High prevalence of non-dipping patterns among black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

Background Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of anti-hypertensive therapy, and intensifying salt restriction. Objectives To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of three 6-months anti-hypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-hour ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium >140mmol/l (OR=1.72, 95% CI: 1.17–2.51, p-value 0.005), a higher office systolic BP (OR=1.03, 95% CI: 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR=0.97, 95% CI: 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's χ2 0.71, p-value 0.40). Conclusion There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Fogarty International Center and the National Institutes of Health of the United States of America Figure 1

The Charnegroes: Black Africans and the Ontological Conflict in Catalonia

This paper frames an in depth reflection on the current social and political changes and the emerging phenomenon of body politics of migrant and racialized groups in Europe. The ongoing discussion aims to address the meaning of “being” Catalan for Black Africans in Catalonia. It is grounded on a criterion of ontological commitment and the epistemological aspect of ethnography. I dig into the debate about what makes a racial identity salient in the context of national identity rhetoric. I look thoroughly at the outcomes of the encounter between Black African migrants and the constant resignification of Catalan national identity. I aim to disentangle the racial premises and tackle what Black Africans share once the racial questions are removed. My approach stands within the growing field of postcolonial criticism to understand historical continuities and ontological conflicts. I focus on culture, race, and identity to analyze the cultural dynamics of Senegalese migrants and Equatoguinean communities within the national identity building process in Catalonia. I coined a new concept, Charnegroes, to propose a practical explanation of the emergence of body politics and the changing reality of the relationship between the “us” and the “other” under the recurrent transitions between old and new, colonial and postcolonial, the past and the future.

High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

Background Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction. Objectives To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17–2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar’s Chi2 0.71, p-value 0.40). Conclusion There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Trial registration ClinicalTrials.gov (NCT02742467).

Association between lipid indices and 10-year cardiovascular risk of a cohort of black Africans living with type 2 diabetes mellitus

Introduction Diabetes mellitus is an established cardiovascular risk factor. Diabetes mellitus impairs lipid metabolism and enhances atherosclerosis development. Absolute lipid parameter are inadequate in predicting cardiovascular risk and some lipid indices have been reported to circumvent this deficiency. The objective of the study was to determine the association between these lipid indices and 10-year cardiovascular risk among black Africans with diabetes. Methods Seventy individuals (35 males and 35 females) living with diabetes who attended the diabetes clinic of a referral hospital in South-western Nigeria were recruited to the study. Ethical approval and participants’ informed consent were duly obtained. Fasting plasma glucose, fasting lipid profile and glycated haemoglobin were done using appropriate laboratory techniques. Atherogenic index of plasma, atherogenic coefficient, Castelli’s risk index I, Castelli’s risk index II and CHOLindex were calculated using appropriate formulae. QRISK 3 score was obtained using a validated calculator. The association between QRISK 3 and the lipid indices was determined using Pearson’s correlation. Results The mean age of the participants was 53.34 ± 9.57 years. The mean duration of diabetes mellitus among the participants was 6.29 ± 2.78 years. The mean HbA1c and FPG were 6.98±0.72% and 6.32±0.87 mmol/L respectively. The mean QRISK 3 score was 7.58±4.80. There was a statistically significant and positive correlation between QRISK 3 score and AIP, AC, CR I and CR II. CHOLindex did not significantly correlate with QRISK 3 score. Conclusion Among black Africans with diabetes, lipid indices (AIP, AC, CR I and CR II) significantly correlated with QRISK 3 score and therefore may be used as cheap markers of 10-year cardiovascular risk in these individuals.

Exploration of traditional beliefs about human immunodeficiency virus and associated stigma among black Africans in the UK: a pilot study with implication for practice in Africa

Background: In the UK, black Africans account for the most affected ethnic population with HIV. Black Africans hold traditional beliefs which have been reported to cause certain misconceptions about the cause of HIV. Also, despite being in a developed country like the UK, it has been noted that Black Africans still hold these beliefs. This study was aimed at exploring the influence of traditional beliefs about the cause of HIV and HIV related stigma among Black Africans in the diaspora.Methods: Semi structured interviews were conducted among six individuals (M-4, F-2), three of which were people living with HIV (PLHIV). Participants were selected purposively. The study included male and/or female English-speaking Black Africans who were 18 years+ and not born in the UK but had migrated to live there.Results: The resulting data was analysed thematically, and three themes were developed: “…God created disease as a punishment for mankind…”: Punishment from God, “…witches, they can make HIV…”: HIV as related to witchcraft and “hanging on to traditional beliefs thus mistreating people with HIV”: Traditional African beliefs cause stigma.Conclusions: The main finding of this study reveals that participants who are knowledgeable about HIV still hold traditional beliefs about HIV. These beliefs are reported to exacerbate stigma against PLHIV. The study recommends that traditional beliefs should be prioritised when planning HIV prevention programs.