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Hypertension prevalence, awareness, treatment and control among older people in Latin America, India and China: a 10/66 cross-sectional population-based survey

Prince, Martin J.a; Ebrahim, Shahb; Acosta, Daisyc; Ferri, Cleusa P.a; Guerra, Mariellad; Huang, Yueqine; Jacob, K.S.f; Jimenez-Velazquez, Ivonne Z.g; Rodriguez, Juan L.h; Salas, Aquilesi; Sosa, Ana L.j; Williams, Joseph D.k; Gonzalez-Viruet, Maribellag; Jotheeswaran, Amuthavilli T.l; Liu, Zhaoruie

doi: 10.1097/HJH.0b013e32834d9eda
Original papers: Therapeutics aspects

Objectives To estimate the prevalence, social patterning, treatment and control of hypertension among older people in the 10/66 Dementia Research Group developing country sites.

Methods Cross-sectional surveys of SBP, hypertension, and hypertension awareness, treatment and control among 17 014 people aged 65 years and over in eight urban and four rural sites in Latin America, India and China.

Results Hypertension prevalence was higher in urban (range 52.6–79.8%) than rural sites (range 42.6–56.9%), and lower in men than women [pooled prevalence ratio 0.89, 95% confidence interval (CI) 0.85–0.93]. Educational attainment was positively associated with hypertension in rural and least-developed sites. Age-standardized morbidity ratios, compared to USA (100), were higher in urban sites in Cuba (105), Dominican Republic (109), and Venezuela (107), similar in Puerto Rico (105), urban Mexico (99) and urban India (101), and lower in urban (75) and rural (61) Peru, rural Mexico (81), urban (91) and rural (84) China and rural India (65). In most Latin American centres, and urban China just over one-third of those with hypertension were controlled (BP < 140/90). Control was poor in rural China (2%), urban India (12%) and rural India (9%). The proportion controlled, not compositional factors (age, sex, education and obesity), explained most of the between-site variation in SBP.

Conclusion Uncontrolled hypertension is common among older people in developing countries, and may rise further during the demographic and health transitions. It is a major determinant of population SBP level. Strengthening primary care to improve hypertension management is necessary for primary prevention.

aKing's College London, Institute of Psychiatry, Health Services & Population Research Department

bSouth Asia Network for Chronic Diseases, Public Health Foundation of India, New Delhi and London School of Hygiene & Tropical Medicine, London, UK

cUniversidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine Department, Geriatric Section, Santo Domingo, Dominican Republic

dPsychogeriatric Unit, National Institute of Mental Health ‘Honorio Delgado Hideyo Noguchi’, Lima, Peru

ePeking University, Institute of Mental Health, Beijing, China

fChristian Medical College, Vellore, India

gInternal Medicine Department, Geriatrics Program, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico

hFacultad de Medicina Finlay-Albarran, Medical University of Havana, Havana, Cuba

iMedicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela

jNational Institute of Neurology and Neurosurgery of Mexico, National University Autonomous of Mexico, Mexico City, Mexico

kDepartment of Community Health, Voluntary Health Services, Chennai

lPublic Health Foundation of India, New Delhi, India

Correspondence to Martin Prince, Institute of Psychiatry, King's College London, Health Services & Population Research Department, De Crespigny Park, PO Box 60, SE5 8AF London, UKTel: +44 20 7848 0177; fax: +44 20 7848 5056; e-mail:

Abbreviations: 10/66 DRG, 10/66 Dementia Research Group; CVD, cardiovascular disease; JNC-7, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; LMIC, low and middle-income countries; NHANES, US National Health and Nutrition Examination Survey; WHO-ISH, World Health Organization/International Society of Hypertension

Received 22 May, 2011

Revised 18 September, 2011

Accepted 28 September, 2011

© 2012 Lippincott Williams & Wilkins, Inc.