One-Year Rates and Determinants of Poststroke Systolic Blood Pressure Control among Ghanaians

Kyem, Gloria; Ovbiagele, Bruce; Akassi, John; Sarfo‐Kantanka, Osei; Agyei, Martin; Badu, Elizabeth; Mensah, Nathaniel

doi:10.1016/j.jstrokecerebrovasdis.2016.08.033

Cited by 18 publications

(11 citation statements)

References 39 publications

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“…A recent study among Ghanaian stroke survivors identified up to 35% with less than optimal blood pressure control within the first year of stroke. (50) However, none of the traditional vascular risk factors were independently associated with VCI in this Ghanaian population, although regular physical activity seemed to confer some protection against VCI in unadjusted analysis. Interestingly regular physical activity which protects against stroke occurrence (44) has also been shown to be protective against VCI (51) potentially via enhanced cerebral perfusion and the elaboration of growth factors (51).…”

Section: Discussionmentioning

confidence: 72%

Burden and Predictors of Poststroke Cognitive Impairment in a Sample of Ghanaian Stroke Survivors

Sarfo

Akassi

Adamu

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Background There are limited data on vascular cognitive impairment (VCI) from low- and middle income countries where the stroke burden is burgeoning. Objective To characterize the burden, determinants, and effects on health-related quality of life, of VCI in sub-Saharan Africa (SSA). Methods From January 2015 to February 2016, we collected information on 147 consecutive stroke survivors (>45 years) seen at a tertiary hospital in Ghana and 49 demographically matched stroke-free controls. Data collected included demographics, clinical factors, health-related quality of life and presence of depression. Cognitive status was evaluated using a standard vascular neuropsychological battery which assessed memory, executive function/mental speed, language, and visuospatial/ visuoconstructive functioning. Expert VCI guideline and DSM IV criteria were used to classify stroke patients into no VCI, VCI but no dementia, and vascular dementia (VD). Results Mean ± SD age of stroke survivors was 59.9 ± 13.7 years of which 47.6% were women. Among the cohort, 77/147 (52.3%) had no VCI, 50/147 (34.0%) had VCI no dementia and 20/147 (13.6%) had VD. Three factors remained significantly associated with VCI: increasing age for each successive 10 year rise (OR 1.44, 95% CI: 1.03–2.02); lack of formal education (OR 5.26, 95% CI: 1.01–27.52); and worse functional disability on the modified Rankin scale (OR 2.46, 1.61–3.75). Patients with VD had the poorest health related quality of life. Conclusion Half of the Ghanaian stroke survivors encountered in this cross-sectional study had evidence of cognitive dysfunction. Future studies in SSA will need to identify strategies to address this immense burden.

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Section: Discussionmentioning

confidence: 72%

Burden and Predictors of Poststroke Cognitive Impairment in a Sample of Ghanaian Stroke Survivors

Sarfo

Akassi

Adamu

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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“…Among hypertensive patients on treatment in the present cohort, we have identified poor adherence to antihypertensive therapy, difficulties obtaining antihypertensive medications, longer duration of hypertension diagnosis, receiving healthcare at tertiary centers and number of antihypertensive medications to be independently associated with poor BP control [ 36 ]. Among Ghanaian stroke survivors with hypertension attending a neurology clinic, approximately 70% were found to have controlled BP during the first year after stroke [ 37 ]. Designing interventions aimed at improving medication adherence such as using mobile health technology [ 38 , 39 ] and cardiovascular polypill with generic antihypertensive medications [ 40 , 41 ] in resource-limited settings could lead to improvements in BP control.…”

Section: Discussionmentioning

confidence: 99%

Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study

Mobula

Plange‐Rhule

Ansong

et al. 2018

Journal of the Neurological Sciences

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BackgroundThe burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups.MethodsA prospective cohort study involving adults with hypertension and or type II diabetes mellitus at 5 public hospitals in Ghana who were stroke-free at enrollment. Patients were followed every 2 months at clinic for 18 months and assessed clinically for first ever stroke by physicians. We calculated crude incidence rates for stroke and assessed the factors associated with stroke occurrence using a multivariate Cox Proportional Hazards regression models.ResultsOf 3220 eligible participants with 3805 person-years of follow-up, there were 54 clinically confirmed new strokes. Incidence rate of stroke was 14.19 events per 1000 person-years [95% CI: 10.77–18.38], with rates among diabetics with hypertension being 16.64 [10.58–25.00], hypertension of 13.77 [9.33–19.64] and diabetes was 9.81 [3.59–21.74]. Two factors independently associated with stroke occurrence were previous cigarette smoking with adjusted HR (95% CI) of 2.59 (1.18–5.67) and physical inactivity, 1.81 (1.06–3.10). In secondary analysis, stage II hypertension compared with optimal BP was associated with aHR of 3.04 (1.00–9.27), p = .05 for stroke occurrence.ConclusionIncident stroke among Ghanaians with hypertension and diabetes is quite high. Stricter control of blood pressure and engaging in regular physical activities are strongly recommended to reduce the risk of strokes.

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“…The average duration from stroke onset to enrollment into our clinic was approximately 1 month and most patients were on secondary preventive interventions at presentation and we were either optimized or maintained existing therapies (16). Indeed among this cohort, we have previously reported systolic blood pressure control rates of up to 70% within the first year after stroke (21) with high rates of compliance with evidence-based secondary prevention cardiovascular medication utilization (22). In the Community based study in Tanzania, crude case fatality rate at 3 years was 60% (9).…”

Section: Discussionmentioning

confidence: 89%

Long-Term Outcomes of Stroke in a Ghanaian Outpatient Clinic

Akassi

Kyem

Adamu

et al. 2018

Journal of Stroke and Cerebrovascular Diseases

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One-Year Rates and Determinants of Poststroke Systolic Blood Pressure Control among Ghanaians

Cited by 18 publications

References 39 publications

Burden and Predictors of Poststroke Cognitive Impairment in a Sample of Ghanaian Stroke Survivors

Burden and Predictors of Poststroke Cognitive Impairment in a Sample of Ghanaian Stroke Survivors

Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study

Long-Term Outcomes of Stroke in a Ghanaian Outpatient Clinic

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