CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 6, July 2013
AFRICA
209
(Omron, MX3 Plus, Kyoto, Japan), which had been validated to
the European Society of Hypertension’s international protocol.
11
BP measurements were done on one occasion and repeated three
times with five-minute intervals between them. The subjects
were in a seated position. The averages of these measurements
were used for further analysis. HTN was systolic blood pressure
(SBP) above 140 mmHg and/or diastolic blood pressure (DBP)
above 90 mmHg (WHO, Guidelines for the Management of
Hypertension),
12
or use of antihypertensive medication by the
study subjects.
Body weight was measured using a digital balance and height
was measured using a traditional cloth tape measure. Body mass
index (BMI) was calculated from the weight and height using
the formula, BMI
=
weight (kg)/height (m
2
). Overweight was
defined as BMI
=
25.0–29.9 kg/m
2
.
All subjects interviewed in this study were adults. All
personal information and measurements were kept confidential.
Authorisation was obtained from the ethics committee at Ahfad
University for Women, Omdurman, Sudan before the start of
the study and an informed consent was signed by the selected
individuals before filling in the questionnaire.
Statistical analysis
All statistical analyses were done using the statistical package
SPSS (version 17.0, SPSS Inc, USA). Results were summarised
as percentage for all variables. Chi-squared (
χ
2
) test was used
for the analysis of factors associated with HTN. The data were
analysed using the Student’s
t-
test to determine means for the
variables;
p
<
0.05 was considered statistically significant.
Results
The study population comprised 200 hypertensive patients
selected randomly from those who were visiting referral clinics
in Khartoum. All study subjects were adults, 20 years of age and
older. The subjects interviewed were 92 (46%) males and 108
(54%) females. Of the study subjects, 148 (74%) were married,
44 (22%) were single, four (2%) were widows and four (2%)
were divorced.
The education level of the subjects varied widely; 32 (16%)
were illiterate, 44 (22%) had primary school level, 80 (40%) had
secondary education and 44 (22%) higher education (university
and graduate). The employment pattern was 68 (34%) unskilled
manual workers, 88 (44%) government employees and 44 (22%)
were self-employed or in the private business sector.
The majority of subjects (144, 72%,
p
<
0.001) were only
hypertensive with no other non-communicable diseases such as
stroke or diabetes. HTN in combination with diabetes was found
in 48 (24%) patients and HTN, combined with stroke in eight
(4%). There were 112 (56%) subjects with a family history of
hypertension, 84 (42%) with diabetes, and four (2%) with other
diseases among their direct blood relatives.
In this study HTN was found in 92 (46%) of the subjects
during a routine general check-up. It was recognised in the other
108 (54%) after the start of complications. Although 56 (28%)
of the subjects did not remember their BP readings during their
last visit to the clinic, BP monitoring in the clinics showed
controlled BP (120–140/60–90 mmHg) (self-referred) in 76
(38%) subjects, and 68 (34%) had uncontrolled BP (
>
140/
>
90
mmHg) (Table 1).
In our BP check-ups during this study, 128 (64%) subjects
showed controlled and 72 (36%) uncontrolled BP and only 2%
showed very high BB levels (Table 1). The uncontrolled BP
was significantly (
p
<
0.001) higher in males (56, 61%) than
females (16, 15%) when genders were analysed separately (Table
2). Marital status had no influence on the lack of BP control
when the genders were pooled, however, a high prevalence of
uncontrolled HTN was shown in 48 males (62%) compared
to eight females (11%,
p
<
0.001) when they were considered
separately (Table 2).
Although uncontrolled BP was found in eight (25%) of the
illiterate subjects, surprisingly, the lack of control increased
with increasing educational level, as it was found in 40 (50%,
p
<
0.01) subjects with secondary education and in 24 (55%,
p
<
0.01) of the higher educated subjects when both genders were
considered together. The highest prevalence was found in males
compared to females (32, 67% and eight, 25%, respectively) (
p
<
0.01) with secondary education, and 16 (67%) and eight (40%),
respectively (
p
<
0.03) with higher education (Table 2) when
genders were considered separately.
Uncontrolled HTN was found in 28 workers (41%), in 36
(41%) government employees and in eight (18%) self-employed
subjects. However, a high prevalence of uncontrolled HTN was
found in 24 (86%) (
p
<
0.01), 28 (50%) (
p
<
0.01) and four
(50%) males compared to four (10%), eight (25%) and four
(11%) females among workers, government employees and self-
employed subjects, respectively, when genders were considered
separately (Table 2).
In this study we also investigated awareness among the study
subjects, their willingness and effort to control their BP, and their
motivation to change their lifestyle. For the variable following up
on their BP and monitoring it at home, 160 (80%) (
p
<
0.001)
of the subjects did not monitor their BP at home, and 184 (82%)
patients took their medication as prescribed by the doctors. Of
all subjects studied, 172 (86%) (
p
<
0.001) showed a desire to
normalise their BP. To follow up on their PB, 132 (66%) subjects
visited doctors on a regular basis. Surprisingly, for control of BP
and change of lifestyle, 104 (52%) subjects did not decrease their
salt intake in their diet, and 120 (60%) still ate Faseekh, which
contains large amounts of salt (Table 3).
TABLE 1. DATA REPRESENTING, HEALTH STATUS, FAMILY
HISTORY, HOW HTNWAS DETECTED FORTHE FIRST TIME,
HISTORICAL MEASUREMENT OF BLOOD PRESSURE INTHE
CLINICSAND BP MEASUREMENT DURING OUR STUDY (
n
=
200)
Variables
n
%
Health status
Hypertension
144 72
Hypertension + diabetes
48 24
Hypertension + stroke
8 4
Family history
Hypertension
112 56
Diabetes
84 42
Other
4 2
HTN detection
Routine check-up
92 46
After complaint
108 54
BP monitoring
120–140/60–90
76 38
(mmHg)
>140/>90
68 34
Do not know
56 28
BP measured in study 120–140/60–90
128 64
(mmHg)
>140/>90
72 36
