Prevalence and Determinants of Hypertension among African American Adults in Southwest Mississippi

Author(s): Edith I. Ezekwe, Azad R. Bhuiyan

Hypertension remains a devastating disease with high prevalence within African Americans (AA) communities in the state of Mississippi. The objective of the study was to determine the prevalence and determinants of hypertension among AA adults using secondary data from churches, soup kitchens, and health fairs in Vicksburg, Mississippi. The study was cross-sectional with a sample of 497 (67.8% females, and 32.2% males) AA adults. The data were analyzed using descriptive statistics to characterize the sample population. Chi-square test was used to determine the relationships between hypertension and age, gender, income, education, fruits and vegetable consumption (FVC), physical activity (PA), and health insurance. Adults with hypertension among this group were 35.2%, 39.0% had Pre-hypertension while 24.5% had normotensive rate. Significant (P<.05) associations existed between exercise, availability of personal doctors, and gender with hypertension while age, education, income, health insurance, FVC, and awareness of hypertension were not significant (P>.05). Only 11.0% of the participants consumed the recommended amount of daily fruits and vegetables, while 55% did not exercise. This study showed that variables such as Exercise, Access to a Personal Doctor and Gender were all determinants for hypertension, also among this group, daily fruit/vegetable intake and physical activity were below recommended levels for adult population. Despite improved access to health insurance and increased awareness of hypertension, the prevalence of hypertension continues to be high in this community. Increased health screening, built environment, lifestyle modifications will positively impact hypertension, health disparities, and provide development of health policies to reduce prevalence of hypertension for adult Mississippians.

Hypertension, African American, Risk Factors, Chronic, Mississippi

1. American Heart Association, https://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer/high-blood-pressure-and-african-americanshttps://doi.org/10.1037/e419002008-001.
2. Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., ... Turner, M. B. (2015). Heart disease and stroke statistics-2015 update: A report from the American Heart Association. Circulation, 131(4), e29-e39. https://doi.org/10.1161/CIR.0000000000000152
3. Bibbins-Domingo, K, Pletcher, MJ, Lin, F, et al. Racial differences in incident heart failure among young adults. N Engl J Med. 2009;360(12):1179–1190. doi:10.1056/NEJMoa0807265
4. Calhoun D.A., Booth, J.N., Opara, S., Irvin, M.R., Shimbo, D., Lackland, D.T., Howard, G., Safford, M.M., & Muntner, P. Refractory hypertension: determination of prevalence, risk factors, and comorbidities in a large, population-based cohort. Hypertension. 2014; 63:451–458.
5. Merai, R., Siegel, C., Rakotz, M., Basch, P., Wright, J., Wong, B., & Thorpe P. (2016, November 18). CDC grand rounds: A public health approach to detect and control hypertension. MMWR Morbidity & Mortality Weekly Report, 65(45)1261-1264.
6. https://doi.org/10.15585/mmwr.mm6545a3
7. Mendy, V. L., & Vargas, R. (2015). Trends in major risk factors for cardiovascular disease among adults in the Mississippi Delta Region, Mississippi Behavioral Risk Factor Surveillance System, 2001–2010. Preventing Chronic Disease, 12, E21. Retrieved from https://www.cdc.gov/pcd/issues/2015/14_0481.htm.
8. Short, V. (2014, September). Report on the Burden of Chronic Diseases in Mississippi in 2014.Burden of Chronic Diseases in Mississippi, p. 22 & 23.
9. Retrieved from http://msdh.ms.gov/msdhsite/_static/resources/4775.pdf.
10. Behavioral Risk Factor Surveillance System (BRFSS) New York State 2011. Retrieved from https://health.data.ny.gov/Health/Behavioral-Risk-Factor-
11. Surveillance-Survey-2011.updated March 10, 2015
12. Opara, F. I. (2010). Racial /ethnic disparities in hypertension in United States residents: A cross- sectional study of potential explanatory covariates (Order No. 3397131).
13. Available from ProQuest Dissertations & Theses A&I. (193245113).
14. Morenoff, J. D., House, J. S., Hansen, B. B., Williams, D. R., Kaplan, G. A., & Hunte, H. E. (2007). Understanding social disparities in hypertension prevalence, awareness, treatment, and control: The role of neighborhood context. Social Science Medicine.
15. https://doi.org/10.1016/j.socscimed.2007.05.038
16. Djoukeng, J. T. (2016). Comparison of risk factors for hypertension among blacks, whites and Mexican Americans.
17. Retrieved from:https://search.proquest.com/docview/1892091210?accountid=40672
18. Guo J, et al., (2015), The dynamics of hypertension prevalence, awareness, treatment, control and associated factors in Chinese adults. J Hypertens. 2015 Aug;33(8):1688-96. doi: 10.1097/HJH.0000000000000594.
19. Ghazali, S. M., Seman, Z., Kee Chee, C., Lim Kuang, H., Manickam, M., Lim Kuang, K.,& Mustafa, A. N. (2015). Sociodemographic factors associated with multiple cardiovascular risk factors among Malaysian adults. BMC Public Health, 15(1), 1105- 1123.
20. https://doi.org/10.1186/s12889-015-1432-z
21. Kavanagh A, Bentley R.J., Turrell, G., Shaw, J., Dunstan, D., & Subramanian S.V. (2010). Socioeconomic position, gender, health behaviors and biomarkers of cardiovascular disease and diabetes. Social Science Medicine, 71(6), 1150–60.
22. Smith, J., Lensing, S., Horton, J., Lovejoy, J., Zaghloul, S., Forrester, I., ... & Bogle, M.L. (1999). Prevalence of self-reported nutrition-related health problems in the lower Mississippi Delta. American Journal of Public Health, 89(9), 1418-1421.
23. Beune, E. J., Moll van Charante, E. P., Beem, L., Mohrs, J., Agyemang, C. O., Ogedegbe, G., & Haafkens, J. A. (2014). Culturally Adapted Hypertension Education (CAHE) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: Cluster-randomized trial. PLoS ONE, 9 (3), 1-11.
24. Williams, M.V., Baker, D.W., Parker, R.M., & Nurss, J.R. (1998). Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives of Internal Medicine 158, 166- 172.
25. MacLaughlin, E.J., Raehl, C.L., Treadway, A.K., Sterling, T.L., Zoller, D.P., & Bond, C.A. (2005). Assessing medication adherence in the elderly: Which tools to use in clinical practice? Drugs & Aging, 22: 231-255.
26. Fiscella, K., Winters, P., Tancredi, D., & Franks, P. (2011). Racial disparity in blood pressure: Is vitamin D a factor? JGIM: Journal of General Internal Medicine, 26(10), 1105-1111. doi:10.1007/s11606-011-1707-8.
27. Centers for Disease Control and Prevention. (2017). State indicator report on fruits and vegetables. Retrieved from U.S. Centers for Disease Control and Prevention: https://www.cdc.gov/nutrition/downloads/State-Indicator-Report-Fruits-Vegetables- 2013.pdf.
28. Mendy, V. L., Vargas, R., El-sadek, L., & Short, V. L. (2016). Decreasing prevalence of no known major risk factors for cardiovascular disease among Mississippi adults, Mississippi Behavioral Risk Factor Surveillance System, 2001 and 2009. BMC Public Health, 16(1), 1-6.
29. Angell, S.Y., Renu, K., Gwynn, Bash, L., Thorpe & Frieden, T. (2008). Prevalence, awareness, treatment and predictors of control of hypertension in New York City. Circulation: Cardiovascular Quality and Outcomes, 1(1):46-53.
30. Keenan N.L., & Rosendorf, K.A., (2011). Prevalence of Hypertension and Controlled Hypertension United States, 2005—2008, National Center for Chronic Disease Prevention and Health Promotion, CDC Supplements January 14, 60(01); 94-97.
31. Dehghan, M., Akhtar-Danesh, N., & Merchant, A. T. (2011). Factors associated with fruit and vegetable consumption among adults. J Hum Nutr Diet. 2011 Apr;24(2):128-34. doi: 10.1111/j.1365-277X.2010.01142.x. Epub 2011 Feb 21.
32. Maimela, E., Van Geertruyden, J., Alberts, M., Modjadji, S. P., Meulemans, H., Fraeyman, J., & Bastiaens, H. (2015). The perceptions and perspectives of patients and health care providers on chronic diseases management in rural South Africa: a qualitative study. BMC Health Services Research, 15(1), 1-12. doi:10.1186/s12913-015-0812-5
33. Casagrande, S.S., & Gary-Webb, T.L. (2010) Trends in US adult fruit and vegetable consumption. In R. Watson & V. Preedy (Eds.), Bioactive foods in promoting health: Fruits and vegetables (111-130). Cambridge, MA: Elsevier.
34. Diaz J.J., & Whitaker, R.C. (2013). Black mothers' perceptions about urban neighborhood safety and outdoor play for their preadolescent daughters. Journal of Health Care Poor & Underserved 24 (1) 206-219.
35. Whelton, P.K., He, J., Appel, L.J., Cutler, J.A., Havas S, Kotchen, T.A., et al. (2002). Primary prevention of hypertension: Clinical and public health advisory from the National High Blood Pressure Education Program. JAMA, 288,1882–8.
36. Olives, C., Myerson, R., Mokdad, A.H., Murray, C.J.L., & Lim, S.S. (2013) Prevalence, awareness, treatment, and control of hypertension in United States Counties, 2001– 2009. PLoS ONE 8(4), e60308. https://doi.org/10.1371/journal.pone.0060308.
37. Armah IV, N. and Henderson, B.R. 2010. “Making the Case for Community-Based Wellness Programs.” National Civic Review, 99 (1). 27-34. doi:10.1002/ncr.20006.
38. Chobanian A.V. (2010). Improved hypertension control: Cause for some celebration.Journal of the American Medical Association, 303(20), 2082–2083.
39. https://doi.org/10.1001/jama.2010.692
40. Chobanian A.V. (2010). Improved hypertension control: Cause for some celebration.Journal of the American Medical Association, 303(20), 2082–2083.
41. https://doi.org/10.1001/jama.2010.692
42. Ostchega Y., Yoon, S.S., Hughes, J., & Louis, T. (2008). Hypertension awareness, treatment, and control—continued disparities in adults: United States, 2005-2006. NCHS Data Brief, 3. https://doi.org/10.1037/e403872008-001
43. CDC national health report: Leading causes of morbidity and mortality and associated behavioral risk and protective factors — United States, 2005–2013.
44. https://www.cdc.gov/mmwr/preview/mmwrhtml/su6304a2.htm
45. Everett, B., & Zajacova A. (2015). Gender differences in hypertension and hypertension awareness among young adults. Biodemography and Social Biology, 61(1), 1–17. http://doi.org/10.1080/19485565.2014.929488.
46. Egan B.M., Zhao, Y, & Axon, R.N. (2010). U.S. trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. Journal of the American Medical Association, 303 (20), 2043–2050.https://doi.org/10.1001/jama.2010.650