Yvonne Commodore-Mensah

Hypertension and overweight/obesity in Ghanaians and Nigerians living in West Africa and industrialized countries: a systematic review.

Context: There is a growing prevalence of cardiovascular disease (CVD) risk factors in West Africa and among its migrants to industrialized countries. Despite this, no study has reviewed CVD risk factor prevalence among West Africans in Africa and industrialized countries. Objective: To appraise studies on the prevalence of two CVD risk factors (hypertension and overweight/obesity) among two major West African populations (Ghanaians and Nigerians) in Africa and industrialized countries. Methods: A comprehensive literature search from 1996 to July 2012 was undertaken to identify quantitative studies on hypertension and overweight/obesity among adult Ghanaians and Nigerians in West Africa and industrialized countries. Results: Twenty studies were included with 10 conducted in Ghana, six conducted in Nigeria and four in industrialized countries. Studies in Ghana and Nigeria reported a hypertension prevalence of 19.3–54.6% with minimal differences between rural, urban, semi-urban, and mixed populations. Of the hypertensive patients, 14–73% were aware of their condition, 3–86% were on treatment, and 2–13% had controlled blood pressures. Overweight/obesity prevalence in Ghana and Nigeria ranged from 20 to 62% and 4 to 49%, respectively. The four studies in industrialized countries reported a hypertension prevalence of 8.4–55% and overweight/obesity prevalence of 65.7–90%. Conclusion: Hypertension and overweight/obesity are highly prevalent conditions in West Africa and in its migrants residing in industrialized countries. Urgent measures are needed to prevent CVD risk factors and halt the clinical sequelae.

Patient education strategies for hospitalized cardiovascular patients: a systematic review.

Although mortality from cardiovascular (CV) disease has fallen in the past decade, the burden of CV disease and related conditions remains high, with rates of hospitalization and disability and cost on the rise. Prevention and treatment of CV conditions often involve a complex regimen of lifestyle modification, medications, and/or symptom monitoring and management. Cardiovascular health professionals spend a great deal of time promoting awareness of and adherence to national guidelines for the prevention and management of CV conditions. In addition, patient education for hospitalized patients is becoming increasingly regulated by national organizations and payors. However, it is unclear which educational intervention elements or strategies are most effective for educating hospitalized CV patients and their families. The purpose of this systematic review of experimental and quasi-experimental studies was to identify and examine the characteristics and outcomes of CV health education interventions for hospitalized CV patients.

Length of Residence in the United States is Associated With a Higher Prevalence of Cardiometabolic Risk Factors in Immigrants: A Contemporary Analysis of the National Health Interview Survey

Background Cardiometabolic risk (CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon. Methods and Results Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010–2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors. The mean (SE) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with <10 years of residence (70% versus 54%, P<0.001). After adjusting for region of birth, poverty income ratio, age, and sex, immigrants residing in the United States for ≥10 years were more likely to be overweight/obese (odds ratio [OR], 1.19; 95% CI, 1.10–1.29), diabetic (OR, 1.43; 95% CI, 1.17–1.73), and hypertensive (OR, 1.18; 95% CI, 1.05–1.32) than those residing in the United States for <10 years. Conclusions In an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR.

Community Based Cardiovascular Health Interventions in Vulnerable Populations: A Systematic Review

Background:Although cardiovascular health has been improving for many Americans, this is not true of those in “vulnerable populations.” To address this growing disparity, communities and researchers have worked for decades, and as a result of their work, a growing body of literature supports the use of community engagement as a component of successful interventions. However, little literature synthesizes community-based interventions that address this disparity among a wide range of vulnerable populations. Objective:This article provides a critical review of community-based cardiovascular disease interventions to improve cardiovascular health behaviors and factors among vulnerable populations based on the American Heart Association’s 7 metrics of ideal cardiovascular health. Methods:In February 2011, 4 databases (PubMed, PsychInfo, CINAHL, and Scopus) were searched using the following keywords: vulnerable populations OR healthcare disparities AND cardiovascular disease AND clinical trials OR public health practice AND English. Results:This search strategy resulted in the retrieval of 7120 abstracts. Each abstract was reviewed by at least 2 authors, and eligibility for the systematic review was confirmed after reading the full article. Thirty-two studies met eligibility criteria. Education was the most common intervention (41%), followed by counseling or support (38%) and exercise classes (28%). Half of the interventions were multicomponent. Healthcare providers were the most frequent interventionists. Interventions aimed at decreasing blood pressure were the most promising, whereas behavior change interventions were the most challenging. Almost all of the interventions were at the individual level and were proof-of-concept or efficacy trials. Conclusions:This analysis provides a step toward understanding the current literature on cardiovascular interventions for vulnerable population. The next step should be integrating the identified successful interventions into larger health systems and/or social policies.

Developing Behavioral Theory With the Systematic Integration of Community Social Capital Concepts

Health behavior theories state that social environments influence health behaviors, but theories of how this occurs are relatively underdeveloped. This article systematically surveys community social capital concepts in health behavior literature and proposes a conceptual framework that integrates these concepts into existing behavioral theory. Fifty-three studies tested associations between community social capital concepts and physical activity (38 studies), smoking (19 studies), and diet (2 studies). Trustworthiness of community members was consistently associated with more health-promoting and less disease-promoting behaviors in 19 studies. Neighborly reciprocity showed mixed results in 10 studies. Reporting a good sense of community was associated with more physical activity in only 5 of 16 studies. Neighborhood collective efficacy, which includes social cohesion and informal social control, was inconsistently associated with behaviors in 22 studies. Behavioral social norms were associated with smoking and physical activity in 2 of 6 studies, and neighborhood modeling of physical activity was associated with increased activity in 12 of 17 studies, with 1 opposing result. This review identifies several community social capital–related concepts that are, at times, associated with both health-promoting and disease-promoting behaviors and often have no associations. Theory explains these findings by describing the relationships and interactions among these concepts. Using these findings, this article proposes a conceptual framework that integrates community social capital concepts into existing behavioral theory. Iterative empirically based theory development is needed to address these concepts, which affect behaviors. These results can also inform theoretically based community-based and socially tailored interventions.

Development and validation of the Hypertension Self-care Profile: a practical tool to measure hypertension self-care.

Background:Adequate self-care is crucial for blood pressure control. A number of hypertension (HBP) self-care instruments are available, but existing tools do not capture all the critical domains of HBP self-care and have limited evidence of reliability and validity. Objective:The purpose of this study was to develop and validate a new tool—the HBP Self-Care Profile (HBP SCP)—in a sample of inner-city residents. Methods:The HBP SCP encompasses comprehensive domains of HBP self-care behaviors. Guided by 2 validated theoretical approaches—Orem’s self-care model and Motivational Interviewing—the HBP SCP includes 3 scales that can be used together or independently: Behavior, Motivation, and Self-efficacy. The sample included 213 English-speaking inner-city residents with HBP (mean age, 68.6 years; 76.1% women; 81.7% African American). Results:Item-total correlations ranged from 0.20 to 0.63 for Behavior, 0.46 to 0.70 for Motivation, and 0.40 to 0.74 for Self-efficacy, meeting the cutoff set a priori at 0.15. Internal consistency reliability coefficients ranged from 0.83 to 0.93. Concurrent and construct validities of the HBP SCP were achieved by significant correlations between HBP SCP scales and theoretically selected instruments (P < .05 for all correlation coefficients). The HBP SCP–Behavior scale also successfully discriminated between those with or without blood pressure control (P < .05). Conclusions:The reliability and validity of the HBP SCP were supported in this sample of inner-city residents with HBP. The high reliability estimates and strong evidence of validity should allow researchers to use the HBP SCP to assess and identify gaps in HBP self-care behavior, motivation, and self-efficacy. Future research is warranted to evaluate the HBP SCP in diverse ethnic and age samples of hypertensive patient populations.

Variations in hypertension awareness, treatment, and control among Ghanaian migrants living in Amsterdam, Berlin, London, and nonmigrant Ghanaians living in rural and urban Ghana-the RODAM study

Objectives: Hypertension is a major burden among African migrants, but the extent of the differences in prevalence, treatment, and control among similar African migrants and nonmigrants living in different contexts in high-income countries and rural and urban Africa has not yet been assessed. We assessed differences in hypertension prevalence and its management among relatively homogenous African migrants (Ghanaians) living in three European cities (Amsterdam, London, and Berlin) and nonmigrants living in rural and urban Ghana. Methods: A multicenter cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25–70 years. Comparisons between sites were made using prevalence ratios with adjustment for age, education, and BMI. Results: The age-standardised prevalence of hypertension was 22 and 28% in rural Ghanaian men and women. The prevalence was higher in urban Ghana [men, 34%; adjusted prevalence ratio = 1.37, 95% confidence interval (CI), 1.10–1.70]; and much higher in migrants in Europe, especially in Berlin (men, 57%; prevalence ratio = 2.21, 1.78–2.73; women, 51%; prevalence ratio = 1.74, 1.45–2.09) than in rural Ghana. Hypertension awareness and treatment levels were higher in Ghanaian migrants than in nonmigrant Ghanaians. However, adequate hypertension control was lower in Ghanaian migrant men in Berlin (20%; prevalence ratio = 0.43 95%, 0.23–0.82), Amsterdam (29%; prevalence ratio = 0.59, 0.35–0.99), and London (36%; prevalence ratio = 0.86, 0.49–1.51) than rural Ghanaians (59%). Among women, no differences in hypertension control were observed. About 50% of migrants to 85% of rural Ghanaians with severe hypertension (Blood pressure > 180/110) were untreated. Antihypertensive medication prescription patterns varied considerably by site. Conclusion: Hypertension prevalence, awareness, and treatment levels were generally higher in African migrants, but blood pressure control level was lower in Ghanaian migrant men compared with their nonmigrant peers. Further work is needed to identify key underlying factors to support prevention and management efforts. Supplement Figure 1, http://links.lww.com/HJH/A831.

African Americans, African Immigrants, and Afro-Caribbeans Differ in Social Determinants of Hypertension and Diabetes: Evidence from the National Health Interview Survey

In the United States (U.S.), Blacks have higher morbidity and mortality from cardiovascular disease (CVD) than other racial groups. The Black racial group includes African Americans (AAs), African immigrants (AIs), and Afro-Caribbeans (ACs); however, little research examines how social determinants differentially influence CVD risk factors in each ethnic subgroup. We analyzed the 2010–2014 National Health Interview Survey, a cross-sectional, nationally representative survey of non-institutionalized civilians. We included 40,838 Blacks: 36,881 AAs, 1660 AIs, and 2297 ACs. Age- and sex-adjusted hypertension prevalence was 37, 22, and 21% in AAs, ACs, and AIs, respectively. Age- and sex-adjusted diabetes prevalence was 12, 10, and 7% in AAs, ACs, and AIs, respectively. In the multivariable logistic regression analyses, social determinants of hypertension and diabetes differed by ethnicity. Higher income was associated with lower odds of hypertension in AAs (aOR 0.86, 95% CI 0.77–0.96) and ACs (aOR 0.55, 95% CI 0.37–0.83). In AAs, those with some college education (aOR 0.79, 95% CI 0.68–0.92) and college graduates (aOR 0.62, 95% CI 0.53–0.73) had lower odds of hypertension than those with < high school education. In AIs, having health insurance was associated with higher odds of hypertension (aOR 1.59, 95% CI 1.04–2.42) and diabetes (aOR 3.22, 95% CI 1.29–8.04) diagnoses. We observed that the social determinants associated with hypertension and diabetes differed by ethnicity. Socioeconomic factors of health insurance and income were associated with a disparate prevalence of hypertension by ethnic group. Future research among Blacks should stratify by ethnicity to adequately address the contributors to health disparities.

New cardiovascular prevention guidelines offer a new approach and effective strategies.

One in 4 Americans will die of heart disease or stroke, and 60% will have a major vascular event before they die. Recognizing this burden on public health, the American College of Cardiology and American Heart Association jointly released 4 new prevention guidelines in November 2013. These guidelines focused on lifestyle management to reduce cardiovascular risk, management of overweight and obesity, assessment of cardiovascular risk, and treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk. These evidence-based guidelines were developed through a rigorous process involvingcareful consideration of an extensive body of high-quality evidence derived from randomized controlled trials and systematic reviews and meta-analyses of randomized controlled trials in answering critical questions in clinical decision making. Key recommendations from each of the prevention guidelines are listed in the Table. Please refer to the published guidelines for details and comprehensive recommendations. The new guidelines recommend new risk assessment and treatment strategies. The Assessment of Cardiovascular Risk guideline recommends a new model for estimating risk for atherosclerotic cardiovascular disease (ASCVD). Risk estimation is based on group averages that are then applied to individual patients in practice. The approach balances an understanding of an individual’s absolute risk for ASCVD and potential treatment benefits against the potential risks for harm from therapy. The Treatment of Blood Cholesterol guideline recommends a new strategy involving focus on reducing ASCVD risk in 4 major statin benefit groups, a new perspective on low-density lipoprotein cholesterol and/or nonYhigh-density lipoprotein cholesterol treatment goals, and use of global risk assessment to guide primary prevention. These approaches are consistent with the existing and widely used paradigm of matching the intensity of preventive efforts with an individual’s absolute risk. Among the tools provided to support clinicians in implementing the new guidelines is a risk calculator to be used to determine 10-year risk for myocardial infarction and stroke among adults aged 40 to 79 years. It uses an updated equation developed from large, racially and geographically diverse community-based populations and includes race, gender, age, total cholesterol, high-density lipoprotein cholesterol, blood pressure, use of blood pressure medication, diabetes status, and smoking status. A downloadable spreadsheet enabling estimation of 10-year and lifetime risk for ASCVD and a Web-based calculator are available at http://my .americanheart.org/cvriskcalculator. If after quantitative risk assessment, a risk-based treatment decision is uncertain, additional risk measures that support revising risk assessment upward may be considered to inform treatment decision making: family history of premature cardiovascular disease (first degree male relative G55 years or female relative G65 years), high-sensitivity C-reactive protein (Q2 mg/L), coronary artery calcium score (Q300 Agatston units or Q75th percentile for age, sex, and ethnicity), or ankle-brachial index

Hypertension, overweight/obesity, and diabetes among immigrants in the United States: an analysis of the 2010–2016 National Health Interview Survey

BackgroundEthnic minority populations in the United States (US) are disproportionately affected by cardiovascular disease (CVD) risk factors, including hypertension, overweight/obesity, and diabetes. The size and diversity of ethnic minority immigrant populations in the US have increased substantially over the past three decades. However, most studies on immigrants in the US are limited to Asians and Hispanics; only a few have examined the prevalence of CVD risk factors across diverse immigrant populations. The prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes was examined and contrasted among a socioeconomically diverse sample of immigrants. It was hypothesized that considerable variability would exist in the prevalence of hypertension, overweight and diabetes.MethodsA cross-sectional analysis of the 2010–2016 National Health Interview Survey (NHIS) was conducted among 41,717 immigrants born in Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia and Southeast Asia. The outcomes were the prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes.ResultsThe highest multivariable adjusted prevalence of diagnosed hypertension was observed in Russian (24.2%) and Southeast Asian immigrants (23.5%). Immigrants from Mexico/Central America/Caribbean and the Indian subcontinent had the highest prevalence of overweight/obesity (71.5 and 73.4%, respectively) and diagnosed diabetes (9.6 and 10.1%, respectively). Compared to European immigrants, immigrants from Mexico/Central America/Caribbean and the Indian subcontinent respectively had higher prevalence of overweight/obesity (Prevalence Ratio (PR): 1.19[95% CI, 1.13–1.24]) and (PR: 1.22[95% CI, 1.14–1.29]), and diabetes (PR: 1.70[95% CI, 1.42–2.03]) and (PR: 1.78[95% CI, 1.36–2.32]). African immigrants and Middle Eastern immigrants had a higher prevalence of diabetes (PR: 1.41[95% CI, 1.01–1.96]) and PR: 1.57(95% CI: 1.09–2.25), respectively, than European immigrants —without a corresponding higher prevalence of overweight/obesity.ConclusionsImmigrants from Mexico/Central America/Caribbean and the Indian subcontinent bore the highest burden of overweight/obesity and diabetes while those from Southeast Asia and Russia bore the highest burden of hypertension.