Suchergebnisse

Objective: To describe the rationale and design of a prospective study of ambula­tory blood pressure measurement (ABPM) combined with measurement of contextual factors to identify hypertensive phenotypes in a Caribbean population with high rates of HTN and cardiovascular disease.Design: Prospective, multi-center sub-study.Setting: Eastern Caribbean Health Outcomes Research Network Cohort (ECHORN) Study, with study sites in Puerto Rico, the US Virgin Islands, Trinidad and Tobago, and Barbados.Participants: Community-residing adults without a diagnosis of HTN and not taking antihypertensive medication.Intervention: Ambulatory BP patterns are assessed using 24-hour ABPM. Contextual factors are assessed with: ecological mo­mentary assessment (7-item survey of expe­riences, exposures and responses associated with daytime BP measurements); actigra­phy (capturing physical activity and sleep quality); and self-report surveys (assessing physical and social health, environmental and social stressors and supports).Main Outcome Measures: Phenotypes of contextual factors associated with hyperten­sive BP patterns (sustained HTN, masked HTN, and nocturnal non-dipping)Methods and Results: This study will enroll 500 participants; assessments of blood pressure and contextual factors will be conducted during Waves 2 and 3 of the ECHORN parent study, occurring 2 years apart. In Wave 2, we will assess the associa­tion between contextual factors and ABPM patterns. Using advanced analytic clustering methods, we will identify phenotypes of contextual factors associated with hyper­tensive ABPM patterns. We will then test the stability of these phenotypes and their ability to predict change in ABPM patterns between Waves 2 and 3.Conclusions: Assessment of ABPM, and the contextual factors influencing ABPM, can identify unique phenotypes of HTN, which can then be used to develop more preci­sion-based approaches to the prevention, detection and treatment of HTN in high-risk populations.Ethn Dis. 2019;29(4):535-544; doi:10.18865/ed.29.4.535

Abstract
Background
Differences in acute COVID-19 associated morbidity based on race, ethnicity, and gender have been well described; however, less is known about differences in subsequent longer term health-related quality of life and well-being.

Methods
This prospective cohort study included symptomatic adults tested for SARS-CoV-2 who completed baseline and 3-month follow-up surveys. Using the PROMIS-29 tool, a validated measure of health and well-being, we compared outcomes at 3 months and change in outcomes from baseline to 3 months among groups with different races, ethnicities, and/or sexes.

Results
Among 6044 participants, 4113 (3202 COVID +) were included. Among COVID + participants, compared to non-Hispanic White participants, Black participants had better PROMIS T-scores for cognitive function (3.6 [1.1, 6.2]) and fatigue (− 4.3 [− 6.6, − 2.0]) at 3 months and experienced more improvement in fatigue over 3 months (− 2.7 [− 4.7, − 0.8]). At 3 months, compared with males, females had worse PROMIS T-scores for cognitive function (− 4.1 [− 5.6, − 2.6]), physical function (− 2.1 [− 3.1, − 1.0]), social participation (− 2.8 [− 4.2, − 1.5]), anxiety (2.8 [1.5, 4.1]), fatigue (5.1 [3.7, 6.4]), and pain interference (2.0 [0.9, 3.2]). Females experienced less improvement in fatigue over 3 months (3.1 [2.0, 4.3]). Transgender/non-binary/other gender participants had worse 3-month scores in all domains except for sleep disturbance and pain interference.

Conclusions
Three months after the initial COVID-19 infection, Black participants reported better cognitive function and fatigue, while females and other gender minoritized groups experienced lower well-being. Future studies are necessary to better understand how and why social constructs, specifically race, ethnicity, and gender, influence differences in COVID-19-related health outcomes.
Trials Registration
ClinicalTrials.gov Identifier: NCT04610515