title: Prevalence and determinants of pre-hypertension and hypertension among the adults in rural Bangladesh: findings from a community-based study.
abstract: BACKGROUND
  The people of low and middle income countries bear about 80% of the global burden of diseases that are attributable to high blood pressure. Hypertensive people contribute half of this burden; the rest is among the people with lesser degrees of high blood pressure. Prehypertension elevates the risk of CVD, and that of end-stage renal disease. Bangladesh is a developing country, with more than 75% of the population live in rural area. This study aims to determine the prevalence and predictors of pre-hypertension and hypertension among the adults in rural Bangladesh.
  
  
  METHODS
  A cross-sectional study of major non-communicable disease risk factors (tobacco and alcohol use, fruit and vegetable intake, physical activity) was conducted in rural surveillance sites of Bangladesh. In addition to the self-reported information on risk factors, height and weight, and blood pressure were measured during household visits using standard protocols of the WHO STEPwise approach to Surveillance. The study population included 6,094 men and women aged 25 years and above. Adjusted and unadjusted logistic regression analyses were performed to evaluate the association of prehypertension and hypertension with various factors.
  
  
  RESULTS
  The prevalence of pre-hypertension and hypertension was 31.9% and 16.0%, respectively. The men had a higher prevalence (33.6%) of pre-hypertension compared to the women (30.3%). Multivariate analysis showed that increasing age [OR 2.30 (1.84-2.87)] and higher BMI [OR 4.67 (3.35-6.51) were positively associated with pre-hypertension. For hypertension, multivariate analysis showed that increasing age [OR 4.48 (3.38-5.94)] and higher BMI (specially the overweight category) was positively associated. Significant linear relationships of prehypertension were found with age [P for trend < 0.0001] and BMI [P for trend < 0.0001]. Linear regression for hypertension shows significant association with age [P for trend < 0.0001] but not with BMI [P for trend 0.3783].
  
  
  CONCLUSIONS
  Approximately one third and one-sixth of the adult population of rural Bangladesh are affected with pre-hypertension and hypertension, respectively. This poses a great challenge ahead, as most of the people with pre-hypertension will progress towards hypertension until otherwise undergo in any pharmacological or lifestyle intervention.
authors.affiliation: Centre for Control of Chronic Diseases in Bangladesh, icddr,b, Dhaka, 1212, Bangladesh. masuma.khanam@uon.edu.au.|Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, the University of Newcastle, Callaghan, NSW, 2308, Australia. masuma.khanam@uon.edu.au.
authors.forename: Masuma Akter
authors.initials: MA
authors.lastname: Khanam
authors.affiliation: Cardialysis in Rotterdam, Rotterdam, the Netherlands. wietze.lindeboom@gmail.com.
authors.forename: Wietze
authors.initials: W
authors.lastname: Lindeboom
authors.affiliation: International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh. razzaque@icddrb.org.
authors.forename: Abdur
authors.initials: A
authors.lastname: Razzaque
authors.affiliation: Professor of Health Economics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. lniessen@jhsph.edu.|International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA. lniessen@jhsph.edu.
authors.forename: Louis
authors.initials: L
authors.lastname: Niessen
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, the University of Newcastle, Callaghan, NSW, 2308, Australia. Milton.hasnat@newcastle.edu.au.
authors.forename: Abul Hasnat
authors.initials: AH
authors.lastname: Milton
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D001459:Bangladesh / Q000453:epidemiology; D001794:Blood Pressure / Q000502:physiology; D001835:Body Weight; D001837:Body Weights and Measures; D003430:Cross-Sectional Studies; D005260:Female; D005638:Fruit; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007676:Kidney Failure, Chronic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D058246:Prehypertension / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D014026:Nicotiana