Prevalence Of Untreated Hypertension Research Articles

Decomposing the rural–urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India

BackgroundAlthough awareness and treatment rates of hypertension have significantly improved in recent years, the prevalence of undiagnosed and untreated hypertension remains a major public health concern for Indian policymakers. While the urban–rural variation in the prevalence, diagnosis, control, and treatment of hypertension is reasonably well-documented, the explanation behind such variation remains poorly understood given the dearth of studies conducted on exploring the determinants of the rural–urban gap in the prevalence of undiagnosed, untreated, and uncontrolled hypertension in India. In view of this research gap, our paper aims to decompose the inter-group differences between rural and urban areas in undiagnosed, untreated, and undertreated hypertension among older adults in India into the major contributing factors.MethodsNationally representative data collected in the Longitudinal Ageing Study of India, Wave-1 (2017–18), was utilized for this study. Maximum-likelihood binary logistic-regression models were employed to capture the crude and adjusted associations between the place of residence and prevalence of undiagnosed, untreated, and undertreated hypertension. Fairlie’s decomposition technique was used to decompose the inter-group differences between rural and urban residents in the prevalence of undiagnosed, untreated, and undertreated hypertension among the older population in India, into the major contributing factors, in order to explore the pathways through which these differences manifest.ResultsThe overall prevalence rates of undiagnosed, untreated, and undertreated hypertension among older adults were 42.3%, 6%, and 18.7%, respectively. However, the prevalence of undiagnosed and untreated hypertension was higher in rural areas, by 12.4 and 1.7 percentage-points, respectively, while undertreated hypertension was more prevalent in the urban areas (by 7.2 percentage-points). The decomposition analysis explained roughly 41% and 34% of the urban advantage over rural areas in the case of undiagnosed and untreated hypertension, while it explained 51% of the urban disadvantage in respect of undertreated hypertension. The rural–urban differentials in education and comorbidities accounted for the majority of the explained rural disadvantage in the prevalence of undiagnosed hypertension, explaining 13.51% and 13.27% of the gap, respectively. The regional factor was found to be the major driver behind urban advantage in the prevalence of untreated hypertension, contributing 37.47% to the overall gap. In the case of undertreated hypertension, education, comorbidities, and tobacco consumption were the major contributors to the urban–rural inequality, which accounted for 12.3%, 10.6%, and 9.8% of the gap, respectively.ConclusionSocio-economic and lifestyle factors seemed to contribute significantly to the urban–rural gap in undiagnosed, untreated and undertreated hypertension in India among older adults. There is an urgent need of creating awareness programmes for the early identification of hypertensive cases and regular treatment, particularly in under-serviced rural India. Interventions should be made targeting specific population groups to tackle inequality in healthcare utilization.

Abstract 127: Untreated Hypertension After Intracerebral Hemorrhage

Objective: We previously reported that 46.9% of acute intracerebral hemorrhage (ICH) patients had untreated hypertension (HTN) on admission. We sought to investigate the prevalence of untreated HTN among patients at follow-up after ICH. Methods: ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) is a prospective multi-center study of ICH among whites, blacks, and Hispanics. Cases were enrolled at 42 recruitment sites. Subjects’ ethnicity, history of HTN, type of insurance, HTN medications, and level of education were collected. Patients were considered to have HTN if they received this diagnosis prior to or during initial ICH admission. Stroke events at follow-up included ischemic stroke, transient ischemic attack, subarachnoid hemorrhage, and recurrent ICH. Medication use was also recorded at follow-up. Results: Of 3,000 cases of ICH, there were 1,822 with HTN who had at least one follow-up, of which 9.4% had untreated HTN. Compared with treated patients at 3 months, those untreated at 3 months more frequently were white or Hispanic (p=0.0064), female (p=0.0236), over 65 years old (p<0.0001), or on Medicare (p<0.0001). Among those treated at 3 months, 60.5% were prescribed beta blockers, 54.9% calcium channel blockers, 52.9% ACE inhibitors, 31.5% diuretics, 16.6% vasodilators, 12.6% angiotensin receptor blockers, 10.3% alpha agonists, 2.8% nitrates, 2.5% alpha blockers, and 3.7% others. Stroke events occurred by 12 months in 5.5% of treated compared with 5.6% of untreated patients. Conclusions: Despite a high rate of untreated HTN at admission, the rate at follow-up was substantially lower. Overall, Hispanics were more likely and blacks less likely to be untreated than whites. Despite the lack of difference in stroke events identified among treated versus untreated patients, there was limited power to identify differences in a short-term follow-up due to a low rate of stroke recurrence and a low proportion of untreated HTN.

Untreated hypertension in the UK household population - Who are missed by the general health checks?

Hypertension is an age-related, long-term condition and a leading risk factor for premature death and disability worldwide. Due to its asymptomatic nature it can often be left undiagnosed. Long-term treatment is available, but blood pressure can also be reduced through health behaviour changes in weight control, smoking cessation, higher physical activity levels, reduced salt and alcohol intake, and healthful diets if discovered early. This paper investigates the prevalence and characteristics of those with untreated (compared to treated) hypertension who did not have a history of cardiovascular disease (CVD); a group who is in effect missed by general health checks.Untreated hypertension was studied in 8933 individuals aged 40–74 years representative of the UK household population, who were interviewed and underwent a physical health examination in their home, 2010–2012. The prevalence of untreated hypertension without a history of CVD was 7% for men, 2% for women, and 5% overall. Untreated hypertension was particularly high among the 55–64 year age group.Age and sex-adjusted analyses found strong positive associations with male gender, smoking, self-reported good–excellent health, full fat dairy preference, white bread preference, higher alcohol consumption, and living alone. Strong negative associations were found for possessing 5 + prescription drugs, statins or antiplatelets, being diagnosed with diabetes or possessing antidiabetics, and long-term limiting illness status.Notably, many reported their health as good to excellent. A fact which emphasises the importance of motivating individuals to take part in the general health checks for an asymptomatic condition such as hypertension.

Determinants of major cardiovascular risk factors among participants of the South Carolina WISEWOMAN program, 2009-2012.

IntroductionCardiovascular disease (CVD) is the leading cause of death among US women, accounting for 25% of all deaths in this population. Approximately 65% of these deaths occur in asymptomatic women. Hypertension, hypercholesterolemia, and diabetes mellitus (diabetes) are major risk factors for CVD and can be treated effectively if identified at an early stage.MethodsData were available from 3,572 uninsured first-time female participants aged 40 to 65 years, referred by their health professional to the South Carolina Well-Integrated Screening and Evaluation for Women Across the Nation (SC WISEWOMAN), 2009–2012. All women completed a structured health-risk and behavior questionnaire. Anthropometric measures were recorded and data on clinical risk-factors were collected. Prevalence-ratios (PRs) were obtained by predictive multivariable log-linear modeling.ResultsThe prevalence of risk factors was 34.7% for uncontrolled hypertension, 9.3% for hypercholesterolemia, and 21% for diabetes. Prevalence of untreated hypertension was 15.6%; hypercholesterolemia, 8%; and diabetes, 4%. The greatest significant predictor of hypercholesterolemia was hypertension (PR = 4.37) and vice versa (PR = 2.39). The greatest significant predictors of diabetes were obesity (PR = 2.23), family history of diabetes (PR = 2.02), and hypercholesterolemia (PR = 1.85). Being obese (PR = 1.36), overweight (PR = 1.23), aged 60 years or more (PR = 1.26), and black (PR = 1.14) were significant predictors of having at least one CVD risk factor. Being black (PR = 1.09) was the only significant predictor of having comorbid conditions.ConclusionPrevalence of uncontrolled CVD risk factors was high among participants in the SC WISEWOMAN program. These findings confirm that the program is reaching high-risk women who are in need of interventions to reduce their risk for CVD through lifestyle changes.

Low prevalence of hypertension with pharmacological treatments and associated factors

OBJECTIVE: To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS: In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS: Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS: The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.