Improvements in Blood Pressure Control and the Hypertension Care Continuum Over 2 Years in Urban Haiti Amidst Civil Unrest

IF 2.5 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Miranda Metz, Rodney Sufra, Anju Ogyu, Vanessa Rouzier, Reichling St. Sauveur, Kelly Celestin, Guyrlaine Forrestal, Fabyola Preval, Mirline Jean, Suzanne Edwidge Marcelin, Auguste Sarine, Catherine Bennett, Serena Koenig, Kenneth Jamerson, Jean William Pape, Lily D. Yan, Margaret L. McNairy
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Abstract

Hypertension (HTN) is the leading cause of death worldwide, yet only 8% of individuals have controlled blood pressure (BP) in low- and middle-income countries, with particular challenges in humanitarian crisis settings including Haiti. The Haiti Cardiovascular Disease Cohort, an observational population-based cohort in Port-au-Prince, offers a unique opportunity to evaluate the HTN Care Continuum in a setting of extreme poverty and civil unrest. From 2019 to 2021, 3005 adults were enrolled, with BP measured every 6 months and free clinical care provided. HTN was defined as SBP ≥ 140, DBP ≥ 90, or antihypertensive medication use. We assessed screening, awareness, treatment, and BP control (BP < 140/90 on antihypertensives) at enrollment and 24 months. Multivariable Poisson regression identified sociodemographic factors associated with BP control. Of 3005 adults, 878 had HTN at enrollment (median age 57; 62% female; 71% earned < $1/day). Among 568 hypertensive participants with 24-month follow-up, awareness increased from 67% to 95%, treatment from 40% to 71%, and BP control from 11% to 32%. Median BP decreased from 150/91 to 138/82 mmHg. Across visits, 67% had ≥ 1 controlled BP and 35% had control at more than half of visits. Younger age (18–39 vs. ≥60 years) was associated with lower BP control (PR: 0.40, 95% CI: 0.18–0.77). Substantial improvements in HTN care, including a threefold rise in BP control and a mean SBP decrease of 12 mmHg, are achievable even in settings of extreme adversity and humanitarian crises.

Trial Registration: ClinicalTrials.gov identifier: NCT03892265

Abstract Image

在内乱的海地城市,血压控制和高血压治疗持续2年的改善
高血压(HTN)是世界范围内导致死亡的主要原因,但在低收入和中等收入国家,只有8%的人控制血压(BP),在包括海地在内的人道主义危机环境中面临着特殊挑战。海地心血管疾病队列是在太子港开展的一项以人群为基础的观察性队列,为在极端贫困和内乱的背景下评估海地心血管疾病队列提供了一个独特的机会。从2019年到2021年,3005名成年人入组,每6个月测量一次血压,并提供免费临床护理。HTN定义为收缩压≥140,舒张压≥90,或使用抗高血压药物。我们在入组和24个月时评估筛查、认知、治疗和血压控制(降压药时血压< 140/90)。多变量泊松回归确定了与血压控制相关的社会人口学因素。3005名成人中,878人在入组时患有HTN(中位年龄57岁,62%为女性,71%收入< 1美元/天)。在568名随访24个月的高血压患者中,意识从67%增加到95%,治疗从40%增加到71%,血压控制从11%增加到32%。中位血压从150/91降至138/82 mmHg。在所有就诊中,67%的患者血压控制≥1,35%的患者在一半以上的就诊中血压控制。年龄较小(18-39岁vs.≥60岁)与较低的血压控制相关(PR: 0.40, 95% CI: 0.18-0.77)。即使在极端逆境和人道主义危机的情况下,HTN护理也可以实现实质性改善,包括血压控制提高三倍,平均收缩压降低12毫米汞柱。试验注册:ClinicalTrials.gov标识符:NCT03892265。
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来源期刊
Journal of Clinical Hypertension
Journal of Clinical Hypertension PERIPHERAL VASCULAR DISEASE-
CiteScore
5.80
自引率
7.10%
发文量
191
审稿时长
4-8 weeks
期刊介绍: The Journal of Clinical Hypertension is a peer-reviewed, monthly publication that serves internists, cardiologists, nephrologists, endocrinologists, hypertension specialists, primary care practitioners, pharmacists and all professionals interested in hypertension by providing objective, up-to-date information and practical recommendations on the full range of clinical aspects of hypertension. Commentaries and columns by experts in the field provide further insights into our original research articles as well as on major articles published elsewhere. Major guidelines for the management of hypertension are also an important feature of the Journal. Through its partnership with the World Hypertension League, JCH will include a new focus on hypertension and public health, including major policy issues, that features research and reviews related to disease characteristics and management at the population level.
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