Stark Regional and Sex Differences in the Prevalence and Awareness of Hypertension An H3Africa AWI-Gen Study Across 6 Sites in Sub-Saharan Africa F. Xavier Gómez-Olivé* ,y,z , Stuart A. Ali x , Felix Made x , Catherine Kyobutungi k , Engelbert Nonterah { , Lisa Micklesfield # , Marianne Alberts**, Romuald Boua yy , Scott Hazelhurst x,zz , Cornelius Debpuur { , Felistas Mashinya**, Sekgothe Dikotope**, Hermann Sorgho yy , Ian Cook xx , Stella Muthuri k , Cassandra Soo x , Freedom Mukomana x , Godfred Agongo { , Christopher Wandabwa k , Sulaimon Afolabi*, Abraham Oduro { , Halidou Tinto yy , Ryan G. Wagner*, Tilahun Haregu k , Alisha Wade*, Kathleen Kahn*, Shane A. Norris # , Nigel J. Crowther kk , Stephen Tollman*, Osman Sankoh y,{{,## , Michèle Ramsay x , *** : as members of AWI-Gen and the H3Africa Consortium Johannesburg, South Africa; Accra, Ghana; Cambridge, MA, USA; Nairobi, Kenya; Navrongo, Ghana; Polokwane, South Africa; Nanoro, Burkina Faso; and Njala, Sierra Leone ABSTRACT Background: There is a high prevalence of hypertension and related cardiovascular diseases in sub-Saharan Africa, yet few large studies exploring hypertension in Africa are available. The actual burden of disease is poorly understood and awareness and treatment to control it is often suboptimal. Objectives: The study sought to report the prevalence of measured hypertension and to assess awareness and control of blood pressure among older adults in rural and urban settings in 6 sites located in West, East, and Southern Africa. In addition, we examined regional, sex, and age differences related to hypertension. Methods: A population-based cross-sectional study was performed at 6 sites in 4 African countries: Burkina Faso (Nanoro), Ghana (Navrongo), Kenya (Nairobi), and South Africa (Agincourt, Dikgale, Soweto). Blood pressure measurements were taken using standardized procedures on 10,696 adults 40 to 60 years of age. Hypertension was defined as systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg or taking antihypertensive medication. Results: The mean prevalence of hypertension ranged from 15.1% in Nanoro to 54.1% in Soweto. All 3 of the South African sites had a mean prevalence of hypertension of over 40.0%, significantly higher than in Nairobi (25.6%) and Navrongo (24.5%). Prevalence increased with age in both sexes and at all sites. A significantly higher prevalence of hypertension was observed in women in Agincourt, Dikgale, and Nairobi, whereas in Nanoro this trend was reversed. Within the hypertensive group the average proportion of participants who were aware of their blood pressure status was only 39.4% for men and 53.8% for women, and varied widely across sites. Conclusions: Our study demonstrates that the prevalence of hypertension and the level of disease awareness differ not only between but also within sub-Saharan African countries. Each nation must tailor their regional hypertension awareness and screening programs to match the characteristics of their local populations. Hypertension is a rising global health problem, with an estimated 1 billion people living with hypertension, and 9.4 million related annual deaths worldwide [1,2]. Low- and middle-income countries suffer two-thirds of the global burden of cardiovascular disease (CVD), which is associated with inadequate treatment of hypertension [3]. In sub-Saharan Africa (SSA) hypertension has become a major public health problem [4,5]. At present, CVDs are considered to be a significant contributor to premature death in this region, with a high prevalence of hypertension found in many SSA settings. The WHO-SAGE (World Health Organization Study on Global Ageing and Adult Health) study [6], which compared nationally representa- tive populations over 50 years of age from China, Russia, India, Ghana, South Africa, and Mexico, reported that the prevalence of hypertension in South Africa was among the highest at over 77%. At the same time, the study reported low levels of awareness and blood pressure control in all of The authors report no relationships that could be construed as a conflict of interest. This paper describes the views of the authors and does not necessarily represent the official views of the National Institutes of Health or the NRF. The AWI-Gen Collaborative Centre is funded by the National Institutes of Health (Grant No. 1U54HG006938) as part of the H3Africa Consortium. Michèle Ramsay is a South African Research Chair in Genomics and Bioinformatics of African Populations hosted by the University of the Witwatersrand, funded by the Department of Science and Technology and administered by National Research Foundation of South Africa (NRF). Osman Sankoh is Executive Director of INDEPTH. The INDEPTH Network receives core support funding from the William and Flora Hewlett Foundation, Sida/Research Cooperation and Wellcome Trust. The Agincourt HDSS received core support from the University of the Witwatersrand and the Medical Research Council, South Africa, and the Wellcome Trust, UK (Grants 058893/Z/99/A; 069683/Z/ 02/Z; 085477/Z/08/Z; 085477/B/08/Z). The Nairobi HDSS receives core support from Sida and the William and Flora Hewlett Foundation. The Soweto Cohort (DPHRU) is supported by the Univer- sity of the Witwatersrand, the Medical Research Council, South Africa, DST-NRF Centre for Excellence in Human Development, and The Wellcome Trust. The Dikgale HDSS has received funding from the Norwe- gian Universities Commit- tee for Development Research and Education (NUFU); the Free University GLOBAL HEART, VOL. -, NO. -, 2017 1 Month 2017: --- ORIGINAL RESEARCH gSCIENCE j