Hypertension Outcomes in a Fragile Setting: Predictors of Blood Pressure Reduction and Control in the Central African Republic

Anna Maria Doro Altan¹Boris Tchenebou²Kevine Iffio²Gabriella Bortolot³Stefano Orlando⁴Giovanni Guidotti⁵Sandro Petrolati⁶Pierre Somse⁷Fausto Ciccacci^4*

• ¹Link Campus University, Rome, Italy
• ²DREAM Program, Community of Sant'Egidio, Bangui, Central African Republic
• ³DREAM Program, Community of Sant'Egidio, Rome, Italy
• ⁴Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
• ⁵Azienda Sanitaria Locale Roma 1, Rome, Italy
• ⁶Department of Cardioscience, San Camillo Hospital, Rome, Italy
• ⁷Minister of Health, Bangui, Central African Republic

Background 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). Methods 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). Results 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). Conclusion 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.