CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 4, July/August 2010
206
AFRICA
Cardiovascular function and psychological distress in
urbanised black South Africans: the SABPA study
N MASHELE, JM VAN ROOYEN, L MALAN, JC POTGIETER
Summary
Objective
: The increased prevalence of cardiovascular disease
risk factors in sub-Saharan Africa has increased the inci-
dence of cardiovascular disease in this region but whether
psychological distress contributes to this observed increased
risk remains largely unclear.
The aim of this study was to investigate the association
between cardiovascular function and psychological distress
in urbanised black South African men (
n
=
101) and women
(
n
=
99).
Methods
: Resting cardiovascular variables were obtained by
making use of the Finometer device and 24-hour ambula-
tory blood pressure (BP) measurements with the Cardiotens
apparatus. Psychological questionnaires assessed the percep-
tion of health (General Health questionnaire) and depres-
sion status (DSM-IV criteria). The resting ECG (NORAV
PC-1200) was used to determine left ventricular hypertrophy
(LVH) by making use of the Cornell product. Confounders
included age, obesity, alcohol intake, smoking and physical
activity.
Results
:The hypertensive groups were overweight, with lower
vascular compliance and higher LVH (only men) compared
to the normotensive groups. In hypertensive men, perception
of health (somatic symptoms) was positively associated with
blood pressure, while in hypertensive women it was associ-
ated with heart rate. Major depression was associated with
LVH in hypertensive men and mean arterial pressure in
hypertensive women. LVH and depression showed odds ratios
of 1.02 (95% CI: 0.997–1.05) and 1.15 (95% CI: 1.01–1.32),
respectively, in predicting hypertension in women.
Conclusions
: Psychological distress was associated with high-
er blood pressure in hypertensive African men but also with
the development of left ventricular hypertrophy in hyperten-
sive African men and women.
Keywords:
depression, perception of health, cardiovascular
function, urbanised Africans, hypertension
Submitted 20/10/09, accepted 10/3/10
Cardiovasc J Afr
2010;
21
: 206–211
Cardiovascular disease (CVD) is one of the leading causes of
death worldwide, with the greatest mortality occurring in low-
and middle-income countries.
1
In black Africans, CVD has been
associated with an inherent salt sensitivity, low-renin hyperten-
sion and urbanisation.
2-4
It remains largely unclear, though, whether the experience of
psychological distress may contribute to the observed increase
in CVD risk. With increasing environmental demands, such as
experienced in urbanised areas, the inability to adapt or cope
may manifest as behavioural (e.g. substance abuse, dietary
changes, inactivity), psychological (e.g. depression and psycho-
somatic complaints) and medical (cardiovascular functioning
and other physical illnesses) consequences.
5,6-11
The effect of
known confounders for CVD risk
12
should therefore at least be
acknowledged in this novel psycho-physiological approach.
Additionally, the loss of social and cultural support, which
often accompanies urbanisation, may lead to psychosocial
disruption and an associated increase in psychological distress.
This may contribute to the high incidence of hypertension in
urban black Africans.
11
In this study, self-report questionnaires
on participants’ perception of their own health and depression
13,14
were used to gain insight into the level of psychological distress
experienced by them. A thorough description of these measures
will be provided in the methods section.
Other studies have shown a relationship between depression
and CVD, such as coronary heart disease (CHD) and coronary
artery disease.
15,16
Unfortunately, these studies focused on the
role of depression in CVD post-cardiac event. Conflicting
results were found with regard to depression and the develop-
ment of hypertension in the African-American population. Shinn
et al
.
17
found that their results did not support the character of
depressive symptoms in the development of hypertension in
normotensive adults.
17
Other researchers found that the associa-
tion between depression and the risk of hypertension compared
favourably with better-established predictors of hypertension,
such as obesity.
18
To our knowledge, investigations exploring the association
between psychological well being or functioning and CVD have
not been done in the African context. Therefore, the aim of this
study was to investigate whether there is a relationship between
cardiovascular function and psychological distress in hyperten-
sive and normotensive urbanised black Africans of the North
West province of South Africa.
Methods
The methods for this study were adapted and abbreviated from
the Sympathetic Activity and Ambulatory Blood Pressure in
Africans (SABPA) study.
19
The SABPA study was a multidisci-
plinary target-population study conducted in 2008. Included in
the data collection were urbanised black Africans from govern-
mental organisations in the North West province. During recruit-
ment, two months prior to data collection, the protocol was
School for Physiology, Nutrition and Consumer
Sciences, North-West University, Potchefstroom Campus,
Potchefstroom, South Africa
N MASHELE, MSc,
JM VAN ROOYEN, DSc,
L MALAN, PhD
School for Psychosocial Behavioural Sciences, North-West
University, Potchefstroom Campus, Potchefstroom, South
Africa
JC POTGIETER, PhD
