Prevalence and associations of hypertension detection, treatment and control in south africa

Objective: Hypertension prevalence is high and rising in South Africa; however, hypertension care remains sub-optimal. The aim was to determine, among participants with hypertension, the prevalence and associations of hypertension care (detection, treatment and control) in Cape Town. Design and method: This randomly selected community-based cross-sectional study was conducted across five townships in Cape Town using a 3-stage cluster sampling procedure. Cardiovascular disease risk factors were determined by administered questionnaires, clinical measurements and fasting biochemical analyses, including oral glucose tolerance tests. Hypertension was defined as blood pressure >=140/90 mmHg or known hypertension on treatment. The Chronic kidney disease (CKD) Epidemiology Collaboration equation was used to define CKD as glomerular filtration rate <60 mL/min/1.73m2. Separate logistic regression models evaluated the associations with hypertension detection, treatment and control. Each model comprised sociodemographic characteristics, family history of hypertension, obesity (body mass index >=30 kg/m2), problem drinking, daily tobacco smoking and comorbidities of diabetes, high low-density lipoprotein cholesterol and CKD. Results: Among 460 participants with hypertension, 50.7 (SD±12.1) years, hypertension detection (62.4%), treatment (47.2%) and control (27%) were sub-optimal, and rates were better in women (73.6%, 58.9%, 34.8%, respectively) compared with men (41.6%, 25.5%, 12.4%) (p<0.001 for all). Hypertension detection among participants with hypertension was associated with increasing age (OR: 1.07, 95%CI: 1.04-1.09), female gender (OR: 3.20, 95%CI:1.75-5.84), urbanisation (OR:1.01), family history of hypertension (OR: 1.77, 95%CI:1.06-2.94), and co-morbidities of diabetes (OR: 3.30, 95%CI: 1.70-6.42) and CKD (OR: 5.04, 95%CI: 1.07-23.64). Participants in the lowest wealth tertile were less likely to have their hypertension detected (OR: 0.56, 95%CI: 0.29-0.95). Hypertension treatment was associated with increasing age, female gender, low education, family history of hypertension, diabetes and CKD. Hypertension control was associated with increasing age, female gender and comorbid diabetes. Conclusions: Participants who were older, female, and with co-morbidities were more likely to have better hypertension care overall, while the poorest participants were less likely to have their hypertension detected. Strategies are required to ensure equitable distribution of hypertension care and target individuals less likely to use healthcare services. In-depth research is required to understand the contributors to suboptimal hypertension care.