Ethnic subgroup differences in hypertension in Pakistan.
OBJECTIVE
Cardiovascular risks are globally elevated in South Asians, but this masks important ethnic subgroup differences in risk factors, such as hypertension, which have not been fully explored. We conducted this study to explore the variations in hypertension within ethnic subgroups among South Asians.


METHODS
Cross-sectional survey [National Health Survey of Pakistan (NHSP) (1990-1994)].


METHODS
Population based.


METHODS
A total of 9442 individuals aged 15 years or over.


METHODS
Data on sociodemographic and clinical variables were collected. Distinct ethnic subgroups - Muhajir, Punjabi, Sindhi, Pashtun and Baluchi - were defined by mother tongue.


METHODS
Hypertension defined as systolic blood pressure >or= 140 mmHg or diastolic blood pressure >or= 90 mmHg, or currently receiving antihypertensive therapy.


RESULTS
The age-standardized prevalence of hypertension was highest among Baluchis (25.3% in men and 41.4% in women), then Pashtuns (23.7% in men and 28.4% in women), Muhajirs (24.1% in men and 24.6% in women), and lowest among Punjabis (17.3% in men and 16.4% in women) and Sindhis (19.0% in men and 9.9% in women) (P = 0.001). While hypertension was more prevalent in urban (22.7%) versus rural dwellers (18.1%) [odds ratio (OR) 1.34; 95% confidence interval (CI), 1.20, 1.49], this difference was no longer significant after adjusting for body mass and waist circumference (OR 1.03; 95% CI, 0.91, 1.16). However, ethnic differences persisted after adjusting for major sociodemographic, dietary and clinical risk factors (unadjusted OR for Baluchi versus Sindhi, 2.92; 95% CI, 2.20-3.89; adjusted OR, 2.71; 95% CI, 1.97-3.75).


CONCLUSIONS
A threefold difference in prevalence of hypertension exists between people of South Asian descent, which, unlike the urban/rural difference, cannot be accounted for by measured risk factors. Further study would provide valuable etiological and therapeutic clues.
Jafar
Tazeen H
TH
Department of Community Health Sciences, Tufts University Medical School, Boston, Massachusetts, USA.
Levey
Andrew S
AS
Jafary
Fahim H
FH
White
Franklin
F
Gul
Asma
A
Rahbar
Mohammad H
MH
Khan
Abdul Q
AQ
Hattersley
Andrew
A
Schmid
Christopher H
CH
Chaturvedi
Nish
N
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000208:ethnology; D015995:Prevalence; D012423:Rural Health; D013599:Systole / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D014504:Urban Health
D000959:Antihypertensive Agents