Are behavioural risk factors to be blamed for the conversion from optimal blood pressure to hypertensive status in Black South Africans? A 5-year prospective study

Longitudinal cohort studies in sub-Saharan Africa are urgently needed to understand cardiovascular disease development. We, therefore, explored health behaviours and conventional risk factors of African individuals with optimal blood pressure (BP) (≤ 120/80 mm Hg), and their 5-year prediction for th...

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Bibliographic Details
Published in:International journal of epidemiology 2012-08, Vol.41 (4), p.1114-1123
Main Authors: SCHUTTE, Aletta E, SCHUTTE, Rudolph, TOWERS, G. Wayne, SALOME KRUGER, H, WENTZEL-VILJOEN, Edelweiss, VORSTER, Hester H, KRUGER, Annamarie, HUISMAN, Hugo W, ROOYEN, Johannes M.van, FOURIE, Carla Mt, MALAN, Nico T, MALAN, Leoné, MELS, Catharina Mc, SMITH, Wayne, MOSS, Sarah J
Format: Article
Language:English
Subjects:
African Continental Ancestry Group
Anthropometry
Arterial hypertension. Arterial hypotension
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Biomarkers - blood
Blood and lymphatic vessels
Blood Pressure - physiology
C-Reactive Protein - metabolism
Cardiology. Vascular system
Chi-Square Distribution
Creatinine - blood
Female
gamma-Glutamyltransferase - blood
Health Behavior
Humans
Hypertension - epidemiology
Linear Models
Lipids - blood
Male
Medical sciences
Middle Aged
Miscellaneous
Predictive Value of Tests
Prospective Studies
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
South Africa - epidemiology
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Summary:Longitudinal cohort studies in sub-Saharan Africa are urgently needed to understand cardiovascular disease development. We, therefore, explored health behaviours and conventional risk factors of African individuals with optimal blood pressure (BP) (≤ 120/80 mm Hg), and their 5-year prediction for the development of hypertension. The Prospective Urban Rural Epidemiology study in the North West Province, South Africa, started in 2005 and included African volunteers (n = 1994; aged > 30 years) from a sample of 6000 randomly selected households in rural and urban areas. At baseline, 48% of the participants were hypertensive (≥ 140/90 mmHg). Those with optimal BP (n = 478) were followed at a success rate of 70% for 5 years (213 normotensive, 68 hypertensive, 57 deceased). Africans that became hypertensive smoked more than the normotensive individuals (68.2% vs 49.8%), and they also had a greater waist circumference [ratio of geometric means of 0.94 cm (95% CI: 0.86-0.99)] and greater amount of γ-glutamyltransferase [0.74 U/l (95% CI: 0.62-0.88)] at baseline. The 5-year change in BP was independently explained by baseline γ-glutamyltransferase [R(2) = 0.23, β = 0.13 U/l (95% CI: 0.01-0.19)]. Alcohol intake also predicted central systolic BP and carotid cross-sectional wall area (CSWA) at follow-up. Waist circumference was another predictor of BP changes [β = 0.18 cm (95% CI: 0.05-0.24)] and CSWA. HIV infection was inversely associated with increased BP. During the 5 years, 24% of Africans with optimal BP developed hypertension. The surge in hypertension in Africa is largely explained by modifiable risk factors. Public health strategies should focus aggressively on lifestyle to prevent a catastrophic burden on the national health system.
ISSN:0300-5771
1464-3685
DOI:10.1093/ije/dys106