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. 2024 Apr 15:459:122968.
doi: 10.1016/j.jns.2024.122968. Epub 2024 Mar 17.

Stroke occurrence by hypertension treatment status in Ghana and Nigeria: A case-control study

Fred Stephen Sarfo  1 , Osahon Jeffery Asowata  2 , Onoja Matthew Akpa  3 , Joshua Akinyemi  4 , Kolawole Wahab  5 , Arti Singh  6 , Albert Akpalu  7 , Priscilla Abrafi Opare-Addo  6 , Akinkunmi Paul Okekunle  8 , Godwin Ogbole  9 , Adekunle Fakunle  10 , Oladimeji Adebayo  11 , Reginald Obiako  12 , Cynthia Akisanya  13 , Morenkeji Komolafe  14 , Taiwo Olunuga  13 , Innocent I Chukwuonye  15 , Godwin Osaigbovo  16 , Paul Olowoyo  17 , Phillip B Adebayo  18 , Carolyn Jenkins  19 , Abiodun Bello  5 , Ruth Laryea  7 , Phillip Ibinaye  11 , Olatundun Olalusi  10 , Sunday Adeniyi  5 , Oyedunni Arulogun  20 , Okechukwu Ogah  11 , Abiodun Adeoye  11 , Dialla Samuel  11 , Benedit Calys-Tagoe  7 , Hemant Tiwari  21 , Onyemelukwe Obiageli  12 , Yaw Mensah  22 , Lambert Appiah  6 , Rufus Akinyemi  23 , Bruce Ovbiagele  24 , Mayowa Owolabi  25
Affiliations

Stroke occurrence by hypertension treatment status in Ghana and Nigeria: A case-control study

Fred Stephen Sarfo et al. J Neurol Sci. .

Abstract

Background: Hypertension is preeminent among the vascular risk factors for stroke occurrence. The wide gaps in awareness, detection, treatment, and control rates of hypertension are fueling an epidemic of stroke in sub-Saharan Africa.

Purpose: To quantify the contribution of untreated, treated but uncontrolled, and controlled hypertension to stroke occurrence in Ghana and Nigeria.

Methods: The Stroke Investigative Research and Educational Network (SIREN) is a case-control study across 16 study sites in Ghana and Nigeria. Cases were acute stroke (n = 3684) with age- and sex-matched stroke-free controls (n = 3684). We evaluated the associations of untreated hypertension, treated but uncontrolled hypertension, and controlled hypertension at BP of <140/90 mmHg with risk of stroke occurrence. We assessed the adjusted odds ratio and population-attributable risk of hypertension treatment control status associated with stroke occurrence.

Results: The frequencies of no hypertension, untreated hypertension, treated but uncontrolled hypertension and controlled hypertension among stroke cases were 4.0%, 47.7%, 37.1%, and 9.2% vs 40.7%, 34.9%, 15.9%, and 7.7% respectively among stroke-free controls, p < 0.0001. The aOR and PAR (95% CI) for untreated hypertension were 6.58 (5.15-8.41) and 35.4% (33.4-37.4); treated but uncontrolled hypertension was 9.95 (7.60-13.02) and 35.9% (34.2-37.5); and controlled hypertension 5.37 (3.90-7.41) and 8.5% (7.6-9.5) respectively. Untreated hypertension contributed a PAR of 47.5% to the occurrence of intracerebral hemorrhage vs 29.5% for ischemic stroke. The aOR of untreated hypertension for stroke occurrence was 13.31 (7.64-23.19) for <50 years; 7.14 (4.51-11.31) for 50-64 years; and 3.48 (2.28-5.30) for 65 years or more.

Conclusion: The contribution of untreated hypertension and treated but uncontrolled hypertension to stroke occurrence among indigenous Africans is substantial. Implementing targeted interventions that address gaps in hypertension prevention and treatment, involving the local population, healthcare providers, and policymakers, can potentially substantially reduce the escalating burden of strokes in Africa.

Keywords: Africa; Hypertension; Prevention; Risk factors; Stroke.

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Conflict of interest statement

Declaration of competing interest We declare no competing interests.

Figures

Fig. 1.
Fig. 1.
All Stroke.
Fig. 2.
Fig. 2.
Ischemic Stroke.
Fig. 3.
Fig. 3.
Intracerebral hemorrhage.
Fig. 4.
Fig. 4.
Systolic & Diastolic BP level with stroke occurrence.
See this image and copyright information in PMC

References

    1. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387:957–67. - PubMed
    1. O’Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet 2016; 388:761–75. - PubMed
    1. O’Donnell MJ, Hankey GJ, Rangarajan S, Chin SL, Rao-Melacini P, Ferguson J, Xavier D, et al. Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level. Heart. 2021;107:282–289. - PubMed
    1. Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-Saharan Africa: a systematic review and meta-analysis. Hypertension. 2015; 65: 291–8. - PubMed
    1. Bosu WK, Reilly ST, Aheto JMK, Zucchelli E. Hypertension in older adults in Africa: a systematic review and meta-analysis. PLoS One. 2019;14:e0214934. - PMC - PubMed

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