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Nyame S, Boateng D, Heeres P, Gyamfi J, Gafane-Matemane LF, Amoah J, Iwelunmor J, Ogedegbe G, Grobbee D, Asante KP, Klipstein-Grobusch K. Community-Based Strategies to Improve Health-Related Outcomes in People Living With Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Glob Heart 2024; 19:51. [PMID: 38883258 PMCID: PMC11177843 DOI: 10.5334/gh.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/18/2024] [Indexed: 06/18/2024] Open
Abstract
Background Individuals living with hypertension are at an increased risk of cardiovascular- and cerebrovascular-related outcomes. Interventions implemented at the community level to improve hypertension control are considered useful to prevent cardiovascular and cerebrovascular events; however, systematic evaluation of such community level interventions among patients living in low- and middle-income countries (LMICs) is scarce. Methods Nine databases were searched for randomized controlled trials (RCTs) and cluster randomized control trials (cRCTs) implementing community level interventions in adults with hypertension in LMICs. Studies were included based on explicit focus on blood pressure control. Quality assessment was done using the Revised Cochrane Risk of Bias tool for randomized trials (ROBS 2). Results were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Fixed-effect meta-analyses were conducted for studies that reported continuous outcome measures. Results We identified and screened 7125 articles. Eighteen studies, 7 RCTs and 11 cRCTs were included in the analysis. The overall summary effect of blood pressure control was significant, risk ratio = 1.48 (95%CI = 1.40-1.57, n = 12). Risk ratio for RCTs was 1.68 (95%CI = 1.40-2.01, n = 5), for cRCTs risk ratio = 1.46 (95%CI = 1.32-1.61, n = 7). For studies that reported individual data for the multicomponent interventions, the risk ratio was 1.27 (95% CI = 1.04-1.54, n = 3). Discussion Community-based strategies are relevant in addressing the burden of hypertension in LMICs. Community-based interventions can help decentralize hypertension care in LMIC and address the access to care gap without diminishing the quality of hypertension control.
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Affiliation(s)
- Solomon Nyame
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Kintampo Health Research Centre, Ghana
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Pauline Heeres
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Joyce Gyamfi
- Department of Global Health, New York University School of Global Public Health, New York University, New York, NY, USA
| | - Lebo F. Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, North-West Province, South Africa
| | | | - Juliet Iwelunmor
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
| | - Diederick Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | | | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gafane-Matemane LF, Craig A, Kruger R, Alaofin OS, Ware LJ, Jones ESW, Kengne AP. Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities. J Hum Hypertens 2024:10.1038/s41371-024-00913-6. [PMID: 38698111 DOI: 10.1038/s41371-024-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus . To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa.
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa.
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa
| | - Omotayo S Alaofin
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
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Gobezie MY, Hassen M, Tesfaye NA, Solomon T, Demessie MB, Fentie Wendie T, Tadesse G, Kassa TD, Berhe FT. Prevalence of uncontrolled hypertension and contributing factors in Ethiopia: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1335823. [PMID: 38660480 PMCID: PMC11040565 DOI: 10.3389/fcvm.2024.1335823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Background Uncontrolled hypertension (HTN) is a major risk factor for cardiovascular and cerebrovascular disease. The prevalence of HTN in the Ethiopian adult population is almost 20%.This study aimed to determine the prevalence of uncontrolled HTN and its contributing factors among patients with HTN in Ethiopia undergoing treatment. Methods Electronic bibliographic databases such as PubMed, Google Scholar, Hinari (Research4Life), Embase, and Scopus were searched for original records in the English language that assessed HTN control in Ethiopia and were available before 29 June 2023. The data were extracted using a format prepared in Microsoft Excel and exported to the software STATA 17.0 for analysis. The study protocol was registered at PROSPERO with the reference number CRD42023440121. Results A total of 26 studies with 9,046 patients with HTN were included in the systematic review and meta-analysis, of which 11 studies were used to assess factors contributing to uncontrolled blood pressure (BP) in patients in Ethiopia. The estimated prevalence of uncontrolled HTN in the population of Ethiopia is 51% [95% confidence interval (CI), 42%-60%]. The subgroup analysis, based on the assessment tools, region, and follow-up period, revealed that the prevalence of uncontrolled BP was highest following the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) (89%; 95% CI: 87%-91%) and in Addis Ababa (58%; 95% CI: 40%-76%), and the lowest proportion of uncontrolled BP was in the 3-month follow-up period (34%; 95% CI: 29%-39%). The presence of diabetes mellitus showed the highest impact (pooled odds ratio: 5.19; CI: 1.41-19.11) for uncontrolled HTN. The univariate meta-regression method confirmed that the sample size, year of publication, and subgroups were not sources of heterogeneity in the pooled estimates. Egger's regression test did not indicate the presence of publication bias. Conclusion More than half of the hypertensive patients in Ethiopia have uncontrolled BP. Diabetes mellitus, advanced age, male sex, and the presence of comorbidities are among the factors contributing to uncontrolled HTN in Ethiopia. The concerned bodies working in this area should implement interventional strategies and recommendations that might be helpful in achieving optimal BP in hypertensive patients. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440121, PROSPERO (CRD42023440121).
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Affiliation(s)
- Mengistie Yirsaw Gobezie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Minimize Hassen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nuhamin Alemayehu Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tewodros Solomon
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mulat Belete Demessie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Teklehaimanot Fentie Wendie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getachew Tadesse
- Department of Statistics, College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Fentaw Tadese Berhe
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Public Health & Economics Modeling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
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Mundagowa PT, Zambezi P, Muchemwa-Munasirei P. The prevalence and determinants of blood pressure control among hypertension patients in eastern Zimbabwe: A cross-sectional study. PLoS One 2024; 19:e0293812. [PMID: 38451890 PMCID: PMC10919662 DOI: 10.1371/journal.pone.0293812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/19/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Uncontrolled blood pressure (BP), also known as hypertension, is a leading cause of morbidity and mortality globally. Lowering the elevated BP can significantly reduce one's risk for cardiovascular diseases. This study aimed to ascertain the determinants of BP control among hypertension patients. METHODS The data analyzed were from the exploratory survey of the Home Management of Hypertension (HoMHyper) project in eastern Zimbabwe. Hypertension patients were selected from the Chronic Disease Registers of five public health clinics using simple random sampling. A pretested interviewer-administered questionnaire was used to collect data, and the patient's BP was measured. The primary outcome, BP control, was used as a categorical variable (controlled vs. uncontrolled) to conduct a bivariate analysis. Variables significant at p<0.2 were included in the multivariable logistic regression analysis to control for confounding. Statistical significance in the final model was set at p<0.05. RESULTS Data from 321 hypertension patients were analyzed; their mean age was 62.3±11.9 years. The prevalence of controlled BP was 41.4% (95% Confidence interval-CI = 36.0%-46.9%). After adjusting for confounding, patients' residence and medication stocks were associated with BP control. Patients who resided in high-density suburbs had higher odds of uncontrolled BP than those who resided in middle- and low-density suburbs (Adjusted odds ratios-AOR = 2.5; 95% CI = 1.4-4.4; p<0.01). Hypertension patients who experienced medication stockouts over the last six months had higher odds of uncontrolled BP than patients who did not experience stockouts (AOR = 1.8; 95% CI = 1.1-2.9). CONCLUSION BP control among hypertension patients was suboptimal. Patient residence and antihypertensive medication stockouts were independent predictors of blood pressure control. We recommend exploring sustainable financing through private-public partnerships to ensure the availability of subsidized antihypertensive medication.
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Affiliation(s)
- Paddington Tinashe Mundagowa
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Pemberai Zambezi
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
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Elijovich F, Kirabo A, Laffer CL. Salt Sensitivity of Blood Pressure in Black People: The Need to Sort Out Ancestry Versus Epigenetic Versus Social Determinants of Its Causation. Hypertension 2024; 81:456-467. [PMID: 37767696 PMCID: PMC10922075 DOI: 10.1161/hypertensionaha.123.17951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Race is a social construct, but self-identified Black people are known to have higher prevalence and worse outcomes of hypertension than White people. This may be partly due to the disproportionate incidence of salt sensitivity of blood pressure in Black people, a cardiovascular risk factor that is independent of blood pressure and has no proven therapy. We review the multiple physiological systems involved in regulation of blood pressure, discuss what, if anything is known about the differences between Black and White people in these systems and how they affect salt sensitivity of blood pressure. The contributions of genetics, epigenetics, environment, and social determinants of health are briefly touched on, with the hope of stimulating further work in the field.
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Affiliation(s)
- Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Cheryl L Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Amarteyfio KNAA, Bondzie EPK, Reichenberger V, Agyepong IA, Ansah EK, Diarra A, Mirzoev T, Perel P, Yaogo M, Antwi E. Factors influencing primary care access, utilisation and quality of management for patients living with hypertension in West Africa: a scoping review protocol. BMJ Open 2024; 14:e077459. [PMID: 38262652 PMCID: PMC10824043 DOI: 10.1136/bmjopen-2023-077459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Hypertension, one of the most prevalent non-communicable diseases in West Africa, can be well managed with good primary care. This scoping review will explore what is documented in the literature about factors that influence primary care access, utilisation and quality of management for patients living with hypertension in West Africa. METHODS AND ANALYSIS The scoping review will employ the approach described by Arksey and O'Malley (2005) . The approach has five stages: (1) formulating the research questions, (2) identifying relevant studies, (3) selecting eligible studies, (4) charting the data and (5) collating, summarising and reporting the results. This review will employ the Preferred Reporting Items for Systematic review and Meta-Analysis extension for scoping reviews to report the results. PubMed, Embase, Scopus, Cairn Info and Google Scholar will be searched for publications from 1 January 2000 to 31 December 2023. Studies reported in English, French or Portuguese will be considered for inclusion. Research articles, systematic reviews, observational studies and reports that include information on the relevant factors that influence primary care management of hypertension in West Africa will be eligible for inclusion. Study participants should be adults (aged 18 years or older). Clinical case series/case reports, short communications, books, grey literature and conference proceedings will be excluded. Papers on gestational hypertension and pre-eclampsia will be excluded. ETHICS AND DISSEMINATION This review does not require ethics approval. Our dissemination strategy includes peer-reviewed publications, policy briefs, presentations at conferences, dissemination to stakeholders and intervention co-production forums.
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Affiliation(s)
| | | | - Veronika Reichenberger
- London School of Hygiene & Tropical Medicine Centre of Global Change and Health, London, UK
| | | | | | | | - Tolib Mirzoev
- London School of Hygiene & Tropical Medicine Centre of Global Change and Health, London, UK
| | - Pablo Perel
- London School of Hygiene & Tropical Medicine Centre of Global Change and Health, London, UK
| | - Maurice Yaogo
- Universite Catholique de L'Afrique de L'ouest (UCAO) UBB, Bobodialassou, Burkina Faso
| | - Edward Antwi
- Ghana College of Physicians and Surgeons, Accra, Ghana
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Mbosso Teinkela JE, Nguemfo EL, Fokou Nzodjou T, Bogning Zangueu C, Kalinski JC, Tsakem B, Assob Nguedia JC, Siwe Noundou X. Antihypertensive potential of the stem bark of Canarium schweinfurthii Engl. (Burseraceae) in wistar rats: UPLC-ESI-QToF-MS/MS-based prediction of antihypertensive phytochemicals. Heliyon 2023; 9:e21841. [PMID: 38027816 PMCID: PMC10663920 DOI: 10.1016/j.heliyon.2023.e21841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Ethnopharmacological relevance Canarium schweinfurthii, also called ''Elemierd'Afrique'', is used in Cameroonian folk medicine (bark decoction) to treat patients suffering from hypertension.Aim of the study: This study aimed at evaluating the antihypertensive activities of the stem bark of Canarium schweinfurthii and identifying potential compounds present in its extract that may support or oppose its ethnomedicinial use. Materials and methods Stem bark extract of Canarium schweinfurthii was prepared by maceration using 70 % ethanol followed by redissolution in methanol and hyphenated. Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry (UPLC-MS/MS) analysis for the detection and characterisation of secondary metabolites. Antihypertensive effects were assessed in Wistar rats after induction of hypertension with sodium chloride (NaCl) 18 % at a dose of 0.01mL/gbody weight once a day for four weeks.Hemodynamic parameters were measured weekly by anon-invasive method using the CODA system. Results The ethanolic bark extract of C. schweinfurthii significantly inhibited the increase of blood pressure with a maximum of 23.18 % (systolic pressure, p < 0.0001), 24.77 % (diastolic pressure, p < 0.001) and 22.95 % (mean pressure, p < 0.0001) at a dose of 200 mg/kgbody weight at the 4th week, compared to agroup of Wistar rats that received only NaCl (negative control). Similarly, the extract significantly inhibited the increase in heart rate by 18.84 % (p < 0.001) at 200 mg/kgbody weight at week four. Hematological parameters did not differ significantly between the extract-treated and control groups. The UPLC-MS/MS spectrometric analysis provided evidence for the presence of several C30 terpenoids containing three or five oxygen atoms and exhibiting pentacyclic triterpenoid structures, as well as C29 terpenoids and related compounds containing nitrogen in addition to oxygen, using spectral matching, and in silico molecular formula and structure prediction. Additionally, two features were annotated with high-confidence as lignans, structurally closely related to hinokinin and dehydrocubebin through MS/MS-based in silico structure prediction using CSI: Finger ID in SIRIUS5. The lignans have been previously reported from stem bark of plants belonging to the Burseraceae family. Conclusion: The ethanolic stem bark extract of C. schweinfurthii demonstrated antihypertensive properties on the tested Wistar rats. These results support the ethnopharmacological use of C. schweinfurthii concoctions for the treatment of hypertension and suggest a protective effect against salt damage, hypothetically by the up regulation of antioxidative enzymes and/or lipids, mitigatings membrane peroxidation.
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Affiliation(s)
- Jean Emmanuel Mbosso Teinkela
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, P.O. Box 2701 Douala, Cameroon
| | - Edwige Laure Nguemfo
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, P.O. Box 2701 Douala, Cameroon
| | - Thierry Fokou Nzodjou
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, P.O. Box 2701 Douala, Cameroon
| | - Calvin Bogning Zangueu
- Department of Biology and Physiology of Animal Organisms, Faculty of Sciences, University of Douala, P.O. Box 24157 Douala, Cameroon
| | - Jarmo-Charles Kalinski
- Department of Biochemistry and Microbiology, Faculty of Science, Rhodes University, Makhanda 6140, South Africa
| | - Bienvenu Tsakem
- Department of Chemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Jules Clement Assob Nguedia
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, P.O. Box 2701 Douala, Cameroon
| | - Xavier Siwe Noundou
- Department of Pharmaceutical Sciences, School of Pharmacy, Sefako Makgatho Health Sciences University, P.O. Box 60, Pretoria 0204, South Africa
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Ambaw Kassie G, Alemu A, Yosef Gebrekidan A, Asmare Adella G, Eshetu K, Wolie Asres A, Sisay Asgedom Y. Undiagnosed hypertension and associated factors among adults in ethiopia: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:278. [PMID: 37244992 PMCID: PMC10225092 DOI: 10.1186/s12872-023-03300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Hypertension is a major public health problem, resulting in 10 million deaths annually. Undiagnosed hypertension affects more people than ever before. It is more likely to be linked to severe hypertension, which can lead to stroke, cardiovascular disease, and ischemic heart disease. Thus, this systematic review and meta-analysis aimed to synthesize the prevalence of undiagnosed hypertension and its associated factors in Ethiopia. METHODS Databases, such as Medline/PubMed, Google Scholar, Science Direct, AJOL, and the Cochrane Library, were systematically searched to find potential studies published until December 2022. A Microsoft Excel spreadsheet was used to enter the extracted data. The pooled prevalence of undiagnosed hypertension and its associated factors was estimated using a random effect model. I2 statistics and the Cochrane Q-test were used to assess statistical heterogeneity across the studies. Begg's and Egger's tests were performed to identify possible publication bias. RESULTS A total of ten articles with 5,782 study participants were included in this meta-analysis. In the random effects model, the pooled prevalence of undiagnosed hypertension was 18.26% (95% CI = 14.94-21.58). Being older (OR = 3.8, 95% CI = 2.56, 5.66), having a body mass index > 25 kg/m2 (OR = 2.71, 95% CI = 2.1, 3.53), having a family history of hypertension (OR = 2.22, 95% CI = 1.47, 3.36), and having DM comorbidity (OR = 2.44, 95% CI = 1.38, 4.32) were significantly associated with undiagnosed hypertension. CONCLUSION In this meta-analysis, the pooled prevalence of undiagnosed hypertension was found to be high in Ethiopia. Being older, having a BMI > 25 kg/m2, having a family history of hypertension, and having DM comorbidity were found to be risk factors for undiagnosed hypertension.
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Affiliation(s)
- Gizachew Ambaw Kassie
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Afework Alemu
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Eshetu
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abiyot Wolie Asres
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yordanos Sisay Asgedom
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Jarab AS, Al-Qerem W, Alqudah S, Abu Heshmeh SR, Mukattash TL, Alzoubi KH. Blood pressure control and its associated factors in patients with hypertension and type 2 diabetes. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
In this retrospective study, the medical records of hypertensive patients with type 2 diabetes attending two major hospitals were reviewed to find the factors associated with poor blood pressure control in patients who have diabetes as a comorbid disease with hypertension. Binary regression analysis was conducted to find the factors independently associated with BP control. A total of 522 participants were included in the study. Most of the participants had uncontrolled hypertension (63.4%) and uncontrolled type 2 diabetes (51.3%). Regression results revealed that having retinopathy (OR=1.468 (95% CI: 1.020-2.113), p<0.05), and not receiving dipeptidyl-peptidase 4 (DPP4) inhibitors were independently associated with uncontrolled BP (OR=0.633 (95%CI 0.423-0.946), p<0.05). Therefore, greater efforts should be exerted to improve BP control in hypertensive patients with type 2 diabetes, particularly in those suffering from retinopathy.
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Affiliation(s)
- Anan S Jarab
- College of Pharmacy, Al Ain University, Abu Dhabi, UAE
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
| | - Walid Al-Qerem
- Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman, JORDAN
| | - Salam Alqudah
- Department of Pharmacy, Jordanian Royal Medical Services, Amman, JORDAN
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, UAE
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
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Iddrisu M, Doat AR, Abdulai AM, Wuni A. They patronize herbal medicine, coincidence or planned behaviour: A case of hypertensive patients in Tamale? Nurs Open 2023. [PMID: 37060167 DOI: 10.1002/nop2.1754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/08/2023] [Accepted: 03/24/2023] [Indexed: 04/16/2023] Open
Abstract
AIM This study assessed, if use of herbal medicine (HM) among hypertensive patients is coincidence or planned. DESIGN Cross-sectional survey. METHODS The study used a cross-sectional survey for collection of data from four (4) herbal medicine clinics in the Tamale metropolis in northern Ghana. RESULTS The final or overall regression model was significant at R2 = 0.350, F(7, 214) = 16.464, p < 0.001. No sociodemographic characteristic predicted herbal medicine use. Only religion and educational level were associated with herbal medicine use. Attitude (p = 0.002), subjective norms (p = 0.001) and behavioural intention (p = 0.000) significantly predicted HM use. PUBLIC CONTRIBUTION Data were collected from respondents only after they had verbally given free and informed consent to take part in the study. The results of this study therefore showed that herbal medicine use among these patients is not coincidence but planned. Health professionals by this study should appreciate the effect of religion and educational background in their health education on Herbal Medicines.
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Affiliation(s)
| | - Abdul Razak Doat
- Department of Nursing, School of Nursing and Midwifery, CK Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | | | - Abubakari Wuni
- Nursing and Midwifery Training College, Tamale, Ghana
- Department of medicine for the elderly, Cambridge University Hospital's NHS Foundation, Adddenrookes Hospital, Cambridge United Kingdom, Cambridge, United Kingdom
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Uwakwe SI, Uwakwe C, Edeh NI, Chukwu CJ, Enyi C, Irouwakwe C, Chukwuemeka-Nworu JI, David AO, Ezepue EI, Aneke MC, Nwankwo BC, Isilebo CN, Ezurike CA, Nweke PO. Efficacy of rational emotive behavior therapy for the improvement of knowledge and risk perception of hypertension among university lecturers in South East Nigeria: REBT for university lecturers' hypertension improvement. Medicine (Baltimore) 2023; 102:e32171. [PMID: 36820571 PMCID: PMC9907944 DOI: 10.1097/md.0000000000032171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND This study determined the effectiveness of a rational emotive behavioral therapy (REBT) intervention on knowledge of risks of hypertension among university lecturers in South-east geopolitical zone of Nigeria. METHODS The study used a group randomized controlled trial design to group the participants into treatment group and a waiting-list control group and the hypertension knowledge questionnaire and the Perceived Risks of Hypertension Questionnaire to collect a pretest, posttest, and follow-up data of this study. The sample of the study was 84 university lecturers in public universities in Southeast Nigeria (University of Nigeria, Nsukka, Enugu State, Nnamdi Azikiwe University, Awka, Anambra State) who satisfies the requirements to participate in the study. The study lasted for 10 weeks. The data collected for the study were analyzed using repeated measures ANOVA and t test statistics. RESULTS The findings of this study were that REBT health educational intervention effectively increased the education foundation and business education lecturers' knowledge and perceived risk of hypertension compared to participants in waitlist group. Lastly, the outcomes of the follow-up measures indicate that the increased knowledge and perceived risks of hypertension acquired during the training program was sustained by the treatment group one month after the end of program. CONCLUSION The REBT health educational intervention program could be utilized to increase knowledge and perceived risks of hypertension among university lecturers in public universities in Southeast Nigeria.
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Affiliation(s)
- Stephen Iro Uwakwe
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
| | | | - Nathaniel Ifeanyi Edeh
- Department of Business Education, University of Nigeria, Nsukka, Nigeria
- * Correspondence: Nathaniel Ifeanyi Edeh, Department of Business Education, University of Nigeria, Nsukka 410001, Nigeria (e-mail: )
| | | | - Chinwe Enyi
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
| | | | | | | | | | - Mary Chioma Aneke
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
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12
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Tebelu DT, Tadesse TA, Getahun MS, Negussie YM, Gurara AM. Hypertension self-care practice and its associated factors in Bale Zone, Southeast Ethiopia: A multi-center cross-sectional study. J Pharm Policy Pract 2023; 16:20. [PMID: 36732868 PMCID: PMC9893557 DOI: 10.1186/s40545-022-00508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hypertension is a serious threat to public health globally owing to its high prevalence and related complications. It is the main risk factor for cardiovascular disease, kidney disease, eye problems, and death. Self-care practices have been emphasized as a major element in reducing and preventing complications from hypertension. Thus, this study aimed to assess hypertension self-care practices and associated factors in Bale Zone, Southeast Ethiopia. METHODS A health facility-based cross-sectional study was conducted at three public hospitals from April 1 to May 31, 2021. Data were entered into Epi-Data version 4.6 and exported to Statistical Package for the Social Sciences (SPSS) version 25.0 for analysis. The study participants were characterized using descriptive statistics. The associations between self-care practice and independent variables were modeled using binary logistic regression analysis. Adjusted odds ratios with a 95% confidence interval were used to estimate the association between self-care practice and independent variables. The statistical significance of the association was declared at p < 0.05. RESULTS This study involved 405 hypertensive patients, with a response rate of 96.7%. The overall level of good self-care practice was 33.1% (95% CI: 28.6, 37.5). The multivariable logistic regression model showed that age under 65 years (AOR = 3.77, 95% CI: 1.60-8.89), good knowledge of hypertension self-care practice (AOR = 6.36, 95% CI: 2.07-19.56), absence of a depression (AOR = 6.08, 95% CI: 1.24-29.73) and good self-efficacy (AOR = 3.33, 95% CI: 1.12-9.87) were independent predictors of good self-care practice. CONCLUSION The level of good hypertension self-care practice in the study area was low. Hence, it is crucial to expand non-communicable disease control programs and implement public health interventions on self-care for hypertension. Moreover, to enhance hypertension self-care practices, patient-centered interventions are essential.
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13
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Moloro AH, Seid AA, Jaleta FY. A systematic review and meta-analysis protocol on hypertension prevalence and associated factors among bank workers in Africa. SAGE Open Med 2023; 11:20503121231172001. [PMID: 37181276 PMCID: PMC10170600 DOI: 10.1177/20503121231172001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Objective This systematic review and meta-analysis will investigate the pooled prevalence of hypertension and associated factors among bank workers in Africa. Methods Studies published with full texts in English will be searched in the PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, African Journals Online, and Google Scholar databases. Checklists from the Joanna Briggs Institute will be used to assess the studies' methodology quality. Data extraction, critical appraisal, and screening of all retrieved articles will be conducted by two independent reviewers. Statistical analysis will be performed using STATA-14 software packages. A random effect will be employed to demonstrate pooled estimates of hypertension among bank workers. For determinants of hypertension, an effect size with a 95% confidence interval will be analyzed. Results Data extraction and statistical analyses will begin after identifying the most pertinent studies and evaluating their methodological quality. Data synthesis and the presentation of the results are scheduled for completion by the end of 2023. After the review is completed, the results will be presented at relevant conferences and published in a peer-reviewed journal. Conclusion Hypertension is a major public health concern in Africa. More than 2 out of 10 people aged older than 18 years suffer from hypertension. A number of factors contribute to hypertension in Africa. These factors include female gender, age, overweight or obesity, khat chewing, alcohol consumption, and family history of hypertension and diabetes mellitus. To address the alarming rise in hypertension in Africa, behavioral risk factors should be given primary attention. Protocol registration This systematic review and meta-analysis protocol is registered in PROSPERO with the registration ID and link as follows: CRD42022364354;CRD-register@york.ac.ukhttps://www.york.ac.uk/inst/crd.
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Affiliation(s)
- Abdulkerim Hassen Moloro
- Abdulkerim Hassen Moloro, Department of Nursing, College of Medicine and Health Science, Samara University, Samara, P.O. Box 132, Afar, Ethiopia.
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14
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Abdisa L, Balis B, Shiferaw K, Debella A, Bekele H, Girma S, Mechal A, Amare E, Kechine T, Tari K, Nigussie K, Assefa N, Letta S. Self-care practices and associated factors among hypertension patients in public hospitals in Harari regional state and Dire Dawa City administration, Eastern Ethiopia: A multi-center cross-sectional study. Front Public Health 2022; 10:911593. [PMID: 35991019 PMCID: PMC9389041 DOI: 10.3389/fpubh.2022.911593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Hypertension is a silent killer that causes serious health issues in all parts of the world. Hypertension is a risk factor for cardiovascular disease, stroke, and kidney disease. Self-care practices have been identified as an important component of hypertension management. Despite the government's commitment and the interventions of various stakeholders, the burden of hypertension and its sequel remain unabated. A recent study showed that hypertension self-care practices play a vital role in controlling and managing high blood pressure, even though there is poor self-practice among hypertensive patients in Ethiopia. Therefore, this study assessed the level of self-care practices and associated factors among hypertension patients in public hospitals in Harari regional state and Dire Dawa City Administration, Eastern Ethiopia. Methods Hospital-based cross-sectional study was conducted from June 15 to July 15/2021 among 415 adult hypertensive patients on follow-up. The participants were selected using systematic sampling. Hypertension Self-Care Activity Level Effects (H-SCALE) was used to collect data through face-to-face interviews. The SPSS version 24 was used for analysis. Logistic regression analyses were done to determine the association between the outcome and independent variables. For multivariate logistic regression models, variables having a P < 0.25 during bivariate analysis were candidates. The strength of the association was estimated using AOR and 95% CI. The level of statistical significance was declared at a p < 0.05. Results This study revealed that 52% (95% CI, 48.2–58%) had good level of self-care practices. Formal education (AOR = 3.45, 95% CI: 2.1–4.85), good knowledge about hypertension (AOR = 1.5, 95% CI: 1.17–2.1) 1.5, abstain from chewing khat (AOR = 2.01, 95% CI: 1.44–3.94), strong social support (AOR= 1.9, 95% CI: 1.16–3.1), and absence of depression (AOR = 2.03, 95% CI: 1.43–3.92) were statistically associated with a good level of self-care practices. Conclusions This study pointed out that about half of the participants had a good level of self-care practices. Formal education, good knowledge about hypertension, abstaining from khat chewing, good social support, and absence of depression showed associations with a good level of self-care practices. Therefore, public health interventions on hypertension self-care practices, and strengthening non-communicable diseases control programs are vital. Moreover, the provision of targeted education to patients can improve disease knowledge and self-care practices.
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Affiliation(s)
- Lemesa Abdisa
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
- Lemesa Abdisa
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
- *Correspondence: Bikila Balis
| | - Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Habtamu Bekele
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Sagni Girma
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Ayalnesh Mechal
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosaena, Ethiopia
| | - Eldana Amare
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosaena, Ethiopia
| | - Temesgen Kechine
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosaena, Ethiopia
| | - Kajela Tari
- Department of Nursing and Midwifery, College of Medical and Health Science, Dilla University, Dilla, Ethiopia
| | - Kabtamu Nigussie
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Sahinoz M, Elijovich F, Ertuglu LA, Ishimwe J, Pitzer A, Saleem M, Mwesigwa N, Kleyman TR, Laffer CL, Kirabo A. Salt Sensitivity of Blood Pressure in Blacks and Women: A Role of Inflammation, Oxidative Stress, and Epithelial Na + Channel. Antioxid Redox Signal 2021; 35:1477-1493. [PMID: 34569287 PMCID: PMC8713266 DOI: 10.1089/ars.2021.0212] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 12/11/2022]
Abstract
Significance: Salt sensitivity of blood pressure (SSBP) is an independent risk factor for mortality and morbidity due to cardiovascular disease, and disproportionately affects blacks and women. Several mechanisms have been proposed, including exaggerated activation of sodium transporters in the kidney leading to salt retention and water. Recent Advances: Recent studies have found that in addition to the renal epithelium, myeloid immune cells can sense sodium via the epithelial Na+ channel (ENaC), which leads to activation of the nicotinamide adenine dinucleotide phosphate oxidase enzyme complex, increased fatty acid oxidation, and production of isolevuglandins (IsoLGs). IsoLGs are immunogenic and contribute to salt-induced hypertension. In addition, aldosterone-mediated activation of ENaC has been attributed to the increased SSBP in women. The goal of this review is to highlight mechanisms contributing to SSBP in blacks and women, including, but not limited to increased activation of ENaC, fatty acid oxidation, and inflammation. Critical Issues: A critical barrier to progress in management of SSBP is that its diagnosis is not feasible in the clinic and is limited to expensive and laborious research protocols, which makes it difficult to investigate. Yet without understanding the underlying mechanisms, this important risk factor remains without treatment. Future Directions: Further studies are needed to understand the mechanisms that contribute to differential blood pressure responses to dietary salt and find feasible diagnostic tools. This is extremely important and may go a long way in mitigating the racial and sex disparities in cardiovascular outcomes. Antioxid. Redox Signal. 35, 1477-1493.
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Affiliation(s)
- Melis Sahinoz
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lale A. Ertuglu
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne Ishimwe
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley Pitzer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mohammad Saleem
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naome Mwesigwa
- Department of Medicine and Dentistry, Kampala International University, Kampala, Uganda
| | - Thomas R. Kleyman
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cheryl L. Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Bokaba M, Modjadji P, Mokwena KE. Undiagnosed Hypertension in a Workplace: The Case of a Logistics Company in Gauteng, South Africa. Healthcare (Basel) 2021; 9:healthcare9080964. [PMID: 34442101 PMCID: PMC8394589 DOI: 10.3390/healthcare9080964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
A large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular diseases in South Africa. A workplace may either mitigate or accentuate the risk factors for hypertension. A cross sectional study was conducted to determine the prevalence of undiagnosed hypertension and associated factors among 312 employees in a Logistics Company, South Africa. A modified, validated, self-administered WHO STEPwise questionnaire was used to collect data on demography, lifestyle factors, anthropometry and blood pressure (BP). Hypertension was defined at BP ≥ 140/90 mmHg. Data was analysed using STATA 14. Mean age of employees was 40 ± 10 years, with a 50% prevalence of undiagnosed hypertension. No significant association was observed between occupation and undiagnosed hypertension, except for high prevalence of undiagnosed hypertension among truck drivers and van assistants (43%), and general workers (27%), having higher odds of increased waist-to-height ratio. Hypertension was associated with age (OR = 2.3, 95%CI; 1.21–4.27), alcohol use (AOR = 1.8, 95%CI; 1.05–2.93), waist circumference (AOR = 2.3, 95%CI; 1.29–4.07) and waist-to-height-ratio (AOR = 3.7, 95%CI; 1.85–7.30). Improved and effective workplace health programs and policies are necessary for management of undiagnosed hypertension among employees. Longitudinal studies on mediation of occupation in association of demographic and lifestyle factors with hypertension in workplaces are needed.
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Affiliation(s)
- Brian L Rayner
- Division of Nephrology and Hypertension, University of Cape Town, Groote Schuur Hospital, South Africa (B.L.R.)
| | - J David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, ON, Canada (J.D.S.)
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Abdelbagi O, Musa IR, Musa SM, ALtigani SA, Adam I. Prevalence and associated factors of hypertension among adults with diabetes mellitus in northern Sudan: a cross-sectional study. BMC Cardiovasc Disord 2021; 21:168. [PMID: 33838664 PMCID: PMC8037914 DOI: 10.1186/s12872-021-01983-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/05/2021] [Indexed: 03/07/2023] Open
Abstract
Background Hypertension and diabetes mellitus (DM), are highly prevalent worldwide health non-communicable diseases, and are associated with chronic complications. The co-existence of both conditions accelerates the related complications and increases morbidities and mortalities. A cross-sectional study was conducted in Nahr an Nil State (River Nile State) in Sudan between May and August 2018 to identify the prevalence of hypertension and risk factors among patients with DM in that region. Results The median (interquartile) age of the 1,973 enrolled patients was 58.0 (50.0‒65.0) years, and 818 (45.6%) were males. The median (interquartile) duration of diabetes was 5.0 (3.0‒9.0) years. Of the 1,973 enrolled participants, 21.7%, 1.3%, 37.1%, and 39.9% were normal weight, underweight, overweight, and obese, respectively. Of 1,973 854 (47.6%) patients also had hypertension. Logistic regression analyses showed that elderly patients (adjusted odds ratio [AOR] = 1.03, 95%; confidence interval [CI] = 1.02‒1.04), males (AOR = 2.96, 95%; CI = 2.15‒4.07), employed patients (AOR = 1.92, 95%; CI = 1.38‒2.70), obese patients (AOR = 1.59, 95%; CI = 1.21‒2.08), and patients with diabetic foot (DF) (AOR = 2.45, 95%; CI = 1.72‒3.47) were at higher risk for hypertension. Conversely, patients with Type 2 DM (T2DM) (AOR = 0.63, 95%; CI = 0.50‒0.80) were at lower risk for hypertension. There was no significant association between overweight, uncontrolled DM, and hypertension. Conclusion This study showed a high prevalence of hypertension among patients with DM. Notably, older age, male gender, employment, duration of DM, DF, underweight, and obesity were significant predictors of hypertension among patients with DM.
Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01983-x.
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Affiliation(s)
- Omer Abdelbagi
- Department of Pathology, Qunfudah Medical college, Umm-Al-Qura University, Al-Qunfudah, Kingdom of Saudi Arabia
| | - Imad R Musa
- Department of Medicine, Royal Commission Hospital, Jubail Industrial City, Al Jubail, Kingdom of Saudi Arabia
| | - Shaza M Musa
- Faculty of Medicine, Najran University, Najran, Kingdom of Saudi Arabia
| | - Salim A ALtigani
- College of Computer Science and Information Technology, Elsheikh Abdallah Elbadri University, Berber, Sudan.
| | - Ishag Adam
- Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
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Anjulo U, Haile D, Wolde A. Prevalence of Hypertension and Its Associated Factors Among Adults in Areka Town, Wolaita Zone, Southern Ethiopia. Integr Blood Press Control 2021; 14:43-54. [PMID: 33758539 PMCID: PMC7981153 DOI: 10.2147/ibpc.s295574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hypertension is an emerging public health problem in many low- and middle-income countries including Ethiopia. However, there are limited studies and data are scarce in these countries, particularly in Ethiopia. Thus, the aim of this study was to assess the prevalence of hypertension and its associated factors in this study area. Methods A community-based cross-sectional study was conducted in Areka town. Multi-stage sampling technique was used to select 581 adults. Information on socio-demographic data, behavioral and dietary habits, and family history of hypertension were collected using face-to-face interview. Measurements of weight, height, and blood pressure were taken using digital weighing scale, Stadio-meter, and digital sphygmomanometer respectively. Data were entered and cleaned in Epi-Data version 3.1, and exported to SPSS version 20 for analysis. Binary logistic regressions were done and odds ratios with 95% confidence intervals were calculated to identify associated factors. Results The overall prevalence of hypertension among the study participants was 19.1% (95% CI: 15.9-22.4). Out of these, more than half (57.3%) of the cases were newly screened for hypertension. In a multivariate logistic regression analysis; history of perceived childhood obesity (AOR:2.8 (95% CI:1.6,5.1)), age 55 years and above (AOR=8.90, 95% CI: 3.77-21.02), family history of hypertension (AOR= 2.57, 95% CI: 1.17-5.64), fatty meat intake (AOR=1.96, 95% CI: 1.05-3.65), eating vegetables less than two days per week (AOR=2.81, 95% CI: 1.24-6.37) and being obese (AOR=11.59, 95% CI: 4.7-27.62) were associated factors of developing hypertension. Conclusion The study revealed that the prevalence was found to be high among adults indicating the hidden burden of the problem in the area. Therefore, the health systems need to develop strategies for community-based screening, strategies that focus on life cycle-based approach because childhood and adolescence are crucial times for the prevention of NCDs including hypertension. Health education on eating behavior and life style modifications to maintain normal body weight are recommended.
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Affiliation(s)
- Ufaysa Anjulo
- Wolaita Zone Health Department, Sodo, Southern Ethiopia
| | - Dereje Haile
- Reproductive Health and Nutrition Department, School of Public Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Southern Ethiopia
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Ogah OS, Umuerri EM, Adebiyi A, Orimolade OA, Sani MU, Ojji DB, Mbakwem AC, Stewart S, Sliwa K. SARS-CoV 2 Infection (Covid-19) and Cardiovascular Disease in Africa: Health Care and Socio-Economic Implications. Glob Heart 2021; 16:18. [PMID: 33833942 PMCID: PMC7977038 DOI: 10.5334/gh.829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/13/2021] [Indexed: 01/08/2023] Open
Abstract
The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.
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Affiliation(s)
- Okechukwu S. Ogah
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria/Department of Medicine, University College Hospital Ibadan, NG
- Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, NG
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Ejiroghene M. Umuerri
- Department of Medicine, Delta State University, Abraka, Delta State Nigeria/Department of Medicine, Delta State University Teaching Hospital, Oghara, Delta State, NG
| | - Adewole Adebiyi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria/Department of Medicine, University College Hospital Ibadan, NG
| | - Olanike A. Orimolade
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria/Department of Medicine, University College Hospital Ibadan, NG
| | - Mahmoud U. Sani
- Department of Medicine Bayero University Kano & Aminu Kano University Teaching Hospital, Kano, NG
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Dike B. Ojji
- Department of Medicine, University of Abuja, Abuja, Nigeria/Department of Medicine, University of Abuja Teaching Hospital, Abuja, NG
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Amam C. Mbakwem
- Department of Medicine, University of Lagos, Akoka, Lagos, Nigeria/Department of Medicine, Lagos University Teaching Hospital, Idi-araba, Lagos, NG
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Simon Stewart
- Torrens University Australia, Adelaide, South Australia, AU
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
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Jones E, Rayner B. The importance of the epithelial sodium channel in determining salt sensitivity in people of African origin. Pediatr Nephrol 2021; 36:237-243. [PMID: 31897716 DOI: 10.1007/s00467-019-04427-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 12/20/2022]
Abstract
Hypertension is highly prevalent in Black Africans and has been found to be associated with worse blood pressure (BP) control and more cardiovascular disease. Black Africans are more salt sensitive with low renin and aldosterone levels. This can be explained in part by variants in the epithelial sodium channel (ENaC) causing an increase in channel activity resulting in sodium and water retention. These variants in the ENaC are increased in the Black African populations presumably due to selective pressure for sodium retention in traditionally low-salt diets. Furthermore, increased endothelial sodium channel activity contributes to the risk of vascular stiffness, which may also result in more difficult to control hypertension. Patients with increased activity of the ENaC are more likely to respond to amiloride (a selective sodium channel antagonist), which has implications for the management of severe and resistant hypertension in Black Africans. A large-scale controlled trial on the use of amiloride compared to usual care is warranted in Blacks with severe or resistant hypertension.
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Affiliation(s)
- Erika Jones
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Brian Rayner
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa. .,E13 Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa.
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Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 2021; 18:785-802. [PMID: 34050340 PMCID: PMC8162166 DOI: 10.1038/s41569-021-00559-8] [Citation(s) in RCA: 487] [Impact Index Per Article: 162.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.
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Ciancio A, Kämpfen F, Kohler HP, Kohler IV. Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa. JOURNAL OF HEALTH ECONOMICS 2021; 75:102388. [PMID: 33249266 PMCID: PMC7855787 DOI: 10.1016/j.jhealeco.2020.102388] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/19/2020] [Accepted: 09/14/2020] [Indexed: 06/01/2023]
Abstract
Evidence for the effectiveness of population health screenings to reduce the burden of non-communicable diseases in low-income countries remains very limited. We investigate the sustained effects of a health screening in Malawi where individuals received a referral letter if they had elevated blood pressure. Using a regression discontinuity design and a matching estimator, we find that receiving a referral letter reduced blood pressure and the probability of being hypertensive by about 22 percentage points four years later. These lasting effects are explained by a 20 percentage points increase in the probability of being diagnosed with hypertension. There is also evidence of an increase in the uptake of medication, while we do not identify improvements in hypertension-related knowledge or risk behaviors. On the contrary, we find an increase in sugar intake and a decrease in physical activity both of which are considered risky behaviors in Western contexts. The health screening had some positive effects on mental health. Overall, this study suggests that population-based hypertension screening interventions are an effective tool to improve health in low-income contexts.
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Affiliation(s)
- Alberto Ciancio
- Department of Economics, HEC, University of Lausanne, Switzerland
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Tiruneh SA, Bukayaw YA, Yigizaw ST, Angaw DA. Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis. PLoS One 2020; 15:e0244642. [PMID: 33382819 PMCID: PMC7774863 DOI: 10.1371/journal.pone.0244642] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Hypertension is a major public health problem globally and it is a leading cause of death and disability in developing countries. This review aims to estimate the pooled prevalence of hypertension and its determinants in Ethiopia. METHODS A systematic literature search was conducted at the electronic databases (PubMed, Hinari, and Google Scholar) to locate potential studies. Heterogeneity between studies checked using Cochrane Q test statistics and I2 test statistics and small study effect were checked using Egger's statistical test at 5% significance level. Sensitivity analysis was checked. A random-effects model was employed to estimate the pooled prevalence of hypertension and its determinants in Ethiopia. RESULTS In this review, 38 studies that are conducted in Ethiopia and fulfilled the inclusion criteria with a total number of 51,427 study participants were reviewed. The overall pooled prevalence of hypertension in the country was 21.81% (95% CI: 19.20-24.42, I2 = 98.35%). The result of the review also showed that the point of prevalence was higher among males (23.21%) than females (19.62%). When we see the pervasiveness of hypertension from provincial perspective; the highest prevalence of hypertension was observed in Addis Ababa (25.35%) and the lowest was in Tigray region (15.36%). In meta-regression analysis as the mean age increases by one year, the likelihood of developing hypertension increases by a factor of 0.58 times (β = 0.58, 95% CI: 0.31-0.86, R2 = 36.67). Male sex (OR = 1.29, 95% CI: 1.03-1.61, I2 = 81.35%), age > 35 years (OR = 3.59, 95% CI: 2.57-5.02, I2 = 93.48%), overweight and/or obese (OR = 3.34, 95% CI: 2.12-5.26, I2 = 95.41%), khat chewing (OR = 1.42, 95% CI: I2 = 62%), alcohol consumption (OR = 1.50, 95% CI: 1.21-1.85, I2 = 64%), family history of hypertension (OR = 2.56, 95% CI: 1.64-3.99, I2 = 83.28%), and family history of diabetes mellitus (OR = 3.69, 95% CI: 1.85-7.59, I2 = 89.9%) are significantly associated with hypertension. CONCLUSION Hypertension is becoming a major public health problem in Ethiopia. Nearly two out of ten individuals who are older than 18 years living with hypertension. Sex, age, overweight and/or obese, khat chewing, alcohol consumption, and family history of hypertension and diabetes mellitus are statistically significant determinant factors for hypertension in Ethiopia. Primary attention should be given for behavioral risk factors to tackle the alarming increase of hypertension in Ethiopia.
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Affiliation(s)
- Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yeaynmarnesh Asmare Bukayaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Seblewongel Tigabu Yigizaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hussen FM, Adem HA, Roba HS, Mengistie B, Assefa N. Self-care practice and associated factors among hypertensive patients in public health facilities in Harar Town, Eastern Ethiopia: A cross-sectional study. SAGE Open Med 2020; 8:2050312120974145. [PMID: 33329893 PMCID: PMC7720317 DOI: 10.1177/2050312120974145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Self-care practice is the activity that a hypertensive patient undertakes intending to improve their health. Poor self-care practice leads to uncontrolled hypertension. Therefore, strategies designed to prevent and control hypertension-related death, disability, and morbidity should consider the level of the patient’s self-care practice and risk factors. This study assessed self-care practice and associated factors among hypertensive patients in public health facilities of Harar Town in eastern Ethiopia. Method: An institution-based cross-sectional study was conducted among 398 randomly selected hypertensive patients from 25 March 2019 to 16 April 2019. Pretested structured questionnaires adapted from validated tools were used to collect data from participants using electronic Open Data Kit software through face-to-face exit interview. Data were analyzed by SPSS version 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with self-care practice. Adjusted odds ratio with 95% confidence interval was used to report association and the significance was declared at p-value < 0.05. Results: Level of good self-care practice was 29.9% (95% confidence interval: 25.3% and 34.7%). Age ⩾ 60 years (adjusted odds ratio = 3.4, 95% confidence interval: 1.2 and 9.3), formal education (adjusted odds ratio = 2.3, 95% confidence interval: 1.3 and 4.2), absence of comorbidities (adjusted odds ratio = 1.8, 95% confidence interval: 1.1 and 3.1), adequate knowledge about hypertension (adjusted odds ratio = 4.7, 95% confidence interval: 2.5 and 8.8), good social support (adjusted odds ratio = 2.7, 95% confidence interval: 1.6 and 4.7), and being khat abstainer (adjusted odds ratio = 1.9, 95% confidence interval: 1.1 and 3.5) were significantly associated with good self-care practice. Conclusion: The prevalence of good self-care practice was low. In this study, good self-care practice was significantly associated with age, formal education, comorbidities, knowledge about hypertension, social support, and current khat chewing condition. Regular check-up and follow-up of patients’ compliance with self-management protocol, and more emphasis should be given to identify factors that potentially impeding patients’ adherence to hypertension self-management protocol.
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Affiliation(s)
- Feysal Mohammed Hussen
- Department of Public Health, College of Health Science, Kebridehar University, Kebridehar, Ethiopia.,School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hassen Abdi Adem
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hirbo Shore Roba
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bezatu Mengistie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Jacobs A, Pieters M, Schutte AE. The association of PAI-1 with 24 h blood pressure in young healthy adults is influenced by smoking and alcohol use: The African-PREDICT study. Nutr Metab Cardiovasc Dis 2020; 30:2063-2071. [PMID: 32811735 DOI: 10.1016/j.numecd.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The association between plasminogen activator inhibitor-1 (PAI-1) and blood pressure is well established, but it is debatable whether raised PAI-1 levels precede or result from raised blood pressure. Furthermore, it is unclear whether this association already exists in the absence of overt hypertension and to what degree it is influenced by health behaviours. Our aim was to investigate the association of 24 h blood pressure with PAI-1 activity (PAI-1act) in a young, healthy cohort, and to assess the influence of alcohol consumption and smoking on these associations. METHODS AND RESULTS Healthy black and white men and women (aged 20-30 years, n = 1156) were cross-sectionally analysed. Statistical analysis was performed first split by ethnicity and sex and then by alcohol consumption and smoking. Regression analyses adjusted for age revealed positive associations of 24 h blood pressure with PAI-1act in most groups (p < 0.05). In multivariate-adjusted analyses, significance was lost in all groups except black men, who also had higher monocyte chemoattractant protein-1 (MCP-1) and von Willebrand factor antigen (vWFag) compared to white men (both p < 0.001). Analyses in black men, split by self-reported alcohol use and smoking, revealed 24 h blood pressure-PAI-1act associations only in alcohol users (24 h SBP [B = 4.22, p < 0.001], DBP [B = 2.04, p = 0.015] and PP [B = 2.18, p = 0.013]) and smokers (24 h SBP [B = 6.10, p < 0.001] and PP [B = 4.33, p = 0.001]). CONCLUSION Our findings support a positive association between 24 h blood pressure and PAI-1, particularly in individuals with higher MCP-1 and vWFag levels. Furthermore, smoking and alcohol consumption play an important role in modifying the association between blood pressure and PAI-1.
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Affiliation(s)
- Adriaan Jacobs
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa; Hypertension in Africa Research Team (HART), Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Marlien Pieters
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa.
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa; School of Public Health and Community Medicine, University of New South Wales, The George Institute for Global Health, Sydney, Australia.
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Plasminogen activator inhibitor-1 activity and the 4G/5G polymorphism are prospectively associated with blood pressure and hypertension status. J Hypertens 2020; 37:2361-2370. [PMID: 31356402 DOI: 10.1097/hjh.0000000000002204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Plasminogen activator inhibitor-1 (PAI-1) has consistently shown positive associations with blood pressure (BP). Whether elevations in PAI-1 levels precede or result from raised BP is still under debate and data on prospective studies are limited. Hence, we investigated the prospective associations of PAI-1 and the 4G/5G polymorphism with brachial and central BP and pulse pressure (PP) over a 10-year period. METHODS Black South Africans aged 30 years and older were included. Baseline data collection commenced in 2005 (n = 2010) with follow-up data collection in 2010 (n = 1288) and 2015 (n = 926). Plasma PAI-1 activity (PAI-1act), 4G/5G polymorphism genotyping, waist circumference and BP measurements were performed and analysed using sequential regression and mixed models. RESULTS In multivariable adjusted analyses, PAI-1act and the 4G/4G (vs. the 5G/5G) genotype increased the odds of developing hypertension in the total group [1.04 (1.01; 1.08) and 1.82 (1.07; 3.12) respectively]. Furthermore, PAI-1act was prospectively associated with brachial SBP (r = 0.0815) and PP (r = 0.0832) in the total group, and with central PP in women (r = 0.1125; all P < 0.05). Addition of waist circumference to the models either decreased or nullified the contribution of PAI-1act to BP and hypertension development. CONCLUSION PAI-1act and the 4G/4G (vs. the 5G/5G) genotype increased the odds of developing hypertension. Furthermore, PAI-1act associated prospectively with both brachial and central BP. These associations were mediated in part by central adiposity. The study supports the hypothesis that PAI-1 also contributes to hypertension development rather than solely being a consequence thereof.
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Abstract
Cardiovascular disease (CVD) is increasingly becoming a major chronic disease burden in sub-Saharan Africa. The aim of this review was to provide an up-to-date overview on prevalence of CVD risk factors in the Gambia. The findings from seven included studies revealed that most CVD risk factors are very prevalent in the Gambia, with some specific groups in the population such as urban dwellers being more at risk. Obesity prevalence ranged from 2.3% to 11.7%, with rate being particularly high in urban women aged ≥35 years. Diabetes prevalence was 0.3%. Hypertension prevalence ranged from 18.3% to 29%. Prevalence of hypercholesterolemia ranged from 2.2% to 29.1%. Prevalence of smoking ranged from 16% to 42.2% in men. Prevalence of insufficient fruit and vegetable consumption, inadequate physical activity, and alcohol consumption was 77.8%, 14.6%, and 2.3%, respectively. These findings suggest urgent need for preventive measures and further research to prevent CVD in the Gambia.
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Fekadu G, Adamu A, Gebre M, Gamachu B, Bekele F, Abadiga M, Mosisa G, Oluma A. Magnitude and Determinants of Uncontrolled Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Nekemte Referral Hospital, Western Ethiopia. Integr Blood Press Control 2020; 13:49-61. [PMID: 32368134 PMCID: PMC7183335 DOI: 10.2147/ibpc.s245068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background Hypertension is the leading cause of morbidity and mortality among non-communicable diseases. The rate of blood pressure (BP) control among hypertensive patients is poor and the reasons for poor control of BP remain poorly understood globally. Therefore, this study aimed to assess the magnitude and determinants of uncontrolled blood pressure among adult hypertensive patients on follow-up at Nekemte referral hospital (NRH). Methods A hospital-based cross-sectional study was conducted from February to April 2018 at NRH. BP control status was determined by the average consecutive BP recordings across the 3 months. The data was entered and analyzed using SPSS version 20.0 and p-value <0.05 was considered statistically significant. Results Out of 297 study participants included, the majority were females, 181 (60.9%), and the mean age of the patients was 59.4 ±10.4 years. About half, 137 (46.12%), of the patients had at least one comorbidity and the most common class of anti-hypertensive medication was angiotensin-converting enzyme inhibitors (88.2%). The mean of systolic blood pressure was 132.41± 15.61mmHg, while the mean of diastolic blood pressure was 84.37± 9.32 mmHg. The proportion of participants with optimally controlled BP was 63.6% and 36% were adherent to their medications. Male sex (Adjusted Odd Ratio [AOR]: 1.89, 95% CI: 1.09-4.84), illiteracy (AOR= 1.56, 95% CI: 1.22-6.78), duration of hypertension diagnosis > 10 years (AOR= 2.01, 95% CI: 1.04-16.11), non-adherence (AOR= 3.14, 95% CI: 1.35-10.76) and lack of physical exercise (AOR= 2.8, 95% CI: 1.16-6.74) were positively associated with uncontrolled BP status. Whereas age older than 55 years (AOR= 0.38, 95% CI: 0.11-0.92) was negatively associated with uncontrolled BP. Conclusion BP control was relatively achieved in about two-third of pharmacologically treated patients. We recommend better health education and care of patients to improve the rate of BP control status.
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Affiliation(s)
- Ginenus Fekadu
- Clinical Pharmacy Unit, Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Abdi Adamu
- Shanan Gibe Hospital, Jimma, Oromia Regional State, Ethiopa
| | - Mohammed Gebre
- Clinical Pharmacy Unit, Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Busha Gamachu
- Clinical Pharmacy Unit, Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Firomsa Bekele
- Department of Pharmacy, College of Health Sciences, Mettu University, Mettu, Ethiopa
| | - Muktar Abadiga
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Getu Mosisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Adugna Oluma
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
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Omar SM, Musa IR, Osman OE, Adam I. Prevalence and associated factors of hypertension among adults in Gadarif in eastern Sudan: a community-based study. BMC Public Health 2020; 20:291. [PMID: 32138715 PMCID: PMC7059678 DOI: 10.1186/s12889-020-8386-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension is becoming an increasingly common health issue worldwide, especially in countries in Sub-Saharan Africa. Hypertension is the leading risk factor for premature death and disability worldwide, and it is the leading risk factor for mortality from cardiovascular diseases worldwide. The data on hypertension in Sudan that has been published is limited. We conducted this study to assess the prevalence of hypertension and its associated risk factors. Methods A multistage sampling survey was conducted in Gadarif, Eastern Sudan, from January to May 2018 to investigate the prevalence of hypertension and associated factors in adults in Eastern Sudan. The World Health Organization (WHO) three-level stepwise approach questionnaire was used to gather sociodemographic characteristics (age, sex, height, weight marital status, education level, smoking habit, alcohol consumption habit, and family history of hypertension). Hypertension was defined as the presence of an average blood pressure of ≥140/90 mmHg or the reported use of anti-hypertensive medications for high blood pressure. Results A total of 600 participants (mean age: 44.9 years) were enrolled in this study. Four hundred twenty-two (70.3%) participants were women, and 196 (32.7%) participants were obese. Of the 600 enrolled participants, 245 (40.8%) individuals had hypertension, 44 (7.3%) had been previously diagnosed with hypertension, and 201 (33.5%) were newly diagnosed with hypertension. A logistic regression analysis showed no significant associations across the education level, marital status, overweight and hypertension factors. However, an older age (adjusted OR = 3.20, 95% CI = 2.28–4.51, P < 0.001) and obesity (adjusted OR = 2.41, 95% CI = 1.57–3.69, P < 0.001) were associated with the presence of hypertension. Conclusion There is a high rate of hypertension in Eastern Sudan, especially among older and obese individuals. Preventive measures, such as dietary measures, should be implemented.
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Affiliation(s)
- Saeed M Omar
- Faculty of Medicine, Gadarif University, Gadarif, Sudan
| | - Imad R Musa
- Royal Commission Hospital at AL Jubail Industrial City, Al Jubail, Kingdom of Saudi Arabia
| | - Osman E Osman
- Faculty of Medicine, Alneelain University, Khartoum, Sudan
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum, Sudan.
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Hassen B, Mamo H. Prevalence and associated anthropometric and lifestyle predictors of hypertension among adults in Kombolcha town and suburbs, Northeast Ethiopia: a community-based cross-sectional study. BMC Cardiovasc Disord 2019; 19:241. [PMID: 31664909 PMCID: PMC6820981 DOI: 10.1186/s12872-019-1225-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/18/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is major public health challenge. Data on HTN prevalence and associated risk factors is necessary to better control it. This study aimed at estimating the prevalence of HTN and associated anthropometric and lifestyle predictors in Kombolcha and suburbs, northeast Ethiopia. METHODS The study followed a community-based cross-sectional sampling design. Adult (≥18) residents of Kombolcha and suburbs in 11 kebeles (villages) formed the target population. Of these kebeles, 5(3 urban and 2 suburban) were selected randomly. Households (HHs) within the selected kebeles and individuals within HHs were similarly recruited in December 2016-May 2017. Anthropometric and blood pressure measurements were done. World Health Organization (WHO) STEPWISE TOOL was used to capture socio-demographic, physical activity, dietary habit, and nutritional status data. RESULTS Totally 318 adults participated in the study. However, only 312 (169(54.2%) males and 143(45.8%) females) were with complete information for statistical analysis. The lowest age was 18 years, the highest 65 and the mean 38.29 ± 10.88. The prevalence of HTN was 30.8% (96/312) (95% confidence interval (CI): 25.9-36.1%), 16.4% male and 14.4% female. While 45 and older age (odds ratio (OR) 7.385, 95% CI 3.563-15.306, p < 0.0001), obesity (OR 126.286, 95% CI 34.481-462.514, p < 0.0001) and overweightness (OR 16.105, 95% CI 7.024-36.927, p < 0.0001), 'substantially high risk' (> 102 cm in men and > 88 cm in female) waist circumference (OR 1.788, 95% CI 1.008-3.173, p = 047), light occupational physical activity (OR 12.427, 95% CI 2.891-53.410, p = 0.001), walking or riding a bicycle for lower than 5 days/week (OR 13.000, 95% CI 5.140-32.882, p < 0.0001) and lack of sport activity (OR 18.322, 95% CI 2.430-138.169, p = 005), smoking (OR 2.283, 95% CI 1.284-4.060, p = 0.005), khat (OR 17.390, 95% CI 6.167-49.037, p < 0.0001), alcohol (OR 4.005, 95% CI 2.357-6.803, p < 0.0001), HH size of two (OR 2.474, 95% CI 1.250-4.895, p = 0.009) and ≥ 3 (OR 6.889, 95% CI 2.610-18.186, p < 0.0001); and HTN in family history (OR 19.417, 95% CI 10.251-36.778, p < 0.0001) were significant predictors of HTN in the binary logistic regression analysis; none of these were so in the multivariable model. CONCLUSION Although there was a high prevalence of HTN in the study area, its independent significant predictors were not identified.
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Affiliation(s)
- Biniem Hassen
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia.
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Three-year change in oxidative stress markers is linked to target organ damage in black and white men: the SABPA study. Hypertens Res 2019; 42:1961-1970. [PMID: 31564719 DOI: 10.1038/s41440-019-0325-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/12/2019] [Accepted: 08/02/2019] [Indexed: 12/22/2022]
Abstract
Oxidative stress is implicated in hypertension, carotid wall thickening, and renal dysfunction. Oxidative stress is linked to cardiovascular pathology in the black South African individuals who have a high prevalence of hypertension and early vascular aging. However, there are limited data relating changes in oxidative stress with vascular and renal deterioration over time. We aimed to investigate whether changes in oxidative stress over 3 years are associated with target organ damage in black (N = 89) and white (N = 91) men. Carotid intima-media thickness was measured using the SonoSite Micromaxx ultrasound system, and cross-sectional wall area (CSWA) was calculated. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease formula. The percentage change (%∆) in oxidative stress markers was calculated and included reactive oxygen species (ROS), superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione reductase (GR). Over 3 years, black men exhibited decreased ROS, SOD, and GR, while white men revealed decreased SOD and GPx. Black men displayed positive associations of CSWA with %∆ ROS (β = 0.28; p = 0.017) and %∆ SOD (β = 0.24; p = 0.047). White men displayed a negative association of CSWA with %∆ SOD (β = -0.22; p = 0.042) and positive associations of eGFR with %∆ GPx (β = 0.33; p = 0.001) and %∆ GR (β = 0.39; p < 0.001). In white men, the association of CSWA with decreased SOD activity suggests oxidative-stress-related carotid remodeling, while associations of eGFR with the glutathione system suggests a postponement of microvascular deterioration. In black men, associations of oxidative stress markers with CSWA suggest that a sufficiently functioning antioxidant system may delay target organ damage.
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Ngongang Ouankou C, Chendjou Kapi LO, Azabji Kenfack M, Nansseu JR, Mfeukeu-Kuate L, Ouankou MD, Kowo M, Magny Thiam E, Kagmeni G, Kaze FJ, Ngu Blackett K. [Severe high blood pressure recently diagnosed in an urban milieu from Subsahelian Africa: Epidemiologic, clinical, therapeutic and evolutionary aspects]. Ann Cardiol Angeiol (Paris) 2019; 68:241-248. [PMID: 31471040 DOI: 10.1016/j.ancard.2019.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES High Blood Pressure (HBP) is a worldwide public health problem. It can be particularly severe in the Black race. Recent studies in Cameroon, showed an alarming prevalence, leading us to want to study the epidemiological, clinical, therapeutic and evaluative aspects of severe, (BP op to 180/110mmHg), recently diagnosed HBP in Yaounde. Our objective was to determine its clinical presentation and evolution. METHODS We conducted nine months prospective cohort study, from January to September 2016. We recruited from the active population participants who voluntarily accepted blood pressure screening offered in various localities in Yaounde, and were aged from 18 years and above. RESULTS Of a total of 6519 people who participated in the screening, 1875 (28.8%.), presented a HBP and 363 (5.6%) had severe HBP. Our cohort comprised 153 (42.1%) of these individuals with sustained severe hypertension, not on medication, who accepted the invitation to participate in the study. The range of 45-54 years and 55-64 years were the most represented; the sex ratio was 0.9. The cardiovascular risk factors number range from 5 to 8 with a median of 6. Systolic BP ranged from 184 to 225mmHg with a median of 200mmHg; while the diastolic BP ranged between 111-132.5mmHg with a median of 119mmHg. Kidney injury (77.8%) was the main complications. We identified 3 clinical forms: hypertensive emergencies 121 (79.1%) cases and hypertensive crises 32 (20.9%) cases. In these two groups, 33 (21.6%) patients presented with "super HBP" (a blood pressure>250/150mmHg). The average rate of BP control over 6 month was 39%. The main cause of poor BP control was lack of therapeutic compliance. We registered one death at the 3rd month of follow up due to acute kidney injury. CONCLUSION Severe HBP prevalence in Yaounde is high in the active fraction of the population insidiously affected. Particularly, unsuspected renal impairment appears to be the major complication. The bad blood pressure control is linked to poor therapeutic observance and persistence.
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Affiliation(s)
- C Ngongang Ouankou
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - L O Chendjou Kapi
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Institut supérieur des sciences de la santé, université des Montagnes, Bangangté, Cameroun.
| | - M Azabji Kenfack
- Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - J R Nansseu
- Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun; Direction de la lutte contre la maladie, les épidémies et les pandémies, Yaoundé, Cameroun.
| | - L Mfeukeu-Kuate
- Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun; Centre cardiologique et médical, Yaoundé, Cameroun.
| | - M D Ouankou
- Centre cardiologique et médical, Yaoundé, Cameroun.
| | - M Kowo
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - E Magny Thiam
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - G Kagmeni
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - F J Kaze
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - K Ngu Blackett
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
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Sombié HK, Kologo JK, Tchelougou D, Ouédraogo SY, Ouattara AK, Compaoré TR, Nagalo BM, Sorgho AP, Nagabila I, Soubeïga ST, Djigma FW, Yonli AT, Zabsonré P, Millogo H, Simporé J. Positive association between ATP2B1 rs17249754 and essential hypertension: a case-control study in Burkina Faso, West Africa. BMC Cardiovasc Disord 2019; 19:155. [PMID: 31242870 PMCID: PMC6595568 DOI: 10.1186/s12872-019-1136-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/12/2019] [Indexed: 01/06/2023] Open
Abstract
Background Genetic and environment play a significant role in the etiology of essential hypertension (EH). Recently STK39 rs3754777, ATP2B1 rs2681472 and rs17249754 have been associated with BP variation and hypertension. In this study we aimed to determine firstly whether index variants were associated with the risk of developing EH in Burkina Faso and secondly to characterize cardiovascular risk markers. Methods We conducted a case-control study with 380 participants including 180 case subjects with EH and 200 control subjects with normal BP. We used TaqMan genotyping assays with probes from Applied Biosystems to genotype polymorphisms using the 7500 Real-Time PCR System. Biochemical parameters were measured using chemistry analyzer COBAS C311. Results T-test showed that cardiovascular risk markers such as body mass index, waist circumference, blood sugar, total cholesterol and triglycerides were significantly higher in hypertensive compared to normotensive (all p < 0.05). Binary logistic regression analysis revealed in decreasing order that overweight, family history of hypertension, central obesity and alcohol intake increased the risk of developing EH (all OR > 3.8; all p < 0.001). In genetic level we observed that individuals carrying the AA+AG genotype of ATP2B1 rs17249754 had a low risk of developing EH than those carrying the GG genotype (OR = 0.48 [95% CI: 0.31–0.75] p = 0.001) and the A allele frequency in the cases was significantly lower than that of the controls (OR = 0.56 [95% CI: 0.38–0.82] p = 0.003). We also observed that ATP2B1 rs17249754 was significantly associated with higher SBP and DPB in case and control groups (GG versus AG + AA; p < 0.05), ATP2B1 rs2681472 was significantly associated with higher SBP only in case and control group (AA versus AG + GG; p < 0.05), STK39 rs3754777 was not significantly associated with any of the BP traits (CC versus CT + TT; p > 0.05). Conclusion Our results confirmed the significant association of ATP2B1 rs17249754 with the risk of developing EH in Burkinabe and showed an increase of cardiovascular risk markers levels in subjects with EH. Electronic supplementary material The online version of this article (10.1186/s12872-019-1136-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Herman Karim Sombié
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso
| | - Jonas Koudougou Kologo
- Saint Camille hospital in Ouagadougou (HOSCO), Burkina Faso, P.O. Box 444, Ouagadougou 01, Burkina Faso
| | - Daméhan Tchelougou
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso
| | - Serge Yannick Ouédraogo
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso
| | - Abdoul Karim Ouattara
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso.,Pietro Annigoni Biomolecular Research Center (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
| | - Tegwindé Rebecca Compaoré
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso
| | - Bolni Marius Nagalo
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso
| | - Abel Pegdwendé Sorgho
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso
| | - Issoufou Nagabila
- Saint Camille hospital in Ouagadougou (HOSCO), Burkina Faso, P.O. Box 444, Ouagadougou 01, Burkina Faso
| | - Serge Théophile Soubeïga
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso.,Pietro Annigoni Biomolecular Research Center (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
| | - Florencia Wendkuuni Djigma
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso. .,Pietro Annigoni Biomolecular Research Center (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso.
| | - Albert Théophane Yonli
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso.,Pietro Annigoni Biomolecular Research Center (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
| | - Patrice Zabsonré
- University Hospital Center-Yalgado Ouedraogo (CHUYO), Ouagadougou, Burkina Faso
| | - Hassanata Millogo
- Pietro Annigoni Biomolecular Research Center (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso
| | - Jacques Simporé
- Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, P.O. Box 7021, Ouagadougou 03, Burkina Faso.,Saint Camille hospital in Ouagadougou (HOSCO), Burkina Faso, P.O. Box 444, Ouagadougou 01, Burkina Faso.,Pietro Annigoni Biomolecular Research Center (CERBA), P.O. Box 364, Ouagadougou 01, Burkina Faso.,Faculty of Medicine, University Saint Thomas d'Aquin, P.O. Box 10212, Ouagadougou, Burkina Faso
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Niriayo YL, Ibrahim S, Kassa TD, Asgedom SW, Atey TM, Gidey K, Demoz GT, Kahsay D. Practice and predictors of self-care behaviors among ambulatory patients with hypertension in Ethiopia. PLoS One 2019; 14:e0218947. [PMID: 31242265 PMCID: PMC6594646 DOI: 10.1371/journal.pone.0218947] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the benefits of evidence-based self-care behaviors in the management of hypertension, hypertensive patients have low rate of adherence to the recommended self-care behaviors. Studies related to self-care behaviors among hypertensive patients are limited in Ethiopia. OBJECTIVE To assess the rate of adherence to self-care behaviors and associated factors among hypertensive patients. METHOD A cross-sectional study was conducted at the cardiac clinic of Ayder comprehensive specialized hospital among ambulatory hypertensive patients. Self-care behaviors were assessed using an adopted Hypertension Self-Care Activity Level Effects (H-SCALE). Data were collected through patient interview and review of medical records. Binary logistic regression analysis was performed to identify predictors of self-care behaviors. RESULT A total of 276 patients were included in the study. The majority of the participants were nonsmokers (89.9%) and alcohol abstainers (68.8%). Less than half of the participants were adherent to the prescribed antihypertensive medications (48.2%) and recommended physical activity level (44.9%). Moreover, only 21.45% and 29% were adherent to weight management and low salt diet recommendations, respectively. Our finding indicated that rural resident (adjusted odds ratio [AOR]: 0.45, 95% confidence interval [CI]: 0.21-0.97), comorbidity (AOR: 0.16, 95% CI: 0.08-0.31), and negative medication belief (AOR: 0.25, 95% CI: 0.14-0.46) were significantly associated with medication adherence. Female sex (AOR: 0.46, 95% CI: 0.23-0.92), old age (AOR: 0.19, 95% CI: 0.06-0.60) and lack of knowledge on self-care behaviors (AOR: 0.13, 95% CI: 0.03-0.57) were significantly associated with adherence to weight management. Female sex (AOR: 1.97, 95% CI: 1.03-3.75) and lack of knowledge on self-care (AOR: 0.07, 95% CI: 0.03-0.16) were significantly associated with adherence to alcohol abstinence. Female sex (AOR: 6.33, 95% CI: 1.80-22.31) and khat chewing (AOR: 0.08, 95% CI: 0.03-0.24) were significantly associated with non-smoking behavior. There was also a significant association between female sex and physical activity (AOR: 0.22, 95% CI: 0.12-0.40). CONCLUSION The rate of adherence to self-care behaviors particularly weight management, low salt intake, physical exercise, and medication intake was low in our study. Elders, females, khat chewers, rural residents, and patients with negative medication belief, comorbidity, and inadequate knowledge of SCBs were less adherent to self-care behaviors compared to their counterparts. Therefore, health care providers should pay more emphasis to patients at risk of having low self-care behaviors.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- * E-mail: ,
| | - Seid Ibrahim
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tesfay Mahari Atey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Gebre Teklemariam Demoz
- Clinical Pharmacy and Pharmacy Practice Unit, Department of Pharmacy, College of Health Sciences, Aksum University, Aksum, Tigray, Ethiopia
| | - Desalegn Kahsay
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Abstract
OBJECTIVE To assess the current prevalence, awareness, treatment and control of arterial hypertension in Mozambican population, including adolescents and young adults, and to appraise their trends over the past decade, for the 25-64 years old population. METHODS A cross-sectional study of a representative sample of the population aged 15-64 years (n = 2965) was conducted in 2014-2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Data from a survey conducted in 2005 using the same methodological approach was used to assess trends in the age group of 25-64 years. RESULTS The prevalence of hypertension increased significantly, from 33.1 to 38.9% (P = 0.048), whereas awareness (2005 vs. 2014-2015: 14.8 vs. 14.5%, P = 0.914) and treatment among the aware (2005 vs. 2014-2015: 51.9 vs. 50.1%, P = 0.770) remained similar. Control among the treated increased (from 39.9 to 44.5%, P = 0.587), although not significantly. Mean blood pressure values increased (SBP: from 132.1 to 134.6 mmHg, P = 0.089; DBP: from 78.2 to 82.5 mmHg, P < 0.001). Among participants aged 15-24 years, in 2014-2015 the prevalence of hypertension was 13.1% (95% confidence interval: 9.8-16.4). CONCLUSION Our findings show that the prevalence of hypertension in Mozambique is among the highest in developing countries, both in adults and adolescents, portraying an ample margin for reduction of the morbidity and mortality burden because of high blood pressure.
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Nyame S, Iwelunmor J, Ogedegbe G, Adjei KGA, Adjei K, Apusiga K, Gyamfi J, Asante KP, Plange-Rhule J. Capacity and Readiness for Implementing Evidence-Based Task-Strengthening
Strategies for Hypertension Control in Ghana: A Cross-Sectional
Study. Glob Heart 2019; 14:129-134. [DOI: 10.1016/j.gheart.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 11/24/2022] Open
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Myburgh C, Huisman HW, Mels CMC. Cardiovascular reactivity and oxidative stress in young and older adults: the African-PREDICT and SABPA studies. Blood Press 2019; 28:229-238. [PMID: 31030564 DOI: 10.1080/08037051.2019.1609348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Oxidative stress and increased cardiovascular reactivity are associated with endothelial dysfunction and cardiovascular disease development. These factors along with early vascular compromise are more pronounced in black populations. We aimed to compare cardiovascular reactivity and investigate associations thereof with oxidative stress in two bi-ethnic cohorts (younger: 25.0 ± 3.19yrs; older: 44.7 ± 9.61yrs). Methods: Cardiovascular reactivity using the color-word conflict test was measured with the Finometer device. Oxidative stress markers included superoxide dismutase (SOD), γ-glutamyl transferase (γ-GT) and reactive oxygen species (ROS). Results: Black groups displayed greater cardiovascular responses to stress than white groups. In younger white participants, diastolic blood pressure (DBP) (β = 0.31; p = 0.001) and mean arterial blood pressure (MAP) (β = 0.28; p = 0.002) associated with ROS. In older black participants, DBP (β = 0.23; p = 0.009), MAP (β = 0.18; p = 0.033), stroke volume (β = -0.20; p = 0.023) and arterial compliance (β = -0.25; p = 0.005) associated with γ-GT. In older white participants, systolic blood pressure (β = -0.20; p = 0.006) and MAP (β = -0.19; p = 0.009) associated with SOD. Conclusions: In the older black group, cardiovascular reactivity associated with markers of glutathione metabolism, suggesting a possible compensatory up-regulation thereof in order to correct their heightened responses to stress. Independent of age, findings in the white groups support a regulatory role of ROS to maintain vascular tone during stress.
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Affiliation(s)
- Caitlynd Myburgh
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom , South Africa.,b University of South Africa (UNISA) , Roodepoort , South Africa
| | - Hugo W Huisman
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom , South Africa.,c MRC Research Unit for Hypertension and Cardiovascular Disease , North-West University , Potchefstroom , South Africa
| | - Catharina M C Mels
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom , South Africa.,c MRC Research Unit for Hypertension and Cardiovascular Disease , North-West University , Potchefstroom , South Africa
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Blackstone S, Iwelunmor J, Plange-Rhule J, Gyamfi J, Quakyi NK, Ntim M, Addison A, Ogedegbe G. 'I believe high blood pressure can kill me:' using the PEN-3 Cultural Model to understand patients' perceptions of an intervention to control hypertension in Ghana. ETHNICITY & HEALTH 2019; 24:257-270. [PMID: 28675047 DOI: 10.1080/13557858.2017.1346178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients' perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana. DESIGN Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data. RESULTS Emergent themes included patients' perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes. CONCLUSIONS This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management.
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Affiliation(s)
- Sarah Blackstone
- a Department of Kinesiology and Community Health , University of Illinois Urbana-Champaign , Champaign , IL , USA
| | - Juliet Iwelunmor
- a Department of Kinesiology and Community Health , University of Illinois Urbana-Champaign , Champaign , IL , USA
| | - Jacob Plange-Rhule
- b Department of Physiology , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Joyce Gyamfi
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
| | - Nana Kofi Quakyi
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
| | - Micheal Ntim
- b Department of Physiology , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Abigail Addison
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
| | - Gbenga Ogedegbe
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
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Kimani S, Mirie W, Chege M, Okube OT, Muniu S. Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study. BMJ Open 2019; 9:e023995. [PMID: 30782721 PMCID: PMC6340423 DOI: 10.1136/bmjopen-2018-023995] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Association of lifestyle modification and pharmacological adherence among patients with hypertension attending a national referral hospital in Kenya. DESIGN Descriptive, cross-sectional. SETTING Medical wards and outpatient clinic of a national referral hospital. PARTICIPANTS Patients (n=229) diagnosed with primary hypertension for at least 6 months. PRIMARY OUTCOMES Clinical makers, cholesterol levels, anthropometrics, lifestyle/dietary habits adjusted for age, gender and education; antihypertensive adherence; views on prevention of hypertension and adequacy of hypertension information. RESULTS Ageing was associated with elevated diastolic blood pressure (BP) (p<0.05), heart rate (HR) and cholesterol. Females had higher body mass index (BMI). More males reported drinking alcohol and smoking (p<0.001), especially the highly educated. Higher BPs were observed in smokers and drinkers (p<0.05). Daily vegetables and fruits intake were linked to lower BP, HR and BMI (p<0.05). Intake of foods high in saturated fat and cholesterol were associated with raised HR (p<0.05). Respondents on antihypertensive medication, those engaged in healthy lifestyle and took their prescribed medications had lower mean BPs than those on medication only (138/85 vs 140/90). Few respondents (30.8%) considered hypertension as preventable, mainly the single and highly educated (p<0.05). Respondents (53.6%) believed they should stop taking their antihypertensive medication once hypertension is controlled. CONCLUSION Missed targets for BP control and hypertension-related risks are associated with ageing, female gender, fast food and animal fat intake. Alcohol and smoking is common in males associated with poor BP control. Daily vegetables and fruits intake are associated with better BP control and overall hypertension risk reduction. Observed suboptimal BP control despite pharmacological adherence suggests lifestyle modification is needed besides antihypertensive medication. Interventions should address modifiable risk factors aggravated by age and adverse lifestyles through adopting combined lifestyle modification, pharmacological adherence and tailored expert delivered hypertension-related information.
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Affiliation(s)
- Samuel Kimani
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Waithira Mirie
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Margaret Chege
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
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Antihypertensive Activity of Leersia hexandra Sw. (Poaceae) Aqueous Extract on Ethanol-Induced Hypertension in Wistar Rat. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2897867. [PMID: 30723512 PMCID: PMC6339736 DOI: 10.1155/2019/2897867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
Leersia hexandra (L. hexandra) is used in traditional medicine to treat many diseases including hypertension. This study aimed to evaluate the curative effects of the aqueous extract of L. hexandra on hypertension. Hypertension was induced in rats by oral administration of ethanol (5 g/kg/day) for five weeks. The animals were divided into 2 groups: one group of 5 rats receiving distilled water (10 mL/kg) and another group of 20 rats receiving ethanol. At the end of the 5 weeks of administration of ethanol, the animals were divided into 4 groups of 5 rats each: one group of hypertensive rats receiving distilled water (10 mL/kg), another one receiving nifedipine (10 mg/kg), and two groups of hypertensive rats receiving L. hexandra at doses of 100 and 200 mg/kg, respectively. The results showed that ethanol induced a significant increase in the mean arterial pressure (MAP) and heart rate of normotensive rats. The administration of the extract (100 and 200 mg/kg) or nifedipine caused a significant decrease of MAP compared to hypertensive rats. Ethanol induced a significant increase of lipid profile, the atherogenic index, creatinine, and transaminase activities. Ethanol also induced a significant decrease in serum HDL-cholesterol and antioxidant markers evaluated. Treatment of hypertensive rats with L. hexandra or nifedipine significantly improved lipid profile, hepatic and renal functions, and antioxidant status. The curative effect of L. hexandra extract on hypertension is probably related to its antihypertensive, hypolipidemic, and antioxidant activities, which justifies its empirical use in the treatment of hypertension.
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Riding NR, Sharma S, McClean G, Adamuz C, Watt V, Wilson MG. Impact of geographical origin upon the electrical and structural manifestations of the black athlete's heart. Eur Heart J 2019; 40:50-58. [PMID: 30169663 DOI: 10.1093/eurheartj/ehy521] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/08/2018] [Indexed: 07/13/2024] Open
Abstract
Aims Black athletes demonstrate an increased prevalence of repolarization anomalies and left ventricular hypertrophy compared to their white counterparts. Recent international recommendations for electrocardiogram (ECG) interpretation in athletes now account for some of these observations, but little attention is given to whether the heart of the black athlete is universal, or whether substantial differences exist according to geographic origin. Our aim was to examine the impact of geographical origin upon the electrical-and structural manifestations of the black athlete's heart. Methods and results A total of 1698 male competitive athletes participating in mixed sports presented at our organization for 12 lead-ECG led pre-participation screening, with 1222 athletes undergoing systematic echocardiography. Black athletes were categorized against United Nations defined geographical regions (North, East, Middle and West Africa, African American/Caribbean, South American, and West Asia) and compared with a cohort of non-black athletes who shared a close geographical boarder with Africa (South European White and Arabic North African). The prevalence of an abnormal ECG suggestive of cardiac pathology significantly varied by geographical origin. Repolarization abnormalities were significantly more common among West (6.4%) and Middle African (8.5%) athletes than East (1.5%) and North Africans (1.2%) (P < 0.05). Left ventricular hypertrophy was significantly more common among African-American/Caribbean (9.5%) and West African (5%) athletes than West Asian (0.8%), East African (0%), and North African (0%) athletes (P < 0.05). This result remained after accounting for body size. Conclusion The collective term 'black' should not imply that the hearts of all black athletes are universally comparable. There is considerable variability in the cardiac electrical and structural remodelling response to exercise that appears to be dependent on geographic origin.
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Affiliation(s)
- Nathan R Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha, Qatar
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Gavin McClean
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Liverpool, UK
| | - Carmen Adamuz
- Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Sports City Street, Doha, Qatar
| | - Victoria Watt
- Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Sports City Street, Doha, Qatar
| | - Mathew G Wilson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Liverpool, UK
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Adisa R, Ilesanmi OA, Fakeye TO. Treatment adherence and blood pressure outcome among hypertensive out-patients in two tertiary hospitals in Sokoto, Northwestern Nigeria. BMC Cardiovasc Disord 2018; 18:194. [PMID: 30340528 PMCID: PMC6194717 DOI: 10.1186/s12872-018-0934-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment adherence play important roles in blood pressure control leading to reduction in morbidity and mortality. This study therefore assessed adherence to pharmacological and non-pharmacological therapies among ambulatory hypertensive patients. Reasons for treatment non-adherence, and association between adherence and blood pressure were also investigated. METHODS Cross-sectional questionnaire-guided interview and retrospective review of medical records of 605-patients from two-tertiary healthcare institutions in Sokoto, Northwestern Nigeria. Nine-item modified Morisky adherence scale was used to assess medication adherence. Overall adherence score to lifestyle modifications was obtained from the total scores from 4-domains of non-pharmacological measures including cigarette smoking and alcohol cessation, salt-restriction and exercise. Patient-specific adherence education was provided at contact to resolve the knowledge gap(s). Clinical-parameters were retrieved at contact and subsequent 2-months appointment. Descriptive statistics, Chi-square and Student's t-test were used for analysis at p < 0.05. RESULTS Fifty-four (8.9%) patients were adherent to medications. Forgetfulness (404; 35.2%) was the most common reason for medication non-adherence. Use of buddy/companion reminder (605, 30.2%) top the list of adherence education. Overall adherence to lifestyle modifications was 36(6.0%). Mean systolic blood pressure (SBP) at contact was 149.6 ± 22.5 versus 134.2 ± 15.8 mmHg at 2-months with a 10% reduction. There were significant associations in baseline SBP for patients with or without adherence to medication, cigarette smoking cessation, and exercise (p < 0.05). CONCLUSIONS Overall adherence to antihypertensive medications and lifestyle modifications is suboptimal, underscoring the need for continuous patient-specific adherence education to ensure better therapeutic outcomes.
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Affiliation(s)
- Rasaq Adisa
- Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Olumide Ayodeji Ilesanmi
- Pharmacy Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto state, Nigeria
| | - Titilayo Oyelola Fakeye
- Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Prynn JE, Banda L, Amberbir A, Price AJ, Kayuni N, Jaffar S, Crampin AC, Smeeth L, Nyirenda M. Dietary sodium intake in urban and rural Malawi, and directions for future interventions. Am J Clin Nutr 2018; 108:587-593. [PMID: 29982267 PMCID: PMC6134286 DOI: 10.1093/ajcn/nqy125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023] Open
Abstract
Background High dietary sodium intake is a major risk factor for hypertension. Data on population sodium intake are scanty in sub-Saharan Africa, despite a high hypertension prevalence in most countries. Objective We aimed to determine daily sodium intake in urban and rural communities in Malawi. Design In an observational cross-sectional survey, data were collected on estimated household-level per capita sodium intake, based on how long participants reported that a defined quantity of plain salt lasts in a household. In a subset of 2078 participants, 24-h urinary sodium was estimated from a morning spot urine sample. Results Of 29,074 participants, 52.8% of rural and 50.1% of urban individuals lived in households with an estimated per capita plain salt consumption >5 g/d. Of participants with urinary sodium data, 90.8% of rural and 95.9% of urban participants had estimated 24-h urinary sodium >2 g/d; there was no correlation between household per capita salt intake and estimated 24-h urinary sodium excretion. Younger adults were more likely to have high urinary sodium and to eat food prepared outside the home than were those over the age of 60 y. Households with a member with previously diagnosed hypertension had reduced odds (OR: 0.59; 95% CI: 0.51, 0.68) of per capita household plain salt intake >5 g/d, compared with those where hypertension was undiagnosed. Conclusions Sodium consumption exceeds the recommended amounts for most of the population in rural and urban Malawi. Population-level interventions for sodium intake reduction with a wide focus are needed, targeting both sources outside the home as well as home cooking. This trial was registered at clinicaltrials.gov as NCT03422185.
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Affiliation(s)
- Josephine E Prynn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi,Address correspondence to JEP (e-mail: )
| | - Louis Banda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Alison J Price
- Departments of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ndoliwe Kayuni
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi,Departments of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- Departments of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Moffat Nyirenda
- Departments of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom,Department of Non-Communicable Disease, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
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Baldo MP, Gonçalves MA, Capingana DP, Magalhães P, da Silva ABT, Mill JG. Prevalence and Clinical Correlates of Left Ventricular Hypertrophy in Black Africans. High Blood Press Cardiovasc Prev 2018; 25:283-289. [PMID: 29956112 DOI: 10.1007/s40292-018-0267-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/23/2018] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION African-Americans present higher prevalence of left ventricular hypertrophy (LVH) when compared with white populations. However, there is a lack of information about the prevalence and determinants of LVH in black individuals living in Africa. METHODS A cross-sectional study was performed with a non-probabilistic sample comprised of 609 University workers from Angola/Africa, describing the prevalence of LVH and the determinants of left ventricular mass. Echocardiographic measurements were performed and left ventricular mass was indexed to body surface area. Systolic and diastolic blood pressures were measured, along with anthropometric and clinical variables. RESULTS Chamber diameter and wall thickness were higher in men compared to women. Additionally, LVM was higher in men (114.2 ± 36 vs 98.4 ± 31.9, P < 0.001), and the overall prevalence of LVH in black Angolans was 41.1%, which tended to be higher in women (44.5 vs 37.4%, P = 0.096). In men, systolic blood pressure and BMI were independently associated with LVM, while age, systolic blood pressure and waist circumference were associated with LVM in women. CONCLUSIONS In summary, blood pressure levels were the main determinants of LVH in black Africans, although different anthropometric variables showed mild influence in LVM. Our data suggests that LVH prevalence and determinants in black Africans are similar to that reported for African-Americans.
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Affiliation(s)
- Marcelo Perim Baldo
- Department of Pathophysiology, Montes Claros State University-UNIMONTES, Av Rui Braga, Vila Mauricéia, 39401-089, Montes Claros, MG, Brazil.
| | - Mauer A Gonçalves
- Department of Physiology, Faculty of Medicine, University Agostinho Neto, Luanda, Angola
| | - Daniel P Capingana
- Department of Physiology, Faculty of Medicine, University Agostinho Neto, Luanda, Angola
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Pedro Magalhães
- Department of Physiology, Faculty of Medicine, University Agostinho Neto, Luanda, Angola
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Amilcar B Tomé da Silva
- Department of Physiology, Faculty of Medicine, University Agostinho Neto, Luanda, Angola
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
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Rush KL, Goma FM, Barker JA, Ollivier RA, Ferrier MS, Singini D. Hypertension prevalence and risk factors in rural and urban Zambian adults in western province: a cross-sectional study. Pan Afr Med J 2018; 30:97. [PMID: 30344881 PMCID: PMC6191248 DOI: 10.11604/pamj.2018.30.97.14717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/25/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Hypertension is a longstanding problem in Zambia, yet little is known about its prevalence and risk factors, particularly in rural and urban settings. Identifying geographical variations in hypertension is important to enhance the health of adult Zambians regardless of where they live. Therefore, the purpose of this study was to compare the prevalence of hypertension and related risk factors between rural (n = 130) and urban (n = 131) communities in Western Province, Zambia. Methods This cross-sectional study included urban and rural adult Zambians attending health checks who completed a modified World Health Organization (WHO) survey, and had blood pressure and anthropometric measurements completed. Descriptive statistics were used to summarize demographic and risk factor variables. Chi-square tests of association were used to analyze relationships between categorical variables, t-tests to analyze relationships between continuous variables and logistic regression to examine associations of hypertension with selected risk factors. Results The prevalence of hypertension in rural Zambians was double (46.9%) that of urban Zambians (22.9%). Increasing age, not engaging in walking/biking, and alcohol intake within the last 30 days were associated with an increased likelihood of hypertension in rural Zambians while eating vegetables more days during the week was associated with a decreased likelihood of hypertension in rural Zambians. Body Mass Index (BMI) was significantly associated with an increased likelihood of hypertension in urban Zambians. Conclusion Modifiable risk factors (such as BMI, dietary intake, and physical activity) are associated with hypertension prevalence in this population, indicating opportunities for screening and other prevention measures.
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Affiliation(s)
- Kathy Lynn Rush
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada
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Dzudie A, Kingue S, Dzudie A, Sliwa K, Mayosi B, Dzudie A, Sliwa K, Rayner B, Ojji D, Schutte AE, Twagirumukiza M, Damasceno A, Ba SA, Kane A, Kramoh E, Kacou JBA, Onwubere B, Cornick R, Anisiuba B, Mocumbi AO, Ogola E, Awad M, Nel G, Otieno H, Toure AI, Kengne AP, Perel P, Adler A, Poulter N. Roadmap to achieve 25% hypertension control in Africa by 2025. Cardiovasc J Afr 2018; 28:262-272. [PMID: 28906541 PMCID: PMC5642030 DOI: 10.5830/cvja-2017-040] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/12/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND AIM The Pan-African Society of Cardiology (PASCAR) has identified hypertension as the highest area of priority for action to reduce heart disease and stroke on the continent. The aim of this PASCAR roadmap on hypertension was to develop practical guidance on how to implement strategies that translate existing knowledge into effective action and improve detection, treatment and control of hypertension and cardiovascular health in sub-Saharan Africa (SSA) by the year 2025. METHODS Development of this roadmap started with the creation of a consortium of experts with leadership skills in hypertension. In 2014, experts in different fields, including physicians and non-physicians, were invited to join. Via faceto-face meetings and teleconferences, the consortium made a situation analysis, set a goal, identified roadblocks and solutions to the management of hypertension and customised the World Heart Federation roadmap to Africa. RESULTS Hypertension is a major crisis on the continent but very few randomised, controlled trials have been conducted on its management. Also, only 25.8% of the countries have developed or adopted guidelines for the management of hypertension. Other major roadblocks are either government and health-system related or healthcare professional or patient related. The PASCAR hypertension task force identified a 10-point action plan to be implemented by African ministries of health to achieve 25% control of hypertension in Africa by 2025. CONCLUSIONS Hypertension affects millions of people in SSA and if left untreated, is a major cause of heart disease and stroke. Very few SSA countries have a clear hypertension policy. This PASCAR roadmap identifies practical and effective solutions that would improve detection, treatment and control of hypertension on the continent and could be implemented as is or adapted to specific national settings.
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Affiliation(s)
- Anastase Dzudie
- Department of Internal Medicine, Yaoundé Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Samuel Kingue
- Department of Internal Medicine, Yaoundé Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Anastase Dzudie
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Bongani Mayosi
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anastase Dzudie
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Brian Rayner
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Dike Ojji
- Department of Medicine, Faculty of Health Sciences, University of Abuja; Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART); MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Marc Twagirumukiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda and African Society of Hypertension (AfSoH) Initiative, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | | | | | - Abdoul Kane
- Service de cardiologie, Hôpital Général de Grand Yolf, Dakar, Senegal
| | - Euloge Kramoh
- Institut cardiologique d’Abidjan, Abidjan, Cote d’Ivoire
| | | | - Basden Onwubere
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Benedict Anisiuba
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Ana Olga Mocumbi
- National Health Institute, Mozambique and University Eduardo Mondlane, Maputo, Mozambique
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya
| | - Mohamed Awad
- Division of Cardiology, University of Khartoum, Khartoum, Sudan
| | - George Nel
- Pan-African Society of Cardiology (PASCAR), Cape Town, South Africa
| | - Harun Otieno
- Section of Cardiology, Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | | | | | - Pablo Perel
- Science Advisory Unit, World Heart Federation, Geneva, Switzerland and London School of Hygiene and Tropical Medicine, London, UK
| | - Alm Adler
- Science Advisory Unit, World Heart Federation, Geneva, Switzerland and London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Poulter
- International Centre for Circulatory Health, Imperial College, London, UK
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Gebreyes YF, Goshu DY, Geletew TK, Argefa TG, Zemedu TG, Lemu KA, Waka FC, Mengesha AB, Degefu FS, Deghebo AD, Wubie HT, Negeri MG, Tesema TT, Tessema YG, Regassa MG, Eba GG, Beyene MG, Yesu KM, Zeleke GT, Mengistu YT, Belayneh AB. Prevalence of high bloodpressure, hyperglycemia, dyslipidemia, metabolic syndrome and their determinants in Ethiopia: Evidences from the National NCDs STEPS Survey, 2015. PLoS One 2018; 13:e0194819. [PMID: 29742131 PMCID: PMC5942803 DOI: 10.1371/journal.pone.0194819] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/10/2018] [Indexed: 12/31/2022] Open
Abstract
The prevalence of diabetes, dyslipidemias, and high blood pressure is increasing worldwide especially in low and middle income countries. World Health Organization has emphasized the importance of the assessment of the magnitude of the specific disease in each country. We determined the prevalence and determinant factors of high blood pressure, hyperglycemia, dyslipidemias and metabolic syndrome in Ethiopia. A community based survey was conducted from -April to June 2015 using WHO NCD STEPS instrument version 3.1. 2008. Multistage stratified systemic random sampling was used to select representative samples from 9 regions of the country. A total of 10,260 people aged 15–69 years participated in the study. Blood pressure (BP) was measured for 9788 individuals. A total of 9141 people underwent metabolic screening. The prevalence of raised blood pressure (SBP ≥140 and/or DBP ≥ 90 mmHg) was 15.8% (16.3% in females and 15.5% in males). The prevalence of diabetes mellitus (FBS ≥ 126 mg /dl) including those on medication was 3.2% (3.5% males and 3.0% females). The prevalence of impaired fasting glucose was 9.1% with ADA criteria and 3.8% with WHO criteria. Hypercholesterolemia was found in 5.2%, hypertriglyceridemia in 21.0%, high LDL cholesterol occurred in 14.1% and low HDL cholesterol occurred in 68.7%. The prevalence of metabolic syndrome using IDF definition was 4.8% (8.6% in females and vs. 1.8% in males). Advanced age, urban residence, lack of physical exercise, raised waist circumference, raised waist hip ratio, overweight or obesity, and total blood cholesterol were significantly associated with raised blood pressure (BP) and diabetes mellitus. Increased waist- hip ratio was an independent predictor of raised blood pressure, hyperglycemia and raised total cholesterol. Our study showed significantly high prevalence of raised blood pressure, hyperglycemia and dyslipidemia in Ethiopia. Community based interventions are recommended to control these risk factors.
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Affiliation(s)
- Yeweyenhareg Feleke Gebreyes
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Medical Association, Addis Ababa, Ethiopia
- * E-mail:
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Animut Y, Assefa AT, Lemma DG. Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study. Integr Blood Press Control 2018; 11:37-46. [PMID: 29720880 PMCID: PMC5918628 DOI: 10.2147/ibpc.s150628] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Large segments of the hypertensive population in the world are either untreated or inadequately treated. The incidence of heart failure and mortality from cardiovascular complications of hypertension is high among patients with uncontrolled blood pressure (BP). But BP control status of hypertensive patients has not been investigated in the study area. The study aimed to assess BP control status and determinant factors among adult hypertensive patients on antihypertensive medication attending outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia. Methods An institution-based retrospective follow-up study was conducted from September 2015 to April 2016. Data were collected using a structured and pretested questionnaire adopted from the World Health Organization STEPwise approach. BP records of 6 months were used, and patients were classified as having controlled BP if their BP readings were <140/90 mmHg for all adults ≥18 years of age and <150/90 mmHg for adults aged ≥60 years. A generalized estimating equation was fitted, and the odds ratio with a 95% confidence level was used to determine the effect of covariates on BP control status. Results Among 395 participants, 50.4% (95% CI: 45–55) of them controlled their BP in the last 6 months of the survey. Physical activity (adjusted odds ratio [AOR]=1.95, 95% CI: 1.41–2.68), duration on antihypertensive drugs of 2–4 years (AOR=1.70, 95% CI: 1.13–2.56) and 5 years or more (AOR=1.96, 95% CI: 1.32–2.92), and high adherence (AOR=2.18, 95% CI: 1.14–4.15) to antihypertensive drugs were positively associated with BP control, while salt intake (AOR=0.67, 95% CI: 0.49–0.93), overweight (AOR=0.50, 95% CI: 0.36–0.68), and obesity (AOR=0.56, 95% CI: 0.36–0.87) were inversely associated with BP control. Conclusion In this study, only half of the hypertensive patients controlled their BP. Thus, health care providers need to be made aware about the importance of counseling hypertensive patients on drug adherence, moderate physical activity, and salt restriction to improve BP control.
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Affiliation(s)
- Yaregal Animut
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemu Takele Assefa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereseh Gezie Lemma
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Myburgh C, Huisman HW, Mels CMC. The relation of blood pressure and carotid intima-media thickness with the glutathione cycle in a young bi-ethnic population: the African-PREDICT study. J Hum Hypertens 2018. [PMID: 29531271 DOI: 10.1038/s41371-018-0044-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Oxidative stress has been implicated in the development of hypertension, arterial stiffness and atherosclerosis. Optimal functioning of the enzymatic antioxidant system is central to prevent increased oxidative stress and its consequences. We aimed to investigate the relationships of ambulatory blood pressure and carotid intima-media thickness with enzyme activities of the glutathione cycle in 396 young, black and white South Africans of the African-PREDICT study. Ambulatory blood pressure and carotid intima-media thickness were measured and glutathione peroxidase and glutathione reductase activities were analyzed. Black participants had higher reactive oxygen species (men: p = 0.019; women: borderline p = 0.064) and total glutathione (both p < 0.001), but lower glutathione peroxidase activity and total antioxidant status (all p < 0.001). In black men, ambulatory pulse pressure was negatively associated with glutathione peroxidase activity (R2 = 0.19; β = -0.25; p = 0.06). Black and white women displayed positive associations of ambulatory systolic blood pressure (black: R2 = 0.25; β = 0.21; p = 0.048; white: R2 = 0.44; β = 0.18; p = 0.016) with glutathione reductase activity, whereas white men displayed a positive association of ambulatory pulse pressure with glutathione reductase activity (R2 = 0.25; β = 0.29; p = 0.01). The lower glutathione peroxidase activity and total antioxidant status, the higher reactive oxygen species, as well as the negative association between ambulatory pulse pressure and glutathione peroxidase activity in the black men suggest that oxidative stress may be associated with early vascular changes in this group. In the other three groups, the positive associations of blood pressure with glutathione reductase activity suggest a possible role for adequate glutathione reductase activity in preventing or delaying the development of hypertension.
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Affiliation(s)
- Caitlynd Myburgh
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.,University of South Africa (UNISA), Science Campus, Private Bag X6, Florida, Roodepoort, 1710, South Africa
| | - Hugo W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Catharina M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa. .,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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