Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Association of socio-demographic characteristics with hypertension awareness, treatment, and control in Bangladesh

Journal of Human Hypertension volume 37, pages 993–999 (2023)Cite this article

Subjects

Abstract

Hypertension has been rapidly growing in Bangladesh. However, there has been limited analysis of differences in the hypertension cascade across socio-demographic groups. This study was a secondary analysis of the 2017–18 Bangladesh Demographic and Health Survey. Four dichotomous outcome variables – hypertension prevalence, awareness among those with hypertension, treatment among those aware, and control among those treated – were analyzed. The variation of each outcome was assessed across socio-demographic factors. The association between socio-demographic characteristics and outcomes was analyzed using logistic regression. Less than half of the hypertensive individuals were aware of their hypertension (42.5%), and awareness was higher among those who were older, female, of higher household wealth, and living in urban areas. Among those aware, most were receiving treatment (87.4%), and this proportion was higher in older individuals (89.2% among 65 + , 70.4% among 18–24; p < 0.001). One-third of those treated (33.8%) had their blood pressure controlled, and this was higher among younger and more educated individuals. In multivariable models stratified by rural/urban community, most of the aforementioned trends remained with additional differences between communities. Notably, the association of higher education level with treatment odds differed in rural and urban communities (OR 0.34 [95%CI 0.16, 0.75] in rural; OR 2.83 [95%CI 1.04, 7.73] in urban). Efforts to improve hypertension awareness among individuals who are younger, male, of lower household wealth, and in rural areas are required to address disparities in care. Socio-demographic variations in hypertension awareness, treatment, and control must be considered to design targeted interventions for each step of the cascade.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Proportion of hypertension awareness, treatment, and control out of all individuals with hypertension in Bangladesh.

Similar content being viewed by others

Data availability

All questionnaire data for the 2017–18 BDHS was requested from the DHS Program, which provides this data to individuals for academic purposes upon request and registration. The dataset can be found at https://dhsprogram.com/methodology/survey/survey-display-536.cfm.

References

  1. Abbafati C, Machado DB, Cislaghi B, Salman OM, Karanikolos M, McKee M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1223–49.

    Article  Google Scholar 

  2. Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. The Lancet: Lancet Publishing Group; 2016. p. 2665–712.

  3. Danaei G, Singh GM, Paciorek CJ, Lin JK, Cowan MJ, Finucane MM, et al. The global cardiovascular risk transition: Associations of four metabolic risk factors with national income, urbanization, and western diet in 1980 and 2008. Circulation. 2013;127:1493–502.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control. Circulation 2016;134:441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States; 2020.

  6. Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. J Am Med Assoc. 2007;297:286–94.

    Article  CAS  Google Scholar 

  7. Akl C, Akik C, Ghattas H, Obermeyer CM. The cascade of care in managing hypertension in the Arab world: A systematic assessment of the evidence on awareness, treatment and control. BMC Public Health. 2020;20:835.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA - J Am Med Assoc. 2013;310:959–68.

    Article  CAS  Google Scholar 

  9. Wozniak G, Khan T, Gillespie C, Sifuentes L, Hasan O, Ritchey M, et al. Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control. J Clin Hypertens. 2016;18:232–9.

    Article  Google Scholar 

  10. Staessen JA, Wang JG, Thijs L. Cardiovascular protection and blood pressure reduction: A meta-analysis. Lancet 2001;358:1305–15.

    Article  CAS  PubMed  Google Scholar 

  11. Turnbull F, Neal B, Algert C, Chalmers J, Woodward M, MacMahon S, et al. Effects of different blood-pressure-lowering regimens on major cardiovascular events: Results of prospectively-designed overviews of randomised trials. Lancet 2003;362:1527–35.

    Article  CAS  PubMed  Google Scholar 

  12. Alam D, Robinson H, Kanungo A, Hossain MD, Hassan M. Health system preparedness for responding to the growing burden of non-communicable disease – a case study of Bangladesh. Melbourne: Nossal Institute for Global Health; 2013 February 2013. Report No.: 25.

  13. Legido-Quigley H, Naheed A, Asita De Silva H, Jehan I, Haldane V, Cobb B, et al. Patients’ experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study. PLoS ONE. 2019;14:e0211100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Rawal LB, Kanda K, Biswas T, Tanim MI, Poudel P, Renzaho AMN, et al. Non-communicable disease (NCD) corners in public sector health facilities in Bangladesh: A qualitative study assessing challenges and opportunities for improving NCD services at the primary healthcare level. BMJ Open. 2019;9:e029562.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bangladesh Ministry of Health & Family Welfare. Non-Communicable Disease Control Operational Plan, January 2017-June 2022. Directorate General of Health Services; 2017.

  16. National Institute of Population Research Training, ICF. Bangladesh Demographic and Health Survey 2017-18. Dhaka, Bangladesh and Rockville, Maryland, USA; 2020.

  17. Verdecchia P, Angeli F, Poeta F, Reboldi GP, Borgioni C, Pittavini L, et al. Validation of the A&D UA-774 (UA-767Plus) device for self-measurement of blood pressure. Blood Press Monit. 2004;9:225–9.

    Article  PubMed  Google Scholar 

  18. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International society of hypertension global hypertension practice Guidelines. Hypertension. 2020;75:1334–57.

    Article  CAS  PubMed  Google Scholar 

  19. Mishra SR, Ghimire S, Shrestha N, Shrestha A, Virani SS. Socio-economic inequalities in hypertension burden and cascade of services: Nationwide cross-sectional study in Nepal. J Hum Hypertens. 2019;33:613–25.

    Article  PubMed  Google Scholar 

  20. Jafar TH, Gandhi M, Jehan I, Naheed A, de Silva HA, Shahab H, et al. Determinants of uncontrolled hypertension in rural communities in South Asia-Bangladesh, Pakistan, and Sri Lanka. Am J Hypertens. 2018;31:1205–14.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Iqbal A, Ahsan KZ, Jamil K, Haider MM, Khan SH, Chakraborty N, et al. Demographic, socioeconomic, and biological correlates of hypertension in an adult population: evidence from the Bangladesh demographic and health survey 2017–18. BMC Public Health. 2021;21:1229.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hossain A, Suhel SA, Chowdhury SR, Islam S, Akther N, Dhor NR, et al. Hypertension and undiagnosed hypertension among Bangladeshi adults: Identifying prevalence and associated factors using a nationwide survey. Front Public Health. 2022;10:1066449.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gupta R, Kaur M, Islam S, Mohan V, Mony P, Kumar R, et al. Association of household wealth index, educational status, and social capital with hypertension awareness, treatment, and control in South Asia. Am J Hypertens. 2017;30:373–81.

    PubMed  Google Scholar 

  24. Alam DS, Chowdhury MA, Siddiquee AT, Ahmed S, Niessen LW. Awareness and control of hypertension in Bangladesh: Follow-up of a hypertensive cohort. BMJ Open. 2014;4:e004983.

    Article  PubMed  PubMed Central  Google Scholar 

  25. World Bank. Hypertension and Type-2 Diabetes in Bangladesh: Continuum of Care Assessment and Opportunities for Action. Washington, DC; 2019.

Download references

Author information

Author notes

  1. These authors contributed equally: Aliya Naheed, David C Boettiger.

Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Masih A. Babagoli

  2. Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA

    Masih A. Babagoli & Yea-Hung Chen

  3. Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh

    Nantu Chakma, Md. Saimul Islam & Aliya Naheed

  4. Kirby Institute, University of New South Wales, Kensington, NSW, Australia

    David C. Boettiger

  5. Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA

    David C. Boettiger

  6. Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    David C. Boettiger

Authors
  1. Masih A. Babagoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yea-Hung Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nantu Chakma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Md. Saimul Islam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aliya Naheed
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David C. Boettiger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception or design of the work: MAB, YC, DCB. Data collection: not applicable. Data analysis and interpretation: MAB, YC, DCB. Drafting the article: MAB. Critical revision of the article: MAB, NC, MDI, AN, DCB. Final approval of the version to be submitted: MAB, YC, NC, MDI, AN, DCB.

Corresponding author

Correspondence to Masih A. Babagoli.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

Ethical approval for this type of study was not required by the University of California, San Francisco since the data are de-identified and any geo-spatial data are displaced to protect the confidentiality of survey respondents.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Babagoli, M.A., Chen, YH., Chakma, N. et al. Association of socio-demographic characteristics with hypertension awareness, treatment, and control in Bangladesh. J Hum Hypertens 37, 993–999 (2023). https://doi.org/10.1038/s41371-023-00815-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-023-00815-z

Search

Advanced search

Quick links