Burden of prehypertension among adults in Kenya: a retrospective analysis of findings from the Healthy Heart Africa (HHA) Programme

Abstract

Background: Hypertension is the leading risk factor for mortality globally. African countries, including Kenya, have a high and rising prevalence of hypertension. Prehypertension is associated with an increased risk of progression to overt hypertension and a higher risk of cardiovascular disease and mortality. Despite this, little is documented on the prevalence and distribution of prehypertension in sub-Saharan Africa. This study sought to estimate the overall burden of prehypertension in Kenyan adults enrolled in a large hypertension control programme, Healthy Heart Africa. The distribution and determinants of prehypertension in the sample were explored as secondary objectives. Methods: This was a post hoc analysis of cross-sectional data obtained from population-level blood pressure (BP) screening of adults aged ≥18 years in the community and ambulatory care facilities in 17/47 sub-national administrative units in Kenya. All participants with a complete record for systolic and diastolic BP were included. Descriptive analyses were performed for sociodemographic characteristics. Pearson's chi-square test was used to assess differences in categorical variables. Multivariate logistic regression analysis was performed to identify factors independently associated with prehypertension. Results: Of 5,985,185 participant records that were included in the analysis, 34% were men (mean age: 45 [SD 2.9] years). The majority (63%) lived in rural Kenya. The prevalence of prehypertension was 54.5% and that of hypertension was 20.8%. Characteristics that were independently associated with prehypertension (adjusted odds ratio [95% CI]) included male sex (1.23 [±0.0023], p < 0.001 for all age groups > 25 years) and rural residence (1.60 [±0.023], p < 0.001). Conclusions: Approximately one in every two Kenyan adults has prehypertension. This calls for urgent development and roll-out of a national BP screening and control programme. It also provides a strong basis for the formulation of multisectoral national policies that will ensure implementation of evidence-based, low-cost public health interventions geared towards primary prevention of hypertension, especially in population groups that are traditionally considered at low risk, such as young adults and rural residents.

High prevalence of undiagnosed hypertension among men in North Central Nigeria: Results from the Healthy Beginning Initiative

“…Additionally, evidence from the United States suggests that transition from prehypertension to hypertension is faster among black people [ 24 , 57 ]. While pharmacological management is not recommended for prehypertension in the absence of other risk factors, identifying patients in this category presents an opportunity for early initiation of low cost lifestyle interventions for cardiovascular disease risk reduction [ 35 , 56 – 58 ]. Implementation Science approaches can inform the best strategies for integrating such risk reduction interventions into the current service delivery system in Nigeria.…”

Socioeconomic inequalities in hypertension in Kenya: a decomposition analysis of 2015 Kenya STEPwise survey on non-communicable diseases risk factors

“…The present study shows pro-rich inequality in hypertension, which is mainly explained by individual health behaviour, socioeconomic and sociodemographic factors. These findings are particularly important considering that more than half of the Kenyan population, aged 18–69 years are pre-hypertensive [ 48 , 67 ]. We call for gender- and equity-focused interventions, as proposed in the national strategy for non-communicable diseases to curb the rising burden of hypertension and address the inequalities in hypertension.…”

Socioeconomic inequalities in hypertension in Kenya: A decomposition analysis of 2015 Kenya STEPwise survey on non-communicable diseases risk factors

“…The present study shows pro-rich inequality in hypertension, which is mainly explained by individual health behaviour, socioeconomic and sociodemographic factors. These ndings are particularly important considering that more than half of the Kenyan population, aged 18-69 years are pre-hypertensive [48,67]. We call for gender-and equity-focused interventions, as proposed in the national strategy for non-communicable diseases to curb the rising burden of hypertension and address the inequalities in hypertension.…”