DETERMINANTS OF HYPERTENSION TREATMENT IN FIRST-GENERATION CHINESE IMMIGRANTS

Objective: Hypertension is one of the most challenging public health issues worldwide and reported as the leading risk factor for both cardiovascular death and hospitalizations. However, the blood pressure (BP) control is poor, and the treatment rate of hypertension is often low among migrant populations. The aim of this study was to assess determinants of hypertension treatment in a cohort of first-generation Chinese immigrants in Italy. Design and method: Population-based, cross-sectional study. Chinese first-generation immigrants underwent BP measurement, blood tests (fasting glucose, FG, and total cholesterol, TC), and anthropometric measurements. Hypertension was diagnosed for BP>140/90 mmHg at 2 visits, and/or BP-lowering medication use; type 2 diabetes (T2DM) for FG>126 mg/dL at 2 visits, and/or glucose lowering drugs use; hypercholesterolemia for TC>240 mg/dL and/or statins use. Other categorized features were age, sex, central obesity, education level, current smoking, health insurance (full registration or not with the National Health Service, NHS), and time spent in Italy since migration (years of residence in Italy) stratified in quartiles. The proportions of participants with hypertension, who were aware of their condition (among those diagnosed), and receiving specific treatment (among those aware), were calculated. Determinants of hypertension treatment (dependent variable) were investigated at multivariable logistic regression analysis. Results: 3435 first-generation Chinese immigrants were enrolled (39.7% male, age 46±11 years). Among the whole cohort, 958 patients (27.9%) were diagnosed with hypertension. 595 (62.1% of hypertensive subjects) were aware of their condition. Among those who were aware, the treatment rate was 81.2% (n=483). Registration with the NHS was associated with increased hypertension awareness, the chance for hypertensive subjects to receive pharmacological treatment being not affected. Conversely, being treated for hypertension was positively associated with age and with T2DM diagnosis. In particular, the chance for hypertensive subjects to receive pharmacological treatment was almost 3 times higher if T2DM was associated (OR 2.8, 1.9-4.0). Conclusions: Hypertension is a relevant condition among Chinese immigrants, and a large subgroup appears to be unaware and untreated. Health policies targeting this hard-to-reach population must be improved.