Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)

Abstract

Background Few studies have characterized epidemiology and management of hypertension across several communities with comparable methodology in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods Between June and August 2018, we conducted household surveys in 7 communities in Kenya, Nigeria, Tanzania, and Uganda and collected data on socio-demographics, health insurance, and healthcare utilization. We measured blood pressure using a standardized protocol and digital monitors. We estimated 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fit hierarchical models to identify determinants of hypertension prevalence, awareness and treatment. Results We analyzed data of 3549 participants with a mean age of 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked, and 32·7% were overweight/obese. A quarter (901, 25·1% (95% Confidence Interval 23·7%, 26·6%)) of participants had hypertension, half of whom (515, 57·6%) were diagnosed. Among diagnosed, 50·5% (260) were taking medication, and among those taking medication 47·3%(123) were controlled. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% Interquartile range, IQR (2·4%, 10·3%) and 13·2% had risk of 20% or greater while 7·1% had risk of > 30%. Conclusion In seven communities in east and west Africa, a quarter of adults had hypertension, about 40% were unaware, half of those aware were treated and half of those treated were controlled blood pressure. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.