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VOLUME 13 NUMBER 1 • JULY 2016
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
found such an association. The ENNS trial found than HTN was
twice as frequent in people with a primary level of education than
in those who had secondary or postgraduate levels of education.
This difference was higher in women: the risk of HTN was four-fold
higher in less-educated women than in those with higher levels
of education.
2
The same observation was made in Brazzaville,
Congo.
9
The association between HTN and low socio-econonomic
conditions is well described in studies conducted in low-income
countries. The lower the socio-economic income, the higher is the
probability of having HTN.
12,13
In our population sample, women were more represented
than men. This could have been related to the observation that
women were more likely to be at home at the time the study team
came around than men, who were involved in economic activities
outside the home. Additionally, men were more inclined to decline
participation in the survey. This observation was noticed by other
authors in this kind of population-based survey.
14
We found a predominance of HTN in women. This observation
was previously reported in the CONSTANT trial in Guadeloupe
(37.3 vs 33%) and Tunisia (36 vs 25%).
12,13
This is in contradiction
with the predominance of HTN found in males, reported in many
epidemiological surveys.
2,14
Some authors have suggested that
women are protected from HTN up to menopause.
In our study, obesity and inactivity were significantly more
frequent in women than men, and females were older than males.
This could explain the predominance of HTN in the women. We
also noted a significantly higher diastolic blood pressure in women
than in men, for which we did not find an explanation, except that
the women may have had more risk factors.
Regarding other risk factors, we found that age correlated with
the prevalence of HTN. This was previously noted in Algeria and
France.
9,15
Obesity accounted for 11 to 25% of HTN and prevention
studies have reported that a decrease of 1 kg of body weight led to
a decrease of 1.1/0.9 mmHg in BP.
16-18
The meta-analysis of Whelton
(54 randomised clinical trials) reported a decrease of 3.8/2.9 mmHg
in people with regular aerobic physical activity; the highest decrease
was found in hypertensive subjects (4.9/3.7 mmHg).
17
Obesity and physical inactivity are known to be risk factors
for the onset of diabetes, HTN and other cardiovascular diseases.
The review of Sowers showed that HTN was twice as frequent
in patients with diabetes than in those with normal glycaemia.
Additionally, Sowers reported an increase in the risk of diabetes in
HTN patients compared to non-hypertensives.
17
Dussol found that
HTN was present in 80% of type 2 diabetes patients.
19
We noticed a lower prevalence of HTN in participants who
reported tobacco smoking. Nebie
et al
. reported a prevalence of
23% of HTN in smokers.
20
The association between tobacco usage
and HTN is still controversial and a possible confounding effect
of both alcohol usage and overweight is being assumed.
21
The
association of HTN with other cardiovascular risk factors contributes
to increase the global cardiovascular risk of patients.
The results showed a higher prevalence of hypertension
with worsening creatinine clearance rates. This was probably
a consequence of hypertension, as shown by the decrease in
creatinine clearance rate with the duration of hypertension.
Conclusion
This population-based survey is the first performed in Senegal. It
was intended to serve as a baseline situation for other surveys locally
or at a national level. We found a high prevalence of hypertension
associated with other cardiovascular risk factors such as diabetes,
obesity, inactivity and dyslipidaemia. The majority of participants
were not aware of their condition.
Nationwide surveys are needed to better assess the burden of
cardiovascular disease in this population. This will help authorities
to formulate and implement adequate strategies to control
hypertension and the emerging epidemic of non-communicable
diseases.
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