Blood Pressure Screening Campaign in Jamaica May Measurement Month 2017 PDF

Original Article Blood Pressure Screening Campaign in Jamaica: May Measurement Month 2017 Magdalene Nwokocha,1 Cesar A. Romero,2,3 Cheryl Holder,4 Natalie Whylie,5 Hiu Wong,5 Joan Lietch,6 Rohan Wilks,7 Mark Hosang,7 Sheena Francis,8 Paul D. Brown,9 Tomlin Paul,5 Wendel Abel,5 Everard Barton,10 Rain...

Original Article Blood Pressure Screening Campaign in Jamaica: May Measurement Month 2017 Magdalene Nwokocha,1 Cesar A. Romero,2,3 Cheryl Holder,4 Natalie Whylie,5 Hiu Wong,5 Joan Lietch,6 Rohan Wilks,7 Mark Hosang,7 Sheena Francis,8 Paul D. Brown,9 Tomlin Paul,5 Wendel Abel,5 Everard Barton,10 Rainford Wilks,7 and Chukwuemeka R. Nwokocha9, METHODS Adults, 18 years old and older, from different parishes of Jamaica were invited to participate during May to June 2017. Demographic data were collected. BP, weight, and height were measured and recorded. RESULTS Five hundred sixty-six participants (n = 566) were enrolled, 91.6% (519) from urban areas, and 72.6% (410) were females. The average age was 53.7 (18–95) years old and body mass index was 28.2 ± 6.6 kg/m2. The prevalence of HTN was 47.3% (267/566), without gender or living areas differences (both P > 0.1). Prevalence of HTN was lower in those who selfidentified as Interracial ethnicity, in comparison with Afro-Caribbean Hypertension (HTN) is the single leading risk factor for burden of disease in Jamaica.1 Thus, the main cause of death and premature death in Jamaica is stroke, for which HTN is an important risk factor.1 HTN affects over a quarter of the Jamaican population.2 The causes of HTN remain unclear, being a complex interaction between environmental, genetic, and social factors. Thus, poverty, type of diet, exercise as well as others lifestyle factors have a great impact on the prevalence of HTN.3 In Jamaica, environmental stressors such as pollutants, and heavy metals, may be associated with this health problem.4,5 Correspondence: Chukwuemeka R. Nwokocha (Chukwuemeka. [email protected]). Initially submitted March 13, 2019; date of first revision May 28, 2019; accepted for publication July 19, 2019; online publication July 27, 2019. (33% vs. 48.3%; P = 0.04). About third of the hypertensive patients were not aware of the high BP (89/267; 35.6%). Between hypertensive patients, 64.4% (172/267) were receiving antihypertensive drugs. The rate of BP control was 32% of the hypertensive patients and 50% of those receiving antihypertensive medication. Significant lower BP control was observed between diabetic vs. nondiabetic patients (34.3% vs. 60%; P < 0.001). CONCLUSION We found a high prevalence of HTN in this population, especially in patients with diabetes or previous cardiovascular diseases. We report an increase in HTN awareness in Jamaica but more advances need to be performed to increase HTN treatment and control. Keywords: Afro-Caribbean; blood pressure; hypertension; Jamaica; May Measurement Month. doi:10.1093/ajh/hpz117 Insufficient exercise, overweight, alcohol, and dietary salt intake are some other factors that may contribute to HTN in the Caribbeans.2 However, many persons are either unaware, or even when aware, are unable to control or manage their blood pressure (BP), even with the use of several antihypertensive therapies or medications.6 HTN is more common in certain ethnic populations, and is seen to have a high prevalence in Black African-Caribbean individuals.7 The disorder also appears to occur earlier, with an increase in severity of hypertensive-related complications such as stroke, heart failure, myocardial infarction (MI), and renal failure.8 The reason for this disparity in the different 1Department of Pathology, The University of the West Indies, Mona, Jamaica; 2Internal Medicine, Hypertension and Vascular Research, Henry Ford Hospital, Detroit, Michigan, USA; 3Global Health Initiative, Henry Ford Hospital, Detroit, Michigan, USA; 4Department of Medicine, Family Medicine and Community Health, Herbert Wertheim College of Medicine, Florida International University, Miami, USA; 5Kingston Public Hospital, Kingston, Jamaica; 6Mona Information Technology, The University of the West Indies, Mona, Jamaica; 7Caribbean Institute for Health Research, The University of the West Indies, Mona Jamaica; 8Natural Products Institute, The University of the West Indies, Mona Jamaica; 9Department of Basic Medical Sciences, The University of the West Indies, Mona, Jamaica. 10Department of Medicine, The University of the West Indies, Mona Campus, Jamaica. © The Author(s) 2019. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For permissions, please e-mail: [email protected] 1186 American Journal of Hypertension 32(12) December 2019 Downloaded from https://academic.oup.com/ajh/article/32/12/1186/5539685 by guest on 16 January 2024 BACKGROUND Hypertension (HTN) is responsible for a significant disease burden in Jamaica. We are reporting the results of the 2017 blood pressure (BP) screening campaign May Measurement Month in Jamaica that aimed to increase the awareness of HTN. May Measurement Month in Jamaica 2017 BP control was defined as average BP of 140/90 mm Hg or individuals previously diagnosed and/or receiving antihypertensive medication.13 Data were presented as frequencies (%) or mean ± SD. t test and analysis of variance were used to compare continuous variables between two or more categories, respectively. Chisquared test of independence was used to test association of HTN between different age groups, gender, DBT, smokers, and other select variables. Spearman correlation was used to evaluate association between continuous variables. Binary logistic regression was used to determine the association of BP and antihypertensive treatment (dependents variables) with age, urban residency, ethnicity, frequency of BP evaluation (less than 12 month), gender, having DBT, stroke, or MI (independent variables). Similar regression analysis was performed with BP control as dependent variable. A P value less than 0.05 was considered statistically significant. SPSS (Chicago) v 17.1 software was used for analysis. RESULTS Population Five hundred sixty-six individuals participated in this study, with 519 (91.6%) living in urban areas. Of the total participants, 411 (72.6%) were female of which 4 (0.97%) were pregnant. Table 1 shows the general characteristic of the population. There was little variation in ethnicity in this study. Most of the participants, 505 (89.2%), were of Afro-Caribbean ethnicity, 54 (9.5%) were Interracial, 3 (0.6%) were from Asia, and 1 (0.2%) was Caucasian. Three individuals (0.5%) gave no indication of ethnicity. The majority, 92.9% (526), of participants did not smoke, 432 (76.3%) of participants never or rarely consumed alcohol, whereas 31 (5.5%) did so regularly. Three hundred seventyone persons (66.9%) were considered overweight or obese. The average BMI for females was 28.3 ± 6.6 kg/m2 and for males was 26.3 ± 6.5 kg/m2. BMI had significant association with systolic BP (r = 0.21; P ≤ 0.01) and age (r = 0.08; P = 0.05). Table 1 shows the comparison between the 2 major ethnicities. African-Caribbean tend to have higher BMI and American Journal of Hypertension 32(12) December 2019 1187 Downloaded from https://academic.oup.com/ajh/article/32/12/1186/5539685 by guest on 16 January 2024 races is unknown. Studies have shown evidence of several factors that may lead to this dissimilarity, such as the role of the sympathetic nervous system, endothelin-1, and salt sensitivity.8 Notwithstanding, awareness of varying types of chronic and communicable diseases is steadily increasing throughout the Caribbean,9 cardiovascular diseases are still the main cause of death, and HTN is the single most important risk factor.1 A particularly high prevalence of stroke as a cause of dead and premature death has been observed in African-Caribbean,10,11 and HTN is closely related to stroke. The International Society of Hypertension and the World Hypertension League initiated a BP screening campaign, May Measurement Month (MMM), in order to increase BP awareness globally.12 Consequently, we aimed at screening adult persons in Jamaica in order to highlight the importance of BP monitoring, and provide, information about lifestyle and dietary advice toward the reduction of the global disease burden associated with increased BP. In this report, we show the results of the MMM17 campaign in Jamaica. Nwokocha et al. more prevalence of DBT, whereas the Interracial have more prevalence of MI. HTN prevalence, awareness, treatment, and control The average BP was 127.9 ± 20.8 and 78.3 ± 14.6 mm Hg, for systolic and diastolic BP, respectively. Table 2 shows the HTN prevalence, awareness, treatment, and control. Two hundred sixty-nine persons (47.5%) were hypertensive, including those with previous diagnosis of HTN. The prevalence of HTN in the sample was 51% in rural areas vs. 46.8% in urban sites (P = 0.9). No significant difference was observed for high BP between males and females within the study group (46.4% males vs. 47.4% females; P = 0.8). We found a lower prevalence of HTN between those with selfdeclared Interracial ethnicity in comparison with the AfroCaribbean persons (Table 2). Figure 1 shows the prevalence, treatment, and control of HTN stratified by age. There was a linear association with age (P < 0.01 for the trend), with the highest prevalence between those in the 70s, not considering only 5 patients in the 90s which all were hypertensive. After the fourth decade, Table 1. Participant’s characteristics of the screened population Participants (n) Total (566) Afro-Caribbean (505) Interracial (54) P* Age (range) 57.7 (18-95) 53.3 ± 18.4 56.5 ± 17.1 >0.1 Female (%) 411 (72.6) 370 (73.3) 39 (72.2) >0.1 BMI (kg/m2) 28.2 ± 6.6 27.9 ± 6.7 26.1 ± 5.5 SBP 127.9 ± 20.8 127.9 ± 22.6 128.1 ± 21.8 >0.1 DBP 78.3 ± 4.6 79.1 ± 12.5 76.6 ± 13.3 >0.1 AfroCaribbean 505 (89.2) 505 (100) — Interracial 54 (9.5) — 54 (100) Asian 3 (0.6) — — 0.06 Ethnicity (%) Caucasian DBT (%) 1 (0.2) — — 85 (15) 77 (15.2) 4 (7.4) 0.1 MI (%) 15 (2.6) 7 (1.4) 7 (13%) 0.1 Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; DBT, diabetes; MI, myocardial infarction. SBP, systolic blood pressure. *P value corresponds to chi-squared test (qualitative) and t test (continue variables) comparing Afro-Caribbean vs. Interracial. Table 2. Prevalence, awareness, treatment, and control of blood pressure in Jamaica Total African-Caribbean Interracial P n 566 505 54 HTN prevalence (%) 269 (47.5) 244 (48.3) 18 (33) 0.04 Not aware (%) 95 (35.3) 89 (36.5) 6 (33) 0.79 Treatment (%) 172 (63.9) 155 (63.5) 12 (66.6) 0.78 Controlled BP 86 (31.9) 77 (31.5) 7 (38.8) 0.52 Abbreviations: BP, blood pressure; HTN, hypertension. 1188 American Journal of Hypertension 32(12) December 2019 Downloaded from https://academic.oup.com/ajh/article/32/12/1186/5539685 by guest on 16 January 2024 around half of the population of each age group was hypertensive. As shown in Figure 1, antihypertensive treatment increases also with age, however very few patients under the age of 60 years old were receiving medication to control BP. In the different age groups, between 40% and 60% of those receiving medical treatment were able to control BP. Systolic BP associates with age (r = 0.49; P < 0.01) and BMI (r = 0.21; P < 0.01). No association was found between prevalence of HTN and presence of DBT, smoke status, previous stroke or MI (all P > 0.05). The total awareness rate was 65% and 442 persons (78.1%) had at least one BP measurement in the last 12 months before the study. Of the 269 hypertensive individuals, 172 (63.9%) reported being on antihypertensive medication. No differences were observed in BP treatment between Afro-Caribbean and Interracial patients (both P > 0.05) (Table 2). Previous MI was associated with antihypertensive treatment (all P < 0.01), however that association was not found between those patients with history of stroke (P = 0.33). Thus, from 15 patients who suffered a heart attack, 14 (93.3%) of them were on antihypertensive medication whereas 9/25 (36%) of those who had experienced May Measurement Month in Jamaica 2017 a previous stroke were on BP lowering medication (P < 0.001). Stratified by gender, 41.6% of hypertensive women were on medication, whereas 31.4% of hypertensive males were receiving antihypertensive drugs (P = 0.06). Having DBT, a previous heart attack, older age, being female, and frequent BP evaluation were associated with antihypertensive treatment (all P < 0.01), however only older age, having DBT, and MI history were associated with antihypertensive treatment after adjustment for gender and age. BP control was observed in 86 of 172 medicated patients. Thus, the rate of BP control was 32% of the hypertensive patients and 50% of those receiving antihypertensive medication. No differences were observed in age, BMI, ethnicity, or residency (urban vs. rural) between those controlled vs. no controlled patients. BP control was lower in diabetic (34.3%, n = 67) vs. nondiabetic (60%, n = 105) (P < 0.001). Only having DBT was negatively associated with BP control (odds ratio 0.33 [95% IC 0.18–0.65] P = 0.001). Those individuals who checked their BP in the last 12 months (n = 442) had a higher prevalence of HTN (48.9% vs. 28.6%, P = 0.006) and received antihypertensive treatment at a higher rate (48.1% vs. 8.21%, P < 0.001) in comparison with those who had never been evaluated or had their last evaluation more than 1 year ago. Also, those with more frequent evaluation showed higher rates of control even though this difference was not statistically significant because there were limited people receiving medication among those who rarely control their BP (50.5% vs. 25%, P = 0.6). According to the 2017 American Heart Association and the American college of Cardiology guidelines for North America, the BP threshold to be hypertensive is 130/80 mm Hg systolic and diastolic, respectively. We calculated HTN prevalence, treatment rate, and BP control considering this BP threshold and compared it with previous guidelines. Table 3 shows that HTN prevalence increases with this threshold, whereas awareness, treatment, and BP control Table 3. Prevalence,awareness, treatment, and control of blood pressure according the 8th Joint National Committee (JNC8) guidelines and the 2017 American Heart Association (AHA) and American College of Cardiology (ACC) in Jamaica 2017 AHA/ACC JNC 8 n 566 guidelines P 566 HTN prevalence (%) 269 (47.5) 370 (65.3)