Epidemiology of hypertension in Yemen: effects of urbanization and geographical area

Abstract

Although globalization can contribute to increased blood pressure by spreading unhealthy behaviors, it also provides powerful means to tackle hypertension. The dissemination of information about and advice on cardiovascular prevention and facilitated contact with health services are valuable resources. To investigate the effects of urbanization, geographical area, and air temperature on hypertension burden and kidney damage, a survey was performed in 2008 with a door-to-door approach among urban and rural adult dwellers of three geographic areas (capital, inland, coast) of Yemen. Subjects (n=10 242) received two visits several days apart to confirm the diagnosis of hypertension. Proteinuria (dipstick test ⩾+1) was used as a marker of kidney damage. Prevalence rates were weighted to represent the Yemen population aged 15–69 years in 2008. Rates of hypertension and proteinuria progressively increased from the capital (6.4% 95% confidence level (CI) 5.8–7.0 and 5.1% 4.4–5.9, respectively), to inland areas (7.9% 7.0–8.7 and 6.1% 5.1–7.1), to the coastal area (10.1% 8.9–11.4 and 8.9% 7.3–10.4). When compared with urban dwellers, rural dwellers had similar hypertension prevalence (adjusted odds ratios (ORs) 1.03; 95% CI 0.91–1.17) but higher proteinuria rates (adjusted ORs 1.55; 1.31–1.85). Overall, home temperature was associated with a lower hypertension rate (adjusted OR 0.98; 0.96–0.99). This large population study reveals that the highest burden of hypertension and kidney damage is detectable in remote areas of the country.

A population-based national estimate of the prevalence and risk factors associated with hypertension in Rwanda: implications for prevention and control

“…The impact of urbanization on lifestyle and health has been reported by other authors [64–68]; however our findings on association between hypertension and semi-urban residence were inconsistent with what was reported in a few low and middle income countries [69–72]. …”

Cardiovascular health in migrants

“…The integration of screening for chronic kidney disease with cardiovascular health programs might indeed increase health awareness among migrant communities. [97][98][99][100] Several recent studies are providing evidence that most forms of renal impairment can be prevented or delayed. 101,102 It is thus important to ensure that best practice with respect to BP and diabetes care is implemented for all patients.…”

From the Epidemiologist to the Physician: A Complex Issue for a Labile Risk

“…However, the predictive value of visit‐to‐visit variability in SBP for stroke or coronary events was found to vary in relation to age, with the strongest association being in the youngest (≤57 years) quartile . In addition, misclassification of HTN at one or two visits was found to be more common in younger ages . Therefore, the observation by Ivy and colleagues should be extended to the youngest cohorts, particularly affected by changes in cardiovascular risk linked to the epidemiological transition that is currently underway in LMICs…”

“…17 In addition, misclassification of HTN at one or two visits was found to be more common in younger ages. 11,20 Therefore, the observation by Ivy and colleagues 1 should be extended to the youngest cohorts, particularly affected by changes in cardiovascular risk linked to the epidemiological transition that is currently underway in LMICs. 21 Last, the authors report that although masked HTN was not common, relatively high nocturnal BP resulted in nighttime HTN in more than two thirds of the cohort of elderly, rural-dwelling Tanzanians.…”