Hypertension incidence among middle-aged and older adults: Findings from a 5-year prospective study in rural South Africa, 2010-2015

Brian Houle, Thomas A. Gaziano, Nicole Angotti, Sanyu A. Mojola, Chodziwadziwa W. Kabudula, Stephen M. Tollman, F. Xavier Gómez-Olivé

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5 Scopus citations


Objectives There is a scarcity of longitudinal cohort studies in sub-Saharan Africa to understand the epidemiology of cardiovascular disease as a basis for intervention. We estimated incident hypertension and associated sociodemographic, health and behavioural risk factors in a population aged 40 years and older over a 5-year period. Design We assessed the association between incident hypertension and sociodemographic, health and behavioural factors using Poisson regression. We adjusted for non-response in 2015 using inverse probability sampling weights from a logistic regression including sex and age at baseline. Setting Rural South Africa. Participants We used a population-based cohort of normotensive adults in 2010 who were aged 40 years and older at retest in 2015. Results Of 676 individuals completing baseline and 5-year follow-up, there were 193 incident cases of hypertension. The overall hypertension incidence rate was 8.374/100 person-years. In multivariable analyses, those who became hypertensive were more likely to be older, have a high waist circumference (incidence rate ratio (IRR): 1.557, 95% CI: 1.074 to 2.259) and be employed (IRR: 1.579, 95% CI: 1.071 to 2.329) at baseline. Being HIV positive and not on antiretroviral therapy at baseline was associated with lower risk of incident hypertension. Conclusions Over a 5-year period, 29% of respondents developed hypertension. Given the high burden of hypertension in South Africa, continued longitudinal follow-up is needed to understand the complex interplay of non-communicable and infectious diseases and their underlying and modifiable risk factors to inform public health prevention strategies and programmes.

Original languageEnglish (US)
Article numbere049621
JournalBMJ open
Issue number12
StatePublished - Dec 7 2021

All Science Journal Classification (ASJC) codes

  • General Medicine


  • South Africa
  • cohort
  • hypertension
  • incidence
  • rural population


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