Elsevier

International Journal of Cardiology

Volume 183, 15 March 2015, Pages 180-189
International Journal of Cardiology

Hypertension control in a large multi-ethnic cohort in Amsterdam, The Netherlands: The HELIUS study

https://doi.org/10.1016/j.ijcard.2015.01.061Get rights and content

Abstract

Objective

Hypertension is a major problem among European ethnic minority groups. We assessed the current situation of hypertension prevalence and its management among a multi-ethnic population in Amsterdam, The Netherlands.

Methods

Data from the HELIUS study were used including 12,974 participants (1871 Ghanaian, 2184 African Surinamese, 2278 South-Asian Surinamese, 2277 Turkish, 2222 Moroccan and 2142 Dutch origin people), aged 18–70 years. Comparisons among groups were made using proportions and age-adjusted prevalence ratios (PRs).

Results

Hypertension prevalence ranged from 24% and 16% in Moroccan men and women to 52% and 62% in Ghanaian men and women. Except for Moroccan women, age-adjusted PR of hypertension was higher in all the ethnic minority groups than in Dutch. Among hypertensives, ethnic minority groups generally had higher levels of hypertension awareness and BP lowering treatment than Dutch. Moreover, prevalence rates for the prescription of more than one BP lowering drug were generally higher in African and South-Asian origin groups compared with Dutch origin people. By contrast, BP control levels were lower in all the ethnic groups than in Dutch, with control rates being significantly lower in Ghanaian men (26%, PR = 0.49; 95% CI, 0.37–0.66) and women (45%, PR = 0.64; 0.52–0.77), African-Surinamese men (30%, PR = 0.61; 0.46–0.81) and women (45%, PR = 0.72; 0.51–0.77), and South-Asian Surinamese men (43%, PR = 0.77; 0.61–0.97) and women (47%, PR = 0.76; 0.63–0.92) compared with Dutch men (53%) and women (61%).

Conclusion

Our findings indicate poor BP control in ethnic minority groups despite the high treatment levels. More work is needed to unravel the potential factors contributing to the poor control in order to improve BP control in ethnic minority groups, particularly among African and South-Asian origin groups.

Introduction

Hypertension is the leading risk factor for cardiovascular diseases (CVDs) worldwide [1], and is highly prevalent among most ethnic minority groups in Europe and North America [2], [3]. In addition, uncontrolled blood pressure (BP) among hypertensive patients tends to be more common among ethnic minority groups, particularly men, compared with European origin populations [3]. A decade ago, we found that the prevalence of adequate BP control (< 140/90 mm Hg) among treated hypertensives was only 14% among African Surinamese men compared with 42% in Dutch origin men in Amsterdam, The Netherlands [4], [5]. Poor BP control is a serious risk factor for cardiovascular events such as stroke and target organ damage [1], which are more common in these ethnic minority groups [6], [7]. Studies have consistently shown that BP control significantly reduces the occurrence of these cardiovascular events and premature deaths [8]. Therefore, improving BP control among ethnic minority groups has been recommended as an important strategy in reducing ethnic inequalities in cardiovascular outcomes [9], [10].

Recent evidence from the United States of America (USA) indicates that BP control has improved significantly in all ethnic groups, despite persistent ethnic inequalities. In the 2009 to 2010 time period, 64% of White-American, 53% of African-American and 48% of Hispanic-American treated hypertensive patients had adequate BP control as compared with control rates of 46% in White-Americans, 39% in African-Americans and 46% in Hispanic-American in 2001–2002 [11]. These improvements in BP control have been attributed, among other factors, to the increasing use of multiple antihypertensive drugs [11]. It is unclear whether similar improvements have been made among various ethnic groups in Europe following the earlier reports in the literature of poor BP control among ethnic minority populations in Europe [3], [4]. Furthermore, some hypertension guidelines recommend different anti-hypertensive strategies for patients of African descent groups [1], but data on anti-hypertensive prescription patterns among ethnic groups are lacking in Europe. As health systems, hypertension treatment guidelines, and access and adherence to antihypertensive therapy differ importantly between USA and Europe, it is imperative to assess the situation in Europe. In this study, we used the HELIUS (Healthy Life in an Urban Setting) study baseline data to assess the prevalence of hypertension, level of hypertension awareness and treatment, and BP control among a multi-ethnic population in Amsterdam, The Netherlands. In addition, we assessed the numbers and type of BP lowering medication within each ethnic group.

Section snippets

Study population

The aims and design of the HELIUS study have been described in detail elsewhere [12]. In brief, HELIUS is a large-scale prospective cohort study on health and health care utilization among different ethnic groups living in Amsterdam, The Netherlands. The study began in 2011 and it includes people aged 18–70 years from ethnic minority groups in Amsterdam: African-Surinamese, South-Asian-Surinamese, Turks, Moroccans, Ghanaians, and Dutch origin people. The HELIUS study focuses on three major

Characteristics of the study population

Table 1 shows the characteristics of the study population by ethnic group and sex. Turkish and Moroccan men and women were younger than the other ethnic groups. In general, ethnic minority groups had lower educational levels, lower mean total-cholesterol, consumed less alcohol, were heavier and had higher fasting glucose levels than Dutch. Among men, Ghanaians smoked less often, but African Surinamese, South-Asian Surinamese and Turks smoked more often than Dutch. Among women, except for

Key findings

Our findings show ethnic inequalities in hypertension prevalence. Levels of hypertension awareness and treatment were generally higher, but adequate BP control level was generally lower in ethnic minority groups, particularly among African and South-Asian origin populations compared with Dutch origin people.

Prevalence of hypertension

Our current findings indicate that ethnic inequalities in the prevalence of hypertension persist; and the patterns seem to be changing unfavourably for ethnic minority groups such as

Conclusion

In conclusion, our current study indicates improvements in hypertension treatment and BP control among all ethnic groups compared to the earlier reports in the literature, but ethnic inequalities persist. In particular, adequate BP control remains low despite the high treatment levels in ethnic minority groups particularly among the African and South-Asian origin populations. The favourable antihypertensive treatment levels in the ethnic minority groups seem to suggest that other factors may

Conflicts of interests

None.

Acknowledgements

The HELIUS study is conducted by the Academic Medical Center Amsterdam and the Public Health Service of Amsterdam. Both organizations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation (grant number 2010T084), The Netherlands Organization for Health Research and Development (ZonMw grant number 200500003), and the European Commission (grant number 278901). We are most grateful to the participants of the HELIUS study and the management team, research

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