Age-standardized Prevalence Of Hypertension Research Articles

Cardiovascular Health of Middle-Aged U.S. Adults by Income Level, 1999 to March 2020 : A Serial Cross-Sectional Study.

Although cardiovascular mortality has increased among middle-aged U.S. adults since 2011, how the burden of cardiovascular risk factors has changed for this population by income level over the past 2 decades is unknown. To evaluate trends in the prevalence, treatment, and control of cardiovascular risk factors among low-income and higher-income middle-aged adults and how social determinants contribute to recent associations between income and cardiovascular health. Serial cross-sectional study. NHANES (National Health and Nutrition Examination Survey), 1999 to March 2020. Middle-aged adults (aged 40 to 64 years). Age-standardized prevalence of hypertension, diabetes, hyperlipidemia, obesity, and cigarette use; treatment rates for hypertension, diabetes, and hyperlipidemia; and rates of blood pressure, glycemic, and cholesterol control. The study population included 20 761 middle-aged adults. The prevalence of hypertension, diabetes, and cigarette use was consistently higher among low-income adults between 1999 and March 2020. Low-income adults had an increase in hypertension over the study period (37.2% [95% CI, 33.5% to 40.9%] to 44.7% [CI, 39.8% to 49.5%]) but no changes in diabetes or obesity. In contrast, higher-income adults did not have a change in hypertension but had increases in diabetes (7.8% [CI, 5.0% to 10.6%] to 14.9% [CI, 12.4% to 17.3%]) and obesity (33.0% [CI, 26.7% to 39.4%] to 44.0% [CI, 40.2% to 47.7%]). Cigarette use was high and stagnant among low-income adults (33.2% [CI, 28.4% to 38.0%] to 33.9% [CI, 29.6% to 38.3%]) but decreased among their higher-income counterparts (18.6% [CI, 13.5% to 23.7%] to 11.5% [CI, 8.7% to 14.3%]). Treatment and control rates for hypertension were unchanged in both groups (>80%), whereas diabetes treatment rates improved only among the higher-income group (58.4% [CI, 44.4% to 72.5%] to 77.4% [CI, 67.6% to 87.1%]). Income-based disparities in hypertension, diabetes, and cigarette use persisted in more recent years even after adjustment for insurance coverage, health care access, and food insecurity. Sample size limitations could preclude detection of small changes in treatment and control rates. Over 2 decades in the United States, hypertension increased in low-income middle-aged adults, whereas diabetes and obesity increased in their higher-income counterparts. Income-based disparities in hypertension, diabetes, and smoking persisted even after adjustment for other social determinants of health. National Institutes of Health.

State-Level Hypertension Prevalence and Control Among Adults in the U.S.

Improving hypertension control is a national priority. Electronic health record data have the potential to augment traditional surveillance systems. This study aimed to assess hypertension prevalence and control at the state level using a previously established electronic health record-based phenotype for hypertension. Adult patients (N=11,031,368) were included from the IQVIA ambulatory electronic medical record-U.S. 2019 data set. IQVIA ambulatory electronic medical record comprises electronic health records from >100,000 providers and includes patients from every U.S. state and Washington DC. Authors compared hypertension prevalence and control estimates against those from the Behavioral Risk Factor Surveillance System 2019. Results were age-standardized and stratified by state and sociodemographic characteristics. Statistical analyses were conducted in 2022-2023. IQVIA ambulatory electronic medical record-U.S. patients had a median age of 55 years, and 56.7% were women. Overall age-standardized hypertension prevalence was higher in IQVIA ambulatory electronic medical record-U.S. (35.0%) than in the Behavioral Risk Factor Surveillance System (29.7%), however, state-level geographic patterns were similar, with the highest burden in the South and Appalachia. Similar patterns were also observed by sociodemographic characteristics in both data sets: hypertension prevalence was higher in older age groups (than younger), men (than women), and Black patients (than other races). Hypertension control varied widely across states: among states with >1% data coverage, control rates were lowest in Nevada (51.1%), Washington DC (52.0%), and Mississippi (55.2%); highest in Kansas (73.4%), New Jersey (72.3%), and Iowa (71.9%). This study provided the first-ever estimates of hypertension control for all states and Washington DC. Electronic health record-based surveillance could support hypertension prevention and control efforts at the state level.

Prevalence of Hypertension and Associated Factors among Residents Aged ≥18 Years in Ganzhou, China: A Cross-Sectional Study.

Reliable epidemiologic data on the present burden of hypertension are needed in developing region-specific strategies since previous studies have suggested that China is lagging in risk factor management. The study aimed at exploring the prevalence of hypertension and its associated factors among adult residents in Ganzhou, China. Methodology. A multistage, stratified, and cluster random sampling method was used to conduct the cross-sectional survey. The study selected four county-level districts in Ganzhou City, China, as the investigation area. Permanent residents aged ≥18 years who have settled in the area for 6 months or more were selected. A total of 7430 residents were involved in the study. Univariate and multivariate logistic regression analysis was carried out to identify predictors of hypertension. The prevalence of hypertension in Ganzhou was 28.5%, and the age-standardized prevalence of hypertension was 22.4%. Univariate logistic regression analysis revealed that multiple variables have a statistically significant effect on the prevalence of hypertension. The elderly (odds ratio [95% CI]: 2.791 [2.594-3.004]), men (1.805 [1.583-2.058]), lower educated (0.848 [0.805-0.893]), a family history of hypertension (4.575 [3.900-5.368]), higher body mass index (1.344 [1.215-1.488]), central obesity (1.532 [1.304-1.799]), and less vegetable intake (1.150 [1.023-1.294]) were the major risk factors for hypertension. Hypertension is a major public health problem in Ganzhou and requires much effort to reduce its prevalence. An effective multifaceted implementation strategy is highly desirable to combat the emerging burden of hypertension.

The prevalence of hypertension and hypertension control among married Namibian couples.

Previous studies suggest that having a marital partner with hypertension is associated with an individual's increased risk of hypertension, however this has not been investigated in sub-Saharan Africa despite hypertension being a common condition; the age-standardised prevalence of hypertension was 46.0% in 2013 in Namibia. To explore whether there is spousal concordance for hypertension and hypertension control in Namibia. Couples data from the 2013 Namibia Demographic and Health Survey were analysed. Bivariable and multivariable logistic regression models were used to explore the odds of individual's hypertension based on their partner's hypertension status, 492 couples. and the odds of hypertension control in individuals based on their partner's hypertension control (121 couples), where both members had hypertension. Separate models were built for female and male outcomes for both research questions to allow independent consideration of risk factors to be analysed for female and males. The unadjusted odds ratio of 1.57 (CI 1.10-2.24) for hypertension among individuals (both sexes) whose partner had hypertension compared to those whose partner did not have hypertension, was attenuated to aOR 1.35 (CI 0.91-2.00) for females (after adjustment for age, BMI, diabetes, residence, individual and partner education) and aOR 1.42 (CI 0.98-2.07) for males (after adjustment for age and BMI). Females and males were significantly more likely to be in control of their hypertension if their partner also had controlled hypertension, aOR 3.69 (CI 1.23-11.12) and aOR 3.00 (CI 1.07-8.36) respectively. Having a partner with hypertension was positively associated with having hypertension among married Namibian adults, although not statistically significant after adjustment. Partner's hypertension control was significantly associated with individual hypertension control. Couples-focused interventions, such as routine partner screening of hypertensive individuals, could be developed in Namibia.

Abstract 04: Neighborhood Social Vulnerability Associated With Increased Hypertension and Cardiovascular Disease in Port-au-Prince: Findings From the Haiti Cardiovascular Disease Cohort Study

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality in low-income countries (LICs). Neighborhood social vulnerability has been associated with increased CVD risk in high-income countries, but the relationship is unknown in LICs. Our objective was to determine the association between neighborhood social vulnerability and prevalent CVD in urban Haiti. Hypothesis: We hypothesize that adults living in neighborhoods with increased social vulnerability will have a greater prevalence of hypertension (HTN) and CVD. Methods: We used cross-sectional enrollment data from the Haiti CVD Cohort study, a population-based cohort of adults ≥18 years living in Port-au-Prince distributed across 97 census blocks. To quantify vulnerability, we created a Haiti-specific Neighborhood Social Vulnerability Index (NSVI) based on the US CDC Social Vulnerability Index. The NSVI included three socioeconomic variables (income, sex, education), two household variables (single parent household, household with child <18 years), and six neighborhood stress and well-being variables (neighborhood cohesion, neighborhood violence, perceived stress, food insecurity, depression, social support). Each variable was determined using validated questionnaires. NSVI was calculated for each census block, which were stratified into quartiles. HTN was defined as SBP ≥140 mmHg, DBP ≥90, or on antihypertensive medications; CVD included heart failure, stroke, myocardial infarction, and angina, defined using adjudicated criteria. HTN and CVD prevalence were calculated for each NSVI quartile. Associations between NSVI quartile and HTN or CVD were quantified using individual-level multivariate logistic regression to adjust for confounders. Results: Among 2932 participants, median age was 40 years (IQR 28-55) and 58% were female. Age-standardized prevalence of HTN and CVD was 32.3% and 13.8%, respectively. The age-standardized prevalence of HTN and CVD was 35.7% and 17.3% across 4 th NSVI quartile blocks, compared to 29.1% and 14.1% across 1 st quartile NSVI blocks (p < 0.001). After adjusting for age, BMI, smoking, and alcohol use, participants living in 4 th NSVI quartile blocks had a greater risk of HTN (Adjusted Odds Ratio (aOR) 1.42; 95% CI 1.07-1.88; p-value 0.01) and CVD (aOR 1.36; CI: 0.99-1.88; p-value 0.06) compared to participants in the 1 st NSVI quartile blocks. NSVI was significantly associated with HTN in males but not females; conversely, NSVI was significantly associated with CVD in females and not males. Conclusions: Individuals living in neighborhoods with the greatest social vulnerability had a higher prevalence of HTN and CVD. Even in a setting of severe poverty such as urban Haiti, gradients in social vulnerabilities are associated with CVD disparities. Screening for social vulnerabilities should be incorporated into CVD prevention and treatment interventions in LICs.

Epidemiology of hypertension among adults in Addis Ababa, Ethiopia

The public health significance of hypertension is increasing in low- and middle-income countries. However, there is limited epidemiological evidence in Ethiopia. We assessed the prevalence of hypertension and explored its predictors among adults in Addis Ababa, Ethiopia. A community-based cross-sectional study was conducted from April to May 2021 among randomly selected adults aged 18–64 years. A face-to-face interview using an adapted STEPwise Approach to NCD Risk Factor Surveillance (STEPS) questionnaire was conducted. Multilevel mixed-effects logistic regression model was fitted to determine factors associated with hypertension. The sample consisted of a total of 600 adults (mean age: 31.2 ± 11.4 years, 51.7% women). The overall age-standardized prevalence of hypertension was 22.1% and 47.8% according to the Seventh Joint National Commission (JNC7) and the 2017 American Heart Association (AHA) guidelines, respectively. About 25.6% were newly diagnosed with hypertension. The age groups of 40–54 years (AOR = 8.97; 95% CI: 2.35,34.23), and 55–64 years (AOR = 19.28; 95% CI: 3.96,93.83) as compared to the 18–24 age group, male sex (AOR = 2.90; 95% CI: 1.22,6.87), obesity (AOR = 1.92; 95% CI: 1.02,3.59), abdominal obesity (AOR = 4.26; 95% CI: 1.42,12.81), and very poor sleep quality (AOR = 3.35; 95% CI: 1.15,9.78) were independent predictors of hypertension. This study revealed that the burden of hypertension among adults is very high. Hypertension is independently associated with older age group, male sex, obesity, abdominal obesity, and poor sleep quality. Therefore, the study highlights the need to develop regular blood pressure surveillance programs, weight loss intervention, and improvement of sleep quality.

Prevalence and clustering of cardiovascular risk factors among resident of coastal areas in Qinzhou, Guangxi, China

ObjectiveWe aimed to estimate the prevalence of CRFs and investigate its associated social-economic factors among adults in coastal areas of Qinzhou, Guangxi.MethodsA representative sample of 1836 participants aged 20 to 70 years was included in Qinzhou, Guangxi in 2020. Data were collected by the questionnaire, anthropometric and laboratory measurements. The prevalence of CRFs, including hypertension, dyslipidemia, diabetes, overweight or obesity, alcohol consumption, and smoking were calculated by standardization. The multivariate logistic regression analysis was performed to explore the independent factors associated with the presence of CRFs.ResultsThe age-standardized prevalence of hypertension, dyslipidemia, diabetes, overweight or obesity alcohol consumption, and smoking was 42.7%, 39.5%, 0.9%, 38.5%, 18.4% and 15.7%, respectively. The prevalence of clustering of at least one and at least two cardiovascular disease risk factors were 82.2% and 45.3% in total. There were differences in the aggregation of cardiovascular risk factors among different age, education, and income levels. There appeared higher clustering of at least one and at least two CRFs among adults with lower education level, higher income level and those elderly.ConclusionsCompared with other regions in China, a higher prevalence of CRFs exists among adults in Guangxi and several social-economic factors were associated with the presence of CRFs. These findings suggest that we should implement effective measures to control the CRFs, to reduce the risk of cardiovascular disease in adults.

S-41-3: HYPERTENSION AND KIDNEY DISEASE IN SINGAPORE

The inter-related lifestyle non-communicable diseases of hypertension and diabetes accounts for 70 to 80% of all end-stage kidney disease (ESKD) in Singapore. Singapore is a multi-ethnic Asian society where the Chinese are the majority (76%), Malay (15%), Indian (9%), and other. The National Population Health Survey 2020 reported that the age-standardized prevalence of hypertension had increased from 21.9% in 2017 to 31.7% in 2019–2020, and more men (41.0%) were affected than women (30.2%). The prevalence of hypertension increased with age; starting at around 10% for those aged 18 to 29 years to 74.9% among those aged 70 to 74 years. Almost half (52.4%) of residents had not been previously diagnosed with hypertension. In adults with known hypertension, 35.7% had good control of their blood pressure (BP). Men (66.0%) had poorer BP control compared to women (62.2%). Among the ethnic groups, Malays (69.4%) had the highest proportion with poor BP control followed by Chinese (64.0%) and Indians (58.6%). The National Nutrition Survey 2018/9 reported that more than 90% exceeded the recommended amount of 5 g per day (average intake 9 g in 2018). This was due mostly to seasonings, salt, and sauces added during food preparation, which accounted for 75% of salt in the diet. We studied the usual clinical practice of hypertension management in chronic kidney disease (CKD) patients in the Nephrology clinics of an academic medical center. Despite intensive follow-up and access to medical care, many patients were unable to achieve the BP goals. We also compared the 24-hour urinary sodium excretion of healthy controls and CKD. Dietary habits vary by ethnicity, and the Indian population take more sodium than other groups. We developed a prediction equation in our population to determine the likelihood of exceeding 100 mmol of sodium in a 24-hour urine from an early morning spot urine sodium test. The age-standardized incidence rate (ASIR) of CKD5 was relatively stable at between 266.7 pmp and 295.3 pmp in 2011 to 2019. ASIR of CKD5 were higher among Malays than other ethnicities. ASIR of definitive dialysis increased from 169.6 pmp in 2011 to 187.3 pmp in 2020. About 39.6% of deaths in dialysis patients were due to cardiac causes. Overall, hypertension was a contributory factor to the main causes of death in the population of Singapore, being ischemic heart disease, cerebrovascular disease, CKD, and hypertensive disease.

Prevalence trends of hypertension and influence factors among children and adolescents aged 7-17 years in China, 2011-2015: A serial cross-sectional study.

Hypertension has rapidly increased in the last decades throughout the world. It is an emerging disease. However, limited information is available on secular trends and factors of childhood and adolescents' hypertension in China. In this study, 5-year successive data were derived from a cross-sectional study of the China Health and Nutrition Survey (CHNS) in 2011 and 2015. We used systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) at least 95th percentile on the basis of age, sex, and height percentiles to define hypertension (HBP). A total of 2,827 children and adolescents aged 7–17 years were included. The age-standardized prevalence of hypertension was increased significantly across 5 years: the standardized prevalence of hypertension was increased from 8.08% (2011) to 11.46% (2015) in China (P < 0.01). The mean SBP of boys increased from 101.21 to 102.79 mmHg, while the mean SBP of girls increased from 98.96 to 100.04 mmHg. The mean DBP of boys increased from 61.20 to 67.40 mmHg, while the mean DBP of girls increased from 64.34 to 65.76 mmHg. The prevalence of hypertension grew continuously in both sexes, but the pace of change for boys was more rapid than that for girls. This study confirmed that the association between rural (odds ratio [OR] = 1.394, 95%CI 1.032–1.883), overweight/obesity (OR = 2.621, 95%CI 1.506–4.562), and BP levels was highly correlated (P < 0.05). The possible protecting factors associated with hypertension were being a girl (OR = 0.788, 95%CI 0.595–1.043). There was no association between weekly physical activity, daily sleep duration, and hypertension (P > 0.05). Further in-depth analysis of influencing factors and comprehensive interventions should be urgently implemented to combat the hypertension epidemic among children and adolescents in China.

Socio-demographic factors, overweight/obesity and nutrients associated with hypertension among rural adults (≥18 years): Findings from National Nutrition Monitoring Bureau survey

BackgroundHypertension is the leading cause of death throughout the world. The study was conducted to assess the prevalence, determinants and knowledge & practices about hypertension among rural adults in India. MethodsA community-based cross-sectional study was carried out in 10 major states of India. Information on socio-economic & demographic particulars was collected and anthropometric measurements like height, weight, waist & hip circumference and blood pressure were measured. Foods and nutrient intakes were assessed by 24-h recall method. Analysis was done using SPSS window 22. ResultsThe prevalence of pre-hypertension was 45.3% (95% CI: 44.6–46.0) and hypertension was 22% (95% CI: 21.5–22.3) (age standardized prevalence; 20.2%) while, overweight/obesity was 22.6% (95% CI: 22.2–23.0) as per Asian cut offs (BMI≥23). The prevalence of hypertension was higher in West Bengal (29.5%) and Kerala (28.9%) and low in Madhya Pradesh and Uttar Pradesh (16–19%). The odds of hypertension was 1.2 times higher among forward communities, businessmen, tobacco users and those consuming alcohol, 2–3 times higher among overweight (CI: 1.87–2.25) and obese (2.65–3.27). The odds of hypertension was 1.2 times higher among those consuming lower tertile of carbohydrates (CI = 1.02–1.41) and zinc (CI = 1.11–1.42). About 76% were aware of hypertension, 21% were old hypertensive & 19% were on treatment. Conclusions: Age standardized prevalence of hypertension was 20% among adults and was associated with age, occupation, overweight/obesity, tobacco and alcohol use, low intake of carbohydrates and zinc. Therefore, increasing awareness and consumption of healthy diet through behavior change communication will help to control hypertension among adults.

Abstract P179: Explaining The Increase Of Hypertension Prevalence In Bangladesh From 2011 To 2018: Evidence From National Surveys

Objective: General trends in the epidemiology of hypertension are best described by studying the same population over time, but studies are limited. Using surveys from Bangladesh in 2011 and 2017-18, we examined i) the change in the prevalence of hypertension, ii) the extent to which changes in traditional hypertension risk factors explained the increase, and iii) the change in the distribution of systolic and diastolic blood pressure over time. Methods: Two independent Bangladesh Demographic and Health Surveys were undertaken in 2011 and 2017-18 using similar methodology in adults aged 35 years and older. Hypertension was defined as having systolic blood pressure (SBP) ≥140 mmHg and/or a diastolic blood pressure (DBP) ≥90 mmHg and/or taking antihypertensive drugs to control blood pressure. Age-standardized prevalence of hypertension was estimated with direct standardization using population census 2011, and a multilevel mixed-effects Poisson regression model with robust variance was used to explain the increase of hypertension from 2011 to 2018. Results: The age-standardized prevalence of hypertension in 2017-18 was 43.4% (95% CI 40.2-46.6) in men and 53.4% (95% CI 50.8-56.0) in women, representing an increase since 2011 of 54% and 8% in men and women, respectively. The age, body mass index, education, and diabetes explained the increase in the prevalence of hypertension from 2011 to 2017-18. We observed statistically significant sex-differences in the increase of hypertension in 2018 (p-difference &lt;0.0001). Increases in SBP and DBP were also seen across the population over the period. Conclusions: In Bangladesh, there has been a marked increase in hypertension prevalence over seven years, especially in men. This largely results from changes in traditional risk factors, leading to population-wide increases in blood pressure levels. Interventions to control this exacerbation of hypertension should focus on population-wide strategies.

Socioeconomic Status and Its Relation to Hypertension in Rural Nepal.

Introduction Hypertension and its association with socioeconomic positions are well established. However, the gradient of these relationships and the mediating role of lifestyle factors among rural population in low- and middle-income countries such as Nepal are not fully understood. We sought to assess the association between socioeconomic factors (education, income, and employment status) and hypertension. Also, we assessed whether the effect of education and income level on hypertension was mediated by lifestyle factors. Methods This cross-sectional study was conducted among 260 participants aged ≥18 years attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors were collected, and blood pressure, weight, and height were measured for all study participants. Those with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or administrating high blood pressure-lowering medicines were regarded as hypertensives. Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and hypertension. We explored mediation, using the medeff command in Stata for causal mediation analysis of nonlinear models. Results Of the 50 hypertensive participants, sixty percent were aware of their status. The age-standardized prevalence of hypertension was two times higher for those with higher education or high-income category. Compared to low-income and unemployed groups, the prevalence ratio of hypertension was 1.33 and 2.26 times more for those belonging to the high-income and employed groups, respectively. No evidence of mediation by lifestyle factors was observed between socioeconomic status and hypertension. Conclusions Socioeconomic positions were positively associated with hypertension prevalence in rural Nepal. Further studies using longitudinal settings are necessary to validate our findings especially in low- and middle-income countries such as Nepal.

Hypertension prevalence in the All of Us Research Program among groups traditionally underrepresented in medical research

The All of Us Research Program was designed to enable broad-based precision medicine research in a cohort of unprecedented scale and diversity. Hypertension (HTN) is a major public health concern. The validity of HTN data and definition of hypertension cases in the All of Us (AoU) Research Program for use in rule-based algorithms is unknown. In this cross-sectional, population-based study, we compare HTN prevalence in the AoU Research Program to HTN prevalence in the 2015–2016 National Health and Nutrition Examination Survey (NHANES). We used AoU baseline data from patient (age ≥ 18) measurements (PM), surveys, and electronic health record (EHR) blood pressure measurements. We retrospectively examined the prevalence of HTN in the EHR cohort using Systemized Nomenclature of Medicine (SNOMED) codes and blood pressure medications recorded in the EHR. We defined HTN as the participant having at least 2 HTN diagnosis/billing codes on separate dates in the EHR data AND at least one HTN medication. We calculated an age-standardized HTN prevalence according to the age distribution of the U.S. Census, using 3 groups (18–39, 40–59, and ≥ 60). Among the 185,770 participants enrolled in the AoU Cohort (mean age at enrollment = 51.2 years) available in a Researcher Workbench as of October 2019, EHR data was available for at least one SNOMED code from 112,805 participants, medications for 104,230 participants, and 103,490 participants had both medication and SNOMED data. The total number of persons with SNOMED codes on at least two distinct dates and at least one antihypertensive medication was 33,310 for a crude prevalence of HTN of 32.2%. AoU age-adjusted HTN prevalence was 27.9% using 3 groups compared to 29.6% in NHANES. The AoU cohort is a growing source of diverse longitudinal data to study hypertension nationwide and develop precision rule-based algorithms for use in hypertension treatment and prevention research. The prevalence of hypertension in this cohort is similar to that in prior population-based surveys.

1063-P: Regional Variation in Hypertension Prevalence among Older Adults with and without Diabetes, 2005-2017

In the US, hypertension prevalence among adults has been stable since 2000. Whether these trends vary for older adults across geographic regions is unknown. This study used the 5% sample of Medicare administrative claims data (2005-2017) to examine trends in hypertension prevalence among older adults with and without diabetes by U.S. Census region (Midwest, Northeast, South, West). Participants aged ≥66 years with 12 months of continuous coverage of Part A and Part B were included. Hypertension and diabetes were assessed using ICD-9/ICD-10 codes from inpatient or outpatient claims in the index year. Joinpoint regression was used to estimate the annual percentage change in age-standardized hypertension prevalence by region. Overall, hypertension prevalence increased among older adults with and without diabetes across regions (Figure 1). Among older adults with diabetes, the average annual percentage change was lowest in the West (0.27) and highest in the South (0.45) from 2011 to 2017. Among those without diabetes, hypertension prevalence declined in the West (-0.2) and increased in the South (0.6) from 2009 to 2017. Regional differences in hypertension prevalence were present among older adults and highlight the importance of identifying and understanding the causes of disease burden across geographies and time. Disclosure J. Uddin: None. S. Zhu: None. G. Malla: None. E. B. Levitan: Research Support; Self; Amgen Inc. D. B. Rolka: None. D. Long: None. A. P. Carson: Research Support; Self; Amgen Inc. Funding Centers for Disease Control and Prevention (U01DP006302)

SUB-OPTIMAL HEALTH SYSTEM CAPACITY TO EFFECTIVELY MANAGE HYPERTENSION IN RURAL INDIA

Abstract Objective: Despite the high burden of hypertension in rural India, limited information is available on the primary health system's capacity for its management. We aimed to determine the burden of hypertension and the health system's capacity to manage it in rural India. Design and method: We implemented a comprehensive diabetes and hypertension prevention and management program entitled “UDAY” in epidemiologically transitioning rural areas of North (Sonipat) and South (Vizag) India. Rural areas comprised a population of 200,000 and were being provided primary healthcare through six public primary healthcare facilities. A representative population based cross-sectional survey, using a multistage cluster random sampling technique among 6173 participants aged 30 years and above was done to determine the prevalence, awareness, treatment and control of hypertension. In addition, all the public primary healthcare facilities and all primary care providers (including private) were surveyed to assess the health system's capacity to manage hypertension according to the Indian Public Health Standards (IPHS) and other international/national standard guidelines. Data were obtained using an interviewer administered questionnaire, anthropometry, biosample collection, health facility survey and provider survey. Hypertension was measured using standard definitions and protocols. Results: The mean age was 48.0 (SD ± 12.7) years. Age-standardized prevalence of hypertension was 23.5% [95% CI: 22.5–24.6]. Among those with hypertension, awareness rate was 46.4% [43.8–49.0], treatment rate 35.3% [32.9–37.8] and control rate 26.3% [24.1–28.7]. Of all the public primary healthcare facilities (n = 6), none had the full sanctioned number of health staff, two did not have functional BP equipment, and no facility had all six classes of antihypertensive medicines available as recommended by the IPHS. Among 41 providers, only 9 (29%) reported using any standard guidelines for managing hypertension. Conclusions: Despite the high hypertension burden, public primary healthcare facilities relied upon by rural population, are inadequately equipped in terms of diagnostics, therapeutics, equipment and workforce to effectively manage hypertension. Health system strengthening along with providers’ training in guideline based hypertension management is imperative to improve management.

Levels and Trends of Hypertension at National and Subnational Scale in Iran from 1990 to 2016: A Systematic Review and Pooled Analysis.

Raised blood pressure is a serious risk factor for several non-communicable diseases (NCDs) in Iran. In this study, we aimed to estimate the mean of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and subsequently, the prevalence of hypertension by sex, age, province, and year in Iran. We conducted a systematic review using PubMed, Web of Science, and Scopus databases through December 2017. We also used individual level data from eight national surveys, aggregated data from seven subnational population-based studies, and extracted data reported in 52 published studies. We used a two-stage model including Age-Spatio-Temporal and Gaussian process regression (GPR) to estimate mean systolic and diastolic blood pressure and used a crosswalk model to estimate the prevalence of hypertension by sex, age, province, and year. The number of hypertensive adults increased in Iran from 1.8 million (882 thousand in women) in 1990 to 13.6 million (7.2 million in women) in 2016. The national age-standardized prevalence of hypertension increased from 8.7% (7.8-9.7) to 28.8% (27.7-30.0) in women and from 8.0% (7.2-8.9) to 24.2% (23.1-25.3) in men from 1990 to 2016. Mean systolic and diastolic blood pressures show a similar increasing trend. During the past 27 years, we observed an increase in the age-standardized prevalence and mean levels of blood pressure. If the current trend in levels of blood pressure and prevalence of hypertension continue in the coming years, Iran will not achieve the sixth target of the Global Action Plan by 2020 and the Sustainable Development Goals (SDGs) by 2030.

Prevalence trends of hypertension among 9\u201317 aged children and adolescents in Yunnan, 2017\u20132019: a serial cross-sectional surveillance survey

BackgroundWe aim to describe the prevalence and trends of hypertension among 9–17 school-aged students from 2017 to 2019 in Yunnan, China.MethodsWe conducted a cross-sectional study by using data from the Students’ Health Surveillance Surveys of 2017, 2018 and 2019 in Yunnan. The Students’ Health Surveillance Surveys in Yunnan collected date on physical fitness and health status of students in Yunnan through multistage-stratified sampling in 3 prefectures. In each prefecture, the study population were classified by gender and region (urban or rural), and each group had an equal size. Diagnosing criteria of hypertension was set with reference to Chinese age-specific and height-specific blood pressure (BP), to identify the abnormal status of boys and girls separately. ANOVA test was adopted to measure the differences in the mean BP stratified by gender, age, prefecture and area, and Chi-square test was used to compare the percentages of hypertension in different areas. For comparability, the age-standard and gender-standard population prevalence was calculated by directly using China Census in 2010 as a standard population. Totally 24,890 participants aged 9–17 years were included in this study.ResultsFrom 2017 to 2019, there were 24,872 students completed physical examinations and included in the analysis, of which 3288 were diagnosed with hypertension. The total prevalence of hypertension was 13.72, 12.49 and 13.45% among 9–17 years school-aged population in Yunnan, respectively. The total age-standardized hypertension prevalence trended to decrease from 13.82 to 13.48%. For urban population, the age-standardized hypertension prevalence decreased slightly from 11.24 to 10.13%. While, for rural population, it increased from 17.58 to 19.16%. The average annual growth rate in rural population was 0.53%.ConclusionsFrom 2017to 2019, there was a significant and continuous increase in the prevalence of hypertension in 9–17 years school-aged population in Yunnan. Hypertension is epidemic among children and adolescents in Yunnan. We should take effective and comprehensive intervention measures to reduce its prevalence among school-aged children.

Hypertension prevalence, associated factors, treatment and control in rural Cameroon: a cross-sectional study

IntroductionSub-Saharan Africa is experiencing a surge in the burden of hypertension, and rural communities are increasingly affected by the epidemic.ObjectivesWe aimed to determine the prevalence of and factors associated with hypertension in rural communities of the Baham Health District (BHD), Cameroon. In addition, we sought to assess awareness, treatment and control rates of hypertension among community members.DesignA community-based cross-sectional study.SettingParticipants from five health areas in the BHD were recruited from August to October 2018.ParticipantsConsenting participants aged 18 years and above were included.ResultsWe included 526 participants in this study. The median age of the participants was 53.0 (IQR=35–65) years and 67.1% were female. The crude prevalence of hypertension was 40.9% (95% CI=36.7–45.1) with no gender disparity. The age-standardised prevalence of hypertension was 23.9% (95% CI=20.3–27.5). Five-year increase in age (adjusted OR (AOR)=1.34; 95% CI=1.23–1.44), family history of hypertension (AOR=2.22; 95% CI=1.37–3.60) and obesity (AOR=2.57; 95% CI=1.40–4.69) were associated with higher odds of hypertension after controlling for confounding. The rates of awareness, treatment and control of hypertension were 37.2% (95% CI=31.0–43.9), 20.9% (95% CI=16.0–26.9) and 22.2% (95% CI=12.2– 37.0), respectively.ConclusionThe high prevalence of hypertension in these rural communities is associated with contrastingly low awareness, treatment and control rates. Age, family history of hypertension and obesity are the major drivers of hypertension in this community. Veracious policies are needed to improve awareness, prevention, diagnosis, treatment and control of hypertension in these rural communities.

Prevalence and determinants of blood pressure variability in pygmies of Southern region Cameroon.

The impact of urbanization and living conditions on the prevalence of hypertension in the Cameroonian population is poorly known. To evaluate the prevalence and determinants of blood pressure (BP) in adult Pygmies and Bantus living in urban and rural areas of Southern Cameroon. This was a cross-sectional comparative study of 406 adults (96 urban Bantus, 100 urban Pygmies, 111 rural Bantus and 99 tropical rainforest Pygmies with a traditional Pygmies way of life), recruited in Southern Cameroon (mean age 42 ± 17 years; 56.7% women). Sociodemographic, anthropometric and BP parameters were collected. Hypertension was defined as BP at least 140/90 mmHg and/or use of BP-lowering drug(s). The age-standardized prevalence of hypertension in urban Bantus, rural Bantus, urban Pygmies and traditional Pygmies was 18.0, 13.5, 9.3 and 4.1%, respectively. Mean SBP and DBP differed significantly according to Bantu vs. Pygmy ethnicity, and urban vs. rural residency. After multiple adjustments, mean arterial pressure was significantly associated with age, BMI, Bantu ancestry and urban residency. Bantu ethnicity and urban residency are significantly associated with high-BP among people from Southern Cameroon.

Prevalence, Awareness, Treatment and Control of Hypertension in Nigeria: Data from a Nationwide Survey 2017

Background:Previous studies that evaluated the prevalence, awareness and treatment of hypertension in Nigeria were either localized to some specific regions of the country or non-standardized thereby making evaluation of trend in hypertension care difficult.Methods:We used the World Health Organization (WHO) STEPwise approach to chronic disease risk factor surveillance to evaluate in a nationally representative sample of 4192 adult Nigerians selected from a rural and an urban community in one state in each of the six geo-political zones of the country.Results:The overall age-standardized prevalence of hypertension was 38.1% and this varied across the geo-political zones as follows: North-Central, 20.9%; North-East, 27.5%; North-West, 26.8%; South-East, 52.8%; South-South, 44.6%; and South-West, 42.1%. Prevalence rate did not differ significantly (p > 0.05) according to place of residence; 39.2% versus 37.5 %; urban vs rural. Prevalence of hypertension increased from 6.8% among subjects less than 30 years to 63.0% among those aged 70 years and above. Awareness was better (62.2% vs. 56.6%; P = 0.0272); treatment rate significantly higher (40.9 % vs. 30.8%; P < 0.0001) and control similar (14 vs. 10.8%) among urban compared to rural residents. Women were more aware of (63.3% vs. 52.8%; P < 0.0001); had similar (P > 0.05) treatment (36.7 vs. 34.3%) and control (33.9% vs. 35.5%) rates of hypertension compared to men.Conclusion:Our results suggest a large burden of hypertension in Nigeria and a closing up of the rural-urban gap previously reported. This calls for a change in public health policies anchored on a primary health care system to address the emerging disease burden occasioned by hypertension.