Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study

Abstract

BackgroundThe burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups.MethodsA prospective cohort study involving adults with hypertension and or type II diabetes mellitus at 5 public hospitals in Ghana who were stroke-free at enrollment. Patients were followed every 2 months at clinic for 18 months and assessed clinically for first ever stroke by physicians. We calculated crude incidence rates for stroke and assessed the factors associated with stroke occurrence using a multivariate Cox Proportional Hazards regression models.ResultsOf 3220 eligible participants with 3805 person-years of follow-up, there were 54 clinically confirmed new strokes. Incidence rate of stroke was 14.19 events per 1000 person-years [95% CI: 10.77–18.38], with rates among diabetics with hypertension being 16.64 [10.58–25.00], hypertension of 13.77 [9.33–19.64] and diabetes was 9.81 [3.59–21.74]. Two factors independently associated with stroke occurrence were previous cigarette smoking with adjusted HR (95% CI) of 2.59 (1.18–5.67) and physical inactivity, 1.81 (1.06–3.10). In secondary analysis, stage II hypertension compared with optimal BP was associated with aHR of 3.04 (1.00–9.27), p = .05 for stroke occurrence.ConclusionIncident stroke among Ghanaians with hypertension and diabetes is quite high. Stricter control of blood pressure and engaging in regular physical activities are strongly recommended to reduce the risk of strokes.

Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross‐sectional study

“…Increased BMI has been shown to lead to CKD through DM and hypertension and through other pathophysiology such as hyperfiltration leading to focal segmental glomerulosclerosis which presents with heavy proteinuria . Physical inactivity has also been associated with the occurrence of incident stroke in the present cohort and indeed among West Africans…”

Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline

“…On a much broader scale, our previous report shows a highly prevalent but poorly controlled hypertension rate in the general population based on evidence gleaned from our HIV-negative sample. 22 This may explain why we found that HIV per se was not to be independently associated with stroke occurrence in a low endemic country such as Ghana, 44 although the burden of stroke and poor outcomes continue to rise in the subregion [45][46][47][48] due to a myriad of factors hampering the control of key CVD risk factors. 49…”

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

“…Overall, it is estimated that up to 70% or more of cases of diabetes are currently undiagnosed in SSA (Mbanya et al, 2010;Fasanmade and Dagogo-Jack, 2015;Pastakia et al, 2017). This is a concern as diabetes and its associated comorbidities increase cardiovascular diseases (CVD), which are responsible for approximately 70% of diabetes-related deaths (Glezeva et al, 2015;Low Wang et al, 2016;Mwita et al, 2017;Sarfo et al, 2018). It is hoped that ongoing activities across Africa (Table 1) will start to address this especially with mortality rates enhanced by uncontrolled hypertension as well as lack of control of HbA1c and lipid levels, especially low density lipoproteins (LDL-C), coupled with inactivity (U.…”