Blood pressure and the hypertension care cascade in The Gambia: Findings from a nationwide survey

Abstract

Community treatment of hypertension in sub-Saharan Africa is hampered by gaps at several stages of the care cascade. We compared blood pressure (BP) levels (systolic, diastolic and pulse pressures) in four groups of participants by hypertension and treatment status. We conducted a nationally representative survey of adults 35 years and older using a multistage sampling strategy based on the 2013 Gambia Population and Housing Census. The BP measurements were taken in triplicate 5 min apart, and the average of the last two measurements was used for analysis. Systolic and diastolic BP levels and pulse pressure were compared by hypertension status using mean and 95% confidence intervals (CI). 53.1% of the sample were normotensive with mean systolic BP (SBP) of 119.2 mmHg (95% CI, 118.7-119.6) and diastolic BP (DBP) of 78.1 mmHg (77.8-78.3). Among individuals with hypertension, mean SBP was 148.7 mmHg (147.7-149.7) among those unaware of their hypertension, 152.2 mmHg (151.0-153.5) among treated individuals and was highest in untreated individuals at 159.3 mmHg (157.3-161.2). The findings were similar for DBP levels, being 93.9 mmHg (93.4-94.4) among the unaware, 95.1 mmHg (94.4-95.8) among the treated and highest at 99.1 mmHg (98.1-100.2) in untreated participants. SBP and DBP were higher in men, and SBP was as expected higher in those aged ≥55 years. BP level was similar in urban and rural areas. Our data shows high BP levels among participants with hypertension including those receiving treatment. Efforts to reduce the health burden of hypertension will require inputs at all levels of the care cascade.

Keywords: blood pressure; hypertension; hypertension care cascade; pulse pressure; sub‐Saharan Africa.

FIGURE 1

Blood pressure level by hypertension treatment status and by age group. BP level in respective groups is represented as mean ± 95% confidence interval of the mean. Systolic BP increased with age. In all groups, the youngest age category had significantly lower systolic BP compared to other age categories in all groups. Among Unaware and Treated groups, respectively, those aged 65−75 and ≥75 years had significantly higher systolic BP than other age categories. Systolic BP was similar across age groups (apart from in the youngest) in Untreated individuals. Diastolic blood pressure did not differ by age in respective groups.

FIGURE 2

Blood pressure level stratified by age group (<55 years vs. ≥55 years) and by hypertension treatment status. (A) Systolic blood pressure level; (B) Diastolic blood pressure level. Blood pressure estimates in respective groups is represented as mean ± 95% confidence interval of the mean. NS, no significant difference; ^*** denotes significant difference. Number of participants by age category: <55 years: Normal = 4962 (63.0%); Untreated = 293 (4.5%); Treated = 867 (13.4%); Unaware = 1229 (19.1%). ≥55 years: Normal = 807 (29.7%); Untreated = 242 (8.9%); Treated = 927 (34.1%); Unaware = 744 (27.4%).