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3 pp. / Revised

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MPH / Department of Public Health

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Hypertension is a serious medical condition. Although men and women of all racial groups in the US suffer from high blood pressure, black women have the highest rates of hypertension. For instance, the age-adjusted prevalence of hypertension among black women ages 20 and over is 44.3, compared to 28.1 among white women, 40.5 among black men, and 31.1 among white men. Past research has focused on SES and behavioral factors as potential explanations for blood pressure disparities between black and white women. But, even after controlling for such factors, considerable disparities remain. The goal of this research is to examine cultural and social factors that have been shown to increase blood pressure. Specifically, I examine social support, psychosocial characteristics, and contextual factors associated with race/ethnicity and hypertension, in hopes of explaining some of the disparities in high blood pressure between black and white women. iii Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health), I estimated a sequence of multinomial logistic regression models predicting prehypertension and hypertension in young adulthood. Cross-sectional models show that racial disparities in hypertension remain after controlling for social support, psychosocial characteristics, and contextual factors. In fact, the only covariate that substantially reduced the racial disparity in hypertension was body mass index (BMI), a fairly reliable measure of body fatness for most people. I also estimated a set of multinomial logistic regression models predicting odds of prehypertension and hypertension by adolescent and cumulative social support, as well as psychosocial, contextual, and behavioral factors. These models were included to determine if early life and/or cumulative factors and conditions would help explain racial blood pressure disparities not explained by adulthood factors. Findings show that none of the early life or cumulative social support, psychosocial, contextual, or behavioral factors helped to explain racial differences in prehypertension or hypertension. Even after controlling for these factors, black women are still 1.18 times more likely than white women to have prehypertension and over two times more likely to suffer hypertension. Indeed, my findings indicate that, of the factors included in all these models, only race, age, and BMI were significant predictors of blood pressure. Also, BMI was the only factor to explain some of the disparities between black and white women. These results are similar to other studies that have examined racial health disparities, suggesting that simply being a black woman in US society may be unhealthy. The health effects of racism, discrimination, and other sources of stress faced disproportionately by black women are not easily measured by social science research, which is possibly why racial disparities in blood pressure have yet to be explained. Future research should also explore possible epigenetic effects introduced by the health conditions experienced by previous generations, as well as the influence of prenatal and early life environments.

MSc (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Pregnancy induced hypertension (PIH) occurring during pregnancy, labour and puerperium is a major contributor to the high percentage of maternal morbidity and mortality in the Eastern Cape Province, and worldwide. In South Africa (SA), PIH is the second most common of all primary causes of maternal mortality reported in the triennium from 1999 to 2001. From 1999 to 2001, PIH was the cause of 20,7 % (n = 507) of all maternal mortalities in SA (Department of Health (DOH), 2001:38). In the light of these statistics and other statistics related to other causes of MMR, the National Confidential Committee on Enquiries into Maternal Deaths (NCCEMD) developed the National Guidelines for Maternity Care in South Africa, a Manual for Clinics, Community Health Centres and District Hospitals. The guidelines related to PIH were of particular interest in this study. A quantitative, descriptive and contextual survey was conducted to determine the implementation of the National Guidelines for Maternity Care for the management of PIH by the midwife at level-1 clinics in the Eastern Cape, and to make recommendations for the management of PIH by midwives at level-1 clinics with the intention of reducing maternal mortality and morbidity due to PIH. The research method comprised a retrospective record review of the records of all patients admitted with PIH at a level-3 hospital who were referred by a midwife from a level-1 clinic. Data were collected by means of a researcher-administered data collection tool based on the iii National Guidelines for Maternity Care in SA for the management of PIH. The researcher wished to determine whether the National Guidelines for Maternity Care in SA was being implemented for the management of PIH by midwives at level-1 clinics in East London. A purposive sample of 290 maternal records of mothers who had been admitted for PIH at level 3 after being referred from level-1 clinics from May 1999 to June 2003 were used. Data were analysed using descriptive statistics. Ethical issues were taken into consideration. Validity and reliability were ensured. In conclusion, given the study findings, the researcher has made recommendations with the intention of reducing mortality due to PHI in the Eastern Cape.

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Magister Artium - MA / Hypertension is estimated to a ect 20 million people in South Africa, with lifestyle factors predisposing certain individuals to this condition disease (Hughes et al., 2013). The prevalence rate of hypertension is higher in areas with low socio-economic status, with women more at risk of developing it than men. Current research suggests that 60-80% of people in South Africa use 'traditional'- most often plant based - medicines at some point for their primary healthcare needs (WHO, 2008; Hughes et al., 2013). In rural and underprivileged areas, such as the community of Nuwerus in the Western Cape Province, the use of herbal medicines and its practices are maintained in an ageing population. This study looks at the ways in which the elderly and the home based care workers of Nuwerus understand hypertension. I focus on the transition from hypertension to high blood pressure and how the two concepts overlap in Nuwerus. I highlight the way the elderly maintain their sense of vitality. I also look at concepts of resilience and vitality to unpack the personal, religious and social dimensions of old age. I focus on the various activities the elderly participate in to unpack the subtle ways with which they push the boundaries of old age consequently challenging conventional notions of health and wellness amongst the aged. The vigour with which the elderly go about their everyday life is what ultimately makes them the pillars and knowledge holders of the community. / National Research Foundation (NRF)

Sushi, von Willebrand factor type A, epidermal growth factor and pentraxin domain containing 1 (SVEP1) is an extracellular matrix protein which may bind to cell surface molecules such as integrins. A non-synonymous single amino acid polymorphism in the Svep1 gene is associated with a 14% increased risk of coronary heart disease, a 13% higher risk of type 2 diabetes and a 1mmHg increase in systolic blood pressure. Expression of the SVEP1 gene is increased in the kidney in the Cyp1a1mRen2 rat model of diabetes and hypertension previously developed in our lab. SVEP1 is also known to be upregulated in human diabetic nephropathy and is upregulated in rodent models of renal fibrosis. I hypothesized that Svep1 played a role in renal fibrosis, diabetes and blood pressure. Hence, the primary goal of this thesis was to investigate the role of SVEP1 and in the pathogenesis of diabetes, hypertension and renal fibrosis. Svep1 gene expression is increased in the kidney in the DOCA-salt-angII-uninephrectomy model of hypertension and following UUO. SVEP1 hemizygous mice showed no differences in expression of pro-fibrotic genes after UUO compared to wildtype littermates. No overt metabolic phenotype was exhibited by the Svep1 hemizygous mice, however there was a significant decrease in fat depot weights after high fat diet (HFD) and a significant increase in blood glucose concentrations during the glucose tolerance test at the 12 week time point in hemizygous Svep1 mice compared with wild-type controls. After telemetry analysis of blood pressure no difference was seen in blood pressure but SVEP1+/-animals had an increased heart rate of 100 beats per minute compared to wildtype animals. Svep1 expression is increased in the kidney in models of hypertension and fibrosis, however loss of one Svep1 allele did not alter the severity of fibrosis in the UUO model or significantly alter glucose tolerance after high fat diet. However, the high fat diet experiment was a pilot study and should be repeated with a larger number of animals. In addition, generation of a mouse with the human point mutation could determine the mechanisms by which this extracellular matrix protein confers risk of diabetes and hypertension.