Hypertension in Haitian Adults

Two years after the January 2010 earthquake, the Haitian Ministry of Public Health and Population defined hypertension as the greatest cause of morbidity and mortality in Haitian adults with prevalence approaching 45%, higher than HIV, cholera, tuberculosis, and malaria combined. In a very poor developing country with limited facilities, funds for non-communicable disease prevention and treatment are scarce. In 2012, the total expenditure on health was only 7.9% of GNP. Three primary factors contribute to the hypertension disease burden in Haiti: the stroke death rate is the highest in the Caribbean, the Haitian dietary salt intake is 10 times greater than the U.S, and the social determinants of disease are very high from extreme poverty, health care inequity, and socio-ecological stress. The objectives of the master's paper are to describe the prevalence and pattern of hypertension, and the relationship between blood pressure, age and gender in Haitian adults living near Port-au-Prince, Haiti. Data from this pilot study will serve as clinical evidence to generate hypotheses for future public health prevention and disease management interventions and for proposal development. The study uses a retrospective, cross-sectional design of clinical data collected during a walk-in mission clinic in fall 2012. The convenience sample was 556 Haitian adults (104 men, 452 women) aged 19-90 years. Patients were seen by 6 U.S. physicians and 7 nurses during a trip led by Family Health Ministries, Durham, NC. The setting was the Blanchard Clinic located near Cite Soleil in NW Port-au-Prince, Haiti. It is a two-story cement brick building built by FHM and is available by car on paved and dirt roads. Patient ID, date, age, and gender were recorded by Haitian staff. Blood pressure and other vital signs were assessed by nurses. Clinical complaints were written by triage volunteers with help of Haitian translators. Patients were seen by general medicine doctors or infectious disease or OB-GYN specialists depending on medical complaints. A medical history and physical exam were performed, and lab work, treatments and medications were ordered on the data sheet and taken to nurses in the treatment area. The de-identified patient data sheets will be destroyed after completion of the study. Data analyses used SPSS statistical software version 22. Of all adults, 254 were hypertensive: 300 (54%) had normal BP, 43 (8%) had systolic hypertension (SHPT), 52 (9%) had diastolic hypertension (DHPT) and 159 (29%) had both systolic and diastolic hypertension (S-D HPT). Prevalence of hypertension in this sample was 46%. There was a significant, positive relationship between increasing age and systolic and diastolic blood pressure (BP) (P<0.001). Severity of hypertension was greatest in those 60-90 years old. Across increasing age categories, prevalence of normal BP decreased 72%, SHPT and S-D HPT increased 400%, and DHPT decreased 40%. Progressively higher prevalence of hypertension occurred by both men and women but the patterns varied. A logistic regression confirmed a significant association of age and hypertension (P=0.000) controlling for gender. The prevalence of hypertension in Haitian adults was 46%, higher than the 42% in U.S. blacks. In this non-random sample, age was a primary risk factor for both systolic and diastolic hypertension in both men and women. Though the data may have limited generalizability to the entire Haitian population, the availability of these data are a "natural experiment" to answer important health questions about prevalence of hypertension in Haiti and to generate hypotheses for future research and treatment strategies using a stratified random sample. The pattern of an increasing systolic hypertension with age is important in guiding treatment. A future study would investigate the relationship of hypertension to cardiovascular risk factors, clinical symptoms, African ancestry, and cultural life-style issues such as dietary salt intake, education, environmental stress and poverty. Collaboration with the Haitian government is essential to plan and implement a chronic disease prevention and management infrastructure.