Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)

Abstract

Background: Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods: Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment. Results: We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4 %) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

Acute Coronary Syndrome patterns in the Young: risk factor profile and in-hospital outcome in a tertiary referral hospital in Kenya

“…We hypothesize the higher proportion to the increased prevalence of multiple cardiovascular risk factors in our cohort: diabetes mellitus, hypertension, obesity and cigarette smoking. These factors are considered silent preventable killers and the main reasons for premature CAD globally and in SSA, with higher prevalence noted in the East African region (37)(38)(39). These observations support the present-day emphasis on controlling risk factors and quitting cigarette smoking to prevent adult coronary artery disease.…”

Hypertension Related Co-Morbidities and Complications in Women of Sub-Saharan Africa: A Brief Review

“…Several studies indicate that 44% to 93% of individuals within SSA are unaware of their hypertensive status. 2,6,8,9 This phenomenon underscores a labyrinth of barriers, including limited access to health care, 10 lack of health care infrastructure, 11 lack of screening programs, 12 demographic factors, 13 low health literacy, 14 the specter of stigma, 15 and the impact of cultural beliefs 16 (Figure 2). Potential solutions may involve utilizing telemedicine and mobile health services to expand medical access to remote regions.…”

“…Many risk factors are on the rise in SSA due to changing lifestyles including increases in sedentary behaviors, cigarette smoking, and alcohol consumption. 2,8,37 A Uganda study found that 61.6% of individuals report spending their work time sitting or standing without engaging in any physical activity lasting more than 10 minutes per day. 38 Additionally, 68.7% of their leisure time was spent in a sedentary manner.…”

“…Over the past 4 decades, the prevalence of hypertension among SSA women rose from 27.2% in 1987% to 33% in 2019. 2 Strategic screening initiatives incorporate routine blood pressure (BP) measurements, public health screening programs, and health education interventions; however, although well-developed screening programs exist in some nations, others are severely underresourced. 3–6…”

“…1 Projections for SSA in 2030 paint a graver picture, with a predicted surge to 217 million hypertensive individuals diagnosed. 2 Notably, women face a higher susceptibility to hypertension in SSA. Over the past 4 decades, the prevalence of hypertension among SSA women rose from 27.2% in 1987% to 33% in 2019.…”