CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 3, April 2013
66
AFRICA
Hypertension and associated factors in older adults in
South Africa
KARL PELTZER, NANCY PHASWANA-MAFUYA
Abstract
Background:
Older adults are disproportionately affected by
hypertension, which is an established risk factor for cardio-
vascular disease. Little attention has been focused on hyper-
tension and associated factors among older adults in Africa.
Therefore, this study aimed to investigate the prevalence and
associated factors of hypertension in a national sample of
older SouthAfricans who participated in the Study of Global
Ageing and Adults’ Health (SAGE) in 2008.
Methods:
In 2008 we conducted a national, population-based,
cross-sectional study of a sample of 3 840 subjects aged 50
years or older in South Africa. The questionnaire included
socio-demographic characteristics, health variables, and
anthropometric and blood pressure measurements.
Results:
The prevalence of hypertension in the sample popu-
lation was 77.3% (male 74.4%, female 79.6%). The rates of
awareness, treatment and control among the hypertensive
participants were 38.1, 32.7 and 17.1%, respectively. The
results of multivariate logistic regression analysis revealed
that the prevalence of hypertension was associated with being
in the Coloured population group, having had a stroke, being
overweight or obese and having had five or more out-patients
care visits in the past 12 months. Hypertension was inversely
associated with current alcohol use.
Conclusion:
This study revealed high rates of hypertension
among older adults (50 years and more) in South Africa,
which puts them at risk for cardiovascular disease. The
percentages of hypertensive subjects who were aware, treated
and controlled were very low. These data underscore the
urgent need to strengthen the public health education and
blood pressure-monitoring systems to better manage hyper-
tension among older adults in South Africa.
Keywords:
hypertension, risk factors, older adults, South Africa
Submitted 7/4/12, accepted 11/1/13
Cardiovasc J Afr
2013;
24
: 67–72
DOI: 10.5830/CVJA-2013-002
High blood pressure in South Africa is estimated to have caused
46 888 deaths and 390 860 disability-adjusted life years in 2000.
1
Hypertension alone is the leading reason for attending primary
care and is the most common diagnosis (13.1%) in South Africa.
2
In population-based surveys, high rates of hypertension were
found among older adults in South Africa, 44.0–52.0% among
men and 51.6–60.4% among women in 1998.
3
In other countries, in Dakar, Senegal, 65.4% of subjects had
hypertension,
4
in urban Zimbabwe 72%.
5
In Malawi, Rwanda
and Tanzania, hypertension was found in 41.0% of men and
36.6% of women.
6
In Costa Rica, 65% were hypertensive,
7
and
42.4% of women in Accra, Ghana had hypertension.
8
In Brazil,
self-reported hypertension was 55%,
9
in rural China it was
57–64.9%,
10
and in another study in China it was 24.2–43.8%.
11
In Turkey 71.2–82.2% of subjects had hypertension,
12
and in
Taiwan 31.1–38.0%.
13
Various factors have been found to be associated with
hypertension, including socio-demographics (older age,
female gender, lower education level, lower household
income),
13-16
geolocality (urban residence),
17
other risk factors
or behaviour, including stroke,
18
diabetes,
19,20
higher body mass
index (BMI),
5,10,13,14
physical inactivity,
16,22,23
insufficient fruit
and vegetable intake,
13,23-25
smoking and drinking,
10,16,22
greater
limitations on activities of daily living (ADLs) and instrumental
activities of daily living (IADLs),
26
higher frequency of doctor
visits,
4
and less social cohesion.
27
In general, it is estimated that in South Africa only 26% of
men and 51% of women are aware of their hypertension.
1
Among
older adults in Senegal, half of those suffering from high blood
pressure were aware of their problem, and among the latter, 70%
said they were on treatment. However, of these, only 17% had
controlled arterial blood pressure.
4
Among rural older adults in
China, the rates of awareness, treatment and control were very
low (overall 35.2, 28.7 and 1.0%, respectively).
10
Few studies exist investigating hypertension among older
adults in low- and middle-income countries. Yet, research studies
‘demonstrate a clear evolution in the prevalence, awareness,
treatment and control of hypertension during the ageing process’.
4
Therefore, this study aimed to investigate the prevalence and
associated factors of hypertension in a national sample of older
South Africans who participated in the Study of Global Ageing
and Adults’ Health (SAGE) in 2008.
Methods
We conducted a national, population-based, cross-sectional study
with a sample of 3 840 subjects aged 50 years or older in South
Africa in 2008. The SAGE sample design entailed a two-stage
probability sample that yielded national and sub-national
estimates to an acceptable precision at provincial level, by
locality type (urban and rural) and population group (including
black, Coloured, Indian or Asian, and white). The overall
response rate among those aged 50 years or older was 60%.
HIV/AIDS/SIT and TB (HAST), Human Sciences Research
Council, Pretoria, South Africa
KARL PELTZER, PhD,
NANCY PHASWANA-MAFUYA, PhD
Department of Psychology, University of Limpopo, Turfloop,
South Africa and ASEAN Institute for Health Development,
Mahidol University, Salaya, Thailand
KARL PELTZER, PhD
Office of the Vice Chancellor, Nelson Mandela Metropolitan
University, Port Elizabeth, South Africa
NANCY PHASWANA-MAFUYA, PhD
