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

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dc.contributor.author O'Donnell, Martin
dc.contributor.author Hankey, Graeme J.
dc.contributor.author Rangarajan, Sumathy
dc.contributor.author Chin, Siu Lim
dc.contributor.author Rao-Melacini, Purnima
dc.contributor.author Ferguson, John
dc.contributor.author Xavier, Denis
dc.contributor.author Lisheng, Liu
dc.contributor.author Zhang, Hongye
dc.contributor.author Pais, Prem
dc.contributor.author Lopez-Jaramillo, Patricio
dc.contributor.author Damasceno, Albertino
dc.contributor.author Langhorne, Peter
dc.contributor.author Rosengren, Annika
dc.contributor.author Dans, Antonio L.
dc.contributor.author Elsayed, Ahmed
dc.contributor.author Avezum, Alvaro
dc.contributor.author Mondo, Charles
dc.contributor.author Smyth, Andrew
dc.contributor.author Judge, Conor
dc.contributor.author Diener, Hans-Christoph
dc.contributor.author Ryglewicz, Danuta
dc.contributor.author Czlonkowska, Anna
dc.contributor.author Pogosova, Nana
dc.contributor.author Weimar, Christian
dc.contributor.author Iqbal, Romana
dc.contributor.author Diaz, Rafael
dc.contributor.author Yusoff, Khalid
dc.contributor.author Yusufali, Afzalhussein
dc.contributor.author Oguz, Aytekin
dc.contributor.author Wang, Xingyu
dc.contributor.author Penaherrera, Ernesto
dc.contributor.author Lanas, Fernando
dc.contributor.author Ogah, Okechukwu Samuel
dc.contributor.author Ogunniyi, Adensola
dc.contributor.author Iversen, Helle K.
dc.contributor.author Málaga Rodríguez, Germán Javier
dc.contributor.author Rumboldt, Zvonko
dc.contributor.author Oveisgharan, Shahram
dc.contributor.author AlHussain, Fawaz
dc.contributor.author Daliwonga, Magazi
dc.contributor.author Nilanont, Yongchai
dc.contributor.author Yusuf, Salim
dc.date.accessioned 2021-04-13T20:50:57Z
dc.date.available 2021-04-13T20:50:57Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/9106
dc.description.abstract 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. en_US
dc.language.iso eng
dc.publisher BMJ Publishing Group
dc.relation.ispartofseries Heart
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject adult en_US
dc.subject aged en_US
dc.subject Article en_US
dc.subject controlled study en_US
dc.subject female en_US
dc.subject human en_US
dc.subject major clinical study en_US
dc.subject male en_US
dc.subject middle aged en_US
dc.subject priority journal en_US
dc.subject disease association en_US
dc.subject blood pressure en_US
dc.subject epidemiology en_US
dc.subject antihypertensive agent en_US
dc.subject antihypertensive therapy en_US
dc.subject awareness en_US
dc.subject blood pressure measurement en_US
dc.subject brain hemorrhage en_US
dc.subject brain ischemia en_US
dc.subject cardiovascular risk en_US
dc.subject case control study en_US
dc.subject cerebrovascular accident en_US
dc.subject clinical outcome en_US
dc.subject country economic status en_US
dc.subject gross national income en_US
dc.subject hypertension en_US
dc.subject knowledge en_US
dc.subject low income country en_US
dc.subject population attributable risk en_US
dc.subject prevalence en_US
dc.subject risk en_US
dc.subject risk assessment en_US
dc.subject risk factor en_US
dc.subject self report en_US
dc.subject stroke en_US
dc.title Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1136/heartjnl-2019-316515
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.04
dc.relation.issn 1468-201X


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