CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 9/10, October/November 2013
AFRICA
349
other cardiovascular risk factors,
6
but a study from Nigeria and
Cameroon did not find any association of hypertension with
ethnicity.
13
A review of existing studies to estimate the prevalence
of hypertension in 11 sub-Saharan African countries found clear
differences by country, which the authors suggested may be partly
explained by ethnicity and other socio-demographic factors.
14
The
very high prevalence of hypertension among some ethnic groups
such as the Kanuri in Nigeria needs further investigation as this
ethnic group is concentrated in one localised region of the country.
Our results show that the prevalence of hypertension in
Nigeria is similar to that in high-income countries and is
therefore a public health challenge. A review of published
studies from Nigeria observed that the pooled prevalence of
hypertension increased from 8.6% over the period 1970–1979
to 22.5% over the period 2000–2011.
16
A national survey on
non-communicable diseases in Nigeria documented that the
prevalence of hypertension using a cut-off value of 160/95
mmHg was 11.2% (age-adjusted prevalence was 9.3%).
36
The observed trend shows that Nigeria is at high risk of
a significant increase in rates of hypertension in the near
future. Recent evidence documents that hypertension is the
commonest condition seen at medical centres in Nigeria.
37
This
has implications on mortality of people during the productive
years of their lives. A study by Ekpenyong
et al.
estimated that
five million Nigerians would die of non-communicable diseases
(NCDs) in Nigeria alone.
38
A significant proportion of these
deaths may be contributed to by hypertension.
Conclusion
The increase in NCDs in sub-Saharan Africa will mean that
additional resources will be required for the detection and
control of NCDs, which would compete with the resources
being allocated for the control of communicable diseases, such
as the neglected tropical diseases, malaria and HIV. Strategies
and interventions will also be required to improve adherence to
life-long medication. It is inevitable that hypertension and its
consequences will lead to financial and societal costs to families
and the states in sub-Saharan Africa and governments will need
to respond to this emerging challenge.
The authors thank the Federal Ministry of Health, state governments and
the local government authorities in Nigeria for providing accommodation
to the survey teams and other administrative and logistical support during
the survey. We also thank Dr Brendan Dineen for his epidemiological input,
members of the technical advisory group, Mrs Oye Quaye for managing
the finances, Auwal Shehu and Dania Charles for data entry, the teams of
ophthalmologists, ophthalmic nurses, enumerators, interviewers, liaison
officers, drivers and cooks, Mr Pak Sang Lee for technical support, and
the staff in the Sightsavers country office for their financial, managerial
and administrative support, without which this survey could not have been
undertaken.
Financial support was provided by Sightsavers International, UK (http://
), Velux Stiftung, Germany (
.
ch/home/index.php) and CBM, Germany (
/). The funders
had no role in the study design, data collection and analysis, decision to
publish, or preparation of the manuscript. The grant code of the London
School of Hygiene and Tropical Medicine was ITCRBY61 (The grant closed
in 2010).
References
1.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He
J. Global burden of hypertension: analysis of worldwide data.
Lancet
2005;
365
(9455): 217–223.
2.
Chobanian AV, Bakris GL, Black HR,
et al
. The seventh report of the
Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure: the JNC 7 report.
J Am Med Assoc
2003;
289
(19): 2560–2572.
3.
LopezAD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Measuring
the global burden of disease and risk factors. In: Lopez AD, Mathers
CD, Ezzati M, Jamison DT, Murray CJL, eds.
Global Burden of Disease
and Risk Factors
. Washington: The World Bank and Oxford University
Press, 2006: 1–13.
4.
Seedat YK. Hypertension in developing nations in sub-Saharan Africa.
J Hum Hypertens
2000;
14
(10–11): 739–747.
5.
Addo J, Smeeth L, Leon DA. Hypertension in sub-Saharan Africa: a
systematic review.
Hypertension
2007;
50
(6): 1012–1018.
6.
Mathenge W, Foster A, Kuper H .Urbanization, ethnicity and cardiovas-
cular risk in a population in transition in Nakuru, Kenya: a population-
based survey.
BMC Public Health
2010;
10
: 569.
7.
Harris MM, Stevens J, Thomas N, Schreiner P, FolsomAR. Associations
of fat distribution and obesity with hypertension in a bi-ethnic popula-
tion: the ARIC study. Atherosclerosis Risk in Communities Study.
Obes
Res
2000;
8
(7): 516–524.
8.
Kramer H, Han C, Post W,
et al
. Racial/ethnic differences in hyperten-
sion and hypertension treatment and control in the multi-ethnic study
of atherosclerosis (MESA).
Am J Hypertens
2004;
17
(10): 963–970.
9.
Chiu M, Austin PC, Manuel DG, Tu JV. Comparison of cardiovascular
risk profiles among ethnic groups using population health surveys
between 1996 and 2007.
Can Med Assoc J
2010;
182
(8): 18.
10. Oparil S, Wright JT Jr. Ethnicity and blood pressure.
J Clin Hypertens
(Greenwich) 2005;
7
(6): 357–364.
11. Jamerson KA.The disproportionate impact of hypertensive cardiovas-
cular disease in African Americans: getting to the heart of the issue.
J
Clin Hypertens
(Greenwich) 2004;
6
(4 Suppl 1): 4–10.
12. De Ramirez SS, Enquobahrie DA, Nyadzi G,
et al
. Prevalence and
correlates of hypertension: a cross-sectional study among rural popula-
tions in sub-Saharan Africa
. J Hum Hypertens
2010;
24
(12): 786–795.
13. Cooper R, Rotimi C, Ataman S,
et al
. The prevalence of hypertension
in seven populations of west African origin.
Am J Public Health
1997;
87
(2): 160–168.
14. Twagirumukiza M, de Bacquer D, Kips JG, de Backer G, Stichele RV,
van Bortel LM. Current and projected prevalence of arterial hyperten-
sion in sub-Saharan Africa by sex, age and habitat: an estimate from
population studies.
J Hypertens
2011;
29
(7): 1243–1252.
15. Andy JJ, Peters EJ, Ekrikpo UE, Akpan NA, Unadike BC, Ekott JU.
Prevalence and correlates of hypertension among the Ibibio/Annangs,
Efiks and Obolos: a cross sectional community survey in rural South-
South Nigeria.
Ethn Dis
2012;
22
(3): 335–339.
16. Ogah OS, Okpechi I, Chukwuonye II,
et al.
Blood pressure, prevalence
of hypertension and hypertension related complications in Nigerian
Africans: A review.
World J Cardiol
2012;
4
(12): 327–340.
17. Onwuchekwa AC, Mezie-Okoye MM, Babatunde S. Prevalence of
hypertension in Kegbara-Dere, a rural community in the Niger Delta
region, Nigeria.
Ethn Dis
2012;
22
(3): 340-6.17.
18. Ogah OS, Madukwe OO, Onyeonoro UU, Chukwuonye II, Ukegbu
AU, Akhimien MO, Okpechi IG. Cardiovascular risk factors and non-
communicable diseases in Abia State, Nigeria: report of a community
based survey.
Int J Med Biomed Res
2013;
2
(1): 57–68.
19. Akinbami JFK, Fadare SO. Strategies for sustainable urban and trans-
port development in Nigeria.
Transport Policy
1997;
4
: 237–224.
20. Dineen B, Gilbert CE, Rabiu M,
et al
. The Nigerian national blindness
and visual impairment survey: Rationale, objectives and detailed meth-
odology.
BMC Ophthalmol
2008;
8
: 17.
21. Whitworth JA, World Health Organization, International Society of
Hypertension writing group. 2003 World Health Organization (WHO)/
International Society of Hypertension (ISH) statement on management
of hypertension.
J Hypertens
2003;
21
(11): 1983–1992.
22. World Health Organization. Physical status: the use and interpretation
of anthropometry. Report of a WHO Expert Committee.
World Health
Organ Tech Rep Ser
1995;
854
: 1–452.
