American Journal of Hypertension 30(4) April 2017 373 ORIGINAL ARTICLE Elevated systolic blood pressure (BP) and hypertension leads to more deaths worldwide than any other risk factor. 1 Global Burden of Disease study has reported that elevated systolic BP accounts for 7.0% of disability adjusted life years and 9.4 mil- lion annual deaths in the world. 2 It is an important public health problem in South Asian countries and is the second-most important risk factor for disease burden as well as mortality. 3 Surveys have reported that hypertension is present in 20–30% of adults in this region. 4–6 Adequate control of hypertension is crucial to prevent its cardiovascular complications. 7 Besides availability and intake of medicines, efective hypertension treatment and control is dependent on multiple factors. Tese include macro-level societal factors (e.g., lack of social poli- cies, poor economics), health-systems-related factors (lack of Association of Household Wealth Index, Educational Status, and Social Capital with Hypertension Awareness, Treatment, and Control in South Asia Rajeev Gupta, 1 Manmeet Kaur, 2 Shofqul Islam, 3 Viswanathan Mohan, 4 Prem Mony, 5 Rajesh Kumar, 2 Vellappillil Raman Kutty, 6 Romaina Iqbal, 7 Omar Rahman, 8 Mohan Deepa, 4 Justy Antony, 5 Krishnapillai Vijaykumar, 6 Khawar Kazmi, 7 Rita Yusuf, 8 Indu Mohan, 1 Raja Babu Panwar, 9 Sumathy Rangarajan, 3 and Salim Yusuf 3 OBJECTIVE Hypertension control rates are low in South Asia. To determine associa- tion of measures of socioeconomic status (wealth, education, and social capital) with hypertension awareness, treatment, and control among urban and rural subjects in these countries we performed the present study. METHODS We enrolled 33,423 subjects aged 35–70 years (women 56%, rural 53%, low-education status 51%, low household wealth 25%, low-social capi- tal 33%) in 150 communities in India, Pakistan, and Bangladesh during 2003–2009. Prevalence of hypertension and its awareness, treatment, and control status and their association with wealth, education, and social capital were determined. RESULTS Age-, sex-, and location-adjusted prevalence of hypertension in men was 31.5% (23.9–40.2%) and women was 32.6% (24.9–41.5%) with vari- ations in prevalence across study sites (urban 30–56%, rural 11–43%). Prevalence was signifcantly greater in urban locations, older subjects, and participants with more wealth, greater education, and lower social capital index. Hypertension awareness was in 40.4% (urban 45.9, rural 32.5), treatment in 31.9% (urban 37.6, rural 23.6), and control in 12.9% (urban 15.4, rural 9.3). Control was lower in men and younger subjects. Hypertension awareness, treatment, and control were signifcantly lower, respectively, in lowest vs. highest wealth index tertile (26.2 vs. 50.6%, 16.9 vs. 44.0%, and 6.9 vs. 17.3%, P < 0.001) and lowest vs. high- est educational status tertile (31.2 vs. 48.4%, 21.8 vs. 42.1%, and 7.8 vs. 19.2%, P < 0.001) while insignifcant diferences were observed in low- est vs. highest social capital index (38.2 vs. 36.1%, 35.1 vs. 27.8%, and 12.5 vs. 9.1%). CONCLUSIONS This study shows low hypertension awareness, treatment, and control in South Asia. Lower wealth and educational status are important in low hypertension awareness, treatment, and control. Keywords: adherence; blood pressure; hypertension; hypertension epi- demiology; hypertension control; social determinants; socioeconomic status. doi:10.1093/ajh/hpw169 Correspondence: Rajeev Gupta (rajeevgg@gmail.com). Initially submitted September 26, 2016; date of frst revision October 31, 2016; accepted for publication December 22, 2016; online publication January 7, 2017. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com 1 Department of Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India; 2 School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India; 3 Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada; 4 Madras Diabetes Research Foundation, Chennai, India; 5 Department of Community Medicine, St John’s Medical College and Research Institute, Bangalore, India; 6 Health Action by People, Thiruvananthapuram, India; 7 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan; 8 School of Life Sciences, Independent University, Dhaka, Bangladesh; and 9 Administrative Office, Rajasthan University of Health Sciences, Jaipur, India. Downloaded from https://academic.oup.com/ajh/article-abstract/30/4/373/2870264 by guest on 03 June 2020