Worldwide, raised blood pressure is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. However, there is little data collected using standardized methods.
Dr. Salim Yusuf, MD, DPhil, MRCP, Professor, Department of Medicine, Director of Population Health Research Institute at McMaster University and colleagues examined hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study.
The researchers conducted a global cross-sectional study on the prevalence, awareness, treatment, and control of hypertension in a population of 142,042 participants, aged 35 to 70 years old, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC) that included Canada, Sweden, and the United Arab Emirates, 10 upper–middle-income countries including Argentina, Brazil, Chile, Poland’s, Turkey, Malaysia, and South Africa and low–middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC) including Bangladesh, India, Pakistan, and Bimbabwe. Information on patients in the United States was excluded.
Participants were followed for ten years and received measurements of cardiovascular disease risk factor history including smoking, history of hypertension, psychosocial factors, alcohol consumptions, and physical measures and sitting blood pressure. 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. Patients were considered to have stage 2 hypertension if they had a systolic blood pressure of 160 mm/Hg and a diastolic blood pressure of 100 mm/Hg.
Among the 140, 042 participants 57,840 or 40.8% had hypertension and 26,877 or 46.5% were of the diagnosis. Among those who were aware of the diagnosis 87.3% were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled 32.5%.
Overall 30.8% of treated patients were taking 2 or more types of blood pressure lowering medications. Participants who were 50 years or older routinely had greater awareness of their hypertension and had higher rates of treatment and control in comparison to younger participants.
Patients in in middle- or higher-income nations compared to low income countries had the lowest rates of awareness of their hypertension and of treatment.
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.
The researchers write “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.”
This study appears online in the Journal of the American Medical Association.
More information on hypertension can be found online at the American Heart Association website.