Prevalence and factors associated with successful treatment of hypertension in sub-Saharan Africa: a meta-analysis
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20242185Keywords:
Sub-Saharan Africa, Hypertension, Uncontrolled blood pressure, Treatment outcome, FactorsAbstract
Hypertension is a growing public health challenge in sub-Saharan Africa (SSA). However, the evidence on the prevalence and factors associated with successful treatment outcome of hypertension among adults in SSA is scarce and inconsistent. We conducted a systematic review and meta-analysis of observational studies that reported on the prevalence and/or factors associated with successful treatment outcome of hypertension among adults in sub-Saharan Africa. The aim of this study was to provide a comprehensive and updated summary of the evidence on this topic and to identify potential sources of heterogeneity among the studies. We searched databases such as PubMed, Embase, National Institute of Health, CINAHL, and Scopus for studies conducted on the prevalence and factors associated with successful treatment of hypertension in sub-Saharan Africa. We searched for articles published in English from 2014 to 2024. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was followed. Analysis was done using Meta XL version 5.3. Twenty-four studies were included in the analysis; eighteen were conducted in Ethiopia. The pooled prevalence of uncontrolled hypertension was 54% (95% CI: 0.48-0.60) with a high heterogeneity observed among the studies (I2=97%). Factors associated with treatment outcomes included gender, adherence to medication, obesity, and physical activity. This study revealed that there was a significant association between sex, adherence to medication, physical activity and obesity and hypertension treatment outcome.
Metrics
References
World Health Organization. Hypertension. 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed on 09 March 2024.
Centres for Disease Control and Prevention. High Blood Pressure Symptoms and Causes. 2021. Available at: https://www.cdc.gov/bloodpressure/ about.htm. Accessed on 09 March 2024.
Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004;22(1):11-9.
Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA. 2006;295(2):180-9.
Guwatudde D, Nankya-Mutyoba J, Kalyesubula R, Laurence C, Adebamowo C, Ajayi I, et al. The burden of hypertension in sub-Saharan Africa: a four-country cross sectional study. BMC Public Health. 2015;15:1-8.
Schutte AE, Srinivasapura Venkateshmurthy N, Mohan S, Prabhakaran D. Hypertension in Low- and Middle-Income Countries. Circ Res. 2021;128(7):808-26.
Eman Yahia Abbas Abdel-Maksoud FHM, Elauoty RM. Assesment of the Level of Compliance with Therapeutic Regimen among Patients with Hypertension. J Complement Med Res. 2023;14(5):236-43.
Labata BG, Ahmed MB, Mekonen GF, Daba FB. Prevalence and predictors of self care practices among hypertensive patients at Jimma University Specialized Hospital, Southwest Ethiopia: cross-sectional study. BMC Res Notes. 2019;12:1-8.
Gebremichael GB, Berhe KK, Zemichael TM. Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018. BMC Cardiovasc Disord. 2019;19:1-10.
Konlan KD, Shin J. Determinants of Self-Care and Home-Based Management of Hypertension: An Integrative Review. Global Heart. 2023;18(1):16.
Pengpid S, Peltzer K. Prevalence, awareness, treatment and control of hypertension among adults in Kenya: cross-sectional national population-based survey. East Mediterr Health J. 2020;26(8):923-32.
Mohamed SF, Mutua MK, Wamai R, Wekesah F, Haregu T, Juma P, et al. Prevalence, awareness, treatment and control of hypertension and their determinants: results from a national survey in Kenya. BMC Public Health. 2018;18:1-10.
Maginga J, Guerrero M, Koh E, Holm Hansen C, Shedafa R, Kalokola F, et al. Hypertension control and its correlates among adults attending a hypertension clinic in Tanzania. J Clin Hypertens. 2016;18(3):207-16.
Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Mol PG. Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia. BMJ Open. 2017;7(8):e015743.
Kebede B, Chelkeba L, Dessie B. Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study. SAGE Open Med. 2021;9:10.
Horsa BA, Tadesse Y, Engidawork E. Assessment of hypertension control and factors associated with the control among hypertensive patients attending at Zewditu Memorial Hospital: a cross sectional study. BMC Res Notes. 2019;12(1):152.
Okai DE, Manu A, Amoah EM, Laar A, Akamah J, Torpey K. Patient-level factors influencing hypertension control in adults in Accra, Ghana. BMC Cardiovasc Disord. 2020;20:1-7.
Menanga A, Edie S, Nkoke C, Boombhi J, Musa AJ, Mfeukeu LK, et al. Factors associated with blood pressure control amongst adults with hypertension in Yaounde, Cameroon: a cross-sectional study. Cardiovasc Diagnosis Therapy. 2016;6(5):439.
Aberhe W, Mariye T, Bahrey D, Zereabruk K, Hailay A, Mebrahtom G, et al. Prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients on follow-up at Northern Ethiopia, 2019: cross-sectional study. Pan Afr Med J. 2020;36:187.
Amare F, Nedi T, Berhe DF. Blood pressure control practice and determinants among ambulatory hypertensive patients attending primary health care facilities in Addis Ababa. SAGE Open Med. 2020;8:2050312120946521.
Melaku T, Bayisa B, Fekeremaryam H, Feyissa A, Gutasa A. Self-care practice among adult hypertensive patients at ambulatory clinic of tertiary teaching Hospital in Ethiopia: a cross-sectional study. J Pharm Policy Pract. 2022;15(1):23.
Solomon M, Negussie YM, Bekele NT, Getahun MS, Gurara AM. Uncontrolled blood pressure and associated factors in adult hypertensive patients undergoing follow-up at public health facility ambulatory clinics in Bishoftu town, Ethiopia: a multi-center study. BMC Cardiovasc Disord. 2023;23(1):258.
Teshome DF, Demssie AF, Zeleke BM. Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia. PLoS One. 2018;13(5):e0196535.
Sarfo FS, Mobula LM, Burnham G, Ansong D, Plange-Rhule J, Sarfo-Kantanka O, et al. Factors associated with uncontrolled blood pressure among Ghanaians: Evidence from a multicenter hospital-based study. PLoS One. 2018;13(3):e0193494.
Omar, S.M., O. Elnour, G.K. Adam, O.E. Osman and I. Adam, Assessment of blood pressure control in adult hypertensive patients in eastern Sudan. BMC Cardiovasc Disord. 2018;18(1):26.
Goverwa TP, Masuka N, Tshimanga M, Gombe NT, Takundwa L, Bangure D, et al. Uncontrolled hypertension among hypertensive patients on treatment in Lupane District, Zimbabwe, 2012. BMC Res Notes. 2014;7:703.
Gebrihet TA, Mesgna KH, Gebregiorgis YS, Kahsay AB, Weldehaweria NB, Weldu MG. Awareness, treatment, and control of hypertension is low among adults in Aksum town, Northern Ethiopia: A sequential quantitative-qualitative study. PLoS One. 2017;12(5):e0176904.
Fentaw Z, Adamu K, Wedajo S. Blood pressure control status of patients with hypertension on treatment in Dessie City Northeast Ethiopia. BMC Public Health. 2022;22(1):917.
Fekadu G, Adamu A, Gebre M, Gamachu B, Bekele F, Abadiga M, et al., Magnitude and Determinants of Uncontrolled Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Nekemte Referral Hospital, Western Ethiopia. Integr Blood Press Control. 2020;13:49-61.
Dedefo MG, Gemechu DB, Fekadu G, Tekle Dibessa T. Blood Pressure Control among Hypertensive Diabetic Patients on Follow-Up at Chronic Clinic of Nekemte Referral Hospital in West Ethiopia. Int J Hypertens. 2020;2020:7526257.
Asgedom SW, Gudina EK, Desse TA. Assessment of Blood Pressure Control among Hypertensive Patients in Southwest Ethiopia. PLoS One. 2016;11(11):e0166432.
Asgedom SW, Atey TM, Desse TA. Antihypertensive medication adherence and associated factors among adult hypertensive patients at Jimma University Specialized Hospital, southwest Ethiopia. BMC Res Notes. 2018;11(1):27.
Abdisa L, Girma S, Lami M, Hiko A, Yadeta E, Geneti Y, et al., Uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at public hospitals, Eastern Ethiopia: A multicenter study. SAGE Open Med. 2022;10:20503121221104442.
Animut Y, Assefa AT, Lemma DG. Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study. Integr Blood Press Control. 2018;11:37-46.
Abegaz TM, Abdela OA, Bhagavathula AS, Teni FS. Magnitude and determinants of uncontrolled blood pressure among hypertensive patients in Ethiopia: hospital-based observational study. Pharm Pract (Granada). 2018;16(2):1173.
Cheong AT, Sazlina SG, Tong SF, Azah AS, Salmiah S. Poor blood pressure control and its associated factors among older people with hypertension: a cross-sectional study in six public primary care clinics in Malaysia. Malaysian Fam Physician. 2015;10(1):19.
Olowe OA, Ross AJ. Knowledge, adherence and control among patients with hypertension attending a peri-urban primary health care clinic, KwaZulu-Natal. Afr J Prim Health Care Fam Med. 2017;9(1):e1-7.
Tesfaye B, Haile D, Lake B, Belachew T, Tesfaye T, Abera H. Uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at Jimma University Teaching and Specialized Hospital: cross-sectional study. Res Rep Clin Cardiol. 2017;30:21-9.
Rahman MM, Gilmour S, Akter S, Abe SK, Saito E, Shibuya K. Prevalence and control of hypertension in Bangladesh: a multilevel analysis of a nationwide population-based survey. J Hypertens. 2015;33(3):465-72.
Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310(9):959-68.
Kalavathy MC, Thankappan KR, Sarma PS, Vasan RS. Prevalence, awareness, treatment and control of hypertension in an elderly community-based sample in Kerala, India. Natl Med J India. 2000;13(1):9-15.
Son PT, Quang NN, Viet NL, Khai PG, Wall S, Weinehall L, et al. Prevalence, awareness, treatment and control of hypertension in Vietnam—results from a national survey. J Human Hypertens. 2012;26(4):268-80.
Choudhary R, Sharma SM, Kumari V, Gautam D. Awareness, treatment adherence and risk predictors of uncontrolled hypertension at a tertiary care teaching hospital in Western India. Indian Heart J. 2016;68(2):S251-2.
Yang L, Xu X, Yan J, Yu W, Tang X, Wu H, et al. Analysis on associated factors of uncontrolled hypertension among elderly hypertensive patients in Southern China: a community-based, cross-sectional survey. BMC Public Health. 2014;14:903.
Dzudie A, Kengne AP, Muna WF, Ba H, Menanga A, Kouam CK, et al. Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study. BMJ Open. 2012;2(4):e001217.
Ekwunife OI, Udeogaranya PO, Nwatu IL. Prevalence, awareness, treatment and control of hypertension in a Nigerian population. Health. 2010;02(07):731-5.
Babiker FA, Elkhalifa LA, Moukhyer ME. Awareness of hypertension and factors associated with uncontrolled hypertension in Sudanese adults. Cardiovasc J Afr. 2013;24(6):208-12.
Nguyen HT, Hoang Thi Phuong N, Tran Nguyen N, Nguyen Anh T, Nguyen Dang V. Characterizing Patients with Uncontrolled Blood Pressure at an Urban Hospital in Hanoi, Vietnam. Int J Hypertens. 2020;2020:5710281.
Ikama MS, Nsitou BM, Makani J, Nkalla-Lambi M, Passi-Louamba C. Arterial hypertension and control in Brazzaville (Congo): role of ambulatory blood pressure monitoring (ABPM). Ann Cardiol Angeiol (Paris). 2015;64(2):76-80.
Essayagh T, Essayagh M, El Rhaffouli A, Khouchoua M, Bukassa Kazadi G, Khattabi A, et al. Prevalence of uncontrolled blood pressure in Meknes, Morocco, and its associated risk factors in 2017. PLoS One. 2019;14(8):e0220710.
Elperin DT, Pelter MA, Deamer RL, Burchette RJ. A large cohort study evaluating risk factors associated with uncontrolled hypertension. J Clin Hypertens (Greenwich). 2014;16(2):149-54.
Jafar TH, Gandhi M, Jehan I, Naheed A, de Silva HA, Shahab H, et al. Determinants of Uncontrolled Hypertension in Rural Communities in South Asia-Bangladesh, Pakistan, and Sri Lanka. Am J Hypertens. 2018;31(11):1205-14.
Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, et al. Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association. Hypertension. 2022;79(1):e1-14.
Bell K, Twiggs J, Olin BR. Hypertension: the silent killer: updated JNC-8 guideline recommendations. Alabama Pharmacy Association. 2015;334.
Lynch WD, Markosyan K, Melkonian AK, Pesa J, Kleinman NL. Effect of antihypertensive medication adherence among employees with hypertension. Am J Manag Care. 2009;15(12):871-80.
Gebremichael GB, Berhe KK, Zemichael TM. Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018. BMC Cardiovasc Disord. 2019;19(1):121.
Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. 2013;15(6):659-68.
Rezaeian S, Ahmadzadeh J. Blood Pressure Control in Hypertensive Patients, Iran: A Cross-Sectional Study. Int J Collab Res Int Med Public Health. 2012;4(12):1952-8.
Jesky MD, Hayer MK, Thomas M, Dasgupta I. Do Obese Individuals With Hypertension Have More Difficult-to-Control Blood Pressure and End Organ Damage Than Their Nonobese Counterparts? J Clin Hypertens (Greenwich). 2015;17(6):466-72.
Madigan CD, Graham HE, Sturgiss E, Kettle VE, Gokal K, Biddle G, et al. Effectiveness of weight management interventions for adults delivered in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2022;377:e069719.