Prevalence and Associations of Hypertension in Sri Lankan Adults: Estimates from the SLHAS 2018–19 Survey Using JNC7 and ACC/AHA 2017 Guidelines

Abstract

Background: Sri Lanka lacks robust estimates of hypertension (HTN) prevalence owing to few national studies, hindering optimization of control strategies. Evidence on how the revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) HTN definition affects prevalence in low-and middle-income countries (LMICs) is also limited. Objectives:To make robust estimates of HTN prevalence in the Sri Lankan adult population, and to assess impact of the ACC/AHA 2017 definitions. Methods: Data were sourced from the 2018-2019 first wave of the Sri Lanka Health and Ageing Study (SLHAS), a nationally representative longitudinal study of the noninstitutionalized adult population. After excluding those with missing data and aged <18 years, 6,342 participants (95.1%) were included in the analysis. HTN was defined using either the traditional threshold of systolic BP (SBP) ≥140 mmHg or a diastolic BP (DBP) ≥90 mmHg, or the ACC/AHA 2017 threshold of SBP ≥130 mmHg or DBP ≥80 mmHg, or if taking antihypertensive medication.Results: Estimated prevalence of HTN in all Sri Lankan adults was 28.2% using the traditional definition, and it doubled to 51.3% when applying the ACC/AHA 2017 definition. Of those classified as hypertensive according to the older and ACC/AHA 2017 definitions, 53.4% and 31.2%, respectively, were previously diagnosed. Of the 23.2% of adults reclassified as hypertensive by the ACC/AHA 2017 definition, 16.6% had a history of CVD or diabetes. Increased prevalence was associated with urban residence, socioeconomic status, obesity, and Muslim ethnicity. Prevalence increased with age, but the increase was steeper in women from their 30s. Conclusions:Nearly one in three adult Sri Lankans are hypertensive, requiring antihypertensive treatment. Applying the ACC/AHA 2017 definitions almost doubles numbers, but many of those reclassified would require treatment under recent WHO guidelines. Study findings also suggest that design effects in HTN surveys may be higher than usually assumed. 2 Rannan-Eliya et al.

Risk factors of cardiovascular and cerebrovascular diseases in young and middle-aged adults: A meta-analysis

“…Furthermore, our pooled results showed that hypertension was significantly associated with increased risk of acute coronary syndrome. With the development of social economy, the incidence of hypertension in young and middle-aged people is gradually increasing, [38] and the incidence of cardiovascular disease is also increasing. [39] Strengthening the prevention of hypertension in young people will help to reduce the incidence of cardiovascular diseases and reduce the social burden.…”

Prevalence of diabetes and pre-diabetes in Sri Lanka: a new global hotspot–estimates from the Sri Lanka Health and Ageing Survey 2018/2019

“…The SLHAS Wave 1 used stratified, multistage probability sampling to recruit a nationally representative sample of the non-institutionalized adult (≥18 years) population of Sri Lanka, details of which have been described previously. 12 The study design treated all 14 014 Grama Niladhari Divisions (GNDs)-the smallest administrative unit in Sri Lanka-as primary sampling units (PSUs). These were stratified by district, residential sector, and quantile of area socioeconomic status (ASES).…”

“…The basic procedure has been described previously. 12 In brief, non-response weights were generated by modeling the propensity to participate as a function of characteristics recorded during recruitment, including whether self-reporting as diabetic. These were then adjusted to the age-sex population structure of strata, districts, and provinces to generate poststratification design weights.…”

“…Finally, weights were calibrated in successive steps using iterative proportional fitting (IPF) to match the strata, age-sex, ethnic and sector structure of the population at district, province, and then national levels. This was done as Muslims were under-represented in the original sample, which could bias prevalence estimates, 12 and since reference data on ethnic proportions were only available in aggregate at the district level, necessitating approaches such as IPF. 15 For this study, the base weights for the eligible sample were again calibrated using IPF at increasing levels of aggregation from stratum to national level to match the 2019 population totals for strata, age-sex groups, sectors, and ethnicity.…”

Are Sinhala and Tamil PHQ-9 versions comparable across the Sri Lankan population? Psychometric equivalence across translations and between demographic subgroups

“…This research used data from the 2018-2019 rst wave of the Sri Lanka Health and Ageing Study (SLHAS), a national longitudinal cohort study, approved by the Ministry of Health (MOH), Sri Lanka, and undertaken by a collaboration of the Institute for Health Policy and four Sri Lankan universities (the Universities of Colombo, Peradeniya, Ruhuna, and Rajarata). The SLHAS recruited a nationally representative sample of Sri Lanka's non-institutionalized adults-one per sampled household-using a strati ed, multistage probability design (41). For this paper, of the total sample of 6,444 participants, 98 were excluded through listwise deletion, as the cases included missing data.…”