Multilevel modeling, prevalence, and predictors of hypertension in Ghana: Evidence from Wave 2 of the World Health Organization's Study on global AGEing and adult health.

Background And Aims: Hypertension is a major public health issue, an important risk factor for cardiovascular diseases and stroke, especially in developing countries where the rates remain unacceptably high. In Africa, hypertension is the leading driver of cardiovascular disease and stroke deaths. Identification of critical risk factors of hypertension can help formulate targeted public health programs and policies aimed at reducing the prevalence and its associated morbidity, disability, and mortality. This study attempts to develop multilevel regression, an in-depth statistical model to identify critical risk factors of hypertension.

Methods: This study used data on 4667 individuals aged ≥18 years from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2 conducted in 2014/2015. Multilevel regression modeling was employed to identify critical risk factors for hypertension based on systolic blood pressure (SBP) (ie, SBP > 140 mmHg). Of the 4667, 27.3% were hypertensive. Final data on 4381 individuals residing in 3790 households were analyzed using multilevel models, and results were presented as adjusted odds ratios (aOR) and their associated 95% confidence intervals (CI).

Results: Risk factors for hypertension identified were age (aOR) = 5.4, 95% CI: 4.11-7.09), obesity (aOR = 1.51, 95% CI: 1.19-1.91), marital status (aOR = 0.75, 95% CI: 0.64-0.89), perceived health state (moderate; aOR = 1.38, 95% CI: 1.15-1.65 and bad/very bad; aOR = 1.35, 95% CI: 1.0-1.83), and difficulty with self-care (aOR = 1.64, 95% CI: 1.1-2.44). We found unobserved significant differences in the likelihood of hypertension prevalence between different households.

Conclusion: Addressing the problem of obesity, targeting specific interventions to those aged over 50 years, and improvement in the general health of Ghanaians are paramount to reducing the prevalence and its associated morbidity, disability, and mortality. Lifestyle modification in the form of dietary intake, knowledge provision supported with strong public health message, and political will could be beneficial to the management and prevention of hypertension.