title: Regional and Sex Differences in the Prevalence and Awareness of Hypertension: An H3Africa AWI-Gen Study Across 6 Sites in Sub-Saharan Africa.
abstract: There is a high prevalence of hypertension and related cardiovascular diseases in sub-Saharan Africa, yet few large studies exploring hypertension in Africa are available. The actual burden of disease is poorly understood and awareness and treatment to control it is often suboptimal.
  
  
  
  The study sought to report the prevalence of measured hypertension and to assess awareness and control of blood pressure among older adults in rural and urban settings in 6 sites located in West, East, and Southern Africa. In addition, we examined regional, sex, and age differences related to hypertension.
  
  
  
  A population-based cross-sectional study was performed at 6 sites in 4 African countries: Burkina Faso (Nanoro), Ghana (Navrongo), Kenya (Nairobi), and South Africa (Agincourt, Dikgale, Soweto). Blood pressure measurements were taken using standardized procedures on 10,696 adults 40 to 60 years of age. Hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or taking antihypertensive medication.
  
  
  
  The mean prevalence of hypertension ranged from 15.1% in Nanoro to 54.1% in Soweto. All 3 of the South African sites had a mean prevalence of hypertension of over 40.0%, significantly higher than in Nairobi (25.6%) and Navrongo (24.5%). Prevalence increased with age in both sexes and at all sites. A significantly higher prevalence of hypertension was observed in women in Agincourt, Dikgale, and Nairobi, whereas in Nanoro this trend was reversed. Within the hypertensive group the average proportion of participants who were aware of their blood pressure status was only 39.4% for men and 53.8% for women, and varied widely across sites.
  
  
  
  Our study demonstrates that the prevalence of hypertension and the level of disease awareness differ not only between but also within sub-Saharan African countries. Each nation must tailor their regional hypertension awareness and screening programs to match the characteristics of their local populations.
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Gómez-Olivé
authors.affiliation: Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Ali
authors.affiliation: Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Felix
authors.initials: F
authors.lastname: Made
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kyobutungi
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana.
authors.forename: Engelbert
authors.initials: E
authors.lastname: Nonterah
authors.affiliation: MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Lisa
authors.initials: L
authors.lastname: Micklesfield
authors.affiliation: Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa.
authors.forename: Marianne
authors.initials: M
authors.lastname: Alberts
authors.affiliation: Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso.
authors.forename: Romuald
authors.initials: R
authors.lastname: Boua
authors.affiliation: Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Scott
authors.initials: S
authors.lastname: Hazelhurst
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Debpuur
authors.affiliation: Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa.
authors.forename: Felistas
authors.initials: F
authors.lastname: Mashinya
authors.affiliation: Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa.
authors.forename: Sekgothe
authors.initials: S
authors.lastname: Dikotope
authors.affiliation: Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso.
authors.forename: Hermann
authors.initials: H
authors.lastname: Sorgho
authors.affiliation: Physical Activity Epidemiology Laboratory (EDST), School of Education, Faculty of Humanities, University of Limpopo, Polokwane, South Africa.
authors.forename: Ian
authors.initials: I
authors.lastname: Cook
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya.
authors.forename: Stella
authors.initials: S
authors.lastname: Muthuri
authors.affiliation: Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Soo
authors.affiliation: Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Freedom
authors.initials: F
authors.lastname: Mukomana
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana.
authors.forename: Godfred
authors.initials: G
authors.lastname: Agongo
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wandabwa
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Sulaimon
authors.initials: S
authors.lastname: Afolabi
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana.
authors.forename: Abraham
authors.initials: A
authors.lastname: Oduro
authors.affiliation: Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso.
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Wagner
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya.
authors.forename: Tilahun
authors.initials: T
authors.lastname: Haregu
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Alisha
authors.initials: A
authors.lastname: Wade
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.affiliation: MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Shane A
authors.initials: SA
authors.lastname: Norris
authors.affiliation: Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Crowther
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tollman
authors.affiliation: INDEPTH Network, Accra, Ghana; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Mathematics and Statistics, Njala University, Njala, Sierra Leone.
authors.forename: Osman
authors.initials: O
authors.lastname: Sankoh
authors.affiliation: Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: michele.ramsay@wits.ac.za.
authors.forename: Michèle
authors.initials: M
authors.lastname: Ramsay
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D001364:Awareness; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012423:Rural Health; D017678:Sex Distribution; D012737:Sex Factors; D014504:Urban Health