Baseline characteristics of the study population
Table 1. Characteristics of participants at baseline with and without Hypertension
Tables 1 showing the baseline characteristics of the study participants, those with hypertension, 775 (43.2%) were males, and 1,018 (56.8%) females and those without hypertension, were 932 (35.9%) males and 1,666(64.1%) females respectively.
Table 2. Socio-demographic Characteristic
Table 2 showing socio-demographic characteristics /indices of the study population with a total of 4436 participants, of these 1,716 [38.7%] were males and 2720 [61.3%] were females, among the males, 775 [45.4%] were hypertensive and 932 [54.6%] had no hypertension and among the females, 1,018 [37.9%] were with hypertension and 1,666 [62.1%] had no hypertension. There was a statistical significant relationship between gender and hypertension (p-value 0.0001). Among the different age groups, as the age increases, the number of people with hypertension also increase. Subjects who were 70 years and above had the highest percentage of the disease.
The result demonstrated that the association between age and hypertension were significant (P-value 0.0001). 3,419 [77.1%] of the subjects were single and 402 [9.1%] were married or in a relationship. 615 [13.9%] did not communicate their marital status.
Those without unfold marital status had the highest hypertensive subjects [73.8%], while single subjects had a lowest rate of 57.5%. The relationship between hypertension and marital status was statistically significant (P-value 0.000).
The study population had 2,320 (53.7%) secondary school subjects and 159 [3.7%] college/University students’ participants. A total number of 1063 had no formal/informal education. Those with hypertension were [55.6%] and had no basic education. The relationship between hypertension and education was statistically significant (P-value 0.000). Body mass index [BMI] showed that 312[7.4%] of the total population were underweight and 2053[48.5%] had normal weight, 1023[24.2%] were overweight and 844(19.9%) were obese. The obese population motif had 53.3% hypertensives. The relationship between the two variables was statistical significant (P-value 0.000).
The total number of participants who consumed/drank alcohol were 2,512 [56.6%], 1,049 [23.7%] did in the past, and 874 (19.7%) subjects currently drink alcohol. Those who presently consumed alcohol had a prevalence of [48.0%] patients with hypertension and those who never drank had the lowest preponderance of [38.2%].The relationship between alcohol consumption and hypertension was also statistically significant (P-value= 0.000). Smoking status had 3,768 (85.0%) of non-smokers, those who smoked in the past were 298 (6.7%) those that currently were 369[8.3%]. The hypothesized test of association between smoking and hypertension was statistically significant (P-value= 0.000). History of chronic diseases revealed that 197 [4.4%] had the diseases and 4,239 [95.6%] had no history of chronic infection. 58.16% of those with history of chronic diseases had hypertension and 40.02% had no hypertension. The relationship between these two variables was found to be significant (with a p value of 0.0001).
Table 3. Description of physical activity pattern among HIV positive and HIV negative
Table 3 shows that among the 4435 of the study participants, 3327 [75.0%] were HIV negative and 1108 [25.0%] were HIV positive. Subjects who engaged in physical practices were 2847, and 2100[73.8%] of these subjects were active participants and were also HIV-negative, 747 [26.2%] were HIV-positive and inactive or less active participants. 1588. 1227[77.3%] were HIV negative and 361[22.7%] of the 1588 population were HIV positive. Moderate activity subjects were 3613 [25.7%] and were also HIV positive while 822 [21.8%] of the population were inactive subjects and were also HIV positive. Those who exercise by travelling from one location (Active) to the other were 3887[25.5%] and 2896 [74.5%] of them were HIV positive, 584[21.4%] of the participants were inactive and 431[78.6%] were HIV positive. The total population of subjects who partake in vigorous sports activities were 730[19.7%] and 586[80.3%] of these were HIV negative. Entrant who were inactive in vigorous exercise were 3705[26.0%] and 2741[ 74.0%] were HIV negative, meaning that more people were inactive in vigorous sports and were HIV positive compared to those who were active
Table 4 Prevalence of Hypertension among HIV positive and HIV negative population
Table 4 shows that, out of 4436 of the total population 1793 had hypertension and 1434 were HIV negative while 359 were had the HIV virus (Positive). 2598 study participants had no hypertension. Among the HIV negative gender groups, male subjects constitute 1356 [79.0%] and females constitute 1972 [72.5%] of the total population. 633[46.9%] and 801[41.1%] of the male and female participants had hypertension. 360[21.0%] males and 748[27.5%] females were HIV positive compared to subjects without the virus. HIV positive males had the highest [60.2%] number of hypertensive individuals compared to those without the virus (HIV negative). HIV positive females had a lower number [29.6%] of hypertensive individuals in contrast to HIV negative subjects. With respect to age demographic indices among HIV negative age groups, 15-19 years had the highest population 483 [96.2%] and 40-44 years had the lowest 194[64.0%]. The number of hypertensive individuals were higher 296 [63.1%] in the age group 70 years above and the youngest age group had the lowest rate of hypertension 116 [24.3%]. A similar result was also observed among HIV positive individual, where hypertension rate was highest in age group 70 years and above compared to the younger age group 35-39 years. Among the HIV negative and positive age groups, hypertension prevalence rate were higher in age group 15-19 years in HIV positive subjects with a difference of 2%, although the lowest rate of hypertension were observed in the age group 20-24 years. Among marital status socio-demography subjects, HIV negative singles had the highest population 2623 [76.3%] and those with unknown status had 453 [73.7%] (Lowest). Individual with unknown status had the highest prevalence rate of hypertension 273[60.7%] and those subjects who were single had the lowest prevalence rate of 1042[40.1%].
Subjects who were HIV positive had a prevalence of 35.1% individuals with hypertension, these was closely followed by the unknown status group. Those participants who tested positive for HIV had the higher prevalence of hypertension compared to the population of negatively assessed subjects. HIV negative participants had a larger population compared to HIV positive individuals among the social demographic determinant educational group. The secondary school educational strata had the largest population of HIV negative [59.0%] and positive [40.8%] individuals. The prevalence of hypertension was highest among high (Secondary) school subjects.
HIV negative individuals that had attained tertiary education had the lowest rate [36%] of hypertension; the same was true for the HIV positive tertiary educated population [15%] group. Among the body mass index categories, HIV negative normal weight had the highest number of participants 1506 [73.4%] in relation to those who were underweight 230[73.7%]. The prevalence of hypertension was very higher [54.5%] among obese subjects and lower in people who are underweight [35.5%]. Subjects who tested positive to HIV had a lower prevalence of hypertension compared to those who tested negative. The prevalence of hypertension was [26.8%] among underweight individuals and [47.8%] among subjects who had normal weight. Among alcohol consumers, the preponderance of hypertension was higher in HIV negative than in HIV positive subjects who drink alcohol. HIV negatives population had a prevalence rate of [40.7%] individuals who had hypertension but never drink alcohol this is in contrast to [50.7%] the prevalence among those who currently drinking alcohol. The prevalence of [39.8%] was observed among HIV positive individuals compared to [10.8%] among HIV negative subjects. Those who were HIV positive and consumed alcohol in the past had a relatively lower hypertension prevalence [33.8%] compared to [43.6%] in HIV negative individuals.
Individuals who were HIV negative and positive and never smoke were 2871 and they constituted 41.9% prevalence of hypertensive subjects and 31.3% of the total population of HIV negative and positive individuals. Hypertension incidence among those subjects who smoke in the past was 65.1% among HIV-negative subjects and 48.9% among HIV-positive subjects. Subjects that had no chronic disease record and were HIV-negative were 3164[74.6%] in relation with HIV-positive subjects 1075[25.4]. Hypertension preponderance was more [60.1%] among chronic disease subjects population of HIV negatives in contrast to [48.5%] in HIV positives individuals. It was also observed that those who had no history of chronic disease had a prevalence of [42.6%] among HIV negative subjects and [32.4%] prevalence among HIV positive individuals
In summary, the association between the outcome variable ( Hypertension) and the explanatory variables namely ,gender, age group, marital status (HIV negative), education (HIV negative), BMI, alcohol, smoking status and history of chronic disease (HIV negative) all had a statistically significant p-value of less than 0.05 at 95% confidence interval. It showed that there was a relationship/association existing between these individual variables and hypertension. However, education (among HIV positive), history of chronic diseases (among HIV positive) indicated a marginal statistical significance of p-value 0.070 and 0.053 respectively, marital status (among HIV positive) had a p-value of 0.635 which indicated there was no relationship/association with hypertension.
Table 5. Univariate and multivariate analysis of Physical Activities and Hypertension among HIV positive and HIV negative individuals
The univariate analysis in table 5 shows that the odds of having hypertension was 1.04 times per every unit increase in vigorous work activity , which is marginally associated at [95% CI; 0.89; 1.20] and is not statistically significant with p value of 0.626. Moderate activity shows that 37% probability of having hypertension for a unit increase is statistically significant with a p-value of 0.001 [95% CI; 1.14; 1.65], multivariate analysis shows that moderate activity was a confounder with an odd ratio change difference of 20%, it indicates a 10% odds of having hypertension and was statistically not significant with a p-value; 0.386; [95% CI; 0.89; 1.36]. Travelling to and from places showed a 1.08 times chances of having hypertension which was not statistically significant p-value 0.488 [95% CI; 0.87; 1.34], but vigorous sports showed a 72% odds of having hypertension for each unit increase with a statistical significant difference of p-value; 0.001[95% CI; 1.41; 2.09].
The multivariate analysis showed an odds of 87% chances of having hypertension for a unit increase in vigorous sports, and the result was statistically significant p-value; 0.013[ 95% CI; 1.13; 3.08]. Metabolic physical activity was a protective factor with an odds of 0.63 times of contracting hypertension and a unit increase which was statistically significant, The multivariate metabolic result shows a protective factor of 0.44 times and was statistically significant p-value 0.015 [95% CI: 0.23; 0.85]. Metabolic physical activity shows a protective factor against hypertension compared to other variables which showed increase chances of having hypertension.
Table 6: Association between physical activities and hypertension among HIV positive and HIV negative individuals, taking into account confounding factors for hypertension
To investigate the association between physical activities and hypertension among HIV positive and HIV negative individuals in this group of individuals, taking into account confounding factors for hypertension.
In table 6, possible confounding factors were included in the analysis of the physical activities showing protection against hypertension. Multivariate analysis shows that a unit increase moderate activity was a protective factor, with a 26% less chances of having hypertension, which was statistically significant with a p-value of 0.043 [95% CI; 0.56; 0.99]. Vigorous sports shows an odd of 0.58 times in having hypertension, however this was not statistically significant p-value of 0.151 [95% CI: 0.27; 1.22]. Univariate analysis shows that the odds of having hypertension was 28% greater in males compared to females, this difference was however statistically significant with a p-value of 0.001 at 95% confidence interval. Multivariate evaluation showed higher chances of having hypertension with an odd ratio of 15% greater in males compared to females and this variable was statistically significant p-value 0.001[95% CI: 1.67; 2.77]. The result shows that males have higher chances of becoming hypertensive in contrast to females. Univariate analysis also showed that a unit increase in age had a 3% chance of contracting hypertension and it was statistically significant p-value 0.001, while in multivariate interpretation, there was a 2 % chance of hypertension and it was also statistically significant with a p-value of 0.001 [95% CI: 1.02; 1.03]. Single demographic variable compared to those in a relationship status, showed a 42% chances of having hypertension and it was statistically significant with a p-value 0.003 [95% CI: 1.13; 1.79], with respect to univariate interpretation and adjusting for confounding factors, there was a 21% odds of having hypertension but this was not statistically significant, p-value of 0.235 [95% CI: 0.88; 1.65]. Individuals with unknown marital status in the unadjusted analysis showed an odd ratio of 2.09 compared to singles with a statistical significant difference p-value of 0.001 [95% CI: 1.72; 2.54], but when adjusted, there was a 9% increase in the odds of having hypertension although the difference was not statistically significant p-value of 0.534[ 95% CI: 0.82; 1.42]. In summary, the results shows that singles were more protective against hypertension in correlation to those in relationships, who possess higher chances of having hypertension. During univariate evaluation, education was a protective factor against hypertension. Participants who achieved at least primary form of education had a 48% less chances of having hypertension when compared to individuals who had no form of education. This demographic characteristic was statistically significant p-value of 0.001[95% CI: 0.47; 0.71]. Subjects who had secondary school level of education had a better protective factor of 64% less chances against hypertension compared to non-educated individuals with a statistically difference which was significance p-value 0.001 [95% confidence interval].
Those who acquired tertiary or university form of education had 64% less chances of hypertension compared to the illiterate population and there was a statistical significant difference with p-value 0.001. When adjusted for possible confounders, the various level of educational status were all protective factors, although less protective compared to the unadjusted, it was however not statistically significant at 95% confidence interval, meaning that it was likely due to attributed chances. The results shows that the non-educated subjects had higher chances of hypertension (none protective).
There were milder chances of having hypertension per unit increase in BMI. Unadjusted analysis showed 8% odds of having hypertension with a significant difference p-value of 0.001 [95% CI 1.07; 1.10]. Adjusting for BMI thereafter with other variables showed a 9% increase in the probability of having hypertension with a p-value 0.001 [95% CI: 1.07; 1.11]. Unadjusted alcohol consumption showed a relative increase in the odds of having hypertension, however for those who were drinking in the past, the odds of having hypertension were 1.12 times compared to those who never drink at all. This was not statistically significant p-value of 0.131[95% CI: 0.96; 131]. Currently drinking subjects had a 1.53 times of acquiring hypertension and it was statistically significant p-value of 0.001[95% CI: 1.29; 1.82] compared to the subjects who never drink. The odds of having hypertension in participants who currently drink alcohol were significantly higher compared to those who drink in the past. After adjusting for alcohol consumption, those who drink in the past showed no relationship with hypertension with an odd ratio of 1.00 and it was not statistically significant. The population of currently alcohol consumers showed a 59% increase in the odds of having hypertension compared to subjects who never drink alcohol. The result was statistically significant with a p value of 0.001 at 95% confidence interval. Current alcohol consumers had higher chances of having hypertension compared to others. Smoking status variable when unadjusted showed higher chances of having hypertension for those who smoke in the past and a relative protective factor was conferred against hypertension for those who currently smoke. The odds of having hypertension in those who smoke in the past was 2.59 times compared to individuals who never smoke at all, with a statistical significance difference, p-value of 0.001 [at 95% CI: 1.95; 3.42]. The population that currently smoke showed a 6% protection against hypertension compared to those who never smoke at all, the result was however not statistically significance with a p-value of 0.642. After the adjustment of confounders, the odds of having hypertension decreased 1.28 times in individuals who smoke compared to those who never smoke and the result was not statistically significant wit a p-value of 0.223[ 95% CI: 0.87;1.86]. The population that current smoke showed a greater protection against hypertension. However, after adjustment an odd of 35% less chances of having hypertension was achieved with a statistical significant difference, with a p value of 0.014 [at 95% confidence interval].
These results therefore, showed that past smokers were at a very high chance/risk of hypertension in relation to current smokers as compared to those who never smoke at all during their life time. In comparing the waist size, those with increase waist size had the odds of 99% in contracting hypertension compared to the population with normal waist. The difference was statistically significant at p value 0.001 with 95% confidence interval. The adjusted variables showed that there were only 40% chances (odds) of hypertension and it was statically significant [p-value of 0.004 and a 95% confidence interval of 1.12; 1.75]. Those with abnormal or increased waist size within the population had higher chances of hypertension compared to normal waist size individuals. Individual members of the population with history of chronic diseases had odds of 2.84 times of contracting hypertension compared to those with no history of chronic diseases There was a statistical significant difference between the two variables [p-value of 0.001 and 95% confidence interval 2.00; 4.0]). After adjusting for possible confounders, the result shows that the odds of having hypertension in subjects with history of chronic diseases were 1.60 times compared to those without history of chronic diseases. But there was no statistical significant difference between the variables [p-value of 0.08; 95% CI: 0.94; 2.72]. Unadjusted HDL cholesterol level shows increased odds of having hypertension with increased level of cholesterol. There was an odds of 30% chances of having hypertension when comparing a normal to low cholesterol levels. The result shows a statistical significant difference between the two [p-value of 0.024 95% CI: 1.03; 1.63], in high cholesterol levels, the odds were 57% greater chances of having hypertension compared to a normal cholesterol level. There was a statistical significant difference between high level cholesterol and low level [p-value of 0.00 at 95% confidence interval].
Multivariate analysis showed protection against hypertension in individual with normal cholesterol with a 17% less chances of hypertension and high cholesterol a 18% less chances of hypertension when compared to low cholesterol level individuals. The protection was not statistically significant [p-values of 0.250 and 0.226 respectively]. LDL lipid level showed no protection against hypertension. Unadjusted normal cholesterol subjects showed an odd of 1.43 times of suffering hypertension compared to subjects with low level cholesterol. There was a statistical significant difference [p-value of 0.005; 95% CI: 1.11; 1.84]. High cholesterol level participants within the study population had a higher probability of suffering hypertension with 88% greater chances when compared to low cholesterol individuals with a significant difference of 95% confidence interval. The assessment of association between blood glucose and hypertension, the unadjusted variables showed odds of 8% greater chances of having hypertension with a statistically significant difference [P; 0.001; 95% CI: 1.05; 1.11] for a unit increase in blood glucose level. After adjustment, blood glucose showed a relatively protective factor with a 2% less chances of hypertension; however it was not statistically significant.
P trend was adopted from metabolic physical activity, p-value as a combined value to understand statistical significances relationship if any, for all the physical activity types with hypertension. A statistically significance relationship was attained in univariate analysis with a p-value of 0.001 meaning, there was an association between physical activity types and hypertension. After adjusting for possible confounders, a non-statistical significance p-value of 0.137 was achieved, indicating there was no association found between physical activity and hypertension.