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J. E. Winters, K. M. Daum; History vs. Clinical Findings Relating to Hypertension and Glaucoma Diagnosis Among African Americans in Rural and Urban Settings. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3992.
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The prevalence of hypertension (htn) and glaucoma (glc) have been shown to be higher in African-Americans (AA) than in other races. Since these conditions are typically asymptomatic, AA patients may not be aware of onset. Clinicians may rely on patient history in assessing risk for these and associated conditions. We hypothesized that independent of their prior knowledge of their condition low-income African-Americans (AA) would be diagnosed as glc suspects or have elevated blood pressure (bp). We also hypothesized that cultural factors associated with life in an urban or rural setting may influence these findings.
The Rural Alabama Diabetes and Glaucoma Initiative completed vision care projects low-income people in rural Alabama (rural). The Vision of Hope Health Alliance provided comprehensive vision care to low-income, uninsured persons in urban Chicago, Illinois (urban). Personal and family history of glc and htn were self-reported by patients. Retrospective record review was performed. Bp was evaluated using Joint National Commission of Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII).
From an overall total of 7030 (urban = 4029 and rural = 3001), 4028 patients identified their ethnicity as AA (urban = 1822 (45.2%); rural = 2386 (79.5%). Mean age was 45.3 (SD 16.3). There were 2737 (65.1%) females examined. 501 were diagnosed as glc/ glc suspect (306 (17%) from the urban clinic and 195 (8%) from rural). Of those only 195 (38.9%) reported a personal or family history of glc (111 (36.5%) from the urban clinic and 67(15.8%) from the rural). Consequently 61% were diagnosed without previous history. Similarly of those without report of htn (n= 856 urban; 1290 rural), bp was elevated in 721 (33.6%) (233 (27.2%) from the urban clinic and 488 (37.8%) from rural).
Independent of clinic setting, glc/glc suspect and htn were present in substantial numbers in those not reporting those conditions. Self- report history of glc or htn were inconsistently related to clinical findings upon examination. Cultural influences possibly related to living in a rural or urban setting may also influence results. These findings illustrate the importance of diagnostic testing to rule out glc and htn in AA.
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