Changes in hypertension prevalence, awareness, treatment and control rates over 20 years in National Capital Region of India: results from a repeat cross-sectional study.
ABSTRACT: BACKGROUND AND OBJECTIVES:Despite being one of the leading risk factors of cardiovascular mortality, there are limited data on changes in hypertension burden and management from India. This study evaluates trend in the prevalence, awareness, treatment and control of hypertension in the urban and rural areas of India's National Capital Region (NCR). DESIGN AND SETTING:Two representative cross-sectional surveys were conducted in urban and rural areas (survey 1 (1991-1994); survey 2 (2010-2012)) of NCR using similar methodologies. PARTICIPANTS:A total of 3048 (mean age: 46.8±9.0 years; 52.3% women) and 2052 (mean age: 46.5±8.4 years; 54.2% women) subjects of urban areas and 2487 (mean age: 46.6±8.8 years; 57.0% women) and 1917 (mean age: 46.5±8.5 years; 51.3% women) subjects of rural areas were included in survey 1 and survey 2, respectively. PRIMARY AND SECONDARY OUTCOME MEASURES:Hypertension was defined as per Joint National Committee VII guidelines. Structured questionnaire was used to measure the awareness and treatment status of hypertension. A mean systolic blood pressure <140?mm Hg and diastolic blood pressure <90?mm Hg was defined as control of hypertension among the participants with hypertension. RESULTS:The age and sex standardised prevalence of hypertension increased from 23.0% to 42.2% (p<0.001) and 11.2% to 28.9% (p<0.001) in urban and rural NCR, respectively. In both surveys, those with high education, alcohol use, obesity and high fasting blood glucose were at a higher risk for hypertension. However, the change in hypertension prevalence between the surveys was independent of these risk factors (adjusted OR (95%?CI): urban (2.3 (2.0 to 2.7)) rural (3.1 (2.4 to 4.0))). Overall, there was no improvement in awareness, treatment and control rates of hypertension in the population. CONCLUSION:There was marked increase in prevalence of hypertension over two decades with no improvement in management.
Project description:OBJECTIVES:We aimed to measure the change in prevalence of Coronary Heart Disease (CHD) and Cardiovascular Diseases (CVDs) risk among those aged 35-64 years in urban and rural areas of National Capital Region (NCR) of Delhi, between 1991-1994 (survey 1) and 2010-2012 (survey 2). METHODS:Both surveys used similar sampling methodology and mean ages of participants were similar. A total of 3048 and 2052 subjects were studied in urban Delhi and 2487 and 1917 participants recruited from rural Ballabgarh in survey 1 and in survey 2 respectively. CHD was diagnosed based on a Minnesota coded ECG and Rose angina questionnaire. Data on behavioural, physical, clinical and biochemical parameters were collected using standard methods. CVD Risk of participants was calculated using the gender specific Framingham risk equation. RESULTS:The age and sex standardised prevalence of CHD in urban Delhi increased from 10.3% (95% CI: 9.2-11.4) to 14.1% (95% CI: 12.6-15.6) between the two surveys as compared to an increase from 6.0% (95% CI: 5.0-6.9) to 7.4% (95% CI: 6.3-8.6) in rural Ballabgarh. The highest increase in the prevalence of CHD was reported among urban women (10.1% to 16.6%).The proportion of population with high 10-year CVD risk increased to 4.1% from 1.2% in rural areas as compared to 4.8% from 2.5% in urban areas. CONCLUSIONS:The CHD and CVD risk has increased over 20 years period in and around Delhi and the increase was more in rural population and women, traditionally considered to be at low risk.
Project description:To determine the awareness, treatment, and control of hypertension and diabetes by migration status.Cross-sectional study, secondary analyses of the PERU MIGRANT study.Rural, rural-to-urban migrants, and urban participants.Awareness, treatment, and control of hypertension and diabetes mellitus were calculated using weights to account for participant's group size.Of 205 of the 987 (weighted prevalence 24.1%, 95% confidence interval: 21.1%-27.1%) participants identified as hypertensive, 48.3% were aware of their diagnosis, 40% of them were receiving treatment, and 30.4% of those receiving treatment were controlled. Diabetes was present in 33 of the 987 (weighted prevalence 4.6%, 95% confidence interval: 3.1%-6%), and diabetes awareness, treatment, and control were 71.1%, 40.6%, and 7.7%, respectively. Suboptimal control rates, defined as those not meeting blood pressure or glycaemia targets among those with the condition, were 95.1% for hypertension and 97% for diabetes. Higher awareness, treatment, and control rates, for both hypertension and diabetes, were observed in rural-to-urban migrants and urban participants compared with rural participants. However, treatment rates were much lower among migrants compared with the urban group.These results identify major unmet needs in awareness, treatment, and control of hypertension and diabetes. Particular challenges are lack of awareness of both hypertension and diabetes in rural areas, and poor levels of treatment and control among people who have migrated from rural into urban areas.
Project description:<h4>Objective</h4>We implemented this study to report the prevalence and associated risk factors of hypertension among adult men and women aged >30 years residing in selected urban and rural areas of Dhaka division, Bangladesh.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>Two urban (Dhaka city north and Dhaka city south) and two rural (Narsinghdi and Gazipur district) areas of the Dhaka division.<h4>Participants</h4>A total of 4856 male and female participants were included in the final analysis, of whom 2340 (48.2%) were from urban and 2516 (51.8%) were from rural areas.<h4>Primary outcome</h4>Hypertension was the dependent variable for this study and was operationally defined as systolic blood pressure <u>></u>140?mm of Hg and/or diastolic blood pressure <u>></u>90?mm of Hg, and/or persons with already diagnosed hypertension.<h4>Results</h4>The overall prevalence of hypertension was 31.0%, and the prevalence was higher among urban participants (urban: 36.9%, rural: 30.6%). Age (across all categories), female (urban-adjusted OR (AOR): 1.3, 95%?CI: 1.0 to 1.5 and rural-AOR: 1.7, 95%?CI: 1.4 to 2.1)), higher educational status (urban-AOR: 1.7, 95%?CI: 1.3 to 2.2 and rural-AOR: 2.1, 95%?CI: 1.5 to 3.1), inadequate physical activity (urban-AOR: 1.3, 95%?CI: 1.0 to 1.7 and rural-AOR: 1.5, 95%?CI: 1.2 to 1.9) and overweight/obesity (urban-AOR: 2.7, 95%?CI: 2.1 to 3.3 and rural-AOR: 2.1, 95%?CI: 1.7 to 2.5) were associated with hypertension in both urban and rural areas. Women who were not currently married during the survey had higher odds of hypertension only in the rural areas (rural-AOR: 1.8, 95%?CI: 1.3 to 2.4), and respondents who were not working during the survey had higher odds of hypertension only in the urban areas (AOR: 1.7, 95%?CI: 1.0 to 2.6).<h4>Conclusion</h4>Since the prevalence of hypertension was high in urban and rural areas, the government of Bangladesh should consider implementing hypertension prevention programmes focusing young population of Dhaka division. In addition, early screening programmes and management of hypertension need to be strengthened for people with hypertension in both the areas.
Project description:To investigate the prevalence, awareness, treatment, control of hypertension and their associated factors in southern China. A cross-sectional survey was conducted in 5 cities of urban areas and 5 counties of rural areas in Southern China in 2013, a stratified multistage random sampling method was used to select a representative sample. Recruitment included a total of 19254 participants aged 15 or older. Socio-demographic profiles, examinations were administrated on each subject. Multilevel logistic regression models were used to identify the risk factors of hypertension, awareness, treatment, and control. Overall, the prevalence of hypertension and pre-hypertension are 24.59% and 32.11%, respectively in southern China. Among all the hypertensive patients, 67.43% were aware of their condition, 55.76% took anti-hypertension medication recent two weeks, and 30.79% had their blood pressure controlled. Compared with male, female hypertensive patients had higher rates of hypertension awareness, treatment and control. Age, gender, marital status, living areas, education, BMI, waist circumference, visceral adipose index (VAI), high body fat percentage (BFP) and family hypertension history correlated with the prevalence of hypertension. SBP/DBP increased with VAI and BFP increasing. There is an increasing prevalence of hypertension and high pre-hypertension in the general population in southern China, but levels of awareness, treatment, and control remain relatively low, especially for young and middle-aged population. Innovative strategies including of adopting appropriate anti-hypertensive medication therapy and healthy lifestyles should be taken.
Project description:BACKGROUND:Hypertension is a rapidly growing epidemic in China. Yet, it remains inadequately controlled, especially in rural areas. The internet has shown potential for better health management in different settings; however, few studies have investigated its role in hypertension management in China. OBJECTIVE:This study aims to examine the association between internet access and hypertension awareness, treatment, and control among elderly Chinese adults and to investigate whether the association between internet access and hypertension management differed between those living in urban and rural areas. METHODS:We obtained data from the nationally representative survey of the China Health and Retirement Longitudinal Study in 2011. Hypertension was defined as (1) average systolic blood pressure of ?140 mm Hg or average diastolic blood pressure of ?90 mm Hg or (2) currently taking antihypertensive medications. The outcome assessed included hypertension awareness, treatment, and control. The key independent variable was defined as whether one had internet access at home. We performed multivariate logistic regressions for each of the 3 outcomes. RESULTS:Among 5135 hypertensive respondents (age 62.4 [SD 9.9] years; 2351/5135, 45.78% men), 12.89% (662/5135) had internet access at home. Compared with those who had no internet access, internet access was positively associated with hypertension awareness (odds ratio [OR] 1.36, 95% CI 1.07-1.73) and treatment (OR 1.38, 95% CI 1.09-1.75), but not with control (OR 1.19, 95% CI 0.90-1.58). Internet access reduced urban-rural disparity in hypertension awareness by 9.6% (P=.02), treatment by 8.3% (P=.05), but not in control. In addition, the moderating effect of internet access on urban-rural disparities in hypertension management was larger among females. The decreased urban-rural disparities were primarily driven by that internet access improved the management level in rural areas. CONCLUSIONS:Despite the low rate of internet access among the elderly population, the internet shows its potential as a platform for achieving better hypertension management in China. Strategies for reducing the disparities in hypertension management and overall disease burden of hypertension among the elderly population might consider the internet as a platform.
Project description:A region-specific (urban and rural parts of north, east, west, and south India) systematic review and meta-analysis of the prevalence, awareness, and control of hypertension among Indian patients have not been done before.Medline, Web of Science, and Scopus databases from 1950 to 30 April 2013 were searched for 'prevalence, burden, awareness, and control of blood pressure (BP) or hypertension (?140 SBP and or ?90 DBP) among Indian adults' (?18 years). Of the total 3047 articles, 142 were included.Overall prevalence for hypertension in India was 29.8% (95% confidence interval: 26.7-33.0). Significant differences in hypertension prevalence were noted between rural and urban parts [27.6% (23.2-32.0) and 33.8% (29.7-37.8); P?=?0.05]. Regional estimates for the prevalence of hypertension were as follows: 14.5% (13.3-15.7), 31.7% (30.2-33.3), 18.1% (16.9-19.2), and 21.1% (20.1-22.0) for rural north, east, west, and south India; and 28.8% (26.9-30.8), 34.5% (32.6-36.5), 35.8% (35.2-36.5), and 31.8% (30.4-33.1) for urban north, east, west, and south India, respectively. Overall estimates for the prevalence of awareness, treatment, and control of BP were 25.3% (21.4-29.3), 25.1% (17.0-33.1), and 10.7% (6.5-15.0) for rural Indians; and 42.0% (35.2-48.9), 37.6% (24.0-51.2), and 20.2% (11.6-28.7) for urban Indians.About 33% urban and 25% rural Indians are hypertensive. Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.
Project description:OBJECTIVES: We aimed to evaluate the changes over time in the prevalence, awareness, treatment, and control rate of hypertension in intervention and reference areas of a comprehensive community trial with reference area. METHODS: Data from independent sample surveys before and after implementation of the program (2001 vs.2007) were used to compare differences in the intervention and references areas over time. Hypertension was defined as blood pressure ?140/90 mmHg in non-diabetic patients and ?130/80 mmHg in diabetic individuals and or taking antihypertensive medications. Interventional activities included educational strategies at population level as well as for hypertensive patients, their families and health professionals. RESULTS: The study population of the baseline survey included 6175 (48.7% males) in the interventional area and 6339 (51.3% male) in the reference area. The corresponding figures in the post-intervention phase was 4717 (49.3% male) in the interventional area and 4853 (50.7% male) individuals in the reference area. The prevalence of hypertension had a non-significant decrease from 20.5%to 19.6%, in the interventional area whereas in the reference area, it increased from 17.4% to 19.6% (P = 0.003). If we consider Bp ? 140/90 in diabetic and non-diabetic patients as hypertension definition, the prevalence of hypertension in the interventional areas had a non-significant decrease from 18.9% in 2001 to 17.8% in 2007, whereas in the reference area, it had a significant rise from 15.7% to 17.9% (P = 0.002) respectively. Awareness, treatment and control rates of hypertension had better improvement in urban and rural part of the interventional area compared to reference area. The awareness, treatment, and control rates of hypertension increased significantly in the age groups of more than 40 years, as well as in all groups of body mass index in interventional areas without significant change in the reference area. Mean systolic blood pressure of study population in the interventional area decreased from 116.13 ±19.37 to 112.92 ± 18.27 mmHg (P < 0.001) without significant change in reference area. CONCLUSIONS: This comprehensive and integrated program of interventions was effective in tackling with the prevalence of hypertension, and may improve the awareness, treatment and control rates of this disorder in a developing country setting.
Project description:<h4>Background</h4>Little attention has been paid to whether CBHIs improve awareness, treatment and control of hypertension in the contexts of low- and middle- income countries (LMICs). This study therefore aims to examine participation in CBHIs for non-communicable diseases (NCDs) and its association with awareness, treatment, and control of hypertension among Indonesians.<h4>Methods</h4>This study used data from the 2014 Indonesia Family Life Survey (IFLS), drawn from 30,351 respondents aged 18 years and older. Participation in CBHIs was measured by respondents' participation in CBHIs for NCDs (Posbindu PTM and Posbindu Lansia) during the 12 months prior to the survey. Logistic regressions were used to identify the relationships between participation in CBHIs for NCDs and awareness, treatment, and control of blood pressure among respondents with hypertension.<h4>Results</h4>The age-adjusted prevalence of hypertension was 31.2% and 29.2% in urban and rural areas, respectively. The overall age-adjusted prevalence was 30.2%. Approximately 41.8% of respondents with hypertension were aware of their condition, and only 6.6% of respondents were receiving treatment. Participation in CBHIs for NCDs was associated with 50% higher odds of being aware and 118% higher odds of receiving treatment among adults with hypertension. There was no significant association between participation in CBHIs for NCDs and controlled hypertension.<h4>Conclusion</h4>Our data emphasise the importance of CBHIs for NCDs to improve the awareness and treatment of hypertension in the Indonesian population.
Project description:Hypertension is one of the main risk factors of cardiovascular diseases. In Madagascar, studies on hypertension in urban and rural communities are scarce.The aim of this study was to determine the prevalence of hypertension and identify associated risk factors in adults living in a health and demographic system in Moramanga, Madagascar.The study included people aged 15 years old and above living in a health and demographic system in Moramanga. A household census was performed in 2012 to enumerate the population in 3 communities in Moramanga. In addition to the questionnaire used in the initial census, a standardized questionnaire and blood pressure were taken twice after 5 and 10 minutes of rest. In urban areas, heights and weights were also measured to calculate the body mass index.There were 3621 and 4010 participants respectively in rural and urban areas. Prevalence of hypertension in rural population was 27.0% (IC95% [25.6-28.5]) and 29.7% (IC95% [28.3-31.1]) in urban population. Among hypertensive subjects, 1.7% (17/979) and 5.3% (64/1191) were on antihypertensive treatment for at least 1 month before the survey in rural and urban population, respectively. In rural areas, increasing age (65 years and older vs 18-25 years OR = 11.81, IC95% [7.79-18.07]), giving more than 3 positive responses to the usual risks factors of hypertension (OR = 1.67, IC95% [1.14-2.42]) and singles in comparison with married people (OR = 1.61, IC95% [1.20-2.17]) were associated to hypertension in a logistic regression model. In urban areas, increasing age (65 years and older vs 18-25 years OR = 37.54, IC95% [24.81-57.92]), more than 3 positive responses to the usual risks of hypertension (OR = 3.47, IC95% [2.58-4.67]) and obesity (OR = 2.45, IC95% [1.56-3.87]) were found as risk factors.Hypertension is highly prevalent in rural areas although it is significantly less treated. As a result, a major epidemic of cardiovascular diseases is at risk in Madagascar's progressively aging society.
Project description:Objective:The increased blood pressure level in children and adolescents is recognized as an essential predictor of adulthood cardiovascular disease. This study aimed to ascertain the prevalence and the urban-rural disparity of childhood hypertension in the southwest of China. Methods:Using stratified cluster sampling in urban and rural areas, a total of 13597 primary school children aged 6?12 years living in the Southwest of China were included. The prevalence of hypertension was analyzed. The risk factors were collected by questionnaires, and the risk factors of childhood hypertension were analyzed by the logistic regression model. Results:The prevalence of hypertension was 13.75%, 9.02%, and 17.47% in total, urban, and rural children, respectively, and the urban-rural difference was 8.44% (95%CI: 7.32%, 9.56%). Children with obesity, maternal gestational hypertension, >10 months of breastfeeding, or low family income had a significantly increased prevalence of hypertension (29.4%, 20.00%, 16.31%, and 16.25%, respectively). Rural residence, intake of more pickle (in rural), maternal gestational hypertension (in urban), low birth weight (in rural), obesity, increased heart rate, and red blood cell counts were the risk factors of childhood hypertension. The adjusted R 2 values were 13.61%, 23.25%, 10.88%, 11.12%, 12.23%, and 25.04% in the full models excluding and including serum indexes for total, urban, and rural children, respectively. Conclusions:The prevalence of childhood hypertension is significant in the Southwest of China and alarming in rural areas, which requires community intervention. Children living in rural areas combined with obesity, low social economic status, dietary imbalance, and abnormal lipid metabolism were associated with an increased risk of hypertension, and routine care programs should be conducted to prevent childhood hypertension.