Blood pressure and hypertension in people living at high altitude in Nepal

Abstract

This study aimed to describe blood pressure (BP) and hypertension (HT) in samples of high altitude populations of Nepal and to explore associations of systolic and diastolic BP with altitude. This was a cross-sectional survey of cardiovascular disease and associated risk factors among 521 people living at four different altitude levels, all above 2800 m, in the Mustang and Humla districts of Nepal. Data on BP was available for all 521 participants. Systolic and diastolic BP levels were highest at the altitude of 3620 m (the highest area surveyed) but did not consistently increase with altitude. Using the cut-point of ≥140/90 mmHg (systolic/diastolic), the prevalence of HT (or on anti-hypertensive medication) was 46.1%, 40.9%, and 54.5% respectively at 2800 m, 3270 m and 3620 m of Mustang district, and 29.1% at 2890 m of Humla district. In a multivariate model adjusting for potential confounders there was strong evidence of a relationship between systolic BP and altitude; mean systolic BP increased by 15.6 mmHg (95% CI 4.0 to 27.2), P=0.009 for every 1000 m elevation. Although diastolic BP and the probability for HT or on anti-hypertensive medication also tended to increase with increasing altitude levels, there was no evidence of a relationship. In the present study three out of four communities living at higher altitude levels showed a greater prevalence of HT among those aged 30 years or older compared with the overall national data. These findings indicate a probable high risk of raised BP in high altitude populations in Nepal.

Socioeconomic differentials in hypertension based on JNC7 and ACC/AHA 2017 guidelines mediated by body mass index: Evidence from Nepal demographic and health survey

“…We observed sex and rural-urban differences in blood pressure outcomes by sex and urbanity stratified analysis. For instance, recent studies also emphasized to investigate the SES gradient along with sex and rural-urban differences in blood pressure outcomes in Nepal [7,8,11,37].…”

Socioeconomic Differentials in Hypertension based on JNC7 and ACC/AHA 2017 Guidelines Mediated by Body Mass Index: Evidence from Nepal Demographic and Health Survey

“…For instance, recent studies also emphasized to investigate SES gradient along with sex and rural-urban differences in blood pressure outcomes in Nepal. 7, 8, 11, 33…”

Geographic components of SARS-CoV-2 expansion: a hypothesis

“…Significant differences between highlanders and lowlanders are observed among the most commonly identified comorbidities ( 10 ) of COVID-19, with residence at higher elevation associated with lower incidence of cardiovascular disease and mortality ( 60 ), diabetes mellitus ( 83 ), obesity ( 84 ), and metabolic syndrome ( 51 ), which have all been linked to higher risk of severe COVID-19 infection and mortality ( 88 ). In contrast, hypertension appears to be higher in HA populations ( 2 , 58 , 61 ), although it is not possible to determine whether this puts these populations at a greater risk for COVID-19 infection, as there is still wide debate about whether the association between hypertension and COVID-19 embodies a causal relationship, or if it is simply indicative of the age and wider health status of those who are worst affected by COVID-19 ( 32 , 70 ).…”