title: Hypertension in four African-origin populations: current 'Rule of Halves', quality of blood pressure control and attributable risk of cardiovascular disease.
abstract: OBJECTIVE
  To assess the public health burden from high blood pressure and the current status of its detection and management in four African-origin populations at emerging or high cardiovascular risk.
  
  
  METHODS
  Cross-site comparison using standardized measurement and techniques.
  
  
  METHODS
  Rural and urban Cameroon; Jamaica; Manchester, Britain.
  
  
  METHODS
  Representative population samples in each setting. African-Caribbeans (80% of Jamaican origin) and a local European sample in Manchester.
  
  
  METHODS
  Cross-site age-adjusted prevalence; population attributable risk.
  
  
  RESULTS
  Among 1,587 men and 2,087 women, age-adjusted rates of blood pressure > or =160 or 95 mmHg or its treatment rose from 5% in rural to 17% in urban Cameroon, despite young mean ages, to 21% in Jamaica and 29% in Caribbeans in Britain. Treatment rates reached 34% in urban Cameroon, and 69% in Jamaican- and British-Caribbean-origin women. Sub-optimal blood pressure control (> 140 and 90 mmHg) on treatment reached 88% in European women. Population attributable risks (or fractions) indicated that up to 22% of premature all-cause, and 45% of stroke mortality could be reduced by appropriate detection and treatment. Additional benefit on just strokes occurring on treatment could be up to 47% (e.g. in both urban Cameroon men and European women) from tighter blood pressure control on therapy. Cheap, effective therapy is available.
  
  
  CONCLUSIONS
  With mortality risk now higher from non-communicable than communicable diseases in sub-Saharan Africa and elsewhere, systematic measurement, detection and genuine control of hypertension once treated can go hand-in-hand with other adult health programmes in primary care. Cost implications are not great. The data from this collaborative study suggest that such efforts should be well rewarded.
authors.affiliation: Clinical Epidemiology Group, University of Manchester Medical School, UK. clinep@man.ac.uk
authors.forename: J K
authors.initials: JK
authors.lastname: Cruickshank
authors.forename: J C
authors.initials: JC
authors.lastname: Mbanya
authors.forename: R
authors.initials: R
authors.lastname: Wilks
authors.forename: B
authors.initials: B
authors.lastname: Balkau
authors.forename: T
authors.initials: T
authors.lastname: Forrester
authors.forename: S G
authors.initials: SG
authors.lastname: Anderson
authors.forename: L
authors.initials: L
authors.lastname: Mennen
authors.forename: A
authors.initials: A
authors.lastname: Forhan
authors.forename: L
authors.initials: L
authors.lastname: Riste
authors.forename: N
authors.initials: N
authors.lastname: McFarlane-Anderson
mesh_terms: D000328:Adult; D044383:Black People; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination / Q000592:standards*; D002163:Cameroon / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000503:physiopathology; D007563:Jamaica / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D001741:Black or African American