Benjamin Palafox, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK.
Martin McKee, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK.
Dina Balabanova, ondon School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK.
Khalid F. Khalid, King Saud University, Riyadh, Saudi Arabia.
Alvaro Jr Avezum, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
Ahmad Bahonar, Hypertension Research Center, Isfahan, Iran.
Noorhassim Noorhassim, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Jephat Chifamba, University of Zimbabwe, Harare, Zimbabwe.
Clara K. Chow, The University of Sydney, Sydney, NSW, Australia.
Daniel J. Corsi, Ottawa Hospital Research Institute, Ottawa, Canada.
Gilles R. Dagenais, Quebec Heart and Lung University Institute, Quebec City, QC, Canada.
Rafael Diaz, Estudios Clinicos Latinoamerica, Rosario, Santa Fe, Argentina.
Rajeev Gupta, Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, India.
Romaina Iqbal, Aga Khan UniversityFollow
Manmeet Kaur, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Rasha Khatib, McMaster University, Hamilton, Ontario, Canada.
Annamarie Kruger, North-West University, Potchefstroom, South Africa.
Iolanthe Marike Kruger, North-West University, Potchefstroom, South Africa.
Fernando Lanas, Universidad de la Frontera, Temuco, Chile.
Patricio Lopez-Jaramillo, University of Santander, Floridablanca, Bucaramanga, Colombia.
Fu Minfan, Daxing Health Center, Shenyang City, Liaoning Province, China.
Viswanathan Mohan, Madras Diabetes Research Foundation, Chennai, India.
Prem K. Mony, St John's Medical College & Research Institute, Bangalore, India.
Aytekin Oguz, Istanbul Medeniyet University, Istanbul, Turkey.
Lia M. Palileo-Villanueva, University of the Philippines Manila, Manila, Philippines.
Pablo Perel, World Heart Federation, Geneva, Switzerland.
Paul Poirier, Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.
Sumathy Rangarajan, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
Lei Rensheng, Center for Disease Control & Prevention, Nanchang City, Jiangxi Province, China.
Annika Rosengren, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden.
Biju Soman, Sree Chitra Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
David Stuckler, University of Oxford, Oxford, UK.
S. V. Subramania, Harvard University, Boston, MA, USA.
Koon Teo, McMaster University, Hamilton, Ontario, Canada.
Lungiswa P. Tsolekile, University of the Western Cape, Bellville, Western Province, South Africa.
Andreas Wielgosz, The Ottawa Hospital, Ottawa, Ontario, Canada.
Peng Yaguang, FuWai Hospital, Beijing, China.
Karen Yeates, Queen's University, Kingston, Canada.
Mo Yongzhen, Institute of Geriatrics, Nanjing City, Jiangsu Province, China.
Khalid Yusoff, UCSI University, Kuala Lumpur, Malaysia.
Rita Yusuf, Independent University, Dhaka, Bangladesh.
Afzalhussein Yusufali, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
Katarzyna Zatońska, Wroclaw Medical University, Wroclaw, Poland.
Salim Yusuf, McMaster University, Hamilton, Ontario, Canada.

Document Type



Community Health Sciences



Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household's ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study.


A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples.


Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden).


Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level.


International Journal for Equity in Health

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.