Prevalence and determinants of hypertension in the urban population of Jaipur in western India

District-Wise Heterogeneity in Blood Pressure Measurements, Prehypertension, Raised Blood Pressure, and Their Determinants Among Indians: National Family Health Survey-5

Objective: The objective of the study was to determine the prevalence and determinants of ever-measured blood pressure, prehypertension, and raised blood pressure at national, state and district levels in India. Methods: We analysed data from the National Family Health Survey (NFHS-5), on 743,067 adults aged 18-54 years. The sample consisted of 87.6% females and 12.4% males. We estimated prevalence rates and determined adjusted odds ratios for various dependent variables related to blood pressure. Geographical variations were visualized on the map of India, and multivariate logistic regression was employed at state and district levels, with significance set at p < 0.05. Results: The prevalence of ever-measured blood pressure varied widely, from 30.3% to 98.5% across districts, with southern and northern regions showing higher rates. Prehypertension affected 33.7% of the population, with varying prevalence across districts. Raised blood pressure was there in 15.9%, with notably higher rates in southern region (16.8%). Determinants included age, gender, education, wealth, lifestyle, obesity, and blood glucose levels. Conclusion: These findings demonstrate the subnational variations in blood pressure, can guide evidence-based interventions at the state and district level, towards reducing the burden of raised blood pressure and enhancing overall population health.

Association between serum liver enzymes and hypertension using propensity score matching analysis: evidence from a large kurdish prospective cohort study

Background

The association between liver enzymes and hypertension (HTN) has been reported in some studies and the findings are inconsistent. This study was conducted to evaluate the association of liver enzymes with HTN among the Iranian Kurdish population.

Methods

This prospective cohort study was a part of the 5-years (2017–2021) follow-up phase of the Ravansar Non-Communicable Disease (RaNCD) cohort study in Kermanshah province, western Iran.The association between alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glut amyl transferase (GGT), and alkaline phosphatase (ALP) and HTN was investigated by Cox proportional-hazard model (CPHM). We used one-to-one Propensity score matching (PSM) analysis to minimize the effects of confounding factors on the relationship between liver enzymes and HTN .

Results

The full population included a total of 8267 participants. According to PSM, for liver enzyme GGT a total of 3664 participants were analyzed. The results of multivariate CPHM showed there is a relationship between participants with high level of GGT and had a higher risk of HTN (HR 1.34; 95% CI: 1.11–1.63). After PSM analysis, the effect of GGT on HTN remained positive and significant (HR 1.48; 95% CI: 1.22–1.78). The 5-years incidence rate of HTN in men and women were 1.27 and 0.81 (person-year), respectively.GGT had the greatest accuracy, which demonstrated an AUROC of 0.7837.

Conclusion

Results of this study showed GGT could be a potential biomarker among liver enzymes for early detection of HTN. Therefore, monitoring GGT levels is helpful in the early detection of HTN.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02884-3.

Mixed Effect of Alcohol, Smoking, and Smokeless Tobacco Use on Hypertension among Adult Population in India: A Nationally Representative Cross-Sectional Study

Sporadic evidence is available on the association of consuming multiple substances with the risk of hypertension among adults in India where there is a substantial rise in cases. This study assesses the mutually exclusive and mixed consumption patterns of alcohol, tobacco smoking and smokeless tobacco use and their association with hypertension among the adult population in India. Nationally representative samples of men and women drawn from the National Family and Health Survey (2015-2016) were analyzed. A clinical blood pressure measurement above 140 mmHg (systolic blood pressure) and 90 mmHg (diastolic blood pressure) was considered in the study as hypertension. Association between mutually exclusive categories of alcohol, tobacco smoking and smokeless tobacco and hypertension were examined using multivariate binary logistic regression models. Daily consumption of alcohol among male smokeless tobacco users had the highest likelihood to be hypertensive (OR: 2.32, 95% CI: 1.99-2.71) compared to the no-substance-users. Women who smoked, and those who used any smokeless tobacco with a daily intake of alcohol had 71% (OR: 1.71, 95% CI: 1.14-2.56) and 51% (OR: 1.51, 95% CI: 1.25-1.82) higher probability of being hypertensive compared to the no-substance-users, respectively. In order to curb the burden of hypertension among the population, there is a need for an integrated and more focused intervention addressing the consumption behavior of alcohol and tobacco.

Study of Body Mass Index among Medical Students of a Medical College in Nepal: A Descriptive Cross-sectional Study

INTRODUCTION

Changes in the lifestyle, food habits, lack of nutritious diet, stress, physical inactivity increases the body mass index among adults. Excess weight gain is an important risk factor for non-communicable diseases such as heart disease, stroke, diabetes, and some cancers (endometrial, breast, colon). Thus, this study aims to find out body mass index of medical students of a medical college in Nepal.

METHODS

This descriptive cross-sectional study was conducted in the department of physiology of a tertiary care center from August 2019 to February 2020 after taking ethical clearence from Institutional Review Committee (Reference number 192/19). Height and weight were recorded and body mass index was then being calculated. Data entry was done in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 22.

RESULTS

Out of 266 medical students, 39 (15%) were overweight and 32 (12%) were underweight with mean body mass index 26.60±1.99kg/m2 and 17.13±1.19kg/m2 respectively. Mean body mass index of males was 21.76±3.06kg/m2 and that of females was 21.70±2.96 kg/m2.

CONCLUSIONS

Comparing with a similar study done in Nepal previously, we found a higher prevalence of overweight in medical students whereas majority of medical students had normal weight. Factors affecting body mass index in medical students should be explored further.

Isolated systolic hypertension in Asia

Isolated systolic hypertension (ISH) is the most common type of essential hypertension in the elderly and young adults. With rapid industrialization and population aging, the prevalence of ISH in Asia will rise substantially. Asian populations have distinct epidemiological features, risk factors and are especially vulnerable to ISH. There is a pressing need for Asian countries to formulate their unique strategies for control of ISH. In this review, we focus on the (1) epidemiology and pathophysiology, (2) risk factors and impact on outcomes, and (3) treatment goal and strategy for ISH in Asia.

Hypertensive and toxicological health risk among women exposed to biomass smoke: A rural Indian scenario

This study shows that exposure to air pollutants from indoor cooking fuel combustion may be associated with elevated Diastolic Blood Pressure (DBP), Systolic Blood Pressure (SBP), Heart rate and Body mass index (BMI) in rural women of India. 60 premenopausal women (using solely agriculture residues, wood, dung, straw, leaf) and 30 women (solely using clean fuel, LPG) were recruited for this study. An ethically approved questionnaire was used in the study and health parameters were measured by standard instruments. Eight pollutants were measured by calibrated instruments, applied both in the living room as well as kitchens of test-subjects. The Test-subjects were divided into two groups, LPG users, and biomass users, and the toxicological risk was assessed by measurement of PM_2.5 levels in the given indoor environments. The concentrations of all the pollutants were significantly (p < 0.001) higher in biomass users than in LPG using households, except in the case of O₃ (p < 0.40₃) at the time of cooking. Results highlighted that DBP (p < 0.070), SBP (p < 0.143), Heart rate (p < 0.002) and BMI (p < 0.052) were varied in the two fuel user groups. In the case of biomass fuel user toxicological risk was higher (5.21) than LPG users (0.69). Moreover, Symptoms like asthma (25%), cough (76.67%), dizziness (36.67%), eye irritation (88.33%), and shortness of breath (43.33%) were highly prevalent among biomass users than in LPG users. The study highlighted that Biomass using women are more prone to cardiovascular disease and policies should be formulated for their sustainable health.

Prevalence of hypertension, diabetes, and associated risk factors among geriatric population living in a high-altitude region of rural Uttarakhand, India

Background:

Hypertension (HTN) and diabetes mellitus (DM) both are rapidly emerging as public health problems among geriatric population in developing countries. HTN can lead to stroke, myocardial infarction, congestive heart failure, and chronic kidney diseases among geriatric population. DM increases the risk of coronary heart disease, cerebrovascular disease, peripheral vascular disease, retinopathy, nephropathy, and neuropathy among geriatric population.

Methodology:

A community-based, cross-sectional study was conducted during 2015–2016 in District Nainital, Uttarakhand. A list of all villages with their population in the district was developed. From this list, 30 villages were identified using population proportionate to size sampling method. From each village, 30 geriatric subjects were selected. A total of 1003 geriatric subjects age 60 years and above were included in the study. Data were collected on sociodemographic profile, blood pressure, fasting blood glucose, anthropometry, and lipid profile from all the enrolled subjects. The prevalence of HTN and DM was assessed. Univariate and multivariate analyses were done to identify risk factors associated with HTN and DM.

Results:

The prevalence of HTN and DM was found to be 54.5% and 14.6%, respectively. For HTN, advancing age, high educational level and body mass index (BMI) (≥25 kg/m²) and for DM higher education level and BMI (≥25 kg/m²) were found to be significant risk factors.

Conclusion:

A high prevalence of HTN and DM was found in geriatric population residing in rural area of Uttarakhand.

Role of Anthropometric Measurements in Development of CVD and Stroke among T2DM in East Godavari District, Andhra Pradesh, India

INTRODUCTION

Cardiovascular morbidity and mortality have been associated with different variables of anthropometric measurements.

AIM

To find out the association of anthropometric measurements in the development of Cardiovascular Disease (CVD) and stroke among Type 2 Diabetes Mellitus (T2DM).

MATERIALS AND METHODS

Three hundred subjects were included in the study out of which 100 subjects were known type 2 diabetics with CVD or Stroke (Group 1), 100 subjects were type 2 diabetic patients (Group 2) and 100 subjects were normal and healthy (Group 3). Blood Pressure (BP), Body Mass Index (BMI) Neck Circumference (NC), Waist Circumference (WC), Hip Circumference (HC), Glycated haemoglobin (HbA1c), high sensitive- C-Reactive Protein (hsCRP), Malondialdehyde (MDA), Homocysteine (Hcy), microalbuminuria and estimated glomerular filtration rate (eGFR) were compared between all three groups by using one-way ANOVA test, comparison between males and females by t-test and association was done by using Chi-square test.

RESULTS

There were a significant difference in the means of anthropometric and biochemical parameters of the three groups (p<0.05). Diastolic BP, NC, WC, HC and homocysteine, are higher in T2DM obese patients than T2DM over weight and normal weight patients are statistically significant (p<0.05). The mean of levels systolic BP, Diastolic BP, hsCRP are higher in T2DM over weight patients than T2DM obese and normal weight patients are statistically significant (p<0.05). Association of physical activity, snoring and interrupted sleep with BMI was statistical significant (p<0.05).

CONCLUSION

Obesity and overweight in T2DM patients play important role in elevation of blood pressure and inflammation markers like hsCRP, homocysteine. Snoring and interrupted sleep also involved development of CVD and Stroke among T2 diabetes.

Prevalence, awareness, and control of hypertension in the slums of Kolkata

BACKGROUND

Slum dwellers have poor socio-environmental conditions and less access to medical care, which make them susceptible to illnesses. Studies on urban slums have primarily focused on communicable diseases and less on lifestyle diseases, such as hypertension. Consequently, there is a paucity of prevalence studies of hypertension in slums in different parts of the country. The aim of the study was to provide estimates of the prevalence, awareness, and control of hypertension in an adult population sample of the slums of Kolkata.

METHODS

A population-based cross-sectional study was conducted in the slums of Kolkata in collaboration with Kolkata Municipality Corporation. Door-to-door survey was conducted by trained healthcare workers using a structured questionnaire. Age, sex, religion, housing conditions (house/hut), average monthly household income, education status, current use of tobacco, history of hypertension, and whether on antihypertensive treatment were recorded. Blood pressure (BP) was recorded as per standard guidelines. Hypertension was diagnosed by JNC-VII criteria. A total of 10,175 adults aged ≥20 years were enrolled in the study.

RESULTS

Overall prevalence of hypertension was 42%. Hypertension was newly detected in 19% of the population. Fifty-four percent of the hypertensive subjects were aware of their hypertension status, 38% were on antihypertensive treatment, and 12% had their BP controlled to target level. Subgroup analysis showed that the prevalence of hypertension was higher in men, above 60 years age, in the minority community, in those with a higher household income, and among the tobacco users.

CONCLUSION

There is a high prevalence of hypertension in the slums of Kolkata. Although the awareness of the condition is high, the control of hypertension is poor.

Socio-economic & demographic determinants of hypertension & knowledge, practices & risk behaviour of tribals in India

Background & objectives:

An increase in prevalence of hypertension has been observed in all ethnic groups in India. The objective of the present study was to estimate prevalence and determinants of hypertension among tribals and their awareness, treatment practices and risk behaviours in nine States of India.

Methods:

A community based cross-sectional study adopting multistage random sampling procedure was carried out. About 120 Integrated Tribal Development Authority villages were selected randomly from each State. From each village, 40 households were covered randomly. All men and women ≥ 20 yr of age in the selected households were included for various investigations.

Results:

A total of 21141 men and 26260 women participated in the study. The prevalence of hypertension after age adjustment was 27.1 and 26.4 per cent among men and women, respectively. It was higher in the States of Odisha (50-54.4%) and Kerala (36.7-45%) and lowest in Gujarat (7-11.5%). The risk of hypertension was 6-8 times higher in elderly people and 2-3 times in 35-59 yr compared with 20-34 yr. Only <10 per cent of men and women were known hypertensives and more than half on treatment (55-68%). Men with general and abdominal obesity were at 1.69 (CI: 1.43-2.01) and 2.42 (CI: 2.01-2.91) times higher risk of hypertension, respectively, while it was 2.03 (CI=1.77-2.33) and 2.35 (CI 2.12-2.60) times higher in women. Those using tobacco and consuming alcohol were at a higher risk of hypertension compared with the non users.

Interpretation & conclusions:

The study revealed high prevalence of hypertension among tribals in India. Age, literacy, physical activity, consumption of tobacco, alcohol and obesity were significantly associated with hypertension. Awareness and knowledge about hypertension and health seeking behaviour were low. Appropriate intervention strategies need to be adopted to increase awareness and treatment practices of hypertension among tribals.

Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income countries.

Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension

Background:

A region-specific (urban and rural parts of north, east, west, and south India) systematic review and meta-analysis of the prevalence, awareness, and control of hypertension among Indian patients have not been done before.

Methods:

Medline, Web of Science, and Scopus databases from 1950 to 30 April 2013 were searched for ‘prevalence, burden, awareness, and control of blood pressure (BP) or hypertension (≥140 SBP and or ≥90 DBP) among Indian adults’ (≥18 years). Of the total 3047 articles, 142 were included.

Results:

Overall prevalence for hypertension in India was 29.8% (95% confidence interval: 26.7–33.0). Significant differences in hypertension prevalence were noted between rural and urban parts [27.6% (23.2–32.0) and 33.8% (29.7–37.8); P = 0.05]. Regional estimates for the prevalence of hypertension were as follows: 14.5% (13.3–15.7), 31.7% (30.2–33.3), 18.1% (16.9–19.2), and 21.1% (20.1–22.0) for rural north, east, west, and south India; and 28.8% (26.9–30.8), 34.5% (32.6–36.5), 35.8% (35.2–36.5), and 31.8% (30.4–33.1) for urban north, east, west, and south India, respectively. Overall estimates for the prevalence of awareness, treatment, and control of BP were 25.3% (21.4–29.3), 25.1% (17.0–33.1), and 10.7% (6.5–15.0) for rural Indians; and 42.0% (35.2–48.9), 37.6% (24.0–51.2), and 20.2% (11.6–28.7) for urban Indians.

Conclusion:

About 33% urban and 25% rural Indians are hypertensive. Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.

Burden and predictors of hypertension in India: results of SEEK (Screening and Early Evaluation of Kidney Disease) study

Background

Hypertension (HTN) is one of the major causes of cardiovascular morbidity and mortality. The objective of the study was to investigate the burden and predictors of HTN in India.

Methods

6120 subjects participated in the Screening and Early Evaluation of Kidney disease (SEEK), a community-based screening program in 53 camps in 13 representative geographic locations in India. Of these, 5929 had recorded blood pressure (BP) measurements. Potential predictors of HTN were collected using a structured questionnaire for SEEK study.

Results

HTN was observed in 43.5% of our cohort. After adjusting for center variation (p < 0.0001), predictors of a higher prevalence of HTN were older age ≥40 years (p < 0.0001), BMI of ≥ 23 Kg/M² (p < 0.0004), larger waist circumference (p < 0.0001), working in sedentary occupation (p < 0.0001), having diabetes mellitus (p < 0.0001), having proteinuria (p < 0.0016), and increased serum creatinine (p < 0.0001). High school/some college education (p = 0.0016), versus less than 9th grade education, was related with lower prevalence of HTN. Of note, proteinuria and CKD were observed in 19% and 23.5% of HTN subjects. About half (54%) of the hypertensive subjects were aware of their hypertension status.

Conclusions

HTN was common in this cohort from India. Older age, BMI ≥ 23 Kg/M², waist circumference, sedentary occupation, education less, diabetes mellitus, presence of proteinuria, and raised serum creatinine were significant predictors of hypertension. Our data suggest that HTN is a major public health problem in India with low awareness, and requires aggressive community-based screening and education to improve health.

Prevalence, awareness, and control of hypertension among Asian Indians living in urban Singapore and rural India

BACKGROUND

Hypertension is a major modifiable risk factor associated with cardiovascular morbidity and mortality. We compared the epidemiology of hypertension in South Asian Indians living in two geographic regions with vastly different socioeconomic settings (urban Singapore and rural India).

METHODS

We analyzed data from two large population-based studies: the Singapore Indian Eye Study (SINDI, n = 3228, aged 40-80 years, 49.2% women) and the Central India Eye and Medical Study (CIEMS, n = 3591, aged ≥40 years, 52.6% women). Hypertension was defined as SBP at least 140 or DBP at least 90 mmHg or self-reported history/treatment for hypertension.

RESULTS

The age-adjusted prevalence of hypertension in SINDI and CIEMS were 58.6 and 25.3%. After adjusting for potential confounders, increasing age, overweight/obese, and diabetes status showed a positive association and 'never drinking alcohol' showed a protective association with hypertension in both populations. Current smoking and being female showed a protective association and no formal education showed a positive association with hypertension in SINDI. Among those with hypertension in SINDI and CIEMS, 72.4 and 25.3% were aware of their condition of whom 85 and 31.6% were on treatment for hypertension. The blood pressure control was similar between the two populations (48.7% in SINDI and 46.9% in CIEMS).

CONCLUSION

The prevalence of hypertension, the level of awareness, and treatment for hypertension was higher in Indians living in Singapore than in rural Indians. Socioeconomic and metabolic factors explain some of the observed differences between the two populations, which may provide insights to develop public health strategies.

Association of diet and anthropometric measures as cardiovascular modifiable risk factors in young adults

Abstract Background: Cardiovascular accidents are the major cause of death in the developing world, accounting for nearly 40% of deaths in adult men and women. Developed countries have already brought this under control, whereas India has to take a giant leap. Diet plays a pivotal role among the various modifiable cardiovascular risk factors. The sole objective of this study is to point at nutrition as being the main modulator of different anthropometric parameters and directly or indirectly has a tremendous impact on the blood pressure levels even during young age. Methods: In a cross-sectional study involving 223 young adults, the pattern of food habits and level of physical activity were determined from self-reported questionnaires, while blood pressure, weight, height, waist circumference (WC), and hip circumference were measured, and body mass index (BMI) and waist-to-hip ratio (WHR) were computed. The subjects were grouped as normotensives and prehypertensives and also were compared according to their BMI and other parameters. Results: Statistically significant, greater association of weight followed by WC with the prehypertensive levels of blood pressure compared to other parameters was seen. The subjects detected as prehypertensives had predilection for salty, fried, oily, sweet, and fast food; BMI >25 kg/m2; and WC and WHR in high risk-categories per World Health Organization standards. More than 69% of subjects had high WHR, whereas only 9% of total subjects exercised regularly. Conclusions: Central obesity is associated with sedentary life and high intake of calories, leading to hypertension with advancing age. Early detection, awareness, and primary prevention would help reduce morbidity and mortality associated with cardiovascular diseases.

Prevalence of metabolic syndrome among newly diagnosed hypertensive patients in the hills of Himachal Pradesh, India

To study the prevalence of metabolic syndrome (MS) among newly diagnosed hypertensive patients in a tertiary care hospital in the northern hilly state of Himachal Pradesh, India, located in western Himalayas at a moderate altitude of 2200 m above mean sea level. One hundred and eighteen newly diagnosed hypertensive patients above the age of 20 years were studied in a hospital-based cross-sectional study. MS prevalence was estimated by International Diabetes Federation (IDF) criteria and modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. Student's t-test was used to compare the mean of the continuous variables. Chi-square test was used to compare discrete variables. The prevalence of MS in hypertensive patients was 68.6% (modified NCEP-ATP III) and 63.6% (IDF criteria). The most common phenotype of MS with the component of hypertension was the coexistence of waist circumference (90.1%), low high-density lipoprotein (HDL; 70.4%), and high triglycerides (67.9%) as per the modified NCEP-ATP III criteria, and low HDL (76.2%) and high triglycerides (66.4%) as per the IDF criteria. Fasting blood glucose (33.2% as per the modified NCEP-ATP III criteria and 32.6% as per the IDF criteria) was the least significant factor having an association with MS. The prevalence of MS among hypertensive patients was high and indicates the need for metabolic screening in all hypertensive patients at the first diagnosis.

Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study

Large-scale hypertension screening campaigns have been recommended for middle-income countries. We sought to identify sociodemographic predictors of hypertension prevalence, diagnosis, treatment, and control among middle-income countries. We analyzed data from 47 443 adults in all 6 middle-income countries (China, Ghana, India, Mexico, Russia, and South Africa) sampled in nationally representative household assessments from 2007 to 2010 as part of the World Health Organization Study on Global Aging and Adult Health. We estimated regression models accounting for age, sex, urban/rural location, nutrition, and obesity, as well as hypothesized covariates of healthcare access, such as income and insurance. Hypertension prevalence varied from 23% (India) to 52% (Russia), with between 30% (Russia) and 83% (Ghana) of hypertensives undiagnosed before the survey and between 35% (Russia) and 87% (Ghana) untreated. Although the risk of hypertension significantly increased with age (odds ratio, 4.6; 95% confidence interval, 3.0-7.1; among aged, 60-79 versus <40 years), the risk of being undiagnosed or untreated fell significantly with age. Obesity was a significant correlate to hypertension (odds ratio, 3.7; 95% confidence interval, 2.1-6.8 for obese versus normal weight), and was prevalent even among the lowest income quintile (13% obesity). Insurance status and income also emerged as significant correlates to diagnosis and treatment probability, respectively. More than 90% of hypertension cases were uncontrolled, with men having 3 times the odds as women of being uncontrolled. Overall, the social epidemiology of hypertension in middle-income countries seems to be correlated to increasing obesity prevalence, and hypertension control rates are particularly low for adult men across distinct cultures.

Establishment of reference intervals in Indian population

The central role of the laboratory scientist is to aid the clinician, in interpreting observed values, by providing relevant reference values in a convenient and practical form. In India, reference values used in laboratories have been established in the western population. But these can be questioned due to differences in genetic load, lifestyle, and diet. This review highlights the approach for establishing reference values in our population using the IFCC guidelines and our observations from our data as compared to the reported values in our laboratory.

Burden of Cardio- and Cerebro-vascular Diseases and the Conventional Risk Factors in South Asian Population

Similar to most populations, South Asian countries are also witnessing the dramatic transitions in health during the last few decades with the major causes of adverse health shifting from a predominance of nutritional deficiencies and infectious diseases to chronic diseases such as cardio and cerebrovascular disease (CVD). We summarized the available information of the burden of CVD and risk factors in the South Asian populations. The prevalence of conventional cardiovascular has been increasing among all South Asian populations. Extensive urbanization, shift in dietary pattern and sedentary daily life style is contributing towards the worsening of the CVD risk factor scenario. The burdens of the chronic cardiovascular risk factors are much prevalent in the South Asian populations. These are also rising alarmingly which ought to influence the already existed heavy CVD burden. Similar to the rest of the world, management for the conventional cardiovascular risk factors is very important for the prevention of CVD in South Asia.

Association between BMI, Blood Pressure, and Age: Study among Tangkhul Naga Tribal Males of Northeast India

Purpose. To find the prevalence of overweight/obesity and hypertension, and to study the association between BMI, blood pressure, and age. Methods. Cross-sectional study was carried out among 257 Tangkhul Naga males of Northeast India, age ranging from 20–70 years. The subjects were divided into five different age groups to study age trend. Results. Mean systolic, and diastolic BP was higher among subjects with elevated BMI and among older subjects. Minimum BP was found among underweight and maximum among obese. BP was found lowest among the youngest age group and higher among the elderly subjects. BMI was also found to be associated with age independently. Although the magnitude of correlation differed, there was significant positive correlation among BMI, age, systolic and diastolic BP. Odd ratios showed overweight/obese subjects to be more likely to have hypertension than those with normal BMI. Changing socioeconomic environment intensifies the prevalence of overweight/obesity and hypertension among the Tangkhul Nagas.

Prevalence, awareness, treatment, control and risk factors for hypertension in a rural population in South India

OBJECTIVES

Hypertension is a major public health problem with prevalence ranging 22-30% in urban India. There are few data on hypertension epidemiology in rural India. We conducted a survey to estimate prevalence, awareness, treatment, control and risk factors for hypertension in a rural population in south India.

METHODS

We did cross-sectional survey in 11 villages in Tamil Nadu. We collected data on behavioral risk factors, anthropometric and blood pressure measurements. We defined hypertension according to WHO criteria.

RESULTS

Study population included 10,463 subjects aged 25-64 years. Among them, 4,900 (46.8%) were males. Hypertension was present for 2,247 (21.4%) subjects and 1,682 (74.9%) among hypertensives were newly detected. Overall 20% were on treatment and 6.6% had blood pressure control. Age ≥35 years, BMI ≥ 23 kg/m(2) and central obesity were risk factors significantly associated with hypertension (p < 0.05). In addition, alcohol consumption, higher education level were risk factor among males and family history of hypertension was risk factor among females (p < 0.05).

CONCLUSION

Hypertension is an emerging challenge in rural India. We need health promotion programs and reorientation of primary health care to improve hypertension detection and management.

Hypertension in the developing world: challenges and opportunities

Hypertension is a major public health problem and a leading cause of death and disability in developing countries. One-quarter of the world's adult population has hypertension, and this is likely to increase to 29% by 2025. Modeled projections indicate an increase to 1.15 billion hypertensive patients by 2025 in developing countries. There is variability in the global prevalence of hypertension: hypertension is present in approximately 35% of the Latin American population, 20%-30% of the Chinese and Indian population, and approximately 14% in Sub-Saharan African countries. This heterogeneity has been attributed to several factors, including urbanization with its associated changes in lifestyle, racial ethnic differences, nutritional status, and birth weight. Compounding this high burden of hypertension is a lack of awareness and insufficient treatment in those with hypertension. The public health response to this challenge should drive greater promotion of awareness efforts, studies of risk factors for hypertension, and understanding of the impact of lifestyle changes. Also important are efforts to develop multipronged strategies for hypertension management in developing nations.

Comparison of risk factors associated with hypertension subtypes by classification tree method in Tongshan County of Jiangsu Province, China

BACKGROUND

There are only a very limited number of studies relating to risk factors for hypertension in rural populations in China. There are even fewer studies comparing various hypertension subtypes.

METHODS

A cross-sectional investigation was carried out in a representative sample of 20,390 subjects drawn from among 1,180,000 adult residents of Tongshan County of Jiangsu Province, China. The impact of risk factors including demographic, socioeconomic, dietary, and behavioral, on three hypertension subtypes, namely, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH), was analyzed by applying statistical tests and a classification tree.

RESULTS

ISH was the predominant untreated hypertension subtype (13.68 +/- 0.24%) in the adults of Tongshan County, followed by SDH (11.70 +/- 0.23%) and IDH (6.24 +/- 0.17%). Age, number of cigarettes smoked daily, and the types of vitamins taken varied among the ISH, IDH, and SDH classification trees. Low socioeconomic status was associated with an increased risk for ISH and SDH. Light alcohol intake was associated with higher risk for ISH, but with lower risks for IDH and SDH. Light cigarette smoking was associated with higher ISH risk but lower SDH risk. The intake of appropriate amounts of fish, shrimp, or meat lowered the risks for ISH and IDH. The intake of appropriate amounts of seafood, eggs, milk, or fruit lowered the risks for all hypertension subtypes. Interestingly, an excessive preference for sweet or salty foods was associated with a higher risk for all the subtypes.

CONCLUSIONS

In Tongshan County, there was a considerable prevalence of hypertension of various subtypes, each associated with distinctive and complex risk factors. This suggests that there is a need for testing more diverse prevention measures, tailored to specific subtypes.

Multi-locus interactions of vascular homeostasis genes in essential hypertension: a gender-based study

BACKGROUND

Studies on genes of endothelial and vascular homeostasis are inadequate in females.

METHODS

We investigated the role of 7 variants of ACE, AGT and NOS3 and their correlation with NO(x) levels and ACE activity in hypertension susceptibility in 910 case-controls of both genders.

RESULTS

Prevalence of alleles D of ACE I/D; -6A of AGT -6G/A; -786C, 894T and 4a of NOS3 -786T/C, 894G/T and 4b/4a polymorphisms was observed in patients (P< or =0.05). The 3 genotypes-combinations containing 6+5 wild-type alleles of AGT and NOS3 were significantly less prevalent in patients (P< or =0.0003). The haplotypes 235T/174T/-6A of AGT (P=4E-3) and -786T/894G/4a and -786C/894G/4a of NOS3 (P=2E-3, P=0.011, respectively) were significantly more prevalent in patients. The AGT and NOS3 findings were similar in males. Genotypes-combinations with 6+5 wild-type alleles of AGT correlated with higher NO(x) levels (P=0.03). The NOS3 genotypes-combinations having 6 and 6+5 wild-type alleles correlated with decreased ACE activity (P=0.025, P=0.0015, respectively) and increased NO(x) levels (P=0.001, P=0.0001, respectively) in patients. In gene-gene interactions, ACE D allele associated with < or =4 wild-type alleles containing genotypes-combinations of AGT and NOS3 in patients (P< or =0.04).

CONCLUSION

Within gene and between genes interactions of variants influence ACE activity and NO(x) levels and associate with EH.

Significance of angiotensinogen gene haplotypes and genotypes combinations in hypertension

OBJECTIVE

Renin-angiotensin system gene polymorphisms are associated with essential hypertension; angiotensinogen gene variants are considered potential genetic risk factors. The aim of this study was to investigate the contribution of the G-6A, T174M, M235T polymorphisms, genotypic interactions, and haplotypes toward essential hypertension.

METHODS

In a case-control design, 810 consecutive ethnically matched unrelated individuals comprising 450 hypertensive patients and 360 controls were recruited. Genotyping by polymerase chain reaction-restriction fragment length polymorphism, genotypes combinations, and haplotypes analyses were performed. Plasma renin activity and plasma aldosterone concentration were measured.

RESULTS

The G-6A and M235T polymorphisms differed significantly (P = 0.007, odds ratio = 1.9, 95% confidence interval = 1.2-2.9; P < 0.0001, odds ratio = 3.7, 95% confidence interval = 2.3-5.7, respectively), wherein the -6A and 235T mutant alleles were over-represented in hypertensive patients (P < 0.0001, each). Genotypes combinations of six wild-type alleles versus the remaining resulted in odds ratio of 2.4 (P < 0.0001), further mutant alleles based combinations linearly correlated with systolic, diastolic, and mean blood pressure. Over-representation of the haplotypes, namely, A/174T, 174T/235T, A/235T, and A/174T/235T in hypertensive patients and G/174T, 174T/235M, G/235M, and G/174T/235M in controls, was identified as risk and protective haplotypes (P < 0.0001, each), respectively. The patients had significantly higher plasma aldosterone concentration and lower plasma renin activity (P < 0.0001), the former correlated with -6A and 235T alleles (P < 0.0001).

CONCLUSION

The interaction among G-6A, M235T and T174M polymorphisms in combinations or haplotypes emerged significant. These findings, conjoint with significant high plasma aldosterone concentration and low plasma renin activity, suggest low-renin hypertension in our study population.

The prevalence and risk factors associated with isolated untreated systolic hypertension in Korea: the Korean National Health and Nutrition Survey 2001

Although isolated systolic hypertension (ISH) increases the risk of coronary heart disease and stroke, more than any other hypertension subtype, the prevalence and risk factors associated with ISH in the Korean population are not known. The 2001 Korean National Health and Nutrition Survey was a cross-sectional and nationally representative survey conducted in 2001. The prevalence of ISH by age and body mass index (BMI) was examined in 6601 Korean adults over 20 years of age. After adjusting for age, 4.32+/-0.32% of Korean adults had ISH, 5.28+/-0.37% had isolated diastolic hypertension and 5.82+/-0.36% had systolic/diastolic hypertension. The overall prevalence of ISH was found to increase directly with advancing age and increasing BMI. Although the ISH was found to be more common in men overall (4.81+/-0.50% in men, 4.12+/-0.37% in women), it was more common in women over 70 years of age. Independent variables associated with risk for ISH included advanced age, BMI, triglyceride (TG) levels, monthly income and alcohol intake. However, gender, fasting blood glucose, total cholesterol and high-density lipoprotein cholesterol levels, residential area, education level and smoking were found not to be significantly associated with ISH risk. The findings of the present study demonstrate that the prevalence of untreated ISH in Korea was lower than in Western countries. Age, BMI, TG levels, monthly income and alcohol intake were associated with ISH.

Association between body mass index and blood pressure across three populations in Africa and Asia

Despite a growing burden of obesity and hypertension in developing countries, there is limited information on the contribution of body mass index (BMI) to blood pressure (BP) in these populations. This study examines the association between BMI and BP in three populations across Africa and Asia. Data on BMI, BP and other background characteristics of study participants were generated using the World Health Organization STEPwise approach to surveillance (STEPS), at three demographic surveillance sites in Ethiopia, Vietnam and Indonesia. BMI and BP increased along the socioeconomic gradient across the three countries. Mean (s.d.) BMI in men varied between 19.41 (2.28) in Ethiopia to 21.17 (2.86) in Indonesia. A high prevalence of overweight/obesity was noted among Indonesian women (25%) and men (10%), whereas low BMI was widely prevalent in Ethiopia and Vietnam, ranging from 33 to 43%. Mean (s.d.) systolic BP (SBP) among men varied between 117.15 (15.35) in Ethiopia to 127.33 (17.80) in Indonesia. The prevalence of hypertension was highest among women (25%) and men (24%) in Indonesia. Mean BP levels increased with increasing BMI. The risk of hypertension was higher among population groups with overweight and obesity (BMI>/=25 kg/m(2)); odds ratio (95% confidence interval); 2.47 (1.42, 4.29) in Ethiopia, 2.67 (1.75, 4.08) in Vietnam and 7.64 (3.88, 15.0) in Indonesia. BMI was significantly and positively correlated with both SBP and DBP in all the three populations, correlation coefficient (r) ranging between 0.23 and 0.27, P<0.01. High BP exists in a background of undernutrition in populations at early stages of the epidemiologic transition.

Hypertension control and co-morbidities in primary health care centers in Riyadh

BACKGROUND

The prevalence of hypertension in Saudi Arabia has been assessed only in preliminary reports. The aim of this study was to determine the degree of control of blood pressure and the prevalence of common hypertension co-morbidities among hypertensive patients at-tending primary healthcare (PHC) centers in Riyadh.

METHODS

A cross-sectional study was conducted by reviewing medi-cal records of hypertensive patients during May and June 2001. Two hundred fifty-five medical records were selected by a stratified randomization process according to the distribution of 73 PHC centers in the city and the total number of hypertensive patients registered in the mini-clinic of each PHC center. Trained mini-clinic nurses collected data using a data collection form developed for this purpose.

RESULTS

Of 255 patients, 121 (47.5%) were males and 134 (52.5%) were females; the mean age was 57.2+/-11.1 years and 8.3% were smokers. The majority, 204 (85.7%), had greater than normal body weight. Only 101 (40.4%) had controlled systolic BP and 129 (51.6%) had controlled diastolic BP. The most common co-morbidity was diabetes mellitus, found in 98 (38.4%), followed by dyslipidemia in 50 (19.6%), bronchial asthma in 28 (11.0%) and renal diseases in 12 (4.7%). Except for osteoporosis, which was reported by females only (P=0.003), the occurrence of hypertensive co-morbidities did not vary from other demographic characteristics.

CONCLUSION

This study demonstrated poor blood pressure control in the mini-clinics in PHC centers. To improve the quality of care for hypertensive patients, we recommend an improvement in PHC physician knowledge of and attitudes toward the importance of achieving targeted blood pressure levels.

Blood pressure and the global burden of disease 2000. Part 1: Estimates of blood pressure levels

OBJECTIVE

To provide global estimates of blood pressure by age and sex for adults aged > or = 30 years, by WHO subregion.

DESIGN AND METHODS

Data were obtained from studies identified in a literature review of population-based surveys. These were complemented by data from MONICA and INTERSALT studies. Estimates of the shape of the age-systolic blood pressure (SBP) association were made from survey data utilizing parametric and non-parametric analyses. A linear sex-specific association of SBP with age was demonstrated from 30 to 70 years in females and 20 to 70 years for males in each subregion. Mean age- and sex-specific estimates of SBP were estimated for each WHO subregion separately, based on study and country-weighted SBP data.

RESULTS

Analyses were based on data from about 230 surveys and over 660 000 participants. Age-specific mean SBP values ranged from 114 to 164 mmHg for females, and 117-153 mmHg for males. Females typically had lower SBP levels than males in the 30-44-year age groups, but in all subregions, SBP levels rose more steeply with age for females than males. Therefore, SBP levels in those aged > or = 60 years tended to be higher in females. Subregions with consistently high mean SBP levels included parts of eastern Europe and Africa. Mean SBP levels were lowest in south-east Asia and parts of the western Pacific.

CONCLUSIONS

These global estimates of blood pressure by age, sex and subregion show considerable variation in estimated levels. The lack of data in developing countries is substantial, and this is an important limitation given the role of blood pressure in increasing cardiovascular disease levels.

Geographical difference in the prevalence of isolated systolic hypertension in middle-aged men and women in Korea: the Korean Health and Genome Study

To compare geographical difference in the prevalence of isolated systolic hypertension (ISH) in between urban (Ansan) and rural (Ansung) Korean adults aged 40-69 years, 4351 men and 4604 women enrolled in the Korean Health and Genome Study were analysed. Information was collected regarding gender, alcohol intake, smoking status, household income, occupation, and years of education by trained interviewers. Eligible subjects included untreated hypertensive and normotensive subjects. ISH was defined as a systolic blood pressure (SBP) > or = 140 mmHg and diastolic BP <90 mmHg. The overall age-adjusted prevalence of ISH was 4.1%. The prevalence of ISH in Ansung (5.7%) was higher than in Ansan (2.5%, P < 0.05). Also it increased with increments of age, from 1.0 to 12.8% in Ansung (P < 0.05) and from 0.3 to 13.0% in Ansan (P < 0.05). In those with body mass index (BMI) > or = 30.0 kg/m2 in Ansung, the prevalence of ISH in women was twice as much as in men. The prevalence of ISH in obese men and women with a waist-hip ratio > or =1.0 and > or = 0.85, respectively, was more than that of nonobese men and women in both areas. In Korea, because of industrialization, the age distribution was skewed and the Korean population in rural areas is more aged. ISH will become a truly major health problem in rural area, because ISH is related to age, BMI and waist-hip ratio. Therefore, the Korean government will be required to institute different policies in the hypertension management to target populations in rural and urban areas.

Patterns and predictors of prehypertension among "healthy'' urban adults in India

Cardiovascular disease is still on the increase in India owing to changing socioeconomic factors and unhealthy lifestyles. Better understanding of the role of hypertension (HTN) has led to new Joint National Committee (JNC-7) guidelines for its diagnosis and management. The authors aimed to evaluate the predictors and correlates of prehypertension (PreHTN) among adults in urban India. Study design is a cross-sectional survey among 2,007 adults in Chennai in July 2003; 1,505 men and 502 women over the age of 18 years were studied. Demographic data collected by direct interview were the following: age, smoking, alcohol intake, type of work, exercise patterns, and monthly income. Anthropometric data of height, weight, and waist and hip dimensions were measured. Blood pressure (BP) was recorded thrice, with at least 15 minutes between readings 2 and 3. The mean of readings 2 and 3 was taken for the study. Of the 2,007 people studied, 951 (47.4%) had PreHTN and 696 (34.7%) had HTN. PreHTN was found in 46.6% of the men and 49.8% of the women. PreHTN was prevalent in 47.4% of adults, and another 34.7% had hypertension (Stage I, 20%, and Stage II, 14.7%). In urban India less than 18% of adults have normal BP of less than 120/80. Multiple logistic regression analysis after age and sex correction identified obesity, diet, family history and middle-income group as correlating with PreHTN. The factors that predict HTN were age, sex, smoking, alcohol intake, sedentary lifestyle, and type of work.

Evidence-based care for the elderly with isolated systolic hypertension

This paper reviews the epidemiology, pathophysiology and clinical significance of isolated systolic hypertension (ISH) in the elderly. Aging is associated with structural and functional changes in the arterial tree. Intimal thickening, migration of small muscle cells to the intima, medial fibrosis, and elastic fiber degeneration result in increased arterial stiffness and ISH. The augmented systemic vascular resistance in the elderly is mediated by increased arterial stiffness. Aging is correlated with overactivity of the sympathetic nervous system, reduced neuronal plasma norepinephrine uptake, and baroreceptor dysfunction. These functional changes all contribute to the development of ISH in elderly persons. Prospective and epidemiological studies have demonstrated that ISH is associated with coronary and cerebrovascular morbidity and mortality. There is good evidence indicating that lifestyle modifications such as weight reduction, increased physical activity, moderation of dietary sodium, and decreased alcohol intake, in combination with pharmacological therapy can effectively reduce blood pressure in elderly individuals with ISH. Primary health care providers can make significant contributions to the care of elderly persons with ISH. These contributions involve educating elderly people to control hypertension through lifestyle modification, monitoring the efficacy of antihypertensive therapy, and preventing complications associated with non-compliance with therapeutic regimens.

Study of urban community survey in India: growing trend of high prevalence of hypertension in a developing country

The prevalence pattern of hypertension in developing countries is different from that in the developed countries. In India, a very large, populous and typical developing country, community surveys have documented that between three and six decades, prevalence of hypertension has increased by about 30 times among urban dwellers and by about 10 times among the rural inhabitants. Various factors might have contributed to this rising trend and among others, consequences of urbanization such as change in life style pattern, diet and stress, increased population and shrinking employment have been implicated. In this paper, we study the prevalence of hypertension in an urban community of India using the JNC VII criteria, with the aim of identifying the risk factors and suggesting intervention strategies. A total of 1609 respondents out of 1662 individuals participated in our cross-sectional survey of validated and structured questionnaire followed by blood pressure measurement. Results showed pre-hypertensive levels of blood pressures among 35.8% of the participants in systolic group (120-139mm of Hg) and 47.7% in diastolic group (80-89 mm of Hg). Systolic hypertension (140 mm of Hg) was present in 40.9% and diastolic hypertension (90 mm of Hg) in 29.3% of the participants. Age and sex-specific prevalence of hypertension showed progressive rise of systolic and diastolic hypertension in women when compared to men. Men showed progressive rise in systolic hypertension beyond fifth decade of life. Bivariate analysis showed significant relationship of hypertension with age, sedentary occupation, body mass index (BMI), diet, ischemic heart disease, and smoking. Multivariate analysis revealed age and BMI as risk factors, and non-vegetarian diet as protective factor with respect to hypertension. Prevalence of prehypertensives was high among younger subjects - particularly students and laborers who need special attention. Role of non-vegetarian diet as a protective factor might have been related to fish-eating behavior of the sample population, who also use mustard oil as cooking medium - both of which have significant level of essential polyunsaturated fatty acids. The observed prevalence of hypertension in this study and other studies suggest the need for a comprehensive national policy to control hypertension in India, and, in other similar developing countries.

Global burden of hypertension: analysis of worldwide data

BACKGROUND

Reliable information about the prevalence of hypertension in different world regions is essential to the development of national and international health policies for prevention and control of this condition. We aimed to pool data from different regions of the world to estimate the overall prevalence and absolute burden of hypertension in 2000, and to estimate the global burden in 2025.

METHODS

We searched the published literature from Jan 1, 1980, to Dec 31, 2002, using MEDLINE, supplemented by a manual search of bibliographies of retrieved articles. We included studies that reported sex-specific and age-specific prevalence of hypertension in representative population samples. All data were obtained independently by two investigators with a standardised protocol and data-collection form.

RESULTS

Overall, 26.4% (95% CI 26.0-26.8%) of the adult population in 2000 had hypertension (26.6% of men [26.0-27.2%] and 26.1% of women [25.5-26.6%]), and 29.2% (28.8-29.7%) were projected to have this condition by 2025 (29.0% of men [28.6-29.4%] and 29.5% of women [29.1-29.9%]). The estimated total number of adults with hypertension in 2000 was 972 million (957-987 million); 333 million (329-336 million) in economically developed countries and 639 million (625-654 million) in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion).

INTERPRETATION

Hypertension is an important public-health challenge worldwide. Prevention, detection, treatment, and control of this condition should receive high priority.

Worldwide prevalence of hypertension: a systematic review

PURPOSE

To examine the prevalence and the level of awareness, treatment and control of hypertension in different world regions.

STUDY SELECTION

A literature search of the MEDLINE database, using the Medical Subject Headings prevalence, hypertension, blood pressure and cross-sectional studies, was conducted. Published studies, which reported the prevalence of hypertension and were conducted in representative population samples, were included in the review. The search was restricted to studies published from January 1980 through July 2003.

DATA EXTRACTION

All data were extracted independently by two investigators using a standardized protocol and data collection form.

RESULTS

The reported prevalence of hypertension varied around the world, with the lowest prevalence in rural India (3.4% in men and 6.8% in women) and the highest prevalence in Poland (68.9% in men and 72.5% in women). Awareness of hypertension was reported for 46% of the studies and varied from 25.2% in Korea to 75% in Barbados; treatment varied from 10.7% in Mexico to 66% in Barbados and control (blood pressure < 140/90 mmHg while on antihypertensive medication) varied from 5.4% in Korea to 58% in Barbados.

CONCLUSION

Hypertension is an important public health challenge in both economically developing and developed countries. Significant numbers of individuals with hypertension are unaware of their condition and, among those with diagnosed hypertension, treatment is frequently inadequate. Measures are required at a population level to prevent the development of hypertension and to improve awareness, treatment and control of hypertension in the community.

Trends in hypertension epidemiology in India

Cardiovascular diseases caused 2.3 million deaths in India in the year 1990; this is projected to double by the year 2020. Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. Indian urban population studies in the mid-1950s used older WHO guidelines for diagnosis (BP > or =160 and/or 95 mmHg) and reported hypertension prevalence of 1.2-4.0%. Subsequent studies report steadily increasing prevalence from 5% in 1960s to 12-15% in 1990s. Hypertension prevalence is lower in the rural Indian population, although there has been a steady increase over time here as well. Recent studies using revised criteria (BP > or =140 and/or 90 mmHg) have shown a high prevalence of hypertension among urban adults: men 30%, women 33% in Jaipur (1995), men 44%, women 45% in Mumbai (1999), men 31%, women 36% in Thiruvananthapuram (2000), 14% in Chennai (2001), and men 36%, women 37% in Jaipur (2002). Among the rural populations, hypertension prevalence is men 24%, women 17% in Rajasthan (1994). Hypertension diagnosed by multiple examinations has been reported in 27% male and 28% female executives in Mumbai (2000) and 4.5% rural subjects in Haryana (1999). There is a strong correlation between changing lifestyle factors and increase in hypertension in India. The nature of genetic contribution and gene-environment interaction in accelerating the hypertension epidemic in India needs more studies. Pooling of epidemiological studies shows that hypertension is present in 25% urban and 10% rural subjects in India. At an underestimate, there are 31.5 million hypertensives in rural and 34 million in urban populations. A total of 70% of these would be Stage I hypertension (systolic BP 140-159 and/or diastolic BP 90-99 mmHg). Recent reports show that borderline hypertension (systolic BP 130-139 and/or diastolic BP 85-89 mmHg) and Stage I hypertension carry a significant cardiovascular risk and there is a need to reduce this blood pressure. Population-based cost-effective hypertension control strategies should be developed.

Increased variance in blood pressure distribution and changing hypertension prevalence in an urban Indian population

The objective of the study was to determine trends in age-specific blood pressure (BP) distribution and hypertension prevalence in an urban Indian population. In successive hypertension epidemiological studies (1995 and 2002), randomly selected 2212 subjects (1412 men, 797 women) in the first and 1123 subjects (550 men, 573 women) in the second study were evaluated. BP was measured using World Health Organization guidelines and hypertension diagnosed using the American Joint National Committee-VI report. Age-specific BP levels in the first and the second study were determined and compared. The mean values of systolic and diastolic BP were not significantly different in various age groups in the first and the second studies. There was an increased variance in the second study as denoted by the significant increase in standard deviations and coefficients of variation in systolic as well as diastolic BP levels at age groups > or =50 years in men and > or =40 years in women (P<0.05). The age-adjusted prevalence of hypertension (known or BP > or =140/> or =90 mmHg) in the first study was 29.5% (men) and 33.5% (women), and in the second study was 30.0% (men) and 30.3% (women) (P=NS). In the second as compared to the first study, there was decrease in age-adjusted prevalence of stage I hypertension (men 16.8 vs 24.9%, women 15.4 vs 27.5%), and increase in stage II hypertension (men 11.7 vs 2.8%, women 18.8 vs 3.1%), and combined stage II and III hypertension (men 13.5 vs 4.7%, women 16.7 vs 6.0%) (P<0.01). This change was associated with greater prevalence of obesity in the second study. In conclusion, increased systolic and diastolic BP dispersion over a 7-year period in this urban population is associated with unchanged hypertension prevalence, decline in stage I hypertension and upsurge in more severe grades. Increasing environmental factors, particularly obesity, appear important.

Hypertension in the Parsi community of Bombay: a study on prevalence, awareness and compliance to treatment

BACKGROUND

Uncontrolled hypertension (HT) is an established risk factor for the development of vascular diseases. Prevalence varies in different communities and no such study has been conducted in the Parsi community living in Bombay, India. The objectives of this study were to determine the prevalence, awareness, compliance to medication and control of HT in this community.

METHOD

We used a 1 in 4 random selection of subjects who were > or = 20 years of age. A questionnaire was administered and the blood pressure (BP) was measured by a doctor. HT was defined as diastolic blood pressure (DBP) > or = 90 mm Hg +/- systolic pressure (SBP) > or = 140 mm Hg. Isolated systolic hypertension (ISH) was defined as SBP > or = 160 mm Hg with DBP < 90 mm Hg. Subsequently, we reanalysed the data using current definition of ISH as SBP > or = 140 mm Hg with DBP < 90 mm Hg.

RESULTS

2879 subjects > or = 20 years of age were randomly selected of which 2415 (84%) participated in the study. The overall prevalence of HT in the community was 36.4%, of whom 48.5% were unaware of their hypertensive status. Of those aware of having HT, 36.4% were non-compliant with their anti-hypertensive drugs and only 13.6% had optimally controlled HT. Prevalence of ISH using the present criteria was 19.5% and 73% of hypertensives > or = 60 years had ISH.

CONCLUSION

This study shows that prevalence of HT in the Parsi community is high and nearly half are unaware of their hypertensive status. ISH is the dominant form of HT in the elderly. Compliance to treatment is poor and optimal BP control is achieved in only a small minority. The study highlights the need for regular screening coupled with educational programs to detect and optimally treat HT in the community.

Is lead exposure the principal cause of essential hypertension?

Lead is a ubiquitous toxin, known to have adverse effects on the body even at low levels of exposure. In this review we explore whether low lead may be the principal or a major contributory cause of essential hypertension, and whether removal of lead from the environment may eventually reduce both the overall incidence of hypertension and the increased incidence with aging.

Distribution of blood pressure and prevalence of hypertension in Tehran adult population: Tehran Lipid and Glucose Study (TLGS), 1999-2000

The purpose of this study was to estimate the current prevalence and distribution of hypertension in an adult Tehranian population. Data were collected for 3343 men and 5148 women aged 20-69 years in the Tehran Lipid and Glucose Study (TLGS), which is a cross-sectional phase of a large epidemiologic study, first established in 1999. The study used the mean of two separate blood pressure (BP) measurements in each individual. Twenty-two percent (23% of women vs 20% of men, P = 0.01) had hypertension according to 'JNC-VI' and 'WHO-ISH' criteria. The average systolic BP (SBP), diastolic BP (DBP) and pulse pressure of hypertensive participants were 31, 16, and 15 mm Hg higher than the corresponding value for normotensives, respectively. Thirty-six percent of participants with JNCVI-based hypertension were using antihypertensive medication (23% of men and 43% of women). Of these, 40% (45% of men and 39% of women) had normal BP. Hypertension awareness was 50% in these participants (57% in men vs 37% in women, P < 0.001). Data for 3179 men and 4646 women aged 20-69 years with no antihypertensive treatment were used for analysis of BP measures. Of these, 15% (16% of men and 14% of women, P = 0.006) had high and 85% (84% of men and 86% of women) normal or high-normal BP levels according to JNC-VI. Prevalence of optimal BP was 49% (47% of men and 51% of women). Mean SBP was 117.8 +/- 16.6 and 116.4 +/- 16.4 mm Hg in men and women, respectively (P < 0.001). The equivalent values were 77.4 +/- 10.7 and 77.3 +/- 9.9 mm Hg for DBP (P = 0.5) and 40.4 +/- 12 and 39.1 +/- 11.7 mm Hg for pulse pressure (P < 0.001). A relatively high prevalence of JNC-VI/WHO-ISH defined hypertension was found in the TLGS adult population with 50% undiagnosed and 60% uncontrolled hypertension. These findings emphasise further considerations for detection and better management of hypertension in the urban population of Tehran.

Prevalence, awareness, treatment, control and risk factors of hypertension in Korea: the Ansan study

OBJECTIVES

To determine prevalence, awareness, treatment, and control of hypertension, and its risk factors in an urban Korean population.

DESIGN AND SETTING

A cross-sectional survey in Ansan-city, Korea.

SUBJECTS AND METHODS

Population-based samples of people aged 18-92 years in Ansan-city, Korea, were selected, yielding 2278 men and 1948 women, and their blood pressures were measured using a highly standardized protocol. Hypertension was defined as a systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or reported treatment with antihypertensive medications, and subclassified according to 1999 WHO-ISH guidelines. Isolated systolic hypertension (ISH) defined as a systolic BP > or = 140 mmHg and diastolic BP < 90 mmHg was also examined. Data were stratified by age and sex.

RESULTS

The overall prevalence of hypertension in this study was 33.7%. Among these, 64.9% had Grade 1 hypertension, 22.5% Grade 2, and 12.5% Grade 3. Age-specific prevalence of hypertension increased progressively with age, from 14.19% in 18 to 24 year-olds to 71.39% in those 75 years or older. Hypertension prevalence was significantly higher in men (41.5%) than in women (24.5%) (P < 0.001). Isolated systolic hypertension had significantly lower prevalence (4.33%) within the population, although in the elderly aged 55 years or more it rose by 11.13%. Overall, 24.6% of hypertensive individuals were aware that they had high blood pressure, as much as 78.6% were being treated with antihypertensive medications, and 24.3% were under control. Hypertension awareness as well as treatment and control rates varied by sex, with women higher in all three rates. Multivariate analysis revealed that age, body mass index and abdomen circumference were significantly associated with prevalence of hypertension both in men and women.

CONCLUSIONS

Hypertension is highly prevalent in Korea. Despite the high rate of treatment, the rates of awareness and control are relatively low, suggesting the nationwide demand for preventing and controlling high blood pressure in Korea in order to avert an epidemic of cardiovascular disease.