CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 4, July/August 2010
AFRICA
209
(28%) seemed to suffer from severe depression in comparison to
women (15%). These differences may be due to the discrepancies
in the expression of depression by men and women. The expres-
sion of emotions, constrained by traditional notions of masculin-
ity, may explain why the prevalence of depression was high in
men even though they did not report symptoms of depression.
32
African men had a higher prevalence of hypertension
compared to the women, which was consistent with other
studies done on this population group.
4,8-11
If participants in
this study were stratified into hypertensive and normotensive
groups, significant associations existed between the perception
of somatic symptoms and 24-hour BP in the HT men. This find-
ing suggests that individuals who suffer from high BP have a
negative experience of their own physical health, and that they
are aware of being physically not well. It has previously been
found that increased BP manifests among Africans with a nega-
tive perception of their well being.
11
This is also consistent with findings from other studies that
showed that Africans may experience more chronic sympathetic
system activation when exposed to social and environmental
TABLE 1. DESCRIPTIVE STATISTICS, MEAN (95% CI) OF THE HYPERTENSIVEAND NORMOTENSIVE MENANDWOMEN
INDEPENDENT OF CONFOUNDERS (AGE, BMI, SMOKING, ALCOHOLAND PHYSICALACTIVITY)
Hypertensive men
(
n
=
79)
Normotensive men
(
n
=
21)
p
-value
Hypertensive women
(
n
=
57)
Normotensive women
(
n
=
42)
p
-value
*Age (years)
44.39 (42.61; 42.17)
39.10 (35.64; 42.55)
0.01
46.61 (44.58; 48.65)
43.74 (41.37; 46.11)
0.07
*BMI (kg/m
2
)
28.48 (27.24; 29.73)
23.10 (20.65; 25.48)
<
0.01 34.63 (32.71; 36.54)
30.38 (28.16; 32.61)
<
0.01
Waist circumference (cm)
100.6 (92.15; 109.07)
82.13 (65.74; 98.53)
0.05 99.59 (95.90; 103.27)
85.52 (81.23; 89.81)
<
0.01
*Smoking
n
(%)
26 (34.21)
5 (23.80)
0.42
3 (5.26)
0 (0)
0.13
*Alcohol n (%)
34 (43.04)
6 (28.57)
0.23
7 (12.28)
5 (11.90)
0.95
*PAI
n
(%)
HIV+
n
(%)
Hypertension medication
n
(%)
56 (70.88)
12 (15.19)
14 (17.72)
15 (71.43)
2 (9.53)
1 (4.76)
0.80
0.20
0.14
41 (71.93)
4 (7.02)
15 (26.31)
34 (80.95)
1 (2.38)
6 (14.29)
0.27
0.30
0.15
TPR (mmHg/ml/s)
1.07 (0.04; 1.00)
1.05 (0.895; 1.21)
0.80
0.99 (0.90; 1.09)
0.92 (0.80; 1.03)
0.29
MAP (mmHg)
113.34 (110.12; 115.85) 101.53 (95.48; 107.58)
<
0.01
105.68 (103.41; 107.95) 95.60 (92.88; 98.31)
<
0.01
C
W
(ml/mmHg)
1.84 (1.77; 1.92)
2.03 (1.87; 2.19)
0.05
1.74 (1.66; 1.81)
2.01 (1.92; 2.10)
<
0.01
Heart rate (b/min)
68.20 (65.73; 70.68)
63.90 (58.67; 69.12)
0.16 70.39 (67.10; 73.69)
68.82 (64.87; 72.78)
0.56
Cornell product (mV.ms)
89.65 (78.29; 101.02)
60.02 (32.44; 87.61)
0.06 60.53 (53.36; 67.71)
49.58 (40.98; 5820)
0.65
24-h DBP (mmHg)
91.48 (88.68; 92.63)
76.92 (72.80; 81.04)
<
0.01
84.25 (82.47; 86.03)
72.38 (70.28; 74.48)
<
0.01
24-h SBP (mmHg)
142 (138.84; 144.56) 122.61 (116.65; 128.58)
<
0.01
137.10 (134.21; 139.91) 117.37 (114.01; 120.73)
<
0.01
PHQ_TT
8.33 (7.07; 9.6)
8.31 (5.72; 10.90)
0.99 10.48 (8.92; 12.02)
10.12 (8.30; 11.95)
0.80
GHQ_T
7.21 (5.74; 8.68)
8.20 (5.13; 11.25)
0.58 9.23 (7.41; 11.04)
9.10 (6.93; 11.21)
0.91
GHQ_Somatic symptomsS
2.38 (1.91; 2.84)
2.35 (1.38; 3.32)
0.97
2.60 (1.95; 3.25)
2.74 (1.97; 3.51)
0.79
GHQ_Anxiety symptomsS
2.31 (1.77; 2.86)
2.60 (1.46; 3.72)
0.67
2.77 (2.10; 3.50)
3.10 (2.28; 3.90)
0.57
GHQ_Social dysfunctionD
1.70 (1.20; 2.20)
2.21 (1.18; 3.23)
0.39
2.44 (1.85; 3.01)
1.94 (1.25; 2.62)
0.29
GHQ_Depressive symptomsS
0.82 (0.48; 1.17)
1.03 (0.31; 1.76)
0.62
1.43 (0.84; 2.01)
1.30 (0.60; 1.97)
0.75
CI, 95% confidence intervals;
n
, number of participants; BMI, body mass index; PAI, physical activity index; TPR, total peripheral resistance; MAP, mean
arterial pressure; C
W
, arterial compliance; 24-h SBP, 24-hour systolic blood pressure; 24-h DBP, 24-hour diastolic blood pressure; PHQ_TT, patient health
questionnaire total score; GHQ_T, general health questionnaire total score; Statistical significance is considered when,
p
≤
0.05. Significant values are
highlighted in bold. *not adjusted.
TABLE 2. PARTIAL CORRELATIONS IN HYPERTENSIVEAFRICAN MENANDWOMEN: CARDIOVASCULAR
VARIABLESWITH DEPRESSION (PHQ-9), PERCEPTION OF SOMATIC SYMPTOMSAND TARGET END-ORGAN
DAMAGE (LVH) INDEPENDENT OF CONFOUNDERS (AGE, BMI, SMOKING, ALCOHOLAND PHYSICALACTIVITY)
Hypertensive men
Hypertensive women
Target end-organ
damage (LVH)
r
-value;
p
-value
Perception of
somatic symptoms
r
-value;
p
-value
PHQ_major
depression
r
-value;
p
-value
Target end-organ
damage (LVH)
r
-value;
p
-value
Perception of
health (GHQ_SS)
r
-value;
p
-value
PHQ_major
depression
r
-value;
p
-value
Waist circumference (cm)
–0.02; 0.86
0.13; 0.30
–0.18; 0.13
0.22; 0.06
0.04; 0.73
–0.16; 0.18
MAP (mmHg)
0.44;
<
0.01
0.18; 0.12
0.15; 0.21
0.20; 0.08
–0.14; 0.22
0.23; 0.05
Hear rate (b/min)
0.03; 0.81
0.15; 0.22
–0.05; 0.69
–0.13; 0.27
0.30; 0.01
–0.03; 0.83
TPR (mmHg/ml/s)
0.13; 0.26
0.10; 0.41
0.10; 0.38
0.18; 0.11
–0.20; 0.08
0.05; 0.69
C
W
(ml/mmHg)
–0.26; 0.03
-0.15; 0.20
–0.12; 0.32
–0.10; 0.37
0.11; 0.35
–0.18; 0.13
SBP (mmHg)
0.43;
<
0.01
0.24; 0.04
–0.00; 1.00
0.21; 0.06
–0.07; 0.55
0.05; 0.69
DBP (mmHg)
0.32; 0.01
0.30; 0.01
–0.01; 0.97
0.12; 0.31
–0.11; 0.34
0.11; 0.35
Cornell product (mV.ms)
–
–0.07; 0.56
0.35;
<
0.01
–
0.03; 0.83
–0.10; 0.40
LVH, left ventricular hypertrophy; BMI, body mass index; PAI, physical activity index; MAP, mean arterial pressure; HR, heart rate; TPR, total
peripheral resistance; C
W
, arterial compliance; SBP, systolic blood pressure; DBP, diastolic blood pressure; Cornell product (
>
2.44 mV.ms). PHQ_
major depression, scores of
<
10 are considered as showing no depressive disorders; whilst a score
>
10 are considered to be major depressed. All
cardiovascular variables were adjusted for age, BMI, PAI, smoking and alcohol consumption. Significant correlations are highlighted in bold.
