Abstract
BackgroundFew studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa.MethodsBetween June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment.ResultsWe analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4%) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of > 30%.ConclusionIn seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.
Highlights
Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa
Results from the Prospective Urban Rural Epidemiology (PURE) study indicate that low-income countries have the lowest rates for awareness, treatment, and control of hypertension globally [6]
In Africa, sub-Saharan Africa compared to North African countries have low levels of awareness, treatment, and control of hypertension especially in rural areas [7]
Summary
Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. Awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. For the past few decades, the burden of hypertension has shifted from high-income countries to low- and middle-income countries including sub-Saharan Africa (SSA) [1]. In Africa, the estimated number of people with hypertension has increased steadily from 54·6 million in 1990 to 92·3 million in 2000 (70% rise) and 130·2 million in 2010 (41% increase from the year 2000). The high burden of hypertension in SSA has severe consequences including increased risk for morbidity and mortality from cardiovascular disease (stroke, myocardial infarction, and hypertensive heart diseases) [5]
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