Immigration Emergency in Italy: The Impact of Socioeconomic Status on Blood Pressure Levels and Control

Introduction Nowadays there are more than 5 millions of immigrants (8.3% of general adult population) in Italy. Aim To evaluate the potential impact of immigration and the possession of a permanent residence on blood pressure (BP) levels and control in a low income population of immigrants from different countries. Methods We evaluated clinical characteristics and social status of adult individuals with known diagnosis of hypertension afferent to the Poliambulatorio della Caritas Diocesana in Rome, Italy, between 2010-2016. Subjects were stratified according to their macro-areas of origin (Europe, Asia, Africa, South-America), housing (with or without house), and immigration status (presence or absence of residence permit). BP levels were measured in three consecutive visits according to recommendations from current European Guidelines. Results From an overall population sample of 9827 adult individuals, we initially identified 994 patients with a diagnosis of hypertension (10.1%), among whom 536 (5.4%) had valid BP data. Among these, 50.6% came from Europe, 21.6% from Africa, 24.1% from Asia, and 3.7% from South-America. They were predominantly male (54.7%), middle aged (42.8 +/- 12.1 years at arrival and 51.6 +/- 10.6 years at first visit) and untreated (72.8%) individuals with baseline systolic/diastolic BP levels of 156.9 +/- 22.2/97.3 +/- 12.4 mmHg). BP levels remained higher in homeless than in housed people at both visit 2 (150.0 +/- 21.8/92.6 +/- 12.9 mmHg vs. 142.9 +/- 19.3/89.9 +/- 11.6 mmHg; P < 0.001) and visit 3 (147.9 +/- 22.2/91.7 +/- 12.5 mmHg vs. 141.8 +/- 19.4/89.2 +/- 12.0 mmHg; P = 0.013). We also observed reductions of both systolic and diastolic BP levels compared to baseline values in immigrants stratified according to residence permit, although without relevant differences among groups. Conclusions Beyond conventional risk factors, socio-economic issues, including lack of residence permit or habitation, may affect BP levels and control in frail populations of immigrants, which have been marginally considered before.