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

Clara K. Chow, Koon K. Teo, Sumathy Rangarajan, Shofiqul Islam, Rajeev Gupta, Alvaro Avezum, Ahmad Bahonar, Jephat Chifamba, Gilles Dagenais, Rafael Diaz, Khawar Kazmi, Fernando Lanas, Li Wei, Patricio Lopez-Jaramillo, Lu Fanghong, Noor Hassim Ismail, Thandi Puoane, Annika Rosengren, Andrzej Szuba, Ahmet TemizhanAndy Wielgosz, Rita Yusuf, Afzalhussein Yusufali, Martin McKee, Lisheng Liu, Prem Mony, Salim Yusuf

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Abstract

IMPORTANCE: Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. OBJECTIVE: To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study. DESIGN, SETTING, AND PARTICIPANTS: 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). MAIN OUTCOMES AND MEASURES: Hypertensionwas 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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.

Original languageEnglish
Pages (from-to)959-968
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume310
Issue number9
DOIs
Publication statusPublished - 2013

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Rural Population
Hypertension
Blood Pressure
Therapeutics
Self Report
Epidemiology
Cross-Sectional Studies
Outcome Assessment (Health Care)
Pharmacology
Morbidity
Education
Equipment and Supplies
Mortality
Population

ASJC Scopus subject areas

  • Medicine(all)

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

In: JAMA - Journal of the American Medical Association, Vol. 310, No. 9, 2013, p. 959-968.

Research output: Contribution to journalArticle

Chow, CK, Teo, KK, Rangarajan, S, Islam, S, Gupta, R, Avezum, A, Bahonar, A, Chifamba, J, Dagenais, G, Diaz, R, Kazmi, K, Lanas, F, Wei, L, Lopez-Jaramillo, P, Fanghong, L, Ismail, NH, Puoane, T, Rosengren, A, Szuba, A, Temizhan, A, Wielgosz, A, Yusuf, R, Yusufali, A, McKee, M, Liu, L, Mony, P & Yusuf, S 2013, 'Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries', JAMA - Journal of the American Medical Association, vol. 310, no. 9, pp. 959-968. https://doi.org/10.1001/jama.2013.184182
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. / Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. In: JAMA - Journal of the American Medical Association. 2013 ; Vol. 310, No. 9. pp. 959-968.
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abstract = "IMPORTANCE: Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. OBJECTIVE: To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study. DESIGN, SETTING, AND PARTICIPANTS: 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). MAIN OUTCOMES AND MEASURES: Hypertensionwas 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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 = "Chow, {Clara K.} and Teo, {Koon K.} and Sumathy Rangarajan and Shofiqul Islam and Rajeev Gupta and Alvaro Avezum and Ahmad Bahonar and Jephat Chifamba and Gilles Dagenais and Rafael Diaz and Khawar Kazmi and Fernando Lanas and Li Wei and Patricio Lopez-Jaramillo and Lu Fanghong and Ismail, {Noor Hassim} and Thandi Puoane and Annika Rosengren and Andrzej Szuba and Ahmet Temizhan and Andy Wielgosz and Rita Yusuf and Afzalhussein Yusufali and Martin McKee and Lisheng Liu and Prem Mony and Salim Yusuf",
year = "2013",
doi = "10.1001/jama.2013.184182",
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TY - JOUR

T1 - Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries

AU - Chow, Clara K.

AU - Teo, Koon K.

AU - Rangarajan, Sumathy

AU - Islam, Shofiqul

AU - Gupta, Rajeev

AU - Avezum, Alvaro

AU - Bahonar, Ahmad

AU - Chifamba, Jephat

AU - Dagenais, Gilles

AU - Diaz, Rafael

AU - Kazmi, Khawar

AU - Lanas, Fernando

AU - Wei, Li

AU - Lopez-Jaramillo, Patricio

AU - Fanghong, Lu

AU - Ismail, Noor Hassim

AU - Puoane, Thandi

AU - Rosengren, Annika

AU - Szuba, Andrzej

AU - Temizhan, Ahmet

AU - Wielgosz, Andy

AU - Yusuf, Rita

AU - Yusufali, Afzalhussein

AU - McKee, Martin

AU - Liu, Lisheng

AU - Mony, Prem

AU - Yusuf, Salim

PY - 2013

Y1 - 2013

N2 - IMPORTANCE: Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. OBJECTIVE: To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study. DESIGN, SETTING, AND PARTICIPANTS: 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). MAIN OUTCOMES AND MEASURES: Hypertensionwas 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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.

AB - IMPORTANCE: Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. OBJECTIVE: To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study. DESIGN, SETTING, AND PARTICIPANTS: 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). MAIN OUTCOMES AND MEASURES: Hypertensionwas 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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.

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