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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
22
VOLUME 16 NUMBER 1 • JULY 2019
Prevalence and sociodemographic correlates of
cardiovascular risk factors among patients with
hypertension in South African primary care
JM Ngango, OB Omole
Correspondence to: JM Ngango
Division of Family Medicine, Department of Family Medicine, University of the
Witwatersrand, Johannesburg, South Africa
e-mail:
drngango@gmail.comOB Omole
Division of Family Medicine, Department of Family Medicine, University of the
Witwatersrand, Johannesburg, South Africa
Previously published in
Cardiovasc J Afr
2018;
29
: 344–351
S Afr J Diabetes Vasc Dis
2018;
16
: 22–29
Abstract
Objective:
Todetermine theprevalenceandsociodemographic
correlates of cardiovascular risk factors among patients with
hypertension at Johan Heyns Community Health Centre,
Sedibeng district, South Africa.
Methods:
A total of 328 participants were systematically
sampled. A researcher-administered questionnaire collected
information on: socio-demography, presence of diabetes,
family history of hypercholesterolaemia, family history
of fatal cardiovascular (CV) events, and engagement in
physical activities. Other measurements included: blood
pressure (BP), weight, height, abdominal circumference and
electrocardiography (ECG). Data analysis included descriptive
statistics, chi-squared test and regression analysis. Main
outcome measures included the proportions of participants
with each CV risk and their significant sociodemographic
determinants.
Results:
Participants’ mean age was 57.7 years. Most
participants were black (86.0%), female (79%) and pensioners
(43.6%). Themean BPwas 139/84mmHg, and 60.7%had their
BP controlled to targets. There was an average of 3.7 CV risk
factors per participant and the prevalence of CV risk factors
was: abdominal obesity (80.8%), physical inactivity (73.2%),
diabetes (30.2%), alcohol use (28.0%), hypercholesterolaemia
(26.5%), smoking (11.9%), past family history of fatal CV
event (14.9%), and left ventricular hypertrophy (5.2%).
Sociodemographic factors significantly associated with each
CV risk factor were: obesity and being female (
p
= 0.00);
alcohol use and young age (
p
= 0.00); smoking, being male
and race other than black (
p
= 0.00 and
p
= 0.00, respectively);
physical inactivity, being a pensioner and male (
p
= 0.02 and
p
= 0.02, respectively); diabetes and being male (
p
= 0.03);
hypercholesterolaemia and race other than black (
p
= 0.03);
family history of hypercholesterolaemia and race other than
black (
p
= 0.00); and family history of fatal CV event and race
other than black (
p
= 0.00).
Conclusion:
There is a high burden of CV risk factors among
patients with hypertension in South African primary care,
signifying a substantial risk of cardiovascular disease (CVD)
in this setting. Interventions aimed at CVD risk reduction
need to take cognisance of the sociodemographic correlates
of CV risk factors.
Keywords:
prevalence, cardiovascular risk factors, hypertension,
primary care
Hypertension is a major risk factor for cardiovascular disease (CVD).
1
It affects a quarter of the world’s adult population and accounts for
80% of deaths and 87% of disability in developing countries.
2,3
Its
burden is greater in low- and middle-income than in high-income
countries.
4
In the past four decades, African countries have experienced an
increased prevalence of CVD due to increasing urbanisation and
lifestyle changes.
5
CVD is the second leading cause of mortality
after HIV/AIDS in South Africa, accounting for up to 40% of deaths
among adults.
6
In South Africa, of all CVD risk factors, hypertension is the
commonest, with a prevalence that is highest among the poor in
urban settings.
7,8
Hypertension often co-exists with other CV risk
factors, resulting in a significantly increased risk for CVD.
9
Of serious
concern is that the prevalence of these other CV risk factors, such
as diabetes, tobacco use, high cholesterol levels, obesity, physical
inactivity and unhealthy diets are also on the increase, both in
urban and rural settings in Africa.
10
Most CV risk factors are modifiable, providing opportunities
for reduction in CVD-attributable morbidity and mortality rates.
11
Simultaneously addressing CV risk factors substantially reduces the
risk of adverse CV events more than controlling for any single risk
factor alone.
12
In this vein, it is well established that lowering only
blood pressure (BP) does not adequately minimise the risk of CV
morbidity and mortality. Despite this knowledge, co-existing CV
risk factors remain inadequately managed among patients with
hypertension.
9
In South Africa, clinicians at the primary healthcare (PHC) level
manage a substantial proportion of patients with hypertension.
This level of care is expected to provide primary and secondary
prevention interventions through patient education on healthy
lifestyle, screening, and prompt management of CV risk factors.
To carry out these tasks effectively for patients with hypertension,
it is important to know which of the CV risk factors are prevalent
in a PHC setting, especially since the burden of CV risks may differ
across populations.
13
Patients with hypertension in health facilities
have a higher baseline CV risk burden than reported in community-
based studies.
Although the South African literature has reported urban–rural
disparity and higher-than-expected CV risk prevalence in the
general population,
14
few studies have focused on patients with