Measuring Hypertension Progression With Transition Probabilities: Estimates From the WHO SAGE Longitudinal Study

Frontiers in Public Health

Richard Berko Biritwum¹  Stella T. Lartey²  Isaac Luginaah³  Godfred O. Boateng⁴  Ziyad Ben Taleb⁴  Andrew J. Palmer⁵  Costan G. Magnussen⁶  Philip Baiden⁷  Lei Si⁸  Paul Kowal⁹ 

[1] Department of Community Health, University of Ghana, Accra, Ghana;Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States;Department of Geography, University of Western Ontario, London, ON, Canada;Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, Arlington, TX, United States;Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia;Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia;Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia;Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland;Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland;School of Social Work, The University of Texas at Arlington, Arlington, TX, United States;The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia;World Health Organization, Geneva, Switzerland;University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, NSW, Australia;

关键词: elevated blood pressure;    hypertension;    multi-state model;    transition probabilites;    ACC/AHA 2017 hypertension guidelines;    sub-Saharan Africa;   

DOI  :  10.3389/fpubh.2021.571110

来源: Frontiers

【 摘 要 】

This paper assessed the transition probabilities between the stages of hypertension severity and the length of time an individual might spend at a particular disease state using the new American College of Cardiology/American Heart Association hypertension blood pressure guidelines. Data for this study were drawn from the Ghana WHO SAGE longitudinal study, with an analytical sample of 1884 across two waves. Using a multistate Markov model, we estimated a seven-year transition probability between normal/elevated blood pressure (systolic ≤ 129 mm Hg & diastolic <80 mm Hg), stage 1 (systolic 130-139 mm Hg & diastolic 80-89 mm Hg), and stage 2 (systolic ≥140mm Hg & diastolic≥90 mm Hg) hypertension and adjusted for the individual effects of anthropometric, lifestyle, and socio-demographic factors. At baseline, 22.5% had stage 1 hypertension and 52.2% had stage 2 hypertension. The estimated seven-year transition probability for the general population was 19.0% (95% CI: 16.4, 21.8) from normal/elevated blood pressure to stage 1 hypertension, 31.6% (95% CI: 27.6, 35.4%) from stage 1 hypertension to stage 2 hypertension, and 48.5% (45.6, 52.1%) for remaining at stage 2. Other factors such as being overweight, obese, female, aged 60+ years, urban residence, low education and high income were associated with an increased probability of remaining at stage 2 hypertension. However, consumption of recommended servings of fruits and vegetables per day was associated with a delay in the onset of stage 1 hypertension and a recovery to normal/elevated blood pressure. This is the first study to show estimated transition probabilities between the stages of hypertension severity across the lifespan in sub-Saharan Africa. The results are important for understanding progression through hypertension severity and can be used in simulating cost-effective models to evaluate policies and the burden of future healthcare.

【 授权许可】

CC BY