Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population‐based cohort in Haiti

Abstract Cardiovascular disease (CVD) is the number one cause of death in low‐income countries including Haiti, with hypertension (HTN) being the leading risk factor. This study aims to identify gaps in the HTN continuum of screening, diagnosis, treatment, and blood pressure (BP) control. Sociodemographic and clinical data were collected from a population‐based sample of adults ≥18 years in Port‐au‐Prince (PAP) from March 2019 to April 2021. HTN was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or use of antihypertensive medication. Screening was defined as ever having had a BP measurement; diagnosis as previously being informed of a HTN diagnosis; treatment as having taken antihypertensives in the past 2 weeks; and controlled as taking antihypertensives and having BP < 140/90 mmHg. Factors associated with attaining each step in the continuum were assessed using Poisson multivariable regressions. Among 2737 participants, 810 (29% age‐standardized) had HTN, of whom 97% had been screened, 72% diagnosed, 45% treated, and 13% controlled. There were no significant differences across age groups or sex. Obesity (BMI ≥ 30) was a significant factor associated with receiving treatment compared to normal weight (BMI < 25), with a prevalence ratio (PR) of 1.5 (95% CI 1.1–2.0). Having secondary or higher education was associated with higher likelihood of controlled BP (PR 1.9 [95% CI 1.1–3.3]). In this urban Haitian population, the greatest gaps in HTN care are treatment and control. Targeted interventions are needed to improve these steps, including broader access to affordable treatment, timely distribution of medications, and patient adherence to HTN medication

Neighborhood cohesion and violence in Port-au-Prince, Haiti, and their relationship to stress, depression, and hypertension: Findings from the Haiti cardiovascular disease cohort study.

Neighborhood factors have been associated with health outcomes, but this relationship is underexplored in low-income countries like Haiti. We describe perceived neighborhood cohesion and perceived violence using the Neighborhood Collective Efficacy and the City Stress Inventory scores. We hypothesized lower cohesion and higher violence were associated with higher stress, depression, and hypertension. We collected data from a population-based cohort of adults in Port-au-Prince, Haiti between March 2019 to August 2021, including stress (Perceived Stress Scale), depression (PHQ-9), and blood pressure (BP). Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or on antihypertensive medications. Covariates that were adjusted for included age, sex, body mass index, smoking, alcohol, physical activity, diet, income, and education, multivariable linear and Poisson regressions assessed the relationship between exposures and outcomes. Among 2,961 adults, 58.0% were female and median age was 40 years (IQR:28-55). Participants reported high cohesion (median 15/25, IQR:14-17) and moderate violence (9/20, IQR:7-11). Stress was moderate (8/16) and 12.6% had at least moderate depression (PHQ-9 ≥ 11). Median systolic BP was 118 mmHg, median diastolic BP 72 mmHg, and 29.2% had hypertension. In regressions, higher violence was associated with higher prevalence ratios of moderate-to-severe depression (Tertile3 vs Tertile1: PR 1.12, 95%CI:1.09 to 1.16) and stress (+0.3 score, 95%CI:0.01 to 0.6) but not hypertension. Cohesion was associated with lower stress (Tertile3 vs Tertile1: -0.4 score, 95%CI: -0.7 to -0.2) but not depression or hypertension. In summary, urban Haitians reported high perceived cohesion and moderate violence, with higher violence associated with higher stress and depression

True believers: the recption of Descartes's meditations by Malebranche and Huet

Both Nicholas Malebranche and Pierre-Daniel Huet were at first positively influenced by Descartes's Meditations, and both came to perceive shortcomings in that work. With respect to mind-body dualism, Malebranche attempted to strengthen Descartes's position by jettisoning clarity and distinctness basing it instead on a principle of intentionality. Huet jettisoned the whole position in favor of skepticism. The source of their different responses lay in their different estimations of Descartes's integrity.<br>Tanto Nicholas Malebranche como Pierre-Daniel Huet foram inicialmente positivamente influenciados pelas Meditações de Descartes e ambos terminaram por perceber falhas nesta obra. No que concerne o dualismo mente e corpo, Malebranche buscou fortalecer a posição cartesiana abandonando o critério de clareza e distinção em favor de um princípio de intencionalidade. Huet abandonou o cartesianismo como um todo em favor do ceticismo. A fonte destas respostas diversas está nas avaliações distintas que fizeram da integridade de Descartes

Sociodemographic characteristics of Haitian adults in the Haiti CVD cohort study (N = 2961).

Sociodemographic characteristics of Haitian adults in the Haiti CVD cohort study (N = 2961).</p

Distribution of neighborhood cohesion, neighborhood violence, perceived stress, depression, and hypertension.

X axis represents the scores, or blood pressure categories. Y axis represents the percent of participants with that score.</p

Association between neighborhood cohesion and mental or physical health outcomes, multivariable linear regression and Poisson regression.

Association between neighborhood cohesion and mental or physical health outcomes, multivariable linear regression and Poisson regression.</p