High Blood Pressure in Sub-Saharan Africa: Why Prevention, Detection, and Control are Urgent and Important

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.

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Abstract P359: High Blood Pressure in African HIV+ Patients Increases Long-Term Mortality

Circulation ◽

10.1161/circ.129.suppl_1.p359 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Gerald S Bloomfield ◽

Joseph W Hogan ◽

Alfred Keter ◽

Thomas L Holland ◽

Edwin Sang ◽

...

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Regression Models ◽

Proportional Hazards ◽

Mortality Rates ◽

Sub Saharan Africa ◽

Proportional Hazards Regression ◽

Crude Mortality ◽

Sub Saharan ◽

The Impact

Background: Patients with human immunodeficiency virus (HIV) in the modern era are at risk of developing cardiovascular diseases. High blood pressure (BP) is common in sub-Saharan Africa, however, global attention in the region has been mostly focused on HIV. The impact of BP on mortality among adults with HIV in this region has not been reported. Objective: The objective was to determine the impact of BP on mortality among HIV seropositive (+) adults without acquired immune deficiency syndrome (AIDS) in Kenya. Methods: We conducted a retrospective analysis of de-identified medical records of the Academic Model Providing Access to Healthcare HIV treatment program between 2005 and 2010. We excluded patients with AIDS, who were <16 or >80 years old, or with data out of acceptable ranges. There were 49,475 HIV+ individuals who satisfied inclusion/exclusion criteria (Figure 1). Missing data for key covariates was addressed by inverse probability weighting. We summarize crude mortality rates across BP categories, separately by gender. We used proportional hazards regression models to characterize the effect of BP on mortality, adjusting for baseline demographic and clinical factors. We subdivided the sample according to those who were clinically stable, defined as having ≥CD4 350 or WHO Stage 1. Results: Our sample was 74% (36,616 of 49,475) women. Mortality rates for men and women were 3.8/100 and 1.8/100 person-years, respectively. Crude mortality rate among clinically stable men was higher with systolic BP ≥140 mmHg (3.0, 95% CI: 1.6-5.5) than with normal systolic BP (1.1, 95% CI: 0.7-1.7). In weighted proportional hazards regression models, clinically stable men with systolic BP ≥140 mmHg carried a higher mortality risk than normotensive men (HR: 2.39, 95% CI: 0.94 to 6.08). Conclusions: Blood pressure is an important aspect of the care of HIV+ patients in sub-Saharan Africa. High systolic BP is associated with mortality among clinically stable men without AIDS. Further investigation into cause of death in warranted.

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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)

BMC Public Health ◽

10.1186/s12889-020-09829-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F. Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

Abstract Background Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies 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. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 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 cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4%) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those 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 predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of > 30%. Conclusion In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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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)

10.21203/rs.3.rs-25100/v2 ◽

2020 ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

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.

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High Blood Pressure Confirmed with 24-Hour Ambulatory Blood Pressure Monitoring in Tanzanian Adolescents Enrolling in a Cohort Study

10.21203/rs.3.rs-123312/v1 ◽

2020 ◽

Author(s):

Mussa Nsanya ◽

Philip Ayieko ◽

Ramadhan Hashim ◽

Ezekiel Mgema ◽

Daniel Fitzgerald ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Public Schools ◽

High Blood Pressure ◽

Cardiovascular Health ◽

Blood Pressure Monitoring ◽

Sub Saharan Africa ◽

White Coat Hypertension ◽

Sub Saharan

Abstract Prevalence estimates for high blood pressure (BP) among adolescents in sub-Saharan Africa vary widely and most studies have relied on attended automated office BP (AOBP) measurements. We aimed to estimate prevalence of high BP using unattended AOBP followed by 24-Hour ambulatory BP monitoring (24-Hour ABPM) for confirmation and to determine factors associated with confirmed high BP. Between April and August 2018, 500 adolescents aged 11 to 15 years were enrolled from three randomly selected public schools in Mwanza city (Tanzania) to participate in a 2-year prospective cohort study. We obtained three consecutive unattended AOBP measurements. Follow-up AOBP measurements were obtained in participants with high BP at initial measurements. Participants whose follow-up measurements remained high underwent 24-Hour ABPM. Of all 500 participants, 36.6% had high BP using first AOBP measurement; 25.6% using average of the second and third AOBP measurements and 10.2% using average of follow-up AOBP measurements and were eligible for 24-Hour ABPM. Only 13(2.6%) had confirmed high BP and they had no unique distinguishing characteristic. White coat hypertension is common among adolescents in Africa. Cardiovascular health promotion in Africa can be done through school-based screening for high BP among adolescents using one unattended AOBP

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Factors associated with high blood pressure in a group of women with a history of pre-eclampsia in Yaoundé in Sub-Saharan Africa

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2019.09.397 ◽

2020 ◽

Vol 12 (1) ◽

pp. 139

Author(s):

C. Nganou-Gnindjio ◽

L.D. Kenmogne ◽

N. Yanwou ◽

P. Foumane

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Sub Saharan Africa ◽

Factors Associated ◽

History Of ◽

Sub Saharan

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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)

10.21203/rs.3.rs-25100/v1 ◽

2020 ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

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 in 7 communities in Kenya, Nigeria, Tanzania, and Uganda and collected data on socio-demographics, health insurance, and healthcare utilization. We measured blood pressure using a standardized protocol and digital monitors. We estimated 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fit hierarchical models to identify determinants of hypertension prevalence, awareness and treatment. Results We analyzed data of 3549 participants with a mean age of 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 (901, 25·1% (95% Confidence Interval 23·7%, 26·6%)) of participants had hypertension, half of whom (515, 57·6%) were diagnosed. Among diagnosed, 50·5% (260) were taking medication, and among those taking medication 47·3%(123) were controlled. 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.

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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)

10.21203/rs.3.rs-25100/v3 ◽

2020 ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

Abstract Background: Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies 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. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 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 cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4 %) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those 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 predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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An afebrile heartwater-like syndrome in goats

Journal of the South African Veterinary Association ◽

10.4102/jsava.v84i1.955 ◽

2013 ◽

Vol 84 (1) ◽

Author(s):

Rhoda Leask ◽

Kenneth P. Pettey ◽

Gareth F. Bath

Keyword(s):

Clinical Signs ◽

Control Measures ◽

Sub Saharan Africa ◽

Limiting Factor ◽

Febrile Reaction ◽

Presumptive Diagnosis ◽

Appropriate Treatment ◽

Sub Saharan ◽

Characteristic Features ◽

And Control

Heartwater is a serious limiting factor for sheep and goat production in the major endemic area of sub-Saharan Africa and therefore most knowledge, research and control methods originate from this region. Whilst the usual or common clinical presentations can be used to make a presumptive diagnosis of heartwater with a good measure of confidence, this is not always the case, and animals suffering from heartwater may be misdiagnosed because their cases do not conform to the expected syndrome, signs and lesions. One aberrant form found occasionally in the Channel Island breeds of cattle and some goats is an afebrile heartwaterlike syndrome. The most constant and characteristic features of this heartwater-like syndrome comprise normal temperature, clinical signs associated with generalised oedema, and nervous signs, especially hypersensitivity. The presumption that the disease under investigation is the afebrile heartwater-like syndrome entails a tentative diagnosis based on history and clinical signs and the response to presumed appropriate treatment (metadiagnosis). The afebrile heartwater-like syndrome presents similarly to peracute heartwater but without the febrile reaction. Peracute cases of heartwater have a high mortality rate, enabling confirmation of the disease on post-mortem examination. Recognition of the afebrile heartwater-like syndrome is important to prevent deaths and identify the need for appropriate control measures.

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