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Ahmmed F, Hossain MJ, Khan MTF, Manik MMR, Shahriar S, Nandi DC, Hussain MP. Mediating effect of BMI on the association of economic status and coexistence of hypertension and diabetes in Bangladesh: A counterfactual framework-based weighting approach. Health Sci Rep 2024; 7:e2063. [PMID: 38660004 PMCID: PMC11039488 DOI: 10.1002/hsr2.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/31/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims Non-communicable diseases such as hypertension and diabetes are matters of huge concern worldwide, with an increasing trend in prevalence over the previous decade. First of all, this study aimed to evaluate the association between economic status (ES) and body mass index (BMI), ES and comorbidity of hypertension and diabetes, and BMI and comorbidity independently. Second, it explored the mediating role of BMI in the association between ES and comorbidity of hypertension and diabetes. Finally, it investigated whether the mediating effect differs with the place of residence, gender, and education levels. Methods A total of 11,291 complete cases from the Bangladesh demographic and health survey 2017-18 were utilized for this study. Survey-based binary logistic regression or multiple logistic regression was used to find the association among outcome, exposure, and mediator variables, and a counterfactual framework-based weighting approach was utilized for mediation analysis. Results Middle-income (adjusted odds ratio [AOR]: 1.696, 95% confidence interval [CI]: 1.219, 2.360) and rich (AOR: 2.770, CI: 2.054, 3.736) respondents were more likely to have comorbidity of hypertension and diabetes compared to the poor. The odds of comorbidity increased with the increase in BMI. A positive association was observed between ES and BMI. A significant mediating role of BMI in the association between ES and comorbidity was found. We observed that 19.85% (95% CI: 11.50%, 49.6%) and 20.35% (95% CI: 14.9%, 29.3%) of total effect was mediated by BMI for middle and rich respondents, respectively, compared to the poor. Conclusions The mediating role of BMI was greater for female, no or primary educated respondents, and respondents from rural areas. Therefore, the study will facilitate policymakers of Bangladesh and other countries with a similar set-up to decide on health policies regarding hypertension and diabetes.
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Affiliation(s)
- Foyez Ahmmed
- Department of StatisticsComilla UniversityCumillaBangladesh
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Md. Jamal Hossain
- Department of Pharmacy, School of Pharmaceutical SciencesState University of BangladeshDhakaBangladesh
| | | | | | - Saimon Shahriar
- Department of Pharmacy, School of Pharmaceutical SciencesState University of BangladeshDhakaBangladesh
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Diabetes, Hypertension, and Comorbidity among Bangladeshi Adults: Associated Factors and Socio-Economic Inequalities. J Cardiovasc Dev Dis 2022; 10:jcdd10010007. [PMID: 36661902 PMCID: PMC9863699 DOI: 10.3390/jcdd10010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Diabetes, hypertension, and comorbidity are still crucial public health challenges that Bangladeshis face. Nonetheless, very few studies have been conducted to examine the associated factors, especially the socioeconomic inequalities in diabetes, hypertension, and comorbidity in Bangladesh. This study explored the prevalence of, factors connected with, and socioeconomic inequalities in diabetes, hypertension, and comorbidity among Bangladeshi adults. We used the Bangladesh Demographic and Health Survey (BDHS) data set of 2017−2018. A total of 12,136 (weighted) Bangladeshi adults with a mean age of 39.5 years (±16.2) participated in this study. Multilevel (mixed-effect) logistic regression analysis was employed to ascertain the determinants of diabetes, hypertension, and comorbidity, where clusters were considered as a level-2 factor. The concentration curve (CC) and concentration index (CIX) were utilized to investigate the inequalities in diabetes, hypertension, and comorbidity. The weighted prevalence of diabetes, hypertension, and comorbidity was 10.04%, 25.70%, and 4.47%, respectively. Age, body mass index, physical activity, household wealth status, and diverse administrative divisions were significantly associated with diabetes, hypertension, and comorbidity among the participants. Moreover, participants’ smoking statuses were associated with hypertension. Women were more prone to hypertension and comorbidity than men. Diabetes (CIX: 0.251, p < 0.001), hypertension (CIX: 0.071, p < 0.001), and comorbidity (CIX: 0.340, p < 0.001) were higher among high household wealth groups. A pro-wealth disparity in diabetes, hypertension, and comorbidity was found. These inequalities in diabetes, hypertension, and comorbidity emphasize the necessity of designing intervention schemes geared towards addressing the rising burden of these diseases.
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Das S, Debnath M, Das S, Sarkar S, Rumana AS. Association of overweight and obesity with hypertension, diabetes and comorbidity among adults in Bangladesh: evidence from nationwide Demographic and Health Survey 2017-2018 data. BMJ Open 2022; 12:e052822. [PMID: 35793916 PMCID: PMC9260812 DOI: 10.1136/bmjopen-2021-052822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The study aimed to determine the association of overweight and obesity with hypertension, diabetes and comorbidity among the adults of Bangladesh. STUDY DESIGN This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017-2018. The main outcome variables were hypertension, diabetes and comorbidity. Comorbidity was defined as the coexistence of hypertension and diabetes. Overweight and obesity, as measured by body mass index, were the main explanatory variables. The strength of the association was determined using the adjusted multiple logistic regression models. SETTING Rural and urban areas in Bangladesh. PARTICIPANTS The study included a total of 11 881 adults (5241 men and 6640 women) aged 18 years or older. RESULTS The prevalence of hypertension, diabetes and comorbidity among the sample population were 28.5%, 9.9% and 4.5%, respectively. Among the respondents, 20.1% were overweight and 4.1% were obese. The risk of hypertension was 2.47 times more likely in the overweight group (adjusted OR (AOR) 2.47; 95% CI 2.22 to 2.75) and 2.65 times more likely in the obese group (AOR 2.65; 95% CI 2.16 to 3.26) compared with the normal or underweight group. Adults who were overweight and obese had 59% (AOR 1.59; 95% CI 1.37 to 1.84) and 88% (AOR 1.88; 95% CI 1.46 to 2.42) higher odds of having diabetes, respectively, than normal or underweight adults. Moreover, the risk of comorbidity was 2.21 times higher in overweight adults (AOR 2.21; 95% CI 1.81 to 2.71) and 2.86 times higher in obese adults (AOR 2.86; 95% CI 2.09 to 3.91) compared with normal or underweight adults. CONCLUSIONS Using large-scale nationally representative data, we found that overweight and obesity were significantly associated with hypertension, diabetes and comorbidity. So, nationally representative data can be used for programme planning to prevent and treat these chronic conditions.
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Affiliation(s)
- Sukanta Das
- Department of Statistics, Begum Rokeya University, Rangpur, Bangladesh
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Manabika Debnath
- Department of Marketing, Begum Rokeya University, Rangpur, Bangladesh
| | - Sunanda Das
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
- Department of Management Science and Statistics, The University of Texas, San Antonio, Texas, USA
| | - Snigdha Sarkar
- Department of Statistics, Begum Rokeya University, Rangpur, Bangladesh
| | - Afrin Sadia Rumana
- Department of Business Administration in Accounting and Information Systems, Faculty of Business Studies, Bangladesh University of Professionals, Dhaka, Bangladesh
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Prevalence of and factors associated with prehypertension and hypertension among Bangladeshi young adults: An analysis of the Bangladesh Demographic and Health Survey 2017–18. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Al Kibria GM, Gupta RD, Nayeem J. Prevalence, awareness, and control of hypertension among Bangladeshi adults: an analysis of demographic and health survey 2017-18. Clin Hypertens 2021; 27:17. [PMID: 34465390 PMCID: PMC8408995 DOI: 10.1186/s40885-021-00174-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/27/2021] [Indexed: 01/02/2023] Open
Abstract
Background The prevalence of hypertension is increasing in Bangladesh, however, few recent studies investigated the proportion of people and factors associated with prevalence, awareness, and control of this condition in this country. This study investigated these among Bangladeshi adults. Methods Using Bangladesh Demographic and Health Survey 2017–18 data, a cross-sectional study was conducted. Multilevel logistic regression analysis was employed after descriptive analysis and prevalence estimation. Results Among 12,926 persons (mean age: 40 years, 57% women), the prevalence of hypertension was 27.4% (n = 3551), it was 28.4 and 26.2% among females and males, respectively. Among hypertensive people, about 42.4% (n = 1508) people were aware of having it, 48.7% among females and 33.5% among males. Of the 1313 people who were taking antihypertensive medication, only 33.8% (n = 443) had controlled hypertension, 34.7 and 31.7% among females and males, respectively. Among the studied factors associated with hypertension, people with older age, female gender, overweight/obesity, diabetes, richer wealth quintiles, and residence in some administrative divisions had higher odds of hypertension (p < 0.05). However, the odds of awareness was lower among younger people, males, and people without overweight/obesity, diabetes, or richer wealth quintiles. Odds of controlled hypertension was also lower among people with older age and higher among college-educated people. Conclusion This study identified several important factors associated with prevalence, awareness, and control of hypertension. It is important to address these factors with nationwide prevention and control programs. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-021-00174-2.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Jannatun Nayeem
- Chattagram International Dental College and Hospital, Chittagong, Bangladesh
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Hossain MB, Khan JR, Das Gupta R. Role of hypertension in the association of overweight and obesity with diabetes among adults in Bangladesh: a population-based, cross-sectional nationally representative survey. BMJ Open 2021; 11:e050493. [PMID: 34330863 PMCID: PMC8327840 DOI: 10.1136/bmjopen-2021-050493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS Overweight and obesity (OWOB) is a modifiable risk factor for both hypertension and diabetes. However, the association between OWOB and diabetes among Bangladeshi adults and how hypertension may mediate this relationship are not well explored. This study aimed to examine (1) whether OWOB is independently associated with diabetes among Bangladeshi adults, (2) whether this association is mediated by hypertension, and (3) the effect modification by wealth status and place of residence in the relationships. RESEARCH DESIGN AND METHODS We used data of 9305 adults aged ≥18 years from the most recent nationally representative cross-sectional study of Bangladesh Demographic and Health Survey 2017-2018. Design-based logistic regression was used to assess the association between OWOB and diabetes, and counterfactual framework-based weighting approach was used to evaluate the mediation effect of hypertension in the OWOB-diabetes relationship. We used stratified analyses for the effect modifications. RESULTS The prevalence of OWOB, diabetes and hypertension was 48.5%, 11.7% and 30.3%, respectively. We observed a significant association between OWOB and diabetes and a mediating role of hypertension in the OWOB-diabetes association. The odds of diabetes was 51% higher among adults with OWOB than those without OWOB (adjusted OR: 1.51, 95% CI 1.29 to 1.77). We observed that 18.64% (95% CI 9.84% to 34.07%) of the total effect of OWOB on the higher odds of diabetes was mediated through hypertension, and the mediation effect was higher among adults from non-poor households and from both rural and urban areas. CONCLUSIONS Adult OWOB status is independently associated with diabetes in Bangladesh, and hypertension mediates this association. Therefore, prevention policies should target adults with both OWOB and hypertension, particularly those from non-poor households and from both rural and urban areas, to reduce the growing burden of diabetes and its associated risk.
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Affiliation(s)
- Md Belal Hossain
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jahidur Rahman Khan
- Biomedical Research Foundation, Dhaka, Bangladesh
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, Canberra, Australia
| | - Rajat Das Gupta
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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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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Opoku S, Addo-Yobo E, Trofimovitch D, Opoku RB, Lasong J, Gan Y, Lu Z. Increased prevalence of hypertension in Ghana: New 2017 American College of Cardiology/American Hypertension Association hypertension guidelines application. J Glob Health 2020; 10:020408. [PMID: 33282222 PMCID: PMC7688293 DOI: 10.7189/jogh.10.020408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background We estimated the prevalence and socio-demographic risk factors of hypertension among Ghanaian adults as per the Joint National Committee 7 and the 2017 American College of Cardiology/American Hypertension Association hypertension thresholds used for diagnosis and treatment. Methods This cross-sectional analysis included 12 151 adults (8295 females and 3856 males) aged 18 years or older who participated in the 2014 Ghana Demographic and health Survey. Multiple logistic regression models were applied to obtain risk factors associated with hypertension as per both guidelines. Results Overall, 30.43% (n = 3698) and 11.48% (n = 1395) respondents had hypertension as per the 2017 ACC/AHA and JNC7 guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: 55-64 years (adjusted odds ratio (aOR) = 6.42, 95% confidence interval (CI): 4.70-8.77), 45-54 years (aOR = 5.72, 95% CI = 4.70-6.85), 3544 years (aOR = 3.91, 95% CI = 3.33-4.59), and 25-34 years (aOR = 2.05, 95% CI = 1.77-2.37) age groups. Males (aOR = 1.39, 95% CI = 1.23-1.53), and urban residents (aOR = 1.18, 95% CI = 1.05-1.38). All the above risk factors were significant according to the JNC7 guideline too. Factors positively associated with only the 2017 ACC/AHA guideline included: middle income (aOR = 1.20, 95% CI = 1.02-1.42) and richest (aOR = 1.36, 95% CI = 1.10-1.69) wealth quintiles, whereas manual (aOR = 1.37, 95% CI = 1.02-1.86) was positively associated with the JNC7 guidelines only. Conclusions We conclude that adopting the ACC/AHA guidelines would lead to a substantial increase in the prevalence of hypertension among Ghanaian adults, thus, hypertension prevention and control should be prioritized.
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Affiliation(s)
- Sampson Opoku
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Diana Trofimovitch
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Rebekah Bless Opoku
- Community 8, Number 3, Junior High School, Ghana Education Service, Tema, Ghana
| | - Joseph Lasong
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Prevalence and Risk Factors of Hypertension Among Young Adults in Albania. High Blood Press Cardiovasc Prev 2020; 28:35-48. [PMID: 33113094 DOI: 10.1007/s40292-020-00419-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hypertension is one of the major risk factors for cardiovascular disease and the leading cause of death worldwide. Hypertension was defined as systolic or diastolic blood pressure according to Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (ACC/AHA) rules. AIM The aims of this study was to determine the difference in hypertension prevalence and its risk factors using ACC/AHA rule, and compared its result with JNC7 rule. METHODS Data were collected using two-stage stratified cluster sample of households from 2017/18 Albanian Demographic and Health Survey. Data were analyzed using the descriptive and multivariate logistic regression model. RESULTS Among 15,003 respondents aged 15-49 years, the overall prevalence of hypertension was 63.48% and 16.24%, as per ACC/AHA and JNC7 rules, respectively with an absolute increase of prevalence by 47.3% (CI 46.4-48.2%). According to the ACC/AHA rule, in most of the categories of the respondents, the prevalence of hypertension was 40% higher compared with the JNC7 rule. In multivariate analysis, age, education, richest respondents, number of living children (≥ 3), health insurance and gender had significant (p < 0.05) impact on hypertension for both rules. Besides, the middle and richer wealth index, religion, and physically active work had also significant (p < 0.05) impact on hypertension for JNC7 rules. CONCLUSIONS Newly established ACC/AHA rule led to a significant increase in the proportion of hypertension among the Albanian populations. Similarly, there was a significant difference in the impact of some socioeconomic factors on hypertension as per both rules. Implementation of the prevention and control programs of hypertension are required to increase the awareness of the bad impact of hypertension.
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Saatchi M, Mansournia MA, Khalili D, Daroudi R, Yazdani K. Estimation of Generalized Impact Fraction and Population Attributable Fraction of Hypertension Based on JNC-IV and 2017 ACC/AHA Guidelines for Cardiovascular Diseases Using Parametric G-Formula: Tehran Lipid and Glucose Study (TLGS). Risk Manag Healthc Policy 2020; 13:1015-1028. [PMID: 32848484 PMCID: PMC7431169 DOI: 10.2147/rmhp.s265887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose An area of interest to health policymakers is the effect of interventions aimed at risk factors on decreasing the number of new cardiovascular disease (CVD) cases. The aim of this study was to estimate the generalized impact fraction (GIF) and population attributable fraction (PAF) of hypertension (HTN) for CVD in Tehran. Patients and Methods In this population-based cohort study, 8071 participants aged ≥30 years were followed for a median of 16 years. A survival model was used to estimate the 10- and 18-year risk of CVD. JNC-IV and 2017 ACC/AHA guidelines were used to categorize blood pressure (BP). PAF and GIF were estimated in different scenarios using the parametric G-formula. Results Of 7378 participants included in analyses, 22.7% and 52.3% were classified as hypertensive according to the JNC-IV and 2017 ACC/AHA guidelines, respectively. According to the 2017 ACC/AHA, the 10-year risk of CVD was 5.1% (4.3–6.0%), 8.9% (6.7–12.0%), and 7.1% (6.1–8.4%) for normal BP, elevated BP, and stage 1 HTN, respectively, and 20.8% (18.8–23.0%) for stage 2 of the 2017 ACC/AHA and JNC-IV. The PAF of stage 2 vs stage 1 and vs normal BP for CVD was 17.4% (11.5–21.8%) and 20.4% (14.6–26.4%), respectively. The GIF of 30% reduction in the prevalence of stage 2 HTN to stage 1 and to normal BP for CVD was 5.1% (3.4–6.6%) and 6.1% (4.4–8.0%), respectively. Based on JNC-IV, the PAF and GIF of 30% for CVD were 17.8% (12.7–22.9%) and 5.4% (4.0–6.9%), respectively. Conclusion By reducing the prevalence of HTN by 30%, a remarkable number of new CVD cases would be prevented. In an Iranian population, the comparison of HTN cases with normal BP showed no association between stage 1 HTN and CVD, whereas elevated BP was a significant risk factor for the incidence of CVD.
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Affiliation(s)
- Mohammad Saatchi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Chowdhury MZI, Rahman M, Akter T, Akhter T, Ahmed A, Shovon MA, Farhana Z, Chowdhury N, Turin TC. Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis. Clin Hypertens 2020; 26:10. [PMID: 32514373 PMCID: PMC7262759 DOI: 10.1186/s40885-020-00143-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/26/2020] [Indexed: 02/08/2023] Open
Abstract
Background Hypertension, itself being a major chronic condition, is one of the most significant risk factors for premature cardiovascular diseases and mortality. Hypertension is responsible for 13% of global deaths and three-quarters of the world’s hypertensive population reside in low- and middle-income countries. Bangladesh is one of those countries that experiencing an epidemiological transition from communicable to non-communicable diseases, a nutritional transition from a traditional diet to process and fast food, and an increase in a sedentary lifestyle, resulting in increased hypertension prevalence. We carried out a systematic review and meta-analysis to identify existing research on hypertension prevalence in Bangladesh, summarize findings and assess its temporal change. Methods We searched MEDLINE, EMBASE and PubMed and relevant references to identify studies on the prevalence of hypertension in Bangladesh. We used Random-effects meta-analysis to pool the prevalence estimates and performed subgroup analyses. We assessed heterogeneity, a trend in prevalence of hypertension and publication bias in selected studies. Results Our search initially identified 735 articles and after removing duplicates, reviewing titles and abstracts, and screening full texts, 53 studies were finally selected. The studies comprised 305,432 subjects and reported overall, gender-specific, geographical location specific and criteria specific prevalence of hypertension. We identified the range of hypertension prevalence is from 1.10% to 75.0% and the overall weighted pooled prevalence of hypertension is 20.0%. An extremely high heterogeneity (I2 = 99.53%; Cochran Q-statistic p < 0.001) was observed in the prevalence of hypertension. Consequently, we performed subgroup analysis based on gender, age group and geographical location of the study participants, the cut-off level used to define hypertension, and the types of hypertension reported and presented our findings accordingly. An overall increasing trend of hypertension prevalence is also observed. Conclusions The prevalence of hypertension is high and rising in Bangladesh. Strategies targeting prevention are required to mitigate a further increase in the prevalence and reduce the morbidity and mortality associated with it.
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Affiliation(s)
- Mohammad Ziaul Islam Chowdhury
- Department of Community Health Sciences, University of Calgary, TRW Building (3rd Floor), 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
| | - Meshbahur Rahman
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Tanjila Akter
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Tania Akhter
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Arifa Ahmed
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Minhajul Arifin Shovon
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Zaki Farhana
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Nashit Chowdhury
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
| | - Tanvir C Turin
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
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Clustering of hypertension, diabetes and overweight/obesity according to socioeconomic status among Bangladeshi adults. J Biosoc Sci 2020; 53:157-166. [PMID: 32146917 DOI: 10.1017/s0021932020000085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The prevalences of hypertension, diabetes and overweight/obesity are increasing in most developing countries, including Bangladesh. Although earlier studies have investigated the factors associated with these three conditions, little is known about whether socioeconomic status is associated with their co-existence. This cross-sectional study analysed data from the 2011 Bangladesh Demographic and Health Survey. An individual was considered hypertensive, diabetic and overweight/obese if their systolic/diastolic blood pressure, fasting plasma glucose concentration, and body mass index were ≥130/80 mmHg, ≥7 mmol/l and ≥23 kg/m2, respectively. Furthermore, individuals who reported taking anti-hypertensive and anti-diabetic drugs were also considered as hypertensive and diabetic, respectively. Two socioeconomic variables were investigated: education level and household wealth quintile. Descriptive analyses and multilevel logistic regression were conducted. Among the 7932 respondents (50.5% female) aged ≥35 years, the prevalences of hypertension, diabetes, overweight/obesity, any one condition and the co-existence of the three conditions were 48.0%, 11.0%, 25.3%, 60.9% and 3.6%, respectively. In adjusted analysis, individuals with secondary (adjusted odds ratio [AOR]: 1.8, 95% confidence interval [CI]: 1.2-2.8) and college or above (AOR: 3.6; 95% CI: 2.2-5.7) education levels had higher odds of the co-existence of all three conditions compared with those with no formal education. Similarly, compared with the poorest wealth quintile, the richer (AOR: 4.6; 95% CI: 2.2-9.4) and richest (AOR: 11.8; 95% CI: 5.8-24.1) wealth quintiles had higher odds of co-existence of these three conditions. Education and wealth quintile also showed significant relationships with each of the three conditions separately. In conclusion, in Bangladesh, hypertension, diabetes and overweight/obesity are associated with indicators of higher socioeconomic status. These findings highlight the importance of developing healthy lifestyle interventions (e.g. physical exercise and dietary modification) targeting individuals of higher socioeconomic status to minimize the burden of these non-communicable diseases.
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Huang Y, Dai M, Deng Z, Huang X, Li H, Bai Y, Yan C, Zhan Q, Zeng Q, Ouyang P, Xu D. Clustering of risk factors and the risk of new-onset hypertension defined by the 2017 ACC/AHA Hypertension Guideline. J Hum Hypertens 2019; 34:372-377. [PMID: 31431682 DOI: 10.1038/s41371-019-0232-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/14/2019] [Accepted: 06/28/2019] [Indexed: 11/09/2022]
Abstract
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) lowered the diagnostic criteria for hypertension. We aimed to explore whether clustering of multiple risk factors are associated with the risk of new-onset hypertension defined by the 2017 ACC/AHA Hypertension Guideline. Subjects who attended ≥2 annual health examinations without baseline hypertension and cardiovascular disease were included. Hypertension was defined according to the 2017 ACC/AHA Hypertension Guideline. Seven predefined risk factors, including age, resting heart rate, overweight or obesity, dyslipidemia, hyperuricemia, impaired glucose regulation, and a poor estimated glomerular filtration rate, were analyzed. A composite, individual-level, cumulative score incorporating these seven risk factors (no = 0 point; yes = 1 point; total range of 0-7 points) was calculated. The association between the cumulative score and the risk of hypertension was analyzed using a Cox regression model. A total of 4424 (21.6%) of 20,190 subjects included had new-onset hypertension during a follow-up duration of 3.6 years. Compared with subjects with 0 points, the adjusted hazard ratios (95% confidence intervals) for the development of hypertension for those with 1, 2, 3, and ≥4 points were 1.21 (1.07-1.38), 1.34 (1.19-1.52), 1.44 (1.26-1.63), and 1.64 (1.44-1.87), respectively (P < 0.001), after adjustment for sex and baseline blood pressure. Age, resting heart rate, overweight/obesity, dyslipidemia, hyperuricemia, impaired glucose regulation, and a poor estimated glomerular filtration rate are associated with an increased risk of future hypertension. When these factors are combined, there is an accumulated increase in risk.
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Affiliation(s)
- Yuli Huang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.,Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, PR China
| | - Meng Dai
- Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Zhihui Deng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Xingfu Huang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Hanlin Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Yujia Bai
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chuanjie Yan
- Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Qiong Zhan
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Ping Ouyang
- Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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Asgari S, Khaloo P, Khalili D, Azizi F, Hadaegh F. Status of Hypertension in Tehran: Potential impact of the ACC/AHA 2017 and JNC7 Guidelines, 2012-2015. Sci Rep 2019; 9:6382. [PMID: 31011156 PMCID: PMC6476880 DOI: 10.1038/s41598-019-42809-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 04/09/2019] [Indexed: 01/19/2023] Open
Abstract
This study aimed to determine the prevalence of hypertension, the recommended anti-hypertensive therapy and the percentage of hypertensive patients who had achieved the blood pressure (BP) target according to 2017 American College of Cardiology/American Heart Association (ACC/AHA) versus JNC7 and 8 guidelines, among Iranian population. Data of participants aged ≥20 years from the fifth phase (2012-2015) of the Tehran lipid and glucose study (N = 10,576) were analyzed, using survey analysis. The weighted prevalence of hypertension among those not on anti-hypertensive medications was 42.7 and 12.6%, applying the ACC/AHA and JNC7 guideline definitions, respectively; the corresponding values with including BP-lowering medication in definition of hypertension were 47.1% and 20.4%, respectively. However, 90% of these hypertensive people were found to have a 10-year cardiovascular disease risk of <10%. Applying the ACC/AHA guideline, anti-hypertensive medication was recommended for 21.9% of Tehranians, compared to 19.3 and 12.2% according to the JNC7 and 8 guidelines, respectively. Among Tehranians taking anti-hypertensive medication, 20% achieved the BP goal according to the ACC/AHA guideline, compared to the 42.1 and 53.6%, using JNC7 and 8 guidelines, respectively. Despite the tremendous increase in the prevalence of hypertension, most of the newly identified cases did not belong to the high-risk group.
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Affiliation(s)
- Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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