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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
26
VOLUME 16 NUMBER 1 • JULY 2019
significant sociodemographic differences in the prevalence of each
CV risk factor, and for each CV risk factor, the prevalence found in
this study was higher than previously published in population-based
studies in South Africa.
24-27
These findings have clinical and policy
implications in that they suggest the presence of a high inherent
risk of CVD among patients with hypertension in South Africa
and call for interventions to address gaps in CV-risk screening and
management, especially that each additional CV risk exponentially
increases the risk of CVD in a patient with hypertension.
28
Since most CV risk factors are modifiable, lowering BP alone
without intervening in co-existing CV risk factors can therefore not
be deemed optimal care. Regrettably, only four to 7% of patients
with multiple CV risk factors receive appropriate risk-management
interventions during clinical encounters,
12
signifying enormous missed
clinical opportunities and the need for strategies to close this gap.
Such strategies should include academic detailing of CV risk factors
in the management of hypertension to improve healthcare providers’
screening behaviours and prompt them to initiate management
for these risk factors. Even when the burden of CV risk factors is
assessed to be low, primary prevention should still be done, since the
prevalence of CV risks tends to increase with age and if not attended,
a relatively low burden of CV risks in the present may translate into
higher lifetime risks of CVD in a patient with hypertension.
29
In line with other African studies,
24,30
this study found that obesity
is prevalent (65.8%) among patients with hypertension; higher
than reported in two recent nationally representative population
surveys in South Africa: SADHS 2016 (29.01%)
26
and SANHNES-1
(29.07%).
27
This is possibly due to clustering of CV risk factors in
patients with hypertension.
The concurrent high prevalence of increased abdominal
circumference (80.8%) in this study also reiterates the substantially
higher risk of CVD in this population compared to the general
population, especially since abdominal circumference is a strong
predictor of adverse CV outcomes. Measurement of abdominal
circumference should therefore form part of the vital signs in
patients with hypertension during clinic visits in PHC. This is to
ensure that healthcare providers respond to abnormal values by
counselling on the need for weight loss, healthy diets and increased
physical activity.
31-33
In addition, health education needs to be
offered to dispel cultural myths that purport obesity as a symbol of
wealth and wellbeing.
34
Physical inactivity is a leading cause of mortality and there is
a graded inverse relationship between physical activity and risk
of CVD.
33
In this study, most participants (73.2%) reported being
physically inactive (Table 3), far greater than the prevalence reported
in previous South African studies.
35,36
A Libyan study has found a
similar prevalence (74.5% among men and 75.5% in women).
37
The implication of this finding is the enormous clinical and
financial burden it places on the ever-stretched healthcare system in
South Africa. This is dire, considering the relative risk for developing
hypertension in sedentary men and women with normal BP at rest is
35 to 70% higher than in their physically active peers.
38
It is therefore
important that clinic visits in primary care be used as opportunities to
promote a physically active lifestyle, especially among patients with
one or more CV risks. This is imperative in the light of the emerging
epidemic of non-communicable diseases in South Africa.
Pensioners, men, blacks and participants of lower socioeconomic
status were significantly more likely to report being physically
inactive (Table 6). While previous studies in South Africa have
reported poor engagement of old people in regular exercise,
39
the significantly higher odds of physical inactivity among men
Table 6.
Sociodemographic determinants of CV risk factors
Risk factor
Odds ratio
95%
CI
p
-value
Alcohol use
Age group, years
20–39
1.00
40–59
0.2227
0.0723–0.6853
0.0088
60–79
0.1830
0.0581–0.5764
0.0037
80+
0.2119
0.0185–2.4242
0.2121
Gender
Female
1.00
Male
4.2939
2.3918–7.7088
0.0000
Cigarette smoking
Race
Other
1.00
Black
0.1543
0.0668–0.3567
0.0000
Gender
Female
1.00
Male
6.2782
2.7958–14.0980
0.0000
Current snuff use
Education level
Below secondary
1.00
Secondary or higher
0.6100
0.3376–1.1021
0.1015
Race
Other
1.00
Black
10.9513
1.4475–82.8551
0.0204
Gender
Female
1.00
Male
0.0477
0.0065–0.3520
0.0028
Physical inactivity
Age group, years
20–39
1.00
40–59
0.6033
0.1806–2.0147
0.4114
60–79
0.8299
0.1753–3.9292
0.8141
80+
118865.6277 0.0000– > 1.0312 0.9641
Employment
Employed
1.00
Pensioner
3.4727
1.1946–10.0953
0.02
Unemployed
1.7198
0.9188–3.2192
0.10
Gender
Male
1.00
Female
0.4342
0.2162–0.8719
0.02
Diabetes mellitus
Gender
Female
1.00
Male
1.8634
1.0701–3.2448
0.0279
Hypercholesterolaemia
Race
Other
1.00
Black
0.3201
0.1131–0.9063
0.0319
Family history of hypercholesterolaemia
Race
Other
1.00
Black
0.1210
0.0296–0.4941
0.0033
Education
Below secondary
1.00
Secondary or higher
0.7258
0.1094–4.8153
0.7399
Family history of fatal CV event
Race
Other
1.00
Black
0.1210
0.0296–0.4941
0.0033
BMI > 30 kg/m
2
Gender
Female
1.00
Male
0.1859
0.1053–0.3283
0.0000