Hypertension in four African-origin populations: current 'Rule of Halves', quality of blood pressure control and attributable risk of cardiovascular disease

J Hypertens. 2001 Jan;19(1):41-6. doi: 10.1097/00004872-200101000-00006.


Objective: To assess the public health burden from high blood pressure and the current status of its detection and management in four African-origin populations at emerging or high cardiovascular risk.

Design: Cross-site comparison using standardized measurement and techniques.

Setting: Rural and urban Cameroon; Jamaica; Manchester, Britain.

Subjects: Representative population samples in each setting. African-Caribbeans (80% of Jamaican origin) and a local European sample in Manchester.

Main outcome measures: Cross-site age-adjusted prevalence; population attributable risk.

Results: Among 1,587 men and 2,087 women, age-adjusted rates of blood pressure > or =160 or 95 mmHg or its treatment rose from 5% in rural to 17% in urban Cameroon, despite young mean ages, to 21% in Jamaica and 29% in Caribbeans in Britain. Treatment rates reached 34% in urban Cameroon, and 69% in Jamaican- and British-Caribbean-origin women. Sub-optimal blood pressure control (> 140 and 90 mmHg) on treatment reached 88% in European women. Population attributable risks (or fractions) indicated that up to 22% of premature all-cause, and 45% of stroke mortality could be reduced by appropriate detection and treatment. Additional benefit on just strokes occurring on treatment could be up to 47% (e.g. in both urban Cameroon men and European women) from tighter blood pressure control on therapy. Cheap, effective therapy is available.

Conclusion: With mortality risk now higher from non-communicable than communicable diseases in sub-Saharan Africa and elsewhere, systematic measurement, detection and genuine control of hypertension once treated can go hand-in-hand with other adult health programmes in primary care. Cost implications are not great. The data from this collaborative study suggest that such efforts should be well rewarded.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Black People*
  • Blood Pressure Determination / standards*
  • Blood Pressure* / physiology
  • Cameroon / ethnology
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hypertension / ethnology*
  • Hypertension / physiopathology
  • Jamaica / ethnology
  • Male
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Rural Population
  • Surveys and Questionnaires
  • Survival Rate
  • United Kingdom / epidemiology
  • United States / epidemiology
  • Urban Population