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Measuring Hypertension Progression With Transition Probabilities: Estimates From the WHO SAGE Longitudinal Study


Boateng, GO and Lartey, ST and Baiden, P and Si, L and Biritwum, RB and Kowal, P and Magnussen, CG and Ben Taleb, Z and Palmer, AJ and Luginaah, I, Measuring Hypertension Progression With Transition Probabilities: Estimates From the WHO SAGE Longitudinal Study, Frontiers in Public Health, 9 pp. 1-12. ISSN 2296-2565 (2021) [Refereed Article]

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Copyright Statement

Copyright 2021 Boateng, Lartey, Baiden, Si, Biritwum, Kowal, Magnussen, Ben Taleb, Palmer and Luginaah. This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) License. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

DOI: doi:10.3389/fpubh.2021.571110


This paper assessed the transition probabilities between the stages of hypertension severity and the length of time an individual might spend at a particular disease state using the new American College of Cardiology/American Heart Association hypertension blood pressure guidelines. Data for this study were drawn from the Ghana WHO SAGE longitudinal study, with an analytical sample of 1884 across two waves. Using a multistate Markov model, we estimated a seven-year transition probability between normal/elevated blood pressure (systolic ≤ 129 mm Hg & diastolic <80 mm Hg), stage 1 (systolic 130-139 mm Hg & diastolic 80-89 mm Hg), and stage 2 (systolic ≥140mm Hg & diastolic≥90 mm Hg) hypertension and adjusted for the individual effects of anthropometric, lifestyle, and socio-demographic factors. At baseline, 22.5% had stage 1 hypertension and 52.2% had stage 2 hypertension. The estimated seven-year transition probability for the general population was 19.0% (95% CI: 16.4, 21.8) from normal/elevated blood pressure to stage 1 hypertension, 31.6% (95% CI: 27.6, 35.4%) from stage 1 hypertension to stage 2 hypertension, and 48.5% (45.6, 52.1%) for remaining at stage 2. Other factors such as being overweight, obese, female, aged 60+ years, urban residence, low education and high income were associated with an increased probability of remaining at stage 2 hypertension. However, consumption of recommended servings of fruits and vegetables per day was associated with a delay in the onset of stage 1 hypertension and a recovery to normal/elevated blood pressure. This is the first study to show estimated transition probabilities between the stages of hypertension severity across the lifespan in sub-Saharan Africa. The results are important for understanding progression through hypertension severity and can be used in simulating cost-effective models to evaluate policies and the burden of future healthcare.

Item Details

Item Type:Refereed Article
Keywords:ACC/AHA 2017 hypertension guidelines, elevated blood pressure, hypertension, multi-state model, sub-Saharan Africa, transition probabilites
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Magnussen, CG (Associate Professor Costan Magnussen)
UTAS Author:Palmer, AJ (Professor Andrew Palmer)
ID Code:146177
Year Published:2021
Web of Science® Times Cited:2
Deposited By:Menzies Institute for Medical Research
Deposited On:2021-08-24
Last Modified:2021-09-01
Downloads:20 View Download Statistics

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