Global Awareness, Management and Control of Arterial Hypertension

Posted On 2012-09-06 16:24:18
Arterial hypertension is a global, major public health problem. A recent article in BMJ Open Cardiovascular medicine describes the prevalence, detection, treatment and control rates of hypertension among adults in Cameroon (1). In a cross-sectional, community-based multicentre study in major cities in Cameroon, self-selected urban dwellers from the Center, Littoral, North-West and West Regions, who attended a screening campaign advertised through mass media, were identified. Outcomes measures were hypertension defined as systolic (and/or diastolic) blood pressure (BP) ≥ 140 (90) mm Hg, or ongoing BP-lowering medications.

2120 participants (1003 women) were included. Among them, 1007 (prevalence rate 47.5%) had hypertension, including 319 (awareness rate 31.7%) who were aware of their status. The prevalence of hypertension increased with age overall and by sex and region. Among aware hypertensive participants, 191 (treatment rate 59.9%) were on regular BP-lowering medication, and among those treated, 47 (controlled rate 24.6%) were at target BP levels (i.e. systolic (and diastolic) BP<140 (90) mm Hg). In multivariable logistic regression analysis, male gender, advanced age, parental history of hypertension, diabetes mellitus, elevated waist and elevated body mass index (BMI) were the significant predictors of hypertension. Likewise, male gender, high BMI and physical inactivity were associated with poor control.

The authors concluded that the high prevalence of hypertension with low awareness, treatment and control are alarming and highlight the need for improvements in access to healthcare and education of these communities. 

In a 2009 article, Damasceno et al. (2) reported the results of a community-based cross-sectional study that studied a representative sample of Mozambican adults aged 25 to 64 years, comparing urban and rural communities. 3323 individuals from 95 geographical clusters were randomly selected and evaluated.

The prevalence of hypertension, awareness (having been informed of the hypertensive status by a health professional in the previous year), treatment among the people who were aware (use of antihypertensive medication in the previous fortnight), and control among those treated (blood pressure <140/90 mm Hg) were 33.1% (women: 31.2%; men: 35.7%), 14.8% (women: 18.4%; men: 10.6%), 51.9% (women: 61.1%; men: 33.3%), and 39.9% (women: 42.9%; men: 28.7%), respectively. Among women, hypertension (OR: 2.0; 95% CI: 1.2 to 3.0) and awareness (OR: 4.3; 95% CI: 1.9 to 9.5) were more frequent in urban areas. No urban/rural differences were observed in men (hypertension: OR: 1.3, 95% CI: 0.9 to 2.0; awareness: OR: 1.5, 95% CI: 0.5 to 4.7). Treatment prevalence was not significantly different across urban/rural settings (women: OR: 1.4, 95% CI: 0.5 to 4.4; men: OR: 0.3, 95% CI: 0.1 to 1.4). Control was less frequent in urban women (OR: 0.2; 95% CI: 0.0 to 1.0) and more frequent in urban men (OR: 78.1; 95% CI: 2.2 to 2716.6). 

The authors concluded that the results illustrate the changing paradigms of “diseases of affluence” and the dynamic character of epidemiological transition, while the urban/rural differences across gender supported a trend toward smaller differences, emphasizing the need for strategies to improve prevention, correct diagnosis, and access to effective treatment. 

Another recent study examined trends in hypertension prevalence, awareness, management, and control in U.S. adults from 1999 to 2010. (3) 28,995 male and female adults with BP measurements from a nationally representative sample of the non-institutionalized U.S. population (National Health and Nutrition Examination Survey [NHANES] were included, with special attention given to 5,764 participants in NHANES 2009 to 2010.

In 2009 to 2010, the prevalence of hypertension was 30.5% among men and 28.5% among women. The hypertension awareness rate was 69.7% (95% confidence interval [CI]: 62.0% to 77.4%) among men and 80.7% (95% CI: 74.5% to 86.8%) among women. The hypertension control rate was 40.3% (95% CI: 33.7% to 46.9%) for men and 56.3% (95% CI: 49.2% to 63.3%) for women. From 1999 to 2010, the prevalence of hypertension remained stable. Although hypertension awareness, management, and control improved, the overall rates remained poor (74.0% for awareness, 71.6% for management, 46.5% for control, and 64.4% for control in management).

From 1999 to 2010, prevalence of hypertension remained stable. Hypertension awareness, management, and control were improved, but remained poor; nevertheless, there has been no improvement since 2007.

These studies demonstrate that arterial hypertension is a global, major public health problem and emphasizes the need to increase awareness, management and control world wide.

1. Dzudie A, Kengne AP, Muna WFT, Ba H, Menanga A, Kouam Kouam C, Abah J, Monkam Y,  Biholong C, Mintom P, Kamdem F, Djomou A, Ndjebet J, Wambo C, Luma H, Blackett Ngu K, Kingue S, on behalf of the CCS Investigator Group. Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study. BMJ Open Cardiovascular Medicine 2012;2:e001217 doi:10.1136/bmjopen-2012-001217
2. Damasceno A, Azevedo A, Silva-Matos C, Prista A, Diogo D, Lunet N. Hypertension Prevalence, Awareness, Treatment, and Control in Mozambique: Urban/Rural Gap During Epidemiological Transition. Hypertension: 2009; 54;77-83. 
3. Guo F, He D, Zhang W, Walton RG. Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010. J Am Coll Cardiol. 2012 Aug 14;60(7):599-606. Epub 2012 Jul 11.