Although commonly associated with affluent societies, the majority of hypertensive disease burden falls on the developing world. Haiti is an example of this phenomenon. There are few studies on essential hypertension in Haiti despite hypertension related disease being a major cause of morbidity and mortality. To our knowledge nothing has been published that objectively examines dietary nutrients known to be associated with hypertension in this population.
The prevalence of hypertension and abnormal BMI were estimated via retrospective chart review from the Sante Total Clinic in Jacsonville, Haiti. A pilot study comparing 24 hour urine analysis results of hypertensive and normotensive patients was then conducted at the clinic. The prevalence of hypertension, pre-hypertension, and normotension was 49.7%, 30.6%, and 19.7% respectively. The prevalence of underweight, normal, overweight, and obese individuals was 25.2%, 64.7%, 11.9% and 2.8% respectively. The average 24 hour urine excretion of sodium and potassium, and estimated dietary protein were 169mmol, 29.0mmol, and 31.17g respectively for hypertensives, and 148.9mmol, 26.9mmol, and 26.95g for normotensives. This translates to daily sodium consumption that is twice the recommended level for African Americans and potassium intake of only 25% of recommended amounts. No significant differences were observed between groups for any 24HUA nutrient, which may be due to the small sample size (n=37).
Conclusion:
There is a high prevalence of hypertension in the rural community of Jacsonville, Haiti despite a low prevalence of excess weight and a high level of physical activity. 24 hour urine data suggests a diet that is high in sodium, and low in potassium and protein, which are associated with hypertension.
Hypertension and Genetics:
APOL1 is a gene and certain alleles are known to be associated with various forms of renal disease particularly focal segmental glomerular sclerosis, but also hypertensive, diabetic, and HIV associated nephropathy. These same alleles also seem to be protective against certain Trypanosome parasite infections. APOL1 alleles associated with renal disease are found in higher frequencies amongst peoples of African descent, particularly those from countries along the Atlantic slave trade routes. We collected buccal mucosa swabs for sequencing and calculated APOL1 allele frequency in the Jacsonville population. We found risk allele frequencies of about 38% which is comparable with those seen in African populations and higher than those in African Americans. We are investigating if there is association between these alleles and the high prevalence of HTN seen in Haiti.}
