Which older people are most at risk of health conditions like hypertension?

Question: Hypertension (aka dangerously high blood pressure) is the leading cause of death and illness for older people in low and middle income countries. This is because it substantially increases the risk older people face of other diseases such as stroke, heart disease and dementia. Data for the six SAGE countries reveal very large variations in the national prevalence of hypertension. They are also show variations in the extent that people are aware of these conditions and receive effective treatment. What are the causes of these national variations, as well as for variations within countries? It is sometimes assumed that in poorer countries conditions like hypertension mainly affect more affluent and urban populations –is this really true?

What we did: For all six SAGE countries, we looked at patterns of obesity, hypertension prevalence, awareness, treatment and control among people aged 50 and over. Among other things, we made comparisons according to their level of wealth, education and location. We also looked at the influence of having health insurance and frequency of outpatient service use. We conducted multivariate analysis to tease out specific associations.

What we found: Our preliminary analysis shows that rates of obesity are the main explanation for national differences in hypertension prevalence. In some countries, including Mexico and South Africa, obesity is a widespread problem among older people, including the poor and rural residents. Poverty and rural residence were often associated with lower awareness, treatment and control of hypertension. The effects of health insurance were not significant, with the exception of Mexico. Our more detailed analysis is currently under review (so watch this space).

What lessons can we take from this: Our research challenges the view that in developing countries conditions such as hypertension primarily affect more affluent, urban populations. It also demonstrates the importance of the details of insurance scheme design, and the potential for other countries to learn from Mexico.

For further information see: 

Lloyd-Sherlock, P., Minicuci, N., Beard, J., Ebrahim, S. and Chatterji, S. (2014) “Hypertension among older adults in low and middle income countries: prevalence, awareness and control” International Journal of Epidemiology 14(1):116-128. Full text here - also available on the UEA Repository. 

Lloyd-Sherlock, P., Ebrahim, S. and Grosskurth, G. (2014) “Is hypertension the new HIV epidemic?” International Journal of Epidemiology 14(1):1-3. Full text here - also available on the UEA Repository.

Hypertension and older people. HelpAge International Policy Brief. 

P.Lloyd-Sherlock (2015) “Investing in the health of older people in low and middle income countries: the case of hypertension”. In Age International (Page 34). Facing the facts: the truth about ageing and development. London.