Hypertension affects full spectrum of socioeconomic groups across countries
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Differences in the prevalence of hypertension between socioeconomic groups are relatively small across low- and middle-income countries, data from cross-sectional interaction analyses show.
“We found that the differences in hypertension prevalence between education and household wealth groups were small in most low- and middle-income countries,” Pascal Geldsetzer, MD, PhD, MPH, assistant professor of medicine in the department of medicine at Stanford University, told Healio. “The frequent assumption that hypertension mostly affects the wealthiest and most educated groups in low- and middle-income countries appears to be largely untenable.”
International survey data
Geldsetzer and colleagues analyzed pooled, nationally representative household survey data from 76 low- and middle-income countries for 1,211,386 participants, of which 58 surveys were from the WHO Stepwise Approach to Surveillance. All surveys were conducted after 2005, were nationally representative for at least two 10-year age groups older than 15 years, had a response rate of at least 50% and included at least two BP measurements. Researchers defined hypertension as a systolic BP of at least 140 mm Hg and a diastolic BP of at least 90 mm Hg or participants reporting taking BP-lowering medication. Education and household wealth were used as measures of socioeconomic status. The researchers disaggregated hypertension prevalence by quintiles of education and household wealth, using regression analyses to adjust for age and sex.
Within the cohort, 19.6% had hypertension. Survey-level median age was 40 years; a survey-level median of 58.5% of participants were women.
Pooling across all countries, hypertension prevalence tended to be similar between education groups and household wealth quintiles. Only Southeast Asia showed a “clear, positive association” of hypertension with education or household wealth quintile; the RR for the wealthiest vs. the least wealthy quintile was 1.28 (95% CI, 1.22-1.34).
“Across the six regions studied, the socioeconomic gradient associated with hypertension tended to be relatively flat,” the researchers wrote.
Countries with a lower GDP per capita had, on average, a more positive association of hypertension with education and household wealth quintile than countries with a higher GDP per capita, especially in rural areas and among men, according to the researchers. There were similar patterns of the interaction of gross domestic product with the socioeconomic gradient of hypertension for rural and urban populations and after adjusting for BMI.
“It is important to examine to what degree raised blood pressure confers a different risk of mortality among different socioeconomic groups in low- and middle-income countries,” Geldsetzer told Healio. “In communities that suffer a high risk of mortality from infectious causes, the risk of death from CVD may be substantially lower, even if the prevalence of CVD risk factors like hypertension is high, because individuals die from other causes before they experience a heart attack or stroke. So, it is important to understand the mortality and morbidity burden caused by hypertension in different socioeconomic groups in low- and middle-income countries to inform the degree to which hypertension prevention and treatment should be prioritized in relation to other health conditions.”
‘Enhance global equity’ in hypertension care
In a related editorial, Yashashwi Pokharel, MBBS, MSCR, a preventive cardiologist at Wake Forest Baptist Health, and colleagues wrote that implementation of hypertension population management programs requires an estimated annual cost per person of less than $1 in low-income countries and less than $1.50 in low- and middle-income countries.
“Now that we know that hypertension prevalence is not different in the poorest, the least educated or the least economically developed countries compared with their wealthier and educated counterparts, we should develop, test and implement effective strategies to enhance global equity in hypertension care," Pokharel and colleagues wrote. “Lessons learned globally, like in rural Nepal, can inform hypertension program implantation locally, such as in rural North Carolina.”
Reference:
Pokharel Y, et al. J Am Coll Cardiol. 2022;doi:10.1016/j.jacc.2022.05.043.
For more information:
Pascal Geldsetzer, MD, PhD, MPH, can be reached at pgeldsetzer@gmail.com; Twitter: @pgeldsetzer1.
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