A primer on hypertension and on the racial / ethnic disparities in diagnosis and management: a comprehensive overview

Abstract

Hypertension is a major cause of premature death worldwide, where it contributes to stroke, cardiovascular and renal disease. Forty percent of adults aged 30-79 years worldwide have hypertension, two-thirds of whom are living in low and middle-income countries. Most adults with hypertension are not fully aware that they have the condition, therefore it often goes ignored and untreated. Of the 1.28 billion people worldwide, who have been reported to have hypertension, data indicates that one in five females and one in four males are included in that estimate. Moreover, data from World Health Organization reports that less than half of adults (42%) with hypertension are diagnosed and treated adequately and approximately only one in five adults (21%) with hypertension have it under adequate control. One of the worldwide goals for non-communicable diseases is to scale back the prevalence of hypertension by 33% between 2010 and 2030. In African Americans, readily available thiazide diuretics or Calcium Channel Blockers (CCBs) have been shown to be more effective in lowering blood pressure than Renin Angiotensin System inhibitors (RAS) or β-adrenergic blockers and are also more effective in reducing cardiovascular disease (CVD) events than RAS inhibitors or adrenergic blockers. The ethnical difference in hypertension and hypertension- related complaint issues are associated with lesser mortality and morbidity pitfalls compared with their white counterparts. These redundant pitfalls from elevated blood pressure have a dramatic effect on life expectancy and career productivity for African American men and women and which is significantly lower than has been reported for Caucasian Americans of either gender. These present challenges remain to be completely understood and give a result to overcome ethnical and racial differences in the frequency and treatment of hypertension. Social determinants of health similar as educational status, access to health care and low income play a crucial part in frequency and blood pressure control rates. Development of appropriate health care programs at the state and public situations to address these issues will be essential to reduce these differences. Thus, the purpose of this paper is to review the prevalence and ethnic disparities in the diagnosis and treatment of hypertension and to suggest steps to improve the outcomes.

Insulin resistance, the unbrowning of brown adipose tissue and beige adipose tissue development in obese and obese-diabetic rats: Is there a link?

“…25 The combination of overweight and obese conditions in association with an NIDDM/ T2DM milieu is now highly prevalent in Westernized populations and present a serious and costly global challenge to the capacity to deliver health care resources to the affected populations. 26…”

“…Early overnutrition results in hyperplasia and hypertrophy of BAT in lean and obese rats, but the intensity of the brown pigmentation in the BAT of the obese phenotype typically becomes less intense over time however in apparent parallel to the progression of hyperinsulinemia and insulin resistance commonly found in obese rodents and the obese of other mammalian species. 26 The epigenetic expression of an obese phenotype may also develop in the absence of NIDDM in some obesity-prone strains. 14,15,19 The increases in BAT mass in obese rats is disproportionate however to the magnitude of thermogenesis typically observed, in that resting and norepinephrine stimulated VO2 remain depressed among the obese phenotype in spite of the increases in BAT mass and cellularity.…”

“…[14][15][16][17][18][19] Café' feeding regimes in both lean and obese rats results in increases in BAT mass, plasma T3 concentrations, Vanilmandelic acid (VMA) excretion, RMR, and norepinephrine stimulated VO2, while pharmacologic sympathomimetic blockade via α-methylparatyrosine results in decreases in VMA and the magnitude of the sympathetic component of the thermogenic responses. [26][27][28]…”

Effect of delayed luminal carbodhydrate uptake via α-glucosidase inhibition on plasma glycemic parameters and lipid profiles in adult wistar fatty rats

“…1,2 The incidence of these illnesses are now approaching severe proportions in Westernized Society with more than a third of the population considered overweight or obese, and has placed an enormous burden on the health care resources of those communities. 3 In addition, the economic loss in the workplace places an additional strain on both health care resources and industrial productivity due to decreased individual and collective capacity when individuals are unable to attend to their workplace obligations. 1,2 Advances in industrialization have brought with them substantial changes in diet preferences and nutritional practices along with improved workplace conditions which have inadvertently changed key contributors to maintaining energy balance in a society that overall now tends to be more sedentary than in the past in many occupations.…”

“…The ingestion of high carbohydrate, high glycemic index diets are often contraindicated in Obesity+NIDDM, where they are commonly associated with elevations weight gain and adiposity, in association with increases in fasting plasma triglycerides, cholesterol including the LDL fractions, fasting and glucose stimulated insulin concentrations and other stigmata of obesity+NIDDM. 3 Therapeutic considerations include adoption of improvements in life style, and diet planning that focuses on a complex carbohydrate, modest fat diet, with special attention to ensure adequacy in fiber and micronutrient intake, all of which is programmed to generate a lower glycemic index diet while controlling caloric intake to match projected energy requirements of the individual. The added incorporation of a starch blocker agent such as acarbose, miglitol or other natural inhibitors of starch digestion via competitive inhibition of a-glucosidase and sucrase that may be additive to the luminal effects of the complex carbohydrate diet regimen may also be recommended by the supervising clinician.…”