The high prevalence of hypertension in rural-dwelling Tanzanian older adults and the disparity between detection, treatment and control: a rule of sixths?

Abstract

There are limited, reliable data on the prevalence of hypertension in East African populations. The aim of this study was to document the prevalence of hypertension in the rural Hai district of Tanzania. All consenting individuals aged 70 years and over who were living in 12 randomly-selected villages in the district underwent three consecutive sitting blood pressure (BP) measurements. An average of the last two measurements was taken. Prior diagnosis of, and treatment for, hypertension was recorded. Of the 2223 subjects, 1553 (69.9%, 95% CI 68.0-71.8) had hypertension (BP ≥140/90). Of those with hypertension 733 (47.2%) had isolated systolic hypertension. Only 586 (37.7%) hypertensives had been previously diagnosed, 94 (6.1%) were currently treated and 14 (0.9%) were adequately controlled. This is the first large-scale prevalence study of hypertension in the elderly in sub-Saharan Africa (SSA). Our results approximate to a 'rule of sixths'; 2/6 of hypertensives were previously detected, 1/6 of those previously detected were on treatment and 1/6 of those on treatment were adequately controlled. Hypertension is a large problem in the elderly population in SSA, and there are a growing number of elderly who are at risk of hypertensive sequelae owing to lack of detection and treatment.

Prevalence and determinants of hypertension in elderly population of Raipur city, Chhattisgarh

“…13 Smoking and residence in an urban area have been associated with a higher prevalence of hypertension in several prior investigations in India and abroad. [20][21][22][23] Kalavathy MC et al reported, socio-demographic variables (such as religion, SES, education) did not influence the hypertension status of men or women in their study while non-smoker was associated with an 80% lower odds of having elevated blood pressure. 11 Surprisingly unlike other study, inverse association was observed with alcohol and smoking status in present study.…”

Ambulatory Blood Pressure Monitoring to Assess the White‐Coat Effect in an Elderly East African Population

“…6 We aimed to assess one quarter of the people aged 70 years and older in the DSS. Twelve villages from the 52 within the DSS were selected using a random number generator, giving a baseline cohort of 2232 people.…”

“…4,5 A recent study by members of our team revealed the prevalence of hypertension to be 69.9% in persons aged 70 years and older in rural Tanzania. 6 Furthermore, few of those who had hypertension had been previously diagnosed, and effective hypertension control was rare.…”

Prevalence, awareness, treatment, and control of hypertension in older people in Central Africa: the EPIDEMCA study

“…We found only one study specifically conducted in elderly people over the age of 70, reporting a prevalence of 70% in rural Tanzania [17]. Other studies reported the prevalence of hypertension in people aged 65 and over [7][8][9][10][11][12][13][14][15][16][17][18][19], ranging from 34.5% in urban Kenya [15] to 88.0% in urban Senegal [13].The disparity in prevalence between the Republic of Congo (68.0%) and the Central African Republic (53.7%), two neighbouring countries, may be related, in part, to differences in socio-economic levels, however, an association between peripheral fat mass (as measured using WHR) as well as abdominal fat mass (as measured using TCT) and the prevalence of hypertension were both observed.Unexpectedly, this study observed that tobacco users, usually found as at higher risk of CVD [33], were less likely to be hypertensive. This result was also observed in one study conducted in adults in Turkey [34], but direct comparisons are difficult as settings are different.…”

“…Ethnic differences cannot be explained solely in terms of socio-economic status [5], suggesting the involvement of other factors. It is therefore important to know more about the epidemiology of hypertension in older native Africans.Several community-based epidemiological studies on hypertension were conducted in Africa [6].Most were carried out in adults and reported prevalence for the ≥65 age group [7][8][9][10][11][12][13][14][15][16][17][18][19]. Only one study in rural Tanzania was specifically conducted on the elderly and reported a prevalence of hypertension of 70% in people over 70 years of age [17].…”