Regional Patterns and Association Between Obesity and Hypertension in Africa: Evidence From the H3Africa CHAIR Study

Onoja M Akpa^{1

2

3

4}, Felix Made^{5

4}, Akinlolu Ojo⁶, Bruce Ovbiagele⁷, Dwomoa Adu⁸, Ayesha A Motala⁹, Bongani M Mayosi¹⁰, Sally N Adebamowo¹¹, Mark E Engel¹², Bamidele Tayo¹³, Charles Rotimi¹⁴, Babatunde Salako¹, Rufus Akinyemi¹, Mulugeta Gebregziabher¹⁵, Fred Sarfo¹⁶, Kolawole Wahab¹⁷, Godfred Agongo¹⁸, Marianne Alberts¹⁹, Stuart A Ali⁴, Gershim Asiki²⁰, Romuald P Boua²¹, F Xavier Gómez-Olivé²², Felistas Mashinya¹⁹, Lisa Micklesfield²³, Shukri F Mohamed²⁰, Engelbert A Nonterah¹⁸, Shane A Norris²³, Hermann Sorgho²¹, Stephen Tollman²², Rulan S Parekh²⁴, Chishala Chishala¹², Kenneth Ekoru²⁵, Salina P Waddy²⁶, Emmanuel Peprah²⁷, George A Mensah²⁸, Ken Wiley²⁹, Jennifer Troyer³⁰, Michèle Ramsay^#⁴, Mayowa O Owolabi^#¹; as members of the CVD Working Group of the H3Africa Consortium

Affiliations

¹ From the Center for Genomic and Precision Medicine, College of Medicine, (O.M.A., B.S., R.A., M.O.O.), University of Ibadan, Ibadan, Nigeria.
² Department of Epidemiology and Medical Statistics, College of Medicine (O.M.A.), University of Ibadan, Ibadan, Nigeria.
³ Institute of Cardiovascular Diseases, College of Medicine (O.M.A.), University of Ibadan, Ibadan, Nigeria.
⁴ Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (O.M.A., F. Made, S.A.A., M.R.).
⁵ The Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Services, Gauteng Region, South Africa (F. Made).
⁶ Clinical research and global health initiatives, University of Arizona Health Sciences (A.O.).
⁷ Department of Neurology, University of California, San Francisco CA, USA (B.O.).
⁸ School of Medicine and Dentistry, University of Ghana, Accra, Ghana (D.A.).
⁹ Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa (A.A.M.).
¹⁰ Department of Medicine, Groote Schuur Hospital (B.M.M.), University of Cape Town, South Africa.
¹¹ Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA (S.N.A.).
¹² Division of Cardiology, Department of Medicine (M.E.E., C.C.), University of Cape Town, South Africa.
¹³ Department of Preventive Medicine and Epidemiology, Loyola University Chicago Stritch School of Medicine, Maywood, IL (B.T.).
¹⁴ Center for Research on Genomics and Global Health, NHGRI, NIH, Bethesda, MD, USA (C.R.).
¹⁵ Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA (M.G.).
¹⁶ Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S.).
¹⁷ Department of Medicine, University of Ilorin, Nigeria (K. Wahab).
¹⁸ Navrongo Health Research Centre, Ghana (G. Agongo, E.A.N.).
¹⁹ Department of Pathology and Medical Science, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa (M.A., F. Mashinya).
²⁰ African Population and Health Research Center, Nairobi, Kenya (G. Asiki, S.F.M.).
²¹ Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Burkina Faso (R.P.B., H.S.).
²² 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 (F.X.G.-O., S.T.).
²³ MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (L.M., S.A.N.).
²⁴ Departments of Pediatrics, Medicine and Epidemiology, Hospital for Sick Children, University Health Network and University of Toronto, Canada (R.S.P.).
²⁵ Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (K.E.).
²⁶ Department of Neurology, Atlanta Veterans Affairs Medical Center, Decatur, GA (S.P.W.).
²⁷ College of Global Public Health, New York University, New York, NY (E.P.).
²⁸ Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD (G.A.M.).
²⁹ Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD (K. Wiley).
³⁰ Human Heredity and Health in Africa, Division of Genome Sciences (J.T.), National Institutes of Health, Bethesda, MD.

^# Contributed equally.

PMID: 32172619
PMCID: PMC7176339
DOI: 10.1161/HYPERTENSIONAHA.119.14147

Comparative Study

Regional Patterns and Association Between Obesity and Hypertension in Africa: Evidence From the H3Africa CHAIR Study

Onoja M Akpa et al. Hypertension. 2020 May.

. 2020 May;75(5):1167-1178.

doi: 10.1161/HYPERTENSIONAHA.119.14147. Epub 2020 Mar 16.

Authors

Affiliations

¹ From the Center for Genomic and Precision Medicine, College of Medicine, (O.M.A., B.S., R.A., M.O.O.), University of Ibadan, Ibadan, Nigeria.
² Department of Epidemiology and Medical Statistics, College of Medicine (O.M.A.), University of Ibadan, Ibadan, Nigeria.
³ Institute of Cardiovascular Diseases, College of Medicine (O.M.A.), University of Ibadan, Ibadan, Nigeria.
⁴ Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (O.M.A., F. Made, S.A.A., M.R.).
⁵ The Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Services, Gauteng Region, South Africa (F. Made).
⁶ Clinical research and global health initiatives, University of Arizona Health Sciences (A.O.).
⁷ Department of Neurology, University of California, San Francisco CA, USA (B.O.).
⁸ School of Medicine and Dentistry, University of Ghana, Accra, Ghana (D.A.).
⁹ Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa (A.A.M.).
¹⁰ Department of Medicine, Groote Schuur Hospital (B.M.M.), University of Cape Town, South Africa.
¹¹ Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA (S.N.A.).
¹² Division of Cardiology, Department of Medicine (M.E.E., C.C.), University of Cape Town, South Africa.
¹³ Department of Preventive Medicine and Epidemiology, Loyola University Chicago Stritch School of Medicine, Maywood, IL (B.T.).
¹⁴ Center for Research on Genomics and Global Health, NHGRI, NIH, Bethesda, MD, USA (C.R.).
¹⁵ Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA (M.G.).
¹⁶ Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S.).
¹⁷ Department of Medicine, University of Ilorin, Nigeria (K. Wahab).
¹⁸ Navrongo Health Research Centre, Ghana (G. Agongo, E.A.N.).
¹⁹ Department of Pathology and Medical Science, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa (M.A., F. Mashinya).
²⁰ African Population and Health Research Center, Nairobi, Kenya (G. Asiki, S.F.M.).
²¹ Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Burkina Faso (R.P.B., H.S.).
²² 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 (F.X.G.-O., S.T.).
²³ MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (L.M., S.A.N.).
²⁴ Departments of Pediatrics, Medicine and Epidemiology, Hospital for Sick Children, University Health Network and University of Toronto, Canada (R.S.P.).
²⁵ Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (K.E.).
²⁶ Department of Neurology, Atlanta Veterans Affairs Medical Center, Decatur, GA (S.P.W.).
²⁷ College of Global Public Health, New York University, New York, NY (E.P.).
²⁸ Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD (G.A.M.).
²⁹ Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD (K. Wiley).
³⁰ Human Heredity and Health in Africa, Division of Genome Sciences (J.T.), National Institutes of Health, Bethesda, MD.

^# Contributed equally.

PMID: 32172619
PMCID: PMC7176339
DOI: 10.1161/HYPERTENSIONAHA.119.14147

Abstract

Hypertension and obesity are the most important modifiable risk factors for cardiovascular diseases, but their association is not well characterized in Africa. We investigated regional patterns and association of obesity with hypertension among 30 044 continental Africans. We harmonized data on hypertension (defined as previous diagnosis/use of antihypertensive drugs or blood pressure [BP]≥140/90 mmHg/BP≥130/80 mmHg) and obesity from 30 044 individuals in the Cardiovascular H3Africa Innovation Resource across 13 African countries. We analyzed data from population-based controls and the Entire Harmonized Dataset. Age-adjusted and crude proportions of hypertension were compared regionally, across sex, and between hypertension definitions. Logit generalized estimating equation was used to determine the independent association of obesity with hypertension (P value <5%). Participants were 56% women; with mean age 48.5±12.0 years. Crude proportions of hypertension (at BP≥140/90 mmHg) were 47.9% (95% CI, 47.4-48.5) for Entire Harmonized Dataset and 42.0% (41.1-42.7) for population-based controls and were significantly higher for the 130/80 mm Hg threshold at 59.3% (58.7-59.9) in population-based controls. The age-adjusted proportion of hypertension at BP≥140/90 mmHg was the highest among men (33.8% [32.1-35.6]), in western Africa (34.7% [33.3-36.2]), and in obese individuals (43.6%; 40.3-47.2). Obesity was independently associated with hypertension in population-based controls (adjusted odds ratio, 2.5 [2.3-2.7]) and odds of hypertension in obesity increased with increasing age from 2.0 (1.7-2.3) in younger age to 8.8 (7.4-10.3) in older age. Hypertension is common across multiple countries in Africa with 11.9% to 51.7% having BP≥140/90 mmHg and 39.5% to 69.4% with BP≥130/80 mmHg. Obese Africans were more than twice as likely to be hypertensive and the odds increased with increasing age.

Keywords: Africa; blood pressure; hypertension; obesity; risk factors.

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Figures

**Figure 1.**
Regional differences in the age-adjusted proportion of hypertension using only the population controls dataset (PC) (for male, female, and the combined samples).

**Figure 2.**
Adjusted odds of hypertension across different age categories and in obesity (body mass index >30; defined by ≥140/90 mm Hg [htn def1] and ≥130/80 mm Hg [htn def2]) stratified by the sex of participant. Age group <40 y was the reference age group in the analysis. def1 indicates hypertension defined as ≥140/90 mm Hg; and def2, hypertension defined as ≥130/80 mm Hg.

See this image and copyright information in PMC

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Regional Patterns and Association Between Obesity and Hypertension in Africa: Evidence From the H3Africa CHAIR Study

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Regional Patterns and Association Between Obesity and Hypertension in Africa: Evidence From the H3Africa CHAIR Study

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