Hypertension awareness, treatment and control in Africa: a systematic review

Prevalence of uncontrolled hypertension and contributing factors in Ethiopia: a systematic review and meta-analysis

Background

Uncontrolled hypertension (HTN) is a major risk factor for cardiovascular and cerebrovascular disease. The prevalence of HTN in the Ethiopian adult population is almost 20%.This study aimed to determine the prevalence of uncontrolled HTN and its contributing factors among patients with HTN in Ethiopia undergoing treatment.

Methods

Electronic bibliographic databases such as PubMed, Google Scholar, Hinari (Research4Life), Embase, and Scopus were searched for original records in the English language that assessed HTN control in Ethiopia and were available before 29 June 2023. The data were extracted using a format prepared in Microsoft Excel and exported to the software STATA 17.0 for analysis. The study protocol was registered at PROSPERO with the reference number CRD42023440121.

Results

A total of 26 studies with 9,046 patients with HTN were included in the systematic review and meta-analysis, of which 11 studies were used to assess factors contributing to uncontrolled blood pressure (BP) in patients in Ethiopia. The estimated prevalence of uncontrolled HTN in the population of Ethiopia is 51% [95% confidence interval (CI), 42%-60%]. The subgroup analysis, based on the assessment tools, region, and follow-up period, revealed that the prevalence of uncontrolled BP was highest following the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) (89%; 95% CI: 87%-91%) and in Addis Ababa (58%; 95% CI: 40%-76%), and the lowest proportion of uncontrolled BP was in the 3-month follow-up period (34%; 95% CI: 29%-39%). The presence of diabetes mellitus showed the highest impact (pooled odds ratio: 5.19; CI: 1.41-19.11) for uncontrolled HTN. The univariate meta-regression method confirmed that the sample size, year of publication, and subgroups were not sources of heterogeneity in the pooled estimates. Egger's regression test did not indicate the presence of publication bias.

Conclusion

More than half of the hypertensive patients in Ethiopia have uncontrolled BP. Diabetes mellitus, advanced age, male sex, and the presence of comorbidities are among the factors contributing to uncontrolled HTN in Ethiopia. The concerned bodies working in this area should implement interventional strategies and recommendations that might be helpful in achieving optimal BP in hypertensive patients.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440121, PROSPERO (CRD42023440121).

The Association Between Alcohol Use and Chronic Diseases' Treatment Outcomes Among Adults Aged 40 Years and Above in Rural South Africa

Chronic diseases are significant problems in South Africa. Chronic diseases' treatment outcomes are critical to the reduction of morbidity and mortality. There is limited data in South Africa on alcohol use and treatment outcomes of chronic diseases in older people. We analysed data from wave 1 of the Health and Ageing in Africa-a longitudinal Study in an INDEPTH community (HAALSI) study. We performed descriptive analysis to determine the prevalence of optimal chronic diseases' treatment outcomes (suppressed HIV viral load, normal blood pressure and normal blood sugar) and applied multivariate modified Poisson regression to determine the association between alcohol use and chronic diseases' treatment outcomes. The prevalence of optimal treatment outcomes were 87.4% for HIV, 42.7% for hypertension, 53.6% for diabetes mellitus and 52.4% for multimorbidity. Alcohol use did not negatively impact the treatment outcomes for HIV (aRR=1.00, 95%CI:0.93-1.09), hypertension (aRR=0.88, 95%CI:0.68-1.14), diabetes mellitus (aRR=0.73, 95%CI:0.44-1.22), and multimorbidity (aRR=1.00, 95%CI:0.93-1.09). Alcohol use was not significantly associated with treatment outcomes possibly due to underreporting of alcohol use. There is need to incorporate objective alcohol measurements in chronic diseases care settings. Furthermore, there is urgent need to strengthen the management of hypertension and diabetes, by adopting the strategies deployed for HIV management.

Current perspectives on prevention of vascular cognitive impairment and promotion of vascular brain health

INTRODUCTION

The true global burden of vascular cognitive impairment (VCI) is unknown. Reducing risk factors for stroke and cardiovascular disease would inevitably curtail VCI.

AREAS COVERED

The authors review current diagnosis, epidemiology, and risk factors for VCI. VCI increases in older age and by inheritance of known genetic traits. They emphasize modifiable risk factors identified by the 2020 Lancet Dementia Commission. The most profound risks for VCI also include lower education, cardiometabolic factors, and compromised cognitive reserve. Finally, they discuss pharmacological and non-pharmacological interventions.

EXPERT OPINION

By virtue of the high frequencies of stroke and cardiovascular disease the global prevalence of VCI is expectedly higher than prevalent neurodegenerative disorders causing dementia. Since ~ 90% of the global burden of stroke can be attributed to modifiable risk factors, a formidable opportunity arises to reduce the burden of not only stroke but VCI outcomes including progression from mild to the major in form of vascular dementia. Strict control of vascular risk factors and secondary prevention of cerebrovascular disease via pharmacological interventions will impact on burden of VCI. Non-pharmacological measures by adopting healthy diets and encouraging physical and cognitive activities and urging multidomain approaches are important for prevention of VCI and preservation of vascular brain health.

Effect and prediction of physical exercise and diet on blood pressure control in patients with hypertension

The study aims to explore the current status of hypertension control and its predictors in patients with hypertension in China and provide evidence for preventing and controlling hypertension. A questionnaire survey was conducted among 300 hypertensive patients who visited the Second Affiliated Hospital of Anhui Medical University from February 20, 2023 to March 11, 2023. The patients were divided into a well-controlled group and an untargeted-control group according to their hypertension control status. A total of 294 subjects, including 83 in the well-controlled group and 211 in the untargeted-control group, were included in the analysis. Multivariate logistic regression analysis showed that hypertensive patients with high BMI and family history of hypertension were risk factors for hypertension control. Married status was a protective factor for hypertension control. SVM optimized the model with γ = 0.001 and a penalty factor of C = 0.001. The prediction accuracy of the final model was 80.9%. The findings indicated that BMI, family history of hypertension, and marital status were independent predictors of blood pressure control. Further studies are warranted to illustrate potential mechanisms for improving hypertensive patients' blood pressure control.

Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model

Objective

Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level.

Methods

This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively.

Results

Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (βdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (βindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects.

Conclusion

A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.

Diabetes health care specific services readiness and availability in Kenya: Implications for Universal Health Coverage

Diabetes is a major cause of morbidity and mortality worldwide yet preventable. Complications of undetected and untreated diabetes result in serious human suffering and disability. It negatively impacts on individual's social economic status threatening economic prosperity. There is a scarcity of data on health system diabetes service readiness and availability in Kenya which necessitated an investigation into the specific availability and readiness of diabetes services. A cross sectional descriptive study was carried out using the Kenya service availability and readiness mapping tool in 598 randomly selected public health facilities in 12 purposively selected counties. Ethical standards outlined in the 1964 Declaration of Helsinki and its later amendments were upheld throughout the study. Health facilities were classified into primary and secondary level facilities prior to statistical analysis using IBM SPSS version 25. Exploratory data analysis techniques were employed to uncover the distribution structure of continuous study variables. For categorical variables, descriptive statistics in terms of proportions, frequency distributions and percentages were used. Of the 598 facilities visited, 83.3% were classified as primary while 16.6% as secondary. A variation in specific diabetes service availability and readiness was depicted in the 12 counties and between primary and secondary level facilities. Human resource for health reported a low mean availability (46%; 95% CI 44%-48%) with any NCDs specialist and nutritionist the least carder available. Basic equipment and diagnostic capacity reported a fairly high mean readiness (73%; 95% CI 71%-75%) and (64%; 95%CI 60%-68%) respectively. Generally, primary health facilities had low diabetic specific service availability and readiness compared to secondary facilities: capacity to cope with diabetes increased as the level of care ascended to higher levels. Significant gaps were identified in overall availability and readiness in both primary and secondary levels facilities particularly in terms of human resource for health specifically nutrition and laboratory profession.

Exploring health promotion efforts for non-communicable disease prevention and control in Ghana

Noncommunicable diseases (NCDs) are a growing public health challenge in Ghana. Health promotion can provide useful avenues to reduce the incidence of NCDs in the country. We used the Ottawa Framework to assess health promotion efforts for the prevention and control of NCDs in Ghana. Data were collected using key informant interviews and documentary sources. A content analysis approach was adopted for data analysis using Nvivo 11 Software. We found a strong policy framework for NCD prevention in Ghana with the ratification of several international protocols and resolutions and the development of national and specific NCD-related policies. Implementation of these policies, however, remains achallenge due to limited resources and the overconcentration on communicable diseases. Attempts have been made to create a supportive environment through increased access to NCD services but there are serious challenges. Respondents believe the current environment does not support healthy eating and promotes unhealthy use of alcohol. The Community-based Health Planning and Services (CHPS) program engenders community participation in health but has been affected by inadequate resources. Personal skills and education programs on NCDs are erratic and confined to a few municipalities. We also found that NCD services in Ghana continue to be clinical and less preventative. These findings have far-reaching implications for practice and require health planners in Ghana to pay equal attention in terms of budgetary allocations and other resources to both NCDs and communicable diseases.

Prevalence of hypertension in a rural community in southeastern Nigeria; an opportunity for early intervention

Hypertension is a leading cause of non-communicable morbidity in Sub Saharan Africa. Recent studies suggest and increase in the prevalence of hypertension in rural Sub-Saharan Africa. Using a three-phase approach, a structured questionnaire was used to determine the prevalence of hypertension in a rural settlement is Enugu State, Southeast Nigeria. Blood pressure measurement was done according to the guidelines of the European Society of Hypertension. Out of 1576 participants aged 18 years and above, 1082 (68.7%) completed the full survey, their blood pressure was measured, and data analyzed. The prevalence of hypertension in this study was 27.6%, (95%CI 25-30.4), similar in males 29.2, (95%CI 24.7-30.4) and females 26.8%, (95%CI 23.5-30.2). p = 0.39. The prevalence of hypertension increased with age reaching a peak of 32.8% (95%CI 26.2-40) in the 40-49 age group, however this was not statistically significant P = 0.22. This age-related increase in the prevalence of hypertension tended towards significance in males (p = 0.05) but not in females (p = 0.44). Awareness of hypertension was 7.2%. Systolic blood pressure positively correlated with older age, higher blood glucose levels and waist-hip ratio. Diastolic blood pressure correlated with the type of work the patients is involved in and blood glucose levels. In conclusion, the prevalence of hypertension in a rural southeastern Nigeria community was 27.6%, however awareness was very low (7.9%). Most participants had mild hypertension thus offering a window of opportunity for public health educators in preventing the complications of hypertension. There is therefore the need for awareness campaigns to be intensified in rural communities.

Spectrum of cardiac diseases among young and older adults defined by echocardiography at Jakaya Kikwete Cardiac Institute: A prospective cross-sectional study

BACKGROUND

Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide, with data showing an increasing trend. Previously uncommon, CVDs of lifestyle are now increasing in many Sub-Sahara African (SSA) countries including Tanzania. The study aimed at determining the spectrum and distribution of CVDs among young (< 45 years) and older (≥ 45 years) adults referred for echocardiography at Jakaya Kikwete Cardiac Institute (JKCI).

METHODS

Hospital-based cross sectional study was conducted among adult patients referred for echocardiography at JKCI between July and December 2021. Patient's socio-demographic and clinical characteristics were recorded. CVD diagnoses were made using established diagnostic criterias. Comparisons were done using chi-square test and student's t-test. Multivariable logistic regression analysis was used to determine factors associated with abnormal echocardiography. A significance level was set at p-value < 0.05.

RESULTS

In total 1,050 patients (750 old and 300 young adults) were enrolled. The mean ± SD age was 62.2 ± 10.4 years and 33.5 ± 7.4 years for older and young adults respectively. Hypertension was the commonest indication for echocardiography both in the young (31%) and older (80%) adults. Majority of older adults were found to have abnormal echocardiography (90.7%), while only 44.7% of the young adults had abnormal echocardiography (p < 0.001). For the older adults, the commonest diagnoses were HHD (70.3%), IHD (9.7%), and non-ischemic cardiomyopathy (6.1%) while for young adults, HHD (16.7%), non-ischemic cardiomyopathy (8%), RHD (8%) and MVP (4.3%) were the commonest. The differences in the echocardiographic diagnoses between young and older adults were statistically significant, p < 0.001. Being an older adult, hypertensive, overweight/obese were independently associated with abnormal echocardiography (p < 0.01).

CONCLUSION

Hypertensive heart disease is the most common diagnosis among adult patients referred for echocardiography at JKCI, both in young and older adults. Primary prevention, early detection and treatment of systemic hypertension should be reinforced in order to delay or prevent its complications.

Prevalence of Cardiovascular Risk Factors among Young Adults (18-25 Years) in Mozambique

The life course development of cardiovascular diseases (CVDs) and the undergoing epidemiological transition in Mozambique highlight the importance of monitoring the cardiovascular risk profile in young adults. Therefore, this study aims to estimate the prevalence of CVD risk factors in a population aged 18-25 years living in Mozambique. A total of 776 young adults from a nationally representative sample were evaluated in 2014/2015 following the World Health Organization's STEPwise approach to chronic disease risk factor surveillance. Current smoking was the most prevalent among rural men (10.8%, 95%CI: 6.3-17.8), and drinking was most prevalent among urban men (38.6%, 95%CI: 29.3-48.8). The proportion of young adults not engaging in at least 75 min of vigorous physical activity per week ranged between 14.5% in rural men and 61.6% in urban women. The prevalence of being overweight/obese and hypertension were highest among urban women (21.6%, 95%CI: 14.7-30.6) and urban men (25.2%, 95%CI: 15.9-37.6), respectively. Education >8 years (vs. none) was independently associated with lower odds of being a current smoker, and increased monthly household income was associated with increased odds of low levels of physical activity. This study shows that important CVD risk factors are already common in the young adult population of Mozambique.

Determinants of Self-Care and Home-Based Management of Hypertension: An Integrative Review

Introduction

Patients with hypertension should perform diverse self-care activities that incorporate medication adherence and lifestyle modification, such as no smoking or alcohol, weight reduction, a low-salt diet, increased physical activity, increased self-monitoring, and stress reduction, for effective management at home.

Aim

This systematic review assessed and synthesized the factors that are associated with self-care and home-based management of hypertension.

Methods

The search of the articles incorporated the population, intervention, comparison, and outcome (PICO) framework. The literature was searched in four databases (PubMed, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, and Web of Science) until 2022. The articles retrieved and searched from the reference list (531) were transported to EndNote version 20, and duplicates (19) were identified and removed to produce 512 titles. Following the eventual title, abstracts, and full-text screening, 13 articles were appropriate for this study. The narrative and thematic data analysis were used to analyze and integrate the data.

Results

The analysis showed five themes were associated with home-based self-care and blood pressure (BP) control among patients diagnosed with hypertension. These themes that emerged were (1) the prevalence of control of BP, (2) sociodemographic factors, (3) treatment-related factors, (4) knowledge of management, and (5) knowledge of the prevention of risk factors of hypertension. The demographic factors influencing home-based self-care for hypertension were gender, age, and socioeconomic status. In contrast, the treatment factors were duration of hypertension treatment, medication burden, and medication adherence. Other factors that influenced self-care were inadequate knowledge of BP management, follow-up care, and risk factors of hypertension.

Conclusion

Hypertension self-care interventions must incorporate individual, societal, and cultural perspectives in increasing knowledge and improving home-based hypertension management. Therefore, well-designed clinical and community-dwelling interventions should integrate personal, social, and cultural perspectives to improve behavior in the home management of hypertension by increasing knowledge and self-efficacy.

Early Stage and Established Hypertension in Sub-Saharan Africa: Results From Population Health Surveys in 17 Countries, 2010-2017

BACKGROUND

Multiple studies have reported a high burden of hypertension in sub-Saharan Africa, but none have examined early stage hypertension. We examined contemporary prevalence of diagnosed, treated, and controlled stage I (130-139/80-89 mm Hg) and II (≥140/90 mm Hg) hypertension in the general population of sub-Saharan Africa.

METHODS

We analyzed World Health Organization STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance surveys from 17 sub-Saharan Africa countries including 85 371 respondents representing 85 million individuals from 2010 to 2017. We extracted demographic variables, blood pressure, self-reported hypertension diagnosis/awareness, and treatment status to estimate prevalence of stage I and II hypertension and treatment by country. We examined diagnosis and treatment trends by national sociodemographic index, a marker of development.

RESULTS

Stage I hypertension prevalence (regardless of diagnosis/treatment) was >25% in 13 of 17 countries, highest in Sudan (35.3% [95% CI, 33.7%-37.0%]), and lowest in Eritrea (20.2% [18.8%-21.6%]). Combined stages I and II hypertension prevalence was >50% in 13 countries; <20% were diagnosed in every country. Treatment among those diagnosed ranged from 26% to 63%, and control (<140/90 mm Hg) from 4% to 17%. In 8 of 9 countries reporting on behavioral interventions (eg, salt reduction, weight loss, exercise, and smoking cessation), <60% of diagnosed individuals received counseling. Rates of diagnosis, but not treatment, were positively associated with sociodemographic index (P=0.008), although there was substantial variation between countries even at similar levels of development.

CONCLUSIONS

Hypertension is common in sub-Saharan Africa but rates of diagnosis, treatment, and control markedly low. There is a large population with early stage hypertension that may benefit from behavioral counseling to prevent progression. Our analyses suggest that success in population hypertension care may be achieved independently of socioeconomic development, highlighting a need for policymakers to identify best practices in those countries that outperform similar or more developed countries.

Prevalence of cardiovascular risk factors in active tuberculosis in Africa: a systematic review and meta-analysis

People with tuberculosis (TB) are at risk of major adverse cardiovascular events. We estimated the prevalence of cardiovascular risk (CVR) factors among people with active TB in Africa. This was a systematic review and meta-analysis of studies from Africa. We searched EMBASE, MEDLINE through PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, mRCTs, Clinical trials.gov, and International Clinical Trials Registry Platform from inception to 31st December 2021. Among 110 eligible studies, 79 (238,316 participants) were included in the meta-analysis for smoking, 67 (52,793 participants) for current alcohol use, 30 (31,450 participants) for hazardous alcohol use, 51 (37,879 participants) for diabetes mellitus (DM), 19 (18,211 participants) for hypertension and 18 (13,910 participants) for obesity. The pooled prevalence was 26.0% (95% confidence interval 22.0–29.0) for smoking, 30.0% (25.0–35.0) for any current alcohol use, 21.0% (17.0–26.0) for hazardous alcohol use, 14.0% (9.0–18.0) for hypertension, 7.0% (6.0–9.0) for DM, and 4.0% (2.0–5.0) for obesity. Cost-effective strategies are needed to screen for CVR factors among people with active TB in Africa.

Gamma glutamyl transferases in association with cardiovascular risk scores in non-diabetic hypertensive Cameroonians: preliminary data from HYRICCA study

Objective

The usefulness of gamma glutamyl transferase (GGT) as biomarker of cardiovascular risk (CVR) remains unexplored in sub-Saharan Africans. To evaluate their relevance on CVR assessment in non-diabetic hypertensive Cameroonians. This was a prospective cross-sectional study on non-diabetic hypertensive adults aged 57.7 ± 10 years (62% female), without evidence of acute or chronic liver disease, in which we assessed GGT levels and correlates it with validated CVR biomarkers, CVR scores (WHO risk score, Framingham 2008, ASCVD 2013, EuroSCORE 2003, and Reynolds score), and plasma atherogenic index (PAI).

Results

We found a positive but weak association between GGT and PAI on linear regression [0.004 (0.001; 0.007); p = 0.021], which was dependent of triglycerides levels (r = 0.17; p = 0.03). We did not find a significant association between GGT levels and the results of the CVR scores studied; Although being related to atherogenic risk, as reported in literature in non-sub-Saharan Africans, GGTs would be of little value for CVR assessment in our population.

Assessing descriptions of scalability for hypertension control interventions implemented in low-and middle-income countries: A systematic review

Background

The prevalence of hypertension continues to rise in low- and middle-income- countries (LMICs) where scalable, evidence-based interventions (EBIs) that are designed to reduce morbidity and mortality attributed to hypertension have yet to be fully adopted or disseminated. We sought to evaluate evidence from published randomized controlled trials using EBIs for hypertension control implemented in LMICs, and identify the WHO/ExpandNet scale-up components that are relevant for consideration during “scale-up” implementation planning.

Methods

Systematic review of RCTs reporting EBIs for hypertension control implemented in LMICs that stated “scale-up” or a variation of scale-up; using the following data sources PubMed/Medline, Web of Science Biosis Citation Index (BCI), CINAHL, EMBASE, Global Health, Google Scholar, PsycINFO; the grey literature and clinicaltrials.gov from inception through June 2021 without any restrictions on publication date. Two reviewers independently assessed studies for inclusion, conducted data extraction using the WHO/ExpandNet Scale-up components as a guide and assessed the risk of bias using the Cochrane risk-of-bias tool. We provide intervention characteristics for each EBI, BP results, and other relevant scale-up descriptions.

Main results

Thirty-one RCTs were identified and reviewed. Studies reported clinically significant differences in BP, with 23 studies reporting statistically significant mean differences in BP (p < .05) following implementation. Only six studies provided descriptions that captured all of the nine WHO/ExpandNet components. Multi-component interventions, including drug therapy and health education, provided the most benefit to participants. The studies were yet to be scaled and we observed limited reporting on translation of the interventions into existing institutional policy (n = 11), cost-effectiveness analyses (n = 2), and sustainability measurements (n = 3).

Conclusion

This study highlights the limited data on intervention scalability for hypertension control in LMICs and demonstrates the need for better scale-up metrics and processes for this setting.

Trial registration

Registration PROSPERO (CRD42019117750).

Case identification, retention and blood pressure control in Kenya

BACKGROUND

Prevalence of hypertension in Africa is rising but it remains underdiagnosed and poorly controlled. In Kenya, only 22% of individuals known to have hypertension were on treatment, and only 51.7% were controlled. This study will assess screening outcomes, retention and blood pressure (BP) control of a hypertension programme in Kenya.

DESIGN

This was a retrospective cohort study using data routinely collected between 2015 and 2018. All patients aged >18 years screened and treated in the programme were included.

RESULTS

Of 663,028 screening encounters, 70.4% were female; the median age was 34 years. Overall, 19% of the study population, mainly males and older persons, had high BP higher rates. Of 66,981 patients started on treatment, the majority were females (71.2%); the median age was 55 years. Only 12% of patients were reported as having been retained after 12 months, and 48.6% of patients on treatment 10.5-13.5 months after enrolment had controlled BP. Older age and treatment at primary care level were associated with better retention and females had better BP control.

CONCLUSIONS

The programme screened primarily females and younger individuals at lower risk. Retention was poor and close to half of patients retained had controlled BP. Hypertension programmes should target high-risk individuals, decentralise treatment, incorporate retention strategies and improve longitudinal data management.

Prevalence and control of hypertension among people living with HIV receiving care at a Nigerian hospital

INTRODUCTION

with the introduction of newer and safer antiretroviral drugs, HIV positive persons are now living longer. Consequently, cardiovascular diseases associated with ageing and chronic low grade inflammation due to the presence of the virus are increasingly found in this population. This study aimed to assess the prevalence and control of hypertension among people living with HIV (PLHIV) receiving care at a Nigerian hospital.

METHODS

this cross-sectional study was conducted as part of the Patient´s HIV Knowledge Questionnaire (PHKQ) validation study among HIV positive outpatients at the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria. Hypertension was self-reported and confirmed by a documented physician diagnosis in the patient´s case notes and/or self-reported use of antihypertensive medication. For each participant, the average of two close blood pressure (BP) measurements obtained using an automatic upper arm BP monitor was taken as the BP. Hypertension control was defined as SBP <140 mmHg and DBP <90 mmHg. Data were analysed using the Statistical Product and Service Solutions (SPSS) v.21.0. Results were considered significant at p < 0.05.

RESULTS

prevalence of hypertension among PLHIV was 24.9%. Age (OR = 1.112, CI = 1.074 - 1.151, p < 0.001), body mass index (OR = 1.087, CI = 1.024 - 1.154, p = 0.004) and duration on antiretroviral therapy (OR = 1.169, CI = 1.090 - 1.254, p < 0.001) significantly predicted hypertension. Only 19 (24.4%) participants had controlled hypertension.

CONCLUSION

hypertension is common among PLHIV seeking care at a Nigerian hospital. However, its control remains suboptimal. Regular screening for hypertension, its appropriate treatment and optimal control are essential in PLHIV.

Prevalence, awareness, treatment, and control of hypertension in Bissau, Western Africa

Hypertension is the leading preventable risk factor for cardiovascular diseases. In Guinea–Bissau there are no previous population‐based hypertension surveys. Therefore, the authors aimed to estimate the prevalence, awareness, treatment, and control of high blood pressure among adults living in Bissau. A sample (n = 973) of dwellers in Bissau, aged 18–69 years, was assembled through stratified and cluster sampling. Patients underwent face‐to‐face interviews and blood pressure measurements following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance. The prevalence of hypertension was 26.9%, and 51.4% of hypertensive individuals were aware of their condition, of whom 51.8% reported having received pharmacological treatment in the previous 2 weeks. Among the latter, 49.9% had blood pressure values below 140/90 mm Hg. These findings show that hypertension has become a major public health problem in Guinea‐Bissau, emphasizing the urgent need to develop and implement national strategies for the prevention and management of hypertension.

Unmet needs of hypertension care in Nigeria: results of the community action against non-communicable diseases (COMAAND) project preintervention survey

OBJECTIVE

Assessing the state of hypertension care remains the first step towards planning a robust health system needed to tackle the rising burden of hypertension. Prior to the commencement of the Community Action Against Non-Communicable Disease project, we assessed hypertension care using the hypertension care cascade (HCC). This will serve as a baseline to evaluate project performance upon completion.

METHODS

Hypertensive subjects were grouped into a mutually exclusive care cascade of 5 categories including unscreened and undiagnosed; screened but undiagnosed; diagnosed but untreated; treated but uncontrolled and treated with controlled hypertension.

RESULTS

Of the 372 participants, mean age 48.9 years, 161 (43.3%) were hypertensive, of whom only 12.0% had controlled blood pressure (BP). Among the 88.0% with uncontrolled BP,19.0% were unscreened and undiagnosed, 48.5% were screened but undiagnosed, 13.0% were diagnosed but untreated and 7.5% were treated but BP uncontrolled. The HCC demonstrates that 19% of the hypertensive patients were lost at the screening stage, 60% of those who were screened never diagnosed, 40% of those who were diagnosed did not receive treatment and 60% of those who were on treatment did not reach target BP.

CONCLUSION

Unmet need of hypertension care is substantially high, thus underpinning the need for intervention with a multifaceted approach.

Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study

OBJECTIVE

In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries.

SETTING

Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015.

PARTICIPANTS

Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departments MAIN OUTCOME MEASURE: We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control.

RESULTS

Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin-angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01).

CONCLUSION

Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.

Causes of medication non-adherence and the acceptability of support strategies for people with hypertension in Uganda: A qualitative study

BACKGROUND

Hypertension is the most common non-communicable disease in Uganda and its prevalence is predicted to grow substantially over the next several years. Rates of hypertension control remain suboptimal, however, due in part to poor medication adherence. There is a significant need to better understand the drivers of poor medication adherence for patients with non-communicable diseases and to implement appropriate interventions to improve adherence.

OBJECTIVE

The purpose of this study was two-fold. First, this study sought to understand what factors support or undermine patients' efforts to adhere to their hypertensive medications at baseline. Second, this study sought to explore the acceptability and feasibility of adherence interventions to both providers and patients.

METHODS

This study was conducted at a large, urban private hospital in Kampala, Uganda. We conducted key informant interviews with both providers and patients. We explored their beliefs about the causes of medication non-adherence while examining the acceptability of support strategies validated in similar contexts, such as: daily text reminders, educational materials on hypertension, monthly group meetings (i.e. "adherence clubs") led by patients or providers, one-on-one appointments with providers, and modified drug dispensing at the hospital pharmacy.

STUDY DESIGN AND PARTICIPANTS

Fifteen healthcare providers and forty-two patients were interviewed. All interviews were transcribed, and these transcripts were analyzed using the NVIVO software. We utilized a conventional content analysis approach informed by the Health Belief Model.

RESULTS

Of the proposed interventions, participants expressed particularly strong interest in adherence clubs and educational materials. Participants drew connections between these interventions and previously underexplored drivers of non-adherence, which included the lack of symptoms from untreated hypertension, fear of medication side effects, interest in traditional herbal medicine, and the importance of family and community support.

CONCLUSIONS

Both providers and patients at the facility recognized medication non-adherence as a major barrier to hypertension control and expressed interest in improving adherence through interventions that addressed context-specific barriers.

Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa

Background

Treatment and control of hypertension are associated with a substantial reduction in adverse cardiovascular disease outcomes. Although South Africa aims to reduce the burden of cardiovascular diseases, there is limited evidence on the hypertension care cascade (HCC) performance in rural areas where stroke and hypertension are high. This study estimated HCC performance and identified predictors of hypertension screening among adults in the Ingwavuma community of KwaZulu-Natal, South Africa.

Methods

This was a cross-sectional study. Data were collected using the WHO STEPwise approach to surveillance (STEPS) questionnaire from 400 adult participants, excluding pregnant women and those with physical or cognitive impairments. Three hundred and ninety-three participants had complete data, and 131 had high blood pressure. We calculated progression rates for screening, diagnosis, treatment and control of hypertension from the sub-sample of participants with high blood pressure and assessed the bivariate association between HCC stages and participant characteristics and their effect sizes. We used binary and multivariable logistic regression to identify predictors of hypertension screening.

Results

Eighty-eight per cent of participants reported prior screening for hypertension. However, only 53.5% of patients under pharmacological treatment for hypertension had controlled blood pressure. In bivariate regression, employed participants were 80.3% (COR = 0.197, 95% CI [0.042–0.921]) more likely to be screened. In multivariable regression, the likelihood of hypertension screening was 82.4% (AOR = 0.176, 95% CI [0.047–0.655]) lower among participants in a cohabiting union than single participants. Similarly, employed participants were 87.4% (AOR = 0.129, 95% CI [0.017–0.952]) less likely to be screened than their unemployed counterparts.

Conclusions

The considerable attrition from the HCC across socio-demographic categories indicates a need for community-wide interventions. Empowering health care workers for community-based health promotion and hypertension management through point-of-care diagnostic tools could improve HCC performance. Efforts to improve the HCC should also focus on social determinants of health, notably gender and formal educational attainment.

Nonadherence to Self-Care Practices, Antihypertensive Medications, and Associated Factors among Hypertensive Patients in a Follow-up Clinic at Asella Referral and Teaching Hospital, Ethiopia: A Cross-Sectional Study

Background

Hypertension is one of the most common noncommunicable diseases affecting several individuals globally. However, the level of nonadherence to self-care practices, antihypertensive medications, and associated factors among hypertensive patients in a follow-up clinic at Asella Referral and Teaching Hospital is unknown.

Objective

To assess the level of nonadherence to self-care practices, antihypertensive medications, and associated factors among hypertensive patients in a follow-up clinic at Asella Referral and Teaching Hospital, Arsi Zone, Oromia Regional State, Ethiopia, in 2020.

Methods

An institution-based cross-sectional survey was conducted on 115 hypertensive patients who visited the follow-up clinic at Asella Referral and Teaching Hospital from December 24, 2020, to January 15, 2021. Data were entered into EpiData version 4.2.0.0 and exported to SPSS version 21.0 for statistical analysis. Binary and multivariable logistic regression analysis was used to assess the presence of statistical association between dependent and independent variables.

Results

A total of 115 hypertensive patients were enrolled into the study, giving a response rate of 98.29%. The mean age of the study participants was 55.17 years (SD = 17.986). More than half of them (59 (51.3%)) were females. More than half of them (58 (50.4%)) were married. Nearly two-thirds of them (79 (68.7%)) had formal education. The level of nonadherence to self-care practices was 67.0% (n = 77, 95% CI: 60.0, 75.7). Meanwhile, the patient's level of nonadherence to antihypertensive medications was 16.5% (n = 19, 95% CI: 10.4, 24.3). The multivariable logistic regression analysis showed that age >45 years (AOR = 2.89, 95% CI: 1.16, 7.18), having no formal education (AOR = 1.67, 95% CI: 1.32, 3.74), and having ≤5 years' duration since diagnoses of hypertension (AOR = 1.56, 95% CI: 1.07, 3.25) were factors significantly associated with nonadherence to self-care practices. Being male (AOR = 2.09, 95% CI: 1.93, 9.59), being married (AOR = 4.22, 95% CI: 1.29, 13.76), and having an average monthly income of ≤2500 ETB (AOR = 1.58, 95% CI: 1.09, 7.08) were factors significantly associated with nonadherence to medications.

Conclusion

In the present study, the level of both nonadherence to self-care practices and antihypertensive medications was relatively high. There is a need to initiate programs that could create awareness about adherence to self-care practices and antihypertensive medications among hypertensive patients to improve their level of adherence.

Acceptability and feasibility of a mobile health application for blood pressure monitoring in rural Uganda

Background

Mobile technologies to improve blood pressure control in resource-limited settings are needed. We adapted and evaluated the acceptability and feasibility of PositiveLinks, a mobile phone application for self-monitoring, social support, and engagement in care for people living with HIV, among patients with hypertension in rural Uganda.

Methods

We enrolled adults on treatment for hypertension at Mbarara Regional Referral Hospital and Mbarara Municipal health center IV, southwestern Uganda. We provided and educated all participants on the use of PositiveLinks application and automated blood pressure monitors. We administered a baseline questionnaire and performed in-depth interviews 30 days later to explore acceptability, feasibility, medication adherence, social support, and blood pressure control.

Results

A total of 37 participants completed the interviews, mean age of 58 years (SD 10.8) and 28 (75.7%) were female. All participants embraced the PositiveLinks mobile app and were enthusiastic about self-monitoring of blood pressure, 35 (94.6%) experienced peer to peer support. Among the 35 participants non-adherent to medications at baseline, 31 had improved medication adherence. All except 1 of the 31(83.8%) who had uncontrolled blood pressure at baseline, had self-reported controlled blood pressure after 30 days of use of PositiveLinks.

Conclusion

Patients with hypertension in rural Uganda embraced the PositiveLinks mobile application and had improved medication adherence, social support, and blood pressure control. Further assessment of cost-effectiveness of the application in blood pressure control in resource-limited settings will be pursued in future studies.

Cost-effectiveness of a Community-based Hypertension Improvement Project (ComHIP) in Ghana: results from a modelling study

OBJECTIVE

To undertake a cost-effectiveness analysis of a Community-based Hypertension Improvement Project (ComHIP) compared with standard hypertension care in Ghana.

DESIGN

Cost-effectiveness analysis using a Markov model.

SETTING

Lower Manya Krobo, Eastern Region, Ghana.

INTERVENTION

We evaluated ComHIP, an intervention with multiple components, including: community-based education on cardiovascular disease (CVD) risk factors and healthy lifestyles; community-based screening and monitoring of blood pressure by licensed chemical sellers and CVD nurses; community-based diagnosis, treatment, counselling, follow-up and referral of hypertension patients by CVD nurses; telemedicine consultation by CVD nurses and referral of patients with severe hypertension and/or organ damage to a physician; information and communication technologies messages for healthy lifestyles, treatment adherence support and treatment refill reminders for hypertension patients; Commcare, a cloud-based health records system linked to short-message service (SMS)/voice messaging for treatment adherence, reminders and health messaging. ComHIP was evaluated under two scale-up scenarios: (1) ComHIP as currently implemented with support from international partners and (2) ComHIP under full local implementation.

MAIN OUTCOME MEASURES

Incremental cost per disability-adjusted life-year (DALY) averted from a societal perspective over a time horizon of 10 years.

RESULTS

ComHIP is unlikely to be a cost-effective intervention, with current ComHIP implementation and ComHIP under full local implementation costing on average US$12 189 and US$6530 per DALY averted, respectively. Results were robust to uncertainty analyses around model parameters.

CONCLUSIONS

High overhead costs and high patient costs in ComHIP suggest that the societal costs of ensuring appropriate hypertension care are high and may not produce sufficient impact to achieve cost-effective implementation. However, these results are limited by the evidence quality of the effectiveness estimates, which comes from observational data rather than from randomised controlled study design.

Mean blood pressure according to the hypertension care cascade: Analysis of six national health surveys in Peru

Background

While we have good evidence about the hypertension care cascade, we do not know the mean blood pressure (BP) in these groups. We described the mean BP in four groups based on the hypertension care cascade at the national and sub-national levels in Peru.

Methods

Descriptive analysis of six national health surveys. Blood pressure was measured twice and the second record herein analysed. We defined four groups: i) people with self-reported hypertension diagnosis receiving antihypertensive medication; ii) people with self-reported hypertension diagnosis not receiving antihypertensive medication; iii) people unaware they have hypertension with blood pressure ≥140 or 90 mmHg; and iv) otherwise healthy people.

Findings

There were 125,066 people; mean age was 49.8 years and there were more women (51.7%). At the national level, in men and women and throughout the study period, we observed that the mean systolic BP (SBP) was the highest in people unaware they have hypertension; the mean SBP was similar between those with and without antihypertension medication, yet slightly higher in the former group. At the sub-national level, even though the mean SBP in the unaware group was usually the highest, there were some regions and years in which the mean SBP was the highest in the untreated and treated groups.

Interpretation

These results complement the hypertension care cascade with a clinically relevant parameter: mean BP. The results point where policies may be needed to secure effective interventions to control hypertension in Peru, suggesting that improving early diagnosis and treatment coverage could be priorities.

Funding

Wellcome Trust (214185/Z/18/Z).

Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020

BACKGROUND

While there is a growing interest in antihypertensive medication rates among people with hypertension in low- and middle-income countries, little has been described about antihypertensive medication rates among eligible people based on the absolute cardiovascular risk approach. Following the risk-based approach, we described the proportion of eligible people receiving antihypertensive medication in Peru.

METHODS

Analysis of six (2015-2020) national health surveys. Absolute cardiovascular risk was computed with the 2019 WHO cardiovascular risk charts and based on local guidelines. Antihypertensive treatment allocation based on the absolute cardiovascular risk was defined using the Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings and the HEARTS guidelines by the WHO; we also followed the recommendations by local guidelines.

RESULTS

There were 120,059 people. Overall, according to the local guidelines the 17.9% of the population would be eligible for antihypertensive medication while this estimate was 8.1% based on the WHO guidelines. At the national level, depending on the guidelines, we observed a steady trend of eligible people receiving antihypertension medication (e.g., men, local guidelines), a decreasing trend (e.g., men, <60, local guidelines) or an increasing trend (e.g., men, ≥60, local guidelines). At the sub-national level, seventeen regions showed an increasing antihypertensive treatment rate based on the local guidelines; when based on the WHO guidelines, eleven regions showed a decreasing rate.

CONCLUSIONS

Peru needs to define a tool for surveillance of absolute cardiovascular risk and to monitor antihypertensive treatment allocation among high-risk people.

FUNDING

Wellcome Trust (214185/Z/18/Z).

Glutathione S-transferase M1 and T1 genes deletion polymorphisms and blood pressure control among treated essential hypertensive patients in Burkina Faso

OBJECTIVE

Glutathione S-transferases have been associated with experimental resistance to some drugs. The present study investigated the factors associated with blood pressure control in patients with essential hypertension, especially the role of GSTT1 and GSTM1 genes polymorphisms. This cross-sectional study in Burkina Faso consisted of 200 patients with essential hypertension and under treatment.

RESULTS

In the present study, 57.5% (115/200) of patients had their hypertension under control. No statistically significant difference was found between controlled and uncontrolled groups for anthropometric and biochemical parameters as well as for GSTT1 or GSTM1 gene polymorphisms (all p > 0.05). Current alcohol consumption (OR = 3.04; CI 1.88-6.13; p < 0.001), Physical inactivity (OR = 3.07; CI 1.71-5.49; p < 0.001), severe hypertension before any treatment (Grade III [OR = 3.79; CI 2.00-7.17; p < 0.001]) and heart damage (OR = 3, 14; CI 1.59-6.02; p < 0.001) were statistically more frequent in uncontrolled essential hypertensive patients than controlled hypertensive patients.

Prevalence of Hypertension and Associated Factors Among Public Servants in North Wollo Zone, Amhara Region, Ethiopia, 2020

Background

The leading preventable risk factor for premature death and disability worldwide is hypertension. Globally, 31.1% of adults (1.39 billion people) have hypertension and 9.4 million deaths are recorded annually, accounting for 13% of overall mortality.

Objective

The objective of this study is to assess the prevalence of hypertension and associated factors among public servants in North Wollo Zone, Amhara Region, Ethiopia.

Materials and Methods

An institutional-based cross-sectional study was conducted among 627 public servants. To classify candidate variables for multivariable logistic regression, a binary logistic regression model was applied. In order to analyze factors associated with hypertension among participants, all variables with a P-value<0.2 were entered into the multivariable logistic regression model. In order to determine statistical significance, a p value of less than 0.05 was taken. The assumptions of Chi square and multi-collinearity were verified. For model fitness, the Hosmer–Lemeshow goodness-of-fit was checked.

Results

The total hypertension rate was 27.6% (95% CI: 24.1–31.3). The prevalence was higher in males 129 (32.5%) than in females 444 (19.1%). History of diabetes mellitus (AOR= 9.64, 95% CI: 3.20–29.30), age >35 years (AOR= 2.94, 95% CI: 1.91–4.51) and body mass index 25kg/m² and above (AOR= 3.44, 95% CI: 2.21–5.34) have been found to be separately associated with hypertension.

Conclusion and Recommendation

Among public servants in the study setting (study area), hypertension has become a major public health issue. Half of the newly reported cases is hypertensive. The conclusion of this study calls for a more holistic approach to hypertension in terms of hypertension prevention, screening, and proper management.

Seasonal and socio-demographic patterns of self-reporting major disease groups in north-west Burkina Faso: an analysis of the Nouna Health and Demographic Surveillance System (HDSS) data

Background

Sub-Saharan Africa (SSA) is facing a rapid growth of non-communicable diseases (NCDs), while communicable diseases still prevail. For rural SSA, evidence for this development is scarce. We aimed at quantifying self-reported major disease groups according to season, and determining the associations with socio-economic factors in rural Burkina Faso.

Methods

This study used data of 4192 adults (age range: 18–101 years; male: 49.0%) from the Nouna Health and Demographic Surveillance System (HDSS) in north-west Burkina Faso, rainy season of 2010 and dry season of 2011. We assessed the proportions and their 95% confidence intervals (CIs) of self-reported major disease groups as defined by the World Health Organization. For their associations with socio-economic factors, odds ratios (OR), 95% CIs and p-values were calculated by logistic regression.

Results

The surveys were completed by 3949 adults in 2010 (mean age: 37.5 ± 14.9 years, male: 48.8%) and by 4039 adults in 2011 (mean age: 37.3 ± 16.2 years, male: 49.1%). The proportions of self-reported communicable diseases were 20.7% (95% CI: 19.4–21.9%) in the rainy season and 11.0% (10.0–11.9%; McNemar’s p < 0.0001) in the dry season. Self-reported NCDs amounted to 5.3% (4.6–6.0%) and 4.5% (3.8–5.1%; p = 0.08), respectively. In each year, less than 1% reported injuries (p = 0.57). Few individuals reported an overlap of communicable diseases and NCDs: 1.4% in 2010 and 0.6% in 2011. In the multiple-adjusted models, formal education (vs. lack of education) showed the strongest association with self-reporting of communicable diseases in both seasons. For NCD-reporting, non-manual occupation (vs. manual) was positively associated, only in the rainy season.

Conclusions

Self-reporting of communicable diseases is subject to seasonal variation in this population in north-west Burkina Faso. The exact reasons for the low overall self-reporting of NCDs and injuries, apart from a low socio-demographic position, require further investigation.

Examining the Relationship Between Occupational Physical Activity and Hypertension Status: Evidence from the Ghana WHO Study on Global Ageing and Adult Health

The employment landscape has changed significantly over the past few years in emerging economies including Ghana where many people are rapidly transitioning from livelihood activities that originally involved physical exertion to work environments where performance of duties are mostly non-physical. Working under non-active conditions could, however, exacerbate the risk of developing chronic diseases that are increasingly becoming problematic in many developing countries. Drawing on a cross-sectional nationally representative sample data of 4425 adult Ghanaian workers collected by the WHO Study on Global Ageing and Adult Health in developing countries, we examined the relationship between occupational physical activity and hypertensive status. We employed the complementary log-log analysis technique to build nested models with results presented in odds ratios. After controlling for several relevant variables, the results show that performing sedentary related work (AOR = 1.23, CI = 1.06-1.42) is significantly associated with a higher likelihood of being hypertensive compared with those whose work involved moderate physical activity. Other factors that were significantly associated with being hypertensive included tobacco use (AOR = 1.33, CI = 1.05-1.70), living in an urban environment (AOR = 1.15, CI = 1.01-1.32), and being a female (AOR = 1.18, CI = 1.01-1.37) and being an older person. Policies on reducing the risk of developing chronic conditions especially hypertension need to recognize the contributions of the work environment in emerging developing economies.

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009-2010 and 2018-2019: is there evidence of changing prevalence?

INTRODUCTION

Although limited, existing epidemiological data on dementia in sub-Saharan Africa indicate that prevalence may be increasing; contrasting with recent decreases observed in high-income countries. We have previously reported the age-adjusted prevalence of dementia in rural Tanzania in 2009-2010 as 6.4% (95% confidence interval [CI] 4.9-7.9) in individuals aged ≥70 years. We aimed to repeat a community-based dementia prevalence study in the same setting to assess whether prevalence has changed.

METHODS

This was a two-phase door-to-door community-based cross-sectional survey in Kilimanjaro, Tanzania. In Phase I, trained primary health workers screened all consenting individuals aged ≥60 years from 12 villages using previously validated, locally developed, tools (IDEA cognitive screen and IDEA-Instrumental Activities of Daily Living questionnaire). Screening was conducted using a mobile digital application (app) on a hand-held tablet. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM-5 criteria and diagnoses subsequently confirmed by consensus panel.

RESULTS

Of 3011 people who consented, 424 screened positive for probable dementia and 227 for possible dementia. During clinical assessment in Phase II, 105 individuals met DSM-5 dementia criteria. The age-adjusted prevalence of dementia was 4.6% (95% CI 2.9-6.4) in those aged ≥60 years and 8.9% (95% CI 6.1-11.8) in those aged ≥70 years. Prevalence rates increased significantly with age.

CONCLUSIONS

The prevalence of dementia in this rural Tanzanian population appears to have increased since 2010, although not significantly. Dementia is likely to become a significant health burden in this population as demographic transition continues.

Combined management can decrease blood pressure: an investigation of health-seeking behaviors among hypertensive patients in urban communities in China

Background

Hypertensive patients can freely choose informal medical facilities, such as pharmacies, community health service centres, and cardiology clinics in secondary or tertiary hospitals, as routine places for medical treatment in China currently. The proportions, influencing factors and effects of different health-seeking behaviours on blood pressure (BP) among hypertensive patients in urban communities are not clear. The aim of the study was to investigate health-seeking behaviours and the effects of different health-seeking behaviours on BP among hypertensive patients in urban communities in China.

Methods

A cross-sectional survey of hypertension was conducted in urban communities in Chengdu. A total of 437 hypertensive patients seeking medical help regularly were sequentially enrolled to complete a the questionnaire on health-seeking behaviours.

Results

The average age was 67.1 ± 7.5 years old. The control rate of BP was 41.0%, and the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 144.2 ± 17.9 mm Hg and 75.4 ± 10.4 mm Hg, respectively. Among the hypertensive patients investigated, 62.8% chose community health service centre, 5.2% chose informal medical facilities, 21.5% chose cardiology clinics in secondary or tertiary hospitals, and 10.5% chose both community health service centre and cardiology clinics as the usual places for medical treatment. There were significant differences in education levels, proportions of home BP monitoring, establishment of chronic disease archives in the community, medication adherence and side effects of drugs among the four groups. The control rates of BP were 39.4%, 23.8%, 43.0% and 54.8% (P = 0.100), respectively. The SBPs were 145.1 ± 18.0, 150.9 ± 19.8, 143.8 ± 17.5 and 136.3 ± 15.1 mm Hg (P = 0.007), respectively, and it was significantly lower in the combined management group than in the other three groups. Compared with patients choosing community health service centre, patients in the combined management group had a significantly lower BP level (β = −0.119, P = 0.038) adjusting for age, sex, education level, establishment of chronic disease archives, medication adherence and number of antihypertensive drugs.

Conclusions

Combined management with both community health service centre and higher-level hospitals can decrease BP.

Self-Care Practice and Associated Factors among Hypertensive Patients in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Hypertension is one of the leading causes of morbidity and mortality in developing countries including Ethiopia. Self-care practice has been provided as one of the most important preventive mechanisms of hypertension and is considered as a basic treatment for hypertension. There is no national-level study that assesses hypertensive self-care practice in Ethiopia. Therefore, this study aimed to assess the pooled level of hypertensive self-care practices and associated factors in Ethiopia.

METHODS

This study was carried out using published and unpublished articles accessed from databases: PubMed/MEDLINE, HENARI, Google Scholar, Web of Science, Scopus, African Journals, and university repositories. Data were extracted using a standard data extraction format. Data analysis was carried out using STATA version 11. Heterogeneity across the included studies was assessed using Cochrane's Q statistics and I 2 test with its corresponding p values. Publication bias was determined using Egger's test and presented with a funnel plot. The pooled level of hypertensive self-care practice was estimated using a random-effects meta-analysis model.

RESULTS

This systematic review included 17 cross-sectional studies with 5,248 study participants. The overall pooled level of self-care practice among hypertensive patients in Ethiopia was 41.55% (95% CI 33.06, 50.05). Participant formal education (AOR = 2.82; 95% CI 2.18, 3.64) and good knowledge of hypertension (AOR = 4.04; 95% CI 2.19, 7.44) were significantly associated with self-care practice among hypertensive patients in Ethiopia.

CONCLUSION

In this study, more than half of hypertensive patients had poor hypertensive self-care practice in Ethiopia. Participant's formal education and good knowledge of hypertension were significantly associated with self-care practice among people living with hypertension in Ethiopia. Therefore, based on the evidence of this study, we recommended that programmers and policymakers should enhance the awareness of hypertensive patients on self-care practice domains and strengthen local programs working on noncommunicable diseases.

Prevalence and 1-year incidence of HIV-associated neurocognitive disorder (HAND) in adults aged ≥50 years attending standard HIV clinical care in Kilimanjaro, Tanzania

OBJECTIVES

HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV (PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combination antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimed to estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults under long-term follow-up in Tanzania and report cognitive comorbidities.

DESIGN

Longitudinal study.

PARTICIPANTS

A systematic sample of consenting HIV-positive adults aged ≥50 years attending routine clinical care at an HIV Care and Treatment Centre during March-May 2016 and followed up March-May 2017.

MEASUREMENTS

HAND by consensus panel Frascati criteria based on detailed locally normed low-literacy neuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history. Demographic and etiological factors by self-report and clinical records.

RESULTS

In this cohort (n = 253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9-53.2, n = 119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these, 64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and 9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but some reversibility (17.6%, 95% CI 10.0-28.6 n = 16) was observed.

CONCLUSIONS

HAND appear highly prevalent in older PLWH in this setting, where demographic profile differs markedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high. Future studies should focus on etiologies and potentially reversible factors in this setting.

Chronic Disease in the Community (CDCom) Program: Hypertension and non-communicable disease care by village health workers in rural Uganda

Background

Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics.

Objective/Methods

We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts.

Results/Conclusions

Of 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.

Prevalence and Correlates of Hypertension Unawareness among Lebanese Adults: The Need to Target Those “Left Behind”

Introduction. Hypertension unawareness is context-specific, and our understanding of factors associated with it has implications on primary healthcare practices locally and contributes to achieving cardiovascular disease (CVD) targets, globally. In this study, we examine the prevalence and correlates of hypertension unawareness among adult Lebanese population. Methods. The study sample included a nationally representative sample of 2214 adults ≥25 years of age from the Noncommunicable Disease (NCD) Risk Factor WHO-STEPS cross-sectional survey conducted in Lebanon. In the first step, hypertension was assessed based on reported morbidity using face-to-face interviews, and in the second step, based on blood pressure (BP) measurement. We defined hypertension prevalence as systolic/diastolic blood pressure ≥140/90 mmHg and/or ongoing treatment for hypertension. Hypertension unawareness was described as lack of prior knowledge of hypertensive status. Those responding negatively to the face-to-face interview question “whether they had ever been told by a health worker that they have hypertension” were labelled as “apparently healthy.” Results. Overall prevalence of hypertension was 30.7%. A total of 369 subjects were unaware of their condition, representing 51.8% of all hypertensives and 15.9% of the apparently healthy. Multivariable analysis controlling for a number of confounders showed that, among apparently healthy participants, insurance coverage and contact with healthcare services were not associated with higher likelihood for hypertension awareness. Among all hypertensives, hypertension unawareness was significantly higher in the young, those with BMI <25 kg/m2 (adjusted OR (aOR): 2.52; 95% CI: 1.35–4.69), no CVD (aOR: 3.30; 95% CI: 1.74–6.29), and participants with no reported family history of hypertension (aOR: 4.87; 95% CI: 2.89–8.22), compared to their counterparts. Conclusion. In Lebanon, unawareness of hypertension occurred in those clinically least perceived to be at risk. These findings are key for optimizing current screening practices and informing NCD prevention efforts in the country and contribute to achieving global targets of the SDGs of “leaving no one behind.”

An assessment of implementation science research capacity in Uganda

Background

In Uganda and other resource-poor countries, relevant research findings face a tortuous path to translation into policy and routine practice. Implementation science (ImSc) research could facilitate faster translation. Presently it is unclear what ImSc research capacity and possible training needs exist among Ugandan researchers. To assess both components, we interviewed potential trainees in Kampala, Uganda.

Methods

We used a cross-sectional design to survey potential ImSc trainees who had some research training and involvement in generating or utilizing research. Using a questionnaire, we documented eligibility for ImSc training, knowledge and interest in training, existing self-assessed confidence in initiating clinical research (SCICR) and self-assessed confidence in initiating ImSc research (SCIIR), availability for training and preferred modes of training. We developed scores from the Likert scales and used descriptive statistics, logistic regression and ordinal logistic regression to evaluate predictors of SCIIR.

Results

Between November 2016 and April 2017, we interviewed 190 participants; 60% were men, with a median age of 37 years. Among participants, 33% comprised faculty, 37% were graduate students and 30% were project staff. The majority of respondents knew about ImSc (73%) and were research-trained (80%). Only 9% reported any ImSc-related training. Previous ImSc training was associated with higher odds of a SCIIR score ≥ 75th percentile. Previous ImSc training compared to not having any training was associated with higher odds of reporting abilities in behaviour change theory integration (OR: 3.3, 95% CI: 1.3–8.5, p = 0.01) and framework use in intervention design and implementation (OR: 2.9, 95% CI: 1.1–7.4, p = 0.03), accounting for age, sex and current employment. In addition, 53% of participants preferred in-person (face-to-face) short ImSc courses compared to a year-long training, while 33% preferred online courses. Participants reported median availability of 6 hours per week (IQR: 4, 10) for training.

Conclusion

Most participants had some understanding of ImSc research, had research training and were interested in ImSc training. Those with previous ImSc training had better skills and SCIIR, compared to those without previous training. A hybrid approach with modular face-to-face training and online sessions would suit the preferences of most potential trainees.

Factors associated with hypertension in Pakistan: A systematic review and meta-analysis

BACKGROUND

High blood pressure is an important public health concern and the leading risk factor for global mortality and morbidity. To assess the implications of this condition, we aimed to review the existing literature and study the factors that are significantly associated with hypertension in the Pakistani population.

METHODS

We conducted several electronic searches in PubMed, ISI Web of Science, PsycINFO, EMBASE, Scopus, Elsevier, and manually searched the citations of published articles on hypertension from May 2019 to August 2019. We included all studies that examined factors associated with hypertension regardless of the study design. To assess the quality of the research, we used the Newcastle-Ottawa Quality Assessment Scale. We also conducted meta-analyses using the DerSimonian & Laird random-effects model to collate results from at least three studies.

RESULTS

We included 30 cross-sectional and 7 case-control studies (99,391 participants country-wide) in this review and found 13 (35.1%) to be high-quality studies. We identified 5 socio-demographic, 3 lifestyle, 3 health-related, and 4 psychological variables that were significantly associated with hypertension. Adults aged between 30-60 years who were married, living in urban areas with high incomes, used tobacco, had a family history of hypertension, and had comorbidities (overweight, obesity, diabetes, anxiety, stress, and anger management issues) were positively associated with hypertension. On the other hand, individuals having high education levels, normal physical activity, and unrestricted salt in their diet were negatively associated with hypertension.

CONCLUSION

We found several socio-demographic, lifestyle, health-related, and psychological factors that were significantly (positively and negatively) associated with hypertension. Our findings may help physicians and public health workers to identify high-risk groups and recommend appropriate prevention strategies. Further research is warranted to investigate these factors rigorously and collate global evidence on the same.

Analyzing Trio-Anthropometric Predictors of Hypertension: Determining the Susceptibility of Blood Pressure to Sexual Dimorphism in Body Stature

Background

Several studies had suggested that complex body stature could be a risk factor of hypertension.

Objectives

We aim to correlate body mass index (BMI), waist-hip ratio (WHR), and waist-height ratio (WHtR) of rural dwellers in Afikpo community, Ebonyi State, Nigeria, with blood pressure parameters. Furthermore, we aim to ascertain how each of the anthropometric variables affects blood pressure in men and women, respectively.

Materials and Methods

A sample of 400 (200 males and 200 females) adults aged 18–89 years were selected for the correlation cross-sectional study. Data for weight, height, waist, and hip circumferences were collected by means of anthropometric measurement protocol with the aid of a calibrated flexible tape and health scale and mercury sphygmomanometer for measurement of blood pressure. A participant was classified as being hypertensive if systolic blood pressure (SBP) was >140 mmHg and diastolic blood pressure (DBP) >90 mmHg. Pulse pressure was recorded as the numeric difference of SBP and DBP.

Results

The result revealed that male BMI and WHR were higher than those of females while female WHtR was higher than that of males (P < 0.01). The prevalence of hypertension failed to correlate with sex among participants in the study (χ² = 0.567; P < 0.05). Variation in SBP and DBP of both sexes was dependent on BMI, WHtR, and waist and hip circumference, but not on WHR. The SBP of both sexes and female pulse pressure did correlate with age (P < 0.001). Waist circumference, BMI, and WHtR correctly predicted the variations in SBP, DBP, and pulse pressure.

Conclusion

The strength of association of BMI, WHtR, and waist girth with SBP and DBP of both sexes was robust and similar, but inconsistent with WHR. Thus, a simple estimation of the trio-anthropometric predictors could serve as a means for routine check or preliminary diagnosis of a patient with hypertension.

Coverage and effectiveness of hypertension screening in different altitudes of Tibet autonomous region

BACKGROUND

Tibet is an autonomous region in China located around an average altitude of 4500 m above sea level. Since 2012 the local government of Tibet has been providing free physical examinations, including screening for hypertension. However, the coverage and effectiveness of this free program have not been uncovered. This study aims to assess the coverage and effectiveness of hypertension screening and management program in 3 altitude levels of Tibet, and also the determinants of the success of the screening program.

METHODS

A stratified cluster survey was conducted among 1636 residents aged 18 years or over in three different altitude areas in Tibet. We adjusted for age and sex based on national census data and used weighted logistic regression models to find factors associated with hypertension screening.

RESULTS

The coverage of the hypertension screening program evaluated by participation rate in the previous screening was 94.9%, while 24.7% (95% CI: 22.1-27.3%) of them were diagnosed with hypertension. Females and alcohol drinkers were more likely to be screened. Among those diagnosed with hypertension, 28.7% had it under control. High altitude areas had a high proportion of controlled hypertension. The overall rate of controlled hypertension in high, moderate and low altitude areas was 35.1% (95% CI: 24.8-45.3%), 32.7% (95% CI: 22.2-43.2%) and 23.7% (95% CI: 14.7-32.6%), respectively. Younger aged persons were more likely to have better control of their hypertension.

CONCLUSIONS

The coverage of hypertension screening in Tibet was high, especially in the low altitude areas. However, the effectiveness of hypertension control was low, indicating a need to implement the treatment adherence routines into the current screening interventions.

The role of dietary salt and alcohol use reduction in the management of hypertension

Introduction: Despite the improved treatment protocol of hypertension, the magnitude of the disease and its related burden remains raised. Hypertension makes up the leading cause of stroke, kidney disease, arterial disease, eye disease, and cardiovascular disease (CVD) growth. Areas covered: This review provides the overview of the role of dietary salt and alcohol use reduction in the management of hypertension, a brief history of alcohol, the vascular endothelium functions, the effects of alcohol use on blood pressure (BP), the mechanisms of alcohol, brief history of salt, the effects of dietary salt intake on BP, and the mechanisms of salt. Expert opinion: Studies found that high dietary salt intake and heavy alcohol consumption have a major and huge impact on BP while both of them have been identified to increase BP. Also, they raise the risk of hypertension-related morbidity and mortality in advance. On the other way, the dietary salt and alcohol use reduction in the management of hypertension are significant in the control of BP and its related morbidity and mortality. Further, studies suggested that the dietary salt and alcohol use reductions are the cornerstone in the management of hypertension due to their significance as part of comprehensive lifestyle modifications.

High prevalence of uncontrolled hypertension among patients with type 2 diabetes mellitus: a hospital-based cross-sectional study in Southwestern Uganda

INTRODUCTION

most patients with diabetes mellitus are prone to uncontrolled blood pressures despite effective medical therapies; only about 30% of hypertensive patients have their blood pressures controlled. Poor control of hypertension is associated with increased risk for cardiovascular mortality and morbidity. We aimed to determine the prevalence and associated factors of uncontrolled hypertension among patients with type 2 diabetes mellitus (T2DM) attending ambulatory care at Mbarara Regional Referral Hospital, Southwestern Uganda.

METHODS

we conducted a cross-sectional study from January to April 2019, among hypertensive T2DM patients. We used a structured questionnaire to obtain data on socio-demographic and clinical characteristics. We defined uncontrolled hypertension in participants with blood pressure ≥140/90mmHg and performed binary logistic regression to determine factors associated with uncontrolled hypertension.

RESULTS

we analyzed data of 206 hypertensive participants with concomitant T2DM, with a median age of 54 (IQR, 49-60) years, and median duration of diabetes of 4 (IQR, 3-8) years; 71% were female. The prevalence of uncontrolled hypertension was 82.5% (170/206). Isolated systolic hypertension (aOR=7.58; 95%CI: 2.18-26.36, P=0.001) and left ventricular hypertrophy (LVH) (aOR=5.38; 95%CI: 1.11-26.10, P=0.037) were significantly associated with uncontrolled hypertension.

CONCLUSION

this study revealed a high prevalence of uncontrolled hypertension among T2DM patients in Southwestern Uganda. Isolated systolic hypertension and LVH were the key factors associated with uncontrolled hypertension. We recommend optimization therapy to reduce the burden of uncontrolled hypertension among patients with T2DM especially in those with isolated systolic hypertension, and left ventricular hypertrophy, who are at higher cardiovascular risk.

Ambulatory Blood Pressure Profiles and Correlation with Cardiovascular Risk Factors in a Sample of 390 University Employees in Tanzania

Background

Hypertension is a major risk factor for cardiovascular morbidity and mortality. Increasingly, evidence suggests that 24-hour ambulatory blood pressure (BP) monitoring (ABPM) is more accurate than clinic BP in predicting cardiovascular risk. However, this association has not been widely studied in subSaharan Africa, especially in Tanzania.

Aim

To explore the relationship between 24-hour ABPM profiles and cardiovascular risk factors in comparison with clinic BP among Muhimbili University of Health and Allied Sciences (MUHAS) employees.

Methods

A descriptive cross-sectional study was conducted from October 2018 to February 2019. Socio-demographic and cardiovascular risk information was gathered. We used an automated ABPM device to record 24-hour ambulatory BP. Correlation between BP profiles and cardiovascular risk factors was done using Pearson’s correlation coefficient, and independent factors for hypertension were determined using logistic regression analysis. P-value of <0.05 was considered statistically significant.

Results

In total, 390 employees participated. Their mean age was 40.5 ± 8.9 years, and 53.6% were men. The mean office systolic and diastolic BP were 126±12 mmHg and 78±13 mmHg, respectively, while the corresponding values for mean 24-hour ABPM were 122±14 and 75±10 mmHg. The prevalence of hypertension was 23.1%. The prevalence of white coat hypertension was 16.2%, while masked hypertension and nocturnal non-dipping were present in 11.5 and 66.7%, respectively. Overall, the mean 24-hour systolic BP showed the strongest correlations with cardiovascular risk factors while mean office systolic BP showed least. Independent associated factors of hypertension were male gender, age ≥40 years, family history of hypertension, central obesity, raised cholesterol and uric acid levels, all p<0.01.

Conclusion

Compared to office BP, ABPM measurements had stronger correlations with cardiovascular risk factors in this population, and therefore likely to reflect true BP. ABPM has revealed high proportion of masked, white coat and nocturnal non-dipping, supporting use of ABPM to detect these clinically important BP profiles.

Porous and highly responsive cross-linked β-cyclodextrin based nanomatrices for improvement in drug dissolution and absorption

AIMS

Aim of the study was to enhance the solubility of Chlorthalidone by developing beta-cyclodextrin cross-linked hydrophilic nanomatrices.

MAIN METHODS

Nine different formulations were fabricated by free radical polymerization technique. All formulations were characterized through different studies. FTIR spectroscopy of unloaded and loaded nanomatrices was processed to determine compatibility of constituents and that of the drug with the system. Surface morphology of the nanomatrices was studied by SEM. The size of the optimized formulation was determined by zeta sizer. Swelling, in-vitro release and solubility studies were carried out in different media and results of in-vitro release profiles of nanomatrices and commercially available tablet of Chlorthalidone were compared. For determination of biocompatibility, toxicity studies were proclaimed in rabbits.

KEY FINDINGS

Main peaks of corresponding functional groups of individual constituents and that of drug were depicted in FTIR spectra of unloaded and loaded nanomatrices. Porous and fluffy structure was visualized through SEM images. Particle size of the optimized formulation was in the range of 175 ± 5.27 nm. Percent loading of optimized formulation showed the best result. Comparing the in-vitro drug release profiles of nanomatrices and commercially available tablet, the results of the synthesized nanomatrices were quite satisfactory. Solubility profiles were also high as compared to the drug alone. Moreover, toxicity studies confirmed that nanomatrices were biocompatible and no sign of any toxic effect was found.

SIGNIFICANCE

We concluded that our developed nanomatrices had successfully enhanced the solubility of Chlorthalidone and can also be used for other poorly aqueous soluble drugs.

Prevalence, risk factors, and management of uncontrolled hypertension among patients with diabetes: A hospital-based cross-sectional study

AIMS

This research examines the prevalence of uncontrolled hypertension and associated risk factors among patients with diabetes in Saudi Arabia.

METHODS

A hospital-based, cross-sectional study was used in patients with diabetes and hypertension attending outpatient diabetes clinics in King Khaled Hospital and Prince Sultan Center for Health Care in Al-Kharj, Riyadh. Patients' information, data on hypertension, type of treatment, and comorbidities were captured through electronic medical records. Uncontrolled hypertension was defined as blood pressure (BP) measurements greater than or equal to 140/90 mmHg. Antihypertensive medication use among these patients was analyzed. Multivariate analysis was performed to detect the associated factors of uncontrolled hypertension.

RESULTS

Of 1178 outpatients‬ with diabetes who were included in the study sample, uncontrolled hypertension presented in 846 (71.8%). Most patients were on two antihypertensive medications, and the most frequently used was calcium channel blockers, followed by angiotensin-converting enzyme inhibitors. Individuals most likely to have uncontrolled hypertension were those older than 65 years (OR 1.99, 95%CI: 1.059, 3.77), male (OR = 1.51, 95%CI: 1.031, 2.22), and obese (OR = 2.39, 95%CI: 1.63, 3.504), with two (OR = 3.894, 95% CI: 2.481, 6.114) or three or more comorbidities (OR = 4.020, 95% CI: 2.510, 6.439), and with polypharmacy (OR = 1.814, 95% CI: 1.238, 2.656).

CONCLUSION

The extent of uncontrolled hypertension among patients with diabetes in the study sample was found to be high. Age, sex, obesity, number of comorbidities, and polypharmacy are the most important correlates with increased risk of uncontrolled hypertension.

Increased prevalence of hypertension in Ghana: New 2017 American College of Cardiology/American Hypertension Association hypertension guidelines application

Background

We estimated the prevalence and socio-demographic risk factors of hypertension among Ghanaian adults as per the Joint National Committee 7 and the 2017 American College of Cardiology/American Hypertension Association hypertension thresholds used for diagnosis and treatment.

Methods

This cross-sectional analysis included 12 151 adults (8295 females and 3856 males) aged 18 years or older who participated in the 2014 Ghana Demographic and health Survey. Multiple logistic regression models were applied to obtain risk factors associated with hypertension as per both guidelines.

Results

Overall, 30.43% (n = 3698) and 11.48% (n = 1395) respondents had hypertension as per the 2017 ACC/AHA and JNC7 guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: 55-64 years (adjusted odds ratio (aOR) = 6.42, 95% confidence interval (CI): 4.70-8.77), 45-54 years (aOR = 5.72, 95% CI = 4.70-6.85), 3544 years (aOR = 3.91, 95% CI = 3.33-4.59), and 25-34 years (aOR = 2.05, 95% CI = 1.77-2.37) age groups. Males (aOR = 1.39, 95% CI = 1.23-1.53), and urban residents (aOR = 1.18, 95% CI = 1.05-1.38). All the above risk factors were significant according to the JNC7 guideline too. Factors positively associated with only the 2017 ACC/AHA guideline included: middle income (aOR = 1.20, 95% CI = 1.02-1.42) and richest (aOR = 1.36, 95% CI = 1.10-1.69) wealth quintiles, whereas manual (aOR = 1.37, 95% CI = 1.02-1.86) was positively associated with the JNC7 guidelines only.

Conclusions

We conclude that adopting the ACC/AHA guidelines would lead to a substantial increase in the prevalence of hypertension among Ghanaian adults, thus, hypertension prevention and control should be prioritized.

High prevalence of undiagnosed hypertension among men in North Central Nigeria: Results from the Healthy Beginning Initiative

BACKGROUND

The prevalence of hypertension in Nigeria is high and growing. The burden and risk factor distribution also vary by geographical zone. Information about prevalence, risk factors and disease status awareness are needed to guide evidence based public health response at the national and sub- national levels.

PURPOSE

This paper describes the prevalence of hypertension and its correlates, as well as hypertension status awareness among men in North Central, Nigeria.

METHODS

A cross sectional survey was administered to male partners of pregnant women participating in the Healthy Beginning Initiative program from 2016-2018. Information on socio-demographic characteristics, risk factors, physical measurement and blood pressure readings were collected using a standardized protocol. Data was analyzed with simple and multiple logistic regression.

RESULTS

The 6,538 men had a median age of 31 years [IQR: 26-37]. The prevalence of hypertension was 23.3% (95% CI: 22.3%-24.4%), while 46.7% had prehypertension. The odds of hypertension was associated with increasing age (OR:1.02, CI:1.01-1.03), being overweight (aOR:1.5,CI:1.3-1.8), being obese (aOR:2.6,CI:2.0-3.3), living in an urban area (aOR:1.6,CI:1.2-2.1), and alcohol use in the 30 days prior (aOR:1.2,CI:1.1-1.4). Overall, 4.5% (297/6,528) of participants had ever been told they have hypertension. Among the 23.3% (1,527/6,528) with hypertension, 7.1% (109/1,527) were aware of their disease status. Men aged 41-50 years (aOR: 1.8, CI: 1.0-3.3), and > 50 years (aOR: 2.2, CI: 1.1-4.3), had higher odds disease status awareness. Living in an urban area was associated with lower odds (aOR: 0.2, CI: 0.03-0.7) of hypertension status awareness.

CONCLUSION

This study showed that hypertension is already a significant public health burden in this population and that disease awareness level is very low. Alcohol use and obesity were associated with hypertension, highlighting some modifiable cardiovascular disease risk factors that are prevalent in the study population. Taken together, these findings can inform the design of interventions for primary and secondary cardiovascular disease prevention in Nigeria and similar settings.

Individual awareness and treatment effectiveness of hypertension among older adults in Ghana: evidence from the World Health Organization study of global ageing and adult health wave 2

INTRODUCTION

the aim of this study was to report the prevalence of hypertension, its awareness and treatment effectiveness among older adults (aged 50 years and above) in Ghana.

METHODS

the Ghana World Health Organization´s (WHO) Study on Global Aging and Adult Health (SAGE) wave 2 dataset was used in this study. The study adopted a cross-sectional study design. Information on self-reported hypertension as well as measured hypertension was analyzed. The level of awareness regarding hypertension and the effectiveness of treatment was determined using descriptive statistics. Factors associated with an individual´s awareness of their hypertensive status were determined using Rao-Scott Chi square test statistic and the predictors of unawareness of hypertension were determined using adjusted logistic regression analysis. A p-value of ≤0.05 was deemed significant.

RESULTS

information on 3,575 adults in Ghana aged 50 years or older was included in this analysis. The mean age of study participants was 65.1 ± 10.7 years with 59% being female. The prevalence of measured hypertension was 50.7% [95%CI=48.3-53.2]. The overall prevalence of hypertension among older adults in Ghana who were hypertensive but were not aware of it was 35.0% [95%CI=31.6-38.5]. Of the 332 individuals who self-reported being hypertensive, only 74 (22.2%) were on any form of treatment, with only 17 (5.1%) having their blood pressures well controlled.

CONCLUSION

approximately half of all older adults in Ghana have elevated blood pressures. Most of these are not aware of their elevated blood pressure and for those who are aware, very few are on treatment and even fewer have their blood pressure well controlled. Structured national population level screening and health promotion for elevated blood pressure by Ministry of Health/ Ghana Health Service is worthy of consideration.