Prevalence of hypertension and associated

cardiovascular risk factors in an urban slum

in Nairobi, Kenya: A population-based
survey

Disusun oleh :
LUKAS W. MANSNANDIFU
DONALD UMBORA
IIN ROSALINAE
Pembimbing dan penguji
Dr. Musnidarti,Sp.JP
 background
Penyakit non-communicable (NCD)
hipertensi penyebab kematian
negara berkembang
Faktor pendukung: demografis,
urbanisasi, gaya hidup
Kenya laju pertumbuhan populasi
4,2% (2x nasional)
Nairobi 60% populasi tinggal di
daerah kumuh
 methods
Mengunjungi RT sekitar pusat
kesehatan, gereja, sekolah
desa/kampung
Usia sampel 18th
Tidak termasuk wanita hamil
Waktu 3bln juli-agustus
Pertanyaan responden: merokok,
alkohol, DM, HT
 BMI : BB (Kg) / TB (m2)
Terlalu ringan BMI < 18,5
Normal BMI 18,5 - 24,9
Kelebihan berat BMI 25 - 29,9
Kegendutan BMI > 30
Lingkar Pinggang
Pria > 102 cm
Wanita > 88 cm
 Tekanan darah diukur setelah
duduk 15 >=140 mmHg / >=90
mmHg
Gula darah secara acak dgn
glucometer > 11,1 mmol/l
Gula darah puasa 8 jam 5mls
fossa ante-cubital 7,0 mmol/l
 Analisa statistik SPSS standar
WHO & standar metode
Rasio: hipertensi, BMI, diabetes
Persetujuan studi: RT berusia 18th
 results
Total sampel 2200 dari 936 RT dlm 8
desa
Dikeluarkan 139 :
38 wanita hamil
50 tidak setuju
51 < 18th)
2061 sampel
 Usia 18-90th rata2 usia 33,4th:
25-44th 53,9%
<25th 28,3%
>55th 5,2%
Faktor resiko & demografis:
Perokok 13,1%
Perokok / hari 84,8%
Minum alkohol 30%
Minum alkohol / 1th 81%
Minum alkohol / hari 19,1%
Minum alkohol / minggu 52%
Table 1 Demographic and behavioural risk factors across sex and hypertensive status
Overall % Male % Female % P value Hypertens Normoten P
(n) (n) (n) ive sive value
Age yrs
18-24 28.3 (578) 27.7 28.8 (287) 0.051
(291)
25-34 31.8 (651) 30.1 33.7 (335)
(316)
35-44 22.1 (452) 22.2 22.0 (219)
(233)
45-54 12.5 (256) 13.7 11.3 (112)
(144)
55-64 3.8 (78) 4.8 (50) 2.8 (28)
65-74 1.2 (25) 1.4 (15) 1.0 (10)
75 0.2 (5) 0.1 (1) 0.4 (4)
18-90 100 51.0 48.4 (995)
(2045) (1050)
Years in school, mean 9.3 (3.3) 9.8 (3.2) 8.7 (3.2) 0.000
(SD)
 Overall Male Female P value Hyperte Normote P
% (n) % (n) % (n) nsive nsive value
Tobacco smoking

Current % (n) 13.1 22 3.8 (38) 0.000 17.8 12.5 0.018

(269) (231) (46) (223)
Smoking daily % 84.8 89.2 57.9 0.000 82.6 85.2 0.656
(n) (228) (206) (22) (38) (190)
Age started yrs 19.7 19.9 18.6 0.304 21.5 19.4 0.037
mean (SD) (5.5) (5.7) (3.4) (6.8) (5.2)
Age started range 10-45 10-45 10-24 - - - -
yrs
Duration years 16.5 16.4 17.3 0.696 21.4 15.4 0.001
mean (SD) (10) (10.2) (9.1) (11.3) (9.5)
Pack years median 6 (2.5- 6 (2.4- 7.5 (4.4- 0.303 8.3 (3.9- 6.0 (2.4- 0.058
(Q1-Q3) 10.9) 10.5) 12.0) 13.8) 10.5)
 Overall Male Femal P Hyper Norm P
% (n) % (n) e % value tensiv otensi valu
(n) e ve e
Alcohol
consumptio
n
Ever 30.1 43.2 16.3(1 0.000 33.3 29.7 0.23
consumed (616) (454) 62) (86) (529) 3
In past 12 81.0 89.6 56.8 0.000 76.7 81.7 0.28
months (499) (407) (92) (66) (432) 1
In past 30 76.8 79.1 66.3 0.009 75.8 77.1 0.81
days (383) (322) (61) (50) (333) 2
Frequency in
past 12
months
 Overall % Male % Female % P value Hypertens Normoten P
(n) (n) (n) ive sive value
Daily 19.1 (95) 22.1 5.5 (5) 0.008 25.8 (17) 18.1 (78) 0.180
(90)
5-6 days/week 14.3 (71) 13.8 16.5 (15) 7.6 (5) 15.3 (66)
(56)
1-4 days/week 28.7 (143) 27.0 36.3 (33) 28.8 (19) 28.7 (124)
(110)
1-3 days/week 23.3 (116) 22.9 25.3 (23) 18.2 (12) 24.1 (104)
(93)
Average number of 4 (36) 4 (36) 3 (25) 0.087 4 (45) 4 (36) 0.272
drinks median
(Q1-Q3)
Largest number of 6 (4.5-9) 6 (59) 6 (47) 0.026 6 (38.5) 6 (59) 0.178
drinks/sitting
 Physical activity
Pekerja keras 75,7% pria 78,2%
wanita 73% 7 jam 6 hari
Pekerja angkut dgn berjalan /
bersepeda 77,4% pria 80,3%
wanita 74,3% 6 hari
 Overall % Male % Female % P value Hypertens Normoten P
(n) (n) (n) ive sive value
Physical Activity
Work Vigorous 29.6 (606) 39.1 19.6 (195) 0.000 24.4 (63) 30.5 (543) 0.050
(411)
Days/week median 6 (57) 6 (57) 6 (37) 0.537 6 (57) 6 (57) 0.116
(Q1-Q3)
Hours/day median 8 (39) 8 (49) 6 (28) 0.000 8 (39) 8 (49) 0.877
(Q1-Q3)
Work moderate 46.1 (943) 39.1 53.4 (532) 0.000 43.0 (111) 46.6 (830) 0.295
(411)
Days/week median 6 (57) 6 (47) 7 (57) 0.000 6 (57) 6 (57) 0.420
(Q1-Q3)
Hours/day median 6 (38) 6 (38) 5 (2.1-8.0) 0.000 8 (310) 6 (38) 0.016
(Q1-Q3)
Travel (walk/cycle) 77.4 80.3 74.3 (740) 0.001 70.2 (181) 78.5 0.003
(1583) (843) (1399)
Days/week median 6 (57) 6 (57) 6 (47) 0.001 6 (57) 6 (57) 0.148
(Q1-Q3)
Hours/day median 1 (0.75-2) 1.3 (0.8- 1 (0.7-2.0) 0.023 1.3 (0.5-3) 1.0 (0.8-2) 0.480
(Q1-Q3) 2.0)
 Overall Male Female P Hypert Normot P
% (n) % (n) % (n) value ensive ensive value

Recreational 15.2 21.7 8.3 0.000 12.0 15.7 0.127
vigorous (311) (228) (83) (31) (280)
Days/week 2.0 (1 2.0 2 (13) 0.737 2 (15) 2 (13) 0.603
median (Q1-Q3) 3) (1.0-
3.0)
Hours/day 2.0 2.0 1.4 (1 0.142 1.2 1.5 (1 0.165
median (Q1-Q3) (0.8-2) (1.0- 2) (0.5-2) 2)
2.0)
Recreational 16.4 16.9 16 0.586 10.5 17.3 0.006
moderate (336) (177) (159) (27) (309)
Days/week 3 (16) 3.0 3 (16) 0.986 4 (27) 3 (16) 0.214
median (Q1-Q3) (1.0-
6.0)
 Overall % (n) Male % (n) Female % (n) P value Hypertensive Normotensive P value

Hours/day median (Q1-Q3) 1 (0.7-2) 1.5 (0.8-2.0) 1 (0.7-2) 0.058 2 (0.5-2) 1 (0.8-2) 0.776

4 (26) 4.0 (26) 4 (27) 0.004 5 (2.5-8.0) 4 (26) 0.001

Time sitting/reclining
hrs mean
(range)+
METS*, median (Q1-Q3) 10800 13474 8400 0.000 11520 10630 0.998

(3840 (504024960) (316815630) (384021110) (384021120)

21120)
 Body mass index
Didapat rata2 normal 24,2 :
pria 24,6 normal rata2
wanita 27,1 obesitas I 32,2% (BMI >
25%); obesitas II 26,1%; normal 38,5%;
over-weight 58,3% (BMI > 25-29,9%)
Underweight pria 5,8% wanita 3,1%
 Waist circumference
Nilai lingkar pinggang:
Pria 81,9cm
Wanita 86,6cm
97,4% nilai LP pria normal
Definisi obesitas menurut LP:
Wanita LP > 88cm 41,5%
Pria LP > 108cm 2,6%
 Waist-hip ratio / WHR
Pria 0,89 Wanita 0,85 WHR normal
24% WHR wanita naik (WHR > 0,80)
Prevalensi definisi obesitas menurut
WHR lebih tinggi pd wanita
 Blood pressure
The crude prevalence (95% CI) of hypertension (BP 140/90 mmHg
or taking prescribed antihypertensive medication), was 12.6% (11.2,
14.1); 11.7% (9.7, 13.6) in males, and 13.7% (11.5, 15.8) in females (P
= 0.166). Prevalence increased with age and was significantly higher
among females in the age strata of 3544 yrs. (p = 0.008) and 55-64
yrs (P = 0.001) (Figure 1).
The new WHO Standard population age standardised prevalence of
hypertension (95% CI) was 22.8% (20.7, 24.9) in the entire sample
and 23.2% (20.4, 26.1) in analysis restricted to those over 35 years of
age. Only 20% (53/258) were aware of their hypertensive status and
among the known and drug treated hypertensive subjects 49% (26/53)
had controlle, hypertension at time of survey (BP < = 140/90 mmHg.).
Figure 1 prevalence of hypertension across
age and sex
 Faktor resiko
Merokok
Konsumsi alkohol
Usia
Faktor seks
Obesitas
Diabetes
 Sterngts and limitations
The availability of dietary data, including salt
intake, and socioeconomic and lipid profile data
would have strengthened our findings. The
limitations of self reported physical activity and
the inherent limitation of a cross-sectional study
design in prohibiting causal interpretation are
acknowledged.
 Kesimpulan
prevalensi hipertensi yang tinggi disesuaikan dengan
usia, kemiskinan di Negara berpenghasilan rendah,
dan berkorelasi dengan kelebihan berat badan dan
obesitas.
Hipertensi yang tidak terdeteksi dan karena itu tidak
menyadari risiko yang mereka hadapi.
Perlu mengontrol hipertensi
Pengobatan dan pengedalian hipetensi
Perubahan gaya hidup perilaku ditingkat masyarakat.