TY - JOUR
T1 - Stroke occurrence by hypertension treatment status in Ghana and Nigeria
T2 - A case-control study
AU - Sarfo, Fred Stephen
AU - Asowata, Osahon Jeffery
AU - Akpa, Onoja Matthew
AU - Akinyemi, Joshua
AU - Wahab, Kolawole
AU - Singh, Arti
AU - Akpalu, Albert
AU - Opare-Addo, Priscilla Abrafi
AU - Okekunle, Akinkunmi Paul
AU - Ogbole, Godwin
AU - Fakunle, Adekunle
AU - Adebayo, Oladimeji
AU - Obiako, Reginald
AU - Akisanya, Cynthia
AU - Komolafe, Morenkeji
AU - Olunuga, Taiwo
AU - Chukwuonye, Innocent I.
AU - Osaigbovo, Godwin
AU - Olowoyo, Paul
AU - Adebayo, Phillip B.
AU - Jenkins, Carolyn
AU - Bello, Abiodun
AU - Laryea, Ruth
AU - Ibinaye, Phillip
AU - Olalusi, Olatundun
AU - Adeniyi, Sunday
AU - Arulogun, Oyedunni
AU - Ogah, Okechukwu
AU - Adeoye, Abiodun
AU - Samuel, Dialla
AU - Calys-Tagoe, Benedit
AU - Tiwari, Hemant
AU - Obiageli, Onyemelukwe
AU - Mensah, Yaw
AU - Appiah, Lambert
AU - Akinyemi, Rufus
AU - Ovbiagele, Bruce
AU - Owolabi, Mayowa
N1 - Publisher Copyright:
© 2024 Elsevier B.V.
PY - 2024/4/15
Y1 - 2024/4/15
N2 - 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.
AB - 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.
KW - Africa
KW - Hypertension
KW - Prevention
KW - Risk factors
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85188563059&partnerID=8YFLogxK
U2 - 10.1016/j.jns.2024.122968
DO - 10.1016/j.jns.2024.122968
M3 - Article
AN - SCOPUS:85188563059
SN - 0022-510X
VL - 459
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 122968
ER -