Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)

Abstract

Background: Few studies have characterized epidemiology and management of hypertension across several communities with comparable methodology 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. Methods: Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. We collected data on socio-demographics, health insurance, and healthcare utilization. We measured blood pressure using digital blood pressure monitors and following a standardized protocol. We estimated 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. Results: We 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, and 32·7% were overweight/obese. A quarter of the participants (25·1% had hypertension, half of whom (57·6%) were diagnosed. Among 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 risk of 20% or greater while 7·1% had risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of adults had hypertension, about 40% were unaware, half of those aware were treated and half of those treated were controlled blood pressure. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

Prevalence of Controlled Systemic Hypertension and Its Associated Risk Factors among Hypertensive Patients at Mbeya Zonal Referral Hospital, Tanzania.

“…This prevalence of controlled hypertension of 39.7% is similar to the study done at Muhimbili National Hospital of Tanzania in 2013 assessing hypertension control which showed control rate of 34%. [16] However the prevalence of controlled hypertension found in this study was higher than the study done in 2020 by Alfa Muhihi et al involving seven communities of East and West Africa in sub-Saharan Africa which showed that among participants with prevalent hypertension, 13% had their blood pressure controlled, [17] Also the study done in Ghana in 2018, in which the prevalence of blood pressure control was 23.8% among of patients taking anti-hypertensive medication [18] .…”

Prevalence of Controlled Systemic Hypertension and Its Associated Risk Factors among Hypertensive Patients at Mbeya Zonal Referral Hospital, Tanzania.

“…This prevalence of controlled hypertension of 39.7% is similar to the study done at Muhimbili National Hospital of Tanzania in 2013 assessing hypertension control which showed control rate of 34%. [16] However the prevalence of controlled hypertension found in this study was higher than the study done in 2020 by Alfa Muhihi et al involving seven communities of East and West Africa in sub-Saharan Africa which showed that among participants with prevalent hypertension, 13% had their blood pressure controlled, [17] Also the study done in Ghana in 2018, in which the prevalence of blood pressure control was 23.8% among of patients taking anti-hypertensive medication [18] . Similarly, a study done in ruraldwelling Tanzanian older adults in 2012 reported a prevalence of controlled hypertension of 14.9% of those on regular treatment and 0.9% of all hypertensives.…”

Undiagnosed Hypertension Among Market Salespersons in Kitgum Central Market, Northern Uganda

“…A study recruiting individuals from a rural community in Sudan found the prevalence of undiagnosed hypertension of about 38.2%, 13 a similar study in Nigeria among market traders, 14 and to another study, where the prevalence of undiagnosed hypertension was 42.8%. 6 The variation in the study results may be due to the differences in the study population as our study was done in urban market where majority of the study participants were possibly more aware about their health status. Secondly, the low consumption of fats and sugar and high consumption of vitamins among our respondents that may explain a healthy diet which is protective for hypertension.…”

“…This number is projected to rise to 216.8 million by the year 2030 (66% rise from the year 2010). 6 In sub-Saharan Africa, the total number of individuals with hypertension was estimated to be 75 million in 2008 and projected to be at 125.5 million by 2025. 7 There is a high burden of hypertension in Africa; however, over three-quarters of the cases are unaware they have hypertension.…”