Blood Pressure Control among Hypertensive Stroke Survivors in Nigeria

Analysis of Health-Related Quality of Life in Elderly Patients with Stroke Complicated by Hypertension in China Using the EQ-5D-3L Scale

Purpose

To evaluate the health-related quality of life(HRQoL)status of elderly patients with hypertensive stroke, to understand the factors influencing it, and to provide a basis for the development of health intervention policies.

Patients and Methods

This study used the EQ-5D-3L scale to assess the HRQoL among elderly patients who experienced a stroke related to high blood pressure. Various analytical methods were employed to examine the factors that influenced the patient's quality of life. Univariate analysis, Tobit regression, random forest, and XGBoost models were applied to analyze the HRQoL of the patients. Furthermore, to interpret the machine learning results, the SHAP method was utilized. This method involved assessing the importance of each feature, examining the effect of each feature on the prediction result of a single sample, and determining the impact of individual features on the overall prediction.

Results

The study found that the median health utility value for elderly patients with hypertensive stroke was 0.427, with an interquartile range of 0.186 to 0.745. The results of the Tobit regression model, Random Forest, and XGBoost model were compared. The results of the model evaluation show that the performance of the machine learning model and the Tobit regression model are not very different. The XGBoost model performs slightly better relative to the random forest model. The factors that strongly influenced the health utility value of patients included BMI, social activities, smoking, education level, alcohol consumption, urban/rural residence, annual income, physical activity level, and hours of sleep at night.

Conclusion

Health-related quality of life in hypertensive stroke patients is influenced by a variety of factors. Health-related quality of life can be positively influenced by modifying these factors and making lifestyle adjustments. Maintaining a healthy weight, being socially active, quitting smoking, improving living conditions, increasing physical activity levels and getting enough sleep are recommended. Lifestyle changes need to be developed for each individual on a case-by-case basis and by medical advice.

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

BACKGROUND

The burden of uncontrolled hypertension in sub-Saharan Africa (SSA) is high and hypertension is known to coexist with other chronic diseases such as kidney disease, diabetes among others. This is the first systematic review and meta-analysis to determine the burden of uncontrolled hypertension among patients with comorbidities in SSA.

METHODS

A comprehensive search was conducted on MEDLINE, Excerpta Medica Database (Embase) and Web of Science to identify all relevant articles published between 1 January 2000 and 17 June 2021. We included studies that reported on the prevalence of uncontrolled hypertension among people in SSA who report taking antihypertensive treatment and have another chronic condition. A random-effects meta-analysis was performed to obtain the pooled estimate of the prevalence of uncontrolled hypertension among patients with comorbid conditions while on treatment across studies in SSA.

RESULTS

In all, 20 articles were included for meta-analyses. Eleven articles were among diabetic patients, five articles were among patients with HIV, two were among patients with stroke while chronic kidney disease and atrial fibrillation had one article each. The pooled prevalence of uncontrolled hypertension among patients with comorbidities was 78.6% (95% CI 71.1% to 85.3%); I² 95.9%, varying from 73.1% in patients with stroke to 100.0% in patients with atrial fibrillation. Subgroup analysis showed differences in uncontrolled hypertension prevalence by various study-level characteristics CONCLUSION: This study suggests a high burden of uncontrolled hypertension in people with comorbidities in SSA. Strategies to improve the control of hypertension among people with comorbidities are needed.

PROSPERO REGISTRATION NUMBER

CRD42019108218.

May Measurement Month 2018: an analysis of blood pressure screening results from Nigeria

Hypertension remains the dominant cardiovascular risk factor worldwide. May Measurement Month (MMM) is an annual global programme of the International Society of Hypertension aimed at screening for undetected hypertension in the general population. We report the outcome of MMM 2018 in Nigeria. An opportunistic screening of adults aged at least 18 years was conducted in the six geopolitical zones of Nigeria in the month of May, 2018. Screening for hypertension was done by trained volunteers with the use of validated digital and mercury sphygmomanometers following the MMM protocol. Hypertension was defined as blood pressure (BP) ≥140/90 mmHg or the use of BP-lowering medication. There were 6398 participants (53.0% female) with a mean (SD) age of 41.7 (15.0) years. Hypertension was present in 36.4% of the participants with 51.1% of the hypertensives aware of their status, 41.8% on medication, of whom 43.1% were controlled. Overall, only 18.0% of all hypertensive participants had their BP under control. The proportion with hypertension is high, and awareness, treatment, and control rates are low. Concerted efforts are needed to improve awareness and treatment of hypertension in Nigeria in order to reduce the high rate of complications associated with uncontrolled BP.

Short-term pilot feasibility study of a nurse-led intervention to improve blood pressure control after stroke in Nigeria

BACKGROUND

Given the paucity of neurologists in Sub-Saharan Africa (SSA), task-shifting post-stroke care to nurses could be a viable avenue for enhancing post-stroke outcomes. This pilot study assessed the feasibility and short-term impact of a nurse-led intervention to manage blood pressure (BP) control in recent stroke survivors in Nigeria.

METHODS

A randomized pilot trial allocated patients within one month of an index stroke from two participating hospitals in Nigeria to either nurse-led group clinic or standard care for 14days. Key study endpoints were successful execution of the protocol, subject retention, and short-term BP effects.

RESULTS

There were no significant differences between the intervention (n=17) and control (n=18) groups at baseline. At the post-intervention clinic, patient retention rate was 100%. In the intervention group, both the systolic and diastolic BPs measured at home were lower than the clinic BPs post-intervention (127±12.88/78.13±19.26mmHg versus 137.50±23.05/84.06±9.67mmHg; p=0.05). However, there was no significant change in clinic blood pressure (BP) recordings in both the intervention and control groups.

CONCLUSION

It is possible to initiate a nurse-led group clinic intervention to address BP management among stroke survivors in SSA with good early retention of participants. A larger and longer-term trial is being planned.