Patterns and predictors of undiagnosed and uncontrolled hypertension: observations from a poor-resource setting

Abstract

Early detection is the cornerstone of hypertension management; still majority remains undetected until complications arise, especially in poor-resource settings. Paucity of information regarding undiagnosed and uncontrolled hypertension in eastern India thus called for a detailed investigation involving a representative sample of adults in Malda, one of the poorest districts in the region. In a cross-sectional study, between October 2013 and July 2014, using multistage random sampling with probability-proportional-to-size, 18 028 consenting adults were interviewed. Diagnosed cases were defined as uncontrolled if they still had hypertensive level of blood pressure (according to JNC-VIII criteria) while those detected during this study were defined as undiagnosed. Descriptive and regression analyses were performed using SAS version 9.3.2. Among 18 028 participants, 4695 (26.04% (95% confidence intervals: 95% CI=25.40-26.68)) had hypertension, of which 3937 (83.86% (82.80-84.91)) were undiagnosed and 548 (72.30 (69.10-75.49)) had uncontrolled hypertension. Relatively older subjects (adjusted Odds ratio (aOR)=0.34 (95% CI=0.26-0.43) and aOR=0.29 (0.21-0.38)), who were divorced/separated/widowed/widower (aOR=0.76 (0.61-0.95)), had higher education (aOR=0.61 (0.43-0.88)), better socio-economic status (SES) (aOR=0.77 (0.60-0.99) and aOR=0.64 (0.48-0.85)) and urban residence (aOR=0.44 (0.36-0.55)) were less likely while subjects who belonged to backward castes (aOR=1.37 (1.15-1.64)) were more likely to have undiagnosed hypertension. Odds of having uncontrolled hypertension were higher among participants aged >60 years (aOR=2.25 (1.27-3.99)). Burden of hypertension (diagnosed and undiagnosed) was high in Malda district of West Bengal. Significant predictors of undiagnosed hypertension were young age, backward caste, poor education and lower SES, while older subjects had poor control. Thus, appropriate surveillance targeting these at-risk groups might be effective in controlling hypertension in similar poor-resource settings.

<p>Magnitude and Determinants of Uncontrolled Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Nekemte Referral Hospital, Western Ethiopia</p>

“…On the other hand, the results of other studies showed that patients aged younger than 60 years were more likely than older patients to have controlled BP. 12,21,27,45,[49][50][51] This was due to with increasing age, there will be increasing stiffness of the aorta and arterial walls which contribute to the observed high prevalence of HTN in the older group. 12,45,52 Thus, ongoing surveillance to determine trends in BP overage is necessary to provide a basis for evaluating and guiding public health interventions.…”

Cognitive impairment and hypertension in older adults living in extreme poverty: a cross-sectional study in Peru

“…The Ministry of Development and Social Inclusion was in charge of the development of the questionnaires and assessments [ 14 ]. The Peruvian National Institute of Statistic and Informatics was in charge of the data collection.…”

“…Previous studies in Peru have described a great gap between diagnosis, treatment, and control of hypertension [ 13 ] and reports worldwide show that the gap increases in settings with fewer resources (33% more awareness of hypertension in people with higher socioeconomic status in comparison to lower socioeconomic status) [ 14 ]. Poverty leads to less access to healthcare, less awareness, and treatment of hypertension, if an association with cognitive impairment is found, is possible that the magnitude of this association would be higher in comparison to other values found in previous studies in not deprived populations.…”

Independent predictors of effective blood pressure control in patients with hypertension on drug treatment in Brazil

“…Older age (>60 years) and obesity are two factors that are consolidated in the literature as predictors of reduced BP control . However, when the association analysis was performed according to sex, it was observed that only younger age in women (<60 years) was associated with better BP control.…”

“…Older age (>60 years) and obesity are two factors that are consolidated in the literature as predictors of reduced BP control. 6,[23][24][25][26] However, when the association analysis was performed according to sex, it was observed that only younger age in women (<60 years) was associated with better BP control. In contrast, in men, there was a lower percentage of younger patients with controlled BP, although this difference was not statistically significant.…”