Prevalence of target organ damage in rural Kenya and The Gambia: a cross-sectional study

Background Sub-Saharan Africa is experiencing a hypertension crisis, potentially contributing to early development of target organ damage (TOD), a cardiovascular disease (CVD) predictor. However, comprehensive TOD prevalence data are lacking in rural SSA. This study aimed to provide the first population-level assessment of TOD prevalence in rural SSA. Methods We conducted a cross-sectional, population-based study in Kilifi (Kenya) and Kiang West (The Gambia) from July 2023–December 2024. We assessed an age-stratified random sample of adults (≥30 years) for 24-h ambulatory blood pressure (BP), electrocardiography, echocardiography, pulse-wave velocity, and renal function. TOD was defined as left ventricular hypertrophy (LVH), reduced global longitudinal strain (GLS), left ventricular systolic dysfunction (LVSD), arterial stiffness, or renal dysfunction. Findings Of 1819 screened, 1379 were recruited, and 1212 were analysed. The mean age was 56.8 ± 14.8 years, 62.9% were female, 33.5% had hypertension. Overall, 57.4% had TOD and prevalence increased with BP (non-elevated BP: 35.0%; hypertension: 77.3% for; p < 0.001) and age (30–39 years: 32.7%; ≥70 years: 77.0%; p < 0.001). TOD prevalence varied by marker: electrocardiogram LVH (31.1%), echocardiogram LVH (10.0%), GLS (16.7%), LVSD (9.8%), arterial stiffness (38.0%), and renal dysfunction (3.8%). Prevalence was higher in The Gambia (64.8%) than Kenya (50.9%) (p < 0.001). Clustering of TOD markers increased with BP. Interpretation TOD is common in rural SSA. These findings provide important information to guide the implementation of TOD assessment in cardiovascular care pathways and inform the optimal ages for CVD screening. Funding National Institute for Health and Care Research, Medical Research Council, and Wellcome Trust.