Prevalence and determinants of hypertension in the urban and rural population of a north Indian district

Abstract

Background: Hypertension is a major contributor to the cardiovascular morbidity and mortality in industrialized countries. Reports suggest that hypertension is rapidly increasing in developing countries like India. Non-communicable diseases are likely to overshadow infectious diseases in the coming years and pose a heavy strain on health budgets in our country. In this study we have tried to study the prevalence of hypertension in a north Indian population based on the recently formulated criteria of the JNC-7 and to identify the determinants of hypertension.

Objectives: (1) To determine the prevalence of hypertension in the urban and rural population of Lucknow District. (2) To study the relationship of hypertension with age. (3) To study the determinants of hypertension in the urban and rural population of Lucknow District.

Setting and design: A community-based cross-sectional study was conducted in four randomly selected areas in urban and rural parts of Lucknow district, respectively. Two-stage stratified random sampling technique was used.

Methods: We studied 800 subjects (355 men, 445 women) aged 20 years and above, 400 from urban area and 400 from rural area of Lucknow district. A pre-tested structured questionnaire was used to elicit the required information from the study participants and the diagnostic criteria for hypertension were taken according to the Seventh Joint National Committee Report on Hypertension (JNC-7).

Statistical analysis: Pearson's Chi-square test, Student's t-test, and multiple logistic regression.

Results: The prevalence of hypertension was 32.8% in the urban population and 14.5% in the rural population. The mean blood pressures were 128.4 +/- 18.8 mmHg systolic and 82.6 +/- 10.2 mmHg diastolic in urban area and 120.5 +/- 16.1 mmHg systolic and 77.8 +/- 8.8 mmHg diastolic in rural area. A significant correlation of blood pressure with increasing age was seen. In urban area, hypertensives were less physically active, and more likely to smoke and consume alcohol. About 9.2% of the hypertensives had coexisting diabetes mellitus. Mean weight, BMI and waist circumference of hypertensives was significantly higher, whereas there was no significant difference between mean heights. In rural area, similar association was seen except alcoholism and diabetes. Multivariate logistic regression showed that regardless of area, age and gender, were significant risk factors of hypertension. In the urban population, diabetes (OR = 6.917) and BMI (OR = 1.195) and in the rural population, physical activity (OR = 0.483) and waist circumference (OR = l.094) were significantly associated.

Conclusions: A high prevalence of hypertension was seen in the urban and rural population of a north Indian district Risk factors of hypertension were age and gender in urban as well as rural population. Diabetes, higher BMI values, decreased level of physical activity and increased waist circumference also significantly contributed to the risk of hypertension, which necessitates intervention at the primary health care level for its prevention.