Abstract
Introduction Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in sub-Saharan Africa. Few studies have examined performance on the management of hypertension in this region, where the context may be distinct from other developing regions. Objectives We aimed to determine the prevalence and correlates of hypertension, awareness, treatment, and control among adults in Botswana, a middle-income African country undergoing rapid demographic transition and with high HIV burden. Methods In this 2014 cross-sectional survey of adults aged 15–69 years, information on sociodemographic characteristics, lifestyle behavior, and medical history was collected through in-person interviews and physical measurements (body mass index and triplicate blood pressure (BP)). Hypertension was defined as self-report of use of antihypertensives in the previous two weeks and/or having elevated BP (≥140/90 mmHg). Multivariable logistic regression was employed to explore factors associated with hypertension, awareness (report of previous diagnosis), treatment (antihypertensives), and control (BP < 140/90). Results Our analysis (N = 4,007) yielded an age-standardized hypertension prevalence of 30% (95% CI: 28%–32%, N = 1,393). Among hypertensives, 54% (50–58%) were unaware of their condition, 45% (40–50%) of those aware were untreated, and 63% (55–70%) of those on medications were suboptimally treated (BP ≥ 140/90 mmHg). A fifth of hypertensives who were diagnosed but not on medications had BP ≥ 180/110 mmHg. Diabetes was the strongest correlate of hypertension and awareness (aOR 4.00, 1.86–8.59; aOR 3.30, 1.44–7.55, respectively). Males were less likely to be aware (aOR 0.62, 0.41–0.94) or controlled (aOR 0.36, 0.16–0.83). Obese individuals were more likely to be treated (aOR 2.17, 1.12–4.22), yet less likely to be controlled (aOR 0.32, 0.15–0.66). Conclusions We report the first nationally representative estimates of the hypertension care cascade performance in Botswana, which will support planning and future policy evaluations. Findings contribute to the relatively sparse evidence on this subject and may inform development of innovations that improve quality of hypertension management and adherence support in similar settings.
Highlights
IntroductionStudies have previously described high levels of hypertension control in high income countries (HICs), exceeding 80% among hypertensives on treatment in Canada and the UK [8, 9]
Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in subSaharan Africa
While many studies have described determinants of hypertension [10, 12,13,14], fewer have explored determinants of hypertension awareness, treatment, and control. is is the case for subSaharan Africa, where Cardiovascular diseases (CVD) is the second leading cause of premature mortality [15], prevalence of hypertension among adults ranges from 15% to 42% [10], and the context may be distinct from other low- and middle-income countries (LMICs) settings [16]
Summary
Studies have previously described high levels of hypertension control in high income countries (HICs), exceeding 80% among hypertensives on treatment in Canada and the UK [8, 9]. These figures are much lower in LMICs [10, 11]. Is is the case for subSaharan Africa, where CVD is the second leading cause of premature mortality [15], prevalence of hypertension among adults ranges from 15% to 42% [10], and the context may be distinct from other LMIC settings [16]. Many African studies have used data that were not populationbased or not nationally representative [12, 13], and the factors examined have often been limited to sociodemographic and lifestyle behavior
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