Age- and gender-specific linear trends in BMI, waist circumference, prevalence of alcohol users and smokers in the South African adult population (aged 15 years and over), between 2008 and 2014–15.

<p>Estimates and 95% confidence intervals.</p

Antihypertensive treatment and blood pressure trends among South African adults: A repeated cross-sectional analysis of a population panel survey

<div><p>Background</p><p>Recent findings suggest a decline in mean blood pressure and prevalence of uncontrolled hypertension in the South African adult population in the last decade, in contrast with the increase previously observed. This study aimed at quantifying the contribution of antihypertensive treatment to this decline.</p><p>Methods</p><p>We used data from the four waves of the National Income Dynamics Study between 2008 and 2015 and analysed changes in systolic (SBP) and diastolic blood pressure (DBP) and prevalence of uncontrolled hypertension among South African adults (15 years and above). We compared the observed changes with a counterfactual scenario in which the impact of antihypertensive treatment was estimated by censored regression and removed, with and without adjustment for BMI, waist circumference, alcohol use and smoking.</p><p>Results</p><p>During the study period, the prevalence of antihypertensive treatment rose from 13.1% to 17.6% among women and from 5.3% to 8.2% among men. Concurrently–despite worsening trends in major biobehavioural risk factors for elevated blood pressure–mean SBP decreased in both genders, DBP decreased among women and was stable among men. The odds of uncontrolled hypertension decreased by 4%/year among women and 1%/year among men. After removing the treatment effect, the downward trend in the odds of uncontrolled hypertension was reduced to 1%/year among women and completely offset among men. Among those 55 years and older, but not among younger subjects, treatment effects also explained most of the observed decreases in mean SBP and DBP.</p><p>Conclusions</p><p>Among South African adults, we infer that diffusion of antihypertensive treatment contributed substantially to the downward trend in the prevalence of uncontrolled hypertension observed between 2008 and 2015. The marked decrease in SBP and uncontrolled hypertension found among younger participants could not be explained by treatment nor by the changing distribution of the measured risk factors available in this study, and requires further investigation.</p></div

Season-adjusted observed and counterfactual trends in the prevalence of uncontrolled hypertension in the South African adult population (15 years and over) by age group and gender.

<p>The lines in the figure represent predicted prevalence of uncontrolled hypertension estimated by logistic models with observed and counterfactual individual values as outcomes.</p

Season-adjusted mean blood pressure and prevalence of uncontrolled hypertension in the South African adult population (aged 15 years and over) by age group and gender, 2008–2015.

<p>Estimates and standard errors.</p

Trends in mean blood pressure and prevalence of uncontrolled hypertension in the South African adult population (aged 15 years and over) between 2008 and 2014–15.

<p>Comparison between observed and counterfactual trends in absence of antihypertensive treatment, by age group and gender. (Regression coefficients and standard errors).</p

Additional file 1 of Obesity trends and risk factors in the South African adult population

Statistical analyses and further results. Methodological details on statistical analyses. Further results. Portable Document Format (.pdf) file. (PDF 214 kb

Observed and counterfactual prevalence of uncontrolled hypertension and number of subjects affected in the South African population (aged 15 years and over) by gender, between 2008 and 2014–15.

<p>Estimates and standard errors.</p

Proportion of subjects on antihypertensive treatment in the South African adult population by age group and gender, 2008–2015.

<p>Estimates and standard errors.</p

Season-adjusted observed and counterfactual linear trends in mean systolic and diastolic blood pressure in the South African adult population (aged 15 years and over), by age group and gender.

<p>Season-adjusted observed and counterfactual linear trends in mean systolic and diastolic blood pressure in the South African adult population (aged 15 years and over), by age group and gender.</p

Season-adjusted observed and counterfactual distribution of systolic and diastolic blood pressure in the South African adult population (15 years and over), by gender.

<p>Solid lines = observed distribution; Dashed lines = distribution in absence of treatment. The curves on the left side refer to DBP, those on the right side refer to SBP. Vertical lines represent the cut-off for diagnosis of diastolic (dashed line) and systolic (solid line) hypertension.</p