Geographic differences in the prevalence of hypertension in Uganda: Results of a national epidemiological study

Abstract

BackgroundHypertension accounts for more than 212 million global disability-adjusted life-years, and more than 15 million in sub-Saharan Africa. Identifying factors underlying the escalating burden of hypertension in sub-Saharan Africa may inform delivery of targeted public health interventions.MethodsAs part of the cross-sectional nationally representative Uganda National Asthma Survey conducted in 2016, we measured blood pressure (BP) in the general population across five regions of Uganda. We defined hypertension as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, or on-going use of medications for the purpose of lowering BP among adults (≥18 years of age); pre-hypertension as systolic BP between 120 and 140 mmHg and/or diastolic BP bteween 80 and 90 mmHg among adolescents and adults (≥12 years of age).FindingsOf 3416 participants who met inclusion criteria, 38.9% were male, and mean age ± SD was 33.8 ± 16.9 years. The age- and sex-adjusted prevalence of hypertension was 31.5% (95% confidence interval [CI] 30.2 to 32.8). The adjusted prevalence of hypertension was highest in the Central Region (34.3%; 95% CI 32.6 to 36.0), and it was comparable to that in the West and East Regions. However, compared with the Central Region, hypertension was significantly less prevalent in the North (22.0%; 95 CI 19.4 to 24.6) and West Nile Regions (24.1%; 95% CI 22.0 to 26.3). Adjustment for demographic characteristics (occupation, monthly income, and educational attainment) of participants did not account for the significantly lower prevalence of hypertension in the North and West Nile Regions. The prevalence of pre-hypertension was 38.8% (95% CI 37.7 to 39.8), and it was highly prevalent among young adults (21–40 years of age: 42.8%; 95% CI 41.2–44.5%) in all regions.ConclusionsHypertension is starkly prevalent in Uganda, and numerous more people, including young adults are at increased risk. The burden of hypertension is highest in the Central, Western, and Eastern regions of the country; demographic characteristics did not fully account for the disparate regional burden of hypertension. Future studies should explore the potential additional impact of epidemiological shifts, including diet and lifestyle changes, on the development of hypertension.

Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation

“…Across the three CHC sites, 91% of all participants were fully screened for HTN (Fig 3), of which 9,649 (11.1%) screened positive, 7,978 (82.7%) received linkage to care, and 3,380 of these persons (42.4%) linked to care by May 2016. Of note, the rate of positive screening for HTN was significantly lower than the reported prevalence of HTN in Uganda and Kenya (25- 30% or greater) [9,12,13], perhaps due to sample bias and/or limitations in the SEARCH measurement protocol as discussed below. These results varied substantially across the three sites ( Table 2).…”

“…Despite these results, SEARCH's HTN treatment outcomes were hampered by cumulative attrition across multiple stages of the HTN care cascade, including linkage to care, treatment initiation, and blood pressure control; and its blood pressure prevalence data is not consistent with nationwide surveys in Uganda and Kenya. SEARCH fully screened 86,676 persons for HTN across the three sites (91.3%); but only 9,649 (11.1%) screened positive, including only 1,004 (4%) in Kenya-substantially lower than population-level estimates of 25% in adults in this region [9,12,13], suggesting possible gaps in measurement protocols. Among the 9,649 identified as positive, 1,671 were lost to follow-up.…”

“…Moreover, in Eastern and Western Uganda, SEARCH demonstrates that supervised nonphysician providers can provide consistent clinical care for HTN according to established algorithms, and retain patients over time, achieving treatment rates comparable to high-income countries [49]. Patients SEARCH succeeded in linking and retaining in care received diagnosis and treatment at far higher rates than Uganda overall, where approximately 7-28% are aware of their diagnosis, 85% of diagnosed persons untreated, and 50% of treated persons were uncontrolled [9,10,11,12].…”

“…Relative to the global age-standardized population [6], HTN afflicts some 30% of adults across sub-Saharan Africa, the highest prevalence worldwide [7], and is projected to affect up to 150 million persons by 2025 [8]. In Uganda, standardized adult HTN prevalence estimates range from 27% to 32% or greater [9,10,11], with disease awareness at 8% [10]. Data in Kenya are similar, with age-standardized prevalence of 25-26% [12,13] disease awareness of 16% [12], and control under 3% [12].…”

Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

“…Persons living with HIV (PLHIV) and receiving antiretroviral therapy (ART) are at increased risk of cardiovascular disease (CVD) [1][2][3]. In Uganda, approximately 1/3 of PLHIV aged ≥18 years have hypertension (HTN), the leading cause of CVD and preventable mortality [4][5][6][7][8][9][10][11][12]. PLHIV with HTN have an increased risk of mortality compared to HIV negative persons [13].…”