부산대학교 도서관

Aim and objectives: The aims were to address the gaps in knowledge about (i) the scope in the burden of uncontrolled hypertension among adults with comorbidities residing in sub-Saharan Africa and (ii) the factors associated with uncontrolled hypertension in these individuals. Methods: A mixed methods approach was used including: (1) a systematic review and meta-analysis to synthesize evidence on uncontrolled hypertension among patients with comorbid conditions and to estimate the prevalence of uncontrolled hypertension among patients with comorbid conditions in sub-Saharan Africa; (2) analysis of nationally representative individual level participant data from 20 sub-Saharan African countries; (3) cross-sectional household level data from two slums in Kenya and (4) a qualitative study exploring facilitators and barriers to blood pressure control among patients with comorbid conditions in two slums in Kenya. Key findings: The prevalence of uncontrolled hypertension is high and it is higher among people with comorbidities. There were regional differences in the prevalence of uncontrolled hypertension in general and uncontrolled hypertension among individuals with comorbidities. The meta-analysis of the individual WHO STEPwise approach to surveillance (STEPS) data further showed significant associations between comorbidities and uncontrolled hypertension. The cross-sectional study in Nairobi slums, showed that the prevalence of single and multimorbidity was high and hypertension was among the most frequently co-occurring conditions. The main barriers to blood pressure control identified in the qualitative study include: poverty, adherence, unsupportive families, limited access to medications, limited health care staffing, major issues with supply chain management system, and guidelines for treatment and lack of resources allocated to hypertension care. Conclusion: The burden of uncontrolled hypertension is high among individuals with comorbidities in sub-Saharan Africa. Often, hypertension does not present in isolation and most clinicians fail to recognize the importance of assessing patients' comorbidities along with managing patient blood pressures mainly because they are accustomed to the single disease framework that most healthcare delivery systems have. An epidemiologic transition is already occurring in sub-Saharan African countries and hypertension is a major risk factor that needs addressing. Hypertension and comorbidities need to be closely monitored and managed for improved outcomes in SSA.