Low blood pressure levels & incident stroke risk among elderly Ghanaians with hypertension

Antihypertensive use insights and experiences among hypertensive patients at Korle-Bu teaching hospital

BACKGROUND

Across the globe, a vast number of people, amounting to 1.28 billion adults aged 30-79 years, suffer from hypertension. Two-thirds of them reside in low- and middle-income countries, and a significant 46% of these adults with hypertension are unaware of their condition. Hence the study aims to determine the Antihypertensive use insights and experiences among hypertensive patients at Korle-Bu Teaching Hospital.

METHODS

A qualitative exploratory design was employed to recruit thirty 30 hypertensive patients from both male and female medical wards as well as the hypertensive clinic at the OPD of Korle Bu Teaching Hospital. The patients were selected using a purposive sampling technique, following which they were involved in face-face in-depth interviews which were audiotaped. Recorded data was then transcribed and analyzed with content analysis.

FINDINGS

The analysis of the data resulted in three (3) main themes and 10 sub-themes. The study uncovered a general lack of knowledge about antihypertensive medications. This limited understanding resulted in a negative attitude among most patients toward the use of prescribed antihypertensive drugs. When it came to their experiences with antihypertensive medications, patients shared a wide range of experiences.

CONCLUSION

It was concluded that there is a need to improve the knowledge and attitude of patients as these play pivotal roles in determining adherence levels. Thus, interventions such as the organization of educational programs and awareness creation is recommended to improve adherence level and in turn, decrease the prevalence of hypertensive complications associated with poor management.

Mixed effects logistic regression analysis of blood pressure among Ghanaians and associated risk factors

Blood pressure (BP) control is a global health issue with an increase in BP beyond the normal BP leading to different stages of hypertension in humans and hence the need to identify risk factors of BP for efficient and effective control. Multiple BP measurement have proven to provide BP readings close to the true BP status of the individual. In this study, we used multiple BP measurement data on 3809 Ghanaians to determine risk factors associated with BP. The data were obtained from World Health Organization study on Global AGEing and Adult Health. We defined high blood pressure (HBP) as [Formula: see text] 130/80 mmHg or normal as [Formula: see text] 130/80 mmHg. We provide summary statistics and also used the Chi-Square test to assess significance of association between HBP versus risk factors of HBP. The aim of this study is to identify risk factors of BP using the mixed effects logistic regression model. Data were analyzed using R version 4.2.2. The results showed that the risk of high blood pressure (HBP) decreases across the three measurement periods. There is reduced risk (OR = 0.274, 95% CI = 0.2008, 0.405) of HBP among male participants relative to female participants. The risk (OR = 2.771, 95% CI = 1.8658, 4.1145) of HBP increased by 2.771-folds among those who are 60 years and above relative to those below the age of 60 years. Those whose work involves/requires vigorous exercise has 1.631-fold increase in the risk (OR = 1.631, 95% CI = 1.1151, 2.3854) of HBP relative to those whose work does not involve vigorous exercise. There is approximately 5-folds increased in the risk (OR = 4.896, 95% CI = 1.9535, 12.2268) of among those who have ever been diagnosed with diabetes. The results also revealed high risk (OR = 1.649, 95%CI = 1.1108, 2.4486) of HBP among those who have formal education. The risk (OR = 1.009, 95% CI = 1.0044, 1.0137) of HBP increases with increasing weight and a reduced risk (OR = 0.996, 95% CI = 0.9921, 0.9993) of HBP with increasing height. We found that sad experience, either mild, moderate or severe, is associated with a reduced risk of HBP. Those who have vegetable servings at least 2 cups per day have increased risk of HBP and those who have fruits servings at least 2 cups per day is associated with a reduced risk of HBP, however this is not statistically significant. To achieve success in BP control, programs should be designed with the aim of reducing weight, educate those with formal eduction on issues relating to HBP. Those whose work requires vigorous exercise are recommended to have regular check-ups to ensure that pressure build-up in the lungs is cleared. SBP is lower for women at young age but continue to increase after menopause as their BP increase becomes salt-sensitive. Hence there is need to give more attention to menopausal women so as to improve BP. Both young and old individuals are recommended to practice regular exercise since this has shown to reduce risk of being overweight or becoming diabetic and reduces the risk of HBP at yong age and old age. Also, to improve blood pressure control, programs for management of blood pressure or hypertension should focus more short stature individuals since such people are more likely to experience HBP.

Determinants of visit-to-visit systolic blood pressure variability among Ghanaians with hypertension and diabetes mellitus

Objective

To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians.

Design

We undertook a secondary analysis of data collected in a prospective study.

Setting

The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana.

Main outcome measures

We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation.

Results

The mean SD of individual patient visit-to-visit SBP overall was 14.8± 6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted β coefficients (95% CI) included age: 0.06 (0.03 - 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 - 4.68) and Methyldopa 3.08 (2.39 - 3.77).

Conclusion

Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets.

Funding

Funding for this study was provided by MSD, Novartis, Pfizer, Sanofi (each a Participant Company) and the Bill and Melinda Gates Foundation (collectively, the Funders) through the New Venture Fund (NVF). FSS and BO are also supported by funding from the National Heart, Lung, and Blood Institute (R01HL152188).

Atherosclerotic event risk and risk reduction therapies among Ghanaian hemorrhagic stroke survivors

BACKGROUND

Intracerebral hemorrhage (ICH) stroke constitute up to 40% of incident strokes in Africa. While ICH patients are at high risk for atherosclerotic events, the risk-benefit of anti-atherosclerotic therapies in this patient population is uncertain.

PURPOSE

To assess whether utility of statins and/or antithrombotic agents after surviving an ICH correlates with atherosclerotic risk of an observational cohort.

METHODS

We analyzed data in a stroke registry prospectively collected on consecutively encountered stroke survivors seen at an out-patient clinic in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details, including diagnosis of ICH, co-morbidities, and key atherosclerotic risk reduction therapies (statins and anti-platelet drugs). We computed ischemic vascular risk using the Framingham Risk Score (FRS) to classify patients into low, intermediate and high vascular risk.

RESULTS

Of 1101 stroke survivors seen during the period, 244 (22.2%) had ICH. Vascular risk profiles were low (n = 86; 35.2%), intermediate (n = 71; 29.1%) and high (n = 87; 35.7%). Utility of statin use was 76.7% (low risk), 84.5% (intermediate risk), and 87.4% (high risk), p = 0.16 while antiplatelet use trended with atherosclerotic risk being 9.3% (low risk), 25.4% (intermediate risk), and high risk (34.5%), p = 0.0004. Independent factors associated with statin use were hypertension (OR 8.80; 95% CI: 2.34-33.11) and cigarette smoking (OR 0.29; 95% CI: 0.09-0.89) while antiplatelet drug use was associated with age (OR 1.43; 95% CI: 1.06-1.92) and time from index stroke (OR: 1.02; 95% CI: 1.01-1.02).

CONCLUSION

Approximately two-thirds of ICH survivors in this African sample had intermediate to high risk of future atherosclerotic events. Clinical trials on the timing, safety, and efficacy of statins and antiplatelet drugs among ICH survivors could help better guide risk mitigation in this population.

Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis

BACKGROUND

Hypertension is a major health problem in Ghana, being a leading cause of admissions and deaths in the country. In the context of a changing food and health policy environment, we undertook a systematic review (PROSPERO registration number: CRD42020177174) and a meta-analysis of the prevalence of adult hypertension, and its awareness and control in Ghana.

METHODS

We searched major databases including PubMed, Embase as well as Google Scholar and online digital collections of public universities of Ghana to locate relevant published and unpublished community-based articles up till April 2020.

FINDINGS

Eighty-five articles involving 82,045 apparently-healthy subjects aged 15-100 years were analyzed. In individual studies, the prevalence of hypertension, defined in most cases as blood pressure ≥ 140/90 mmHg, ranged from 2.8% to 67.5%. The pooled prevalence from the meta-analysis was 27.0% (95% CI 24.0%-30.0%), being twice as high in the coastal (28%, 95% CI: 24.0%-31.0%) and middle geo-ecological belts (29%, 95% CI: 25.0%-33.0%) as in the northern belt (13%, 95% CI: 7.0%-21.0%). The prevalence was similar by sex, urban-rural residence or peer-review status of the included studies. It did not appear to vary over the study year period 1976-2019. Of the subjects with hypertension, only 35% (95% CI: 29.0%-41.0%) were aware of it, 22% (95% CI: 16.0%-29.0%) were on treatment and 6.0% (95% CI: 3.0%-10.0%) had their blood pressure controlled. Sensitivity analyses corroborated the robust estimates. There was, however, high heterogeneity (I2 = 98.7%) across the studies which was partly explained by prevalent obesity in the subjects.

CONCLUSION

More than one in four adults in Ghana have hypertension. This high prevalence has persisted for decades and is similar in rural and urban populations. With the low awareness and poor control of hypertension, greater investments in cardiovascular health are required if Ghana is to meet the global target for hypertension.

Prevalence and predictors of post-stroke epilepsy among Ghanaian stroke survivors

BACKGROUND

Post-stroke epilepsy (PSE) is associated with poorer quality of life, higher mortality, and greater health expenditures. We are unaware of any published reports on the frequency of and factors associated with PSE in Africa.

PURPOSE

To assess the frequency and factors associated with PSE among Ghanaian stroke survivors.

METHODS

We conducted a cross-sectional study of consecutive stroke survivors seen at an out-patient Neurology clinic enrolled into a stroke registry at a tertiary medical center in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details including diagnosis of post-stroke epilepsy, anti-epileptic medications, presence, treatment and control of vascular risk factors. Multivariate logistic regression models were constructed to identify factors associated with PSE.

RESULTS

Of 1101 stroke patients encountered, 126 had PSE (frequency of 11.4%; 95% CI of 9.6-13.5%). Mean (± SD) age among PSE vs. non-PSE patients was 57.7 (± 15.2) vs. 58.7 (± 13.9) years. Factors independently associated with PSE were being male (aOR 1.94; 95% CI: 1.32-2.86), cortical ischemic strokes (1.79; 1.12-2.87), blood pressure > 130/80 mmHg (OR 2.26; 1.06-4.79), use of antihypertensive treatment (OR 0.43; 0.23-0.79). There was an inverted J-shaped curve association between number of classes of antihypertensive drugs prescribed and occurrence of PSE, with the lowest inflection point at 3 classes (OR 0.34; 0.17-0.68).

CONCLUSION

In this convenience sample of ambulatory Ghanaian stroke survivors, one in ten had PSE. Further investigations to confirm and clarify the associations between the identified demographic and clinical characteristics are warranted.

Prevalence and predictors of statin utilization among patient populations at high vascular risk in Ghana

BACKGROUND

Inadequate implementation of evidence-based preventive measures for individuals at high risk of cardiovascular disease (CVD) will only worsen the current epidemic of CVDs in sub-Saharan Africa. We assessed rates and predictors of statin utilization among two high CVD risk patient populations, people with type 2 diabetes mellitus (T2DM) and those with stroke, encountered across five hospitals in Ghana.

METHODS

A cross-sectional study among 1427 patients with T2DM and 159 stroke survivors encountered at 5 hospitals (1 primary-level, 2 secondary level and 2 tertiary level) in Ghana between July 2015 and June 2018. We collected baseline demographic and clinical details including statin prescription from medical records. Factors associated with statin prescription among T2DM for primary prevention and stroke survivors for secondary prevention were evaluated using multivariate logistic regression analysis.

RESULTS

Among patients with T2DM without CVDs, 240 (16.8%) were on statins for primary prevention. Factors associated with statin use among diabetics expressed as aOR (95% CI) were being treated at a tertiary level hospital 5.86 (3.22-10.68), hypertension comorbidity 1.80 (1.25-2.60), and lower income 0.43 (0.26-0.70). Among 159 stroke survivors, 22 (14.0%) were on statins with the following associated factors: lower income 0.16 (0.03-0.77), secondary level vs. tertiary level education 0.21 (0.05-0.97) and having T2DM 4.69 (1.63-13.49).

CONCLUSION

Approximately 1 in 6 individuals with T2DM without CVD and 1 in 7 stroke survivors are prescribed statins in Ghana. Efforts to bridge this practice gap and improve access to life saving preventative medications for CVD risk reduction in low-and-middle income countries are urgently warranted.