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Socioeconomic position and hypertension: a study of urban civil servants in Ghana
  1. J Addo,
  2. L Smeeth,
  3. D A Leon
  1. Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  1. Dr J Addo, London School of Hygiene and Tropical Medicine, Department of Epidemiology and Population Health, Keppel Street, London WC1E 7HT, UK; Juliet.addo{at}


Background: The association of socioeconomic position and cardiovascular disease risk factors in low- and middle-income countries has not been as consistent as that reported from high-income countries.

Methods: A cross-sectional study of 1015 participants from seven civil service departments in Accra, Ghana, was conducted in 2006. Hypertension was diagnosed when the mean of a second and third blood pressure reading on each of two visits 3 weeks apart was ⩾140/90 mmHg or where participants were already diagnosed and on antihypertensive drugs. Socioeconomic measures considered were education, early life and adult wealth and civil service employment grade.

Results: The age-adjusted prevalence of hypertension was lowest in participants of lower socioeconomic position (OR 21.9%; 95% CI 16.3 to 27.5) and highest in those of highest socioeconomic position (OR 31.8%; 95% CI 23.4 to 40.2) with inconsistent patterns among participants in the intermediate socioeconomic groups. Participants in the highest employment grade category were more likely to have hypertension than those in the lowest category (OR 1.91; 95% CI 1.14 to 3.20). There was a positive graded association between adult wealth and hypertension, with more assets associated with a greater risk (p trend 0.008). This trend was partly explained by body mass index differences. Blood pressure control among those with diagnosed hypertension was generally poor across the socioeconomic strata.

Conclusions: In low-income countries such as Ghana, there is a need to promote primary prevention of hypertension across the socioeconomic strata, with a focus on weight control among civil servants of higher socioeconomic position, and better hypertension control in those with hypertension.

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  • Funding: Funding was from the Commonwealth Scholarship Commission and the Wingate Foundation, UK. LS is supported by a Senior Research Fellowship in Clinical Science from the Wellcome Trust.

  • Competing interests: None.

  • Ethics approval: The protocol was approved by the ethics committees of the University of Ghana Medical School and the London School of Hygiene and Tropical Medicine, and written informed consent was obtained from each participant before inclusion in the study.