Barriers to Treating Hypertension and Preventing Potential Risk for Cardiovascular Disease Among Haitians
Hamilton, Jill B.
Davidson, Patricia M.
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Session presented on Friday, July 22, 2016: Purpose: Hypertension (HTN) is the greatest cause of morbidity in Haiti, where it is an identified cause of heart failure for 45% of patients, and primarily associated with more than 70% of cardiovascular disease-related hospital admissions. The literature is limited regarding HTN in Haiti, where HTN and related complications are responsible for an estimated 20% of deaths. In this review, we explored the scientific literature regarding HTN and heart failure in Haiti. Specifically, we focus on HTN as a cause of morbidity and mortality in Haiti. We also synthesize the evidence on assessment and management of HTN among Haitians, with particular attention on interventions aimed to reduce or control HTN and heart failure. Methods: We conducted a literature search with the supervision of a medical librarian, for evidence related to hypertension and heartfailure in Haiti. We obtained papers from PubMed, EMBASE, CINHAL, and LILAC databases. The original search yielded 152 citations in total, using keywords hypertension, high blood pressure or heart failure with Haiti. Boolean phrases 'heart failure AND Haiti' as well as 'hypertension AND Haiti' were used for advanced searches. To identify relevant papers, search limitations were set to human only, men and women ages 18 and older, and English only. The search resulted in 152 titles that included published articles, abstracts, conference proceedings, book chapters and dissertations. Results: Eight publications were selected and synthesized for the review. No randomized control studies or systematic reviews were found. Studies reported prevalence rates for HTN among patients in rural and urban area clinics and hospitals across Haiti. Although results varied, the articles report similarities with respect to prevalence, disease burden, public health challenges, and the identified barriers to effective management of HTN among this underserved population. Conclusion: Studies have identified several barriers to management of hypertension in Haiti but the evidence for effective and efficient interventions is sparse. Challenges include a lack of knowledge of hypertension among Haitians, low awareness of HTN as a health condition, lack of health education and resources. Findings from previous studies recommend educational strategies for future interventions. Future research is necessary to address the barriers of effective management of hypertension and the avoidance of serious complications of HTN. The literature about HTN in Haiti supports the need for culturally-appropriate, community-based HTN-management programs. Evaluation of community-based patient education programs have not been reported but are likely a fertile area for future research. The literature highlights several broad recommendations, including the development, implementation, and evaluation of community-based programs to promote health education; reliable medical follow-up for those in treatment; and management of HTN, with specific focuses on rural areas. Further scientific research is needed to explore cultural beliefs that influence understanding of HTN, culturally-relevant approaches to disease management, and improved medication adherence.