Rates of hypertension awareness, treatment and control remain inadequate, particularly in certain patient groups. The 17-country, multicentre Prospective Urban and Rural Epidemiological Study (PURE) investigated the factors which determine awareness, treatment and control of hypertension in urban and rural populations. These predictors could identify target groups for treatment and focus initiatives in patient management.

Participating countries included Canada, Sweden, the United Arab Emirates, Argentina, Brazil, Chile, Colombia, Poland, Turkey, Malaysia, Iran, South Africa, China, Bangladesh, India, Pakistan and Zimbabwe. Using standardized instruments, investigators evaluated more than 150,000 individuals aged 35 to 70 years and collected information on cardiovascular disease (CVD) risk factors for over 7 years starting from 2002. Hypertension was defined as having a blood pressure ≥140/90 mmHg. From the number of diagnosed hypertensive patients, the investigators calculated the percentage of patients who reported being aware of their condition, from which the percentage of treated patients was also determined. Finally, from the set of treated patients, they determined the number of patients whose hypertension was controlled (ie, BP <140/90 mmHg).

Multivariate analysis of CVD risk factors, including age, gender, marital status, level of education, occupation, body mass index (BMI), BP level, comorbidities and history of tobacco use and alcohol consumption, was conducted. Patients’ economic level, country of residence and location (whether urban or rural) were also analyzed.

Interim analysis showed that 40% of 150,782 participants were hypertensive, of which 54% were determined to be aware of their condition. Of these patients, only 41% were treated, and only 34% of those treated achieved control. Increased awareness of hypertension was associated with increased age, female gender and currently or previously married status. These factors, along with a higher level of education, were likewise associated with reported medical treatment. After adjusting for confounding variables, high-income nations did not demonstrate any significant difference in awareness rates between rural and urban areas, while awareness rates in rural areas in low-income countries were significantly lower than in urban areas. Rate of treatment likewise followed a similar pattern in high- and low-income countries.