147 Burden of Undiagnosed Hypertension in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Abstract

The burden of hypertension in Sub-Saharan Africa has been increasing over the past few decades. However, a large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular disease in the region. We conducted a systematic review and meta-analysis to assess the recent burden of hypertension in Sub-Saharan Africa, based on studies published between 2000 and 2013. We pooled data from 33 surveys involving over 110 414 participants of mean age 40 years. Hypertension prevalence varied widely across the studies (range 15%–70%), partly because of differences in participant mean ages (31–76 years). The predicted prevalence of hypertension at mean participant ages of 30, 40, 50, and 60 years were 16%, 26%, 35%, and 44%, respectively, with a pooled prevalence of 30% (95% confidence interval, 27%–34%). Of those with hypertension, only between 7% and 56% (pooled prevalence: 27%; 95% confidence interval, 23%–31%) were aware of their hypertensive status before the surveys. Overall, 18% (95% confidence interval, 14%–22%) of individuals with hypertension were receiving treatment across the studies, and only 7% (95% confidence interval, 5%–8%) had controlled blood pressure.This review found a high prevalence of hypertension, as well as low percentage of hypertension awareness, treatment, and control in Sub-Saharan Africa, highlighting the need for implementation of timely and appropriate strategies for diagnosis, control, and prevention.Abstract 147 Figure 1Prevalence of hypertension awareness among hypertensive individuals

Characteristics of self-measured home blood pressure in a Nigerian urban community

“…Emerging epidemiological data from Nigeria [1] and indeed the entire sub-Saharan Africa [2][3][4] indicate that hypertension has become a major public health challenge. Accurate measurement and diagnosis of hypertension is key to overcoming this challenge.…”

Non-adherence to anti-hypertensive medication in low- and middle-income countries: a systematic review and meta-analysis of 92443 subjects

“…2 Systematic reviews from South Asia, Arab and sub-Saharan countries showed prevalence of hypertension in these regions of 27, 29.5 and 30%, respectively. [3][4][5] Hypertension can be managed through lifestyle modifications and adherence to anti-hypertensive medication. 6 The World Health Organization (WHO) has defined adherence as 'The extent to which a person's behavior-taking medication, following a diet, and/or executing lifestyle changes-corresponds with agreed recommendations from a health care provider'.…”

Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients

“…Unfortunately, a substantial proportion of hypertensive treated individuals fail to achieve long-term BP control 5–7. For instance, in sub-Saharan Africa, only as few as 7% of treated patients with hypertension have controlled BP 8. Several factors account for poor BP control, including absence of hypertension treatment guidelines or non-adherence to these guidelines by physicians, non-compliance to pharmacological treatment or life styles changes 6.…”