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,

S2-169 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.

S2-171 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-

172 Ethnicity & Disease, Volume 13, Spring 2003

ISHIB2003 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

S2-173 Ethnicity & Disease, Volume 13, Spring 2003

ISHIB2003 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.

S2-174 Ethnicity & Disease, Volume 13, Spring 2003

ISHIB2003 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)

S2-175 Ethnicity & Disease, Volume 13, Spring 2003

ISHIB2003 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-

176 Ethnicity & Disease, Volume 13, Spring 2003

ISHIB2003 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

S2-178 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.

S2-180 Ethnicity & Disease, Volume 13, Spring 2003

ISHIB2003 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 AREAÐA 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 PROMOTIONÐA 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