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J Hypertens. 2001 Jan;19(1):41-6.

Hypertension in four African-origin populations: current 'Rule of Halves', quality of blood pressure control and attributable risk of cardiovascular disease.

Author information

1
Clinical Epidemiology Group, University of Manchester Medical School, UK. clinep@man.ac.uk

Abstract

OBJECTIVE:

To assess the public health burden from high blood pressure and the current status of its detection and management in four African-origin populations at emerging or high cardiovascular risk.

DESIGN:

Cross-site comparison using standardized measurement and techniques.

SETTING:

Rural and urban Cameroon; Jamaica; Manchester, Britain.

SUBJECTS:

Representative population samples in each setting. African-Caribbeans (80% of Jamaican origin) and a local European sample in Manchester.

MAIN OUTCOME MEASURES:

Cross-site age-adjusted prevalence; population attributable risk.

RESULTS:

Among 1,587 men and 2,087 women, age-adjusted rates of blood pressure > or =160 or 95 mmHg or its treatment rose from 5% in rural to 17% in urban Cameroon, despite young mean ages, to 21% in Jamaica and 29% in Caribbeans in Britain. Treatment rates reached 34% in urban Cameroon, and 69% in Jamaican- and British-Caribbean-origin women. Sub-optimal blood pressure control (> 140 and 90 mmHg) on treatment reached 88% in European women. Population attributable risks (or fractions) indicated that up to 22% of premature all-cause, and 45% of stroke mortality could be reduced by appropriate detection and treatment. Additional benefit on just strokes occurring on treatment could be up to 47% (e.g. in both urban Cameroon men and European women) from tighter blood pressure control on therapy. Cheap, effective therapy is available.

CONCLUSION:

With mortality risk now higher from non-communicable than communicable diseases in sub-Saharan Africa and elsewhere, systematic measurement, detection and genuine control of hypertension once treated can go hand-in-hand with other adult health programmes in primary care. Cost implications are not great. The data from this collaborative study suggest that such efforts should be well rewarded.

[Indexed for MEDLINE]

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