Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

A cross-sectional study of the prevalence and risk factors for hypertension in rural Nepali women

Authors: Rumana J Khan, Christine P Stewart, Parul Christian, Kerry J Schulze, Lee Wu, Steven C LeClerq, Subarna K Khatry, Keith P West Jr

Published in: BMC Public Health | Issue 1/2013

Login to get access

Abstract

Background

The prevalence of hypertension is increasing in much of the South Asian region, including Nepal. This paper reports the prevalence and risk factors of hypertension and pre-hypertension among adult women in a rural community of Nepal.

Methods

Cross-sectional data on socioeconomic status (SES), lifestyle factors and blood pressure (BP) were collected from a cohort of 15,934 women in rural Nepal in 2006–08. Among a subsample (n = 1679), anthropometry and biomarkers of cardiovascular risk were measured.

Results

The mean age of women was 34.2 years (range 16.4-71.2 years). More than three percent (3.3%) had hypertension and 14.4% had pre-hypertension. In an adjusted analysis, lower SES, especially lower household farm assets and storage of food for long term consumption, was associated with increased odds of hypertension (OR = 1.14 for mid-level SES and OR = 1.40 for low SES; p for trend < 0.01). Smoking, alcohol use and not working outside the home were also associated with higher risk. In a subsample, both systolic BP (SBP) and diastolic BP (DBP) were positively associated with high triglycerides (SBP β = 4.1 mm Hg; DBP β =3.6 mm Hg), high HbA1c (SBP β = 14.0; DBP β = 9.2), raised fasting glucose (SBP β = 10.0; DBP β = 6.9), high BMI (SBP β = 6.7; DBP β = 5.1) and high waist circumference (SBP β = 6.2; DBP β = 5.3) after adjusting for potential confounders (p for all <0.01).

Conclusions

Although the prevalence of hypertension was low in this cohort, it was more prevalent among the poorer women and was strongly associated with other cardiovascular risks. These associations at a relatively young age may confer greater risk for cardiovascular disease among women in later life, indicating the need for interventions to reduce the progression from pre-hypertension to hypertension.
Literature
1.
Leeder SR, Raymond SU, Greenberg H, Lui H, Esson K: Race against time: The challenge of cardiovascular disease in developing economies. 2004, New York: Trustees of Columbia University
2.
Murray CJ, Lopez AD: The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. 1996, Cambridge, MA: Harvard University Press
3.
4.
Goyal A, Yusuf S: The burden of cardiovascular disease in the Indian subcontinent. Indian J Med Res. 2006, 124: 235-244.PubMed
5.
Gaziano TA: Reducing the growing burden of cardiovascular disease in the developing world. Health Aff (Millwood). 2007, 26: 13-24.CrossRefPubMedCentral
6.
Gupta R: Burden of coronary heart disease in India. Indian Heart J. 2005, 57: 632-638.PubMed
7.
Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, Pandey MR, Haque S, Mendis S, Rangarajan S, Yusuf S: Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007, 297: 286-294.CrossRefPubMed
8.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J: Global burden of hypertension: analysis of worldwide data. Lancet. 2005, 365: 217-223.CrossRefPubMed
9.
10.
West KP, Katz J, Khatry SK, LeClerq SC, Pradhan EK, Shrestha SR, Connor PB, Dali SM, Christian P, Pokhrel RP, Sommer A: Double blind, cluster randomised trial of low dose supplementation with vitamin A or beta carotene on mortality related to pregnancy in Nepal. The NNIPS-2 Study Group. BMJ. 1999, 318: 570-575.CrossRefPubMedPubMedCentral
11.
Stewart CP, Christian P, Katz J, Schulze KJ, Wu LSF, LeClerq SC, Shakya TR, Khatry SK, West KP: Maternal supplementation with vitamin A or β-carotene and cardiovascular risk factors among pre-adolescent children in rural Nepal. Journal of Developmental Origins of Health and Disease. 2010, 1: 262-270.CrossRefPubMed
12.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003, 289: 2560-2572.CrossRefPubMed
13.
Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001, 285: 2486-2497.
14.
International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009, 32: 1327-1334.
15.
Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004, 63: 157-163.
16.
Alberti KG, Zimmet P, Shaw J: The metabolic syndrome–a new worldwide definition. Lancet. 2005, 366: 1059-1062.CrossRefPubMed
17.
Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, Joshi SR, Sadikot S, Gupta R, Gulati S, Munjal YP: Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009, 57: 163-170.PubMed
18.
19.
Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K: The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007, 370: 1929-1938.CrossRefPubMed
20.
Pandey MR, Upadhyaya LR, Dhungel S, Pillai KK, Regmi HN, Neupane RP: Prevalence of hypertension in a rural community in Nepal. Indian Heart J. 1981, 33: 284-289.PubMed
21.
Jafar TH, Levey AS, Jafary FH, White F, Gul A, Rahbar MH, Khan AQ, Hattersley A, Schmid CH, Chaturvedi N: Ethnic subgroup differences in hypertension in Pakistan. J Hypertens. 2003, 21: 905-912.CrossRefPubMed
22.
Sayeed MA, Banu A, Haq JA, Khanam PA, Mahtab H, Azad Khan AK: Prevalence of hypertension in Bangladesh: effect of socioeconomic risk factor on difference between rural and urban community. Bangladesh Med Res Counc Bull. 2002, 7-18.
23.
24.
Malhotra P, Kumari S, Kumar R, Jain S, Sharma BK: Prevalence and determinants of hypertension in an un-industrialised rural population of North India. J Hum Hypertens. 1999, 13: 467-472.CrossRefPubMed
25.
Kinra S, Bowen LJ, Lyngdoh T, Prabhakaran D, Reddy KS, Ramakrishnan L, Gupta R, Bharathi AV, Vaz M, Kurpad AV, Smith GD, Ben-Shlomo Y, Ebrahim S: Sociodemographic patterning of non-communicable disease risk factors in rural India: a cross sectional study. BMJ. 2010, 341: c4974-CrossRefPubMedPubMedCentral
26.
Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D: Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet. 2001, 358: 1682-1686.CrossRefPubMed
27.
Hsia J, Margolis KL, Eaton CB, Wenger NK, Allison M, Wu L, LaCroix AZ, Black HR: Prehypertension and cardiovascular disease risk in the Women’s Health Initiative. Circulation. 2007, 115: 855-860.CrossRefPubMed
28.
Gilberts EC, Arnold MJ, Grobbee DE: Hypertension and determinants of blood pressure with special reference to socioeconomic status in a rural south Indian community. J Epidemiol Community Health. 1994, 48: 258-261.CrossRefPubMedPubMedCentral
29.
Todkar SS, Gujarathi VV, Tapare VS: Period prevalence and sociodemographic factors of hypertension in rural Maharashtra: a cross-sectional study. Indian J Community Med. 2009, 34: 183-187.CrossRefPubMedPubMedCentral
30.
Singh RB, Sharma JP, Rastogi V, Niaz MA, Singh NK: Prevalence and determinants of hypertension in the Indian social class and heart survey. J Hum Hypertens. 1997, 11: 51-56.CrossRefPubMed
31.
Fernald LC, Adler NE: Blood pressure and socioeconomic status in low-income women in Mexico: a reverse gradient?. J Epidemiol Community Health. 2008, 62: e8-CrossRefPubMed
32.
Stuff JE, Casey PH, Szeto KL, Gossett JM, Robbins JM, Simpson PM, Connell C, Bogle ML: Household food insecurity is associated with adult health status. J Nutr. 2004, 134: 2330-2335.PubMed
33.
Seligman HK, Laraia BA, Kushel MB: Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010, 140: 304-310.CrossRefPubMedPubMedCentral
34.
Das M, Pal S, Ghosh A: Rural urban differences of cardiovascular disease risk factors in adult Asian Indians. Am J Hum Biol. 2008, 20: 440-445.CrossRefPubMed
35.
Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V: Metabolic syndrome in urban Asian Indian adults–a population study using modified ATP III criteria. Diabetes Res Clin Pract. 2003, 60: 199-204.CrossRefPubMed
36.
Gupta R, Gupta VP, Sarna M, Bhatnagar S, Thanvi J, Sharma V, Singh AK, Gupta JB, Kaul V: Prevalence of coronary heart disease and risk factors in an urban Indian population: Jaipur Heart Watch-2. Indian Heart J. 2002, 54: 59-66.PubMed
37.
Singh RB, Rastogi V, Niaz MA, Ghosh S, Sy RG, Janus ED: Serum cholesterol and coronary artery disease in populations with low cholesterol levels: the Indian paradox. Int J Cardiol. 1998, 65: 81-90.CrossRefPubMed
38.
Limbu YR, Rai SK, Ono K, Kurokawa M, Yanagida JI, Rai G, Gurung N, Rai CK: Lipid profile of adult Nepalese population. Nepal Med Coll J. 2008, 10: 4-7.PubMed
39.
Ghandehari H, Kamal-Bahl S, Wong ND: Prevalence and extent of dyslipidemia and recommended lipid levels in US adults with and without cardiovascular comorbidities: the National Health and Nutrition Examination Survey 2003–2004. Am Heart J. 2008, 156: 112-119.CrossRefPubMed
40.
Radhika G, Van Dam RM, Sudha V, Ganesan A, Mohan V: Refined grain consumption and the metabolic syndrome in urban Asian Indians (Chennai Urban Rural Epidemiology Study 57). Metabolism. 2009, 58: 675-681.CrossRefPubMed
41.
Srinath Reddy K, Shah B, Varghese C, Ramadoss A: Responding to the threat of chronic diseases in India. Lancet. 2005, 366: 1744-1749.CrossRefPubMed
42.
Sasaki H, Kawasaki T, Ogaki T, Kobayashi S, Itoh K, Yoshimizu Y, Sharma S, Acharya GP: The prevalence of diabetes mellitus and impaired fasting glucose/glycaemia (IFG) in suburban and rural Nepal-the communities–based cross-sectional study during the democratic movements in 1990. Diabetes Res Clin Pract. 2005, 67: 167-174.CrossRefPubMed
43.
Singh DL, Bhattarai MD: High prevalence of diabetes and impaired fasting glycaemia in urban Nepal. Diabet Med. 2003, 20: 170-171.CrossRefPubMed
44.
Chow CK, Naidu S, Raju K, Raju R, Joshi R, Sullivan D, Celermajer DS, Neal BC: Significant lipid, adiposity and metabolic abnormalities amongst 4535 Indians from a developing region of rural Andhra Pradesh. Atherosclerosis. 2008, 196: 943-952.CrossRefPubMed
45.
Vaidya A, Shakya S, Krettek A: Obesity prevalence in Nepal: public health challenges in a low-income nation during an alarming worldwide trend. Int J Environ Res Public Health. 2010, 7: 2726-2744.CrossRefPubMedPubMedCentral
46.
Barreto SM, Passos VM, Firmo JO, Guerra HL, Vidigal PG, Lima-Costa MF: Hypertension and clustering of cardiovascular risk factors in a community in Southeast Brazil–The Bambui Health and Ageing Study. Arq Bras Cardiol. 2001, 77: 576-581.CrossRefPubMed
47.
Nguyen NT, Magno CP, Lane KT, Hinojosa MW, Lane JS: Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg. 2008, 207: 928-934.CrossRefPubMed
48.
Goel R, Misra A, Agarwal SK, Vikram N: Correlates of hypertension among urban Asian Indian adolescents. Arch Dis Child. 2010, 95: 992-997.CrossRefPubMed
49.
Grundy SM: Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome. Am J Cardiol. 1998, 81: 18B-25B.CrossRefPubMed
50.
Kahn R, Buse J, Ferrannini E, Stern M: The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2005, 28: 2289-2304.CrossRefPubMed
51.
Gluckman PD, Hanson MA, Spencer HG: Predictive adaptive responses and human evolution. Trends Ecol Evol. 2005, 20: 527-533.CrossRefPubMed
52.
Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, Roccella EJ, Stout R, Vallbona C, Winston MC, Karimbakas J: Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002, 288: 1882-1888.CrossRefPubMed
Metadata
Title
A cross-sectional study of the prevalence and risk factors for hypertension in rural Nepali women
Authors
Rumana J Khan
Christine P Stewart
Parul Christian
Kerry J Schulze
Lee Wu
Steven C LeClerq
Subarna K Khatry
Keith P West Jr
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-55

Other articles of this Issue 1/2013

BMC Public Health 1/2013 Go to the issue

Research article

Regional differences in diabetes prevalence and awareness between coastal and interior provinces in China: a population-based cross-sectional study

Commentary

Advancing maternal survival in the global context: are our strategies working?

Research article

Traumatic experiences and mental health consequences among child survivors of the 2008 Sichuan earthquake: a community-based follow-up study

Study protocol

Engineering online and in-person social networks to sustain physical activity: application of a conceptual model

Research article

Assessing positive mental health in people with chronic physical health problems: correlations with socio-demographic variables and physical health status

Research article

Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary public care clinics in South Africa: results from a cluster randomized controlled trial