Faculty Bibliography

Sex disparity in hypertension prevalence is well established in developed nations; however, there is paucity of data on the distribution of hypertension prevalence between the sexes in developing countries. Therefore, the authors examined sex differences in hypertension prevalence and cardiovascular risk factors in a sample of 352 healthy hospital workers in Nigeria. The mean ages of the men and women were 37.2+/-7.9 and 44.7+/-9.1 years, respectively. Thirty-five percent of participants were hypertensive, with 54% on treatment and 70% with controlled blood pressure. Men had a higher prevalence of hypertension (38.4% vs 33.0%) and prehypertension (37.6% vs 29.7%). Women had significantly higher odds of developing hypertension and of being on treatment. Mean blood pressure and fasting plasma glucose values were higher in men, while women were more often older, obese, and dyslipidemic and had a lower mean estimated glomerular filtration rate (P<.0001). These findings indicate sex disparity in blood pressure among hospital employees. Sex-focused management of hypertension is therefore advocated for hospital employees.

BACKGROUND: Few studies have examined the social and behavioral predictors of insufficient sleep. OBJECTIVE: To assess the social and behavioral predictors of insufficient sleep in the U.S. POPULATION: METHODS: Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Telephone interviews were conducted in six representative states that completed the optional sleep module. A total of 31,059 respondents were included in the present analysis. BRFSS-provided weights were applied to analyses to adjust for the use of complex design. RESULTS: The mean age for the sample was 56 +/- 16 years, with 63% of the sample being female; 88% identified as non-Hispanic white and 12% identified as non-Hispanic black; 42% were not married and 8% did not have a high school degree. The prevalence of insufficient sleep (<7 hours) was 37%. Multivariate-adjusted logistic regression revealed associations of four important factors with insufficient sleep, which were: working more than 40 hours per week [OR = 1.65, p < 0.001, 95% CI = 1.65-1.66], black race/ethnicity [OR = 1.37, p < 0.001, 95% CI = 1.37-1.38], history of heart disease [OR = 1.26, p < 0.001, 95% CI = 1.25-1.28], care-giving to family/friends [OR = 1.50, p < 0.001, 95% CI = 1.49-1.51], and lack of social and emotional support [OR = 1.24, p < 0.001, 95% CI = 1. 23-1.25]. CONCLUSION: Social and behavioral predictors of health uniquely contribute to the report of insufficient sleep and should be considered when developing programs to increase awareness of the adverse effects of insufficient sleep.

Many adults with elevated clinic blood pressure (BP) have lower BP when measured outside the clinic. This phenomenon, the "white-coat effect," may be larger among older adults, a population more susceptible to the adverse effects of low BP. The authors analyzed data from 257 participants in the Jackson Heart Study with elevated clinic BP (systolic/diastolic BP [SBP/DBP] >/=140/90 mm Hg) who underwent ambulatory BP monitoring (ABPM). The white-coat effect for SBP was larger for participants 60 years and older vs those younger than 60 years in the overall population (12.2 mm Hg, 95% confidence interval [CI], 9.2-15.1 mm Hg and 8.4 mm Hg, 95% CI, 5.7-11.1, respectively; P=.06) and among those without diabetes or chronic kidney disease (15.2 mm Hg, 95% CI, 10.1-20.2 and 8.6 mm Hg, 95% CI, 5.0-12.3, respectively; P=.04). After multivariable adjustment, clinic SBP >/=150 mm Hg vs <150 mm Hg was associated with a larger white-coat effect. Studies are needed to investigate the role of ABPM in guiding the initiation and titration of antihypertensive treatment, especially among older adults.

Uncontrolled blood pressure (BP) is linked to increased risk of obstructive sleep apnea (OSA). However, few studies have assessed the impact of this relationship among blacks with metabolic syndrome (MetS). Data for this study were collected from 1035 blacks (mean age=62+/-13 years) enrolled in the Metabolic Syndrome Outcome study. Patients with a score 6 on the Apnea Risk Evaluation System were considered at risk for OSA. Of the sample, 77.1% were low-to-high OSA risk and 92.3% were hypertensive, of which 16.8% had uncontrolled BP levels. Analysis also showed that 60.4% were diabetic, 8.9% had a stroke history, 74.3% had dyslipidemia, 69.8% were obese and 30.9% had a history of heart disease. Logistic regression analyses were employed to investigate associations between uncontrolled BP and OSA risk, while adjusting for known covariates. Findings showed that uncontrolled BP independently increased the odds of OSA risk twofold (odds ratio=2.02, 95% confidence interval=1.18-3.48, P<0.05). In conclusion, our findings show that uncontrolled BP was associated with a twofold greater risk of OSA among blacks, suggesting that those with MetS and who have uncontrolled BP should be screened for the presence of OSA.Journal of Human Hypertension advance online publication, 6 August 2015; doi:10.1038/jhh.2015.78.

BACKGROUND: Although the efficacy of therapeutic lifestyle change (TLC) interventions are well proven, their relative effectiveness vs. single-session lifestyle counseling (SSC) on blood pressure (BP) reduction in primary care practices remains largely untested in hypertensive Blacks. The aim of this trial was to evaluate the comparative effectiveness of a comprehensive practice-based TLC intervention (motivational interviewing (MINT)-TLC) vs. SSC on BP reduction among 194 Blacks with uncontrolled hypertension. METHODS: The MINT-TLC arm included 10 weekly group classes on TLC, followed by 3 individual MINT sessions. The SSC group received 1 individual counseling session on lifestyle modification plus print versions of the intervention material. The primary outcome was within-patient change in systolic BP (SBP) and diastolic BP (DBP) from baseline to 6 months. The secondary outcome was BP control at 6 months. RESULTS: Mean age of the total sample was 57 (10.2) years; 50% were women, and the mean baseline BP was 147.4/89.3mm Hg. Eighty-four percent of SSC and 77% of MINT-TLC patients completed the final 6-month assessments. BP declined significantly (P < 0.001) in both groups at 6 months with a net-adjusted systolic BP reduction of 12.9mm Hg for the SSC group vs. 9.5mm Hg for the MINT-TLC group (P = 0.18); and diastolic BP reduction of 7.6 and 7.2mm Hg for the SSC and MINT-TLC group, respectively (P = 0.79). The between-group difference in proportion of patients with adequate BP control at 6 months was nonsignificant (P = 0.82). CONCLUSION: A significant group difference in BP between the intervention groups was not observed among a sample of hypertensive Blacks. Implementation of the pragmatic single-session intervention and its effects on utilization of healthcare services should be further evaluated. CLINICAL TRIAL REGISTRATION: Trial Number NCT01070056 at http://clinicaltrials.gov/ct2/show/NCT01070056?term=TLC+clinic&rank=1.

Hypertension, once a rare problem in Sub-Saharan Africa (SSA), is predicted to be a major cause of death by 2020 with mortality rates as high as 75%. However, comprehensive knowledge of provider-level factors that influence optimal management is limited. The objective of the current study was to discover physicians' perceptions of factors influencing optimal management and control of hypertension in SSA. Twelve physicians attending the Cardiovascular Research Training (CaRT) Institute at the University of Ghana, College of Health Sciences, were invited to complete a concept mapping process that included brainstorming the factors influencing optimal management and control of hypertension in patients, sorting and organizing the factors into similar domains, and rating the importance and feasibility of efforts to address these factors. The highest ranked important and feasible factors include helping patients accept their condition and availability of adequate equipment to enable the provision of needed care. The findings suggest that patient self-efficacy and support, physician-related factors, policy factors, and economic factors are important aspects that must be addressed to achieve optimal hypertension management. Given the work demands identified by physicians, future research should investigate cost-effective strategies of shifting physician responsibilities to well-trained no-physician clinicians in order to improve hypertension management.

The 2014 Evidence-based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) raised the systolic blood pressure (SBP) threshold for treatment initiation and goal attainment to 150 mm Hg in adults 60 years and older without a history of diabetes or chronic kidney disease (CKD). Using data from the nationwide Reasons for Geographic and Racial Difference in Stroke (REGARDS) study linked with Medicare claims, we examined the association between SBP levels and coronary heart disease (CHD), stroke, cardiovascular disease (CVD), heart failure, and serious injurious fall events among adults > 65 years of age taking antihypertensive medication. We excluded participants with a history of diabetes, CKD, and diastolic blood pressure > 90 mm Hg. Baseline REGARDS data were collected during telephone interviews and in-home study visits in 2003 through 2007 and included two blood pressure measurements following a standardized protocol. SBP was categorized as < 140 mm Hg, 140-149 mm Hg, and > 150 mm Hg. Outcomes were identified through December 31, 2011 using primary data collection and Medicare claims. Of the 2,279 REGARDS participants taking antihypertensive medications with Medicare linked data (mean age 72.2 years, 54.8% female), 309 (13.6%) had SBP of 140 to 149 mm Hg and 200 (8.8%) had SBP > 150 mm Hg. After multivariable adjustment, SBP of 140 to 149 mm Hg versus SBP < 140 mm Hg was not associated with any of the outcomes (Table 1) whereas SBP > 150 mm Hg was associated with an increased risk for CVD. In summary, SBP levels between 140 and 149 mm Hg were not associated with CVD-related outcomes or falls in comparison to SBP < 140 mm Hg among adults > 65 years taking antihypertensive medication. These data suggest the higher SBP threshold for treatment initiation and goal attainment among individuals > 65 years of age without a history of diabetes or CKD, with