Abstract
BackgroundAn estimated 55% of older adults in Africa have systemic hypertension, a major risk factor for stroke, heart failure and dementia in the region. The risk factors associated with hypertension in this population group in Africa have not been systematically evaluated. We, therefore, undertook a systematic review to identify these risk factors.MethodsWe searched for population-based studies of adults aged ≥50 years living in Africa and reporting an estimate of hypertension and associated risk factors. We included articles published in any language between January 1980 and May 2018 using a comprehensive search strategy. We extracted data including the sample characteristics, prevalence of hypertension and risk factors with their effect sizes.ResultsFrom an initial 10,719 records, we retained 63 eligible full text articles for review out of which we analyzed 23 studies made up of 19 primary and four multiple publications which had data on risk factors from bivariate or multivariable analysis. The primary studies, published from 2010 to 2018, involved a total of 30,500 participants in 12 different countries with mean ages ranging from 62.7 ± 9 years to 76.9 ± 8.4 years. Through narrative synthesis, we found consistent determinants of hypertension (overweight/obesity and history of stroke), less consistent but frequent determinants (including older age group, female sex and urban residence), inconsistent determinants (including education, wealth index, alcohol intake and physical activity) and nonsignificant covariates (marital status and having health insurance). Overall, the highest adjusted odds ratios were those associated with obesity and history of stroke.ConclusionThe key determinants of systemic hypertension in older adults in Africa are older age group, overweight/obesity, history of stroke and female sex. Health programmes should promote weight reduction throughout the life course, including during the middle and older age of African adults.
Highlights
An estimated 55% of older adults in Africa have systemic hypertension, a major risk factor for stroke, heart failure and dementia in the region
There is currently no published report of a systematic review of the determinants of hypertension among older adults in Africa. It is in this context that, we systematically reviewed the literature to identify factors associated with hypertension in older adults in Africa
One of the seven primary publications reported sexspecific prevalence of hypertension in cities in two African countries (Bangui and Brazzaville) and so provided two data contributions relating to hypertension and its associated risk factors in two countries [17]
Summary
An estimated 55% of older adults in Africa have systemic hypertension, a major risk factor for stroke, heart failure and dementia in the region. The risk factors associated with hypertension in this population group in Africa have not been systematically evaluated. According to the Global Burden of Disease Study, cardiovascular diseases were the leading cause of death in Africa in 2017, being responsible for 1.42 million deaths in that year or 16.4% of the total deaths in all ages compared with 11.3% of total deaths in 1990 [1]. Africa has an onerous task in meeting the global target of 25% relative reduction in the prevalence of hypertension by the year 2025. The number of African countries that have conducted the chronic disease risk factor STEPS surveillance has doubled from 20 in 2009. There is a renewed political commitment to tackle NCDs following the third high-level meeting of the United Nations General Assembly in October 2018 during which Heads of State and Governments committed to reorienting health systems to respond to the needs of the rapidly ageing population in relation to NCDs [5]
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