High prevalence of hypertension in an agricultural village in Madagascar

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.

Prevalence and associated factors of hypertension among adults in Gadarif in eastern Sudan: a community-based study

“…The prevalence rates of hypertension found in this study were much higher than those (15.9%) recently reported for four states (Khartoum, Gezira, Blue Nile, and Kassala) in Sudan [15]. Interestingly, a much higher prevalence (49.1%) of hypertension was reported among 513 adults in a rural setting in Madagascar [12]. Conversely, a lower rate (28.0%) of hypertension was reported in Tanzania [13] and in a population-based sectional study that enrolled 67,397 participants in Ethiopia (31.9%) [24].…”

“…Because of our study design (controlled for age), it might not be valid to compare our results (age and hypertension) with the results of the large study that was recently conducted in four states (Khartoum, Gezira, Blue Nile and Kassala) in Sudan [15]. Several studies have shown that an older age is significantly associated with hypertension in neighbouring countries, including Ethiopia [8,9,11], Tanzania [13] and Madagascar [12]. Similarly, a recent metaanalysis including 43,025 older adults (> 53 years) in 15 African countries showed that an older age is independently associated with hypertension [25].…”

“…Our finding showing an association between obesity and hypertension is consistent with the findings that were recently reported for four states (Khartoum, Gezira, Blue Nile and Kassala) in Sudan [15]. Several previous studies conducted in Africa-e.g., Uganda [14], Ethiopia [8,10,11] and Madagascar [12]-have reported significant associations between obesity and hypertension. In a recent meta-analysis of 43,025 adults in 15 African countries, overweight/obesity was shown to be independently associated with hypertension [25].…”

“…Hypertension is the leading risk factor worldwide for mortality from cardiovascular diseases, such as stroke and ischaemic heart disease [4,5]. Various factors, such as an individual's age [6,7], smoking [8], consuming alcohol [9] and obesity [8,[10][11][12], were reported as factors associated with hypertension.…”

“…The epidemiology of hypertension (prevalence and associated risk factors) has been extensively investigated in many African countries, e.g., Ethiopia [9,10], Tanzania [13], Uganda [14] and Madagascar [12], but little published data exist on the epidemiology of hypertension in Sudan [6,7,15]; in addition, there are no published data on the prevalence of and risk factors for hypertension in Eastern Sudan. The current study was conducted to investigate the prevalence and associated factors of hypertension in Gadarif in Eastern Sudan.…”