1
|
Gebresilase FG, Bekele YA, Gebremedhin KB, Tolera BD. Knowledge and self-care practice among patients with hypertension in tertiary public hospitals of Addis Ababa, Ethiopia: A multicenter cross-sectional study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 23:200333. [PMID: 39309074 PMCID: PMC11415806 DOI: 10.1016/j.ijcrp.2024.200333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 09/05/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024]
Abstract
Introduction Globally, hypertension is the leading cause of death due to its related complications. Patients' knowledge and self-care practice in hypertension is crucial for achieving optimal blood pressure control and prevention of related complications. This study aimed to evaluate the level of knowledge and self-care practice among hypertensive patients in Addis Ababa, Ethiopia. Methods A facility-based cross-sectional study was conducted among 413 hypertensive patients using simple random sampling methods. A face-to-face interview was administered using a structured questionnaire. Data was analyzed using SPSS version 27.0. Frequency percentage, and mean were calculated. Multivariable logistic regression was used to identify the association between predictors and outcome variables. Results Out of 413 respondents, 46.0 % (95 % CI: 40-50 %) and 40.9 % (95 % CI: 36-46 %) had poor knowledge and self-care practice respectively. Being married (AOR = 1.92, 95 % CI:1.19-3.06, P = 0.007), higher education [AOR = 7.38 (95 % CI: 2.29-23.78), P < 0.001); family history (AOR = 3.68, 95 % CI: 2.28-5.94, P < 0.001); getting information from healthcare providers (AOR = 3.17, 95 % CI: 1.46-6.87, P = 0.003) were significantly associated with knowledge of hypertension. Being female (AOR: 0.62,95 % CI: 0.39-0.97, P = 0.033), owing sphygmomanometer (AOR: 4.41,95 % CI: 2.40-8.13, P < 0.001) were associated with self-care practice towards hypertension. Conclusion The overall knowledge and self-care practice of respondents was low. Gender, marital status, educational level, family history, source of information, and owing sphygmomanometer were determinant factors. Improving patients' awareness and self-care practice is essential for prevention and control of hypertension.
Collapse
Affiliation(s)
| | - Yohannes Ayalew Bekele
- Addis Ababa University, College of Health Sciences, School of Nursing and Midwifery, Ethiopia
| | | | - Boka Dugassa Tolera
- Addis Ababa University, College of Health Sciences, School of Nursing and Midwifery, Ethiopia
| |
Collapse
|
2
|
Salam A, Sani MU, Ogah OS, Huffman MD, Schutte AE, Pant R, Ghosh A, Dhurjati R, Lakshmi JK, Rodgers A, Ojji DB. deliVERy of optimal blood pressure coNtrol in afrICA (VERONICA)-Nigeria study: Rationale and design of a randomized clinical trial. Am Heart J 2024; 277:66-75. [PMID: 39094841 DOI: 10.1016/j.ahj.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Blood pressure (BP) control among treated patients in Africa is very suboptimal, with low levels of combination therapy use and therapeutic inertia being among the major barriers to effective control of hypertension. The VERONICA-Nigeria study aims to evaluate, among Black African adults with hypertension, the effectiveness and safety of a triple pill-based treatment protocol compared to Nigeria hypertension treatment protocol (standard care protocol) for the treatment of hypertension. METHODS This study involves a randomized, parallel-group and open-label trial. Adults with uncontrolled hypertension (n = 300), untreated or receiving monotherapy, with no contraindication to study treatments will be randomly assigned 1:1 to treatment with a triple pill based-treatment protocol or standard care protocol. Follow-up is for 6 months, with interim follow up visits at month 1, 2, and 3. In a noncomparative extension treatment period, participants completing the 6 months randomized period and on ≤3 BP-lowering drugs will receive treatment with the triple pill-based treatment protocol for 12 months. The primary outcome is change in home mean SBP from baseline to month 6, and key secondary efficacy outcome is percentage of participants with clinic BP <140/90 mmHg at month 6. The primary safety outcome is discontinuation of trial treatment due to adverse events from randomization to month 6. Economic evaluation will be conducted to assess the cost-effectiveness of the triple pill-based treatment protocol, and process evaluation will be conducted to understand the context in which the trial was conducted, implementation of the trial and interventions and mechanisms of effect, and potential barriers and facilitators to implementing the intervention in clinical practice. CONCLUSION The VERONICA-Nigeria trial will provide evidence of effectiveness and safety of the triple-based treatment protocol for the pharmacological management of hypertension, in Black African adults. TRIAL REGISTRATION PACTR202107579572114.
Collapse
Affiliation(s)
- Abdul Salam
- The George Institute for Global Health, Hyderabad, Telangana, India; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Prasanna School of Public Health, Manipal Academy of Higher Education, India.
| | - Mahmoud U Sani
- Department of Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Okechukwu S Ogah
- Department of Internal Medicine, University College Hospital, Ibadan, Nigeria
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Medicine and Global Health Center, Washington University in St. Louis, St. Louis MO
| | - Aletta E Schutte
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Rashmi Pant
- The George Institute for Global Health, Hyderabad, Telangana, India
| | - Arpita Ghosh
- The George Institute for Global Health, Hyderabad, Telangana, India; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Prasanna School of Public Health, Manipal Academy of Higher Education, India
| | - Rupasvi Dhurjati
- The George Institute for Global Health, Hyderabad, Telangana, India
| | - Josyula K Lakshmi
- The George Institute for Global Health, Hyderabad, Telangana, India; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Prasanna School of Public Health, Manipal Academy of Higher Education, India
| | - Anthony Rodgers
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Dike B Ojji
- Department of Internal Medicine, University of Abuja, Abuja, Nigeria; University of Abuja Teaching Hospital, Abuja, Nigeria
| |
Collapse
|
3
|
Alemu C, Wudu H, Bogale B, Getachew Z, Nega A. Time to death and its determinant factors of stroke patients at Gambella General Hospital, Gambella, Ethiopia. Eur J Med Res 2024; 29:452. [PMID: 39252104 PMCID: PMC11382527 DOI: 10.1186/s40001-024-02026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 08/13/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND AND PURPOSE A stroke or a cerebrovascular accident is a common cause of death and a leading cause of long-term, severe disability in both developed and developing countries. The most recent global burden of disease report states that there were 11.9 million new cases of stroke worldwide; stroke accounts for nearly 1 in 8 deaths globally (12%, 6.5 million deaths) and claims a life every 5 s, making it the second most common cause of death worldwide. The goal of the study was to identify the most important factors influencing stroke patients' time to death at Gambella General Hospital. METHODS Data was gathered from patient files in a hospital using a retrospective study methodology, spanning the period from September 2018 to September 2020. R 3.4.0 statistical software and STATA version 14.2 were used for data entry and analysis. The survival time was compared using the log-rank tests and the Kaplan-Meier survival curve. The fitness of the Cox proportional hazard model was examined. RESULTS The final model that was fitted was the log-logistic AFT model. A statistically significant correlation was defined as having a p value of less than 0.05 and the accelerated factor (γ) with its 95% confidence interval was employed. Eight days was the total median death time (95% CI 6-10). Significant predictors for shortened mortality time were age (γ = 0.94; 95% CI (0.0.920-0.980), hypertension (γ = 0.63; 95% CI (0.605-0.660), and baseline complications (γ = 0.24; 95% CI (0.223-0.256). CONCLUSIONS The shortened timing of death was significantly predicted by age, hypertension, and baseline complications. In light of the study's findings, health administrators and caregivers should work to improve society's overall health.
Collapse
Affiliation(s)
- Chekol Alemu
- Department of Statistics, College of Natural and Computational Sciences, Gambella University, Gambella, Ethiopia.
| | - Habitamu Wudu
- Department of Statistics, College of Natural and Computational Sciences, Gambella University, Gambella, Ethiopia
| | - Bizuayehu Bogale
- Monitoring, Evaluation, Accountability and Learning (MEAL) Officer, Doctors with Africa-CUAMM, Gambella, Ethiopia
| | - Zerihun Getachew
- Department of Rural Development and Agricultural Extension, College of Agriculture and Natural Resource, Gambella University, Gambella, Ethiopia
| | - Abebe Nega
- Department of Statistics, College of Natural Sciences, Jimma University, Jimma, Ethiopia
| |
Collapse
|
4
|
Diallo BA, Hassan S, Kagwanja N, Oyando R, Badjie J, Mumba N, Prentice AM, Perel P, Etyang A, Nolte E, Tsofa B. Managing hypertension in rural Gambia and Kenya: Protocol for a qualitative study exploring the experiences of patients, health care workers, and decision-makers. NIHR OPEN RESEARCH 2024; 4:5. [PMID: 39238902 PMCID: PMC11375402 DOI: 10.3310/nihropenres.13523.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2024] [Indexed: 09/07/2024]
Abstract
Background Hypertension is the single leading risk factor for premature death in Sub-Saharan Africa (SSA). Prevalence is high, but awareness, treatment, and control are low. Community-centred interventions show promise for effective hypertension management, but embedding such interventions sustainably requires a good understanding of the wider context within which they are being introduced. This study aims to conduct a systematic health system assessment exploring the micro (patients/carers), meso (health care workers and facilities), and macro (broader system) contexts in rural Gambia and Kenya. Methods This study will utilise various qualitative approaches. We will conduct (i) focus group discussions with people living with hypertensive to map a 'typical' patient journey through health systems, and (ii) in-depth interviews with patients and family carers, health care workers, decision-makers, and NCD partners to explore their experiences of managing hypertension and assess the capacity and readiness of the health systems to strengthen hypertension management. We will also review national guidelines and policy documents to map the organisation of services and guidance on hypertension management. We will use thematic analysis to analyse data, guided by the cumulative complexity model, and theories of organisational readiness and dissemination of innovations. Expected findings This study will describe the current context for the management of hypertension from the perspective of those involved in seeking (patients), delivering (health care workers) and overseeing (decision-makers) health services in rural Gambia and Kenya. It will juxtapose what should be happening according to health system guidance and what is happening in practice, drawing on the experiences of study participants. It will outline the various barriers to and facilitators of hypertension management, as perceived by patients, providers, and decision-makers, and the conditions that would need to be in place for effective and sustainable implementation of a community-centred intervention to improve the management of hypertension in rural settings.
Collapse
Affiliation(s)
- Brahima A Diallo
- Nutrition and Planetary Health, MRC Unit The Gambia at LSHTM, Banjul, Other / None, 273, The Gambia
| | - Syreen Hassan
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Jainaba Badjie
- Nutrition and Planetary Health, MRC Unit The Gambia at LSHTM, Banjul, Other / None, 273, The Gambia
| | - Noni Mumba
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Andrew M Prentice
- Nutrition and Planetary Health, MRC Unit The Gambia at LSHTM, Banjul, Other / None, 273, The Gambia
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ellen Nolte
- London School of Hygiene and Tropical Medicine, London, UK
| | | |
Collapse
|
5
|
Abera B, Yazew T, Legesse E, Kuyu CG. Dietary adherence and associated factors among hypertensive patients in governmental hospitals of Guji zone, Oromia, Ethiopia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:108. [PMID: 39044296 PMCID: PMC11267951 DOI: 10.1186/s41043-024-00598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce blood pressure in hypertensive adults, but there is limited information available on dietary adherence and related factors among hypertensive patients in the study area. Hence, the current study aimed to assess dietary adherence and associated factors among hypertensive patients aged greater than or equal to 18 years old in governmental hospitals of Guji zone, Oromia region, Ethiopia. METHODS A facility-based cross-sectional study was conducted between June 5, 2023, and August 30, 2023. For this study, patients with a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher on two separate occasions were classified as hypertensive. Thus, the study involved 399 hypertensive patients who were selected using systematic random sampling methods. The level of knowledge regarding hypertension was measured through the use of hypertension knowledge-level scale (HK-LS) questionnaires, while the reliability and validity of the questionnaire were assessed using the Cronbach's alpha test (α ≥ 0.70).The association between factors was analyzed using adjusted odds ratio (AOR) and a 95% confidence interval. Variables with p-values below 0.05 were considered statistically significant. RESULTS Among the respondents, only 28.30% (CI: 23.9, 33) of participants were found to be adherent to the recommended diet. Factors like participation in nutritional education, level of knowledge, respondents' ages, and length of time since hypertension diagnosis showed a strong association with adherence to recommended dietary guidelines. CONCLUSIONS The research findings indicated that the level of compliance with the prescribed diet was generally subpar among individuals with hypertension in comparison to the Dietary Approaches to Stop Hypertension (DASH) diet recommendations. So, it is essential to offer hypertensive patients an education focused on health and nutrition in order to enhance their adherence to dietary guidelines and promote a healthier dietary routine. The results of this research will also be valuable in increasing awareness among policymakers and the general public about the dietary adherence and its associated factors, thus aiding in the development and execution of suitable interventions.
Collapse
Affiliation(s)
- Berhanu Abera
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Tamiru Yazew
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia.
| | - Elsabeth Legesse
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Chala G Kuyu
- Department of Postharvest Management, Jimma University College of Agriculture and Veterinary Medicine, Jimma, Ethiopia
| |
Collapse
|
6
|
Hussein M, Muyinda A, Olet SC, Hersi AM, Said AI, Elmi HSA. Prevalence rate of left ventricular hypertrophy and the burden of arrhythmias among hypertensive patients attending Jinja regional referral hospital, eastern Uganda. Curr Probl Cardiol 2024; 49:102576. [PMID: 38653445 DOI: 10.1016/j.cpcardiol.2024.102576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/20/2024] [Indexed: 04/25/2024]
Abstract
In Uganda, hypertension is an escalating health issue, but there is limited specific data regarding the prevalence of left ventricular hypertrophy (LVH) among hypertensive patients in eastern Uganda. This study aimed to establish the prevalence of LVH among hypertensive patients at Jinja Regional Referral Hospital. A cross-sectional study conducted at the hospital enrolled 323 participants using convenience sampling. The results revealed a prevalence rate of 19.50 % for LVH, primarily observed in male participants and younger age groups (25-35 years). Furthermore, the study found a low incidence of associated cardiac arrhythmia, with only 1.59 % of participants having atrial fibrillation. These findings indicate a relatively low burden of LVH and arrhythmia in this population, emphasizing the importance of continued efforts in hypertension management and LVH prevention. Further research and interventions are necessary to mitigate the impact of hypertension-related complications in the eastern region of Uganda.
Collapse
Affiliation(s)
- Mustafe Hussein
- Department of internal medicine, Kampala international university western campus, Ishaka, Uganda
| | - Asad Muyinda
- Department of internal medicine, Kampala international university western campus, Ishaka, Uganda
| | - Stephen Charles Olet
- College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Abshir Mohamoud Hersi
- Department of internal medicine, Kampala international university western campus, Ishaka, Uganda
| | | | - Hassan Sh Abdirahman Elmi
- Department of Biology, Amoud University, Borama Somaliland; Faculty of Science Charles University, Czech Republic.
| |
Collapse
|
7
|
Gumede SB, de Wit JBF, Venter WDF, Wensing AMJ, Lalla‐Edward ST. Intervention strategies to improve adherence to treatment for selected chronic conditions in sub-Saharan Africa: a systematic review. J Int AIDS Soc 2024; 27:e26266. [PMID: 38924296 PMCID: PMC11197966 DOI: 10.1002/jia2.26266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/23/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Evidence-based intervention strategies to improve adherence among individuals living with chronic conditions are critical in ensuring better outcomes. In this systematic review, we assessed the impact of interventions that aimed to promote adherence to treatment for chronic conditions. METHODS We systematically searched PubMed, Web of Science, Scopus, Google Scholar and CINAHL databases to identify relevant studies published between the years 2000 and 2023 and used the QUIPS assessment tool to assess the quality and risk of bias of each study. We extracted data from eligible studies for study characteristics and description of interventions for the study populations of interest. RESULTS Of the 32,698 total studies/records screened, 2814 were eligible for abstract screening and of those, 497 were eligible for full-text screening. A total of 82 studies were subsequently included, describing a total of 58,043 patients. Of the total included studies, 58 (70.7%) were related to antiretroviral therapy for HIV, 6 (7.3%) were anti-hypertensive medication-related, 12 (14.6%) were anti-diabetic medication-related and 6 (7.3%) focused on medication for more than one condition. A total of 54/82 (65.9%) reported improved adherence based on the described study outcomes, 13/82 (15.9%) did not have clear results or defined outcomes, while 15/82 (18.3%) reported no significant difference between studied groups. The 82 publications described 98 unique interventions (some studies described more than one intervention). Among these intervention strategies, 13 (13.3%) were multifaceted (4/13 [30.8%] multi-component health services- and community-based programmes, 6/13 [46.2%] included individual plus group counselling and 3/13 [23.1%] included SMS or alarm reminders plus individual counselling). DISCUSSION The interventions described in this review ranged from adherence counselling to more complex interventions such as mobile health (mhealth) interventions. Combined interventions comprised of different components may be more effective than using a single component in isolation. However, the complexity involved in designing and implementing combined interventions often complicates the practicalities of such interventions. CONCLUSIONS There is substantial evidence that community- and home-based interventions, digital health interventions and adherence counselling interventions can improve adherence to medication for chronic conditions. Future research should answer if existing interventions can be used to develop less complicated multifaceted adherence intervention strategies.
Collapse
Affiliation(s)
- Siphamandla Bonga Gumede
- Ezintsha, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Interdisciplinary Social ScienceUtrecht UniversityUtrechtthe Netherlands
| | - John B. F. de Wit
- Department of Interdisciplinary Social ScienceUtrecht UniversityUtrechtthe Netherlands
- Centre for Social Research in HealthUNSWSydneyNew South WalesAustralia
| | - Willem D. F. Venter
- Ezintsha, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Annemarie M. J. Wensing
- Department of Medical MicrobiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
- Ndlovu Research ConsortiumElandsdoornSouth Africa
| | | |
Collapse
|
8
|
Sani RN, Connelly PJ, Toft M, Rowa-Dewar N, Delles C, Gasevic D, Karaye KM. Rural-urban difference in the prevalence of hypertension in West Africa: a systematic review and meta-analysis. J Hum Hypertens 2024; 38:352-364. [PMID: 35430612 PMCID: PMC11001577 DOI: 10.1038/s41371-022-00688-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/16/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022]
Abstract
Urbanisation is considered a major contributor to the rising prevalence of hypertension in West Africa, yet the evidence regarding rural-urban differences in the prevalence of hypertension in the region has been mixed. A systematic literature search of four electronic databases: PubMed, Embase, African Journals Online, and WHO's African Index Medicus; and reference lists of eligible studies was carried out. Original quantitative studies describing the rural-urban difference in the prevalence of hypertension in one or more countries in West Africa, and published in English language from the year 2000 to 2021 were included. A random effects meta-analysis model was used to estimate the odds ratio of hypertension in rural compared to urban locations. A limited sex-based random effects meta-analysis was conducted with 16 studies that provided sex-disaggregated data. Of the 377 studies screened, 22 met the inclusion criteria (n = 62,907). The prevalence of hypertension was high in both rural, and urban areas, ranging from 9.7% to 60% in the rural areas with a pooled prevalence of 27.4%; and 15.5% to 59.2% in the urban areas with a pooled prevalence of 33.9%. The odd of hypertension were lower in rural compared to urban dwellers [OR 0.74, 95% CI: 0.66-0.83; p < 0.001]. The pooled prevalence of hypertension was 32.6% in males, and 30.0% in females, with no significant difference in the odds of hypertension between the sexes [OR 0.91, 95% CI: 0.8-1.05, p = 0.196]. Comprehensive hypertension control policies are needed for both rural, and urban areas in West Africa, and for both sexes.
Collapse
Affiliation(s)
- Ruqayya Nasir Sani
- Department of Medicine, Aminu kano Teaching Hospital, Kano, Nigeria.
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Paul J Connelly
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mette Toft
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Neneh Rowa-Dewar
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Christian Delles
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Danijela Gasevic
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kamilu Musa Karaye
- Department of Medicine, Aminu kano Teaching Hospital, Kano, Nigeria
- Bayero University Kano, Kano, Nigeria
| |
Collapse
|
9
|
Mundagowa PT, Zambezi P, Muchemwa-Munasirei P. The prevalence and determinants of blood pressure control among hypertension patients in eastern Zimbabwe: A cross-sectional study. PLoS One 2024; 19:e0293812. [PMID: 38451890 PMCID: PMC10919662 DOI: 10.1371/journal.pone.0293812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/19/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Uncontrolled blood pressure (BP), also known as hypertension, is a leading cause of morbidity and mortality globally. Lowering the elevated BP can significantly reduce one's risk for cardiovascular diseases. This study aimed to ascertain the determinants of BP control among hypertension patients. METHODS The data analyzed were from the exploratory survey of the Home Management of Hypertension (HoMHyper) project in eastern Zimbabwe. Hypertension patients were selected from the Chronic Disease Registers of five public health clinics using simple random sampling. A pretested interviewer-administered questionnaire was used to collect data, and the patient's BP was measured. The primary outcome, BP control, was used as a categorical variable (controlled vs. uncontrolled) to conduct a bivariate analysis. Variables significant at p<0.2 were included in the multivariable logistic regression analysis to control for confounding. Statistical significance in the final model was set at p<0.05. RESULTS Data from 321 hypertension patients were analyzed; their mean age was 62.3±11.9 years. The prevalence of controlled BP was 41.4% (95% Confidence interval-CI = 36.0%-46.9%). After adjusting for confounding, patients' residence and medication stocks were associated with BP control. Patients who resided in high-density suburbs had higher odds of uncontrolled BP than those who resided in middle- and low-density suburbs (Adjusted odds ratios-AOR = 2.5; 95% CI = 1.4-4.4; p<0.01). Hypertension patients who experienced medication stockouts over the last six months had higher odds of uncontrolled BP than patients who did not experience stockouts (AOR = 1.8; 95% CI = 1.1-2.9). CONCLUSION BP control among hypertension patients was suboptimal. Patient residence and antihypertensive medication stockouts were independent predictors of blood pressure control. We recommend exploring sustainable financing through private-public partnerships to ensure the availability of subsidized antihypertensive medication.
Collapse
Affiliation(s)
- Paddington Tinashe Mundagowa
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Pemberai Zambezi
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
| | | |
Collapse
|
10
|
Olowoyo P, Dzudie A, Okekunle AP, Obiako R, Mocumbi A, Beheiry H, Parati G, Lackland DT, Sarfo FS, Odili A, Adeoye AM, Wahab K, Agyemang C, Campbell N, Kengne AP, Whelton PK, Pellicori P, Ebenezer AA, Adebayo O, Olalusi O, Jegede A, Uvere E, Adebajo O, Awuah B, Moran A, Williams B, Guzik TJ, Kokuro C, Bukachi F, Ogah OS, Delles C, Maffia P, Akinyemi R, Barango P, Ojji D, Owolabi M. ACHIEVE conference proceedings: implementing action plans to reduce and control hypertension burden in Africa. J Hum Hypertens 2024; 38:193-199. [PMID: 38424209 DOI: 10.1038/s41371-024-00903-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels.
Collapse
Affiliation(s)
- Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Anastase Dzudie
- Departments of Internal Medicine and Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Akinkunmi Paul Okekunle
- College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Seoul National University, 08826, Seoul, Republic of Korea
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria
| | - Ana Mocumbi
- Departamento de Medicina, Universidade, Eduardo Mondlane, Maputo, Mozambique
| | - Hind Beheiry
- Physiology Department, Faculty of Medicine, International University of Africa (IUA), Khartoum, Sudan
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, Univeristy of Milano-Bicocca, Milan, Italy
| | - Daniel T Lackland
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustine Odili
- Department of Medicine, University of Abuja, FCT, Abuja, Nigeria
| | | | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Norman Campbell
- Departments of Medicine, Physiology, and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Andre Pascal Kengne
- South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Pierpaolo Pellicori
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Oladimeji Adebayo
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladotun Olalusi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ayodele Jegede
- Department of Sociology, University of Ibadan, Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | - Tomasz J Guzik
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda
- Centre for Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Internal and Agricultural Medicine and Omicron Medical Genomics Laboratory, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Collins Kokuro
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Fred Bukachi
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda
- Department of Medical Physiology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Okechukwu S Ogah
- Cardiology Unit, Department of Medicine, University of Ibadan/ University College Hospital, Ibadan, Nigeria
| | - Christian Delles
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Pasquale Maffia
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda
- Centre for Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
- School of Infection & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Rufus Akinyemi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, Ibadan, Nigeria
| | - Prebo Barango
- WHO African Regional Office, DRC, Brazzaville, Democratic Republic of the Congo
| | - Dike Ojji
- Department of Medicine, University of Abuja, FCT, Abuja, Nigeria
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, University College Hospital, Ibadan, Nigeria.
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda.
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, Ibadan, Nigeria.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
| |
Collapse
|
11
|
Hahka TM, Slotkowski RA, Akbar A, VanOrmer MC, Sembajwe LF, Ssekandi AM, Namaganda A, Muwonge H, Kasolo JN, Nakimuli A, Mwesigwa N, Ishimwe JA, Kalyesubula R, Kirabo A, Anderson Berry AL, Patel KP. Hypertension Related Co-Morbidities and Complications in Women of Sub-Saharan Africa: A Brief Review. Circ Res 2024; 134:459-473. [PMID: 38359096 PMCID: PMC10885774 DOI: 10.1161/circresaha.123.324077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Hypertension is the leading cause of cardiovascular disease in women, and sub-Saharan African (SSA) countries have some of the highest rates of hypertension in the world. Expanding knowledge of causes, management, and awareness of hypertension and its co-morbidities worldwide is an effective strategy to mitigate its harms, decrease morbidities and mortality, and improve individual quality of life. Hypertensive disorders of pregnancy (HDPs) are a particularly important subset of hypertension, as pregnancy is a major stress test of the cardiovascular system and can be the first instance in which cardiovascular disease is clinically apparent. In SSA, women experience a higher incidence of HDP compared with other African regions. However, the region has yet to adopt treatment and preventative strategies for HDP. This delay stems from insufficient awareness, lack of clinical screening for hypertension, and lack of prevention programs. In this brief literature review, we will address the long-term consequences of hypertension and HDP in women. We evaluate the effects of uncontrolled hypertension in SSA by including research on heart disease, stroke, kidney disease, peripheral arterial disease, and HDP. Limitations exist in the number of studies from SSA; therefore, we will use data from countries across the globe, comparing and contrasting approaches in similar and dissimilar populations. Our review highlights an urgent need to prioritize public health, clinical, and bench research to discover cost-effective preventative and treatment strategies that will improve the lives of women living with hypertension in SSA.
Collapse
Affiliation(s)
- Taija M Hahka
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Rebecca A Slotkowski
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Anum Akbar
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Matt C VanOrmer
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Lawrence Fred Sembajwe
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdul M Ssekandi
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Namaganda
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Muwonge
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Josephine N Kasolo
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology (A. Nakimuli), Makerere University College of Health Sciences, Kampala, Uganda
| | - Naome Mwesigwa
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Jeanne A Ishimwe
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Robert Kalyesubula
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annet Kirabo
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Ann L Anderson Berry
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Kaushik P Patel
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
12
|
Olowoyo P, Barango P, Moran A, Williams B, Whelton PK, Owolabi M. Priorities to reduce the burden of hypertension in Africa through ACHIEVE. Lancet Glob Health 2024; 12:e192-e193. [PMID: 38245107 DOI: 10.1016/s2214-109x(23)00540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria; Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Prebo Barango
- WHO African Regional Office, Brazzaville, Democratic Republic of the Congo
| | | | - Bryan Williams
- Department of Medicine, University College London, London, UK; International Society of Hypertension, Eastbourne, UK
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; World Hypertension League, Hong Kong Special Administrative Region, China
| | - Mayowa Owolabi
- World Hypertension League, Hong Kong Special Administrative Region, China; Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria; Lebanese American University of Beirut, Beirut, Lebanon; Department of Medicine, University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Center, Ibadan, Nigeria.
| |
Collapse
|
13
|
Boateng EB, Ampofo AG. A glimpse into the future: modelling global prevalence of hypertension. BMC Public Health 2023; 23:1906. [PMID: 37789258 PMCID: PMC10546636 DOI: 10.1186/s12889-023-16662-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Hypertension is a major risk factor for cardiovascular diseases. Insights and foresights on trends of hypertension prevalence are crucial to informing health policymaking. We examined and projected the patterns of hypertension prevalence among sexes. METHODS Using annual hypertension prevalence (18 + years) data sourced from WHO Global Health Observatory data repository from 1975 to 2015, Prophet models were developed to forecast the 2040 prevalence of hypertension in males, females, and both sexes. We used k-means clustering and self-organising maps to determine the clusters of hypertension prevalence concerning both sexes among 176 countries. RESULTS Worldwide, Croatia is estimated to have the highest prevalence of hypertension in males by 2040, while that of females is in Niger. Among the world's most populated countries, Pakistan and India are likely to increase by 7.7% and 4.0% respectively in both sexes. South-East Asia is projected to experience the largest hypertension prevalence in males, whereas Africa is estimated to have the highest prevalence of hypertension in females. Low-income countries are projected to have the highest prevalence of hypertension in both sexes. By 2040, the prevalence of hypertension worldwide is expected to be higher in the male population than in female. Globally, the prevalence of hypertension is projected to decrease from 22.1% in 2015 to 20.3% (20.2 - 20.4%) in 2040. We also identified three patterns of hypertension prevalence in 2040, cluster one countries are estimated to have the highest prevalence of hypertension in males (29.6%, 22.2 - 41.1%) and females (29.6%, 19.4 - 38.7%). CONCLUSION These findings emphasise the need for new and effective approaches toward the prevention and control of hypertension in Africa, South-East Asia, and Low-income countries.
Collapse
Affiliation(s)
- Emmanuel B Boateng
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Ama G Ampofo
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| |
Collapse
|
14
|
Touray TA, Woodall J, Warwick-Booth L. Lived experience of diet-related health education in type 2 diabetes and hypertension comorbidity in The Gambia. Health Promot Int 2023; 38:daad125. [PMID: 37791594 PMCID: PMC10548409 DOI: 10.1093/heapro/daad125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
The incidence and prevalence of type 2 diabetes mellitus (T2DM) and hypertension (and their comorbidity) have been increasing in sub-Saharan Africa, including The Gambia. Diet is a critical driver of these public health problems, and diet-related health education is a major strategy employed for their prevention and management. The aim of this paper is to explore the lived experiences of diet-related health education among individuals with comorbid type 2 diabetes and hypertension in Serrekunda, The Gambia, a subject hitherto unexplored in the country. The study employed a qualitative (interpretivist) methodology. Thirty-two interviews were conducted with 18 participants, with most participating in two interviews at separate time-points between November 2018 and July 2019. In addition to participant validation, the two points in time interviews elicited more depth and provided rich data. The data were analysed using Braun and Clarke's six-phased approach to Thematic Analysis. Four main themes were generated in relation to the experiences: (i) one-off blanket dietary advice (ii) education in a vacuum (iii) diabetes-hypertension diet dichotomy and (iv) imbalanced power relationship. The study underscores the need for a reconfiguration of diet-related health education in The Gambia to include lived experiences as critical components of health promotion in tackling T2DM and hypertension. This requires an ecological approach, critical health education, regulations on unhealthy foods, and active participation of individuals as equal partners in health education.
Collapse
Affiliation(s)
- Tahir Ahmad Touray
- Cardiff School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - James Woodall
- Centre for Health Promotion Research, Leeds Beckett University, Leeds, UK
| | | |
Collapse
|
15
|
Abdelhamid M, Al Ghalayini K, Al‐Humood K, Altun B, Arafah M, Bader F, Ibrahim M, Sabbour H, Shawky Elserafy A, Skouri H, Yilmaz MB. Regional expert opinion: Management of heart failure with preserved ejection fraction in the Middle East, North Africa and Turkey. ESC Heart Fail 2023; 10:2773-2787. [PMID: 37530028 PMCID: PMC10567674 DOI: 10.1002/ehf2.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023] Open
Abstract
Although epidemiological data on heart failure (HF) with preserved ejection fraction (HFpEF) are scarce in the Middle East, North Africa and Turkey (MENAT) region, Lancet Global Burden of Disease estimated the prevalence of HF in the MENAT region in 2019 to be 0.78%, versus 0.71% globally. There is also a high incidence of HFpEF risk factors and co-morbidities in the region, including coronary artery disease, diabetes, obesity, hypertension, anaemia and chronic kidney disease. For instance, 14.5-16.2% of adults in the region reportedly have diabetes, versus 7.0% in Europe. Together with increasing life expectancy, this may contribute towards a higher burden of HFpEF in the region than currently reported. This paper aims to describe the epidemiology and burden of HFpEF in the MENAT region, including unique risk factors and co-morbidities. It highlights challenges with diagnosing HFpEF, such as the prioritization of HF with reduced ejection fraction (HFrEF), the specific profile of HFpEF patients in the region and barriers to effective management associated with the healthcare system. Guidance is given on the diagnosis, prevention and management of HFpEF, including the emerging role of sodium-glucose co-transporter-2 inhibitors. Given the high burden of HFpEF coupled with the fact that its prevalence is likely to be underestimated, healthcare professionals need to be alert to its signs and symptoms and to manage patients accordingly. Historically, HFpEF treatments have focused on managing co-morbidities and symptoms, but new agents are now available with proven effects on outcomes in patients with HFpEF.
Collapse
Affiliation(s)
| | | | | | - Bülent Altun
- Faculty of MedicineHacettepe UniversityAnkaraTurkey
| | | | - Feras Bader
- Cleveland ClinicAbu DhabiUnited Arab Emirates
| | | | | | | | - Hadi Skouri
- Sheikh Shakhbout Medical CityAbu DhabiUnited Arab Emirates
| | | |
Collapse
|
16
|
Yao KH, Diopoh SP, Konan SD, Guehi MC, Kamagate S, Ouattara K, Moudachirou MIA. Prevalence and Risk Factors of Chronic Kidney Disease in the General Population in Abidjan, Côte d'Ivoire: A Cross-sectional Study. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:427-436. [PMID: 38995301 DOI: 10.4103/1319-2442.397204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Chronic kidney disease (CKD) is a major cause of morbidity and mortality worldwide, but few studies are available on CKD in Cote d'Ivoire. We aimed to assess the prevalence of CKD and identify its associated factors in the general population in Abidjan in 2016 in a cross-sectional study that included 1418 subjects. We did not receive laboratory data for 38 subjects, including serum creatinine data. Of the 1380 remaining subjects, 138 cases of CKD were included in the study (10% prevalence). We observed a female predominance (sex ratio = 0.81), and the mean age was 43.7 ± 14.5 years. Histories of hypertension (HTN) (29.7%) and diabetes (10.1%) were reported. The main clinical signs were high blood pressure (51.4%), obesity (21%), proteinuria (37.9%), and hematuria (37.4%). The glomerular filtration rate (GFR) was <60 mL/min in 8.2% of cases according to the Modification of Diet in Renal Disease equation, in 8.6% according to the CKD Epidemiology Collaboration equation, and in 12.6% according to the Cockroft-Gault (CG) equation. The other laboratory signs were hyperglycemia (51.4%), hypercholesterolemia (34.1%), and hyperlipidemia (21%). In the multivariate analysis, factors such as female sex (P = 0.013), age >55 years (P = 0.02), a history of HTN (P = 0.001), hypercholesterolemia (P = 0.010), and hyperlipidemia (P = 0.009) were associated with the risk of CKD. The prevalence of CKD was high in our study. The CG equation should not be used to estimate the GFR in the general population. Prevention involves managing modifiable risk factors.
Collapse
Affiliation(s)
- Kouamé Hubert Yao
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Sery Patrick Diopoh
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Serge Didier Konan
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Monlet Cyr Guehi
- Department of Nephrology, University Hospital of Yopougon, Abidjan, Côte d'Ivoire
| | - Sira Kamagate
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Kolo Ouattara
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | | |
Collapse
|
17
|
Spencer SA, Rylance J, Quint JK, Gordon SB, Dark P, Morton B. Use of hospital services by patients with chronic conditions in sub-Saharan Africa: a systematic review and meta-analysis. Bull World Health Organ 2023; 101:558-570G. [PMID: 37638357 PMCID: PMC10452942 DOI: 10.2471/blt.22.289597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/13/2023] [Accepted: 06/07/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To estimate the prevalence of individual chronic conditions and multimorbidity among adults admitted to hospital in countries in sub-Saharan Africa. Methods We systematically searched MEDLINE®, Embase®, Global Index Medicus, Global Health and SciELO for publications reporting on patient cohorts recruited between 1 January 2010 and 12 May 2023. We included articles reporting prevalence of pre-specified chronic diseases within unselected acute care services (emergency departments or medical inpatient settings). No language restrictions were applied. We generated prevalence estimates using random-effects meta-analysis alongside 95% confidence intervals, 95% prediction intervals and I2 statistics for heterogeneity. To explore associations with age, sex, country-level income status, geographical region and risk of bias, we conducted pre-specified meta-regression, sub-group and sensitivity analyses. Findings Of 6976 identified studies, 61 met the inclusion criteria, comprising data from 20 countries and 376 676 people. None directly reported multimorbidity, but instead reported prevalence for individual conditions. Among medical admissions, the highest prevalence was human immunodeficiency virus infection (36.4%; 95% CI: 31.3-41.8); hypertension (24.4%; 95% CI: 16.7-34.2); diabetes (11.9%; 95% CI: 9.9-14.3); heart failure (8.2%; 95% CI: 5.6-11.9); chronic kidney disease (7.7%; 95% CI: 3.9-14.7); and stroke (6.8%; 95% CI: 4.7-9.6). Conclusion Among patients seeking hospital care in sub-Saharan Africa, multimorbidity remains poorly described despite high burdens of individual chronic diseases. Prospective public health studies of multimorbidity burden are needed to generate integrated and context-specific health system interventions that act to maximize patient survival and well-being.
Collapse
Affiliation(s)
- Stephen A Spencer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, England
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, England
| | - Ben Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| |
Collapse
|
18
|
Batubo NP, Moore JB, Zulyniak MA. Dietary factors and hypertension risk in West Africa: a systematic review and meta-analysis of observational studies. J Hypertens 2023; 41:1376-1388. [PMID: 37432889 PMCID: PMC10399948 DOI: 10.1097/hjh.0000000000003499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Contrary to North America and Europe, the prevalence of hypertension is rising in West Africa. Although diet is implicated as a contributor to this trend, nutritional guidelines in West Africa are not tailored to address this concern. This study aimed to address this limitation by investigating dietary factors common to West Africa and evaluating their association with hypertension. METHODS PubMed, Scopus, Web of Science, and Medline were searched to identify studies that investigated diet and hypertension in West African adults. All meta-analyses used a generic inverse-variance random effects model, with subgroup analyses by age, BMI, and study location, and were performed in R. RESULTS Three thousand, two hundred ninety-eight studies were identified, of which 31 ( n = 48 809 participants) satisfied inclusion criteria - all cross-sectional. Meta-analyses of the association between dietary factors and hypertension included dietary fat [odds ratio (OR) = 1.76; 95% confidence interval (95% CI) 1.44-2.14; P < 0.0001], red meat (OR = 1.51; 95% CI: 1.04-2.18; P = 0.03), junk-food (OR = 1.41; 95% CI: 1.19-1.67; P < 0.0001), dietary salt (OR = 1.25; 95% CI: 1.12-1.40; P < 0.0001), alcohol (OR = 1.17; 95% CI: 1.03-1.32; P = 0.013), and 'fruits and vegetables' (OR = 0.80; 95% CI: 0.24-1.17; P < 0.0001). Subgroup analyses suggested that 'fruit and vegetable' consumption is less protective in the elderly. CONCLUSION High consumption of dietary salt, red meat, dietary fat, junk food, and alcohol are associated with increased odds of hypertension, whereas high fruit and vegetable appear protective. This region-specific evidence will support the development of nutritional assessment tools for clinicians, patients, and researchers aiming to reduce hypertension in West Africa.
Collapse
Affiliation(s)
- Nimisoere P Batubo
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | | |
Collapse
|
19
|
Ezeala-Adikaibe BA, Mbadiwe CN, Okafor UH, Nwobodo UM, Okwara CC, Okoli CP, Anyim OB, Anigbo EG, Chime PE, Ezeme MS, Onyebueke CG, Abonyi CM, Udeh CA, Okechukwu CU, Onodugo PN, Okpara CT, Nnaji OT, Obumneme-Anyim I, Orjioke C, Ekochin CF, Onyekonwu LC, Onodugo OD, Nwosu IN. Prevalence of hypertension in a rural community in southeastern Nigeria; an opportunity for early intervention. J Hum Hypertens 2023; 37:694-700. [PMID: 37120682 DOI: 10.1038/s41371-023-00833-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 04/01/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
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.
Collapse
Affiliation(s)
- Birinus A Ezeala-Adikaibe
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria.
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria.
| | - Chigekwu Nkeiruka Mbadiwe
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Ume Monday Nwobodo
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Chibuzo Celestine Okwara
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Chibuike Paul Okoli
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | | | - Ekene Gideon Anigbo
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Peter Ekpunobi Chime
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Mark Sunday Ezeme
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | | | | | - Callistus Afam Udeh
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | | | - Pauline Nkiruka Onodugo
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Obiora Thomas Nnaji
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | | | - Casmir Orjioke
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | | | - Laura Chinwe Onyekonwu
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Ikechukwu Nnamdi Nwosu
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| |
Collapse
|
20
|
Bayaraa N, Azahar NM, Kitaoka K, Kobayashi Y, Yano Y. African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): a holistic approach for hypertension control in Africa. J Hum Hypertens 2023:10.1038/s41371-023-00845-7. [PMID: 37386123 DOI: 10.1038/s41371-023-00845-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/07/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Nomin Bayaraa
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Division for University Hospital Development, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Nazar Mohd Azahar
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Pulau Pinang, Kampus Bertam, Pulau Pinang, Malaysia
| | - Kaori Kitaoka
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Yusuke Kobayashi
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University, Yokohama, Japan
| | - Yuichiro Yano
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan.
| |
Collapse
|
21
|
Farhadi F, Aliyari R, Ebrahimi H, Hashemi H, Emamian MH, Fotouhi A. Prevalence of uncontrolled hypertension and its associated factors in 50-74 years old Iranian adults: a population-based study. BMC Cardiovasc Disord 2023; 23:318. [PMID: 37355590 PMCID: PMC10290783 DOI: 10.1186/s12872-023-03357-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/19/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND By the lengthening of life span, the incidence of chronic diseases such as hypertension and uncontrolled hypertension has increased. This study aims to determine the prevalence of uncontrolled hypertension and its related factors in the age group of 50-74 years in Shahroud, northeast Iran. METHODS The data of the third phase of the Shahroud Eye Cohort Study were used in this study. This phase of the cohort study included 4394 participants aged 50 to 74 years from the previous phases. In addition to ophthalmological and optometric examinations, demographic characteristics, blood biochemistry tests, and blood pressure measurements were performed in this phase. Individuals with a blood pressure ≥ 140/90 mm/Hg (being treated or not treated with antihypertensive medicines) were defined as uncontrolled hypertension. In patients with diabetes and chronic kidney disease, blood pressure equal to or higher than 130/80 mm/Hg was considered uncontrolled hypertension. Descriptive statistics and multiple logistic regression were used to analyze the data. FINDINGS Overall, the prevalence of uncontrolled hypertension out of all the participants was 61.7% (95% CI: 60.3-63.2). Multiple regression results showed that the male gender (OR: 2.1, 95% CI: 1.5-2.9), patients with diabetes (OR:3.2, 95% CI: 2.4-4.3), and patients with chronic kidney disease (CKD) (OR: 3.2, 95% CI: 2.5-4.1) increased the risk of uncontrolled hypertension while in patients with cardiovascular disease (OR: 0.6, 95% CI: 0.4-0.8) and polypharmacy (OR: 0.2, 95% CI: 0.1-0.2) reduced the risk of uncontrolled hypertension. CONCLUSION The present study showed that uncontrolled hypertension has a high prevalence, and factors such as male gender, diabetes, and CKD are associated with this disorder. So, it is recommended to take the necessary measures to formulate and implement immediate actions to prevent or control hypertension.
Collapse
Affiliation(s)
- Fariba Farhadi
- Student Research Committee, School of Nursing & Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Roqayeh Aliyari
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hossein Ebrahimi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
22
|
Dukunde A, Ntaganda JM, Kasozi J, Nzabanita J. Prediction of the Prevalence of Hypertension and Associated Risk Factors in Rwanda Using Gibbs Sampling Method. Diseases 2023; 11:87. [PMID: 37366875 DOI: 10.3390/diseases11020087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
In Rwanda, the prevalence of hypertension was 15.3% in 2015. At present, there are no accurate predictions of the prevalence of hypertension and its trend over time in Rwanda to assist decision makers in making plans for prevention and more effective interventions. This study used the Gibbs sampling method in combination with the Markov Chain Monte Carlo approach to predict the prevalence of hypertension and its associated risk factors in Rwanda over a period of ten years. The data were from World Health Organization (WHO) reports. The findings showed that the prevalence of hypertension is estimated to reach 17.82% in 2025, with tobacco use, being overweight or obese, and other risk factors having a respective prevalence of 26.26%, 17.13%, 4.80%, and 33.99%, which shows the increase and, therefore, measures for prevention to be taken. Therefore, to prevent and reduce the prevalence of this disease, the government of Rwanda should take appropriate measures to promote a balanced diet and physical exercise.
Collapse
Affiliation(s)
- Angélique Dukunde
- African Center of Excellence in Data Science-Biostatistics, College of Business and Economics, University of Rwanda, Kigali P.O. Box 4285, Rwanda
| | - Jean Marie Ntaganda
- Department of Mathematics, College of Science and Technology, University of Rwanda, KN 67 Street, Nyarugenge P.O. Box 3900, Rwanda
| | - Juma Kasozi
- Department of Mathematics, College of Natural Science, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Joseph Nzabanita
- Department of Mathematics, College of Science and Technology, University of Rwanda, KN 67 Street, Nyarugenge P.O. Box 3900, Rwanda
| |
Collapse
|
23
|
Van Hout MC, Zalwango F, Akugizibwe M, Chaka MN, Birungi J, Okebe J, Jaffar S, Bachmann M, Murdoch J. Implementing integrated care clinics for HIV-infection, diabetes and hypertension in Uganda (INTE-AFRICA): process evaluation of a cluster randomised controlled trial. BMC Health Serv Res 2023; 23:570. [PMID: 37268916 DOI: 10.1186/s12913-023-09534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/10/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa is experiencing a dual burden of chronic human immunodeficiency virus and non-communicable diseases. A pragmatic parallel arm cluster randomised trial (INTE-AFRICA) scaled up 'one-stop' integrated care clinics for HIV-infection, diabetes and hypertension at selected facilities in Uganda. These clinics operated integrated health education and concurrent management of HIV, hypertension and diabetes. A process evaluation (PE) aimed to explore the experiences, attitudes and practices of a wide variety of stakeholders during implementation and to develop an understanding of the impact of broader structural and contextual factors on the process of service integration. METHODS The PE was conducted in one integrated care clinic, and consisted of 48 in-depth interviews with stakeholders (patients, healthcare providers, policy-makers, international organisation, and clinical researchers); three focus group discussions with community leaders and members (n = 15); and 8 h of clinic-based observation. An inductive analytical approach collected and analysed the data using the Empirical Phenomenological Psychological five-step method. Bronfenbrenner's ecological framework was subsequently used to conceptualise integrated care across multiple contextual levels (macro, meso, micro). RESULTS Four main themes emerged; Implementing the integrated care model within healthcare facilities enhances detection of NCDs and comprehensive co-morbid care; Challenges of NCD drug supply chains; HIV stigma reduction over time, and Health education talks as a mechanism for change. Positive aspects of integrated care centred on the avoidance of duplication of care processes; increased capacity for screening, diagnosis and treatment of previously undiagnosed comorbid conditions; and broadening of skills of health workers to manage multiple conditions. Patients were motivated to continue receiving integrated care, despite frequent NCD drug stock-outs; and development of peer initiatives to purchase NCD drugs. Initial concerns about potential disruption of HIV care were overcome, leading to staff motivation to continue delivering integrated care. CONCLUSIONS Implementing integrated care has the potential to sustainably reduce duplication of services, improve retention in care and treatment adherence for co/multi-morbid patients, encourage knowledge-sharing between patients and providers, and reduce HIV stigma. TRIAL REGISTRATION NUMBER ISRCTN43896688.
Collapse
Affiliation(s)
| | - Flavia Zalwango
- MRC/UVRI & LSHTM Research Unit, MRC/UVRI & LSHTM, Entebbe, Uganda
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Katsukunya JN, Soko ND, Naidoo J, Rayner B, Blom D, Sinxadi P, Chimusa ER, Dandara M, Dzobo K, Jones E, Dandara C. Pharmacogenomics of Hypertension in Africa: Paving the Way for a Pharmacogenetic-Based Approach for the Treatment of Hypertension in Africans. Int J Hypertens 2023; 2023:9919677. [PMID: 38633331 PMCID: PMC11022520 DOI: 10.1155/2023/9919677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 04/19/2024] Open
Abstract
In Africa, the burden of hypertension has been rising at an alarming rate for the last two decades and is a major cause for cardiovascular disease (CVD) mortality and morbidity. Hypertension is characterised by elevated blood pressure (BP) ≥ 140/90 mmHg. Current hypertension guidelines recommend the use of antihypertensives belonging to the following classes: calcium channel blockers (CCB), angiotensin converting inhibitors (ACEI), angiotensin receptor blockers (ARB), diuretics, β-blockers, and mineralocorticoid receptor antagonists (MRAs), to manage hypertension. Still, a considerable number of hypertensives in Africa have their BP uncontrolled due to poor drug response and remain at the risk of CVD events. Genetic factors are a major contributing factor, accounting for 20% to 80% of individual variability in therapy and poor response. Poor response to antihypertensive drug therapy is characterised by elevated BPs and occurrence of adverse drug reactions (ADRs). As a result, there have been numerous studies which have examined the role of genetic variation and its influence on antihypertensive drug response. These studies are predominantly carried out in non-African populations, including Europeans and Asians, with few or no Africans participating. It is important to note that the greatest genetic diversity is observed in African populations as well as the highest prevalence of hypertension. As a result, this warrants a need to focus on how genetic variation affects response to therapeutic interventions used to manage hypertension in African populations. In this paper, we discuss the implications of genetic diversity in CYP11B2, GRK4, NEDD4L, NPPA, SCNN1B, UMOD, CYP411, WNK, CYP3A4/5, ACE, ADBR1/2, GNB3, NOS3, B2, BEST3, SLC25A31, LRRC15 genes, and chromosome 12q loci on hypertension susceptibility and response to antihypertensive therapy. We show that African populations are poorly explored genetically, and for the few characterised genes, they exhibit qualitative and quantitative differences in the profile of pharmacogene variants when compared to other ethnic groups. We conclude by proposing prioritization of pharmacogenetics research in Africa and possible adoption of pharmacogenetic-guided therapies for hypertension in African patients. Finally, we outline the implications, challenges, and opportunities these studies present for populations of non-European descent.
Collapse
Affiliation(s)
- Jonathan N. Katsukunya
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Nyarai D. Soko
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Jashira Naidoo
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Brian Rayner
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dirk Blom
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Lipidology and Cape Heart Institute, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Phumla Sinxadi
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Clinical Pharmacology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile R. Chimusa
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle, Tyne and Wear NE1 8ST, UK
| | - Michelle Dandara
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Kevin Dzobo
- Medical Research Council-SA Wound Healing Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences University of Cape Town, Anzio Road Observatory, Cape Town 7925, South Africa
| | - Erika Jones
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
25
|
Sharma JR, Dludla PV, Dwivedi G, Johnson R. Measurement Tools and Utility of Hair Analysis for Screening Adherence to Antihypertensive Medication. Glob Heart 2023; 18:17. [PMID: 36968302 PMCID: PMC10038111 DOI: 10.5334/gh.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Poor adherence to the prescribed antihypertensive therapy is an understated public health problem and is one of the main causes of the high prevalence of uncontrolled hypertension in sub-Saharan Africa. Medication adherence is vital for the effectiveness of antihypertensive treatment and is key to ameliorating the clinical outcomes in hypertensive patients. However, it has often been ignored because the current methods used to assess medication adherence are not reliable, limiting their utilization in clinical practice. Therefore, the identification of the most accurate and clinically feasible method for measuring medication adherence is critical for tailoring effective strategies to improve medication adherence and consequently achieve blood pressure goals. This review not only explores various available methods for estimating medication adherence but also proposes therapeutic drug monitoring in hair for the measurement of medication adherence to the antihypertensive medication period.
Collapse
Affiliation(s)
- Jyoti R. Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Phiwayinkosi V. Dludla
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Girish Dwivedi
- Medical School, University of Western Australia, Harry Perkins Institute of Medical Sciences, Fiona Stanley Hospital, Verdun Street, Nedlands WA, 6009, Australia
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
| |
Collapse
|
26
|
A Oseni TI, Emonriken A, Ahmed SD, Dic-Ijiewere M. Determinants of blood pressure control among hypertensive patients attending a rural teaching hospital in Southern Nigeria. Niger J Clin Pract 2023; 26:260-266. [PMID: 37056097 DOI: 10.4103/njcp.njcp_1678_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Background Hypertension (HTN) is the commonest cardiovascular risk factor in sub-Saharan Africa. It is a global public health threat, often associated with significant morbidities and mortality with rising prevalence both in rural and semi-urban areas of economically disadvantaged countries. Aim This study aimed to assess the determinants of blood pressure control among patients with hypertension receiving care at the Irrua Specialist Teaching Hospital in Southern Nigeria. Patients and Methods A cross-sectional study of 502 consenting hypertensive adults receiving care at the Irrua Specialist Teaching Hospital, Irrua in Edo State, South-south Nigeria. A pre-tested semi-structured interviewer-administered questionnaire was used to collect data which was analyzed using SPSS version 21 and the level of significance was set at P < 0.05. Results Five hundred and two participants (226 males, 276 females) completed the study with a mean age of 52.98 ± 12.82 years. Optimal blood pressure control was found in 15.5% of the study participants. Blood pressure control was significantly associated with being married (OR 1.549, CI: 1.040-2.309), having a monthly household income of over N50,000 (OR 1.691, CI: 0.999-2.863), engaging in physical activity (OR = 1.537, CI: 0.989-2.388), and not being obese evidenced by a normal Waist Hip Ratio (OR = 2.276, CI: 1.555-3.332). Conclusion Blood pressure control to target goal was low in the study population and achieved only in less than one-fifth of respondents on antihypertensive therapy. Numerous socio-demographic and lifestyle variables were shown to be associated with blood pressure control. Physicians should emphasize medication adherence and lifestyle modification approaches in hypertensive adults.
Collapse
Affiliation(s)
- T I A Oseni
- Department of Family Medicine, Ambrose Alli University, Ekpoma, Edo State, Nigeria
| | - A Emonriken
- Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - S D Ahmed
- Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - M Dic-Ijiewere
- Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| |
Collapse
|
27
|
Olanrewaju TO, Osafo C, Raji YR, Mamven M, Ajayi S, Ilori TO, Arogundade FA, Ulasi II, Gbadegesin R, Parekh RS, Tayo B, Adeyemo AA, Adedoyin OT, Chijioke AA, Bewaji C, Grobbee DE, Blankestijn PJ, Klipstein-Grobusch K, Salako BL, Adu D, Ojo AO. Cardiovascular Risk Factor Burden and Association With CKD in Ghana and Nigeria. Kidney Int Rep 2023; 8:658-666. [PMID: 36938080 PMCID: PMC10014339 DOI: 10.1016/j.ekir.2022.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD); however, the burden of cardiovascular risk factors in patients with CKD in Africa is not well characterized. We determined the prevalence of selected cardiovascular risk factors, and association with CKD in the Human Heredity for Health in Africa Kidney Disease Research Network study. Methods We recruited patients with and without CKD in Ghana and Nigeria. CKD was defined as estimated glomerular filtration rate of <60 ml/min per 1.73 m2 and/or albuminuria as albumin-to-creatinine ratio <3.0 mg/mmol (<30 mg/g) for ≥3 months. We assessed self-reported (physician-diagnosis and/or use of medication) hypertension, diabetes, and elevated cholesterol; and self-reported smoking as cardiovascular risk factors. Association between the risk factors and CKD was determined by multivariate logistic regression. Results We enrolled 8396 participants (cases with CKD, 3956), with 56% females. The mean age (45.5 ± 15.1 years) did not differ between patients and control group. The prevalence of hypertension (59%), diabetes (20%), and elevated cholesterol (9.9%), was higher in CKD patients than in the control participants (P < 0.001). Prevalence of risk factors was higher in Ghana than in Nigeria. Hypertension (adjusted odds ratio [aOR] = 1.69 [1.43-2.01, P < 0.001]), elevated cholesterol (aOR = 2.0 [1.39-2.86, P < 0.001]), age >50 years, and body mass index (BMI) <18.5 kg/m2 were independently associated with CKD. The association of diabetes and smoking with CKD was modified by other risk factors. Conclusion Cardiovascular risk factors are prevalent in middle-aged adult patients with CKD in Ghana and Nigeria, with higher proportions in Ghana than in Nigeria. Hypertension, elevated cholesterol, and underweight were independently associated with CKD.
Collapse
Affiliation(s)
- Timothy O. Olanrewaju
- Division of Nephrology, Department of Medicine, University of Ilorin, Ilorin, Nigeria
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charlotte Osafo
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Ghana
| | - Yemi R. Raji
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Manmak Mamven
- Department of Medicine, University of Abuja, Abuja, Nigeria
| | - Samuel Ajayi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Titilayo O. Ilori
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Ifeoma I. Ulasi
- Department of Medicine, College of Health Sciences, University of Nigeria, Enugu, Nigeria
| | - Rasheed Gbadegesin
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Rulan S. Parekh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Bamidele Tayo
- Department of Public Health Sciences, Loyola University Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Adebowale A. Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Adindu A. Chijioke
- Division of Nephrology, Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Clement Bewaji
- Department of Biochemistry, University of Ilorin, Ilorin, Nigeria
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Dwomoa Adu
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Ghana
| | - Akinlolu O. Ojo
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | |
Collapse
|
28
|
Janse Van Rensburg Z, Vincent-Lambert C, Razlog R, Phaladze N. Prevalence of hypertension in a sample of community members in a low-income peri-urban setting in Gaborone, Botswana. J Public Health Afr 2023; 14:2068. [PMID: 37065813 PMCID: PMC10099957 DOI: 10.4081/jphia.2023.2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/15/2022] [Indexed: 03/06/2023] Open
Abstract
Background: Cardiovascular disease remains the leading cause of death worldwide. Hypertension is a primary risk factor for the development of cardiovascular disease and affects more than a quarter of the global adult population. Africa is a continent where the prevalence of non-communicable diseases including cardiovas- cular disease and hypertension, is increasing rapidly. Botswana is a developing country in Sub-Saharan Africa. In such contexts the early identification of hypertension, through community screening initiatives, is an important tool for the management of cardiovas- cular disease in the population.
Objective: To investigate and describe the prevalence of hypertension in a sample of community members residing in a low-income peri-urban setting in Gaborone, Botswana.
Method: 364 adult participants had their blood pressures mea- sured during a community health screening exercise. The values were analysed and categorised using the American Heart Association classification scale as either being normal, elevated, hypertensive stage 1 or hypertensive stage 2.
Results: 234/364 (64%) of participants were found to have blood pressures within normal limits. 53/364 (15%) had elevated blood pressures, 57/364 (16%) were in hypertensive stage 1 and 20/364 (5%) were in hypertensive stage 2.
Conclusions: Hypertension in Africa is a growing concern. Botswana appears to be no exception with a 36% prevalence of abnormal blood pressures being recorded. However, the majority of these were classified as elevated or stage 1. Early identification and treatment of hypertension in these early stages can significant- ly decrease the risk of developing stage 2 hypertension and the related systemic complications.
Collapse
|
29
|
Mogaka JN, Lagat H, Otieno G, Macharia P, Wamuti B, Masyuko S, Sharma M, Kariithi E, Farquhar C, Temu TM. Descriptive study: Feasibility of integrating hypertension screening into HIV assisted partner notification services model in Kenya. Medicine (Baltimore) 2023; 102:e33067. [PMID: 36827044 PMCID: PMC11309717 DOI: 10.1097/md.0000000000033067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Prevalence of hypertension (HTN) and human immunodeficiency virus (HIV) are high among men while screening rates are low. Assisted partner notification service is a strategy recommended by the World Health Organization that aims to increase HIV testing and treatment uptake and may present an opportunity to offer integrated HIV/HTN screening and treatment services. In this prospective cohort study, we assessed the feasibility of integrating HTN screening for male sexual partners of females newly tested HIV-positive in 10 health facilities in Kenya. Participants were notified of the exposure and offered HIV testing and HTN screening; if they accepted and tested positive for either HTN, HIV, or both, they were referred for care. HTN was defined as systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90, or the use of antihypertensive medication. Among 1313 male partners traced, 99% accepted HIV testing and HTN screening. Overall, 4% were found to have HTN, 29% were in the pre-HTN stage, and 9% were HIV-positive. Only 75% had previously been screened for HTN compared to 95% who had previously tested for HIV. A majority preferred non-facility-based screening. The participants who refused HTN screening noted time constraints as a significant hindrance. HIV and HTN screening uptake was high in this hard-to-reach population of men aged 25 to 50. Although HTN rates were low, an integrated approach provided an opportunity to detect those with pre-HTN and intervene early. Strategic integration of HTN services within assisted partners services may promote and normalize testing by offering inclusive and accessible services to men.
Collapse
Affiliation(s)
| | | | | | - Paul Macharia
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Sarah Masyuko
- Ministry of Health-National AIDS and STI Control Program, Nairobi, Kenya
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA
- Department of Epidemiology and Medicine, University of Washington, Seattle, WA
| | - Tecla M. Temu
- Department of Global Health, University of Washington, Seattle, WA
- Institute of Tropical Diseases, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
30
|
Moloro AH, Seid AA, Jaleta FY. A systematic review and meta-analysis protocol on hypertension prevalence and associated factors among bank workers in Africa. SAGE Open Med 2023; 11:20503121231172001. [PMID: 37181276 PMCID: PMC10170600 DOI: 10.1177/20503121231172001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Objective This systematic review and meta-analysis will investigate the pooled prevalence of hypertension and associated factors among bank workers in Africa. Methods Studies published with full texts in English will be searched in the PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, African Journals Online, and Google Scholar databases. Checklists from the Joanna Briggs Institute will be used to assess the studies' methodology quality. Data extraction, critical appraisal, and screening of all retrieved articles will be conducted by two independent reviewers. Statistical analysis will be performed using STATA-14 software packages. A random effect will be employed to demonstrate pooled estimates of hypertension among bank workers. For determinants of hypertension, an effect size with a 95% confidence interval will be analyzed. Results Data extraction and statistical analyses will begin after identifying the most pertinent studies and evaluating their methodological quality. Data synthesis and the presentation of the results are scheduled for completion by the end of 2023. After the review is completed, the results will be presented at relevant conferences and published in a peer-reviewed journal. Conclusion Hypertension is a major public health concern in Africa. More than 2 out of 10 people aged older than 18 years suffer from hypertension. A number of factors contribute to hypertension in Africa. These factors include female gender, age, overweight or obesity, khat chewing, alcohol consumption, and family history of hypertension and diabetes mellitus. To address the alarming rise in hypertension in Africa, behavioral risk factors should be given primary attention. Protocol registration This systematic review and meta-analysis protocol is registered in PROSPERO with the registration ID and link as follows: CRD42022364354;CRD-register@york.ac.ukhttps://www.york.ac.uk/inst/crd.
Collapse
Affiliation(s)
- Abdulkerim Hassen Moloro
- Abdulkerim Hassen Moloro, Department of Nursing, College of Medicine and Health Science, Samara University, Samara, P.O. Box 132, Afar, Ethiopia.
| | | | | |
Collapse
|
31
|
Mendelian randomization study reveals a causal relationship between adiponectin and LDL cholesterol in Africans. Sci Rep 2022; 12:18955. [PMID: 36347891 PMCID: PMC9643497 DOI: 10.1038/s41598-022-21922-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
Adiponectin has been associated with cardiometabolic traits in observational studies across populations, yet it is unclear if these associations are causal. We performed Mendelian randomization (MR) analysis to assess the relationship between adiponectin and cardiometabolic traits in sub-Saharan Africans. We constructed a polygenic risk score (PRS) for adiponectin levels across 3354 unrelated sub-Saharan Africans. The PRS was used as the instrumental variable in two-stage least-squares MR analysis to assess its association with insulin resistance, HDL, LDL, total cholesterol, triglycerides, blood pressure, Type 2 Diabetes (T2D), and hypertension. The adiponectin PRS was causally related with LDL (β = 0.55, 95%CI 0.07-1.04, P-value = 0.024) but not the other traits. This association was observed in both overweight/obese and normal weight individuals, but only reached statistical significance among overweight/obese individuals (β = 0.55, 95%CI 0.01-1.08, P-value = 0.045). In normal weight individuals, the adiponectin PRS was associated with T2D (OR = 0.13, 95%CI 0.02-0.73, P-value = 0.021), and in men with HDL (β = 1.03, 95%CI 0.14-1.92, P-value = 0.023). The findings of this first MR study in sub-Saharan Africans support a causal relationship of adiponectin with LDL, with T2D in normal weight individuals only, and with HDL in men only. These observations add to the small but growing literature on adiponectin MR studies.
Collapse
|
32
|
Prevalence and associated factors of undiagnosed hypertension among adults in the Central African Republic. Sci Rep 2022; 12:19007. [PMID: 36347923 PMCID: PMC9643345 DOI: 10.1038/s41598-022-23868-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022] Open
Abstract
The study aimed to estimate the prevalence and associated factors of undiagnosed hypertension (HTN) among adults in the Central African Republic (CAR). In the cross-sectional 2017 CAR (Bangui and Ombella M'Poko) STEPS survey, 3265 persons aged 25 to 64 years (non-pregnant and with complete blood pressure measurement), responded to an interview, biomedical and physical, including blood pressure, measurements. Undiagnosed HTN was classified as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg among adults who had never been told by a doctor or other health worker that they had raised blood pressure or hypertension and had not been taking antihypertensive medication. Binary logistic regressions are used to estimate factors associated with undiagnosed HTN. Among those with HTN (N = 1373), the proportion of undiagnosed HTN was 69.8% and 30.2% diagnosed HTN. In the adjusted logistic regression analysis, male sex (AOR: 2.12, 95% CI 1.39-3.23), current tobacco use (AOR: 1.58, 95% CI 1.03-2.42), and high physical activity (AOR: 1.93, 95% CI 1.00-3.71) were positively associated, and age (AOR: 0.75, 95% CI 0.59-0.96), and underweight (AOR: 0.58, 95% CI 0.37-0.90) were inversely associated with undiagnosed HTN. In addition, among men, ever screened for glucose (AOR: 0.07, 95% CI 0.02-0.27) was negatively associated with undiagnosed HTN, and among women, married or cohabiting (AOR: 1.20, 95% CI 1.00-1.44), current heavy drinking (AOR: 1.41, 95% CI 1.04-1.91) were positively associated with undiagnosed HTN. Seven in ten of the adult population with HTN had undiagnosed HTN in CAR. Efforts should be reinforced to screen for HTN in the general population.
Collapse
|
33
|
Oni OO, Akinwusi PO, Owolabi JI, Odeyemi AO, Israel GM, Ala O, Akande JO, Durodola A, Israel OK, Ajibola I, Aremu AO. Chronic Kidney Disease and Its Clinical Correlates in a Rural Community in Southwestern Nigeria. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:774-783. [PMID: 38018719 DOI: 10.4103/1319-2442.390257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Chronic kidney disease (CKD) is a burgeoning problem globally, and more than a billion adults were affected as of 2016, with 1.2 million people dying from renal failure in 2017. To arrest the seemingly relentless progression of CKD to renal failure, there is a need to detect CKD early in the community. A community-based study was carried out to look at the prevalence and risk factors of CKD. Anthropometric and other clinical variables were measured. Blood samples were taken for determining creatinine, uric acid, urea, and lipids. CKD was defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2. Electrocardiograms and renal ultrasound scans were performed. In total, 201 people were recruited. Those with CKD had a male:female ratio of 1:3.9 and were older. The prevalence of autosomal-dominant polycystic kidney disease and CKD was 531.9 persons/100,000 population and 46.3%, respectively. Systolic blood pressure, pulse pressure, total cholesterol, triglycerides, high-density lipoprotein (HDL), uric acid, QTc interval, and electrocardiographic left ventricular hypertrophy were higher in those with CKD. Age, female sex, and HDL were independently associated with CKD. There was a steep rise in CKD at the community level. Increased awareness of CKD and prompt interventions are therefore imperative.
Collapse
Affiliation(s)
- Opeyemi O Oni
- Department of Medicine, Bowen University, Iwo, Nigeria
| | | | | | | | | | | | - Joel O Akande
- Department of Chemical Pathology, Bowen University, Iwo, Nigeria
| | | | | | - Idowu Ajibola
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| | - Ayodele O Aremu
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| |
Collapse
|
34
|
Masenga SK, Pilic L, Hamooya BM, Nzala S, Heimburger DC, Mutale W, Koethe JR, Kirabo A, Munsaka SM, Elijovich F. Immediate pressor response to oral salt and its assessment in the clinic: a time series clinical trial. Clin Hypertens 2022; 28:25. [PMID: 36104796 PMCID: PMC9476589 DOI: 10.1186/s40885-022-00209-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 05/06/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND High blood pressure (BP) is associated with high-salt consumption especially in sub-Saharan Africa. Although the pressor effect of salt is viewed as a chronic effect, some studies suggest that a salty meal may increase BP immediately in some individuals, and that this effect may cause endothelial dysfunction. Therefore, the aim of our research was to study the immediate pressor response to oral salt (IPROS) and its determinants, with the expectation that a simple methodology may be devised to diagnose it in the clinic or in low-resource environments. METHODS We conducted a time series trial at Livingstone Central Hospital. We present data in 127 normotensive participants who ingested 2 g of sodium chloride; their BP was monitored for 120 minutes in intervals of 10 minutes. Sociodemographic and clinical data were collected. Descriptive and inferential statistics were used for analyses of data. RESULTS Median age was 30 years (interquartile range, 22-46 years) and 52% were female patients. An increase of ≥10 mmHg in mean arterial pressure (MAP), considered a clinically significant IPROS, was present in 62% of participants. Systolic BP 30 minutes after the salt load was a significant predictor of IPROS, avoiding the need to calculate MAP in the clinic setting. CONCLUSIONS We confirm the presence of an IPROS in a high proportion (62%) of otherwise normotensive participants. The average time course for this response was 30 minutes and its duration was sustained for the 120-minutes period of study in most of the participants. Prediction of IPROS by ∆SBP (change in systolic blood pressure) at 30 minutes allows for easy assessment of possible responder status in the clinic. Our data indicate that the IPROS to oral salt-loads in the range currently consumed by the Western world and African populations in single meals may increase the 24-hour BP load, which is a risk factor for hypertension and target organ damage. The relevance of our findings indicates the need to include dietary sodium assessment in the diagnosis, prevention, and management of high BP.
Collapse
Affiliation(s)
- Sepiso K. Masenga
- grid.442660.20000 0004 0449 0406HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Akapelwa street, LUTH Premises, Livingstone, Zambia ,grid.12984.360000 0000 8914 5257Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Leta Pilic
- grid.417907.c0000 0004 5903 394XFaculty of Sport, Health and Applied Science, St. Mary’s University, Twickenham, London, UK
| | - Benson M. Hamooya
- grid.442660.20000 0004 0449 0406HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Akapelwa street, LUTH Premises, Livingstone, Zambia ,grid.12984.360000 0000 8914 5257School of Public Health and School of Medicine, University of Zambia, Lusaka, Zambia
| | - Selestine Nzala
- grid.12984.360000 0000 8914 5257School of Public Health and School of Medicine, University of Zambia, Lusaka, Zambia
| | - Douglas C. Heimburger
- grid.12984.360000 0000 8914 5257School of Public Health and School of Medicine, University of Zambia, Lusaka, Zambia ,grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt Institute for Global Health and Vanderbilt University Medical Center, Nashville, TN USA
| | - Wilbroad Mutale
- grid.12984.360000 0000 8914 5257School of Public Health and School of Medicine, University of Zambia, Lusaka, Zambia
| | - John R. Koethe
- grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt Institute for Global Health and Vanderbilt University Medical Center, Nashville, TN USA
| | - Annet Kirabo
- grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt Institute for Global Health and Vanderbilt University Medical Center, Nashville, TN USA
| | - Sody M. Munsaka
- grid.12984.360000 0000 8914 5257Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Fernando Elijovich
- grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt Institute for Global Health and Vanderbilt University Medical Center, Nashville, TN USA
| |
Collapse
|
35
|
Tsuro U, Oladimeji KE, Pulido-Estrada GA, Apalata TR. Risk Factors Attributable to Hypertension among HIV-Infected Patients on Antiretroviral Therapy in Selected Rural Districts of the Eastern Cape Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11196. [PMID: 36141463 PMCID: PMC9517599 DOI: 10.3390/ijerph191811196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Antiretroviral therapy has improved HIV patients' quality of life and life expectancy. However, complications have emerged in the form of hypertension. In the rural Eastern Cape, there is minimal information about HIV-infected people. The current study intended to evaluate the factors associated with hypertension in HIV-infected individuals receiving antiretroviral therapy in rural areas of South Africa's Eastern Cape. METHODS For this cohort study, HIV-positive people taking antiretroviral therapy aged 15 and up were recruited at random from several rural locations in the Eastern Cape. Using Cox univariate and multivariate analyses, the key predictors of hypertension were found. RESULTS Of the total participants (n = 361), 53% of individuals had hypertension. In the Cox multivariate model, patients that had hypertension heredity, BMI ≥ 25 kg/m2, eGFR < 60 mL/min/1.73 m2, advanced and severe CD4 counts, 1TFE and 1T3E regimens, and the male gender were found to be at greater risk of hypertension. CONCLUSIONS The findings of this study indicate that hypertension is a prevalent concern among HIV patients receiving antiretroviral therapy. HIV patients should have their blood pressure checked regularly, and they should be screened for high blood pressure and given treatment for it.
Collapse
Affiliation(s)
- Urgent Tsuro
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
| | - Kelechi E. Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
- College of Graduate Studies, University of South Africa, Pretoria 0001, South Africa
| | | | - Teke R. Apalata
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
| |
Collapse
|
36
|
Moussouni A, Sidi-Yakhlef A, Hamdaoui H, Aouar A, Belkhatir D. Prevalence and risk factors of prehypertension and hypertension in Algeria. BMC Public Health 2022; 22:1571. [PMID: 35982441 PMCID: PMC9386961 DOI: 10.1186/s12889-022-13942-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/27/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Hypertension, also referred to as the silent killer, is known to be one of the most common chronic diseases in the world today. This study aimed to identify the prevalence and risk factors of prehypertension and hypertension among Algerian population. METHODS This is a descriptive cross-sectional epidemiological study involving individuals aged 18 to 69 years old who were identified in the database of the national survey on non-communicable diseases (NCDs) risk factors conducted in Algeria between 2016 and 2017 using the World Health Organization's (WHO) STEPwise approach. Differences in prevalence between normotensives, prehypertensives and hypertensives were assessed using the chi-square test. We also looked at the role of numerous socio-demographic, economic, geographical, and behavioural factors in blood pressure status using a logistic regression model. RESULTS The prevalence of prehypertension and hypertension was 36.2% (95% confidence interval: 35.2-37.5%) and 31.6% (95% CI: 30.5-32.7%) respectively. Prehypertension was shown to be substantially higher in males than in women, while hypertension was found to be higher in females compared to men. In addition, both sexes had a rise in the prevalence of blood pressure as they grew older. A according to multivariate logistic regression analysis, the main common risk factors for prehypertension and hypertension were ageing, obesity, and abdominal obesity. Moreover hypercholesterolemia, and marital status (separated/divorced) were correlated to hypertension. CONCLUSION Prehypertension and hypertension are high and epidemic in Algeria. Therefore, the urgent quantification and monitoring of their risk factors becomes a necessity to plan appropriate preventive measures, in order to fight against NCDs in general.
Collapse
Affiliation(s)
- Abdellatif Moussouni
- National Center for Prehistoric, Anthropological and Historical Research (CNRPAH, Tlemcen's station), Algeria, 03, Rue Franklin Roosevelt, 16500, Alger, Algeria.
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Anthropology, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria.
| | - Adel Sidi-Yakhlef
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Human Actions' Valorisation for Protection of Environment and Application in Public Health, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria
| | - Houari Hamdaoui
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Human Actions' Valorisation for Protection of Environment and Application in Public Health, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria
| | - Amaria Aouar
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Human Actions' Valorisation for Protection of Environment and Application in Public Health, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria
| | - Djamel Belkhatir
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Human Actions' Valorisation for Protection of Environment and Application in Public Health, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria
| |
Collapse
|
37
|
Sleep quality and associated factors among adult hypertensive patients attending a chronic follow up care clinic in northwest Amhara regional state referral hospitals, Northwest Ethiopia. PLoS One 2022; 17:e0271072. [PMID: 35797273 PMCID: PMC9262207 DOI: 10.1371/journal.pone.0271072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Sleep plays an essential role in every individual’s life since it contributes greatly to their well-being and health. Poor sleep quality is one of the most common consequences of hypertension (HTN), which is a leading public health problem. In Ethiopia, it is the main health concern among hypertension patients. Thus, in the study area, there is limited information regarding the investigation of sleep quality among hypertension patients. Therefore, this study aimed to assess sleep quality and associated factors among adult hypertensive patients attending a chronic follow up care clinic in northwest Amhara regional state referral hospitals, Northwest Ethiopia.
Methods
An institution-based cross-sectional study was conducted among adult HTN patients from March 15/2021 to May 15/2021 in Northwest Amhara Regional State Referral Hospitals. A systematic random sampling method was used to select the study participants. A face-to-face interviewer-administered questionnaire with chart review was used. The Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality was used in this study. A binary logistic regression was used to see the association between dependent and independent variables. Variables having a p-value < 0.05 with a 95% CI were considered statistically significant in the multivariable logistic regression analysis.
Results
In this study, 563 hypertensive patients were included, with a response rate of 96.9%. The overall prevalence of poor sleep quality was 37.7% (95% CI: 33.4%–41.6%). Female gender (AOR = 2.55, 95% CI: 1.55–4.18), age ≥ 65 years (AOR = 4.07, 95% CI: 2.07–7.97), overweight (BMI) ≥ 25 kg/m2 (AOR = 1.68, 95% CI: 1.06–2.65), WHO stage II hypertension (AOR = 1.78, 95% CI:1.01–3.12), poor physical activity (AOR = 2.39, 95% CI:1.41–4.05), participants who had depression (AOR = 2.03,95% CI:1.24–3.34) and participants who had anxiety (AOR = 1.89, 95% CI: 1.16–3.03) were factors associated with poor sleep quality.
Conclusions
In this study, more than one-third of the study participants had poor sleep quality. Female gender, age ≥ 65 years, overweight (BMI) ≥ 25 kg/m2, stage II hypertension, physical inactivity, depression, and anxiety were all associated with poor sleep quality. Managing depression and anxiety disorders, encouraging physical activity, and providing health education about weight loss are all necessary for HTN patients.
Collapse
|
38
|
Barriers to up-titrated antihypertensive strategies in 12 sub-Saharan African countries: the Multination Evaluation of hypertension in Sub-Saharan Africa Study. J Hypertens 2022; 40:1411-1420. [PMID: 35762480 DOI: 10.1097/hjh.0000000000003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa. METHODS We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies. RESULTS The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11-1.77)], complication of hypertension [OR 2.4 (1.89-3.03)], former hypertension [OR 3.12 (2.3-4.26)], good adherence [OR 1.98 (1.47-2.66)], from MIC [OR 1.38 (1.10-1.74)] and living in urban areas [OR 1.52 (1.16-1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC. CONCLUSION In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.
Collapse
|
39
|
Ntaganda E, Mugeni R, Harerimana E, Ngoga G, Dusabeyezu S, Uwinkindi F, Utumatwishima JN, Mutimura E, Davila-Roman VG, Schechtman K, Nishimwe A, Twizeyimana L, Brown AL, Cade WT, Bushaku M, de Las Fuentes L, Reeds D, Twagirumukiza M. High rates of undiagnosed and uncontrolled hypertension upon a screening campaign in rural Rwanda: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:197. [PMID: 35473501 PMCID: PMC9044706 DOI: 10.1186/s12872-022-02606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypertension remains the major risk factor for cardiovascular diseases (CVDs) worldwide with a prevalence and mortality in low- and middle-income countries (LMICs) among the highest. The early detection of hypertension risk factors is a crucial pillar for CVD prevention. DESIGN AND METHOD This cross-sectional study included 4284 subjects, mean age 46 ± 16SD, 56.4% females and mean BMI 26.6 ± 3.7 SD. Data were collected through a screening campaign in rural area of Kirehe District, Eastern of Rwanda, with the objective to characterize and examine the prevalence of elevated blood pressure (BP) and other CVD risk factors. An adapted tool from the World Health Organization STEPwise Approach was used for data collection. Elevated BP was defined as ≥ 140/90 mm/Hg and elevated blood glucose as blood glucose ≥ 100 mg/dL after a 6-h fast. RESULTS Of the sampled population, 21.2% (n = 910) had an elevated BP at screening; BP was elevated among individuals not previously known to have HTN in 18.7% (n = 752). Among individuals with a prior diagnosis of HTN, 62.2% (n = 158 of 254) BP was uncontrolled. Age, weight, smoking, alcohol history and waist circumference were associated with BP in both univariate analyses and multivariate analysis. CONCLUSION High rates of elevated BP identified through a health screening campaign in this Rwandan district were surprising given the rural characteristics of the district and relatively low population age. These data highlight the need to implement an adequate strategy for the prevention, diagnosis, and control of HTN that includes rural areas of Rwanda as part of a multicomponent strategy for CVD prevention.
Collapse
Affiliation(s)
- Evariste Ntaganda
- Rwanda Biomedical Center (RBC), Rwanda Ministry of Health, Kigali, Rwanda
| | - Regine Mugeni
- Rwamagana Provincial Hospital, Rwamagana, Eastern Province, Rwanda.
| | | | - Gedeon Ngoga
- Partners in Health (PIH)/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | - Francois Uwinkindi
- Rwanda Biomedical Center (RBC), Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Eugene Mutimura
- National Council for Science and Technology (NCST), Kigali, Rwanda
| | - Victor G Davila-Roman
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kenneth Schechtman
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Aurore Nishimwe
- Regional Alliance for Sustainable Development (RASD Rwanda), Kigali, Rwanda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Angela L Brown
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - W Todd Cade
- Duke University School of Medicine, Durham, NC, 27710, USA
| | - Marcus Bushaku
- Regional Alliance for Sustainable Development (RASD Rwanda), Kigali, Rwanda
| | - Lisa de Las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Dominic Reeds
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Marc Twagirumukiza
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
40
|
Wang X, Carcel C, Woodward M, Schutte AE. Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure. Stroke 2022; 53:1114-1133. [PMID: 35344416 DOI: 10.1161/strokeaha.121.035852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.
Collapse
Affiliation(s)
- Xia Wang
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia
| | - Cheryl Carcel
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia (C.C.)
| | - Mark Woodward
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom (M.W.)
| | - Aletta E Schutte
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,School of Population Health (A.E.S.), University of New South Wales, Sydney, Australia.,Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
| |
Collapse
|
41
|
Uthman OA, Ayorinde A, Oyebode O, Sartori J, Gill P, Lilford RJ. Global prevalence and trends in hypertension and type 2 diabetes mellitus among slum residents: a systematic review and meta-analysis. BMJ Open 2022; 12:e052393. [PMID: 35210339 PMCID: PMC8883228 DOI: 10.1136/bmjopen-2021-052393] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE First, to obtain regional estimates of prevalence of hypertension and type 2 diabetes in urban slums; and second, to compare these with those in urban and rural areas. DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA Studies that reported hypertension prevalence using the definition of blood pressure ≥140/90 mm Hg and/or prevalence of type 2 diabetes. INFORMATION SOURCES Ovid MEDLINE, Cochrane CENTRAL and EMBASE from inception to December 2020. RISK OF BIAS Two authors extracted relevant data and assessed risk of bias independently using the Strengthening the Reporting of Observational Studies in Epidemiology guideline. SYNTHESIS OF RESULTS We used random-effects meta-analyses to pool prevalence estimates. We examined time trends in the prevalence estimates using meta-regression regression models with the prevalence estimates as the outcome variable and the calendar year of the publication as the predictor. RESULTS A total of 62 studies involving 108 110 participants met the inclusion criteria. Prevalence of hypertension and type 2 diabetes in slum populations ranged from 4.2% to 52.5% and 0.9% to 25.0%, respectively. In six studies presenting comparator data, all from the Indian subcontinent, slum residents were 35% more likely to be hypertensive than those living in comparator rural areas and 30% less likely to be hypertensive than those from comparator non-slum urban areas. LIMITATIONS OF EVIDENCE Of the included studies, only few studies from India compared the slum prevalence estimates with those living in non-slum urban and rural areas; this limits the generalisability of the finding. INTERPRETATION The burden of hypertension and type 2 diabetes varied widely between countries and regions and, to some degree, also within countries. PROSPERO REGISTRATION NUMBER CRD42017077381.
Collapse
Affiliation(s)
| | - Abimbola Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Oyinlola Oyebode
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - R J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
42
|
Comparative Assessment of the Utility of Anthropometric and Bioelectrical Impedance Indices as Potential Predictors of Hypertension within a Ghanaian Adult Population: A Cross-Sectional Study. Int J Hypertens 2022; 2022:2242901. [PMID: 35127158 PMCID: PMC8813306 DOI: 10.1155/2022/2242901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hypertension is an important public health concern that is claiming millions of lives worldwide. In sub-Saharan African countries, where some of the highest prevalence rates are being recorded, sufficient attention has not been given to its control. Objective The aim of this study was to determine the association and predictive potential of different anthropometric and bioelectrical impedance analysis (BIA) measures for hypertension. Methods A total of 812 individuals (204 men and 608 women) were enrolled, and their blood pressure measurement was determined. Direct anthropometric measures (weight, height, waist circumference (WC), and hip circumference) and derived anthropometric measures (body mass index, conicity index, abdominal volume index (AVI), and body adiposity index) were determined. BIA indices investigated included visceral fat level (VF), percentage body fat (%BF), resting metabolic rate (RMR), and skeletal muscle mass. Results A prevalence of 31.28% was observed for hypertension in the total study population, with males having a slightly higher prevalence than females. Except for the skeletal muscle mass, all the other indices measured showed an increasing trend from normotension to prehypertension and hypertension. Age and visceral fat level showed the highest correlation with systolic blood pressure for both genders. Receiver operator characteristic analysis showed that age was the best predictor of hypertension in both genders, whereas, in predicting prehypertension, RMR was the best predictor in males, and WC was the best predictor in females. VF, WC, and AVI were other good predictors of hypertension in this study population. However, BMI and % BF had a low predictive value for hypertension. Conclusion The result of this study shows that within this study population in addition to age, measures of central obesity rather than general obesity are the likely drivers of the hypertension epidemic; thus, measures aimed at controlling central obesity may offer some therapeutic and preventive advantage.
Collapse
|
43
|
Gumede SB, de Wit JBF, Venter WDF, Lalla-Edward ST. Study protocol: Strengthening understanding of effective adherence strategies for first-line and second-line antiretroviral therapy (ART) in selected rural and urban communities in South Africa. PLoS One 2021; 16:e0261107. [PMID: 34932588 PMCID: PMC8691643 DOI: 10.1371/journal.pone.0261107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel convergent study will be conducted in seven high volume public health facilities in Gauteng and one in Limpopo province in South Africa. The study consists of four phases; a retrospective secondary data analysis of a large cohort of patients on ART (using TIER.Net, an ART patient and data management system for recording and monitoring patients on ART and tuberculosis (TB)) from seven Johannesburg inner-city public health facilities (Gauteng province); a secondary data analysis of the Intensified Treatment Monitoring Accumulation (ITREMA) trial (a randomized control trial which ran from June 2015 to January 2019) conducted at the Ndlovu Medical Center (Limpopo province); in-depth interviews with people living with Human Immunodeficiency Virus (PLHIV) who are taking ART (in both urban and rural settings); and a systematic review of the impact of treatment adherence interventions for chronic conditions in sub-Saharan Africa. Data will be collected on demographics, socio-economic status, treatment support, retention in care status, disclosure, stigma, clinical markers (CD4 count and viral load (VL)), self-reported adherence information, intrapersonal, and interpersonal factors, community networks, and policy level factors. The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting and Population, Interventions, Comparisons and Outcomes (PICO) criteria. Analyses will involve tests of association (Chi-square and t-test), thematic analysis (deductive and inductive approaches) and network meta-analysis. Using an integrated multilevel socio-ecological framework this study will describe the factors associated with adherence for PLHIV who are taking first-line or second-line ART. Implementing evidence-based adherence approaches, when taken up, will improve patient's overall health outcomes. Our study results will provide guidance regarding context-specific intervention strategies to improve ART adherence.
Collapse
Affiliation(s)
- Siphamandla Bonga Gumede
- Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Faculty of Social and Behavioural Sciences, Department of Interdisciplinary Social Science, Utrecht University, The Netherlands
| | - John Benjamin Frank de Wit
- Faculty of Social and Behavioural Sciences, Department of Interdisciplinary Social Science, Utrecht University, The Netherlands
| | | | | |
Collapse
|
44
|
Cavagna P, Takombe JL, Damorou JM, Kouam Kouam C, Diop IB, Ikama SM, Kramoh KE, Ali Toure I, Balde D, Dzudie A, Ferreira B, Houenassi M, Kane A, Kimbally-Kaki SG, Kingue S, Limbole E, Mfeukeu Kuate L, Mipinda JB, N'Guetta R, Nhavoto C, Sidy Ali A, Gaye B, Tajeu GS, Macquart De Terline D, Perier MC, Azizi M, Jouven X, Antignac M. Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study. BMJ Open 2021; 11:e049632. [PMID: 34857562 PMCID: PMC8640662 DOI: 10.1136/bmjopen-2021-049632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Pauline Cavagna
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Jean Laurent Takombe
- Department of Internal Medicine, General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Stephane Méo Ikama
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Kouadio Euloge Kramoh
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | - Ibrahim Ali Toure
- Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niamey, Niger
| | - Dadhi Balde
- Cardiology, University Hospital of Conakry, Conakry, Guinea
| | - Anastase Dzudie
- Cardiac Intensive Care & Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon
| | | | - Martin Houenassi
- National University Hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, Benin
| | - Adama Kane
- Cardiology, St Louis Hospital, Dakar, Senegal
| | - Suzy Gisele Kimbally-Kaki
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | - Emmanuel Limbole
- Cardiology, University of Medicine of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Internal Medicine of la Gombe (CMCG), Department of Internal Medicine, Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo
| | | | | | - Roland N'Guetta
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | | | | | - Bamba Gaye
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Gabriel S Tajeu
- Department of Health Services Administration Cardiology Clinics and Policy, Temple University, Philadelphia, Pennsylvania, USA
| | - Diane Macquart De Terline
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | | | - Michel Azizi
- Hypertension Unit, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
- INSERM, Centre d'Investigation Clinique 1418, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
- Cardiology, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
| | - Marie Antignac
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| |
Collapse
|
45
|
Aheto JMK, Dagne GA. Multilevel modeling, prevalence, and predictors of hypertension in Ghana: Evidence from Wave 2 of the World Health Organization's Study on global AGEing and adult health. Health Sci Rep 2021; 4:e453. [PMID: 34938897 PMCID: PMC8661999 DOI: 10.1002/hsr2.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/22/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Hypertension is a major public health issue, an important risk factor for cardiovascular diseases and stroke, especially in developing countries where the rates remain unacceptably high. In Africa, hypertension is the leading driver of cardiovascular disease and stroke deaths. Identification of critical risk factors of hypertension can help formulate targeted public health programs and policies aimed at reducing the prevalence and its associated morbidity, disability, and mortality. This study attempts to develop multilevel regression, an in-depth statistical model to identify critical risk factors of hypertension. METHODS This study used data on 4667 individuals aged ≥18 years from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2 conducted in 2014/2015. Multilevel regression modeling was employed to identify critical risk factors for hypertension based on systolic blood pressure (SBP) (ie, SBP > 140 mmHg). Of the 4667, 27.3% were hypertensive. Final data on 4381 individuals residing in 3790 households were analyzed using multilevel models, and results were presented as adjusted odds ratios (aOR) and their associated 95% confidence intervals (CI). RESULTS Risk factors for hypertension identified were age (aOR) = 5.4, 95% CI: 4.11-7.09), obesity (aOR = 1.51, 95% CI: 1.19-1.91), marital status (aOR = 0.75, 95% CI: 0.64-0.89), perceived health state (moderate; aOR = 1.38, 95% CI: 1.15-1.65 and bad/very bad; aOR = 1.35, 95% CI: 1.0-1.83), and difficulty with self-care (aOR = 1.64, 95% CI: 1.1-2.44). We found unobserved significant differences in the likelihood of hypertension prevalence between different households. CONCLUSION Addressing the problem of obesity, targeting specific interventions to those aged over 50 years, and improvement in the general health of Ghanaians are paramount to reducing the prevalence and its associated morbidity, disability, and mortality. Lifestyle modification in the form of dietary intake, knowledge provision supported with strong public health message, and political will could be beneficial to the management and prevention of hypertension.
Collapse
Affiliation(s)
- Justice Moses K. Aheto
- Department of BiostatisticsSchool of Public Health, College of Health Sciences, University of GhanaAccraGhana
- College of Public Health, University of South FloridaTampaFloridaUSA
| | - Getachew A. Dagne
- College of Public Health, University of South FloridaTampaFloridaUSA
| |
Collapse
|
46
|
Reddy SP, Mbewu AD, Williams DR, Harriman NW, Sewpaul R, Morgan JW, Sifunda S, Manyaapelo T, Mabaso M. Race, geographical location and other risk factors for hypertension: South African National Health and Nutrition Examination Survey 2011/12. SSM Popul Health 2021; 16:100986. [PMID: 34950763 PMCID: PMC8671114 DOI: 10.1016/j.ssmph.2021.100986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hypertension is the leading cardiovascular disease in Africa. It is increasing in prevalence due partly to the epidemiological transition that African countries, including South Africa, are undergoing. This epidemiological transition is characterised by a nutrition transition andurbanisation; resulting in behavioural, environmental and stress changes that are subject to racial and geographic divides. The South African National Health and Nutrition Examination Survey (SANHANES) examined the association of traditional risk factors; and less traditional risk factors such as race, geographical location, social stressors and psychological distress with hypertension in a national population-based sample of South Africans. METHODS Data were analysed on individuals ≥15 years who underwent a physical examination in the SANHANES (n = 7443). Hypertension was defined by blood pressure ≥140/90 mmHg or self-reported hypertension medication usage. Stepwise regression examined the association of demographic, socioeconomic, life stressors, and health risk factors with systolic blood pressure, diastolic blood pressure, and hypertension. Secondly, the risk factor associations and geographical location effects were investigated separately for the African race group. RESULTS Increasing age (AOR = 1.069, p < 0.001); male gender (AOR = 1.413, p = 0.037); diabetes (AOR = 1.66, p = 0.002); family history of high blood pressure (AOR = 1.721, p < 0.001); and normal weight, overweight and obesity (relative to underweight: AOR = 1.782, p = 0.008; AOR = 2.232, p < 0.001; AOR = 3.874, p < 0.001 respectively) were associated with hypertension. Amongst African participants (n = 5315) age (AOR = 1.068, p < 0.001); male gender (AOR = 1.556, p = 0.001); diabetes (AOR = 1.717, p = 0.002); normal weight, overweight and obesity (relative to underweight: AOR = 1.958, p = 0.006; AOR = 2.118, p = 0.002; AOR = 3.931, p < 0.001); family history of high blood pressure (AOR = 1.485, p = 0.005); and household crowding (AOR = 0.745, p = 0.037) were associated with hypertension. There was a significantly lower prevalence of hypertension in rural informal compared to urban formal settings amongst African participants (AOR = 0.611, p = 0.005). Other social stressors and psychological distress were not significantly associated with hypertension. CONCLUSION There was no significant association between social stressors or psychological distress and hypertension. However, the study provides evidence of high-risk groups for whom hypertension screening and management should be prioritised, including older ages, males, people with diabetes or with family history of hypertension, and Africans who live in urban formal localities.
Collapse
Affiliation(s)
- Sasiragha Priscilla Reddy
- Health & Wellbeing, Human & Social Capabilities (HSC), Human Sciences Research Council (HSRC), Private Bag X9182, Cape Town, 8000, South Africa
- Faculty of Health Sciences, Nelson Mandela University, PO Box 77000, Port Elizabeth, 6031, South Africa
| | - Anthony David Mbewu
- School of Medicine, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria, South Africa
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, 02115, USA
| | - Nigel Walsh Harriman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, 02115, USA
| | - Ronel Sewpaul
- Health & Wellbeing, Human & Social Capabilities (HSC), Human Sciences Research Council (HSRC), Private Bag X9182, Cape Town, 8000, South Africa
| | - Justin Winston Morgan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, 02115, USA
| | - Sibusiso Sifunda
- Health & Wellbeing, Human & Social Capabilities (HSC), Human Sciences Research Council (HSRC), Private Bag X9182, Cape Town, 8000, South Africa
| | - Thabang Manyaapelo
- Health & Wellbeing, Human & Social Capabilities (HSC), Human Sciences Research Council (HSRC), Private Bag X9182, Cape Town, 8000, South Africa
| | - Musawenkosi Mabaso
- Health & Wellbeing, Human & Social Capabilities (HSC), Human Sciences Research Council (HSRC), Private Bag X9182, Cape Town, 8000, South Africa
| |
Collapse
|
47
|
Prevalence of Hypertension and Adherence to Dietary Approaches to Stop Hypertension Diet Score in Childbearing Age Tunisian Women: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6686299. [PMID: 34778455 PMCID: PMC8589476 DOI: 10.1155/2021/6686299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/11/2021] [Accepted: 10/28/2021] [Indexed: 01/02/2023]
Abstract
Background and Aims The prevalence, awareness, and treatment of hypertension, along with their sociodemographic, anthropometric, and lifestyle associations, were evaluated in a cross-sectional survey of childbearing age Tunisian women. Adherence to the Dietary Approaches to Stop Hypertension diet score was also assessed for hypertensive versus nonhypertensive women. Methods and Results A total of 1689 nonpregnant women, aged 20-49 years, were randomly sampled a regional (Greater Tunis), two-stage, stratified, cross-sectional cluster survey from March 2009 to January 2010. Data on medical history and sociodemographic characteristics were collected using a questionnaire. The average daily intake of energy and nutrients was computed using a specific Tunisian food composition database. The Dietary Approaches to Stop Hypertension diet score (0 to 10) was assessed by adding the individual scores (0 to 1) of ten nutrient components according to dietary guidelines. The overall prevalence of hypertension was 21.4%. Age, obesity, abdominal fat, parity, and family history were significantly associated with hypertension. The mean Dietary Approaches to Stop Hypertension accordance score was 4.93 for hypertensive women and 4.86 for nonhypertensive women (P = 0.0556). After adjustment for age, energy intake, and all nutritional covariates, no associations were observed between hypertension and Dietary Approaches to Stop Hypertension diet components. Conclusion Though no clear-cut associations between hypertension and environmental or behavioral factors were identified in the study, the association with abdominal obesity and multiparity suggests that interventions aimed at lifestyle modifications to reduce these risk factors could be also useful in the prevention of hypertension.
Collapse
|
48
|
Chikafu H, Chimbari M. Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa. PeerJ 2021; 9:e12372. [PMID: 34824908 PMCID: PMC8590801 DOI: 10.7717/peerj.12372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/01/2021] [Indexed: 12/02/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Herbert Chikafu
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Moses Chimbari
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| |
Collapse
|
49
|
Wake AD, Tuji TS, Sime AT, Mekonnin MT, Taji TM, Hussein AA. 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. Int J Hypertens 2021; 2021:7359318. [PMID: 34754517 PMCID: PMC8572638 DOI: 10.1155/2021/7359318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Addisu Dabi Wake
- Nursing Department, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Techane Sisay Tuji
- Nursing Department, College of Health Sciences, Arsi University, Asella, Ethiopia
| | | | | | | | | |
Collapse
|
50
|
Al-Raddadi R, Al-Ahmadi J, Bahijri S, Ajabnoor GM, Jambi H, Enani S, Eldakhakhny BM, Alsheikh L, Borai A, Tuomilehto J. Gender Differences in The Factors associated with Hypertension in Non-Diabetic Saudi Adults-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111371. [PMID: 34769893 PMCID: PMC8583204 DOI: 10.3390/ijerph182111371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/11/2022]
Abstract
The association between lifestyle practices, obesity and increased BP are under-investigated. We aimed to investigate this association to identify the factors associated with hypertension and prehypertension in Saudis. Non-diabetic adults were recruited from public healthcare centers using a cross-sectional design. Recruits were interviewed using a predesigned questionnaire. Weight, height, waist circumference (WC), hip circumference (HC), neck circumference (NC) and BP were measured. The variables were analyzed by comparing the prehypertensive and hypertensive groups with the normotensive group. A total of 1334 adults were included. The study found that 47.2% of men and 24.7% of women were prehypertensive, and 15.1% of men and 14.4% of women were hypertensive. High BMI, WC, NC, and WC: HC ratios were associated with an increased risk of prehypertension and hypertension in men and women. Low physical activity was associated with an increased risk of elevated BP in men, while sleep duration of ≤6 h and sitting for ≥4 h were associated with increased risk in women. Women from central Asia, southeast Asia, and those of mixed origin had a higher prevalence of hypertension compared to those from Arabian tribes. In conclusion, prehypertension and hypertension increase with age and obesity. Gender differences were apparent in the association between several lifestyle practices and prehypertension or hypertension among various ethnic/racial groups.
Collapse
Affiliation(s)
- Rajaa Al-Raddadi
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- Food, Nutrition and Lifestyle Research Unit, King Fahd for Medical Research Centre, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Jawaher Al-Ahmadi
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- Food, Nutrition and Lifestyle Research Unit, King Fahd for Medical Research Centre, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Suhad Bahijri
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- Food, Nutrition and Lifestyle Research Unit, King Fahd for Medical Research Centre, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Correspondence: ; Tel.: +966-564-370-571
| | - Ghada M. Ajabnoor
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- Food, Nutrition and Lifestyle Research Unit, King Fahd for Medical Research Centre, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Hanan Jambi
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- Food, Nutrition and Lifestyle Research Unit, King Fahd for Medical Research Centre, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah 3270, Saudi Arabia
| | - Sumia Enani
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- Food, Nutrition and Lifestyle Research Unit, King Fahd for Medical Research Centre, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah 3270, Saudi Arabia
| | - Basmah Medhat Eldakhakhny
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- Food, Nutrition and Lifestyle Research Unit, King Fahd for Medical Research Centre, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Lubna Alsheikh
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- Food, Nutrition and Lifestyle Research Unit, King Fahd for Medical Research Centre, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Anwar Borai
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), College of Medicine, King Abdulaziz Medical City, Jeddah 22384, Saudi Arabia
| | - Jaakko Tuomilehto
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 3270, Saudi Arabia; (R.A.-R.); (J.A.-A.); (G.M.A.); (H.J.); (S.E.); (B.M.E.); (L.A.); (A.B.); (J.T.)
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| |
Collapse
|