Rural-urban difference in the prevalence of hypertension in West Africa: a systematic review and meta-analysis

Abstract

Urbanisation is considered a major contributor to the rising prevalence of hypertension in West Africa, yet the evidence regarding rural-urban differences in the prevalence of hypertension in the region has been mixed. A systematic literature search of four electronic databases: PubMed, Embase, African Journals Online, and WHO’s African Index Medicus; and reference lists of eligible studies was carried out. Original quantitative studies describing the rural-urban difference in the prevalence of hypertension in one or more countries in West Africa, and published in English language from the year 2000 to 2021 were included. A random effects meta-analysis model was used to estimate the odds ratio of hypertension in rural compared to urban locations. A limited sex-based random effects meta-analysis was conducted with 16 studies that provided sex-disaggregated data. Of the 377 studies screened, 22 met the inclusion criteria (n = 62,907). The prevalence of hypertension was high in both rural, and urban areas, ranging from 9.7% to 60% in the rural areas with a pooled prevalence of 27.4%; and 15.5% to 59.2% in the urban areas with a pooled prevalence of 33.9%. The odd of hypertension were lower in rural compared to urban dwellers [OR 0.74, 95% CI: 0.66-0.83; p < 0.001]. The pooled prevalence of hypertension was 32.6% in males, and 30.0% in females, with no significant difference in the odds of hypertension between the sexes [OR 0.91, 95% CI: 0.8-1.05, p = 0.196]. Comprehensive hypertension control policies are needed for both rural, and urban areas in West Africa, and for both sexes.

Similar, yet different! Comparing Ugandan secondary cities’ food system and nutritional transformations to findings from African primary cities

“…We find the NCD experience fairly similar to Kampala and to other African cities, despite possible differences in food sources and access strategies. We should also note the number of studies beginning to point out similar relatively high prevalence of hypertension (Sani et al 2022), diabetes and obesity (Mayega et al 2012;Steyn and Mchiza 2014) even in rural areas to caution against viewing NCDs as a strongly urban phenomenon. Rural residents have different food sources and access strategies than urban residents.…”

Telemonitoring in hypertension management for patients with chronic kidney disease: a narrative review

“…Sustained elevated blood pressure contributes to worsening kidney function, while a progressive decline in kidney function can lead to worsening BP control [10] . Prevalence of hypertension and CKD is often reported to be higher in rural than urban settings [3,11] . However, access to optimal healthcare delivery, including healthcare interventions and treatment for hypertension and CKD, may be considerably less available for those who reside in rural than urban communities.…”

“…Hypertension is estimated to affect 1.39 billion adults worldwide, with prevalence higher in low-and middle-income countries (LMICs) (31.5%, 1.04 billion people) than in high-income countries (28.5%, 349 million people) [1] . Urbanization, especially unplanned or poorly planned, has been identified as a major driver of the rising burden of high blood pressure (BP) in LMICs as it encourages poor nutrition, a sedentary lifestyle and obesity, increased alcohol and tobacco consumption, and exposure to psychological stressors [2][3][4] . In a meta-analysis of studies conducted in LMICs [3] , hypertension prevalence increased over time with the rate of change greater in rural compared to urban areas [5] .…”

“…Urbanization, especially unplanned or poorly planned, has been identified as a major driver of the rising burden of high blood pressure (BP) in LMICs as it encourages poor nutrition, a sedentary lifestyle and obesity, increased alcohol and tobacco consumption, and exposure to psychological stressors [2][3][4] . In a meta-analysis of studies conducted in LMICs [3] , hypertension prevalence increased over time with the rate of change greater in rural compared to urban areas [5] . Furthermore, mortality associated with hypertension has also been shown to be higher in the rural than in the urban population.…”

Hypertension prevalence by degrees of urbanization and altitude in Peru: pooled analysis of 186 906 participants

“…For example, urbanization alongside rapid economic growth, growing pollution, and changing lifestyles have facilitated hypertension development [3]. Indeed, large data showed higher hypertension rates among urban rather than rural dwellers, albeit this evidence relies mostly on urban-rural differences [4,5]. Data on how hypertension varies across varying levels of urbanization is limited and scarcely analyzed using countrywide data [6], which could be useful to improve the identification of locations with higher hypertension burden.…”