Less than one-fifth of patients with hypertension worldwide well controlled

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1. Less than 50% of patients with hypertension worldwide are aware of their diagnosis.

2. Lowest rates of hypertension control associated with low economic status and limited education.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Hypertension remains the leading cause of cardiovascular disease in the world, resulting in millions of preventable deaths every year. As a result hypertension control is one of the most researched, spoken about, and understood areas of medicine. However, it is also one of the more difficult goals to achieve in most patient populations. This is due to variables ranging from the patient’s inability to notice the signs and symptoms of hypertension to the personal difficulties associated with daily changes in diet and lifestyle. While medication regimens have changed with advancements in research, physicians have not been able to improve patient adherence to a particular treatment plan that typically includes lifestyle changes, counseling, and medications. This demonstrates a clear disconnect between doctor recommendations and patient compliance.

The goal of the Prospective Urban Rural Epidemiology (PURE) study was to improve on past efforts to measure hypertension prevalence, efforts limited by a lack of inclusiveness and diversity in study populations. Overall, the study showed less than one-fifth of patients worldwide with hypertension were well controlled and fewer than 50% of patients with hypertension are aware of their diagnosis. These findings were even more striking among those in low-middle income countries where the rates were even lower. The study limited by the nonrandom selection of countries as well as the disparate sampling methods in each country. Nonetheless, this international study conclusively suggests that the current methods of hypertension control need to be improved, particularly in the areas of detection and treatment.

Click to read the study published today in JAMA

Relevant Reading: Global burden of hypertension: analysis of worldwide data

In-Depth [cross-sectional]: This study recruited 142, 042 patients from 17 countries on 5 continents between 2003 and 2009. Of those enrolled, 57,840 had hypertension (40.8%; 95% CI, 40.5-41.0). Of these, 26,877 were aware they had hypertension (46.5%; 95% CI, 46.1-46.9), 23,510 were receiving treatment (40.6%, 95% CI, 40.2-41.0), and 7,634 of those receiving treatment had their blood pressure controlled (32.5%; 95% CI, 31.9-33.1). The lowest rates of awareness (31.2%; 95% CI, 25.2-38.0) and treatment rates (36.1%; 95% CI 29.0-43.9) of hypertension were found in rural low-income countries (LIC). However, the rates of blood pressure control were consistently lower among rural areas when compared to urban areas at all income levels. Further, among LICs, lowest rates of awareness, treatment, and control were associated with primary or no education.

By John Prendergass and Brittany Hasty

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