Hypertension is common among the world’s poorest and least educated

Hypertension is a prevalent condition among the poorest and least educated people in low- and middle-income countries (LICs), despite often presumed low rates of common risk factors such as sedentary lifestyle and obesity, according to a study published in the ‘Journal of the American College of Cardiology’. However, investment in interventions aimed at reducing hypertension rates and risk in these regions is scarce compared to other global health problems such as HIV, tuberculosis and malaria. Hypertension is a highly prevalent but modifiable risk factor for cardiovascular disease. It is also estimated to be the main cause of death in the PBIs and the PIMs; however, hypertension is often thought to primarily affect wealthier individuals in those countries. Researchers in this study examined rates of hypertension across socioeconomic levels to determine the association between educational level and household wealth with hypertension; whether the relationship between socioeconomic status and hypertension differs across regions, and how socioeconomic gradients in hypertension within countries are associated with the level of economic development.”To achieve equity in health, it is necessary to understand what conditions of health are more prevalent among socioeconomically disadvantaged segments of society,” explains Pascal Geldsetzer, lead author of the study and assistant professor of medicine in the Division of Primary Care and Population Health at Stanford University. “This is especially important in the case of hypertension, as people with low socioeconomic status are often the least able to access high-quality stroke and heart attack care, and are often the most dependent on their health to make a living,” he adds. The researchers looked at more than 1.2 million people from 76 LMICs, qu e were classified into six regions according to the World Health Organization regional groupings: Africa, Eastern Mediterranean, Europe, Americas, Southeast Asia and Western Pacific. The mean age was 40 years and 58.5% were women. They found that differences in the prevalence of hypertension between groups divided by level of education and household wealth were small in most countries. These conclusions, according to the researchers, may be “contradictory”, since it is often assumed that the poorest people in LMICs get a lot of physical activity through manual labor and are not overweight or obese. However, other risk factors, such as aging and pollution, could be a cause of the high rates of hypertension. There were some variations in the results, such as in Southeast Asia, where there was a higher prevalence of hypertension in people educated and wealthier and in countries with lower gross domestic product versus higher gross domestic product, but the absolute differences were still small.”Policymakers concerned with improving the health of the most disadvantaged groups could invest in prevention and control of hypertension among these groups,” adds Geldsetzer. “This seems particularly warranted given that we have found in previous research that adults with less education and family wealth are the least likely to be on treatment for their hypertension and ultimately gain control of your blood pressure.” In an editorial comment regarding Onado, Yashashwi Pokharel, associate professor of cardiology and affiliated with the Office of Global Health at Wake Forest School of Medicine, notes that the burden of hypertension worldwide is “grim,” and that there have been few data on differences in prevalence of hypertension by socioeconomic status.”Now that we know that the prevalence of hypertension is no different in the poorest, least educated, or least economically developed countries compared to their richer, more educated counterparts, we need to develop, test and implement effective strategies to improve global equity in hypertension care,” Pokharel concludes.