Fred Stephen Sarfo1, Linda Meta Mobula2, Titus Adade3, Yvonne Commodore-Mensah2, Martin Agyei4, Collins Kokuro4, Rexford Adu-Gyamfi3, Christiana Duah5, Bruce Ovbiagele6. 1. Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana. Electronic address: stephensarfo78@gmail.com. 2. Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. 3. Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana. 4. Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana. 5. Kumasi South Regional Hospital, Kumasi, Ghana. 6. University of California San Francisco, USA.
Abstract
BACKGROUND: Clinical trial data indicate that more intensive blood pressure (BP) lowering below standard cut-off targets is associated with lower risks of strokes in the elderly. There is a relative paucity of real-world practice data on this issue, especially among Africans. OBJECTIVE: To assess BP control rates, its determinants, and whether a lower BP < 120/80 mmHg is associated with a lower incident stroke risk among elderly Ghanaians with hypertension. METHODS: We retrospectively evaluated data, which were prospectively collected as part of a cohort study involving adults with hypertension and/or diabetes in 5 Ghanaian hospitals. BP control was defined using the JNC-8 guideline of <150/90 mmHg for elderly with hypertension aged >60 years or 140/90 mmHg for those with diabetes mellitus. Risk factors for poor BP control were assessed using multivariable logistic regression models. We calculated incident stroke risk over an 18-month follow-up at 3 BP cut-off's of <120/80, 120-159/80-99, and > 160/100 mmHg. RESULTS: Of the 1365 elderly participants with hypertension, 38.2% had diabetes mellitus and 45.8% had uncontrolled BP overall. Factors associated with uncontrolled BP were higher number of antihypertensive medications prescribed adjusted odds ratio of 1.45 (95% CI: 1.27-1.66), and having diabetes 2.56 (1.99-3.28). Among the elderly, there were 0 stroke events/100py for BP < 120/80 mmHg, 1.98 (95%CI: 1.26-2.98) for BP between 120 and 159/80-99 mmHg and 2.46 events/100py (95% CI: 1.20-4.52 at BP > 160/100 mmHg. CONCLUSION: A lower BP target <120/80 mmHg among elderly Ghanaians with hypertension is associated with a signal of lower incident stroke risk. Pragmatic trials are needed to evaluate lower BP targets on stroke incidence in Africa.
BACKGROUND: Clinical trial data indicate that more intensive blood pressure (BP) lowering below standard cut-off targets is associated with lower risks of strokes in the elderly. There is a relative paucity of real-world practice data on this issue, especially among Africans. OBJECTIVE: To assess BP control rates, its determinants, and whether a lower BP < 120/80 mmHg is associated with a lower incident stroke risk among elderly Ghanaians with hypertension. METHODS: We retrospectively evaluated data, which were prospectively collected as part of a cohort study involving adults with hypertension and/or diabetes in 5 Ghanaian hospitals. BP control was defined using the JNC-8 guideline of <150/90 mmHg for elderly with hypertension aged >60 years or 140/90 mmHg for those with diabetes mellitus. Risk factors for poor BP control were assessed using multivariable logistic regression models. We calculated incident stroke risk over an 18-month follow-up at 3 BP cut-off's of <120/80, 120-159/80-99, and > 160/100 mmHg. RESULTS: Of the 1365 elderly participants with hypertension, 38.2% had diabetes mellitus and 45.8% had uncontrolled BP overall. Factors associated with uncontrolled BP were higher number of antihypertensive medications prescribed adjusted odds ratio of 1.45 (95% CI: 1.27-1.66), and having diabetes 2.56 (1.99-3.28). Among the elderly, there were 0 stroke events/100py for BP < 120/80 mmHg, 1.98 (95%CI: 1.26-2.98) for BP between 120 and 159/80-99 mmHg and 2.46 events/100py (95% CI: 1.20-4.52 at BP > 160/100 mmHg. CONCLUSION: A lower BP target <120/80 mmHg among elderly Ghanaians with hypertension is associated with a signal of lower incident stroke risk. Pragmatic trials are needed to evaluate lower BP targets on stroke incidence in Africa.
Authors: Paul A James; Suzanne Oparil; Barry L Carter; William C Cushman; Cheryl Dennison-Himmelfarb; Joel Handler; Daniel T Lackland; Michael L LeFevre; Thomas D MacKenzie; Olugbenga Ogedegbe; Sidney C Smith; Laura P Svetkey; Sandra J Taler; Raymond R Townsend; Jackson T Wright; Andrew S Narva; Eduardo Ortiz Journal: JAMA Date: 2014-02-05 Impact factor: 56.272
Authors: Paul K Whelton; Robert M Carey; Wilbert S Aronow; Donald E Casey; Karen J Collins; Cheryl Dennison Himmelfarb; Sondra M DePalma; Samuel Gidding; Kenneth A Jamerson; Daniel W Jones; Eric J MacLaughlin; Paul Muntner; Bruce Ovbiagele; Sidney C Smith; Crystal C Spencer; Randall S Stafford; Sandra J Taler; Randal J Thomas; Kim A Williams; Jeff D Williamson; Jackson T Wright Journal: J Am Coll Cardiol Date: 2017-11-13 Impact factor: 24.094