Timeline of History of Hypertension Treatment
Accurate data from countries lacking national disease surveillance is needed to guide future evidence-driven health policies. The authors aimed to estimate the prevalence, awareness, management and control of hypertension and associated factors in an adult population of Angola.
A community-based survey of 1, adults, following the World Health Organization's Stepwise Approach to Chronic Disease Risk Factor Surveillance, was conducted to estimate the prevalence of hypertension, awareness, treatment and control in Dande, Northern Angola. Using a demographic surveillance system database, a representative sample of subjects, stratified by sex and age 18—40 and 41—64 years old , was selected.
Amongst hypertensive individuals, Only Our survey is the first to provide insightful data on hypertension prevalence in Angola. There is an urgent need for strategies to improve prevention, diagnosis and access to adequate treatment in this country, where a massive economic growth and consequent potential impact on lifestyle risk factors could lead to an increase in the prevalence of hypertension and cardiovascular disease. Accounting for more than 7 million lives lost annually and for 57 million disability-adjusted life years, arterial hypertension is not only a major risk factor for CVDs, but also recognized as the number one single risk factor for death worldwide [ 2 ].
The majority of hypertensive individuals lives in developing regions, with recent estimates pointing to 75 million suffering from this condition in Sub-Saharan Africa SSA , and a projected It is acknowledged, however, that limitations regarding the availability of data [ 1 , 4 — 6 ] surround predictive models such as those proposed by Twagirumuzika et al.
When combined with Demographic Surveillance Systems DSSs , this approach has been recognized as a powerful tool for generating information that can be used in guiding control and prevention of non-communicable diseases' NCDs , as in this context, its longitudinal capability can detect the dynamics of NCDs and associated factors at the population level [ 8 ].
Despite having endured a year conflict period that ended in , Angola has been repeatedly ranked among the 3 fastest-growing economies in the World [ 10 ].
Abbreviations and acronyms
Given this economic growth and consequent impact on risk factors for CVDs such as hypertension and obesity, hypertension is likely to become an increasingly important public health problem in Angola. The aim of this study was to estimate the prevalence, awareness, management and control of hypertension and associated factors in an adult population of Angola through collection of baseline data utilizing the WHO STEPS' approach and our DSS as a platform. The public health implications of our findings are discussed in light of the current economic boom in Angola.
Located 60 km north of Luanda, this area covers a population of 60, people, spread across 4, km 2 [ 11 , 12 ]. Following the WHO STEPS methodology [ 7 ], a representative sex- and age 18—40 and 41—64 years stratified random sample was drawn from the DSS adult population database, which comprises 29, uniquely identified individuals aged 18—64 years old. Due to logistic constraints, probability proportionate to size sampling was used to choose 35 out of 69 hamlets in the study area from which eligible adults could be selected.
Fieldwork was conducted during a week period, between October and December , allowing for the recruitment of 1, of the selected subjects. Information on sociodemographic characteristics and behavioural risk factors i. Frequent alcohol drinkers were defined as subjects that would consume alcohol 3 or more days per week and tobacco users were defined as subjects currently smoking tobacco on a daily basis.
Place of residence urban versus rural was classified according to the definition provided by the National Institute of Statistics [ 13 ].
Information on level of education was obtained from the DSS database and categorized per number of years of schooling completed: none; one to four; five to eight and nine or more. The following physical measurements were taken using standardized and internationally validated instruments: blood pressure, weight, height, waist and hip circumferences [ 14 ]. Three readings were taken after a minute rest, three minutes apart.
Measurements were performed with the participant seated, on the right arm and using the appropriate cuff size 22x32 cm or 32x42 cm. For data analysis, the average of the last two readings was used, as postulated by WHO [ 7 ]. Awareness was assessed by asking hypertensive subjects if they had ever been informed to be hypertensive by a health professional. Individuals taking anti-hypertensive medication at the time of survey administration were considered to be controlled if their blood pressure levels were below the thresholds aforementioned.