Cardiovascular Disease Risk and the Association with Acculturation in West African Immigrants in the United States

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the United States (US). Despite substantial reduction in CVD events of Americans, many ethnic minorities experience striking CVD disparities, with insufficient research to explain these disparities. Limited research conducted in West African Immigrants (WAI), specifically Ghanaian and Nigerian immigrants residing in other high-income countries has revealed a high prevalence of CVD risk factors. However, no epidemiological studies have explored CVD risk and the association with behavioral, social, economic and cultural factors in African immigrants in the US. Design and Methods: : Cross-sectional study epidemiological of West African immigrants (Ghanaian and Nigerian-born ) aged 35–74 years residing in the Baltimore, Washington-D.C metropolitan area. A full fasting lipid-profile, glucose concentrations, blood pressure and anthropometric measured were obtained and a modified World Health Organization questionnaire with items assessing social support, CVD knowledge and acculturation was administered to participants. Findings: The mean age of the 253 participants was 49.5±9.2 years and 58% were female. Males were more likely to be employed than females (90% vs. 72%; p=0.001). Only 52% of participants had health insurance. The majority (54%) had ≥3 CVD risk factors and 28% had PARS10 ≥7.5%. Smoking was the least prevalent (<1%) and overweight/obesity the most prevalent (88%) risk factor. Although females (64%) were more likely to be treated for hypertension than males (36%), there was no difference in hypertension control by sex. Diabetes was identified in 16% of the participants. Mean total cholesterol (TC) was 180.9±33.9mg/dL and 32% had TC level ≥200mg/dL. Also, 44% were found to be physically inactive. In females, employment [0.18 AOR, 95%CI: 0.075-0.44)] and health insurance [0.35 AOR, 95%CI 0.14-0.87)] were associated with a PARS10 ≥7.5%. In males, higher social support was associated with a 0.92 (95%CI: 0.84-0.98) odds of having ≥3 CVD risk factors. Conclusions: The healthy immigrant effect may not hold for this current generation of African immigrants. Larger studies are need to confirm the relationships between predisposing, reinforcing and enabling factors and CVD risk as well as the association between acculturation and CVD risk identified in this study

Association between Non-Cigarette/Smokeless Tobacco and Hypertension in the National Health Interview Survey: A Pseudo-Panel Analysis

This study sought to examine assumption between having ever used non-cigarette tobacco or smokeless tobacco, and a diagnosis of hypertension among a sample of 13, 086 United States adults participating in the National Health Interview Series from 2012-2014. A pseudo-panel analysis of data extracted from the Integrated Health Interview Series Survey was conducted. The generalized linear mixed model was used to quantify the effect of a history of non-cigarette tobacco, smokeless tobacco, and socio-demographic predictor variables on the response variable, a diagnosis of hypertension. The transformed data, based on the pseudo-panel technique, resulted in fifty-seven (57) birth cohorts and followed in 2012, 2013, and 2014. The mean age was 51.6 years (±12.4). The findings of this study revealed that the odds of hypertension diagnosis for non-cigarette tobacco users was 0.8846 times lower (95% CI: 0.7907, 0.9896) than non-users after adjusting for possible confounders such as age, language, education, income and years of smoking. Our study suggested that the association between the use of non-cigarette tobacco and the diagnosis of hypertension among the sample population is consistent enough to assume a less plausible association between the two variables

Association between Non-Cigarette/Smokeless Tobacco and Hypertension in the National Health Interview Survey: A Pseudo-Panel Analysis

This study sought to examine assumption between having ever used non-cigarette tobacco or smokeless tobacco, and a diagnosis of hypertension among a sample of 13, 086 United States adults participating in the National Health Interview Series from 2012-2014. A pseudo-panel analysis of data extracted from the Integrated Health Interview Series Survey was conducted. The generalized linear mixed model was used to quantify the effect of a history of non-cigarette tobacco, smokeless tobacco, and socio-demographic predictor variables on the response variable, a diagnosis of hypertension. The transformed data, based on the pseudo-panel technique, resulted in fifty-seven (57) birth cohorts and followed in 2012, 2013, and 2014. The mean age was 51.6 years (±12.4). The findings of this study revealed that the odds of hypertension diagnosis for non-cigarette tobacco users was 0.8846 times lower (95% CI: 0.7907, 0.9896) than non-users after adjusting for possible confounders such as age, language, education, income and years of smoking. Our study suggested that the association between the use of non-cigarette tobacco and the diagnosis of hypertension among the sample population is consistent enough to assume a less plausible association between the two variables

Expanding the Role of Nurses to Improve Hypertension Care and Control Globally

The role of the nurse in improving hypertension control has expanded over the past 50 years, complementing and supplementing that of the physician. Nurses' involvement began with measuring and monitoring blood pressure (BP) and patient education and has expanded to become one of the most effective strategies to improve BP control. Today the roles of nurses and nurse practitioners (NPs) in hypertension management involve all aspects of care, including (1) detection, referral, and follow up; (2) diagnostics and medication management; (3) patient education, counseling, and skill building; (4) coordination of care; (5) clinic or office management; (6) population health management; and (7) performance measurement and quality improvement. The patient-centered, multidisciplinary team is a key feature of effective care models that have been found to improve care processes and control rates. In addition to their clinical roles, nurses lead clinic and community-based research to improve the hypertension quality gap and ethnic disparities by holistically examining social, cultural, economic, and behavioral determinants of hypertension outcomes and designing culturally sensitive interventions to address these determinants

Controlling High Blood Pressure: An Evidence-Based Blueprint for Change

High Blood Pressure (HBP) is a major risk factor for cardiovascular disease and related mortality, with recent estimates that show that 46% (or 116 million) of US adults have HBP. Despite strong guideline-based recommendations for the accurate diagnosis and effective treatment of HBP, existing quality measures for BP control have not changed over the past several years, and now may be worsening during the COVID-19 pandemic. Internationally recognized experts will discuss urgent imperatives for a new, cross-cutting “Blueprint for Change”, calling on leaders of health systems, payers, public health and technology companies to work collaboratively to measurably improve Guideline-based through a new system of care delivery for the many Americans with HBP. Co-sponsored with: AJMQ and ACMQ Presentation: 1:00:3

Use of Self-Measured Blood Pressure Monitoring to Improve Hypertension Equity.

Purpose of reviewTo evaluate how self-measured blood pressure (SMBP) monitoring interventions impact hypertension equity.Recent findingsWhile a growing number of studies have recruited participants from safety-net settings, racial/ethnic minority groups, rural areas, or lower socio-economic backgrounds, few have reported on clinical outcomes with many choosing to evaluate only patient-reported outcomes (e.g., satisfaction, engagement). The studies with clinical outcomes demonstrate that SMBP monitoring (a) can be successfully adopted by historically excluded patient populations and safety-net settings and (b) improves outcomes when paired with clinical support. There are few studies that explicitly evaluate how SMBP monitoring impacts hypertension disparities and among rural, low-income, and some racial/ethnic minority populations. Researchers need to design SMBP monitoring studies that include disparity reduction outcomes and recruit from broader populations that experience worse hypertension outcomes. In addition to assessing effectiveness, studies must also evaluate how to mitigate multi-level barriers to real-world implementation of SMBP monitoring programs

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

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. 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. 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. 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%. 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 sequela

Engaging Communities to Improve Healthcare for Non-communicable Diseases: Notes from the Field in Southeastern Nigeria

In rural communities in low-and middle-income countries like Nigeria, healthcare is a patchwork of services. Only a small portion of the healthcare provision in Nigeria comes from a unified health system. Therefore, remote and rural communities receive minimal preventive health services. Medical missions can play a critical role in closing gaps in care and improving healthcare access for vulnerable populations. However, long-term sustainability is difficult to achieve without deliberate community engagement from planning to evaluation. In this manuscript, the authors describe a collaborative, community-engaged global health service project in rural southeastern Nigeria that included medical missions and provided continuous care of non-communicable diseases post-mission for sustained impact. The authors conclude with insights gained regarding the challenges of engaging communities at a distance through translational collaboration as well as implications for conducting such work

The Association Between Acculturation and Cardiovascular Disease Risk in Ghanaian and Nigerian-born African Immigrants in the United States: The Afro-Cardiac Study

The burden of cardiovascular disease (CVD) risk in ethnic minorities in the United States (US) is high. Acculturation may worsen or improve cardiovascular health in immigrants. We sought to examine the association between acculturation and elevated cardiovascular disease risk in African immigrants, a growing immigrant population in the US. We conducted a cross-sectional study of Ghanaian and Nigerian born-African immigrants in the US. To determine whether acculturation was associated with having elevated CVD risk (defined as ≥3 CVD risk factors or Pooled Cohort Equations score ≥7.5%), we performed unadjusted and adjusted logistic regression analyses. For both outcomes, sex-specific models were fitted. Participants (N = 253) were aged 35-74 years and resided in Baltimore-Washington-D.C. The mean age (SD) was 49.5 (9.2) years and 58% were female. Residing in the US for ≥10 years was associated with an almost fourfold (95% CI 1.05-14.35) and eightfold (95% CI 2.09-30.80) greater odds of overweight/obesity and elevated CVD risk respectively in males. Females residing in the US for ≥10 years had 2.60 times (95% CI 1.04-6.551) greater odds of hypertension than newer residents. Participants were classified according to acculturation strategies: Integrationists, 166 (66%); Traditionalists, 80 (32%); Marginalists, 5 (2%); and Assimilationists, 2 (1%). Integrationists had a 0.46 (95% CI 0.24-0.87) lower odds of having ≥3 CVD risk factors and 0.38 (95% CI 0.18-0.78) lower odds of having elevated CVD risk (Pooled Cohort Equations score ≥7.5%) than Traditionalists. Although longer length of stay was associated with CVD risk, Integrationists had lower CVD risk than Traditionalists. Our results suggest that coordinated public health responses to the epidemic of CVD risk factors in the US should target this understudied population. Acculturation should be considered as a meaningful contributor of increased CVD risk and acculturation strategies may be used to tailor interventions in African immigrants. Promoting successful integration may reduce immigrants' CVD ris