Results of the Women's Health Study of Accra: Assessment of blood pressure in urban women

Background: The Women's Health Study of Accra was conducted to determine the burden of illness in a representative sampling of adult urban women. Methods: This community-based survey selected study participants by a 2-stage cluster probability sample stratified by socioeconomic status based on the 2000 Ghanaian census data. It included a comprehensive household survey and medical and laboratory examination for 1328 women. Hypertension was defined as systolic blood pressure measurement ≥ 140 mm Hg or a diastolic of ≥ 90 mm Hg. Results: A positive review of systems for hypertension was reported in 309 (23.7%) with only 52.5% using anti-hypertensive medication and only 4.4% had a normal blood pressure. The blood pressure measurement was elevated in 712/1303 (54.6%). Significant risk factors for an elevated blood pressure included age ≥ 50 years (OR = 14.24 [10.74,18.8], p < 0.001); BMI ≥ 30.00 (OR = 2.89 [2.26,3.70], p < 0.001); parity of three or more children (OR = 5.16 [2.90,9.19], p < 0.001); menopause before age 50 years (OR = 5.88 [1.11,31.17], p = 0.037); elevated fasting blood glucose (OR = 3.98 [2.38,6.64], p < 0.001); elevated fasting cholesterol (OR = 1.69 [1.24, 2.30], p = 0.001); no formal education (OR = 2.75 [1.70,4.43], p < 0.001) and first degree family history of hypertension (p < 0.001). There was no association with income level, diet or activity. Significant protective factors include young age, nulliparity, normal BMI, and a lower than normal fasting LDL-cholesterol. Conclusion: The prevalence of presumptive hypertension is greater than anticipated. Public health initiatives to increase awareness of hypertension and to initiate and maintain treatment regimens will serve to improve the health of the women and the urban community.