hypertension and alterations in left ventricular structure and geometry in African Americans: the Jackson Heart Study. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2016; 10:550-558.e10. [PMID: 27339075 PMCID: PMC4958512 DOI: 10.1016/j.jash.2016.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 01/13/2023]
Abstract
African Americans (AAs) have an increased risk for hypertension-related cardiovascular outcomes compared with whites, which may be related to abnormal left ventricular (LV) structure. We examined the association of prevalent hypertension with concentric remodeling (CR; normal LV mass index [LVMI] and increased relative wall thickness [RWT]), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (CH; increased LVMI and increased RWT) within the Jackson Heart Study. Among 4721 participants (mean ± SD, age 55.7 ± 12.7 years), 2841 (60.2%) had prevalent hypertension, defined as mean clinic blood pressure ≥140/90 mm Hg or antihypertensive medication use. Prevalent hypertension was associated with a statistically significantly increased odds for having CR (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 1.42-2.24), eccentric hypertrophy (OR = 1.68; 95% CI = 1.15-2.44), and CH (OR = 3.86, 95% CI = 2.28-6.54) after multivariable adjustment. In conclusion, in a population-based sample of AAs, hypertension was associated with increased odds for having abnormal LV structure, particularly CH.
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Affiliation(s)
- Marwah Abdalla
- Department of Medicine, Columbia University Medical Center, New York, NY, US
| | - John N. Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, US
| | - Keith M. Diaz
- Department of Medicine, Columbia University Medical Center, New York, NY, US
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, US
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, US
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY, US
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Residential Proximity to Major Roadways Is Not Associated with Cardiac Function in African Americans: Results from the Jackson Heart Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060581. [PMID: 27304962 PMCID: PMC4924038 DOI: 10.3390/ijerph13060581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/17/2016] [Accepted: 06/06/2016] [Indexed: 12/25/2022]
Abstract
Cardiovascular disease (CVD), including heart failure, is a major cause of morbidity and mortality, particularly among African Americans. Exposure to ambient air pollution, such as that produced by vehicular traffic, is believed to be associated with heart failure, possibly by impairing cardiac function. We evaluated the cross-sectional association between residential proximity to major roads, a marker of long-term exposure to traffic-related pollution, and echocardiographic indicators of left and pulmonary vascular function in African Americans enrolled in the Jackson Heart Study (JHS): left ventricular ejection fraction, E-wave velocity, isovolumic relaxation time, left atrial diameter index, and pulmonary artery systolic pressure. We examined these associations using multivariable linear or logistic regression, adjusting for potential confounders. Of 4866 participants at study enrollment, 106 lived <150 m, 159 lived 150–299 m, 1161 lived 300–999 m, and 3440 lived ≥1000 m from a major roadway. We did not observe any associations between residential distance to major roads and these markers of cardiac function. Results were similar with additional adjustment for diabetes and hypertension, when considering varying definitions of major roadways, or when limiting analyses to those free from cardiovascular disease at baseline. Overall, we observed little evidence that residential proximity to major roads was associated with cardiac function among African Americans.
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Cardiovascular Risk in Midlife African American Women Participating in a Lifestyle Physical Activity Program. J Cardiovasc Nurs 2016; 31:304-12. [PMID: 27074650 DOI: 10.1097/jcn.0000000000000266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the largest contributor to disparate morbidity and mortality in African American women. OBJECTIVE The aims of this article are to describe in a cohort of sedentary, urban community-based midlife African American women eligible for a physical activity program their (1) CVD risk factors and (2) awareness, treatment, and control of hypertension and hypercholesterolemia. METHODS Cross-sectional baseline findings on 297 women were examined at baseline of a controlled physical activity clinical trial. Cardiovascular disease risks included hypertension, hypercholesterolemia, smoking, diabetes, and obesity. Among women with hypertension and hypercholesterolemia, rates of awareness, treatment, and control were calculated. RESULTS Our sample had significantly more hypertension and obesity than reported in other national samples of African American women. The women mirrored national samples of African American women: fewer than 60% had adequate control of hypertension. Versus national samples of African Americans (men/women combined), our study groups both showed significantly lower low-density-lipoprotein cholesterol level: treatment, 33% versus 63.8%, and control, 24.8% versus 45.3%. CONCLUSIONS Because national samples are more heterogeneous, our sample provides important information about CVD risks in inactive, urban community-dwelling, midlife African American women. Given the opportunity, many such women at elevated risk for CVD are willing to participate in a physical activity intervention. They must be identified and offered pharmacological and lifestyle interventions.
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Redmond N, Booth JN, Tanner RM, Diaz KM, Abdalla M, Sims M, Muntner P, Shimbo D. Prevalence of Masked Hypertension and Its Association With Subclinical Cardiovascular Disease in African Americans: Results From the Jackson Heart Study. J Am Heart Assoc 2016; 5:e002284. [PMID: 27025968 PMCID: PMC4943234 DOI: 10.1161/jaha.115.002284] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Studies consisting mostly of whites have shown that the prevalence of masked hypertension differs by prehypertension status. Using data from the Jackson Heart Study, an exclusively African American population‐based cohort, we evaluated the association of masked hypertension and prehypertension with left ventricular mass index and common carotid intima media thickness. Methods and Results At the baseline visit, clinic blood pressure (CBP) measurement and 24‐hour ambulatory blood pressure monitoring were performed. Masked hypertension was defined as mean systolic/diastolic CBP <140/90 mm Hg and mean daytime systolic/diastolic ambulatory blood pressure ≥135/85 mm Hg. Clinic hypertension was defined as mean systolic/diastolic CBP ≥140/90 mm Hg. Normal CBP was defined as mean systolic/diastolic CBP <120/80 mm Hg and prehypertension as mean systolic/diastolic CBP 120 to 139/80 to 89 mm Hg. The analytic sample included 909 participants. Among participants with systolic/diastolic CBP <140/90 mm Hg, the prevalence of masked hypertension and prehypertension was 27.5% and 62.4%, respectively. The prevalence of masked hypertension among those with normal CBP and prehypertension was 12.9% and 36.3%, respectively. In a fully adjusted model, which included prehypertension status and antihypertensive medication use as covariates, left ventricular mass index was 7.94 g/m2 lower among those without masked hypertension compared to participants with masked hypertension (P<0.001). Left ventricular mass index was also 4.77 g/m2 lower among those with clinic hypertension, but this difference was not statistically significant (P=0.068). There were no significant differences in left ventricular mass index between participants with and without masked hypertension, or clinic hypertension. Conclusions Masked hypertension was common among African Americans with prehypertension and also normal CBP, and was associated with subclinical cardiovascular disease.
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Affiliation(s)
- Nicole Redmond
- Clinical Applications and Preventions Branch, National Heart Lung and Blood Institute (NHLBI), Bethesda, MD
| | - John N Booth
- Department of Epidemiology, University of Alabama at Birmingham, AL
| | - Rikki M Tanner
- Department of Epidemiology, University of Alabama at Birmingham, AL
| | - Keith M Diaz
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Marwah Abdalla
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, AL
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY
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Abstract
Abdominal obesity and elevated blood pressure commonly occur in the same patient and are key components of the metabolic syndrome. However, the association between obesity and increased blood pressure is variable. We review mechanisms linking cardiovascular and metabolic disease in such patients including altered systemic and regional hemodynamic control, neurohumoral activation, and relative natriuretic peptide deficiency. Moreover, we discuss recent results using omics techniques providing insight in molecular pathways linking adiposity, metabolic disease, and arterial hypertension. Recognition of the mechanisms orchestrating the crosstalk between cardiovascular and metabolic regulation in individual patients may lead to better and more precise treatments. It is reassuring that recently developed cardiovascular and metabolic medications may in fact ameliorate, both, cardiovascular and metabolic risks.
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Affiliation(s)
- Jens Jordan
- Institute for Clinical Pharmacology, Medical School Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Andreas L Birkenfeld
- Section of Metabolic Vascular Medicine, Medical Clinic III, Dresden University School of Medicine, Dresden, TU, Germany
- Center for Clinical Studies, GWT-TUD GmbH, Dresden, Germany
- Paul Langerhans Institute Dresden (PLID), A Member of the German Center for Diabetes Research (DZD e.V.), Dresden, Germany
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46
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Hypertension unawareness among Chinese patients with first-ever stroke. BMC Public Health 2016; 16:170. [PMID: 26893185 PMCID: PMC4759941 DOI: 10.1186/s12889-016-2835-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 02/04/2016] [Indexed: 01/19/2023] Open
Abstract
Background The low rates of hypertension treatment and control, partly due to its unawareness, are the main causes of the high stroke incidence in China. The purpose of this study was to evaluate hypertension unawareness amongst patients with first-ever stroke and to detect factors associated with its unawareness. Methods We selected those diagnosed with hypertension from patients with first-ever stroke registered in the Nanjing Stroke Registry Program between 2004 and 2014. These hypertensives were divided as being aware or unaware of their hypertension by using a brief questionnaire conducted shortly after the stroke. Multivariate logistic regression analysis was performed to identify potential factors associated with hypertension unawareness. Results Of the 5309 patients with first-ever stroke, 3732 (70.3 %) were diagnosed with hypertension. Among which, 593 (15.9 %) were unaware of their hypertension at the time of stroke onset. Lower-level of education (primary school or illiteracy) and smoking were associated positively with hypertension unawareness; while advanced age, overweight, diabetes mellitus, heart diseases and family history of stroke were associated negatively with hypertension unawareness. Annual data analyzed indicated that the rate of hypertension awareness increased during the past 11 years (r = 0.613, P = 0.045 for trends). Conclusions A substantial proportion (15.9 %) of Chinese patients with hypertension had not been aware of this covert risk until an overt stroke occurred. Hypertension unawareness was associated with lower educational levels and smoking, which address the importance of health education especially in these individuals.
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47
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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) 2016; 18:139-45. [PMID: 26279070 PMCID: PMC4742426 DOI: 10.1111/jch.12644] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [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 EpidemiologyUniversity of Alabama at BirminghamBirminghamAL
| | - Daichi Shimbo
- Department of MedicineColumbia University Medical CenterNew YorkNY
| | - Samantha R. Seals
- Center of Biostatistics and BioinformaticsUniversity of Mississippi Medical CenterJacksonMS
| | - Kristi Reynolds
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - C. Barrett Bowling
- Department of Veterans Affairs Medical CenterAtlantaGA
- Department of MedicineEmory UniversityAtlantaGA
| | - Gbenga Ogedegbe
- Department of Population HealthNew York University School of MedicineNew YorkNY
| | - Paul Muntner
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAL
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Prevalence, Awareness, Treatment, Control and Risk Factors Associated with Hypertension among Adults in Southern China, 2013. PLoS One 2016; 11:e0146181. [PMID: 26784948 PMCID: PMC4718602 DOI: 10.1371/journal.pone.0146181] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/13/2015] [Indexed: 12/05/2022] Open
Abstract
To investigate the prevalence, awareness, treatment, control of hypertension and their associated factors in southern China. A cross-sectional survey was conducted in 5 cities of urban areas and 5 counties of rural areas in Southern China in 2013, a stratified multistage random sampling method was used to select a representative sample. Recruitment included a total of 19254 participants aged 15 or older. Socio-demographic profiles, examinations were administrated on each subject. Multilevel logistic regression models were used to identify the risk factors of hypertension, awareness, treatment, and control. Overall, the prevalence of hypertension and pre-hypertension are 24.59% and 32.11%, respectively in southern China. Among all the hypertensive patients, 67.43% were aware of their condition, 55.76% took anti-hypertension medication recent two weeks, and 30.79% had their blood pressure controlled. Compared with male, female hypertensive patients had higher rates of hypertension awareness, treatment and control. Age, gender, marital status, living areas, education, BMI, waist circumference, visceral adipose index (VAI), high body fat percentage (BFP) and family hypertension history correlated with the prevalence of hypertension. SBP/DBP increased with VAI and BFP increasing. There is an increasing prevalence of hypertension and high pre-hypertension in the general population in southern China, but levels of awareness, treatment, and control remain relatively low, especially for young and middle-aged population. Innovative strategies including of adopting appropriate anti-hypertensive medication therapy and healthy lifestyles should be taken.
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Newman AB, Avilés-Santa ML, Anderson G, Heiss G, Howard WJ, Krucoff M, Kuller LH, Lewis CE, Robinson JG, Taylor H, Treviño RP, Weintraub W. Embedding clinical interventions into observational studies. Contemp Clin Trials 2015; 46:100-105. [PMID: 26611435 DOI: 10.1016/j.cct.2015.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
Abstract
Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed.
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Affiliation(s)
- Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, A527 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - M Larissa Avilés-Santa
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, 6701 Rockledge Drive, Suite 10018, Bethesda, MD 20892-7936, USA.
| | - Garnet Anderson
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division, 1100 Fairview Ave N, M3-A410, PO Box 19024, Seattle, WA 98109, USA.
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 137 E Franklin St, Ste 306, Chapel Hill, NC 27514-3628, USA.
| | - Wm James Howard
- Medstar Health Research Institute, Medstar Washington Hospital Center, Department of Internal Medicine, Rm. 6A 126, 110 Irving St. NW, Washington, DC 20010, USA.
| | - Mitchell Krucoff
- Departments of Medicine and Cardiology, Duke University Medical Center, 508 Fulton Street, Room A3006, Durham, NC 27705, USA.
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Avenue, Room 550, Pittsburgh, PA 15213, USA.
| | - Cora E Lewis
- University of Alabama School of Medicine, Division of Preventive Medicine, Medical Towers 614, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Jennifer G Robinson
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S455 CPBH, Iowa City, IA 52242, USA.
| | - Herman Taylor
- Jackson Heart Study, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
| | - Roberto P Treviño
- Social and Health Research Center, 1302 South Saint Mary's Street, San Antonio, TX 78210, USA.
| | - William Weintraub
- Center for Heart & Vascular Health, Christiana Care Health System, 4755 Ogletown-Stanton Road, Suite 1070, Newark, DE 19713, USA.
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Tompkins G, Forrest LF, Adams J. Socio-Economic Differences in the Association between Self-Reported and Clinically Present Diabetes and Hypertension: Secondary Analysis of a Population-Based Cross-Sectional Study. PLoS One 2015; 10:e0139928. [PMID: 26466384 PMCID: PMC4605711 DOI: 10.1371/journal.pone.0139928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/19/2015] [Indexed: 12/17/2022] Open
Abstract
Background Diabetes and hypertension are key risk factors for coronary heart disease. Prevalence of both conditions is socio-economically patterned. Awareness of presence of the conditions may influence risk behaviour and use of preventative services. Our aim was to examine whether there were socio-economic differences in awareness of hypertension and diabetes in a UK population. Method Data from the Scottish Health Survey was used to compare self-reported awareness of hypertension and diabetes amongst those found on examination to have these conditions, by socioeconomic position (SEP) (measured by occupation, education and income). Odds ratios of self-reported awareness against presence, and the sensitivity, specificity and predictive value of self-reporting as a measure of the presence of the condition, were calculated. Results Presence and self-reported awareness of both conditions increased as SEP decreased, on most measures. There was only one significant difference in awareness by SEP once other factors had been taken into account. Sensitivity showed that those in the most disadvantaged groups were most likely to self-report awareness of their hypertension, and specificity showed that those in the least disadvantaged groups were most likely to self-report awareness of its absence. There were few differences of note for diabetes. Conclusion We found no consistent pattern in the associations between SEP and the presence and self-reported awareness of hypertension and diabetes amongst those with these conditions. Without evidence of differences, it is important that universal approaches continue to be applied to the identification and management of those at risk of these and other conditions that underpin cardiovascular disease.
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Affiliation(s)
- Gerald Tompkins
- Health Education North East, Newcastle upon Tyne, United Kingdom
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lynne F. Forrest
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jean Adams
- Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
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