Olugbenga Ogedegbe

Olugbenga Ogedegbe
Olugbenga Ogedegbe

Professor

Professional overview

Gbenga Ogedegbe, a physician, is Professor of Population Health & Medicine, Chief Division of Health & Behavior and Director Center for Healthful Behavior Change in the Department of Population Health at the School of Medicine. Gbenga is a leading expert on health disparities research; his work focuses on the implementation of evidence-based interventions for cardiovascular risk reduction in minority populations. He is Principal Investigator on numerous NIH projects, and has expanded his work globally to Sub-Saharan Africa where he is funded by the NIH to strengthen research capacity and reduce the burden of noncommunicable diseases. He has co-authored over 250 publications and his work has been recognized by receipt of several research and mentoring awards including the prestigious John M. Eisenberg Excellence in Mentorship Award from the Agency for Healthcare Research and Quality, and the Daniel Savage Science Award. He has served on numerous scientific panels including the NIH, CDC, World Health Organization, and the European Union Research Council. Prior to joining NYU, he was faculty at Cornell Weill Medical School and Columbia University College of Physicians and Surgeons. 

Education

MPH from Columbia University, 1999
Residency, Montefiore Medical Center, Internal Medicine, 1998
MD from Donetsk University, 1988

Areas of research and study

Access to Healthcare
Global Health
Health of Marginalized Population
Implementation and Impact of Public Health Regulations
Implementation science
Stroke and Cardiovascular Disease

Publications

Publications

Application of the Consolidated Framework for Implementation Research to examine nurses' perception of the task shifting strategy for hypertension control trial in Ghana

Gyamfi, J., Allegrante, J. P., Iwelunmor, J., Williams, O., Plange-Rhule, J., Blackstone, S., Ntim, M., Apusiga, K., Peprah, E., & Ogedegbe, G.

Publication year

2020

Journal title

BMC health services research

Volume

20

Issue

1
Abstract
Background: The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. Methods: Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). Results: Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. Conclusion: Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. Trial registration: Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: US Preventive Services Task Force Recommendation Statement

Failed generating bibliography.

Publication year

2020

Journal title

JAMA

Volume

324

Issue

7

Page(s)

674-681
Abstract
Importance: Approximately 20 million new cases of bacterial or viral sexually transmitted infections (STIs) occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years. Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions. Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS. Objective: To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of behavioral counseling interventions for preventing STI acquisition. Population: This recommendation statement applies to all sexually active adolescents and to adults at increased risk for STIs. Evidence Assessment: The USPSTF concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, including for example, those who have a current STI, do not use condoms, or have multiple partners, resulting in a moderate net benefit. Recommendation: The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. (B recommendation).

Building cardiovascular disease competence in an urban poor Ghanaian community: A social psychology of participation approach

De-Graft Aikins, A., Kushitor, M., Kushitor, S. B., Sanuade, O., Asante, P. Y., Sakyi, L., Agyei, F., Koram, K., & Ogedegbe, G.

Publication year

2020

Journal title

Journal of Community and Applied Social Psychology

Volume

30

Issue

4

Page(s)

419-440
Abstract
This paper describes conceptual, methodological, and practical insights from a longitudinal social psychological project that aims to build cardiovascular disease (CVD) competence in a poor community in Accra, Ghana's capital. Informed by a social psychology of participation approach, mixed method data included qualitative interviews and household surveys from over 500 community members, including people living with diabetes, hypertension, and stroke, their caregivers, health care providers, and GIS mapping of pluralistic health systems, food vending sites, bars, and physical activity spaces. Data analysis was informed by the diagnosis-psychosocial intervention-reflexivity framework proposed by Guareschi and Jovchelovitch. The community had a high prevalence of CVD and risk factors, and CVD knowledge was cognitive polyphasic. The environment was obesogenic, alcohol promoting, and medically pluralistic. These factors shaped CVD experiences and eclectic treatment seeking behaviours. Psychosocial interventions included establishing a self-help group and community screening and education. Applying the “AIDS-competent communities” model proposed by Campbell and colleagues, we outline the psychosocial features of CVD competence that are relatively easy to implement, albeit with funds and labour, and those that are difficult. We offer a reflexive analysis of four challenges that future activities will address: social protection, increasing men's participation, connecting national health policy to community needs, and sustaining the project.

Cardiovascular Disease Guideline Adherence: An RCT Using Practice Facilitation

Shelley, D. R., Gepts, T., Siman, N., Nguyen, A. M., Cleland, C., Cuthel, A. M., Rogers, E. S., Ogedegbe, O., Pham-Singer, H., Wu, W., & Berry, C. A.

Publication year

2020

Journal title

American journal of preventive medicine

Volume

58

Issue

5

Page(s)

683-690
Abstract
Introduction: Practice facilitation is a promising practice transformation strategy, but further examination of its effectiveness in improving adoption of guidelines for multiple cardiovascular disease risk factors is needed. The objective of the study is to determine whether practice facilitation is effective in increasing the proportion of patients meeting the Million Hearts ABCS outcomes: (A) aspirin when indicated, (B) blood pressure control, (C) cholesterol management, and (S) smoking screening and cessation intervention. Study design: The study used a stepped-wedge cluster RCT design with 4 intervention waves. Data were extracted for 13 quarters between January 1, 2015 and March 31, 2018, which encompassed the control, intervention, and follow-up periods for all waves, and analyzed in 2019. Setting/participants: A total of 257 small independent primary care practices in New York City were randomized into 1 of 4 waves. Intervention: The intervention consisted of practice facilitators conducting at least 13 practice visits over 1 year, focused on capacity building and implementing system and workflow changes to meet cardiovascular disease care guidelines. Main outcome measures: The main outcomes were the Million Hearts’ ABCS measures. Two additional measures were created: (1) proportion of tobacco users who received a cessation intervention (smokers counseled) and (2) a composite measure that assessed the proportion of patients meeting treatment targets for A, B, and C (ABC composite). Results: The S measure improved when comparing follow-up with the control period (incidence rate ratio=1.152, 95% CI=1.072, 1.238, p<0.001) and when comparing follow-up with intervention (incidence rate ratio=1.060, 95% CI=1.013, 1.109, p=0.007). Smokers counseled improved when comparing the intervention period with control (incidence rate ratio=1.121, 95% CI=1.037, 1.211, p=0.002). Conclusions: Increasing the impact of practice facilitation programs that target multiple risk factors may require a longer, more intense intervention and greater attention to external policy and practice context. Trial registration: This study is registered at www.clinicaltrials.gov NCT02646488.

Primary Care-Based Interventions to Prevent Illicit Drug Use in Children, Adolescents, and Young Adults: US Preventive Services Task Force Recommendation Statement

Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., Donahue, K., Doubeni, C. A., Epling, J. W., Kubik, M., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Tseng, C. W., & Wong, J. B.

Publication year

2020

Journal title

JAMA - Journal of the American Medical Association

Volume

323

Issue

20

Page(s)

2060-2066
Abstract
Importance: In 2017, an estimated 7.9% of persons aged 12 to 17 years reported illicit drug use in the past month, and an estimated 50% of adolescents in the US had used an illicit drug by the time they graduated from high school. Young adults aged 18 to 25 years have a higher rate of current illicit drug use, with an estimated 23.2% currently using illicit drugs. Illicit drug use is associated with many negative health, social, and economic consequences and is a significant contributor to 3 of the leading causes of death among young persons (aged 10-24 years): unintentional injuries including motor vehicle crashes, suicide, and homicide. Objective: To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the potential benefits and harms of interventions to prevent illicit drug use in children, adolescents, and young adults. Population: This recommendation applies to children (11 years and younger), adolescents (aged 12-17 years), and young adults (aged 18-25 years), including pregnant persons. Evidence Assessment: Because of limited and inadequate evidence, the USPSTF concludes that the benefits and harms of primary care-based interventions to prevent illicit drug use in children, adolescents, and young adults are uncertain and that the evidence is insufficient to assess the balance of benefits and harms. More research is needed. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care-based behavioral counseling interventions to prevent illicit drug use, including nonmedical use of prescription drugs, in children, adolescents, and young adults. (I statement).

Renin–angiotensin–aldosterone system inhibitors and risk of covid-19

Reynolds, H. R., Adhikari, S., Pulgarin, C., Troxel, A. B., Iturrate, E., Johnson, S. B., Hausvater, A., Newman, J. D., Berger, J. S., Bangalore, S., Katz, S. D., Fishman, G. I., Kunichoff, D., Chen, Y., Ogedegbe, G., & Hochman, J. S.

Publication year

2020

Journal title

New England Journal of Medicine

Volume

382

Issue

25

Page(s)

2441-2448
Abstract
BACKGROUND There is concern about the potential of an increased risk related to medications that act on the renin–angiotensin–aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2). METHODS We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference. RESULTS Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive. CONCLUSIONS We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.

Self-monitoring of Blood Pressure in Patients with Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis

Sheppard, J. P., Tucker, K. L., Davison, W. J., Stevens, R., Aekplakorn, W., Bosworth, H. B., Bove, A., Earle, K., Godwin, M., Green, B. B., Hebert, P., Heneghan, C., Hill, N., Hobbs, F. D., Kantola, I., Kerry, S. M., Leiva, A., Magid, D. J., Mant, J., Margolis, K. L., Mckinstry, B., Mclaughlin, M. A., Mcnamara, K., Omboni, S., Ogedegbe, O., Parati, G., Varis, J., Verberk, W. J., Wakefield, B. J., & Mcmanus, R. J.

Publication year

2020

Journal title

American Journal of Hypertension

Volume

33

Issue

3

Page(s)

243-251
Abstract
Background: Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. Methods: A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. Results: A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (-3.12 mm Hg, [95% confidence intervals -4.78, -1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease. Conclusions: Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.

Tailored approach to sleep health education (TASHE): A randomized controlled trial of a web-based application

Jean-Louis, G., Robbins, R., Williams, N. J., Allegrante, J. P., Rapoport, D. M., Cohall, A., & Ogedegbe, G.

Publication year

2020

Journal title

Journal of Clinical Sleep Medicine

Volume

16

Issue

8

Page(s)

1331-1341
Abstract
Study Objectives: In a randomized controlled trial, we compared the effect of the Tailored Approach to Sleep Health Education (TASHE) on obstructive sleep apnea (OSA) self-efficacy among community-dwelling blacks in New York City. Methods: Study participants were 194 blacks at high risk for OSA based on the Apnea Risk Evaluation System. TASHE intervention was delivered via a Wi-Fi-enabled tablet, programmed to provide online access to culturally and linguistically tailored information designed to address unique barriers to OSA care among blacks. Blacks in the attention-controlled arm received standard sleep information via the National Sleep Foundation website. Blacks in both arms accessed online sleep information for 2 months. Outcomes (OSA health literacy, self-efficacy, knowledge and beliefs, and sleep hygiene) were assessed at baseline, at 2 months, and at 6 months. Results: We compared outcomes in both arms based on intention-to-treat analysis using adjusted Generalized Linear Mixed Modeling. TASHE exposure significantly increased OSA self-efficacy (OSA outcome expectation [β =.5; 95% CI:.1-.9] and OSA treatment efficacy [β = 0.4; 95% CI:.0-.8]) at 2 months but not at 6 months. Additionally, TASHE exposure improved sleep hygiene at 6 months (β = 6.7; 95% CI: 2.2-11.3) but not at 2 months. Conclusions: Community-dwelling blacks exposed to TASHE materials reported increased OSA self-efficacy compared with standard sleep health education. Stakeholder-engaged, theory-based approaches, as demonstrated in the TASHE intervention, can be used successfully to deliver effective sleep health messages. Clinical Trial Registration: Registry: ClinicalTrials.gov; URL: https://clinicaltrials.gov/ct2/show/NCT02507089; Identifier: NCT02507089.

Adopting Task-Shifting Strategies for Hypertension Control in Ghana: Insights From a Realist Synthesis of Stakeholder Perceptions

Iwelunmor, J., Onakomaiya, D., Gyamfi, J., Nyame, S., Apusiga, K., Adjei, K., Mantey, K., Plange-Rhule, J., Asante, K. P., & Ogedegbe, G.

Publication year

2019

Journal title

Global Heart

Volume

14

Issue

2

Page(s)

119-127
Abstract
Background: The adoption, intention, initial decision or action to implement evidence-based strategies for hypertension control in real-world settings is a challenge in low- and middle-income countries. Although stakeholders are essential for the adoption of evidence-based interventions, data on how to engage them to improve uptake of these strategies is lacking. Using a realist synthesis of stakeholder perspectives, the authors describe a process for engaging stakeholders to identify facilitators and barriers to the adoption of an evidence-based task-strengthening strategy for hypertension control in Ghana. Objectives: To identify stakeholder perceptions of the factors influencing the adoption of evidence-based task-shifting strategies for hypertension control in Ghana. Methods: A realist evaluation of interviews, focus groups, and brainstorming activities was conducted to evaluate stakeholder perceptions of an evidence-based strategy designed to identify, counsel, and refer patients with hypertension for care in community health centers. Stakeholders included community health officers, administrators, and policymakers from the Ghana Health Service, researchers, and community health officers in community-based health planning services in the Kintampo region of Ghana. The study used a realist synthesis approach to thematically analyze the qualitative data generated. Results: Sixty-two stakeholders participated in the study. They identified inner contextual characteristics such as the provision of resources, training, supervision, and monitoring as well as community outreach as important for the adoption of an evidence-based strategy in Ghana. The findings highlight how stakeholders are faced with multiple and often competing system strains when contemplating uptake of evidence-based strategies for hypertension control. Conclusions: Through the application of a realist synthesis of stakeholder perceptions, the study identified factors likely to enhance the adoption of an evidence-based strategy for hypertension control in Ghana. The lessons learned will help shape the translation of evidence in real-world settings, and could be valuable in future planning to enhance the adoption of evidence-based strategies for hypertension control in LMICs.

Association Between High Perceived Stress Over Time and Incident Hypertension in Black Adults: Findings From the Jackson Heart Study

Spruill, T. M., Butler, M. J., Thomas, S. J., Tajeu, G. S., Kalinowski, J., Castañeda, S. F., Langford, A. T., Abdalla, M., Blackshear, C., Allison, M., Ogedegbe, G., Sims, M., & Shimbo, D.

Publication year

2019

Journal title

Journal of the American Heart Association

Volume

8

Issue

21
Abstract
Background: Chronic psychological stress has been associated with hypertension, but few studies have examined this relationship in blacks. We examined the association between perceived stress levels assessed annually for up to 13 years and incident hypertension in the Jackson Heart Study, a community-based cohort of blacks. Methods and Results: Analyses included 1829 participants without hypertension at baseline (Exam 1, 2000–2004). Incident hypertension was defined as blood pressure≥140/90 mm Hg or antihypertensive medication use at Exam 2 (2005–2008) or Exam 3 (2009–2012). Each follow-up interval at risk of hypertension was categorized as low, moderate, or high perceived stress based on the number of annual assessments between exams in which participants reported “a lot” or “extreme” stress over the previous year (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings). During follow-up (median, 7.0 years), hypertension incidence was 48.5%. Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress. Age-, sex-, and time-adjusted risk ratios (95% CI) associated with moderate and high perceived stress versus low perceived stress were 1.19 (1.04–1.37) and 1.37 (1.20–1.57), respectively (P trend<0.001). The association was present after adjustment for demographic, clinical, and behavioral factors and baseline stress (P trend=0.001). Conclusions: In a community-based cohort of blacks, higher perceived stress over time was associated with an increased risk of developing hypertension. Evaluating stress levels over time and intervening when high perceived stress is persistent may reduce hypertension risk.

Association of Daytime and Nighttime Blood Pressure with Cardiovascular Disease Events among African American Individuals

Yano, Y., Tanner, R. M., Sakhuja, S., Jaeger, B. C., Booth, J. N., Abdalla, M., Pugliese, D., Seals, S. R., Ogedegbe, G., Jones, D. W., Muntner, P., & Shimbo, D.

Publication year

2019

Journal title

JAMA Cardiology

Volume

4

Issue

9

Page(s)

910-917
Abstract
Importance: Little is known regarding health outcomes associated with higher blood pressure (BP) levels measured outside the clinic among African American individuals. Objective: To examine whether daytime and nighttime BP levels measured outside the clinic among African American individuals are associated with cardiovascular disease (CVD) and all-cause mortality independent of BP levels measured inside the clinic. Design, Setting, and Participants: This prospective cohort study analyzed data from 1034 African American participants in the Jackson Heart Study who completed ambulatory BP monitoring at baseline (September 26, 2000, to March 31, 2004). Mean daytime and nighttime BPs were calculated based on measurements taken while participants were awake and asleep, respectively. Data were analyzed from July 1, 2017, to April 30, 2019. Main Outcomes and Measures: Cardiovascular disease events, including coronary heart disease and stroke, experienced through December 31, 2014, and all-cause mortality experienced through December 31, 2016, were adjudicated. The associations of daytime BP and nighttime BP, separately, with CVD events and all-cause mortality were determined using Cox proportional hazards regression models. Results: A total of 1034 participants (mean [SD] age, 58.9 [10.9] years; 337 [32.6%] male; and 583 [56.4%] taking antihypertensive medication) were included in the study. The mean daytime systolic BP (SBP)/diastolic BP (DBP) was 129.4/77.6 mm Hg, and the mean nighttime SBP/DBP was 121.3/68.4 mm Hg. During follow-up (median [interquartile range], 12.5 [11.1-13.6] years for CVD and 14.8 [13.7-15.6] years for all-cause mortality), 113 CVD events and 194 deaths occurred. After multivariable adjustment, including in-clinic SBP and DBP, the hazard ratios (HRs) for CVD events for each SD higher level were 1.53 (95% CI, 1.24-1.88) for daytime SBP (per 13.5 mm Hg), 1.48 (95% CI, 1.22-1.80) for nighttime SBP (per 15.5 mm Hg), 1.25 (95% CI, 1.02-1.51) for daytime DBP (per 9.3 mm Hg), and 1.30 (95% CI, 1.06-1.59) for nighttime DBP (per 9.5 mm Hg). Nighttime SBP was associated with all-cause mortality (HR per 1-SD higher level, 1.24; 95% CI, 1.06-1.45), but no association was present for daytime SBP (HR, 1.13; 95% CI, 0.97-1.33) and daytime (HR, 0.95; 95% CI, 0.81-1.10) and nighttime (HR, 1.06; 95% CI, 0.90-1.24) DBP. Conclusions and Relevance: Among African American individuals, higher daytime and nighttime SBPs were associated with an increased risk for CVD events and all-cause mortality independent of BP levels measured in the clinic. Measurement of daytime and nighttime BP using ambulatory monitoring during a 24-hour period may help identify African American individuals who have an increased cardiovascular disease risk.

Capabilities, opportunities and motivations for integrating evidence-based strategy for hypertension control into HIV clinics in Southwest Nigeria

Iwelunmor, J., Ezechi, O., Obiezu-Umeh, C., Gbajabiamila, T., Musa, A. Z., Oladele, D., Idigbe, I., Ohihoin, A., Gyamfi, J., Aifah, A., Salako, B., & Ogedegbe, O.

Publication year

2019

Journal title

PloS one

Volume

14

Issue

6
Abstract
Background Given the growing burden of cardiovascular diseases in sub-Saharan Africa, global donors and governments are exploring strategies for integrating evidence-based cardiovascular diseases prevention into HIV clinics. We assessed the capabilities, motivations and opportunities that exist for HIV clinics to apply evidence-based strategies for hypertension control among people living with HIV (PLHIV) in Nigeria. Methods We used a concurrent Quan-Qual- study approach (a quantitative first step using structured questionnaires followed by a qualitative approach using stakeholder meetings).We invited key stakeholders and representatives of HIV and non-communicable disease organizations in Lagos, Nigeria to 1) assess the capacity of HIV clinics (n = 29) to, and; 2) explore their attitudes and perceptions towards implementing evidence-based strategies for hypertension management in Lagos, Nigeria (n = 19)The quantitative data were analyzed using SPSS whereas responses from the stakeholders meeting were coded and analyzed using thematic approach and an implementation science framework, the COM-B (Capabilities, Opportunities, Motivations and Behavior) model, guided the mapping and interpretation of the data. Results Out of the 29 HIV clinics that participated in the study, 28 clinics were public, government-owned facilities with 394 HIV patients per month with varying capabilities, opportunities and motivations for integrating evidence-based hypertension interventions within their services for PLHIV. Majority of the clinics (n = 26) rated medium-to-low on the psychological capability domains, while most of the clinics (n = 25) rated low on the physical capabilities of integrating evidence-based hypertension interventions within HIV clinics. There was high variability in the ratings for the opportunity domains, with physical opportunities rated high in only eight HIV clinics, two clinics with a medium rating and nineteen clinics with a low rating. Social opportunity domain tended to be rated low in majority of the HIV clinics (n = 21). Lastly, almost all the HIV clinics (n = 23) rated high on the reflective motivation domain although automatic motivations tended to be rated low across the HIV clinics. Conclusion In this study, we found that with the exception of motivations, the relative capabilities whether physical or psychological and the relative opportunities for integrating evidence-based hypertension intervention within HIV clinics in Nigeria were minimal. Thus, there is need to strengthen the HIV clinics in Lagos for the implementation of evidence-based hypertension interventions within HIV clinics to improve patient outcomes and service delivery in Southwest Nigeria.

Capacity and Readiness for Implementing Evidence-Based Task-Strengthening Strategies for Hypertension Control in Ghana: A Cross-Sectional Study

Nyame, S., Iwelunmor, J., Ogedegbe, G., Adjei, K. G. A., Adjei, K., Apusiga, K., Gyamfi, J., Asante, K. P., & Plange-Rhule, J.

Publication year

2019

Journal title

Global Heart

Volume

14

Issue

2

Page(s)

129-134
Abstract
Background: Assessing the practice capacity for hypertension management and control within community-based health planning and services system is an important step toward implementing evidence-based interventions to reduce uncontrolled hypertension at the community level. Objectives: To assess the capacity and readiness of community health workers to implement a task-strengthening strategy for hypertension control (TASSH) at the community level. Methods: This was a cross-sectional study guided by the Consolidated Framework for Implementation Research conducted among community health workers in 6 contiguous districts within the Brong-Ahafo Region of Ghana. Study variables were described using frequency tables. Results: A total of 179 community health officers (CHOs) were interviewed. The majority of respondents knew lifestyle-related messages to be provided to their clients such as heart-healthy diets (91.6%, n = 164), physical activity (90.5%, n = 162), and low sodium intake (88.3%, n = 158), but not about other lifestyle-modifying messages such as caffeine reduction (46.4%, n = 83). The majority (79%) of the respondents did not know the names of the first-line hypertension medications. Fifty-one percent of respondents did not know about the blood pressure threshold for initiation of blood pressure management. About 90% of respondents had not been trained on hypertension management. More than 80% are however motivated to implement the TASSH intervention. Conclusions: The majority of CHOs in this study were aware of lifestyle modifications such as diet modifications and increase in physical activity. However, their knowledge was limited in the blood pressure threshold for initiating treatment and in the knowledge of first-line hypertension medication, irrespective of the number of years practiced. Training on hypertension is also low. However, CHOs are motivated to control hypertension at the community level. Community-level interventions such as TASSH can leverage on their motivation to demonstrate an impact on hypertension control.

Cardiovascular Disease and Mortality in Adults Aged ≥60 Years According to Recommendations by the American College of Cardiology/American Heart Association and American College of Physicians/American Academy of Family Physicians

Jaeger, B. C., Anstey, D. E., Bress, A. P., Booth, J. N., Butler, M., Clark, D., Howard, G., Kalinowski, J., Long, D. L., Ogedegbe, G., Plante, T. B., Shimbo, D., Sims, M., Supiano, M. A., Whelton, P. K., & Muntner, P.

Publication year

2019

Journal title

Hypertension

Volume

73

Issue

2

Page(s)

327-334
Abstract
In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) and the American College of Physicians/American Academy of Family Physicians (ACP/AAFP) published blood pressure guidelines. Adults recommended antihypertensive medication initiation or intensification by the ACP/AAFP guideline receive the same recommendation from the ACC/AHA guideline. However, many adults ≥60 years old are recommended to initiate or intensify antihypertensive medication by the ACC/AHA but not the ACP/AAFP guideline. We compared atherosclerotic cardiovascular disease event rates according to antihypertensive treatment recommendations in the ACC/AHA and ACP/AAFP guidelines among adults ≥60 years old with systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) and the JHS (Jackson Heart Study). Among 4311 participants not taking antihypertensive medication at baseline, 11.4%, 61.2%, and 27.4% were recommended antihypertensive medication initiation by neither guideline, the ACC/AHA but not the ACP/AAFP guideline, and both guidelines, respectively. Atherosclerotic cardiovascular disease event rates (95% CI) for these groups were 3.4 (1.6-5.2), 18.0 (16.1-19.8), and 25.3 (21.9-28.6) per 1000 person-years, respectively. Among 7281 participants taking antihypertensive medication at baseline, 57.9% and 42.1% were recommended antihypertensive medication intensification by the ACC/AHA but not the ACP/AAFP guideline and both guidelines, respectively. Atherosclerotic cardiovascular disease event rates (95% CI) for these groups were 18.2 (16.7-19.7) and 33.0 (30.5-35.4) per 1000 person-years, respectively. In conclusion, adults recommended initiation or intensification of antihypertensive medication by the ACC/AHA but not the ACP/AAFP guideline have high atherosclerotic cardiovascular disease risk that may be reduced through treatment initiation or intensification.

Comprehensive examination of the multilevel adverse risk and protective factors for cardiovascular disease among hypertensive African Americans

Schoenthaler, A., Fei, K., Ramos, M. A., Richardson, L. D., Ogedegbe, G., & Horowitz, C. R.

Publication year

2019

Journal title

Journal of Clinical Hypertension

Volume

21

Issue

6

Page(s)

794-803
Abstract
This paper describes the multilevel factors that contribute to hypertension disparities in 2052 hypertensive African Americans (mean age 52.9 ± 9.9 years; 66.3% female) who participated in a clinical trial. At the family level, participants reported average levels of life chaos and high social support. However, at the individual level, participants exhibited several adverse clinical and behavioral factors including poor blood pressure control (45% of population), obesity (61%), medication non-adherence (48%), smoking (32%), physical inactivity (45%), and poor diet (71%). While participants rated their provider as trustworthy, they reported high levels of discrimination in the health care system. Finally, community-level data indicate that participants reside in areas characterized by poor socio-economic and neighborhood conditions (eg, segregation). In the context of our trial, hypertensive African Americans exhibited several adverse risks and protective factors at multiple levels of influence. Future research should evaluate the impact of these factors on cardiovascular outcomes using a longitudinal design.

Developing a Tailored Website for Promoting Awareness about Obstructive Sleep Apnea (OSA) Among Blacks in Community-Based Settings

Robbins, R., Senathirajah, Y., Williams, N. J., Hutchinson, C., Rapoport, D. M., Allegrante, J. P., Cohall, A., Rogers, A., Ogedegbe, O., & Jean-Louis, G.

Publication year

2019

Journal title

Health Communication

Volume

34

Issue

5

Page(s)

567-575
Abstract
Blacks are at greater risk for lower sleep quality and higher risk for obstructive sleep apnea (OSA) than other racial groups. In this study, we summarize the development of a tailored website including visuals, key messages, and video narratives, to promote awareness about sleep apnea among community-dwelling blacks. We utilized mixed methods, including in-depth interviews, usability-testing procedures, and brief surveys (n = 9, 55% female, 100% black, average age 38.5 years). Themes from the qualitative analysis illuminated varied knowledge regarding OSA symptoms and prevalent self-reported experience with sleep disturbance and OSA symptoms (e.g., snoring). On a scale from 1 (not at all) to 5 (very high), participants provided favorable ratings of website usefulness (mean = 4.9), user friendliness (mean = 4.9) and attractiveness (mean = 4.3). Our findings suggest although tailored health communication has potential for serving as a tool for advancing health equity, usability-testing of health materials is critical to ensure that culturally and linguistically tailored messages are acceptable and actionable in the intended population.

Different Relationship between Systolic Blood Pressure and Cerebral Perfusion in Subjects with and without Hypertension

Glodzik, L., Rusinek, H., Tsui, W., Pirraglia, E., Kim, H. J., Deshpande, A., Li, Y., Storey, P., Randall, C., Chen, J., Osorio, R. S., Butler, T., Tanzi, E., McQuillan, M., Harvey, P., Williams, S. K., Ogedegbe, G., Babb, J. S., & De Leon, M. J.

Publication year

2019

Journal title

Hypertension

Volume

73

Issue

1

Page(s)

197-205
Abstract
Although there is an increasing agreement that hypertension is associated with cerebrovascular compromise, relationships between blood pressure (BP) and cerebral blood flow are not fully understood. It is not known what BP level, and consequently what therapeutic goal, is optimal for brain perfusion. Moreover, there is limited data on how BP affects hippocampal perfusion, a structure critically involved in memory. We conducted a cross-sectional (n=445) and longitudinal (n=185) study of adults and elderly without dementia or clinically apparent stroke, who underwent clinical examination and brain perfusion assessment (age 69.2±7.5 years, 62% women, 45% hypertensive). Linear models were used to test baseline BP-blood flow relationship and to examine how changes in BP influence changes in perfusion. In the entire group, systolic BP (SBP) was negatively related to cortical (β=-0.13, P=0.005) and hippocampal blood flow (β=-0.12, P=0.01). Notably, this negative relationship was apparent already in subjects without hypertension. Hypertensive subjects showed a quadratic relationship between SBP and hippocampal blood flow (β=-1.55, P=0.03): Perfusion was the highest in subjects with mid-range SBP around 125 mm Hg. Longitudinally, in hypertensive subjects perfusion increased with increased SBP at low baseline SBP but increased with decreased SBP at high baseline SBP. Cortical and hippocampal perfusion decrease with increasing SBP across the entire BP spectrum. However, in hypertension, there seems to be a window of mid-range SBP which maximizes perfusion.

Effect of Stroke Education Pamphlets vs a 12-Minute Culturally Tailored Stroke Film on Stroke Preparedness among Black and Hispanic Churchgoers: A Cluster Randomized Clinical Trial

Williams, O., Teresi, J., Eimicke, J. P., Abel-Bey, A., Hassankhani, M., Valdez, L., Gomez Chan, L., Kong, J., Ramirez, M., Ravenell, J., Ogedegbe, G., & Noble, J. M.

Publication year

2019

Journal title

JAMA Neurology

Volume

76

Issue

10

Page(s)

1211-1218
Abstract
Importance: Black individuals and Hispanic individuals are less likely to recognize stroke and call 911 (stroke preparedness), contributing to racial/ethnic disparities in intravenous tissue plasminogen activator use. Objective: To evaluate the effect of culturally tailored 12-minute stroke films on stroke preparedness vs the usual care practice of distributing stroke education pamphlets. Design, Setting, and Participants: Cluster randomized clinical trial between July 26, 2013, and August 16, 2018, with randomization of 13 black and Hispanic churches located in urban neighborhoods to intervention or usual care. In total, 883 congregants were approached, 503 expressed interest, 375 completed eligibility screening, and 312 were randomized. Sixty-three individuals were ineligible (younger than 34 years and/or did not have at least 1 traditional stroke risk factor). Interventions: Two 12-minute stroke films on stroke preparedness for black and Hispanic audiences. Main Outcomes and Measures: The primary outcome was the Stroke Action Test (STAT), assessed at baseline, 6 months, and 12 months. Results: In total, 261 of 312 individuals completed the study (83.7% retention rate). Most participants were female (79.1%). The mean (SD) age of participants was 58.57 (11.66) years; 51.1% (n = 159) were non-Hispanic black, 48.9% (n = 152) were Hispanic, and 31.7% (n = 99) had low levels of education. There were no significant end-point differences for the STAT at follow-up periods. The mean (SD) baseline STAT scores were 59.05% (29.12%) correct for intervention and 58.35% (28.83%) correct for usual care. At 12 months, the mean (SD) STAT scores were 64.38% (26.39%) correct for intervention and 61.58% (28.01%) correct for usual care. Adjusted by education, a post hoc subgroup analysis revealed a mean (SE) intervention effect of 1.03% (0.44%) (P =.02) increase per month in the low-education subgroup (about a 10% increase in 12 months). In the high-education subgroup, the mean (SE) intervention effect was -0.05% (0.30%) (P =.86). Regarding percentage correct, the low-education intervention subgroup improved from 52.4% (7 of 21) to 66.7% (14 of 21) compared with the other subgroups. Conclusions and Relevance: No difference was observed in stroke preparedness at 12 months in response to culturally tailored 12-minute stroke films or conventional stroke education pamphlets. Additional studies are required to confirm findings from a post hoc subgroup analysis that suggested a significant education effect. Trial Registration: ClinicalTrials.gov identifier: NCT01909271.

Improving hypertension outcome measurement in low- and middle-income countries

Zack, R., Okunade, O., Olson, E., Salt, M., Amodeo, C., Anchala, R., Berwanger, O., Campbell, N., Chia, Y. C., Damasceno, A., Phuong Do, T. N., Tamdja Dzudie, A., Fiuza, M., Mirza, F., Nitsch, D., Ogedegbe, G., Podpalov, V., Schiffrin, E. L., Vaz Carneiro, A., & Lamptey, P.

Publication year

2019

Journal title

Hypertension

Volume

73

Issue

5

Page(s)

990-997
Abstract
High blood pressure is the leading modifiable risk factor for mortality, accounting for nearly 1 in 5 deaths worldwide and 1 in 11 in low-income countries. Hypertension control remains a challenge, especially in low-resource settings. One approach to improvement is the prioritization of patient-centered care. However, consensus on the outcomes that matter most to patients is lacking. We aimed to define a standard set of patient-centered outcomes for evaluating hypertension management in low- and middle-income countries. The International Consortium for Health Outcomes Measurement convened a Working Group of 18 experts and patients representing 15 countries. We used a modified Delphi process to reach consensus on a set of outcomes, case-mix variables, and a timeline to guide data collection. Literature reviews, patient interviews, a patient validation survey, and an open review by hypertension experts informed the set. The set contains 18 clinical and patient-reported outcomes that reflect patient priorities and evidence-based hypertension management and case-mix variables to allow comparisons between providers. The domains included are hypertension control, cardiovascular complications, health-related quality of life, financial burden of care, medication burden, satisfaction with care, health literacy, and health behaviors. We present a core list of outcomes for evaluating hypertension care. They account for the unique challenges healthcare providers and patients face in low- and middle-income countries, yet are relevant to all settings. We believe that it is a vital step toward international benchmarking in hypertension care and, ultimately, value-based hypertension management.

Inappropriate Left Ventricular Mass and Cardiovascular Disease Events and Mortality in Blacks: The Jackson Heart Study

Anstey, D. E., Tanner, R. M., Booth, J. N., Bress, A. P., Diaz, K. M., Sims, M., Ogedegbe, G., Muntner, P., & Abdalla, M.

Publication year

2019

Journal title

Journal of the American Heart Association

Volume

8

Issue

16
Abstract
Background: Left ventricular hypertrophy (LVH) is associated with an increased risk for cardiovascular disease (CVD) events and all-cause mortality. Many individuals without LVH have a left ventricular mass that exceeds the level predicted by their sex, body size, and cardiac workload, a condition called inappropriate left ventricular mass (iLVM). We investigated the association of iLVM with CVD events and all-cause mortality among blacks. Methods and Results: We analyzed data from the Jackson Heart Study, a community-based cohort of blacks. The current analysis included 4424 participants without CVD and with an echocardiogram at baseline. Among this cohort, the prevalence of iLVM was 13.8%. There were 262 CVD events and 419 deaths over a median follow-up of 9.7 years (maximum, 12 years). Compared with participants without iLVM, participants with iLVM had a higher rate of CVD events and all-cause mortality. After multivariable adjustment, including for the presence of LVH, iLVM was associated with an increased risk of CVD events (hazard ratio, 1.87; 95% CI, 1.33–2.62). The multivariable-adjusted hazard ratio for all-cause mortality was 1.29 (95% CI, 0.98–1.70). Among participants without and with LVH, the multivariable-adjusted hazard ratios of iLVM for CVD events were 2.53 (95% CI, 1.68–3.81) and 1.21 (95% CI, 0.74–2.00), respectively (Pinteraction=0.029); and for all-cause mortality, the hazard ratios were 1.24 (95% CI, 0.81–1.89) and 1.26 (95% CI, 0.86–1.85), respectively (Pinteraction=0.664). Conclusions: iLVM is associated with an increased risk for CVD events among blacks without LVH.

Is the cardiovascular health of South Africans today comparable with African Americans 45 years ago?

Breet, Y., Lackland, D. T., Ovbiagele, B., Owolabi, M. O., Ogedegbe, G., Kruger, I. M., & Schutte, A. E.

Publication year

2019

Journal title

Journal of Hypertension

Volume

37

Issue

8

Page(s)

1606-1614
Abstract
Objectives:Hypertension occurs frequently among black populations around the world. In the United States (US) health system, interventions since the 1960s resulted in improvements in hypertension awareness, management and control among African Americans. This is in stark contrast to current health systems in African countries. To objectively assess the current situation in South Africa, we compared the cardiovascular health status of African Americans from 1960 to 1980 to black South Africans from recent years, as there is potential to implement best practices from the US. We also reviewed the recent cardiovascular health changes of a South African population over 10 years.Methods:Men and women were included from three studies performed in the United States (Evans County Heart Study; Charleston Heart Study; NHANES I and II) and one in South Africa (PURE, North West Province). We compared blood pressure (BP), BMI, cholesterol, diabetes and smoking status.Results:Age-adjusted SBP and DBP of South African men were lower than US studies conducted from 1960 to 1971 (Evans County; Charleston; NHANES I; all P < 0.001) but similar to NHANES II (P = 0.987) conducted in 1976. South African women had lower SBP than all four of the US studies (all P < 0.001); their DBP was lower than Evans County and Charleston studies, but similar to NHANES I and II. Reviewing South African data, BMI increased steeply over 10 years in women (P < 0.001) but not men (P = 0.451).Conclusion:Blood pressure of South Africans is lower than African Americans from the 1960s, but comparable for 1970s to 1980s. With obesity of South African women rising sharply, escalating figures for hypertension and diabetes are anticipated.

Measurement of blood pressure in humans: A scientific statement from the american heart association

Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., Myers, M. G., Ogedegbe, G., Schwartz, J. E., Townsend, R. R., Urbina, E. M., Viera, A. J., White, W. B., & Wright, J. T.

Publication year

2019

Journal title

Hypertension

Volume

73

Issue

5

Page(s)

E35-E66
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.

Partnerships to improve shared decision making for patients with hypertension-health equity implications

Langford, A. T., Williams, S. K., Applegate, M., Ogedegbe, O., & Braithwaite, R. S.

Publication year

2019

Journal title

Ethnicity and Disease

Volume

29

Page(s)

97-102
Abstract
Shared decision making (SDM) has increasingly become appreciated as a method to enhance patient involvement in health care decisions, patient-provider communication, and patient-centered care. Compared with cancer, the literature on SDM for hypertension is more limited. This is notable because hypertension is the leading risk factor for cardiovascular disease and both conditions disproportionately affect certain subgroups of patients. However, SDM holds promise for improving health equity by better engaging patients in their health care. For example, many reasonable options exist for treating uncomplicated stage-1 hypertension. These options include medication and/ or lifestyle changes such as healthy eating, physical activity, and weight management. Deciding on "the best" plan of action for hypertension management can be challenging because patients have different goals and preferences for treatment. As hypertension management may be considered a preference-sensitive decision, adherence to treatment plans may be greater if those plans are concordant with patient preferences. SDM can be implemented in a broad array of care contexts, from patient-provider dyads to interprofessional collaborations. In this article, we argue that SDM has the potential to advance health equity and improve clinical care. We also propose a process to evaluate whether SDM has occurred and suggest future directions for research.

Population-Attributable Risk for Cardiovascular Disease Associated with Hypertension in Black Adults

Clark, D., Colantonio, L. D., Min, Y. I., Hall, M. E., Zhao, H., Mentz, R. J., Shimbo, D., Ogedegbe, G., Howard, G., Levitan, E. B., Jones, D. W., Correa, A., & Muntner, P.

Publication year

2019

Journal title

JAMA Cardiology

Volume

4

Issue

12

Page(s)

1194-1202
Abstract
Importance: The prevalence of hypertension and the risk for hypertension-related cardiovascular disease (CVD) are high among black adults. The population-attributable risk (PAR) accounts for both prevalence and excess risk of disease associated with a risk factor. Objective: To examine the PAR for CVD associated with hypertension among black adults. Design, Setting, and Participants: This prospective cohort study used data on 12497 black participants older than 21 years without CVD at baseline who were enrolled in the Jackson Heart Study (JHS) from September 26, 2000, through March 31, 2004, and cardiovascular events were adjudicated through December 31, 2015. The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study participants were enrolled from July 1, 2003, through September 12, 2007, and cardiovascular events were adjudicated through March 31, 2016. Data analysis was performed from March 26, 2018, through July 10, 2019. Exposures: Normal blood pressure and hypertension were defined using the 2017 American College of Cardiology/American Heart Association blood pressure guideline thresholds. Main Outcomes and Measures: The PAR for CVD associated with hypertension, calculated using multivariable-adjusted hazard ratios (HRs) for CVD, coronary heart disease, heart failure, and stroke associated with hypertension vs normal blood pressure. Prevalence of hypertension among non-Hispanic black US adults 21 years and older without CVD was calculated using data from the National Health and Nutrition Examination Survey, 2011-2014. Results: Of 12497 participants, 1935 had normal blood pressure (638 [33.0%] male; mean [SD] age, 53.5 [12.4] years), 929 had elevated blood pressure (382 [41.1%] male; mean [SD] age, 58.6 [11.8] years), and 9633 had hypertension (3492 [36.3%] male; mean [SD] age, 62.0 [10.3] years). For a maximum 14.3 years of follow-up, 1235 JHS and REGARDS study participants (9.9%) experienced a CVD event. The multivariable-adjusted HR associated with hypertension was 1.91 (95% CI, 1.48-2.46) for CVD, 2.41 (95% CI, 1.59-3.66) for coronary heart disease, 1.52 (95% CI, 1.01-2.30) for heart failure, and 2.20 (95% CI, 1.44-3.36) for stroke. The prevalence of hypertension was 53.2% among non-Hispanic black individuals. The PAR associated with hypertension was 32.5% (95% CI, 20.5%-43.6%) for CVD, 42.7% (95% CI, 24.0%-58.4%) for coronary heart disease, 21.6% (95% CI, 0.6%-40.8%) for heart failure, and 38.9% (95% CI, 19.4%-55.6%) for stroke. The PAR was higher among those younger than 60 years (54.6% [95% CI, 37.2%-68.7%]) compared with those 60 years or older (32.0% [95% CI, 11.9%-48.1%]). No differences were present in subgroup analyses. Conclusions and Relevance: These findings suggest that a substantial proportion of CVD cases among black individuals are associated with hypertension. Interventions to maintain normal blood pressure throughout the life course may reduce the incidence of CVD in this population.

The Kathmandu Declaration on Global CVD/Hypertension Research and Implementation Science: A Framework to Advance Implementation Research for Cardiovascular and Other Noncommunicable Diseases in Low- and Middle-Income Countries

Aifah, A., Iwelunmor, J., Akwanalo, C., Allison, J., Amberbir, A., Asante, K. P., Baumann, A., Brown, A., Butler, M., Dalton, M., Davila-Roman, V., Fitzpatrick, A. L., Fort, M., Goldberg, R., Gondwe, A., Ha, D., He, J., Hosseinipour, M., Irazola, V., Kamano, J., Karengera, S., Karmacharya, B. M., Koju, R., Maharjan, R., Mohan, S., Mutabazi, V., Mutimura, E., Muula, A., Narayan, K. M., Nguyen, H., Njuguna, B., Nyirenda, M., Ogedegbe, G., Van Oosterhout, J., Onakomaiya, D., Patel, S., Paniagua-Ávila, A., Ramirez-zea, M., Plange-Rhule, J., Roche, D., Shrestha, A., Sharma, H., Tandon, N., Thu-Cuc, N., Vaidya, A., Vedanthan, R., & Weber, M. B.

Publication year

2019

Journal title

Global Heart

Volume

14

Issue

2

Page(s)

103-107