Risk Factors for Hypertension among a Church-based, Black Population in London
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Abstract
Compared to other ethnic groups, there is an increased prevalence of hypertension, and subsequent morbidity and mortality, among people of African descent residing in the United Kingdom. We studied a group of people of African descent living in London to examine the impact of their lifestyle on hypertension. A cross-sectional study, using a convenience sample of individuals aged 25-79 from 17 predominantly Black Seventh-day Adventist churches across London. Linear regressions were run between the main variables of RR score for hypertension and blood pressure levels. Hypertension was more prevalent among males (34%) than females (21.6%). Relative Risk Estimates for hypertension were predictive of diastolic blood pressure (p<.05). The blood pressure levels among the participants in this study were lower than Caribbean-born Blacks but higher than African-born Blacks in the national UK data for minorities. For this church-based group education concerning health practices did not significantly impact their moving towards lifestyles that decreased HTN risk. Behavior change, therefore, must be the focus of future interventions.
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References
Agyemang, C., & Bhopal, R. (2003). Is the blood pressure of people from African origin adults in the UK higher or lower than that in European origin white people? A review of cross-sectional data. Journal of Human Hypertension, 17, 523-534.
Appleby, P. N., Davey, K. D., & Key, T. J. (2002). Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford. Public Health Nutrition, 5, 645-654.
Bedi, M., Varshey, V. P., & Babbar, R. (2000). Role of cardiovascular reactivity to mental stress in predicting future hypertension. Clinical and Experimental Hypertension, 22, 1-22.
Berkow, S. E., & Bernard, N. D. (2005). Blood pressure regulation and vegetarian diets. Nutrition Reviews, 63, 1-8.
Bernaards, C. M., Twisk, J. W., Snel, J., van Mechelen, W., & Kemper, H. C. (2005). In a prospective study in young people, associations between changes in smoking behavior and risk factors for cardiovascular disease were complex. Journal of Clinical Epidemiology, 58, 1165-1171.
Bierhaus, A., Humpert, P. M., & Nawroth, P. P. (2004). NF-KB as a molecular link between psychosocial stress and organ dysfunction. Pediatirc Nephrology, 19, 1189-1191.
Brookes, L. (2005). Hypertension highlights: Significant new definitions, publication, risks, benefits—and gene therapy? Medscape Cardiology, 9(2). Retrieved March 10, 2006, from http://www.medscape.com/ viewarticle/514644
Champion, V. L. (1984). Instrument development for health belief model constructs. Advances in Nursing Science, 6, 73-85.
Cohen, S., Kamarck, T., Mermelstein, R. (1983). A global measure of perceived stress.
Colditz, G. A., Atwood, K. A, Emmons, K., Monson, R. R., Willet, W. C., Trichopoulos, D. et al. (2000). Harvard report on cancer prevention volume 4: Harvard cancer risk index. Cancer Causes and Control, 11, 477-488.
Department of Health.(1999). Saving lives: Our healthier nation. The Stationary Office.
Desmond, S., Price, J., Roberts, S., Pituch, M., & Smith, D. (1992). Perception of hypertension in Black and White adolescents. The Journal of Health Behavior, Education & Promotion, 16, 3-10.
DeStefano, A. L., Gavras, H., Heard-Costa, N., Bursztyn, M, Manolis, A., Farrer, L. A., et al. (2001). Maternal component in the familial aggregation of hypertension. Clinical Genetics, 60, 13-21.
Dong, Y., Zhu, H., Sagnella, G. A., Carter, N. D., Cook, D. G., & Cappiccio, F. P. (1999). Association between the C825T polymorphism of the G protein b3-subunit Gene and hypertension in blacks. Hypertension, 34, 1193-1196.
El-Atat, F., Aneja, A., McFarlane, S.,& Sowers, J. (2003). Obesity and hypertension. Endocrinology and Metabolism Clinics of North America, 32, 823-854.
Fønnebø, V. (1994). The healthy Seventh-day Adventist lifestyle: What is the Norwegian experience? American Journal of Clinical Nutrition, 59, 1124S-1129S.
Fraser, G. E. (1994). Diet and coronary heart disease: Beyond dietary fats and low-density-lipoprotein cholesterol. American Journal of Clinical Nutrition, 59, 1117S-1123S.
Fraser, G. E. (1999). Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. American Journal of Clinical Nutrition, 70, 532S-538S.
Fraser, G. E. (1999). Diet and primordial prevention in Seventh-day Adventists. Preventive Medicine, 29, S18-S23.
Goldberg, G. (2003). FLAIR-FLOW 4: Synthesis report on obesity for health professionals. Nutrition Bulletin, 28, 343-354.
Hajat, C., Tilling, K., Stewart, J. A., Lemic-Stojcevic, N., & Wolfe, C. D. (2004). Ethnic differences in risk factors for ischemic stroke: A European case-control study. Stroke, 35,
He, F. J., & MacGregor, G. A. (2009). A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. Journal of human hypertension, 23(6), 363-384.
Henderson, L., Gregory, J., & Swan, G. (2002). National diet and nutrition survey: Adults aged 19 to 64 years. Vol. 1: Types and quantities of foods consumed. London: The Stationary Office.
Higginbottom, G. M. (2006). ‘Pressure of life’: Ethnicity as a mediation factor in mid-life and older peoples’ experience of high blood pressure. Sociology of Health & Illness, 28, 583-610.
Hooper, L., Bartlett, C., Davey Smith, G. & Ebrahim. (2004). Advice to reduce dietary salt for prevention of cardiovascular disease. The Cochrane Database of Systematic Reviews, 1, CD003656.pub2. DOI:10.1002/14651858.pub2.
Jackson E. M., & Dishman, R. K. (2002). Hemodynamic responses to stress among black women: Fitness and parental hypertension. Medicine & Science in Sports & Exercise, 34, 1097-1104.
John, J. H., Ziebland, S., Yudkin, P., Roe, L. S., & Neil, H. A. W. (2002). Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: A randomized controlled trial. The Lancet, 359, 1969-1974.
Kaplan, N. M. (2004). Hypertension curriculum review: Lifestyle modifications for prevention and treatment of hypertension. Journal of Clinical Hypertension (Greenwich), 6, 716-719.
Khan, J. M., & Beevers, D. G. (2005). Management of hypertension in ethnic minorities. Heart, 91, 1105-1109.
Lane, D. A., & Lip, G. Y. H. (2001). Ethic differences in hypertension and blood pressure control in the UK. QJM: An International Journal of Medicine, 94, 391-396.
Lee, K. S., Park, C. Y., Meng, K. H., Bush, A., Lee, S. H., Lee, W. C., et al. (1998). The association of cigarette smoking and alcohol consumption with other cardiovascular risk factors in men from Seoul, Korea. Annals of Epidemiology, 8, 31-38.
Lemic-Stojcevic, N., Dundas, R., Jenkins, S., Rudd, A., & Wolfe, C. (2001). Preventable risk factors for coronary heart disease and stroke amongst ethnic groups in London. Ethnicity & Health, 6, 87-94.
Lip, G., Barnett, A. H., Bradbury, A., Cappuccio, F. P., Gill, P. S., Hughes E et al. (2007). Ethnicity and cardiovascular disease prevention in the United Kingdom: A practical approach to management. Journal of Human Hypertension 21, 183-211.
Lopes, H. F., Bortolotto, L. A., Szlejf, C., Kamitsuji, C. S., & Krieger, E. M. (2001). Hemodynamic and metabolic profile in offspring of malignant hypertensive parents. Hyptertension, 38, 616-620.
Malinski, M. K., Sesso, H. D., Lopez-Jimenez, F., Buring, J. E., & Gaziano, J. M. (2004). Alcohol consumption and cardiovascular disease mortality in hypertensive men. Archives of Internal Medicine, 164, 623-628. Mead, M. (2004). British Hypertension Society guidelines 2004-BHS IV. Ten key comments for primary care. British Journal of Cardiology, 11, 246-250. Retrieved November 16, 2004, from http://www.bjcardio. co.uk/pdf/950Vol11_Num3_May-June_2004_p246-250.pdf
Montgomery. S., Herring, P., Yancey, A., Beeson, L., Butler, T., Knutsen S, et al. (2007). Comparing self-reported disease outcomes, diet, and lifestyles in a national cohort of Black and White Seventh-day Adventists. Preventing Chronic Disease [serial online] Retrieved October 14, 2008, from http://www.cdc.gov/pcd/ issues/2007/jul/06/06_0103.htm.
Nanchahal, K., Ashdon, W. D., Wood, D. A. (2000). Alcohol consumption, metabolic cardiovascular risk factors and hypertension in women. International Journal of Epidemiology, 29, 57-64.
National Centre for Social Research. (2005) Health survey for England 2004: Volume 1: The health of minority ethnic groups. Retrieved Jan 28, 2008, from http://www.ic.nhs.uk/webfiles/publications/healthsurvey2004ethnicfull/HealthSurveyforEnglandVol1_210406_PDF.pdf.
National Health Services. (2005). Health survey for England 2004: The health of minority ethnic groups-Headline tables. Health and Social Care Information Centre.
Nazroo, J. Y. (2001). Ethnicity, class and health. London. Policy Studies Institute.
Ohmori, S., Kiyohara, Y., Kato, I., Kubo, M., Tanizaki, Y., Iwamoto, H et al. (2002). Alcohol intake and future incidence of hypertension in a general Japanese population: The Hisayama study. Alcoholism, Clinical and Experimental Research; 26, 1010-1016.
Onal, A. E., Erbil, S., Ozel, S., Aciksari, K., & Tumerdem, Y. (2004). The prevalence of risk factors for hypertension in adults living in Istanbul. Blood Pressure, 13, 31-36.
Padilla, J., Wallace, J. P., & Park S. (2005). Accumulation of physical activity reduces blood pressure in pre-and hypertensives. [Electronic version] Medicine and Science in Sports & Exercise, 1264-1275. Retrieved March 10, 2006, from http://www.acsm-msse.org
Pausova, Z. (2006). From big fat cells to high blood pressure: Obesity-associated hypertension. Current Opinion in Nephrology and Hypertension, 15, 173-178.
Pescatello, L. S., Franklin, B. A., Fagard, R., Farquhar, W. B., Kelley, G. A., & Ray, C. A. (2004). American College of Sports Medicine position stand. Exercise and hypertension. Medicine and Science in Sports and Exercise, 36, 533-553.
Plante, G. E. (2002). Vascular response to stress in health and disease. Metabolism, 51, Suppl 1, 25-30.
Player, M. S., & Peterson, L. E. (2011). Anxiety disorders, hypertension, and cardiovascular risk: a review. The International Journal of Psychiatry in Medicine, 41(4), 365-377.
Desmond, S. M., Price, J. H., Roberts, S. M., & Pituch, M. J. (1992). Perceptions of hypertension in Black and White adolescents. Health Values: The Journal of Health Behavior, Education & Promotion.
Schwartz, A. R., Gerin, W., Davidson,. K. W., Pickering, T. G., Brosschot, J. F., & Thayer, J. F. (2003). Toward a causal model of cardiovascular responses to stress and the development of cardiovascular disease. Psychosomatic Medicine, 65, 22-35. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. Your Disease Risk: Relative Risks. Retrieved October 14, 2007, from http://www.yourdiseaserisk.wustl.edu/ pdf_files/rr_ydr.pdf.
Stein, M. C., Lang, C. C., Singh, I., He H. B., & Wood A. J. J. (2000). Increased vascular adrenergic vasoconstriction and decreased vasodilation in Blacks: Additive mechanisms leading to enhanced vascular reactivity. Hypertension; 36, 945-951.
Swift, P. A., Markandu, N. D., Sagnella, G. A., He, F. J., & MacGregor, G. A. (2005). Modest salt reduction reduces blood pressure and urine protein excretion in Black hypertensives: A randomized control trial. Hypertension; 6, 308-312.
Tomson, J., & Lip, G. Y. H. (2006). Alcohol and hypertension: An old relationship revisited. Alcohol & Alcoholism, 41, 3-4.
Townes, E. M. (1998). Breaking the fine rain of death. New York: Continuum Publishing Company.
Twisk, J. W. R., Kemper, H. C. G., Van Mechelen, W., & Bertheke Post, G. (2001). AEP, 11,
Wolfe, C. (2002). IS10: The incidence, natural history, resource use, and outcome of stroke [1 of 2]. Retrieved November 16, 2004, from http://www.dh.gov.uk/PolicyAndGuidance/ResearchAndDevelopment/Re searchAndDevelopmentAZ/CardiovascularDiseaseAndStroke/CardiovascularDiseaseAndStrokeArticle/fs/en?CONTENT_ID=4001897&chk=8uIeVM
Appleby, P. N., Davey, K. D., & Key, T. J. (2002). Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford. Public Health Nutrition, 5, 645-654.
Bedi, M., Varshey, V. P., & Babbar, R. (2000). Role of cardiovascular reactivity to mental stress in predicting future hypertension. Clinical and Experimental Hypertension, 22, 1-22.
Berkow, S. E., & Bernard, N. D. (2005). Blood pressure regulation and vegetarian diets. Nutrition Reviews, 63, 1-8.
Bernaards, C. M., Twisk, J. W., Snel, J., van Mechelen, W., & Kemper, H. C. (2005). In a prospective study in young people, associations between changes in smoking behavior and risk factors for cardiovascular disease were complex. Journal of Clinical Epidemiology, 58, 1165-1171.
Bierhaus, A., Humpert, P. M., & Nawroth, P. P. (2004). NF-KB as a molecular link between psychosocial stress and organ dysfunction. Pediatirc Nephrology, 19, 1189-1191.
Brookes, L. (2005). Hypertension highlights: Significant new definitions, publication, risks, benefits—and gene therapy? Medscape Cardiology, 9(2). Retrieved March 10, 2006, from http://www.medscape.com/ viewarticle/514644
Champion, V. L. (1984). Instrument development for health belief model constructs. Advances in Nursing Science, 6, 73-85.
Cohen, S., Kamarck, T., Mermelstein, R. (1983). A global measure of perceived stress.
Colditz, G. A., Atwood, K. A, Emmons, K., Monson, R. R., Willet, W. C., Trichopoulos, D. et al. (2000). Harvard report on cancer prevention volume 4: Harvard cancer risk index. Cancer Causes and Control, 11, 477-488.
Department of Health.(1999). Saving lives: Our healthier nation. The Stationary Office.
Desmond, S., Price, J., Roberts, S., Pituch, M., & Smith, D. (1992). Perception of hypertension in Black and White adolescents. The Journal of Health Behavior, Education & Promotion, 16, 3-10.
DeStefano, A. L., Gavras, H., Heard-Costa, N., Bursztyn, M, Manolis, A., Farrer, L. A., et al. (2001). Maternal component in the familial aggregation of hypertension. Clinical Genetics, 60, 13-21.
Dong, Y., Zhu, H., Sagnella, G. A., Carter, N. D., Cook, D. G., & Cappiccio, F. P. (1999). Association between the C825T polymorphism of the G protein b3-subunit Gene and hypertension in blacks. Hypertension, 34, 1193-1196.
El-Atat, F., Aneja, A., McFarlane, S.,& Sowers, J. (2003). Obesity and hypertension. Endocrinology and Metabolism Clinics of North America, 32, 823-854.
Fønnebø, V. (1994). The healthy Seventh-day Adventist lifestyle: What is the Norwegian experience? American Journal of Clinical Nutrition, 59, 1124S-1129S.
Fraser, G. E. (1994). Diet and coronary heart disease: Beyond dietary fats and low-density-lipoprotein cholesterol. American Journal of Clinical Nutrition, 59, 1117S-1123S.
Fraser, G. E. (1999). Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. American Journal of Clinical Nutrition, 70, 532S-538S.
Fraser, G. E. (1999). Diet and primordial prevention in Seventh-day Adventists. Preventive Medicine, 29, S18-S23.
Goldberg, G. (2003). FLAIR-FLOW 4: Synthesis report on obesity for health professionals. Nutrition Bulletin, 28, 343-354.
Hajat, C., Tilling, K., Stewart, J. A., Lemic-Stojcevic, N., & Wolfe, C. D. (2004). Ethnic differences in risk factors for ischemic stroke: A European case-control study. Stroke, 35,
He, F. J., & MacGregor, G. A. (2009). A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. Journal of human hypertension, 23(6), 363-384.
Henderson, L., Gregory, J., & Swan, G. (2002). National diet and nutrition survey: Adults aged 19 to 64 years. Vol. 1: Types and quantities of foods consumed. London: The Stationary Office.
Higginbottom, G. M. (2006). ‘Pressure of life’: Ethnicity as a mediation factor in mid-life and older peoples’ experience of high blood pressure. Sociology of Health & Illness, 28, 583-610.
Hooper, L., Bartlett, C., Davey Smith, G. & Ebrahim. (2004). Advice to reduce dietary salt for prevention of cardiovascular disease. The Cochrane Database of Systematic Reviews, 1, CD003656.pub2. DOI:10.1002/14651858.pub2.
Jackson E. M., & Dishman, R. K. (2002). Hemodynamic responses to stress among black women: Fitness and parental hypertension. Medicine & Science in Sports & Exercise, 34, 1097-1104.
John, J. H., Ziebland, S., Yudkin, P., Roe, L. S., & Neil, H. A. W. (2002). Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: A randomized controlled trial. The Lancet, 359, 1969-1974.
Kaplan, N. M. (2004). Hypertension curriculum review: Lifestyle modifications for prevention and treatment of hypertension. Journal of Clinical Hypertension (Greenwich), 6, 716-719.
Khan, J. M., & Beevers, D. G. (2005). Management of hypertension in ethnic minorities. Heart, 91, 1105-1109.
Lane, D. A., & Lip, G. Y. H. (2001). Ethic differences in hypertension and blood pressure control in the UK. QJM: An International Journal of Medicine, 94, 391-396.
Lee, K. S., Park, C. Y., Meng, K. H., Bush, A., Lee, S. H., Lee, W. C., et al. (1998). The association of cigarette smoking and alcohol consumption with other cardiovascular risk factors in men from Seoul, Korea. Annals of Epidemiology, 8, 31-38.
Lemic-Stojcevic, N., Dundas, R., Jenkins, S., Rudd, A., & Wolfe, C. (2001). Preventable risk factors for coronary heart disease and stroke amongst ethnic groups in London. Ethnicity & Health, 6, 87-94.
Lip, G., Barnett, A. H., Bradbury, A., Cappuccio, F. P., Gill, P. S., Hughes E et al. (2007). Ethnicity and cardiovascular disease prevention in the United Kingdom: A practical approach to management. Journal of Human Hypertension 21, 183-211.
Lopes, H. F., Bortolotto, L. A., Szlejf, C., Kamitsuji, C. S., & Krieger, E. M. (2001). Hemodynamic and metabolic profile in offspring of malignant hypertensive parents. Hyptertension, 38, 616-620.
Malinski, M. K., Sesso, H. D., Lopez-Jimenez, F., Buring, J. E., & Gaziano, J. M. (2004). Alcohol consumption and cardiovascular disease mortality in hypertensive men. Archives of Internal Medicine, 164, 623-628. Mead, M. (2004). British Hypertension Society guidelines 2004-BHS IV. Ten key comments for primary care. British Journal of Cardiology, 11, 246-250. Retrieved November 16, 2004, from http://www.bjcardio. co.uk/pdf/950Vol11_Num3_May-June_2004_p246-250.pdf
Montgomery. S., Herring, P., Yancey, A., Beeson, L., Butler, T., Knutsen S, et al. (2007). Comparing self-reported disease outcomes, diet, and lifestyles in a national cohort of Black and White Seventh-day Adventists. Preventing Chronic Disease [serial online] Retrieved October 14, 2008, from http://www.cdc.gov/pcd/ issues/2007/jul/06/06_0103.htm.
Nanchahal, K., Ashdon, W. D., Wood, D. A. (2000). Alcohol consumption, metabolic cardiovascular risk factors and hypertension in women. International Journal of Epidemiology, 29, 57-64.
National Centre for Social Research. (2005) Health survey for England 2004: Volume 1: The health of minority ethnic groups. Retrieved Jan 28, 2008, from http://www.ic.nhs.uk/webfiles/publications/healthsurvey2004ethnicfull/HealthSurveyforEnglandVol1_210406_PDF.pdf.
National Health Services. (2005). Health survey for England 2004: The health of minority ethnic groups-Headline tables. Health and Social Care Information Centre.
Nazroo, J. Y. (2001). Ethnicity, class and health. London. Policy Studies Institute.
Ohmori, S., Kiyohara, Y., Kato, I., Kubo, M., Tanizaki, Y., Iwamoto, H et al. (2002). Alcohol intake and future incidence of hypertension in a general Japanese population: The Hisayama study. Alcoholism, Clinical and Experimental Research; 26, 1010-1016.
Onal, A. E., Erbil, S., Ozel, S., Aciksari, K., & Tumerdem, Y. (2004). The prevalence of risk factors for hypertension in adults living in Istanbul. Blood Pressure, 13, 31-36.
Padilla, J., Wallace, J. P., & Park S. (2005). Accumulation of physical activity reduces blood pressure in pre-and hypertensives. [Electronic version] Medicine and Science in Sports & Exercise, 1264-1275. Retrieved March 10, 2006, from http://www.acsm-msse.org
Pausova, Z. (2006). From big fat cells to high blood pressure: Obesity-associated hypertension. Current Opinion in Nephrology and Hypertension, 15, 173-178.
Pescatello, L. S., Franklin, B. A., Fagard, R., Farquhar, W. B., Kelley, G. A., & Ray, C. A. (2004). American College of Sports Medicine position stand. Exercise and hypertension. Medicine and Science in Sports and Exercise, 36, 533-553.
Plante, G. E. (2002). Vascular response to stress in health and disease. Metabolism, 51, Suppl 1, 25-30.
Player, M. S., & Peterson, L. E. (2011). Anxiety disorders, hypertension, and cardiovascular risk: a review. The International Journal of Psychiatry in Medicine, 41(4), 365-377.
Desmond, S. M., Price, J. H., Roberts, S. M., & Pituch, M. J. (1992). Perceptions of hypertension in Black and White adolescents. Health Values: The Journal of Health Behavior, Education & Promotion.
Schwartz, A. R., Gerin, W., Davidson,. K. W., Pickering, T. G., Brosschot, J. F., & Thayer, J. F. (2003). Toward a causal model of cardiovascular responses to stress and the development of cardiovascular disease. Psychosomatic Medicine, 65, 22-35. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. Your Disease Risk: Relative Risks. Retrieved October 14, 2007, from http://www.yourdiseaserisk.wustl.edu/ pdf_files/rr_ydr.pdf.
Stein, M. C., Lang, C. C., Singh, I., He H. B., & Wood A. J. J. (2000). Increased vascular adrenergic vasoconstriction and decreased vasodilation in Blacks: Additive mechanisms leading to enhanced vascular reactivity. Hypertension; 36, 945-951.
Swift, P. A., Markandu, N. D., Sagnella, G. A., He, F. J., & MacGregor, G. A. (2005). Modest salt reduction reduces blood pressure and urine protein excretion in Black hypertensives: A randomized control trial. Hypertension; 6, 308-312.
Tomson, J., & Lip, G. Y. H. (2006). Alcohol and hypertension: An old relationship revisited. Alcohol & Alcoholism, 41, 3-4.
Townes, E. M. (1998). Breaking the fine rain of death. New York: Continuum Publishing Company.
Twisk, J. W. R., Kemper, H. C. G., Van Mechelen, W., & Bertheke Post, G. (2001). AEP, 11,
Wolfe, C. (2002). IS10: The incidence, natural history, resource use, and outcome of stroke [1 of 2]. Retrieved November 16, 2004, from http://www.dh.gov.uk/PolicyAndGuidance/ResearchAndDevelopment/Re searchAndDevelopmentAZ/CardiovascularDiseaseAndStroke/CardiovascularDiseaseAndStrokeArticle/fs/en?CONTENT_ID=4001897&chk=8uIeVM