title: Awareness and control of hypertension in Bangladesh: follow-up of a hypertensive cohort.
abstract: OBJECTIVE
  To assess the effect of awareness and advice to seek care on blood pressure (BP) control among patients with hypertension in Bangladesh.
  
  
  METHODS
  Longitudinal study.
  
  
  METHODS
  The study was carried out in icddr,b surveillance sites at rural Matlab in Chandpur district and semi-urban Kamalapur in Dhaka, Bangladesh.
  
  
  METHODS
  Randomly selected men and non-pregnant women aged 20 years or older without any acute illness or history of any vascular events such as stroke or acute myocardial infarction.
  
  
  METHODS
  Hypertension was defined as systolic BP (SBP) ≥140 and/or diastolic BP (DBP) ≥90 mm Hg or as self-reported hypertension under medication. We advised patients to seek care from a qualified provider and to adopt a healthy lifestyle. We compared changes in BP from baseline to follow-up at around 6 months.
  
  
  RESULTS
  Overall, 17.1% (n=287) of participants had hypertension at baseline with significantly higher prevalence in the semi-urban than in the rural population (23.6% vs 10.8%; p<0.001); half were unaware of their condition. At follow-up, 83% (n=204) reported a visit to any healthcare provider. In the semi-urban area, a higher proportion of patients visited medically qualified practitioners than in the rural area (76.7% vs 36.6%, p<0.000). SBP (-3.3±20.7 mm Hg; p<0.01) and DBP (-2.0±13.0 mm Hg; p<0.02) were lower at follow-up. Those who visited medically qualified practitioners had significant SBP (-3.9±22.4 mm Hg; p<0.03) and DBP (-2.7±14.1 mm Hg; p<0.02) reduction. BP reduction did not reach statistical significance among those visiting a pharmacist or their village doctors. Overall, half of the patients with hypertension achieved the BP control goal (BP<140/90 mm Hg).
  
  
  CONCLUSIONS
  Awareness and simple health messages increase provider visit, reduce blood pressure and improve BP control in hypertensive Bangladeshis. Longer-term follow-up is required to verify the sustainability.
authors.affiliation: Centre for Control of Chronic Diseases (CCCD), icddr,b, Dhaka, Bangladesh.
authors.forename: Dewan Shamsul
authors.initials: DS
authors.lastname: Alam
authors.affiliation: Centre for Control of Chronic Diseases (CCCD), icddr,b, Dhaka, Bangladesh.
authors.forename: Muhammad Ashique Haider
authors.initials: MA
authors.lastname: Chowdhury
authors.affiliation: Centre for Control of Chronic Diseases (CCCD), icddr,b, Dhaka, Bangladesh.
authors.forename: Ali Tanweer
authors.initials: AT
authors.lastname: Siddiquee
authors.affiliation: Centre for Control of Chronic Diseases (CCCD), icddr,b, Dhaka, Bangladesh.
authors.forename: Shyfuddin
authors.identifier: http://orcid.org/0000-0003-4754-6281
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Liverpool School of Tropical Medicine, University of Warwick, Liverpool, UK.
authors.forename: Louis Wilhelmus
authors.initials: LW
authors.lastname: Niessen
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001364:Awareness; D001459:Bangladesh / Q000453:epidemiology; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006293:Health Promotion; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010595:Pharmacists; D012424:Rural Population; D014505:Urban Population
chemical_list: D000959:Antihypertensive Agents
keywords: EPIDEMIOLOGY; PRIMARY CARE; PUBLIC HEALTH