Background
Hypertension is a major public health issue, a critical risk factor for cardiovascular diseases and stroke, especially in developing countries where the rates remain unacceptably high. In Africa, hypertension is the leading driver of cardiovascular disease and stroke deaths. Identification of critical risk factors of hypertension can help formulate targeted public health programmes and policies aimed at reducing the prevalence and its associated morbidity, disability, and mortality. This study attempts to develop multilevel binary logistic regression model, an in-depth statistical model to identify critical risk factors of hypertension to inform interventions aimed at improving cardiovascular health outcomes among adults.
Methods
This study used data on 4667 individuals aged ≥ 18 years from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2 conducted in 2014/2015. Multilevel regression modelling was applied on final sample of 4381 individuals residing in 3790 households to identify critical risk factors for hypertension based on systolic blood pressure (SBP) (i.e. SBP > 140 mmHg).
Results
A total of 1273(27.3%) were hypertensive. Critical risk factors for hypertension identified were aged ≥ 50 years (OR = 5.4, 95% CI: 4.11–7.09), obese (OR = 1.51, 95% CI: 1.19–1.91), currently married (OR = 0.75, 95% CI: 0.64–0.89), individuals in moderate (OR = 1.38, 95% CI: 1.15–1.65) or bad/very bad health state (OR = 1.35, 95% CI: 1.0-1.83) and moderate difficulty with self-care (OR = 1.64, 95% CI: 1.1–2.44). Strong unobserved household-level residual variations were found. The results from the variation analyses showed that over 12% of variance in hypertension could be attributable to residual household-level variations.
Conclusion
Hypertension remains high in Ghana. Addressing the problem of obesity, targeting specific interventions to those aged over 50 years, and improvement in the general health of Ghanaians are paramount to reducing the prevalence and its associated morbidity, disability, and mortality. Lifestyle modification in the form of dietary intake, knowledge provision supported with strong public health message and political will could be beneficial to the management and prevention of hypertension.