Prevalence and correlates of multimarker hypertension-mediated organ damage in Ghanaian adults: evidence from the Ghana Heart Study

Q: What are the key findings of this study?

Multimarker HMOD was present in 20.7% of Ghanaian adults, was independently associated with rural residence, and was better discriminated by baPWV than PCE.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension-mediated organ damage (HMOD) (n=1106). Intervention: Rural residence and clinical risk factors (including hypertension and brachial-ankle pulse wave velocity) vs. Urban residence / Pooled Cohort Equations (PCE). Primary outcome: Multimarker hypertension-mediated organ damage (HMOD; ≥2 of 8 abnormal vascular, cardiac, and renal markers) (OR 1.99, 95% CI 1.29-3.08).

Q: What does this research mean for the field?

Multimarker hypertension-mediated organ damage affects approximately one in five Ghanaian adults, increases markedly with age and blood pressure, is more prevalent in rural settings at younger ages, and is discriminated substantially better by brachial-ankle pulse wave velocity than by the Pooled Cohort Equations. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kwabena Oteng Agyapong; Esther Kyeremah; Aba Ankomaba Folson; Francis Agyekum; Kim Blenman; Lambert Tetteh Appiah; Yaw Adu Boakye; Isaac Kofi Owusu

doi:10.21203/rs.3.rs-11444055/v1

November 12, 2026Open Access

Prevalence and correlates of multimarker hypertension-mediated organ damage in Ghanaian adults: evidence from the Ghana Heart Study

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Key result

Rural residence is linked to ~99% higher odds of multimarker HMOD in Ghanaian adults.

OR 1.99
95% CI 1.29-3.08
n=1,106

Why the study?

A comprehensive characterization of hypertension-related damage to multiple organs and its comparison with conventionally calculated cardiovascular disease risk in a West African setting was lacking.

Does brachial-ankle pulse wave velocity (baPWV) improve the discrimination of multimarker hypertension-mediated organ damage compared to the Pooled Cohort Equations in community-dwelling Ghanaian adults?

Study Design

Type

Cross-Sectional (n=1,106)

Multicenter

Yes

Structured PICO

Does brachial-ankle pulse wave velocity (baPWV) improve the discrimination of multimarker hypertension-mediated organ damage compared to the Pooled Cohort Equations in community-dwelling Ghanaian adults?

P

Population

1,106 community-dwelling Ghanaian adults (mean age 46.9 years, 58.0% female, 80.4% urban) from four regions without established cardiovascular disease evaluated in a cross-sectional survey.

E

Exposure

Brachial-ankle pulse wave velocity (baPWV) assessment (alone and combined with the ASCVD Pooled Cohort Equations) and multivariable clinical risk factor evaluation

C

Comparator

ASCVD Pooled Cohort Equations (PCE) alone

O

Outcome

Multimarker hypertension-mediated organ damage (HMOD), defined as ≥2 abnormal markers among participants with ≥6 measured components out of 8 endpoints: high baPWV (≥14 m/s), peripheral artery disease (ankle-brachial index <0.9), carotid plaque, electrocardiographic left ventricular hypertrophy (Sokolow-Lyon or Cornell criteria), echocardiographic left ventricular hypertrophy, diastolic dysfunction, chronic kidney disease stage ≥3 (eGFR <60 mL/min/1.73 m²), and albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g).composite

Main Result

Odds Ratio: 1.99 (95% CI 1.29–3.08)

In a community-based cohort of Ghanaian adults, multimarker hypertension-mediated organ damage affects approximately one in five individuals—with a higher burden among younger rural residents—and is much more accurately discriminated by brachial-ankle pulse wave velocity than by the conventional Pooled Cohort Equations.

Limitations

Cross-sectional design precludes causal inference
Single-visit blood pressure measurement rather than 24-hour ambulatory blood pressure monitoring
Relative underrepresentation of rural participants (19.6% of analytic sample)
Incomplete urine albumin-to-creatinine ratio data
Partial predictor-outcome circularity because high baPWV (≥14 m/s) was one of the eight HMOD outcome components
Potential overdiagnosis of left ventricular hypertrophy by ECG voltage criteria in African populations
Lack of validation of the baPWV measurement device in a West African population
Cross-sectional nature of the data prevents defining causal relationships
Use of a single blood pressure measurement visit rather than 24-hour ambulatory blood pressure monitoring (ABPM) or central pressure measurements
Relative lack of data from rural communities (final analytic sample was 80.4% urban)
Incomplete information on urine albumin measurements and potential lack of validation of the baPWV device in a West African setting
Partial circularity in the vascular domain because high baPWV is itself one of the eight outcome components, and potential overdiagnosis of left ventricular hypertrophy by ECG voltage criteria in African populations

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Implication

baPWV may better detect multimarker HMOD than PCE in Ghanaian adults; hypothesis-generating for risk models, needs prospective validation.

Abstract

Manifestations of hypertension-related organ damage have been described in several African populations. Yet a comprehensive characterization of hypertension-related damage to multiple organs and a comparison with conventionally calculated cardiovascular disease risk in a West African setting is lacking. We performed a secondary analysis of the Ghana Heart Study, which included 1 106 community-dwelling Ghanaian adults from 4 regions. Eight vascular, cardiac, and renal endpoints were determined. Multimarker HMOD (≥ 2 abnormal markers among participants with ≥ 6 measured components) was present in 20.7% and true multiorgan HMOD (≥ 2 of three organ systems) in 16.2%. Prevalence rose from 8.6% at ages < 45 years to 44.1% at ≥ 60 years. In an external- predictor model (n = 1 044), age, systolic blood pressure, hypertension, and rural residence were independently associated with multimarker HMOD; Central region residence was inversely associated. Brachial-ankle pulse wave velocity (baPWV) showed the highest discrimination among continuous markers (AUC 0.832). Among 530 participants aged 40–74 years, baPWV alone (AUC 0.807) and baPWV plus the Pooled Cohort Equations (AUC 0.815) substantially outperformed the Pooled Cohort Equations alone (AUC 0.526), with improved net benefit across thresholds. Multimarker HMOD is common, strongly age- and blood pressure- dependent, and more frequent in rural settings at younger ages. baPWV may usefully complement conventional risk assessment; prospective studies are required to confirm whether baPWV-guided care improves outcomes.

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Cite This Study

Agyapong et al. (2026) conducted a cross-sectional in Hypertension-mediated organ damage (HMOD) (n=1,106). Rural residence and clinical risk factors (including hypertension and brachial-ankle pulse wave velocity) vs. Urban residence / Pooled Cohort Equations (PCE) was evaluated on Multimarker hypertension-mediated organ damage (HMOD; ≥2 of 8 abnormal vascular, cardiac, and renal markers) (OR 1.99, 95% CI 1.29-3.08). Multimarker HMOD was present in 20.7% of Ghanaian adults, was independently associated with rural residence, and was better discriminated by baPWV than PCE.

synapsesocial.com/papers/6af73ada9badce7b6084db48 https://doi.org/10.21203/rs.3.rs-11444055/v1

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Prevalence and correlates of multimarker hypertension-mediated organ damage in Ghanaian adults: evidence from the Ghana Heart Study

Study Design

Structured PICO

Main Result

Limitations

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Implication

Abstract

Discussion

Cite This Study

Prevalence and correlates of multimarker hypertension-mediated organ damage in Ghanaian adults: evidence from the Ghana Heart Study

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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