Abstract

BackgroundHypertension is the leading risk factor for mortality globally. African countries, including Kenya, have a high and rising prevalence of hypertension. Prehypertension is associated with an increased risk of progression to overt hypertension and a higher risk of cardiovascular disease and mortality. Despite this, little is documented on the prevalence and distribution of prehypertension in sub-Saharan Africa. This study sought to estimate the overall burden of prehypertension in Kenyan adults enrolled in a large hypertension control programme, Healthy Heart Africa. The distribution and determinants of prehypertension in the sample were explored as secondary objectives.MethodsThis was a post hoc analysis of cross-sectional data obtained from population-level blood pressure (BP) screening of adults aged ≥18 years in the community and ambulatory care facilities in 17/47 sub-national administrative units in Kenya. All participants with a complete record for systolic and diastolic BP were included. Descriptive analyses were performed for sociodemographic characteristics. Pearson’s chi-square test was used to assess differences in categorical variables. Multivariate logistic regression analysis was performed to identify factors independently associated with prehypertension.ResultsOf 5,985,185 participant records that were included in the analysis, 34% were men (mean age: 45 [SD 2.9] years). The majority (63%) lived in rural Kenya. The prevalence of prehypertension was 54.5% and that of hypertension was 20.8%. Characteristics that were independently associated with prehypertension (adjusted odds ratio [95% CI]) included male sex (1.23 [±0.0023], p < 0.001 for all age groups > 25 years) and rural residence (1.60 [±0.023], p < 0.001).ConclusionsApproximately one in every two Kenyan adults has prehypertension. This calls for urgent development and roll-out of a national BP screening and control programme. It also provides a strong basis for the formulation of multisectoral national policies that will ensure implementation of evidence-based, low-cost public health interventions geared towards primary prevention of hypertension, especially in population groups that are traditionally considered at low risk, such as young adults and rural residents.

Highlights

  • Hypertension is the leading risk factor for mortality globally

  • The primary objective of this study was to estimate the burden of prehypertension in a population of Kenyan adults who were enrolled in a large hypertension screening, treatment and control programme, Healthy Heart Africa (HHA)

  • Men had a mean age of 47 years (SD 1.13) and were older than women who had a mean age of 43 years (SD 1.7)

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Summary

Introduction

Hypertension is the leading risk factor for mortality globally. Prehypertension is associated with an increased risk of progression to overt hypertension and a higher risk of cardiovascular disease and mortality. Raised blood pressure (BP) is the leading risk factor for global morbidity and mortality [1]. A meta-analysis of recent studies in Africa showed a prevalence of 30%, with a progressive rise with increasing age [3]. Prehypertension as a BP category was introduced in 2003 by the Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) [6] to highlight the excess risk associated with BP in this range [7]. Given the link between the continuum of prehypertension, hypertension, and cardiovascular disease morbidity and mortality, early identification of prehypertension may be a critical first step in increasing awareness and designing and implementing early preventive interventions

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