title: Modifiable risk factors of hypertension: A hospital-based case-control study from Kerala, India.
abstract: BACKGROUND
  Hypertension is a major cause of cardiovascular morbidity and mortality in Kerala. Excess dietary salt, low dietary potassium, overweight and obesity, physical inactivity, excess alcohol, smoking, socioeconomic status, psychosocial stressors, and diabetes are considered as modifiable risk factors for hypertension.
  
  
  OBJECTIVE
  To estimate and compare the distribution of modifiable risk factors among hypertensive (cases) and nonhypertensive (controls) patients and to estimate the effect relationship of risk factors.
  
  
  METHODS
  Age- and sex-matched case-control study was conducted in a tertiary care hospital in Kerala using a pretested interviewer-administered structured questionnaire based on the WHO STEPS instrument for chronic disease risk factor surveillance. Bivariate and multiple logistic regression analyses were done.
  
  
  RESULTS
  A total of 296 subjects were included in the study. The mean age of study sample was 50.13 years. All modifiable risk factors studied vis-ΰ-vis obesity, lack of physical activity, inadequate fruits and vegetable intake, diabetes, smoking, and alcohol use were significantly different in proportion among cases and controls. Obesity, lack of physical activity, smoking, and diabetes were found to be significant risk factors for hypertension after adjusting for other risk factors.
  
  
  CONCLUSIONS
  Hypertension is strongly driven by a set of modifiable risk factors. Massive public awareness campaign targeting risk factors is essential in controlling hypertension in Kerala, especially focusing on physical exercise and control of diabetes, obesity, and on quitting smoking.
authors.affiliation: Department of Family Medicine, Lourdes Hospital, Kochi, Kerala, India; Department of Family Medicine, KIMS Hospital, Thiruvananthapuram, Kerala, India.
authors.forename: Zarin
authors.initials: Z
authors.lastname: Pilakkadavath
authors.affiliation: Global Institute of Public Health, Ananthapuri Hospital, Thiruvananthapuram, Kerala, India.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Shaffi
keywords: Case–control study; Kerala; WHO STEPS; hypertension; risk factors of hypertension