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

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dc.contributor.authorChow, Clara K.spa
dc.contributor.authorTeo, Koonspa
dc.contributor.authorRangarajan, Sumathyspa
dc.contributor.authorIslam, Shofiqulspa
dc.contributor.authorGupta, Rajeevspa
dc.contributor.authorAvezum, Alvarospa
dc.contributor.authorBahonar, Ahmadspa
dc.contributor.authorChifamba, Jephatspa
dc.contributor.authorDagenais, Gillesspa
dc.contributor.authorDiaz, Rafaelspa
dc.contributor.authorKazmi, Khawarspa
dc.contributor.authorLanas, Fernandospa
dc.contributor.authorWei, Lispa
dc.contributor.authorLopez-Jaramillo, Patriciospa
dc.contributor.authorFanghong, Luspa
dc.contributor.authorIsmail, Noorhassimspa
dc.contributor.authorPuoane, Thandispa
dc.contributor.authorRosengren, Annikaspa
dc.contributor.authorSzuba, Andrzejspa
dc.contributor.authorTemizhan, Ahmetspa
dc.contributor.authorWielgosz, Andyspa
dc.contributor.authorYusuf, Ritaspa
dc.contributor.authorYusufali, Afzalhusseinspa
dc.contributor.authorMcKee, Martinspa
dc.contributor.authorLiu, Lishengspa
dc.contributor.authorMony, Premspa
dc.contributor.authorYusuf, Salimspa
dc.contributor.authorThe PURE (Prospective Urban Rural Epidemiology) Study investigatorseng
dc.date.accessioned2019-07-06T13:50:05Zspa
dc.date.available2019-07-06T13:50:05Zspa
dc.date.issued2013-09-04spa
dc.description10 p.spa
dc.description.abstractImportance 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 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. 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. High blood pressure is the leading cause of cardiovascular disease (CVD) and deaths globally. It is associated with at least 7.6 million deaths per year worldwide (13.5% of all deaths), making it the leading risk factor for CVD.1 The majority of CVD occurs in low-, low–middle-, and upper–middle-income countries (LIC, LMIC, and UMIC).1,2 The importance of blood pressure as a modifiable risk factor for CVD is well-recognized and many effective and inexpensive blood pressure–lowering treatments are available. Therefore, hypertension control and prevention of subsequent morbidity and mortality clearly should be achievable. Information on hypertension prevalence, awareness, treatment, and control in multiple countries and different types of communities is necessary to provide a baseline for monitoring and also to inform the development of new strategies for improving hypertension control. A number of initiatives from the World Health Organization (WHO) have documented prevalence of hypertension and some have recorded treatment rates.3-5 The largest systematic analysis of health surveys from 199 countries for individuals aged 25 years and older was conducted in 2008 and reported the prevalence and mean of hypertension.6 However, most studies were limited to few countries and were conducted at least 2 decades ago, few reported awareness, and none reported on variations between urban vs rural settings, economic status and other variables, rates of blood pressure control, or the types of treatments used. Such information is key to developing strategies for better detection and control of hypertension globally. The overall Prospective Urban Rural Epidemiology (PURE) study is a prospective, standardized collaborative study7,8 in which we report a cross-sectional analysis of baseline data to assess the prevalence, awareness, treatment, and control of hypertension by the economic status of countries and by sex, age group, location (urban vs rural), and education of the participants.eng
dc.format.mimetypeapplication/pdfspa
dc.identifier.doi10.1001/jama.2013.184182spa
dc.identifier.doi0098-7484spa
dc.identifier.urihttps://repositorio.udes.edu.co/handle/001/3277spa
dc.language.isoengspa
dc.relation.ispartofJAMA - Journal of the American Medical Associationeng
dc.rightsDerechos Reservados - Journal of the American Medical Association, 2013spa
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.creativecommonsAtribución-NoComercial 4.0 Internacional (CC BY-NC 4.0)spa
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/spa
dc.sourcehttps://jamanetwork.com/journals/jama/fullarticle/1734702eng
dc.subject.proposalHypertensioneng
dc.subject.proposalRuraleng
dc.subject.proposalUrbaneng
dc.titlePrevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countrieseng
dc.typeArtículo de revistaspa
dc.type.coarhttp://purl.org/coar/resource_type/c_6501spa
dc.type.contentTextspa
dc.type.driverinfo:eu-repo/semantics/articlespa
dc.type.redcolhttp://purl.org/redcol/resource_type/ARTspa
dc.type.versioninfo:eu-repo/semantics/publishedVersionspa
dspace.entity.typePublication
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2spa
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85spa
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