Background
Methods
Study design and participants
Measurement of health-related outcomes and participant characteristics
Standard lower threshold definitiona
| Subjects reported having been diagnosed with hypertension by a health care professional and receiving blood pressure-lowering medication, or if they had an average sitting systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or both. |
Alternative lower threshold definition | Subjects reported having been diagnosed with hypertension by a health care professional or receiving blood pressure-lowering medication, or if they had an average systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or both. |
Alternative ‘higher threshold’ definition | Subjects reported having been diagnosed with hypertension by a health care professional and receiving blood pressure-lowering medication, or if they had an average blood pressure above the threshold of 160/100 mm Hg. |
Analysis of wealth-related differences
Results
Participant characteristics
2006 World Bank country income group | Participants | ||||||||
---|---|---|---|---|---|---|---|---|---|
Country | No. of Communities | Number | No. Rural (%) | No. Women (%) | Mean Age in years (SD) | ||||
High income | Canada | 77 | 10412 | 2527 | (24.3) | 5588 | (53.7) | 53.4 | (9.2) |
Sweden | 24 | 4150 | 902 | (21.7) | 2192 | (52.8) | 52.7 | (9.0) | |
UAE | 3 | 918 | 429 | (46.7) | 653 | (71.1) | 49.2 | (10.2) | |
Saudi Arabia | 18 | 1729 | 186 | (10.8) | 734 | (42.5) | 46.5 | (9.0) | |
Upper-middle income | Argentina | 21 | 7497 | 3897 | (52.0) | 4607 | (61.5) | 51.1 | (9.9) |
Brazil | 14 | 5581 | 1302 | (23.3) | 3086 | (55.3) | 52.2 | (9.4) | |
Chile | 5 | 3270 | 694 | (21.2) | 2158 | (66.0) | 51.9 | (9.9) | |
Malaysia | 36 | 11825 | 7024 | (59.4) | 6736 | (57.0) | 51.3 | (9.8) | |
Poland | 4 | 2029 | 825 | (40.7) | 1274 | (62.8) | 54.6 | (9.8) | |
South Africa | 11 | 3252 | 1766 | (54.3) | 2213 | (68.1) | 49.9 | (10.3) | |
Turkey | 38 | 4060 | 1426 | (35.1) | 2459 | (60.6) | 50.0 | (9.1) | |
Lower-middle income | China | 110 | 46751 | 23558 | (50.4) | 27318 | (58.4) | 51.0 | (10.0) |
Philippines | 2 | 1671 | 630 | (37.7) | 1125 | (67.3) | 51.8 | (9.7) | |
Colombia | 60 | 7506 | 4036 | (53.8) | 4819 | (64.2) | 50.7 | (9.8) | |
Iran | 20 | 6013 | 2982 | (49.6) | 3137 | (52.2) | 48.5 | (9.2) | |
OPT | 39 | 1563 | 663 | (42.4) | 780 | (49.9) | 49.3 | (10.0) | |
Low income | Bangladesh | 56 | 2747 | 1437 | (52.3) | 1504 | (54.8) | 46.0 | (9.4) |
India | 97 | 27458 | 14300 | (52.1) | 15507 | (56.5) | 48.7 | (10.5) | |
Pakistan | 4 | 1294 | 373 | (28.8) | 674 | (52.1) | 47.4 | (8.7) | |
Zimbabwe | 3 | 822 | 568 | (69.1) | 590 | (71.8) | 52.4 | (10.1) | |
Tanzania | 19 | 1071 | 420 | (39.2) | 833 | (77.8) | 49.9 | (11.3) | |
Total | 661 | 151619 | 69945 | (46.1) | 87987 | (58.0) | 50.6 | (10.0) |
Participants | Hypertensive participants – Standard lower threshold a
| |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Country | Number | No. with Hypertension – Standard lower threshold a (%) [95%CI] | No. with Hypertension – Alternative lower thresholda (%) [95%CI] | No. Aware (%) [95%CI] | No. Treated (%) [95%CI] | No. Controlled (%) [95%CI] | ||||||||||
Canada | 10412 | 3908 | (37.5) | [35.3–39.8] | 4347 | (41.7) | [39.4–44.1] | 2157 | (55.2) | [53.3–57.0] | 2112 | (54.0) | [52.2–55.9] | 968 | (24.8) | [23.2–26.4] |
Sweden | 4150 | 1923 | (46.3) | [44.3–48.4] | 2008 | (48.4) | [46.1–50.6] | 696 | (36.2) | [32.0–40.6] | 608 | (31.6) | [26.8–36.8] | 169 | (8.8) | [7.5–10.3] |
UAE | 918 | 477 | (52.0) | [48.7–55.2] | 487 | (53.1) | [49.8–56.3] | 247 | (51.8) | [47.3–56.3] | 240 | (50.3) | [45.8–54.8] | 63 | (13.2) | [10.4–16.6] |
Saudi Arabia | 1729 | 515 | (29.8) | [27.1–32.6] | 546 | (31.6) | [29.0–34.3] | 319 | (61.9) | [56.8–66.9] | 309 | (60.0) | [55.2–64.6] | 169 | (32.8) | [28.5–37.5] |
Argentina | 7497 | 3809 | (50.8) | [49.1–52.5] | 4045 | (54.0) | [52.5–55.4] | 2073 | (54.4) | [51.7–57.2] | 1924 | (50.5) | [47.8–53.3] | 569 | (14.9) | [12.8–17.4] |
Brazil | 5581 | 2938 | (52.6) | [51.0–54.3] | 3096 | (55.5) | [54.2–56.7] | 1896 | (64.5) | [61.9–67.1] | 1838 | (62.6) | [60.0–65.1] | 685 | (23.3) | [21.7–25.0] |
Chile | 3270 | 1530 | (46.8) | [42.6–51.0] | 1664 | (50.9) | [46.5–55.2] | 890 | (58.2) | [53.8–62.4] | 798 | (52.2) | [46.6–57.6] | 332 | (21.7) | [18.0–25.9] |
Malaysia | 11825 | 5509 | (46.6) | [43.9–49.3] | 5894 | (49.8) | [47.3–52.3] | 2648 | (48.1) | [45.3–50.9] | 2272 | (41.2) | [38.1–44.5] | 690 | (12.5) | [10.9–14.3] |
Poland | 2029 | 1368 | (67.4) | [63.6–71.0] | 1412 | (69.6) | [65.7–73.2] | 739 | (54.0) | [35.0–71.9] | 706 | (51.6) | [33.4–69.4] | 151 | (11.0) | [5.4–21.1] |
South Africa | 3252 | 1857 | (57.1) | [45.4–68.1] | 1975 | (60.7) | [50.1–70.5] | 580 | (31.2) | [20.3–44.7] | 616 | (33.2) | [26.3–40.8] | 117 | (6.3) | [3.9–9.9] |
Turkey | 4060 | 1595 | (39.3) | [36.3–42.3] | 1770 | (43.6) | [40.6–46.6] | 910 | (57.1) | [53.1–60.9] | 808 | (50.7) | [46.6–54.8] | 330 | (20.7) | [16.9–25.0] |
China | 46751 | 19471 | (41.6) | [39.2–44.1] | 20367 | (43.6) | [41.2–46.0] | 8114 | (41.7) | [37.5–46.0] | 6557 | (33.7) | [29.3–38.4] | 1556 | (8.0) | [5.9–10.7] |
Philippines | 1671 | 855 | (51.2) | [43.3–59.0] | 891 | (53.3) | [45.2–61.3] | 466 | (54.5) | [29.1–77.8] | 394 | (46.1) | [21.0–73.3] | 115 | (13.5) | [3.8–37.7] |
Colombia | 7506 | 2817 | (37.5) | [35.7–39.4] | 3110 | (41.4) | [39.8–43.0] | 1461 | (51.9) | [48.7–55.0] | 1309 | (46.5) | [43.2–49.7] | 484 | (17.2) | [15.1–19.5] |
Iran | 6013 | 1598 | (26.6) | [23.6–29.8] | 1939 | (32.2) | [29.3–35.4] | 841 | (52.6) | [45.7–59.5] | 816 | (51.1) | [44.5–57.6] | 293 | (18.3) | [13.4–24.6] |
OPT | 1563 | 591 | (37.8) | [34.1–41.6] | 657 | (42.0) | [38.5–45.6] | 347 | (58.7) | [51.8–65.3] | 345 | (58.4) | [52.4–64.1] | 130 | (22.0) | [16.5–28.6] |
Bangladesh | 2747 | 1080 | (39.3) | [36.1–42.7] | 1154 | (42.0) | [38.7–45.4] | 261 | (24.2) | [20.3–28.5] | 174 | (16.1) | [13.1–19.7] | 43 | (4.0) | [2.6–6.0] |
India | 27458 | 8473 | (30.9) | [28.5–33.4] | 9443 | (34.4) | [31.7–37.2] | 3565 | (42.1) | [38.1–46.2] | 2843 | (33.6) | [29.9–37.4] | 1159 | (13.7) | [11.1–16.7] |
Pakistan | 1294 | 435 | (33.6) | [25.8–42.4] | 565 | (43.7) | [40.2–47.1] | 206 | (47.4) | [39.2–55.6] | 162 | (37.2) | [28.7–46.6] | 76 | (17.5) | [12.9–23.2] |
Zimbabwe | 822 | 453 | (55.1) | [37.0–72.0] | 515 | (62.7) | [44.8–77.6] | 223 | (49.2) | [31.3–67.4] | 119 | (26.3) | [17.1–38.0] | 36 | (7.9) | [4.9–12.6] |
Tanzania | 1071 | 410 | (38.3) | [34.7–42.0] | 439 | (41.0) | [37.1–45.0] | 45 | (11.0) | [7.4–15.9] | 12 | (2.9) | [2.0–4.3] | 2 | (0.5) | [0.1–1.7] |
Total | 151619 | 61612 | (40.6) | 66324 | (43.7) | 28684 | (46.6) | 24962 | (40.5) | 8137 | (13.2) |
Gaps in the hypertension management pathway within countries
Wealth-related inequalities in the hypertension management pathway within countries
Country | Hypertension % of all participants | Hypertension awareness % of hypertensive participants | Hypertension treatment % of hypertensive participants | Hypertension control % of hypertensive participants | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Q1 | Q5 | Difference [95% CI] |
p-value | Q1 | Q5 | Difference [95% CI] |
p-value | Q1 | Q5 | Difference [95% CI] |
p-value | Q1 | Q5 | Difference [95% CI] |
p-value | |||||
Canada | 38.5 | 34.2 | −4.3 | [-8.0--0.7] | 0.019 | 58.6 | 52.1 | −6.5 | [-12.5--0.6] | 0.031 | 55.6 | 51.8 | −3.7 | [-9.8–2.4] | 0.229 | 21.8 | 24.9 | 3.0 | [-2.0–8.0] | 0.240 |
Sweden | 46.5 | 46.3 | −0.2 | [-5.4–5.0] | 0.941 | 37.8 | 34.1 | −3.7 | [-10.8–3.4] | 0.305 | 34.1 | 26.8 | −7.3 | [-14.1--0.5] | 0.034 | 9.7 | 6.9 | −2.8 | [-6.7–1.1] | 0.161 |
UAE | 46.5 | 50.7 | 4.2 | [-7.3–15.6] | 0.476 | 45.1 | 55.9 | 10.9 | [-4.6–26.3] | 0.168 | 46.8 | 52.9 | 6.1 | [-9.5–21.6] | 0.444 | 7.2 | 12.2 | 5.0 | [-3.9–13.9] | 0.271 |
Saudi Arabia | 28.2 | 26.9 | −1.3 | [-8.6–6.0] | 0.730 | 70.2 | 70.4 | 0.2 | [-14.0–14.3] | 0.983 | 68.4 | 66.4 | −2.0 | [-16.7–12.7] | 0.788 | 23.8 | 37.5 | 13.8 | [0.2–27.4] | 0.047 |
Argentina | 51.2 | 46.7 | −4.6 | [-8.6--0.5] | 0.028 | 57.9 | 52.7 | −5.2 | [-10.5–0.2] | 0.060 | 49.9 | 49.3 | −0.6 | [-6.1–4.8] | 0.816 | 13.1 | 12.5 | −0.6 | [-4.0–2.8] | 0.734 |
Brazil | 53.9 | 52.7 | −1.2 | [-6.2–3.7] | 0.634 | 67.7 | 60.4 | −7.3 | [-13.7--0.9] | 0.025 | 67.1 | 62.3 | −4.8 | [-11.7–2.0] | 0.168 | 26.1 | 22.2 | −3.9 | [-10.1–2.3] | 0.213 |
Chile | 45.2 | 45.3 | 0.1 | [-6.9–7.1] | 0.981 | 60.6 | 60.0 | −0.6 | [-10.2–9.0] | 0.902 | 50.3 | 51.9 | 1.6 | [-8.7–11.9] | 0.757 | 16.4 | 19.0 | 2.6 | [-4.6–9.8] | 0.473 |
Malaysia | 42.8 | 42.7 | −0.2 | [-3.5–3.1] | 0.926 | 44.4 | 51.0 | 6.6 | [1.6–11.6] | 0.010 | 36.6 | 41.5 | 4.9 | [0.0–9.8] | 0.052 | 9.8 | 12.2 | 2.5 | [-0.6–5.5] | 0.110 |
Poland | 69.2 | 73.8 | 4.7 | [-3.3–12.6] | 0.248 | 54.2 | 46.0 | −8.3 | [-18.9–2.4] | 0.128 | 53.4 | 42.1 | −11.3 | [-22.0--0.6] | 0.038 | 7.3 | 7.7 | 0.4 | [-4.6–5.5] | 0.869 |
South Africa | 59.9 | 59.3 | −0.6 | [-7.2–6.0] | 0.855 | 21.4 | 34.1 | 12.7 | [5.0–20.4] | 0.001 | 27.7 | 38.1 | 10.4 | [2.6–18.1] | 0.009 | 2.0 | 9.3 | 7.2 | [3.8–10.7] | 0.000 |
Turkey | 37.5 | 31.4 | −6.1 | [-11.3--0.8] | 0.023 | 56.3 | 57.1 | 0.7 | [-7.8–9.3] | 0.864 | 49.4 | 50.4 | 1.0 | [-7.6–9.6] | 0.820 | 17.6 | 22.2 | 4.5 | [-2.2–11.2] | 0.185 |
China | 40.8 | 38.4 | −2.4 | [-4.3--0.6] | 0.009 | 39.2 | 44.8 | 5.7 | [2.8–8.5] | 0.000 | 26.7 | 34.0 | 7.3 | [4.7–9.9] | 0.000 | 4.1 | 7.7 | 3.6 | [2.2–4.9] | 0.000 |
Philippines | 43.0 | 58.6 | 15.6 | [4.1–27.1] | 0.008 | 44.7 | 69.7 | 25.0 | [9.1–40.9] | 0.002 | 34.1 | 64.5 | 30.4 | [14.4–46.3] | 0.000 | 4.8 | 26.1 | 21.3 | [9.1–33.5] | 0.001 |
Colombia | 34.8 | 32.9 | −1.9 | [-6.6–2.7] | 0.416 | 46.4 | 59.0 | 12.6 | [4.5–20.7] | 0.002 | 38.4 | 53.6 | 15.3 | [7.1–23.4] | 0.000 | 10.9 | 19.5 | 8.6 | [2.7–14.6] | 0.004 |
Iran | 25.3 | 20.2 | −5.1 | [-9.2--1.0] | 0.015 | 53.3 | 58.1 | 4.8 | [-5.3–14.8] | 0.350 | 49.8 | 55.9 | 6.0 | [-4.2–16.2] | 0.246 | 16.0 | 18.2 | 2.2 | [-5.0–9.3] | 0.554 |
OPT | 37.8 | 33.7 | −4.1 | [-13.1–4.8] | 0.368 | 62.2 | 52.1 | −10.1 | [-25.1–4.9] | 0.188 | 60.0 | 51.3 | −8.7 | [-23.5–6.1] | 0.250 | 17.3 | 13.3 | −3.9 | [-13.8–5.9] | 0.431 |
Bangladesh | 31.8 | 52.0 | 20.2 | [13.8–26.6] | 0.000 | 14.0 | 24.9 | 10.9 | [2.0–19.8] | 0.016 | 8.8 | 21.2 | 12.5 | [4.5–20.4] | 0.002 | 1.7 | 4.9 | 3.2 | [-0.6–7.0] | 0.101 |
India | 13.6 | 35.4 | 21.9 | [19.2–24.6] | 0.000 | 27.2 | 48.0 | 20.8 | [16.3–25.3] | 0.000 | 20.9 | 43.0 | 22.1 | [17.7–26.6] | 0.000 | 8.9 | 15.0 | 6.1 | [3.2–9.1] | 0.000 |
Pakistan | 29.8 | 31.7 | 1.8 | [-11.2–14.8] | 0.784 | 27.9 | 56.2 | 28.3 | [8.8–47.9] | 0.005 | 15.7 | 50.1 | 34.4 | [16.7–52.2] | 0.000 | 9.9 | 26.2 | 16.3 | [1.3–31.3] | 0.033 |
Zimbabwe | 57.9 | 64.3 | 6.4 | [-10.2–23.1] | 0.449 | 43.1 | 51.1 | 8.0 | [-15.8–31.8] | 0.511 | 19.5 | 25.8 | 6.3 | [-11.9–24.5] | 0.497 | 4.4 | 8.0 | 3.7 | [-6.6–13.9] | 0.485 |
Tanzania+
| 34.7 | 40.0 | 5.3 | [-6.7-17.2] | 0.389 | 9.7 | 5.1 | -4.5 | [-13.7-4.7] | 0.338 | 3.0 | 3.9 | 0.9 | [-5.7-7.5] | 0.790 |