Abstract
Elevated blood pressure presents a global health threat, with rates of hypertension increasing in low and middle-income countries. Lifestyle changes may be an important driver of these increases in blood pressure. Hypertension is particularly prevalent in African countries, though the majority of studies have focused on mainland Africa. We collected demographic and health data from 513 adults living in a community in rural Madagascar. We used generalized linear mixed models to assess body mass index (BMI), age, sex, and attributes related to household composition and lifestyle as predictors of blood pressure and hypertension. The prevalence of hypertension in this cohort was 49.1% (both sexes combined: N = 513; females: 50.3%, N = 290; males: 47.5%, N = 223). Blood pressure, as well as hypertensive state, was positively associated with age and BMI. Lifestyle and household factors had no significant relationships with blood pressure. The prevalence of hypertension was similar to that found in urban centers of other African countries, yet almost double what has been previously found in Madagascar. Future research should investigate the drivers of hypertension in rural communities worldwide, as well as the lifestyle, cultural, and genetic factors that underlie variation in hypertension across space and time.
Highlights
Elevated blood pressure affects millions of people around the world [1], with the World Health Organization identifying hypertension as a major global health challenge [2]
High blood pressure contributes to 92 million disability-adjusted life years (DALYs) and 7.6 million premature deaths [3]
Of the 513 participants, we identified 49.1% as hypertensive (Stages 1 and 2 combined). Of those that were not hypertensive, we found that 8.4% had elevated blood pressures, with only 42.5% having clinically normal measurements (Table 2 and Fig 1)
Summary
Elevated blood pressure affects millions of people around the world [1], with the World Health Organization identifying hypertension as a major global health challenge [2]. High blood pressure contributes to 92 million disability-adjusted life years (DALYs) and 7.6 million premature deaths [3]. In 2000, hypertension was responsible for 62% of stroke, 49% of ischemic heart disease, and almost 13% of all deaths worldwide [4]. Hypertension remains a leading global risk factor for associated cardiovascular diseases, ranking above tobacco smoking and household air pollution [5].
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