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Peniston S, Sivaramakrishnan D, Holloway A. Undiagnosed and uncontrolled hypertension in rural African adults: a scoping review protocol of primary health care interventions. BMJ Open 2024; 14:e081937. [PMID: 38589263 PMCID: PMC11015176 DOI: 10.1136/bmjopen-2023-081937] [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: 11/09/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Non-communicable diseases cause 74% of global deaths, with cardiovascular diseases as the major contributor. Hypertension, a primary risk factor for cardiovascular disease, is highly prevalent in Africa. Diagnosis, treatment and control rates are notably limited in rural areas. This limitation results in increased risks of premature mortality and complications such as stroke due to socioeconomic, cultural and geographical challenges. Progress in African countries enhancing hypertension services through primary health care interventions exists. However, a comprehensive review of all primary health care interventions addressing undiagnosed and uncontrolled hypertension in rural African settings is lacking. This scoping review aims to categorise primary health care interventions targeting undiagnosed and uncontrolled hypertension in rural African adults. Intervention components will be mapped to the four stages outlined in the hypertension care cascade to develop a pilot intervention logic model for rural African adults with hypertension. METHOD AND ANALYSIS The scoping review protocol will adhere to the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Studies considered for inclusion will include any intervention delivered by any healthcare provider in a rural African primary care setting targeting any stage of hypertension care. Eight databases will be searched without date restrictions, supplemented by grey literature and reference list searches. A two-stage screening process (title/abstract and full text) will determine evidence source eligibility. All eligible sources of evidence will be extracted, charted and evaluated using the Template for Intervention Description and Replication checklist. A pilot logic model categorising and mapping interventions to the four stages of the hypertension care cascade will be visually presented and analysed using narrative synthesis. ETHICS AND DISSEMINATION No primary data will be collected; therefore, ethics approval is not required. Findings will be disseminated to local health authorities in Ghana and other African Regions and through national and international conferences and publications in peer-reviewed journals.
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Affiliation(s)
- Sandra Peniston
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, UK
- School of Nursing, Faculty of Health, York University, Toronto, ON, Canada
| | - Divya Sivaramakrishnan
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, UK
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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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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Olowoyo P, Dzudie A, Okekunle AP, Obiako R, Mocumbi A, Beheiry H, Parati G, Lackland DT, Sarfo FS, Odili A, Adeoye AM, Wahab K, Agyemang C, Campbell N, Kengne AP, Whelton PK, Pellicori P, Ebenezer AA, Adebayo O, Olalusi O, Jegede A, Uvere E, Adebajo O, Awuah B, Moran A, Williams B, Guzik TJ, Kokuro C, Bukachi F, Ogah OS, Delles C, Maffia P, Akinyemi R, Barango P, Ojji D, Owolabi M. ACHIEVE conference proceedings: implementing action plans to reduce and control hypertension burden in Africa. J Hum Hypertens 2024; 38:193-199. [PMID: 38424209 DOI: 10.1038/s41371-024-00903-8] [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: 11/25/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels.
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Affiliation(s)
- Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Anastase Dzudie
- Departments of Internal Medicine and Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Akinkunmi Paul Okekunle
- College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Seoul National University, 08826, Seoul, Republic of Korea
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria
| | - Ana Mocumbi
- Departamento de Medicina, Universidade, Eduardo Mondlane, Maputo, Mozambique
| | - Hind Beheiry
- Physiology Department, Faculty of Medicine, International University of Africa (IUA), Khartoum, Sudan
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, Univeristy of Milano-Bicocca, Milan, Italy
| | - Daniel T Lackland
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustine Odili
- Department of Medicine, University of Abuja, FCT, Abuja, Nigeria
| | | | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Norman Campbell
- Departments of Medicine, Physiology, and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Andre Pascal Kengne
- South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Pierpaolo Pellicori
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Oladimeji Adebayo
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladotun Olalusi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ayodele Jegede
- Department of Sociology, University of Ibadan, Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | - Tomasz J Guzik
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda
- Centre for Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Internal and Agricultural Medicine and Omicron Medical Genomics Laboratory, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Collins Kokuro
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Fred Bukachi
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda
- Department of Medical Physiology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Okechukwu S Ogah
- Cardiology Unit, Department of Medicine, University of Ibadan/ University College Hospital, Ibadan, Nigeria
| | - Christian Delles
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Pasquale Maffia
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda
- Centre for Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
- School of Infection & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Rufus Akinyemi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, Ibadan, Nigeria
| | - Prebo Barango
- WHO African Regional Office, DRC, Brazzaville, Democratic Republic of the Congo
| | - Dike Ojji
- Department of Medicine, University of Abuja, FCT, Abuja, Nigeria
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, University College Hospital, Ibadan, Nigeria.
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda.
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, Ibadan, Nigeria.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
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Hahka TM, Slotkowski RA, Akbar A, VanOrmer MC, Sembajwe LF, Ssekandi AM, Namaganda A, Muwonge H, Kasolo JN, Nakimuli A, Mwesigwa N, Ishimwe JA, Kalyesubula R, Kirabo A, Anderson Berry AL, Patel KP. Hypertension Related Co-Morbidities and Complications in Women of Sub-Saharan Africa: A Brief Review. Circ Res 2024; 134:459-473. [PMID: 38359096 PMCID: PMC10885774 DOI: 10.1161/circresaha.123.324077] [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] [Indexed: 02/17/2024]
Abstract
Hypertension is the leading cause of cardiovascular disease in women, and sub-Saharan African (SSA) countries have some of the highest rates of hypertension in the world. Expanding knowledge of causes, management, and awareness of hypertension and its co-morbidities worldwide is an effective strategy to mitigate its harms, decrease morbidities and mortality, and improve individual quality of life. Hypertensive disorders of pregnancy (HDPs) are a particularly important subset of hypertension, as pregnancy is a major stress test of the cardiovascular system and can be the first instance in which cardiovascular disease is clinically apparent. In SSA, women experience a higher incidence of HDP compared with other African regions. However, the region has yet to adopt treatment and preventative strategies for HDP. This delay stems from insufficient awareness, lack of clinical screening for hypertension, and lack of prevention programs. In this brief literature review, we will address the long-term consequences of hypertension and HDP in women. We evaluate the effects of uncontrolled hypertension in SSA by including research on heart disease, stroke, kidney disease, peripheral arterial disease, and HDP. Limitations exist in the number of studies from SSA; therefore, we will use data from countries across the globe, comparing and contrasting approaches in similar and dissimilar populations. Our review highlights an urgent need to prioritize public health, clinical, and bench research to discover cost-effective preventative and treatment strategies that will improve the lives of women living with hypertension in SSA.
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Affiliation(s)
- Taija M Hahka
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Rebecca A Slotkowski
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Anum Akbar
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Matt C VanOrmer
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Lawrence Fred Sembajwe
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdul M Ssekandi
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Namaganda
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Muwonge
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Josephine N Kasolo
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology (A. Nakimuli), Makerere University College of Health Sciences, Kampala, Uganda
| | - Naome Mwesigwa
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Jeanne A Ishimwe
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Robert Kalyesubula
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annet Kirabo
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Ann L Anderson Berry
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Kaushik P Patel
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
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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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Kengne AP, Brière JB, Zhu L, Li J, Bhatia MK, Atanasov P, Khan ZM. Impact of poor medication adherence on clinical outcomes and health resource utilization in patients with hypertension and/or dyslipidemia: systematic review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:143-154. [PMID: 37862440 DOI: 10.1080/14737167.2023.2266135] [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: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION We aimed to summarize evidence on the effect of poor medication adherence on clinical outcomes and health resource utilization (HRU) among patients with hypertension and/or dyslipidemia. AREAS COVERED A systematic review of studies reporting clinical outcomes and HRU for patients by status of adherence to antihypertensives and/or lipid-lowering medications was searched using Embase, MEDLINE, and MEDLINE In-Process and supplemented by manual searches of conference abstracts. In total, 45 studies were included, with most being retrospective observational studies (n = 36). Patients with poor adherence to antihypertensives and lipid-lowering medications compared with those with good adherence showed less reduction of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-c) after 6-12 months follow-up (∆ systolic BP: 1.2 vs. -4.5 mmHg; ∆LDL-c: -14.0 to -18.9 vs. -34.1 to -42.0 mg/dL). Poor adherence was also significantly associated with a higher risk of cardiovascular events (HR: 1.1-1.9) and mortality (HR: 1.4-1.8) in patients with hypertension and dyslipidemia and increased HRU (i.e. outpatient visits, risk of cardiovascular-related and all-cause hospitalization, annual inpatient days, total health-care costs). EXPERT OPINION Poor adherence is associated with poor clinical outcomes and increased HRU, highlighting the need to enhance medication adherence in patients with hypertension and/or dyslipidemia.
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Affiliation(s)
- André Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Lucía Zhu
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Jingya Li
- Health Economics and Market Access, Amaris Consulting, Shanghai, China
| | | | - Petar Atanasov
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
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Povia JP, Masenga SK, Hamooya BM, Gebremeskel Y. Productivity-adjusted life-years and correlates of uncontrolled hypertension at two health facilities in Zambia. PLoS One 2023; 18:e0295401. [PMID: 38060497 PMCID: PMC10703239 DOI: 10.1371/journal.pone.0295401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Hypertension has in the recent past surfaced as one of the conditions that has a significant impact on workforce productivity in emerging economies. Zambia is no different and has in the recent past recorded increasing cases. Despite the impact of hypertension being of great importance in regards to productivity, we have scarcity of data and studies on hypertension-related Productivity-Adjusted Life-Years (PALYs) in Zambia and Africa at large. This study assessed the impact of hypertension on PALYs lost and socioeconomic factors associated with nonadherence to antihypertensive medication (NATAM). METHODS This was a cross-sectional study of 198 participants from Livingstone University Teaching Hospital and Maramba Clinic situated in Livingstone, Zambia. Structured questionnaires were used to collect data. Productivity index multiplied by years lived was used to calculate PALYs and descriptive statistics were used to summarize sociodemographic, clinical and economic variables. Multivariable logistic regression was used to determine factors associated with NATAM. RESULTS The participants had a median age (interquartile range (IQR)) of 49 years (41, 59) and 60.1% (n = 119) were females while 39.9% (n = 79) were male. Our estimated PALYs lost per person due to hypertension were 0.2 (IQR 0.0, 2.7). Cumulative PALYs value lost due to the burden of hypertension was estimated to be at $871,239.58 in gross domestic product (GDP). The prevalence of NATAM was 48% (n = 95). The factors that were significantly associated with NATAM were age (odds ratio (OR) 0.94; 95% confidence interval (CI) 0.90, 0.98), female sex (OR 2.52; 95%CI 1.18, 5.40), self-employment (OR 2.57; 95%CI 1.02, 6.45) and absenteeism from work (OR 3.60; 95%CI 1.16, 11.22). CONCLUSIONS Findings in our study highlight a high economic loss of PALYs due to hypertension with a potential to impact GDP negatively. We also found that NATAM reduced productivity and income among individuals of working age further impacting PALYs lost due to hypertension. The factors associated with NATAM were age, sex, employment status and absenteeism from work. This study underscores the need for interventions targeting young people, females, self-employed individuals, and absentees at work to improve adherence to antihypertensive drugs in order to reduce PALYs lost due to hypertension.
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Affiliation(s)
- Joreen P. Povia
- Department of Economics, School of Social Sciences, Mulungushi University, Kabwe, Zambia
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Sepiso K. Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Benson M. Hamooya
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Yordanos Gebremeskel
- Department of Economics, School of Social Sciences, Mulungushi University, Kabwe, Zambia
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Jayawardena R, Kodithuwakku W, Sooriyaarachchi P. The impact of the Sri Lankan economic crisis on medication adherence: An online cross-sectional survey. DIALOGUES IN HEALTH 2023; 2:100137. [PMID: 38515479 PMCID: PMC10953977 DOI: 10.1016/j.dialog.2023.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 03/23/2024]
Abstract
Background The economic crisis in Sri Lanka has disarrayed the country's healthcare services, posing a challenge to people with chronic diseases on routine care. This study investigated the changes in medication adherence during the economic crisis. Methods A web-based cross-sectional survey was undertaken in July-August 2022. It assessed socio-demographics, diseases, medication adherence, and reasons for changes in compliance of respondents and their family members during the economic crisis. Descriptive statistics and multivariable logistic regression analysis were used. Findings A total of 1214 respondents, aged ≥18 years were included in the survey. The majority were females (60%). The main finding was that 39%, 41%, and 37% of participants, their family members, or children respectively have changed medication use during the crisis. Among those who changed their medication practices, the most significant change was the change in the brand, reported by 44.7% of the respondents. A similar pattern was observed among other family members, with 61.3% of adults and 53.8% of children switching brands. Respondents who lived outside the Colombo district had a significantly increased risk of changing medication (OR = 1.425, 95% CI = 1.020-1.992, P = 0.038). Respondents with monthly incomes of less than 100,000 LKR had a twofold greater risk of medication nonadherence compared to participants who earned more than 100,000 LKR per month (OR = 2.278, 95% CI = 1.37-3.78, P = 0.001). The most stated reason for changing medication among adults was the high cost of drugs, whereas among, children, the lack of access to drugs in the public or private sector was the leading cause of non-compliance. Interpretation The population's adherence to medication is negatively impacted by the economic crisis in Sri Lanka.
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Affiliation(s)
- Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Sri Lanka
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Wasana Kodithuwakku
- Department of Physiology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Piumika Sooriyaarachchi
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Sri Lanka
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Australia
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Davis K, Moorhouse L, Maswera R, Mandizvidza P, Dadirai T, Museka T, Nyamukapa C, Smit M, Gregson S. Associations between HIV status and self-reported hypertension in a high HIV prevalence sub-Saharan African population: a cross-sectional study. BMJ Open 2023; 13:e067327. [PMID: 36635037 PMCID: PMC9843216 DOI: 10.1136/bmjopen-2022-067327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES This study examined whether HIV status and antiretroviral therapy (ART) exposure were associated with self-reported hypertension in Zimbabwe. DESIGN Study data were taken from a cross-sectional, general population survey, which included HIV testing (July 2018-December 2019). SETTING The data were collected in Manicaland Province, Zimbabwe. PARTICIPANTS 9780 people aged 15 years and above were included. OUTCOME MEASURE Self-reported hypertension was the outcome measure. This was defined as reporting a previous diagnosis of hypertension by a doctor or nurse. After weighting of survey responses by age and sex using household census data, χ2 tests and logistic regression were used to explore whether HIV status and ART exposure were associated with self-reported hypertension. RESULTS The weighted prevalence of self-reported hypertension was 13.6% (95% CI 12.9% to 14.2%) and the weighted prevalence of HIV was 11.1% (10.4% to 11.7%). In univariable analyses, there was no evidence of a difference in the weighted prevalence of self-reported hypertension between people living with HIV (PLHIV) and HIV-negative people (14.1%, 11.9% to 16.3% vs 13.3%, 12.6% to 14.0%; p=0.503) or between ART-exposed and ART-naive PLHIV (14.8%, 12.0% to 17.7% vs 12.8%, 9.1% to 16.4%,p=0.388). Adjusting for socio-demographic variables in logistic regression did not alter this finding (ORs:HIV status:0.88, 0.70 to 1.10, p=0.261; ART exposure:0.83, 0.53 to 1.30, p=0.411). CONCLUSIONS Approximately one in seven PLHIV self-reported having hypertension, highlighting an important burden of disease. However, no associations were found between HIV status or ART exposure and self-reported hypertension, suggesting that it will be valuable to focus on managing other risk factors for hypertension in this population. These findings should be fully accounted for as Zimbabwe reorients its health system towards non-communicable disease control and management.
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Affiliation(s)
- Katherine Davis
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Louisa Moorhouse
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | | | | | - Tawanda Dadirai
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tafadzwa Museka
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Constance Nyamukapa
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mikaela Smit
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Simon Gregson
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Soubra L, Elba G. Pharmacist Role in Hypertension Management in the Community Setting: Questionnaire Development, Validation, and Application. Patient Prefer Adherence 2023; 17:351-367. [PMID: 36789207 PMCID: PMC9922562 DOI: 10.2147/ppa.s394855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Hypertension is a leading cause of mortality and morbidity globally. Pharmacists can play a substantial role in decreasing the burden of the disease. PURPOSE The primary aim of this study was to develop and validate a scale assessing the pharmacist role in hypertension management in the community pharmacy setting. The secondary aims were to assess the services/interventions in hypertension management that were performed in the real-life setting, as well as the patient satisfaction from these services/interventions. METHODS This cross-sectional study was conducted in Egypt. The data were collected using a survey composed of three sections: a general section, the pharmacist role questionnaire section, and the patient satisfaction from the provided interventions/services section. The pharmacist role questionnaire was developed based on the pharmaceutical care practice conceptual model and included 23 questions. The face validity, content validity, reliability testing using Cronbach alpha, and construct validity using exploratory factor analysis were determined. The percentage of the frequency by which each role was reported to be performed was determined. Patient satisfaction from the provided interventions/services was determined by means of an overall rating. The correlation between practiced roles and patient satisfaction with received interventions/services was determined. RESULTS The questionnaire was valid with a 4-factor structure and a Cronbach alpha >0.75, reiterating the main pharmaceutical care practice domains: medication management, disease-state education, disease-state management, and care plan monitoring. Roles falling in the domains of disease state management and disease state education were significantly more practiced than roles falling in the other domains. CONCLUSION Pharmacist practice in hypertension management in the community setting was inclined towards contemporary roles, such as disease state education and management. Patients seem to be satisfied with these roles.
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Affiliation(s)
- Lama Soubra
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
- Correspondence: Lama Soubra, Environmental Sciences Program, College of Arts and Sciences, Qatar University, Doha, Qatar, Email
| | - Ghada Elba
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
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Mistry SK, Hossain MB, Parvez M, Gupta RD, Arora A. Prevalence and determinants of hypertension among urban slum dwellers in Bangladesh. BMC Public Health 2022; 22:2063. [DOI: 10.1186/s12889-022-14456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In low- and middle- income countries such as Bangladesh, urban slum dwellers are particualry vulnerable to hypertension due to inadequate facilities for screening and management, as well as inadequate health literacy among them. However, there is scarcity of evidence on hypertension among the urban slum dwellers in Bangladesh. The present study aimed to determine the prevalence and factors associated with hypertension among urban slum dwellers in Bangladesh.
Methods
Data were collected as part of a large-scale cross-sectional survey conducted by Building Resources Across Communities (BRAC) between October 2015 and January 2016. The present analysis was performed among 1155 urban slum dwellers aged 35 years or above. A structured questionnaire was adminstered to collect data electronically and blood pressure measurements were taken using standardised procedures. Binary logistic regression with generalized estimating equation modelling was performed to estimate the factors associated with hypertension.
Results
The prevalence of hypertension was 28.3% among urban slum dwellers aged 35 years and above. In adjusted analysis, urban slum dwellers aged 45–54 years (AOR: 1.64, 95% CI: 1.17–2.28), 55–64 years (AOR: 2.47, 95% CI: 1.73–3.53) and ≥ 65 years (AOR: 2.34, 95% CI: 1.47–3.72), from wealthier households (AOR: 1.94, 95% CI: 1.18–3.20), sleeping < 7 h per day (AOR: 1.87, 95% CI: 1.39–2.51), who were overweight (AOR: 1.53, 95% CI: 1.09–2.14) or obese (AOR: 2.34, 95% CI: 1.71–3.20), and having self-reported diabetes (AOR: 3.08, 95% CI: 1.88–5.04) had an increased risk of hypertension. Moreover, 51.0% of the participants were taking anti-hypertensive medications and 26.4% of them had their hypertension in control.
Conclusions
The findings highlight a high burden of hypertension and poor management of it among the slum dwellers in Bangladesh requiring a novel approach to improve care. It is integral to effectively implement the available national non-communicable disease (NCD) control guidelines and redesign the current urban primary health care system to have better coordination.
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12
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Son M, Heo YJ, Hyun HJ, Kwak HJ. Effects of Marital Status and Income on Hypertension: The Korean Genome and Epidemiology Study (KoGES). J Prev Med Public Health 2022; 55:506-519. [PMID: 36475316 DOI: 10.3961/jpmph.22.264] [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: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study aimed to analyze the associations of income, marital status, and health behaviors with hypertension in male and female over 40 years of age in the Korea. METHODS The data were derived from the Korean Genome and Epidemiology Study (KoGES; 4851-302) which included 211 576 participants. To analyze the relationships of income, marital status, and health behaviors with hypertension in male and female over 40 years of age, multiple logistic regression was conducted with adjustments for these variables. RESULTS The prevalence of hypertension increased linearly as income decreased. The odds ratio for developing hypertension in people with an income of <0.5 million Korean won (KRW) compared to ≥6.0 million KRW was 1.55 (95% confidence interval [CI], 1.25 to 1.93) in the total population, 1.58 (95% CI, 1.27 to 1.98) in male, and 1.07 (95% CI, 0.35 to 3.28) in female. The combined effect of income level and marital status on hypertension was significant. According to income level and marital status, in male, low income and divorce were most associated with hypertension (1.76 times; 95% CI, 1.01 to 3.08). However, in female, the low-income, married group was most associated with hypertension (1.83 times; 95% CI, 1.71 to 1.97). CONCLUSIONS The results of this study show that it is necessary to approach male and female marital status separately according to income in health policies to address inequalities in the prevalence of hypertension.
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Affiliation(s)
- Mia Son
- Department of Preventive Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yeon Jeong Heo
- Department of Nursing, Kangwon National University, Chuncheon, Korea
| | - Hye-Jin Hyun
- Department of Nursing, Kangwon National University, Chuncheon, Korea
| | - Ho Jong Kwak
- Department of Nursing, Kangwon National University, Chuncheon, Korea
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13
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Pallangyo P, Komba M, Mkojera ZS, Kisenge PR, Bhalia S, Mayala H, Kifai E, Richard MK, Khanbhai K, Wibonela S, Millinga J, Yeyeye R, Njau NF, Odemary TK, Janabi M. Medication Adherence and Blood Pressure Control Among Hypertensive Outpatients Attending a Tertiary Cardiovascular Hospital in Tanzania: A Cross-Sectional Study. Integr Blood Press Control 2022; 15:97-112. [PMID: 35991354 PMCID: PMC9390787 DOI: 10.2147/ibpc.s374674] [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: 05/23/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Notwithstanding the availability of effective treatments, asymptomatic nature and the interminable treatment length, adherence to medication remains a substantial challenge among patients with hypertension. Suboptimal adherence to BP-lowering agents is a growing global concern that is associated with the substantial worsening of disease, increased service utilization and health-care cost escalation. This study aimed to explore medication adherence and its associated factors among hypertension outpatients attending a tertiary-level cardiovascular hospital in Tanzania. Methods The pill count adherence ratio (PCAR) was used to compute adherence rate. In descriptive analyses, adherence was dichotomized and consumption of less than 80% of the prescribed medications was used to denote poor adherence. Logistic regression analyses was used to determine factors associated with adherence. Results A total of 849 outpatients taking antihypertensive drugs for ≥1 month prior to recruitment were randomly enrolled in this study. The mean age was 59.9 years and about two-thirds were females. Overall, a total of 653 (76.9%) participants had good adherence and 367 (43.2%) had their blood pressure controlled. Multivariate logistic regression analysis showed; lack of a health insurance (OR 0.5, 95% CI 0.3–0.7, p<0.01), last BP measurement >1 week (OR 0.6, 95% CI 0.4–0.8, p<0.01), last clinic attendance >1 month (OR 0.4, 95% CI 0.3–0.6, p<0.001), frequent unavailability of drugs (OR 0.6, 95% CI 0.3–0.9, p = 0.03), running out of medication before the next appointment (OR 0.6, 95% CI 0.4–0.9, p = 0.01) and stopping medications when asymptomatic (OR 0.6, 95% CI 0.4–0.8, p<0.001) to be independent associated factors for poor adherence. Conclusion A substantial proportion of hypertensive outpatients in this tertiary-level setting had good medication adherence. Nonetheless, observed suboptimal blood pressure control regardless of a fairly satisfactory adherence rate suggests that lifestyle modification plays a central role in hypertension management.
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Affiliation(s)
- Pedro Pallangyo
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Makrina Komba
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Zabella S Mkojera
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Peter R Kisenge
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Henry Mayala
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Engerasiya Kifai
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mwinyipembe K Richard
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Khuzeima Khanbhai
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Robert Yeyeye
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Nelson F Njau
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Thadei K Odemary
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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Govender N, Khaliq O, Moodley J, Naicker T. Unravelling the Mechanistic Role of ACE2 and TMPRSS2 in Hypertension: A Risk Factor for COVID-19. Curr Hypertens Rev 2022; 18:130-137. [PMID: 36508271 DOI: 10.2174/1573402118666220816090809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND This review explores the mechanistic action of angiotensin-converting enzyme- 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) in the renin-angiotensinaldosterone system (RAAS) that predisposes hypertensive patients to the adverse outcome of severe COVID-19. METHODS AND RESULTS Entry of SARS-CoV-2 into the host cell via ACE2 disrupts the RAAS system, creating an imbalance between ACE and ACE2, with an increased inflammatory response, leading to hypertension (HTN), pulmonary vasoconstriction and acute respiratory distress. SARSCoV- 2 may also predispose infected individuals with existing HTN to a greater risk of severe COVID-19 complications. In the duality of COVID-19 and HTN, the imbalance of ACE and ACE2 results in an elevation of AngII and a decrease in Ang (1-7), a hyperinflammatory response and endothelial dysfunction. Endothelial dysfunction is the main factor predisposing hypertensive patients to severe COVID-19 and vice-versa. CONCLUSION Despite the increase in ACE2 expression in hypertensive SARS-CoV-2 infected patients, ARBs/ACE inhibitors do not influence their severity and clinical outcomes, implicating continued usage. Future large-scale clinical trials are warranted to further elucidate the association between HTN and SARS-CoV-2 infection and the use of ARBs/ACEIs in SARS-CoV-2 hypertensive patients.
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Affiliation(s)
- Nalini Govender
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa
| | - Olive Khaliq
- The Department of Paediatrics and Child Health, Faculty of Health Sciences, The University of the Free State, Bloemfontein 9300, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Thajasvarie Naicker
- Optics & Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
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15
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Ntaganda E, Mugeni R, Harerimana E, Ngoga G, Dusabeyezu S, Uwinkindi F, Utumatwishima JN, Mutimura E, Davila-Roman VG, Schechtman K, Nishimwe A, Twizeyimana L, Brown AL, Cade WT, Bushaku M, de Las Fuentes L, Reeds D, Twagirumukiza M. High rates of undiagnosed and uncontrolled hypertension upon a screening campaign in rural Rwanda: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:197. [PMID: 35473501 PMCID: PMC9044706 DOI: 10.1186/s12872-022-02606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypertension remains the major risk factor for cardiovascular diseases (CVDs) worldwide with a prevalence and mortality in low- and middle-income countries (LMICs) among the highest. The early detection of hypertension risk factors is a crucial pillar for CVD prevention. DESIGN AND METHOD This cross-sectional study included 4284 subjects, mean age 46 ± 16SD, 56.4% females and mean BMI 26.6 ± 3.7 SD. Data were collected through a screening campaign in rural area of Kirehe District, Eastern of Rwanda, with the objective to characterize and examine the prevalence of elevated blood pressure (BP) and other CVD risk factors. An adapted tool from the World Health Organization STEPwise Approach was used for data collection. Elevated BP was defined as ≥ 140/90 mm/Hg and elevated blood glucose as blood glucose ≥ 100 mg/dL after a 6-h fast. RESULTS Of the sampled population, 21.2% (n = 910) had an elevated BP at screening; BP was elevated among individuals not previously known to have HTN in 18.7% (n = 752). Among individuals with a prior diagnosis of HTN, 62.2% (n = 158 of 254) BP was uncontrolled. Age, weight, smoking, alcohol history and waist circumference were associated with BP in both univariate analyses and multivariate analysis. CONCLUSION High rates of elevated BP identified through a health screening campaign in this Rwandan district were surprising given the rural characteristics of the district and relatively low population age. These data highlight the need to implement an adequate strategy for the prevention, diagnosis, and control of HTN that includes rural areas of Rwanda as part of a multicomponent strategy for CVD prevention.
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Affiliation(s)
- Evariste Ntaganda
- Rwanda Biomedical Center (RBC), Rwanda Ministry of Health, Kigali, Rwanda
| | - Regine Mugeni
- Rwamagana Provincial Hospital, Rwamagana, Eastern Province, Rwanda.
| | | | - Gedeon Ngoga
- Partners in Health (PIH)/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | - Francois Uwinkindi
- Rwanda Biomedical Center (RBC), Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Eugene Mutimura
- National Council for Science and Technology (NCST), Kigali, Rwanda
| | - Victor G Davila-Roman
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kenneth Schechtman
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Aurore Nishimwe
- Regional Alliance for Sustainable Development (RASD Rwanda), Kigali, Rwanda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Angela L Brown
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - W Todd Cade
- Duke University School of Medicine, Durham, NC, 27710, USA
| | - Marcus Bushaku
- Regional Alliance for Sustainable Development (RASD Rwanda), Kigali, Rwanda
| | - Lisa de Las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Dominic Reeds
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Marc Twagirumukiza
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Sorato MM, Davari M, Kebriaeezadeh A, Sarrafzadegan N, Shibru T. Societal economic burden of hypertension at selected hospitals in southern Ethiopia: a patient-level analysis. BMJ Open 2022; 12:e056627. [PMID: 35387822 PMCID: PMC8987749 DOI: 10.1136/bmjopen-2021-056627] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES There is inadequate information on the economic burden of hypertension treatment in Ethiopia. Therefore, this study was conducted to determine the societal economic burden of hypertension at selected hospitals in Southern Ethiopia. METHODS Prevalence-based cost of illness study from a societal perspective was conducted. Disability-adjusted life years (DALYs) were determined by the current WHO's recommended DALY valuation method. Adjustment for comorbidity and a 3% discount was done for DALYs. The data entry, processing and analysis were done by using SPSS V.21.0 and Microsoft Excel V.2013. RESULTS We followed a cohort of 406 adult patients with hypertension retrospectively for 10 years from September 2010 to 2020. Two hundred and fifty (61.6%) of patients were women with a mean age of 55.87±11.03 years. Less than 1 in five 75 (18.5%) of patients achieved their blood pressure control target. A total of US$64 837.48 direct cost was incurred due to hypertension. A total of 11 585 years and 579.57 years were lost due to hypertension-related premature mortality and morbidity, respectively. Treated and uncontrolled hypertension accounted for 50.83% (6027) of total years lost due to premature mortality from treated hypertension cohort. Total productivity loss due to premature mortality and morbidity was US$449 394.69. The overall economic burden of hypertension was US$514 232.16 (US$105.55 per person per month). CONCLUSION Societal economic burden of hypertension in Southern Ethiopia was substantial. Indirect costs accounted for more than 8 out of 10 dollars. Treated and uncontrolled hypertension took the lion's share of economic cost and productivity loss due to premature mortality and morbidity. Therefore, designing and implanting strategies for the prevention of hypertension, early screening and detection, and improving the rate of blood pressure control by involving all relevant stakeholders at all levels is critical to saving scarce health resources.
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Affiliation(s)
- Mende Mensa Sorato
- Department of Pharmacy, Arba Minch University, Arba Minch, Ethiopia
- Faculty of Pharmacy, Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Majid Davari
- Faculty of Pharmacy, Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Abbas Kebriaeezadeh
- Faculty of Pharmacy, Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences School of Pharmacy, Tehran, Iran (the Islamic Republic of)
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamiru Shibru
- School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 1076] [Impact Index Per Article: 358.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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