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. 2020 Jun 15:413:116770.
doi: 10.1016/j.jns.2020.116770. Epub 2020 Mar 4.

Low blood pressure levels & incident stroke risk among elderly Ghanaians with hypertension

Fred Stephen Sarfo  1 , Linda Meta Mobula  2 , Titus Adade  3 , Yvonne Commodore-Mensah  2 , Martin Agyei  4 , Collins Kokuro  4 , Rexford Adu-Gyamfi  3 , Christiana Duah  5 , Bruce Ovbiagele  6
Affiliations

Low blood pressure levels & incident stroke risk among elderly Ghanaians with hypertension

Fred Stephen Sarfo et al. J Neurol Sci. .

Abstract

Background: Clinical trial data indicate that more intensive blood pressure (BP) lowering below standard cut-off targets is associated with lower risks of strokes in the elderly. There is a relative paucity of real-world practice data on this issue, especially among Africans.

Objective: To assess BP control rates, its determinants, and whether a lower BP < 120/80 mmHg is associated with a lower incident stroke risk among elderly Ghanaians with hypertension.

Methods: We retrospectively evaluated data, which were prospectively collected as part of a cohort study involving adults with hypertension and/or diabetes in 5 Ghanaian hospitals. BP control was defined using the JNC-8 guideline of <150/90 mmHg for elderly with hypertension aged >60 years or 140/90 mmHg for those with diabetes mellitus. Risk factors for poor BP control were assessed using multivariable logistic regression models. We calculated incident stroke risk over an 18-month follow-up at 3 BP cut-off's of <120/80, 120-159/80-99, and > 160/100 mmHg.

Results: Of the 1365 elderly participants with hypertension, 38.2% had diabetes mellitus and 45.8% had uncontrolled BP overall. Factors associated with uncontrolled BP were higher number of antihypertensive medications prescribed adjusted odds ratio of 1.45 (95% CI: 1.27-1.66), and having diabetes 2.56 (1.99-3.28). Among the elderly, there were 0 stroke events/100py for BP < 120/80 mmHg, 1.98 (95%CI: 1.26-2.98) for BP between 120 and 159/80-99 mmHg and 2.46 events/100py (95% CI: 1.20-4.52 at BP > 160/100 mmHg.

Conclusion: A lower BP target <120/80 mmHg among elderly Ghanaians with hypertension is associated with a signal of lower incident stroke risk. Pragmatic trials are needed to evaluate lower BP targets on stroke incidence in Africa.

Keywords: Africa; BP thresholds; Elderly; Stroke risk.

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Conflict of interest statement

Declaration of Competing Interest The authors do not have any competing interests. Funding for this study was provided by MSD, Novartis, Pfizer, Sanofi (each a Participant Company) and the Bill and Melinda Gates Foundation (collectively, the Funders) through the New Venture Fund (NVF). The NVF is a not-for-profit organization exempt as a public charity under section 501(c)(3) of the United States Internal Revenue Code of 1986, and assumes financial management of the study as a fiduciary agent and primary contractor for the Funders. Consistent with anti-trust laws that govern industry interactions, each Participant Company independently and voluntarily will continue to develop its own marketing and pricing strategies reflecting, among other factors, the Company's product portfolios and the patients it serves. For the avoidance of doubt, the Participant Companies committed not to: (i) discuss any price or marketing strategy that may involve any Project-related product; or (ii) make any decision with respect to the presence, absence or withdrawal of any Participant Company in or from any therapeutic area; or (iii) discuss the launching, maintaining or withdrawing of any product in any market whatsoever. Each Participant Company is solely responsible for its own compliance with applicable anti-trust laws. The Funders were kept apprised of progress in developing and implementing the study program in Ghana but had no role in study design, data collection, data analysis or in study report writing. FSS was supported by National Institute of Health- National Institute of Neurological Disorders & Stroke; R21 NS094033.

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