Stroke occurrence by hypertension treatment status in Ghana and Nigeria: A case-control study

BACKGROUND

Hypertension is preeminent among the vascular risk factors for stroke occurrence. The wide gaps in awareness, detection, treatment, and control rates of hypertension are fueling an epidemic of stroke in sub-Saharan Africa.

PURPOSE

To quantify the contribution of untreated, treated but uncontrolled, and controlled hypertension to stroke occurrence in Ghana and Nigeria.

METHODS

The Stroke Investigative Research and Educational Network (SIREN) is a case-control study across 16 study sites in Ghana and Nigeria. Cases were acute stroke (n = 3684) with age- and sex-matched stroke-free controls (n = 3684). We evaluated the associations of untreated hypertension, treated but uncontrolled hypertension, and controlled hypertension at BP of <140/90 mmHg with risk of stroke occurrence. We assessed the adjusted odds ratio and population-attributable risk of hypertension treatment control status associated with stroke occurrence.

RESULTS

The frequencies of no hypertension, untreated hypertension, treated but uncontrolled hypertension and controlled hypertension among stroke cases were 4.0%, 47.7%, 37.1%, and 9.2% vs 40.7%, 34.9%, 15.9%, and 7.7% respectively among stroke-free controls, p < 0.0001. The aOR and PAR (95% CI) for untreated hypertension were 6.58 (5.15-8.41) and 35.4% (33.4-37.4); treated but uncontrolled hypertension was 9.95 (7.60-13.02) and 35.9% (34.2-37.5); and controlled hypertension 5.37 (3.90-7.41) and 8.5% (7.6-9.5) respectively. Untreated hypertension contributed a PAR of 47.5% to the occurrence of intracerebral hemorrhage vs 29.5% for ischemic stroke. The aOR of untreated hypertension for stroke occurrence was 13.31 (7.64-23.19) for <50 years; 7.14 (4.51-11.31) for 50-64 years; and 3.48 (2.28-5.30) for 65 years or more.

CONCLUSION

The contribution of untreated hypertension and treated but uncontrolled hypertension to stroke occurrence among indigenous Africans is substantial. Implementing targeted interventions that address gaps in hypertension prevention and treatment, involving the local population, healthcare providers, and policymakers, can potentially substantially reduce the escalating burden of strokes in Africa.

Novel functional insights into ischemic stroke biology provided by the first genome-wide association study of stroke in indigenous Africans

BACKGROUND

African ancestry populations have the highest burden of stroke worldwide, yet the genetic basis of stroke in these populations is obscure. The Stroke Investigative Research and Educational Network (SIREN) is a multicenter study involving 16 sites in West Africa. We conducted the first-ever genome-wide association study (GWAS) of stroke in indigenous Africans.

METHODS

Cases were consecutively recruited consenting adults (aged > 18 years) with neuroimaging-confirmed ischemic stroke. Stroke-free controls were ascertained using a locally validated Questionnaire for Verifying Stroke-Free Status. DNA genotyping with the H3Africa array was performed, and following initial quality control, GWAS datasets were imputed into the NIH Trans-Omics for Precision Medicine (TOPMed) release2 from BioData Catalyst. Furthermore, we performed fine-mapping, trans-ethnic meta-analysis, and in silico functional characterization to identify likely causal variants with a functional interpretation.

RESULTS

We observed genome-wide significant (P-value < 5.0E-8) SNPs associations near AADACL2 and miRNA (MIR5186) genes in chromosome 3 after adjusting for hypertension, diabetes, dyslipidemia, and cardiac status in the base model as covariates. SNPs near the miRNA (MIR4458) gene in chromosome 5 were also associated with stroke (P-value < 1.0E-6). The putative genes near AADACL2, MIR5186, and MIR4458 genes were protective and novel. SNPs associations with stroke in chromosome 2 were more than 77 kb from the closest gene LINC01854 and SNPs in chromosome 7 were more than 116 kb to the closest gene LINC01446 (P-value < 1.0E-6). In addition, we observed SNPs in genes STXBP5-AS1 (chromosome 6), GALTN9 (chromosome 12), FANCA (chromosome 16), and DLGAP1 (chromosome 18) (P-value < 1.0E-6). Both genomic regions near genes AADACL2 and MIR4458 remained significant following fine mapping.

CONCLUSIONS

Our findings identify potential roles of regulatory miRNA, intergenic non-coding DNA, and intronic non-coding RNA in the biology of ischemic stroke. These findings reveal new molecular targets that promise to help close the current gaps in accurate African ancestry-based genetic stroke's risk prediction and development of new targeted interventions to prevent or treat stroke.

Secondhand smoke exposure is independently associated with stroke among non-smoking adults in West Africa

BACKGROUND

Stroke is a leading cause of disability and mortality worldwide, but little is known about the contribution of secondhand smoke exposure (SHSE) to stroke epidemiology among indigenous Africans.

OBJECTIVE

To evaluate the association of SHSE with stroke among indigenous Africans.

METHODS

We analyzed the relationship of SHSE with stroke among 2990 case-control pairs of adults who had never smoked (identified in the SIREN study) using conditional logistic regression at a two-sided P < 0.05.

RESULTS

Multivariable-adjusted odds ratio and 95% confidence interval; 1.25 (1.04, 1.50; P = 0.02) revealed SHSE was positively associated with stroke independent of stroke subtypes.

CONCLUSION

Culturally relevant primary prevention strategies targeted at SHSE might be promising in preventing stroke among Africans.

Association between Height and Blood Pressure in Middle Age and Older Adults in Southeast Nigeria

BACKGROUND

This study was carried out in Abia State, Southeast Nigeria, to determine the association between height and blood pressure in middle age and elderly adults.

MATERIALS AND METHODS

This was a cross-sectional study carried out in Abia State, Southeast Nigeria, between August 2011 and March 2012. The participants were residents in the state and were recruited from the three senatorial zones of the state. The total number of participants that took part in the study was 2,487 adults. The World Health Organisation STEPwise approach to surveillance of chronic disease risk factors was used. Information collected included blood pressure and anthropometric measurements. The association between height and blood pressure was determined.

RESULTS

A total of 1,363 participants that took part in the study were >40 years old. Six hundred and fifty-five participants (48.1%) were males and 708 participants (51.9%) were females. There was no significant inverse relationship between height and blood pressure components ( Systolic Blood Pressure Diastolic Blood Pressure, and Pulse Pressure ) among the males. Among the females there was a high inverse relationship between height and blood pressure components. However, this relationship was not statistically significant. In addition, among the males there was no relationship between height and hypertension. Among the females, there was some degree of inverse relationship between height and hypertension, although multivariate regression analysis showed that this was not significant.

CONCLUSION

There was an inverse but non-significant relationship between height and blood pressure components/ hypertension among males and females in Southeast Nigeria in this study.

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans

BACKGROUND AND PURPOSE

To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans.

METHODS

The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI.

RESULTS

There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively (P<0.0001).

CONCLUSIONS

Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

Risk Factors for Chronic Kidney Disease in Newly Diagnosed Hypertensive Subjects in Southeast Nigeria

BACKGROUND

The aim of this study was to determine the prevalence and associated risk factors for chronic kidney disease (CKD) in newly diagnosed hypertensive patients.

MATERIALS AND METHODS

This was a cross-sectional analytical study involving consenting newly diagnosed hypertensive patients who presented at GOPD of Federal Medical Centre, Umuahia, within 0-3 months of diagnosis; and non-hypertensive controls. A semi-structured interviewer- administered questionnaire was used to record the socio-demographic, anthropometric, clinical and bio-chemical characteristics of the respondents. Data were analyzed and compared between the hypertensive group and the non-hypertensive control group.

RESULTS

Two hundred and sixty participants took part in the study. However, only 240 completed the study (120 hypertensive, and 120 control participants). After follow-up for 3 months, 42 (35.0%) hypertensive patients had CKD compared to 11 (9.2%) of the non-hypertensive control group. The prevalence of CKD in the hypertensive participants was significantly higher (2=23.27, p<0.001). Multivariate regression analysis of CKD with variables in the hypertensive study group showed an association between CKD and sex (p=0.020), serum triglycerides (p=0.030) as well as serum uric acid (p=0.030). In the control group there was significant association between CKD and sex (p=0.020), serum total cholesterol (p=0.030) as well as serum uric acid (p=0.030).

CONCLUSION

The prevalence of CKD among newly diagnosed hypertensives in southeast Nigeria was high. In this group, CKD had an association with sex, serum uric acid and serum triglyceride.

Performance of Multiple True or False Options with Negative Scoring Schemes Against Single Best of Five Answer Options in a Medical School

BACKGROUND AND OBJECTIVES

The multiple true or false (MTF) options with different negative scoring schemes and the Single Best of Five Answer (SBOFA) option of multiple choice questions are used in assessing knowledge in medical schools in Nigeria. There are diverse reasons for specific institutions to use a given scheme. These include large candidates' population, time pressure on those conducting the examination and limited resources. This study was set out to compare the performance of two negative scoring schemes of the MTF pattern of objective questions with the SBOFA pattern as the standard objective questions pattern in a medical school Methodology: In this cross-sectional comparative study, selected response items were administered to medical students. A set comprised of SBOFA options (taken here as A-score) and the other two, MTF options with different negative marking schemes; negative marking (-1/2) as B-score, and negative marking (-1) as C-score. The mean scores were compared among the three schemes. Cutoff or pass mark was 50% across-board. Correlation statistics, Bland Altman plots and ROC analyses were used to compare the two negative scoring schemes of the MTF pattern with the SBOFA pattern as the standard objective questions pattern Results: The mean scores of the students for the schemes were A-score 42.9%, B-score 45.6% and C-score 35.0%. The correlation between A-score and B-score was significant (r=0.351, p=0.009). A-score also correlated significantly with C-score, (r=0.381, p=0.004). In B-score versus A-score the bias was -2.6 (47.4%), limits of agreement -29.4 - 24.1 (20.6% -74.1%). In C-score versus A-score the bias was 8.1 (58.1%) and limits of agreement -21.5 - 37.7 (28.5%-087.7%). For B-score and A-score area under receiver operator curve (AUROC) was 0.720 and for C-score and A-score 0.714. B-score at best cutoff mark 45.0% (sensitivity 93%), predicted A-score 50.0%. C-sore at best cutoff mark 33.0% (sensitivity 93%) predicted A-score 50%.

CONCLUSION

The MTF objective questions with negative marking scheme of -1/2 as penalty and the SBOFA scheme were more closely related than the MTF with -1 as penalty and SBOFA option. The SBOFA option had better correlation with the MTF with -1 as penalty while the -1/2 penalty had a much higher pass rate.

Impaired Renal Function and its Predictors among Treatment-Naive HIV-seropositive Patients in a Tertiary Institution in South-East Nigeria

BACKGROUND

Renal impairment is a significant independent risk factor for mortality among HIV-infected patients. Some antiretroviral drugs are nephrotoxic, especially to the tubules, and their dosage need to be modified in the presence of renal impairment to avoid progression to chronic kidney disease.

AIM

To determine the prevalence and predictors of renal impairment among treatment-naïve HIV sero-positive patients seen at Federal Medical Centre, Umuahia, Abia state.

MATERIALS AND METHODS

This was a cross-sectional study involving 115 HIV-seropositive treatment-naïve cases and 115 seronegative controls. Questionnaires were administered and history regarding health status was obtained. Participants had biophysical profile measured. Blood and urine specimens were analyzed in the laboratory. The re-expressed modification of diet in renal disease (MDRD) was used to determine estimated Glomerular Filtration Rate (eGFR). Factors found to be associated with renal impairment were subjected to binary logistic regression analysis to determine the predictors of renal impairment.

RESULTS

The prevalence of renal impairment among the cases was 27.8%. Factors associated with renal impairment included duration of HIV diagnosis of 12 months and above, significant intake of herbal remedies, hypertension, significant proteinuria, WHO clinical stage 3 or 4, anaemia and CD4 count less than 350cells/µL. Predictors of renal impairment were hypertension, WHO clinical stage 3 or 4 disease, significant proteinuria and significant intake of herbal remedies.

CONCLUSION

Renal impairment was prevalent in this sample. Concerted efforts should be directed to early diagnosis of renal impairment among these patients. Reno-protective measures need to be instituted early to avoid deleterious outcomes.

Prevalence and Risk Factors for Diabetes Mellitus in A State in South East Nigeria: Results of a Population Based House to House Survey

BACKGROUND

Population based studies on diabetes mellitus (DM) are scarce in Nigeria.

INTRODUCTION

This was a population-based house to house survey aimed at determining the prevalence of DM and assessing the risk factors associated with DM in a state in Southeast Nigeria.

METHODS

This was a cross-sectional observational study in which 1680 adults were recruited using a multistage sampling method to randomly select not more than two suitable participants of both sex in each household from four enumeration areas (EAs) in each local government area (LGA) and the three senatorial zones in the state. A modified World Health Organization (WHO) Stepwise Approach to Surveillance questionnaire was used for data collection and random blood glucose (RBG) was measured after anthropometric assessment. Test statistics used were chi-square, t-test, and logistic regression.

RESULTS

The overall prevalence of DM in this study was 3.3%. A positive family history of DM was significantly higher in patients with diabetes: 18.2% vs. 9.6% (p=0.036). The mean (SD) of weight, body mass index (BMI), hip circumference (HC) and waist circumference (WC) were significantly higher in patients with DM(p=0.001,<0.001,<0.001,<0.001, respectively).The odd ratio (95% CI) of a person>35years developing DM was 3.89(1.11-13.60). The OR (95% CI) for waist-hip ratio (WHR) was 3.04 (1.02-9.03) and family history of DM had an OR of 2.62(0.88-6.50). The odd of developing DM is positively associated with age>35years, increased WHR, WC, family history of DM, BMI>25Kg/m2, and HC. The odd of developing DM was negatively associated with smoking.

CONCLUSION

The prevalence of DM in this study was 3.3%. A BMI>25 kg/m2, WHR >0.85, family history of DM, HC, and older age were associated with significantly higher prevalence.

Urine osmolality in treatment-naïve HIV-positive subjects in Southeast Nigeria

BACKGROUND AND OBJECTIVES

Urine osmolality varies over a wide range of values in a healthy state. Dilute urine or concentrated urine may be observed in many environmental, physiologic, and disease conditions. Urine osmolality is not commonly evaluated in routine clinical practice and in human immunodeficiency virus (HIV) subjects. The factors that influence urine osmolality have not been completely identified. The aim of this study was to evaluate urine osmolality in treatment-naïve HIV subjects and to identify the factors that may influence dilute and concentrated urine in this group of patients.

METHODOLOGY

This was a cross-sectional study of treatment-naive HIV subjects conducted in Federal Medical Centre (FMC), Owerri, Nigeria. Demographic and anthropometric data were obtained. Urine osmolality and other relevant investigations were conducted. Normal urine osmolality was defined as 24-h urine osmolality (24 HUOsm) 300-750 mOsm/kgH2O, dilute urine as 24 HUOsm 2O and concentrated urine as 24 HUOsm> 750 mOsm/kgH2O. The association between the variables and urine osmolality and the strength of variables to predict dilute urine and concentrated urine were determined.

RESULTS

The mean 24HUOsm was 564 ± 501 mOsm/kgH2O and the mean spot urine osmolality (SUOsm) 464 ± 271 mOsm/kgH2O. Normal urine osmolality was observed in 29.6%, dilute urine in 64.5%, and concentrated urine in 5.9% of the HIV subjects. There was a significant association between urine osmolality and body mass index (BMI), creatinine clearance, as well as serum cholesterol level. Only high-density lipoprotein cholesterol (HDL) predicted dilute urine, whereas BMI, spot urine protein, 24-h urine protein, spot urine creatinine, serum HDL, and CD4 cell count predicted concentrated urine.

CONCLUSION

The prevalence of dilute urine was high among the treatment-naïve HIV subjects. Abnormalities of serum lipids, renal function, and weight were common in treatment-naïve HIV subjects who had dilute urine. There is a need for clinicians to routinely assess urine osmolality and further diagnose for dyslipidemia, renal function impairment, and abnormal weight in HIV subjects at the early stage of the infection.

Urban-Rural Differences in Health-Care-Seeking Pattern of Residents of Abia State, Nigeria, and the Implication in the Control of NCDs

BACKGROUND

Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria.

METHODS

This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above. Data were collected using the modified World Health Organization’s STEPS questionnaire, including data on care seeking following the onset of illness. Descriptive statistics and logistic regressions were used to analyze care-seeking behavior and to identify differences among those seeking care in urban and rural areas.

RESULTS

In both urban and rural areas, patent medicine vendors (73.0%) were the most common sources of primary care following the onset of illness, while only 20.0% of the participants used formal care. Significant predictors of difference in care-seeking practices between residents in urban and rural communities were educational status, income, occupation, and body mass index.

CONCLUSIONS

Efforts should be made to reduce barriers to formal health-care service utilization in the state by increasing health insurance coverage, strengthening the health-care system, and increasing the role of patent medicine vendors in the formal health-care delivery system.

Obstetric outcomes of human herpes virus-2 infection among pregnant women in Benin, Nigeria

OBJECTIVE

This study investigated the obstetric outcomes of herpes simplex virus (HSV-2) infection among pregnant women.

MATERIALS AND METHODS

In this prospective cohort study, a total of 674 consenting pregnant women attending ante-natal clinic in the University of Benin Teaching Hospital and Central Hospital Benin were recruited between November 2011 and December, 2012. The women were screened for HSV-1, and HSV-2 using glycoprotein-G-based type-specific Enzyme Linked Immunosorbent Assay on archived blood samples; and were followed up to the delivery period and postnatal clinic. The HSV-2-seronegative participants underwent second blood sampling for HSV-2 IgG and IgM assay during the delivery period. The patients were thus categorized into "HSV-2 seropositive", "HSV-2-seronegative," and "incident HSV-2 infection" cohorts. The pregnancy outcomes were assessed by review of hospital records. Data analysis was with SPSS version 16 software.

RESULTS

Of 674 pregnant women surveyed, 312 (46.3%) were HSV-2 seropositive; while 362 (56.7%) were HSV-2 seronegative. Comparing the "HSV-2 seropositive" and "HSV-seronegative" groups, there were no significant differences in occurrence of low birth weight (LBW), prematurity, spontaneous abortions, and stillbirth events (P=0.96; 0.95; 1.0; and 0.77, respectively). Comparing the "incident HSV-2 infection" with the "HSV-2 seronegative" groups, the relative risks of occurrence of LBW deliveries, preterm deliveries, and stillbirths were 12.6, 25.1, and 4.5, respectively.

CONCLUSION

First episode HSV-2 infection among pregnant women in Benin, Nigeria is associated with an increased risk of occurrence of spontaneous abortion, LBW delivery, stillbirths, and preterm delivery.

Prevalence and predictors of chronic kidney disease in newly diagnosed human immunodeficiency virus patients in Owerri, Nigeria

Human immunodeficiency virus (HIV) infection is a common cause of chronic kidney disease (CKD) in Sub-Saharan Africa. This study aims at identifying the prevalence and predictors of CKD in newly diagnosed HIV patients in Owerri, South East Nigeria. This was a cross-sectional study consisting of 393 newly diagnosed HIV-seropositive subjects and 136 age- and sex-matched seronegative subjects as controls. CKD was defined as 24-hour urine protein (24-HUP) ≥0.3 g and/or glomerular filtration rate (GFR) < 60 ml/min. Subjects were recruited from the HIV clinic and the Medical Outpatient Department of Federal Medical Centre, Owerri. Clinical and anthropometric data were collected. Relevant investigations were performed, including HIV screening and relevant urine and blood investigations. The mean age of the HIV subjects was 38.84 ± 10.65 years. CKD was present in 86 (22.9%) HIV subjects and 11 (8.l %) controls. Low waist circumference (WC), high serum creatinine, high spot urine protein/creatinine ratio (SUPCR), high 24-HUP/creatinine Ratio (24-HUPCR), high 24-HUP/osmolality Ratio (24-HUPOR) predicted CKD in HIV subjects. CKD prevalence is high (22.9%) among newly diagnosed HIV patients in South East Nigeria. The predictors of CKD included WC, serum creatinine, SUPCR, 24-HUPCR, and 24-HUPOR.

Awareness level of kidney functions and diseases among adults in a Nigerian population

The prevalence of kidney diseases is on the increase in Nigeria. The cost of its management is far beyond the reach of an average patient. Prevention is thus of paramount importance and awareness of kidney diseases will help in its prevention. The aim of this study is to assess the level of awareness of kidney functions and diseases among adults in a Nigerian population. A semi-structured, researcher - administered questionnaire was the tool for data collection. Four hundred and thirty-five questionnaires were analyzed. There were 160 males (36.8%) and 275 females (63.2%). The mean age was 42.8 ± 14 years with a range of 18-78 years. Among these, 82.1% were aware of the kidneys' involvement in waste removal from the body through urine while 36% and 29% were aware of kidneys' role in blood pressure regulation and blood production, respectively. Only 26.6% correctly identified at least two basic functions of the kidneys. Also, 32.6% of the respondents were aware of at least three common causes of kidney diseases in our environment. Majority of the respondents (70.7%) did not know that kidney diseases could be inherited. Furthermore, belief in alternative therapy for kidney disease was documented in 83.2%, while unawareness of dialysis as a treatment modality was recorded in 68% of the respondents. The awareness of kidney functions and diseases among the population is poor. Measures are needed to improve this to stem the rising prevalence of chronic kidney disease in Nigeria.

Prevalence and determinants of hypertension in Abia State Nigeria: results from the Abia State Non-Communicable Diseases and Cardiovascular Risk Factors Survey

OBJECTIVE

Hypertension is the most common non-communicable disease and risk factor for heart failure, stroke, chronic kidney disease and ischemic heart disease in sub-Saharan Africa. Few population-based studies have been conducted recently in Nigeria and, in Abia State, no previous study has been conducted on the prevalence and correlates of hypertension among the populace. The purpose of our study was, therefore, to determine the prevalence and determinants of high blood pressure in Abia State, southeastern Nigeria. We hypothesise that high blood pressure burden is high in Abia State.

DESIGN

The study was a community based cross-sectional house-to-house survey aimed at ascertaining the burden/prevalence of hypertension in the state as well as identifying related risk factors associated with them.

SETTING

The study was conducted in rural and urban communities in Abia State, Nigeria.

PARTICIPANTS

Participants in the study were men and women aged > or =15 years and were recruited from the three senatorial zones in the state.

MAIN OUTCOMES

A total of 2,999 respondents were selected for the survey and, 2,983 consented to be interviewed giving a response rate of 99.5%. The data for 2,928 participants were suitable for analysis. Of these, 1,399 (47.8%) were men. The mean age of the population was 41.7 +/- 18.5 years (range 18-96 years). About 54% of the population were < or =40 years. Ninety percent had at least primary education with about 47% having completed secondary education. Expectedly, 96% of the respondents were Ibos, the predominant tribe in the southeastern part of the country. Women had significantly higher BMI than the men. Similarly, waist circumference was also larger in women but waist-to-hip ratio was only significantly higher in women in the urban areas compared to those in rural areas. Thirty-one percent of all participants had systolic hypertension (33.5% in men and 30.5% in women). This sex difference was statistically different in the urban area. On the other hand, diastolic hypertension was 22.5% in all the population (23.4% in men and 25.4% in women). Age and indices of obesity were the strongest predictors of blood pressure.

CONCLUSION

The prevalence of hypertension was high in our study both in rural and urban settings. The major determinants of blood pressure in our participants included age, sex, indices of obesity and pulse rate.

Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review

To review studies on hypertension in Nigeria over the past five decades in terms of prevalence, awareness and treatment and complications. Following our search on Pubmed, African Journals Online and the World Health Organization Global cardiovascular infobase, 1060 related references were identified out of which 43 were found to be relevant for this review. The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population, type of measurement and cut-off value used for defining hypertension. The prevalence is similar in men and women (7.9%-50.2% vs 3.5%-68.8%, respectively) and in the urban (8.1%-42.0%) and rural setting (13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5% (2000-2011). Awareness, treatment and control of hypertension were generally low with attendant high burden of hypertension related complications. In order to improve outcomes of cardiovascular disease in Africans, public health education to improve awareness of hypertension is required. Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.