Examining the prevalence, correlates and inequalities of undiagnosed hypertension in Nepal: a population-based cross-sectional study

Abstract

ObjectiveTo examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal.DesignThis study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured.SettingNepal.ParticipantsAdult patients with hypertension.ResultsAmong 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=−0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces.ConclusionsUndiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden.

Undiagnosed hypertension in Peru: analysis of associated factors and socioeconomic inequalities, 2019

“…This expression is a good description of the scenario of patients with hypertension in many regions of the world and in countries such as Peru. In low-and middle-income countries, it has been reported that the prevalence of undiagnosed hypertension is between 12% and 50% [ 6 , 8 , 26 , 27 ]. The value found in Peru is above this range, with more than half of adults with hypertension presenting undiagnosed hypertension, making this an important public health problem.…”

“…The following independent variables were considered: age in years (18–29/30-49/50–69/70 or more), gender (female/male), ethnicity (non native, native, afro-peruvian), educational level (none or pre-school/primary education/secondary education/higher education), marital status (single/married/widowed, divorced, or separated), health insurance (yes/no), body mass index (underweight or normal/overweight/obesity), physical or psychological limitation (yes/no), depressive symptoms (determined by a score of ten or more in the Patient Health Questionnaire-9 [PHQ-9] screening test in the 14 days prior to the survey [yes/no]), diabetes (yes/no), smoking status (if smoked cigarettes in the last 30 days [yes/no]), binge drinking (consumption of five and four or more alcoholic beverages on the same occasion for men and women, respectively, in the last 30 days prior to the survey [yes/no]), wealth quintile (richest/rich/middle/poor/poorest), area of residence (urban/rural), natural region of residence (Jungle/Andean/Coast), and altitude in meters above sea level (MASL) The selection and inclusion of these independent variables in the study were based on a literature review [ 7 , 8 , 9 , 12 ].…”

“…It is estimated that in one out of every five people with hypertension, the condition is controlled [ 4 ], and among patients not diagnosed with hypertension, 3 out of every four are considered to be at high cardiovascular risk [ 5 ]. There is a high prevalence of individuals with undiagnosed hypertension (66%), ranging from 50.4% to 59.9%, mainly in middle-income and in Southeast Asian countries [ 6 , 7 , 8 , 9 ], which contrast with the prevalence of between 4.1% and 6.5% in the United States [ 10 ]. According to the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study, the prevalence of undiagnosed hypertension varies between 24% and 47% in 7 cities of Latin America [ 11 ].…”

“…Previous studies have reported the following factors as being associated with undiagnosed hypertension: younger age, male sex, living in a rural area, having a lower level of education, belonging to a low socioeconomic level, not having health insurance, and not having overweight or obesity [ 7 , 8 , 9 , 12 ]. These factors lead to a delay in the treatment of hypertension and, consequently, an increase in cardiovascular complications [ 1 , 7 ].…”

“…These factors lead to a delay in the treatment of hypertension and, consequently, an increase in cardiovascular complications [ 1 , 7 ]. The promotion of primary health prevention based on education and healthy lifestyles is necessary to decrease the burden of hypertension and premature mortality due to cardiovascular conditions as well as reduce the inequalities in undiagnosed hypertension based on individual characteristics such as socioeconomic and educational level [ 4 , 7 , 8 ].…”