• Cardiology Clinical Trials
• Hypertensive Disease
• Prevention & Screening

Hypertension is a global epidemic; yet rates of awareness, treatment, and control are lower than expected around the world, according to the results of the Prospective Urban Rural Epidemiology [PURE] study. Reporting on the study, Rafael Diaz, MD, Estudios Cardiológicos Latinoamérica, Rosario, Argentina, noted that the overall prevalence of hypertension was approximately 41%, with fewer than half of people with hypertension being aware of the diagnosis or being treated for it, and only 13% of those with a diagnosis of hypertension having controlled blood pressure (BP).

The PURE study included 153,996 adults (ages 35 to 70 years; mean age, 50.4 years) from 628 rural and urban communities in 3 high–income countries (HIC), 10 upper-(UMIC) and lower–middle-income countries (LMIC), and 4 low-income countries (LIC). Hypertension was defined as an average systolic BP (SBP) ≥140 mm Hg or a diastolic BP (DBP) ≥90 mm Hg, the self-report of a medical diagnosis of hypertension, or the use of BP-lowering medications. The mean SBP for the study population was 131.23 mm Hg, and the mean DBP was 81.99 mm Hg. Most individuals (36.8%) had prehypertension; 21.9% had stage 1 hypertension, and 13.4% had stage 3 or 4 hypertension. Approximately 28% of the population had an optimal BP.

Awareness, treatment, and control of hypertension varied among rural and urban areas within the 3 categories of countries. In HIC and MIC, there was a greater prevalence of hypertension in rural areas than in urban areas; in LIC, the reverse was true, with a higher prevalence in urban areas. The prevalence of hypertension was greater among men in HIC and MIC, but was greater among women in LIC.

The investigators also assessed prevalence, awareness, treatment, and control among subgroups categorized by the presence of other cardiovascular risk factors (eg, diabetes, current or past smoking, obesity, age >65 years, and male sex). Rates were highest among individuals with ≥2 risk factors (compared with no or 1 risk factors). Hypertension was controlled in 15% of individuals with ≥2 risk factors, in 12% with 1 risk factor, and in 8% with no risk factors.

The low rates of BP control may be related to the low use of ≥2 BP-lowering medications. Although the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure notes that ≥2 medications are required for most people with hypertension, the control rates in PURE ranged from 15.7% in HIC to 13.1% in MIC to 1.6% in LIC.

Prof. Diaz noted that novel strategies to detect hypertension (such as systematic screening), simplified treatment algorithms, and facilitation of the early use of combination therapies may be helpful in improving the global control of hypertension, particularly in LIC.

The comparisons were adjusted for age and sex. The urban-rural differences in awareness (LIC and LMIC), treatment (LIC, LMIC, and UMIC), and control (LIC, LMIC, and UMIC) were significant (p<0.001).

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