Prevalence of hypertension in Ghanaian society: a systematic review, meta-analysis, and GRADE assessment

Abstract

Background Hypertension has become an important public health concern in the developing world owing to rising prevalence and its adverse impact on ailing health systems. Despite being a modifiable risk factor for cardiovascular disease, hypertension has not received the needed attention in Ghana as a result of various competing interests for scarce health resources. This systematic review and meta-analysis provides a comprehensive and updated summary of the literature on the prevalence of hypertension in Ghana. Methods Major databases such as MEDLINE, EMBASE, and Google Scholar and local thesis repositories were accessed to identify population-based studies on hypertension among Ghanaians. Data extracted from retrieved reports were screened independently by two reviewers. The quality of eligible studies was evaluated and reported. A reliable pooled estimate of hypertension prevalence was calculated utilizing a random-effects model and reported according to the GRADE framework. Additionally, a meta-regression analysis was performed to analyze the contribution of study-level variables to variance in hypertension prevalence. Results In general, a total of 45,470 subjects (n = 22,866 males and 22,604 females) were enrolled from urban (n = 12), rural (n = 8), and mixed populations (n = 7). Blood pressure (BP) was measured across studies according to a validated and clinically approved protocol by trained field workers or healthcare workers including nurses and physicians. A combined total of 30,033 participants across twenty studies reporting on the population prevalence of hypertension were pooled with 10,625 (35.4%) identified to satisfy study criteria for elevated BP. The pooled prevalence across 24 studies was 30.3% (95% CI 26.1–34.8%) after fitting a random effects model. Prevalence of hypertension was 30.1% (95% CI 25.6–36.0%) among females and 34.0% (95% CI 28.5–40.0%) among males. Significant differences in pooled estimates across regions emerged from subgroup comparisons of regional estimates with an increasing trend in the north-to-south direction and with increasing age. Compared to rural settings, the burden of hypertension in urban populations was significantly higher. Age structure and population type accounted for 65.0% of the observed heterogeneity in hypertension estimates. Conclusions The prevalence of hypertension in Ghana is still high. The gap in hypertension prevalence between rural and urban populations is closing especially in elderly populations. These findings must claim the attention of public health authorities in Ghana to explore opportunities to reduce rural hypertension. Systematic review registration The protocol for this review has been published previously with PROSPERO (CRD42020215829).

Predictors of Nonadherence to Medications among Hypertensive Patients in Ghana: An Application of the Health Belief Model

“…Respondents who had not been formally educated beyond the basic stage were more likely (p < 0.009) to forfeit their HPT medications (Table 4). Concordant results have been reported by other studies around the country [1,12,34]. Our data is also in line with a recent systematic review where a low level of education was significantly associated with low knowledge of the HPT condition and of the value of pharmacological treatment, which invariably has a negative consequence on medication adherence especially in rural communities where HPT cases are increasing [35].…”

“…In contrast to reports from other settings, patients with high perceived susceptibility and perceived severity in this study were more likely to be classified as noncompliant with HPT medication [ 31 , 33 ]. In a previous investigation into the psychosocial experiences of HPT patients in the region, key subthemes that emerged from the data were suicidal ideations and resignation to fate [ 1 ]. Although they were well-informed about the risk posed by complications of HPT, as seen from the responses to statements such as “I am worried about becoming sick or disabled from high blood pressure” and “Having high blood pressure could lead to serious health problems for me,” rather than resulting in positive medication behaviour, participants were more deeply troubled by the psychosocial burden of an incurable disease and life-long therapy.…”

“…Hypertension (HPT) remains an overwhelming global health concern [ 1 , 2 ]. Despite the implementation of national and global policy agenda to deal with this challenge [ 2 ], HPT control remains elusive, resulting in many instances of cardiovascular complications and deaths.…”

“…In addition, studies have shown that poor adherence to HPT medications usually leads to increased cardiovascular risk and chronic kidney disease (CKD) [ 1 , 13 ]. Current estimates reveal that in Ghana, about 31% of the adult population have HPT, presenting a high cost burden to the healthcare system, patients, and their dependents and are at a significant risk of cardiovascular morbidity and mortality as well [ 1 , 14 ]. Furthermore, nearly half of persons identified with HPT may have evidence of target-organ damage in Ghana due to delay in detection and poor compliance to therapy [ 15 , 16 ].…”

Hypertension and Diabetes in Akatsi South District, Ghana: Modeling and Forecasting

“…According to a survey published by the Ministry of Health (MOH) in 2012, hypertension and diabetes affect 19-48 percent and up to 9 percent of Ghanaian adults, correspondingly [ 9 ]. Nevertheless, current research shows that Ghanaians have hypertension and diabetes prevalence rates of 30.3% and 6.46 %, respectively [ 11 , 12 ].…”