Regional and Sex Differences in the Prevalence and Awareness of Hypertension: An H3Africa AWI-Gen Study Across 6 Sites in Sub-Saharan Africa

F Xavier Gómez-Olivé; Stuart A Ali; Felix Made; Catherine Kyobutungi; Engelbert Nonterah; Lisa Micklesfield; Marianne Alberts; Romuald Boua; Scott Hazelhurst; Cornelius Debpuur; Felistas Mashinya; Sekgothe Dikotope; Hermann Sorgho; Ian Cook; Stella Muthuri; Cassandra Soo; Freedom Mukomana; Godfred Agongo; Christopher Wandabwa; Sulaimon Afolabi; Abraham Oduro; Halidou Tinto; Ryan G Wagner; Tilahun Haregu; Alisha Wade; Kathleen Kahn; Shane A Norris; Nigel J Crowther; Stephen Tollman; Osman Sankoh; Michèle Ramsay; AWI-Gen and the H3Africa Consortium

doi:10.1016/j.gheart.2017.01.007

Regional and Sex Differences in the Prevalence and Awareness of Hypertension: An H3Africa AWI-Gen Study Across 6 Sites in Sub-Saharan Africa

Glob Heart. 2017 Jun;12(2):81-90. doi: 10.1016/j.gheart.2017.01.007. Epub 2017 Mar 13.

Authors

F Xavier Gómez-Olivé¹, Stuart A Ali², Felix Made², Catherine Kyobutungi³, Engelbert Nonterah⁴, Lisa Micklesfield⁵, Marianne Alberts⁶, Romuald Boua⁷, Scott Hazelhurst⁸, Cornelius Debpuur⁴, Felistas Mashinya⁶, Sekgothe Dikotope⁶, Hermann Sorgho⁷, Ian Cook⁹, Stella Muthuri³, Cassandra Soo², Freedom Mukomana², Godfred Agongo⁴, Christopher Wandabwa³, Sulaimon Afolabi¹⁰, Abraham Oduro⁴, Halidou Tinto⁷, Ryan G Wagner¹⁰, Tilahun Haregu³, Alisha Wade¹⁰, Kathleen Kahn¹⁰, Shane A Norris⁵, Nigel J Crowther¹¹, Stephen Tollman¹⁰, Osman Sankoh¹², Michèle Ramsay¹³; AWI-Gen and the H3Africa Consortium

Affiliations

¹ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.
² Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ African Population and Health Research Center, Nairobi, Kenya.
⁴ Navrongo Health Research Centre, Navrongo, Ghana.
⁵ MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa.
⁷ Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso.
⁸ Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, South Africa.
⁹ Physical Activity Epidemiology Laboratory (EDST), School of Education, Faculty of Humanities, University of Limpopo, Polokwane, South Africa.
¹⁰ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹¹ Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹² INDEPTH Network, Accra, Ghana; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Mathematics and Statistics, Njala University, Njala, Sierra Leone.
¹³ Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: michele.ramsay@wits.ac.za.

Abstract

Background: There is a high prevalence of hypertension and related cardiovascular diseases in sub-Saharan Africa, yet few large studies exploring hypertension in Africa are available. The actual burden of disease is poorly understood and awareness and treatment to control it is often suboptimal.

Objectives: The study sought to report the prevalence of measured hypertension and to assess awareness and control of blood pressure among older adults in rural and urban settings in 6 sites located in West, East, and Southern Africa. In addition, we examined regional, sex, and age differences related to hypertension.

Methods: A population-based cross-sectional study was performed at 6 sites in 4 African countries: Burkina Faso (Nanoro), Ghana (Navrongo), Kenya (Nairobi), and South Africa (Agincourt, Dikgale, Soweto). Blood pressure measurements were taken using standardized procedures on 10,696 adults 40 to 60 years of age. Hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or taking antihypertensive medication.

Results: The mean prevalence of hypertension ranged from 15.1% in Nanoro to 54.1% in Soweto. All 3 of the South African sites had a mean prevalence of hypertension of over 40.0%, significantly higher than in Nairobi (25.6%) and Navrongo (24.5%). Prevalence increased with age in both sexes and at all sites. A significantly higher prevalence of hypertension was observed in women in Agincourt, Dikgale, and Nairobi, whereas in Nanoro this trend was reversed. Within the hypertensive group the average proportion of participants who were aware of their blood pressure status was only 39.4% for men and 53.8% for women, and varied widely across sites.

Conclusions: Our study demonstrates that the prevalence of hypertension and the level of disease awareness differ not only between but also within sub-Saharan African countries. Each nation must tailor their regional hypertension awareness and screening programs to match the characteristics of their local populations.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Africa South of the Sahara / epidemiology
Awareness*
Blood Pressure*
Cross-Sectional Studies
Female
Humans
Hypertension / epidemiology*
Hypertension / psychology
Male
Middle Aged
Prevalence
Retrospective Studies
Risk Factors
Rural Health*
Sex Distribution
Sex Factors
Urban Health*

Abstract

Publication types

MeSH terms

Grants and funding