Abstract
Objective: To assess the prevalence of prehypertension and hypertension, their determinants and associated cardiovascular risk factors in Congolese urban dwellers. Methods: From July 2007 to March 2008, we collected information on lifestyle habits, medical history and anthropometric data in 1292 household members of Adoula Quarter, Kinshasa, aged 20 years or more, 731 women (56.6%). We obtained measurements of BP, blood glucose, serum lipids and qualitative proteinuria. We defined blood pressure categories according to JNC7 classification and used logistic regression analyses to assess their independent determinants. We obtained age adjustment of continuous and categorical variables using GLM and Genmod procedures, respectively. Results: Prehypertension was observed in 30.3% of subjects, 34.9% of men and 26.7% of women (P = 0.0045). The prevalence of hypertension amounted to 30.9% with no difference between genders. Participants with prehypertension had average age, BMI and waist circumference intermediate between those with normal BP and hypertensive subjects. Their glucose and lipids levels were similar to those of normotensives. The prevalence of prehypertension amounted to 33% at age 20 - 29 years and decreased to 16.7% at ≥60 years whereas the prevalence of hypertension increased from 11.2% to 71.4%. The rates of diabetes mellitus were similar accross blood pressure catogo- ries whilst prevalences of overweight/obesity, abdominal adiposity, dyslipidemia and metabolic syndrome significatively increased (P = 0.05 or less). Among participants with prehypertension, 73% had two or more additional cardiovascular risk factors. In the logistic model the probability of prehypertension was higher in men (OR: 1.429; 95% CI: 1.099 - 1.857) and participants with overweight/obesity (OR: 1.666; 1.146 - 2.422), lower in participants aged ≥ 55 years (0.427; 0.267 - 0.683) and those with high fruit intake (0.691; 0.488 - 0.977). The probability of hypertension was higher in participants aged ≥ 55 years (OR: 6.988; 4.561 - 10.706), overweight/obesity (2.263; 1.704 - 3.004), those with high vegetables consumption (1.152; 1.003 - 1.324) and faster pulse rate (1.013; 1.002 - 1.025). Conclusion: Our results suggest that fruit consumption and control of over-weight are important issues for prevention of cardiovascular disease in sub-Saharan Africa where high blood pressure is the main driver of the current epidemic.
Highlights
In sub-Saharan Africa, chronic non communicable diseases are expected to account for 46% of all deaths by 2030 according to World Health Organisation prevision [1]
Blood pressure was normal in 502 participants (39.8%), whilst 391 (30.3%) and 399 subjects (30.9%) had prehypertension and definite hypertension, respectively
Prehypertension predominated among men (34.9% vs 26.7%; P = 0.0045) whereas definite hypertension tended to affect more women than men (31.7% vs 29.8 %; P = 0.0748)
Summary
In sub-Saharan Africa, chronic non communicable diseases are expected to account for 46% of all deaths by 2030 according to World Health Organisation prevision [1]. With between 20% and 50% of adult people affected in western societies and 25% to 28% in the Africans, hypertension is among the most prevalent chronic non communicable conditions [2]. Elevation of systolic blood pressure by 20 mm Hg or diastolic blood pressure by 10 mmHg above the threshold of 115/75 mmHg was reported to twofold increase cardiovascular mortality [3] Such an elevation conveys arterial blood pressure in JNC7 category of pre-hypertension defined as systolic blood pressure of 120 - 139 mmHg and/or diastolic blood pressure of 80 - 89 mmHg [4]. Pre-hypertension appears to be an intermediate step towards definite hypertension It is 1.65 times more likely to be associated with another risk factor thereby considerably raising the odds of severe cardiovascular events. Non pharmacological treatment of the subjects with prehypertension is highly advised with the potential to avoid the development of high blood pressure and the various subsequent clinical disorders [5]-[9]
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