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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
Authors: Rajat Das Gupta, Sojib Bin Zaman, Kusum Wagle, Reese Crispen, Mohammad Rashidul Hashan, and Gulam Muhammed Al Kibria
Source: BMJ Open, 9: e030206; DOI: 10.1136/bmjopen-2019-030206
Topic(s): Hypertension
Country: Asia
Published: AUG 2019
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.