Rural and urban differences in blood pressure and hypertension in Ghana, West Africa

Background: Hypertension, once rare in traditional African societies, is rapidly becoming a major public health problem. Objective: To assess urban and rural differences in blood pressure (BP) and hypertension, and to determine factors associated with BP in this sub-Saharan Africa population. Study design: Cross-sectionat survey. Setting: Ashanti region of Ghana, West Africa. Participants: There were 1431 participants (644 mates and 787 females). Of these, 578 were from the rural setting (237 mates and 341 females) and 853 from the urban setting (407 mates and 446 females). Results: Age-adjusted mean systolic and diastolic BP levels were lower in rural men than in urban men (129/75 versus 133/78, P < 0.001). The mean systolic and diastolic BP levels were also tower in rural women than in urban women (126/76 versus 131/80, P < 0.001). After adjustments for age, the odds ratios (95% CI) for being hypertensive were 1.9 (1.3-2.9; P < 0.01) for urban men and 1.9 (1.3-2.8; P < 0.0001) for urban women. Urban women were more likely than rural women to be aware of their hypertensive condition (odds ratio 2.3, 95% CI, 1.2-4.2; P < 0.001). Treatment and control of hypertension did not differ between the groups in either men or women. In multiple linear regression analysis, age, urban dwelling, BMI and heart rate were independently associated with systolic and diastolic BP in both men and women. Smoking and alcohol consumption were independently associated with systolic and diastolic BP but only in men. Conclusion: The findings of this study demonstrate that high BP (hypertension) is an important public health burden in both urban and rural settings in this sub-Saharan African population. Cost-effective public health measures are urgently needed to prevent high BP from becoming another public health burden. (c) 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.