OBJECTIVES: Hypertension medication and control are understudied among the elderly in middle-income countries, particularly as contextualized within social and community factors.

METHODS: We used 2012 International Mobility in Aging Study data of community-dwelling adults 65-74 years across three study sites (Tirana, Albania n=394; Natal, Brazil n=402; Manizales, Colombia n=407; N=1,203). The study framework was the socioecological model, positing that individual-level health outcomes are influenced by interpersonal (e.g., family, friends), organizational (e.g., health system), community (e.g., neighborhood safety), and policy levels. Logistic regression models identified factors associated with uncontrolled (vs. controlled) hypertension among those with diagnosed hypertension. Of particular interest was the role of antihypertensive medication contextualized within other factors specified by the socioecological model.

RESULTS: Among those with diagnosed hypertension, control was: Albania: 33%; Brazil: 30%; Colombia: 51% At all sites, those not in control were less likely to have hypertension medications in their homes than those in control, but this difference only differed significantly in Brazil and Columbia. A high proportion of those not in control (>80%) had antihypertensive medications at all sites. In final models, distinct factors from the socioecological model were strongly associated with uncontrolled hypertension across sites: Perceived income insufficiency (OR:3.23;95% CI:1.79-5.82) in Tirana; hypertension medication (OR:0.38;95%CI:0.16-0.88) and religious participation (OR:0.36;95% CI:0.13-0.97) in Colombia; and hypertensive medication (OR:0.38;95%CI:0.16-0.88) and strolling shops and stores (OR:0.44;95%CI:0.21-0.94) in Brazil. No behavioral variables (e.g. smoking, exercise, alcohol) were associated with control once organizational and community factors were considered.

CONCLUSIONS: In two of three middle-income study sites, all with low hypertension control, antihypertensive medication in the participants’ homes was significantly associated with a lower likelihood of uncontrolled hypertension. However, hypertension medication use was high across both controlled and uncontrolled hypertension. Contextualizing medication use within other socioecological factors is important to understand key predictors of hypertension control generally as well as variation across communities.