Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control

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Abstract

Background This study uses data from the World Health Organization’s Study on Global Ageing and Adult Health (SAGE) to examine patterns of hypertension prevalence, awareness, treatment and control for people aged 50 years and over in China, Ghana, India, Mexico, the Russian Federation and South Africa.

Methods The SAGE sample comprises of 35 125 people aged 50 years and older, selected randomly. Hypertension was defined as ≥140 mmHg (systolic blood pressure) or ≥90 mmHg (diastolic blood pressure) or by currently taking antihypertensives. Control of hypertension was defined as blood pressure below 140/90 mmHg on treatment. A person was defined as aware if he/she was hypertensive and self-reported the condition.

Results Prevalence rates in all countries are broadly comparable to those of developed countries (52.9%; range 32.3% in India to 77.9% in South Africa). Hypertension was associated with overweight/obesity and was more common in women, those in the lowest wealth quintile and in heavy alcohol consumers. Awareness was found to be low for all countries, albeit with substantial national variations (48.3%; range 23.3% in Ghana to 72.1% in the Russian Federation). This was also the case for control (10.2%; range 4.1% in Ghana to 14.1% India) and treatment efficacy (26.3%; range 17.4% in the Russian Federation to 55.2% in India). Awareness was associated with increasing age, being female and being overweight or obese. Effective control of hypertension was more likely in older people, women and in the richest quintile. Obesity was associated with poorer control.

Conclusions The high rates of hypertension in low- and middle-income countries are striking. Levels of treatment and control are inadequate despite half those sampled being aware of their condition. Since cardiovascular disease is by far the largest cause of years of life lost in these settings, these findings emphasize the need for new approaches towards control of this major risk factor.

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National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants.

Goodarz Danaei, Mariel Finucane, John K Lin … (2011)

Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP). We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5·4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative. In 2008, age-standardised mean SBP worldwide was 128·1 mm Hg (95% uncertainty interval 126·7-129·4) in men and 124·4 mm Hg (123·0-125·9) in women. Globally, between 1980 and 2008, SBP decreased by 0·8 mm Hg per decade (-0·4 to 2·2, posterior probability of being a true decline=0·90) in men and 1·0 mm Hg per decade (-0·3 to 2·3, posterior probability=0·93) in women. Female SBP decreased by 3·5 mm Hg or more per decade in western Europe and Australasia (posterior probabilities ≥0·999). Male SBP fell most in high-income North America, by 2·8 mm Hg per decade (1·3-4·5, posterior probability >0·999), followed by Australasia and western Europe where it decreased by more than 2·0 mm Hg per decade (posterior probabilities >0·98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0·8-1·6 mm Hg per decade in men (posterior probabilities 0·72-0·91) and 1·0-2·7 mm Hg per decade for women (posterior probabilities 0·75-0·98). Female SBP was highest in some east and west African countries, with means of 135 mm Hg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mm Hg or more. Men and women in western Europe had the highest SBP in high-income regions. On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries. Funding Bill & Melinda Gates Foundation and WHO. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use.

Perviz Asaria, Dan Chisholm, Colin Douglas Mathers … (2007)

In 2005, WHO set a global goal to reduce rates of death from chronic (non-communicable) disease by an additional 2% every year. To this end, we investigated how many deaths could potentially be averted over 10 years by implementation of selected population-based interventions, and calculated the financial costs of their implementation. We selected two interventions: to reduce salt intake in the population by 15% and to implement four key elements of the WHO Framework Convention on Tobacco Control (FCTC). We used methods from the WHO Comparative Risk Assessment project to estimate shifts in the distribution of risk factors associated with salt intake and tobacco use, and to model the effects on chronic disease mortality for 23 countries that account for 80% of chronic disease burden in the developing world. We showed that, over 10 years (2006-2015), 13.8 million deaths could be averted by implementation of these interventions, at a cost of less than US$0.40 per person per year in low-income and lower middle-income countries, and US$0.50-1.00 per person per year in upper middle-income countries (as of 2005). These two population-based intervention strategies could therefore substantially reduce mortality from chronic diseases, and make a major (and affordable) contribution towards achievement of the global goal to prevent and control chronic diseases.

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What has made the population of Japan healthy?

Shunya Ikeda, Mitsuhiko Noda, Manami Inoue … (2011)

People in Japan have the longest life expectancy at birth in the world. Here, we compile the best available evidence about population health in Japan to investigate what has made the Japanese people healthy in the past 50 years. The Japanese population achieved longevity in a fairly short time through a rapid reduction in mortality rates for communicable diseases from the 1950s to the early 1960s, followed by a large reduction in stroke mortality rates. Japan had moderate mortality rates for non-communicable diseases, with the exception of stroke, in the 1950s. The improvement in population health continued after the mid-1960s through the implementation of primary and secondary preventive community public health measures for adult mortality from non-communicable diseases and an increased use of advanced medical technologies through the universal insurance scheme. Reduction in health inequalities with improved average population health was partly attributable to equal educational opportunities and financial access to care. With the achievement of success during the health transition since World War 2, Japan now needs to tackle major health challenges that are emanating from a rapidly ageing population, causes that are not amenable to health technologies, and the effects of increasing social disparities to sustain the improvement in population health. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Epidemiol

Journal ID (iso-abbrev): Int J Epidemiol

Journal ID (publisher-id): ije

Journal ID (hwp): intjepid

Title: International Journal of Epidemiology

Publisher: Oxford University Press

ISSN (Print): 0300-5771

ISSN (Electronic): 1464-3685

Publication date (Print): February 2014

Publication date (Electronic): 6 February 2014

Publication date PMC-release: 6 February 2014

Volume: 43

Issue: 1

Pages: 116-128

Affiliations

¹School of International Development, University of East Anglia, Norwich, UK, ²Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland ³National Research Council, Institute of Neuroscience, Padova, Italy, ⁴London School of Hygiene and Tropical Medicine, London, UK and ⁵Department of Health Statistics and Informatics, World Health Organization, Geneva, Switzerland

Author notes

*Corresponding author. School of International Development, University of East Anglia, Norwich NR4 7TJ, UK. E-mail: p.lloyd-sherlock@ 123456uea.ac.uk

Article

Publisher ID: dyt215

DOI: 10.1093/ije/dyt215

PMC ID: 3937973

PubMed ID: 24505082

SO-VID: 6e128b41-2bfe-42b4-868e-3c3c13a21aa1

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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Date accepted : 19 September 2013

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Pages: 13

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Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control

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Most cited references 41

National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants.

Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use.

What has made the population of Japan healthy?

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Cited by 180

Most referenced authors 1,033