Hypertension Among Adults in Addis Ababa, Ethiopia: Prevalence and Dietary Risk Factors
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Date
2024-06
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Addis Ababa University
Abstract
The global burden of hypertension is rising rapidly, especially in low- and middle-income countries (LMICs) like Ethiopia, where it has emerged as the leading non-communicable disease (NCD) in recent years. Overweight and obesity are also increasingly recognized as major modifiable risk factors for hypertension and
cardiovascular disease (CVD). Hence, early detection of CVD risk is crucial for prevention and treatment. The Framingham risk score (FRS) is a simplified tool to
predict 10-year CVD risk but has not been validated in sub-Saharan Africa. Fruits and vegetables (FV) may help lower CVD risk, though the optimal intake levels remain uncertain. In addition to other lifestyle habits, dietary patterns as a whole likely impact hypertension and obesity. The Dietary Approaches to Stop Hypertension (DASH) diet is proven to reduce blood pressure in Western populations, nonetheless, its applicability to Ethiopia is unknown. Therefore, this dissertation investigated the epidemiology of hypertension among adults, predicted the 10-year CVD risk of hypertensive patients and its association with FV intake, and lastly assessed DASH-style diet adherence and its relation to hypertension and adiposity among adults in Addis Ababa. A community-based cross-sectional study was conducted from May to June 2021 among randomly selected adults aged 18-64 years (n=600). A face-to-face interview using an adapted STEPwise was conducted. The participants completed standardized blood pressure, blood glucose, lipid profile, and anthropometric measurements
including body fat percentage (BF%). FV consumption, salt intake, and stress levels were also measured with 24-hour dietary recall, INTERSALT equation, and Cohen’s Perceived Stress Scale, respectively. The 10-year CVD risk was calculated among a subset of the original samples using the FRS as well as a country-specific Globorisk score from 191 patients diagnosed with hypertension. Dietary pattern was assessed using a DASH diet score based on eight food groups constructed from a validated food frequency questionnaire. Multilevel mixed-effects logistic regression, multiple linear regression, and multivariate logistic regression models were fitted to determine factors associated with different outcomes of interests related to hypertension.
The sample consisted of a total of 600 adults (mean age: 31.2 ± 11.4 years, 51.7% women). The overall age-standardized prevalence of hypertension was 22.1% and 47.8% according to the JNC7 and the 2017 AHA guidelines, respectively. The age groups of 40-54 years (AOR= 8.97; 95% CI: 2.35,34.23), and 55-64 years (AOR=19.28; 95% CI: 3.96,93.83) as compared to the 18-24 age group, male sex (AOR=2.90; 95% CI: 1.22,6.87), obesity (AOR=1.92; 95% CI: 1.02,3.59), abdominal obesity (AOR=4.26; 95% CI: 1.42,12.81), and very poor sleep quality (AOR=3.35; 95% CI: 1.15,9.78) were independent predictors of hypertension. In the prevalence of predicted 10-year CVD risk study, a total of 42.4%, 27.7%, and 29.8% of hypertensive patients were at low, moderate, and high CVD risks, respectively. There was a substantial agreement between the FRS and Globorisk models (weighted kappa 0.77).
After adjusting for covariates, increasing FV intake from 120-450g/day was significantly related to 11.1-15.2% lower CVD risk in a dose-response manner.
Additionally, the highest tertile of total fruit, but not total vegetable was associated with decreased CVD risk. The average DASH score was 22.5 (95% CI: 22.2-22.8), higher in women 23.7 (95% CI: 23.3-24.2) than men 21.2 (95% CI: 20.7-21.5). After controlling for confounders, individuals in the highest DASH-style diet adherence had 72% lower odds of hypertension than those in the lowest level. Furthermore, the risk of adiposity assessed using BF%, waist circumference, and waist-to-hip ratio were reduced by 15%, 62%, and 82%, respectively, in participants with higher DASH
adherence compared to lower.
The study concluded that hypertension is fairly high among adults and independently associated with the older age group, male sex, obesity, abdominal obesity, and poor sleep quality. There is a high prevalence of CVD risk among hypertensive patients and inversely associated with high FV consumption. The adherence to a DASH-style diet is moderate; however, high adherence is associated with a reduced risk of hypertension and adiposity among adults in Addis Ababa. Therefore, the study suggests a need to develop an integrated NCD prevention and control approach. Specifically, healthy dietary patterns should be adopted and tailored to public health policies and clinical practice to halt the NCD burden
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Keywords
Non-Communicable Diseases, Blood Pressure, Hypertension, Cardiovascular Disease, Fruits, Vegetables, Framingham Risk Score, Obesity, Adiposity, DASH Score, Dietary Patterns