Prevalence of uncontrolled hypertension in people with comorbidities in sub-Saharan Africa: a systematic review and meta-analysis

Mohamed, Shukri F.; Uthman, Olalekan A.; Mutua, Martin Kavao; Asiki, Gershim; Abba, Mustapha S; Gill, Paramjit

doi:10.1136/bmjopen-2020-045880

Cited by 13 publications

(16 citation statements)

References 48 publications

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“…The pooled prevalence of suboptimal blood control in diabetes patients among 21 studies in SSA was 69.8% (95% CI : 63.43, 76.25%), which is in line with the study among diabetes patients in 11 sub-Saharan African countries (74.5%) [ 63 ]. However, due to the difference in blood pressure cut point used to diagnose suboptimal BP control by these studies, subgroup analysis was done by BP cut point.…”

Section: Discussionsupporting

confidence: 81%

Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

et al. 2022

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Background Suboptimal blood pressure control among people living with diabetes mellitus (DM) is one of the primary causes of cardiovascular complications and death in sub-Saharan Africa (SSA). However, there is a paucity of evidence on the prevalence and associated factors of suboptimal blood pressure control in SSA. Therefore, this review aimed to estimate its pooled prevalence and associated factors among people living with DM in SSA. Methods We systematically searched PubMed, African Journals OnLine, HINARI, ScienceDirect, Google Scholar, and direct Google to access observational studies conducted in SSA. Microsoft Excel spreadsheet was used to extract the data, which was exported into STATA/MP version 16.0 for further analyses. Heterogeneity across studies was checked using Cochran’s Q test statistics and I2 test, and small study effect was checked using Funnel plot symmetry and Egger’s statistical test at a 5% significant level. A random-effects model was used to estimate the pooled prevalence and associated factors of suboptimal blood pressure control at a 95% confidence interval (CI) and significance level of p < 0.05. Results Of the 7329 articles retrieved, 21 articles were eligible for the meta-analysis. After performing random-effects model, the pooled prevalence of suboptimal blood pressure control was 69.8% (95% CI: 63.43, 76.25%). Poor adherence to antihypertensive treatment (OR = 1.7; 95% CI: 1.03–2.80, I2 = 0.0%, p = 0.531) and overweight (OR = 2.4, 95% CI: 1.57–3.68, I2 = 0.00%, p = 0.47) were significantly associated with suboptimal blood pressure control. Conclusions The prevalence of suboptimal blood pressure control among diabetic patients in SSA was high, and poor adherence to antihypertensive treatment and overweight were significantly associated with suboptimal blood pressure control. Hence, there is an urgent need for initiatives to improve and control hypertension, and preventive measures should concentrate on modifiable risk factors. Systematic review registration PROSPERO CRD42020187901.

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Section: Discussionsupporting

confidence: 81%

Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

et al. 2022

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“…This is lower than the findings from other previous studies conducted in Tanzania, which reported 66% prevalence in Dar es Salaam and 84.5% in Mwanza 42 43. Our study findings are also lower when compared with systematic reviews and meta-analyses of uncontrolled hypertension among patients with comorbidities in SSA which reported a prevalence ranging between 69.9% and 78.6% among patients with comorbidities and 79.8% among patients with CKD in China 19 20 25. These differences could be accounted by variations in the studied populations.…”

Section: Discussioncontrasting

confidence: 98%

“…The African region reported the highest prevalence of hypertension (46%) compared with other regions 18. The prevalence of uncontrolled hypertension among patients with comorbidities in SSA has been reported to be 78.6%, and it was 79.8% in a study conducted in China among patients with CKD 19 20. The prevalence of CKD in Tanzania is estimated to range between 25.7% and 45%, with the leading cause of CKD being hypertension 21–24.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of and factors associated with uncontrolled hypertension among patients with early chronic kidney disease attending tertiary hospitals in Dodoma, Tanzania: a cross-sectional study

Katatwire,

Meremo

2023

BMJ Open

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ObjectiveTo determine the prevalence of uncontrolled hypertension and its associated factors among patients with early chronic kidney disease (CKD) attending medical outpatient clinics at tertiary hospitals in Dodoma, Tanzania.DesignCross-sectional study.SettingTwo tertiary hospitals in Dodoma, Tanzania.ParticipantsThe participants in this study were adult patients (≥18 years) with early CKD stages (1, 2 and 3) who were attending nephrology and medical outpatient clinics from November 2020 to March 2021. Patients who had been attending the clinic for at least 3 months, had baseline clinical data on their files, had estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2and who provided written informed consent were eligible. A total of 352 patients were enrolled, of whom 182 were men and 170 were women.Outcome measureThe dependent variable was uncontrolled hypertension among patients with early CKD, based on blood pressure measurements.ResultsThe prevalence of hypertension was 58.5% (206 of 352) and the prevalence of uncontrolled hypertension was 58.3% (120 of 206). Among patients with uncontrolled hypertension, 88.3% (106 of 120) had CKD stage 3, 80.2% (96 of 120) reported non-adherence to antihypertensives, 76.7% (92 of 120) were overweight or obese, 72.5% (87 of 120) reported current alcohol use and 26.7% (32 of 120) had diabetes mellitus. Factors that contributed to higher odds of uncontrolled hypertension were: age ≥50 years (OR=5.17, 95 % CI 2.37 to 13.33, p=0.001), alcohol use (OR=11.21, 95% CI 3.83 to 32.84, p=0.001), non-adherence to antihypertensives (OR=10.19, 95% CI 4.22 to 24.61, p=0.001), overweight/obesity (OR=6.28, 95% CI 2.54 to 15.53, p=0.001) and CKD stage 3 (OR=3.52, 95% CI 1.32 to 9.42, p=0.012).ConclusionUncontrolled hypertension was highly prevalent among patients with early CKD in this setting and was associated with age, current alcohol use, non-adherence to antihypertensives, overweight/obesity and declining eGFR.

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“…Salt is a well-documented risk factor for hypertension, but not for diabetes [41]. However, hypertension and diabetes present together in a high proportion of patients [42][43][44]. Therefore, the analogy could also signify familiarity with the healthy eating advice provided to patients with diabetes in Sub-Saharan Africa, which typically includes salt-reduction to prevent or control comorbid hypertension [45,46].…”

Section: I) Depth Of Contentmentioning

confidence: 99%

“I see salt everywhere”: A qualitative examination of the utility of arts-based participatory workshops to study noncommunicable diseases in Tanzania and Malawi

Bissett

Gray

Abdulla

et al. 2022

Preprint

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The burden of noncommunicable diseases (NCDs) including hypertension, diabetes, and cancer, is rising in Sub-Saharan Africa countries like Tanzania and Malawi. This increase reflects complex interactions between diverse social, environmental, biological, and political factors. To intervene successfully, new approaches are therefore needed to understand how local knowledges and attitudes towards common NCDs influence health behaviours. This study compares the utility of using a novel arts-based participatory method and more traditional focus groups to generate new understandings of local knowledges, attitudes and behaviours towards NCDs and their risk factors. Single-gender arts-based participatory workshops and focus group discussions were conducted with local communities in Tanzania and Malawi. Thematic analysis compared workshop and focus group transcripts for depth of content and researcher-participant hierarchies. In addition, semiotic analysis examined the contribution of photographs of workshop activities to understanding participants’ experiences and beliefs about NCD risk factors. The arts-based participatory workshops produced in-depth, vivid, emotive narratives of participants’ beliefs about NCDs and their impact (e.g., “... it spreads all over your body and kills you - snake’s poison is similar to diabetes poison” ), while the focus groups provided more basic accounts (e.g., “diabetes is a fast killer” ). The workshops also empowered participants to navigate activities with autonomy, revealing their almost overwhelmingly negative beliefs about NCDs. However, enabling participants to direct the focus of workshop activities led to challenges, including the perpetuation of stigma (e.g., comparing smells associated with diabetes symptoms with sewage). Semiotic analysis of workshop photographs provided little additional insight beyond that gained from the transcripts. Arts-based participatory workshops are promising as a novel method to inform development of culturally relevant approaches to NCD prevention in Tanzania and Malawi . Future research should incorporate more structured opportunities for participant reflection during the workshops to minimise harm from any emerging stigma.

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Prevalence of uncontrolled hypertension in people with comorbidities in sub-Saharan Africa: a systematic review and meta-analysis

Cited by 13 publications

References 48 publications

Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

Prevalence of and factors associated with uncontrolled hypertension among patients with early chronic kidney disease attending tertiary hospitals in Dodoma, Tanzania: a cross-sectional study

“I see salt everywhere”: A qualitative examination of the utility of arts-based participatory workshops to study noncommunicable diseases in Tanzania and Malawi

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