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Mthethwa WS, Mampofu ZM, Mokwena MA, Ramoshaba NE. The relationship between mid-upper arm circumference and blood pressure in Walter Sisulu University community. Blood Press 2024; 33:2296904. [PMID: 38254330 DOI: 10.1080/08037051.2023.2296904] [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: 10/11/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
Prevalence of hypertension is increasing to higher levels in South Africa. Anthropometric measures for obesity are well known to predict the development of hypertension. However, the relationship between mid-upper arm circumference (MUAC) and blood pressure (BP) is scant in South African communities such as universities. Therefore, this study was aimed at investigating the correlation between MUAC and BP among the community of Walter Sisulu University (WSU). A total of 230 participants from WSU (students and staff members), 113 females and 117 males aged ≥ 18 years participated in this cross-sectional study. MUAC, systolic BP (SBP) and diastolic BP (DBP) were measured using standard procedures. In a Pearson's correlation analysis, MUAC was positively correlated with SBP and DBP in both women (SBP; r = 0.53, P< 0.001; DBP; r = 0.45 P < 0.001) and men (SBP; r = 0.29 P = 0.001; DBP; r = 0.25 P = 0.007). Furthermore, in the multivariable-adjusted regression analysis, MUAC was positively associated with SBP in women only (adjusted R2 = 0.489, β = 0.29 (95% CI = 0.16; 2.08)), P =0.023) after adjusted for age, body fat percentage, waist-to-height ratio, smoking and alcohol. MUAC is positively correlated with BP in women, not in men of WSU community. MUAC, as a simple and low-cost quantifiable parameter, could be employed as a risk indicator in the early detection and prevention of cardiovascular diseases (CVDs) in women.
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Affiliation(s)
- Wenzile S Mthethwa
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| | - Zuqaqambe M Mampofu
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| | - Madigoahle A Mokwena
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| | - Nthai E Ramoshaba
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
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2
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Sharma JR, Fokkens H, Laubscher R, Apalata TR, Nomatshila SC, Alomatu SY, Strijdom H, Johnson R. No Association Between AGT Gene Polymorphisms with Hypertension in a South African Population. Diabetes Metab Syndr Obes 2024; 17:1853-1865. [PMID: 38706806 PMCID: PMC11069114 DOI: 10.2147/dmso.s452272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/16/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Hypertension is a leading cause of cardiovascular-related morbidity and mortality worldwide, with a prevalence increasing at an alarming rate in both middle- and low-income countries. Various environmental and genetic factors have been attributed to play a significant role in the increasing prevalence of hypertension. Single nucleotide polymorphisms (SNPs) in the angiotensinogen (AGT) gene are reported to have a significant association with hypertension; however, there are limited studies done on South African populations. Therefore, this case-control study aimed to investigate the association between AGT SNPs (rs2004776, rs3789678, rs5051 and rs7079) with hypertension in a study population of isiXhosa-speaking participants from the Eastern Cape Province in South Africa. Materials and Methods The SNPs were genotyped in 250 hypertensive cases and 237 normotensive controls, using TaqMan genotyping assays. Results For the SNP rs2004776, the frequency of CC genotype (18.4%) and C allele (44%) in hypertensive cases showed no significant differences (p = 0.52, χ2 = 1.32), when compared to the normotensive control group (CC: 19.8% and C allele: 43%). Similar results were obtained for the genotypic and allelic frequencies between hypertensive cases and normotensive controls for rs3789678 (p = 0.88, χ2=0.26) and rs5051 (p = 0.57, χ2=1.12), and rs7079 (p = 0.33, χ2=2.23). These findings demonstrate that there were no significant associations between the SNPs rs2004776, rs3789678, rs7079, rs5051 with hypertension in our study population. Conclusion These findings suggest that AGT gene polymorphisms are not associated with the development of hypertension in the studied population. The present study represents the first genetic report to investigate the AGT gene polymorphisms with hypertension in an isiXhosa-speaking South African population.
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Affiliation(s)
- Jyoti Rajan Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| | - Hannah Fokkens
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
- Centre for Cardiometabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ria Laubscher
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Teke Ruffin Apalata
- Department of Laboratory-Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University and National Health Laboratory Services, Mthatha, South Africa
| | - Sibusiso Cyprian Nomatshila
- Department of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Samuel Yao Alomatu
- Department of Internal Medicine, Nelson Mandela Central Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Hans Strijdom
- Centre for Cardiometabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
- Centre for Cardiometabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Haile M, Degelo T, Adilo TM, Adem FM, Gidisa B. Prevalence of Hypertension and Its Associated Factors Among Adults Living with HIV on Antiretroviral Treatment in Selected Public Hospitals in Addis Ababa, Ethiopia. HIV AIDS (Auckl) 2024; 16:109-122. [PMID: 38533310 PMCID: PMC10963170 DOI: 10.2147/hiv.s447396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction Hypertension significantly increases the risk of heart, brain, and renal diseases and is one of the leading causes of death and disease worldwide. It is a major comorbidity among HIV-positive people. There have been limited attempts to detect hypertension and its related variables in patients receiving antiretroviral treatment, notably in Addis Ababa, Ethiopia. The current study intended to examine the incidence of hypertension and related variables among adults aged 18 and over living with HIV on ART at selected public referral hospitals in Addis Ababa, Ethiopia. Methods A hospital-based cross-sectional study was conducted on 411 HIV-positive individuals aged 18 on ART at Alert and St. Peter's Specialized Hospitals. The research was conducted between December 15, 2021, and January 20, 2022, using an interviewer administered standardized questionnaire. Epi-Info version 7.0 was used to enter and code the collected data, which was subsequently exported to SPSS version 23.0. Bivariate and multivariate logistic regression models were used to identify associated variables. Results The prevalence of hypertension among people with HIV on ART was 37.5% (95% CI: 32.8-42.5). Age groups 35-50 years (AOR: 2.18; 95% CI: 1.13-4.21), alcohol consumption (AOR: 5.58; 95% CI: 2.92-10.65), no physical exercise (AOR: 2.35; 95% CI: 1.06-5.21), family history of hypertension (AOR: 4.39, 95% CI: 2.48-7.76), duration of ART (AOR: 3.13; 95% CI: 1.20-8.12), low CD4 count (AOR: 1.87; 95% CI: 1.04-3.37), and body mass index greater than or equal to 25 kg/m2 (AOR: 2.38; 95% CI: 1.33-4.25) were factors associated with hypertension among HIV patients on ART. Conclusion and Recommendation According to this study, hypertension is prevalent in HIV-positive people. Factors related with hypertension in PLHIV include alcohol intake, lack of physical activity, age 35-50 years, family history of hypertension, ART duration, low CD4 count, and BMI ≥25kg/m2. As a result, health education on the significance of keeping a healthy lifestyle can be effective in preventing and treating hypertension in HIV patients.
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Affiliation(s)
- Meskelu Haile
- Providers Affairs and Quality Assurance Directorate, Ethiopian Health Insurance Service, Addis Ababa, Ethiopia
| | - Tamiru Degelo
- Providers Affairs and Quality Assurance Directorate, Ethiopian Health Insurance Service, Addis Ababa, Ethiopia
| | - Takele Menna Adilo
- School of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fatimetu Mohammed Adem
- School of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bedasa Gidisa
- Public Health Department, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Minkah Md Fwacp DO, Owusu IK, Kokuro C, Norman BR, Arthur JA, Ogyefo IN, Kweki AG. Prevalence of Increased QTc Dispersion Among Hypertensive Patients and Its Correlation to Clinical Risk Factors: A Hospital-Based Case-Control Study. Cureus 2024; 16:e56423. [PMID: 38505141 PMCID: PMC10948943 DOI: 10.7759/cureus.56423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 03/21/2024] Open
Abstract
Background In Ghana and other sub-Saharan African countries, hypertension (HTN) prevalence is rapidly increasing. Hypertensive left ventricular hypertrophy (LVH) is associated with excess fibrous tissue deposition throughout the myocardium. This could lead to ventricular arrhythmias and sudden cardiac death. Increased corrected QT dispersion (QTcd) can cause ventricular repolarization and be used to identify patients at risk of ventricular tachyarrhythmia. The measurement of increased QTcd among hypertensive patients is a simple screening tool to stratify patients at cardiovascular risk. Methods A case-control hospital-based study was conducted on 200 consecutive hypertensive patients. Age- and sex-matched control groups of 200 normotensive individuals who gave informed consent were also recruited. The baseline clinical and demographic characteristics of participants were acquired using structured questionnaires. A physical examination and a resting 12-lead ECG were performed. Increased QTcd and LVH were determined. Results The mean age of hypertensive patients was 50.99±6.73 and 48.19±7.17 for the controls (p-value 0.63). The study population was predominantly female (1:2.4 male:female ratio). Higher mean values for QTcd and LVH (Sokolow-Lyon) were observed among hypertensive patients compared to controls. The prevalence of increased QTcd was 45.0% among hypertensive patients compared to 16.5% in controls (χ2 =38.14, p-value <0.0000001, odds ratio = 4.14). Conclusion Increased QTcd is prevalent among hypertensive Ghanaians. Its measurement can be an effective non-invasive screening tool to risk-stratify hypertensive patients.
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Affiliation(s)
| | - Isaac K Owusu
- Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
| | - Collins Kokuro
- Cardiology, Komfo Anokye Teaching Hospital, Kumasi, GHA
- Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
| | - Betty R Norman
- Internal Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
- Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, GHA
| | - Joshua A Arthur
- Epidemiology and Public Health, Ghana Health Service, Accra, GHA
| | - Isaac N Ogyefo
- Medicine and Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
- Medicine and Surgery, Komfo Anokye Teaching Hospital, Kumasi, GHA
| | - Anthony G Kweki
- Internal Medicine and Cardiology, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust (ESNEFT), Colchester, GBR
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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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Olowoyo P, Barango P, Moran A, Williams B, Whelton PK, Owolabi M. Priorities to reduce the burden of hypertension in Africa through ACHIEVE. Lancet Glob Health 2024; 12:e192-e193. [PMID: 38245107 DOI: 10.1016/s2214-109x(23)00540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria; Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Prebo Barango
- WHO African Regional Office, Brazzaville, Democratic Republic of the Congo
| | | | - Bryan Williams
- Department of Medicine, University College London, London, UK; International Society of Hypertension, Eastbourne, UK
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; World Hypertension League, Hong Kong Special Administrative Region, China
| | - Mayowa Owolabi
- World Hypertension League, Hong Kong Special Administrative Region, China; Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria; Lebanese American University of Beirut, Beirut, Lebanon; Department of Medicine, University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Center, Ibadan, Nigeria.
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8
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Onalu C, Okah P, Okoye UO. A Focused Group Perspective of Risk Factors for Hypertension Among Middle-Aged Adults in Rural Areas of Anambra State, Nigeria. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:1-17. [PMID: 37634142 DOI: 10.1080/26408066.2023.2252411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
PURPOSE Recent records by the World Health Organization show that hypertension is more prevalent in Africa than in other parts of the world, and remains the foremost common risk factor for cardiovascular-related diseases, stroke, renal diseases, and death. However, little is known about the risk factors for hypertension by people from rural areas, especially among middle-aged adults. Therefore, the study examined the knowledge of the risk factors for hypertension among middle-aged adults in rural areas of Anambra state, Nigeria. MATERIALS, AND METHOD Focus group discussions were used to collect data from 40 middle-aged adults (20 males and 20 females). Two key themes stood out from the data collection guides. These are "awareness of hypertension and its' symptoms" and "knowledge of risk factors of hypertension". RESULTS The findings showed that the participants were aware of hypertension but lacked in-depth knowledge of the risk factors for the disease. Most participants did not believe that intake of certain foods like starchy foods and excess alcohol consumption could lead to one being hypertensive. DISCUSSION AND CONCLUSION There is a need for social workers to sensitize and enlighten the middle-aged adults in the study area on the risk factors for the disease.
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Affiliation(s)
- Chinyere Onalu
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
| | - Paulinus Okah
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
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9
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Islam MM, Alam MJ, Maniruzzaman M, Ahmed NAMF, Ali MS, Rahman MJ, Roy DC. Predicting the risk of hypertension using machine learning algorithms: A cross sectional study in Ethiopia. PLoS One 2023; 18:e0289613. [PMID: 37616271 PMCID: PMC10449142 DOI: 10.1371/journal.pone.0289613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertension (HTN), a major global health concern, is a leading cause of cardiovascular disease, premature death and disability, worldwide. It is important to develop an automated system to diagnose HTN at an early stage. Therefore, this study devised a machine learning (ML) system for predicting patients with the risk of developing HTN in Ethiopia. MATERIALS AND METHODS The HTN data was taken from Ethiopia, which included 612 respondents with 27 factors. We employed Boruta-based feature selection method to identify the important risk factors of HTN. The four well-known models [logistics regression, artificial neural network, random forest, and extreme gradient boosting (XGB)] were developed to predict HTN patients on the training set using the selected risk factors. The performances of the models were evaluated by accuracy, precision, recall, F1-score, and area under the curve (AUC) on the testing set. Additionally, the SHapley Additive exPlanations (SHAP) method is one of the explainable artificial intelligences (XAI) methods, was used to investigate the associated predictive risk factors of HTN. RESULTS The overall prevalence of HTN patients is 21.2%. This study showed that XGB-based model was the most appropriate model for predicting patients with the risk of HTN and achieved the accuracy of 88.81%, precision of 89.62%, recall of 97.04%, F1-score of 93.18%, and AUC of 0. 894. The XBG with SHAP analysis reveal that age, weight, fat, income, body mass index, diabetes mulitas, salt, history of HTN, drinking, and smoking were the associated risk factors of developing HTN. CONCLUSIONS The proposed framework provides an effective tool for accurately predicting individuals in Ethiopia who are at risk for developing HTN at an early stage and may help with early prevention and individualized treatment.
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Affiliation(s)
- Md. Merajul Islam
- Department of Statistics, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Jahangir Alam
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- Mainanalytics GmbH, Sulzbach/Taunus, Germany
| | - Md Maniruzzaman
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | - Md Sujan Ali
- Department of Computer Science and Engineering, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | | | - Dulal Chandra Roy
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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Nedzingahe V, Tambe BA, Zuma MK, Mbhenyane XG. Associations among Food Systems, Food Environments, Food Choices, Food Security, and Nutrition Transition in Limpopo Province, South Africa: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6557. [PMID: 37623143 PMCID: PMC10454841 DOI: 10.3390/ijerph20166557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
A cross-sectional study was applied to investigate the influence of food systems and food environments on food choices and nutrition transition of households in Limpopo province, South Africa. A sample of 429 households was systematically selected using a paper selection draw from three districts. This paper determines the association among food systems, food environments, food choices, and nutritional measurements of the respondents. A validated questionnaire was used. Most of the respondents responsible for food procurement were females (80.4%). There was a significant association (p < 0.001) between proximity to food stores and dietary diversity of the households. Staple foods such as bread, maize, rice, samp, and mealie rice were available in almost all surveyed households (95.6%). More than half of the households (59.8%) had home gardens in their yards. Almost half of the households (48.4%) had a low Dietary Diversity Score. The study further revealed that 46.0% of households were food secure. Over a third (36.2%) of the respondents were obese, and 32.5% were diabetic. The mean total blood cholesterol was 3.69 ± 0.74 mmol/L. A high percentage of both females (89.6%) and males (91.5%) had normal hemoglobin levels. Almost half of the respondents had normal systolic blood pressure levels (45.6%), and nearly a quarter had high diastolic levels (21.4%). The 25 coping strategies were applied during food shortage periods. Even though the food environments provided both obesogenic and protective foods, the consumption of unhealthy foods was high.
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Affiliation(s)
- Vhushavhelo Nedzingahe
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, Western Cape, South Africa; (V.N.); (B.A.T.); (M.K.Z.)
| | - Betrand Ayuk Tambe
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, Western Cape, South Africa; (V.N.); (B.A.T.); (M.K.Z.)
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea P.O. Box 63, Cameroon
| | - Mthokozisi Kwazi Zuma
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, Western Cape, South Africa; (V.N.); (B.A.T.); (M.K.Z.)
- Impact and Partnerships Division, Agricultural Research Council, P.O. Box 8783, Pretoria 0084, Gauteng, South Africa
| | - Xikombiso Gertrude Mbhenyane
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, Western Cape, South Africa; (V.N.); (B.A.T.); (M.K.Z.)
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11
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Kilama D, Ayella DO, Asiimwe I, Nakibuuka B, Laker F, Bongomin F. Undiagnosed Hypertension Among Market Salespersons in Kitgum Central Market, Northern Uganda. Integr Blood Press Control 2023; 16:37-46. [PMID: 37484203 PMCID: PMC10362878 DOI: 10.2147/ibpc.s402988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/15/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Hypertension may be common among market salespersons who are mostly physically inactive throughout the day. However, the burden of hypertension in this population remains unknown. In this study, we determined the prevalence of undiagnosed hypertension and associated factors among market salesperson in Kitgum central market, Kitgum district, Northern Uganda. Methods A cross-sectional study, recruiting market salespersons aged 18 years or older without a prior diagnosis of hypertension or currently on anti-hypertensive therapy was conducted. A standardized questionnaire was administered, and body mass index (BMI) estimated. Hypertension was defined as two consistent measurements of systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg measured 4 hours apart. Multivariable logistic regression analysis was performed to determine factors independently associated with undiagnosed hypertension. P<0.05 was considered statistically significant. Results We enrolled 240 participants. The mean age was 39.4 ± 12.8 years. Most (83.3%, n=199) participants were female and urban dwellers (88.3%, n=212). The prevalence of undiagnosed hypertension was 16.7% (n=40). Of the 40 participants with hypertension, 16 (40%) were younger than 40 years. Factors associated with undiagnosed hypertension were, age >50 years (adjusted odds ratio (aOR): 7.0, 95% confidence interval (CI): 1.9-25.6, p=0.003), male gender (aOR: 4.2, 95CI: 1.5-11.1, p=0.005), alcohol consumption (aOR: 2.6, 95CI: 1.1-6.0, p=0.021), and being overweight (aOR: 3.6, 95CI: 1.5-8.8, p=0.005). Conclusion About one in six of market salespersons had undiagnosed hypertension, with a disproportionately high burden among those younger than 40 years. A larger multi-centric study is recommended to confirm our findings.
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Affiliation(s)
- Denish Kilama
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Daniel Okumu Ayella
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Isaac Asiimwe
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Betty Nakibuuka
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Florence Laker
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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12
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Katsukunya JN, Soko ND, Naidoo J, Rayner B, Blom D, Sinxadi P, Chimusa ER, Dandara M, Dzobo K, Jones E, Dandara C. Pharmacogenomics of Hypertension in Africa: Paving the Way for a Pharmacogenetic-Based Approach for the Treatment of Hypertension in Africans. Int J Hypertens 2023; 2023:9919677. [PMID: 38633331 PMCID: PMC11022520 DOI: 10.1155/2023/9919677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 04/19/2024] Open
Abstract
In Africa, the burden of hypertension has been rising at an alarming rate for the last two decades and is a major cause for cardiovascular disease (CVD) mortality and morbidity. Hypertension is characterised by elevated blood pressure (BP) ≥ 140/90 mmHg. Current hypertension guidelines recommend the use of antihypertensives belonging to the following classes: calcium channel blockers (CCB), angiotensin converting inhibitors (ACEI), angiotensin receptor blockers (ARB), diuretics, β-blockers, and mineralocorticoid receptor antagonists (MRAs), to manage hypertension. Still, a considerable number of hypertensives in Africa have their BP uncontrolled due to poor drug response and remain at the risk of CVD events. Genetic factors are a major contributing factor, accounting for 20% to 80% of individual variability in therapy and poor response. Poor response to antihypertensive drug therapy is characterised by elevated BPs and occurrence of adverse drug reactions (ADRs). As a result, there have been numerous studies which have examined the role of genetic variation and its influence on antihypertensive drug response. These studies are predominantly carried out in non-African populations, including Europeans and Asians, with few or no Africans participating. It is important to note that the greatest genetic diversity is observed in African populations as well as the highest prevalence of hypertension. As a result, this warrants a need to focus on how genetic variation affects response to therapeutic interventions used to manage hypertension in African populations. In this paper, we discuss the implications of genetic diversity in CYP11B2, GRK4, NEDD4L, NPPA, SCNN1B, UMOD, CYP411, WNK, CYP3A4/5, ACE, ADBR1/2, GNB3, NOS3, B2, BEST3, SLC25A31, LRRC15 genes, and chromosome 12q loci on hypertension susceptibility and response to antihypertensive therapy. We show that African populations are poorly explored genetically, and for the few characterised genes, they exhibit qualitative and quantitative differences in the profile of pharmacogene variants when compared to other ethnic groups. We conclude by proposing prioritization of pharmacogenetics research in Africa and possible adoption of pharmacogenetic-guided therapies for hypertension in African patients. Finally, we outline the implications, challenges, and opportunities these studies present for populations of non-European descent.
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Affiliation(s)
- Jonathan N. Katsukunya
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Nyarai D. Soko
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Jashira Naidoo
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Brian Rayner
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dirk Blom
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Lipidology and Cape Heart Institute, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Phumla Sinxadi
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Clinical Pharmacology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile R. Chimusa
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle, Tyne and Wear NE1 8ST, UK
| | - Michelle Dandara
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Kevin Dzobo
- Medical Research Council-SA Wound Healing Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences University of Cape Town, Anzio Road Observatory, Cape Town 7925, South Africa
| | - Erika Jones
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
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13
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Madela S, Harriman NW, Sewpaul R, Mbewu AD, Williams DR, Sifunda S, Manyaapelo T, Nyembezi A, Reddy SP. Individual and area-level socioeconomic correlates of hypertension prevalence, awareness, treatment, and control in uMgungundlovu, KwaZulu-Natal, South Africa. BMC Public Health 2023; 23:417. [PMID: 36864433 PMCID: PMC9979474 DOI: 10.1186/s12889-023-15247-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/09/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Hypertension is the second leading risk factor for death in South Africa, and rates have steadily increased since the end of Apartheid. Research on the determinants of hypertension in South Africa has received considerable attention due to South Africa's rapid urbanization and epidemiological transition. However, scant work has been conducted to investigate how various segments of the Black South African population experience this transition. Identifying the correlates of hypertension in this population is critical to the development of policies and targeted interventions to strengthen equitable public health efforts. METHODS This analysis explores the relationship between individual and area-level socioeconomic status and hypertension prevalence, awareness, treatment, and control within a sample of 7,303 Black South Africans in three municipalities of the uMgungundlovu district in KwaZulu-Natal province: the Msunduzi, uMshwathi, and Mkhambathini. Cross-sectional data were collected on participants from February 2017 to February 2018. Individual-level socioeconomic status was measured by employment status and educational attainment. Ward-level area deprivation was operationalized by the most recent (2011 and 2001) South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and diabetes diagnosis. RESULTS The prevalence of hypertension in the sample was 44.4% (n = 3,240). Of those, 2,324 were aware of their diagnosis, 1,928 were receiving treatment, and 1,051 had their hypertension controlled. Educational attainment was negatively associated with hypertension prevalence and positively associated with its control. Employment status was negatively associated with hypertension control. Black South Africans living in more deprived wards had higher odds of being hypertensive and lower odds of having their hypertension controlled. Those residing in wards that became more deprived from 2001 to 2011 had higher odds of being aware of their hypertension, yet lower odds of receiving treatment for it. CONCLUSIONS Results from this study can assist policymakers and practitioners in identifying groups within the Black South African population that should be prioritized for public health interventions. Black South Africans who have and continue to face barriers to care, including those with low educational attainment or living in deprived wards had worse hypertension outcomes. Potential interventions include community-based programs that deliver medication to households, workplaces, or community centers.
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Affiliation(s)
- Slm Madela
- Expectra Health Solutions, Dundee, South Africa
| | - N W Harriman
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - R Sewpaul
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
| | - A D Mbewu
- Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - D R Williams
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, Boston, USA.,African and African American Studies Department, Harvard University, Cambridge, USA
| | - S Sifunda
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
| | - T Manyaapelo
- Africa Health Research Institute, Somkhele, South Africa
| | - A Nyembezi
- University of the Western Cape, Cape Town, South Africa
| | - S P Reddy
- University of KwaZulu-Natal, Berea, South Africa
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Hou J, Zhu L, Jin S, Li J, Xing Z, Wang Y, Wan X, Guo X, Wang A, Wang X, Liu J, Ma J, Zhou S, Zhang X, Zheng H, Wang J, Feng H, Sun S, Wang T. Prevalence of hypertension in endemic and non-endemic areas of Keshan disease: A cross-sectional study in rural areas of China. Front Nutr 2023; 10:1086507. [PMID: 36860691 PMCID: PMC9969988 DOI: 10.3389/fnut.2023.1086507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Background Hypertension is a major public health concern that strongly influences the quality of life of people worldwide. Keshan disease (KD) is an endemic cardiomyopathy related to low selenium, threatening residents in rural areas of 16 provinces in China. Furthermore, the prevalence of hypertension in the KD-endemic areas has been increasing annually. However, hypertension research associated with KD has only focused on endemic regions, and no studies have compared hypertension prevalence between endemic and non-endemic areas. Therefore, this study investigated the prevalence of hypertension to provide a basis for preventing and controlling hypertension in the KD-endemic areas, even in rural areas. Methods We extracted blood pressure information from cardiomyopathy investigation data from a cross-sectional study of the KD-endemic and non-endemic areas. The hypertension prevalence between the two groups was compared using the Chi-square test or Fisher s exact test. Additionally, Pearson's correlation coefficient was employed to evaluate the relationship between the per capita gross domestic product (GDP) and hypertension prevalence. Results There was a statistically significant increase of hypertension prevalence in the KD-endemic areas (22.79%, 95% confidence interval [CI]: 22.30-23.27%) over the non-endemic areas (21.55%, 95% CI: 21.09-22.02%). In the KD-endemic areas, more men had hypertension than women (23.90% vs. 21.65%, P < 0.001). Furthermore, the hypertension prevalence was higher in the north than in the south in the KD-endemic areas (27.52% vs. 18.76%, P < 0.001), non-endemic areas (24.86% vs. 18.66%, P < 0.001), and overall (26.17% vs. 18.68%, P < 0.001). Finally, the prevalence of hypertension positively correlated with per capita GDP at province level. Conclusions The increasing hypertension prevalence is a public health problem in the KD-endemic areas. Healthy diets, such as high consumption of vegetables and seafoods, and foods that are rich in selenium, might help prevent and control hypertension in the KD-endemic areas and other rural areas in China.
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Affiliation(s)
- Jie Hou
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China,National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China,*Correspondence: Jie Hou,
| | - Lifang Zhu
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Shuran Jin
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Jinshu Li
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Zhifeng Xing
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China
| | - Yanling Wang
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Xiaoyan Wan
- The Second Research Institute for Endemic Disease Control and Prevention of Jilin Province, Jilin City, China
| | - Xianni Guo
- Shaanxi Institute for Endemic Disease Control and Prevention, Xi’an, China
| | - Anwei Wang
- Yunnan Institute of Endemic Disease Control and Prevention, Dali, China
| | - Xiuhong Wang
- Shandong Provincial Institute for Endemic Disease Control, Jinan, China
| | - Jinming Liu
- The Inner Mongolia Autonomous Region Comprehensive Center for Disease Control and Prevention, Hohhot, China
| | - Jing Ma
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Shuang Zhou
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xiangdong Zhang
- Shanxi Institute of Endemic Disease Control and Prevention, Linfen, China
| | - Heming Zheng
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Jianhui Wang
- Liaoning Center for Disease Control and Prevention, Shenyang, China
| | - Hongqi Feng
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China,National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China
| | - Shuqiu Sun
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China,National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China
| | - Tong Wang
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China,National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China,Tong Wang,
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Gaudji GR, Bida M, Conradie M, Damane BP, Bester MJ. Renal Papillary Necrosis (RPN) in an African Population: Disease Patterns, Relevant Pathways, and Management. Biomedicines 2022; 11:biomedicines11010093. [PMID: 36672600 PMCID: PMC9855351 DOI: 10.3390/biomedicines11010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/02/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Renal papillary necrosis (RPN) is characterized by coagulative necrosis of the renal medullary pyramids and papillae. Multiple conditions and toxins are associated with RPN. Several RPN risk factors, or POSTCARDS, have been identified, with most patients presenting with RPN having at least two contributing risk factors. Currently, there is no specific test to diagnose and confirm RPN; however, several imaging tools can be used to diagnose the condition. RPN is currently underdiagnosed in African populations, often with fatal outcomes. In African clinical settings, there is a lack of consensus on how to define and describe RPN in terms of kidney anatomy, pathology, endourology, epidemiology, the identification of African-specific risk factors, the contribution of oxidative stress, and lastly an algorithm for managing the condition. Several risk factors are unique to African populations including population-specific genetic factors, iatrogenic factors, viral infections, antimicrobial therapy, schistosomiasis, substance abuse, and hypertension (GIVASSH). Oxidative stress is central to both GIVASSH and POSTCARDS-associated risk factors. In this review, we present information specific to African populations that can be used to establish an updated consensual definition and practical grading system for radiologists, urologists, nephrologists, nuclear physicians, and pathologists in African clinical settings.
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Affiliation(s)
- Guy Roger Gaudji
- Department of Urology, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria 0007, South Africa
- Correspondence: (G.R.G.); (M.J.B.)
| | - Meshack Bida
- Department of Anatomical Pathology, National Health Laboratory Service (NHLS), Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa
| | - Marius Conradie
- Urology Practice, Netcare Waterfall City Hospital, Cnr Magwa Avenue and Mac Mac Road, Johannesburg 1682, South Africa
| | - Botle Precious Damane
- Department of Surgery, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria 0007, South Africa
| | - Megan Jean Bester
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria 0007, South Africa
- Correspondence: (G.R.G.); (M.J.B.)
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Ntenda PAM, El-Meidany WMR, Tiruneh FN, Motsa MPS, Nyirongo J, Chirwa GC, Kapachika A, Nkoka O. Determinants of self-reported hypertension among women in South Africa: evidence from the population-based survey. Clin Hypertens 2022; 28:39. [PMCID: PMC9664601 DOI: 10.1186/s40885-022-00222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Hypertension (HTN), characterized by an elevation of blood pressure, is a serious public health chronic condition that significantly raises the risks of heart, brain, kidney, and other diseases. In South Africa, the prevalence of HTN (measured objectively) was reported at 46.0% in females, nonetheless little is known regarding the prevalence and risks factors of self-reported HTN among the same population. Therefore, the aim of this study was to examine determinants of self-reported HTN among women in South Africa.
Methods
The study used data obtained from the 2016 South African Demographic and Health Survey. In total, 6,027 women aged ≥ 20 years were analyzed in this study. Self-reported HTN was defined as a case in which an individual has not been clinically diagnosed with this chronic condition by a medical doctor, nurse, or health worker. Multiple logistic regression models were employed to examine the independent factors of self-reported HTN while considering the complex survey design.
Results
Overall, self-reported HTN was reported in 23.6% (95% confidence interval [CI], 23.1–24.1) of South African women. Being younger (adjusted odds ratio [aOR], 0.04; 95% CI, 0.03–0.06), never married (aOR, 0.69; 95% CI, 0.56–0.85), and not covered by health insurance (aOR, 0.74; 95% CI, 0.58–0.95) reduced the odds of self-reported HTN. On the other hand, being black/African (aOR, 1.73; 95% CI, 1.17–2.54), perception of being overweight (aOR, 1.72; 95% CI, 1.40–2.11), and perception of having poor health status (aOR, 3.53; 95% CI, 2.53–5.21) and the presence of other comorbidities (aOR, 7.92; 95% CI, 3.63–17.29) increased the odds of self-reported HTN.
Conclusions
Self-reported HTN was largely associated with multiple sociodemographic, health, and lifestyle factors and the presence of other chronic conditions. Health promotion and services aiming at reducing the burden of HTN in South Africa should consider the associated factors reported in this study to ensure healthy aging and quality of life among women.
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Makura-Kankwende CBT, Gradidge PJ, Crowther NJ, Ratshikombo T, Goedecke JH, Micklesfield LK, Norris SA, Chikowore T. Association of Longitudinal Nutrient Patterns with Body Composition in Black Middle-Aged South African Women: A Five-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12792. [PMID: 36232088 PMCID: PMC9565998 DOI: 10.3390/ijerph191912792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to evaluate the association of longitudinal nutrient patterns with body composition in a cohort of 132 black South African middle-aged women over five years. Nutrient patterns were identified using principal component analysis at baseline and follow-up 5 years later. Associations between nutrient patterns and repeated body composition measures were evaluated using generalized estimating equations, before and after adjusting for baseline education and repeated measures of age, socio-economic status, physical activity and employment. The animal-driven nutrient pattern was associated with increases in repeated measures of visceral adipose tissue (VAT) (β coefficient, 5.79 [95% CI, 0.01-11.57] cm2), fat mass index (FMI) (0.47 [0.01-0.93] kg·m-2) and lean mass index (LMI) (0.50 [0.18-1.17] kg·m-2) (p < 0.05) after adjustment. Vitamin C, sugar, and potassium-driven nutrient pattern was associated with higher FMI (0.50 [0.12-0.88] kg·m-2) and LMI (0.58 [0.07-1.10] kg·m-2) before and after adjustment (p < 0.05). These findings suggest that dietary interventions to curb obesity in black middle-aged South African women should focus on attenuation of nutrient patterns centred on added sugar, animal fat and animal protein.
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Affiliation(s)
- Caroline B. T. Makura-Kankwende
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
| | - Philippe J. Gradidge
- Department of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
| | - Nigel J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2192, South Africa
| | - Tshifhiwa Ratshikombo
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
| | - Julia H. Goedecke
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town 7505, South Africa
- University of Stirling, Stirling FK9 4LA, UK
| | - Lisa K. Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
- School of Human Development and Health, University of Southampton, Southampton SO17 1BJ, UK
| | - Tinashe Chikowore
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
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18
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Mabhida SE, Sharma JR, Apalata T, Masilela C, Nomatshila S, Mabasa L, Fokkens H, Benjeddou M, Muhamed B, Shabalala S, Johnson R. The association of MTHFR (rs1801133) with hypertension in an indigenous south African population. Front Genet 2022; 13:937639. [PMID: 35938016 PMCID: PMC9353403 DOI: 10.3389/fgene.2022.937639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Aims: The current study sought to investigate the association between the methylenetetrahydrofolate reductase (MTHFR) variant (rs1801133) and the risk of developing hypertension (HTN) in an indigenous South African population. Methods: A total of 442 participants (hypertensive, n = 279 and non-hypertensive, n = 163) from the indigenous tribe residing in Mthatha, Eastern Cape (South Africa) were recruited. HTN was defined as a systolic (SBP) and diastolic blood pressure (DBP) of ≥130/80 mmHg following American Heart Association guidelines. The genotyping of MTHFR (rs1801133) was assessed using MassARRAY® System. Thereafter, the association between rs1801133 in various genetic models and HTN was determined by logistic regression model analysis. Furthermore, the interaction between rs1801133 and selected risk factors on HTN was performed using the open-source multifactor dimensionality reduction (MDR). Results: The low frequency of the T allele (5%) was also observed when compared with the C allele (95%) in both cases and controls. After adjusting for confounding factors (gender, smoking status, BMI, and blood glucose levels), there were no significant associations were observed between rs1801133 and the risk of HTN in all genetic models: genotypic (OR 0.75, 95% CI 0.29–1.95, p = 0.56), dominant (OR 0.86, 95% CI 0.35–2.16, p = 0.75), co-dominant (OR 1.33, 95% CI 0.51–3.48, p = 0.55) and allelic (OR 0.80, 95% CI 0.49–1.62, p = 0.70) in logistic regression analysis. However, a significant interaction was reported among rs1801133, age, and gender (p < 0.0001) with the risk of HTN. Conclusion: The present study reports on the lack of association between MTHFR (rs1801133) and the risk of HTN in an indigenous South African tribe. However, an interaction between gender, age, and rs1801133 was observed. Thus, future studies with a large sample size are required to further validate these findings.
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Affiliation(s)
- Sihle E. Mabhida
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Cape Town, South Africa
| | - Jyoti R. Sharma
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
| | - Teke Apalata
- Division of Medical Microbiology, Department of Laboratory-Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University and National Health Laboratory Services, Mthatha, South Africa
| | - Charity Masilela
- Department of Biochemistry, North-West University, Mmabatho, South Africa
| | - Sibusiso Nomatshila
- Division of Preventive Medicine and Health Behavior, Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Lawrence Mabasa
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
| | - Hannah Fokkens
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Mongi Benjeddou
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Cape Town, South Africa
| | - Babu Muhamed
- Division of Infections Disease - University of Tennessee Health Sciences Center (UTHSC), Memphis, TN, United States
| | | | - Rabia Johnson
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- *Correspondence: Rabia Johnson,
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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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Kohli-Lynch CN, Erzse A, Rayner B, Hofman KJ. Hypertension in the South African public healthcare system: a cost-of-illness and burden of disease study. BMJ Open 2022; 12:e055621. [PMID: 35193918 PMCID: PMC8867372 DOI: 10.1136/bmjopen-2021-055621] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To quantify the health and economic burden of hypertension in the South African public healthcare system. SETTING All inpatient, outpatient and rehabilitative care received in the national public healthcare system. PARTICIPANTS Adults, aged ≥20 years, who receive care in the public healthcare system. OUTCOMES Worksheet-based models synthesised data from multiple sources to estimate the burden of disease, direct healthcare costs, and societal costs associated with hypertension. Results were disaggregated by sex. RESULTS Approximately 8.22 million (30.8%, 95% CI 29.5% to 32.1%) South African adults with no private health insurance have hypertension. Hypertension was estimated to cause 14 000 (95% CI 11 100 to 17 200) ischaemic heart disease events, 13 300 (95% CI 10 600 to 16 300) strokes and 6100 (95% CI 4970 to 7460) cases of chronic kidney disease annually. Rates of hypertension, hypertension-related stroke and hypertension-related chronic kidney disease were greater for women compared with men.The direct healthcare costs associated with hypertension were estimated to be ZAR 10.1 billion (95% CI 8.98 to 11.3 billion) or US$0.711 billion (95% CI 0.633 to 0.793 billion). Societal costs were estimated to be ZAR 29.4 billion (95% CI 26.0 to 33.2 billion) or US$2.08 billion (95% CI 1.83 to 2.34 billion). Direct healthcare costs were greater for women (ZAR 6.11 billion or US$0.431 billion) compared with men (ZAR 3.97 billion or US$0.280 billion). Conversely, societal costs were lower for women (ZAR 10.5 billion or US$0.743 billion) compared with men (ZAR 18.9 billion or US$1.33 billion). CONCLUSION Hypertension exerts a heavy health and economic burden on South Africa. Establishing cost-effective best practice guidelines for hypertension treatment requires further research. Such research will be essential if South Africa is to make progress in its efforts to implement universal healthcare.
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Affiliation(s)
- Ciaran N Kohli-Lynch
- SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
- Center for Health Services & Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - B Rayner
- Division of Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Karen J Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
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