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

Abstract

ObjectivesThis 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.DesignCross-sectional study.SettingThis study used data collected from the 2016 Nepal Demographic and Health Survey data.Participants13 393 weighted adults aged ≥18 years enrolled by a stratified cluster sampling strategy were included in our analysis.Primary and secondary outcome measuresThe 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.ResultsAbout 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.ConclusionsPer 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.

Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis

“…From the random effects model estimate, the pooled odds of developing hypertension among males were 29% higher than females. This finding was similar with the studies conducted in Nepal, Varanasi India, Burkina Faso, Debrecen city of Hungary, and a meta-analysis study from Vietnam [ 62 , 69 , 77 – 80 ], whereas it is not similar to a study conducted at Uganda [ 81 ]. The possible reason might be males were more vulnerable to behavioral risk factors for hypertension.…”

Prevalence of and factors associated with prehypertension and hypertension among Bangladeshi young adults: An analysis of the Bangladesh Demographic and Health Survey 2017–18

“…The independent variables included in the study were selected based on previous literature reporting the risk of developing hypertension in populations of LMICs. 18,19,29,30,[33][34][35][36][37] The household-level factors included: administrative division (Barisal, Chittagong, Dhaka, Khulna, Mymensingh, Rajshahi, Rangpur, Sylhet), place of residence (urban, rural), and wealth status (poor, middle, rich). Socioeconomic and individual-level factors were: sex of participants (male, female), age of participants in years (18-20, 21-24, 25-30, 31-34), education level (no education, primary, secondary, higher), and occupational status (not working, working).…”

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“…From the random effects model estimate, the pooled odds of developing hypertension among males were 29% higher than females. This finding was similar with the studies conducted in Nepal, Varanasi India, Burkina Faso, Debrecen city of Hungary, and a meta-analysis study from Vietnam [62,69,[77][78][79][80], whereas it is not similar to a study conducted at Uganda [81]. The possible reason might be males were more vulnerable to behavioral risk factors for hypertension.…”

“…The pooled effect of age greater than 35 years was 3.6 times higher than age less than 35 years to develop hypertension, which is similar to the community-based studies conducted in Uganda, Nepal, Benin, Varanasi city India, and another city of New Delhi, India [79][80][81][82][83]. As well, from meta-regression analysis showed that mean age and hypertension had a direct linear relationship.…”