Diane Macquart de Terline1, Kouadio Euloge Kramoh2, Ibrahima Bara Diop3, Carol Nhavoto4, Dadhi M Balde5, Beatriz Ferreira4, Martin Dèdonougbo Houenassi6, Dominique Hounsou6, Méo Stéphane Ikama7, Adama Kane8, Suzy Gisèle Kimbally-Kaki7, Samuel Kingue9, Florent Koffi2, Charles Kouam Kouam10, Emmanuel Limbole11, Liliane Mfeukeu Kuate12, Jean Bruno Mipinda13, Yves N'goran2, Zouwera Sesso14, Abdallahi Sidi Aly15, Ibrahim Ali Toure16, Pierre François Plouin17, Michel Azizi17, Marie Cécile Perier18, Kumar Narayanan19, Jean Philippe Empana18, Xavier Jouven17, Marie Antignac20. 1. Sorbonne Université, AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de Pharmacie, 75012 Paris, France; Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France. Electronic address: diane.macquart-de-terline@aphp.fr. 2. Institute of Cardiology of Abidjan, BPV 206, Abidjan, Côte d'Ivoire. 3. Cardiology Department, University Hospital of Fann, Dakar, Senegal. 4. Instituto do Coração (ICOR), Maputo, Mozambique. 5. Department of Cardiology, University Hospital of Conakry, Guinea. 6. National University Hospital of Hubert K. Maga (CNHU-HKM), 01 BP 386, Cotonou, Bénin. 7. Cardiology Department, National University Hospital of Brazzaville, Marien Ngouabi University, Brazzaville, Congo. 8. Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal. 9. University of Yaoundé, Ministry of Public Health, Cameroon. 10. Internal Medicine Department, Regional Hospital, Bafoussam, Cameroon. 11. Department of Internal Medicine of la Gombe (CMCG), Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo. 12. Central Hospital of Yaoundé, Cameroon. 13. University Hospital of Libreville, Libreville, Gabon. 14. Cardiology Department, Lomé, Togo. 15. Cardiology Clinics, Nouakchott, Mauritania. 16. Internal Medicine and Cardiology Department, University Hospital of Lamordé, Niamey University, Niamey, Niger. 17. Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France; Department of Cardiology, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France. 18. Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France. 19. MaxCure Hospitals, Hyderabad, Telangana, 500081 India. 20. Sorbonne Université, AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de Pharmacie, 75012 Paris, France; Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France.
Abstract
BACKGROUND: Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. AIMS: To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. METHODS: We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. RESULTS: Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. CONCLUSIONS: High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.
BACKGROUND: Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. AIMS: To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. METHODS: We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. RESULTS: Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. CONCLUSIONS: High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.
Authors: Camille Lassale; Bamba Gaye; Ibrahima Bara Diop; Jean Bruno Mipinda; Kouadio Euloge Kramoh; Charles Kouam Kouam; Méo Stéphane Ikama; Jean Laurent Takombe; Jean Marie Damorou; Ibrahim Ali Toure; Dadhi M Balde; Anastase Dzudie; Martin Houenassi; Abdoul Kane; Suzy Gisèle Kimbally-Kaki; Samuel Kingue; Emmanuel Limbole; Liliane Mfeukeu Kuate; Beatriz Ferreira; Carol Nhavoto; Abdallahi Sidy Ali; Michel Azizi; Roland N'Guetta; Marie Antignac; Xavier Jouven Journal: BMJ Glob Health Date: 2022-06
Authors: Goitom Mebrahtu; Mary M Moleki; Oliver Okoth Achila; Yemane Seyoum; Elias T Adnoy; Martin Ovberedjo Journal: Patient Prefer Adherence Date: 2021-11-23 Impact factor: 2.711