Under pressure: the challenge of hypertension in Ghana

Hypertension, or persistently high blood pressure, is the most common cause of cardiovascular disease in Africa and rates are rising as urban centres expand. How are health services coping with this growing problem? Researchers looked at rates, detection, treatment and control of hypertension in Ashanti, Ghana.

Researchers from St. George’s Hospital Medical School,London, and Komfo AnokyeTeaching Hospital in Ghana gave a detailed questionnaire to 385 men and 628women and recorded their height, weight and blood pressure. The participantshad an average age of 55 and lived in 12 villages – 532 in semi-urban and 481in rural villages. Hypertension was defined as a systolic (cause by contractionof the heart) blood pressure of at least 140 millimetres of mercury (mmHg)and/or a diastolic (dilation of the heart after contraction) blood pressure ofat least 90 mmHg or being on drug therapy.

Key findings include:

• The women in the survey had a higher body massindex than the men (21.6 versus 20.2 kg/m2). People in semi-urban areas wereheavier and had higher blood pressure than rural dwellers (129/76 versus 121/72mmHg).
• 291 people have hypertension, giving an overallprevalence of 28.7 percent. Rates were similar for men and women, buthypertension was more common in semi-urban villages and increased with age.
• Overall, 22 percent of sufferers knew they hadthe condition, 11.3 percent were on drug treatment, but only 2.8 percent hadtheir blood pressure under control.
• The detection of hypertension was higher forwomen (27.3 percent identified) than men (13.9 percent). Treatment and controlrates were low for men (7.8 and 4.4 percent) and women (13.6 and 1.7 percent).
• Detection, treatment and control rates werehigher in semi-urban (25.7, 14.3 and 3.4 percent) than in rural villages (16.4,6.9 and 1.7 percent).

Differences in blood pressure, body weight and hypertensionrates between rural and semi-urban areas suggest that even limited urbanisationcan lead to important changes in cardiovascular risk factors. The researchersrecommend that the Government of Ghana should:

• place the incidence of high blood pressure onits health agenda
• set up a national control programme
• develop guidelines for the detection andmanagement of hypertension
• promote a reduction in salt intake
• provide low-cost drugtreatment for high blood pressure.