Hypertension in a resource‐limited setting: Is it associated with end organ damage in older adults in rural Tanzania?

Abstract

Few data from sub‐Saharan Africa exist on the effects of hypertension on the organs of the human body. We aimed to establish the prevalence of hypertensive end organ damage (EOD) in an elderly cohort of Tanzanians. The population aged 70 years and over of 2 villages in northern Tanzania (n = 246), had blood pressure (BP) data available from 2010 and 2013, and underwent in‐depth follow‐up for markers of hypertensive EOD in 2016. Assessment included ankle‐brachial pressure index, lying‐standing BP, electrocardiogram, and mid‐stream urine dip. Sustained hypertension (those with hypertension at all 3 assessments) was found in 129 (52.4% subjects). Of the entire cohort, 13.9% had left ventricular hypertrophy and 26.4% had peripheral arterial disease, both of which were associated with sustained hypertension, although orthostatic hypotension, stroke, proteinuria, and arterial stiffening were not. Further investigation, particularly in younger age groups, is merited if hypertension‐associated morbidity is to be controlled.

Retinal imaging to identify target organ damage in older Africans: A pilot study

“…The prevalence of EOD in our population reflects the lack of adequate diagnosis and treatment of hypertension in this setting . Although changes in diet may help control hypertension to some extent, few people in this setting are able to make active dietary choices.…”

“…Assessment took place at the participants’ local health clinic. Methods for data collection of basic demographics (age, sex, weight, socioeconomic status, and education), arterial hypertension, and EOD have been previously described . EOD markers used included 12‐lead electrocardiography to assess left ventricular hypertrophy, IDEA cognitive screen to assess cognitive function, ankle‐brachial pressure index to assess peripheral arterial disease and arterial stiffening, urine dip stick to assess proteinuria (a marker of renal impairment), and self‐reported stroke history.…”

“…EOD markers used included 12‐lead electrocardiography to assess left ventricular hypertrophy, IDEA cognitive screen to assess cognitive function, ankle‐brachial pressure index to assess peripheral arterial disease and arterial stiffening, urine dip stick to assess proteinuria (a marker of renal impairment), and self‐reported stroke history. Further details on these assessment methods have been previously published . Three blood pressure measurements were obtained with the patients in a seated position, and the average of the second and third readings was used, as per the WHO STEPwise approach to surveillance protocol.…”

“…Sub‐Saharan Africa (SSA) will see the largest growth of any world region in the proportion of people living with hypertension . In SSA, where diet, lifestyle, patterns of disease, and genetic factors vary markedly from those seen in high‐income settings, the effects of hypertension on the organs of the body are less well understood than in most high‐income settings . Part of the reason for this may be that most methods of end‐organ damage (EOD) assessment are either invasive or require analysis of urine or blood samples, raising issues of cultural appropriateness and affordability, particularly in a community setting.…”

Retinopathy in adults with hypertension and diabetes mellitus in Western Tanzania: a cross‐sectional study

“…In the last 10 years, the age standardised mean systolic BP has risen in east, west, central and southern Africa more than any other region of the world [1]. The burden of HTN is a particular concern in Tanzania, and data on the prevalence of the sequelae of HTN are limited [2][3][4].…”