Prevalence of hypertension and high-normal blood pressure among young adults in Zimbabwe: findings from a large, cross-sectional population-based survey.

Journal

The Lancet. Child & adolescent health
ISSN: 2352-4650
Titre abrégé: Lancet Child Adolesc Health
Pays: England
ID NLM: 101712925

Informations de publication

Date de publication:
06 Dec 2023
Historique:
received: 02 07 2023
revised: 09 10 2023
accepted: 11 10 2023
medline: 10 12 2023
pubmed: 10 12 2023
entrez: 9 12 2023
Statut: aheadofprint

Résumé

Hypertension is the greatest driver of cardiovascular mortality and onset might be in youth. We aimed to investigate the prevalence of and risk factors for elevated blood pressure (hypertension ≥140 mm Hg systolic, ≥90 mm Hg diastolic, or both) and high-normal blood pressure (130-139 mm Hg systolic, 85-89 mm Hg diastolic, or both) among youth in Zimbabwe. A population-based, cross-sectional survey of randomly sampled youth aged 18-24 years from 24 urban and peri-urban communities in three provinces (Harare, Bulawayo, and Mashonaland East) in Zimbabwe was conducted between Oct 4, 2021, and June 2, 2022. Standardised questionnaires were used by research assistants to collect sociodemographic, behavioural, and clinical data. Height, bodyweight, and blood pressure were recorded. Three seated blood pressure measurements were taken at standardised timepoints during participant interview using a digital sphygmomanometer and cuffs sized on mid-upper arm circumference. The association of potential risk factors with elevated blood pressure was examined using multivariable logistic regression. 17 682 (94·4%) of 18 729 eligible participants were recruited, 17 637 (99·7%) of whom had complete data, and 16 883 (95·7%) of whom were included in the final study sample after excluding 754 (4·3%) pregnant women. The median age was 20 years (IQR 19-22), 9973 (59·1%) participants were female, and 6910 (40·9%) were male. The prevalence of hypertension was 7·4% (95% CI 7·0-7·8) and high-normal blood pressure was 12·2% (11·7-12·7). Overall, prevalence of hypertension was higher in men (8·7% [95% CI 8·2-9·6]) than in women (6·6% [6·0-6·9]), but with age increased to similar levels (at age 18 years 7·3% [6·2-8·6] and 4·3% [3·5-5·2]; at age 23-24 years 10·9% [9·3-12·6] and 9·5% [8·4-10·7] in men and women, respectively). After adjusting for factors associated with hypertension in the crude analysis, hypertension was associated with male sex (adjusted odds ratio 1·53 [95% CI 1·36-1·74]), increasing age (age 19-20 years 1·20 [1·00-1·44]; age 21-22 years 1·45 [1·20-1·75]; age 23-24 years 1·90 [1·57-2·30], vs age 18 years), and BMI of 30·0 kg/m Prevalence of elevated blood pressure is high among urban and peri-urban youth in Zimbabwe and increases rapidly with age. Further research is needed to understand drivers of blood pressure elevation and the extent of target organ damage in youth in Zimbabwe and similar sub-Saharan African settings, to guide implementation of prevention and management strategies. Wellcome Trust.

Sections du résumé

BACKGROUND BACKGROUND
Hypertension is the greatest driver of cardiovascular mortality and onset might be in youth. We aimed to investigate the prevalence of and risk factors for elevated blood pressure (hypertension ≥140 mm Hg systolic, ≥90 mm Hg diastolic, or both) and high-normal blood pressure (130-139 mm Hg systolic, 85-89 mm Hg diastolic, or both) among youth in Zimbabwe.
METHODS METHODS
A population-based, cross-sectional survey of randomly sampled youth aged 18-24 years from 24 urban and peri-urban communities in three provinces (Harare, Bulawayo, and Mashonaland East) in Zimbabwe was conducted between Oct 4, 2021, and June 2, 2022. Standardised questionnaires were used by research assistants to collect sociodemographic, behavioural, and clinical data. Height, bodyweight, and blood pressure were recorded. Three seated blood pressure measurements were taken at standardised timepoints during participant interview using a digital sphygmomanometer and cuffs sized on mid-upper arm circumference. The association of potential risk factors with elevated blood pressure was examined using multivariable logistic regression.
FINDINGS RESULTS
17 682 (94·4%) of 18 729 eligible participants were recruited, 17 637 (99·7%) of whom had complete data, and 16 883 (95·7%) of whom were included in the final study sample after excluding 754 (4·3%) pregnant women. The median age was 20 years (IQR 19-22), 9973 (59·1%) participants were female, and 6910 (40·9%) were male. The prevalence of hypertension was 7·4% (95% CI 7·0-7·8) and high-normal blood pressure was 12·2% (11·7-12·7). Overall, prevalence of hypertension was higher in men (8·7% [95% CI 8·2-9·6]) than in women (6·6% [6·0-6·9]), but with age increased to similar levels (at age 18 years 7·3% [6·2-8·6] and 4·3% [3·5-5·2]; at age 23-24 years 10·9% [9·3-12·6] and 9·5% [8·4-10·7] in men and women, respectively). After adjusting for factors associated with hypertension in the crude analysis, hypertension was associated with male sex (adjusted odds ratio 1·53 [95% CI 1·36-1·74]), increasing age (age 19-20 years 1·20 [1·00-1·44]; age 21-22 years 1·45 [1·20-1·75]; age 23-24 years 1·90 [1·57-2·30], vs age 18 years), and BMI of 30·0 kg/m
INTERPRETATION CONCLUSIONS
Prevalence of elevated blood pressure is high among urban and peri-urban youth in Zimbabwe and increases rapidly with age. Further research is needed to understand drivers of blood pressure elevation and the extent of target organ damage in youth in Zimbabwe and similar sub-Saharan African settings, to guide implementation of prevention and management strategies.
FUNDING BACKGROUND
Wellcome Trust.

Identifiants

DOI: 10.1016/S2352-4642(23)00287-0 PMID: 38070533
pubmed: 38070533
pii: S2352-4642(23)00287-0
doi: 10.1016/S2352-4642(23)00287-0
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests RAF's institution received a grant from the Wellcome Trust. Salary support for VS and RJH was in part from a grant from the Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat (MR/K012126/1). All other authors declare no competing interests.

Auteurs

Kalpana Sabapathy (K)

Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: kalpana.sabapathy@lshtm.ac.uk.

Fredrick Cyprian Mwita (FC)

National Institute for Medical Research, Mwanza, Tanzania.

Ethel Dauya (E)

The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.

Tsitsi Bandason (T)

The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.

Victoria Simms (V)

Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.

Chido Dziva Chikwari (C)

Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.

Aoife M Doyle (AM)

Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.

David Ross (D)

Institute for Life Course Health Research, Stellenbosch University, Tygerberg, South Africa.

Anoop Shah (A)

Department of Noncommunicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.

Richard J Hayes (RJ)

Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK.

Aletta E Schutte (AE)

School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia.

Katharina Kranzer (K)

Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.

Rashida Abbas Ferrand (RA)

Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.

Classifications MeSH