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Risk factors associated with hypertension awareness, treatment, and control in a multi-ethnic Asian population

Wu, Yia; Tai, E Shyongb; Heng, Derrickc; Tan, Chee Engd; Low, Lip Pinge; Lee, Jeannettef

doi: 10.1097/HJH.0b013e328317c8c3
Original papers: Therapeutic aspects

Objectives To investigate demographic and cardiovascular disease risk factors associated with awareness, treatment and control of hypertension in a multi-ethnic Asian population.

Methods Participants from four previous cross-sectional studies were invited for a repeat examination (2004–2007). Information of demographic details and cardiovascular disease risk factors was obtained using questionnaire, physical examination and blood tests. Odds ratios and 95% confidence intervals were calculated using multiple logistic regression models.

Results The final number of respondents was 5022 (response rate 49.7%). Although hypertension treatment (84.4% of those aware of hypertension) was high, awareness (51.8% of those having hypertension) and control (27.1% of hypertension on treatment) were low. Reduced awareness and treatment were associated with being younger, never married, and working adults with a higher education level. Low socioeconomic status individuals were more likely to be treated but had poorer control. A similar relationship was found for treatment and control for individuals with coexisting cardiovascular disease risk factors. The use of multiple drug classes was not associated with better control. Diuretic use for treatment of hypertension, as recommended by local and international guidelines, was not common (15.0% of all hypertension medications used).

Conclusions The awareness, treatment, and control of hypertension in Singapore can be improved. There is a need to improve awareness through education and target screening and treatment in younger, working adults with higher levels of education and higher economic status, as well as Malays. Control of hypertension could be improved among older or diabetic hypertensive individuals.

aCentre for Molecular Epidemiology, National University of Singapore

bDepartment of Endocrinology, Singapore General Hospital, Singapore

cMinistry of Health, Singapore

dGleneagles Medical Centre, Singapore

eLow Cardiology Clinic, Mt Elizabeth Medical Centre, Singapore

fCommunity, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

Received 23 June, 2008

Revised 26 August, 2008

Accepted 3 September, 2008

Correspondence to Dr Jeannette Lee, Assistant Professor, Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, MD3 National University of Singapore, 16 Medical Drive, Singapore 117597, Singapore Tel: +65 65164964; fax: +65 67791489; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.