Differences In Prevalence Of Hypertension Research Articles

Neighborhood Stressors and Race/Ethnic Differences in Hypertension Prevalence (The Multi-Ethnic Study of Atherosclerosis)

The reasons for racial/ethnic disparities in hypertension (HTN) prevalence in the United States are poorly understood. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether individual- and neighborhood-level chronic stressors contribute to these disparities in cross-sectional analyses. The sample consisted of 2,679 MESA participants (45-84 years) residing in Baltimore, New York, and North Carolina. HTN was defined as systolic or diastolic blood pressure ≥140 or 90 mm Hg, or taking antihypertensive medications. Individual-level chronic stress was measured by self-reported chronic burden and perceived major and everyday discrimination. A measure of neighborhood (census tract) chronic stressors (i.e., physical disorder, violence) was developed using data from a telephone survey conducted with other residents of MESA neighborhoods. Binomial regression was used to estimate associations between HTN and race/ethnicity before and after adjustment for individual and neighborhood stressors. The prevalence of HTN was 59.5% in African Americans (AAs), 43.9% in Hispanics, and 42.0% in whites. Age- and sex-adjusted relative prevalences of HTN (compared to whites) were 1.30 (95% confidence interval (CI): 1.22-1.38) for AA and 1.16 (95% CI: 1.04-1.31) for Hispanics. Adjustment for neighborhood stressors reduced these to 1.17 (95% CI: 1.11-1.22) and 1.09 (95% CI: 1.00-1.18), respectively. Additional adjustment for individual-level stressors, acculturation, income, education, and other neighborhood features only slightly reduced these associations. Neighborhood chronic stressors may contribute to race/ethnic differences in HTN prevalence in the United States.

Social disparities in prevalence, treatment and control of hypertension in Iran: Second National Surveillance of Risk Factors of Noncommunicable Diseases, 2006

Assessing hypertension prevalence, treatment and control by sociodemographic factors in Iran. We analyzed data from the 2006 National Surveillance of Risk Factors for Noncommunicable Diseases of Iran with a population-based sample of almost 30,000 people aged 15-64 years. Multiple logistic regression models were used to explore differences in hypertension prevalence, treatment and control, adjusting for sociodemographic factors, comorbidities and behavioral factors. Hypertension prevalence was 17.37%. Among hypertensive patients, 33.35% were under treatment, and, among treated people, 35.10% had hypertension controlled. In multiple-regression analysis, age, male sex, low level of education, Kurd ethnicity, overweight and obesity, diabetes mellitus, lower level of physical activity and high-Human Development Index provinces were independently associated with higher prevalence of hypertension. Income and living in rural or urban area were not related to hypertension prevalence. Treatment rates were lower in men, younger people and people of low education and low income, but there were no treatment rate disparities connected to living area, ethnicity and provinces (by Human Development Index). In addition, diabetic patients, obese people and past daily smokers had higher treatment rates. Lower control rates were independently associated with male sex, higher age and lower education, but not with other variables. In Iran, there is comparatively higher prevalence of hypertension among people of Kurdish ethnicity, people of low education and in high-Human Development Index provinces; a lower treatment rate among men, younger people, people of low education and low income; and a lower control rate among men and people of low education. These disparities should be addressed by researchers and health policy makers.

Depression and hypertension among Chinese nonagenarians and centenarians

In this study, we explored association between hypertension and depression in the very elderly using a sample ranged in age from 90 to 108 years. A cross-sectional study. The sample included 687 unrelated Chinese nonagenarians/centenarians (67.4% women, mean age 93.51 years). The mean depression score (measured with brief 23-item geriatrics depression scale Chinese-edition (GDS-CD)) was 8.46 (standard deviation (SD) 3.33 range 0-20). There was no significant difference in depression scores between subjects with and without hypertension and there was also no significant difference in depression prevalence between subjects with and without hypertension. There was no significant difference in prevalence of hypertension between subjects with and without depression and there were also no significant differences in levels of arterial blood pressure (including SBP and DBP). Neither odd ratio (OR) of depression as a function of increased hypertension nor OR of hypertension as a function of increased depression was significant. In summary, we found that depression was not directly correlated with hypertension among Chinese nonagenarians and centenarians.

Analysis of Factors Associated with Renal Function in Chinese Adults with Congenital Solitary Kidney

Patients with congenital solitary kidney have an increased risk of developing hypertension, proteinuria and renal insufficiency. However, the specific factors associated with the progression of renal function in adults with congenital solitary kidney remain still unclear. The purpose of this study was to identify factors that are independently associated with renal function progression in patients with congenital solitary kidney. Sixty-five Chinese adults with congenital solitary kidney (48 patients with unilateral renal agenesis and 17 with severe unilateral renal dysplasia) were recruited into our study retrospectively. Clinical data were analyzed. Of sixty-five patients with congenital solitary kidney, the prevalence of hypertension, proteinuria and renal insufficiency was 36.9%, 35.4% and 38.5%, respectively. There was no significant difference in the glomerular filtration rate (GFR) between patients with and without hypertension, whereas GFR in patients with proteinuria was significantly lower than in those without proteinuria (p<0.05). While there was no statistically significant difference in prevalence of hypertension between patients with and without renal insufficiency, the prevalence of proteinuria in patients with renal insufficiency was significantly higher than in those without renal insufficiency (p<0.05). Logistic regression analysis revealed that kidney length and proteinuria were independently associated with the progression of renal function (OR=0.20, 95%CI 0.05-0.79, and OR=8.30, 95%CI 2.30-29.96, respectively). Hypertension, proteinuria or renal insufficiency was present in approximately one-third of adults with congenital solitary kidney. Those with a kidney length of less than 120 mm or proteinuria had a much higher risk of renal insufficiency.

Risk factors for the occurrence of cardovascular system diseases in students

Cardiovascular diseases are a leading cause of death in the majority of developed, as well as in many developing countries. The aim of this study was to determine cardiovascular risk factors in student population and to suggest possible measures for prevention. The study was carried out during 2007-2008 at the School of Medicine, University of Nis. It included 824 students in their final year (220 males, 604 females). There was no significant difference in prevalence of hypertension among the male (1.81%) and female students (0%). The prevalence of obesity (Body Mass Index - BMI > 30 kg/m2) was significantly higher (p < 0.001) in the male (7.27%) than in the female population (1.32%). Abdominal obesity was also more frequently encountered (p < 0.01) in the male (9.09%) than in female population (1.32%). Every fourth student smoked cigarettes with no significant difference between the male and female students. Alcohol consumption was a significantly higher problem (p < 0.001) in the male population (18.18%) than in the female one (2.65%). Physical inactivity was more often found (p < 0.001) in the female students (65.56%), than in male ones (36.36%). By the bivariate correlation of cardiovascular risk factors, it was determined that in the male student population systolic blood pressure correlated significantly with diastolic blood pressure, BMI and waist size, whereas age correlated with sistolic blood pressure, waist size and smoking. In the female students sistolic blood pressure correlated with diastolic blood pressure, BMI and waist size; diastolic blood pressure correlated with BMI and physical inactivity; cigarette smoking correlated with alcohol consumption and age. Cardiovascular risk factors are present in the final-year students of the School of Medicine, University of Nis. It is necessary to insist on decreasing obesity prevalence, cigarette and alcohol consumption, and on increasing physical activity of students in order to prevent cardiovascular diseases.

Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients

Background. Numerous reports have linked atypical antipsychotics, especially clozapine and olanzapine, to the development of cardiovascular risk factors. In this retrospective chart review study, we investigated the blood pressure changes in Korean schizophrenic inpatients treated with clozapine or olanzapine. Method. We reviewed the medical record of schizophrenic patients treated with clozapine or olanzapine for 8 weeks. A total of 167 patients were included in the study; 70 patients in clozapine group and 97 patients in olanzapine group. Systolic and diastolic blood pressures prior to medication and at post-treatment (8-week) were assessed, and changes in blood pressure were analyzed. The prevalence of hypertension at the time of study period was assessed and compared between the two groups. Results. There was a significant difference in hypertension prevalence in comparisons between the clozapine and olanzapine group. The systolic and diastolic blood pressures in the clozapine group were significantly increased after treatment, but systolic and diastolic blood pressures in olanzapine group did not change significantly. Conclusion. Our findings suggest that clozapine treatment may be associated with increased blood pressure and higher prevalence of hypertension, which may have a significant impact on medical morbidity and mortality.

Death Toll From Uncontrolled Blood Pressure in Ethnic Populations: Universal Access and Quality Improvement May Not Be Enough

Cardiovascular disease (CVD) is the number 1 cause of death globally.1 An estimated 17.5 million people died from CVD in 2005 (7.6 million from coronary heart disease and 7.6 million from stroke), representing 30% of all global deaths.2 Globally, two-thirds of stroke and one-half of ischemic heart disease are attributable to nonoptimal blood pressure. Worldwide, nonoptimal blood pressure contributes to approximately 12.8% of all deaths (7.1 million) and 4.4% of all disability-adjusted life years (64.3 million) in the year 2000. These proportions are highest in more developed countries, such as the United States and the United Kingdom.3 Racial and ethnic disparities in cardiovascular disease prevalence, treatment, and outcomes are well documented in the United States, and racial and ethnic differences in hypertension are no exception.4-7 Cardiovascular disease accounts for 35% of excess overall mortality in US blacks, largely because of hypertension.8 In Europe, ethnic differences in hypertension prevalence and morbidity and mortality from cardiovascular disease have also been described.

Gender-Specific Differences in Hypertension Prevalence, Treatment, Control, and Associated Conditions among the Elderly: Data from a Greek Population

Purpose. In the present study we sought to assess the gender-specific prevalence, treatment rates, and control of hypertension, as well as to identify its associated conditions and additional cardiovascular (CV) risk factors, in a Greek population aged ≥ 65 years old. Methods. This is a population-based study including a clinical interview, an ECG recording, and blood pressure (BP) measurements by sphygmomanometer. Results. The overall prevalence of hypertension was 83.3%, higher in females and increasing with age. In males, hypertension was independently associated with increased body mass index (BMI), a history of stroke, and myocardial infarction, while in females increased age, BMI, and a history of diabetes were independently associated with hypertension. A considerable proportion of hypertensives were treated (77.3%), while an effective control of BP was achieved in 42.5% of treated subjects. Despite the fact that hypertension treatment rates did not differ between the genders, control rates were lower among females. Finally, more hypertensive females presented additional CV risk factors than normotensives. Conclusion. Elderly females exhibit a higher prevalence of hypertension and are characterized by lower hypertension control compared to hypertensive males.

Hypertension in peritoneal dialysis patients

Continuous ambulatory peritoneal dialysis (CAPD) is effective in reducing blood pressure. Mean arterial pressure falls within 6 months of starting CAPD in the majority of patients. This improved blood pressure control reflects removal of excess fluid volume and body sodium. However, after several years, there is a decline in the efficacy of CAPD in controlling blood pressure. High incidence of hypertension in long-term CAPD patients may be related to hypervolemia as a consequence of loss of residual renal function (RRF), loss of ultrafiltration (UF) due to functional or structural changes in the peritoneal membrane, to a more liberated intake of sodium and fluid, or to administration of erythropoietin. The aim of the present study was to compare the efficacy in blood pressure contol in peritoneal dialysis patients depending on the dialysis modality and duration, RRF and dialysis adequacy. This study was a retrospective analysis of 67 patients who attended our Clinic monthly in 2003. All patients received antihypertensive therapy (monotherapy - 16 pts, two drugs - 27 pts, three drugs - 22 pts and four - 2 pts.). The prevalence of hypertension (TA > 140/90 mmHg) was 73.13%. Most of them (50.75%) had mild hypertension (mean value TA <160/100 mmHg). There was no statistically significant difference in hypertension prevalence between diabetic (78.27%) and non-diabetic patients (75%). The prevalence of hypertension in patients with residual diuresis of more than 1000 ml was 36.6%, but there were 80.64% patients with residual diuresis less than 500 ml. A statistically significant negative correlation was found between D/D0, UF volume and systolic blood pressure and RRF, D/D0 and Ccr and diastolic blood pressure. A statistically significant positive correlation was found between age, body weight, duration of dialysis and systolic blood pressure and age and diastolic blood pressure. We can conclude that duration of PD treatment has a negative effect on blood pressure control. Residual renal function plays an important role in volume and blood pressure control. High and high average transporters are the two groups of patients at increased risk of developing hypertension, especially if they are anuric.

Hypertension in HIV-Infected Patients: Prevalence and Related Factors

Little is known about hypertension in the HIV-infected population. This study aimed to assess the prevalence of hypertension and related factors in HIV-infected patients. In this prospective cross-sectional study, 710 HIV-infected patients (626 on combination antiretroviral therapy and 84 naive) managed at the outpatient clinic of a tertiary hospital during 2003 and 802 controls completed the study protocol consisting of medical examination and a 6-month follow-up period including three control visits. Hypertension prevalence was 13.1% in HIV-infected patients and 13.5% in the control group. Age (per 10-year increment) (odds ratio [OR]: 1.92; 95% confidence interval [CI]: 1.48-2.48), body mass index (OR: 1.18; 95% CI: 1.10-1.27), and lipoaccumulation pattern of fat redistribution (OR: 2.26; 95% CI: 1.20-4.24) were independently and significantly associated with the presence of hypertension in HIV-infected patients at logistic regression analysis. The present results suggest no meaningful difference in prevalence of hypertension between subjects with and without HIV infection. Thus, the influence of combination antiretroviral therapy appears to have little impact on the prevalence of hypertension.

Racial disparities in hypertension prevalence, awareness, and management.

Effectively reducing cardiovascular disease disparities requires identifying and reducing disparities in risk factors. Improved understanding of hypertension disparities is critical. Cross-sectional analysis of nationally representative samples of black and white adults 20 years and older who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2002 (white, n = 4624; black, n = 1837) and NHANES III conducted in 1988-1994 (white, n = 7121; black, n = 4709). We examined differences in hypertension prevalence, awareness, treatment, and blood pressure (BP) control among both treated and prevalent cases across the 2 periods. Hypertension prevalence increased significantly from 35.8% to 41.4% among blacks and from 24.3% to 28.1% among whites and remains significantly higher among blacks. Awareness is higher among blacks (77.7% vs 70.4%; P<.001), as is treatment (68.2% vs 60.4%; P<.001). These results are driven by higher rates in black women. Blood pressure control rates among those treated have increased in both races, primarily as a result of increased BP control in black and white men (27.3% and 44.7%, respectively; P<or=.03). Despite the improved BP control rates, disparity in BP control among treated cases increased, with 59.7% of treated whites and 48.9% of treated blacks now reaching BP goal (P<.001). Racial differences in BP control rates among those treated cannot be explained by nonpharmacologic management or health insurance, but educational attainment is associated with BP control. The higher prevalence of hypertension in blacks and the growing disparity in BP control among those treated pharmacologically are causes for concern.

Prevalence of hypertension and ethnic differences in sociodemographic and cardiovascular health characteristics of U.S. hypertensives

To measure the prevalence of hypertension (HTN) in the US population as well as ethnic minorities and compare their sociodemographic and health-related characteristics. The National Health and Nutrition Examination Survey (NHANES) 2001–2002 (n=11,039) was used to identify hypertensive participants≥18 years old of Hispanic, Black, White, and “Other” ethnicity (n=5,993). HTN was defined as SBP≥140mmHg or DBP≥90mmHg, current antihypertensive drug use, or told by health professional to have high BP. Descriptive statistics were performed on demographic, socioeconomic, and comorbidity data for hypertensives. Age-adjusted prevalence of HTN was 33% with prevalence of 29% among Hispanics (mean 51 yrs, 46% male), 46% in Blacks (mean 50 yrs, 48% male), 32% in Whites (mean 58 yrs, 47% male) and 33% in “other” ethnic groups (mean 56 yrs, 37% male). Hispanics and Blacks had lower levels of education and annual income and greater difficulty accessing health care as compared to Whites and “other” groups. Of all hypertensives, 55.2% were treated with antihypertensive medication with BP found to be controlled (<140/90mmHg) in 45%. Treatment and control rates among participants receiving antihypertensive therapy were, respectively:43% and 43% in Hispanics, 59% and 42% in Blacks, 57% and 46% in Whites and 63% and 47% in “others”. Among hypertensives, diabetes was prevalent in 27% of Hispanics (mean HgA1c 7.8), 23% of Blacks (mean HgA1c 7.8), 17% of Whites (mean HgA1c 7.1) and 20% of “others” (mean HgA1c 6.9). Cardiac disease (i.e. having being diagnosed with CHF, CHD, angina or prior MI) was prevalent in 12%, 16%, 20% and 11% of Hispanics, Blacks, Whites or “others”, respectively. Prevalence of HTN is increasing in the US with BP control rates remaining low. Significant differences in prevalence of HTN, BP treatment and control rates, access to health care and other underlying characteristics exist across ethnic groups in the USA. Important differences in prevalence of diabetes or cardiac disease were observed.

Sex-differences in prevalence of electrocardiographic left ventricular hypertrophy in Type 2 diabetes: the Casale Monferrato Study.

AIMS Although left ventricular hypertrophy (LVH) defined by either standard 12-lead ECG or echocardiography strongly predicts cardiovascular mortality, its prevalence in Type 2 diabetes is largely unknown. We have assessed prevalence of ECG-LVH and its relationship with clinical and metabolic variables in an Italian population-based cohort of subjects with Type 2 diabetes. METHODS The study-base was 965 (61.3%) subjects with Type 2 diabetes of the population-based cohort living in Casale Monferrato (Italy). LVH was defined by ECG Cornell voltage-duration product. All measurements were centralized. RESULTS ECG-LVH was diagnosed in 165/965 subjects, giving a prevalence of 17.1% (95% CI 14.7-19.5). Large sex differences were found, with higher prevalence in women (23.5%, 19.9-27.0) than in men (8.4%, 5.6-11.0), even after adjustment for age, BMI and hypertension (OR 3.83, 95% CI 2.5-5.9). At the examination, subjects with ECG-LVH were older than those without it. Similar age- and sex-adjusted values of HbA(1c), plasma lipids, fibrinogen, uric acid and creatinine were found in the two subgroups. No differences in prevalence of hypertension, CHD, increased QT duration or dispersion, micro- and macro-albuminuria were found between subjects with ECG-LVH and those without it. In logistic regression analysis, variables independently associated with ECG-LVH, after age-adjustment, were sex and diastolic blood pressure. This population-based study shows: (i) a high prevalence of ECG-LVH in Type 2 diabetic subjects; (ii) 3-fold higher risk in women than in men, independently of age, BMI, and blood pressure; (iii) an independent association between ECG-LVH and diastolic blood-pressure. Screening for ECG-LVH in diabetic subjects is therefore recommended, particularly in diabetic women.

Efficacy and safety of sildenafil citrate (Viagra ®) in black and Hispanic American men

The objective of this study was to assess the efficacy and safety of sildenafil citrate (Viagra) in black American and Hispanic American men with erectile dysfunction (ED) of broad-spectrum etiology. A total of 246 black American and 197 Hispanic American men were randomized to sildenafil (50 mg, adjustable to 25 mg or 100 mg, depending on efficacy and tolerability; n = 124 and n = 99, respectively) or matching placebo (n = 122 and n = 98, respectively). After 6 weeks, patients were given the option of switching to the other blinded treatment for the following 6 weeks. The 12 weeks of double-blind treatment were followed by 12 weeks of open-label extension. Despite differences in prevalence of hypertension, diabetes mellitus, hyperlipidemia, and use of concomitant antihypertensive agents between the 2 study groups, sildenafil was efficacious and well tolerated. After 6 weeks, scores for questions 3 and 4 from the International Index of Erectile Function (IIEF) were significantly higher among sildenafil-treated black and Hispanic patients than in placebo-treated patients. In addition, compared with placebo, a significantly larger proportion of sildenafil patients reported improved erections and improved ability to have sexual intercourse. When efficacy results were stratified by ED severity or number of risk factors, scores for IIEF questions 3 and 4 were lower in men with severe ED versus mild-to-moderate ED. Similarly, the percentage of patients reporting improved erections decreased with ED severity and number of risk factors. The proportion of patients switching to the other treatment after 6 weeks was significantly higher in the placebo group (71% to 85%) than in the sildenafil group (27% to 28%). The most common adverse events included headache and vasodilation, which were mild to moderate in nature and were comparable between groups. These data demonstrate that despite differences in prevalence rates of comorbidities, efficacy and safety of sildenafil is maintained across different ethnic groups.

Physical Activity and Ethnic Differences in Hypertension Prevalence in the United States

Background. In the United States, non-Hispanic blacks have higher rates of hypertension than other ethnic groups. In addition, they have higher rates of physical inactivity, a behavior linked to high blood pressure. We examined associations between ethnicity, leisure-time physical activity (LTPA), and hypertension prevalence in a representative sample of U.S. adults.Methods. Using data on 16,246 adults in the third National Health and Nutrition Examination Survey, hypertension prevalence was determined for non-Hispanic white, non-Hispanic black, and Mexican Americans at various levels of LTPA (none, 0.1–4.9 bouts/week at any intensity, 5+ bouts/week of moderate-to-vigorous activity). Logistic regression was used to examine relationships between hypertension prevalence, race, LTPA, and other variables.Results. Hypertension prevalence was significantly less in the most active group, compared with their sedentary peers (odds ratio = 0.73, CI 0.59 to 0.90). Blacks had an odds ratio for hypertension of 1.77 (CI 1.49 to 2.10) compared with non-Hispanic whites, after adjusting for gender, age, income, LTPA, smoking, BMI, salt intake, rural/urban dwelling, and alcohol intake. Mexican Americans had an adjusted odds ratio of 0.75 (CI 0.62 to 0.89), relative to non-Hispanic whites.Conclusion. Ethnicity and LTPA are both associated with hypertension prevalence after controlling for each other, as well as other confounders. Thus, race and physical activity are important independent contributors to hypertension prevalence.

Hypertension and its determinants among adults in high mountain villages of the Northern Areas of Pakistan.

We studied the prevalence and determinants of hypertension among adults in mountainous rural villages in the Ghizar district Northern Areas of Pakistan, an area that recently has undergone substantial economic development. We selected a stratified random sample of 4203 adults (age > 18 years) from 16 villages in Punial Valley of Ghizar district where the number of study subjects from each village was proportionate to the size of the village. We obtained blood pressure (BP) records by taking the mean of the second and third BP measurement, using a standard mercury sphygmomanometer, and assessed risk factors for hypertension in the study subjects. The mean +/- s.d. blood pressures (mm Hg) were 125 +/- 19 systolic and 80 +/- 12 diastolic in men and 125 +/- 22 systolic and 78 +/- 14 diastolic in women. The 125 +/- 22 systolic and 78 +/- 14 diastolic in women. The mm Hg, or systolic BP > or = 140 mm Hg or currently taking antihypertensive medication) was 15%, increasing from 4% in the 18-29 year age group to 36% among persons 60 years of age or older. The age-standardised prevalence of hypertension was 14% (12.5% among men and 14% among women). There was no significant difference in prevalence of hypertension in males, and in females. Multivariate analysis revealed that age, and higher body mass index (overweight and obesity) were independently associated with higher prevalence of hypertension. People with hypertension were more likely to have a first-degree relative with physician-diagnosed hypertension (OR = 1.90, 95% CI 1.49, 2). Hypertension is a significant health problem in rural northern Pakistan. The primary health care programme in the Northern Areas of Pakistan needs to address this problem, especially identifying people at risk.

Gender differences in emotional disability and negative health perception in cardiac patients 6 months after stent implantation

Objectives: In this study we evaluate gender differences in affective adaptation and health perception in patients 6 months after stent implantation. Background: Assessment of gender-specific behavioral strategies to cope with serious cardiac disease conditions has not been given much attention until now. Preliminary data suggest greater impairments in female patients, which might be of clinical relevance. Methods: Three hundred seventeen patients were eligible for the 6-month follow-up investigation, 78 (24.6%) of whom were women. The women were significantly older but did not differ from men in their cardiac risk features and treatment procedures. There were no gender differences in prevalence of hypertension, hypercholesterolemia, and family history. Men had a significantly higher prevalence of smoking than women, whereas women had a significantly higher prevalence of diabetes than men. A structured interview and a standardized psychodiagnostic assessment was carried out, which covered domains of affective dysfunction (depression, anxiety, intrusion, and avoidance), vegetative symptoms (sleeping disorders), and parameters of negative health perception. Results: There were no significant gender differences in the prevalence of depressive symptoms. Women exhibited higher mean values of anxiety than men, which did not reach significance. Sleeping disorders were significantly more prevalent in women. The absolute level of being distressed by intrusive thoughts and avoidance behavior related to the severe underlying disease process was low in the total group of patients examined. Measurable gender differences did not emerge. Fifty-one (16.5%) patients exhibited pessimistic anticipation of dire consequences and severe signs of negative health perception (NHP group). There was a trend, although not statistically significant, toward more women being in the NHP group. The distribution of cardiac risk factors, however, was completely balanced in the NHP + and NHP − patient groups. Objective somatic cardiac disease parameters did not account for the negative health perception. NHP was, however, associated with significantly more prestent angina pectoris ( p < 0.040) and poststent angina pectoris ( p < 0.0001). High levels of anxiety, depression, and of disturbed sleep also led to a sharp separation between patients with high degrees of an anticipated incapacitation due to the disease process. Univariate regression analysis suggested an effect of female gender on the occurrence of NHP (odds ratio 1.70; 95% CI 0.88 to 3.25), which was of borderline significance. Control for confounders in a multiple regression model, however, eliminated the gender effect (odds ratio 1.04, 95% CI 0.48 to 2.23). Poststent chest pain (odds ratio 7.75, 95% CI 3.28 to 18.32) and sleeping disorders (odds ratio 1.32, 95% CI 1.16 to 1.51) were identified as the most powerful confounders of the gender–NHP association. Conclusion: Contrary to expectation, women were not per se more distressed than men in all areas of adaptation of the midterm course after stent implantation, although the higher levels of anxiety and sleeping disorders in women deserve attention. A considerable proportion of patients exhibited a pessimistic disease perspective independent of their somatic status, which was associated with affective morbidity. The tendency toward more negative health perception in women may be due to their more frequent occurrence of chest pain and sleeping disorders.

Geographic variation in stroke risk in the United States. Region, urbanization, and hypertension in the Third National Health and Nutrition Examination Survey.

In the United States, stroke mortality is higher in the south than in other regions. Hypertension is the main risk factor for stroke among older adults; however, few studies have examined group-specific regional and urbanization differences in hypertension prevalence. Data from the Third National Health and Nutritional Examination Survey (NHANES III), 1988 to 1994, were analyzed to calculate the prevalence of hypertension (systolic >140 mm Hg and/or diastolic >90 mm Hg and/or taking antihypertensive medication) by region and urbanization for age (40 to 59 and 60 to 79 years), sex, and ethnic subgroups. Logistic regression models were fitted to estimate the association of hypertension with region and urbanization. With age and urbanization kept constant, southern residence was associated with hypertension among middle-aged non-Hispanic white men (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.12 to 1.90; P<0.006), non-Hispanic black men (OR, 1.36; 95% CI, 1.05 to 1.66; P=0.019), and non-Hispanic black women (OR, 1.23; 95% CI, 1.01 to 1.45; P=0.034). Among older non-Hispanic white men, a significant interaction was noted between region and urbanization (P=0.01), with a higher prevalence in the south only for nonmetropolitan residents (OR, 1.32; 95% CI, 1.06 to 1.56; P<0.013). A similar but not statistically significant trend was also confirmed among non-Hispanic black men in logistic regression analysis (OR, 1.38; 95% CI, 0.97 to 1.68; P=0.061). No statistically significant association was observed for urbanization or region in the other subgroups. Southern residence was associated with increased hypertension prevalence among middle-aged non-Hispanic white men, non-Hispanic black men and women, and older non-Hispanic white men.

Do ethnic differences in dietary cation intake explain ethnic differences in hypertension prevalence? Results from a cross-sectional analysis

PURPOSE: To better understand how the magnitude of the association between ethnicity and hypertension is affected by ethnic differences in dietary cation intake, we describe differences in dietary cation intakes and prevalence of hypertension across four ethinic groups (African-Americans, European-Americans, Mexican-Americans, and Puerto Ricans). We also assess the cross-sectional association between: ( i) hypertension and self-reported dietary intakes of sodium, potassium, and calcium for each ethnic group; and ( ii) ethnicity and hypertension before and after adjustment for dietary cation intakes. METHODS: Data from the Second National Health and Nutrition Examination Survey (1976–1980) and the Hispanic Health and Nutrition Examination Survey (1982–1984) were analyzed. Multiple logistic regression was used to estimate odds ratio (OR) for hypertension for each ethnic group, with adjustment for age, body mass index (BMI), and diabetes status. Comparisons were made to assess whether the magnitude for the ethnicity ORs changed when the three nutrient variables were entered into the model. RESULTS: Mexican-American and Puerto Rican men and women showed clinically and statistically significantly higher mean intakes of the three cations than did African-American men and women, who reported clinically and statistically significantly lower mean intakes of sodium, potassium, and calcium than did European-American men and women. Mean dietary intakes of potassium and calcium were higher for normotensives than for hypertensives among all ethnic groups, except African-American and Mexican-American women. In multivariate modeling, stark differences in ORs for hypertension persisted across ethnic groups despite inclusion of the nutrient variables. CONCLUSION: In this cross-sectional study, adjustment for dietary cation intakes did not alter the magnitude of the ethnic differences in prevalence of hypertension.

Prevalence of hypertension in Mexico City and San Antonio, Texas.

Few data are available on the prevalence of hypertension in Mexico. We compared the prevalence of mild hypertension (systolic blood pressure > or = 140 mm Hg and/or diastolic blood pressure > or = 90 mm Hg and/or use of antihypertensive medications) in 1500 low-income Mexican Americans who participated in the San Antonio Heart Study and 2280 low-income Mexicans who participated in the Mexico City Diabetes Study. The crude prevalence of mild hypertension was 17.1% in Mexican men versus 24.4% in Mexican American men (P = .001) and 17.4% in Mexican women versus 22.0% in Mexican American women (P = .005). After adjustment for age, body mass index (BMI), waist-to-hip ratio (WHR), non-insulin dependent diabetes mellitus (NIDDM), educational attainment, and percent native American genetic admixture (Caucasian and native American), the odds ratio (Mexico City/San Antonio) was 0.55 (95% CI, 0.39, 0.77; P < .001) in men and 0.81 (CI, 0.54, 1.12; P = .201) in women. In a pooled model including both men and women, the odds ratio was 0.67 (95%, CI, 0.53, 0.84; P < .001). In the pooled model, city, age, female sex, NIDDM, BMI, WHR, and low educational attainment were significantly related to the prevalence of hypertension. The causes for these differences in hypertension prevalence are not known but may reflect a less modernized lifestyle in Mexico City, including greater physical activity, less obesity, and the consumption of a high-carbohydrate, low-fat diet.