|Year : 2016 | Volume
| Issue : 1 | Page : 67-75
Prevalence of hypertension and associated factors among residents of Ibadan-North Local Government Area of Nigeria
Ikeoluwapo O Ajayi1, Ibukun Opeyemi Sowemimo2, Onoja Matthew Akpa1, Ndudi Edmund Ossai3
1 Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
2 Eagle’s Heart Foundation, Ibadan, Nigeria
3 Department of Community Medicine, Ebonyi State University Teaching Hospital, Ebonyi, Nigeria
|Date of Web Publication||13-Jan-2016|
Ibukun Opeyemi Sowemimo
17 Eagle’s Heart Foundation, Ibadan, Oyo State
Source of Support: None, Conflict of Interest: None
Background: Hypertension is a major public health challenge worldwide. It is the most important risk factor for cardiovascular disease.
Objectives: This study aimed to investigate the prevalence of hypertension and associated factors among the residents of Yemetu community in Ibadan-North Local Government Area of Oyo State, Nigeria.
Methods: A descriptive cross-sectional design was used. The study involved 806 respondents aged from 18-90 years from 171 households, selected by cluster sampling technique. It was a house-to-house survey. Behavioural risk factors were measured using World Health Organisation (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS 1 & 2). Hypertension was defined as Systolic blood pressure (SBP) ≥ 140 and/or Diastolic blood pressure (DBP) ≥ 90mm Hg or currently on anti-hypertensive medication. Data were analysed using descriptive statistics, Chi-square and binary logistic regression tests at P<0.05.
Results: The overall prevalence of hypertension was 33.1% (male 36.8% and female 31.1%). The proportion of self reported hypertension was 11.1%, while 5.1% were currently on anti-hypertensive medication. The mean age of the respondents was 38.8 ±15.6 years. The body mass index of the respondents was 5.2%, 52.0%, 29.5% and 13.3% for underweight, normal, overweight and obese, respectively. Alcohol and tobacco use were found in 11.5% and 3.2%, respectively. The result of binary logistic regression analysis revealed that hypertension was significantly associated with being in age groups 30-49 years (OR 2.258, 95% CI: 1.311 - 3.884), ≥50 years (OR 7.145, 95% CI: 3.644 - 14.011), being overweight or obese (OR 2.281, 95% CI: 1.022 – 5.088). Hypertension was inversely associated with being underweight (OR 0.537, 95% CI: 0.395 – 0.832).
Conclusion: This study revealed a high prevalence of hypertension. These data underscores the need for urgent steps to create awareness and implement interventions for prevention and early detection of hypertension, especially among those aged ≥30 years and the overweight or obese.
Keywords: Hypertension, prevalence, residents
|How to cite this article:|
Ajayi IO, Sowemimo IO, Akpa OM, Ossai NE. Prevalence of hypertension and associated factors among residents of Ibadan-North Local Government Area of Nigeria. Nig J Cardiol 2016;13:67-75
|How to cite this URL:|
Ajayi IO, Sowemimo IO, Akpa OM, Ossai NE. Prevalence of hypertension and associated factors among residents of Ibadan-North Local Government Area of Nigeria. Nig J Cardiol [serial online] 2016 [cited 2019 Sep 21];13:67-75. Available from: http://www.nigjcardiol.org/text.asp?2016/13/1/67/165168
| Introduction|| |
Hypertension, also known as high or raised blood pressure (BP) is a global public health challenge.,,,, Hypertension is a chronic medical condition in which the BP in the arteries is elevated., The higher the pressure in blood vessels the harder the heart has to work in order to pump blood, thus making the heart to work too hard. It is popularly known as the “silent killer,” because it has no specific sign and symptoms in the initial stage.
Hypertension is the most important modifiable risk factor for cardiovascular disease., Hypertension cuts across every social class. Both lower-income groups and higher-income groups may be at increased risk of developing hypertension. The etiology of hypertension is multifactorial., Aside genetic factors, several behavioral and socioeconomic factors can put an individual at risk. Metabolic risk factors like obesity, diabetes and raised blood lipids, can also contribute to the development of hypertension and its complications. Lifestyle modification is very important for the prevention and management of hypertension.
According to the World Health Organization (WHO), the prevalence of hypertension is highest in the African Region at 46% of adults aged 25 years and above, while the lowest was found in the American region., High prevalence of hypertension has been reported in some recent studies conducted in Nigeria.,,,,, Hypertension is the most common noncommunicable disease in Nigeria. Hypertension and its complications constitute approximately 25% of emergency medical admissions in urban hospitals in Nigeria. It is the most frequently diagnosed cardiovascular disorder in Nigeria.
Hypertension is rarely accompanied by any symptom and its identification is usually through screening, or when seeking healthcare for an unrelated problem.,, Screening, ideally not only detects hypertension, but also the basis for education and therapy., The Country's statistics on hypertension are unreliable; “most data are outdated speculation based on mathematical models and surveys that are scanty and unrepresentative with low validity.” This makes it necessary to conduct surveys that will generate reliable data that will inform decision-making at the appropriate levels of government. A prevalence rate is an important tool for assessing the magnitude and burden of a health event. Determining the prevalence of hypertension will help estimate its magnitude in the community. The prevalence rate found can also be compared with that of other community-based studies.
The study aimed at determining the prevalence of hypertension and associated factors among the residents of Yemetu community: An urban-slum in Ibadan-North Local Government Area (LGA) of Oyo State, Nigeria.
| Materials and Methods|| |
The study was conducted in Yemetu community, ward 3, Ibadan-North LGA, Ibadan, Oyo State, South-West, Nigeria. The community combines some of the features of an urban-slum as described by the United Nations Human Settlements Programme. A cross-sectional design was used for this study. The study population were adults (both sexes) aged 18 years and above. The study participants were selected by cluster sampling technique. Data were collected using WHO STEPS instrument 1 and 2 and the International Physical Activity Questionnaire (IPAQ). The survey was executed in two steps. Step one captured sociodemographic characteristics, history of hypertension and behavioral measurements. The section on physical activity was determined by IPAQ. Stage 2 captured physical measurements, that is; height in meters (m), weight (kg), and BP measurements were recorded in this stage.
Hypertension was defined as systolic BP (SBP) ≥140 mmHg and or diastolic BP (DBP) ≥90 mmHg, that is, ≥140/90 mmHg and/or self-reported treatment of hypertension with antihypertensive medication taken in the past 2 weeks, according to WHO/International Society of Hypertension guidelines. OMRON M2 (HEM-7116-E) Sphygmomanometer was used for BP measurement. Respondents sat on a chair with their feet flat on the floor and arm resting on a table and hence that their arm cuff was at their heart level. The cuff was securely applied to the upper arm of the participants using the fabric fastener strip. BP was taken from the left arm after at least 10 min of rest using appropriate cuff size. Respondents were told to be calm and not talk while their BP was being measured. The mean of two readings taken at least 2 min apart was determined. Hypertension was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg. It was classified thus:
- Stage 1: SBP 140–159 mmHg and/or DBP 90–99 mmHg;
- Stage 2: SBP ≥160 and/or DBP ≥ 100 mmHg;
- Isolated systolic hypertension: SBP ≥140 mmHg and <90 mmHg.,,,
Body mass index (BMI) was calculated using weight in kilogram (kg) divided by square of height in meters (m). The BMI was classified using WHO classification of BMI.
The Statistical Package for Social Sciences (SSPS Inc., Chicago, IL, USA) version 16.0 statistical software was used for data analysis. Descriptive statistics such as mean, frequency tables, charts and proportion, were used for data summarization. Inferential statistics was carried out using Chi-square and binary logistic regression at P < 0.05. The Chi-square test was used to analyze the relationship between sociodemographic characteristics, risk factors, and hypertension. Variables that are significant on Chi-square and those not significant, but have a P value that was <20% (P < 0.2), were selected for binary logistic regression test. Binary logistic regression analysis revealed the predictors of hypertension.
| Results|| |
Respondent's sociodemographic characteristics
A total of 820 respondents participated in this study. Only 806 (285 male and 521 female) had analyzable data. The remaining ones (14) could not be analyzed due to incomplete data. The response rate was 100%. Mean age was 38.8 ± 15.6 years. Age-wise distribution of the respondents showed the highest proportion, 266 (33.0%) in the 18–29 years age-group. Primary, secondary, and tertiary education was found in 24.4%, 54.6%, and 6.6%, respectively. The majority of the respondents were employed 669 (83.0%), majority being self-employed (73.4%). More than half (52.7%) of the respondents had lived in the community for 10 years or less, 217 (26.9%) have lived between 11 and 29 years, while, 164 (20.3%) had lived for 30 years or more [[Table 1].
History of hypertension
The frequency distribution of BP check among the respondents was as follow: Barely half (419, 52.0%) checked their BP within the past 12 months, 237 (29.4%) checked their BP more than a year ago, and 150 (18.6%) had never checked. A higher proportion of females 307 (58.9%) checked their BP within the past 12 months compared to males 112 (39.3%). More males 93 (32.6%) than females 57 (10.9%) had never checked their BP.
The proportion of respondents who had been diagnosed of hypertension by a health professional prior to the survey was 89 (11.0%).
[Table 2] shows the type of treatment received by hypertensives currently receiving treatment. About half (46.1%) of the hypertensives were currently on the antihypertensive drug. In addition, 36 (40.4%), 10 (11.2%), 25 (28.1%), and 11 (12.4%) were prescribed special diet, advised to or given treatment to lose weight, advised to start or do more exercise and on herbal or traditional remedy, respectively.
|Table 2: Type of treatment currently received by those diagnosed to be hypertensive prior to survey (n=89)|
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Prevalence of hypertension
Prior to the survey, a total of 89 respondents had been diagnosed of hypertension within the past 12 months by a health professional. Of this proportion, 41 (46.1%) were currently on antihypertensive medication. A total of 226 (28.0%) respondents were found to be hypertensive during BP measurement at the survey.
The overall prevalence of hypertension was 267 (33.1%), comprising those detected by survey 226 (28.0%) and hypertensives currently on medication 41 (5.1%).
The frequency distribution of BP categories of the respondents was as follow: Normal, prehypertension and hypertension were recorded in 259 (32.1%), 280 (35.4%), and 267 (33.1%), respectively. Hypertension Stage 1, Stage 2 and isolated systolic hypertension, were recorded in 88 (20.9%), 90 (11.2%), and 82 (10.2%), respectively.
[Figure 1] shows the prevalence of hypertension across sex and age-groups of the respondents. Prevalence of hypertension was 105 (36.8%) for males and 162 (31.1%) for females. The highest prevalence was found among respondents in the age-group ≥70 years.
[Table 3] shows the prevalence of hypertension across age-groups of respondents. Prevalence of hypertension increased with age. Respondents in ≥70 years age-group had the highest prevalence 39 (78.0%), while those in <20 years age-group had the lowest prevalence 5 (11.6%).
Frequency distribution of body mass index categories
The mean weight (kg), height (m), and BMI (kg/m 2) of the respondents were 64.8 ± 1.3, 1.61 ± 0.08, and 24.9 ± 4.9, respectively.
[Figure 2] shows the frequency distribution of BMI categorization into four categories. Underweight, normal, overweight, and obese were recorded in 5.2%, 52%, 29.5%, and 13.3%, respectively. The stages of obesity were 8.90%, 3.60%, and 0.70% for Stages 1, 2, and 3, respectively.
|Figure 2: Frequency distribution of body mass index categorization into four groups|
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[Figure 3] shows the frequency distribution of BMI categorization into two categories. More than half (57.2%) of the respondents were either underweight or normal while 42.8% were either overweight or obese.
|Figure 3: Frequency distribution of body mass index categorization into two groups|
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Association between sociodemographic characteristics and presence of hypertension
[Table 4] shows the association between respondent's sociodemographic characteristics and hypertension. Age-wise distribution of hypertension showed the highest prevalence 86 (71.1%) in the ≥60 years age-group, while the lowest prevalence 39 (14.7%) was recorded in the 18–29 years age-group. This difference was statistically significant (P ≤ 0.001). Prevalence of hypertension was slightly higher for males 105 (36.8%) compared to females 162 (31.1%). This difference was however not statistically significant (P = 0.097). Widow/er had the highest prevalence 49 (71.0%) compared to singles which had the lowest prevalence 30 (20.3%). This difference was found to be statistically significant (P ≤ 0.001). Respondent's level of education was statistically significant with hypertension (P ≤ 0.001). Respondents with primary education had the highest prevalence 150 (47.9%). Work status was statistically associated with hypertension (P ≤ 0.001). Unemployed respondents had the highest prevalence 35 (62.5%). More Muslims 164 (34.3%) had hypertension compared to Christians 103 (31.5%), this difference was not statistically significant (P = 0.405). Prevalence was higher among respondents in other ethnic groups 6 (42.9%) compared to the Yorubas 261 (33.0%). The difference was however not statistically significant (P = 0.435). Duration of residence in the community was statistically associated with hypertension (P ≤ 0.001). Respondents who had lived for 30 years or more had the highest prevalence 96 (57.3%).
|Table 4: Association between sociodemographic characteristics and presence of hypertension|
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Association between presence of risk factors and hypertension
[Table 5] shows the association between presence of risk factors and hypertension. BMI status was statistically associated with hypertension (P ≤ 0.001). Obese respondents had the highest prevalence 55 (51.4%), while the under weights had the lowest prevalence 12 (28.6%). Respondents who consumed fruits and vegetables on a typical day in the last 7 days, had slightly higher prevalence 190 (33.0%) compared to those who did not 77 (32.8%). This difference was not statistically associated with hypertension (P = 0.889). Alcohol consumption was not statistically associated with hypertension (P = 0.092). Alcohol consumers had a higher prevalence of hypertension 51 (39.5%) compared to abstainers 216 (31.9%). Prevalence was almost the same for those who engaged in vigorous physical activities 72 (33.5%) and those who did not 195 (33.0%) P = 0.895. Whereas, prevalence was lower 166 (27.6%) among respondent who engaged in moderate physical activities compared to those who did not 101 (49.3%). The difference was statistically significant (P ≤ 0.001). There was no significant association between walking and hypertension (P = 0.411). Prevalence of hypertension was higher among smokers 11 (42.3%) compared to nonsmokers 256 (32.8%). The association was not statistically significant (P = 0.312).
|Table 5: Association between presence of risk factors and hypertension (n=806)|
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Predictors of hypertension
[Table 5] shows the predictors of hypertension. The odds of developing hypertension was 7 times more among respondents in ≥50 years age-group compared to those in ≤30 years age-group (odds ratio [OR]: 7.145, 95% confidence interval [CI]: 3.644–14.011), while it was 2 times more in those in 30–49 years age-group (OR: 2.258, 95% CI: 1.311–3.884). The odds of developing hypertension was 2 times more among overweight/obese respondents, compared to those with BMI in the normal category (OR: 2.281, 95% CI: 1.022–5.088). Underweight respondents (OR: 0.537, 95% CI: 0.395–0.832) were protected from hypertension [Table 6].
| Discussion|| |
A total of 806 adults aged 18–90 years from 171 households were studied. The mean age of the respondents was 38.8 ± 15.6 years. This was similar to 38.02 ± 13.3 years found in a survey of hypertension and its awareness amongst traders and artisans in Ogbete Market, Enugu State.
Sex distribution of the respondents was males (35.6%), females (64.6%). There were more females respondents. This agrees with the sex distribution of respondents in a survey of hypertension among residents of Ajegunle community, a popular slum in Lagos State, Nigeria: 34.2% (male) and 65.8% (female).
Normal BP and prehypertension were recorded in 259 (32.1%) and 280 (34.7%) respondents, respectively. The overall prevalence of hypertension in this study was 33.1%. About one-third of the respondents were hypertensive. In this study, the overall prevalence of hypertension (33.1%) was the same with that found in 95 geographical clusters in Mozambique  and very similar to 32.8% found in three communities in Enugu North LGA of Enugu State, Nigeria.
Compared to recent community-based hypertension studies in Nigeria, the overall of prevalence of hypertension in this study was higher than 18.3% found in Kegbara-Dere; a rural community in the Niger-Delta Region of Nigeria  and 23.6% found among the inhabitants of three rural communities in Akwa-Ibom and Cross-River States. The overall prevalence of hypertension of 33.1% was however 3 times higher than the rates found in two studies conducted in the same Ibadan city about 15 years ago: 9.3% found among urban workers in Ibadan city  and 10.3% found in a civil service population in Ibadan city. This wide margin further confirmed the upsurge of hypertension in communities across Nigeria. The overall prevalence of 33.1% was however lower than 36.6% found among adult residents of Ile-Ife in Osun State, Nigeria  and 38.2% found among adult residents of Ajegunle in Lagos State, Nigeria.
Compared to community-based studies in other parts of the world, prevalence of hypertension in this study was higher than 15% found among adults residents of Karen ethnic rural community, Thasongyang, Thailand; 27.1% found in Adansi South, Ghana; 29.9% found among residents of Rukungiri district, Uganda; 30.3% found in subsistent farmers community in remote rural central India. But, it was lower than 33.7% found in Ansas-city, Korea; and 55.9% found among herdsmen living in Tibet, China.
This study confirms local report of high prevalence of hypertension in some communities across Nigeria. However, prevalence of hypertension in this study was lower than 46.0%; the estimated prevalence of hypertension for WHO African Region.
In our study, more males (36.8%) had hypertension compared to females (31.1%). This was consistent with the findings in several community-based studies: Survey of hypertension among residents of a rural community in South-East Nigeria, where it was (50.2%) male and (44.8%) female; a survey of hypertension in a rural community in Eastern Nigeria: Male (49.3%), female (42.3%); in a survey of hypertension amongst herdsmen living in Tibet, China: Male (66.1%), female (48.3%). Contrary to our finding, prevalence of hypertension was higher among females (79.6%) compared to males (74.4%) in a survey of hypertension in an older adult population in South Africa.
In our study, prevalence of hypertension increased with age. Prevalence increased from 14.3% in 18–29 years age-group to 70.2% in the ≥60 year age-group. This was in consonance with the findings in most recent community-based studies conducted in Nigeria.,,, Age was the only sociodemographic factor that was significantly associated with hypertension. This was consistent with the result of a survey of hypertension among adult residents of Ajegunle community, Lagos State, Nigeria; a survey of hypertension among adults patients attending a Missionary Hospital in Ibadan, Oyo State, Nigeria; and in a survey of BP gradients and cardiovascular risk factors in urban and rural populations in Abia State, Nigeria. Age was however not significant with hypertension in a survey conducted in a rural community in Eastern Nigeria. Multivariate analysis revealed age was a predictor of hypertension. Compared to respondents in <30 years age-group, the odds of developing hypertension was 7 times more in those 50 years or more and 2 times more among those aged 30–49 years. This was consistent with the results of a survey of hypertension in a civil service population in Ibadan, Oyo State, Nigeria; a cardiovascular risk factors survey in Abia State, Nigeria; a survey of hypertension, awareness, treatment and control of risk factors among adults in Ansan-City, Korea.
In this study, BMI categorization into four groups showed that 5.2%, 52%, 29.5%, and 13.3% were underweight, normal, overweight and obese, respectively. Further categorization into two groups showed that 57.2% and 42.8% were underweight/normal and overweight/obese, respectively. Numerous studies had established the association between BMI and hypertension.,, BMI is one of the most accurate ways to determine when extra body weight translates into health risks. BMI was the only risk factor that was significantly associated with hypertension. Obese respondents had the highest prevalence of hypertension. This agreed with the findings in a survey of hypertension among adult patients attending a Missionary Hospital in Ibadan, Nigeria; survey of hypertension among herdsmen living in Tibet, China; in a survey of hypertension among residents of Ajegunle, Lagos State, Nigeria; and in a survey of hypertension in a rural community in Eastern Nigeria. Multivariate analysis revealed that being overweight or obese was a predictor of hypertension. Compared to those with BMI in the normal category, the odds of developing hypertension was 2 times more among those in the overweight/obese category.
| Conclusion|| |
A high prevalence of hypertension was recorded in this study. About one-third of the respondents were hypertensive. This finding has public health implication as it puts one in every three adults in the community at-risk of cardiovascular disease (s). It was also found that majority of the hypertensives were not aware of their status prior to the survey. This underscores the need for urgent steps to create awareness and implement interventions for prevention and early detection of hypertension especially among those aged ≥30 years and the overweight/obese.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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