# Hypertension outcomes in a fragile setting: predictors of blood pressure reduction and control in the Central African Republic

## TL;DR

This study examines hypertension care in the Central African Republic, finding that while blood pressure reduction is common, control rates remain low, especially in patients with diabetes or kidney disease.

## Contribution

The study identifies predictors of blood pressure control and reduction in a fragile healthcare setting in the Central African Republic.

## Key findings

- BP control was achieved in 39.5% of patients, while 86.7% experienced clinically significant BP reduction.
- Diabetes and chronic kidney disease were strong predictors of lower BP control and reduction.
- Higher baseline hypertension severity and older age were associated with greater BP reduction.

## Abstract

Hypertension is a leading contributor to cardiovascular disease and early mortality, and its impact is growing rapidly in low-income countries. In the Central African Republic, the condition represents a major and under-addressed health problem. This study examines the outcomes of hypertension care in Bangui, focusing on factors influencing blood pressure control and reduction (CAR).

This cross-sectional study analyzed clinical records of hypertensive patients receiving care in Bangui. Demographic and clinical data were collected at baseline and at the most recent follow-up (October-November 2024) to identify factors associated with BP control (<140/90 mmHg) and reduction (decrease of ≥20 mmHg in systolic or ≥10 mmHg in diastolic BP).

We included 656 patients (69% female, median age 59 years). BP control and clinically significant BP reduction were achieved in 39.5 and 86.7% of patients. Diabetes was an independent predictor of lower BP control (OR = 0.36; 95%CI:0.25–0.52; p < 0.001) and lower BP reduction (OR = 0.56; 95%CI:0.35–0.88; p = 0.012). Chronic kidney disease was associated with lower BP reduction (OR = 0.10; 95%CI:0.02–0.52; p = 0.006). Higher baseline hypertension correlated with BP reduction (Grade 3 hypertension: OR = 88.3; 95%CI:23.4–587; p < 0.001). Older age was associated with BP reduction (OR = 1.16; 95%CI:1.04–1.29; p = 0.007).

In Bangui, structured hypertension care proved feasible and led to significant BP reductions, although target control rates remained low, particularly in patients with diabetes and CKD. Strengthening follow-up and access to tailored treatment could improve outcomes in this fragile setting.