Stroke occurrence by hypertension treatment status in Ghana and Nigeria: A case-control study

Fred Stephen Sarfo, Osahon Jeffery Asowata, Onoja Matthew Akpa, Joshua Akinyemi, Kolawole Wahab, Arti Singh, Albert Akpalu, Priscilla Abrafi Opare-Addo, Akinkunmi Paul Okekunle, Godwin Ogbole, Adekunle Fakunle, Oladimeji Adebayo, Reginald Obiako, Cynthia Akisanya, Morenkeji Komolafe, Taiwo Olunuga, Innocent I. Chukwuonye, Godwin Osaigbovo, Paul Olowoyo, Phillip B. AdebayoCarolyn Jenkins, Abiodun Bello, Ruth Laryea, Phillip Ibinaye, Olatundun Olalusi, Sunday Adeniyi, Oyedunni Arulogun, Okechukwu Ogah, Abiodun Adeoye, Dialla Samuel, Benedit Calys-Tagoe, Hemant Tiwari, Onyemelukwe Obiageli, Yaw Mensah, Lambert Appiah, Rufus Akinyemi, Bruce Ovbiagele, Mayowa Owolabi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Hypertension is preeminent among the vascular risk factors for stroke occurrence. The wide gaps in awareness, detection, treatment, and control rates of hypertension are fueling an epidemic of stroke in sub-Saharan Africa. Purpose: To quantify the contribution of untreated, treated but uncontrolled, and controlled hypertension to stroke occurrence in Ghana and Nigeria. Methods: The Stroke Investigative Research and Educational Network (SIREN) is a case-control study across 16 study sites in Ghana and Nigeria. Cases were acute stroke (n = 3684) with age- and sex-matched stroke-free controls (n = 3684). We evaluated the associations of untreated hypertension, treated but uncontrolled hypertension, and controlled hypertension at BP of <140/90 mmHg with risk of stroke occurrence. We assessed the adjusted odds ratio and population-attributable risk of hypertension treatment control status associated with stroke occurrence. Results: The frequencies of no hypertension, untreated hypertension, treated but uncontrolled hypertension and controlled hypertension among stroke cases were 4.0%, 47.7%, 37.1%, and 9.2% vs 40.7%, 34.9%, 15.9%, and 7.7% respectively among stroke-free controls, p < 0.0001. The aOR and PAR (95% CI) for untreated hypertension were 6.58 (5.15–8.41) and 35.4% (33.4–37.4); treated but uncontrolled hypertension was 9.95 (7.60–13.02) and 35.9% (34.2–37.5); and controlled hypertension 5.37 (3.90–7.41) and 8.5% (7.6–9.5) respectively. Untreated hypertension contributed a PAR of 47.5% to the occurrence of intracerebral hemorrhage vs 29.5% for ischemic stroke. The aOR of untreated hypertension for stroke occurrence was 13.31 (7.64–23.19) for <50 years; 7.14 (4.51–11.31) for 50–64 years; and 3.48 (2.28–5.30) for 65 years or more. Conclusion: The contribution of untreated hypertension and treated but uncontrolled hypertension to stroke occurrence among indigenous Africans is substantial. Implementing targeted interventions that address gaps in hypertension prevention and treatment, involving the local population, healthcare providers, and policymakers, can potentially substantially reduce the escalating burden of strokes in Africa.

Original languageEnglish
Article number122968
JournalJournal of the Neurological Sciences
Volume459
DOIs
Publication statusPublished - 15 Apr 2024

Keywords

  • Africa
  • Hypertension
  • Prevention
  • Risk factors
  • Stroke

Fingerprint

Dive into the research topics of 'Stroke occurrence by hypertension treatment status in Ghana and Nigeria: A case-control study'. Together they form a unique fingerprint.

Cite this