Measuring hypertension progression with transition probabilities: Estimates from the WHO SAGE longitudinal study

Boateng, Godfred O., Lartey, Stella T. ORCID:, Baiden, Philip, Si, Lei, Biritwum, Richard Berko, Kowal, Paul, Magnussen, Costan G., Ben Taleb, Ziyad, Palmer, Andrew J. and Luginaah, Isaac (2021) Measuring hypertension progression with transition probabilities: Estimates from the WHO SAGE longitudinal study. Frontiers in Public Health, 9. ISSN 2296-2565

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This paper assessed the transition probabilities between the stages of hypertension severity and the length of time an individual might spend at a particular disease state using the new American College of Cardiology/American Heart Association hypertension blood pressure guidelines. Data for this study were drawn from the Ghana WHO SAGE longitudinal study, with an analytical sample of 1884 across two waves. Using a multistate Markov model, we estimated a seven-year transition probability between normal/elevated blood pressure (systolic ≤ 129 mm Hg & diastolic <80 mm Hg), stage 1 (systolic 130-139 mm Hg & diastolic 80-89 mm Hg), and stage 2 (systolic ≥140mm Hg & diastolic≥90 mm Hg) hypertension and adjusted for the individual effects of anthropometric, lifestyle, and socio-demographic factors. At baseline, 22.5% had stage 1 hypertension and 52.2% had stage 2 hypertension. The estimated seven-year transition probability for the general population was 19.0% (95% CI: 16.4, 21.8) from normal/elevated blood pressure to stage 1 hypertension, 31.6% (95% CI: 27.6, 35.4%) from stage 1 hypertension to stage 2 hypertension, and 48.5% (45.6, 52.1%) for remaining at stage 2. Other factors such as being overweight, obese, female, aged 60+ years, urban residence, low education and high income were associated with an increased probability of remaining at stage 2 hypertension. However, consumption of recommended servings of fruits and vegetables per day was associated with a delay in the onset of stage 1 hypertension and a recovery to normal/elevated blood pressure. This is the first study to show estimated transition probabilities between the stages of hypertension severity across the lifespan in sub-Saharan Africa. The results are important for understanding progression through hypertension severity and can be used in simulating cost-effective models to evaluate policies and the burden of future healthcare.

Item Type: Article
Additional Information: Funding Information: Study on global AGEing and adult health (SAGE) Waves 1 and 2 were supported by WHO and the US National Institute on Aging’s Division of Behavioral and Social Science Research (BSR) through Interagency Agreements (OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-01) with WHO. Financial and in-kind support has come from the University of Ghana’s Department of Community Health. GB is supported by a Start-up fund at the University of Texas at Arlington. LS is supported by a National Health and Medical Research Council Early Career Fellowship (GNT1139826); AP is funded by the Centre of Excellence in Population Ageing Research, Australian Research Council (CE170100005); CM is funded by the National Heart Foundation of Australia Future Leader Fellowship (100849). IL is supported by Social Sciences and Humanities Research Council.
Uncontrolled Keywords: aha 2017 hypertension guidelines,elevated blood pressure,hypertension,multi-state model,sub-saharan africa,transition probabilites,public health, environmental and occupational health,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2739
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
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Depositing User: LivePure Connector
Date Deposited: 18 Aug 2022 13:31
Last Modified: 07 Apr 2024 00:49
DOI: 10.3389/fpubh.2021.571110


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