Sociodemographic correlates of hypertension prevalence, awareness, and control in the Eastern Caribbean

Abstract

Background: This study aimed to quantify prevalence, awareness, and control of hypertension in the Eastern Caribbean and identify sociodemographic correlates. Methods: Baseline data (2013–2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) was used (n = 2961). The ECS is an ongoing longitudinal study of community-dwelling persons 40 years and older conducted in Barbados, Puerto Rico, Trinidad and Tobago, and U.S. Virgin Islands. Participants completed a self-administered health survey, clinical examination, and laboratory testing. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines defined hypertension prevalence and control. Self-reported hypertension and clinical blood pressure values defined awareness. Binomial proportions, including 95% confidence intervals and logistic regression, were used for analyses. Findings: Analyses included 2932 participants with complete data. The mean age of participants was 57 (SD = 10.3) years, and 65.3% (n = 1916/2932) were women. Prevalence of hypertension was 57.9% (n = 1698/2932), among whom 36.8% (n = 591/1698) were unaware, and 56.4 percent (n = 624/1107) of aware persons lacked control. Persons who were 70 and older (82.9%, n = 325/392, 95% CI:79.2%–86.6%), had low educational attainment (63.4%, n = 642/1012, 95% CI:60.5%–66.4%), obese (67.2%, n = 753/1121, 95% CI:64.4%–69.9%), and low physical activity (63.3%, n = 766/1210, 95% CI:60.6%–66.0%) had the highest prevalences of hypertension. Awareness was highest among persons 70 and older (76.6%, n = 249/325, 95% CI:72.0%–81.2%), women (70.7%, n = 781/1104, 95% CI:68.1%–73.4%), and those with a usual source of healthcare (70.4%, n = 1042/1480, 95% CI:68.1%–72.7%). Persons with lower educational attainment had lowest control across sociodemographic groups (36.1%, n = 154/427, 95% CI:31.5%–40.6%). Multivariable results showed ages 70 and older (OR = 10.6, 95% CI:7.4–15.2) and obesity (OR = 4.0, 95% CI:3.1–5.1) were the strongest predictors of hypertension. Usual source of care (OR = 5.66, 95% CI:3.8–8.4) and ages 70 and older (OR = 4.2, 95% CI:2.7–6.5) were most strongly associated with awareness. Results for control were not statistically significant. Interpretation: Findings highlight challenges across the hypertension care cascade in the Eastern Caribbean, particularly with control. These findings have implications for public health and healthcare system solutions to improve screening and blood pressure control. Funding: National Heart, Lung, and Blood Institute Award-- 1K01HL145347-01A1, National Institute on Minority Health and Health Disparities (Yale-TCC)-- U54MD010711, and National Institute on Minority Health and Health Disparities through the Eastern Caribbean Health Outcomes Research Network (ECHORN)-- U24MD006939.