Heart Health News

Genetic Tests for a Heart Disorder Mistakenly Find Blacks at Risk

Genetic tests for an inherited heart disorder are more likely to have incorrect results in black Americans than in whites, according to a new study that is likely to have implications for other minorities and other diseases, including cancer.

Mistakes have been made because earlier research linking genetic traits to illness did not include enough members of minority groups to identify differences between them and the majority white population or to draw conclusions about their risks of disease.

The new study, published Wednesday in The New England Journal of Medicine, focused on hypertrophic cardiomyopathy — a thickening of the wall of the heart that can cause abnormal rhythms and sudden death. The condition often has no symptoms, but can cause young athletes to pass out or even die during the intense activity of their sport. It can be caused by inherited mutations in one of 10 to 20 genes, and affects one in 500 people in the United States. More than 1,000 mutations have been linked to the condition.

Genetic testing can identify people who have suspect mutations, and is frequently offered to family members of those who have the disease. But now researchers have found that after genetic testing, black people are more likely than whites to be told mistakenly that they are at risk.

The misdiagnosis can have big repercussions. Besides the emotional stress of being told one has a potentially fatal heart condition, there is the time and expense needed for medical follow-up. Active young people may be told to drop out of competitive sports, and in some cases even advised to have devices surgically implanted in their chests to prevent sudden death from abnormal heart rhythms.

Mistakes have been more common in blacks because they are more likely than whites to carry certain mutations that, in earlier studies, were thought to cause the disease, said Arjun K. Manrai, the first author of the study and a researcher in the department of biomedical informatics at Harvard Medical School. Later research has proved those mutations to be harmless.

The conclusions are based in part on analyzing large, relatively new databases that contain information about mutations and their occurrence in various racial and ethnic groups.

Some laboratories that perform the genetic tests have not kept up with the science, and are still mistakenly telling patients that their mutations are dangerous, according to Dr. Isaac S. Kohane, the senior investigator on the study. Even the labs that do keep up may not contact past patients to let them know that their test results are no longer valid, he said. Researchers do not know how common the problem is.

“The cost of gene sequencing is now tiny, so I think we have the luxury to be able to get good representative control samples of our population, to make sure our studies are diversely controlled,” Dr. Kohane said.

A researcher not involved in the study, Dr. Kenneth Offit, chief of the clinical genetics service at Memorial Sloan Kettering Cancer Center in New York, said the new report identified an important problem that applied to other diseases, such as cancer.

“From the vantage point of one who sits on several federal advisory bodies in the field of genetics, the importance of more extensive genomic sequencing in diverse populations cannot be over-emphasized,” he said.

Dr. Offit said in an email that his lab had recently observed that outside laboratories were reporting that a certain gene mutation was causing an increased risk of a cancer he declined to specify. But his team found that the mutation was relatively common in Ashkenazi Jews.


“We had to generate our own data using close to a thousand stored DNA samples to finally conclude that this variant was not associated with cancer risk in the population in which it was most prevalent,” Dr. Offit wrote. “But until these findings are published, some may continue to receive false alarms.”

Source: The New York Times

Study targets indigenous disease prevention

A multinational study, led by Dr Lee Stoner, has identified key priorities that could help prevent heart disease and obesity-related diabetes in indigenous populations. The study, Principles and Strategies for Improving the Prevention of Cardio-metabolic Diseases in Indigenous Populations: A Delphi Study, was recently completed using independent panels of experts in indigenous cardiovascular and metabolic health from New Zealand, Australia and the United States.

Dr Stoner, from Massey's College of Health in the School of Sport and Exercise, says the study aimed to establish local consensus opinion on appropriate strategies for improving the prevention and management of cardiovascular and metabolic diseases, such as obesity and type 2 diabetes.

Sixty experts (20 from each country) were interviewed using a process called Delphi, which includes three interview rounds. Participants were asked a series of questions relating to disease prevention, consultation with indigenous communities, use of educational resources, societal issues, workforce issues, and the importance of family and culture.
Dr Stoner says, "Some key differences emerged between the three countries, but all experts agreed certain areas need urgent addressing."

These areas were identified as:

  • Socio-economic and education inequalities. These should be addressed to minimise several social issues, such as poor education, poor income and poorer access to higher income jobs and drive effective prevention strategies.
  • Educational, behaviour change and prevention strategies. These should address environmental factors, such as poor access to space for physical access, and easy access to fast food. It also needs to be culturally appropriate, which can be achieved through consultation with indigenous communities, cultural competency training, use of indigenous health workers, and use of appropriate role models.

Dr Stoner says the findings also indicate there are complex interactions between factors contributing to the indigenous health gap. "It is unlikely a simple strategy focusing on an independent factor will close the gap. For example, primary prevention efforts could be married with policy reform targeting the environmental and social determinants which lead to poor health status in the first place."

Dr Stoner says while there is not yet a concrete example of how indigenous populations can be specifically aided, the study has brought about higher-level thinking. "Primary prevention has been highlighted as an area needing urgent attention. A prime example includes children being encouraged to exercise when they visit primary health care providers. In terms of environmental policy reform, we could ensure equal and equitable access to green space and recreational facilities to encourage exercise.

"While there are a number of big challenges in reducing the indigenous cardiovascular and metabolic health burden, many can be addressed with political will and well-designed policy approaches. Findings from this study indicate a number of key priorities, some of which can be implemented in the medium or short-term."


Dr Stoner led the research in collaboration with Curtin University in Perth, Australia, and Harvard and Western Carolina University in the United States. The project served as the thesis for Dr Stoner's Master of Public Health with Massey's Centre for Public Health Research.

Source: www.medicalxpress.com

Blood pressure drugs rethink urged

More lives could be saved if doctors considered giving blood pressure drugs to all patients at high risk of heart disease - even if their blood pressures are normal, a study suggests

The report calls for a move away from current guidelines which recommend pills only be prescribed if blood pressure is above a certain threshold. However, experts acknowledge lifestyle factors also have an important role to play in bringing blood pressures down. The study appears in the Lancet.
Current guidelines - issued by England's National Institute for Health and Care Excellence - suggest patients should only take medication when their blood pressure levels reach 140 mmHg. Until this point even those at highest risk, for example people who have had strokes, are offered monitoring but not pills. Now a global team of experts are calling for doctors to focus on an individual's risks rather than rigid and "arbitrary" blood pressure thresholds.
Experts analysed the results of more than 100 large-scale trials involving some 600,000 people between 1966 and 2015. They found those patients at highest risk - including smokers with high cholesterol levels and people over 65s with diabetes - would benefit most from treatment, lowering their chance of heart attacks and strokes.
In addition the report suggests once on treatment, blood pressure levels could be reduced even further than the targets currently used. The study also adds to growing evidence that patients may benefit from lowering their blood pressure whatever their baseline levels - either through lifestyle changes or drugs. But it shows the lower the person's blood pressure to start with, the lower the benefit they gain from reducing it.
The authors do not go as far as to suggest everyone should be given pills and caution side-effects of medication must be weighed up. Dr. Liam Smeeth, of the London School of Hygiene and Tropical Medicine, agreed the findings were important for those at highest risk.
But he warned: "One important caveat is that not everyone will be able to tolerate having their blood pressure reduced to low levels, and there is a need to balance possible drug side effects and likely benefits." 
Heart specialist Dr. Tim Chico, of the University of Sheffield, said medication need not be the only way to tackle the issue.  He added: "We can all reduce our blood pressure.
"We can do this safely, cheaply and as effectively as tablets by eating healthily, taking more physical activity, reducing alcohol intake, and maintaining a healthy weight."
Study shows housing insecurity plays role in health

According to a report from the Washington State Department of Health and the Centers for Disease Control and Prevention, Washington residents who were worried or stressed about paying their rent or mortgage were twice as likely to report poor or fair health status. 

The report, which provides a closer look at the prevalence of housing insecurity and its relationship to certain unhealthy behaviors and outcomes, showed that housing insecurity may play an important role in a person’s health, even after accounting for demographics and socioeconomic measures.

The report’s authors point to the need for broad-based strategies such as the one by the National Prevention Council Action Plan that connects access to affordable housing with healthy lifestyle choices as a way housing programs could have greater impact on public health.

An estimated 41 million U.S. households paid more than 30 percent of their pre-tax income from housing, making it difficult to afford other necessities, including food, transportation and medical care.

Other studies have reported associations between housing insecurity and mental health problems or avoiding medical care, but not the association with health risk behaviors and outcomes, such as smoking, binge drinking and delaying trips to the doctor.


The report’s authors believe this is the first study to show associations between housing insecurity and health even after controlling for various socioeconomic and demographic measures.

The study was based data reflecting a snapshot in time, and was not able to determine if housing insecurity and health outcomes were causally related. It also excluded participants who were homeless. Additionally, data was self-reported through a telephone survey and could be subject to a participant’s memory and willingness share certain details.

Blood Pressure Check At Barbershop Benefits African-American Males

In study published in Archives of Internal Medicine revealed that African-American males who can have their blood pressure gauged at their local barbershop have a significantly higher chance of better hypertension (high blood pressure) control.

Ronald G. Victor, M.D., who was at University of Texas Southwestern Medical Center, Dallas, and team carried out a randomized study in Dallas County, Texas involving 17 barbershops between March 2006 and December 2008; they were all owned by African-Americans.

Comparison Group - nine barbershops were randomized into the comparison group when the study began. An average of 77 patrons with hypertension per establishment (695) were given general pamphlets about hypertension.

Intervention Group - at the other eight barbershops 602 clients (75 per shop) with hypertension were given personalized, sex-specific health messaging. They could also see posters of male clients with hypertension seeking treatment. They were offered blood pressure checks when they came in for a haircut.

The researchers followed up on collected data ten months later.

The investigators report there was significantly more hypertension control in the intervention group.
In the intervention group - the control rate for clients with hypertension rose 19.9%, from 33.8% to 53.7% at follow-up
In the comparison group - the control rate for clients with hypertension rose 11.1%, from 40% to 51% at follow up
In other words, an 8.8% absolute difference between the two groups. The authors add that there was an 11.2% increase in hypertension treatment in the intervention group compared to 6.2% in the comparison group.

Black-owned barbershops hold special appeal for community-based intervention trials because they are a cultural institution that draws a large and loyal male clientele and provides an open forum for discussion of numerous topics, including health, with influential peers.

Data from this study add to an emerging literature on the effectiveness of community health workers in the care of people with hypertension: contemporary barbers constitute a unique workforce of community health workers whose historical predecessors were barber-surgeons.

Hypertension drug reduces inflammation from traumatic brain injury

A new study has found that inflammation after traumatic brain injury is caused by a protein produced by the liver. What is more, this protein can be blocked by a drug used to treat high blood pressure. Until now there has been no way to reduce the damage caused by this inflammation, but this latest study from Georgetown University Medical Center (GUMC) in Washington, DC,  is promising. The study found that TBI results in a response from the liver that increases the production of a protein that increases inflammation in the brain by up to 1,000-fold.


Is your heart older than you are?

There is a good chance that your actual heart is much “older” than you are, according to the first study to provide population-level estimates of heart age.

In a report published Tuesday, researchers from the Centers for Disease Control and Prevention said that three out of four U.S. adults’ heart age is older than their actual age, putting them at greater risk of heart attack and stroke.

This study is the first to provide population-level estimates of heart age and to highlight disparities in heart age nationwide. Using data collected from all 50 states and information from the large, ongoing Framingham Heart Study, the report showed that heart age varied by race/ethnicity, gender, region and other sociodemographic characteristics.

“Heart age” is the calculated age of a person’s cardiovascular system based on risk factor profile. Risks include high blood pressure, cigarette smoking, diabetes status and body mass index as an indicator for obesity. The researchers determined that nearly 69 million U.S. adults between the ages of 30 and 74 have a heart age older than their actual age,

The average adult man’s heart is eight years older than his chronological age. For women, it’s five years, according to the study.

Heart age is highest among African-American men and women, with an average age of 11 years older for both. Geographic differences showed that adults in the Southern U.S. typically have higher heart ages. Mississippi, West Virginia, Kentucky, Louisiana and Alabama have the highest percentage of adults with a heart age five years or more over their actual age. Meanwhile Utah, Colorado, California, Hawaii and Massachusetts have the lowest percentage.

“Too many U.S. adults have a heart age years older than their real age, increasing their risk of heart disease and stroke,” said CDC director Tom Frieden, M.D. “Everybody deserves to be young – or at least not old – at heart.”

By AMERICAN HEART ASSOCIATION NEWS http://blog.heart.org/is-your-heart-older-than-you-are-2/


Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Summary

Background

Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.

Methods

Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.

Findings

Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.

Interpretation


Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.

SOURCE: http://dx.doi.org/10.1016/S0140-6736(15)60692-4 The Lancet

Poverty-linked heart risks greatest for poor black women, younger adults


According to a large new study, among African American adults with low education and income levels, the increase in risk of heart disease or stroke associated with living in poverty is largest for women and people under age 50.

In the Mississippi African American population studied, women with the lowest “socioeconomic position“ were more than twice as likely to have heart disease or stroke as those with the highest socioeconomic position.

The effect was also greatest among younger adults, with low-income men and women under age 50 more than three times as likely to experience cardiovascular problems compared to peers with the highest socioeconomic status, according to lead author Samson Y. Gebreab of the National Human Genome Research Institute at the National Institutes of Health in Bethesda, Maryland.

“African Americans with low SES (socioeconomic status) are more likely to have higher rates of obesity, hypertension, type 2 diabetes and physical inactivity compared to their counterparts of higher SES,” Gebreab told Reuters Health by email.

These risk factors partly, but not entirely, explained the higher risk of heart disease in African American women of low socioeconomic status, he said.

“Another possible explanation is that African American women of low SES experience higher rates of psychosocial stressors such as chronic stress, depression, discrimination and are more likely to live and work in a worse physical and social environment,” he said.

Having far fewer resources at their disposal to cope with these stressors creates a recipe for a higher risk of heart attack and stroke in African American women of lower SES, Gebreab said.

The researchers used a previous long-term study of 5,301 African Americans ages 21 to 94, most of whom were women. Half were followed for more than seven years. Over that time, there were 362 cases of cardiovascular events like heart attack or stroke.

Using in-person and telephone interviews, researchers collected data on participants’ socioeconomic position in childhood, based on parental home ownership, mother’s education level and available amenities. Questions about current education, wealth, income and public assistance were used to estimate each person’s adult socioeconomic position.

Adult socioeconomic position was more strongly tied to heart disease and stroke risk than childhood position, as reported in a paper scheduled for publication in the Journal of the American Heart Association.

Wealth was a more important predictor of heart risk than education level or public assistance. And men showed a similar, but smaller increase in risk with lower socioeconomic position.

After age 50, the risk increase specifically linked to socioeconomic position was also smaller, which may be a result of more widespread heart disease in older groups – weakening the links to socioeconomic position alone.

The study team notes that participants with higher adult socioeconomic position were less likely to smoke or drink and tended to have better quality diets and higher levels of physical activity, with lower body mass index and blood pressure and fewer cases of high blood pressure or diabetes compared to the low-socioeconomic status group.

“Although we have not accounted for health care access in our study, these (low SES) groups of people often also have less access to health care and encounter barriers to CVD (cardiovascular disease) related diagnosis and treatment,” Gebreab said.

Other research suggests that African Americans of any socioeconomic status may be at higher risk for heart disease or stroke than others, according to Maria Glymour of the epidemiology and biostatistics department at the University of California, San Francisco.

“We all need resources and supports to help us stay healthy, like a safe place to exercise, an affordable grocery store, time to do whatever is needed to take care of our health, and attentive medical care for managing diseases such as hypertension,” she told Reuters Health by email. “Low SES people on average simply have fewer of these resources.”

Low SES is also tied to higher risk of cardiovascular disease among white people, noted Glymour, who was not involved in the new study.

“People with low SES, particularly African American women, should be considered as a high-risk group for developing CVD, as such they should be considered as priority in health care services,” Gebreab said. “They should be targeted for early detection and intervention for the prevention of CVD and related risk factors.”

But there is no “magic bullet” solution to reduce heart health disparities based on socioeconomic status, he said.


SOURCE: bit.ly/1f4U4k9 Journal of the American Heart Association, released May 27, 2015.


Heart Risk Factors May Affect Black Women More Than White Women

A study Published in the Journal of the American Heart Association found that African-American women can be at risk of heart disease even if they don't have metabolic syndrome.

This is problematic because the current thinking is that metabolic syndrome — defined as high triglycerides, bad cholesterol, abdominal fat, high blood pressure and impaired glucose metabolism — is the big risk factor for heart attacks and strokes.

The picture with women appears to be a lot more complicated, especially when you compare women in different racial or ethnic groups.  The found that having just having two metabolic abnormalities raised heart disease risk in African-American women. Being overweight or obese with two or three metabolic factors almost doubled their heart disease risk. This wasn't the case for white women as being overweight or obese didn't boost their risk unless they had full-on metabolic syndrome.

"The metabolic health concept has has only been investigated in the white population," says Dr. Michelle Schmiegelow of Copenhagen University Hospital Gentofte in Denmark. She led the research while at Stanford University. "We found that it cannot be directly applied to black individuals."


Looking just at metabolic syndrome will underestimate risk in African-American women and overestimate it in white women, Schmiegelow says.

The study looked at data from 14,364 postmenopausal women who participated in the Women's Health Initiative, tracking their health for 13 years. Hispanic women were included, but there weren't enough of them to come to any firm conclusions.

"There's a lot we don't know," says Dr. Robert Eckel, a professor at the University of Colorado's Anschutz School of Medicine who was not involved in the study. "Does culture or race, environmentally or genetically, have impacts that we can't quite assess accurately?"

It also raises the question of how the health effects of race and culture vary around the globe, Eckel says.

And it shows that a one-size-fits-all approach to health risks doesn't cut it.


"You have to make an individual risk assessment," Schmiegelow told Shots. "I'm really hoping this study will motivate other groups to see if they can replicate our finding in men or in other races and ethnicities."


The Structuring of Ethnic Inequalities in Health: Economic Position, Racial Discrimination, and Racism

Abstract

Differences in health across ethnic groups have been documented in the United States and the United Kingdom. The extent to which socioeconomic inequalities underlie such differences remains contested, with many instead focusing on cultural or genetic explanations. In both the United States and the United Kingdom, data limitations have greatly hampered investigations of ethnic inequalities in health. Perhaps foremost of these is the inadequate measurement of ethnicity, but also important is the lack of good data on socioeconomic position, particularly data that address life-course issues. Other elements of social disadvantage, particularly experiences of racism, are also neglected.

The author reviews existing evidence and presents new evidence to suggest that social and economic inequalities, underpinned by racism, are fundamental causes of ethnic inequalities in health.

James Y. Nazroo, PhD
American Journal of Public Health: February 2003, Vol. 93, No. 2, pp. 277-284



Understanding social disparities in hypertension prevalence, awareness, treatment, and control: the role of neighborhood context 

Abstract

The spatial segregation of the US population by socioeconomic position and especially race/ethnicity suggests that the social contexts or "neighborhoods" in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racial-ethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10-15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks' greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40-50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial/ethnic and, to a lesser degree, socioeconomic disparities in hypertension prevalence and, in a different way, awareness, but not in treatment or control of diagnosed hypertension

Morenoff JD1, House JS, Hansen BB, Williams DR, Kaplan GA, Hunte HE.
Soc Sci Med. 2007 Nov;65(9):1853-66


 Socioeconomic Position, and Blood Pressure in a Multi-Ethnic Urban Community

Abstract

Objectives

The John Henryism (JH) hypothesis suggests that, under adverse social and economic conditions, high-effort coping styles that reflect hard work and determination may contribute to elevated blood pressure. Results from tests of this hypothesis have been mixed, with variations by region, urban versus rural areas, race, gender, and age. The majority of studies reporting that socioeconomic position modifies associations between JH and blood pressure have been for non-Latino Blacks in rural communities. In contrast, most studies conducted in urban areas report little support for the JH hypothesis. Few studies have been conducted in samples that include Latinos. We extend previous research by testing the JH hypothesis in a multi-ethnic, low-to-moderate income urban community.

Design

We used multivariate linear regression to test the hypothesis that associations between JH and blood pressure were modified by income, education, or labor force status in a multi-ethnic (non-Latino Black, Latino, non-Latino White) sample (N=703) in Detroit, Michigan. The outcome measures were systolic (SBP) and diastolic blood pressure (DBP).

Results

John Henryism was associated with higher SBP (β=3.92, P=.05), but not DBP (β=1.85, P=.13). These associations did not differ by income, education, or labor force status. Results did not differ by race or ethnicity.

Conclusions


John Henryism is positively associated with SBP in this multi-ethnic, low-to-moderate income sample. This association did not differ by income, education, or labor force status. Results are consistent with studies conducted in urban communities, finding limited evidence that associations between JH and blood pressure vary by socioeconomic position.

LeBrón, A. M., Schulz, A. J., Mentz, G., & Perkins, D. W. (2015). John Henryism, Socioeconomic Position, and Blood Pressure in a Multi-Ethnic Urban Community. Ethnicity & disease, 25(1), 24.

Racial Disparities in Hypertension Awareness and Management: Are There Differences among African Americans and Whites Living under Similar Social Conditions?

Abstract

Although racial disparities in hypertension awareness and management are well documented, studies have not accounted for the differing social contexts in which whites and African Americans live.

Objective

To examine the nature of disparities in hypertension awareness, treatment, and control within a sample of whites and African Americans living in the same social context and with access to the same healthcare environment.

Design

Cross-sectional study

Participants


949 hypertensive African American and white adults in the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) Study.

Measurements

Logistic regression models were conducted to estimate the association between race and hypertension awareness, treatment and control adjusting for potential confounders.

Results

African Americans had greater odds of being aware of their hypertension than whites (odds ratio=1.44; 95% confidence interval 1:04, 2.01). However, African Americans and whites had similar odds of being treated for hypertension, and having their hypertension under control.

Discussion


Within this racially integrated sample of hypertensive adults who share similar healthcare market, race differences in treatment and control of hypertension were eliminated. Accounting for the social context should be considered in public health campaigns targeting hypertension awareness and management.

Thorpe Jr, R. J., Bowie, J. V., Smolen, J. R., Bell, C. N., Jenkins Jr, M. L., Jackson, J., & LaVeist, T. A. (2014). Racial disparities in hypertension awareness and management: Are there differences among African Americans and Whites living in similar social and healthcare resource environments?. Ethnicity & disease, 24(3), 269.


Ethnicity and health literacy: a survey on hypertension knowledge among Canadian ethnic populations

ABSTRACT 

With an increase and diversity in ethnic populations in Westernized countries, understanding the differences in levels of knowledge surrounding hypertension is important in planning appropriate prevention strategies. The purpose of our study was to assess levels of hypertension knowledge in Chinese, Indian and White populations in a large metropolitan Canadian city. 


Cunningham, C. T., Sykes, L. L., Metcalfe, A., Cheng, A., Riaz, M., Lin, K., ... & Quan, H. (2014). Ethnicity and health literacy: a survey on hypertension knowledge among Canadian ethnic populations. Ethn Dis, 24(3), 276-82.


An international comparative study of blood pressure in populations of European vs. African descent

Abstract

Background


The consistent finding of higher prevalence of hypertension in US blacks compared to whites has led to speculation that African-origin populations are particularly susceptible to this condition. Large surveys now provide new information on this issue.

Methods

Using a standardized analysis strategy we examined prevalence estimates for 8 white and 3 black populations (N = 85,000 participants).

Results

The range in hypertension prevalence was from 27 to 55% for whites and 14 to 44% for blacks.

Conclusions

These data demonstrate that not only is there a wide variation in hypertension prevalence among both racial groups, the rates among blacks are not unusually high when viewed internationally. These data suggest that the impact of environmental factors among both populations may have been under-appreciated.