title: Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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
  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.
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.forename: Shofiqul
authors.initials: S
authors.lastname: Islam
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: Ahmad
authors.initials: A
authors.lastname: Bahonar
authors.forename: Jephat
authors.initials: J
authors.lastname: Chifamba
authors.forename: Gilles
authors.initials: G
authors.lastname: Dagenais
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz
authors.forename: Khawar
authors.initials: K
authors.lastname: Kazmi
authors.forename: Fernando
authors.initials: F
authors.lastname: Lanas
authors.forename: Li
authors.initials: L
authors.lastname: Wei
authors.forename: Patricio
authors.initials: P
authors.lastname: Lopez-Jaramillo
authors.forename: Lu
authors.initials: L
authors.lastname: Fanghong
authors.forename: Noor Hassim
authors.initials: NH
authors.lastname: Ismail
authors.forename: Thandi
authors.initials: T
authors.lastname: Puoane
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.forename: Andrzej
authors.initials: A
authors.lastname: Szuba
authors.forename: Ahmet
authors.initials: A
authors.lastname: Temizhan
authors.forename: Andy
authors.initials: A
authors.lastname: Wielgosz
authors.forename: Rita
authors.initials: R
authors.lastname: Yusuf
authors.forename: Afzalhussein
authors.initials: A
authors.lastname: Yusufali
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.forename: Lisheng
authors.initials: L
authors.lastname: Liu
authors.forename: Prem
authors.initials: P
authors.lastname: Mony
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D007182:Income; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D057566:Self Report; D014505:Urban Population / Q000706:statistics & numerical data*
chemical_list: D000959:Antihypertensive Agents