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Brazilian Journal of Clinical Medicine and Review

Original research

Vol. 3 No. 1 (2025): January/December - 2025

Prevalence, Awareness, Treatment and Control of Hypertension in Residents’ Sample of Luanda, Angola

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2025.3.1.bjcmr27
Submitted
November 29, 2024
Published
2025-01-16

Abstract

Hypertension (HTN) is an important risk factor for cardiovascular complications and is considered a public health problem worldwide. We aimed to evaluate the prevalence, awareness, treatment and control of HTN in a population sample in Luanda, Angola. A cross-sectional study was carried out which included 1480 individuals, between May 2018 and June 2019; we recruited participants at three different points of the city. Blood pressure (BP) was measured with semi-automatic device (Omron®, EM-7131-E). For each participant, three BP measurements were taken after 5 minutes resting and the mean of the two last measurements was used for systolic and diastolic BP. HTN was defined as BP ≥140/90 mmHg or use of antihypertensive drugs. The sample included mostly young people (39.7±11.6 years old) and male (69.3%). HTN prevalence was 34.9%; 47.4% of patients were aware of their condition; 36.8% were taking medication and of these only 35.8% had BP under control. There was a positive correlation between BP and age. The prevalence of HTN was high, almost half of the patients were unaware and, among the hypertensive patients who were under medication, most of them did not have their BP under control. HTN prevalence was high; awareness, treatment and control were low.

References

  1. World Health Organization (WHO). Global Atlas on Cardiovascular Disease Prevention and Control., Mendis S, Puska P, Norrving B (editors). Geneva. 2011. https://iris.who.int/handle/10665/44701.
  2. Talaei M, Sadeghi M, Mohammadifard N, Shokouh P, Oveisgharan S, Sarrafzadegan N. Incident hypertension and its pre-dictors: the Isfahan Cohort Study. J Hypertens. 2014;32(1):30-8. doi: 10.1097/HJH.0b013e32836591d4.
  3. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, Alexander L, Estep K, Hassen Abate K, Akinyemiju TF, Ali R, Alvis-Guzman N, Azzopardi P, Banerjee A, Bärnighausen T, Basu A, Bekele T, Bennett DA, Biadgilign S, Catalá-López F, Feigin VL, Fernandes JC, Fischer F, Gebru AA, Gona P, Gupta R, Hankey GJ, Jonas JB, Judd SE, Khang YH, Khosravi A, Kim YJ, Kimokoti RW, Kokubo Y, Kolte D, Lopez A, Lotufo PA, Malekzadeh R, Melaku YA, Mensah GA, Misganaw A, Mokdad AH, Moran AE, Nawaz H, Neal B, Ngalesoni FN, Ohkubo T, Pourmalek F, Rafay A, Rai RK, Rojas-Rueda D, Sampson UK, Santos IS, Sawhney M, Schutte AE, Sepanlou SG, Shifa GT, Shiue I, Tedla BA, Thrift AG, Tonelli M, Truelsen T, Tsilimparis N, Ukwaja KN, Uthman OA, Vasankari T, Venketasubramanian N, Vlassov VV, Vos T, Westerman R, Yan LL, Yano Y, Yonemoto N, Zaki ME, Murray CJ. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mmHg, 1990-2015. JAMA. 2017;317(2):165-182. doi: 10.1001/jama.2016.19043.
  4. Kibria GMA, Swasey K, Hasan MZ, Choudhury A, Gupta RD, Abariga SA, Sharmeen A, Burrowes V. Determinants of hy-pertension among adults in Bangladesh as per the Joint National Committee 7 and 2017 American College of Cardiolo-gy/American Hypertension Association hypertension guidelines. J Am Soc Hypertens. 2018;12(11): e45-e55. doi: 10.1016/j.jash.2018.10.004
  5. Adler AJ, Prabhakaran D, Bovet P, Kazi DS, Mancia G, Mungal-Singh V, Poulter N. Reducing Cardiovascular Mortality Through Prevention and Management of Raised Blood Pressure: A World Heart Federation Roadmap. Glob Heart. 2015;10(2):111-22. doi: 10.1016/j.gheart.2015.04.006.
  6. Ezzati M. Excess weight and multimorbidity: putting people's health experience in risk factor epidemiology. Lancet Public Health. 2017; 2(6): e252-e253. doi: 10.1016/S2468-2667(17)30093-2.
  7. Adeloye D, Basquill C. Estimating the prevalence and awareness rates of hypertension in Africa: a systematic analysis. PLoS One. 2014;9(8): e104300. doi: 10.1371/journal.pone.0104300.
  8. Simão M, Hayashida M, dos Santos CB, Cesarino EJ, Nogueira MS. Hypertension among undergraduate students from Lubango, Angola. Rev Lat Am Enfermagem. 2008 Jul-Aug;16(4):672-8. doi: 10.1590/s0104-11692008000400004.
  9. Capingana DP, Magalhães P, Silva AB, Gonçalves MA, Baldo MP, Rodrigues SL, Simões CC, Ferreira AV, Mill JG. Prevalence of cardiovascular risk factors and socioeconomic level among public-sector workers in Angola. BMC Public Health. 2013; 13:732. doi: 10.1186/1471-2458-13-732.
  10. Baldo MP, Zaniqueli DA, Magalhães P, Capingana DP, Silva AB, Mill JG. Gender-specific determinants of blood pressure elevation in Angolan adults. Blood Press. 2017;26(1):9-17. doi: 10.1080/08037051.2016.1179500
  11. Victória Pereira S, Valentim M, Feijão A, Gonçalves M, Oliveira P, Neto M, Manuel C, João A, Mbala C, Tinta D, Beaney T, Xia X, Poulter NR, Fernandes M. May Measurement Month 2017: an analysis of blood pressure screening in Angola-Sub-Saharan Africa. Eur Heart J Suppl. 2019 Apr;21(Suppl D): D5-D7. doi: 10.1093/eurheartj/suz049.
  12. Bakilo EL, Nkarnkwin D-S, Womba L, Atheno V, Kika M, Booto J, Wiyaka R, Ekeba M, Ngoma G. Lifestyle and Cardiovascular Risk Factors: Urban Population versus Rural Population in Sub-Saharan Africa. IntechOpen; 2021. Available from: http://dx.doi.org/10.5772/intechopen.96881.
  13. Bernabe-Ortiz A, Sanchez JF, Carrillo-Larco RM, Gilman RH, Poterico JA, Quispe R, Smeeth L, Miranda JJ. Rural-to-urban migration and risk of hypertension: longitudinal results of the PERU MIGRANT study. J Hum Hypertens. 2017;31(1):22-28. doi: 10.1038/jhh.2015.124.
  14. Patil RR. Urbanization as a determinant of health: a socioepidemiological perspective. Soc Work Public Health. 2014;29(4):335-41. doi: 10.1080/19371918.2013.821360.
  15. Sani RN, Connelly PJ, Toft M, Rowa-Dewar N, Delles C, Gasevic D, Karaye KM. Rural-urban difference in the prevalence of hypertension in West Africa: a systematic review and meta-analysis. J Hum Hypertens. 2024 Apr;38(4):352-364. doi: 10.1038/s41371-022-00688-8.
  16. Fonseca DJ, Fonseca S de LF. Refugiados e migrantes na Luanda contemporânea. Soc. e Cult. 2017;20(2):114-137. doi.org/10.5216/sec.v20i2.53068.
  17. Kodaman N, Aldrich M, Sobota R, Asselbergs FW, Poku R, Brown NJ, et al. cardiovascular disease risk factors in Ghana during the rural-to-urban transition: A cross-sectional study. PLoS One. 2016;11:e0162753. doi: 10.1371/journal.pone.0162753.
  18. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. doi: 10.1093/eurheartj/ehy339.
  19. Pires JE, Sebastião YV, Langa AJ, Nery SV. Hypertension in Northern Angola: prevalence, associated factors, awareness, treatment and control. BMC Public Health. 2013; 13:90. doi: 10.1186/1471-2458-13-90.
  20. Victória Pereira S, Neto M, Feijão A, Oliveira P, Brandão M, Soito E, Mbala C, João A, Manuel C, Mundombe L, Muela H, Beaney T, Ster AC, Poulter NR, Fernandes M. May Measurement Month 2018: an analysis of blood pressure screening results from Angola. Eur Heart J Suppl. 2020;22(Suppl H):H8-H10. doi: 10.1093/eurheartj/suaa015.
  21. Muela HCS, Sebastião DA, Teixeira CCN, Isidor CMD, Malamba DJAG, Augusto DL, Sebastião DS, Moniz CD, Cassoma DC, Sebastião DV, Almeida DX, Pascoal CAD, Lucamba CM, Manda DS, Viana MJ, Lopes ICA. Physical Activity and Cardiovascular Risk Factors among Sellers at Congolenses Market in Luanda, Angola. EC Cardiology 2021;8(3): 04-13.
  22. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, Bahonar A, Chifamba J, Dagenais G, Diaz R, Kazmi K, Lanas F, Wei L, Lopez-Jaramillo P, Fanghong L, Ismail NH, Puoane T, Rosengren A, Szuba A, Temizhan A, Wielgosz A, Yusuf R, Yusufali A, McKee M, Liu L, Mony P, Yusuf S; PURE (Prospective Urban Rural Epidemiology) Study investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310(9):959-68. doi: 10.1001/jama.2013.184182.
  23. Kayima J, Wanyenze RK, Katamba A, Leontsini E, Nuwaha F. Hypertension awareness, treatment and control in Africa: a systematic review. BMC Cardiovasc Disord. 2013; 13:54. doi: 10.1186/1471-2261-13-54.
  24. Seedat YK. Why is control of hypertension in sub-Saharan Africa poor? Cardiovasc J Afr. 2015 Jul-Aug;26(4):193-5. doi: 10.5830/CVJA-2015-065.
  25. Okello S, Muhihi A, Mohamed SF, Ameh S, Ochimana C, Oluwasanu AO, Bolarinwa OA, Sewankambo N, Danaei G. Hyper-tension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of seven communities in East and West Africa (SevenCEWA). BMC Public Health. 2020 Nov 13;20(1):1706. doi: 10.1186/s12889-020-09829-5.
  26. Frøystad M, Mæstad O, Villamil N. Health services in Angola: Availability, quality and utilisation. CMI Report. R 2011: 9. Available: https://www.cmi.no/publications/file/4319-health-services-in-angola.pdf.
  27. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation. 2016;134(6):441-50. doi: 10.1161/CIRCULATIONAHA.115.018912.
  28. Bastos-Barbosa, RG, Ueta J, Santos LAC, Nobre F, Lima NKC. (2005). Avaliação da adesão medicamentosa em idosos hipertensos em serviço ambulatorial de geriatria. Hipertensão; 8:30
  29. Sasu DD. Number of people living in extreme poverty in Angola 2016-2026. Available: https://www.statista.com/statistics/1269331/number-of-people-living-in-extreme-poverty-in-angola/ - Accessed, December 28, 2024.
  30. Tvedten I, Lázaro G, Jul-Larsen E, Agostinho M. Urban poverty in Luanda, Angola. Bergen: Chr. Michelsen Institute CMI Report R 2018:6. Available: https://www.cmi.no/publications/6497-urban-poverty-in-luanda-angola.
  31. Krousel-Wood M, Thomas S, Muntner P, Morisky D. Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol. 2004;19(4):357-62. doi: 10.1097/01.hco.0000126978.03828.9e.
  32. Kengne AP, Ntyintyane LM, Mayosi BM. A systematic overview of prospective cohort studies of cardiovascular disease in sub-Saharan Africa. Cardiovasc J Afr. 2012;23(2):103-12. doi: 10.5830/CVJA-2011-042.
  33. Criqui MH, Thomas IC. Alcohol Consumption and Cardiac Disease: Where Are We Now? J Am Coll Cardiol. 2017;69(1):25-27. doi: 10.1016/j.jacc.2016.10.049.
  34. Cerdá M, Diez-Roux AV, Tchetgen ET, Gordon-Larsen P, Kiefe C. The relationship between neighborhood poverty and alcohol use: estimation by marginal structural models. Epidemiology. 2010 Jul;21(4):482-9. doi: 10.1097/EDE.0b013e3181e13539.
  35. Sasu DD. Consumption of alcohol per capita in Angola, by beverage 2010-2019. Available: https://www.statista.com/statistics/1261679/per-capita-consumption-of-alcohol-by-beverage-in-angola/ - Accessed: Decem-ber 28, 2024.
  36. Silva CA, Tavares EO, Pinheiro TS, José HMG. Health diagnosis: a responsibility of community health nursing in Angola. Rev Bras Enferm. 2018;71(5):2506-10. doi: http://dx.doi.org/10.1590/0034-7167-2017-0610.
  37. World Health Organization‎. Global status report on alcohol and health 2018. World Health Organization. 2018. https://apps.who.int/iris/handle/10665/274603
  38. Klatsky AL. Alcohol-associated hypertension: when one drinks makes a difference. Hypertension. 2004;44(6):805-6. doi: 10.1161/01.HYP.0000146538.26193.60.
  39. Wildman RP, Gu D, Muntner P, Huang G, Chen J, Duan X, He J. Alcohol intake and hypertension subtypes in Chinese men. J Hypertens. 2005;23(4):737-43. doi: 10.1097/01.hjh.0000163141.82212.5f.
  40. Okamura T, Tanaka T, Yoshita K, Chiba N, Takebayashi T, Kikuchi Y, Tamaki J, Tamura U, Minai J, Kadowaki T, Miura K, Nakagawa H, Tanihara S, Okayama A, Ueshima H; HIPOP-OHP research group. Specific alcoholic beverage and blood pressure in a middle-aged Japanese population: the High-risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) Study. J Hum Hypertens. 2004;18(1):9-16. doi: 10.1038/sj.jhh.1001627.
  41. Wilson PW, D'Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162(16):1867-72. doi: 10.1001/archinte.162.16.1867.
  42. Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension. 2015;65(2):291-8. doi: 10.1161/HYPERTENSIONAHA.114.04394.
  43. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020 Oct 17;396(10258):1223-1249. doi: 10.1016/S0140-6736(20)30752-2.
  44. Peters R, Amugsi DA, Mberu B, Ensor T, Hill AJ, Newell JN, Elsey H. Nutrition transition, overweight and obesity among rural-to-urban migrant women in Kenya. Public Health Nutr. 2019 Dec;22(17):3200-3210. doi: 10.1017/S1368980019001204.
  45. Criqui MH, Wallace RB, Mishkel M, Barrett-Connor E, Heiss G. Alcohol consumption and blood pressure. The lipid research clinics prevalence study. Hypertension. 1981 Sep-Oct;3(5):557-65. doi: 10.1161/01.hyp.3.5.557.
  46. Black HR. The paradigm has shifted to systolic blood pressure. J Hum Hypertens. 2004;18 Suppl 2: S3-7. doi: 10.1038/sj.jhh.1001795.
  47. Bosu WK, Reilly ST, Aheto JMK, Zucchelli E. Hypertension in older adults in Africa: A systematic review and meta-analysis. PLoS One. 2019;14(4): e0214934. doi: 10.1371/journal.pone.0214934.
  48. Gurven M, Blackwell AD, Rodríguez DE, Stieglitz J, Kaplan H. Does blood pressure inevitably rise with age?: longitudinal evidence among forager-horticulturalists. Hypertension. 2012;60(1):25-33. doi: 10.1161/HYPERTENSIONAHA.111.189100.
  49. Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet. 2001;358(9294):1682-6. doi: 10.1016/S0140-6736(01)06710-1.