Cardiovascular risk and comorbid conditions among black South Africans with hypertension in public and private primary care settings: The HiHi study

Objective: To describe the HiHi Study and assess cardiovascular disease (CVD) risk profile and comorbid conditions of Black patients receiving hypertension (HTN) care. Design: Cross sectional, descriptive. Setting: Public and private primary care sites in three townships near Cape Town, South Africa. Participants: 403 hypertensive Black patients (183 men, 220 women), ages 35-65 years. Methods: Self-reported sociodemographic, lifestyle, and medical history factors were assessed. Height, weight, and blood pressure (BP) were measured and 12-lead electrocardiogram recorded. Blood and urine were collected to assess lipid profile, diabetes, and renal impairment. Type and number of medications were abstracted from medical records. Results: Antihypertensive medication was prescribed for all participants, with HTN controlled (BP<140/90 mm Hg) for 36% of public and 51% of private patients. Mean systolic and diastolic BP were higher in the public than private sector (148/90±28/13 and 138/86±21/13 mm Hg) as was LVH (37% and 30%) but diabetes (18% and 29%) and obesity (55% and 75%) were less common in the public sector. There were no significant differences between public and private settings in use of antihypertensive medications, total cholesterol ≥ 5 mmol/L, daily tobacco use, or total CVD risk. More men than women smoked tobacco daily (30% and 6%) and used alcohol excessively (53% and 15%). Conclusions: Despite attending HTN primary care, CVD risk factors were addressed inadequately. Differences in risk factor prevalence and control were identified by healthcare sector and sex. A critical need exists to improve HTN care and CVD risk management programs for this high risk group.