title: Undertreated Hypertension and its Implications for Public Health in Nepal: Nationwide Population-Based Survey.
abstract: BACKGROUND
  Hypertension (HTN), a major risk factor for cardiovascular diseases (CVDs), is a substantial global public health problem. Occasional studies indicate a high prevalence of HTN in the Nepalese population, but no nationwide population-based data exist so far. We opportunistically used a survey of major disorders of the brain in Nepal to measure blood pressure (BP) in participants selected randomly from the adult general population.
  
  
  OBJECTIVE
  To establish the prevalence of elevated BP (eBP), and factors associated with it, regardless of any antihypertensive therapy being taken. We took this to be indicative of unmet health-care need.
  
  
  METHODS
  This was a cross-sectional study, conducted by unannounced household visits, employing multistage random cluster sampling. To achieve representativeness, 15 districts out of 75 in the country were investigated: one district from each of the three physiographic divisions in each of the five development regions of Nepal. One adult aged 18-65 years was selected from each household and interviewed by structured questionnaire. BP was recorded in a standardised manner by digital device (Microlife 3BM1-3®).
  
  
  RESULTS
  From 2,109 eligible households, 2,100 adults (99.6%) participated. The prevalence of eBP (>140/90 mmHg on ≥2 readings) was found to be 15.1%. Multivariate logistic regression showed significant and independent associations with demographic variables (higher age, male gender), with life-style factors (daily alcohol consumption, BMI ≥25), and with living at high altitude (≥2000 m).
  
  
  CONCLUSIONS
  In the context of the survey we could not collect data on antihypertensive therapy being taken but, clearly, whatever this might have been, it was failing to meet treatment needs. Almost one in six adults met criteria for hypertension, carrying risk implications for CVDs and their substantial public-health consequences. Two remediable associated factors were identified, although in a cross-sectional survey we could not prove causation.
authors.affiliation: Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
authors.forename: R
authors.initials: R
authors.lastname: Koju
authors.affiliation: Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal.
authors.forename: K
authors.initials: K
authors.lastname: Manandhar
authors.affiliation: Department of Psychiatry, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
authors.forename: A
authors.initials: A
authors.lastname: Risal
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. Division of Brain Sciences, Imperial College London, London, UK.
authors.forename: T J
authors.initials: TJ
authors.lastname: Steiner
authors.affiliation: Department of Neurology and Neurophysiology, St Olavs University Hospital, Trondheim, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Holen
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. Department of Neurology and Neurophysiology, St Olavs University Hospital, Trondheim, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Linde
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D009390:Nepal / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult