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    Regional Patterns and Association between Obesity and Hypertension in Africa evidence from the H3 Africa CHAIR Study
    (Wolters Kluwer Health, Inc., 2020) Akpa, O. M.; Made, F.; Ojo, A.; Ovbiagele, B.; Adu, D.; Motala, A. A.; Mayosi, B. M.; Adebamowo, S. N.; Engel, M. E.; Tayo, B.; Rotimi, C.; Salako, B.; Akinyemi, R.; Gebregziabher, M.; Sarfo, F.; Wahab, K.; Agongo, G.; Alberts, M.
    Abstract—Hypertension and obesity are the most important modifiable risk factors for cardiovascular diseases, but their association is not well characterized in Africa. We investigated regional patterns and association of obesity with hypertension among 30044 continental Africans. We harmonized data on hypertension (defined as previous diagnosis/ use of antihypertensive drugs or blood pressure [BP]≥140/90 mmHg/BP≥130/80 mmHg) and obesity from 30 044 individuals in the Cardiovascular H3Africa Innovation Resource across 13 African countries. We analyzed data from population-based controls and the Entire Harmonized Dataset. Age-adjusted and crude proportions of hypertension were compared regionally, across sex, and between hypertension definitions. Logit generalized estimating equation was used to determine the independent association of obesity with hypertension (P value<5%)Participants were 56% women; with mean age 48.5±12.0 years. Crude proportions of hypertension (at BP≥140/90 mmHg) were 47.9% (95% CI, 47.4–48.5) for Entire Harmonized Dataset and 42.0% (41.1–42.7) for population-based controls and were significantly higher for the 130/80 mmHg threshold at 59.3% (58.7–59.9) in population-based controls. The age-adjusted proportion of hypertension at BP≥140/90 mmHg was the highest among men (33.8% [32.1–35.6]), in western Africa (34.7% [33.3–36.2]), and in obese individuals (43.6%; 40.3–47.2). Obesity was independently associated with hypertension in population-based controls (adjusted odds ratio, 2.5 [2.3–2.7]) and odds of hypertension in obesity increased with increasing age from 2.0 (1.7–2.3) in younger age to 8.8 (7.4–10.3) in older age. Hypertension is common across multiple countries in Africa with 11.9% to 51.7% having BP≥140/90 mmHg and 39.5% to 69.4% with BP≥130/80 mmHg. Obese Africans were more than twice as likely to be hypertensive and the odds increased with increasing age. (Hypertension. 2020;75:00-00. DOI: 10.1161/HYPERTENSIONAHA.119.14147.)
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    Unraveling the risk factors for spontaneous intra cerebral hemorrhage among West Africans
    (American Academy of Neurology., 2020) Sarfo, F. S.; Ovbiagele, B.; Gebregziabher, M.; Akpa, O.; Akpalu, A.; Wahab, K.; Ogbole, G.; Akinyemi, R.; Obiako, R.; Komolafe, M.; Owolabi, L.; Lackland, D.; Arnett, D.; Tiwari, H.; Markus, H. S.; Akinyemi, J.; Oguntade, A.; Fawale, B.
    "Abstract Objective To characterize risk factors for spontaneous intra cerebral hemorrhage (sICH) occurrence and severity among West Africans. Methods The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors. Results Of 2,944 adjudicated stroke cases, 854 were intra cerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were non lobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78–213.72); dyslipidemia, 2.95 (1.84–4.74); meat consumption, 1.55 (1.01–2.38); family history of CVD, 2.22 (1.41–3.50); non consumption of green vegetables, 3.61 (2.07–6.31); diabetes mellitus, 2.11 (1.29–3.46); stress, 1.68 (1.03–2.77); and current tobacco use, 14.27 (2.09–97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were non consumption of leafy green vegetables, 2.03 (1.43–2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00–1.01); presence of midline shift, 1.54 (1.11–2.13); lobar ICH, 1.72 (1.16–2.55); and supratentorial bleeds, 2.17 (1.06–4.46). Conclusions Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.
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    Differential impact of risk factors on stroke occurrence among men versus women in West Africa The SIREN Study
    (American Heart Association, Inc., 2019) Akpalu A.; Gebregziabher M.; Ovbiagele B.; Sarfo F.; Iheonye H.; Akinyemi R.; Akpa O.; Tiwari H. K.; Arnett D.; Wahab K.; Lackland D.; Abiodun A.; Ogbole G.; Jenkins C.; Arulogun O.; Akpalu J.; Obiako R.; Olowoyo P.; Fawale M.; Komolafe M.; Osaigbovo G.; Obiabo Y.; Chukwuonye I.; Owolabi L.; Adebayo P.; Sunmonu T.; Owolabi M.
    Background and Purpose—The interplay between sex and the dominant risk factors for stroke occurrence in sub-Saharan Africa has not been clearly delineated. We compared the effect sizes of risk factors of stroke by sex among West Africans. Methods—SIREN study (Stroke Investigative Research and Educational Networks) is a case-control study conducted at 15 sites in Ghana and Nigeria. Cases were adults aged >18 years with computerized tomography/magnetic resonance imaging confirmed stroke, and controls were age- and sex-matched stroke-free adults. Comprehensive evaluation for vascular, lifestyle, and psychosocial factors was performed using validated tools. We used conditional logistic regression to estimate odds ratios and reported risk factor specific and composite population attributable risks with 95% CIs. Results—Of the 2118 stroke cases, 1193 (56.3%) were males. The mean±SD age of males was 58.1±13.2 versus 60.15±14.53 years among females. Shared modifiable risk factors for stroke with adjusted odds ratios (95% CI) among females versus males, respectively, were hypertension [29.95 (12.49–71.77) versus 16.1 0(9.19–28.19)], dyslipidemia [2.08 (1.42–3.06) versus 1.83 (1.29–2.59)], diabetes mellitus [3.18 (2.11–4.78) versus 2.19 (1.53–3.15)], stress [2.34 (1.48–3.67) versus 1.61 (1.07–2.43)], and low consumption of green leafy vegetables [2.92 (1.89–4.50) versus 2.00 (1.33–3.00)]. However, salt intake and income were significantly different between males and females. Six modifiable factors had a combined population attributable risk of 99.1% (98.3%–99.6%) among females with 9 factors accounting for 97.2% (94.9%–98.7%) among males. Hemorrhagic stroke was more common among males (36.0%) than among females (27.6%), but stroke was less severe among males than females. Conclusions—Overall, risk factors for stroke occurrence are commonly shared by both sexes in West Africa favoring concerted interventions for stroke prevention in the region.