CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 6, July 2012
AFRICA
311
and farmers (6.3%). Forty-three per cent of hypertensive subjects
had no education, 27.5% had a primary level of education, 18%
had a secondary level of education, and 7.2% were university
educated.
Discussion
This research was done using the STEPS-wise approach of the
WHO with regard to risk factors for non-communicable diseases
at the population level.
8
The sample was representative. This
standard method of the WHO served as the official barometer
in our particular context by which we collected comparable data
and conducted reproducible surveys.
The main objective was to assess the current prevalence of
hypertension and other cardiovascular risk factors in Lome, in
order to assess the impact of individual preventive strategies in
certain populations. The prospect of an investigation on a larger
scale could determine the national prevalence of hypertension.
The average level of SBP of our respondents, 128.6 mmHg,
was comparable to that reported in Morocco,
12
at 129.8 mmHg.
However, it was below the upper limit of 145 mmHg observed
in Ouagadougou.
5
The mean DBP was 84.6 mmHg in our study.
The authors cited above
5,12
found the respective values of 76 and
78 ± 12 mmHg in their studies.
SBP and the prevalence of hypertension increased with
age, peaking at around 50 years.
1-5
This was in agreement with
what several other authors observed
1-5,9
on the prevalence of
hypertension in male participants. It should be noted that a slight
female predominance of hypertension was inconsistently found
in some African series: 21% of women versus 18.7% of men in
rural Senegal,
13
and 33% of women and 31% of men in Egypt.
14
The overall prevalence of hypertension was 26.6% in Lome,
explained partly by the new definition of hypertension used
in this study, the urban area of residence of our respondents
and their lifestyle, including their eating habits. Our result
was lower than the overall prevalence of 32.9 and 33.6%,
respectively, observed in urban areas at Ashanti in Ghana
1
and
in Morocco.
12
However, the Eritrean investigation
15
reported a
prevalence of hypertension of 16.5%, reflecting the profile of
these populations. These authors all used the current definition
of hypertension.
Professional concerns, such as conditions of work and family
life could explain the high prevalence of hypertension that we
found among the unemployed, civil servants and housewives.
In Zaire, Malu
et al.
16
reported a prevalence of hypertension of
35.5% among employees and 45.4% among housewives. At the
autonomous port of Abidjan, 54.5% of hypertensive workers said
they were stressed while they executed their duties.
17
Educational level, according to Bertrand
et al.
18
was
inversely associated with the occurrence of hypertension. In
our respondents, 43% with no education were hypertensive,
and 27.5% had a primary-level education. Literacy levels of
hypertensive individuals, especially in Africa, represents a real
challenge. It is imperative to lay particular emphasis on education
and the change of lifestyle in pre-hypertensive subjects. It is also
important to inform new patients with hypertension, even those
who are asymptomatic, of the need for lifelong treatment.
Other cardiovascular risk factors were also present, namely
stress, a sedentary lifestyle, dyslipidaemia, obesity and active
smoking. These risk factors are modifiable, and a change of
lifestyle is imperative. People need to change their eating habits
by avoiding fatty foods and eating more vegetables and fruit.
These other risk factors, once detected, help prevent the
occurrence of complications related to hypertension, and
atherosclerosis. This could prevent the development from
pre-hypertensive to hypertensive status. It should therefore be
emphasised that the most important part of prevention, with little
cost for state and communities, is based on the primary level.
This involves educating people about the practices of a healthy
lifestyle.
Conclusion
The prevalence of hypertension and other cardiovascular risk
factors in the general population is currently high in Lome.
The situation is probably similar in other urban and suburban
areas of Togo. These findings should draw the attention of the
authorities to define a national policy to combat the development
of hypertension and other cardiovascular risk factors. It is
imperative to establish a national surveillance system for
hypertension and other risk factors for atherosclerosis.
We thank the Ministry of Health of Togo for its administrative and material
support, the Physicians’Association ‘People-Togo’ for their material support,
and the supervising physicians and investigators who helped obtain the data.
We also thank Joan Minguet and Sophie Domingues-Montanari at Koonec
(
) for the excellent scientific translation.
References
1.
Cappucio FP, Micah FB, Emmert L,
et al.
Prevalence, detection,
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TABLE 4. OTHER CARDIOVASCULAR RISK FACTORS,
ACCORDINGTO GENDER
Male
n
(%)
Female
n
(%)
Overall
n
(%)
Obesity*
150 (16.7)
354 (32.2)
504 (25.2)
Smoking
182 (20.2)
40 (3)
186 (9.3)
Sedentary lifestyle
192 (21.4)
628 (57)
820 (41)
Stress
420 (46.7)
440 (39.9)
860 (43)
Hypercholesterolaemia 114 (22)
149 (30.3)
263 (26)
Hypertriglyceridaemia
114 (21.9)
98 (19.9)
212 (21)
Alcohol use
165 (18.3)
55 (5)
220 (11)
Diabetes
36 (6.9)
38 (7.7)
74 (7.3)
*Android obesity: 18%; *gynoid obesity: 7.2%
Sixty per cent of subjects had two or more risk factors.
