Sorbonne Université, AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de Pharmacie, 75012 Paris, France; Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France.
Institute of Cardiology of Abidjan, BPV 206, Abidjan, Côte d'Ivoire.
Arch Cardiovasc Dis. 2020 Jun-Jul;113(6-7):433-442. doi: 10.1016/j.acvd.2019.11.009. Epub 2020 May 17.
Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control.
To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension.
We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country.
Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively.
High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.
撒哈拉以南非洲地区的高血压负担日益加重。抗高血压药物和饮食是有效控制高血压的基石。
评估 12 个撒哈拉以南国家的药物治疗和盐限制的依从性，并研究高血压患者的依从性与血压控制之间的关系。
我们在 12 个撒哈拉以南国家的城市诊所进行了一项横断面调查。收集了在诊所就诊的高血压患者的人口统计学、治疗和血压控制充分性的数据。通过患者填写的问卷评估依从性。高血压分级根据欧洲心脏病学会指南定义。使用多水平逻辑回归分析调整年龄、性别和国家后，研究了依从性与血压控制之间的关系。
在 2198 名患者中，77.4%的患者血压未得到控制，34.0%的患者盐限制依从性差，64.4%的患者药物治疗依从性差，24.6%的患者同时对盐限制和药物治疗依从性差。盐限制（比值比[OR]1.33，95%置信区间[CI]1.03-1.72）、药物（OR 1.56，95% CI 1.25-1.93）或两者（OR 1.91，95% CI 1.39-2.66）依从性差与血压未得到控制有关。此外，同时对药物和盐限制的依从性差与高血压 1 级、2 级和 3 级的发生风险分别增加 1.52 倍（95% CI 1.04-2.22）、1.80 倍（95% CI 1.22-2.65）和 3.08 倍（95% CI 2.02-4.69）有关。
在这项撒哈拉以南地区的城市研究中，发现对盐限制和药物治疗的依从性很差的情况很普遍；两者都与血压未得到控制显著相关，这为改善撒哈拉以南非洲的高血压控制提供了重要的干预机会。
