Predictors of risk and protection for hypertension in Yup'ik people from Southwest Alaska.

Hypertension (HTN) contributes to vascular disease, and is increasingly common in non-western, rural contexts, such as the Yup'ik people of Southwestern Alaska. While much is known regarding HTN risk factors in western contexts, little is known about their relevance to non-western populations. We explore an American Heart Association risk factor model for HTN in predicting risk and protection from HTN among Yup'ik people. Using data from 1015 Yup'ik individuals residing in remote Southwestern Alaska, we explore age, sex, education, waist circumference, physical activity, tobacco, social support, and cultural identification in multinomial logistic regressions comparing pre-hypertension (pre-HTN; systolic 120 to 129 mm Hg), and hypertension (HTN; systolic > or = 130 mm Hg) to optimal blood pressure (opt-BP; systolic < 120 mm Hg). We find positive associations between age (2%, 5% greater odds respectively), waist circumference (3%, 5% greater odds respectively) and hypertension medication usage (60%, 85% greater odds respectively) with both pre-HTN and HTN. We also find men have 86% greater odds of pre-HTN, people with fasting blood glucose > or = 110 mg/dL have 52% increased odds of pre-HTN, and married persons have 19% lower odds of having pre-HTN compared to having opt-BP. Bicultural identification mitigates age related increases in BP and deleterious effects of low formal education. While model continuities are noted in our Yup'ik study, important points of divergence are also noted. Future research on cultural identification and social support has promising implications for guiding responsive interventions.