Title : Are hypertension prevalence and control different between community types in La Romana, Dominican Republic?
Abstract:
Hypertension (HTN) is a major contributor to cardiovascular disease, the leading cause of death in the Dominican Republic (DR). Undiagnosed and inadequately treated HTN is particularly common among underserved populations, such as those living in bateyes and barrios, who often face limited access to healthcare. Bateyes, originally formed around sugarcane plantations, are home to many undocumented Haitian migrant workers and Dominicans of Haitian descent. As bateyes grow, improve infrastructure, and gain resources, they may evolve into semi-urban barrios. While studies have documented a high prevalence of HTN (57.8%) in these areas, research comparing health between bateyes and barrios remains limited. This study aimed to compare the prevalence of HTN, treatment patterns, and blood pressure (BP) control among adult residents of bateyes versus barrios in La Romana, DR. We conducted a retrospective chart review of patients aged ≥18 years who attended mobile medical clinics in July 2024. Collected variables included demographics (age, sex), vital signs (height, weight, BP), prior diagnosis of HTN, and medications prescribed at discharge. Elevated BP was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg. Descriptive statistics were used to summarize the data. Chi-square tests were performed to compare the prevalence of HTN, number of antihypertensive medications prescribed, and frequency of elevated BP readings between bateyes and barrios. Univariate ANOVA was used to compare systolic and diastolic BP between the two community types, controlling for age and body mass index (BMI). A total of 427 patients were identified, with 196 (66.3% female) from bateyes and 231 (80.0% female) from barrios. The mean age was similar between communities (batey: 45.75 ± 17.35 years; barrio: 46.02 ± 17.01 years). Average BMI was slightly lower in batey patients (25.79 ± 5.22) compared to barrio patients (27.29 ± 5.37). A prior diagnosis of HTN was present in 60 (30.6%) batey patients and 78 (33.8%) barrio patients. Mean systolic BP was nearly identical between groups (batey: 133.32 ± 24.23 mmHg; barrio: 133.29 ± 22.83 mmHg), as was mean diastolic BP (batey: 87.19 ± 13.66 mmHg; barrio: 86.85 ± 13.17 mmHg). Elevated BP readings were recorded in 94 (48.0%) batey patients and 115 (49.8%) barrio patients. 63 batey patients were prescribed antihypertensive medications (56 on one, 6 on two, and 1 on three), while 74 barrio patients were treated (48 on one, 25 on two, and 1 on three). There were no statistically significant differences between batey and barrio populations across all measured variables. Although HTN cannot be diagnosed with a single measurement, nearly half of patients in both community types had an elevated BP reading, suggesting poor control. While barrios are often presumed to have better access to healthcare resources and higher socioeconomic status, our data suggests similar healthcare gaps among both. Clinically, these results emphasize the need for enhanced screening efforts, more frequent BP monitoring, improved continuity of care, and patient education on medication adherence and lifestyle modifications. Addressing these gaps across both settings is critical to reducing cardiovascular risk and improving long-term health outcomes in these vulnerable populations.
