What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Undiagnosed hypertension (n=8835). Intervention: Low socioeconomic status (poorest wealth quintile) vs. High socioeconomic status (richest wealth quintile). Primary outcome: Undiagnosed hypertension (OR 1.86, 95% CI 1.25-2.78, p=<0.01).

What does this research mean for the field?

Among Bangladeshi adults with hypertension, 59.9% are undiagnosed, with individuals in the poorest wealth quintile having significantly higher odds of remaining undiagnosed compared to the richest quintile. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 15, 2019Open Access

Inequalities in the prevalence of undiagnosed hypertension among Bangladeshi adults: evidence from a nationwide survey

Q: What are the key findings of this study?

Among Bangladeshi adults with hypertension, 59.9% were undiagnosed, with individuals in the poorest wealth quintile having significantly higher odds of being undiagnosed compared to the richest quintile (OR 1.86).

Q: What does this research mean for the field?

Among Bangladeshi adults with hypertension, 59.9% are undiagnosed, with individuals in the poorest wealth quintile having significantly higher odds of remaining undiagnosed compared to the richest quintile. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Among Bangladeshi adults with hypertension, 59.9% were undiagnosed, with individuals in the poorest wealth quintile having significantly higher odds of being undiagnosed compared to the richest quintile (OR 1.86).

Study Design

Type

Cross-Sectional (n=8,835)

Multicenter

Yes

Structured PICO

Population

8,835 adults aged 35 years and older from a nationally representative survey in Bangladesh, of whom 1,685 had hypertension, were analyzed to determine the prevalence and socioeconomic inequalities of undiagnosed hypertension.

Outcome

Prevalence of undiagnosed hypertension (defined as having SBP ≥140 mmHg or DBP ≥90 mmHg and never taking prescribed medicine or being told by health professionals to lower/control blood pressure)

A large proportion (59.9%) of hypertensive adults in Bangladesh remain undiagnosed, with significant socioeconomic inequalities disproportionately affecting the poor and less educated.

Main Result

Odds Ratio: 1.86 (95% CI 1.25–2.78)

Absolute Event Rate: 69.7% vs 50.8%

p-value: p=<0.01

Limitations

Blood pressure was measured three times on a single day rather than monitored for a prolonged period.
The cross-sectional nature of the data prevents establishing causal relationships between risk factors and undiagnosed hypertension.

Abstract

BACKGROUND: In recent years, developing countries like Bangladesh are facing a higher burden of non-communicable diseases such as hypertension as a result of demographic transition. Prevalence of hypertension is often studied in this setting. However, evidence on undiagnosed hypertension is not widely available in the existing literature. Therefore, the current study focuses on inequalities in the prevalence of undiagnosed hypertension in Bangladesh. METHODS: A total of 8835 participants aged 35+ years were included in this study using nationally representative Bangladesh Demographic and Health Survey 2011 (BDHS). In the survey, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of these participants were measured three times with approximately 10 minutes of an interval between each measurement. Any respondent with either SBP ≥ 140 mmHg or DBP ≥ 90 mmHg was considered as patient with hypertension as per the guidelines from American Heart Association. Among the participants, undiagnosed hypertension was defined as having SBP > =140 mmHg or DBP > =90 mmHg and never taking prescribed medicine or being told by health professionals to lower/control blood pressure. Multiple logistic regression analysis was applied for identifying factors associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (C). RESULTS: We found 978 (59.9% of the total) were undiagnosed among 1685 hypertensive patients studied. Regression analysis showed individuals with being underweight, having poor socioeconomic conditions, and lower educational qualifications were more likely to have undiagnosed hypertension. A similar association between undiagnosed hypertension and socioeconomic quintiles was observed using concentration index (C = - 0.07). On the other hand, individuals from higher age group (50-64 or above), female sex, and Sylhet region were at lower risk of undiagnosed hypertension. CONCLUSIONS: This study showed that a large proportion of the cases with hypertension are remained undiagnosed in Bangladesh, especially among the poor and low educated population. Screening and awareness building initiatives on hypertension should be taken for this group of population to reduce the burden of undiagnosed hypertension.

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