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Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally
Neo M Tapela1,2, Lei Clifton1, Gontse Tshisimogo3
1Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Insights
Hypertension affects 30% of adults in Botswana, with over half unaware of their condition. Management remains suboptimal, highlighting a critical public health need for improved hypertension control strategies.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Disease Research
Background:
- Hypertension is a major risk factor for cardiovascular mortality, particularly in sub-Saharan Africa.
- Limited data exists on hypertension management in this region due to unique contextual factors.
Purpose of the Study:
- To determine the prevalence and correlates of hypertension, awareness, treatment, and control in Botswana.
- To assess the hypertension care cascade in a middle-income African nation with demographic transition and high HIV burden.
Main Methods:
- A 2014 cross-sectional survey of 4,007 adults aged 15-69 in Botswana.
- Data collected via in-person interviews and physical measurements (BMI, triplicate BP).
- Hypertension defined by antihypertensive use or BP ≥140/90 mmHg; multivariable logistic regression used.
Main Results:
- Age-standardized hypertension prevalence was 30%.
- Among those with hypertension, 54% were unaware, 45% of aware individuals were untreated, and 63% of treated individuals had uncontrolled BP.
- Diabetes was strongly associated with hypertension and awareness; males had lower awareness and control; obesity linked to higher treatment but lower control.
Conclusions:
- This study provides the first nationally representative estimates of the hypertension care cascade in Botswana.
- Findings will aid in planning and policy evaluation for hypertension management.
- Results can inform interventions to improve hypertension care quality and adherence support in similar settings.
Introduction:
Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in sub-Saharan Africa. Few studies have examined performance on the management of hypertension in this region, where the context may be distinct from other developing regions.
Objectives:
We aimed to determine the prevalence and correlates of hypertension, awareness, treatment, and control among adults in Botswana, a middle-income African country undergoing rapid demographic transition and with high HIV burden.
Methods:
In this 2014 cross-sectional survey of adults aged 15-69 years, information on sociodemographic characteristics, lifestyle behavior, and medical history was collected through in-person interviews and physical measurements (body mass index and triplicate blood pressure (BP)). Hypertension was defined as self-report of use of antihypertensives in the previous two weeks and/or having elevated BP (≥140/90 mmHg). Multivariable logistic regression was employed to explore factors associated with hypertension, awareness (report of previous diagnosis), treatment (antihypertensives), and control (BP < 140/90).
Results:
Our analysis (N = 4,007) yielded an age-standardized hypertension prevalence of 30% (95% CI: 28%-32%, N = 1,393). Among hypertensives, 54% (50-58%) were unaware of their condition, 45% (40-50%) of those aware were untreated, and 63% (55-70%) of those on medications were suboptimally treated (BP ≥ 140/90 mmHg). A fifth of hypertensives who were diagnosed but not on medications had BP ≥ 180/110 mmHg. Diabetes was the strongest correlate of hypertension and awareness (aOR 4.00, 1.86-8.59; aOR 3.30, 1.44-7.55, respectively). Males were less likely to be aware (aOR 0.62, 0.41-0.94) or controlled (aOR 0.36, 0.16-0.83). Obese individuals were more likely to be treated (aOR 2.17, 1.12-4.22), yet less likely to be controlled (aOR 0.32, 0.15-0.66).
Conclusions:
We report the first nationally representative estimates of the hypertension care cascade performance in Botswana, which will support planning and future policy evaluations. Findings contribute to the relatively sparse evidence on this subject and may inform development of innovations that improve quality of hypertension management and adherence support in similar settings.
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