Hypertension is a prevalent condition among the least educated and poorest people in low- and middle-income countries (LMICs), despite often presumed low rates of common risk factors like sedentary lifestyle and obesity, according to a study published Aug. 15 in the Journal of the American College of Cardiology. However, investment in interventions toward reducing hypertension rates and risk in these regions is lacking compared to other global health issues like HIV, tuberculosis and malaria.

Tabea K. Kirschbaum, et al., looked at hypertension rates across levels of socioeconomic status to determine the association of educational attainment and household wealth with hypertension; whether and how the relationship between socioeconomic status and hypertension differs between regions; and how socioeconomic gradients of hypertension within countries are associated with level of economic development. The researchers looked at more than 1.2 million people in 76 LMICs, which were categorized into six regions according to the World Health Organization's regional groupings: Africa, Eastern Mediterranean, Europe, the Americas, Southeast Asia and the Western Pacific. The median age was 40 years old and 58.5% were female.

Results showed that the differences in hypertension prevalence between groups divided according to education level and household wealth were small in most countries. Findings that researchers said may be "counterintuitive" because the poorest people in LMICs are often assumed to engage in large amounts of physical activity through manual labor and not be overweight or obese. However, other risk factors like aging and pollution, might be a cause of high hypertension rates. There were some variations in findings, including in Southeast Asia where there was a greater prevalence of hypertension in more educated and wealthier people and in countries with lower gross domestic product versus higher gross domestic product, but absolute differences were still small.

"Achieving equity in health requires an understanding of which health conditions are most prevalent among the most socioeconomically disadvantaged segments of society," said Pascal Geldsetzer, ScD, senior author of the study. "Policymakers who are concerned with improving health among the most disadvantaged groups may want to invest in improving hypertension prevention and control among these groups. This appears particularly justified given that we have found in previous research that adults with the least education and household wealth are least likely to be on treatment for their hypertension and ultimately achieve control of their blood pressure."

In a related editorial comment, Yashashwi Pokharel, MBBS, FACC, said the global hypertension burden is "dismal," and there has been little data on the differences in hypertension prevalence by socioeconomic status. "Now that we know that hypertension prevalence is not different in the poorest, the least educated or the least economically developed country as compared with their wealthier and educated counterparts, we should develop, test and implement effective strategies to enhance global equity in hypertension care," Pokharel explains.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Exercise, Hypertension

Keywords: Developing Countries, Blood Pressure, Overweight, Prevalence, Global Health, Economic Development, Developed Countries, Gross Domestic Product, Sedentary Behavior, Socioeconomic Factors, Hypertension, Social Class, Obesity, Risk Factors, World Health Organization, Exercise, Asia, Southeastern, Tuberculosis, Americas, Malaria, Africa, Europe, Aging, HIV Infections

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