Abstract 9163: Demographic Differences in Hypertension and Its Treatment in Malawi

Background: Hypertension (HTN), a strong risk factor for cardiovascular disease (CVD), is highly prevalent in Sub-Saharan Africa. Health system interventions targeting demographic determinants of diagnosis and treatment may reduce downstream CVD burden. We investigated age, sex, and location-specific differences in HTN diagnosis and treatment in Malawi. Methods: We examined population-based household survey data (2013 - 2017) from the Malawi Epidemiology and Intervention Research Unit of 30,575 adults > 18 years with self-reported HTN diagnosis/treatment status and resting blood pressure measurements using standardized protocols. We used logistic regression to explore associations between demographic variables (age, sex, rural/urban location) and two outcomes: (1) measured HTN (defined as SBP > 130 mmHg, regardless of diagnosis/treatment status), and (2) treatment for previously diagnosed HTN. Results: The overall prevalence of diagnosed and undiagnosed HTN was 9% and 19.6%, respectively; 45.4% of those previously diagnosed were on antihypertensive treatment. The probability of measured HTN regardless of treatment for those aged >65 years was 80.8% (95% CI 79.1 - 82.5) and 66.5% (64.0 - 68.9) for urban women and men, respectively, and 65.6% (63.5 - 67.7) and 52.2% (49.7 - 54.7) for rural women and men, respectively. Among those with previously diagnosed HTN, probability of treatment was higher in older age groups, but did not differ between locations. Conclusions: We observed a high prevalence of undiagnosed HTN among rural- and urban-dwelling Malawians; over half of those reporting a diagnosis were untreated. Probability of measured HTN varied by sex and location, but probability of treatment did not. Population-level interventions that account for these patterns are needed in both rural and urban settings to increase effective HTN treatment coverage.