Skip to main content

Advertisement

SpringerLink
Log in

‘Inequalities in prevalence of hypertension, prehypertension, anti-hypertensive coverage, awareness, and effective treatment in 429 districts of Iran; a population-based STEPS 2016 small area spatial estimation model’

  • Research article
  • Published:
Journal of Diabetes & Metabolic Disorders Aims and scope Submit manuscript

Abstract

Purpose

While many studies have reported hypertension (HTN) and pre-hypertension (PHTN) in large geographic locations of Iran, information regarding district levels is missing. We aimed to examine inequalities in the prevalence of hypertension, prehypertension, anti-hypertensive coverage, awareness, and effective treatment of adults in districts of Iran.

Methods

We used 27,165 participants’ data from the STEPS 2016 study in Iran. A small area estimation model was carried out to predict HTN in the 429 districts of Iran. HTN and PHTN were defined based on the American Heart Association Guideline. Awareness of being hypertensive, treatment coverage, and effective treatment were also estimated.

Results

HTN’s crude prevalence was estimated to be in the range of 11.5–42.2% in districts. About PHTN, it was estimated to be 19.9–56.1%. Moreover, for awareness, treatment coverage, and effective treatment crude estimates ranged from 24.3 to 79.9%, 9.1 – 64.6%, and 19.5 – 68.3%, respectively, indicating inequalities in the distribution of aforementioned variables in 429 districts of Iran. Overall, better conditions were detected in central geographical locations and in females.

Conclusion

The inequality of increased blood pressure disorder and related measures are high in districts of Iran and pave the way for policymakers and local health organizers to use the findings of this study to address the inequity of existing resources and improve HTN control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Esteghamati A, Abbasi M, Alikhani S, Gouya MM, Delavari A, Shishehbor MH, et al. Prevalence, awareness, treatment, and risk factors associated with hypertension in the iranian population: the national survey of risk factors for noncommunicable diseases of Iran. Am J Hypertens. 2008;21(6):620–6.

    PubMed  Google Scholar 

  2. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. The lancet. 2005;365(9455):217–23.

    Google Scholar 

  3. Lackland DT, Weber MA. Global burden of cardiovascular disease and stroke: hypertension at the core. Can J Cardiol. 2015;31(5):569–71.

    PubMed  Google Scholar 

  4. Mensah GA. The global burden of hypertension: good news and bad news. Cardiol Clin. 2002;20(2):181–5.

    PubMed  Google Scholar 

  5. Mirzaei M, Moayedallaie S, Jabbari L, Mohammadi M. Prevalence of hypertension in Iran 1980–2012: a systematic review. J Tehran Univ Heart Cent. 2016;11(4):159.

    Google Scholar 

  6. Drouin D, Campbell NR, Kaczorowski J, Program CHE. Implementation of recommendations on hypertension: the canadian Hypertension Education Program. Can J Cardiol. 2006;22(7):595–8.

    PubMed  PubMed Central  Google Scholar 

  7. Anderson KM, Odell PM, Wilson PWF, Kannel WB. Cardiovascular disease risk profiles. Am Heart J. 1991;121(1, Part 2):293–8.

    CAS  PubMed  Google Scholar 

  8. Samuelsson O, Wilhelmsen L, Elmfeldt D, Pennert K, Wedel H, Wikstrand J, et al. Predictors of cardiovascular morbidity in treated hypertension: results from the primary preventive trial in Göteborg, Sweden. J Hypertens. 1985;3(2):167–76.

    CAS  PubMed  Google Scholar 

  9. Passi-Solar Á, Margozzini P, Mindell JS, Ruiz M, Valencia-Hernandez CA, Scholes S. Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017. BMC Public Health. 2020;20(1):1–11.

    Google Scholar 

  10. Geraedts TJ, Boateng D, Lindenbergh KC, van Delft D, Mathéron HM, Mönnink GL, et al. Evaluating the cascade of care for hypertension in Sierra Leone. Tropical Med Int Health. 2021;26(11):1470–80.

    Google Scholar 

  11. Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar A-A, Hekmatdoost A, et al. Prospective Epidemiological Research Studies in Iran (the PERSIAN Cohort Study): Rationale, objectives, and design. Am J Epidemiol. 2018;187(4):647–55.

    PubMed  Google Scholar 

  12. Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari 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. The Lancet. 2020;396(10258):1223–49.

  13. Larki A, Tahmasebi R, Reisi M. Factors predicting self-care behaviors among low health literacy hypertensive patients based on health belief model in Bushehr District, South of Iran. International journal of hypertension. 2018;2018.

  14. Rafraf M, Gargari BP, Safaiyan A. Prevalence of prehypertension and hypertension among adolescent high school girls in Tabriz, Iran. FoodNutr Bull. 2010;31(3):461–5.

    Google Scholar 

  15. Taheri F, Namakin K, Kazemi T, Chahkandi T, Bijari B, Zardast M. The prevalence of high blood pressure among children aged 11–18 years in Birjand district, Eastern Iran in 2012: a cross-sectional study. Int J School Health. 2014;1(2):1–4.

    Google Scholar 

  16. Talaei M, Sadeghi M, Mohammadifard N, Shokouh P, Oveisgharan S, Sarrafzadegan N. Incident hypertension and its predictors: the Isfahan Cohort Study. J Hypertens. 2014;32(1):30–8.

    CAS  PubMed  Google Scholar 

  17. Allameh M, Ghanei Gheshlagh R, Rahmani K. Prevalence and Associated Risk Factors of Hypertension for the Middle-Aged Population (30–59 Years) in Iran: A National Cross-Sectional Study.High Blood Pressure & Cardiovascular Prevention. 2021:1–6.

  18. Djalalinia S, Modirian M, Sheidaei A, Yoosefi M, Zokaiee H, Damirchilu B, et al. Protocol Design for large-scale cross-sectional studies of Surveillance of Risk factors of non-communicable Diseases in Iran: STEPs 2016. Arch Iran Med. 2017;20(9):608–16.

    PubMed  Google Scholar 

  19. Population and Housing Census, Census. 2016. Available at:https://www.amar.org.ir/english/Population-and-Housing-Censuses [

  20. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH et al. /ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension (Dallas, Tex: 1979). 2018;71(6):1269 – 324.

  21. Pfeffermann D. New important developments in small area estimation. Stat Sci. 2013;28(1):40–68.

    Google Scholar 

  22. Azadnajafabad S, Ebrahimi N, Mohammadi E, Ghasemi E, Saeedi Moghaddam S, Aminorroaya A, et al. Disparities and spatial variations of high salt intake in Iran: a subnational study of districts based on the small area estimation method. Public Health Nutr. 2021;24(18):6281–91.

    PubMed  Google Scholar 

  23. Mahdavi M, Parsaeian M, Mohajer B, Modirian M, Ahmadi N, Yoosefi M, et al. Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines. BMC Public Health. 2020;20(1):1–9.

    Google Scholar 

  24. Armstrong C. JNC8 guidelines for the management of hypertension in adults. Am Fam Physician. 2014;90(7):503–4.

    PubMed  Google Scholar 

  25. HAGHDOUST A, Sadeghirad B, REZAZADEH KM. Epidemiology and heterogeneity of hypertension in Iran: a systematic review. 2008.

  26. Ebrahimi M, Mansournia MA, Haghdoost AA, Abazari A, Alaeddini F, Mirzazadeh A, et al. Social disparities in prevalence, treatment and control of hypertension in Iran: second National Surveillance of Risk factors of noncommunicable Diseases, 2006. J Hypertens. 2010;28(8):1620–9.

    CAS  PubMed  Google Scholar 

  27. Islam SMS, Purnat TD, Phuong NTA, Mwingira U, Schacht K, Fröschl G. Non-Communicable Diseases (NCDs) in developing countries: a symposium report. Globalization and health. 2014;10(1):1–8.

  28. Hosseini M, Yousefifard M, Baikpour M, Rafei A, Fayaz M, Heshmat R, et al. Twenty-year dynamics of hypertension in iranian adults: age, period, and cohort analysis. J Am Soc Hypertens. 2015;9(12):925–34.

    PubMed  Google Scholar 

  29. Elliott WJ, Black HR, Prehypertension. Nat Clin Pract Cardiovasc Med. 2007;4(10):538–48.

    PubMed  Google Scholar 

  30. Egan BM, Stevens-Fabry S. Prehypertension—prevalence, health risks, and management strategies. Nat Reviews Cardiol. 2015;12(5):289–300.

    Google Scholar 

  31. Svetkey LP. Management of prehypertension. Hypertension (Dallas, Tex: 1979). 2005;45(6):1056-61.

  32. Dong G-H, Wang D, Liu M-M, Liu Y-Q, Zhao Y, Yang M, et al. Sex difference of the prevalence and risk factors associated with prehypertension among urban chinese adults from 33 communities of China: the CHPSNE study. J Hypertens. 2012;30(3):485–91.

    CAS  PubMed  Google Scholar 

  33. Qureshi AI, Suri FK, Kirmani JF, Divani AA. Prevalence and trends of prehypertension and hypertension in United States: National Health and Nutrition examination surveys 1976 to 2000. Med Sci Monit. 2005;11(9):CR403–CR9.

    PubMed  Google Scholar 

  34. Najafipour H, Nasri HR, Afshari M, Moazenzadeh M, Shokoohi M, Foroud A, et al. Hypertension: diagnosis, control status and its predictors in general population aged between 15 and 75 years: a community-based study in southeastern Iran. Int J public health. 2014;59(6):999–1009.

    PubMed  Google Scholar 

  35. Kaona FAD, Tuba M, Siziya S, Sikaona L. An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients on TB treatment. BMC Public Health. 2004;4(1):68.

    PubMed  PubMed Central  Google Scholar 

  36. Heydari A, Ziaee ES, Gazrani A. Relationship between awareness of Disease and Adherence to Therapeutic Regimen among Cardiac Patients. Int J Community Based Nurs Midwifery. 2015;3(1):23–30.

    PubMed  PubMed Central  Google Scholar 

  37. Strömberg A. Patient-related factors of compliance in heart failure: some new insights into an old problem. Eur Heart J. 2006;27(4):379–81.

    PubMed  Google Scholar 

  38. Misra AK, Sharma A, Shukla JB. Modeling and analysis of effects of awareness programs by media on the spread of infectious diseases. Math Comput Model. 2011;53(5):1221–8.

    Google Scholar 

  39. Leonardo Alves T, Martins de Freitas AF, van Eijk MEC, Mantel-Teeuwisse AK. Compliance of Disease Awareness Campaigns in printed dutch media with National and International Regulatory Guidelines. PLoS ONE. 2014;9(9):e106599.

    PubMed  PubMed Central  Google Scholar 

  40. Sarafidis PA, Bakris GL. State of hypertension management in the United States: confluence of risk factors and the prevalence of resistant hypertension. J Clin Hypertens. 2008;10(2):130–9.

    Google Scholar 

  41. Guo F, He D, Zhang W, Walton RG. Trends in Prevalence, Awareness, Management, and control of Hypertension among United States adults, 1999 to 2010. J Am Coll Cardiol. 2012;60(7):599.

    PubMed  Google Scholar 

  42. Hou Z, Meng Q, Zhang Y, Hypertension Prevalence. Awareness, treatment, and Control following China’s Healthcare Reform. Am J Hypertens. 2016;29(4):428–31.

    PubMed  Google Scholar 

  43. Gasse C, Hense HW, Stieber J, Döring A, Liese AD, Keil U. Assessing hypertension management in the community: trends of prevalence, detection, treatment, and control of hypertension in the MONICA Project, Augsburg 1984–1995. J Hum Hypertens. 2001;15(1):27–36.

    CAS  PubMed  Google Scholar 

  44. Meisinger C, Heier M, Völzke H, Löwel H, Mitusch R, Hense H-W et al. Regional disparities of hypertension prevalence and management within Germany. J Hypertens. 2006;24(2).

  45. Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens. 2009;27(5).

  46. Delavar A, Horri N, Haghighi S, Alikhani S, Mahdavi A, Hosseini SM et al. Hypertension and pre-hypertension: prevalence, awareness and management among iranian adults older than 20 years. Journal of medical council of iri. 2007;24(4):372 –80.

  47. Geldsetzer P, Manne-Goehler J, Marcus M-E, Ebert C, Zhumadilov Z, Wesseh CS, et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. The Lancet. 2019;394(10199):652–62.

  48. Hanachi P, Ali PN, Rezayi N, Latiff LA. Comparison of physiological and psychological well-being in physical active and sedentary women in Iran. Global J Health Sci. 2010;2(2):249.

    Google Scholar 

  49. Amanolahi S. Fieldwork among pastoral nomads and in sedentary communities of Iran. Iran Stud. 2004;37(4):613–21.

    Google Scholar 

  50. Tavousi M, Haeri Mehrizi A, Rafiefar S, Solimanian A, Sarbandi F, Ardestani M, et al. HEALTH LITERACY IN IRAN: FINDINGS FROM A NATIONAL STUDY. PAYESH. 2016;15(1):95–102.

    Google Scholar 

  51. Azadnajafabad S, Saeedi Moghaddam S, Rezaei N, Ghasemi E, Naderimagham S, Azmin M et al. A report on statistics of an online self-screening platform for COVID-19 and its effectiveness in Iran. International Journal of Health Policy and Management. 2021.

  52. Keykhaei M, Koolaji S, Mohammadi E, Kalantar R, Saeedi Moghaddam S, Aminorroaya A, et al. Dissection of non-pharmaceutical interventions implemented by Iran, South Korea, and Turkey in the fight against COVID-19 pandemic. J Diabetes Metabolic Disorders. 2021;20(2):1919–31.

    CAS  Google Scholar 

  53. Madani S, Shahin S, Yoosefi M, Ahmadi N, Ghasemi E, Koolaji S, et al. Red flags of poor prognosis in pediatric cases of COVID-19: the first 6610 hospitalized children in Iran. BMC Pediatr. 2021;21(1):1–9.

    Google Scholar 

  54. Mohammadi E, Azmin M, Fattahi N, Ghasemi E, Azadnajafabad S, Rezaei N, et al. A pilot study using financial transactions’ spatial information to define high-risk neighborhoods and distribution pattern of COVID-19. Digit Health. 2022;8:20552076221076252.

    PubMed  PubMed Central  Google Scholar 

  55. Rezaei N, Montazeri F, Malekpour M-R, Ghanbari A, Azadnajafabad S, Mohammadi E, et al. COVID-19 in patients with diabetes: factors associated with worse outcomes. J Diabetes Metabolic Disorders. 2021;20(2):1605–14.

    CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank other investigators and researchers.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136, Tehran, Iran

    Esmaeil Mohammadi, Moein Yoosefi, Elaheh Shaker, Elnaz Shahmohamadi, Erfan Ghasemi, Naser Ahmadi, Sina Azadnajafabad, Mohammad-Mahdi Rashidi, Nazila Rezaei, Sogol Koolaji, Arezou Dilmaghani-Marand, Sahar Mohammadi Fateh, Ameneh Kazemi, Rosa Haghshenas & Negar Rezaei

  2. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Nazila Rezaei & Arezou Dilmaghani-Marand

Authors
  1. Esmaeil Mohammadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moein Yoosefi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elaheh Shaker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elnaz Shahmohamadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erfan Ghasemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Naser Ahmadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sina Azadnajafabad
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mohammad-Mahdi Rashidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nazila Rezaei
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sogol Koolaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Arezou Dilmaghani-Marand
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sahar Mohammadi Fateh
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ameneh Kazemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Rosa Haghshenas
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Negar Rezaei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Negar Rezaei.

Ethics declarations

Competing interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Additional information

Publisher’s Note

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

Esmaeil Mohammadi and Moein Yoosefi contributed equally.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary Material 2

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

Mohammadi, E., Yoosefi, M., Shaker, E. et al. ‘Inequalities in prevalence of hypertension, prehypertension, anti-hypertensive coverage, awareness, and effective treatment in 429 districts of Iran; a population-based STEPS 2016 small area spatial estimation model’. J Diabetes Metab Disord 22, 1095–1103 (2023). https://doi.org/10.1007/s40200-023-01186-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40200-023-01186-5

Keywords

Search

Navigation