Social Epidemiology of Hypertension Stages
To the Editor:
We read with great interest the article by Basu and Millett1 on social epidemiology of hypertension in low- and middle-income countries from World Health Organization’s Study on global AGEing and adult health (SAGE).
Categorical definitions of hypertension show additional variation in hypertension prevalence and social determinants of awareness compared with dichotomous definitions. Roughly half of the total SAGE sample with measured hypertension (n=16 945) would be classified as stage 2.2 Half of those with stage 2 in SAGE’s South Africa and Ghana samples could be reclassified as World Health Organization/International Society of Hypertension stage 3.3 We found the association between sex and hypertension awareness Basu and Millett showed varied by hypertension stage. Men had significantly lower probability of hypertension awareness than women at stage 1 (Wald P<0.001; Figure), but not at stage 2.
Extending Basu and Millett’s laudable work, future studies might examine social patterning across the full distribution of blood pressure. Disaggregated information on hypertension stages and their social determinants is critical for informed clinical decision making, epidemiological surveillance, and health policy planning and evaluation in low- and middle-income countries facing high burdens of hypertension.
Benjamin D. Capistrant
Division of Epidemiology and Community Health
University of Minnesota
Department of Health Statistics and Information Systems
World Health Organization
Sources of Funding
This work was supported by National Institutes of Health (T32 HD007168, R24 HD050924, and R01 AG034479-01A1) and the governments of China and South Africa.
- © 2013 American Heart Association, Inc.
- Basu S,
- Millett C
- Lenfant C,
- Chobanian AV,
- Jones DW,
- Roccella EJ