54
VOLUME 10 NUMBER 2 • JUNE 2013
REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Correspondence to:
HIV/AIDS/SIT and TB (HAST), Human Sciences Research
Council, Pretoria, South Africa
Karl Peltzer, PhD
E-mail:
Department of Psychology, University of Limpopo, Turfloop,
South Africa and ASEAN Institute for Health Development,
Mahidol University, Salaya, Thailand
Nancy Phaswana-Mafuya, PhD
Office of the Vice Chancellor, Nelson Mandela Metropolitan
University, Port Elizabeth, South Africa
S Afr J Diabetes Vasc Dis
2013;
10
: 54–58
Hypertension and associated factors in older adults
in South Africa
KARL PELTZER, NANCY PHASWANA-MAFUYA
Abstract
Background: Older adults are disproportionately affected by
hypertension, which is an established risk factor for
cardiovascular disease. Little attention has been focused on
hypertension and associated factors among older adults in
Africa.Therefore,thisstudyaimedtoinvestigatetheprevalence
and associated factors of hypertension in a national sample of
older South Africans who participated in the Study of Global
Ageing and Adults’ Health (SAGE) in 2008.
Methods:
In 2008we conducted a national, population-based,
cross-sectional study of a sample of 3 840 subjects aged 50
years or older in South Africa. The questionnaire included
socio-demographic characteristics, health variables, and
anthropometric and blood pressure measurements.
Results:
The prevalence of hypertension in the sample
population was 77.3% (male 74.4%, female 79.6%). The rates
of awareness, treatment and control among the hypertensive
participants were 38.1, 32.7 and 17.1%, respectively. The
results of multivariate logistic regression analysis revealed
that the prevalence of hypertension was associated with
being in the Coloured population group, having had a stroke,
being overweight or obese and having had five or more out-
patients care visits in the past 12 months. Hypertension was
inversely associated with current alcohol use.
Conclusion:
This study revealed high rates of hypertension
among older adults (50 years and more) in South Africa,
which puts them at risk for cardiovascular disease. The
percentages of hypertensive subjects who were aware,
treated and controlled were very low. These data underscore
the urgent need to strengthen the public health education
and blood pressure-monitoring systems to better manage
hypertension among older adults in South Africa.
and is the most common diagnosis (13.1%) in South Africa.
2
In
population-based surveys, high rates of hypertension were found
among older adults in South Africa, 44.0–52.0% among men and
51.6–60.4% among women in 1998.
3
In other countries, in Dakar, Senegal, 65.4% of subjects had
hypertension,
4
in urban Zimbabwe 72%.
5
In Malawi, Rwanda and
Tanzania, hypertension was found in 41.0% of men and 36.6%
of women.
6
In Costa Rica, 65% were hypertensive,
7
and 42.4% of
women in Accra, Ghana had hypertension.
8
In Brazil, self-reported
hypertension was 55%,
9
in rural China it was 57–64.9%,
10
and in
another study in China it was 24.2–43.8%.
11
In Turkey 71.2–82.2%
of subjects had hypertension,
12
and in Taiwan 31.1–38.0%.
13
Various factors have been found to be associated with hyper-
tension, including socio-demographics (older age, female gender,
lower education level, lower household income),
13-16
geolocal-
ity (urban residence),
17
other risk factors or behaviour, including
stroke,
18
diabetes,
19,20
higher body mass index (BMI),
5,10,13,14
physical
inactivity,
16,22,23
insufficient fruit and vegetable intake,
13,23-25
smoking
and drinking,
10,16,22
greater limitations on activities of daily living
(ADLs) and instrumental activities of daily living (IADLs),
26
higher
frequency of doctor visits,
4
and less social cohesion.
27
In general, it is estimated that in South Africa only 26% of men
and 51% of women are aware of their hypertension.
1
Among older
adults in Senegal, half of those suffering from high blood pressure
were aware of their problem, and among the latter, 70% said they
were on treatment. However, of these, only 17% had controlled
arterial blood pressure.4 Among rural older adults in China, the
rates of awareness, treatment and control were very low (overall
35.2, 28.7 and 1.0%, respectively).
10
Few studies exist investigating hypertension among older adults in
low- and middle-income countries. Yet, research studies ‘demonstrate
a clear evolution in the prevalence, awareness, treatment and con-
trol of hypertension during the ageing process’.
4
Therefore, this study
aimed to investigate the prevalence and associated factors of hyper-
tension in a national sample of older South Africans who participated
in the Study of Global Ageing and Adults’ Health (SAGE) in 2008.
Methods
We conducted a national, population-based, cross-sectional study
with a sample of 3 840 subjects aged 50 years or older in South
Africa in 2008. The SAGE sample design entailed a two-stage
probability sample that yielded national and sub-national estimates
to an acceptable precision at provincial level, by locality type (urban
and rural) and population group (including black, Coloured, Indian
or Asian, and white). The overall response rate among those aged
50 years or older was 60%.
The Global Study on Ageing (SAGE) survey was carried out in
South Africa in partnership with the World Health Organisation
(WHO), the National Department of Health, and the Human
Sciences Research Council (HSRC). The study was approved by the
Human Sciences Research Council Research Ethics Committee and
the national Department of Health. Blood pressure (systolic and
Keywords:
hypertension, risk factors, older adults, South Africa
High blood pressure in South Africa is estimated to have caused
46 888 deaths and 390 860 disability-adjusted life years in 2000.
1
Hypertension alone is the leading reason for attending primary care
Submitted 7/4/12, accepted 11/1/13
