Student shows hypertension, urban link
The following article describes one of
many poster presentations set for this year’s faculty convocation Aug.
22. The Catalyst will highlight some of the presentations on MUSC’s
international clinical, educational and research opportunities and
outreach. by Maggie Diebolt
Public Relations
Ann-Marie Rader, a senior in the College of Health Professions' physician assistant program, first became interested in medicine after going on a medical mission trip with her church.
Now on the cusp of finishing her degree and with six trips to Togo, West Africa, under her belt—and plans for a seventh in the works—Rader has focused her energy on researching the prevalence of hypertension and its relationship to the degree of urbanization among men and women in the small sub-Saharan country.
Togo is a country slightly smaller than West Virginia, with a population of roughly 6,145,000. The average life expectancy in Togo is 54 years, a low figure when compared to the average life expectancy in the United States, 77.5 years. Rader’s is the first report describing the prevalence of hypertension in Togo.
Ann-Marie Rader
performs an oral exam at a Sokodé clinic.Hypertension, or high blood pressure, is one of the primary independent risk factors for cardiovascular disease. It affects 1 billion people globally, and approximately 50 million people in the U.S. Rader noted that “currently, hypertension is being reported in all areas of Africa, and has emerged as the most common cause of cardiovascular disease on the continent and a major cause of the high mortality rates of adults in sub-Saharan Africa.”
Hypertension occurs when systolic blood pressure (the “top” number in a blood pressure measurement, which represents the pressure generated when the heart beats) is consistently more than 140, and diastolic blood pressure (the “bottom” number of a blood pressure measurement that represents the pressure in the vessels when the heart is at rest) is more than 90.
Rader was inspired to research hypertension in Togo after attending a lecture by Brent Egan, M.D., on the theory of access to excess. The theory states that wherever a population has access to excess calories, salt, sugar, fat, labor saving devices and passive entertainment, etc.—problems with obesity, hyper-tension, diabetes, heart and kidney disease flourish. When there is no access to excess, these problems rarely develop or they are fairly insignificant.
In her study, Rader compares the frequency of hypertension in relation to urbanization, body mass index and gender among ambulatory care patients living in three regions of Togo.
Each region represents a degree of urbanization, ranging from the rural village Agbokope, population 1,100; the semi-urban township Sokodé, population 94,000; to the urban city Lomé, population 1 million. The locations were selected based on population size, primary occupations of inhabitants, infrastructure and access to a public water supply, sewage management and electricity.
Through the data collected, Rader discovered that patients seen in the rural region had almost non-existent rates of hypertension while only a small percentage of those living in an urban environment and with more access to non-necessary goods had normal blood pressure.
Results indicate that a larger percentage of patients seen in urban clinics were classified as overweight or obese and also possessed hypertensive characteristics when compared with those seen in rural clinics. Research also showed that “a rural Togolese is 99 percent less likely to be hypertensive and 89 percent less likely to be obese than an urban Togolese,” suggesting that lifestyle has a major impact on hypertension, obesity rates and public health.
“It is interesting to consider these results in light of the fact that 80 percent of the African-American genome in the U.S. originates in West Africa,” said Rader. “This connection between increasing rates of hypertension and obesity with increasing urbanization is the opposite of the trend in the U.S., where hypertension and obesity are more prevalent in rural settings.”
Rader began collecting data in March 2005 and was assisted on this project by Lloyd Taylor, Ph.D., clinical services; Reamer Bushardt, Pharm.D., clinical services; Kit Simpson, Dr.PH, health administration and pharmacy; and Egan, general internal medicine, hypertension.
Rader will continue her research when she returns to Togo in September. She said her study is still a work in progress. She wants to include a larger sample of patients to make the results more generalizable.
Friday, July 28, 2006
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