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Table 5 Comorbidities and other determinants associated with hypertension in older adults in Africa

From: Determinants of systemic hypertension in older adults in Africa: a systematic review

No.

Country

Reference

Physical activity

Obesity or adiposity

Alcohol

Diabetes

Other determinants

1

Nigeria

Abegunde 2013 [24]

 

Compared with normal BMI: obese OR = 2.8 (1.52–5.29); p = 0.001

   

2

Ghana

Boateng 2017 [21]

 

Compared with BMI normal weight category: underweight RR = 0.65 (0.40, 0.81) p ≤ 0.01 (Stage 1 SHTN); RR = 0.57 (0.41, 0.81), p ≤ 0.001 (Stage 2 SHTN).

Overweight RR = 1.73 (1.24, 2.40), p ≤ 0.001 (Stage 2 SHTN)

Obese RR = 1.64 (1.07, 2.51) p ≤ 0.05 (Stage 1 SHTN); RR = 1.81 (1.19, 2.77), p ≤ 0.01 (Stage 2 SHTN)

Consumes alcohol compared with does not consume alcohol: RR 1.41 (1.08, 1.85) p ≤ 0.05 (Stage 1 SHTN); RR = 0.89 (0.68, 1.18) NS (Stage 2 SHTN).

 

Compared with subjects with no religion: Traditional religion, RR 0.38 (0.19, 0.75) p ≤ 0.01 (Stage 2 SHTN)

3

Ghana

Boateng 2017 [21]

 

Compared with BMI normal weight category: underweight RR = 0.75 (0.54, 1.02) NS (Stage 1 DHTN); RR = 0.63 (0.47,0.85), NS (Stage 2 DHTN).

Overweight RR = 1.51 (1.06, 2.15), p ≤ 0.05 (Stage 1 DHTN); 1.67 (1.21, 2.31), p ≤ 0.001 (Stage 2 DHTN)

Obese RR = 1.79 (1.16, 2.77) p ≤ 0.01 (Stage 1 DHTN); RR = 1.77 (1.18, 2.63), p ≤ 0.01 (Stage 2 DHTN)

Consumes alcohol compared with does not consume alcohol: RR 0.94 (0.71, 1.23), NS (Stage 1 DHTN); RR = 0.91 (0.71, 1.16), NS (Stage 2 DHTN).

 

Compared with subjects with no religion: Other religion, RR 0.30 (0.11, 0.82) p ≤ 0.01 (Stage 1 DHTN);

Traditional religion RR = 0.35 (0.19, 0.75) p ≤ 0.001 (Stage 2 DHTN)

4

Tanzania

Dewhurst 2013 [25]

 

Increasing BMI: OR 1.09 (1.06–1.12)

  

Compared with subjects of non-Chagga tribal origin: Chagga tribe, OR 1.65 (1.18–2.30)

5

Tunisia

Hammami 2011 [26]

 

BMI (continuous) OR 2.01 (1.5–2.5); P < 0.01

 

Self-reported diabetes OR 2.06 (1.45–3.5), p < 0.001

Disability OR 1.6 (0.9–2.7), p < 0.001

6

Ghana

Lloyd-Sherlock 2014 [18]

High physical activity (ref.): Moderate, OR = 1.02 (0.83–1.25); Low, OR 1.09 (0.92–1.30)

Normal BMI (ref): Underweight, OR 0.65 (0.54–0.79); Overweight, OR 1.77 (1.48–2.12); Obese, OR 2.30 (1.76–3.00)

Life-time abstainers (ref.): non-heavy drinker, OR 0.80 (0.69–0.94); Infrequent heavy drinkers, OR 1.24 (0.66–2.33); Frequent heavy drinkers, OR 1.24 (0.66–2.33)

 

Never smoker (ref.): Less than daily / ever smoker, OR 1.24 (1.02–1.49); Daily, OR 0.83 (0.61–1.12).

Has health insurance vs. Uninsured, OR 1.08 (0.94–1.25)

7

South Africa

Lloyd-Sherlock 2014 [18]

High physical activity (ref.): Moderate, OR = 0.91 (0.66–1.26); Low, OR 0.77 (0.61–0.97)

Normal BMI (ref): Underweight, OR 0.96 (0.58–1.59); Overweight, OR 1.57 (1.29–2.06); Obese, OR 1.85 (1.43–2.39)

Life-time abstainers (ref.): non-heavy drinker, OR 0.66 (0.47–0.91); Infrequent heavy drinkers, OR 0.41 (0.25–0.67); Frequent heavy drinkers, OR 0.45 (0.17–1.15)

 

Never smoker (ref.): Less than daily / ever smoker, OR 1.05 (0.78–1.42); Daily, OR 1.07 (0.81–1.42).

Has health insurance vs. Uninsured, OR 0.92 (0.71–1.20)

8

Senegal

Macia 2012 [30]

 

Compared with BMI < 25: BMI ≥25, OR = 1.86 (1.24–2.79), p < 0.01

  

Married (ref.): Not married, OR 0.81 (0.51–1.28)

9

Kenya

Mathenge 2010 [31]

 

BMI and WHR adjusted

Alcohol use adjusted

Diabetes (laboratory-confirmed) adjusted

Ethnicity Kalenjins (ref.): Kikuyus OR 1.4 (1.2–1.7)

10

Ghana

Minicuci 2014 [22]

 

Normal weight (ref.): Overweight BM 25.0–29.9 kg/m2 OR = 1.72 (1.40–2.11);

Obese BMI ≥30.0 kg/m2 OR 2.03 (1.53–2.71)

Underweight (BMI < 18.5 kg/m2) OR 0.63 (0.50–0.80)

  

Administrative region. Greater Accra (ref.): Ashanti OR 1.14 (0.78–1.66); Brong Ahafo, OR 0.98 (0.66–1.45); Central, OR 1.03 (0.69–1.52); Eastern, OR 1.03 (0.73–1.45); Northern, OR 0.90 (0.54–1.49); Upper East, OR 0.37 (0.24–0.58); Upper West, OR 0.24 (0.12–0.46); Volta, OR 0.99 (0.65–1.48); Western, OR 0.81 (0.54–1.21)

11

Ghana

Nuertey 2017 [34]

 

Adjusted OR 1.8 (1.5–2.0) compares overweight/obese in hypertensives and non-hypertensives

 

Adjusted for self-reported diabetes

 

12

South Africa

Peltzer 2013 [23]

 

Normal weight (ref.): Overweight BMI ≥25 kg/m2 OR = 1.52 (1.15–2.01), p < 0.01

Underweight (BMI < 18.5 kg/m2) OR 0.77 (0.36–1.64

Alcohol use over past one month, OR = 0.64 (0.49–0.84)

Self-reported diabetes, OR 1.30 (0.86–1.98)

Race black African (ref.): white OR 1.23 (0.66–2.30); Coloured OR 1.89 (1.04–3.44); Indian or Asian OR 0.82 (0.47–1.42)

Self-reported stroke OR 4.48 (1.48–13.59), p < 0.01

Self-reported arthritis OR 1.13 (0.75–1.69)

Outpatient visits in past 12 months; Nil (ref.):1–4 visits OR 1.14 (0.80–1.63); ≥ 5 visits vs. nil, OR = 1.93 (1.48–2.51)

13

CAR, Congo

Pilleron 2017 [36]

high physical activity ≥150 min/wk. vs. < 150 min/wk.; OR = 0.75 (0.59–0.96); p = 0.023

BMI (continuous variable); OR = 1.09 (1.06–1.12); p < 0.001

Compared with abstainers: light OR = 0.99 (0.77–1.27); moderate to heavy OR = 0.89 (0.42–1.89); p = 0.953

Diagnosed diabetes OR 0.85 (0.56–1.28), p = 0.408

Compared with tobacco nonuser: ex-user OR = 0.65 (0.41–1.03); current smoker OR = 0.60 (0.38–0.95); other mode of intake OR = 0.81 (0.60–1.11)

High cholesterol vs normal level: OR 1.33 (0.90–1.97)

14

Nigeria

Raji 2017 [37]

 

Overweight/obesity BMI ≥25 kg/m2 OR = 3.72 (1.47–9.40), p = 0.007

Never drank alcohol (ref.): Drank alcohol OR 0.84 (0.66–1.09), NS

No history of self-reported diabetes (ref.): Self-reported diabetes OR 0.91 (0.50–1.75), p value = 0.389

Cigarette smoking OR 0.97 (0.73–1.29), p value = 0.819

15

Uganda

Scholten 2011 [38]

    

Married (ref.): Not married, OR 0.92; NS

HIV infection and treatment, No HIV (ref.): HIV on ART, OR 0.50, NS; HIV no ART, OR 0.23, p value = 0.01

16

Cameroon

Tianyi 2017 [39]

 

Overweight/obesity vs. Others, OR = 3.46 (2.38–5.03), p < 0.001

   

17

Ghana

Tyrovolas 2015 [20]

Compared with high level physical activity: Moderate, OR 0.96 (0.72–1.28), NS; Low, OR 1.12 (0.91–1.38), NS

Compared with normal BMI:

underweight OR 0.70 (0.55–0.90), p < 0.01;

overweight OR 1.90 (1.54–2.35), p < 0.001; BMI 30.0–34.9 category OR 2.14 (1.51–3.04), p < 0.001; BMI ≥ 35 OR 2.78 (1.65–4.69), p < 0.001

Compared with never: Non-heavy OR 1.01 (0.86–1.19), NS; Heavy OR 1.07 (0.62–1.84), NS

Self-reported Yes vs No: OR 2.37 (1.51–3.74), p < 0.001

History of stroke, Yes vs. No: OR 3.45 (1.70–7.01), p < 0.001.

Fruit servings/day, 0–1 (ref): 2–4 servings OR 1.05 (0.86–1.28); ≥5 servings, OR 1.64 (1.13–2.39), p < 0.01

Vegetable servings/day, 0–1 (ref): 2–4 servings OR 1.04 (0.84–1.27); ≥5 servings, OR 0.68 (0.35–1.34)

Compared with never smoker: Current smoker OR 0.78 (0.60–1.01); Ex-smoker, OR 1.22 (0.96–1.54)

18

South Africa

Tyrovolas 2015 [20]

Compared with high level physical activity: Moderate, OR 0.76 (0.50–1.17), NS; Low, OR 0.67 (0.47–0.96), p < 0.05

Compared with normal BMI:

underweight OR 0.84 (0.47–1.51);

overweight OR 1.53 (1.07–2.19), p < 0.05; BMI 30.0–34.9, OR 1.65 (1.06–2.58), p < 0.05; BMI ≥ 35 OR 1.60 (1.04–2.44), p < 0.05

Compared with never: Non-heavy OR 0.92 (0.62–1.35), NS; Heavy OR 0.43 (0.23–0.81), p < 0.01

Self-reported Yes vs No: OR 1.61 (0.96–2.70)

History of stroke, Yes vs. No: OR 3.18 (1.36–7.43), p < 0.01

Fruit servings/day, 0–1 (ref): 2–4 servings OR 0.90 (0.65–1.24); ≥5 servings, OR 1.87 (0.63–5.54)

Vegetable servings/day, 0–1 (ref): 2–4 servings OR 1.55 (1.11–2.18), p < 0.05; ≥5 servings, OR 1.20 (0.58–2.46)

Compared with never smoker: Current smoker OR 1.25 (0.87–1.78); Ex-smoker, OR 1.70 (1.01–2.85), p < 0.05

  1. ART = antiretroviral therapy; BMI = body mass index; DHTN = diastolic hypertension; HIV = human immunodeficiency virus; NS = not statistically significant; OR = odds ratio; RR = relative risk; SHTN = systolic hypertension