Joshi Mark David, Ayah Richard, Njau Elijah Kaharo, Wanjiru Rosemary, Kayima Joshua Kyateesa, Njeru Erastus Kennedy, Mutai Kenneth Kipyegon
Department of Clinical Medicine and Therapeutics, School of Medicine, College of Health Sciences, University of Nairobi, P,O, BOX 19676-00202, KNH, Nairobi, Kenya.
BMC Public Health. 2014 Nov 18;14:1177. doi: 10.1186/1471-2458-14-1177.
Urbanisation has been described as a key driver of the evolving non-communicable disease (NCD) epidemic. In Africa, hypertension is the commonest cardiovascular problem. We determined the prevalence and risk factor correlates of hypertension in the largest Nairobi slum.
In 2010 we conducted a population-based household survey in Kibera, a large informal settlement in Nairobi City; utilising cluster sampling with probability proportional to size. Households were selected using a random walk method. The WHO instrument for stepwise surveillance (STEPS) of chronic disease risk factors was administered by trained medical assistants, who also recorded blood pressure (BP) and anthropometric measures. BP was recorded using a mercury sphygmomanometer utilising the American Heart Association guidelines. Hypertension was defined as per the 7th Report of the Joint National Committee or use of prescribed antihypertensive medication. Those with hypertension or with random capillary blood sugar (RCBS) >11.1 mmol/l had an 8 hours fasting venous blood sugar sample drawn. Age standardised prevalence was computed and multivariate analysis to assess associations.
We screened 2200 and enrolled 2061 adults; 50.9% were males; mean age was 33.4 years and 87% had primary level education. The age-standardised prevalence of hypertension (95% CI) was 22.8% (20.7, 24.9). 20% (53/258) were aware of their hypertensive status; 59.3% had pre-hypertension; 80% reported high levels of physical activity and 52% were classified as harmful alcohol drinkers; 10% were current smokers and 5% had diabetes. Majority of males had normal BMI and waist circumference, whereas a third of females were obese or overweight and 40% had central obesity. Older age, higher general and central obesity were independently associated with hypertension and higher SBP and DBP readings.
Our findings of high prevalence of hypertension, in association with excess body weight in this poor urban slum community, point to the need for greater awareness and implementation of primary preventive strategies.
城市化被认为是不断演变的非传染性疾病（NCD）流行的关键驱动因素。在非洲，高血压是最常见的心血管问题。我们确定了内罗毕最大贫民窟中高血压的患病率及其相关危险因素。
2010年，我们在肯尼亚内罗毕市的一个大型非正式定居点基贝拉进行了一项基于人群的家庭调查；采用与规模成比例的概率整群抽样。使用随机游走方法选择家庭。由经过培训的医学助理使用世界卫生组织慢性病危险因素逐步监测（STEPS）工具进行调查，他们还记录了血压（BP）和人体测量数据。使用汞柱式血压计按照美国心脏协会指南记录血压。高血压的定义依据美国国家联合委员会第7次报告或使用处方抗高血压药物。对患有高血压或随机毛细血管血糖（RCBS）>11.1 mmol/l的患者采集8小时空腹静脉血糖样本。计算年龄标准化患病率并进行多变量分析以评估关联。
我们筛查了2200名成年人并纳入2061名；50.9%为男性；平均年龄为33.4岁，87%接受过小学教育。高血压的年龄标准化患病率（95%CI）为22.8%（20.7, 24.9）。20%（53/258）知晓自己的高血压状况；59.3%有高血压前期；80%报告身体活动水平高，52%被归类为有害饮酒者；10%为当前吸烟者，5%患有糖尿病。大多数男性的体重指数（BMI）和腰围正常，而三分之一的女性肥胖或超重，40%有中心性肥胖。年龄较大、总体肥胖和中心性肥胖程度较高与高血压以及较高的收缩压（SBP）和舒张压（DBP）读数独立相关。
我们关于该贫困城市贫民窟社区高血压患病率高且与超重相关的研究结果表明，需要提高认识并实施一级预防策略。
