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Shakya S, Shrestha V, Neupane D. Social determinants of health and cardiometabolic risk factors in Nepal: A scoping review. Nutr Metab Cardiovasc Dis 2023; 33:2308-2316. [PMID: 37798230 DOI: 10.1016/j.numecd.2023.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/23/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023]
Abstract
AIMS Cardiometabolic risk factors are modifiable contributors to cardiometabolic disease and adverse outcomes. Cardiometabolic risk factors are emerging health concerns among adults in low and middle-income countries. The role of social determinants of health on cardiometa gaps. DATA SYNTHESIS A comprehensive search was conducted in multiple databases: PubMed (MEDLINE), Web of Science (Clarivate), and CINAHL (EBSCO). Joanna Briggs Institute's (JBI) Scoping Review methodology and PRISMA extension for scoping reviews-SCRA guided this review. Forty-four cross-sectional studies published between 2010 and 2022 were eligible for this review. Men were more likely to have hypertension, while women were more likely to have obesity and abdominal obesity. Participants from marginalized caste/ethnicity, urban regions, and those with lower education, and greater wealth index had a greater likelihood of hypertension, dyslipidemia, and hyperglycemia; however, differences across these sociodemographic subgroups are narrowing. Smoking, harmful alcohol use, high salt intake, low fruit and vegetable intake, and sedentary lifestyles were associated with one or more cardiometabolic risk factors. Finally, one cardiometabolic risk factor increased the risk of others. CONCLUSIONS Findings reflect that Nepal is at the intersection of rapid urbanization, nutritional transition, and socioeconomic shift. Future studies should take a multilevel approach to investigate the role of social determinants in increasing the cardiometabolic risk burden in Nepal.
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Affiliation(s)
- Shamatree Shakya
- College of Nursing, University of Illinois at Chicago, United States.
| | | | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Yesmin M, Ali M, Saha S. The prevalence and influencing factors of coexisting prediabetes and prehypertension among Bangladeshi adults. BMC Public Health 2023; 23:1184. [PMID: 37337196 DOI: 10.1186/s12889-023-16090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Early detection of diabetes and hypertension is helpful to prevent and/or delay the onset of these diseases through proper interventions. Therefore, it is a prerequisite to know the prevalence of prediabetes and prehypertension and the factors associated with these conditions but people from developing countries including Bangladesh often remain undiagnosed and unaware of these conditions. In this study we investigate the prevalence of prediabetes and prehypertension and their associated factors in Bangladesh using nationally representative data. METHOD We used nationally representative Bangladesh Demographic and Health Survey (BDHS) 2017-18 survey data, which included a total sample of 14,704 adults aged 18 years and more from whom blood pressure and fasting plasma glucose were collected. Chi-square test was used to examine the differences between sociodemographic and outcome variables. The univariate and multivariate logistic regression was performed to identify the factors associated with prediabetes and prehypertension. RESULTS Overall, the prevalence of prediabetes and prehypertension was 8.6% with 14% of the sampled population having from prediabetes and prehypertension separately. Among the prediabetic and prehypertensive participants, one-fourth of the participant were from the richest families and around one-third were overweight/obese, while more than fifty percent had normal Body Mass Index (BMI) and completed secondary and higher education. In the univariate analysis, the richest wealth status (UOR 3.3, 95% CI: 2.46 -4.35) and overweight/obesity (UOR 3.2, 95% CI: 2.62-3.85) are the highest predictors for prediabetes and prehypertension. After adjusting the other variables, overweight/obesity remains the largest predictor for prediabetes and prehypertension (AOR:2.5, 95% CI:2.05-3.05). Further, people aged 31 and above and from the richest family had around 2 times and 1.8 times higher risk of being prediabetic and prehypertensive compared to the younger age people (18-30 years) and the poorest family (respectively). CONCLUSION The coexistence of prediabetes and prehypertension is an early sign of a greater burden of noncommunicable diseases (NCDs) in the near future for Bangladesh. To reduce the higher burden of NCDs, our findings call for a multisectoral approach to identify the precondition of NCDs with particular attention to maintaining body weight.
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Affiliation(s)
- Maksuda Yesmin
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Medicon Village, Scheelevagen 2, 223 63, Lund, Sweden
| | - Masum Ali
- International Food Policy Research Institute (IFPRI), Dhaka, Bangladesh
| | - Sanjib Saha
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Medicon Village, Scheelevagen 2, 223 63, Lund, Sweden.
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Zaragoza-García O, Gutiérrez-Pérez IA, Delgado-Floody P, Parra-Rojas I, Jerez-Mayorga D, Campos-Jara C, Guzmán-Guzmán IP. Emergent Anthropometric Indices in Differential Prediction of Prehypertension and Hypertension in Mexican Population: Results according to Age and Sex. Int J Hypertens 2022; 2022:4522493. [PMID: 35844253 PMCID: PMC9283069 DOI: 10.1155/2022/4522493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hypertension (HTN) is recognized as a significant public health problem in the world. The objective of this study is to evaluate emergent anthropometric indices as predictors of preHTN and HTN according to age and sex in a sample of Mexican adults. Methods A cross-sectional study was conducted in 1,150 participants aged 18-80 years old. Anthropometric data and blood pressure measurements were analyzed. Comparisons between men and women were carried out by independent analysis. Cutoff points for each emergent anthropometric index were obtained using the values' upper second and third tertiles. Logistic regression models and receiver operating characteristics curve analyses were used to assess the association and the predictive value of several emergent anthropometric indices with the presence of preHTN and HTN. Results The prevalence of preHTN and HTN was 29.74% and 14.35%, respectively. In a logistic regression analysis adjusted by age and sex, the body roundness index (BRI) (OR = 2.08, p < 0.001) and conicity index (CI) (OR = 1.37, p=0.044) were associated with preHTN, while CI (OR = 2.47, p < 0.001) and waist to height squared (W/Ht2) (OR = 2.19, p < 0.001) were associated with HTN. Furthermore, in both sexes, BRI was the main predictor of preHTN (AUC: 0.634 and 0.656, respectively). Particularly, according to sex and age range, the predictive emergent anthropometric indices in men were the body shape index (ABSI) and waist to height cubic (W/Ht3) (AUC = 0.777 and 0.771, respectively), whereas in women, the predictors were CI and ABSI (AUC = 0.737 and 0.729, respectively). In men ≤40 years old, central body fat indices were predictors of preHTN and HTN, but in men >40 years old, the predictor indices were W/Ht3 and W/Ht2. In women ≤40 years, the pulse mass index (PMI) was the best main predictor (AUC = 0.909) of HTN. Conclusion CI, PMI, W/Ht3, W/Ht2, and ABSI could represent differential predictors of preHTN and HTN between men and women according to age range.
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Affiliation(s)
- Oscar Zaragoza-García
- Faculty of Chemical-Biological Sciences, Universidad Autónoma de Guerrero, Chilpancingo 39087, Guerrero, Mexico
| | | | - Pedro Delgado-Floody
- Department of Physical Education, Sport, and Recreation, Universidad de La Frontera, Temuco 4780000, Chile
| | - Isela Parra-Rojas
- Faculty of Chemical-Biological Sciences, Universidad Autónoma de Guerrero, Chilpancingo 39087, Guerrero, Mexico
| | - Daniel Jerez-Mayorga
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada 18011, Spain
| | - Christian Campos-Jara
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
| | - Iris Paola Guzmán-Guzmán
- Faculty of Chemical-Biological Sciences, Universidad Autónoma de Guerrero, Chilpancingo 39087, Guerrero, Mexico
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Joshi S, Thapa BB. Socioeconomic risk factors of hypertension and blood pressure among persons aged 15-49 in Nepal: a cross-sectional study. BMJ Open 2022; 12:e057383. [PMID: 35649602 PMCID: PMC9161073 DOI: 10.1136/bmjopen-2021-057383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study estimated the prevalence of hypertension, in accordance with the American College of Cardiology and American Heart Association's 2017 guidelines, and examined the association between various socioeconomic factors and systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension. SETTING AND DESIGN We used nationally representative data from the 2016 Nepal Demographic and Health Survey. Multivariate analysis was used to study the association of hypertension with socioeconomic factors: logistic regression was used for hypertension and linear regression was used for DBP and SBP. PARTICIPANTS Our sample consisted of 9827 adults between the ages of 15 and 49 years. RESULTS The prevalence of hypertension was 36%. The mean DBP and SBP were 76.4 and 111.5, respectively. Janjatis (adjusted OR (AOR): 1.34, CI: 1.12 to 1.59), Other Terai castes (AOR: 1.38, CI: 1.03 to 1.84), Muslim and other ethnicities (AOR: 1.64, CI: 1.15 to 2.33) and Dalits (AOR: 1.26, CI: 1.00 to 1.58) had higher odds of hypertension. Individuals employed in professional, technical and managerial professions collectively (AOR: 1.62; CI: 1.18 to 2.21) also had higher odds of hypertension. Moderately food insecure household had lower odds of hypertension (AOR: 0.84; CI: 0.72 to 0.99) compared with households with no issue of food insecurity. Results were similar for SBP and DBP. When stratified by sex, there were differences mainly in terms of occupation and ethnicity. CONCLUSION There are substantial disparities in hypertension prevalence in Nepal. These disparities extend across ethnic groups, occupational status and food security status. Differences also persist across different provinces. As hypertension continues to be increasingly more significant, more research is needed to better understand the disparities and gradients that exist across various socioeconomic factors.
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Affiliation(s)
- Sushant Joshi
- Public Policy and Management, University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA
| | - Bishnu Bahadur Thapa
- Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Abba MS, Nduka CU, Anjorin S, Mohamed SF, Agogo E, Uthman OA. Influence of contextual socioeconomic position on hypertension risk in low- and middle-income countries: disentangling context from composition. BMC Public Health 2021; 21:2218. [PMID: 34872517 PMCID: PMC8647420 DOI: 10.1186/s12889-021-12238-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension has emerged as the single most significant modifiable risk factor for cardiovascular disease and death worldwide. Resource-limited settings are currently experiencing the epidemiological transition from infectious diseases to chronic non-communicable diseases, primarily due to modifications in diet and lifestyle behaviour. The objective of this study was to examine the influence of individual-, community- and country-level factors associated with hypertension in low- and middle-income countries (LMICs). Methods Multivariable multi-level logistic regression analysis was applied using 12 Demographic and Health Survey (DHS) datasets collected between 2011 and 2018 in LMICs. We included 888,925 respondents (Level 1) nested within 33,883 neighbourhoods (Level 2) from 12 LMICs (Level 3). Results The prevalence of hypertension ranged from 10.3% in the Kyrgyz Republic to 52.2% in Haiti. After adjusting for the individual-, neighbourhood- and country-level factors, we found respondents living in the least deprived areas were 14% more likely to have hypertension than those from the most deprived areas (OR = 1.14, 95% CI 1.10 to 1.17). We observed a significant variation in the odds of hypertension across the countries and the neighbourhoods. Approximately 26.3 and 47.6% of the variance in the odds of hypertension could be attributed to country- and neighbourhood-level factors, respectively. We also observed that respondents moving to a different neighbourhood or country with a higher risk of hypertension had an increased chance of developing hypertension, the median increase in their odds of hypertension was 2.83-fold (95% CI 2.62 to 3.07) and 4.04- fold (95% CI 3.98 to 4.08), respectively. Conclusions This study revealed that individual compositional and contextual measures of socioeconomic status were independently associated with the risk of developing hypertension. Therefore, prevention strategies should be implemented at the individual level and the socioeconomic and contextual levels to reduce the burden of hypertension.
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Affiliation(s)
- Mustapha S Abba
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
| | - Chidozie U Nduka
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK
| | - Seun Anjorin
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK
| | - Shukri F Mohamed
- Academic Unit of Primary Care (AUPC) and the NIHR Global Health Research Unit on Improving Health in Slums, University of Warwick, Coventry, UK.,Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya.,Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emmanuel Agogo
- Resolve to Save Lives, Country Office Nigeria, Abuja, Nigeria
| | - Olalekan A Uthman
- Warwick Centre for Global Health Research, The University of Warwick, Coventry, CV4 7AL, UK.,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.,Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Rahman MA, Halder HR, Yadav UN, Mistry SK. Prevalence of and factors associated with hypertension according to JNC 7 and ACC/AHA 2017 guidelines in Bangladesh. Sci Rep 2021; 11:15420. [PMID: 34326418 PMCID: PMC8322062 DOI: 10.1038/s41598-021-94947-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022] Open
Abstract
Most studies either followed Joint National Committee 7 (JNC 7) or World Health Organization-International Society of Hypertension (WHO-ISH) guidelines to ascertain the prevalence of hypertension among Bangladeshi adults. The American College of Cardiology/American Heart Association (ACC/AHA) revised the definition of hypertension in 2017, which has significant public health importance. In Bangladesh, the new guideline has resulted changes in prevalence and risk factors for hypertension compared to the JNC7 guideline. This study used data from the most recent round (2017-2018) of the Bangladesh Demographic and Health Survey (BDHS). According to the 2017 ACC/AHA guideline, the participants were categorized as hypertensive if they had blood pressure (BP) ≥ 130/80 mmHg, but it was ≥ 140/90 mmHg in JNC 7 guideline. A total of 11,959 participants were involved in the analysis. The median (IQR) age of the respondents was 34.0 (18.0-95.0) years. The prevalence of hypertension was 24.0% according to the JNC 7 guideline, which was 50.5% according to the 2017 ACC/AHA guideline. Participants who were overweight and obese, aged, member of affluent households, Rangpur and Rajshahi division inhabitants had significantly higher odds of being hypertensive according to both guidelines. The new guideline suggests that half of the adult population in Bangladesh is hypertensive when measured according to the new guideline, urging the policymakers and public health practitioners to take immediate action to address the already established modifiable risk factors.
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Affiliation(s)
- Md Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh.
| | - Henry Ratul Halder
- Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh
- Rady Faculty of Health Sciences, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Uday Narayan Yadav
- Forum for Health Research and Development, Dharan, Nepal
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
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Lin PY, Chang CC, Tung CY, Chu WH, Tong FG. Risk factors of prehypertension and hypertension among workers at public elderly welfare facilities in Taiwan: A cross-sectional survey. Medicine (Baltimore) 2021; 100:e24885. [PMID: 33663118 PMCID: PMC7909213 DOI: 10.1097/md.0000000000024885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023] Open
Abstract
The prevalence and factors that influence prehypertension and hypertension in workers at elderly welfare facilities remain unknown. This study investigated prehypertension and hypertension as well as the relevant factors affecting the development of these conditions in workers at elderly welfare facilities.A cross-sectional survey was conducted among 242 workers at 3 elderly welfare facilities in northern Taiwan. A structured questionnaire survey comprising demographic characteristics, job characteristics, burnout inventory, and health information was employed for data collection. Chi-Squared tests and multinomial logistic regression were adopted to analyze the correlation between research variables and blood pressures as well as relevant factors influencing prehypertension and hypertension.The results indicated that sex, age, education level, type of work shift, work-related burnout, and body mass index of the research participants were significantly correlated with prehypertension and hypertension. The results of multinominal logistic regression demonstrated that being male, being older, being a nonnurse assistant, being obese, working in shifts, and having moderate or severe work-related burnout were associated with higher risks of prehypertension and hypertension. The interaction between age and being a nonnurse assistant was statistically significant. Compared with nonnurse assistants, nurse assistants aged ≥55 years had a relatively low risk of prehypertension and hypertension.Age, job characteristics, work-related burnout, and obesity of workers in elderly welfare facilities were the major risk factors for prehypertension and hypertension.
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Affiliation(s)
- Pei-Ying Lin
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City
- Taitung Hospital, Ministry of Health and Welfare, Taitung County
| | - Chia-Chen Chang
- Department of Senior Citizen Service Business, College of Human Ecology and Design, St. John's University, New Taipei City
| | - Chen-Yin Tung
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City
| | - Wan-Hsia Chu
- Taipei City Haoran Senior Citizens Home, Taipei City, Taiwan
| | - Fu-Guan Tong
- Taipei City Haoran Senior Citizens Home, Taipei City, Taiwan
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The Effect of Cognitive-Behavioral Intervention on Self-Care Behaviors and Blood Pressure Control in Patients with Primary Hypertension. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2021. [DOI: 10.52547/jech.8.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lan R, Bulsara MK, Pant PD, Wallace HJ. Relationship between cigarette smoking and blood pressure in adults in Nepal: A population-based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000045. [PMID: 36962115 PMCID: PMC10022357 DOI: 10.1371/journal.pgph.0000045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
Smoking and hypertension are two major risk factors for cardiovascular disease, the leading cause of death in Nepal. The relationship between cigarette smoking and blood pressure (BP) in Nepal is unclear. This study analysed the data from the 2016 Nepal Demographic and Health Survey to explore the differences in systolic BP (SBP) and diastolic BP (DBP) between current daily cigarette smokers and non-smokers in Nepali adults aged 18 to 49 years. A total of 5518 women and 3420 men with valid BP measurements were included. Age, body mass index, wealth quintile (socio-economic status) and agricultural occupation (proxy for physical activity) were included as potential confounders in multivariable linear regression analysis. Women smokers were found to have significantly lower SBP (mean difference 2.8 mm, 95% CI 0.7-4.8 mm) and DBP (mean difference 2.2 mm, 95% CI 0.9-3.6 mm) than non-smokers after adjustment. There were no significant differences in BP between smokers and non-smokers in males, either before or after adjustment. The lower BP in female cigarette smokers in Nepal may be explained by the physiological effect of daily cigarette smoking per se in women, or unmeasured confounders associated with a traditional lifestyle that may lower BP (for example, diet and physical activity). In this nationally representative survey, daily cigarette smoking was not associated with increased BP in males or females in Nepal.
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Affiliation(s)
- Renqiao Lan
- School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | | | - Hilary Jane Wallace
- School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
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Mirzaei M, Mirzaei M, Mirzaei M, Bagheri B. Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017. BMC Cardiovasc Disord 2020; 20:372. [PMID: 32799819 PMCID: PMC7429880 DOI: 10.1186/s12872-020-01657-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022] Open
Abstract
Background Different definitions have been proposed to categorize hypertension. We aimed to investigate the difference in prevalence of measures associated with hypertension according to the American College of Cardiology/American Heart Association (ACC/AHA) criteria versus Joint National Committee 7 (JNC7) criteria. Methods We analyzed the data of 10,000 participants of Yazd Health Study (YaHS) aged 20–69 years. Blood pressure was measured three times with standard protocol defined by ACC/AHA. Prevalence of high blood pressure measure was compared in both definitions and absolute differences reported. Results The prevalence of high blood pressure in our measurement was 61.0% according to ACC/AHA, and 28.9% according to JNC 7. The prevalence of self-reported hypertension was 18.6%. Age and sex standardized prevalence rates of high blood pressure measure indicates a 2.4-fold increase in the prevalence rate (30.1% absolute difference) by the ACC/AHA guideline. While the prevalence increased in all age groups, the age group of 20–29 showed the highest relative increase by 3.6 times (10.6% vs. 38.1%). High blood pressure measure among people with diabetes increased from 45.8 to 75.3% with the ACC/AHA guideline. Of the people who had no past history of diagnosed hypertension (n = 7887), 55.1 and 22.7% had high blood pressure measure by ACC/AHA and JNC-7 guidelines, respectively. From JNC7 to ACC/AHA, the overall difference in unawareness about HTN increased by 32.4%. Conclusion Prevalence of hypertension associated measures increased over two folds by using the ACC/AHA criteria compared to JNC 7. Also, change in the criteria, reduces awareness of the disease and increases uncontrolled hypertension respectively. More research is needed to determine if the new definitions can affect management of hypertension in societies. Considering local priorities and implication of cost effective may improve implementation of new definitions for hypertension in different countries.
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Affiliation(s)
- Mohsen Mirzaei
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojtaba Mirzaei
- Yale New Haven Medical Center, Waterbury Hospital, Waterbury, USA
| | - Behnam Bagheri
- Shahediah Cohort Study, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Determinants of hypertension in Nepal using odds ratios and prevalence ratios: an analysis of the Demographic and Health Survey 2016. J Biosoc Sci 2020; 53:522-530. [PMID: 32611458 DOI: 10.1017/s0021932020000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This cross-sectional study investigated the factors associated with hypertension among Nepalese adults aged 18 years or above using data from the Nepal Demographic and Health Survey 2016. Prevalence ratios (PRs) and odds ratios (ORs) were obtained using log-binomial regression and logistic regression, respectively. Initially, unadjusted PRs and ORs were obtained. The variables that yielded a significance level below 0.2 in unadjusted analyses were included in the multivariable analysis. The overall prevalence of hypertension among the 13,393 participants (58% male and 61.2% urban) was 21.1% (n = 2827). In the adjusted analysis, those aged 30-49 years (adjusted PR [APR]: 3.1, 95% Confidence Interval (CI): 2.6, 3.7; adjusted OR [AOR]: 3.6, 95% CI: 2.9, 4.5), 50-69 years (APR: 5.3, 95% CI: 4.4, 6.6; AOR: 8.2, 95% CI: 6.4, 10.4) and ≥70 years (APR: 7.3, 95% CI: 5.8, 9.2; AOR: 13.6, 95% CI: 10.1, 18.3) were more likely to be hypertensive than younger participants aged 18-29 years. Males (APR: 1.3, 95% CI: 1.2, 1.4; AOR: 1.5, 95% CI: 1.3, 1.7), overweight/obese participants (APR: 1.8, 95% CI: 1.7, 2.0; AOR: 2.4, 95% CI: 2.2, 2.8) and those in the richest wealth quintile (APR: 1.3, 95% CI: 1.1, 1.5; AOR: 1.5, 95% CI: 1.1, 1.9) had higher prevalences and odds of hypertension than their female, normal weight/underweight and poorest wealth quintile counterparts, respectively. Those residing in Province 4 (APR: 1.2, 95% CI: 1.0, 1.5; AOR: 1.4, 95% CI: 1.1, 1.8) and Province 5 (APR: 1.2, 95% CI: 1.0, 1.4; AOR: 1.3, 95% CI: 1.1, 1.7) were more likely to be hypertensive than those residing in Province 1. The point estimate was inflated more in magnitude by ORs than by PRs, but the direction of association remained the same. Public health programmes in Nepal aimed at preventing hypertension should raise awareness among the elderly, males, individuals in the richest wealth quintile and the residents of Provinces 4 and 5.
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Haider MR, Das Gupta R. Inequalities in undiagnosed hypertension among adult Nepalese population: Evidence from a nationally representative survey. Int J Cardiol Hypertens 2020; 5:100026. [PMID: 33447755 PMCID: PMC7803054 DOI: 10.1016/j.ijchy.2020.100026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION With one in every five adults suffering from hypertension and three-fifth of these patients undiagnosed, Nepal faces an enormous problem of undiagnosed hypertension. This study aims to assess the prevalence and determinants of undiagnosed hypertension in Nepal and to examine the extent of socioeconomic inequalities in undiagnosed hypertension in Nepal. METHODS This study used the nationally representative Nepal Demographic and Health Survey 2016 data. Undiagnosed hypertension was defined having systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mmHg and being told two or more times by health professionals to lower/control blood pressure. Multiple logistic regression analysis was used for identifying determinants associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (CI). RESULTS The study results show that out of total 2831 hypertensive patients, 1611 (56.9%) were undiagnosed. In the adjusted model, older age, overweight/obesity, higher wealth quintiles had less odds of being undiagnosed. Male gender and residing in Province 7 had higher odds of being undiagnosed. Overall CI showed that poor patients were disproportionately affected by undiagnosed hypertension (CI: 0.21, Standard Error (SE) of CI: 0.03). The poor (Q1)-to-rich (Q5) ratio was 1.57 showed again that poorest patients in Nepal had higher prevalence of undiagnosed hypertension than richest patients. CONCLUSION Poor patients are disproportionately affected by undiagnosed hypertension in Nepal. Awareness should be created specially among the poor wealth quintiles regarding checking blood pressure regularly. Innovative implementation strategies required to be developed to detect undiagnosed case and provide treatment accordingly.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Grover Center W333, 1 Ohio University Drive, Athens, OH, 45701, USA
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA
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Gupta RD, Talukdar A, Haider SS, Haider MR. Prevalence and Associated Factors of Hypertension Subtypes Among the Adult Population in Nepal: Evidence from Demographic and Health Survey Data. Osong Public Health Res Perspect 2019; 10:327-336. [PMID: 31897361 PMCID: PMC6927420 DOI: 10.24171/j.phrp.2019.10.6.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives This study aims to determine the prevalence, and associated factors of undiagnosed hypertension [Systolic Diastolic Hypertension (SDH), Isolated Systolic Hypertension (ISH) and Isolated Diastolic Hypertension (IDH)] in the Nepalese adult population. Methods Nepal Demographic and Health Survey 2016 data from adults (≥ 18 years) was used in this study. The final weighted sample size was 13,393. Blood pressure (BP) was measured 3 times and the average of the second and third measurement was reported. SDH (systolic BP (SBP) ≥ 140 mmHg and diastolic BP (DBP) ≥ 90 mmHg), ISH (SBP ≥ 140 mmHg and DBP < 90 mmHg), and IDH (SBP < 140 mmHg and DBP ≥ 90 mmHg) were measured. Multilevel logistic regression analyses were conducted to find the association between the independent variables and the covariates. Results The prevalence of SDH, IDH and ISH were 8.1%, 7.5%, and 3.3% respectively. The odds of having SDH and ISH increased with old age. However, the odds of having IDH decreased with increasing age. Females has lower odds of having SDH and IDH compared with male participants. Individuals that had been married, resided in Province 4 (p < 0.05) or 5 (p < 0.01) were statistically significantly associated with having IDH. Being overweight or obese was statistically significantly associated with all 3 HTN subtypes (p < 0.001). Conclusion The necessary steps should be taken so that public health promotion programs in Nepal may prevent and control undiagnosed hypertension.
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Affiliation(s)
- Rajat Das Gupta
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh.,Centre for Science of Implementation & Scale-Up, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Animesh Talukdar
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh.,CAPABLE Consortium, University of Cambridge, UK.,Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shams Shabab Haider
- Centre for Science of Implementation & Scale-Up, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, USA
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Das Gupta R, Haider SS, Hashan MR, Rahman MA, Sarker M. Association between height and hypertension in the adult Nepalese population: Findings from a nationally representative survey. Health Sci Rep 2019; 2:e141. [PMID: 31890899 PMCID: PMC6920697 DOI: 10.1002/hsr2.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/27/2019] [Accepted: 10/07/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS The burden of hypertension is increasing in Nepal. Different studies have evaluated the relationship between height and blood pressure in different regions, with mixed results. The relationship between height and hypertension has not yet been explored in the Nepalese context. Given this knowledge gap, this study aims to determine the relationship between height and hypertension among Nepalese adults (aged ≥18 years). METHODS This study utilized the dataset from the Nepal Demographic and Health Survey (NDHS) 2016. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg. Height, measured in centimeters (cm), was analyzed as a continuous variable. Based on previous evidence, the following covariates were considered: age, sex, presence of overweight or obesity, educational status, household wealth status, and place, province, and ecological zone of residence. Multilevel multivariable logistic regression was done to evaluate the association between height and hypertension. Both crude odds ratio (COR) and adjusted odds ratio (AOR) are reported, along with a 95% confidence interval (CI). Sample weight of NDHS was adjusted during analysis. RESULTS Among 13 393 weighted individuals over the age of 18 years, the prevalence of hypertension in Nepal was found to be 21.1% (95% CI, 19.9%-22.4%). In the final multivariable model, after adjusting for relevant covariates, it was found that height was inversely associated with hypertension. For a Nepalese adult, the odds of hypertension decreased by 10% with each 10-cm increase in height (AOR 0.9; 95% CI 0.8-0.9; P = 0.003). CONCLUSION Awareness should be raised among people with low stature for prevention of hypertension. Longitudinal studies are recommended to include genetic and social/environmental determinants of stature in the analyses.
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Affiliation(s)
- Rajat Das Gupta
- Centre of Excellence for Non‐Communicable Diseases and Nutrition, BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
- Centre of Excellence for Science of Implementation and Scale‐Up, BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUnited States of America
| | - Shams Shabab Haider
- Centre of Excellence for Science of Implementation and Scale‐Up, BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | - Mohammad Rashidul Hashan
- Infectious Diseases DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Muhammad Aziz Rahman
- School of Nursing and Healthcare ProfessionsFederation UniversityVictoriaAustralia
- School of Nursing and MidwiferyLa Trobe UniversityHeidelbergAustralia
| | - Malabika Sarker
- Centre of Excellence for Non‐Communicable Diseases and Nutrition, BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
- Centre of Excellence for Science of Implementation and Scale‐Up, BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
- Institute of Public HealthHeidelberg UniversityHeidelbergGermany
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Das Gupta R, Bin Zaman S, Wagle K, Crispen R, Hashan MR, Al Kibria GM. Factors associated with hypertension among adults in Nepal as per the Joint National Committee 7 and 2017 American College of Cardiology/American Heart Association hypertension guidelines: a cross-sectional analysis of the demographic and health survey 2016. BMJ Open 2019; 9:e030206. [PMID: 31401611 PMCID: PMC6701821 DOI: 10.1136/bmjopen-2019-030206] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/14/2019] [Accepted: 07/05/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study investigated the determinants of hypertension in Nepal according to both the Joint National Committee 7 (JNC7) and the American College of Cardiology/American Heart Association (2017 ACC/AHA) guidelines. DESIGN Cross-sectional study. SETTING This study used data collected from the 2016 Nepal Demographic and Health Survey data. PARTICIPANTS 13 393 weighted adults aged ≥18 years enrolled by a stratified cluster sampling strategy were included in our analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was hypertension, which was defined according to JNC7 (systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg) and 2017 ACC/AHA guidelines (SBP ≥130 mm Hg and/or DBP ≥80 mm Hg). Antihypertensive medication users were also classified as hypertensive. After descriptive analysis, multilevel logistic regression was applied to obtain ORs. RESULTS About 21% (n=2827) and 44% (n=5918) of the individuals aged ≥18 years were classified as hypertensive according to the JNC7 and 2017 ACC/AHA guidelines, respectively. Following factors were found to be significantly associated with hypertension according to the 2017 ACC/AHA guideline: ≥70 years (adjusted OR (AOR) 5.2; 95% CI 4.3 to 6.2), 50-69 years (AOR 3.9; 95% CI 3.4 to 4.4) and 30-49 years (AOR 2.7; 95% CI 2.4 to 3.0) age groups, male gender (AOR 1.7; 95% CI 1.6 to 1.9), being overweight/obese (AOR 3.0; 95% CI 2.7 to 3.3), residence in provinces 4 (AOR 1.5; 95% CI 1.2 to 2.0) and 5 (AOR 1.5; 95% CI 1.2 to 1.9). No significant association was identified with household wealth status and ecological regions of residence using the 2017 ACC/AHA guideline. CONCLUSIONS Per both guidelines, multiple factors were associated with hypertension. Public health programme aiming to prevent and control hypertension in Nepal should prioritise these factors and focus on individuals with a higher likelihood of hypertension irrespective of educational level, household wealth status and ecological regions of residence.
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Affiliation(s)
- Rajat Das Gupta
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Centre for Science of Implementation and Scale-Up, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kusum Wagle
- Research Division, Center for Research on Environment Health and Population Activities, Kathmandu, Nepal
- Department of Public Health, Om Health Campus Pvt. Ltd, Kathmandu, Nepal
| | - Reese Crispen
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
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Rezamand F, Shahnazi H, Hassanzadeh A. Effectiveness of continuous‐care model on self‐care in patients with heart failure: application of line follow‐up. Scand J Caring Sci 2019; 33:940-948. [DOI: 10.1111/scs.12692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/17/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Fatemeh Rezamand
- School of Health Isfahan University of Medical Sciences Isfahan Iran
| | - Hossein Shahnazi
- Department of Health Education and Promotion School of Health Isfahan University of Medical Sciences Isfahan Iran
| | - Akbar Hassanzadeh
- Department of Epidemiology and Biostatistics School of Health Isfahan University of Medical Sciences Isfahan Iran
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Al Kibria GM, Burrowes V, Choudhury A, Sharmeen A, Swasey K. Sex differences in prevalence and associated factors of prehypertension and hypertension among Bangladeshi adults. Int J Cardiol Hypertens 2019; 1:100006. [PMID: 33447740 PMCID: PMC7803050 DOI: 10.1016/j.ijchy.2019.100006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 12/13/2022] Open
Abstract
Globally, complications of raised blood pressure are fundamental public health issues. There has been limited research if prevalence and risk factors vary by sex in many countries, including Bangladesh. We stratified the prevalence and associated factors of prehypertension and hypertension according to sex in Bangladesh. This cross-sectional study analyzed the Bangladesh Demographic and Health Survey 2011 data. After estimating prevalence according to sex, multilevel logistic regression was applied to obtain associated factors. This study analyzed data of 3876 males and 3962 females aged ≥35 years. The prevalence of hypertension was 19.4% (95% confidence interval [CI]: 18.0-21.0) among males and 31.9% (95% CI: 30.1-33.6) among females. Among both males and females, prevalence and odds of hypertension increased with age, overweight/obesity, diabetes, upper wealth status, and residence in some divisions. Education level was a significant positive correlate of hypertension for males only. Males and females had similar prevalence of prehypertension, 27.2% (95% CI: 25.6-28.8) and 27.6% (95% CI: 26.0-29.2), respectively. Characteristics such as older age, overweight/obesity, and diabetes were associated with higher prevalence and odds of prehypertension among females; prehypertension among males was associated with advancing age, overweight/obesity, education level, wealth status, and division of residence. In Bangladesh, almost half of the males and females could have increased risks of complications resulting from hypertension and prehypertension. Addressing the characteristics associated with higher prevalence or odds of these conditions is crucial. Several common risk factors indicate that a common prevention and control strategy could work for both sexes.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Vanessa Burrowes
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Allysha Choudhury
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Atia Sharmeen
- School of Community Health and Policy, Morgan State University, Baltimore, MD 21251, USA
| | - Krystal Swasey
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
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