Rural and urban differences in blood pressure and hypertension in Ghana, West Africa

BACKGROUND: Hypertension, once rare in traditional African societies, is rapidly becoming a major public health problem. OBJECTIVE: To assess urban and rural differences in blood pressure (BP) and hypertension, and to determine factors associated with BP in this sub-Saharan Africa population. STUDY DESIGN: Cross-sectional survey. SETTING: Ashanti region of Ghana, West Africa. PARTICIPANTS: There were 1431 participants (644 males and 787 females). Of these, 578 were from the rural setting (237 males and 341 females) and 853 from the urban setting (407 males and 446 females). RESULTS: Age-adjusted mean systolic and diastolic BP levels were lower in rural men than in urban men (129/75 versus 133/78, P<0.001). The mean systolic and diastolic BP levels were also lower in rural women than in urban women (126/76 versus 131/80, P<0.001). After adjustments for age, the odds ratios (95% CI) for being hypertensive were 1.9 (1.3-2.9; P<0.01) for urban men and 1.9 (1.3-2.8; P<0.0001) for urban women. Urban women were more likely than rural women to be aware of their hypertensive condition (odds ratio 2.3, 95% CI, 1.2-4.2; P<0.001). Treatment and control of hypertension did not differ between the groups in either men or women. In multiple linear regression analysis, age, urban dwelling, BMI and heart rate were independently associated with systolic and diastolic BP in both men and women. Smoking and alcohol consumption were independently associated with systolic and diastolic BP but only in men. CONCLUSION: The findings of this study demonstrate that high BP (hypertension) is an important public health burden in both urban and rural settings in this sub-Saharan African population. Cost-effective public health measures are urgently needed to prevent high BP from becoming another public health burden.     

Treated hypertensives with good medication compliance are still in a state of uncontrolled blood pressure in the Japanese elderly

Objectives Blood pressure (BP) is poorly controlled in many countries. Poor compliance was suggested as the main cause for poor BP control. The purpose of this study was to examine the association between compliance and the control of both casual blood pressure (BP) and 24-hr ambulatory BP in a Japanese elderly population. Methods The study was a cross-sectional survey. Casual BP and 24-hr ambulatory BP were measured at home. Hypertension was defined as casual systolic BP (SBP)≧140 and/or diastolic BP (DBP)≧90 mmHg, or as treated hypertension. A compliance rate of greater than 80% by the pill count method was defined as good compliance. Results Of the 178 treated hypertensives, 82.6% showed good compliance. Between the treated hypertensives with good compliance and those with poor compliance, no significant difference was found in either casual BP or ambulatory BP. Of the treated hypertensives with good compliance, the prevalence of achieved target ambulatory BP, i.e., daytime BP<135/85 mmHg, nighttime BP<120/75 mmHg, and 24-hr BP<125/80 mmHg, was, respectively, 35.4%, 43.5%, and 20.4%. Conclusions Casual BP and 24-hr ambulatory BP were poorly controlled in the community-living elderly although many of the treated hypertensives showed good compliance. It is unlikely that this inadequate control of hypertension is due to poor compliance on the part of the subjects.     

The prevalence, awareness and control of hypertension in Laval, Quebec, 1986

The prevalence, awareness and control of hypertension were assessed in a representative sample (n = 1,374) of the Laval population (aged 30-69 years). The study was designed to identify people at increased risk for cardiovascular disease because of elevated blood pressure levels rather than to establish a strict clinical prevalence. Defining hypertension as systolic pressure greater than or equal to 140 mm Hg and/or diastolic pressure greater than or equal to 90 mm Hg and/or on anti-hypertensive medication, the study found a prevalence of 25% (32% in men, 19% in women). Two thirds (67%) of the male hypertensives and 41% of the female hypertensives were previously unaware of their condition. One in three hypertensives were on medication, and less than half of these were under control. As observed in other studies, control was better in women. The study suggests the continuing need for high blood pressure education and detection in the Laval population, particularly among men.     

Income,education, and blood pressure in adults in Jamaica,a middle-income developing country

BACKGROUND: At present, little is known about how socioeconomic status (SES) is related to blood pressure (BP) and hypertension in developing countries. This cross-sectional study examined associations between SES and BP in 2082 adults from a peri-urban area of Jamaica, a middle-income developing country. METHODS: Hypertension (systolic BP >/=140 mmHg, diastolic BP >/=90 mmHg or current hypertensive medication use) was estimated based on self-reported medication use and the mean of the second and third of three manual BP measurements. Income and education were self-reported. Linear or logistic regressions were used to estimate multivariate associations between BP or hypertension and SES. RESULTS: Hypertension prevalence was 20% in men and 28% in women. In both men and women, the income distributions of BP and hypertension were non-linear, indicating elevated levels in low as well as in high-income groups. In contrast to the negative relationships typical for industrialized countries, multivariate-adjusted BP and hypertension were highest in the wealthiest women. In men with some high school education, income was positively associated with BP, while there were negative associations in men with lesser education. Unlike women, mean BP were highest in poor men with limited education. Low SES men were also least likely to receive diagnosis and treatment. CONCLUSIONS: Socioeconomic status is related to BP and hypertension in Jamaica, although relationships are non-linear. Behavioural and environmental factors that explain elevated BP among both low and high SES adults in developing countries must be identified to develop effective prevention strategies.     

Association Between Exposure to Cadmium and Blood Pressure in Japanese Peoples

The authors studied the effects of environmental cadmium exposure on blood pressure (BP). Subjects 1,140 men and 1,713 women, aged ≥ 50 yr lived in three areas of Japan considered “unpolluted” by cadmium. Multiple logistic regression analysis was used to evaluate relationships between hypertension/nonhypertension and cadmium concentrations in blood (B-Cd) or urine (U-Cd). Age, body mass index, drinking and smoking habits, and blood and urine chemistry data were incorporated into the model. Odds ratios for hypertension were significantly less than 1 in either gender when U-Cd was the indicator of cadmium exposure and hypertension was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. The results suggest a significant negative association between cadmium exposure and BP in inhabitants in Japan.     

Association between exposure to cadmium and blood pressure in Japanese peoples

The authors studied the effects of environmental cadmium exposure on blood pressure (BP). Subjects 1140 men and 1713 women, aged > or =50 yr lived in three areas of Japan considered "unpolluted" by cadmium. Multiple logistic regression analysis was used to evaluate relationships between hypertension/nonhypertension and cadmium concentrations in blood (B-Cd) or urine (U-Cd). Age, body mass index, drinking and smoking habits, and blood and urine chemistry data were incorporated into the model. Odds ratios for hypertension were significantly less than 1 in either gender when U-Cd was the indicator of cadmium exposure and hypertension was defined as systolic BP > or =140 mmHg and/or diastolic BP > or =90 mmHg. The results suggest a significant negative association between cadmium exposure and BP in inhabitants in Japan.     

Health risk behaviours, awareness, treatment and control of hypertension among rural community people in Thailand

This cross-sectional study aimed to assess health risk behaviours, prevalence, awareness, treatment, and control of hypertension and associated factors among Thai rural community people. 527 people, aged 35-60 years, were randomly sampled and interviewed. Two blood pressure (BP) measurements were assessed by standardized protocol. Hypertension was defined as a mean systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg. 76.9% lacked regular exercise, 28.5% were current alcohol drinkers, and 23.7% were current smokers. The prevalence of hypertension was 17.8%. Among the hypertensive cases, 64.9% (61/94) were aware of their high BP, 42.6% (26/61) were treated, and 42.3% (11/26) achieved BP control (< 140/ 90 mmHg). Multiple logistic regression analysis indicated four variables significantly associated with hypertension: age > 40 years (adjusted OR = 4.20, 95% CI 1.93-9.11), married status (adjusted OR = 0.48, 95% CI 0.26-0.89), family history of hypertension (adjusted OR = 2.39, 95% CI 1.40-4.07), and BMI > 23.0 kg/m2 (adjusted OR = 3.41, 95% CI 1.80-6.45). Lifestyle modification programs are needed to prevent hypertension.     

Trends in hypertension prevalence and management in Southwestern France, 1985-1996

The changes occurring in Southwestern France between 1985 and 1996 in hypertension prevalence, awareness and control were assessed in 622 men and 626 women for 1985 and in 614 men and 569 women for 1996. In women, prevalence of hypertension (defined as systolic blood pressure 160 mmHg and/or diastolic blood pressure 95 mmHg and/or presence of antihypertensive treatment) was 19% and 19% (NS), awareness was 67% and 87% (P < 0.001), treatment was 85% and 87% (NS) and control was 44% and 68% (P < 0.01) in the first and the second surveys, respectively. In men, prevalence of hypertension was 28% and 21% (P < 0.01), awareness was 47% and 71% (P < 0.001), treatment was 81% and 80% (NS) and control was 41% and 58% (NS). After stratifying on survey, women received significantly more beta-blockers and significantly less calcium channel blockers and ACE inhibitors than men, but those differences became nonsignificant after adjusting for other cardiovascular risk factors. We conclude that in Southwestern France, screening and management of hypertension have improved significantly, but more than one-third of treated hypertensive subjects still lacks adequate control.     

Prevalence, awareness, treatment, and control of hypertension in a Spanish population

A cross-sectional population survey using a random, stratified sample into phases was conducted in order to assess the prevalence, awareness, treatment, and control of hypertension in Albacete (a south-eastern province in Spain) with 248 000 inhabitants over 18 years of age. The sample size was of 1322 people. Both systolic and diastolic BP were higher in men than in women and showed an increasing trend with age independently of gender. Assuming a cut-off for hypertension of <140/90 mm Hg and <160/95 mm Hg, we found a prevalence of hypertension of 32.7% and 23.1%, respectively. Overall, 56.5% of hypertensive subjects were aware of their condition. The degree of this awareness was significantly higher in women and in the elderly. The percentage of patients who were receiving antihypertensive treatment was 49.1%. This proportion was also higher among women, elderly people, and subjects living in urban areas. High BP was successfully controlled in 10.9% of the total hypertensive population which accounted for 24.4% of the treated patients. The corresponding figures for the <160/95 mm Hg cut-off were 38.5% and 60.6%, respectively. In the logistic regression model, male gender and size of the local community were significantly associated with a better pharmacological control of hypertension. We found a high prevalence of hypertension with low degree of awareness and control, despite the general progress made in the diagnosis and treatment of hypertension in Spain. Specific intervention programs are necessary to increase the extent of control of hypertension in our country.     

中国成年人高血压患病率、知晓率、治疗和控制状况

目的　评估中国成年人高血压的患病率、高血压知晓率、治疗和控制状况。方法　亚洲国际心血管病合作研究 (InterASIA)于 2 0 0 0～ 2 0 0 1年进行 ,应用多阶段抽样方法选择有代表性的样本。共调查了 35～ 74岁的成年人 15 838人。测量血压时 ,先让调查对象休息 5min ,由经过培训合格的调查人员应用标准水银柱血压计测量 3次血压。应用标准问卷询问高血压病史及高血压的治疗情况。高血压定义为收缩压≥ 140mmHg、舒张压≥ 90mmHg或正在服用降压药。结果　 35～ 74岁的中国成年人的高血压患病率为 2 7 2 %,即全国约有 1 3亿高血压患者。 35～ 44、45～ 5 4、5 5～ 6 4和 6 5～ 74岁年龄组的高血压患病专率分别为男性 17 4%、 2 8 2 %、 40 7%和 47 3 %;女性为 10 7%、2 6 8%、38 9%和 5 0 2 %。在高血压病人中 ,44 7%知道自己患有高血压 ,2 8 2 %正在服用降压药 ,8 1%的人血压得到了控制 ( <140 / 90mmHg)。在过去 10年中 ,高血压知晓、治疗和控制率的增长百分率分别为 86 2 %、92 6 %和 145 4%。结论　在过去的 10年中 ,高血压知晓、治疗和控制率有显著的提高。中国成年人高血压的患病率比较高 ,而高血压的知晓率偏低 ,治疗率和控制率又非常低。在我国迫切需要改善高血压的预防、检测和治疗状况     

Migration, blood pressure pattern, and hypertension: the Yi Migrant Study.

Rural-urban migration provides an ideal opportunity to examine the effects of environment and genes on blood pressure. The effect of migration on the Yi people of China was studied. The Yi people live in a remote mountain area in southwestern China. In 1989, blood pressure was measured in 14,505 persons (8,241 Yi farmers, 2,575 urban Yi migrants, and 3,689 Han urban residents) aged 15-89 years. Different patterns were seen for men and women. Among the men, Yi farmers had the lowest mean blood pressure, the least rise in blood pressure with age (systolic blood pressure, 0.13 mmHg/year; diastolic blood pressure, 0.23 mmHg/year), and the lowest prevalence of hypertension (0.66%). In contrast, both Yi migrant men and Han men had higher levels of mean blood pressure, rise in blood pressure with age (Yi migrants: systolic pressure, 0.33 mmHg/year; diastolic pressure, 0.33 mmHg/year; Han: systolic pressure, 0.36 mmHg/year; diastolic pressure, 0.23 mmHg/year), and prevalence of hypertension (Yi migrants, 4.25%; Han, 4.91%). Among the women, however, mean systolic pressure was higher in Yi farmers than in Yi migrants or in Han. Diastolic pressure was similar among the three groups. However, the Yi farmer women's age-related rise in blood pressure (systolic pressure, 0.06 mmHg/year; diastolic pressure, 0.14 mmHg/year) and their prevalence of hypertension (0.33%) were lower than those in the other two groups. Yi migrant women had an intermediate rise in blood pressure with age (systolic pressure, 0.37 mmHg/year; diastolic pressure, 0.23 mmHg/year) and prevalence of hypertension (2.40%). Han women had the greatest rise in blood pressure with age (systolic pressure, 0.56 mmHg/year; diastolic pressure, 0.36 mmHg/year) and the highest prevalence of hypertension (4.76%). For both men and women, the above differences were only partially explained by age, body mass index, heart rate, smoking, and alcohol use. This study, using standardized methods, demonstrates an important effect of migration on rise in blood pressure with age and on the prevalence of hypertension.     

Prevalence,awareness, treatment,and control of hypertension in the inner city

This article reports on the prevalence, awareness, treatment, and control of hypertension in a predominantly black population residing in the inner city of Detroit, Michigan. The data reported come from a cross-sectional survey of approximately 800 adults conducted in the fall of 1978. The prevalence of hypertension in the population studied, 38%, was similar for men and women below age 55; above age 55, women were more likely to have high blood pressure than men. Hypertension was positively related to the respondent's age and weight, but was not associated with having a family history of hypertension, or with the amount of cigarettes smoked daily. Compared with estimates of awareness, treatment, and control status of hypertensives derived from community surveys conducted in the 1960s, our findings indicate substantial improvement in hypertension management among a predominately black, urban population during the past decade. Of the hypertensives identified in our sample, 80% were aware of their hypertension before participation in the survey, 86% of those previously detected were being treated for their hypertension, and 26% of those being treated were adequately controlled (BP < 140/90 mm Hg). Awareness, treatment, and control rates appear to be age-related, with younger respondents less likely to be aware of their hypertension, on antihypertensive therapy, and successfully controlled. Below age 54, women were much more likely to be aware of their hypertension condition than men. Because of the lower detection rates among younger age groups it is recommended that future blood pressure screening efforts in the inner city be directed at younger adults (between the ages of 18 to 44), especially men.     

The Edgecombe County High Blood Pressure Control Program: I. Correlates of uncontrolled hypertension at baseline.

To guide the planning of a multifacetted hypertension control program in Edgecombe County, North Carolina, a baseline survey of a stratified (by township) random sample of 1,000 households was conducted. All adults (greater than or equal to 18 years) were interviewed and had their blood pressures (BP) measured. Five hundred thirty-nine individuals, 27 per cent of the survey population, had diastolic BP greater than or equal to 90 mm Hg or were receiving anti-hypertensive drug therapy. The 539 hypertensives were divided into seven subgroups reflecting successive stages in the control of hypertension based on the awareness, treatment, and control of their hypertension. Unaware hypertensives were further subdivided into three groups according to the recency of their last BP check, and those aware but untreated were subdivided by whether they had previously received treatment. The seven subgroups of hypertensives were compared, separately for women and men, with respect to sociodemographic characteristics, health behaviors, and health status. In general, the progression from undetected hypertension to treatment and control appeared to be associated with being older, female, and White. This progression was further associated with greater educational levels and higher family incomes among women and increasing self-reported morbidity among men. The implications for intervention of these and other described associations are discussed.     

中国中年人群高血压患病率及知晓率、治疗率、控制率的演变趋势

目的 了解中年人群高血压患病率及知晓率、治疗率和控制率的演变趋势。方法 利用国家“八五”(1992～1994年)和“九五”(1998年)期间年龄在35～59岁的13组可比人群资料进行分析。结果 高血压的标化患病率有小幅增加,“九五”期间达到24.0％。城市的增幅要大于乡村。高血压知晓率“九五”期间较“八五”期间增加了5.3％,达到42.6％;治疗率“八五”期间27.3％、“九五”期间为31.1％;控制率“九五”期间较“八五”期间增加了近50％,但也只有6.0％。在接受治疗的高血压患者中,不同时期的控制率分别为12.7％、19.9％,为同期整体控制率的3倍多。无论患病率、知晓率、治疗率和控制率,城乡之间、性别之间都存在差异。结论 不断上升的高血压患病率和低水平的知晓率、治疗率、控制率仍是高血压防治面临的主要现状。必须认真开展有效的措施以降低高血压的患病率,提高治疗率和控制率。     

Prevalence, Awareness, Treatment, and Control of Hypertension in Rural Areas of Davanagere

Objective:

To study the prevalence, awareness, treatment, and control of hypertension in the rural areas of Davanagere.

Type of Study:

Cross-sectional community-based study.

Setting:

Villages belonging to six sectors of the Davanagere Taluk.

Materials and Methods:

General population above 18 years.

Methodology:

A community-based sample was chosen by a multistage sampling technique. Subjects were screened for hypertension by a house-to-house survey. Subjects with systolic blood pressure more than 140 and diastolic blood pressure more than 90 mm of Hg, on hypertensive treatment, and history of hypertension were classified as hypertensives. The data thus obtained was compiled and analyzed.

Results:

The prevalence rate of hypertension in the study population was 18.3% (95% CI, 16.7-19.9%). Prevalence of hypertension was more in males 19.1% (95% CI, 16.7-21.5%) than in females 17.5% (95% CI, 14.9-20.1%); 11.6%, 5.6%, and 1.2% of the total subjects had Grade I, Grade II, and Grade III, respectively. Only 33.8% of them were aware of their hypertensive status. Hypertensives of 32.1% were on treatment, and 12.5% adequately controlled their BP. About 6.9% of the total hypertensives had severe hypertension.

Statistical Analysis:

Proportions, One way Analysis of Variance, Chi-square test.     

动态血压监测指导腹膜透析患者高血压治疗的临床观察

目的　探讨动态血压监测指导腹膜透析患者高血压治疗的意义。方法　使用非侵入性的动态血压监测仪监测 34例腹膜透析 (CAPD)合并有高血压的患者 ,通常从早上 9:0 0开始每 30分钟记录 1次血压 ,共监测 2 4小时。结果　所有病人 2 4小时的平均血压是 14 5 6 / 91 3mmHg ,39 6 %收缩压记录超过 15 0mmHg ,4 8 7%的舒张压记录超过 90mmHg。糖尿病肾病患者 (12例 )平均血压是 15 7 3/ 88 8mmHg ,5 8 5 %的收缩压记录和 4 4 6 %的舒张压记录超过 15 0 / 90mmHg。平均血压、心率和血压负荷白天和夜间没有显著性差异。结论　大多数的CAPD患者伴有高血压的病人其血压控制不佳 ,糖尿病患者血压控制情况更差。大多数CAPD患者血压 2 4小时节律性消失 ,白天和夜间高血压控制不佳并没有区别 ,使用动态血压监测仪评估血压可以指导降压治疗和增加降压达标。     

Blood Pressure Success Zone: You Auto Know. A worksite-based program to improve blood pressure control among auto workers

Worksite-based wellness programs can be a means to improve employee health awareness and potentially reduce health care costs. The "BP Success Zone: You Auto Know" program was a worksite-based intervention to reduce the incidence of hypertension among auto workers at Chrysler LLC. This 6-month program comprised an intervention consisting of education, awareness, and support intended to intensify the engagement of Chrysler employees at moderate-to-high cardiovascular risk who were not adequately controlling their blood pressure. The 539 participants had systolic blood pressure of ≥ 120 mmHg, diastolic blood pressure of ≥ 80?mmHg, or were told by a health care provider that they had hypertension. Questionnaires compared awareness and knowledge of hypertension and lifestyle choices before and at the end of the intervention. After the 6-month intervention, mean systolic blood pressure had decreased from a baseline value of 133 mmHg to 129 mmHg (P < 0.0001) and mean blood diastolic pressure had decreased from 85 mmHg to 82 mmHg (P < 0.0001). The proportion of participants with controlled blood pressure increased from 52% to 62% (P < 0.0001) over the course of the intervention. Eighty-six percent of the participants reported that the program helped them to better understand and control their blood pressure and 84% reported that they had a better understanding of their treatment options. In conclusion, a program of hypertension awareness, education, and lifestyle modification helped to improve blood pressure control among a group of Chrysler LLC employees.     

Interrelations among smoking habits, casual blood pressure and intraocular pressure in middle and old-aged Japanese residents

Objectives To investigate the association of smoking habits with blood pressure (BP) and intraocular pressure (IOP), and to examine whether the smoking-BP association is related to the IOP level. Methods This study was conducted on the basis of a cross-sectional design using annual health check-up data during one-year between August, 1999 and August, 2000 for 611 middle and old-aged Japanese residents living in Ibaraki prefecture, Japan. Results After adjustment for age, gender, body mass index and alcohol intake score, the proportion of hypertensives, and the mean systolic and diastolic blood pressure (SBP and DBP) of the subjects without antihypertensive medications were the highest (50.4%, 129.6 mmHg and 75.9 mmHg, respectively) in the “smokers of 25 or more cigarettes per day with intraocular pressure (IOP)≥15 mmHg” of six subgroups crossed by three smoking categories (non-smokers, 1 to 24 cigarettes per day, and 25 or more cigarettes per day) and two IOP categories (less than 15 mmHg, and 15mmHg or greater). On the other hand, the adjusted proportion of hypertensives, and the adjusted mean SBP and DBP decreased with increasing smoking category in the individuals with less than 15 mmHg of the IOP (p for trend=0.028 for proportion of hypertensives 0.008 for the SBP, and 0.001 for the DBP, respectively). Conclusions Heavy smoking may be specifically related to ‘high BP accompanied by high IOP’, although the BP may be inversely associated with smoking under the condition without high IOP.     

Distribution of blood pressures in Gemlik District,north-west Turkey

The objectives of the present study were to evaluate the prevalence, awareness and control of hypertension among individuals over 30 years of age and to plan a follow-up programme for the same age group. A community-based sample of 1992 individuals (952 men and 1,040 women) was selected randomly. Out of the total study population, 1,388 (69.7%) individuals had normal blood pressure according to World Health Organisation criteria (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg), and the rest (n = 604, 30.3%) had hypertension to varying degrees. Since 61 individuals with normal blood pressure were using antihypertensive medication, the overall hypertension prevalence was 33.4%. Among the study subjects with hypertension, 44.4% were aware of their condition, 37.7% were using medication and 9.2% had controlled hypertension. One out of five individuals (n = 399, 20.0%) had never had their blood pressure measured before. Females had a higher hypertension prevalence than males (36.7% and 29.7%, respectively). Hypertension prevalence increased with age and individuals with a body mass index > 25 were at greater risk. The present findings suggest that there is a need to implement an effective, community-based and low-cost management programme.     

Prevalence, awareness, treatment and control of hypertension in a working Bulgarian population

Arterial hypertension is a major risk factor for coronary heart disease and stroke mortality. Few data exist on prevalence, awareness, and management of hypertension in Bulgaria, precluding development of potentially beneficial risk reduction initiatives. Between September 1996 and July 1997, an age-sex stratified sample of 847 male and 771 female employees (age 18–64 y) of the national transport industry resident in Sofia was recruited during their annual physical examination. A structured interview was conducted and resting blood pressure (BP) measured. Prevalence: Elevated BP (mean of two consecutive readings SBP 140 mmHg and/or DBP 90 mmHg) was observed among 24% of women and 58% of men (p < 0.001). Prevalence increased with age in both men and women. Awareness: Among 722 employees with elevated BP, 49% of women and 33% of men (p < 0.001) reported history of hypertension. Awareness increased with age. Management: Among 345 employees with history of hypertension, 37% of women and 36% of men (p > 0.05) reported taking antihypertensive treatment. The proportion under management increased with age. Control: Normal BP was measured in only 6% of men and 7% of women taking antihypertensive medication (p > 0.05; no consistent trends by age). Elevated BP is widespread and hypertension is underdiagnosed and poorly controlled in this urban working-age Bulgarian population, especially among those under 40 y. This may contribute to the high rates of coronary heart disease and stroke incidence and mortality in Bulgaria.