Impact of hypertension on mortality in adults in Moramanga, Madagascar: a retrospective cohort study in the community

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Abstract

Background

Hypertension remains a global public health problem. This study aimed to evaluate the impact of hypertension on premature mortality among people living in Moramanga, Madagascar.

Methods

Three communes of Moramanga district have been monitored since 2012 as part of the MHURAM project (Moramanga Health Survey in Urban and Rural Areas in Madagascar). In 2013, individuals aged 15 years and above were surveyed to estimate the prevalence of hypertension and identify risk factors. A follow-up survey was conducted in 2016–2017 to record deaths; causes of death were assessed through verbal autopsy (VA). The occurrence of premature death was evaluated using a retrospective cohort study design applied to data collected from adults aged 30 to 70 who participated in the hypertension survey. Mortality rates and partial life expectancy by sex and hypertension status were estimated using survival analysis; covariates associated with premature risk of mortality were identified using a Cox proportional hazards model. The contribution of causes of death to the difference in partial life expectancy between hypertensive and non-hypertensive individuals was evaluated using a decomposition analysis.

Results

There were 4,472 participants in the hypertension survey aged between 30 and 70 during the follow-up. The average follow-up was 2.7 years per individual, resulting in 11,892 person-years in total with 117 deaths reported giving a mortality rate of 9.8‰ (13.1‰ for males and 7.1‰ for females). An estimated 3.2 years of life was lost among those diagnosed with hypertension compared to normotensive (32.0 years and 35.2 years respectively). Adjusted for gender, smoking habit, sedentary lifestyle, and wealth index, hypertension is a risk factor for premature death [HR = 1.58 95%CI (1.07–2.36)]. Hypertensive individuals also experienced higher all-cause and communicable disease mortality in people aged between 30 and 39 years.

Conclusion

Hypertension is associated with higher risks of premature death in the community of Moramanga. In addition, hypertension contributes not only to mortality via cardiovascular diseases, but also through all causes combined. The health system should enhance prevention efforts, particularly for young hypertensive patients, when risk is most pronounced.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-22171-y.

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Most cited references 48

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The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

Aram V Chobanian, George L Bakris, Henry R Black … (2003)

"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.

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Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

José Huerta (2022)

Summary Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding WHO.

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Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.

Dena Ettehad, Connor Emdin, Amit Kiran … (2016)

The benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established. However, the extent to which these effects differ by baseline blood pressure, presence of comorbidities, or drug class is less clear. We therefore performed a systematic review and meta-analysis to clarify these differences.

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Author and article information

Contributors

Rila Ratovoson: rila@pasteur.mg

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 13 March 2025

Publication date PMC-release: 13 March 2025

Publication date Collection: 2025

Volume: 25

Electronic Location Identifier: 992

Affiliations

[1 ]Unité d’Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, ( https://ror.org/03fkjvy27) Antananarivo, Madagascar

[2 ]Unité DemoSud, Institut national d’études démographiques, ( https://ror.org/02cnsac56) Aubervilliers, France

[3 ]Centre Hospitalier de Soavinandriana, Antananarivo, Madagascar

[4 ]Centre Hospitalier Manaram-penitra Andohatapenaka, Antananarivo, Madagascar

[5 ]Epi-GH, Independent Global Health Consultant, Nice, France

Article

Publisher ID: 22171

DOI: 10.1186/s12889-025-22171-y

PMC ID: 11907952

PubMed ID: 40082796

SO-VID: acd6af77-769f-433f-94a9-aa6bc079079f

License:

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

History

Date received : 25 September 2024

Date accepted : 3 March 2025

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ScienceOpen disciplines: Public health

Keywords: hypertension,premature death,community,survival,madagascar

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ScienceOpen disciplines: Public health

Keywords: hypertension, premature death, community, survival, madagascar

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Impact of hypertension on mortality in adults in Moramanga, Madagascar: a retrospective cohort study in the community

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Supplementary Information

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Most cited references 48

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.

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