What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=820). Intervention: 11-12 years of follow-up vs. Baseline (Wave 1). Primary outcome: Diastolic blood pressure (MD -9.7 mmHg, p=<0.001).

January 8, 2021Open Access

Determinants of change in blood pressure in Ghana: Longitudinal data from WHO-SAGE Waves 1–3

Q: What are the key findings of this study?

Over an 11-12 year follow-up period, older adults in Ghana experienced a significant 9.7 mmHg decrease in diastolic blood pressure and a 37% increase in hypertension awareness.

Key Result

Over an 11-12 year follow-up period, older adults in Ghana experienced a significant 9.7 mmHg decrease in diastolic blood pressure and a 37% increase in hypertension awareness.

Study Design

Type

Cohort (n=820)

Multicenter

Yes

Structured PICO

Population

820 adults aged 50 years and older in Ghana were followed for 11-12 years to assess longitudinal changes in blood pressure and hypertension awareness.

Outcome

Changes in blood pressure (systolic, diastolic, and pulse pressure) over 11-12 years.surrogate

In older adults in Ghana, diastolic blood pressure decreased and pulse pressure increased over an 11-12 year period, highlighting age-related vascular changes and an ongoing need for improved hypertension management.

Main Result

Mean Difference: -9.7

Absolute Event Rate: 78.9% vs 88.6%

p-value: p=<0.001

Limitations

High rate of loss to follow up
Inability to generalize the findings over the entire population because of the higher age of the cohort and lack of weighting applied
Survival bias could not be ruled out due to lack of access to information on cause and time of death

Abstract

The prevalence of hypertension is increasing in low- and middle-income countries, however statistics are generally derived from cross sectional surveys that utilize different methodologies and population samples. We investigated blood pressure (BP) changes over 11-12 years in a large cohort of adults aged 50 years and older (n = 820) included in the World Health Organization's Study on global AGEing and adult health (WHO-SAGE Ghana) Wave 1 (2007/8) with follow up in Wave 3 (2019). Participants' BP were measured in triplicate and a survey completed at both time points. Survey instruments collected information on sociodemographic characteristics, lifestyle, health behaviors and chronic conditions. While no significant difference was found in systolic BP between Waves 1 and 3, diastolic BP decreased by 9.7mmHg (mean = 88.6, 15.4 to 78.9, 13.6 respectively) and pulse pressure increased by 9.5mmHg (44.8, 13.7 to 54.3, 14.1). Awareness of hypertension increased by 37%, from (20% to 57%), but no differences were found for the proportion of hypertensives receiving treatment nor those that had controlled BP. Mixed effects modelling showed a decrease in diastolic BP was associated with increasing age, living in rural areas and having health insurance. Factors associated with an increased awareness of hypertension were residing in urban areas, having health insurance and increasing body mass index. While diagnosis of hypertension has improved over time in Ghana, there is an ongoing need to improve its treatment in older adults.

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