Determinants of Mean Blood Pressure and Hypertension among Workers in West Africa

Prevalence, risks factors, and control of hypertension in Guinean older adults in 2021: a cross-sectional survey

BACKGROUND

The incidence of arterial hypertension increases with the aging of the population, but its magnitude remains insufficiently assessed. The aim of this study was to investigate the prevalence of hypertension and associated factors in elderly people in Guinea.

METHODS

Data were obtained from a cross-sectional general population survey, conducted among people aged ≥ 60 years. A stratified enumeration area random sample survey was conducted in the four natural regions of Guinea from February to April 2021. This study included an interview on sociodemographic data, and a clinical examination. Hypertension was defined as systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥ 90mmHg or previous diagnosis of hypertension (with or without antihypertensive medication). Hypertension control was defined as blood pressure below 140/90 mmHg during treatment. Age-standardized prevalence was calculated, and logistic regression was used to examine factors associated with hypertension.

RESULTS

A total of 1698 adults (1079 men, mean age: 71.6 ± 9.4 years) had at least two blood pressure measurements. The standardized prevalence of hypertension was 61.4% [95% CI: 61.3-61.6], ranging from 52% in Middle Guinea to 67% in Upper Guinea, and was higher in women (65.2%: 65.0-65.4) than in men (59.1%:58.9-59.3). Among those with hypertension, 46.7% were unaware of their condition before the survey and 49.6% were on treatment and only 18.5% had controlled hypertension. Whatever the residence (rural or urban), increasing age, being unmarried, working as a trader or functionary, jobless, living in upper Guinea, low monthly income, intake of extra salt, known diabetic, overweight, and obesity increased the risk of hypertension. In urban area, female sex (AOR: 1.14: 1.12-1.17), living in lower Guinea (AOR: 3.08: 2.97-3.20), being Maninka (AOR: 1.26: 1.21-1.31), being Nguerze (AOR: 1.71: 1.63-1.81) increased the risk of hypertension, but living in forest Guinea (AOR: 0.88: 0.83-0.93), being Soussou (AOR: 0.88: 0.85-0.92) decreased the risk. In rural area, living in forest Guinea (AOR: 2.14: 2.03-2.26), being Soussou (AOR: 1.14: 1.12-1.17) increased the risk of hypertension, but female sex (AOR: 0.96: 0.94-0.98), living in lower Guinea (AOR: 0.87: 0.85-0.89), being Maninka (AOR: 0.94: 0.92-0.97), being Nguerze (AOR: 0.50: 0.47-0.52) decreased the risk.

CONCLUSION

Hypertension is a major problem in the elderly population in Guinea, and the level of treatment and control in elderly with known hypertension is inadequate. The place of hypertension among cardiovascular diseases and the identification of associated factors underlines the need to develop innovative approaches to control this major risk factor.

The burden and treatment of non-communicable diseases among healthcare workers in sub-Saharan Africa: a multi-country cross-sectional study

Introduction

Non-communicable diseases (NCDs), the leading cause of death globally, are estimated to overtake communicable diseases in sub-Sahara Africa, where healthcare workers (HCWs) play a crucial role in prevention and treatment, but are in extreme shortage, thereby increasing the burden of NCDs among this specific population. To provide evidence for policy-making, we assessed the NCD burden, associated factors and treatment among HCWs in four sub-Saharan African countries.

Materials and methods

We conducted a cross-sectional study across four sub-Saharan African countries [Côte d'Ivoire (CIV), Democratic Republic of the Congo (DRC), Madagascar (MDG), and Nigeria (NIG)] between February and December 2022. In a standardized questionnaire, sociodemographic, chronic disease and treatment data were self-reported. We estimated the prevalence of (1) at least one chronic disease, (2) hypertension, and used backward elimination logistic regression model to identify risk factors.

Results

We recruited a total of 6,848 HCWs. The prevalence of at least one chronic disease ranged between 9.7% in NIG and 20.6% in MDG, the prevalence of hypertension between 5.4% in CIV and 11.3% in MDG. At most, reported treatment rates reached 36.5%. The odds of each of both outcomes increased with age (at least one chronic disease adjusted odds ratio: CIV: 1.04; DRC: 1.09; MDG: 1.06; NIG: 1.10; hypertension: CIV: 1.10; DRC: 1.31; MDG: 1.11; NIG: 1.11) and with BMI (at least one chronic disease: CIV: 1.10; DRC: 1.07; MDG: 1.06; NIG: 1.08; hypertension: CIV: 1.10; DRC: 1.66; MDG: 1.13; NIG: 1.07). Odds of both outcomes were lower among males, except in CIV. In NIG, the odds of both outcomes were higher among medical doctors and odds of hypertension were higher among those working in secondary care. In MDG, working in secondary care increased and working as auxiliary staff decreased the odds of at least one chronic disease.

Conclusion

The prevalence of self-reported chronic disease varied across the four sub-Saharan countries with potentially very low treatment rates. We identified several individual (age, sex, and BMI) and occupational (profession, level of healthcare) factors that influence the odds of NCDs. These factors should be taken into account when developing interventions addressing the burden and management of NCDs among HCWs.

Work environment and hypertension in industrial settings in Benin in 2019: a cross-sectional study

OBJECTIVE

To determine the association between occupational factors, particularly psychosocial factors, and hypertension.

DESIGN

Descriptive and analytical cross-sectional study using logistic multivariate regression.

SETTING

Fifteen cotton ginning plants in Benin.

PARTICIPANTS

Permanent and occasional workers in the cotton ginning industry.

DATA COLLECTION

Data on sociodemographic, occupational, behavioural and clinical history characteristics were collected using a number of standardised, interviewer-administered questionnaires. These questionnaires were based on the WHO's non-communicable disease questionnaire, Karasek questionnaire and Siegrist questionnaire. Weight, height and blood pressure were measured. Any worker with systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg according to the WHO criteria was considered hypertensive, as was any subject on antihypertensive treatment even if blood pressure was normal.

RESULTS

A total of 1883 workers were included, with a male to female ratio of 9.08. Of these, 510 suffered from hypertension (27.1%, 95% CI 25.1 to 29.2). In the multivariate analysis, the risk factors identified were occupational stress (adjusted OR (aOR)=3.96, 95% CI 1.28 to 12.2), age ≥25 years (aOR=2.77, 95% CI 1.55 to 4.96), body mass index of 25-30 kg/m2 (aOR=1.71, 95% CI 1.32 to 2.2), body mass index >30 kg/m2 (aOR=2.74, 95% CI 1.84 to 4.09), permanent worker status (aOR=1.66, 95% CI 1.44 to 2.41) and seniority in the textile sector >5 years (aOR=2.18, 95% CI 1.7 to 2.8). Recognition at work emerged as an effect-modifying factor subject to stratification.

CONCLUSIONS

Occupational factors, particularly job strain and recognition at work, are modifiable factors associated with hypertension in the ginning plants sector and deserve to be corrected through occupational health promotion and prevention.

Occupational risk factors for hypertension

The identification and characterization of the modifiable risk factors of hypertension is of great value for public health and clinical medicine to achieve primary prevention. A large amount of literature on the effects of occupational factors on blood pressure and hypertension has been published. In this review, I summarize current evidence regarding the role of occupational factors in hypertension. The results of this review suggest that there is sufficient evidence to support the association between increased risk of hypertension and job stress, shift work, occupational lead exposure, and noise exposure. The association of hypertension with physical inactivity, sedentary behavior, and occupational exposure to mercury, arsenic, cadmium, or carbon disulfide remains inconclusive, although several studies have reported this finding. This review will serve as a step toward future research and provide baseline information for developing strategic interventions to prevent hypertension in the working population.

Prevalence of hypertension and its risk factors among cotton textile workers in low- and middle-income countries: a systematic review

OBJECTIVE

The objective of this study was to evaluate the prevalence of hypertension and its risk factors among adult cotton textile workers in low- and middle-income countries (LMICs).

STUDY DESIGN

Systematic review.

METHODS

A review of English articles was performed between January 1, 2000, and December 31, 2021, using the following databases: PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library. Studies that measure the prevalence and risk factors of hypertension among adult cotton textile workers in LMICs were included. Extraction of articles and quality assessment of included studies were performed independently by two authors using the Mixed Methods Appraisal Tool checklist.

RESULTS

Of 2476 titles screened after duplication, 50 studies were shortlisted for full-text review, and a total of 10 studies were included. Of those 10 studies, seven were carried out in India, one in Indonesia, Iraq, and Iran. Using Stata version 6, the pooled prevalence of hypertension among the cotton textile workers was 18.0% (95% confidence interval: 11.0-25.0, random effect model: I² = 97.12%). Classic risk factors, including age, family history of hypertension, alcohol consumption, body mass index, and high waist-to-hip ratio, were recounted, whereas peculiar to the settings, noise level, improper use of earplugs, duration of noise exposure, working duration, and working in weaving section were reported.

CONCLUSION

The limited available evidence indicates a significant prevalence of hypertension among cotton workers in LMICs. In the wave of double burden of non-communicable diseases in developing countries, considering context-specific risk factors is critical in controlling hypertension by prioritizing organizational plans and policies to optimize workers' health.

PROSPERO REGISTRATION NUMBER

CRD42020167175.

Examining the effects of individual and neighbourhood socioeconomic status/wealth on hypertension among women in the Greater Accra Region of Ghana

Hypertension is one of the leading causes of morbidity and mortality among women in sub-Saharan Africa. Although research on the relationship between individual-level socioeconomic status (SES) and hypertension exists, to the best of our knowledge, limited empirical studies examined the effects of neighbourhood-level SES/wealth on the risks of living with hypertension in Ghana. Using data from the 2009 Women's Health Study of Accra (WHSA-II), and applying multilevel logistic regression, this study investigates the effects of both individual and neighbourhood wealth status on hypertension among women in the Greater Accra Region of Ghana. The results show that individual-level SES/wealth is a significant determinant of hypertension among Ghanaian women in Accra. Specifically, wealthy women are more likely to be hypertensive compared to poorer women. However, the effect of neighbourhood SES/wealth was attenuated after adjusting for individual-level SES/wealth. These findings suggest that it is important to develop health promotion programs targeted at a segment of SES group in the prevention, control and management of hypertension among women in the Greater Accra Region of Ghana.

Multilevel modeling, prevalence, and predictors of hypertension in Ghana: Evidence from Wave 2 of the World Health Organization's Study on global AGEing and adult health

BACKGROUND AND AIMS

Hypertension is a major public health issue, an important risk factor for cardiovascular diseases and stroke, especially in developing countries where the rates remain unacceptably high. In Africa, hypertension is the leading driver of cardiovascular disease and stroke deaths. Identification of critical risk factors of hypertension can help formulate targeted public health programs and policies aimed at reducing the prevalence and its associated morbidity, disability, and mortality. This study attempts to develop multilevel regression, an in-depth statistical model to identify critical risk factors of hypertension.

METHODS

This study used data on 4667 individuals aged ≥18 years from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2 conducted in 2014/2015. Multilevel regression modeling was employed to identify critical risk factors for hypertension based on systolic blood pressure (SBP) (ie, SBP > 140 mmHg). Of the 4667, 27.3% were hypertensive. Final data on 4381 individuals residing in 3790 households were analyzed using multilevel models, and results were presented as adjusted odds ratios (aOR) and their associated 95% confidence intervals (CI).

RESULTS

Risk factors for hypertension identified were age (aOR) = 5.4, 95% CI: 4.11-7.09), obesity (aOR = 1.51, 95% CI: 1.19-1.91), marital status (aOR = 0.75, 95% CI: 0.64-0.89), perceived health state (moderate; aOR = 1.38, 95% CI: 1.15-1.65 and bad/very bad; aOR = 1.35, 95% CI: 1.0-1.83), and difficulty with self-care (aOR = 1.64, 95% CI: 1.1-2.44). We found unobserved significant differences in the likelihood of hypertension prevalence between different households.

CONCLUSION

Addressing the problem of obesity, targeting specific interventions to those aged over 50 years, and improvement in the general health of Ghanaians are paramount to reducing the prevalence and its associated morbidity, disability, and mortality. Lifestyle modification in the form of dietary intake, knowledge provision supported with strong public health message, and political will could be beneficial to the management and prevention of hypertension.

Prevalence of Chronic Kidney Disease as a Marker of Hypertension Target Organ Damage in Africa: A Systematic Review and Meta-Analysis

Introduction

Hypertension is a major global cause of cardiovascular disease and death with rising worldwide prevalence, particularly in low-income countries. With low awareness, poor treatment, and low control of hypertension in Africans, there is an increased number of patients with target organ damage (TOD), especially chronic kidney disease (CKD), as a consequence of hypertension. The aim of our study is to assess the prevalence of CKD from studies in Africa reporting TOD related to hypertension.

Methods

We performed a search of PubMed/MEDLINE, Web of Science, EBSCOhost, and African Journals Online (AJOL) for studies reporting on CKD as TOD in patients with hypertension. The pooled estimate of CKD was then presented by subregions, age group, eGFR equations, and urban or rural location.

Results

We identified 1,334 articles from which 12 studies were included for quantitative analysis. The studies included 5297 participants from 6 countries (Ghana, Nigeria, Uganda, Tanzania, Democratic Republic of Congo, and South Africa). The pooled prevalence of CKD was 17.8% (95% CI 13.0-23.3%), and CKD was significantly more prevalent in West Africa (21.3% (95% CI: 16.1-27.0); p < 0.0001) and in studies conducted in urban settings (p < 0.001). CKD prevalence was not significantly different by type of GFR equation or age.

Conclusion

This study reports a high prevalence of CKD related to hypertension with a higher prevalence in urban than rural areas. This emphasizes the role of hypertension in causing kidney damage, and the need for strategies to improve awareness, treatment, and control of hypertension in Africans. This study is registered with PROSPERO registration number CRD42018089263.

Prevalence and biosocial determinants of hypertension in a rural population in Edo State, Southern Nigeria

Background

Hypertension is a public health threat of global concern with increasing prevalence in many countries, including Nigeria.

Aim

The aim of the study was to determine the prevalence and determinants of hypertension in a rural agrarian community in Edo North, Nigeria.

Setting

The study was carried out in Ayua, a community in Edo North, southern Nigeria.

Methods

This cross-sectional descriptive study involved the use of a structured interviewer-administered questionnaire to obtain relevant data. Body mass index (BMI), blood pressure and glucose were recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0.

Results

Two hundred and nineteen participants aged > 15 years completed the study with a mean age of 54.03 ± 16.61 years and females comprising 159 (72.6%) of the total. The prevalence of hypertension was 27.9% (in 61 participants). Twenty-one (9.8%) respondents gave a family history of hypertension. The mean BMI amongst respondents was 27.10 ± 6.61 kg/m². Obesity and pre-obesity were found in 58 (26.5%) and 71(32.4%) respondents, respectively. The determinants of hypertension were age and BMI. Compared with those who were less than 40 years old, those aged 40–65 years and > 65 years had 1.9 and 4.2 times increased odds of developing hypertension, respectively. Similarly, compared with the non-obese, obese participants had 2.3 times increased odd of having hypertension.

Conclusion

Hypertension was highly prevalent in this rural community. Health sensitisation and intervention programmes are recommended in rural communities for early detection and management of hypertension, especially amongst older and obese adults.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

CONCLUSION

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

Gender differences in quality of life, physical activity, and risk of hypertension among sedentary occupation workers

PURPOSE

This study aimed to explore gender differences among sedentary occupation workers with regard to their quality of life (QoL), physical activity, and risk for high blood pressure, and to identify factors associated with QoL.

METHODS

A convenience sample of 2562 employees from randomly selected ten ministries in Kuwait completed self-administered questionnaires. Collected data included employees' socio-demographic characteristics, levels of QoL (using World Health Organization QoL-Brief tool), and physical activity (using the New Zealand Physical Activity Questionnaire Short Form), and anthropometric measures of weight, height, and blood pressure. Multinomial regression analysis, Chi-square, ANOVA, and student's t tests were implemented. A p value of 0.05 was considered significant.

RESULTS

Participants' mean age was 35.3 years. QoL mean scores were total QoL (74.7), physical health (81.1), psychological health (75.4), social relationship (71.1), and environment (70.8). Females showed worse level of QoL, better physical activity, and higher prevalence of hypertension relative to males. Multinomial regression analysis revealed that female gender, low educational attainability, poor income, high job ranks, shorter working years, obesity, physical inactivity, hypertension, or having at least one chronic illness significantly correlated to fair and poor QoL.

CONCLUSION

Sedentary occupation workers reported modest level of QoL and were at high risk of hypertension. Socio-demographic factors, physical activity, and health status were correlated to QoL. Gender differences existed in QoL, physical activity, and risk of hypertension. Improving employees' QoL through adopting strategies to promote healthy lifestyle in work settings should be activated. Further studies are recommended to explore cultural factors that drive gender differences in QoL.

Prevalence of Overweight and Obesity, and Its Associated Factors Among Health-care Workers, Teachers, and Bankers in Arusha City, Tanzania

BACKGROUND

Tanzania is one of the developing countries experiencing an increasing trend of overweight and obesity among adults. Working adults have been identified as a high-risk group more exposed to the predictors of overweight and obesity than the general population. However, limited studies have been done in this group. This study aimed to identify the prevalence of overweight and obesity and its associated risk factors among health-care workers, teachers, and bankers in Arusha city council.

SUBJECTS AND METHODS

A descriptive cross-sectional study was conducted among health-care workers, teachers, and bankers. A total of 305 working adults aged 18-60 years participated in the study. A modified World Health Organization (WHO) STEPwise approach for chronic disease risk factor surveillance was used to collect data about socio-demographic characteristics, lifestyle behaviors, dietary practices and anthropometric measurement. The Global Physical Activity Questionnaire (GPAQ) was used to collect information about level of physical activities. The anthropometric measurement and level of physical activities were calculated and ranked according to WHO guidelines.

RESULTS

Overall, 68.9% (31.1% overweight and 37.8% obese) of working adults were overweight or obese. Age (adjusted odds ratio [AOR=7.73; 95% CI: 1.93-30.87]), gender (AOR=2.60; 95% CI: 1.30-5.21), marital status (AOR=2.47; 95% CI: 1.11-5.50), years spent with the current institution (AOR=4.59; 95% CI: 1.38-17.80), using private car or public transport to and from work (AOR=2.43; 95% CI: 1.10-5.39) and sedentary work (AOR=2.43; 95% CI: 1.04-5.71), were significant factors associated with overweight or obesity.

CONCLUSION

The study identified a higher prevalence of overweight and obesity in Tanzania compared with previous studies. The results from this study are useful for the education sector, financial institutions and health sector on designing workplace wellness programs to reduce the burden of overweight and obesity among this working category.

Prevalence, Awareness and Control of Hypertension among Sanitary Workers Employed in a Tertiary Care Centre in Puducherry, South India

Background and Aims:

Sanitary workers have higher tendency to develop hypertension as they spend most of their time in polluted or stressful environments. Hence, the current study was done to determine the prevalence, awareness and control of hypertension among sanitary workers in tertiary care centre in Puducherry.

Methods:

A cross sectional study was conducted among the sanitary workers in tertiary care centre from May to December 2019. Socio-demographic, work related and behavioural characteristics was obtained using a pretested semi-structured questionnaire. Individuals was diagnosed as hypertensive if systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg.

Results:

Prevalence of hypertension among the sanitary workers was 36.6% (95% CI: 31.3-41.3%). Amongst them, only 34 (29.8%) participants were aware of their hypertension status. Prehypertension was present in 114 out of 277 participants (41.1%; 95% CI: 35.3-47.2%) without any history of hypertension. Among the 34 patients with known hypertension, only 12 (35.3%) had controlled BP. Workers in age group of 40 years (aPR = 1.22), unmarried workers (aPR-1.65), obese workers (aPR-1.25), current tobacco users (aPR-1.61) and alcohol users (aPR-1.25) had significantly higher association with hypertension.

Conclusion:

Current study found that more than one-third of the sanitary workers had hypertension. However, almost three fourth of the hypertensives were not aware about their status and only one-third of the known hypertension cases had controlled BP. Hence, it is important to conduct periodic screening and awareness sessions about the possible risk factors for better prevention and control of hypertension.

Blood Pressure Indices and Associated Risk Factors in a Rural West African Adult Population: Insights from an AWI-Gen Substudy in Ghana

Systolic (SBP) and diastolic blood pressure (DBP) are commonly used for cardiovascular disease (CVD) risk prediction, and pulse pressure (PP) and mean arterial blood pressure (MAP) can provide additional information. It is therefore important to understand the factors associated with these cardiovascular risk markers. This cross-sectional study involved 1839 men and women aged 40-60 years. Data on SBP, DBP, MAP, PP, sociodemography, lifestyle, anthropometry, and lipids were collected. Gender-stratified linear regression analyses were performed to determine the association between log-transformed blood pressure indices and the study variables. Age was associated with all measured blood pressure indices (p < 0.001) among men and women. Men had higher SBP (p=0.007) and PP (p < 0.001) than women. Nankana ethnicity was associated with higher PP levels (p < 0.005) in the total population. Vendor meal consumption among women was associated with higher PP levels (p < 0.05). Fruit intake among men was associated with lower PP levels (p < 0.05). Currently unmarried women had higher SBP (p < 0.005), DBP (p < 0.05), MAP (p < 0.005), and PP (p < 0.005) than currently married women. Pesticide exposure was negatively associated with SBP (p < 0.005), DBP (p < 0.005), MAP (p < 0.005), and PP (p < 0.05) among women. Increased subcutaneous fat was associated with DBP (p < 0.005) and MAP (p < 0.05) among women. Among men, hip circumference was associated with higher DBP and MAP (p < 0.05 for both associations), subcutaneous fat associated with higher SBP (p < 0.005), DBP (p < 0.001), and MAP (p < 0.001) and visceral fat was associated with higher PP (p < 0.05). In the total population, visceral fat was associated with higher DBP (p < 0.05) and MAP (p < 0.001). High-density lipoprotein cholesterol was positively associated with SBP (p < 0.005), DBP (p < 0.005), and MAP (p < 0.001) for women and positively associated with SBP, DBP, and MAP (p < 0.001 for all three) and PP (p < 0.05) for men. The association of blood pressure indices with modifiable risk factors suggests that targeted health interventions may reduce CVD risk in this population.

Relationship between obesity and blood pressure among employees in the Vhembe district municipality of Limpopo Province, South Africa

OBJECTIVE

The aim of this study was to investigate the relationship between obesity and blood pressure among employees of the Vhembe district municipality of Limpopo province.

METHODS

A cross-sectional study was conducted among 452 local government employees (207 males, 245 females) aged 24-65 years. Body mass index (BMI), blood pressure (BP) and waist circumference (WC) measurements, and waist-to-height ratio (WHtR) were assessed. Data were analysed using Statistical Package for Social Sciences (SPSS) statistics, version 21.

RESULTS

The results showed that 27% of the participants were classified as overweight and 34% as obese, with females being more overweight and obese (29 and 48%, respectively) compared to males (24 and 17%, respectively). Twenty-five per cent of the participants were hypertensive, with females (27%) showing a higher prevalence compared to males (22%). Based on BMI categories, the obese group (35%) had a higher prevalence of hypertension in contrast to groups that were of normal weight (18%) and overweight (22%). The results also showed that systolic blood pressure (SBP) was positively (p ≤ 0.05) correlated with BMI (r = 0.15), WC (r = 0.26) and WHtR (r = 0.29) in the normal and overweight groups (WC, r = 0.23 and WHtR, r = 0.26), and WHtR correlated with SBP (r = 0.26) and diastolic blood pressure (DBP) (r = 0.19).

CONCLUSIONS

The study showed a high prevalence of overweight, obesity and hypertension, with females more affected than their male counterparts. BMI, WC and WHtR were positively correlated with SBP in the normal and overweight groups, with WHtR positively correlated with both SBP and DBP in the overweight group. Therefore, it is recommended that intervention regimes designed to address obesity and hypertension should consider risk awareness for cardiovascular diseases, impaired quality of life and productivity among local government employees.

Determinants of systemic hypertension in older adults in Africa: a systematic review

BACKGROUND

An estimated 55% of older adults in Africa have systemic hypertension, a major risk factor for stroke, heart failure and dementia in the region. The risk factors associated with hypertension in this population group in Africa have not been systematically evaluated. We, therefore, undertook a systematic review to identify these risk factors.

METHODS

We searched for population-based studies of adults aged ≥50 years living in Africa and reporting an estimate of hypertension and associated risk factors. We included articles published in any language between January 1980 and May 2018 using a comprehensive search strategy. We extracted data including the sample characteristics, prevalence of hypertension and risk factors with their effect sizes.

RESULTS

From an initial 10,719 records, we retained 63 eligible full text articles for review out of which we analyzed 23 studies made up of 19 primary and four multiple publications which had data on risk factors from bivariate or multivariable analysis. The primary studies, published from 2010 to 2018, involved a total of 30,500 participants in 12 different countries with mean ages ranging from 62.7 ± 9 years to 76.9 ± 8.4 years. Through narrative synthesis, we found consistent determinants of hypertension (overweight/obesity and history of stroke), less consistent but frequent determinants (including older age group, female sex and urban residence), inconsistent determinants (including education, wealth index, alcohol intake and physical activity) and nonsignificant covariates (marital status and having health insurance). Overall, the highest adjusted odds ratios were those associated with obesity and history of stroke.

CONCLUSION

The key determinants of systemic hypertension in older adults in Africa are older age group, overweight/obesity, history of stroke and female sex. Health programmes should promote weight reduction throughout the life course, including during the middle and older age of African adults.

Prevalence of hypertension among office workers in a multi-national company in the Niger-Delta with the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines propose a new classification of blood pressure (BP).

The objective was to compare the prevalence of hypertension among staff of a multinational oil/gas company in Niger-Delta, Nigeria using the 2017 ACC/AHA guidelines and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) guidelines.

Cross-sectional analysis of 235 individuals who presented for their annual medical review between March 2017 and February 2018 was done. Demographic, medical and family history data were obtained with a questionnaire. Blood pressure was measured using the recommended procedure. Fasting blood samples were analysed for blood glucose and lipids. Ten-year cardiovascular risk was estimated with the 2008 modified Framingham risk score (FRS).

The prevalence of hypertension using the JNC7 and the 2017 ACC/AHA guidelines was 25.9% and 53.9% respectively. With the former, family history of hypertension and increased BMI were independently significantly associated with hypertension. With the latter, male gender, family history of hypertension, BMI and physical inactivity were significant predictors of hypertension. 184 (78.3%) were categorised as low CVD risk, 38 (16.2%) intermediate risk and 13 (5.5%) high risk for CVD.

The 2017 ACC/AHA guidelines doubled the prevalence of hypertension from 25.9% to 53.9%. Adoption of this guideline will necessitate careful consideration of the consequences of labeling individuals as hypertensive as well as an increment of the health care budget provided by companies for its staff to meet the increased burden of hypertension.

Hypertension in older adults in Africa: A systematic review and meta-analysis

BACKGROUND

Hypertension is the leading driver of cardiovascular disease deaths in Africa. Its prevalence is highest in older populations. Yet, this group has received little attention in many African countries. We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42017056474) to estimate the prevalence of hypertension in older adults living in Africa.

METHODS

We searched grey literature and major electronic databases including PubMed and Embase for population-based studies and published between 1 January 1980 to 28 May 2018 reporting the prevalence of hypertension for adults aged ≥50 years living in Africa. We employed a random effects model to estimate the pooled prevalence across included studies.

FINDINGS

We screened 10,719 articles and retrieved 103 full-text articles to evaluate for inclusion in the review. Thirty-four unique studies providing 37 data points on 43,025 individuals in 15 African countries were analyzed. The prevalence of hypertension ranged from 22.3% to 90.0% from the individual studies while the overall pooled prevalence was 57.0% (95% CI 52%-61%). The prevalence was not statistically significantly different by sex, residence, or African sub-region. In individual studies, older age and overweight/obesity were independently associated with hypertension. Twenty-nine (78%) data points were deemed to be of low- or moderate-risk of bias. Eliminating high-risk bias studies made little difference to the pooled estimate of hypertension. Sensitivity analyses, omitting one study at a time, identified three studies with significant but relatively small impact on the pooled estimate. We observed substantial heterogeneity (I2 = 98.9%) across the studies which was further explored by meta-regression analyses. Overall, the GRADE assessment suggested moderate quality evidence in the results.

CONCLUSION

The persistent high prevalence of hypertension among older adults in Africa, even in rural populations warrants more attention to the cardiovascular health of this group by public health authorities.

Microalbuminuria and Retinopathy among Hypertensive Nondiabetic Patients at a Large Public Outpatient Clinic in Southwestern Uganda

BACKGROUND

Routine testing of microalbuminuria and retinopathy is not done among patients with high blood pressure in resource-limited settings. We determined the prevalence of microalbuminuria and retinopathy and their risk factors among hypertensive patients at a large hospital in western Uganda.

METHODS

We consecutively recruited nondiabetic patients with hypertension at the outpatients' clinic over a period of 3 months. Spot urine samples were tested for urine albumin. Direct fundoscopy was done to assess retinal vasculature and optic disc for signs of hypertensive retinopathy. Logistic regression was done with retinopathy and microalbuminuria as primary outcomes.

RESULTS

We enrolled 334 patients and, of these, 208 (62.3%) were females, with median age of 55 years (range: 25-90). The prevalence of microalbuminuria was 59.3% (95% CI: 50.1-72.2) and that of retinopathy was 66.8% (95% CI: 58.6-76.5). The independent correlates of retinopathy and microalbuminuria were systolic blood pressure (SBP) > 140 mmHg (OR = 2.76, 95% CI: 1.29-5.93) and treatment with beta-blockers (OR = 2.16, 95% CI: 1.05-4.44). Use of ACEIs was unrelated to the study outcomes.

CONCLUSION

The prevalence of retinopathy and microalbuminuria is high. Clinicians should aim for better control of blood pressure and routinely perform fundoscopy and urine albumin, especially for patients with poorly controlled blood pressure.

Sedentary Lifestyle and Hypertension in a Periurban Area of Mbarara, South Western Uganda: A Population Based Cross Sectional Survey

Introduction

Globally, cardiovascular diseases (CVDs) and diabetes constitute over 50% of the noncommunicable disease (NCD) burden and projections indicate Sub-Saharan Africa will experience a larger burden. Urbanization on the continent is contributing to the change in lifestyle such as diet and physical activity, which may increase the risk for CVDs. There is lack of sufficient data from the African continent on hypertension and its association with sedentary lifestyle.

Methods

We conducted a cross sectional study in periurban Uganda among adults aged at least 35 years. We administered questions on diet, physical activity, and smoking. We took anthropometric measurements, blood pressure, and fasting blood glucose. Hypertension was defined as systolic BP > = 140 and/or diastolic BP > = 90 and/or history of hypertension medications. Logistic regression was used to determine the crude and adjusted odds ratios for the factors associated with hypertension.

Results

We enrolled 310 participants and 50% were female. The prevalence of systolic hypertension was 24.5%, diastolic hypertension was 31%, obesity was 46%, and diabetes was 9%. Of those with hypertension (n = 76), 53 participants (69.7%) were not aware they had high BP. Sedentary lifestyle was significantly associated with hypertension even after adjusting for age and obesity.

Conclusion

There is a high prevalence of obesity, hypertension, and diabetes and majority of participants with hypertension are not aware. Participants with a sedentary work style should be targeted for prevention and screening.

Predictors of Hypertension in a Population of Undergraduate Students in Sierra Leone

We report on the first survey of hypertension in undergraduates in Sierra Leone. Levels of hypertension (12%) and obesity (4%) appear low compared to the general population but given the rapid increase of both and the expectation that many graduates will enter the formal employment sector and a sedentary lifestyle, there is still cause for concern. We measured their BMI (body mass index) and used a questionnaire to investigate demographic and lifestyle choices. In agreement with most authorities, we found that BMI and age were statistically significant predictors of systolic and diastolic blood pressure but that the explanatory power was low (r = 0.21 to 0.27). Men may be more sensitive than women to an increase in BMI on blood pressure (p < 0.1). We failed to find statistically significant relationships with ethnicity, religion, stress, course of study, levels of physical activity, diet, smoking, or consumption of caffeine and alcohol. Family history of hypertension, consumption of red palm oil, and self-diagnosed attacks of typhoid fever were close to conventional levels of significance (p < 0.1). We intend to use this as a baseline for longitudinal studies to assess risks and suggest appropriate public health action.