Awareness, Treatment and Control of Hypertension
among Filipino Americans
Mariano Rey, M.D.
Principal Investigator
July 8-9, 20110
Gaylord National Hotel and Convention Center, Maryland
Overview of Project AsPIRE
(Asian American Partnership in
Research and Empowerment)




Background on Project AsPIRE: Development Process
Descriptive Study
Experimental Study
Future Directions
Project EXPORT P60 Center
CSAAH was founded in 2003 and funded by NIH/NIMHD as a Center of
Excellence dedicated to the research and reduction of health disparities
affecting Asian Americans through research, training, and partnership.
Lead Community Partner:
Mission
Kalusugan Coalition is a multidisciplinary collaboration dedicated to
creating a unified voice to improve the health of the Filipino community in
the NY/NJ area through network development, educational activities,
research, community action, and advocacy.
Project AsPIRE: Overall Goal
To improve the health care access and
CVD health status in the NYC Filipino
American community through
interventions by community health
workers
The Big Picture
Potential funding for 11 years
7th year
3 year
planning
grant
5 year
implementation
grant
3 year
dissemination
grant
Funding by NIH/NIMHD for health
disparities intervention research
Community-Based Participatory Research
(CBPR)
“A collaborative approach to research
that equitably involves all partners in
the research process and recognizes
the unique strengths that each brings”.
--W.K. Kellogg Foundation (2001)
Descriptive Study
What the literature shows:
Filipinos and Hypertension

Heart disease accounted for 33% of all deaths for Filipino
Americans compared to 19% for Vietnamese, 24% for Koreans,
28% for Japanese, and 29% for Chinese.
Ryan et al., 2000

The 2004-2006 National Health Interview Survey showed Filipino
American adults as having the highest HTN prevalence among
Asian Americans at 27%.

NHANES
What the literature shows:
Filipinos and Diabetes

Filipinos had a higher incidence of diabetes (34.7% vs. 24.1%) than
whites.


Filipinos (n=294) had higher prevalence of type 2 diabetes and
metabolic syndrome compared to White women (n=379) [Filipina
women (36.4%), Caucasian women (8.7%)].


Ryan et al., 2000
Araneta et al., 2002
Diabetes is more common among Filipino (n = 268) than in Whites
(n=3164) and other Asian Pacific Islander subgroups (n = 801)
[Filipinos (21.2%), Whites (8.1 %), All Asians combined (12.9%)].

Javier et al., 2007; Gomez et al, 2004.
Who are we targeting:
Filipino Population in NYC & NJ
Total Filipino Population
10,223
New York State:
120,940
New Jersey State: 121,197
5,446
Total NYS & NJS: 242,137
Note: Alone or in Combination
Source: U.S. Census Community
Health Survey, 2008
33,225
NJ - largest population by county
Morris County Essex County Union County Middlesex Bergen County Hudson County -
3,459
8,406
6,313
13,507
15,403
30,066
7,918
5,246
Experimental Study
AsPIRE Screening Data
Sample size: n=1634
Gender: 68% female, 32% male
Geography: NYC (59%), NJ (41%)
Place of birth: 98% born outside of the U.S.
Insurance status: 50% uninsured
Self-perceived health status:
Poor (2%)
Fair (21%)
Good (49%)
Very good (21%)
Excellent (7%)
Hypertension Awareness, Treatment, and
Control (AsPIRE Sample)
Predictors of HTN Awareness
Predicting Awareness of Hypertension
a, b
Final Model
OR
95% C.I.
p-value
Age Range (25-55)
56-65
66-85
2.4
3.7
1.7 – 3.5
2.4 – 5.7
<0.001
<0.001
Self-Reported Health (Excellent/Very good)
Good
Fair/Poor
1.7
2.2
1.1 - 2.4
1.4 - 3.4
<0.01
<0.01
2.1
1.5 - 2.9
<0.001
2.9
2.1 - 4.1
<0.001
High cholesterol diagnosis (No/Don’t know)
Yes
Family History of Hypertension (No/Don’t know)
Yes
a Adjusted
b
for gender
Categories in parentheses are reference groups
Predictors of HTN Treatment
Predicting hypertension treatment a, b
Age Range (25-55)
56-65
66-85
Insurance (Uninsured)
Insured
Years in the U.S. (≤ 5 years)
6-15 years
> 15 years
Smoking (Yes)
No
Diabetes diagnosis (No/Don’t know)
Yes
a
b
Adjusted for gender
Categories in parentheses are reference groups
OR
Final Model
95% C.I.
p-value
3.0
9.7
1.6 - 5.5
3.3 - 28.6
<0.001
<0.001
2.4
1.3 - 4.5
<0.01
1.3
2.6
0.7 - 2.5
1.1 - 5.7
0.37
<0.05
3.2
1.3 - 7.9
<0.05
3.23
1.2 - 9.2
<0.05
Predictors of HTN Control
Predicting controlled hypertension a, b
Final Model
OR
95% C.I.
p-value
56-65
0.4
0.2 - 0.7
<0.01
66-85
0.6
0.3 - 0.9
<0.05
2.1
1.3 - 3.4
<0.01
0.4
0.2 – 0.6
<0.01
Age Range (25-55)
Insurance (Uninsured)
Insured
Diabetes diagnosis (No/Don’t know)
Yes
a Adjusted
b
for gender
Categories in parentheses are reference groups
Single vs. Multi Antihypertensive Drug Use
2 antihypertensive
drugs
20%
3 antihypertensive
drugs
2%
1 antihypertensive
drug
78%
(n=419)
Type of Medication, Single Antihypertensive Drug Therapy
N=317
27.5%
13.5%
27.7%
27.8%
3.9%
Future Directions

States and certain localities should develop surveillance capacity
that would include direct assessment of “awareness, detection,
treatment, and control of obesity, HTN, dyslipidemia, and diabetes.”
Angell SY et al., 2008

Community organizing strategies increase the feasibility of reaching
a large community-based population.

Coalition building and engagement of multiple sectors (faith-based
and community-based organizations, businesses, and health
professional associations), optimize recruitment efforts and provide
mechanisms to refer participants to necessary healthcare resources,
especially to manage and control their HTN.
Future Directions

Findings from CBPR efforts such as this study can provide valuable
information to policy makers and health departments as to how to
address the burden of HTN in similar populations.

Community-based screenings provide an effective means of
increasing HTN awareness.

Behavioral interventions are also critical to improving HTN control.
This presentation was made possible by Grant
Number R24 MD001786 from NIMHD and its
contents are solely the responsibility of the
authors and do not necessarily represent the
official views of the NIMHD.
Acknowledgements
Rhodora Ursua, Project Director
David Aguilar, Project Coordinator
Henry Soliveres, CHW
Romerico Foz, CHW
Leonie Gamboa, CHW
Jay Duller, Research Analyst
Chau Trinh-Shevrin, Academic Partner
Nadia Islam, Academic Partner
Darius Tandon, Academic Partner
Ed Fryer, Biostatistician
Thomas Miyoshi, Biostatistician
Laura Wyatt, Data Manager
Noilyn Abesamis-Mendoza, KC Chair
Ben Ileto, Community Advisor
Josephine Rago-Adia, Community Advisor
Potri Ranka Manis, Community Health Nurse
Patricia Roy, Research Assistant
Mary Grace Centeno, Research Assistant
Denise Kim, Research Assistant
Cinyuki Chung, Research Assistant
Rachel Slutsky, Research Assistant
For more information:
Rhodora Ursua, MPH
Project Director, Project AsPIRE
rhodora.ursua@nyumc.org
(212) 263-3776
Mariano J. Rey, MD
Director, Institute of Community Health and Research
mariano.rey@nyumc.org
(212) 263-0985