Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries

Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiol...

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Published in:JAMA : the journal of the American Medical Association Vol. 310; no. 9; p. 959
Main Authors: Chow, Clara K, Teo, Koon K, Rangarajan, Sumathy, Islam, Shofiqul, Gupta, Rajeev, Avezum, Alvaro, Bahonar, Ahmad, Chifamba, Jephat, Dagenais, Gilles, Diaz, Rafael, Kazmi, Khawar, Lanas, Fernando, Wei, Li, Lopez-Jaramillo, Patricio, Fanghong, Lu, Ismail, Noor Hassim, Puoane, Thandi, Rosengren, Annika, Szuba, Andrzej, Temizhan, Ahmet, Wielgosz, Andy, Yusuf, Rita, Yusufali, Afzalhussein, McKee, Martin, Liu, Lisheng, Mony, Prem, Yusuf, Salim
Format: Journal Article
Language:English
Published: United States 04.09.2013
Subjects:
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure
Cross-Sectional Studies
Developed Countries
Developing Countries
Female
Health Knowledge, Attitudes, Practice
Humans
Hypertension - diagnosis
Hypertension - drug therapy
Hypertension - epidemiology
Income
Male
Middle Aged
Prevalence
Rural Population - statistics & numerical data
Self Report
Urban Population - statistics & numerical data
ISSN:1538-3598, 1538-3598
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Abstract Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study. A cross-sectional study of 153,996 adults (complete data for this analysis on 142,042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper-middle-income and low-middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC). Hypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure-lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg. Among the 142,042 participants, 57,840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26,877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23,510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure-lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries. Among a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment.
AbstractList Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods.IMPORTANCEHypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods.To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study.OBJECTIVETo examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study.A cross-sectional study of 153,996 adults (complete data for this analysis on 142,042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper-middle-income and low-middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC).DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study of 153,996 adults (complete data for this analysis on 142,042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper-middle-income and low-middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC).Hypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure-lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg.MAIN OUTCOMES AND MEASURESHypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure-lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg.Among the 142,042 participants, 57,840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26,877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23,510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure-lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries.RESULTSAmong the 142,042 participants, 57,840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26,877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23,510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure-lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries.Among a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment.CONCLUSIONS AND RELEVANCEAmong a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment.
Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study. A cross-sectional study of 153,996 adults (complete data for this analysis on 142,042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper-middle-income and low-middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC). Hypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure-lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg. Among the 142,042 participants, 57,840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26,877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23,510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure-lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries. Among a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment.
Author Bahonar, Ahmad
Wielgosz, Andy
Gupta, Rajeev
Avezum, Alvaro
McKee, Martin
Ismail, Noor Hassim
Puoane, Thandi
Liu, Lisheng
Islam, Shofiqul
Chow, Clara K
Yusuf, Salim
Yusufali, Afzalhussein
Kazmi, Khawar
Lopez-Jaramillo, Patricio
Diaz, Rafael
Mony, Prem
Temizhan, Ahmet
Fanghong, Lu
Rosengren, Annika
Lanas, Fernando
Szuba, Andrzej
Yusuf, Rita
Teo, Koon K
Rangarajan, Sumathy
Chifamba, Jephat
Dagenais, Gilles
Wei, Li
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/24002282$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Contributor Teo, K
Jian, Bo
Linetsky, B
Rangarajan, S
Moroz, S Papadakis I
Hrnic, R
Yusuf, R
Yusuf, S
Hage-Moussa, S
Wielgosz, A
Talukdar, A T
Proulx, M C
Fodor, G
Mente, A
Zafar, S
Juan, Li
Solano, N
Farago, M
Farago, L
Qing, Deng
Solano, R
Gasevic, D
Kaszyca, J
Teo, K K
Dagenais, G
Cherry, H M
Dehghan, M
Mannan, A
Turbide, G
Xingyu, Wang
Muthuri, S
Casaccia, G
ElSheikh, W
Bonneville, N
Hassan, I
Lear, S
Mustaha, M
Mattos, A C
Rimac, J
Hui, Chen
Kabali, C
Hall, K
Rahman, O
Vukmirovich, I
Xinye, He
Kay, I
Chunming, Chen
Wenhua, Zhao
Auger, D
Xiaohong, Chang
Poirier, P
Wei, Li
Lisheng, Liu
Xiong, J
Bahit, C
Martinez, S
Pipe, A
Madhavan, M
MacLeod, M
Marcilio, C S
Khan, M U
Lanas, F
Tooheen, R B
Cayer, M
Mackie, P
Corsi, D
Xiaoru, Cheng
Bo, Hu
Wang, X
Michael, J
Diaz, R
McQueen, M
Cuneo, J M Maini
Islam, S
Keys, J
Trottier, S
Keneth, J
Rabbani, K A
Chow, C K
DeJesus, J
Azad, A K
Jian, Li
Oliveira, G B
Seron, P
Chockalingam, A
Mah, G
Tao, Chen
Zhang, M
Orlandini, A
Xuan, Jia
Toscanelli, S
Avezum, A
De Bluts, A LeBlanc
Williams, D
Gyawali, S
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References 24449325 - JAMA. 2014 Jan 22-29;311(4):419-20
24449324 - JAMA. 2014 Jan 22-29;311(4):418-9
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Snippet Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized...
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SubjectTerms Aged
Antihypertensive Agents - therapeutic use
Blood Pressure
Cross-Sectional Studies
Developed Countries
Developing Countries
Female
Health Knowledge, Attitudes, Practice
Humans
Hypertension - diagnosis
Hypertension - drug therapy
Hypertension - epidemiology
Income
Male
Middle Aged
Prevalence
Rural Population - statistics & numerical data
Self Report
Urban Population - statistics & numerical data
Title Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries
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