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      Towards prevention of hypertension in Nigeria: a study of prehypertension and its associations among apparently healthy adults in Umuahia, South-East Nigeria

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          Abstract

          Background:

          The prevalence of hypertension is on the increase in Nigeria. Prehypertension is considered a precursor of hypertension and a predictor of excessive cardiovascular risk. Identifying individuals with prehypertension and initiating effective measures will aid in reducing the incidence and prevalence of hypertension in our environment. The aim of this study was to quantify the magnitude of prehypertension and determine its associations among adults in a representative semi-urban Nigerian population.

          Methods:

          A cross-sectional study which was carried out in a semi-urban setting in Southeast Nigeria. Blood pressure (BP) was measured using the standard methods. A cardiovascular risk factor screening based on physical characteristics, individual medical, and family history of participants was done.

          Results:

          There were a total of 389 participants comprising 223 (57.3%) males and 116 (42.7%) females; male:female ratio been 1.9:1. The prevalence of prehypertension and hypertension were 45.5% and 37.8%, respectively. Males were significantly more likely to have prehypertension than females (61% vs. 39% respectively; OR = 1.32, P = 0.03). There was a weak positive significant correlation between age and both systolic ( r = 0.16, P < 0.01) and diastolic ( r = 0.12, P = 0.02) blood pressures. Up to 72.6% of individuals with prehypertension have abnormal body mass index (BMI). While up to 8.5% of the participants had a family history of cardiovascular disease, 20.3%, and 17.3% had a history of significant intake of alcohol and smoking, respectively.

          Conclusions:

          The prevalence of prehypertension in the community was high. It was associated with increasing age, male gender, and increasing BMI. Interventions at this stage may aid in stemming the rising prevalence of hypertension in our environment.

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          Most cited references34

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          Prevalence of hypertension and pre-hypertension among adolescents.

          To determine the prevalence of hypertension and pre-hypertension on the basis of the 2004 National High Blood Pressure Education Program Working Group guidelines in an adolescent school-screening population. Cross-sectional assessment of blood pressure (BP) in 6790 adolescents (11-17 years) in Houston schools was conducted from 2003 to 2005. Initial measurements included height, weight, and 4 oscillometric BP readings. Repeat measurements were obtained on 2 subsequent occasions in students with persistently elevated BP. Final prevalence was adjusted for loss to follow-up and logistic regression used to assess risk factors. BP distribution at initial screen was 81.1% normal, 9.5% pre-hypertension, and 9.4% hypertension (8.4% Stage 1; 1% Stage 2). Prevalence after 3 screenings was 81.1% normal, 15.7% pre-hypertension, and 3.2% hypertension (2.6% Stage 1; 0.6% Stage 2). Hypertension and pre-hypertension increased with increasing body mass index. Sex, race, and classification as either at-risk for overweight or overweight were independently associated with pre-hypertension. Only classification as overweight was associated with hypertension. Application of new classification guidelines for adolescents with elevated BP reveals approximately 20% are at risk for hypertension. Further research determining the significance of each BP category and refining definitions to account for BP variability is warranted.
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            Prevalence of overweight and obesity in adult Nigerians – a systematic review

            Background Obesity is a major health problem, and there is an increasing trend of overweight and obese individuals in developing countries. Being overweight or obese is known to contribute significantly to morbidity and mortality rates in various countries around the world. We therefore aimed to identify and discuss current epidemiological data on the prevalence of obesity in Nigeria. Method A systematic review of papers published on the prevalence of obesity among adults in the country was carried out. We covered work published in MEDLINE, PubMed, Google, and African Journals Online using the terms “prevalence of overweight and obesity in Nigeria” or “overweight and obesity in Nigeria.” In addition, personal inquiries were made. The search limits were articles published from January 2001 to September 2012. Only studies that used the body mass index to assess for overweight and obesity were included. Results Four studies met the inclusion criteria out of the 75 studies reviewed. In Nigeria, the prevalence of overweight individuals ranged from 20.3%–35.1%, while the prevalence of obesity ranged from 8.1%–22.2%. Conclusion The prevalence of overweight and obese individuals in Nigeria is of epidemic proportions. There is a need to pay closer attention to combating these health disorders.
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              Screening for Future Cardiovascular Disease Using Age Alone Compared with Multiple Risk Factors and Age

              Background Risk factors such as blood pressure and serum cholesterol are used, with age, in screening for future cardiovascular disease (CVD) events. The value of using these risk factors with age compared with using age alone is not known. We compared screening for future CVD events using age alone with screening using age and multiple risk factors based on regular Framingham risk assessments. Methods Ten-year CVD risk was estimated using Framingham risk equations in a hypothetical sample population of 500,000 people aged 0–89 years. Risk estimates were used to identify individuals who did and did not have a CVD event over a ten-year period. For screening using age alone (age screening) and screening using multiple risk factors and age (Framingham screening) we estimated the (i) detection rate (sensitivity); (ii) false–positive rate; (iii) proportion of CVD-free years of life lost in affected individuals with positive results (person-years detection rate); and (iv) cost per CVD-free life year gained from preventive treatment. Results Age screening using a cut-off of 55 years detected 86% of all first CVD events arising in the population every year and 72% of CVD-free years of life lost for a 24% false-positive rate; for five yearly Framingham screening the false-positive rate was 21% for the same 86% detection rate. The estimated cost per CVD-free year of life gained was £2,000 for age screening and £2,200 for Framingham screening if a Framingham screen costs £150 and the annual cost of preventive treatment is £200. Conclusion Age screening for future CVD events is simpler than Framingham screening with a similar screening performance and cost-effectiveness. It avoids blood tests and medical examinations. The advantages of age screening in the prevention of heart attack and stroke warrant considering its use in preference to multiple risk factor screening.
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                Author and article information

                Journal
                Int J Prev Med
                Int J Prev Med
                IJPVM
                International Journal of Preventive Medicine
                Medknow Publications & Media Pvt Ltd (India )
                2008-7802
                2008-8213
                2015
                13 July 2015
                : 6
                : 61
                Affiliations
                [1]Nephrology Unit, Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
                [1 ]Nephrology Unit, Department of Internal Medicine, Federal Medical Centre, Owerri, Imo State, Nigeria
                [2 ]Department of Ophthalmology and Eye Centre, Abia State Specialist Hospital and Diagnostic Centre, Umuahia, Abia State, Nigeria
                [3 ]Nephrology Unit, Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
                [4 ]Cardiology Unit, Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
                [5 ]Department of Surgery, Abia State University Teaching Hospital Aba, Abia State, Nigeria
                Author notes
                Correspondence to: Dr. Chimezie Godswill Okwuonu, Nephrology Unit, Department of Internal Medicine, Federal Medical Centre, PMB 7001 Umuahia, Abia State, Nigeria. E-mail: getchimezie@ 123456yahoo.com
                Article
                IJPVM-6-61
                10.4103/2008-7802.160968
                4521306
                447afb6f-bc0b-4c4b-a553-6698ce4fd02e
                Copyright: © 2015 Okwuonu CG.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 03 October 2014
                : 05 April 2015
                Categories
                Original Article

                Health & Social care
                body mass index,cardiovascular risk factors,hypertension,nigeria,obesity,prehypertension

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