Department of Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Burkina Faso.
Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, United Kingdom.
PLoS One. 2019 Apr 5;14(4):e0214934. doi: 10.1371/journal.pone.0214934. eCollection 2019.
Hypertension is the leading driver of cardiovascular disease deaths in Africa. Its prevalence is highest in older populations. Yet, this group has received little attention in many African countries. We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42017056474) to estimate the prevalence of hypertension in older adults living in Africa.
We searched grey literature and major electronic databases including PubMed and Embase for population-based studies and published between 1 January 1980 to 28 May 2018 reporting the prevalence of hypertension for adults aged ≥50 years living in Africa. We employed a random effects model to estimate the pooled prevalence across included studies.
We screened 10,719 articles and retrieved 103 full-text articles to evaluate for inclusion in the review. Thirty-four unique studies providing 37 data points on 43,025 individuals in 15 African countries were analyzed. The prevalence of hypertension ranged from 22.3% to 90.0% from the individual studies while the overall pooled prevalence was 57.0% (95% CI 52%-61%). The prevalence was not statistically significantly different by sex, residence, or African sub-region. In individual studies, older age and overweight/obesity were independently associated with hypertension. Twenty-nine (78%) data points were deemed to be of low- or moderate-risk of bias. Eliminating high-risk bias studies made little difference to the pooled estimate of hypertension. Sensitivity analyses, omitting one study at a time, identified three studies with significant but relatively small impact on the pooled estimate. We observed substantial heterogeneity (I2 = 98.9%) across the studies which was further explored by meta-regression analyses. Overall, the GRADE assessment suggested moderate quality evidence in the results.
The persistent high prevalence of hypertension among older adults in Africa, even in rural populations warrants more attention to the cardiovascular health of this group by public health authorities.
高血压是非洲心血管疾病死亡的主要驱动因素。其患病率在老年人群中最高。然而，在许多非洲国家，这一群体几乎没有得到关注。我们进行了一项系统评价和荟萃分析（PROSPERO 注册：CRD42017056474），以估计生活在非洲的老年人中高血压的患病率。
我们检索了灰色文献和主要电子数据库，包括 PubMed 和 Embase，以获取发表于 1980 年 1 月 1 日至 2018 年 5 月 28 日、报告年龄≥50 岁的成年人在非洲的高血压患病率的基于人群的研究。我们采用随机效应模型估计纳入研究的汇总患病率。
我们筛选了 10719 篇文章，并检索了 103 篇全文文章以评估是否纳入综述。34 项独特的研究提供了 15 个非洲国家的 43025 名个体的 37 个数据点，进行了分析。个别研究中高血压的患病率从 22.3%到 90.0%不等，而总体汇总患病率为 57.0%（95%CI 52%-61%）。患病率在性别、居住地或非洲次区域之间无统计学差异。在个别研究中，年龄较大和超重/肥胖与高血压独立相关。29（78%）个数据点被认为是低风险或中风险偏倚。消除高风险偏倚研究对高血压的汇总估计影响不大。敏感性分析，每次删除一项研究，发现三项研究对汇总估计值有显著但相对较小的影响。我们观察到研究之间存在很大的异质性（I2=98.9%），并通过荟萃回归分析进一步探讨了这种异质性。总体而言，GRADE 评估结果表明证据质量为中等。
非洲老年人中高血压的持续高患病率，即使在农村人群中也是如此，这使得公共卫生当局更需要关注这一群体的心血管健康。
