Cappuccio, Francesco P., Kerry, Sally M., Micah, Frank B., Plange-Rhule , Jacob and Eastwood, John B.. (2006) A community programme to reduce salt intake and blood pressure in Ghana. BMC Public Health, Vol.6 (No.13). ISSN 1471-8219

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Abstract

Background In Africa hypertension is common and stroke is increasing. Detection, treatment and control of high blood pressure (BP) is limited. BP can be lowered by reducing salt intake. In Africa salt is added to the food by the consumer, as processed food is rare. A population-wide approach with programmes based on health education and promotion is thus possible. Methods We carried out a community-based cluster randomised trial of health promotion in 1,013 participants from 12 villages (628 women, 481 rural dwellers); mean age 55 years to reduce salt intake and BP. Average BP was 125/74 mmHg and urinary sodium (UNa) 101 mmol/day. A health promotion intervention was provided over 6 months to all villages. Assessments were made at 3 and 6 months. Primary end-points were urinary sodium excretion and BP levels. Results There was a significant positive relationship between salt intake and both systolic (2.17 mmHg [95% CI 0.44 to 3.91] per 50 mmol of UNa per day, p < 0.001) and diastolic BP (1.10 mmHg [0.08 to 1.94], p < 0.001) at baseline. At six months the intervention group showed a reduction in systolic (2.54 mmHg [-1.45 to 6.54]) and diastolic (3.95 mmHg [0.78 to 7.11], p = 0.015) BP when compared to control. There was no significant change in UNa. Smaller villages showed greater reductions in UNa than larger villages (p = 0.042). Irrespective of randomisation, there was a consistent and significant relationship between change in UNa and change in systolic BP, when adjusted for confounders. A difference in 24-hour UNa of 50 mmol was associated with a lower systolic BP of 2.12 mmHg (1.03 to 3.21) at 3 months and 1.34 mmHg (0.08 to 2.60) at 6 months (both p < 0.001). Conclusion In West Africa the lower the salt intake, the lower the BP. It would appear that a reduction in the average salt intake in the whole community may lead to a small but significant reduction in population systolic BP.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Clinical Sciences Research Institute (CSRI) Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Health promotion -- Ghana, Hypertension -- Ghana
Journal or Publication Title:	BMC Public Health
Publisher:	BioMed Central Ltd
ISSN:	1471-8219
Date:	24 January 2006
Volume:	Vol.6
Number:	No.13
Identification Number:	10.1186/1471-2458-6-13
Status:	Not Peer Reviewed
Access rights to Published version:	Open Access
References:	1. Cooper RS, Osotimehin B, Kaufman JS, Forrester T: Disease burden in sub-Saharan Africa: what should we conclude in the absence of data? Lancet 1998, 351:208-210. 2. Murray CJL, Lopez AD: Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997, 349:1269-1276. 3. Poungvarin N: Stroke in the developing world. Lancet 1998, 352(suppl III):1922-1924. 4. Cooper RS, Rotimi C, Ataman S, McGee D, Osotomehin B, Kadiri S, Muna WFT, Kingue S, Fraser H, Forrester T, Bennet F, Wilks R: The prevalence of hypertension in seven populations of West African origin. Am J Public Health 1997, 87:160-168. 5. Amoah AGB: Hypertension in Ghana: a cross-sectional community prevalence study in Greater Accra. Ethn Dis 2003, 13:310-315. 6. Cappuccio FP, Micah FB, Emmett L, Kerry SM, Antwi S, Martin-Peprah R, Phillips RO, Plange-Rhule J, Eastwood JB: Prevalence, detection, management and control of hypertension in Ashanti, West Africa. Hypertension 2004:1017-1022. 7. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J: Global burden of hypertension: analysis of worldwide data. Lancet 2005, 365:217-223. 8. Cooper RS, Rotimi C, Kaufman JS, Muna WFT, Mensah G: Hypertension treatment and control in sub-Saharan Africa: the epidemiological basis for policy. Br Med J 1998, 312:614-617. 9. Anim JI, Kofi AD: Hypertension, cerebral vascular changes and stroke in Ghana: cerebral atherosclerosis and stroke. East African Medical Journal 1989, 66:468-475. 10. Nyame PK, Bonsu-Bruce N, Amoah AG, Adjei S, Nyarko E, Amuah EA, Biritwum RB: Current trends in the incidence of cerebrovascular accidents in Accra. West Afr Med J 1994, 13:183-186. 11. Wiredu EK, Nyame PK: Stroke-related mortality at Korle Bu Teaching Hospital, Accra, Ghana. East African Medical Journal 2001, 78:180-184. 12. Walker RW, McLarty DG, Kitange HM, Whiting D, Masuki G, Mtasiwa DM, Machibya H, Unwin N, Alberti KGMM: Stroke mortality in urban and rural Tanzania. Lancet 2000, 355:1684-1687. 13. The SASPI Project Team: Prevalence of stroke survivors in rural South Africa. Stroke 2004, 35:627-632. 14. Report of a WHO/FAO Expert Consultation: Diet, nutrition and the prevention of chronic diseases. Volume 916. Geneva, World Health Organization. WHO Technical Report Series.; 2003:1-149. 15. World Health Organization: The World Health Report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization; 2002:1-248. 16. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER III, Simons-Morton DG, Karanja N, Lin P-H, for the DASH-Sodium Collaborative Research Group: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 2001, 344:3-10. 17. Cappuccio FP, Plange-Rhule J, Phillips RO, Eastwood JB: Prevention of hypertension and stroke in Africa. Lancet 2000, 356:677-678. 18. Adeyemo AA, Prewitt TE, Luke A, Omotade OO, Rotimi CN, Brieger WR, Cooper RS: The feasibility of implementing a dietary sodium reduction intervention among free-living normotensive individuals in south West Nigeria. Ethn Dis 2002, 12:207-212. 19. Forrester T, Adeyemo A, Soarres-Wynter S, Sargent L, Bennett F, Wilks R, Luke A, Prewitt E, Kramer H, Cooper RS: A randomized trial on sodium reduction in two developing countries. J Hum Hypert 2005, 19:55-60. 20. Forte JG, Miguel JMP, Miguel MJP, de Padua F, Rose G: Salt and blood pressure: a community trial. J Hum Hypert 1989, 3:179-184. 21. Tuomilehto J, Jousilahti P, Rastenyte D, Moltchanov V, Tanskanen A, Pietinen P, Nissinen A: Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet 2001, 357:848-851. 22. Plange-Rhule J, Phillips R, Acheampong JW, Saggar-Malik AK, Cappuccio FP, Eastwood JB: Hypertension and renal failure in Kumasi, Ghana. J Hum Hypert 1999, 13:37-40. 23. Mathers CD, Sadan R, Salomon JA, Murray CJL, Lopez AD: Healthy life expectancy in 191 countries. Lancet 2001, 357:1685-1691. 24. Plange-Rhule J, Cappuccio FP, Emmett L, Kerry SM, Edmundson AR, Acheampong D, Eastwood JB: A community study of health promotion in rural West Africa: details of a household survey and population census. Q J Med 2002, 95:445-450. 25. Kerry SM, Emmett L, Micah FB, Martin-Peprah R, Antwi S, Phillips RO, Plange-Rhule J, Eastwood JB, Cappuccio FP: Rural and semi-urban differences in salt intake, and its dietary sources, in Ashanti, West Africa. Ethn Dis 2005, 15:33-39. 26. Kerry SM, Cappuccio FP, Emmett L, Plange-Rhule J, Eastwood JB: Reducing selection bias in a cluster randomised trial in West African villages. Clinical Trials 2005, 2:125-129. 27. Woodhouse PR, Khaw KT, Plummer M: Seasonal variation of blood pressure and its relationship to ambient temperature in an elderly population. J Hypertens 1993, 11:1267-1274. 28. Chifamba J, Mufunda J, Sigola LB, Matenga JA, Sparks HV: Effect of variation in environmental temperature on blood pressure: is it important? Central Afr J Med 1998, 44:37-40. 29. He FJ, MacGregor GA: Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypert 2002, 16:761-770. 30. Kumanyika SK, Cook NR, Cutler JA, Belden L, Brewer A, Cohen JD, Hebert PR, Lasser VI, Raines J, Raczynski J, Shepek L, Diller L, Whelton PK, Yamamoto M: Sodium reduction for hypertension prevention in overweight adults: further results from the Trials of Hypertension Prevention Phase II. J Hum Hypertens 2005, 19:33-45. 31. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ: Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 2005, 293:43-53. 32. Ebrahim S: There are no shortcuts to finding out what works – population laboratories are essential tools. Tropical Medicine and International Health 1998, 3:256-257. 33. Ebrahim S, Davey-Smith G: Exporting failure? Coronary heart disease and stroke in developing countries. Int J Epidemiol 2001, 30:201-205. 34. Hawe P, Shiell A, Riley T: Complex interventions: how "out of control" can a randomised controlled trial be? Br Med J 2004, 328:1561-1563. 35. Murray CJL, Lauer JA, Hutubessy RCW, Niessen L, Tomijima N, Rodgers A, Lawes CMM, Evans DB: Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular- disease risk. Lancet 2003, 361:717-725. 36. Rodgers A, Ezzati M, Vander HS, Lopez AD, Lin RB, Murray CJ: Distribution of Major Health Risks: Findings from the Global Burden of Disease Study. Plos Med 2004, 1:e27. 37. Buabeng KO, Matowe L, Plange-Rhule J: Unaffordable drug prices: the major cause of non-compliance with hypertension medication in Ghana. J Pharm Pharmaceut Sci 2004, 7:350-352. 38. Bray GA, Vollmer WM, Sacks FM, Obarzanek E, Svetkey LP, Appel LJ: A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: results of the DASH-Sodium Trial. Am J Cardiol 2004, 94:222-227. 39. He FJ, MacGregor GA: How far should salt intake be reduced? Hypertension 2003, 42:1093-1099. 40. He J, Ogden LG, Vupputuri S, Bazzano LA, Loria C, Whelton PK: Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA 1999, 282:2027-2034. 41. He J, Whelton PK, Appel LJ, Charleston J, Klag MJ: Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension 2000, 35:544-549. 42. Nagata C, Takatsuka N, Shimizu N, Shimizu H: Sodium intake and risk of death from stroke in Japanese men and women. Stroke 2004, 35:1543-1547.
URI:	http://wrap.warwick.ac.uk/id/eprint/171

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