TY - JOUR

T1 - Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level

AU - O'Donnell, Martin

AU - Hankey, Graeme J.

AU - Rangarajan, Sumathy

AU - Chin, Siu Lim

AU - Rao-Melacini, Purnima

AU - Ferguson, John

AU - Xavier, Denis

AU - Lisheng, Liu

AU - Zhang, Hongye

AU - Pais, Prem

AU - Lopez-Jaramillo, Patricio

AU - Damasceno, Albertino

AU - Langhorne, Peter

AU - Rosengren, Annika

AU - Dans, Antonio L.

AU - Elsayed, Ahmed

AU - Avezum, Alvaro

AU - Mondo, Charles

AU - Smyth, Andrew

AU - Judge, Conor

AU - Diener, Hans Christoph

AU - Ryglewicz, Danuta

AU - Czlonkowska, Anna

AU - Pogosova, Nana

AU - Weimar, Christian

AU - Iqbal, Romana

AU - Diaz, Rafael

AU - Yusoff, Khalid

AU - Yusufali, Afzalhussein

AU - Oguz, Aytekin

AU - Wang, Xingyu

AU - Penaherrera, Ernesto

AU - Lanas, Fernando

AU - Ogah, Okechukwu Samuel

AU - Ogunniyi, Adensola

AU - Iversen, Helle K.

AU - Malaga, German

AU - Rumboldt, Zvonko

AU - Oveisgharan, Shahram

AU - Alhussain, Fawaz

AU - Daliwonga, Magazi

AU - Nilanont, Yongchai

AU - Yusuf, Salim

N1 - Funding Information: Contributors All authors contributed to the collection of data, discussions and interpretation of the data, and to the writing of the report. All authors reviewed and approved the manuscript for submission. The study was designed, the analyses were planned and the manuscript was drafted by MO’D and SY. Statistical analyses were performed by PR-M and JF. MO’D and SY wrote the first draft of the manuscript. Funding The INTERSTROKE study is funded by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, and through unrestricted grants from several pharmaceutical companies with major contributions from Astra Zeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MERCK, Sharp and Dohme], Swedish Heart and Lung Foundation, UK Chest, and UK Heart and Stroke. Disclaimer No medical writer or other people were involved in the design, analysis or writing of this manuscript. Publisher Copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - 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.

AB - 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.

KW - epidemiology

KW - hypertension

KW - stroke

U2 - 10.1136/heartjnl-2019-316515

DO - 10.1136/heartjnl-2019-316515

M3 - Journal article

C2 - 33318082

AN - SCOPUS:85097961252

VL - 107

SP - 282

EP - 289

JO - Heart

JF - Heart

SN - 1355-6037

IS - 4

ER -