CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
AFRICA
183
The association between HTN and low socio-econonomic
conditions is well described in studies conducted in low-income
countries. The lower the socio-economic income, the higher is
the probability of having HTN.
12,13
In our population sample, women were more represented than
men. This could have been related to the observation that women
were more likely to be at home at the time the study team visited
than men, who were involved in economic activities outside
the home. Additionally, men were more inclined to decline
participation in the survey. This observation was noticed by other
authors in this kind of population-based survey.
14
We found a predominance of HTN in women. This observation
was previously reported in the CONSTANT trial in Guadeloupe
(37.3 vs 33%) andTunisia (36 vs 25%).
12,13
This is in contradiction
with the predominance of HTN found in males, reported in many
epidemiological surveys.
2,14
Some authors have suggested that
women are protected from HTN up to menopause.
In our study, obesity and inactivity were significantly more
frequent in women than men, and females were older than males.
This could explain the predominance of HTN in the women.
We also noted a significantly higher diastolic blood pressure in
women than in men, for which we did not find an explanation,
except that the women may have had more risk factors.
Regarding other risk factors, we found that age correlated
with the prevalence of HTN. This was previously noted in
Algeria and France.
9,15
Obesity accounted for 11 to 25% of
HTN and prevention studies have reported that a decrease of
1 kg of body weight led to a decrease of 1.1/0.9 mmHg in BP.
16-18
The meta-analysis of Whelton (54 randomised clinical trials)
reported a decrease of 3.8/2.9 mmHg in people with regular
aerobic physical activity; the highest decrease was found in
hypertensive subjects (4.9/3.7 mmHg).
17
Obesity and physical inactivity are known to be risk factors
for the onset of diabetes, HTN and other cardiovascular diseases.
The review of Sowers showed that HTN was twice as frequent
in patients with diabetes than in those with normal glycaemia.
Additionally, Sowers reported an increase in the risk of diabetes
in HTN patients compared to non-hypertensives.
17
Dussol found
that HTN was present in 80% of type 2 diabetes patients.
19
We noticed a lower prevalence of HTN in participants who
reported tobacco smoking. Nebie
et
al.
reported a prevalence
of 23% of HTN in smokers.
20
The association between tobacco
usage and HTN is still controversial and a possible confounding
effect of both alcohol usage and overweight is being assumed.
21
The association of HTN with other cardiovascular risk factors
contributes to increase the global cardiovascular risk of patients.
The results showed a higher prevalence of hypertension
with worsening creatinine clearance rates. This was probably
a consequence of hypertension, as shown by the decrease in
creatinine clearance rate with the duration of hypertension.
Conclusion
This population-based survey is the first performed in Senegal.
It was intended to serve as a baseline situation for other surveys
locally or at a national level. We found a high prevalence of
hypertension associated with other cardiovascular risk factors
such as diabetes, obesity, inactivity and dyslipidaemia. The
majority of participants were not aware of their condition.
Nationwide surveys are needed to better assess the burden of
cardiovascular disease in this population.This will help authorities
to formulate and implement adequate strategies to control
hypertension and the emerging epidemic of non-communicable
diseases.
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