Low blood pressure levels & incident stroke risk among elderly Ghanaians with hypertension

Fred Stephen Sarfo, Linda Meta Mobula, Titus Adade, Yvonne Commodore-Mensah, Martin Agyei, Collins Kokuro, Rexford Adu-Gyamfi, Christiana Duah, Bruce Ovbiagele

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Clinical trial data indicate that more intensive blood pressure (BP) lowering below standard cut-off targets is associated with lower risks of strokes in the elderly. There is a relative paucity of real-world practice data on this issue, especially among Africans. Objective: To assess BP control rates, its determinants, and whether a lower BP < 120/80 mmHg is associated with a lower incident stroke risk among elderly Ghanaians with hypertension. Methods: We retrospectively evaluated data, which were prospectively collected as part of a cohort study involving adults with hypertension and/or diabetes in 5 Ghanaian hospitals. BP control was defined using the JNC-8 guideline of <150/90 mmHg for elderly with hypertension aged >60 years or 140/90 mmHg for those with diabetes mellitus. Risk factors for poor BP control were assessed using multivariable logistic regression models. We calculated incident stroke risk over an 18-month follow-up at 3 BP cut-off's of <120/80, 120–159/80–99, and > 160/100 mmHg. Results: Of the 1365 elderly participants with hypertension, 38.2% had diabetes mellitus and 45.8% had uncontrolled BP overall. Factors associated with uncontrolled BP were higher number of antihypertensive medications prescribed adjusted odds ratio of 1.45 (95% CI: 1.27–1.66), and having diabetes 2.56 (1.99–3.28). Among the elderly, there were 0 stroke events/100py for BP < 120/80 mmHg, 1.98 (95%CI: 1.26–2.98) for BP between 120 and 159/80-99 mmHg and 2.46 events/100py (95% CI: 1.20–4.52 at BP > 160/100 mmHg. Conclusion: A lower BP target <120/80 mmHg among elderly Ghanaians with hypertension is associated with a signal of lower incident stroke risk. Pragmatic trials are needed to evaluate lower BP targets on stroke incidence in Africa.

Original languageEnglish (US)
Article number116770
JournalJournal of the Neurological Sciences
Volume413
DOIs
StatePublished - Jun 15 2020

Keywords

  • Africa
  • BP thresholds
  • Elderly
  • Stroke risk

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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