The State of Hypertension in Sub-Saharan Africa: Review and Commentary

Yoruk, Ayhan; Boulos, Peter K.; Bisognano, John D.

doi:10.1093/ajh/hpx196

Cited by 19 publications

(21 citation statements)

References 7 publications

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“…However, hypertension prevalence is not the primary goal of this study. It is worth mentioning that hypertension is at epidemiological thresholds in Africa accounting for the highest prevalence of 46% compared to other regions of the world 62 . Nevertheless, all control data in the SIREN study were collected using validated instruments and in relevant situations, responses were verified by physicians.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with hypertension among stroke‐free indigenous Africans: Findings from the SIREN study

Akpa

Okekunle

Ovbiagele

et al. 2021

J of Clinical Hypertension

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Hypertension is one of the most important risk factors for stroke and cardiovascular diseases (CVD) globally. Understanding risk factors for hypertension among individuals with matching characteristics with stroke patients may inform primordial/primary prevention of hypertension and stroke among them. This study identified the risk factors for hypertension among community‐dwelling stroke‐free population in Ghana and Nigeria. Data for 4267 community‐dwelling stroke‐free controls subjects in the Stroke Investigative Research and Education Network (SIREN) study in Nigeria and Ghana were used. Participants were comprehensively assessed for sociodemographic, lifestyle and metabolic factors using standard methods. Hypertension was defined as a previous diagnosis by a health professional or use of an anti‐hypertensive drug or mean systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Logistic regression analysis was used to estimate adjusted odds ratios (aOR) of hypertension and their 95% confidence intervals (CI) at p < .05. Overall, 56.7% of the participants were hypertensive with a higher proportion among respondents aged ≥60 years (53.0%). Factors including physical inactivity (aOR: 9.09; 95% CI: 4.03 to 20.53, p < .0001), diabetes (aOR: 2.70; CI: 1.91 to 3.82, p < .0001), being ≥60 years (aOR: 2.22; 95% CI: 1.78 to 2.77, p < .0001), and family history of CVD (aOR 2.02; CI: 1.59 to 2.56, p < .0001) were associated with increased aOR of hypertension. Lifestyle factors were associated with hypertension in the current population of community‐dwelling stroke‐free controls in west Africa. Community‐oriented interventions to address sedentary lifestyles may benefit this population and reduce/prevent hypertension and stroke among them.

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Section: Discussionmentioning

confidence: 99%

Factors associated with hypertension among stroke‐free indigenous Africans: Findings from the SIREN study

Akpa

Okekunle

Ovbiagele

et al. 2021

J of Clinical Hypertension

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“…This study was conducted in accordance with the Helsinki Declaration of studies on human subjects. Ethical approval to conduct the study was obtained from ease and stroke [7].…”

Section: Ethical Considerationsmentioning

confidence: 99%

Prevalence, Types and Clinical Presentation of Heart Failure among Hypertensive Patients Seen at a Tertiary Hospital in Dar Es Salaam, Tanzania

George¹,

Pilly²

2021

Int J Clin Cardiol

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Background: Heart failure (HF) is a common complication in patients with hypertension who may present as HF with preserved ejection fraction (HFpEF) or HF with reduced ejection fraction (HFrEF). These categories have different clinical presentations and may require special attention to diagnose, especially when the presentation is HFpEF. The aim of this study was to assess the prevalence, types and clinical presentation of HF among hypertensive patients being followed-up at a tertiary hospital in Tanzania. Methods:We included all known and newly diagnosed hypertensive adults (≥ 18 years) referred for echocardiogram examination at the Muhimbili National Hospital -Mloganzila, between June and December 2019. A detailed cardiovascular history, physical, laboratory and echocardiogram examination was performed in all patients. HF was diagnosed according to the Framingham criteria and was further categorized as HFpEF (EF ≥ 50%) or HFrEF (EF < 50%), according to the echocardiography findings. Patients from these two groups were then compared in terms of demographic, clinical, laboratory and echocardiographic characteristics. The chi-square and Student's t test was used to compare categorical and continuous data respectively. A p-value of < 0.05 indicated a statistically significant difference.Results: Out of 633 hypertensive patients seen during the study period, 346 (54.7%) fulfilled the inclusion criteria and were enrolled. Mean ± SD age was 58.3 ± 12.4 years, and 60.4% were women. Mean ± SD systolic and diastolic BP was 152 ± 23 and 91 ± 15, respectively. A total of 102 (29.5%) patients were found to have HF. Three quarters of HF patients (74.5%) had HFpEF and the remaining (25.5%) had HFrEF. In comparison, patients with HFpEF were more likely to be outpatients, older, obese, and with higher mean BP and more concentric left ventricular hypertrophy when compared to those with HFrEF, all p < 0.05. Conclusion:The prevalence of HF among hypertensive patients seen at a tertiary hospital in Tanzania is 29.5%, majority of them having HFpEF. HFpEF differs from HFrEF in terms of BP levels, obesity status and some echocardiographic parameters. These factors need to be carefully examined when HF is suspected in otherwise less symptomatic patients.

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“… 1 Africa has the highest age-standardized prevalence of hypertension estimated at 46% in individuals above 25 years old. 2 Despite this rising burden in Sub-Saharan Africa, where healthcare systems are fragile; awareness, treatment, and control rates remain low at 27%, 18%, and 7%, respectively as reported in a recent meta-analysis. 3 In Kenya, a nationally representative population-based survey in 2015 showed that 56% of the respondents had never had their blood pressure (BP) checked yet a third of deaths in the country are due to non-communicable diseases (NCDs) with cardiovascular disease contributing to the largest share (59%).…”

Section: Introductionmentioning

confidence: 99%

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

Ogola

Mbau²,

Gachemba

et al. 2021

European Heart Journal Supplements

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Elevated blood pressure (BP) is the leading cause of global mortality, but control rates remain poor because most patients, especially in Africa, are unaware. May Measurement Month (MMM) is an annual global BP screening campaign that was initiated by the International Society of Hypertension (ISH) in 2017 to raise awareness of raised BP. Following participation in 2017 and 2018, Kenya participated again in 2019 and the results are reported here. Screening was carried out in 30 sites by volunteers coordinated by the Kenya Cardiac Society. Participants had three BP readings by standard methods with the last two being averaged and recorded. Heart rate, weight, height, socio-demographic parameters, and co-morbidities were documented. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg and/or a diastolic BP (DBP) ≥90 mmHg or being on treatment with at least one antihypertensive medication. A total of 33 992 participants were screened, mean age was 42.5 (SD 16.8) years and 58.7% of participants were female. Only 27.3% had their BPs checked within the preceding 12 months. After multiple imputation, 26.1% were hypertensive, of whom 34.5% were aware of their hypertension and 31.5% were on treatment. Of those on treatment, 59.7% were controlled translating to 18.8% of all hypertensives. Being on treatment for hypertension, overweight, obese or having had hypertension in previous pregnancy were associated with increased SBP and DBP, while diabetes was associated with raised SBP. Two-thirds of hypertensives were unaware. Only a third of those aware were on treatment, with about 60% of these controlled. Lack of awareness remains a significant barrier to BP control. Programmes to raise awareness such as MMM are significant in raising population awareness.

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The State of Hypertension in Sub-Saharan Africa: Review and Commentary

Cited by 19 publications

References 7 publications

Factors associated with hypertension among stroke‐free indigenous Africans: Findings from the SIREN study

Factors associated with hypertension among stroke‐free indigenous Africans: Findings from the SIREN study

Prevalence, Types and Clinical Presentation of Heart Failure among Hypertensive Patients Seen at a Tertiary Hospital in Dar Es Salaam, Tanzania

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

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