Hypertension Rampant Untreated
September 4, 2013

High Blood Pressure Rampant And Untreated Worldwide, Says International Study

Rebekah Eliason for redOrbit.com – Your Universe Online

Many people with hypertension, or high blood pressure, are unaware of their condition, and too few of those who are receive adequate therapy, according to a study published Tuesday in the Journal of the American Medical Association (JAMA).

The study, which included more than 142,000 participants from 17 countries, found that more than one-half of those with hypertension were unaware they had high blood pressure, while only one-third of those being treated for hypertension were successfully controlling their blood pressure.

"Our study indicates over half of people with hypertension are unaware of their condition and, amongst those identified, very few are taking enough treatment to control their blood pressure," said Professor Clara Chow, lead author of the study and an associate professor of medicine at Sydney University and the George Institute for Global Health in Australia.

Chow and colleagues assessed the prevalence, awareness, treatment, and control of hypertension in participants in the Prospective Urban Rural Epidemiology (PURE) study.

Dr. Salim Yusuf , senior author of the study and professor of medicine of McMaster University's School of Medicine, said that while drug treatments to control hypertension are well known, too few are achieving target blood pressure control.

"Blood pressure lowering drugs are generally inexpensive and commonly available treatments," said Yusuf, executive director of the Population Health Research Institute (PHRI), which initiated the PURE study.

"Only a third of patients commenced on treatment are on enough treatment to control their blood pressure. This is worst in low income countries, but significant in high and middle income countries too,” he said.

This is significant because hypertension is the leading cause of cardiovascular disease (CVD) worldwide, which is associated with at least 7.6 million deaths per year, about 13.5 percent of all deaths.

“The importance of blood pressure as a modifiable risk factor for CVD is well-recognized, and many effective and inexpensive blood pressure-lowering treatments are available. Therefore, hypertension control and prevention of subsequent morbidity and mortality clearly should be achievable," the researchers wrote in their report.

"Information on hypertension prevalence, awareness, treatment, and control in multiple countries and different types of communities is necessary to provide a baseline for monitoring and also to inform the development of new strategies for improving hypertension control."

Participants in the PURE study included more than 140,000 adults 35 to 70 years of age recruited from 628 communities in three high-income countries, 10 upper-middle-income and low-middle-income countries, and four low-income countries. Participants included individuals with and without a history of heart disease or stroke.

Hypertension was defined as individuals with self-reported treated hypertension or with an average of two blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Each study participant had their blood pressure measured and medication use recorded, along with information about their age, gender, education and key risk factors, including whether they knew they had hypertension.

The results revealed that just 46.5 percent of those with hypertension were aware they had the condition, while blood pressure was adequately controlled among just 32.5 percent of those being treated.

"The findings are disturbing and indicate a need for systematic efforts to better detect those with high blood pressure," said Yusuf. "Early use of combination therapies, that is, two or more types of blood pressure-lowering treatments taken together, may be required."

The results of the study clearly show that “while initial therapy was started in the large majority of individuals who are detected to have hypertension, control in participants receiving treatment was very poor,” the researchers said.

“The use of combination therapies, generally required to achieve blood pressure control, was low.”

The study found that awareness, treatment and control were lower among participants from lower income countries compared with other countries, and in rural settings of lower-middle income countries and lower-income countries compared with urban ones.

The researchers also found that despite men having higher rates of hypertension, women consistently had higher awareness, treatment and control of their high blood pressure. These results are consistent with a large body of research on gender and health-seeking behavior, the researchers said.

Participants with more education also had greater awareness, treatment and control, particularly in lower income countries, the study found.

"The widespread lack of hypertension awareness and poor control in all countries studied, despite the identification and control of blood pressure being prioritized by many national and global organizations and despite the availability of inexpensive and effective medications, is concerning," the researchers wrote.

"These findings suggest that substantial improvement in hypertension diagnosis and treatment is needed."