Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey

Abstract

Introduction. Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in sub-Saharan Africa. Few studies have examined performance on the management of hypertension in this region, where the context may be distinct from other developing regions. Objectives. We aimed to determine the prevalence and correlates of hypertension, awareness, treatment, and control among adults in Botswana, a middle-income African country undergoing rapid demographic transition and with high HIV burden. Methods. In this 2014 cross-sectional survey of adults aged 15–69 years, information on sociodemographic characteristics, lifestyle behavior, and medical history was collected through in-person interviews and physical measurements (body mass index and triplicate blood pressure (BP)). Hypertension was defined as self-report of use of antihypertensives in the previous two weeks and/or having elevated BP (≥140/90 mmHg). Multivariable logistic regression was employed to explore factors associated with hypertension, awareness (report of previous diagnosis), treatment (antihypertensives), and control (BP < 140/90). Results. Our analysis (N = 4,007) yielded an age-standardized hypertension prevalence of 30% (95% CI: 28%–32%, N = 1,393). Among hypertensives, 54% (50–58%) were unaware of their condition, 45% (40–50%) of those aware were untreated, and 63% (55–70%) of those on medications were suboptimally treated (BP ≥ 140/90 mmHg). A fifth of hypertensives who were diagnosed but not on medications had BP ≥ 180/110 mmHg. Diabetes was the strongest correlate of hypertension and awareness (aOR 4.00, 1.86–8.59; aOR 3.30, 1.44–7.55, respectively). Males were less likely to be aware (aOR 0.62, 0.41–0.94) or controlled (aOR 0.36, 0.16–0.83). Obese individuals were more likely to be treated (aOR 2.17, 1.12–4.22), yet less likely to be controlled (aOR 0.32, 0.15–0.66). Conclusions. We report the first nationally representative estimates of the hypertension care cascade performance in Botswana, which will support planning and future policy evaluations. Findings contribute to the relatively sparse evidence on this subject and may inform development of innovations that improve quality of hypertension management and adherence support in similar settings.

May Measurement Month 2019: an analysis of blood pressure screening results from Botswana

“…A 2014 national survey estimated the prevalence of hypertension in Botswana at 30%, 1 consistent with findings from the World Health Organisation (WHO) 2014 STEPS survey, which also showed a high prevalence of hypertension in Botswana with only 29.9% of hypertensive participants on treatment and 24.2% of hypertensive participants unaware of their condition. 2 Hypertension was ranked the 2nd highest cause of morbidity among all-cause morbidities in outpatient services across Botswana with an insidious increase from 0.2% to 0.6% between 2014 and 2018.…”

Factors associated with treatment and control of hypertension among elderly adults in Shenzhen, China: a large-scale cross-sectional study

“…In addition, the control of hypertension was lower with higher WC in our study, consistent with some previous studies. 19 38 Greater WC is correlated with higher levels of fat mass, an increase in salt retention and insulin resistance, which cause increased high blood pressure. 39 In our study, patients who had diabetes or dyslipidaemia had higher probability of having controlled blood pressure, consistent with other studies.…”

Prevalence and determinants of hypertension control among almost 100 000 treated adults in the UK

“…3 Despite this, and the availability of low-cost treatments for hypertension, 4 many hypertensives are undiagnosed or inadequately treated. [4][5][6] More evidence on factors influencing hypertension control is needed to support the efforts of clinicians and policymakers to reduce the CVD burden.…”