Regional disparities of hypertension prevalence and management within Germany

OBJECTIVE: To investigate regional variations in the prevalence and management of hypertension in two communities in the north-east and the south-west of Germany. STUDY SETTING: Two population-based surveys of men and women aged 25-74 years, using a common standardized protocol: the Study of Health in Pomerania (SHIP; 3744 participants) and the Kooperative Gesundheitsforschung in der Region Augsburg (KORA; 4224 participants). MAIN OUTCOME MEASURES: Comparison of SHIP and KORA with regard to mean systolic (SBP) and diastolic blood pressure (DBP), prevalence of hypertension, percentage of awareness, treatment and control of hypertension in the community, by age and sex. RESULTS: The overall age-standardized prevalence of hypertension for men was 60.1% in SHIP and 41.4% in KORA; the corresponding values for women were 38.5 and 28.6%. Mean blood pressure differences were present in each 10-year age group and sex. The overall SBP difference between SHIP and KORA was 8.2 mmHg (95% confidence interval 7.2-9.3) in men and 6.3 mmHg (5.3-7.3) in women, the respective DBP differences were 3.8 mmHg (3.2-4.5) and 3.6 mmHg (3.0-4.2). Nevertheless, the percentage of awareness, treatment and control of hypertension was strikingly similar in the two studies (women, P = 0.858; and men, P = 0.564). CONCLUSIONS: The entire distribution of diastolic and systolic blood pressure values was shifted upwards in the north-eastern as compared to the south-western German population samples and the prevalences of hypertension differed accordingly. Despite such substantial epidemiologic differences, the community management of hypertension was of almost identical quality.