WORLD CONGRESS ON CARDIOVASCULAR HEALTH: PREVENTING THE GLOBAL PANDEMIC IN DEVELOPING COUNTRIES
GUEST EDITORIAL
A World Congress on Cardiovascular Health in Sub-Saharan Africa: Much Ado aboutSomething!
George A. Mensah, MD
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ORIGINAL REPORTS
A Heart-Healthy and "Stroke-Free'' World Through Policy Development, Systems Change, and Environmental Supports: A 2020 Vision for Sub-Saharan Africa
George A. Mensah, MD
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Capacity Building for an Integrated Noncommunicable Disease Risk Factor Surveillance System in Developing Countries
Timothy Armstrong, PhD; Ruth Bonita, PhD, MDhc
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Public Health Surveillance for Disease Prevention: Lessons from The Behavioral Risk Factor Surveillance System
Ali H. Mokdad, PhD; Virginia S. Bales, MPH; Kurt J. Greenlund, PhD; George A. Mensah, MD
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The Public Health Workforce in Sub-Saharan Africa: Challenges and Opportunities
Robert Beaglehole, DSc; David Sanders, MRCP; Mario Dal Poz, PhD
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A Two-Week Workshop to Promote Cardiovascular Disease Prevention Programs in Countries with Limited Resources
Pascal Bovet, MD, MPH; Jean-Pierre Gervasoni, MD, MSc; Fred Paccaud, MD, MSc
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The Role of Professional Education in Building Capacity for Health Promotion in the Global South: A Case Study from Norway
Maurice B. Mittelmark, MA, PhD
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Research Capacity Development for CVD Prevention: The Role of Partnerships
Thomas C. Nchinda, MD, DTPH
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Transdisciplinary Approaches to Building the Capacity of the Public Health Workforce
Alyson Taub, EdD, CHES
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High Blood Pressure: The Foundation for Epidemic Cardiovascular Disease in African Populations
Richard S. Cooper, MD; Albert G. B. Amoah, MD, PhD; George A. Mensah, MD
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Genetic Epidemiology of Hypertension: An Update on the African Diaspora
Harold I. Daniel, MD, PhD; Charles N. Rotimi, PhD
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Challenges for the Management of Hypertension in Low-Resource Settings
Shanthi Mendis, MD, FRCP
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Improving Cardiovascular Disease Prevention and Management in Africa: Issues to Consider for the 21st Century
Ernest C. Madu, MD; Kelly D. Richardson, MSW; Obinna H. Ozigbo, MD; Dainia S. Baugh, MD
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Population Aging and Implications for Epidemic Cardiovascular Disease in Sub-Saharan Africa
Suzanne M. Smith, MD; George A. Mensah, MD
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Tobacco Use and the Cardiovascular Disease Epidemic in Developing Countries: Global Crises and Opportunity in the Making
Samira Asma, DDS, MPH; George A. Mensah, MD; Charles W. Warren; Rosemarie Henson
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The Tobacco Industry and Secondhand Smoke: Lessons from Central and South America
Joaquin Barnoya, MD, MPH; Stanton A. Glantz, PhD
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Optimal Nutrition for the Prevention of Coronary Heart Disease: A Worldwide Challenge
Richard C. Pasternak, MD
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Obesity in Adult Residents of Accra, Ghana
Albert G. B. Amoah MD, FRCPE, PhD
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Global Epidemic of Type 2 Diabetes: Implications for Developing Countries
Kwame Osei, MD
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Lipid and Lipoprotein Testing in Resource-Limited Laboratories
Gary L. Myers, PhD
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Prevalence and Determinants of Diabetic Retinopathy and Cataracts in West African Type 2 Diabetes Patients
Charles Rotimi, PhD; Harold Daniel, MD, PhD; Jie Zhou; Augustine Obisesan, BS; Guanjie Chen, MD, MPH; Yuanxiu Chen, MD, PhD; Albert Amoah, MD; Victoria Opoku, MD; Joseph Acheampong, MD; Kofi Agyenim-Boateng, MD; Benjamin Ackon Eghan Jr, MD; Johnnie Oli, MD; Godfrey Okafor, MD; Ester Ofoegbu, MD; Babatunde Osotimehin, MD; Fayeofori Abbiyesuku, MD; Thomas Johnson, MD; Olufemi Fasanmade, MD; Ayo Doumatey, MS; Temilolu Aje, BS; Francis Collins, PhD, MD; Georgia Dunston, PhD
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Lessons From Chronic Renal Diseases in African Americans: Treatment Implications
Lawrence Agodoa, MD
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Secondary Glomerulonephritides
Sarala Naicker, PhD, FRCP
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Increasing Trends in Pre-Transport Stroke Deaths-United States, 1990-1998
Carma Ayala, PhD; Janet B. Croft, PhD; Nora L. Keenan, PhD; Linda J. Neff, PhD; Kurt J. Greenlund, PhD; Ralph S. Donehoo, MPH; Zhi Jie Zheng, MD; George A. Mensah, MD
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Cardiovascular Disease Prevention in Low Resource Settings: Lessons from the Heartfile Experience in Pakistan
Sania Nishtar, MRCP, PhD
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Non-Communicable Diseases, Political Economy, and Culture in Africa: Anthropological Applications in an Emerging Pandemic
Philip W. Setel, PhD
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Education and Income: Double-Edged Swords in the Epidemiologic Transition of Cardiovascular Disease
Thomas A. Pearson, MD, MPH, PhD
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The Role of the World Heart Federation in Cardiovascular Health Promotion and Disease Prevention in Developing Countries with a Special Emphasis on Sub-Saharan Africa
Elinor E. Wilson, RN, PhD on behalf of the World Heart Federation
View Article
ABSTRACTS FROM THE 18TH ANNUAL INTERNATIONAL INTERDISCIPLINARY CONFERENCE ON HYPERTENSION AND RELATED RISK FACTORS IN ETHNIC POPULATIONS: ISHIB2003-WORLD CONGRESS ON CARDIOVASCULAR HEALTH: PREVENTING THE GLOBAL PANDEMIC IN DEVELOPING COUNTRIES View Article
S2-167
Ethnicity & Disease, Volume
13, Spring 2003
Abstracts
from the 18th Annual International
Interdisciplinary
Conference on Hypertension and
Related
Risk Factors in Ethnic Populations:
ISHIB2003—World
Congress on Cardiovascular
Health:
Preventing the Global Pandemic in
Developing
Countries
Hypertension
001
BURDEN
AND PATTERN OF HYPERTENSION IN
PREGNANT
MOTHERS OF SUBSAHARAN ORIGIN
BL
SALAKO; AA Odukogbe; O Olayemi; KS Adedapo;
CO
Aimakhu.
DESIGN
AND EVALUATION OF ``PARTNERSHIP
CARE
MODEL'' IN CONTROL OF HYPERTENSION
E MOHAMMADI; H Ali Abedi; F
Gofranipour; F Jalali;
A
Kazemnejad, PhD.
Tarbiat
Modarres University, Tehran, Iran; Medical Sciences
University,
Esfahan, Iran; Medical Sciences University,
Babal,
Iran.
One
of the common goals of the World Hypertension League
(WHL)
and WHO is the control of hypertension. Although each organization
has
vast local and international investigations, they have yet
to
gain significant success. More investigations are needed to find out
a
precise and suitable way to reach this goal. Based on past investigations,
this
study was done to design and evaluate a ‘‘partnership care
model’’
to control hypertension. Our study is a randomized clinical
trial
with 75 patients in an intervention group and 70 in a control
group
have been evaluated for a period of one year. The partnership
care
model has been developed and designed by qualitative research
(Grounded
theory method) by investigators. Patients’ outcomes in this
model
included: systolic and diastolic blood pressure, cardiovascular
risk
factors, clinical target organ damages (cardiac, cerebral and renal
complications),
quality of life, mortality rate and patient compliance
with
their therapeutic regimens. The results showed that the partnership
care
model is effective to decreasing systolic and diastolic blood
pressure
and increasing rate of controlled hypertension (based on criteria
of
WHO/WHL) (1.8% vs 33.3% before and after intervention
respectively).
This model also showed positive effects on health-related
quality
of life (mean increase 3.2 score) and to reduce the body mass
index
(mean decrease 1 kg/m2); anxiety (mean decrease 6 score); mitral
valve
prolapse (mean decrease 4.3%); mortality rate (4.5%); decreasing
HDL
level (mean increase 3); and compliance rates (mean
increase
3.2 score); and improving nutritional habits of the hypertensive
patients.
We recommend that this model be used to control hypertension.
006
PREVALENCE,
DETECTION, MANAGEMENT AND
CONTROL
OF HYPERTENSION IN ASHANTI, WEST
AFRICA:
DIFFERENCES BETWEEN SEMI-URBAN
AND
RURAL AREAS
FP
CAPPUCCIO1; L Emmett1; FB Micah3; SM Kerry1; RO
Phillips3
J Plange-Rhule123; JB Eastwood2.
Departments
of 1Community Health Sciences and 2Renal
Medicine,
St George’s Hospital Medical School, London (UK);
3Medicine,
KATH, Kumasi (Ghana)
Background.
Hypertension and stroke are emerging as
important
threats
to the health of adults in Africa. However, due to scarce resources
and
healthcare provision, the detection of hypertension is still
haphazard
and unreliable and the prevention of stroke lacking.
Objectives.
To assess the prevalence, detection,
management and
control
of hypertension in rural and semi-urban areas of West Africa.
Design
and Methods. 1,013 adult men (N5395)
and women
(N5618)
were screened as part of a community-based trial of health
promotion
in the Ashanti region of Ghana. They were identified
through
a household survey and population census of 16,965 inhabitants
in
12 villages (QJM 2002;95:445–50). 532 lived in semi-urban
and
481 in rural villages. The participants were seen in their villages.
They
underwent measurements of height, weight and blood pressure
(OMRON
HEM705CP) and answered a detailed questionnaire on
demography,
socioeconomic status, health, diet, lifestyle and drug therapy.
Hypertension
was defined as blood pressure .140/90
mm Hg or
being
on drug therapy.
Results.
Rural and semi-urban participants were
comparable for age
(55
[SD 11] vs 55 [11] years). In semi-urban areas they were heavier
(BMI
22.3 [4.6] vs 19.8 [3.2] kg/m2; P,.001)
and had higher blood
pressure
(129/76 [26/14] vs 121/72 [25/13] mm Hg; P,0.001
for
both)
than participants from rural areas. Hypertension prevalence was
28.7%
(291/1013) overall. It was higher in semi-urban than rural
villages
(32.9% [95% CI 28.9 to 36.9] vs 24.1% [20.3 to 27.9], or
1.54
[1.17 to 2.03], and increased with age. Detection, treatment and
control
rates also tended to be higher in semi-urban (25.7%, 14.3%
and
3.4%) than in rural areas (16.4%, 6.9% and 1.7%), but they
appeared
constant in the different age groups. Differences between
semi-urban
and rural areas were not due to age, gender and body
weight.
Conclusions.
Hypertension is common in West Africa
and tends to
be
more common in urbanized areas. Detection rates are suboptimal,
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Ethnicity & Disease, Volume
13, Spring 2003
ISHIB2003
ABSTRACTS
especially
in rural areas and appropriate management is barely attained.
There
is clearly an urgent need for preventive strategies for hypertension
control
in West Africa.
008
PREVALENCE,
DETECTION, MANAGEMENT AND
CONTROL
OF HYPERTENSION IN ASHANTI, WEST
AFRICA:
GENDER DIFFERENCES
FB
MICAH1,3; FP Cappuccio1; L Emmett1; SM Kerry1; R
Martin-Peprah3;
J Plange-Rhule123; JB Eastwood2.
Departments
of 1Community Health Sciences and 2Renal
Medicine,
St George’s Hospital Medical School, London (UK);
3Medicine,
KATH, Kumasi (Ghana).
Background.
Hypertension and stroke are emerging as
important
threats
to the health of adults in Africa. However, due to scarce resources
and
healthcare provision, the detection of hypertension is still
haphazard
and unreliable and the prevention of stroke lacking.
Objectives.
To assess the prevalence, detection,
management, and
control
of hypertension in men and women in Ashanti, West Africa.
Design
and Methods. 1,013 adult men (N5395)
and women
(N5618)
were screened as part of a community-based trial of health
promotion
in the Ashanti region of Ghana. They were identified
through
a household survey and population census of 16,965 inhabitants
in
12 villages (QJM 2002;95:445–50). 532 lived in semi-urban
and
481 in rural villages. The participants were seen in their villages.
They
underwent measurements of height, weight and blood pressure
(OMRON
HEM705CP) and answered a detailed questionnaire on
demography,
socio economic status, health, diet, lifestyle and drug
therapy.
Hypertension was defined as blood pressure .140/90
mm
Hg
or being on drug therapy.
Results.
Men and women were comparable for age
(55 [SD 11] vs
55
[11] years). Women were heavier but shorter than men. Thus, BMI
was
higher in women than men (21.6 [4.6] vs 20.2 [3.1] kg/m2;
P,.001).
Diastolic, but not systolic, blood pressure was higher in men
(126/76
[25/14] vs 125/73 [27/13] mm Hg; P5.43/.008).
Hypertension
prevalence
was 28.7% (291/1013) overall. While it was comparable
in
men and women (29.6% [95% CI: 25.1 to 34.1] vs 28.0%
[24.5
to 31.6], its detection rate was lower in men than in women
(14.5%
vs 27.2%; P5.012;
OR50.46 [0.25 to 0.85]).
Treatment and
control
rates were very low in both groups (7.7% and 3.4% vs 13.8%
and
2.3%, respectively). These gender differences were not due to age
and
BMI.
Conclusions.
Hypertension is common in West African
men and
women.
Detection rates are lower in men than women. Appropriate
management
and control are barely attained in both men and women.
The
reasons for the gender inequalities in detection rates are unknown.
013
MAINTAINING
COMPARABILITY OF TREATMENT
GROUPS
IN A COMMUNITY- BASED CLUSTER
RANDOMIZED
INTERVENTION TRIAL TO REDUCE
BLOOD
PRESSURE IN ASHANTI, GHANA
SM
KERRY1; FP Cappuccio1; FB Micah1,3; L Emmett1;
J
Plange-Rhule123; JB Eastwood2.
Departments
of 1Community Health Sciences and 2Renal
Medicine,
St George’s Hospital Medical School, London (UK);
3Medicine,
KATH, Kumasi (Ghana).
Background.
Cluster randomized trials (CRTs) have
been used to
evaluate
communicable disease interventions in developing countries,
but
there is a lack of such trials involving health promotion in these
settings.
In rural and semi-urban Ghana, health education takes place
at
the village level, so cluster randomization is necessary to evaluate
such
programs.
Objectives.
To describe measures for maintaining
comparability of
treatment
groups in the design of a CRT.
Design
and Methods. A household survey and population
census
identified
16,965 inhabitants in 12 villages (6 rural, 6 semi-urban) in
the
Ashanti region, Ghana (QJM 2002;95:445–50). Between 95–250
subjects
from each village were invited to attend for screening. The
villagers
were selected using stratified (for age and sex) random sampling
from
a list of all inhabitants age 40–75 years. After baseline
measurements
were completed in a pair of villages, the villages were
randomized
to intervention or control arms, stratified for locality
(semi-urban
or rural). The intervention was a health education program
to
encourage dietary salt reduction. Primary outcomes of the
trial
will be reduction in 24-hour sodium excretion and reduction in
systolic
blood pressure (BP) at six months.
Results.
1,013 individuals agreed to take part
in the study out of
1,896
invited (response rate 53%). Response rates varied between villages
(range
40 to 88%) but were similar in the two intervention
groups
(51% vs 56%). The mean age (55 [SD 11] years vs 54 [11]
years)
was similar in both groups. At baseline, systolic and diastolic
BP
was similar in each intervention group (125/74 (27/14) vs 126/
75
(25/14) mm Hg). The percentage of participants adding salt to
their
food at the table was similar in both groups (54% vs 50%).
Conclusion.
By design, the age/sex structure of the
two intervention
groups
should be similar but there is a potential for bias to be introduced
by
the low response rate. However the subjects were recruited
blind
to treatment allocation thus removing the potential for such bias.
Initial
comparisons of the groups showed no evidence of bias between
the
groups.
020
AT1-RECEPTOR-BLOCKER
(ARB) COMBINATION
WITH
THIAZIDE: THE MOST EFFECTIVE
ANTIHYPERTENSIVE
BITHERAPY FOR GLOBAL
CARDIOVASCULAR
AND RENAL PROTECTION IN
BLACK
HYPERTENSIVES?
A
FOURNIER1; D Lemogoum2; G Amah3; JJ Pik4;
JP
Degaute2; F Gueyffier.5
1Nephrology-Internal
Medicine–CHU Amiens; 2Cardiology
Hopital
Erasmus–Brussels (Belgium); 3CHU Lariboisiere–Paris;
4Internal
Medicine Clermont de l’Oise;
5Hospices
de Lyon (France).
For
ALLHAT African Americans (AA), chlorthalidone is the preferred
initial
blood pressure lowering (BPL) treatment vs amlodipine
S2-170
Ethnicity & Disease, Volume
13, Spring 2003
ISHIB2003
ABSTRACTS
because
of lower heart failure (HF) risk and vs lisinopril because of
greater
HF and stroke risk reduction. Second-step drug was atenolol,
clonidine
or reserpine, which had BPL-synergy with chlorthalidone
and
amlodipine, whereas the synergy was lacking with lisinopril, yielding
a
4 mm Hg higher SBP. ACEI as second-step drug would be,
however,
as relevant as beta blockers, since in UKPDS, captopril and
atenolol
granted the same BP and cardiovascular protection in association
with
diuretics and that, in the AASK study, ramipril granted
better
renal protection than metoprolol and amlodipine. Combination
of
beta blocker or ACEI with a calcium channel blocker (CCB) would
be
also relevant because they are BPL-synergistic and effective in treatment
of
HF, a complication not well prevented by CCB, especially in
AA.
No specific data on ARB in AA hypertensives are yet available,
but
the LIFE trial found a greater BP-independent, selective strokeprotective-
effect
(SPE) of losartan compared with atenolol, likely related
to
AT2-mediated brain anti-ischemic effect, secondary to AIIstimulation.
Indeed
ARB not only decreases AT1-deleterious vascular
effects
as beta blockers and ACEI, but cancel AII-mediated renin secretion
inhibition.
This
suggests that, in AA hypertensives, ARB may be the most
efficient
drug to combine with thiazide for better preventing HF and
renal
failure (vs CCB) and stroke (vs ACEI and beta blockers). This
justifies
cost-effectiveness comparisons of these bitherapies in Black
hypertensives.
028
NATRIURETIC
PEPTIDES MODULATE STRESSINDUCED
PRESSURE
NATRIURESIS IN
AFRICAN-AMERICAN
YOUTH
GK
KAPUKU; GA Harshfield, RS Timm; ME Wilson;
L
Mackey; D Gillis; HC Davis; L Carter; FA Treiber.
Georgia
Prevention Institute, Medical College of Georgia,
Augusta,
Georgia.
Impaired
pressure-natriuresis is partially responsible for ethnic differences
in
the development of essential hypertension (HTN) and associated
target
organ damage. The aim of the study was to assess the
effects
of the natriuretic peptides on stress-induced pressure natriuresis
among
African-American youth. Subjects (N523;
aged 15–18 years)
were
brought into similar levels of sodium balance. Atrial natriuretic
peptide
(ANP), brain natriuretic peptide (BNP) and sodium secretion
(UNAV)
were measured hourly for two hours prior to, during and
following
a one-hour video game stress period. Systolic BP (SBP) was
measured
at 15-minute intervals. The effect of condition was signifi-
cant
for SBP (P,.01).
SBP increased significantly from baseline to
stress
and decreased significantly during recovery. The effect of condition
was
also significant for UNaV (P,.0001).
The stress-induced
change
in SBP was related to the level of ANP and BNP during stress.
Subjects
with higher stress-induced ANP had higher sodium excretion
during
stress. In addition, subjects with higher BNP during stress had
lower
SBP during recovery (r50.43;
P,.02).
The results of this study
are
consistent with the hypothesis that impairment of natriuretic peptide
regulation
may be an important determinant of BP elevation.
035
HYPERTENSION
IN RURAL GA: A STUDY OF FOUR
COMMUNITIES
IN THE GA DISTRICT OF GHANA
J
ADDO1; AGB Amoah1,2; K Koram3.
National
Diabetes Management and Research Center, Korle Bu
Teaching
Hospital, Korle Bu, Accra, Ghana; Department of
Medicine,
University of Ghana Medical School, College of
Health
Sciences, Accra, Ghana; Noguchi Memorial Institute for
Medical
Research, College of Health Sciences, University of
Ghana,
Legon, Ghana.
Objective.
To determine the prevalence of
hypertension in rural
subjects
in the greater Accra region of Ghana.
Design.
Cross-section cluster community study.
Setting.
Four rural communities in the Ga
district of Accra.
Subjects
and methods. Adults, aged 18 years and older, in 4
communities
were
sampled, and blood pressures were measured using standard
protocol.
Weight and height were measured with subjects in light
clothing.
Hypertension was defined as .140/90
mm Hg or current
anti-hypertensive
treatment. Risk factors were ascertained with the aid
of
a structured standardized questionnaire.
Results.
A total of 363 subjects with a mean age
of 42.3 years was
studied.
30% were males. The overall crude prevalence of hypertension
was
25.3%. Hypertension prevalence increased with age, obesity and
lower
physical activity. Out of the 92 respondents diagnosed with
hypertension,
only 26% (N524)
had prior knowledge of their condition
and
only 50% (N512)
of these were on treatment. 16.7%
(N52)
of hypertensives on treatment were found to be controlled.
Conclusions.
Hypertension is relatively high in
rural Accra. Control
and
prevention programs may prove cost-effective in reducing hypertension-
associated
morbidity and mortality.
036
CORRELATES
OF HYPERTENSION IN ADULT
GHANAIANS
AGB
AMOAH.
Department
of Medicine, University of Ghana Medical School,
College
of Health Science, Accra, Ghana.
Objectives.
To determine the sociodemographic
correlations of hypertension
in
adult Ghanaians.
Design.
6,300 adults, aged 25 years and older,
were selected by
random
cluster sampling using electoral enumeration areas and listing
of
adults.
Setting.
Three communities (urban high class,
urban low class residential
areas
and rural area) in Greater Accra Region of Ghana.
Subjects
and Methods. A total of 4731 (male-to-female ratio51:
1.5)
participated, representing a response rate of 75%. The mean of
2
blood pressure readings taken with a mercury sphygmomanometer
after
10 min rest was used in analysis. Hypertension was defined as
.140/90
mm Hg or current anti-hypertensive treatment.
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Ethnicity & Disease, Volume
13, Spring 2003
ISHIB2003
ABSTRACTS
Normal
BP (N53394)
High BP (N51337)
Age
(y)
BMI
42.1613.8
24.165.0
50.0615.3*
25.065.9*
Waist
WHR
SBP
DBP
84.4612.3
0.8560.07
124621
72612
88.7613.6*
0.8860.07*
143629*
81616*
*
P,.001
Results.
The crude prevalence of hypertension
was 28.3%. In both
sexes,
the prevalence of hypertension was highest in urban subjects
from
low class residential areas and least in rural dwellers. The rates
of
hypertension increased with age. Akan and Ga subjects had relatively
higher
rates of hypertension compared to Ewes. Generally, the
rates
of hypertension were high in the following subjects; those with
no
formal education, those in sedentary occupations, those with no
leisure
physical activity, those who drank alcohol, smokers and obese
subjects.
Conclusion.
Hypertension is relatively common in
urban and rural
Accra.
Cardiovascular control and health promotion measures that address
lifestyle
cardiovascular risk factors may prove beneficial.
040
LEFT
VENTRICULAR DIASTOLIC FUNCTION IN
NIGERIAN
HYPERTENSIVES
A ADEWOLE; A Akinyemi; D Adekola; O
Okechukwu;
O Olulola; F Ayodele.
Background. Systemic
hypertension has been associated with impaired
left
Ventricular diastolic function. This is yet to be evaluated
in
an African population. We sought to determine left ventricular
diastolic
function in Nigerian hypertensives.
Methods.
184 subjects, with hypertension (97
females), and average
age
59.2 (SD 10.39) years were recruited for echocardiography. Each
subject
underwent two-dimensional and Doppler echocardiography.
The
parameters measured included left ventricular (LV) dimensions;
early
and late atrioventricular (AV) flow velocities (E and A wave respectively);
E/A
ratio, deceleration time (DT), systolic (S), diastolic
(D)
and retrograde (R) pulmonary venous flow velocities; S/D ratio.
Results.
Parameter
Mean (SD)
E
(m/s)
A
(m/s)
E/A
S
(m/s)
D
(m/s)
S/D
DT
(msec)
0.63
(0.191)
0.67
(0.188)
1.03
(0.506)
0.49
(0.237)
0.45
(0.190)
1.15
(0.505)
221
(58.6)
There
were no differences in the parameter between the sexes.
Conclusion.
There is no gender difference in the
parameters of left
ventricular
diastolic function in Nigerian hypertensives. Comparison
of
the parameters of left ventricular function with normal controls will
be
presented at ISIB 2003.
041
CENTRAL
AND PERIPHERAL
MALADAPTATIONS
ASSOCIATED WITH
SALT-INDUCED
HYPERTENSION
MA BAYORA; AA Ganafa; N Emmet; D
Eatman; RR Socci;
ILFridie;
IA Abukhalaf.
Morehouse
School of Medicine, Atlanta, GA USA.
Hypertension
is a recognized risk factor for organ damage including
changes
in blood vessel morphology. Earlier studies using the Dahl
salt-sensitive
(SS) rat have demonstrated vascular remodeling of the
mesenteric,
renal and cerebral arteries. Here, we examined factors associated
with
salt-induced vascular dysfunction and renal damage.
Male
Dahl SS rats were fed either high salt (8%NaCl, HS) or low
salt
(0.3%NaCl, LS) diet for 3–4 weeks. Mean arterial pressure (MAP)
and
heart rate were measured weekly. Magnetic resonance imaging
(MRI)
of the brain and regional blood flows were determined. Plasma
isoprostane,
nitric oxide (NO), prostacyclin, and thromboxane A2
(TXA2)
were determined by enzyme immunoassay. Plasma and kidney
GSH
and GSSG were analyzed by HPLC. Kidneys were prepared and
stained
for histology. Reactivity of mesenteric arteries was assessed in
vessel
chambers.
HS
increased MAP, isoprostane and TXA2 and decreased the GSH:
GSSG
ratio, NO and prostacyclin. Renal and aortic blood flow was
decreased
and vascular resistance was increased. MRI scans, in the HS
group,
showed white matter hyper intensity. Glomeruli from the HS
were
found to be sclerotic and exhibited severe fibrinoid necrosis.Mesenteric
arteries
from the HS group had reduced lumen diameter, increased
wall
thickness and reduced vasodilatory response to acetylcholine.
These
studies suggest a strong correlation between oxidative stress
and
the vascular and renal maladaptations associated with salt-induced
hypertension.
052
NATURAL
VITAMIN-RICH PALM OIL ATTENUATES
THE
PROGRESSION OF SALT-INDUCED
HYPERTENSION
AA
GANAFA; IA Abukhalaf; SW Sahlu; D Eatman;
N
Silvestrov; MA Bayorh.
Morehouse
School of Medicine, Atlanta, GA USA.
The
pathogenesis of hypertension in Dahl salt-sensitive (SS) rats,
fed
a high salt (HS) diet has been associated with endothelial dysfunction
and
oxidative stress. In our previous studies, palm oil (PO)
reduced
oxidative stress-induced hypertension in normal rats. Here,
we
investigated the effect of dietary supplementation with natural vitamin-
rich
PO on the progression of salt-induced hypertension.
Male
Dahl SS rats were fed either HS (8% NaCl), or low salt (LS,
0.3%
NaCl) diet with or without PO (Carotino, 5 g/kg/d) for 4 weeks.
Mean
arterial pressure (MAP) and heart rate were measured weekly.
Plasma
isoprostane, nitric oxide (NO), prostacyclin, thromboxane A2
(TXA2)
and aortic cyclic GMP were measured by enzyme immunoassay.
Heart,
kidney and plasma GSH and GSSG were analyzed by
HPLC
and superoxide production by fluorescence spectrometry.
HS
increased MAP, isoprostane, aortic superoxide and TXA2 and
decreased
the GSH: GSSG ratio, NO and prostacyclin. The HS-inS2-
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ABSTRACTS
duced
elevations in MAP, isoprostane and superoxide and the reductions
in
prostacyclin and kidney GSH: GSSG ratio, were attenuated
by
PO. In the LS group, PO reduced MAP and TXA2 and increased
the
GSH: GSSG ratio, NO and cGMP. The mortality associated with
HS
was reduced by PO.
Thus,
palm oil attenuates the progression of salt-induced hypertension,
via
mechanisms involving a reduction in oxidative stress and
modulation
of endothelial function.
053
THE
DIFFERENTIAL EFFECT OF PSYCHOLOGICAL
STRESS
ON BODY FAT MASS AND BLOOD
PRESSURE
WITHIN LOW AND NORMAL BIRTH
WEIGHT
AFRICAN- CARIBBEAN ADOLESCENTS:
IMPLICATIONS
FOR THE INSULIN
RESISTANCE
SYNDROME
EC
CHAMBERS; ES Tull; H Fraser; N Mutunhu; N Sobers;
E
Niles.
Low
birth weight is known to increase the risk for obesity and
hypertension
later in life. Similarly, psychological stress also contributes
to
the cascade of metabolic abnormalities leading to insulin resistance
in
adults. The role of psychosocial stress and birth weight on
subsequent
risk of metabolic abnormalities, however, has not been
explored
thoroughly in Black youth. This study examined the effect
of
psychological stress on body fat distribution and blood pressure in
Barbadian
adolescents age 14–16 years. A sample of 73 low birth
weight
(lbw) and 127 normal birth weight (nbw) adolescents were
interviewed.
Abdominal fat and overall fat mass was measured using
waist
circumference (WC) and body mass index (BMI), respectively.
Blood
pressure (BP) was assessed using a Baumanometer. Psychological
stress
was defined using a measure of perceived stress and hostility
(low
score indicates high hostility) ascertained by questionnaire. In
univariate
analyses, perceived stress and hostility were positively correlated
(P,.05)
in both birth weight groups. There was no significant
difference
in the mean levels of perceived stress (18.6 and 17.1,
P5.122)
or hostility (68.7 and 68.5, P5.897)
between low and normal
birth
weight groups respectively. Among lbw adolescents, perceived
stress
was significantly correlated with BMI (r5.271,
P5.021)
but
not with WC or BP. In addition, levels of hostility were positively
correlated
with birth weight (r52.323,
P5.005).
Among nbw adolescents,
there
was no significant association between measures of psychosocial
stress
and body fat mass or blood pressure. This study shows
that
lbw adolescents may be more sensitive to the effects of psychosocial
stress
on body fat mass than their nbw counterparts.
055
PLASMA
ENDOTHELIN-1 AND GLOMERULAR
FILTRATION
RATE IN AFRICAN AMERICANS ARE
NOT
INFLUENCED BY SHORT-TERM AEROBIC
EXERCISE
TRAINING
JM
JONES1; D Vizcaino1; TC Dowling2; MR Weir2; JJ Johnson1;
JJ
Park1; BD Hand1; T Obisesan3; MD Brown1.
Department
of Kinesiology, University of Maryland, College
Park,
MD; University of Maryland Medical Center, Baltimore,
MD;
Department of Medicine, Howard University,
Washington,
DC.
Hypertension
in African Americans (AA) has been associated with
elevated
glomerular filtration rates (GFR) and a reduced ability to
autoregulate
GFR. An inverse relationship between plasma endothelin-
1
(ET-1) and GFR has been reported, and plasma ET-1 is thought to
decrease
with aerobic exercise training (AEX). Therefore, the purpose
of
this study was to determine if short-term AEX influences GFR and
plasma
ET-1 levels in hypertensive AA. Eleven sedentary, obese AA
hypertensive
(7 women, 4 men; mean age 59.661.2
years; SBP
14863
mm Hg, DBP 8963 mm
Hg) completed 7 consecutive days
of
AEX for 50 min/day at 65% of heart rate reserve. Plasma ET-1 was
measured
by enzyme linked immunoassay and GFR was measured by
iothalamate
renal clearance using a 2.5-hour constant-rate intravenous
infusion
technique, before and after AEX. Plasma ET-1 levels did not
change
after short-term AEX (0.360.2
vs. 0.4 60.3
pg/ml; P5.72).
Average
GFR following short-term AEX remained unchanged
(125.266.9
vs. 130.369.0
ml/min/1.73 m2, P5.37).
The observed
elevated
GFR in AA suggests that a reduction in plasma ET-1 with
AEX
may not be beneficial. Therefore, the lack of change in plasma
ET-1
and GFR indicates that AA can participate in exercise training
without
the risk of further increasing GFR.
056
SELF-REPORTED
HIGH BLOOD PRESSURE (HBP)
TREATMENT
AMONG AFRICAN AMERICANS,
WHITES,
AND HISPANICS IN THE
UNITED
STATES, 1999
HF
DAVIS; A Malarcher; T Antoine; C Ayala; GA Mensah.
Objective.
Healthy People 2010 objectives include
reducing the
proportion
of adults with HBP and increasing the proportion with
controlled
blood pressure. We examined the relationship between race/
ethnicity
and self-reported HBP and treatment as well as the prevalence
of
co-morbidities in the United States.
Methods.
The 1999 National Health Interview
Survey, a nationally
representative
household survey of the noninstitutionalized US population,
was
used to estimate the self-reported prevalence of HBP and
patterns
of medication use, timing and results of blood pressure screening,
and
co-morbidities among 1,144 African-American, 707 Hispanic
and
4,383 White adults with hypertension. Racial/ethnic differences
were
assessed by chi-squared statistics using SUDAAN.
Results.
African Americans (23.8%) and Whites
(19.3%) were
more
likely to report having hypertension than Hispanics (12.5%).
Among
those with hypertension, Hispanics (70.9%) were less likely
than
whites (80.1%) and African Americans (82.2%) to have been
prescribed
an antihypertensive and to be currently taking medication
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ABSTRACTS
(Hispanics
80.3%, whites 87.2% and African Americans 86.5%). Hispanics
were
also less likely to have blood pressure measurements in
the
past six months. Among those with HBP, Whites (68.1%) were
more
likely than African Americans (61.5%) and Hispanics (53.8%)
to
report normal blood pressure at their last visit. Concerning comorbidites,
Hispanics
and African Americans were more likely to have
diabetes
than Whites, and African Americans (8.15%) were more likely
to
have had a stroke.
Conclusion.
In contrast to national surveys
measuring blood pressure,
this
self-reported prevalence of controlled HBP is substantially
higher.
Future research into the systematic assessment of differences
between
self-reported and measured blood pressure is necessary.
059
ORIGINS
OF THE BLACK/WHITE DIFFERENCE IN
BLOOD
PRESSURE: ROLES OF BIRTH WEIGHT,
POSTNATAL
GROWTH, EARLY BLOOD PRESSURE
AND
CURRENT ANTHROPOMETRY. THE
BOGALUSA
HEART STUDY
JK
CRUICKSHANK; L Liu; FMzayek; L Kieltyka; LS Webber;
R
Sherwin; GS Berenson.
Tulane
Center for Cardiovascular Research & Dept.
Epidemiology,
Tulane; University Medical Center School of
Public
Health, New Orleans, LA. USA; Clinical Epidemiology
Group,
Manchester University Medical School, UK.
Objective.
To examine relative impact of pre-natal
vs early childhood
growth
effects confounding from early blood pressure (BP) on
BP
at age 151 y
in the Bogalusa Heart Study of White and Black
Americans.
Design
and Methods. A cohort of newborns (N5440)
with detailed
growth
measures from 0–4 years, and of BP from year 1, with full
followup
to age 15 years on 102, pooled with a 2nd cohort measured
from
4 y and birthweights retrospectively, N584.
Birth weight, change
in
weight and in height from 0–4 y, BMI at age 15 y, ethnicity and
BPs
at age 4 y were assessed in relation to BP age 15 years.
Results.
African-American boys were lighter by
400 gms than
White
boys at birth, with less ethnic difference in girls. Tracking of
weight
and height was clear. At 15 y followup, Black girls were 1.3
kg
and 2 cm bigger than White girls; Black boys were 4 cm shorter
and
6 kg lighter than White, with BPs a mean of 3.3/2.1 mm Hg
higher,
still present when sexes were pooled (P,.05).
In multivariage
analysis,
birth weight (standardised regression coefficients, allowing direct
comparison,
95% CI of original BP) 20.36,
28.6 to 24.1),
height
at 15 y (0.38; 0.27–0.57), BMI at 15y (0.3; 0.3–0.85) change
in
weight from 0–4 y (20.25;
21.3 20.3),
and systolic BP at age 4
y
(0.19; 0.1–0.44) were systolic BP predictors at 15 y. The ethnic
effect
was displaced by birth weight.
Conclusion.
These truly longitudinal data suggest 2
important conclusins:
1)
intrauterine factors have a major impact on later BP together
with
achieved height, BMI.early
growth or early BP; 2) ethnic
difference
in BP at 15 y is accounted for by birth weight, or length
at
6 m.
061
IMPACT
OF STRESS REDUCTION ON
AMBULATORY
BLOOD PRESSURE IN
AFRICAN-AMERICAN
ADOLESCENTS
VA
BARNES; MH Johnson; FA Treiber.
Medical
College of Georgia; Augusta, Georgia.
Objective.
To determine the impact of stress
reduction via the
Transcendental
Meditation (TM) program on ambulatory blood pressure
in
adolescents.
Methods.
100 African-American (AA) adolescents
(16.261.3
years)
with
high normal systolic blood pressure (BP), were randomly assigned
to
either 4-month TM (N550,
18F) or health education control
(CTL,
N550,
19F) groups. The TM group engaged in 15-min sessions
at
home and at school each day for 4 months. Systolic BP (SBP)
and
diastolic BP (DBP) measures were recorded using the Spacelabs
ambulatory
BP monitor 90207 from 8–10 every 20 min (daytime)
and
from midnight-6 every 30 min (nighttime) in the natural environment
over
24 hour periods, at pretest, 2- and 4-month posttests,
and
4-month followup (visits 1–4).
Results.
The TM group exhibited greater
decreases in daytime SBP
(P,.03)
and DBP (P,.04)
measures compared to the CTL group
across
visits 1–4. No significant differences were observed across time
for
nighttime values.
Conclusion.
These findings demonstrate the
beneficial impact of
the
TM program upon ambulatory BP during daily activities in AA
adolescents
at-risk for development of essential hypertension.
062
EXPECTATIONS
OF PATIENTS' AND PHYSICIANS'
ROLE
IN THE MANAGEMENT OF HYPERTENSION
IN
AFRICAN-AMERICAN PATIENTS
GO
OGEDEGBE.
Background.
African Americans have the highest
prevalence of hypertension
and
they experience a greater hypertension-related morbidity
and
mortality than other groups in the US. Patient expectations
have
been linked to improved clinical outcomes in patients with
chronic
diseases. We elicited the expectations of treatment among a
group
of hypertensive African-Americans in a primary care practice.
Methods.
Open-ended interviews were conducted
with 93 patients
during
routine clinic visits. Patients were asked the following question:
‘‘What
is your expectation of the treatment you will receive for high
blood
pressure?’’ Responses were recorded and analyzed using standard
qualitative
techniques.
Results.
Of the 93 patients interviewed, 60%
were women; 68%
had
a college degree; 24% were unemployed; mean age was 55 yrs;
and
68% had uncontrolled hypertension. 58 different expectations
were
elicited and grouped into 3 categories reflecting medication effects,
patients’
role, and physicians’ role. Patients expected medications
to
lower their BP, help them live longer, prevent heart attack, stroke
and
kidney failure. They expected to take an active role in their treatment,
especially
as it related to adoption of healthy behaviors. They
also
expected their physicians to educate them about BP treatment.
However,
some misconceptions were identified: 51% expected a cure,
61%
did not expect to take their medications for life, and 34% expected
to
take medications only with symptoms.
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ABSTRACTS
Conclusions.
Patients cited various expectations of
treatment for
hypertension
including several misconceptions. An understanding of
patients’
expectations regarding the treatment they receive may enhance
the
quality of the doctor-patient communication, which may in
turn
lead to patient satisfaction and adherence.
067
BIOLOGICAL
AND PSYCHO-SOCIAL PREDICTORS
OF
BLOOD PRESSURE REACTIVITY IN BLACKS:
MULTIPLICATIVE
EFFECTS
R
CLARK.
Objective.
This investigation explored the
relationship of racismspecific
coping
responses and parental history of hypertension to blood
pressure
changes to a personal and ethnically relevant speaking task.
Methods.
The sample consisted of 195 Black male
and female college
volunteers
(M age526.12
years). During the speaking task, participants
responded
to standardized questions about personal perceptions
of
intra- and inter-ethnic group racism. Systolic blood pressure
and
diastolic blood pressure were measured via an automated blood
pressure
monitor. Racism-specific coping responses were assessed with
the
COPE Scale, and parental history of hypertension was self-reported
by
participants.
Results.
After statistically adjusting for
several control variables, hierarchical
regression
analyses indicated that the main effect of parental
history
of hypertension was positively related to changes in systolic
blood
pressure (P,.05),
and the main effect of emotion-focused coping
was
negatively associated with diastolic blood pressure (P,.05)
and
systolic blood pressure (P,.01)
changes. These analyses also revealed
that
parental history of hypertension interacted with: 1) the
coping
responses of Planning (P,.05)
and Denial (P,.01)
to predict
changes
in systolic blood pressure and diastolic blood pressure and 2)
emotion-focused
coping responses to predict diastolic blood pressure
changes
(P,.05).
Conclusion.
This study highlights the importance of
examining the
joint
contribution of biological factors and coping responses to blood
pressure
reactivity in Blacks.
068
ANTIHYPERTENSIVE
TREATMENT IN BLACK
PEOPLE.
A COCHRANE SYSTEMATIC REVIEW
L
BREWSTER1; G Van Montfrans1; J Kleijnen2.
Academic
Medical Center, Amsterdam, Holland; University of
York,
York, UK.
Objective.
To add new data including the final
results of the AASK,
ALLHAT
and LIFE studies, to the Cochrane Systematic Review of
Antihypertensive
Drug Therapy in Black People (in press).
Design
and Methods. Main databases searched without
language
restriction
were: the Cochrane Library, Medline, Embase and LILACS
(March
2002); and Pubmed (Dec 2002). More than 2200 papers
yielded
28 trials considering 51 interventions in 19,911 patients.
Results.
Calcium blockers were the only drug
type that lowered
blood
pressure levels effectively across all prespecified subgroups of
Black
patients. In several trials using beta-adrenergic blocking drugs,
greater
increases than placebo were noted in systolic blood pressure
and
pulse pressure. ACE-inhibitors reduced blood pressure levels, but
relative
risk (RR) [95% CI] for reaching goal blood pressure was not
significant:
1.43 [0.97; 2.10]. Only 23.5% of all Black participants
reached
goal blood pressure.
Regarding
morbidity and mortality outcomes, the AASK, ALLHAT
and
LIFE studies found no difference between drugs in primary
outcomes
for black people. Notably, the LIFE study showed a trend
toward
greater risk with losartan than atenolol for the primary outcome
(heart
attack, stroke or cardiovascular death) for Black people
(RR
[95%CI] 1.55 [1.00; 2.38]); in contrast with the RR 0.87 [0.77;
0.98],
favoring losartan in the total group.
For
secondary outcomes, risk reduction [95% CI] for GFR decline,
end
stage renal disease (ESRD) or death in AASK was 22% [1;
38%]
for ramipril vs metoprolol, and the latter drug carried lower risk
than
amlodipine for ESRD (P,.001)
and ESRD or death (P5.003).
Secondary
outcomes in ALLHAT for Black people indicated ACE inhibitors
to
be less effective than diuretics for stroke reduction (RR
[95%
CI]) 1.40 [1.17; 1.68]; combined CHD 1.15 [1.02; 1.30] and
combined
CVD 1.19 [1.09; 1.30]; while RR for the subgroup heart
failure
was 1.32 [1.11; 1.58] for ACE inhibitors and 1.47 [1.24; 1.74]
for
calcium antagonists, compared with diuretics. Results remained
significant
after adjustment for differences in systolic blood pressure,
found
to be 4 mm Hg higher with ACE inhibitors vs diuretics in
Blacks
(blood pressures were not reported for calcium blockers vs diuretics).
Conclusions.
Present evidence indicates that blood
pressure lowering
efficacy
in Black people is most robust for calcium blockers. Ef-
ficacy
of drugs to reduce morbidity and mortality outcomes differed
only
for secondary outcomes, indicating diuretics and calcium antagonists
to
be more effective in reducing cardiovascular endpoints in
Black
people than ACE inhibitors.
069
PHARMACOLOGICAL
BASIS FOR THE
ETHNOBOTANICAL
USE OF LAVANDUAL
STOECHAS
IN HYPERTENSION
H
GILANI1; Q Jabeen2 ; N Aziz.
Department
of Biological & Biomedical Sciences, The Aga Khan
University,
Karachi, Pakistan; Department of Pharmacy, Islamia
University,
Bahawalpur, Pakistan.
Cardiovascular
diseases, such as hypertension, are a major cause of
morbidity
and mortality and one-fifth of the adult population of Pakistan
suffers
from hypertension. Modern imported drugs are beyond
the
reach of many Pakistanis, who rely mainly on traditional remedies.
This
study describes the pharmacological basis for the traditional use
of
Lavandula stoechas flowers in
hypertension.
Dried
flowers were soaked in 70% aqueous methanol at room
temperature
for 3 days. The solution was shaken and the filtrate was
dried
on a rotary evaporator under reduced pressure yielding about
20%.
The blood pressure was measured through carotid cannulation
of
anesthetized rats and the isolated tissue preparations such as rabbit
aorta,
jejunum, and guinea-pig atria, were set up separately in a 10
mL
tissue bath containing physiological salt solution.
The
crude extract (3–30 mg/kg) lowered blood pressure in anesthetized
rats.
Pretreatment of the animals with atropine (1 mg/kg)
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ABSTRACTS
partially
abolished the hypotensive effect suggestive of muscarinic receptors
involvement.
In the in vitro studies,
plant extract (0.3–3.0 mg/
mL)
caused an inhibitory effect on isolated spontaneously beating
atria.
It also caused inhibition of K1-induced
contractions in rabbit
aorta
at similar concentrations. In spontaneously contracting rabbit
jejunum,
it caused atropine sensitive mild spasmogenic effect at lower
doses
(0.01–0.1 mg/mL) followed by complete relaxation at 0.3–1.0
mg/mL.
It also shifted dose-response curves of Ca11 (constructed
in
Ca11
free medium) to right, suggestive of Ca11
channel blockade
(CCB).
The presence of cholinergic and CCBs components explains
the
traditional use of the plant in hypertension.
071
SERUM
CREATINE KINASE AS A MARKER OF
ENERGETIC
CAPACITY TO CREATE HIGH
BLOOD
PRESSURE
LM
BREWSTER; G Mairuhu; N Bindraban; K Stronks;
JF
Clark; GA van Montfrans.
Dept.
of Internal Medicine, AMC, Amsterdam; Dept. of Social
Medicine,
AMC, Amsterdam; Dept. of Neurology, University of
Cincinnati, The Vontz Center, USA.
Background.
A vast amount of ATP is needed to
create and sustain
high
blood pressure. Cardiovascular contractility and salt retention are
both
high-energy-demanding processes. Creatine kinase (CK) is the
main
ATP generating enzyme in muscle tissue, including cardiovascular
tissue.
High tissue activities of this enzyme are thought to lead
to
greater energetic capacity to develop high blood pressure levels,
through
greater ATP buffering capacity, an increase in cardiovascular
contractile
reserve, and greater renal tubular ability to retain salt. The
level
of physiologic creatine kinase activity in serum is thought to be
a
marker of the level of tissue activity. Creatine kinase activity is found
to
be particularly high in Black people of West-African descent.
Objective.
To assess whether people with high
physiologic activity
of
serum creatine kinase have higher blood pressure levels at rest.
Methods.
Creatine kinase activity at rest was
estimated in serum of
460
patients of both gender groups (159 male, 301 female), using a
standard
hospital assay. Subjects (35–60 y) were a random population
sample
from the Dutch SUNSET and CRANS cohort studies on risk
factors
for cardiovascular disease. Subjects were instructed to refrain
from
heavy exercise three days before the test. The following participants
were
excluded from this analysis: using antihypertensive drugs
(54),
missing data on antihypertensive drug status (22); no antihypertensive
drug
use, but CK more than twice the upper limit (42). The
latter
were referred for further diagnosis. Blood pressure was measured
in
the sitting position using an Omron M4 oscillometric device. Data
were
analyzed with SPSS-ANOVA, using blood pressure as dependent
variable,
CK levels as factors, and age and BMI as covariates.
Results.
Blood pressure levels of healthy
subjects correlated highly
with
CK, with P5.006
for systolic blood pressure (SBP) and P5.011
for
diastolic blood pressure (DBP) when controlling for age and BMI.
CK
(U/I) Mean SBP (sd) Mean DBP (sd)
1±100
[N5124]
100±200
[N5166]
200±300
[N553]
120.0
(17.7)
124.9
(17.8)
128.0
(19.6)
79.5
(9.9)
82.4
(10.9)
84.3
(12.6)
Conclusion.
People with high physiologic serum CK
at rest may
represent
a subgroup of the population with high tissue CK and energetic
capability
to create high blood pressure levels. Physiologic serum
CK
at rest might serve as a marker of hypertension risk.
073
THE
RELATIONSHIP BETWEEN RACE/ETHNICITY,
SELF-REPORTED
HYPERTENSION, AND
SECONDARY
PREVENTION PRACTICES AMONG
PERSONS
WITH SELF-REPORTED CORONARY
HEART
DISEASE (CHD) IN THE UNITED STATES,
1997±2001
TL
ANTOINE; AM Malarcher; HF Davis; JB Croft;
GA
Mensah.
Background.
Effectively controlling risk factors
among people with
CHD
reduces morbidity and improves quality of life. Little information
exists
on the relationship between hypertension and secondary
prevention
practices among people with CHD in the United States.
Methods.
The 1997–2001 National Health Interview
Surveys, annual
surveys
of US civilian, non-institutionalized population, were
used
to examine the relationship between race/ethnicity, hypertension,
and
secondary prevention practices among persons with self-reported
CHD.
Odds ratios (OR) for being a current smoker, being overweight,
having
leisure time physical activity, and excessive alcohol intake were
obtained
from logistic regression models controlling for age and gender.
All
calculations were performed using SUDAAN.
Results.
Persons with hypertension were less
likely to be current
smokers
(OR50.80, P
,.01).
However, they were more likely to be
overweight
(OR51.83, P,.01)
and physically inactive (OR51.29,
P,.01).
After controlling for age, gender, other sociodemographic
characteristics,
and hypertension, African Americans and Hispanics
were
less likely to exercise at the recommended levels than Whites;
and
Whites were more likely than African Americans to have excess
alcohol
consumption (.2
drinks/day). Hispanics and other ethnic
groups,
but not African Americans, were less likely to be current smokers
than
were Whites (P,.05).
There were no racial/ethnic differences
in
being overweight in multivariate analyses.
Conclusions.
Persons with self-reported CHD are
either not receiving
and/or
not following secondary prevention guidelines. Renewed
efforts
in secondary prevention are needed particularly among persons
with
hypertension who are at extremely high risk for recurrent events.
077
A
STUDY OF THE KNOWLEDGE OF
HYPERTENSION (HT) IN SAGAMU,
OGUN STATE, NIGERIA
OB FAMILONI; SA Ogun.
Department
of Medicine, Olabisi Onabanjo, University Teaching
Hospital
Sagamu, Nigeria.
Objective.
It has been observed that myths and
half-truths are associated
with
hypertension (HT) in Nigeria. Hospital workers (including
those
outside clinical areas), university students, and hyperS2-
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ABSTRACTS
tensive
patients are looked upon as knowledgeable in all areas of the
disease.
We sought to determine the knowledge level of these groups
of
people, as well as the knowledge level of HT among factory workers
in Sagamu, Ogun State, Nigeria.
Method.
The study population comprised 700
subjects; 240 preclinical
students
(who had not attended hypertension lectures), 240
hospital
workers (excluding all workers with any formal training in
HT),
120 hypertensive patients attending our clinic, and 100 factory
workers.
Each was taken though a structured questionnaire asking
what
the normal rate of BP was, the most common symptom of HT,
common
complications of HT, and whether HT is more common in
Blacks
or Caucasians, and in males vs females. Questions on the duration
of
treatment of HT were asked and each respondent was asked
to
state when last he checked his BP.
Results.
Knowledge of the normal BP rate was
51.7%, while 60.3%
knew
that stroke, heart and renal failure were common complications.
Other
responses included: HT more common in Blacks (62.3%); more
severe
in males (40.9%); HT had no symptoms (10.9%). 42.2% believed
HT
should be treated for life and only 58% (including hypertensive
patients)
had checked their BP in the last year. 30.2% did not
know
that renal failure can be caused by HT. Excluding hypertensives,
only
29.3% have checked BP once in the last year.
Conclusion.
Knowledge of HT is not adequate,
particularly in
symptomatology,
duration of treatment, and need to check personal
BP.
080
POPULATION
DISTRIBUTION OF MEAN BLOOD
PRESSURE
IN AFRICA. EVIDENCE
FROM
13 COUNTRIES
R
BONITA; K Strong; D Hannoun.
NCD
Surveillance, WHO Geneva, Switzerland and WHO
Regional
Office, Brazzaville.
Objective.
To compare the population distribution
of mean levels
of
systolic blood pressure in 13 selected African countries as a way of
approaching
an understanding of the population risk of coronary heart
disease
and stroke, using the methodology of theWorld Health Report
2002:
Reducing Risks, Promoting Healthy Life.
Method.
The WHO Global NCD (non-communicable
disease)
InfoBase
brings together country-level data for 8 important risk factors
for
cardiovascular disease, including raised blood pressure. This database
is
a tool to research new methods in harmonizing data from
different
countries. We have used this database to identify data on
mean
systolic blood pressure available by age group and sex for 13
African
countries and to develop a methodology for improving the
accuracy
of predicting raised blood pressure in African countries where
no
data currently exists.
Results.
The NCD InfoBase tool identifies mean
systolic blood
pressure
data from 13 African countries; the data are then included in
a
regression model with age to determine if the relationship between
systolic
blood pressure and age differs significantly within and between
countries.
Our results, in line with recent studies, suggest that mean
blood
pressure does not differ significantly by age within and between
countries.
Further, we suggest that this type of data can be used to
predict
patterns for rising blood pressure in other countries, which
may
not have to capacity to collect this data for themselves but would
still
benefit from an analysis of their country’s situation.
Conclusion.
The WHO NCD InfoBase is an important
contribution
to
the use of existing data and demonstrates, in this setting,
that
by intervening at the population level and reducing all systolic
blood
pressures, shifting the distribution of mean systolic blood pressure
can
prevent a larger proportion of the population from suffering
a
coronary event or stroke.
085
NATIONAL
HYPERTENSION MANAGEMENT AUDIT
PROJECT
IN FOUR AFRICAN COUNTRIES
KK
AKINROYE1; H Agboton.2
African
Heart Network (AHN), Ikoyi, Lagos, Nigeria; Pan-
African
Society of Cardiology (PASCAR), Cotonou, Benin.
Background.
Hypertension is a major public health
problem in
Africa
with a prevalence of 25% to 30% in certain populations. A
joint
initiative of AHN/PASCAR has identified hypertension as a main
concern
that needs concerted efforts by all stakeholders in Africa. The
initiative
will assess the levels and quality of management of hypertension
by
physicians in selected African countries: Benin, Ghana,
Nigeria,
and South Africa in the first phase of the pilot project. The
project
is being initiated by AHN/PASCAR, in line with previous
projects
by WHO and WHL.
Objective.
The objective of the project is to
assess the knowledge
and
attitudes of general practitioners and physicians in the community
(of
each country) concerning the management and treatment of hypertension.
Method.
A self-administered questionnaire will
be sent out to 50
general
practitioners and physicians in each country. The questionnaire
is
simple and its completion should not take more than 10–15 minutes.
It
will be accompanied by a cover letter; inviting the physicians
to
participate in the project and informing them of the advantages
they
may derive from the project. Non-respondents would receive a
reminder
letter 5 weeks after the first mailing. Telephone calls and
clinic
visits would be emphasized to ensure that questionnaires are
filled
properly and promptly delivered.
Expectation.
The results of the project are expected
to raise more
general
interest in the assessment of the level and quality of hypertension
control
in the community. The main purpose of the study is to
identify
the limitations in the community control of hypertension in
various
countries as this will help to reinforce the process. It is hoped
that
health policy-makers would be stimulated by this approach to
improve
hypertension management and control in each country.
092
PRESCRIBING
MODALITIES FOR HYPERTENSION
IN
THE UNITED STATES
KJ
KEEN; AGB Amoah; JT Wright, Jr.
Objective.
To assess the prescribing modalities by
physicians in the
United
States for the treatment of essential hypertension.
Design.
The study design is that of the
National AmbulatoryMedical
Care
Survey (NAMCS). The survey is a multi-year multistage
probability
design that involves probability samples of primary samS2-
177
Ethnicity & Disease, Volume
13, Spring 2003
ISHIB2003
ABSTRACTS
pling
units (PSU’s), physician practices within PSU’s, and patient visits
within
practices. PSU’s are counties or groups of counties, cities,
towns,
and townships.
Method.
The sampling frame of physicians was
obtained from the
master
files of the American Medical Association and the American
Osteopathic
Association and is restricted to non-federally employed
physicians
in office-based patient care.
Results.
Statistical analysis was conducted
using the publicly available
survey
data from years 1995 to 1999 inclusive, in order to have
a
sufficiently large sample size of African Americans, and individuals
with
diabetes mellitus. Results for the ranking of the top 10 hypertension
agents
for each of the 5 years for Hispanic or Latino African
Americans
and Caucasian Americans did not reveal a noticeable trend
or
change in prescribing modalities over time. Based on this, the surveys
for
the 5 years were pooled. Among the top 10 drugs prescribed
by
name, noticeable differences in prescribing modalities between African
and
Caucasian Americans are not apparent. Beta-blockers seemed
to
be under utilized in both domains. In a comparison of diabetic
hypertensives
with non-diabetic hypertensives, a shift to loop diuretics
and
calcium channel blockers was not apparent. In conclusion, generic
alternatives
to brand name drugs are provided.
093
EFFECT
OF ENVIRONMENTAL EXPOSITION TO
MANGANESE
ON ARTERIAL BLOOD PRESSURE
AND
VARIOUS ACTH DEPENDENT HORMONES IN
GABONESE
MINERS
D
MAVOUNGOU1; MY Akoume-Ndong2; JD Kouilla1;
B
Koudogbo1; B Ongali3.
1Centre
de Recherche sur les Pathologies Hormonales, Montre´al,
QC,
Canada; 2Department of Pharmacology; 3Department of
Physiology, Universite` de Montre´al,
Montre´al, Que´bec, Canada.
The
present study was undertaken to examine the effects of manganese
(Mn)
exposition on blood pressure (SP, DP), Prolactin (Prl)
and
some ACTH related hormones including DHEA, DHEAS and
Cortisol
(F) in Gabonese miners exposed at Low (LR) and High (HR)
risk
of toxicity., using RIA and NIOSH technique spectroscopy absorption.
Miner
groups were identified as follows: LR (N514,
air
Mn50.0660.004
mg/m3), HR (N524,
air Mn551.1266.07
mg/
m3),
without significant difference for age and exposure duration. Significant
increased
of serum levels of Mn (P,.001),
PRL (P,.01)
and
SP
(P,.05)
were noted in the HR group while DHEA levels were
significantly
(P, .01)
decreased. Tendency to low F levels were also
noted
in HR group. These data indicates notable dose dependent manner
effects
of environmental Mn on the studied parameters in agreement
with
ACTH mineralocorticoid stimulation that is implicated in
the
regulation of blood pressure via the rennin–angiotensin system.
097
A
BRIEF SUBSTANCE ABUSE INTERVENTION FOR
BLACK
MEN WITH HIGH BLOOD PRESSURE: A
PILOT
STUDY
CR
DENNISON; MN Hill
Substance
abuse, a widely recognized health problem in the United
States,
has a devastating impact on individuals and families. Many
illnesses
are due directly to alcohol and illicit drug abuse, rendering
substance
abusers among the highest cost users of medical care. Blacks
suffer
disproportionately from substance use-related health and social
problems,
as well as early and severe complications of HBP. The objective
of
this pilot study was to test the effect of a brief substance
abuse
intervention on: 1) completion of referral to substance abuse
treatment;
2) substance use; 3) situation-specific coping self-efficacy;
4)
readiness to change substance use behaviors; and 5) BP level. Substance
abusing
Black men with HBP (N533)
were randomized to
receive
either: 1) HBP care by a nurse practitioner (N516);
or 2) a
brief
substance abuse intervention in addition to HBP care provided
by
a nurse practitioner (N517)
and outcomes were measured at 1 and
3
months. There were no statistically significant differences between
groups
in outcomes at followup. However, both groups showed statistically
significant
decreases across time in alcohol and drug use measures,
with
intervention group reductions exceeding control group reductions.
Approximately
30% of participants completed referral to
substance
abuse treatment. This pilot study was significant because it
specifically
targeted the vulnerable, under-served population of Black
men
with substance use-related problems who are at high risk for
premature
morbidity and mortality. Moreover, trends were identified
to
support further research leading to the development and evaluation
of
practical and cost-effective interventions that address substance
abuse
in this population.
098
TRACKING
AND FOLLOW-UP RATES AND BLOOD
PRESSURE
OUTCOMES AT 48 MONTH FOLLOW
UP
IN YOUNG URBAN BLACK MEN
CR
DENNISON; MN Hill; D Monroe; S Robinson;
L
Lewis-Boyer; C Lewis; LR Bone; DM Levine.
Black
American men with hypertension in low socioeconomic urban
populations
achieve poor rates of hypertension control and suffer
early
from its complications. In an ongoing 5-year randomized clinical
trial
of 309 hypertensive urban Black men ages 21–54 years, we are
evaluating
the effectiveness of a more intensive (MI), comprehensive,
educational-behavioral-pharmacological
hypertension intervention by a
nurse
practitioner-community health worker-physician (NP/CWH/
MD)
team and a less intensive (LI) education and referral intervention.
The
objective of this analysis was to examine trends in tracking, followup,
and
BP lowering at 48 months. Tracking and follow-up rates
at
48 months were 70% (217 completed of 309) for the entire cohort
and
93% for the cohort accounting for men who were deceased, incarcerated,
or
moved out of state.
Data
Point
Systolic
BP, mm Hg
Mean (SD)
MI LI P
Diastolic BP, mm Hg
Mean (SD)
MI LI P
Baseline
48
month
146.8
(19.4)
138.3
(19.4)
147.5
(20.9)
147.0
(25.5)
.74
.006
99.4
(14.5)
89.4
(13.0)
98.5
(14.9)
95.1
(16.6)
.60
.006
At
48 months, the mean SBP/DBP change from baseline was
28.5/29.9
mm Hg for the MI group and 2.54/23.4
mm Hg for
the
LI group (P5.006
for between-group differences in SBP and
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Ethnicity & Disease, Volume
13, Spring 2003
ISHIB2003
ABSTRACTS
DBP).
Significant lowering of SBP and DBP from baseline to 48
months
was observed in the MI group only. Over 48 months, tracking
and
follow-up rates remained high in both groups and the MI intervention
led
to greater lowering of BP in a sample of hypertensive
young
black men.
099
RATES
OF HYPERTENSION AMONG CONGOLESE
RESIDENTS
OF MIXED ETHNIC GROUPS
M
LADISLAS; B Shabishimbo.
Association
des Diabetiques du Congo Diocese de Goma.
Background.
The Diabetes Association of Congo
(L’association des
diabetiques
du Congo, ADIC) is located in the eastern part of the
Congo,
near Rwanda and Uganda. Since August 1998, the region has
been
governed by the Congolese Rally for Democracy.
Purpose.
To determine rates of hypertension
experienced by residents
of
the eastern part of the Congo.
Method.
Study participants included 70 persons
with diabetes of
ADIC:
59% female and 41% male. The participants came from 8
ethnic
groups: Hunde, Nande, Banyabwisha, Warega, Bembe, Bashi,
Nyanga,
Bangubangu. Blood pressure measurements were taken 4
times/wk,
before and after meals for a period of 2 months.
Results.
The highest blood pressure measurements
found were 220/
100
mm Hg and the lowest measurements were 150/90 mm Hg.
Results
found after a 2-month study period are presented in Table 1.
Ethnic
Group N Systolic
Diastolic %
Hunde
21 170 94 30
Nande
Banyabwisha
Warega
Bembe
Bashi
Nyanga
Bangubangu
13
7
7
3
10
5
4
163
158
157
160
158
187
167
86
91
84
80
87
98
100
19
10
10
4
14
7
6
Discussion.
In an attempt to explain why the Hunde
people had
the
highest rates of hypertension, we looked at the environmental
conditions
affecting their health. Currently, the Hunde are victims of
the
80-year ethnic war, which became the starting point of the civil
war
still raging in the country. The Hunde have lost their homes and
properties
and this strife adds to their overall poor health. Also, we
hypothesized
why the women, for the Hunde ethnic group only, suffer
higher
blood pressure rates than the men of all groups. Our theory is
that,
since the destruction of our country by the last Mobutu’s regime,
jobs
and men were lost and many women became the head of the
household,
responsible for the care and health of their families, the
children’s
schooling and school fees, food and nutrition. Women live
in
fear of rape by soldiers, an all-too-often occurrence in this war-torn
country.
106
INCREASES
IN HOSPITALIZATION PREVALENCE
AND
DEATH RATES FOR PERSONS WITH
PULMONARY
HYPERTENSION- UNITED STATES,
1985±1998
C
AYALA; JB Croft PhD; Z-JZheng; GA Mensah.
Introduction.
Pulmonary hypertension primarily
affects women in
the
work force. This rare chronic disease often remains undiagnosed
because
of its slow progression and nonspecific symptoms; thus, there
are
low response rates to treatment. Most persons with pulmonary
hypertension
are diagnosed late. Current reports of pulmonary hypertension
hospitalization
and death rates trends are not available.
Objective.
To assess prevalences of
hospitalization and death rates
among
men and women with pulmonary hypertension during 1985–
1998.
Methods.
National Hospital Discharge Survey and
national vital
statistics
mortality files from 1985–1998 were analyzed for persons
with
pulmonary hypertension (International Classification of Diseases,
Ninth
Revision codes 416.0-416.8). Age-standardized and age-specific
death
rates (per 100,000) and hospitalization prevalences (per 10,000)
were
assessed.
Results.
Death rates doubled from 1.2 in 1985 to
2.7 in 1998.
Prevalences
of hospitalization tripled from 1985 to 1998 for both
women
(1.9 to 7.2) and men (1.8 to 6.0). In 1998, the overall death
rate
and hospital prevalence for pulmonary hypertension were 2.7 and
6.6,
respectively. Women had higher death rates (2.9 vs 2.3 in 1998)
and
higher hospital prevalences (7.2 vs 6.0 in 1998) than men, respectively.
Persons
aged 55-84 years had greater death rates and prevalences
than
those aged ,55
or .85 years.
Conclusion.
This increasing trend in death rates
and hospitalizations
suggests
a strong need for clinical research to prevent and treat,
as
well as to identify risk factors for pulmonary hypertension. Early
diagnosis
and aggressive treatment are critical to improve prognosis of
those
with pulmonary hypertension.
107
ISHIB
ANNUAL INTERNATIONAL
INTERDISCIPLINARY
CONFERENCES: A
HISTORICAL
REVIEW /PERSPECTIVE
MO
ASHAYE; GA Mensah; WD Hall.
International
Society on Hypertension in Blacks, Atlanta, GA;
Centers
for Disease Control and Prevention (CDC), Atlanta,
GA;
Emory University, Atlanta, GA.
Background.
The International Society on
Hypertension in Blacks
(ISHIB)
is a unique, professional health organization providing education,
advocacy,
and research on hypertension and related risk factors
in
ethnic populations. Its mission is to improve the health and life
expectancy
of ethnic populations worldwide. ISHIB2003,World Congress
on
Cardiovascular Health: Preventing the Global Pandemic in
Developing
Countries is the 18th in ISHIB’s series of annual scientific
sessions.
Objective.
To describe the trends and
characteristics of conference
attendees,
workshop and plenary program content, abstracts presented
and
conference proceedings from 1986 to 2003.
Methods.
Using graphic presentation to
illustrate the trend in sesS2-
179
Ethnicity & Disease, Volume
13, Spring 2003
ISHIB2003
ABSTRACTS
sions
and abstract presentations, we highlight the growth and diversity
of
both participants and scientific content of the conferences.
Results.
Since 1986, the diversity of conference
attendees, abstracts,
plenary
and workshop sessions has grown. Plenary sessions have increased
from
four to six, and workshops from four to nine. From eight
abstracts
for poster and fifteen for scientific presentations in 1986, the
numbers
of abstracts have increased to 109 this year. The expanded
content
for high blood pressure-related cardiovascular risk factors now
also
includes diabetes, dyslipidemia, obesity, renal disease, tobacco
abuse,
and other related risk factors.
Conclusion.
ISHIB is an organization on a rapid
path for growth.
Through
partnerships with more than 20 health organizations including
Centers
for Disease Control and Prevention; the International Society
of
Nephrology; National Heart, Lung and Blood Institute; National
Institute
of Diabetes and Digestive and Kidney Diseases and
the
World Health Organization, ISHIB plays a major role in preventing
and
controlling the global pandemic of cardiovascular disease.
108
AN
EXPLORATIVE STUDY ABOUT PERCEPTIONS
ON
HYPERTENSION OF CREOLE SURINAMESE
HYPERTENSIVE
PATIENTS
EJAJ
BEUNE
Academic
Medical Centre , University of Amsterdam.
Background.
In Suriname, a formal colony of the
Netherlands, a
big
part of the population is of West-African origin. After 1975, when
Suriname
became independent, many Surinamese settled in the Netherlands.
Today,
the Surinamese comprise the largest non-Western ethnic
group
in the Netherlands and most live in Amsterdam, especially
in
the southeast area of the city. In this area, 62% of the people belong
to
diverse ethnic minorities. 31% are Surinamese, of which 60% are
Creole.
Hypertension
is an important risk factor for cardiovascular disease
and
the prevalence is higher among people from African origin. According
to
Kleinman and Leventhal: a) patients and doctors have their
own
explanatory models of health and illness (lay models and professional
models);
and, b) culture-related perceptions play an important
role
in those models. Research shows this can lead to personal perspectives
on
treatment, which may cause difficulties in doctor-patient
communication.
Objective.
The objective of the study was to
explore the illness
perceptions
of Creole Surinamese with hypertension, the integration
of
treatment advice in daily life, and compliance of the General Practitioners
(GP)
guidelines.
Methods.
Qualitative research using
semi-structured patient interviews
and
their medical dossiers. Data-analysis with Winmax. Special
attention
to experienced symptoms, causes, consequences, course and
control.
15 Creole Surinamese patients with hypertension were interviewed
and
recruited from GP’s health center in Amsterdam southeast.
Selection
criteria. age540–60;
ICPC-code: K86; ‘‘usual care’’; having
been
treated with hypertension medication for at least one year;
and
no use of medication for other chronic disease.
Summary
of results. In the medical perspective,
hypertension has
several
causes (risk factors). However, in the patients’ perspective the
primary
cause was psychological distress, mostly due to reasons out of
their
own control. In the medical perspective, hypertension is asymptomatic,
but
the patients’ point of view shows they do experience
symptoms.
Reported
treatments differed from the recorded ones in the medical
dossier,
especially in medication-dosage. Also, patients modified
treatment
advice, mostly on their own initiative.
The
respondents showed a lot of knowledge about traditional Surinamese
remedies
for hypertension, which were sometimes used as an
additive
or as a substitute for the prescribed treatment.
Conclusions.
There are differences between
lay-explanatory models
and
the medical standard concerning the illness explanations and adequate
treatment
for hypertension. The respondents’ explanatory models
sometimes
referred to their Surinamese history and community in
Amsterdam.
The results of this study have led to a new research project,
called
‘‘Hee Broedoe’’ at the Academic Medical Centre of Amsterdam,
which
started in September 2002. The aim of the project is
to
investigate to what extent differences in explanatory models of hypertension
are
related to the social and cultural backgrounds of patients.
It
compares Dutch, Creole Surinamese, and Ghanese patients
with
hypertension and seeks to answer the question whether it is necessary,
useful
and possible to employ a culture-specific approaches in
hypertension
care for these ethnic groups in the Netherlands.
Diabetes
003
SICKLE
CELL TRAIT IS A CONTRIBUTING FACTOR
TO
DIABETIC MICRO-ANGIOPATHY
AA
AJAYI; BA Kolawole.
Type
2 diabetes is characterized by endotheliopathy and nitric oxide
(NO)
deficit, which appears worse in Blacks. The complication
rate
and mortality from this disease is higher in diaspora Africans,
after
socioeconomic adjustments, suggesting a genetic predilection.
Hemoglobin
AS genotype is also common in Blacks and is associated
with
diminished NO production, endothelial cytoadherence leading
to
ischemia via vascular adhesion molecules. We tested the hypothesis
that
asymptomatic sickle cell trait worsens diabetic vascular disease.
49
consecutive Nigerians (21 women) with type 2 diabetes and hypertension,
aged
40–75 years, were scored for diabetic vascular complications
(0–5)
and hemoglobin genotype was determined by electrophoresis.
Multiple
regression analysis, with complication load as the
dependent
variable revealed an important contribution of genotype, as
an
independent variable (r250.18,
F52.4) but with a
diminished predictability
when
genotype was excluded (r250.11,
F51.76). The mean
severity
scores were significantly different by genotype and gender
(P50.027
ANOVA, F53.3)
; male–AS (N57)
2.460.33, male–AA
(N521)1.4860.22,
with a 95% CI relative risk [RR] of 1.58–1.62
for
AS. The female–AS score was (N58)
1.1860.45,
female–AA
(N513)
0.8560.26,
The median diabetes duration was 4 years and
was
similar for the 4 groups. The RR 95% CI of female AS to AA
was
0.43–1.59. All male AS had at least one complication, especially
proteinuria
and/or severe retinopathy. These results indicate that sickle
cell
trait, as well as the male gender, enhances the risk for type 2
diabetic
vascular complications in Blacks.
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13, Spring 2003
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ABSTRACTS
030
HIGH
BLOOD PRESSURE PRECEDES
DETERIORATION
IN GLUCOSE TOLERANCE IN
AFRICAN
AMERICANS
B
FALKNER; H Kushner.
Thomas
Jefferson University.
Objective.
To examine the relationship of blood
pressure (BP) with
deterioration
of glucose tolerance in young adult African Americans.
Methods.
Measures of BP, anthropometrics,
glucose tolerance, and
insulin
sensitivity by insulin clamp (M) were obtained in a young adult
sample
(Exam-1; mean age 31 yrs). These measures were repeated five
years
later in N5141
men and women (Exam-2). To determine if BP
level
contributed to a change in metabolic measures, all subjects were
rank
ordered according to systolic BP at Exam-1. Subjects were then
stratified
into systolic BP tertiles. Metabolic parameters at Exam-1 and
Exam-2
were analyzed by BP tertile assignment: High5H,
Mid5M,
Low5L.
Results.
Systolic BP level for the H group was .130
mm Hg in
males,
and .126
mm Hg in females. At Exam-1 fasting insulin only
was
significantly higher in H (P5.006).
At Exam-2 both glucose and
insulin
were significantly higher in H (both ,.005)
and the H group
was
significantly more insulin resistant (P,.003).
No change in insulin
sensitivity
occurred in the M and L tertile of systolic BP.
Conclusions.
High systolic BP preceded the
deterioration in glucose
tolerance
in young adult African Americans. Those with high BP also
became
more insulin resistant. These data suggest that microvascular
alterations
that are related to higher BP may contribute to the deterioration
in
glucose tolerance that leads to type 2 diabetes.
031
EVALUATION
OF A PATIENT RESOURCE AND
EMPOWERMENT
TOOL, THE TRAFFIC LIGHT
DIABETES
RECORD BOOKLET:
A
PRELIMINARY REPORT
NEN
AMOAH2; AGB Amoah1,2; S Yeboah2; RY Amoah2;
G
Takyi2.
MORBIDITY
AND MORTALITY IN MEDICAL
PATIENTS
WITH DIABETES FROM A NATIONAL
REFERRAL
CENTER IN GHANA
AGB
AMOAH1,2, R Biritwum3; AO Amaning4.
COMPLIANCE
AND ADHERENCE TO TREATMENT
BY
GHANAIAN SUBJECTS WITH DIABETES: A
PRELIMINARY
REPORT
AGB
Amoah1,2 ; S YEBOAH2; NEN Amoah2; RY Amoah2;
G
Takyi; R Amegashie1; D Kutuasti.
ASSESSING
DIABETES RISK IN THE JACKSON
METROPOLITAN
AREAĐA PILOT STUDY
DF
SARPONG.
CAUSE
OF DEATH AMONG PERSONS WITH
DIABETES:
LAST THREE DECADES OF
THE
20TH CENTURY
EA LARYEA; RS Squire; C Zambrana; P
Rolla.
Obesity
EFFECT
OF EXERCISE AND DIET IN LOWERING
PULSE
PRESSURE IN OBESE AFRICAN AMERICANS:
ANALYSIS
OF 24-HOUR AMBULATORY BLOOD
PRESSURE
DATA
OS
RANDALL; J Kwagyan; A Maqbool; S Xu; EC Tabe.
SOCIO-DEMOGRAPHIC
CORRELATES OF OBESITY
IN
GHANAIAN ADULTS
AGB
AMOAH.
Other
Risk Factors, Prevention and Health Promotion
COMMUNITY-BASED
STUDY OF HEALTH
PROMOTION
IN ASHANTI, WEST AFRICA.
DEFINITION
OF RURAL AND SEMI-URBAN AREAS
L
EMMETT1; FP Cappuccio1; FB Micah1,3; SM Kerry1;
S
Antwi3; J Plange-Rhule1,2,3; JB Eastwood2.
COMMUNITY-BASED
STUDY OF HEALTH
PROMOTION
IN ASHANTI, WEST AFRICA: SELFREPORTED
INTAKE
OF SALT AND SALTED FOODS
L
EMMETT1; FP Cappuccio1; FB Micah1,3; SM Kerry1;
RO
Phillips1; J Plange-Rhule123; JB Eastwood2.
DOES
NEIGHBORHOOD ENVIRONMENT
ACCOUNT
FOR RACIAL DISPARITIES IN
INTERVENTION
EFFECTIVENESS? RESULTS FROM
THE
WISEWOMAN PROJECTS
JC
WILL; EA Finkelstein; RP Farris; CG Sanders.
INNOVATION
IN CARE: A HANDY EDUCATIONAL
AND
EMPOWERMENT TOOL FOR SUBJECTS WITH
DIABETES
IN LOW-RESOURCE SETTINGS
AGB
AMOAH.
SOURCES
OF INFORMATION ON DIABETES FOR
GHANAIAN
SUBJECTS WITH DIABETES
AGB
Amoah1,2; R AMEGASHIE1; NEN Amoah2; S Yeboah2;
RY
Amoah2; G Takyi; D Kutuatsi2.
RACIAL
AND ETHNIC APPROACHES TO
COMMUNITY
HEALTH (REACH 2010)
CARDIOVASCULAR
HEALTH PROGRAMS:
TRADITIONAL
AND NONTRADITIONAL PARTNERS
PJ
TUCKER; S McNary; C Morrison; TD Sterling.
PREVENTIVE
MEASURES FOR CARDIOVASCULAR
HEALTH
PROMOTIONĐA COMMUNITY-BASED
APPROACH
OF THE REACH 2010 PROGRAM
CM
MORRISON; PJ Tucker; SL McNary.
INCEPTION,
DEVELOPMENT, AND
IMPLEMENTATION:
REACH 2010 LESSONS
LEARNED
FROM THE FIELD
L
PRESLEY-CANTRELL; TD Sterling.
IMPROVING
QUALITY OF LIFE WITHIN AN
AFRICAN-AMERICAN
COMMUNITY: A LAY HEALTH
ADVISOR
APPROACH
L
CHAVIS; M Groblewski.
PRIMARY
AND SECONDARY PREVENTION OF CORONARY HEART DISEASE: DIFFERENCES BETWEEN
GUIDELINE RECOMMENDATIONS AND ACTUAL PRACTICE ACHIEVEMENTS
A
SUNDARAM; GA Mensah.
PARTNERING
TO ADDRESS THE GLOBAL BURDEN OF HEART DISEASE AND STROKE IN DEVELOPING
COUNTRIES
KJ
GREENLUND; NL Keenan; GA Mensah; NB Watkins; JB Croft; V Bales.
WHY
THE UNITED STATES TARGETS RACIAL ANDETHNIC COMMUNITIES OF COLOR TO ELIMINATE
HEALTH DISPARITIES
I
MA’AT; A Troutman; BC Miller.
REDUCING
HEART DISEASE AND STROKE AMONG WOMEN: CDC'S GLOBAL COLLABORATIONS
NL
KEENAN; KJ Greenlund; GA Mensah; E Wilson; V Bales.
COPOLOGY:
A MODEL FOR THE PREVENTION AND TREATMENT OF STRESS LEADING TO HYPERTENSION AND
CARDIOVASCULAR DISEASES
E
HUGHLEY.
SCHOOLS
AS EFFECTIVE SETTINGS FOR HEALTH PROMOTION AND PRIMORDIAL PREVENTION
L
KANN1; L Kolbe1; C Gollmar2; L Riley2; J Jones2; P Morgan1.
THE
GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY: A NEW PROGRAM PLANNING TOOL FOR SCHOOL
HEALTH PROGRAMS
L
KANN1; L Riley2; C Gollmar2.
STRESS
REDUCTION AND PREVENTION OF CARDIOVASCULAR MORBIDITY AND MORTALITY IN AFRICAN
AMERICANS WITH
ANGIOGRAPHIC
CAD
CE
GRIM; A Dalmar; H Fenderson; A LaFave; M Faizuddin;
M
Lawrence; M Rainforth; S Nidich; R Schneider.
STRESS
REDUCTION AND HYPERTENSION PREVENTION IN AFRICAN AMERICANS
CE
GRIM; J Peete; A LaFave; M Faizuddin; M Lawrence; M Rainforth; S Nidich; R
Schneider.
THE
POWER OF VISUALS: A HEALTH COMMUNICATIONS STRATEGY
ML
HOUSTON; M Casper; I Williams.; K Greenlund; DC Ray; E Barnett; J Halverson; GA
Mensah.
UTILIZING
DIVERSE COMMUNICATIONS CHANNELS TO DISSEMINATE INFORMATION ON HEART DISEASE AND
STROKE
ML
HOUSTON; M Greenwell; N Watkins; A Holmes-Chavez; G Mensah.
HEALTHY
VILLAGE-NUTRITIONAL AND LIFESTYLE SUPPORT PROGRAM
QK
ALI
WORLD
ATLAS ON HEART DISEASE, STROKE, AND OTHER CARDIOVASCULAR DISORDERS: AN IMPORTANT
EDUCATIONAL AND ADVOCACY TOOL FOR HEALTH PROMOTION AND THE PREVENTION AND
CONTROL OF THE WORLD'S LEADING CAUSES OF DEATH
GA
MENSAH; JM Mackay; R Bonita; K Greenlund; S Mendis; P Poole-Wilson; K Strong; D
Yach.
THE
UNITED STATES CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) SUPPORTS POPULATION-BASED
STRATEGIES FOR THE PREVENTION AND CONTROL OF HEART DISEASE AND STROKE
GA
MENSAH; NB Watkins; JB Croft; M Malone; M Houston; WH Giles; D Labarthe; VS
Bales; JL Collins; JS Marks.
PREVALENCE
OF SELF-REPORTED RISK FACTORS AMONG BLACK AND WHITE WOMEN WITH HISTORY OF HEART
DISEASE - BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), 2001
AA
SUNDARAM; C Ayala; K Greenlund; NL Keenan; GA Mensah.
COMMUNICATING
FOR POLICY AND ENVIRONMENTAL CHANGE FOR PREVENTION OF HEART DISEASE AND STROKE
S
LOCKHART; N Watkins.
LESSONS
LEARNED ON ADAPTING A PUBLIC HEALTH COMMUNICATION PLANNING TOOL FOR GLOBAL USE
S
LOCKHART; N Watkins.
Cardiovascular
Diseases
APOE
POLYMORPHISM AND LIPOPROTEIN AND APOLIPOPORTEIN LEVELS IN A GULF ARAB POPULATION
AO
AKANJI; HR Fatania; R Al-Radwan; S Al-Shammri.
CARDIOVASCULAR
DISEASE AND AUSTRALIAN INDIGENOUS PEOPLE
MJ
MORRISSEY.
BLOOD
PRESSURE AND BODY WEIGHT IN ASHANTI, WEST AFRICA
FP
CAPPUCCIO; L Emmett1; FB Micah; SM Kerry; A Antwi; J Plange-Rhule; JB Eastwood.
BLOOD
PRESSURE AND HEMATOLOGICAL MEASURES OF VISCOSITY IN ASHANTI, WEST AFRICA
JB
EASTWOOD; L Emmett; FB Micah; SM Kerry; RMartin-Peprah; G Bedu-Addo; J
Plange-Rhule; FP Cappuccio.
CARDIOMEGALY
IN GHANA: AN AUTOPSY STUDY
H
ARMAH; AB Akosa.
AN
INTEGRATED PROGRAM TO REDUCE MORBIDITY AND MORTALITY FROM CHRONIC DISEASES IN
REMOTE AUSTRALIAN ABORIGINAL COMMUNITIES
S
KONDALSAMY-CHENNAKESAVAN; W
Hoy.
CIRCULATORY
DISEASES AMONG HOSPITALIZED ADULTS IN A NATIONAL
REFERRAL
CENTER IN AFRICA
J
ADDO; G Dodoo; AGB Amoah; JOM Pobee
INFLUENCE
OF ISOPROTERENOL ON AORTIC AUGMENTATION INDEX IN BLACKS AND WHITES
D
LEMOGOUM; W Van den Abeele; A Ciarka; L Van Bortel; M Leeman; JP Degaute; P Van
de Borne.
EFFECTS
OF VAGAL WITHDRAWAL AND IMPROVEMENT OF ARTERIAL COMPLIANCE ON ARTERIAL
BAROREFLEX SENSITIVITY
A CIARKA; D Lemogoum; W Van den Abel; N
Montano; JP Degaute; P Van de Borne.
ARTERIAL
STIFFNESS AND CARDIOVASCULAR RISK: IMPLICATION FOR AFRICA
D
LEMOGOUM.
THE
ROLE OF INCREASED PULSE PRESSURE INPREDICTING ABNORMAL MYOCARDIAL PERFUSION
IMAGES
EK
AMEGASHIE.
CARDIOVASCULAR
DISEASE AND PATIENT EDUCATION: A GLOBAL REVIEW FROM A LITERACY PERSPECTIVE 1967-2002
LM
TOMLINSON; J Lester; M Salinas.
ASSOCIATION
BETWEEN HYPERTENSION, DIABETES AND THE GLU298ASP POLYMORPHISM OF THE
ENDOTHELIAL NITRIC OXIDE SYNTHASE GENE IN A COHORT OF WEST AFRICAN PATIENTS AND
CONTROLS: THE ADDM STUDY
H
DANIEL; Y Chen; H Huang; A Doumatey; TA Jie zhou; G Chen; A Amoah; J
Acheampong; J Oli; B Osotimehin; T Johnson; F Collins; G Dunston; CN Rotimi.
Stroke
SECONDARY
STROKE PREVENTION IN RURAL SOUTH AFRICA: REPORT FROM THE SOUTHERN AFRICA STROKE
PREVENTION INITIATIVE (SASPI) AGINCOURT FIELD SITE
M
THOROGOOD; MD Connor; G Hundt; B Ngoma, on behalf of the SASPI project team.
RISK
FACTORS AND DISABILITY BURDEN ASSOCIATED WITH STROKE SURVIVORS IN RURAL SOUTH
AFRICA: FINDINGS FROM THE SOUTHERN AFRICA STROKE PREVENTION INITIATIVE (SASPI)
RURAL AGINCOURT FIELD SITE
MD
CONNOR; BL Casserly; C Dobson; M Thorogood; CP Warlow, on behalf of the SASPI
Project Team.
STROKE
PROTECTIVE EFFECT OF ANGIOTENSIN-II STIMULATING ANTIHYPERTENSIVE DRUGS. SPECIAL
RELEVANCE IN BLACK HYPERTENSIVES?
A
FOURNIER; F Boutitie; D Lemogoum; G Amah; P Fievet; F Gueyffier.
EXPERIMENTAL
EVIDENCES EXPLAINING THE STROKE PROTECTIVE EFFECT (SPE) OF ANTIHYPERTENSIVE
DRUGS STIMULATING ANGIOTENSIN-II-FORMATION
A
FOURNIER; H Mazouz; F Dalmay; L Fernandez;
JM
Achard
THE
PAUL COVERDELL NATIONAL ACUTE STROKE REGISTRY PROTOTYPES: COLLECTING AND UTILIZING
DATA FOR QUALITY IMPROVEMENT
GA
MENSAH; AM Malarcher; JB Croft.
Renal
Function and Disease
AN
EARLY EVALUATION OF THE PRIMARY PREVENTION PROGRAM (PPP), A KIDNEY DISEASE RENOPROTECTION
PROGRAM (KDRP) IN AFRICA
IJ
KATZ; V Luyck; O Butler; M Hopley.
THE
ROLE OF CYTOCHROME P450-DERIVED EICOSANOIDS IN NITRIC OXIDE-MEDIATED REGULATION
OF BLOOD PRESSURE AND RENAL FUNCTION
G
OGUNGBADE; A Oyekan.
DIVERSITY
OF HLA CLASS I IN KIDNEY DONORS AND RECIPIENTS IN KWA-ZULU NATAL (SOUTH AFRICA)
ACCORDING TO RACE
AGH
ASSOUNGA; V Schreiber.
Women’s
Health
HYPERTENSION
IN PREGNANCY: A RETROSPECTIVE CASE REVIEW.
PRELIMINARY
REPORT
EFO
ENATO; AO Okhamafe; NS Omoruyi; CJ Ifedili.
THE
ROLE OF MOTHERS IN THE MANAGEMENT OF MALARIA IN CHILDREN 5 YEARS AND YOUNGER IN
A NIGERIAN COMMUNITY
EFO
ENATO; OE Aghomo; AO Okhamafe.
LIPID
PROFILE IN HORMONAL CONTRACEPTIVE USERS: HAS THE DUST SETTLED?
AC
MBAKWEM; MO Fadoyomi.
DIABETES
IN PREGNANCY: DOES QUALITY OF CARE MATTER?
M
HARGRAVES; J Van Hook; C Manning; G Anderson.
GYNECOLOGISTS
AS CHAMPIONS FOR CARDIOVASCULAR HEALTH PROMOTION AND THE PREVENTION AND CONTROL
OF HEART DISEASE AND STROKE
LG
MENSAH GA Mensah.
Children
and Young Adults
037
RELATIONSHIPS
BETWEEN BIRTH WEIGHT, WEIGHT GAIN DURING FIRST YEAR OF LIFE, OVERWEIGHT, AND
HYPERTENSION IN CHILDREN IN SEYCHELLES (INDIAN OCEAN)
P
BOVET; N Stettler, G Madeleine; B Viswanathan; F Paccaud.
STRONG
RELATIONSHIP BETWEEN BODY WEIGHT AND BLOOD PRESSURE: A STUDY OF 14,180 CHILDREN
IN THE SEYCHELLES (INDIAN OCEAN)
P
BOVET; N Stettler; G Madeleine; B Viswanathan; JP Gervasoni; F Paccaud.
THIN
BLACK BABIES WHO ARE LOW BIRTH WEIGHT INFANTS HAVE A HIGHER RISK OF HYPERTENSION
IN ADOLESCENCE: A CARIBBEAN PERSPECTIVE
EC
CHAMBERS; ES Tull; H Fraser; N Mutunhu; N Sobers; E Niles.
DASH-DETERMINANTS
OF ADOLESCENT SOCIAL WELL-BEING AND HEALTH. A SCHOOL-BASED SURVEY OF YOUNG
PEOPLE FROM DIFFERENT ETHNIC GROUPS IN LONDON, UK
M
MAYNARD; S Harding.
COMPARISON
OF BIRTH WEIGHTS BY ETHNIC GROUP OF FOREIGN-BORN AND UK-BORN MOTHERS IN A
COHORT STUDY
S
HARDING; K Cruickshank; M Rosato.
Translational
Research/Public Health Practice
AN
EARLY EVALUATION OF THE PRIMARY PREVENTION PROGRAM (PPP), A KIDNEY DISEASE RENOPROTECTION
PROGRAM (KDRP) IN AFRICA
IJ
KATZ; V Luyck; O Butler; M Hopley.
PREVENTIVE
MEASURES FOR CARDIOVASCULAR HEALTH PROMOTION-A COMMUNITY-BASED APPROACH OF THE
REACH 2010 PROGRAM
CM
MORRISON; PJ Tucker; SL McNary.
INCEPTION,
DEVELOPMENT, AND IMPLEMENTATION: REACH 2010 LESSONS LEARNED FROM THE FIELD
L
PRESLEY-CANTRELL; TD Sterling.
IMPROVING
QUALITY OF LIFE WITHIN AN AFRICAN-AMERICAN COMMUNITY: A LAY HEALTH ADVISOR
APPROACH
L
CHAVIS; M Groblewski.
PARTNERING
TO ADDRESS THE GLOBAL BURDEN OF HEART DISEASE AND STROKE IN DEVELOPING
COUNTRIES
KJ
GREENLUND; NL Keenan; GA Mensah; NB Watkins; JB Croft; V Bales.
BUILDING
CAPACITY IN CHRONIC DISEASE SURVEILLANCE: THE WHO STEP WISE APPROACH TO
SURVEILLANCE (STEPS) ON NCD RISK FACTORS NATIONAL HYPERTENSION MANAGEMENT AUDIT
PROJECT IN FOUR AFRICAN COUNTRIES
KK
AKINROYE; H Agboton
THE
GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY: A NEW PROGRAM PLANNING TOOL FOR SCHOOL
HEALTH PROGRAMS
L
KANN; L Riley; C Gollmar.
THE
UNITED STATES CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) SUPPORTS POPULATION-BASED
STRATEGIES FOR THE
PREVENTION
AND CONTROL OF HEART DISEASE AND STROKE
GA
MENSAH; NB Watkins; JB Croft; M Malone; M Houston;
WH
Giles; D Labarthe; VS Bales; JL Collins; JS Marks.
LESSONS
LEARNED ON ADAPTING A PUBLIC HEALTH COMMUNICATION PLANNING TOOL FOR GLOBAL USE
S
LOCKHART; N Watkins.
DRUG
USE PATTERN ON A NIGERIAN UNIVERSITY CAMPUS
EFO
ENATO; OE Aghomo; AO Okhamafe.
EFFECTIVENESS
OF DISEASE MANAGEMENT OF HYPERTENSIVE AND HYPERLIPIDEMIA PATIENTS BY
PHARMACISTS
DF
SARPONG; K Woodard.
KNOWLEDGE
AND SELLING PRACTICES OF PATENT MEDICINE VENDORS (PMVs) REGARDING THE TREATMENT
OF MALARIA IN IDIKAN COMMUNITY, SOUTHWEST NIGERIA
PE
OSAMOR.
THE
FEASIBILITY OF UTILIZING DEPARTMENT OF MOTOR VEHICLE (DMV) RECORDS IN RECRUITING
AFRICAN AMERICANS INTO
COHORT
STUDIES
C
HOYO K McCullough; R Cleveland; P Godley; L Reid; T Ostbye; M Gammon.
THE
USE OF MEDICAL SURPLUS TO PROVIDE AND IMPROVE HEALTHCARE DELIVERY WORLDWIDE
AB SHORT; NN Diallo
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