Publication:
Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level

Issued Date

2021-02-01

Resource Type

Article

ISSN

1468201X
13556037

DOI

10.1136/heartjnl-2019-316515

Other identifier(s)

2-s2.0-85097961252

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Heart. Vol.107, No.4 (2021), 282-289

Suggested Citation

Martin O'Donnell, Graeme J. Hankey, Sumathy Rangarajan, Siu Lim Chin, Purnima Rao-Melacini, John Ferguson, Denis Xavier, Liu Lisheng, Hongye Zhang, Prem Pais, Patricio Lopez-Jaramillo, Albertino Damasceno, Peter Langhorne, Annika Rosengren, Antonio L. Dans, Ahmed Elsayed, Alvaro Avezum, Charles Mondo, Andrew Smyth, Conor Judge, Hans Christoph Diener, Danuta Ryglewicz, Anna Czlonkowska, Nana Pogosova, Christian Weimar, Romana Iqbal, Rafael Diaz, Khalid Yusoff, Afzalhussein Yusufali, Aytekin Oguz, Xingyu Wang, Ernesto Penaherrera, Fernando Lanas, Okechukwu Samuel Ogah, Adensola Ogunniyi, Helle K. Iversen, German Malaga, Zvonko Rumboldt, Shahram Oveisgharan, Fawaz Alhussain, Magazi Daliwonga, Yongchai Nilanont, Salim Yusuf Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level. Heart. Vol.107, No.4 (2021), 282-289. doi:10.1136/heartjnl-2019-316515 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78490

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Title

Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level

Author(s)

Martin O'Donnell
 Graeme J. Hankey
 Sumathy Rangarajan
 Siu Lim Chin
 Purnima Rao-Melacini
 John Ferguson
 Denis Xavier
 Liu Lisheng
 Hongye Zhang
 Prem Pais
 Patricio Lopez-Jaramillo
 Albertino Damasceno
 Peter Langhorne
 Annika Rosengren
 Antonio L. Dans
 Ahmed Elsayed
 Alvaro Avezum
 Charles Mondo
 Andrew Smyth
 Conor Judge
 Hans Christoph Diener
 Danuta Ryglewicz
 Anna Czlonkowska
 Nana Pogosova
 Christian Weimar
 Romana Iqbal
 Rafael Diaz
 Khalid Yusoff
 Afzalhussein Yusufali
 Aytekin Oguz
 Xingyu Wang
 Ernesto Penaherrera
 Fernando Lanas
 Okechukwu Samuel Ogah
 Adensola Ogunniyi
 Helle K. Iversen
 German Malaga
 Zvonko Rumboldt
 Shahram Oveisgharan
 Fawaz Alhussain
 Magazi Daliwonga
 Yongchai Nilanont
 Salim Yusuf

Other Contributor(s)

Siriraj Hospital
 Dubai Health Authority
 Universidad de Santander
 Istanbul Medeniyet University
 Estudios Clínicos Latinoamérica, Argentina
 Military Institute of Aviation Medicine
 Alzaiem Alazhari University
 Universidade Eduardo Mondlane
 Hospital Luis Vernaza
 University of the Philippines College of Medicine
 Universidad Peruana Cayetano Heredia
 National Medical Research Center of Cardiology, Moscow
 The Aga Khan University
 The University of Western Australia
 Sahlgrenska Universitetssjukhuset
 Københavns Universitet
 St. John's National Academy Of Health Sciences India
 Hospital Alemao Oswaldo Cruz
 Rush University Medical Center
 University College Hospital, Ibadan
 University of Limpopo
 Universität Duisburg-Essen
 King Saud University
 Universidad de la Frontera
 NUI Galway
 Hamilton Health Sciences
 Universitätsklinikum Essen
 Sveučilište u Splitu
 University of Ibadan
 Universiti Teknologi MARA
 University of Glasgow
 St John's Research Insitiute
 Kiruddu National Referral Hospital
 National Center for Cardiovascular Diseases
 BDH Clinic Elzach
 Beijing Hypertension League Institute

Abstract

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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/78490

Collections

Scopus 2021