Med Student Finds ‘Alarmingly’ High Rates of Hypertension in Haiti

Hypertension affects 30.5 percent of the 572 study participants and is far more common among women (40.6 percent) than men (23.4 percent).

“These data indicate an alarmingly high prevalence of hypertension,” despite very little use of alcohol and tobacco, notes Polsinelli, whose mentor is David M. Holmes, MD, clinical associate professor of family medicine.

Polsinelli won a $4,000 2014 summer fellowship from The Arnold P. Gold Foundation — one of 41 awardees nationwide — to conduct the 10-week project. He also received a UB Glasauer Travel Fellowship.

The study — the first known cross-sectional analysis of its kind — also revealed that many participants did not know they had hypertension or were not being treated for it.

Among those with hypertension:

• 62.2 percent of men and 47 percent of women were unaware of their condition
• 57.8 percent of men and 56 percent of women were not on medication for the condition
• 71.1 percent of men and 74.2 percent of women did not have controlled blood pressure of less than 140/90 mmHg                    

“Our work will identify patients requiring care and guide them to intervention before complications manifest,” notes Polsinelli, who presented his preliminary findings at UB in August.

Uncontrolled hypertension can lead to serious adverse outcomes, including coronary heart disease, stroke and chronic kidney disease. 

“The health system is already very fragile and not built to handle the complicated adverse events associated with cardiovascular disease,” says Polsinelli. In fact, the nation of Haiti lacks even one cardiac surgeon, he adds.

As a first-year medical student, Polsinelli organized a UB medical relief trip to Fontaine.

Eleven students, including Polsinelli, worked alongside UB family medicine faculty in makeshift clinics, immersing themselves in the culture — and the myriad health care challenges — of the developing world.

Hypertension was the No. 1 diagnosis or symptom, affecting 284 adults, or more than half of the group’s patients over age 20.

Although the large number of elderly patients affected these results, “the trip reaffirmed the need for a cross-sectional survey,” notes Polsinelli.

Among his Haitian friends and colleagues, Polsinelli would hear anecdotes about people who die suddenly in their 40s. Through conversations with clinicians in Haiti, he learned that high blood pressure is a major health problem there. 

So Polsinelli embarked on a long-term goal: to formally assess the prevalence of hypertension throughout the community, identify risk factors and begin working toward prevention.

“I hope our results provide the medical community with information to facilitate preventive public health measures and help Haitians take leadership in their own care,” he says.

To involve the community, Polsinelli engaged local residents in the project and worked with Pierre-Louis Joizil, a community leader and educator in Fontaine.

Polsinelli trained and managed five paid research assistants who “proudly became health advocates and community educators,” he says.

They went door-to-door conducting surveys written in Creole and English — a modified version of the World Health Organization’s STEPS chronic disease surveillance instrument — to assess lifestyle habits such as alcohol and tobacco use, diet and physical activity.

The research assistants also gathered physical data including height, weight, waist and hip measurements and blood pressure.

Polsinelli has been building collaborations with the people in this medically underserved township since 2012. As an undergraduate at Siena College in Albany, he became involved with the nonprofit Friends of Fontaine, eventually serving on its board.

He has traveled to this isolated community of about 10,000 several times, leading or organizing efforts to teach English and make needed improvements to a local school building.

“The strong relationship I had already developed with this community was an absolute necessity to the project’s success,” Polsinelli adds.

Polsinelli and his team adapted their work to the cultural nuances of the community.

When they found women were overrepresented in the study sample, the researchers varied their schedules to include afternoon visits, when men would more likely be home after working in the fields.

The data on salt intake that the researchers gathered accounted for the use of “aran sel,” pre-salted herring sold in local markets.

They assessed economic status in part by the number and type of livestock owned.

To further analyze and organize data from the survey, Polsinelli has been working with the Department of Family Medicine's Primary Care Research Institute and Ranjit Singh, MB BChir, MBA, associate professor of family medicine and vice chair for research.

He sees the results as just a starting point.

“This project offers great opportunities for future research and interventions in this community,” Polsinelli says.

“Further study will need to address the prevalence of consequences of hypertension — such as coronary artery disease, stroke and renal disease — and the most effective treatment of hypertension in this culture, such as specific medications or dietary and lifestyle changes,” notes Holmes.

Polsinelli has been honored with a Primary Care Career Track Award from the Department of Family Medicine.

The federally funded program supports medical students who plan to pursue a primary care discipline, many of whom take on leadership roles. It comes with mentorship and up to $3,000 per year for enrichment activities in the United States, including clinical and research experiences targeting underserved patients.

No matter where he eventually practices, Polsinelli’s work in Haiti has underscored the importance of building one-on-one relationships with individual patients. 

“People trusted me to help them improve their health, and I was humbled when I saw their progress,” he says, recalling inspiring moments when he was able to assist patients in a meaningful way.

“As a physician, I will probably not eradicate any disease or make massive widespread improvements in health infrastructure, but I know if I care for each of my patients, I can make a difference in their lives,” he says.

Holmes directs global health education for UB’s family medicine department, facilitating a variety of experiences for medical students and graduate trainees who want to work with patients in medically underserved areas of the world or with refugees in Buffalo.

He also oversees the department’s focused global health scholars track for select residents.