Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association

Carnethon, Mercedes R.; Pu, Jia; Howard, George; Albert, Michelle A.; Anderson, Cheryl A.M.; Bertoni, Alain G.; Mujahid, Mahasin S.; Palaniappan, Latha; Taylor, Herman A.; Willis, Monte S.; Yancy, Clyde W.

doi:10.1161/cir.0000000000000534

Cited by 856 publications

(708 citation statements)

References 276 publications

(292 reference statements)

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“…2 Because currently 58.4% of U.S. black men with hypertension have a blood pressure of 140/90 mm Hg or more, our intervention offers an evidence-based model for implementing these new, more stringent guidelines, 2 which were influenced by the Systolic Blood Pressure Intervention Trial (SPRINT). 36 Because black men with hypertension often have multiple cardiovascular risk factors, 37 marked reductions in blood pressure — if sustained with the use of our approach and then initiated more widely — might reduce the high rates of hypertension-related disability and death among black men with hypertension in the United States. 11 …”

Section: Discussionmentioning

confidence: 99%

A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

et al. 2018

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BACKGROUND Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings. METHODS We enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg or more from 52 black-owned barbershops (nontraditional health care setting) in a cluster-randomized trial in which barbershops were assigned to a pharmacist-led intervention (in which barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors) or to an active control approach (in which barbers encouraged lifestyle modification and doctor appointments). The primary outcome was reduction in systolic blood pressure at 6 months. RESULTS At baseline, the mean systolic blood pressure was 152.8 mm Hg in the intervention group and 154.6 mm Hg in the control group. At 6 months, the mean systolic blood pressure fell by 27.0 mm Hg (to 125.8 mm Hg) in the intervention group and by 9.3 mm Hg (to 145.4 mm Hg) in the control group; the mean reduction was 21.6 mm Hg greater with the intervention (95% confidence interval, 14.7 to 28.4; P<0.001). A blood-pressure level of less than 130/80 mm Hg was achieved among 63.6% of the participants in the intervention group versus 11.7% of the participants in the control group (P<0.001). In the intervention group, the rate of cohort retention was 95%, and there were few adverse events (three cases of acute kidney injury). CONCLUSIONS Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT02321618.)

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Section: Discussionmentioning

confidence: 99%

A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

et al. 2018

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“…Recent epidemiologic studies have used this metric to examine the prevalence of CVH in the US population and have unmasked striking health disparities in ideal CVH among blacks compared with whites . A significantly lower percentage of blacks has ideal levels of the LS7 components than whites, and they have 82% lower odds of meeting at least 5 components of ideal CVH .…”

Section: Introductionmentioning

confidence: 99%

Stress and Achievement of Cardiovascular Health Metrics: The American Heart Association Life's Simple 7 in Blacks of the Jackson Heart Study

Brewer

Redmond

Slusser

et al. 2018

JAHA

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BackgroundIdeal cardiovascular health metrics (defined by the American Heart Association Life's Simple 7 [LS7]) are suboptimal among blacks, which results in high risk of cardiovascular disease. We examined the association of multiple stressors with LS7 components among blacks.Methods and ResultsUsing a community‐based cohort of blacks (N=4383), we examined associations of chronic stress, minor stressors, major life events, and a cumulative stress score with LS7 components (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting plasma glucose) and an LS7 composite score. Multivariable logistic regression assessed the odds of achieving intermediate/ideal levels of cardiovascular health adjusted for demographic, socioeconomic, behavioral, and biomedical factors. The LS7 components with the lowest percentages of intermediate/ideal cardiovascular health levels were diet (39%), body mass index (47%), and physical activity (51%). Higher chronic, minor, and cumulative stress scores were associated with decreased odds (odds ratio [OR]) of achieving intermediate/ideal levels for smoking (OR [95% confidence interval], 0.80 [0.73–0.88], 0.84 [0.75–0.94], and 0.81 [0.74–0.90], respectively). Participants with more major life events had decreased odds of achieving intermediate/ideal levels for smoking (OR, 0.84; 95% confidence interval, 0.76–0.92) and fasting plasma glucose (OR, 0.90; 95% confidence interval, 0.82–0.98). Those with higher scores for minor stressors and major life events were less likely to achieve intermediate or ideal LS7 composite scores (OR [95% confidence interval], 0.89 [0.81–0.97] and 0.91 [0.84–0.98], respectively).ConclusionsBlacks with higher levels of multiple stress measures are less likely to achieve intermediate or ideal levels of overall cardiovascular health (LS7 composite score), specific behaviors (smoking), and biological factors (fasting plasma glucose).

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“…Middle aged Black compared to White Americans are also at a greater risk of developing type 2 diabetes and have higher BP prior to the development to diabetes (207–209). The increased prevalence of these traditional CV risk factors in Blacks likely require additional strategies to promote equitable CV outcomes as noted in a 2017 American Heart Association Scientific Statement (210). Similarly, women have generally been underrepresented in relation to their burden of disease in RCTs of CVD prevention (211, 212).…”

Section: Discussionmentioning

confidence: 99%

Chronotherapy for Hypertension

et al. 2018

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Given the emerging knowledge that circadian rhythmicity exists in every cell and all organ systems, there is increasing interest in the possible benefits of chronotherapy for many diseases. There is a well-documented 24-h pattern of blood pressure with a morning surge that may contribute to the observed morning increase in adverse cardiovascular events. Historically, antihypertensive therapy involves morning doses, usually aimed at reducing daytime blood pressure surges, but an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk. To more effectively reduce nocturnal blood pressure and still counteract the morning surge in blood pressure, a number of studies have examined moving one or more antihypertensives from morning to bedtime dosing. More recently, such studies of chronotherapy have studied comorbid populations including obstructive sleep apnea, chronic kidney disease, or diabetes. Here, we summarize major findings from recent research in this area (2013-2017). In general, nighttime administration of antihypertensives improved overall 24-h blood pressure profiles regardless of disease comorbidity. However, inconsistencies between studies suggest a need for more prospective randomized controlled trials with sufficient statistical power. In addition, experimental studies to ascertain mechanisms by which chronotherapy is beneficial could aid drug design and guidelines for timed administration.

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Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association

Abstract: The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.

Cited by 856 publications

References 276 publications

A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

Stress and Achievement of Cardiovascular Health Metrics: The American Heart Association Life's Simple 7 in Blacks of the Jackson Heart Study

Chronotherapy for Hypertension

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