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BMJ Open. 2019 Aug 10;9(8):e030206. doi: 10.1136/bmjopen-2019-030206.

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.

Author information

1
Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh rajat89.dasgupta@gmail.com.
2
Centre for Science of Implementation and Scale-Up, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
3
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
4
Research Division, Center for Research on Environment Health and Population Activities, Kathmandu, Nepal.
5
Department of Public Health, Om Health Campus Pvt. Ltd, Kathmandu, Nepal.
6
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA.
7
Department of Medicine, Dhaka Medical College and Hospital, Dhaka, Bangladesh.

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.

KEYWORDS:

key-words:2017 acc/aha; JNC7; determinants; hypertension; nepal

PMID:
31401611
DOI:
10.1136/bmjopen-2019-030206
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Conflict of interest statement

Competing interests: None declared.

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