Poststroke hypertension in Africa

Background and Purpose: Little is known about the frequency of hypertension and related knowledge in Africans who have had a stroke. The objective of this study was to determine the frequency of hypertension, its control, and associated knowledge among patients with and without a history of stroke at Uganda's main referral hospital. Methods: Subjects with a history of stroke (n=157) were compared with stroke-free control subjects (n=149). Demographics and clinical characteristics were recorded and hypertension-related knowledge assessed by questionnaire. Multiple logistic regression including cases and control subjects was used to determine factors independently associated with blood pressure control and hypertension-related knowledge. Results: A total of 69.4% of cases versus 54.7% of control subjects were hypertensive at the time of the research visit (P=0.001). Univariable analyses showed the odds of having good blood pressure control (OR, 0.53; 95% CI, 0.33-0.84; P=0.006) and good hypertension knowledge (OR, 0.35; 95% CI, 0.22-0.56; P<0.0001) were lower in cases. Age <40 years (P=0.002), good hypertension-related knowledge (P=0.002), and poorer medication adherence (P<0.0001) were independently associated with poorer blood pressure control. Those with a history of hypertension had better hypertension-related knowledge (P=0.001), but knowledge was poorer among cases (P<0.0001). Conclusion: Hypertension is common in Ugandans with and without a history of stroke. Barriers to effective blood pressure control in Uganda other than patient knowledge need to be identified.