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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level
Heart, Volume 107, No. 4, Year 2021
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Description
Objective Hypertension is the most important modifiable risk factor for stroke globally. We hypothesised that country-income level variations in knowledge, detection and treatment of hypertension may contribute to variations in the association of blood pressure with stroke. Methods We undertook a standardised case-control study in 32 countries (INTERSTROKE). Cases were patients with acute first stroke (n=13 462) who were matched by age, sex and site to controls (n=13 483). We evaluated the associations of knowledge, awareness and treatment of hypertension with risk of stroke and its subtypes and whether this varied by gross national income (GNI) of country. We estimated OR and population attributable risk (PAR) associated with treated and untreated hypertension. Results Hypertension was associated with a graded increase in OR by reducing GNI, ranging from OR 1.92 (99% CI 1.48 to 2.49) to OR 3.27 (2.72 to 3.93) for highest to lowest country-level GNI (p-heterogeneity<0.0001). Untreated hypertension was associated with a higher OR for stroke (OR 5.25; 4.53 to 6.10) than treated hypertension (OR 2.60; 2.32 to 2.91) and younger age of first stroke (61.4 vs 65.4 years; p<0.01). Untreated hypertension was associated with a greater risk of intracerebral haemorrhage (OR 6.95; 5.61 to 8.60) than ischaemic stroke (OR 4.76; 3.99 to 5.68). The PAR associated with untreated hypertension was higher in lower-income regions, PAR 36.3%, 26.3%, 19.8% to 10.4% by increasing GNI of countries. Lifetime non-measurement of blood pressure was associated with stroke (OR 1.80; 1.32 to 2.46). Conclusions Deficits in knowledge, detection and treatment of hypertension contribute to higher risk of stroke, younger age of onset and larger proportion of intracerebral haemorrhage in lower-income countries. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Authors & Co-Authors
O'Donnell, Martin J.
Ireland, Galway
University of Galway
Hankey, Graeme J.
Australia, Perth
The University of Western Australia
Rangarajan, Sumathy
Canada, Hamilton
Population Health Research Institute, Ontario
Chin, Siu Lim
Canada, Hamilton
Population Health Research Institute, Ontario
Rao-Melacini, Purnima
Canada, Hamilton
Population Health Research Institute, Ontario
Ferguson, John P.
Ireland, Galway
University of Galway
Xavier, Denis
India, Bengaluru
St John's Research Insitiute
Lisheng, Liu
China, Beijing
National Center for Cardiovascular Diseases
China, Beijing
Beijing Hypertension League Institute
Zhang, Hongye
China, Beijing
Beijing Hypertension League Institute
Pais, Prem S.
India, Bengaluru
St. John's National Academy of Health Sciences India
López-Jaramillo, P.
Colombia, Bucaramanga
Universidad de Santander
Damasceno, A. Antonio Moura
Mozambique, Maputo
Universidade Eduardo Mondlane
Langhorne, Peter
United Kingdom, Glasgow
Glasgow Royal Infirmary
Rosengren, Annika H.
Sweden, Gothenburg
Göteborgs Universitet
Dans, Antonio L.L.
Philippines, Manila
University of the Philippines College of Medicine
ElSayed, Ahmed Sayed
Sudan, Khartoum
Alzaiem Alazhari University
Avezum, Álvaro Jr
Brazil, Sao Paulo
Hospital Alemao Oswaldo Cruz
Mondo, Charles Kiiza
Uganda, Kampala
Kiruddu National Referral Hospital
Smyth, Andrew
Ireland, Galway
University of Galway
Judge, Conor S.
Ireland, Galway
University of Galway
Diener, Hans Christoph W.
Germany, Essen
Universitätsklinikum Essen
Ryglewicz, Danuta Krystyna
Poland, Warsaw
Military Institute of Aviation Medicine
Członkowska, Anna
Poland, Warsaw
Military Institute of Aviation Medicine
Posogova, Nana
Russian Federation, Moscow
National Medical Research Center of Cardiology of the Ministry of Healthcare of the Russian Federation
Weimar, Christian
Germany, Duisburg
Universität Duisburg-essen
Germany, Elzach
Bdh-clinic Elzach
Iqbal, Romaina
Pakistan, Karachi
The Aga Khan University
Díaz, Rafaël J.
Argentina, Rosario
Estudios Clínicos Latinoamérica, Argentina
Yusoff, Khalid
Malaysia, Kuala Lumpur
Ucsi University
Yusufali, Afzal Hussein
United Arab Emirates, Dubai
Dubai Medical College
Oǧuz, Aytekin
Turkey, Istanbul
Istanbul Medeniyet University
Wang, Xingyu
China, Beijing
Beijing Hypertension League Institute
Peñaherrera, Ernesto
Ecuador, Guayaquil
Hospital Luis Vernaza
Ogah, Okechukwu Samuel
Nigeria, Ibadan
University of Ibadan
Ogunniyi, Adesola O.
Nigeria, Ibadan
University College Hospital, Ibadan
Iversen, Helle Klingenberg
Denmark, Copenhagen
Rigshospitalet
Málaga, Germán M.
Peru, Lima
Universidad Peruana Cayetano Heredia
Rumboldt, Zvonko
Croatia, Split
University of Split
Oveisgharan, Shahram
United States, Chicago
Rush University Medical Center
Alhussain, Fawaz
Saudi Arabia, Riyadh
King Saud University
Daliwonga, Magazi
South Africa, Sovenga
University of Limpopo
Nilanont, Yongchai
Thailand, Nakhon Pathom
Mahidol University
Yusuf, Salim N.
Canada, Hamilton
Population Health Research Institute, Ontario
Statistics
Citations: 30
Authors: 42
Affiliations: 36
Identifiers
Doi:
10.1136/heartjnl-2019-316515
ISSN:
13556037
Research Areas
Genetics And Genomics
Noncommunicable Diseases
Study Design
Cross Sectional Study
Case-Control Study