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Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey

INTRODUCTION: Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in sub-Saharan Africa. Few studies have examined performance on the management of hypertension in this region, where the context may be distinct from other developing regions. OBJEC...

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Autores principales: Tapela, Neo M., Clifton, Lei, Tshisimogo, Gontse, Gaborone, Moagi, Madidimalo, Tebogo, Letsatsi, Virginia, Masupe, Tiny, Mosepele, Mosepele, Makhema, Joseph, Lockman, Shahin, Hunter, David J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281842/
https://www.ncbi.nlm.nih.gov/pubmed/32550019
http://dx.doi.org/10.1155/2020/8082341
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author Tapela, Neo M.
Clifton, Lei
Tshisimogo, Gontse
Gaborone, Moagi
Madidimalo, Tebogo
Letsatsi, Virginia
Masupe, Tiny
Mosepele, Mosepele
Makhema, Joseph
Lockman, Shahin
Hunter, David J.
author_facet Tapela, Neo M.
Clifton, Lei
Tshisimogo, Gontse
Gaborone, Moagi
Madidimalo, Tebogo
Letsatsi, Virginia
Masupe, Tiny
Mosepele, Mosepele
Makhema, Joseph
Lockman, Shahin
Hunter, David J.
author_sort Tapela, Neo M.
collection PubMed
description INTRODUCTION: Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in sub-Saharan Africa. Few studies have examined performance on the management of hypertension in this region, where the context may be distinct from other developing regions. OBJECTIVES: We aimed to determine the prevalence and correlates of hypertension, awareness, treatment, and control among adults in Botswana, a middle-income African country undergoing rapid demographic transition and with high HIV burden. METHODS: In this 2014 cross-sectional survey of adults aged 15–69 years, information on sociodemographic characteristics, lifestyle behavior, and medical history was collected through in-person interviews and physical measurements (body mass index and triplicate blood pressure (BP)). Hypertension was defined as self-report of use of antihypertensives in the previous two weeks and/or having elevated BP (≥140/90 mmHg). Multivariable logistic regression was employed to explore factors associated with hypertension, awareness (report of previous diagnosis), treatment (antihypertensives), and control (BP < 140/90). RESULTS: Our analysis (N = 4,007) yielded an age-standardized hypertension prevalence of 30% (95% CI: 28%–32%, N = 1,393). Among hypertensives, 54% (50–58%) were unaware of their condition, 45% (40–50%) of those aware were untreated, and 63% (55–70%) of those on medications were suboptimally treated (BP ≥ 140/90 mmHg). A fifth of hypertensives who were diagnosed but not on medications had BP ≥ 180/110 mmHg. Diabetes was the strongest correlate of hypertension and awareness (aOR 4.00, 1.86–8.59; aOR 3.30, 1.44–7.55, respectively). Males were less likely to be aware (aOR 0.62, 0.41–0.94) or controlled (aOR 0.36, 0.16–0.83). Obese individuals were more likely to be treated (aOR 2.17, 1.12–4.22), yet less likely to be controlled (aOR 0.32, 0.15–0.66). CONCLUSIONS: We report the first nationally representative estimates of the hypertension care cascade performance in Botswana, which will support planning and future policy evaluations. Findings contribute to the relatively sparse evidence on this subject and may inform development of innovations that improve quality of hypertension management and adherence support in similar settings.
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spelling pubmed-72818422020-06-16 Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey Tapela, Neo M. Clifton, Lei Tshisimogo, Gontse Gaborone, Moagi Madidimalo, Tebogo Letsatsi, Virginia Masupe, Tiny Mosepele, Mosepele Makhema, Joseph Lockman, Shahin Hunter, David J. Int J Hypertens Research Article INTRODUCTION: Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in sub-Saharan Africa. Few studies have examined performance on the management of hypertension in this region, where the context may be distinct from other developing regions. OBJECTIVES: We aimed to determine the prevalence and correlates of hypertension, awareness, treatment, and control among adults in Botswana, a middle-income African country undergoing rapid demographic transition and with high HIV burden. METHODS: In this 2014 cross-sectional survey of adults aged 15–69 years, information on sociodemographic characteristics, lifestyle behavior, and medical history was collected through in-person interviews and physical measurements (body mass index and triplicate blood pressure (BP)). Hypertension was defined as self-report of use of antihypertensives in the previous two weeks and/or having elevated BP (≥140/90 mmHg). Multivariable logistic regression was employed to explore factors associated with hypertension, awareness (report of previous diagnosis), treatment (antihypertensives), and control (BP < 140/90). RESULTS: Our analysis (N = 4,007) yielded an age-standardized hypertension prevalence of 30% (95% CI: 28%–32%, N = 1,393). Among hypertensives, 54% (50–58%) were unaware of their condition, 45% (40–50%) of those aware were untreated, and 63% (55–70%) of those on medications were suboptimally treated (BP ≥ 140/90 mmHg). A fifth of hypertensives who were diagnosed but not on medications had BP ≥ 180/110 mmHg. Diabetes was the strongest correlate of hypertension and awareness (aOR 4.00, 1.86–8.59; aOR 3.30, 1.44–7.55, respectively). Males were less likely to be aware (aOR 0.62, 0.41–0.94) or controlled (aOR 0.36, 0.16–0.83). Obese individuals were more likely to be treated (aOR 2.17, 1.12–4.22), yet less likely to be controlled (aOR 0.32, 0.15–0.66). CONCLUSIONS: We report the first nationally representative estimates of the hypertension care cascade performance in Botswana, which will support planning and future policy evaluations. Findings contribute to the relatively sparse evidence on this subject and may inform development of innovations that improve quality of hypertension management and adherence support in similar settings. Hindawi 2020-05-31 /pmc/articles/PMC7281842/ /pubmed/32550019 http://dx.doi.org/10.1155/2020/8082341 Text en Copyright © 2020 Neo M. Tapela et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Tapela, Neo M.
Clifton, Lei
Tshisimogo, Gontse
Gaborone, Moagi
Madidimalo, Tebogo
Letsatsi, Virginia
Masupe, Tiny
Mosepele, Mosepele
Makhema, Joseph
Lockman, Shahin
Hunter, David J.
Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey
title Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey
title_full Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey
title_fullStr Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey
title_full_unstemmed Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey
title_short Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey
title_sort prevalence and determinants of hypertension awareness, treatment, and control in botswana: a nationally representative population-based survey
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281842/
https://www.ncbi.nlm.nih.gov/pubmed/32550019
http://dx.doi.org/10.1155/2020/8082341
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