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Predictors of hypertension awareness, treatment and control in South Africa: results from the WHO-SAGE population survey (Wave 2)

Journal of Human Hypertensionvolume 33pages157166 (2019) | Download Citation


South Africa has one of the highest levels of hypertension globally, coupled with poor rates of diagnosis, treatment and control. Risk factors that predict hypertension in high income countries may perform differently in the African context, where communicable disease, obesity and malnutrition co-exist. This study investigated traditional risk factors alongside other health and sociodemographic indicators to determine predictors of hypertension prevalence and management. Participants were recruited from households across South Africa as part of WHO’s Study on global AGEing and adult health (WHO SAGE) Wave 2 (2015). Blood pressure (BP) was measured in triplicate and sociodemographic and health data collected by survey (n = 1847; 30% 18–39 years, 39% 40–59 years, 31% 60 years+; median age 51 years; 68% female). Of all adults, 43% were hypertensive (n = 802), of which 58% (n = 398) were unaware, 33% (n = 267) were on medication, with only 18% (n = 141) controlled on medication (BP < 140/90 mmHg). Multivariate logistic regression showed waist-to-height ratio > 0.5 and diabetes comorbidity were the most significant predictors of hypertension presence, awareness and treatment. Individuals with diabetes were twice as likely to have hypertension, 7.0 times more likely to be aware, 3.3 times more likely to be on antihypertensive medication, and 2.4 times more likely to be controlled on medication. Women and individuals reporting lower salt use were more likely to be aware and treated for hypertension. Applying the 2017 AHA/ACC hypertension guidelines showed only 1 in 4 adults had normal BP. As with HIV, similarly intensive efforts are now needed in the region to improve non-communicable disease diagnosis and management.

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The authors are grateful towards all individuals participating voluntarily in the study. The dedication of the support and research staff is also duly acknowledged. The authors would also like to acknowledge Dr Stephen Rule, Dr Robin Richards and Mr Godfrey Dlulane of Outsourced Insight who were subcontracted to conduct the surveys and coordinate data collection for WHO SAGE within South Africa.


WHO SAGE: Multi-country study is supported by WHO and the Division of Behavioural and Social Research (BSR) at the National Institute on Aging (NIA), US National Institutes of Health, through Interagency Agreements (OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-01) with WHO, a Research Project Grant R01AG034479, and in-kind support from the South Africa Department of Health. The nested WHO SAGE Salt & Tobacco study is supported by an agreement with the CDC Foundation with financial support provided by Bloomberg Philanthropies and a Partnerships & Research Development Fund (PRDF) grant from the Australia Africa Universities Network. DPHRU are supported by the South African Medical Research Council.

Author’s contributions:

The authors’ contributions were as follows: LW coordinated data collection for the WHO SAGE substudy in South Africa, conducted analysis, and wrote the manuscript; GC contributed to the statistical analysis and interpretation of data; AES is the South African PI for the WHO SAGE substudy in South Africa, contributed to data interpretation and writing of the manuscript; KC and PK designed the WHO SAGE Wave 2 sub-study. All authors read, edited and approved the final manuscript.

Author information


  1. SA MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    • Lisa Jayne Ware
    •  & Glory Chidumwa
  2. Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa

    • Lisa Jayne Ware
    •  & Aletta Elisabeth Schutte
  3. School of Medicine, University of Wollongong, Wollongong, Australia

    • Karen Charlton
  4. Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia

    • Karen Charlton
  5. MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa

    • Aletta Elisabeth Schutte
  6. University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, Australia

    • Paul Kowal
  7. Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand

    • Paul Kowal
  8. World Health Organization (WHO), Geneva, Switzerland

    • Paul Kowal


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The authors declare that they have no conflict of interest.

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Correspondence to Aletta Elisabeth Schutte.

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